Babys Best Chance - 6th Edition

revised sixth edition
My Team Contact Information
Partner at work: _____________________________________ Cell phone: ________________________________________
Health Care Support Team
Name/Title Contact Information
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Personal Support Team
Name Contact Information
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© 2005 Province of British Columbia, Ministry of Health, Victoria, BC
All rights reserved. The use of any part of this publication reproduced, transmitted in any form or by any means,
electronic, mechanical, recording or otherwise, or stored in a retrieval system, without the prior consent of the publisher
is an infringement of the copyright law. In the case of photocopying or other reprographic copying of the material,
permission must be obtained from the Intellectual Property Program at (250) 356-5055, website www.ipp.gov.bc.ca.
Library and Archives Canada Cataloguing in Publication Data

Main entry under title:
Baby’s best chance : parents’ handbook of pregnancy and baby care.
“Sixth edition”
Rev. ed. Previously published in 1998 by MacMillan Canada.
Includes index.
ISBN 0-7726-5371-2
1. Pregnancy – Popular works. 2. Prenatal care –

Popular works. 3. Childbirth – Popular works. 4. Infants –
Care – Popular works. I. British Columbia. Ministry of
Health.
RG525B33 2005 618.2’4 C2005-960123-X
You may purchase this book through Government Publications Services at 1-800-663-6105 or online at
www.publications.gov.bc.ca. Special discounts for bulk purchases are available.
Authors and publishers have used their best efforts in preparing this book. The authors make no representations or warranties
with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of
merchantability of fitness for a particular purpose. There are no warranties that extend beyond the descriptions contained in
this paragraph. No warranty may be created or extended by sales representatives or written sales materials. The accuracy and
completeness of the information provided herein and the opinions stated herein are not guaranteed or warranted to produce
any specific results, and the advice and strategies contained herein may not be suitable for every individual. The authors shall
not be liable for any loss of profit or any other commercial damages including but not limited to special, incidental,
consequential or other damages.
Published by Open School BC, Victoria, British Columbia, Canada.
Printed by The Queen’s Printer of British Columbia, Canada.

Contents
Preface 5
Acknowledgements 5
Introduction 7
How to Use this Handbook 7
Becoming a Parent 9
Your Support Team 10 Sexuality 49 Your Body After Pregnancy 83
Choosing Health Care Practitioners 11 Working Safely 50
Life With Your Baby 85
Parent Checkup 12 Pregnancy Risk Factors 51 Postpartum Depression 86
Mid-life Pregnancies 51 Being a Supportive Partner 86
Lifestyle and Risk Factors 13 Medical Complications 52 Parenting Can Be Frustrating 87
Saunas, Hot Tubs, and Hot Baths 13 Being a Single Parent 88
Getting X-rays and Other Tests 13 Preparing To Give Birth 54
Taking Medications 13 Health Care Support 54 Doing the Paperwork 89
Smoking 13 Personal Support 55 Leave from Work 89
Drinking Alcohol 14 Your Birth Plan 55 Changing Your Will 89
Using Street Drugs 15 Packing for the Hospital 57 Registering the Birth 89
Living with Abuse 16 Preparing for Labour 58 Choosing a Name 90
Sexually Transmitted Infections 16 Relaxing for Labour 59 Arranging for Tax Benefits 90
Breathing for Labour 60 Arranging for Medical Coverage 90
Stages of Pregnancy 19 Comfort Positions during Labour 61
Next Steps 91
Fetal Growth Stages 26 Giving Birth 65 Babysitters 91
Fetal Monitoring 67 Family Planning 92
Medical Care during Pregnancy 31 First Stage 67
Second Stage 71
Eating for Pregnancy and Breastfeeding 36 Third Stage 73 Your Baby 97
Eating Guidelines 36 Fourth Stage 74 Breastfeeding Your Baby 98
Taking Supplements 41 Comfortable Positions 99
Food Safety 41 Medical Procedures that May Be Needed Latching On 100
to Assist Labour and Birth 75 The Let-down Reflex 101
Weight Gain in Pregnancy 43 Pain Relief Options 75 How Much and How Long? 101
Caesarean Birth 78 Taking Care of Yourself 103
Self Care for Mothers and Partners 44 Getting Help with Breastfeeding 106
Exercising 44 Special Birth Issues 80 Expressing Breast Milk 106
Checking Posture 45 Preterm Labour 80 Formula Feeding 108
Exercising after Baby 47 Losing a Baby 81 Breastfeeding and Work 108
Reducing Stress 48 Vitamin D Supplement 109
Travelling 48 Coming Home 82 Feeding the First Solid Foods 109
Baby Care 110 Special Circumstances 133
Sleeping 110 Preterm Babies 133
Safety and Sleeping 111 Low Weight Babies 133
Sleeping Equipment 112 Twins, Triplets, or More 133
Diapering 113
Bathing 114 Baby Development 134
Caring for Baby’s Skin 116 Physical Development 135
Caring for Baby’s Nails 116 Social/Emotional Development 136
Jaundice 116 Language Development 137
Bowel Movements 117
Urination (Peeing) 117
Diarrhea 118 Parents’ Best Chance 139
Vomiting 118 Resources 140
Coughing and Sneezing 118
Dental Care 118 Glossary 144
Vaccinations 119 Index 150
Tummy Time 121
Crying 121
Shaken Baby Syndrome 123
Anger Management 124
Baby Medical Care 125

Vitamin K Injection 125
Erythromycin Eye Ointment 125
Universal Newborn Screening 125
Hearing 125
Vision 126
Thrush (Yeast Infection) 126
Circumcision 126
Allergies 126
High Temperatures 127
Baby Safety 128

Maintaining Basic Hygiene 128
General Home Safety Tips 128
Safe Baby Equipment 129
Infant/Child Car Seats 131
Preface Work on this project was guided by a Provincial Advisory Committee
comprising:
Welcome to the sixth edition of Baby’s Best Chance: Parents’ Handbook of Anne Caulfield Past Chair, Public Health Audiology Council
Pregnancy and Baby Care published by the Government of British Columbia. Pat Chisholm President, BC Association of Pregnancy
The first edition was published in 1979 in honour of the “Year of the Child.” Outreach Programs
This edition has been revised to give parents easy to read information, based Corinne Eisler Community Nutritionist, Pacific Spirit Community
on best practices and evidence, to ensure a healthy pregnancy and baby. Health Centre, Vancouver
Barbara Findlay Registered Nurse, BC NurseLine
Baby-Friendly Initiative Dr. Pam Glassby Dentist, BC Dental Association
The sixth edition of Baby’s Best Chance has been revised to meet the Marit Main Regional Nursing Practice Advisor , Okanagan,
Baby-Friendly Initiative criteria. The Baby-Friendly Initiative (BFI) is a global Registered Nurses Association of BC
program of the World Health Organization (WHO) and UNICEF to increase Becky Milne Telehealth Nurse, BC NurseLine
hospital and community support for promoting, supporting, and protecting Jill Mitchell Audiologist, Public Health Audiology Council
breastfeeding. Accepted criteria have been established for designation of Candace Porter Consultant, Early Childhood Development,
Baby-Friendly hospitals, maternity facilities, and communities. Ministry of Children and Family Development
Dr. Jill Peacock Board Member, BC College of Family Physicians
More information on the Baby-Friendly Initiative can be found at: Rose Perrin Public Health Nursing Leaders Council of BC
www.unicef.org/programme/breastfeeding/baby.htm Barbara Selwood Community Perinatal Nurse Consultant,
BC Reproductive Care Program, Provincial
Public Health Nursing Perinatal Committee
Thais Turner Speech and Language Pathologist Representative,
Acknowledgements BC Speech Language Pathology Council for
Early Childhood Development
Many professionals in the province of British Columbia reviewed the Jennie Walker Health Director, Three Corners Health Services Society,
information in this handbook. Thanks are given to them all, with a special Williams Lake
word of gratitude to Barbara Selwood. Thanks are also given to the people who Tana Wyman BC Dental Public Health Committee
worked on the previous editions. Their work has made this edition possible.
The Design Team included: Subject Matter Experts who conducted extensive review of the content
Del Nyberg Ministry of Health Consultant include:
Michelle Nicholson Project Manager Eileen Bennewith Community Nutritionist, Vancouver Island
Dini Steyn Project Coordinator Health Authority
Carol Orom Instructional Designer Vera Berard Registered Midwife, Midwifery Care North Shore,
Cindy Lundy Consultant North Vancouver
Barbara Selwood Main Content Reviewer Marina Green Clinical Educator/International Board
Janet Bartz Art Director and Book Designer Certified Lactation Consultant,
Pat McCallum Illustrator and Cover Designer BC Baby-Friendly Network
Lee McKenzie McAnally Copy Editor Lyn Jones Clinical Resource Nurse, Richmond Hospital,
Ian de Hoog Cover Photographer Vancouver Coastal Health
Jaya and Raj Saroya Photography Models Jennesse Oakhurst Registered Midwife and International Board
Carrie Ferguson Illustration Model Certified Lactation Consultant,
David Lloyd Illustration Model Ridge Meadows Midwifery Practice, Maple Ridge
5
Rose Perrin Public Health Nursing Leaders Council of BC, Linda Reid Child Passenger Safety Network
Northern Health Authority Dr. Mary Lou Riederer BC Association of Optometrists
Barbara Selwood Community Perinatal Nurse Consultant, Sonny Senghera Vehicle Safety Strategies, Insurance Corporation of BC
BC Reproductive Care Program Dr. Jeffrey Simons Pediatrician, Prince Rupert
Susan Walter Clinician/Educator, Vancouver Coastal Health Dr. Paul Thiessen Pediatrician, Children's and Women's Health Centre
North Shore Community and Family Health of British Columbia
Lois Toms Ministry of Attorney General
Finola Turgeon Benefit Programs, Canadian Revenue Agency
Other professionals who provided specific content review include: Laurie Usher Audiology Clinical Coordinator, Children's and
Marilyn Barr National Center on Shaken Baby Syndrome (USA) Women's Health Centre of British Columbia
Ron Barr Centre for Community Child Health Research at the Sue Wastie Vancouver Community, Vancouver Coastal Health
BC Research Institute for Children’s and Anne Williams Safe Start Injury Prevention Program,
Women’s Health BC Children's Hospital
Radhika Bhagat Provincial Public Health Nurses Early Childhood June Yee Clinical Pharmacist, Children's and Women's Health
Development Committee Centre of British Columbia
Doris Bodnar Reproductive Mental Health, Lori Zehr Consultant, Chronic Disease Prevention
BC Women’s Hospital and Health Centre
Susannah Britnell BC Women's Physiotherapy Department,
BC Women’s Hospital and Health Centre
Elaine Chong BC NurseLine (Pharmacy) Thanks to Ministry of Health personnel who contributed to the project,
Paul Coleman Income Taxation Branch including:
Dr. Ray Copes Director, Environmental Health, Frankie Best, Janet Carter, Valery Dubenko, Lisa Forster-Coull, Joan Geber,
BC Centre for Disease Control Pauline James, Anne Kent, Roberta L. Moyer, Dr. Malcolm Williamson,
Larry Copeland Director, Food Protection Services, and Laurie Woodland.
BC Centre For Disease Control
Jan Christilaw Specialized Women's Health, BC Women’s Hospital
and Health Centre We also appreciate the feedback provided by our parent focus groups,
Marty Deshaw Surrey Taxation Canada, Benefit Programs, comprising:
Canadian Revenue Agency Healthiest Babies Possible (Surrey/Delta/White Rock) participants and
Azmina Dharamsi Children's and Women's Health Centre Baby Talk (Kelowna) participants organized by Christina Sutter
of British Columbia and Pam Benson.
Mary Falconer Legal Services Branch, Ministry of Attorney General
Dr. Duncan Farquharson Obstetrical Medical Consultant,
BC Reproductive Care Program
Shanti Gidwani Options for Sexual Health
Anthea Kennelly Vancouver Island Health Authority, North Island
Dr. Christine Loock Sunny Hill Health Centre, BC's Children's Hospital
Dr. Brian Lupton Pediatric Medical Consultant,
BC Reproductive Care Program
Karen Pielak Epidemiology Services, BC Centre for Disease Control
Nancy Poole BC Women's Hospital and
BC Centre of Excellence for Women's Health
6
Introduction Page Arrangement
The layout will help you sort information quickly.
You’re going to have a baby! Congratulations! Baby’s Best Chance: Parents’
Handbook of Pregnancy and Baby Care will help you during your pregnancy and
prepare you for the birth of your baby, and the first six months of your baby’s Parent Checkup
life. You can use this book as your main guide to having a successful, healthy I would highly recommend that all
pregnant women get involved in Your lifestyle affects the health of your baby, even before
pregnancy and giving your baby a good start in life. The months while your their pregnancies. Join a prenatal
group and meet other pregnant
your baby is conceived. You’ll have a much better chance
of having a healthy baby if you start making healthy
women. Talk to your baby and choices now. It doesn’t matter how far along you are in What lifestyle or medical concerns do I/we need to
baby is developing as a fetus and the first few months of life are very important try your best to enjoy the your pregnancy. See the lists below and check what you discuss with our health care practitioner?
pregnancy — it only lasts nine plan to do so your baby will be as healthy as possible.
for the future health and happiness of your child. months. It may seem challenging at
times but it is worth it. For moms to be: ________________________________________________
To help my baby be as healthy as possible, Activities you can
I will: ________________________________________________
As you read this book you will see it is divided into two sections. The first is to • eat a balanced diet of healthy foods
• exercise regularly
do to help you
________________________________________________
• have a health care practitioner I trust and
help support you during and after your pregnancy. The second section gives you can talk to about my needs make important
________________________________________________
• have people to help and support me
information on getting the best start with your new baby. Every effort has been • see my dentist early in pregnancy for routine dental decisions.
________________________________________________
care, and will floss and brush every day
made to give you information that you can trust. Using this book will help you • avoid second-hand smoke ________________________________________________
make sound decisions about your pregnancy and your baby. I won’t:
• smoke
________________________________________________
• use illegal drugs or share needles ________________________________________________

• drink alcohol
• drink more than 2 cups or 1 1/2 mugs ________________________________________________
Baby’s Best Chance: Parents’ Handbook of Pregnancy and Baby Care is the first of of coffee a day
________________________________________________
two books on pregnancy and early childhood development available from the
________________________________________________
Government of British Columbia. The second book, Toddler’s First Steps, covers Motherisk is a Canadian organization that provides
specific support for pregnant and breastfeeding women. ________________________________________________
child development from six months to three years. Pick up your copy of Information that Important
Motherisk can be found online or contacted by phone.
It has separate help lines for alcohol and substance use. ________________________________________________
There is also a helpline for nausea and vomiting. For
Toddler’s First Steps when your baby is about four months old. You can get goes with the moreinformation yousection at the
information, check the Resources ________________________________________________
back of the book or visit www.Motherisk.org
it from your public health office or the BC Ministry of Health website at: main topic is in need to know. ________________________________________________
www.health.gov.bc.ca/cpa/publications/firststeps.pdf. this coloured

column. There The main information and helpful tips
12 Becoming a Parent
Welcome to the rewarding and challenging world of parenthood. are icons for and strategies are in these two columns. B a b y ’s B e s t C h a n c e
Good luck on your new venture! each kind of Read this information to be sure you
information. are up-to-date.
How to Use this Handbook Information Icons
How do you read a book? From cover-to-cover, or do you dip in and out Important information you need to know.
seeking specific information? This book is designed for both types of reading.
The following components will help you find the information you need,
quickly and efficiently. Interesting tidbits of information that can help you.
Contents
The table of contents will help you find a specific topic. Note that the book Successful pointers on how to build your team.
is divided into two large sections: Becoming a Parent and Your Baby. Everything
to do with you is in the first section and everything to do with your new baby
is in the second section. Real accounts from actual parents relating
their experiences.
7
At the back of the book you’ll find:
Resources
Need a phone number or contact information? See the Resources on page 140.
Glossary
Don’t know the meaning of some words in this book? Check the Glossary on
page 144.
Index
Need to find a topic quickly? See the Index on page 150.
Websites
Throughout this book, there are many references to Internet websites. If you do
not have Internet access at home, go to your local public library for free use of a
computer with access.
8
" E CO M IN G A 0 A R E N T
7 ELC OM E TO PAREN TH OOD 9OU W ILL FIN D ALL KIN D S OF IN FORM ATION IN TH IS SEC TION " ROW SE TH ROUG H IT W ITH YOUR PARTNER TO LEARN
ABOUT TH E STAG ES OF PREG N AN C Y &IND OUT H OW TO TAKE G OOD C ARE OF YOURSELVES H OW TO H AND LE ANY D ISC OM FORTS YOU M AY BE
FEELIN G AN D TH E D ETAILS OF BIRTH 4 H ERE IS ALSO A SPEC IAL SEC TION ON NUTRITION W RITTEN ESPEC IALLY FOR PREG N AN T W OM EN
"ECOM INGA0ARENT
Your Support Team
My family and friends really rallied
around me when I was pregnant. My You, the father of your child Who might be on your personal support team?
dad would drive me to work on his or your partner, and your • your partner, friends
way into town and pick me up after baby will benefit from • a social worker
work so I could rest on the way having a team of supportive • a doula (trained, supportive labour companion)
home. My sister-in-law filled our people. Who can be on your support team? Anyone you • family members
freezer with food for when the baby trust. For many women, the primary support person is their • neighbours
came home. Friends would listen to partner. However, mothers and fathers need more than one • expectant families from prenatal classes
my worries and fears and make me support person. They need a health care support team and • community groups
feel like I was normal and that it was a personal support team. Remember, support teams vary • co-workers
all going to be OK in the end. and are unique to each expectant family. • members of your cultural or religious groups
Who might be on your health care support team? How can your support team help?
You might choose among any of these professionals: • provide medical expertise
• family doctor and/or obstetrician • help you make decisions
• registered midwife • provide emotional support
• hospital nurses • provide practical support
I found that my best friend was a • public health nurses • help while you are pregnant
great help when Chanel was preg- • the BC NurseLine • help at the birth
nant. He’s got two kids and had gone • dentist • help after the birth
through all the same fears I had • dental hygienist
about being a dad. He gave me tips • prenatal educator A Special Word to Partners
on how to be supportive when • registered dietitian You can be supportive by:
Chanel was so nauseated in the early • pharmacist • sharing a healthy lifestyle before, during,
stages and so uncomfortable in the • lactation consultant and after pregnancy
last stage. His hints on how not to • naturopathic physician • sharing in physical exercise
faint at the birth were great too! • helping with relaxation techniques
• listening
• attending appointments and prenatal classes
• preparing the home for the new baby
Who will be on your personal support team? Once • being involved in the labour and birth
you have decided, share your plans with them and • talking about and planning for parenting
ask for their commitment. Go to My Team Contact • being actively involved in caring for the baby
Information on the inside front cover and record their • encouraging and helping with breastfeeding
contact information. You will think about your • arranging holidays or leave from work to help
medical support team when reading Choosing Health with the new baby
Care Practitioners.
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5 SE h PREG N AN C Yv AS YOUR SEARC H TERM
"ECOM INGA0ARENT
Parent Checkup
I would highly recommend that all
pregnant women get involved in Your lifestyle affects the health of your baby, even before
their pregnancies. Join a prenatal your baby is conceived. You’ll have a much better chance
group and meet other pregnant of having a healthy baby if you start making healthy
women. Talk to your baby and choices now. It doesn’t matter how far along you are in What lifestyle or medical concerns do I/we need to
try your best to enjoy the your pregnancy. See the lists below and check what you discuss with our health care practitioner?
pregnancy — it only lasts nine plan to do so your baby will be as healthy as possible.
months. It may seem challenging at
times but it is worth it. For moms to be: ________________________________________________
To help my baby be as healthy as possible,
Also make a journal, something you I will: ________________________________________________
can show your child later in life so • eat a balanced diet of healthy foods
they can see how you felt about • exercise regularly ________________________________________________
them, day by day, while you were • have a health care practitioner I trust and
expecting. I put in weekly pregnancy can talk to about my needs ________________________________________________
photos, ultrasound photos, my • have people to help and support me
thoughts, and details of doctor • see my dentist early in pregnancy for routine dental ________________________________________________
appointments. Once she is born I will care, and will floss and brush every day
add other details of her life and of • avoid second-hand smoke ________________________________________________
course a lot more photos. I think it
will be something she will always I won’t: ________________________________________________
appreciate. • smoke
• use illegal drugs or share needles ________________________________________________
• drink alcohol
• drink more than 2 cups or 1 1/2 mugs ________________________________________________
of coffee a day
________________________________________________
For dads to be:
To help my baby be as healthy as possible, ________________________________________________
I will:
• eat healthy nutritious foods ________________________________________________
• exercise with my partner
• be supportive to my partner ________________________________________________
• avoid second-hand smoke
________________________________________________
I won’t:
• smoke ________________________________________________
• use illegal drugs or share needles
Lifestyle and Risk Factors
More people die from smoking
Saunas, Hot Tubs, and Hot Baths Taking Medications than from vehicle crashes, alcohol,
drugs, suicide, AIDS, and homicide
Hot tubs and saunas can be relaxing and soothing, but it If you are pregnant, breastfeeding, or even thinking combined. In BC, that’s about 5,600
is important not to increase your inner body temperature. about having a baby, you may be worried about using people each year.
This overheating can increase your developing baby’s body medication. Some medicines are safe for use during
temperature. It is important for your baby not to become pregnancy or when breastfeeding; however, others
overheated. Being overheated can affect your baby’s may not be safe.
healthy development.
Safety issues can arise with all types of medication,
If you choose to use a hot tub or sauna: including:
• Lower the temperature to below 38.9°C. • those available only by prescription
• those available as over-the-counter
• Limit your time in the hot tub or sauna to 10 minutes, or non-prescription products
or less if you feel uncomfortable. • natural health products
• Have another adult with you. Check with your doctor, pharmacist, or health care
professional for advice on your medication. They can
• Get out right away if you feel dizzy, faint, have rapid help make sure all your medications are safe to take.
pulse, irregular heartbeat, stomach pain, or tingling Some medications, such as those for mood or seizure
in feet and hands. disorders, should not be stopped suddenly. If you are
unsure, and it is after office hours, you can call the
For more information, see the BC HealthFile #27a, Hot BC NurseLine at 1- 866 -215 - 4700 and speak with
Tubs — Health and Safety Tips, available at BC HealthGuide a pharmacist between the hours of 5 p.m. and
at www.bchealthguide.org. You can also get this file at your 9 a.m. daily.
local public health office.
Getting X-rays and Other Tests Smoking
Some medical tests may not be safe for pregnant and It is best to stop smoking before you plan to become
breastfeeding women. Before having X-rays, dental X-rays, pregnant. Smoking and second-hand smoke are harmful
CT scans, and other tests, be sure to tell the technician you during pregnancy, and after your baby is born. Cigarettes
are pregnant or breastfeeding. If you want to learn more contain many chemicals that cross the placenta into the
about conditions and tests before you take them, see baby’s blood.
BC HealthGuide OnLine at www.bchealthguide.org.
If you are pregnant and smoke, now is the time for both
you and your partner to stop or reduce the amount
you smoke.
Becoming a Parent 13
To help you quit smoking or reduce the amount Smoking and exposure to second-hand smoke
you smoke: during pregnancy contribute to a higher risk of:
• See your health care practitioner. • slowing your baby’s growth and development
The best thing you can do is quit. • miscarriage
• Join a stop-smoking program and stick with it. • stillbirth (two to three times higher)
No one should smoke in your home. • preterm birth and low birth weight
A smoke-free home is important for • Contact Quitnow by phone at 1-877-455-2233 for free,
your baby’s health and for everyone confidential, no-pressure counselling and support from Smoking and second-hand smoke after birth
else in your family. trained specialists. Or you can log onto www.quitnow.ca contribute to a higher risk of:
for support in the privacy of your home. • Sudden Infant Death Syndrome (SIDS).
• Call your public health office, the BC NurseLine at • More hospital admissions in the first year of life than
1- 866 -215 - 4700, or check the BC HealthGuide children of non-smoking parents. Children of smokers
OnLine at www.bchealthguide.org, for information have more ear infections. They also have more
on local stop smoking programs. illnesses, such as asthma and bronchitis.
• Read the BC HealthFile #30, Second-Hand Smoke: More • A reduced milk supply in the mother.
Dangerous than You Realize at www.bchealthguide.org
if you need more reasons to quit. • Your baby having colic or inconsolable crying spells.
Smoking during pregnancy is associated with an
Partners can help by not drinking. • Ask for the support of your partner, friends, family, increased risk for colic, but many infants with colic
They can also help by being involved and co-workers. also come from non-smoking households.
with the mother in social activities
that don’t involve alcohol. Bring a • Buy yourself something special with the money • Your child also becoming a smoker.
bottle of sparkling apple juice to a you save.
friend’s house for dinner, or go to a
movie instead of a bar or nightclub. • If you find that you smoke to deal with stress, Drinking Alcohol
A milkshake or juice is a healthy find other healthy ways to relax.
substitute for beer. How does alcohol affect the fetus?
• Focus on the health of your baby as a motivator. Drinking alcohol during pregnancy can result in lifelong
disabilities for your child. This is called Fetal Alcohol
Harmful effects of smoking on the mother Spectrum Disorder (FASD). Children with FASD have
and father: problems with speech and vision, learning problems,
• promotes high cholesterol poor memory, and poor coordination. They also have
• increases the risk of cancer of the cervix, difficulty handling emotions. These challenges make it
infertility, and menstrual problems difficult for them to handle even simple daily life tasks.
• is a powerful stimulant
• is extremely addictive When you drink during pregnancy, alcohol passes from
• causes gum disease your bloodstream to the baby. This can have an effect on
• causes heart and circulatory disease, lung and other your baby’s development. There is no known safe amount
cancers, emphysema, and chronic bronchitis of alcohol that you can drink in pregnancy. Daily drinking
and binge drinking (three or more drinks at any one time)
are the most risky. Since we don’t know any safe level of
alcohol use in pregnancy, it is recommended that women Cocaine and Methamphetamine (Crystal Meth)
don’t drink at all during pregnancy. Using stimulants, such as cocaine and crystal meth, can be
very harmful to your overall health, affecting your heart rate,
What are solutions? energy, sleeping patterns, memory, and mental health. If Motherisk is a Canadian organization
• Plan to stop drinking before you become pregnant. used during pregnancy, stimulants can cause the premature that provides specific support for
separation of the placenta from the wall of the uterus. pregnant and breastfeeding women.
• If you are already pregnant, stop drinking as soon This is a very serious health concern for both you and Motherisk can be found online or
as possible. It is never too late to stop. your baby. Babies are also at risk for Sudden Infant contacted by phone. It has separate
Death Syndrome (SIDS). help lines for alcohol and substance
If you find it hard to stop drinking: use. There is also a helpline for
• Talk to your health care practitioner or someone you Heroin nausea and vomiting. For more infor-
trust about services and supports to help you. Using heroin can be risky because of the drug’s effects and mation, check the Resources section
the use of needles if you inject it. Using heroin in pregnancy at the back of the book or visit
• Contact a Pregnancy Outreach Program for assistance. can increase the risk of miscarriage and stillbirth. It is www.Motherisk.org.
important to get help during pregnancy to help you slowly
• Ask for help from a support group or alcohol and decrease your use so your baby does not have withdrawal
drug counsellor. symptoms, even before it is born. Support for using
methadone instead of heroin during pregnancy is available
• Contact Motherisk. See Resources at the back of the in BC for mothers who cannot stop their heroin use.
book for phone numbers.
Babies born to mothers who have used heroin during If you find it hard to stop using
• If you cannot stop drinking completely, it is important to pregnancy can have withdrawal symptoms that often street drugs, there are specialized
reduce the amount you drink. Less is better, none is best. start within 72 hours after their birth. At birth, it is services available to help. If you can’t
important to have medical practitioners help the baby stop drug use, there are ways to
with these symptoms. reduce harm to you and your baby.
Using Street Drugs There are support services in your
After the withdrawal period, children whose mothers used community including:
Illegal drugs and street drugs can be harmful for you and heroin during pregnancy may do well in the long term, if • health care providers, such as
for your developing baby during pregnancy. Like alcohol, they were not exposed to other risks and if they are raised street nurses and clinics
these drugs pass through the placenta to the baby. in a positive environment. • pregnancy outreach programs
If you use street drugs during pregnancy, you increase the Inhalants Services can be found by calling
risk of miscarriage, stillbirth, and preterm delivery. You may Solvents (such as glue, gasoline, paint thinner and cleaning the Alcohol & Drug Information
also eat poorly, not get enough sleep, and be at risk for fluids) and aerosols (such as compressed gases from and Referral Service, toll-free at
diseases such as hepatitis and HIV. Mothers who continue hairspray and spray paint cans) can be very risky for your 1-800-663-1441.
to use street drugs are usually advised not to breastfeed. health when breathed in. In pregnancy they can affect your
blood pressure and increase the risk of miscarriage. Babies
Marijuana of mothers who use solvents in pregnancy are at risk for a
Use of marijuana can affect your energy, judgment, and range of physical birth defects. There is also concern that
motivation at this important time. Using marijuana during babies born to mothers who use inhalants, or come in
pregnancy can increase your risk of giving birth to your contact with them a lot in pregnancy, may be at risk for
baby prematurely, and it can affect your baby’s growth long lasting mental health and behaviour problems similar
and long-term health. to Fetal Alcohol Spectrum Disorder.
Living with Abuse
Intimate partner violence is a pattern of physical, sexual, or • Tell my health care practitioner about any
emotional violence. It uses power and control. Twenty-five history of sexually transmitted infections (STIs).
to thirty percent of women have been physically harmed by
their partner or boyfriend at sometime in their lives. Most • Tell my health care practitioner if I suspect I
women who are abused do not report it. Forty percent of have been exposed to an STI, and get tested.
wife abuse starts in a women’s first pregnancy. Only three
percent of women who were abused during their • Talk with my partner about our sexual history.
pregnancy told their health care practitioners.
• Use a condom for six months with a new sexual
If your partner used physical, verbal, emotional, or sexual partner and be tested for STIs.
abuse in the past, this may get worse once you are pregnant
and after you have the baby. You are not the only one at risk • Do not share needles or have multiple
if your partner abuses you. Your baby is also at risk. Seek sexual partners.
help and safety. You can start by talking to your health care
practitioner. She or he will put you in touch with the right • Read the BC HealthFiles series on Sexually
resources. Do not feel ashamed. It is not your fault. Transmitted Diseases found at:
www.bchealthguide.org.
Sexually Transmitted Infections
• Some sexually transmitted infections (STIs) can be You can reduce the chance of getting STIs, including HIV,
cured and others cannot. by avoiding high-risk activities, such as:
• having multiple partners
• Some STIs can cause problems with your pregnancy • injecting or using street drugs
or harm your baby. • sharing needles
• having a number of sexual partners
You can protect yourself and your baby by using condoms, and not using condoms
especially if you are not in a steady relationship. For • engaging in anal sex without condoms
example, condoms will reduce your risk of catching herpes
(an infected partner may have symptoms you cannot see). If you suspect that you have been exposed to an STI, talk
It is important for both your health and your baby’s health with your health care practitioner, public health nurse, or
that you talk with your health care practitioner if you have, call the BC NurseLine at 1- 866-215- 4700 right away.
or think you may have, an STI, such as herpes, hepatitis B,
or HIV. There are treatments available for you and Motherisk offers information and counselling to Canadians
your baby. about HIV and other STIs. Call the toll-free health line at
1-888-246-5840 or visit www.Motherisk.org.
The charts on the next two pages provide information on
some STIs that could affect your pregnancy, be a risk to
your baby, or increase your risk of preterm labour.
Sexually Transmitted Infections that Cannot be Cured
Infection Risks/Complications Method of Transfer Treatment/Comments
Herpes Mom: Can have blisters/sores Can transfer in Mom: No cure. Antiviral drugs
Diagnosed by culture of in genital area only once or she the birth canal are used to treat outbreaks. If
lesion or vaginal secretions. may have outbreaks every once during birth. herpes sore is in genital area at
in a while. She may not know time of labour, a caesarean
she is carrying the virus. birth is recommended. This is
Avoid intercourse if a lesion is to prevent transfer to the baby.
present. Avoid oral sex if your
partner has a cold sore. Using Baby: Antiviral drugs can be
condoms during sex helps, but given if baby develops
it is not a guarantee that you neonatal herpes.
won’t get herpes.
Baby: Has poor energy, fever,

poor weight gain, infection of
skin, eyes, mouth. There can
be severe brain injury or death.
Hepatitis B Mom: Carrier for life; risk for Can transfer Mom: If exposed during
Diagnosed by blood test. liver disease and liver cancer during birth. pregnancy, early treatment
(Also spread by contact with later in life. with Hepatitis B immune
infected blood.) globulin (HBIG) and Hep B
Baby: Without treatment, will vaccine can prevent disease.
become a carrier for life.
Baby: HBIG and Hep B vaccine
at birth if mother (or other
caretaker) is a carrier and
follow-up vaccinations can
prevent disease.
Human Immuno-deficiency Mom: HIV can develop into Can cross placenta Mom: No cure; treatment with
Virus (HIV) AIDS. Adults with AIDS have during pregnancy antiviral drugs during
Diagnosed by blood test. a shortened lifespan. and can transfer to pregnancy and during labour
baby during birth. to reduce risk of passing
Is also possible to virus to baby.
transfer through
breastfeeding. Baby: Antiviral medication
given for six weeks after birth.
B a b y ’s B e s t C h a n c e
Bacterial Sexually Transmitted Infections that Can be Cured
Infection Risks/Complications Method of Transfer Treatment/Comments
Chlamydia Mom: May have pain when Can transfer in Mom: Antibiotics.
Diagnosed by a culture peeing, vaginal discharge, or the birth canal
of vaginal discharge. no symptoms. Increased risk during birth. Baby: Antibiotics; routine eye
of preterm labour, premature treatment with antibiotic
rupture of membranes. ointment soon after birth
prevents infection in
Baby: Pneumonia, eye infections. baby’s eyes.
Gonorrhea Mom: May have lower Can transfer through Mom: Antibiotics.
Diagnosed by a culture abdominal pain, vaginal birth canal into uterus
of vaginal discharge. discharge, pain when and to baby, during Baby: Antibiotics placed in
peeing, or no symptoms. pregnancy or the eyes of newborns shortly
during birth. after birth.
Baby: Eye infections if mother
not treated during pregnancy.
Bacterial Vaginosis Mom: May have vaginal Can transfer through Mom: Antibiotics.
Diagnosed by culture discharge, vaginal itching or birth canal into uterus
of vaginal secretions. burning; sometimes no and to baby. Baby: Care needed for
symptoms. Increased risk of preterm birth.
preterm labour, premature
rupture of membranes, infection
during labour or postpartum.
Baby: Preterm birth.
Syphilis Mom: May have small, painless Can cross the Mom and Baby: Antibiotics
Diagnosed by a sore in genital area within two placenta during during pregnancy.
blood test. months of exposure. Illness pregnancy and can
(about six weeks after sore transfer during birth. Baby: Antibiotics if
heals) — fever, rash, headache, mother not treated
swollen glands. If not treated can during pregnancy.
cause problems years later,
e.g. nervous system, eyes, heart.
Possible preterm labour.
Baby: Possible stillbirth;

congenital syphilis with physical
and mental problems.
3 T A G E S O F 0 R E G N A N CY
) T H O U G H T T H A T B E IN G P R E G N A N T W O U LD
0REG N ANC Y AFFEC TS EVERY SYSTEM OF YOUR BOD Y N OT JUST YOUR UTERUS 4 H E C H ART BEG IN N IN G ON TH E N EX T PAG E LISTS SOM E OF THE BE FAN TASTIC SINC E M Y M OTH ER HAD
C OM M ON C H AN G ES YOU M AY EX PERIENC E IN PREG N AN C Y )T ALSO SUG G ESTS W HAT YOU C AN D O TO STAY C OM FORTABLE G OOD PREG NAN C IES ) W AS SHOC KED TH AT
INSTEAD OF HAVIN G TH AT h G LOW v ) W AS
N A U SE A T E D A N D V O M I T I N G 4 H E N )
END ED UP IN THE HOSPITAL EARLY W ITH
B L E E D I N G A N D H A D A C A E SA R E A N
SEC TION BIRTH " UT IN TH E EN D THE
PREG N ANC Y SEEM ED LIKE SUC H A SHORT
T IM E C O M P A R E D T O P A R E N T IN G W H IC H
LASTS FOREVER
%N D OF FIRST TRIM ESTER %ND OF SEC ON D TRIM ESTER %ND OF TH IRD TRIM ESTER
"ECOM INGA0ARENT
st
1
First Trimester 0 – 14 weeks
What’s Happening? Now What?
your periods will stop and • wear a comfortable, supportive bra
trimester
you may have tender or
painful breasts
mother unexpected mood changes • this is normal

• focus on yourself and the changes you are going through
• talk with the people around you
Check in:
If you are feeling down for longer than seven days and the things that used to give you
• Don’t smoke, drink, or joy no longer do, you may have depression. See page 86. Talk with your health care
use drugs. practitioner now about how you are feeling.
• If your partner smokes, feeling excitement, fear, • it is normal to have many feelings about a new pregnancy
encourage her to stop. or uncertainty about • share your feelings
being a parent • spend time with other new parents, a pregnancy support group, or new parent group
• Expect and accept
mood changes. Call your public health office for information on pregnancy/perinatal support groups.
You can find the number in the blue pages of your phone book. You can also ask your
• Share meal preparation, health care practitioner.
especially if your partner
is nauseated. fatigue • this is normal; rest whenever you can
(feeling tired and sleepy) • have periods of activity and then of rest; stop before you become overtired
• Take over some responsibilities • eat small meals several times a day and drink plenty of water
if your partner is feeling tired. • if you are working, try to rest on your breaks and at lunchtime
• Go to prenatal checkups Feeling tired — how much is normal?

with your partner. You may not feel tired at all, or you may be falling asleep during the day. Both are normal.
headaches • headaches are quite common

(due to hormonal and • practice good posture
postural changes) • eat small, nutritious meals several times a day
• drink plenty of water daily
Nausea and vomiting bother up to • avoid activities that cause eyestrain
80% of pregnant women to some • get plenty of sleep at night and rest during the day
degree. For many women this can go • have your neck, shoulders, face, and scalp massaged
on beyond 20 weeks. • apply a cool or warm washcloth to your forehead and the back of your neck
• drink two cups of water and take some acetaminophen
• talk to your health care practitioner if your headache does not go away
st
What’s Happening?
need to pee more often
morning sickness
Now What?
• drink water, milk, and juice instead of coffee, tea, or colas
• eat smaller amounts of food every one to two hours during the day
1
trimester
mother
(nausea and vomiting) • try to follow Canada’s Food Guide to Healthy Eating as much as possible; however,
ignoring the guidelines for a short time won’t hurt your baby
• if your iron or prenatal supplements make you feel queasy, take them with a
slushy-type drink
• try taking a liquid form of vitamins
• try to keep taking your folic acid supplement even if you can’t take prenatal vitamins
for a period of time
• eat whatever appeals to you during this time See your health care practitioner
• avoid fatty and fried foods if you:
• drink fluids such as apple juice, ginger ale, water, and clear black tea
• don’t drink red raspberry leaf herbal tea as it may cause uterine contractions • are sick most of the time and
• try eating cold meals to avoid food smells, or have someone else cook can’t keep fluids or food down
• have fresh air in the bedroom while resting, and in the kitchen while cooking
• try not to get too tired • vomit more than 5 times a day
• wear loose clothing around your chest and waist
• have lost more than 5% of your
If you do vomit, rinse your mouth with water. You can also use a fluoride mouth rinse. pre-pregnant weight
This will help protect your teeth from the damage of stomach acids.
• pee less than 3 times in
increased vaginal secretions • wear small pads, cotton underwear, and looser slacks 24 hours
(thin and milky) • shower or bathe often
• contact your health care practitioner if there is itchiness or frothy, smelly, If you can’t manage your nausea and
or coloured discharge vomiting, talk with your health care
practitioner about medication you
bigger or painful breasts • wear a supportive bra for comfort, even at night if it helps can take to help.
and darkening of the areola
(brown part around the You can also contact Motherisk
nipple) with small lumps Nausea and Vomiting of Pregnancy
becoming visible Helpline, toll-free at 1-800-436-8477.
light-headedness or • stand up slowly

feeling faint • maintain good posture and exercise regularly
• eat regularly and often
shortness of breath • this is usually normal, but check with your health care practitioner if there is a history
of heart problems in your family
nd
2
Second Trimester 15 – 27 weeks
red, inflamed gums • this can be caused by changes in your hormones, throughout your pregnancy,
trimester (can be pregnancy gingivitis) and happens if plaque is left on your teeth
• to prevent this, floss and brush your teeth regularly
mother • see your dentist and be sure to tell her that you are pregnant
little nausea, less bladder • the chances of having a miscarriage are very small at this stage
pressure, less fatigue
early milk leaking • wear breast pads in your bra if needed

from your breasts
Some women feel as if they have a stuffy nose and nose bleeds • do not smoke or be around second-hand smoke
constant cold with nasal conges- • place warm, moist towels on your face for comfort
tion. This will go away after birth. • breathe steam from a hot shower, a pot of boiling water, or a vaporizer
• a cool-mist humidifier may be helpful
• massage your sinuses by rubbing on the bony ridge above and under your eyebrows,
under your eyes, and down the sides of your nose
• drink 8 to 10 cups of water a day
• try saltwater nose drops made from 1/4 teaspoon of salt dissolved in 1 cup of warm water
• do not use antihistamines unless recommended by your health care practitioner
quickening — the mother • know that the feeling (e.g., bubbling, fluttering, knocking) can differ for each pregnancy
feels the baby’s movement • note the date, and tell your health care practitioner on your next visit
an increased sense that the • pay attention to your body and baby and enjoy your pregnancy
pregnancy is real • celebrate your pregnancy
• connect with your baby, and include your partner
emotions may be more stable • you and your partner can talk to your baby and/or gently massage your belly
than in the first trimester • keep a diary during your pregnancy
• keep a pregnancy photo album
low back pain • maintain good posture while sitting or standing — pull in your stomach muscles, tighten
your buttocks, and tuck in your seat to flatten your lower back (also see page 46)
• sit in straight-backed chairs whenever possible
• wear low-heeled shoes that give support
• sleep on your left side with a pillow under your upper leg for support
• avoid lifting heavy items
• try heat or cold on your back or have someone give you a massage
• consult your health care practitioner
nd
What’s Happening?
pubic pain
Now What?
•
•
•
walk around objects instead of stepping over them
try not to push objects on the floor, such as boxes, with your feet
avoid opening your knees wide apart
2trimester
• consult your health care practitioner
mother
throbbing of legs and • rest and sleep on either side with a pillow between your legs; do not lie flat on your back
appearance of varicose veins • walk or do other exercise
• wear support hose if recommended
• don’t sit with your legs crossed
• when sitting, do ankle and foot exercises; avoid placing a pillow underneath your knees
• try not to wear knee-highs and garters • Enjoy feeling movements of
• use a footrest or another chair to lift your legs when sitting the baby.
mild swelling of ankles, feet, • raise your legs and feet whenever possible • Attend prenatal checkups.
hands, and face (edema) • lie on your left side when resting or at night to reduce pressure on major blood vessels
— may be accompanied by • avoid wearing clothes or accessories that feel tight • Talk to the baby.
tingling in one or both hands (e.g., watches, rings, or socks with elastic tops)
• exercise regularly • Gently massage the mom.
Tips: • Exercise together.

Swelling of your feet and ankles is normal in pregnancy. Most of the swelling should be
gone when you get up in the morning. If it does not decrease with rest, talk with your • Encourage the mother to eat
health care practitioner. a healthy diet.
hard, dry bowel movements • drink lots of water (8 to 10 cups per day) • Help the mother avoid drugs
(constipation) • if you feel your iron supplement is causing constipation, talk to your and alcohol.
health care practitioner
• eat high-fibre foods
• exercise regularly
• have bowel movements when you feel the urge
• do not hold back or force the bowel movement
• do not use suppositories, mineral oil, laxatives, or enemas unless recommended by
your health care practitioner
a brownish “tan” on your face • these signs will occur in some women and disappear after the baby is born
or a line running from the • the line from the belly button may stay there
belly button to the pubic area
rd
3
Third Trimester 28 – 40 weeks
purple or red marks • after birth, the stretch marks will gradually change from red or purple to tan or white
trimester
(striae or stretch marks) on and will become harder to see
abdomen, breasts, and thighs • some women never lose their stretch marks
mother dry, itchy skin •

•
if you choose to use soap, try glycerin soap
avoid long, hot baths
• apply oils or lotions to keep your skin moisturized, especially after a bath or shower
• calamine lotion may relieve the itching
• if you have severe itching, talk with your health care practitioner
increased fatigue • rest often and listen to your body

• Attend prenatal classes with (feeling more tired) • ask someone to help with daily chores
the mother. • if possible, stop work early if you are overtired
• Help develop a birth plan. feelings of doubt or • develop a birth plan

fear about labour • talk with your health care practitioner about concerns and plans for labour
• Help prepare your home for • learn about labour and birth so you know your options
the baby. • attend prenatal classes
• Practice labour positions pre-labour or • these contractions are normal

and relaxation. Braxton Hicks contractions • tell your health care practitioner if the contractions are regular
and become uncomfortable
• Be ready and available for
labour support. muscle cramps in legs, • make sure you get enough calcium in your diet or talk to your health care practitioner
especially at night about a calcium supplement
• avoid getting too tired
• put your feet up
• exercise daily
• take a warm bath before going to bed
• stretch your lower leg area before going to bed
feeling impatient because the • a full term pregnancy is anywhere from 38 to 42 weeks
pregnancy seems as though • call upon your support system when you feel frustrated and talk about your feelings
it will never end
hemorrhoids (piles) • avoid constipation and straining

• do pelvic floor (Kegel) exercises; see page 46 to find out to how to do these
• rest and sleep on either side with a pillow between your legs; do not lie flat on your back
• try not to sit or stand for long periods of time — change positions or walk around
• for relief, apply ice wrapped in a cloth to the area
rd
What’s Happening?
heartburn
Now What?
•
•
•
eat small, frequent meals
avoid fried, fatty, and spicy foods
drink lots of liquids between meals
3
trimester
•
•
elevate your head and shoulders while resting
do not bend or lie down immediately after a meal mother
• do not wear tight waistbands
• chewing sugarless, non-peppermint gum (ideally containing xylitol) may also help
sudden groin pain • avoid sudden movement

• bend slightly at the hips when you expect to cough or sneeze
shortness of breath • try taking deep, slow breaths through the mouth
• wear loose clothing
• use good posture
• get plenty of rest
difficulty sleeping • have regular sleep habits

• exercise daily (take walks)
• before going to bed try:
• taking a warm, relaxing bath
• eating a snack with a warm drink
• using extra pillows for support
• practising deep breathing and relaxation exercises
• listening to relaxing music
improved breathing • make a note when this happens and tell your health care practitioner at your next visit
(this usually means your baby has moved down into your pelvis in preparation for birth)
increased need to pee • pee regularly

• avoid caffeine
• do pelvic floor (Kegel) exercises (see page 46)
an increase in Braxton Hicks • this is normal

contractions • your uterus is contacting to soften and thin your cervix in preparation for labour
• pack your hospital labour kit (see page 57 for what to pack)
• arrange to have care for your children and your house while you are in the hospital
&E T A L ' R O W T H 3 T A G E S
4 H E FIRST TRIM ESTER OR FIRST W EEKS IS AN IM PORTAN T TIM E IN 4 HE THIRD TRIM ESTER IS THE TIM E BETW EEN W EEKS AN D YOUR
YOUR BABYS LIFE )TS A TIM E OF FAST G ROW TH AND D EVELOPM EN T BABYS BIRTH 4 HE C LOSER TO FULL TERM OR W EEKS G ESTATION
)TS ALSO A TIM E W H EN YOUR BABY IS M OST AT RISK FROM HAZARD S YOUR BABY IS THE BETTER YOUR BABY IS ABLE TO C OPE W ITH BIRTH
SUC H AS SM OKIN G ALC OH OL D RUG S IN FEC TIONS AN D 8 RAYS AN D TO LIFE OUTSID E YOUR BOD Y &ORTY W EEKS G ESTATION IS TH E
D ATE ESTIM ATED TO BE YOUR D UE D ATE
4 HE SEC ON D TRIM ESTER IS TH E TIM E BETW EEN AN D W EEKS
G ESTATION $ URIN G THIS TIM E YOUR BABYS BRAIN G ROW S A LOT )F YOUR BABY IS BORN BEFORE W EEKS G ESTATION IT IS
4 HE BABY IS STILL TOO SM ALL TO LIVE OUTSID E OF YOUR BOD Y C ON SID ERED TO BE PRETERM BORN EARLY )F YOUR BABY IS BORN
AFTER W EEKS G ESTATION IT IS SAID TO BE POST TERM 4 HERE IS
A H IG H ER RISK OF ILLNESS AND D EATH IN BABIES BORN TOO EARLY
O R T O O LA T E
# H EC K TH E C HART ON PAG ES n TO FOLLOW TH E

WEEKS D EVELOPM EN T OF YOUR BABY
MM IN
WEEKS WEEKS WEEKS

n MM IN CM IN CM IN
"ECOM INGA0ARENT
WEEKS WEEKS
CM IN n CM IN
"ECOM INGA0ARENT
st
1
First Trimester 0 – 14 weeks
The first trimester (the first three months of pregnancy) is a critical time in your baby’s life. It is the period of rapid growth
and development. By the end of the first trimester, all of your baby’s organs will be formed and functioning.
trimester Time Weight and Length Events
baby 1 day The sperm and ovum unite.
7– 10 days The fertilized ovum attaches to the lining of the uterus.

The placenta begins to form.
2 weeks Your baby, called an embryo, is now a layered disc on the

uterus wall. You will miss your menstrual period.
4 weeks 0.4 g (0.01 oz.) The beginnings of the embryo’s eyes, ears, nose, spine,
digestive tract, and nervous system are present.
The tube for the future heart starts beating.
8 weeks 22–24 mm (1 in.) Your baby, called a fetus, now has all the organs that a full
1g (0.036 oz.) term baby will have. The heart is functioning.
Bones begin to form.
12 weeks 9 cm (3 1/2 in.) Tooth buds are present. Fingernails and toenails are
15 g (0.5 oz.) forming. Immature kidneys secrete urine to the bladder.
External genitalia are forming. The fetus can now move
in the amniotic fluid, but you can’t feel it. Your health care
practitioner may be able to hear your baby’s heart beat
with an electronic listening device.
nd
2
Second Trimester 15 – 27 weeks
During the second trimester (the next three months of your baby’s life) the brain develops a lot. Most of the brain’s
development begins now and continues for two or more years after your baby’s birth. During the second trimester
until about 24 weeks, the fetus cannot live outside your body because its lungs, heart, and blood systems have not
developed enough.
Time Weight and Length Events trimester

16 weeks 16 cm (6 1/2 in.)
100 g (4 oz.)
The face looks more human, the head has hair, the ears
stand out, and your baby can hear your voice. Between
baby
16 to 20 weeks you may feel the baby’s movements.
You may not feel the movements until 18 to 20 weeks,
especially if this is your first pregnancy.
17 weeks The baby begins to store some of your antibodies.

This slowly increases until birth.
20 weeks 25 cm (10 in.) Eyebrows and eyelashes appear. A fine downy hair (lanugo)
300 g (10 oz.) appears all over your baby’s body and may be present at
birth. Your baby’s skin is thin, shiny, and covered with a
creamy protective coating called vernix. Oil glands appear.
Your baby’s legs lengthen, and move well. Teeth develop —
enamel and dentine are being formed. This can begin as
early as 14 weeks. By the end of the fifth month, your baby
is about half the length of a newborn. During the second
trimester, meconium (the baby’s first stool) begins to
appear in the intestines.
24 weeks 30 cm (12 in.) Sweat glands form. Your baby has a lean body with red
600 g (1 1/3 lb.) and wrinkled skin. Early breathing movements begin.
A substance called surfactant is formed in the lungs.
This substance helps the lungs to expand normally
after the baby is born.
26 weeks The baby’s outline may be felt through your abdomen.

The eyes may be open now.
rd
3
Third Trimester 28 weeks to birth
During the third trimester (the last three months of pregnancy) the baby could survive if born before it is full term.
The earlier a baby is born, the greater the need for special care to decrease the risks from a preterm birth. The closer
to full term, the more able the baby is to cope with the birth process and life outside the uterus.
trimester Time Weight and Length Events
baby 28 weeks 35 – 37 cm. (14 in.)

1100 g (2 lb. 5 oz.)
Your baby’s body is still lean but the skin is less wrinkled
and red. The baby can now store iron, calcium, and other
nutrients. Your baby can hear and respond to sounds.
32 weeks 40 – 42 cm (16 in.) Your baby’s skin is pink and smoothes out as the fat forms
1800 – 2100 g under it. Your baby develops a sense of taste and becomes
(4 lb.– 4 lb. 7 oz.) aware of sounds outside your body. The male baby’s
testicles begin to drop into the scrotum. The pupils in the
baby’s eyes can react to light.
36 weeks 45 – 47 cm (18 in) Your baby’s body is rounded and usually plump. The downy
2200 – 2900 g hair on the baby’s body begins to disappear. The skin is
(4 lb. 11 oz. – 6 lb. 5 oz) smooth, pink, and covered with a grayish-white cheese-like
substance called vernix. The baby continues to increase the
store of your antibodies and is able to resist some diseases.
Usually your baby can safely be born at this age.
40 weeks 45 – 55 cm (18 – 22 in.) Head hair is usually present. The testicles of male babies are
3200 g + (7 lb.+) now in the scrotum, and the labia majora of female babies
are developed.
Your baby is now full term!
40 – 42 weeks weight will increase The fontanels (soft spots on the head) are becoming smaller
(post dates) and the skull bones are growing firmer and less flexible. The
skin may become looser as the fat layer decreases. Skin is
also drier and may have small cracks as the amount of
vernex decreases. Nails may be long.
More than 42 weeks weight will increase The skin continues to get drier and will have cracks as the
(Overdue) amount of vernix continues to decrease.
Medical Care during Pregnancy
Your health care practitioner will ask
you some questions during your first
Your doctor or midwife can help you have a healthy prenatal visit.
pregnancy and healthy baby. At the beginning of your My last regular menstrual period began on ____________
pregnancy you should visit your health care practitioner To prepare, take a moment to fill in
every four to six weeks. After about 30 weeks you will have My last Pap test was done on ________________________ the questionnaire on this page.
visits every two to three weeks. In the last month, your
health care practitioner will want to see you every one to Our blood groups are _______________________________
two weeks or more.
I have had:
You may need extra medical attention or health care advice Miscarriages No Yes How many? ___________
from your health care practitioner if you: Stillbirths No Yes How many? ___________
• are underweight or overweight Live births No Yes How many? ___________
• had problems with a previous pregnancy, Forceps, breech, caesarean section births
for example, if your baby was preterm or No Yes How many? ___________
weighed less than 2500 g (5 lb. 8 oz.)
• have diabetes, high blood pressure, Our lifestyle risk factors include: ______________________
or other medical conditions
• are over 35 or under 16 years of age Medical conditions I have that may affect pregnancy include:
• are carrying more than one baby
• have had a caesarean birth or uterine surgery ___________________________________________________
• use alcohol, cigarettes, or drugs
• are under emotional stress or there is violence in your life I am taking these medications: _______________________
• are dealing with depression or other mental health issues
I am using these herbal remedies:_____________________
Before you visit your health care practitioner, write down
any questions you may want to ask. The BC HealthGuide We had or have these sexually transmitted infections:
handbook has two tools you can use. These are the
“Healthwise Self-Care Checklist” and the “Ask the Doctor ____________________________________________________
Checklist” at the front of the book. Use these to write your
questions and concerns. If you don’t have a copy of the BC I have had German measles (Rubella) No Yes
HealthGuide handbook, you can request a free copy from I have had Chicken pox (Varicella): No Yes
the Ministry of Health Information Line at 1-800-465-4911.
This is what we would like from our health care practitioner:
Take important information when you visit your health
care practitioner. This can be a family medical history or ___________________________________________________
changes in your condition. Have your partner or support
person go with you. That way, they can ask questions, We have these questions:
hear the same information, and share in the excitement
of your growing baby. ___________________________________________________
___________________________________________________
Your First Visit
Your first pregnancy visit is usually the longest because your health care practitioner will take a detailed physical history and
do a physical examination. What may be done at the first visit?
Tests that are usually done at all
prenatal visits include: Discussion/Procedures Why?
• blood pressure and pulse
• urine test take a pregnancy test • to confirm your pregnancy
• baby’s heart rate
• measuring your abdomen to take a detailed medical history • to find any risk factors you may have
check the growth of
your baby discuss lifestyle factors • to keep your baby as healthy as possible
(use of alcohol, drugs, tobacco,
exercise habits, and nutrition)
discuss prenatal supplements • 0.4 mg of folic acid daily reduces the risk of spina bifida in your baby
• do not take high-dose vitamin A supplements in pregnancy
• some natural herbal remedies are not safe in pregnancy
have a complete checkup that includes:

• listening to your heart
• taking your blood pressure
• measuring your height and weight
• having an abdominal examination
• having a pelvic exam that • to check your cervix and to check for infections
includes a Pap test or vaginal swab
(if not done in the last 12 months)
complete blood tests • to check complete blood count (includes hemoglobin and iron levels)
• to confirm blood group, Rh type, and antibody screen
• to test exposure to syphilis
• to screen for HIV (recommended)
• to test for hepatitis
• to test for rubella (German measles) antibody
complete urine tests • to check for any sugar, protein, and urinary tract infections
Your Next Visits
What may happen on the visits that follow?
Discussion/Procedures Why?
ultrasound test • to check the development and position of the baby

(done between 18 – 20 weeks) • to check the due date (you may be unsure when you had your last period)
complete a Maternal Serum Screening • this is a blood test to help find out the risk of certain abnormalities that
(also known as Triple Marker Screening) may affect your baby (see page 51)
blood test (done between 15 – 20 weeks
and is only useful when the due date The test does not tell whether a baby is healthy or not. It only gives a risk
is known) factor. If the risk factor is high, further testing is done.
conduct glucose screening • checks for gestational diabetes that may develop during pregnancy
(done 24 – 28 weeks)
This type of diabetes happens during pregnancy because pregnancy
hormones change the way a woman’s body uses insulin. For most women,
blood sugar levels can be controlled by diet, but some women may need to
take insulin by injection. For most women, gestational diabetes goes away
after their baby is born.
conduct another complete blood test • a shot of Rh-immune globulin will be given to women who are Rh-negative
(done at 24 – 28 weeks)
take a vaginal swab for • Group B Streptococcus (GBS) is a type of bacteria found in the vagina
Group B Streptococcus and large bowel of 15 to 20% of healthy pregnant women
(done at 35 – 37 weeks)
Around the time of birth, GBS may be passed to the baby through the
birth canal. If the baby gets a GBS infection, it can be serious. Because of
the small chance of GBS infection in the newborn, all pregnant women
should be screened at 35 – 37 weeks of pregnancy. A swab for GBS is taken
from the vagina and anal areas. Women whose test is positive are given
intravenous antibiotics, just to be safe. Often it is a brand of penicillin and is
given at the time their membranes rupture or during labour. Treatment of
the pregnant woman with antibiotics has been shown to decrease the
chance of serious infection. However, no method has been proven to
prevent all serious infections.
Whether or not you need treatment in labour depends on your situation.

Discuss GBS with your health care practitioner.
Your Next Visits (continued)
Discussion/Procedures Why?
discuss your emotional feelings • women may become depressed during the third trimester of pregnancy
10 – 16% of pregnant women will have depression during their pregnancy.

A smaller number will also have anxiety or panic disorder.
count fetal (baby) movements • to be aware of your baby’s movements

(done from 35 – 37 weeks and onward)
Babies who are well have active periods and quiet periods during the day
and/or night. Healthy babies may slow down slightly toward the end of
pregnancy, but they do not slow down a lot. Your baby should not stop
moving at a time when she is normally active.
You don’t need to record your baby’s movement count unless:

• you are asked to do so by your health care practitioner
• you have noticed a big drop or no movement at a time when
your baby is normally active
To count your baby’s movements:

• pick a time when your baby is normally active
• pick a comfortable position — semi-sitting or lying on your
left side — and relax
• with your hands on your abdomen, count your baby’s bouts
of movement — these may be a short kick or wiggle, or long,
continuous squirming motion
• time how long it takes for your baby to move 10 times,
then record the length of time on a chart
Tell your health care practitioner if your baby is moving a lot less than usual.
do a non-stress test • tells how well your baby is doing

• a painless test to check your baby’s heartbeat while resting and moving
• done before labour with an electronic fetal monitor
See your health care practitioner right away or call the BC NurseLine’s 24-hour toll-free number
at 1-866-215-4700 if you have:
• contact with anyone who has rubella (German measles) as there is a danger to your baby if you get sick
with rubella during your pregnancy
• rashes of any kind except the ones you often get, like eczema
• sudden, unusual thirst
• coughing that isn’t getting better
• a feeling of being tired all the time
• dizziness, headaches, dimming and/or blurring of vision
• sudden or continuing swelling of your hands or face
• frequent vomiting, when you are unable to keep fluids down
• abdominal pain or if your abdomen feels hard
• bleeding from your vagina, bowel, or bladder
• a burning sensation when peeing
• coloured, frothy and/or bad-smelling vaginal discharge, or vaginal discharge causing itchiness or irritation
• a gush or trickle of water from your vagina
• constant negative feelings or anxiety about your pregnancy and care of the baby
• depression or periods of weeping that don’t go away
• any violence or threatening behaviour towards you in your home or workplace
• found that your baby has moved a lot less than usual in the last 12 hours
• signs of preterm labour (see page 80)
Share this information with your partner so you both know what to watch for.
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A Guide to Healthy Foods
This chart shows you how to use Canada’s Food Guide to Healthy Eating to get the nutrients you need.
Nutrient
Iron Folic Acid Calcium Essential Fatty Acids Fibre
Benefits Needed to prevent Lessens the risk of You need calcium Necessary for the Helps prevent
anemia (low iron in having a baby with and vitamin D for normal constipation.
the blood). Low iron neural tube your baby’s healthy development of
can cause low birth defects, such as bones and teeth your baby’s
weight. It can make spina bifida. Folic and to protect your nervous system
the mother feel acid is also bones later in life. and eyesight
tired, make it hard important for during pregnancy
to fight infection, healthy growth and breastfeeding.
and cause difficulty and development.
coping with blood
loss during birth.
Grain bran cereal, cream enriched bread and bread bran muffin, bran
Products of wheat, enriched cereal, wheat (calcium-fortified) cereals, fibre cereal,
cereals, wheat germ, germ, whole-grain fibre-enriched
whole-grain cereal, bread, cereal crackers, whole-
whole-grain bread grain cereal
Vegetables apricots (dried), bananas, broccoli, bok choy, broccoli, berries, dates,
and Fruit asparagus, romaine lettuce, kale, mustard pears, dried figs,
broccoli, dates, Brussels sprouts, greens, Swiss chard bananas, potatoes,
prunes, raisins, corn, beets, oranges, prunes, kiwi, corn,
spinach, peas, spinach, peas
Swiss chard asparagus, avocado
Milk Ovaltine® or milk, all types buttermilk, cheese,

Products Instant Breakfast® milk, skim milk
added to milk powder, yogurt, ice
milk, frozen yogurt
Meat and tofu, baked beans, almonds, dried almonds, baked beef, pork, poultry, dried beans, dried
Alternatives lentils, clams, dried beans, dried peas, beans, sardines, salmon, sardines, peas, lentils, nuts,
beans, egg yolk, lentils, peanuts, salmon with bones, mackerel, walnuts, seeds
pumpkin seeds, sunflower seeds, soybeans, sesame, pumpkin seeds,
meat, fish, poultry, chickpeas, egg tahini, tofu made Brazil nuts, peanuts
hazelnuts, yolk, sesame seeds, with calcium,
almonds, walnuts hazelnuts, cashews, hazelnuts
walnuts
Vegetarian Eating
Write down everything you ate and drank yesterday. You need extra amounts of iron, calcium, and vitamin B12
during pregnancy. It may be hard to get these nutrients
Find the foods in the food groups in Canada’s Food if you only eat vegetarian choices of food. Talk with your The best practice I got at being a
Guide to Healthy Eating. health care practitioner or a registered dietitian about parent was to try doing everything I
supplements. normally did, but I did it while hold-
Note below how many servings you ate of each food: ing a bag of sugar in one arm.
Iron
Grain Products: ________ servings Vitamin C helps with iron absorption. Combine iron-rich
foods with vitamin C-rich foods, such as berries, citrus fruits,
Vegetables and Fruit: ________ servings peppers, broccoli, or tomatoes.
Milk Products: ________ servings Calcium

Milk products are a good source of calcium. If you do not
Meat and Alternatives: ________ servings eat or drink dairy products, increase these calcium-rich
foods in your diet:
Compare your totals with Canada’s Food Guide to • enriched soy or rice beverages
Healthy Eating. • enriched orange juice
I ate the recommended number of servings in all four For other non-dairy sources of calcium, see the BC
food groups. Yes No HealthFile #68e, Food Sources of Calcium and Vitamin D
at www.bchealthguide.org. The calcium in non-dairy
If I ate less than the recommended number of sources is less easily absorbed than the calcium in milk.
servings in the four food groups, I need to eat more:
Vitamin B12
Grain Products ________ servings Vitamin B12 is found in milk and eggs. Your developing
baby needs vitamin B12 for brain and nervous system
Vegetables and Fruit ________ servings development. If you do not eat these foods, you should
have your vitamin B12 level checked by your health care
Milk Products ________ servings practitioner. Make sure you take a supplement containing
vitamin B12 — at least three micrograms per day. Some
Meat and Alternatives ________ servings nutritional yeast contains vitamin B12, but during
pregnancy and breastfeeding it is best to make sure
How will you eat more of the foods you need? you get enough by taking a supplement.
________________________________________________
Check A Guide to Healthy Foods, page 38, and circle

all the foods you ate. In which food group are you
strongest? Of which nutrient group did you have
the most? Of which nutrient did you get the least?
# A F F E IN E % SSE N T I A L &A T T Y ! CI D S % &!
# AFFEINE IS FOUN D IN M AN Y PROD UC TS IN C LUD ING C OFFEE TEA %SSENTIAL FATTY AC ID S ARE N EED ED SO YOUR BABYS N ER VOUS AND
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! SM ALL AM OUN T OF C AFFEINE SH OULD N OT H ARM YOU OR YOUR BREASTFEED IN G 4 H E AM OUN T OF %&! N EED ED INC REASES D URING
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OR FRUIT JUIC ES
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( E R B A L 4E A S
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3OM E H ERBAL TEAS ARE SAFE TO H AVE D URIN G PREG N AN C Y AN D
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4EAS M AD E FROM ED IBLE FOOD PROD UC TS ARE G EN ERALLY SAFE
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s 3OM E H ERBAL TEAS M AY AG G RAVATE ALLERG IES
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Taking Supplements
It is important to tell your health care practitioner what • Do not take an iron supplement with tea or coffee,
types of supplements you are taking. Remember to include and do not take it with foods that are high in calcium Always store vitamin and iron
any herbal supplements or remedies or natural vitamin or with your calcium supplements. See page 38 for a supplements safely out of reach of
products that you use. Taking too much of any supplement list of foods high in calcium. young children. This is to avoid
may be harmful to your baby. This includes natural or poisoning.
herbal products. • An iron supplement may cause constipation.
If constipation is a problem, see page 23.
Prenatal Supplements
Your health care practitioner may recommend a vitamin Vitamin A
and mineral supplement made for pregnancy. This is High levels of vitamin A can harm your baby. Do not take
called a prenatal supplement. A healthy diet and these extra supplements that contain vitamin A during pregnancy
supplements will give you the extra vitamins and minerals or breastfeeding. Prenatal supplements have safe levels of
you need for your growing baby. It is important to take vitamin A for pregnant and breastfeeding women.
them every day. If you can’t afford prenatal supplements,
check with your local health office. There may be a prenatal Calcium
program that provides these supplements at no cost. • Your health care provider may recommend a calcium
supplement along with foods that are extra high
Folic Acid in calcium.
Take a folic acid supplement or a prenatal vitamin
supplement with 0.4 to 1 mg of folic acid every day. • Calcium is best absorbed when taken with food.
For more information, see BC Healthfile #38c,
Pregnancy and Nutrition: Spina Bifida and Folic Acid • Do not take bone meal or dolomite because you can’t
at www.bchealthguide.org. be sure they are good sources of calcium.
Iron • See BC HealthFile #68e, Food Sources of Calcium

Your health care practitioner may recommend that you take and Vitamin D at www.bchealthguide.org.
an iron supplement and eat foods that are extra high in
iron. For more information, see BC HealthFile #68c, Iron
and You at www.bchealthguide.org. Food Safety
• An iron supplement is best absorbed if taken between Some foods can carry bacteria or parasites that may make
meals with a light snack. you sick. Some can affect your baby too. Follow these
safety guidelines.
• An iron supplement may cause nausea if taken on
an empty stomach. How can I practice food safety?
• Wash your hands well with soap and warm water after
• Take an iron supplement with foods high in vitamin C. going to the toilet, and before and after preparing
These include berries, citrus fruits, peppers, broccoli, food. If you touch raw meat, wash your hands well
or tomatoes. before handling other foods.
• Wash raw vegetables well. Use a brush to remove • Do not keep food in the refrigerator for more
visible soil. than 2 days.
Health Canada advises that pregnant • Be careful with raw and cooked foods. Keep uncooked • Keep cooking tools and surfaces clean.
women, women of child-bearing meats and seafood separate from vegetables and other
age, and young children should eat ready-to-eat foods. • Never leave food in open cans. Store food in
no more than one meal per month of covered containers.
shark, swordfish, or fresh or frozen • Do not put cooked foods on cutting boards or plates
tuna. This does not apply to canned that were used for raw meat. • Check for safety seals.
tuna. These foods should be limited
because high mercury levels in these • Do not let raw or cooked foods sit at room • Change dishcloths and towels daily.
fish may cause health problems. temperature. The general rule is no longer
than a total of 2 hours. For more information call the BC NurseLine or
Dial-a-Dietitian. See Resources at the back of the
• Keep hot foods hot (60°C) and cold foods cold (4°C). book for phone numbers.
• Do not eat undercooked meat. Thoroughly cook these

foods until their internal temperatures are as shown: Pet Safety
• all poultry (74°C) If you have contact with your cat’s feces (poop), you can
• egg products (63°C) get a parasite that can cause a serious infection, called
• meat dishes (68°C) toxoplasmosis , in your unborn baby. This can result in
miscarriage or birth defects. The disease is often mild or
• Reheat food really well, to an internal temperature without symptoms and can be mistaken for the flu.
of 74°C.
How can I practice safety with my cat?
• Use only pasteurized milk and milk products. • Have someone else empty the cat litter box, or wear
gloves and wash your hands well.
• Avoid eating raw fish.
• Wear gloves and avoid direct contact with garden soil
• Avoid or cook well: that may have cat feces in it.
• soft cheeses such as brie, feta, Camembert,
blue veined, and Mexican-style cheese You should wash your hands with soap and water for
• deli meats, hot dogs, and refrigerated pâtés 15 seconds after handling your pets.
• previously cooked seafood and smoked fish
• Wash and sanitize utensils and cutting boards after

handling uncooked foods. To sanitize, use 1 teaspoon
of household bleach in 1 litre of water.
• Cooked foods should be refrigerated and

used promptly.
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• Do this exercise often throughout the day. • Place your hand flat along the middle of your
stomach, fingers pointed towards toes. You may
• Do not hold your breath while tightening feel a gap between the bands of stomach muscles.
your muscles. Note if there is any bulging in the middle of the I really wanted to help Peggy with
abdominal muscles. exercising so I started to join in on
• To prevent leaking urine, try tightening your pelvic her evening walks. It seemed to help
floor muscles before you cough, sneeze, or lift. • If you have any bulging or gaping in the middle of that I was interested too. We would
your abdomen, talk with your health care practitioner. clock our time and distance and
gradually increase it. She had to slow
Exercising after Baby Good Exercises down after about eight months but
• Walking — gradually increase the pace and distance. she still kept at it. She actually walked
Exercising will help you regain muscle tone, lose weight, Use a good stroller or soft carrier so you can take for a lot of her labour; it seemed to
and have more energy. After a vaginal birth, most exercises your baby with you. If you jog or walk quickly, help distract her. We got back at it
can be started again as soon as you are comfortable. Start wear a supportive bra. again about a week after Jamie
slowly, then gradually build up the length of exercise. If you was born. We would put Jamie in the
have heavier and brighter bleeding after exercise, you need • Swimming — you can begin swimming after vaginal stroller and he would nap while
to slow down. After a caesarean birth, exercise can be bleeding and discharge have stopped. we exercised and had an adult
started when you are comfortable and have discussed your conversation.
exercise plans with a physiotherapist or doctor. • Postnatal fitness classes — your community may have
classes designed for new mothers.
You can begin Kegel exercises a day after a vaginal birth.
Let pain be your guide. These exercises will help strengthen • Yoga — start slowly or join a class that is designed for
and tone the area around your vagina, and will help you new mothers.
control peeing. Make Kegel exercises a regular part of your
daily routine for the rest of your life. Exercising and Breastfeeding
Exercise does not affect the amount or quality of your
Exercise can be a time for you, your partner, and your baby breast milk and will not affect the growth of your baby
to spend together. Choose an activity that is comfortable if you are breastfeeding. Rarely, in some women, intense
for all of you, and make it one that easily fits into your daily exercise will cause an increase in lactic acid in breast milk
schedule. If you feel pain while exercising, stop and rest. and the baby may not like the taste.
Separation of the Abdominal Muscles If your baby does not feed well after you have done
Before starting an exercise program after birth, check to see intense exercise:
if you have a separation in your abdominal muscles by • slow down
doing this test: • feed your baby before exercising
• Lie on your back with your knees bent and feet flat • express breast milk before exercising to give to
on the floor. your baby after you exercise
• try feeding again a little later
• Lift your head and shoulders off the floor, keeping
your chin tucked in. Remember — your milk is still good for your baby.
2 E D U CIN G 3 T R E SS 4R A VE LLIN G
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AN D ORG ASM S ARE M ORE IN TEN SE / TH ER W OM EN FIND THEY ARE
) S SE X D U R IN G P R E G N A N CY SA F E TOO TIRED AN D N AUSEATED AN D H AVE TO STRUG G LE TO AD APT TO
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Tips for Having Sex If your baby is due, sex may help your body get ready for
• Uncomfortable? Try positions you do not normally use, labour because:
Since Susan has been pregnant, I and use pillows to help support where needed. When • Semen contains a hormone called prostaglandin that
have greater understanding for the baby has engaged in the pelvis, the woman can may help start contractions and soften the cervix.
pregnant women where I work. I try lying, crouching, or kneeling with her back to her
completely get it that they need to partner so he enters her from behind. • Stimulation of the nipples by rubbing, rolling, or
have a nap during the day and that a sucking releases the hormone oxytocin. This can also
sudden exit may mean they’re sick. I • Too tired? Try the morning, afternoon, or a time when cause the uterus to contract. You will notice these as
am much more willing to pick up any you are more rested. after pains when you first start breastfeeding after birth.
slack during the nine months of
pregnancy. • Breasts leaking? Try wearing a padded nursing bra. • Orgasm can cause the uterus to contract.
Tips for Partners How soon after the baby is born can we have sex?
Use questions to keep communication open: You may have sex again when you feel ready, usually when
• Is this position still comfortable for you at this stage? vaginal bleeding has decreased and any tears or stitches
• What can I do to make this better? have healed. It is normal for women to need time to “get in
• Does this hurt? the mood.” Feeling well rested and lots of foreplay will
• Are you worried about the baby? help. Vaginal dryness can make intercourse uncomfortable,
• Would you like to try something else? but using a sterile, water-soluble lubricant in the vagina
and/or on the penis can help. Before you start having sex
Check in frequently during sex to be sure your partner is again, ensure you have effective birth control.
comfortable and enjoying the experience.
What about orgasm? Working Safely

A mother’s orgasm can trigger the uterus to contract. This
can happen even with masturbation or oral sex. However, Talk to your health care practitioner about any risks at work,
this usually does not affect the baby. Contractions normally such as dangerous chemicals and fumes. Also talk about
stop after a few minutes. If you have a risk for preterm infections or if you get overheated at work. You may have
labour, you may be advised by your health care practitioner to stop doing physical work, such as heavy lifting, during
to avoid orgasms during your pregnancy. your pregnancy. Talk to your boss about job changes
during this time.
Is oral sex OK?
Oral sex can be an alternative to vaginal sex. Two points to Be comfortable at work. If you stand for long periods:
remember are: • shift your weight from one foot to the other often
• Don’t let your partner blow air into your vagina • put one foot on a footrest
because it can cause an air bubble in your blood • wear comfortable, supportive shoes
stream. This is a very serious complication. • have as many breaks as possible and try to find a quiet
place to lie down or at least put your feet up
• Do not have oral sex if your partner has a cold sore
(herpes virus) because the virus can infect you. If you sit for long periods:
• change your position often
Will sex start labour? • use a footrest
Not unless you are ready to go into labour already or are at • get up and walk as often as possible
risk for preterm labour.
0 R E G N A N C Y 2 I S K &A C T O R S
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s C O N T A C T Y O U R H E A LT H C A R E P R A C T IT IO N E R s AFTER AN AM N IOC ENTESIS
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Preparing To Give Birth
In British Columbia, women and their partners can choose Health Care Support
where to have their baby — in a hospital with a doctor or
midwife, or at home with a midwife. Doctors in BC are not While you are pregnant you will get medical care from your
permitted to do home births. midwife or family doctor. You may have special needs, such
as carrying more than one baby, or you may have a medical
You may be advised to have your baby in a hospital if: condition, such as diabetes or heart or kidney disease. If this
• you are carrying more than one baby is the case, your doctor or midwife may ask an obstetrician
• your baby is in a breech position (bottom down) to give you medical care. An obstetrician is a doctor trained
or other unusual position to care for women who have special needs during their
• you have early labour before 37 weeks, or late labour pregnancies and birth. If needed, an obstetrician may also
after 42 weeks of pregnancy be called during your labour and birth.
• you have a medical condition, such as high blood
pressure, heart or kidney disease, or diabetes Having your baby at home?
• you have active genital herpes You need to get medical care from a midwife if you plan to
• you have had a caesarean birth before have your baby at home. Your midwife will be with you
• you have a high-risk pregnancy for any other reason during your labour. A second birth attendant will also be
present for the birth of your baby. She will be there for a
short period of time before and after your baby’s birth. Until
six weeks after the birth, your midwife will give information
and care as you need it. This help is for you and your baby
It’s important that both you and your partner are and includes breastfeeding support.
comfortable with the place where you choose to
have your baby. After the birth, your midwife will see you or contact you at
home on a daily basis for a week. At two weeks, you will
When thinking of birth choices, ask: return with your baby to your midwife’s office for visits until
• Where will we feel safe and be able to relax and six weeks after your baby’s birth. At that time your care will
focus on my labour? be transferred back to your family doctor. You will receive
information from a public health nurse about services from
• Am I in good health, without any medical the health office and services in your community.
problems in my pregnancy?
Having your baby in a hospital?
• Where can my health care practitioner attend A nurse and your midwife — if you have one — will be with
the birth? you during your labour and birth. Your doctor will usually
check on you during labour and will be with you during the
• Will my partner and I be involved in the choices birth of your baby.
about my care?
After you go home you will be contacted and visited as What about children?
needed by a public health nurse. She will answer questions Can my other children be at the birth?
about your baby’s feeding and care. She will also talk with Yes, children can usually be there. Talk to your health care Our birth plan was useful because I
you about your health and postpartum adjustment. She will practitioner about this ahead of time. You will need to have didn’t have to tell everyone what we
give you information about services provided by the health someone look after your child. If your child needs to leave wanted. Our nurses changed at the
office and about other services in your community. the room, the support person can look after her. The person hospital at shift time, and during
who looks after your child should be someone other than their lunch breaks. They would read
The public health nurse is not available after office hours the people who are providing your labour support. the birth plan and come into the
and on weekends or statutory holidays. During these times, room knowing who I was and what
call the BC NurseLine, at 1- 866-215-4700, for confidential we hoped for. It also made us think
health information and advice from a registered nurse. and talk about what we really want-
ed. I just wanted a healthy baby. My
Your Birth Plan wife wanted a great experience and a
Personal Support healthy baby. We agreed on safety
A birth plan is a written outline of the things you would first and experience second.
During labour and birth you can choose to have your prefer to do or have happen during your labour, birth, and
partner and anyone else you want to be with you. Having the days following birth. It can be a useful tool for you and
someone with you and your partner during labour has been your support team as you work together. During your
shown to lessen the amount of pain medication needed prenatal visits, talk to your health care practitioner about
and to shorten labour. Before your baby’s birth it is helpful the things you would like, but be aware that for a number
to decide who you want to be with you. Many women of reasons, it is not always possible for every part of a birth
choose their partner and other important people, such plan to be followed.
as a close friend, relative, or parent to be with them.
Some women also choose to have a doula. A doula There are many reasons why you may want to write a
provides emotional and physical support to you and birth plan:
your partner before, during, and just after birth. A doula • To inform your doctor, midwife, and nurses at the
does not provide medical care. The cost of a doula is not hospital what you would prefer to happen during
covered by the Medical Services Plan. your labour and birth. Examples include walking as
much as possible or having no medication unless
Because your labour may be longer than you expect, it may asked for. Other examples are being in a semi-sitting
be helpful to have more than one person with you. Then position for the birth or touching your baby’s head
they can take short breaks if needed and you will not be during the birth.
alone. For more information on pregnancy care and who
can help, see the pregnancy topic in BC HealthGuide • To inform your doctor, midwife, and the nurses at the
OnLine at www.bchealthguide.org. hospital what you would prefer to have happen if your
labour or birth needs medical help. For example, being
awake for a caesarean birth.
• To inform your care providers about the care you

would prefer for your baby after birth, such as holding
your baby skin-to-skin.
• To help you and your support team work together.
Birth Plan for: Kim and Tom Lee
Due Date: October 2nd
• Your birth plan is just that — Doctor: Dr. Goodforyou
a plan. Be flexible. Sometimes
things happen that you cannot What we prefer for labour and birth:
control and your plan has • My support people will be my partner Tom, my mother Peggy, and my friend Heather.
to change. I would like them to stay with me during my labour and birth.
• A short plan — about one • We would like to walk around during my labour and spend as much time in the shower as possible.
page — is easiest for everyone
involved in your care to read. • I would like to drink water and juice during labour. I do not want an intravenous unless it is necessary.
• My goal is to avoid drugs, except perhaps Entonox near birth, if I ask for it.
I would really like your ideas and support for non-medical ways to manage pain.
• Please help Tom in his efforts to help me.
• We would like to have music playing during labour. We will bring a CD player.
We didn’t do a birth plan this time.
We had one when our daughter was • I would like to push squatting or semi-sitting when I have the urge, not with coaching.
born and I felt like a failure as our
birth changed so much from what • We would like to have a mirror in place to see the birth.
we had initially planned. We had
wanted a natural birth, soft lights, • I would rather have a small tear than an episiotomy, and neither if possible.
and no painkillers. As it turned out
the baby was in a posterior position • After the birth, we would like to have the baby placed up on my chest, unbundled and skin-to-skin.
so I had a back labour all through
the night. By the morning I was • Tom would like to cut the umbilical cord.
exhausted and asking for an epidural.
I ended up with an epidural, IV, • I would like to breastfeed our baby as soon as possible after birth and continue breastfeeding on cue.
monitor, and six people in the room.
We were still delighted with our • I know babies feed frequently at night and I want to feed on cue without supplements. Help us
daughter but had this written proof breastfeed frequently and find ways to settle our baby.
that things went wrong. This time we
are just going to go with the flow • If I am overwhelmed with visitors, help me remind them that I need to rest.
and do the best we can with the kind
of labour we get and be happy with If things do not go the way we hope they do:
a healthy baby. • If I have a caesarean birth:
• I would like to be awake and have Tom with me.
• All other plans for our baby would remain the same.
Sample birth plan
Packing for the Hospital
Have your things prepared before you go into labour. Pack Personal Items: I promise that:
a small bag; you may be in hospital for only 24 to 36 hours To be brought in after the baby is born. • This birth will be the priority for
and personal storage space is limited. Place the things you (Note: your clothes should be loose fitting and comfortable.) my time and energy.
will need for labour at the top of your bag or in a separate • washable dressing gown
bag. If you are planning a home birth, your midwife will (front-opening for breastfeeding) • I will make sure everyone at
give you a list of the supplies you will need to prepare. • two or three nightgowns or pairs of pajamas work knows I may have to
(front-opening for breastfeeding) leave on short notice.
Here are some ideas for what to take to the hospital. • nursing bra and pads, if desired
• at least three pairs of panties • I will have gas in the car or have
Labour Kit: • socks other transportation arranged
• Baby’s Best Chance: Parents’ Handbook of • comfortable bedroom slippers ahead of time.
Pregnancy and Baby Care • large sanitary pads
• lip balm or lip gloss • clothes to wear home • I will not plan important travel or
• massage oil or talcum powder events for two weeks before and
• snacks and drinks for you and the support team For the Baby: two weeks after the
• partner’s swimsuit, so he or she can get into the • Canadian Motor Vehicle Safety Standards (CMVSS) due date.
shower with you approved infant seat
• camera, film • undershirt and sleepers • I can be reached at any time.
• CD player or tape player (with headphones) and some music • diapers, pins, and plastic pants or disposable diapers
• a picture, a design, a figure, or anything you find (newborn size) • I will have child care arranged
pleasant to look at • sweater, bonnet, and booties (if wearing a gown) for any children who will not
• list of friends’ and family’s telephone numbers • shawl or blanket, depending on the weather be attending the birth.
• slippers • soft carrier or sling to use to help calm your baby
• dental care products • I will have arranged child care
• hair care products For the Partner: for any children who will be
• skin care products • sleeping bag or bedding and pillows for partner attending the birth.
• other personal items (hospitals usually only supply the sleeping mat)
• coins for phone calls • sweat pants and top suitable for sleeping • I will be kind, supportive,
encouraging, and helpful.
Preparing for Labour
The start of Michelle’s labour was
pretty confusing. She was awake all What is the difference between pre-labour What should we do if we’re not sure of
Sunday night with contractions that and true labour? pre-labour or labour?
kept her awake but then fell asleep It is easy to confuse pre-labour with true labour. • If it’s night, try to sleep. You want to be well rested
again in the morning and everything Contractions may be uncomfortable in both true and for childbirth. In true labour you may not be able to
stopped. The contractions started up pre-labour. Although both may be uncomfortable, there sleep but will at least rest. If you fall asleep, it is most
again and she walked to try to keep are clear differences between them. If you are less than likely pre-labour.
it going. All day it was off and on. 37 completed weeks in your pregnancy, you may be in
She was awake most of Monday preterm labour. See page 80. • Take a shower. The contractions in pre-labour will
night with contractions and a little often become less frequent and shorter. In true labour
bit of show. She sent me to bed, the contractions will continue no matter what you
thank goodness. Again it stopped are doing.
when she had breakfast and a bath.
On Tuesday we went to the hospital • Distract yourself. Watch a movie, walk in the garden,
exhausted, and our son was born late play cards. If you are in true labour, the contractions
that night. will demand your attention. If it’s pre-labour, you may
be able to carry on with your usual routines.
Pre-labour True labour
• Contractions are at irregular intervals, • Contractions occur at more regular intervals,

e.g., every 5 to 15 minutes. e.g., 5 to 10 minutes apart.
• Contraction length varies, • The length of contractions usually increases,

e.g., lasting 20 seconds to 90 seconds. e.g., lasting 30 to 60 seconds.
• Although they may be painful, the strength of • Intensity of contractions gradually increases, becoming
contractions remains the same or may lessen. progressively more painful.
• Contractions are often felt in the lower abdomen. • Contractions can be felt in the abdomen, across the
lower back, and sometimes in the thighs
• You may find that contractions are most
uncomfortable when you are moving • Contractions do not decrease when you are resting,
and lessen when you are resting. but continue regardless of what you are doing.
• The cervix usually remains closed. • The cervix thins and shortens (effaces) and opens (dilates).
• There is usually no “show” (blood-tinged mucus). • There may be “show” and/or leaking from your
bag of waters.
When should we call our health care practitioner Visualization
or hospital? Picture something or some place that makes you feel
• When your contractions are regular and painful, last relaxed and safe. • Practice the relaxation and
30 to 60 seconds, and happen at 5-minute intervals. breathing techniques with the
Water Therapy mother throughout pregnancy.
• If your bag of waters breaks. A shower and bath can be very comforting in any stage of You may be her main source of
labour. Stand or sit in the shower and direct the water to ideas and support during labour.
• If you have vaginal bleeding or show. where it feels comfortable or soak in a tub. Try to postpone
a bath until you are in active labour, unless you are tired. • Make practice a fun and
• If you are unsure and have concerns. Baths may slow your contractions temporarily when taken relaxing time for both of you.
in early labour. Later in labour, having a bath is very helpful
• If your health care practitioner has advised you to call early. because it can help decrease the pain and increase your • Attend prenatal classes with the
labour progress. Remember to drink lots of fluids when mother to learn and practice
• If your baby stops moving or moves less than usual. using the shower or tub. techniques with others.
• If you’re not sure and can’t reach your health care Massage • Remind the mother to find her
provider by phone, call the BC NurseLine at 1-866- Use smooth, rhythmic stroking or rubbing of the face, neck, focal point at the beginning of
215- 4700. That way you can speak with a registered shoulders, back, thighs, feet, or hands. Do it yourself or the practice contraction (see
nurse who can give you helpful information and have someone give you a massage. Focal Point Concentration).
advice when you need it most.
There are three types of massage: • Signal the beginning and
• light, rhythmic stroking of your abdomen ending of the practice
• squeezing and releasing contractions.
Relaxing for Labour • pressing with the hand on the lower back
to relieve backache • Use the exercises to relax.
Learning to relax can help with childbirth and the busy You may need them during
time after your baby is born. Remember; try to relax, labour — and your child’s
stay positive, breathe through your contractions, and early years — to stay focused
rest between them. and calm.
Here are some relaxation and breathing techniques you can • Have a shower together.
use. Practice all the techniques well before you go into The water is relaxing and
labour, so you know which will be the most helpful to you may help with the pain.
when labour begins. If possible, practice the techniques
with the person who will be with you during the birth.
Focal Point Concentration

Being able to focus on something other than pain can
help you relax. This is true even when you are having
a contraction. During labour you may want to look at
something or someone and try to clear your mind.
Complete Relaxation Light Breathing in Labour
You can do this exercise alone or with your partner: • Let your contractions guide you in the rate and
• Tense and relax each part of your body in turn, using depth of your breathing.
Labour is like getting ready for a moderate tension, for a period of three to five seconds.
marathon. You need to be (Tensing too strongly can cause muscle cramps.) • Breathe in and out through an open mouth.
prepared. If you have practiced com- Breaths will be shallower than slow breathing.
fort positions, relaxation, breathing • Breathe in as you tense and out as you relax.
techniques, and other rituals, you will Focus on how good it feels each time you relax. • Breaths will be about twice your normal rate.
be able to choose the ones you find
helpful. While in labour you will need • Work from your toes to the top of your head. • When a contraction starts to decrease, return to
to pace yourself and rest whenever your slow breathing.
possible. Drink fluids to keep
hydrated. Use comfort positions as Breathing for Labour • When the contraction ends, take a deep breath
well as breathing techniques to help and end with a relaxing sigh.
with relaxation. During labour, breathing techniques or variations of them
can be used to: • Try to completely relax, change your position,
• help with relaxation or have a sip of fluid as desired.
• focus your attention during a contraction
• maintain a good supply of oxygen to Short Breath Holding
yourself and your baby • During the second stage of labour, you may feel the
• help relieve pain impulse to push down with each contraction.
Practice a variety of breathing techniques before labour. • The number of pushing (bearing down) efforts
This will help you to use and change them as needed increases as the baby moves down the birth canal.
during labour. They will help you be calm and relaxed.
• You may push down with some short breath holding
When you cannot remain relaxed or walk or talk during a (usually lasts less than 6 seconds).
contraction, you may wish to use slow breathing for as
long as it is helpful. Then you may wish to change to light • If you have an epidural, you may have a delayed,
breathing. You may find that you use both or only one lessened, or loss of the urge to push.
of these breathing techniques. You will also adapt them
to suit your needs. Panting
During the second stage, you may be asked to use panting
Slow Breathing breaths. This helps you control the urge to push and allows
• Breathe in slowly through your nose, or through your the baby’s head to come out slowly and gently.
mouth if your nose is congested.
• Lift your chin.
• Breathe out through your mouth, letting all the air out
like a relaxing sigh. • Have your mouth open slightly.
• Breathe about half your normal rate. • Breathe in and out lightly and quickly
(like a dog panting).
• Try to keep your shoulders dropped and relaxed.
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• Listen to the mother. She can tell you what she needs. • Stay with her.
• During labour, actively support her. Make eye contact, • Try to stay calm.
say “Breathe with me,” and do the breathing yourself
so she can follow you. At the end of contractions say, • Take care of yourself— bring snacks and something
“Take a deep breath and relax.” to drink.
• Help her to stay relaxed by touching, massaging, • Talk to the doctor, midwife, and the nurse about
talking, breathing with her, and reminding her to your birth plan.
move around. Check for relaxation by touching her
arms, shoulders, and legs. • Ask questions if you have any concerns or don’t
understand something.
• When a contraction starts, focus on her. If people are
trying to talk to her, let them know she is having a Any time the mother needs help to cope, you may need
contraction. If you find it helpful, you can time the to take charge for a while. To take charge:
contractions. That way you can tell her when a • Move in close and have your face near hers.
contraction is at its peak and when it should be
easing off. • Be calm and say encouraging things.
• When a contraction is over, give her sips of fluids and • Hold her shoulders or head in your hands.
help her to move and relax. Hug her tightly but gently.
• Talk and encourage her. Give verbal encouragement • Tell her to open her eyes and look at you.
by saying, “You’re doing great. The contraction is Make eye contact.
almost over.” When the contraction ends, say, “Take
a deep breath and relax. It’s over.” • Encourage her with every breath and say things like,
“Breathe with me, stay with it, look at me, good for you,
• If the she tells you something is not working for her, it’s going away now.” Use a calm and confident tone.
do not try to force her to follow you. Move onto
another relaxation or breathing technique that may • Talk with her between contractions and ask if you are
be more effective. helping. You might say, “Let’s breathe together. You
are doing great. Let’s get through this part together.
• Tell her she is doing well. Make eye contact and smile. Let me help you more this time.”
• Tell her not to worry about any noises she makes — • Don’t give up when she says she can’t go on. Tell her
many women find making noise helps them get it is hard now but that you can do it together, this is
through the pain of their contractions. normal, and think of the baby to come. It is OK to
ask for help.
• Get ice chips, wipe her forehead, walk with her, rub
her back, and help her with comfort positions. • Stay with the mother during labour.
• Have her eyeglasses with you so she can watch • If you are unsure of what to do, ask the health care
her baby being born. practitioner to give you some ideas.
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1
Early First Stage
What is happening? What might you be feeling? What can you and your support person do?
• Your cervix is opening to • Backache and pelvic pressure, • Carry on your usual activities as long as possible.
stage labour
about 3 – 4 centimetres as if your period is starting. Go for a walk, try to sleep or rest, make meals.
and is softening. Some women will feel
discomfort in their thighs, • Breathe in a normal manner until you can no longer
• The baby’s head is coming hips, and abdomen. talk or walk through contractions, then start with slow
down in your pelvis. breathing as needed.
• Contractions may feel like
• You may have some mild cramps and may last • Eat a light meal and remember to drink fluids.
diarrhea. about 20 – 45 seconds.
• Take a shower if someone is nearby. Try to postpone a
• You may notice “show” • Contractions may not be bath until you are in active labour, unless you are tired.
(slightly pink, mucusy regular. They may start every Baths may slow your contractions temporarily when taken
vaginal discharge). 10 – 20 minutes, or you may in early labour. Later in labour, having a bath is very
The mucus plug not be aware of them at first. helpful because it can help decrease the pain and increase
normally sits in the your labour progress. Remember to drink lots of fluids
cervix. As the cervix when using the shower or tub.
opens, the plug falls out.
• If your membranes rupture, put on a sanitary pad and call
• Your bag of waters your health care practitioner.
(membranes) may leak
or rupture. This can • If your membranes rupture and the amniotic fluid is
happen any time before green go to the hospital. Green amniotic fluid means that
or during labour. You your baby has had a bowel movement (meconium). This
may have a small trickle may happen for no reason. It may also happen if your
or a big gush. baby has been stressed or is in a breech position.
Call your health care practitioner or hospital when: • Your bag of water breaks or leaks.
• Your contractions are regular and uncomfortable, • You have vaginal bleeding, more than show.
usually about 3 – 5 minutes apart and lasting
45 – 60 seconds. • You are uncomfortable staying at home.
• You have been advised to call for other reasons.
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1
Transition Stage
• Your cervix is now • Moments of panic • You need a lot of support during transition.
stage labour almost fully dilated. and confusion.

• Picture your cervix and body opening up to
• The baby moves down • More and more irritable, let your baby out.
further into your pelvis. sensitive, and having trouble
This puts pressure on saying what you need. • Tell someone if you have the urge to push.
your bottom.
• Some nausea and vomiting. • If you have the urge to push and you are not fully dilated
• Contractions may be (10 centimetres) use panting until you are fully dilated.
strong. They may come • Leg cramps.
every 2 – 3 minutes and
• Tell her she is almost done and last 60 seconds. • Trembling of arms and legs.
everything is going well.
• Your health care • Hot or cold flashes.
• Wipe her forehead with practitioner will listen to
cool cloths. your baby’s heartbeat • Constant discomfort with no
every 15 – 30 minutes. relief between contractions.
• Offer small sips of fluids
between contractions. • Sweating on your face.
• Look her in the eyes and • A strong urge to push

help her to focus during with contractions.
contractions.
nd
2
Second Stage
During the second stage of labour you will push your baby out. Second stage begins with full dilation and ends with the
birth of your baby. This stage can last from a few minutes to two to three hours.
stage labour
• You will have a vaginal examination • Contractions will be powerful • Breathe deeply.
to be sure you are fully dilated. If you and pushing the baby out.
push too soon the cervix can become They will come about every • Relax your bottom and go with the
swollen and difficult to open further. 2 – 3 minutes and last urge to push.
60 – 90 seconds.
• Once your cervix is fully open, your • If you feel better grunting with contractions
baby is pushed out. • You may feel a strong urge and giving small pushes go with this urge.
to push.
• If your bag of waters has not broken • Use the same muscles to push that you
already it may be broken to help • You may go through a short would use for a bowel movement.
you along. time with no contractions and
no urge to push. • Drop your chin towards your chest and
• Your baby’s head pushes against relax your tongue.
your perineum. • You will have a splitting and
burning feeling on your • Get into your birthing position
• Your baby’s heartbeat will be perineum or vagina as (e.g. semi-sitting, squatting, kneeling or
checked every 5 minutes or after they stretch. side-lying). Support people can help hold
every contraction. your legs, or support you as you squat.
• Surprised, overwhelmed or
• Your baby’s head is usually facing frightened by the pushing • Continue with relaxation techniques
your spine. sensation. between contractions.
• As your baby’s head first emerges, • Listen to your body and use the breathing
it will slip back into your vagina techniques you practiced.
between contractions.
• If you are asked to stop pushing, use the
• Your vagina stretches to allow your panting breathing technique.
baby to pass through.
• your perineum may not tear at all
• you may have a small tear of
the perineum
• you may have an episiotomy (cut
in the perineum) to allow more

room for your baby’s head
nd
2
Second Stage (continued)
• As your baby’s head crowns (the • Very tired but feeling a burst • After the baby’s head is born, you may be
stage labour
largest part of the head is birthing) of energy. asked again to stop pushing for a moment
you may be asked to stop pushing. so your health care practitioner can check if
This allows the head to come out • Anxious and hesitant to push the umbilical cord is around your baby’s
slowly and helps prevent tears. due to pressure on your bottom. neck. Use the panting technique.
• When your baby’s head is out, it is • Like you are having a bowel • You may be able to touch and stroke your
usually face down but will turn to movement (you may pass some baby’s head before the body is born.
one side. Mucus in the baby’s nose stool as you push).
and mouth may be suctioned out. • Look at your baby being born, either by
• Full of emotion at the birth looking down or having a mirror in place.
• With the next contraction your baby’s of your baby.
shoulders and body will come out. • Your baby will be placed on your chest.
rd
3
Third Stage
During the third stage, the uterus contracts. The placenta completes its separation from the wall of the uterus and is birthed.
This stage can take 5 to 30 minutes or longer.
stage labour
• The umbilical cord will be cut and • You may have cramps as the • Cuddle with your baby on your chest.
clamped after the baby is born. placenta comes out.
• If your partner wants to cut the umbilical
• Just after birth a health care • You may be asked to push out cord, he or she will be given scissors and
practitioner will take an Apgar the placenta. told where to cut.
score. This checks your baby’s
overall health. • You may feel relieved, grateful, • Bring your baby to your breast to begin
and filled with joy. Some breastfeeding. Some will suck right away;
• The placenta separates from the mothers don’t have any others will take a little while. It was amazing when our son was
wall of the uterus and is pushed particular feelings at born. He was put right up onto my
out the vagina. this time. • Warm blankets will be put over you and wife’s chest, all slippery and wet. I
your baby to keep your baby warm. had to hold onto him so he didn’t
• The uterus rises in the abdomen • Exhausted. slide off. Even before the placenta
and takes on a grapefruit shape • If asked to, give small pushes to push out was out he was rooting round for the
and size. • Shaky and cold. the placenta. nipple. So my wife moved him over a
bit and he latched on right away. I
• A gush of blood often comes with • Hungry and thirsty. • Talk to your baby. He already knows the think the breastfeeding really
or before the placenta comes out. sound of your voice. helped because as soon as he was
• Focused on the baby and nursing, my wife had cramps and the
• You may be given a shot to stimulate wanting to know that your placenta was delivered.
contractions of the uterus and stop baby is normal.
you from bleeding too much.
• If you have had a tear or episiotomy,

the area may be frozen and stitched.
th
4
Fourth Stage
The fourth stage is the first two or three hours after birth.
stage labour • Your body is recovering from the

hard work of labour and birth.
• Tremors and chills. • Ask for more warm blankets as you
need them.
• Discomfort from after pains,
• Your baby may breastfeed or episiotomy or tears, and • Place an ice pack (wrapped in a towel)
nuzzle your breast. hemorrhoids. between your legs to decrease swelling
in your perineal area.
• You have lost blood during the • Dizzy or faint if you try
birth and you may be very tired. to get up. • Drink fluids and have a light meal if you
are hungry.
The birth of our baby was the • Your body may begin to shake.
most amazing thing we have ever • Have help before you get up.
experienced. It was hard work for my • Difficulty peeing due to swelling.
wife but she was so strong and in • Continue breastfeeding and cuddling
control. I was in awe of her. The your baby.
moment we first held our daughter
will be forever etched in my heart. • Keep your baby skin-to-skin for as long as
I’m a pretty tough guy but it brings you wish. Skin-to-skin is the best way to
tears to my eyes just thinking of it. keep your baby warm. Partners can help
keep baby warm skin-to-skin if you need
to get up.
Medical Procedures that May Be Needed
to Assist Labour and Birth
Sometimes interventions may be needed for you or your Vacuum Extraction

baby during the birth process. The most common are A soft plastic vacuum cup is sometimes used to assist with
outlined below. You may wish to discuss these with birth. It is put on the baby’s head and suction can then be
your health care practitioner ahead of time. used to help pull the baby out. The cup can leave a bruise
and swelling on the baby’s head, but this will fade a few
Induction days after birth.
Induction of labour is used to start labour before it begins
on its own. It can be done by: A vacuum is used if:
• breaking the water bag around the baby • the mother has a prolonged pushing stage of labour
• putting a gel into the vagina • the mother is exhausted and unable to push effectively
• giving medication by IV to start contractions • the baby’s heart rate slows showing signs of stress
Induction may be considered if:

• the mother is one to two weeks past the due date Pain Relief Options
• the mother has an illness, such as heart disease,
diabetes, or high blood pressure Labour pain is different for every woman. Many women
• the baby is not growing well cope with pain with the help of:
• a supportive person
Episiotomy • breathing techniques
An episiotomy is an incision (cut) made in the area between • relaxation
the vagina and rectum. This cut enlarges the space for the • warm baths
baby to pass through the vaginal opening. Freezing is • showers
usually given first. After the placenta comes out, the cut • changing positions
is sewn shut with self-dissolving stitches. • massage and/or visualization
• ice packs
Forceps • acupressure
Forceps are instruments that are placed around the baby’s • hypnosis
head and used to gently help pull the baby out. They can
leave red marks or slight bruises on the baby’s head, but Transcutaneous Electronic Nerve Stimulation (TENS) can be
these soon fade. An episiotomy may be done before used for relief of back pain. Four electrodes are placed on
forceps are used. the lower back. They are attached to a small, hand-held
battery device. The woman adjusts the stimulation. The
Forceps are used if: stimulation gives tingling, buzzing, or prickling sensations
• the mother has a prolonged pushing stage of labour over the back.
• the mother is exhausted and unable to push effectively
• the baby’s heart rate slows showing signs of stress
• the position of the baby’s head needs to be changed
Pharmacological Options
Sometimes women in labour need additional pain relief. This table outlines some options for pain relief medications
during labour and birth.
Pain Relief Option Benefits Side Effects
Nitrous Oxide and Oxygen • Can be used right up until birth with • Only recommended for 2 – 3 hours.
(Entonox) no effect on the baby.
Commonly known as • May make some women feel dizzy and have
laughing gas. • The woman in labour holds the face temporary tingling or numbness in their
mask and breathes in the amount face or hands.
she requires.
• Will only dull the pain, but will not take the
pain away.
Narcotic Pain Medications • Can be given by a health care • May make the baby sleepy. If a narcotic is given
(such as Demerol, Fentanyl) professional by one of two routes: near birth, it may affect the ability of some
• Intramuscularly (IM) — the babies to breathe and breastfeed.
medication is injected directly
into a muscle. • Usually given before the late part of the first
stage of labour due to its effect on the baby
• Intravenously (IV)—the medication at birth. This way, it can wear off before the
is injected directly into a vein. baby’s birth.
• Most given by IM will work within • May make some women feel drowsy, dizzy,
20 – 30 minutes and will last or nauseated.
2 – 4 hours.
• Will only dull the pain, but will not take the
• Most given by IV will work within pain away.
2 – 3 minutes and will last
1 – 2 hours.
• These time frames may vary

depending on the medication.
• In general, narcotic medications

will make most women feel sleepy
and relaxed.
Pain Relief Option Benefits Side Effects
Epidural/Spinal • Used at any time during labour. • Women may have to stay in bed as they will not
Local anaesthetic is injected have good control of their legs.
into the space around the • Provides the most effective
spinal cord, providing pain pain relief. • Women may shiver at first and may itch from
relief from the waist down. the medication.
During a caesarean birth, • Women in labour can have more
pain relief is from the medication if needed. • Blood pressure will be checked frequently.
breastbone down.
• May be used for a caesarean birth • Most women will also need to have an
so women can be awake during intravenous (IV) during an epidural.
the birth.
• Women usually have a fetal monitor during an
• Women generally do not feel drowsy epidural, which may restrict movement.
or groggy.
• Women may have a catheter inserted into
their bladder to drain urine.
• Women may not feel the urge to push or

be able to push well.
• Increased risk of forceps delivery.
• Pain relief may not be complete.
• Some women have a headache after an epidural.
Pudendal Block • May be given at the time of birth. • May affect the ability of some babies to
Local anaesthetic is injected to breastfeed immediately after birth.
numb the nerves around the
vagina. This blocks pain in the
vagina, vulva, and perineum.
General Anaesthetic • Is used when an epidural or spinal is • A woman may react to anaesthesia or other
Completely asleep during not possible or unsafe to give. medications during the surgery. This can be
caesarean and birth. dangerous to her health. An example of a
• Is used when there is not enough reaction is her blood pressure dropping quickly.
time to place an epidural.
• Her throat may feel dry and sore after the
• Is used in an emergency situation. anaesthetic. This is due to the breathing tube
placed in her windpipe while she’s asleep.
• She may feel nauseated and vomit after surgery.
Caesarean Birth
A caesarean section (or C-section) is the birth of a baby • If you have a general anaesthetic, you will be
through a cut in the abdomen and uterus. Your doctor completely asleep during the surgery and birth. Your
may recommend a caesarean birth to protect you or your partner will not be allowed in the operating room but
baby. A caesarean can be done before or during labour. can usually hold the baby very soon after birth.
When would I have a caesarean birth? What happens after a caesarean birth?
• The cervix does not open completely. • Pain medication will help you move around more
easily. You will probably need it for several days.
• Labour is not progressing. Ask for it when you need it.
• The baby is too big to fit through the mother’s pelvis. • You will have an IV in your arm until you are
drinking well.
• The baby is in distress (not tolerating labour well).
• You will have a catheter — a tube into your bladder to
• Multiple pregnancy (twins or triplets) in which the take away the urine — until you are able to get up to
babies are in difficult positions. the bathroom.
• The baby is in a breech (bottom or feet first) or • You will be getting out of bed within 24 hours after
transverse (sideways) position. the birth. You will need to have help the first few
times you get up.
• The mother has a serious medical condition.
• The surgery will not affect breastfeeding.
• The mother has active herpes lesions on her genitals
that make vaginal birth unsafe for the baby. • If you had staples, they will need to be removed. If
you have sutures (stitches), they will usually dissolve by
• The mother has had a previous caesarean birth. themselves. If you have small adhesive strips across the
incision and they do not fall off within a week,
What are the choices for an anaesthetic? carefully peel them off.
• The most desirable anaesthetic is an epidural or spinal
anaesthesia. When you have these, you are usually • You may have a shower or tub bath as desired.
awake and alert during the surgery and birth. Most
hospitals allow your partner in the operating room • You will need help at home. If you try to return to
if you are awake. your usual activities too soon, you will slow your
recovery. Healing may take six weeks or longer.
• If you have had an epidural or spinal anaesthetic, you
will be able to cuddle your baby skin-to-skin. In some • Don’t lift anything that weighs more than your
hospitals you may be able to put your baby to the newborn baby. If you have toddlers, sit down and
breast soon after birth. have them climb up on your knee.
• You will need to heal from major surgery as well as

the birth of your baby.
• You can resume driving when you feel well enough, Vaginal Births Versus Caesarean Births
are able to twist your body to look to each side, and Some people may think a caesarean birth is easier and less
can quickly use the foot pedals in an emergency painful than a labour and vaginal birth. Caesarean births
situation. (Similar to before you were pregnant.) are quick but they do have risks. You may have a lot of conflicting
emotions following a caesarean
• Eating healthy foods and drinking lots of fluids will If you have a caesarean birth, you will have: birth. Some parents feel depressed
help you heal. • a greater chance of infection about missing the planned vaginal
• a higher risk of complications to you and birth. Others are relieved they have a
What about breastfeeding? your baby from the anesthesia healthy baby. The best way to deal
You will need to experiment to find the most comfortable • a longer hospital stay with these feelings is to talk openly
way to feed your baby. If you hold the baby across your • fewer support people with you at the birth about them with someone you trust.
abdomen, try to prop your baby well above your incision. • a longer recovery time
Many women find lying on their side comfortable. This • pain from the surgery
position works better if you have someone to help latch
your baby. The football position may also work If you’re afraid of a long and painful labour, talk to your
(see page 99). health care practitioner. You may want to consider having
additional support during your labour and birth. This could
What about future births? be a doula, who can provide support to both you and your
Most women who have had a caesarean birth can have a partner. Pain relief is available during labour if you need it.
vaginal birth for their next pregnancy. You should be
offered a “trial of labour” or an attempt to have a vaginal
birth if:
• your hospital has timely access to do a caesarean
birth if needed
• your pregnancy is normal In your birth plan, include your thoughts and feelings
• the reason you had a caesarean before no about your choices related to caesarean births. You
longer applies may need to talk to your health care practitioner
• the incision you had before is across your about what you would like.
uterus, not up and down
The worry with a vaginal birth after a caesarean is that the

scar on the uterus may pull apart during labour and cause
bleeding. This is a rare complication. Your health care
practitioner or nurse will ask if you have constant
abdominal pain during labour, heavy vaginal bleeding,
dizziness, or faintness.
If you want to learn more about vaginal births after a

caesarean (VBAC), go to BC HealthGuide OnLine at
www.bchealthguide.org. Search the database for
“Caesarean Birth.”
Special Birth Issues
Our daughter was born at
34 weeks gestation by caesarean Preterm Labour What can you and your partner do to decrease
section. My wife had really high your risk of preterm labour?
blood pressure and the baby was Preterm labour is labour that begins before 37 completed • go to regular prenatal visits with your doctor
being stressed. I watched her heart weeks of pregnancy. Preterm labour can happen to anyone or midwife
beat going down with every cramp. and it is often not known why. Preterm labour may result • follow Canada’s Food Guide to Healthy Eating
It was a very scary thing for both of in your baby being born too soon. • do not smoke, drink alcohol, or use drugs
us. I had to leave the operating room • seek help if you are abused
because my wife was having a Preterm babies are at higher risk of: • avoid strenuous work and do not work for
general anesthetic, which was the • breathing difficulties more than 8 hours
fastest way to get the baby out. I did- • sucking and swallowing problems • talk with your health care practitioner about
n’t know if I would see a live, healthy • jaundice (yellowish skin) extra stress in your life
baby come out of that room or not. • infections • try to have time to rest each day
It turned out she was very small, but • bruising and bleeding • wear your seat belt low and over the pelvic bones,
healthy. She did need to stay in the • problems maintaining body temperature with the shoulder belt worn normally
special care nursery for a few weeks • longer hospital stays • listen to your body — talk with your health care
though. I’d have to say that was one practitioner if you feel that something is different
of the most frightening things we The earlier your baby is born before term, the greater the
have ever gone through. risk of developing lifelong problems, such as: What are the signs of preterm labour?
• vision problems • bleeding from the vagina
• breathing difficulties • a trickle or gush of fluid from your vagina
• learning problems • stomach pains or bad cramps that don’t go away
• walking difficulties • lower back pain or pressure or a change in
lower backache
What causes preterm labour? • pressure in the pelvis, feeling that the baby is
We do not know what causes most preterm labour. It is pushing down
known that the chance of having preterm labour is • contractions — they feel regular and don’t go
more likely if you: away when you walk or rest
• have already had a preterm baby • an increase in the amount of vaginal discharge
• are carrying more than one baby (twins, triplets) • feeling that something is just not right
• smoke and are exposed to smoke in pregnancy
• do not eat a healthy diet
• are using alcohol and/or drugs What do I do if I think I’m in preterm labour?
• work long hours which cause you to be very tired Contact your health care practitioner and go to the
• are physically or emotionally abused hospital right away. You need to be examined by a
• have a chronic illness, such as diabetes, heart disease, doctor or midwife. This can make a big difference
or kidney disease to your baby’s health.
• have a current bladder or kidney infection or
high blood pressure
Losing a Baby
The loss of a baby is difficult for both you and your partner.
A small number of parents lose their baby through a Being patient with each other helps. Men and women often You may be tempted to stay away
miscarriage, ectopic pregnancy, stillbirth, or other react differently to losing a baby and time helps. Seek from the grieving parents because
misfortune. These events bring emotions of grief, professional help. you don’t know what to say. The best
guilt, and despair, and can be difficult to handle. thing to say is “I’m so sorry.” Allow
Each person grieves differently. the woman to respond (or not) in her
Having a Baby after a Pregnancy Loss own way. Letting her know you are
You may feel very sad and empty and have problems being If you have had a baby die in pregnancy and are now there for her is most helpful.
around other pregnant women and mothers with babies. pregnant again, know that it is normal to be anxious.
This is normal. It is also normal to need to hear many times that your
baby is doing well. Talk about your concerns with your
If your baby is stillborn, or dies near birth, you will have health care practitioner. Also talk about your wishes for
the opportunity to see and hold your baby. If you feel this birth. Some women may feel detached during the
comfortable, take pictures of the baby alone or cuddled labour of a pregnancy following a stillbirth.
with you and your partner. Talk with your baby and say
goodbye. Take your time. Don’t let your baby go until you
feel ready. Many women find this helps with their grieving, If you have other children, include
but this is your choice. them in the grieving process. Siblings
often experience sadness, confusion,
Mementos of your baby will be offered to you — things and loneliness. They may sometimes
such as footprints, baby blanket, bracelets, or a lock of hair. blame themselves for the death.
You may not be able to look at them or you may think you
don’t want them, but this may change over time. You may
wish to put them away for a while.
Knowing where to turn for help is important. Your health

care practitioner can give you information, help you make
difficult decisions and possibly set up counselling or
referrals. Help is also available from the hospital social
worker, chaplain, and nurses.
You will need physical and psychological postpartum care

in hospital and in the community. In addition to emotional
support, you may need help dealing with engorged breasts
and a sore perineum. After you leave the hospital, your
health care practitioner, the public health nurse, local
crisis centre, and others who have been in a similar
situation, can help.
Coming Home
What should I be careful of when
visiting the new parents and baby? What can we do to prepare for bringing You can help prepare another child for the new baby by:
the baby home? • Introducing the idea that families often have more
• Please do not drop in • Bring your infant car seat to the hospital the day you than one child. Take your child to a playgroup. Make
unannounced. Call first. go home. Learn how to use it correctly before your friends with parents who have children the same age.
baby is born. The law requires that unless you come
• Do not visit if you are sick. home in a taxi, you must have your baby in an infant • Making changes in routines several months before
seat that meets the Canadian Motor Vehicle Safety the baby arrives, or by making them well after.
• Wash your hands before Standards. See page 131. Some examples are toilet training or moving from
touching the baby. a crib to a bed.
• Have diapers, blankets, clothes, and a safe, firm,
• Do not smoke in the house. sleeping space ready at home. • Reading books or watching videos with your child
about pregnancy and having a sibling.
• If you have a cold sore, • Ask friends and family to help with older children and
do not kiss the baby. things such as preparing meals. • Giving your child a chance to practise staying with
Don’t kiss anybody. family or friends while you give birth. Do this
• Plan time for rest. Think of this as your “nesting time” sometime before the event.
• Do not stay long. when you can focus on each other and your
new baby. How can we help an older child?
• When you come, bring • If your child goes back to baby-like behaviours,
something, such as fresh • Do not get a new pet when you are bringing wetting his pants, wanting the crib back, or
bran muffins or a meal. your baby home. wanting to breast or bottle feed, just relax. This
will not last long.
• Offer to help in whatever What can your partner do to support you?
way you can. • arrange time off from work • Give extra love and attention to your older child and
• be present tell her that you love her and the baby.
• plan to share in the care for your baby
• plan to take responsibility for making meals • Plan quiet feeding times with the new baby. Prepare
and housework a snack for your older child, listen to a favorite tape,
or read together while you feed your baby.
What about visitors?
You may have a few visitors or dozens who want to visit. • Give your child something to do to show that this is
This can disturb your sleep and rest time. Let visitors know his baby too. He can tell stories or sing to the baby, or
your visiting guidelines before your baby is born. That way, help to wash the baby. Mention how helpful he is.
their visits can be a positive part of your recovery.
• Make special time just for your older child each day.
What about older brothers and sisters?
Brothers and sisters will react differently to the new baby. • If you are still worried because nothing works with
Some may love the baby and others may be angry. Many your older child, call your public health nurse or
children will go back to acting like babies themselves for contact a local parent group.
a while.
Your Body After Pregnancy
Cramps Caution: use pads, not tampons, until any incision or

After birth, your uterus continues to contract. Cramps are vaginal tears are healed.
most noticeable in the first few days. They may be more
painful if you have had other children. Cramps are often felt Menstruation (Period)
most strongly while you breastfeed. They usually disappear Your period may not start as long as your baby’s only
after the first week. If they are severe, ask your health care source of food is breastfeeding. If you do not breastfeed,
practitioner about using something for pain. your period will usually return four to nine weeks after the
birth. You can become pregnant again before your period
Vaginal Discomfort and Care starts once more. If you do not want another pregnancy,
The area between your legs (perineum) may be sore, use some form of birth control.
bruised, and swollen. If you have stitches, you may
feel more pain. Urination (Peeing)
At first, it may be difficult to pee or tell when your bladder
To ease discomfort: is full. It is helpful to pee at regular times to prevent the
• Cool the area with crushed ice or tap water for bladder from becoming too full. You may also find it hard
short-term relief. Do not put ice directly on your skin. to start peeing, or it may sting. To help, you can pour warm
Place a towel or pad between the ice and the skin. water over your perineum or pee in the shower or bath.
• Clean your perineum by pouring warm water over You may have some leakage of urine for up to three months
your vaginal area or sitting in a warm bath. and sometimes longer after your baby is born. This is called
urinary incontinence. A cough, sneeze, laugh, or physical
• Use pain relievers as needed. activity can make this happen. Doing Kegel exercises can
help to control urine leakage. For most women, this
• Sit on a soft cushion to relieve pressure on your bottom. gradually goes away.
• Continue to do Kegel (pelvic floor) exercises. Bowel Movements

See page 46. After birth, your bowels are often sluggish. This is due to
stretched muscles, a sore perineum, and some pain
Vaginal Bleeding (Lochia or Flow) medications. Most mothers have a bowel movement
Following the baby’s birth there will be bleeding and within two to three days after birth.
discharge from the vagina. This flow will usually last from
two to six weeks. In the first two to three days, this flow is To make bowel movements easier:
dark red with small clots about the size of a loonie. It • drink plenty of fluids, especially water
should soak less than one maxi-pad in two hours and not • eat foods such as whole grains, bran, dried fruits
smell bad. Flow then lessens and becomes brownish to (especially prunes and figs), fresh fruits,
pinkish in colour, similar to bleeding during the last days vegetables, and juices
of a menstrual period. After the tenth day, the discharge • if the first suggestions do not work, try using stool
is yellowish white or brown. If your flow does not become softeners that can be bought at drug stores
less or smells bad, call your health care practitioner.
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TIM E BY HERSELF s C H RON IC OR SERIOUS H EALTH PROBLEM S OTH ERS C ONTAC T YOUR HEALTH C ARE PRAC TITIONER RIG H T
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s " E A FFE C T IO N A T E B U T W A IT U N T IL ( O W CA N ) T E LL IF ) M IG H T H A VE P O ST P A R T U M

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s HAVE A D EPRESSED M OOD
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s ARE SLEEPIN G TOO LITTLE OR TOO M UC H ARE STARTIN G FROM YOU ARE NOT ALON E 7 H ATEVER YOU ARE
s ' E T H E LP FR O M Y O U R H E A LT H C A R E s ARE PH YSIC ALLY OVERAC TIVE OR HAVE N O ENERG Y FEELIN G FEAR EX C ITEM EN T OR PAN IC OTHER PEOPLE H AVE FELT
PRAC TITION ERS AND LET THEM HELP s SW IN G FROM H UN G ER TO LOSS OF APPETITE TH E SAM E TH ING %X AM IN E YOUR FEELIN G S 0AREN THOOD IS A N EW
Y O U B O TH s FE E L V E R Y T IR E D AN D EX C ITIN G STATE IN YOUR LIFE ( ERE ARE A FEW FEELIN G S NEW
s FEEL M OSTLY SAD UN H APPY IRRITABLE OR G UILTY FATH ERS H AVE REPORTED
AN D H AVE LOTS OF C R YING SPELLS
s FEEL YOU ARE W ORTH LESS s - Y PARTNER IS SO IN VOLVED W ITH TH E BABY THAT TH ERE
s H A V E A H A R D T IM E C O N C E N T R A T IN G IS N O TIM E FOR US
s HAVE TH OUG H TS OF D EATH OR KILLIN G YOURSELF
T H A T K E E P C O M IN G B A C K s ) D ON T HAVE FRIEN D S W H O ARE PARENTS . ON E OF M Y OLD
FRIEN D S UN D ERSTAND W HAT ) M G OING THROUG H
"ECOM INGA0ARENT
• I’m scared of the baby. What if I drop her? My partner • Change your baby’s diaper, give him a bath, dress,
is much more at ease with changing, bathing, sing, dance, or just cuddle your baby. Always wash
handling, and playing with our baby than I am. your hands first.
I couldn’t believe how angry I could
• How will I be able to protect and provide for • Play with your baby as often as possible. It’s OK to become with this beautiful baby that
my new family? choose toys you like to play with too. I loved so much. Our daughter was
premature so needed a lot of care
• I used to feel immortal. Now I have to be here to • Remember not to leave your baby alone even for a every two to three hours, day and
look after my family. I had never thought about life second on a change table, counter, chair, or couch, night for the first five months. I was
insurance before. or in the bath. so sleep deprived I couldn’t drive the
car at times. I had to put her down
• I’m afraid of being replaced by the baby. My partner • Don’t leave your baby alone with your pet. almost every day and walk away just
loves the baby so much and only seems to let me be to keep my cool. I called on my
involved when she says it’s OK. • Get enough sleep, exercise, go for walks as a family, friends to take her for a walk in the
and eat healthy foods. afternoons just so I could sleep. Once
• This is a whole new role for me. I’m not sure I like I got enough rest, I coped so much
having to do more chores around the house. I • Listen to other parents. They have been through this. better.
want my partner and my old life back.
• Get involved with other dads — from your prenatal
• I’m so tired. Getting a whole night’s sleep is all I classes, work, or from a new parenting class.
want right now.
• Remember — all parents make mistakes.
• How can someone like me be a good Dad? I don’t
know what I’m doing. • Enjoy each phase of being a parent. It won’t come
around again with this child.
Here are some things you can do:
• Talk with your partner as often as possible about your • Plan to have time for activities other than parenting.
feelings, what you need, and how you can best be Do tag team parenting — let one parent be
involved in caring for your baby. “off” sometimes.
• Support your partner while she is breastfeeding. Bring • Talk with your partner about the best method of birth
her a glass of water, milk, or juice. control for both of you.
• Don’t worry about being scared of the baby. You are • Don’t expect your partner to be her old self in a week
not alone with this feeling. Always think safety first. or two — recovery from birth takes time.
Ask yourself what is the safest thing to do here?
By handling your baby, you will become more
comfortable. You probably didn’t feel comfortable Parenting Can Be Frustrating
the first time you drove a car either.
Bringing home a baby is not easy. Your family has changed,
• Lay your baby on your chest and relax together. your schedule will change, and you will be more tired than
Children need closeness with both parents. you have ever been in your life. This is normal!
Here are a few frustrations mothers have expressed: • I talked to my partner about what the baby and I
• I don’t feel as though I have the same body I had might need. He used to wait until I told him what
We were both getting frustrated before pregnancy. to do. Now he just does what needs to be done.
being in the house so much. The
baby would cry at times and I’d • I have never been so tired in my life. • We would talk about how we felt. We became
think, “What have we done? I want very good at being frank about our needs.
my old life back.” But then the good • I get so frustrated when the baby cries and I can’t
times are so great, I can’t imagine soothe her, and the crying seems endless. • We would plan to spend time together, just the two
not being a dad. It does all work out of us, at least once a week. Even if it was to just go
in the end but the first few months • I can’t do the same activities I did before having the baby. for a walk. We would ask a friend or family member
were tough. If I could give advice it to help out by watching the baby.
would be to take help when it’s • I was so tired, and there I was acting like a happy
offered and know when to just walk hostess to all these visitors who wanted to see the baby. • We found it really helped to talk to a group of new
away for a few minutes. parents. We got together with our prenatal group to
• Everyone has an opinion on how we should take swap stories and advice. It was reassuring to find out
care of our baby. that most of them felt the same way we did.
A few frustrations partners have expressed: • When we found things were getting too difficult
• I didn’t seem to have any time for myself. I was with the baby, we talked with the public health
either working or taking care of the baby. nurse. She told us about a parenting group that
was really helpful.
• I couldn’t seem to find a way to comfort him that
would make him stop crying.
Being a Single Parent
• I have never been so sleep starved in my life. I just
wanted one complete night’s rest. Being a single parent is common today. For some people,
family and friends are a good source of support. Others
• It seemed like we never left the house. may not have family and friends close by. If you don’t have
a partner, that does not mean you will be alone. There are
• I really miss having sex and my partner isn’t as people and programs to help you, and it is important to
close as she used to be. find them. To find these programs, contact your public
health nurse or social worker, or talk with your health
Hints on staying calm: care practitioner.
• Anytime I started to lose my temper I put the baby
down somewhere safe and left the room. Some of the places where parents meet are:
• parents and infant groups at the public health office
• I realized how much I needed my sleep. I got my • pregnancy outreach programs
family to help by taking the baby out for a walk • breastfeeding groups
every day so I had time to nap and catch up. • movie theatres for parents and babies
• local playgrounds
• I’d plan a nap for the late afternoon. That gave me • community centres
more strength to handle my baby’s nighttime needs. • family resource centres
• spiritual or religious groups
Doing the Paperwork
Call the Employment Standards
Leave from Work Changing Your Will information line for more information
on any provincial rules. Look in the
Two different kinds of leave from work are available for If either or both of you die, you want to be sure your child blue pages of your phone book for
parents: maternity leave and parental leave. is well taken care by someone you trust. Decide who will be the phone number. You can also visit
the best guardian to look after your child, then ask if they the Employment Standards Branch
• Maternity leave is available only to the birth mother. If will do it. After you get their consent, you can either make website, www.labour.gov.bc.ca/esb,
she’s been employed prior to the birth, she may qualify a will or change your current will. where you’ll find links to a number of
for Employment Insurance benefits during this time. fact sheets. One of these deals with
leaves.
• Parental leave is available to the birth mother and/or Registering the Birth
father. If they have been employed prior to the birth, For information on federal rules and
they may qualify for Employment Insurance benefits The birth registration creates a legal record of your baby’s Employment Insurance for maternity,
during this time. The birth mother usually takes birth and legal name. As soon as possible after the birth of parental or other leaves, call Human
parental leave right after her pregnancy leave is over. your baby (within 30 days), you must fill out the Resources Development Canada.
Adoptive parents also qualify for parental leave. Registration of Live Birth form. Send this form to any Vital Check the blue pages of your
Statistics office or Government Agent’s office. There is no phone book for the Government of
Under the British Columbia Employment Standards Act, cost if you do this within 30 days of your baby’s birth. Canada section and look under
employees are entitled to a leave of absence from work, Normally, both parents sign the registration form. If the “Employment.” You can also visit
without pay, so they can spend time with a new child. A father does not sign it, none of his personal information their website at: www.hrdc.gc.ca
birth mother is entitled to up to 17 consecutive weeks of can be registered or printed on the baby’s birth certificate. /en/ei/types/special.shtml.
unpaid maternity leave. This leave period may be extended
by up to six consecutive weeks if an employee is unable to The Registration of Live Birth form is available from: • Talk to your employer about any
return to work for reasons related to the birth. An employer • the hospital where you give birth other benefits your place of
may require an employee to provide a doctor’s certificate in • your midwife, if you give birth at home work may have.
support of a request for leave or a leave extension. The Act • any Vital Statistics office
also provides for parental leave of 35 weeks for birth • the government website: www.vs.gov.bc.ca/forms
mothers and 37 weeks for fathers and adopting parents. • Your employer must keep your
If you need help filling out your form, contact your local job or a similar position while
Please note: This is for general information only. It is not a Vital Statistics Office. The number can be found in the blue you are on maternity or
legal document. Please refer to the Employment Standards pages of your local phone book. parental leave.
Act and Regulation for purposes of interpretation and
application of the law. Getting a Birth Certificate
A birth certificate is used for official identification and as • Your benefits, such as medical
proof of a person’s legal name, date, and place of birth. It is coverage, will continue during
an important document to have. To get a birth certificate, your unpaid leave if you keep
you can fill out the order form on the back of the Registration paying your share of the
of Live Birth form. Another option is to fill out an Application premium cost.
for Service form from the Vital Statistics Agency. You can also
print a form from the government website listed in Resources
at the back of the book. There is a fee for a birth certificate.
Choosing a Name Arranging for Medical Coverage
Yes, you can choose any name you like for your baby. Your To get medical coverage, you must fill out the Medical
baby must have a first name (given name) and a last name Services Plan (MSP) Baby Registration form. This form should
(surname). You can give your baby one or more middle be filled out and sent within 60 days of your baby’s birth.
names if you wish. The baby’s surname can be different It is available at the hospital or from your midwife.
from the mother or father’s surname. The baby’s surname
can be two surnames, hyphenated or combined together. If you pay your own premiums, or if the premiums are paid
by Health Canada, send the form to the MSP address on
the form. If your premiums are to be paid by the Ministry
Arranging for Tax Benefits of Human Resources, take the form to your social worker.
If premiums are paid through your place of work or union
After your baby’s birth, you can apply for the following two welfare plan, take the form to your group administration
benefits, and register your child for the Goods Services for authorization.
Tax/Harmonized Sales Tax (GST/HST) credit, using a single
application form: A British Columbia CareCard for your baby will be sent to
• The Canada Child Tax Benefit. (This includes both you six to eight weeks after the MSP office receives the
the Child Tax Benefit and the National Child completed form. In the first 60 days after birth, your baby
Benefit Supplement.) will get medical care using your medical number.
• BC Family Benefits. (This includes both the Family Arranging for Drug Coverage
Bonus and Earned Income Benefit.) Fair PharmaCare Coverage gives financial help with
prescription drugs costs. To register for Fair PharmaCare
The form to complete is called the Canada Child Tax Benefit financial help you must have:
application. It is a separate form from the Registration of Live • lived in British Columbia for at least three months
Birth. It is often available at the hospital or from your • medical services coverage with the Medical Services
midwife. If you do not receive this form, call Canada Child Plan of British Columbia
Tax Benefit (toll-free: 1-800-387-1193) or look under “Child • sent in an income tax return for the right taxation year
and Family Benefits” in the blue pages of your telephone
book. You can also visit www.cra.gc.ca online. If you are already registered, your baby will automatically
be registered. If you need information or wish to register,
phone the PharmaCare Program. Look in the Provincial
section of the phone book blue pages or visit the website
at https://pharmacare.moh.hnet.bc.ca.
PharmaCare offers a voluntary Monthly Deductible Payment

Option. This is for families with annual incomes over
$15,000 who do not have third party insurance benefits
through work. It is to help people who think they will have
high drug costs. For more information, contact the Fair
PharmaCare Registration toll-free at 1-800-387-4977.
Next Steps
I’m glad we had been together
Babysitters for a few years before our baby was
born. After Jacob came into our lives
You may decide to leave your baby with family or friends • Show your babysitter where things are kept. we would pass by each other like
for short periods of time in the first months after your baby zombies. Sex didn’t happen for quite
is born. You should know and feel comfortable with the • Reinforce that to warm breast milk or formula, the awhile even before the birth and
person you choose to leave your baby with — even if it’s bottle should be set in a container of warm tap water. then after, I was just too tired from
just for a few minutes. Check to see if the sitter has taken Milk for your baby should never be warmed on the being awake at night. We had to
a recognized babysitter course. stove or in a microwave. A microwave will heat the consciously make time for us as a
breast milk (or formula) unevenly and can burn your couple so we could reconnect.
• Have her hold and play with your baby and watch baby’s mouth.
how they act together.
To make the babysitter’s job easier, and to make you feel
• Ask her how she would deal with a crying/fussy baby. more confident about leaving your baby, be sure to leave
this information:
• Watch as she feeds and diapers your baby. • Where you are going, when you expect to return, Write down all the emergency
and how you can be reached. information listed on this page to
Be clear about your expectations regarding care of your leave close to your telephone for
baby. Things you might mention: • Insist that if there are any problems, she should call your babysitter.
• never leave your baby unattended on a change table, you home early. Remind her she must never shake
couch, or sofa or hit your baby.
• how often you expect your baby to be checked
when sleeping • Keep these emergency telephone numbers close
• it is never OK to hit or shake your baby to the phone:
• fire
Pay attention to how you feel about the potential • police
babysitter. Do you feel secure and confident? Or tense, • poison information
worried, and ill at ease? Remember — the goal of leaving • doctor
your baby with a sitter is for you to have time to relax. • hospital (pediatric emergency number)
• helpful neighbour (name and number)
When the babysitter arrives: • closest relative
• Allow time for her to play with your baby (if awake) • taxi
before you leave.
• Some personal information may be needed in an
• Stress that the baby be placed on his back emergency, so leave the following close to the
for sleeping. phone as well:
• baby’s and your last name(s)
• Review with her your expectations regarding care • home phone number
and attention to your baby. See above. • home address
Family Planning
Once your pregnancy is over and you have given birth to Is breastfeeding an effective birth control method?
What should we ask ourselves when your baby, you and your partner will have to think about Although there are no absolute guarantees, breastfeeding
choosing birth control methods? birth control methods. As soon as you start having sex, may be effective birth control if all the following apply
it is possible to get pregnant. to you:
• How effective is it? • your baby is under six months old, and
Which methods of birth control are NOT reliable and • your baby is exclusively breastfed day and night, and
• Will the method affect NOT recommended? • your baby is not given a bottle or soother, and
breastfeeding? • withdrawing the penis before ejaculation • you have not started your period
(73 – 96% effective)
• How easy is it to use? • douching or rinsing the vagina with a water-based However, as soon as your baby is sleeping longer at night
or spermicide-containing solution after intercourse or having other foods or fluids, breastfeeding is less likely
• How much does it cost? to work as a birth control method.
• How do we feel about Single Use Birth Control Methods

the method?
Type Advantages Disadvantages
• Will we be protected
against STIs? Male Condom (85 – 98% effective) • does not require a prescription • condoms can fail by falling off
A latex sheath rolled onto the erect penis • protects against most STIs or breaking
Need more information? Talk with before any contact with the vagina, • safe while breastfeeding • some men and women are allergic
your health care practitioner or call carefully taken off the penis after ejaculation to the latex and/or the lubricant
the Options for Sexual Health Facts to prevent spillage, and then discarded.
of Life Line, the BC NurseLine, or see It is recommended to use with water-based
the BC HealthGuide handbook. See lubrication.
the Resources section at the back of
the book for contact information. Female Condom (79 – 95% effective) • protects against most STIs • can be difficult to insert
A polyurethane sheath inserted to cover the • safe while breastfeeding • can be noisy during sex
wall of the vagina during intercourse. • can be expensive
May need to use water-based lubricant.
Diaphragm with spermicidal cream or jelly • has long life with proper care • must be inserted properly before
(84 – 94% effective) • can be inserted up to 6 hours intercourse
Cervical Cap (80 – 90% effective) before intercourse • some risk of allergic reactions to
Rubber cup-like barriers inserted into the • safe while breastfeeding rubber or spermicide
vagina to cover the entrance to the uterus. • more risk of bladder infections
Must be fitted by a doctor. They must be used • cannot be used during menstruation
with a spermicide and left in at least 6 to 8 • must be refitted after pregnancy
hours after intercourse. Need to carefully clean or weight changes
with soap and warm water when removed, • no protection against STIs
and inspected for holes. The woman must
learn how to insert them correctly.
Spermicides (71 – 82% effective if used alone) • does not require a prescription • can create sensitivity or allergic
Creams, gels, foams, vaginal film, or vaginal • adds extra lubrication reactions
suppositories that destroy sperm. These must • use as a backup to other methods • no protection from STIs
be inserted high into the vagina 15 to 20 • safe while breastfeeding (can actually increase risk)
minutes before intercourse. They only work for
about one hour. If you choose to douche after
using a spermicide with intercourse, wait six
hours before you do.
Contraceptive sponges (72 – 95% effective) • does not require a prescription • can create sensitivity or
A sponge treated with spermicide that is placed • use as backup to other methods allergic reactions
over the cervix. Sometimes used with a condom, • safe while breastfeeding • no protection from STIs
diaphragm, or cervical cap. Must be left in place
for 6 to 8 hours and works for 24 hours.
Long-term Birth Control Methods
Intra-uterine Contraception Device (IUD) • can be left in place for • may cause more painful
(99% effective) 2 1/2 to 5 years or heavier periods
A small, flexible piece of plastic (with copper • removed whenever necessary • no protection from STIs
wire or progestin) inserted into the uterus by • progestin IUDs may make • may cause increased risk of
a doctor. A small string hangs through the periods lighter pelvic inflammatory disease
cervix allowing the woman to check that it • safe while breastfeeding if an STI is contracted
is in position.
Oral Contraceptive Pills (92 – 99% effective) • easy to use • may have hormonally-related
The “pill” is usually a combination of the • may regulate periods side effects (minor weight gain,
hormones estrogen and progestin, and • may lower the risk of some headaches, nausea, etc.)
prevents ovulation. Pills are prescribed by types of cancers (ovarian, • women who smoke and are older than
doctors and must be taken on a regular endometrial, etc.) 35 years should not take the pill as it
daily schedule. increases their risk of heart disease
• women with some medical conditions
may not be able to use the pill
• some prescription medicines and some
natural supplements may stop the pill
from working; discuss with your doctor
• no protection from STIs
• may lower breast milk supply and
should be used with caution if
breastfeeding is not well established
Transdermal Patch (92 – 99% effective) • easy to use • less than 3% of patches become
The patch works the same way as the birth • may regulate periods unstuck, but may remain effective
control pill but is worn on the skin and if replaced within 24 hours
replaced once a week. • need to check every day that it’s on
• some women may have side effects
• no protection from STIs
• not recommended for women
who are breastfeeding
Depo-Provera® (97 – 99% effective) • easy to use • some side effects (irregular periods,
A hormonal contraception given as an • may cause lighter periods depression, weight gains, etc.)
injection by a doctor every 11 to 13 or may stop them • return to fertility may take 1 – 2 years
weeks. It prevents ovulation. • no estrogen-related side effects • no protection from STIs
• not affected by antibiotic use • mothers must have more calcium and
• can be used when breastfeeding vitamin D while on Depo-Provera®
• can start 6 weeks after your
baby's birth The use of Depo-Provera® is linked with
the loss of bone mineral density. This
could lead to osteoporosis and related
bone fractures in later life. A review of a
woman’s risks and benefits of using this
method of birth control need to be
discussed with a health care practitioner.
NuvaRing® (92% effective) • a good method to use if you do • may not be suitable for women who
A contraception device that you insert in your not want to take a pill every day are uncomfortable with touching
vagina for three weeks per month. It releases their genitalia
hormones and needs to be changed monthly. • some partners may be able to feel
the ring during intercourse, but it is
recommended you do not remove
the NuvaRing® for sexual intercourse
• may lower breast milk supply and
should be used with caution if
breastfeeding is not well established
• may have hormone-related side
effects (minor weight gain,
headaches, etc.)
Permanent Birth Control Methods
Sterilization: Vasectomy (male) • no fears of pregnancy • slight chance of complications

Tubal Occlusion (female) (99.9% effective) • both covered by the from surgery
The tubes carrying sperm from the testes in BC Medical Services Plan • permanent; reversals rarely work
men or the eggs from the ovaries in women • safe while breastfeeding • no protection from STIs
are surgically cut or plugged. Males must
have follow-up visits to determine when
sperm production has ceased. Both can be
done on an outpatient basis. Tubal occlusion
can be done during a caesarean birth.
Fertility Awareness Techniques (75 – 98% • inexpensive • the woman must have a regular cycle
effective depending on what method you use) • teaches about fertility patterns • may not work during breastfeeding
Involves accurately predicting the menstrual • safe while breastfeeding as menses is changing
cycle to determine when a woman is fertile • requires careful monitoring of the
and when sex should be avoided or other woman’s cycle and avoiding sex
protection used. Special training from a or using extra protection
qualified fertility counsellor is needed to • no protection from STIs
use this method effectively.
Emergency Birth Control
Emergency Contraceptive Pill • provides a second chance • may cause nausea and vomiting
(Progestin-only emergency contraceptive such to prevent an unplanned • may disrupt your period
as Plan B® is 89% effective if used within 72 pregnancy in case another • no protection from STIs
hours of unprotected intercourse. Combined method fails
hormonal emergency contraceptive such as • a single dose of the pill will
Ovral® is 75% effective.) not likely affect breastfeeding
The Emergency Contraceptive Pill can be taken
up to 120 hours — or 5 days — after
unprotected intercourse. However, the sooner
you take it, the more effective it will be. Used
as an emergency option after unprotected sex
or after a failed birth control method.
Prescribed by a doctor or may be issued by a
pharmacist and at some public health offices.
Notes
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96
9O U R " A B Y
4 H IS SEC TION OF TH E BOOK W ILL H ELP YOU LEARN ABOUT YOUR BABY )T G IVES YOU LOTS OF INFORM ATION ON H OW YOUR BABY G ROW S
H OW TO BREASTFEED AN D H ELPFUL H IN TS ON C ARIN G FOR YOUR BABY 9OU M AY H AVE REC EIVED THIS BOOK AFTER YOUR BABY W AS BORN
- AYBE YOU G OT IT W H EN YOUR AD OPTIVE BABY JOIN ED YOUR FAM ILY " E ASSURED TH AT IF ANY OF TH E TH IN G S REC OM M END ED EARLIER
IN TH E BOOK D ID N OT H APPEN YOU C AN STILL M AKE A D IFFERENC E 9OUR BABYS BRAIN AN D BOD Y G ROW TH H APPEN IN TH E W OM B
BUT TH E G ROW TH ESPEC IALLY OF TH E BRAIN C ON TIN UES IN TH E FIRST TW O OR M ORE YEARS 9OU AS A PAREN T AN D YOUR FAM ILY C AN
M AKE AN IM PORTAN T D IFFEREN C E IN YOUR BABYS D EVELOPM EN T
9OUR " A BY
Breastfeeding Your Baby
Health Canada, The World Health Breastfeeding is the normal way to feed your baby. Breast • Feed your baby frequently — 8 or more times a day.
Organization, UNICEF, and many milk provides all the nutrition your baby needs. It has
other national and international hundreds of antibodies, enzymes, and other factors that will • After your baby’s first breastfeeding, she may sleep
organizations recommend that no protect your baby from infections and disease. Breast milk is for a few hours so may not feed 8 times.
other foods besides breast milk be always at the right temperature, easy to provide, always
given to your baby until she is six handy, changes as your baby grows, and is free. Babies who • In their second 24 hours, babies wake up a lot to
months old. They also recommend are breastfed have better mental development and feed — 8 or more times a day and, in the beginning,
that you continue to breastfeed emotional security. They score higher on developmental very often during the night.
after you start giving your baby and cognitive (IQ) tests. They also have better jaw and
solid foods at six months. It is tooth development and improved immune systems. • Look for signs that your baby is ready to nurse.
recommended that you breastfeed These are called feeding cues. Feeding cues may
for two years or longer. Why is it important to breastfeed my baby? include bringing her hands to her mouth, rooting
Babies who are breastfed have lower rates of: (moves her head as if she is looking for your nipple),
• Sudden Infant Death Syndrome (SIDS) mouth opening, lip licking, sucking, clenching fingers
• obesity and fists over chest and tummy, bending arms and
• Type I diabetes legs, or fussiness. Crying is a late cue — this means
• childhood cancers, including leukemia and lymphoma you have not noticed the other feeding cues.
• pneumonia and other respiratory infections
• coughs and colds • When your baby is full, she may fall away from your
• gastrointestinal infections breast, decrease sucking, extend her arms and legs,
• vomiting, diarrhea, constipation straighten her arms along her sides, relax her fingers,
• urinary tract infections or fall asleep.
• ear infections that can damage hearing
• meningitis • In the first three to four days after birth, your baby
• Crohn’s disease, ulcerative colitis may lose some weight. This is normal.
• Celiac disease
• asthma, allergies, and eczema • Give your baby only your breast milk. The small
• heart disease and liver disease in adulthood amount of colostrum (first milk) your baby gets in
the first two to three days is perfect until the
What are the benefits for the mother? amount of your milk increases.
• a faster return to pre-pregnancy weight
• stronger bones in later life • You can hand express drops of colostrum to
• lower rates of breast and ovarian cancer give your baby.
How can we get a good start? • Be sure you are in a comfortable position to nurse and
• It is important to put your baby on your bare chest, get your baby on your breast well — a good latch.
especially in the first few days after birth. This is
called skin-to-skin. • Support your breast with your free hand. You can
usually let go of the breast once your baby is latched
• Offer your breast soon after birth. Most babies will show on and sucking.
readiness to feed in the first 30 to 60 minutes after birth.
98 Yo u r B a b y
s 3UPPORT YOUR BREAST W ITH YOUR FREE H AN D 9OU C AN # O M F O R T A B LE 0 O SIT IO N S
USUALLY LET G O OF TH E BREAST ON C E YOUR BABY IS LATC H ED
ON AN D SUC KIN G 4 HE POSITION YOU USE ISN T IM PORTAN T AS LON G AS BOTH YOU
A N D Y O U R B A B Y A R E C O M FO R T A B LE R E LA X E D A N D Y O U R B A B Y - O R E FEED IN G M O R E M ILK
s # ALL YOUR PUBLIC HEALTH N URSE OR TH E " # . URSE,INE AT IS ABLE TO LATC H ON TO TH E BREAST 9OU M AY FIN D TH AT TH E )N OTHER W ORD S THE M ORE YOU FEED
IF YOU N EED EX TRA SUPPORT TO KEEP M OD IFIED C RAD LE OR FOOTBALL H OLD IS EASIEST TO USE UN TIL YOUR BABY THE M ORE M ILK YOU W ILL
G OIN G OR IF YOU H AVE Q UESTION S )TS W ORTH IT FOR YOU Y O U A N D Y O U R B A B Y LE A R N H O W T O LA T C H O N W E LL M A K E A S L O N G A S Y O U R B A B Y I S
AN D YOUR BABY FE E D IN G W E LL
&OOTBA LL HOLD
- ODIFIED CRA DLE POSITION
3IDE LYING # RA DLE POSITION
9OUR " A BY
, A T CH IN G / N
,EARN IN G TO BREASTFEED C AN TAKE TIM E # ORREC TLY LATC H IN G YOUR BABY ON TO TH E BREAST IS AN
C O M M IT M E N T A N D C O N C E N T R A T IO N ) N IM PORTANT STEP IN SUC C ESSFUL BREASTFEED IN G ! POOR LATC H
THE LON G RUN IT IS THE M OST REW ARD ING M AY C AUSE SORE NIPPLES A H UN G R Y BABY AN D A SM ALLER M ILK
E X P E R IE N C E A M O T H E R A N D B A B Y C A N SUPPLY )F YOU FEEL PAIN W H EN YOUR BABY IS ON TH E BREAST
SH ARE 5 SE THE C OM M UN ITY BREAST N OT A PASSIN G D ISC OM FORT A POOR LATC H M AY BE TH E
FEED IN G C LINIC IF YOU H AVE C ONC ERN S OR PROBLEM ' EN TLY REM OVE YOUR BABY FROM TH E BREAST AN D
P R O B L E M S 3 U R R O U N D Y O U R SE L F W I T H START AG AIN 4O TAKE YOUR BABY OFF YOUR BREAST AN D BREAK
OTH ER BREASTFEED ING M OM S W H O C AN TH E SUC TION FROM H ER SUC KIN G G EN TLY PLAC E A FIN G ER IN
G IVE SUPPORT AN D SHARE HELPFUL TIPS TH E C ORN ER OF YOUR BABYS M OUTH
( O W CA N ) G E T A G O O D LA T CH
s 5 N W RAP YOUR BABY " LAN KETS M AKE IT H ARD FOR BABY
TO BE C LOSE EN OUG H TO LATC H W ELL
s 4URN YOUR BABYgS W H OLE BOD Y TO FAC E YOU TUM M Y TO

TU M M Y
s 3UPPORT YOUR BREAST BUT KEEP YOUR FIN G ERS W ELL BAC K
FR O M T H E A R E O LA B R O W N P A R T
s !IM YOUR N IPPLE H IG H IN YOUR BABYS M OUTH
s 4OUC H TH E BABYS LIPS W ITH YOUR BREAST TO H ELP H ER "A BY IS WELL LA TCHED ONTO THE BREA ST
T O O P E N H E R M O U T H W ID E
s 7 H ILE SUC KING YOUR BABY M AY SUC K Q UIC KLY THEN M ORE
s 7AIT UNTIL YOUR BABY OPENS HER M OUTH W IDE SLOW LY W ITH SH ORT REST PAUSES 9OU M AY BE ABLE TO H EAR
LIKE A YAW N TH E BABY SW ALLOW IN G ,ISTEN FOR A h C Av SOUND 9OU W ILL
H EAR TH IS M ORE EASILY W HEN YOUR M ILK INC REASES
s " RIN G YOUR BABY IN C LOSE TO YOU
s 3OM ETIM ES YOU M AY H EAR YOUR BABY G ULPING ESPEC IALLY
s 0UT YOUR H AN D ON H ER SH OULD ERS N OT H ER H EAD IF YOU H AVE LOTS OF M ILK
7 H E N IS M Y B A B Y W E LL LA T CH E D s # LIC KIN G OR SM AC KIN G SOUND S M AY M EAN TH AT YOUR BABY
s 4 H E IN ITIAL LATC H M AY H URT BUT YOU SHOULD N T FEEL PAIN IS N OT LATC H ED C ORREC TLY
IN TH E N IPPLE AREA 9OU M AY FEEL A TUG
s 9OUR NIPPLE LOOKS ROUNDED N OT FLATTENED W HEN YOUR
s 9OUR BABYS C H IN IS TOUC H IN G YOUR BREAST AN D HER NOSE BABY C OM ES OFF YOUR BREAST
IS SLIG H TLY AW AY FROM TH E BREAST
s 4 HE NIPPLE DOES NOT HAVE ANY CRACKS BLISTERS OR BLEEDING
s 9OUR BABY BEG INS TO SUC K ( ER C HEEKS W ILL BE FULL AN D
ROUN D ED )F TH ERE ARE D IM PLES IN TH E C H EEKS TH E BABY s 9OU C AN T EASILY SLID E HER OFF TH E BREAST
M AY N OT BE LATC H ED W ELL
9OUR " A BY

The Let-down Reflex How Much and How Long?
Let-down happens as milk is released into milk ducts in your How often and how long should I feed my baby? After reading all about the benefits of
breast. This usually happens when your baby sucks on your • Healthy babies, when fed according to their feeding cues, breastfeeding I was excited to get
breast. You may even have a let-down when your baby or will take what they need. Let your baby be your guide. started. But after a couple days of
someone else’s baby cries, or for no reason at all. Some nursing I started to get discouraged.
women don’t feel the let-down. Others may feel a pins and • Keep in mind that your baby’s stomach at birth is very The process of engorgement left my
needles or tingling sensation. Others will have a very strong small, which means that she will want to be fed often. breasts swollen and very sore, not to
sensation or discomfort. Other signs of let-down include mention the pain in my nipples. I felt
leaking milk from the opposite breast, cramping, increased • In the early days, breastfeed from both breasts to like giving up. However, after a
vaginal flow, increased thirst, and relaxation. help make your milk supply. Later your baby may couple of weeks it got much easier
still feed from both breasts, or may be satisfied and I actually began to enjoy the
Can I have a let-down if I’m not feeding my baby? after one. special time spent with my baby. The
Yes. If you find you are soaking your shirts with milk at discomfort and short-term pain were
inconvenient times: • Feed on the first breast until the baby falls away from long forgotten, as I knew I was doing
• Wear one or more breast pads as needed. your breast. This usually tells you that your baby has the best for my baby.
Change these pads to keep the skin dry. had enough milk. Don’t rush though — your baby
may be just resting and not yet finished.
• Wear dark patterned clothes to hide the milk spilled
on your tops. • Your breast should feel soft. It’s important to empty
the breast well.
• Cross your arms and press the palm of your hand
on the nipple area when you feel the let-down • After burping, offer the other breast. From 2 weeks to about 3 months,
happening. This will help to hold back the milk. babies should gain about 180 – 240
• If still hungry, your baby will latch on, suck, and swallow. grams (6 – 8 ounces) per week.
What if my let-down is slow?
Make sure you are comfortable when breastfeeding. If you • Begin the next feeding on the breast you didn’t use at From about 3 to 6 months, babies
are embarrassed or anxious about breastfeeding, it may the last feeding, or the one you finished last. should gain about 90 – 180 grams
take a little longer for the milk to flow well. (3 – 6 ounces) per week.
• Some babies feed very often at first — as much as
• Find a private, quiet place if you are uncomfortable. every one to two hours, from the start of one feed to
the start of the next — and then go for longer periods
• Sit or lie comfortably. between feedings. This cluster feeding is normal.
• Have a drink handy (non-alcoholic). • It is normal to feed eight or more times in 24 hours.
This will usually decrease once breastfeeding is well
• Massage your breasts or apply a warm face cloth established. When babies go through a growth spurt,
to the breast before feeding. they may want to nurse more often for a couple of
days to increase the milk supply.
If you have followed these tips and still have a problem with
let-down, talk with your public health nurse, midwife, or a • There is no set amount of time for how long your
lactation consultant — a person with extra knowledge to baby should feed at your breast. In the early days it
help breastfeeding mothers and babies. may seem as though it takes a very long time to feed
your baby.
Yo u r B a b y 101
• Ask for help if you are having difficulty or feedings take How can I tell that my baby is getting
longer than an hour. Call your public health nurse, enough milk in the first weeks?
We both felt that breastfeeding midwife, or community or hospital breastfeeding clinic. • Your baby is feeding eight or more times a day
would be the best thing to do after the first 24 hours.
for our baby. I got involved by bring- • After your milk supply is well established, the feedings
ing my wife a glass of water every will be shorter. • You see your baby sucking and swallowing.
time she sat down to nurse the baby. You will hear a “ca” sound during the feeding.
We ate well, exercised, didn’t drink
and generally were the most healthy • In the first three days of life, your baby has 1 to 2
Baby's Age Baby's Stomach Size
we’ve ever been during those two wet diapers per day. By days four to six, as your milk
years. She would express milk some- supply increases, your baby should have 5 or more
times so she could go out for a break wet diapers a day. His urine should be pale yellow.
1–2 days Size of a cooked
and I would take over and do the
chick pea or a hazelnut
feeding. I really liked the closeness at • Your baby has 2 to 3 or more bowel movements a day.
those times. After the first four to six weeks it is common for bowel
movements to be less often. They may come once
every few days. As long as the bowel movement is
loose and the baby has wet diapers, this is normal.
3–7 days Size of a cherry
or a teaspoon
• Your baby is satisfied and content after most feedings.
• Your baby has returned to his birth weight by about

Your baby needs to nurse often. two weeks.
Even though she only drinks 10 to
2–5 weeks Size of a walnut
100 ml (1 tablespoon to 1/2 cup) per • Your breasts are full before the feedings and softer
or a tablespoon
day in the first few days, nursing will after. After several weeks, it is normal to have soft
help increase the milk supply for your breasts all the time and still have lots of milk.
baby as she needs it.
If you are worried that your baby isn’t getting enough milk,
remember that the size of your baby’s stomach is very small.
(Adapted with permission by the Best Start Resource Centre.)
Call your health care practitioner, the BC NurseLine, or Dial-A-Dietitian right away if your baby:
• does not have 1– 2 wet diapers in the first 3 days
• does not have 5 very wet diapers each day after 4 – 6 days of age
• does not have at least 2 – 3 bowel movements a day after 4 days of age
• is not interested in feeding and often goes without feeding for 4 – 5 hours in the first few week
See the Resources section for contact numbers.
102 Yo u r B a b y
Is it OK to use a soother? Positions to try:
Soothers should not be given in the first six to eight weeks Sitting
when a baby is learning to breastfeed. You should not use • sit your baby sideways on your lap
a soother if your baby has any problems with feeding or • cup your thumb and first finger under her chin Sucking is important for feeding,
you have low milk production. If your baby uses a soother, to support her head and use the rest of your comfort, stress release, and pleasure
he may feed less often at the breast, which will decrease hand to support her chest for babies. Your baby may suck on
milk production. Full term babies should not be given • support her back with your other hand her hand, fingers, or thumb.
soothers. If you choose to use a soother, wait until • gently rock your baby back and forth and lightly
breastfeeding is well established. rub or pat her back until you hear a burp
Breastfeeding babies rarely need soothers as their need to suck On the shoulder
for comfort, stress release, and pleasure can easily be met by • hold your baby upright with her head peeking
breastfeeding. A soother is one way to comfort a baby but over your shoulder
other choices include breastfeeding, holding your baby, or • support her head and back with your hand
letting her suck on your finger. Many people think soother use • gently rub or pat her back until you hear a burp
prevents thumb sucking. This is not true. Babies normally suck
on their fingers and thumbs. If you choose to use a soother, On the lap
also remember to hold your baby a lot. • lay your baby on her tummy on your lap
• gently rub or pat her back until you hear a burp
What about spitting up?
Spitting up small amounts after a meal is very common in
the first few months of life and is not the same as vomiting.
Spitting up usually stops as your baby grows. Spitting up is Taking Care of Yourself
not a concern as long as your baby is healthy, happy, and
gaining weight well. Nutrition
• When breastfeeding, follow Canada’s Food Guide to
What about hiccups? Healthy Eating for breastfeeding and pregnant women.
Many babies have frequent hiccups, which can be quite loud. Drink lots of water to satisfy your thirst.
Baby’s hiccups often bother the parents more than they seem
to bother the baby. Hiccups go away by themselves. • Whenever you are breastfeeding, have a glass of
water, milk, soup, or juice within reach.
How do I burp my baby?
Burping between feedings may help bring up air bubbles • You may continue to take a multivitamin if
and prevent some spitting up. To burp your baby, gently you choose.
rub or pat her on the back. Thumping your baby on the
back can make her spit up all the milk that was just taken. Rest
Sometimes just sitting your baby upright works. • You will be up during the night to feed your baby so
rest whenever possible.
When your baby has finished nursing from one breast, try
burping her. You will soon find out which position works • Breastfeeding takes time. Don’t take on too many
best. If your baby doesn’t burp after a minute or two and activities and responsibilities other than caring
seems content, she probably does not need to burp. for your baby.
Yo u r B a b y 103
Alcohol and Street Drugs • Be sure your bra fits well.
Alcohol may affect your baby’s sleep or decrease the
amount of milk your baby takes at feeding time. It’s best • If your bra leaves a mark on your breast tissue, it is too
not to drink at all while breastfeeding. However, if you tight. A good estimate is to buy a bra two sizes larger
choose to have a drink, feed your baby first. Since breast than you normally wear.
milk is so good for your baby, you do not need to stop
breastfeeding if you have a drink. Alcohol is not trapped • If the nipple is too sore to breastfeed, express or
in breast milk. It is continually circulated into and out of pump your milk.
breast milk.
Most mothers have sore nipples in the first week. However,
If you are taking street drugs or drinking alcohol in large if your nipples are damaged — cracked, bleeding, scabbed
amounts, do not breastfeed. These substances pass through or blistered — talk with your public health nurse, midwife,
your breast milk and can affect your baby. Talk with your or lactation consultant about your baby’s latch. It may help
doctor, pharmacist, health care practitioner, public health to nurse on the least sore side first.
nurse, or the BC NurseLine, at 1-866-215- 4700, about
getting help. The Motherisk Alcohol and Substance Use What should I do if I have full, heavy, painful breasts
Helpline can be reached at 1- 877-327- 4636. (engorgement)?
This usually occurs after your milk increases between the
The Alcohol and Drug Information Referral Service has third or fourth day. It may also happen if you miss a
information regarding drug and alcohol programs. feeding. The nipples are often flattened against a swollen,
Call them toll-free at 1- 800-663-1441. sore breast. This condition usually doesn’t last long and
can be avoided by feeding early and frequently.
Being Healthy
If you get sick with the cold or flu, you should continue To help:
to breastfeed. • Feed your baby at least every two to three hours.
Night-time feedings are important.
Before taking any prescription or non-prescription
medications — including natural health products — speak • Before feeding, take a shower or place warm wet
with your doctor or pharmacist. Some medications will pass washcloths on your breasts. Massage your breasts as well.
into the breast milk. While some are safe, others are not.
Check to be sure that all your medications are safe to take • Soften the nipple area by expressing a small amount of
while breastfeeding. milk before feeding in order to help the baby latch on.
Keeping Breasts Healthy • Position and latch your baby correctly.

• Wash your hands before handling your breasts.
• Express some milk from your breasts if they are still full
• Express a bit of milk onto your nipples and allow them and painful after feeding your baby. Make sure both
to air dry after each feeding. breasts are well drained at least once a day.
• If you wear nursing pads, change them as soon • Apply ice packs or a bag of frozen peas to your breasts
as they are wet. after feedings. Place a cloth between you and the
ice pack.
104 Yo u r B a b y
• Chilled, washed, and dried raw cabbage leaves can also Mastitis
be placed on your breasts or inside your bra for comfort. If you develop a fever greater than 38˚C, feel as though you
are getting the flu, or your breast is red and sore, you may
• Get as much rest as possible and drink water, milk, have mastitis. Continue to breastfeed. Mastitis is an infection
or juice when you are thirsty. of the breast tissue and/or milk ducts. It may come on
suddenly and make you feel sick with chills and aches.
What causes a red sore area in a breast? The breast may feel firm, swollen, hot, and painful and may
This may be a plugged duct. This can occur when a duct is appear red or have red streaking. If you think you have
not fully emptied often enough. Pressure builds up behind mastitis, contact your health care practitioner or the BC
the duct and can cause soreness in the surrounding area. NurseLine (1-866- 215-4700) immediately.
Plugged ducts can become infected. With continued
nursing, plugged ducts usually clear up in 24 to 48 hours. Mastitis can be treated with frequent feedings, antibiotics,
and pain relievers. Rest is extremely important in treating
To relieve plugged ducts: mastitis. Keep the breast well emptied by breastfeeding and
• Breastfeed every two to three hours. Sucking will expressing milk frequently if necessary. Your baby will not
help relieve the plugged duct. get sick from this infection.
• Before feeding, take a shower or place warm, Thrush

wet washcloths on your breasts. If you have red, itching, persistent sore nipples, burning or
shooting pain in the breast during and after feeding, or
• Massage your breast before the feeding. During cracked nipples that don’t heal, you may have thrush or a
feeding, firmly massage the breast from behind yeast infection. Both the mother and the baby may show
the lumpy area towards the nipple area to help signs of infection, or just one may show signs.
the milk come out of the breast.
Your baby may refuse to breastfeed, may repeatedly pull off
• Change the baby’s nursing position to encourage the breast during feedings, be gassy and cranky, and have
proper drainage. slow weight gain. The baby may have thrush in the mouth
(white patchy areas that look like milk that won’t rub off)
• Drain one breast well before switching sides. or in the diaper area (red rash).
• Express the milk from your breasts by hand or with If you have thrush, both you and your baby need to be
a pump if they are still lumpy after feeding. treated. See your health care practitioner as soon as possible.
Antifungal creams are used to help clear up thrush. Wash
• Get as much rest as possible and drink whenever bras daily and avoid using breast pads if possible. If you are
you are thirsty. using a breast pump, boil the parts daily.
• Make sure your clothing and bra are loose. If you have chosen to use a soother for your baby, replace
or boil the soother for two minutes each day to prevent
re-infecting your baby’s mouth.
Babies need a prescription for antifungals. Mothers can

use non-prescription medications.
Yo u r B a b y 105
Getting Help with Breastfeeding
The best piece of advice I would give A new baby can be overwhelming and exhausting. It is How can you express breast milk?
for breastfeeding is to be persistent. important to have people around you to talk to or help • by hand
Don’t give up if you have problems. with your concerns. If you are having difficulties with • with a hand pump
There are many supports out there to breastfeeding, such as sore nipples, or are tired or having • by an electric pump
help with breastfeeding and it is so emotional difficulties, call for help right away. Your public
worthwhile. I loved breastfeeding all health office or the BC NurseLine can help with All bottles, containers, and pump pieces used for expressing
of my babies. When they woke at breastfeeding questions. Many health offices and hospitals milk should be washed and cleaned daily before use until
night, it was so much easier to have have breastfeeding clinics where you can go and have a your baby is three months old.
their food warm and ready just when nurse help you while feeding. If you have a midwife, she
they needed it. will help you with breastfeeding. The La Leche League is Before cleaning all bottles, containers, and pump pieces:
also a valuable resource. • wash hands well
• take pump pieces apart so each piece can be
Using a Bottle or Cup cleaned separately
Once they have settled into a breastfeeding routine after • rinse milk off all pump pieces using cold water
four to six weeks, some mothers introduce an occasional • wash in hot, soapy water and rinse well
cup or bottle of pumped breast milk. Remember to empty • air dry by placing on a paper towel
your breast if you have missed a feeding. This milk can be
stored for future use. If your baby is preterm or ill, you will also need to disinfect the
pump parts once a day. Use one of these methods:
If the baby is getting several bottles a day on a regular basis • Put pump parts in a pot, cover with water, and boil on
and your milk supply decreases because the baby is nursing the stove for 10 minutes.
less, it is possible that the baby will start refusing the breast,
even if he is very well established in breastfeeding. • Soak pump parts for 10 minutes in household bleach.
Use 250 ml (1 cup) of bleach and 2.25 litres (10 cups)
of tap water. Rinse with boiled water. Air dry.
Expressing Breast Milk
• Use the sani cycle on your dishwasher. Place pump
You may want to express breast milk: parts on the top rack.
• If your baby is unable to breastfeed (ill or in the special
care nursery). When your milk supply is first coming in, you may only get
a few drops when you express. This will increase as you
• If you are going to be away from your baby for longer practice and your milk supply increases. If you express milk
than a few hours. for a preterm or sick baby, or a baby having difficulty
breastfeeding, express or pump for every feeding (eight
• To relieve full breasts so your baby can latch better. times in 24 hours). If you are expressing to get extra milk
for a feeding when you will be away, you may need to
• If you are going back to work. express milk several times to get enough milk for one
feeding. Find the time that works best for you. You may
• So your partner can feed the baby after 4 to 6 weeks feel fullest in the morning, so this is a good time to try to
when your milk supply is well established. express your milk.
106 Yo u r B a b y
9OU C AN TUC K A SM ALL N ON BREAKABLE C ON TAIN ER UN D ER YOUR s ' ENTLY PUSH YOUR THUM B AND FING ERS BACK TOW ARDS YOUR
N IPPLE ON THE SEC ON D BREAST W H ILE YOUR BABY IS N URSIN G CHEST THEN SQUEEZE THEM TOG ETHER W HILE YOU M OVE
9OU M AY FIN D YOU LEAK M ILK FROM BOTH BREASTS W H EN YOU THEM TOW ARDS THE NIPPLE BUT DO NOT PINCH YOUR NIPPLE
H AVE TH E LET D OW N REFLEX 3AVE TH IS M ILK FOR USE LATER $ O Y O U H A VE T O O M U C H M ILK
s # ATC H TH E M ILK IN TH E C LEAN C UP BOW L OR JAR # ON SID ER C ON TAC TIN G THE " # 7 OM EN S
( A N D % X P R E SSIN G - ILK " ANK AT " # 7 OM EN S ( OSPITAL
s 7 ASH YOUR H AN D S AN D G ET C OM FORTABLE s - OVE YOUR FIN G ERS AROUN D TH E AREOLA IN A C IRC LE TO A N D ( E A LTH # E N T R E
EX PRESS FROM D IFFEREN T PARTS OF YOUR BREAST 0RESS AND
s ( AVE A C LEAN C UP BOW L OR JAR READ Y TO C ATC H TH E M ILK RELEASE REPEAT THE M OVEM EN T ON YOUR BREAST AND # A LL T O FIN D O U T A B O U T
SW ITC H BETW EEN BREASTS EVER Y FEW M IN UTES THE SC REEN IN G PROC ESS TO BEC OM E A
s ' ENTLY M ASSAG E YOUR BREAST IN A C IRC ULAR M OTION M ILK D ON OR
W ORKIN G FROM SH OULD ER TO NIPPLE ( A N D 0 UM P S
3OM E W OM EN LIKE TO USE HAND PUM PS 4 HESE PUM PS CAN
s 4O START TH E LET D OW N REFLEX ROLL YOUR N IPPLE BETW EEN USUALLY BE BOUG HT IN A DRUG STORE OR CHILD CARE SUPPLY STORES
YOUR TH UM B AN D FIN G ER
% LE CT R IC P U M P S
s 0UT YOUR HAN D IN A # SH APE ON YOUR BREAST 0UT FIN G ERS %LEC TRIC PUM PS ARE FAST AN D EFFIC IEN T 4 HEY ARE USEFUL IF YOU
O N T H E B O T T O M A N D Y O U R T H U M B O N T H E T O P A T T H E W ILL BE EX PRESSIN G M ILK OFTEN OR FOR A LON G ER PERIOD OF TIM E
O U T E R E D G E O F T H E A R E O LA 9OU ARE ABLE TO EX PRESS BOTH BREASTS AT TH E SAM E TIM E W ITH
SOM E ELEC TRIC PUM PS %LEC TRIC PUM PS TH AT SUC K AND RELEASE
AUTOM ATIC ALLY W ORK BEST - AN Y M OTH ERS FIN D TH AT PUM PS
REQ UIRING TH EM TO C REATE AN D RELEASE TH E SUC TION W ITH THEIR
FIN G ERS D O NOT W ORK W ELL 4ALK W ITH TH E N URSES IN THE
H OSPITAL OR YOUR PUBLIC H EALTH N URSE ABOUT REN TIN G OR
B U Y IN G A N E LE C T R IC P U M P
# O LLE CT IN G A N D 3 T O R IN G " R E A ST - ILK

3TORE YOUR EX PRESSED BREAST M ILK FOR
s 5 P TO H OURS AT ROOM TEM PERATURE
s D AYS IN A FRID G E TH AT HAS A TEM PERATURE OF TO ² #

3TORE IN TH E REFRIG ERATOR N OT IN TH E D OOR )F YOU D ON T
H AVE A FRID G E TH ERM OM ETER IT IS BEST TO FREEZE M ILK
YOU D ON T IN TEND TO USE W ITH IN H OURS
s M ONTH IN A FREEZER COM PARTM ENT THAT IS INSIDE A FRIDGE
s 5 P TO M ON TH S IN A SEPARATE D OOR FRID G E FREEZER TH E

TEM PERATURE C H AN G ES IF TH E D OOR IS OPEN ED OFTEN
+ EEP M ILK ON TH E BAC K TOP SH ELF AT A TEM PERATURE
O F ² #
%XPRESSING MILK BY HA ND s TO M ON TH S IN A D EEP FREEZE ² #
9OUR " A BY

How do I use frozen breast milk safely? Refer to Toddler’s First Steps for further information on
Always use the oldest milk first. Breast milk can separate feeding older infants and toddlers
when it is frozen. Gently shake to remix once it thaws.
Information on formula feeding your baby is available from
Thaw breast milk by: HealthFile #68l, which can be picked up at your public
• putting the container in the fridge health office or viewed online at www.bchealthguide.org.
• running the container under warm tap water You can also call Dial-a-Dietitian or the BC NurseLine (see
• putting the container in a bowl of warm water Resources section for phone numbers).
Once milk has thawed, it may be refrigerated for up to

24 hours. Do not store at room temperature. Avoid Breastfeeding and Work
wasting thawed breast milk. Thaw only what you need
for one feeding. You can breastfeed and work outside the home. In British
Columbia, employers must make reasonable efforts to allow
Do not refreeze breast milk. you to breastfeed or express milk at work.
Do not heat breast milk on top of the stove. It can get too How can you be successful?
hot too fast. • Have breastfeeding well established before returning to
work. The first six weeks or more are the most
Do not microwave breast milk because the uneven heating important for getting a good milk supply for your baby.
can burn your baby’s mouth.
• Contact your public health nurse, lactation consultant,
Warm breast milk by: La Leche League, or breastfeeding support group for
• running the container under warm tap water (if using help and advice.
an infant bottle, keep the nipple area out of the water)
• putting the container in a bowl of warm water • Talk to your boss before you go back to work. Talk
about the importance of support for breastfeeding.
Breastfed babies are healthier. Their mothers need
Formula Feeding less time off work to care for sick babies.
It is rare that a woman is unable to or advised not to You will need:

breastfeed her baby. If you are unsure about breastfeeding • A quiet, smoke-free place to feed or express milk.
or are considering formula feeding, talk first with your
health care practitioner or phone the BC NurseLine at • A fridge to store expressed milk. If you don’t have a
1- 866 -215- 4700. They have many ways to help you fridge at work, use a Styrofoam box with an ice pack
with breastfeeding. to store expressed milk that will be fed to your baby
within 24 hours.
After age nine months, it is all right to give your baby small
amounts of pasteurized whole cow or goat milk or fortified • A reasonable workload.
soy drink, but your baby still needs breast milk or formula.
Once your baby is 12 months old and eating a variety of To keep enough breast milk, you will need to pump your
solid foods, it is okay to give whole cow or goat milk breasts or feed your baby one to three times during an
fortified with vitamin D, instead of formula. eight-hour work shift.
108 Yo u r B a b y
Remember to take healthy snacks to work, as well as breast • Your baby needs vitamin D to build strong, healthy
pads, breast pump, clean cups or jars to store your breast bones and teeth.
milk, and phone numbers of support people.
• Not enough vitamin D increases the risk of your baby
How can I get ready to go back to work? getting rickets — a disease that affects the way bones
• Learn how to express your milk by hand or pump. grow and develop.
Start storing milk 10 to 14 days before you plan
to return to work. Vitamin D and Sunlight
Sunlight is the main source of vitamin D for all humans, but
• About two weeks before you go back to work, slowly wearing sunscreen prevents vitamin D from being formed.
introduce your baby to other ways of feeding. Let Canada’s northern location and our use of sunscreen to
your baby get used to a cup or bottle. It may help lessen the risk of skin cancer means we can’t count on
if someone other than you feeds the baby at these getting enough vitamin D from being in the sun. Children
times. If you use a bottle and your baby refuses the and adults can get additional vitamin D from foods. See BC
nipple, try a different nipple or a cup. HealthFile #68e, Food Sources of Calcium and Vitamin D
at www.bchealthguide.org.
• Breastfeed as soon as you see your baby after work
and breastfeed often on your days off, in the evening, • Infants under one year should be kept out of
and at night. direct sunlight.
• Your baby may refuse food, wake at night, or be • Sunscreen should not be used on babies less than
fussier when you are away. 6 months of age.
• Tell your child care provider how important • For infants over 6 months who are exposed to
breastfeeding is to you and your baby. Talk sunlight, sunscreen is recommended.
about when you will be gone, when you will
breastfeed your baby, and about your baby’s
feeding routines. Make sure your caregiver
knows how to safely prepare and store milk. Feeding the First Solid Foods
• Get extra help with chores at home. Your baby does not need any food except breast milk for
the first six months. Babies should be able to sit up with
• Breastfeeding helps your baby adjust to you some support, open their mouths when they see food
going back to work. coming, and move the soft food from the front of the
tongue to the back of the mouth to swallow. If you wait
until your baby can do these things, your baby will feel
Vitamin D Supplement more confident about learning to eat and will give you
signals about hunger, fullness, likes, and dislikes by turning
Health Canada recommends that all breastfed, healthy, full her head away. Infants who start solid foods too early have
term babies get a daily vitamin D supplement of 400 IU per a greater chance of developing food allergies.
day. You should start giving your baby vitamin D
supplement at birth. Continue giving it until your baby’s
foods include 400 IU of vitamin D each day.
Yo u r B a b y 109
" ABY # AR E
3 LE E P IN G
&OR TH E FIRST M ONTH YOUR BABY M AY SLEEP FOR ABOUT

HOURS OF EVER Y H OURS 3H E W ILL USUALLY NOT SLEEP LON G ER
THAN TW O OR TH REE H OURS AT A TIM E )N TH E EARLY D AYS IT IS
C OM M ON FOR BABIES TO W AKE UP SEVERAL TIM ES AT N IG HT
' ETTIN G EN OUG H SLEEP C AN BE A BIG ISSUE FOR M AN Y PARENTS
" REASTFEED IN G IS TH E BEST W AY TO G ET YOUR BABY BAC K TO
SLEEP / VER TIM E YOUR BABY W ILL G RAD UALLY SLEEP LON G ER
D U R IN G T H E N IG H T
( ERE ARE A FEW TIPS

s ( A V E A C LE A R D IFFE R E N C E B E T W E E N D A Y T IM E A N D
NIG HTTIM E SLEEPIN G 7 H EN YOU ARE UP AT N IG H T TO FEED
YOUR BABY KEEP TH E ROOM D ARKEN ED AND D ON T TURN ON
TH E 4 6 OR RAD IO 4R Y N OT TO PLAY W ITH OR STIM ULATE YOUR
BABY BEFORE PUTTIN G HIM BAC K D OW N TO SLEEP $ URIN G
TH E D AYTIM E LET YOUR BABY SLEEP IN A LIG H TEN ED ROOM
W ITH N ORM AL D AYTIM E N OISES )N TH E D AYTIM E SIN G TO
H IM PLAY AN D G ENERALLY G ET ON W ITH YOUR D AY
) S " A B Y 4O O 7 A R M O R 4O O # O L D
4 H E BEST G UID E FOR H OW M AN Y C LOTH ES OR BLAN KETS A BABY OF TIN Y PIN K PIM PLES SURROUND ED BY PINK SKIN 9OUR BABY
NEED S IS TO D RESS YOUR BABY AS YOU W OULD D RESS YOURSELF M AY ALSO G ET SLEEPY AND SW EATY
9OUR BABY N EED S TO BE C OM FORTABLY W ARM OR C OOL
D EPEN D IN G ON TH E TEM PERATURE OUTSID E AND IN SID E )N FAN TS W HO ARE TOO C OLD W ILL USUALLY FUSS UNTIL TH E
YOUR H OUSE PROBLEM IS FIX ED # OLD HAN D S AN D FEET D ON T NEC ESSARILY
M EAN TH AT THE BABY IS C OLD &EEL TH E W ARM TH ON TH E
)N THE HOUSE BABIES NEED ABOUT THE SAM E NUM BER OF UPPER ARM S OR THIG H S !D D A SW EATER OR A LIG HT BLANKET
LAYERS OF CLOTHES AS AN ADULT TO STAY W ARM 7 HEN PUTTING
YOUR BABY TO SLEEP IT IS RECOM M ENDED THAT YOU USE A ! LARG E PORTION OF AN INFANTS BOD Y SUR FAC E AREA IS ON
SLEEPER AND A LIG HT BLANKET OR A BLANKET W EIG HT SLEEPER TH EIR H EAD S )N OTHER W ORD S TH EIR H EAD S ARE LARG E IN
+ EEP YOUR BABYS HEAD UNCOVERED W HEN SLEEPING 4 HIS C OM PARISON TO THEIR BOD IES " EC AUSE OF TH IS THEY C AN
IS SO YOUR BABY DOES NOT G ET TOO HOT !VOID USING HEAVY LOSE A LOT OF H EAT THROUG H THEIR HEAD S 7 HEN OUTD OORS
BLANKETS QUILTS AND DUVETS IT IS W ISE TO USE A HAT TO KEEP YOUR BABY W ARM W HEN
THE W EATHER IS C OOL )N SUM M ER PROTEC T YOUR BABYS
)F YOUR BABY IS OVERD RESSED OR IS W RAPPED IN TOO M AN Y H EAD FROM TH E SUN BY USIN G A LIG HT HAT
BLAN KETS SH E M AY D EVELOP A RASH TH AT LOOKS LIKE C LUSTERS
9OUR " A BY

• Have enough nap time during the day. An over-tired The Canadian Pediatric Society (CPS) released
baby will not sleep better at night. recommendations in 2004 that discourage bedsharing for
the first year of life. Sharing a bed with your baby can
• Make sure your baby is warm but not hot. increase your risk of smothering your baby, especially if you Do not swaddle (wrap snugly in a
are very tired or have been drinking alcohol or using drugs. blanket) or cover your baby’s head
• Put your baby to sleep in a safe sleeping environment. The CPS also knows that some parents will choose to share with the blanket if you have your
a bed with their baby. baby in bed with you.
• Have a routine that you follow at night. This may not
be possible in the first few months. As your baby gets You should not share a bed with your baby if you (or any
older, have a warm bath at night followed by rocking other person in the bed):
or singing and quiet time. This routine signals to your • are a smoker, or your baby is exposed to
baby that sleep is coming. second-hand smoke
• have been drinking alcohol or using drugs
• have taken any medicines that could make you extra sleepy
Safety and Sleeping • are very tired, to the point where you would not be
able to respond to your baby
Safe Sleeping for You And Your Baby • are ill or have a medical condition that might make
You need to carefully choose where your baby sleeps. it difficult to respond to your baby
There are many ways to help you and your baby sleep • have long hair that is not tied back
well and safely. • are unusually heavy (obese)
Co-sleeping refers to the sleeping arrangement where the There are other things you need to know when choosing
infant sleeps in the same room as a parent, but not in where your baby sleeps:
the same bed. • It is safest to put your baby on his back to sleep.
This is very important!
Bedsharing means the baby shares the same sleep surface
with another person, usually a parent. In many areas of the • Your baby should sleep on a firm, flat mattress.
world it is a common practice for mothers to sleep with Do not put your baby to sleep on a waterbed,
their babies so they can watch them, breastfeed them, and sagging mattress, feather bed, air mattress, sofa,
be near them. Sometimes you may decide to have your couch, daybed, or any other surface that is very soft.
baby sleep beside your bed and at other times have your
baby share your bed. • Be sure your baby will not fall out of bed. There should
be no spaces between the mattress and the headboard,
You need to know the benefits and risks of co-sleeping and walls, or other surfaces that can trap your baby.
bedsharing, and consider them each time you choose
where your baby sleeps. Having your baby in bed with you • Do not sleep with your baby while sitting or lying on
makes breastfeeding easier and your baby can feed more a sofa, recliner, or chair. Your baby could fall between
often. It is best to put your baby on his back when not the cushions and suffocate, or fall on the floor.
breastfeeding. Having your baby share your room,
particularly at night, may help lower the risk of Sudden • Make sure your baby does not get too warm. Use only
Infant Death Syndrome (SIDS). Being close can also help a light blanket to cover him. Do not swaddle or wrap
to calm your baby if he is unsettled. your sleeping baby tightly in a blanket or cover
his head.
Yo u r B a b y 111
• Do not put your baby down to sleep on or beside properly and securely in place at all times. Follow the
a pillow. manufacturer’s instructions when putting the crib together.
Cribs should also have double locks for securing the drop
Do not use: • Use a crib that meets safety standards and don’t use side. Check for the manufacture date — most cribs made
• sheep skins bumper pads, sheepskins, or comforters, or have before 1986 do not meet current safety regulations. For
• pillows stuffed toys in the crib. more information, see the Canadian Health Network website
• comforters at www.canadian-health-network.ca and search for “cribs.”
• stuffed toys • Do not leave your baby alone on an adult bed or let
• bumper pads other children sleep in the same bed as your baby. What do I need to know about mattresses?
The mattress should be firm, no more than 15 cm (6 inches)
These things can stop good air SIDS (Sudden Infant Death Syndrome) thick, fit the frame properly, have no gaps greater than 3 cm
circulation around your baby’s SIDS, also known as crib death, is the sudden and (1 1/8 inches) along the sides or ends of the crib. If spaces
face. Plastics, such as the mattress unexpected death of a healthy baby. No one can explain are larger than this, your baby can get his head stuck in any
wrapping, may also prevent air why a baby dies of SIDS but there are steps you can take gaps between the mattress and the frame and suffocate. If
circulation. These should be removed to lessen the risk. the mattress is worn or has a tear, it is dangerous. Do not
to reduce the risk of SIDS and use it. The mattress support should hold firmly and be
suffocation. • Babies should sleep on their backs on a firm surface. checked often. You can do this by shaking the mattress
support, thumping the mattress from the top, and pushing
Do not let your baby sleep on: • When your baby can turn over on his own, there is no hard on the support from underneath. Make sure all screws,
• waterbeds need to continue to place your baby in the back sleep locks, and clamps are tight.
• couches or sofas position. When your baby is awake, allow some
• recliner chairs tummy time to help develop arm and neck strength. What do I need to know about bedding?
• pillows See page 121 for more information on tummy time. • To protect the crib mattress, you can use either a
• down comforters quilted crib pad (one side waterproof) or a mattress
• beanbag chairs • No one should smoke inside your home. A cover, placed under the sheets. Do not use plastic
smoke-free home is important — not only for your sheets as they can get in the way of breathing.
baby’s health but also to reduce the risk of SIDS.
• Pillowcases can be used as a bottom sheet for a
• Keep your baby warm, not hot. To check if your baby bassinet or carriage mattress.
is too hot, place your hand on the back of the neck.
Your baby should not be sweating. • Have some bottom sheets (can be fitted) for the
crib mattress.
• Breastfeeding may help to prevent SIDS.
• In a warm room, a sleeper and a light blanket or a
blanket-weight sleeper should be enough to keep
Sleeping Equipment your baby comfortable.
What do I need to know about cribs? • Your baby should be warm but not hot.
Your baby can sleep in a crib, cradle, bassinet, basket, or
even a box as long as the surface is firm and not soft. When • Top sheets are not recommended until your child is an
your baby becomes active you may find that a crib is needed. older toddler. Babies can get tangled in a top sheet.
Only use cribs that meet the federal government’s Cribs and • Never cover your baby’s face or head with blankets.
Cradles Regulations. Be sure that each part of the crib is
112 Yo u r B a b y
Diapering How do I diaper and clean a girl?
Wipe from the front to the back to prevent germs from her
Your newborn baby may need her diaper changed 10 to15 bowel movements getting into the urinary tract. Gently
times a day. Since you will spend a lot of time doing this, clean between the outer folds of the labia. There is no
make it a special time for talking, laughing, and playing need to clean inside the vagina.
with your baby. You do not need to wake your baby to
change her diaper. How do I diaper and clean a boy?
Do not pull the foreskin back when cleaning the penis.
Tips for Diapering Pulling this skin back may cause infection or tightening of
• Wash your hands before and after each change. the foreskin. Wash the area well and clean from the front
to the back.
• Put your baby on a flat, safe surface, such as
a change table with side rails or on the floor. What is diaper rash?
This is a red and painful rash on the diaper area. Rashes can
• Keep one hand on your baby at all times. be caused by:
• Irritation from dampness of urine or bowel movement
• Babies move around, so keep creams, pins, etc., out on the skin.
of reach. Give your baby a toy or something to watch
to keep her entertained. • Allergic reaction to soaps, perfumes, or oils that touch
the skin.
• Wipe the diaper area with a warm wet washcloth or
baby wipe (one that does not have perfume). • Yeast infection that can be spread from the mouth or
from stool. A yeast infection can develop after your
• Pat the area dry or allow it to air dry. baby has had a rash for several days.
• Safety pins pushed into a bar of soap are easier to Hints to Avoid Diaper Rash
pin into the diaper. • Wash your hands before and after changing diapers.
• Do not use powder or cornstarch. A puff of powder • Keep the skin dry by changing diapers as soon as they
near the face or nostrils can cause choking and are wet or soiled.
breathing difficulty.
• Wash the diaper area with warm water and dry well.
Your pregnancy hormones may have caused some changes Do not use soap.
in your baby’s body after birth. A girl’s genitals may look
larger than normal and you might see a small amount of • Take the diaper off and expose the area to the air for
bleeding or white discharge from the vagina. Boys may 10 to 15 minutes, three or four times a day. You can
have a reddened scrotum. Breasts in both boys and girls lay your baby on an absorbent towel and play with
may be larger than normal and may even leak a small her during this time.
amount of milk. These changes are normal and will go
away in a few days. • When the diaper area is clean and dry, rub on a thin
layer of petroleum jelly or zinc-based cream.
Yo u r B a b y 113
• Avoid using perfumed fabric softeners or baby care • Fill the diaper pail three-quarters full of water and add
products like diaper wipes (purchased diaper wipes 175 millilitres (3/4 cup) of vinegar (not bleach).
may cause or further irritate diaper rash).
To prevent burns, keep the tempera- • Rinse soiled diapers in the toilet. Wet diapers do not
ture of your hot water tank below • If you use cloth diapers you may want to do an extra need to be rinsed.
49°C (120°F). rinse when washing the diapers or use an antibacterial
product or vinegar in the wash. This will decrease the • If you use diaper pail deodorizing tablets, you must
ammonia build up in the diapers caused by urine. keep the pail out of reach of your children.
• Avoid using airtight plastic pants over the diaper. • When the diaper pail is full, empty the contents into
the washing machine and spin out the excess water.
• Try switching to cloth diapers if you are using
disposables and the rash is getting worse. • Fill the machine with hot water to the highest water level.
Contact your health care practitioner if you have followed • Use a phosphate-free detergent or biodegradable soap.
these suggestions and the rash lasts longer than five days, Run diapers through an extra rinse at the end of the cycle.
has blisters, pus, peeling areas or crusty patches,
or is mainly in the skin creases. • Dry diapers in the dryer on a hot setting or hang
outside to dry. Many diapers will stay softer if put in
Choosing Diapers a dryer for 15 minutes, then hung outside on a line
Your baby will be in diapers for two to three years. or rail to finish drying.
Consider these factors when making your choice.
Disposable diapers:
• do not need to be worn with waterproof pants Bathing
• will cost more than cloth diapers
• come in a number of styles and sizes You don’t need to bathe your baby every day. Washing the
• are convenient, no laundering is needed face, neck, hands, and diaper area, in that order and with
• create a lot of extra garbage attention to skin folds, can be done daily. Your baby may
love the bath or cry when he is naked. Most babies usually
Cloth diapers: relax when they are floating in the water. Don’t worry, you
• can be made or bought are not harming your baby. If you are calm and talk gently,
• can be fastened with diaper pins or Velcro fasteners your baby will get used to the routine and start to enjoy the
• will need to be worn with waterproof pants bath. For the first bath it helps to have someone with you
• can be cleaned by a diaper service that picks up who has done it before. Try to make bath time a relaxed
soiled diapers and leaves clean ones playful experience for your baby. Smile, make eye contact,
sing, and talk with your baby.
Washing Diapers
• Diapers may be soaked in a diaper pail until there are
enough to be washed. Never leave your baby alone in the bath.
114 Yo u r B a b y
s 5 SIN G OILS IN TH E BATH C AN M AKE YOUR BABY SLIPPER Y
!PPLY AN Y OILS YOU M AY W AN T TO USE AFTER THE BATH
s 7 H EN W ASH IN G THIN K C LEANEST TO D IRTIEST ( EA LT H # A N A D A R EC O M M EN D S T H A T

7 ASH TH E EYES AN D FAC E FIRST PARENTS N OT USE BATH SEATS OR RING S
BEC AUSE OF C ONC ERN S W ITH TH EIR SAFETY
% Y E S A N D &A C E )T IS VER Y EASY FOR AN INFAN T TO TIP OVER
s 7 ASH TH E FAC E USIN G W ARM W ATER ON LY 3OAP IS NOT OR SLIP UND ER W ATER AN D D ROW N 4 HIS
N E E D E D O N T H IS A R E A C AN HAPPEN IN LESS THAN A M IN UTE
s 7 IPE EYES FROM IN N ER C ORNER TO TH E OUTER C ORNER
s $ O NOT USE COTTON TIPPED APPLICATORS IN YOUR BABYS

EARS NOSE OR EYES AS THEY CAN HARM THE DELICATE TISSUES
s 5 SE A SOFT W ASH C LOTH AN D ON LY C LEAN TH E OUTER PART OF

TH E EAR $ ON T D IG IN TO TH E EAR C ANAL !NOTH ER W AY TO BATH E YOUR BABY
HAVE ON E AD ULT SIT IN A BATH TUB W HILE
s 7 IPE YOUR BABYS GUM S WITH A SOFT CLEAN CLOTH EVERY DAY THE OTH ER PASSES TH E BABY IN FOR A
BATH 7 H EN THE BATH IS FIN ISH ED TH E
3 CA LP A N D ( A IR BABY C AN BE PASSED TO TH E OTHER
' E N E R A L 4 IP S F O R " A T H IN G s 9OU C AN USE A M ILD SOAP OR BABY SH AM POO ,ATHER UP A D U LT 9O U R B A B Y M A Y FEEL M O R E
s ( AVE TH E ROOM W ARM ABOUT TO ² # TO ² & AN D RIN SE W ELL W ITH C LEAR W ATER SEC URE AND C R Y LESS
s 2EM OVE JEW ELLER Y TH AT C OULD SC RATC H YOUR BABY s 9OUR BABYS SC ALP IS N ORM ALLY M ILD LY SC ALY )F THE SC ALP IS
C RUSTY YOU C AN RUB IN A SM ALL AM OUN T OF N ON PER FUM ED
s 7 ASH YOUR H AN D S OIL TH EN W ASH IF OFF / IL LEFT ON TH E SC ALP C AN C AUSE A
BUILD UP OF OIL AN D SKIN KN OW N AS C RAD LE C AP
s ! BABY C AN H AVE A BATH IN TH E SIN K A BASIN A BABY
B A T H T U B O R IN A B A T H T U B W IT H A N A D U LT 5 M B ILICA L # O R D
s 4 H E UM BILIC AL C ORD STUM P W ILL USUALLY FALL OFF IN # A LL Y O U R H E A LT H CA R E P R A CT IT IO N E R IF
s ,AY OUT A BLAN KET OR TOW EL NEX T TO THE SINK BASIN TO D AYS s 4 H E SKIN AROUN D YOUR BABYS
O R B A B Y B A T H T U B T O LA Y Y O U R B A B Y O N UM BILIC AL C ORD IS W ARM RED
s + E E P IN G T H E C O R D C LE A N A N D D R Y IS IM P O R T A N T T O OR SW OLLEN
s " ATH W ATER SH OULD BE LUKEW ARM # H EC K THE P R E V E N T IN FE C T IO N
TEM PERATURE OF TH E W ATER ON YOUR W RIST OR ELBOW s 4 H ERE IS A BAD SM ELLIN G
)T SH OULD FEEL W ARM N OT H OT s 5 SE W ATER ON A C OTTON TIPPED APPLIC ATOR OR W ASH C LOTH D ISC H ARG E FROM TH E C ORD
TO C LEAN G EN TLY AROUN D TH E BASE OF THE C ORD 7 IPE
s ( AVE EVER YTHING W ITH IN EASY REAC H BEFORE YOU START AW AY ANY C ORD D ISC H ARG E s 4 H E C O R D IS V E R Y W E T A N D W ILL
N OT D R Y W ITH EX POSURE TO AIR
s !LW AYS KEEP AT LEAST ON E HAN D ON YOUR BABY W H EN s # LEAN AROUN D TH E BASE OF TH E C ORD AFTER BATH ING AN D AT
IN T H E B A T H O R O N T H E T A B LE D IAPER C H ANG ES
9OUR " A BY

• Fold the diaper below the cord to stop irritation and to • Bathe your baby every second or third day. Keep the
keep it dry and exposed to air. baths short and the water lukewarm, not hot. Water
and soap can dry and irritate the skin.
If a rash flares up and becomes • Continue to clean the belly button (umbilicus) for a
red, itchy, and oozes fluid, call few days after the cord falls off. • Dress your baby in 100% cotton.
your health care practitioner. For
more information on checking the The cord may be infected if the area around the cord • Use plain non-medicated, unscented skin lotions
seriousness of a rash and knowing becomes reddened, swollen, or has pus coming from it. or oils to keep the skin moist.
when to call a doctor, look in the BC Call your health care practitioner or the public health
HealthGuide handbook. You can also nurse if you are concerned.
visit BC HealthGuide OnLine at Caring for Baby’s Nails
www.bchealthguide.org and search Diaper Area
for “rashes.” Or you can call the BC Wash this area last as it will be the least clean. Keeping your baby’s nails trimmed will help prevent your
NurseLine at 1- 866-215- 4700 for baby from scratching himself.
confidential help and advice. Drying
After you have bathed your baby, place her on the towel • Use blunt scissors or an emery board to cut or file
and pat her dry, being sure to remember the skin folds. your baby’s nails.
Your baby will cool down quickly when wet. Have warm
clothes ready to dress her. • The best time to do your baby’s nails is when he is
asleep or at least sleepy and his hands are open and still.
Caring for Baby’s Skin

Jaundice
A newborn’s skin is usually soft and smooth but may be
peeling or wrinkled in the first few days after birth. Jaundice appears in about half of full term babies and about
three-quarters of preterm babies. Following birth, your baby
What are the tiny white raised dots on my baby’s face? has extra red blood cells. As the blood cells break down, a
These spots are called milia. Your hormones before birth yellow-coloured substance called bilirubin is released. The
cause extra oil gland activity in your baby. Milia are caused yellow-coloured substance in the baby’s blood causes the
by plugged oil glands and will usually clear within three to skin and the whites of the eyes to take on a yellowish tinge
four weeks. Do not try to remove or pop these glands. called jaundice.
Do I need to treat newborn rash? In most infants, jaundice is mild. It comes on during the first
Newborn rash is common in the first few months after three to five days and lasts only a few days. The only
birth. This rash is blotchy red with tiny pinpoints that can treatment needed is lots of breastfeeding. Your baby may be
be found anywhere on the body. The cause is unknown. a little sleepier and may need to be woken on a regular
It’s normal and will pass on its own with no treatment. basis — every three hours — for feeding. The extra milk will
help get rid of the bilirubin. To help with jaundice, feed your
What can I do to avoid rashes on my baby? baby as often and for as long as she wants. Do not give
• Remove your baby’s extra clothing. Keep him warm water by bottle as bilirubin is better eliminated through stools
but not hot. than urine. Water will only fill up the tummy and decrease
breastfeeding. This will decrease the number of stools.
• Don’t use perfumed soaps, lotions, or fabric softeners.
116 Yo u r B a b y
In rare cases, jaundice is severe. Untreated severe jaundice Stools of Formula Fed Babies
can lead to brain damage and deafness. With higher levels Formula-fed infants pass stools that are pasty and pudding-
of jaundice, your baby still needs lots of breastfeeding. He like. They are pale-yellow to light brown with a strong odor.
will be placed under special lights to get rid of bilirubin. Formula-fed newborns usually have one to two bowel
movements daily in the first weeks. After the first month
Call your health care practitioner if: your baby may have a bowel movement every one to two
• Your baby seems sleepy and refuses the breast or bottle. days. It is important to know that almost all infants will
grunt and turn red when passing a stool. If you think your
• You notice your newborn is jaundiced, especially on child is having a hard time passing a stool, contact your
his arms and legs. health care practitioner.
Constipation
Bowel Movements A baby who is completely breastfed rarely gets constipated.
Breast milk is almost totally digested. After the first few
Normal Stools weeks, a fully breastfed baby may go as long as a week
For the first week after birth, the appearance of your baby’s between bowel movements. Newborns and infants may
stool will change every day. Usually within the first 24 hours grunt and get red in the face when having a bowel
after birth, your baby will pass her first bowel movement, movement. This does not mean they are constipated.
called meconium. This first stool will be thick, dark, Babies differ in how often they have bowel movements.
greenish-black, sticky, and tar-like, and have no smell. The After the first few weeks, some newborns will have stools
next stool is called transitional stool. It will be looser and every day. Others will go for days without a bowel
greenish-brown. After the meconium has passed, your movement. Constipation may be evident if stools are dry
baby’s stools will vary, depending on how your baby is fed. and hard or if your baby has difficulty passing them.
If your baby is less than two weeks old and has fewer than
two stools per day, contact your health care practitioner or If constipation continues for more than a week, or if there
public health nurse. is fresh blood in the baby’s stools, see your health care
practitioner or call the BC NurseLine or Dial-A-Dietitian
Stools of Breastfed Babies (see the Resources section for phone numbers). Do not
After the third or fourth day, the stool will tend to be soft use laxatives, suppositories, or enemas unless a doctor
and golden-yellow (mustard) coloured. The stools will be prescribes them.
soft and runny with a curdled or seed-like appearance. They
will not smell. Breastfed babies often pass a stool after each
feeding. After day four, your baby should have at least three Urination (Peeing)
to four stools about the size of a loonie or one large stool
every 24 hours in the first weeks. After the first month, When and how much should my baby pee?
bowel movements happen less often. Breast milk leaves Your baby may pee either immediately after birth or several
very little waste in the intestines so bowel movements may hours later. Most newborns will pee within 24 hours of
come only once every few days to once a week. Almost all birth. In the first three days of life, one to two wet diapers
infants will grunt and turn red when passing a stool. If your per day are normal. By days four to six, as your milk supply
baby is totally breastfed, he will not be constipated. increases, your baby should have five or more very wet
diapers per day.
Yo u r B a b y 117
Urine will be pale and may be difficult to see. To tell if your Vomiting
baby has peed:
• feel how heavy the diaper is compared to a dry one Vomiting involves the forceful throwing up of large
• a tissue or paper towel can be used inside a disposable amounts of liquid. Vomiting is usually caused by a virus
diaper to see if it becomes wet or bacteria. It can lead to dehydration. See your health
• cut the disposable diaper and feel if it is wet care practitioner if your baby is unable to keep any fluids
down or appears dehydrated.
It is common to find a pink stain on the diapers. A rusty
orange stain may also be seen on the diaper in the first
one to three days after birth. This stain is caused by uric Coughing and Sneezing
acid crystals in the urine. If you notice these crystals after
the fourth day, feed your baby more often. Babies clear their nasal passages by coughing and sneezing.
This is common in newborns and does not mean they have
Call your health care practitioner or the BC NurseLine’s a cold. It is uncommon for a newborn to develop a cold
24-hour toll free number at 1-866-215-4700 if: within the first six weeks. If you are concerned, check with
• the uric acid crystals continue your health care practitioner. You can also call the BC
• urine is bloody or the colour of cola NurseLine for helpful information and advice on when to
• there is little or no urine for 8 hours see a health care practitioner.
Diarrhea Dental Care
Diarrhea is often caused by an infection or some other illness Did you know?
or irritation. Diarrhea is different from normal stools. Diarrhea Tooth decay is an infectious disease caused by bacteria in
stools are watery and foul smelling. Diarrhea can cause the mouth. Babies are not born with the bacteria that cause
dehydration. Babies can become very sick, very quickly. decay. These germs can be passed from parent to baby by
kissing, sharing spoons, tasting food or putting the baby’s
Most cases of mild diarrhea can be treated at home. Your soother in your mouth. If either parent has tooth decay, see
baby should be taking in enough fluids and nutrients and your dentist. Good dental care can help to prevent passing
be peeing normal amounts and seem to be improving. If bacteria onto your baby.
your baby has signs of dehydration, see your health care
practitioner right away. Once babies have their first teeth, allowing them to have
bottles during the day for long periods or during sleep
times (naps and overnight) can lead to tooth decay.
What are the signs of dehydration? To learn more about baby dental care, go to BC HealthFile
• has less than 4 wet diapers in 24 hours #19a, Infant Dental Care at www.bchealthguide.org.
• dry mouth and tongue
• a sunken front fontanel or soft spot on their head How can I care for my baby’s mouth?
• grey skin colour You should start to clean your baby’s mouth with a
clean, wet cloth soon after birth. Find a position that
is comfortable for both of you. One suggestion is to
have your baby lie in your lap. Position your baby so
her head is stable and you can see into her mouth.
118 Yo u r B a b y
3OM E TH IN G S YOU C AN D O TO RELIEVE SORE OR TEND ER G UM S
s ' IV E Y O U R B A B Y A C LE A N C H ILLE D T E E T H IN G R IN G O R C O LD
W E T C LO T H T O C H E W O N
" Y HAVIN G YOUR BABY G ET HIS SH OTS
s # LEAN AN D M ASSAG E TH E G UM S REG ULARLY TO Y O U G I V E H I M T H E B E ST P O SSI B L E
EASE D ISC OM FORT P R O T E C T I O N A G A I N ST M A N Y SE R I O U S
D ISEASES
s 4EETH IN G G ELS AN D OIN TM EN TS ARE N OT REC OM M END ED
' IV E Y O U R B A B Y E X T R A LO V E A N D P A T IE N C E T O H E LP H E R T H R O U G H
THE TEETH ING PROC ESS
%VEN TH OUG H BABY OR FIRST TEETH ARE REPLAC ED BY PERM ANENT

TEETH YOUR BABYS FIRST TEETH ARE VER Y IM PORTANT
&IRST TEETH
s - AKE IT POSSIBLE FOR YOUR BABY TO EAT SOLID FOOD S
s 0LAY A ROLE IN H ELPIN G YOUR BABY LEARN TO SPEAK
s !ID IN JAW D EVELOPM EN T AN D H OLD THE SPAC E FOR THE

PERM AN EN T TEETH 9OUR C H ILD W ILL HAVE SOM E BABY TEETH
s 7 IPE ALL AROUN D YOUR BABYS G UM S W ITH A C LEAN W ET UN TIL H E IS TO YEARS OLD
C LOTH H ELD OVER YOUR FIN G ER
s / N C E TEETH APPEAR LIFT TH E LIP SO YOU C AN SEE ALONG 6 A CCIN A T IO N S

T H E G U M LIN E W H E N C LE A N IN G
7 H A T A R E VA CCIN A T IO N S
s 5 SE A SOFT BABY TOOTH BRUSH AND A SM EAR OF FLUORID E 6ACCINATIONS PROTECT YOUR CHILD FROM A DISEASE BEFORE IT HAS A
TOOTH PASTE TO C LEAN TEETH CHAN CE TO M AKE YOUR CHILD SICK / THER W ORDS FOR VACCINATIONS
ARE SHOTS NEEDLES BOOSTERS AND IM M UNIZATIONS
s " RUSH YOUR BABYS TEETH TW IC E A D AY / N E BRUSHIN G
SH OULD BE AFTER TH E LAST FEED IN G OF TH E D AY ( O W D O VA CCIN A T IO N S W O R K
6AC C IN ATION S HELP YOUR BABYS IM M UN E SYSTEM M AKE
s &OR M ORE IN FORM ATION ON FLUORID E REFER TO 4ODDLERS &IRST SUBSTAN C ES C ALLED AN TIBOD IES TH AT FIG H T D ISEASES 9OUR BABY
3TEPS AN D " # ( EALTH &ILE 7A TER &LUORIDA TION &A CTS AT TH EN D EVELOPS PROTEC TION AG AIN ST TH ESE D ISEASES 7 ITH
W W W BC HEALTH G UID E ORG VAC C IN ATION S YOUR BABY D OESN T H AVE TO G ET SIC K FIRST TO G ET
TH AT PROTEC TION 6AC C IN ATION S W ORK BEST W H EN TH EY ARE G IVEN
4E E T H I N G AT C ERTAIN AG ES &OR EX AM PLE TH E M EASLES VAC C IN E IS N OT
%AC H BABY H AS ITS OW N SC H ED ULE FOR TEETH IN G / N C E TEETH IN G G IVEN UN TIL A C H ILD IS AT LEAST A YEAR OLD )F IT IS G IVEN EARLIER
STARTS IT C ON TIN UES ALM OST UN IN TERRUPTED FOR ABOUT TW O T H A N T H A T IT M A Y N O T W O R K A S W E LL 3 O M E V A C C IN E S A R E O N LY
YEARS 3OM E BABIES H AVE N O D IFFIC ULTY W ITH TEETH IN G W H ILE G IVEN ON C E OR TW IC E AN D SOM E N EED TO BE G IVEN OVER A
OTH ERS M AY BEC OM E FUSSY AN D UN C OM FORTABLE PERIOD OF TIM E IN A SERIES OF PROPERLY SPAC ED SH OTS
9OUR " A BY

Why should I have my baby vaccinated? What diseases do vaccines protect against?
Vaccination is the best way to protect your child against In British Columbia, vaccines protect your child against
many serious diseases. Thanks to vaccinations, many these diseases: measles, mumps, rubella, hepatitis B,
It is important for your baby to get diseases are not common in Canada, but in other diphtheria, tetanus, pertussis (whooping cough), polio,
his shots on time. For more informa- countries the germs that cause these diseases still exist. Haemophilus influenzae type b disease (Hib), chicken pox,
tion you can read about various pneumococcal, and meningococcal diseases. Without
immunizations in the BC HealthFiles How can I keep my child’s shots up-to-date? getting his shots, your child could get very sick.
found at www.bchealthguide.org. It is important to keep a record of all the shots your child
You can also call the BC NurseLine, at gets. Children in Canada are protected against dangerous Are vaccines safe?
1- 886 -215- 4700, and your public diseases when they are up-to-date with their shots. Keeping Vaccines are very safe. Most shots cause only temporary
health office for more information a record helps you keep your child up-to-date. Ask your minor side effects. These side effects might be soreness
about vaccines. public health nurse for a Child Health Passport to help you where the needle went into the arm or leg or a slight fever.
keep track of your child’s immunizations. Always take your These do not usually last long. Serious side effects from
child’s record with you when he gets his shots. Keep it vaccines are very rare. Remember — if your child gets one
with other important papers. Your child will need his of these diseases, the risks of the disease are far greater than
immunization record when he is older. the risk of a serious vaccine reaction. If you have questions
about these side effects or how to make your baby more
comfortable if he gets a fever or a sore arm or leg, ask your
health care practitioner.
When should I have my child vaccinated?

Your child’s first shots begin at two months of age. Please see the vaccine schedule below.
Remember — some vaccines are only given once or twice, and some need to be given over a period of time.
2 months 4 months 6 months 12 months 18 months 4 – 6 years

Vaccine of age of age of age of age of age of age
Diphtheria, Pertussis, Tetanus,

Poliomyelitis, Haemophilus (except Hib)
Influenzae Type b (Hib)
Hepatitis B
Pneumococcal Conjugate
MMR
(Measles, Mumps, and Rubella)
Meningococcal C Conjugate
Varicella (chicken pox)
120 Yo u r B a b y
4UM M Y 4 IM E # R Y IN G
4UM M Y TIM E IS LAYIN G YOUR BABY ON H IS STOM AC H OR SID E # R YIN G IS YOUR BABYS W AY OF C OM M UN IC ATIN G AN D LETTING ) W AS OVER W HELM ED BY HOW M UC H OUR
W HEN H E IS AW AKE 9OUR BABY C AN BE ON TH E FLOOR ON A SAFE YOU KN OW H E N EED S SOM ETH IN G )F BABIES ARE TIRED SIC K B A B Y C R IE D ) H A D A H A R D T IM E U N D E R
FIRM SUR FAC E ON YOUR LAP OR ON YOUR C H EST )T IS A TIM E W H EN H UN G R Y FRUSTRATED W ET BORED OR LON ELY TH EY SAY SO BY STAND ING THAT SHE W OULD C R Y FOR N OT
YOU C AN SH OW TOYS OR PIC TURES SIN G OR TALK OR M ASSAG E YOUR C R YING - AN Y N EW BORN S W HEN TH EY AREN T EATIN G OR M IN UTES AT A TIM E BUT HOURS 7 E
BABYS BAC K ARM S AN D LEG S 9OUR BABY SH OULD BE SUPER VISED SLEEPING SPEN D TIM E C R YIN G # R YIN G USUALLY IN C REASES AT W OULD FEED D IAPER ROC K AN D C UD D LE
W H ILE HE IS ON HIS STOM AC H ABOUT TW O W EEKS OF AGE AN D PEAKS AT AROUN D TW O M ON THS H ER BUT SOM ETIM ES NOTH ING SEEM ED
OF AG E !T ABOUT TH REE TO FOUR M ONTH S TH E LON G BOUTS OF TO C OM FORT H ER 4 H E ONLY TH ING TH AT
( AVIN G TUM M Y TIM E FOR SEVERAL SH ORT PERIOD S EAC H D AY HELPS C R YIN G USUALLY STOP )T IS N ORM AL FOR A BABY TO C R Y BETW EEN W OULD C ALM H ER AT TH OSE TIM ES W OULD
IN YOUR BABYS D EVELOPM EN T )T H ELPS ONE TO FOUR H OURS A D AY " ABIES W ILL OFTEN H AVE FUSSY TIM ES BE A D RIVE IN TH E C AR ) D ID M AN Y TRIPS
s P R E V E N T Y O U R B A B Y FR O M G E T T IN G A FLA T A R E A O N AROUN D SUPPER TIM E AN D INTO TH E EVEN IN G 4 H IS IS N ORM AL IN TH E EVEN ING JUST D RIVIN G AROUN D
H IS H EAD C ALLED POSITIONA L PLA GIOCEPHA LY ,ISTEN TO THE SOUND S YOUR BABY M AKES YOU W ILL SOON THE NEIG H BOURH OOD UNTIL SHE W OULD
s M AKE TH E M USC LES OF YOUR BABYS NECK D ISC OVER H OW H E TALKS TO YOU 2EM EM BER IT IS NORM AL FOR G O TO SLEEP
BAC K AN D ARM S STRONG BABIES TO M OVE AND M AKE SOUND S EVEN W H EN SLEEPING
s Y O U R B A B Y LE A R N T O R O LL A N D C R A W L
! BABY C AN G ET A FLAT AREA ON TH E H EAD BEC AUSE OF

s POSITION IN PREG N AN C Y OR D URIN G BIRTH
s ALW AYS RESTIN G ON TH E SAM E AREA OF TH E H EAD
TH IS C AN C AUSE THE BON ES OF TH E SKULL TO FLATTEN
9OU C AN H ELP YOUR BABY H AVE A ROUN D H EAD SH APE BY

s H AVIN G SUPER VISED TUM M Y TIM E SEVERAL TIM ES A D AY
s AVOID IN G LON G PERIOD S IN BOUN C Y SEATS IN FAN T SW IN G S
AN D STROLLERS
s LIM ITING TH E TIM E YOUR BABY SPEN D S IN A C AR SEAT
s C H AN G IN G TH E POSITIONS YOU USE TO H OLD AN D C ARR Y
Y O UR B AB Y
s C H AN G IN G YOUR BABYS POSITION IN TH E C RIB EAC H D AY
POSITION TH E BABYS H EAD AT ALTERN ATING EN D S
O F T H E C R IB
s M OVIN G M OBILES AROUND TH E C RIB
2EM EM BER TO PLAC E YOUR BABY ON H IS BAC K TO SLEEP
)F YOU H AVE Q UESTION S SPEAK TO YOUR H EALTH C ARE

PRAC TITIONER )N FORM ATION IS ALSO AVAILABLE ON
TH ESE W EBSITES
s W W W C RANIALTEC H C OM M ED IC ALIN FO PLAG IOC EPH ALY H TM L
s W W W C H EO ON C A
9OUR " A BY

How can I soothe a crying baby? • a quiet, rhythmic motion, e.g., rocking, patting,
If you think your baby is hungry or thirsty, try: going for a stroller or car ride
We would tag team every evening for • feeding your baby, especially if it has been more • creating a soothing background noise by turning on
the first three months. I would walk than one hour since the last feeding the dishwasher, clothes dryer, or vacuum cleaner as
and rock for 20 minutes and then my many babies like sounds of this sort
partner would take over for 20 If you think your baby may be uncomfortable, try: • moving to a quieter spot, e.g., place the baby on
minutes. And then when we would • cuddling and comforting your baby her back in the crib
both be worn out, my mother would • burping your baby • taking a warm bath with your baby
take over and we would walk outside • checking for open diaper pins
for a 20 minute break. The key for us • changing the diaper if it is wet or soiled If it’s their fussy time of day — usually late afternoon or
was to not leave one person to cope • changing your baby’s position or giving your baby evening — try the previous suggestions, and:
alone for too long. It was definitely a a gentle back rub • reduce household needs, e.g., prepare supper ahead
team effort. • checking that the room temperature isn’t too warm of time, have activities planned for other children
or too cold and that your baby isn’t over- or • have your partner, a family member, or some other
under-dressed. person available to help out so you can be with
your baby
To find out how to tell if your baby is too warm or too cold, • try holding the baby in different positions — some
see page 110. babies cry less when they are put to the shoulder
and held upright
If you think your baby may be feeling insecure, bored,
or lonely, try: If you have tried all of these hints and your baby is still
• holding your baby close to your body and cuddling crying, remember that it is more important for you to stay
• moving slowly and calmly with your baby calm than it is to stop the baby’s crying. Crying will not
• smiling and making eye contact hurt your baby. Shaking your baby is dangerous. If you
• talking, singing, or reading to your baby are frustrated, put your baby in a safe place and leave
• playing soothing music the room for a few minutes.
• having an interesting toy or mobile for the baby to watch
• taking your baby for a walk in a front carrier or stroller Some parents are afraid that if they give too much
• taking your baby into a room with other people attention, they will spoil their baby. This is not true.
• rocking your baby Babies need attention, cuddling, and handling. When
• wrapping your baby snugly in a light blanket babies cry, they need more care, not less. Crying is their
and holding her way of telling you they need something. The best thing
to do is to pick up and cuddle your baby.
Never take a snugly wrapped baby to bed with you. What is colic?
Your baby may get too warm, and needs to be able There is no clear reason or prevention for colic. Infants
to use her arms and legs to move away from your who have colic tend to:
body if needed. • have long periods of crying, fussiness, and
restlessness throughout the day
• become more fussy in the late afternoon
or early evening
If your baby is over stimulated or overtired, try: • be difficult to soothe
• offering your breast • appear to be in pain
122 Yo u r B a b y
Colic can occur in breastfed or formula-fed infants. It Some formula-fed babies may react to cow’s milk-based
usually begins at about two to three weeks of age and formula. Talk about any formula changes with your health
lasts until the third or fourth month. Colic usually stops care practitioner.
quite suddenly. Never, ever shake your baby.
Colic is not your fault, and anxious or tense parents do not
Colic can be very disturbing to the whole family. It can be cause it. A colicky baby can be very difficult to cope with If you have a babysitter tell her she
hard to stay calm while caring for a colicky baby. If you’re on your own. Before the stress of the baby’s crying becomes must never shake or hit your baby.
stressed and frustrated by the baby’s crying, and feel you unbearable, ask for help. Trusted friends, relatives, and
might hurt the baby, put the baby in the crib and close the neighbours may be able to help for short periods of time.
door. Take a break until you feel calmer or someone has
come to help you. If nothing helps, check with your health care practitioner
to ensure your baby is well. Your public health nurse or the
Although there are no proven treatments, parents have BC NurseLine (1- 866 -215- 4700) can also suggest help.
found some things that may help with colic, for example:
• carrying your baby as much as possible
• having a regular routine of feeding, sleeping, Shaken Baby Syndrome
and activity
• responding quickly to crying Shaken baby syndrome happens when a baby or small child
• lowering the lights and noise in the room is shaken hard. This shaking can cause serious injury to a
• gentle movements and rhythmic rocking baby’s neck or cause brain damage, blindness, paralysis,
• when your baby is fussy, don’t over-handle her mental retardation, and seizures. Some babies die from
or pass her among a lot of people being shaken. No parent thinks that he will shake his baby
• taking your baby for a car ride and cause her harm. Crying is the number one reason that
• massaging your baby caregivers harm babies.
• bathing your baby or taking your baby in
the bath with you Never shake, hit, or throw your baby, ever. It only takes
• some parents have developed special ways a moment to change your life — and your baby’s
to hold their babies that comfort them life — forever.
Sometimes mothers who have lots of milk have babies who If you feel angry or afraid that you may hurt your baby, put
act colicky. If you think this might be you, breastfeed longer your baby down somewhere safe and call someone to help
on the first breast before switching to the other breast. For you right away. Do not try to care for your baby when you
example, if you give both breasts for a feeding, give one are angry. Call someone from your support team, your
breast longer. If your baby takes just one breast, try giving health care practitioner or the Crisis and Information Line
the same breast at the next feeding. listed under “Other Emergency Numbers” near the front
of your local telephone book.
Occasionally, changes in your diet when you are
breastfeeding may help with colic symptoms. Try removing Only leave your baby with caregivers you can trust to
foods from your diet such as milk or other foods that you control their anger. Tell them they must never shake your
think may be causing the crying. Do this for a week to see if baby. If they are frustrated or cannot calm your baby, tell
it makes a difference to your baby. If the crying decreases, them to call you for help. If you know or think that
avoid that food until your baby outgrows the colic. If you someone has anger management problems, do not
plan to remove a major food or a whole food group, talk leave your baby with that person.
with a registered dietitian first.
Yo u r B a b y 123
If you have shaken your baby, call your health care
practitioner right away. Don’t lay your baby down If you are concerned about your baby:
I actually got out of the car at one hoping that he will be better after a rest. Delaying • If it’s an emergency, call 911 or the local
point and walked away. I couldn’t medical help can cause more harm to your baby. emergency number in your phone book.
believe I would just walk away from
my husband and baby like that but I Do not shake your baby if he is choking or needs • Check the BC HealthGuide handbook to learn
just cracked. The crying was too resuscitation. Shaking will only make him worse. about ways to manage over 190 health
much some times. But after a short conditions and concerns. This includes when
break and a cry, I got back in the car. to see a doctor or other health professional.
That’s what parenting is all about, Anger Management
just doing the best you can, day after • Visit BC HealthGuide OnLine and the BC
day, and realizing that being a It can be very difficult to deal calmly with a crying baby day HealthFiles at www.bchealthguide.org for more
parent doesn’t make you a super after day. Many parents feel they are responsible for the in-depth health information. These resources cover
human being. crying or that they are bad parents. Crying won’t last over 3,000 conditions and concerns. This includes
forever and it is OK to ask for help. when to see a doctor or other health professional.
Have a plan to help you stay calm and deal with the • Call the BC NurseLine, at 1- 866-215- 4700, to
difficult times. speak to a registered nurse if you need:
• more information
• If you are becoming angry, put your baby down and • help to decide when it’s best to
hold onto something you can’t throw. Count to ten, see a health professional
leave the room, cry into or pound a pillow, or run on • help to decide when its safe to
the spot. Don’t touch your baby until you are calm. try home treatment
• Ask someone to be your immediate back up, someone • Pharmacists are also available through the BC
you can call if you are losing control. Keep their NurseLine between 5 p.m. and 9 a.m. every day.
number close by your phone.
• If you need a translator for this information, BC
• Take regular breaks. Have someone take over so you NurseLine can provide service in 130 languages.
can rest, walk, or just get away. Be sure the caregiver
has a plan if the crying is hard to cope with. • If your baby is under the care of a doctor,
specialist, or other health care professional,
• Talk with your partner about how you can help always follow their advice. The BC HealthGuide
each other. handbook, online website, BC HealthFiles
and the BC NurseLine do not replace the
• Talk with other parents about how they coped. care provided by your doctor or other
health care professional.
• Talk with your health care practitioner about courses
on anger management or parenting.
124 Yo u r B a b y
Baby Medical Care
Vitamin K Injection every baby has a blood test. This is done by one heel prick
that is sent for testing. If the test is positive, the baby’s
The Canadian Pediatric Society advises that all newborns health care practitioner is told and more testing is planned.
have an injection of vitamin K within six hours after birth. If further testing is positive, the baby will be given
This injection helps prevent hemorrhagic disease of the treatment. The sooner treatment is started, the better
newborn. Hemorrhagic disease of the newborn is a it will be for the baby.
bleeding problem that occurs during the first few days of
life. Babies are born with low levels of vitamin K, an Some diseases include:
important factor in blood clotting. In the newborn, the low • Hypothyroidism. This is treated by giving the baby
level of vitamin K is the main cause of hemorrhagic disease. a daily pill containing thyroid hormone.
If you do not want your baby to receive the injection, talk • PKU (phenylketonuria), which is treated with a special diet.
with your health care practitioner. Giving vitamin K by
mouth may be an option. However, the recommended way • Galactosemia. This is treated with a special diet.
to give vitamin K is by injection. Oral vitamin K needs to
be given at birth and twice more over four to eight weeks. • Medium Chain Acyl-CoA Dehydrogenase Deficiency
(MCAD). This is treated with a special diet.
Erythromycin Eye Ointment Early Hearing Screening

New equipment is helping to screen hearing in younger
The Canadian Pediatric Society recommends that all and younger babies. If your hospital has this equipment and
newborns receive treatment to prevent an infection of has begun this program, it will screen the hearing of your
gonorrhea or chlamydia. These infections can get into the newborn and follow up with you as needed.
baby’s eyes during birth. Today, an eye ointment is usually
used to treat a baby’s eyes. If not treated, these infections
are severe and can cause blindness. Hearing
Treatment can be delayed for about one hour after birth. Good hearing is very important for normal speech,
This allows for parent-infant contact, for the baby to be language, and emotional development. Even mild or
skin-to-skin with the mother, and for breastfeeding. temporary hearing loss may result in delays in these areas of
development. An audiologist can test your baby’s hearing,
even shortly after birth. About one out of every 300 babies
Universal Newborn Screening will have some hearing loss at birth. Over half of babies with
hearing loss are healthy and have no history of risk factors.
Early Disease Screening
Even though your baby looks healthy in the first few days or Some risk factors for hearing loss are:
even months of life, certain rare diseases can be present at • family history of permanent childhood hearing loss
birth. If untreated, these diseases can cause permanent • low birth weight or admission to the special care nursery
mental retardation. Between 24 and 48 hours after birth, • jaundice that requires a transfusion
Yo u r B a b y 125
• exposure to some infections during pregnancy Thrush (Yeast Infection)
• unusual eyes, nose, ears, mouth, or palate
Thrush is a common infection in infants. Thrush appears as a
If your baby doesn’t get an early The most common cause of hearing problems in very young whitish-gray coating on the tongue and on the insides of the
disease newborn screening (blood children is ear infection (otitis media). Signs may include: cheeks and gums. This coating is not easily wiped off. Babies
test) in the hospital, talk to your • irritability may also develop thrush on their skin. Most babies do not
health care practitioner or public • pain have any pain or complications with thrush. For more
health nurse. • hand or fist to the ear information, see page 105. If you think your baby has
• fever thrush, see your health care practitioner.
• mild hearing loss
Many factors can contribute to the risk of ear infection. Circumcision

Having cigarette smoke in the household will increase
the risk of ear disease. Circumcision is surgery to remove the layer of skin (foreskin)
that covers the head of the penis and part of the shaft. The
If you think your baby cannot hear, or if you have questions Canadian Pediatric Society does not recommend routine
about screening, contact your health care practitioner or circumcision because it is not medically necessary. However,
audiologist immediately. For more information related to some parents may choose this for religious reasons. There is
hearing, see pages 137– 138. pain during and after the procedure. Complications from
circumcision include bleeding, infection, cutting the
foreskin too short or too long, and poor healing. The cost
Vision of circumcision is not covered by provincial medical plans.
From birth, babies can distinguish light and dark, shapes,

and patterns. When they are quiet and alert, babies can Allergies
focus on objects 18 to 45 cm (7 to 18 in.) away for brief
periods of time. Babies prefer to look at faces rather than Allergic symptoms in babies with food allergies
objects, especially their mother’s eyes. may include:
• stomach pains
It is not uncommon for your baby’s eyes to “wander” or • diarrhea
cross independently at times. This is normal in the first • vomiting or frequent spitting up
three months until he develops proper eye co-ordination. • skin rashes or eczema
Constant eye wandering should not be ignored. • constant runny nose
Some important points about your baby’s vision: These symptoms may have other causes. If your baby
• Children with a family history of a lazy or crossed frequently has any of these symptoms, talk them over with
eye are at a higher risk of having an eye problem. your health care practitioner or public health nurse. Ask for
a referral to a registered dietitian, doctor, or nurse who
• Early treatment of turned eye or decreased vision is specializes in allergies. If you are breastfeeding, you may
very important for sight. need to change your own food choices.
• If you have any concerns about your baby’s vision, Breastfeeding is the best way to prevent allergies to cow’s
contact your health care practitioner. milk and other foods. Babies from families with allergies are
126 Yo u r B a b y
more likely to have allergies themselves. For these babies, What is a normal temperature range?
avoid any exposure to cow’s milk or cow’s-milk formula. Your baby’s body temperature changes throughout the day.
Do not introduce solids until six months of age. It is lowest in the early morning and highest in the early
evening. Normal temperature taken under the armpit is Immunizations may cause a temporary
Removing a major food or a whole food group requires 36.5°C to 37.4°C (97.7°F to 99.3°F). Your infant may have a fever.
careful planning with a registered dietitian in order to meet higher or lower temperature and still be considered normal.
your nutritional needs. Ask your health care practitioner for
more information on food allergies. Taking your baby’s temperature:
• Do not take your baby’s temperature by mouth.
High Temperatures • Put the tip of the thermometer in the centre of

the armpit. Not every sick baby will have a fever,
Fever is usually caused by an infection. The source of the especially if they are less than one
infection can be bacteria or a virus. Fever is the normal • Tuck the arm snugly against the body, then comfort month old. Some signs of a sick baby
process of fighting an infection. It is important to watch and distract your baby. may be poor feeding or not acting
your baby’s behaviour. Often, this is more important than normally.
the actual degree on the thermometer. If you think your • After about one minute the thermometer will beep if
baby has a fever, take action right away. Babies less than it’s digital. If it is not digital, wait about five minutes. Contact your primary health care
six months old should be taken to their doctor if they Gently remove the thermometer and read the practitioner if you think your baby
have a fever. Call your health care practitioner or the BC temperature. may be sick. You can also call the BC
NurseLine’s 24-hour toll-free number, at 1-866-215-4700, NurseLine at 1- 866-215-4700.
if you are unsure. • An armpit temperature is usually 0.3°C (0.5°F) to 0.6°C
(1°F) lower than a reading taken from the mouth.
Some signs of fever in your baby are:
• the back of the neck feels hot, even when • If you find your baby has a temperature by taking
extra clothing is removed it under the arm, check it again.
• having no interest in usual things
• looking ill or overly sleepy • Forehead strips or pacifier thermometers are not good
• looking flushed or pale ways to take a temperature.
• may be sweaty
• may be extra thirsty When your baby has a fever, check the BC HealthGuide
handbook and use the helpful tips to learn when to consult
What kind of thermometer should I use? a health care practitioner and when to use home treatment.
Use an easy-to-read thermometer, such as a digital one.
A rectal thermometer is not recommended as this might Call the BC NurseLine for confidential health information and
cause rectal injuries. You might want to be prepared by advice to learn how to assess and manage your baby’s fever.
buying a thermometer before your baby arrives.
How should I take the temperature? Acetylsalicylic acid (ASA or aspirin) should not be
If you suspect that your baby has a fever, you can check given to babies, children, or teenagers. If used when
by taking a temperature under his armpit. there is a fever, there is a link between ASA and the
development of a very dangerous illness called
Reye’s Syndrome (see page 148).
Yo u r B a b y 127
Baby Safety
As an intern, I cared for a three-
month-old baby with both legs Maintaining Basic Hygiene
fractured from falling off a change
table. When we had our own babies, During your pregnancy and after the birth of your baby, • Post poison control, ambulance, and doctor’s numbers
I changed, bathed, fed, and played you can keep your family healthy by following these and other emergency numbers near your phone so
with them on a blanket on the floor practices: you can find them quickly.
to make sure they would never fall.
Washing hands — wash your hands with soap and water • Install smoke detectors and a fire extinguisher. Plan an
for 15 seconds before feeding your baby, after using the escape route to help you and your baby get out safely
bathroom or handling diapers, handling pets, sneezing, or in case of fire. Check your smoke detector batteries.
coughing. Make sure your older children do this as well. A helpful hint — check them each time you turn your
clock forward in the spring and back in the fall.
Cleanliness — keep high chairs, bibs, and eating areas clean
by washing with water and soap after each use. Clean and • To prevent burns, keep the temperature in your hot
sanitize other surfaces in the home. It is important to clean water heater below 49°C (120°F).
the surfaces that your baby will come in contact with.
These include floors, toys, teething ring, crib, stroller, • Remove leaded PVC mini-blinds that may be in your
changing table, etc. Hint: Use a bleach/water solution. home. Do not have any dangling cords in or near the
baby’s crib or the floor.
For additional information, see Food Safety on page 41 and
Pet Safety on page 42. • Know how to help a choking baby. Courses on basic
first aid and baby and home safety may be available
through community centres, St. John Ambulance, and
General Home Safety Tips the Red Cross. Check with your public health nurse
for courses in your area.
You will have to protect your baby from all danger. Not
surprisingly, most injuries can be prevented and happen • Furniture such as bookcases or television stands that
in your own home: could topple or fall during an earthquake should be
• when you are not prepared for your baby’s next stage fastened to the wall.
of development, such as learning to roll over,
crawl, or walk • See Toddler’s First Steps for more information on
childproofing your home (see Resources).
• when you are busy with something else
Keeping Your Baby Safe
• when either you or your baby are tired • Toys should be soft, non-toxic, and washable.
Toys that have no removable small parts or sharp
Childproof your home before your baby begins edges are best.
moving around.
• Fasten carpet on stairs and remove loose rugs to avoid • Keep small objects, such as pins (e.g., large diaper
falling while carrying your baby. pins), coins, buttons, marbles, and disc batteries,
out of reach and in safe containers.
128 Yo u r B a b y
• Keep all small objects out of the crib and out of reach. Do not leave your infant in a drop-sided mesh playpen
unless all of the sides are fixed firmly in the fully raised
• Never leave your baby alone with a toddler, a pet, position. Do not put scarves, necklaces, long cords, pillows,
a bottle, or on a soft surface. or large toys in a playpen. Many brands of playpens made
in the 1990s have been recalled because they can injure
• To prevent burns, never hold the baby while or kill babies. Always check for recalls before accepting
smoking, drinking a hot drink, cooking, or handling a second-hand playpen or portable crib.
a hot utensil.
Baby Walkers
• Move baby’s crib away from long mobiles, blinds, Baby walkers are banned in Canada because they allow
or curtain cords to avoid strangling. babies to move too fast and can cause serious head injuries.
Instead, use an activity centre that doesn’t move around
• Always ask door-to-door canvassers and service on the floor.
personnel for ID. Public health nurses will call to
make an appointment and should also be Soothers
wearing identification. • Make sure the soother is a one-piece design.
• If your baby has thrush, replace or boil the soother

Safe Baby Equipment for two minutes each day to prevent re-infecting your
baby’s mouth.
Playpens
Playpens must meet these guidelines: • Wash the soother with warm water. Be sure it is clean
• Playpen walls should be mosquito-type netting. for your baby.
Your little finger should not be able to pass through
the mesh. • Never wet the soother in your own mouth as this
passes your mouth germs to your baby.
• Have no more than two wheels or casters.
• Throw away any soother with an unusual colour or
• Have walls at least 48 cm (19 in.) high. texture or if it becomes sticky, cracked, or torn.
• All parts must be free from rough or sharp edges. • Check the soother often — give a strong tug on the
Hinges should be designed to prevent pinching or nipple to make sure it won’t come off the shield.
unintended collapse.
• Never use a cord to attach the soother to your baby.
• Any open holes drilled in metal, plastic, or wood
components should be less than 3 mm (1/8 in.) or • Never dip the soother into honey or any other
more than 10 mm (3/8 in.) in diameter. sweetener. This causes tooth decay.
• All parts that are small enough for a baby to choke

on must be firmly attached. Do not give honey to babies less than12 months of
age. It can cause serious infection.
• Vinyl rails and mattress pads should not be torn.
Yo u r B a b y 129
3 T R O LLE R S
s 5 SE TH E FIVE POIN T H ARN ESS TO PREVEN T YOUR BABY FROM
FALLIN G FOR W ARD AN D TIPPIN G THE STROLLER OVER
s " E C AREFUL TO PREVEN T IN JUR Y TO FIN G ERS W H EN FOLD ING

AND UN FOLD IN G A STROLLER !LSO BE C AREFUL W H EN
C H AN G IN G TH E H AN D LE ON REVERSIBLE H AN D LE STROLLERS
s $ O NOT H AN G YOUR PURSE OR H EAVY PAC KAG ES ON TH E

STROLLER H AN DLE 4 HEY C AN UPSET TH E STROLLERS BALAN C E
s # HEC K TH E STROLLER REG ULARLY FOR SH ARP ED G ES LOOSE

FOLD IN G PARTS BRAKES TH AT D ON T W ORK PROPERLY AN D
LOOSE W H EELS
s !LW AYS READ TH E M AN UFAC TURERS IN STRUC TION S FOR A

N EW OR USED STROLLER
s . EVER USE A C ARRIER W H ILE SKIIN G JOG G ING BIKING
*O G G I N G O R 2 U N N I N G 3 T R O L L E R S OR IN A C AR
*OG G ING STROLLERS ARE M EAN T FOR UN EVEN SUR FAC ES SUC H AS
PATHS TRAILS OR SN OW 5 N TIL YOUR BABY IS AT LEAST ON E YEAR s $ O N OT USE A C ARRIER W HEN YOU ARE D OIN G AN Y AC TIVITY
OLD D O N OT JOG W ITH YOUR BABY IN ON E OF TH ESE STROLLERS SUC H AS C OOKIN G THAT C OULD HARM YOUR BABY
)N FAN TS H AVE W EAK N EC K M USC LES AN D C AN N OT H AN D LE TH E
C ON STANT JOSTLIN G OR TH E BUM PY TERRAIN W HEN ON TRAILS )F s ' IV E Y O U R B A B Y P LE N T Y O F T IM E O U T O F T H E C A R R IE R T O
USED AS A STROLLER FOR IN FAN TS TH EY M UST H AVE A FULLY REC LIN IN G M O V E C R A W L A N D E X P LO R E H E R E N V IR O N M E N T
SEAT !LW AYS USE A FIVE POINT H ARN ESS TO SEC URE YOUR BABY
IN TO THESE TYPES OF STROLLERS 4 H EY ARE BULKY AN D D O NOT FOLD &R A M E D " A C K # A R R I E R
EASILY SO M AY N OT BE TH E BEST C HOIC E IF YOU PLAN TO LOAD A s $ O N OT USE A FRAM ED BAC K C ARRIER UN TIL YOUR BABY C AN
STROLLER IN TH E BAC K OF YOUR C AR SIT ALON E ABOUT SIX M ONTHS OF AG E
" A B Y # A R R IE R S s . EVER LEAVE YOUR BABY ALONE EVEN W H EN IT SEEM S SAFE

" ABY C ARRIERS C AN BE SOFT STRAP ON C ARRIERS SLIN G S OR FRAM ED
BAC K C ARRIERS s 4 H E C ARRIER SH OULD H AVE A W ID E SOLID BASE SO IT C AN T
TIP OVER . EVER PLAC E THE C ARRIER ON A TABLE W ITH YOUR
3AFETY TIPS FOR SLIN G S OR STRAP ON C ARRIERS B A B Y IN IT
s !LW AYS READ TH E IN STRUC TION S FIRST
s )F A SEAT HAS W IRE SUPPORTS THAT SNAP ON THE BAC K M AKE
s - AKE SURE IT H AS A FIRM PAD D ED H EAD SUPPORT TH AT SURE TH EY ARE SEC URE
AD JUSTS TO TH E SIZE OF YOUR BABY
s &ASTEN STRAPS AND RESTRAININ G BUC KLES EVER Y TIM E YOU
s # H E C K T H A T T H E LE G H O LE S A R E W ID E E N O U G H FO R Y O U R USE TH E SEAT 4 HEY SH OULD BE AD JUSTED TO FIT
BABY TO BE C OM FORTABLE BUT SM ALL EN OUG H TH AT TH E C O M FO R T A B LY A N D T O P R E V E N T Y O U R B A B Y FR O M
BABY C AN T SLIP TH ROUG H TURN IN G IN THE SEAT
9OUR " A BY

Babies in back carriers should not be placed on tables, When using your child seat:
counters, or furniture. An active baby may lunge forward, • Never place a rear-facing child seat in a vehicle seat
tip the carrier, and fall to the floor. This can cause a equipped with an active air bag.
head injury. When you leave the car for any
• A rear-facing seat is safest. Use a rear-facing seat for as reason, take time to unbuckle the
long as possible, at least until one year of age. child seat and bring your baby with
A framed back carrier is not a car seat and must you. An infant should never be left
never be used as one. • Follow the instructions in your vehicle’s owner’s alone in a vehicle! Never. Not for any
manual and the instructions that come with your length of time.
child seat. They contain important information for
safe installation of the seat.
Infant/Child Car Seats • If you are securing the child seat with your vehicle’s
lap belt, make sure it is long enough to go through
Use an infant/child car seat every time your child travels the child seat’s frame or over the seat according to
in a car. Car seats are required by law and must meet the instructions.
Canadian Motor Vehicle Safety Standards (CMVSS).
• Some lap-shoulder belt systems will need a locking
When buying a child car seat: clip. This special H-shaped metal clip must be used to
• Look for the CMVSS label. Do not buy a child seat in lock the lap and shoulder portion of a seat belt to keep
the United States — it will not have this label. the child seat in position. Refer to the owner’s manual
for your vehicle for specific information.
• Look for a child seat that is easy to use and fits in your
vehicle. Try it in your vehicle before buying it. Be sure Infant Seats
it is easy to use so you will use it correctly every time. • Infant seats are for infants from birth or 2.3 kilograms
(5 pounds) up to 9 to10 kilograms (20 to 22 pounds).
• Look for a child seat with at least two sets of shoulder
harness strap slots to allow room for growth. • Infant seats must be used in the rear-facing position.
Make sure they are easy to adjust. Always follow the manufacturer’s instructions for the
seat and your vehicle when putting the seat in
It is recommended that you do not buy a second-hand your car.
child seat. If you do, the child seat should be inspected
and checked for any possible recalls. Make sure a second- • The safest place for the infant seat is in the middle
hand child seat meets CMVSS standards. Do not use a child of the back seat.
seat that has been in a crash or has passed the expiration
date stamped on the seat. If no expiration date is present, If your baby has outgrown the infant seat and is still under
check with the child seat manufacturer and do not use a one year of age, use a convertible seat in the rear-facing
seat that is more than 10 years old. posiiton. Your baby has outgrown his infant seat if he
weighs over 9 to 10 kilograms (20 to 22 pounds) or his
If you want to rent a child seat, contact your local health head is within 2.5 centimetres (1 inch) of the top edge of
office for the names of local rental/loaner programs. You the seat. Use the convertible rear-facing seat until your baby
can also call the toll-free Child Seat Information Line is at least one year old or exceeds the rear-facing weight
1-877-247-5551 for a list of providers. limit of the seat. This will prevent severe head and spinal
cord injuries in a crash.
Yo u r B a b y 131
Convertible Rear-facing Seats • When rear-facing, the harness straps should be at your
• A convertible seat should only be used when your baby's shoulders, or slightly below, to ensure a snug
baby has outgrown the infant seat, weighs over fit. Raise the harness straps to the next slots in the seat
Besides always putting your baby in 9 to 10 kilograms (20 to 22 pounds), and is still back when the infant’s shoulders are level with or
an infant or child seat, vehicle safety under one year of age. above the lower slots.
includes removing any loose, break-
able, and sharp objects from inside • A convertible seat with a five-point harness is • Avoid the use of head huggers that were not
the vehicle. recommended. manufactured with the child seat. A rolled receiving
blanket or towel, one on either side of the baby’s head
Correct Installation and body will provide support. A rolled washcloth or
• Place the child seat, rear-facing, in the back seat. Read diaper between the crotch and the crotch strap can
and follow instructions that come with the child seat. prevent slouching.
• Lower the carrying handle behind the infant seat. • Place your baby in the seat and fasten the harness
snugly. Only one finger should fit between the harness
• Maintain the correct reclining angle for the child seat. and the baby’s collarbone.
The back of the rear-facing seat should be tilted back
to a maximum of 45 degrees so the baby’s head and • Avoid dressing your baby in heavy clothing or bunting
body lie back comfortably. If your baby’s head falls bags. Dress your baby in clothes that have arms and
forward, the seat is too upright. legs. In cold weather, put blankets over your baby
after he’s been fastened in the seat.
• Secure the child seat with the Universal Anchorage
System (UAS) or with the adult seat belt and, if • On each trip, check the harness tension and raise the
necessary, use a locking clip. chest clip to the level of your baby’s underarms.
The chest clip holds the harness straps in place on
• Check the ICBC website for more information the shoulders.
www.icbc.com/Road_Safety/carseat_instal_moreeq.
html#clip • Double back all harness straps that pass through
buckles to prevent them from slipping under tension.
Never place a rear-facing infant or child seat in the front • Be sure that anyone who will have your baby in their
seat if there is an active air bag. car is aware of the correct use of child seats.
• For small babies, use a child seat without a lap pad or

shield as these may come into contact with the baby’s
Correct Harnessing face and neck.
• Always check the manufacturer’s instructions and your
vehicle’s owner’s manual. Reproduced and adapted with permission from the Insurance
Corporation of British Columbia
• Buckle your baby into the infant/child seat before
every trip, no matter how short. For more information on car seats, see www.canadian-
health-network.ca/ and search for “car seats.”
132 Yo u r B a b y
Special Circumstances
I was scared to touch my son at first;
Preterm Babies Low Weight Babies he was so small and fragile. All of the
wires, tubes, and alarms put me off
Preterm babies or preemies are those who are born before About one-third of low birth weight babies (less than 2.5 kg for the first day. After that I got so
37 weeks gestation. Preemies may have immature organ or 5 1/2 lb.) are born at term (40 weeks gestation). used to it all that I was completely
systems. Generally the younger your baby’s age at birth, comfortable handling him. My tip
the more health problems she may have. If your baby is Low weight babies may have some of the complications would be to take each day one at a
36 weeks gestation at birth he may have very few, or no seen in the preterm baby. As with the preterm baby, the time. Ask questions until you are
problems at all. On the other hand a baby born at low weight baby should be encouraged to have skin-to-skin satisfied. Count the blessings you are
25 weeks gestation would be expected to need intensive contact or Kangaroo Care. This will keep the baby warm given, like today he’s feeding better,
care and monitoring. Birth weight is usually closely related and encourage extra breastfeeding. You may need extra or he’s grown. Don’t focus on what
to the length of the pregnancy. support with breastfeeding. could go wrong.
Your preterm baby may need to be separated from you at Once at home, it is important that your preterm or low
birth if special care is required. Have your partner go with weight baby be placed on her back for sleeping.
the baby to the nursery if possible. You should be able to
visit your baby soon after the birth.
Twins, Triplets, or More
Preterm babies, like all babies, need to be touched, stroked,
and talked to, even while inside the incubator or isolette. Multiple births can cause complications with your More than 4,000 sets of twins and
When your baby is well enough, you may be encouraged to pregnancy, labour and birth. The babies can be delivered more than 75 sets of triplets,
have skin-to-skin contact. This is called Kangaroo Care. Your vaginally or by caesarean section. The type of delivery quadruplets, and quintuplets (com-
baby is unwrapped and placed on your chest where he can depends on the position of the babies in your uterus, their bined) are born in Canada each year.
hear your heart beat, feel you breathing, and breastfeed. A gestational age, and their health.
warm blanket is placed on the baby. Research shows that Almost 50% of twins and 90% of
babies who have lots of contact with their mothers grow Multiples can be breastfed successfully. Feeding early and triplet, quadruplet, and quintuplet
faster than babies who don’t. often will help you to have enough milk for all of your babies are born preterm and/or have
babies. Try different positions for holding your babies while low birth weight.
Small babies may have problems with feeding. Often you breastfeeding. Parents of multiples need extra support and
will need to pump breast milk to give for feedings. assistance with their infants. Do not be afraid to ask for help
when you get home.
Preterm babies may have problems breathing while in an
infant car seat. They may be more floppy and the chin may
drop down on the chest blocking breathing. They need to
be checked in their car seat before leaving the hospital.
After a feeding, the baby will be place in his car seat and
observed for about an hour. The baby will be observed
longer if the drive home is more than an hour.
Yo u r B a b y 133
" A B Y $ E VE LO P M E N T
) F Y O U H A V E A N Y C O N C ER N S A B O U T Y O U R
B A B Y S D E V E LO P M E N T O R IN T E R A C T IO N " ABIES D EVELOP Q UIC KLY BEC AUSE OF RAPID PHYSIC AL G ROW TH ( O W CA N ) B E A CA R IN G A N D N U R T U R IN G P A R E N T
W IT H Y O U C O N T A C T Y O U R H E A LT H C A R E AN D BRAIN D EVELOPM EN T 4 H IS IN TURN HELPS A BABY TO s + EEP SAFE ALW AYS KEEP YOUR BABY W ARM D R Y
P R A C T I T I O N ER T O G E T A D V I C E D EVELOP TH IN KIN G AN D LAN G UAG E SKILLS AN D TO G ROW C OM FORTABLE AN D SAFE
SOC IALLY AN D EM OTION ALLY - OST BABIES D EVELOP IN
PRED IC TABLE W AYS AN D PARENTS USUALLY H AVE A KEEN s + EEP H EALTH Y EN SURE YOUR BABYS HEALTH THROUG H
E Y E FO R W H A T T H E IR B A B Y IS D O IN G 0A R E N T S N E E D T O BREASTFEED ING AN D G OOD M ED IC AL C ARE
R E M E M B E R T H A T E A C H B A B Y IS U N IQ U E
s &OLLOW C UES LISTEN TO AN D W ATC H YOUR BABY )T IS EASY
7 H ILE YOUR BABY IS M OVIN G ALON G ON H IS OR H ER OW N TO OVER OR UND ER STIM ULATE A BABY &OLLOW TH EIR C UES
U N IQ U E D E V E LO P M E N T T IM E T A B LE Y O U A R E A K E Y P A R T N E R )F YOUR BABY TURN S H ER H EAD AW AY OR FUSSES OR C RIES
IN TH IS D EVELOPM EN T 9OUR C ARIN G N URTURIN G AN D SAFE SH E W ANTS TO STOP AN AC TIVITY
PAREN TIN G W ILL H ELP EN SURE YOUR BABYS OPTIM AL
D EVELOPM EN T ( ELP YOUR BABY UN D ERSTAN D THAT H IS s ' IVE PRAISE W HEN YOUR BABY AC C OM PLISHES
OR H ER W ORLD IS A SAFE AN D W ELC OM IN G PLAC E SOM ETH ING NEW G IVE EN C OURAG EM ENT C LAP
H UG HER M AKE H APPY N OISES ETC
s " E E N G A G E D B E T H E R E FO R Y O U R B A B Y A N D A LW A Y S
RESPOND G ENTLY AND SOOTHIN G LY
s $ ISC OVER YOUR BABY YOUR BABY H AS A UN IQ UE

PERSON ALITY 7 ATC H FOR THIS TO EM ERG E AND C ELEBRATE
YOUR BABYS UNIQ UEN ESS
9OUR " A BY

Physical Development
baby’s
During the first six months your baby will gain about 240 grams (8 ounces) per week. Your baby will sleep about 15 hours
per day in the first three to four months, and less time as she grows older. Eyesight and hearing develop and become more
physical
acute. Your baby’s brain continues to develop.
development
First month: Second month: Third month:
• weight will drop after birth but will • muscles relax and twitch less • stretches out arms and legs
be regained quickly • lifts head about 45 degrees while • rolls over from back to side
• hand, arm, leg, and rooting lying on tummy • holds head up to search for sounds
movements are all reflex motions • hands start to unfold and movement
• head flops if not supported • may reach and grasp an object for • discovers feet and hands
• focuses eyes at 18 to 45 cm a short time • holds objects longer Our daughter put everything she
• stares at high contrast patterns and • eyes move in unison and can track • swipes with arms could reach into her mouth. It got
objects but does not reach close moving objects • briefly bears weight on legs worse when she could move around
• recognizes mother’s voice • may roll over one way • responds to detailed, more. I always gave her something
• startles at noise high-contrast objects safe to play with when I was chang-
• cuts first tooth ing her and made sure anything
(3rd to 6th month or later) sharp or dangerous was a long way
out of her reach.
Fourth month: Fifth month: Sixth month:
• stands up and holds weight • rolls over from front to back • holds head steady
with help • grabs toes and feet • sits with back straight when propped
• rolls over from front to side • wiggles forward on floor • grasps small objects and
• lifts head about 90 degrees • reaches with a good aim studies them
• sits with arms propped • transfers objects from hand to hand • rolls in both directions
• reaches for objects • understands that object may be
• lets go of objects hiding behind another
• holds hands together
Activities for Healthy Development

• Always supervise your baby to • Provide bright hanging objects that • Take lots of walks with your baby in
prevent falling. make noise within hitting range. the fresh air.
• Baby proof your home so that • Give clean rattles and toys that your • Give safe, clean, chewable toys.
everything harmful is out of the way. baby can feel and mouth.
• Everything will go in the mouth.
• Hold the things you want your baby • Provide a variety of toys and objects Make sure objects are big enough
to see close to her eyes so she can with textures. that they cannot be swallowed.
focus clearly.
• Play in front of a mirror. • Extend bath time so your baby can kick
• Have lots of supervised tummy time on and squeal while you supervise. Never
a mat so your baby can kick and move. • Create safe play spaces on the floor. leave your baby alone in the bath.
Yo u r B a b y 135
baby’s Social/Emotional Development
social The first six months are an important time for you and your baby. Take time to give love, hugs, smiles, and lots of
reassurance. Can you spoil a new baby? No. Research has shown that well-loved babies do better in every way.
emotional What about crying? Again, research says that you should go to and comfort a crying baby within one or two minutes.
development First month:

• is alert 1 out of every 10 hours
Second month:
• responsive smiling
Third month:
• makes eye contact
• enjoys eye contact • communicates moods • smiles at faces and may laugh
• smiles at faces • enjoys visual stimulation out loud
• recognizes parents’ voices • studies faces • knows difference between parents
• begins to trust caregiver • your baby’s personality becomes and strangers
• cries if under or over stimulated more obvious • stops crying when you come in
• persistent crying can start at about • cries to have needs met the room
two to three weeks • persistent crying usually peaks in • persistent crying usually stops in
My mother-in-law kept saying I was the second month month three or four
spoiling our baby by carrying her all
the time and picking her up when Fourth month: Fifth month: Sixth month:
she fussed. But I had read about child • laughs hard when tickled • turns head toward speaker • mimics facial expressions
development and knew just the • greets caregiver • watches your mouth movements • exhibits moods with varied sounds
opposite was true. Now our little girl • starts social gestures • shows interest in colours and body movements
is trusting and calm. She knows we • may move arms to signal • pushes away disliked actions • may be shy or afraid of strangers
will always be there for her, and that “pick me up” • responds to her name
we come back if we’ve been away. • enjoys social interaction • raises arms to signal she wants to
I’m glad I listened to my own heart be picked up
and did what I knew was right. • likes her reflection

• Have skin-to-skin contact with • Don’t feel rejected if your baby • Don’t over stimulate your baby.
newborns. turns away from you — young
babies get tired easily. • Copy your baby’s movements
• Always respond to crying within one and sounds.
or two minutes. • Plan daily quiet times with
your baby. • Rock and cuddle your baby.
• Look into your baby’s eyes; you will
fall in love. • Don’t jiggle crying babies — • Do finger and toe playing.
use slow, gentle motions.
• Talk to your baby soothingly.
136 Yo u r B a b y
Language Development
baby’s
Babies first communicate by crying. Then they learn to make sounds and smile. This is “talking.” Eventually they learn to use
words. Communicating is a two-way street — so talk to your baby when your baby “talks” to you. Your baby will want to
language
“talk” with you using her language.
development
First month: Second month: Third month:
• responds to voices • discovers her own voice • begins extended vowel sounds,
• small cooing begins • gurgles, coos, and squeals e.g. “ah”
• responds when you talk • exhibits emotions • starts to laugh
• communicates with smiles, • smiles at mother or father • has different cries for different needs
gazes, and crying when they smile
• looks at mother’s or father’s
face when they talk
Fourth month: Fifth month: Sixth month:

• changes shape of mouth • babbles (“ba-ba”) • longer and more varied sounds
to change sounds • tries to mimic sounds (“ga-ga dada, papa”)
• sputters, gurgles • squeals and is interested in • experiments with different volumes
• begins babbling the sounds the parent makes and pitches of sounds
• laughs out loud • squeals with delight when happy
• makes sputtering sounds with the
lips and tongue
• makes sounds or talks to toys

• Talk to your baby using the language • Play games (peek-a-boo, imitating • Talk to your baby about what you
in which you feel most comfortable. sounds your baby makes, gentle think he is trying to tell you with his
Don’t worry if it is not English. tickling, shaking toys, etc.). coos, cries, and babbles.
• Comfort your crying baby with a • Talk to your baby about what you • Mimic any sounds your baby makes.
soothing voice and gentle words. are doing (bathing, diapering, This encourages your baby to make
nursing, etc.). more sounds.
• Hum to your child.
• Call your baby by name.
• Sing nursery rhymes and songs.
• Make sure your baby can see your
• Read and tell stories to your baby, face when you talk to him.
even your newborn.
Yo u r B a b y 137
7 H E N SH O U LD Y O U B E CO N CE R N E D A B O U T Y O U R . OTES
B A B Y S D E V E L O P M E N T
) F Y O UR B AB Y ?????????????????????????????????????????????????????
) F Y O U H A V E A N Y C O N C ER N S A B O U T Y O U R s H AS AN UN USUALLY STIFF OR FLOPPY BOD Y
B A B Y S D E V E LO P M E N T O R IN T E R A C T IO N s IS N O T W A T C H IN G FA C E S B Y T W O T O T H R E E M O N T H S ?????????????????????????????????????????????????????
W IT H Y O U C O N T A C T Y O U R H E A LT H C A R E s IS UN USUALLY Q UIET OR PLAC ID
PRAC TITIONER TO G ET AD VIC E s H AS UNUSUAL D IFFIC ULTIES W ITH FEED IN G ?????????????????????????????????????????????????????
s D OES N OT STARTLE TO LOUD NOISES
s H OLD S H AN D S IN TIG H T FISTS ?????????????????????????????????????????????????????
s D O E S N O T FO LLO W A C T IV IT IE S W IT H H IS E Y E S
s D OES N OT SEEM TO REC OG N IZE H IS M OTH ER ?????????????????????????????????????????????????????
s D O E S N O T V O C A LIZ E
s D OES NOT SEEK SOUN D S W ITH H IS EYES ?????????????????????????????????????????????????????
s IS PERSISTEN TLY UN ABLE TO SETTLE
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
?????????????????????????????????????????????????????
&OR M ORE IN FORM ATION ON YOUR C H ILD S D EVELOPM EN T AFTER
SIX M ON TH S REFER TO 4ODDLERS &IRST 3TEPS ! C OPY OF TH IS ?????????????????????????????????????????????????????
P U B LIC A T IO N IS A V A ILA B LE T O A LL " # P A R E N T S O F C H ILD R E N A G E D
SIX M ONTH S TO TH REE YEARS BY C ON TAC TIN G YOUR LOC AL PUBLIC ?????????????????????????????????????????????????????
HEALTH OFFIC E &OR OTH ER HELPFUL IN FORM ATION ON A VARIETY
OF TOPIC S RELATED TO IN FAN T AN D C H ILD D EVELOPM ENT AN D ?????????????????????????????????????????????????????
PAREN TIN G SEE THE # HILD $EVELOPMENT 3ERIES IN TH E
" # ( EALTH&ILES FOUN D AT W W W BC H EALTH G UID E ORG ?????????????????????????????????????????????????????
9OUR " A BY

4 H E LAST W ORD IN TH IS H AN D BOOK IS TO YOU AS A PAREN T ( AVING OUR BABY W AS TH E BEST TH IN G
9OU H AVE W ON D ER FUL OPPORTUN ITIES TO C ARE FOR AN D N URTURE W E H A V E EV ER D O N E 3 H E H A S B R O U G H T
YOUR BABY AN D H ELP YOUR BABY BEC OM E HAPPY AN D H EALTHY SUC H JOY NOT ON LY IN TO OUR LIVES BUT
7 H ILE YOU READ TH E W ORD S OF OTH ER PAREN TS TH IN K ABOUT TH E TO OUR W H OLE FAM ILY
K IN D O F P A R E N T Y O U W O U LD LIK E T O B E
( ERE ARE A FEW TH OUG H TS FROM OTHER PAREN TS ON H OW TH EY

W A N T T O P A R EN T
) W A N T T O B E A P A R EN T W H O
s IS TH ERE W H EN EVER M Y BABY NEED S M E
s FEED S M Y BABY W H EN EVER AND W H EREVER SH E IS H UN G R Y
s KEEPS M Y BABY SAFE
s KEEPS M Y BABY AS HEALTHY AS POSSIBLE
s P LA Y S W IT H M Y B A B Y E V E R Y C H A N C E ) G E T
s H E LP S M Y B A B Y E X P LO R E T H E W O R LD
s LISTEN S TO M Y BABY
s READ S AN D SIN G S TO M Y BABY
s KN OW S W HEN TO W ALK AW AY AN D C OOL D OW N
s KN OW S W H EN TO SEEK AD VIC E AN D HELP
s M AKES TIM E TO LOOK AFTER M Y OW N H EALTH 4AKE A FEW M OM EN TS TO RETH IN K YOUR SUPPORT TEAM
A N D D E C ID E W H O M Y O U M IG H T W A N T T O A D D
( E A LT H # A R E 3 U P P O R T
4ALK OVER YOUR PAREN TIN G D REAM S W ITH YOUR PARTN ER ????????????????????????????????????????????????
AN D TOG ETH ER W RITE D OW N A FEW G OALS YOU C AN USE TO
G U ID E Y O U R P A R E N T IN G ????????????????????????????????????????????????
0ERSON AL 3UPPORT
! . E W 3 U P P O R T 4E A M
! SUPPORT TEAM IS ON E OF TH E M OST IM PORTAN T RESOURC ES YOU ????????????????????????????????????????????????
C A N H A V E ) T C A N H E LP Y O U B E T H E P A R E N T Y O U W A N T T O B E
4 H R O U G H O U T T H IS H A N D B O O K Y O U H A V E E X P LO R E D T H E W A Y S ????????????????????????????????????????????????
SUPPORT TEAM S C AN H ELP D URIN G AN D AFTER PREG N AN C Y
/ N C E YOU LEAVE PREG N AN C Y BEH IN D AN D START TO C ARE FOR ????????????????????????????????????????????????
AN D N URTURE YOUR BABY YOU W ILL FIN D TH AT YOU N EED N EW
M EM BERS ON YOUR M ED IC AL AN D PERSON AL SUPPORT TEAM
Resources
Alcohol and Drug Information BC Dental Hygienists’ Association

All provinces and territories have programs for people Suite 311 9600 Cameron Street
with alcohol and other drug problems. Ask your health Burnaby, BC, V3J 7N3
care practitioner or check in the yellow pages under Phone: 604-415-4559
“Alcohol” or “Drug” information. or toll-free for members in BC: 1-888-305-3338
Fax: 604-415-4579
Residents of British Columbia can call the Ministry Email: info@bcdha.bc.ca
of Health’s Alcohol and Drug Referral Service. It is a Website: www.bcdha.bc.ca
confidential, information line to alcohol and other
drug programs in the province. BC HealthGuide Program
Phone: toll-free 1-800-663-1441 The BC HealthGuide Program has four components:
• The BC HealthGuide handbook. It is available in English
For information on breastfeeding and alcohol, visit the and French, and as the First Nations Health Handbook.
Motherisk website, or call its Alcohol and Substance To request your copy, call 1-800-465-4911.
Use Helpline.
Phone: 1-877-327-4636 • BC HealthGuide OnLine. This reliable website with
Website: www.Motherisk.org in-depth health information is found at
www.bchealthguide.org
BC College of Family Physicians
#350 1665 West Broadway • The BC HealthFiles is a series of easy-to-read one-page
Vancouver, BC V6J 1X1 Fact Sheets on a variety of environmental, public
Phone: 604-736-1877 health, and safety topics. These may be of interest
Fax: 604-736-4675 to you and your family. They can be found on
Website: www.bccfp.bc.ca BC HealthGuide at www.bchealthguide.org
BC College of Midwives • The BC NurseLine. This confidential telephone nursing

College Of Midwives Of British Columbia service is available 24 hours a day, seven days a week. It
Suite 210 1682 West 7th Avenue includes the BC NurseLine Pharmacist Service for
Vancouver, BC V6J 4S6 medication inquiries. The pharmacist service is available
Phone: 604-742-2230 between the hours of 5 p.m. and 9 a.m. daily. Both
Fax: 604-730-8908 services answer your health care questions and concerns,
Website: www.cmbc.bc.ca including when to see a doctor or visit emergency.
BC Dental Association Phone: 604-215-4700 (in the Lower Mainland)

Suite 400 1765 West 8th Avenue or toll-free elsewhere in BC: 1-866-215-4700
Vancouver, BC V6J 5C6 Deaf and Hearing Impaired: 1-889-215-4700
Phone: 604-736-7202 or 1-888-396-9888 Translation services are available in over 130 languages.
Fax: 604-736-7588
Email address: post@bcdental.org
Website: www.adsbc.bc.ca
140 Resources
Breastfeeding See BC HealthGuide and the Canadian Health Network for
La Leche League more tips and information on choosing child care providers.
Website: www.lalecheleague.org Website: www.bchealthguide.org
Website: www.canadian-health-network.ca
Registered Nurses Association of British Columbia, Policy
Statement: Breastfeeding: Protection, Promotion and Support: Dial-a-Dietitian
Website: www.rnabc.ca/registrants/publications_and_ For nutrition information for you and your baby.
resources/topic_policy_statements.htm Phone: 604-732-9191(Lower Mainland)
or toll-free 1-800-667-DIET (3438)
For information on formula feeding your baby, Website: www.dialadietitian.org
refer to HealthFile # 68l.
Website: www.bchealthguide.org/healthfiles Family Planning
Planned Parenthood Federation of Canada
Canadian Health Network Website: www.ppfc.ca
Website: www.canadian-health-network.ca
Sexuality and U
Canadian Pediatric Society Website: www.sexualityandu.ca
Website: www.cps.ca
Options for Sexual Health Facts of Life Line
Canadian Red Cross A confidential phone line staffed by registered nurses and
The Canadian Red Cross offers a ChildSafe Program that trained volunteers.
teaches CPR and basic skills for dealing with emergencies. Phone: 604-731-7803 (in the Lower Mainland)
Look in the white pages for your local branch. or toll-free 1-800-739-7367
Phone: toll-free 1-888-307-7997 Website: www.factsoflifeline.com
Website: www.redcross.ca
Family Violence
Children with Disabilities When violence happens, get help. If it is an emergency,
Your public health nurse can help if you think your baby has call 911 or the operator and ask for the police.
a developmental problem or a disability. Most communities
have an Infant Development Program for children. Staff in Crisis lines and transition houses in your community are
this program can help you with activities for your baby that listed under the Emergency tab found in the first portion of
will encourage development. You will also have help finding the TELUS (BCTel) phone book. (Note: In Vancouver, this
other support services. information appears inside the front cover page.)
Check BC HealthGuide for helpful information that includes You can get also information on the victim services closest
access to the database of the National Organization for Rare to you by calling the VictimLink phone line. The line
Disorders (NORD). operates 24 hours a day, 7 days a week.
Website: www.bchealthguide.org Phone: toll-free 1-800-563-0808
Access for hearing impaired: 604-875-0885
Child Care
Your local Ministry of Children and Family Development Pride Line: 7 days a week, 7 p.m. – 10 p.m.
office or health office can give you information to help you Phone: 604-684-6869 (Lower Mainland)
select a child care facility. or toll-free 1-800-566-1170 (outside Lower Mainland)
Resources 141
Fathering Motherisk
Canadian Father Involvement Initiative Provides specific support for pregnant and
Website: www.cfii.ca breastfeeding women. Motherisk call centre is
BC’s public libraries welcome open Monday to Friday from 9 a.m. to 5 p.m.,
new babies and their parents. Your Dads Can Eastern Standard Time.
community library has books CDs, Website: www.dadscan.org Phone: 416-813-6780
videos, and access to online informa- Website: www.motherisk.org
tion to help you care for your baby. Ask Dr. Sears
Library staff know what services and Website:www.askdrsears.com Motherisk Alcohol and Substance Use Helpline
agencies are in your community and Phone: toll-free at 1-877-327-4636.
how to contact them. Immunization Information
For information on immunizations, visit: Motherisk Nausea and Vomiting of Pregnancy Helpline
Research shows that reading to your Canadian Pediatric Society Phone: toll-free at 1-800-436-8477
baby helps the brain develop. Website: www.cps.ca
Libraries have books written for Motherisk HIV Helpline
babies and young toddlers. And best BC HealthFiles Phone: toll-free at 1-888-246-5840.
of all, libraries are free! To find your Website: www.bchealthguide.org/healthfiles
community library, look under Multiple Births
“library” in the blue pages of your BC HealthGuideOnline Multiple Births Canada
local telephone book. Website: www.bchealthguide.org Website: www.multiplebirthscanada.org
Or call your public health office or the BC NurseLine Talk with the staff in your local hospital or your public
Phone: 1-866-215-4700 health office for information on twins and triplets
associations and support groups in your area.
Insurance Corporation of British Columbia (ICBC)
For information on safe child restraints. Postpartum Depression
Public Affairs and Corporate Marketing, ICBC For information about postpartum depression support
240 151 West Esplanade groups, contact your public health nurse.
North Vancouver, BC V7M 3H9
Website: www.icbc.com The Pacific Post Partum Support Society has a guide for
mothers who have postpartum depression: Post Partum
Legal Paperwork Depression and Anxiety: A Self Help Guide for Mothers.
Employment Standards 104 1416 Commercial Drive
Website: www.labour.gov.bc.ca/esb/esaguide/ Vancouver, BC V5L 3X9
Phone: 604-255-7999
Forms for Birth Certificate and Registration of Birth Website: www.postpartum.org
Website: www.vs.gov.bc.ca/forms
The BC Reproductive Mental Health Program provides
PharmaCare Coverage counselling to women with depression in pregnancy
Phone: 604-683-7151 (Lower Mainland) and postpartum. They have information and resources
or toll-free 1-800-663-7100 (outside Lower Mainland) on their websites.
Website: www.healthservices.gov.bc.ca/pharme/ Websites: www.bcrmh.com and www.bcwomens.ca
142 Resources
Safe Start For advice on financial support, including BC’s Family Bonus
Safe start is an injury prevention program of BC Children’s or family maintenance, contact the Ministry of Human
Hospital. It provides information to parents and caregivers Resources. For information about enforcement of
on how to make homes and cars safer. maintenance orders, contact the Ministry of Attorney
Phone: 604-875-3273 (Lower Mainland) General. Check the blue pages of your phone book for
or toll-free 1-888-331-8100 (outside Lower Mainland) the nearest office.
Website: www.cw.bc.ca/safestart
Support groups, such as Parents without Partners, Mother
Sexually Transmitted Infections Goose! and Nobody’s Perfect, and the family resource
Motherisk offers information and counselling to Canadians program (Family Place) are in many communities. Contact
about HIV and other STIs (see Motherisk). your local public health office, mental health agency, or
Ministry of Human Resources office about programs.
Smoking Information
BC Smokers Helpline Nobody’s Perfect Parenting Program,
Phone: toll-free 1-877-455-2233 BC Council for Families
Website: www.quitnow.ca Phone: 604-738-0568
Health Canada If you plan to return to school, the Ministry of Human

Website: www.hc-sc.gc.ca/hecs-sesc/tobacco/quitting/ Resources may be able to help you look at options for
your education and planning your career.
BC Stop Smoking Project
Website: www.bc.lung.ca St. John Ambulance
St John Ambulance offers programs in first aid, CPR, and
BC HealthGuide OnLine child care. Local branches of St. John Ambulance are listed
Website: www.bchealthguide.org in the white pages of your telephone directory, and in the
Yellow Pages under “First Aid Services.”
Society of Obstetricians and Phone: 604-321-2651
Gynecologists of Canada Website: www.sja.ca
780 Echo Drive
Ottawa, ON K1S 5R7 Toddler’s First Steps
Phone: 613-730-4192 or toll-free 1-800-561-2416 Contains information about child care and development
Fax: 613-730-4314 from the ages of six months to three years old. Available
Website: www.sogc.org from your local public health office or the BC Ministry of
Health website.
Support for Parents Website: www.health.gov.bc.ca/cpa
Support programs, Pregnancy Outreach Programs (POP), /publications/firststeps.pdf
and family resource centres offer programs and services to
support families and single parents. Contact your local
health office or public health nurse for more information.
Pregnancy Outreach Programs

Website: www.bcapop.ca
Resources 143
' LO SSA R Y
ABD OM EN A M N IO T IC F LU ID B A CT E R IA L VA G IN O SIS

4 H E FRONT PART OF THE BOD Y BETW EEN TH E C H EST 4 HE LIQ UID TH AT SURROUN D S TH E FETUS )T H ELPS TH E ! SEX UALLY TRANSM ITTED D ISEASE OF TH E VAG INA THAT
AN D TH E PELVIS BABY BY ABSORBIN G BUM PS FROM TH E OUTSID E C AN BE C URED # AUSED BY BAC TERIA
M AINTAIN IN G AN EVEN TEM PERATURE IN SID E AN D
A CE T A M IN O P H E N ALLOW IN G TH E BABY TO M OVE EASILY 7 H EN TH E B ILIR UB IN
! M ED IC INE TH AT IS USED TO RELIEVE PAIN AN D AM NIOTIC SAC K RUPTURES AT BIRTH IT IS OFTEN 4 H E YELLOW C OLOURED SUBSTAN C E FORM ED W HEN THE
D EC REASE FEVER C ALLED TH E WA TER BREA KING E X T R A R E D B LO O D C E LLS B R E A K D O W N A FT E R B IR T H
%LIM IN A T E D FR O M T H E B A B Y S B O D Y IN IT S B O W E L
A CE T Y LSA LICY LIC A CID ! 3 ! A M N IO T IC SA C M OVEM ENTS )T IS THE C AUSE OF JAUN D IC E
# OM M ONLY KNOW N AS ASPIRIN ! D RUG USED TO 4 H E M EM BRANE IN SID E TH E UTERUS TH AT H OLD S TH E
RELIEVE PAIN AN D RED UCE FEVER $ O N OT G IVE ASPIRIN FE T U S A N D A M N IO T IC FLU ID 3 E E D IA G R A M O N " R A X T O N ( ICK S CO N T R A CT IO N S
!3! TO BABIES C H ILD REN OR TEENAG ERS BEC AUSE P A G E # O N T R A C T IO N S O F T H E U T E R U S T H A T O C C U R D U R IN G
THERE IS AN ASSOC IATION BETW EEN TH E D EVELOPM EN T PREG N ANC Y 4 HEY ARE NOT USUALLY PAIN FUL AN D
OF 2EYES 3YND ROM E AN D TH E USE OF ASPIRIN A N T IB IO T IC C AN LAST FOR ABOUT A M INUTE / FTEN C ALLED
$ RUG S USED TO FIG H T M AN Y INFEC TION S C AUSED BY PRA CTICING CONTRA CTIONS
!)$ 3 BAC TERIA !NTIBIOTIC S D O N OT W ORK AG AINST VIRAL
!C Q UIRED )M M UNE $ EFIC IEN C Y 3YN D ROM E )T C AN IN FEC TION S B R E E CH P O SIT IO N
D EVELOP IF ON E BEC OM ES IN FEC TED BY TH E ( )6 VIRUS 4 H E UNBORN BABYS BUTTOC KS BUTTOC KS AN D LEG S
A N T IH IST A M IN E OR LEG S ARE FAC IN G D OW N AND W OULD BE BORN FIRST
A M N IO CE N T E SIS ! D RUG TH AT AC TS TO RELIEVE TH E EFFEC TS OF H ISTAM IN E
! D IAG N OSTIC TEST FOR FIN D IN G G EN ETIC FETAL A N ORM AL BOD Y C H EM IC AL THAT IS TH OUG HT TO C AUSE
ABN ORM ALITIES SUC H AS $ OW N 3YN D ROM E )T IS USUALLY SYM PTOM S IN PEOPLE W H O ARE VER Y SEN SITIVE TO
D ON E BETW EEN TO W EEKS OF PREG N AN C Y )T IS VARIOUS ALLERG EN S SUBSTANC ES C AUSIN G A PERSON
D ONE BY REM OVIN G A SM ALL AM OUN T OF AM N IOTIC FLUID TO BEC OM E SEN SITIVE
USING A N EED LE UN D ER ULTRASOUN D G UID AN C E
! P G A R T E ST
! SIM PLE AN D EASY W AY TO M EASURE HOW H EALTH Y A
BABY IS 4 H E TEST RATES FIVE AREAS TH E BABYS HEART
RATE BREATH IN G M USC LE TON E REFLEX ES AN D SKIN
C OLOUR 4 H E RATIN G IS A N UM BER OUT OF A TOTAL OF
C ALLED TH E !PG AR SC ORE - OST BABIES SC ORE AN CA E SA R E A N
!PG AR BETW EEN AN D ! SURG IC AL PROC ED URE USED TO D ELIVER A BABY
TH ROUG H INC ISIONS IN THE ABD OM EN AN D THE UTERUS
" A B Y &R I E N D L Y ) N I T I A T I V E / FTEN REFERRED TO AS A C AESAREAN BIRTH OR # SEC TION
! G LO B A L P R O G R A M O F T H E 7 O R LD ( E A LT H / R G A N IZ A T IO N
7 ( / A N D 5 . ) # %& T O E N C O U R A G E P R A C T IC E S IN CE R VIX
HOSPITALS AN D C OM M UN ITIES TH AT PROM OTE PROTEC T 4 H E LO W E R P A R T O F T H E U T E R U S T H A T P R O T R U D E S IN T O
AN D SUPPORT BREASTFEED IN G TH E VAG INA TH ROUG H W HIC H THE BABY PASSES
D U R IN G B IR T H 3 E E D IA G R A M O N P A G E

chloasma making or using insulin (a hormone that makes it Entonox
The darkening of the skin around the eyes and possible for the body to use sugar as a source of The drug nitrous oxide, commonly known as
over the nose and cheeks during pregnancy. energy). Without the help of insulin, the blood laughing gas. It is used to relieve pain during labour.
Often called the mask of pregnancy. sugar level will become much higher than normal.
epidural
chorionic villus sampling (CVS) dilation Local anaesthetic given into the space around the
A diagnostic test used to detect genetic The opening of the cervix during the first stage of spinal cord, providing pain relief from the waist
abnormalities in the fetus. Done by removing labour. It is measured in centimetres and is about down. Used during labour and vaginal birth by
a small amount of chorionic villi tissue through 10 centimetres when fully opened. some women and for most caesarean births.
the woman’s vagina or the abdomen. The test is
unable to detect neural tube defects. doula episiotomy
A labour companion who is trained and An incision (cut) made in the area between the
chromosome abnormality experienced in childbirth, and provides continuous vagina and rectum to enlarge the space for the
Genetic defects in the structure of a baby’s physical and emotional support during labour, baby to pass through the vaginal opening.
chromosomes. birth, and the immediate postpartum period.
erythromycin eye ointment
circumcision Down syndrome An antibiotic cream used in the eyes of newborns
The surgical procedure to remove the layer of skin A genetic disorder that causes physical to prevent infection.
(foreskin) that covers the head of the penis and abnormalities and mental disabilities.
part of the shaft. family-centred care
ectopic pregnancy The process of providing safe, skilled care to meet
colic A pregnancy in which the fertilized egg begins the physical, emotional, and psychosocial needs of
Excessive and inconsolable crying in a normally to develop outside the uterus. each mother, newborn, and family. Pregnancy and
developing infant. birth are considered to be a normal and healthy life
eczema event. Also recognizes the importance of family
colostrum A skin rash that often has itching, swelling, support and participation and care is adapted to
The first breast milk produced. It begins to be blistering, oozing, and scaling of the skin. meet their needs.
produced during pregnancy and is important
for the baby’s first feedings. effacement feeding on demand
The ongoing thinning and shortening of the cervix Feeding a baby on cue when they indicate hunger
cue-based feeding during the first stage of labour. by watching for the baby’s feeding cues. Newborns
Feeding an infant when she shows an interest in feed frequently. This is the preferred approach.
feeding before reaching the crying state. Feeding embryo A regular timed schedule is not followed.
cues include: rapid eye movements (eyes moving The developing baby from the fourth week after
under eyelids), waking, stretching, stirring, hand-to- the egg has been fertilized until the eighth week fetal
mouth movements, sucking, licking, and rooting. of pregnancy. The unborn baby or fetus.
dehydration engorgement Fetal Alcohol Spectrum Disorder (FASD)

Loss of water from the body. Usually due to not Occurs when the breasts become overly full The full range of birth defects and disabilities
taking in enough fluids. Can be serious. (swollen), hard, and painful. It is prevented by early that can result from with drinking alcohol during
(soon after birth) and frequent breastfeeding, not pregnancy. Can range from mild to very severe
diabetes restricting the time for feeding, and ensuring the defects and developmental delays. Is totally
A disease that occurs when the body has difficulty baby is welll latched on and feeding well. preventable by not drinking during pregnancy.
145
fetus hemorrhagic disease Kangaroo Care
The unborn baby from eight weeks until birth. A bleeding problem that can occur during the first Care that places a baby, even preterm babies,
Also spelled foetus. few days of life. Vitamin K is given to newborns to skin-to-skin with a parent. Babies benefit from the
prevent hemorrhagic disease. smell, sound of the heartbeat, and the warmth the
folic acid parent provides. Improves the growth of preterm
One of the B vitamins that women of childbearing hemorrhoids infants and gives parents an opportunity to be
age (18 – 45 years old) are recommended to take Painful, itchy, and sometimes bleeding veins that close to their baby.
before pregnancy and in early pregnancy to bulge out around your anus, especially during
prevent defects of the spinal cord, such as pregnancy or after birth. Kegel exercises
spina bifida. Exercises to strengthen the vaginal and perineal
HIV (Human Immunodeficiency Virus) area (between the vagina and anus).
forceps The virus that causes AIDS (Acquired Immune
Spoon-like instruments that are placed on either Deficiency Syndrome). Can be passed from the labia
side of the baby’s head during some deliveries. mother to the unborn child. Antiviral drugs are The fold of skin, on both sides, at the opening
They are used to gently help pull the baby out. used to help prevent infant infection. of the vagina in females. (See diagram on
page 149.)
fundus HSV (herpes simplex virus)
The top part of the uterus. Common viral sexually transmitted disease. labour nurse
Registered nurse who provides nursing care to the
galactosemia hypertension pregnant mother and supports the family during
One of the disorders included in the Newborn High blood pressure. labour and birth.
Screening Test. A baby with this disorder cannot
process galactose, a sugar found in milk. This is hypothyroidism lactation consultant
treated with a special diet. One of the disorders included in the Newborn A healthcare provider who has training and is
Screening Test. A baby born with this disorder certified to help women with breastfeeding. This
gestational diabetes cannot make enough thyroid hormone. Thyroid person receives a certificate from the international
Diabetes that can develop during pregnancy and hormone keeps a baby’s body growing strong and board of lactation consultants.
usually disappears after birth. Women with healthy. Treated by giving a pill of thyroid
gestational diabetes are at increased risk for hormone each day. lanugo
developing diabetes in later life. Fine hair that covers the body of the fetus.
incontinence
glucose screening (glucose tolerance test) Leakage of urine. let-down reflex
Screening test used to screen for gestational Hormonal reaction to the baby sucking on the
diabetes. Measures the mother’s blood after intravenous (IV) breast that causes milk to flow into the breasts.
drinking a liquid high in sugar. Giving fluid through a vein. May be felt as a warm, tingling feeling.
groin jaundice leukemia

The place where the abdomen and the thigh meet. The breaking down of extra red blood cells, Cancer of the tissues in the bone marrow, spleen,
forming a yellow substance called bilirubin. When and lymph nodes.
group B streptococcus (group B strep) extra bilirubin accumulates, it appears in the skin,
Bacteria that is found in the vagina and bowel of the mucous membranes, or the whites of the eyes. linea nigra
15 – 20% of healthy pregnant women. It can pass Common in newborns. A dark line between the pubic bone and the navel
from the mother to the baby during birth and that appears in some women. Due to hormonal
cause serious infection. Treated by antibiotics. changes during pregnancy.
146
lochia morning sickness placenta
Bloody discharge flowing from the uterus and Nausea and vomiting that woman may experience The structure that grows on the wall of the uterus
vagina following birth. during pregnancy. Commonly seen in the first during pregnancy that connects the fetus to the
trimester but can occur throughout the pregnancy. mother. Blood passes through the placenta to the
lymphoma baby, providing oxygen, nutrition, and antibodies.
A tumor or condition affecting the lymph tissue. non-stress test Blood circulated back to the mother’s body brings
Electronic monitoring test used before labour to waste from the baby’s body for removal. The
mastitis check the functioning of the fetus’ heart rate placenta also produces a number of hormones
An infection of the breast tissue and/or milk ducts. patterns in response to fetal movement. that affect the body during pregnancy. (See
There is always a hard, swollen, red, painful area diagram on page 149.)
in the breast. otitis media
Infection of the middle ear. Most commonly seen placenta previa
maternal serum screening in young children. It frequently follows or occurs A condition in which the placenta covers all or part
Blood test offered to pregnant women to screen at the same time as an upper respiratory of the cervix. It can cause bleeding.
whether they are at an increased risk of carrying infection (cold).
a baby with either Down syndrome or an open plaque
neural tube defect (spina bifida). oxytocin A sticky film of bacteria that is present in the
A hormone naturally produced by the body that is mouth all the time. This bacteria is the primary
meconium responsible for starting uterine contractions. cause of inflammation of the gums (gum disease
The baby’s first bowel movement. It is a sticky, or gingivitis) and tooth decay.
greenish-black substance present in the baby’s perinatal nurse
intestine before birth. It is passed for one to two A Registered Nurse who provides nursing care for positional plagiocephaly
days after birth. the woman, newborn, and the family during The flattening of one side or the back of the baby’s
labour, birth, and postpartum. head. It is caused by the baby always lying in the
Medium Chain Acyl-CoA Dehydrogenase same position.
Deficiency (MCAD) perineum
One of the disorders included in the Newborn The area between the vagina and the anus, posterior position
Screening Test. A baby with MCAD may have including the pelvic floor muscles, the external The back of the unborn baby’s head is toward
problems using fats stored in their body for energy. genitals, urethra, and anus. (See diagram on the mother’s back.
The baby is healthy when eating well. This is page 149.)
treated with a special diet and not fasting. postpartum
Phenylketonuria (PKU) The period after childbirth.
menstruation One of the disorders included in the Newborn
A woman's monthly bleeding. It is also called Screening Test. A baby with PKU is missing an postpartum blues
menses, menstrual period, or period. enzyme that is needed to process the essential Occur within the first 3 – 5 days after birth.
amino acid phenylalanine. It is found in certain Up to 80% of mothers can experience temporary
milia foods. This is treated with a special diet. emotional distress (from happiness to sadness).
Small white raised spots commonly seen on a In most women these resolve without treatment
newborn’s face. Milia are caused by plugged oil pica within a week or two. Also known as the “baby
glands and usually clear within three to four weeks. An unusual craving or compulsion to eat non-food blues.”
substances. Examples of common substances
craved for in pregnancy are dirt, clay, and
laundry starch.
147
postpartum depression quickening sexually transmitted infections (STIs)
A variety of emotional problems that can affect the The first time a baby’s movements can be felt Once called venereal diseases, these are spread
mother after giving birth. It is described as a group by the pregnant woman. mostly by sexual contact. There are about 20
of symptoms that can change a woman’s mood, identified types, including herpes, Hepatitis B,
behaviour, and outlook. Registered Midwife Chlamydia, AIDS/HIV, genital warts, gonorrhea,
A trained professional who provides care for and syphilis. They can cause sterility, miscarriage,
pregnancy gingivitis women during normal pregnancy labour, birth, ectopic pregnancies, etc., and can affect the baby
Red, swollen, tender, and bleeding gums. and after the baby is born. while in the uterus or at the time of birth.
Pregnancy gingivitis is caused by hormonal Treatment and prevention is available for
changes in pregnancy combined with poor oral Reye’s syndrome most STIs.
hygiene. It can be prevented with correct gum A serious disease that affects the organs of the
care. If the condition persists, or there is extreme body. It can cause very serious damage to the liver shaken baby syndrome (SBS)
swelling, see a dentist or dental hygienist. and the brain. Because there is an association Shaken baby syndrome is a form of non-accidental
between the development of Reye’s Syndrome and head injury with or without impact, that results
pregnancy-induced hypertension (PIH) the use of aspirin (ASA), babies, children, and from violent shaking. It is a form of child abuse
High blood pressure that occurs in pregnancy in a teenagers should not be given aspirin (ASA). and can cause serious lifelong injuries or death.
woman who has had normal blood pressure. High
blood pressure disappears quickly after birth. Rh-negative show
Women who are Rh-negative can develop Blood-tinged vaginal discharge that may be one of
pre-labour antibodies to an Rh-positive baby. If there is mixing the signs of labour. Bloody show continues as
The time before labour actively begins when the between the blood of the mother and baby, the labour progresses. It has blood in it because small
uterus may start gentle but irregular contractions woman’s body may respond by developing blood vessels in the cervix break as the cervix thins
(Braxton Hicks). antibodies as if it is allergic to the baby. This can and opens.
be very serious for the baby. This is preventable.
prenatal An injection or Rh immunoglobulin (RhIg) is given skin-to-skin
Related to the time from when a woman becomes at about 28 weeks pregnancy. It will also be given The naked or diaper-clad baby is placed on the
pregnant to the time of birth. at any time in pregnancy there is bleeding or an mother’s or partner’s bare chest. A blanket is
amniocentesis. Rh-negative women will also be placed over both for warmth. Babies benefit
prenatal supplement tested after birth to determine if another from the smell, sound of the heartbeat, and
Vitamin and/or mineral pill designed for pregnancy injection of RhIg is needed. the warmth of the parent’s body. It also
and taken in addition to a healthy diet. These encourages breastfeeding.
supplements provide extra vitamins and minerals rubella antibody screen
needed to help meet the needs of a growing baby. A blood test to determine a woman’s immunity station
to rubella (German measles). If a woman becomes The position of the baby’s presenting part (the
public health nurse infected during pregnancy her unborn baby can lowest part, usually the head) in relation to the
Registered Nurse who provides prevention and be affected. mother’s pelvic bones.
health promotion services to mothers, infants and
families in homes, preschools, schools, and other salmonella stillbirth
community settings. A bacterium of the genus Salmonella, especially When a baby that appeared to be well during
of a species causing food poisoning. pregnancy is born dead.
pudendal block
Local freezing given around the vagina. This stops scrotum stool
the pain in the vagina, vulva, and perineum. Given The skin-covered pouch below the penis that The waste that comes out of the bowels.
at the time of birth. contains the testes in males.
148
3 UD D EN ) N F A N T $ EA T H 3 YN D R O M E 3 ) $ 3 " ABIES BORN W ITH TOX OPLASM OSIS M AY H AVE SERIOUS VA G IN A
4 H E SUD D EN AN D UN EX PEC TED D EATH OF A H EALTH Y PH YSIC AL AN D M EN TAL D ISABILITIES 4 HE C AN AL G OING FROM THE C ER VIX TO THE OUTSID E OF
B A B Y T H A T R E M A IN S U N E X P LA IN E D A FT E R A LL K N O W N THE BOD Y THROUG H W HIC H THE BABY PASSES D URIN G
AN D POSSIBLE C AUSES H AVE BEEN C AREFULLY RULED OUT T R IM E ST E R A V A G IN A L B IR T H
2ESEARC H SUG G ESTS TH AT C IG ARETTE SM OKE AN D TH E 4 HE N IN E M ON TH S OF PREG NAN C Y D IVID ED IN TO
BABY SLEEPIN G ON ITS TUM M Y ARE C ON TRIBUTIN G TH REE PARTS
FAC TORS !LSO KNOW N AS C RIB D EATH
U LT R A SO U N D T E ST
SU P P LE M E N T S ! SC AN THAT USES VER Y H IG H FREQ UEN C Y SOUN D
6 IT A M IN A N D O R M IN E R A L P ILL T A K E N IN A D D IT IO N T O W AVES C AN T BE H EARD BY H UM AN S TO SH OW
A H E A LT H Y D IE T 3 U P P LE M E N T S P R O V ID E E X T R A V IT A M IN S THE D EVELOPM EN T OF TH E BABY IN TH E UTERUS
AND M IN ERALS NEED ED TO H ELP M EET TH E N EED S OF
A G ROW IN G BABY U M B ILICA L CO R D
,INKS TH E PLAC EN TA TO TH E BABY . UTRIEN TS AN D W ASTE
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! SUBSTAN C E FORM ED IN TH E LUN G S LATE IN FETAL LIFE A T T A C H E D T O T H E B A B Y A T T H E B E LLY B U T T O N 4 H E
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VA R ICO SE VE IN S
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4 %. 3 TW ISTED SH OW IN G JUST BEN EATH TH E SKIN ESPEC IALLY
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# E R V IX
P LA C E D O N T H E LO W E R B A C K 4 H E Y A R E A T T A C H E D T O A O F B LO O D P R O B A B LY IN C O M B IN A T IO N W IT H D E FE C T S IN
6AG INA
SM ALL H AN D H ELD BATTER Y D EVIC E 4 HE STIM ULATION T H E V A LV E S W IT H IN T H E V E IN S A N D W E A K E N E D W A LLS O F
G IVES TIN G LIN G BUZZIN G OR PRIC KLIN G SEN SATION S !NUS TH E VEIN S 0REG NAN C Y IS OFTEN A C AUSE OF THESE
O V ER T H E B A C K 4 HEY M AY D ISAPPEAR AT TH E EN D OF PREG N AN C Y
T H R U SH 6 $ 2 , T E ST
! YEAST INFEC TION TH AT C AN C AUSE BREAST IN FEC TION ! BLOOD TEST TO ID ENTIFY W OM EN W ITH UNTREATED
9EAST G ROW S W ELL ON M ILK AN D IN W ARM M OIST AREAS UR ET H R A SYPHILIS
SUC H AS M OTH ERS N IPPLES INFANTS M OUTH D IAPER 4 H E T U B E B E T W E E N T H E B LA D D E R A N D T H E O P E N IN G
AREA AN D VAG IN AL AREA ' EN ERALLY RESPON D S W ELL TO TO THE OUTSID E OF TH E BOD Y 5 RIN E PASSES TH ROUG H VE R N IX
TREATM EN T - OTHER AN D BABY ARE USUALLY TREATED T H IS T U B E ! W HITE C REAM Y SUBSTANC E TH AT C OVERS TH E BABYS
TOG ETHER # ONTIN UE TO BREASTFEED SKIN FOR PROTEC TION W H ILE IN THE UTERUS
UR IN E
T O X O P LA SM O SIS 4 H E FLUID C ON TAIN IN G W ATER AND W ASTE PROD UC TS TH AT VO ID IN G
! D ISEASE C AUSED BY A PARASITE AN D TRANSM ITTED BY IS PROD UC ED BY TH E KID N EYS STORED IN TH E BLADD ER 5 R IN A T IN G O R P E E IN G
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FOOD S IN C LUD ING FRUITS AN D VEG ETABLES D RIN KIN G TO TH E B ATH R O O M VULVA
UN PASTEURIZED M ILK C LEAN IN G C AT LITTER BOX ES OR 4 H E E X T E R N A L P A R T S O F A W O M A N S R E P R O D U C T IV E
W ORKIN G IN G ARD EN S OR PLAYIN G IN SAN D BOX ES TH AT UT E R US SYSTEM THAT SURROUND TH E OPENIN G OF TH E VAG INA
C ON TAIN C AT FEC ES POOP # AN RESULT IN M ISC ARRIAG E ! HOLLOW M USC ULAR PEAR SH APED ORG AN LOC ATED IN
POOR FETAL G ROW TH PRETERM BIRTH OR STILLBIRTH TH E W OM AN S PELVIS )T H OLD S TH E G ROW IN G FETUS

Index
A birth registration 89 Canada Child Tax Benefit 90

abdominal muscles, care 46 birth, stages of labour 65 Canada’s Food Guide to Healthy Eating 37
abuse 16 early first stage 68 chlamydia 18, 125
alcohol 14, 104 active first stage 69 chorionic villus sampling 52, 145
allergies, baby 126 transition stage 70 circumcision 126, 145
amniocentesis 51, 52, 144 second stage 71 cocaine 15
anemia 36 third stage 73 colic 122, 145
antibody screen test 32, 148 fourth stage 74 colostrum 98, 145
Apgar score 73, 144 bowel movements, baby 102, 117 constipation, baby 117
Braxton Hicks contractions 24, 25, 144 constipation, mother 23, 38, 41
B breast pads 22, 101, 105, 109 contraception 92
baby carriers 130 breastfeeding 98 coughing and sneezing, baby 118
Baby-Friendly Initiative 5, 144 alcohol 104 cramps 24, 73, 80, 83
babysitters 91 amount 101 cravings (pica) 43, 147
back care 45 benefits 98 crying 121
back pain 22, 45, 75, 80 breast care 104 anger management 124
bacterial vaginosis 18, 144 expressing milk 105, 106, 107 colic 122, 145
bathing, baby 114 getting help 106 soothing 122
diaper area 116 getting started 98
eyes and face 115 latching on 100 D
scalp and hair 115 let-down reflex 101, 146 death of baby 81
tips 115 mother care 103 dehydration, baby 118, 145
umbilical cord 115 painful breasts (engorgement) 104, 145 dental care, baby 118
bilirubin 116, 144 positions 99 mouth care 118
birth certificate 89 storing breast milk 107 teething 119
birth control methods 92 street drugs 104 depression 85, 86, 148
cervical cap 92 vitamin D 109 development, baby 134
contraceptive sponge 93 working 108 language 137
Depo-Provera 94 breathing for labour 60 physical 135
diaphragm 92 light 60 social/emotional 136
emergency contraceptive pill 95 panting 60 diapering 113
female condom 92 short 60 choosing diapers 114
fertility awareness techniques 95 slow 60 diaper rash 113
Intra-uterine Contraception Device (IUD) 93 breech position 53, 144 laundry 114
male condom 92 bringing baby home 82 tips 113
oral contraceptive pills 93 burping baby 103 diarrhea 118
spermicide 93 dilation 67, 71
transdermal patch 94 C doctor, choosing 11
tubal occlusion 95 caesarean, c-section 78, 144 doula 10, 55, 79, 145
vasectomy 95 caffeine 40 Down syndrome 51, 52, 145
birth plan 55, 56 car seats 131
150
E H M
edema 23 headaches 18, 20, 35, 53 marijuana 15
effacement 67, 145 hearing, baby 125 massage 20, 22, 59
embryo 28, 145 heartburn 25 mastitis 105, 147
engorgement 104, 145 hemorrhoids 24, 61, 63, 74, 84, 146 maternal serum screening 33, 51, 147
episiotomy 75, 145 hepatitis B 17 maternity leave 89
erythromycin eye ointment 125, 145 Hepatitis B Immune Globulin (HBIG) 17 meconium 29, 68, 117, 147
exercising 44 herbal teas 40 medical care, mother 31
after birth 47 heroin 15 first visit 32
guidelines 44 herpes 17, 50 next visits 33
safety 44 hiccups 103 Medical Services Plan, baby 90
while breastfeeding 47 high blood pressure 53 Medical Services Plan 11, 90
while pregnant 44 home birth 54 medication, ASA (aspirin) 127
hospital birth 54 medication, mother 13, 21, 76, 90
F hospital stay 57 menstrual period 20, 83, 147
Fair PharmaCare coverage 90 hot baths 13 methamphetamine, crystal meth 15
false labour (pre-labour) 24, 58, 148 hot tubs 13 mid-life pregnancies 51
family planning 92 Human Immuno-Deficiency Virus (HIV) 16, 17 midwives 11
fatigue 20, 24, 44 hygiene 128 milia 116, 147
Fetal Alcohol Spectrum Disorder (FASD) mood changes 20, 85
14, 145 I morning sickness (nausea)
fetal monitoring 67 immunizations 119, 120 15, 20, 21, 36, 41, 142, 147
fetal movement 34 induction 75 muscle cramps 24, 60
fevers, baby 127 inhalants 15
first trimester, baby 26, 28 itchy skin, mother 24 N
first trimester, mother 19, 20, 52 nail care, baby 116
focal point concentration 59 J naming baby 90
folic acid 21, 32, 38, 41, 146 jaundice 116, 146 nausea 15, 20, 21, 36, 41, 142
fontanels 30 neural tube defects 38, 51
food safety 41 K non-stress test 34, 147
forceps 75, 146 Kegel exercises 46, 47, 83, 146 nose bleeds 22
formula feeding 108
L O
G labia 30, 146, 149 older mothers 51
genetic counselling 51 labour 65 oxytocin 50, 147
German measles (rubella) 32, 35, 120, 148 breathing for 60
gestational diabetes 33, 146 comfort positions 61 P
gingivitis, pregnancy 22, 148 medical procedures 75 pain relief, in labour 75
glucose screening test 33, 146 pain relief 75 epidural 77, 145
gonorrhea 18 preparing for 58 general anaesthetic 77
groin pain 25 relaxing for 59 nitrous oxide 76
group B streptococcus 33, 146 lanugo 29, 146 pain medication 76
low weight babies 133 pudendal block 77, 148
151
painful breasts, pregnancy 20, 21 skin care, baby 116 Transcutaneous Electronic Nerve Stimulation
parasites 41 sleep problems, mother 25 (TENS) 75, 149
parental Leave 89 sleeping, baby 110 travelling
parenting 134, 139, 143 bedsharing 111 air travel, mother 49
pelvic exam 32 co-sleeping 111 infant/child car seats 131
pelvic floor exercises 46 equipment 112 seat belts for mothers 48
pelvis care 46 Sudden Infant Death Syndrome (SIDS) 112 tummy time 121
PharmaCare program 90 temperature 110 twins and triplets 133
piles (hemorrhoids) 24, 61, 63, 74, 84, 146 smoking 13, 14
placenta previa 52, 147 solid foods 109 U
playpens 129 soothers (pacifiers) 103, 118, 129 ultrasound 33, 52, 149
postpartum depression 86, 148 spina bifida 32, 38 umbilical cord 115, 149
posture 45 spitting up 103 universal newborn screening 125
pre-labour 24, 58, 148 street drugs 15 urination, baby 117
premature rupture of membranes 44, 53 stress 48 urination, mother 83, 84
prenatal supplements 21, 41, 148 stretch marks 24
prescription medication striae 24 V
13, 21, 40, 76, 90 strollers 130 vaccinations 119
preterm babies 133 Sudden Infant Death Syndrome (SIDS) vacuum extraction 75
preterm labour 80 14, 15, 111, 112, 149 vaginal bleeding, baby 113
pubic pain 23 supplements, baby vaginal bleeding, mother 35, 44, 52
vitamin D 109 vaginal care, baby 113
Q vitamin K 125 vaginal secretions 17, 18, 21, 35, 44, 52, 68
quickening 22, 148 supplements, mother varicose veins 23, 149
calcium 24, 38, 39, 41 vegetarianism 39
R essential fatty acids 38, 40 vernix 29, 30, 149
relaxation for labour 59 folic acid 21, 32, 38, 41, 146 violence 16, 31, 35, 86, 124
Rh factor and blood type 53, 148 iron 38, 39, 41 vision, baby 126
rubella 32, 35, 120, 148 prenatal 41 visualization 59
vitamin A 32, 41 vomiting, baby 103, 118, 126
S vitamin B12 39
safety, baby 128 support team 10, 20, 23, 24, 48, 57, W
car 131 59, 66, 70, 82, 86, 139 walkers 129
home 128 syphilis 18, 32 water therapy 59
saunas 13 weight gain, baby 102
second trimester, baby 26, 27, 29 T weight gain, mother 43, 84
second trimester, mother 19, 22 teething 119 wills, changing 89
sexuality 49 third trimester, baby 27, 30 working, safety 50
Sexually Transmitted Infections (STIs) 16, 148 third trimester, mother 19, 24 working, breastfeeding and 108, 109
shaken baby syndrome 123, 148 thrush 105, 126, 129, 149
siblings 82 Toddler’s First Steps 7, 138, 143 X
SIDS 14, 15, 111, 112, 149 toxoplasmosis 42, 149 X-rays 13
single parents 88
152
You will experience many physical and emotional changes during pregnancy, childbirth, and new parenthood.
Knowing what to expect can make these changes easier to handle and to enjoy.
In this easy-to-read handbook you will ﬁnd the answers to your questions about your pregnancy, birth, and
taking care of your baby for the ﬁrst six months.
The sixth edition of this popular handbook contains important information on more than 70 key topics.
Additional resources you may wish to access:
BC NurseLine
Speak with a registered nurse 24 hours a day, or with a pharmacist from 5 p.m. to 9 a.m. daily by calling:
Greater Vancouver: 604-215-4700
Toll-free elsewhere in BC: 1-866-215-4700
Hearing impaired toll-free province-wide: 1-866-889-4700
Translation services available in 130 languages
BC HealthGuide OnLine and BC HealthFiles

Up-to-date health information can be found online at www.bchealthguide.org
BC HealthGuide Handbook
This handbook covers more than 190 common health concerns.
To get a free copy, visit your local pharmacy or Government Agents Office.
A French BC HealthGuide and BC First Nations Health Handbook are also available.
Call toll-free 1-800-465-4911 or e-mail HLTH.Health@gems1.gov.bc.ca to request a copy.
Endorsed by:
• BC Baby-Friendly Network • Community Nutritionists Council of BC
• British Columbia College of Family Physicians • Public Health Nursing Council of British Columbia
• British Columbia Dental Association • College of Registered Nurses of British Columbia
• British Columbia Reproductive Care Program $12.95
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Library and Archives Canada Cataloguing in Publication Data

1. Pregnancy – Popular works. 2. Prenatal care –

RG525B33 2005 618.2’4 C2005-960123-X

Published by Open School BC, Victoria, British Columbia, Canada.

Printed by The Queen’s Printer of British Columbia, Canada.

Baby Medical Care 125

Baby Safety 128

• use illegal drugs or share needles ________________________________________________

www.health.gov.bc.ca/cpa/publications/firststeps.pdf. this coloured

How to Use this Handbook Information Icons

s !RE TH EY OPEN TO W ORKIN G W ITH YOU REG ARD IN G

Getting X-rays and Other Tests Smoking

Sexually Transmitted Infections

Infection Risks/Complications Method of Transfer Treatment/Comments

Baby: Has poor energy, fever,

Infection Risks/Complications Method of Transfer Treatment/Comments

Baby: Preterm birth.

Baby: Possible stillbirth;

What’s Happening? Now What?

your periods will stop and • wear a comfortable, supportive bra

mother unexpected mood changes • this is normal

• Go to prenatal checkups Feeling tired — how much is normal?

headaches • headaches are quite common

need to pee more often

• drink water, milk, and juice instead of coffee, tea, or colas

light-headedness or • stand up slowly

What’s Happening? Now What?

early milk leaking • wear breast pads in your bra if needed

Tips: • Exercise together.

What’s Happening? Now What?

mother dry, itchy skin •

increased fatigue • rest often and listen to your body

• Help develop a birth plan. feelings of doubt or • develop a birth plan

• Practice labour positions pre-labour or • these contractions are normal

hemorrhoids (piles) • avoid constipation and straining

sudden groin pain • avoid sudden movement

difficulty sleeping • have regular sleep habits

• eating a snack with a warm drink

• using extra pillows for support

• practising deep breathing and relaxation exercises

• listening to relaxing music

increased need to pee • pee regularly

an increase in Braxton Hicks • this is normal

# H EC K TH E C HART ON PAG ES   n   TO FOLLOW TH E

 WEEKS   WEEKS   WEEKS

trimester Time Weight and Length Events

baby 1 day The sperm and ovum unite.

7– 10 days The fertilized ovum attaches to the lining of the uterus.

2 weeks Your baby, called an embryo, is now a layered disc on the

Time Weight and Length Events trimester

17 weeks The baby begins to store some of your antibodies.

26 weeks The baby’s outline may be felt through your abdomen.

trimester Time Weight and Length Events

baby 28 weeks 35 – 37 cm. (14 in.)

Your baby is now full term!

have a complete checkup that includes:

ultrasound test • to check the development and position of the baby

Partner at work: _ Cell phone: ____

# H EC K TH E C HART ON PAG ES n TO FOLLOW TH E

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