If you've been pregnant and haven't read Ina May Gaskin's Guide to Childbirth, you are missing out! Go to Amazon.com or your local library and start reading. During my last several months of pregnancy I vowed to not watch any television or movies that depicted labor and/or birth (because of the over-dramatization and de-sacredization - is that a word? - of the experience). Instead, I would read one or two of Ina May's birth stories each evening before falling to sleep. These short vignettes offer wonderful inspiration and insight into natural birth. Each story is different and unique, told from the perspective of mother and partner - yet also interestingly similar. Many of the emotions felt during and after natural labor are almost identical. Always, there is a profound sense of awe ... a sense of "I actually just did that!"
I only have one small complaint: accessibility for some readers. The stories all take place on "The Farm" (a commune where Ina May has lived and worked since the 1970's) in a home birth-type setting. I am a firm believer in home birth for low-risk pregnant women ... but they account for only 2% of births in the United States. The majority of births in our country take place in birth centers, or, more commonly, in hospital settings. Additionally, some of the language is a little hard to get past. Phrases like, "I was feeling very psychedelic" or "We were grooving out and tripping together" are everywhere. While most moms I know don't seem to mind the dated descriptions, I've had other moms feel like they just couldn't quite connect.
My goal? An updated book of birth stories. While I firmly believe that every woman has an incredible, unique birth story to share ... I am specifically looking to gather stories of women who labored without pain medications (I am including births where pitocin was given if necessary, or where medical interventions such as cesarean/vacuum extraction were necessary after natural labor did not progress). Our culture is currently full of stories on television and in movies that depict only epidurals, c-sections, and over-dramatized birth scenes. And while those are definitely necessary and important options for many women, I would like to give women something to read that can inspire them in their decision to labor without pain meds. Whether it is at home, in a birth center, or at the hospital ... I hope to collect stories of women who chose natural birth as an option.
Would you be willing to share your story? Do you have a friend or family member that would? Stories will be short (1-2 pages) and can include your partner's point of view as well, if you like. I'd love a photo of you and your little one after birth (or during birth, if you want to share) to go along with the birth story.
If this is something you feel you might be willing to share, please email me at oregonmother@gmail.com and I will send you more detailed information about the project.
Please pass this link along to friends that might be interested!
Shopping for Baby
Tuesday, October 25, 2011
Thursday, October 6, 2011
Breast Cancer Awareness Month
It's been a long time since my last post! We went through several months where Josephine simply wouldn't let me sit and type for longer than 5 minutes at a time - so I took a break from blogging. I also have been focusing my energy on becoming a DONA International Trained Doula - which I successfully accomplished in September. My new website (www.oregonmother.com) should be up and running next week. I will continue posting blogs on this site, as well as reposting them on my new site.
I was asked to write an article for a local newspaper to honor Breast Cancer Awareness Month this October. I am reposting the article here. Because I was limited in word count - and because there is so much information to cover in regard to breast cancer - the article below covers the mere basics. For more detailed information on breast cancer, please visit The National Breast Cancer Foundation or The American Cancer Society.
I was asked to write an article for a local newspaper to honor Breast Cancer Awareness Month this October. I am reposting the article here. Because I was limited in word count - and because there is so much information to cover in regard to breast cancer - the article below covers the mere basics. For more detailed information on breast cancer, please visit The National Breast Cancer Foundation or The American Cancer Society.
If you’ve somehow missed the quirky status updates on Facebook, or all the pink ribbons around town, you might have forgotten why October is so special for over 2.4 million American wome: National Breast Cancer Awareness Month. And those 2.4 million women? Breast cancer survivors.
While we have made great progress in the prevention, diagnosis and treatment of breast cancer over the past several decades, it is still the #2 cause of cancer death in women in the U.S (lung cancer being #1). Roughly 200,000 new cases of breast cancer will be diagnosed this year; nearly 40,000 women will die this year from the disease. (While it is uncommon, men can also get breast cancer and make up about 1% of those diagnosed with the disease.)
While there are still many questions about what may cause breast cancer and how to prevent it, the Willamette Valley Cancer and Research Institute in Oregon suggests that we can at least reduce our risk by making several lifestyle choices:
1. Limit alcohol consumption; it not only reduces your risk of breast cancer, but many other types of cancers, as well. The Center for Disease Control (CDC) states that drinking in moderation equals “one drink per day” (for women).
2. Maintain a healthy body weight (an increased risk of breast cancer has been linked to excessive body weight in postmenopausal women). Not sure if you have a healthy body weight? Talk with your doctor, or use a Body Mass Index (BMI) calculator online.
3. Engage in regular physical activity. Several studies have shown that regular physical activity may decrease your risk of breast cancer. Don’t like to run? Walk. Don’t like to walk? Bike. Or play basketball. Or hopscotch. It doesn’t matter so much as what you do, as long as you are getting your heart pumping and your blood moving.
4. Breastfeed! Nature truly does have a way of knowing what is best not only for baby, but mom as well. If you are pregnant or plan on becoming pregnant in the future, make breastfeeding your baby a top priority. It not only makes for a healthier baby, but can reduce your risk of breast cancer, as well.
While making good lifestyle choices is a great start in reducing your risk of breast cancer, being aware of other risk factors is very important. Know your family history. Did your mother or sister have breast cancer? Starting menstruation at an early age, menopause at a late age, or having children at a later age (or not having them at all) can all increase your risk, as well. It was discovered in the last decade that taking postmenopausal hormones also increases a woman’s risk of breast cancer. The USDA recommends women that must take these hormones use the lowest dose that eases symptoms for the shortest time needed. Age is a well-determined risk factor for breast cancer: the older a woman is, the more likely she is to develop the disease.
We must remember, however, that while many women will present with all of the above risk factors – she may never get breast cancer. At the same time, a woman who stays fit, eats healthy, and follows all the prevention guidelines may still be diagnosed with the disease. Because of this, breast cancer screening is an important step for all women to take.
The American Cancer Society (ACS) suggests all women begin having a yearly mammogram screening at age 40. The ACS suggests that women in their 20s and 30s should have a clinical breast exam performed every 3 years, while women in their 40s and older should have a clinical breast exam performed annually. Women of all ages should know what their breasts look and feel like, and report any changes to their doctor or nurse practitioner immediately. The ACS also notes that some women (due to family history or certain risk factors) may want to begin mammogram screenings at a younger age, or be screened with an MRI in addition to a mammogram. Talk with your care provider if you feel you may fit into this category.
Remember: Early detection means a higher cure rate! The sooner breast cancer can be diagnosed, the better chance we have to cure it. Call your local public health office for information on free or low-cost screenings.
Let’s make this October the month when we dedicate ourselves to getting the screenings we need. Make a special donation to www.nationalbreastcancer.org if you can. Let’s keep up the fight so that our mothers, sisters, daughters, and wives can beat this thing called breast cancer. We’re winning small battles every day … let’s keep fighting to win the war.
Monday, June 6, 2011
Waiting to Cut the Cord
Why there is even a debate over this topic is a testimony to how slow evidence-based practices are to take root in hospitals across the nation. There really is no debate over this matter. Multiple research studies make it very clear: waiting several minutes after birth to cut the umbilical cord of newborns is beneficial to a newborn's health. Unfortunately, medical dogma remains and old habits die hard. And so the debate remains and what should clearly be a standard of practice is still not consistently being observed by midwives and obstetricians across the United States. And so, yet again, it is up the parents to educate themselves on the matter and make sure that their wishes are followed regarding cord clamping following delivery.
So what exactly is cord clamping, and why does it matter when it occurs? More often than not, clamping of the umbilical cord is simply something that new parents see as a ceremonial task that often gets handed over to the father. The cord is clamped, then cut, and a small plastic clamp placed near the newborns belly that will remain for 24 hours or so. Eventually, the stump of the umbilical cord falls off. Simple, right? It's not quite that simple, unfortunately. The umbilical cord is the life-line from baby to mother. In-utero, baby receives oxygen and nutrients from it's mother through the umbilical cord. Deoxygenated and nutrient-depleted blood is then removed from the baby via that same cord. Immediately following birth, blood is still being pumped from the placenta inside the mother into her newborn child. The umbilical cord pulsates with each beat of mom's heart and can easily be felt by simply grasping the cord. Typically, an umbilical cord will pulsate 2-3 minutes after a baby is born. In water births that occur in warm water, pulsation may continue 5 minutes or longer (World Health Organization - WHO). Studies have shown that after 1 minutes of pulsating, 80 ml of blood have been pushed into the newborn. By 3 minutes, this number rises to 100 ml. A baby is typically born with 75 mg/kg of body iron. Waiting just 3 minutes to clamp the cord increase that number to about 115-125 mg/kg. The effects of this are long term. At 6 months of age, babies that received cord clamping after pulsation had stopped had higher levels of iron than babies that had early cord clamping (WHO).
The Cochrane Review summed up their most recent findings regarding cord clamping at follows: “The suggested neonatal benefits associated with this increased placental transfusion include higher haemoglobin levels (Prendiville 1989), additional iron stores and less anaemia later in infancy (Chaparro 2006; WHO 1998b), higher red blood cell flow to vital organs, better cardiopulmonary adaptation, and increased duration of early breastfeeding (Mercer 2001; Mercer 2006). There is growing evidence that delaying cord clamping confers improved iron status in infants up to six months post birth (Chaparro 2006; Mercer 2006; van Rheenen 2004).”
Also being pushed into baby during these few extra precious minutes are those ever-so-precious stem-cells. Stem cells are cells that can develop into other cells. Researcher Paul Sanberg from the University of Florida recently published an article in the Journal of Cellular and Molecular Medicine that concluded that waiting to clamp the umbilical cord could reduce the infant's risk of many illnesses, including "respiratory distress, chronic lung disease, brain hemorrhages, anemia, sepsis and eye disease." Fascinating. Especially since giving vitamin K injections to babies immediately after birth are routinely given to help prevent brain hemorrhages. Vitamin K started being given for this reason during the 1960s. Early clamping of the cord was first suggested in the 1930s (in order to minimize the amount of anesthesia baby would receive from mom's blood) and became routine by the 1960s. While I have not been able to find any studies that could confirm it, I cannot help but wonder if this new technique of early clamping of the umbilical cord lead to a greater risk of brain hemorrhages in infants, which in turn lead to giving vitamin K shots. Is this, yet again, another example when (overall) less medical intervention during birth is actually better?
Humans are the only mammals that severe the umbilical cord of their young so early after birth. Most animals will - after a while - gnaw through the cord to separate the placenta from the newborn. Chimpanzees ignore the cord altogether and allow it to remain attached. After several days, the cord will dry and fall off (as does the stump of the cut cord with all newborns). Several cultures around the world practice this method (commonly referred to as a Lotus Birth). Diaries from pioneers reveal that this method was practiced at times in order to avoid causing an infection when clean instruments and supplies were not available. While leaving the umbilical cord attached for several days does not seem exactly practical, leaving it attached for 3-5 minutes after birth is. The cord will cease pulsating as the last of the blood is pushed into the newborn and a gelatinous substance called Wharton's jelly inside the cord helps it to occlude naturally within 5-10 minutes.
I could find no studies, unfortunately, that addressed premature clamping of the cord when resuscitation was required.
And the downfalls of waiting to clamp and cut the cord? Several studies have suggested that delaying cord clamping may result in a higher incidence of hyperbilirubinemia (jaundice). Other studies do not find this link. Either way, almost all breastfed babies will experience some sort of jaundice during their first 5-10 days of life. It is a very normal part of a baby adapting to the outside world and, when properly managed, is nothing to worry about. Frequent breastfeeding (every 2 hours) and exposure to a little sunlight will help clear almost all babies of this very normal condition. Little Bear had jaundice the first week of her life and was treated with a little light and lots of breast milk! (**Note: Rarely, jaundice can become a life-threatening condition. If yellowing worsens, baby becomes lethargic, or feeding/elimination habits change, contact your physician or midwife immediately.) Yet others suggest that an increase in jaundice may indeed be related to delaying cord clamping only if labor is augmented with the drug pitocin (a drug very commonly used in labor). One of the side-effects of pitocin is jaundice and it makes sense that the more blood that is pushed in from the cord would also mean more pitocin from the the mother is also reaching baby. No studies that I have found have been done to look at pitocin and jaundice rates with cord clamping.
And so there we have it. A myriad of reasons why delaying cord clamping and cutting by 1-3 minutes is beneficial to the health of your baby. The debate, in my opinion, is not a debate at all. Modern science is, yet again, proving what humans have known and practiced for thousands of years. Waiting to cut the cord is best. Premature cutting of the cord is a 50-year old practice that should be left to historical textbooks, just like lobotomies and bloodletting. Unfortunately, this practice still continues. It is up to us as expectant and new parents to insist that this practice is stopped so that our children receive the most health benefits possible from the moment they take their first breath.
So what exactly is cord clamping, and why does it matter when it occurs? More often than not, clamping of the umbilical cord is simply something that new parents see as a ceremonial task that often gets handed over to the father. The cord is clamped, then cut, and a small plastic clamp placed near the newborns belly that will remain for 24 hours or so. Eventually, the stump of the umbilical cord falls off. Simple, right? It's not quite that simple, unfortunately. The umbilical cord is the life-line from baby to mother. In-utero, baby receives oxygen and nutrients from it's mother through the umbilical cord. Deoxygenated and nutrient-depleted blood is then removed from the baby via that same cord. Immediately following birth, blood is still being pumped from the placenta inside the mother into her newborn child. The umbilical cord pulsates with each beat of mom's heart and can easily be felt by simply grasping the cord. Typically, an umbilical cord will pulsate 2-3 minutes after a baby is born. In water births that occur in warm water, pulsation may continue 5 minutes or longer (World Health Organization - WHO). Studies have shown that after 1 minutes of pulsating, 80 ml of blood have been pushed into the newborn. By 3 minutes, this number rises to 100 ml. A baby is typically born with 75 mg/kg of body iron. Waiting just 3 minutes to clamp the cord increase that number to about 115-125 mg/kg. The effects of this are long term. At 6 months of age, babies that received cord clamping after pulsation had stopped had higher levels of iron than babies that had early cord clamping (WHO).
The Cochrane Review summed up their most recent findings regarding cord clamping at follows: “The suggested neonatal benefits associated with this increased placental transfusion include higher haemoglobin levels (Prendiville 1989), additional iron stores and less anaemia later in infancy (Chaparro 2006; WHO 1998b), higher red blood cell flow to vital organs, better cardiopulmonary adaptation, and increased duration of early breastfeeding (Mercer 2001; Mercer 2006). There is growing evidence that delaying cord clamping confers improved iron status in infants up to six months post birth (Chaparro 2006; Mercer 2006; van Rheenen 2004).”
Also being pushed into baby during these few extra precious minutes are those ever-so-precious stem-cells. Stem cells are cells that can develop into other cells. Researcher Paul Sanberg from the University of Florida recently published an article in the Journal of Cellular and Molecular Medicine that concluded that waiting to clamp the umbilical cord could reduce the infant's risk of many illnesses, including "respiratory distress, chronic lung disease, brain hemorrhages, anemia, sepsis and eye disease." Fascinating. Especially since giving vitamin K injections to babies immediately after birth are routinely given to help prevent brain hemorrhages. Vitamin K started being given for this reason during the 1960s. Early clamping of the cord was first suggested in the 1930s (in order to minimize the amount of anesthesia baby would receive from mom's blood) and became routine by the 1960s. While I have not been able to find any studies that could confirm it, I cannot help but wonder if this new technique of early clamping of the umbilical cord lead to a greater risk of brain hemorrhages in infants, which in turn lead to giving vitamin K shots. Is this, yet again, another example when (overall) less medical intervention during birth is actually better?
Humans are the only mammals that severe the umbilical cord of their young so early after birth. Most animals will - after a while - gnaw through the cord to separate the placenta from the newborn. Chimpanzees ignore the cord altogether and allow it to remain attached. After several days, the cord will dry and fall off (as does the stump of the cut cord with all newborns). Several cultures around the world practice this method (commonly referred to as a Lotus Birth). Diaries from pioneers reveal that this method was practiced at times in order to avoid causing an infection when clean instruments and supplies were not available. While leaving the umbilical cord attached for several days does not seem exactly practical, leaving it attached for 3-5 minutes after birth is. The cord will cease pulsating as the last of the blood is pushed into the newborn and a gelatinous substance called Wharton's jelly inside the cord helps it to occlude naturally within 5-10 minutes.
I could find no studies, unfortunately, that addressed premature clamping of the cord when resuscitation was required.
And the downfalls of waiting to clamp and cut the cord? Several studies have suggested that delaying cord clamping may result in a higher incidence of hyperbilirubinemia (jaundice). Other studies do not find this link. Either way, almost all breastfed babies will experience some sort of jaundice during their first 5-10 days of life. It is a very normal part of a baby adapting to the outside world and, when properly managed, is nothing to worry about. Frequent breastfeeding (every 2 hours) and exposure to a little sunlight will help clear almost all babies of this very normal condition. Little Bear had jaundice the first week of her life and was treated with a little light and lots of breast milk! (**Note: Rarely, jaundice can become a life-threatening condition. If yellowing worsens, baby becomes lethargic, or feeding/elimination habits change, contact your physician or midwife immediately.) Yet others suggest that an increase in jaundice may indeed be related to delaying cord clamping only if labor is augmented with the drug pitocin (a drug very commonly used in labor). One of the side-effects of pitocin is jaundice and it makes sense that the more blood that is pushed in from the cord would also mean more pitocin from the the mother is also reaching baby. No studies that I have found have been done to look at pitocin and jaundice rates with cord clamping.
And so there we have it. A myriad of reasons why delaying cord clamping and cutting by 1-3 minutes is beneficial to the health of your baby. The debate, in my opinion, is not a debate at all. Modern science is, yet again, proving what humans have known and practiced for thousands of years. Waiting to cut the cord is best. Premature cutting of the cord is a 50-year old practice that should be left to historical textbooks, just like lobotomies and bloodletting. Unfortunately, this practice still continues. It is up to us as expectant and new parents to insist that this practice is stopped so that our children receive the most health benefits possible from the moment they take their first breath.
Tuesday, May 17, 2011
Letting Go of Expectations ... One Sleepless Night at a Time.
When Little Bear was 6 weeks old she was virtually sleeping through the night. She'd fall asleep on her own after we laid her down, and she wouldn't wake-up for 8-9 hours. I was warned that babies change their sleep patterns many times during the first few years, so I wasn't all that surprised (though maybe I was a bit disappointed) when Little Bear suddenly started waking up several times each night at around 7 months.
I'll be honest: I like my sleep. I like my sleep A LOT. I've always been one of those 9-hour-a-night sleepers. My husband used to make fun of me because I used to say my favorite part of the day was pulling the covers up over me in the evening and putting my head down on the pillow (being a former Marine, K can go for many days on little to no sleep). While I still love cuddling down into my comforter in the evening, it's not quite the same anymore because instead of 9 hours of blissful rest to look forward to ... I know that I will now be up several times, and more often than not, I will wake-up feeling tired. My morning cup of coffee has never been more crucial (thank goodness K usually has a pot already brewed by the time I stumble downstairs).
I woke-up this morning absolutely exhausted and at my wit's end. On Friday Little Bear slept 7 hours without waking (the longest she's slept in months). Saturday she woke-up 3 times. Sunday 3 times. Last night 5 times. Her sleep/wake schedule is completely erratic with no pattern what-so-ever - despite having a set night-time routine and bedtime. Last night, as I sat up to flip sides for nursing for the 5th time, I kept going through all the things I've read about growing babies. Maybe it's her teeth? She started crawling last month ... I'd heard that this can mess with their sleep pattern. Is she too hot? Too cold? If she wouldn't try crawling around in the middle of the night and getting herself into weird sleeping positions, maybe she'd sleep better. Should I let her cry it out ... maybe after a few sleepless nights she'd start putting herself back to sleep. Then again, maybe not. My mind kept going over all the reasons Little Bear would be waking up over and over throughout the night. And I kept trying to come up with solutions ... including moving her crib into another room and letting her cry.
And then I reached out and got some feedback from friends. And I was reminded that: 1) this is normal for a 10 month old, and 2) there is no right answer or solution. And that's really all I needed. Reassurance from friends and a reminder that babies wake-up at night. And that when we decided to become parents, this was part of what I signed-up for. There is so much literature and advice out there telling us that "babies should be sleeping through the night" by such and such an age. Yet when I talk with parents, I've yet to meet one that had a baby consistently doing this. The norm seems to be quite the opposite in fact.
Reading a little history on sleep patterns of babies, I was again reminded that this notion that a young child should sleep through the night without needing mom to feed or comfort him came about only in the last 100 years or so. Up until this point it was simply assumed that mom was going to waking-up at night to feed and care for her little ones. Which is why co-sleeping has also been the norm until just recently. Having a child either in the same bed or within arm's reach made nightly feedings much easier on everyone.
So even though I am feeling quite sleep-deprived and a bit loopy ... I am (again) letting go of my expectations. Little Bear will continue coming to bed with me, I will continue flipping over so Little Bear can nurse when she needs to ... and I'll try and remember that this is all part of becoming a mother, and that someday, when Little Bear no longer needs me in the middle of the night, and is perfectly happy asleep in her own bed in her own bedroom ... I'll probably miss it.
I'll be honest: I like my sleep. I like my sleep A LOT. I've always been one of those 9-hour-a-night sleepers. My husband used to make fun of me because I used to say my favorite part of the day was pulling the covers up over me in the evening and putting my head down on the pillow (being a former Marine, K can go for many days on little to no sleep). While I still love cuddling down into my comforter in the evening, it's not quite the same anymore because instead of 9 hours of blissful rest to look forward to ... I know that I will now be up several times, and more often than not, I will wake-up feeling tired. My morning cup of coffee has never been more crucial (thank goodness K usually has a pot already brewed by the time I stumble downstairs).
I woke-up this morning absolutely exhausted and at my wit's end. On Friday Little Bear slept 7 hours without waking (the longest she's slept in months). Saturday she woke-up 3 times. Sunday 3 times. Last night 5 times. Her sleep/wake schedule is completely erratic with no pattern what-so-ever - despite having a set night-time routine and bedtime. Last night, as I sat up to flip sides for nursing for the 5th time, I kept going through all the things I've read about growing babies. Maybe it's her teeth? She started crawling last month ... I'd heard that this can mess with their sleep pattern. Is she too hot? Too cold? If she wouldn't try crawling around in the middle of the night and getting herself into weird sleeping positions, maybe she'd sleep better. Should I let her cry it out ... maybe after a few sleepless nights she'd start putting herself back to sleep. Then again, maybe not. My mind kept going over all the reasons Little Bear would be waking up over and over throughout the night. And I kept trying to come up with solutions ... including moving her crib into another room and letting her cry.
And then I reached out and got some feedback from friends. And I was reminded that: 1) this is normal for a 10 month old, and 2) there is no right answer or solution. And that's really all I needed. Reassurance from friends and a reminder that babies wake-up at night. And that when we decided to become parents, this was part of what I signed-up for. There is so much literature and advice out there telling us that "babies should be sleeping through the night" by such and such an age. Yet when I talk with parents, I've yet to meet one that had a baby consistently doing this. The norm seems to be quite the opposite in fact.
Reading a little history on sleep patterns of babies, I was again reminded that this notion that a young child should sleep through the night without needing mom to feed or comfort him came about only in the last 100 years or so. Up until this point it was simply assumed that mom was going to waking-up at night to feed and care for her little ones. Which is why co-sleeping has also been the norm until just recently. Having a child either in the same bed or within arm's reach made nightly feedings much easier on everyone.
So even though I am feeling quite sleep-deprived and a bit loopy ... I am (again) letting go of my expectations. Little Bear will continue coming to bed with me, I will continue flipping over so Little Bear can nurse when she needs to ... and I'll try and remember that this is all part of becoming a mother, and that someday, when Little Bear no longer needs me in the middle of the night, and is perfectly happy asleep in her own bed in her own bedroom ... I'll probably miss it.
Friday, May 13, 2011
Why Is Little Bear So ... Little?
It was about the third time in one week that someone at the store asked how old Little Bear was, then commented “she’s so little for her age!” after finding out she was nearly 9 months. Now, I’m not around many little ones. I have nothing to compare Little Bear’s size against … and really have absolutely no idea what a 9 month old should look like. After hearing how small she was, though, for the third time, I thought: maybe I should weigh her.
A caveat: I don’t believe in all the “norms” that we like to place children into. We are a country that loves percentiles, statistics, and averages. We like to poke, measure, prod … and compare. Being a nurse, I have been trained in looking at numbers and comparing them to norms. Every patient I see I must take blood pressures, heart rates, etc. and report numbers that are outside these norms. It’s what we love to do in the medical field.
Here’s the problem, however. Our children (for the most part) are not sick. They are not ill. They are healthy, growing, and thriving. They are fed good foods, live in sanitary conditions, and given plenty of attention and love. It’s one of the wonderful perks of living a middle class lifestyle in a first world country. And yet we still want to measure and compare, measure and compare. Let me be completely honest: Little Bear has not been to the doctor’s office since she was 7 weeks old. I am aware of what milestones she should be meeting, know her better than anyone else on this planet, and trust that I will recognize any changes that would warrant a visit to the doctor’s office. Because of this, I also have not worried about weighing and measuring her. So until recently, I had absolutely no idea where Little Bear fit on the growth chart. And quite honestly, I didn’t really care.
And then I gave in. Last week, after hearing how “small” she was yet again, I finally climbed on the scale with Little Bear and discovered she weighed roughly 15 pounds. Of course this number meant absolutely nothing to me since I hadn’t seen a growth chart since nursing school. Little Bear was eating good foods, drinking plenty of my breastmilk, crawling all over the place, and interacting with her environment. I knew there was nothing wrong with her. Yet when I pulled up the CDC growth chart and saw that my 9 month old fell into the bottom 3rd-5th percentile for weight, yet the top 75th percentile for height, I started to wonder. And then to worry. And then I got mad at myself for wondering and worrying, because I knew there was nothing wrong my Little Bear. But still … it stayed on my mind.
And then I talked with my neighbor, a retired midwife from Arizona. When I told her my concerns about Little Bear’s weight, she laughed. “You’re still breastfeeding, right?” Yes. “Well, the CDC’s growth charts are based on the U.S. population of babies, most of whom are bottlefed either from birth or from 3 months on. Bottlefed babies simply weigh more on average … so the charts are all skewed. You have to look at the World Health Organization’s growth charts if you are breastfeeding exclusively.” And so I did. And Little Bear was in the close to the 25th percentile. Yep, that’s right. She went from almost being off the chart percentile-wise, to right in the norm. I have had 4 friends recently share with me that their babies have shown up “very small” on growth charts. One friend even shared that her pediatrician ordered multiple blood tests on her poor son just to confirm that there was nothing wrong with him! All four of these friends have exclusively breastfed their babies. Then again, I have a friend who exclusively breastfed and her baby was considered "overweight" statistically ... and her pediatrician told her to feed him less! At two years of age his weight has leveled and off and he is now considered in the "normal" range (even though he still breastfeeds when he wants). After just a few Google searches I discovered the following about growth charts:
1. 1. The Center for Disease Control and Prevention (CDC) came out with a growth chart in 2000 that many pediatricians still use. This growth chart was made based on U.S. data. http://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf
2. 2. In the U.S. only 50% of babies are breastfed at all; only 1/3 of babies are still receiving some breastmilk at 3+ months. That means that the far majority of babies are receiving all or some formula either from birth or by 3 months of age.
3. 3. Formula fed babies simply weigh more, meaning that the 2000 CDC growth charts are appropriate to use for formula fed babies, but NOT appropriate for breastfed babies.
4. 4. In 2006 The World Health Organization (WHO) produced their own growth charts that are more representative of breastfed babies throughout the world. These charts are based on babies being exclusively breastfed for 4+ months, and still breastfeeding at 12 months of age. http://www.cdc.gov/growthcharts/who_charts.htm
5. 5. The CDC now recommends that pediatricians use the WHO’s growth charts for the first 2 years of life. Unfortunately, this advice is not always followed by pediatricians.
With my father’s analytical/engineering genes flowing strongly through my blood, I struggle with remembering that numbers and statistics and norms are just that … numbers, statistics, and norms. They may, and they may not, mean anything. Yet it is nice to know that the WHO has a growth chart that more accurately represents the growth of breastfed babies. Because we are a country that likes to analyze and place kids into percentiles, at least we can do it more appropriately now. The challenge remains, however, to keep that mother’s intuition in the forefront – out ahead of all the numbers and statistics. We spend every morning and night with our little ones. We were there when they took their first breath. We watch them as they learn to crawl, clap, laugh, and smile. We know what their different cries mean. And we know when something is wrong, and we usually know when something isn’t. Our challenge as mothers (and fathers), then, is to look at all these “norms” … look at our unique son or daughter … and trust our instincts. To date, my mother’s intuition has yet to be wrong.
Sunday, April 17, 2011
Elimination Communication: 9 Months
Little Bear will be 9 months old next weekend, and I thought it was time for an update on how the Elimination Communication process has been going for us. We have moved 3 times in the past 3 months (finally settling down into our permanent new home a few weeks ago), meaning that Little Bear's schedule has been all over the place. While I've tried my best to maintain a routine and keep on top of her schedule, it has not always been possible. With packing, cleaning, unpacking ... times three ... there have been days that I haven't set Little Bear on her potty at all. Other days I managed mornings and evenings. And yet other days I was able to get her on it throughout the day. Now that we are settling into our new home, however, I am able to give more attention to Little Bear and her Elimination Communication. And yes, she still does communicate with me. It's usually a simple fuss. If I catch it and put her on the potty - bingo, no problem. But the last few weeks I've often just had to let her fuss because I've been in the middle of a call to our bank or realtor, driving around running errands, etc. So she fusses, wets her diaper, and then fusses some more. Eventually I will check her and, sure enough, she will be soaked.
BUT, when I am listening, and when I do place her on the potty on a regular basis ... she goes. Consistently. And despite the hectic schedule we've been keeping the last several months, the one thing Little Bear does NOT like to do is poop in her diaper. While she will simply give a little fuss when having to wet, pooping is another matter all together. Her cue is simply getting extremely upset and frantic. She usually quits playing or eating (or whatever it is she happened to be in the middle of at the time) ... and she gets very irritated. To an outsider, it may seem like she is simply throwing a fit for no reason. As her mom, I know immediately that it's time to poop. Up the stairs, onto the potty, and ... 9/10 she poops immediately.
Other times I will be placing her on the potty to pee, then realize that #2 is also on its way. But what remains consistent is that she will not poop in her diaper ... unless I don't put her on her potty. This has only happened about 3 times in the past 3 months. And every time it was my fault for ignoring her cues. That means that since Little Bear turned 6 months old, she has only pooped in her diaper 3 times. Every other time has been on her potty. Which means no messy, smelly bum to clean or diaper to rinse out. How awesome is that?
BUT, when I am listening, and when I do place her on the potty on a regular basis ... she goes. Consistently. And despite the hectic schedule we've been keeping the last several months, the one thing Little Bear does NOT like to do is poop in her diaper. While she will simply give a little fuss when having to wet, pooping is another matter all together. Her cue is simply getting extremely upset and frantic. She usually quits playing or eating (or whatever it is she happened to be in the middle of at the time) ... and she gets very irritated. To an outsider, it may seem like she is simply throwing a fit for no reason. As her mom, I know immediately that it's time to poop. Up the stairs, onto the potty, and ... 9/10 she poops immediately.
Other times I will be placing her on the potty to pee, then realize that #2 is also on its way. But what remains consistent is that she will not poop in her diaper ... unless I don't put her on her potty. This has only happened about 3 times in the past 3 months. And every time it was my fault for ignoring her cues. That means that since Little Bear turned 6 months old, she has only pooped in her diaper 3 times. Every other time has been on her potty. Which means no messy, smelly bum to clean or diaper to rinse out. How awesome is that?
Monday, April 11, 2011
Why a Doula
First of all, what is a "doula?" I had never even heard the word until about 4 years ago. It sounded foreign and unfamiliar. The word "doula" can trace its roots back to Ancient Greece, where the word meant "female slave" or "female servant." Currently, today, the word is most closely associated with a woman whose role is to support another woman during the labor and delivery process. The role of a doula is actually wider than just that, however, and also encompasses the emotional support of a woman and her family in the weeks prior to and following delivery, as well as through times of loss and grieving.
This post specifically looks at birth doulas and their role in the birth process.
Birth doulas work in many different settings. There is a stereotype and misconception that doulas only work in birth centers and at home deliveries. Nothing is further from the truth. Doulas are not only often found in the hospital setting - it is the place where (I believe) they are most needed! Women considering a hospital birth may find that they benefit more from having a doula than women in a birth center or at home. Because a doula's role is to be a constant companion for the laboring woman, they offer women in the hospital something that they would not have otherwise: a supportive female always at their side. Nurses and doctors will be in and out of a patient's room - but a doula will constantly be at your side, giving her support wherever it is needed. At home and in the birth center, a midwife will often (though not always) play the role of constant female companion. Still, however, women considering a home or birth center birth may want the consistency and reassurance of a doula who may arrive earlier and stay longer than even a midwife will.
So what does a birth doula do? In short, she supports the laboring woman. This may mean a back rub. It may mean running a bath, standing with her in a shower, suggesting different sitting, squatting, or standing positions. It may mean words of support ("You're doing great. Your body is doing exactly what it is supposed to be doing. Great job on that last contraction!"). It may mean humming a tune, singing a quiet song, panting and moaning with her during a contraction. It may also mean heating up food for a hungry husband, or simply letting him know it's okay to lay down and take a nap. The role of a birth doula is multi-faceted and without any true definition. She is there to serve the woman in labor, in whatever way is most appropriate.
And the amazing thing is: it works. Intuitively, this makes sense. It seems like common sense that having a woman provide emotional and physical support for a woman in labor would help the labor progress better. Research, though, is finally proving what women have intuitively known for thousands of years.
McGrath and Kennell (2008) conducted a randomized control trial that showed very positive results for laboring women with doulas in the hospital setting. Epidural use was decreased from 76% to 64.7%. More importantly, however, cesarean rates dropped from 25% (our current national average is 30%) to 13.4%. That is huge. Cesarean sections have become so common that we often forgot what major surgery it is. It poses some major risks for not only mother, but also baby. And this is not the only study that has shown these wonderful results. A 1999 meta analysis done by Scott, Berkowitz, and Klaus looked at 11 clinical trials that involved doula care during labor. They found that continuous doula support (when compared to intermittent support) was "significantly associated with shorter labors, decreased need for the use of any analgesia, oxytocin, forceps, and cesarean sections." The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. Read that again. No region in the world is justified in having a cesarean rate greater than 10 to 15 perfect. Yet here we are, in a first world country with excellent prenatal care with cesarean rates hovering 2-3 times what is justified. Having a doula helps to bring those numbers down to a justifiable rate.
The findings of studies like the ones above are huge. And there are more out there. Why studies like these came out years ago, yet no changes in the care of laboring women in the hospital setting have been made, speaks volumes about the priorities of our medical culture. The incentives for doctors and medical institutions (financially) to perform cesarean sections far outweighs the incentives for them to find ways to support women in vaginal deliveries. For the women, however, the incentives to have a healthy vaginal delivery are many. Not only are you paying much less to the hospital and insurance companies, the recovery for you and your baby is much quicker and without as much risk.
Studies like the ones above help prove the importance of doula-work in the labor and delivery room. Why doctors and hospitals are not actively seeking out doulas can only be explained (in my opinion) by the financial gains these organizations are not willing to give up. Taking charge of our own bodies, our own labor process, and our own babies (yes, our babies ARE affected by these choices) is the only answer at this time. We must educate ourselves, look at the research based evidence, and choose accordingly. At this time, the evidence clearly shows that choosing a doula can help reduce the needs for medical interventions in birth.
Share this information with those around you. Support a daughter or friend by offering to be their doula (weekend workshops are available throughout the US), or to help pay the fee for one (doula fees typically run between $400-$800). Do a little research to find out if anyone is working to become a doula in your area, in which case you may receive services for free. My hope is that by the time Little Bear is thinking about starting her own family, the word "doula" is as commonly heard as "OBGYN" and "midwife" - and that insurance companies are helping to pay for their services. My hope is that the word "doula" becomes a part of every woman's birth story ... just as it was before, for thousands of years. Just as it continues to be now, in many other parts of the world.
This post specifically looks at birth doulas and their role in the birth process.
Birth doulas work in many different settings. There is a stereotype and misconception that doulas only work in birth centers and at home deliveries. Nothing is further from the truth. Doulas are not only often found in the hospital setting - it is the place where (I believe) they are most needed! Women considering a hospital birth may find that they benefit more from having a doula than women in a birth center or at home. Because a doula's role is to be a constant companion for the laboring woman, they offer women in the hospital something that they would not have otherwise: a supportive female always at their side. Nurses and doctors will be in and out of a patient's room - but a doula will constantly be at your side, giving her support wherever it is needed. At home and in the birth center, a midwife will often (though not always) play the role of constant female companion. Still, however, women considering a home or birth center birth may want the consistency and reassurance of a doula who may arrive earlier and stay longer than even a midwife will.
So what does a birth doula do? In short, she supports the laboring woman. This may mean a back rub. It may mean running a bath, standing with her in a shower, suggesting different sitting, squatting, or standing positions. It may mean words of support ("You're doing great. Your body is doing exactly what it is supposed to be doing. Great job on that last contraction!"). It may mean humming a tune, singing a quiet song, panting and moaning with her during a contraction. It may also mean heating up food for a hungry husband, or simply letting him know it's okay to lay down and take a nap. The role of a birth doula is multi-faceted and without any true definition. She is there to serve the woman in labor, in whatever way is most appropriate.
And the amazing thing is: it works. Intuitively, this makes sense. It seems like common sense that having a woman provide emotional and physical support for a woman in labor would help the labor progress better. Research, though, is finally proving what women have intuitively known for thousands of years.
McGrath and Kennell (2008) conducted a randomized control trial that showed very positive results for laboring women with doulas in the hospital setting. Epidural use was decreased from 76% to 64.7%. More importantly, however, cesarean rates dropped from 25% (our current national average is 30%) to 13.4%. That is huge. Cesarean sections have become so common that we often forgot what major surgery it is. It poses some major risks for not only mother, but also baby. And this is not the only study that has shown these wonderful results. A 1999 meta analysis done by Scott, Berkowitz, and Klaus looked at 11 clinical trials that involved doula care during labor. They found that continuous doula support (when compared to intermittent support) was "significantly associated with shorter labors, decreased need for the use of any analgesia, oxytocin, forceps, and cesarean sections." The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. Read that again. No region in the world is justified in having a cesarean rate greater than 10 to 15 perfect. Yet here we are, in a first world country with excellent prenatal care with cesarean rates hovering 2-3 times what is justified. Having a doula helps to bring those numbers down to a justifiable rate.
The findings of studies like the ones above are huge. And there are more out there. Why studies like these came out years ago, yet no changes in the care of laboring women in the hospital setting have been made, speaks volumes about the priorities of our medical culture. The incentives for doctors and medical institutions (financially) to perform cesarean sections far outweighs the incentives for them to find ways to support women in vaginal deliveries. For the women, however, the incentives to have a healthy vaginal delivery are many. Not only are you paying much less to the hospital and insurance companies, the recovery for you and your baby is much quicker and without as much risk.
Studies like the ones above help prove the importance of doula-work in the labor and delivery room. Why doctors and hospitals are not actively seeking out doulas can only be explained (in my opinion) by the financial gains these organizations are not willing to give up. Taking charge of our own bodies, our own labor process, and our own babies (yes, our babies ARE affected by these choices) is the only answer at this time. We must educate ourselves, look at the research based evidence, and choose accordingly. At this time, the evidence clearly shows that choosing a doula can help reduce the needs for medical interventions in birth.
Share this information with those around you. Support a daughter or friend by offering to be their doula (weekend workshops are available throughout the US), or to help pay the fee for one (doula fees typically run between $400-$800). Do a little research to find out if anyone is working to become a doula in your area, in which case you may receive services for free. My hope is that by the time Little Bear is thinking about starting her own family, the word "doula" is as commonly heard as "OBGYN" and "midwife" - and that insurance companies are helping to pay for their services. My hope is that the word "doula" becomes a part of every woman's birth story ... just as it was before, for thousands of years. Just as it continues to be now, in many other parts of the world.
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