1. Class 5 Thanks for coming!

2. Questions From Last Week
More info on placenta encapsulation?
When are boys circumcised?
Handout with pros/cons of epidural/narcotic?
More ?’s for providers regarding Iv’s?
What does Ohana offer postpartum?
Does the woman poop when pushing?

3. Transition

4. Transition What’s Happening?
The cervix finishes dilating and effacing.
Contractions are now powerful and efficient, so this phase is usually quite short (less than an hour).
Some women feel nauseous, shaky, restless or irritable during this phase of childbirth.

5. Transition
What Helps
To keep from feeling overwhelmed, focus on one contraction at a time.
Continue with breathing, vocalization (if it helps) and rhythmic movement.
Even though rest periods are short, they allow you to relax deeply and restore yourself.
Partner support: close undivided attention, unwavering encouragement and praise.

6. Pushing Positions SQUATTING opens the outlet of the pelvis
may enhance the urge
to push
reduces chance of tear
to perineum
gravity assists delivery

7. Pushing Positions
BIRTH STOOL - Stabilizes mom while pushing -Opens pelvic outlet -Gravity assists delivery

8. Pushing Positions LYING ON SIDE Ideal if mom is exhausted
May ease a fast
pushing stage
Counter pressure
offers great relief

9. Newborn Procedures
Skin to Skin Cord Clamping Apgar scores Weighing & Measuring Vitamin K Eye Drops

10. Skin to Skin Benefits… -Baby feels safe
-Helps regulate heart rate, breathing, blood pressure, and temperature
-Provides mom with an increase in oxytocin, the love hormone
-American Academy of Pediatrics recommends placing baby skin to skin immediately after birth as long as there is no medical need for separation
-Better chance for a successful latch for breastfeeding
-Csec or med attention - skin to skin whenever reunited

11. Cord Clamping

12. APGAR Score APGAR scores are given in 5 categories Appearance (color)
Pulse
Grimace (do they cry or pull away when stimulated)
Activity (muscle tension)
Respiration (sound of the cry)
APGAR of 7-9 considered good

13. Procedures the nurses conduct after the birth of the baby…
Weighing and measuring
Vitamin K shot
Eye drops
Can ask for all these to be delayed up to 2 hours to give you time to bond w/ baby first.

14. Placenta Delivery Usually within 45 min after baby is born
Different providers have different practices
Wait for the placenta to detach by itself
Cord traction (pull on cord to assist)

15. Immediately after Birth
Shaking – hormonal Uterine Compression (“Massage”)

16. Homework
With your partner, discuss elements of loss you feel associated with your upcoming birth.
Birth of your baby is an exciting time but there are also important elements of loss associated with having a baby.  
Feeling of loss associated with giving up a degree of independence and freedom.
You may feel loss around the absence of people who you would like to be there to welcome and meet your baby with you, but who either live far away or have passed away.  
There is also loss of a certain kind of relationship with your partner when it was just the two of you.  
Experiences with abortion or miscarriage can also come to the surface.
There is also a feeling of loss sometimes associated with the baby not being inside the mother anymore.

17. Priorities Activity To help you discuss your birth preferences
Each card has two sides. With your partner, lay out your perfect birth face up.

18. BREAK

19. BREASTFEEDING

20. BREASTFEEDING First few days is COLOSTRUM
High concentration of nutrients & antibodies
Small in quantity
High in protein
Baby’s first immunization
Mild laxative effect
The day old newborn’s stomach doesn’t stretch to hold more. It stays firm, so excess milk is often spit up. Newborns have small digestive systems & colostrum delivers nutrients in a concentrated, low-volume form.

21. NORMAL NEWBORN FEEDING
8-10 times per day
Day time, offer the breast every 2 hours. At night, every 3 hours, or if the baby is a healthy weight, every 4 hours.
Once milk is established, then can space out the feedings.
Not necessarily evenly spaced.
Typical is every 1-3 hours, then “cluster-nursing” every ½ hour for 2-4 hours, then one long sleep stretch after the cluster nursing
When breast is full, low fat content
As breast empties, more fat
As the baby grows, typically the same number of feedings, but the time on the breast goes down and down
Babies often lose between 7-10% of their body weight.

22. RED FLAGS
Sore nipples
Engorgement that doesn’t resolve with feeding
Baby not pooping or peeing

23. Looking at baby’s poop & pee can tell you if your baby is getting enough to eat:
Peeing and pooping a lot, 6-8 wet diapers in a 24hr period and the pee should be clear, not smelly.
By day 4, the poop should change to yellow. First it is black tar-like, then it will change to greenish, and by day 4 it should be yellow.
Signs of dehydration are ~no pee, ~no poop, or dark yellow smelly pee.

24. Pumping Hospital grade rentals - meant to help bring in milk
Two types of pumps:
Hospital grade rentals - meant to help bring in milk
Pumps you can purchase- meant to be used after your supply is already steady

25. Homework
Look over postpartum plan and think about who you can ask for help with various components p