Pregnancy: Should I Use a Seat Belt?

Should I wear a seat belt while I'm pregnant?

Yes, you should always wear a seat belt. Wearing your seat belt protects you and your baby from injury or death in a car crash. You should wear a seat belt no matter where you sit in the car.

How should I wear my seat belt?

The seat belt should be a 3-point restraint. That means it should have a lap strap and a shoulder strap. Lap and shoulder belts keep you from being thrown from the car during an accident. The shoulder strap also keeps the pressure of your body off of the baby after a crash.
Be sure to wear your seat belt correctly. The lap strap should go under your belly, across your hips and as high as possible on your thighs. The shoulder strap should go between your breasts and off to the side of your belly. Seat belt straps should never go directly across your stomach. The seat belt should fit snugly. If possible, adjust the height of the shoulder strap so that it fits you correctly.

What about air bags?

Most experts agree that air bags are safe and can protect pregnant women from head injury. The air bags in your car should not be turned off when you are pregnant. To be safe, you should move the seat back as far as possible and tilt the seat to get some distance between your belly and the steering wheel or dashboard.
Air bags are not a substitute for a seat belt, so always wear your seat belt even if your car has air bags.

Where should I sit if I'm a passenger?

Where a mother sits has not been shown to affect the safety of an unborn baby in a crash. However, if you are not driving, you should sit in the back seat. Injuries from car crashes tend to be less serious in people who are sitting in the back seat. It is still important to wear a seat belt.

What should I do if I am in a car crash?

You should get treatment right away, even if you think you are not hurt. Most injuries to the baby happen within a few hours after a crash. Your doctor needs to check you and your baby as soon as possible after a crash, especially if you are more than 6 months pregnant.

What danger signs should I watch for after a car crash?

Call your doctor right away if you have pain in your belly, blood or fluid leaking from your vagina, or contractions.

Morning Sicknes

What is morning sickness?

Morning sickness refers to the nausea and vomiting that some women have when they become pregnant. It is caused by the sudden increase in hormones during pregnancy. Although morning sickness is more common in the morning, it can last all day for some women.

How long will morning sickness last?

Morning sickness is very common early in a pregnancy. It tends to go away later in pregnancy, and it's almost always gone by the second trimester (the fourth month). But there isn't a set time for it to stop because each woman is different, and each pregnancy is different.

Will morning sickness hurt my baby?

It shouldn't. Morning sickness can become more of a problem if you can't keep any foods or fluids down and begin to lose a lot of weight. Many doctors think morning sickness is a good sign because it means the afterbirth (the placenta and fetal membranes) is developing well

The tips below may help reduce morning sickness.

1. Eat small meals throughout the day so that you're never too full or too hungry.
2. Avoid rich, fatty foods.
3. Avoid foods with smells that bother you.
4. Eat more carbohydrates (plain baked potato, white rice, dry toast).
5. Eat saltine crackers and other bland foods when you feel nauseous.
6. Try gelatin desserts (Jell-O), flavored frozen desserts (popsicles), chicken broths, ginger ale (nondiet), sugared decaffeinated or herbal teas, and pretzels.
7. The iron in prenatal vitamins can bother some women. If you think your morning sickness is related to your vitamins, talk with your doctor and he or she may change your vitamins.
8. Wearing "acupressure" wrist bands, which are sometimes used by passengers on boats to prevent sea sickness, may help some women who have morning sickness. You can buy the bands at boating stores or travel agencies.

If these tips don't give you relief from morning sickness, your doctor may have other ideas. Keep in mind that morning sickness doesn't mean your baby is sick.

Pregnancy: Taking Care of You and Your Baby part1

Is prenatal care important?
Yes! You can help make sure that you and your baby will be as healthy as possible by following some simple guidelines and checking in regularly with your doctor.

What will happen during prenatal visits?
Your doctor will probably start by talking to you about your medical history and how you've been feeling. You'll probably be weighed and have your blood pressure taken on every visit.

On your first visit, you'll also probably have a pelvic exam to check the size and shape of your uterus (womb) and a Pap smear to check for signs of cancer of the cervix (the opening of the uterus).

Urine and blood tests may be done on the first visit and again later. Urine tests are done to check for bacteria in your urine, high sugar levels (which can be a sign of diabetes) and high protein levels (which can put you at risk for preeclampsia, a type of high blood pressure in pregnancy). Blood tests are done to check for low iron levels (anemia).

Sometimes, an ultrasound may be done to help figure out when your baby is due or to check on your baby's growth and position in your uterus. An ultrasound uses sound waves to create an image of your baby on a video screen.

Other tests may be needed if you or your baby are at risk for any problems.

How much weight should I gain during pregnancy?
About 25 to 30 pounds. If you don't weigh enough when you get pregnant, you may need to gain more. If you're very heavy when you get pregnant, you may need to gain only 15 to 18 pounds.

Pregnancy isn't the time to diet! It's best to gain about 2 to 3 pounds during the first 12 weeks and about 1 pound a week after that. Talk to your doctor about how much weight you should gain.
What should I eat?
One of the most important things you can do for yourself and your baby is eat a balanced diet. There are a few foods that you should be more careful about eating while you are pregnant. Meat, eggs and fish that are not fully cooked could put you at risk for an infection. Do not eat more than 2 or 3 servings of fish per week (including canned fish). Do not eat shark, swordfish, king mackerel, tilefish or tuna. These fish sometimes have high levels of mercury, which could hurt your baby.

Wash all fruit and vegetables. Keep cutting boards and dishes clean. Eat 3 to 4 servings of dairy foods each day. This will give you enough calcium for you and your baby. Do not drink unpasteurized milk or eat unpasteurized milk products. Soft cheeses such as Brie, feta, Camembert and Mexican queso fresco may have bacteria that can cause infections.

If you drink coffee or other drinks with caffeine, do not have more than 1 or 2 cups each day.

It is okay to use artificial sweeteners such as aspartame (some brand names: Equal, NutraSweet) and sucralose (brand name: Splenda) while you are pregnant, but you should try to them in moderation. If you have a genetic disease called phenylketonuria, or PKU, you shouldn't use aspartame at all.

Blue baby syndrome

From Wikipedia, the free encyclopedia

A cyanotic newborn, or "blue baby"Blue baby syndrome (or simply, blue baby) is a layman's term used to describe newborns with cyanotic conditions, such as

Cyanotic heart defects
Tetralogy of Fallot
Dextro-Transposition of the great arteries
Hypoplastic left heart syndrome
Methemoglobinemia
Respiratory distress syndrome
On November 29, 1944, the Johns Hopkins Hospital was the first to successfully perform an operation to relieve this syndrome. The syndrome was brought to the attention of surgeon Alfred Blalock and his laboratory assistant Vivien Thomas in 1943 by pediatric cardiologist Helen Taussig, who had treated hundreds of children with Tetralogy of Fallot in her work at Hopkins' Harriet Lane Home for Invalid Children. The two men adapted a surgical procedure they had earlier developed for another purpose, involving the anastomosis, or joining, of the subclavian artery to the pulmonary artery, which allowed the blood another chance to become oxygenated. The procedure became known as the Blalock-Taussig shunt, although in recent years the contribution of Vivien Thomas, both experimentally and clinically, has been widely acknowledged.

Reference:
Thomas, Vivien T (1985). Partners of the Heart: Vivien Thomas and His Work with Alfred Blalock (originally published as Pioneering Research in Surgical Shock and Cardiovascuar Surgery: Vivien Thomas and His Work with Alfred Blalock). U. Penn . Press.

Birth Defects

About 120,000 babies (1 in 33) in the United States are born each year with birth defects (1). A birth defect is an abnormality of structure, function or metabolism (body chemistry) present at birth that results in physical or mental disabilities or death. Several thousand different birth defects have been identified. Birth defects are the leading cause of death in the first year of life (2).

What causes birth defects?
Both genetic and environmental factors, or a combination of these factors, can cause birth defects. However, the causes of about 70 percent of birth defects are unknown (1).

Single gene defects: In many cases, a single gene change can cause birth defects. Every human being has about 20,000 to 25,000 genes that determine traits like eye and hair color (3). Genes also direct the growth and development of every part of our physical and biochemical systems. Genes are packaged into each of the 46 chromosomes inside our cells.

Each child gets half its genes from each parent. A person can inherit a genetic disease when one parent (who may or may not have the disease) passes along a single faulty gene. This is called “dominant inheritance.” Examples include:
Achondroplasia (a form of dwarfism)
Marfan syndrome (a connective tissue disease)
Many other genetic diseases are inherited when both parents (who do not have the disease) carry an abnormality in the same gene and pass it on to a child. This is called “recessive inheritance.” Examples include:
Tay-Sachs disease (a fatal nervous system disorder)
Cystic fibrosis (a serious disorder of lungs and other organs, affecting mainly Caucasians)
There also is a form of inheritance called “X-linked,” in which sons can inherit a genetic disease from a mother who carries the gene (usually with no effect on her own health). Examples include:
Hemophilia (a blood-clotting disorder)
Duchenne muscular dystrophy (progressive muscle weakness)
Chromosomal birth defects: Abnormalities in the number or structure of chromosomes can cause many birth defects. Chromosomal abnormalities usually result from an error that occurred when an egg or sperm cell was developing. As a result of this error, a baby can be born with too many or too few chromosomes, or with one or more chromosomes that are broken or rearranged.

Down syndrome, in which a baby is born with an extra chromosome 21, is one of the most common chromosomal abnormalities. Children with Down syndrome have varying degrees of mental retardation, characteristic facial features and, often, heart defects and other problems. Babies born with extra copies of chromosome 18 or 13 have multiple birth defects and often die in the first months of life. Extra copies of most other chromosomes rarely allow survival to live birth and are common causes of miscarriage.

Missing or extra sex chromosomes (X and Y) affect sexual development and may cause infertility, growth abnormalities and behavioral and learning problems. However, most affected individuals live fairly normal lives. Examples include Turner syndrome (in which a girl is missing all or part of an X chromosome) and Klinefelter syndrome (in which a boy has one or more extra X chromosomes).

Environmental factors: Environmental substances that can cause birth defects are called teratogens. These include alcohol, certain drugs/medications, infections, and certain chemicals.

Each year between 1,000 and 6,000 babies are born with fetal alcohol syndrome (FAS) in this country (4). FAS is a pattern of mental and physical birth defects that is common in babies of mothers who drink heavily during pregnancy. Women who are pregnant or planning pregnancy should not drink any alcohol. Even moderate or light drinking during pregnancy may harm the baby.

Some drugs and medications can contribute to birth defects. For example, the acne drug isotretinoin (sold under the brand names Accutane, Amnesteem, Claravis and Sotret) poses a high risk of serious birth defects. A woman who is pregnant or who could become pregnant should never use this drug. Illicit drugs such as cocaine also may pose a risk.

Certain infections can result in birth defects when a woman contracts them during pregnancy. About 40,000 babies a year (about 1 percent of all newborns in this country) are born with a viral infection called cytomegalovirus (CMV) (5). About 1 in 10 infected babies develop serious disabilities, including mental retardation and loss of vision and hearing (5). Pregnant women often get CMV from young children who have few or no symptoms.

Sexually transmitted infections in the mother also can endanger the fetus and newborn. For example, untreated syphilis can result in stillbirth, newborn death or bone defects. About 412 babies were affected by congenital syphilis in 2002(6).

Multi-factorial birth defects: Some birth defects appear to be caused by a combination of one or more genes and environmental exposures. This is called “multi-factorial inheritance.” In some cases, an individual may inherit one or more genes that make him more likely to have a birth defect if he is exposed to certain environmental substances (such as cigarette smoke). These individuals have a genetic predisposition to a birth defect. But if the individual is not exposed to the environmental substance before birth, he probably won’t have the birth defect. Examples of multi-factorial birth defects include:
Cleft lip/palate (opening in the lip and/or roof of the mouth)
Neural tube defects (serious birth defects of the brain and spinal cord, including spina bifida and anencephaly)
Heart defects
What are the most common birth defects?
Cleft lip/palate and Down syndrome are among the most common birth defects in the United States (7). About 6,800 babies are born with cleft lip/palate each year (7). Cleft lip/palate can cause problems with eating, speech and language. Some affected babies have a small cleft that can be corrected with one surgical procedure, while others have severe clefts and need multiple surgeries. About 5,500 babies are born each year with Down syndrome (7).

About 1,900 babies are born with a serious heart defect called transposition of the great arteries each year (7). Many more babies are born with other serious heart defects. While advances in surgery have dramatically improved the outlook for affected babies, heart defects remain the leading cause of birth defect-related infant deaths (8). Health care providers usually do not know what causes a baby’s heart to form abnormally, although both genetic and environmental factors play a role.

Spina bifida (open spine) occurs in about 1,300 babies each year (9). Affected babies have varying degrees of paralysis and bladder and bowel problems. Both genetic and environmental factors (including insufficient amounts of a vitamin called folic acid) appear to play a role.

Other common birth defects include musculoskeletal defects (including arm and leg defects), gastrointestinal defects (including defects of the esophagus, stomach and intestines) and eye defects (7). These birth defects usually are multi-factorial.

What are birth defects of body chemistry?
In 2002, about 3,000 babies were born with disorders affecting body chemistry (metabolic disorders) (10). These disorders are not visible, but they can be harmful or even fatal.

Most disorders of body chemistry are recessive genetic diseases. These diseases result from the inability of cells to produce enzymes (proteins) needed to change certain chemicals into others, or to carry substances from one place to another. An example is Tay-Sachs disease. Affected babies lack an enzyme needed to break down certain fatty substances in brain cells. These substances build up and destroy brain cells, resulting in blindness, paralysis and death by age 5.

Another example is phenylketonuria (PKU). Affected babies cannot process a part of protein, which builds up and damages the brain. Newborn screening tests routinely detect babies with PKU, so they can be placed on a special diet that prevents mental retardation. The March of Dimes recommends that all newborns be screened for 29 disorders (including hearing loss) for which effective treatment is available.

Can birth defects be prevented?
There are a number of steps a woman can take to reduce her risk of having a baby with a birth defect. One important step is a preconception visit with her health care provider. During this visit, the provider can identify, and often treat, health conditions that can pose a risk in pregnancy, such as high blood pressure or diabetes. The provider can provide advice on lifestyle factors, such as quitting smoking and avoiding alcohol, and occupational exposures that can pose pregnancy risks. The provider also can make sure that any medications a woman takes are safe during pregnancy. All of these steps help prevent birth defects.

A preconception visit is especially crucial for women with chronic health conditions, like diabetes, high blood pressure and epilepsy, which can affect pregnancy. For example, women with diabetes who have poor blood sugar control are several times more likely than women without diabetes to have a baby with a serious birth defect. However, if their blood sugar levels are well controlled starting before pregnancy, they are almost as likely to have a healthy baby as women without diabetes (11).

At a preconception visit, the provider can check to see if a woman’s vaccinations are up to date. If she is not immune to rubella and chickenpox, she should be vaccinated before pregnancy. With widespread childhood vaccination, rubella is now uncommon. However, if a pregnant woman comes down with the disease, it poses a high risk of birth defects. Chickenpox also can cause birth defects, though the risk is low. A woman should wait for one month after being vaccinated before trying to become pregnant.

The provider also will ask a woman about her health history, as well as that of her partner and her family. This may help the provider identify risk factors for birth defects or inherited genetic conditions. The provider may refer couples with risk factors to a genetic counselor. A genetic counselor can discuss the risks of birth defects in their children and arrange for blood tests (such as carrier tests), when needed.

All women who could become pregnant should take a daily multivitamin containing 400 micrograms of the B-vitamin folic acid. Studies show that taking this vitamin before and during early pregnancy reduces the risk of having a baby with neural tube defects (spina bifida and anencephaly). If a woman already has had a pregnancy affected by one of these birth defects, she should consult her provider before pregnancy about how much folic acid to take. Generally a higher dose, 4 milligrams, is recommended (12). Women with diabetes or epilepsy or who are obese are at increased risk of these birth defects. They should ask their providers before pregnancy about whether they should take the larger dose of folic acid.

A woman who is pregnant or planning pregnancy should avoid drinking alcohol, smoking and using drugs. All of these can cause birth defects and other pregnancy complications. She should not take any medication (prescription, over-the-counter or herbal) without first checking with her health care provider. She should also avoid changing the cat’s litter box or eating raw or undercooked meat. These are possible sources of an infection called toxoplasmosis that can cause birth defects.

Can some birth defects be diagnosed before birth?
Some birth defects can be diagnosed before birth using one or more prenatal tests, including ultrasound, amniocentesis and chorionic villus sampling (CVS). Ultrasound can help diagnose structural birth defects, such as spina bifida, heart defects and some urinary tract defects. Amniocentesis and CVS are used to diagnose or rule out chromosomal abnormalities, such as Down syndrome, and numerous genetic birth defects. Most women have screening tests (blood tests) to see if they are at increased risk of certain birth defects, including Down syndrome and spina bifida. These screening tests cannot diagnose a condition, but they can suggest that further diagnostic testing is needed.

Can birth defects be treated before birth?
A small percentage of couples learn through prenatal diagnosis that their baby has a birth defect. While this news can be devastating, prenatal diagnosis sometimes can improve the outlook for the baby. It is now possible to treat some birth defects before birth. For example, biotin dependence and methylmalonic academia (two life-threatening inherited disorders of body chemistry) have been diagnosed by amniocentesis and treated in the womb, resulting in the births of healthy babies.

Prenatal surgery has saved babies with urinary tract blockages and rare tumors of the lung. More than 300 babies have undergone experimental prenatal surgery to repair spina bifida before birth (13). Prenatal surgery poses a number of serious risks for mother and baby, including preterm birth. (The National Institutes of Health is currently conducting a study through 2007 to compare the safety and effectiveness of surgery before and after birth for babies with spina bifida. For information contact www.spinabifidamoms.com.) Doctors also have saved babies with serious heart rhythm disturbances by treating the pregnant woman with medications.

However, even when a fetus has a condition for which prenatal treatment is not yet possible, prenatal diagnosis permits parents to prepare themselves emotionally, and to plan with their provider the safest timing, hospital facility and method of delivery.

Couples who have had a baby with a birth defect, or who have a family history of birth defects, should consider consulting a genetic counselor. These health professionals help families understand what is known about the causes of a birth defect, and the chances of the birth defect recurring in another pregnancy. Genetic counselors can provide referrals to medical experts as well as to appropriate support groups in the community. The National Society of Genetic Counselors provides the names and contact information of genetic counselors.


References

Centers for Disease Control and Prevention (CDC). Birth Defects: Frequently Asked Questions. March 21, 2006.
Martin, J.A., et al. Annual Summary of Vital Statistics—2003. Pediatrics, volume 115, number 3, March 2005, pages 619-634.
National Institutes of Health (NIH). International Human Genome Sequencing Consortium Describes Finished Genome Sequence. NIH News, October 20, 2004.
Centers for Disease Control and Prevention (CDC). Fetal Alcohol Information. Updated 8/5/04.
American Academy of Pediatrics. Cytomegalovirus, in Pickering, L.K. (ed.), Red Book: 2003 Report of the Committee on Infectious Diseases, 26th edition. Elk Grove Village, IL: American Academy of Pediatrics, 2003, pages 259-262.
Centers for Disease Control and Prevention (CDC). Syphilis: CDC Fact Sheet. Accessed 6/7/05.
Centers for Disease Control and Prevention (CDC). Improved National Prevalence Estimates for 18 Selected Major Birth Defects—United States, 1999-2001. Morbidity and Mortality Weekly Report, volume 54 (51&52), January 6, 2006, pages 1301-1305.
Kochanek, K.D., et al. Deaths: Final Data for 2002. National Vital Statistics Reports, volume 53, number 5, October 12, 2004.
Centers for Disease Control and Prevention (CDC). Spina Bifida and Anencephaly Before and After Folic Acid Mandate— United States, 1995-1996 and 1999-2000. Morbidity and Mortality Weekly Report, volume 53, number 17, May 7, 2004, pages 362-365.
National Newborn Screening and Genetics Resource Center, published in General Accounting Office, Newborn Screening: Characteristics of State Programs. Washington, DC: U.S. General Accounting Office, 2003, publication GAO-03-449.
American College of Obstetricians and Gynecologists (ACOG). Pregestational Diabetes Mellitus. ACOG Practice Bulletin, number 60, March 2005.
Centers for Disease Control and Prevention (CDC). Folic Acid: Frequently Asked Questions. Updated 9/25/03.
Bennett, K.A., et al. Fetal Surgery for Myelomeningocele, in Wyszynski, D. (ed.): Neural Tube Defects: From Origin to Treatment. New York City, Oxford University Press, 2006, pages 217-230.

Understanding Your Newborn: An Interactive Program for New Parents

Newborns send signals to their parents about how they feel and what they need. But as a new parent, you may not know how to read those signals. This engaging, interactive program explains how infants respond to the world around them. It describes:

How babies signal that they're hungry, tired, don't feel well or want to play
How sleep patterns change over time
How a newborn responds and moves
How to manage a crying baby
Understanding Your Newborn includes sections on these topics:

States of awareness
Sleeping
The newborn's senses
Reflexes and movements
Crying
Playing and break time
The program includes photographs, animation, video clips, and interactive games and quizzes.

What You Need to Get Started
In order for you to view Understanding Your Newborn, your computer must meet these requirements:
Windows or Macintosh operating system

Windows or Macintosh operating system
Web browser with Flash Plug-in 7.0 or higher.
Internet connection: High speed recommended. You can view the program on a dial-up connection, but certain elements will function slowly.
Ability to play audio (optional).
Adobe Acrobat Reader (for downloading printouts).
for detail please visit www.marchofdimes.com

Let's Eat!: A Picture Guide to Breastfeeding Your New Baby

If you're like many new moms you have some concerns about breastfeeding. You know that breastmilk is the perfect food for your baby, and that it protects against illness and helps baby's brain develop. But you also might be thinking, "Can I do it?" and "Will my baby get enough to eat?"

With some guidance, planning, patience and practice, you and your baby can breastfeed successfully. We visited two families at the hospital on baby's second day of breastfeeding. We hope the highlights of our visit will help you get breastfeeding off to a good start.

STEP 1. Hey, When Do We Eat?
You and baby will find feeding easier if baby is interested but not overly hungry. Begin the feeding before your baby is crying. Look for early feeding cues, like this alert face and open mouth. Tongue and hand movements are also signs that baby is ready to eat.

STEP 2. Help for Sleepyheads!
Some babies will be sleepy the first several days after birth and need a little coaxing to feed. To get baby ready, Dad can undress him down to his diaper and hold baby in an upright position (a burping position). By gently massaging and walking his fingers up baby's back and talking softly, he will help baby become more alert and interested in eating. If baby's skin feels too cool, you can throw a light blanket over his back.

STEP 3. What About Mom?
Gather the things you'll need to be comfortable. Take a few slow breaths. Sip some water and keep it within reach. There is no one best position for breastfeeding. You can be seated in a chair or on a sofa. You can sit or lie in bed. Use cushions, pillows, a nursing stool—whatever you need to support your back and feet. Your goal is to be able to support your baby without straining your back, neck, arms or shoulders.

STEP 4. Get Baby in Position
Once you've made yourself comfortable, position baby. Here our lactation consultant helps Mom make her baby feel secure and supported. A pillow helps place the baby at a good height so neither you nor baby have to strain. Your baby needs to be close to your body to feed easily. Support her body from her head to her bottom. Your baby should be looking straight ahead at your breast with her head, back and bottom in one line. This mom is supporting her breast with her outside hand and supporting baby's body with her opposite arm.

Step 4b. With Baby by Your Side
This mom supports her baby's shoulders and head with her outside hand. (This is called the "football" hold.) She supports her breast with the opposite hand. To support your breast correctly, have four fingers resting on your rib cage and your thumb resting lightly on top of your breast, back from the areola (the dark part of the breast that surrounds the nipple). In the first few weeks it helps baby if you support your breast for the whole feeding. Later on do what is comfortable for both of you.

STEP 5. Nose to Nipple
Place baby so that when his mouth is closed his nose is level with your nipple. When baby opens wide and you move him forward, he will be well-positioned on your breast. His gums will be on the areola, centered around the nipple. As he feeds, this will feel comfortable to you and satisfying to baby.

STEP 6. Say Ahhh!
Wait until baby opens wide (like a yawn) then bring the baby forward to your breast. With your supporting arm, move the baby's head and body to the breast. Think and do: baby to breast. Be patient. It does take practice. The latch-on may be uncomfortable for a moment or two. Continued breastfeeding should not hurt. If it does, most likely the positioning is not right. Gently break the suction by using your finger to release the nipple. Take a minute for a few calming breaths. Then try again. This is a good time to ask for help.

STEP 7. Success! What You See and Feel
When baby is positioned correctly, she is tucked in close to the breast with her mouth open wide. Her chin is right up against the lower part of the breast. Baby's nose is near the breast but nostrils are clear and baby can breathe well. Her lips are flanged (opened and flattened outward) and she has a good mouthful of breast. At first, some moms notice the feeling of the nipple being drawn back into baby's mouth at the start of the feeding. You might also feel a mild to strong tingling sensation in your breast. This is the let-down reflex.

STEP 8. Dad's in the Picture
Dad's role in breastfeeding is very important. When Dad has a positive attitude it is easier for Mom to begin and continue breastfeeding. Dads-to-be and new dads can learn about breastfeeding along with Mom. And dads have their own ways to nurture and play with baby—cuddling, changing, bathing, burping and soothing. Babies love to snuggle against Dad's warm chest.

Keep Working Together
When baby latches on, he will take a few quick sucks and then begin to suck a bit more slowly, deeply and rhythmically. He will pause from time to time and then continue. The pauses will get longer as the feeding continues until it is complete.

Your baby may want to nurse on both breasts each feeding or only on one. After baby finishes on one side, give him a few minutes to rest. Then always offer the second side but keep in mind that baby may be full.

Babies have different patterns. But all newborns need to be nursed often. In general, you'll need to breastfeed between 9 and 12 times a day for the first couple of weeks.

Try to get baby interested in feeding every couple of hours during the day and evening. You don't need to wake your baby unless he sleeps longer than four or five hours, your breasts are uncomfortably full or your baby's health care provider tells you to do so.

Is Baby Getting Enough?
You'll know your baby is getting enough to eat if by the time your baby is a week old he has:

At least six or more wet diapers each day (urine should be pale yellow)
Three or more bowel movements each day (stool will be soft, yellow and seedy-looking)
Steady weight gain—most babies are back to their birth weight in about a week and gain 4–8 ounces per week for the next few months
Periods of contentment for an hour or two after most feedings
If you think your baby is not getting enough to eat, call your health care provider right away.