Birth Stories - Are You Willing to Share Yours?

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!

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.

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. 

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.

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.

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 3^rd-5^th percentile for weight, yet the top 75^th 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 25^th 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.

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?

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.

The Importance of Writing a Birth Plan

Not too long ago, having to write down a birth plan would have seemed ridiculous. Birth was simply birth, and there weren't many options or choices in the matter. Fast forward to the 21st century and the wonders of modern medicine have made giving birth an event filled with decisions that must be made. To begin with, do you choose a professional midwife, a nurse midwife, a doctor ... or do you decide to go it alone? Do you want to be at home, in a birth center, or in the hospital? If pregnancy goes beyond 40 weeks, do you induce, or wait it out? Do you want a "natural" birth with no pain medication or IVs ... or do you want oral pain meds, an epidural, or even a c-section? What kind of monitoring would you like? Do you want the baby suctioned after delivery? What about vaccinations, the vitamin K shot, and erythromycin ointment? While some women will have absolutely no preference on some of these decisions - most women do have a preference. And those preferences, as much as humanly possible, should be followed. Remember: this is YOUR body and YOUR baby. Making sure that baby goes directly onto your bare chest after delivery instead of getting swept away in a nurses arms to be weighed and measured matters. A lot. If you choose to decline or postpone the Hepatitis B vaccination during the first few days of your baby's life - that decision needs to be known and honored.

Sitting down and writing out your birth plan not only helps you better visualize what type of birth you want to have, it also forces you to consider some of the options you might not have even realized you had. It also ensures that you, your partner, and other supporters (such as a doula and other family members) are on the same page so that they can better support you during the labor process. When you are in the middle of transition and focused only on getting through each contraction, your spouse or doula can gently remind the nurse and doctor that you prefer the lights dimmed, or that you only want to be checked for dilation if absolutely necessary (instead of routinely).

Writing a birth plan will also help you make more educated decisions on the various options you will face. For example, what are the pros and cons of erythromycin ointment? What are the pros and cons of having regular checks for dilation? What are the benefits of an epidural - and what are the setbacks? Why might you want to have your baby suctioned after delivery, and why might you not? Rather than simply accepting whatever practice is considered "the norm" for a particular hospital or doctor (and yes, these practices do vary greatly depending on who your hospital, doctor, or midwife is), you get to make an educated decision on what is best for YOU and what is best for YOUR baby. And what is right for you may not be what is right for the mother that delivered just before you, or the mother that will deliver just after you. That is the beauty of writing your own birth plan ... it is individualized, just for you!

Discuss birth plan preferences with your provider early on. If they are unsupportive of your birth plan, you may consider finding a different provider that will be supportive. For example, many doctors will require that you be monitored on the fetal heart monitor and that you deliver laying down in bed. If this is not what you want, consider talking to another doctor, nurse midwife, or professional midwife.

Several weeks prior to your due date (usually around 36-37 weeks), make plans to thoroughly discuss your birth plan with your doctor or midwife. Give a copy to your provider. If you have a doula that will be attending your birth, make sure she also has a copy. Print out several more copies to take with you if you are going to a birth center or hospital. Have your partner give one copy to your nurse upon arrival, and tape the other copy somewhere in the room where nurses and doctors can easily see it. Because nurses and doctors change shifts every 8-12 hours, it is very likely that you will not have the same nurse upon admittance that you have during delivery. Making sure everyone has access to your birth plan is very important and will help your nurse, doctor, and midwife better support you in the labor process.

I recommend reading through your birth plan at least once daily. This helps serve as a sort of "visualization" of how you would like your labor to progress. Make sure that you leave room for flexibility, however, for unforeseen circumstances. For example, I preferred not to have Little Bear suctioned after delivery. However, because she was not a crier and her lungs sounded more gargley than the midwife was comfortable with - I allowed her to be suctioned based on the midwife's recommendation. Because I knew and trusted my midwife, I felt comfortable adjusting my birth plan preferences under her recommendation. I also preferred to tear naturally, rather than have an episiotomy. However, I did state in my birth plan that if my midwife felt that performing an episiotomy for the safety of my baby was necessary - I would allow that (sometimes this is necessary to allow for a faster delivery). This was not necessary during Little Bear's delivery, but I trusted my midwife to make that decision. As you can see, having complete and total trust in the individual delivering your baby helps make the process much easier!

Below I have listed a number of questions to answer in your birth plan. It is definitely not a complete list, but it covers many of the options/choices you will face as you go through the labor and delivery experience. Depending on if you plan on having a hospital, birth center, or home birth - some of these questions may or may not be relevant. Many of these topics I have discussed in previous posts - or plan to discuss in future posts. Please feel free to contact me at oregonmother@gmail.com with any questions you may have. Otherwise, read-up on the issues, discuss options with your partner, and write up a birth plan that will work best for you!

1.     When do you plan to come to the hospital? How far along in labor would you like to be?

2.    Would you like to be able to eat and drink during labor? Many hospitals require women in labor to only have ice-chips or sips of clear liquids.

3.     Would you like to be able to be out of bed during labor? Would you like to use the tub, shower, etc?

4.     What sort of lighting and atmosphere do you prefer in the room? 

5.     Do you want an IV and continuous fetal heart monitoring? If not, does your hospital allow you to decline these interventions? If you do not want continuous fetal heart monitoring, what type do you want (doppler, intermittent with a strap around your abdomen, fetoscope)?

6.     What type of pain management do you want to use? Consider your various options including: verbal support, techniques learned in lamaze classes, water therapy, oral medications, epidural, etc. (Remember that while many hospitals will offer epidurals as a first option for pain management, there are many non-pharmacological options available that have less side affects on mother and baby.)

7.     Would you consider induction of labor after 40 weeks, or do you prefer to wait? Many mothers go 42 weeks before labor begins. What sort of induction would you be okay with? Having a doctor or midwife strip your membranes is very different than being given a drug to induce labor. Consider your options.

8.     Would you be okay with a routine episiotomy? Most providers are moving away from this practice as evidence shows that it is more harmful than helpful in most situations. However, some providers still practice this technique. In what situation would it be okay? 

9.     Presence of others in the delivery room ... who do you want to be allowed in the room? Do you want your children there? Your mother? Just your spouse?

10  Are you okay with an AROM (Artificial Rupture of Membranes)? This technique may be used to help speed up labor. Consider the pros and cons, as well as when it might be appropriate and when it is not.

     Are you okay with intermittent vaginal checks to measure dilation? 

1   Suctioning of the newborn: Do you prefer that your baby's nose and throat be cleared of fluids with a bulb syringe? Or do you prefer that no intervention be done? If you prefer no suctioning, would you be okay with it if meconium is in the amniotic fluid?

1   When baby arrives, do you want her placed on your bare chest? Do you want her wrapped and swaddled first? Do you prefer that the newborn assessment be done while baby is on your chest? Do you wish to wait one hour or more before baby is weighed, measured, etc? 

1   Cutting of the umbilical cord: Who do you wish to cut the cord? Do you wish to wait until it stops pulsating before it is cut (this is the recommended practice currently, though it is often not done)?  

1   Do you prefer that the afterbirth (placenta) be delivered naturally, without intervention? If so, how long are you willing to wait? What would you like done with the placenta? (Many cultures save the placenta and plant it under a tree, etc.). 

1  What would you like administered to your baby? Vitamin K, erythromycin eye ointment, and the hepatitis B vaccine are all routinely given to newborns in their first hours and days of life. Parents may sign consents stating they do not want these interventions. 

     

     Do you plan on breastfeeding your baby? If so, allowing baby to suckle on your breast during the first hour of his or her life will help both of you. 

     If you tear naturally during delivery, do you prefer to heal naturally, or do you want stitches?

     When do you wish to give baby his or her first bath? Do you prefer it be done the first day - or do you wish to wait 2-3 days? 

     When do you plan on going home? Do you wish to go home soon or stay longer (most birth centers allow you to go home within 4 hours after delivery; many hospitals require you to stay 24-48 hours). 

Waiting to Bathe Baby

When giving birth in a hospital setting, nurses will almost always ask mothers when they want to give their little newborn that first bath. This exciting ritual of bathing your new one for the first time is often greeted with excitement, anticipation, and a little nervousness (those newborns are so tiny and slippery!). A family member is often designated to take photos, and a well-meaning nurse usually stands-by to offer a helping hand. And while that first bath is definitely an event to look forward to, it is usually an event best postponed for 2-3 days.

Waiting 2-3 days to give that first bath may surprise many new parents. Newborns are typically covered in blood and a white goop (called "vernix") when they make their first appearance. Nurses quickly towel dry the baby (ideally this is done while baby is resting on mom's chest) and wipe off most of the fluids and blood. What is left is typically the vernix, that white goop that looks like a waxy cheese substance. While it is many parent's (and nurse's) instinct to want to clean it off their baby to reveal that beautiful, soft pink skin beneath - that vernix is serving several important purposes.

Vernix is thought to help baby slide more easily through the birth canal. It also helps to moisturize baby's skin once out of the womb. In fact, it is the best moisturizer out there for babies! Instead of bathing baby right away to get rid of the white substance, gently massage it into baby's skin! This will help minimize drying and cracking that can often occur as baby makes it way out of it's watery surroundings of the placenta into the outside world.

Vernix is also thought to help baby conserve heat and stay warm, allowing baby to better adjust to life outside the womb. More recently, pediatricians have recognized an antibacterial benefit of vernix. In other words, that white, waxy substance actually forms a barrier between bacteria in the environment and your newborn's skin! Why in the world would we want to wash that off?!?

Some babies will have more vernix than others when born. Babies born full term (40 weeks) will have more vernix than a baby born post term (41+ weeks). Baby's born post term actually absorb much of the vernix into their skin while still in the womb. Because Little Bear was born at almost 42 weeks, she did not have much vernix left on her skin. She did have some left in the folds of her skins.

When Little Bear came home, we washed her hair (she had a lot of it!), but didn't bathe the rest of her body until day 3. By that time, all the vernix had been absorbed into her skin. Even after the vernix is gone, however, resist the temptation to bathe baby every day. Natural oils in the skin help protect and moisturize the skin (this is true even as adults!). Bathing a newborn twice a week is more than enough. Wiping down areas such as the bottom, neck, armpits, and skinfolds that can collect dirt and milk inbetween baths will keep baby's skin healthy and clean.

Remember that some drying and cracking of your newborn's skin the first few weeks after birth is normal. Resist the temptation to rub all sorts of lotions and oils onto baby. Simply let the dead skin slough off naturally.

When writing your birth plan for your home, birth center, or hospital delivery - make sure to include when you want to bathe baby. This will let nurses, doctors, and midwives know that you wish to wait to bathe your little one. A little waxy white stuff in those first baby photos won't hurt anyone - in fact, it can only help!

Ready, Set ... Diaper (Part 1)

It's funny how something so basic (such as diapering a baby) can become so complicated. Yet our culture has a tendency to offer consumers so many options for an item that one can literally stand in the pen and pencil aisle of a grocery store for 30 minutes debating on what brand, style, color, etc. is best. Unfortunately, or perhaps fortunately (for those that like lots and lots of options), the same is true for choosing cloth diapers. No longer is there one style. And no longer do we simply learn by watching. After nearly 3 decades of disposable diapers running the show, cloth diapering has become somewhat of a lost art - something that seems complicated, mysterious, and perhaps even gross. In recent years, however, cloth has made a resurgence as we have learned that, yes, once again, sometimes less is more - and more natural is better. And the good news?  Using cloth is easier than you think.

When I first started looking into cloth diapering, I'm embarrassed to admit how overwhelmed I became. There were SO many options, so many styles, so many decisions. What worked? What didn't? Did friends have recommendations? Luckily, I found an excellent article in Mothering Magazine that discussed in great details the various styles and types of cloth diapering available. I also had a friend who wrote in detail in her blog about her personal experience with cloth diapering. And lastly, my brother had been using cloth for the last 12 months and was able to offer his thoughts on the subject.

Everyone will have a favorite style or brand that they absolutely swear by. My recommendation is to simply pull up reviews online of each style. Most consumers will be very upfront about their likes and dislikes for certain products. I have really only used 2 brands of diapers, so I'm not a very good resource for offering you advice on the "best product out there". I can, however, get you started in what I believe are the basics you will need to begin cloth diapering your little one.

Cover/Shell. This is the part of the diaper that keeps the pee from leaking through the cloth part of the diaper and onto your baby's clothing - or your lap. It usually consists of some sort of soft inside lining and a waterproof outer lining. Bummis, Thirsties, Kissaluvs (as well as many, many others) all make covers. These are designed to fit over a basic cloth diaper. They come in various sizes, or a one-size-fits-all style that has adjustable snaps. The one-size-fits-all usually advertise that they will fit an 8 pound - 35 pound baby. My personal experience is that you will need between 10-15 covers if you simply want to toss them in the laundry and only do the wash 2 times a week. If you don't mind washing more often, you will need less. When Little Bear was really tiny, I used 5 Thirties Newborn Covers, but was doing washes more often than I do now.

Cloth Diapers (prefolds). These are the basic rectangular diapers that some of our mother's probably used. They work great as burp cloths and dust rags, too. They come in various sizes, as well. Depending on how often you want to do laundry will depend on how many you decide to buy. I recommend buying at least 60 if you only want to do laundry 2 times a week. A breastfeeding baby will often pee 15-20 times/day - and with cloth, they will need changing each time. They immediately feel when they are wet and will let you know it's time to change. Cloth diapers are available in cotton and hemp, organic and non-organic. There are many types of prefolds available, with the most popular being the Chinese Prefolds and Indian Prefolds.

Snappies. These are plastic stretchy bands that are used in place of safety pins to keep on the cloth diapers. These are used when you use the cloth diapers to wrap around your baby's bottom and waist. I used them the first 6 weeks (before switching over to the Diaper Cover with Insert). I ordered 5, but imagine 2-3 would do just fine ... if you don't tend to lose things.

OR ...

Diaper Cover with Insert. These are incredibly popular right now. BumGenius, FuzziBunz, and Flip all make a style of insert diaper. They are essentially taking the above two categories (cover and cloth diaper) and combining them into one system. They come with an "insert" that you stuff into the cover, forming one complete "diaper." Supposedly by stuffing the insert into the cover, it helps keep the wetness away from your baby. I know many people that love this diaper style. I have 2 complaints: 1) Little Bear knew immediately when she wet anyways and so we ended up changing her just as often, and 2) you had to stuff inserts into the covers and then remove them - which is very time consuming. I ended up using these diapers like covers, instead. They work great for this, as well, and I no longer have to stuff liners after every load of laundry. If using this system as intended (stuffing the diaper), they recommend you buy at least 36. This is a very expensive investment and many people just simply don't have that kind of money laying around.

YOU WILL ALSO NEED ...

Wipes. I wasn't sure I wanted to use cloth wipes (seemed like it could get messy), but now that I do, I wouldn't ever go back! We bought flannel cloth wipes (about 40 of them) and absolutely love them. I do use disposables when we are out and about, and even then I keep saying to myself that I'm going to change over. The disposables just seem so wet and flimsy after using cloth.

Spray. We bought Kissaluvs Diaper Lotion Potion. I recommend buying one spray bottle, as well as several bottles of concentrate. It is an all natural concentrate that you mix with witch hazel. It smells amazing, feels great on the skin, and Little Bear has yet to have a diaper rash. It also works great to spray on a little bit of cloth to clean out those smelly neck folds that gather sour milk during the first few months!

Diaper Pail. This can be anything, as long as it has a lid that fits tightly. We bought one made by BumGenius and are very happy with it. There are many styles and types out there. Some come with a vent in the lid that have filters in them to help the soiled diapers "breathe". By doing laundry every 3-4 days I have found that smell is never an issue.

Diaper Pail Liner. These are important. We also bought the BumGenius and are very happy with ours. These are sturdy plastic, reusable, washable liners that you place in the diaper pail. Buy two of these so that you can immediately replace one while the other is being washed and hung to dry.

Wet Bags. If you plan on going 100% cloth, you will want to buy wet bags for when you are out and about and don't have access to your diaper pail. These are like miniature diaper pail liners in that they are reusable and washable. Buy two of these, as well, so that you can always have one clean, dry one available. They are small and fit easily in a diaper bag.

Sprayer Attachment for Toilet. BumGenius also makes a good sprayer that is easy to install onto almost any toilet. It's a great invention and you'll be really happy you have it the first few months when baby poop can get a bit sloppy and messy. Simply spray as much poop as you can off the diaper before putting in your diaper pail. It works great and is worth the little extra money you'll spend on it.

If you are a minimalist, I'm certain you can do without several of my suggested items listed above. But I've found that by having some of the "extras" - like the diaper sprayer and Kissalvus Diaper Lotion Potion - it's just a little easier. And everything smells a bit nicer, too.

Ready, Set ... Diaper (Part 2) will be up shortly!

Birth Story Circles

I attended my first Birth Story Circle last week at a local birth center in town. It was a wonderful 2 hours and I left feeling very privileged to have had the opportunity to listen to women share the stories of their most intimate memories of their birth experience.

So what exactly is a Birth Story Circle? I had never been to one and did not know quite what to expect. The Birth Story Circle is simply an opportunity for women to gather together and share the stories of their birth. It is very informal, and anyone who wants to participate in sharing their story can. One can also simply come and listen, if they choose. The circle I went to had about 10 ladies in attendance, and 8 out of the 10 shared a personal birth story. Sometimes the stories were long and very detailed; others were brief and to the point. But it was obvious that each woman sharing her story did so out of some desire to share her experience with others. The experiences shared were inspiring and empowering ... encouraging several of the pregnant women in the circle who had yet to give birth that their bodies were designed for this very purpose. One woman shared of a baby she lost when she was younger - and the joy she felt when her most recent baby was born on her first baby's expected due date. Another shared her fears of trying to deliver her second child naturally, after having a cesarean section. One mother shared how her husband helped deliver her fifth baby at home in the bathroom when labor progressed too quickly for the midwife to arrive.

Each story was remarkable and unique ... and at the same time, not remarkable - and not unique. And that is what I love about birth. It happens almost every second of every day, changing forever the lives of those welcoming that little one into their arms. For the rest of our lives, K and I will remember and talk about the night that Little Bear was born: when the contractions started, what time my water broke, the hot showers we took throughout the night to help with the pain, the crazy car ride to the hospital, and of course the moment Little Bear finally burst out and we got to see - for the very first time - the face of our daughter. Every 8 seconds this miracle occurs. Every 8 seconds a mother meets her child for the first time. And she will have her own story to share, different from anyone else, yet also so similar.

I believe that Birth Story Circles can help inspire mothers-to-be. They are wonderful reminders that roughly 97% of women can naturally birth their baby into this world with no serious complications. They help us to remember that we are not "special" or "unique" in that women all over the world have been birthing their babies for thousands of centuries. And yet they also allow us to share why our birth was special and unique, about how this universal experience affected us individually at an emotional, physical, even spiritual level.

Through the Birth Story Circles we can connect with women in our communities, share our vulnerabilities, and gain new strength.

If you are interested in attending a Birth Story Circle, call local birth centers in your area and ask if they hold one. And if they don't, ask if they might be willing to facilitate one. Perhaps you can even organize one of your own. They are a wonderful, intimate, and inspiring experience - one I urge all mothers and mothers-to-be to experience for themselves.

BabyLegs: Super Cute & Super Convenient

LB & her BabyLegs: What a Feeling!

It's back to the 1980's for Little Bear! While consignment store shopping last week I found 2 pairs of BabyLegs that looked almost brand new. I decided to spend the $2.00 and try them out! I'm so happy I did. I read about BabyLegs in Mothering Magazine last year and thought that while it was a cute idea, I wasn't sure if I'd actually use them. Cute, yes. Useful? Not so sure. And if I have to choose between the two, I'll go with useful almost every time.

BabyLegs got their start in 2005 when a mother decided to opt for useful (as many, many mothers do). Her little one had a bad diaper rash and she wanted to air her bum out - but also didn't want to freeze her to death. In a moment of inspiration, she snipped off the toes to a pair of socks and used them as leg warmers for her daughter. She soon discovered that diaper changing - and eventually potty training - became much more practical when she didn't have to fight with pants and bottoms all the time. Brilliant. The company BabyLegs has now expanded to include more - but they got their start from a baby with a bad case of diaper rash and a desperate mother. Click here to visit their homepage. It's pretty cool.

So Little Bear tried out her first pair of BabyLegs yesterday and they were a big hit (for me, at least ... she didn't seem to notice the difference). Diaper changes have never been quicker or easier. And she did look awfully cute, I must admit. Because we use cloth diapers (read here about reasons why we chose cloth), I find myself doing more diaper changes than if we were using disposables (this is actually a good thing because it means Little Bear is not sitting in her own pee, like disposables allow). Not having to take pants off - and then put them back on - really does save A LOT of time. Needless to say, I'm sold on the idea.

BabyLegs makes two sizes: newborn, and one-size-fits-most. Obviously, if you have an extremely chunky monkey, you may be out of luck. But the pair I picked up fits Little Bear very well at 7 months and should fit her for quite some time (even another year?). If that's the case - or, if you just have a creative streak in you - you can always make a pair of leg warmers yourself. I found a wonderful tutorial on Prudent Baby's website on do-it-yourself-leg-warmers. I think they'd probably take all of about 5 minutes to complete.


BabyLegs cost about $10-$12/pair on their website. Again, consignment store shopping can save you tons of money if you have a little extra time and patience. There is a knock-off brand called My Little Legs which cost about $7.50/pair on their website.. Supposedly Target has a brand, as well, but I couldn't find them on their online store, if so. Then, of course, Amazon.com offers both BabyLegs and My Little Legs - selling them for less than on each individual store's website.

However you find them, and for whatever cost you find them at, I'm sure you'll enjoy them. They come in an endless assortment of colors, and really are quite practical given certain circumstances. We probably won't wear them every day, but Little Bear will definitely be sporting the 1980's "Flash Dance" style from time to time.

Erythromycin Ointment for Newborns - Is It Necessary?

Look at almost any photo of a newborn and you will notice something funny about their eyes: they are usually gooey and slightly red. It is so common to see this in newborns, that some people actually think that is just how they come out! The truth is, that gooey stuff on the eyes is actually erythromycin ointment (an antibiotic). It is usually placed in a newborn's eyes within the first hour after birth, when the nurse or midwife is weighing and measuring the baby. It has become so common that many parents simply accept it as readily as they accept cutting the umbilical cord. But is it really necessary? The answer to that is: it depends.

Eye ointments have been used to prevent serious eye infections in babies since the late 1800s. At that time, silver nitrate was used. Unfortunately, silver nitrate - if given an incorrect dose - can cause blindness. Given correctly, it saved the vision of countless babies. Why? While being birthed, a baby's head, face, and eyes have to pass through the mother's birth canal and vagina. If a mother has an active case of gonorrhea or chlamydia, the infection can be passed from a mother's birth canal to her baby's eyes. This, in turn, can cause blindness in the infant.

Eventually, silver nitrate was replaced (for the most part) by erythromycin ointment. It is safer to use and has less side effects than the silver nitrate. However, erythromycin ointment can still sting slightly, causes temporary blurring of vision, and may cause allergic reaction in rare cases. For public health measures, most states and hospitals have made it mandatory that ALL babies receive a prophylactic dose of erythromycin ointment after birth. Better safe than sorry. And yet ...

There is absolutely no need for this eye ointment if you are 100% certain that you and your partner do not have any STDs. This means that a couple needs to be in a mutually monogamous relationship and certain that neither partner has an STD. I stress mutually monogamous. If either partner is having sexual relations outside the partnership, an STD could be unknowingly introduced to the mother - which could then be passed onto their baby. Unfortunately,  chlamydia and gonorrhea can be active without showing any obvious signs or symptoms. Therefore, proper STD testing at the beginning of pregnancy, followed by a mutually monogamous relationship for the duration of that pregnancy, can ensure a mother that she is not infected.

K and I chose not to have erythromycin ointment placed in Little Bear's eyes after birth. We knew I did not have chlamydia or gonorrhea and were not worried about infecting our newborn with an STD (one wonderful benefit of choosing to live monogamously!). We also wanted Little Bear to be able to see Mommy's and Daddy's face clearly during her first few hours of life - with no blurry goop to look through. Because the state of Oregon requires erythromycin ointment to be given to all newborns, I did have to sign a waiver before I left the hospital acknowledging that I did not want this treatment done.

Deciding whether or not you should have erythromycin ointment placed in your newborn's eyes after birth is a decision only your and your partner can make. But remember, it is completely unnecessary if you are certain you do not have chlamydia or gonorrhea at the time of birth. So whether you decide to have it done or not, sit down with your midwife or doctor and clearly let them know ahead of time what your wishes are.

Thrift Store Shopping!

I've always loved a good bargain ... and I've always loved taking something old and making it new. When I was a little kid I used to love reading The Boxcar Children. They would go to the dump and rummage through old stuff ... and they always found something worthwhile! While in college I would go to Goodwill and Christian Help (local thrift stores out West) for furniture, clothes, kitchen items, etc. It saved me tons of money, I still looked fashionable (you won't believe what people give away), and I was reducing my carbon footprint. Instead of paying $70 for a pair of shoes, I might pay $10.

Now that we've started a family (and especially since K is attending school part-time and I am staying home with Little Bear), shopping smart is more important than ever. Luckily, baby consignment stores are growing in number. There are two in our town - and many more in most larger cities. Here's what I love about baby consignment stores: almost everything they sell is brand new. Why? Two reasons, mainly: 1) because babies grow so darned fast that they only get to wear an outfit several times before they are too big for it! and 2) everyone loves to buy gifts for a new baby ... and items are often duplicated, unnecessary, or simply not something the parents will use.

Here are a few practically new items we've bought at consignments shops at less than half the retail value: Kelty Baby Backpack (tags still attached!), Ergo Baby Carrier Infant Insert (for our next baby ... someday), Robeez baby shoes, baby seat, BabyLegs, and a brand new leather/lambs wool snow jumper from Macy's! Here are items I've seen but haven't bought: jogging strollers, bassinets, co-sleepers, Ergo Baby Carriers, baby tubs, exersaucers, Baby Einstein DVDs, highchairs, brand new bottles and pacifiers, cloth diapers and diaper covers ... the list goes on and on and on.

Just yesterday I found a brand new Ergo Baby Carrier in the box for less than $60. They retail for around $120 on Amazon.com. Of course the trick with consignment shops is you never know what they are going to have - or when they are going to get something new. So just popping in every now and then is a must. Every once in a while a store will take your name down if you are looking for a certain item. K and I did this for the Baby Kelty Backpack. We lucked out and they called us 2 days later (which they admitted was highly unusual ... but it's worth a try).

In Little Bear's first 7 months of life, I've probably saved $300 from shopping at consignment stores. Also, I have a whole box of unused or barely used items I will be taking in next month to sell/trade-in - another benefit to consignment shopping. By trading in items that you no longer are using, you can usually get either cash - or credit at the store.

And for those of you that don't have a little one yet but just got invited to your 3rd baby shower this year ... I recommend making a trip to the consignment store! You'll save yourself a ton of money, and no-one even has to know (unless of course you are like me and like to brag about these sorts of things!).

Baby Poop 101

As a nurse, one of the first questions I will ask my patients (of any age) is, "When did you have your last bowel movement?" Nurses and doctors are obsessed with poop ... and for good reason. Changes in bowel movements (frequency, consistency, color, etc.) are more often than not some of the first indications of improving or worsening health. While we are all quite familiar with our own bowel movements as adults, knowing what is normal - and not normal - for a baby can be quite a completely new experience. When I first had Little Bear, I was unfamiliar with what I should be looking for with her poops. Knowing what to expect, what is normal, and what should cause concern can help a new mom or dad relax and not be so surprised at what they find in their little one's diaper!

The first rule of baby poop is "there is no normal." While a caring friend may share what to expect based on her own baby's poops, be aware that your experience may be completely different. Remember: this is normal! There are some general rules, however, that you can go by to help understand what you are looking at!

Green-Black. This is what you will most likely see the first few days. This green-black poop is actually called "meconium". This amniotic fluid that has been digested by your little one and has been sitting in your baby's intestines for quite some time. It is often described as having the consistency of "tar" ... and for good reason. It is like tar, and can be quite sticky and hard to wash off. Some babies will have one or two meconium stools. Little Bear had about 15 over a period of 5 days. I literally could not believe that my little baby could be holding that much junk in her intestines! Yet she was, and it is normal! Note: If you see black, tarry poop later on, after all the meconium is gone, this is an indicator that there is blood in the poop. Black specks in poop may occur if your nipples are cracked and bleeding and could simply be your digested blood. To be on the safe side, though, I recommend at least calling your doctor and letting them know what you found.

Green-Brown to Yellow-Brown. As your milk comes in and your little one begins drinking more (or, if you are giving formula, even sooner) the green-black color will slowly begin changing color. It will most likely start to take on a more brown tinge. Over the first week this brown will become lighter and lighter as the last of the meconium moves out of your baby's system (usually by day three). Little Bear took almost 7 days to clear her meconium. The midwives were a little worried that I was not producing enough milk. They weight Little Bear on a scale, however, and saw she was gaining weight - a solid indication that she was getting plenty to eat and all was okay!

Yellow. Bright yellow to brownish yellow, actually. Breastfed babies usually have a bright yellow poop until another food source (formula, solids, etc.) are added. It is usually watery. Often it looks "seedy".

Light Brown. Formula feeding (or supplementing breastmilk with formula) will cause poops to be a pasty light brown - sometimes light, sometimes darker, depending on baby and formula type. At times the poop may appear to have tan or greenish hues.

Green. Iron-fortified formula can cause green streaks in baby poop. Most formula is iron-fortified. Frothy green poop may mean that baby is not getting a proper balance of breastmilk. Breastmilk actually varies (what comes out in the first few minutes of a feeding, versus the last part of a feeding). Making sure baby feeds 10 minutes on one breast before switching can help solve this problem.

Green Specks. Okay, this one freaked me out. I noticed small little specks of green in Little Bear's poop at around 6 weeks. I did some research and found out THIS IS NORMAL and that it has to do with bile being excreted. Whew.

White/Chalky. This is one color you DON'T want to see. It means that there is an issue with not enough bile being produced to properly digest foods. Save a sample of poop and call your doctor for an appointment.

Bright Red Streaks. This means blood. This often occurs if a baby gets constipated, which in turn can cause small skin tears to the anus. If you don't believe constipation is the problem, call your doctor. And save a sample of your baby's poop to bring in!

Black. Just like in adults, iron supplements can cause black colored poop. Did your pediatrician recently add iron supplements to your baby's diet? This is most likely the cause behind that black poop.


Other colors. Once solids are added, poops can vary greatly in color. They may be brown, orange, even blue ... depending on what you are feeding your little one. Little Bear has a lot of bright orange poops because she eats a lot of sweet potatoes!

Smell. Breastfed babies have what is often described as "sweet-smelling" poop. And it's true. Which makes changing diapers much more enjoyable! Formula fed babies will have more "stinky" diapers with "grown-up poop" smells. Once solid food is added to a baby's diet, a range of smells is quite common. Right now we are giving Little Bear lots of vegetables, some fruits, and a few meats. Her poops are still quite pleasant smelling!

Consistency. Watery poop is going to be normal for breastfed babies. Formula fed babies will have a more pasty consistency to their poop. Around 4 months, however, Little Bear suddenly developed beautiful yellow, pasty poop! I describe it as "smooth peanut butter" consistency. We didn't add anything to her diet ... it just suddenly changed! I think her system must have started digesting things differently. Once solids are added, poop will very quickly take on a more formed consistency - similar to ours. It should still be soft, however, and never hard. Little Bear started getting hard stools when I fed her too much banana. This indicates constipation, meaning that stools are sitting longer than necessary in the intestines. Not good. Visit my post on constipation for ideas to solve this issue!

Frequency. Here is another category that can vary greatly depending on baby! It can be very normal for a newborn to poop after every meal! Little Bear had many poops every day the first month. On the other hand, your baby may only poop once every day or two. Breastfed babies are more likely to poop several times a day. Formula fed babies will often poop much less - even during the first month. And it changes, as each baby grows older. It can be quite common for a baby to be pooping several times a day - and then suddenly go several days without pooping. Even a week without pooping is considered normal! Little Bear went 5 days without pooping once. I was a little nervous, but because we were breastfeeding and had not changed our feeding habits, I doubted she was constipated. And she wasn't. When she finally did poop, however, it was quite a sight to see!

Using your mothering instincts, however, is especially important during times like these. If your little ones looks uncomfortable - trust your instincts!

Changes in Frequency and/or Consistency. While there are going to be changes in color and consistency, always make sure to be alert and aware of these changes. As mentioned above, it is very normal to see changes in these patterns as you change food sources and/or your baby grows older. What is not normal, though, is going from formed poop one day ... to multiple watery poops the next. This is an indication that your baby has diarrhea. Again, be aware and trust your instincts!

Grunting/Crying. As an adult, we hear a baby grunting/crying and think: constipation! And perhaps this is true. But more likely than not, your baby is simply getting used to this new sensation of pooping! Little Bear did NOT like pooping once she started having more formed poops. She would sit and scream on her potty, very upset at the whole scenario. She has since gotten used to the fact that pooping is okay and not as scary as she first thought. Very hard poops, however, may very well indicate constipation.

Click here for a wonderful look at various pictures of baby poops!

Remember, though, that every baby is different. Those little GI tracts all work at different speeds - resulting in very different looking poops and pooping patterns. Use your instincts, observe your baby, and if really concerned, call your doctor.

Breastfeeding: Benefits for Mom

It's easy for moms to look at their little one and decide that breast really is best. All the health benefits for baby are amazing and incredible. Click here to read about many benefits to baby of exclusive breastfeeding for 6 months. But here is some more great news: breastfeeding isn't just good for baby ... it's good for mom, too!

1. Weight Loss. Okay, it might not be the most important reason to keep breastfeeding, but it definitely is a motivating one! I gained 48 pounds while pregnant with Little Bear. I went from a size 4/6 jeans to a size 14. It seemed that no matter how healthy I ate, the pounds just kept packing on! The female body knows what it needs to do to carry a baby - and gaining weight is part of the process. Two weeks after Little Bear was delivered, though, I couldn't help but wonder if I'd ever fit into my pre-pregnancy pants again. Suddenly, around month three, the weight just started falling off. And falling off. And falling off. Weight loss typically peaks during months 3-6. As Little Bear grew and required me to make more milk for her - my body started burning calories like crazy. Breastfeeding can burn between 200-500 calories/day. That's like going out and running several miles - every day!

Some things to remember: Your body needs lots of calories the first two months after delivery! Don't restrict calories to try and lose weight at this time. Doing so could interfere with your milk supply. Eat a healthy diet and drink plenty of fluids. Click here for more information.

2. Uterine Contractions. The sooner a baby is put to her mother's breast after delivery, the better. There are several reasons for this, but one of them is to start uterine contractions. Stimulation of the nipples causes a release of oxytocin in the mother. Oxytocin works naturally on the body to begin uterine contractions. And why is this a good thing? In the first few hours, these contractions will help seal off blood vessels in the uterine walls, lessening the amount of bleeding you experience overall. Over the next 4-6 weeks, these contractions will help the uterus shrink back to it's pre-pregnancy size. Each time your little one suckles at the breast the first few weeks, you may be aware of cramping in your abdomen. This is not only normal - it's good! The drug pitocin was introduced as a man-made alternative to oxytocin. Pitocin also works to contract the uterus after delivery. It is often times given to women after delivery. But why even bother with a man-made alternative when we have the real thing built into our own bodies! Pitocin can have the following side-effects: anaphylactic reaction, postpartum hemorrhage, nausea, vomiting, pelvic hematoma, hypertensive episodes, heart arrhythmias. Oxytocin made in a woman's body has no side effects! So start nursing and get the oxytocin flowing!

3. Reduced Cancer Risk. Here is perhaps my favorite reason for women to breastfeed - other than for the health of the baby, of course. Research done over the past 10-15 years is showing that breastfeeding can significantly reduce a woman's risk of getting breast, ovarian, uterine, and edometrial cancers. And even better news: the longer you breastfeed, the lower the risks. Breastfeeding for a total of 6 years throughout your lifetime (if you have 3 children, that's 2 years for each child ... which is the World Health Organization's recommendation) decreases your risk of breast cancer 63%. That's huge. So here's to less cancer and more breastfeeding!

4. Increased Bone Density. This one is a bit counter-intuitive. One might think that all that nursing and providing nutrients to your little one would actually decrease bone density. And actually, it does, for a while. But studies show that upon weaning, a woman's bone density actually increases again.  In a culture where osteoporosis is rampant, this is a good thing (one might also consider giving up those diet sodas that can also cause a loss in bone mineral density - but that is another topic altogether). Dr. Sears states that "non-breastfeeding women have a four times greater chance of developing osteoporosis than breastfeeding women and are more likely to suffer from hip fractures in post-menopausal years."

5. Oxytocin (the "love hormone"). Every time your baby suckles at your breast, oxytocin rushes through your body. It not only helps in the uterine contractions ... it is also considered the "love" or "bonding" hormone. Oxytocin helps reduce post-partum anxiety and depression. It also can help a mother to relax and adjust to all the changes a new baby brings into her life. Oxytocin is a tremendous hormone and anything that helps us get more of it on a regular basis is a good thing!

6. Natural Birth Control. Exclusively breastfeeding can actually work as a natural birth control for the first 6 months, and in some cases, much longer! One must be following what is called the lactation amenorrhea method (LAM) of family planning, however, for it to be effective. If followed, this method has been shown to be over 99% effective in preventing pregnancy. Here is information on LAM. Be aware of all the specifications that must be met ... women in our culture rarely meet all of them and therefore should not rely solely on LAM for birth control (for example: using a breastpump on a regular basis does not meet the specifications).

7. Saving Money/Convenience. Formula for a baby costs anywhere from $60-$250/month, depending on the brand and type of formula you choose. Wow. Breastfeeding literally costs you $0/month. Even if you factor in the cost of buying a breastpump, you are still saving big time by breastfeeding. The convenience of breastfeeding, in my opinion, cannot be overstated. Whether we decide to go for a drive, take Little Bear on a long hike, or are out to dinner with friends, I never have to think about packing a bottle for Little Bear. Having an instant supply of food for our little ones is another wonderful advantage!

8. Time Together. They grow so darned fast. I can't believe Little Bear turned 7 months yesterday. She has started eating solids and skips 2 breastfeeding sessions each day. Soon, I know, she'll need me even less. I cherish, more than ever, our nursing time together. I love watching her when she finally gets to latch on ... her eyes close and her breathing becomes calm and content. Her little fingers stroke my skin and I can feel her heart beating against mine. I know that all too soon these intimate moments will be nothing more than fond memories. She won't remember these times together, but I will remember them even when I'm old and grey. It's easy to get caught up in the crazy business of our culture. Our forced quiet times together helps me to slow down, enjoy the present, and remember what an incredible gift and blessing it is to be a mom.

Diapering: Why We Use Cloth

For thousands of years women have diapered their babies using natural ingredients from the earth. It may have been grass stuffed in a rabbit skin. It may have been moss, linens, and leaves. Often times babies were simply naked so mothers used Elimination Communication with their infants. Only in the past 30-40 years have parents used disposable man-made materials on their children's bums (disposable diapers where technically in use beginning in the 1950s, but they were considered a rare novelty and only used during special occasions by parents that could afford them). Growing up as a child I didn't really consider that there was an option other than disposables. They were so popular that I can honestly say I don't ever remember seeing a cloth diaper during my teens or twenties. Slowly, though, the truth began to seep out. And as I began thinking about starting my own family, I started to pay attention.

Environmental Impact. It started out with acknowledging the huge environmental implications of using disposable diapers. In the United States alone, 27.4 BILLION diapers are used each year ... resulting in 3.4 MILLION tons of used diapers ending up in landfills every year. The more I studied the environmental impact of disposable versus cloth diapers, the more convinced I was that I would use the latter. Cloth diapering does not come without environmental impacts, however. Washing, drying (if using a machine), even growing cotton to make the cloth diapers, all impacts the environment. However, with a little education and proper care, cloth diapering can be the more environmentally responsible choice. Some things to consider: 1) wait to wash a full load of diapers, 2) hang diapers to dry in the sun whenever possible, 3) buy 100% organic cotton, hemp or bamboo cloth diapers rather than regular cotton (cotton crops are notorious for using lots of chemicals), and 4) re-use cloth diapers for more than one child.

Did you know that on the package of disposable diapers it clearly states that "when disposing of soiled diapers, empty contents into toilet." First of all, nobody I know of does this. Second, why is this? Because dumps and landfills are not allowed to store human waste. Only sewage systems and septic tanks are made to dispose of human waste. Yet each year millions of towns of human waste are placed in landfills via disposable diapers.

Chemicals. Exactly what is in a disposable diaper remains a mystery. Why? Because the diaper companies won't tell you, and legally, they don't have to. Here is a list of a few ingredients that is known about what is in a disposable diaper: paper pulp, polyethylene (and other plastics), glues, dyes, synthetic perfumes, and sodium polyacrulate (a super absorbent material that absorbs urine in a type of "gel"). And here is why I care. In 1999, a study was published in The Archives of Environmental Health that found that mice exposed to various brands of disposable diapers suffered increased eye, throat, and nose irritation - including bronchoconstriction similar to that of an asthma attack. The Asthma and Allergy Foundation of America states that "the prevalence of asthma has been increasing since the 1980s." Of course other environmental factors need to be looked at as well, but with disposable diaper use hitting an all time high in the late 70s and early 80s - it causes one to stop and wonder.

Our skin is like a sponge. It soaks up whatever is on it. That is why we can use patches for medications like birth control, nicotine, and fentanyl (for pain). Why would be want chemicals sitting against our baby's bum all day? The skin WILL absorb them.

Diaper Rash & Fertility. The incidence of diaper rash has increased from 7% in the 1970s to 60% by the mid-1990s ... which happens to coincide with the increase in disposable diaper usage. Wearing disposable diapers make infants feel dry - even when they are wet. Wearing disposable diapers actually cause an increase in skin wetness and pH - which in turn can cause diaper rash. Visit this website for more on diaper rashes. Using cloth diapers alerts an infant immediately when they have soiled. Little Bear cries immediately upon wetting or pooping, notifying me that it is time to change her! Very rarely will she allow me to let her sit longer than several minutes in a soiled diaper! As of yet, we have had no diaper rashes.

Additionally, in October 2000, the Archives of Disease in Childhood speculated that disposable diapers may be partially responsible for the increase in male infertility over the past 25 years. Disposable, plastic-lined diapers keep the testicles hotter than core body temperature - 1.8 degrees hotter that cloth diapers! An increase in testicle temperature for extended periods of time can cause reduction in sperm production and possible long-term infertility. Think about it ... all male babies that wear disposable diapers the first 2-3 years of their life are constantly exposing their testicles to higher than normal temperatures!

Economics (saving money!). Over time, cloth diapering costs less. Here is a great website that looks at the costs associated with each option. Cloth diapering saves you roughly $1000/year ... if not more. This savings jumps even higher if you use the same cloth diapers on baby number two and three!

Potty Training. Children that wear cloth diapers potty train faster and earlier than children that wear disposables. It is assumed that because a child knows immediately when he or she has wet or soiled a cloth diaper that potty training is made easier for them, as opposed to disposable diapers that wick moisture away and cause the child to feel dry - even when they are not. Cloth diapering also, I am sure, makes Elimination Communication (early use of the potty with infants) easier for both mother and baby, as well. Because a baby wearing cloth diapers lets someone know immediately when they have wet their diaper, parents can more easily learn their child's potty cues and potty schedules. This way, a parent can more easily anticipate when their child might need to use the potty - even from a very young age.

I'm sure there are many more reasons to choose cloth over disposable. Feel free to list your reasons in the comments below! And the best part: once you get a routine down with your cloth diapers, they really are just as convenient and easy to use as disposables. Really. So I encourage everyone out there to at least do a little more homework and consider the option of switching from disposable to cloth ... whether it is for the health of your baby, to save money, to assist in potty training, or to help out the environment. It's a choice you won't regret. I promise.