UVA Health System Blog

Stories about the patients, staff and services of UVA

 

Maternity Monday: Sleep Schedules for Moms and Babies

On June 29, 2015 | At 10:37 am

Giving birth puts your body through a lot of trauma, and the baby has gone through an ordeal as well. Your body needs to relax! It may go without saying, but don’t make big plans in the days and weeks following baby’s arrival. Sleep is a priority! Visitors may come and go, but it’s OK to tell people it’s time to relax and ask them to come back another time.

Mommy and Baby Need Sleep

The new baby needs a lot of sleep, anywhere between 16 to 20 hours per day, says pediatrician Heather Quillian, MD. The baby’s sleep schedule will be disjointed and erratic, and you may not be able to predict when the baby will sleep. Your baby will only be comfortably awake for an hour or two at a time.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Baby will let you know when they are sleepy. Watch for certain signs:

  • Yawning
  • Rubbing eyes
  • Fussing
  • Acting fidgety

Don’t be alarmed if baby sleeps for more than a few hours at a time, but remember your baby will need to eat every several hours, Quillian says, don’t allow or expect your new baby to sleep a full nights sleep (8 hours or more). If this is the baby’s sleeping habit, consult your pediatrician.

Mommy needs sleep, too. Doctors recommend lying down and resting every time baby sleeps, even if you don’t fall asleep. Your body has gone through a lot and needs time to recover. Pregnancy prepares you for a lack of sleep, Quillian points out. It’s rare to sleep through the night at nine months pregnant, and in the first months of baby’s life, mommy and daddy shouldn’t expect a full night’s sleep either.

Getting on a Sleep Schedule

Quillian admits it’s hard to get baby on a sleep schedule until about four months of age. A new baby doesn’t really understand the concept of daytime and nighttime, just that they feel tired and want to sleep. Don’t try to keep baby awake through the daylight hours to ensure they sleep longer at night. It won’t work and you will likely have a fussy baby.

A baby's crib or bassinet should have absolutely nothing in it. "Make it boring," says Dr. Quillian

A baby’s crib or bassinet should have absolutely nothing in it. “Make it boring,” says Dr. Quillian

During the early days and weeks, be sure to cuddle and snuggle your baby as much as you can. “There is no such thing as too much spoiling,” says Quillian. Baby loves to be held and needs the human interaction. The snuggling will help baby feel comforted and will promote sleep.

Baby may sleep as long as four hours at a time, but it may not be at night. It’s easier to adjust our schedule than to try to adjust theirs.

If you try to implement a sleep schedule too early, you may feel like you’re spinning your wheels, and, in fact, even at four months old, baby may not catch on. After a few months though, you can start a routine that implies to baby that it’s nighttime and time to sleep:

  • Keep your household at a manageable noise level during the day and quieter at night.
  • Turn the lights down low at nighttime.
  • Change baby into pajamas.

Remember, sleep promotes sleep, and babies may not learn how to sleep on a schedule if left to do their own thing. Do not leave them to their own devices, Quillian warns. With help from parents they will learn slowly over time that nighttime is sleep time. Getting a baby into a good sleep pattern can take some work, but it is worth it, Quillian advises. A good night’s sleep benefits everyone.

SIDS, Sleep and Safety

There is plenty of information out there regarding baby sleep safety and sudden infant death syndrome (SIDS) prevention. “Make sure there is a firm sleep surface; that’s the most important thing,” says Quillian. “A crib or bassinet will do. There should be nothing in it. No blankets, no pillows.”

Quillian adds that baby should be laid on his or her back, and pediatricians at UVA do not recommend any sleep positioners. It’s okay, she adds, to be swaddled in a light blanket or sleep sack, but keep the crib as boring as possible. All the things that make your bed cozy are an absolute no-no for your baby.

Having a new baby at home will be intimidating, and you may be worried about baby sleeping too much or too little. If you have any concerns, be sure to call your pediatrician.

 
 

Maternity Monday: The Reality of Postpartum Depression

On June 22, 2015 | At 10:43 am

Having a baby: It’s a delight, it’s a joy — and it is also stressful. No matter how positive the birth experience, how well-prepared you are as a parent (you read every Maternity Monday post, for instance!) and no matter how pleasantly your infant integrates into the world, the arrival of a whole new person into your family shifts the very fundamental makeup of life as you know it.

Which is why postpartum depression (PPD) happens to a lot of new mothers.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Diane Sampson, a Lamaze Certified Childbirth Educator, spends time in the classes she teaches helping parents anticipate the emotional highs and lows having a baby can produce. She explains that the post-partum period (the time after your baby arrives) is an emotionally trying and physically demanding time because:

  • You and your partner will experience new demands on your relationship, where you can’t give each other the same amount of attention and time as you could before.
  • You may mourn for your loss of free time, or even, if you are having a second child, for the loss of alone time with your first.
  • Newborns have shifting, sometimes unpredictable patterns of feeding, sleeping, crying, etc.
  • Sleep deprivation, coupled with the care newborns require, can result in extremely intense emotional strain.

While you may not be able to prepare for the postpartum period, knowing that it’s normal and expected to feel overwhelmed sometimes can help new parents seek help from friends, family and their doctor.

What is Postpartum Depression?

Everyone experiences hormonal and emotional stress when a baby arrives.

Postpartum depression should not be confused with “baby blues,” a hormonal and emotional phase that happens in the first two weeks after delivery. The irritability and sadness from baby blues comes and goes. PPD can occur anytime in the first year, lasts longer and requires treatment.
postpartum depression facts

Postpartum depression:

  • Happens in about 10 percent of women after giving birth
  • Often coincides with returning to work after maternity leave
  • Qualifies as an adjustment disorder, resulting from a woman having issues adjusting to the role and demands of becoming a mother

Signs of Postpartum Depression

Sampson explains that typically, “At the six-week checkup, during the follow-up pelvic exam, women get screened for PPD. Your OB/gyn will ask you a few questions about how you are feeling—about yourself, your baby and your relationships.” Providers consider this inquiry into how a mother feels about her new role as part of the total care of her health.

But, Sampson says, if a new mother doesn’t experience PPD until half a year after giving birth, she could miss being diagnosed, especially if she isn’t checking in with a healthcare provider or counselor on a regular basis.

So, often it’s up to the mother, her partner or a close family member to watch for the symptoms of PPD.

How can you tell if you or someone you know has PPD? Some postpartum depression symptoms to look for:

  • Behavior or emotions that look like regular depression — sadness, low mood, low energy
  • Emotional detachment — mom doesn’t make much eye contact with the baby, doesn’t coo or talk to baby
  • Hyper-vigilance — mother tends towards excessive anxiety about protecting the baby or is fearful
  • Being off kilter, not settling in
  • A lack of joy with the baby
  • Lasts more than three weeks (not just a bad day or week)

Partners Can Get PPD, Too

A husband or partner can also experience depression. With a new baby comes loss of autonomy, loss of attention from the mother. “You’re not the focus of her attentions anymore,” Sampson says.

Of course, the parent who did not deliver the baby will not feel PPD as acutely, not being as physically drained or as hormonally affected. But a baby changes everyone’s routines, including sleep, and lack of sleep contributes to emotional fluctuations for anyone.

Preventing Postpartum Depression: Set Realistic Expectations

According to Lynn McDaniel, MD, our cultural expectations of how a mother should behave after giving birth causes or exacerbates PPD, and explains why it’s so common in the U.S.

“In other societies, you stay in your bed for 40 days; here, we expect you to hop up and get dressed. We make ourselves crazy,” she notes.

“We have new moms whose expectations are that they will be awake all day and feed the baby. But you’re on the baby’s schedule, a 24-hour schedule, not yours.”

So, McDaniel advises, prepare to follow your newborn’s cues. And “don’t worry about preparing gourmet meals or cleaning toilets. Focus on the most important thing, and that’s this new baby.”

One Mother’s PPD

We spoke briefly with Daphne, a local Charlottesville mother, about her experience with postpartum depression.

Daphne experienced postpartum depression after her second child.I felt depressed, very sensitive, emotionally reacting to things out of proportion for sure — teary, easily crying, easily drawn towards the negative perspective of things.”

What helped?My parents came here for 23 days. They noticed I was very teary, and, you know, they helped me with the kids, and also they pushed me to get out of bed and do something, have a shower, put clothes on, go outside, take a walk.”

Daphne discovered her PPD to be temporary.At that moment you feel so devastated and so dark, but it doesn’t mean that feeling will be forever long. Remember it will pass!” Daphne also recommends finding someone to talk to, whether it’s a friend or counselor. “My support network got me through,” she says.

We Recommend

Before you have your baby:

  • Find local support groups and info at Postpartum Support Virginia
  • Read “What Mothers Do… Especially When it Looks Like Nothing” by Naomi Stadlen, a gentle but powerful book based on interviews with new mothers

Be Brave: Tell Your Provider

While the mother may feel hesitant to admit it, and a partner might be hesitant to point out that there might be an issue, avoiding talking to your doctor and getting treated will only make it worse.

If not treated, PPD can last.

As Sampson says, “Some moms may see PPD as a shortcoming in their mothering. You’re supposed to be really happy, and you’re not. This really puts mothers in a bind. We need to make new mothers feel okay with however they feel and asking for help.”

PPD Treatment

Usually providers:

  • Proscribe Zoloft (which is safe for breastfeeding)
  • Refer to counseling, especiallyy a therapist who specializes in PPD
  • Encourage mothers to find support and self-care practices, like taking yoga or other exercise classes and getting out of the house with baby

Know a New Mother? Offer Support

Partners, family members and friends can support new mothers by:

  • Listening
  • Normalizing
  • Encouraging

McDaniel says, “The biggest thing is, in the first few weeks, it’s about baby being with mom. Anything people can do to keep it going is good.” Her guidelines for visitors:

Do:

Clean toilets, make meals, run errands, clean the kitchen, vacuum, mow the lawn, wash your hands before holding the baby, give mom permission to say now is not a good time to visit.

Don’t:

Visit without checking with mother first, bring your kids to visit the baby, get in the way of the mom spending time with her baby.

Do you think you have postpartum depression?

Talk to an OB/gyn or primary care provider.

 
 

Maternity Monday: Welcoming Baby Home, What to Expect

On June 15, 2015 | At 10:08 am

People often say that having a baby changes life dramatically. You understand them, but do you really comprehend those changes? Bringing a newborn home for the first time is both exciting and overwhelming. Diane Sampson helps parents understand these new challenges and lets them know what to expect in baby’s first months home.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Accept Help And Support From Others

With a new addition comes an outpouring of support from friends and family. It’s become increasingly common for grandparents to visit for an extended period of time. They can help acclimate their children to parenthood, as well as care for and bond with the newborn.

This often causes a role reversal between parents and grandparents. It’s an unexpected issue for couples used to their independence and established lifestyle, which is now being interrupted as their parents are caring for them again.

As a mother herself, Sampson knows the best celebratory gifts are not balloons and stuffed animals. She reminds visitors that necessities like food, offering to do laundry or providing time for new parents to do some self-care is much more valuable.

It’s important to tend for new parents just as much as the baby. Sampson encourages parents to spend part of each day participating in a non-baby related activity. Read a book, get a mani-pedi or take an exercise class — don’t confine yourself to strictly caring for baby.

Sleep When The Baby Sleeps

According to the National Sleep Foundation, newborns under six weeks old sleep an average of 14-17 hours a day. This may seem like plenty of time, but newborns tend to only sleep in small chunks. Three hours here, 45 minutes there — an unpredictable cycle driven by hunger. With a golf ball-sized stomach, they get hungry a lot. When they wake they tend to be hungry, and when they’re full they tend to sleep.

“I think the thing that shocks most new parents is the unpredictability of a newborn,” says Sampson. Adjusting to a life that revolves around a new newborn’s eating and sleeping patterns can be challenging to parents. Her number one piece of advice: Sleep when the baby sleeps.

An adult needs an average of seven to eight hours of sleep a day to be healthy and functional. Parents will still get those hours, but it will be in smaller portions of time just like the baby. Sleep deprivation can lead to a host of issues like loss of energy, anxiety and depression. “Women and partners need to protect their sleep as a prize,” says Sampson, “it makes them happier, better and more adjusted.”

Prepare For Unexpected Life Changes

“There is a mourning of a loss of freedom for most new parents,” says Sampson. They don’t have the flexibility they previously enjoyed, as a get-up-and-go lifestyle is almost impossible. Sampson understands this world of change is hard to describe prenatally, but all parents eventually face this realization.

The notion of being able to do it all: parent while maintaining a clean house and keeping up with social networks needs to be dialed back. It’s common for friend cohorts to change as those without kids may have a hard time understanding your new schedule and lifestyle.

Although priorities may shift, parents agree the sacrifices are worth it. “There’s a certain amount of magic to it — your affection for this child and the waiting and anticipating are just unbelievably magical,” Sampson says.

Don’t Stress Over The “Baby Blues”

Baby blues usually occur one to two weeks after the baby is born. It’s a hormonally based adjustment disorder, where an overwhelming feeling comes in waves. You can have a really bad afternoon but wake up and have a great morning. It’s different from postpartum depression, which can occur anytime in the first year after pregnancy.

These feelings often happen when your partner goes back to work and the number of visitors drops off. The newness of the situation dies down, and the realization of baby care begins to kick in. It can also be accompanied by a parent’s fear of not instantly connecting with their newborn. Don’t second-guess yourself — Sampson reassures parents that this is normal. It may take some time, but it will eventually click.

Take A Deep Breath, Relax and Enjoy

A calm, slow routine at home is best to develop a bond with your baby. The first few months home are an adjustment period, but you’ll begin to see changes and milestones at the six-week mark. Newborns will endure some growth spurts, begin nursing more frequently and explore the “social smile.”

If you’re interested in learning more about labor, delivery and caring for yourself and baby when you go home, check out our Preparing for Birth and Baby seminar.

The social smile is a distinctive smile your baby gives you that is a powerful interaction of love and connection. Many parents say this is the most rewarding milestone because they receive the gratification of a back and forth interaction between them and baby.

Besides checking for steady growth and attending regular check-ups, parenthood will become easier with practice. Don’t hesitate to call your doctor if you have questions about your newborn’s health and progress.

 
 

Maternity Monday: Top Baby Shower Gifts & What Babies Really Need

On June 8, 2015 | At 10:43 am

Buying a gift for a baby shower? Making a baby registry? Read this before you buy or make your list.

I will never forget coming home with my first child and discovering this tiny little being needed more time, energy, resources and accessories than it seemed someone that new and small should require.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

And socks. She lost a lot of socks. She didn’t even walk, and we were always running out of socks.

But let’s not even talk about the necessities: The available options for baby’s first year abound.

There’s What You Can Stick Your Baby In category: Carriers, bouncers, baskets, papasans, seats, chairs, rockers, swings, play mats, baby gyms and five million strollers, some of which do just about everything but make coffee in the morning. (And really, you could use a stroller that made coffee in the morning!)

Then there’s What You Can Stick On Your Baby: Ruffled pants, bows that slip off their bald heads, hats, mittens, tennis shoes, soft shoes, fancy shoes, fancy dresses, fancy pants, onesies, two-piece bathing suits, sunscreen, lotion, baby oil, baby shampoo, diaper cream, rash cream, sleep sacks and a million types of diapers, disposable, reusable, biodegradable and generic.

I’m exhausted just thinking about it. And we haven’t even gotten to toys and books and decorations and bottles and pacifiers and nail clippers and thermometers and the rest of it — their own special-sized, specially made pack of accessories for every activity.

All of it costs a lot of money to buy, a lot of time to consider, and by the time you get the hang of keeping track of and using all of it, the baby has become a toddler and all those wipe warmers and bottle brushes and swaddling blankets are obsolete.

Baby Item Essentials

According to UVA experts Ann Kellams, MD and Lynn McDaniel, MD, we’ve been overdoing it. All of this stuff is not only unnecessary, but many of the baby-holding devices and chirping toys interfere with the most important thing a baby needs in his/her first year of life: to be held and talked to by caregivers.

So what items do you really need?

  • Car seat
  • Safe place to put baby down
  • Safe sleep environment
  • Milk
  • Clothing and blankets
  • Nasal syringe
  • Rectal thermometer

That’s it.

Baby Items to Avoid

But, of course, no matter how much you intend to keep it simple, you may see the advertisements for safety gadgets and pretty accessories and put them on your baby registry.

Before you do that, Kellams and McDaniel want you to know that some “safety” items actually pose dangers to your infant. Guidelines for SIDS prevention, for instance, specifically instruct caregivers to put babies to sleep on flat surfaces with no accessories that could interfere with breathing.

Worried about SIDS? Kellams and McDaniel say nix the baby monitors and, for the first six months, have your baby sleep in your room with you, in their own safe space.

So, along with your list of what you need for your baby you need this list of items to avoid—and if you get them for a gift, return them (politely, of course).

Leave these dangerous and unhelpful baby accessories at the store:

  • Special accessories that claim to prevent SIDS, like heart and breathing monitors (not proven)
  • Sound machines (not regulated)
  • Anything with wires (entrapment risk)
  • Bumper pads in the crib
  • Walkers (interfere with development)
  • Fold-out cradles (not a flat surface)
  • Boppy pillow (ok to sit on, but not for propping up your baby)
  • Stuffed animals (should be kept away from infants)

Best Baby Shower Gifts

Ok, so now we know about the bare necessities and the no-nos. But you’re going to a baby shower, the basics have been bought, and you still need to buy a gift.

Kellams and McDaniel suggest the following “timeless and practical” items that, while not absolutely necessary, every new parent would welcome.

  • Diapers
  • Bibs
  • Onesies
  • Pack and play
  • Wearable blankets/sleep sacks
  • Thin receiving blankets
  • Washcloths/towels
  • Rattles, teething toys
  • Books
  • Flat play mat
  • Gift cards

Best Baby Shower Gifts: According to You

As part of our research for this article, we asked our Facebook fans to tell us: When you had a baby, what was the one item you couldn’t live without?

The responses included creative, surprising answers that you may find useful whether you’re shopping for yourself or for another expecting parent.

Practical Life-Savers

“A laminated list of every phone number a parent could possibly need, and another list of tried and true sitters you are willing to share.” – Palma Pustilnik

“Nipple cream.” – Beth Wright Robbins

“An assortment of bottles to try so that the parents don’t invest too much in one system that winds up not working for the baby.” – Elaine Lund

“Family-size battery recharger and rechargeable batteries. Energizer makes a fabulous one I’ve been using for nearly 7 years. It’s insane how many batteries you need for kids items! Saves $ and the planet!” – Amy Mulhern Ensinger

“Nature’s Miracle. While meant for pet accidents, it has been a life saver for the variety of accidents babies have.” -  Marla Melito

“College savings account.” – Christian DeBaun

Presents for New Parents:

“Coupons for some time out for Mom, even if it’s just to take a bath and get an uninterrupted nap in.” – Jennifer Ormond

“Babysitting coupons. That you actually force the new mom to redeem!” – Mo Nichols

“Gift cards to restaurants for take-out for frazzled new parents.” – Elaine Lund

“I second the gift cards for take out and gift card for cleaners or laundry service.” – Hope Smith LeGro

“Massage, mani/pedi gift certificates for the mom. She’s worked hard for 9 months and now has a crying infant to deal with. She needs a break.” – Amy Mulhern Ensinger

“Some sort of primer on all the sudden decisions one has to make.” – Taylor Greenwood

“Anne Lamott’s book ‘Operating Instructions.’” – Susan Scofield

“Serotonin and coffee.” – Elaine Lund

Go-To Specialty Items

“Socks, socks, and more socks!” – Marla Melito

“For winter babies, wool sweaters for infants.” – Heather Warren

“HALO SleepSack Swaddle.” – Kate Rhamey

“Aden and Anais blankets. And the miracle blanket was a complete life-saver for me. My son broke out of the swaddle no matter how tight I did it, and the miracle blanket was the most amazing item that I ended up buying myself that actually got him to sleep more than an hour at a time after 8 weeks.” – Megan Yaniglos

“Piyo nail scissors instead of clippers.” – Hope Smith LeGro

“Infant Tylenol!!!!” – Kelly Blumenthal

“Ergo Carrier.” – Erin Conger McElwain

“I loved my rocking chair especially for 3am’ish nursing.”– Heather Warren

“We have a glider and it was AMAZING to have. I spent more time in that chair than I realized. And we still use it to read before bed and sometimes rock my 2-1/2 year old. This is one item I didn’t realize how much I would love.” – Jenna Katherine Massie

What’s Missing? Let us know!

Tell us in a comment below what baby item you called essential.

 Going shopping?

Download, view or print this list to take with you, our baby shower shopping guide (PDF).

 
 

Maternity Monday: Helping Siblings Adjust to a New Baby

On June 1, 2015 | At 10:38 am

As a first time mom, everything is new, exciting, terrifying. Life will never be the same. Now your world revolves around this one tiny little human being that needs you for every little thing. Maybe after the first month or so, you start getting used to it; you get yourself and baby in a nice little rhythm. After a year or so, you can’t imagine your life without baby.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

And then, naturally, you start thinking about baby number two.

A second baby can throw a wrench in your new rhythm. Now, you don’t just have one little life to look after, but two. How in the world are you supposed to feel? How is big brother or sister supposed to feel? How are you supposed to divide your time?

Take a breath. Remember, moms and dads have been dealing with this for years and years and years.

Feelings and Emotions

First, let’s tackle baby number one’s feelings. For the entirety of their life, he or she has been the apple of your eye, receiving all the attention from mom, dad, grandma, grandpa, the stranger at the grocery store, etc. When the idea of a little brother or sister comes along, big sibling may feel lots of different emotions.

“It’s normal for big siblings to feel jealous or confused,” says pediatrician Heather Quillian, MD. “They might also feel intense love or even protective for their new sibling. All of these feelings are normal and natural.”

If you are keeping the gender of new baby a surprise, older siblings may be hoping for a brother or a sister and may be disappointed.

“Emphasize their role instead of the gender of the new baby,” Dr. Quillian suggests. “Say things like, ‘You’re going to be a great big brother/sister’ or ‘No matter if baby is a boy or girl, this new baby is going to be a big part of our lives.’ If you don’t make gender a big deal, it won’t be. If it becomes one, just let them know that mom and dad don’t have control over the gender, so it’s going to be a surprise for the whole family!”

Dr. Quillian also warns about putting too much pressure on the older sibling; he or she may start to resent the new baby. Also remember, big sibling may still be a baby, too, so treat him or her like one. Give lots of love and attention.

Big sibling may have an intense love for new baby or feel completely ambivalent. Either way, in time, he or she will learn their role in new baby’s life. It’s important to let older sibling find these feelings on their own.

New mom of two Heather Vanderweide helped older sister Sophia, 3, get acclimated to the idea of a new baby by getting her involved in the nesting process.

Being a mom of two is a lot different than being a mom of one. Be sure to ask for help! It won't be long until there is a new normal in your household.

Being a mom of two is a lot different than being a mom of one. Be sure to ask for help! It won’t be long until there is a new normal in your household.

“Sophia helped me pick out some new clothes and re-organize the nursery, which she had just moved out of herself,” Vanderwiede said. “She attended some of my prenatal appointments and enjoyed seeing her baby brother on the ultrasound.”

When it comes to mom’s feelings and emotions, remember that your hormones are a little out of whack throughout pregnancy and in the weeks initially after giving birth. It’s okay to feel happy or sad or whatever else. If you feel overwhelmed, don’t be afraid to ask for help. Your body needs rest, so be sure to sleep or relax whenever you can.

Divvying Up Mom’s Time

With one baby, all of your attention can be placed on him or her. With a new baby in the mix, your time and attention may seem divided.

To help yourself, Quillian says to keep big siblings in a normal routine. “If they are school age or go to daycare, make sure they keep going on a regular basis,” she says. Not only will this give you time to relax at home, but it will be less stressful for them.

If the older sibling’s regular day is spent at home, Quillian emphasizes asking for help. “You can schedule play dates or sleepovers at a family member’s house,” she suggests. “Your body needs rest, so let Daddy take him or her for the day to ensure they get that one-on-one attention.”

Vanderweide admits the difficulty of having a second baby at home. “It truly is challenging,” she says. “I try to make sure that we have time to sit down together during baby James’ naps, and we take a short outing together each weekend while my husband watches James.”

Breastfeeding moms may find it extra challenging when the new baby is hungry and older sibling needs attention. Quillian suggests preparing an extra-special basket of fun activities that only comes out at feeding time. Get older sibling involved in prepping the basket before baby is born so they get excited about the idea of using it.

“It’s hard,” Vanderweide admits, “and I am looking forward to James getting a little bit older so that I can spend more time interacting with both of them instead of devoting attention to each one in turn.”

Introducing Big Sibling to New Baby

Introducing the idea of a new baby to your child may seem intimidating. There’s no right way or right time.

Quillian suggests telling the older sibling about the baby around the same time you’re telling other family members. Depending on age, he or she may ask where the baby comes from and Quillian recommends looking for age-appropriate books or asking your pediatrician for advice.

Bringing the older sibling to doctor appointments throughout the pregnancy may help with understanding the process as well, but this may be confusing to younger children. For some moms, there may not be any other option.

Sign Up For A Class

As far as meeting the baby, it’s up to you. “I would suggest you not have older sibling in the delivery room,” Quillian says and adds that it may not even be allowed. “It’s an incredibly intense atmosphere and may cause resentment towards the new baby if they see mommy in pain.”

However, the older sibling will recognize that something big is going on and will want to make sure mommy is okay as soon as they can. Whenever mom is ready and feeling up for it, it’s certainly reasonable to have big brother or big sister meet the new family member in the hospital. Plus, you’ll want to snap that family photo!

“Meeting her brother really didn’t seem to be a big deal for Sophia,” Vanderweide remembers. “I think all of the monitors and wires did make an impression since the first thing that she asked was, ‘Is he real?’”

 
 

Maternity Monday: Breastfeeding Barriers and Benefits

On May 25, 2015 | At 10:21 am

When I meet with Ann Kellams, MD and Lynn McDaniel, MD, in the sunny conference room of the maternity floor, they speak eagerly and passionately about the changes taking place in the world of breastfeeding.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

“When my father was born, my grandmother was knocked out and put to sleep,” McDaniel says. “She woke up and there was a baby. We forget what it was like.”

There have been a lot of changes.

Certainly, the way our culture has treated pregnancy, birth and breastfeeding has significantly altered throughout the last century, and that change is reflected in hospital practices across the country.

“Even if you had kids 5-10 years ago,” McDaniel notes, “The information and the procedures after delivery are different.” For instance, newly instituted at UVA:

  • All babies are put skin-to-skin with their mother immediately after birth
  • Babies sleep in the same room as their mothers at all times
  • All staff have been trained to support breastfeeding mothers, in the NICU
  • Lactation consultants visit new mothers regularly

Kellams, who directs the Breastfeeding Medicine Program that has lead the way in implementing these types of policies and procedures, has achieved great success:

  • UVA is one of only 12 hospitals recognized by the Virginia Department of Health for its support to breastfeeding moms.

    Breastfeeding experts Kellams and McDaniel

    Breastfeeding experts Kellams and McDaniel “want you to love feeding your baby and feel good about it.”

  • In 2014, a federal survey ranked UVA Medical Center in the top 5 percent of hospitals nationally for its support of breastfeeding.
  • Just last week, the Children’s Hospital earned an international award for its support of breastfeeding mothers.

“We have made major changes to ensure that every mother has the best chance of reaching her feeding goal and that mothers and babies have the smoothest transition possible both after birth and when they go home,” says Kellams.

Even better than the awards and recognition? The health improvements visible in their patients.

With the increased rate of breastfeeding mothers, Kellams and her team “see less weight loss, less jaundice, less babies with fast breathing rates after delivery, more stable conditions all around. We’re optimizing the conditions to make this organic process occur naturally. Removing the barriers that 50 years of medicine put in place.”

Breastfeeding Barriers

About 80 percent of women giving birth at UVA choose to breastfeed. So what is happening with the 20 percent who do not?

Cultural and Historical Context

“Before WWII,” Kellams explains, “If a mother died or couldn’t breastfeed, then mom, sister, friend would breastfeed the child. After WWII, we developed formula, and women started working. Science came in and everyone jumped on the formula bandwagon. And it was expensive, so it was a status thing.”

Breastfeeding Benefits

For the Mother:

  • Lower rates of breast/ovarian cancer
  • Lower rates of type 2 diabetes
  • Quicker return to baseline weight
  • Less postpartum bleeding

For the Baby:

  • Lower rate of infections, especially for premature babies
  • Lowers SIDS rates
  • Lessens diabetes risk
  • Fewer ear infections
  • Fewer allergies
  • Better immune function
  • Better digestion

In countries like Mexico and China, she notes, people perceive formula as a status symbol, because of its costs.

Cultural values around modesty and sexuality also play a role in restricting public breastfeeding.

Stress and Lack of Planning

McDaniel wants mothers to think “pre-conceptually. Post birth can be so stressful, I’d prefer that moms think about this before they deliver, when fatigue, pain, stress make thoughtful decision-making difficult. Get as much info as you can beforehand. You need to come in with a commitment and a plan.”

That’s why the first step in the breastfeeding program begins with prenatal consultations. “We want to give you all the information, so you can make the best choice for you and your baby,” Kellams notes. “As a new mom, you need all the knowledge you can get.”

In fact, Kellams and McDaniel have found that successful breastfeeding can improve a mother’s ability to manage post-partum depression. “Breastfeeding is a protective factor for depression. Instilling mom’s confidence in her body is a way to protect moms against PPD.”

Hospital Practices That Miss the Golden Hour

A huge culprit when it comes to factors that hinder breastfeeding: Hospital practices that remove the baby from mom.

The sooner you feed your baby, the better. Professionals call it the golden hour or power hour, the time right after birth when the largest amount of colostrum releases (the most protein and nutrient-rich part of breast milk) and the highest prolactin level exists in the mother.

If you do the first feeding in the first hour, and keep the baby with the mother, the benefits include:

  • The baby eats more later
  • The baby receives a boost to the immune system
  • The baby’s vital signs are more stable
  • The unit is quieter, due to fewer babies crying

Keeping the baby with the mother, eliminating the need for a nursery, reflects a big shift in best practices. “We used to say you should do this for various reasons, give the mom rest, etc.,” McDaniel says. “But now we know that separating them sets them up for failure.”

Medical or Other Hindrances

According to Kellams and McDonald, not many medical issues exist that completely prevent a woman from breastfeeding. Even procedures like C-sections do not render breastfeeding impossible.

Certainly, being HIV-positive, a drug user, a prison inmate or having some emotional barriers due to abuse could interfere with a breastfeeding plan.

Breast Pumps: Lack of Access

One barrier to sustained breastfeeding occurs if the mother needs a breast pump, either due to a medical condition or to return to work, and can’t afford to buy one.

At UVA, “We are now starting a program where we will have the insurance-approved pumps for mom. If they need to go back to work, we will provide that and it will get billed to insurance. We give prescriptions. WIC comes to the hospital, and they provide pumps. We provide hand pumps. We test pumps if they aren’t working well. Help mothers find a pump to rent before they leave the hospital.”

How UVA Helps

At UVA, we help you manage these barriers to breastfeeding.

Post-Hospital Support

The UVA program also sees mothers after they have returned home. They can help a mother manage:

  • Dealing with medications
  • A dwindling milk supply
  • A baby refusing a bottle
  • Mastitis
  • Soreness
  • Oversupply
  • Nursing when the baby is hospitalized

Supporting Your Choice

“Everyone that starts thinking about breastfeeding worries the doctors will pressure you into it,” notes McDaniel. But that’s not the approach the doctors at UVA take.

Certainly, the benefits to both mother and child clearly make the case for breastfeeding as opposed to formula feeding. But, McDaniel says, “In the end after all the info we give you, your choice is what we’re going to support. The thing we want most is we want you to love feeding your baby and feel good about it.”

Get Breastfeeding Support

Preparing to Breastfeed?

Problems Breastfeeding?

We can help: Call or visit the Breastfeeding Medicine Clinic

 
 

Maternity Monday: The Partner’s Role in Pregnancy

On May 18, 2015 | At 10:18 am

Forty weeks of pregnancy is a long time and can put a toll on a woman’s body. She’ll experience every emotionfrom stress to excitement to feeling out of control. Pregnancy can put a strain on a relationship as well, and without the emotional and physical support of a partner, a woman may feel completely overwhelmed with everything going on. The partner’s role is quite simple: to be there.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Meanwhile, partners are trying to navigate through their own emotions. There’s an old saying that goes, “a mom becomes a mom when she finds out she is pregnant. A dad becomes a dad when he sees the baby.” Partners play their own special role in the journey of pregnancy. Julie Ruffing is a labor and delivery nurse at UVA and a new mom. Here’s her perspective on the role her husband played in her pregnancy.

Question: What role did you husband take in your pregnancy?

Julie Ruffing: During pregnancy my husband was incredibly supportive. I think for a man, expecting a child can be a difficult time that is often underrepresented. For me, physical and emotional changes were obviously apparent, but for him, his life was changing slowly without his full comprehension. Early in my pregnancy I went through normal morning sickness and I just wasn’t myself. My husband struggled to understand why I was not excited to eat the meals he cooked and he often tried to get me motivated to be active when all I wanted to do was take a nap. As the pregnancy progressed, he was great! He massaged my aching feet after a 12 hour shift, made food that I was craving, and didn’t care that I needed 10 pillows to get a good night sleep. He did everything he could to support me in the changes that were taking place.

Q:Did you take labor classes? Did your husband attend?

Julie, her husband Ross, and their daughter, Josephine.

Julie, her husband Ross, and their daughter, Josephine.

JR: Since I am a labor and delivery nurse, I attempted to teach him about the labor process myself. We spent many long car rides discussing his role at the bedside during labor and all of the crazy events that may take place. We also talked about what would happen once the baby was born. Although I tried to cover everything I don’t think I prepared him fully for what to expect.  I’m sure he believed what I had taught him, but there is very little you can do to help someone understand what they’re in for when being a part of labor for the first time.

Q: Did your partner attend doctor’s appointments?

JR: My husband was present for the first appointment as well as the most important appointments throughout, including both of our ultrasounds. I find the ultrasounds important for the partner because it helps them to conceptualize that there is a living person growing inside the pregnant mother. During the process my husband was very excited and wanted to be a part of each step.  He is also the kind of person who seeks understanding and was quick to ask questions along way. At first I found this slightly frustrating because many of his questions I felt like I could answer.  However, as the process went along this trait proved to be very helpful and encouraging.

Pregnant?

Sign up for a prenatal class.

Q: Do you think there was a difference in how you felt toward the pregnancy and how your partner felt toward the pregnancy? Why or why not?

JR: Absolutely. I don’t think any man can fully understand pregnancy because they can’t go through it. It’s a crazy feeling to have a baby moving around inside your belly. During the pregnancy, I was constantly reminded that there was a living being inside me. She was always so active, rolling around and kicking me — 24/7. For the man, or a supportive partner, this simply is not the case. You may see the belly moving and continuing to grow but in many ways the reality of that does not sink in until that baby is born. Pregnancy can be a difficult time for any woman. A support system can be quite helpful.  For me that support came from my husband and has continued into raising our child together.

Filed under : Maternity Monday,Women's Health | By
Comments : 0 |
 
 

Maternity Monday: UVA’s Free Prenatal Classes

On May 11, 2015 | At 11:11 am

Are you a new parent or a parent-to-be and looking for some free advice? Oh Baby! is a free night of advice from UVA doctors.

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

Diane Sampson, education director for UVA Obstetrics and Gynecology, explains the event: “The talks are based on what our obstetricians and pediatricians wish they had known as first time parents themselves, and what our physicians want our patients to know before baby comes.”

What You’ll Learn:

  • Typical newborn behavior
  • Tips for calming a fussy baby
  • The top 10 things to know about breastfeeding before your baby is born
  • Postpartum: the good, the bad and the ugly

All participants receive door prizes, refreshments and helpful take-home materials.

Where: Quayle Learning Center, Battle Building. Park for free in the 11th Street Garage.

When: Wed., May 20th 6-8 p.m.

UVA also offers a variety of prenatal classes for family members of all ages. From breastfeeding and newborn care basics to grandparents and siblings classes, you can learn all aspects of welcoming a new addition to the family. They’re free, and new sessions start all the time.

Learn more about our available class options and sign up for Oh Baby!

 

Filed under : Events,Maternity Monday,Women's Health | By
Comments : 0 |
 
 

Maternity Monday: Twins, Triplets and Multiple Births (Infographic)

On May 4, 2015 | At 10:09 am

Multiple Births

 
 

Maternity Monday: Working Out While Pregnant

On April 27, 2015 | At 10:12 am

Spoiler alert: Your body is going to change when you get pregnant. It’s healthy and normal to gain weight throughout your pregnancy, but at the same time you can gain too much weight. Keeping yourself in shape may not be in the forefront of your mind, but doctors say that working out before, during and after pregnancy is extremely important. In fact, being at a healthy weight may increase your chances of getting pregnant. Being in good shape during your pregnancy will make your labor and delivery a little easier on your body. 

preconception, pregnancy and childbirth

Join us as we journey through preconception, pregnancy, childbirth and beyond in a series we call Maternity Monday.

When To Start Exercising If Pregnant

UVA pediatrician Ina Stephens, MD, highly recommends women work out during pregnancy. ”A pregnant woman can certainly work out and should be encouraged to do so,” she says. “Heavy weight lifting should be deterred, but otherwise, working out as you had been doing prior to becoming pregnant should be continued as long as you are feeling well and your ob/gyn feels that you are having a healthy pregnancy without complications.”

In fact, Stephens herself earned a black belt in Tae Kwon Do while she was eight months pregnant.

“If you work out before getting pregnant, continue to do so during pregnancy,” Stephens says. “It’s healthy, normal and safe.”

On the other hand, if you weren’t big into exercise before getting pregnant, Stephens warns that it may not be the best time to start pushing yourself to the limit. It is still safe to be active, of course. Great options include low-impact exercises such as:

  • Stretching
  • Walking
  • Swimming

In addition, Stephens highly recommends prenatal yoga. The stretching benefits along with the connection you will have with your body are valuable for both you and your baby.

Body Expectations & Healthy Weight Gain During Pregnancy

So, what is a healthy weight gain? Stephens says to expect about 20-23 pounds of weight gain during a healthy pregnancy. This range will depend on your body type and whether you start at, below, or under your ideal weight before getting pregnant. Pregnant women should expect to gain about a pound per week during the second and third trimester. You’ll gain less weight the first and last month of your pregnancy than the remainder of the time.

One myth that must be busted is that a smaller baby is easier to deliver. Some pregnant women will go on a diet while pregnant to ensure a smaller baby. This can be incredibly dangerous to both you and your unborn child. You should add calories to your diet, not take them away. An additional 300 calories per day should be extremely helpful to keep up your energy as well as give your baby the nutrition it needs to grow.

Losing the Baby Weight

If you’re breastfeeding, continue to eat extra calories after giving birth. “There is no place for dieting when it comes to breastfeeding moms,” says Stephens. “Your body needs the extra calories, and it can take a toll on the baby if they do not get the calories they need. Your body is already going to be exhausted from lack of sleep, so stamina is important.”

Losing weight after giving birth comes naturally when breastfeeding. Continue on the healthy diet that you followed while you were pregnant, and your body will begin to shed the baby weight naturally.

Be sure to ask your obstetrician before resuming your workout routine after giving birth. Your body has been through a lot of trauma and needs time to repair itself before you start working out. Stephens says two weeks is a safe amount of time for those moms who had a natural birth and a little longer for those who had a cesarean section.