Preconception Planning

The physicians at OB/GYN Specialists strongly recommend that women who are planning to have a baby schedule an appointment for preconception planning before they conceive. While there are no guarantees in life, you can certainly reduce the risk of complications (for both you and your baby) by taking the time to prepare for your pregnancy ahead of time.

Birth Control - If you have been taking birth control pills, OB/GYN Specialists physicians recommend that you discontinue the pills and wait approximately three months before attempting to conceive. Not only does this break allow you to be on prenatal vitamins or folic acid supplements for a full three months before you become pregnant, it also allows you to go through several normal cycles before becoming pregnant, enables us to more accurately predict when you ovulated and conceived, and will help us to establish a more reliable due date. During this period, you should use condoms or another barrier form of birth control. You can discuss the options with your physician during your preconception meeting.

Current and Past Health Issues - If you have an on-going medical condition such as high blood pressure, diabetes, or asthma, it is best to ensure that your condition is under control before becoming pregnant. Even if your condition has been stable, you may require special care and monitoring during pregnancy since your growing baby will put many new demands on your body. Medicines should be evaluated for their safety in pregnancy prior to conception.

Previous Pregnancies - Your doctor will want to know about your previous pregnancies (if applicable), including any complications you might have had. These include high blood pressure, gestational diabetes, preterm labor, and delivery by cesarean section, as well as other possible complications. This will allow you and your doctor to take proactive measures that will increase the probability that your next pregnancy will be a healthy one.

Prenatal Vitamins and Folic Acid - You will get most of the vitamins and minerals you need from a healthy diet. However, it is difficult to get enough calcium, iron, and folic acid (a B-vitamin that helps to prevent defects of the brain and spinal cord known as neural tube defects) from the food you eat. Therefore, we recommend that you take a prenatal vitamin or folic acid supplement every day. According to the Centers for Disease Control and Prevention, up to 70% of neural tube defects can be prevented if women have adequate levels of folic acid leading up to and immediately following conception. Because neural tube defects originate during the first month of pregnancy (before many women know they are pregnant), it is desirable for women planning to become pregnant to take a folic acid supplement - by taking either a prenatal vitamin or 1 mg of folic acid daily - before conception. This will help reduce the risk of neural tube defects. If you prefer to take a folic acid supplement rather than prenatal vitamins during the preconception period, we recommend that you switch to prenatal vitamins once you conceive.

Medications - Your doctor will want to know any medications that you are currently taking. This includes prescription medications as well as over-the-counter medications, herbs, and other supplements. Some herbs, medications, and supplements should not be taken during pregnancy. Your doctor will provide you with information about medications that are safe to take during the preconception period and pregnancy.

Family History - Your physician will ask you and your partner questions about your family medical history. A history for potentially inheritable health conditions (such as seizure disorders, diabetes, or high blood pressure) or genetic diseases (such as cystic fibrosis, sickle cell anemia, Tay-Sachs, or Duchenne muscular dystrophy) may increase your risk of having a baby with certain conditions or birth defects. If this is a concern, your physician may refer you to a genetic counselor for an evaluation. Your physician may recommend that you and your partner be tested for certain genetic diseases (such as sickle cell trait), especially if you are uncertain about your family history. Even if you do not have the disease yourself, you and your partner might carry the defect in your genes and can pass it along to your baby.

Immunities - Your doctor will want to know if your immunizations for tetanus, rubella, and chicken pox are current. If you are unsure, your doctor may want to do a blood test to check your immunity. Diseases such as rubella and chicken pox can cause serious complications for your unborn baby. If you are not immune, you can receive vaccinations to help protect you against these diseases. After vaccination, you should wait at least one month, preferably two to three, before becoming pregnant.

Diet - If you want to lose weight, we encourage you to do so before you become pregnant. Pregnancy is not the time to diet! To help your baby get a head start in life, we encourage you to eat a balanced diet that includes lean meats, fresh fruits and vegetables, whole-grain breads and cereals, dairy products and other calcium and iron-rich foods. Limit your intake of caffeine to the equivalent of two (2) caffeinated beverages per day.

The Food & Drug Administration (FDA) has assured the public that the safety of aspartame (Nutrasweet, Equal), including during pregnancy, is clear-cut, saying that aspartame is one of the most thoroughly tested and studied food additives of all time. The FDA and the joint FAO/WHO (Food & Agriculture Organization of the U.N. and the World Health Organization) Expert Committee on food additives have deemed sucralose (Splenda) safe for everyone to consume, including pregnant women. However, some still question whether these sweeteners are safe to use during pregnancy. Therefore, especially if you have concerns, we recommend limiting your intake of these sweeteners. (Patients with PKU should not use aspartame at all while attempting to conceive or during pregnancy.) There are many questions about the safe use of saccharine (Sweet 'n Low) during pregnancy.

You may eat up to 12 ounces (approximately 2 average meals) per week of fish or shellfish that are lower in mercury including salmon, canned light tuna, pollock, catfish, and shrimp. Avoid shark, swordfish, king mackerel, and tilefish. Because of U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) recommendations, we advise that you eat no more than 6 ounces of albacore (white) tuna per week while attempting to become pregnant and during your pregnancy. You should also avoid eating any game fish without first checking its safety with their local health department. For more information about the risks of mercury in fish and shellfish or for information about specific types of fish, visit the FDA's Food Safety Website at http://www.cfsan.fda.gov/~frf/sea-mehg.html. For information about the safety of locally caught fish and shellfish, visit the Environmental Protection Agency's Fish Advisory website or contact your State or Local Health Department.

Exercise - Establishing a regular exercise routine during the pre-pregnancy period will help you improve your fitness level (which will be helpful during your labor and delivery), help relieve stress, and will help prevent health problems such as high blood pressure. Maintaining your exercise routine during pregnancy will help relieve some of the common discomforts of pregnancy (such as backache and constipation) and will help you feel your best. There is evidence that exercise may help prevent gestational diabetes. If you do not already exercise, your doctor will be able to provide you with guidelines for exercise based on your current condition and your medical history, as well as parameters to follow once you become pregnant.

Dental Care - We encourage you to make an appointment with your dentist prior to pregnancy. Let your dentist know that you are trying to conceive so that adequate precautions can be taken, as indicated. You may have dental x-rays with a shield, and the dentist may use local anesthesia. Your dentist may call the office if there are any questions regarding medications to be prescribed.

Body Temperature - Raising your core body temperature over 102 degrees orally can be dangerous to your unborn baby, especially during the early weeks of pregnancy. Therefore, you should avoid the hot tub, sauna, or any prolonged exposure to hot water that might increase your body temperature while you are trying to get pregnant. Treat high fever with acetaminophen (Tylenol) and avoid other sources that might significantly increase your body temperature.

Other factors - Other factors that should be considered during the preconception period are possible occupational and environmental exposure to substances that may be harmful during pregnancy such as organic solvents, agricultural or household pesticides and insecticides, chlorinated hydrocarbons, alkylating agents, polychlorinated biphenyls, and radiation. Your doctor will want to know if you work in a chemical plant, laboratory, dry cleaners, pharmacy or compounding shop, are employed or live in an agricultural area, or if you work or live in an environment where you are exposed to chemicals, radiation, or other potentially harmful substances. If you need x-rays for any reason, be sure to let the technician know that there is a possibility that you may be pregnant so that they can properly shield you beforehand.

Smoking - Smoking nearly doubles the risk for having a low-birth weight baby, which puts the baby at risk for serious health problems during the neonatal period and chronic life-long problems. Smoking has also been linked to a number of pregnancy complications and puts a woman at twice the risk for developing serious placental problems (such as placenta previa and abruption). Studies show that women who smoke may have more problems conceiving than non-smokers. If you smoke, your doctor will provide you with resources to help you kick the habit before you become pregnant.

Alcohol - Alcohol can cause serious mental and physical defects. When a woman drinks alcohol, it passes through the placenta to her unborn baby. The baby's immature system breaks down the alcohol much more slowly than an adult's system, so the alcohol level in the baby's blood is higher and remains elevated longer than the alcohol level in the mother's blood. This can lead to serious and life-long damage to the baby. Babies born to women who drink excessively or have repeated episodes of binge drinking during pregnancy are at great risk for developing fetal alcohol syndrome (FAS), a combination of physical and mental defects and one of the most common known causes of mental retardation. It is unlikely that a drink or two (before a woman realizes that she is pregnant) will harm her baby, but no amount of alcohol has been proven safe. Therefore, we recommend that women do not drink ANY alcohol during pregnancy. If you are attempting to become pregnant, you should abstain from alcohol. If you have a drinking problem, you should discuss it with your physician and address it before becoming pregnant.

Illegal Drug Use - Everything that is taken into your body during pregnancy has an impact on your growing baby. Use of illegal drugs can cause serious complications - for you and your baby. The risks for complications to mother and baby are as varied as the list of illegal drugs. However, birth defects and pregnancy-related problems caused by illegal drug use are completely preventable. As with smoking and alcohol abuse, pregnancy should be delayed until the problem is resolved. If you have a drug problem, please discuss it with your physician.

Domestic Violence - Unfortunately, domestic violence is all too common in women's lives, especially during pregnancy. If this is a problem for you, please discuss it with your physician.

Smoking, alcohol abuse, drug abuse, and domestic violence are all issues that should be addressed prior to pregnancy - for your health and your baby's health. More importantly, your baby will be more safe, secure, and happy in a home where these are not issues - for either you or your partner.

Planning Ahead - While nothing is risk-free, taking all these factors into consideration before you conceive is a smart plan and will help move you closer to your goal of delivering a healthy and happy baby.

Eighty to ninety percent of couples that are trying to conceive will do so within one year. Occasionally, it takes a bit longer. If you and your partner have been unable to conceive after a year of unprotected intercourse, there is a possibility that one of you may have a fertility problem. If this is the case, speak with your doctor. Infertility usually does not mean that you cannot have a baby, but it may be more of a challenge for you to become pregnant. Your doctor can help you take measures to increase the likelihood that you will conceive or can refer you to a specialist that treats infertility problems.

Candle Research Study

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We are a participating physician practice in the UT Candle Research Study. The University of Tennessee is looking for women who:

• Are less than 28 weeks pregnant
• Have a low risk pregnancy
• Live in Shelby County, TN

Moms receive $500 in gift cards during the study. We will be happy to discuss the study with you during a prenatal visit. For more information, click on this link: www.candlestudy.org.

Basic Information

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On your initial obstetrical (OB) visit you will receive a packet of information regarding your new pregnancy. You will also have a chance to meet with one of our insurance department staff who will assist you with many of the financial details of your prenatal care, such as providing you with an explanation of your insurance benefits and establishing a financial agreement and payment plan for any amount not covered by your insurance.

If you need to inquire about starting prenatal vitamins or folic acid, please call our office. Prenatal vitamins can be refilled as needed throughout your pregnancy by calling your pharmacist.

During your pregnancy, you will usually be seen for regular visits every four weeks until 28 weeks; every two to three weeks until 36 weeks; then weekly until delivery. We will do a number of routine tests to assess your health and the health of your baby. These include a standard blood pregnancy profile and a pap smear and cultures at your first visit; blood tests for diabetes and anemia in the second trimester; and a vaginal culture for Group B Strep at 35-36 weeks. We offer a Quadruple Screening Test at 15-18 weeks to screen for Spina Bifida and Down's Syndrome. Amniocentesis will be offered (as indicated) for women age 35 or over or for any woman who has other risk factors for genetic abnormalities. We offer everyone a routine screening sonogram at 18-22 weeks. This test is not always covered by insurance. Please check with your insurance provider.

Safe Medications during Pregnancy

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You may use this as a guideline for medications which are safe to use during your pregnancy. Please call the office if your symptoms persist or if you have a fever over 100.4 degrees.

Cold Symptoms
For allergy or cold symptoms, you may take Sudafed or Sinus Tylenol, Robitussin (Plain or DM) for cough, and Sucrets or Chloraseptic Lozenges for sore throat associated with allergies or a cold.

Indigestion
Mylanta (either chewable or liquid), Maalox, Mylicon, Gaviscon or Tums are all safe to take for indigestion. If you have persistent problems with indigestion, there are some things you can do: eat small, frequent meals, avoid carbonated beverages and spicy foods, do not drink through a straw, and do not lie down after eating. If these changes do not help or if you have nausea and vomiting or severe abdominal pain, contact your physician.

Headaches or Discomfort
Tylenol - Regular or Extra Strength. Ibuprofen may be used in the first and second trimesters ONLY. DO NOT USE ASPIRIN. Call the office if pain persists or if headaches are accompanied by blurred vision, pain in the upper right abdomen, sudden weight gain, or swelling of the face and/or hands.

Minor Bladder Irritations
Eliminate all carbonated beverages, coffee, and tea from your diet. Increase your water intake to 8-10 glasses per day and drink 3-4 glasses of cranberry juice per day. If not better within 24 hours, please call the office.

If urinary symptoms include hesitancy when you start to void, a strong sense of urgency to void, increased frequency and burning on urination, fever, chills, low abdominal pain or cramping, back or flank pain, blood in the urine, or foul-smelling urine, please call the office immediately.

Swelling
Do not add salt to your food (get rid of the salt shaker!) and limit or omit high-sodium foods such chips, salted nuts, pretzels, soy sauce, bouillon and canned soups, bacon or ham and other processed meats. Many canned and processed foods contain a lot of sodium. Check nutrition labels and limit your sodium intake to 2 gms. per day. Elevate your feet whenever possible. Please call the office if swelling continues, if you notice significant swelling in your face or hands, or if swelling is accompanied by a headache or epigastric pain.

Backache
Avoid wearing shoes with heals and standing for long periods of time. Sit in chairs that provide good back support. A warm bath, heating pad, or cold compresses can help ease back pain. You may take Tylenol as needed for pain. Call the office if backache continues.

In the late second and third trimesters, back pain can be a sign of preterm labor or urinary tract infection. If you have back pain that is intermittent and rhythmic, does not respond to any of the above treatments, or is accompanied by severe pain and/or fever, call the office immediately.

Nausea
Try eating dry crackers before getting out of bed in the morning. Eat every two or three hours throughout the day. Avoid smells that trigger nausea, highly seasoned or fatty foods, alcohol, caffeine, and cigarette smoke. Sometimes peppermints or ginger tea can help reduce nausea. Do not take prenatal vitamins on an empty stomach or if feeling nauseated. If not controlled with diet, try Emetrol (if not diabetic) or Nestrex. If vomiting continues, call the office.

Leg Cramps
Avoid standing or sitting with your legs crossed for long periods and stay well-hydrated. Eat a balanced and calcium-rich diet. Get regular exercise and stretch your calf and thigh muscles by stretching them three times a day and before you go to bed (see below). Lie down on your left side to improve circulation to your legs. Try taking a warm bath before going to bed to help relax your muscles. Increase calcium intake by taking Calcet or Forfree (over the counter).

If you do get a cramp, immediately stretch your calf muscles by straightening your leg - press down on your heel first and gently flex your toes back toward your shins. It might hurt at first, but it will ease the spasm and the pain will gradually go away. Walking around for a few minutes after the cramp subsides may be helpful, too.

Call the office immediately if your muscle pain is continuous and is accompanied by redness, warmth, tenderness, or swelling. These can be signs of deep vein thrombosis.

Stool Softener
Surfak, Docusate, Dialose, Metamucil, Fibercon are all safe to take during pregnancy.

Constipation
Try to avoid constipation by staying well-hydrated (drink plenty of fluids), eating fresh fruits and vegetables, and exercising. Milk of Magnesia or Senekot are safe to take for constipation.

Diarrhea
If you have diarrhea, you should stick to a bland or clear liquid diet until the diarrhea subsides. It is safe to take Kaopectate or Immodium to treat diarrhea after 12 weeks of pregnancy. If diarrhea lasts more than 48 hours or is accompanied by weakness and fatigue, nausea and vomiting, right upper abdominal or epigastric pain, headache, blurred vision, bleeding from the gums or from minor trauma, jaundice or yellowing of the skin, or pain in the shoulder or neck, call the office immediately.

Hemorrhoids
To prevent hemorrhoids (or piles), eat a healthy diet that includes fresh fruits and vegetables, drink plenty of liquids, exercise regularly, use a stool softener (if needed), and avoid standing or sitting in the same position for prolonged periods. If you develop hemorrhoids, you can soak your rectal area in tepid water for 10-20 minutes several times per day in the bathtub or using a sitz bath (a small basin that will fit into the opening of your toilet - can be purchased at most drug stores). Preparation-H, Anusol, and Tucks can be used to treat hemorrhoids.

Postpartum Information

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Congratulations on the birth of your baby! Here are some guidelines for homecare and breastfeeding from our OB/GYN Specialists physicians:

1. Your rest is important! Rest during the day when your baby sleeps. Limit visitors. Taking care of yourself and your baby is a big job. Do not expect to be "Super Mom." Ask family members and friends to help you.
2. Take your prenatal vitamins, as directed by your doctor. You will heal faster and have more energy to care for yourself and your family. If you are breastfeeding, be aware that some foods may cause your baby to be gassy or colicky. These foods include cow's milk, cruciferous vegetables (such as broccoli, cauliflower, cabbage, and greens), onions, chocolate, peanuts, corn, tomatoes, wheat, citrus fruits, highly spiced or seasoned foods, beans and other legumes, seafood, garlic, caffeinated beverages, and strawberries. That does not mean that you cannot eat these things at all while breastfeeding, but it is often wisest to omit these items from your diet when you first start breastfeeding. You may then slowly add new foods, one at a time. Every baby is different and what may cause problems for one baby may be perfectly fine for the next. If the new addition to your diet causes gas or colic, your baby may have a sensitivity issue with that particular food and avoiding it in the future would be a good idea. Sometimes you will find that offending foods do not cause problems if you reintroduce them in your diet when your baby is older.
3. Drink 6-8 glasses of fluid each day. This is especially important if you are breastfeeding.
4. Your baby needs to eat every 2-3 hours or on demand. For breastfeeding mothers, continue to use the various positions taught by the nursing staff and breastfeeding educators. A good, supportive bra should be worn. Manual breast pumps may be used at home if necessary. Electric pumps are available for rent or purchase from the hospital in which you delivered. For formula feeding mothers, increase the amount of formula based on your baby's demand. You will usually start out with the same formula that was given to your baby while you were in the hospital. Any change in formula should be discussed with the pediatrician. To limit milk production in the first few days, bind the breasts with an ACE wrap. Remove the wrap daily to shower. Uncomfortable engorgement usually gets better within three to four days. DO NOT pump the breasts to relieve discomfort as this will only stimulate more milk production. Cold compresses or ice packs can be applied to the breasts for short periods of time and you may also take ibuprofen to provide relief. For further information consult your doctor or childbirth/breastfeeding educator.
5. Continue your perineal care (peri-care) with warm water after going to the bathroom. Pat dry. Change your sanitary napkins with each trip to the bathroom. You may soak your perineal area in tepid water for 10-20 minutes in the bathtub or using a sitz bath (a small basin that will fit into the opening of your toilet - can be purchased at most drug stores) 3-4 times daily if stitches or hemorrhoids are painful. The stitches will absorb in three to four weeks and do not need to be removed.
6. Do not douche or use tampons for six weeks after delivery.
7. Kegel exercises will help to promote healing and improve muscle tone. Kegels, or pelvic floor muscle exercises, are done to strengthen the muscles that support the urethra, bladder, uterus, and rectum. To identify and isolate the muscles of the pelvic floor, sit on the toilet and start to urinate. Try to stop the flow of urine mid-stream. The muscles you use to stop or slow the flow of urine are the pelvic floor muscles. "Kegels" are done by squeezing these muscles as if you are trying to stop the flow of urine. Do the exercises twice a day for five minutes. Try to hold the contraction for five seconds, then rest for five seconds. Gradually increase the time that you hold the contraction.
8. Try not to strain to move your bowels. If you do, splint or hold the episiotomy with a clean sanitary pad. Be sure to wipe yourself from the front to back. You may need to take a stool softener or laxative.
9. Avoid sexual intercourse until after your postpartum check-up. You can become pregnant without a return to your normal menstrual cycle.
10. Notify doctor of: (1) Fever, 100.4 orally or greater (2) Burning on urination, (3) Excessive bleeding (more than a heavy menstrual flow), (4) Swelling, redness and/or tenderness in one or more areas of the breasts or legs, (5) Foul-smelling vaginal drainage, (6) Redness, swelling and/or drainage from your abdominal incision or episiotomy stitches, (7) Excessive pain.
11. Cesarean Delivery: Keep your abdominal stitches clean and dry. Shower daily. Carefully cleanse your incision with soap and water. Pat dry with a towel. If clips or staples are used, they will be removed before you go home or at your first doctor's office visit. Avoid the use of any oil based or petroleum products on the incision, especially if surgical glue was used on your incision.
12. Exercise during the first six weeks after delivery should be limited to walking. Do not lift anything heavier than your baby. Be aware that over-activity can cause bleeding.
13. Your doctor will tell you when you may resume driving your car. You make take short rides and resume light housekeeping activities after delivery. Try not to do too much. Your first weeks at home should be devoted to you and your new baby!
14. Most mothers report feeling very sad and/or tired from time to time the first few weeks. This is normal. If these feelings interfere with caring for yourself or the baby, please call your doctor or childbirth educator. (See Postpartum Depression.)
15. Your desire for sexual intimacy will depend on your physical health, emotional state, and your feelings (and your partner's) about adjusting to your new lifestyle. Share your needs and desires, as well as your concerns, with your partner. Again, avoid sexual intercourse until after your postpartum check-up as you can become pregnant again without a return to your normal menstrual cycle.
16. When you get home, call your doctor's office and make an appointment for your postpartum check up. Birth control information will be discussed at this visit. Returning to work will also be discussed.

Baby Blues

Taking a new baby home should be a time of overwhelming joy and excitement. This time can also be extremely stressful for most women as they experience concern for their healthy baby and significant lifestyle changes. Some anxiety and nervousness is considered normal during this period; however, increasing fear and worry, great sadness, or "not feeling normal" may be a sign of more significant problems.

It is not uncommon for women to experience a roller coaster of emotions during the first days after delivery "happy one minute; crying and sad the next" a period often referred to as the "baby blues" (most commonly seen on the third or fourth day after delivery). More than 50% of new mothers will experience the "baby blues." Although each woman's experience may be different, the "baby blues" are often characterized by feelings of disappointment, crying for no known reason, irritability, impatience, anxiety, or restlessness. These feelings are likely due to biochemical changes and new mothers should be reassured that the situation is generally transient. Symptoms usually go away without treatment within a few days up to two weeks after onset. However, new mothers with the "baby blues" should be monitored for development of more severe psychiatric disturbances such as postpartum depression or postpartum psychosis.

Postpartum Depression

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While the exact cause for postpartum depression is not known, it is likely that a number of different factors, such as the changing of roles (as a spouse and new parent), hormonal changes, stress, a personal or family history of depression or other mental illness (especially postpartum depression), and marital strife may be involved. Depression can occur during pregnancy or within a year after delivery. The exact number of women with depression during this time is unknown, but researchers believe that depression is one of the most common complications during and after pregnancy. Often, the depression is not recognized or treated, because some normal pregnancy changes cause similar symptoms and are happening at the same time. Tiredness, problems sleeping, stronger emotional reactions, and changes in body weight may occur during pregnancy and after pregnancy. But these symptoms may also be signs of depression. The difference between “baby blues” and postpartum depression/postpartum psychosis is that the baby blues can happen in the days right after childbirth and normally go away within a few days to a week. A new mother can have sudden mood swings, sadness, crying spells, loss of appetite, sleeping problems, and feel irritable, restless, anxious, and lonely. Symptoms are not severe and treatment is not needed. But there are things you can do to feel better. Nap when the baby does. Ask for help from your spouse, family members, and friends. Join a support group of new moms or talk with other moms.

Postpartum depression can happen anytime within the first year after childbirth. A woman may have a number of symptoms such as sadness, lack of energy, trouble concentrating, anxiety, and feelings of guilt and worthlessness. The difference between postpartum depression and the baby blues is that postpartum depression often affects a woman’s well-being and keeps her from functioning well for a longer period of time. Postpartum depression needs to be treated by a doctor. Counseling, support groups, and medicines are things that can help.

Postpartum psychosis is rare. It occurs in 1 or 2 out of every 1000 births and usually begins in the first 6 weeks postpartum. Women who have bipolar disorder or another psychiatric problem called schizoaffective disorder have a higher risk for developing postpartum psychosis. Symptoms may include delusions, hallucinations, sleep disturbances, and obsessive thoughts about the baby. A woman may have rapid mood swings, from depression to irritability to euphoria.

For More Information . . .

You can find out more about depression during and after pregnancy by contacting the National Women's Health Information Center (NWHIC) at 1-800-994-9662 or the following organizations.

National Institute of Mental Health, NIH, HHS
Phone: (301) 496-9576
Internet Address: http://www.nimh.nih.gov

National Mental Health Information Center, SAMHSA, HHS
Phone: (800) 789-2647
Internet Address: http://www.mentalhealth.org

American Psychological Association
Phone: (800) 374-2721
Internet Address: http://www.apa.org

National Mental Health Association
Phone: (800) 969-NMHA
Internet Address: http://www.nmha.org

Postpartum Education for Parents
Phone: (805) 564-3888
Internet Address: http://www.sbpep.org

Postpartum Support International
Phone: (805) 967-7636
Internet Address: http://www.postpartum.net

Postpartum Breast Care

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Breastfeeding - Do not use soap on your breasts while breastfeeding as this can dry out your nipples. Rinsing with clear water is sufficient. If your nipples are very dry, you may use a small amount of pure lanolin on them. Lotions are generally not necessary as your nipples are already producing all they need for their protection. Always wash hands thoroughly before breast feeding or touching your breasts. Make sure nipples are dry after nursing. Leaving your bra flaps down for a few minutes to let them "air dry" is often helpful.

Sore nipples - some mild tenderness is to be expected as you and your baby get used to breastfeeding, but should improve within three to five days. Breastfeeding should not be painful. If it is, you need to find out what the problem is and correct it. Very sore nipples are usually caused by poor positioning or a baby that is latching onto the nipple improperly.

Improper positioning - make sure you are positioned comfortably, with pillows supporting your arms and in your lap (to bring baby up to the position of your breast). The baby should be face to nipple and tummy to tummy with you so that he does not have to turn his head to latch on to your nipple. Baby's chin should be just below the nipple so that it presses into your breast while nursing. If you do not feel comfortable, detach and reposition baby. Do not get frustrated. Some babies seem to take to breastfeeding more naturally and easier than others; it is a learning process. As you and baby become more experienced, you will find that there are a number of other comfortable positions for breastfeeding. Experiment and see what works - as long as you are comfortable and baby is nursing well.

Latching onto the nipple improperly - when latching onto the nipple, the baby needs to open wide to take in a good mouthful. (You may need to brush the tip of the nipple along the center of the baby's lips to stimulate the baby to "root" for the nipple.) If baby does not get enough of the nipple into the back of the mouth during sucking, the baby's tongue may be rubbing against the tip of the nipple or the baby may be gumming the base of the areola (over the milk sinuses). This kind of nursing is very inefficient (baby will not get enough milk and will want to nurse more frequently, making nipples even more sore) and will lead to painful nipples. If baby is making a smacking sound while sucking, he is not latched on properly. If you are having problems, try the following:

Make sure baby's mouth is opened very wide before pulling baby into the breast. Baby should latch on far back on the areola - approximately one inch beyond the nipple.

Make a "V" with your first and second fingers around the edge or slightly beyond the margins of the areola or by supporting your breast with your fingers underneath and thumb on top, pressing in to flatten the breast while pushing back toward your chest. This makes the areola more taut, longer, and narrower and easier for baby to take into the mouth.

Use the index finger on the hand supporting the breast to push down on baby's chin while baby is latching on. This will help keep baby's mouth open wide.

Always break the suction before taking baby off the breast by slipping a clean finger into the corner of baby's mouth or pressing down gently on the breast near baby's mouth.

Other causes for sore nipples include:

Flat or inverted nipples: Mothers with flat or inverted nipples can successfully breastfeed their babies without pain, but it may take a little more work and patience. Wearing breast shells during pregnancy may help to draw out your nipples. Once your baby is born, it may be helpful to use a breast pump immediately before nursing your baby to help pull out your nipple before baby latches on to the breast.

Engorgement: When your milk first comes in and during the early days of nursing, engorgement is not uncommon. Some babies have a difficult time latching on to an engorged breast. To avoid this, be sure your breasts are being emptied frequently. If your newborn is not breastfeeding every two to three hours, hand-expressing, or using a breast pump may help you avoid engorgement. The first breast that baby nurses on will be emptied more completely, so alternate breasts with each feeding to avoid having one breast that is overly engorged. Your milk supply will adjust according to baby's demands and the engorgement should resolve within a few days.

Removing Baby from Your Breast: Most mothers find that once full, baby will release the breast on their own. If baby must be removed from the breast before this happens, break the suction by inserting a finger into the corner of your baby's mouth, pulling down on baby's chin, or pressing down on your breast near baby's mouth. "Popping" your baby off the breast can cause sore nipples.

Thrush or Candida: If your baby is no longer a newborn and you suddenly find yourself with sore nipples that are red, blistery, itching, or burning or with deep breast pain, you may have thrush - especially if your baby has oral thrush (white patches on the tongue or sides of the mouth) or if you have just finished taking a course of antibiotics. Call your doctor if you suspect you have thrush.

Mastitis: Occasionally, you might experience blocked milk ducts. Signs of a blocked duct include areas of the breast that are reddened and/or tender and engorged. It is important to continue breastfeeding when you notice this so that the baby will drain the breast. This will not hurt the baby. Offer the affected breast first and, if possible, position baby so that affected area is aligned with baby's nose and chin. The symptoms should subside once the breast is adequately drained. If the breast becomes hot and painful, if you run fever, or if the skin appears tight and shiny, you should notify your doctor. DO NOT stop breastfeeding on the affected breast.

Lactation Suppression: To limit milk production in the first few days, bind the breasts with an ACE wrap. Remove the wrap daily to shower. Uncomfortable engorgement usually gets better within three to four days. DO NOT pump the breasts to relieve discomfort as this will only stimulate more milk production. Cold compresses or ice packs can be applied to the breasts for short periods of time and you may also take ibuprofen to provide relief. For further information consult your doctor or childbirth/breastfeeding educator.