Safe sleep

Sudden Infant Death Syndrome, commonly referred to as SIDS, describes the sudden, unexplained death of an infant younger than one year of age. 

What should I know about SIDS?

Health care providers don’t know exactly what causes SIDS, but they do know:

• Babies sleep safer on their backs. Babies who sleep on their stomachs are much more likely to die of SIDS than babies who sleep on their backs.
• Sleep surface matters. Babies who sleep on or under soft bedding are more likely to die of SIDS.
• Every sleep time counts. Babies who usually sleep on their backs but then are placed on their stomachs, even for a nap, are at very high risk for SIDS. It is important for everyone who cares for your baby to use the back sleep position for naps and at night.
• Communities across the nation have made great progress in reducing SIDS. Since the Back to Sleep campaign began in 1994, the SIDS rate in the United States has decreased by more than 50 percent.

Some people call SIDS “crib death” because many babies who die of SIDS are found in their cribs. But cribs are not the cause of SIDS.

How can I help reduce the risk of SIDS?

Here are ten ways you and others who care for your baby can reduce the risk of SIDS:

1. Always place your baby on his or her back to sleep, for naps and at night. The back sleep position is the safest, and every sleep time counts.
2. Place your baby on a firm sleep surface, such as on a safety-approved crib mattress covered by a fitted sheet. The American Academy of Pediatrics suggests using a wearable blanket to keep your baby warm. Welia Health recommends HALO® SleepSacks® to help babies sleep safely from the start. For more information on crib safety guidelines, contact the Consumer Product Safety Commission at 800-638-2772 or www.cpsc.gov.
3. Keep soft objects, toys and loose bedding out of your baby’s sleep area. Don’t use pillows, blankets, quilts, sheepskin, or pillow-like crib bumpers in your baby’s sleep area, and keep all items away from your baby’s face.
4. Do not allow smoking around your baby. Don’t smoke before or after the birth of your baby, and don’t let others smoke around your baby.
5. Keep your baby’s sleep area close to, but separate from, where you and others sleep. Your baby should not sleep in a bed, on the couch or armchair with adults or other children, but he or she can sleep in the same room as you. If you bring your baby into bed with you to breastfeed, put him or her back in a separate sleep area, such as a bassinet, crib, cradle or bedside co-sleeper (infant bed that attaches to an adult bed) when finished.
6. Think about using a clean, dry pacifier when placing your infant down to sleep, but don’t force the baby to take it. (If you are breastfeeding your baby, wait until your child is one month old or is used to breastfeeding before using a pacifier.)
7. Do not let your baby overheat during sleep. Dress your baby in light sleep clothing, and keep the room at a temperature that is comfortable for an adult.
8. Avoid products that claim to reduce the risk of SIDS because most have not been tested for effectiveness or safety.
9. Do not use home monitors to reduce the risk of SIDS. If you have questions about using monitors for other conditions, talk to your health care provider.
10. Reduce your baby’s chance of developing flat spots on its head. Provide “Tummy Time” when your baby is awake and someone is watching; change the direction that your baby lies in the crib from one week to the next; and avoid too much time in car seats, carriers and bouncers.

What about tummy time?

Place babies on their stomachs when they are awake, and someone is watching. Tummy Time helps your baby’s head, neck and shoulder muscles get stronger and helps to prevent flat spots on the head.

Fast facts about SIDS

• SIDS is the leading cause of death in infants between one month and one year of age.
• Most SIDS deaths happen when babies are between two months and four months of age.

To learn more, visit the Centers for Disease Control and Prevention.

Questions?

Talk with your Welia Health provider or call Welia Health at 800.245.5671 or 320.225.3625.

48-hour well-baby visit

Welia Health offers a 48-hour well-baby visit to ensure you and your baby are adjusting to being at home. This is a free visit that will be scheduled before you are discharged.

During this check, the following will be measured or checked:

• Weight
• Jaundice and bilirubin
• Breastfeeding (latching, mastitis, supply, expectations, etc.)
• Circumcision site, if applicable
• Hearing screening

Of course, we’ll also answer questions you may have now that you’re at home with your baby.

Appearances

Most babies, when delivered, don’t look like what you see in a magazine. Babies have been crammed up in a water-filled uterus for months. After the journey down the birth canal, sometimes their appearance can be affected. 

Common features of newborns

• Acrocyanosis – bluish color on hands or feet
• Vernix caseosa – right after delivery, your baby will be covered with this protectant from the amniotic fluid
• Lanugo – fine hair on a newborn
• Head molding – an abnormal head shape that results from pressure on the baby’s head during childbirth
• Cephalohematoma – the unnecessary pooling of blood from damaged blood vessels that is between the skull and inner layers of skin
• Stork bite – a pink patch that can appear on a baby’s forehead, eyelids, nose, upper lip or back of the neck
• Milia – tiny white bumps on a baby’s nose, chin or cheeks
• Peeling skin – shedding the outer layer of their skin within one to three weeks 
• Cross-eyed – eyes that wander or cross now and then as newborns learn to work their eyes together
• Swollen genitals – Due to the surge of female hormones from the placenta before birth, genitals (scrotum and labia) are often swollen, including their nipples

Screenings

Several screenings occur after the birth of your baby. This is a public health service used to help identify potentially serious conditions at birth. For those potentially affected, appropriate screenings allow providers to start treatment right away.

Common disorders with screenings

• Metabolic disorder
• Phenylketonuria (PKU)
• Immune discrepancies
• Hemoglobinopathies
• Cystic fibrosis
• Hearing
• CCHD (critical congenital heart disease)
• Congenital cytomegalovirus (cCMV)
• 60+ inheritable and congenital disorders

Learn more about screenings from the Minnesota Department of Health.

Pain management

Welia Health encourages you to meet with your provider to discuss how to have a positive birth experience while managing your pain during your birthing experience, whether it be with medication or by utilizing a more holistic approach.

Holistic pain management

• Labor balls – Utilizing a large ‘yoga’ ball that helps the pelvis open to allow room for the baby while influencing fetal descent and dilation

• Labor coach or doula – A person of your choosing to help with words of encouragement, a calming presence during intense moments, ice chips and or massage techniques

• Labor bar – A device that attaches to the birthing bed allows you to be in a squatting position and can be used as leverage with pushing and bearing down

• Other options
  
  • Hypnosis
  • Yoga
  • Meditation
  • Walking
  • Massage
  • Position changes
  • Baths or showers
  • Distraction techniques
  • Aromatherapy
  • Focal points
  • Visualization

Medications

Pain can also be controlled with medication and can be administered independently or in conjunction with one another, allowing you to deliver your baby with minimal pain and anxiety yet leaving you free to fully participate in the experience.

• IV pain medications – Nubain and morphine can be administered at >4cm but less than <8cm so as to not affect the baby. These will reduce the pain but not eliminate the pain entirely.

• Spinal – A spinal is like an epidural, but because the drugs are administered with a needle into the spinal canal, the effects are felt much more quickly. You may feel numb and need assistance in moving during the delivery. Spinal anesthetics are sometimes used for delivery by c-section.

• Pudendal – A pudendal block numbs your vaginal area in preparation for delivery.

Epidurals and intrathecals

• Epidural – An epidural is a method (think of a small catheter, about the size of a fishing line for delivering pain relief drugs or local anesthetics through a catheter placed in the small of the back, just outside the spinal canal. Epidurals allow women to participate in the birth experience (continue to feel touch and pressure) while relieving most, if not all, of the pains of labor. In most cases, the nurse anesthetist will start the epidural when cervical dilation is four to five centimeters.

• Intrathecal – An intrathecal is a one-time shot of medicine. It is administered in the same areas as the epidural, but a catheter is not inserted. It is fast acting and only works for a limited amount of time, typically 1.5-3 hours.

What are the benefits?

• Reduced discomfort of labor
• No sedation for the soon-to-be mom or infant
• Allows for time to rest before pushing
• Can help reduce anxiety associated with childbirth
• Can be used for C-section if needed

What are the risks?

• Drop in blood pressure
• Mild itching can occur
• Urinary retention
• In rare occurrences, an infection at the injection site and headache may occur

When is it “too late” to get an epidural or intrathecal?

After you are complete and ready to push, there is normally not enough time to provide the procedure. However, that may not always be true. We will assist you whenever you and your provider agree is the best time for an epidural or intrathecal.

Can I walk around with the epidural?

Not normally. Your legs will get a “heavy” feeling, and for safety reasons, laboring moms should stay in their beds after they receive their epidural.

Will I feel anything after the procedure?

Yes. Most women can still feel when they are having contractions, but they are no longer as painful, making it an advantage when it comes time to “push.”  The medication used for LABOR epidurals is not intended to totally disconnect you from the labor process.

Does the procedure hurt, and how long does it take?

The procedure is done using local anesthesia (like when you go to the dentist), which takes approximately 5-15 minutes. Sometimes placement can be more difficult and take a bit longer. During the procedure, you may feel a little “pinch” when we numb up the insertion site on your back, but you shouldn’t feel any severe pain or discomfort, and we will stop if anything we are doing hurts.

Can I be paralyzed from an epidural/intrathecal?

It is extremely rare to be paralyzed from a lumbar epidural/intrathecal. There are rare reports of nerve injury from the procedure. In those isolated cases, nerve function generally returned over time.

Will it hurt to take out an epidural?

Taking the tape off will be the most uncomfortable part of taking out the epidural. You will not be uncomfortable with the removal of the catheter itself. Remember the site may be tender for a day or two after delivery.

C-section delivery

Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother’s abdomen. Most cesarean births result in healthy babies and mothers. But a c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades. Today, nearly 1 in 3 women have babies by c-section in this country. The rate was 1 in 5 in 1995.

Public health experts think that many c-sections are unnecessary. So it is important for pregnant women to get the facts about c-sections before they deliver. Women should find out what c-sections are, why they are performed, and the pros and cons of this surgery.

Your doctor might recommend a c-section if it’s deemed safer for you or your baby than vaginal birth. Some c-sections are planned. But most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of c-section delivery. Limited studies show that the benefits of having a c-section may outweigh the risks when:

• The mother is carrying more than one baby
• The mother has health problems, including HIV infection, herpes infection, and heart disease
• The mother has dangerously high blood pressure
• The mother has problems with the shape of her pelvis
• There are problems with the placenta
• There are problems with the umbilical cord
• There are problems with the position of the baby, such as breech
• The baby shows signs of distress, such as a slowed heart rate
• The mother has had a previous c-section

We encourage you to raise any questions or concerns you many have with your Welia Health provider.

Preterm labor

If labor begins prior to 37 completed weeks of pregnancy, it is considered preterm. Preterm labor can be dangerous because if your baby is born too early, s/he could have health problems or not be developed enough to survive outside the uterus.

Warning signs of preterm labor

• Change or increase in vaginal discharge
• Ruptured membranes or “broken water” (a slow leak, steady trickle or sudden gush)
• Six or more uterine contractions in one hour in a regular pattern
• Menstrual-like cramps, a dull backache or increased pelvic pressure for more than one hour
• Throbbing in the vagina, cramps in the thighs or feeling like your baby is pushing down
• Intestinal cramping with or without diarrhea or indigestion for more than one hour

Tests and treatment for preterm labor

Your provider can tell if you have preterm labor by using a fetal monitor to check for contractions, doing a pelvic exam to check your cervix, or conducting lab tests to tell if you are at risk for delivering early. There are several treatment options to slow or stop preterm labor, and they include:

• Increased fluids
• Medication to stop contractions or treat infections
• Bed rest to relieve pressure on your cervix

Remember do not to lie flat on your back because lying on your side will increase blood flow to your baby. Many times, preterm labor can be treated at home. Other times a hospital stay may be needed. Your provider will help determine what is best for you.

General instructions for preterm labor

Your health care provider may give you specific activity restrictions, but keep these general tips in mind as well:

• Empty your bladder often.
• Drink plenty of fluids, especially water. Drink enough to keep your urine pale yellow in color.
• Eat a well-balanced diet with foods high in fiber.
• Do not smoke, use alcohol or drugs.
• Avoid strenuous activities like yard work, jogging, aerobics or a lot of stair climbing.
• Do not lift small children, heavy laundry, groceries or boxes.
• Avoid heavy cleaning such as scrubbing floors, moving furniture or vacuuming.
• Avoid car trips longer than 30 minutes and do not fly.
• Avoid breast or nipple stimulation or sex.

What to Expect: The stages of labor >

Contractions

Contractions can feel like a tightening sensation, menstrual cramps, a dull backache or pain in the front of the thighs. To check for contractions, lie on your left side and put your fingertips just above your belly button. If you feel your muscles tighten (become hard) and relax (become soft), you may be having contractions.

Count the time between contractions from the start of one tightening to the start of another. It is normal for your uterus to contract up to five times per hour during your pregnancy. To help slow contractions, cramps or pain, drink two to three glasses of water or juice, urinate and lie down on your left side to rest.

Recheck your symptoms. If you still have signs of labor, if you think your water has broken, or if you are bleeding, call your provider or go to the hospital birthing center immediately.

When to call your doctor?

• If you experience more than six (6) contractions in one (1) hour and you are less than 38 weeks pregnant
• Any leaking fluid or if you have vaginal bleeding

Birth plan

As you’re imagining your baby’s birth, what do you envision?

• Do you want to have pain medication?
• Do you want a “natural” childbirth?
• Do you want someone special to cut the umbilical cord?
• What should your Welia Health team know about you or your pregnancy?

A birth plan helps to answer some of these key questions. It’s a document that you create before delivery. A birth plan outlines to the OB team what’s important to you, helping you to have the best possible birthing experience. Here’s a guide for creating a birth plan and a downloadable worksheet for you to use during planning.

Stages of labor

Labor occurs in three stages. When regular contractions begin, the baby moves down into the pelvis as the cervix both effaces (thins) and dilates (opens). How labor progresses and how long it lasts are different for every woman. But each stage features some milestones that are true for every woman.

Stage 1 – Contractions and cervix dilation

The first stage begins with the onset of labor and ends when the cervix is fully opened. It is the longest stage of labor, usually lasting about 12 to 19 hours. Many women spend the early part of this first stage at home. You might want to rest, watch TV, hang out with family, or even go for a walk. Most women can drink and eat during labor, which can provide needed energy later. Yet some doctors advise laboring women to avoid solid food as a precaution should a cesarean delivery be needed. Ask your doctor about eating during labor. While at home, time your contractions and keep your doctor up to date on your progress. Your doctor will tell you when to go to the hospital or birthing center.

At the hospital, your doctor will monitor the progress of your labor by periodically checking your cervix, as well as the baby’s position and station (location in the birth canal). Most babies’ heads enter the pelvis facing to one side and then rotate to face down. Sometimes, a baby will be facing up towards the mother’s abdomen. Intense back labor often goes along with this position. Your doctor might try to rotate the baby, or the baby might turn on its own.

As you near the end of the first stage of labor, contractions become longer, stronger, and closer together. Many of the positioning and relaxation tips you learned in childbirth class can help now. Try to find the most comfortable position during contractions and to let your muscles go limp between contractions. Let your support person know how he or she can be helpful, such as by rubbing your lower back, giving you ice chips to suck, or putting a cold washcloth on your forehead.

Sometimes, medicines and other methods are used to help speed up labor that is progressing slowly. Many doctors will rupture the membranes. Although this practice is widely used, studies show that doing so during labor does not help shorten the length of labor.

Your doctor might want to use an electronic fetal monitor to see if the blood supply to your baby is okay. For most women, this involves putting two straps around the mother’s abdomen. One strap measures the strength and frequency of your contractions. The other strap records how the baby’s heartbeat reacts to the contraction.

The most difficult phase of this first stage is the transition. Contractions are very powerful, with very little time to relax in between, as the cervix stretches the last few centimeters. Many women feel shaky or nauseated. The cervix is fully dilated when it reaches 10 centimeters.

Stage 2 – Pushing and delivery

The second stage involves pushing and delivery of your baby. It usually lasts 20 minutes to two hours. You will push hard during contractions and rest between contractions. Pushing is hard work, and a support person can really help keep you focused. A woman can give birth in many positions, such as squatting, sitting, kneeling, or lying back. Giving birth in an upright position, such as squatting, appears to have some benefits, including shortening this stage of labor and helping to keep the tissue near the birth canal intact. You might find pushing to be easier or more comfortable one way, and you should be allowed to choose the birth position that feels best to you.

When the top of your baby’s head fully appears (crowning), your doctor will tell you when to push and deliver your baby. Your doctor may make a small cut, called an episiotomy, to enlarge the vaginal opening. Most women in childbirth do not need an episiotomy. Sometimes, forceps (tool shaped like salad tongs) or suction is used to help guide the baby through the birth canal. This is called assisted vaginal delivery. After your baby is born, the umbilical cord is cut. Make sure to tell your doctor if you or your partner would like to cut the umbilical cord.

Stage 3 – Delivery of the placenta

The third stage involves the delivery of the placenta (afterbirth). It is the shortest stage, lasting five to 30 minutes. Contractions will begin five to 30 minutes after birth, signaling that it’s time to deliver the placenta. You might have chills or shakiness. Labor is over once the placenta is delivered. Your doctor will repair the episiotomy and any tears you might have. Now, you can rest and enjoy your newborn!

Stage 4 – Post-delivery

Following labor and delivery, care continues for both mom and baby.

For mom

• Stitching of tears or episiotomy and massaging of the uterus happens to help it return to the pre-pregnancy size (called involution)

For baby

Within 12 hours (of birth):

• Hearing screening checks for hearing loss in the range where speech is heard. Identifying hearing loss early helps babies stay on track with speech, language, and communication skills. Learn more.

Within 24 hours (of birth):

• CCHD
• Heart screening
• Bilirubin test
• Spot test for several rare disorders

Learn more about newborn screenings from the Minnesota Department of Health.

Golden Hour

We respect the special private time for parents and their new baby for the first hours after birth. This uninterrupted time is enormously beneficial to the child’s growth and development. Mothers and fathers maximize the bonding experience before introducing the little one to family and friends.

Read more in this issue of Minnesota Parent.

Breastfeeding

If you choose to breastfeed your baby, our OB staff will help initiate breastfeeding within an hour of birthing your baby.  We will encourage breastfeeding on demand and practice rooming-in, allowing mothers and babies to remain together 24 hours a day. Learn more about breastfeeding.

Welia Health has certified lactation consultants to help new moms achieve their breastfeeding goals.

You and your baby: Resources for new parents >