text: The Futu for re ints Footpr Volume 10 English Dear Expectant Parent, We are happy that you have chosen to deliver your baby at Advocate Condell Medical Center. You can feel confident that you have made the right choice. Our expanded and renovated New Life Maternity Center was designed to meet your every need. We planned each detail to ensure your comfort, privacy and peace of mind. Our goal is to make your delivery a wonderful and memorable experience for you and your family. If there is anything you can suggest to make your stay more comfortable, please let us know, we will be happy to accommodate you! Best wishes, Donna M Clark Manager, Advocate Condell Medical Center's New Life Center 2 Dear Patient, It is our pleasure to have the opportunity to care for you and you growing family. We encourage you to pre-register for your maternity care at Advocate Condell Medical Center early in your pregnancy. Once we have your current information on file, we will be able to quickly register you for any obstetrical related service you have prior to your delivery date, and through the birth of your baby. Please complete the Maternity Pre-Admission information form that is included in this binder. It can be mailed or faxed to: Advocate Condell Medical Center Confidential Fax Number 801 S Milwaukee Ave. 847-990-6030 Libertyville, IL 60048 Attention: Pre-Access Department Please be aware that many insurance companies have pre-approval requirements for maternity care. Please speak with your physician about required insurance authorizations and be sure to let both your physician and Advocate Condell Medical Center know if you change insurance coverage during your pregnancy. While payment requirements and plan benefits are determined by your insurance, we want you to know that you may qualify for financial assistance through Advocate Condell Medical Center or another financial assistance program if you have no insurance or limited insurance coverage. To determine if you will qualify for a discount on your estimated patient balance, or to discuss other types of financial assistance for which you may qualify, please contact Patient Financial Services Department at 847-990-6358. Please contact our Pre-Access department if you have questions or concerns related to preregistering for service or understanding your insurance benefits. A Pre-Access Coordinator can be reached at 847-990-5227. We thank you for the trust you place in us each time you use one of our services. Sincerely, Patient Access and Patient Financial Services Departments 3 Maternity Pre-Admission Information (Please type or print.) Due Date / / Physician mm/dd/yyyy Name: Last Current Address: City State Zip Code Birthplace/Date Religion Marital Status Spouse's Name Telephone Email Spouse's Date of Birth Name of Nearest Relative Relationship Telephone Patient Employer Full/Part-Time SS# Patient Employer Address City State Zip Code Telephone Spouse Employer Full/Part-Time SS# Spouse Employer Address City State Zip Code Telephone Insurance: Name of Primary Insurance Policy # Name of Policyholder Date of Birth _____________ ID# Name of Secondary Insurance Policy # Name of Policyholder Date of Birth _____________ ID# State and Federal law require that we ask all patients admitted to the hospital if you have: Mental Health Declaration? Y N Living Will? Y N Durable Power of Attorney for Healthcare? Y N Have you ever been a patient at Advocate Condell Medical Center before? What name? Does your insurance company require pre-certification? Y N If yes, phone number Attach copy of both sides of insurance card. Please provide the name of a contact person and best time to reach you. Name____________________ Phone _______________ Best time to contact _____AM _____PM Please complete and return to your Physician as soon as possible. Table of Contents The information contained in this binder is general information and not intended to serve as medical advice. Individual questions should be addressed to your healthcare provider. Please bring this book with you to the hospital. Maternity Pre-Admission Information Form Taking Care of Yourself Before Admission 2 Bladder 21 When to Come to the Hospital 6 Bleeding 21 Entering the hospital 7 Blues 22 What to Bring to the Hospital 7 Bowel 22 During Your Stay 8 Breast Self-Exams 22 Infant Safety and Security 9 Depression 22 Infant Birth Certificate 9 Diet 23 Services of Interest to Expectant Parents 9 Episiotomy 23 Hemorrhoids 24 Immediately Following Delivery 10 Hygiene 24 Transfer to Mother-Baby Unit 10 Menstruation 24 Baby's Transfer to Nursery 10 Pain 24 Mother-Baby Care 11 Physical Changes 24 During Your Stay 11 Sexuality 24 Cesarean Section 12 Varicose Veins 24 Immediately Following a Cesarean Section 13 Weight Loss 25 Mother-Baby Care Following Cesarean Newborn Screen 13 Taking Care of Your Baby Bathing 25 Breastfeeding 14 Bowel Movements 26 Milk Production 14 Breathing 26 Anatomy of the Breast 14 Building Trust 26 Your Breastmilk 15 Circumcision Care 26 Breast Care 15 Colic 27 Breastfeeding Techniques 15 Cord Care 27 Burping 17 Cradle Cap 27 Breastfeeding After Cesarean Birth 17 Crying 27 If Baby is Unable to Nurse 17 Diapering 28 Breast Pumps 17 Dressing 28 Pumping Hints 18 Eyes 28 Breastmilk Storage 18 Fingernails 28 Nutritional Needs While Breastfeeding 18 Fontanels 28 Substances to Avoid While Breastfeeding 19 Hiccups 28 Common Problems 19 Jaundice 29 Lactation Services 20 Rashes 29 Bottlefeeding 20 Safety 29 Choosing a Formula 20 Shaken Baby Syndrome 30 Preparing the Formula 21 SIDS 31 Feeding by Bottle 21 Skin 31 Temperature/Fever 31 When to call your Healthcare provider 32 Resources 33 7/09 5 Introduction Congratulations from the Advocate Condell Medical Center family! As your family is growing, we at Advocate Condell Medical Center will work together to meet your needs. Whether you are seeing an obstetrician or using the Lake County Health Department clinics, be assured we will provide outstanding services in our state-of-the-art facility. Expanding your family takes a lot of preparation before, during and after birth. We have compiled this information to help you through this busy time. Please bring this booklet to the hospital when you are ready to deliver, and use it as a reference before, during and after your delivery. The New Life Maternity Center is a Level II Plus Obstetric Department affiliated with the Northwestern Perinatal Network. Our modern LDR (Labor, Delivery and Recovery) suites are designed to accommodate you and up to three support persons who can support you during the birthing process. On-site perinatologists (specialists in high-risk pregnancies) are available to consult with your physicians should the need arise. Our Level II Plus (Special Care) Nursery is dedicated to keeping the family close if your special baby requires the attention of our staff neo-natologists (specialists in sick/premature infants). These specialists are available 24 hours a day. Pediatric hospitalists provide 24 hour inhouse coverage for any newborn or pediatric emergency. In the Mother-Baby Unit, your nurse will coordinate care for you and your baby to ensure that all your needs are met. What You Need to Do Before Admission • Complete your pre-admission form and mail it to the Registration Department of Advocate Condell Medical Center. • Check with your insurance company regarding pre-admission requirements, length of stay and other concerns. It is your responsibility to know your insurance requirements and maternity benefits. If you need assistance with this process or have questions regarding payment, please call Advocate Condell's Patient Financial Services department at 847-990-6358. • Bring your insurance identification card or forms with you at the time of admission. We will need to make a copy of your insurance card during your hospital stay. • Choose a healthcare provider for your baby. The most current listing of physicians on staff at Advocate Condell Medical Center is available at www.advocatehealth.com. If you would like assistance choosing a physician, contact Physician Referral at 1-800-3-ADVOCATE. • Make a decision regarding cord blood banking. You should receive information on banking cord blood from your healthcare provider. Should you choose to bank, it is imperative that you let your nurse know immediately upon admission. If you have any questions regarding this option before you deliver, please contact the Perinatal Education Office at 847-990-5407. When to Come to the Hospital We recommend that you come to the hospital if: • Your contractions are strong and regular • Your bag of waters breaks • You are concerned or not comfortable at home Check with your healthcare provider for any changes to these recommendations. 6 Entering the hospital Main Entrance The hospital's main entrance is open from 5:30 am until 8:30 pm. Valet parking is available. Please use the main entrance when visiting or for scheduled appointments in the laboratory or radiology. Emergency Department Please use the Emergency Department if you are in labor or if your physician sends you to the hospital for a problem or complication during your pregnancy. A nurse will assess your status and prioritize your transfer to the New Life Maternity Center. New Life Maternity Center At the entrance to the New Life Maternity Center is a doorbell. Please ring the doorbell. You will be buzzed in. Proceed through the doors and check in at the desk. You will be directed to the appropriate area. All visitors to Labor and Delivery are asked to provide a valid ID in order to receive a visitor's badge. The ID will be returned to the visitor upon return of the badge. Three visitor badges will be available for each room. Other visitors will be directed to the Family Waiting Room. For safety reasons, visitors may not wait in the hallways outside of the labor rooms or in the postpartum area. What to Bring What Mom should bring to the hospital: o Personal hygiene items—toothbrush/paste, shampoo, brush, etc. o Items that will help you to be more comfortable (lotions, lip balm, etc.) o Your favorite music (CD or tape) o Insurance card o This booklet o Socks, slippers, support/nursing bras o Hair tie o Robe o Loose, comfortable clothes for going home The New Life Maternity Center provides gowns, sanitary pads, and hair dryer. What your support person/coach should remember to bring: o Comfortable clothes o Personal care items—toothbrush/paste, shampoo, brush, etc. o Any medications necessary for a 24-hour period Remember to bring for baby: o T-shirt and sleeper/outfit for going home o Hat and blankets for going home o The New Life Maternity Center provides everything your baby will need while at the hospital (diapers, T-shirts, blankets). At discharge you are welcome to take your baby's comb, crib cards, bulb syringe and any remaining diapers. If you are in need of infant clothing, please tell your nurse. o Infant car seat 7 During Your Stay Snacks The New Life Maternity Center has a refreshment center located near the LDR suites. You or your labor coach may help yourselves. After your delivery a hospital meal will be ordered. Snacks and beverages also are provided for labor support people. A refrigerator is located at the Mother-Baby nurse's station. Please ask for assistance if you would like a snack item. Labor and Delivery Support Support people are welcome in the labor and delivery area. Two to three people at a time may be in your room during your labor; your nurse will use her discretion to maintain your privacy and your wishes. The family waiting room and library are available for additional family members to wait. Phone Use • For local calls: Dial 8 + area code + number (no charge). • For calls outside the local calling area, use your calling card or call collect. Directions are on each phone. A • ll incoming, personal phone calls will be directed to your room. If you wish not to receive phone calls for any reason, simply unplug the phone or alert the nurse. Your phone calls will come to the nurse's station and the callers will be told to call back at a later time. No information is given out over the phone regarding you or your baby. • Cellular phones may be used in identified areas of the hospital. Y • our nurse will carry a wireless phone and will give you her extension at the beginning of her shift. You may call her directly at anytime from your room phone if you need assistance. Room Comfort The thermostat is individually controlled in each room so you may adjust it as needed. Please check with your nurse if you need assistance locating the thermostat. Overnight Accommodations One support person is welcome to stay overnight anytime. Pillows, linens and blankets are provided. Siblings at Birth If you are considering having the baby's siblings attend the labor or birth, preparation is necessary. Please discuss this option with your physician well in advance of the birth. At the birth, a support person for the child is required. Seeing their sibling born can be a wonderful experience for children who are emotionally ready, well-prepared and well-supported. Please contact the Perinatal Education Department at 847-990-5407 to make these arrangements. Following the class, students will receive a signed consent form from the instructor which must be presented before the child is allowed to participate in the labor or birth process. Visiting Hours in the Mother Baby Unit The birth of your newborn is an exciting time to share with close family members. Liberal visiting with family offers the family time to bond and get to know the newest family member. However, too many visitors can overwhelm many new parents. Let family and friends know it is best to keep visits brief to allow you to rest and take part in learning opportunities with your nurse. Always ask visitors to wash their hands before having contact with your newborn. Visitors who are sick should not visit to avoid exposure of illness to newborns and mothers. Grandparents and siblings may visit you and your baby anytime throughout your hospital stay. Special Care Nursery visitation is arranged with the baby's primary nurse. 8 Infant Safety and Security The safety and security of you and your infant is very important to us. Several security measures are in place. You will notice all staff members will be wearing a Advocate Condell Medical Center photo identification badge. Your nurse will introduce herself at the beginning of every shift. Take note of her name. She will coordinate your care with your baby's and be aware of all testing ordered by your physicians. The following are suggestions to foster safety. • When the nurse brings your baby to you, she will ask you to read the number printed on your band to ensure it matches the number on the baby's band. • You may go to the nursery to get your baby, and the same band checking procedure will be done. Only Mom or the significant other may get the baby from the nursery. • Do not leave baby alone in your room. If you plan on walking in the hallway, place your baby in the crib and take him/ her with you. When showering, close the outer door, push the baby's crib near the bathroom and leave the bathroom door open. • Never leave the baby alone on the bed. Newborns move around a bit so always keep a hand on your baby when he/she is out of the crib. • Question unfamiliar people entering your room or inquiring about your infant even if they appear to belong there. Contact your nurse immediately if you have any question or doubt about someone. • No one should carry your baby out of the room in their arms. Anyone trying to do so should be stopped and reported to your nurse immediately. Birth Certificate Your baby's birth certificate will be completed during your hospital stay. Your baby's Social Security card will be applied for at the same time. Social Security cards will be mailed to you approximately two to five months following application. You will receive paperwork regarding obtaining copies of the legal birth certificate when the birth registrar verifies your information. If you are a single parent, a form, "Voluntary Establishment of Paternity," will be available for your consideration. If you have questions regarding your birth certificate or Social Security card application, please call the birth registrar at 847-990-5460, 7 am to 3 pm daily. Services of Interest for Expectant Parents Tours You may schedule a tour of the New Life Maternity Center by calling 1-800-323-8622 or register online at www.advocatehealth.com/condell. If you have questions, special requests or needs, please contact the Perinatal Education Coordinator at 847-990-5407. Childbirth Classes Childbirth Classes will enhance and complement your doctor's advice. Taught by trained instructors, these classes provide understanding, support and information that will take you from pregnancy through the postpartum period, and help you to adjust to the changes that having a baby brings. Register online at www.advocatehealth.com or call the Perinatal Education Office at 1-800-3-ADVOCATE. 9 What to Expect During Your Hospital Stay Immediately Following Delivery Congratulations! These first few moments after birth are unbelievable and sometimes a bit of a blur. As you bond with your new baby, your nurse will begin your transition into the postpartum period. This "transition" or recovery period will take place in your LDR (Labor, Delivery and Recovery) suite and last approximately two hours. Once your physician has completed the delivery of the placenta and any surgical repairs necessary, your nurse will assist you in freshening up. She will begin teaching you about your self care. Your nurse will be monitoring your vital signs (temperature, pulse, blood pressure and respiration) as well as your uterine bleeding. If you are planning to breastfeed, this is an excellent time to begin. Oral fluids will be encouraged and offered and a meal or snack will be provided. This recovery time lasts approximately two and a half hours. Use this time to bond with your baby and rest. Your baby and support person and you will each receive an ident-a-band at this time. This numbered band system identifies the three of you, and all bands need to remain on until discharge. The number on the band will be compared each time your baby is returned to your room for any reason. Any IV fluids you received usually will be discontinued when it is safe to do so. You may experience afterbirth pains or cramping. Pain medication is available if you feel discomfort. Your nurse will assist you to the bathroom to urinate. Urine output is measured as long as necessary following a delivery. While up in the bathroom you will receive instructions on perineal care. All supplies are provided for this care during your stay. If you had an episiotomy, your physician has closed this incision with sutures that will dissolve in 2–6 weeks and do not need to be removed. If your perineal area causes you discomfort, let your nurse know. Your physician has left orders for oral and topical pain medication. Transfer to Mother-Baby Unit Once your recovery time is complete, your nurse will transfer you by wheelchair to your room in the Mother-Baby Unit. You will be oriented to your room. For your safety, call your nurse for assistance to the bathroom your first few times up. All of your personal items will be transferred with you. You will meet your mother-baby nurse who will provide her phone extension so you can call her directly with any needs or requests. Please share any questions or concerns with your nurse. A menu will be delivered to your room so you can select your meal. Baby's Transfer to Nursery Your baby will transfer to the nursery some time during your recovery period. At times, newborns require special care from a nursery nurse. Your baby will transfer to the nursery in his crib and be placed on the infant warmer, and be given a head-to- toe assessment. A bath will be given when your baby has a stable temperature, and a newborn photo will be taken. Baby's first Hepatitis B vaccine will be given. When your newborn is able to maintain her temperature on the warmer, she will be placed in an open crib, wrapped in two blankets with a hat and rejoin you in the Mother-Baby Unit. When your baby comes out to you, usually your mother-baby nurse will care for you as a couple. She will begin the educational process to prepare you for caring for your baby at home. 10 Mother–Baby Care Your nurse will coordinate the care you receive in the Mother-Baby Unit. She will introduce herself as each shift begins and write her name and wireless phone extension on a small board visible from your bed. She will assist you as needed with your care and your baby's care. First-time parents may wish to have the nurse help with diaper changes, caring for the umbilical cord and feeding baby, while experienced moms may prefer asking questions only as necessary. Whatever your comfort level, your nurse is there to help you. During Your Stay n Breastfeeding: Breastfeed often and refer to the Infant Feeding section of this book. Please let your nurse know the times you started and ended and how well the baby nursed. n Bottlefeeding: If you are bottlefeeding your baby, you may request a bottle any time baby seems hungry or fussy. Refer to the Infant Feeding section in this book for additional tips. Please let your nurse know the times you started and ended and how much baby ate. n Daily Showers: You will receive towels and a clean gown in the morning. n Birth Certificate: You will receive a birth certificate worksheet during your stay. n Cord Care: Keep the cord clean and dry. Cleanse with soap and water and air dry if cord becomes soiled. n Diaper Changes: If you need assistance changing your baby's diaper, let the nurse demonstrate or assist you. Please report diaper contents to your nurse— all contents must be charted in your baby's record. n Diet/Menu Selection: It is important for you to follow the same well-balanced diet after delivery as you followed prior to the birth. Choose 3–4 servings of calcium-rich foods, 3 servings of protein-rich foods, 3 servings of fruit , 3–4 servings of vegetables, and 9 servings of bread. Continue to take your prenatal vitamins daily. n Discharge: Both your physician and the baby's physician must write an order for your discharge. The physicians will review their discharge instructions with you before you leave the hospital or provide written instructions for you. Please have clothing for you and your baby that is appropriate for the season. You'll also need a car seat for the baby's ride home. Please have it adjusted to fit a newborn and know how it attaches into your vehicle. Your nurse will review infant care as well as postpartum care. Ident-a-bands will be compared one last time prior to discharge and then removed. The cord clamp will be removed. A nurse or OB tech will escort you by wheelchair to your car. n Hearing Screen: A hearing screen will be performed on your baby during your hospital stay. The State of Illinois requires all hospitals to perform a hearing screen on all infants prior to discharge, unless parents object on religious grounds. n Hemorrhoids: Hemorrhoids are dilated blood vessels surrounding the anus that can swell during the labor and delivery process. Keep this area clean using soap and water. Your physician may prescribe sprays, sitz baths, suppositories and ointments. Your nurse will instruct you on their use. Lie on your side in bed and make sure your pad does not irritate the hemorrhoids. n Pain Management: Let your nurse know of any discomfort or pain you are experiencing. You will be asked to rate your pain on a scale of 0–10. While some pain or discomfort is to be expected following the birth process, several things can be done to keep you as comfortable as possible. Please use the following table to help you describe your level of pain: 0–1 . . . . . . . . . . . . . . . . . . . . . . . . . . pain free 2–4 . . . . . . . . . . . . . . . . . . . . . . . . . . fair 5–6 . . . . . . . . . . . . . . . . . . . . . . . . . . moderate 7–8 . . . . . . . . . . . . . . . . . . . . . . . . . . hurts a lot 9–10 . . . . . . . . . . . . . . . . . . . . . . . . . intolerable 11 Your physician has prescribed medication for use as needed. Topical medications, ice and other comfort measures also may be used. Discuss your options for pain relief with your nurse and let her know if they are working.Your newborn's pain will be assessed as well throughout his/her hospital stay. Physical characteristics, facial expression and cry are evaluated before, during and after procedures such as IV placement, blood draws and circumcision. Interventions such as swaddling, breastfeeding and pacifier use as well as medications such as Acetaminophen and Emla Cream are common treatments for treating pain in the newborn. n Pediatrician: Upon admission, you will need to specify a pediatrician or family practitioner to provide care for your newborn. If you have not chosen a pediatrician or family practitioner, your obstetrician may recommend one, or the physician on call will be notified to care for your baby. These physicians are notified following your delivery and usually make rounds daily. Your infant will be seen on daily rounds and the physician will see you regarding this visit. Your baby's physician will be notified of any problems that your infant is experiencing. n Pericare: You will receive a spray bottle to cleanse your perineal area. Please rinse your perineal area with this bottle following urination or bowel movements. Continue to do this as long as you have a discharge. It is helpful to use cooler water for the first 24 hours to decrease swelling. After this initial period, use warmer water. Carefully pat the area dry and then apply any sprays or ointments. Apply a clean pad, being careful not to touch the inner surface of the pad, then wash your hands. A sitz bath may be used for comfort. You may fill a clean bathtub with three to four inches of warm water and sit for a period of 20 to 30 minutes. A portable sitz bath which sits in your toilet bowl may be given to you in the hospital. You will receive instructions on its use from your nurse. n Newborn Screen: Your baby will receive a newborn screening test before discharge. A few drops of blood will be taken from your baby's heel after 24 hours of age to complete this test. Your pediatrician/family practitioner will receive the test results and you will be notified if this test needs to be repeated or if there is an abnormal result. n Rest: Rest is extremely important following the birth of your new baby. Try to rest when the baby is sleeping. A hospital is a busy place with numerous people involved in your care and the baby's. Visitors and phone calls can be overwhelming. At night, your nurse will care for you as you as needed. Your night nurse will visit you at the beginning of her shift, then follow up as you awaken for feedings with the baby. In the daytime, close your door to keep hallway noise down if you are trying to nap. n Rhogam: You will receive a Rhogam injection prior to discharge if your blood type is Rh negative and your baby is Rh positive. Rhogam is an injection given to Rh-negative women to minimize the problems associated with Rh incompatibilities between the mother and newborn. n Rubella: You will receive a Rubella immunization prior to discharge if you are not immune or you are low-immune. n Safety: The safety of you and your baby is extremely important to us. During your stay, always transport your baby in his/her crib. Never walk in the hallways carrying your baby. Please wear shoes or slippers on your feet. Use your side rail and a pillow as a barrier to prevent your baby from falling from your bed. Please do not sleep with your baby in your bed or propped on you. Your baby should sleep on her back in the crib. Never leave your baby alone in your room. When showering, bring the crib into the bathroom or in the bathroom doorway and close your outer door. If bottle feeding, never prop the bottle when feeding. Always hold your baby when feeding him/her. Cesarean Section When your physician determines the safest delivery method will be a Cesarean section, you will require additional information and preparation. If the surgery is planned and scheduled, you will arrive a few hours before the scheduled time. The admission process will begin from the front lobby of the hospital. The admission clerk will escort you up to the New Life Maternity Center to meet your nurse. You will be asked to change into a patient gown and the fetal monitor will be applied. IV fluids will be started, a urinary catheter will be inserted, lab work will be completed, and your abdomen will be shaved. You will review and sign a consent form for the surgery. Your nurse will explain your procedure and answer any additional questions. Foods and oral fluids will be restricted several hours before the surgery. If your surgery is done on an emergency basis, several of these preparations and procedures may be done simultaneously. 12 Immediately Following a Cesarean Section You will spend the initial hour or so following a Cesarean section in the recovery room. During this hour, a nurse will monitor you very closely. Your baby will have been taken directly to the nursery by the pediatrician/family practitioner/ neonatologist and placed on an infant warmer. Your support person will have followed along to the nursery. While the baby is being examined and measured in the nursery, you will begin your recovery period. Vital signs and sensation will be observed and pain medication will be given, and you will be asked to cough and take deep breaths. Your support person will rejoin you in the recovery room and update you on your baby's vital statistics. Once your condition is stable, you will be transferred into your postpartum room on the Mother-Baby Unit. Mother-Baby Care Following Cesarean You will meet your mother-baby nurse and she will assume your care, paying close attention to your vital signs, condition and pain level. You will be asked to rate your pain on a scale of 0–10. You may be given a PCA (patient-controlled analgesia) pump, which will give you the ability to administer your own pain medication. If a PCA pump is not used, your physician will have orders to use an injectable narcotic for pain relief, which your nurse will administer. Whichever pain relief is ordered, please let your nurse know how well it is working. This method of pain relief will be used for approximately 24 hours. The use of oral pain medication, such as Tylenol with codeine or Motrin, usually begins on the first post-operative day. The first 8 to 12 hours after birth you will be on bedrest, after that time you will be able to sit on the side of the bed or up in a chair. A urinary catheter, IV and abdominal dressing will remain in place for up to 24 hours. You will be able to shower and walk about your room and hallway after 18 to 24 hours. Your hospital stay usually is extended a day for recovery following a Cesarean section. Your incision was closed with staples. Physicians remove the staples either before you leave the hospital or a few days later in their office. Once the staples have been removed, strips of tape called steri strips will be applied across the incision to give it support as it heals. As they loosen, you may remove them. Your nurse or your support person will assist with baby care. If you are breastfeeding, you may need assistance finding a comfortable position to nurse. Newborn Metabolic Blood Screening Why Your Baby Should Be Tested Some babies who seem healthy at birth may have a rare hidden disease. If a disease is found and treated early, serious health problems may be prevented. To make sure at-risk infants are identified, the State of Illinois requires testing of all newborns for certain genetic/metabolic disorders before they leave the hospital. The screening procedure begins with a simple heel stick test. If you are going home from the hospital before 24 hours, the blood test will need to be repeated. The nurse will inform you about the arrangements. Your doctor will inform you if these tests or your baby's health indicate a need for further testing. 13 Infant Feeding Before your baby arrives you should consider whether to breastfeed or to give infant formula. This is an important decision. Condell New Life Maternity Center is committed to supporting your decision to breastfeed or bottlefeed. Consider the advantages and disadvantages of each before making your final decision. Many times you receive "helpful advice" from family members and friends who have strong feelings about feeding methods. Feel confident that whichever feeding method you choose will be the best option for you and your baby. If you are considering breastfeeding but are unsure, keep in mind it is easier to begin breastfeeding and switch to formula than to begin bottle-feeding and switch to breastfeeding. Breastfeeding If you decide to breastfeed, the New Life Maternity Center will assist and support your decision. Along with help from your nurse, the services of the Lactation Consultants are available to all patients. Your nurse will assist you with getting started in your Labor and Delivery Room (LDR) suite during your recovery period. All staff nurses have received breastfeeding continuing education from the Lactation Consultants team. These consultants will see you during your stay at the New Life Center, maintain a "Lactation Warmline" for breastfeeding questions and problems, and offer a breastpump rental program. If you have questions about breastfeeding or need assistance after discharge from the New Life Center, please call the Advocate Condell Lactation Office at 847-362-2905, ext. 1278. During your hospital stay, alert your nurse if you have any questions or problems. Milk Production The breast is a gland consisting of fatty and connective tissues that support the milk production. The milk is produced in the alveoli and travels down the milk ducts to the nipple pores on the surface of the areola. Milk production is based on supply and demand. The baby's sucking stimulates the milk production. After the first few days of breastfeeding, the supply can exceed the demand, causing engorgement, or an over-filling of the breast. Over a period of time, this supply and demand will balance. Lactiferous glands Anatomy of the Breast milk The nipple and areola (the dark area around the nipple) enlarge and darken during pregnancy. This may assist the baby in latching on. The small bumps on the areola are nipple called Montgomery Glands. They secrete oil, which cleans, lubricates and protects the nipple during pregnancy and breastfeeding. The oil contains a bacteria-killing enzyme, which helps prevent infection. The nipple has 15 – 20 small openings through which Ducts the milk flows. As the baby begins to suck on the nipple and areola the milk flows through these openings. This stimulates the let-down or milk ejection reflex. When the baby nurses on the areola (compressing the milk sinuses), the sucking action of the jaws and tongue and the suction Ductules areola Anatomy of the Breast 14 The let-down reflex activates the release of milk from the breasts. It is experienced in different ways; as your infant actively sucks and swallows, milk drips from the opposite breast, or you may feel a tingling or a full sensation. This reflex can occur several times during a feeding. Other times, let-down can occur when you think about your baby, when you hear any baby cry, when it is about feeding time, when you are sexually stimulated or during orgasm. Fatigue, inadequate sucking, emotions and fear of pain all can interfere with the let-down reflex. It is helpful to create a supportive nursing environment to ensure that let-down occurs. Here are some suggestions: n Find a peaceful environment n Insist on your privacy if necessary n Position your baby properly and comfortably n Use a warm shower or warm packs prior to nursing to encourage the flow of milk n Unplug the phone, play relaxing music, abdominal breathe before beginning to feed n Establish a routine; get a beverage, a book to read or position your pillows prior to nursing n If you experience difficulty, consult the Lactation Office. Your Breastmilk Colostrum is the early or first milk produced by your breasts and is usually present by the fifth or sixth month of pregnancy. Colostrum is yellow, thick, high in protein and low in fat and sugar. The protein content is three times higher than mature milk due to the immunities passed on from the mother. Colostrum not only contains enzymes and immunities to protect your baby, but also acts as a laxative, which helps in eliminating the baby's first stool, called meconium. Your milk will change from colostrum to mature milk during the first 72 hours after birth. Foremilk is the name for the milk that comes out at the beginning of a breastfeeding session. It looks thin and watery with a light blue tint. Hind-milk, which follows the foremilk, is higher in fat and is released after several minutes of nursing. It is similar in consistency to cream. This milk makes your baby feel full and has a sleepy effect. Breast Care Be sure to keep your breasts clean. Cleanse them when you shower, however, it is best to avoid using soap on the nipple or areola area because it can have a drying effect. Also, wash your hands before each nursing session. Wear a nursing bra to provide support, even at night. The increased size and weight of the breasts can strain the Cooper's ligaments, which support the breast tissue. The bra must fit well and should not be tight in the cup area or around your ribs. Breast creams usually are not needed. If nipples become sore during nursing, it is most often caused by improper positioning. A helpful treatment for sore nipples is to express and apply breastmilk to the affected area and allow it to air dry. (Leave the flaps of the nursing bra open until dry.) If breast cream is desired, a purified lanolin cream, such as Lansinoh or Pur-Lan can be used following a feeding by applying a thin coating on the areola and nipple. These creams are available at your pharmacy. Once nursing is established, breast pads or breast shells may be worn to keep outer clothing dry. Breast pads should be changed when damp. Do not pull off a breast pad if it is sticking. Wet it first with warm water to help remove it from the breast. Milk collected in the base of the breast shell should be discarded. This milk may contain bacteria and should not be fed to the baby. Breastfeeding Techniques Getting started Breastfeeding is a learned skill, so be patient with yourself and your baby. Create a comfortable environment. Sit in a rocking chair with a pillow on your lap or sit on a couch and place pillows under the arm you use to hold the baby's head or lie on your side in bed. Prepare baby by unwrapping the blanket and checking the diaper. This activity will arouse baby and stimulate her to nurse. If baby is awake and ready to nurse, changing can be done after the first breast. 15 To proceed, form the letter "C" with your hand; place the thumb on the top part of the areola (about one inch from the nipple) and the forefinger underneath. Stroke the baby's lips with the nipple. The baby will open his/her mouth or "root" towards the nipple. This response is known as the "rooting reflex." As the baby roots, pull her in closer to "latch on" to the breast. Baby's tongue should be down and he will begin to suck. The entire nipple and some areola should be inside the mouth. You should see sucking and swallowing. It should not be painful. If you are experiencing pain, check to see if the baby is only sucking the nipple. The baby needs to have some areola in her mouth to properly empty the breast. To remove baby from the breast, slip your little finger between baby's mouth and gums to break the suction. Choose one of the following positions to nurse: Cradle hold (tummy to tummy) n Cradle your baby in your arm with his/her tummy against yours and his/her head resting in the bend of your elbow. n Tuck your baby's lower arm out of the way, with her mouth close to your breast. n Grasp your breast with the C hold. Lift your breast upward and stroke your baby's lips with your nipple. n Pull baby close onto your breast as he opens his mouth wide with his tongue down. n Be sure to sit up straight. Try not to lean into the baby, as your back will quickly tire! It is helpful to have a pillow under your elbow and arm for support. Football hold Cradle Hold n Position baby so that her legs and body are under your arm with your hand holding her head (like a football). n Grasp your breast using the C hold. n Bring baby's head in close as he/she latches on. n This position is especially comfortable if you have had a Cesarean section, if your breasts are large or you have inverted nipples. n Again, placing a pillow under the arm you use to hold the baby will help prevent fatigue. Side-lying position n Lie down on your side in bed (place a pillow behind your back and one between your knees Football Hold for comfort) and place your baby on her side with your two tummies facing. n Grasp your breast with the C hold and attempt to latch on. Breastfed babies will want to nurse every two to three hours (from the start of one feeding to the start of the next). This is especially important in the first two to four weeks. Breastmilk is digested faster than formula, requiring more frequent feedings. Most newborns will breastfeed from 20 to 45 minutes; feed for 10 to 20 minutes on one breast and continue on the second side until baby stops the feeding. Have your baby suckle from each breast to establish your milk supply and allow for adequate nutrition. You will know that your baby is getting enough milk if he n Has six to eight wet diapers a day (once milk is established) n Produces urine that is pale in color n Has frequent bowel movements n Is calm and relaxed after eating n Is gaining weight 16 Massaging the breast may be helpful to promote let-down of milk. Gently massage the breast starting from the chest and making small circles with the tips of your fingers, gradually moving toward the nipple. Massage may also help during engorgement or plugged ducts. Burping Burp baby after nursing each breast and at the end of the feeding. For the most part, breastfed babies burp less than bottlefed babies. If baby was crying prior to the feeding she may have to Side-lying position burp due to swallowed air. Nurse first for a short time, remove her from the breast to burp, and resume feeding. There are three positions to burp baby: n Lying tummy-down across your lap n Sitting up, while leaning over your supportive hand n Propped up on your shoulder Pat your baby's back gently. Babies usually burp within the first five minutes, or they don't have to. Breastfeeding After Cesarean Birth A surgical birth does not directly affect the process of breastfeeding; however, incisional discomfort, fatigue and medications used in surgery and afterwards offer challenges in the beginning. Breastfeed as soon as possible after surgery (within two hours) and every two to three hours thereafter. Your support person and nurse will assist you in finding a comfortable position and help you position the baby. Using the football hold or side-lying is usually more comfortable. It's also helpful to use a pillow for support. If Baby Is Unable to Nurse Occasionally, babies are unable to immediately breastfeed; respiratory problems, blood sugar problems and infections are a few reasons why. You may begin pumping your breasts, which will provide the needed stimulation to increase your breast milk production. Colostrum may be pumped and stored to feed your baby when oral feedings are initiated. Your nurse or Lactation Consultant will provide the equipment and instruction to begin pumping your breasts. The first few times you pump, you may only release a few drops of milk. Begin double-pumping Burping Technique as soon as possible and continue to pump on a regular basis; gradually your milk supply will increase. It is recommended that you double-pump for 10 to 15 minutes per session (every 2 to 3 hours) or single breast pump (one side) 15 to 20 minutes per breast every 2 to 3 hours. Breast Pumps Several manual, battery-operated and electric breast pumps are available. Selection of a pump is very important and many factors should be considered. If you plan on long-term use and returning to work, it may be cost-effective to purchase an electric pump, whereas if you plan to be pumping shorter term it may make sense to rent a pump or use a battery-operated pump. Some pumps can be less effective and cause breast and nipple damage. Attending a breastfeeding class or consulting with a professional Lactation Consultant can be helpful in choosing a pump to meet your needs. Manual breast pump kits are available in the New Life Maternity Center. This kit will convert for use with the rented electric breast pump. To rent an electric breast pump, purchase an electric breast pump, or to discuss your needs with a Lactation Consultant, call the Lactation Office at 847-362-2905, ext. 1278. 17 Pumping Hints n Look at your baby or a picture or think about your baby. n Wash your hands, have something to drink. n Be in a comfortable position. n Massage the breasts or use a warm, wet cloth beforehand. n Don't stare at the bottles! n Listen to music, watch TV, say a prayer or affirmation, breathe evenly. n Relax! Pumping helps stimulate hormone levels. Duration Double pumping: Pump 10–15 minutes Single side pumping: Pump 15–20 minutes or until the milk comes only in drops again. Guidelines for Storing Breastmilk Handwashing should start each breastpumping session. A dishwasher or very hot water and soap can be used to clean pumping items. Rinse these items well and allow to air dry. Small disposable bottle bags or plastic bottles are the preferred storage containers for breast milk. They can be labeled easily with the date and time of collection. If you will be taking breastmilk to daycare, the hospital or someplace where a refrigerator will be shared, it is important to also label the breastmilk with your name. Plan on refrigerating all breastmilk after collection as it contains living cells, which help kill bacteria. Breastmilk may be stored in the refrigerator for up to 5-7 days. If you are unable to place the milk directly into a refrigerator, place it in a cooler with ice packs. When transporting breastmilk, such as to daycare, from work or when traveling, carry it in an insulated bag with cooling packs or ice. This will help prevent spoiling. Freezing breastmilk Type of freezer Maximum storage Deep freezer: 6 - 12 months at 0° F (-19° C) Refrigerator freezer: 3 - 4 months Ice cube freezer: 2 weeks Thawing breastmilk Thaw breastmilk in the refrigerator and use within 24 hours. Never refreeze. The freezing process deactivates the living cells that kill bacteria. Breastmilk may be warmed in the plastic container in warm tap water, using as little heat as possible. Microwaving breastmilk is not recommended because: n Immunities are altered n Microwaves do not heat uniformly n Areas of hot milk could burn the baby Nutritional Needs While breastfeeding It is important to eat a well-balanced diet while breastfeeding and during pregnancy. Most women need approximately 300- 500 extra calories per day to establish and maintain their milk supply. Balanced choices from the food pyramid provide needed calories and nutrition. 18 Fluids are important while breastfeeding. Drinking when you feel thirsty will meet your body's needs. Drink enough fluids so that your urine appears light yellow. Darkened or concentrated urine means you need to increase your fluids. If you have allergies in your family, you may want to be careful about those foods in your diet. Most babies can tolerate the lactose in breastmilk, even though you may be lactose intolerant. Babies do not become allergic to breastmilk, however, sometimes they can be allergic to foods coming through the milk. It can take several days of avoiding a food to determine if your baby is sensitive to it in your milk. Discuss concerns or problems with your Lactation Consultant or healthcare provider. You do not need to eliminate all of your favorite foods while breastfeeding, however, gas-forming foods can cause your baby some discomfort. Beans, cabbage and broccoli may not agree with your baby. Experiment with small amounts of these types of food. Caffeinated beverages should be limited to two servings or less per day. Caffeine can cause the baby to be jittery. Substances to avoid while nursing n Alcohol: Alcohol transfers to breastmilk very rapidly. Research has not been able to determine a "safe" amount of alcohol during pregnancy or lactation. We recommend that you discontinue drinking alcohol while you are pregnant. n Smoking: Nicotine and marijuana smoke is passed through breastmilk and may be inhaled by your baby through second- hand smoke. Second-hand smoke can be harmful to your baby, causing increased ear infections, asthma and cancers. n Medications: Many medications are passed into breastmilk. Check with your healthcare provider before taking any medication. Always remind healthcare providers, including dentists, that you're a breastfeeding mother. Common Problems Inverted or Flat Nipples n Women with flat or inverted nipples will find it helpful to wear breast shells over the nipples the last month of pregnancy & while nursing. Breast shells help draw out the nipple. n It is not recommended to roll, twist or pull on the nipple. This can cause nipple trauma or contractions and possibly preterm labor. n After delivery, the use of a breast pump can help draw out the nipple. Engorgement Breast fullness is caused by increased blood supply and fluid. An engorged breast may flatten your nipple and make it more difficult for the baby to latch on. Prevention is the best treatment, therefore: n Feed your baby every two hours; do not skip feedings. n A warm shower or warm washcloths applied to the breasts before feedings will help the milk flow and ease engorgement. n Engorgement may make it difficult for baby to latch on. Wearing a breast shell or pumping a small amount can soften the areola and allow the nipple to protrude. n Cold compresses between feedings can reduce swelling and relieve discomfort. Sore Nipples Research has shown the primary cause of nipple soreness is improper positioning of the baby on the breast. Checklist for proper positioning: n Make sure baby is not sucking on just the nipple. If the latch is incorrect, remove baby from the breast and try again. n If you see baby's cheeks caving in, he is sucking his own tongue. Remove baby from the breast and latch on again. 19 Other ways to prevent sore nipples: n Try different positions each feeding. n Express a little breastmilk onto the nipple and allow to air dry after every feeding. n Insert finger between baby's jaws to break the suction when taking baby off the breast to prevent trauma to the nipple. n Keep the nipple area free of irritations by avoiding breast creams containing alcohol and vitamin E. (We can't measure the amount the baby ingests.) n If using nursing pads, change frequently. n Consider more frequent, shorter nursing periods. n Avoid using a nipple shield. Nipple confusion Some babies become confused when bottles and pacifiers are offered in the first weeks of breastfeeding. The sucking mechanisms differ and can confuse the baby. It is helpful to breastfeed exclusively the first three to four weeks without using bottles and pacifiers. If a bottle must be given, offer it infrequently or only following breastfeeding. Check with your Lactation Consultant for recommendations on bottle and nipple types. Lactation Services 847-362-2905, ext. 1278 Advocate Condell Medical Center Lactation Services provides phone counseling and individualized counseling to women and their families. Prenatal breastfeeding classes offer basic breastfeeding information as well as information on returning to work and pumping. During your hospital stay, one of our Certified Lactation Consultants will visit you to offer any extra assistance you might need with breastfeeding your baby. After our discharge the "Lactation Warmline" provides breastfeeding assistance and is just a phone call away! A private counseling session is available by appointment. Breastfeeding support is available upon request weekly at the Look What We Can Do infant development class. Please call 847-990-5407 for details. Bottlefeeding Your decision to bottlefeed can include the entire family in your baby's care. Dad, siblings and grandparents all can share in the bonding and caring. There are other reasons parents feel more comfortable with bottlefeeding. Knowing exactly how much food the baby is getting offers some parents less worry, mothers have more flexibility in sharing in the baby's care and there is no concern over medications and dietary needs affecting the mother's milk. Although formulas offer nutrients your infant needs, manufacturers have not been able to reproduce some of the components and antibodies human milk contains. Choosing a formula Your baby's healthcare provider will assist you in choosing a formula that is appropriate for your newborn. Please alert them of any allergies to cow's milk or dairy products in the immediate family. Formulas are either cow's milk-based or soy- based. There are many specialized formulas manufactured for infants with special needs. Always discuss the formula choice with your healthcare provider and alert him of any problems your infant experiences with the formulas. Infant formulas are available in three types: concentrate, powder or ready to feed. Powder and concentrate need to be mixed with water. This water should be sterilized or bottled nursery water. If you have questions or concerns about the water ask the baby's doctor. Follow the directions on the label for mixing powdered or concentrated formula. Cans of formula must be washed before opening and covered when refrigerated. Ready to feed formula simply needs to be poured into a bottle; no mixing is required. 20 Preparing the formula Bottles, nipples, can opener, mixing spoon and anything touching formula should be clean. Begin by washing your hands and the top of the formula can. Check the expiration date on the formula can. Always discard outdated formula or damaged cans. Bottles, nipples and bottle-parts can be sterilized in a dishwasher on the hot cycle or by boiling for 5 minutes. Several bottles may be prepared then stored in the refrigerator until needed. Opened cans of formula may be stored in the refrigerator for up to 48 hours. Bottles should be refrigerated or kept cold in a cooler until warmed for a feeding. Most newborns take about 2–4 ounces every 2–4 hours. Ask your physician how many ounces to prepare for each feeding. Feeding by bottle Formula may be served at any temperature. To warm chilled bottles, place the bottle in a pan of warm water or in a bottle warmer. Formula and breastmilk should not be heated in a microwave due to temperature inconsistencies. Microwaved bottles can feel cool on the outside and the formula inside can be too hot for the baby. Shake the bottle after warming and test the temperature of the formula on your wrist. It should feel lukewarm to warm, but never hot. Always hold baby close during a feeding. Never prop a bottle. Babies can choke and gag during feedings and need your constant attention. Place the nipple in baby's mouth and tilt the bottle so milk always covers the inside of the nipple and lower neck of the bottle. This decreases the amount of air baby swallows. Baby should begin sucking when feeling the nipple in his mouth. If he does not suck, move the nipple to drip a small amount of formula on his tongue; this should stimulate him to suck. If baby is eating too fast, take the nipple out of his mouth to rest and restart the feeding. Burp her after every two to three ounces. Discard any leftover formula from each feeding session. Taking Care of Yourself The weeks following birth are important ones as your body returns to normal. At the same time you are busy adjusting to the new role of parenthood, or perhaps adding a new member to a family with other children. Knowing what to expect and what your resources are will help you relax and enjoy the postpartum experience with as much comfort and confidence as possible. Bladder Frequently traumatized during labor and delivery, the bladder may not empty completely following delivery. Your nurse measured your urine output immediately following birth. It is important to empty your bladder every 3–4 hours as it's tone returns in the first days after you give birth. You will notice you are eliminating large amounts of urine the first few days after your baby's birth as your body rids itself of the extra fluid and swelling from the latter part of your pregnancy. Inform your physician of any frequency or burning with urination. Bleeding The vaginal discharge after birth is known as lochia. It is a combination of the uterine lining and blood. The lochia usually changes from bright red to pink to whitish over the course of several weeks. It is common for the bleeding to start and stop intermittently and contain tiny clots. If you notice an increase in bright red bleeding, it is a signal to slow down and rest more. Large clots (larger than a walnut) or saturating more than one pad per hour is not normal; call your health care provider. 21 Blues The "blues" is a common reaction that can occur in the first few days after delivery, most commonly on the third or fourth day postpartum. Up to 75% of all new mothers experience this feeling of letdown after the birth. Symptoms include crying for no reason, impatience, irritability, restlessness and anxiety. Symptoms often disappear as quickly as they come and usually are brief. Bowel Dietary fiber, extra water and fluids can help prevent constipation. Walking is the best exercise to assist with elimination. Increase your walking as you recover from the birth. Drinking six to eight extra glasses of water each day helps maintain your bowel function. Increasing your daily intake of fiber also helps. Dietary fiber is found in fresh fruits and vegetables (especially unpeeled) and in whole grain cereals and breads. Before using laxatives or stool softeners, check with your healthcare provider. Breast Self-Exams It should be a monthly practice for you to examine your breasts in the days following your menstrual cycle. If you are breastfeeding, you should continue to examine your breasts. n Check your breasts and armpit area while standing in the shower. Raise one arm, and with fingers flat touch every part of the breast using the vertical strip pattern as shown. Feel for lumps or thickness. Use your right hand to examine your left breast and your left hand to examine your right breast. n After your shower, with arms at your sides, then raised above your head, look carefully for changes in the size, shape and contour of each breast. Look for puckering, dimpling and changes in the skin's texture. n Gently squeeze both nipples and look for abnormal discharge. If you are breastfeeding, there will be discharge. n Lying down, place a towel or pillow under your right shoulder and your right hand behind your head. Examine your right breast with your left hand. Fingers flat, gently press starting at the center of the chest and using the vertical strip pattern as shown. Repeat with left breast. See your healthcare provider for regular examinations or if you notice any changes. Depression Postpartum depression can start as soon as the second or third day postpartum or it may take several weeks or months to develop. Many of the symptoms of the "blues" are present, but they are more intense. Other symptoms include: n Being overly concerned or having no concern about the baby n Fear of touching the baby n Little or no concern about your own appearance n Sleep disturbances or need of excessive sleep These symptoms require treatment, which may include medication, counseling or a combination of both. With appropriate treatment most women recover fully. Please contact your healthcare provider for treatment options. 22 Diet The average woman needs about 2,200 calories each day. If breastfeeding, 500 more calories are needed each day to stay healthy and to produce nutritious breastmilk. Your diet should be balanced and contain the appropriate amount of calories and nutrients to fulfill these special needs. The food pyramid (shown on page 4) was developed by the U.S. Department of Agriculture to assist adults in choosing foods that provide the nutrients they require. Use it as a guide for planning servings and serving sizes. Recommended Minimum Number of Servings Breastfeeding Bottle-feeding < age 25 > age 25 Proteins 7 5 5 (at least one as vegetable) Milk Products 3 3 2 Breads, grains 7 7 6 and cereals (4 as whole grains) (3 as whole grains) Fruits and vegetables 5 5 5 For further healthful information please refer to MyPyramid.gov Unsaturated fats 3 3 3 Breastfeeding mothers need extra fluid, calories, protein and calcium. Milk and dairy products such as yogurt, ice cream, cottage cheese and other cheeses can supply calcium and protein. You should avoid tobacco, alcohol and other medications while breastfeeding, as they can affect your baby. Take your prenatal vitamins and any iron supplements your healthcare provider recommends. Episiotomy If you had an episiotomy your stitches will dissolve in about two weeks. There is no need for them to be removed. The skin will heal in two to three weeks. Small pieces of the stitches may be found in your underwear as healing occurs; this is normal and there is no need to be concerned. Care for your episiotomy as you were instructed in the hospital, using the squirt bottle with warm water. If a disposable sitz bath was given to you before leaving the hospital, use it 3–4 times daily, with warm water. You also may take a sitz bath in your own clean tub filled with shallow, warm water for approximately 20 minutes. Discomfort usually will improve daily. A mild pain reliever such as Tylenol may be used. Many women find it is helpful to sit on a hard surface rather than a soft chair. Keeping the perineum dry and wearing cotton underwear will promote healing. Begin your Kegel exercises soon after delivery. 23 Hemorrhoids Many women develop hemorrhoids during pregnancy and after delivery. Hemorrhoids, which are varicose veins of the rectum, can cause pain and discomfort. This can be relieved with ice packs, Tucks or other creams and suppositories recommended by your healthcare provider. Hygiene Showers are preferred for the first few weeks postpartum. A daily shower is recommended whether you had a vaginal birth or C-section. Cleanse the area around the surgical incision if you had a C-section. Vaginal douching is not necessary or recommended until after your postpartum checkup. Frequent handwashing is the best way to prevent the spread of infections. Always wash your hands after diaper changes. Menstruation While breastfeeding, your menstrual period may not resume. If it does, it should not interfere with breastfeeding. If bottle- feeding, your period may return within four to eight weeks following delivery. Your first period may be heavier than normal, with clotting, and may start and stop intermittently. Pain Afterbirth pains occur as the uterus shrinks and contracts. These contractions are much less painful than labor contractions and are more uncomfortable during breastfeeding. They are most uncomfortable the first few days following delivery, however, they do reduce the blood loss after delivery while helping to shrink the size of the uterus. Contact your healthcare provider if Tylenol or Motrin do not relieve this discomfort. Physical Changes Many postpartum changes are a result of hormone shifts and fluid adjustment after delivery. Some of these changes are: n Fluid retention/swelling n Dry skin n Initial hair loss (It will return!) n Mood swings n Hot flashes n Increased urination n Night sweats n Vaginal dryness Sexuality You should refrain from intercourse until after the bleeding has stopped for a few days and you feel more comfortable. This time is needed for tissue healing and to prevent infection. It may take longer depending on your own recovery. Check with your healthcare provider for his/her recommendations.Vaginal dryness can make the first attempts at intercourse somewhat uncomfortable. A lubricant such as KY Jelly may be helpful, and is available at your pharmacy. Varicose Veins If you have developed varicose veins during pregnancy, elevating the legs while wearing elastic hose are recommended for the first six weeks following delivery. Surgery is not usually indicated for the first six months postpartum for women with residual problems with varicosities. 24 Weight Loss Most of the remaining weight after delivery is due to fluid excess. The delivery of the baby, placenta and amniotic fluid will result in an average weight loss of 12 pounds immediately. An additional 8–10 pounds should occur later in the postpartum period as your fluid levels return to normal. If you still need to lose more weight, a healthy diet and exercise program following your postpartum checkup will help. Taking Care of Your Baby The first few weeks at home are an exhausting and exciting time. Be patient as you get to know your baby and her routine. Everyone in the family has a new role to develop and learn. Bathing Give your baby sponge baths the first week or two (until the umbilical cord falls off or the circumcision heals). First, gather all the supplies you will need: n basin filled with 2–3 inches of warm water n 2–3 small washcloths n 2 towels n unscented soap/liquid baby bath n clean diaper and clothes Pick a spot in your home that will be comfortable for you. This area should be warm and free of drafts. Free yourself from distractions, take the phone off the hook or let the answering machine pick up your messages. Never leave the baby alone, not even for a minute! Always keep one hand on the baby. Sponge Baths n Check the water temperature with your elbow to make sure it is warm, not hot. n Using the corner of a clean wash cloth and no soap, wipe the baby's eyelids starting at the inner corner and moving to the outer corner, then use a new area of the wash cloth on the other eye. n Wash the baby's face with clear water, no soap; cleanse the baby's ears with the corner of the wash cloth. Do not insert cotton swabs into the ear canal. Pat the face dry with a towel. n Soap now can be used. Wash the baby's neck inside the folds, rinse and dry. Keep the legs wrapped as you wash the arms, trunk and back, then unwrap and wash the legs and feet. The genitals are washed last. Remove the diaper. If your baby is a girl, there may be a whitish discharge that may be difficult to wipe away. It is not necessary to do so. Wash from front to back (towards the rectum). If you have a boy who is circumcised, drip soapy water over his circumcision, rinse and pat dry. Apply Vaseline (from a tube) and diaper. Proceed with dressing the baby. n The hair may now be washed, using a baby shampoo. Change to clean water and wrap the baby in a blanket. While holding the baby snugly between your body and arm, rinse the baby's head with water, apply shampoo and lather with your hand. You may use a soft brush to loosen flakes on the scalp. Rinse and carefully dry baby's hair with a towel. 25 Tub Baths A tub bath is given after the cord falls off and circumcision is healed. Place a washcloth or small towel in the bottom of the basin or tub to prevent slipping. The first few times you bathe your baby you may want some help available, because babies can get quite slippery! Remember to wash the eyes and face before the soap is used. When finished, lift the baby out of the water and towel dry. Babies should be bathed as necessary. The face and diaper area should be kept clean as needed. It is not necessary to apply lotions or powders to your infant's skin. Bowel Movements Baby's first bowel movements are a green-black sticky material called meconium. These stools are present for two days following birth. Later, it is normal for babies to have yellow stools. Straining sounds during defecation are normal. The number of stools per day and their consistency vary with each baby. A breastfed baby will generally have loose, seedy stools and a bottle-fed baby will have more pasty stools. A hard, dry stool usually indicates constipation, while diarrhea is usually mucousy, thin and watery. Breathing Babies breathe solely through their nose for the first few months, except when crying. It is normal for babies to have periods of irregular breathing. While your baby is sleeping she may snort or pause briefly in her breathing. Your baby's breathing pattern will appear more regular in about a month or two. If your baby has a lot of mucus, you can remove it with a bulb syringe. Follow these steps: n Squeeze the air out of the bulb syringe n Gently insert the tip into the baby's nostril n Release the pressure and remove the mucus n Remove the syringe and discard the mucus n Repeat with the other nostril n Clean the bulb syringe by flushing with hot, soapy water Building Trust A common misconception is that tending to a crying baby will "spoil" him. In fact, responding to a baby's cry in a positive way communicates that you are there to meet the infant's needs. When a baby's cry is answered, trust is built and a sense of security develops. Responses to an infant's cry may include verbal reassurance, feeding, diapering or any calming techniques. Circumcision Care The circumcision often is performed on the day of discharge. Before leaving the hospital your nurse will have given you some instructions regarding the care. The dressing needs to be removed in 24 hours if it does not fall off on its own. This dressing is soaked with Vaseline and will be easy to remove. You may see a bit of reddish fluid in the diaper as the wound drains. This is normal. If you see blood oozing from the dressing, hold a clean diaper firmly on the penis for a short period. If this does not stop the bleeding, alert your physician. If it should stick, sponge warm water over the area and it will loosen. It is important to watch for a wet diaper following the procedure and to note any swelling. On the second day, the penis will develop a cloudy film. This is a normal process of healing. Simply cleanse the penis gently with warm clear water; it is not necessary to remove this film. 26 A small amount of Vaseline (from a tube) may be applied the first few days of healing to prevent the diaper from sticking. After the circumcision has healed for a few days, gently retract remaining foreskin after bathing to loosen. This will prevent adhesions (scar tissue) from forming. An uncircumcised penis requires no special care. Do not attempt to retract the foreskin. As your baby gets older, you'll find the foreskin easier to retract, but it may not retract completely for many years. Colic Colic is a catchall name for extreme irritability and hard crying that occurs daily. Colic appears as screaming, clenched fists, drawn up knees and a tense abdomen. This cry can last a few hours. Colic typically appears at two to three weeks of age and lasts until 3 months. There are many theories about the cause of colic. A popular theory is that swallowed air enters the baby's intestines and causes gas. Swallowed air from crying however, may be the result of colic, not the cause. Infant massage and a warm bath are two ways parents can cope with this difficult time. Some babies benefit from gentle pressure on the abdomen as they lie across your knees. Other babies prefer to be upright with their stomach over your shoulder. Be sure to contact your physician with any concerns regarding colic or the amount of crying from your baby. Cord Care The umbilical cord will fall off in a week to 10 days. It should be kept clean and dry. It is important to diaper below the cord to prevent a wet diaper from slowing this process. Cleanse the cord with soap and water ONLY IF THE CORD BECOMES SOILED. Sponge bathe the infant until the cord falls off. Cradle Cap Cradle cap is a common condition that appears as a yellowish, scaly and patchy area over part of the scalp or behind the ears. Daily washing and brushing may help prevent this condition. Using a baby comb, brush or soft toothbrush, gently scrub this area with mild baby shampoo and continue until the cradle cap is gone. Crying Babies express their needs and wants by crying. When babies cry, it is hard to know what they are trying to communicate. As you get to know your baby, you will be able to recognize each cry and interpret its meaning. Your baby may need to be held or require a change in position. They express their need for food, diaper changes, holding and sleeping through crying. Many babies have a fussy period each day, commonly in the evening hours, during which nothing seems to soothe them. Most experts in infant behavior believe that this fussiness is caused by the baby's heightened sensitivity to the environment (such as noise and light). Dr. T. Berry Brazelton states it this way: "Crying for a small infant serves many purposes, not the least of which is an outlet for tension and pent-up energy. Crying shuts out disturbing stimuli that the infant can't handle otherwise. It is, like sleep, a barrier against stimulation." It is normal for a baby to cry, especially during the first three months. The average newborn cries very little the first week, but at two weeks of age crying increases. At six to nine weeks of age it is not uncommon for babies to cry three hours a day! At three months of age this average drops to one hour a day. 27 Diapering Disposable diapers offer convenience and are more frequently used than cloth diapers. Diapers need to be changed after every bowel movement and whenever the diaper is wet. Many brands and designs offer fit and comfort no matter what the size and shape of your baby. The following are a few tips to remember: n Lay the diaper flat, sticky side/Velcro side of the tape up n Place the baby on his back on the diaper and bring the lower part of the diaper up and through his legs to the front. Bring the tapes/Velcro around to the front and attach them close to the navel n Fold the front edge of the diaper down below the umbilical cord while it is healing or use newborn diapers that are specially designed to leave the umbilical cord exposed Cloth diapers or the use of a diaper service are other options to consider. Dressing Babies need comfortable clothing that launders easily. Keep in mind the following when purchasing infant clothing: n Check for softness, inside and out; there should be no rough seams or frills n Pulling clothes over your baby's head can be difficult; look for shirts with side or front openings, shoulder snaps and stretchable necklines n Select clothes that allow easy access to the diaper area for frequent changing n Dress your baby as you clothe yourself. Try not to overdress, which can cause rashes and excessive sweating. n In cold weather, use layers of clothing so you'll be able to add or subtract clothing according to the temperature inside and out. Eyes During the first few days of life the area around the baby's eyes can appear puffy due to the birth process and the medication used in the infant's eyes to help prevent infection. It is common for a newborn's eyes to have poor control or to appear cross-eyed. This should decrease as the eye muscles strengthen. Newborns' eyes usually look blue-gray or brown. In general, your baby's permanent eye color will be apparent within six to 12 months. Fingernails Your baby's fingernails and toenails will need to be trimmed to prevent accidental scratching. Be cautious when cutting your baby's nails. They are very soft and it may be difficult to distinguish from the tip of the finger. The nails should be trimmed with round-edged or stainless steel baby scissors or baby clippers. Cut straight across the nail, not in the corners. An emery board may be used to smooth the nails. Try to cut the nails while baby is sleeping or busy with a feeding. Fontanels Fontanels are commonly known as the "soft spots" on baby's head. These are areas where the bones of the skull have not yet grown together. The larger one is diamond shaped and toward the front and the smaller one is located at the back of the head. The smaller fontanel closes within two to six months, and the larger one usually closes by 18 months. The fontanels have a tough, membranous covering, so the scalp can be gently brushed and shampooed without causing harm to your baby. Hiccups Hiccuping is common in newborns and is not a cause for concern. Hiccups require no treatment and will stop on their own. 28 Jaundice Newborn jaundice, a yellow or orangish discoloration of the skin and eyes, is seen in more than one half of all full-term babies during the first few days of life. This condition occurs because the infant's liver has not yet fully developed, causing the body to take longer to clear bilirubin. Bilirubin is produced by the breakdown of red blood cells that the baby no longer needs. When bilirubin is not cleared from the body, it causes a yellowish color to rise to the skin. The level of bilirubin peaks at 3–5 days old. A blood test can measure the level of bilirubin. Jaundice usually is not a major problem, but it can require the following treatment: n Feeding baby more often so that he takes in more fluid and passes more stool, which will increase the amount of bilirubin passed. n Placing the body under special bilirubin lights (usually done at home) that help the body change the bilirubin into a form that can be removed by the kidneys. n Call your healthcare provider if your baby's skin looks increasingly yellow or orange, or if your baby is very sleepy, not eating well or wetting as many diapers. Rashes Baby Acne A red, pimply rash known as "baby acne" may break out on your baby's face in the first weeks of life. No treatment is necessary. Hormones passed from the mother at birth cause this rash. Diaper Rash Irritation to your baby's skin caused by urine and stool, as well as some laundry products, can cause a diaper rash. Sometimes disposable diapers can cause an irritation as well. Preparations such as Desitin or A&D ointment are sometimes recommended to treat diaper rash. Check with your healthcare provider for a recommendation. Heat Rash Heat rash is a common problem during warm weather and with babies who are overdressed. It appears most often in the shoulder and neck regions and looks like clusters of tiny pink blemishes. The best treatment is to keep your baby cool and dry and to dress the baby as you dress yourself. Safety At one month of age, music boxes and lullaby tapes, bright pictures and an unbreakable mirror will stimulate baby's development. Mobiles above the crib that face down at your baby are excellent until about 5 months of age. Car Safety It is required by law that infants be placed in an approved car safety seat when traveling in a motor vehicle. To make sure your child restraint complies with federal standards, always purchase a new car seat. Purchasing a used restraint is risky; it could be damaged, missing parts, or not fit correctly into your car. Used car seats also could have been recalled without your knowledge. Only use car seats that meet the following standards: n Has a label stating that the car seat conforms to applicable Federal Motor Vehicle Safety Standards. n Includes a set of instructions. n Has never been involved in a crash. 29 Please refer to the following websites for the most current child passenger safety information. n www.aap.org n www.nhtsa.org It is recommended that you have your child's safety seat inspected by a certified Child Passenger Safety Technician. A complete listing of local technicians is available at www.buckleupIllinois.org. A listing of Car Seat Safety Inspections scheduled at Advocate Condell Medical Center is available at www.advocatehealth.com. Choking Choking is a possibility if a baby spits up. Be sure to keep the bulb syringe close by, especially in the first few days of life. Also, keep all small items out of reach that could cause your baby to choke. Be particularly careful with small toys that belong to older siblings. Sleep positions The newest research shows that the safest position for sleeping babies is lying on their backs. Be sure to allow "tummy time" during the awake hours. This helps the baby to develop muscles to lift her head and prevents the back of the head from flattening. Shaken Baby Syndrome Babies who suffer injury or death from violent shaking are victims of Shaken Baby Syndrome. It occurs when adults take out their anger or frustration on babies by shaking them. Because babies have weak neck muscles and heavy heads, even a few seconds of violent shaking can cause serious damage to children up to three years of age. Injuries can include: n Brain damage n Mental retardation n Blindness n Seizures n Paralysis n Death Shaking a baby can be very dangerous; it is child abuse. It is never OK to shake a baby. Caring for a baby is a full-time job that can be very stressful. Parents, grandparents, teenage babysitters and care providers can become frustrated. It is important to tell everyone who cares for your baby that is never OK to shake the baby. It is important to get away from the baby before your anger gets out of control. You may try to cope by: n Offering the baby a pacifier n Taking the baby for a walk in a stroller or a ride in the car n Placing the baby in her crib and walking to another room n Letting your anger out in a safe way (listening to music, taking a shower, exercising) n Taking some deep breaths and calming down n Calling a friend or relative and talking out your frustration, or seeing if they can relieve you for a while n Calling your baby's healthcare provider for other tips on caring for a fussy baby 30 SIDS Sudden Infant Death Syndrome (SIDS) is sudden death of an infant less than one year of age. The death remains unexplained after a thorough case investigation. It is a major cause of death in babies from one month to one year of age, most occurring before four months of age. Some ideas to reduce the risk: n Place infants on their backs to sleep. n Use a firm mattress. n Do not place soft stuffed toys, bumper pads or pillows in the crib. n Babies should be kept warm, but not too warm. Keep the temperature so that the room feels comfortable for you. n No one should smoke around your baby. Babies exposed to smoke have more colds and upper respiratory tract infections as well as increased risk for SIDS. n Mothers who smoked during pregnancy place the baby at higher risk for SIDS. n Breastfeeding provides antibodies to keep your baby healthier. Skin Newborns' skin can remain slightly transparent for several weeks and have purplish blotches. This is particularly true of fair-skinned babies. Their circulation is immature and it is not uncommon for their hands and feet to be blue. Mongolian spots, a greenish-blue pigmentation seen on the lower back and buttocks area, are commonly seen on Hispanic or Sicilian infants. These spots fade over time. During the first few weeks, a newborn's skin peels. Overdue babies seem to peel more than babies born closer to their due date. This is normal and no creams or treatments are necessary. "Stork bites" are a reddened area of blood vessels close to the skin. They usually are found on the baby's neck, eyelids, nose or forehead. They usually fade over several months. Temperature / Fever If you are concerned that your baby might be ill, check your baby's temperature. It is recommended to take an infant's temperature under the baby's arm (axillary). Taking the temperature by mouth is not recommended until a child is about 4 years old. If you use an ear thermometer, inform your physician that this was the method used when reporting your baby's temperature. The ear thermometer is not recommended for newborns and infants. Instructions for taking baby's temperature: Axillary n Make sure the underarm area is dry n Insert the thermometer under your baby's arm and hold his arm snugly against his/her body n Wait until the electronic thermometer signals reading n Normal axillary temperature is 97.6° F 31 Rectal Use this method only if instructed by your physician. n A rectal thermometer must be used (bulb tipped) n Coat the bulb of the rectal thermometer with petroleum jelly (such as Vaseline) n Gently insert the bulb end of the thermometer into the baby's rectum no further than 1⁄2 inch. n Hold thermometer in place until electronic thermometer signals reading n Normal rectal temperature is 100.4° F or less When to Call Your Healthcare Provider n A temperature above 100 degrees Fahrenheit or flu-like symptoms n A foul-smelling discharge from your vagina or incision n Any reddened, warm or tender areas in your breasts n Heavy bleeding and/or passing of large blood clots n Burning, frequency or pain with urination n A feeling of depression for longer than two weeks after the birth of your baby n Call your healthcare provider before taking any medications other than those prescribed n Call your healthcare provider to set up your postpartum checkup for six weeks after the birth of your child or as directed by your physician When to Call Your Baby's Healthcare Provider n Fever of 99 degrees Fahrenheit when the temperature has been taken axillary (under the arm) n Refusal to eat for two or three feedings n Forceful vomiting of the stomach contents n Crying inconsolably for more than two hours or unusual irritability n Listless behavior (lethargic) or unable to arouse n Skin rashes n Drainage from the eyes, circumcision or skin around the umbilical cord n Bleeding from the umbilical site or circumcision n Frequent watery stools, may contain mucous or blood Never hesitate to call your healthcare provider if you are concerned about your baby's health. 32 Childbirth and Family Education Childbirth and family education classes are offered year 'round and include specialty classes for new dads, siblings and grandparents and CPR instruction for Family and Friends. Whether delivering a first child or one of many, our classes enhance and complement the advice of you healthcare provider. Taught by certified experienced nurse instructors, these classes provide support and information that will take participants from pregnancy through the postpartum period and beyond. Register for these classes at www.advocatehealth.com/condell or 1-800-323-8622. Web Sites for New Parents www.advocatehealth.com/system/services/babies www.ParentsPlace.com www.babycenter.com www.safekids.org www.parentsoup.com www.mypyramid.gov www.cspc.gov References The American College of Obstetrics and Gynecologists, 4th Edition 33 Advocate Condell Medical Center Parking Map PATIENT / VISITOR PARKING PHYSICIAN PARKING ASSOCIATE PARKING AMBULANCE PARKING MOTORCYCLE PARKING BUILDINGS Milwaukee Ave. Off Site Parking Lot C ondel l D r. 755 G ol f R oad J Cent r e Cl u b Fai rvi ew ng ki ar C ool i dge P K sh ip b er ED Mem I S tewart Ave. B ED A Y ED A H Heart AA Center Hospital Va l et I DC B ue 880 / 890 Co C en nf ent er er C Av en ce el d C l evel and rf i Ga D G E Chu r ch Park ing F CALL SECURITY AT EXT. 5240 FOR ASSISTANCE Advocate Condell Medical Center's beautiful 75-acre campus in Libertyville is centrally located in Lake County near major roadways. It is accessible from Milwaukee Avenue (Rt. 21) via Condell Drive, which leads to the Emergency Department and the main hospital entrance. All maternity admissions enter through the Emergency Department. Complimentary valet parking is available at the main entrance from 6 am to 9 pm daily.


text:
Easton Cemetery
Easton Cemetery
Easton Cemetery. 7th Street Gate. August 2013.
|401 N. Seventh St., Easton, Pennsylvania
|40°41′55″N 75°13′7″W / 40.69861°N 75.21861°WCoordinates: 40°41′55″N 75°13′7″W / 40.69861°N 75.21861°W
|58.5 acres (23.7 ha)
|Sidney, James Charles; Sebring, William
|Architectural style
|Greek Revival, Late Victorian, Gothic
|Governing body
|NRHP Reference #
|Added to NRHP
|October 25, 1990
Easton Cemetery is a historic cemetery and burial site of many notable individuals, located in Easton, Pennsylvania. [2]
The cemetery was added to the National Register of Historic Places in 1990.[1]
Easton Cemetery's parklike cemetery landscape design is based on the picturesque romantic styles of the early and late 19th century. Its landscape is set with thousands of examples of funeral artwork, in a variety of decorative styles, spanning Greco-Roman Revival, Gothic Victorian, and Art Deco. Established in 1849, Easton Cemetery is the earliest and best surviving example of a romantic parklike cemetery within the Lehigh Valley metro area. Architecturally noteworthy features include a Gothic Revival Gatehouse and office, stable, cemetery chapel, and a Gothic frame workshop.
Notable burials[edit]
- Fred Ashton (1931-2013)[3]
- Jefferson Davis Brodhead (1859-1920)
- Richard Brodhead (1811-1863)
- Thomas Coates (1803-1895), pioneer of American wind band music, bandleader 47th PA Inf. Regt. Band
- Peter Ihrie, Jr. (1796-1871)
- Philip Johnson (1818-1867)
- William Sebring Kirkpatrick (1844-1932)
- Howard Mutchler (1859-1916)
- William Mutchler (1831-1893)
- James Madison Porter (1793-1862)
- James F. Randolph (1791-1872)
- Joseph Fitz Randolph (1803-1873), represented New Jersey at large in the United States House of Representatives from 1837 to 1843.[4]
- Andrew Horatio Reeder (1807-1864)
- Samuel Sitgreaves (1764-1827)
- Henry Joseph Steele (1860-1933)
- George Taylor (1716-1781)
- David Douglas Wagener (1792-1860)
- Charles A. Wikoff (1837-1898)
- Conrad Meyer Zulick (1838-1926)
- Samuel Morton Zulick (1824-1876)
- ^ a b "National Register Information System". National Register of Historic Places. National Park Service. 2009-03-13.
- ^ ""National Historic Landmarks & National Register of Historic Places in Pennsylvania"" (Searchable database). CRGIS: Cultural Resources Geographic Information System. Note: This includes Thomas E. Jones (May 1990). "National Register of Historic Places Inventory Nomination Form: Easton Cemetery" (PDF). Retrieved 2011-10-29.
- ^ "Former Easton Mayor Fred Ashton dies". The Express-Times. 2013-05-09. Retrieved 2013-06-08.
- ^ Joseph Fitz Randolph, Biographical Directory of the United States Congress. Accessed October 11, 2007.
External links[edit]
|Wikimedia Commons has media related to Easton Cemetery.

subset: commoncrawl


text:
Auto-Feed Screw Guns
Avoid fumbling around for screws, work effectively and efficiently with an auto-feed screw gun making your job easier, saving you time and hassle. To accompany your auto-feed screw gun we offer a variety of strip screws.
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text:
Tech Helproom
It's free to register, to post a question or to start / join a discussion
Can't print
Likes # 0
Posted June 13, 2011 at 5:46PM
At least once a week I try to print and am told to install a printer. Looking at the Printers page, I find it blank. I go to services and look for Print Spooler. The entry "Status" has no entry. "Start up type" reads Manual. I click properties and select Start and Automatic - and all is well. A few weeks ago I asked for help and was asked if using Microsoft malicious removal,but I do not have it on board, but did not really understand the advice. What can I do to resolve this. I have Vista and Open Office. Glen
Likes # 0
Posted June 13, 2011 at 6:24PM
I don't understand how you can print if you have no printers installed in the Printers section of Control Panel - you say it is blank. Can you explain further? What printer are you printing to?
Likes # 0
Posted June 13, 2011 at 6:36PM
Following on from chub_tor - equally mystified. When you select Start and Automatic in the Services Print Spooler does that create an entry in the Printers/Faxes section?
Likes # 0
Posted June 14, 2011 at 2:12PM
Hi guys Sorry if I did not make it clear. When the problem arises it turns out that the printer page is quite blank. After I reset the spooler to Start and Automatic the printers re-appear as normal in the printer page.. Then I can print in the usual manner. I don't understand why, or how to stop it happening again Glen
Likes # 0
Posted June 14, 2011 at 2:24PM
I can't imagine why you should want to enable the Spooler unless you are trying to print an item that are longer than the available memory or some suuch.
All the spooler does is to store the Print Queue on your PC until the Printer is ready for it. With most Printers, if you send something to the Spooler you also have to tell the Printer when you are ready to start printing.
Say you wish to print a whole leaflet, 200 pages long, but only have a 80 page Paper Tray. That is when you would use it.
Likes # 0
Posted June 14, 2011 at 2:41PM
If the printers show on the printers page after you have enabled the Spooler do they dissapear after the print request has finished or when you re-boot?
I have no idea how this is happening but what I would do when the printers appear in the printers page is to uninstall them and their drivers and then let Windows find them again by using the Add Printer Wizard and see if they stay there after a re-boot.
Likes # 0
Posted June 14, 2011 at 3:58PM
In Printer Folder why not try it with it set to print direct to Printer? cut the spooler out. You can do this in Printer Properties
Just had a look under XP, you can set it to print direct to Printer
Likes # 0
Posted June 15, 2011 at 12:40PM
Thanks guys for explanation. Have started with woodchip's hint and all printers set top direct printing. previously not all set the same way. If any more trouble will try Chub_tor's ideas, to uninstall and add tghem again. Hopefully now solved Glen
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You're leaving Wedding Paper Divas to see the Deal of the Day at our parent site, Tiny Prints.
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S&P 500 index data: S&P 500 Copyright ©
All data supplied by Morningstar Real-Time Data. U.S. intraday real-time exchange quotes are sourced from BATS when available. End-of-day quotes for Nasdaq, NYSE, and Amex securities will appear 15 minutes after close. Graph times are Eastern Standard. © Copyright Morningstar, Inc .
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