Table of Contents
Congratulations! You are planning a homebirth! By doing so you may already realize that you are on a extraordinary journey! I will be working closely with you to develop a plan of care that meets your individual wishes and needs.
Please read the handbook carefully and do not hesitate to request explanation or clarification on a topic. We look forward to your birth day!
Homebirth is designed so that the expectant parents and their children or family can be involved in and enjoy the events of pregnancy and childbirth in the safe, personalized setting of the family home.
Homebirth is maternity care for mothers who can expect a normal pregnancy and birth. The mothers health status is followed closely during scheduled prenatal visits with a midwife. Parents are expected and instructed on how to assume a full share of responsibility for their own good health. This program is designed for those who wish to be actively involved in every phase of the childbirth experience.
Parents are encouraged to participate in childbirth and breastfeeding classes offered in the community.
2. Prenatal Care
Prenatal Visits: It is best to begin prenatal care as soon as you think you are pregnant. This allows your midwife to counsel you early on if you require any dietary adjustments or support in the healthy development of your baby. The first prenatal visit includes a complete physical examination. Please schedule it for a time when you and your partner can be seen together. Please allow one and a half hours for your first visit. Thereafter, you will be seen every month until you reach 28 weeks, bi-monthly until 36 weeks and weekly until delivery, prior to 42 weeks. Occasionally more visits may be necessary
Midwife Consent: By choosing a midwife, the care you may experience will be different than that of an obstetrical doctor. The Florida Midwifery Law requires that you sign a consent form accepting midwifery care. The midwife will provide you with this document.
Birth Plan: Many of us have hopes and visions of how we would like things to happen at the birth. Its good to think about what youd like to have happen and what kind of atmosphere youd like to create.
Plan on who you would like to be present at your birth and what type of music (if any), lighting and extra supplies you may need to help you feel comfortable and supported. Perhaps you want to record the birth with videos or photographs. Let the midwife know about these things.
Remember, all of this can change and its best to remain flexible and ready to readjust to a variety of situations. Dont ever be reluctant to share your hopes, thoughts and ideas.
Emergency Plan: Birth is most often a normal process, but when things occur that may be out of our control its best to be prepared.
Think about which doctor you can trust to take care of complications beyond the midwives range of normal. Sometimes you may need that doctor prenatally. Find out if the doctor can also treat you in labor if a transport to the hospital becomes necessary. Know where the nearest hospital is and talk to your midwife about the doctors and hospital. And remember you also need to line up a pediatrician for follow-up for your baby as well.
A formal agreement for the emergency plan will be provided by the midwife.
Next to the telephone, post a list of these phone numbers:
o Midwife and Assistants/doula
o Emergency numbers
o OB doctor (if applicable)
o Nearest Hospital
o Your birth helpers/family that you want at your birth
You can choose to have the tests or refuse them but please be informed.
The World Wide Web is an available resource for information. google
Ask questions about the test and if you decide to refuse a test you will need to provide our service with a copy of the test you have had or sign the refusal and tells us why.
The following laboratory work-ups are required by the Florida Midwifery law:
1.) Pap smear - a vaginal exam testing for vaginal and cervical infections, as well as cancer.
2.) Gonorrhea and Chlamidia culture - and extra sample of vaginal mucous will be taken to test for this sexually transmitted disease. This will be done together with the pap test.
3.) Blood group including Rh factor and antibody screen - this blood test determines your blood type, A, B, or O, and your Rh factor, positive or negative. If your factor is negative the antibody screen will check to see that your body is ok with the baby even if baby has a positive factor.
4.) Complete blood count (CBC) - this test looks at a variety of cells and nutrients in you blood to assess general health.
5.) Rubella titer - a blood test to see if you are immune to German measles.
6.) Serological screen for syphilis - a blood test checking for a particular sexually transmitted disease
7.) Screen for hepatitis B surface antigen (HBsAG) - blood test for hepatitis B early in pregnancy and at 36 weeks.
8.) Sickle cell screening for at risk population - determines the sickle cell trait, which is a genetic characteristic most commonly found in people of African descent.
9.) HIV/AIDS - for moms with initial labs and at 36 weeks
10.) Urinalysis with culture - a test to check for bacteria and infection in the urine.
11.) Diabetic screening between 24 and 28 weeks gestation - this checks for elevated blood sugar levels.
12.) Hematocrit or hemoglobin levels at 28 and 36 weeks gestation - this checks iron levels in the blood.
The following test are also offered:
AFP, a screen for neural tube defects and genetic screening- for baby from 14 to 16 weeks of pregnancy.
CVS (chorionic villi sampling) or genetic Amniocentesis for women 35 years or older.
GBS, Chlamidia or GC Vaginal screen at 36 weeks
Ultrasound screening as needed
You can choose to have other offerings or refuse them but please be informed.
Ask questions about why it is being offered to you, accept or refuse (you will need to provide a signed refusal) tell us why.
Rhogam Injection given at 28 weeks and post partum if RH negative to prevent antibodies from entering baby circulation.
Vit K Injection to Baby given during the first hour after the birth to prevent hemorrhage in the newborn.
Antibiotic Eye Ointment, applied to the baby during the first hour after birth to prevent infection in the eyes.
3. Preparing for the Homebirth
You may go into labor anytime between 37 and 41 weeks of pregnancy
Please be prepared with the following items on this list at least 3 weeks before your due date.
Gather and launder as necessary all the items and store in one place away from small children or pets.
3-4 baby blankets
2 baby hats and pre-washed soft sleeper outfit for baby
3 oz. bulb syringe for baby
Alcohol and cotton balls or cotton swabs for cleaning babys cord
Gauze pads 4x4 2 dozen (drug store) to clean baby or for mom during the birth
Thermometers - one for mom and one for baby
3-4 washcloths and towels for mom and baby - more if planning a waterbirth
Clock with a second hand - check that all have the correct time
Flashlight with batteries. Candles.
2 Plastic liners (from paint store) to protect your mattress or furniture
2 spare sheet sets
Towels or Chux pads (incontinent) for soaking up fluids under mom, 1-2 dozen
Newspaper to protect rugs
Garbage bags for double bagging trash and carrying soiled laundry
Bean bag chair or several small firm pillows for resting, during labor and for support during pushing
12 or more Large or Night sized sanitary pads for mom
A post partum outfit for mom and extra underwear
Squeeze bottle for mom after birth (drug store)
Almond or olive oil for perineum (new bottle) and ginger
1 oz each of Alfalfa, Penny Royal and Shepherds Purse loose herbs for postpartum tea
Golden seal loose herb for sitz bath after birth and for babys cord
Herbs for post partum sitz bath (comfrey, garlic, sea salt, sage, calandula, camomile etc)
Food and snacks for you during labor and also for your birth attendants. Having an adequate supply of nourishing foods, especially juices, miso soup and other nutritious snacks for all who attend your birth. You will drink them for energy in labor and drinking will facilitate milk flow and bowel movement after birth.
Nutritional foods and teas for your first post partum days. Do some cooking in advance if possible and have meals frozen for the days to follow. If friends wish to be helpful, invite them to prepare casseroles, do laundry, help with cleaning, shopping, etc. You will need help for 2-6 weeks after the birth.
Nourishment throughout pregnancy, labor and postpartum is as important as it is in life!. "You are what you eat." Observe your diet. Are you getting a balance of fruits, vegetables, (providing vitamins and minerals) proteins, (for healthy blood and muscle),carbohydrates, (for energy) and calcium (for strong bones) Besides other beverages, are you drinking plenty of water (8-12 glasses/day) This prevents dehydration, which could cause more Braxton-Hicks contractions and keeps your hard working kidneys flushed from toxins.
Are you snacking frequently to maintain good blood/sugar levels? Are your snacks healthy ones and not just sugar indulgences? Do you have any cravings? What are they, discuss them with us. Enjoy the food you eat, make sure that its colorful and robust!
Children who will be present for birth need to be prepared and educated about the process. If you have children whom you would like to be with you during the birth, an additional adult should be present to support and care for them.
Before labor: Rest frequently, get some exercise daily, eat wisely, keep up perineal preparation, breast care and get involved in something to help the time pass,(i.e. journals!)
Activities and exercise are vital during pregnancy: We encourage you to continue partaking in dance, running, swimming or other non-contact sports as long as it feels good to your body. If you are not exercising currently, now is a good time to go walking for conditioning for pregnancy, labor and birth.
You may continue sexual activities throughout pregnancy so long as you do not have bleeding, or other physical discomforts with sex.
Enjoy these last few days/weeks of pregnancy as your baby will be born very soon!
Danger Signs Before Labor
Please call immediately if any of the following occur:
o Bright red bleeding from vagina
o Severe abdominal pain or cramping
o Leaking of fluid (bag of waters) from the vagina (prior to 37 weeks)
o Severe headaches
o Blurred vision or seeing spots in front of your eyes
o No fetal movement
o Sudden or severe swelling
o Premature labor (contractions prior to 37 weeks)
HAVE YOUR SUPPLIES AND YOUR HOME READY FOR THE BIRTH
FIND A HELPER TO HELP YOU WITH:
Scrubbing clean and maintaining the room where you intend to labor/birth. Plan to cover valuable carpeting in the birth area. Cover rugs with the newspaper and tape down.
Cleaning your bathroom, especially the tub and toilet. Set out clean hand towels for the midwives. This should be done the day of the birth.
Make the bed:
Clean plastic over mattress, fitted or masked to prevent slipping
Clean fitted sheet and top sheet
Clean plastic over sheet
Clean fitted sheet and top sheet
Cover pillows with plastic bags the pillow case
Remove decorative pillows, duvets, comforters
For a Water Birth:
Prepare the home for a birth as above. Set up the tub with plenty of time. Perform a dry run first to make sure you know how to set the tub up. You will need a plastic cover and soft materials for under the tub. Make sure you are going to have enough water to fill the tub. Make a space close to the tub for your post partum if your bedroom is far away from the tub. You may also use your own bathroom tub for the birth, ask your midwife.
4. Labor Day
Call the midwife at the very first signs of labor. This helps us re-arrange time in our personal lives.
If you are coping well with your early labor contractions, its OK to wait until morning (7-8 a.m.) to notify us.
Call us if the bag of waters breaks or you think it did.
We like to arrive during active labor. We will be in frequent contact with you by phone until then.
Here is a list of what you may be experiencing in order to help you decide whats happening:
o Bloody show with some contractions
o Contractions getting significantly stronger and more frequent
o Bag of waters leaking or breaking (anytime during labor)
o Intestinal irritability
o Flushed face with perspiration - working hard
o Fixed expression or intense concentration
o Little conversation - movement is awkward
o Making noise with contractions
o Weak, shaky, anxious, doubtful
o Involuntary pushing or feeling pressure
What to do: Prepare your bed, gather supplies and clean off a flat surface for the midwifes supplies. Keep the house warm for the baby and please,
NO smoking in the house during labor.
Take this time to relax and get in touch with your body and trust the process. Most mothers in labor prefer low lighting in the labor and birth areas.
Please drink lots of juice, red raspberry and mint teas, water and eat light and easily digestible foods.
Phone your helpers/ support people. Be careful about calling to many friends, labor can take a while sometimes and you wouldnt want a lot of anxious phone calls.
We recommend that you ask visitors to wait until you are settled in with baby and when you are rested and comfortable.
Happy Birth Day
Post partum Care: You will have a postpartum visit within the first 24 hours after birth. This will include an exam of you and baby. The baby will need to be seen by a pediatrician as well. You will also have at least two other postpartum visit within the first six weeks postpartum.
5. Baby Care at Birth
As your baby emerges you or your loved one can touch the babys head.
The midwife may help ease the baby out and the baby is generally placed on the mothers belly within seconds of the birth. If the baby is born in water the baby is gently brought out of the water into the moms arms.
Routine care is carried out without separation of the new mom and baby.
This may include:
o Evaluation of breathing, heart rate, color tone and cry
o Covering baby and mother together to keep warm.
o Initiation of breastfeeding
o Drying baby off
o Suctioning the nose and mouth
o Cord clamping and cutting
Let us know how you like us to receive your baby at the birth
The baby is not routinely bathed in order to avoid getting chilled. The odors of the birth may help baby establish nursing more successfully. A bath the following day, when baby’s temperature is stable is usually soon enough. Of course, this is your decision as a Leboyer bath ritual can be an enjoyable part of your birth experience if you choose to include it. If you had a water Birth the baby and you can bath together.
When the baby is about 1-2 hours old, the newborn exam will be done which includes:
o Weighing and measuring
o Physical exam and evaluation
o Antibiotic eye ointment if desired
o Vitamin K injection if indicated
o Diapering, dressing and wrapping
A pediatric doctor must be chosen by the 36th week.
We can recommend pediatricians who are happy to care for babies in an out of hospital setting, are breastfeeding friendly, and that are willing to assist with the newborns care if needed during the first 24 hours of life.
Let us know if you are already working with one you like and trust.
You will need to visit your pediatrician in the first 24-48 hours after the birth.
6. For Mother
Someone alert should stay with mom the first 24 hours
Lochia (LO - kee- uh) normal postpartum bleeding or vaginal discharge.
At first - your discharge will be bright red for the first 1-3 days, like a heavy period. A few clots large enough to fit in the palm of your hand can be normal, especially when you stand up for the first few times.
Later - discharge gradually turns lighter and more watery, its color ranging from pink to yellow-brown. This can last 1-4 weeks. Each woman is individual.
Watch out - if bleeding returns after discharge has become very pale and has slowed down. You are probably doing too much and need more rest. Mark it on your calendar however, there is a small possibility that it may be your first period. Most exclusively breastfeeding moms wont get there periods for about 6 months.
CALL IMMEDIATELY IF:
o You soak a maxi pad through to the other side or full within one hour.
o Your discharge smells foul or contains pus. Normal lochia normally smells a little stronger than your period,
but if a fishy odor remains even after bathing please inform us.
o You have any severe pain, especially if accompanied by fever.
o Your temperature exceeds 100 degree F.
Rest, eat, drink lots (8-12 glasses daily) and then rest again! You will require an amazing amount of sleep for a few days and continue to need more than usual for weeks. You will recover faster and feel better if you listen to your bodys signals and follow them.
At first you have colostrum, a rich high concentrated protein and immune booster-type milk Frequent nursing is necessary because it usually brings in the true milk in 2-4 days. As the milk comes in, your breasts may sometimes be hot and painfully swollen or hard. Massage, manual expression, a breast pump, a hot shower and again, frequent nursing is essential. It is a temporary adjustment in the first week but it takes 3-6 weeks for the nursing relationship to really become established.
Sore nipples can be avoided through correct positioning. The baby should lie directly at your breast with head and belly forward. The babys gums should be as deep onto your areola as possible. However if you are experiencing sore nipples, be patient, this too shall pass, let us know so that we can assist you during this time. Warm compresses, vitamin E oil, pure lanolin, exposure to air and sunlight frequent nursing position changes and applying your own breast milk to your nipples after feeding will help heal the tender skin quickly.
Breast infection symptoms include fever, aching, sore, hot and heavy breasts with redness, chills, extreme fatigue. Do not stop nursing! This may make it worse. Call your midwife or lactation consultant. Echinacea rest unlimited nursing and drinking extra fluids and antibiotics are all part of the preferred treatment
Emotions - you will experience a lot of bliss! This is a special journey. By day 3, when your milk starts to flow, tears may flow as well. Let them. Your new baby will bring change into your life and change can awaken some strong feelings in you. Please discuss them with your loved ones and with us.
At first, your uterus will feel like a large grapefruit sized mass in you belly, usually in the middle near you belly button. If it is off to one side or way up high, go the bathroom to pee, then recheck. A full bladder pushes the uterus aside and makes postpartum contracting less effective. If you cant find it rub your belly in the general area until it firms up under your hand. Rub at least every 30 minutes for the first 4 hours. Rub more frequently if it gets soft again.
Later, the uterus gets smaller every day. Keep rubbing it several times a day until it disappears downward and you cant feel it anymore, usually by 2 weeks. You may experience some cramping, especially within the first few days or while your baby is nursing. This is usually a good sign that it is working properly, a soothing chamomile tea or cramp bark herb can help with the tension.
With second and consecutive babies you may experience after pains which may be stronger than they were following your first birth. These can make you tense, awake and uncomfortable. Massage, a heating pad, teas or up to 600 mg. of Tylenol every 4-6 hours may help. Try relaxation breathing and secure extra postpartum help especially for your younger children. This cramping rarely lasts more than 2-5 days.
Soak in a clean tub or sitz bath 2-4 times a day until soreness is gone. Comfrey roots and leaves in tea form added to the water are very soothing and healing. Witch hazel or comfrey compresses laid on your pad are also soothing. Ginger is helpful for itching, garlic to avoid infection and golden seal to help healing. Perineal swelling can be normal, witch hazel or ice packs can decrease it faster.
After voiding (peeing) pour or squirt warm water on the perineu, Pat dry gently
Keep you legs together especially if you had a tear. Avoid lifting anything heavier than your newborn. Avoid exercise or sex until your bottom is healed, in about 6 weeks.
Hemorrhoids are healed by drinking lots of water, avoiding constipation, taking sitz baths and using the compresses.
7. For Baby
Baby needs to be held a lot and kept warm: Carry your baby as much as possible and have her sleep close to you. Love her plenty; snuggling your baby helps your body know what to do. Shes been through a tremendous amount of physical exertion and will need plenty of rest. Her hands and feet are normally cooler than the rest of her. She loses a lot of heat through the top of her head, so keep her out of drafts and drape the receiving blanket over her head the first two days. Be careful not to bundle her too tightly.
Baby is not used to controlling her head and cannot turn it to drain spit-up, so keep her off her back. Put her on either side or, hold her in your arms face down. Babies do get bored and upset lying on the same spot. Help your baby by changing positions and propping them comfortably.
Check babys cord - it should dry up and fall off within the first two weeks.
To encourage it to do so faster, keep it dry:
Clean the cord stump with each diaper change all around inside folds of skin with rubbing alcohol. Fan fold diaper below cord. For Boys point penis down or sideways, if applicable in your case.
Report to midwife or pediatrician if the cord:
Bleeds more than a few drops when it separates.
Shows greenish pus.
Smells infected or foul, even after cleaning,
(as it deteriorates, it can smell stinky).
Gets red on the skin of the belly, around the base of the cord.
Your baby should be immune to many germs in your home environment due to immunities you passed to her during pregnancy and in the colostrum of your breast milk. She should however, be protected from too many outside germs, especially from other children.
If your baby does get sick, she may not show a temperature but will just not seem to be herself. Doctors understand that parents worry and are concerned about a new baby, so you will not be the first one to call many times in the first few weeks. Feel free to call.
The baby may go outside traveling 3 days after the birth, as long as everything is normal and they is dressed accordingly.
Jaundice ( yellow skin color) If you notice yellow eyes in the first 48 hours, or if the baby is lethargic and won’t eat on 3rd and 4th days, call the pediatrician. If a slight yellow tinge is present in an active and hungry baby, continue to breast-feed frequently and put your baby in a sunny window 2-3 times a day for 10-20 minutes. This will help draw out the bilirubin.
Call your midwife or doctor with any changes in babys skin color.
Nursing: Milk production works on a supply and demand basis, If baby is fussy, nurse more and in a few hours you will have more to satisfy your baby, as long as you rest and drink enough. If the baby seems happy and falls asleep after feedings, it is because she is getting enough milk.
The baby needs peace more than sleep and love more than food.
Their "really dependent" time passes very quickly, its 3-4 years out of your life. Do not wish them away for you might become nostalgic for them the rest of your life. Give yourself over for the time being. Look for peace, love, beauty and harmony unconditionally. Find them in the baby and in yourself. Enjoy being together.
Color - After birth, the babys hands, feet, and mouth may stay a little blue and cool until she gets the circulation going. Rub the baby to stimulate circulation.
Vernix - This is a protective cream that forms in utero. It collects in creases and can be scarce or abundant at birth. Its good to rub in or, if theres lots, save some for rashes or rub it around your own eyes, legend has it that it prevents "crows feet" (wrinkles!)
Molding - Some babies are born with a large, round bump (caput) or a misshapen head due to the tremendous pressure at birth. Often it rounds out within 24 hours. If it seems that the bump is filled with blood it should be checked by a physician. These should gradually recede and disappear in about 3 weeks.
Eyes - They can be swollen at first of get pus filled, you can squirt breast milk into them, wipe them with a cotton ball soaked in clear water or chamomile tea, in one stroke from the inner tear duct out to the edge. Dont go over them with the same cotton ball twice. You can also gently massage the tear ducts, at the side of the nose, close to the eye. You may notice red spots in the whites of the eye. These are broken blood vessels due to the pressure of birth. They will be absorbed and disappear and cause no harm. Changes of the iris color can occur within the first months. Babies cross their eyes a lot until their muscles become stronger. Within several months this usually subsides.
Genitals - Before birth the increase in hormones to the mom affect baby as well. This causes swelling of the scrotum or labia and in girls may cause drops of blood from her vagina. Some babies, regardless of sex get milk in their breasts, you can feel lumps or hardness which disappears with time.
Breathing - Babys breathing should be easy, with no fluid or mucous. Newborns have very irregular breathing patterns, but range from 30-60 breaths per minute. Dont let it keep you up nights!
Bowel Movements - Be prepared! The first few days there is a black-green and sticky tar-like substance called meconium. Its a chore to clean up, using baby oil helps! Gradually it changes to a yellow-green or mustard yellow color with a cottage cheese consistency.
Though it’s liquidy it is common for babies to strain during bowel movements Breast-fed babies can go for several days, up to 10, without a bowel movement while others go every time they nurse. Either way is normal, as long as the baby urinates at least 6 times a day after it’s first week of life.
Poop from breast milk has a rather pleasant and sweet odor.
Burping - After feeding, hold her up with her belly on your shoulder or in your arms on her stomach and let her burp if she wants.
Gas - If the baby has GAS, remain calm and comfort her. Going for walks, gentle belly massage, or calming chamomile tea baths often help.
Sleeping while eating - Breast feeding is hard work! Babies occasionally nap while nursing.
Hiccups - Babies hiccup frequently. Nursing while holding a finger over the ear will help control this, as will nursing a bit more after a feeding. Your grandmothers might have other "tricks."
Sneezing - This is how a baby removes lint, dust and mucus from his nose. It is normal and a good sign that all is well. Bless you!
Spitting up - Many babies spit up after feeding. This is normal, their bellies are about the size of their fists and sometimes they just swallow more than they can hold. If repeated or projectile vomiting occurs and especially if urinary output decreases, call your pediatrician.
A few more things you may notice...
Skin cracks and peeling - About a week after birth, the skin dries and peels like healing sunburn. The skin had been in a watery environment for a long time and now it is exposed to air. Dont worry it will go away.
Nose - Sweat glands on the nose are just learning how to work and quite often there are white heads on the nose, - just when the relatives come to oooh and aaah!
Infant acne - This can occur anytime in the first 3 weeks until the babys skin glands work properly.
Stork bites - These are red spots on the forehead, eyebrows, or the back of the head, also due to pressure from birth. They will fade in time.
Mongolian spots - Mostly noted in non-Caucasian babies, they look like giant bruises at the base of the spine or buttocks. Take heart, these to will disappear but it may take 1-2 years. They dont hurt.
Feet - Getting all cramped in the uterus, the feet take a while to straighten out. The bones in the feet have not formed yet and are cartilage at birth.
Shape - The head is the largest part of the babys body for a while, holding the developing brain. The belly is large too, like a frogs
8. For Father
You will really be needed during the birth to provide that loving support for your ladys needs.
A new job is just beginning. Nurturing your newborn is a big, new role for you both.
Mama may feel shaky and insecure but will always do the job because she is so emotionally coupled with your child and because it is the "usual" role of the woman.
You will need to take fathering responsibility, or you may miss this incredible experience.
How can you help?
Mother may find it hard to share your child; if she is just learning for the first time herself. She may feel she "must do it all". Gently take your baby when Mama seems tired, saying, "You need time for yourself. Ill take care of our baby while you bathe or read or nap - whatever." Then dont hand her back if she begins to cry; learn to comfort baby, burp, change and out her down to sleep. You can do all these things as well as Mother.
Help with night feedings for at least the first 2 weeks.
Respect Mothers need for a nap -- stay alert and watchful, or she wont be able to let go and really rest.
Take the baby for a long walk, daily if possible, To spend time with your baby and give Mama an additional chance to rest,, cook,, take a bath, etc.
Encourage her breastfeeding. Especially if shes new at it, she doesnt need any criticism.
Deliver hints gently and with tact: her ego and hormone levels are touchy!
Keep house. No housework should be done by the new mom for at least 2 weeks; continue helping out afterwards.
Its a tedious job with little children about. If you wont or cant do these chores, either dont complain about the mess - or hire a maid!
Remember that your house will never be as organized or clean as it was before you had children. Enjoy this new casualness, messiness and spontaneity that has entered you life.
As baby grows and you go out more, learn how to pack the diaper bag and be responsible for hiring the baby-sitter. When you are out, keep an eye on the baby half the time so your lady can enjoy herself equally.
P. S. for the NEW MOTHER:
Allow Dad to enjoy his baby, its his child too! If you show that you think you do the job better, then Dad will not be motivated to try.. Dont criticize his way of handling and dressing, diapering, etc. Its just as good as your way, perhaps a bit different than your own, but just as valid. A man can truly enjoy his new baby. Encourage, dont discourage. The baby too, needs to experience many different techniques.
Advantages: Human milk is perfectly made for your infant’s needs and digestion. It can be delivered directly to baby without heating or handling. It is always fresh and is germ-free. Colostrum and breastmilk are filled with immunities, vitamins, and minerals, which result in fewer illnesses in the early months. It is less work and costs little. Because you must hold your infant close to you, she is guaranteed cuddling and touching. Psychologically this is very beneficial to both mom and baby. The hormone that expels milk also causes your uterus to contract and "grow down" to normal.
How It Works: Supply and Demand. As you nurse, your breasts are triggered to replace what is being emptied.
The hormone, oxytocin is secreted, which causes the milk to "let down" from the producing lobes to the "reservoirs" under the dark brown area behind the nipple. The milk production is initiated and maintained by another hormone, prolactin, which also causes a "mellow feeling" in mom.
The first milk secreted is "skim", the "cream" comes away from the walls of the lobes last. So the "quickie" type of nurser may not gain as much as the long, relaxed nurser. Burping is necessary for some babies and not for others.
We think, one work will be the most helpful with your breastfeeding: RELAXATION!
Relax: Practice your breathing and relaxation while you breast-fed and be sure to drink lots of liquids--water, juice, milk, teas, etc. You will need this to produce your milk. Take naps and rests: remember that fatigue is an enemy in the first few weeks. If you have "achy all over", flu-like symptoms, you should suspect breast infection, because you have a rich blood supply to your breasts to carry bacteria. Fatigue will lower resistances to these germs. Warm, moist compresses, bed, and liquids will help but if your fever goes up and/ or a red spot appears on your breast--go to your midwife. Do not discontinue breastfeeding. Your baby is already exposed to the germ by now--plus the media in his intestines will not allow the bacteria to survive in his body
Starting: Your baby may be interested in sucking right away, but most wait 20 minutes to 1 hour. During this time, the baby enjoys "playing with and trying out the nipple. Baby will lick, feel, smell and generally communicate with the nipple while he "bonds" with his eyes, listening intently to Mamas voice.
If you touch babys cheek with your fingers or nipple, she will turn in that direction and "root". Following this first feeding, baby will sleep and finally waken to nurse again. From then on, 10-12 nursings in 24 hours will be common. Each babys personality dictates the way he or she nurses.
Your first milk will be colostrum which has many valuable antibodies, plus a laxative effect on the baby, aiding her to expel meconium. Then it will change to "true milk" in the first 48 hours to 4 days. This is individual but is generally earlier at home because of frequent demands on the breasts. Your hormones will help to build your supply and to aid this, use both breasts at each feeding the first few weeks.
Your Nipples and Breasts: In your pregnancy you will notice your breast become larger and your nipples get darker. Your body is changing to prepare for breastfeeding. When Baby finds Mamas nipple, shell usually "latch on" correctly. Some babies need readjusting especially if you are getting sore nipples. It is best when the baby has all or as much of your areola (the darker part around the nipple) in her mouth You should feel her gums well behind the tip of the nipple.
It also helps to have the newborns head straight in line with his belly, directly facing you, if he has his head turned sideways, its harder to swallow and its harder to get the whole nipple into the mouth.
If your nipples do get sore, get in a good position and try feeding more often, for 5 minutes on each breast. You can rub some breast milk on your nipple after feeding and air dry them. Allow your nipples exposure to air and sun. Hydrous lanolin and warm wash cloths also help heal the sore nipple. Call the midwives for help. Sore nipples can feel terrible at first but with help they get better quickly. A persistent case of sore nipples could be "thrush" ( a monilia infection) and requires treatment of both mom and baby. Discontinuing breastfeeding is not necessary.
When your "true milk" comes in your breasts grow larger still. Your body is now making milk for Baby. Your breasts fill and even overflow with milk. Its good that your baby nurses frequently, that way you can empty your breasts and produce more milk.
If breastmilk isnt released enough you may become engorged. This can be uncomfortable. If the pressure in your breasts is too much, you can place warm wash cloths or soak your breasts in hot water and massage some of the extra milk out. You might use a breast pump to relieve the hardness of engorged breast.
If your baby is eating well you might only feel the pressure for 1-2 days. Then, your breasts will feel better and not so heavy, even though they continue to produce more milk.
Enough: If your baby has 6 wet diapers a day and bowel movements (excluding the baby that saves up his movements), she is getting plenty of milk.
Your breasts were made to nurture your baby, just as your uterus was made to grow your baby--keep breastfeeding simple-- its the "lazy way" to go.
Bottles: If your choice is bottle, give 2-4 ounces, every 2-4 hours of iron-fortified formula. Be aware that this can cause constipation in non-breastfed babies. Always hold your baby while feeding. Your baby needs that love and attention.
You may pump your breast milk and store in the refrigerator for days, but no longer than a week. It can be frozen for a few months and up to 6 months in a deep freeze. Thaw out frozen breast milk at room temperature or put the bottle in a glass of warm water. Do not microwave or re-freeze breast milk. Get to know the smell of your milk to determine freshness.
Babies prefer milk directly from you, but breast milk in a bottle is helpful for working mothers and it gives
fathers a chance to feed their child.
Comadres gives thanks to all the parents, past, present and future,
who contribute to the fund of birthing and parenting knowledge.
And to the midwives who have contributed to the literature:
Marina Alzugaray, Nancy Bardacke, Paula Deva, Carole Hagin, Chris Meneley,
Yeshi Neumann, Peggy Nixdrof, Peggy Vincent, Basia Klincewicz,
doula Mirine Dye and the UCSF Midwifery Education Program,
and so many more.
© Marina Alzugaray