Healthy Baby and You A pregnancy and breastfeeding resource guide for USC families
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Healthy Baby and You A pregnancy and breastfeeding resource guide for USC families
Table of Contents
Lactation Support Initiative Insurance................................................................................................. 4
Insurance Guidelines
State Health Plan (Standard and Savings Plans)
Blue Choice Health Plan (HMO)
AIG Student Health Insurance (Pearce and Pearce)
Services Provided at USC Student Health Services
Through Healthy Carolina’s Lactation Support Initiative, we aim to support Breastfeeding and the Patient Protection and Affordable Care Act
new and expecting USC families navigate this exciting time in their lives. University Policies and Guidelines................................................ 6
Faculty and Staff Family Leave Policies
The goal of the initiative is to help mothers meet the American Academy Graduate Student Family Leave (GS-FL) Policy
USC Lactation Support Policy
of Pediatrics recommendations of breastfeeding for a total of 12 months by Pregnancy Discrimination
Talking with Your Supervisor about Your Pregnancy
providing support and resources for nursing mothers returning to work or class. Expressing Milk When Your Return to Work
2012 South Carolina and U.S. Breastfeeding Rates
Pregnancy Care.................................................................................. 10
We hope that you use this booklet to help make informed decisions about Nutrition for Expecting Moms
your pregnancy and infant feeding options, which can help insure that you Tobacco Use During Pregnancy
Foods to Avoid While Breastfeeding
and your baby are happy and healthy. At the end of the booklet, we provide a Breastfeeding Nutrition
Breastfeeding and Alcohol
comprehensive list of resources at USC and in the community that you can Physical Activity During Pregnancy and Postpartum
access to learn more about the topics included in this booklet. Childbirth............................................................................................. 12
Choosing Your Care Provider
Preparing for Childbirth
Benefits of Taking a Childbirth Class
If you are planning to become pregnant, expecting What Types of Classes are Available
Choosing a Class
or recently welcomed a baby into your family
Child Care............................................................................................ 14
and are interested in participating in any of the “As one of the most Choosing Child Care Checklist
Breastfeeding and Child Care
services provided through the Lactation Support universal and natural
Child Care Facilities and Licensing
South Carolina’s Baby Net Program
Initiative, please contact Healthy Carolina using facets of motherhood, the
the contact information below. ability to breastfeed is a Breastfeeding..................................................................................... 16
Breastfeeding Matters
great gift. Breastfeeding Benefits of Breastfeeding
When to Seek Help
helps mothers and babies
Breastfeeding in Public
bond, and it is vitally Tips for Dad
803.777.1650 important to mothers’ and
Supplies for Breastfeeding at Work
Breastmilk Storage
HealthyC@mailbox.sc.edu infants’ health.”
Breastfeeding Tips: Preparation, Initiation, Continuation
Worksheets......................................................................................... 20
www.sc.edu/HealthyCarolina My Breastfeeding Goals
My Breastfeeding in the Hospital Plan
#HCLactationSupport Kathleen Sebelius
My Breastfeeding and Working Plan
Secretary
Resources........................................................................................... 22
U.S. Department of Health Lactation Support Initiative Resources and Services
@MyHlthyCarolina and Human Services Resources Available at USC
Resources Available in the Community
facebook.com/HealthyCarolina National Resources
Pregnancy and Breastfeeding Policies
2 Hotlines for Parents
3Insurance Guidelines
Insurance Navigating insurance benefits and procedures concerning maternity and your new baby can be an AIG Student Health Insurance (Pearce and Pearce)
overwhelming process. If you start early, you will save money and reduce confusion and stress. Below we have If a student would like to add a dependent child, it is considered a qualifying event. We will need the following
highlighted simple steps to take as a University of South Carolina parent covered by the insurance options within 31 days of the birth or adoption:
available through USC. Resources and links for more detailed information can be found on the Public
1. A copy of the birth certificate or declaration of birth
Employee Benefit Authority (PEBA) Insurance Benefits’ website at www.eip.sc.gov.
2. Provide a contact name and phone number.
The costs associated with maternity care vary depending on coverage, condition and type of birth. Participants
of the State Health Plan’s Standard and Savings plan have access to a Treatment Cost Estimator which may be
If the qualifying event is approved, we can take a payment over the phone. You may email the copy of the birth
accessed via Blue Cross Blue Shield of South Carolina’s website, located at www.southcarolinablues.com, under
certificate or a declaration of birth to qualifier@studentinsurance.com so that we may verify and review the
My Health Toolkit/ Resources.
information. Please remember that we must receive this information within 31 days after the adoption or birth
Maternity costs are shared between you and your insurance provider, depending on your plan. The general of the dependent child.
guidelines for the plans offered to USC benefits-eligible employees are covered are briefly outlined below.
Pregnancy related costs are subject to a deductible. After the deductible has been met, pregnancy is paid at
the same as any other “sickness.” For network providers, after deductible charges will be covered at 80%. For
out-of-network providers, after deductible chargers are covered at 70% of the reasonable and customary (what
State Health Plan (Standard and Savings Plan) standard, set charges are for medical procedures and services).
You or your covered spouse must participate in the Maternity Management Program, also known as “Coming
Some pregnancy related costs are covered at 100% including folic acid supplements and prenatal vitamins.
Attractions,” administered through Medi-Call. There is a $200 penalty for failing to enroll within the first three
Comprehensive lactation support and counseling by a trained provider during pregnancy and/or in the
months of pregnancy. There is an additional $200 penalty for each admission you fail to preauthorize, whether
postpartum period, as well as costs for renting breastfeeding equipment are also covered at 100%.
it is maternity related or not. A coinsurance penalty is also applicable, which makes any coinsurance you pay
not included toward your coinsurance maximum. Again, you must enroll in the program by calling 699-3337
(Greater Columbia area) or 1-800-925-9724 (outside the Columbia area) within the first trimester (first three
months) of your pregnancy.
Services Provided at USC Student Health Services
You may also enroll online through the Personal Health Record’s maternity screening program at
Student Health Services does not provide O.B. care. The facility can administer blood pregnancy tests and
www.SouthCarolinaBlues.com and log into “My Health Toolkit.”
provide initial pregnancy consultations. After the original consultation, patients are referred to outside facilities
Participating in the Maternity Management Program or contacting Medi-Call about the birth of your baby for appropriate prenatal care with an obstetrician or family doctor.
does not add your baby to your health insurance. You must add the baby to your policy by completing an NOE
form (Notice of Election) and submitting a long-form birth certificate within 31 days of your baby’s birth. This
form can be found at www.eip.sc.gov under “Active Subscribers” and then “Forms.”
Primary differences in the two plans:
Breastfeeding and the Patient Protection and
• The Standard Plan has higher premiums, but lower deductibles.
• The Savings Plan has a higher deductible, and as a result you save money on premiums.
Affordable Care Act of 2010
* You may have the opportunity to change plans, which typically happens in October of each year.
The Affordable Care Act made changes to how breastfeeding related costs are covered
by insurance companies. Unfortunately, these changes do not affect any of the State
Blue Choice Health Plan (HMO) Public Benefits Authority’s Insurance Benefits programs.
You or your covered spouse are covered for hospital care, hospital-based birthing center care, and prenatal and If you are insured through you spouse’s insurance plan or through the AIG Student
postpartum care, including childbirth, miscarriage and complications related to pregnancy. Inpatient benefits Health Insurance plan, be sure to inquire about the types of breastfeeding supplies and
are provided for the mother and newborn for 48 hours after normal delivery (not including the day of delivery) support covered through your insurance.
or 96 hours after Caesarean section (not including the day of surgery). Coverage for the newborn includes, but
is not limited to, routine nursery care and/or routine well-baby care during this period of hospital confinement.
Charges for home births are not covered. For maternity care, patient pays $45 co-payment for first visit, then
15 percent for subsequent visits. For hospital services, patient pays a $200 co-payment per admission, then 15
4 percent coinsurance. All services, except for emergency care, must be pre-authorized.
5Faculty and Staff Family Leave Policies
Planning and Approval
USC Policies An expectant mother and/or father may be entitled to job-protected leave under the Family and Medical Leave
Act (FMLA). Check with your Department Human Resource Contact or the USC Benefits Office to see if you
Students contemplating family leave must advise their academic unit of the intention to take family leave and begin
the family leave planning process at least six (6) weeks before the leave start date. Once planning has been completed
are eligible for FMLA.
at the unit level, a written petition for family leave with required supporting documentation and signatures must be
To be eligible for FMLA benefits, an employee must: submitted as a single packet to the dean of the Graduate School for approval at least three (3) weeks before the start
of the leave. The petition must contain evidence of consultation and planning with the student’s academic advisor(s)
• Work for a covered employer
and a memo of support from the academic unit signed by the program’s graduate director, a leave timeline, and
• Have worked for the employer for a total of 12 months appropriate documentation. Appropriate documentation for a female student for childbirth includes written
certification from the student’s health care provider confirming the pregnancy and anticipated due date or the
• Have worked at least 1,250 hours over the previous 12 months
baby’s birth certificate and for a male student either certification confirming the anticipated due date or the baby’s
• Work at a location in the United States or in any territory or possession of the United States where the same birth certificate. For adoption of a child less than 6 years old, a written certification of adoption from a certifying
employer within a 75-mile radius employs at least 50 employees. individual or agency specifying the date of adoption and the age of the child is the appropriate documentation.
If eligible, apply for an FMLA through the USC Benefits Office. To apply for FMLA, an employee should This planning process with the academic unit should also be used to determine if any additional length of time
complete the appropriate forms labeled under “Leave Forms” located at http://hr.sc.edu/forms.html. These forms beyond the one year extension of academic responsibilities period will be needed for the student opting for family
require a doctor’s signature and should be submitted in advance of taking leave. leave to complete degree requirements. While a one year extension of academic responsibilities will be granted
to any student on approved family leave, academic units often have specific timelines for exams, fieldwork,
Please note: While an employee is on FMLA, the employer must continue to pay its portion of insurance
course sequences, etc., which may necessitate extension beyond the one year period. Graduate students with such
premiums; should the employee go into leave without pay status while on FMLA, the employee must make
circumstances may petition The Graduate School for extension of leave time. Academic unit requirements or
arrangements with the Payroll Office to make his/her portion of the premium payment. Otherwise, the coverage
limitations are a valid justification to petition for the extension. Petitions for extension of time beyond the one year
will be canceled for nonpayment.
family leave should be supported by the student’s academic unit and will be reviewed by The Graduate School on an
Faculty should consult with the appropriate Faculty Manual or the Provost Office to determine if there are any individual basis.
other requirements that need to be met in preparation for leave.
Note: Medical complications or other extenuating circumstances are not included in this policy. Such situations are
more appropriately covered by the University’s current policies regarding course incompletes and withdrawal and/or
leave of absence due to extenuating circumstances.
Graduate Student Family Leave (GS-FL) Policy
Summary International Students
A graduate student who is the primary child-care provider is eligible to take a one major term of family leave The family leave policy is also intended to allow an international student to be coded as a “special enrollment”
from graduate study the major term during or following the event for the birth of a child or adoption of a child student and not affect current visa status. However, immigration regulations might dictate a different definition of
less than 6 years old. The graduate student taking family leave will receive a one year extension of all academic enrollment than that defined as “special enrollment” for this policy. The Office of International Student Services is
responsibilities, including time to degree, removal of incomplete grades, and course in-date time. During family the authority on campus for interpreting current enrollment regulations for international students, so international
leave the graduate student will be on special enrollment (Z-status) status and must have health coverage. The students contemplating family leave must consult the Office of International Student Services to address proactively
student may waive out of University-sponsored health insurance if covered by other insurance or may elect to any individual or unique visa issues and/or to consider how the latest applicable regulations would affect eligibility
continue enrollment in the University-sponsored student health insurance plan. The student is responsible for for family leave. International students applying for family leave must discuss the intended leave period with the
submitting required waivers and/or for contacting the student health insurance contactor directly to enroll in the Office of International Student Services at the beginning of the six (6) week planning period and must include a
health insurance program and for paying premiums by the deadline. Students should be aware that a graduate signed memo from the Office of International Student Services detailing immigration status and any consequences
assistantship position or other financial support may not be available upon return from family leave. of taking family leave in the written petition packet submitted to the student’s program graduate director for
signature and to the dean of The Graduate School for approval.
Note: While this policy does not mandate that programs continue financial support during family leave and/
or guarantee student support or resumption of an assistantship after returning from family leave, programs are Once the family leave has been approved, a memo will be placed by The Graduate School in the student’s academic
strongly encouraged to do so whenever possible. file indicating the leave dates and the extension date for academic responsibilities. It is the student’s responsibility
to communicate with their academic unit while on leave. It is also the student’s responsibility to work with faculty
and program administrators on arrangements for course completion, achievement of degree requirements, and for
continuation of research and/or teaching activities before and following the period of the leave.
6 7USC Lactation Support Policy (HR 1.60) Talking with Your Supervisor about Your Pregnancy
The University of South Carolina has a Lactation Support Policy that supports mothers in their decision to Many women find themselves juggling the inside “job” of growing a baby and the outside job of working for pay.
express milk for their baby after returning to work. The policy mandates that mothers returning to work or Ultimately, it is up to you and your personal situation how you want to balance the two.
school who wish to continue breastfeeding be given a comfortable, private room that is not a bathroom or
Timing: There are many factors to consider, and it is important to communicate with your supervisor regarding
locker room, can be locked from the inside and contains at minimum a chair, table and an electrical outlet where
your thoughts and plans. The best time to tell is just after people begin to suspect you might be pregnant and before
they can express milk.
they are sure. Although you are excited about your news, most women recommend against revealing a pregnancy in
The policy also mandates that breastfeeding mothers be given reasonable break times for breastfeeding or the early months. Be careful not to wait too long to tell, either. You don’t want to give your employer any reason to
expressing milk. To do this, employees may request to readjust their schedule for the purposes of lactation. think you are untrustworthy; any suggestion that you concealed your pregnancy for your own gain may make you
Supervisors and employees should work together to establish mutually convenient times for milk expression. look as though you are not a “team player.”
Supervisors must work to ensure that there are no negative consequences to nursing mothers who need
lactation breaks. What do you want? Before setting up a meeting with your employer, interview yourself. If you truly know what
you want, you are more likely to get it. Determine what you ideally want, what you can afford and what’s best
Both the provisions of adequate space and break time to express milk are allowed for up to one year after giving
for your pregnancy and your family. Can you grow a baby and do your job? Do you want to? Bear in mind that
birth. It is the mother’s responsibility to contact her supervisor to request space and time to express milk.
complications during your pregnancy or after delivery may make some of these decisions for you. Unless your doctor
Employees should contact their next level of supervisor or Human Resources if their unit does not allow determines otherwise, could you work through most of your pregnancy? Would you prefer to start maternity leave
for reasonable breaks or arrangements for adequate space for milk expression. early, continue your job on a part-time basis from home? After the baby is born, do you want to come back to your
present job, or one that is more compatible with family life? Do you want full-time work or part-time?
Expressing Milk When You Return to Work The conversation: With all negotiations, consider where the other person is coming from. Your supervisor will want
to know when you are leaving, when you are coming back, and how best to fill in the gap while you’re gone. Be
Healthy Carolina is committed to building a campus that is supportive of working mothers who intend to
ready with those answers. Realistically, your supervisor is more concerned about the company’s operations than your
breastfeed their infants. Healthy Carolina recognizes that breastfeeding is the healthiest choice for your baby and
personal needs.
helps you recover from pregnancy and birth. Most
supervisors recognize the importance of breastfeeding; Some topics to consider:
however, your supervisor may not know what you need
in order to continue breastfeeding. Simply explain your
Pregnancy Discrimination • Can you develop a flexible work schedule before and/or after the baby comes on a partial basis?
It’s against the law to fire, dock pay, hold • Talk to your supervisor about things you are doing to prepare for your absence, whether that is preparing for
basic needs for privacy and flexible breaks to express
someone to fill in while you are away, or taking care of responsibilities ahead of time.
milk. See Healthy Carolina’s website for the current back benefits, or demote any woman because
of pregnancy and under the Pregnancy • Familiarize yourself with maternity leave policies and your legal rights.
list of Nursing Mothers’ Lounges which are located
Discrimination Act, all forms of pregnancy Adopted from askdrsears.com.
throughout campus. You can check out a key to one
discrimination are illegal.
of these lounges and keep it for as long as you need.
The Family and Medical Leave Act also
Employee responsibilities for supporting
breastfeeding programs:
ensures employers must hold a worker’s job
for up to twelve weeks if the worker has to 2012 South Carolina and U.S. Breastfeeding Rates
take an approved FMLA leave of absence for Breastfeeding rates across the nation are consistently rising every year and South Carolina is no exception to
• Communicate with your supervisor and coworkers.
medical reasons, including pregnancy and this trend! The CDC reports that breastfeeding rates for South Carolina and the Nation are as follows:
• Maintain cleanliness of milk expression areas. childbirth.
• Label, date, and discard milk appropriately.
• Responsibly use break time for milk expression.
For resources about the Family Medical Leave
Act or the Pregnancy Discrimination Act,
64% of SC mothers have
ever breastfed
77% ofeverUSbreastfed
mothers have
see page 22.
27% 36% ofbreastfeeding
• Express need for clean, private room to breastfeed
of SC mothers are exclusively US mothers are exclusively
that is not a bathroom.
breastfeeding at 3 months at 3 months
35% 47% ofbreastfeeding
Benefits of breastfeeding to communicate to your
supervisor include: of SC mothers are US mothers are
breastfeeding at 6 months at 6 months
• Employees are less likely to miss work to take care of a sick baby because the baby is healthier.
16%
of SC mothers are
26% ofbreastfeeding
• Health care costs are lower, since both baby and mother are healthier. US mothers are
• Employees who receive support for breastfeeding are happier and more productive. breastfeeding at 12 months at 12 months
8 9Nutrition for Expecting Moms Breastfeeding Nutrition
The types and quality of the foods you eat play a critical role in your baby’s growth and development. Below
Breastfeeding and Alcohol
Breastfeeding moms should eat approximately an extra 300 calories per day and
Pregnancy Care are recommendations from the USDA. Check out their website for individualized meal plans, recipes and more According to the U.S. Office on Women’s Health
just like when you are pregnant, it’s quality, not quantity that matters most. Avoid you can continue to breastfeed and have an
nutrition related information at: www.mypyramid.gov/mypyramidmoms/index.html
empty calories and eat plenty of nutritious, nutrient-dense foods to meet your extra occasional alcoholic beverage if you are cautious
Empty Calories Low-Fat Dairy calorie requirements. Below are some tips for healthy eating while nursing: and follow these guidelines:
Empty calories are the calories from added sugars and Choose 3 to 4 servings per day of fat-free or low-fat • Wait until your baby has a routine breastfeeding
• Drink plenty of fluids to stay hydrated. Drink when you are thirsty and drink pattern, at least 3 months of age.
fats in foods like soft drinks, desserts, fried foods, cheese, milk & milk products. Dairy foods provide calcium for
more fluids if your urine is dark yellow. A common suggestion is to drink a
whole milk and fatty meats that provide no nutritional baby’s teeth and bones, as well vitamins A & D. When • Wait at least four hours after having a single
glass of water or other beverage every time you breastfeed. alcoholic drink before breastfeeding.
value. Look for low-fat, fat-free, unsweetened or with no you do not eat enough Calcium each day, your body
added-sugars foods to avoid eating empty calories. takes Calcium from your bones and shifts it to the baby, • Drinking a moderate amount (2 to 3 cups a day) of coffee or other caffeinated • Or, express breast milk before having a drink and
increasing your risk of osteoporosis in your later years. beverages does not cause a problem for most breastfeeding babies. Too much use it to feed your infant later.
Whole Grains
Buy whole grains in place of white breads for added fiber. Choline caffeine can cause the baby to be fussy. Breastfeeding provides many benefits. Do not stop
Check the ingredient list on breads and cereals for the Choline is a nutrient that helps the brain & memory breastfeeding altogether just because you would
• Breastfeeding can help you return to a healthy weight more quickly because of
word “whole” before the name of the grain used to make development of your baby. Eggs are an excellent source & like to have an occasional drink.
the energy required to produce milk! Your body will naturally start to shed
the product. Fortified grains supply folic acid, a B vitamin should be included in your diet at least 3 times per week.
weight as it begins to use calories for milk production. Avoid restrictive weight
that helps your baby grow properly. Try to eat at least 3
Folic Acid loss diets that may affect your body’s nutritional needs, leading to lowered energy and lowered immune function.
servings of whole grains per day while pregnant.
Folic acid plays a key role in reducing the risk of neural
• Make sure to eat foods with calcium! You do not need to drink milk to make milk. To meet your daily calcium
Fruits and Vegetables tube defects, including spina bifida. Experts recommend
needs of 1,000mg, eat a variety of dairy foods including low-fat yogurt and cheese, as well as non-dairy foods
Fruits and vegetables supply many important vitamins 500 to 600 micrograms daily for pregnant women. You
and minerals including fiber, folate & potassium, which can find this nutrient in green leafy vegetables and fruits including salmon, broccoli, sesame seeds, tofu and kale.
are all important to the health of you and your baby. such as spinach, oranges and strawberries.
Choose a variety of brightly colored fruits and vegetables
Alcohol Physical Activity
every day - fresh, frozen, canned or dried. Eat at least 2 to
Even moderate drinking during pregnancy can cause
3 servings of fruits and vegetables per day while pregnant
developmental problems for your baby. Pregnant women During Pregnancy
Meat & Beans and women who may become pregnant should not drink Almost all women can and should be physically active during pregnancy. Talk to your health care provider first,
You may need additional protein during alcohol. especially if you have high blood pressure, diabetes, anemia, bleeding or other disorders, or if you are obese or
pregnancy because protein works as underweight. Consult with our physician about what level of exercise is safe for you. According to the U.S. Weight-
building blocks and helps your baby grow.
Tobacco Use During Pregnancy Control Information Network, the benefits of regular to moderate physical activity during pregnancy include:
Protein is found in meat, poultry, fish, Tobacco use during pregnancy causes many health problems • Helping you and your baby to gain proper • Improving your mood and energy level.
beans, peas, nuts and seeds. Try to for both you and your baby including: amounts of weight. • Improving your sleep.
include a variety of choices and eat at • Mothers who smoke are more likely to have difficulties • Reducing the discomforts of pregnancy, such as
becoming pregnant, miscarriages, ectopic pregnancies and • Helping you have an easier, shorter labor.
least 3 servings per day while pregnant. bloating, backaches, leg cramps, constipation,
have their water break too early. and swelling. • Helping you to recover from delivery and return
Multi-Vitamin • Smoking causes higher risks of pre-term births and babies to a healthy weight faster.
• Reducing your risk for gestational diabetes.
While multi-vitamin supplements cannot with low birth weight.
replace a healthy diet, you may need a • Smoking during and after pregnancy increases your baby’s Postpartum
multivitamin and mineral supplement in risk for SIDS (Sudden Infant Death Syndrome).
After you deliver your baby, physical activity can help you return to a healthy weight. Not losing any extra weight
addition to a healthy diet. Talk with your • Babies who are born to mothers who smoke are more likely
to have certain birth defects including cleft lip, clubfoot, gained during pregnancy may lead to overweight or obesity later in life. Talk to your health care provider about
doctor about taking a supplement and
and some heart defects. what is a healthy weight for you and how you can start slowly incorporating physical activity into your routine after
follow his or her advice.
If you are pregnant and are currently using tobacco, free giving birth. Remember, breastfeeding can help you return to a healthy weight more quickly because of the energy
services are available to help you quit. See page 22 for info.
required to produce milk!
Foods to Avoid While The time after you deliver is stressful, exciting, emotional and tiring all at once. Taking the time to care for yourself
Pregnant and Breastfeeding can help you to process your feelings and reestablish healthy physical activity and eating habits. Even though it
The USDA recommends that pregnant and breastfeeding women avoid the following foods while pregnant due to the may be difficult, try to get an adequate amount of sleep, set aside time for yourself (even if it is only for ten
risks of contracting a food-borne illness:
minutes) to take a hot shower or watch your favorite show and remember to take time to enjoy the miracles
• Unpasteurized milk or cheeses (feta, goat cheeses, • Sprouts (Alfalfa sprouts) of pregnancy and birth.
brie, Camembert, blue cheeses and Mexican-style soft • Types of fish that may contain high amounts of
cheeses like queso blanco.) mercury (swordfish, shark, mackerel & albacore tuna) Sources: Weight-control Information Network: http://win.niddk.nih.gov/publications/two.htm#physicalactive
10 11
• Lunch meats • Raw or under cooked meats, eggs and seafood U.S.D.A: www.choosemyplate.gov/pregnancy-breastfeeding/pregnancy-nutritional-needs.html
• Hot Dogs http://fnic.nal.usda.gov/lifecycle-nutrition/pregnancyChoosing Your Care Provider What Types of Classes Are Available?
Childbirth Obstetricians Midwives Many childbirth classes embrace a particular philosophy about pregnancy and birth. The two most common
Obstetricians are physicians who have completed a Care is flexible, individualized and supportive, rather childbirth classes in the United States are the Lamaze technique and the Bradley method. The Lamaze technique
residency specializing in obstetrics and gynecology. than interventional and attentive to emotional issues. is the most widely used method in the United States.
They have the knowledge and skills to diagnose and Midwives apply a broad array of low-risk strategies
The Lamaze philosophy holds that birth is a normal, natural and healthy process and that woman should be
treat serious complications of pregnancy and childbirth for correcting problems arising in pregnancy or labor.
empowered through education and support and should approach birth with confidence. The goal of Lamaze is
and are surgical specialists in the pathology of female Pregnancy or labor complications may mean
to explore all the ways women can find strength and comfort during labor and birth. Classes focus on relaxation
reproductive organs. transferring to an obstetrician. Many midwives and all
techniques, but they also encourage the mother to condition her response to pain through training and
certified nurse-midwives, have hospital-based practices.
Family Practitioners preparation (this is called psychoprophylaxis). This conditioning is meant to teach expectant mothers constructive
Also known as general practitioners, family There are several types of midwives. Certified nurse responses to the pain and stress of labor (for example, controlled breathing patterns) as opposed to
practitioners have completed a residency in family midwives (CNM) are RNs that have completed counterproductive responses (such as holding the breath or tensing up). Other techniques, such as distraction
practice. They tend to intervene less than obstetricians. additional postgraduate training at an institution (a woman might be encouraged to focus on a special object from home or a photo, for example) or massage by a
This provider can also see other members of the family accredited by the American College of Nurse- supportive coach, are also used to decrease her perception of pain.
and follow up with you and your baby after the baby Midwives. Direct-entry midwives have trained as
midwives without becoming a nurse first. The Lamaze courses don’t advocate for or against the use of drugs and routine medical interventions during labor
is born. Pregnancy or labor complications may mean
American College of Nurse-Midwives and the North and delivery. Instead, they educate mothers about their options so they can make informed decisions when
transferring to an obstetrician. Few family practitioners
American Registry of Midwives offer certification to the time comes.
attend births at freestanding birth centers, and virtually
none attend home births. direct-entry midwives. In South Carolina, direct-entry
The Bradley method (also called “husband-coached birth”) places an emphasis on a natural approach to birth and
midwives work in freestanding birth centers and/or
Adapted from The Thinking Woman’s Guide to Better on the active participation of the baby’s father as the birth coach. A major goal of this method is the avoidance of
assist with home births.
Birth by Henci Goer. medications unless absolutely necessary. Other topics include the importance of good nutrition and exercise
during pregnancy, relaxation techniques (such as deep breathing and concentration on body signals) as a method
Preparing for Childbirth of coping with labor and the empowerment of parents to trust their instincts and become active, informed
There are many options and decisions that laboring and birthing mothers have to make during the childbirth participants in the birth process. The course is traditionally offered in 12 sessions.
process. Here are some things to consider as you prepare throughout your pregnancy:
Although Bradley emphasizes a birth experience without pain medication, the classes do prepare parents for
• Research, talk to others and find out what kind of birth environment you would feel most comfortable in unexpected complications or situations, like emergency cesarean sections. After the birth, immediate
for giving birth. Is it a hospital? Is it a birth center? At home?
breastfeeding and constant contact between parents and baby is stressed. Bradley is the method of choice for
• Who would you like to be part of your birth team, to support you during labor and birth? Your partner? many women who give birth at home or in other non-hospital settings.
Your mother? A sister? A doula? Other children?
• Look online for books and resources that explain in an unbiased, consumer-oriented way your choices and There are several other types of birthing classes available. Some include information from the two previously
options for labor and childbirth. An example is the Guide to a Healthy Birth published by the non-profit mentioned techniques, and some are offshoots that explore one particular area. Two options that might be
Choices in Childbirth. www.choicesinchildbirth.org available in your area are active birth classes that teach yoga techniques to prepare for labor and
• Access the Healthy Carolina Lending Library to check out one of our great books. “hypnobirthing” courses, which use deep relaxation and self-hypnosis as relaxation techniques.
• Take a childbirth class to learn about the physiology of birth and ways to cope during labor. Classes range Most childbirth class series include a component on breastfeeding your baby; however, it may serve you well to
from your typical hospital-based childbirth class to Bradley method classes to Lamaze technique classes.
take a class focused solely on breastfeeding.
Benefits of Taking a Childbirth Class
Choosing a Class
A childbirth class can provide you with a great forum to ask lots of questions and can help you make informed
The type of class that is right for you depends on your personality and values, as well as those of your labor
decisions about key issues surrounding your baby’s birth. Some of the information you can learn from a birthing
partner. There is no one correct method. If you are the kind of person who likes to share and is eager to meet
class includes:
people, you might like a smaller, more intimate class designed for couples to swap stories and support each other.
• How your baby is developing • How to write a birth plan
If you don’t like the idea of sharing in a small group, you might want a larger class, where the teacher does most of
• Healthy developments in your pregnancy • How to tell when you are in labor
the talking. Before you sign up for a class, it’s a good idea to ask what the curriculum includes and what
• Warning signs that something is wrong • Pain relief options during labor
philosophy it is based upon. You can also request the course outline.
• How to make your pregnancy, labor, and • What to expect during labor and delivery
delivery more comfortable • The role of the coach or labor partner
• Breathing and relaxation techniques Adopted from KidsHealth.org, sponsored by the Nemours Foundation.
12 Adopted from KidsHealth.org, sponsored by the Nemours Foundation. 13Choosing Child Care Checklist Breastfeeding and Child Care
Start early! Get on waiting lists as soon as you think you want to become pregnant. Once you become pregnant, Some child care providers are experienced in caring for breastfed infants, others are not. Be sure to ask each
let caregivers know your due date and the date you plan to return to work. When selecting the appropriate child
Child Care care setting, parents need to consider issues such as availability, affordability and quality. The following checklist
prospective provider about their experience providing care for breastfed babies. Staff might have questions
concerning breastmilk storage, feeding times, how to feed a baby breastmilk, breastmilk labeling and more.
can help parents choose child care and guide parents as they observe child-care programs for quality. It might be helpful to provide staff at the facility you have chosen with a one-page sheet with all the
information staff will need concerning feeding your baby.
Do both parents and children Are the children involved in
feel the program is a safe and meaningful activities? If you can, feed your baby when you arrive at your provider to drop your child off in the morning, even if
comfortable place to be? • Do activities support children’s natural curiosity? you’ve just fed your baby at home. Also, let your provider know if you want to feed your baby when you pick
• Is there ample space? • Are children allowed to explore? him or her up in the afternoon so they will not feed your baby in the last couple hours before you’re expected
• Are there caring providers? to arrive. Breastfeeding your baby before you drop them off in the morning and when you pick them up will
• Do caregivers attempt to build on language?
• Is there support upon separation (e.g., when mean you have to pump less and will provide more milk for your baby straight from the source.
• Are questions posed to foster thinking and
parents leave for work/school)? reasoning? Picking a child care provider located close your work or home may make it easier to breastfeed right before
• Is care consistent, or is there a lot of turnover? • Are problem solving and personal expression work, right after work or during your lunch break. Talk to your employer about leaving to nurse your baby
• Do caregivers deal with parent and child feelings encouraged?
in a relaxed way? during your lunch break.
• Are there a variety of age-appropriate play
• Is the environment reasonably clean? materials available? Adapted from Le Leche League’s “Preparing Your Child Care Provider for Your Breastfed Baby” and from the USDA’s information
• Are proper health practices followed • Is a schedule of daily activities posted and packet entitled “Breastfed Babies Welcome Here.”
(hand washing, separate & sanitary toileting followed?
and diapering areas)? • Is there a healthy mix of activities offered? For
• Are there enough adults for the group’s size and age? example, is there a balance between active and
quiet activities, large and small group activities
Child Care Facilities and Licensing
and adult-directed and child-directed activities? Child care licensing enforces laws and regulations established by the South Carolina Legislature to ensure that
Are the children encouraged to feel
good about themselves? child care facilities provide the basic health and safety requirements for all children in their care. Parents can go
Is the environment child-centered?
• Are activities suitable for the children’s ages? on South Carolina’s Division of Child Care Services website to search the records of any childcare facility in the
• Are materials on shelves accessible to the children?
• Is independence encouraged? state. Parents can find the facility’s contact information, if the facility is an ABC Program provider, as well as
• Is there child-sized furniture and is the furniture in
• Are children allowed choices throughout the day? good condition? facility reviews and complaint information. http://childcare.sc.gov/main/default.aspx
• Are positive guidance techniques used? • Are rooms tidy and organized in a way that makes Some of the licensing requirements for child care centers in South Carolina include: having background checks
sense to a child?
• Are reasonable limits set with consistent and fingerprint reviews on all caregivers; having regular fire inspections, sanitation inspections, and child care
reinforcement? • Are children’s projects displayed at their eye level?
licensing inspections; having staff certified in basic first aid and
• Do caregivers supervise play without being • Are children’s physical development supported
intrusive? through appropriate health, nutrition, and CPR; and having two unannounced visits per year by the South
safety practices? Carolina Division of Child Care Services or in response to a complaint. South Carolina’s Baby Net Program
Are efforts made to ensure Baby Net is South Carolina’s interagency early intervention
consistency between home and Does the environment encourage The South Carolina Division of Child Care Services lists several
positive social behavior? system for infants and toddlers under three years of age
child care? items parents should look for when choosing a child care facility
• Are rules for behavior fairly and consistently with developmental delays, or who have conditions
• Is there an effort for daily parent-provider to ensure that the facility is safe and staff are well trained: associated with developmental delays. BabyNet matches
enforced?
exchange?
• Do caregivers provide reasons for rules? the special needs of infants and toddlers who have
• Do staff members ease transitions and separation • Are policies available for review?
developmental delays with professional resources available
felt by the child as well as the parent? • Are children encouraged to find positive
solutions to conflicts? • Are there parent-staff meetings? within the community. Services are provided in everyday
• Are parents encouraged to visit? routines, activities and places relevant to the life of
• Are there opportunities for children to have • Are staff authorized to work?
• Do staff and parents discuss important issues such meaningful interactions with both children the family.
as guidance and discipline and toileting and adults? • Is a current, valid license or registration information displayed?
techniques? Anyone (a parent, doctor, caregiver, teacher or friend) can
• Are the indoor and outdoor environments safe • Can the facility meet any special needs your child may have? make a referral by the number listed below. The earlier a
for children?
If infants are present, are their needs • Does director have background and central registry results? baby or toddler receives help, the better! To make a referral
being met? • Are there regularly scheduled nutritious meals or to get additional information call 1-877- 621-0865 or send
and snacks? • Are the staff trained in child development, as well as safety,
• Are there enough caregivers to provide individual emergency and first aid procedures? an email to: babynet@ cfirststeps.org for assistance.
attention? • Is physical activity encouraged during play time?
• Is scheduling flexible to meet individual needs? • Is meal time pleasant? • Is appropriate discipline used with the children? Remember,
physical punishment is not allowed without parent’s written permission.
• Do caregivers respond promptly to signs of • Is there an adequate setting and equipment for
distress? rest time? • Is there enough staff and are they actively supervising the children?
14 • Are toys and play areas sanitized daily? Adapted from Karen DeBord, Ph.D., child development specialist,
available at www.nncc.org/choose.quality.care/dc36_choose.care.html.
15Breastfeeding Matters Breastfeeding Definitions
When to Seek Help
Breastfeeding The American Academy of Pediatrics recommends Breastfeeding: The child receives breast milk
Many mothers experience sore nipples, breast engorgement and overall soreness during the first few weeks Did You Know?
breastfeeding your baby for twelve months, with the first direct from the breast or expressed. of breastfeeding. Allow your body and your baby time to establish to a breastfeeding routine. While most
issues resolve themselves over a few days and do not affect your ability to breastfeed, some women Approximately 73% of all
six months exclusively breastfeeding your baby. After six Exclusive breastfeeding: The infant receives
experience issues where a consultation with a lactation specialist may be best in order to insure issues are breastfeeding moms get
months, you can gradually introduce iron-enriched solid only breast milk directly from the mother or
resolved quickly and do not interrupt your pumping and feeding schedule. Some of these issues include: outside help from a
foods to complement the breast milk diet. Breastfeeding expressed, and no other liquids or solids with
the exception of drops or syrups consisting of lactation expert at one
your baby is the beginning of a special relationship • When your baby is nursing only on one breast
vitamins, mineral supplements or medicines. point. Check out page 22
between you and your baby. When you breastfeed, the • Mastitis (breast infection) when moms have soreness or a lump in the breast that can be
Predominant breastfeeding: The infant’s for more information on
skin-to-skin interaction helps you form a relationship with accompanied by fever, flu-like symptoms, nausea or vomiting
predominant source of nourishment is breast how to find a lactation
your baby that no one else can have. Breast milk is a special • Painful cracked or bleeding nipples
milk. However, the infant may also receive specialist in your area.
food that supplies perfect nutrition for your baby. Each water, water-based drinks, fruit juice, and drops • Inverted, flat or very large nipples that make it difficult for your baby to establish a proper latch
time you breastfeed, you will also be helping your baby or syrups consisting of vitamins, mineral • Concerns with low milk supply
supplements or medicines
fight germs. Your breast milk is always available when your • Breastfeeding in special situations such as jaundice, reflux disease, cleft palate, premature birth, low
baby wants it, anytime, anywhere. You can be sure your Complementary feeding: The child receives birth weight, when breastfeeding multiples, or after breast surgery.
both breast milk and solid or semi-solid food.
breast milk is pure, clean, and safe and that it
changes to meet the needs of your growing baby.
Breastfeeding in Public
Don’t feel intimidated to breastfeed in public! South Carolina law states that a woman may breastfeed in public in
Benefits of Breastfeeding any location where the mother is allowed and that the act of breastfeeding is not considered indecent exposure
For Infants For Mothers (S.C. Code Ann. §63-5-40). Even though breastfeeding is allowed in public, some mothers still feel uncomfortable
doing so. Remember, you are feeding your baby - not doing something inappropriate! Le Leche League gives some
• Breastfeeding is the most complete form of • Breastfeeding burns calories making it easier to lose
nutrition for infants, providing just the right pregnancy weight. great tips for moms who are hesitant or uncomfortable with breastfeeding in public:
amount of nutrients for growth and development. • Wear nursing clothes or loose fitting tops that can • Bring a blanket or nursing cover to lay over
• Breastfeeding helps a mother’s uterus go back
• Breast milk is easier to digest than formula. to pre-pregnancy size quicker and lessens any be lifted or unbuttoned at the waist that will let the exposed part of your midrift.
bleeding that may occur after birth. you feed your baby without exposing your breast.
• Breastfed infants gain less unnecessary weight, • Choose seating next to a wall or in a booth to
which may lead to a reduced risk of obesity in • Breastfeeding, especially exclusive breastfeeding, • Wear a nursing bra that can easily be pulled up give you the most privacy.
adulthood. delays the onset of normal menstrual cycles and or unfastened with one hand.
• Practice discretely breastfeeding in front of a
ovulation. • Purchase a sling for your baby that is worn over mirror so you will be able to see what others
• Premature babies react to breastfeeding better than
formula feeding. • Breastfeeding lowers a mother’s risk of breast your shoulder and is adjustable. The fabric of would see and make adjustments to your
cancer, ovarian cancer, hip fractures, osteoporosis the sling can be pulled up to cover your baby techniques.
• Breastfed babies score higher on IQ tests. and your exposed skin.
and anemia.
• Breastfed babies are less likely to become ill.
• Breastfeeding can make your life easier! When
• Breastfeeding protects against ear infections, breastfeeding, you have no formula to mix and no Tips for Dads - It’s Easier to Work as a Team!
diarrhea, rashes, allergies, pneumonia, botulism, bottles to warm.
bronchitis, influenza and other serious illnesses. • Provide food and drink to help keep up her milk • You can still bond with your baby while your
• Breastfeeding is inexpensive with the average supply. Many new mothers are so busy they don’t partner is nursing. Dress the baby in just a diaper
• Breastfed babies are hospitalized 10 times less family saving approximately $1,000 to $1,500 realize they’re not drinking enough to stay hydrated! and lay him or her on your bare chest so the baby
in the first year of life than babies who are not per year by breastfeeding instead of purchasing
can feel your skin and learn how you smell.
breastfed. formula and formula feeding supplies. • Be her research partner and proactively read about
breastfeeding in books and online. You can use the • Act as a gatekeeper by screening calls and
• A mother’s milk contains her antibodies that fight • Breastfeeding provides immediate satisfaction for
online resources on our website as a starting point. monitoring visitors the first few weeks to give your
whatever disease/infection may be present. your baby when he or she is hungry.
partner time to recover after childbirth, to allow her
• Breastfeeding allows mothers to relax and you can • After several weeks, once breastfeeding is well-
• Sucking at the breast helps the infant produce a establish a breastfeeding routine, and to allow the
strong jawbone and straight, healthy teeth. even take a short nap every day while established, get involved in the feeding process by
three of you time to bond.
breastfeeding your baby! giving the baby a bottle of expressed breast milk.
• The risk of SIDS (Sudden Infant Death Syndrome) • Keep an eye on mom for signs of postpartum
dramatically decreases - of every 87 cases of SIDS • Breastfeeding allows for the mother & child to • Whenever possible, bring the baby to mom for
depression. This is the most critical job dad takes on
reported, only three are breastfed. bond and can make babies feel more secure. feedings - especially those in the middle of the night!
after the new baby arrives. If you notice your partner
• Nursing promotes facial structure • Be a human shield to give your partner privacy while is restless or irritable, feeling sad, depressed or crying
development, enhances vision and Did You Know? nursing in public. a lot, lacks energy, is experiencing headaches, chest
enhances speech. If you leave the hospital before your baby, you can express pains, or hyperventilation, talk with her and seek the
• Encourage and reassure your partner in her choice
16 milk for the hospital staff to give the baby by feeding tube. of breastfeeding to help her feel more confident. advice of a medical professional.
17Breastfeeding Tips
During Pregnancy Transitioning Back to Work
• Pregnancy is the best time to prepare for breastfeeding and returning to work! Returning to work gradually can help your body and your baby adjust to the change in schedule. Some tips on
• Attend prenatal classes available at your hospital, workplace or private physician clinic. Through Healthy gradually starting back to work include:
Carolina’s Lactation Support Initiative, USC mothers can attend a breastfeeding class with a board certified
• Work from home or combine working from home and at the office.
lactation consultant at little to no cost. See page 22 for more details.
• Go back to work on a Thursday or Friday or just before you have one to two days off. This gives you and your
• Attend La Leche League meetings to learn more about how to combine breastfeeding and employment. baby a shorter period to adjust to being away from each other before you go back full time.
• Talk with your supervisor to discuss your plans to breastfeed. • Start back part-time for a brief period before working full-time.
Did You Know? • Locate the Nursing Mothers’ Lounge that is closest to your office or classes. A map of the location of all • Take Wednesdays (or another day that fits your schedule) off for a few weeks and breastfeed on your baby’s
Breast size is not Lounges at USC is available on our website. schedule to rebuild your milk supply.
important when • Consider using child care close to work so you can breastfeed your baby, if feasible, based on your work schedule.
During The First Weeks After Delivery
it comes to • When you arrive to pick up your baby from child care, take time to breastfeed first. This will give you both time
• Get a good start in the hospital by putting your baby to the breast within the first hour after birth and at to reconnect before traveling home and returning to other family responsibilities.
breastfeeding.
least 8 to 12 times every 24 hours. This will help you establish a good milk supply for when you return to
No matter what size
work. See page 22 for a worksheet to help you develop a plan for initiating breastfeeding in the hospital.
you are, you’ll make Pumping at Work Supplies for Pumping at Work
enough milk for • Your milk is perfect for your baby’s needs, even though it may seem you are not making much the first days. • Cooler with ice packs if no refrigerator is available
A high-quality electric breast pump may be your best strategy for efficiently
your baby! Your baby’s stomach is very small at first (only the size of a large marble!) and only holds 1 to 2 teaspoons, so • Breast pump
expressing milk during the workday. Contact your local hospital, or public health
the baby does not need much! By days 2 to 5 your body will begin making larger volumes of milk. • Breastmilk storage bags or bottles
department to find where to buy or rent a pump and call your insurance company
• Ask the hospital for names of people you can call if you have questions about breastfeeding. See page 22 for a • Sanitizing wipes to clean breast pump
to see what types of rental pumps they will cover.
list of local resources. • Bra pads in case of leakage
Find out where the nearest Nursing Mothers’ Lounge is at USC by visiting Healthy • An extra shirt in case of leakage
• Watch for signs that your baby is getting plenty of milk. By day five, your baby should have around four to six
Carolina’s website. Nursing Mothers’ Lounges have been established to provide • Reusable water bottle to stay hydrated
wet diapers and three to four yellow, seedy stools every 24 hours.
private areas where you can comfortably and safely express milk after returning to • A photo of your baby or a recording of their voice
• Avoid using bottles or pacifiers for the first 3 to 4 weeks, as this may decrease your milk supply. A lactation work. When using one of the lounges, feel free to bring photos or baby items to to help with milk let-down
consultant can help you know you are making plenty of milk. help with let down, which will help you to finish pumping quicker.
• If you and your baby need to be apart, you can express your milk manually or with a breast pump to keep up
Most moms express milk for 10 to 15 minutes approximately two to three times during a typical eight-hour work
your milk supply, and refrigerate or freeze your milk to give to your baby later.
period. Remember, in the first months of life babies need to breastfeed 8 to 12 times in 24 hours. So you need to
• Expect engorgement. A new mother usually produces lots of milk, making the breasts temporarily big and express and store milk during those usual feeding times when you are away from your baby. This will maintain a
sometimes painful. Feeding the baby often will help relieve the engorgement. sufficient amount of milk for your childcare provider to feed your baby. The number of times you need to express
milk should be equal to the number of feedings your baby needs. As the baby gets older, the number of feeding times
During Maternity Leave
may decrease. When babies are around 6 months old and begin solid foods, they often need to feed less often.
• Take as many weeks off as you can. Ideally, you will be able to take off work at least six weeks to recover from
childbirth and establish strong breastfeeding techniques. Twelve weeks is even better.
Storing Your Milk
• Focus on your baby during this time and make time to rest 20-30 minutes every few hours. Housework can
Because your milk is full of antibodies that fight germs and bacteria, it can be safely stored and given to the baby
wait or be taken on by family and friends.
later. Breast milk is food, so it is safe to keep in an employee refrigerator or a cooler with ice packs. Discuss with your
• Practice expressing your milk by hand or with a quality breast pump, and freeze 1-2 ounces at a time to save supervisor the best place for you to store your milk. If you work in a medical department, do not store milk in the
for your baby after you return to work. This also helps you build a greater milk supply. Pick times of the day same refrigerators where medical specimens are kept. Be sure to label the milk container with your name and the
when you seem to have the most milk. Some women express milk during or after their baby nurses since the
date you expressed the milk.
milk has already “let down” and flows easily.
• Be patient with yourself! It takes time for both you and your baby to adjust to your new lives together. Follow
The U.S. Office on Women’s Health recommends the following storage
your baby’s cues for when and how long to breastfeed, and enjoy this special time together! times and temperatures for breast milk.
• Help your baby adjust to taking breast milk from a bottle shortly before you return to work. Thawed breast milk Room temperature Small cooler Refrigerator Freezer
• Talk with your family and your childcare provider about your progress, questions, and intent to continue at room temperature 60-85°F with an ice-pack 30°F or colder 0°F or colder
breastfeeding, and let them know you are counting on their support and help.
Use within Use within Use within Use within Use within
18 Adapted from the U.S. Department of Health and Human Services,“The Business Case for Breastfeeding: Employees’ Guide 1-2 hours 3-4 hours 24 hours 3 days 6 months 19
to Breastfeeding and Working” www.womenshealth.gov/breastfeeding/government-in-action/business-case-for-breastfeedingYou can also read
