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Midwives offer care alternative for women at all stages of life

Joanne Burris, APRN, CNM

In honor of National Midwifery Week, we asked certified nurse midwife Joanne Burris of the UK Midwife Clinic a few questions about midwifery as well as the care and services offered at the UK Midwife Clinic.

UK HealthCare is proud to work in collaboration with the midwives at the UK Midwife Clinic. The partnership began this spring as the clinic, formerly Womankind Midwives, merged with UK HealthCare to promote positive health experiences for women and provide more opportunities for research and exceptional, compassionate care.

What kind of training do midwives go through?

There are several different types of midwives, but all of the midwives at UK are certified nurse midwives. This means our midwives have attended nursing school to earn their registered nurse (RN) license as well as graduate school to earn a Master of Science in Nursing (MSN) specializing in midwifery. Additionally, CNMs must pass a national board exam after earning their master’s degree. They are then called advanced practice registered nurses, or APRNs.

What kind of services can a midwife provide?

From the American College of Nurse-Midwives (ACNM): Midwifery as practiced by certified nurse midwives (CNMs) encompasses a full range of primary health care services for women from adolescence to beyond menopause. These services include primary care, gynecologic and family planning services, preconception care, and care during pregnancy, childbirth and the postpartum period.

How is the midwife approach to care different than that of a traditional obstetrician?

Certified nurse midwives are experts in normal pregnancy. We care for healthy, low-risk women. One of the hallmarks of midwifery is refraining from intervention in the absence of complications, so we value allowing nature to take its course when things are going well.

A physician is an expert in pathology and we are grateful for our collaborative relationships with OBs when our patients present with risk factors.

Can I deliver at a hospital if I use a midwife?

Absolutely! According to the ACNM, 94 percent of CNMs attend births in hospitals. All of UK’s midwives attend births only at UK Albert B. Chandler Hospital.

Can my midwife prescribe any medications that I may need?

With the exception of some controlled substances, midwives with the proper certification can prescribe most medications.

Who should seek midwifery care?

Midwives are experts in low-risk, healthy pregnancies. Women who have known high-risk factors would be better served by an obstetrician.

What’s a doula, and do we have them as part of our UK midwifery practice?

A doula provides continuous non-clinical support to women during their birth. They offer education, physical and emotional support, and advocacy. They should not offer medical advice, perform clinical exams or speak for the patient. We do not have doulas as a part of the UK Midwife Clinic staff, but some insurance policies will cover the cost of a doula and we encourage our patients to use them.


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benefits of breastfeeding

Breastfeeding gives your baby the best possible start

Did you know that breastfeeding is a healthy choice for both mom and baby?

Celebrate National Breastfeeding Month by learning more about breastfeeding’s benefits. Breastfeeding provides warmth and closeness, and the physical contact helps create a special bond between you and your newborn.

Benefits for babies

  • Breast milk is easier for your baby to digest.
  • It doesn’t need to be prepared.
  • It’s always available.
  • It has all the nutrients, calories and fluids your baby needs to be healthy.
  • It has growth factors that ensure the best development of your baby’s organs.
  • It has many substances that formulas don’t have that protect your baby from diseases and infections. In fact, breastfed babies are less likely to have:
    • Ear infections.
    • Diarrhea.
    • Pneumonia, wheezing and bronchiolitis.
    • Other bacterial and viral infections, such as meningitis.
  • Research also suggests that breastfeeding may help to protect against obesity, diabetes, sudden infant death syndrome (SIDS), asthma, eczema, colitis and some cancers.

Benefits for mothers

  • Breastfeeding releases hormones in your body that promote mothering behavior.
  • It returns your uterus to the size it was before pregnancy more quickly.
  • It burns more calories, which may help you lose the weight you gained during pregnancy.
  • It delays the return of your menstrual period to help keep iron in your body.
  • It provides contraception, but only if these three conditions are met:
    • You are exclusively breastfeeding and not giving your baby any other supplements.
    • It is within the first six months after birth.
    • Your period has not returned.
  • It reduces your risk of ovarian cancer and breast cancer.
  • It keeps your bones strong, which helps protect against bone fractures in older age.

UK HealthCare is Baby-Friendly

At UK HealthCare, we’re committed to ensuring a happy, healthy start for newborns and their mothers. In fact, we’re a Baby-Friendly USA® hospital, which is a prestigious acknowledgment of the top-notch care that we provide.

Baby-Friendly USA is a global initiative sponsored by the World Health Organization and the United Nations Children’s Fund (UNICEF). The initiative encourages hospitals to provide breastfeeding mothers with information, confidence, support and skills necessary to initiate and continue breastfeeding.

Find out more about the Baby-Friendly initiative.


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postpartum depression

If ‘baby blues’ persist or worsen, it’s time to talk to your doctor

From sleep deprivation to learning how to breastfeed, you face a lot of challenges as the mother of a newborn.

As you adjust to these challenges, it’s not uncommon to experience mood changes or feelings of sadness. These “baby blues” will often go away after a few weeks.

Sometimes, though, mothers of infants can develop symptoms that are more severe and last longer than baby blues. This is known as postpartum depression. One study has shown as many as one in every seven mothers of newborns suffer from this debilitating condition.

Luckily, most women find that treatment helps.

What is postpartum depression?

Postpartum depression can start at any time during your baby’s first year. Usually, you’ll start to feel its effects during the first three weeks after birth.

You might feel sad, hopeless or guilty because you may not feel like bonding with or caring for your baby.

Postpartum depression doesn’t just affect first-time moms, either. You can experience it even if you didn’t have it with your previous children.

Why does it happen?

There are many causes of postpartum depression, including:

  • Hormone levels. Your hormone levels increase when you’re pregnant. After your baby arrives, they drop suddenly. This quick change can trigger depression in some women.
  • A history of depression. If you’ve previously had depression or if it runs in your family, you may be more susceptible to postpartum depression.
  • Other stress and problems. If you didn’t want to be pregnant or if your partner and family aren’t helping you care for your baby, you’re more likely to become depressed as a new mom. Postpartum depression is also more common among women with other stresses such as financial issues, problems with drugs or alcohol, or relationship troubles.

Symptoms

Postpartum depression varies among women, but here are some of the most common symptoms:

  • Sadness, loss of hope or despair.
  • Feeling unable to care for your baby or do basic chores.
  • Crying a lot, sometimes for no obvious reason.
  • Trouble bonding with or feeling close to your baby.
  • Less interest in other things you used to enjoy.
  • Too much sleep.
  • Trouble with focus, learning or memory.

Diagnosis and treatment

Only a doctor can diagnose you with postpartum depression. But if you think you have it, make an appointment right away. There are treatments that will get you back to feeling like yourself. They include:

  • Medication. Your doctor might decide to prescribe you antidepressants. If you’re nursing, be sure and tell your doctor. He or she can prescribe an antidepressant that is safe for nursing mothers.
  • Counseling. Talking to a psychologist or therapist can also help. You can learn ways to recognize when you’re having negative thoughts so you know how to better deal with them.

Postpartum psychosis

Postpartum psychosis is a rare and serious form of mental illness that can happen with postpartum depression. Symptoms often begin during the first two weeks after your baby is born and are more severe than those for postpartum depression. They include:

  • Frequent crying and irritability.
  • Lack of energy.
  • Trouble concentrating and making decisions or confusion.
  • Inability to sleep.
  • Feeling hopeless.
  • Lack of interest in eating.
  • Thoughts of harming yourself or your baby.

Postpartum psychosis is a medical emergency. If you think you might be experiencing symptoms of postpartum psychosis, call your doctor immediately.


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Empowering those in our community affected by Down syndrome

Written by Traci Brewer, executive director of the Down Syndrome Association of Central Kentucky (DSACK). UK HealthCare is proud to support DSACK and many other community organizations.

Today, March 21, is World Down Syndrome Day. Why? Because it’s 3/21, and people with Down syndrome have three copies of the 21st chromosome. That means they have 47 chromosomes instead of the typical 46, so we like to say they have a little something extra.

A lot has changed over the years for people with Down syndrome and for those who help care for them. As recently as the 1980s, individuals with Down syndrome had an average life expectancy of 25. Today, thanks to better medical treatments and screening, people with Down syndrome can live well into their 60s.

Education has also changed dramatically. As recently as the 1980s, families were told to institutionalize their loved ones with Down syndrome because they would never be able to read, write, talk, or contribute anything of value to their family or society. Today, right here in Kentucky, people with Down syndrome are attending college, working in meaningful jobs, driving, dating, volunteering in their communities and living productive, meaningful lives.

Organizations such as the Down Syndrome Association of Central Kentucky provide support for new families and empower self-advocates and their families by providing important information such as early math and literacy learning, financial planning, Individualized Education Plans consulting, career planning, and much more. One of our most exciting initiatives is We Work!, a multiphase program for students age 15 and older that teaches job skills, leadership skills, how to explore career opportunities and how to serve as peer mentors.

Recently someone said that DSACK has a great story to tell and many more chapters to be written. We still have more milestones to reach, more bridges to cross and many more chapters to write. You can learn more about us by visiting our website at www.dsack.org and by visiting our Facebook page, the Down Syndrome Association of Central Kentucky.


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Whether planning for a baby or entering menopause, every woman deserves a healthcare provider who respects her values, preferences and personal goals.

Certified nurse midwives partner with women for better health

JoAnne Burris, APRN, CNM

Written by JoAnne Burris, advanced practice certified nurse and certified nurse midwife at UK HealthCare.

Whether planning for a baby or entering the stages of menopause, every woman deserves a healthcare provider who respects her values, preferences and personal goals.

The certified nurse midwife offers a range of medical services and expertise to support women throughout the female reproductive lifespan, not just through pregnancy and birth. Firmly grounded in evidence-based science, the certified nurse midwife is trained to put the patient at the center of her healthcare decision-making.

Some pregnant women believe choosing a nurse midwife for prenatal and postnatal care means forgoing the comforts of modern medicine. Nurse midwives are frequently associated with home birth, but according to the American College of Nurse Midwives, 94 percent of nurse midwives in the U.S. attend births in hospitals. Nurse midwives support birth according to the preferences of the mother, whether she desires an epidural or unmedicated birth.

What makes nurse midwifery unique

From supporting a woman during delivery to providing primary care, nurse midwives can be found throughout the spectrum of women’s healthcare. There are a few distinguishing features of midwifery that every prospective patient should consider.

  • Emphasis on education. Nurse midwives counsel patients on a variety of health topics, from contraception to nutrition to breastfeeding. Rather than giving advice, the nurse midwife offers reliable information and encourages women to make individualized decisions. Consistent with this philosophy, patients acquire knowledge so they can make informed decisions and feel confident about their care.
  • Partnership. Nurse midwifery services are provided in partnership with women and their families in order to empower women to determine their individualized journeys to motherhood. In addition to working in partnership with women, they work in close collaboration with obstetricians, anesthesiologists and neonatologists as a part of an integrated healthcare team.
  • Birth is normal. For healthy, low-risk women, interventions during birth are usually unnecessary. A hallmark of nurse midwifery care is non-intervention in the absence of complications. While nurse midwives are experts in normal birth, they are highly trained to detect complications and will collaborate with physicians when necessary.
  • Founded on evidence-based science. Certified nurse midwives are registered nurses who have earned a master’s of science in nursing with an additional certification in midwifery. They are licensed professionals capable of attending births, writing prescriptions, conducting annual exams and providing birth control counseling as a part of their wide spectrum of healthcare services.

Nurse midwives empower women to take control of their health and birth experience. This sense of control can be a positive influence on the entire family unit. Midwifery is a beautiful healthcare partnership designed to help women realize their potential to be a force for optimal health and wellness.

If you are interested in nurse midwife services, talk to your OB-GYN.


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Being proactive about teen pregnancy prevention, education

Jennifer Coffaro

Jennifer Coffaro

Written by Jennifer Coffaro, PA-C, advanced practice provider at UK Adolescent Medicine and the Young Parents Program. This post is part of a series written by Dr. Hatim Omar and his team in Adolescent Medicine related to the unique health concerns faced by teens and young adults.

Teen pregnancy rates have dropped to historic lows in the United States, but compared to other developed countries, our rates remain high. Regardless of why this is, teen pregnancy continues to be a public health concern.

Concerning trends

Teen pregnancy rates are higher in minorities, particularly African-American and Hispanic populations. Low education levels and low household incomes are associated with increased risk of teenage pregnancies.

Young people born to teen parents are more likely to become teen parents themselves, and current teen mothers are at greater risk for repeat teen births. Young women in foster care are twice as likely to be a pregnant teen.

In Kentucky, nearly half of all high school students are sexually active. However, only about 40 percent of these students use hormonal birth control and only 40 percent use condoms.

Starting a conversation

Sexuality and sexual desire are normal parts of human development. Teens need to be provided with an environment where they are comfortable discussing their sexuality. Ideally, these conversations should happen before teens become sexually active.

It is important for parents and guardians to be willing to discuss abstinence and safe sexual practices with teens. Too often, teenagers look to their peers or the internet for advice, which can be inaccurate. Medical providers are also great resources for teens and parents who may be uncomfortable discussing sex.

How we can help

UK Adolescent Medicine provides contraceptive education and care for teenagers and their families. Our counselors are experts at communicating with adolescents and will work with you and your family to address any concerns you might have related to pregnancy or contraception.

We offer additional resources and information about numerous contraceptive methods that are safe and effective in reducing the risk of pregnancy.

We respect the privacy of teens and their families. You can be sure that all discussions and care are absolutely confidential.


Next steps:

  • The Young Parents Program at UK was created to address the unique health concerns of young parents and their children. Learn more about our program.
  • Read Omar’s post about how UK Adolescent Medicine is helping improve health and well-being for teens and young adults across Kentucky.
5 ways to prevent preterm birth

5 ways to prevent preterm birth

Written by Diana Frankenburger, the childbirth education coordinator for UK HealthCare.

Prematurity and its complications are the leading cause of death in children younger than 5 in the world today. Infants born before 37 weeks gestation have more complications than full-term babies, including problems with feeding and digestion, vision and hearing, and breathing.

Premature report card

Each November, the March of Dimes publishes a Premature Birth Report Card, which grades the U.S. and each state on prematurity rates for the previous year. The goal is to be at 8.1 percent, an objective set by the Healthy People 2020 initiative, a science-based, 10-year program to improve the health of all Americans.

This year, the U.S. has a rate of 9.6 percent, earning a C letter grade. Kentucky’s rate is 10.8 percent, which unfortunately gives our state a D.

Tips to prevent preterm birth

While some risks for premature birth cannot be avoided, there are things you can do to help prevent a preterm birth. Here are a few tips:

  1. Stop smoking, or cut down to less than a half-pack per day. Smoking contributes to preterm birth, and a baby who lives in a house with smokers is also 3.5 times more likely to die of sudden infant death syndrome than a baby who doesn’t.
  2. Avoid alcohol and drugs.
  3. Get prenatal care. Learn more about prenatal care at UK Women’s Health OB-GYN.
  4. Practice oral hygiene and see your dentist. Oral infections can lead to infections that can cause preterm labor.
  5. Practice stress reduction. Be aware of how you are handling stress and get sufficient exercise and rest to help get you ready for your new family member.

Delivering at full term will help your baby be healthier, stronger and avoid the complications that come with preterm birth.


Next steps:

  • Learn more about the UK Birthing Center, the leading facility in Central Kentucky specializing in high-risk pregnancies and deliveries.
  • The Birthing Center also offers a Childbirth Preparation Program, which will help prepare you for the changes that happen during pregnancy, labor, birth and postpartum. Find out more about our class offerings.
Mom Katie Schaftlein bonds with baby Sadie for the first time.

Quintuplets arrive at UK, granting mom a special birthday wish

The smallest of the quintuplets, Sadie, defied her size with her energy, churning her legs inside and out of the womb. Her sister Scarlett, on the other hand, established herself as the calm and docile member of the bunch. And family members have already pinned Lucas, the sole boy in the group, as the sweetheart perhaps a future golfer, his dad speculated.

“They have the same personalities as they did in my belly,” mom Katie Schaftlein said while getting situated for Kangaroo Care bonding with baby Sadie.

Surrounded by her 6-day-old babies in the Kentucky Children’s Hospital Neonatal Intensive Care Unit (NICU), Katie Schaftlein beheld a lifelong dream fulfilled overnight. She always wanted five children, although her husband Lucas thought they might end up with three or four. The couple’s quintuplets arrived as on Katie’s 26th birthday. She delivered five early but healthy babies Sadie, Sofia, Scarlett, Savannah and Lucas at the UK HealthCare Birthing Center before the stroke of midnight on Friday, Nov. 11.

Preparing for quintuplets

The Lexington couple and UK graduates found out early in Katie’s pregnancy that five babies were on the way. They consulted with high-risk obstetrics specialists at UK HealthCare and neonatologists at Kentucky Children’s Hospital in preparation for delivery, with the goal of sustaining the pregnancy through 28-weeks gestation.

An interdisciplinary team of doctors, nurses and therapists from UK Women’s Health, Obstetrics and Gynecology and Kentucky Children’s Hospital coordinated a integrative care plan for the Schaflein quintuplets, whose expected early arrival would require specialty care in the region’s only Level IV Neonatal Intensive Care Unit.

Quintuplets are extremely rare, with the Centers for Disease Control reporting 47 national cases of quintuplets or higher order multiple births in 2014.

On a Friday morning in September, Lucas boarded a flight for a business trip to Japan. As soon as he landed on the other side of the world, he learned Katie, who was 22-weeks pregnant at the time, was admitted to the hospital while he was in flight. He booked a flight back to the U.S. as soon as possible, flying home a couple days later.

“I left her that day and kissed her goodbye, and three four hours later she was in the hospital,” Lucas said.

Five babies in four minutes

Katie remained in the hospital on bed rest for two months before delivering the babies at 29 weeks and five days gestation. Teams of nurses were assigned to each of the five babies upon arrival, and the medical teams made special accommodations to ensure three additional neonatologists were on-call at all times. Five NICU beds were reserved for the Schaftlein quintuplets.

Neonatologists met with the family during inpatient treatment to assess infant development and predict the status of each baby upon arrival. Katie’s ultrasound a day prior to delivery provided the comprehensive medical team with current information on the development status of each baby.

When Sadie’s water broke at 7:30 p.m. on Nov. 11, Dr. Wendy Hansen’s obstetrics team alerted KCH neonatologists to prepare to receive the babies and took Katie into surgery for an emergency caesarian section. The operation started at 11:30 p.m., but all the babies were delivered in time to share a birthday with their mother.

Hansen, who delivered five babies within four minutes, presented each baby to Lucas and Katie before sending the infants to the NICU for precautionary care and respiratory support. Hansen delivered the last baby at 11:56 p.m., a declaration that sent a cheer through the halls of the UK Birthing Center.

“We were worried because we didn’t want them to have two different birthdays,” Katie said. “Everyone cheered, and at that point I was like, ‘Okay, they are out.’”

It takes a team

Dr. Peter Giannone, the chief of the Department of Neonatology at KCH, credits the dedication of the Schaftlein family, as well as collaborative efforts and streamlined communication among obstetricians, nurses, neonatologists and therapists, for a positive outcome for the quintuplets.

The two departments recently formed the Obstetrics, Maternal-Fetal-Medicine, Neonatology, and Infant (OMNI) follow-up care service line, eliminating communication and collaboration barriers common in academic medical systems by coordinating cross-disciplinary efforts and uniting medical teams to enhance family-centered care.

“My biggest memory is the teamwork that everyone showed to pull this off so seamlessly,” Giannone said.

The Schaftlein quintuplets will remain in the hospital for several weeks before they are ready to go home. In the meantime, UK neonatologists will monitor the respiratory strength and development of the babies. Lucas and Katie Schaftlein, as well as family members in Louisville and Lexington, are visiting and bonding with the babies in the NICU.

The couple said they are grateful for the support, dedication and poise of members of their integrative medical team. Katie was put at ease by the calm demonstrated by Hansen as her water broke and delivery was imminent. Several nurses who assisted the family throughout Katie’s hospitalization were present at the delivery to “catch” (or retrieve) each baby to the NICU.

“It came full circle,” Katie said. “Everyone who helped in the beginning was there for the delivery.”


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Media inquiries: Elizabeth Adams, University of Kentucky Public Relations and Marketing, elizabethadams@uky.edu

E-cigarettes are not safe during pregnancy

Written by Kristin Ashford, PhD, WHNP-BC, FAAN, associate professor and assistant dean of research in the UK College of Nursing.

Kristin Ashford, PhD, WHNP-BC, FAAN, is an associate professor and assistant dean of research in the UK College of Nursing.

Kristen Ashford, PhD, WHNP-BC, FAAN

E-cigarettes are increasingly popular, and adult women of childbearing age are the most common users. This is especially true in Kentucky, which has the country’s second highest rate of smoking during pregnancy. Many women try to quit or reduce their smoking while pregnant, and may turn to e-cigs under the belief that they are safer or harmless during pregnancy.

But are e-cigs and other electronic smoking products safe for an unborn child? The short answer is no.

E-cigarettes may be new, but we know they’re harmful

E-cigs and similar products are fairly new, so we are still learning about their full health effects on the body and brain of developing babies, but we do know that e-cigarettes are not safe during pregnancy. Here are the reasons why:

  • Nicotine harms a fetus. E-cigarettes and other electronic smoking products, like vapes, contain nicotine, which we know can cause birth defects and long-term health consequences for the developing brain and body of an unborn child.
  • E-cigs don’t help you quit smoking. Recent research shows that most pregnant women who have used e-cigs end up using both e-cigs and traditional cigarettes (dual use), or relapse back to traditional cigarettes entirely. It is possible that e-cig use could actually increase harm to a fetus as a result of dual use or full relapse.
  • E-cigs contain other harmful chemicals. There is formaldehyde and cancer-causing agents in the cartridges and aerosol (commonly referred to as vapor) of e-cigarettes. A fetus is exposed to these agents if the mother uses e-cigs. E-cigs and similar products were not previously regulated, so it is not always clear what other harmful chemicals they might contain.
  • Secondhand exposure e-cigs is also dangerous during pregnancy. Pregnant women should not be around e-cig aerosol (vapor), just like they should not be around secondhand smoke from traditional cigarettes.

If you are pregnant or might become pregnant and would like to quit smoking or using e-cigs, talk to your nurse midwife, doctor or pregnancy care provider. You can also call the Health Department’s Quit Line, specifically for women who are pregnant or recently had a baby, at 800-784-8669.

At UK, we are conducting a health research study to learn more about the effects of e-cig use during pregnancy. If you are in your first trimester of pregnancy and have used cigarettes or e-cigs in the last three months, we invite you to participate. All information is kept confidential. To learn more, call our research team at 859-333-1572 or visit our website.


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5 benefits of breastfeeding

5 benefits of breastfeeding

Breastfeeding is a natural way for mothers to bond with their new baby and provide the vital nutrition the baby needs.

Celebrate World Breastfeeding Week this week by learning more about breastfeeding’s benefits.

  1. Breastfeeding has preventive power. Research has shown that breastfeeding can help prevent allergies, asthma, diabetes, ear infections, childhood obesity, leukemia and even sudden infant death syndrome. Your first milk, colostrum, provides your baby with all your immunity to diseases.
  2. It creates a special bond. Breastfeeding allows you to have a special bond with your baby. Studies have shown that breastfeeding can improve your child’s neurodevelopment. And the hormones released during breastfeeding have been found to decrease maternal stress and increase bonding.
  3. Breast milk is easy on your baby’s tummy. Breast milk is easier to digest than formula, meaning your baby will have fewer stomach aches and develop fewer food allergies. Breast milk also changes to meet your growing baby’s needs
  4. Breastfeeding is good for you, too. Breastfeeding can decrease your risk of heart disease, diabetes, osteoporosis, postpartum depression and some forms of breast and ovarian cancer. The longer you breast feed, the greater your protection. Plus, you burn an extra 500 calories per day breastfeeding!
  5. Breastfeeding saves you money. Formula, bottles and supplies can cost about $3,000 annually, but breast milk is free. There’s no prep time for breast milk, and it’s always the right temperature.

The Birthing Center at UK HealthCare wants your breastfeeding experience to get off to the right start. Our nursing staff and physicians have received special training to help you begin breastfeeding. We also have lactation consultants who will see you during your hospitalization and the Mommy and Me Clinic, located at the Kentucky Clinic, for assistance after you are discharged.

For more information, visit our breastfeeding support services website or contact your physician or the Childbirth Education Coordinator at 859-323-2750.


Next steps:

  • UK HealthCare is a Baby-Friendly Hospital, which means we offer the highest-quality care for newborns and their mothers, emphasizing mother-baby bonding and successful breastfeeding. Learn more out what it means to be Baby-Friendly.
  • Are you expecting or thinking about having a child? Check out our UK Delivers blog, where our experts discuss topics related to pregnancy and childbirth.