**NOTE: All medications listed are available at your drug store without a prescription, except where noted. If you need a prescription drug, call our office at 687-5477 with your pharmacy’s number and a brief description of your problem.

2) NO X-RAYS UNLESS ABSOLUTELY NECESSARY

The answers to those questions are that by the end of the third month most women have said good-bye to morning sickness, and yes, a number of things may provide relief during those first few months.

1)  Eating nutritionally complete diet high in protein and complex carbohydrates and low in fats.
2)  Drinking plenty of fluids, including fruit and vegetable juices and broths.
3)  Avoiding any food whose smell, sight, or taste makes you queasy.
4)  Eating often - before you feel hungry. (Low blood sugar levels can trigger episodes of morning sickness, as can the action of stomach acid with nothing to digest. Try eating 6 or 7 meals a day (including a late night snack--pregnancy does have advantages!), before nausea strikes. And try eating a snack in bed the moment you wake up, if your morning sickness really does happen in the morning.)
5)  Get plenty of rest - fatigue is a common trigger of morning sickness.
6)  Staying in bed for a while after your wake-up snack, then taking your time getting and preparing a good breakfast.

1) Continue to eat your well planned, healthy diet - DO NOT skip meals and eat sensibly

2) Drink 8-10 oz. glasses of water, more if it is hot or you are active

3) Get plenty of rest

Another sign of pregnancy is increased vaginal discharge or "loss of the mucous plug". Again this is a sign that the cervix is getting ready - not that labor is imminent. This mucous may have some spots of blood; do NOT let this alarm you. This is normal.

You may notice a constant sensation of increased pelvic pressure in the last month of your pregnancy. Also, you may notice that there is more room in your upper abdomen. These are signs that the baby has "dropped" or descended into the pelvis.

Some guidelines for when to call the doctor are:

1)  Regular, predictable contractions that have been five minutes apart or less (beginning of one contraction to the next contraction)        and lasting from 45 to 90 seconds (beginning to end) for about one hour.

2) Bleeding, however, a small amount can be normal.

3) Breaking of the bag of water.

Your milk should "come in" 2 to 4 days after delivery. If your baby seems hungry after most nursing and you do not think your milk has come in by the fifth day consult your health care provider and have your baby weighed.

Your baby should latch on correctly to your breast and suck rhythmically for at least 10 minutes on each breast. He or she may pause periodically but should nurse vigorously though out most of the feeding. A baby usually gets more milk from nursing at both breasts than from nursing on one side only. Alternate the side on which you start feedings, so that both breasts receive comparable stimulation and emptying.

Your baby should appear satisfied after nursing and probably will fall asleep at the second breast. If your baby falls asleep and will not take the second breast, try to divide the baby’s effective suckling time between the two sides. A sleepy baby will get more milk by nursing for 5 minutes at each breast than 10 minutes at one. Breast- fed infants who appear hungry after most feedings, who chew their hands after nursing, or who often require a pacifier, may not be getting enough milk.

Your newborn baby should nurse at least eight times in 24 hours. A pattern that works well for many infants is nursing at 1.5 to 3-hour intervals throughout the day, with a single 5-hour stretch during the night. Time feedings from the beginning of one nursing to the beginning of the next. Four-hour intervals (six nursings in 24 hours) are too long for a newborn; very few breastfed babies will gain adequate weight that way. Do not be surprised if you need to wake your baby up to feed; it is not uncommon. Some babies do not demand to be fed as often as they need.

Your breasts should feel full before each feeding and softer after your baby has nursed. You should hear your baby swallow regularly while breastfeeding. One breast may drip milk while your baby nurses on the other side. After your longest night interval, your breasts should feel particularly full.

Your baby should urinate six or more times a day. Most breastfed babies wet their diapers after every feeding. The urine should be colorless, not yellow. Dark urine or a red "brick dust" appearance on the diaper could suggest that your baby is not getting enough milk. You may have difficulty telling whether a super-absorbent diaper is wet; put a piece of toilet tissue between the baby’s bottom and the diaper surface to help you be sure.

Your baby’s bowel movements should look yellow--somewhat like a mixture of cottage cheese and mustard--by the fourth or fifth day of life. These are called "milk stools". If your baby is still having dark meconium or greenish brown "transition" stools by 5 days of age, he or she may not be getting enough milk.

Your baby should have four or more bowel movements each day. Many breastfed infants pass a stool with every nursing during the first 4 weeks of life. If your newborn baby is having fewer than four stools each day, he or she may not be getting enough milk.

Your nipples may be slightly tender for the first several days of nursing. Usually, tenderness is present only at the beginning of the feedings, and discomfort is gone by the end of the first week. Severe nipple pain, pain that lasts throughout a feeding or pain persisting beyond one week probably means your baby is nursing incorrectly. If your baby is not latched on properly to nurse, not only will your nipples hurt, but your baby may not obtain enough milk. If your nipples are very sore, ask your baby’s health care provider to check your infant’s weight and refer you to a breastfeeding specialist who can evaluate your nursing technique.

After 2 or 3 weeks, you may be aware of the sensations associated with the milk letdown reflex. The feeling can be described as a tingling, pins-and-needles or tightening sensation in your breasts as the milk begins to flow. When letting down occurs, your baby may start to gulp milk, and milk may drip or spray from the other breast. Simply hearing your baby cry can cause milk to let down, even before your baby latches on. Although some women breastfeed successfully without noticing signs of the milk ejection reflex, failure to perceive let-down sensations could mean that your milk supply is low. If you are in doubt, ask your baby’s health provider to weight your infant.

"Unrelieved engorgement is a lactation emergency," says Kathleen Huggins, RN, MS, director of a breastfeeding clinic at San Luis Obispo General Hospital in California. Suspended breastfeeding during the period of engorgement can cuase the cessation of milk production and can cause a lactating mother to "dry up" in a little as 24 hours, Huggins says. If can also inhibit mothers from trying breastfeeding again.

Initial breast engorgement usually occurs during the first 72 hours postpartum and can continue for up to 14 days. During this period, mothers can experience varying degrees of swelling, but all should experience some breast change. The majority of mothers report some firmness and tenderness in their breasts following a birth, reports Pamela D. Hill, PhD, RN, associate professor in the College of Nursing at the University of Illinois in Chicago.

Some researchers have found that multiparous women experience engorgement sooner and more severely than primiparous mothers, regardless of whether the child was a vaginal or cesarean birth (Hill P. Humenick S. The occurrence of breast engorgement. J Hum Lact. 1994;10:79-86).

Researchers disagree about the exact cause of breast engorgement, but do agree that milk excretion is necessary to reduce the size of the breast. One theory holds that milk is retained in part of the breast called the alveolus, which expands and cuts off the outflow of milk (Newton M, Newton N. Am J Obstet Gynecol 1951;61:664-667). Another theory maintains that blood and lymph circulation increase when milk production is initiated, causing tenderness in the breasts.

Whatever the exact cause of breast engorgement, most researchers agree that infant feeding can reduce engorgement and that the more an infant feeds, the faster swelling will be reduced. When nursing her infant, a woman should be certain to empty one breast before switching the baby to the other breast. Switching breasts before all the milk is emptied can prolong engorgement, Huggins cautions.

If the child happens to get full from the milk of one breast the mother can use manual expression to massage the milk out of the other breast. She may also use a breast pump to release the milk. The mother does not have to save the milk she massages from the breast--her breasts will fill again with milk by the time the baby wants to feed again.

Proper positioning of mother and infant during breastfeeding is essential. The baby’s lips should be firmly around the areola to promote a smooth suck. Improper infant latch-on can make sucking painful for the mother.

Huggins also recommends placing ice packs on engorged breasts after nursing to help swelling subside. While nursing, some women place heating pads on breasts for comfort, but Huggins cautions that excessive use of heat can prolong engorgement.

In cases of severe engorgement, Huggins says she asks the mother to come to her office to have breast milk removed using a breast pump. This technique is usually not used until the fourth or fifth day postpartum.

All of the most dramatic growth of a child’s life--physical, cognitive, social and emotional--occurs during infancy. By the time a baby reaches one year of age, he has tripled his birth weight, added almost 50 percent to his length, and achieved most of his brain growth.

The easiest way to understand safety is to consider it in the context of a baby’s development. Infants are completely reliant on their parents and caregivers to keep them safe from harm.

The Newborn Baby

The One-Month Old

• Responds to sound by blinking, crying, quieting, changing respiration or showing a startle response
• Fixates on the human face and follows with eyes
• Responds to parent’s face and voice
• Has flexed posture
• Moves all extremities
• Can sleep for three or four hours at a time; can stay awake for one hour or longer
• When crying, can be consoled most of the time by being spoken to or held

The Two-Month Old

The Four-Month Old

The Six-Month Old

As you can see, the rapid changes in an infant’s development during the first six months of life mean that babies quickly progress to a stage when they can roll off a changing table, bed, or other furniture; pull up into a standing position (often using tablecloths and appliance cords for support); and put items in their mouths.

Remember, infants and children are especially vulnerable to injury: