annaannaannaannaannaannaannaannaannaannaannaannaannaannaanna The big day is finally here! Your baby is ready to make his or her debut! But what can you expect between the first signs of labor and the arrival of your newborn? Every birth story is different, but most women can expect to experience these stages of labor in some capacity.

Heading to the Hospital

In the movies, the actress’s water breaks and they rush to the hospital. In real life, this scenario rarely happens. It can be hard to know whether you’re actually in labor or just experiencing Braxton Hicks contractions. One of the toughest decisions for first-time moms is when to make their way to the hospital.anna The laboring process can take days. At your prenatal appointments, your doctor will make you well aware of when to come to the hospital. However, the 5-1-1 Rule is a common guideline. According to the 5-1-1 Rule, if your contractions come every five minutes and last one minute each for at least one hour, it’s time to grab your bag and head to the hospital. Call your doctor if you are experiencing other symptoms or aren’t sure whether you should stay home or head to the hospital. When in doubt, it’s best to go ahead and get checked out by the doctor.

Hospital Check-In

When you arrive, the nurse will check you in to make sure you are in active labor. She will take your vitals, ask about your contractions, go over your birth plan and assess your pain. A tocidynamoter will be placed on your abdomen to measure your contractions and your baby’s heart rate. You will be able to read the monitor and track the strength of your contractions. Throughout labor, the doctor will periodically check your cervix to see how dilated and effaced it is. Your nurse will continue checking on you to make sure you’re as comfortable as possible while laboring.

Active Labor Phase

Once your cervix dilates from 4 to 7 centimeters, you are in active labor. Your contractions will become much more frequent and intense. If you decide to have an epidural or other pain medications, this is usually when most women request it. Your nurse may suggest you move positions to help progress your labor. If you had an epidural, your nurse may place a large peanut ball between your legs while you’re lying on your side to help promote dilation and position the baby.

Cervix Dilates to 8 to 10 Centimeters

This is the most intense phase of labor. Your contractions will be intense and occur every one to three minutes in this stage. You may become nauseous and shaky. You may also feel pressure and an urge to push. Let your nurse know exactly what you’re feeling at this point. It’s important not to push until your doctor tells you it’s time.

Time to Push

Once your cervix is fully dilated, your doctor will let you know when you can begin pushing. Pushing can last a few hours for first-time mothers or just a few minutes for women who have had children before. Don’t be surprised when your delivery room fills with nurses. They will begin preparing for your baby’s arrival. With each contraction your nurse and doctor will coach you to push and help your baby through the birth canal. If your baby is in distress or is not making his way through the birth canal, your doctor might make a call to deliver by c-section or to use forceps to assist in the delivery.

Delivery

Once your baby emerges, and you hear his first cry, he will be placed on you to hold. Your support person will have the option to cut the umbilical cord. When you’re ready, the hospital staff will clean off the baby, measure and weigh him and wrap him in a warm blanket. Then you will be able to hold your baby again.

Afterbirth

A few minutes after you deliver your baby, contractions will begin again. When it’s time, your doctor will ask you to push and expel the placenta. More than likely you will be too busy adoring your new baby to feel much discomfort or pay much attention to this process.

Bonding Time!

The last stage is the part you’ve been anxiously awaiting: bonding with your new baby! This is your time to learn everything you can about your little one and soak in those newborn snuggles. New moms are encouraged to spend as much time as possible making skin-to-skin contact to help bond with Baby. Skin-to-skin contact is also important for Dad to make a connection with the baby. While Dad and baby are bonding, you can give your body a much needed rest.

True or False Labor?

Braxton Hicks, also known as “practice contractions,” are when the muscles in the uterus tighten for anywhere from 30 seconds to 2 minutes. They most often occur in the third trimester but can happen as early as the second trimester. Most false labor pains cause mild discomfort and not severe pain. Braxton Hicks do not cause labor and are not a sign that labor is beginning. Many first-time moms confuse these false labor pains with true labor contractions and make their way to the hospital only to be sent back home. So how do you know whether you’re in true labor or experiencing Braxton Hicks?

You’re in true labor if your contractions are getting closer together and not stopping, becoming progressively stronger and continue when you move around and change positions. Other signs of true labor also include your water breaking (rupture of membranes) and the loss of your mucus plug. If you’re in doubt, call your doctor and describe the symptoms you’re experiencing. An examination by your doctor is the only definite way to know whether you’re in true labor.

Regan Lyons is a girl mom and freelance writer. She lives with her husband, Cale, and daughters, Atley, 8, and Ensley, 2, in St. Joseph, MO.

As always, please consult your health care provider with any questions or concerns.

Breastfeeding may be natural, but as many moms can tell you, that doesn’t always guarantee that it’s easy. Thankfully, what is easy is getting the pro tips you need should a snag arise. Here are some of the most common nursing challenges that moms and babies alike may face during their breastfeeding journey.

A Painful Latch.

Let’s be perfectly clear. That delicate little newborn of yours will be anything but delicate to your boobs. This can be a huge surprise to first-time moms! Expect to be a little sore when you get started. But if pain persists beyond the first few seconds of nursing, it may be that Baby has a bad latch.

Solution: To encourage a wide-open mouth, softly brush your nipple directly under Baby’s nose. Because hungry babies instinctively root, giving them something to root toward opens their mouths nice and wide. Next, make sure their bottom lip is well below your nipple, not simply at the base of your nipple. Last, bring Baby toward you instead of putting the breast in her mouth. A good latch will show itself when Baby’s chin rests directly on your breast, lips splayed out, with your nipple or lower areola covered by Baby’s latch. Still struggling? Don’t be afraid to reach out for help. Both your attending nurse or an on-call lactation consultant can assist you bedside during labor recovery. Still struggling after you’ve been discharged? Look into consulting with a lactation specialist or join a breastfeeding support group like La Leche.

Engorgement

Engorgement happens when your breasts overfill with milk, making them rock hard, tender to the touch, feeling as if they’ll explode. Another culprit? The lymphatic fluid that tries to escape your body near your armpit while your body is simultaneously trying to produce milk can cause a fluid traffic jam. Though common, engorgement left untreated can result in more serious issues like clogged milk ducts or even mastitis. Most women experience engorgement a few days after giving birth when their bodies make the switch from producing nutrient-dense colostrum to mature milk, though it can happen throughout your nursing career as a result of over pumping or not fully draining the breasts with each feeding. Although engorgement is uncomfortable, moms can take heart that it is actually a sign their bodies are working properly. So long as a fever isn’t involved, engorgement has nothing to do with infection and can be relieved immediately.

Solution: Because engorgement can make latching difficult initially, you might think using a pump will bring instant relief. But pumping will signal your body to produce more than you need to nurse, further exacerbating the issue. Try hand expressing to soften your nipple and then nurse on demand, making sure Baby drains your breasts fully. If you feel the need to nurse, and annaBaby is sleeping or drowsy, don’t be afraid to wake him to try.

Clogged Ducts & Mastitis

Clogged ducts can be the result of a number of things: engorgement, using the wrong-sized pump parts or wearing a poorly fitting, overly constricting bra. Some moms even find themselves naturally predisposed to getting clogged ducts for no rhyme or reason. Clogged ducts can be equally distressing to Baby, who may get frustrated at ineffective nursing. Mastitis, on the other hand, can result from clogged ducts that are left untreated, resulting in an infection that causes incredible pain throughout the entire breast, as well as flu-like symptoms such as fever, chills and body aches.

Solution: Clogged ducts can typically be tackled with home remedies. It’s incredibly important to continue to nurse regularly, rest, stay hydrated, employ massage or the use of warm or cold compresses. Avoid sleeping on your stomach or wearing uncomfortable underwire bras for the first few weeks of nursing when your breasts are the most sensitive to constriction. If you find yourself in the uncomfortable situation of having a clogged duct for more than two days, reach out to your doctor as you will likely develop mastitis. As a bacterial infection, mastitis can only be treated with an antibiotic. Thankfully, the infection doesn’t transfer to Baby, and appropriate medications are nursing-friendly. Nursing will actually relieve the problem with the added benefit of keeping your milk supply up. Too painful? Pump instead and offer bottles to Baby while the mastitis clears up (typically a two- or three-day process, though your doctor will recommend completing a full round of antibiotics).

Yeast Infection

Thrush is a yeast infection that begins in Baby’s mouth and can ultimately transfer into your breast, causing deep shooting pain, itchiness and red, shiny nipples. It’s the gift that keeps on giving … only neither of you want it.

Solution: Your doctor will treat both you and your baby with an antifungal medication to ensure that fungi doesn’t continue to persistently pass back and forth. It’s important to sanitize all pumping parts well, along with anything else that comes into contact with your breasts (i.e., nursing bras, pads and clothing) in hot water and vinegar to kill the yeast spores.

Low Supply

According to Stephanie Nguyen, RN, a board certified lactation consultant and founder of Modern Milk, 90 percent of moms have the ability to produce enough milk for their babies, and the other 10 percent usually have some reason that can be remedied.

What are some reasons for low supply?

a) not feeding enough

b) having a preemie who struggles to nurse

c) using a pacifier to suppress hunger cues

d) drinking and/or smoking

e) advanced maternal age

d) pre-existing health conditions, such as PCOS or thyroid issues, or medications like contraceptives or decongestants

Solution: One of the simplest ways to boost supply is to relax, eat well and nurse often. Add in extra pumping sessions using a medical grade pump between nursing sessions to signal to your body to increase production. And fill up on nourishing foods such as oatmeal, flaxseed, brewer’s yeast, fenugreek, and lactation tea. Trying to find ways to incorporate these superfoods into your diet? Try making lactation cookies (recipes abound online!). Tea and cookies, anyone?

—————————————-Did You Know?———————————-

Susie Roth of Starting Point Dental suggests checking one other culprit for bad latch and low supply: mouth restrictions. “A lip or tongue tie can present a significant challenge to nursing mothers,” she cautions. “A thick frenum can restrict the babies tongue or lip movement creating decreased mobility and failure to latch or create the seal needed for successful feeding.” Consult with your doctor if you have any concerns.

Lauren Greenlee is a freelance writer and an Olathe mom of four who is thankful for the number of resources that abound in the KC metro that helped support her breastfeeding journeys.

As always, please consult your health care provider with any questions or concerns.

You get lots of warnings when you are pregnant. Most people will talk to you about baby sleep and about the options to feed your baby. You then get warned about the early toddler years, better known as the terrible twos. We receive so many warnings as parents, but where is the warning about potty training? Why does there both seem to be so much information about potty training and yet also no actually helpful information at all? Perhaps you are very prepared, and your 18-month-old already goes to the bathroom regularly on the toilet. Or perhaps your 3-and-a-half-year-old still wants to wear diapers all the time, and you feel like your 18-month-old may go potty on the toilet before the older one! Potty training is hard. Here are some do’s and don’ts to help you along the way.anna

Do’s:anna

• Do remember you can choose from many different techniques to potty train. oS many books and blogs offer the “right” method to follow, but no one method is perfect for everyone.anna Do recognize your child will probably not be the perfect example that is often highlighted in these books and blogs, and your little one will experience setbacks and accidents.anna
• Do keep an open mind. Toddlers are notorious for loving something one minute only to change their minds minutes later and say they absolutely hate that same thing. Using the toilet will be the exact same thing. On the first day of potty training, my son peed 17 times on the pottyannachair. I wish I was kidding because I had such high hopes after day one. By day two, the excitement had worn off, and he had zero interest in the potty chair or the toilet. As with everything, kids will find their way and go at their own pace.anna
• Do your best to relax. Has your child ever asked you for something, like a cookie at bedtime, over and over and over even though she will never get that cookie at bedtime? Relax about asking your child to go potty over and over and over. Do focus on making sure your youngster is drinking plenty of water so she actually needs to go potty frequently. The more liquid kids drink, the more opportunities they will have to go potty in the toilet.anna
• Do enlist additional help. Maybe a well-meaning grandparent, babysitter or daycare staff member who gives some prompting will do the trick.anna
• Do encourage your child to come into the bathroom with you. You can then talk about what is happening as you go. Sometimes fear of the unknown can create a stop in the process.anna
• Do encourage role-playing for children. Perhaps a favorite stuffed animal needs to go potty every few hours, as well!anna

Don’ts:anna

• Don’t make your whole world about your child’s going to the bathroom. Yes, make sure he goes before you leave home and, yes, make sure he knows where the bathroom is when you get someplace new. Don’t stay home for three months straight because you want to make sure your child can use the bathroom all the time.anna
• Don’t get mad at your child.anna This is a hard one, but who really wants to be forced to pull down her pants and sit somewhere that might seem scary and then be told to perform on cue?anna Not me either!anna Give your child and yourself a break from the yelling and figure out a different form of motivation.anna
• Don’t be afraid to use a diaper when needed when you are just starting out. For example, perhaps you are going to a wedding or on a longer car ride. Give yourself a little break and explain to your child why he is wearing one for this special time only and that the diaper will go away after the planned event.annaIf you do this, remember to tell your child you know he won’t need to use the diaper though.anna
• Don’t feel weird about using your backyard to your advantage. Have your child wear a longer shirt, add some extra sunscreen and let the accidents happen outside.
• Don’t forget to get creative. Maybe your child has not caught onto using the potty chair or the big toilet yet. Maybe he will go potty in a cup instead. Focus on small wins to get to the bigger goal.
• Do not feel like a failure because your child does not want to go potty in the toilet. It will happen. Some children walk later or talk later, and some children will potty train later. I didn’t know a single person in college who wore a diaper!anna

Janelle Cumro-Sultzer lives in Manhattan, KS, with her husband, two children and two dogs. Janelle loves to focus on learning through play and getting messy with crafts.

As always, please consult your health care provider with any questions or concerns.

annaannaannaannaannaannaannaannaanna During your baby’s first year, you’re going to be spending quite a bit of time with your child’s health care provider. Take steps before your baby arrives to choose a trustworthy doctor with whom you feel comfortable.

annaannaannaannaannaannaannaannaannaannaanna When should you start the process? Anywhere between one and three months before your due date is an ideal time to start shopping around for a pediatrician or a family physician. Try not to wait until the last minute.

annaannaannaannaannaannaannaannaannaannaanna “Once you go to the hospital, there’s a lot going on. You’ll be seeing a lot of doctors. You’ll be going through labor. It’s not something you want to decide off the cuff,” says pediatrician Aaron Mayer, DO, Meritas Health Pediatrics, Kansas City, MO.

annaannaannaannaannaannaannaannaannaannaanna When you arrive at the hospital to deliver your baby, you’ll be asked who you’ve selected for your child’s primary care doctor. They will then notify your baby’s physician, and he or she will provide a physical examination of your infant within 24 hours after delivery.

annaannaannaannaannaannaannaannaannaannaanna Pediatrician or a family physician? Both practitioners are trained to provide quality health care for your family. Your choice will most likely boil down to personal preference and the rapport you have with a particular physician. Here are the primary differences between the two types of physicians:

annaannaannaannaannaannaannaannaannaannaanna A family practice doctor is trained to provide health care to individuals at all stages of life, from newborn to senior. According to the American Academy of Family Physicians, family physicians train for three years in real-life clinical settings and are trained in all areas of medicine ranging from pediatrics and internal medicine to obstetrics. Physicians should be board certified by the American Board of Family Medicine and licensed in the state in which they practice.

annaannaannaannaannaannaannaannaannaannaanna A pediatrician specializes specifically in childhood conditions, diseases and treatment for patients from newborn to age 18. According to the American Academy of Pediatrics (AAP), following medical school, a pediatrician-in-training completes three or more years of courses focused entirely on pediatrics. Seek a pediatrician who is licensed and has obtained the designation of Fellow of the American Academy of Pediatrics (FAAP), which means they are board certified in pediatrics and adhere to the AAP’s standards and guidelines.

annaannaannaannaannaannaannaannaannaannaanna Where to begin? “Honestly, I think consulting with friends and family is probably best. If your friends like their doctor, you are likely to find a good fit with them as well,” says Kallie Foss, MD, FAAP, Olathe Health Pediatrics.

annaannaannaannaannaannaannaannaannaannaanna Make sure the recommended physicians are part of your health insurance network. Also check out area hospital websites, which often feature doctors who are nearby and accepting new patients.

annaannaannaannaannaannaannaannaannaannaanna Schedule a prenatal visit. Once you’ve got a list of two or three physicians, call and schedule a prenatal visit to help you get a feel for their personalities and office environments. Though some physicians may prefer to do a phone consultation, a face-to-face appointment can help you get a sense of the office and nursing staff. Are they courteous, warm and helpful? You’ll also be able to gauge the overall feel of the clinic. Is it kid-friendly, clean and welcoming?

annaannaannaannaannaannaannaannaannaannaanna “You don’t really know if the physician’s personality meshes with your family unless you speak with them in person,” Dr. Mayer says. “It’s important to do prenatal visits to see if the way they act, the way they treat you and the environment of the clinic fits with what you want for your family.”

annaannaannaannaannaannaannaannaannaannaanna Make a list of questions. Now that you have prenatal appointments lined up, consider what issues are most important to you. For example, you might ask:

• Who will see my baby in the hospital?
• How soon after we leave the hospital should we see you?
• What is the schedule for well-child checks and immunizations?
• What can I expect during well-child checks?
• How long are the typical wait times at appointments?
• How do you handle after-hours calls?
• Which urgent care do you recommend?
• What’s your availability for last-minute appointments?
• What kind of acute care do you provide?

annaannaannaannaannaannaannaannaannaannaanna “If you’re having a boy, you might want to also ask about circumcision,” Dr. Foss says. “It would also be good to let the doctor know if you have had any complications during the pregnancy that may affect Baby after he or she is born.”

annaannaannaannaannaannaannaannaannaannaanna Evaluate the visit. After the appointment, reflect on how you felt about the doctor and the practice. annaannaannaannaannaannaannaannaannaannaanna

• Were your most pressing questions and concerns addressed?
• Did you feel comfortable?
• Did the doctor support or respect your opinion regarding issues that matter to you?
• Did you feel listened to?
• Did you feel rushed?
• What were the office and support staff like?
• What was the clinic environment like?
• Was the location convenient?

annaannaannaannaannaannaannaannaannaannaanna Need to break up? If, over time, you become dissatisfied with your child’s physician or you need to switch providers due to changes in insurance or a relocation to a new community, make sure you have your child’s medical records, including vaccine history, transferred to the new physician that you select.

annaannaannaannaannaannaannaannaannaannaanna Most of all, take the time to partner with a health care practitioner who will listen to your concerns, offer sound advice and options, and provide quality, compassionate health care throughout your child’s development. You’ll feel more supported and well-informed as you go about the business of raising a healthy, thriving youngster from babyhood and beyond.

Freelance journalist Christa Melnyk Hines and her family reside in Olathe. She is thankful to have found a compassionate and thoughtful pediatrician for her kids. Christa is the author of Confidently Connected: A Mom’s Guide to a Satisfied Social Life.

Additional Resources

HealthyChildren.org (American Academy of Pediatrics)

FamilyDoctor.org (American Academy of Family Physicians)

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Many people, including physicians, have strong opinions about issues like breastfeeding and circumcision. Choose a physician who will support you or at least respect your personal views regarding issues that are important to you.