Friday, May 31, 2013

Ask-Me Monday: Breastfeeding Positions

Sorry for the delay in posting this! It's been a hectic week. Here is last Monday's Ask-Me Monday video, all about breastfeeding positions! Enjoy!

To submit a question for Ask-Me Monday, like the Facebook page and comment to one of the Ask-Me Monday posts throughout the week!

Wednesday, May 29, 2013

Girl or Boy? Why Does Everyone Else Care More Than I Do?

Tomorrow, May 30, is the "big ultrasound," where we'll (hopefully) finally find out whether I'm carrying our first girl or our fourth boy. While some families choose to wait for the birth and let the baby's gender be a surprise, we've always liked to know at the major anatomical ultrasound (which is usually done between 18 and 20 weeks). I've been known to say that if peeing on the stick could not only confirm the pregnancy but tell me the gender, I'd be happy! My husband always says that it's a surprise whether you find out at the ultrasound or at the birth, and we both like having that time to talk about names and get mentally prepared for the actual baby who is coming. I find it makes the pregnancy more real to me and helps me begin to bond with the baby growing within me.

(G's ultrasound pictures)

So far, we're three for three, reliably producing adorable little boys. At each new pregnancy, friends, family, and strangers express genuine curiosity as to whether we're "hoping" for a girl, "trying" for a girl, or if we'll "keep trying" for a girl if this next one is another boy. Indeed, it seems like everyone around us is more excited and more curious than we are about the gender of this fourth baby! It's not that I don't want to know, and it's not that I'm not excited about the baby, and it's not that I will be disappointed either way. It's just that I don't understand why everyone else seems to have invested so much emotional energy in my pregnancy! It's nice that people care so much, don't get me wrong, but is it fair to the baby I'm actually carrying to hope so strongly for one gender? What if it's not what you're hoping for?

I think it's fair to suffer a fleeting moment of disappointment or grief if you never get the son or daughter you've always dreamed of having. I know people who wanted only sons, people who wanted only daughters, or people who yearned for one of each. Usually, once you're holding your sweet little one in your arms, you're thrilled with whatever you've got, but that doesn't mean you might not wonder what it would have been like if the X had been a Y, or vice versa. It is not fair to the child you have, however, to wish he was a she, or she was a he. We have to take people as they are, and that includes our children! Sure, I had "planned" to have a girl first, but when N came along, I couldn't imagine life any other way.

My husband and I are fairly certain we're having another boy. I've been consistently using "he" when talking about this baby, when before I've been hesitant to use a gender pronoun until we knew for sure. According to this site, if you have three boys, you have a slightly increased (more than 50%) chance that the fourth will also be a boy. You hear people toss out stats like, "Oh, the chances of another boy are 70% if you already have three," but this is apparently not supported in the data. Still, it does seem to me like some couples may be more predisposed to one gender than the other. Who knows? Obviously, there are plenty of families with three of one and one of the other, but then you get the stories about families with six boys and one girl, or seven girls and one boy, and so on, and it makes you wonder.

Ever since I found out my first was a boy, I've assumed that at some point in the future, I'd have a daughter. It just seems...normal. But after I found out G was a boy, I became fairly content with the whole situation. I realized I was kind of relieved. I already know how to "do" a boy. I understand them. I have the clothes and the toys. And, let's be honest, here, I'm not exactly "girly." I don't wear makeup. I don't get my nails done. I don't do my hair. I'm not a tomboy, but I'm not well versed in a lot of "feminine" activities, either. I'm terrified that if I did have a girl, she'd be "girlier" than me! I'm terrified of female puberty, of girl drama, and of body image issues. And, to be crude, as many have said only half-jokingly, when you have a boy, you have only one penis to worry about. (Okay, so I have three, and possibly four, but you get the point.)

So, I'm pretty much at peace this time. If it's another boy, which I'm willing to assume it is at this point, then I'm happy. If it's a girl, I'll be shocked but happy. I don't see us continuing to "try" for a girl. I can't predict how I'll feel about it in five years, but right now, I don't feel like I need "one of each" for a complete family. Our family will be complete because we'll have the kids we're supposed to have.

Until I'm ready to reveal the results of the ultrasound scheduled for tomorrow, go ahead and make your predictions. I'm curious as to what my readers think! If you want any data from me besides knowing that we already have three boys, assuming it's not invasive information, go ahead and ask. Have fun guessing, and we'll see what happens!

For some thoughts on the flip side of the equation, a while back Jessica at The Leaky B@@b shared her thoughts on having 5 girls when she was pregnant with her sixth, and how it feels to be asked if she wants a boy - and how it feels for her daughters!

Now, granted, N and S have both expressed their desire for a sister, although I'm not exactly sure if they're able to verbalize why they want a sister. Still, it's super cute, and I know that my boys will be awesome big brothers whether this little one is a boy or a girl.

Friday, May 24, 2013

Childbirth Choices Series Part I: I've Just Found Out I'm Pregnant; Now What?

This is the first in a series of posts that I plan to enhance into an online course along the same lines. The goal is to educate women before they become pregnant, or when they are newly pregnant, about the many options they have when it comes to their prenatal and maternity care, including choosing a care provider, choosing where and how to give birth, and information about labor, delivery, and the immediate postpartum time. This is not meant to replace or substitute for a childbirth education class. Rather, it is intended to get women thinking about their options and making informed choices when it comes to their care throughout pregnancy and labor and delivery.

More articles in this series:

Part II: Meeting Your Care Provider
Part III: Do I Need a Doula?
Part IV: What Will Happen at My Prenatal Appointments?
Part V: It's Almost Time to Have a Baby!
Part VI: Labor and Delivery

Choosing a Care Provider

Once you've gotten a positive home pregnancy test or a blood test confirming that you are, indeed, pregnant, one of your first steps will be to choose a care provider (CP). By care provider, I mean the person or persons who will handle your prenatal care and help you deliver your baby.

I've described below the three main types of care providers available in most states to provide maternity care. Before you can choose a CP, you'll need to decide what you're looking for when it comes to your prenatal and maternity care. I suggest you talk to friends and family members who have given birth to find out about their experiences with their CPs and the birth(s) of their child(ren). You may find that attitudes vary widely, from those who prefer a medical approach to birth to those who want a more hands-off, back-to-nature style. If you're not sure what you want, it will pay off to do some research and talk to people who have made various choices, and, most importantly, discuss why they made those choices. Your options and decision will also depend on your location. For example, you may have a Baby-Friendly hospital nearby that provides excellent maternity care. Or, your local hospital may have a dismal maternity record, but there is a birthing center not far away that is very highly rated. I'll get into where you might want to give birth right after the discussion about CPs.

Obstetrician (OB)

An OB, or obstetrician, is the type of care provider most of us think about when it comes to pregnancy. An obstetrician is a medical doctor who specializes in maternity care, including prenatal care and delivering babies, either vaginally or via cesarean section, as well as postpartum care. Most OBs also handle general gynecological issues and regular GYN checkups. OBs typically work in an individual or group practice and deliver babies at a local hospital at which they have privileges.

Why Might I Choose an OB?

As mentioned, an OB is the most commonly selected option in the United States when it comes to maternity care. Many women will simply continue to see the same doctor they have been seeing for their regular GYN care. If you are comfortable with your current OB/GYN and feel that your needs and desires for your maternity care are being addressed, then sticking with a provider you already know can be a great option. An OB can oversee your pregnancy and delivery, and it may be comforting to you to have a medical doctor and surgeon with you at delivery and throughout your pregnancy.

Why Might I Not Want an OB?

Depending on what you're looking for in your prenatal and maternity care, you may find that OBs tend to be clinical and traditional when it comes to how they view birth. This is not a blanket statement about OBs, because I know of many OBs who believe strongly in the course of normal birth and are not so quick to offer interventions. However, often OBs think in medical terms and will take a clinical approach to your care, meaning that they will be more likely to recommend interventions, medications, and tests. For some women, this is comforting and familiar and will be attractive. For others, they may want to look for either a non-traditional OB or investigate another care provider, such as a Certified Nurse-Midwife.

Certified Nurse-Midwife (CNM)

Another option for maternity care is a nurse-midwife (CNM). A CNM is a registered nurse who has gone on for special training in prenatal and maternity care, as well as general gynecological care. A CNM is not a surgeon and cannot perform a cesarean section. She (or he) can deliver a baby vaginally as well as order the use of certain medications and tests during pregnancy and delivery, if indicated. CNMs may work privately or in group practices or may be affiliated with a particular hospital or birthing center. Some CNMs work independently or in a group offering home birth services.

Why Might I Choose a CNM?

Midwives tend to take an approach to pregnancy and birth that is less medically oriented. This means they will be more likely to view pregnancy, labor, and delivery as a natural process rather than as a medical issue that needs to be addressed. Women who are interested in having a "natural" (non-medicated) birth, or who are looking for a CP who will take a more holistic approach to their care, may find a CNM an attractive choice. Please note that a competent CNM can and will monitor you and your baby throughout your pregnancy and labor and will know if it is necessary to recommend emergency intervention by an OB.

Why Might I Not Want a CNM?

First of all, CNMs generally cannot take high-risk cases, so if you have a high-risk pregnancy, a CNM may not be able to take you on as a patient. It may also be the case that you cannot find a CNM who can deliver in the venue you've chosen. For example, you may want to deliver in a hospital, but the hospital you go to may not allow CNMs to oversee deliveries. Also, if you have any concerns about the need for medical or surgical interventions during your pregnancy or delivery, you may be more comfortable with an OB.

Licensed Midwife (LM)/Certified Professional Midwife (CPM)

A Licensed Midwife is a practitioner who specializes solely in maternity and women's health services and is licensed by a particular state's medical board. A Certified Professional Midwife (CPM) is a midwife who has been certified by the North American Registry of Midwives. Similar to a CNM, but not a registered nurse, a midwife can provide prenatal and maternity care, deliver babies, and order medications and tests, as needed. She cannot perform surgery. Not all states recognize or license midwives. In some states, out-of-hospital midwifery is illegal. You will need to find out what the options and laws are in your state if you wish to work with a midwife. Most LMs and CPMs work outside of the hospital setting, often offering home birth and home care services.

Why Might I Choose a Midwife?

A midwife will likely be similar to a CNM when it comes to practice and philosophy. Midwives typically work with low-risk women and babies in the normal course of pregnancy and childbirth. Their services are typically low-intervention and focus on pregnancy and birth as a normal process that may require assistance but not necessarily medical or surgical action.

Why Might I Not Choose a Midwife?

If you prefer to deliver in a hospital or a birth center affiliated with a hospital, you may not have the option of a midwife other than a CNM. A competent midwife will have the necessary equipment, medications, and knowledge to assist with birth, and she will also be able to determine if the mother and/or baby need to be transferred to a hospital for medical or surgical intervention if there is a problem. However, if you are more comfortable delivering in a hospital setting, or you feel strongly that an M.D. should attend your birth, for whatever reason, the option of a midwife may not be attractive to you. And, as stated above, midwifery is illegal in some states.

Do I Want a Group or Individual Practice?

You'll also need to decide if you want to see a CP who works privately or one who is part of a group practice. There are advantages and disadvantages to each.

With a CP in an individual practice, you'll be certain to see the same person at every prenatal appointment, and if you deliver your baby during your provider's working or on-call hours, you'll be certain that he or she will attend your birth. However, if your CP is not available at that time, you will be seen by whichever provider is on-call when you're ready to deliver. Some individual practitioners try to make it a point to be available to all of their patients. This is something you'll want to discuss with your provider at an early appointment.

With a group practice, there are several providers who work together. The advantage to this is that there is a good chance that one of the CPs from the practice will be available/on-call when you have your baby. If you choose a group practice, you'll probably want to schedule appointments with each provider in the group so that you can get to know each of them, so that whoever does end up delivering your baby won't be a stranger.

Choosing a Venue

As you can see, the choice of care provider and venue are closely intertwined. If you want a midwife and a hospital, you'll need to find a hospital that allows midwives to attend deliveries, and you'll need to find a midwife who has privileges at that hospital. If you want an OB and an unmedicated birth, you'll probably need to give birth in a hospital, but you'll want to choose an OB and hospital who will be supportive of your wishes. You will also need to check your state's laws concerning midwifery and home birth, and find out the availability of a birth center near you. You'll want to research your local hospitals to find one that fits best with your needs and desires. Some women will find that there doesn't appear to be a "perfect" or even a "good" option that fits with her ideals, and for those women, being armed with knowledge and research will be especially valuable.


Over 98% of American women give birth in a hospital. Many women may not even be aware that there are options other than a hospital birth. Hospital birth is seen as the norm in the United States. Most hospitals have a Labor & Delivery unit where women come to labor and give birth, then stay for an average of two to four days (depending on the method of birth and if there were any complications) while they and their babies are cared for by doctors and nurses on the hospital staff.

Why Might I Choose a Hospital to Give Birth?

As mentioned, hospital birth is considered by most to be the "normal" and expected choice for women in the United States. Nearly all women deliver their babies in a hospital setting. In a hospital, you'll be certain to have access to an operating room, if necessary, medications and anesthesia, if you want them, and nurses and doctors for both mother and baby. A hospital will be prepared with personnel and equipment for dealing with most complications of birth and the neonatal period. In a hospital, you will have the reassurance that, should something (G-d forbid) go wrong, you're in a place that can help you.

What Hospital Should I Go To?

The temptation is typically to go to the nearest hospital to your home that has a Labor & Delivery unit. No one relishes the idea of a long car ride or cab ride while in labor just to get to the hospital, and there's always that fear of giving birth on the way if the hospital is far. However, when choosing a hospital, it's important to know a few details.

- Do they have a well-equipped NICU?
Since a major reason for choosing to give birth in a hospital is the comfort of being there "just in case," it's important to know that your baby will be well cared for if there are complications. If the hospital you choose does not have a NICU and you have need of one, then your baby will have to be transported to a different location for care, and you may be separated for several days. If you have the option, giving birth in a hospital with a respected NICU may be important to you.

- What is their rate of cesarean section compared to vaginal births?
If a hospital has a high cesarean rate (and you'll have to decide for yourself what "high" is), there is a higher chance that you may be pressured into a c-section that you didn't necessarily want or need. Over 32% of babies today are delivered via c-section, and most authorities and experts agree that this number is too high. A hospital with a lower c-section rate likely first turns to methods of managing your care during labor that will reduce your risk of c-section, while a hospital with a higher c-section rate likely jumps straight to surgery as an answer to problems or blips that may not actually be emergency situations. You can investigate a hospital's cesarean rate and learn more about c-sections by visiting

- What is their policy on rooming-in? Do they have a nursery in the Postpartum ward?
Research shows that rooming-in with your new baby - keeping your baby in the room with you at all times, rather than having him/her cared for in a nursery - facilitates breastfeeding and bonding and is healthier for mom and baby, assuming neither suffered major complications during labor and delivery (which the majority do not). Find out what your hospital's policy is on rooming-in. Some hospitals do not even have a nursery for healthy babies and require that the baby remain with the mother if there are no extenuating circumstances. Others will require that the baby is kept in the nursery at night and brought to the mother only for feedings. Some hospitals will offer each family a choice between using the nursery and rooming-in.

- What kind of breastfeeding support do they offer?
If you plan to start out breastfeeding - as the majority of new moms do - you'll want to know what kind of breastfeeding support your chosen hospital offers. Do they have a high rate of suggesting formula supplementation in otherwise healthy babies? Do they offer the use of a hospital-grade breast pump if needed? Are babies supplemented with bottles or formula without the parents' consent? Are there lactation consultants on staff who are available to new mothers on the postpartum ward? Are the maternity nurses trained in basic breastfeeding support? These are important questions, which you can ask on your hospital tour, ask of friends who have given birth there, and look for more information about online. Research shows that good breastfeeding support in the hospital fosters continued breastfeeding success after mom and baby go home.

- Are they Baby-Friendly?

"Baby-Friendly" is an official designation given by the Baby-Friendly Hospital Initiative (BFHI), an initiative of UNICEF to improve breastfeeding rates and increase exclusive breastfeeding duration. Only 6.7% of births in the United States currently occur in a Baby-Friendly designated hospital. There are 159 Baby-Friendly hospitals in the United States as of January 2013. You can find out if there is a Baby-Friendly hospital near you by visiting this site. A Baby-Friendly hospital will follow all of the 10 Steps to Successful Breastfeeding that evidence has shown to increase the rates and duration of successful exclusive breastfeeding. Some hospitals are working toward the Baby-Friendly designation and may follow some or all of the 10 steps even if they have not received the official title. You can ask if your chosen hospital follows any or all of these steps, as this can greatly affect your birth and postpartum experience at the hospital.

Why Might I Not Want to Give Birth in a Hospital?

There are many reasons why you personally may not want to give birth in a hospital. Reasons some women cite for not wanting to go to a hospital include fear of hospital-borne infection, fear of doctors, fear of hospitals due to previous trauma, or lack of a good hospital close to home. Some women, rather than an issue of a specific reason not to want to be in a hospital, simply want to give birth in another setting. Many women feel that hospitals are for sick people, and pregnancy and birth are not diseases that need to be treated. In a hospital, you are more likely to be offered interventions such as epidurals, Pitocin, and constant monitoring, and your risk of c-section is likely higher.

Home Birth

A home birth is just what it sounds like: giving birth at home (usually your home). Typically, you hire a midwife or team of midwives to attend you prenatally and at delivery. The midwife will advise you how to set up your home for the birth. When you are in labor, she (or they) will come to your home and monitor you as you labor, help you with techniques for pain management and positioning of the baby, and assist with the delivery. A midwife will have equipment to allow her to listen to your heartbeat and that of the baby, to check your blood pressure, to give you an IV of saline or medication if needed, and can make the call that transfer to a hospital is necessary if an emergency situation should arise.

Why Might I Choose a Home Birth?

I'll preface this by saying that home birth is not legal in every state, and many states have regulations about where your home has to be in relation to a hospital if you choose the home birth route. If you're thinking about a home birth, make sure it is an option where you live.

Although fewer than 1% of births in the United States occur at home, the number is rising quickly. Women who choose home birth give a few reasons for their decision. One is that they enjoy being in the comfort of their own home, feeling that being in a familiar environment helps them to relax and give birth in a peaceful state of mind. At home, you may feel you are more in control of your birth, able to make decisions about where in your house (bed, bathtub, special birthing tub, backyard) you feel most comfortable, what position to give birth in, and to avoid medications and interventions. Women who choose home birth also like that they can have their family around them (or not, as desired). Some like the idea of older siblings being present for the birth, for example. Also, if you give birth at home without complications, you don't have to suddenly pick up and go anywhere: you're already home!

Why Might I Not Choose a Home Birth?

There are many reasons you may not want a home birth. Many families are uncomfortable with the idea of not being in a hospital if an emergency should arise. Some are worried about the mess or feel that their home is just too small for comfort. Some desire an epidural or other medication options, which they would not have in a home birth situation. Also, if you have a high-risk pregnancy or birth, you are not a good candidate for home birth, as your risk of requiring emergency interventions is higher, and these cannot be provided at home by a midwife. Some women simply like being in the hospital, recovering on the postpartum floor, and having a couple of days to be waited on by nurses.

Birth Center

A happy medium if you're torn between a hospital birth and a home birth may be a birth center. Birth centers are typically free-standing facilities that strive for a home-like feel, employ midwives for prenatal and delivery care, and promote a non-intervention birth environment. Some birth centers are within hospitals or on hospital grounds, while others are independent.

Why Might I Choose a Birth Center?

If you are striving for a low-intervention or unmedicated birth but you don't want to or cannot give birth in your home, a birth center may be a good option for you. At a birth center, you will typically be attended by midwives who will help you manage the pain of labor, ensure the baby is in a good position, and assist with delivery. You and your baby will be monitored as needed. Many birth centers will offer the option of giving birth in a tub, in a bed, or in whatever position is comfortable for you. You generally will not stay long after your baby is born, just long enough to ensure that you both are healthy, perhaps eight hours or so after the birth, so if you don't want to be away from home for long, this may be another reason to select a birth center.

Why Might I Not Want to Give Birth in a Birth Center?

As with home birth, if you have a high-risk pregnancy, a birth center may not be able to take you on as a patient. Birth centers typically do not have emergency services such as a ready OR or a NICU. If you would like the option of epidurals and other medications, a birth center will generally not offer these, and you may want to consider a hospital instead. Also, if you want to stay longer after giving birth, a birth center will not have the facilities for you to spend several nights there like you would at a hospital.

Making Your Choice

The best way to get most of this information is word-of-mouth from friends and neighbors who have given birth in the last few years. You may also want to join an online community to get more perspectives, or attend a support group meeting such as La Leche League or ICAN where you can learn about options you may not have considered and hear from individual women about their own experiences and why they made the choices they did.

You will also probably have financial considerations when it comes to making your decision. Find out what your health insurance will cover, as you may be limited in your options of hospital and care provider. You'll want to find out what your out-of-pocket share will be. Some insurance companies will cover the services of a midwife and a birth center birth, although most will not cover a home birth - you'll need to find out if this is the case with your insurer. It is important to know that typically the fees for a home birth and the services of a midwife are considerably lower than a hospital birth with an OB, and if your out-of-pocket commitment with your insurance company is high, paying for a home birth in cash may not be much of a difference. You should also consider the importance of a healthy pregnancy and birth for yourself and your child.

Be aware that you may switch care providers and venues far into your pregnancy. If you have made a decision and are not happy with it, even if you're 30 weeks along already, it may be worth investigating other options so that you can be satisfied with your experience.

For the record, I've had three babies, all in a hospital setting. My first was with an OB in a well-respected hospital near my home. I got my referrals from neighbors and friends who had recently given birth at that hospital and were happy with their experience. I didn't know what my other options were, and the most important thing for me at the time was to be in a hospital close to home. Because I had complications and hemorrhaging with my first, and because my first was a c-section birth, my husband and I both felt that it was important that I give birth in a hospital in the future as well. With my second and third babies, I knew about the options of home birth or birthing centers, and I knew about the option of using a midwife rather than an OB. My health insurance HMO did not give me many options of care providers or birth locations, but the hospital where I gave birth to my second and third sons was excellent and had achieved Baby-Friendly status by the time my third was born. My care providers were mostly CNMs, and I appreciated their approach to pregnancy and birth. An OB delivered my second baby, and my third was delivered by a CNM. I was very pleased with both experiences.


More articles in this series:

Part II: Meeting Your Care Provider
Part III: Do I Need a Doula?
Part IV: What Will Happen at My Prenatal Appointments?
Part V: It's Almost Time to Have a Baby!
Part VI: Labor and Delivery

Wednesday, May 22, 2013

Guest Post: Traveling Abroad with Special Needs Children

Today we have a guest post from Marcela De Vivo. Marcela's son has cerebral palsy, and she offers some insights and tips for traveling abroad with a special needs child. Have you traveled with a child with special needs? We'd love to hear about your experiences!


My oldest son, Nathan, is six years old, and has severe cerebral palsy. What many people are surprised to learn is that Nathan has traveled to about 10 countries, including England, Thailand, Argentina, Brazil and even the Dominican Republic.

Nathan has always enjoyed every trip, and it has been incredibly beneficial to him from a developmental standpoint. As a parent, I would encourage any family with special needs children to travel as much as possible.

Of course, the first question in your mind is probably a big HOW? How do we manage the logistics of traveling with a non-verbal, non-ambulatory special needs child?

The answer isn't always simple, and what you need to do will be based on the special needs of your child, but let me tell you right now, travel is certainly possible.

Traveling abroad with a special needs child is possible. We’re proof.
Image Courtesy of

Plan Ahead, Arrive Early

Whenever we travel, we call the airline and let them know we need wheelchair access. We also have our own wheelchair, which makes the process easier and more efficient; if your child needs one, bringing your own wheelchair can be very helpful.

One key note when it comes to traveling with a wheelchair: keep it with you as long as possible. Airlines treat it like luggage if you check it, and it could ultimately end up broken. It happened to us, and it’s not something that you will want to deal with.

We also take the time to let airport security know that we have fluids with us and that we’re traveling with our child’s medication, which, of course, he needs. It’s always taken us a bit more time to go through security, but most people are quite supportive and friendly while helping us through the process. On the rare occasion that we've encountered security or airline staff members that were rude, we've generally said something to management so that they’ll be more prepared in future situations when dealing with children with special needs.

Leave yourself ample time for getting through airport security when traveling with a 
special needs child.
Image Courtesy of Flickr

Ask for Help

Once on the plane, we generally explain to people around us about our son’s needs. Of course, we don’t go into a long drawn out story, but it often helps to give people some information about what’s going on around them.

In many cases, people will offer their assistance and help with basic things – like making room for our child. Typically, we bring a special seat, called a Special Tomato Chair, which makes our son more comfortable during flights, but requires just a little bit of extra room in some cases.

Once the airplane lands, we’re often the first ones off. In some cases, we’re the last ones off. It works either way – we just want to make sure we’re not involved in the general mayhem of a large group of people exiting an airplane.

Consider Your Destination

When you arrive in your destination, it’s important to consider where you are and what you’re going to be doing. For example, when we've visited places like Canada, which really aren't all that much different than home in the United States, we've rented a car. This is helpful since we can take our time and make sure we have everything we need for a day trip.

In other places, we've had to rely on taxis, and we may need to take some special equipment. In general, we simply try to make sure that we have everything our son will need with us. From there, we really just have to go with the flow of travel since everything can’t be completely under our control.

For most people, the most difficult part of traveling with a special needs child is the actual travel, not the day-to-day stuff that occurs when you arrive in your destination. Once you have that figured out, you’re well on your way to a successful trip.

Of course, the information here was personal, and it may not all apply to your child. Nathan has cerebral palsy, so his needs are very different from those of a child with autism, for example. Before you plan a trip, always take your child’s needs into account and talk to your child’s doctor if you’re unsure about health and safety concerns of traveling abroad.

Marcela De Vivo is a freelance health & wellness writer from the Los Angeles area whose specializes in alternative medicine, sustainability, and special needs advocacy. She works with the California Special Needs Law Group to spread the world about inclusion and offer advice to other parents with special needs children. Marcela keeps a personal blog about her son and their story at

Monday, May 20, 2013

Ask-Me Monday 5/20/13: Infant Car Seats

This week's Ask-Me Monday video is for fan Megan, who asked, "How long should I use my infant car seat?" I've written several blog posts about car seats and extended rear-facing, and I'm excited to offer this video full of useful information about when it's time to stop using your infant car seat.


To submit a question for Ask-Me Monday, like Jessica on Babies on Facebook and comment to one of my Ask-Me Monday posts throughout the week. I'll select one question each week to answer in an Ask-Me Monday video. And subscribe to the channel so you don't miss any new videos!

Monday, May 13, 2013

Is a Helmet a Helmet If It's Not Buckled, or Is It Just a Hat?

Walking with my first-grader to and from school each day, I see lots of other kids of all ages riding scooters, skateboards, and bicycles. My son occasionally rides the scooter he got for his birthday, and, of course, always wears his helmet when he does so. The other skateboarders, scooter-riders, and bicyclists also wear helmets, per state law. (In California, all children under 18 must wear a helmet when riding a bicycle, scooter, or skateboard, as of 2003.) However, I've noticed a disturbing trend: The older (fourth and fifth grade?) skateboarders, especially, will put their helmets on their heads but not buckle the chin strap.

Now, it should seem obvious to the average adult, and hopefully to the average 10-year-old, that wearing a helmet that isn't fastened to your head isn't going to do a whole lot of good in protecting your brains should you take a spill on your skateboard. I wonder, if these kids' parents knew that they were skateboarding, scootering, or bicycling with their helmets' chin straps dangling uselessly, would they be concerned? I would be. In fact, it occurred to me to double-check the proper way to fit a helmet so that I can teach my kids to use one correctly. I'm not much of a bicyclist (I haven't ridden in, oh, 5 years?), so I haven't worn a helmet much recently, and I wasn't sure exactly what the guidelines were. Here are some excellent instructions from NHTSA.

Now, let's be honest, my kid is mostly only riding his scooter along flat sidewalks at a fairly leisurely pace just to and from school, with me following as close behind as I can. I don't imagine the copious brains contained under his adult-sized helmet are in much danger from a fall from his scooter. But that isn't the point, is it? The point is to establish good scootering and bicycling habits, so that if he should take an interest in more "extreme" riding, he will know how to properly wear his helmet, and will know the importance of doing so. And random falls do happen, even at the scootering-to-school-with-Mommy-following-behind pace.

N proudly showing off his new scooter. And now that I look at it, I don't think his helmet is fitted properly after all.

When my son is older and getting himself to and from school without me, should he decide to ride his scooter, he will, of course, be required to wear his helmet. And if he disdains to wear it correctly, then he will not have the privilege of riding, because I personally find his skull and brains far more valuable than his desire to ride a two-wheeled scooter when his own two feet will serve him nicely. I do hope the parents of these other kids I see, wearing decorative helmets, chin straps a-dangling, would care enough about their kids' brains to insist upon proper strap-fastening should they become aware of the misuse. Maybe they wouldn't. I know that plenty of people do not like helmet laws and may feel that allowing their kids to flout these laws is their prerogative. It's not my business, and it's not my kid. I'm just making an observation.

If your son was spotted by a neighbor improperly wearing his helmet, and your neighbor, out of concern, came to you one day and said, "Hey, I saw Nate on his skateboard yesterday coming home from school. His helmet was on his head, but the strap wasn't fastened. I just thought you might want to know about it," how would you react? Perhaps some people might say, "Yes, I know. He wears the helmet because it's the law, but I told him if he doesn't like the chin strap, he can just not fasten it. I'm not that worried about it." Others might say, "Oh, he's in trouble now! If he's not going to wear his helmet properly, then he doesn't get to ride!" Still others might say, in all honesty, that they didn't realize that not fastening the chin strap rendered the helmet useless, for all intents and purposes, and would be glad to have filled in that information.

I'm sure that by now you can see where I'm going with this.

I see properly buckling your kid in his car seat as in the same vein as making sure your kid is wearing his helmet correctly. The goal is to keep our kids as safe as possible from preventable injury while still allowing them to be out and about and exploring the world. Kids can and should be out there on their bikes and skateboards and scooters. They should be seeing how fast they can go and riding with no hands and jumping off curbs (when there aren't cars coming) and taking turns on the ramps at the local skate park. But they should be wearing helmets when they do so. They'll need those brains for years after they need those skateboarding skills.

Five Rules for Proper Car Seat Use:

1.  The harness should be snug. When you try to pinch the harness strap at the child's collarbone, you should not be able to maintain a fold in the strap between your thumb and forefinger.
2.  The chest clip should be fastened and aligned with the child's armpits, and the crotch strap should be fastened.
3.  The car seat should be installed tightly with either LATCH or the vehicle seat belt (but not both), so that it cannot wiggle more than 1" (one inch) side to side or front to back. Make sure the seat belt is locked if installing with the vehicle seat belt.
4.  Your child should be in the proper car seat for his age, weight, and height.
5.  Your child should remain in a five-point harness until he is at least four years old and 40 pounds (the older, the better) and tall enough that when he sits in a booster seat, the seat belt falls comfortably across his upper thighs (not abdomen) and shoulder (not neck).

Wednesday, May 8, 2013

Watching What We Say To Our Kids

When my oldest, N, was young, probably toddler-aged, I read in a book or on a blog or in some article a very, very important bit of parenting advice that has stuck with me more than anything else I've read or tried, and applies regardless of what other parenting or discipline methods you subscribe to. It has to do with how we talk to our kids, both in praise and in displeasure.

It's a simple concept, really, but in practice it takes concentration and self-control. What it boils down to is, when we talk to our children about their behavior, positive or negative, good or bad, it's vital to talk about the action, not the character of the child. We need to reinforce actions we want them to take again, and we want to point out and correct actions we want them to change. What we don't want to do is praise or criticize things they can't change or traits they can't "do."

Let's look at a positive example first.

Let's say your kid is very smart (of course!), and they bring home their first report card, and it's straight A's (of course), and the teacher's comment is that your child is a pleasure to have in class and is above grade level in every subject. That's fantastic. You're ecstatic! You've always demanded academic excellence of your children, and you knew he had it in him, and you're thrilled that he's living up to all your expectations for him. You want to convey to your child that you are very happy with his performance in school and want him to continue to excel, put out effort, work hard, and enjoy learning.

What not to say: "You're so smart!"

Why not? He is smart! He should be proud of himself!

Yes, but "smart" isn't something he does or doesn't do. "Smart" isn't something he can change about himself. "Smart" isn't a lesson he can learn or an action he can repeat. And what happens when he fails his first test or forgets to do his homework or gets yelled at by a teacher? Is he suddenly not "smart"? How is he supposed to remedy any setbacks with "smart"?

What to say instead: "You worked hard and it shows! I'm so proud of the effort you made!"

Here, you're praising what he did, not the trait of "smartness." This way he knows that hard work and persistence is what's going to get him ahead in life and in school. "Smart" is all well and good, but it's what you do with "smart" that will make the difference. Plenty of smart people do poorly in school, fail out, or give up, either because they're bored or because they don't know how to deal with not understanding something or failing once. With praising the effort rather than the trait, he now knows that it's up to him to continue to put out that effort to do well, and that if there is a setback or failure, he can step it up and keep trying in order to succeed.

Now, let's look at the flip side - a negative example.

By negative, I mean a behavior you want to correct.

Let's say your kid has trouble getting ready for school on time. She dawdles when she's getting dressed, wastes time while eating breakfast, and takes twice as long as she should to pack up her backpack, and even then manages to forget stuff, and you find yourself constantly having to bring her lunch or homework to school for her later. This, understandably, causes frustration every morning, and in a moment of pique, you yell at her.

What not to say: "You're so lazy! What's wrong with you? It's the same every morning! Why are you so slow?!"

Why not? She is being lazy and slow! And it's annoying! And you're sick of it!

Yes, of course you're sick of it, and frustrated, and you can't understand why she hasn't learned yet. But telling her she's lazy and slow is reinforcing an image she's already created of herself. And if she's a lazy, slow kid, then that's just who she is - see, even Mom thinks so - and it's not going to change now. You even said so: it's the same every morning.

What to say instead: (And, yes, you can yell this if you need to!) "It takes so long for you to get ready in the morning! Why don't you get your stuff together the night before! That would save so much time, and I wouldn't have to constantly be bringing your things to you at school! You need to get dressed before you eat breakfast, and you need to eat more quickly."

Here, we're talking about specific actions she can take to improve the mornings. Suggesting, even yelling, that she get her backpack together in the evening gives her a goal, something clear she can do to help her along and save her time. Maybe she honestly hasn't thought of doing that, and having you plant the idea is all she needed. Knowing that she doesn't get breakfast until she's dressed might mean she'll get dressed more quickly, because she has a goal. And, if you're willing to go that far, you can even add in that if she doesn't get dressed fast enough, she won't have time for breakfast and will either have to skip it (not recommended) or take a banana or something along in the car or on the walk to school so she isn't starving.

It's very important in a scenario like this that when she does make a positive change, such as getting her backpack ready the night before, that you acknowledge it. And, referring to above, don't say, "Good job!" Say, "Wow, getting your things ready last night made it so much easier this morning. Look at that, you're ready to go 10 minutes early!" You don't actually have to praise her, but you definitely need to show that you noticed and point out what a difference it made. If she's anything like my kid, you'll see her swell with pride at having done something "right," and hopefully that's a feeling she'll want to recapture and will continue to improve.

Let's look at one more example of each.

First, the positive.

Let's say your teenage daughter is very pretty (of course!). People are always telling her, "You're so pretty!" Even you take pride in the fact that she's so beautiful and perfect. One day, she wears an outfit that suits her especially well. Her makeup is done just-so, her hair is shiny and perfect. You're so lucky to have such a pretty daughter.

What not to say: "You're so pretty!"

Why not? She is pretty!

Well, we all know that beauty can fade, and while girls can get by on their looks for a while, eventually they also need some substance to their character to be anything in life. I hope that beyond beauty, you have dreams for your daughter to succeed in areas that require persistence, intelligence, or kindness as well.

What to say instead: I think there's a twofold reaction needed here. First, if you want to express that she's looking especially good that day, start with, "Wow, I love that outfit on you. You pick out such nice clothing." This is praising the act of choosing an attractive outfit, rather than the trait of "being pretty." She can continue to choose flattering, appropriate clothing for herself even if something happens to alter her current looks. But it's also important that you don't emphasize beauty over everything else. Be sure you're praising her for other achievements or activities, such as acts of kindness, persistence, or academic excellence. She needs to know there's more to life than looks, and she also needs to know that you value her for more than her appearance.

And now something you want to change.

Your four-year-old son is having trouble with his behavior at preschool. He's been biting and pinching other kids, and finally the director calls you in and says that if there's one more incident, he'll be asked to leave. The violence, defiance, and other difficult behaviors have to stop, because it's causing too much of a disruption and other parents are angry that their children are being hurt. You know it's time for some serious action on your part.

What not to say: "You're such a bad kid! Look at you, four years old and getting kicked out of school! Why can't you behave?!"

Why not?

I hope this time it's obvious. At four years old, you've already told him he's "bad" and that he can't behave. He's going to internalize statements like these and just assume that it's true: He's a bad kid who can't behave. And guess what bad kids who can't behave do? They misbehave!

Calling names or assigning negative traits to your child will only make things worse. Instead, they need to know both the "don't"s and "do"s of what happened so that they can hopefully make corrections in the future.

What to say instead: "Biting and pinching hurts other kids and makes them sad. If you hurt other kids, you won't be allowed to go to school anymore, and I think that will make you sad. You always tell me how much you like going to school." That's the "don't" part. But he may need more help. Continue with, "If you don't like something another child does, you need to use your words to tell them. Say, 'Don't do that!' instead of pinching, or go tell the teacher if you're upset about something." Now he has an action he can take. You've given him an alternative to violence. You're telling him to use words, and not just a vague, "use words," but exactly what words to use.

It's important to model that behavior for him, too. If he tries to bite or pinch a sibling when he's angry, or he takes a swipe at you when you do something he doesn't like, that's your opportunity to show him, in the heat of the moment, how he should act. Stop the negative behavior first, physically if you have to (grab his wrist to stop a pinch, or pull him away from the sibling - not something violent, just stop it before he gets there, if possible), and then supply the words instead. "We don't pinch, remember?! Say, 'David, I was playing with that toy and you took it. Please give it back!'" Or, "We don't hit Mommy! If you're angry with me, you can say, 'Mommy, I'm mad that you won't let me watch TV!'" Then encourage him to try it. That doesn't mean you have to let him do whatever it was he wanted to do, but you're giving him words for his feelings and a healthy way to express those feelings, instead of hitting you.

I'm not saying you're going to see a change overnight in any of these scenarios. Indeed, if there are deeper issues affecting your child's behavior, it may take far more than simple words to make that change. But words are a great place to start, because kids take far more meaning from what we say than we think they will. They also imitate what they hear and internalize values based on what you say to them. If we show them the proper behavior, demonstrate it in context, and live according to the values we want them to absorb, most kids will live up to, or even exceed, the goals we have for them.

Monday, May 6, 2013

Ask-Me Monday: Induction Advice

Today's Ask-Me Monday gives some general advice for an induction of labor. I hope you find it helpful.

To submit a question for Ask-Me Monday, like the Facebook page and comment to one of the Ask-Me Monday threads!

Friday, May 3, 2013

Four Kinds of Breastfeeding Support: Emotional, Practical, Improper, and Unhelpful

I can't emphasize enough that when you have a new baby, you need support. Going it alone is unnatural and stressful. They say it takes a village, and while you may not have an entire village to help you, I hope you at least have your partner and a few trusted friends and relatives who are there for you.

When it comes to breastfeeding support, you need to make sure that (a) you have some, and (b) you have the right kind.

I've identified four types of support for new mothers. Each description below contains suggestions for the new mom herself and for the support people around her.

1.  Emotional Support

For Mom: Emotional support is crucial. You might also call this moral support. This kind of support could come from your partner, your mother, your sister, aunt, cousin, best friend, a random person you meet in the park, or even someone on the internet. When someone is offering emotional support, it's those encouraging words when you're at the end of your rope; it's the, "You're doing great!" when you feel like you're doing everything wrong. Emotional support helps you keep going, push through the rough spots, and lets you know that others have been where you are, and it does get better.

To Support Mom: Even if you don't have personal breastfeeding experience, you can be there for her. Let her vent, listen to her concerns, and offer an encouraging word, whatever comes naturally to you. Some of us are more comfortable with being cheerleaders, while others are better at simply listening and being a sympathetic ear. Avoid trying to give advice she isn't asking for, but offer to help in any way you can. For example, "Can I do something around the house for you so you can rest? I'm a great laundry folder! Do you need anything from the store? Diapers? Snacks? Juice? Can I get you a glass of water?" Make specific offers, not a general, "Is there anything I can do to help?" because she may not be able to think of something in particular, or she may feel uncomfortable making a request.

2.  Practical Support

For Mom: Practical support is also crucial. As much as you think you might know going in (and I say this as someone who's nursed a few babies!), it never hurts to have someone you can call upon when you have a practical question about your baby's latch, strange nursing behaviors, or other concerns. Every baby is different, and every nursing relationship is unique, and you'll want to know someone you can contact who has seen lots of  mom-baby pairs and helped solve many types of problems. It's important that whoever you lean on for practical support actually knows what to say or do to help. This may be a La Leche League leader, a breastfeeding peer counselor or other trained breastfeeding support person, an International Board Certified Lactation Consultant, or even just your mom who's nursed four kids. You need to know that the advice you're going to receive is correct advice. If you get advice you're not sure of, feel free to double check it on a reputable site like, or contact a lactation consultant.

To Support Mom: Unless you're sure you know what you're talking about - i.e., you're a lactation consultant, peer counselor, CLC, La Leche League leader, or you've at least done your breastfeeding research, it's best to leave the advice to someone who is one of those people. If you do know how to help, make the offer. "Hey, I'm a lactation educator. If you want, I can come sit with you and check out your baby's latch." If I'm not absolutely certain what to say or do to help a new mother with her question, I will always recommend that she meet with a local lactation consultant. If you don't know of one, you could help her find one. If you do, give her the number!

3.  Improper Support

For Mom: Many friends and relatives will mean well, and they probably really do want to help you. However, sometimes you get tips and advice from people that is not what would be recommended by a lactation expert. For example, just because your best friend introduced a bottle of formula every night but continued to nurse for a year doesn't mean it's a good idea or that it will work for you. People improvise, get lucky, or make decisions based on unique situations that may or may not apply to you. Make sure you've done your own research and have consulted with someone trained in lactation before you supplement unnecessarily or make a decision that could harm your breastfeeding relationship.

To Support Mom: It's important not to give advice willy-nilly. Every mom will have different circumstances, and unless you are a trained lactation support person or have an educational background to go with your personal experience, you can end up doing more harm than good, even if you're trying to help. Simple suggestions like, "Maybe you want to get his latch checked," or, "My son had a tongue tie and I had the exact problems you're having" can be very helpful and give her a starting point for finding assistance. Thoughts based on your own experience that may make her life easier such as, "My daughter was really fussy, too, and babywearing really helped us on the bad evenings." It's best not to begin supplementation or take drastic measures without being seen by a lactation expert, however.

4.  Unhelpful Support

For Mom: The least helpful kind of support is from people who think they're being supportive but are actually making you feel worse. A great example of this would be, "I'm can see that you're trying really hard to nurse your baby, but if it's this stressful, I would totally understand if you wanted to switch to bottles. A happy mom makes for a happy baby!" This kind of advice, while usually well-meaning, does not help the mother who sincerely wants to exclusively breastfeed but is in the throes of the two-week growth spurt or is battling thrush or mastitis. It's hard, but as a new parent it's important to not allow unhelpful comments like these to affect your mindset.

To Support Mom: Rather than trying to deter her from a path you think may be causing her stress, it is more helpful and more supportive to try to understand what her own goals are. A better comment in the above situation might be, "I can tell you really want to make nursing work, and you're doing an amazing job. I heard of a great lactation consultant in the area. Do you want her number?" If the mom really wants to breastfeed, suggesting that she stop will not make her feel supported. Helping her attain her goals will improve her mood and situation.

Preparation and Education

As new parents, we need to be prepared to avoid the improper and unhelpful advice and to call upon our emotional and practical support people whenever we need to. Gather your support system around you before you give birth, and be ready to discard information and advice that isn't what you want to hear.

As supportive friends and family members of new parents, it's our job to say the right words and be prepared with the right information. It doesn't hurt for others besides the new mom to learn a little about breastfeeding so that we can help in a way that the new parents will appreciate. It's important to know what the parents want and how to help them achieve that. Parents are bombarded by advice, some of which is contradictory, and knowing they have people to lean on who will simply be there to say, "I know it's hard now, but you're doing great, and it gets easier" will be invaluable.

How have you supported friends or relatives as they begin their parenting journeys? How have you been best supported when you've had a new baby? When we came home from the hospital with my third son, it was an incredibly hot and humid day, he screamed whenever he wasn't on the breast, and I was completely emotionally drained. A friend texted me just to say I was doing great, and it felt so good to hear that, even though it was my third baby. What is your favorite thing to tell a new parent, and how do they usually respond?