New moms: Protect your posture

By Dr. Heather Dacey
Sentara Therapy Services

At first, when the babies are small, they are easy to carry or put down in order to complete household activities. Safely carrying these little ones means cradled in your arms close to the body or perhaps in a double shoulder carrying pack. While some argue the swaddle sling is best for the baby bonding, if not positioned correctly, this sling can cause significant pain and stress to the low back of the mother as well as increased stress to the baby’s back.

Once the babies get a little more mobile and older, the “new mom posture” really kicks in. The forward shoulders, hunched back, and forward head – all attempts at making dinner while answering the phone and carrying the baby on your hip. Anatomically, this means possible rotator cuff strains, upper and mid back pain, headaches and possible sciatica pain.


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Add Tdap to your mom-to-be to-do list

By: Dr. Holly Puritz
Sentara Leigh Hospital

All pregnant women have to-do lists – find a pediatrician, register for classes, sign up for a hospital tour… Let’s add Tdap to every expectant parents list of things to do before the baby arrives.

Tdap (Tetanus, Diphtheria and Acellular Pertussis) is a safe vaccine that will protect you and pass that protection on to your baby during your pregnancy. Newborns cannot receive many vaccines until 2 -6 months of age but will be protected if you are vaccinated while you are pregnant.

Whooping cough or pertussis (the “P” in Tdap) is a communicable illness that’s on the rise and it can be fatal to newborns. The disease can occur at any age but infants are at highest risk for severe disease and death. That’s the scary news.

The good news? It’s easily preventable with a vaccine that’s safe for pregnant moms after 20 weeks of pregnancy.  All moms to be should be sure to ask their OBs or family doctors about the vaccine – many obstetricians now offer it in their offices.

The next step after you are vaccinated is to make sure close family members also receive the vaccine.  Dads, grandparents, caregivers who will be in close contact with your baby after birth need to be vaccinated. It’s easy and safe – a onetime vaccine is protective.

Local health departments are also offering the vaccine to family members (often at reduced fees) or they can go to their own physicians.  Family members and moms need to receive the vaccine at least two weeks before having contact with your baby.  This creates a safety cocoon of vaccinated caregivers around your baby.

According to ACOG (American College of Obstetricians and Gynecologists): “The vaccine is safe and effective and has not been shown to cause autism or other adverse effects.  All family members who will be in contact with your newborn or ANY infant younger than 12 months of age should be vaccinated.  This helps provide protection for your baby because he or she cannot get this vaccination until 2 months of age.”

So spread the word – the best gift we can give our newborns is a safe and healthy first year and Tdap is one way to do this.  Want more information? Here are some websites that will give you accurate information you can trust:


About the author:

Dr. Holly S. Puritz has been in private practice since 1987 and still loves delivering babies. She graduated from Tufts University School of Medicine and completed a residency in OBGYN at Eastern Virginia Medical School. She is currently the Medical Director for Labor and Delivery at Sentara Leigh Hospital where her group practices. She is involved with the American College of Obstetricians and Gynecologists serving as Chair for the Virginia Section of ACOG 2013-2016 and is a member of ACOG’s Government Affairs Committee. She also serves on the Health Commissioners Task Force for Infant Mortality in Virginia as well as the Virginia Department of Health Immunization Advisory Committee.

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Should I wake a sleeping baby for a feeding?

By: Cheryl L. Price, PA-C, IBCLC, LCCE
Sentara Pediatric Physicians

All new parents hear the advice from well-meaning family members to never wake a sleeping baby. In the early days and weeks, however, you may need to wake your baby for a feeding.

Babies sleep an average of 15-16 hours a day and need to eat at least 8 times a day. So, a good rule of thumb is to not let your baby go longer than 3 hours from the beginning of one feeding to the beginning of the next. If your baby is eating regularly during the day, and their weight is stable, you may be able to let them have one 4-hour stretch at night without waking them.

Babies do tend to be sleepier during the day in the first few weeks. If your baby is not waking on their own regularly during the day, do wake them.

How to wake your baby:

Babies have two sleep states. They go in and out of light sleep and deep sleep, and it can be very difficult to wake them from a deep sleep. During light sleep, your baby will squirm, make faces, and flutter their eyes – this is a good time to take them out of any blankets, place them skin-to-skin on your bare chest, and get your hands on their bare skin to wake them up. It can also be helpful to sit your baby on your lap for a burp to wake them, or change their diaper. Once they’re awake, they may be more interested in eating. Keep in mind, a baby allowed to sleep for long periods during the day may want to eat all night long!

Won’t they wake on their own if they need to eat?

Not necessarily. A baby who is losing weight may sleep more to conserve energy. A jaundiced baby may also tend to be sleepy and not feeding well.

Babies will usually lose some weight after birth, and may lose more in the first few days after discharge from the hospital. The American Academy of Pediatrics recommends a weight check at the doctor’s office at 3-5 days of age to keep an eye on their weight.

Wake your baby if they’re not waking on their own until at least the 2 week well visit when the weight will be assessed again. If your baby’s weight is appropriate at that point, you will probably be able to let them wake on their own at night.


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Running during pregnancy

By: ExploreHealth Content Team

When you find out you are pregnant, questions flood to your mind about every aspect of life – eating, sleeping, medication, travel and more. But if you are a runner, you find yourself asking many more questions.

Always consult with your doctor or midwife about any questions you may have specific to your own condition and risk factors. Some pregnancy problems will absolutely place restrictions on your activity level. If you suffer from placenta previa, preterm labor, short cervix, preeclampsia, or a growth restricted baby, it’s going to be time-out from running until after your baby arrives.

Generally speaking, if you ran regularly before getting pregnant, it may be okay to continue — as long as you take some precautions if you are having an uncomplicated pregnancy. Women who exercise while pregnant have lower rates of diabetes and preeclampsia, and they are less likely to gain an unhealthy amount of weight.

But pregnancy isn’t the time to start a running routine. Pregnancy is also not the time to start training for a marathon, a triathlon, or any other race.

There are two things pregnant women need to be wary of: overheating (specifically in the first trimester) and falling (in the second and third trimesters).

First Trimester Tips

Follow the usual precautions, such as drinking lots of water before, during, and after your run. Dehydration can decrease blood flow to the uterus and may even cause premature contractions.

Whether you’re pregnant, running can be hard on your knees. During pregnancy, your joints naturally loosen, which may make you more prone to injury. Wear shoes that give your feet plenty of support, especially around the ankles and arches. Over time you may find that your go to running shoes no longer fit as the joints in your feet also loosen.  Invest in a good sports bra to keep your breasts well supported.

The first trimester is when the baby’s major organs are forming, and overheating’s a real issue. If a woman’s core temperature gets too high, it could cause problems with the baby. Instead, train for the marathon of labor by strengthening your abdominal muscles and pelvic floor muscles.

Second trimester tips

Your center of gravity’s shifting as your belly grows, leaving you more vulnerable to slips and falls. For safety, choose to run on flat pavement, such as a track or running path versus running on grass, sand or gravel. Another great option is to walk or run in a swimming pool. The resistance of the water provides a great work-out without the added risk of falling.

Third trimester tips

Be as careful as you’ve been during the first two trimesters. And remember: If you feel too tired to go for a run, listen to your body and take a break. Being sedentary is unhealthy, but pushing yourself too hard is also harmful.

Most pregnant runners find that their jogging pace slows down considerably during the third trimester — a fast walk may be a better choice. As your due date approaches, lower-impact activities like swimming and walking may be more comfortable. Besides brisk walking, swimming and water aerobics are ideal for pregnancy. Water sports carry little chance of physical injury, and water resistance helps tone and strengthen muscles.

Warning signs

Never run to the point of exhaustion or breathlessness. Stop running or jogging immediately and call your doctor or midwife if you have any of the following symptoms:

  • vaginal bleeding
  • difficulty breathing, especially when resting
  • dizziness
  • headache
  • chest pain
  • muscle weakness
  • calf pain or swelling
  • preterm labor (contractions)
  • decreased fetal movement
  • fluid leakage

Running is a great way to maintain your fitness levels during pregnancy — just remember that pregnancy is not the time to try new things or reach for your personal best. A little extra care and caution will help you reach the goal of a healthy mom and baby!

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Never shake your baby

By Dr. Julie Cherry
Children’s Hospital of The King’s Daughters

Having a new baby is a happy time, and also one that can be full of mixed emotions. Even in the best circumstances bringing a baby home changes a family’s schedule with things like sleeping, eating and other activities of daily life.

Did you know that many baby’s go through a period of increased crying that begins at about 2 weeks of age and continues until about 3-4 months of age?

During this phase of a baby’s life they can cry for hours and still be healthy and normal. Taking care of a crying baby can leave parents feeling frustrated, drained, and a little desperate; a normal reaction to a new and sometimes difficult situation. Keeping your emotions in check – staying calm – is important for you and your baby.  No matter how frustrated or upset you become it is so important that you never shake your baby.

Current research shows that crying is the number one reason why babies are shaken. Shaking your baby can result in irritability, poor feeding, vomiting and lethargy to the more serious symptoms of breathing difficulties, seizures, coma, and death.

Shaken Baby Syndrome (SBS) is a form of Abusive Head Trauma (AHT) that occurs when a frustrated caregiver “shakes” or “slams” a child, usually to stop him/her from crying.

Thousands of children each year are victims of this form of abusive head trauma. It is considered a serious crime and a severe form of child abuse.

The best thing that parents and other caretakers can do when faced with a crying baby is stay calm. It may sound simple, but it can be hard to do when you are tired, frustrated, and worried about your baby. It is okay to feel those things; the trick is to not let your feelings shape how you treat your baby.

How to cope with a crying baby:

  1. Check to see that the baby’s basic needs (food, diapering, appropriate clothing, burping, etc.) are met.
  2. Offer the baby a pacifier.
  3. Take the baby for a ride in a stroller or car.
  4. Call a friend, relative, or neighbor.
  5. If a baby’s crying becomes intolerable, put the baby in a safe place such as a crib, swing, or car seat and get yourself away from the baby. Take a break, cool down, and remember that this time will pass.

If you feel yourself getting to a point of frustration or anger where you could potentially hurt your baby, put them down in a safe place and use one of the options listed to get help.

  • Call the Child Help Hotline. Child Help is 24/7 toll free number that you can call and talk to a professionally trained counselor and get help on dealing with your baby’s crying as well as other development topics which you may find frustrating.

 CHILD HELP HOTLINE: 1-800-4-a-child

  • Call your pediatrician
  • Call “9-1-1”


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Are you experiencing post-partum depression?

By: ExploreHealth Content Team

Postpartum Depression (PPD) is the leading complication of pregnancy and occurs in as many as 25 percent of all pregnant women. PPD can occur from a few days up to 18 months after delivery. PPD can be treated and prevented with timely screening and diagnosis.

New mothers experiencing depression say:

  • I’m supposed to be happy….why do I feel so sad?
  • I worry all the time.
  • Why am I such a failure?
  • Everything would be better if I got a good night’s sleep.
  • Why can’t I snap out of it?
  • I want to run away

Signs and symptoms of PPD include:

  • Feeling overwhelmed
  • Anxious
  • Sad
  • Guilty
  • Irritable
  • Hopeless
  • Exhausted but can’t sleep

Complications of this major depressive disorder can lead to altered bonding, cognitive and developmental delays in the newborn that can persist into and through adolescence, negative effects on relationships with family and spouse/significant other that can lead to divorce, suicide, or infanticide.

If you feel that you may be experiencing PPD please call your doctor to discuss your treatment options. Early diagnosis and treatment is important.

Local support groups are available to help you though this time by providing an opportunity to talk with other mothers who have dealt with postpartum depression. A list of support groups is available here.

You may also contact Postpartum Support Virginia at 703-829-7152 or

If you feel as though you are in immediate danger of harming yourself or your baby please reach out to a physician, go to the nearest emergency department or call 911.

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Post-baby fitness: Take your time

By: Melanie A. Butler
Exercise specialist, Sentara Comprehensive Weight Loss Solutions

When losing weight post-baby, take your time! Headlines are inundated with celebrities who lose their post-baby weight within a month or even a just few short weeks after pregnancy. Choosing a quick fix to weight loss doesn’t mean it’s the healthiest choice to successful, long-term weight loss.

It’s very important to receive medical clearance from your OBGYN before beginning any exercise program after having a baby – especially if you have had a C-section. Once you’re approved to start exercising again, take baby steps in your fitness regimen. Your body is healing post-baby and it’s important not to start off doing too much too soon.
Start Walking 

Walking is one of the easiest and best forms of exercise to start doing after pregnancy. Bring your newborn for a walk in the stroller in your neighborhood. Not only will you be able to get some much needed cardio in, but it will allow you to spend quality time with your newborn.  If you can’t get outside due to inclement weather, try mall walking.

The key is to start with low-impact cardio and gradually increase over time. Begin to strengthen your core again with pelvis tilts, bridges, planks and stability ball exercises.

Benefits of Exercise

Exercise not only helps with weight loss after pregnancy, but it also helps with depression, increased energy levels, sleep and stress.

Overcoming Barriers

Every mom experiences barriers and distractions to focusing on their health and fitness. Sleep deprivation kicks in and schedules are inconsistent from day-to-day.

Here are a few tips to overcoming barriers to exercise after pregnancy:

  1. Add short bouts of exercise throughout the day. Take advantage of nap time, even if it’s for 20-30 minutes at a time.
  2. Find a support group. The key to long-term, successful weight loss is support. Connect with other moms or groups that you can exercise with. A support group can help hold you accountable to your daily fitness routine.
  3. Find activities that your baby can join in the workout. Turn your exercise into play with your baby; you won’t even realize you’re working out!


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Losing your post-baby weight – small changes go a long way

By: Katie Abbott
Clinical Registered Dietitian Nutritionist, Sentara Comprehensive Weight Loss Solutions

Post pregnancy, many moms want to get back to their pre-baby bodies. Oftentimes, that’s easier said than done – especially if you have a newborn, multiple kids, and a full-time job.

Small changes go a long way. And you don’t have to spend hours a day at the gym or cook extravagant meals from scratch. Your diet and nutrition are crucial in your weight loss success. When you don’t eat, you have less energy, and it won’t help with weight loss or having energy to exercise either.

Eat breakfast. It will give you the necessary energy to start your day and it will help prevent fatigue.

Don’t skip any meals. With a new baby, many new moms forget to eat or feel like they don’t have time to eat.  Stock up on quick, healthy foods such as; low-fat Greek yogurt, part skim cheese sticks, prepackaged cut-up fruits and vegetables, readymade salads, cooked whole-grains like brown rice, whole-grain unsweetened cereals, whole-wheat bread, and low-fat deli meats.

Eat often and eat enough.  If you are overly hungry, you are likely to binge on sugary foods or foods high in unhealthy fats.

Consume 3 meals per day and 2 snacks, especially if you are breastfeeding. Always choose lean proteins, low-fat dairy, an abundance of vegetables and fruits, and make all your grains, whole-grains. Choose protein rich snacks like a hard-boiled egg, low-fat yogurt, pumpkin seeds, edamame, or hummus.

Drink water. It is not uncommon to mistake thirst for hunger.  When you are breastfeeding, your fluid needs increase significantly.  Make sure you drink a glass of water or an unsweetened beverage every time you breastfeed.  Avoid drinking sugar sweetened beverages such as sodas and fruit drinks.

Talk to your doctor or a dietitian. These experts can help you determine your personal calorie prescription for weight loss. If you are not losing weight or losing weight too slowly, cut back on the calories you are currently eating. The best way to eat fewer calories is to decrease the amount of empty calories you are eating.  Empty calories are the calories from added sugars and solid fats in foods like sodas, desserts, fried foods, whole milk cheeses, whole milk, and fatty meats.  Instead, choose foods that are low-fat, fat-free, unsweetened, or with no added sugars. Limit sweets, sugar, and fat because these foods will limit your success with weight loss.

Losing your post-baby weight is possible if you make these small changes. Choose to make healthy choices for yourself and for your family.

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Baby steps: What to expect during baby’s first year

By: Dr. Hyeon Choi
Sentara Pediatric Physicians

Being a new parent is such a joy! So many precious moments to look forward to – first smile, laugh and, of course, the first time you hear your child call you “mom” or “dad.” But, let’s face it, being a new parent can be a bit scary too! With so many rapid changes and developments, it’s easy to get overwhelmed.

Have no fear. Here is a short timeline of developmental milestones to help guide you through your baby’s first year and put your mind at ease.

At 2 months:
• Smiles responsively, coos and responds to noise
• Holds head up briefly and when on tummy

At 4 months:
• Smiles, laughs and starts to babble
• Holds head up when placed in sitting position
• Starts to roll and uses hands to reach, bat or hold things

At 6 months:
• Lots of babbling!
• Rolls from stomach to back and back to stomach
• Starts to sit without support
• Uses both hands to hold things and may even start transferring things from one hand to another

At 9 months:
• Says “mama” and “dada” nonspecifically with babbling and responds to own name
• Sits up well, likely crawling, starting to pull up to a stand or cruising around furniture
• Transfers items from one hand to another and picks things up between thumb and index finger

At 12 months:
• Says “mama” and “dada” specifically and possibly 1-2 words, understands simple commands
like “no” and continues to babble
• Cruises well and takes steps holding on or may be able to walk independently
• Claps and/or waves


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Navigating the waters: Safety tips for eating fish during pregnancy

By: Phyllis Woodson, MS, RD, CDE
Maternal-Fetal Medicine at EVMS

Pregnancy can be such a confusing time with so many questions about activity, health and eating, and many many opinions offered by helpful friends and family. Lots of myths and “wives tales” abound particularly around food!  It can be difficult to know what are the best choices, particularly if you have a diet rich in fish.

Fish can be a great choice during pregnancy and some fish intake during pregnancy is recommended. Fish is the main dietary source of docosahexaenoic acid (DHA), an omega-3 polyunsaturated fatty acid (n-3 PUFA) that may benefit fetal brain and eye development.  Caution is needed when you are making choices about what fish to eat. Some fish contains mercury at levels that might not be safe for your baby.

The FDA (US Food and Drug Administration) and the EPA (Environmental Protection Agency) have issued guidelines which apply to women who plan to become pregnant, pregnant women, nursing mothers, and children.  When you are pregnant you should avoid raw fish and shellfish (e.g. oysters or clams), any fish from polluted water, and refrigerated smoked seafood (e.g. lox). For more information contact 1-888-SAFEFOOD or visit FDA’s Food Safety website.

Avoid these fish generally having the highest mercury content:

  • Grouper
  • King Mackerel
  • Marlin
  • Orange Roughy
  • Tilefish
  • Shark
  • Swordfish

Fish generally having high mercury content (no more than 4 ounces should be consumed weekly):  

  • Bass saltwater
  • Bluefish
  • Croaker
  • Halibut
  • Lobster (American/Maine)
  • Sea trout
  • Tuna (canned, white Albacore)
  • Tuna (fresh Bluefin, Ahi)

Fish generally having lower mercury content (no more than 9 ounces should be consumed weekly):                     

  • Carp
  • Crab (dungeness, blue and snow)
  • Cod
  • Herring
  • Mahi Mahi
  • Monkfish
  • Perch (freshwater)
  • Skate
  • Snapper
  • Tuna (canned, chunk light)
  • Tuna (fresh Pacific Albacore)

 Fish generally having the lowest mercury content (No more than 12 ounces of fish “low” in mercury should be consumed weekly):

  • Anchovies
  • Butterfish
  • Calamari (squid)
  • Caviar (farmed)
  • Clams
  • Crab (king)
  • Crawfish/crayfish
  • Catfish
  • Flounder
  • Haddock
  • Hake
  • Herring
  • Lobster (spiny/rock)
  • Oysters
  • Perch (ocean)
  • Pollock
  • Sardines
  • Sturgeon (farmed)
  • Scallops
  • Shad
  • Sole
  • Salmon
  • Shrimp
  • Trout (freshwater)
  • Tuna (canned light)
  • Tuna (albacore white–no more than 6 oz per week)
  • Tilapia
  • Whitefish

Fish sticks and fast food fish sandwiches are usually prepared from low mercury fish.

Other food sources of omega-3 fatty acids:

  • Flax seed
  • Canola oil
  • Soybeans
  • Walnuts (black)
  • Olive oil
  • Omega-3 eggs
  • DHA supplemented prenatal vitamins.


References  / Additional Resources


About the author

Phyllis Woodson is a diabetes nutrition specialist with The Strelitz Diabetes Center and Maternal-Fetal Medicine at EVMS. Previous positions: Chief Clinical Dietitian, Director of a county WIC Program, Director of a county Expanded Nutrition and Education Program, Extension Home Economist, and instructor of college courses at community and 4 yr degree academic institutions. Professional activities: Delegate from Virginia to the Academy of Nutrition and Dietetics; former President of the Virginia Dietetic Association, Chair of the 2010 VDA Annual Meeting, Chair of the Chapter President’s Council of the American Association of Diabetes Educators, ex officio member of the BOD of the AADE.

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