There's a lot of things people will "warn" you about when you are pregnant or thinking about having kids. They'll talk about the sleepless nights, their worst "poop" story, the endless diapers, illness, worry, expenses. They'll talk about the joys, the highlights, and the lows. They'll tell you all about the births, the pregnancies, and the pain. So, you'll go into pregnancy and childbirth thinking you're prepared for what life with kids will be like. You'll be expecting incredible feelings of love, stressful nights of crying, and worry worry worry.
But there is one thing no one ever warns you about when it comes to kids, and it's something that will become a major part of your life. I am here to fill you in!
The number one thing people should warn you about when it comes to having kids is laundry. You probably have a laundry routine for yourself. Maybe you do laundry once or twice a week, or maybe you have enough underwear that you can go two weeks between loads. You probably have a load or two of clothes, plus the occasional load of sheets and towels. Once in a while, you run a delicates cycle. My point is, laundry is not a major part of your week.
Until you have kids.
Now, granted, babies' clothes are small and don't take up too much extra space. But I've had days where my newborn goes through three outfits in 12 hours, so they generate way more than one or two additional items of clothing per day to your laundry basket. Then there's the burp rags, the receiving blankets, the bibs, and your clothes that get pooped on, spit-up on, or peed on (or, if you're very lucky, all three!). If you have the baby in a crib, you have his sheet to wash in addition to your own. If he's in bed with you, you'll probably be changing your sheets more often, due to various bodily fluids he will be kind enough to emit all over your bed. You have his bath towels and washcloths to wash.
And after the infancy period, you have a toddler. Toddlers get DIRTY. You'll have food-covered shirts, mud-covered pants. And the socks! Let me tell you about the socks! You can tell your socks from your spouse's, presumably. You can tell yours and your spouse's socks from your baby's. But can you tell your three-year-old's socks from your five-year-old's socks? Word of advice about socks: Give each kid completely different kinds of socks, or you'll forever be hearing, "Mom, why are my socks in his drawer?" or "Mom, I don't have any socks!" even if you've just done the laundry. (Although this phenomenon may also be attributed to the problem of socks jumping off of feet and landing directly under the couch, rather than ending up in the laundry basket. We have this problem at our house. Do you?)
And, with each additional kid, you have all of this additional laundry! Suddenly, you can't do all the sheets in one load; you need two. Suddenly, you have two loads of kids' clothes to do, not just one. And the guilt you'll feel if you go one too many days between loads of laundry and your son runs out of school uniform shirts (not that that could ever happen at my house...)!
So yeah. Laundry. Lots and lots of laundry.
I'm a breastfeeding counselor with a side hobby in educating parents and caregivers in proper car seat use. I have four sons, one born by c-section and three born by VBAC. I blog about my life with four kids, pregnancy and birth, breastfeeding, and car seats.
Wednesday, October 19, 2011
Thursday, October 13, 2011
Just One Bottle?
The latest hullabaloo in breastfeeding blog-land is the controversy over hospitals' supplying formula freebies to new moms, specifically in the context of the take-home bags. There are two issues under discussion here.
The first is that by handing out free formula, hospitals (and doctors) are advertising a product, which many feel they should not be doing. The reason hospitals give out free formula is that they have agreements with the formula companies that if they give (read: endorse) free formula to outgoing new moms, then the formula company will in turn provide free formula to the hospital to use in the nursery. The idea is that once a family starts using a particular brand of formula, they'll stick with that brand for fear of adverse reactions from switching (despite all formulas being essentially the same, and generics costing approximately half of what the identical brand-name product goes for). So, by giving a mom $30 worth of formula as she walks out the door, Enfamil or Similac or Nestle has just gained a new customer for at least the next 12 months, or so the formula companies' thinking goes.
The second issue is that studies show that mothers who have formula readily available at home are more likely to stop breastfeeding sooner or to supplement when it isn't necessary. Thus, mothers who are sent home with formula samples endorsed by the hospital are less likely to breastfeed exclusively for six months and are less likely to continue to breastfeed to a year and beyond, just because the hospital or pediatrician gave them a can of formula.
The first point is more of an ethical argument: Should hospitals be endorsing or advertising one brand over another (essentially identical) one? The second is a health issue: If the goal is for women to breastfeed their babies, then hospitals are undermining their own efforts at promoting breastfeeding by handing out formula as patients walk out the door. An associated problem is that if the hospital gives you formula, then the hospital is tacitly stating that you "can" or "should" use it, even if said hospital is otherwise trying to promote exclusive breastfeeding. It sends mixed signals.
There is one more, less controversial, issue as well. If you go home intending to breastfeed but decide to use formula for whatever reason, simply being handed a can of powdered formula with the hospital's blessing isn't enough. You need to know how to properly prepare and use formula, and if you don't do it correctly, it can be unsafe for a young baby. So if a hospital or doctor is going to give formula freebies, they should also give instructions on formula's proper use.
Okay, leaving that third bit aside, I want to talk about the other two problems from my own experience.
I've mentioned a few times now, if you're a long-time reader, that I had gone into the birth of my first son with the intention to exclusively breastfeed him. However, a difficult birth and lack of preparation on my part led to his being formula-fed. They asked us which kind of formula they should give the baby, and we, not having looked into formula at all, shrugged and asked what they suggested. They told us many moms liked the Enfamil Lipil, so we said sure, why not. When we left the hospital, they were "kind" enough to give us as much free formula as they could (a case of ready-to-feed bottles). When we ran out of those, we hesitantly bought a can of powdered stuff from the store and read the instructions carefully on how to prepare it. Naturally, we bought the Enfamil Lipil, because that's what they gave us in the hospital. He wasn't super-happy on it, so we eventually tried Enfamil Gentlease, which he did very well on. It wasn't until the baby was about 4 months old and I saw that Walmart carried a generic version of the Gentlease for about half the price that we got savvy and started using the generic, especially when we saw that the baby didn't care what brand was in his bottle! It didn't ever occur to me to buy Similac or Nestle, because, by golly, they'd given us Enfamil in the hospital, and that's what we were using! In fact, we were even convinced by Enfamil's excellent marketing that our son needed the additional nutrients found in their toddler formula, and continued using formula until our son started refusing it at about 16 months, at which point he was weaned to exclusively solid foods and cow's milk.
My second son was born at a hospital that gave out custom bags with no formula branding or free formula. I did get some free samples in the mail from Similac, and Enfamil and Gerber generously sent coupons regularly. I kept the Similac samples around but never touched them and eventually gave them to a friend who was formula-feeding. I was so gung-ho and had so few problems with my second son's breastfeeding that, even when I was frustrated, the thought of using formula never even crossed my mind. So having it in the house was not a temptation for me, but only because I was so committed (and obsessed? Maybe). If I had been slightly less so, the difficult times might have been just difficult enough to make "just one bottle" seem very attractive.
My third son was born at the same hospital as my second, and, as mentioned in his birth story last month, the breastfeeding support there was stellar. I again received a very nice, custom bag with no formula branding or freebies. I had intentionally signed up with some baby products mailing lists so I'd get free stuff, but the only free stuff I've gotten is formula. (I was hoping for a diaper bag or something!) There was a can of Similac sitting on top of my fridge for a while, until I moved it to the garage. I have to figure out who to give it to. So far, I don't have any formula-feeding friends this time around! (Not that I'm complaining.)
We brought our third son home on a Tuesday afternoon in September, on the first day of an awful, four-day heat wave. It was 92 degrees and humid. (This is quite unusual here in southern California, especially in September!) We don't have A/C, and the house was sweltering. The baby wouldn't stop nursing, probably because he was uncomfortably hot. His latch was not very good, and my nipples hurt so badly every time he latched on. (If that hadn't improved promptly, I would have gone to a lactation consultant for help!) And he latched on a lot! If I put him down, he'd scream. This went on into Wednesday, also 92 degrees and humid. I asked a friend to come over to meet the baby and keep me company, because I was all alone. She was a Godsend. She played with my other two boys, got us lunch - in the midst of my postpartum hormone surges, figuring out how to handle lunch actually had me in tears - held the baby, and was generally awesome. (You know who you are. THANK YOU for saving my sanity that day!) And the baby just kept on screaming whenever he wasn't nursing. We decided he was just so thirsty because it was so hot, and I had nothing but colostrum.
It was in that moment, the 674th time he latched on that day (okay, I may be exaggerating), that I understood the temptation of "just one bottle." I hadn't understood it with my second son, probably because it was December, I had fewer problems with his latch, and I was so worried that something would go wrong that I was afraid even to think about formula. This time, though I knew I wouldn't actually give him a bottle of formula, I understood why someone might. I needed relief. The poor baby wanted something to drink. If he had something other than my colostrum, maybe he would be happier, and my nipples could recover for an hour or two. Just one bottle... just one bottle...
Another friend of mine, who has a four-month-old, came over briefly to drop off some food for me and held the baby for a minute. He started rooting and screaming (of course). She jokingly said that she did have what he was looking for, but she wasn't sure how his mommy would feel about that. Truth be told, I actually almost asked her to nurse him for me!
Thank G-d, my milk came in Wednesday afternoon, and the baby got a good, long, satisfying feed, and he was suddenly the most content and happy baby you could ask for. It was a miracle. I had started to think that he would be a screamy, hungry monster for six months, and there was no way I could handle that, not with two other kids. I was in tears just thinking about it.
But once he had something to drink, he was fine, and he's actually been incredibly easy-going as a newborn nursling, giving me as much as two to three hours between feedings sometimes, which feels like a great luxury. My second son nursed, almost literally, every hour, so two hours feels like an eternity sometimes! It's nice.
But those first two days, with that can of Similac sitting up there on top of the fridge... Yes. I understand. Just one bottle. Just one. Just two hours of relief. Give me time to shower, apply some Lansinoh, close my eyes. Just one bottle. Just one. You know what the problem would have been if I had decided to give him that one bottle? I didn't have any bottles! (Ironic, eh? I had the formula but not the bottles.)
So, about those free formula samples interfering with breastfeeding in the early days? Yes. They can. Because another mom who had two days like I did, whose baby wouldn't stop screaming when he wasn't nursing, whose nipples were on fire, who had two other boys at home, who was all by herself on her newborn's third day of life, another mom who wanted to breastfeed but maybe didn't know quite as much as I do about how bottles can be a problem early in the breastfeeding relationship, that mom might give in and use "just one bottle."
Now, obviously, anyone can run to the store and buy some formula in such a situation, but it's less convenient, and she might be scared off by the price of a can. Or, in my case, she actually might not be able to run to the store, because she's all alone! But a free sample already in the house, given with the implied endorsement of the hospital, is very easy to tear open and use.
I'm not trying to paint formula or formula companies as evil. It's just business. And if a mom decides she does want to use formula, or wants to try to combination feed, or must supplement because of supply problems or weight-gain issues, then those free samples can be really helpful to have around! But if we're talking about supporting exclusive breastfeeding, which I am, then free formula samples really do get in the way.
The first is that by handing out free formula, hospitals (and doctors) are advertising a product, which many feel they should not be doing. The reason hospitals give out free formula is that they have agreements with the formula companies that if they give (read: endorse) free formula to outgoing new moms, then the formula company will in turn provide free formula to the hospital to use in the nursery. The idea is that once a family starts using a particular brand of formula, they'll stick with that brand for fear of adverse reactions from switching (despite all formulas being essentially the same, and generics costing approximately half of what the identical brand-name product goes for). So, by giving a mom $30 worth of formula as she walks out the door, Enfamil or Similac or Nestle has just gained a new customer for at least the next 12 months, or so the formula companies' thinking goes.
The second issue is that studies show that mothers who have formula readily available at home are more likely to stop breastfeeding sooner or to supplement when it isn't necessary. Thus, mothers who are sent home with formula samples endorsed by the hospital are less likely to breastfeed exclusively for six months and are less likely to continue to breastfeed to a year and beyond, just because the hospital or pediatrician gave them a can of formula.
The first point is more of an ethical argument: Should hospitals be endorsing or advertising one brand over another (essentially identical) one? The second is a health issue: If the goal is for women to breastfeed their babies, then hospitals are undermining their own efforts at promoting breastfeeding by handing out formula as patients walk out the door. An associated problem is that if the hospital gives you formula, then the hospital is tacitly stating that you "can" or "should" use it, even if said hospital is otherwise trying to promote exclusive breastfeeding. It sends mixed signals.
There is one more, less controversial, issue as well. If you go home intending to breastfeed but decide to use formula for whatever reason, simply being handed a can of powdered formula with the hospital's blessing isn't enough. You need to know how to properly prepare and use formula, and if you don't do it correctly, it can be unsafe for a young baby. So if a hospital or doctor is going to give formula freebies, they should also give instructions on formula's proper use.
Okay, leaving that third bit aside, I want to talk about the other two problems from my own experience.
I've mentioned a few times now, if you're a long-time reader, that I had gone into the birth of my first son with the intention to exclusively breastfeed him. However, a difficult birth and lack of preparation on my part led to his being formula-fed. They asked us which kind of formula they should give the baby, and we, not having looked into formula at all, shrugged and asked what they suggested. They told us many moms liked the Enfamil Lipil, so we said sure, why not. When we left the hospital, they were "kind" enough to give us as much free formula as they could (a case of ready-to-feed bottles). When we ran out of those, we hesitantly bought a can of powdered stuff from the store and read the instructions carefully on how to prepare it. Naturally, we bought the Enfamil Lipil, because that's what they gave us in the hospital. He wasn't super-happy on it, so we eventually tried Enfamil Gentlease, which he did very well on. It wasn't until the baby was about 4 months old and I saw that Walmart carried a generic version of the Gentlease for about half the price that we got savvy and started using the generic, especially when we saw that the baby didn't care what brand was in his bottle! It didn't ever occur to me to buy Similac or Nestle, because, by golly, they'd given us Enfamil in the hospital, and that's what we were using! In fact, we were even convinced by Enfamil's excellent marketing that our son needed the additional nutrients found in their toddler formula, and continued using formula until our son started refusing it at about 16 months, at which point he was weaned to exclusively solid foods and cow's milk.
My second son was born at a hospital that gave out custom bags with no formula branding or free formula. I did get some free samples in the mail from Similac, and Enfamil and Gerber generously sent coupons regularly. I kept the Similac samples around but never touched them and eventually gave them to a friend who was formula-feeding. I was so gung-ho and had so few problems with my second son's breastfeeding that, even when I was frustrated, the thought of using formula never even crossed my mind. So having it in the house was not a temptation for me, but only because I was so committed (and obsessed? Maybe). If I had been slightly less so, the difficult times might have been just difficult enough to make "just one bottle" seem very attractive.
My third son was born at the same hospital as my second, and, as mentioned in his birth story last month, the breastfeeding support there was stellar. I again received a very nice, custom bag with no formula branding or freebies. I had intentionally signed up with some baby products mailing lists so I'd get free stuff, but the only free stuff I've gotten is formula. (I was hoping for a diaper bag or something!) There was a can of Similac sitting on top of my fridge for a while, until I moved it to the garage. I have to figure out who to give it to. So far, I don't have any formula-feeding friends this time around! (Not that I'm complaining.)
We brought our third son home on a Tuesday afternoon in September, on the first day of an awful, four-day heat wave. It was 92 degrees and humid. (This is quite unusual here in southern California, especially in September!) We don't have A/C, and the house was sweltering. The baby wouldn't stop nursing, probably because he was uncomfortably hot. His latch was not very good, and my nipples hurt so badly every time he latched on. (If that hadn't improved promptly, I would have gone to a lactation consultant for help!) And he latched on a lot! If I put him down, he'd scream. This went on into Wednesday, also 92 degrees and humid. I asked a friend to come over to meet the baby and keep me company, because I was all alone. She was a Godsend. She played with my other two boys, got us lunch - in the midst of my postpartum hormone surges, figuring out how to handle lunch actually had me in tears - held the baby, and was generally awesome. (You know who you are. THANK YOU for saving my sanity that day!) And the baby just kept on screaming whenever he wasn't nursing. We decided he was just so thirsty because it was so hot, and I had nothing but colostrum.
It was in that moment, the 674th time he latched on that day (okay, I may be exaggerating), that I understood the temptation of "just one bottle." I hadn't understood it with my second son, probably because it was December, I had fewer problems with his latch, and I was so worried that something would go wrong that I was afraid even to think about formula. This time, though I knew I wouldn't actually give him a bottle of formula, I understood why someone might. I needed relief. The poor baby wanted something to drink. If he had something other than my colostrum, maybe he would be happier, and my nipples could recover for an hour or two. Just one bottle... just one bottle...
Another friend of mine, who has a four-month-old, came over briefly to drop off some food for me and held the baby for a minute. He started rooting and screaming (of course). She jokingly said that she did have what he was looking for, but she wasn't sure how his mommy would feel about that. Truth be told, I actually almost asked her to nurse him for me!
Thank G-d, my milk came in Wednesday afternoon, and the baby got a good, long, satisfying feed, and he was suddenly the most content and happy baby you could ask for. It was a miracle. I had started to think that he would be a screamy, hungry monster for six months, and there was no way I could handle that, not with two other kids. I was in tears just thinking about it.
But once he had something to drink, he was fine, and he's actually been incredibly easy-going as a newborn nursling, giving me as much as two to three hours between feedings sometimes, which feels like a great luxury. My second son nursed, almost literally, every hour, so two hours feels like an eternity sometimes! It's nice.
But those first two days, with that can of Similac sitting up there on top of the fridge... Yes. I understand. Just one bottle. Just one. Just two hours of relief. Give me time to shower, apply some Lansinoh, close my eyes. Just one bottle. Just one. You know what the problem would have been if I had decided to give him that one bottle? I didn't have any bottles! (Ironic, eh? I had the formula but not the bottles.)
So, about those free formula samples interfering with breastfeeding in the early days? Yes. They can. Because another mom who had two days like I did, whose baby wouldn't stop screaming when he wasn't nursing, whose nipples were on fire, who had two other boys at home, who was all by herself on her newborn's third day of life, another mom who wanted to breastfeed but maybe didn't know quite as much as I do about how bottles can be a problem early in the breastfeeding relationship, that mom might give in and use "just one bottle."
Now, obviously, anyone can run to the store and buy some formula in such a situation, but it's less convenient, and she might be scared off by the price of a can. Or, in my case, she actually might not be able to run to the store, because she's all alone! But a free sample already in the house, given with the implied endorsement of the hospital, is very easy to tear open and use.
I'm not trying to paint formula or formula companies as evil. It's just business. And if a mom decides she does want to use formula, or wants to try to combination feed, or must supplement because of supply problems or weight-gain issues, then those free samples can be really helpful to have around! But if we're talking about supporting exclusive breastfeeding, which I am, then free formula samples really do get in the way.
Tuesday, October 4, 2011
Breastfeeding Support: The Disconnect from the Hospital to the Pediatrician
I promised a post about the hospital after my third son was born, and I might actually have found some time to sit down and write it. You forget pretty quickly what a time-suck having a newborn is. Everything takes longer, from getting out of the house to doing laundry. Just when everyone's got their shoes on, or just when you've finally found the energy to fold that pile of clothes, oops, baby's hungry! Be ready in 20 minutes (if we're lucky). It goes by so fast, though. He's four weeks old already, if you can believe it (I can't)!
I was very, very impressed with the breastfeeding and normal-birth supportive environment at the hospital where I gave birth. If you read my second and third sons' birth stories, you know that I was very pleased with my treatment. Both were at the Kaiser Foundation Hospital/San Diego Medical Center. Before giving birth to Son #3, I could only hope the hospital experience would be at least as good as it had been when I had Son #2, and I was pleasantly surprised to find it even better. The first improvement, and the one I liked the most, was that they are converting to all private rooms on the postpartum floor. I had a roommate for a few hours after Son #2's birth, and I didn't like the feeling of intrusion (I'm sure she didn't like it either!). The second improvement, and by far the most important, was the amount of breastfeeding training they had given all the maternity nurses.
From the moment my son was born, I truly felt he was under my care, not the hospital's. They were there to help me. They let me hold him and nurse him until I was ready for them to take him to be weighed. They didn't even give him a bath or dress him until I said it was okay (later in the day, in my hospital room!). They didn't take him out of my sight except for the hearing test, and then only for a few minutes. I was encouraged to keep him skin-to-skin. Every nurse who came to my room was able to help me with breastfeeding, armed with up-to-date information. Not one nurse gave me "bad" or "wrong" advice. The most negative thing any nurse said to me (and only if you take it in a negative context) was a fairly neutral, "He's using you as a pacifier!" I didn't exactly take it as discouragement - she didn't say, "Don't become a human pacifier!" - but I still felt it was an unhelpful comment. The nurse on duty both mornings was clearly well-trained in breastfeeding support, even had a lanyard saying as much, and was able to give me very helpful, hands-on advice about positioning. She was very supportive. When I half-complained about how often he was nursing, she said, "He's just doing what he needs to to get your milk in!" No comments about supplementing or hunger. No comments about pacifiers or taking a break. Just a "this is normal," and "you're doing great" attitude. I was very pleased.
When we were getting ready to leave, I had to detach him from my nipple so we could put him in the car seat. He wasn't too happy about this and started to cry piteously. We had a 45-minute drive, and I was so afraid he would scream the entire way. We tentatively asked the person who was helping us get ourselves ready to go if we could have a pacifier to try to calm him. She said they actually didn't have pacifiers, because giving a pacifier that early can interfere with breastfeeding (which is absolutely true!). I was disappointed but happy at the same time. As it turned out, he calmed down after a few minutes and slept the whole way home, so a pacifier wasn't necessary anyway.
Kaiser has a custom-made diaper bag that they give out. It's a very nice, high-quality bag. (We still regularly use the one we got when Son #2 was born, and now we have a new one to use as well!) It doesn't contain anything remotely formula-related. They gave me some samples of Lansinoh lanolin, lots of diapers, baby soap, alcohol wipes (for his umbilical cord), and anything else we wanted to take from the bassinet. They gave me discharge instructions with more breastfeeding information. And, a really nice baby blanket! No pacifiers, no formula samples, no bottles.
I don't know how I would have felt about the push for breastfeeding if I had not gone in intending to breastfeed. Perhaps it would have felt too pressuring, or I would have felt ashamed if I decided not to breastfeed, but I don't know. I'm actually curious to know how other new mothers feel about the way breastfeeding is presented there. I'm sure that my nurse-midwife and the maternity nurses all got the vibe from me pretty quickly that, (a) I was going to breastfeed, and (b) I pretty much knew what I was doing.
I fully intend to write to the hospital expressing my delight about my experiences. But I also intend to write to the Kaiser general offices about my disappointment upon taking my newborn son to the pediatrician for his 3-day checkup.
The hospital was so supportive of breastfeeding, and the OB/GYN offices were full of breastfeeding literature and posters (and no references to formula), and so I naturally assumed that that breastfeeding-supportive environment should also continue into the pediatric offices.
The breastfeeding support that had so impressed me through my pregnancy and delivery completely evaporated when I entered the pediatrician's office. The initial form I was given to fill out asked me if I was feeding my baby formula in such a way that I felt like I ought to be. The nurse asked how often he was feeding, and when I told her it had been basically nonstop, she said, "Oh, getting sore already, Mama?" The doctor informed me that breastfed babies needed Vitamin D supplementation (which is true, according to the latest research), but that if I started giving formula, and at least 50% of his diet was formula, then I didn't have to give extra Vitamin D anymore. What? Throwing around the words "formula" and "supplementation" next to a mother who had had as rough a second day home as I did might have been enough to drive her to start using formula right away, since the doctor had implied it was "okay." (That's not to say it isn't "okay" to use formula if that's what you need to do. It's just that it is not supportive of breastfeeding to imply that formula would be in any way "better" than breastmilk.)
At the two-week checkup, upon seeing that my son had gained over two pounds in two weeks, the doctor (a different one this time) said, "Whatever you're doing, keep doing it!" So that, at least, was encouraging. But I wouldn't have made it two weeks if I wasn't me, in the sense that I was already well-educated and gung-ho about nursing my babies. I wouldn't have made it two days if I wasn't me. I get the feeling that the pediatricians at Kaiser are fairly autonomous, so support for breastfeeding (and knowledge about breastfeeding) will vary from doctor to doctor. I happen to very much like and respect the doctor I usually take my kids to there, the one I saw at the two-week appointment. The doctor I saw at the first appointment was very personable and friendly, but his breastfeeding support was not good. One positive comment I have, though, is that when my baby turned out to have jaundice, they didn't jump right to suggesting formula supplementation to clear the bilirubin; all of the doctors (three!) I saw over those few days just said, "Feed, feed, feed!" So there was some trust in breastfeeding!
A few days ago, Kaiser sent me a survey asking me to rate my experience at the hospital. I gave them very good marks. It is clear that breastfeeding initiation and continuation is very important to them, as several of the questions on the survey asked about the breastfeeding education and support offered during prenatal visits and in the hospital.
If they are truly so invested in Kaiser members breastfeeding their babies (as well they should be), then that support needs to continue into the pediatric offices. They need to have lactation consultants on staff. They need to train the pediatrics nurses in basic breastfeeding education, just as they did for the postpartum nurses. And they should insist on a uniform attitude toward breastfeeding among their pediatricians and possibly offer basic breastfeeding classes to the MDs, so that mothers who come in desperate for help will be able to get the support they desire.
For those who are unfamiliar with Kaiser Permanente, a brief explanation so this post will make sense: Kaiser Permanente is an HMO health insurance plan. If you are a member of Kaiser, all of your healthcare needs are attended to within the Kaiser system, which includes general practitioners, specialists, hospitals, physical therapy, pharmacy, etc.
It seems to me that if Kaiser as a whole has a philosophy of care, such as with breastfeeding support, then that philosophy should carry over from practitioner to practitioner, from prenatal care all the way through to pediatrics. If enough mothers write in with my above suggestions, maybe we will continue to see positive change throughout the Kaiser system.
I was very, very impressed with the breastfeeding and normal-birth supportive environment at the hospital where I gave birth. If you read my second and third sons' birth stories, you know that I was very pleased with my treatment. Both were at the Kaiser Foundation Hospital/San Diego Medical Center. Before giving birth to Son #3, I could only hope the hospital experience would be at least as good as it had been when I had Son #2, and I was pleasantly surprised to find it even better. The first improvement, and the one I liked the most, was that they are converting to all private rooms on the postpartum floor. I had a roommate for a few hours after Son #2's birth, and I didn't like the feeling of intrusion (I'm sure she didn't like it either!). The second improvement, and by far the most important, was the amount of breastfeeding training they had given all the maternity nurses.
From the moment my son was born, I truly felt he was under my care, not the hospital's. They were there to help me. They let me hold him and nurse him until I was ready for them to take him to be weighed. They didn't even give him a bath or dress him until I said it was okay (later in the day, in my hospital room!). They didn't take him out of my sight except for the hearing test, and then only for a few minutes. I was encouraged to keep him skin-to-skin. Every nurse who came to my room was able to help me with breastfeeding, armed with up-to-date information. Not one nurse gave me "bad" or "wrong" advice. The most negative thing any nurse said to me (and only if you take it in a negative context) was a fairly neutral, "He's using you as a pacifier!" I didn't exactly take it as discouragement - she didn't say, "Don't become a human pacifier!" - but I still felt it was an unhelpful comment. The nurse on duty both mornings was clearly well-trained in breastfeeding support, even had a lanyard saying as much, and was able to give me very helpful, hands-on advice about positioning. She was very supportive. When I half-complained about how often he was nursing, she said, "He's just doing what he needs to to get your milk in!" No comments about supplementing or hunger. No comments about pacifiers or taking a break. Just a "this is normal," and "you're doing great" attitude. I was very pleased.
When we were getting ready to leave, I had to detach him from my nipple so we could put him in the car seat. He wasn't too happy about this and started to cry piteously. We had a 45-minute drive, and I was so afraid he would scream the entire way. We tentatively asked the person who was helping us get ourselves ready to go if we could have a pacifier to try to calm him. She said they actually didn't have pacifiers, because giving a pacifier that early can interfere with breastfeeding (which is absolutely true!). I was disappointed but happy at the same time. As it turned out, he calmed down after a few minutes and slept the whole way home, so a pacifier wasn't necessary anyway.
Kaiser has a custom-made diaper bag that they give out. It's a very nice, high-quality bag. (We still regularly use the one we got when Son #2 was born, and now we have a new one to use as well!) It doesn't contain anything remotely formula-related. They gave me some samples of Lansinoh lanolin, lots of diapers, baby soap, alcohol wipes (for his umbilical cord), and anything else we wanted to take from the bassinet. They gave me discharge instructions with more breastfeeding information. And, a really nice baby blanket! No pacifiers, no formula samples, no bottles.
I don't know how I would have felt about the push for breastfeeding if I had not gone in intending to breastfeed. Perhaps it would have felt too pressuring, or I would have felt ashamed if I decided not to breastfeed, but I don't know. I'm actually curious to know how other new mothers feel about the way breastfeeding is presented there. I'm sure that my nurse-midwife and the maternity nurses all got the vibe from me pretty quickly that, (a) I was going to breastfeed, and (b) I pretty much knew what I was doing.
I fully intend to write to the hospital expressing my delight about my experiences. But I also intend to write to the Kaiser general offices about my disappointment upon taking my newborn son to the pediatrician for his 3-day checkup.
The hospital was so supportive of breastfeeding, and the OB/GYN offices were full of breastfeeding literature and posters (and no references to formula), and so I naturally assumed that that breastfeeding-supportive environment should also continue into the pediatric offices.
The breastfeeding support that had so impressed me through my pregnancy and delivery completely evaporated when I entered the pediatrician's office. The initial form I was given to fill out asked me if I was feeding my baby formula in such a way that I felt like I ought to be. The nurse asked how often he was feeding, and when I told her it had been basically nonstop, she said, "Oh, getting sore already, Mama?" The doctor informed me that breastfed babies needed Vitamin D supplementation (which is true, according to the latest research), but that if I started giving formula, and at least 50% of his diet was formula, then I didn't have to give extra Vitamin D anymore. What? Throwing around the words "formula" and "supplementation" next to a mother who had had as rough a second day home as I did might have been enough to drive her to start using formula right away, since the doctor had implied it was "okay." (That's not to say it isn't "okay" to use formula if that's what you need to do. It's just that it is not supportive of breastfeeding to imply that formula would be in any way "better" than breastmilk.)
At the two-week checkup, upon seeing that my son had gained over two pounds in two weeks, the doctor (a different one this time) said, "Whatever you're doing, keep doing it!" So that, at least, was encouraging. But I wouldn't have made it two weeks if I wasn't me, in the sense that I was already well-educated and gung-ho about nursing my babies. I wouldn't have made it two days if I wasn't me. I get the feeling that the pediatricians at Kaiser are fairly autonomous, so support for breastfeeding (and knowledge about breastfeeding) will vary from doctor to doctor. I happen to very much like and respect the doctor I usually take my kids to there, the one I saw at the two-week appointment. The doctor I saw at the first appointment was very personable and friendly, but his breastfeeding support was not good. One positive comment I have, though, is that when my baby turned out to have jaundice, they didn't jump right to suggesting formula supplementation to clear the bilirubin; all of the doctors (three!) I saw over those few days just said, "Feed, feed, feed!" So there was some trust in breastfeeding!
A few days ago, Kaiser sent me a survey asking me to rate my experience at the hospital. I gave them very good marks. It is clear that breastfeeding initiation and continuation is very important to them, as several of the questions on the survey asked about the breastfeeding education and support offered during prenatal visits and in the hospital.
If they are truly so invested in Kaiser members breastfeeding their babies (as well they should be), then that support needs to continue into the pediatric offices. They need to have lactation consultants on staff. They need to train the pediatrics nurses in basic breastfeeding education, just as they did for the postpartum nurses. And they should insist on a uniform attitude toward breastfeeding among their pediatricians and possibly offer basic breastfeeding classes to the MDs, so that mothers who come in desperate for help will be able to get the support they desire.
For those who are unfamiliar with Kaiser Permanente, a brief explanation so this post will make sense: Kaiser Permanente is an HMO health insurance plan. If you are a member of Kaiser, all of your healthcare needs are attended to within the Kaiser system, which includes general practitioners, specialists, hospitals, physical therapy, pharmacy, etc.
It seems to me that if Kaiser as a whole has a philosophy of care, such as with breastfeeding support, then that philosophy should carry over from practitioner to practitioner, from prenatal care all the way through to pediatrics. If enough mothers write in with my above suggestions, maybe we will continue to see positive change throughout the Kaiser system.
Thursday, September 22, 2011
Breastfeeding a Newborn
I'm back in the "breastfeeding a newborn" phase of life. Actually, the new baby has been amazingly good to me. I've written about how my second son was a snacker, eating every hour. This new guy, he eats very enthusiastically, sometimes only for 10 minutes, other times for 20, but he cluster feeds for a bit, then takes a nice long nap, sometimes close to two hours. (Not that I can make any definite statements about his habits at 17 days old, but this is sorta how it's been so far.) It's kind of amazing. I was prepared for another every-hour eater, so this is pleasant.
Before my milk came in, his latch was horrible, it was hot as heck here (no A/C), and he would not let go of my nipple without screaming. I dreaded latching him on, I cried, thinking I couldn't possibly handle a baby like this, I despaired. And then my milk came in, and he became the most content, easy-going guy. I'm very lucky.
I read a very good article yesterday - which I wish I'd read two weeks ago! - about how positioning is more important than how the latch looks, and how the latch feels is more important than it looking like they describe in the books, and suddenly he's latching better, with just a few simple tips. Hold the baby tummy-to-tummy with you, so his ears, shoulders, AND HIPS are in one line. Bring the baby to your breast, with the nipple in line with his NOSE, and let your breast brush his CHIN. This will stimulate him to open his mouth, and then you can drop the nipple in. If it doesn't hurt, you're fine. Also, it helps keep him latched comfortably if you recline a bit. This is called biological nurturing, or laid-back nursing, and it helps keep the baby from flinging his head backward and coming off the nipple in a rather painful way.
I would like to brag a little at this point. Baby was born 8lbs., 3.5oz. By day three he had lost about 6 ounces, and was down to 7lbs., 12oz. The very next day, day four, he was up to 7lbs., 15.5oz. (yes, he gained 3.5 ounces in one day, once my milk came in). Today, he had his two-week appointment, and at 17 days old, he's 9lbs., 14oz. Yes, folks, he gained over two pounds in two weeks. He's a good eater, that one!
Anyway, I have mastitis. I've preached up and down, here and in my book, about getting rid of plugged ducts and avoiding mastitis, and here I wake up yesterday morning with a horribly engorged right breast, chills, achy joints, and a hard, sore spot on the outside of said right breast. Damn. I tried my usual tricks, massaging the spot while nursing, nursing a lot on that side, letting the hot water from the shower help open up the duct, massaging some more. I thought I'd taken care of it, until my 600mg dose of ibuprofen wore off and the chills came back last night. I spent the night alternately having chills and sweats, so I called the doctor this morning and asked for antibiotics. If you can't clear the infection with home remedies within 24 hours, it's not worth taking any chances. Mastitis can be serious stuff. I was hoping to avoid antibiotics, because that can lead to thrush, which is its own ball of trouble. Ah well. I got some probiotics to take along with the antibiotics, so hopefully this will be the end of it.
And, finally, I've decided to start pumping and storing breastmilk again, like I did with my second son, in order to donate it. I have someone in mind to give it to, if she wants it. A friend of my housekeeper's had a baby who was in the hospital for a few weeks after birth. She desperately wanted to breastfeed him, but she didn't have good support, and she didn't have a full supply established. I tried to pass along some tips, but I think it was too late. At three months old, now, her milk is dried up, and her son has had four ear infections already. She's terribly upset. I asked my housekeeper if she thought her friend might take donated milk, and said I'd be very happy to start pumping for her. I won't be able to give her enough to get him off formula, but even one bottle a day may help. Poor baby.
Before my milk came in, his latch was horrible, it was hot as heck here (no A/C), and he would not let go of my nipple without screaming. I dreaded latching him on, I cried, thinking I couldn't possibly handle a baby like this, I despaired. And then my milk came in, and he became the most content, easy-going guy. I'm very lucky.
I read a very good article yesterday - which I wish I'd read two weeks ago! - about how positioning is more important than how the latch looks, and how the latch feels is more important than it looking like they describe in the books, and suddenly he's latching better, with just a few simple tips. Hold the baby tummy-to-tummy with you, so his ears, shoulders, AND HIPS are in one line. Bring the baby to your breast, with the nipple in line with his NOSE, and let your breast brush his CHIN. This will stimulate him to open his mouth, and then you can drop the nipple in. If it doesn't hurt, you're fine. Also, it helps keep him latched comfortably if you recline a bit. This is called biological nurturing, or laid-back nursing, and it helps keep the baby from flinging his head backward and coming off the nipple in a rather painful way.
I would like to brag a little at this point. Baby was born 8lbs., 3.5oz. By day three he had lost about 6 ounces, and was down to 7lbs., 12oz. The very next day, day four, he was up to 7lbs., 15.5oz. (yes, he gained 3.5 ounces in one day, once my milk came in). Today, he had his two-week appointment, and at 17 days old, he's 9lbs., 14oz. Yes, folks, he gained over two pounds in two weeks. He's a good eater, that one!
Anyway, I have mastitis. I've preached up and down, here and in my book, about getting rid of plugged ducts and avoiding mastitis, and here I wake up yesterday morning with a horribly engorged right breast, chills, achy joints, and a hard, sore spot on the outside of said right breast. Damn. I tried my usual tricks, massaging the spot while nursing, nursing a lot on that side, letting the hot water from the shower help open up the duct, massaging some more. I thought I'd taken care of it, until my 600mg dose of ibuprofen wore off and the chills came back last night. I spent the night alternately having chills and sweats, so I called the doctor this morning and asked for antibiotics. If you can't clear the infection with home remedies within 24 hours, it's not worth taking any chances. Mastitis can be serious stuff. I was hoping to avoid antibiotics, because that can lead to thrush, which is its own ball of trouble. Ah well. I got some probiotics to take along with the antibiotics, so hopefully this will be the end of it.
And, finally, I've decided to start pumping and storing breastmilk again, like I did with my second son, in order to donate it. I have someone in mind to give it to, if she wants it. A friend of my housekeeper's had a baby who was in the hospital for a few weeks after birth. She desperately wanted to breastfeed him, but she didn't have good support, and she didn't have a full supply established. I tried to pass along some tips, but I think it was too late. At three months old, now, her milk is dried up, and her son has had four ear infections already. She's terribly upset. I asked my housekeeper if she thought her friend might take donated milk, and said I'd be very happy to start pumping for her. I won't be able to give her enough to get him off formula, but even one bottle a day may help. Poor baby.
Tuesday, September 13, 2011
My Third Son's Birth!
Hello out there. You may have gathered from my longer-than-average hiatus that I've been indisposed. You were right. I gave birth to my third son on September 5 (Labor Day!), and I've finally had an opportunity to sit down and write about the experience. I'm very excited to share with you my birth story!
For over two weeks, I had been having strong, recurrent
bouts of contractions. They weren’t painful, but they were strong enough to
make me stop and wonder, then look for other signs of labor. And then they’d
stop. Starting at 36 weeks, at each appointment with my nurse-midwife, she’d
check my cervix (per my request), and each week, I had opened another centimeter. Each week, we
were both certain that I’d give birth before the next appointment. But I was
there, still pregnant, at 37 weeks… 38 weeks… By my 39-week appointment, I was
3cm dilated and 80% effaced, and still no labor. I was getting antsy. Very
antsy. But I knew baby would come when he was ready, and I sincerely wanted to
let nature take its course. I was determined to have a spontaneous labor and
successful second VBAC.
It was the Sunday of Labor Day weekend. I was due the
following Wednesday. I had convinced myself that I couldn’t possibly have this
baby before 40 weeks, because otherwise I was going to lose my mind. On that
Sunday, we went to the park with the boys and had a picnic, then to a community
barbecue. The whole afternoon, I’d have occasional strong contractions, much
like before, but they didn’t come to an end. I started to toy with the idea
that maybe, just maybe, they meant something this time. But, by that point, I’d
had so many, “Maybe this is it!” moments that I was not ready to commit.
Around 10:30 that night, I decided the contractions were
actually getting stronger, and I started timing. Five minutes apart. Well,
that’s the tell-tale sign, right? But, they didn’t hurt as much as I thought
they should, and I could walk and talk during each one, so I still wasn’t
totally convinced. I decided to take a bath and see if I could relax them away,
then try to get some sleep. If I was going into labor soon, I should try to get
a few hours of sleep first.
I took a bath, and they didn’t stop. I got ready for bed,
laid down, and WHAM, I had a really strong contraction. My thought was, "Well, I won't be able to sleep through these!" Five minutes later, another
one. Okay, I said. This is it. I put clothes back on and told my husband I
thought it was for real this time. We called someone to come stay with the kids
and called the hospital to make sure it was okay to come in (it was). By the time
everything was arranged, the hospital bag was double-checked, and we were ready to go,
it was about 12:30am, Labor Day. We took off for the hospital. We didn’t want
to wait at home too long, because the hospital was 40 miles away, and I didn’t
want to take the chance that we would be “too late,” as it were. I also didn’t
want to be too early and hang around in the hospital for more hours than
necessary, or to get there and find out it was false labor again, but I was
pretty certain. I was completely certain about halfway there when I realized I
was no longer able to carry on a conversation during a contraction. Whew.
My husband drove… er… rather fast, and I think we got to the
hospital in about half an hour, around 1:00 in the morning. To my delight, the
nurse-midwife on call that evening was none other than the one I’d been seeing
for my prenatal appointments. We were mutually excited, since that rarely
happens at Kaiser. They triaged me and checked my dilation, and I had gained
another centimeter and was having regular contractions. Time for baby!
My nurse-midwife told me I could have the epidural whenever
I wanted. I wasn’t sure that I wanted one at all, and I said I knew I could
have it, and that I’d ask for it if I wanted it. I definitely didn’t feel that
I “needed” it yet. The contractions were definitely growing in intensity, but the
five minute break in between was enough for me to catch my breath. My husband
knew I was hesitant to have any medications during labor, and I’m really glad
we talked about that beforehand, because the idea of the epidural becomes very,
very tempting at 3:00 in the morning in active labor, let me tell you.
Sidebar: I wanted to avoid epidural and Pitocin during this
labor, if possible, because I was intent on having another VBAC and because I
knew that any interventions could lead to further interventions, which might
eventually lead to c-section. Additionally, I had Pitocin with each of my
previous deliveries, and in each of the previous deliveries, I had postpartum
hemorrhage, and both boys had jaundice. Pitocin is a risk factor for both
postpartum hemorrhage and jaundice in the baby. I did NOT want Pitocin, and, by
extension, I did not want an epidural, in case it created a “need” for Pitocin.
They kept offering to break my water to move labor along,
but I kept refusing. The amniotic sac protects the baby from the brunt of the
contractions, and it also lessens the intensity of the pain. Once the water is
broken, everything gets ramped up. I didn’t want that. I wanted my water to
break naturally. I think they really wanted to do it, but I didn’t. I really
really didn’t. So I kept refusing. Besides, labor seemed to be moving along
quite quickly!
I had dilated to about 6cm when labor went crazy. I was
managing the every-five-minutes contractions reasonably well, but all of a sudden
they went from every five to every 1.5 to 3 minutes! There was no break in
between to breathe or relax. One ended and the next began. The nurse, who was
wonderfully attentive, strong, and worked with me very well, was coaching me to
blow and breathe, which is NOT EASY. At the end of each breath, I desperately
wanted to push, but I couldn’t, because it wasn’t time. I started to
hyperventilate a bit, and they gave me oxygen. I’m not sure if it helped. I had
to breathe so fast to stay ahead of that “push” feeling, I barely had time to
exhale before I had to inhale again.
And that’s when I said, “I want the epidural!”
The nurse and my husband both knew that I wasn’t so sure
about it. I knew I wasn’t so sure about it. They asked if I really wanted it, and all
the fears about what might happen if I got one surfaced, and I backed down. And
then said I wanted it. And then backed down. I just couldn't make a decision.
Between them, my husband and my nurse were very good about putting me off
without making it seem like they were. I did want it, in that moment, but then
I didn’t. I was so tired. I think my feeling was that if I could just rest a
little, I’d be okay to continue, and an epidural would let me rest.
The other nurse-midwife on call came in, because mine was taking
a break until I was ready to deliver (she was staying around because she wanted
to deliver me, but I think she was technically supposed to be off). She
suggested that I try the shower. So I got in the shower for a bit, and the hot
water felt really good, but the contractions were just coming and coming and
coming, and I was so tired. I hadn’t expected it to hurt quite so much, and I
hadn’t expected the contractions to be so close together or so intense. How
much longer did I have to endure these? Hours? I couldn't do hours. I just
couldn't. I got out of the shower and returned to the bed, somehow hoping that sitting or lying down would help. Maybe I was just tired of standing.
I think the nurse realized that I must be close, because she
said to me, “Jessica, listen. I want to tell you something about the epidural.
I’m happy to get you one if you want it. But by the time we get the anesthesiologist
up here, and we sit you up and do it, it will still be 20 minutes before it
kicks in. By then, you might be ready to push, and you won’t even get to enjoy
the epidural.”
That convinced me to keep going, and, sure enough, I was
almost fully dilated. At 4:40am, my water broke with a pop. The nurse checked
and found that I had just a lip of cervix left. She said I was absolutely NOT
to push until she got my nurse-midwife up there. I distinctly remember saying,
“Tell her to RUN!” She got there quickly, checked me, and said the words I’d
been longing to hear, “Go ahead and push!”
I pushed. Boy did I push. I wanted this labor OVER WITH. I
wanted that baby OUT. Besides, it hurt a lot less when I was pushing then when
I wasn’t. I heard the nurse-midwife call for a local. She said my perineum just
wasn’t stretching quite enough. She made a little cut, I made another few
pushes, and I felt that baby slide out. I had never felt that before. My
previous VBAC had been with an epidural, and I’d had a c-section before that,
so I had no idea that you could actually FEEL the baby slide out. Wow. He was
born at 4:57am, just 17 minutes after my water broke!
They put him right on my stomach, whereupon my first words
were, I believe, “I made a baby!”. They dried him off, but otherwise waited,
per our request, for a couple minutes to cut the cord, and then we brought him
right to my chest to nurse. At the same time, there was a flurry of activity
around me, administering medications by injection in each leg, Pitocin to contract my uterus - I had actually YANKED my IV out of my hand while pushing, so first they
were frantically trying to put a new one in while I was trying to hug my new
baby - and stitching up the episiotomy. They were working
furiously to prevent a hemorrhage, and, you know what? I had blood loss within
normal limits! Spectacular!
They waited until I felt he was taking a break from nursing
before weighing him. He came in at a healthy 8lbs., 3.5oz. Pink and
strong. They gave him right back to me.
Just before we were ready to head up to the postpartum ward,
they made me go pee. I had never been ambulatory right after giving birth
before. This was all so new to me. I sat in a wheelchair (rather than lying on
a bed) to go up to my room, and I got to hold the baby while we went up there. So
cool.
My stay at the hospital was really good. The breastfeeding
support was phenomenal. I was actually told that I should sleep with him
skin-to-skin on my chest! I will be writing a separate blog post in more detail about the hospital, so I won't get into it too much here.
We went home the next day at noon. The baby did become
jaundiced, but his numbers came down on their own, rather than his needing
phototherapy like my first two had. I don’t know if the method of birth had
anything to do with the jaundice or not.
The second day home was very hard. We were in the middle of
a heatwave. It was 90 degrees, and I had no milk yet, just colostrum. The poor
baby was so thirsty. I couldn’t unlatch him for two minutes without him
screaming. My nipples were sore beyond belief. I was having horrible hot
flashes, crying jags, the postpartum hormone surges. It was pretty awful. But
I’m already feeling better. My milk came in Wednesday afternoon, and the change
in the baby was incredible. He became so content!
Overall, I feel that the birth went just about as well as you
could ask for. Only 4 hours of labor in the hospital? Wow! Natural birth (even if it was kind of by
accident), immediate and constant skin-to-skin. I got pretty much everything I
wanted out of this birth. If we have another child in the future, G-d willing,
another birth like this one would be just fine!
Monday, August 29, 2011
Sitting Around Waiting To Go Into Labor...
No baby yet. I still hope to be posting a birth story soon. (Like, really soon? Maybe?)
I'm very happy to report that this pregnancy has been my "healthiest," in terms of weight gain and overall feelings of well-being. The very beginning was rough. I didn't have much morning sickness, but I had some other weird symptoms that were apparently hormonal, and I also had a lot of trouble with my sciatic nerve until the middle of the second trimester. However, I haven't gained nearly as much weight as I did in my first two pregnancies, and, in even better news, my blood pressure has been very stable! Every week now when I see my CNM, I wait anxiously for the blood pressure monitor to display my numbers, and every week I heave a great sigh of relief when the numbers are in the normal range once again. My biggest worry since the beginning of this pregnancy would be that I would have high blood pressure again and need to be induced or c-sectioned.
I am now 38 weeks, and delivery seems imminent. For almost two weeks, now, I've been having intermittent contractions, strong but relatively painless. I can feel that the baby is moving down, and when I told my CNM that I had showed up to the hospital dilated 4cm with my second son, she decided to check my dilation at my office visit just to see what was going on. As of Wednesday, I was 3cm dilated and 80% effaced, and she could just feel the baby's head! She swept my membranes, saying that if labor was on the verge of starting, doing so could get things going. And yet, here I am, five days later, still no baby. Amazing how pregnancy can fake you out even right at the end.
I wrote out a "birth plan" and then decided not to print it. I have just a few desires for this birth, the main one of which is "have a vaginal birth." My intention is to avoid all interventions (IV, Pitocin, epidural) not because I have any kind of "earth mama" thing going, not because I'm altruistic or hippy or crunchy, not because I have any kind of "I am woman, hear me roar" complex (I'm more likely to whimper than roar), but because, to be honest, I'm more afraid of the drugs than I am of the pain of labor. Now that I know as much as I do about how interventions can negatively affect the birth outcome and the health of the mother and baby, I'm afraid of them.
I know this sounds a bit silly. I've had Pitocin and epidural with both previous deliveries. How can I now be afraid of them, when I consented to them before?
Well.
My first birth did not go at all as I'd hoped, ending in a rather unfortunate c-section as it did. I went into that birth wholly uninformed about what epidurals and Pitocin really do. My second birth went phenomenally well, but even so, I avoided the epidural as long as I could because I knew being mobile might be key to having the VBAC I wanted. As for the Pitocin in that second birth, when they present to you your option of "have a stroke or give birth right now," it's sort of a no-brainer.
So why am I so afraid now? Well, I learned that the use of Pitocin is linked to increased risk of both postpartum hemorrhage in the mother and jaundice in the baby. Both of my sons were jaundiced enough to require home phototherapy, and both births resulted in postpartum hemorrhage for me. I don't think it's unreasonable to want to avoid Pitocin, knowing that! And I'm more likely to avoid Pitocin and get the baby out more easily if I also avoid an epidural, which would require me to spend the rest of the labor on my back, which I'm really not that interested in doing. I figure I'll play it by ear, though.
This time, my blood pressure is steady, my weight gain is good, the baby seems to be average size (I've been measuring right on target for fundal height, at least), and everything is progressing normally. I get to have a spontaneous labor, and I'm GBS (group B strep) negative, which means they won't require IV antibiotics during labor, which means I get to choose, well, pretty much everything. Having so much choice, in a way, is scary. I admit that part of me was hoping my blood pressure would spike and they'd tell me they had to induce (a very very small part of me, of course). Part of me was hoping that when she did that internal check and swept my membranes, labor would start. The biggest part of me, certainly, keeps reminding the rest of me that "He'll come when he's ready" and "Don't be in such a hurry." Really, I'm just uncomfortable.
I think what gets me is the uncertainty. I've been so sure, every evening, that tonight will be the night. And then it isn't. But surely tomorrow? No? I keep reminding myself that I haven't even reached my due date, but when you've been having contractions for almost two weeks, the due date starts to seem a little irrelevant. Why won't the contractions build into labor?
Because?
Because either the baby or my body just isn't quite ready. I'd venture to say my body is quite ready, which leads me to believe the baby has just a little more growing to do. And I want to let him do that.
Did you know that in the last few weeks, the lungs and brain are still developing? That's why medically unnecessary scheduled inductions and c-sections before 39 weeks are not recommended. In fact, some hospitals are banning them. Babies born between 37 and 39 weeks are being called "late-term preemies," and quite a few beds in the NICU are taken up by these babies who were born, unnecessarily, before they were quite ready.
So I'll stick it out a bit longer. I'll be 39 weeks on Wednesday, and then I'll have a serious talk with the little guy inside, because, really, I'm kind of tired of all this almost-labor business. I've reached a point where when I sit on the toilet, I'm sure I'll go to wipe and find his head crowning. In some ways, that's pretty cool. In other ways, well... My preferred hospital is 45 minutes away, and I'd like a little warning before the whole crowning thing!
So, here's hoping my next post will be a birth story. In the meantime, anyone else out there who's almost in labor, like me, hang in there! We won't be pregnant forever, and a week isn't really that long.
I'm very happy to report that this pregnancy has been my "healthiest," in terms of weight gain and overall feelings of well-being. The very beginning was rough. I didn't have much morning sickness, but I had some other weird symptoms that were apparently hormonal, and I also had a lot of trouble with my sciatic nerve until the middle of the second trimester. However, I haven't gained nearly as much weight as I did in my first two pregnancies, and, in even better news, my blood pressure has been very stable! Every week now when I see my CNM, I wait anxiously for the blood pressure monitor to display my numbers, and every week I heave a great sigh of relief when the numbers are in the normal range once again. My biggest worry since the beginning of this pregnancy would be that I would have high blood pressure again and need to be induced or c-sectioned.
I am now 38 weeks, and delivery seems imminent. For almost two weeks, now, I've been having intermittent contractions, strong but relatively painless. I can feel that the baby is moving down, and when I told my CNM that I had showed up to the hospital dilated 4cm with my second son, she decided to check my dilation at my office visit just to see what was going on. As of Wednesday, I was 3cm dilated and 80% effaced, and she could just feel the baby's head! She swept my membranes, saying that if labor was on the verge of starting, doing so could get things going. And yet, here I am, five days later, still no baby. Amazing how pregnancy can fake you out even right at the end.
I wrote out a "birth plan" and then decided not to print it. I have just a few desires for this birth, the main one of which is "have a vaginal birth." My intention is to avoid all interventions (IV, Pitocin, epidural) not because I have any kind of "earth mama" thing going, not because I'm altruistic or hippy or crunchy, not because I have any kind of "I am woman, hear me roar" complex (I'm more likely to whimper than roar), but because, to be honest, I'm more afraid of the drugs than I am of the pain of labor. Now that I know as much as I do about how interventions can negatively affect the birth outcome and the health of the mother and baby, I'm afraid of them.
I know this sounds a bit silly. I've had Pitocin and epidural with both previous deliveries. How can I now be afraid of them, when I consented to them before?
Well.
My first birth did not go at all as I'd hoped, ending in a rather unfortunate c-section as it did. I went into that birth wholly uninformed about what epidurals and Pitocin really do. My second birth went phenomenally well, but even so, I avoided the epidural as long as I could because I knew being mobile might be key to having the VBAC I wanted. As for the Pitocin in that second birth, when they present to you your option of "have a stroke or give birth right now," it's sort of a no-brainer.
So why am I so afraid now? Well, I learned that the use of Pitocin is linked to increased risk of both postpartum hemorrhage in the mother and jaundice in the baby. Both of my sons were jaundiced enough to require home phototherapy, and both births resulted in postpartum hemorrhage for me. I don't think it's unreasonable to want to avoid Pitocin, knowing that! And I'm more likely to avoid Pitocin and get the baby out more easily if I also avoid an epidural, which would require me to spend the rest of the labor on my back, which I'm really not that interested in doing. I figure I'll play it by ear, though.
This time, my blood pressure is steady, my weight gain is good, the baby seems to be average size (I've been measuring right on target for fundal height, at least), and everything is progressing normally. I get to have a spontaneous labor, and I'm GBS (group B strep) negative, which means they won't require IV antibiotics during labor, which means I get to choose, well, pretty much everything. Having so much choice, in a way, is scary. I admit that part of me was hoping my blood pressure would spike and they'd tell me they had to induce (a very very small part of me, of course). Part of me was hoping that when she did that internal check and swept my membranes, labor would start. The biggest part of me, certainly, keeps reminding the rest of me that "He'll come when he's ready" and "Don't be in such a hurry." Really, I'm just uncomfortable.
I think what gets me is the uncertainty. I've been so sure, every evening, that tonight will be the night. And then it isn't. But surely tomorrow? No? I keep reminding myself that I haven't even reached my due date, but when you've been having contractions for almost two weeks, the due date starts to seem a little irrelevant. Why won't the contractions build into labor?
Because?
Because either the baby or my body just isn't quite ready. I'd venture to say my body is quite ready, which leads me to believe the baby has just a little more growing to do. And I want to let him do that.
Did you know that in the last few weeks, the lungs and brain are still developing? That's why medically unnecessary scheduled inductions and c-sections before 39 weeks are not recommended. In fact, some hospitals are banning them. Babies born between 37 and 39 weeks are being called "late-term preemies," and quite a few beds in the NICU are taken up by these babies who were born, unnecessarily, before they were quite ready.
So I'll stick it out a bit longer. I'll be 39 weeks on Wednesday, and then I'll have a serious talk with the little guy inside, because, really, I'm kind of tired of all this almost-labor business. I've reached a point where when I sit on the toilet, I'm sure I'll go to wipe and find his head crowning. In some ways, that's pretty cool. In other ways, well... My preferred hospital is 45 minutes away, and I'd like a little warning before the whole crowning thing!
So, here's hoping my next post will be a birth story. In the meantime, anyone else out there who's almost in labor, like me, hang in there! We won't be pregnant forever, and a week isn't really that long.
Monday, August 22, 2011
The Three-Across Car Seat Adventure
I'm in a place right now that I hope my next post after this one will be a birth story (mine!), but it could still be a couple of weeks. In the meantime, I bring you, The Three-Across Car Seat Adventure!
Even before we managed to conceive Baby #3, I started worrying about how we were going to fit all three kids in our little Toyota Corolla. See, we had a Rav4, which might have been wide enough to fit three car seats across, but when Baby #2 was about 11 months old, we traded the Rav4 for a Corolla to save money, figuring we wouldn't want a third for at least three years. We'd worry about a bigger car, preferably a minivan, when the time came.
Except, we got baby fever a little earlier than anticipated, and even as we hoped every month to see the positive result on the pee-stick, I worried about the car seat situation.
Our first son is not yet five, although he's big for his age. I really wanted to keep him in a five-point harness as long as possible, and he's not even close to the 65-pound limit on the Graco Nautilus he was riding in, so I had assumed he'd just stay in that until he hit the limit. Then there's our second, who's now 2.5, and average size for his age. He had plenty of room to grow in his Britax Roundabout. But in between those two massive car seats wedged into the backseat of our tiny Corolla was... not enough space for even a skinny person, much less a car seat. Yikes.
Knowing I had at least nine months to solve this problem, I started asking around. What I found out is that there are two car seats on the market that advertise themselves as being narrower than all the others. One even claimed you could fit three across in a Toyota Corolla! That is the Combi Cocoro. Problem? It's a small convertible seat, with an upper weight limit of 40 pounds. Fine for the baby, but certainly not for the 4.5-year-old, and the 2.5-year-old probably wouldn't get much use from it either. The other option is a Sunshine Kids Radian convertible seat. They have models that go to 65 pounds and 85 pounds. Awesome, right? Could I do a Cocoro and two Radians?
Well, cost was an issue, of course. The Cocoro runs anywhere from about $160 to $230, depending on sales and color. (I didn't much care what color it was, so I'd take the cheapest if I could.) The Radian runs between about $180 to $250. Similar price range. And to buy three of these? I wondered if there was a better way.
There was also the pesky problem of not being able to take any passengers with us, ever. If all five of us were in the car, the car would be packed to the brim. Even with only the two kids, the car was cramped when full. It was livable, but not fantastic.
When the then almost-2-year-old's birthday approached, Grandpa asked what he wanted. I said he really, really wanted a Radian 65. I figured, I could get one and see how it fit. If it looked like it might work, I could splurge for two more. And... the two-year-old refused to use it, wanting to stick with his old seat, but the 4.5-year-old wanted to use it. Fine. I put the bigger kid in the new car seat and the smaller kid got to stay in his same Grace Nautilus. (At some point, I'd switched him out of the Britax and into the Graco. I can't remember when.)
The Radian was definitely narrower, but there still wasn't nearly enough room for a third seat. The Nautilus is also quite wide, meant to accommodate a child up to 100 pounds, so it wasn't going to be viable anyway. I spent an afternoon testing out different configurations with the Radian, out there in the backseat of the Corolla with a measuring tape, trying to figure out if I could fit three Radians across. I came to the conclusion that I could, but only if I could make the car about two inches wider. Obviously, this was not an option.
I was skeptical that I'd have any more luck with the Cocoro. I scoured the Web for any evidence that someone had actually put three Cocoros across the backseat of their 2010 Corolla. I couldn't find a single article, blog post, or forum question that addressed this problem. Most people who put three car seats across had mid-size cars, SUVs, or minivans. All much wider than my little Corolla. See? I needed those two inches!
Wonderful.
By the time I was five months pregnant with Baby #3, I was quite concerned. I was beginning to think that we only had two options: Put the oldest child in the front seat (legal if you have no other option, but I was not comfortable with this idea) and never have all five of us in the car, or never have all three kids in the car at the same time. Obviously, not very practical.
We broke down and admitted we needed a bigger car. A minivan would be ideal. If we could get a bare-bones, bare minimum, used van, our car seat (and passenger!) problem would be solved.
We couldn't find much in our price range. Plus, the arrangement we had cooked up in order to afford such a purchase was not very viable. So, in a last-ditch effort at solving this sticky sticky problem, I went back to the dealership where we'd bought the Corolla. We'd bought three cars there, and we hoped our loyalty would buy us a favor.
Lo and behold, it did! They found us a used Toyota Highlander, seven-seats, in brilliant condition, and were able to finance it for us and take back the Corolla. It was a miracle! I'm actually very happy with this car, car seat problem or no car seat problem, so that worked out well.
But I still had to actually, you know, fit three car seats somehow. The third row in the 2006 Highlander is quite utilitarian and not ideal for installing a car seat. Plus, if you have the third row unfolded, you have basically eight inches of trunk space. Not exactly enough for a stroller and groceries. Not exactly enough for just groceries. Plus, whoever was in the back had to get there somehow, either by climbing in through the trunk or over the second row, which would involve folding down the second-row seat... hard to do when there's a car seat attached to it! I was determined to fit three across in the second row, so we'd only have to put up the third row if we needed to take additional people besides the five of us.
I came to the conclusion that the simplest option was to put the oldest in a booster seat, so he could buckle and unbuckle himself. Plus, simple boosters seemed to be narrower than most of the car seats out there. So, I bit my lip and purchased a Graco Turbobooster. If he was going to be in a booster, it was going to have a back, at least, to properly position the shoulder belt and offer more head protection.
It was narrower, but was it narrow enough? I spent another few hours arranging and rearranging the car seats, trying to figure out how I was going to get the booster, the Radian, and either a rear-facing something or, preferably, the Chicco KeyFit30 infant bucket-style car seat I already had. My preferred arrangement would have been the bucket in the middle, or, failing that, the booster in the middle, but neither way worked! I finally managed to squeeze the booster behind the passenger's seat, the infant seat behind the driver's seat, and the Radian in the middle. Talk about a challenge! I tested my car seat prowess with that configuration, let me tell you.
I don't love the arrangement, but it works well enough, and I got everything else that I wanted out of the deal. The biggest problem now is that the oldest can't actually buckle his seat belt because the booster and the Radian are so close together. He has to move the booster over, get in, buckle, and then I have to shove the booster back into the correct position. He can, thankfully, unbuckle himself and get out. Buckling the 2.5-year-old into a five-point harness in the middle seat is uncomfortable, especially with my large pregnant belly, but it's not unmanageable, and the low profile of the Radian allows my short-ish toddler to climb in and out of the seat with relative ease, so at least I don't have to lift him into it. And, because I'm using the bucket-style car seat for the baby, it will be easy just to plop him in last, once the other more complicated kids are taken care of.
I shudder to think what gyrations I'll have to perform when the baby is ready for a convertible seat, though. I'm thinking I'll have to buy a Cocoro at that point. Maybe with three narrower seats, it will be less of a problem. I'll let you know when that happens!
In the meantime, think good labor thoughts for me. As I said, I'm hoping my next post will be a birth story! If not, it'll probably be about something new and different, like breastfeeding.
--------
Also, please check out my breastfeeding book for Kindle, The "Yes, It's Normal!" Guide To Breastfeeding!
Even before we managed to conceive Baby #3, I started worrying about how we were going to fit all three kids in our little Toyota Corolla. See, we had a Rav4, which might have been wide enough to fit three car seats across, but when Baby #2 was about 11 months old, we traded the Rav4 for a Corolla to save money, figuring we wouldn't want a third for at least three years. We'd worry about a bigger car, preferably a minivan, when the time came.
Except, we got baby fever a little earlier than anticipated, and even as we hoped every month to see the positive result on the pee-stick, I worried about the car seat situation.
Our first son is not yet five, although he's big for his age. I really wanted to keep him in a five-point harness as long as possible, and he's not even close to the 65-pound limit on the Graco Nautilus he was riding in, so I had assumed he'd just stay in that until he hit the limit. Then there's our second, who's now 2.5, and average size for his age. He had plenty of room to grow in his Britax Roundabout. But in between those two massive car seats wedged into the backseat of our tiny Corolla was... not enough space for even a skinny person, much less a car seat. Yikes.
Knowing I had at least nine months to solve this problem, I started asking around. What I found out is that there are two car seats on the market that advertise themselves as being narrower than all the others. One even claimed you could fit three across in a Toyota Corolla! That is the Combi Cocoro. Problem? It's a small convertible seat, with an upper weight limit of 40 pounds. Fine for the baby, but certainly not for the 4.5-year-old, and the 2.5-year-old probably wouldn't get much use from it either. The other option is a Sunshine Kids Radian convertible seat. They have models that go to 65 pounds and 85 pounds. Awesome, right? Could I do a Cocoro and two Radians?
Well, cost was an issue, of course. The Cocoro runs anywhere from about $160 to $230, depending on sales and color. (I didn't much care what color it was, so I'd take the cheapest if I could.) The Radian runs between about $180 to $250. Similar price range. And to buy three of these? I wondered if there was a better way.
There was also the pesky problem of not being able to take any passengers with us, ever. If all five of us were in the car, the car would be packed to the brim. Even with only the two kids, the car was cramped when full. It was livable, but not fantastic.
When the then almost-2-year-old's birthday approached, Grandpa asked what he wanted. I said he really, really wanted a Radian 65. I figured, I could get one and see how it fit. If it looked like it might work, I could splurge for two more. And... the two-year-old refused to use it, wanting to stick with his old seat, but the 4.5-year-old wanted to use it. Fine. I put the bigger kid in the new car seat and the smaller kid got to stay in his same Grace Nautilus. (At some point, I'd switched him out of the Britax and into the Graco. I can't remember when.)
The Radian was definitely narrower, but there still wasn't nearly enough room for a third seat. The Nautilus is also quite wide, meant to accommodate a child up to 100 pounds, so it wasn't going to be viable anyway. I spent an afternoon testing out different configurations with the Radian, out there in the backseat of the Corolla with a measuring tape, trying to figure out if I could fit three Radians across. I came to the conclusion that I could, but only if I could make the car about two inches wider. Obviously, this was not an option.
I was skeptical that I'd have any more luck with the Cocoro. I scoured the Web for any evidence that someone had actually put three Cocoros across the backseat of their 2010 Corolla. I couldn't find a single article, blog post, or forum question that addressed this problem. Most people who put three car seats across had mid-size cars, SUVs, or minivans. All much wider than my little Corolla. See? I needed those two inches!
Wonderful.
By the time I was five months pregnant with Baby #3, I was quite concerned. I was beginning to think that we only had two options: Put the oldest child in the front seat (legal if you have no other option, but I was not comfortable with this idea) and never have all five of us in the car, or never have all three kids in the car at the same time. Obviously, not very practical.
We broke down and admitted we needed a bigger car. A minivan would be ideal. If we could get a bare-bones, bare minimum, used van, our car seat (and passenger!) problem would be solved.
We couldn't find much in our price range. Plus, the arrangement we had cooked up in order to afford such a purchase was not very viable. So, in a last-ditch effort at solving this sticky sticky problem, I went back to the dealership where we'd bought the Corolla. We'd bought three cars there, and we hoped our loyalty would buy us a favor.
Lo and behold, it did! They found us a used Toyota Highlander, seven-seats, in brilliant condition, and were able to finance it for us and take back the Corolla. It was a miracle! I'm actually very happy with this car, car seat problem or no car seat problem, so that worked out well.
But I still had to actually, you know, fit three car seats somehow. The third row in the 2006 Highlander is quite utilitarian and not ideal for installing a car seat. Plus, if you have the third row unfolded, you have basically eight inches of trunk space. Not exactly enough for a stroller and groceries. Not exactly enough for just groceries. Plus, whoever was in the back had to get there somehow, either by climbing in through the trunk or over the second row, which would involve folding down the second-row seat... hard to do when there's a car seat attached to it! I was determined to fit three across in the second row, so we'd only have to put up the third row if we needed to take additional people besides the five of us.
I came to the conclusion that the simplest option was to put the oldest in a booster seat, so he could buckle and unbuckle himself. Plus, simple boosters seemed to be narrower than most of the car seats out there. So, I bit my lip and purchased a Graco Turbobooster. If he was going to be in a booster, it was going to have a back, at least, to properly position the shoulder belt and offer more head protection.
It was narrower, but was it narrow enough? I spent another few hours arranging and rearranging the car seats, trying to figure out how I was going to get the booster, the Radian, and either a rear-facing something or, preferably, the Chicco KeyFit30 infant bucket-style car seat I already had. My preferred arrangement would have been the bucket in the middle, or, failing that, the booster in the middle, but neither way worked! I finally managed to squeeze the booster behind the passenger's seat, the infant seat behind the driver's seat, and the Radian in the middle. Talk about a challenge! I tested my car seat prowess with that configuration, let me tell you.
I don't love the arrangement, but it works well enough, and I got everything else that I wanted out of the deal. The biggest problem now is that the oldest can't actually buckle his seat belt because the booster and the Radian are so close together. He has to move the booster over, get in, buckle, and then I have to shove the booster back into the correct position. He can, thankfully, unbuckle himself and get out. Buckling the 2.5-year-old into a five-point harness in the middle seat is uncomfortable, especially with my large pregnant belly, but it's not unmanageable, and the low profile of the Radian allows my short-ish toddler to climb in and out of the seat with relative ease, so at least I don't have to lift him into it. And, because I'm using the bucket-style car seat for the baby, it will be easy just to plop him in last, once the other more complicated kids are taken care of.
I shudder to think what gyrations I'll have to perform when the baby is ready for a convertible seat, though. I'm thinking I'll have to buy a Cocoro at that point. Maybe with three narrower seats, it will be less of a problem. I'll let you know when that happens!
In the meantime, think good labor thoughts for me. As I said, I'm hoping my next post will be a birth story! If not, it'll probably be about something new and different, like breastfeeding.
--------
Also, please check out my breastfeeding book for Kindle, The "Yes, It's Normal!" Guide To Breastfeeding!
Subscribe to:
Comments (Atom)