After delivery FAQ's

Do I want my infant given the Hep B vaccine after birth?

**Hepatitis B Vaccine sheet**

If I have a male infant, do I want him circumcised?

Feeding options for the baby

    Bottle feeding

• You will need to chose a brand of formula if you are planning on bottle feeding
• Similac or Enfamil are the basic brands to start with.

Breastfeeding

• You need to initiate breastfeeding within the first hour after birth if possible!
• The baby is in a state of quiet alertness the first 2 hours after birth

Guidelines and Technical Pointers

• Most babies need and naturally request 8-12 feedings in a 24 hour period.
• Approximately every 1-3 hours
• They may cluster feed (feed every hour for several hours in a row)
• Early sleepy days the baby tends to not request feeds often enough
• Notice hunger cues
• Wake the baby by 2 ½ hours from the beginning of last feed
• Keep baby interested and awake during feeding

How do I know my baby is getting enough to eat?

• Is the baby eating every 1-3 hours?
• Sleeping no longer than 3 hours between feeds during the day
• Should have no more than one 4 hour stretch at night the first week of life.

Other positive signs to be aware of

• Audible swallowing- you will hear milk being swallowed
• Breast feel less full
• Baby is satisfied
• Baby is content between feedings
• Expect initial weight loss of baby after delivery; weight gain of 4-7 oz per week once milk is in greater supply.
• Your baby should be back to birth weight by day 10

Milk production is regulated by DEMAND and supply.  The concept being:

• The more milk that is removed, the more milk that is made.
• The less milk that is removed, the less milk that is made.

Breastmilk

Colostrum

• This is the first milk
• Very high in protein
• Easily digested
• Provides protection by containing antibodies and passive immunities

Transitional Milk

• This occurs after colostrum in approximately 48-72 hours
• High levels of fat, lactose and water soluble vitamins
• More calories and high protein

Mature milk

• Your milk will change and increase in quantity in approximately 48-72 hours.  It may take longer depending on when breastfeeding was initiated and breastfeeding frequency.

Breastmilk Storage

Breastmilk	Refrigerator Storage	Freezer Storage
Expressed Breastmilk	-Store for 5-7 days in coldest part of refrigerator -Do not store in door of refrigerator	-Store for 3-4 months in the back of freezer. Do not store in door of freezer. - 6 months in deep freeze.
Frozen Breastmilk	-Thawed breastmilk that is unopened or unused is fine in the refrigerator for 24 hours.	- Do not refreeze breastmilk
If you intend to freeze breastmilk	-Always chill freshly pumped breastmilk in refrigerator before adding to frozen or refrigerated breastmilk	Freeze within 24 hours

How much can my baby's stomach hold?

• A newborn baby's stomach is the size of a small marble.
• It can hold 5-7 mls
• The walls of stomach cannot stretch
• Perfect for small amounts of colostrum.
• From 7-10 days it increases to around the size of a ping pong or golf ball
• It can hold 1.5-2 oz

 Engorgement:  What do I do?!!

• Three to four days postpartum, your breasts will feel heavy and become swollen
• This is due to: increase in blood flow, swelling of surrounding tissue, accumulation of milk

Some effective treatment measures for engorgement

• Nurse frequently
• Apply warm compresses or stand in shower to initiate let-down with breast massage
• Manually express or pump out milk to soften areola and nipple (the baby cannot latch-on if it is too hard)
• Apply cold compresses to breast after nursing to relieve the swelling and soothe discomfort
• Wear a sleep bra even at night but make sure it is not too tigh

Lactation Consults

• Maternal Child Department -  688-2200
• CC Public Health - 

Stool and Urine in the breast fed infant

• Baby will be passing meconium for the first stools. (thick black tarry stool)
• Stool will change to mustard color, runny and seedy in texture once your milk is in greater supply.
• 3-4 stools pre day in the first month
• May have a little stool after each feeding as well

Urine

•  Your infant should have 1 wet diaper in the first 24 hours after delivery
•  2 on the second day of life
•  3 on the third day of life
•  5-6 wet diapers of urine that is yellow in color once milk is in greater supply

Nutrition during pregnancy

• On average, the increased demands of pregnancy require an additional 300 calories each day.
• Women who are pregnant with twins or higher-order multiples need an additional 300 calories per fetus each day.
• Recommended weight gain is 28-40 lbs for underweight women
• 25-35 lbs for normal weight women
• 15-25 lbs for overweight women

Nutrition during Breastfeeding

For each 20 calories of breastmilk produced.  The women must consume an additional 30 calories.  This results in a dietary increase of 500 to 1000 calories each day for women who are maintaining body weight.

Visiting Guidelines

• We have visiting guidelines to protect our patients, their families, other visitors, and staff from potentially contagious disease. 
• We will allow only 4 visitors at one time + FOB

Visiting Restrictions

• During heightened flu awareness, usually October thru March,  only 4 designated visitors + father of the baby and or support person will be allowed on unit.
• Patient will be given 4 bands that can be given to any 4 individuals (age 12 and above) the patient chooses.  These bands will only allow these 4 people to visit during the duration of patient's stay.  We will not honor cut off or taped on bands.
• In severe flu outbreaks, the patient will only be allowed to have the father of the baby and/or the support person visit the mother for the duration of the stay.