Newborn Prep 9:30 – 4:00

Supplies Needed: Newborn Care Kits, Babies (n+1). Poster: Normal Newborn Appearance. Breastfeeding Box. Food vouchers. Water (juice?)  Nametags, roster.

Handouts: Outline, Feeding your Newborn, Getting Ready for your Baby, Crying and Calming in Newborns, This is the Way the Baby Rides, [Characteristics of Newborn Babies], PEPS brochure, resource guides. Cord blood donation.

Supplies I bring from home: Sling, video of normal newborn appearance and newborn cues. Video of breastfeeding. Breastfeeding Myths and Truths. Video of crying

Write on board: My email. (206)386-MOMS. 215-3338 Class Registration.

Introductions: 15 minutes interactive. 9:30 – 9:45

Housekeeping. Bathrooms. Breaktimes. Drinks.

Intro myself

Intro the class: Mostly focus on the first month. Focus on: Keep Baby Safe and Healthy and well-nourished, help you feel more confident and more prepared, and give you some resources to turn to for more information as questions arise. All info from both classes, interwoven. We’ll go through in same order you’ll experience: pre-birth onwards. Book refs.

Intro themselves, what experience they have with baby and breastfeeding, big questions

Holding the Baby 9:45 – 9:50

- Baby size. Dolls are 7-9 pounds, 18-21 inches. Avg. newborn 7.5

- Anchor points: back of neck, somewhere on rest of body. Passed the test.

- Options: cradle, football, sitting up with back on chest, burping, on thigh; yes it’s scary

- Slings.

- For next 3 hours, don’t put baby down!

Things to do Before the Baby comes: ~10:10

Taking care of baby now: Nutrition: 300 extra calories per day. Lots of iron (2x as much as normal: Increased blood volume, baby storing. 30 mg), protein (all cells formed from protein. 60 grams/day: 6-8 oz food), and calcium (66% more. 1200 mg) Prenatal vitamins. Fluids: 2 quarts per day.  Baby gaining ½ pound a week.

Decisions.  to make before the baby comes.

· Care Provider: Has anyone done this yet? Pediatrician or family practice. Insurance? Referrals. Interview. Book 155-57

· Circumcision: decide in advance. AAP: not medically necessary, insurance may not cover.  $200+. Who/How/When. Locker room: in 1999 65% nation-wide, but 37% in Western states. Pp 402-4

· Cord Blood Donation:

· Feeding. Plan before birth. Breastfeeding best. Can combine. Classes. Pp 423-425. If planning to breastfeed: No roughing up. Inverted nipples. Bras, clothes, nursing pads.

Supplies and Equipment.  Handout: Getting Ready for your Baby.

Essentials: Diapers, a few basic outfits, a place for them to sleep (crib, bassinet, bed) and a car seat to bring them home in. I would add a sling or front pack. Loving people.
Plan where to change baby’s diaper, and come up with something to use as a diaper bag.

Bras, nursing clothes, nursing pads.   Consignment shops. Prints and plaids, no tight shirts.

What you don’t need:

Get support!!

Newborn Procedures: Lecture.  10:10 – 10:20

Immediately after birth: Suction / oxygen. Laid on chest or warming table.

Cutting the Cord:

ID Bands

Apgar: heart rate, respiratory effort, muscle tone, reflexes, skin color. 1/5 mins. Exam w/in 24 hrs.

First hour is yours.

Newborn eye care: W/in one hour erythromycin. Required.

Vitamin K shot. Helps with blood clotting. Required.  Hepatitis B

Blood Tests. Heel prick: PKU, hyperthyroidism, galactosemia, sickle cell anemia, and sometimes hypoglycemia. Conditions rare but severe effects, treatable. Required.  Book 389-93

Weighing and Measuring. First Bath.

Paperwork for birth certificate, SS#

Beginning Breastfeeding 10:20 – 10:35

Start within First Hour

Anatomy and Physiology of Breastfeeding

Ask them: What’s happened to your breasts during pregnancy?

Nipples darken, target. Montgomery glands become more prominent. Blood flow to breasts increase: may see veins. Fatty tissue develop to cushion and protect milk ducts. Each breast grows average of 2 lbs. New bra?

Pregnancy: >estrogen = sensitive nipples, milk ducts lengthen. > progesterone = alveoli develop. 

3^rd trimester, colostrum. Has anyone seen yet? Just wipe off with warm water

15-20 milk ducts per breast… not just one opening!

Inverted nipples? With finger and thumb at noon and 6:00 on areola, gently press down toward wall of chest. (Don’t squeeze thumb and finger together, or the nipple may invert further.) Nipple should pop out. If it turns inward…

When baby is born, placenta delivered, progesterone and estrogen levels plummet, and prolactin, another hormone, tells your body to begin producing milk.

Your milk does not begin to come in until 3-5 days after birth. In meantime, colostrum.

Nursing lots helps _mature_ milk come in, gives baby lots of colostrum benefits

Start nursing baby within one hour of birth.

Once mature milk comes in: foremilk, hindmilk. Oxytocin letdown. (Nachos, dinner)

Supply and demand: breasts don’t necessarily feel full

Position and Latch ~10:40

Have moms pick up babies: show common mistakes: baby in lap, baby head turned to side

Look, magically, you’re doing cradle hold. Teach details.

Latch

Teach football hold. Touch on breastfeeding after cesarean

Teach side-lying. While they practice, touch on night-time feeding. Address safe co-sleeping.

Video 10:40 – 10:50

Baby Communication ~10:50

Baby Cues. If learn to speak language, they have less need to escalate to 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 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. Sudden, louder than normal cry, high-pitched, may hold his breath for longer.

12 months of pregnancy  ~10:55

4 million years ago: walking upright. 1.5 million yrs, big heads. Neurologically immature: temp regulation, breathing, startle easily, more consistent the environment with womb, the better. Avoid overstimulation: can’t filter yet.

Break

Taking Baby Home.  ~ 11:10

The rest of the time in the hospital: get to know each other, get advice, breastfeeding class at 11

Going home: simple clothes, feed just before leaving

Car seat details: rear facing to one year AND 20 pounds. Center of back seat, behind driver. 5 pt harness. PRACTICE installing, practice putting baby in. Check car owner’s manual and car seat manual. Booster till 6 yrs / 60 pounds.

www.saferidenews.com Search for WA Booster Seat Coalition or “Child Transportation Safety Tips”

Feeding  7 minutes  See chapter in baok ~11:20

- Frequency: every 1.5 – 3 hours. Start-time to start-time. Tiny tummies, milk digests quickly. Doesn’t mean not enough milk! Supply and demand.

- How do you know when hungry? Cues reminder. Avg. time from 1^st cue to cry: 15 minutes

- Feed baby on demand. (Dads help look for cues!) NO SPOILED BABIES

- Swedish strongly discourages scheduling in first month. Babywise after 6 weeks at earliest.

- Let eat till done. (Pulling away, fall asleep, more pause than suck)

- Growth spurts at 2 weeks, 6 weeks, 3 months.  (Periods of disequilibrium.)

Burping. What do you need to do when you’re done feeding baby? Burp. ~3:15

Switching Sides.

“Signs” Baby is getting enough.  Write on board.  7 minutes.  11:30

Start just after birth. Colostrum till day 5.

How you know milk comes in: More wet diapers/Bms. More swallowing. “Flooding”

Do I have enough milk? Assume you do!

Feeding 8-12 times per day, at least ten minutes per feeding!

Wet / soiled diapers: at least 1 diaper per day for every day old. After 7 days 5-10 per day.

            Disposables: how can you tell? Girls: assume peeing.  Can chart to keep track.

Gaining weight.

24 hour cure

Elimination. Diapering. Interactive / Practice. 15 minutes.  ~11:45

Show cloth and disposable. Talk about options briefly,

• Show how to change, including info on how to wipe, covering boys up, etc. Then have everyone practice on dolls. As they practice, review following things.

· Meconium. Greenish black, tarry poop.

· After Day 3 or so: Breastfed baby poop. Appearance, mild smell, at least 2 BM a day for first month, may have lots more. Diarrhea rare, constipation rare.

· Formula-fed: one or two putty-like stools per day. Odor is stronger, Constipation 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.

· Diaper-changing station.

· Cloth vs. Disposables. How many a week.

Dressing. Demonstrate ideas like reaching in to pull the hand through, how to hold / turn over / support while dressing.

Swaddling. Demonstrate. ~11:55

Bathing, lecture, demo. 5 minutes.  12:10 – 12:20

Cord Care:

Sponge baths.

Bathing.

Normal Newborn Characteristics (Video?) 10 minutes.  12:20 – 12:30

Sleeping  Lecture. 10 minutes. ~4:15

How much does a newborn sleep? Newborn 12 - 20 hours / day. Wake frequently, rarely sleep more than 3 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 need to breastfeed every 1.5-3 hrs. Bottlefeed every 3

Where should baby sleep? For daytime naps, 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. No blankets, pillows, stuffed animals. Sleep in gown, or warm p.j.’s Room temp 65-68 in winter… no man-made heat over 70 degrees.

If in crib: mattress on highest level, AAP recommends no bumper pads. (If you have them, need 6 pairs of ties, top and bottom, four corners and sides, firm, no more than 14” high. Take out when baby can roll and sit up.) No more than 2 3/8 inches between slats of crib, no more than one adult finger between mattress and slats.

If sleeping with parents: avoid soft mattresses, couches, and waterbeds. Parents under influence of alcohol or drugs should not co-sleep.

Co-sleeping in same room. Wake more frequently, more time in light sleep than deep sleep. 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.

Reducing risk of SIDS, the 3^rd most common cause of death in infants: Sleep on back, keep away from second hand smoke, breastfeed, keep stuff out of crib, no blankets, room temp.

Baby’s Temperament

Different Parenting Styles. Book references.

Crying and Calming. Lecture.  ~4:35

· Video: 10 minutes?

· Study of 3 different cultures showed babies cried the same number of times per day no matter what parents did. However, in the !Kung culture, the total time spent crying was only half as much crying as American babies. !Kung babies are carried much of the time, sleep near family members, and are fed frequently.

· So, a study was done to examine effect of carrying on crying. Experimental group asked to carry an extra 3 hours per day.

· Controls: “normal” crying curve started at 1.7 hours a day at week 3, peaked at 2.2 hours at week 6, and decreased to 1.3 hours a day at week 12.

· Supplemented: the peak at week 6 was eliminated. 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 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 U.S., up to 20% of parents report. In other cultures, unknown. Physiological causes (allergies and food intolerances) in 5% of cases. Overtired, over-stimulated babies? Window of opportunity.

Plug slings and front packs.

Warning Signs

Temperature Taking. Axillary temperature above 99.5 degrees F. should be reported to baby’s dr.

Health Care: Get a good book, use it often!!

Doctor visits, immunizations.

Hurdles. (Write on board)   ~12:35

Engorgement: Sometimes in first week, can be anytime. Need to release some milk: warm washcloths, shower, hand express. Then nurse as long as baby will take it.

Sore Nipples: keep dry, express and rub in. Fresh air and sunshine. Keep nursing!

Thrush: White patches that don’t rub away. See dr.

Clogged Ducts, Mastitis. Massage, warm compresses, natural tx. antibiotics (milk not infected)

Lack of support, tiredness, fears, pressure to share feeding responsibilities, etc.

Pumping and Bottles ~15 minutes

Introducing the Bottle: wait until at 3-4 weeks (it’s easy, baby will get lazy) Do by 3 months or so. If you haven’t started one yet by 5 months or so, try a sipper cup

What type of bottle: doesn’t matter. They will nurse differently than on breast

If medically possible, don’t pump for first few weeks, want to focus on baby bonding

Show pumps. Discuss options. Whittlestone. Where to get (www.kidalog.com) Can rent! ~12:50

How to Bottlefeed: ~12:55

Tip bottle up. 2-4 oz 8-10 times a day. 2-3 ounces for every pound of baby.

Once they’ve eaten off a bottle, can’t be re-stored for later use as bacteria builds

Serve milk or formula at room temp to body temp

How to heat: not microwave!

Whenever baby eats from bottle, you should pump! Keeps us milk production.

Storage:  ~1:00

4 Best Foods for Baby

Pump, put in bag. Label. Don’t put more than 2 ounces in bag for newborn, 4 at most. Twist tie

CDC: room temp for 10 hours

Fridge for 8 days. Set up a system, use oldest milk first

Freeze for 3 months, if fridge cold enough to keep ice cream hard. (Turn up) Middle of freezer

Thawing: in fridge overnight. Or in warm water bath (replace water when cool)

Combining formula and breastfeeding.

Doesn’t have to be all or nothing.

How long to breastfeed:  ~1:05

AAP says exclusive for 6 months. (No water, juice or food needed)

Supplement with solid foods for 6-12 months.

Then as long as mutually desired. Talk about what it’s like to nurse a toddler.

Sanity/Self Care for Parents. ~4:45

Parenting a Newborn is incredibly challenging… pushes all your coping abilities… “can’t understand the idea of abuse, yet do….”

What can you do:

- One of the worst problems is sleep deprivation: Sleep when the baby sleeps.

- Make sure you have nutritious food in the house that doesn’t need to be cooked, and that you can hold in one hand while you hold the baby in the other.

- Bring a bouncer seat or a carseat into the bathroom with you so you can still get a shower, with the baby nearby (often the sound of the water will lull a baby to sleep.)

- Be gentle with yourself: if the house isn’t as clean as you normally keep it, try not to stress about it; if you’re not making progress on any of the projects you had planned for “quiet times” at home, stay relaxed.

- Try to let go of “rules”: shoulds, always, and nevers. Stay in the moment: what can you do to make things better right now.

- Find peer support: There’s nothing quite like being around other people who are experiencing some of the same challenges you’re facing. Seek out other new parents. The resource list includes support groups, postnatal exercise groups, and parent education groups; there are also things like Gymboree, Kindermusik, baby swim classes, etc. Hanging out at playgrounds and chatting with other parents also helps. Being around other parents helps lighten the sense of isolation and overwhelming change for the parents. It also allows you to see lots of different babies and lots of different parenting styles, and come up with new ideas that work for you and for your family.

- Call on friends or family before it gets bad.

Impact on Relationship

Sexuality

Resources

(206)386-MOMS.

Family Help Line: Referral to support. Crisis line 9 am-11 pm 1-800-932-HOPE (4673) or (206)233-0139

Parent Anonymous/Family Helpline. 24-hour support line; 1-800-932-4673

Seattle Children’s Hospital Resource Line, for basic health information: (206)526-2500

PEPS Resource Guide: www.pepsgroup.org

Breastfeeding Discreetly

Safety. Before your baby begins crawling, you’ll need to do some childproofing in the home. Before he begins walking, you’ll need to do more. Before he begins climbing, you’ll need to do still more.

Entertaining / Playing

Talk about songs and games if there’s time left.