Hey Mama! A Guide to Pregnancy, Birth and Babies

A Guide to Pregnancy,

Birth and Babies

Hey Mama!

Welcome and thank you for choosing Boston Medical Center for

care while you are pregnant. Maybe you are pregnant for the ﬁrst time. Maybe you have

been pregnant before. You will feel different each time you are pregnant. You may have

many new questions, thoughts and feelings. You may want to know how your baby is

growing. And you may want to know how to take care of yourself. You will have many

visits with your provider during your pregnancy. Your provider may be a midwife, a doctor

or a nurse practitioner. Ask lots of questions at your visits. Go to a childbirth education

class. Learn as much as you can.

Part 1:

Pregnancy

First Trimester

Taking Care of Yourself while

You Are Pregnant ...................................................................................... 4

Safety in Pregnancy ...............................................................................5

Exercise ..............................................................................................................6

Healthy Eating ............................................................................................. 7

Problems during Pregnancy ...........................................................9

Making Love during Pregnancy ..............................................10

What to Expect at Prenatal Visits ..........................................11

Your Growing Baby .............................................................................13

Changes in Your Body Months 1 to 3 ...............................14

Birth Sisters

Program .....................................................................15

Childbirth Education ..........................................................................16

Second Trimester

Changes in Your Body Months 4 to 6 ...............................17

Third Trimester

Changes in Your Body Months 7 to 9 ...............................19

Getting Ready for Your Baby ....................................................21

Part 2:

Birth

This section will answer some of your questions

about labor and birth. Talk to your provider before

you go into labor. Ask questions and learn as much

as you can. Think about what is important to you

and your family during labor and birth.

What Are the Signs of Labor? ....................................................23

Directions to Labor and Delivery ...........................................24

What Should I Expect

When I Get to the Hospital? .........................................................25

What Happens to My Body

in Labor and Birth? .............................................................................26

What Are My Choices?

- Labor Pain without Medication .........................................27

- Labor Pain with Medication ...................................................28

Problems during Birth ......................................................................29

What Should I Know about

Cesarean Birth? .......................................................................................31

What Happens after I Give Birth? ........................................32

Facts about Breastfeeding .............................................................33

When You Leave the Hospital ...................................................35

Part 3:

Babies

Congratulations and welcome to your new baby!

The ﬁrst hours after birth are ﬁlled with many

changes. You have been waiting a long time to

meet your baby. And giving birth takes a lot of

energy. You may feel excited as well as tired,

sore and a little nervous about what to expect

when you go home.

Taking Care of Yourself

- Changes in Your Body after Birth .....................................37

- Your Body after Cesarean/

Emotions after Birth .......................................................................39

- Healthy Eating and Exercise ..................................................40

- Family Planning ..................................................................................41

- Methods of Birth Control ..........................................................42

- More Important Tips .......................................................................43

Taking Care of Your Baby

- The Look of Your New Baby ................................................44

- Baby Care: What Should I Know? .................................45

- More Important Tips .....................................................................47

Glossary .........................................................................................................48

CONTENTS

Pregnancy 3

Part 1:

Pregnancy

Pregnancy 4

TAKING CARE OF YOURSELF

While You Are Pregnant

Ten ways to stay healthy while you are pregnant:

1. Go to your prenatal visits (health care while you are pregnant).

2. Drink 8 to 10 glasses of water every day.

3. Eat healthy foods.

4. Exercise.

5. Get plenty of rest.

6. Do not use alcohol, cigarettes or street drugs.

7. Wear your seat belt.

8. Go to a childbirth education group.

9. Learn to relax with deep breathing.

10. Talk about your questions and worries. Ask for help.

Ways Your Support Person Can Help

Your support person may be your partner, the father of the baby, a friend or family

member. Your support person can:

• Be a good listener.

• Go to a childbirth education group

or prenatal visit.

• Ask questions at prenatal visits.

• Help with housework, errands

and cooking.

• Help with childcare.

FIRST TRIMESTER

Pregnancy 5

Safety in Pregnancy

Many women have questions about foods, chemicals, germs or behaviors

they have heard can hurt the baby. Here are some facts:

Alcohol, cigarettes and street drugs:

• Alcohol (beer, wine and liquor) can

hurt your baby’s brain and body.

•Cigarettes can cause your baby to be

born too early or too small.

• Secondhand smoke (the smoke from another

person smoking) can hurt your baby.

• Street drugs can hurt your baby’s brain and cause

labor to begin too early.

Do you need help to stop?

Smoking Cessation Program: 617.414.4847

Addiction and Pregnancy Helpline: 617.414.4165

Chemicals: Avoid breathing strong-smelling

chemicals in your home or workplace.

Chemicals include paint, cleaning ﬂuids

and varnish.

Dirty cat litter: Cat stool (poop) can have a

virus called toxoplasmosis. Getting sick

with this virus could harm your baby.

Have someone else change the cat litter.

Hot tubs or saunas: You may become too hot

in a hot tub or sauna. This can hurt your

baby’s brain and body.

Caffeine: More than 2 drinks with caffeine a day

may affect your pregnancy. Some drinks with

caffeine are coffee, tea and certain sodas.

Fish with mercury: Mercury is a poisonous

metal found in some ﬁsh. These

ﬁsh include shark, swordﬁsh and

king mackerel. Avoid eating a lot

of ﬁsh with mercury.

Foods with germs that could harm your baby:

Raw or under-cooked raw meat, ﬁsh,

shellﬁsh and eggs. Unpasteurized cheese,

milk or juice.

Is it safe to take medications while I am

pregnant? Talk to your provider about any

herbs, vitamins or medications you may be

taking or want to take.

Is it safe to travel? Most women can travel up to

the last month of pregnancy. Wear your

seat belt. Take breaks when driving. Get

up and walk around every hour when

ﬂying. Drink plenty of water. Take a copy of your

prenatal records with you.

Pregnancy 6

Exercise helps you to stay healthy while you are pregnant.

Talk to your provider about how to exercise while you are pregnant.

Exercise can help you:

• Have stronger muscles for birth.

• Have more energy.

• Be in a better mood.

• Lower your stress.

• Prevent too much weight gain.

• Ease leg cramps and backaches.

• Help with constipation.

Even a few minutes of stretching each day can

make you feel better and stronger. Try things

like swimming, housecleaning, yard work or a

combination of these activities.

Try to exercise for 30 minutes every day. Drink

plenty of water before and after you exercise.

Stop exercising if you feel:

• Pain.

• Dizziness.

• Shortness of breath.

• Uterine cramps like when you get your period.

• Contractions (your stomach gets tight and hard).

Yoga

You can take a yoga class or

practice with a yoga video.

Dancing

You can dance anywhere!

Walking

Walk for 30 minutes a day.

You can walk to the park, to

the store or to the bus stop.

Exercise

Pregnancy 7

Healthy Eating

Foods you need when you are pregnant:

Vegetables

Eat 3 – 5 servings a day

Have vitamins and minerals that keep

you and your baby healthy.

Meats, Beans and Eggs

Eat 3 – 4 servings a day

Have protein that helps build your baby’s brain,

muscles, heart, lungs and other organs.

Bread, Rice and Cereal

Eat 6 – 11 servings a day

Have vitamins, minerals and energy

you need to grow a healthy baby.

Pregnancy 8

Weight Gain During Pregnancy

Gain 28 to 40 pounds if you are underweight.

Gain 25 to 35 pounds if you are average weight.

Gain 15 to 25 pounds if you are overweight.

Talk with your provider about the best

weight gain for your body.

Fruits

Eat 2 – 4 servings a day

Have vitamins and minerals that keep you

and your baby healthy.

Milk, Cheese and Yogurt

Eat 3 – 4 servings a day

Have calcium that helps build your baby’s

bones and teeth.

Breasts 2 pounds

Blood 3 pounds

Uterus 2 pounds

Placenta 1.5 pounds

Baby 7.5 pounds

Fat 1.5 pounds

Amniotic Fluid 1.5 pounds

Other Fluids 1.5 pounds

Helpful Hints

• Water is good for you. Drink 8 or more

glasses of ﬂuid every day.

• Avoid foods like cookies, chips, french fries,

donuts and soda. They ﬁll you up but do not

give you the vitamins and minerals you need

to grow a healthy baby.

• Eat small servings of food every 2 to 3 hours.

A small amount is 1 cup of cooked rice,

1 piece of fruit, 1 slice of cheese or a piece of

meat the size of the palm of your hand.

• Get folic acid early in pregnancy from leafy

green vegetables, beans, citrus fruits, whole

grain breads and cereals. Folic acid lowers the

chance of problems with your baby’s spine.

• Eat food with iron such as red meat, leafy

green vegetables, beans and cereal. Iron helps

your blood carry oxygen to you and your baby.

Pregnancy 9

Warning Signs in Pregnancy

Call your clinic during ofﬁce hours.

After ofﬁce hours call 617.414.2000 or the

number given to you by your provider for:

• Very bad nausea with vomiting that

won’t go away.

• Pain or burning when you pass urine.

• Very bad stomach pain.

• Sharp blow or trauma to your stomach.

• Chills or fever greater than 100.4° F.

• Your baby is not moving as much as before.

• Very bad headache that won’t go away.

• You feel dizzy.

• Your vision is blurry.

• Bleeding.

Preterm Labor (labor before 37 weeks)

Some signs may be:

• Contractions (your stomach gets hard)

more than 4 times in an hour.

• Stomach cramps like when you get

your period.

• Low, dull backache.

• Blood or ﬂuid from your vagina.

Depression while You Are Pregnant

Some women feel sad or depressed when they are pregnant. Maybe you felt this way before you were

pregnant. Maybe this is the ﬁrst time you have felt this way. You may wonder why you feel sad when others

tell you that you should feel happy to be pregnant. Pregnancy is a time of change, and change can be

stressful. Too much stress can make you feel depressed, worried or unsure.

Some signs of depression include:

• Feeling sad.

• Sleeping all day or having trouble sleeping.

• Changes in eating (eating too much or too little).

• Feeling anxious or worried.

• Feeling grumpy or irritable.

It is not your fault that you are depressed. With help, you can feel better. Talk to your provider to learn

more about treatment.

Problems at Home

In some families, people hurt each other by hitting or using mean or hurtful words. Does this happen in

your family? Being pregnant can make the hurting worse. Here are some ways to get help for

yourself and your children:

• Talk with your provider.

• Call the National Domestic Violence Hotline: 800.799.SAFE (7233)

Problems during Pregnancy

Pregnancy 10

Your feelings about sex may change during pregnancy. You may ﬁnd

sex very exciting. Or you may not enjoy sex as much as before. You or

your partner may worry sex will hurt your baby.

It may not be easy for you to talk with your partner about your feelings. Or you may feel like your partner

will not understand. Pick a time to talk when you are not making love. Try new positions. Find other ways to

please each other.

Here are some facts about sex when you are pregnant:

• Gentle lovemaking will not hurt your baby.

• You can get an infection in your vagina from having sex with a partner who has HIV,

hepatitis B & C, herpes, warts (HPV), chlamydia, gonorrhea or syphilis.

• Infections may cause problems for your baby.

• Infections in your vagina may cause your labor to begin too soon.

• Using a condom will lower your chance of infection.

• Sex with one faithful partner will lower your chance of infection.

Making Love during Pregnancy

Pregnancy 10

Pregnancy 11

Why do I need prenatal visits?

Prenatal visits help you and your

provider to:

• Make sure your baby is growing well.

• Check you for problems in pregnancy

such as high blood pressure, diabetes,

infections or anemia.

• Talk about questions or worries you may have.

How often will I have

prenatal visits?

Expect 1 prenatal visit a month until you are 7

months. Then you will have a visit every 2 weeks

until the last month. You will have a visit every

week in the last month. Your provider may ask you

to come more often for any problems you may have.

What happens at my ﬁrst

prenatal visit?

You will see a provider on your ﬁrst visit. The

provider may be a midwife, obstetrician, family

medicine doctor or nurse practitioner. Expect

your provider to:

• Ask questions about your health history.

• Check your weight, blood pressure, heart, lungs,

thyroid and breasts.

• Check your uterus and cervix.

• Decide your baby’s due date.

Your provider will also order some tests.

These might be:

• A Pap test to check for cancer of your cervix.

• A test for infections in your vagina.

• A blood test to check for anemia, your blood

type and signs of infection.

• A urine test to check for protein, sugar or

infection.

• A test for tuberculosis (an infection in your lungs).

• HIV counseling and the choice to take an HIV test.

Will I have an ultrasound or other

tests for my baby?

Your provider will talk to you about an ultra-

sound to check for problems in your baby. Your

provider may ask you to talk with a genetic

counselor. A genetic counselor will talk to you

about the chance of your baby having a genetic

problem like Down Syndrome.

What to Expect at Prenatal Visits

Pregnancy 12

Here are some facts about some

tests for your baby:

Ultrasound: An ultrasound uses sound waves to

make a picture of your baby. Ultrasound can be

used to check the:

• Age of your baby.

• Heartbeat.

• Growth of your baby’s heart, brain, spine,

kidneys and other organs.

• Position and size of your baby.

First trimester or 3-month screen test: You

may have this test when you are in month 3. This

test is an ultrasound and a blood test that tells the

chance of some birth defects.

Quadruple screen test: The quadruple screen

is a blood test. It looks at 4 substances in your

blood that may be related to some genetic prob-

lems or problems with your baby’s spine.

Sickle cell test: This is a blood test for you, and

sometimes for the baby’s father, to tell the chance

of your baby having sickle cell disease. You can

inherit (get it from your mother or father) sickle

cell disease. Sickle cell disease is more common

in people of African ancestry.

Cystic ﬁbrosis test: This is a blood test for you,

and sometimes for the baby’s father, to tell the

chance of your baby having cystic ﬁbrosis. You can

inherit (get it from your mother or father) cystic

ﬁbrosis. Cystic ﬁbrosis is more common in people

of Northern European ancestry.

What other tests will I have?

Tests at 6 months:

• Diabetes test or 1-hour glucola test. This is a

blood test to check for diabetes you can get

when you are pregnant.

• A blood test to check for anemia.

Tests at 9 months:

• Group B Strep (GBS) test. GBS is bacteria

(germ) in your vagina that can make your

baby sick. Women with GBS need antibiotics

(medicine) during labor to lessen the chance

that the baby will get sick.

• Another HIV test.

Pregnancy 13

At 4 weeks

• Your baby is the size of a pea and the

heart is beating.

At 6 weeks

• Your baby’s face, eyes, ears and mouth

are forming.

At 8 weeks

• Your baby is a little less than 1 inch long.

At 12 weeks

• Your baby is about 2 ½ inches long and weighs

about 1 ounce—about as much as a slice of

cheese. You may hear your baby’s heartbeat

at your prenatal visit. The placenta is fully

formed. The placenta carries oxygen and

nutrients to the baby.

At 16 weeks

• Your baby is about 5 inches long and now

weighs 5 ounces or a little more than

a quarter of a pound.

At 20 weeks

• Your baby is about 6 inches long and weighs ½

to 1 pound. Your baby can suck its thumb. Your

baby’s eyes can open and close. Your baby can

turn a full circle and kick.

At 24 weeks

• Your baby is about 8 inches long and

weighs 1 to 1 ½ pounds.

At 32 weeks

• Your baby is about 10 inches long and

weighs 2 to 3 ½ pounds.

At 40 weeks

• Your baby is almost 19 inches long and weighs

about 7 pounds.

Your Growing Baby

12 weeks 24 weeks 40 weeks

Pregnancy 14

Changes What will I notice? What can I do?

Nausea (feeling like you

want to vomit)

You may wake up with nausea. Or you may have

nausea all day. Notice smells more than before.

Feel like you need to spit.

Eat some crackers or dry cereal before lifting

your head off the pillow in the morning. Keep

some food in your stomach at all times. Eat every

2 to 3 hours. Eat plain foods not greasy or fried

foods. Drink ﬂuids between meals instead

of with your food.

Breast changes

Your breasts get larger and may feel heavy and

tender. Your nipples get darker and bigger. Your

breasts get ready to make milk. You may leak

some early milk (colostrum).

Wear a bigger bra that gives you good support.

Feeling tired

You may feel very tired, like you want to

sleep all day.

Take naps if you can. Go to bed earlier.

Need to urinate (pee)

more often

Your growing uterus or womb presses on your

bladder. You may feel like you need to urinate

more often.

Avoid drinks with caffeine that make you urinate

more. These drinks include coffee, tea and soda.

Headaches

Some women get headaches. Drink 8 to 10 glasses of water each day.

Eat healthy food every 2 to 3 hours.

Mood changes

You may have feelings that change quickly from

happy and excited to unsure or worried.

Talk about your feelings. Decide what you need

and ask for help.

CHANGES IN YOUR BODY

Months 1 to 3

Pregnancy 15

Birth Sisters

Program

Birth Sisters are women from the communities around Boston

who are specially trained to give you support during pregnancy,

birth and after the baby comes.

They speak your language, listen to your needs and help you talk with your providers

about your questions or concerns. They will:

• Meet with you before the baby comes.

• Stay with you through labor and birth.

• Support you at home after the baby comes.

• Help you with breastfeeding.

To learn more, call: 617.414.5168

I love my Birth Sister. She has become my friend. She

has been at the birth of my three children! I especially

remember when I gave birth to my ﬁrst child. My Birth

Sister was making me laugh so much that I pushed my

baby out while I was laughing very hard!

*Birth Sisters is a registered service mark of Urban Midwife Associates and is used with permission.

Pregnancy 16

Come to a childbirth education class. Maybe this is your ﬁrst baby.

Maybe you have had a baby before. Anyone can come to this group.

You can also bring your support person.

In the group you can:

• Talk about being pregnant with other pregnant women.

• Learn about how your body works and how your baby is growing.

• Talk about birth. Learn the signs of labor and what to expect during birth.

• Learn about breastfeeding.

• Talk about parenting.

• Find support. You may need a safe place to ask questions or talk about worries.

To learn more, talk to your provider or call 617.414.3875.

CenteringPregnancy

Program

The CenteringPregnancy

Program at Boston Medical Center offers you prenatal visits in a group

with 8 to 12 other pregnant women and a midwife or doctor. During your visits you will talk about

how to have a healthy pregnancy, get to know other mothers and have your check-up. Women say they

love CenteringPregnancy

because the group offers:

• Unhurried time with the midwife or doctor.

• Pre-scheduled visits for the whole pregnancy and no waiting the day of appointment.

• Support from other women going through the same changes at the same time.

Childbirth Education

Changes What will I notice? What can I do?

Your uterus grows bigger

You start to look pregnant. Wear loose-ﬁtting clothes or maternity clothes.

Avoid very high-heeled shoes as they can cause

your lower back to hurt.

You can feel your baby move

You will feel your baby move at about month 5.

This feels like a ﬂutter at ﬁrst. The moves will feel

stronger as your baby grows.

Learn when your baby is most active and when

your baby rests. Enjoy feeling your baby move!

More energy, less nausea

You may feel less tired and less nauseated. Enjoy it!

Skin changes

You may have brown marks on your face or a dark

line down your stomach. The skin around your

nipples gets darker and bigger. You may get stretch

marks on your stomach, hips and breasts. These

are brown or dark red lines that come from your

skin stretching.

Dark areas on your skin go away after pregnancy.

Stretch marks get lighter after pregnancy.

Stuffed-up nose

Pregnancy hormones may make your nose feel

stuffed up like you have a cold.

Use saline drops (Ocean

spray drops)

to clear your nose.

Bleeding gums

Pregnancy hormones can make your gums

bleed more easily.

Use a soft toothbrush and ﬂoss every day.

Go to a dentist for a cleaning.

CHANGES IN YOUR BODY

Months 4 to 6

SECOND TRIMESTER

Pregnancy 17

Pregnancy 18

Changes What will I notice? What can I do?

Heartburn

Your growing baby and uterus put pressure on

your stomach. Pregnancy hormones relax the

opening to your stomach. Acid from your stomach

can burn your esophagus (the tube from your

mouth to your stomach).

Eat small meals every 2 to 3 hours. Sit up

after meals. Eat plain food not spicy or greasy

foods. Talk to your provider about medicine

to help heartburn.

Sharp pulling feeling on the

side of your uterus

You may feel a sharp cramp or pulling feeling on

the side of your uterus. This is called round

ligament pain. This happens when the

ligaments on the sides of your uterus stretch.

Change your position. This might be sitting

instead of standing or turning onto your other

side if you are lying down.

Constipation

Pregnancy hormones slow digestion. This may

cause constipation. Your stool (poop) or bowel

movement may be hard and painful to pass. You

may not pass stool as often as before.

Drink 8 to 10 glasses of water a day. Eat

vegetables, fruit and whole grains to make

softer stools.

Hemorrhoids

Many women get hemorrhoids during pregnancy.

They feel sore and may bleed when you pass stool.

They may itch as they heal.

Use witch hazel pads (Tucks

) or hemorrhoid

cream prescribed by your provider.

Feelings

You may feel:

•Happy to feel less tired and less nauseated.

•Excited to feel your baby move.

•A sense of well-being.

Enjoy this exciting time in your pregnancy!

CHANGES IN YOUR BODY

Months 4 to 6

Pregnancy 19

Changes What will I notice? What can I do?

Aches and pains

You may have a backache, pain under the

ribs, pain in the groin, pain over the pubic

bone or leg cramps.

Change your position. Avoid standing for a long

time. Sleep with a pillow behind your back and

between your knees. Try stretching. Call your

provider about any pain that does not go away.

Braxton Hick’s contractions

You may feel your stomach get hard. This is

not painful. These contractions do not come at

regular times.

Rest when you need to. Drink 8 to 10 glasses

of ﬂuids a day. Call your provider for more than

4 Braxton Hick’s contractions in an hour.

Swollen feet, ankles and

hands

Your feet, ankles and hands may look swollen or

puffy. Your shoes or rings may not ﬁt.

Raise your legs when you sit or lie down.

Drink 8 to 10 glasses of ﬂuids a day.

Swimming helps.

Vaginal discharge

You may have more white or yellow discharge.

This is normal. Discharge keeps your vagina

clean and healthy.

Wear cotton underwear. Do not wash inside your

vagina or douche. Call your provider if you have

discharge that is red, green, smelly or itchy.

Varicose veins

The veins in your legs may stick out

or seem bigger.

Raise your legs when you sit or lie down. Try not

to sit, stand or cross your legs for a long time.

Ask your provider about support stockings.

Feelings

You may feel:

•Tired of being pregnant.

•Excited and scared about birth.

•Eager to get everything done.

Talk to your support person about

your feelings.

CHANGES IN YOUR BODY

Months 7 to 9

THIRD TRIMESTER

Pregnancy 19

Pregnancy 20

CHANGES IN YOUR BODY

Months 7 to 9

stomach

intestine

placenta

umbilical cord

uterus

bladder

pubic bone

anus

vagina

rectum

spine

cervix

mucus plug

Pregnancy 21

Picking a provider for your baby

A provider for your baby may be a doctor

(pediatrician or family medicine doctor) or

a nurse practitioner. You will have many visits

with your baby’s provider. You may want to

meet this person before your baby is born.

Pick a provider who:

• Answers your questions.

• Listens.

• Knows about breastfeeding.

• Has an ofﬁce close to your home.

Circumcision for boy babies

Circumcision removes the foreskin from the penis.

Some people decide to do this. Others do not. Talk

to your provider to learn more.

Tests for new babies

Hearing test: Your baby will have a hearing test

after birth. Talk more with your provider or your

baby’s provider about this test.

Newborn screening test: This is a blood test to

check your baby for diseases that can be treated. To

learn more, talk to your provider.

Health care proxy

All people who go to a hospital are offered a health

care proxy. This is a person who can decide about

your care if you are not able to make decisions due

to a physical or mental problem (such as being

unconscious). Read the health care proxy form.

Think about whom you trust to decide for you. You

can ﬁll out the form and give it to your provider.

What to pack when you

go to the hospital

• Lip balm and hair ties.

• Pajamas, robe, slippers.

• Several sets of spare underwear.

• A change of clothes to wear home.

• Comfortable support bra or nursing bra.

• Toothbrush, deodorant, soap and lotion.

• Clothes for your baby.

• A camera if you want to take pictures.

• A car seat.

Getting Ready for Your Baby

Pregnancy 22

Ways to learn more:

Websites:

www.childbirthconnection.org

www.marchofdimes.com

www.nchealthystart.org

www.cfsan.fda.gov (for mercury in seafood)

Help lines:

Smoking Cessation: 617.414.4847

Depression: 617.414.5245 or 866.472.1897

Domestic Violence: 800.799.SAFE (7233)

Childbirth Education: 617.414.3875

Birth Sisters

Program: 617.414.5168

Addiction and Pregnancy Helpline:

617.414.4165

Breastfeeding help:

BMC Warmline: 617.414.MILK (6455)

www.bmc.org/breastfeeding

Birth Sisters

Program: 617.414.5168

LaLeche League: 877.4.LALECHE

(877.452.5324) or www.lllusa.org

Nursing Mothers Council: 617.244.5102

Main WIC Ofﬁce: 800.WIC.1007

Jewish Family and Children’s Services

781.647.5327 extension 1968

Department of Health and Human

Services - Women’s Health 800.994.9662

or www.womenshealth.gov

Birth 23

Part 2:

Birth

What Are the Signs of Labor?

What to do about early labor:

• During the night, stay in bed and rest as much

as you can.

• During the day, go for a walk or talk to friends.

•  Drink plenty of water and eat meals and snacks

at regular times.

• For pain relief, try a warm bath or shower massage

or a hot water bottle.

•  Ask for help from your partner, Birth Sister or other

support person.

• Call your provider before you come to the hospital.

•  Leave valuables like jewelry at home.

Many changes happen in your body before labor begins.

You may have some of these signs before you go into labor:

• A small amount of light pink or brownish mucus from your vagina.

• Your baby moves down into your pelvis. You may feel less pressure on your stomach

and more pressure on your bladder.

• Diarrhea.

• Cramps or mild contractions. These feel like when you get your period.

• Lower back pain.

•  Your bag of water may break. You might have a gush or a trickle of ﬂuid from your vagina.

(You can be in labor without breaking your water.)

When do I call my provider?

Call your clinic during ofﬁce hours. After ofﬁce hours, call 617.414.2000 or the number

your provider gives you if:

•  Your bag of water breaks. Call even if you do not have contractions.

• You have regular, painful contractions.

• You have bleeding from your vagina.

• Your baby is not moving as much as before.

Birth 23

Birth 24

A postpartum room at BMC

Directions to Labor and Delivery

Getting to Labor and

Delivery at BMC

• You can park your car in the garage

at 710 Albany St.

•  Go to Labor and Delivery on the 3rd

ﬂoor of the Menino Pavilion.

• After 11 p.m., you can use the Albany St.

door at the Emergency Room.

For a tour, call 617.414.5875

Entrance Parking Garage Valet Parking

Emergency Department

Birth 25

WHAT SHOULD I EXPECT

When I Get to the Hospital?

At the hospital

• In the Labor and Delivery Unit, a nurse will

check your vital signs (your blood pressure and

temperature), your baby’s heartbeat and your

contractions.

•  A provider will see you. The provider may do a

vaginal exam to check your cervix.

• You will move to a private birthing room if you

stay in the hospital.

• The nurse will put an IV (intravenous needle) in

your arm. You can get extra ﬂuids and medicines

through your IV if you need to during labor.

•  The nurse will take some blood to check for

anemia and your blood type.

•  A provider will talk to you about the risks of

labor and birth and ask you to sign a consent

form to care for you during labor and birth.

Is it really labor?

You may have contractions that do not open your

cervix. Your provider may ask you to drink water and

walk for 1 or 2 hours. Your contractions may stop or

get stronger. The provider will check your cervix

again and decide if you should stay or go home.

Can I have visitors?

Support people are very important during labor.

You may have up to 3 support people during your

labor and birth. For safety reasons, your support

person may be asked to leave the room during a

procedure, like getting an epidural. You may have

one support person for a cesarean birth if you are

awake. Your support person will need to wait for

you outside of the operating room if you are asleep

for a cesarean birth. (To learn more, see Cesarean

Birth on page 31.) Talk to your provider about

having a sibling attend the birth before you are

admitted in labor. Children must be with an adult

at all times.

Birth 26

What Happens to My Body

in Labor and Birth?

Early Labor

(5 – 24 hours)

Rest, eat and drink lightly.

Breathe slowly through

contractions and relax.

Active Labor

(3 – 6 hours)

Change your position.

This may be taking a shower,

sitting in a chair or rocking

on your hands and knees.

Transition

(10 – 60 minutes)

This is a very intense part

of labor but does not last

very long. You may need

extra support during this

part of labor.

Pushing and Birth

(5 minutes – 3 hours)

Push in a comfortable position.

Blow or pant when your

baby’s head is crowning.

This helps to prevent tears

to your vagina.

Birth of the Placenta

(5 minutes – 3 hours)

Contractions feel very mild.

Your vagina may feel sore.

You may be shaky and cold.

Your placenta moves

out of your uterus,

through your vagina and

out of your body.

Cervix opens

0 – 4 centimeters.

Cervix opens

4 – 8 centimeters.

Cervix opens

8 – 10 centimeters.

Your baby moves out

of your uterus, through

your vagina and out

of your body.

Birth 27

WHAT ARE MY CHOICES?

Labor Pain without Medication

Each woman deals with her labor pain in her own way. Understanding how your body works and feeling

relaxed, loved and supported will help you to deal with labor.

You can also:

• Breathe through your contractions.

• Take a shower to help with pain.

•  Use warm packs or ice packs where it hurts.

•  Walk if you can.

• Choose a support person who can help you

through the contractions.

•  Change your position when it is hard to cope.

Positions that can help are...

Birth 28

WHAT ARE MY CHOICES?

Labor Pain with Medication

Some women choose pain medication to deal with labor pain. There are two types of medications:

narcotic medication and anesthesia medication.

Narcotic medication

This is medication given through your

IV or by shot. Narcotic medication helps to:

• Take away some of the pain.

• Make you feel more relaxed.

• Sleep in between contractions.

Narcotic medication may:

• Not take all of the pain away.

• Make your baby sleepy and have a harder

time breathing if you get the medicine too

close to giving birth.

• Cause an allergic reaction in some women.

This is rare.

Anesthesia medication

This is a medication given by an anesthesiologist

(a doctor specially trained to give anesthesia

medicine) to numb labor pain. During labor or a

cesarean section, anesthesia can be given in 3 ways:

1. Epidural anesthesia

The anesthesiologist places a small catheter or tube

in your back. Pain medication goes through the

tube to numb your labor pain. You can get more

pain medication through the tube as you need it

during your labor. It takes about 20 minutes for the

pain to stop. An epidural is the most common way

to give anesthesia pain medication.

2. Spinal anesthesia

The anesthesiologist gives you a shot of pain

medication in your back. Spinal anesthesia numbs

labor pain in a short amount of time and is more

often used for a cesarean section.

Epidural and spinal anesthesia help to:

• Numb most of your labor pain.

• Make you feel more relaxed.

Epidural and spinal anesthesia may:

• Slow the pace of your contractions and make

pushing time longer.

• Cause a headache that can last several days.

3. General anesthesia

The anesthesiologist gives you medicine to make

you go to sleep during surgery. You will have a tube

down your throat to help you breathe while you are

asleep. General anesthesia is not used very often.

Birth 29

Problem What treatments will help?

What else should I know

about the treatments?

What if my labor needs

to be induced?

Misoprostol and oxytocin (pitocin).

These are medicines to ripen your cervix

and start contractions.

Misoprostol and pitocin can make contractions too

strong. Your baby may have a hard time with strong

contractions. Your provider can change your

medicine should you or your baby have a problem.

What if my labor

slows down?

Position changes, rest or extra ﬂuid through your IV

Amniotomy. This is when your provider breaks your bag of water with a small hook, like a crochet needle.

This does not hurt. This may shorten your labor.

Oxytocin (pitocin). This is a medication that can make contractions stronger. (To learn more, see

What if my labor needs to be induced?)

Intrauterine pressure catheter. This is a small tube your provider puts inside your uterus. It shows

how strong your contractions are.

Cesarean birth. You may need a cesarean birth because other treatments did not help.

(To learn more, see Cesarean Birth on page 31.)

What if there’s a problem

with my baby’s heartbeat?

Position changes.

Extra oxygen for you to breathe.

Fetal Scalp Electrode (FSE). This is a small monitor your provider puts on your baby’s head.

It gives more information about your baby’s heartbeat.

Problems during Birth

While most labor and births go normally, sometimes problems develop. This section will answer

some of your questions about the most common problems.

Birth 30

Problem What treatments will help?

What else should I know

about the treatments?

What if my baby needs help

coming out quickly?

Forceps or a vacuum cup.

Episiotomy. This is a small cut in your vagina.

Most women do not need an episiotomy.

Cesarean birth. (To learn more, see Cesarean Birth

on page 31.)

Most babies do ﬁne with forceps or a vacuum

cup. Forceps may bruise your baby’s skin or

very rarely hurt a nerve in your baby’s face. The

vacuum cup may cause swelling on your baby’s

scalp or very rarely hurt blood vessels in your

baby’s head. Forceps or a vacuum may increase

the risk of hurting the muscles in your pelvis.

Episiotomies can increase the risk of deep tears

in the vagina. Tears into the rectum can cause

problems with holding gas or bowel movements.

What if I get a fever

during labor?

Antibiotics. An infection in your uterus may cause

a fever. Your provider may give you antibiotics

through your IV.

Your baby may also need IV antibiotics after birth.

What if my vagina tears

during birth?

Sometimes your vagina can tear during birth. Your provider will check your vagina for tears after your

baby is born. You may need stitches to heal the tear. A cold pack helps with soreness on the ﬁrst day.

What if I bleed a lot?

Massage. Your provider may massage your uterus to help it to contract.

Oxytocin and other medicines. These medicines can stop your uterus from bleeding.

Dilation and Curettage. This is surgery to take out any tissue left in your uterus after birth.

It can help to stop the bleeding. Dilation and Curettage may increase your risk of infection

and damage to your uterus, bladder or intestines.

Blood transfusion. This is when you get new blood to replace the blood you lost.

Hysterectomy. This is when your doctor removes your uterus to stop the bleeding.

Very few women need a hysterectomy.

Shoulder dystocia

This is when the baby’s head is born but the shoulder gets stuck behind your pubic bone. This is an

emergency. This happens in 2 out of every 100 births. Your provider may ask you to change your

position. They might cut an episiotomy. Your baby’s collar bone could break during birth. Mostly this

gets better quickly. Sometimes pressure on the baby’s shoulder can hurt a nerve in your baby’s arm.

Mostly the nerve gets better with physical therapy. Although rare, brain damage or death

can happen to a baby stuck for a long time.

Birth 31

WHAT SHOULD I KNOW ABOUT

Cesarean Birth?

Cesarean birth means your doctor makes a cut through your skin and uterus to deliver your baby.

You may need to have a cesarean

birth because:

•  Your baby has a problem in pregnancy or in labor.

• Your labor stops.

• You had a cesarean birth before.

• Your baby is not in the right position.

• You have a medical problem.

What problems can a cesarean birth cause?

• Blood loss.

•  Infection.

•  Pain after cesarean.

•  Scar tissue. This can make other abdominal

surgeries harder to do.

Some rare problems might be:

•  Damage to your bladder, intestines

or blood vessels.

• A small cut on your baby.

• Hysterectomy (surgery to remove your uterus).

• Death.

Can I have a vaginal birth after

a cesarean birth?

Maybe. Although rare, the scar on your uterus can

tear in labor. You are more likely to tear if you have

had more than one cesarean. Your midwife or doctor

will talk to you about the chance of having problems

in your next pregnancy.

Your provider will talk to you about cesarean

birth and ask you to sign a consent form. Your

support person can be with you in the operating

room. After the cesarean, you, your support person

and your baby stay in a recovery room. A nurse

will take care of you.

Birth 32

What Happens after I Give Birth?

Enjoy the special time after your baby is born. Your baby is awake for the ﬁrst hour after birth. This is a good

time to breastfeed your baby for the ﬁrst time. Your provider, nurse or Birth Sister can help you and your

baby to breastfeed. Expect to stay in your labor room for 1 to 2 hours after you give birth.

Your nurse will:

•  Check your baby’s weight.

•  Put erythromycin, an antibiotic ointment, in your

baby’s eyes. The ointment prevents infections that

can pass from you to your baby during birth.

•  Give your baby a shot of vitamin K.

Vitamin K helps to prevent problems with

bleeding in your baby.

•  Check your bleeding and vital signs.

•  To learn more, see Your Stay at Boston Medical

Center After Birth.

Keeping your baby safe:

• The nurse will put a security band around your

baby’s ankle. Taking your baby out of the

postpartum area will set off an alarm. This is

to keep your baby safe.

• You will have many visitors during your stay.

These visitors may be nurses, doctors, midwives

and other hospital workers. Anyone who comes

into your room should wear a hospital ID badge.

• Your baby may go to the nursery during your stay.

Make sure the person taking your baby to the

nursery is wearing a hospital badge.

• Do not leave your baby alone. Ask your nurse for

help as you need to.

• Do not leave your baby alone on an open surface,

like the edge of your bed. Put your baby in the

bassinet (plastic crib).

Birth 33

Breast milk is healthier for babies than formula. Here are some reasons why:

Why is breastfeeding good for my baby?

Babies who breastfeed have:

•  Fewer ear infections, colds and diarrhea.

• Fewer allergies.

•  Less chance of diabetes.

• Less chance of being overweight as children.

•  Less tooth decay.

• Less chance of some cancers.

Why is breastfeeding good for me?

For moms, breastfeeding helps to:

• Make your uterus smaller after birth.

• Lose pregnancy weight.

• Feel closer to your baby.

• Lower the chance of breast or ovarian cancer.

• Lower the chance of diabetes.

How does breastfeeding work?

• You and your baby work together as a

breastfeeding team.

• Your breasts start to make some milk while you

are pregnant. This early milk is called colostrum.

• Your baby’s sucking helps your body to

release milk.

• Each time your baby takes milk from your

breast, your body will make a little more milk.

• It is normal for your baby to breastfeed many

times in the ﬁrst few days.

Why is colostrum good for newborn babies?

Colostrum is special milk for your newborn baby.

You can see it by gently squeezing your nipple.

It may be yellow, clear, dark or pink. Colostrum:

• Fills your baby’s small stomach.

• Is easy to digest.

• Helps your baby to ﬁght colds, diarrhea

and other viruses.

How will I know my baby is getting

enough milk?

• Count the number of wet and stool (poopy)

diapers your baby makes. Your baby should make

6 to 8 wet diapers and 3 stools a day after you go

home. The stools should change to a yellow color

when the baby is 3 or 4 days old.

• Count how many times your baby breastfeeds in

24 hours. Most new babies want to breastfeed 8

to 12 times in 24 hours. Your baby has a small

stomach for the ﬁrst few days after birth. So lots

of breastfeeding is normal.

• Watch and hear your baby swallow.

• Go to your baby’s doctor visits for a weight

check. Most babies lose some weight the ﬁrst

2 to 3 days after birth. Your baby should be back

to his or her birthweight by 2 weeks after birth.

•  Many new babies breastfeed for a long time, fall

asleep and wake a short time later wanting to

feed again. Babies sometimes breastfeed 3 or 4

times in 2 hours. This is called cluster feeding.

Babies may cluster feed during a growth spurt or

in the early evening hours.

What helps sore nipples?

• Sore nipples may come from your baby having

only the nipple and not enough breast in her

mouth. Ask for help to make sure your baby is

in a good position.

• Ask your provider or lactation consultant

(a person specially trained to help with breast-

feeding) about treatments to help sore nipples.

Babies who cannot breastfeed right after birth

Some babies cannot breastfeed after birth. The baby

may be born too early or may need special care.

Some babies need more time to learn how to

breastfeed well. You can use a breast pump to

Facts about Breastfeeding

Birth 34

remove milk from your breast. You can give this

milk to your baby or store it for later. Ask your

nurse for more help.

Can I breastfeed and bottle feed my baby?

The more time you wait to give your baby

a bottle, the more time your baby has to learn

to breastfeed. Waiting 4 weeks to give your

baby a bottle helps:

•  Build your milk supply.

•  Teach your baby to breastfeed.

•  Prevent sore nipples.

Can I breastfeed my baby when I go back

to work or school?

Yes, you can! You can pump and store your milk for

when you are away.

Can I breastfeed and take birth control

pills or other medicines?

Many medications and some birth control pills

are safe to take. Talk to your provider ﬁrst. The

pharmacy at Boston Medical Center can tell you

what medications are safe for breastfeeding.

Can I breastfeed and drink alcohol?

• 1 drink or fewer each day does not seem to

hurt your baby.

• Drinking a lot of alcohol every day (2 drinks or

more) may hurt your baby’s growth over time.

Can I breastfeed and smoke?

Smoking can cause many health problems for you

and the people who breathe your smoke. You and

your family will be healthier if you quit or cut down.

Some women cannot stop smoking when they are

breastfeeding. It is still healthier for your baby to

breastfeed. Here are some tips to keep your baby

as healthy as possible:

• Avoid smoking right before you breastfeed.

• Do not smoke around your baby.

• Do not let anyone smoke around your baby.

Can I breastfeed and give my baby a paciﬁer?

A paciﬁer may make it harder for your baby

to learn to breastfeed. Avoid a paciﬁer for the

ﬁrst 4 weeks.

Birth 35

• Plan to leave between 10 a.m. and noon on

the day you go home.

•  Have a car seat for your baby.

•  Your nurse will make a visit time with your

provider between 1 and 6 weeks after birth.

•  Your nurse will make a visit time with your

baby’s provider about 1 week after birth.

My midwife or doctor

Telephone number

Visit date

My baby’s doctor or nurse practitioner

Telephone number

Visit date

When You Leave the Hospital

Birth 36

Babies 37

Part 3:

Babies

Changes What will I notice? What helps?

Feeling tired

You may feel very tired after giving

birth. This is not surprising. Giving

birth is hard work. Your baby will

also wake you every 1 to 3 hours to

feed during the night.

Rest as much as you can. Sleep when

your baby sleeps. Ask for help with

housework and care of other children.

Your breasts ﬁll

with milk

Your breasts will ﬁll with milk

between days 2 and 4 after birth.

Your breasts may get swollen, sore

and hard.

Breastfeed your baby often. Cold packs

and Tylenol

can help women who do

not breastfeed.

Your uterus

gets smaller

Your uterus contracts or tightens

to get smaller. You may feel cramps

like when you get your period. You

may feel more cramps when you

breastfeed.

Empty your bladder often. A full

bladder may cause more cramps.

Your provider can prescribe Tylenol or

Motrin

to help with cramps.

Sweating

Sweating is your body’s way of

getting rid of extra ﬂuid. You may

notice sweating more at night.

Change your clothes or take a shower

for comfort. Sweating goes away after

a few days.

Hemorrhoids

Many women get hemorrhoids

during pregnancy. They feel sore and

may bleed when you pass stool. They

may itch as they heal.

Use witch hazel pads (Tucks

) or

hemorrhoid cream prescribed by your

provider.

TAKING CARE OF YOURSELF

Changes in Your Body after Birth

Babies 37

Babies 38

Changes What will I notice? What can I do?

Bleeding (lochia)

Bleeding from your vagina starts as a heavy red

ﬂow like your period. You may have a few small

clots of blood. Bleeding gets lighter in color and

lessens over a week. Expect bleeding to last from

2 to 8 weeks.

Wear thick sanitary pads. Avoid putting

anything in your vagina until the bleeding stops

(about 6 weeks). Call your provider if you soak

more than 2 pads in an hour.

Weight loss

You may feel like you still look pregnant after you

have your baby. For most women, it takes 6 months

to a year to lose all of the pregnancy weight.

Exercise for 30 minutes most days of the week.

Eat healthy foods.

Constipation

You may not pass stool for several days after

giving birth. This is normal. You may also feel

nervous about passing stool with stitches or a sore

perineum (place between the opening of your

vagina and your anus).

Drink lots of water and eat vegetables, fruit and

whole grains to make soft stool. Support your

perineum with a clean pad or folded toilet paper

while you pass stool.

Urinating

For a day or so after giving birth, you may not

feel the need to pass urine even when your bladder

is full. Urinating may burn your perineum while

it is healing.

Make sure to pass urine every 2 hours. Drink

8 – 10 glasses of water a day. Spray your perineum

with water in a spray bottle while you are urinating.

Sore perineum

Your perineum (place between the opening of your

vagina and your anus) may be swollen and sore.

You may have stitches from a tear or an episiotomy.

Use a cold pack on your perineum on the ﬁrst day.

Take warm baths or sitz baths (a small tub of

warm water) on the other days. Warm water helps

to clean and heal the area. Ask your nurse for help

with a sitz bath. Use a spray bottle to clean

yourself after urinating or passing stool. Wash

your perineum gently when you shower. Do not

wash inside of your vagina. Use a mild soap like

Dove

. Pat the area dry. Wear cotton underwear.

Change your sanitary pad often. Your stitches will

dissolve in 1 – 2 weeks.

Sore muscles

You may have sore muscles in your legs and back

from giving birth. You may also feel a little achy

all over.

This is normal. Heat or massage on the sore area

can help. Avoid lifting anything heavier than your

baby for 2 weeks. Talk to your provider about

problems with walking or pain that does not go

away after a few days.

Babies 39

Blues and Postpartum Depression

Your hormones change after giving birth. You may be tired from being awake with your

baby at night. Caring for your new baby can be stressful. At times you may feel moody,

sad or depressed.

Blues often start on day 3 after giving birth. The

blues may come and go for 10 days to 2 weeks.

Common signs of the blues:

• Crying without knowing why.

• Feeling grumpy.

• Worrying about your baby or being

a good mother.

• Having trouble sleeping.

Postpartum depression

Signs of postpartum depression may be the

same as the blues. But the signs last longer than

2 weeks and get worse.

Common signs of postpartum depression:

• Feeling very sad or badly about yourself.

• Sleeping all day or having trouble sleeping.

• Not wanting to eat.

• Worrying so much that you cannot think of

anything else.

• Not wanting to care for yourself or your baby.

• Having panic attacks (heart beats quickly, throat

feels tight, sweaty palms, shortness of breath).

• Feeling like you want to hurt yourself

or your baby.

• Rarely, seeing or hearing things that are not

there (psychosis).

It is not your fault that you feel depressed. Changing

hormones after giving birth cause depression in

some women. Counseling and medicine can help

postpartum depression. Talk to your provider

to learn more about treatment. With help, you

will feel better.

What to Expect after

a Cesarean Birth

You will go through many of the same

changes in your body and your emotions

as a woman who had a vaginal birth.

But the ﬁrst days after a cesarean may

be hard. You may also:

• Feel pain at the site of the surgery.

• Feel pain when you change position, cough

or hold your baby.

• Have gas pains or become constipated.

• As the site heals, you will have a scar. Some

women have numbness at the incision site.

The skin may be itchy and dry.

To help with healing:

• Avoid lifting anything heavier than your baby

for 8 weeks after giving birth.

• Avoid driving your car for 2 weeks

after giving birth.

• Take short walks around the hospital and your

home every 2 to 3 hours for the ﬁrst week after

giving birth.

• Drink 8 – 10 glasses of water a day and empty

your bladder every 2 hours.

TAKING CARE OF YOURSELF

Your Body after a Cesarean/

Emotions after Birth

Babies 40

Eating Healthy Food after Giving Birth

Eating healthy food after birth matters as much as when you were pregnant. Breastfeeding women need

500 calories more every day. Eat fruits, vegetables, whole grains and foods with protein and iron like meat,

chicken and ﬁsh. Take your prenatal vitamins for extra iron.

Exercise: What Can I Do? How Does it Help?

Ask your provider when you can start exercising. Start slowly. As little as 20 minutes 3 times a week

makes you healthier. Work up to 30 minutes most days of the week. Here are some exercises you can do:

Walking Go for a walk every day! Take your baby with you. You will have more energy. Walking

calms a crying baby. Babies need fresh air. Walking also helps a bad mood.

Sit-ups Sit-ups make your muscles stronger and your stomach ﬂatter. Strong stomach muscles help

your back to be strong.

Kegel exercises Squeeze the muscles inside your vagina. Can you stop the ﬂow of urine?

You have used the right muscles. Squeeze the muscles for 5 – 10 seconds. Relax. Do this exercise

10 times each day. Kegel exercises make the muscles in your pelvis stronger. You will have

fewer problems with leaking urine.

TAKING CARE OF YOURSELF

Healthy Eating and Exercise

Babies 40

Babies 41

Making Love after

Giving Birth

You may or may not feel like having sex for a while

after giving birth. Many women do not. This is

normal. You may feel tired, out of shape or just not

in the mood. When you do decide to have sex:

• Wait to have sex until your bleeding stops and

your perineum heals.

• Use birth control. You can get pregnant

2 weeks after birth.

• Breastfeeding does not stop pregnancy.

• You can get pregnant without getting your period.

• Your vagina may be dry. Use a lubricant like

Astroglide

• Talk with your partner about your feelings.

Maybe you do not want to have sex but your

partner does.

• Find other ways to be intimate. This may be

hugging, touching or talking.

Planning or Preventing

Another Baby

Your body needs time to recover after having a

baby. It may be healthier to wait 1 to 2 years to

have another baby. Here are some questions

to ask yourself and your partner:

• Do you want to have another baby?

• When do you want to have another baby?

• Is birth control important to you?

• What kind of birth control is right for you?

TAKING CARE OF YOURSELF

Family Planning

Babies 42

Here is some information about different methods of birth control. Talk to your provider about

what type of birth control is right for you.

Condom

Fits over the man’s penis. Catches sperm.

Depo-Provera

A shot of hormones you get every 3 months.

Implanon

A small rod with hormones that goes under your skin. Works for 3 years.

Diaphragm

Covers the cervix. Prevents sperm from going into your uterus.

January 2008

Foam, Suppositories and Film

Made of chemicals that kill sperm.

Intrauterine Device (IUD)

A small device your provider puts in your uterus. Stops sperm from joining egg.

January 2008

Pill, Patch and Vaginal Ring

Hormones that stop ovaries from making an egg.

January 2008

Natural Family Planning

Learn fertile days. Avoid sex on fertile days.

Sterilization

Makes you unable to have a baby. Permanent.

TAKING CARE OF YOURSELF

Methods of Birth Control

Babies 43

When to Call Your Provider

• Fever higher than 100.4° F.

• Pain when you pass urine.

• Heavy bleeding (soak more than 2 pads in 1 hour).

• Very bad stomach or back pain.

• Sore or red area on your breast or leg.

• You feel short of breath.

• You feel very dizzy or you faint.

• Bad-smelling bleeding from your vagina.

• You feel like you want to hurt yourself or your baby; or you feel

like you cannot take care of yourself or your baby.

Staying Healthy between Babies

The better your health, the better the health of your next baby.

Before you get pregnant again, you can:

• Lose the weight you gained when you were pregnant

by exercising and eating healthy foods.

• Get treatment for medical problems.

• Stop smoking.

• Stop using street drugs.

• Take folic acid.

• See your provider for regular check-ups, and as

soon as you know you are pregnant again.

Emergency Contraception

What do I do if I had sex and...

• The condom broke or slipped?

• I didn’t start my pills on time?

• I missed my depo shot?

• I didn’t use any birth control?

You have the option to take emergency

contraception, or Plan B. This is two

pills of a hormone called progesterone.

Here are some facts about Plan B:

• The sooner you use it after you have sex,

the better it works.

• Plan B is very safe.

• Some women may feel a little nausea

(feeling like you need to vomit).

• Plan B will not end a pregnancy if you

are already pregnant.

• Your provider can give you a prescription

for Plan B.

• For women forced to have sex, the emergency

room at any hospital in Massachusetts

will give Plan B. It’s the law.

TAKING CARE OF YOURSELF

More Important Tips

Babies 44

New babies have a special look. Your new baby may have:

Ver ni x A white, creamy coating that protects your baby’s skin during pregnancy.

Molding A long, cone-shaped head that comes from ﬁtting through your pelvis.

This goes away after a day or so.

Swollen nipples and genitals This will go away after several days.

Vaginal discharge or bleeding (girl babies) This is normal and goes away by itself

in a few days.

All babies also have:

Fontanels Two soft spaces on your baby’s head. There is a small one on the back of the

head and a larger one on the top of the head. The back fontanel closes when your baby

is 6 to 8 weeks old. The top fontanel closes when your baby is 15 months old.

Dark gray eyes They will change to their ﬁnal color in several months. Your baby can

see about 12 inches.

The same sense of hearing and smelling as you. Loud noises will startle your baby.

TAKING CARE OF YOUR BABY

The Look of Your New Baby

Babies 45

TAKING CARE OF YOUR BABY

Baby Care: What Should I Know?

Umbilical cord care Your baby’s umbilical cord will dry up and fall off in 1 to 2 weeks. Keep the area

around the cord clean and dry. Fold the diaper below the cord. Check for redness or pus around the cord.

Call your baby’s provider if you see these signs.

Bathing You can bathe your baby after birth. Your nurse can help you with the ﬁrst bath.

Diaper care Change your baby’s diaper often to prevent diaper rash. Clean your baby’s bottom with water

or baby wipes. Wipe a girl baby from front to back so that stool does not get in her vagina. Use diaper

cream for a rash.

Circumcision care Change your baby’s diaper often. Use warm water to clean the penis. Let the penis

dry. Put A+D

ointment on the tip of the penis each time you change the diaper. Expect the tip of the penis

to be red. The penis may bleed a little bit.

Clothing Dress your baby as warmly as you dress yourself. Put a hat on your baby in cool weather.

Do not overdress your baby. Babies can get hot.

Feeding To learn more about breastfeeding, see Facts About Breastfeeding, page 33.

Babies 46

Comforting Your Crying Baby

Many new babies have a fussy time each day. Your

baby may cry because he or she is tired, hungry,

wet, in pain, sick or just wants to be held. You will

learn about your baby’s different cries. Here are

some ways to comfort your baby:

• Feed your baby.

• Change your baby’s diaper.

• Wrap or swaddle your baby in a blanket.

• Gently rock your baby in your arms, a chair or in

a swing.

• Walk your baby in a sling, front carrier or stroller.

• Sing to your baby or repeat a sound like “shhh,

shhh, shhh” again and again.

Colic Some babies have colic, crying hard for

many hours. Often you cannot comfort a baby with

colic. Most babies cry less after 3 or 4 months.

Talk to your provider to learn more about colic and

ways to cope with your baby’s crying.

Shaken Baby Syndrome

A crying baby can make you feel tense and angry.

Do not shake your baby. This can hurt your baby’s

head, neck or spine. Put your baby down in the crib

if you feel tense and angry. Ask someone to care for

your baby while you take a break. Warn others

about the danger of shaking a baby.

Keeping Your Baby Safe

• Wash your hands and ask others to wash their

hands before holding or touching your baby.

• Use a car seat every time you are in the car.

• Put your baby on his back to sleep to stop SIDS,

Sudden Infant Death Syndrome.

• Support your baby’s neck.

• Put your baby in the crib or bassinet when you

are not holding her.

• Do not leave your baby alone on the changing

table, couch or bed. Your baby could roll over

and fall.

• Do not put pillows, stuffed animals or large

blankets in your baby’s crib. Your baby could

suffocate.

Siblings

Older children may need extra love when a

new baby joins the family. Spend some time

alone with your older child each day. Some

ways you can do this are to read a book, take

a walk, listen or play with your child.

Babies 47

When to Call Your

Baby’s Provider

• You count fewer than 6 wet diapers in 24 hours.

• Your baby looks yellow or tanned.

• Your baby has rectal temperature greater

than 100.4° F.

• Your baby vomits a whole feeding with force.

• The area around the umbilical cord is red,

swollen and has yellow or green pus.

• Your baby will not eat or has diarrhea.

• Your baby seems more tired or more restless

than before.

• Your baby is having a hard time breathing

or turns blue.

Circumcision Warning Signs

Some reasons to call your baby’s provider might be:

• Swelling around the penis.

• Yellow or green pus.

• Bleeding more than the size of a quarter.

• Fever greater than 100.4° F.

• No wet diaper in 8 hours.

Ways Your Support Person

Can Help

Babies need many people to give them love. And

mothers need many people to help. Maybe your

support person is your partner, the father of the

baby, a friend or a family member. As the support

person, you can:

• Hold, bathe or change the baby.

• Take care of the baby while mom takes a nap.

• Help with housework, cooking and errands.

• Help with the other children in the family.

Children need lots of love and support when a

new baby joins the family.

• Support the breastfeeding mother. Tell her she is

doing a good job. Get her a snack and a glass of

water when she breastfeeds.

• Go to the baby’s provider visits when you can.

Ask questions.

• Be understanding. Having a new baby can be a

stressful and tiring time.

Babies 47

TAKING CARE OF YOUR BABY

More Important Tips

Glossary 48

Glossary

Amniotomy Breaking the bag of water around

your baby with a special plastic hook.

Anemia Low levels of hemoglobin (see Hemoglobin)

in your red blood cells. Hemoglobin is the part of

your red blood cells that carries oxygen to your

body and your baby’s body. Anemia can be caused

by low iron or a disease.

Anesthesiologist A doctor specially trained to

give anesthesia pain medication during surgery

or when you are in labor.

Antibiotics Medicine to treat infection caused

by bacteria.

Areola The pink or brown skin around your

nipple.

Braxton Hick’s Contractions Your uterus gets

hard without pain.

Cervix The opening of your uterus or womb.

Cesarean Birth Surgery to remove your baby

from your uterus. Also called C Section.

Circumcision Removing the foreskin from

a baby boy’s penis.

Colostrum Early milk in your breasts during

pregnancy and at birth.

Constipation You are not able to pass stool at

regular times. Your stool may be hard and painful

to pass.

Contraction Your uterus gets tight. Contractions

can be strong and regular or mild and not regular.

Strong, regular contractions can open your cervix.

Dilation & Curettage Surgery to take out any

tissue left in your uterus after giving birth. Also

called D & C.

Epidural Anesthesia Anesthesia pain medication

by an anesthesiologist through a tube or catheter in

your back.

Episiotomy A small cut in your vagina and

perineum (see Perineum) to help your baby to be

born more quickly.

Esophagus The tube from your mouth to your

stomach.

Express Milk To remove milk from your breast

with your hand or a breast pump.

Family Medicine Doctor A doctor who gives

care to all people. This includes prenatal, labor and

delivery and newborn care.

Fetal Scalp Electrode A small monitor that

attaches to your baby’s head to measure the baby’s

heartbeat.

Group B Strep or GBS A type of bacteria or

germ that can be found in your vagina.

Heartburn A burning feeling in your stomach

caused by stomach acid in your esophagus (see

Esophagus).

Hemoglobin The part of your red blood cells that

carries oxygen to your body and your baby’s body.

Hemorrhoids Swollen blood vessels around your

anus that may bleed and feel sore.

Hysterectomy Surgery to remove your uterus.

Intrauterine Pressure Catheter A small tube

put into your vagina and uterus to measure the

strength of your contractions.

Lochia Bleeding from your vagina after giving

birth.

Mercury A poisonous metal found in some ﬁsh.

Nausea Feeling like you want to vomit.

Glossary 49

Nurse-Midwife A provider specially trained to

give clinical care, support and education to women

during normal pregnancy, labor and birth.

Nutrients Vitamins and minerals found in food.

Obstetrician A doctor specially trained to provide

medical care during pregnancy and birth.

Oxytocin (Pitocin) Medicine given through your

IV that causes contractions. Pitocin may be used to

induce labor or to stop bleeding after birth.

Pediatric Nurse Practitioner A nurse with

extra training in caring for babies and children.

Pediatrician A doctor who is specially trained to

care for babies and children.

Perineum The tissue between the opening of your

vagina and your anus.

Placenta A red, ﬂeshy organ that grows with your

baby inside your uterus. Oxygen and nutrients cross

through the placenta to your baby by the umbilical

cord (see Umbilical Cord).

Provider This may be a midwife, a doctor or a

nurse practitioner.

Round Ligament Pain Sharp cramp or pulling

feeling on the side of the uterus as the ligaments

stretch.

Secondhand Smoke Smoke from another person

smoking.

Spinal Anesthesia Anesthesia pain medication

given by an anesthesiologist as a shot in your back.

Toxoplasmosis A virus found in cat stool. Getting

sick with this virus could harm your baby.

Ultrasound A test that uses sound waves to make

a picture of your baby.

Umbilical Cord Blood vessels that carry oxygen

and nutrients from the placenta to your baby (see

placenta).

Uterus Your womb or the part of your body where

your baby grows.

Varicose Veins Blood vessels in your legs that get

bigger and stick out.

Vernix White creamy coating on your baby’s skin.

Women’s Health Nurse Practitioner A nurse

with extra training to give clinical care, support and

education to pregnant and non-pregnant women.

Glossary 4

The initial concept for this project was created by

students at the Massachusetts College of Art and

Design, under the direction of Associate Professor

of Graphic Design Lisa Rosowsky.

Written by:

Carolyn Fox, CNM, MSN

Boston Medical Center Childbirth Education Program

Boston Medical Center is the primary teaching affiliate

of the Boston University School of Medicine.

One Boston Medical Center Place, Boston, MA 02118

617.414.2000 I www.bmc.org/obgyn