Session 8: Week 34- Boobs, Blues, and Contraception

The postpartum period begins right after the birth of a baby.  During this time, there is often joy and excitement.  It is also a time of many changes in the life of the parents.  A mother may feel happy one minute and sad or stressed the next.  These feelings of sadness, called the baby blues, usually happen in the period right after the baby is born and go away within a week or two.

Symptoms of baby blues include:

• Anxiety
• Irritability
• Loss of appetite
• Crying spells and tearfulness
• Difficulty sleeping
• Changes in mood, such as going from extreme happiness to sadness
• A decrease in concentration

If these symptoms last for more than 2 weeks or become more severe, you may have postpartum depression

Postpartum depression is a mood disorder that occurs after your baby is born.  Your symptoms may last up to 12 months after delivery.  Your symptoms may become serious and affect your daily activities and relationships.

Symptoms of postpartum depression include:

• Feeling sad, anxious, tearful, discouraged, hopeless, or alone
• Trouble sleeping, even after the baby is asleep
• Feeling unimportant or guilty most of the time
• An overwhelmed feeling with your new baby and a belief that it will not get better
• Feeling restless, irritable, or withdrawn
• Lack interest in your baby
• Lack of appetite
• Trouble completing daily tasks, concentrating, or remembering things
• Thoughts that you are not a good mother

Call your doctor if:

• Your feelings of depression or sadness are strong
• Your symptoms last most of the day for days in a row
• Your symptoms last more than 1 week
• You have questions or concerns about your condition

Call 911 or go to the emergency room if you are thinking about hurting yourself or your baby

Contraceptive Implant (Nexplanon)

• A contraceptive implant is a thin, plastic tube that contains a hormone that prevents pregnancy.  It is different from an intrauterine device (IUD).  It is inserted into the upper part of the arm by a health care provider.  Implants can be effective for up to 3 years

Progestin-Only Injections (Depo-Provera)

• Progestin-only injections are injections of progestin, a synthetic form of the hormone progesterone.  They are given every 3 months by a health care provider.

Birth Control Pills

• Birth control pills are pills that contain hormones that prevent pregnancy.  They must be taken once a day, preferably at the same time each day.  A prescription is needed to use this method of contraception.

Birth Control Patch

• The birth control patch contains hormones that prevent pregnancy.  It is placed on the skin and must be changed once a week for three weeks and removed on the fourth week.  A prescription is needed to use this method of contraception.

Vaginal Ring

• A vaginal ring contains hormones that prevent pregnancy.  It is placed in the vagina for three weeks and removed on the fourth week.  After that, the process is repeated with a new ring.  A prescription is needed to use this method of contraception.

Male Condom

• A male condom is a thin sheath that is worn over the penis during sex.  Condoms keep sperm from going inside a woman’s body.  They can be used with a sperm-killing substance (spermicide) to increase their effectiveness.  They should be thrown away after one use.

Spermicides are chemicals that kill or block sperm from entering the cervix and uterus.  They can come as a cream, jelly, suppository, foam, or tablet.  A spermicide should be inserted into the vagina with an applicator at least 10-15 minutes before sex to allow time for it to work.  The process must be repeated every time you have sex.  Spermicides do not require a prescription

An IUD is a T-shaped device that is put in a woman’s uterus. There are two types:

Hormone IUD (Mirena, Kyleena, Skyla)

• This type of IUD contains progestin, a synthetic form of the hormone progesterone.  This type can stay in place for 8 years.

Copper IUD

• This type of IUD is wrapped in copper wire.  It can stay in place for 10 years

Male Sterilization (Vasectomy)

• This is a procedure to tie off the tubes that carry sperm.  After the procedure, the man can still ejaculate fluid (semen).  Another form of birth control must be used for 3 months after the procedure.

Female Sterilization (Salpingectomy)

• This is a surgery to remove your fallopian tubes.  The fallopian tubes carry eggs from the ovaries to the uterus.  They are part of a woman’s reproductive system.  A salpingectomy may be done to treat an ectopic pregnancy, cancer, endometriosis, or an infection.  It may also be done to prevent pregnancy or some types of cancer.

In this method, a couple does not have sex on days when the woman could become pregnant.

Research shows that breastfeeding offers many health benefits for infants and mothers.  It also offers a cost-free and convenient way to feed your baby.

For your baby:

• Your first milk (colostrum) helps your baby’s digestive system to function better
• Special cells in your milk (antibodies) help your baby to fight off infections.
• Breastfed babies are less likely to develop asthma, allergies, obesity, or type 2 diabetes.  They are also at lower risk for sudden infant death syndrome (SIDS).
• Nutrients in breast milk are better able to meet your baby’s needs compared to infant formula.
• Breast milk improves your baby’s brain development.

For you:

• Breastfeeding helps to create a very special bond between you and your baby.
• Breastfeeding is convenient.  Breast milk costs nothing and is always available at the correct temperature.
• Breastfeeding helps to burn calories.  It helps you to lose the weight that you gained during pregnancy.
• Breastfeeding makes your uterus return faster to its size before pregnancy.  It also slows bleeding (lochia) after you give birth.
• Breastfeeding helps to lower your risk of developing type 2 diabetes, osteoporosis, rheumatoid arthritis, cardiovascular disease, and breast, ovarian, uterine, and endometrial cancer later in life.

• Find a comfortable place to sit of lie down, with your neck and back well-supported.
• Place a pillow or a rolled-up blanket under your baby to bring him or her to the level of your breast (if you are seated).  Nursing pillows are specially designed to help support your arms and your baby while you breastfeed.
• Make sure that your baby’s tummy (abdomen) is facing your abdomen
• Gently massage your breast.  With your fingertips, massage from the outer edges of your breast inward toward the nipple.  This encourages milk flow.  If your milk flows slowly, you may need to continue this action during the feeding.
• Support your breast with 4 fingers underneath and your thumb above your nipple (make the letter “C” with your hand).  Make sure your fingers are away from your nipple and your baby’s mouth
• Stroke your baby’s lips gently with your finger or nipple.
• When you baby’s mouth is open wide enough, quickly bring your baby to your breast, placing your entire nipple and as much of the areola as possible into your baby’s mouth.  The areola is the colored area around your nipple.
• More areola should be visible above your baby’s upper lip than below the lower lip.
• Your baby’s lips should be opened and extended outward (flanged) to ensure an adequate, comfortable latch
• Your baby’s tongue should be between his or her lower gum and your breast.
• Make sure that your baby’s mouth is correctly positioned around your nipple (latched).  Your baby’s lips should create a seal on your breast and be turned out (everted).
• It is common for your baby to suck about 2-3 minutes in order to start the flow of breast milk.

• Teaching your baby how to latch onto your breast properly is very important.  An improper latch can cause nipple pain, decreased milk supply, and poor weight gain in your baby.  Also, if your baby is not latched onto your nipple properly, he or she may swallow some air during feeding.  This can make your baby fussy.  Burping your baby when you switch breasts during the feeding can help to get rid of the air.  However, teaching your baby to latch on properly is still the best way to prevent fussiness from swallowing air while breastfeeding. 
• Signs that your baby has successfully latched onto your nipple
• Silent tugging or silent sucking, without causing you pain.  Infant’s lips should be extended outward (flanged).
• Swallowing heard between every 3-4 sucks once your milk has started to flow (after your let-down milk reflex occurs).
• Muscle movement above and in front of his or her ears while sucking
• Signs that your baby has not successfully latched onto your nipple
• Sucking sounds or smacking sounds from your baby while breastfeeding.
• Nipple pain.
• If you think your baby has not latched on correctly, slip your finger into the corner of your baby’s mouth to break the suction and place it between your baby’s gums.  Attempt to start breastfeeding again.

Signs from your baby

• Your baby will gradually decrease the number of sucks or will completely stop sucking.
• Your baby will fall asleep.
• Your baby’s body will relax.
• Your baby will retain a small amount of milk in his or her mouth.
• Your baby will let go of your breast by himself or herself.

Signs from you

• Breasts that have increased in firmness, weight, and size 1-3 hours after feeding.
• Breasts that are softer immediately after breastfeeding.
• Increased milk volume, as well as a change in milk consistency and color by the fifth day of breastfeeding.
• Nipples that are not sore, cracked, or bleeding.

Signs that your baby is getting enough milk

• Wetting at lease 1-2 diapers during the first 24 hours after birth
• Wetting at least 5-6 diapers every 24 hours for the first week after birth.  The urine should be clear or pale yellow by the age of 5 days
• Wetting 6-8 diapers every 24 hours as your baby continues to grow and develop.
• At least 3 stools in a 24 hour period by the age of 5 days.  The stool should be soft and yellow.
• At least 3 stools in a 24 hour period by the age of 7 days.  The stool should be seedy and yellow.
• No loss of weight greater than 10% of birth weight during the first 3 days of life.
• Average weight gain of 4-7oz. (113-198g) per week after the age of 4 days.
• Consistent daily weight gain by the age of 5 days, without weight loss after the age of 2 weeks.
• After a feeding, your baby may spit up a small amount of milk.  This is normal.

Frequent feeding will help you make more milk and can prevent sore nipples and extremely full breasts (breast engorgement).

Breastfeed when you feel the need to reduce the fullness of your breasts or when your baby shows signs of hunger.  This is called “breastfeeding on demand”.  Signs that your baby is hungry include:

• Increased alertness, activity, or restlessness.
• Movement of the head from side to side.
• Opening of the mouth when the corner of the mouth or cheek is stroked (rooting).
• Increased sucking sounds, smacking lips, cooing, sighing, or squeaking.
• Hand-to-mouth movements and sucking on fingers or hands.
• Fussing or crying.

Avoid introducing a pacifier to your baby in the first 4-6 weeks after your baby is born.  After this time, you may choose to use a pacifier.  Research has shown that pacifier use during the first year of a baby’s life decreases the risk of sudden infant death syndrome (SIDS).

Allow your baby to feed on each breast as long as he or she wants.  When your baby unlatches or falls asleep while feeding from the first breast, offer the second breast.  Because newborns are often sleepy in the first few weeks of life, you may need to awaken your baby to get him or her to feed.

Breastfeeding times will vary from baby to baby.  However, the following rules can serve as a guide to help you make sure that your baby is properly fed:

• Newborns (babies 4 weeks of age or younger) may breastfeed every 1-3 hours.
• Newborns should not go without breastfeeding for longer than 3 hours during the day or 5 hours during the night.
• You should breastfeed your baby a minimum of 8 times in a 24-hour period.

Pumping and storing breast milk allows you to make sure that your baby is exclusively fed your breast milk, even at times when you are unable to breastfeed. This is especially important if you go back to work while you are still breastfeeding, or if you are not able to be present during feedings. Your lactation consultant can help you find a method of pumping that works best for you and give you guidelines about how long it is safe to store breast milk.

• Nipples can become dry, cracked, and sore while breastfeeding
• Avoid using soap on your nipples.
• Wear a supportive bra designed especially for nursing.  Avoid wearing underwire-style bras or extremely tight bras (sports bras)
• Air-dry your nipples for 3-4 minutes after each feeding.
• Use only cotton bra pads to absorb leaked breast milk.  Leaking of breast milk between feedings is normal.
• Use lanolin on your nipples after breastfeeding.  Lanolin helps to maintain your skin’s normal moisture barrier.  Pure lanolin is not harmful (not toxic) to your baby.  You may also hand express a few drops of breast milk and gently massage that milk into your nipples and allow the milk to air-dry.
• In the first few weeks after giving birth, some women experience breast engorgement. Engorgement can make your breasts feel heavy, warm, and tender to the touch.  Engorgement peaks within 3-5 days after you give birth.
• Completely empty your breasts while breastfeeding or pumping. You may want to start by applying warm, moist heat (in the shower or with warm, water-soaked hand towels) just before feeding or pumping.  This increases circulation and helps the milk flow.  If your baby does not completely empty your breasts while breastfeeding, pump any extra milk after he or she is finished.
• Apply ice packs to your breasts immediately after breastfeeding or pumping unless this is too uncomfortable for you.  To do this:
  • Put ice in a plastic bag
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2-3 times a day.
• Make sure that your baby is latched on and positioned properly while breastfeeding.
• If engorgement persists after 48 hours of following these recommendations, contact your health care provider or a lactation consultant.

• Eat 3 healthy meals and 3 snacks every day.  Well-nourished mothers who are breastfeeding need an additional 450-500 calories a day.  You can meet this requirement by increasing the amount of a balanced diet that you eat.
• Drink enough water to keep your urine pale yellow or clear.
• Rest often, relax, and continue to take your prenatal vitamins to prevent fatigue, stress, and low vitamin and mineral levels in your body (nutrient deficiencies).
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes.  Your baby may be harmed by chemicals from cigarettes that pass into breast milk and exposure to secondhand smoke.  If you need help quitting, ask your health care provider.
• Avoid alcohol.
• Do not use illegal drugs or marijuana
• Talk with your health care provider before taking any medicines. These include over-the-counter and prescription medicines as well as vitamins and herbal supplements.  Some medicines that may be harmful to your baby can pass through breast milk.
• It is possible to become pregnant while breastfeeding.  If birth control is desired, ask your healthcare provider about options that will be safe while breastfeeding your baby.