·
Handouts:
Outline with warning signs, onset info on back. Cards with my contact info. Student
info sheets.
·
From
office: Books. Doll and pelvis. Posters: pre-pregnant anatomy, full term anatomy.
Cervical dilation, effacement. Baby rotation and descent.
·
From
Home: Post-its for Onset of Labor, Stages of Labor video, contact info cards. Handouts.
Who are you?
Introductions. 10 minutes. End by
o
Bathrooms,
Other Facilities Issues. Schedule.
o
Intro
Self. They intro selves: name, due date, where giving birth.
Why are we here? 5 minutes. End
o
Class
objectives: Teach about late pregnancy, labor and birth so you know what to
expect. Help give you info and
practice time so you’ll you know in head and in body. Give you confidence. Teach
informed consent.
o
Participation:
Having fun. % Learned. Will be brainstorming, playing true/false games, sorting
games, etc. Needn’t know all answers; guess.
o
Practice
and homework: the more you put in, the more you get out.
o
Book:
I’ll give you page numbers and homework assignments.
What’s your
experience of pregnancy? 10 minutes. ~7:25
Discussion
of common discomforts of late pregnancy. I give feedback / ideas.
What’s actually
happening during labor? 10 minutes ~7:35
o
Show
pre-pregnant body, full-term body. Comment on common Discomforts.
o
Vocabulary
(uterus, placenta, amniotic sac, cervix, etc.)
o
Cover
6 ways to progress. Ripening, Effacement, Cervical Position, Dilation, Baby’s
Rotation, and Station. Show diagrams for these.
What can I do to
affect these processes? 5 minutes ~7:40
o
Optimal
Fetal positioning: Why? Last 6 weeks, as baby engages.
§
How
do you tell what position your baby is in?
§
Baby’s
back heaviest, will naturally shift. Demonstrate w/ doll.
§
Positions
to avoid: leaning back in easy chairs, leaning back in car seats, putting knees
above pelvis, sleeping on back
§
Positions
to try as much as possible: kneeling, sitting upright, hands and knees, sitting
backwards on a chair, sitting on a birth ball; swimming breaststroke, crawling.
How will I know I’m
in labor? 15 minutes - 7:55
Onset of Labor Post-It
Game
Are there problems I
should be watching out for? 5 minutes.
Warning Signs in Late
Pregnancy. Ask them to brainstorm ideas w/o looking at
sheet. (Anything they don’t cover, I will add onto board at the end of
exercise)
Vaginal bleeding (except spotting after exam), fluid from
vagina (trickle / gush), sharp / constant abdominal pain, headaches, blurred
vision, significant decrease in fetal movements; Cramps and dull backache that
lasts more than hour, and that persists even if you drink water, change
positions. CALL CAREGIVER.
Basic Breathing. 5 minutes. ~8:05
Purpose: O2 to mom & baby. Relaxation.
Distraction.
Cleansing breath, and slow, relaxed, abdominal breathing.
Break ~8:15
What should I eat and drink in late
pregnancy? 10 minutes ~8:25
Protein: Breaks down into amino acids, used
to rebuild cells and support the growth of new tissue. You’ll need 60 grams of
pure protein a day; equal to 6-8 ounces of protein-rich foods.
Calcium: For strong bones and teeth, for
controlling heartbeat, transmitting nerve messages, blood clotting, and muscles
contraction. If the mother does not continually replenish her calcium, the
fetus will draw calcium from maternal stores, leaving the mom at risk for
osteoporosis later in life. Recommended: 1200 mg of calcium
per day.
Iron: Component of red blood cells. Pregnant
women’s blood volume doubles, and so do daily iron needs. Physicians typically
recommend daily supplements of 30 mg. Combine vitamin C-rich foods or juices
with iron-rich foods or supplements to maximize absorption. Baby is storing.
Sodium: Doctors used to advise women to
reduce salt intake to minimize fluid retention and swelling in late pregnancy.
However, we now know that reducing salt or fluids triggers the body to conserve
sodium and water, worsening swelling and causing blood pressure to rise. Salt to taste.
Fluids: While pregnant, your blood volume
increases by 50%, your baby is immersed in 1 quart of amniotic fluid, and
tissue fluid volume increases by 2-3 quarts. You need to drink at least 2
quarts of liquid a day (64 oz) to meet these extra fluid needs.
Raspberry Leaf Tea.
Calorie Intake: During 3rd
trimester, daily needs increase by about 300 calories.
Weight Gain During Pregnancy: Typical is 25-35 pounds. Underweight
before ~ 35 pounds. Overwt ~ 20. Gain should average 1 pound a week for the last 6
months.
Things to Avoid: Swordfish and shark due to mercury
contamination (may also affect tuna, pike, trout, and walleye.) All raw fish, especially raw shellfish. Raw
or undercooked meat. Unpasteurized milk. Soft cheeses, such as Brie, feta,
camembert. (Cream cheese is OK.) Caffeine, alcohol,
artificial sweeteners.
Are there exercises I can do to help prepare my body for
labor? 15 minutes.
o
Body
Mechanics: Hormones cause joints and ligaments to relax. Lift carefully. Watch
your posture: having strong abdominal muscles helps with this. Lying down and
supine hypotension. Getting up.
o
Exercise:
exercise regularly. Avoid bouncing / high impact. Avoid overheating. Stop if
you feel pain, headache, nausea, or dizziness.
o
Demonstrate
and have them practice: Kegels, Squatting, Pelvic
Tilts
Why is there pain in
labor? What makes it worse? Better? 15 minutes ~8:55
·
Pain
in Labor / Purpose of Comfort Techniques. 5 – 10 minutes.
o
Some
pain unavoidable, normal. We don’t want to stop processes, just minimize the
pain.
o
Other
factors are within our control. Stretching of pelvic floor muscles can cause pain, it helps if you do your Kegel exercises in advance.
Pressure on the bladder causes pain, so make sure you go to the bathroom at
least once an hour during labor. Reduced oxygen to uterine muscle increases
pain: breathing techniques can help. Muscle tension increases pain, and fear
and anxiety make you more sensitive to pain: relaxation can help with these.
o
Two
important concepts to help you understand the role of comfort techniques in
reducing the labor pain you experience.
§
Gate
Theory of pain.
§
Fear-tension-pain
triangle.
·
Bunnies.
·
Relaxation.
10 minutes.
o
Relaxation.
Purpose of relaxation: conserve energy / reduce fatigue. Calms mind, and
reduces stress. Reduces pain: physically, the muscle relaxation reduces pain.
Emotionally, reducing anxiety reduces perception of pain.
§
Roving
body check. They lay down, breathe deeply, I guide
through checking in with parts of their body, release tension on exhales.
o
Massage
and Touch Relaxation. Demo and practice if any time left.
Homework:
Practice exercises and slow paced breathing. Read Chapter 7, chapter 9
discussion of First Stage Labor (pp. 209-234).
Class 2 – First Stage Labor
·
Handouts
on table: Feedback folders with comment/question sheets, outline with first
stage labor info on back.
·
A-V
Materials Needed: Positions for Labor. Stages of Labor Video. Stages poster.
·
Supplies
to bring from home: Index cards for early labor techniques. Stages of Labor
video. BOOKS!!!!!!!!!!!!
Four-Breath Relaxation Technique (2-Breath)
Intros: What is your experience with labor and birth? Have you seen one? 10 mins
Early Labor
What does it feel like? What does it look
like? < 5 minutes
Effaces 50-100%, dilate to 4 cm. Ctx up to 30 minutes apart, getting to 6 or 7, 30-45 seconds long. Ask: “do you go to hospital as soon as labor starts?” Nope, because early labor lasts 2-24 hrs. Dr: 8-10 hrs normal; may augment past that.
Can walk and talk through contractions. Mom’s mood.
How do I know if I’m making progress? <5 minutes
Timing contractions (draw chart on board). Reminder of 6 ways to progress.
What should I do during early labor? 15 minutes
Vacation: Alternate rest, relaxation, distraction, and labor-enhancing activities.
An Early Labor Card Game: They draw cards describing comfort techniques, distractions, etc. They comment on why those might be helpful to people, and whether it would be helpful for them.
Active Labor
What does it feel like? What does it look
like? 5 minutes
Completely effaces, goes from 4-8 cm. Contractions 3-5 minutes apart, lasting 40-70 seconds. More painful. 30 minutes to 10 hours. Can’t walk and talk. Change in mom’s mood.
When is it time to go to the hospital?
What can I do to cope with labor and reduce
pain?
Breathing
Techniques: Hee-Hee. Hee-Hee-Blow. <5 minutes
Comfort Techniques:
Brainstorming Exercise with Feedback. 5 minutes
Positions: Hands-On
Exploration - which ones work best for you. 5-10 min
Transition
What does it feel like? What does it look
like?
Dilates fully to 10 cm. Contractions 2-3
minutes apart, lasting 60-90 seconds. More painful.
Lasts 10 minutes to 2.5 hours. Average is 1-1.5 hours
in first time moms. Mom’s mood:
Irritability, hostility; confusion and disorientation; may feel trapped and
want to go home; fear she is dying; dependence; extremely discouraged: “I
can’t, I can’t.” Mom’s
What does mom need?
What can help moms cope with transition?
Breathing technique: Variable Breathing
Take Charge Routine
Surrender to the Process
Break
Video: Stages of Labor.
Friedman’s
Labor Curve, Labor Plateaus, etc.
The range of “what’s normal” in labor.
Note: don’t include these times on graph!
They are more “physician’s view” than midwives’ view of how long labor “should”
take. For example, 
physician’s
expectation for progress from 4-10 cm is 1 cm dilation per hour; if you’re
dilating at less than half that rate, a physician may prescribe pitocin.
However, a recent study indicates that at non-augmented births, the average /
normal amount of time elapsed between 4 and 10 cm is 7½ hours, and that abnormal
progress shouldn’t be declared unless it has taken over 19½ hours for
first-time moms, 13½ for a woman who’s given birth
before.
What choices can I
make about my birth? How can I communicate those?
Birth Plans and Informed Consent.
What might my labor
be like? A dice game.
Explain: “
Two brown dice, one green. Set up four teams. Have each do step 1, then 2… write progress of each team on the board.
1. What time does labor begin? The two brown dice show the hour, on green dice, odd equals a.m. Even equals p.m. After they know time, ask them what they should do if their labor begins at this time.
2. Roll three dice to find out how long early labor is: how long till they’re ready to go to the hospital in active labor. Have them talk about how to cope with
3. Roll two dice to find out how long active labor lasts. How would you cope?
4. Roll one die, divide result in half to see how long they push. How cope?
Relaxation Exercise:
Homework. Practice breathing techniques and positions. Read remainder of chapter 9: pp
235-256. Discuss with partner: plans for early labor: where would you like to
be? What do you want to do? What will help you remain calm and relaxed?
Next week: Birth. Labor Support.
Class
3 – Delivery. Labor Support
AV needed: Position posters
From home: Video of Labor
Support, Labor Rehearsal materials
Practice contractions with ice cubes. Once, fighting it for 60 seconds; once, deep breathing and relaxing.
Intros: Tell me some of your
normal techniques for coping when sick/stressed. ~7:15
Stage
2 Labor: Pushing and Birth ~
What does it feel
like? What does it look like?
3 – 5 cm dilated, 45 –
90 seconds long. Urge to push
How will I know when
to start pushing?
What are some helpful
ideas for Stage 2 Labor?
Breathing Techniques: When pushing. When you are asked Not to push.
Spontaneous versus Directed Pushing.
Positions for Birth: Hands-On Practice and Evaluation.
What happens immediately after the baby is born?
Stage 3 Labor: Delivering the Placenta
Repair of Tears or Episiotomies
Initial Newborn Procedures
Labor Support –
Who will support me
during labor? What can they do to help?
Who: Partners, friends and family, doula, nurse.
What is labor support?
What is not helpful labor support?
Break
Video: Labor Support. 20
minutes. ~8:15
Putting it into Practice:
Labor Rehearsal ~
Relaxation Technique
Homework: Practice positions
and breathing. Read chapter 12. Discuss, or explore through art or journaling:
“What are my fears about labor and birth?”
Next week: Hospital
Procedures, Pain Medication.
Class 4 – Hospital Procedures, Pain Meds, Video
·
A-V
Materials Needed: Picture of monitor, IV. Where does epidural catheter go?
Hello Baby Video
·
Supplies
to bring from home: Epidural role-play kit. Birth bag. My positions poster,
supplies for labor rehearsal.
Intros: Birth Bag Exercise.
~7:15. Pass around my birth bag. Have
everyone pull out an item, then go around and ask: “What is it? Why would it be
helpful?”
What will the
hospital be like? 20 minutes. ~7:35
· “Unwritten Rules” of Hospitals: What do you wear? Where does a patient “belong”? What are hospitals for? What is the goal of medicine? Ask the question, (gets them to explore cultural assumptions), and then discuss how this applies to birth (wear what you want, don’t be in bed, etc.)
· Triage: they’ll check your status. May send you home.
· Vaginal Exams: what? Why? Best to minimize.
· Vital Signs
· Fetal Monitoring: Discuss advantages and disadvantages. Protocols.
· Food? Liquid? IV? Lots of hospitals don’t let you eat in labor… so, eat before you go to the hospital!!
If I want to avoid pain medication, what will help me do that? 5 minutes ~7:40
What are my options for pain medication? 10 minutes ~7:50
IV, IM, Epidural
Analgesics (Narcotics) versus Anesthetics: explain that analgesics “take the edge off” but don’t take away pain. When would that be a good option…
Advantages and Disadvantages of IV / IM medications
What is an epidural? How does it work? 20-25 minutes. ~8:10
The Epidural Role Play. Practice informed consent.
Advantages and Disadvantages of Epidurals
Maximizing the Advantages and Minimizing the Disadvantages
Break
Video: Carl and Donna on
Hello Baby
Practice session: positions,
breathing techniques, etc.
Activity:
Homework: Discuss pain med
preference scale with partner, and discuss how to make pain medication
decisions during labor. Discuss (or journal) the following questions: What does
pain mean to me? How do I usually deal with pain? How does
our society / my upbringing tell me to deal with pain? What can I do now which
will help me accept the normal pain of labor and not fight against it?
Read chapter 10 and 11.
Class 5 – Variations of
Labor, Medical Interventions, Cesarean Birth.
AV
Materials Needed: Poster of positions for back labor. Forceps.
Vacuum. Alternatives to Pitocin.
Home:
Flip chart 2nd stage interventions. Video of c-section, back labor techniques
Before class: Roving body check.
Intros: Share
a birth story you’ve heard that doesn’t seem to fit the pattern you’ve heard
for what a “normal birth” is. ~7:15
What
if my labor starts before my due date? 2 minutes
Premature Labor. (And a discussion of the meaning of due dates.)
What if my baby is overdue? 2 minutes ~7:20
My doctor has mentioned inducing labor. What does that mean? 10 minutes ~7:30
Reasons why a doctor would recommend inducing labor
Methods for inducing labor: Natural methods (nipple stim, intercourse, etc.)
Medical methods (prostaglandins, pitocin, AROM)
Risks of inducing labor: longer, stronger contractions. Hard on mom: may lead to
more need for pain meds. May lead to fetal distress.
Tests of fetal well-being: Kick counts, NST, CST (Before a baby is induced, just for being “late” doctors should check to see if the baby is having any problems…)
First
Stage Interventions 5 minutes. ~7:35
What
if first stage labor is moving really slowly?
Remind them of normal variations in the length of first stage labor
Patience versus Augmentation
Changing position, being active, Natural methods of augmentation
AROM and Pitocin
I’m throwing up a lot during labor. What
should I do? Emphasize: it’s normal to throw up
in labor… not everyone does, but many people do. If it’s early labor, keep
eating light snacks to keep your energy up. Late in labor,
probably a cue to stop eating…
Keep drinking! Try non-sugary drinks like water, tea, etc.
Second Stage Interventions
– 10 minutes. ~7:45
Second stage is going
slowly. What can I do? What might doctor do?
Refresher: normal length of labor, position changes
Episiotomy
Forceps and Vacuum Extractor
Cesarean Birth 20 minutes
~8:05
Why would I need to have a cesarean section?
Indications. For planned c-section: breech, multiples, certain medical conditions in mom or baby, previous c-section. For emergency cesarean: emphasize that these are very rare, only due to medical emergencies where mom or baby’s immediate well-being is at risk. For unplanned c-section: failure to progress, “CPD” (controversial), fetal distress (controversial: may be overdiagnosed due to EFM), maternal exhaustion.
Exploring alternatives with your caregiver. (e.g. do we have to do this now, or can we wait another hour and see if I progress?)
What are the risks of cesarean surgeries?
What is a cesarean?? How does it work?
Video.
What is recovery like after cesarean?
What can I do to help avoid a cesarean
birth? Prior to labor: Optimal Fetal
Positioning, good nutrition, rest, Kegels, pelvic
tilts. Avoid induction. Early labor: stay at home, eat, drink, alternate rest and labor-enhancing activities. Active labor:
delay pain medication, avoid AROM, change positions
often. Pushing: Change positions often, try hands and knees, kneeling, or
supported squat
Break
Back Labor and Convincing
Posterior Babies to Rotate 15 minutes ~
What should I do if I’m feeling
contractions in my back? Hands and knees, open
knee chest, counterpressure, double hip squeeze
What other signs are there that my baby
might be posterior? Coupling
contractions. A contraction pattern that goes ctx,
ctx, pause, pause, ctx, ctx, pause pause instead of ctx pause ctx pause ctx pause
Video and/or Practice!!
Labor
Scenarios: Small group discussion,
“practicing” how to deal with some of the variations that may come up in your
labor process. 30 minutes
I
have index cards I hand out with things like:
Homework:
Chapter 13, 14, 15. Write up birth plan, discuss with physician.
Next
week: Breastfeeding and Newborn Care
Class
6 – Breastfeeding and Newborn Care
AV
Supplies Needed: Dolls. Diapers. Blanket.Poster of breast anatomy,
poster of latch. Breastfeeding booklets to hand out: Motherwear
and Medela.
Bring
from home: Breastfeeding video. Sling. Outline for
Breastfeeding on flip chart. Cards for breastfeeding myths.
Baby Books.
Pre-Class:
Touch Relaxation or Visualization
Introductions: 5 minutes
interactive. ~7:15
Have
everyone share a little about their experience with caring for babies.
Things
to do Before the Baby comes: 5 minutes lecture. ~7:20
Supplies. Car
seat, diapers, a few simple outfits. A sling. A place for baby to sleep.
Decisions: Baby’s doctor. Cord
blood donation. Circumcision? Breast
or bottle?
·
Care
Provider: Pediatrician. Family practice. Check insurance. Referrals? Prenatal
interviews: see baby books for info on how to choose.
·
Cord
Blood: What? Why? Can donate at Swedish. Bank anywhere??
·
Circumcision:
Can be done by an
·
Feeding.
Before the birth, plan for this. The best option for baby’s health is:
breastfeeding, second best is pumping breastmilk and feeding in a bottle, third
best is pumping milk, freezing it, then thawing it. Fourth best option is
formula.
Newborn
Procedures:
Lecture. 5 minutes. ~7:25
Immediately after birth, suctioned, placed on chest,
sometimes given oxygen.
Apgar scores: Heart rate,
respiratory effort, muscle tone, reflexes and skin color. Gives
a snapshot of the baby’s condition at 1 minute after birth and 5 minutes after
birth. More thorough exam in first 24 hours.
Cutting
the Cord:
Clamped and cut. Timing? Does Dad want to? Tell
caregiver…
Newborn eye care: Within 1 hour. Required by law. Doesn’t hurt, does make blurry.
Blood Tests. Heel
prick. PKU, hyperthyroidism, galactosemia,
sickle cell anemia, and sometimes hypoglycemia. Most are quite rare, but
they can cause severe health issues for the baby, early treatment and
prevention help. Required.
Normal
Newborn Appearance 2 minutes.
-
Jaundice: if yellow eyes or yellow below nipples, call dr. Light therapy.
-
Swollen genitals. “Stork bites” coneheads,
birthmarks, milia, pimples.
12
months of pregnancy. 1 minute.
4
million years ago, human ancestors began walking upright, pelvises became
smaller to accommodate upright stance. By 1.5 million years ago, size of
hominid brain had doubled. Babies needed to be born sooner to fit. Thus born
neurologically immature: extremely dependent, can’t regulate temp, needs to eat
frequently, easily overstimulated. Thus, human babies
tend to be most content when their first few months resemble life in the womb: carried
much of the time, fed frequently, kept at a comfortable temperature, and given
the opportunity to rest when tired.
Baby Communication. 2 minutes. ~7:30
Baby Cues. Babies have lots of
ways to communicate their needs to their caregivers. Some are subtle, but if
you learn to speak their language, and respond to these early cues, babies may
have less need to escalate up to full-scale crying.
·
Hunger
Cues. Rooting, tongue thrusts, sucking, wiggling.
·
Tired.
May stare off and yawn. May rub at ears or eyes. May turn her head from side to
side as though fighting sleep. Eyes may roll back under eyelids.
·
Too
hot. Breathes rapidly and may have a clammy neck. Too cold: skin may be marbled
or blotchy.
·
Bored
or overstimulated. Turns away from something, looks
away.
·
Calming
themselves: may do a repetitive, moaning cry to “blow off steam”
·
Pain.
Comes on suddenly, is louder than a normal cry, may be high-pitched, and baby
may hold his breath for longer.
Temperament. Give examples.
Elimination. Diapering.
Interactive / Practice. 15 minutes. ~7:45
Diapering. Show cloth and disposable options. Practice. As they practice, review:
·
Meconium.
·
After
day 3 or so, stools change. Normal stools of breastfed baby: yellow, mustardy looking, loose stools; may have curds like cottage
cheese, fairly mild-smelling. Some babies have a bowel movement after every
feeding; breastfed babies should have at least 2 bowel movements a day for the
first month. After that, some babies only have a few bowel movements a week
(some babies still have 10 a day).
o
Constipation
is rare in breastfed babies.
o
Very
wet stools are normal. Diarrhea is different: mucousy,
foul-smelling, potentially blood-tinged… child appears ill and listless.
·
Formula-fed
babies may have only one or two putty-like stools per day. Odor is stronger
than with breastfed babies. Constipation is much more common.
·
Touch
on diaper rash and diaper creams, touch on night-time
diaper issues.
·
Touch
on how to tell if a disposable diaper is wet, and when to change it.
Dressing. Demonstrate ideas like
reaching in to pull the hand through, how to hold / turn over / support while
dressing.
Swaddling. Demonstrate.
Crying. Lecture. 5 minutes. ~7:50
·
How
much: 2 weeks: 1.8 hours a day. 6 weeks: 3 hrs. 12 wks, 1 hr. Draw on board,
note pattern.
·
They’ve
done studies worldwide on baby’s crying. They find that all babies cry about
the same number of times each day. However, the total amount of time spent
crying ranges radically from culture to culture, depending on how baby’s are cared for. In !Kung culture, where they’re
carried most of the time, and fed quite frequently, they spend half as much
total time crying per day as American babies.
·
After
looking at this, an American researcher did a study where Experimental group
asked to carry an extra 3 hours per day. They averaged 4.4 hours of carrying
per day, versus the Control group babies carried 2.7
hrs per day.
·
Supplemented:
They cried for 1.8 hours a day at week 3, when the carrying began. This amount
decreased gradually to 1 hour a day at week 12. The peak at week 6 was
eliminated. Total amount of crying time for babies who were carried more was
reduced by 43% at week 6, and 23% at week 12.
·
Colic:
3 hrs/day, 3 days/wk, peaks at 2-3 mos, fades 4 mo High-pitched, distressed, babies grimace. Evening hours.
In the
·
Holding
and rocking the baby, walks, drives
Demonstrate slings.
Sleeping
Lecture.
10 minutes. ~7:55
How much does a
newborn sleep?
Newborn 12 to 20 hours of the day.
Wake
frequently, rarely sleep for more than three hours in
a continuous period.
Study:
Maximum bout at 2 months was 5 hours.
Why do they wake up so
often?
More time in light sleep, than deep. SIDS protection
Newborns
also need to eat fairly often. Breastfeed every 1.5-3 hrs.
Bottlefeed every 3
Where should baby
sleep?
For daytime naps, you can put them down in whatever room you’re in. At night,
share a bed; sleep in a cradle or bassinet in their parents’ room, or may sleep
in a crib in a separate room.
1/3
always share, 1/3 occasionally, and 1/3 never sleep w/ parents. World-wide…
Safety:
firm surface, on back, light sheet. If sleeping with parents: avoid soft
mattresses, couches, and waterbeds. Parents under influence of alcohol or drugs
should not co-sleep.
Co-sleeping. Wake more
frequently, spend more time in light sleep than deep sleep. They nurse twice as
often (average interval: 1½ hrs), 3x as long per bout. Rarely cry, sleep for
longer total time than solitary sleepers. Mothers get at least as much sleep.
Benefits
for Baby: Immature nervous systems. Adult’s body may serve as a cue or trigger
to help the baby regulate temperature, breathing, and arousal patterns.
Solitary Sleeping. Solitary infants
wake less often, and spend more time in deep sleep. (Easier on the parents, but
SIDS risks: sleep deeply and unable to arouse) Nurse less often: average
interval 3 hours. However, total sleep time less than co-sleep. When wake up,
cry loudly or for a longer time, may be harder to settle down. One study showed
that the average co-sleeping baby spent .5 hours per night crying, the average
solitary sleeper spent 2.5 hours per night crying.
Combination of co-sleeping
and solitary sleeping.
Put baby on back.
BREAK.
Introductions. 10 minutes
Comment
on breastfeeding as “natural and instinctive” but yet something you need to
learn how to do.
Go
around, and have everyone share what
experience they have with breastfeeding: family? Friends?
Women in malls?
Anatomy
and Physiology:
5 minutes (Lecture with Diagram / Drawing on Board)
Cover
areola; alveoli,
sinuses… sucking action compresses these
sinuses, openings in nipple.
Colostrum:
rich in protein, vitamins A and E, antibodies. Low volume.
Invaluable
When
placenta detaches, drop in estrogen and progesterone signals production of prolactin, which
guides the body in milk production. The
Mature
milk begins to be produced around 3-5 days after birth.
Prolactin: foremilk.
Suckling signals oxytocin production
and milk ejection reflex (“letdown”),
Supply
and Demand! Even if breasts don’t feel full, milk is there.
Breastfeeding Myths and Truths. 15 minutes.
Positions: No matter the
position, make sure (demonstrate what NOT to do)
·
You are comfortable. bring
the baby up to your breast. Pillows help.
·
Belly-to-belly. Lying straight, with ears, shoulders, and
hips in a straight line.
·
Make
sure you can support your breast and your baby to ensure a good latch. (see
below)
Everyone practices.
Latching-On: Areola not just
nipple. Baby bird mouth. Flanged
lips. 5 minutes.
Sucking rhythmic, wavelike, with audible swallowing after
5 days.
No lip smacking.
Suck-swallow,
suck-suck-swallow, pause…
Video showing positions and latch. 5-10 minutes
Hunger
Cues: how do you tell if your baby is hungry? Rooting, sucking,
tongue thrusts, wiggling. Crying is LATE cue. 2 minutes
How often? How long? How do you tell when you’re done? at least 8-10 times a day, at least every three hours. Many babies want more! Feed on demand. More you nurse, more you produce. Each feeding should be a minimum of five minutes at each breast. Typical feeding 10-15 minutes at each breast.
Nurse until the baby either falls asleep, pauses more than he sucks, or pulls away from the breast. When you want to remove a baby from your breast, first break the suction by slipping a finger in the corner of the baby’s mouth.
Then burp the baby, and switch sides. 5 minutes
Burping the Baby: (Demonstration)
Switching Sides:
How do I know if I have enough milk?
· 99% of women make enough milk.
· Is baby pooping and peeing? After day 5 or so, you should see about 6-10 wet diapers a day, and at least 2 bowel movements (may be a b.m. with every feeding!).
· Is the baby gaining weight? It is normal for a baby to lose 10% of his birth weight in the first few days after birth. As long as he gains again after that, he’s getting enough milk.
· If you are concerned about your milk supply, remember that it works on supply and demand. Give it more demand (i.e. nurse your baby more often!) and your milk supply will increase. Eat well, drink lots, and rest, and you will produce milk. Taking a 24 hour cure can also help with milk production. Snuggle up, skin-to-skin, in bed with your baby for 24 hours, nursing as much as he wants to.
First
Nursing:
One of the factors most important to long-term breastfeeding success is to
initiate (begin) breastfeeding in the first hour after the baby’s birth. Most
babies have an awake and alert period in this first hour, and interested in
feeding.
Technique
is not important here. It’s just important to begin that connecting and bonding
process. Ideally, you and the baby should be skin-to skin, his belly against
yours (cover the rest of him up with a blanket to keep him warm.
Because
of the importance of this feeding, you can request that medical staff wait
until the end of this hour for such interventions as eye treatment, weighing
and measuring the baby, first baths, etc. [Please note: this feeding is
important, but if for some reason you are unable to nurse in the baby’s first
hour, this shouldn’t cause any long-term problems.) 2 min
Birth
Plan:
2 minutes. To ensure the best start to your breastfeeding relationship, request
the following: 24 hour rooming-in (baby stays in mom’s hospital room rather
than in nursery), feeding on demand (you feed your baby whenever he seems
hungry, not following a schedule), no formula or water for the baby, no
artificial nipples for the baby, and minimal intervention in the first hour
after birth.
Early
Days of Breastfeeding:
For the first few days, the mother’s body produces colostrum, which is low
volume, but high in nutrients and antibodies. She will begin to produce mature
milk starting around day 3 to day 5. The more mom nurses the baby, the more
milk production is stimulated.
Some
babies will have a rough day on day 3 to 5. They may be fussy and act hungry,
or they may be sleepy. They may not have bowel movements or urinate as much.
This is generally not a cause for concern. It is usually simply because the
mother’s milk has not come in yet, and the baby is not getting much volume of
liquid. Nurse frequently, and your milk should be in
full production within a few days. 2 min
Early Weeks of Breastfeeding 5 minutes.
Sore Nipples: It is not unusual for
the mom to develop sore nipples in the first few weeks of breastfeeding. If
your nipples are sore, seek out a lactation consultant (see resource list for
contact info) or experienced moms to be certain that you have a good latch,
good positioning, and that the baby seems to be nursing well. If everything
seems fine, this is likely to be a temporary problem that will improve soon.
To
help prevent sore nipples, and help sore nipples heal: Don’t wash your breasts
with soap, just use clear water: your breasts produce natural lubrication,
which soap washes away.
Hold
your baby close, belly to belly. Make sure he’s latched well. Switch sides, and
vary positions. Break suction before moving baby away from breast. After the
baby is done nursing, express a little breastmilk, and rub it into your
nipples. The vitamin E in the milk acts as a moisturizer.
Expose
the nipples to fresh air for at least 15 minutes a day, and expose them to
sunlight through a window if possible.
Most
importantly: Nurse more often, for less time at each nursing.
To
cope with sore nipple pain: Usually it will only hurt for the first minute or
so that you’re nursing. Use labor breathing techniques to help relax. Start on
the least sore side first.
Engorgement: Sometimes, before
your milk production regulates itself, you may have times when your breasts are
very full with foremilk; so full that they are hard, swollen, and painful. If
this happens, soften them with: warm showers, warm washcloths or heating pads,
or pumping or expressing a little milk. Once you have softened your breasts
enough that the baby can latch on, nurse the baby. Again, nurse more often, but
for less time at each feeding.
Long-Term: Once breastfeeding
has been established, it is the only food that your baby needs for the first
six months of his life. There is no need to supplement with water, or formula,
or solid foods. After six months, you can begin adding in solid foods.
The
The
World Health Organization recommends nursing until at least two years of age,
and there are many cultures worldwide where children are nursed beyond that
age.
Many
babies experience growth spurts at around age 6 weeks, 3 months, and 6 months.
At these times, it may seem like they want to nurse non-stop to meet their
increased nutritional needs. Just nurse them when they’re hungry, and know that
soon your milk production will increase to meet the increased demand.
Pumping,
Storing, Babysitters, and Going Back to Work 5 minutes.
Breastfeeding
does not have to be an all-or-nothing proposal. Many people breastfeed for a
portion of the baby’s feedings, pump and bottle-feed breastmilk for some
feedings, and use formula for other feedings. Breastmilk is better for your
baby than formula, so the more feedings that include breastmilk, the better.
We’ll talk a little today about pumping and storing breastmilk to feed your
baby, and I encourage you to seek out more information on this, by reviewing
the information in the booklet, handouts that come with your breastpump, and the books listed in the reference section
of the breastfeeding guide (page 31). There are lots of ways to make
breastfeeding work for you and your family, and you don’t have to give up
breastfeeding completely until you and the baby are ready to do so. If you
reach a point where it’s difficult to pump to meet all your baby’s needs, and
you switch to using formula primarily, you can still include breastfeeding: for
example, some women nurse their babies only at bedtime as part of the bedtime
ritual. Their milk supply adapts to this lowered demand.
There
are several different types of breastpumps available.
Take a look at the Medela guide over break for more
details on all of these. Generally, if you plan to breastfeed you baby the
majority of the time, and will only be pumping occasionally, you can get a
small handheld pump, either manual, or battery-operated; pumping with these can
take up to 30 minutes. If you plan on pumping every day, or multiple times a
day, you’ll want an electric pump, possibly one that can pump both breasts at
the same time. This can reduce your pumping time to
Storage:
Make sure your pump is kept clean. For storage, use glass or plastic containers
that can be washed in the dishwasher, or specially designed disposable plastic
bags. You can safely keep your milk for up to 8 hours at room temperature, for
eight days in the back of the refrigerator, or two weeks in the back of your
freezer section. ETC. on food safety (not thawing and
re-freezing, etc.)
Using:
Thaw or warm breastmilk by placing it under cool running water, then gradually
increase the water temperature until milk is warm, or by placing it in a
container of warm water. Do not use the microwave to thaw breastmilk, or to
warm formula, as it can lead to “hot spots.” Warm only as much as you expect
the baby to eat; you can always warm more if he’s still hungry.
Bottles:
there are several different brands of bottles and nipples on the market. If
your child doesn’t do well with one brand, try another. Try to delay
introducing artificial nipples till the baby is at least six weeks old and
nursing is well-established. Starting it earlier can lead to nipple confusion
and inefficient nursing. (ETC on breastfeeding is harder work than bottlefeeding for baby…)