These truly alarming numbers are why during Black History Month and beyond the nurses of AWHONN want healthcare providers and moms alike to learn and share post-birth warning signs that have been shown to help new moms and their caregivers recognize potential problems and get the help they need—perhaps even saving their lives.

AWHONN has created specific instructions for acting on these warning signs called “SAVE YOUR LIFE: Get Care for these POST-BIRTH Warning Signs.” Here are the specific signs women should watch for and act on during the first year after birth:

• Pain in your chest
• Obstructed breathing or shortness of breath
• Seizures
• Thoughts of hurting yourself or your baby
• Bleeding that is soaking through one pad/hour, or blood clots the size of an egg or bigger
• Incision that is not healing
• Red or swollen leg that is painful or warm to touch
• Temperature of 100.4 °F or higher
• Headache that does not improve, even after taking medicine, or bad headache with vision changes

If you are experiencing any of these post-birth warning signs, contact your healthcare provider or go to the nearest urgent care or hospital as soon as possible. For serious and potentially life-threatening warning signs like pain in your chest, obstructed breathing, or seizures, or if you have thoughts of hurting yourself or your baby, call 911. Let all responders know that you’ve just given birth within the past year.

Recognizing and acting on these warning signs and complications that can lead to a mom’s death or injury is essential to reducing maternal deaths in the United States. Currently, maternal mortality rates—the number of women dying during or within 1 year of childbirth—are increasing, climbing 27% to 24 maternal deaths per 100,000 births since 2000. In the United States, more than half of all maternal deaths occur after birth—often after discharge from the hospital. This doesn’t have to happen.

For black moms, it’s even bleaker. Black mothers in the United States die during or within 1 year of giving birth at 3-4 times the rate of white mothers. This difference in maternal deaths and injury among black women is a serious issue that needs our action. At least half of all pregnancy-related deaths are preventable when the warning signs of pregnancy or childbirth complications emerge and a mom can get the timely care she needs from her healthcare providers.

Share this information with other nurses and pregnant women you care for so that moms and nurses can work to reduce maternal mortality rates, especially the higher rates among black women. Together, we can help women recognize the signs of a post-birth problem to prevent unnecessary injury or death.

Mary Elizabeth Elkordy is the Communications and Public Relations Manager for the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN).

Have you often thought when you find out a co-worker is working on a graduate degree, “That’s not for me — I don’t have the time or the money and besides I enjoy what I am doing now”? I did not seek a graduate degree until my children were in high school and after beginning; I wish I had started on that journey earlier! Let’s address some of the myths.

• I do not have time in my life right now.
  I delayed a pursuing graduate degree because I thought I would be on campus as much as undergraduate classes require. Many graduate nursing programs offer online and on campus options or a combination. I often advise nurses, just stick your toe in the water and try one class. You can fit the assignments in your life no matter what shift you are currently working. Just trying one class a semester is “doable”

• I am not sure I can afford the tuition
  There are many options-private and public colleges. There are scholarships and some employers offer tuition reimbursement. It is an employee benefit-check it out!

• I have not been in school in years. I am not sure I am smart enough for graduate school.
  I hear this one a lot. You are smart-you are a RN and passed boards! Hands down for most nurses, our first program is the most difficult whether it was a BSN, diploma or AD program. You will be pleasantly surprised that a graduate degree builds on your existing knowledge and you will be encouraged to focus on your specialty area for assignments. You will often be able to combine an assignment with a project you wanted to do at work anyway. Plus for all of us “seasoned” nurses, when we have to use an example from practice, we have years of case studies and examples to use in assignments.

• I really enjoy being at the bedside, I don’t want to do anything different right now
  Great! We need advanced degree nurses using their expertise and practicing evidence based practice in every setting. A graduate degree will open doors that you may not even think about right now. There may be an amazing opportunity that will come your way that requires an advanced degree.

• I am not sure I can keep up with the technology now-discussion boards and on line classes.
  I was not confident either, however if you have middle or high school age children or neighbors, they will enjoy helping you. You will quickly adjust just as you have to EMRs.

I share all these myths because this is what I heard as I was working on my MSN and then a PhD. I began my MSN part time at the age of 50 when I was working about 24 hours a week and had all three children still at home. I did not intend to pursue a doctorate degree, however I became fascinated at the opportunity to influence care through research.

I started on my PhD one year after completing my MSN. I worked full-time during my PhD journey and I completed it within 4 ½ years. To add to the craziness, all three of my children got married during this time. It has now been a year since I graduated and I am an assistant professor at a university. I am able to continue to work occasionally in a clinical setting, conduct research, and teach the next generation of maternal child nurses.  I never would have dreamed that this would be my journey when I began taking that first graduate course. Therefore, if you are considering giving it a try, jump in, the water really is great. There are many others ready to encourage you along the way.

Janet Tucker is an assistant professor at the University of Memphis Loewenberg College of Nursing, where she is currently teaching maternal child nursing. She completed her MSN in 2010 and PhD in 2017. Her research interests are expectant women experiencing a fetal anomaly diagnosis.

AWHONN Resources

With generous support from individual and corporate donors, AWHONN’s Every Woman, Every Baby charitable giving program provides the opportunities to AWHONN members to apply for research grants and project grants who work in continue to improve the health of mothers, babies and their families. Additionally, AWHONN’s commitment to support emerging leaders also provides opportunities to apply to academic scholarships and enhance their professional development through attending AWHONN’s Annual Convention and information of education resources. , For more information on AWHONN scholarships and professional development opportunities visit http://www.awhonn.org/page/awards

When I became pregnant with my first child, I did everything I could to prepare—from research on cribs, bottles, breastfeeding, you name it. Having suffered miscarriages in the past, I was very concerned and anxious about SIDS. I made sure that my daughter’s crib had nothing but the mattress and sheet. I even contemplated buying one of those boards that detects movement and alerts you when a baby stops moving.

Once my daughter was born, she slept in the bassinet in our bedroom. I was still recovering from my cesarean, so my husband was there to help put her in and take her out of her bassinet when it was time to nurse. I was very good about following the safe sleep guidelines, but we would sometimes take naps together while I nursed on my side. I knew in the back of my mind it wasn’t the best option, but we were both able to get rest.

Fast forward 2 years, and my son is born. Again, I was cautious as I prepared for a new baby: I purchased a firm mattress and was sure not to have any toys, bumpers, or blankets in his crib. I told myself I was going to be much better with following safe sleep guidelines than I was with my daughter.

He, too, was born via cesarean, and in the beginning I was very good about not allowing him in bed and always putting him back in his bassinet. When he was about 3 months old, it became harder and harder to follow the guidelines. My son wasn’t sleeping at night, he refused any kind of pacifier (I tried six different brands), and the only thing that soothed him was nursing.

Baby Maxwell in his sleepsuit

Around this time, I returned to my full-time job. I found it easier to nurse him while lying down and returning to sleep. He also seemed to sleep better when he was next to me. I knew it wasn’t right, but I just wanted him to sleep—and I wanted to sleep myself. I tried swaddling, sleep suits, white noise… everything. It’s not supposed to be this hard the second time around, I thought. I’d already been through this; they say the second kid is easier!

When he was about 8 months old, I woke up to a boom and a baby screaming: He had fallen out of the bed, and I felt like the world’s worst mother. Luckily he was ok, but it could have been worse. He could have really gotten injured, or worse, I could have lost him. I knew the rules, I knew that babies were supposed to sleep in their own space, but I ignored them because I wanted my baby to sleep during the night and I was exhausted.

After my son’s fall, I knew something had to change; my son could no longer sleep in my bed at night. I decided to move his crib from our room into another room, and I gave the pacifier another shot. While sleep training hasn’t been successful, he is now taking a pacifier. Instead of bringing him into my bed when he wakes up at night, I offer him his pacifier if it’s before 3 a.m. If he wakes up again, I stay in his room to nurse him and then place him back in his crib. In addition, I had to make the decision to go to sleep earlier to ensure that I got my rest, too.

This got me thinking: What are some ways to help moms follow safe sleep practices after the baby is home? I enlisted the help of nurse Sharon Hitchcock, DNP, RN-C and some fellow moms.

Sharon is an obstetrics nurse and teaches at the University of Arizona. She is quite passionate about the topic of SIDS and safe infant sleep as she now knows why most of these deaths occur and, more importantly, how to prevent them (at least most of them).

She routinely talks about the American Academy of Pediatrics (AAP) safe sleep recommendations to students as well as parents and nurses. She’s also gotten a recent taste of some of the struggles, as she’s the happy grandma of a 9-month-old!

Naomi is mom of 9-month-old Samuel and became a safe sleep advocate long before having her baby. Heidi is almost finished with nursing school and has two kids, 3-month-old Eli and 4-year-old Sophia. Melanie, a mom of three, teaches obstetrics at the University of Arizona and is a childbirth educator at the local hospitals.

I shared with them my struggles of following safe sleep practices with my son and asked several questions about how parents can better follow safe sleep guidelines. Here’s what they had to say:

1. Night feedings can be exhausting, especially when breastfeeding. What are some best practices to help resist the urge to nurse while lying down?  

NAOMI: I resisted the urge to nurse while lying down simply because I didn’t want to bring the baby into bed with me. There were some times when I nursed while sitting up in bed, but I also nursed in a rocking chair in my son’s room, just next to his crib, so I could immediately put him back to bed when he finished eating. I’m a light sleeper and didn’t worry much about falling asleep while feeding him, but I’ve heard it’s a good idea to use a timer, like the one on your phone, if you’re worried about falling asleep.

HEIDI: I was aware of the risks of breastfeeding while lying down from my OB classes in nursing school and had heard the horror stories of parents falling asleep with their infants and accidently suffocating them during their sleep. This was enough to make me take precautions the majority of the time that I was breastfeeding at night. I would feed him in my bed, sitting up, with him in the cross cradle position. I would set alarms just in case I did fall asleep with him, as studies have shown that the longer you are asleep with your infant, the greater the risk of SIDS. If mothers are truly so exhausted that they feel like they need to lie down while nursing, they should remove all pillows and blankets from around the baby and set alarms that will wake them should they fall asleep

2. What are some ways to keep baby warm at night without using blankets?

NAOMI: Our son was born at the end of November, just when it really started to cool down here in southern Arizona. We kept the room warm and comfortable, and he wore footed pajamas.

HEIDI: For both of my children, I used sleep sacks that are available to buy online or in any baby store. They have worked well for me both times. I made sure the house was kept warm enough that they would be comfortable throughout the night.

MELANIE: It is recommended to keep the bedroom at a temperature that is comfortable for a lightly clothed adult. Overheating a baby is very dangerous, as they cannot just push the covers off.

3. The risk of SIDS goes down once a baby turns 6 months—is it okay to bed-share then?

HEIDI: No. The baby can still roll over and suffocate on the softer mattress, pillows, and thick blankets that we have. In addition to the suffocation risks, I believe that getting the baby into a routine of sleeping in their parents’ bed will be one that is hard to break. Neither of my children have been able to sleep in my bed with me, mostly due to my concern for their safety. I am a hard sleeper and would not wake up if I rolled onto them. I also always wanted them to be able to sleep in their own rooms, once old enough.

MELANIE: It is true that most SIDS deaths occur before 6 months, but the infant is still at risk for SIDS until 12 months of age, and adult beds are not designed for infants. Most babies are rolling over by 6 months, and adult beds are usually too soft and have too many blankets and pillows. The other risks include the parents rolling onto the infant or the infant falling out of the bed.

4. My baby has reflux and spits up during the night. Can I place a wedge or pillow in his crib?

HEIDI: No. This is another thing that infants could suffocate on if they rolled over. My son spits up a lot, too, but thankfully I knew from my OB class that it was safer for him to be on his back when he sleeps than on his stomach or wedged if he spits up. A baby is less likely to choke when on their back if they spit up because their airway sits above their esophagus (the tube going to their stomach), making it easier for the fluid to stay away from the airway and easier to swallow.

MELANIE: The AAP recommends that infants are always placed on their backs and not on their sides. Infants are quite good at protecting their airways while on their backs (unless they have a swallowing impairment, which your doctor would tell you). The U.S. FDA has stated that infant sleep positioners are not recommended as there have been several cases of infant deaths from the use of side positioners after the baby rolled to the stomach position or when their face got wedged into the positioner. Keeping the infant upright on a parent’s shoulder for 20–30 minutes after a feeding can decrease reflux.

SHARON: Some parents may think it’s a good idea to elevate the head of the crib to help with the reflux. However, multiple studies have shown this does not help and actually puts the baby at risk for sliding down to the foot of the bed and getting into an unsafe sleeping position.

5. If I nurse while lying down, should I remove everything from my bed in case we fall asleep?  

NAOMI: This is what the newest recommendations advise you to do. Make sure all the blankets, pillows, etc., are moved out of the way, so that in the event you fall asleep, the bed will be a little bit safer.

HEIDI: Absolutely. This is the safest practice if you must nurse while lying down. This is what I did. I also asked my husband to adjust his pillow, and if possible, stay awake with me to ensure that I didn’t fall asleep with the baby. We aren’t perfect, though, and there were a couple of times where we dozed off with him, but fortunately I had alarms set to wake me within 15 minutes of beginning nursing. Once I knew he was full and had a clean diaper on, I set him back down in his crib and went to sleep.

6. Sometimes the baby falls asleep on my chest. It’s recommended that babies sleep on their backs, but since he’s on my chest is it okay?

HEIDI: I believe so, as long as you are rested enough that there is no risk of you falling asleep and you are able to monitor the baby while he is asleep on his tummy. I did this a lot with both of my children during the day and think it is the perfect opportunity for skin-to-skin time.

SHARON: Make sure you can see your baby’s face (to make sure it is not covered or does not become wedged into your breasts) and you are awake and attentive to him.

7. The only way to get my baby to sleep is if I nurse him; when I go to transfer him into his own bed, he wakes up and cries. Is it okay to let him cry it out?

NAOMI: This is a hard topic. There are so many opinions out there, and it’s hard not to get discouraged by all the articles in my Facebook newsfeed that highlight how awful it is to let your baby “cry it out.” It became important for me to consider our circumstances and the fact that every baby is different. I didn’t use the formal “cry-it-out” method for sleep training, but there were, and still are, so many times when I have to let my son cry for a while before he’ll give in and go to sleep. He’s fed. His diaper is clean. He has burped. He’s still crying. He’s not comforted by me holding him close. I’m starting to go a little crazy, and my left ear is ringing from his screams. I know he’s exhausted. What he needs is sleep. It’s okay to place him in his crib and walk away. It’s OKAY to let him cry. I had to learn this early on. It’s made a huge difference.

MELANIE: Crying is a baby’s language and the only way they have to communicate. They cry because they are hungry, tired, uncomfortable, and sometimes just because they are fussy and need to get rid of excess energy. If they have burped and their diaper is clean, you can try to console them with rhythmic noise, music, or gently stroking their head. If the baby is tired, they will usually fall asleep quickly.

Safe sleep is harder than it appears, at least for some of the recommendations. This is an extraordinarily complex topic, and we know it’s hard. In order to keep your baby  as safe as possible, learn  the recommendations, start them at birth, do the best you can, and know that you are not alone in your struggle.

Do you have safe sleep tips/advice you want to share with parents? Share them at www.awhonn.org/SafeSleepTips

Resources

• American Academy of Pediatrics Safe Sleep Recommendations – 2016
• American Academy of Pediatrics Safe Sleep Website
• Healthy Mom&Baby article: What’s New with Infant Safe Sleep
• More health4mom.org resources on safe sleep

References

American Academy of Pediatrics. (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, 138(5), 1–12. doi:10.1542/peds.2016-2938

Centers for Disease Control and Prevention. (2017). Sudden unexpected infant death and sudden infant death syndrome. Retrieved from https://www.cdc.gov/sids/data.htm

Gradisar, M., Jackson, K., Spurrier, N. J., Gibson, J., Whitman, J., Williams, A. S., . . . Kennaway, D. J. (2016). Behavioral interventions for infant sleep problems: A randomized controlled trial. Pediatrics, 137(6), 1–10. doi:10.1542/peds.2015-1486

Hitchcock, S. C. (2017). An update on safe infant sleep. Nursing for Women’s Health, 21(4), 307–311. doi:10.1016/j.nwh.2017.06.007

Moon, R. Y., & Task Force on Sudden Infant Death Syndrome (2016). SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant sleep environment. Pediatrics, 138(5), e1–e29. doi.org:10.1542/peds.2016-2940

Storrs, C. (2016). It’s OK to let your baby cry himself to sleep, study finds. Retrieved from http://www.cnn.com/2016/05/24/health/cry-it-out-sleep-training-ok/index.html

Courtney Duggan is a digital marketing manager in the Washington, D.C. area and is a mother of 2.

What you can easily forget in all the excitement is that you take care of yourself too!

To help you focus on YOU, we recently asked our nurses and midwives what postpartum recovery advice they give their patients.

We received advice for you from over 100 nurses!

Take note of the clear themes – limit visitors to take that time to bond with your new baby, accept help from others, do skin-to-skin and sleep when the baby sleeps!

Good luck in all your new parenting adventures!

Top 20 tips from our nurses and midwives:

1. Absolutely choose a hospital for the care you will receive and not the new beautiful building. You’re much more likely to receive a positive birth experience and the education you receive from your postpartum nurses will make all the difference in the world.
2. As a former postpartum nurse, I noticed how often new mothers put their needs last. It seems often families look at postpartum time as party time. I have seen c-section moms sleeping in the same room as 15-20 family members talking loudly and passing baby around for hours. My best advice is for new mothers to have 1-2 designated family helpers to be there to help care for baby while she gets much needed naps throughout those exhausting first days. Baby’s hunger cues are often missed when there are too many visitors for long stretches of time. It is difficult for new mothers to set limits.
3. Don’t be afraid to ask people to leave. I have seen so many new mothers that are worn out from feeling like they cannot turn people away. Turn off your phone too. I wish I did for the first couple of days.
4. Breastfeeding is an acquired skill for you and baby, be prepared to be patient and try, try again. It is a wonderful thing for you both, but needs to be learned. Do not suffer in silence, please contact your OB/midwife for lactation nurse help/referral if you are having difficulty with latching and/or very sore nipples.
5. Sleep when baby sleeps.

6. If you had a cesarean, take a pillow for the car ride home to support your incision for the bumps in the road.
7. Use the Dermoplast (benzocaine topical) spray before having a bowel movement…it’ll make the process a whole lot more comfortable and a lot less scary.
8. If someone offers to come over so you can shower, take them up on it.  For c-section moms remember not only did you have a baby, but you had major surgery.
9. Trust yourself and your instincts. Pick and choose the advice, tips, expert advice etc. that works for you. And know that if you’re worried about being a good mom, you already are.
10. Padsicle! Pad, ice pack, tucks, then a spray of Dermoplast.
11. Know your body. When you get home, use a hand held mirror to look at your perineum or you cesarean section incision. This way, if you experience problems, you will have a baseline to know if something is different, for example: increased swelling, redness, tenderness, or drainage from incision. It is helpful in knowing when to contact your physician with these issues.
12. Limit your visitors. You will not get this time back. Use it to bond as a family, seek help with breastfeeding. Skin to skin is the best bonding tool! We want to help you succeed with breastfeeding. You can press your call light for every feeding if you need to. Your baby needs your love and protection. You are your baby’s primary advocate. Not all mothers’ choose to or are able to breastfeed. How you feed your baby is your decision and your nurse will support you. Ask visitors to wait until you’ve been home for at least a couple weeks. Settle in, recover. Don’t be afraid to ask for help. If someone wants to visit, ask them to leave their little ones at home.
13. Sleep when the baby sleeps. Keep drinking water to flush out the excess fluids and keep hydrated. Accept help from anyone willing to cook a meal, run errands or do housework so you can rest and spend more time enjoying your new baby. Get outside for a walk. Fresh air and activity help to restore and rejuvenate sleep deprived minds and bodies as well as improve the blues!
14. While planning your new routine, ask someone to watch the baby for an hour of each day for you to spend as you please.
15. Good nutrition is key. Have a healthy snack each time you feed baby if you don’t have an appetite. Try to get a good four hour blocks of sleep several times a week. Ask support people to change, burp, comfort baby and only bring baby to you for breast feeding to extend your sleep when tired. Have a good support system and don’t be afraid to ask them for help. Soak up the sun when you can. Have an enjoyable activity to look forward to each week. Try to get out of the house, but if you can’t do something you enjoy at home or pamper yourself. Relax and enjoy your baby. Use what works for you and don’t try to follow everyone else’s advice.
16. Accept offers of help and assistance with meals, cleaning etc. I tell father’s to give moms one uninterrupted hour to herself each day. She can bathe, sleep, read, or anything that she wants for that hour. Daddy needs time to get to know baby too!
17. When you get home, set visiting hours and have each visitor bring groceries or food (they’ll be thrilled to get what you need). And stay in your pajamas. Most people will be less likely to overstay their welcome.
18. Once “settled” in with the baby reach out to a Mother’s group ( stroller club, baby sitting co-op, Mommy and me Gym or Yoga class), to get out of the house and receive and provide support to other new Mom’s.
19. Give yourself a break. Sit at the bottom of the shower and cry if you need to every now and then, parenting is hard work. Learning to breastfeed is hard work and so is incorporating another member into your family. Sleep deprivation and shifting hormones will, in fact, make you feel crazy at times but it will get better. You will find your new norm. It’s not all cute onesies and hair bows, it’s more like poopy onesies and newborn rashes, and that’s ok.
20. You’re stronger than you think! Don’t worry about what others might think. Enjoy every moment.  Parenthood is a beautiful experience. Allow yourself grace & room to grow.

Do you have advice for new moms as well? If so let us know. We’ll keep rolling out the advice.

For additional resources for mom visit our Healthy Mom&Baby website!