Have you taken your multivitamin with folic acid today?

Folic acid, also known as folate, is a B vitamin that works to help the body maintain and produce new cells. Everyone needs folic acid. It is especially important for ALL women who are able to get pregnant to have sufficient folic acid supplementation. Taking a multivitamin with folic acid is recommended, even if you don’t plan on getting pregnant and/or are using birth control.

Why? Over half of all pregnancies in the United States are NOT planned, which leaves 51% of all pregnancies at risk of birth defects of the brain and spine that can happen in the very early stages of pregnancy, often before pregnancy is known. Folic acid supplementation is an easy intervention that can prevent major birth defects and promote a healthy pregnancy. For these reasons, every woman of childbearing age (15-45 years old) needs a multivitamin with 400 mcg of folic acid every day!

Most standard multivitamins have at least 400mcg of folic acid; check the label on the bottle to be sure. An over-the-counter generic multivitamin, in addition to a balanced diet, will provide assurance that the woman is obtaining adequate amounts of essential nutrients and of folic acid.ˡ Help spread the word to promote the public health of childbearing women, as 50-70% of neural tube defects can be prevented with adequate folic acid supplementation PRIOR to pregnancy.

Source: ˡwww.beforeandbeyond.org; The National Preconception Curriculum and Resources Guide for Clinicians

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Feeding you, while you feed your baby

Breastfeeding gives your baby the best food available for growth and nutrition but can raise questions about your nutrition. How much do you need to eat? Are there foods you should eat? Foods to avoid? And how does your diet affect your baby? These are great questions to ask and though every mom and baby is unique, there are some principles to follow for best results:

  • You do need extra calories and fluids. It takes 400-500 additional calories for you to make milk and keep your energy levels high enough to care for your new baby. Remember these calories should come from nutritionally rich foods. A sandwich made with whole grain bread, lean meat and veggies works great. Drink to thirst and remain well hydrated. Lots of moms report that their milk supply is impacted by their hydration level.
  • Eat a variety of foods, your baby will get used to different tastes and smells and may even be more apt to explore many foods when she begins solids. Protein, iron and calcium are essential building blocks for your milk so all of those healthy choices you made during pregnancy should continue with an assortment of lean proteins, whole grains, washed fresh fruits and vegetables, and dairy throughout the day. Most physicians recommend that you keep taking your prenatal vitamins while breastfeeding.
  • Avoid fish that has high mercury levels. Mercury can pass through breast milk so, swordfish, mackerel and tilefish should be avoided. Moderate amounts (2-3 cups of coffee/day) of caffeine are usually tolerated by babies through breast milk. Some babies may experience agitation and sleep disturbances so, be ready to eliminate caffeine if needed.

If you suspect that a food you are eating is causing your baby to be uncomfortable, eliminate it from your diet for 2-3 weeks. If your baby improves you will want to avoid it for a couple of months before you try again. If your baby does not improve, call for help. Your pediatric provider or a lactation consultant can guide you through these often challenging times.

Remember, there’s no need to go on a special diet while you’re breast-feeding. Try to make healthy choices — you and your baby will both benefit.

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A Shot of Prevention- Vitamin K

Vitamin K plays an important role in the normal clotting of blood.  A baby who does not have enough Vitamin K can start to bleed suddenly, anywhere in their bodies and without warning. This is known as Vitamin K deficiency bleeding, and can lead to brain damage or even death.

Babies are born with very small amounts of vitamin K, and all Babies are at higher risk for bleeding until they start to eat regular foods, at which time the intestinal bacteria starts making vitamin K.

Why don’t babies have enough?

  • Before birth very little vitamin K crosses from the mother to the baby through the placenta, even if the mom takes vitamins and eats vitamin K rich foods.
  • After birth breast milk does not provide enough vitamin K, even if the mom supplements her diet with Vitamin K.

How do babies the Vitamin K they need?

The American Academy of Pediatrics recommends that all babies receive an injection of vitamin K shortly after birth, as it very effective in protecting newborns against bleeding.  Giving a Vitamin K injection at birth has been routine for more than five decades — since it was first recommended in 1961. At Overlake’s Childbirth Center we recommend this as a standard practice for your baby!

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Scheduled for Induction? Here’s What to Expect…

So you’ve just made it to 39 weeks, you’ve finished up your childbirth classes and your bag is packed. You’re counting the days until contractions begin and you can head into the hospital, excitedly awaiting the arrival of your baby. Just like the movies right? But then your doctor or midwife tells you that you need an induction. What!?! That definitely wasn’t in your birth plan. So what does this mean and what can you expect?

Why Induce?

At Overlake we follow evidenced-based guidelines that dictate NOT inducing unless it’s medically necessary. This means if your provider wants to induce labor there’s a very good reason for it. Some common reasons for induction include gestational diabetes, high blood pressure, fetal growth restriction, low amniotic fluid levels, post-date gestation (over 41 weeks), etc.

How long will it take?

When the date for your induction comes around, plan for a very long day (or two!!). If your cervix isn’t dilated (or favorable) and this is your first baby, expect that you’ll spend many hours on the Labor & Delivery Unit. Bring something to keep you entertained – books, magazines, iPad, snacks (if your provider allows food). And of course, bring your labor bag in with you – you’ll need that too!

What will be used to induce me?

There are a few options we use at Overlake for induction. Depending on the dilation of your cervix, your provider will choose the best option for you – there’s no “one size fits all” prescription for induction. If your cervix is closed and not in the process of softening yet, your provider may need to first “ripen” your cervix or get it ready and receptive to induction medications. To ripen the cervex we sometimes use a prostaglandin medication – Cytotec or Prepidil. We occasionally use a balloon device to mechanically dilate your cervix; this is a safe and simple method without the potential side effects of medications.

If your cervix is already favorable for labor, you may only need Pitocin. Pitocin is a synthetic form of your body’s natural hormone oxytocin. We give Pitocin prudently and do our best to only give what your body needs for adequate contractions. It’s infused through an IV and is carefully titrated on an IV pump.

Key Points

The important thing to keep in mind is that this process isn’t immediate! There’s time to get settled in, meet your nurse, monitor how your baby is doing and ask questions. The majority of the time it takes hours for you to feel anything different and for labor to start. We know that this is an uncertain time for you and probably not what you were expecting. We’re here to answer any questions you may have and guide you through the process step-by-step. Remember, though you may not get to experience rushing to the hospital after a long night of spontaneous contractions, you will still meet your beautiful and healthy baby. That’s our most important job.

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Newborn temperature needs

Seattle’s summer has certainly heated up this year .  Normally, new parents are fussing over blankets and hats to ensure their newborn stays warm enough in our normally cooler, damp Seattle weather.   This year we need to discuss the opposite and how to help your newborn stay cool in the 90 degree heat.

Here are some tips to help keep your infant comfortable during our summer heat:

  1. If you are remaining indoors a good rule of thumb is to dress your infant as you are.   Loose fitting, lightweight clothing.   Cotton will help absorb any moisture.   When outside during the heat a long sleeved shirt and long pants should suffice.   A good way to tell how your infant is handling the heat is to feel their core body.  This is the area around their chest and abdomen.  Does it feel hot or cool to your touch?  Adjust their clothing level so it feels warm to your touch (but not overly hot).
  2. Monitor the exposure to the sun.  Infant’s skin can easily be burned even on cloudy days.   Summer sun can penetrate the clouds and cause painful sunburns.  Canopies or wide brimmed hats are advised to help block the sun’s rays.  Remember the sun is the most powerful between 10am – 4pm.
  3. Avoid hot temperature rooms and cars.   Car temperatures can increase dramatically even in just a few minutes.   Infants should never be left unattended in cars as it could be life threatening.   As infant’s temperature regulation is still immature, a fan in their room should never be directly placed to blow air on them.  Have the fan circulate the room air.

Your pediatrician’s office can also provide useful information on how to manage the summer heat.  Lucky for us Seattleites (or unlucky on how you view it), the summers are not always this heated and the cool rain will eventually return.

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Celebrating World Breastfeeding Week

Overlake Medical Center is Celebrating World Breastfeeding Week August 1-7. The theme this year is: “Breastfeeding and Work: Let’s Make it Work!”

Breastfeeding is widely accepted as the optimal way to nourish babies and reduce health risks for both moms and babies. Returning to work can present unique challenges but continuing the breastfeeding relationship is good for both you and your baby.

You may be asking, can I continue to breastfeed once you return to work? Our answer is, of course you can!

It takes a little planning, but millions of women are succeeding at returning to work without weaning their babies.

What does it take?

  1. Knowledge of how to manage milk expression at work
  2. The right equipment
  3. Advance planning with caregivers and employers
  4. Knowledge of employment laws
  5. Time and private space in the workplace

Your Plan:

  1. Try to breastfeed in the morning before you leave.
  2. Try to pump during your morning break.
  3. If possible, try to breastfeed your baby during lunch if baby is nearby. If not, pump again during lunch.
  4. Pump again during afternoon break.
  5. Breastfeed as soon as you can after your return home or if possible breastfeed at the daycare or caregivers when you pick–up the baby.
  6. Store your milk in a cooler or refrigerator if provided at work. Transport milk in a storage container which keeps the milk at the correct temperature. Be sure to label containers with date and  time milk is expressed.
  7. During the weekend continue to pump after your first two feedings in the morning unless you are experiencing over-supply. This will assist you in maintaining your milk supply and re-stocking your stored milk supply.

If you have questions about your individualized plan; please register for: Strategies to Provide Breastmilk Through Pumping While Returning to Work at http://www.overlakehospital.org/classes/

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Storing Breast Milk

Have you ever smelled your breast milk and thought “Holy cow, this smells different?” Don’t worry; the smell is not a reflection of your mood after another sleepless night tending to your baby. It could be related to either the chemical composition of the breast milk or how it is stored. Human milk that has truly soured has a very distinct sour taste and odor – much like soured cow’s milk. If your milk doesn’t smell distinctly sour or rancid, then it should be safe to feed to your baby. If you have any doubts about the safety of your milk, throw out that serving.

Here are a few tips on how to store your milk in the refrigerator/ freezer to avoid spoiling:

  • If you do not plan to use the refrigerated milk within 5-8 days of expression, then freeze it. Be sure to use the milk within 24 hours of thawing.
  • Keep the milk in the back of your freezer rather than at the door.
  • If you choose to store in bottles, try glass rather than plastic. Glass bottles need to be loose during the freezing process then tightened when fully frozen to avoid bottle breakage from the expanding contents.
  • Try using bags designed for storing human milk rather than standard plastic bottle liners.
  • Eat lots of antioxidant rich foods. As the name suggests, antioxidants help to prevent oxidation. Foods rich in antioxidants include: red kidney beans, pinto beans, blueberries, pomegranate, kale and sweet potatoes.
  • Try to avoid your usual drinking water (it might have free copper or iron ions that cause oxidation).
  • Try to stay away from fish-oil and flaxseed supplements, and foods like anchovies that are full of rancid fats.

If your milk tastes slightly soapy, it may be due to an excess of an enzyme called lipase. This enzyme is a perfectly normal enzyme found in the human body. One of its main jobs is to break down fat, so the baby can easily digest the breast milk. As a result, the milk can develop a soapy or bitter taste. Many babies don’t mind the smell or flavor and there is no need to change your freezing method. If your baby is not taking your thawed milk you can inactivate the lipase. To do this, you must scald the milk on a stove or microwave. Heat the milk to 180 F (82 C) for about 15 seconds, or until you see little bubbles around the rim of the pan. Once this is done, you should immediately cool and store the milk. Keep in mind that heating the milk does damage some of the nutritional benefits. Remember, this is only required for milk you plan to freeze and reheat. There is no need to scald milk that you plan to use before freezing and scalded milk needs to be completely cooled before feeding to prevent injury.

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Join us! Third Annual NICU Reunion

With the 3rd annual NICU Reunion happening soon at Overlake Medical Center, the NICU staff is actively preparing for this fun event!  This wonderful celebration will occur on Sunday, September 13, 2015 from 1 – 4 pm.  There will be activities for all ages including a Bouncy House and possible a visit from the Bellevue Fire Department.  Light refreshments will be served.  We all look forward to seeing our graduates and their families.  Email invitations have been sent out and we are ready to begin taking registrations.  If you haven’t received one you can call 425-688-5259 to register or go online www.overlakehospital.org/reunion.  Looking forward to seeing everyone in September.

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The Sunshine Vitamin

Breast milk is the best food for all babies. It contains all the essential nutrients and immune benefits babies need – except for Vitamin D and iron. Most full-term infants are born with enough iron stores to last until iron-rich solids are introduced at 6 months of age.

However, infants may not be born with enough Vitamin D stores. Studies have shown that giving mom extra Vitamin D does not always increase the Vitamin D content of breast milk predictably and it’s unclear if the high doses necessary to get more in mom’s milk are safe for moms long term.

Doctors have been seeing more cases of rickets among breastfed infants in the U.S. due to Vitamin D deficiency. Vitamin D is made by the body when there is enough exposure to sunlight. There are many factors that affect this process and lead to low levels of Vitamin D:

  • Living at high latitudes, particularly in winter months when Vitamin D can’t be made
  • Air quality, i.e. high levels of pollution
  • Weather conditions – dense cloud covering (Pacific Northwest!)
  • The amount of skin exposed to sun
  • Use of sunscreens- public health effort to decrease skin cancer risk by limiting sun exposure
  • Darker skin pigmentation

In 2008, the American Academy of Pediatrics issued the following recommendation:

A supplement of 400 international units (IU)/day Vitamin D is recommended for all breast-fed and formula fed infants (consuming less than I liter formula/day) beginning in the first few days of life. 

Infant liquid multi-vitamin products or vitamin D only products can provide the recommended amounts of Vitamin D. These are available without prescription. Most term infants should need Vitamin D only.

The AAP and FDA recommend choosing products that deliver 400 IU in a 1 ml dose.

NOTE: Avoid products for infants that deliver very high concentrations of Vitamin D in 1 or 2 drops. There is a high risk of overdose and this may lead to serious health problems.

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The Childbirth Center at Overlake recognized in a national publication for focus in perinatal patient safety

Overlake received an “A” score from The Leapfrog Group and excellence awards from various other regional and national public reporting parties due to our success and commitment safety of moms and babies (Healthcare Business Insights, 2015).  We have used safe practices for many years, including eliminating early deliveries.  An early elective delivery means choosing to have a baby born before 39 weeks of pregnancy without a medical reason.  Research has told us that babies that are born between 37-39 weeks do not do as well as babies born between 39-41 weeks unless there is a medical reason.  Therefore we remain committed to not taking the risk of delivering babies early unless there is approved reason to.

Healthcare Business Insights Cost & Quality Academy. (2015). Improving Patient Safety Measures by Reducing Risk and Focusing on Quality Initiatives. Efficiency & Effectiveness, (May), 1-4.

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