New Beginnings: A Pregnancy Guide

NEW BEGINNINGS

A Guide Through Pregnancy and Early Parenting

Welcome to Mission Hospital. We are delighted that you have chosen Mission Hospital for your upcoming birth. We will strive to exceed your expectations in keeping with our core values of Mercy, Excellence, Respect, Integrity and Trust/Teamwork (MERIT). We hope that our New Beginnings Pregnancy Guide will help you: • Become familiar with Mission Hospital’s services for families • Learn more about pregnancy, birth and the early days of parenting • Make positive, healthy choices for yourself and your baby • Become better informed about the many choices during this special time On behalf of the staff and administration at Mission Hospital, we offer our sincerest wishes for a healthy, joyous birth and a positive transition into your early days of parenting. Sincerely,

Ginny Raviotta Director of Women’s Services

Table of Contents How To Use This Book��5 In The Beginning First Trimester: Weeks 1-14��7 Important Terms To Know��7 Check-Ups��8 What Will Happen At Your Check-Ups?��8 Tests In The First Trimester��9 Warning Signs��9 Ultrasounds�� 10 Baby�� 10 Father/Partner�� 10 Staying Healthy��11 Nutrition Hints For Mom�� 12 The Weight You Gain�� 12 Healthy Food Choices�� 12 Rate Your Diet�� 13 Medications For Pregnancy�� 14 Tips To Reduce Stress�� 14 First Trimester To-Do List�� 15 Recommended Reading�� 16 Fetal Alcohol Spectrum Disorder�� 16 OB Registration Form�� 17 Birth And Parenting Education Programs��20 Labor And Delivery Entrance��22 Driving Directions��23 Phone Numbers And Resources��24 Family Support Programs��27 Along The Way Second Trimester: Weeks 15-28�� 31 Important Terms To Know�� 31 Check-Ups��32 Baby��33 Father/Partner��34 Travel Tips��34 Second Trimester To-Do List��35 Prepare Your Pet For A New Baby��35 Changes In Your Body��36 Recommended Reading��37 Preventing Preterm Labor��38 Preventing Preterm Birth��39 Special Concerns��40

In The Home Stretch Third Trimester: Weeks 29-40��43 Important Terms To Know��43 Check-Ups��44 Tests In The Third Trimester��45 Baby��45 Father/Partner��46 Your Body Gets Ready For Birth��46 Third Trimester To-Do List��47 Preparing Other Children For A New Baby��47 Making Important Decisions For Your Baby��48 Breastfeeding��48 Scheduling An Early Birth��50 When To Call Your Doctor��50 Staying At Home During Early Labor�� 51 Things You Need In The Hospital�� 51 Recommended Reading��53 Support For Sexual Abuse Survivors��53 Choosing Your Baby’s Doctor��54 Choosing A Day Care��54 During Your Labor And Birth��55 Going Home�� 59 Child Passenger Safety Technicians�� 61 We Made It After The Birth To First 6 Weeks��63 Warning Signs In A Newborn��65 Spitting Up��66 Colic��66 My Baby Won’t Stop Crying��66 Never Shake Your Baby��67 Kangaroo Care/Skin-To-Skin Contact��67 How Will My Baby Act After It Is Born?��67 Warning Signs After Birth��68 Taking Care Of Yourself��69 Vaginal Childbirth�� 71 Postpartum Depression�� 74 Support For New Mothers��75 Early Breastfeeding�� 71 Baby’s First Check-Up��72 Checking Baby’s Growth��72 Radon Gas��73 Learn More, Sign-Up Online�� 76 Birth Survey�� 76

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HOW TO USE THIS BOOK

Welcome This book provides information about pregnancy to help you prepare for giving birth at Mission Hospital and help you plan for your new baby. Your doctor or midwife and their staff will be your main advisors during your pregnancy.

In this book you will find: • An OB Pre-Admission Form to register yourself at Mission Hospital • You can also register online at: mission-health.org/ob-pre-admission • Information about classes and other helpful resources • Information about what to expect when you come to Mission Hospital • Information about pregnancy, birth and caring for your new baby • To-do lists for organizing and planning • Pages in the back of this book to write important information for quick and easy reference—a wonderful way to track important milestones in your pregnancy

This book is color-coded to help guide you through each section: Pink is for early in the pregnancy or the first trimester (1-14 weeks). This section has prenatal parenting class information, community resources and phone numbers for support services. Blue is for the middle of the pregnancy or the second trimester (15-28 weeks). Green is for late pregnancy or the third trimester (29-40 weeks). Orange is a guide for newborn care, self-care and after-birth information.

New Beginnings: A Pregnancy Guide, by Christi Lorenz, BSN, CCE The information contained in this publication should not be considered specific medical advice, as each individual’s circumstances differ. Should you feel a need for medical advice, do not rely on knowledge gained from this publication, but seek advice from your doctor. © 2013 Mission Hospital

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IN THE BEGINNING

First Trimester: Weeks 1-14 Conception To 4 Weeks Finding out you are pregnant can be exciting and maybe a little scary. Your first clue may be a missed period. In the first weeks your body begins to change because of female hormones. A basic pregnancy test checks for the hormone called hCG (human chronic gonadotropin). This hormone is found in your blood and in your urine. 4-8 Weeks You may begin to feel the changes in your body as early as 6-8 weeks after you have become pregnant. The most common changes are: • Feeling tired most of the time • Tender breasts and nipples • Urinating often • Nausea and maybe vomiting • Bleeding gums and nose bleeds • Dizziness or fainting spells • Headaches • Big changes in your moods like being upset, crying a lot or feeling scared These changes can last as little as a few weeks and as many as 20 weeks. To help you deal with these changes, try these tips: • Plan to rest during the day or after you get home. Rest is very important for you and your growing baby. • Go to bed earlier than normal. • Get help with chores or do fewer chores for a while. • Wear a bra that fits and supports you. You may want to wear it to bed. • Empty your bladder regularly. • Eat small meals every 2 hours. Keep crackers next to your bed to eat before you get up. • Do not drink liquids when you first get up or with your meals or snacks. • Try taking 25mg of vitamin B6 at breakfast,

lunch, dinner, and at bedtime. This takes about 4 days to begin helping with nausea. • Wear loose clothes. Do not wear tight clothing around your belly. • Use a cold mist vaporizer close to your bed. • Drink peppermint or ginger tea. • Take ginger capsules (500mg) 4 times a day. • Avoid greasy or spicy foods. • Move slowly when you get out of bed or stand up. • Use a soft-bristle child’s toothbrush. Avoid brushing gums too hard. Floss your teeth once a day. • Talk with your family, friends or healthcare provider about how you feel. • Ask questions and read books to help you understand and cope with these changes. 8-I2 Weeks During this time your body may begin to change shape. Your breasts may get bigger, and clothes may feel tight around your waist and low abdomen. You may have gained 3-4 pounds by the end of week 12. Your uterus is about the size of a grapefruit. Your chances of early miscarriage are less after 12 weeks.

Important Terms To Know Abdomen: The part of the body in a woman that contains her intestines, stomach, bowels and uterus. Amniotic Fluid: The fluid that surrounds the fetus inside the uterus. Amniotic Sac: A thin membrane inside the uterus that surrounds the fetus and amniotic fluid. This is also called the bag of water. Cervix: The lowest part of the uterus that opens and shortens for birth. Conception: The union of the sperm and egg (fertilization).

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Fetus: The medical word for a developing baby in the uterus. The baby is a fetus after 8 weeks of development. Gestation: The age of your unborn baby measured in weeks. This is from 0-42 weeks. Healthcare Provider: In this guide “healthcare provider” will refer to a health professional who is licensed to provide medical care to pregnant women and newborn infants. Miscarriage: The loss of a baby before the 20th week of pregnancy. Placenta: The organ that develops inside the uterus where the fertilized egg starts off. This organ provides the growing baby with food and oxygen. It also protects the baby and the inside of the uterus from harm. Prenatal: The time from conception to the birth of your baby. Trimester: A block of time during pregnancy measured in weeks. Pregnancy is divided into 3 trimesters: first: 0-14 weeks, second: 15-28 weeks and third: 29-40 weeks. Types Of Healthcare Providers: OB/GYN Medical Doctor, Certified Nurse Midwife, OB/GYN Nurse Practitioner, Family Practice Medical Doctor, Pediatric Medical Doctor and Pediatric Nurse Practitioner Umbilical Cord: The cord connecting the fetus to the placenta. Uterus: Also called your “womb.” The hollow organ made of muscle in a woman’s abdomen. This is where a fertilized egg will start growing. The egg will bury itself into the lining of the uterus. In the first 8 weeks the growing baby is called an embryo. After 8 weeks, the baby is called a fetus.

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Check-Ups In your first trimester you will begin regular visits to your doctor or midwife’s office. The first visit will usually be between the 6th and 10th week of the pregnancy. Prenatal visits give you the chance to ask questions and learn about your pregnancy. Here are some things that you may want to talk about: • What are the office hours? How do I make appointments? What do I do when the office is closed and I need to talk to my healthcare provider? • What foods should I be eating? • What things could harm me or the baby? • What activities and exercise can I do during pregnancy? • Is intercourse/sexual activity during pregnancy OK? • What tests will be done in the first trimester and what do they mean?

What Will Happen At Your Check-Ups Pregnancy lasts about 40 weeks. It starts with the date of your last menstrual period (LMP) and is divided into 3 trimesters. Your prenatal visits to your doctor or midwife will be scheduled once a month until about 28 weeks. From 28-36 weeks you may be seen every 2-3 weeks. After 36 weeks they will want to see you once a week or more. At your first prenatal visit you will: • Set your due date (the date your baby might be born). Your healthcare provider may suggest an ultrasound to help set the due date. Your due date does not mean that your baby will be born on that day. You might deliver two weeks before that date or two weeks after that date.

• Have lab tests such as checking your urine and blood. Your healthcare provider will do an HIV test. • Be asked questions about your health, your partner’s health and your family’s health (mostly your mother and father’s health). • Be weighed and have your blood pressure checked. • Have a vaginal exam to feel your uterus to see how your baby is growing. • Have a pap smear. Your visits after the first check-up will take less time. You will: • Be weighed to make sure that you are gaining weight. • Have your urine and blood pressure checked. • Have the baby’s heartbeat checked (after 12 weeks). • Have time with your doctor, midwife or nurse practitioner to talk about your health during the last month and to ask questions.

Tests In The First Trimester Pregnancy Tests: A blood or urine pregnancy test may be done even if you did a pregnancy test at home. Urine Check: This test will check your kidneys and look for signs of infection. Blood Tests: Many things can be checked from the blood drawn from your arm: • Sexually transmitted diseases like gonorrhea, syphilis and HIV • Hepatitis (a disease of the liver) • Your blood type (A, B, AB or O) and the Rh factor (positive or negative) • Anemia (low red blood cells)

• A rubella (measles) test will show if you have had rubella or if you have come in contact with someone who had rubella. • Other testing: Ask your healthcare provider about testing for genetic conditions such as diabetes, sickle cell anemia and cystic fibrosis. Pap Smear: Your cervix is the opening to your uterus. This test looks for signs of cancer cells in your cervix.

Warning Signs Call your doctor or midwife if any of these things happen: • Bright red vaginal bleeding like a menstrual period (You might have spotting after a vaginal exam, vaginal ultrasound or intercourse. A small amount of blood after these events is normal.) • Sharp abdominal pain with your uterus becoming very hard (Talk with your healthcare provider about sharp pain low in your belly that might be tightening of ligaments that hold your uterus. This is not a warning sign.) • Leaking or gushing of fluid from your vagina • Sudden swelling of hands and face • Changes in vision (blurred or dark spots in front of your eyes) • Severe headache • Being very dizzy • Swollen, red or painful area on the leg (especially the calf area) • Pain or burning when you urinate • Itching, burning or pain in the vaginal area • Vaginal discharge with a strong odor • Fever higher than I00.4 (taken by mouth) • Vomiting for 24 hours or urine that is dark yellow or orange • A change in the kicks and movements of your baby

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Ultrasounds The ultrasound machine uses sound waves to make pictures of the baby. Ultrasound can help set your due date when it is performed in the first trimester. It can show your baby’s growth and the growth of the placenta. It can also show how many babies are in your uterus. There is no radiation used with ultrasound.

Baby At The End Of The 1st Month: Your baby is smaller than a grain of rice. In the next 2 weeks many of the baby’s organs (brain, spinal cord, heart, intestines and stomach) begin to form. The head and body begin to form. The heart begins to beat on or around the 25th day after conception. By The End Of The 2nd Month: The baby begins to look more like a person. From the top of the head to the bottom of the buttocks your baby is about I1/4 inch long. Your baby weighs the same as an aspirin tablet. Arms, hands, fingers and legs are forming. Most of the internal organs are completely formed. Eyelids are formed and sealed shut. The middle ear is forming for both hearing and balance. The head is large compared to the rest of the body. The baby is beginning to move now. At The End Of The 3rd Month: Your baby is 21/2-3 inches long and weighs about half of an ounce. The body organs are starting to work. Blood is flowing through veins and urine is being formed in the kidneys. Muscles are growing and movements of the arms and legs are more frequent. Sex organs are formed, but it is still difficult to determine the sex of the baby.

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Ultrasound at 12 weeks

Father/Partner It is normal for you to have many feelings at this time, just like mom. Feeling excited, nervous and afraid all at once is normal. Mom will be getting a lot of attention and you may feel left out. A great way to feel involved and important is to go to prenatal visits with mom. Read about pregnancy with her. Ask her about how she’s feeling and what’s happening to her body. Mom will need and want to “lean on you” for support and encouragement. Sometimes the best way to support is to just listen. Women cope with change and stress by talking about it. You will not always have to fix the stress by doing something. Listening may give her what she needs. You might see mom acting a little strange at times. One minute she is laughing and joking, the next minute she is crying and afraid. One minute she is feeling sick and the next minute she’s eating a full meal. This is normal in pregnancy even though it might not make any sense to you.

Staying Healthy Exposure To Toxins • Do not smoke or expose yourself to secondhand smoke. Call Mission Hospital’s Smoking Cessation Program at 828-213-5527 for help with quitting for yourself or a family member. • Do not drink alcohol or use street drugs. • Do not take any medications unless you have talked with your healthcare provider. • Do not empty the litter box of a cat. • Try to stay away from anyone who is sick, especially with chicken pox, fifth disease, measles or flu. • Avoid working around toxic chemicals, fumes or radiation. Notify the X-ray personnel that you are pregnant before they take an X-ray. Nutrition • Do not drink or eat food with caffeine, such as colas, coffee, tea and chocolate. • Do not eat raw or undercooked meat, soft cheeses or blue-veined cheeses. • Eat a balanced diet. (See the Nutrition Information in this guide.) • Drink 8 glasses of fluid each day. Water, milk or fruit juices are best. • Take your daily multi-vitamins or folic acid tablets as told by your healthcare provider. Personal Care • Brush your teeth twice a day. Floss once a day. Keep regular check-ups with your dentist. • Wear a shoulder and lap seat belt. • Do not douche. Call your healthcare provider if you have vaginal itching, burning or odor with your discharge. • Sex is considered safe in a normal pregnancy. Talk with your healthcare provider to make sure it is safe for you. • If you have more than one sex partner, use a condom with intercourse. Using a condom helps protect mother and baby from some sexually transmitted diseases.

Lifestyle • Avoid overheating your body with very hot baths or saunas. • Do not sit or stand for long periods of time. When taking a car trip, stop every 1-2 hours to stretch your legs. • Rest every day. If you work outside the home, rest when you come home. Exercise Exercise is important and can help in many ways during your pregnancy: • Do light, easy exercise for 30 minutes, 3 times a week. Walking or swimming are best. • It can help with headache, backache, constipation, leg cramps and insomnia (trouble sleeping). • It can help build strength in your muscles and give you more energy for pregnancy and birth. • It can help with stress. Stress can give you headaches, keep you from sleeping, make you feel tired and make you feel nervous. During pregnancy your muscles relax, your balance changes, and you may feel more tired. This can affect exercising. If you were active before you got pregnant, you can continue this exercise. If you were not active, start off slowly with gentle stretching and walking or swimming. Things to remember about exercising: • Talk with your doctor or midwife before you begin an exercise plan. • Drink plenty of water before, during and after you exercise. • Do not exercise outside during hot weather. • Stop if you have pain, become dizzy, have cramps or have trouble breathing.

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Nutrition Hints For Mom Even though you are now eating for two, you will only need to eat 300-500 calories more a day. This is equal to half of a peanut butter sandwich and a glass of milk. Eating enough food is very important for your baby’s growth. Gaining too much weight will make it harder for you to lose the weight after the baby is born. Limit foods high in sugar and fat. If you are overweight, now is not the time to diet. A healthy weight gain during pregnancy is between 25-35 pounds. (Your doctor or midwife will tell you what is best for you.) Most moms need to gain 3-4 pounds during the first 3 months and about 3-4 pounds each month for the rest of the pregnancy. It is not necessary to cut down on salt unless your doctor tells you to. Drink plenty of fluids during your entire pregnancy, 8-10 (8 ounce) glasses daily. Enjoy water, fruit and vegetable juices and milk. Avoid caffeine (tea, coffee, colas) and drinks high in sugar.

The Weight You Gain 0.5 pounds..................Increase in breast size 1.5 pounds...................Placenta 2 pounds......................Uterus getting bigger 2-3 pounds..................Mother’s body storing extra fluid for pregnancy and breastfeeding. This is important for the baby. 4-6 pounds.................Mother’s body storing fat 6-8 pounds.................Baby 25-35 pounds............Total weight gain

HEALTHY FOOD CHOICES

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Grains 6-11 Servings Daily

Whole grain bread, tortillas, cereal, biscuits, pasta, rice, pita bread or crackers

Vegetables 3-5 Servings Daily

Broccoli, spinach, collard greens, sweet potato, cabbage, carrots, green beans (wash all fresh vegetables thoroughly)

Fruits 2-4 Servings Daily

Apple/orange juice, watermelon, banana, guava, mango, strawberry, blueberry, apple (wash all fresh fruit thoroughly)

Milk and Milk Products 4 Servings Daily

Milk, yogurt, cottage cheese, hard cheese, ice cream, pudding, custard (avoid unpasteurized milk and soft cheese)

Meat and Protein 2-3 Servings Daily

Pork, beef, chicken, fish, turkey, shellfish, tuna, nuts, peanut butter, canned beans, dried beans/peas, tofu (avoid undercooked or raw meats)

Rate Your Diet Check your answer to each question. Y=Yes, N=No, S=Sometimes Y

N

S

..................................... I eat 2 or more servings of vegetables each day (example: 1/2 cup broccoli, 1/2 cup carrots).

Y

N

S

..................................... I eat 2 or more servings of fruit each day.

Y

N

S

..................................... I eat 1 serving of food high in vitamin A each day (example: carrots, spinach, squash, mango).

Y

N

S

..................................... I eat foods high in vitamin C every day (example: orange, grapefruit, tomato, melon, strawberries).

Y

N

S

..................................... I have four glasses of milk or I eat 4 servings of dairy foods each day (example: cheese, yogurt, pudding).

Y

N

S

..................................... I eat at least 2 servings of lean meat, fish, chicken, turkey, beans, nuts or soy foods each day.

Y

N

S

..................................... I eat 4 or more servings of bread, cereal, pasta and rice each day.

Y

N

S

..................................... I eat whole grains (wheat bread, whole grain cereal).

Y

N

S

..................................... I eat no more than 4 eggs each week.

Y

N

S

..................................... I eat no more than 1 serving of cake, cookies, pastries, baked goods or candy each day.

Y

N

S

..................................... I do not eat very salty food (example: bacon, pickles, chips).

Y

N

S

..................................... I do not eat lots of fat and oils (example: butter, margarine, salad dressing, fried foods).

Y

N

S

..................................... I eat breakfast each day.

Y

N

S

..................................... I eat when I am hungry, not when the clock says it is mealtime.

Y

N

S

..................................... I snack.

How Are You Doing? Give yourself 2 points for every "Y" and 1 point for every "S" you checked. Add up all the points. 20-30 points...............Keep it up. You are eating well. 17-20 points................Pretty good. You are doing fine, but there’s room for improvement. 9-16 points..................Your eating habits need some work. Look for ways to improve them. 8 or less........................You need to take better care of yourself and your developing baby. Start today!

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MEDICATIONS THAT ARE OK TO USE DURING PREGNANCY* Symptom

Medication

Cough

Robitussin (Plain or DM)

Constipation

Senekot or Perdiem (vegetable supplement), Colace, Citrucel/ Metamucil (fiber supplements)—Do not use a stimulant laxative

Diarrhea

Imodium AD, Kaopectate, Lomotil (eat yogurt with live cultures)

Headache

2 Tylenol tablets (regular or extra strength)

Hemorrhoids

Witch hazel, Tucks Pads, Anusol, Americaine or Nupercainal ointment

Indigestion/Heartburn

Antacids (chewable tablets or liquids), Papaya Enzyme tablets

Insomnia

Benadryl, Tylenol PM (talk with your healthcare provider before use)

Nausea/Vomiting

Emetrol (if not diabetic), Dramamine (makes you sleepy)

Sinus/Head Colds

Sudafed, Tylenol Cold, Tylenol Sinus, Dimetapp, Drixoral, Saline nose spray (do not use for more than 3 days)

Sore Throat

Chloraseptic spray or sore throat lozenges/cough drops (report a fever over 100.4 degrees) *Always consult your healthcare provider before using any medication.

Tips To Reduce Stress 1 .......................... Exercise. Take a walk during the day. alk with your family and friends about your feelings. It is important for them to 2 .......................... T know how you feel so they can help you. 3 .......................... Get enough sleep. 4 .......................... Eat a balanced diet. 5 .......................... Think positively. Remember the things that are good in your life. 6 .......................... Take a few deep breaths. This makes you breathe slower and helps your muscles relax. 7 .......................... Count to 10. This makes you stop and relax before you react to a stressful situation. 8 .......................... Take a good stretch. Stretching makes muscles relax and helps you feel less tense. 9 .......................... Massage tense muscles. The muscles in the back of your neck and upper back usually get tense when you are stressed. 10 .......................... Take warm (but not hot) baths to help you relax. This will help with sleep, too. 11 .......................... Do things you find relaxing. Listen to music, read, meditate or pray. 12 .......................... If you are trying to do too much, learn to say no and slow down.

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First Trimester To-Do List Know Your Rights Look into your rights before your baby is born. Find out your company’s policies on paid or unpaid leave, and if your company is covered by the Family Medical Leave Act. • Family Medical Leave Act (FMLA) The FMLA requires employers with more than 50 workers to provide both women and men with 12 weeks of unpaid leave for the birth or adoption of a child. FMLA also covers all public agencies, including state, local and federal employers and local schools. • Pregnancy Discrimination Act (PDA) The PDA requires employers with more than 15 workers to treat pregnant workers like disabled ones. Under this law, if a company provides paid leave or job security for an employee to have surgery, it must do the same for pregnant women. Take Classes We recommend that all first time parents take pregnancy, childbirth and parenting classes. Ask your healthcare provider about classes that may be offered in their office. In Buncombe County, classes are available at: • Mission Hospital: call toll-free 877-213-1221 or local 828-213-2222. • Some classes may also be available with a private teacher in your community.

Detailed information about classes offered at Mission Hospital is provided on pages 20-21. Your healthcare provider can help you decide which class may be best for you. Remember to sign up early since classes fill up quickly. If it has been more than 2 years since you have had a baby, it is a good idea to take a refresher childbirth class. Other Things To Do • Fill out your OB Pre-Admission form on page 17. Your healthcare provider will send this to Mission Hospital. Or, you can complete the form online at mission-health.org/ob-pre-admission. • Talk with your employer about time off for birth. Talk with your insurance company about maternity coverage for your doctor visits and hospital costs. • If you do not have insurance, please call 828-213-1508 for information about your hospital bill. See pages 27-29 for more information on support, Medicaid and other services. • Get a good pregnancy book from the bookstore or a friend or check one out from your local library. (See page 16 for a list of books.) • If you have a dog, enroll him or her in an obedience or refresher course. Commands like sit, down, stay and come are helpful.

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Recommended Reading

Fetal Alcohol Spectrum Disorder

• A Child Is Born by Lennart Nilsson

Fetal Alcohol Spectrum Disorder (FASD) is the most common nonhereditary cause of mental retardation. FASD can occur if a pregnant woman drinks at any point during pregnancy.

• A New Life : Pregnancy, Birth, and Your Child’s First Year—A Comprehensive Guide by John T. Queenan, MD and Carrie Neher Queenan • Having Your Baby: A Guide For African American Women by Hilda Hutcherson, MD with Margaret Williams • Having Your Baby With A Nurse Midwife: Everything You Need To Know To Make An Informed Decision by The American College of NurseMidwives and Sandra Jacobs • Planning Your Pregnancy And Birth, Third Edition by The American College of Obstetrics and Gynecology

According to the U.S. Department of Health and Human Services, prenatal alcohol exposure has a more devastating long-lasting effect on an unborn child than drugs such as marijuana, cocaine, heroin and tobacco. Prenatal exposure to alcohol may result in any or all of the following conditions in your baby: • Excessive crying • Hyperactivity and inattention

• Pregnancy, Childbirth And The Newborn:The Complete Guide by Penny Simkin, Janet Whalley,Ann Keppler, Janelle Durham and April Bolding

• Impaired growth

• Birth Over 35 by Sheila Kitzinger

• Organ damage

• Birthing From Within: An ExtraOrdinary Guide To Childbirth Preparation by Pam England and Rob Horowitz

• Poor feeding

• While Waiting by George E. Verrilli, MD, FAC, OG and Anne Marie Mueser, EdD • The Birth Partner, Third Edition: A Complete Guide To Childbirth For Dads, Doulas, And All Other Labor Companions by Penny Simkin • Our Bodies, Ourselves: Pregnancy And Birth by Boston Women’s Health Book Collective and Judy Norsigian

• Intellectual developmental delays • Low birth weight

• Respiratory problems • Sleeping problems The effects of prenatal alcohol exposure on the brain are permanent and cannot be repaired. In school, children who are affected by prenatal alcohol exposure may have: • Learning and behavioral problems • Difficulty with mathematical skills • Difficulty with memory and attention • Difficulty with school performance • Poor impulse control or judgment

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OB PRE-REGISTRATION FORM Please complete this form and return to your healthcare provider’s staff or mail to the address below, or complete the form online at mission-health.org/ob-pre-admission. If you have questions, call 828-213-1508. IMPORTANT: Please include your expected delivery date. PERSONAL INFORMATION Patient’s Name__________________________________________________________________________________________________________ Date of Birth____________________ SS#___________________________________________________ Race�� Marital Status_________________________________ Spouse’s Name�� Street Address�� City__________________________________________________State___________Zip__________________County�� Home Phone (________ ) _____________________ Work Phone (_________ )___________________ Cell Phone (________ )�� Patient’s Occupation________________________________ Employer�� Employer’s Street Address_________________________________________________________________________________________________ City_________________________________________________________ State____________________ Zip_______________________________ EMERGENCY INFORMATION (Whom should we contact in case of an emergency?) Name_______________________________________________________________ Relationship To You�� Street Address________________________________________________________________ Home Phone (___________)___________________ City_____________________________________________ State________ Zip_______________ Cell Phone (___________ )�� Responsible Party (if you are 18 years or older you are responsible for your account) Is Responsible Party information the same as patient information above?

YES

NO (If no, complete the Responsible Party section below.)

Responsible Party Name________________________________________________ Relationship To You�� Street Address�� City_____________________________________________ State________ Zip_______________ SS#�� Home Phone (________ ) _____________________ Work Phone (_________ )___________________ Cell Phone (________ )�� INSURANCE INFORMATION (Please bring insurance cards when you come to the hospital) Do you have insurance coverage?

YES*

NO

Medicaid

Health Choice

*Contact your insurance provider as soon as you know you are pregnant to see if they need more information. Primary Insurance Company Name____________________________________ Address____________________________ Phone (_______ )�� Subscriber ID#______________ Group ID#______________ Insured Name____________________________ Insured Birthdate�� Insured Relationship To You_____________ Insured SS#_________________________ Precertification Phone (_______ )�� Primary Insured Employer_______________________________________________ Employment Status�� Employer Address_____________________________________________________ Phone (_____________ )_____________________________ City_________________________________________________________ State____________________ Zip�� Secondary Insurance Company Name____________________________________ Address____________________________ Phone (_______ )�� Subscriber ID#______________ Group ID#______________ Insured Name____________________________ Insured Birthdate�� Insured Relationship To You_____________ Insured SS#_________________________ Precertification Phone (_______ )�� Primary Insured Employer_______________________________________________ Employment Status�� Employer Address_____________________________________________________ Phone (_____________ )_____________________________ City_________________________________________________________ State____________________ Zip��

IMPORTANT INFORMATION Have you ever been a patient at Mission Hospital?

YES

DO NOT FORGET!

MAIL FORM TO

NO

Please include a copy of

Mission Patient Accounting

Under what name(s)?��

your Insurance Card(s)

ATTN: Pre OB

Expected Delivery Date��

(front and back)

950 Hendersonville Road

Obstetrical Provider’s Name��

Asheville, NC 28803

_____________________ _____________________ _____________________

PLACE STAMP HERE

Mission Patient Accounting ATTN: Pre OB 950 Hendersonville Road Asheville, NC 28803

Birth and Parenting Education Programs The Basics This course has everything first-time parents need to prepare for a new baby. The Basics 8-class program strives to ensure that you have a timely, organized and enjoyable experience. Your time with other expectant parents will support you in exploring your choices for birth and parenting. The Basics Series Part 1

Cost: $55

• Taken between 20-28 weeks • 4 classes, each 2.5 hours, offered weeknights • Complete guide to a safe and healthy pregnancy • Newborns and their care • Family changes and preparations • Family safety and infant CPR • Feeding your infant

The Basics Series Part 2

Cost: $45

• Taken between 30-38 weeks • 4 classes, each 2.5 hours, offered weeknights • Choices for labor and birth • Comfort methods; relaxation, breathing and positioning • Hospital tour of nursing units • Medical procedures, medications for pain and cesarean birth

The Basics: Weekend Intensive This is a condensed version of The Basics for families who have busy schedules. Weekend Intensive Part I Cost: $55 • Taken between 20-28 weeks • Healthy pregnancy, parenting, newborns, infant nutrition and safety/CPR • Saturday and Sunday, 1:00pm-6:00pm

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Weekend Intensive Part 2 Cost: $55 • Taken between 28-36 weeks • Labor, birth and hospital tour • Saturday and Sunday, 1:00pm-6:00pm, or two consecutive Sundays, 1:00pm-6:00pm

Additional Birthing Classes Refresher Childbirth Preparation Cost: $40

Weekend Childbirth Preparation Complete

For families who completed a childbirth preparation course with the birth of a previous child, we recommend you join us for the first day of our Basics Part 2: Weekend Intensive. On the first day of the weekend, Saturday from 1:00pm-6:00pm, you will review:

This intense weekend class (Saturday and Sunday 1:00pm-6:00pm) focuses on the birth process, comfort measures for birthing, cesarean birth, recovery after birth and basic early newborn care. This class is recommend at 32-36 weeks. Breastfeeding and Infant Safety/CPR is not included. Hospital tour is included.

• Labor and birth process • Comfort methods and skills

Cost: $90

The weekend course is offered once each month. A hospital tour is included.

Birth eClass Birth eClass

Hospital Tour Cost: $65

This online class is self-paced for and full of engaging activities, animations and videos. Course topics include pregnancy, labor, birth stories, comfort techniques, medical procedures, cesarean birth and newborn care, as well as postpartum care and adjustments. Also included is an “Ask a Nurse” email where you may submit questions to a certified nurse educator. Participants should complete the program within 60 days of first log-in.

Hospital Tour

Cost: FREE

This tour is for the pregnant mother, dad or support person and will include areas that will care for mother and baby. The tour is designed for those who do not attend a Mission Hospital class. Please do not bring children.

To register for any of these courses call 828-213-2222, option 2 or toll-free at 877-213-1221. For more info, visit womens.mission-health.org.

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Birth and Parenting Education Programs Newborn Classes Newborn classes are designed for families who are not enrolled in The Basics Series or The Basics Weekend Intensive.

Safe Babies

Cost: $30/couple $10 for each additional person

Everyone involved in caring for your baby should plan to attend this 2.5 hour class based on the American Heart Association’s general child safety recommendations. CPR/rescue breathing instruction is included.

Breastfeeding

Cost: $20

This two-hour class helps prepare you for breastfeeding. Included is information about benefits, techniques, resources and support. Dad (or a support person) is encouraged to attend. This one-time class is offered at Mission Hospital.

Additional Classes Prenatal Yoga

Cost: $80/8 classes

Practicing yoga during pregnancy encourages relaxation, flexibility and strength in a gentle and non-strenuous way. Yoga helps women learn to trust their bodies and relax into the experience of childbirth. Each class includes breath work, body awareness, postures, guided imagery and meditation. The class specializes in gentle, therapeutic and restorative yoga. Written approval from your healthcare provider is required to participate in this class. To register, call 828-213-2222, option 2. Your healthcare provider may fax your written approval to 828-213-8251. If you take any of our classes, you get a 50% discount off of an 8-class series.

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Working Moms and Breastfeeding

Cost: $20

This two-hour class covers breastfeeding during the first year, pumping and storing milk and weaning. Mothers will benefit from taking this class before or after giving birth.

To register for any of these courses call 828-213-2222, option 2 or toll-free at 877-213-1221. For more info, visit womens.mission-health.org.

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Labor And Delivery Entrance Use the Biltmore Avenue entrance to the Memorial Campus of Mission Hospital. Follow the arrows for Patient Entrance. Look for our “stork signs” to locate designated parking. You will see an awning that says “Patient/Outpatient Entrance.” Use this entrance all hours of the day and night. Between the hours of 5:00pm-5:00am, press the button next to the door for entry. Walk straight ahead to the “G” elevators, look for more “stork signs” and take the elevator to the 4th floor. You can get to Labor & Delivery by turning either right or left off the elevator. Important When you come to Mission Hospital, do not go to the Emergency Department. Go to the Patient Entrance on the Memorial Campus. Family And Friends Your family and friends can use the parking deck off McDowell Street and enter the hospital through the Visitor Entrance into the main lobby. The Information Desk staff will direct them. Unlisted Patient Medical privacy laws today give hospitalized patients the right to choose whether or not they would like personal information available to the public. They can choose to be “listed” or “unlisted” in our patient directory. If you decide to be unlisted before your baby’s birth, do not tell anyone you are going to the hospital. If someone tries to visit a patient who has chosen to be “unlisted,” Mission Hospital cannot: • Tell them if the patient is in the hospital • Give them a room number • Tell them the patient’s condition, such as critical, serious, fair, etc. • Deliver mail, flowers or gifts to the room

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These restrictions also apply to family or the person who brought the patient to the hospital. “Unlisted” patient rules can be difficult and may cause inconveniences, but Mission Hospital must obey the medical privacy laws. Day And Evening Visiting Hours For family and friends, visiting hours are 9:00am-2:00pm and 4:00pm-8:30pm. The time from 2:00pm-4:00pm is Mother-Baby, “Quiet Time.” This quiet time is for the new mom and baby to rest and bond. Fathers or a support person and any big brothers or sisters are welcome during quiet time. Keeping moms and babies safe from illness is very important in the first weeks after the birth. For this reason we ask for your help with the following: • Big brothers and sisters are welcome to visit. Other children are welcome to visit if they are 14 or older. • All children need to have an adult with them while in the hospital. • Siblings, family and friends need to be free of signs of illness. • Everyone must wash their hands when they arrive and leave the room. Night-Time Visiting Hours For family and support persons, night-time visiting hours are 8:30pm-5:00am. For the safety of families and staff, please check in with our security staff in the main lobby. After registering, visitors will receive a visitor’s badge. Smoking And Tobacco Use As a community leader in healthy living and improving the wellness of our patients and staff, Mission Hospital is a tobacco-free environment. This includes hospital rooms, hallways, waiting areas, parking lots and all hospital property.

Driving Directions From 19/23 (Johnson City, Erwin) • Take the I-240 East Expressway (Downtown) exit off of 19/23 • Get in right-hand lane to take the right fork (expressway) • Go 1.0 miles and take exit 5B (Charlotte Street) • Turn right at the end of the exit ramp onto Charlotte Street • Go 0.9 miles (through 2 lights), and then get into the left-hand lane • Take a left at the 3rd light onto Biltmore Avenue • Get in right-hand lane • Go 0.7 miles to light at Mission Hospital Memorial Campus (4th light) • Take a right at the light and follow the signs to Patient Entrance From I-26 (Spartanburg, Tryon) • Take exit 1A (Hickory) off of I-26 • Go 4.4 miles and take exit 50 (South Asheville) • Turn left at the light at the end of the ramp • Go 0.5 miles, through 1 light, and get in the left-hand lane • Turn left at the 2nd light (toward Biltmore Estate) • Get in the right-hand lane • Go 0.9 miles to the light at the Mission Hospital Memorial Campus sign (4th light) • Take a right at the light and follow the signs to Patient Entrance From I-40 Eastbound (Knoxville, Sylva) • Take exit 50 (South Asheville) off of I-40 • Turn left at the light at the end of the ramp • Go 0.5 miles, through 1 light, and get in the left-hand lane • Turn left at the 2nd light (toward Biltmore Estate) • Get in right-hand lane • Go 0.9 miles to light at the Mission Hospital Memorial Campus sign (4th light) • Take a right at the light and follow the signs to Patient Entrance

BABY ON BOARD

Coming From I-40 Westbound (Marion, Morganton) • Take exit 50-B for Asheville (Biltmore Estate) off of I-40 • At the end of the ramp, get into the left lane • Go 0.4 miles, through 1 light • Turn left at the 2nd light (toward Biltmore Estate) • Get in right-hand lane • Go 0.9 miles to the light at the Mission Hospital Memorial Campus sign (4th light) • Take a right at the light and follow the signs to Patient Entrance

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PHONE NUMBERS AND RESOURCES MISSION HEALTH SERVICES Breastfeeding Center And Boutique��828-213-1103 missionchildrens.org/breastfeeding Childbirth Classes at Angel Medical Center��828-369-4421 angelmed.org/expectant-mothers.asp

Mission Hospital Registration And Financial Counselors��828-213-1508 Mommy And Me And Toddler Fun��828-213-2222, Option 2 missionchildrens.org/mommyandme Pregnancy Loss Support��828-251-0126 Pregnancy Massage�� 828-213-8250

Childbirth Classes at Blue Ridge Regional Hospital�� 828-765-4201 blueridgehospital.org/womensservices Childbirth Classes at McDowell Hospital��828-659-5257 mcdowellhospital.org/womensservices

Prenatal Yoga��828-213-2222, Option 2 mission-health.org/prenatalyoga Safe Kids WNC�� 828-213-5548 missionchildrens.org/safekids Smoking Cessation Program��828-213-5527

Childbirth Classes at Mission Hospital��828-213-2222, Option 2 Toll-Free��877-213-1221 Childbirth Classes at Transylvania Regional Hospital��828-883-5283 trhospital.org/services/womens-services Diabetes And Health Education Center�� 828-213-4700 mission-health.org/healtheducationcenter Disordered Eating Support Group��828-337-4685 mission-health.org/disordered-eating Family Support Network Of Western NC�� 828-213-0033 Toll-Free�� 1-888-810-2800, Ext. 2 missionchildrens.org/familysupportnetwork Fullerton Genetics Center��828-213-0022 mission-health.org/fullertongeneticscenter

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CHILDBIRTH, CHILD CARE AND PARENTING SUPPORT Asheville Area Mothers Of Multiples��828-808-9241 ashevillemom.com The Baby Lady Of WNC��828-303-6352 Susan Mooney, BS, IBCCE wncbabylady.com Beginning With Birth Childbirth Education�� 828-777-8899 Chama Woydak, LCCE, HBCE, CD(DONA) familytofamily.org/classes_childbirth.html Buncombe County Health and Human Services�� 828-250-5500 • Breastfeeding Program�� 828-250-5172 • WIC Registration�� 828-250-5170

PHONE NUMBERS AND RESOURCES Child Care (Mountain Child Care Connections)�� 828-252-5955 Toll-Free�� 1-877-752-5955 Email��[email protected]

DIAPER SERVICES

Empowered Birthing��828-231-9337 empoweredbirthing.org

Busy Bottoms Diaper Service��828-713-7293 busybottomsdiaperservice.com

La Leche League��828-628-4438 lllofnc.org/groups/Asheville.html Mom-to-mom breastfeeding support group

DOMESTIC AND FAMILY VIOLENCE ASSISTANCE SERVICES

MAMA Time: Mothers of Asheville Mothering All Together��828-582-4653

Child Abuse Prevention Services childabusepreventionservices.org�� 828-254-2000

Midwifery In The Mountains��828-678-9797 Lisa Goldstein, LM, RN, CPM, CNM midwiferyinthemountains.com

Family Services Of McDowell County familyservicesofmcdowell.org��828-652-6150

Mountain Area Child And Family Center��828-298-0808 macfc.org Project NAF (Nuturing Asheville Families)�� 828-225-6155 Education and support for African-American families during pregnancy through the first year of life

COMMUNITY ORGANIZATIONS United Way’s 2-1-1 Of WNC�� 211 211wnc.org 24-hour services for finding emergency assistance with housing needs, substance abuse, etc.

Smarty Pants Diaper Service�� 828-684-7254 ashevillediaperservice.com

Helpmate (Buncombe County) helpmateonline.org��828-254-0516 Mainstay Inc. (Henderson County) mainstayhelp.org�� 828-693-3840 My Sister’s Place (Madison County) mysistersplace28753.com�� 828-649-2446 North Carolina Coalition Against Domestic Violence�� 800-799-SAFE (7233) nccadv.org/service_providers.htm DOULAS To learn more about doulas for birth and postpartum services in the Asheville area, google “doula services in Asheville, NC.”

NC Pregnancy Exposure Risk Line��1-800-532-6302 ncpregnancy.org Education and counseling for exposure risks in pregnancy related to substance and alcohol abuse

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PHONE NUMBERS AND RESOURCES WEBSITES

ADOPTION SERVICES

American Academy Of Family Physicians��aafp.org

Asheville Pregnancy Support Service�� 828-252-1306 preginfo.org

American Academy Of Pediatrics�� aap.org American College Of Nurse Midwives��midwife.org American Congress Of Obstetricians And Gynecologists�� acog.org Birth Techniques�� lamazeinternational.org

Catholic Charities��828-255-0146 ccdoc.org Bethany Christian Services�� 828-651-8600 bethany.org National Safe Haven Program Toll-Free��888-510-BABY (2229) nationalsafehavenalliance.org

Breastfeeding And Parenting��kellymom.com Childbirth Connection��childbirthconnection.org Mothering Of Preschoolers (MOPS)��mops.org New Dad Support�� newdads.com Pet Preparation For New Baby��familypaws.com livingwithkidsanddogs.com Postpartum Depression�� ppdsupportpage.com

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DO NOT ABANDON YOUR NEWBORN BABY

ake your newborn to any hospital, T emergency department or fire station during hours of operation. No questions asked. Your secret and your newborn will be safe.

FAMILY SUPPORT PROGRAMS PROGRAM

HOW DO I QUALIFY?

WHERE DO I APPLY?

Medicaid for Pregnant Women (MPW)

• You must qualify based on the income of those in your home.

This state program pays for the healthcare of low-income pregnant women.

• Please call for an appointment, and the office will let you know what information you need for the application.

• If you get prenatal care from Mountain Area Health Center (MAHEC) Women’s Health Clinic, a private practice or MAHEC Family Practice you can apply at DSS located downtown on Coxe Avenue or call 828-250-5500.

• For Medicaid approval you will need a letter from your doctor or midwife stating your expected delivery date. • Pregnant women with health insurance may also be able to get MPW. If you are not able to get MPW, the Department of Social Services (DSS) may know of other programs to help you.

Women, Infants and Children (WIC) his free government program T is set up to help get healthy food to low-income families including: • Pregnant women • Women after delivery • Breastfeeding women • Infants • Children up to age 5

Complete an application at the Buncombe County Health Center, Mon-Fri, 8:30am-4:00pm. Bring one of the following forms of Identification: • Valid driver’s license • Social Security card • Current work/school ID • Birth certificate • Immunization record • Health record Bring one of the following items to prove residency: • Recent water, electric, cable, gas or telephone bill • Recent rental or mortgage agreement Bring information to verify income for all household members: • Medicaid card or Work First eligibility • Food Stamp certification letter • If above does not apply, please bring recent paycheck stubs or self-employed tax return

• If you get prenatal care at the Buncombe County Health Center, you can obtain a mailin application from the DSS access unit. • If you live outside of Buncombe County, you can call your local DSS or county Health Department.

• If you get prenatal care at a private practice, the Buncombe County Health Center or MAHEC Family Practice, you can apply at Buncombe County Health Center located at 35 Woodfin Street or call 828-250-5000, Monday-Friday, 8:30am-4:00pm. • If you get prenatal care from the MAHEC Women’s Health Center, at your first office visit you will be checked to see if you qualify and then can sign up for the program. You will be asked about the foods you eat and given advice from a counselor. • If you live outside of Buncombe County, you can call your local DSS or county Health Department.

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FAMILY SUPPORT PROGRAMS PROGRAM

HOW DO I QUALIFY?

WHERE DO I APPLY?

Baby Love (Maternity Care Coordinator)

These services are available for women with Medicaid; however they are also open to other qualifying pregnant women. Contact Buncombe County Health Center or MAHEC Women’s Health Center for information.

• If you are receiving care at the Buncombe County Health Center or MAHEC Women’s Health Center, ask to see a Maternity Care Coordinator or Baby Love Worker.

This state program helps pregnant women find early prenatal care and care after the baby’s birth. Help is provided with: • Making medical appointments • Education and support • Getting transportation • Childbirth/parenting classes • Childcare and housing • Referral to other programs

This is a free program.

Home Visiting Nursing Services

These services are available for women with Medicaid; however they are also open to other qualifying pregnant women.

Registered Nurses visit your home during pregnancy and/ or after birth. Services include checking for health problems, education and support.

Child Service Coordination (CSC) This program helps families with children (birth to 5 years) get support and services for raising healthy children. Services include: • Developmental screening • Information for your child’s health needs • Parenting education • Family support • Support in working with other programs

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• If you are receiving care at a private practice or MAHEC Family Practice, you can call Buncombe County Health Center at 828-250-5299, or your healthcare provider can make a referral for you. • If you live outside of Buncombe County, you can call your local DSS or county Health Department.

Your healthcare provider must request these services. Medicaid will cover the cost of these services. Some private insurance plans will cover the cost of these services for high-risk pregnancies.

This is a free program.

For information, contact Buncombe County Health Center located at 35 Woodfin Street or call 828-250-5299.

OTHER SUPPORT PROGRAMS Asheville Pregnancy Support Services

This is a Christian outreach ministry to help women whose pregnancies may be a personal crisis. The program also helps families and the father of the child. It is designed to help the family prepare for birth and parenting, and assist mothers with maternity clothes and supplies such as diapers and bottles. 828-252-1306

Family Support Network of WNC

This free outreach program is designed to enhance the lives of children with special needs by: • Providing support and education for family members • Parent-to-parent support and encouragement • Providing resources for families • Designing and coordinating the delivery of services Receive a quarterly newsletter and community education programs through Project SPEAK. 828-213-0033 or 1-888-810-2800, Ext. 2

Mountain Area Child and Family Center, Pregnant Moms Program

This Early Head Start Program helps pregnant moms find the services and information they need, including home visits, pregnancy education, infant/child development classes and support. They will work with the family until the child is age 3. Childcare at the center is provided when space is available. 828-298-0808

Project NAF (Nuturing Asheville Families)

This outreach program of Mt. Zion Community Development, Inc. serves African-American families by providing: • Personal support during pregnancy • Help with child care, medical appointments and transportation • Personal parenting support during the child’s first year 828-776-1428

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ALONG THE WAY 32

Second Trimester: Weeks 15-28 12-18 weeks During this time your body will be changing so that others will notice you are pregnant.Your breasts continue to change.You may notice a dark line forming in your skin from your upper abdomen to your pelvis.You may need to start wearing maternity clothes. Some mothers wonder if they are “going crazy’’ because they cannot remember things. Having trouble thinking or forgetting things is common.Your baby’s heartbeat can be heard through your abdomen.Your doctor or midwife will be listening to the heartbeat each visit. Most of the early pregnancy discomforts will start going away during this time. 19-22 weeks You will start to feel your baby move between 16 and 22 weeks. These movements may start as flutters and then feel stronger. The first movements are known as “quickening.” Your breasts are making colostrum at this time. This is a clear or yellowish fluid that may leak from your nipples. 23-28 weeks This is when you and others may see even more changes in your body. Your baby is growing in size and your belly is dearly growing in size because of this. The fundus (top of your uterus) will be above your belly button. Your feet and ankles may seem puffy at the end of the day. You may feel sharp pains below your belly button and off to one side. This can happen when you roll over in bed or stand up quickly. The ligaments attached to the outside of your uterus and pelvis are tightening as they try to keep your uterus from moving in your abdomen. Other changes in your body may become a challenge to deal with. (See the insert with this guide for more information.) You will feel your baby move

most of the time. Movements may feel low or high in your abdomen depending on the position of your baby. You may feel like you are hot no matter what the temperature is.

Important Terms To Know Braxton Hicks Contractions: The uterus is a muscle. Muscles are made to move, tighten and relax. When the uterus tightens it is a contraction. You have contractions as soon as you get pregnant. Most women do not feel contractions until the 6th or 7th month. These “Braxton Hicks” contractions during pregnancy are normal. They keep the uterus strong. Colostrum: The first milk made by the breast. This milk is yellowish and may leak from the breast during pregnancy. Doula: A person trained to help a mother and her partner during labor and birth. She can help with ideas for dealing with pain in labor. A doula can help with massage, breathing and encouragement. She will show the partner how to help the mother. (Visit dona.org for more information.) Fundus: The top of the uterus. As your baby grows, your uterus gets bigger. Your healthcare provider can feel your uterus through your abdomen. They will measure the size of the uterus by measuring from the pubic bone to the top of the uterus (fundus). Genes/Genetics: Genes are the instructions that tell our bodies how to grow and develop properly. For example, they tell us what our eye color will be and how tall we will be. Sometimes a mistake can happen in those instructions that might cause a problem or birth defect. Some of these problems can be passed along to your baby in the genes you get from your parents. Other problems can happen by chance.

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High-Risk Pregnancy: Some women have health problems before they get pregnant. Others have problems that start after they become pregnant. The problem could mean the doctor will need to watch you and your baby more closely. You may need to see a doctor who has special training (Maternal Fetal Medicine Specialist).

Check-Ups

Indigestion Or Heartburn: When the food and fluids of the stomach back up into the esophagus (the tube from your mouth to your stomach). This may burn or feel like a lot of pressure in your chest and neck.

• The following tests may be offered or suggested at the recommended intervals:

Kegel Exercises: Your body has muscles in your pelvic floor that hold your baby, uterus, bladder and intestines up inside. These are called the pelvic floor muscles. Kegel exercises help those muscles stay strong.

– A lpha-fetoprotein: Also called AFP or Triple Screen. This is a blood test that screens for problems with the spinal cord or other chromosomal problems like Down syndrome.

Kegel Instructions: Tighten your pelvic muscles like you are trying to stop your urine from coming out. Hold these muscles tight for 5 seconds. If you do this 20-30 times a day you will feel better. It can help keep urine from leaking when you cough or sneeze. It will also help your muscles work better when you are birthing. Ligaments Of The Uterus: There are ligaments attached to the outside of the uterus and your body. They keep the uterus from moving around in the abdomen. If the ligament stretches too quickly it can cause pain in the low belly. The pain is usually on the left or right side below the belly button. Quickening: The first movements of the baby that the mother feels. Movement is usually felt between 16 and 22 weeks. Vulva: The female genitals that are covered with pubic hair.

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• After about 12 weeks, your healthcare provider will start listening to your baby’s heartbeat. • They will ask you to watch for first movements of the baby. Try to remember the date, or write it down.

16-18 Weeks

– A mniocentesis: A test of amniotic fluid that can show genetic problems.

18-20 Weeks – U ltrasound: A test that uses sound waves through the abdomen of the mother to make a picture of the baby. It can tell how many babies are in the uterus, how the baby is growing and how the placenta is working.

26-28 Weeks – 0 ’Sullivan: A blood test to look at the sugar in your blood. If your blood sugar is too high, a GTT (3-hour Glucose Tolerance Test) will be done. These tests check for diabetes in pregnancy (gestational diabetes).

Check-Up Questions To Ask 1 What do I need to know about traveling? 2 Am I at risk for preterm labor? 3 How can I have a healthier pregnancy? 4 Are there classes I should take? 5 Are there books or videos I should get? 6 Can I try to have a vaginal birth if I already had a cesarean birth? What do I need to know about a vaginal birth after a cesarean?

Ultrasound at 22 weeks

7 Do you suggest using a doula for help in labor?

Baby

8 Are there medical problems in our families (mine and my partner’s) that should be checked out by the Fullerton Genetics Center?

At The End Of The 4th Month: Your baby has grown to about 6 inches and weighs about 5 ounces. The sex of your baby may be seen by ultrasound. Small eyebrows and eye lashes have formed. A fine, thin hair (lanugo) covers your baby’s body. Your baby begins to look more like a person. Fingernails and toenails are forming.

Examples:

– B irth Defects (Cleft Palate, Heart Defects, Spina Bifida)

– Cystic Fibrosis

– Mental Retardation

– Muscular Dystrophy

– Sickle Cell Anemia

– T wo Or More Unexplained Miscarriages 9 Are the following safe during pregnancy?

– Chiropractic Care

– Herbs

– Homeopathies

– Pregnancy Massage

– Spas (Hot Tubs)

At The End Of The 5th Month: Your baby has grown very fast and is about 8-12 inches long and weighs 8 ounces to 1 pound. A white creamy substance (vernix) covers your baby to protect the skin. Hair has started to grow on the head. Your baby practices swallowing, sucking and breathing movements. Your baby’s first teeth have formed in the gums. The bones inside the ear have formed and your baby can hear the outside world. At The End Of The 6th Month: Your baby’s eyes begin to open and close. The first bowel movement (meconium) is forming in the intestines. The lungs are formed, but not ready to work on their own. The baby can cough and hiccup. Sweat glands are forming in the skin. Your baby is about 12-14 inches and weighs 11/2-2 pounds.

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Father/Partner As the early weeks of pregnancy have now passed, you may be thinking more about the future. You may have the questions like these: • How much does it really cost to have a baby? • Do we need help with money or maybe services in the community? • Can I take time off from work when the baby is born? • What things do we need for the baby? • How do we find a pediatrician? • How do we find out about daycare? • Is it okay to have sex during pregnancy? These are important questions to think about. Below are some ideas on getting answers to these questions. • You can talk with our staff at Mission Hospital about the cost of having a baby. Call 828-213-1508. They can help you make payment arrangements and answer any questions. • Your doctor’s or midwife’s office staff can discuss payment for their fee. This charge includes all prenatal care and the fee for delivering your baby. • Talk with your employer about scheduling time off. (See page 15 for information about the Family Medical Leave Act (FMLA). • A list of things you will need for your baby is on page 52. A great way to get these things for less money is to visit thrift shops and yard sales. • If you need help getting a car seat, call Safe Kids WNC at 828-213-5548. • For information about finding a pediatrician see page 54. • For a list of child care services in Buncombe County, call 828-252-5955 or 877-752-5955.

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• Unless your doctor has told you differently, sex is considered safe during pregnancy. By 28 weeks mom may be having changes that make her uncomfortable. Your patience and understanding are very important to her. Read and go to classes with her to find out ways to help her be more comfortable.

Travel Tips Most women can travel during their pregnancy. If you are told you have a “high-risk” pregnancy your doctor may give you special instructions for traveling. The best time for traveling will be in the second trimester (weeks 14-28). Always talk with your doctor before you travel. Traveling In A Car • Always wear your seat belt. Put the lap belt below your tummy or low on your hips. Do not wear the lap belt in the middle or above your tummy. Put the shoulder strap between your breasts. Traveling By Car, Train Or Bus • Try not to travel more than 6 hours a day. • Take pillows for your head and low back. • Wear loose, comfortable clothes and comfortable shoes. • Stop every 1-2 hours to walk around. • Do not drink caffeinated drinks. Drink lots of water, juice or milk. Traveling By Plane • Sit in seats that are in front of the wings. The ride is less noisy and bumpy. • Ask for an aisle seat so you can move around. • Eat light bland foods before the flight and take crackers with you. • Wear loose comfortable clothes. Take a light jacket or sweater for changes in temperature. • Do not drink caffeinated drinks. Drink lots of water, juice or milk.

Second Trimester To-Do List • Start taking childbirth and parenting classes.

Prepare Your Pet For A New Baby

• If you are not taking childbirth classes contact Mission Hospital for a free hospital tour. Call 828-213-2222 or toll-free 877-213-I22I.

1 Identify and decrease attention-seeking behaviors such as pawing, barking, jumping or any demanding behavior. Learn leadership skills and start these with your pet.

• Sign up for a prenatal exercise or yoga class at Mission Hospital. Call 828-213-2222 or toll-free 877-213-I22I.

2 Become familiar with subtle signs and body language of pet communication.

• Start getting things ready and organized for you and your baby (See pages 51-52). • If you have questions about paying for your child's birth, call Mission Hospital’s financial counselors at 828-213-1508. They can talk with you about ways to make payments and answer questions about hospital costs. • Learn about doulas and find out how they can help during labor. Discuss using a doula with your husband or support person.

3 Begin a baby-friendly or flexible routine of feeding and activities with your pet and incorporate obedience skills.

4 Expose your pet to baby sounds, smells and new baby equipment, and use positive reinforcement.

• Plan for the care of other children or pets while in the hospital.

5 Identify and begin to use designated “pet zones” in your home, especially in the baby’s room. Begin looking to the future, and discuss growth/development and child safety related to your pets.

If you are unable to attend birth and parenting classes, consider Mission Hospital’s online eClass, Understanding Birth. Visit mission-health.org/birth-eclass for a free preview of the course.

6 Schedule a trip to the vet for your pet for an update on needed vaccinations and other health screenings.

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CHANGES IN YOUR BODY YOUR BODY

WHAT HAPPENS?

WHAT CAN I DO?

Eyes

• Contact lens irritation

• Talk with your pharmacist about eye drops.

A part of your eye gets thicker and ligaments stretch Nose The lining of your nose swells with extra blood Breast Your glandular tissue grows

• Your vision is blurred or it is hard to focus

• After the birth of your baby, your eyes will go back to “normal.”

• Stuffy nose, hard to breathe

• Try saline (salt) nose drops.

• Nose bleeds

• Drink plenty of water. • Use a cold mist vaporizer at home.

• Breasts become tender • Breasts get larger

• Wear a good bra that fits you well. Mission Hospital's Breastfeeding Center and Boutique can help fit you for a bra. Call 828-213-1103 for an appointment at 37 weeks or later. • Fit your bra on the first set of hooks so there is room to expand to the last set of hooks. • Consider using a maternity bra. • Talk with your doctor, or the breastfeeding specialist at Mission Hospital or call Buncombe County Health Center if nipples are flat or inverted (they go into the breast)

Stomach/Bowel Your digestion slows down

• Indigestion/Heartburn

• Drink 8-10 glasses of water each day.

• Constipation

• Eat 6 small meals each day. • Eat 3-5 servings of fresh fruits and vegetables each day. • Do not drink when you are eating. • Wait 2 hours after eating before you lie down. • Exercise at least 3 times a week. • Talk with your doctor about a fiber supplement. • Ask your doctor about using antacids.

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CHANGES IN YOUR BODY YOUR BODY

WHAT HAPPENS?

WHAT CAN I DO?

Hemorrhoids And Varicose Veins

• Pain, itching and swelling in the rectum are hemorrhoids

• Drink 8-10, 8-ounce glasses of water each day. (A total of 64 ounces)

The extra pressure in your pelvis from the uterus and baby causes blood to fill up the blood vessels in the rectum, vulva or legs

• Sore, itchy blue veins bulging in the genital area or legs are varicose veins

• Eat 3-5 servings of fresh fruits and vegetables each day. • Do Kegel exercises. • Use witch hazel pads to help with swelling and cleanse the rectal area. • Avoid sitting or standing for long periods of time. • Do not cross legs when sitting. • Do not wear knee-high stockings. Wear full-leg support stockings instead.

Legs Your legs cramp, especially at night

Swelling (Edema) Your body stores extra fluid, especially towards the end of pregnancy and in hot weather

• Muscles in the calf tighten into a painful cramp

• Avoid sitting or standing for long periods of time. • Stretch your legs before bed. • Do not point your toes.

• Swelling of feet, ankles, legs, hands and face

• Avoid sitting or standing for long periods of time.

• With swelling you may have pain or itching

• Go for a swim, or lie down in a full, lukewarm bath. • Swim several times a week for 30-60 minutes at a time. • Call your doctor if you have rapid swelling in your face and hands.

Recommended Reading • On Becoming A Family by T. Berry Brazelton • Ourselves As Mothers by Sheila Kitzinger • Mother: Famous Writers Celebrate Motherhood With A Treasury Of Short Stories, Essays, And Poems Edited by Claudia O’Keefe • Pregnant Fathers: Entering Parenthood Together by Jack Heinowitz, PhD

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Preventing Preterm Labor What Is Preterm Labor? Preterm labor is uterine contractions that can dilate (or enlarge) your cervix and cause your baby to be born before 37 weeks. Preterm labor may not always feel the same as labor at 40 weeks. The contractions may not feel painful.

NEVER IGNORE ANY OF THE FOLLOWING SYMPTOMS

What Should I Do If I Think I Am Having Preterm Labor? 1 Stop what you are doing. 2 Go empty your bladder. 3 Lie down on your left side for one hour. 4 Drink 2-3 glasses of water or juice while you are resting. 5 Call your doctor if the symptoms stay the same or get worse during that hour.

• Menstrual-like cramps (constant or occasional)

6 Return to a light activity if the symptoms go away after 1 hour. Do not do what you were doing when the symptoms began.

• Low, dull backache (constant or occasional)

7 If the symptoms come back, call your doctor. Never ignore your symptoms or assume they are not important.

• Pelvic pressure (feels like the baby is pushing down) in the vagina

8 Be sure to tell your doctor at your next prenatal visit what symptoms you had and what you did about them.

• Abdominal cramping (with or without diarrhea) • Increase or change in vaginal discharge • Uterine contractions every 10 minutes or more often (the contractions may not hurt and may only feel like pressure or tightening) • Call your doctor right away if you are bleeding or you feel water leaking from your vagina

Preterm Labor And The Link To Gum Disease Preterm labor can happen to any woman. Doctors do not know exactly what causes preterm labor, but new research shows that as many as 45,500 of the 250,000 premature births each year may be caused by gum disease. The bacteria P. gingivalis is the main cause of gum infections.This bacteria can get into your blood and travel to your uterus.Your body may react to this bacteria by producing a substance called prostaglandin. Prostaglandins may be the cause of the premature labor and birth. What you can do to prevent gum disease: • See your dentist regularly during pregnancy. • Call your dentist immediately if your gums have tenderness, bleeding or swelling.

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Preventing Preterm Birth What Is A Preterm Birth? Any baby born 3 weeks or more before the due date is preterm. When babies are born preterm they have a greater chance for health problems. These can be health problems at the time of birth and for the rest of their lives. A preterm baby can have problems with:

5 If you have contractions when you exercise, stop exercising until you talk with your doctor. 6 Avoid sitting for long periods. If you sit at your job, get up from your desk every hour and walk around.

• Sucking and digesting their food. This could mean they do not gain weight and their body will not get the things it needs for growing.

7 Use a condom with intercourse if you are told by your doctor that you are at risk for preterm labor.*

• Breathing. Asthma and other illnesses like pneumonia and bronchitis can result from a preterm birth.

8 Use a condom if you have more than one sex partner during pregnancy.*

How To Prevent Preterm Birth Your doctor cannot always tell if you might deliver preterm. All pregnant women need to do things that might prevent a premature baby. Here are some tips to help you prevent preterm birth: 1 Rest each day. Lie on your sides, not on your back. 2 Avoid standing for long periods. If your job requires standing, take 15 minute breaks in the morning and the afternoon. Lie down if possible, or at least prop up your feet during your breaks. 3 Avoid heavy lifting. Do not carry groceries, laundry baskets, toddlers or anything over 25 pounds. Heavy lifting may lead to preterm labor.

9 Brush your teeth 2 times each day and floss each day.* 10 Call your doctor: • If you have pain or burning when you urinate. • If you feel like you have to urinate all the time. • If you have itching, burning or strong odor to your vaginal discharge. *Prevents infections that can cause preterm labor. 11 A lot of stress during pregnancy can cause preterm labor. Stress is different for each woman. If you feel that parts of your life are too much for you to handle, talk with your healthcare provider. He or she may be able to help you find ways to deal with stress. Refer to page 14 for other ways to help you handle stress.

4 Avoid heavy housework. Scrubbing floors, washing walls and other heavy chores need to be done by someone else.

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Special Concerns Being pregnant is not like being sick. Most women are healthy during their pregnancy. However, things can happen.The mother or the baby can have health problems that make the pregnancy “high risk.” Mom may need to see her doctor more often during the pregnancy. She might not be able to work or may be put on bed rest during the pregnancy.When something goes wrong during pregnancy, it can be very hard on the mother and her family. “Our Baby Died” The loss of a baby before the 20th week of pregnancy is called a miscarriage. Babies born this early are not able to live. A baby born after 20 weeks that has died in the uterus is called a stillbirth. There are many reasons why a miscarriage or stillbirth might happen. Your doctor may be able to help you understand. If your baby dies any time during your pregnancy, it can be very sad and hard to deal with. Some women want to be alone after their baby dies. Other women need the support of other people who have had a baby die. Hospital staff or your doctor can help you find a support group. While you are in the hospital, our staff, including our chaplains, can comfort you and provide you with spiritual care. Your nurse can call the chaplain for you. After you go home, licensed bereavement counselors are available for one-on-one counseling, grief education and ongoing support. All this is offered for a voluntary donation. Call 828-251-0126 for enrollment or more information. “Does It Run In Our Family?” Some conditions or birth defects can be passed from parent to child. Other birth defects can happen by chance. The Fullerton Genetics Center helps:

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• Families with health conditions caused by a genetic problem • Families whose baby has died • Families whose baby is born with a birth defect Your doctor will set up a visit with the Fullerton Genetics Center for you. The staff will look for causes of the problem. They may offer testing to look for a genetic cause. If a genetic cause is found, they will: • Share information to help you understand • Listen and answer questions • Help you find services that might be helpful “Something Might Be Wrong” When a mother or a baby has a health problem, mom may be sent to a special doctor. This doctor is called a Maternal Fetal Medicine Specialist. This doctor is an OB/GYN who has special training and special equipment for checking your baby. You might see this doctor once or several times during your pregnancy. You will also have regular checkups. Your healthcare provider will set up the visit with this specialist for you. “I Have To Go To The Hospital” Some mothers need care during their pregnancy that can only be given in the hospital. At Mission Hospital, the Maternal Fetal Medicine Unit provides special care for pregnant women with special needs. All of the rooms in the unit are private and family and friends are welcome to visit. When a mother has to stay for a long time, we encourage her to bring things from home that will make her room feel more comfortable. Personal pillows, blankets and photos can help mom feel less alone. A day room on the unit provides a meeting place where mothers can spend time together.

“Our Baby Needs Special Care” Babies born with health problems have a special place to go at Mission Hospital.The 51 beds in our Neonatal Intensive Care Unit (NICU) are for:

Parents stay in a caring, supportive environment while their baby receives medical treatment at Mission Hospital. Our discharge planners can help you make arrangements to stay at the Rathbun Center.

• Babies born prematurely • Babies born with health problems • Babies born in other hospitals in western North Carolina that need special care

Once your baby is ready, our NICU staff will help you prepare to go home. Individual teaching and CPR instructions are just a couple of things they will offer to help you feel more at ease. Once you are home, you can continue receiving support and education from the Family Support Network of Western North Carolina.

A specially trained staff cares for babies and their families 24 hours a day. (The only baby we are not able to care for is one who needs an operation on their heart.) When a baby stays in the NICU, it is stressful on the parents and their family. To help ease their stress:

For More Information Call the Family Support Network of Western North Carolina at 828-213-0033 or toll-free at 1-888-810-2800, Ext. 2.

• We have 24-hour visitation for parents, siblings and grandparents. • Our nurses encourage parents to start taking care of their baby as soon as possible. • The area where each baby stays is set up to help parents feel comfortable in taking care of their baby. • Staff asks parents to actively help plan their baby’s care. • We offer private rooms for parents and baby to stay together as your baby improves and prepares to go home. Some of our mothers and fathers may live a long distance from Asheville and may need to leave their baby in the NICU after mom is discharged from the hospital. Traveling back and forth from home to the hospital becomes a challenge. Rather than traveling long distances, Mission Hospital offers parents a place to stay close by. The Lewis Rathbun Center is a welcoming, Victorian-style home where out-of-town families can stay free of charge.

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IN THE HOME STRETCH

Third Trimester: Weeks 29-40 What’s Next For Mom Congratulations, you are now in the last 3 months of your pregnancy. You may have even more changes in your body to cope with: • More aching in your back, pelvis, hips and legs • Rib pain from the pressure of the baby • More pressure on your bladder • Stretch marks on your abdomen and breasts • Trouble getting comfortable when you sleep • Feeling tired most of the time • Swelling in the ankles and feet • Indigestion getting worse • More uterine contractions that may start to feel painful • Discomfort when the baby is moving a lot • Dreams about the baby or birth • Constipation • The “I can’t move because I am so big” feeling Because of the changes in your body, you may have trouble: • • • •

Tying your shoes Getting up off the floor or out of the bathtub Getting out of a chair or out of bed Climbing stairs

Do not give up. You are almost ready to give birth. Try these tips to make yourself more comfortable: • Exercise. Practice yoga, walking, swimming and Kegels and pelvic tilts. • Eat small meals frequently and do not drink fluids with meals. • Drink plenty of water, low-fat milk or juice. • Think positive thoughts. Think about seeing your baby soon. • Relax. Play gentle music and practice slow deep breaths while you relax tight muscles.

• Prop up with lots of pillows between your legs, under your knees and under your belly when you lie on your side. • Use a stool to prop your feet up. • Talk to your partner, family, friends or doctor about your fears and concerns.

Important Terms To Know Breathing Patterns:* Breathing in a rhythm during labor can help a woman deal with pain and not tense up the muscles of the body. It helps you to not hold your breath and gives you something to think about instead of pain. Cesarean Birth: A cut is made through the mother’s abdomen and uterus so the baby can be born through her abdomen. A cesarean birth could be performed if: • The placenta is in front of the baby (previa) • The baby is lying sideways in the uterus • The baby is breech (coming bottom or feet first) • The baby is unable to fit through your pelvis • Genital herpes germs are in the vagina • The baby is having trouble getting enough oxygen during the labor • The umbilical cord has dropped into the vagina in front of the baby • A mother has had a cesarean birth before and would need another one Some of these problems happen before labor starts and you and your doctor might schedule a day for your cesarean. Sometimes the problems happen during labor. Circumcision: When the foreskin that covers the head of the penis of a boy baby is removed. Contraception (Birth Control): Ways to keep a woman from getting pregnant. The type of method you use should be discussed with your doctor so it works best for you.

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Fetal Kick Counts: A healthy baby moves a lot in your uterus. You can help look out for your baby’s health by paying attention to these movements. Ask your doctor about doing fetal kick counts. Focusing Your Mind:* During labor you need to think about something other than the pain. Try to distract yourself with one of these ideas: • Close your eyes and think about a nice place (the beach, sitting by a waterfall). • Open your eyes and look at a favorite picture or a stuffed animal you got for the baby. • Move around in labor. • Listen to music. Genital Herpes: A sexually transmitted germ that can make your baby sick. Babies get it from you when they come through the vagina (birth canal) during birth.Your doctor will watch you closely for signs of genital herpes. Informed Consent: Written permission for a doctor to perform a procedure or operation. The doctor will explain the procedure or operation before the consent form is signed. Examples of consents you may need to sign in the hospital: • Epidural (spinal anesthesia) • Circumcision • Vaccinations • Cesarean birth Relaxation:* The ability to release muscle tension (make a muscle soft instead of tight). If you relax in labor you will: • Become less tired • Be less afraid and have less stress • Have less pain

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*These skills are best learned in a childbirth preparation class. They will also work best for you if you practice them before birth.

Check-Ups You will see your doctor every 2 weeks until 36 weeks. After 36 weeks you will go every week until you give birth. In the last weeks, talk with your doctor about: • Do I need to count my baby’s kicks and movements? How do I do this? For more information about following your baby’s movements, visit: starlegacyfoundation.org/ see-me-feel-me • How will I know when I am in labor? When do I call my doctor or midwife? • How do I find a pediatrician or family doctor to care for my baby? • What are my choices for helping with pain in labor? • When can we talk about my choices for how I want my birth? • What do you think about circumcision? • What birth control option is best for me? – Hormonal Methods: Oral Birth Control Pills, Depo-Provera Shots, Birth Control Skin Patches – Barrier Methods: Condoms, Diaphragm, Spermicides, IUD (Intrauterine Device), Sterilization (Tubal For Mom, Vasectomy For Dad)

Tests In The Third Trimester Group B Strep During a vaginal exam your doctor will take a sample of your vaginal discharge. This will be tested for the Group B strep germ. This germ could be passed to your baby during birth. If the test is positive, you will be given antibiotics during labor to help keep the baby from getting sick. Blood Tests Your doctor may need to repeat the tests for sexually transmitted diseases.

Baby 28-32 Weeks Your baby now weighs about 3-4 pounds and is about I5 inches long. Your baby’s lungs are formed but are not ready to start working. Calcium is being stored in the bones. The brain is growing very fast and your baby’s own blood supply is being made. Remember, to help your baby’s blood, bones and brain develop: • Eat 4 servings of dairy foods each day or take I,200mg of calcium. • Eat 3 servings of protein a day (eggs, meat, beans, nuts, soy products, tofu) • Eat 3-5 servings of dark green vegetables (spinach, collard greens, mustard greens, kale, broccoli) Your baby’s movements may seem different. As baby’s brain starts growing, movements change. Baby will move less when sleeping, more when awake. Baby’s brain grows the most during sleeping cycles.

Ultrasound showing fetal spine development

32-36 Weeks In the next month your baby will gain 1-2 pounds and grow 1-2 inches. By the end of the month baby will weigh about 5.5 pounds and will be 18 inches long. The lungs are almost developed. Your baby’s body is making fat to help the baby stay warm after the birth. 36-40 Weeks An average pregnancy is 280 days or 40 weeks. At the end of this time your baby will weigh about 7.5 pounds and be about 19-20 inches long. As your baby gets ready to be born several things happen: • The lanugo (fine hair) goes away except for forehead, shoulders and back. • The vernix (white substance on the skin) is shed and turns the amniotic fluid cloudy. • Antibodies (made by the body to keep your baby from getting sick) are generated.

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Father/Partner

Your Body Gets Ready For Birth

Mom will now be getting more and more uncomfortable as the weeks go by. It is hard to sleep because she is uncomfortable and urinating more at night. Lifting and bending are becoming very difficult. She is getting very tired more often. Try to:

In the weeks and days before labor starts there are signs your body is getting ready for the big birthday party:

• Do more chores around the house, like laundry, vacuuming and grocery shopping. • Encourage her to rest more, especially if she is working outside the home. • Keep your sense of humor. • Do not take her mood swings personally. • Tell her she’s beautiful and you love her. • Be patient. As she gets closer to the due date she may start to be more afraid about the birth. She may be worrying about and asking herself: • Can I deal with the pain? • Will I be OK? • Will the baby be OK? • Will I have a really long labor? • Will I be able to do what I plan to do during the labor and birth?

• The baby will move down lower into your pelvis, away from your rib cage. You may notice you can breathe easier, you can eat more and you are in the bathroom all the time. Your baby has dropped. This is normal. • Your vaginal discharge may become thicker and have a little blood. You may see something that is the shape of the end of your finger. This is the mucus plus. • You may have a burst of energy, with a strong urge to get things ready for the baby. This is a change in your hormones, and you are “nesting.” • Your bowel movements may become softer, almost like diarrhea. This is a hormone change and your body is cleaning out your bowel. This makes more room for the baby to be born. • You may have contractions that are stronger but do not come in a regular pattern. Your uterus is practicing for labor. • You may lose 2-3 pounds at a check-up.

Ask her to talk about her worries with you, or ask her if she would like to talk to her doctor or childbirth instructor.

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Third Trimester To-Do List

Preparing Other Children For A New Baby

• Pack a bag for labor. • Tell your child the story of his or her birth. • Pack another bag for after the birth. • Choose a name for your baby for the birth certificate and Social Security card. You will fill out this paperwork in the hospital. • Get a car seat and install it with a trained person. See page 61 for a helpful list of trained safety technicians. • Make meals and freeze them or have family and friends plan to bring meals. • Decide about circumcision. • Finish getting the things you and your baby will need at home. • Decide who will be with you in labor. Talk with them about what you want them to do for you in labor and after the baby is born. • Talk with your doctor about your plans for birth. Write a plan for your birth. Give one copy to your doctor and put another copy in your labor bag. • Finalize your plans for who will be caring for your pets during and after birth. • Make a plan for introducing your baby to the family pets. This can be done within days or weeks after birth.

• Show your child pictures of what they looked like as a baby. • Talk about what the new baby will be like, what babies can and cannot do and how to carefully hold a baby. • Teach your child about being calm and patient. Have them practice waiting before the baby is born. • Help your child get ready to be away from you. Call home from another place and let them practice talking on the phone with you. • Make an audio tape or video of you reading a favorite story. • Give your child small chores to do so they can “help Mom” while you are at the hospital. • Spend special time during the day, especially at bedtime, with your older child(ren). • Bring a birthday cake to the hospital. • Do not expect too much. It is a stressful time for everyone. Be patient. These are only a few suggestions you can use. Many more are found in the books listed under Recommended Reading. For More Information Mission Hospital’s Child Life Specialists offer sibling classes each month. Call 828-213-8302 to register.

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Making Important Decisions For Your Baby Healthy Choices During your pregnancy you have made some parenting choices that were important to your baby, like: • Stopping smoking • Eating healthy foods • Exercising • Not drinking alcohol As you get closer to the birth there are more choices to be made: • Should the baby be circumcised (if a boy)? • What kind of doctor will I use for my baby’s care? • Should I use cloth or disposable diapers? • Should we put our baby in day care? How do I find the right kind of day care for my baby? • How do I get my other children ready for the new baby?

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Medicaid and some insurance companies may not pay for circumcision. Talk with your baby’s doctor about how you will pay for the circumcision. If your baby is circumcised before you leave the hospital, your nurses can teach you how to take care of the circumcision.

Breastfeeding Exclusive Breastfeeding Recommended The United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) recommend exclusive breastfeeding for the first 6 months of a baby’s life. This is based on research that shows benefits for infant survival and proper growth and development. Breast milk provides all the nutrients that an infant needs during the first 6 months of life. Exclusive breastfeeding may also reduce infant deaths caused by illnesses such as diarrhea and pneumonia. Breast milk also helps infants recover from an illness more quickly. Breast milk is the best food for a baby because: • Breast milk helps with physical growth and brain development.

Talking with your doctor or your baby’s doctor is a great way to get help with these choices. Reading or talking with family and friends is also helpful. Below are a few things you need to know.

• Breastfed babies have less problems with spitting up and gas.

Circumcision It is important to talk with your baby’s doctor about circumcision. You need to know the reasons for doing or not doing a circumcision. After talking with your doctor, you will know more and can make the best choice for your son. You do need to make this decision before the birth. The nurses will have you sign a consent for circumcision in the hospital.

• Breast milk has antibodies that protect your baby from germs—formula does not.

• Breastfeeding is free. • Breast milk is always ready.

• Breastfed babies have fewer health problems even when they are older. • Breastfeeding mothers have fewer occurrences of breast or ovarian cancer. • Breastfeeding keeps a mother from bleeding too much after birth.

Formula Formula feeding puts your baby at risk for several health problems. Some of these problems are chronic or can occur in adulthood: • Gastrointestinal Disease • Ear Infections • Asthma • Allergies • Respiratory (Lung) Infections • Multiple Scerlosis • Obesity • Sudden Infant Death Syndrome (SIDS) • Some Childhood Cancers • Juvenile Rheumatoid Arthritis • Diabetes: Type 1 and Type 2 • Thyroid Disease • Dental Cavities and Fluorosis • Lower Intelligence Quotient (IQ) Rooming and Feeding Cues Mothers and babies should stay together if possible. If your baby stays in your room, you actually get more rest. Sleep when your baby sleeps. Keeping mother and baby together also supports breastfeeding. You are more likely to feed your baby when they are ready to feed. It has been shown that babies who stay in the mother’s room:

These benefits are due to the fact that you are seeing your baby’s feeding cues and “sleep-wake” cycles and feeding your baby frequently (8-12 feedings within a 24-hour period). This is helpful for early and plentiful milk production. Signs that your baby is ready to feed include: • Sucking on tongue or lips during sleep • Sucking on fingers

• Are happier • Cry less • Develop more regular sleep-wake cycles earlier

• Moving arms and hands toward mouth • Fussing or fidgeting while sleeping • Turning head from side to side

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Scheduling An Early Birth

When To Call Your Doctor

Every Week Counts Scheduling your baby’s birth too early can cause problems for both mom and baby. As long as you and your baby are healthy, it is best to stay pregnant for at least 39-40 weeks. Your baby needs 39 weeks because:

Call Your Care Provider If:

• Brain, lungs and liver need this time to fully develop. • Baby will be less likely to have problems with vision and hearing. • Baby will have time to gain more weight, which keeps your baby warm. • Baby will be better able to suck, swallow and stay awake to eat. And, we also know that: • Due dates may not be exactly right. If you schedule to have your baby, and your dates are off by 1 or 2 weeks, your baby may actually be premature. • Inducing labor may not work—especially if your body and baby are not ready—and then you may need to have a cesarean birth. • Cesarean birth can cause problems in future pregnancies. • Cesarean birth is major surgery. It takes longer to recover and you are more at risk for problems, like infections. If your doctor is recommending your baby’s delivery before 39 weeks, you may want to ask: • Is there a problem with my health or my baby’s health? Why do you recommend inducing labor? Why do you recommend scheduling a cesarean? • Can I wait until I am closer to 39 weeks? • What risks do I and my baby face with this earlier delivery?

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• This is your first baby and contractions are: – 5 minutes apart – 60 seconds long • You cannot walk during the contraction and have to use a breathing pattern • Contractions have been in this pattern for 1 to 2 hours • This is not your first pregnancy and you are having regular contractions • Your doctor has asked you to call when you think you are starting labor • You are afraid that something is “not right” • You have bright red bleeding like your period has started • Your water breaks • If your water breaks, tell your doctor: – What time your water broke – What color the fluid is – If you are having any contractions When You Call, Be Ready To Tell Your Doctor: • How far apart your contractions are • How strong they are • How long they last • If your vaginal discharge has some blood in it • If and when (what time) your water broke

Staying At Home During Early Labor

Things You Need In The Hospital

Unless your healthcare provider has told you to go to the hospital, stay at home until your labor is strong.

We suggest that you pack 2 bags for the hospital: 1 for labor and 1 for after the birth.

What Should I Do At Home? • If you wake up having mild contractions, try to go back to sleep. • If you start labor during the day, distract yourself. Do easy chores, go to the mall, watch TV or read. • Drink lots of clear liquids (drinks you can see through) such as water, juices, ginger ale, Sprite, Kool-aid or lemonade. • Eat small, light meals—scrambled eggs, toast, soups, bagels, baked potatoes, pasta, rice or dairy foods. • Rest when you feel tired. • Take long, slow walks followed by resting. • Get your bags ready. • Time your contractions every couple of hours or when you think they have changed. • Watch for your contractions to get: – Regular: They come at the same time, each time, not 10 minutes, then 20 minutes then 25 minutes apart. – Closer together: Over time the contractions will go from being 15-20 minutes apart to 5-7 minutes apart. – Longer: Each contraction lasts 45-60 seconds, not 20-30 seconds. – Stronger: You cannot walk or talk while you are having a contraction. If you start holding your breath, start using a breathing pattern to help you with the pain.

Remember, when you go to the hospital for labor, leave your “after the birth” bag in the car until you are moved to your room. Labor And Birth Supplies (Bag 1) Choose anything for bag 1 from the list below that you might need for labor. Bring this bag to your Labor and Delivery room: • Spray bottle for misting your face • 1-2 pillows (brightly colored pillow case) • Lip balm • Snack for support person • Money for vending machines • iPod, MP3 player and CD player • Massage tools and oils (because of fire codes, candles or incense cannot be used) • Rice bag for moist, warm heat • Warm socks • Camera or video camera • Focal point (like a small stuffed animal or a favorite photograph) • Birth Plan or preferences (See page 55) • Robe and slippers for walking during labor • Toothbrush and toothpaste for mom and support person • Baby book for foot prints • Hair ties and clips • Hand-held fan • Sweater or sweatshirt for support person since the room will be cool for mom’s comfort Remember: Please leave valuable jewelry at home. Do not bring large sums of money.

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After The Birth Supplies (Bag 2) Please leave these “after birth” supplies in your car until you are taken to the Mother Baby Unit after the birth: • Nightgown or pajamas • Underwear • Personal care items (shampoo, toothpaste, lotion, etc.) • An outfit for the baby and blanket • Loose-fitting clothing to wear home • Health insurance and/or Medicaid card • Money for vending machine • Favorite snacks (there is a small refrigerator in your room) • Car seat (unless this has already been installed before your delivery)

Electrical Appliances • Inform the admissions clerk or nurse if you want to bring any electrical appliance(s) into the hospital or if a visitor brings in a device for you. To ensure your safety, all such devices should be made available for inspection by hospital personnel. • Small battery-powered devices, such as iPods, MP3 players and CD players are permitted, as long as they do not disturb other patients or hospital personnel. Please note: earphones are recommended.

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Ideas For Things To Have At Home For Your New Baby: • Crib or safe place for baby to sleep • Sheets for crib or cradle • 2-3 receiving blankets • Mild soap for bathing • Rubbing alcohol • Petroleum jelly (Vaseline) • Cotton balls and swabs • 2-week supply of diapers • Bag for diapers and supplies when away from home • 4-6 undershirts • 1-2 heavier blankets • 4-6 gowns or sleepers • 4-6 outfits (weather appropriate)

You will receive the following items from Mission Hospital: • Digital thermometer • Brush and comb • Bulb syringe

Recommended Reading • Mom, Dad and I are Having a Baby by Maryann Malecki, RN • T he New Baby at Your House by Joanna Cole and Margaret Miller • The Nursing Mother Companion by Kathleen Huggins, RN, MS • T he Complete Book of Breastfeeding, Fourth Edition by Sally Wendkos Olds, Marvin S. Eiger, MD and Laura Marks, MD • T he Womanly Art of Breastfeeding by La Leche League International • Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers by Nancy Mohrbacher, IBCLC, FILCA and Kathleen Kendall-Tackett, PhD, IBCLC

Birth Support For Sexual Abuse Survivors If you are a survivor of sexual abuse you may have special fears and needs during your labor. Mission Hospital’s Survivor Services can help. This program gives you the chance to meet with a Labor and Delivery nurse during your pregnancy to discuss your special needs, fears or past birth experiences. We can help you understand what happens during birth, then create a birth plan that addresses your specific needs so that you feel more confident and safe. This care plan can be a valuable tool as you work with your doctors and nurses to have a birth that leaves you feeling in control and involved in the decisions about your care. During your pregnancy, your visit to the hospital will include: • A personal tour of our unit and labor rooms

• The Baby Book by Dr. W. Sears

• Discussion of a typical labor, vaginal and cesarean delivery

• Giving Birth, The Parents' Emotions in Childbirth by Sheila Kitzinger

• Discussion of your specific concerns about labor and birth

• Y our Amazing Newborn by Drs. M. and P. Klaus

• The creation of a Nursing Care Plan that addresses your concerns and develops strategies for coping with labor and birth

• A New Baby for Us by L. Kugler (includes activities for older siblings) • T he Happiest Baby on the Block by Dr. H. Karp

For More Information Call 828-213-8473 to make an appointment with Mission Hospital’s Resource Nurse.

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Choosing Your Baby’s Doctor You can choose a pediatrician or a family practice doctor to care for your baby. It is best to select a doctor for your child before he or she is born so that you can ask questions and have a plan in place. Pediatrician: Has at least three years of training after medical school. This training is focused on children only. Family Practice Doctor: Has at least three years of training after medical school. This training is focused on children and adults.

• What will happen at these check-ups? • What immunizations does he or she need? • When should I call if the baby seems sick? • If I have an emergency during office hours, what should I do? • If I have an emergency after office hours, what should I do? • If there is an emergency that needs hospital treatment, what should I do? • What do you think about breastfeeding?

• Ask your doctor, friends and family for names of doctors and references.

• What do you think about circumcision?

• Make an appointment to meet the doctor before your baby is born.

• How do I pay for circumcision?

Questions To Ask The Doctor • What is your training? • How long have you been in practice? • What tests for the baby need to be done after the birth? • If my baby is healthy, when can we go home? • Do you have privileges at Mission Hospital? If not, can you recommend a doctor I should use at the hospital? • When should I bring my baby in for the first visit?

• Who will perform the circumcision?

Choosing A Day Care If you need day care or you think you might need it later, read below for some important information on finding a good day care for your new baby. • Adult-To-Child Ratio: Ask how many children there are for each adult. • Group Size: Find out how many children are in each group or class. • Caregiver Qualifications: Ask about caregiver training and education.

• Are you in practice by yourself? Who is on-call when you are not available?

• T urnover: Ask how long caregivers have been at the center or providing care in home.

• If I have questions, can I talk with someone over the phone?

• Accreditation: Find out if the child care program has been accredited by a national or state organization.

• What are your office hours?

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• How often do you need to see my child?

Other Things To Consider:

During Your Labor And Birth

• Are caregivers trained in CPR and first aid?

Your Room When you arrive at Mission Hospital to have your baby, you will be taken to a Labor, Delivery and Recovery (LDR) room. This is where you will labor, birth your baby and stay for 1-2 hours after the birth. These rooms are set up to make you feel more at home. Items needed for your baby’s birth are kept in each room. Each room has a private bath and some have large garden-style tubs. These larger tubs are for warm, comforting baths during labor (hydrotherapy) and are available on a firstcome, first-served basis. If you are interested, ask about them when you arrive.

• Does the caregiver welcome drop-in visits and parent involvement? • Are there planned activities as well as lots of free play time? • Are materials such as books, art supplies and toys available? • Is there scheduled play outside each day? • What procedures are in place for controlling infections? • Does the caregiver have references? • Are there written policies and procedures, including emergency plans? Mountain Child Care Connections is a great place to find out about your choices. They have information about: • All licensed day care centers in Buncombe and surrounding counties. This includes how each center is rated for the activities they offer, training of staff, cleanliness, etc. • How to choose the best child care for your child. • Which centers take day care vouchers. For More Information Contact Mountain Child Care Connections at 828-252-5955, toll-free at 877-752-5955, or email [email protected]. Visit their website at swcdcinc.org/family-services/ mountain-child-care-connections.php.

Birth Plan Or Preferences Your nurse will ask you about the birth preferences you have discussed with your doctor or midwife. Give her a copy of your birth plan if you have one. Talk with the nurse about the things she can do to help support you. Tell your nurse if you or your support person need an interpreter or if you plan to use a doula for labor support. Relaxation Station Be sure to tune in to our Relaxation Station, channel 32 on your LDR room TV. The continuous soothing music and relaxing photographs can be a great help during and after birth. Staying In Touch By Telephone Each room has a phone for local calls. For long distance calls, please bring a calling card. Collect long distance calls cannot be accepted. Cell phones can be used inside your labor room and in the waiting room. We ask that you not use cell phones in hallways or in the cesarean operating room. Your nurse will remind you of the areas where you can and cannot use your cell phone.

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Family And Friends During Labor Mission wants families and friends to be able to support mothers and couples at this very special time. Mothers in labor need to be able to save their energy and focus on the birth. To respect the needs, safety and privacy of all moms and families please follow these guidelines: • Have 1-4 support persons with you during labor and birth. Choose people who will help support you the most. If you use a doula, she will count as one of the 4 persons. Talk with your nurse if you need assistance with other visitors. • For safety and privacy, all visitors can wait in the waiting room, not in the hallways. For the health of all mothers and new babies, all support persons and visitors need to be in good health. Family and visitors need to wash their hands upon entering and leaving a patient room. • There may be times when support persons may be asked by the staff, doctor or midwife to leave the room briefly for the mother’s privacy and comfort. They may wait in the waiting room during this time. • The presence of siblings at a birth can be very important to families. If you desire your other children’s presence during labor and birth, please arrange this with your care provider. Big brothers and sisters are welcome to visit on the nursing units. Other children are welcome to visit if they are age 14 or older. Older Brothers And Sisters Talk with your doctor or midwife during your office visits about having the baby’s siblings at the birth. If you are thinking about having your children at the birth, ask yourself these questions:

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• Will they be a distraction for me during the labor and birth? • Will they get bored and restless? • How will they feel seeing me as my labor progresses? • Who will be the child’s support person? Guidelines For Siblings • The baby’s brothers or sisters are welcome. Other visitors under the age of 14 (cousins or friends) are encouraged to visit once mom and baby are home. Remember, all visitors need to be in good health. • Younger siblings (12 years old or younger) need an adult with them at all times. This adult can be their support person. • Please let family and friends know that an adult needs to watch other children at all times. This helps with everyone’s safety and privacy during your hospital stay. Children can wait in the waiting area or the mother’s room. Special classes for siblings are offered by Mission Hospital. For more information call 828-213-8302. Guidelines For Photography This is a very special time in your life, and we know photos help save special memories. Talk with your midwife or doctor about taking photos during labor and after the birth. Some staff may not want to be included in your photos or videos, so please ask them first. • Photos may be taken during labor. We ask that no photos be taken while the mother is being examined or having procedures like starting an IV or an epidural. All video

cameras must be handheld. There is not enough space in the room for tripods or extra lights. • At the time of birth, everyone will be focusing on helping you have a safe birth and healthy baby. Please, no photos or videos during this time. Enjoy this very special moment. • In a cesarean birth, still photos can be taken with your new baby. Your nurse will tell you when you can start taking photos. Guidelines For Cesarean Birth • One support person may be in the room if the mother is awake. If the mother is receiving general anesthesia (going to sleep) there is an emergency and things will be happening very fast. Staff will be focusing on caring for mom and baby. Dad or your support person will need to wait outside the operating room, where staff can keep them updated. • We have specialty staff present in the hospital, ready to take care of your baby’s special needs. • We encourage you to bond with your baby during and after the birth in the recovery area. • Once you are comfortable in the recovery room, recovery time after a cesarean is about 2-3 hours. • If you are scheduled for a cesarean birth, please leave all personal belongings in your car until you are transferred to the Mother Baby Unit.

Your Baby’s Safety When your baby is born, 4 identification (ID) bracelets will be made for the baby’s wrist, the baby’s ankle, mom’s wrist and dad’s or the main support person’s wrist. These bracelets will be checked anytime the staff takes your baby in or out of your room. If a bracelet falls off, let your nurse know right away. A Room For Mother And Baby After your baby is born, you will be taken to a room you will share with your new baby until you go home. Babies stay with their mothers at all times. The nurses in this area are skilled in caring for mothers who have given birth and their newborns. They are called Mother Baby Nurses. They will help you begin to care for your baby. If your baby has special medical needs, he or she will stay in the Neonatal Intensive Care Unit (NICU) for close observation and specialized care. Family And Friends After Birth During the first hour, a family member or friend can help the nurse get you settled. During this time, your other family or friends may visit the cafeteria on the 2nd floor or bring your things from the car. We hope each family can enjoy the birth of their baby in private, safe and caring surroundings. For this reason, all family and friends need to stop at the front desk each time they visit the Mother Baby Unit. Asking guests to check in helps our staff determine if mom is ready for guests. Before your baby is born, talk with your family and friends about how much company you would like to have while you are in the hospital. • One adult support person (husband, father of the baby, partner, other family member or friend) is welcome to stay with the new mom and baby around the clock. A daybed and linens are provided. All other family and friends are welcome 9:00am-2:00pm and 4:00pm-8:30pm.

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• “Quiet Time” is given to new moms, babies, fathers or an adult support person, and any new big brothers or sisters from 2:00pm-4:00pm. All other family and friends are asked to respect this time for privacy, rest and bonding with the new baby. • Keeping moms and babies safe from illness is very important in the first weeks after the birth. For this reason, big brothers and sisters are welcome to visit only if they do not have signs of illness. Other children are welcome to visit if they are age 14 or older. Siblings will adjust to a new baby better with good sleep. Please make arrangements for their care at home during nighttime hours. • For family and support persons staying with Mom between 8:30pm-5:00am, please check in with our security staff for the safety of families and staff. Go to the main lobby to register and get a visitor’s badge.

If you and your baby have special needs with breastfeeding, lactation consultants (breastfeeding experts) can work with you. Mission Hospital’s Western North Carolina Breastfeeding Center rents and sells electric breastfeeding pumps for use after you go home. You can also call for an appointment with a lactation consultant if you have questions or problems after you go home. Call the Western North Carolina Breastfeeding Center at 828-213-1103, or visit us online at missionchildrens.org/breastfeeding.

• For the safety, privacy and comfort of all persons, please limit visits to 4 persons at a time. This does not include the father or adult support person or siblings.

For The Safety Of Your Baby We want you and your family to feel safe and comfortable. To provide you and your baby with the safest surroundings, it is very important that you know the following:

• Door signs indicating mom’s need for privacy and rest are available for hanging on the room door. Please ask your nurse for a sign if you would like one.

• Never leave your baby alone, even to take a shower. Staff can help care for your baby at any time.

• If you would like to be an “unlisted” patient for maximum privacy, speak to your nurse as soon as possible. For more information about medical privacy laws, see page 22 under “Unlisted Patient.”

• If someone you do not know asks to take your baby, press the call bell for the nurse right away.

• All family and friends need to wash their hands when arriving and leaving the room. Anyone who is ill may not visit.

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Breastfeeding Breastfeeding provides the best food to start your baby’s life. In the last few weeks of your pregnancy, consider taking a breastfeeding class offered through Mission Hospital, the Buncombe County Health Center or other health centers in your area. Mission Hospital’s Mother Baby nurses have special training to help you get started with breastfeeding.

• Know your nurses’ names.

• Put your baby in a bassinet any time he or she leaves the room. No one should carry your baby in their arms out of your room. • An electronic security system is in place on the Mother Baby Unit. Your nurse will explain how the system works.

Your Comfort Getting relief from pain is important for healing. Ask your nurse about pain medicine and other care methods to help you feel better. The pain medicines will not cause addiction and will help you get out of bed sooner. Being active will help you feel better.Tune in to our Relaxation Station, channel 32, for soothing music and photos. Spiritual Support This can be a very emotional time and you may have special needs. Mission Hospital has chaplains in the hospital to offer spiritual support or a listening ear. At your request, your nurse will call a chaplain. Learning More About Baby Care Channel 6 is Mission Hospital’s newborn TV channel. Take time to watch these programs with your family while you are in the hospital for information on caring for your new baby. Birth Certificate And Social Security Card A Birth Certificate Clerk will visit you during your stay on the Mother Baby Unit. She will collect information used to obtain a birth certificate and a Social Security number (SSN) for your newborn. An SSN is required when claiming a new baby on an income tax return. The Social Security Administration will mail your baby’s Social Security card to the address of your choice. Mission Hospital’s Birth Certificate clerk will submit your forms and instruct you on the cost and steps for obtaining the official birth certificate from the Register of Deeds for Buncombe County. New parents are asked to come prepared with your choice for your baby’s name. Please take time to consider the choice and spelling of your baby’s name. Once determined, it can be very time-consuming and require a lawyer to change names or information on this legal document.

Many families have questions about completing the birth certificate. It is always better to ask questions ahead of time. Feel free to call our Birth Certificate Clerks at 828-213-8559 any time before your baby’s birth.

Going Home Length Of Stay The time you spend in the hospital will depend on the health of you and your baby. After a vaginal birth you may stay 1-2 days. After a cesarean birth you may stay 3-4 days. The recommended checkout time is 11:00am-12:00pm (noon). Please keep this in mind when making plans to go home. Your doctor or midwife and your baby’s healthcare provider must complete their exams before you can be discharged. Before Your Baby Goes Home • H earing screenings: Your baby’s hearing will be tested before going home to measure how she or he reacts to soft sounds. This painless test is performed in your room, and you will be told the results after it is finished. • N ewborn screenings: State law requires all babies to be tested for certain diseases. Blood is taken from your baby’s heel for these tests. • Hepatitis B Vaccine: Hepatitis B can cause liver problems and doctors recommend that all newborn babies be vaccinated to prevent this disease. Discuss this with your baby’s doctor prior to giving birth. • C ircumcision: Circumcision means cutting away a small piece of skin covering the end of the penis. Please talk with your doctor or midwife about making this choice for your baby boy. It is also a good idea to find out before your baby’s birth if your insurance plan covers the cost of circumcision.

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• A Newborn Exam: Your baby will be given a head-to-toe check-up in the first 24 hours after birth and on the day you go home. Mission Hospital will mail these records to the doctor you have chosen to care for your baby. • Discharge Planner Consultant: You may have a visit from a member of the Patient and Family Services staff. The consultant can talk with you and your doctor about things you may need help with once you go home. He or she will then contact local programs that may be able to help you. Before Mom Goes Home • The morning you go home you will have an exam by your doctor or midwife. • Take time to review how to take care of yourself and your baby with your nurse. • Some mothers may be given a Rhogam shot or Hepatitis B vaccine. Your doctor or midwife will talk with you about these medicines. • If you have questions about breastfeeding or would like more help with it, your nurse can call one of the lactation consultants. Car Seats Your baby must have a car seat the day he or she goes home. Car crashes are one of the leading causes of death for children under the age of 14. State law requires using a car seat and this is one of the ways to protect your baby. Get a good quality car seat and have it fitted for your car before you come to the hospital. Most infant safety seats are not put in cars the correct way. To make sure you know how to install your baby’s car seat correctly,

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call your local fire department, Safe Kids WNC or your county health center for help. Before you come to the hospital, it is a good idea to adjust the straps of the seat using a life-size baby doll to get a fit that will be close to your baby’s size. Car Seat Safety For Your Baby A Child Passenger Safety Technician can make sure your car seat is safely secured. Nationally Certified Technicians are available at the following locations in western North Carolina. Call one of the following locations to make an appointment with a trained professional:

CHILD PASSENGER SAFETY TECHNICIANS BUNCOMBE COUNTY

Safe Kids WNC Mission Children’s Hospital �� 828-213-5548 Buncombe County Health Center��828-250-5156 Asheville Fire Department��828-259-5636 Barnardsville Fire Department��828-626-2222 Enka-Candler Fire Department��828-667-0798 Fairview Fire Department�� 828-628-2001 Leicester Fire Department�� 828-683-3433 Reynolds Fire Department�� 828-298-5200 Riceville Fire Department��828-298-2456 Skyland Fire Department��828-684-6421 Upper Hominy Fire Department�� 828-667-1324 Weaverville Fire Department�� 828-645-7116 OTHER COUNTIES

Valley Hill Fire Department��828-692-2581 Jackson County Department of Public Health��828-586-8994 Madison County Health Department��828-649-3531 Yancey County Health Department�� 828-682-6118

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WE MADE IT 64

First 6 Weeks After Birth How Do I Take Care Of My Baby? Below are the basic instructions of how to take care of your new baby. Your baby’s doctor may also give you special instructions before you go home from the hospital. Baby Care • Use a bulb syringe to remove mucous from baby’s nose and mouth. Squeeze the bulb before placing in nose or mouth, then release the squeeze into nose or mouth to remove mucous. • Cleanse the bulb syringe after each use. Use warm soapy water then clean water. Squeeze soapy water in and out of bulb, then repeat with clean water. • Check the digital temperature under baby’s arm. Remove baby’s shirt, place the thermometer under baby’s arm in the middle of the armpit and press the button. Hold the thermometer in place until it beeps. Do not use mercury glass thermometers. • Normal temperature is 97.6-99˚ F (36.5-37.2˚ C). A fever is greater than 100.4˚ F (38˚ C). • If baby feels cool or baby’s temperature is less than 97.6˚ F, dress baby in a t-shirt underneath the top layer of clothes and place a hat on baby’s head. You can also try skin-to-skin contact explained on page 67. Retake baby’s temperature in 15-30 minutes. If baby has a fever (100.4˚ F or greater) call your baby’s doctor. • Do not use Q-tips to clean ears.

Diapering • Change diapers when wet or soiled. • Use a mild soap and water to clean baby’s bottom after bowel movements. • Avoid diaper wipes at first. They can be irritating to the skin. • Girls may have mucous or blood-tinged discharge from the vagina during the first week. This is normal. • Always wipe baby’s bottom from front to back. Umbilical Cord Care • The cord stump will change from yellowishgreen to brown to black as it dries out. This is normal. The cord stump will fall off within 2 weeks after birth. • Keep the stump clean. Dry the cord stump with a dry towel or cotton ball at least once a day and as needed with diaper changes. • If the stump becomes dirty or sticky, clean it with plain water and dry it by holding a clean, absorbent cloth around the stump. During the healing process it is normal to see a little crust or dried blood near the stump. • Expose the cord stump to air to dry out the base. Keep diapers folded below the stump to allow it to dry out. • Sponge baths are most practical during the cord stump healing process. Once the stump falls off, you can bathe baby in a sink or baby tub. • Let the stump fall off on its own. Resist the temptation to pull off the stump yourself, even if it is hanging only by a thread. It is normal for the stump to fall off once healed.

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Care For The Uncircumcised Penis • Wash and rinse the baby’s penis daily with soap and water. • Do not pull back the foreskin (skin covering the tip of the penis). Forcing it back can cause pain, bleeding and possible scar tissue. Positioning

• If all of these things are not happening by 5 days of age, or you have sore nipples, questions and concerns, do not hesitate to call your doctor or the Breastfeeding Center at 828-213-1103. Formula Feeding

• Lie baby on his back for sleeping, and give him time on his tummy each day while he is awake. Spending time on his tummy helps baby develop control of his head and back. This will help him later with crawling and walking.

• Infant formulas are available as ready-to-feed liquid, concentrated liquid and powder. It is very important to follow the instructions on the container very carefully when mixing formula.

• Be sure you can see your baby while he is on his tummy.

• Feeding is a special time for you and your baby. Always hold baby for feedings so they can make eye contact with you.

Immunizations • Immunizations are very important to your baby’s health. Keep immunizations up to date. Breastfeeding • Your baby is getting enough breast milk if by the time your baby is 5 days old: – Your baby breastfeeds with feeding cues at least 12 times in 24 hours, or every 2-3 hours. – Before breastfeeding, your breasts feel heavier and firmer. After breastfeeding, at least one of your breasts is softer.

• Never prop bottles. Always hold the bottle and your baby for feedings. • Burp the baby after every 0.5-1 ounce of formula. • Baby will not be very hungry during the 1st day of life, but by 3 days old, your baby should be eating every 3-4 hours. • Formula-fed babies should have at least 6 wet diapers and at least 1 stool per day. • Discard any formula leftover after feeding. Never reuse a bottle of formula. Lotions, Soaps And Oils

– You observe a rhythmic sucking and hear swallows at each feeding.

• Baby skin is very sensitive to lotions, soaps and oils.

– After breastfeeding, the baby does not root (open his mouth when his lips are touched).

• Use soaps and lotions recommended by your baby’s doctor.

– The baby is soaking at least 6 diapers in every 24-hour period.

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– The baby has 3 or more mustardcolored, loose, seedy stools (not just smears) in every 24-hour period.

• Do not use baby powder. It can make your baby cough or sneeze.

Safety At Home • Never leave baby alone on the bed or changing table.

is limp in your arms. Newborn babies should have their arms and legs curled to their body when they are awake.

• Never leave baby alone in a bath tub.

– Baby is very fussy, cries without stopping or the cry sounds like a sharp squeak.

• Always check the water temperature before bathing your baby.

• Problems with the umbilical cord:

• Never hold the baby under a faucet of running water. • Never shake your baby. It could hurt your baby very badly. • Learn CPR. Take Mission Hospital’s Safe Babies class.

– Bright red blood the size of a quarter appears on baby’s diaper or clothes. – Red skin appears around the cord. – Cord has yellow-green discharge that smells bad. • Problems with the circumcision:

• Always use rear-facing infant car seats in the back seat of your car. This is a law in NC and all states. To schedule an appointment for installation, see page 61 for phone numbers of local fire departments.

– Bright red blood larger than a quarter appears on his diaper or clothes.

Warning Signs In A Newborn

• Fewer than 6 wet diapers in a 24-hour period after 4-5 days of life

Call your baby’s care provider if any of these signs appear in the first month:

• Problems with bowel movements:

• Axillary (under the arm) temperature above 99.5˚ F or below 97.7˚ F • Rectal (in the rectum) temperature is 100.4˚ F or greater

– There is swelling of the end of the penis. – Penis has yellow-green discharge that smells bad.

– Baby’s stools are hard, dry, small round balls, dark brown or black in color. It is hard for the baby to pass the stool.

• Unusual rash

– Stool smells bad and may have mucous or blood in it. Most of the stool will be like water.

• Refuses to eat and misses two feedings

• Problems with breathing:

• Repeated vomiting that is forceful

– Baby has blue color around lips.

• Yellow color in your baby’s face, chest or the white part of the eyes (this may indicate newborn jaundice)

– There is deep pulling (sinking skin) between ribs.

• Changes in the way baby acts:

– Baby’s breathing sounds like he is struggling.

– Baby sleeps past feeding time, or you have trouble waking her up and she

– Baby’s nose flares (opens wide) when he breathes.

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Spitting Up Lots of babies spit up during the feeding or after they are done. Most of the spitting comes from:

One in 5 babies might get colic between 2-4 weeks of age, but it usually stops by 3-4 months. Doctors are not sure what causes colic. Always talk to your baby’s doctor if you think your baby might have colic.

• Crying hard before the feeding

Some things to try for a “colicky” baby:

• Eating too fast • Swallowing air while feeding Milk can come up with an air bubble when baby burps through his mouth or out his nose. Help your baby by feeding him before he is crying. A newborn’s stomach is the size of a large marble at birth and only the size of a golf ball by 3-4 weeks of age. Handle your baby gently after feeding. Call your doctor if: • Your baby seems to be in pain with spitting up (crying loudly) • Large amounts of milk shoot out of your baby’s mouth for 2 or more feedings and your baby seems sick

Colic Watch for the signs and symptoms of colic: • Crying that does not stop after 2-3 hours • Crying day or night (the crying usually worsens at night) • Crying for more than 6 hours a day Babies with colic will: – Scream when they cry – Stiffen their legs out or draw their legs close to their tummies – Pass a lot of gas (you may be able to feel the gas moving in your baby’s tummy) – Have a fat, tight tummy

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• All of the points listed under “My Baby Will Not Stop Crying,” (this page). • Stroke your baby’s tummy starting under the breastbone, back and forth, from one side to the other, all the way down the tummy. Use firm but gentle touch. • Lay your baby tummy-down across your legs and gently rub his back. Putting gentle, firm, warm pressure against the tummy may help. • Talk with your doctor if you think there might be a problem with your formula or breast milk. Some babies need formula that does not have cow’s milk in it. Some breastfeeding mothers might need to stop eating certain foods.

My Baby Will Not Stop Crying It is normal for babies to have fussy crying periods each day. Most of the time the fussing is about 3-5 hours each day; by 4-5 months it is usually about 1-2 hours each day. If your baby calms in a few hours and sleeps peacefully there is no reason to worry. For more understanding about why babies cry, view the DVD, Period of Purple Crying. You will get a copy of this in the hospital. Crying can be very hard to listen to without getting angry or tense. You may want to give the following a try (From the book The Happiest Baby on the Block by Dr. Harvey Karp):

1 S waddle: Wrap baby tightly in a receiving blanket. Wrap baby’s arms and legs close to his body and hold him close to your body. 2 S ide or Stomach Lying: Holding baby in your arms, place baby on his tummy or side. 3 S himmy and Sway: Sway baby from side to side and gently bounce up and down (like Jello bouncing on a plate). 4 S hooshing: Make a loud continuous “Shhhh” sound. 5 S ucking: Give baby a pacifier to suck. Baby’s hands or fingers are okay, too.

Most of the research on the benefits of kangaroo care has been done on premature infants in neonatal intensive care units. However, we have also learned that full-term infants benefit as well. These benefits include: • Regular beating of baby’s heart • Steady, regular breathing • More oxygen to baby’s body • More sleep time, deeper sleep • Faster weight gain • Less crying • More successful breastfeeding • Faster warming of the baby

NEVER SHAKE YOUR BABY!

• When you feel tense and angry, put your baby in a safe place and leave the room. • Call a friend or family member to come and help. Try to get away for an hour or two. • Shaking a baby can cause blindness, brain damage or death.

“Kangaroo Care” Or Skin-To-Skin Contact “Kangaroo care” is holding a baby against the bare chest of an adult, allowing skin-to-skin contact. The baby wears only a diaper and is covered with a blanket. Over the years this parenting technique has been shown to have wonderful benefits for babies.

Kangaroo care is recommended to start as soon after birth as possible. It continues for several hours a day in the first month of life. You can “kangaroo” your baby a couple of hours at a time, a few times each day. For More In-Depth Information Visit the following sites and search for “kangaroo care” or “skin-to-skin contact:” • midwiferytoday.com • my.clevelandclinic.org • kangaroomothercare.com • sciencedaily.com

How Will My Baby Act After The Birth? This is a good question to ask. The more you know about your baby, the better you can love and care for him. You will also help your baby’s brain to grow by stimulating his senses. Here are some things to know:

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Vision At birth your baby can see 8-15 inches from her face. For 2 weeks her eyes are sensitive to bright light. By 3 months she will be able to see 3 feet away. Your baby sees the world in “black and white.” She does not see much color until about 4 months. Sometimes one or both eyes will cross until the muscles get stronger.

Smell And Taste Your baby’s sense of smell and taste are strong. He will turn his head toward the smell of your breast milk but not toward another mother’s milk. Baby will make a funny face and turn away from the smell of vinegar or alcohol. This sense of smell helps your baby at feeding times and warns him away from things that could harm him. Baby will like the taste of sweet things the most.

The things your baby likes to look at the most: • Your face, especially your eyes • Round shapes • Black and white things like a paper plate with black and white stripes, checker-board patterns or circles • Himself in a mirror What Can I Do? When your baby is quiet and looking around, take a brightly colored toy (a panda bear is great) and let her look at it. Hold it in front of her until she sees it. Move it a little to the right and a little to the left. Watch her eyes follow the toy. Hearing Your baby hears from the moment he is born. He knows the voices of his mother, father or partner and people who have been around mom during the pregnancy. He likes voices that are high-pitched like a woman’s voice. He also knows the heart beat sound of your womb. When he hears these familiar sounds he might stop crying or turn to listen to the sound.

What Can I Do? • Lay your baby on your chest next to your skin. She will learn who you are by the way you smell. • Have her close by when you cook. Let her enjoy the smells. Touch One of the best ways to show your love to your baby is with touch. He is very aware of things against his skin. The touch of another person’s skin against him is very calming. Soft things like cotton or sheepskin can comfort him. Scratchy things like plastic or wool will make him pull away. Your baby’s sense of touch is very strong. What Can I Do? • Cuddle, rock and carry baby close to you. • Have soft things next to baby’s skin. • Massage your baby’s body with oils or lotions from head to toe. (Babies who get massaged grow faster, sleep better and have fewer problems with gas.)

Some babies are upset by loud noise. They may cry or startle (throw their arms and legs out and shake) when they hear loud noises.

Warning Signs After Birth

What Can I Do?

Call your doctor or midwife if you experience any of these:

• Talk to your baby frequently.

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• Read books to your baby every day.

• Temperature > 100.4° F by mouth

• Let your baby listen to calm music when she is awake or falling asleep.

• You feel cold and have the chills (shivering) • Burning or pain when you urinate

• Unable to pass urine

Activity

• Firm, red, painful or warm area on the lower leg (the calf)

• Avoid becoming too tired.

• Heavy bleeding that soaks more than 1 pad per hour • Passing a blood clot larger than a lemon and soaking a pad in the next 30 minutes to 1 hour

• Rest as much as possible. • Following a cesarean birth, do not lift anything heavier than your baby for the first week, or drive a car for 2 weeks. • Gradually begin your usual activity as you feel up to it.

• Itching, burning or pain in vaginal area or a strong odor to the discharge

Exercise

• Severe headache that is not relieved with pain medicine

• Walking is good exercise for building strength. Begin as soon as you feel up to it.

• Redness, swelling or drainage from your cesarean incision

• Follow your doctor’s or midwife’s instruction about exercising after childbirth.

• Any pain that becomes worse

Sexual Activity

• Feelings of sadness or wanting to hurt yourself or your baby

• Wait until your bleeding has completely stopped before having intercourse.

• Racing heartbeat, difficulty catching your breath and uncontrollable crying

• Intercourse may be uncomfortable at first. You may need to use a lubricant (like Astroglide) for intercourse.

• Unable to sleep even when you are exhausted • No desire to get out of bed or care for yourself or your baby • Red areas, red streaks or sore areas on your breasts, along with flu-like symptoms

• Discuss with your doctor or midwife the type of birth control that is right for you. You can become pregnant even if you do not have a period. Birth Control

Call your doctor or midwife if you have any of these signs or if you are not sure you are having a problem.

• Carefully follow your doctor’s or midwife’s instructions about birth control.

Taking Care Of Yourself

• You can ask your doctor about other birth control choices at your 6-week check-up.

These are the basic instructions of how to take care of yourself after the birth. Your doctor may also give you special instructions before you go home.

• If you take Depo-Provera (the shot), your next shot is due in 3 months.

• Breastfeeding is not a form of birth control. • You can get pregnant even if you do not have a period.

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Bathing

Care When Breastfeeding

• You may take a shower or tub bath.

• Drink extra water and juices to replace fluid used to make milk while nursing.

• If you have an incision, pat it dry with a clean, dry towel. • Remove the tape covering the incision only as the tape comes loose. • Do not douche. • Do Kegel exercises to help your bottom heal and to help with hemorrhoids. Bleeding • Use a Peri bottle (you will get one in the hospital) and warm water to clean your bottom each time you use the bathroom. Pat your bottom dry while it is healing. • The bleeding will gradually decrease over a few weeks, becoming dark red or brown then yellow. • Your first period will probably start 4-8 weeks after birth if you are not breastfeeding. It may start later if you are breastfeeding.

• Breastfeed your baby often (or pump your breast milk), every 2-3 hours, for a total of 8-12 times every 24 hours. • Wear a supportive bra. • If nipples become sore, expose them to air. • Call the Mission Hospital Breastfeeding Center for questions at 828-213-1103 or call WIC at 828-250-5170. Refer to the breastfeeding booklet you received in the hospital. Care When Not Breastfeeding • Wear a well-fitted, supportive bra for at least 4 days after giving birth. • Use ice packs if your breasts become swollen, hard and tender. Do not apply heat. • Use pain medication as instructed by your healthcare provider.

• Your first period may be heavier than normal.

• Do not express milk or stimulate your breasts.

• Do not douche or use tampons for at least 6 weeks.

Diet • Eat a healthy diet as you did while pregnant.

Pain • Sitz baths or warm baths may relieve pain from your episiotomy. • Take 1-2 tablets of regular or extra strength acetaminophen (Tylenol) by mouth every 4-6 hours for pain. • Or, take 1-2 tablets of ibuprofen (Advil, Motrin) by mouth every 6-8 hours for pain.

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• Drink 8 glasses of water a day. • Remember, you gained weight over a period of time, so plan to lose the extra weight slowly. • Avoid foods high in calories, with little nutritional value (like junk food). • Continue to take a daily multi-vitamin.

Once you are home, call to schedule a checkup with your doctor. You may be given special instructions about this check-up before you go home from the hospital.

Vaginal Childbirth

• Get into a comfortable position. Support your back and use pillows to support your arms. • Try to nurse your baby anytime baby is awake in the first few days. This is practice time for you and the baby.

Vaginal childbirth is a risk factor for problems such as urinary urgency and incontinence. Common symptoms are:

• Offer both breasts.

• Having trouble making it to the toilet in time

• Ask for help.

• Passing urine when you cough, sneeze, laugh or exercise

• Be patient. Remember some babies take a while to learn how to feed.

• Making frequent trips to the bathroom

• Feed your baby when she widely opens her mouth or if she is trying to suck on her hands or fingers.

If you experience any of these issues after your 6-week postpartum check-up, talk with your doctor. He or she may want to refer you to Mission Hospital’s Pelvic Floor Program. Visit womens.mission-health.org/pelvicfloor-program for more information and to take an online self-assessment.

How To Get Breastfeeding Off To A Good Start In Labor And Delivery At The Hospital: • Breastfeed as soon as possible after the birth. Most babies are alert and ready to try nursing. Early breastfeeding can help your milk supply and prevent problems later. • Feed with as few people in the room as you can. With privacy you can be more relaxed and calm.

• Do not watch the clock, watch your baby.

After you are home, watch for signs that your baby is getting enough milk: • Eats 8-12 times in 24 hours • Has 6-8 soaking wet diapers in 24 hours • Has 3 or more loose stools in 24 hours (some babies have stools at each feeding) • Seems happy after eating (goes to sleep or is quiet while awake) • Is growing in length and gaining weight at check-ups • You observe rhythmic sucking and hear swallowing for at least 10-20 minutes at each feeding

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Signs your baby may not be getting enough milk: • Eats fewer than 8 times in 24 hours. • Has fewer than 6 soaking wet diapers or the urine is a dark orange color. • Has fewer than 3 stools a day after day 2 of life. • Always seems hungry and fusses after feedings. • Mouth is dry. For Questions Or Concerns Call a lactation consultant at the Breastfeeding Center at 828-213-1103, or the Buncombe County Health Center at 828-250-5170.

Baby’s First Check-Up

Your doctor may also ask questions about how your baby did during the labor, birth and first few days. (Remember, the hospital will send your baby’s records to your doctor. These records include the delivery information and the check-ups your baby had in the hospital.) • Health problems that run in the family are important for you and your doctor to discuss. • It is important for your doctor to know how you and the rest of your family are doing with a new baby in the house. If you are having problems, your doctor can give ideas that may help things go more smoothly.

Here are some things you might expect at the first check-up:

• Your baby will be checked from head to toes by the doctor (eyes, ears, mouth, tummy, heart, etc.).

• Weighing and measuring the length of your baby, and measuring the size of baby’s head. (Newborns will usually gain 1/2 an ounce to 1 ounce each day. They lose weight in the first days after the birth, but gain back to their birth weight after about 2 weeks.)

• Whether this is your 1st baby or 10th baby, there is always a chance to learn something new. Each baby is special and different. Ask questions, and talk about what you see or hear when you are caring for your baby.

• Your doctor will ask how feedings are going. He or she may ask some questions such as:

Learning is how you become the best parent you can be.

– How often does your baby eat? – How many diapers does your baby wet per day?

Checking Baby’s Growth

– How many stools (poopy diapers) does your baby soil per day?

Your baby’s brain and nervous system are still growing when he is born. This fast growth will last until about kindergarten, then it slows down. The nurses and your baby’s doctor will check your baby’s brain and nervous system in the hospital. You can keep watching for brain growth in the first months by watching for the following:

– Does your baby sleep or seem calm after eating? – Is your baby spitting up with feedings? – How much does baby spit up? How often?

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Things Baby Will Do��Age

• 1-2 weeks after the birth

Look or stare at your face�� Birth-4 weeks

• During the 1st year at 2 months, 4 months, 6 months, 9 months and 12 months

Hold head off the bed for a few moments while lying on stomach�� Birth-4 weeks

• During the 2nd year at 15 months, 18 months and 24 months

Pay attention to sound by becoming alert or turning toward it�� Birth-6 weeks Smile or coo when you smile, talk or play with him�� 3 weeks-2 months Hold head upright while lying on stomach��5 weeks-3 months Hold head steady when upright��6 weeks-4 months Bring hands together in front�� 6 weeks-3.5 months Laugh and squeal��6 weeks-4.5 months Roll over from front to back or back to front�� 2 months-5 months Grasp a rattle placed in front of him�� 2.5 months-4.5 months Your baby’s doctor will be watching for your baby’s growth, too. In the first 2 years of your baby’s life the doctor will want you to come in for regular check-ups. Usually the schedule for “well child” check-ups is:

Talk with your baby’s doctor about immunizations. It is recommended that all newborns get a vaccination for Hepatitis B in the hospital. If you have questions or concerns please talk with you baby’s doctor before the birth.

Radon Gas Radon is a colorless, odorless, radioactive gas that is the leading cause of lung cancer in nonsmokers. Radon naturally comes out of the soil and rock and enters the environment. When radon gas is under a house, it can enter the house through cracks and openings in the foundation and collect in the air of the home. The levels of radon in the air can become unsafe. Testing a home for radon is simple and easy. The NC Radon Program provides radon test kits free of charge for expecting families. For a home that has unsafe levels of radon (above 4pCi/L) there are several ways to remove the gas. The process is called mitigation. The best way is to hire a certified radon mitigator, who is trained in properly removing the gas. For More Information Visit ncradon.org for a list of certified mitigators in the state, or contact the western NC Radon Program coordinator at 828-712-0972.

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Postpartum Depression What Are The Baby Blues? • Over 50% of women who give birth may have strong emotional feelings called the baby blues. • This may occur within the first 3 days after giving birth and lasts about 2 weeks. If you have baby blues, you may feel: • Irritable

• Extreme sadness • Afraid to be alone with your baby • Loss of interest in normal activities • No interest in your baby • Unable to cope • Fear of losing control

• Nervous

• No desire to get out of bed

• Emotional

• Extreme tiredness and fatigue

• Overwhelmed

• Extreme feelings of guilt

• Moody • Tearful How Can I Cope With The Baby Blues? • Sleep when your baby sleeps. Lack of sleep leads to exhaustion and makes the blues worse. • Get some exercise each day. • Have a support system you can call on to help with meals, chores and running errands. • Try to meet other mothers. • Take some time to relax each day. What Is Postpartum Depression Or Anxiety? • I out of 5 mothers has postpartum depression or other mood disorders. • Postpartum depression usually starts within the first 6 months after the baby is born, but can occur up to one year after the birth.

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If you have postpartum depression or anxiety, you may feel:

• Thoughts of death or suicide • No desire to be with family and friends • Intense anxiety, fear, and worry • Trouble sleeping • Fast heartbeat and dizziness for no reason • Thoughts of hurting yourself or your baby • Strange thoughts, over and over • Feeling like a bad mother If you have some of these feelings, do not be afraid to get help. It does not mean you are a bad mother or that you do not want your baby. It means you have an illness that can be treated. The sooner it is diagnosed, the easier it is to treat and the sooner you will get better. Postpartum depression or anxiety can be treated with medication (even if you plan to breastfeed) and counseling. If you think you may have depression or anxiety, call your doctor as soon as possible.

For More Information

Support For New Mothers

Support is another helpful way to heal and recover. Call 828-213-8241 for more information about local resources.

There are many places for new mothers and families to find support after their baby’s birth.

What Is Postpartum Psychosis?

Asheville Area Mothers Of Multiples��828-808-9241 ashevillemom.com

• Postpartum psychosis is very rare. • It usually comes on very suddenly in the first month after birth.

Perinatal Loss Support Group��828-251-0126

• It is very serious. You will need to go into the hospital immediately.

Mission Hospital Family Support Network�� 828-213-0033 Toll-free��888-810-2800, Ext. 2

If you have postpartum psychosis, you may experience: • Extreme confusion • Hearing voices telling you to hurt yourself or your baby • Very irrational thinking • Seeing things that are not there (hallucinations) • Severe agitation • Confusion about what is real and not real If you experience these symptoms, cal1 911 or have someone drive you to the hospital immediately.

Mission Hospital Mommy And Me��828-213-2222, Option 2

Toll-free��877-213-1221 New mom support group meeting once a week for moms of newborns to pre-walkers. Perinatal Emotional Health Network (PEHN) of WNC��828-213-8241 postpartumwnc.blogspot.com Support for women experiencing pregnancy or postpartum depression and anxiety The Pisgah Institute��828-254-9494 pisgahinstitute.com Support for women experiencing pregnancy or postpartum depression and anxiety Postpartum Depression��ppdsupportpage.com

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Learn More, Sign-Up Online A weekly e-newsletter is part of the educational offerings from Mission Hospital. These emails include research findings about pregnancy, breastfeeding, health and wellness, newborn care and child development up to 3 years of age. You can also email questions or comments to a staff person here at Mission Hospital. Feel free to share this email with friends and family. Visit womens.mission-health.org to sign-up for our weekly emails.

Birth Survey Visit thebirthsurvey.com to share your birth experience on this consumer feedback website. Families choosing where and with whom to give birth can use this feedback to help make informed healthcare decisions.

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Notes

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Mission Hospital is the first Baby Friendly Hospital in North Carolina, and one of only 166 in the nation. What Does This Mean? The Baby Friendly Hospital Initiative (BFHI) is a worldwide program sponsored by: • World Health Organization (WHO) • United Nation’s Children’s Fund (UNICEF) BFHI promotes, protects and supports all efforts for initiating and continuing breastfeeding. It encourages and recognizes hospitals and birthing centers that offer the best care for breastfeeding. BFHI assists hospitals in giving breastfeeding mothers: • Information • Confidence • Skills needed to be a successful parent Visit babyfriendlyusa.org for more information.

Mission Hospital is part of Mission Health, which has been named one of the Top 15 Health Systems in the nation by Truven Health Analytics for the second year in a row.