Welcome Baby!

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.

Breastfeeding Support Group

We are happy to announce that our postpartum breastfeeding support group is meeting virtually on ZOOM. The group will meet weekly on Wednesdays from 12:00 - 1:30 pm. The group is free, but registration is required for each weekly session. Register for our new online breastfeeding group here.

Benefits of Breastfeeding

There are many benefits for breastfeeding both for you and your baby. Breastfed babies enjoy a reduced risk of certain viruses, respiratory illnesses, allergies, ear infections, and childhood obesity. The longer women breastfeed, the greater the mothers' protection against breast and ovarian cancer, type 2 diabetes and cardiovascular disease.

We encourage skin-to-skin contact with your baby in the first moments, hours and days of life. Skin-to-skin contact benefits baby by staying warm from mothers skin, baby has more stable temperature, breathing and heart rates. Babies also breastfeed better, cry less and it has been found to improve parent bonding.

Breastfeeding Know How

Position
In preparation for a breastfeeding session, it is important that you have clean, washed hands and are in a comfortable position. A feeding is best done in an upright position and supporting your baby to bring him up to the level of your breasts will decrease strain on your arm, shoulder and back muscles.

Once you are comfortable, be sure that the baby and you are tummy-to-tummy-that he is completely turned toward you. In the tummy-to-tummy position, the infant's mouth will be directly in front of your nipple and areola (the dark part of skin surrounding the nipple tip). Now you are in a position for proper latch-on.

Latch-on
With the hand that is not holding the baby, shape your breast by forming the letter "C" with your free hand. Do this by placing the four palm fingers under your breast and your thumb on top, about an inch or so behind the areola. This technique of "cupping" your breast will help to shape the nipple and areola so that it will go easily into the baby's mouth for effective latch-on. Remember to keep the "C" hold wide. Do not collapse it by bringing the thumb and the fingers closer, as this might make your pointed nipple recede a little.

To get the baby to open her mouth wide for latch-on, stroke the middle of her lips (especially the lower lip) with your nipple tip to elicit the rooting reflex. Once she opens her mouth, direct your nipple so that it is centered in the baby's mouth. Be sure to get your nipple/areola above her tongue, which ideally should be lying slightly beyond her lower gum line and not touching the roof of her mouth.

Encourage your baby to get as much of the nipple and areola into her mouth as possible. She may not be able to get the entire areola into her mouth, but she should latch on to more than just the nipple tip. (The extent of latch-on depends on the size of the baby's mouth and your areola.) When your baby has an adequate amount of the nipple and areola in her mouth it will be wide and open with lips flared outward onto the breast rather than tightly pursed inward. This is important not only for your comfort but also for effective breastfeeding. When a baby sucks on only the nipple tip, it can hurt you, cause cracks in the nipple, and prevent the baby from getting enough milk.

Once your baby has latched-on she will not easily fall off the breast. You will see her jaws in motion and the breast tissue near the nipple/areola actually pulled in with the rhythm of her sucking. When the volume of milk increases, your baby will nurse in bursts of four to 10 sucks in a row, followed by a pause during which the nipple/areola stays in her mouth. A baby may slow down or pause in her sucking rate to swallow the milk. With colostrum, your baby will probably suck two or four times in a row before obtaining enough fluid in her mouth to cause her to swallow. It is important to try to notice the swallowing to be sure that she is taking milk in; you can sense this by a quiet "gulp" or a sound like a puff of air coming from her.

Switching Sides
When you want to switch sides, slide your finger into her mouth between her gums. This will partially open her mouth, breaking the high-pressure suction and preventing trauma to your nipple. Then burp the baby, change to the opposite side, and begin again. In the beginning it can be difficult to teach a baby to latch on correctly. It is important for your baby to suck properly — both for your comfort and for efficient breastfeeding. It may take several attempts before your baby opens her mouth wide enough and latches on properly, but persistence and patience on your part will teach her how to do this correctly and minimize your discomfort. As you both learn, it will get easier.

How Long and How Frequently to Feed?
No one can tell you exactly how long on each side your baby may want to breastfeed. Look for cues when your baby wants to breastfeed. Breastfeeding should occur at least eight times in any 24-hour period. A four-to-five-hour interval between breastfeeding may occur at night, but repeated long intervals without a feeding can hamper weight gain.

During the first few days you may notice that your baby appears to be sleepy. If your baby seems sleepy and not interested in feeding, try changing the diaper or unwrapping him from a swaddled blanket to expose him to the air in the room. Mild stimulation, such as light massage and skin-to-skin contact, also will help arouse your baby. If you cannot arouse him for a feeding, hold her skin-to-skin and wait. Try to feed again in one hour or observe him for hunger cues, such as hand-to-mouth motions, finger sucking, fussiness, arching of the back and stretching, or simply a quiet, alert state. Once your baby appears alert and interested, find a comfortable position to begin feeding.

Once your baby is feeding, allow him to feed until he seems satisfied. Begin with the breast you ended with during the last feeding. Observe your baby's sucking and swallowing and how he occasionally rests before beginning to suck again (the bursts and pauses). At the onset of a feeding, these pauses are usually 10 to 15 seconds long. The average feeding per side is about 15 to 20 minutes after the milk comes in. But your baby may be different in the pace he sets. Let him lead the way! Note: If he is nursing very frequently, the duration of the feedings will be shorter (like snacking); this is okay.

When your baby becomes increasingly satisfied, the sucking will slow down and the rests will get longer. Then you can insert a clean finger between your baby's gums and gently break the suction. Try to burp him (some babies may not burp). Always offer the second breast. If the baby still seems hungry after taking the second side, you can continue the feeding by going back to the first breast. This is called switch nursing.

If, when switching sides, the baby does not resume active feeding after about four to five minutes, he likely got satisfied from the first side. This is common in the early weeks and has been shown not to be a problem for infant growth and intake. You may feel "lop-sided" for a couple of hours, but just start the next feeding on the "full" side.

After the feeding session is completed, the baby may still seem hungry. Overall, you will want to breastfeed your baby between eight and 12 times every 24 hours. These feedings may occur around the clock every two-and-a-half to three hours or closer together. It is perfectly normal for breastfed infants to want and need to be fed this frequently because human milk digests through their system significantly faster than commercial formula.

Storing Milk

Cluster Feeding
Sometimes, especially in the first few weeks of life, your baby may want to feed more often. This is called "cluster feeding," when your baby demands to be breastfed very often over a short period of time (e.g., every 30 to 60 minutes for roughly five minutes a side). Then she may sleep for an extended period. This does not mean that your milk isn't enough for her. She is just making sure the supply will increase to keep up with her growth. You will discover that if you let her set the pace, she will breastfeed perhaps three or four sessions that way but will then settle down and sleep for a while. Watch her behavior rather than the clock, and you will discover when your baby is awake, alert, and giving cues that she is ready to feed.

Nipple Soreness
Mothers can experience nipple soreness at the start of a feeding session. This initial latch-on soreness decreases after 15-30 seconds and the baby begins to eat with a suck-swallow-suck-swallow feeding rhythm. If your nipples hurt after 15-30 seconds, you should make sure there was effective latch-on. You may need to break the suction and reposition him. Limiting the frequency or duration of feedings in the first few postpartum days does not prevent nipple soreness.

To help start milk flow, try massaging your breast, applying a warm towel or pack to it, and/or stimulating some milk to come out before your baby latches on (called "hand expression"). These actions ease his first strong sucking motions and may decrease the soreness. Soreness usually improves by 2-3 weeks or sooner.

Adequate Milk Supply
Another common concern among breastfeeding mothers is whether babies need to supplement with water or formula. If breastfeeding is going well, babies usually are satisfied by breast milk alone. Some mothers wish to feed their babies both breast milk and an occasional bottle of formula. The American Academy of Pediatrics recommends that breastfeeding be the only source of feeding for your baby during the first six months of life (unless other feeds are medically indicated) to allow your body to build up an adequate supply of breast milk. Many mothers may also wonder if a breastfed baby needs to have supplementary water during hot summer weather. Supplementary water for breastfed infants is not necessary.

Expressing Breast Milk
You may choose to collect and store your breast milk for your baby if you expect to be away during a feeding. Use either hand expression or a breast pump to collect your milk. Begin by washing your hands and massaging your breasts several times. Place both hands around your breast, against your chest, and apply gentle pressure as you move your hands toward your nipple. Continue to massage around your entire breast. Applying a warm washcloth may help your milk to let down. Breast milk should be collected and stored in a clean plastic or glass container. Pre-sterilized, disposable plastic bags can be convenient for storage but can split and leak upon thawing; therefore, they are not recommended for long-term storage. Only specially-made mother's milk storage bags (these have a layering of plastic and nylon to prevent splitting) are recommended. These can be purchased from the major breast pump rental stations. Baby bottles with a tight-fitting cap are also effective.

Once you take your baby home breast milk may be stored for up to five days in a 40°F refrigerator, for six months in a 0°F freezer if self-defrosting (frost-free type), or for nine to 12 months in a regular freezer.

One of the best times to collect breast milk is after a feeding, especially in the morning since this is when your milk supply tends to be higher. If your baby has a long interval between some feedings, you can take advantage of this time to collect additional breast milk.

Remember, when you are away from your baby, you also may wish to express milk either for future feedings or to relieve breast fullness. Many types of manual, battery-operated, and electric breast pumps are available. To select the best pump for your needs, consult a nurse or lactation consultant after your baby is born.

Your Breasts
You may have noticed that, through your pregnancy, your breasts have been preparing for breastfeeding. Colostrum, the first milk, has been present since the third month of pregnancy. After delivery, your breasts will gradually begin producing increased amounts of mature milk. The breasts enlarge because more blood is sent there to provide nutrients and fluid for milk production. Increased normal breast fullness usually occurs on the third or fourth day after birth. This natural fullness partially subsides after 1-2 weeks. Softening of the breasts does not indicate that your milk supply is dropping off. It merely signals that your breasts are returning to a normal but functioning state and are producing milk more efficiently. While you are in the hospital, your nurse will be observing your breasts for signs of filling. She will assist you with feedings and make recommendations to prevent engorgement- a back-up of milk with congestion of fluids in the breast tissues.

Engorgement
Engorgement results in very firm, painful, warm breasts and possible flattening of the nipple. By breastfeeding right after delivery and for as long and as often as your baby demands, you may avoid painful engorgement.

If your nipples are so firm that your baby cannot get adequate hold of your nipple and areola, try taking a hot shower or applying hot, wet towels to your breasts three minutes before you nurse. Massage all around the breast from outer areas in toward the nipple. Hand expression of a small amount of breast milk before attempting to nurse also will help. Once the fullness around the areola is relieved, the baby will be able to latch on better. Feeding more frequently for a day or two will help, too. If your baby cannot nurse as frequently as needed to decrease the engorgement for you, try hand expressing or using a breast pump to remove the excess milk. All of these actions can allow your milk to let down, decreasing the discomfort from engorgement. If your breasts do not soften after these measures, apply ice wrapped in a thin towel for 20 minutes.

Wearing a well-fitted, supportive bra 24 hours a day, starting when you begin to feel your breasts becoming heavier, will help give your breasts the support they need while you are breastfeeding. In addition, wearing a bra continuously will provide more comfort when your breasts are very full. A nursing bra with flaps makes breastfeeding access easier.

Nipple Care
As mentioned above, most breastfeeding women experience some nipple soreness during the first 10 days of feedings. If you follow the techniques described in previous sections, nipple soreness should diminish.

Cracks or blisters on the nipples may occur when the baby is not latched on correctly or is not sucking properly. It is essential to discover the reason for this trauma, and a lactation consultant can help to diagnose the problem. Until then, moistening your nipples with expressed milk and letting them air-dry before putting your bra back on may alleviate your discomfort. If the cracked nipple is absolutely too painful to have the baby nurse from, consider hand expressing or pumping on that side in place of direct infant feedings until the crack heals more. Many women report some relief with the proper use of a medical-grade lanolin product made specifically for breastfeeding mothers. Your healthcare provider may recommend this once all the important actions described above have been tried. It can be applied sparingly once expressed milk has been applied and allowed to air-dry. You may also want to work with a lactation consultant, who can assess how your baby latches on to determine if this is contributing to the problem.

• Care: The best advice for nipple care is to avoid drying agents like soaps or alcohol. Change moist nursing pads or bras as soon as they get wet, and avoid the routine application of creams and ointments to your nipples. Moisten your nipples with breast milk and allow them to dry for 10 minutes after each feeding and before covering your breasts.
• Plugged Ducts or Breast Infection: Occasionally, you may feel lumps (plugged ducts) forming in your breasts. If you also have a fever, localized pain, or redness in your breasts, you may have a breast infection (mastitis). Notify your obstetrician, nurse-midwife, or nurse practitioner. Most healthcare providers encourage you to continue nursing through mastitis and will prescribe an antibiotic to help clear the infection.
• Leaking: Many new mothers experience leaking at the onset of breastfeeding because muscles in the nipple pores may not be able to hold back the milk. You cannot control leaking, but be reassured that it tapers off by itself. To halt the flow when you sense it happening, gently put pressure against the nipple with your palms or by crossing your arms across your chest. If necessary, nursing pads, either disposable or reusable, can be placed inside your bra cups to absorb any leaking between feedings.

Taking Care of Yourself
Breastfeeding depletes somewhere between 400 and 600 calories from your body each day, so you will need some extra rest, calories, and fluid to make up for this loss. An adequate intake while breastfeeding is about two to two-and-a-half quarts per day, or six to eight eight-ounce glasses of fluids. Drinking water is best, but drinking milk or juice or eating soups, sherbets, sorbets, and Italian ice is sufficient.

You should maintain a healthy diet, and it is important to make sure you get 1,200 - 1,500 milligrams of calcium every day. However, for the most part, you do not need to worry about what you eat while breastfeeding. Once in a while, babies will be sensitive to some foods their mothers eat. If you suspect that your baby is fussy because of something you ate, wait a few days and try it again. If the problem recurs, consider limiting that food in your diet. If your baby does not have the same reaction, it probably was not food-related.

Drugs and Breastfeeding
Breast milk will absorb almost any medication you take, whether a prescription or over-the-counter drug. Some medications, including antihistamines and birth control pills, can decrease milk production when taken before lactation is fully established. Although you can breastfeed with most medications, you should check with your obstetrician, nurse, nurse-midwife, or pharmacist about their compatibility with breastfeeding.

How Long To Breastfeed and When to Wean
No one but you knows how long you should breastfeed your baby. The American Academy of Pediatrics (AAP) recommends that babies receive breast milk alone for the first six months, and any introduction of foods thereafter should serve as a complement to breast milk. The AAP further recommends breastfeeding for at least the first 12 months, or longer if mutually desired.

Feeding pumped breast milk is a reasonable alternative if breastfeeding is not possible or desired. It is possible to breastfeed and supplement with formula if pumping is not an option after returning to work. A lactation consultant will be able to help you do this successfully.

Building a Milk Supply
If you plan to go back to work while continuing to breastfeed, you may want to build up a supply of milk beforehand. One way to do so is to pump your breasts for extra milk during the week or two prior to your return date. This works best after the first two feedings each morning because milk supply is highest then. If you are planning to use a bottle, you may want to try to introduce the artificial nipple at three to five weeks after delivery so that your baby can become used to sucking from a bottle nipple. Some babies need time to master this new feeding method, but they usually do, especially if someone besides the mother begins the new process.

When you do decide to wean your baby, the recommended method is to eliminate one breastfeeding session per day, every two to three days. You may begin the weaning process by choosing to eliminate the feeding that is the least convenient for you or the feeding that the baby is the least interested in. Continue to eliminate feedings until the weaning process is complete. Most women can stop nursing over a 10-14 day period.

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.

View Info Sheet

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.

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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.