Health Services
It’s finally here – the last trimester. This is perhaps the most exciting time of your pregnancy; your baby is almost here! As the birth draws nearer, you probably find yourself daydreaming about the baby. You also may be increasingly nervous about the changes that are occurring in your life. You can make the transition easier by preparing before the baby’s arrival.
Packing for the Hospital
As your delivery date draws near, you should have a bag packed ahead of time with as many of the following items as possible:
| • | A clean nightgown for each day, or you can wear a hospital gown. Short gowns are more convenient. If you are going to breastfeed, make sure your nightgown has a front opening. |
| • | A robe, bedroom slippers, toothbrush and paste, deodorant, shampoo, makeup and a case for your eyeglasses or contacts |
| • | Clothing for the baby to wear home — an undershirt, outer garments (dress, gown or sleeper) and a cap, booties, sweater and blanket, depending on the weather |
| • | Several bras that provide good support, one for each day of your expected hospital stay. Include nursing bras if you are going to breastfeed. |
How Are You Feeling?
During the final trimester, you will continue to gain weight at the rate of about a pound a week until your last month, when your gain will be limited to only a pound or two for the entire month. You often may be uncomfortable during the last trimester, but there are some things that you can do to alleviate some of this discomfort. The following are some tips to address certain comfort concerns during your last trimester:
| • | Backache —Your back may hurt, especially when rising and at the end of a busy day due to the strain on your muscles. Maintain good posture, walk tall and straight, and use the right body mechanics for lifting. Avoid fatigue and wear flat, wide-based shoes. |
| • | Frequency of urination —You will probably either need to urinate often, or you will feel as though you need to. This is caused by pressure on your bladder from your growing fetus. Wear a panty liner if you "dribble." |
| • | Swelling – Your hands and feet may swell due to the decrease in blood circulation in those areas. If this occurs, elevate your feet during the day, decrease the salt in your diet and be sure to inform your physician of any rapid increase in swelling. |
| • | Sleeping — Many mothers say that their babies’ movements keep them awake at night. Try changing positions in bed and experiment with propping pillows in different places to get more comfortable. |
During this trimester, you may be feeling compressed in your mid-chest area. It also may be hard to draw deep breaths because your uterus is pressing on your diaphragm. In the last month before birth, you will get some relief when the baby settles lower into your pelvis to prepare for the birth. This step is called "lightening" (i.e., the relief of pressure makes you feel lighter). As a result, your breathing now will be easier and you will experience less indigestion from the pressure of the baby on your stomach.
Until lightening happens, however, you can help the pressure by eating several small, light meals during the day rather than three large ones. If you have trouble breathing at night, prop yourself on two or three pillows. Try lying on your side with a pillow under your upper knee to provide support. If you lie on your back during late pregnancy, the pressure of the baby's weight may press on a major vein and decrease the blood flow to your head. This will cause light-headedness.
During this trimester, you may be constipated. Be careful not to strain, because straining can cause hemorrhoids. Rather, drink more fluids, especially fruit juices, to naturally stimulate your body to eliminate waste.
If you notice the appearance of tiny spiderlike red blood vessels along the backs of your knees and thighs, discuss their presence with your physician, who may suggest the use of support hosiery.
If your body begins to accumulate fluid, most noticeably at your ankles and fingers, be sure to remove your rings before they become too tight. Discuss this fluid accumulation (called edema) with your physician.
Despite these discomforts, you should still be enjoying the healthy experience of your pregnancy. Soon you may find yourself concerned with a flurry of tasks to be done before your due date. This activity is known as the "nesting urge" as you and your family prepare for the baby's birth.
Call your physician immediately if any of the following symptoms appear:
| • | Blurred vision or dimness |
| • | Constant and severe abdominal pain |
| • | Lack of activity by the fetus in the uterus |
| • | Leakage of the amniotic fluid from the vagina |
| • | Nausea and vomiting more than once within several hours |
| • | Severe headache |
| • | Sudden swelling in your hands, legs, face or eyes |
| • | Urinary problems, such as marked decrease in urine output or pain or burning with urination |
| • | Vaginal bleeding of any kind |
Growth of the Fetus
Seventh Month
The infant within you is rapidly maturing. The average length of a 28-week fetus is about 15 inches, and the average weight is about 2 1/2 pounds.
If the birth occurs during this month, your baby has a 50 percent chance of survival if intensive care is provided in a high-risk nursery like the one at Great River Medical Center. Babies prematurely born at seven months often have breathing problems because the respiratory system is not fully mature at that stage of pregnancy.
The baby's sexual development continues during this month. If the fetus is a boy, his testicles may begin to descend into the scrotum. Although your baby’s skin is very delicate and thin, fat and tissue are being produced beneath the skin. Your baby’s skin is covered with vernix caseosa, a cheesy substance that protects the skin from the amniotic fluid.
Eighth Month
An eight-month baby is about 16 1/2 inches long and weighs about 4 pounds. If the birth occurs during this month, your baby would have more than a 90 percent chance of survival. Your baby is continuing to gain weight as a layer of fat develops beneath the skin. The downy hair (lanugo) that covered the baby’s body is beginning to disappear.
Ninth Month
During this month, your baby will gain about two inches and 2 1/2 pounds. Your baby may seem less active because the space inside your uterus is restricting movement. By the end of this month, your baby's head will probably be engaged in your pelvis. Most of the lanugo will disappear by this time, although there may still be some small patches of it at birth. At term, the average baby will be 20 inches long and will weigh 7 1/2 pounds.
Preparing for Labor and Delivery
Every woman's labor and delivery is different. Labor pain, a natural part of the birth experience, is often feared and dreaded by pregnant women. The perception of pain is very subjective. Five percent of all mothers have little or no pain during labor, and most women tolerate labor pains well, even though the pain may be severe at times.
An understanding of the birth process and the various methods of controlling pain will make you feel more prepared and more able to tolerate discomfort. There are a variety of ways to control labor pain, and most methods are discussed in prenatal classes. You also should discuss them with your physician.
Non-pharmaceutical techniques of pain control during labor are:
| • | Relaxation — This is achieved through a variety of methods and conserves energy by relaxing the other muscles of the uterus to do their job. |
| • | Positioning — Depending on you physician's wishes, you may find different positions and activities to increase your comfort. |
| • | Listening — The instructions and conversations of your coach and others will distract you from pain. Music helps too. A tape/CD player is available for your use during labor and delivery. |
| • | Focusing — You will learn in prenatal class just how much focusing your attention on an object can truly help control pain. |
| • | Breathing techniques — Proper breathing techniques will aid in relaxation and control. Different breathing patterns are used in the different phases of labor. |
| • | Massage — Light stroking of the abdomen is relaxing and supplies different stimuli on which to focus. |
| • | Counter pressure — Firm pressure applied to the lower back |
| • | Heat and cold — Both hot and cold packs can be used in a variety of places to help the mother cope with pain. |
Medication relief for pain control is available if needed, but it's important to know that all drugs that affect the mother also affect the baby. You and your physician will make the decision as to when and what kind of medication you will use, if any, during labor.
If you have not yet attended any prenatal classes there may still be time. Please call Great River Medical Center at (319) 768-4000 to check on the availability of these classes.
Indications of Labor
The beginning of labor can be confusing because "false labor" feels similar to "true labor." It is helpful to know the symptoms so that you can differentiate between the two.
False labor:
| • | Does not become more intense |
| • | Does not result in a change in thickness of the cervix, and the cervix does not dilate |
| • | Is often felt in the abdomen |
| • | Stops with exercise or change in position |
True labor:
| • | Cervix becomes thinner and dilates. |
| • | Contractions come at irregular intervals and increase in frequency (contractions are timed from the beginning of one to the beginning of the next). |
About one or two weeks before true labor begins, the baby will "drop" (move into position in the birth canal). This is a sign that labor is not far away.
A gush or a trickle of the amniotic fluid indicates that the membranes have ruptured. This may occur several hours before labor begins, and you should call your physician. If the sac does not break on its own during labor, the physician may break it.
Inform your physician of any onset of labor. Your physician will tell you when you should prepare to go to the hospital.
Admission to the Hospital
Your physician will call the Obstetrics Unit to tell the nurses to prepare for your arrival. Your length of stay will probably depend on what your insurance covers. All insurance plans limit the number of days or hours of coverage for birth. Discuss this with you physician who must write a discharge order for you before you leave the hospital.
When you arrive at Great River Medical Center, come directly to the Obstetrics Unit on the second floor. Use the Emergency Department entrance if you arrive after 10 p.m. or before 6 a.m. If you are uncomfortable and want a wheelchair, please ask for help – either in the Emergency Department or Registration by the main entrance.
The nurse in the Obstetrics Unit will show you to your private room. When you are in your room, the nurse will ask you several questions, such as when your labor started, if you are allergic to anything and what physician you have selected to care for your baby. She will take your temperature, blood pressure and check the baby's heart rate with a fetal monitor.
When the admission preparations are completed, you may get up to walk around, depending on your labor and how you feel. Your room has a telephone and television set and a comfortable chair. Early labor is a time to keep your mind occupied with quiet activity while your physician and nurse monitor the labor progress. While you are in your room, you may have no more than two visitors at a time. If you are going to have more than two visitors while you are in labor, they may wait in the waiting room on the Obstetrics Unit. Be sure to ask your physician and nurse any questions you have during labor.
The Four Stages of Labor
Now that your baby's birth is imminent, the stages of labor and birth are undoubtedly foremost in your mind. You have probably discussed the stages with your physician and also have participated in discussions during prenatal classes. It is helpful to fully understand the birth process so that you are less anxious when the time arrives. Before a baby can be delivered, the cervix must first become completely dilated (opened up) so the baby can descend through the pelvis to birth. This process takes place in four stages:
Stage I begins with the onset of contractions and ends when the cervix is fully dilated. The first stage is divided into three phases — early, active and transition.
In the early phase, mild contractions last for 30 to 45 seconds and occur every five to 20 minutes. These mild contractions feel like a backache, pressure or pulling in the groin area as the cervix dilates.
In the active phase, the contractions progress to three minutes apart and last for about 60 seconds. They increase in intensity and are usually felt in the abdomen. The cervix dilates from 4 to 7 centimeters in the active phase.
The transition phase is the most difficult period of labor, with intense contractions occurring two to three minutes apart and lasting from 60 to 90 seconds. At this time, the cervix dilates to 8 to 10 centimeters.
Stage II begins with full cervical dilation (10 cm) and ends with the birth of the baby. This stage may last from a few minutes to two hours.
Stage III begins with the birth of the baby and ends with the delivery of the placenta. This stage may last from five to 30 minutes.
Stage IV follows the delivery of the placenta and will last for up to three hours until the mother’s condition has stabilized following birth. Both mother and baby will be under careful observation, and the mother's blood pressure, pulse and respiration, amount of bleeding and uterine position will be checked every 15 minutes for at least an hour. This is an important time for the mother and father to bond with their new baby. If you are planning to breastfeed, this is a great time to start.
Your Baby in the Hospital
Following the birth, your baby’s footprints are taken and identification bracelets are placed on both ankles. The bottoms of your baby’s feet will be black until his first bath, about eight hours following birth.
To retain body heat, your baby is only dried off, not bathed, immediately after birth. Your baby has come from the warm body of the mother into what is comparatively a cold world, so precautions are taken to keep the baby warm. A knitted cap is kept on your baby’s head for 24 hours. Volunteers knit these caps with yarn donated by the hospital’s Auxiliary. The cap is yours to take home.
On arrival in the Nursery, an ointment is placed in your baby’s eyes to prevent infection and an injection of vitamin K is given to increase the blood’s clotting ability. Your baby then is snugly wrapped and placed in a warm isolette for eight hours. Your baby can be brought to your room to be fed. Remember to wrap and cuddle your baby closely to retain body heat.
There are three nurseries at Great River Medical Center: the Neonatal Intensive Care Unit; the Intermediate Care Nursery for infants with monitors or intravenous feedings and medications; and a general nursery. Nurses caring for babies in Great River Medical Center’s nurseries are trained in newborn care, and there is always a nurse in each nursery.
Bonding – that very special time immediately after delivery when the parents become acquainted with the newest member to the family -- has become increasingly important in the birthing experience. Great River Medical Center offers a "rooming-in" option that allows the mother to keep her baby in the room with her as much as she chooses.
The nurses will teach you how to care for your baby, including information about:
| • | Bathing your baby |
| • | Breast- and bottle-feeding |
| • | How to take baby's temperature |
| • | Safety |
| • | Skin and genital care |
| • | Use of a bulb syringe |
| • | When to call the physician |
They also will instruct you in how to care for your baby’s cord. The clamp is taken off the cord the day following birth. You will notice a purple dye on it after your baby’s first bath. This is to help the cord dry. It is wiped with alcohol two to three times daily thereafter.
Please ask questions. Now is the time for you to learn to be comfortable and confident while caring for your child. Your baby's physician is also an excellent resource for child-care information, and there are many excellent books on the subject.
Pros and Cons of Circumcision
You will want to discuss the pros and cons of circumcision with your baby's physician. Circumcision is a surgical procedure for male infants in which the foreskin of the head of the penis is removed. This procedure takes about 10 minutes. Afterward, the baby will be observed for bleeding and urination.
Circumcision requires special care until the penis is healed, usually about one to two weeks. Care of the incision includes removing diapers immediately after each soiling, cleaning the area with warm water and mild soap after each diaper change, and applying a light covering of petroleum jelly for about seven to 14 days.
There are some risks involved in circumcision, notably hemorrhage and infection. Parents should immediately report any fever, swelling, skin redness and more than slight blood spotting to their baby's physician.
The reasons parents choose to have their boys circumcised vary, and it is important that you make a decision based on information from your baby's physician. Uncircumcised male infants need special care for effective hygiene. At birth, a boy's foreskin is usually unretractable and does not become fully retractable until four to six years of age. During bathing it is important to gently and gradually retract the foreskin and cleanse the penis with soapy water. As your child grows, you must teach this cleansing as a daily part of his hygiene.
Your Baby's Legal Birth Certificate
While you are at the hospital, information will be collected for your newborn's state birth certificate, and this information will be filed with the Iowa State Department of Health. There is a $20 fee in Iowa to register the birth. Money from this fee goes toward the prevention of child abuse.
The hospital will provide you with a Record of Birth, which is not a legal document. If you wish to receive a copy of the birth certificate, it's necessary to write to the Iowa State Department of Health, Records and Statistics Division, State Office Building, Des Moines, IA 50319. The fee for a copy is $10.
A Photo You Will Want to Keep
You will probably want a photo of you newborn. If you do not want to take your own photographs, the hospital offers parents the option of having their babies’ pictures taken and processed through a contract service. The picture will be taken on the day the baby goes home. Color prints are available in a variety of sizes and prices.
Transporting Your Baby
A baby is particularly vulnerable and very fragile when riding in a vehicle that stops suddenly or is involved in an accident. Nearly 200 infants in this country die each year on their way home from the hospital following birth.
Holding a baby in your arms is dangerous in a car. If an accident occurs, a child in a parent’s arms can be crushed between the car’s interior and the unrestrained parent. Even if the parent is wearing a seatbelt, a 10 pound infant exerts a 300 pound force in a 30 mile-an-hour crash, and chances are that the adult could not hold on to the infant.
Many infants are injured in "incidents" rather than accidents — sudden stops or swerves that send unrestrained babies flying through the windshield or into the dash. Iowa has a seatbelt law that requires infants to be restrained in an infant seat at all times in an automobile. All infant seats should be placed with the baby facing the back seat. The infant seat should be placed in the back seat if the car you are riding in has air bags. The sooner your baby gets used to riding in an infant car seat – and the first ride in an infant car seat should be home from the hospital – the safer and more comfortable you both will be.
First Month Following Birth — Taking Care of Yourself
You were pregnant for nine months, and you are not going to return to your "original" self over night. It will take some patience and time to help your body recover from pregnancy and the birth experience.
Continue the personal care of your perineal area and stitches, as your physician instructed. You will heal soon after your dismissal from the hospital. If you are still sore, a soak in a warm bath for a few minutes will soothe and heal your stitches (place a soft towel on the bottom of the tub). Drink lots of liquids to prevent constipation, which will irritate the area.
You will continue to have some bloody discharge for up to six weeks after delivery. If the flow ever becomes heavier than a normal menstrual flow or if it develops a foul odor or a bright red color, you should notify your physician.
If you are breastfeeding, avoid using soap or drying agents on your nipples. Just rinse them with clear water. If your nipples are sore, expose them to the air whenever you can.
Although you are probably anxious to improve your figure right now, you must not skimp on nutrition. You need the energy that a balanced diet will give you. If you are breastfeeding, your diet is even more important. Continue to eat plenty of meat, fish, eggs and cheese, along with balanced portions of green and dark-yellow vegetables, grains, fruits and dairy products. If you are nursing your baby, try drinking an 8-ounce glass of water or a non-carbonated beverage when you nurse. It is a good way to remember that you need extra liquids when nursing.
You may want to tighten up the loose muscles that resulted from your pregnancy. Ask your physician before you undertake a rigorous exercise program. Until then, walking is always good for you, and it is good for your baby, too.
This will be a busy time and getting adjusted to a new baby in the house is an added pressure to the whole family. Now is the time to let a family or a friend help you with your housework. If someone offers to help you care for your baby, you may want to suggest that what you really need is help with the housework.
Try to allow yourself some rest time during the day. Your nights will be interrupted with caring for and feeding your baby. So sit down with your feet up or take a nap when you get the opportunity during the day. Your strength will come back.
After your baby is home for a few weeks, you will establish a routine, and things will fall into place. Remember: Your body is not kidding you when it tells you it is tired. You may want to consider setting "visiting hours" if you have too many visitors. Some mothers have found it helpful to put a note on the door saying, "Mom and baby are resting now. Please return in an hour."
The myth of the "Super Mom" is just that — a myth. No one can do it all. You will find your own method of balancing your time and energy with all of the demands placed on you now. Just do not forget to take care of yourself, too.
Common Concerns
All infants are different, and it takes a certain amount of experience to acquire confidence in caring for your baby. However, after a short time, you will find yourself becoming more acquainted with your baby’s needs.
When your baby cries
Most new parents are concerned about what to do when their babies cry. A crying baby can distress the whole household and certainly will upset the mother. She will be looking for ways to calm her child. Parents should not be afraid to pick up their babies and comfort them. Sometimes that is all that your baby wants — reassurance that someone is there. It is normal to want to be held and loved. Babies who are comforted and cuddled by their parents will become confident of their love and will probably cry less as they get older.
Sometimes it will seem as if nothing you do will comfort you baby. Babies can comfort themselves to sleep and should be allowed to do so occasionally. If your baby is dry and still cries after being fed, burped, held and cuddled, put your baby to bed and stand for awhile at the crib side, patting your baby’s back gently. Surprisingly, sounds can calm a baby. Examples of soothing sounds include a ticking clock, the clacking of a wind-up cradle and the human heart.
It helps to discuss your baby's crying with other mothers or your physician. You will find that it is a problem that your child will outgrow.
Feeding your baby
New parents often have questions about feeding their babies. You should discuss this with your baby’s physician. Babies usually can drink cow's milk after they are 1 year old and can begin eating solids after four to six months.
If your baby gains weight, it is eating enough, and even babies who spit up a lot or have colic will gain weight. After awhile, you will find that a definite eating pattern emerges, and you will no longer worry about your child getting enough to eat. Discuss any food changes with your baby’s physician.
Parents should be attentive about cleanliness when they bottle-feed their babies. Bottles and nipples can be washed in the dishwasher or washed in hot soapy water after every use and rinsed well in scalding water. Do not save milk that is left in the bottle after your baby feeds.
Diaper rash
Most babies will get some form of diaper rash. This is mainly caused by urine’s acidic nature and its reaction to the skin. Disposable diapers keep babies fairly dry. However, when you begin to feed your baby solid food, the stool interacts with the urine and causes a rash.
If your baby gets a red bottom, the first thing to do is expose the area to air. Leave the baby's bottom uncovered during naps with a couple diapers underneath. This works in most cases. Or, you can purchase an over-the-counter diaper rash ointment that can be applied after cleaning the baby's bottom. If the rash does not clear up with these treatments, contact your baby’s physician. Some babies are allergic to the perfume in disposable diapers.
To prevent diaper rash, be sure your baby's bottom is clean and dry. When the diaper is dirty, wash the baby's bottom with soap and water and pat it dry. Baby wipes are convenient, but they also are expensive, and contain alcohol and perfume. As a general rule, the less you put on your baby's skin, the better.
Cradle cap
Keep your baby's head clean, and rub it. Cradle cap appears as a crust on the scalp and behind the ears. To help prevent cradle cap, wash your baby's scalp daily with baby shampoo and use a washcloth or soft brush to massage the scalp. Do not be afraid of washing the soft spot because it is a thick membrane and you will not harm the baby.
If you are a first-time parent, you may feel somewhat unsure about when you should check with a physician about your baby's health and safety. It is important for you to know what is considered serious enough to warrant a call to your baby’s physician. If you are unsure, it is best to call. However, first-time parents, and sometimes experienced parents, will naturally worry about what they consider abnormal behavior or symptoms. The following occurrences are common:
| • | Babies become cranky with head colds. |
| • | They are constipated once in awhile. |
| • | They break out in rashes (especially on hot days). |
| • | They have single episodes of diarrhea. |
| • | They vomit occasionally. |
Constipation is a frequent concern of most parents. It can be normal for a baby to have a bowel movement only once every two or three days. Babies are constipated only when the stools are like small, hard pellets. Ask your physician or your physician’s nurse about treatment for constipation.
Safety
There are many things that parents can do to make the world a safer place for their baby. The following are some safety suggestions that are important for you to observe:
| • | Always use an approved infant carrier placed in the back seat of a car. |
| • | Burns in children are serious, painful and disfiguring. Do not cook with the baby in your arms. |
| • | You can safely turn your hot-water heater down to 120 F degrees to avoid scalds from the tap. |
| • | Do not put cords or necklaces of any kind around babies’ necks. They can strangle with them. |
| • | Go through your house and carefully place all cleaning solutions, disinfectants, etc., out of reach of children. Even though your child is still a baby, it is a good idea to begin safe storage of poisonous items. |
| • | Keep medicines out of reach and discard them when you are through with them. Keep ipecac syrup in your home. This is used to induce vomiting if a child ingests a poison. Call your physician or the hospital’s Emergency Department first. |
| • | Never leave your baby alone in the bath or on a table. Babies can drown in as little as _ inch of water and can fall on the floor from a table or chair in an instant. |
| • | Never place plastic bags in a crib or playpen, or where a child can reach them. |
| • | Toys should be washable and washed frequently. They should not have any sharp edges and should be large enough so that they cannot be swallowed. |
Trust your own judgment. Remember that the trust you place in your baby's physician is important. Your physician is your best resource for advice.
The Father's Role
With the exception of breastfeeding, a baby's father can do anything the mother can do. After a new baby comes home, a father and mother usually will divide and share the household chores whenever possible. A father will feel closer to his new child if childcare is shared. The bond between parent and child begins at birth and equally sharing that bond will provide a foundation of security for the baby.
Infants recognize and respond to their fathers; the voice is deeper and the body feels different. A baby accustomed to being breastfed will often accept a bottle from the father but not the mother; the baby associates the mother's "feel" and odor with breast milk.
Breastfeeding Requires Rest, Fluid, Nutrition
A mother who decides to breastfeed her baby usually gets a good start in the hospital, with help from the nurses. However, breastfeeding sometimes becomes a problem after she is home again and is experiencing all of the excitement and duties of a new mother.
Things to remember:
| • | Many people think that the baby sucks the nipple. This is not true. Your baby squeezes the milk from the breast by pressing with his hard palate and tongue on the ducts behind the areola. |
| • | The baby's sucking will not damage your nipples or make them sore if the baby is in the right position. |
| • | You do not need to restrict the length of feedings. Feeding time will become shorter as your baby grows. |
| • | Your baby will gradually take more milk at fewer times. Eventually, your baby will sleep through the night. |
| • | Your breasts do not need to be emptied at each feeding. Your supply will adapt to the baby's demand. |
Breastfeeding is increasingly the choice of more women for its convenience and natural nourishment. Relaxation is one of the keys to successful breastfeeding. If your household is active and noisy, you will probably want to retreat to a quiet bedroom with your baby. Sit comfortably with your back supported and your feet propped up and have something to eat or drink. You may want to take the telephone off the hook or listen to relaxing music. Put toys or books nearby for older children.
Choosing Daycare for Your Baby
Many mothers must return to jobs outside the home after six or eight weeks of maternity leave. Choosing a childcare provider is often difficult. The mother has several options. She can hire a baby sitter to come to the house, she can take the infant to a daycare center or to a private home, or she may be lucky enough to have a relative who is capable — and willing — to care for a baby.
If you decide to hire a baby sitter to come to your home, it is important to have full confidence in the sitter's ability to care for your child similar to the way you provide care. References are important, and you should always check them.
Trust your instincts. If you do not like the person, your baby probably will not either. Before interviewing potential sitters, prepare some questions to ask them regarding how they feel about child rearing, toilet training, eating habits, cleanliness and their ability to handle emergencies.
Social Security tax must be paid for the full-time baby sitter in your home. Form 942, available from the Internal Revenue Service or locally at banks or lawyers' offices, must be filled out. If you hire someone to take care of your children while you are employed, you are probably eligible for a tax credit on federal and state income taxes.
Another choice is childcare provided in the home of the caregiver, who is often a mother, too. Because many of these homes are not inspected or licensed by local or state agencies, it will be up to you to make sure that adequate health and safety standards are met. You will want to ask the same kinds of questions that you would ask a sitter who would come to your home.
Daycare centers may be the choice that you make. Daycare centers are established to care for a group of children and should be licensed by the state. They often have a program of activities to help children learn. You will be interested in whether or not the infants are cared for in a separate room, and whether the center is clean and the staff qualified. To meet Iowa qualifications, there should be at least one staff person for every four children ages 2 weeks to 2 years. Visit various daycare centers and talk to the directors, asking questions about your concerns. Check with Iowa State University Cooperative Extension Service regarding free daycare information.
Sometimes your baby may dislike something and be unhappy, no matter how competent the daycare center or baby sitter is. Discuss the situation with the care providers and allow some time for change, but be prepared to change sitters or daycare centers, if necessary.
Mothers Tell Us ...
Some frequent comments we hear from new mothers include:
| • | "Babies do recognize their mothers." |
| • | "Babies do smile. It's not just gas." |
| • | "Babies see fairly clearly - up to 12 inches immediately following birth." |
| • | "Enjoy your baby. That was one of your reasons for having one!" |
| • | "Feeding your baby, whether by the bottle or breast, will become much easier after about eight weeks, when the growth pattern becomes more regular. Have patience!" |
| • | "If you are breastfeeding and would like to introduce a bottle, wait two to four weeks until your milk is well established. After that, it’s fine to use an occasional supplement of pumped breast milk or infant formula." |
| • | "You can't raise a baby by the book. You and the baby are too individualistic for that. Use resources, but trust your instincts too." |
Good Luck!
We hope you have found this informative and helpful. It has been our aim to provide practical, easily understood information for expectant parents beginning with the early stages of pregnancy and continuing through the second month after the baby is born. All of us at Great River Medical Center wish joy and happiness to you and the new addition to your family.
Recommended Reading
The American Academy of Pediatrics — Caring for You Baby and Young Child. Steven Shelov, M.D. Bantam Books.
Dr. Gollup's Survival Guide for New Parents. Howard Gollup, M.D. Iguana Medical Books.
What to Expect the First Year. Arlene Eisenberg, Heidi Murkoff and Sandy Hathaway. Workman Publishing.