We’re happy to report that Giving Birth with Confidence made Babble’s 10 Best Pregnancy/Birth Blogs of 2010! We’ve had an incredible first year in blogging and we owe our success to our readers and knowledgeable writers. Thank you for sharing in our journey… we look forward to continuing to inform, communicate with and support women, fathers and families in 2011.
Key Tips to Keep Breastfeeding Simple
December 28, 2010 4 Comments
Nursing is natural, but it helps to learn as much possible before you start.
Nursing is a natural and simple way to provide nutrients to your newborn. Nature intended your baby to drink breast milk, and your body is perfectly designed to produce it. During pregnancy your body has been preparing for breastfeeding, and colostrum (early breast milk) will be ready and waiting. Right from birth your baby is able to let you know when he is hungry, to attach to the breast, and to suck, swallow and digest milk that meets his specific nutritional needs.
So how does it work? Your baby’s sucking at the breast stimulates milk production, so the more he nurses, the more milk will be available to him. Pacifiers and formula supplements will interfere with this process, especially in the early weeks. Your baby should nurse at least eight to 12 times in 24 hours during the first weeks. (The exception to this is the first 24 hours after birth, when many babies sleep more.) He may nurse in clusters, rather than every 2 hours, and he should nurse until he’s satisfied. This ensures that he receives your hind milk, which is rich in fat and calories. Limiting nursing to 5 or 10 minutes on each side deprives your baby of this important and nutritious food. Let baby finish the first breast before offering the second. Watch your baby, not the clock.
Contrary to what you may have heard, you do not need to drink large amounts of fluid or avoid certain foods* when you’re breastfeeding. Eat and drink to satisfy your thirst and your appetite, but aim to take in about 500 additional calories per day, for a total of about 2,700 calories daily (discuss your personal nutritional needs with your doctor). Most women find nursing helps shed some pregnancy pounds since it burns between 600 and 800 calories a day.
Your baby will let you know when he is ready to nurse, lastly by crying but first with a number of early feeding cues: rapid eye movements under the eyelids, an imitation of sucking, hand-to-mouth gestures and small sounds. If you wait until your baby cries, it may be difficult to help him settle down enough to latch on properly. Keep your baby close, and you’ll learn to spot his hunger cues.
Latching On
It’s instinctual for a newborn to attach to the breast. Studies have shown that a baby placed skin-to-skin on his mother’s chest right after birth can crawl to the breast and latch on. If you hold your baby in the traditional cradle position, he’ll be able to latch on properly when his head is level with your breast, aligned with his body, and he is facing you. You should not have to lean toward him, and he should not have to reach toward you to attach. Wait for your baby to open his mouth wide so that he attaches to the areola, not just the nipple.
Another option is the football hold, where your baby is tucked by your side. Hold him on his side, his nose to your nipple. Place your arm along his back, supporting his shoulders and neck with your fingers and thumb behind his ears. Don’t hold the back of his head; he will instinctively throw it back as he latches on. Be patient and let your baby lead you; don’t rush him or pressure yourself. Remember, he knows how to do this.
As he sucks, watch and listen for his swallowing. This is the ultimate assurance that he is getting milk. Your baby will let you know when he is finished by unlatching or falling asleep; he may not want to nurse on the other breast. If he doesn’t, it will feel full when he is ready to nurse again, so start with that side.
If you pay attention to your baby’s feeding cues, nurse him often and allow him to nurse until he is finished, you can be sure he is getting enough milk. Look for these signs:
- You will notice the change in his sucking: bursts of sucking will be followed by a pause as he swallows. You can also see the neck muscles move as he swallows milk.
- The color of his stool will change from the dark meconium to mustard yellow by day four if he’s getting enough milk. By day six, your baby should have at least six wet diapers and three or more bowel movements in a 24-hour period.
- Your baby should be gaining weight, although it may take 2 to 3 weeks for him to regain his birth weight.
Some babies take a few days or even weeks to breastfeed effortlessly. If yours is not nursing frequently, you are unable to identify swallowing or he is not producing enough wet diapers and bowel movements, contact your health care provider or lactation consultant immediately. Also, keep in mind that it’s common to experience some discomfort during the first few minutes of breastfeeding. However, your nipples shouldn’t hurt throughout the entire feeding. If they do, it’s likely that your baby isn’t latching on properly. If your baby is latched correctly and you’re still experiencing pain after a few minutes, you should seek help. Most breastfeeding problems have simple solutions, but it’s important to get help sooner rather than later. Many pediatricians and hospitals have lactation consultants on staff – and may conduct regular breastfeeding classes. Your local department of health may also have a referral service.
You and your baby were made to breastfeed. Have confidence in yourself and your baby’s ability, and treasure this natural bonding time.
*Alcohol and many prescription and non-prescription drugs pass through your breastmilk to your baby. Consult your health care provider or lactation consultant for information on what is safe. Some women have reported that certain foods they consume cause their babies to have increased gas. If you suspect that is the case, discuss it with your pediatrician or a lactation consultant.
Understanding Postpartum Disorders: An Interview with Jane Honikman
December 23, 2010 5 Comments
A pivotal moment of my life came when I was a new mother suffering from postpartum depression/anxiety: I hit the proverbial wall and had finally gotten treatment. I was laying on a futon on my living room floor with my dear friend Gwen holding my hand. It was the first time in 3 weeks I would sleep. That night, due Gwen’s support, I slept life back into myself. It was the kindest thing anyone had ever done for me. I wasn’t alone. I wasn’t to blame. With help, I would be well again. My darkest days were over. The profound gift given by my friend changed the trajectory of my life. As with many of us who have “been through it” with postpartum depression/anxiety, helping others became a passion—and I discovered Postpartum Support International (PSI):
PSI is a non-profit organization whose mission is to promote awareness, prevention and treatment of mental health issues related to childbearing in every country worldwide. It is the vision of PSI that every woman and family worldwide will have access to information, social support, and informed professional care to deal with mental health issues related to childbearing. PSI promotes this vision through advocacy and collaboration, and by educating and training the professional community and the public. 1-800-944-4PPD
In October, it was my profound honor to meet the founder of PSI, Jane Honikman, M.S. A survivor of postpartum depression, and a tireless advocate for women’s rights, Jane founded PSI in 1987 after twenty years of advocacy in civil rights, feminism, and natural childbirth movements. Jane ran PSI for nearly two decades from her home, with the help of her husband, Terry. To this day, Jane dedicates herself to the rights of all women, and families, to informed health care, treatment, and the ending of stigma regarding maternal mental illness. Not surprisingly, Jane was delighted to do an interview with me for Giving Birth With Confidence. My questions were designed to get Jane’s advice for women today in how they can give birth with confidence, empower themselves with the tools to take care of their emotional health, and address the stigma of motherhood and mental health. To read more of my interview with Jane regarding how professionals can address perinatal mental health please visit: www.scienceandsensibility.com.
How can a woman who may be at risk for depression “give birth with confidence” today?
Jane: Women today can give birth with confidence by being open and honest with themselves, their family members, and their healthcare providers about their emotional health. We know that mental illness runs in families. We also know that a woman’s personal mental health history is vital to her pregnancy, birth and postpartum experience. But the truth is we cannot predict the future. I actually prefer to assume that everyone is “at risk”. Women need to take into account their partner’s emotional history as well. This is not a woman’s issue. It is important to lower one’s expectations about parenthood and to prepare a nurturing home environment. Everyone who surrounds the pregnant woman is part of the picture of having a happy and healthy outcome.
Find out more about emotional health in pregnancy and postpartum: http://www.postpartum.net/Get-the-Facts.aspx
How would you advise pregnant and breastfeeding women to fight stigma today?
Jane: The fight to end stigma begins within one’s own heart. A woman and her partner need to be frank, open, and honest about their own family and personal history of mental illness. My advice is to learn to talk openly about past disappointments, losses, and traumas. It begins with conversations among one’s friends over fears about being pregnant, giving birth, and bringing a baby home. Honesty is disarming. It should set the stage for dialogue. This continues with her health care providers. Whenever I get a chance I speak openly about my own journey through depression and anxiety, it includes telling the truth about my first pregnancy and my story of placing our first born in an adoptive home. It took me twenty five years to find inner peace because I kept that secret. It takes courage to fight stigma.
What do you see as the main causes of stigma regarding mental health for pregnant and breastfeeding women today?
Jane: The causes of stigma include ignorance and denial about the importance of emotional wellbeing of childbearing women. On the community, national and international levels this ignorance is being eliminated through educational awareness campaigns. There is no excuse not be educated about the range of emotional reactions during the perinatal period. Denial is a personal issue and more difficult to confront. It is impossible to know how one’s expectations of motherhood will be met. The mythology that surrounds parenthood is another huge barrier. Taboos need to be openly discussed. Often there are conflicts between the woman and her partner. These need to be discussed. It is difficult to parent alone. Family members should participate in supporting the new family. It is important to have frank and honest conversations about opinions and expectations within the extended family unit during pregnancy and following the arrival of the baby.
Have stigmas changed over time?
Jane: Yes, we have overcome major barriers in the fight against stigma. Awareness has increased tremendously since I first got involved nearly forty years ago. The availability of accurate information, resources and referral networks is responsible for these changes. The media has been our movement’s best friend. For example, there are now free materials from the federal government, healthy start programs include maternal mental health curriculums, and states have active coalitions. Insurance companies have eliminated barriers to receiving and providing mental health coverage. All of the major medical organizations have stepped forward offering educational seminars to their members. The courts now consider mental health history when they encounter a crime. The internet has played an enormous role. Postpartum Support International’s website www.postpartum.net has been a leader in this progress.
How are support groups helpful to a woman with depression or anxiety?
Jane: The role of a support group is to provide a confidential and safe environment for women to share their concerns and experiences. They are surrounded by nonjudgmental listeners. In a support group you’re physically not alone even if your emotional state is fragile. It is the best possible therapy even when you are not depressed or anxious. In one word, it is about friendship. I meet weekly with my girlfriends for breakfast and have done so for nearly thirty years. It is not an “official” support group but it works like one. During my darkest days I always knew I could go and find comfort.
To find a support group near you, please visit http://www.postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators.aspx
What is the worst advice you ever received?
Jane: It wasn’t bad advice, but rather the absence of any. The era in which I was raised gave me strength to help others but not to take care of myself. I kept silent about the most painful part of own experience.
Self-care tips for moms: http://postpartum.net/Get-Help/Living-Self-Care.aspx
What is the best advice you ever received?
Jane: The best advice I received was to get help for myself. Fighting my own denial was a long, slow, and painful process. I am a good example of how deeply stigma reaches into one’s own soul. Even though I had been helping thousands of women and their families I had not confronted my own demon. I knew my options but I wasn’t ready.
To read more about Jane’s personal story: http://janehonikman.com/janesstory.html
Getting help: http://postpartum.net/Get-Help/Support-Resources-Map-Area-Coordinators.aspx
What have been the highlights of your advocacy work in the field of postpartum depression?
Jane: The remarkable growth of Postpartum Support International (PSI) www.postpartum.net makes me smile. We started with a few members thinly spread throughout the world. I operated the PSI office fulltime for seventeen years in my home. During those years I listened to thousands women and their families tell me their stories. My greatest joy is to have someone I have supported, tell me they’re well and now ready to help others. I have traveled the world learning about maternal mental health at conferences and sharing my vision. I have written two books about achieving this goal. It has been a privilege to participate in mental health efforts by local, state, and federal governments. I love to network, linking individuals with resources, and helping to create resources for referrals. It was a highlight in May 2010 to hear the President of American College of Obstetrics and Gynecology Congress speak about his initiative on postpartum depression. On a personal, level I’ve been fortunate to provide postpartum support to my own children. I feel very blessed.
Where is the future of maternal mental health advocacy? Where are you focusing your efforts next?
Jane: The future of maternal mental health advocacy is with peer support, grassroots, community-based, local efforts. Consumers, professionals, and organizations must collaborate to develop postpartum parent support networks in every community. Pregnant and postpartum families need information, resources and a way to meet. They deserve to have friendships that will last a life time. My current focus is to help spread the word about the organization I helped to establish in 1977. Postpartum Education for Parents (PEP) www.pepsb.org is a model that has not been replicated. For over thirty years PEP volunteers have been offering free nonjudgmental emotional support to new parents. I want to see PEP spread around the world. It is an elegant yet simple program rooted in the belief that every new parent deserves emotional support. In the future my focus will be to travel the world inspiring others to join in the effort to make maternal mental health the priority it needs to be in all societies.
Jane Honikman embodies an unwavering, fierce determination to help women suffering from depression/anxiety know that they are not alone. Every woman deserves to know universal messages support not only to get through her darkest days, but to avoid dark days altogether by addressing stigma head-on. If you have questions about depression/anxiety in pregnancy or postpartum, please visit www.postpartum.net; or call the PSI Warm-line at: 1-800-944-4PPD.
You are not alone. You are not to blame. With help, you will be well.
I would like to extend my gratitude to Jane Honikman, M.S., for her contribution to this article, and for her steadfast commitment to women everywhere. Jane…I will pass my heart to you any day. Also, thank you to both Cara Terreri, and Kimmelin Hull for giving me the opportunity to write for their sites, and to Lamaze International for their courage to go where no other birth organization has gone before: maternal mental health.
Jane Honikman, M.S.
Jane Honikman, M.S., is a Parent Support Consultant/ Postpartum Specialist from Santa Barbara, California. In 1977, she co-founded Postpartum Education for Parents (PEP), and became the Executive Director of the Santa Barbara Birth Resource Center in 1984. She founded Postpartum Support International (PSI) in 1987 as a result of hosting the first conference on Women’s Mental Health Following Childbirth held in Santa Barbara. She was PSI’s first President and operated the organization from her home until 2004. Jane has authored many articles and educational materials on postpartum issues and how to start a support group including her books Step by Step (2000) and I’m Listening (2002). She developed a website resource www.janehonikman.com and continues to lecture internationally on the role of social support and the emotional health of families.
Great Expectations: Liz @ 36 Weeks
December 22, 2010 1 Comment
The past week brought another rollercoaster ride of emotions. We saw the perinatologist, and they were unable to do the amniocentesis since there wouldn’t be enough time to get results back before my birth
. As disappointing as that was, the level 2 ultrasound showed no signs of any major defect, reassuring us. We also learned that it is my husband who is affected, and that it’s extremely rare for fathers to pass on the congenital form, like my son has (meaning this baby should be okay). In fact, there are only a handful of other cases on record–nothing like being an anomaly! However, if our wild concoction of DNA created this once, it could happen again, and we’re not really wanting to chance things.
This brings us back to the the hard reality that we need to change our birth plans. We have settled on the hospital where my last baby was born, in the water, completely free of interventions, so I feel confident that we will have a fantastic experience there once again. Our goal is to bring as many elements from our home birth vision into our hospital birth as possible.
The ultrasound also confirmed what I had feared all along–our little nugget is breech! I have plenty of time and plenty of amniotic fluid to get this little guy or gal headed in the right direction, so we have begun “Operation: Flip Baby.” Thus far, I have had accupunture and we’re doing moxibustion twice daily, or as my husband calls it, “Smoking your toes.” I had a fabulous Mayan abdominal massage early in the week, with chiropractic care scheduled. At home, my nightly ritual now includes lots of inversions hanging off whatever piece of furniture is closest, and the children have been having lots of discussions with their sibling about turning around, including somersault demonstrations by my oldest daughter. We are far from exhausting our list of baby turning strategies, and I’m hopeful this little one will get it figured out in the next few weeks!
Birth Day, Your Way
December 21, 2010 Leave a Comment
By Charlotte De Vries
With your body and life changing in profound ways, it isn’t always easy to feel in control as your due date approaches. Creating a birth plan helps you make decisions early on and build confidence before labor and birth. Your plan is a source of strength and inspiration, not a rigid map of what must be done. It isn’t about checklists or completing a form. Every pregnancy and birth is unique, and one plan does not fit all. Sift through information from health care providers, classes, books, friends and family, and get to know your options. Keep an open mind and a peaceful, positive outlook. A plan isn’t any guarantee that your birth will go just as you envision it. Plan for the unexpected. Consider these key factors:
Environment
You probably already know where you’ll have your baby, but you can still shape that environment so it becomes a private, safe space where your voice will be heard and your choices will be respected. Choose a few ground rules, such as closed doors, restrictions on who can come in and out, and a minimum number of machines.
Support Team
Do you want a doula? Will siblings be present? The people who will be with you to offer support during labor and birth should be central to your plan – their job is to make you feel confident, comfortable and safe. Share your desires clearly. Remember that what is obvious to you is not necessarily apparent to them.
Pain Relief
There are many natural ways to cope with the valuable and important pain of labor. Simple measures like walking, movement, massage and aromatherapy are noninvasive with no risk to you or your baby. Remember: Pain is central to the design of birth – it is not an unfortunate side effect. Express how you would like to manage it and consider the natural, safe alternatives to anesthesia. Trust your ability to cope with the pain.
Freedom to Move
Moving around as you wish and choosing your own positions for pushing is important. Make it known if you’d prefer to forgo machines, monitors and drugs.
Meeting Baby
Your early moments with your newborn are just as important as your labor and birth. This is intimate time to connect and bond. If mother and baby are well, hospital routines and procedures can wait. Protect the first moments you meet and marvel at each other as you begin your lives together.
A Woman’s Guide to VBAC: What We Don’t Know
December 17, 2010 1 Comment
This article is part of A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations, a collection of resources that address the most common and pressing questions women may have about their birth choices. View all sections in the guide, including a link to the authors, on theindex page.
By Amy Romano
The NIH Consensus Conference Panel set out to review and publicize the evidence (research) to help women make informed choices between planned VBAC and planned repeat cesarean. Their review revealed that most of the research has focused on short-term outcomes such as bleeding, infection, and length of hospital stay and serious events such as uterine rupture, hysterectomy, and newborn death or serious injury. Much less attention has been given to longer-term outcomes or to the modifiable factors (such as care in pregnancy and labor) that can produce the best health outcomes for mother and baby and make VBAC – or for that matter, repeat cesareans – safer.
The Panel identified ten critical gaps in the evidence, which can be reviewed in full in this section of the Panel’s recommendations: http://consensus.nih.gov/2010/vbacstatement.htm#q6.
This article will take a closer look at several of these gaps, and suggest strategies for making the best choice possible in the absence of good research.
What is the safest way to care for a woman in labor with a scarred uterus? Your likelihood of safely achieving a vaginal birth should you plan a VBAC is affected by some factors that cannot be changed, such as your general health, whether you have had a prior vaginal birth, and the reason for your prior cesarean. But it may also be affected by factors that can be altered by your care providers, your birth setting, your support team, and your choices in labor. Surprisingly, almost no research has been conducted to define the best way to care for women in VBAC labors.
What you can do in the absence of good evidence: Until that research is available, women may need to rely on research about safe practices in any labor, plus some common sense. Try to make choices that keep you and your baby safe and are associated with a higher chance of vaginal birth, such as:
- Use a midwife for your care, or if none is available, choose a doctor with a low cesarean rate and a high VBAC rate.
- Avoid induction of labor unless there is a clear need.
- Plan for excellent labor support, including a doula if possible.
- Walk, move, and change positions in labor as much as possible.
- Plan to use a variety of strategies to cope with pain before considering an epidural, including a tub or shower, position changes, relaxation techniques, and massage or counter-pressure.
- Stay well nourished and hydrated.
- Follow your own urge to push and stay off your back when pushing.
Women without a prior cesarean can also reduce their chance of a c-section by staying home in early labor and having intermittent (periodic) monitoring of the baby’s heartbeat in labor. These recommendations are more controversial for women with prior c-sections. Many care providers, concerned about the small possibility of uterine rupture and their professional liability should it occur, will insist that a woman with a scarred uterus come to the hospital as soon as regular contractions begin and that the fetal heart rate be continuously monitored after hospital admission. There is no evidence that coming to the hospital early in labor is safer than encouraging the woman to experience early labor in their own home, and it is very likely to increase the chance of a cesarean by setting into motion the cascade of interventions and putting you “on the clock.” If you do stay home in early labor, have someone there to give you continuous physical and emotional support and call your care provider if you have any symptoms that concern you.
Continuous electronic fetal monitoring (EFM) increases the chance that a low-risk woman will have a c-section, but no research tells us if the same is true in VBAC labors, nor under which circumstances, if any, continuous EFM improves health outcomes for the baby in VBAC labors. An abnormally slow fetal heart rate is the best indicator that the woman’s uterine scar has ruptured or is about to rupture, and continuous monitoring can detect a slow heart rate quickly. But early diagnosis of a problematic fetal heart rate pattern may not always alter the outcome – some babies may still be injured no matter how early the diagnosis and other babies may be OK even if the diagnosis is delayed. In the absence of conclusive evidence, most care providers will recommend or insist on continuous EFM and many women may feel safer with continuous monitoring. If you have continuous fetal monitoring, ask for cordless (or “telemetry”) monitoring that allows you to move around. Most hospitals have water-proof fetal monitoring equipment so you may be able to use a shower or tub for pain relief even with continuous monitoring.
What are the long-term outcomes for mothers and babies after VBAC, unplanned repeat cesarean, and planned repeat cesarean? Not enough research is available to provide a full picture of the long-term benefits and harms of different birth routes.
By far, most of the evidence from long-term studies or observations favors planned VBAC. Women who plan and achieve a VBAC have the best long-term health, in part because they avoid the known increased risks of placenta accreta, placenta previa, and hysterectomy should they become pregnant again. (These risks are reviewed in this section of the guide.) We have less evidence for other long-term outcomes, but the evidence we do have suggests that planned VBAC may also reduce the likelihood of:
- chronic pain
- subsequent ectopic pregnancy
- stillbirth in a subsequent pregnancy
- infertility
- complications during subsequent abdominal or pelvic surgeries, including surgical adhesions (which may make the surgery and the recovery more difficult), significant bleeding, and injuries to the bladder, ureters, and bowel.
On the other hand, although the overall likelihood of injury to the baby is low whether a woman plans a VBAC or a repeat cesarean, more babies experience brain or nerve injuries during VBAC labors than during planned repeat cesareans, and some of these injuries have long-term consequences. The researchers found no studies that measured the impact of planned VBAC versus planned repeat cesarean on the long-term neurologic development of infants.
The researchers tried to determine if planned repeat cesarean protected pelvic floor strength and function. They found no studies that looked at this issue, and state that the body of literature that suggests that primary (first birth) elective cesarean delivery offers a modest, short-term benefit to the pelvic floor may not apply to women considering repeat cesarean delivery. This is because, unlike a woman considering a cesarean for her first birth, women considering repeat cesareans have had prior pregnancies and may have had prior labors, both of which alter the pelvic floor muscles.
What you can do in the absence of good evidence: It is reasonable to incorporate these findings into your decision-making even though they come from studies that are not as strong as they could be. It is clear that for women who may go on to have more children, a history of multiple cesareans increases risks substantially in subsequent pregnancies. Therefore, you should strongly consider a VBAC if you think there is a chance you might become pregnant again in the future. Even if you do not plan to have more children, you should be aware of risks for future pregnancies. Many women change their mind about becoming pregnant again or decide to carry an unplanned pregnancy.
What approach to decision-making, what care around the time of birth, and which planned mode of birth protect and promote the psychological and emotional wellbeing of mothers, infants, and families? The researchers found no studies that address psychological or emotional outcomes.
What you can do in the absence of good evidence: Even though there is no research specific to women with prior cesareans, research generally suggests that you are the least likely to suffer emotionally or psychologically when you:
- participate actively in your care
- have care providers who are responsive to your needs and desires
- have good emotional support around the time of birth and in the days and weeks after the baby is born.
On the other hand, unexpected serious outcomes, such as death or injury to the baby or a hemorrhage requiring hysterectomy, can cause emotional suffering that can sometimes be debilitating and long-term. Serious outcomes are least likely in women who successfully birth vaginally, so strategies that safely increase the likelihood of vaginal birth in women planning a VBAC may protect emotional and psychological wellbeing as well.
If you experience emotional distress after birth, reach out to support groups in your community or online. Solace for Mothers, the International Cesarean Awareness Network, and Postpartum Progress are great resources.
What is the effect on breastfeeding of VBAC, unplanned repeat cesarean, and planned repeat cesarean? The researchers found no studies that address breastfeeding rates or the likelihood and severity of breastfeeding problems.
What you can do in the absence of good evidence: Be aware that it is very likely that VBAC will increase the ease with which you will be able to breastfeed, since vaginal birth and breastfeeding are part of a biological continuum. In addition, in most settings, cesarean surgery necessitates at least a brief (and sometimes prolonged) separation between mother and baby, which is known to disrupt breastfeeding, and postoperative pain may make early breastfeeding difficult.
Also be aware that with excellent lactation support and patience, breastfeeding difficulties related to cesarean surgery can usually be overcome. Whether you plan a vaginal birth or a repeat cesarean, discuss with your care providers your desire to minimize separation from your baby, including strategies for keeping your baby with you or your partner should you have a cesarean. If possible, give birth in a setting that adheres to the standards of the Baby-Friendly Hospital Initiative.
Taking Care of Baby: Keep it Simple
December 15, 2010 4 Comments
By Carole Anderson Lucia
Taking care of a baby can be less stressful than you fear. Here are the 10 most important things you need to know (including what you don’t need to do).
The prospect of caring for a newborn 24/7 can be daunting, what with the floppy head, shrill cries and sheer mystery of it all. But with time, practice and a common-sense approach, you’ll quickly be a diapering, bathing, burping pro.
1. Breastfeeding is the healthiest way to feed your baby. But it’s not necessarily easy. Lactation has come out of the shadows, and it’s no longer taboo to admit that nursing is difficult for many women. If you find you’re having any problems whatsoever, call a lactation consultant—pronto.
2. You don’t need to bathe your baby every day. In fact, you shouldn’t, as too much water and soap can irritate a newborn’s delicate skin. “Babies are not yet rolling in the mud, so bathing twice a week is usually what I recommend,” says Atlanta pediatrician Jennifer Shu, M.D., co-author of Heading Home With Your Newborn: From Birth to Reality (American Academy of Pediatrics). In the meantime, a sponge bath should do the job if your baby has a particularly messy blowout, or if milk or other crud builds up in the folds of his neck or elsewhere.
3. It’s really important to put your baby to sleep on his back. Since the federal Back to Sleep campaign began 14 years ago, studies have confirmed that back sleeping reduces the risk of sudden infant death syndrome (SIDS) by 50 percent. Place your baby on his back to sleep. Every time. No excuses. And make sure any caregivers do, too, including grandma.
4. Infants are more mobile than you think. Although the average age at which babies roll over is 4 months, it could happen as early as 2 weeks. “The first time your baby rolls over could be off the bed, changing table or couch,” Shu says, “so get in the habit from day one of never leaving him unattended on a raised surface.” Also never put him in a bouncy seat on, say, the kitchen counter—even newborns can jiggle enough to send the seat crashing to the floor.
5. Three out of four car seats are installed incorrectly. You need to become an expert at this, so read your car seat and vehicle manuals thoroughly, take a class if possible, and have your installation inspected by a professional. (For a list of car-seat safety checks nationwide, visit www.usa.safekids.org and click on “find car seat >> check-up events near you.”) “Knowing how to install your baby’s car seat is of paramount importance,” Shu says.
6. You don’t need to change a wet diaper immediately. “Today’s disposables wick away moisture, so your baby will stay dry until the diaper is close to overflowing,” Shu says. (Not that you should let it get this full; this can set the stage for a nasty rash, especially if you’re using cloth diapers.) Use discretion with wet diapers at night, too: Changing your baby can be stimulating and make it difficult for him to get back to sleep. A poopy diaper is another matter, though: Change promptly. Cloth diapers, however, should be changed promptly with both wet and poopy diapers.
7. Your job is to go with the flow. Most newborns have absolutely no eating or sleeping schedules, and trying to impose them will only frustrate you both. But with time, your baby will naturally fall into a routine. “Babies typically establish a sleep routine between the age of 1 and 4 months,” Shu says. “Eating is more predictable: Newborns fall into an eating pattern pretty soon after birth.”
8. Crying is normal. It’s your baby’s only way of expressing himself. This is small comfort at 3 a.m., of course. To soothe your baby, try pediatrician Harvey Karp’s “5 S’s”:
• Swaddle your baby tightly.
• Hold him on his side or stomach.
• Make shushing noises in his ear.
• Make them as loud as the crying.
• Swing him, either in your arms or a swing.
• Let your baby suck.
If this doesn’t work and you become concerned, don’t be shy about calling your pediatrician. “It’s typical for infants to cry for a total of two to three hours over the course of a day,” Shu explains. (It often peaks around your dinnertime.) “But if there’s a change in your baby’s crying pattern and you’re worried, err on the side of caution and seek help. Parents’ hunches are often correct.”
Also keep in mind that babies do outgrow their fussiness. “It usually begins about two weeks after birth and peaks by the age of 6 weeks,” Shu explains. “And it’s usually gone by 3 to 4 months.”
9. It’s OK to walk away. If your baby is screaming inconsolably and you need a break, take 10 seconds or 10 minutes—whatever is required—to compose yourself. Just be sure your baby is safe before doing so. “Babies don’t die from being in a crib or bassinet when you have to walk away,” Shu says. “They die when parents get so overworked that they shake them.”
10. You don’t need to entertain your baby every minute. Whether they’re looking out the window or staring at a light, infants are continually learning. Give your baby the space to discover his world—and don’t feel that you need to bombard him with stimulation; this may only make him fussy. “Any time you spend engaged with your baby is quality time,” Shu explains. “Even if you’re doing something as mundane as going to the grocery store, talk to him and make eye contact as you shop.”
5 Tips for a Strong Relationship: Part 2
December 13, 2010 2 Comments
I hope you had a chance to check out the first 5 tips I shared with you in my last post, Having Kids & Staying in Love: 5 Tips for a Strong Relationship. If not, be sure to take a look and bring them to life in your relationship! Now I’d like to share 5 more tips with you, excerpted from my booklet, 52 Tips for a Magical Marriage After Your Child is Born.
1. Lighten up. The more you laugh the more loving you’ll feel. Laugh at each other. Laugh at yourself. Share it with your partner when you can find the humor underneath the stress.
As simple as this sounds it speaks volumes for maintaining a loving relationship. Although lack of sleep, middle-of-the-night feedings, baby vomit on your clothes, arguing siblings, very little sex, and different parenting philosophies may not seem so funny, you must find a place for
humor.
When my son was 7 months old I was bouncing him around on my shoulders, doing anything I could to get him happy. In the meantime, my husband and I were not talking because of a huge disagreement we were having over something that seemed really important at the time. All of a sudden, during my pacing and bouncing, my beautiful baby boy chose to vomit all over my head, dripping down my face. I let out some sort of primal scream that had my husband come running in to the room. With one look at me, and a now giggling baby, he started laughing hysterically. I stood there quite angry for a moment and then all I could do was laugh, too. The ice was broken.
I got cleaned up and my husband and I were able to resolve our disagreement quite quickly. There’s no doubt in my mind that it was the laughter that brought us back together.
Raising children can be overwhelming. So if you can find the punch line amidst the stress, share it out loud and have a good laugh together. If you can’t see the humor, look harder. Believe me, it’s there.
2. Express any new needs now that you’re a parent. Your needs will change tremendously as a parent. It’s critical that you share with each other what those needs are. These are some needs I’ve learned are quite common for new parents:
- Hearing from your partner that you’re still attractive.
- Needing less physical connection after having a baby on you all day.
- Wanting to socialize less.
- Needing more alone time.
- Needing to have your partner fend more for his or herself.
- Needing more adult conversation.
- Needing to be acknowledged for your contribution to the family.
3. Call to say, “I love you” and surprise your partner. A quick phone call filled with expressions of love reconnects the two of you instantly. Leave love notes with special messages to find during the day. It will make a tough day more pleasant and keep you connected when you’re apart.
4. Respond to the question lovingly. If asked during the call. “How’s your day going?” and it’s been a rough day at home or at work, simply say, “It’s been a challenging day. Your call just made it better. I can’t wait to see you and spend some alone time. I love you for calling.”
As human beings, when we’re having a bad day, we’re quick to complain
to our partner about everything that’s gone wrong. This is not the time for
that. It’s simply about staying lovingly connected in the moment. So put
your frustrations aside and be your partner’s lover.
5. Give an unexpected hug. When asked, “What’s that for?” simply say, “Because you’re the best partner and dad/mother in the world, and we’re lucky to have you.”
Nothing brings your partner more joy than those unsolicited, physical
affections of love and comments of appreciation. And I promise you, as
you do this for your partner, you’ll end up on the receiving end when you
least expect it!
In a couple of weeks I’ll post my final 5 relationship-nurturing tips. For now, I invite you to apply the tips I’ve shared with you in this post and see what a difference they make in your relationship!
Great Expectations: Liz @ 34 Weeks
December 10, 2010 1 Comment
Last week, I attended my last two births as a doula (for now). While it brought a sense of relief, it was also difficult as both ended very differently than the mamas had envisioned. As a birth professional, I see this all the time, and it’s not always a bad thing. I tell families that the one sure thing about birth is that it’s completely unpredictable and it will surprise you. Birth can be easier and shorter or longer and harder than you imagined. It can involve little to no intervention or spiral into a very “medical” event. Therefore, I prepare families to keep an open mind. I remind them that despite the circumstances surrounding their birth, they have the ability to make it a positive experience by creating a comforting environment, finding good support, and being truly informed about all of their options throughout the process. In addition, once they meet that baby, it’s all worth it.
Last week, our family also received devastating news, forcing me to heed my own advice. We learned that my 6-year-old son has a degenerative disorder called myotonic dystrophy. It is genetic, so either my husband or I also have it and there is a 50-50 chance that all of our children, including little nugget, do as well, meaning that he or she could need lots of help at birth. In a moment, the beautiful, calm homebirth that I had been envisioning for months, vanished.
Then I started hearing my own voice in my head. We did some research, got a second opinion, and have decided to have an amniocentesis done. In a couple of weeks, we will know for certain whether or not the baby has myotonic dystrophy. While I never imagined in a million years that I would have this procedure done, it will give us a “known” amongst the array of “unknowns” our family is facing right now. If all is well with the baby, my midwife has given the green light for our homebirth. If not, we will go to the hospital best equipped to help our little nugget. Regardless of the place of birth, I will create the calm environment that I know is best for birth, surround myself with loving support, make truly informed decisions, and ultimately meet this little one that I already love tremendously.
Breastfeeding Tips: Making Work Work for Your Baby
December 8, 2010 1 Comment
By Jeannette Crenshaw, MSN, RN, IBCLC, LCCE, FACCE and Allison Walsh, IBCLC, LCCE, FACCE
Committed to breastfeeding but concerned that going back to work or school might make breastfeeding too hard? Breastfeeding can make it easier to stay connected. With a little planning, you can do it! Here are some simple ideas that have helped other moms:
- Focus on learning to breastfeed and making lots of milk.
- Delay returning to work as long as possible.
- Plan to go back to work part-time at first, if you can.
- Plan to start work at the end of the week, to ease into your new routine.
The Countdown*
Before your baby is born:
- Take a breastfeeding class.
- Talk with your childcare provider and your employer about your plans to continue breastfeeding.
- Consider childcare close to work or school, where you may be able to breastfeed during lunch breaks.
- Choose a healthcare provider for your baby who supports breastfeeding.
- Join a support group for breastfeeding mothers.
Once your baby is born:
- Focus on learning to breastfeed and making lots of milk. (You don’t need to start pumping yet!)
2 weeks before returning to work:
- Rent or buy a double electric pump, if possible.
- Begin pumping and storing milk.
- Have someone else feed the baby with the new feeding method.
- Find clothes that make pumping easier, such as two-piece outfits and tops that button in the front. (Prints hide leaks better than solid colors.)
4-7 days before going back to work:
- Leave your baby with the caregiver for a short practice session.
- Work out an emergency plan for the unexpected, such as a sick child, car trouble, or traffic.
The night before you go back to work:
- Pack your baby’s bag, and a healthy lunch and snack for you.
- Gather your pump, cooler, and milk storage containers.
- Lay out your clothes for work. Pack extra cotton breast pads and extra tops or sweaters in case of leaking.
Going to work:
- Allow enough time so that your morning breastfeeding is relaxed and not rushed.
- Plan ahead for the evening meal. For example, take food from the freezer or place something in a slow cooker.
- Nurse your baby at home and again at the caregiver’s to keep up your milk supply.
- Nurse or pump at work at least 3 times in 8 hours for a young baby.
Picking your baby up from the caregiver:
- Plan to stop and nurse your baby as soon as you get to the caregiver’s.
- Leave the milk you pumped while at work with the caregiver for the next day.
- When you get home, nurse your baby again and enjoy reconnecting.
Every morning:
- Give yourself enough time so that your morning breastfeeding is relaxed.
- Plan ahead for the evening meal.
Did You know?
- Hand washing is the best way to help keep you and your baby well. Wash your hands for 15 seconds before nursing and pumping.
- Your breasts are never empty. Your baby can get milk if you’ve just pumped.
- Try pumping in the morning. Milk volume is greater. (Some women pump on one side while nursing on the other.)
- Three short pumping sessions, about 10 minutes each, are more effective than one long one.
- Gentle massage while pumping may help you pump more milk.
- Start at the lowest suction setting on your pump and increase to a setting that removes milk and feels comfortable. (Pumping shouldn’t hurt.)
- When you and your baby are apart, pump often to maintain your milk supply. Avoid waiting until your breasts feel full.
- Weekends are a great time to enjoy breastfeeding your baby while building your milk supply. Leave pumping and other feeding methods for workdays.
Storing and Using Pumped Breastmilk — A Guide
To Store
- Store breastmilk in a clean, airtight container. Use hard plastic or glass with tight fitting, solid lids or disposable feeding bottle liners or breastmilk storage bags. Leave ¼ of the container empty if you plan to freeze.
- Store it in the coldest part of the freezer, under the icemaker or in a back corner.
- Label the milk with the date and your child’s name. This is important when leaving pumped milk with the caregiver. Expert opinions vary on how long you can safely store breastmilk.**
- Keep fresh breastmilk at room temperature up to 4-6 hours.
- Keep fresh breastmilk in a cooler with frozen gel packs up to 24 hours.
- Store breastmilk in the refrigerator between 3 to 8 days.**
- Store breastmilk in a refrigerator freezer for 3 to 6 months and in a deep freezer with manual defrost for 6 to 12 months. (A freezer is cold enough to store breastmilk if it keeps ice cream hard.)
To Thaw
- Refrigerator thawed: Place container of frozen breastmilk in the refrigerator to thaw gradually.
- Warm-water “quick” thawed: Place container of frozen breastmilk in a bowl of warm tap water. Once the breastmilk is liquid, use it right away or refrigerate.
- Never microwave! “Hot spots” in the milk may burn your baby and the microwave destroys some of the infection fighting benefits of your milk.
- Keep thawed breastmilk in the coldest part of the refrigerator. For example, the back of the refrigerator is colder than the door. Do not refreeze. Use thawed milk within 24 hours or discard.
To Use After Refrigerating or Thawing
- Warm cold breastmilk by holding container under running warm water or in warm water for a few minutes.
- Gently mix breast milk before feeding because breastmilk components separate when thawing.
- Discard leftover milk if the bottle has been in the baby’s mouth.
To Transport
- Keep breastmilk as cold as possible. Use insulated carriers and reusable frozen gel packs (not ice cubes).
To Clean Your Pumps
- Rinse pieces that came in contact with breastmilk with cool water.
- Wash pieces with warm soapy water, rinse, and air dry on a clean towel or wash pieces in the dishwasher.
*You will need to adapt this schedule if you work or go to school at night.
**This information should be considered a supplement to, and not a substitute for, care by a health care provider.
Ask our resident obstetrical expert, Henci Goer, any question you have about conception, pregnancy, birth, and newborns. 
