3.5 year old in Radian

Combination Car Seat Reviews

Sorry no blog post last week, Cradled in Joy fans. Just as I was finishing writing a blog post – it was, I assure you, witty, informative, even earth shaking! – my 2009 white Macbook finally lost the last of its ability to draw power from either the battery or the power cord. One technology-deprived week later (in a house only three dead computers, four iOS devices, three outdated Nintento systems, one television, a modem, and a router), we are now wildly outnumbered by modern Apple products and I can attempt to rewrite what was mostly lost.

****

Car seats became mandatory for Ohio children (really, for children nationwide, but, like seatbelts, these are state laws and there is some variation from place to place) on January 1, 1981. Since that time babies under 1 year and 20 pounds (must meet both criteria) must ride in a properly installed rear-facing car seat, and children under 4 years and 40 pounds (again, gentle reader, that is AND not OR) must ride in a 5-point harness.

In the early 2000s a booster law was added, and more recently national recommendations for rear-facing have increased. I’ll go into these issues in more detail another time. Today, I will share some of my experiences with forward-facing seats.

My eldest child, now 4.5 years, rode from birth in a Cosco Scenera, a convertible (can be used both rear-facing and forward-facing) seat. It was simple, safe, and inexpensive. Its maximum passenger weight is 40 pounds, which initially concerned me a bit: what if my darling reached 40 long before turning 4? Would I need to purchase a higher-weight-limit seat for a few months? Well, I would have, but I needn’t have worried. My darling, instead, reached age 4 long before 40 pounds. On her 4th birthday the child weighed 32.2 pounds, in clothes and shoes.

No problem, then, right? Wrong. Because as the year has worn on, her shoulder height has increased beyond the Scenera’s maximum strap slot. Forward-facing seats must be used with the STRAPS AT OR ABOVE THE SHOULDERS; this prevents compression in an accident. On her current growth curve, my kidlet won’t be 40 pounds and booster eligible until almost her sixth birthday. And she’s not the only one, as she is only just barely below the 50th percentile for girls. So this problem could well happen to you.

Or, you could have a kid who does max out a 40-pound seat before her fourth birthday. Or your sweetie may be just perfectly convenient in height and weight and outgrow his seat all in one go, but lack the responsibility to sit upright and facing forward in a mere booster. For all these reasons, it is worth seeking out a 5-point harness seat with higher shoulder strap settings and a higher weight limit.

In the end, I wound up with three models (in different cars my daughter rides in), of combination seats, that is, forward-facing 5-point-harness seats that can later have the straps removed for use as boosters. Two of the three can further have their backs removed to become backless boosters that you just toss in whatever car your child needs to ride in; I look forward to that time! Because I was working with a child who’s taller than she is heavy, all three have particularly tall maximum shoulder strap heights. Also, all three can be used with harness for children to about 65 pounds (this is important if you have a chunkier kid – or just if you want the safest ride possible, as, really, we would ALL be safer in 5-point harnesses).

One important feature that all three of our seats share is that they are allowed to be attached to the car with the LATCH system when used as high-back boosters. This does not secure the child to the seat, obviously, but does prevent the seat from becoming a projectile if you’re in an accident while the seat’s vacant. Most boosters don’t allow this. Both the Defender and the Nautilus can be used as backless boosters, and they do not LATCH to the car in this configuration; but then, a backless booster has a lot less mass to knock front seat passengers in the back of the head with.

The first, a Diono Radian, is installed in our own car and so is the one I’m most familiar with. The Radian is kind of an amazing seat in that it may be the only car seat you ever need. It installs rear-facing (if your car is less tiny than mine) for babies 5-40 lbs–though it does not click in and out like the bucket-type carrier seats, so if that’s important to you it is not the seat to begin with. It can be turned around and used as a forward-facing seat from as early as 20 pounds. (We’ll talk more another time about why you want a seat that rear-faces beyond 20.) Finally, it converts to a high-back booster seat from 30 to 120 pounds (30 is the legal minimum in some states, but as I said above, in Ohio a harness is required by law to at least 40 pounds). It has the nicest buckles and is easiest for the kid to climb in and out of. In fact, she can operate the chest clip fully on her own and has been able to for about a year. She just got the lap buckle snapped on her own this week, and still cannot unsnap it – in any seat. The Radian has the nicest LATCH clips. But it is nonetheless kind of a pain to move between vehicles because it is super heavy and tips over if set on the ground. It also only has one height for threading the shoulder strap through in booster mode, though as I haven’t used it as a booster I can’t be sure how much this matters.

The Harmony Defender (installed in my father’s car) has two amazing selling features: it is under $100, and it has a no-rethread harness height adjustment (just squeeze a handle in the headrest!). Also it comes with two cupholders, which the kid likes. It was a nuisance to assemble out of the box, but that’s a one-time, 20-minute issue, so not at all a deal-breaker. Its harness straps sit oddly close together around even my skinny minny’s neck. The biggest downside of the Defender, though, is buying it: it is sold exclusively by the evil empire Walmart – and it often goes out of stock for months at a time.

The Graco Nautilus (we have two – one in my mom’s car, and one in my in-laws’) has the smoothest-pull strap tightener, one good cupholder, is lightweight, and assembles and installs easily. I personally don’t like its chest clip; I actually struggle to unbuckle it, but I don’t use this seat daily and would perhaps get used to it. Also, critically from my 4 year old’s point of view, we own the Nautilus in pink. So clearly it’s the best.

Advertisements

What If My Baby Is Too Big?

One worry common among pregnant mamas is that they will grow a baby “too big to birth (naturally).” We’ve all heard the horror stories – and maybe seen the photos on the internet – of 10, 11, or 15-pound whoppers of newborns. And most of us receive at least one third-trimester ultrasound, a standard part of which is the estimation of fetal size. So, just what are the risks of a large baby, and how should we proceed?

First, we need to know what constitues a “big” baby. There are two kinds of “big”: macrosomia and large for gestational age. Macrosomia, or “large body,” can be alternately defined as a birth weight greater than 8lb 13 oz (4000g) or one greater than 9lb 15oz (4500g). Slightly over 7% of American babies are born greater than 4000g, and slightly over 1% weigh more than 4500g at birth. Large for gestational age (LGA), on the other hand, is the medical term for any baby born over the 90th percentile for babies born on the same day of pregnancy (how many weeks and days pregnant mama is when baby is born). By definition, 10% of all babies are LGA.

Your baby’s birth weight is influenced by many factors, including maternal and paternal height, whether mom was obese prior to pregancy, mom’s weight gain during pregnancy, baby’s sex, and chemical exposures including smoking. By far the biggest risk factor for unusually (and unhealthily) large babies, though, is gestational diabetes. Like other pregnancy complications, gestational diabetes carries its own list of risks for both mom and baby, and is to be taken seriously.

However, even in the uncomplicated pregnancy there are certain complications associated purely with fetal size. Most of these are a result of the increased mechanical demands of a larger baby passing through the birth canal. Labor is more likely to stall, vacuum or forceps delivery is more often necessary, and perineal tearing and pelvic/tailbone trauma are more common. The increased risk most cited by physicans is also a mechanical complication: shoulder dystocia, which is quite simply the baby’s shoulders getting stuck behind the mother’s tailbone after the head is born. Although shoulder dystocia is more common among large babies, it is not altogether uncommon in babies of any size, and it can nearly always be managed with relative ease when it does occur. (And, lest this all seem rather bleak, there is some good news for parents of larger than average babies: big newborns – up to about 10lbs – grow up to be more successful grade school students.)

Thus it would seem that prenatal diagnosis of fetal size would be useful information for a birth team, right? After all, surely that is the reason two-thirds of US women receive late-pregnancy u/s to estimate size. Well, yes and no, for it turns out these estimates are notoriously inaccurate. Of the many formulas used to estimate birth weight, the very best formula is within +/-10% of baby’s weight only 70% of the time. All formulas work best on mid-sized babies. Using a little back-of-the-envelope math, this means that, if you’re told your baby is “large” or “very large”, there is at least a one-in-three chance that your baby’s real weight is a whole pound different than the estimate you’ve been given. In fact, with most methods there is little better than a 50/50 chance that your “suspected large” baby is in fact macrosomic – about the same accuracy as a physican’s guess after feeling the mother’s belly, and only moderately more accurate than just guessing every baby at 3455g (7lbs 10oz, or perfectly average).

As unreliable as fetal size estimates are, however, they can have a marked impact on pregnancy and labor management. As many as two out of three physicans will propose induction, and as many as one in three will propose scheduled cesarian, on the basis of such an ultrasound finding. Additionally, doctors are more likely to diagnose the labors of suspected large babies as failing to progress, thereby setting off a string of interventions to speed/assist the birth, even when those labors are in fact progressing at the same speed as labors without suspected large babies. Comparing labors in which a baby that was both suspected to be and actually large with labors in which an actually large baby was not previously suspected, the suspicion of macrosomia markedly increases medical intervention without significantly changing outcomes. The American College of Obstetricians and Gynecologists specifically names macrosomia as an insufficient reason to induce birth (or schedule a cesarian) prior to 39 weeks gestation.

So, while it is certainly true that big babies can be hard to birth, it is not necessarily the case that estimated fetal size alone should alter an expecting mother’s plans. After all, babies of any size can be difficult to birth. Quite often the culprit in a difficult birth isn’t baby’s size so much as baby’s positoning. The strategies for vaginally birthing a large baby are really the same as those for any other baby: using good posture through late pregnancy, and utilizing motion and gravity during labor. Certainly, it is true that a large baby has less room to maneuver during birth, which makes such positioning tactics even more important.

Whether your baby is large or small, your doula can help you try out labor positions and techniques including walking, dancing, kneeling, leaning, lunges, and squatting. Even with an epidural, periodic position changes help the baby ease its way down the birth canal and into the world.

References

Dekker, Rebecca. “What Is the Evidence for Induction or C-Section for a Big Baby?” Evidence Based Birth. http://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/

Nahum, Gerard G, MD, FACOG. “Estimation of Fetal Weight.” Medscape. http://emedicine.medscape.com/article/262865-overview#aw2aab6b2

“The Dangers of Estimating Fetal Weight Near Term.” The Well-Rounded Mama. http://wellroundedmama.blogspot.com/2012/09/the-dangers-of-estimating-fetal-weight.html

“Optimal Fetal Positioning.” Spinning Babies. http://spinningbabies.com/about-spinning-babies/optimal-fetal-positioning

Leonhardt, David and Amanda Cox. “Heavier Babies Do Better in School.” The New York Times. http://mobile.nytimes.com/2014/10/12/upshot/heavier-babies-do-better-in-school.html?referrer&_r=2

Meet Jackie

Greetings and salutations! My name is Jackie Warmke, and I’ll be joining Rachel here at Cradled in Joy, so I reckoned I should start by introducing myself. A short version of my bio will be over on the About Us page, but here’s a more chatty narrative version (which you will soon learn is my preferred style).

I’m a native of Athens, Ohio, the child of teenage parents (well, they aren’t anymore, of course!). I met my husband in a high school creative writing course sixteen years ago; next spring we will have spent half our lives together. Our two daughters are four and one, and I am awestruck every day by how entirely themselves they are. I earned my undergraduate degree in English language and literature from Butler University, with a minor in anthropology, then returned home for a masters in literary history at Ohio University. My favorite class in college was Anthropology of Sex and Love: though at the time I was inundated by the workload, it formed the foundation of how I would eventually approach motherhood and, of course, my work as a doula.

I met Rachel two years ago in birth doula training. She began taking clients immediately and so has completed her certification with Doulas of North America (DONA); in fact, I hired her for the birth of my second child. Because of the demands of my own pregnancy and postpartum year, I only began attending births in July of 2014 and am still working toward certification.

Around town you’re likely to find me at Birth Circle and La Leche League meetings, the farmers’ market, and various little-kid hangouts including the Athens Public Library and the Ohio Valley Museum of Discovery, as well as popping up in several local moms’ groups on Facebook.

I am excited to be coordinating childbirth services with Rachel. We share a love of evidence-based practice and a passion for helping expecting mothers and their partners gain the information and skills they need to be empowered by the journey through and into their new lives as parents. Cradled in Joy’s current professional offerings include Lamaze childbirth classes, DONA birth doula services, and placenta encapsulation. Together with her husband Jason, Rachel offers photography sessions to capture the seasons of your life, as an individual and a family. Over the next weeks I will be undertaking a correspondence course to add postpartum doula services to Cradled in Joy’s menu of services, and I am registered for Child Passenger Saftey Technician (that is, car seat expert) training in the spring.

Beyond these listed professional services, we’re both great big birth nerds, always reading and learning about all sorts of matters related to pregnancy, birth, postpartum mama care, breastfeeding, cloth diapers, and more–and always looking for ways to share the knowledge that so excites us! Watch this space for continued blog posts, links, and more.