Category: 2. Delivery and Beyond

There’s a lot going on when your baby is first born. They’re weighed and measured. Their noses are suctioned out and their vital signs are tested. They may have ointment or drops put in their eyes. They get a complete checkup by your pediatrician.

Most newborns get their first hepatitis B vaccine in the hospital. They also routinely get a vitamin K shot.

But what exactly is vitamin K, and do newborns really need it? Read on to learn more.

What does vitamin K do?

Vitamin K is a fat-soluble nutrient that helps our bodies make blood clots. We need blot clots to stop bleeding. Vitamin K is important for keeping bones healthy too.

Adults and older children get vitamin K from food such as green, leafy vegetables, meat, dairy, and eggs. The healthy bacteria in our intestines, which make up our microbiome, also produce some vitamin K.

Babies, though, have very little vitamin K in their bodies at birth. This puts them at risk for bleeding. Fortunately, it’s easy to prevent VKDB with a vitamin K shot. The injection is given in your baby’s thigh within 6 hours of birth.One shot is all it takes to protect your baby from getting vitamin K deficiency bleeding. This is why, as pediatricians, we have recommended since 1961 that all newborns get a vitamin K shot at birth.

Why babies aren’t born with enough vitamin K?

The two big reasons newborns need vitamin K:

1. They don’t get much vitamin K from the mother during pregnancy. Unlike many other nutrients, vitamin K doesn’t pass through the placenta very easily.
2. Babies’ intestines don’t have very many bacteria yet, so their bodies can’t make enough vitamin K.

What is vitamin K deficiency bleeding?

Newborns who don’t get a Vitamin K shot and are low on the vitamin are are at risk of vitamin K deficiency bleeding (VKDB). This happens when a baby’s blood can’t make clots, and their body can’t stop bleeding.

The bleeding can happen on the outside of the body. It can also happen inside the body where parents can’t see it. A baby could be bleeding into their intestines or brain before their parents know anything is wrong. Brain bleeding happens in about half of all babies who develop VKDB, and it can lead to brain damage or death.

There are three types of vitamin K deficiency bleeding:

• Early-onset: This begins within the first 24 hours after birth. It usually happens when the mother is taking certain medications that interfere with vitamin K.
• Classical: This happens between 2 days and 1 week after birth. Doctors don’t know exactly what causes most of these cases. Early-onset and classical VKDB occur in 1 in 60 to 1 in 250 newborns.
• Late-onset: This happens between 1 week and 6 months after birth. It’s rarer than early-onset or classical VKDB, occurring in 1 in 14,000 to 1 in 25,000 babies. Infants who didn’t get a vitamin K shot at birth are 81 times more likely to develop late-onset VKDB than babies who do get the shot.

Cases of VKDB seem to be increasing. This is partly because more parents are refusing the vitamin K shot for their newborns. VKDB is fairly rare, so many parents aren’t aware of how dangerous the effects of this disease can be.

Are vitamin K shots safe?

Yes, vitamin K shots are very safe. The vitamin K from the injection is stored in your baby’s liver and released slowly over months. This gives your baby the vitamin K they need until they can start getting it from solid food and making it themselves.

You may have heard about a study from the 1990s about a possible link between the vitamin K shot and developing childhood cancer. This didn’t only worry parents; doctors and scientists were concerned too. Since then, experts have done many different kinds of studies to verify this link. None of the studies have ever been able to find that link again.

Can my newborn get oral vitamin K instead?

Some parents may ask for oral vitamin K instead of the shot. But babies can’t absorb the oral form very well, so it doesn’t work well to prevent VKDB. A vitamin K shot is the safest and best option for all newborns.

Does breastfeeding give my baby vitamin K?

Breast milk does give your baby a little bit of vitamin K. But it’s not enough to prevent VKDB. Babies who are exclusively breastfed are at higher risk of developing VKDB because their vitamin K levels are low.

This all changes when your baby is old enough to start eating solid foods, usually between 4 and 6 months. The bacteria in your baby’s intestines will also start making vitamin K once they’re eating solid foods.

What are the signs of vitamin K deficiency bleeding?

In most cases, there aren’t any warning signs to let you know beforehand that something serious—and possibly life-threatening—is happening.

When babies develop VKDB, they might have one or more of these signs:

• Bleeding from the umbilical cord or nose
• Paler skin or, in dark-skinned babies, pale gums
• Bruising easily, especially around the face and head
• Bloody stool or black, dark, sticky stool
• Vomiting blood
• A yellow tint to the white parts of the eyes 3 weeks or more after birth
• Seizures, irritability, excessive vomiting, or sleeping too much

Remember

It’s easy and safe to prevent VKDB with a vitamin K shot at birth. If you have any questions or concerns, be sure to talk to your pediatrician. They can help you weigh the benefits and risks.

The timing of newborn discharge from the hospital should be a mutual decision between the parents and the physician caring for the infant. The American Academy of Pediatrics (AAP) believes that the health and well-being of the mother and her baby should take precedence over financial considerations.

AAP policy has established minimum criteria for early discharge of a mother and her baby, which include term delivery, appropriate growth, and normal physical examination, and states that it is unlikely that all of its criteria can be met in less than forty-eight hours.

The AAP supports state and federal legislation based on AAP guidelines as long as physicians, in consultation with parents, have the final authority in determining when to discharge the patient.

​By: Laura A. Jana, MD, FAAP & Jennifer Shu, MD, FAAP

The birth of your baby will undoubtedly be a momentous occasion—one worthy of capturing for posterity (if you are so inclined). However, it’s one thing to envision the perfect photo (or video) of your baby’s grand entrance in the delivery room and another to actually get it. Also worthy of consideration is figuring out exactly how much of “the moment” you want to capture, how you’re going to go about doing it, and how much of it you intend to share with others.

• Plan ahead. If and when you fall into delivery preparedness mode and pack your suitcase in anticipation of your trip to labor and delivery, don’t forget to charge whichever photographic device you hope to use (and bring along any chargers, batteries, memory cards, or other accessories they may require, if you opt for anything more than the camera on your phone). Even beyond showing up with your phone or other camera equipment of choice, we suggest you take a few minutes between breathing exercises and obstetrician appointments to discuss a simple photographic game plan.

First and foremost, be sure to find out if your hospital has photographic restrictions. If there are any, you’ll want to factor them in as you think about your photographic goals. If you’ve got your heart set on capturing a particular shot, the odds of getting it will be better if you make your wishes known ahead of time to whomever you plan on having in the delivery room with you. Don’t forget to figure out a place to keep your camera of choice that’s out of the way but easily accessible. While all this advance planning may seem a little extreme to some of you (especially those of you less “into” photography than we are), trust us when we say the resulting photos will speak for themselves.

• Delegate. Maybe you don’t consider yourself much of a photographer, or have no desire to rise to the occasion and focus your efforts on capturing the moment. Or, you may just anticipate having too many other things on your mind when you deliver. If this describes you, then, we (and the realities of childbirth) suggest you delegate. If you plan on having family or friends in the delivery room, pick one you consider to be the best photographer and who’s least likely to be overcome with emotion when it’s time to push the button, click the shutter, or start the video rolling. Then clarify which shots you hope to have captured when all is said and done. Also make sure your designated photographer is comfortable using whichever camera equipment you plan to have on hand, as well as prepared to charge it, swap out memory cards, or replace batteries.

In short, the delivery room isn’t a great place to sit down for the first time and attempt to figure out someone else’s phone or the latest in digital photography and technology.

• Use discretion. You don’t have to have gone through labor and delivery or witnessed a baby being born before to realize there’s not a whole lot of privacy involved in the process. That does not, however, mean you can’t control the degree of exposure evident in the commemorative photographs. I’m sure you all know what we’re talking about because you inevitably have to give at least some thought to how to take pictures of a baby being born without getting what seems crude to say, but has nonetheless been best described as, the infamous “crotch shot.”

Fathers-to-be (or other family members or friends) who might otherwise find themselves caught up in the moment often do well in their role as photographer. Just make sure you’ve not only delegated the job ahead of time, but made it very clear what you do and do not want to see revealed in the family photo album or posted online for all of eternity. The fact that digital photographs can quickly and easily be edited or cropped helps, but you’ll still want to make sure ahead of time that nothing gets shared socially without your approval first.

• Consider composition. Now you may be thinking to yourself, “Who has the time to consider composition? I’m just focused on maintaining some degree of composure.” But that’s why it’s worth mentioning the concept to you now and not in the delivery room. After all, many new parents have regretted not discussing photographic discretion in advance of the big event, much less having the designated photographer give some quick thought to such photographic challenges as the fact that open curtains on a bright sunny day can ruin even the best new baby pictures. How much forethought you choose to devote to this subject will depend purely on how important the photographic end result is to you.

The perfect pose: cutting the cord

Long before I (Laura) went into labor, someone suggested I try to take a photo of my baby on the delivery room scale so I could use it for the birth announcement. Having made that a personal goal, I instructed my husband to keep track of our camera and to give it to me as soon as I delivered. Little did I expect to find myself with camera in hand well before my son made his way to the scale—in time to snap photos of my squawking baby in the obstetrician’s arms as his father did the honors on the cord. Thrilled with what I considered to be the ultimate once-in-a-lifetime photo, I decided to try again with my next child. Two years later, I ended up with an even better photo of my husband cutting the cord—this time complete with a clock in the immediate background bearing witness to the momentous event.

• Digital distribution. There’s no question that as a society, we’re now fully embedded in the digital age. When it comes to sharing the joyous news (and photos and videos and texts and tweets) of your baby’s birth, this means the opportunity to do so almost instantaneously. That said, we recommend you figure out your game plan ahead of time.

Some parents prefer the good old-fashioned method of compiling an email list ahead of time and sending out an email announcing the arrival. Others find it easier and faster to post photos and updates on Facebook, upload photos to photo-sharing websites, or make use of Twitter, Instagram, or any of the rapidly multiplying, ready-made venues for sharing news with accompanying photographic documentation. For those who are digitally adept and so inclined, you can even create your baby’s first digital footprint in the form of a dedicated web page or blog—ideally spending some time setting it up before you get preoccupied with new parenthood.

As you experience all of the physiological changes preceding the birth of your baby, which ones are preparing your body to breastfeed? And how does the process work?

You probably noted early in your pregnancy—at around the fifth or sixth week—that your breasts had become fuller and your nipples were more tender than before. Your nipples and the darker-colored area around them, called the areolae, may have enlarged and darkened, and the small bumps on the areolae, called the Montgomery’s glands, became more prominent. Starting about the third month of pregnancy, the complex interplay of a number of hormones—including prolactin, estrogen, progesterone, and human growth hormone—leads to the proliferation of milk ducts and gland-producing cells in your breasts as your body prepares for milk production.

As your pregnancy progresses, the glandular tissue necessary to produce milk replaces much of the fatty and supportive tissue that normally makes up most of the volume of your breast. This causes your breasts to become substantially larger during pregnancy and lactation. Such changes may worry you that breastfeeding will cause your breasts to sag or change shape after weaning, but there is no reason for concern. Once your baby is weaned from the breast (when you stop nursing and your milk glands are once again replaced by fatty and supportive tissue) and you return to your prepregnancy weight, your breasts will return to their approximate prepregnancy size and shape.

By the end of the second trimester, your body has become fully capable of producing breastmilk—which means that even if your child is born prematurely, you will be able to produce breastmilk. Colostrum, the first milk produced, is thick, somewhat sticky, and yellow or orange in color. (If you notice yellow or orange stains on the inside of your maternity bra, your breasts are making colostrum. However, some mothers do not notice any colostrum being secreted until after their babies are born.)

After your baby is born, the areolae of your breasts, and especially the nipples, will become exquisitely sensitive to touch. When your baby’s mouth touches the nipple, nerve cells will send a signal to your brain, causing the release of the hormone oxytocin. Oxytocin causes tiny muscle cells within the breasts to contract, squeezing milk from the milk-producing cells down the milk ducts toward small sacs or sinuses near the nipples.

As your baby suckles at the breast, drawing milk from the sinuses through the nipple and into her mouth, the production of oxytocin will increase, causing more milk to be moved through the ducts in a process called the let-down or milk-ejection reflex. This is a simplified description of the complex system by which your body ensures that whenever your infant is hungry, your body will provide her with the nourishment she needs.

Most hospitals will discharge you and your baby within forty-eight hours if you have delivered vaginally. However, if you undergo a Cesarean section, you may stay at the facility for four to five days. If your baby is born in an alternative birthing center, you may be able to go home within twenty-four hours. Nevertheless, just because a full-term, healthy infant could be discharged from the hospital in less than forty-eight hours doesn’t mean it should necessarily occur.

The American Academy of Pediatrics believes that the health and well-being of the mother and her child is paramount. Since every child is different, the decision to discharge a newborn should be made on a case-by-case basis. If a newborn does leave the hospital early, he or she should be seen by a doctor twenty-four to forty-eight hours after discharge.

Prior to making the decision about when to go home, you and your doctor need to weigh the advantages and disadvantages carefully. From an emotional and physical standpoint, there are arguments for both a short (one to two days) and a longer (three-plus days) stay. Some women simply dislike being in the hospital and feel more comfortable and relaxed at home; as soon as they and their baby are proclaimed healthy and able to travel, they’re eager to leave. By keeping the hospital stay short, they’ll certainly save themselves—or their insurance company—money. However, many new mothers often cannot get as much rest at home as in the hospital—especially if there are older children clamoring for attention. Nor are they likely to have access to the valuable support that trained nurses can offer in the hospital during the first days of breastfeeding and baby care.

If a newborn does leave the hospital early, he should have received all the appropriate newborn tests such as a hearing screen, and he also should be seen by the pediatrician twenty-four to forty-eight hours after discharge. Of course, the doctor should be called immediately whenever a newborn appears listless or is feverish, is vomiting, has difficulty feeding, or develops a yellow color to his skin (jaundice).

Before you do leave the hospital, your home and car should be equipped with at least the bare essentials. Make sure you have a federally approved car safety seat that is appropriate for your baby’s size, and which you have correctly installed rear-facing in the backseat of your vehicle. It is extremely important to follow the car seat manufacturer’s instructions on installation and proper use carefully, and if possible, it is helpful to get your car seat installation checked by a certified child passenger safety technician to ensure that you’ve gotten it right.

At home you’ll need a safe place for the baby to sleep, plenty of diapers, and enough clothing and blankets to keep him warm and protected. If you’re formula-feeding, you’ll also need a supply of formula.

In a routine vaginal delivery, your first view of your child may be the top, or crown, of his head, seen with the help of a mirror. After the head is delivered, the obstetrician will suction the nose and mouth and your baby will take her first breath. She doesn’t need to be slapped or spanked to begin breathing, nor will she necessarily cry; many newborns take their first breath quietly.

With the most difficult part of the birth now over, there is usually one last pause before the push that sends the rest of your child’s body, which is smaller than his head, gliding smoothly into the doctor’s or nurse midwife’s waiting arms. After another, more thorough suctioning of his nose and mouth, your child may be handed to you to hold—and behold.

At First Sight of Your Newborn

Even if you’ve seen pictures of newborns, you’re bound to be amazed by the first sight of your own infant. When she opens her eyes, they will meet yours with curiosity. All the activity of birth may make her very alert and responsive to your touch, voice, and warmth. Take advantage of this attentiveness, which may last for the first few hours. Stroke her, talk to her, and look closely at this child you’ve created. The obstetrician or nurse midwife may place the baby on your abdomen or lower chest in those first few moments. Watch how the baby moves up toward your breast, seeking that first feeding. Those moments are magical for you and the baby. Those moments should not be hindered; they should be allowed to happen. The natural wonder of your baby looking at you, looking at your breasts and wriggling upward, will make you realize just how exciting those important first few minutes are. Attendants should not wash you, nor should they wash the baby or interfere. The smell and feel of the moment will guide the baby to her first feeding. As with many moms, you may find that putting your baby to your breast creates an intense emotional bond between you and your newborn.

Fresh from birth, your child may be covered with a white cheesy substance called vernix. This protective coating is produced toward the end of pregnancy by the sebaceous (oil-producing) glands in her skin. She’ll also be wet with amniotic fluid. If there was an episiotomy (surgical cutting) or tearing of tissue in the vaginal area, she may have some of your own blood on her. Her skin, especially on the face, may be quite wrinkled from the wetness and pressure of birth.

Your baby’s shape and size also may surprise you, especially if this is your first child. On one hand, it’s hard to believe that a human being can be so tiny; on the other, it’s incredible that this “enormous” creature could possibly have fit inside your body.

Head Size

The size and shape of her head in particular may alarm you. How could the head possibly have made it through the birth canal? The answer lies in its slightly elongated shape. The head was able to adapt to the contours of the passageway as it was pushed through, squeezing to fit. Now free, it may take up to several days to revert to its normal oval shape.

Skin

Your baby’s skin color may be a little blue at first, but gradually will turn pinker as her breathing becomes regular. Her hands and feet may be slightly blue and feel cool, and may remain so, on and off, for several weeks until her body is better able to adjust to the temperature around he

In a routine vaginal delivery, your first view of your child may be the top, or crown, of his head, seen with the help of a mirror. After the head is delivered, the obstetrician will suction the nose and mouth and your baby will take her first breath. She doesn’t need to be slapped or spanked to begin breathing, nor will she necessarily cry; many newborns take their first breath quietly.

With the most difficult part of the birth now over, there is usually one last pause before the push that sends the rest of your child’s body, which is smaller than his head, gliding smoothly into the doctor’s or nurse midwife’s waiting arms. After another, more thorough suctioning of his nose and mouth, your child may be handed to you to hold—and behold.

At First Sight of Your Newborn

Even if you’ve seen pictures of newborns, you’re bound to be amazed by the first sight of your own infant. When she opens her eyes, they will meet yours with curiosity. All the activity of birth may make her very alert and responsive to your touch, voice, and warmth. Take advantage of this attentiveness, which may last for the first few hours. Stroke her, talk to her, and look closely at this child you’ve created. The obstetrician or nurse midwife may place the baby on your abdomen or lower chest in those first few moments. Watch how the baby moves up toward your breast, seeking that first feeding. Those moments are magical for you and the baby. Those moments should not be hindered; they should be allowed to happen. The natural wonder of your baby looking at you, looking at your breasts and wriggling upward, will make you realize just how exciting those important first few minutes are. Attendants should not wash you, nor should they wash the baby or interfere. The smell and feel of the moment will guide the baby to her first feeding. As with many moms, you may find that putting your baby to your breast creates an intense emotional bond between you and your newborn.

Fresh from birth, your child may be covered with a white cheesy substance called vernix. This protective coating is produced toward the end of pregnancy by the sebaceous (oil-producing) glands in her skin. She’ll also be wet with amniotic fluid. If there was an episiotomy (surgical cutting) or tearing of tissue in the vaginal area, she may have some of your own blood on her. Her skin, especially on the face, may be quite wrinkled from the wetness and pressure of birth.

Your baby’s shape and size also may surprise you, especially if this is your first child. On one hand, it’s hard to believe that a human being can be so tiny; on the other, it’s incredible that this “enormous” creature could possibly have fit inside your body.

Head Size

The size and shape of her head in particular may alarm you. How could the head possibly have made it through the birth canal? The answer lies in its slightly elongated shape. The head was able to adapt to the contours of the passageway as it was pushed through, squeezing to fit. Now free, it may take up to several days to revert to its normal oval shape.

Skin

Your baby’s skin color may be a little blue at first, but gradually will turn pinker as her breathing becomes regular. Her hands and feet may be slightly blue and feel cool, and may remain so, on and off, for several weeks until her body is better able to adjust to the temperature around her.

Breathing

You also may notice that your newborn’s breathing is irregular and very rapid. While you normally take twelve to fourteen breaths per minute, your newborn may take as many as forty to sixty breaths per minute. An occasional deep breath may alternate with bursts of short, shallow breaths followed by pauses. Don’t let this make you anxious. It’s normal for the initial days after birth.

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Breathing

You also may notice that your newborn’s breathing is irregular and very rapid. While you normally take twelve to fourteen breaths per minute, your newborn may take as many as forty to sixty breaths per minute. An occasional deep breath may alternate with bursts of short, shallow breaths followed by pauses. Don’t let this make you anxious. It’s normal for the initial days after birth.

Most pregnancies last between 37 and 40 weeks. Then, it’s time for your baby’s big entrance!

Labor contractions are the clearest indication that your body is getting ready to deliver your baby. When labor starts, your cervix (the lower end of the uterus) will open, and the uterus will begin contracting (or squeezing). The cervix must be thinned out in order for the baby’s head to move into the birth canal.

How to know when labor has started

Each time a contraction occurs, your uterus and abdomen will become tighter and firmer. Between contractions, the uterus will soften, and you can relax for a short time while awaiting the next contraction.

Although most women know when they are nearing labor or when labor has started, it isn’t always easy to tell when this process has begun. That’s because “false labor” can occur. With false labor, contractions are sporadic and relatively weak. Still, don’t be embarrassed to call your doctor or go to the hospital if you’re uncertain whether this is the real thing!

With actual labor, you will experience:

• Repeated contractions, cramps, and increases in pain levels corresponding to the opening (dilating) of your cervix and the baby’s descent through the birth canal
• A slightly bloody, pink, or clear vaginal discharge that is the mucus plug at the cervix
• A breaking of your water, which is really a rupture in the amniotic sac that contains watery fluid that surrounds and protects your baby

As labor progresses, the contractions will become stronger. They’ll also occur more often, and continue for about thirty to seventy seconds each. The pain of the contractions will tend to start in your back and then move forward to the lower abdomen.

When should you call your doctor or go to the hospital?

Hopefully you’ve already discussed this with your doctor. In general, you should head for the hospital or phone your doctor if:

• your water breaks (even if you aren’t having contractions yet),
  
• you’re experiencing vaginal bleeding,
  
• or the pain is severe and persistent even between contractions.

When labor is induced

Your doctor may induce labor before you go into labor on your own. Usually, this is because your health or the health of your baby may be at risk. Perhaps you have a chronic disease such as diabetes or high blood pressure that may pose risks to you or your child. Or your doctor may recommend inducing labor if tests indicate that your baby’s growth is unusual.

With certain medications (such as oxytocin or prostaglandin drugs that may be given intravenously in the hospital), the mother will have contractions and her cervix will start to dilate and thin. The doctor can also intentionally rupture the membranes that surround the fetus or use other means to get labor started.

That goo, in most hospitals, is erythromycin ointment, and it serves as a simple, harmless, cost-effective means of preventing blindness. The blindness in question results from infection with 1 of 2 sexually transmitted infections, chlamydia and gonorrhea (often people get both at the same time). Both infections can progress rapidly in newborns’ eyes, damaging the clear part over the pupils (corneas) and causing irreversible harm. Men and women can harbor chlamydia and gonorrhea infections without any symptoms. Obstetricians test most women for these infections during their pregnancies and treat them if their tests come back positive, but mothers can still pick up those diseases after their tests come back, so to be safe we treat everyone.

Erythromycin ointment is close to 100% effective in preventing gonorrhea eye infections, but chlamydia infections can still pop up as long as 2 weeks after delivery. When this happens, only oral antibiotics provide effective treatment. Because of the danger from chlamydia, most pediatricians test newborns’ eyes for the disease before prescribing antibiotics. Other eye infections may also threaten a baby’s vision, including herpes simplex virus and Staphylococcus aureus. There are several other reasons a baby might develop eye discharge in the first few weeks of life, including a rare allergic reaction to erythromycin.

When to Call the Doctor

If your newborn develops thick, yellow discharge from one or both eyes, make sure a doctor sees him quickly.

Gestational diabetes affects at least 7% and possibly as many as 18% of pregnancies in the United States. It occurs more often in women with a family history of diabetes, overweight or obese women, and Latina, African American, American Indian, Asian, Pacific Islander, and Alaska Native women.

Even if the diabetes goes away after your baby is born, you still have a greater chance of developing type 2 diabetes later in life, and your child from that pregnancy may have a greater chance of being obese and getting type 2 diabetes. The good news is that there are steps you can take to prevent or delay type 2 diabetes and keep your child from that pregnancy healthy.

Action Steps for You:

Get tested for diabetes.

• Get tested for diabetes 6 to 12 weeks after your baby is born. If the test is normal, get tested every 3 years. If the test results show that your blood sugar (glucose) is higher than normal but not high enough to be diabetes, also called prediabetes, get tested for diabetes every year.
• Talk to your doctor about your test results and what you can do to stay healthy.
• If your test results show that you could get diabetes and you are overweight, ask your doctor about what changes you can make to lose weight and for help in making them. You may need to take medicine such as metformin to help prevent type 2 diabetes.

Change the foods you eat and be more active.

• Choose healthy foods such as:
  • Fruits that are fresh, frozen, or canned in water
  • Lean meats, chicken and turkey with the skin removed, and fish
  • Skim or low-fat milk, cheese, and yogurt
  • Vegetables, whole grains, dried beans, and peas
• Drink water instead of juice and regular soda.
• Eat smaller amounts of food to help you reach and stay at a healthy weight. For example, eat a 3-ounce hamburger instead of a 6-ounce hamburger. Three ounces is about the size of your fist or a deck of cards.

Be more active each day.

• Try to get at least 30 minutes of activity, 5 days a week. It is okay to be active for 10 minutes at a time, 3 times a day. Walk with friends, swim, or garden to move more.
• Try to get back to a healthy weight. Talk to your health care team about a plan to help you lose weight slowly. Being at a healthy weight can help reduce your chances of getting type 2 diabetes.

Action Steps for the Whole Family:

• Ask your doctor for an eating plan that will help your children grow and be at a healthy weight.
• Help your children make healthy food choices.
• Help your children be active for at least 60 minutes each day.
• Do things together as a family, such as making healthy meals or playing active games together.
• Limit your kids’ screen time in front of the computer, tablets, smartphones, and TV to 2 hours or less per day.
• Contact your local parks department or local health department to learn where you can find safe places to be active and get healthy foods.

Other Action Steps:

• Tell your doctor or health care team if you had gestational diabetes and/or you want to get pregnant again.
• Breastfeed your baby to help you lose weight and improve your child’s health.
• Make sure your history of gestational diabetes is in your child’s health record.

Things to Remember:

• Get tested for diabetes 6 to 12 weeks after your baby is born.
• Take steps to lower your chances of getting diabetes by being more active and making healthy choices to get back to a healthy weight.
• Help your children be healthy and lower their chances of getting type 2 diabetes.

By: Natasha K. Sriraman, MD, MPH, FAAP

Have you been feeling deeply sad, anxious or overwhelmed since giving birth? Maybe you’ve had trouble sleeping or eating. You might feel like a robot who’s just going through the motions – or you freak out when anyone gets near your newborn.

If some or all of these feelings ring true, I hope you’ll be relieved to hear how often this happens to parents. Did you know that 50% to 80% of all people who deliver a child experience the mood shifts known as “the baby blues?” And that 1 in 8 will develop a more serious case of postpartum depression?

These facts can be scary and confusing, especially right after your baby arrives. Your plans for blissful bonding with your child may feel like they’ve gone out the window—and every day seems like an eternity.

As a mom who went through PPD herself without fully recognizing it, I’ve made it my mission to learn about the life shifts that happen around pregnancy, delivery and those first few weeks of parenting. All of us need help getting through the intense emotions and dramatic changes that are part of becoming a parent.

How will I know if it’s postpartum depression?

Lots of new parents ask me about the baby blues, depression and how to tell the difference. I explain that mood swings are very common after giving birth, especially in the first 2 weeks. What separates the blues from postpartum depression (PPD) is the length of time you’re suffering and how severely you’re affected.

Hormonal shifts that happen right after birth can make you feel incredibly sad, tearful, overwhelmed and confused. Pair this with the 24/7 challenges of caring for an infant and you have the perfect storm of biological triggers that can lead to mood changes.

The baby blues tend to disappear after a few days or weeks, and while they can be frightening, getting enough rest and accepting plenty of family and social support helps most parents recover. But if the raw feelings and fatigue just won’t go away, you may be experiencing PPD.

Many new parents also experience anxiety that goes well beyond just being nervous about having a baby. In fact, the excessive and continued worrying of post-partum anxiety is as common as PPD, and may even happen at the same time.

Can depression start before my baby arrives?

Absolutely. Even though we hear a lot about postpartum mood swings, many pregnant people become depressed before giving birth. The name for this is perinatal depression, and it is similar to PPD in terms of the symptoms you feel and the treatment you may need.

What does postpartum depression look like in real life?

Parents who develop depression before or after giving birth experience deep sadness, confusion, loss of energy and a sense of hopelessness about the future. You may have angry outbursts or moments when everything gets under your skin.

Difficulty sleeping is another sign of depression—and while it’s always hard to get enough rest with a new baby, depression makes it especially hard for you to fall asleep and stay there. You may wake feeling you’ve never even gotten a wink, leaving you to struggle through your day without the energy and positive mood that make parenting so much easier.

Changes in appetite and eating habits also come with depression. Many new parents don’t feel like eating at all, or they binge on carb-laden snacks for energy or comfort. Caffeine, sugar and other short-term boosts can make matters worse, since they can disrupt your sleep and cause your energy to crash multiple times during the day.

Depression can also make you feel agitated and mistrustful, pushing you over the edge when anyone tries to help with the baby or handle simple chores around the house. Feelings of guilt, shame and blame can even make you feel you don’t deserve help—and this is when things can take a turn for the worse.

Why should I prioritize my own health when there’s sooooo much else on my plate?

First, because your health is absolutely essential to your baby’s health, growth and development (and your family’s well-being, too). Second, because you deserve to be healthy and happy, especially right now.

If you’re feeling guilty as you read this, I encourage you to offer yourself the same compassion you’d give your loved ones if they were in your shoes. Parenting isn’t about burying your needs while caring for everyone else’s. It’s a continuous flow of giving and receiving. Needing help doesn’t make you weak—but seeking out help is a profound act of strength.

Does postpartum depression only affect first-time parents?

Like many moms, I experienced PPD after the birth of my second child. It wasn’t simply because I suddenly had two kids in diapers or was struggling to get quality sleep. The adjustments that new parents go through with each birth can be complex and intense, so if you’re wondering why you’re struggling to cope as your family grows, realize you’re one of many, many experienced parents who do.

Do adoptive parents sometimes get depressed?

Naturally they do—because creating or adding to a family always means grappling with strong emotions and demanding new routines. Caring for a newborn is no less challenging for adoptive parents than for birth parents. And the long, often exhausting process of adopting a child can produce such high levels of stress that many parents feel completely worn out by the time their baby arrives.

If you’ve just adopted a child and you’re feeling depressed, please don’t tell yourself you “shouldn’t be reacting this way.” Your family is counting on you to get the help you need.

Where can I find effective treatment for postpartum depression?

Consider starting with your pediatrician, who truly understands what you’re going through, both medically and personally. If you feel more comfortable approaching your ob-gyn or primary care doctor, that’s fine too. It is also good to talk with someone close to you who you trust, like a partner, parent, friend or family member, how you’re feeling. The main thing is not to chalk it up to a normal part of parenthood. Seek care as soon as you can, since depression rarely disappears on its own. You’re not supposed to tough it out alone.

Treatment for PPD or perinatal depression may include talk therapy, support groups, and discussions with friends and family about what you need while recovering. Light exercise and calming practices such as yoga and meditation can help. You may also receive a prescription for antidepressants, many of which are safe to take while breastfeeding.

Keep in mind that these medications provide short-term support while you regain your balance. They’re not a crutch, just one part of the treatment plan that millions of people follow when they’re experiencing depression.

What if I’m worried about my partner’s mental health?

Partners get depressed, too, so if you see your mate suffering some of the same symptoms I’ve outlined here, please don’t stay silent. The two of you are a team, both essential to your family’s health. Your pediatrician or primary care doctor can help you find seeking care, whether it’s for one or both of you.

What should I do if I’m experiencing dangerous thoughts?

If you are considering harming yourself or your baby, immediately call the National Suicide Prevention Lifeline at 1-800-273-8255 or 9-1-1. Don’t wait, because these thoughts are a sign that you need expert help right now.

The National Maternal Mental Health Hotline is available 24/7 by calling 1-833-943-5746. And for non-emergency resources and support, you can contact Postpartum Support International. Call or text “Help” to 1-800-944-4773.

Remember

Your child’s routine check-ups are an opportunity to talk with the pediatrician about how you are coping with new parenthood. However, don’t hesitate reach out any time about feelings of sadness and anxiety after the birth of your baby.