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Pregnancy: Miscarriage

Miscarriage is the unplanned end of a pregnancy that occurs before you reach 20 weeks of pregnancy.  According to the March of Dimes, as many as 50% of all pregnancies end in miscarriage — most often before a woman misses a menstrual period or even knows she is pregnant. About 15% of recognized pregnancies will end in a miscarriage.

More than 80% of miscarriages occur within the first three months of pregnancy. Miscarriages are less likely to occur after 20 weeks gestation; these are termed late miscarriages. Symptoms of a miscarriage include:

  • Bleeding which progresses from light to heavy
  • Severe cramps
  • Abdominal pain
  • Fever
  • Weakness
  • Back pain

The causes of miscarriage are not well understood. Most  miscarriages that occur in the first trimester are caused by chromosomal abnormalities in the baby. Chromosomes are tiny structures inside the cells of the body which carry many genes. Genes determine all of a person’s physical attributes, such as sex, hair and eye color, and blood type. Most chromosomal problems occur by chance and are not related to the mother’s or father’s health.

Miscarriages are also caused by a variety of other factors, including:

  • Infection
  • Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents
  • Hormonal problems
  • Uterine abnormalities
  • Incompetent cervix (the cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor)
  • Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs
  • Disorders of the immune system, including lupus
  • Severe kidney disease
  • Congenital heart disease
  • Diabetes that is not controlled
  • Thyroid disease
  • Radiation
  • Certain medications, such as the acne drug Accutane
  • Severe malnutrition

In addition, women may be at increased risk for miscarriage as they get older due to the increased incidence of chromosomal abnormalities.  There is no proof that stress or physical or sexual activity causes miscarriage.

A pelvic exam and/or  an ultrasound may be done to confirm a miscarriage. If the miscarriage is complete and the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilation and curettage (D&C) procedure is performed.  Or as an alternative to a D&C, certain medications can be given to cause your body to expel the contents in the uterus. This option may be more ideal in someone who wants to avoid surgery and whose condition is otherwise stable.

Blood tests, genetic tests, or medication may be necessary if a woman has more than two miscarriages in a row (called repeated miscarriage) to evaluate the cause of repeated miscarriage.  If you’ve had two miscarriages in a row, you should stop trying to conceive and ask your health care provider to perform diagnostic tests to determine the cause of the miscarriages.  Usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal. If a specific problem is identified with testing, then treatment options may be available.

At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. On the other hand, about 1%-2% of women may have repeated miscarriages (three or more).  There are treatments that may improve the chances for a successful pregnancy such as a procedure to close the cervix (called cerclage) to help maintain a viable pregnancy or if your blood type is Rh negative, your doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby as well as any of your future pregnancies. Your obstetrician may recommend treatment with progesterone, a hormone needed for implantation in the uterus.

Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don’t blame yourself for the miscarriage. Counseling is available to help you and your partner cope with the loss. Remember, men grieve too, so it may be helpful to share your feelings of loss, frustration, helpless

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Pregnancy: Common Questions

Can I change the cat litter box?

Cats carry a disease called toxoplasmosis.  In adult humans, it show up as a mild infection of the blood and organs.  If your are infected during pregnancy, the baby’s brain and eyes could be damaged.  To be safe, have someone else change the litter.  If you must handle the cat litter, wear a paper mask over your nose and mouth  and wear gloves and wash your hands afterward.

Can I use a jacuzzi/hot tub or sauna?

Don’t sit in a hot tub or jacuzzi.  A long warm bath is fine, but not in water over 100 degrees Fahrenheit.  A hot bath, which is not uncomfortable or scalding, is a safer way to relax. In a bath much of your upper body will remain out of the water, making you less likely to overheat. Additionally, the water in a bath begins to cool off, as opposed to a hot tub, further reducing any risk of overheating.

For many pregnant women, sitting in a hot tub sounds like a great way to ease muscle aches related to pregnancy. It is important to use caution when choosing a hot tub for relaxation and pain relief. Hot tubs can cause hyperthermia, which is an abnormally high body temperature.

According to the Organization of Teratology Information Services (OTIS), a body temperature of 101º F and above can raise concerns during pregnancy. Some studies have shown an increased risk of birth defects in babies of women who had an increased body temperature during the first trimester of pregnancy.

The American College of Obstetricians and Gynecologists (ACOG) states that becoming overheated in a hot tub is not recommended during pregnancy. ACOG also recommends that pregnant women never let their core body temperature rise above 102.2º F.

Although the specific degree differs, both OTIS and ACOG attest to the concern related to hot tub use during pregnancy.

Hot tubs are often factory programmed to maintain a water temperature of approximately 104º F. It takes only 10-20 minutes in a hot tub to raise your body temperature to 102º F or higher. To maintain a steady temperature, water is circulated and re-circulated through the hot tub to pump out cold water and pump in hot water.

Will working harm my baby?

In most cases, working throughout your pregnancy will not be harmful to your baby.  There may be concerns if your job involves working with chemicals, dangerous machinery of lifting/standing for long periods of time.

As your pregnancy progresses, everyday activities such as sitting and standing can become uncomfortable. Remember to take short, frequent breaks to combat fatigue.  Moving around every few hours can also ease muscle tension and help prevent fluid buildup in your legs and feet.

When sitting, use an adjustable chair with good lower back support  to help make long hours of sitting easier — especially as your weight and posture change. If your chair isn’t adjustable, use a small pillow or cushion to provide extra support for your back. Don’t cross your legs.

If you have to stand for long periods of time, put one of your feet up on a footrest, low stool or box. Switch feet every so often and take frequent breaks. Wear comfortable shoes with good arch support. Consider wearing support hose, too.

Even when you’re lifting something light, proper form can spare your back. Bend at your knees, not your waist. Get a good grip and test the weight of the load; tighten your abdominal muscles and exhale as you lift; lift with your legs, not with your back; carry the load close to your body and hold the load so that you can see where you are going. Avoid twisting your body while lifting.

Certain working conditions might increase your risk of complications during pregnancy — especially if you’re at high risk of preterm labor — including:  exposure to harmful substances. excessive noise, heavy vibrations, such as from large machines or extreme temperatures. If you’re concerned about any of these issues, mention it to your health care provider. Together you can decide if you need to take special precautions or modify your work duties during your pregnancy.

I am breaking out with acne, Why and What can I do about it? 

Pregnancy acne isn’t a special form of acne. Many women simply seem to have trouble with acne during pregnancy. Although it isn’t always clear what causes acne to get worse during pregnancy, the likely culprit for most women is an overproduction of oil (sebum) — which happens when certain hormones go into overdrive.  You have options for treating acne during pregnancy including self-care and medication. To treat pregnancy acne, start with good skin care: Wash acne-prone areas carefully. Be gentle and use a mild cleanser with lukewarm water in the morning and at night. You might also wash your skin after exercising. If you have oily hair, shampoo daily. Be careful to keep hair off your face. Avoid picking, scratching, popping or squeezing acne sores. These habits can cause scarring. Look for cosmetic products like skin care creams, lotions and oils that do not block the pores of the skin which are called noncomedogenic or nonacnegenic products (products that do not contain ingredients known to cause acne breakouts).

Beyond self-care, you might consider medication as a treatment for pregnancy acne. However, any medication that’s applied to your skin or swallowed can enter your bloodstream and affect your baby. As a result, it’s important to exercise caution during pregnancy — even with over-the-counter products.

Options for treating pregnancy acne with medication include erythromycin (Erygel), clindamycin (Cleocin T, Clindagel, others) and azelaic acid (Azelex, Finacea). These medications are typically applied to the skin and are available by prescription. However, opinions about using benzoyl peroxide to treat pregnancy acne are mixed. There’s little research on the safety of benzoyl peroxide during pregnancy, although problems haven’t been reported.

Organization of Teratology Information Services, http://otispregnancy.org/pdf/hyperthermia.pdf

Planning Your Pregnancy and Birth Third Ed. The American College of Obstetrics and Gynecology, CH. 5.

Pregnancy, Childbirth, and the Newborn: The Complete Guide. Simkin, Penny P.T., et al, CH. 5.

Infant Crying

 

 

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All infants cry as a way to communicate.  Crying gives your baby a way to call for help when he/she is hungry or uncomfortable. It helps him/her to relieve tension when sights, sounds or other sensations are too intense.  Your baby is learning how to cope with her/his new environment outside of the womb and it can be stressful.   You may notice that your baby gets fussy at certain times of the day; this kind of fussy crying seems to help babies get rid of excess energy so they can return to a more contented state.

As you and your baby learn more about each other, you may notice that your baby has different cries. You may even be able to identify his/her specific needs by the way he/she cries.  The best way to handle crying is to respond promptly to your baby whenever he/she cries during his/her first months of life.  You cannot spoil a baby by giving her/him attention, and if you promptly answer his/her calls for help, your infant may cry less overall.

When responding to your infants cries, check to see what be the most pressing need first.  Is your baby hungry? is her/his diaper wet or soiled? Is your baby too cold or too hot? Does your baby need to be burped?  Is he/she tired?  Sometimes babies can get overwhelmed from too much activity and need to be consoled.

Here are some things you can do to provide comfort to your crying baby:

  • allow your baby to eat and sleep on demand
  • check diapers often and change as soon as your baby is wet or soiled
  • rock your baby in your arms
  • sing or talk softly to your baby
  • play soft music or recordings of falling rain, wave sounds or play a wind up stuffed animal or mobile
  • take your baby for a ride in the car if possible and be sure to secure your baby in an infant car seat
  • try a warm, soaking bath
  • gently massage your baby’s arms, legs or feet
  • carry your infant against your body in a sling
  • swaddle your baby in a blanket
  • provide sucking opportunities; which can include nursing, offering your own clean, clipped finger or a pacifier
  • keep lights low and noises to a minimum

 

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It is also very important for you to have a plan for when you feel stressed from caring for a new baby.  The more relaxed you are the easier it is for you to console your baby.   Don’t take your baby’s crying personally; your baby is just adjusting to a new world outside of the womb.  Listening to a crying baby can be difficult, but try not to let your frustration turn to anger or panic, as this will most likely increase your baby’s own distress.   No matter how impatient or angry you feel, do not shake your baby.  Shaking an infant can cause brain damage or other serious injury and even death.   Even mild shaking can cause damage.   Your baby depends on you to provide loving and nurturing care; so it is okay for you to ask for help.   Remember no parent is immune to feeling that circumstances are beyond their ability to manage,  plan ahead and develop a list of available support people and keep the list next to your phone.  These people should be people who you know you can count on to be encouraging, understanding, reliable and responsible.  If you find that the stress is becoming to intense for you, set your baby down gently in his/her crib if you think you might be inclined to shake or harm him/her baby and walk into another room to give yourself time to calm down.  If you feel you are beyond your ability to cope, call someone who can come to your home within a few minutes or call the National Parent Hotline 1-855-427-2736. If feelings of loss of control or a desire to harm your baby persist, talk to your obstetrician or family doctor immediately or call any crisis organization to assist you.

 

Bottlefeeding

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Should you feel guilty if you choose not to breastfeed? Absolutely not!   Infant formulas have gotten better and better at matching the ingredients and their proportions to that of human milk.   The most important point to consider is that the less stressed you are the better it will be for both you and your baby.   If you feel that bottle feeding best fits your needs, then it’s the best for meeting your baby’s needs as well.

 

Also, bottlefeeding allows others to help feed and bond with your baby.

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When choosing a formula don’t worry about picking a less expensive brand of formula if finances are a factor. Most formulas are pretty much the same. More expensive does not necessarily mean better.

Avoid low-iron formula.  The American Academy of Pediatrics recommends all babies who aren’t breastfed should be given formula with iron for the first year of their lives. It keeps them from developing low iron levels in their blood (anemia). Most formulas on the market have adequate iron. Just be sure to check that its iron fortified when you buy a formula. There is a lot of evidence that iron deficiency in the first years adversely affects brain development. And side effects from iron (gas, constipation, discomfort) while much discussed, are actually very rare.

There is a misconception by parents that infants fed iron-fortified formulas will have constipation. Mothers often associate iron with constipation from their own experience of taking iron supplements or prenatal vitamins during pregnancy. However, clinical studies found no such association among babies being fed iron-fortified formulas.  It is not unusual for a baby to not pass stool for 2 or 3 days. In addition, it is normal for a baby to grunt or get red in the face when having a bowel movement.

Pick whichever type of formula — powder, concentrate, or ready-to-feed — best suits your needs. There is no nutritional difference between them. You may want to keep in mind that powdered formula is the least expensive, though.  While you’re stocking your nursery with diapers and wipes, think about what type of baby formula you’ll use. Buy enough to last a week or two. You don’t want to get stuck with too much in case the brand you choose doesn’t agree with your baby.

Baby formula is safe. The FDA monitors all these products, and guidelines dictate what can and can’t be added to them. Although formula doesn’t contain everything found in breast milk, it has many vitamins and other nutrients that babies need, as well as calories.  Often while you are still in the hospital after delivery the staff can answer questions you may have about formula’s.

If your baby develops rashes, is colicky or is extremely fussy, make sure to see a pediatrician right away as these may be symptoms of allergy. To manage cow’s milk protein allergy, the American Academy of Pediatrics (AAP) recommends the use of extensively hydrolyzed formulas.  These types of formulas are usually referred to as “predigested” formulas. The protein content of these formulas have been broken down or “predigested”.   It’s also thought these formulas may make it less likely for the baby to develop allergies.  In more extreme cases, completely predigested formula may be required.  Note: Your pediatrician may also prescribe extensively hydrolyzed formulas for your babies for medical reasons other than allergy.  These formulas tend to be more expensive.  Some formulas also contain probiotics, the “good” bacteria that live in the gut and are added to yogurt for adults. Probiotics offer formula-fed babies the same bacteria that are found in breastfed babies, to keep their intestines healthier. Ask your doctor if they’re right for your baby.

The AAP recommends using a premature formula for premature babies to 9 months of age. Using these formulas in premature babies can result in greater length and weight gain compared to the use of standard formulas. Premature formulas are more appropriate for premature babies as they provide more calories, higher levels of protein, vitamins and minerals.

Lactose-free formulas may temporarily be used for babies suffering from acute diarrhea; your pediatrician may temporarily recommend lactose-free or soy formulas (also lactose-free).

When preparing your baby’s formula here are some important steps:

Wash your hands before preparing formula. Use tap water if it’s safe, or bottled water if you’re not sure. You can also use water that you’ve boiled for at least a minute and cooled. If you’re mixing powder or liquid concentrate with water, pay attention to the measurements — they’re important. There’s no need to heat the formula for your baby. Drinking it at room temperature is fine.

Don’t warm formula in the microwave,which heats things unevenly. Instead, place the bottle in a container of warm water for a few minutes, or run it under a hot tap.

Help your baby from swallowing air by tilting the bottle upward, filling the entire nipple with formula.

Your baby should drink the bottle within an hour after you fix it. Throw away any unused formula. Bottles may be mixed ahead of time and stored in the fridge for 24 hours. You can, though, save unused formula that your baby did not sip from for the next feeding.

Talk to your pediatrician about how much your baby should eat and how often. Most infants need 2-4 ounces per feeding, depending on their weight and age. If your baby vomits or has diarrhea often, isn’t gaining weight well, or if you think the formula doesn’t agree with him/her, ask the doctor if you should switch to another type of formula.

 

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Baby Blues and Postpartum Depression

Having a baby is a happy time for most women.  But often some women feel sad, afraid, or moody.   Mood swings after the birth of your baby are not uncommon. But some of the feelings you experience after childbirth may not match how you felt while pregnant and certainly not how you thought you would feel after your girl or boy baby was born.

Baby blues affect about 70-80% of women after the birth of their baby.  Baby blues are the least severe form of postpartum depression.  Many women feel unsure about the transition to motherhood and often don’t even know how to put the thoughts into words.  Becoming a mother can be both exciting and stressful.  So talking about how you are feeling about the changes and challenges of being a new mother are a very positive way to cope with the blues.

About 2-3 days after giving birth or earlier (depending on how your labor went) you may begin to feel anxious and upset.  You may cry for no reason, have trouble sleeping, eating, making choices and question whether or not you can handle caring for your baby.  Other symptoms of the Baby Blues include: irritability, fatigue, restlessness and trouble concentrating. Baby blues may be related to hormonal changes that occur during pregnancy and after your baby is born.  Hormonal changes along with the amount of adjustment that comes along with the birth of your baby such as changes in your normal sleep patterns, disruption in the family routine and emotions you experience with childbirth can all contribute to how you feel. Symptoms of the baby blues usually last from as little as a few minutes to a few hours each day and should lesson and go away within a couple of weeks after delivery.

Taking care of you is the best way to decrease the symptoms of the “baby blues.” There are several different ways that you can care of yourself if you are having the “baby blues.”

First it important to maintain a well-balanced diet and get adequate rest; when your baby is napping, take a nap too. Having a new baby may cause you not to eat correctly; limit the caffeine and junk food which can make mood swings more pronounced.

Keep a journal of your thoughts and feelings.

Take your baby out in the stroller to enjoy fresh air and life outside the confines of your four walls. I used to go to the park and spend time with other mothers who needed to get out of the house; in the winter months I would trek over to the mall. Sometimes just a different view for a short period of time can make a huge difference.

Ask for help–help with meals, other children, getting into a “routine”, or any help that allows you to focus on the joy of having a new baby and not just the pressure of juggling it all.  Take some time to soak in the tub and give yourself a facial.

Don’t expect perfection in the first few weeks. Give yourself time to heal from birth, to adjust to your new “role” and for feeding and sleeping routines to settle in.

There is nothing instinctive about becoming a mother.  No matter how many books you have read or videos you’ve watched or classes you have taken, learning mothering skills takes time and patience.   Bonding with your baby takes time.  Keep in mind, that babies have distinct personalities; some infants are easier to care for than others.  Rather than get angry with your baby, take time to learn about your baby. Remember your baby is adjusting to life outside of your womb.

It is also very important to remember that you are not alone.  If your symptoms last longer than fourteen days it could be an indication of a more serious condition, such as postpartum depression. Be honest with your obstetrician or healthcare provider at all of your follow up appointments. Remember you are not going to shock them with your feelings. They speak with postpartum women all the time and can evaluate how you are doing if you are honest about what you are feeling and thinking. Tell your doctor if you are afraid you might neglect or hurt your baby.  Your doctor can refer you to experts in treating postpartum depression and there are hotlines and support groups available for women with postpartum depression.

 

Breastfeeding Myths and Truths

There are many myths or “old wives tales” about breastfeeding, so this post is going to address some of the myths.   One of the myths is that you cannot get pregnant while breastfeeding.   Working in women’s health for many years now, I have sat across many mothers who find themselves pregnant again while still nursing.  Exclusive breastfeeding may delay ovulation for some women, but it is not 100% effective in preventing pregnancy.  If you do not want to become pregnant use some additional method of birth control such as condoms.  There are other safe and effective methods of birth control that you can use while nursing. Talk to you obstetrician or healthcare provide for details.  If you become pregnant while nursing there is no need to stop nursing. You may find your milk production decreases, but if your baby is already taking other foods, it should not be a problem.

Another myth is that you will not be able to breastfeed if you have had breast surgery (such as breast augmentation or breast reduction).  Mothers who have had breast surgery can breastfeed their babies.  Milk production may be reduced and supplementation may be needed.  It may help to contact a lactation consultant to discuss the best way to successfully breastfeed after breast surgery who will be able to give you tips.  The bottom line is that size and shape of your breast is due to layers of muscle and fat; size has not effect on milk production.

Still another myth is that women with flat or inverted nipples cannot breastfeed.   Definitely not true!  Babies breastfeed on the breast, not the nipple. Although it may be easier for the baby to latch on to the breast  with a prominent nipple, it is possible to nurse your baby.  A lactation consultant can help to get you and your baby off to a good start to help you to nurse your baby.

You may have heard that you shouldn’t nurse if you’re sick, however, continuing to breastfeed while you have a cold or the flu actually helps protect your baby from illness. The germ-fighting antibodies that your body is busy making are transferred to your baby every time he/she nurses. As a result, your baby probably won’t get sick at all, or if he/she does, it will be a milder version of whatever is ailing you.

There are many more but one of the worst myths is that if you don’t nurse, you’re not being a good mom.  Although breastfeeding provides significant health benefits for your baby and you, deciding not to breastfeed–or being unable to breastfeed for whatever reason–doesn’t make you an unfit mother. Feed your baby a formula that you feel good about, and move on. With your love and care, your child will thrive whether she/he dines on breast milk, formula, or some combination of the two.

Many hospitals have lactation nurses or consultants to help with getting you off to a good start so ask for help.  The March of Dimes offers a few videos and additional information to help with feeding your baby.

 

 

 

 

Using a Breast Pump

Using a breast pump is a good way to provide the benefits of breastfeeding when you have to be away from your baby. Pumping will help keep up your milk supply and prevent discomfort and breast engorgement.  There are different types of breast pumps to choose from. They may look confusing at first, but they are easy to use. If you have any problems with pumping, ask for help.  Many healthcare facilities have lactation consultants who can help you learn how to use a breast pump.

  • Read all the instructions that came with your pump. Be sure you know how to put it together and how often you will need to clean and sanitize the parts.
  • Choose a good place to pump. Find a spot that’s clean, comfortable, and private so you can relax. If you’re pumping at work, you may feel more at ease in a room that has a door you can lock.

Things to remember

  • Wash your hands before you touch the breast shield or your breast. Use soap and scrub your hands for 10 to 15 seconds, then rinse well in warm water. Use a clean paper towel to dry your hands completely.
  • Put the pump together. As you put it together, check to see that all parts are clean.
  • Get in the mood.  If you aren’t with your baby, try looking at a photo; often just thinking about your baby will start the let-down reflex.
  • Position the breast shield over your breast. Your nipple should be right in the middle of the shield. You may need to try a few different sizes of breast shield to find one that fits you best.
  • Start pumping with a low level of suction. Increase suction as your milk begins to flow. Some pumps will do this for you.
  • Empty both breasts during each pumping session. After pumping, your breasts should feel soft with no hard areas.

After you have finished pumping

  • Put the milk in a refrigerator or cooler right away. It’s best to use milk as soon as possible after pumping it. If you won’t be using the milk within a few days, you can freeze it. Be sure to store breast milk safely.
  • Take the pump apart and wash well any part that came in contact with your breast or breast milk. Let the parts air-dry.
  • Pumping with an electric pump will probably take 10 to 20 minutes for each breast, but it may take longer. To know when to stop pumping, watch for signs that your breasts are empty.
  • You will feel a tugging when the pump is on, but pumping should not be painful. If it hurts, turn off the pump. Change the position of the breast shield or try a larger breast shield.
  • To keep your milk supply up, try to pump at least every 3 to 4 hours, and breast-feed as often as you can. Talk to a lactation consultant if your milk supply is getting smaller.
  • A painful lump or swollen area in the breast may be a sign of a blocked milk duct or breast infection. Call your doctor if you notice this problem. You may be able to solve the problem on your own by pumping or breast-feeding more often from the breast that has the lump or swelling.

Important information for storing your breast milk!

  • When collecting milk, be sure to store it in clean containers, such as screw cap bottles, hard plastic cups with tight caps, or heavy-duty bags that fit directly into nursery bottles. Avoid using ordinary plastic storage bags or formula bottle bags, as these could easily leak or spill.
  • If delivering breast milk to a child care provider, clearly label the container with your baby’s name and date.
  • Clearly label the milk with the date it was expressed to facilitate using the oldest milk first.
  • Do not add fresh milk to already frozen milk within a storage container. It is best not to mix the two.
  • Do not save milk from a used bottle for use at another feeding.

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Safely thawing breast milk

  • As time permits, thaw frozen breast milk by transferring it to the refrigerator for thawing or by swirling it in a bowl of warm water.
  • Avoid using a microwave oven to thaw or heat bottles of breast milk
    • Microwave ovens do not heat liquids evenly. Uneven heating could easily scald a baby or damage the milk
    • Bottles may explode if left in the microwave too long.
    • Excess heat can destroy the nutrient quality of the expressed milk.
  • Do not re-freeze breast milk once it has been thawed.

Source: American Academy of Pediatrics