The baby should swallowing sounds when nursing
Your baby should have at least 6-8 wet diapers after day five and about 2-3 bowel movements each day that become yellow after day four.

All breast fed babies initially will lose some weight but will begin to gain 1/2 to 1 oz. a day once your milk supply is established.

Your baby should seem satisfied after nursing but remember all babies will cry some and occasionally be fussy. Make sure to breast feed often, usually 8-12 times each day, especially the first few weeks.

If you have other questions about breastfeeding, ask your nurse midwife.

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Are nurse midwives covered by my insurance plan?

Nurse midwifery care is covered by private insurance carriers, Medicare, Medicaid and most managed care programs. Call your insurance company to make sure an individual nurse midwife or nurse midwifery group is covered.

If you are a Baystate Midwifery Associates patient, or are thinking of becoming one, our office staff can help with questions about insurance coverage. Call 413-794-8336.

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If a woman is already pregnant, should she stop smoking?

It is never too late to stop smoking! If you quit early in pregnancy, or just try to cut down, your baby will have a better chance of a normal birth weight. If not, there is a much greater risk of having a premature birth, a baby with a low birth weight and also an increased risk of miscarriage or stillbirth. Also, infants exposed to cigarette smoke have a higher risk of sudden infant death syndrome.

Remember that if you are pregnant and smoking, you are really smoking for two. You can get help to quit; ask your nurse midwife for more information.

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How many ultrasounds can I expect to have?

Baystate Midwifery recommends that pregnant women have an ultrasound at about 18 weeks (4 1/2 months) if you are experiencing a normal, uncomplicated pregnancy. This is considered the best time for the radiologist to get a really good look at the baby and confirm the accuracy of the due date. It is frequently difficult to tell the sex of the baby no matter how many ultrasounds a woman has. This has to do with the position of the baby - most babies lie with their legs crossed and knees up.

More ultrasounds could be ordered in high risk pregnancies such as twins or poor baby growth.

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What does "CNM" stand for after a nurse-midwife's name?

"CNM" stands for "Certified Nurse-Midwife". These initials mean that the midwife is a registered nurse who has attended a midwifery education program accredited by the American College of Nurse-Midwives and passed a rigorous national certification exam.

All of the midwives in Baystate Midwifery Associates are "CNMs".

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How do I choose a car seat?

The proper car seat is a crucial piece of baby equipment. Car seats much be placed in the back seat and be rear facing until the baby is one year of age and weighs at least 20 lbs. Never put your baby in the front seat especially if your car has passenger air bags as this can be fatal in case of accidents. If possible, try to attend a car seat safety class and practice installing and adjusting the car seat before you bring your baby home.

If you would like a qualified car seat technician to install your car seat please email Baystate Health Link or call 1-800-377-HEALTH to schedule an appointment. For additional information contact Western Mass Safe Kids Coalition at 413-794-5434.

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What can I do to decrease the risk of SIDS?

Sudden infant death syndrome or SIDS is the sudden and unexplained death of an infant under one year of age. There is no known cause for SIDS but there are some things you can do to help decrease the risk of SIDS. Always place your baby on his/her back or propped on the side to sleep. This is now considered the safest sleep position.

Other ways to decrease the risk of SIDS is to make sure your baby sleeps on a firm mattress, do not use pillows or fluffy blankets, sheepskin or comforters under your baby. Keep your baby warm at a comfortable temperature. It is important to create a smoke free zone around your baby. Babies exposed to smoke have more colds and other diseases along with higher risk of SIDS.

If possible, breast feed your baby as breast milk helps to keep your baby healthier. For more information on how to decrease the risk of SIDS, ask your nurse midwife.

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If I need medications, can my nurse midwife write my prescriptions?

Prescriptions for most medications can be written by a nurse midwife. The nurse midwives of Baystate Midwifery Associates are able to prescribe vitamins, antibiotics, asthma medications, and pain-relieving medication for labor, delivery and the postpartum period.

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What is the cesarean birth rate for nurse midwives?

National studies show that women who use nurse-midwives have a higher rate of vaginal births compared to cesarean births. The cesarean birth rate for women using nurse-midwives is about 5%. The United States overall average is 25%.

Baystate Midwifery Associates' cesarean rate has been less than 13% for the last 14 years.

Our CNMs take great pride in facilitating vaginal birth.

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The episiotomy question - what is it and is it needed?

An episiotomy is a surgical cut that is made in the area between the vagina and the anus. This cut used to be thought of as better for both the mom and baby during childbirth. More recent research suggests that an episiotomy is usually not necessary, causes more pain and leads to more vaginal tearing than birth without an episiotomy. Nurse-midwives are skilled in guiding the baby's head as it emerges and supporting the perineum which reduces the need of episiotomy and lowers the risk of tearing.

The episiotomy rate of the CNMs in Baystate Midwifery Associates is 5%, compared with the national rate of over 35%. For more information on episiotomy, ask your nurse midwife.

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What can I do to help with heartburn during pregnancy?

Heartburn in pregnancy is caused by the relaxation of smooth muscle resulting in slower digestion. Some relief measures include:

Eating smaller, more frequent meals
Avoiding greasy, fried or spicy foods
Sitting upright or walking after a meal
Sleeping with at least two pillows
Trying to avoid fatigue and stress
Using an antacid such as Maalox, Mylanta or Gelusil one hour after meals.

If you have heartburn, speak to your nurse midwife to decide what's best for you.

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Are ultrasounds safe in pregnancy? Do I have to have one?

Ultrasounds have been widely used in pregnancy for the last 30 years. Major benefits include the ability to give an accurate due date, measure the size of the baby and screen for some anomolies. However, ultrasound can't tell us everything about a pregnancy or a baby.

Having an ultrasound is a choice a woman makes after discussing the risks and benefits with her nurse midwife. Ultrasound does not guarantee a healthy pregnancy, nor is it essential that most women have one.

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Are there any health benefits to birth control pills

The pill not only is one of the most effective ways for preventing pregnancy but also has other health benefits. Women taking the pill usually have less pain and cramping with their periods. Also, some women experience a decrease in PMS (premenstrual tension). Birth control pills are known to lessen the risk of two types of cancers, ovarian cancer and endometrial cancer (lining of the uterus).

The pill may also help to protect you against osteoporosis (brittle bones) and colon cancer. If you think birth control pills may be the right contraceptive for you, speak with your nurse midwife.

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When does my baby's heart begin beating?

Your baby's heart begins to beat at the end of the fourth week after fertilization or at about six weeks of pregnancy. However, you will not be able to actually hear your baby's heart beat until the twelfth week of your pregnancy. At that time your nurse-midwife will use a small device called a doptone that amplifies the baby's heart beat.

It is a good idea to bring your partner or family member to share the excitement of hearing your baby's heart beat for the first time.

If you have other questions about your baby's growth and development, ask your nurse-midwife.

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Are there any medical benefits to circumcision?

As you may already know, there is a lot of varying advice about circumcision. In general, there is no real medical need to do a circumcision on a newborn. With proper care and hygiene, a boy will be equally well off either with or without a circumcision. Many parents are concerned about doing surgery on their newborn baby, as all surgery, no matter how minor, carries risks of bleeding, infection and scarring.

Considerations on circumcision are often traditional, cultural or religious and are up to the parents to decide. Please feel free to discuss circumcision with your nurse midwife.

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Is it harmful to my baby if my partner and I have sex?

Questions about the safety of sex in pregnancy often trouble couples who are sometimes embarrassed to ask. During pregnancy some women will have an increase in sexual interest, others may feel a decrease in libido due to fatigue, especially during the first three months. Sometimes a woman's changing body may make her feel less desirable.

It is considered safe to have sex in pregnancy, unless you have bleeding, premature labor or placenta previa. You should discuss your individual situation with your nurse midwife. She will be able to counsel you knowledgeably and sympathetically.

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Why is folic acid considered important to a healthy baby?

Folic acid is a B vitamin that helps to reduce the risk of having a baby that is born with certain defects of the brain and spinal cord, called neural tube defects. The recommended daily intake is 400 mcg. It is best to begin taking folic acid before you even get pregnant. Foods rich in folic acid include orange juice, green leafy vegetables and beans. Many grain products such as cereals and bread are fortified with B vitamins including folic acid.

If you have any other questions, ask your nurse-widwife.

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