Starting Solids, eh?

Since my youngest babe has just started solids, I thought it might be fun to visit the topic, especially since Canada has released some innovative new “starting solids” guidelines in the last year. With our first, we started on purees at 6 months, but we are finding that our youngest child is doing a lot better with feeding when we let him take the lead, which, as it turns out, is right in line with Canada’s new recommendations!

Our first child, exploring blueberries!!!

Our first child, exploring blueberries!!!

These new guidelines are right in line with the latest research on infant health and development. The American Academy of Pediatrics is about halfway there with their guidelines, but Canada is much more clear about waiting to start solids and introducing them in a more natural form, rather than as messy (and let’s face it–unappetizing) goop.

Even though we are based in the US, it is important to know how other countries are responding to research for feeding babies. The US will not be far behind, so it’s not a bad idea to get a head start on upcoming changes. The new guidelines are very similar to the popular infant feeding method known as Baby-Led Weaning, which encourages independence and feeding when children are ready.

Both Canada and the AAP suggest your baby is ready to start solids when all of the following milestones are met:

  • Your baby is 6 months or older
  • Your baby is over 13 pounds or has doubled in weight since birth
  • Your baby can sit up on his or her own
  • Your baby can bring food to his or her mouth using hands or a spoon
  • The tongue-thrust reflex has disappeared
  • Baby is eager for mealtime and is grabbing at your food

What are Canada’s new recommendations?

  • As always, breastfeeding exclusively for the first six months, and continuing alongside solids for a year or longer (World Health Organization recommends breastfeeding alongside solids for 2 years and longer)
  • Starting solids around or after 6 months (best for baby’s gut, no matter how big your baby is!)
  • Starting with lumpy textures and soft finger foods, rather than purees
  • Also starting with iron-rich foods, including meat!
  • No cow’s milk until 9 months (formula fed babies) or after 12 months (breastfed babies)
  • No honey until 1 year of age
  • No sippee cups!  Use an open-mouth cup to introduce beverages
  • Not waiting on allergenic foods–introduce them alongside others, but space out the allergens (nuts, eggs, etc) by a couple days to monitor for reaction

These latest guidelines show an increased respect for the intelligence of our children. As it turns out, babies are a lot smarter than we think they are, and they find ways to explore and learn and grow all on their own!

“Women’s Choice of Positions during Labour”

A new research study by an Italian team looks at how the mother’s position affects labor and delivery. “Women’s Choice of Positions during Labour: Return to the Past or a Modern Way to Give Birth? A Cohort Study in Italy” (BioMed Research International, Volume 2014 (2014), Article ID 638093, 7 pages). The authors may not speak English as their first language, but their findings are perfectly clear:

WHEN GIVING BIRTH, THE BED IS NOT YOUR FRIEND!

The study authors are careful to emphasize that these results are those of a group of healthy, low-risk first-time mothers and larger studies are in order before upright posture can be recommended across the board, but let’s look at what they found to be true of their cohort:

  • Moche - Female Figure in Birthing Position - Walters 482836Upright posture led to an average of 2 hours shorter dilation stage, 45 minutes shorter pushing stage;
  • Recumbent posture had significantly higher rates of epidural, episiotomy, cesarean, dystocia, and abnormal fetal heart rate;
  • “no differences between two groups in terms of neonatal outcomes were reported”;
  • Recumbent posture (including in a bed with the back up) is more convenient for doctors.

If you’re interested in learning more about using gravity-assisted positions in labor, phone Rachel at 765.977.3817 for Lamaze childbirth education classes and Jackie at 740.590.9994 for birth doula support.

Hospital Class vs Lamaze

The biggest battle in birth education is on: hospital class vs Lamaze.

I can’t tell you how many people say, “Oh we’ll just take the hospital class. It is cheaper and they cover the same stuff anyways.”

The problem with the above statement? It’s not true. At all. A good birth education is worth every penny because it saves you costs in the delivery room AND it covers far, far more than a hospital class ever could.

Think about it: the hospital class is usually about 3 hours long, and one of those hours is used for a floor tour, which means you get a miserly 2 hours to learn all about birth. Lamaze classes are 12 hours, and there are times when I feel they are still not long enough to impart all the necessary knowledge for a safe and empowering birth.

Still not convinced? Let’s break it down.

Here is what the hospital class typically covers:

  • Admissions process
  • Labor, delivery, and postpartum floor tour
  • Common interventions and how they are done (i.e., they will show you the epidural catheter)
  • Bare bones basics of birth

That’s it. What about what labor will feel like? What choices will you have if something is abnormal in your labor? What, in fact, is normal in labor? How can you cope with a difficult labor if you don’t use drugs? If you do use drugs, how can you make sure your labor is still safe and quick? The hospital class won’t answer these questions, but a Lamaze class will.

Now let’s look at what the Lamaze class covers:

  • Basics of labor
  • typical and atypical timelines of labor
  • sensations of labor at each stage and phase
  • how to cope with each sensation of labor
  • hands-on practice with coping tools
  • how partners and doulas can best support moms in labor
  • multiple real-life videos and birth stories to show what it is like
  • benefits and risks of various interventions
  • signs of trouble in labor, and choices you have for each issue
  • benefits and risks of cesarean birth
  • postpartum expectations
  • newborn appearance, characteristics, and procedures
  • benefits and risks of newborn procedures
  • breastfeeding initiation
  • breastfeeding issues and how to overcome them
  • bonding with your baby
  • and so much more!

Birth is about more than just a few hours in a hospital room or birthing tub; it is about a life-changing process that will affect your outlook for the rest of your life. Treat it like the great moment it is and prepare well for it. Your knowledge will help you feel empowered in your birth and will help you to take an active role in welcoming your baby into the world. A birth class puts you in touch with other new parents and resources you can use after the baby is born for help with anything from socialization to breastfeeding and more. Plus, you may be able to avoid interventions (and thus, save money) by using the many skills you learn in a Lamaze class.

I recently had a couple who took both my class and the hospital class, and they couldn’t say enough how helpful my class was in comparison. They said many of the other people in the class were clueless about what to expect, whereas my students had no questions or fears because they were equipped with the information they needed to make informed decisions in the delivery room.

Can my mother/sister/husband/friend/midwife be my doula?

A laboring woman should be accompanied by whatever people as she chooses. However, the support of professional doula is different from – and complimentary to! – the support offered by loved ones, and that offered by medical professionals.

You wouldn’t expect your partner to stand in for the doctor, or the doctor to stand in for your partner, would you? Of course not! The primary role of the medical team – doctor/nurse/midwife – is to monitor and support the physical health of mother and baby. Doctors, nurses, and midwives typically endeavor to support the laboring woman emotionally as well, but when the birth room gets busy, that’s not their primary task.

So what about loved ones? Well, at my first birth I was assisted by two midwives, my husband, and my mother. My mother is an experienced nurse and nursing instructor. Although not an expert in labor and delivery, you’d likely imagine she’d be able to provide “emotional support, physical comfort measures and an objective viewpoint, as well as helping the woman get the information she needs to make informed decisions,” right? Well, she certainly provided emotional and physical support and gave my partner the breaks he needed, but so far as objective viewpoint goes: NOPE! This was her baby, in pain and bringing forth her grandbaby. In this moment, she was just – and wonderfully – Jackie’s Mommy.

For my second birth, I hired a doula. (I hired Rachel.) You can see her here, working together with my husband to support me through pushing. My midwives are present but out of the shot – because they are busy with the medical work of assisting delivery.Rachel assisting at the birth of Jackie's second child

This does not mean you should not invite your mother or other loved one as well as a professional doula! We strongly believe that women in labor should be attended by whomever they choose (though you may need to check in with your provider’s/birth location’s policies regarding number of attendants). Because just as your mother/sister/husband/friend/midwife isn’t a professional doula (and perhaps even if s/he is), a professional doula knows very well that her role is not the same as you mother/sister/husband/friend/midwife’s. Only the medical team is the medical team, and only your loved ones are your loved ones.

Indeed, although your doula’s primary duty is to you, the laboring mother, most medical professionals and loved ones wind up finding that the presence of a professional doula enhanced their own ability to support the laboring mother. The doula eases the pressure on the partner, and on the medical staff, to fill all the roles all the time. She helps hold the birthing room as a sacred space, in which every attendant is able to bring her or his particular skills and gifts.

Together, we support the mother and her birth memory.

FREE Cloth Diaper 101 Class!

As part of my partnership with GroVia, I am now offering a Free Cloth Diaper 101 class!

The class will be held February 7 at 10 am.

In about an hour, I will explain the benefits of cloth diapering, the different types of cloth diapers, how to care for cloth and much more! There will be a giveaway for free cloth diapering supplies at the end, and I will have plenty of tea and cocoa available for all who attend!  This is a great introduction to cloth diapering and you will be able to order cloth diapers at the class if you decide that cloth diapering is for you.

RSVP on the Facebook Event Page to register for the class!

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The Dreaded Pelvic Exam

Last week I provided some jumping-off points for selecting the right prenatal testing for your own situation.

This week, I’m going to discuss a prenatal test that many of us submit to without even considering it a prenatal test at all: the pelvic examination.

There are several points in pregnancy when pelvic exams may be offered or suggested. They used to be performed as a routine part of a pregnancy diagnosis, though this is not common anymore. If you are behind schedule on Pap smears (which test for cancer of the cervix; current guidelines recommend one every third year to most healthy childbearing-aged women), your provider may encourage you to have one early in pregnancy. Pelvic exams may also be indicated to diagnose or manage any of a wide range of disorders, from STIs to yeast infections to unexpected bleeding.

Finally, there are the pelvic exams that are often part of routine care in the last month of gestation. At this point in pregnancy, you’re visiting your doctor or midwife every week (more, if your pregnancy is complicated or you go more than a few days past your due date). And you, your provider, your mother-in-law, and the guy who bags your groceries all desperately want to know one thing:

When will this baby get born?!

You have doubtless heard friends, or characters in movies, talk about their late-pregnancy cervical checks. “Oh, the doctor said I’m 3.” “I’m closed tight, and my due date is tomorrow; help!” “I was 1 cm last week; I wonder what I’ll be tomorrow?” And there you are, at the office and the nurse is handing you a hospital gown and a drape for your lap. Surely you want checked, right?

Well, maybe not.

Plenty of women have been “shut up tight” at a prenatal appointment only to be holding their baby less than 24 hours later. Others walk around for days or weeks–really: weeks!!–dilated 3 centimeters or more. Either finding, then, can set some moms up for unnecessary stress (“Oh no! I’ll never have this baby”)  or disappointment (“Great, I’m almost done!”). Because of course you will have this baby, and you are almost done–but maybe not that almost done.

Furthermore, there is some reason for concern that a pelvic exam, even when performed with sterile gloves, can introduce germs to the cervix and uterus by pushing up critters that are perfectly normal and healthy residents of the vulva but do not belong higher in the vagina or uterus. These germs can lead to premature rupture of membranes (particularly risky when baby’s not ready to be born; but even at term if the waters break before labor contractions start, this puts you at an increased risk of additional unnecessary interventions) and increased risk of infection in both mom and baby.

Then there is the separate, but related, intervention of membrane sweeping or stripping. This is when, during a pelvic exam, a provider inserts her or his finger through the partially dilated cervix and rotates it to detach any places where the bag of waters may be stuck to the cervix. Membrane sweeping is a valid way to attempt to bring on labor without (or before) resorting to hospital admission for a medical induction. It is particularly common in the UK, where it is routinely offered to first-time moms at 40 weeks and to all moms at 41 weeks. It has some demonstrated success at triggering labor within 48 hours, though it is not a sure thing. Membrane sweeps are generally regarded as extremely uncomfortable, and they carry a risk of artificially rupturing the membranes. Some providers have been known to perform membrane sweeps without actually offering: it’s just something they do “while they’re in there,” whether the mom wants it done or not. So if you don’t want it done, declining late-pregnancy pelvic exams is one way to be sure. (As is, one would hope, telling your provider beforehand whether or not you are interested in a sweep.)

One time you definitely should have a late-pregnancy cervical check is if you are considering scheduling an induction. An induction is not (any nerds in the audience will get this reference) a magic missile: it is not guaranteed to hit the target every time without fail. If you are deciding between a medical induction, a planned cesarian, and just plain waiting (which options are available will, of course, depend on your and baby’s health status), your decision-making will be aided by discussing your Bishop Score with your provider. This is a cumulative assessment of four qualities of your cervix (dilation, effacement, consistency, and position), plus the height of your baby’s head in your pelvis. A Bishop Score of 9 or higher usually indicates that either induction or waiting for baby to choose a birthday should be quick and easy; a score of 5 or less means baby is unlikely to appear on his own within 48-72 hours and an induction is only moderately likely to succeed.

The long and short of pelvic exams in pregnancy is that they can give important information for your care, but they don’t always and are widely overused, largely out of the mistaken belief that they always give important information, which they don’t. So, next time the nurse offers you a gown and a drape, think carefully before you don it. Will you and your provider learn something meaningful from this exam, or might you want to keep your pants on?

Safety Training Completed

Hi, Rachel here!

I am happy to announce that I have completed two very important trainings to aid in my placenta encapsulation work. As you may or may not know, placenta capsules are an ingestible item, which makes them susceptible to food borne illness and pathogen transmission. My best practices have always included proper protection and sanitation procedures, but now I have the certifications to back them up!  I am now trained and certified (with 100% scores on my tests, I might add) in Bloodborne Pathogens and Foodsafe practices. Check out my sweet new certificates and hop on over to my placenta services page to have a look at my offerings!

foodsafe

BBP

Bringing Baby Home; Navigating the Postpartum

Read this article first.  It’s pretty hilarious, and pretty accurate.

http://www.pregnantchicken.com/pregnant-chicken-blog/2010/9/23/happily-after-giving-birth-10-things-they-dont-tell-you.html

Things you need:

A good pump.  A hand pump will do in a pinch, but let your insurance cover a quality closed system electric pump from specialty brands like Medela, Ameda and Hygeia

A giant water bottle. And lots of snack food.  You will be dying of thirst and hunger for the next three months.  Start your stockpile now.

Bookmark Kellymom.  That way, when you have questions, you can get good, legitimate advice and not the horror stories you will see on your due date club boards. Also, the Baby Book by Dr. Sears is a great resource.

Family and friends.  Not for visiting; for helping.  Let family and friends bring you food, do some laundry and run the vacuum for you.  Now is the time for you to bond with and get to know your baby, not try to be wonder woman. You may even wish to seek the services of a postpartum doula for additional support.

Nursing supplies: get some cotton leak pads, or try Lily Pads to help with the leaking.  Nursing tanks are better than bras because you can throw a shirt over them and then not have to worry about exposing yourself every time you feed the baby.  Or just go topless for the first couple of weeks; lots of skin to skin and easy access to the breast are great for the baby.  Put your La Leche League Leader and Lactation Consultant numbers on the fridge or by your phone so you will be able to get nursing assistance right away. And finally, learn how to hand express.  This will help SO MUCH with engorgement.

As you are recovering, keep tabs on your mood.  Postpartum mood disorders can manifest any time in the baby’s first year of life.  If you need something to gauge your mood, I highly recommend the Edinburgh Postnatal Depression Scale as a great quick quiz to assess your mental health. You may also wish to consider having your placenta encapsulated to help stave off postpartum blues.

Some things that will help you adjust to motherhood:  EAT.  I mean it, you will forget to eat.  Just keep shoving food in your mouth, or have friends sign up to bring you meals.  And take at least 30 minutes a day for yourself.  Have your partner hold the baby so you can take a nap, read a magazine, go to the store, whatever.  Regular mama time is vital to keeping your sanity!

When you finally feel up to it, don’t forget to get back into a fitness routine. No, your body won’t zip back in 8 weeks like Heidi Klum.  But exercise does release endorphins and help you lose weight and keep postpartum mood disorders at bay.

And if anyone asks you what you need or want, tell them to get you a gift certificate for a massage.  You probably will only be thinking of things the baby needs, but don’t be afraid to ask people to help take care of you.  You won’t believe how sore you get from rocking the baby all the time.

What things helped you in the postpartum?

Basic Questions for Prenatal Testing

yes-238371_1280Beginning with your first prenatal appointment – or possibly even in preconception counselling – and lasting through the end of your maternity care, you will be offered a seemingly unending battery of tests and procedures. There’s blood-work to be drawn, pelvic exams to submit to, ultrasound appointments to schedule… Some of these will be presented as options and others as “just how it is” when you’re expecting. The truth, though, is ALL TESTS AND INTERVENTIONS ARE OPTIONAL.

Does this mean that I, some doula on the internet, am advising you to decline all tests and interventions? HECK NO! The right procedure at the right time can can give needed peace of mind or prepare you for struggles ahead, can save you money or other interventions down the road, and can even save your or your baby’s life. The wrong procedure, however, can cause unnecessary heartache and expense. So which are the right procedures, and which are the wrong ones? That will, of course vary from one pregnancy to another and is a decision you must make for yourself in collaboration with your physician or midwife.

The key advice I can give is to encourage you to practice informed consent and refusal. Your doctor or midwife is not the boss of your medical care, or your baby’s: YOU ARE! You, not your provider, are the person who must live with the consequences and accept the responsibility for your decisions, so it stands to reason that only you should be the final determiner of your healthcare choices.

But doesn’t your provider have her/his degrees for a reason? Yes! Yes, of course. But you are an intelligent, responsible adult about to take on the total care of a tiny new human. Your provider has experience and protocols and access to evidence. (You also have access to evidence if you care to access it–it’s a brave new internet, and for all the unscientific forums, there is also real scientific research at your fingertips!–and as your doula I’ll be glad to help you hunt down and understand research related to your care). And before you do or don’t choose a particular test or procedure, you have a right to ask your provider to share a distillation of her/his knowledge with you. A couple of key questions to ask include:

  • What information will this test give me?
  • How accurate is that information (margin of error, false positives and false negatives, etc.)?
  • What, if any, risks are associated with this test?
  • How will your care of my pregnancy change based on my test results?
  • How will you react if I decline this test?

You may also be helped in your decision-making by asking:

  • What will this test cost?

Cost, of course, is often a frustratingly un-answerable question in US medical practice, as actual cost won’t be determined until the office or laboratory negotiates with your particular insurer, who then filter their cost through your plan’s deductible and co-pay and so on. Still, you may wish to check with your insurance company to be sure the proposed tests are covered; you really don’t want to be hit for a bill for several hundred dollars for a test you were only partly convinced you needed.

Once you have this information, you are in a position to ask yourself the truly important question that only you can answer:

How will these test results affect the rest of my pregnancy?

What is the benefit to you of reassurance, versus the cost of knowing something is (or is more likely to be) amiss? If you knew for sure your baby was severely disabled, would you terminate? Would you change your birth plan? Would you seek counseling now to be better prepared? Or are you someone who would rather cross that bridge when you come to it? If the test is unpleasant to have done or carries risks to yourself or the fetus, how important to you is that unpleasantness versus how important to you are the results?

Your doctor can’t answer these questions. Your doula can’t answer these questions. Your childbirth educator, your mother, your preacher can’t answer these questions. Only you (and your co-parent) can hold the scale of risks and benefits and come to the right conclusion for your own circumstance. This is your pregnancy, your parenthood, your life: own it!

Cloth diaper partnership announced!

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Exciting news! Rachel has just been approved as a GroVia cloth diaper advocate!! What does this mean for you?  This means that as part of our services, Cradled In Joy will now be able to provide you with the opportunity to learn about and shop for cloth diapers! What does this mean for you??????

  • A special section of each Lamaze course will introduce you to the world of cloth diapering
  • Free cloth diaper 101 classes
  • Cloth diaper show and tell available during doula appointments and visits
  • The opportunity to purchase cloth diapers directly through someone local
  • The ability to host a cloth diaper shower or party in your own home!

More information will be available soon. For now, take a look at Gro-Via.com and pick out your new favorites!  (And if you want to order, shoot Rachel an email message for ordering details and free shipping!)