Welcome Baby!
Postpartum Care and Support
Our care and support doesn't end when you leave the hospital.
Welcoming a new baby into your life can be both an amazing and overwhelming experience, especially for first-time parents. It is important to remember that you also need to take care of yourself during this postpartum period. As always, if you have any concerns or would like further information, please talk to your health care provider.
Nursery Designated as Provider of Highest Level of Care
If your baby needs immediate medical care after delivery, state-of-the-art medical technology and newborn care specialists are just seconds from your labor and delivery room.
The staff of the neonatal intensive care unit (NICU) care for babies who require a range of care. Some babies have mild problems that require a short stay for observation. Other babies have complex medical issues and require the highest level of care. Our NICU is designated as Level III, meaning that we have the technology and expertise to care for babies who require the very highest level of care.
Close Collaboration with High Risk Obstetricians
If your pregnancy is considered high risk, your provider may arrange for you to meet with one of our neonatologists. A neonatologist is a doctor who specializes in caring for newborns, including those born with medical problems and those who have an increased risk of developing complications. Our neonatologists and high-risk obstetricians collaborate closely to ensure that the NICU team is aware of all women who may deliver babies that require their care.
Providing Family-Centered Care
NICU clinicians work as a team to provide your baby with the best care possible. Our care focuses on your baby and includes the entire family. Each clinician is committed to teaching parents and fully involving them in the care of their newborns. Families are provided with the knowledge and support they need to increase their confidence and competence in meeting the needs of their babies. Family meetings with the NICU team are held at regular intervals to address questions that range from newborn care to the psychological impact of caring for their child.
We are now offering both in-person and virtual breastfeeding support.
Weekly In-Person Breastfeeding Support
Breastfeeding is a wonderful and natural way to feed your baby. This is especially true during the fourth trimester. We are happy to be able to offer a space for practice and support. We offer in-person breastfeeding support for the lactating caregiver and their baby age 0-12 weeks, with our IBCLC Lactation Consultant.
In order to align with the BIDMC Infection Control Policies, to keep you and the baby safe, we are only able to invite the lactating caregiver and baby to these sessions.
When: Wednesdays: 12:00 pm - 1:30 pm
Cost: Free!
- Registration is required for each session
- Please email us to sign up for one session at a time (If you are not pre-registered, we would not be able to accommodate you during that particular time)
Where: 5 Feldberg Solarium, East Campus 330 Brookline Ave, Boston, MA
Virtual Breastfeeding Support
This resource is designed for families age newborn through the end of their breastfeeding journey. The purpose of this weekly question and answer opportunity is to support families as they progress along their breastfeeding journey. Common topics include general breastfeeding, pumping, returning to work, breastfeeding and the addition of solid food and weening. These weekly sessions are hosted by an IBCLC via Zoom.
When: Wednesdays 3:30 pm - 4:30 pm on Zoom
Cost: Free!
- Registration is required for each session
- Please email us to sign up for one session at a time
We recommend ordering your breast pump for home use before you deliver so that you're ready when baby comes home. There are a few options you can use for ordering your breast pump, whether you're using insurance or not.
Commonly used BIDMC vendors include:
- M&M Medical Supply: 877-966-6337
- Acelleron: 978-738-9800
- Byram Healthcare: 877-902-9726
- Cambridge Medical Supply: 617-876-3810
- Dartmouth Medical Equipment: 508-997-1241
- Healthy Baby Essentials: 888-495-7491
View the Breast Pump Information Sheet for more details about specific breast pumps and which ones are typically covered by insurance.
Nutritional Value of Formula
You may choose formula-feeding over breastfeeding because it is the desirable method for you. If you have decided to formula-feed your baby, it is important to be comfortable with your decision.
Commercial formulas provide adequate nutrition for your baby during her first year of life. Actually, formula ingredients are made by modifying cow's milk-based protein and adding a milk sugar (lactose), fats, vitamins, and minerals to mimic the components of human milk. Babies should not be fed cow's milk until they are a year old because it is hard to digest and some components are not in the recommended amount for infants. For example, it contains too much sodium (salt), not enough iron, and can make a baby anemic.
In general, all your baby needs in the first four to six months of life is breast milk or formula. She does not need solids (like cereals, fruits, or vegetables), juices, or extra water. To provide the right amount of iron for a baby in her first year, keep her on formulas with iron added, as this amount fits the recommendations for infants.
Formula Types and Feeding Equipment
In the hospital, we use ready-to-feed formula with one-time-use nipple sets. There are several different brands of formula, and most are available in all the different forms listed below. The list starts with the formulas that are the most expensive but the easiest to prepare. Product convenience, personal preference, and financial resources are all factors in your choice of formula type.
The expiration date on any can or package should be checked to ensure freshness. The powder form is least likely to spoil. You can make small amounts at a time, to waste less formula. Store a powder can in a cool, dry area. Both the ready-to-feed and concentrated liquid forms must be refrigerated and used or discarded 48 hours after being opened.
First, wash your hands any time you prepare formula for bottles. Follow the preparation directions on the can. When preparing formula from concentrated liquid or powder, the amount of water is very important. Too much water may prevent your baby from getting enough nutrients; with too little water the formula is too strong and can hurt your baby's kidneys.
Soy-based formulas are also available for babies that have a milk intolerance. Soy formulas do not have all the nutrients that are in milk-based formulas, so it is best to check with your pediatric care provider before changing to soy formula.
To feed the baby, you will need to buy containers for the formula and a nipple set to attach. Choices for containers are: glass bottles, boilable plastic bottles (straight or with the newer, "angled" neck), disposable nurser bags (with hard plastic holder to fit the bag onto). Artificial nipples will also be needed. They can be traditional nipples (smaller base with tapered, somewhat pointed nipple) or those needed for disposable nursing systems (larger base with shorter nipple shank).
Formula Preparation
Remember, all canned or prepared formulas are sterile in their cans. To maintain the sterility when you mix it up and bottle it, you must take special steps. First, clean the baby's bottles, bottle caps, and nipples with soap and water, rinsing well. Wash the can opener and the top of the can of formula before opening. Boil the water you are going to use for the formula for five minutes, and then mix it with the brand of formula according to the directions on the can. Divide the formula into the number of bottles you have cleaned, put on the caps and tops, and store the bottles in the refrigerator. Formula, including the powdered kind, should be used within 48 hours of preparation.
Using boiled water is generally recommended for about six weeks. Do not use bottled water for formula preparation. As soon as your baby is putting his hands in his mouth, it is reasonable to stop boiling the water.
Temperature of Formula
It was once felt that all formulas should be warm, but it actually makes no difference whether formula is cold, warm, or at room temperature. If you warm the bottle, be careful it does not get too hot. To heat the bottle of formula, place it in a pan of hot water. Do not warm the bottle in the microwave oven- hidden hot spots can burn your baby's mouth. You should test the temperature of the warmed formula by sprinkling a few drops on the inside of your wrist.
Checking the Nipple
Sucking at a regular bottle nipple is a squeezing action. Check the nipple to see if it is too small or big by turning the bottle upside down and watching if it drips freely or one drop at a time. If it drips too fast, the baby may not be able to swallow quickly enough, causing some drooling or choking until she can adapt. In this case, it will help to get bottle nipples with smaller holes. If it drips too slowly, the baby may only get enough formula to stimulate her to swallow after every two or three sucks (instead of a swallow after each suck). Then a vacuum will build in the bottle, making it harder to drain. Using larger-holed nipples will help remedy this.
Positioning the Baby
Before you start feeding, remember to wash your hands. When you are ready, get into a comfortable position with good back support. Try to minimize distractions (TV, visitors, loud noises) so that the time can be devoted to the feeding and the caregiving. Baby interaction is especially helpful if the infant is fussy or crying before the feeding begins. Hold the baby close to you in a cradle position with his head slightly higher than his chest. This will allow any air swallowed to rise to the top of his stomach to burp out later. You may want a bib or cloth to protect his clothing. Now tilt the bottle so the nipple and neck are filled with formula and little air is sucked out during the feeding. With an "angled" bottle feeding system, you will not have to tilt the bottle to ensure that the nipple unit is always filled.
The Feeding Session
Stroke the baby's lips, especially the lower one, gently with the nipple tip. This will stimulate the mouth to open wide so that you can insert the nipple well into her mouth to trigger the sucking reflex. Some infants take the nipple without prodding, while others need to be coaxed. Check to ensure the lips are flared out onto the widened nipple base for a tight seal.
You can feel if your baby is taking formula by watching for tiny bubbles at the top of the formula level. With a disposable nurser bag, you will not see these bubbles, but you can tell if the baby is getting enough by the plastic bag collapsing within the holder unit. These disposable feeding systems are often chosen because they are believed to limit the amount of air swallowed.
At about every half-ounce of intake or halfway through a typical feeding session, withdraw the nipple and try to burp the baby. It usually takes a minute or two if she has a bubble to expel. After she burps, continue feeding. It is a good idea to switch sides once in a feeding and hold the baby in a cradle position in your other arm for the rest of the session. Although you may be most comfortable holding the baby in one particular arm, this action resembles the changing of sides in breastfeeding and helps to stimulate both sides of the baby's body- especially eye muscle development. Burp her once again when she is finished.
NOTE: NEVER prop a bottle for a feeding and leave your baby unattended- she may choke. Also, propping may cause ear infections and tooth cavities ("bottle mouth syndrome"). Lastly, holding and interacting with a feeding infant conveys trust and is an important means of parental or caregiver contact.
How Long and How Frequently to Feed?
The formula intake varies with the baby's size, age, and activity level. Remember that a newborn's stomach is about the size of a golf ball, so he can be easily satiated with a small amount of formula. Because his stomach is small though, he will need to be fed often, not on an adult's three-meals-a-day schedule! It is expected that he will need to pace feedings over a 24-hour period and be fed two or three times a night during the first couple months at least. Digestion of commercially prepared formula is slower than breast milk because part of the protein has a tougher curd than in human milk. Thus, formula-fed babies usually have longer intervals between feedings than exclusively breastfed babies (every three to four hours versus every two-and-a-half to three hours in the newborn period).
Start off with about one-half to one-ounce feeds during the first few days of life. If the baby shows continuing signs of hunger (watch for cues after burping), increase the next feeding by one-half ounce. Try feeding every three to four hours during the day (awaken a newborn if this much time goes by) or according to hunger cues, whatever comes first. If the baby does not give hunger cues and gently rousing him does not work for two feedings in a row, contact his pediatrician.
The younger and smaller the baby, the more frequently he will need to feed until his stomach volume increases. As he grows, he will drink more formula per feeding and be able to space the feedings out longer. A formula-fed baby normally takes 20 to 30 minutes to complete a feeding, depending on the feed volume, nipple flow rate, suck-swallow pace, and amount of time for burping afterward.
Typical Feeding Pattern
Birth to 2 weeks: 6 to 10 feedings; .5 - 2 oz. per feeding
2 weeks to 1 month: 6 to 8 feedings; 3 - 4 oz. per feeding
1 to 3 months: 5 to 6 feedings; 5 - 6 oz. per feeding
Weaning from Formula
Weaning from formula means beginning to use regular cow's milk. Weaning usually takes place at about one year of age. Remember that, especially in the second half of the first year, babies need extra iron for their blood. If you shift to cow's milk too early, your baby may become anemic. You may introduce your baby to a cup at as early as five or six months of age. Use a special cup with a lid to avoid spills, and offer either juice or formula. Gradually increase cup feedings during this time.
Circumcision is a surgical procedure which involves cutting away the foreskin (skin that covers the glans, or head of the penis- it is usually done before your baby is discharged from the hospital. Circumcision is not a mandatory procedure. Whether or not to have your baby circumcised is a personal choice that parents must make. We hope that the following information helps you to make the best decision for you and your baby. If you have any questions or concerns as you consider this option, be sure to speak with your health care provider.
Factors that Commonly Influence Choice
Cleanliness In uncircumcised males, cells shed from the outer layer of skin can accumulate the foreskin. If this area is not cleaned regularly, odor and/or infection may occur. Teaching an older child to routinely pull back his foreskin when bathing will prevent this problem. In circumcised males, the foreskin has been removed, so cells cannot accumulate beneath it.
Tradition
If a baby's father is circumcised, some parents opt to have their baby circumcised so that he will be physically similar. In addition, some parents do not want their child to enter puberty looking different from his circumcised peers.
Breaking With Tradition
Some parents feel that their wish to not have their child look different from his peers and his family is not a good enough reason to have him undergo a surgical procedure.
Myths and Shades of Truth
Circumcision does not prevent masturbation, increase fertility, prevent cancer of the prostate, or prevent cancer of the penis – good hygiene does. Uncircumcised men with very poor hygiene have a higher incidence of cancer of the penis. Circumcision may help prevent urinary tract infections, as well as infection and inflammation of the head and foreskin. However, these problems are rare, and so are the problems that may be caused by circumcision (see "Risks" below).
The Procedure
Circumcision is usually performed on newborns, although it can be done at any time in a male's life. For the newborn, circumcision is performed before discharge, and is usually in performed in the newborn nursery. If you decide to have your baby circumcised after discharge, the procedure will take place in an operating room with anesthesia (except in the case of Jewish ritual).
In the Nursery
If you intend to have your baby circumcised in the nursery, you can expect the following:
- The procedure will be performed by your obstetrician.
- The baby will be placed on his back and held still with straps.
- A topical or injected anesthetic (pain killer) may be used – be sure to talk to your provider beforehand about this option.
- Babies may also receive acetaminophen (Tylenol) and/or pacifiers dipped in sugar water for pain relief in the BIDMC nursery.
- The surgical area will be cleansed.
- The foreskin will be removed.
- There will be minimal bleeding, and it is easily controlled.
- Ointment and gauze may be placed over the cut to protect it from rubbing against the diaper.
- The baby will cry during the procedure and for a short time afterward.
Risks
Risks from circumcision are rare. Risks include hemorrhage (excessive bleeding), infection, and injury to the penis, scrotum (sac that holds the testes), or urethra (tube that urine passes through). There is also a chance that you will not be pleased with the cosmetic result, which could require a revision of the circumcision when your baby is older.
Care for the Uncircumcised Newborn
Parents should wash the outside of the penis with soap and water. No attempt should be made to pull the foreskin back- the foreskin may not be completely retractable (able to pull back) until a child is four3, or more, years old. Parents should teach their child to wash his penis, including under the foreskin after it has begun to retract, as part of his daily routine.
Care for the Circumcised Newborn
The gauze placed on the baby's penis after surgery will soak off easily in the bath and does not need to be replaced. Diapers should be changed frequently to prevent feces and urine from irritating causing infection to the area. Wash the penis daily with plain water until it heals. Do not rub the penis, but squeeze water from a cloth so that it gently rinses the area. Apply generous amounts of petroleum jelly ("Vaseline") to the sore area to keep it from sticking to the diaper while it heals. After healing, which usually takes about a week, you may then use soap and water to wash the penis.
Beth Israel Deaconess Medical Center offers a free email service in which you can follow your baby's development. The BIDMC ParentCare email service includes information tailored to your week of pregnancy and then the age of your newborn.
Before your baby is born, you will receive weekly emails about your changing body and your growing baby. After your baby is born, you'll receive updates for the first year of your baby's life. Since all of the information you receive is carefully written and overseen by our practitioners at the medical center, you can be sure that the information is accurate.
Share Your Precious New Baby With Family and Friends
We know how eager friends and family will be to see your new baby, and how excited you will be to share your experience with them. We also know that sometimes distance can make a loved one's wait for your baby's first hello a long one. To allow you to share your joy immediately, the Beth Israel Deaconess offers you access to a live video visit while you are in the hospital.
How To Connect
To connect, you will need to call the toll-free number while you are in the hospital and request that a rental camera be delivered to your family member. Your family member must have a touch tone phone and a cable ready television.