Month 8

What's Happening to Me?

During this last trimester of pregnancy, you can expect to gain three to four pounds a month. As you continue to gain weight, you may begin to feel an increased sense of awkwardness. You may feel more fatigue. Constipation, hemorrhoids, and lower-back pain may cause discomfort. Continue to eat enough fiber.

During your eighth month, it is especially important to listen to your body. Relax. Take an extra nap. Prop your feet up to reduce swelling. Use extra pillows to get comfortable at night. If you're feeling a little uncomfortable, take heart in knowing that this is completely normal. You're getting closer to the big day!

Your uterus begins to exert pressure on the breathing muscles in your lower chest, which may cause some women to be short of breath. Baby's size also adds some strain to your skeletal system, especially in the back and stomach areas. You may feel as if you are carrying a bowling ball. You may also have trouble finding a comfortable sleeping position.

NEWSLETTER
Table of Contents

Baby's Development

What to Feed Baby

Choosing Child Care

Mommy's Notes

Practice Relaxation Techniques

Becoming a Family

New Mother's Forum

Baby may be so active you may think you are carrying an Olympic athlete in your womb! If baby makes repetitive or quick movements, don't worry. He or she may have the hiccups

In the middle of your eighth month of pregnancy, you may find sitting down uncomfortable. You might feel an odd, tingling sensation in your vagina, the result of baby lifting and lowering his or her head against your lower pelvic muscles

Now that baby has made his or her presence obvious, your emotions may begin to take off. Many mothers begin to feel anxious about labor and delivery and worry about life-style or financial adjustments that will need to be made after baby arrives. But the joy of anticipation and other experiences, such as childbirth classes, can offset these worries. Making an effort to share the birthing experience with your birth partner can also be very rewarding.

Good nutrition is vital in the third trimester. Baby's brain cells are rapidly forming, especially during the last two months before birth. Eat well now, and you'll be helping baby after his or her birth in terms of learning skills, physical coordination, and energy. It is not advisable to skip meals during pregnancy. Baby has a special need for more calcium for proper bone and tooth development. If you don't get enough calcium in your diet, the calcium needed by the fetus, and later for milk production, is drawn away from your bones and teeth. During pregnancy and nursing, most women require about 1200 milligrams of calcium daily. To get that much calcium, you would have to drink four cups of whole milk a day or substitute other dairy foods such as cheese, yogurt, and milk puddings. Since a steady diet of such foods would probably add too many calories, modify with low-fat versions at least part of the time. Of course, if you are concerned about your diet or vitamin and mineral intake, consult with your physician.

Baby's Development

In the eighth month, baby's eyes are now fully formed and opened. Your baby is 16 to 18 inches long and weighs approximately four to six pounds. The baby's weight gain can be attributed to accumulated (and essential) fat deposits. This weight gain is beginning to smooth out the baby's wrinkles as well as decrease the reddish appearance of the skin. Baby's proportions are as you would expect them to be at birth.

The vernix is thick on the baby's skin, and the lanugo is almost completely gone. During pregnancy, your immunities will be

transferred to the baby. This will help baby fight off infections for a short while after he or she is born.

Your baby will assume a favorite position sometime during the next few weeks. Your physician will feel your abdomen to determine the position of the baby. There are many different ways the baby can lie in your uterus. Vertex, or head first, is the most common and the best for delivery. Baby's movements are most like jabs as he or she settles into the position for birth.

What to Feed Baby

Your baby grows faster in the first year of life than at any other time. As you might expect, what you feed your baby during this time of rapid growth is very important. The decision of whether or not to breast-feed is a personal one in which you need to feel confident and comfortable. You will hear many options on feeding your baby. Discuss them with your physician.

There are many reasons why breast-feeding is the best way to nourish a new baby. Actual milk won't flow until several days after delivery. Until then, the baby benefits from colostrum, your pre-milk liquid, which cleanses baby's intestines and bowels and protects baby against infection.

After secreting colostrum, your breasts will secrete "transitional" milk, then mature milk in about two weeks. What is mature milk made of? About 88 percent water. Its nutrient content is typically about 55 percent fat, 37 percent carbohydrate, and 8 percent protein. In addition, substances in breast milk build up an infant's immune system, or baby's ability to fight infection. Breast milk is well tolerated, which means it is not likely to cause any unpleasant reactions in your baby. Breast-fed babies are known to have fewer allergic symptoms such as runny nose, skin rash, spitting up, asthma, colic, or fussiness. Substances in breast milk also kill some bacteria, fungi, and viruses. Breast-fed babies have fewer cases of diarrhea and other digestive problems.

If you have decided to breast-feed, there are several things you can do ahead of time to make the adjustment easier for you and your baby.

The first step is eating a well-balanced diet during pregnancy and after. After your baby is born, you'll need to add approximately 500 calories to your daily diet to be sure that your body has the extra energy required for nursing. While you are nursing, remember that what you eat shows up in your breast milk. If you are eating something to which baby is sensitive or allergic, he or she may have a reaction. If your breast-fed baby shows an intolerance to your milk, your doctor may ask you to cut certain foods from your diet. The most likely "villains" include cow's milk, wheat, eggs, nuts, and shellfish.

Make sure you clean your breasts and nipples every day. The colostrum that seeps from them during pregnancy can form a crust around your nipples, making them more susceptible to tenderness and cracking. This can also increase the possibility of infection. Experts recommend using plain water to cleanse the breast, avoiding soaps, alcohol, or other strong solutions which may rob them of natural moisture. After bathing, expose your nipples to the air. Take time to do this every day. If your nipples become tender or dry, ask your physician to suggest a moisturizer. Most doctors recommend over-the-counter products containing cocoa butter or lanolin.

NOTE: Since it is known that many drugs can be passed from mother to baby during breast-feeding, consult with your physician prior to taking any medication.

Going back to work?
If you plan to go back to work outside the home after delivery, you can still breast-feed in the morning before work and in the evening. Some women also pump their breasts and store the extra milk in the refrigerator so that the baby-sitter can then warm it and feed the infant mother's own milk during the day.

If you choose not to breast-feed
Some mothers decide not to breast-feed. For some, nursing may not be feasible or medically possible, while others may choose to supplement nursing with another form of nourishment. Most doctors agree that cow's milk does not contain the right balance of nutrients that infants need and is difficult for them to digest. Cow's milk does not have enough iron, has too much protein, and is too high in sodium chloride and other minerals. Also, it doesn't have enough linoleic acid, an important fat babies need. A baby's brain needs iron to grow and develop properly, and cow's milk does not provide enough iron. Cow's milk can also cause a baby to lose small amounts of blood from the intestines, which can lead to a serious disease called iron deficiency anemia. Always consult your doctor before making any changes in breast-feeding or in your baby's formula during the first year.

The next-best food, after mother's milk, is infant formula because it is designed to give babies the right balance of all the nutrients they need.

Reasons to consider breast-feeding baby:

Breast milk is nutritionally superior to cow's milk formulas.
Breast milk increases resistance to diseases and decreases the chance of allergic reactions when other foods are introduced.
Breast-feeding helps the uterus return to normal size after delivery.
Breast-feeding is economical and convenient.
Nursing provides a special bonding between baby and mom.

Getting started
Before each feeding:

Settle into a comfortable chair or on the bed. Use pillows as a support.
With one arm hold baby close to you, with his body turned toward you, tummy to tummy. Tuck his lower arm about your waist. Rest baby's head snugly in the crook of your arm, with your hand securely holding his bottom or upper thigh.
Place all four fingers under your breast and your thumb on top. Make sure your fingers are behind the areola.
Lift the breast slightly to make the nipple point down toward baby.
When baby is positioned securely, center the nipple and pull baby onto the breast. When baby has taken the breast properly, he or she will have all of the nipple and much of the areola in his mouth.
If you need to provide an airway for baby, pull his hips closer to your body and lift your breast slightly.
Offer both breasts at each feeding. Since the first breast is usually emptied more completely, alternate the breast offered first at each feeding.
To take baby off the breast, insert your finger in the side of baby's mouth and cup it around the end of the nipple to break the suction. Do not pull baby off the nipple; baby will automatically tighten his or her mouth.
Breast-feed baby as long as he or she wants to nurse. Most babies will nurse every two or three hours.

Verdugo Hills Hospital BEGINNINGS Family Education program offers a Breast-Feeding Class. Obtain valuable information from the lactation consultant who leads the class. Call (818) 952-2272 to find out dates and times and to register.

Choosing Child Care

If you plan to return to work after you have your baby, you'll need to make arrangements for baby's care in your absence. For new mothers, this is one of the most difficult decisions to be made-finding someone you trust to care for your baby. There are several child-care options from which to choose: in-home sitters, family day care, and day care centers.

In-Home Sitter
Having a sitter come to your home keeps your baby in a familiar environment and lessens the amount of car travel your baby will experience. Skilled and experienced sitters aren't easy to find. The best way to find a reliable sitter is by word-of-mouth. Ask friends, neighbors, relatives, or fellow employees for leads. Candidates should be interviewed in person.

Some things you should find out are:

Work History. How much experience does he or she have in baby care? When did he or she leave his or her last care-giving job, and why?
Does he or she know infant/child CPR?
Is the caregiver interested in long-term employment?
What are his or her fees?
Health History. Are there any health problems which might impact his or her ability to work regularly?
Does he or she smoke, drink alcoholic beverages, or use drugs?
Are there any special situations which might prevent him or her from coming to work some days?
Can he or she work overtime?
What is his or her philosophy on child rearing? What does he or she consider important? What about discipline?
Can you communicate well with him or her?
Is this person enthusiastic, warm, caring?

Trust your instincts. If the person looks good on paper, but you are not comfortable, look elsewhere. Make sure all responsibilities about the position are understood. Make sure your expectations are understood and discussed before making a collaborative agreement. When you've reached a decision, it is recommended that you draw up a contract. Be sure the sitter has special care guidelines, information on the baby's routine, and emergency phone numbers before you return to work.

Be sure to check with the IRS concerning tax laws regarding private day care. As a rule, if you are taking your child to a private sitter or day care, the caregivers are responsible for their own wage withholding. If your sitter comes to your home, he or she is considered a household employee, and you are responsible for taking out one-half of the Social Security withholding from the salary and matching that one-half as an employer. You are also required to deduct federal withholding if the sitter requests it.

Family Day Care
It is estimated that 40 percent of children with working parents go to other people's homes for day care. There may be other children. Babies enjoy watching older children at play. As your baby starts to crawl and walk, he or she will start socializing and become a part of their activities.

When evaluating a caregiver, find out:

How many children do they care for? What are their ages?
How does the caregiver handle illness-their own, a family member, or a child in their care?
Does the caregiver take children in his or her car? If so, does he or she have child safety seats for each child?
Does he or she carry special insurance to protect the children?
What are the usual hours? Can exceptions be made?

Here are some things to look for when evaluating a family day care provider home:

Is it clean?
Is the caregiver healthy and well kept?
Do the children look cared for-clean, happy, and contented?
Is there room for babies and toddlers to explore and play?
Are any small objects lying around that babies could swallow?
Is the environment safe-guard rails at stairwells, fans out of reach, medicines and cleaning fluids and other dangerous substances out of reach?

As with a sitter in your home, discuss philosophy of child care and other issues. You want a caregiver who is friendly and warm, calm and has a sense of humor, and who is involved in the children's activities beyond directing them. It is important the caregiver respects your views and family values.

Day Care Center
With the demand for day care rising each year, the number of day care centers is increasing. Some are privately owned, some are church affiliated or government supported, while others belong to a chain. With a day care center, you can usually count on care being available throughout the year. In a good day care center, the workers have some training in child development, health, and safety. Reputable centers have planned educational programs, even for babies.

There may be some disadvantages, though. Babies are likely to pick up colds and other minor illnesses. Because day care is notoriously a low-paid field, staff turnover may be high. Centers are usually busy and noisy, with lots of children, and some babies prefer a quieter environment.

Some questions to ask when visiting a center include:

Is the center licensed or registered?
What hours are they open?
What are their fees?
Do they have a written plan for play and learning activities?
How many babies are in the nursery section? What is the ratio of workers to babies?
On an average day, how many children come to the center?
Can you visit and observe before registering your baby?
Can you visit anytime your baby is there?
How is feeding handled? If you are breast-feeding, will your breast milk be stored and fed as you wish? If you want to come to the center to nurse your baby, is it allowed?
Will someone be watching your baby at all times?
Has the staff been trained in first aid and emergency procedures for children?
Is a pediatrician on call when needed?
Is there a special area for sick children?
How are prescribed medicines given?

When you visit the center, check the following:

Are babies and children happy?
Do the caregivers enjoy their work?
Do they respond to the babies when the babies cry?
Is there enough space for babies to crawl? Is it unencumbered and safe?
Is there a quiet sleeping area?
Is the equipment clean and well maintained?
Does it smell clean?

You may need to be placed on a waiting list, as many centers' infant slots fill quickly. Consider driving time to and from the day care center. Before you register, make sure you have a clear understanding about your business arrangement. Many centers provide written contracts which outline payment arrangements, hours during which care is provided, policy for late pickup, food, items to be brought from home, insurance coverage for your child, and notice and conditions for quitting day care.

The Child Care Resource Center supports parents in making personal decisions about child care by providing accurate, objective information about available care. It also offers parents an opportunity to become familiar with the issues involved in selecting child care. For more information call (818) 756-3360.

Relaxation Techniques

Relaxation is the release of tension from the mind and body through conscious effort. By reducing muscle tension, you short-circuit the fear-tension-pain cycle, allowing your body to work naturally

Relaxation is a learned skill and one that must be practiced to be effective. The more proficient you become, the more self-confident you will be during labor.

Progressive relaxation
Beginning with your head or your feet, relax one muscle group at a time, moving toward the other end of your body. If you have trouble isolating the muscles, first tense each group for a few seconds, then release and feel the tension ebb away. Come back to your jaw now and then, because if your jaw is loose, you are too.

Touch relaxation
Your cue for releasing each muscle group is when your partner presses, strokes, or massages in tiny circles. He or she should apply pressure for five to ten seconds, then move on to the next spot. Practice together, until your response becomes automatic. Tips for practicing touch relaxation skills:

Choose a quiet environment.
Ask your partner to begin at your head and work down.
- Temples: Press temples gently but firmly with fingertips.
- Base of skull: Press firmly with thumbs or fingertips on either side of the spine, just below the skull.
- Shoulders: Use firm fingertip pressure on top of the shoulders, midway between the neck and arms.
- Back: Rest hands on shoulder blades and move thumbs to either side of spine. Apply pressure for three to five seconds and then move thumbs down an inch. Repeat until you reach the waist, then move outward and work your fingertips along the hip bones.
- Arms: Beginning at the shoulder, firmly press massage points that extend down the top of the arms to within about two inches of the wrists.
- Legs: Apply thumb pressure in a firm, stroking action down the middle of the backs of the thighs and lower legs. Avoid pressure to the areas behind the knees.
- Feet: Apply firm pressure with the thumbs, beginning at the heel and moving toward the toes.

Massage
Massage helps muscles relax and causes the brain to release endorphins, which enhance the sense of well-being. However, not everyone likes to be touched during labor. If you don't want to be touched, your labor coach can still be involved by giving you verbal rather than tactile cues.

Guided imagery
Guided imagery has been called daydreaming with a purpose. We all have a special, peaceful place we can go in our imaginations. Choose what makes you most relaxed-sit on a desert island, climb a mountain, watch a flower open. Concentrate on the details, such as smells, colors, or the wind against your skin. Feel your body growing heavier and enjoy the sensation.

Meditation
Meditation can be achieved by focusing on a single point-something external in the room or a mental image or word you repeat to yourself over and over. When distracting thoughts come into your consciousness, allow them to pass by without dwelling on them, and bring your focus back to your focal point.

Become aware of the areas of tension in your body and concentrate on relaxing them. Use slow, deep abdominal breathing. Feel the coolness of the air as you breathe in; feel the tension carried away as you breathe out.

With any of the relaxation techniques, the more you practice, the better they will work when you need them. Take the time now to practice with your birthing coach.

Becoming a Family
	At times you are delighted with the prospect of becoming a parent, and at other times you and your birth partner may be apprehensive. Worries may grow into concerns about the baby, yourselves, and your relationship. All of these feelings are useful because they help make you aware of what you want to learn about having a baby and parenthood. Just how much your moods change depends on your personalities,	how much stress you are under, and how much support and assurance you receive. Support each other, talk over anxieties and concerns, and be open to the caring of your family and close friends. Be sure to discuss these feelings with your doctor. You and your birth partner are about to journey into a dimension so joyous and tumultuous you can hardly imagine what to expect until you have that little bundle in your arms and in your lives.

New Mother's Forum
	New Mother's Forum is a free, informal, weekly discussion group led by a family education instructor designed to help mother ease through the adjustments of having a new baby.	Breast- or bottle-feeding, baby care, and growth and development during infancy are some of the topics addressed. And babies are welcome! For more information, call the *BEGINNINGS* program at (818) 952-2272.