Sunday, December 9, 2012

Baby's first tooth

With our first tooth popping through came a cold, runny nose, sneezing and itchy eyes. After one night of Alexandria rubbing her eyes, her sharp little nails, no matter how well they are cut, scratched her nose and cheek. Having not worn her mittens since she was born, I almost gave away all but one, boy am I glad I did not.

Poor baby rubbing her red eyes and her nose getting snot all over her face. The mittens absorbed some of the tears and kept the snot contained. Nosefrida, mittens, and Puremedy Baby Salve to the rescue! A sleepy baby bundled in her Boppy with bottle, while Mommy watches her.

While sleeping I popped homeopathic Tiny Cold Tablets by Hyland's baby into her mouth followed by her pacifier. She slept for an hour cycle and woke up less red-eyed and happy. After a little while she was ready to play. More medicine, food, and sleep for this baby, with plenty of listening to how she is feeling.

For the tooth, she has Green Sprouts fruit cool soothing teether. My mom also suggested cold wet face cloth, which I may try when her immune system is better. She seems to like the teether, but looks for smooth almost satin fabric surfaces more.





Saturday, December 8, 2012

Finding a daycare

Here is a checklist that my friend, who is a daycare/preschool teacher, put together for me when touring a daycare. It really helped me be able to ask questions, when I otherwise felt like I had no clue what to ask or even look for having never interviewed a daycare. In the end of it, I would follow your gut in terms of how you feel about a place, as it needs to feel like a place that you will want to leave your child - working needs to be non-stress and fun and having your child at a place you don't like can be tough.

My advice for anyone in Seattle, is to look early in pregnancy. Daycare is like the real estate market; there are not many infant spots, and if it's a hot spot they go fast. Since wait-lists can be a year or more long, you need to get on top of it sooner rather than later. Even if you are unsure your daycare plans, hedge your bets and place a deposit. Deposits are anywhere from $50 to $150.

I cannot stress enough that the checklist is a good starting place, but always listen to your heart. You know what is best for your child and don't accept anything less. I had my child in a daycare that I did not care for, for all of two days before she was moved. In my situation, we had been on the wait-list for our number one choice for six months and thought we would get in by the time we needed care, but it did not turn out that way, so come August we were scrambling to find care. We secured care for January and found a last resort for immediate care, since it had no wait-list, but as I concluded it had no wait-list for a reason. We were lucky our January daycare opened up a spot earlier than expected. Timing is also something to consider because things fill-up during the normal school months of May and September, looking on off times will give you the chance to already be on the list for consideration. Spots open up when children transition or families move their children to another daycare, and the later is unpredictable and beneficial to those on a wait-list.

                                                       Things to look for in a child care

Entrance: is it warm and welcoming
     ◦ Are there bulletin boards for parent communication, sharing, things to do in town?
     ◦ Is there car seat or stroller storage?
     ◦ Can parents hang out and chat with each other in the lobby?
     ◦ Are there toys for kids to play there at drop off and pick up?
     ◦ What is the security upon entering? Also, what is it like in the rooms?

Overall Space
    ◦ Does each class had their own room
    ◦ Do the rooms connect to each other? Via a half wall, window, shared counter space, half door...
    ◦ Windows are cool, they can see each other from other rooms
    ◦ Other shared spaces, not so cool, the rooms can get to loud and it is very confusing when you hear noise from another class that you cannot see.
    ◦ Playground
        ▪ Is there a separate younger/older space?
        ▪ Do they look fun? Would you want to play there? :)

Staff to Child Ratios
     ◦ Very Important, the more teachers per room, the better.
     ◦ Infants should be no more than 3 kids per staff member. From experience, I never had more than 3 kids to myself.
     ◦ What are the staff schedules like? How many teachers in the room at opening? Closing? Throughout the day? Are they ever alone? If so, with how many children?
          ▪ I personally think it is always best for there to be 2 people in the room at open and close. That way if one adult is talking to parents, you know that the other one is with the children.

The Infant Room:
   ◦ Is it warm and friendly?
   ◦ Can you come in, sit down with your child, chat with the teacher, play a little then say goodbye? Can you come in one day at drop off or pick up to observe?
   ◦ Is the staff sitting on the floor with the kids? How long have they been there? Do they get along? Worked together a while? Who fills in when someone is out?
   ◦ Is there a parent communication board?
          ▪ How do they communicate? Email, journals, one on one chats? Daily? Weekly?
    ◦ Are there adult chairs? Rocking Chairs?
          ▪ If you want to come in to nurse, where can you sit? Is it private? Are you just in the room? (In the room is fine, but you will want a comfy spot to sit)
   ◦ Are there kid chairs? Bouncy seats are fine for feeding, but not for sitting in all day.
   ◦ No bumbo seats! So stupid and dangerous, not sure why they were ever invented
   ◦Do you see:
         ▪ Books?
         ▪ Clean Rugs or play mats?
         ▪ Areas defined? Ex: books, blocks, soft toys, climbing area...
         ▪ Climbing structure? Do they add one as the year goes on?
         ▪ Soft toys?
   ◦ Are there things on the wall? Are they at kid level or is the child looking up to see them?
   ◦ Art? Is it actually messy, I had fun child art or an adult put my hand on the paper so it looks perfect kind of art?
   ◦ Where does the child sleep? Is it far from the rest of the room? Do they use nap music?
   ◦ Schedule: Do they get to sleep whenever or do they encourage the same time?
   ◦ Walks: What does the buggy look like? How often to they go?
   ◦ Food: You provide? What do they provide?
   ◦ Diapers: You provide or them? If you do not use their brand, do you get credit?
   ◦ What is the daily schedule? Is it flexible?
   ◦ How do the children transition in and out of the room?
          ▪ Is it by year, every one starts and September and moves to the toddler room together or so they transition one by one according to age?

*All in all, you will know when you found the right place. You will fell comfortable as soon as you walk in and you will get more excited and comfortable the longer the tour lasts. The center does not have to be NAEYC accredited, it can be fabulous without it.



Wednesday, September 12, 2012

Getting my 3 Month Old Baby Sleeping through the Night

Sleeping through the night means no waking periods. I have heard that sleeping through the night for an infant means six hours. For my little girl, she is sleeping nine hours without waking at three months old, whereas some babies don't do that until they are a year or more old. So how did this happen?

First I have to say all babies are different. For my baby, her sleep schedule started in the womb; she would wake me between 3 or 4 am and then again at 6 am. When we brought her home from the hospital we would go to bed between 10 and 11 pm and she would wake up at 3 or 4 am, so that was four or five hour stretches of sleep time. As a new mom, I was told by my doctor that for my brain to rest I needed to get at least 4 hours of sleep in one period. While this first tip is not anything that you can do to influence your baby, it is important to note that your baby may just be programmed with his or her own sleep schedule.

The key to creating a bedtime for your infant is creating a repeatable and consistent process. For example, we say to our daughter "We change the baby, then we swaddle the baby (also read "6 Tips to a Tight Swaddle"), and then we feed the baby." This is something that we do (not necessarily always say) at all nighttime feedings ie. putting the baby back to bed. When she was younger she would cry when waking up in the middle of the night, as her way to tell us that she needed food. We understood that this was her way of communicating and ours was to complete the process of change, swaddle and feed. Then, as she got older she now does not fuss when she wakes up for food and the only time she cries (usually bloody murder) is when we break the routine - for example, my husband thought the swaddle job needed to fixed, so he removed her from the feeding position and back into the swaddle position, boy was she disappointed and confused.

The feeding position and environment is also consistent during the nighttime. The feeding position always is in the semi-upright position, regardless of the time of day, but where we feed her is the same. The environment itself should be calming and dim-lit. For us, we have a 30w bulb that powers our changing station, which is bright enough to see what you are doing. Then, we shut that off to turn on a dimmer light, that is by where we feed her, which is lit just enough to see her feeding. All the while we are doing the process we are keeping talking to a minimum and talk to her in a soft and soothing voice.

After every feeding regardless of the time of day, we give her a pacifier as this helps her to not spit-up after a feeding. Also giving this to her at the nighttime feedings, allows her to soothe herself back to sleep.

All of the tips so far have been how to put your baby to sleep consistently at night and you may be wondering, how do I now take this to help me, er I mean the baby, sleep longer at night? The answer is keeping with this routine until your baby consistently knows that it is time to go to bed, does it and then sleeps for longer periods of time. Plus, you can influence when  he or she goes to sleep. For example, I believe you have heard of the witching hour, in the evening when babies are generally fussy, well this time is when our baby needed to be put down to bed. Most babies cannot just go to sleep, rather they fuss to "ask" to be put to sleep. We would swaddle her, pacify her, and hold her in a rocking chair or bounce on a yoga ball (OMG the yoga ball should be on every new mom's baby registry, it really works!). This would be good, but this nap would happen at 7 pm. And then we would let her sleep with fingers crossed that the nap did not ruin her stretch of 4 to 5 hours once she woke up and was out to bed. It was not until just recently that we realized that we could keep her consoled until 8 or 9 pm, skip the nap, and just put her to bed, then she would sleep through the prior 10 or 11 pm sleep time.

Another key point here is that for a baby to sleep you need to let the baby sleep - do not wake the baby up because you think you should, let the baby sleep and trust that your baby will wake when he or she is hungry. In the very first few weeks they say to wake the baby if they sleep for longer a certain amount of hours, which you should follow if your pediatrician advises. Generally though, if you baby is gaining weight then you don't need to be concerned with tracking sleeping and eating patterns. Of course, knowing the eating pattern helps with knowing so you can sooth your baby, I just mean don't set weight to both combined - don't wake the baby. The first night she slept for 8 hours, I walked into the baby's room to check on her she reacted to the hallway light and I knew that my baby was still alive (my reaction in response to my fear of SIDS).

The final key to setting a bedtime schedule is getting the feeding schedule aligned with bedtime. Naturally your baby will be on a schedule. Mine feeds every two and a half to three hours. I know she eats at 6 am, 9 am, 12 noon, 3 pm, 6 pm, and 9 pm give or take. With that being said there is a range too and that can either be too close or after her 8 pm bedtime. So, we feed her as schedule and then when it comes time for bed, we feed her the allocated amount of food she needs since her last feeding. One note here is we are exclusively bottle feeding her breast milk (see here for information on how much breast milk to express a baby), so you would offer the breast and let the baby eats until they get full.

Tuesday, September 11, 2012

How to Hire a Doula

A doula is a birth coach, that is there to do ask you ask, to empower you to have the type of birth that you wish. I highly recommend every pregnant women, especially those that have fears, either personally or a partner, of the birthing process. You want to feel supported in the delivery room. Words cannot describe the connection I have to my doula. Finding a doula that is right for you is key. To find a certified doula, go to PALS Doulas here.

Doula services may or may not be covered by your insurance. A doula charges anywhere from $700 to $1400, depending on their experience. My policy with Regence did not cover a doula, so I emailed info@pals.org to find a doula-in-training, who will have done training, but need to attend a certain number of births to become certified. In hiring a doula-in-training, the cost will be significantly less - $250 to $500 give or take. In the end it may come down to money for you, but if you can try to hire based on fit of personality to your birth wishes.

PALS Doulas also has good information on how to hire a doula. Having no experience at this, I started by reading up on the service that a doula can provide. When I reached out to the doula I knew that she was available, so it was a matter of meeting them. I had an initial conversation with two over the phone, before setting up an in-person meeting, just in case I did not click with them immediately. While I had some awkward silences as I was unsure what to ask, I turned the tables to have the doula tell me more about herself. While not everyone has the best phone skills, I gave one lady the benefit of the doubt and met her in-person; however my gut instinct was correct and I did not end-up going with her. It was about fit between my birthing wishes and her attitude. I was willing to accept less experience for more of a fit personally. The interview included my husband, so we could make the decision together.

My doula was interested in potentially becoming a midwife, so in addition to the two pre-birth meetings, I also brought her to two of my prenatal appointments for her to meet both my midwives. The doula is there for you during the birth, at what ever point you would like her to be, but mostly leading up to active labor. I had a scheduled induction, so my doula was there when I was admitted to review the induction plan and then returned when contractions picked up. Then, she was there for me until after the baby was born. A few days after she returned to see me post-birth, then again a week later and another couple of weeks later for the final meeting. It was sad to have such a connection with a person and then say goodbye. I made her a Thank you note that included a birth picture of my baby, a bottle of wine, and a generous tip.

Why I could not do without my doula:

  • Able to talk about prebirth fears and plan should things materialize
  • Comforted that my husband had support 
  • Knowledge about birthing process
  • Reminded me about things that were important to me, in the heat of the moment
  • She was my rock, my focus and my encouragement
  • The massage of my lower back during contractions
  • Letting me smack her hand when the pain was too much
  • "Playing" the staring contest when I got my epidural inserted
  • Advocate for my birthing wishes
  • Post-birth check-in 

Sunday, September 9, 2012

Placenta Encapsulation can Prevent Postpartum Depression

Prior to birth I was concerned about postpartum depression, as I wanted to enjoy the months following birth, but concerned I may be predisposed to it having lived with anxiety on-and-off-again. In anticipation, I was prepared to have my placenta encapsulated within 72 hours following birth. I had heard about this through my naturopathic doctor and started to do some research. I found Seattle Placenta Encapsulation explained the benefits and the procedure in clear and understandable terms.

I included instructions in my birth plan to have my placenta saved, placed in a double-bagged gallon size ziploc bag, laid flat, and returned to me upon departure from the hospital. Unfortunately, my placenta was infected during birth and was reason for it not to be encapsulated. Fortunately though, I did not experience postpartum depression - my doctor gave me a series of questions to answer to confirm I did not meet the criteria. However, a few days following birth, while in the hospital my anxiety came back, but was soothed after talking about the birth process to my doula and OB.

I write this blog to let you know about the alternative to western medicine approach - placenta encasulation - to preventing postpartum depression*, but also to allow you a forum to share your experience, so you can help others with ways to deal with and find support for postpartum depression.    

*I do not claim to have tried this, cannot confirm the statement, and can merely go based on the information I have found on this subject. 

Thursday, September 6, 2012

Breast Pump Covered by Insurance


Through a lactation consultant I found out that my insurance covers a breast pump. IRS is also allowing Breastpumps and supplies that assist lactation to be covered by your health and flex spending accounts, for more information from the IRS.  

I was able to get my Medela Pump In Style Advanced breast pump with Metro Bag free! I choose this version pump because the motor was not inserted or attached permanently to the bag. This is handy when you are mobile, especially when going back to work or going from room-to-room in your house. And the bag can be re-purposed once you are done breast pumping. But, wouldn't you know there is a website for top breast pump reviews because not all pumps are created equally. I was recommended Medela (only one person can ever use this) and Hygeia (can be passed down or have more than one user in a lifetime) breast pumps by the lactation consultants that I have seen. 

The process to getting insurance to cover some or all of the cost is to check with your insurance provider on your coverage first, give them the code E0603NU. Then have your doctor write you a prescription saying you are pregnant, with your due date, and note saying you will need a pump for medical reasons. The prescription is what you give to a retail seller that bills insurance directly or you can submit the claim to your insurance otherwise. 

Wednesday, September 5, 2012

Impressions of Baby's Feet and Hands

Source: theimaginationtree.com via Jen on Pinterest 
In a previous post I told you that I was obsessed with Pinterest, I still am. Lately what I have been doing is actually completing the DIY pins I add or 'like'. If you follow the category DIY & Crafts you will see this popular pin for a recipe of mold to make a baby foot impression; the recipe sounds simple and includes ingredients that are most commonly found in the kitchen (flour, salt and water). I followed the 1:1 recipe, which the source blog lets you know that you may need more or less to get it just right. I however could not get the combination just right - following the recipe exactly it was too wet and there was no give in the batter to get a detailed impression.  I am not a baker, so getting the combination just right was a DIY fail. I think that if the pin is advertised as simple, then it should be simple.

In deciding that this recipe was not right for me, I found an alternative method to get an impression of my baby's feet and hands. I choose to go with a baby safe washable ink pad, which I think will be perfect to include in a scrapbook, or make into a card for the grandparents.

6 Tips to a Tight Swaddle

If your baby turns out to be a breakout-swaddle-artist you will need these tips on how to wrap a tight swaddle. With these 6 tips your baby will be able to rest more peaceful and you will be sharing these tips with parents alike.

Tip #1: Fold the Top Down to Cover Almost 2/3 the Remainder
The reason for this is it creates a fluid and longer extension of the wings.

Tip #2: Position the Tag of the Blanket at Either the Left or Right Wing
This will allow the tag to lay at baby's feet rather than under his or her back (top folded down) or under his or her top shoulder (bottom folded up). This tip is more about comfort then a secure hold, this tip will allow the fold to be as smooth as possible without any bunching of the fabric.



Tip 3: Pull Tension Above the Elbows
This is the most important tip of them all! In the above manufacturer directions for how to swaddle, it looks as if you fold the blanket over the baby, which you do, however it does not specify to create tension. If you just fold left or right with no tension point a baby will be able to get their arms out in a matter of seconds. To create tension, after you have the baby's arm straight down, pull the fabric in the direction of the fold (left or right) and, hold while pulling, pull the fabric tight just above the elbows, then wrap the blanket around the baby. If wrapping the blanket under the baby moved the blanket or loosened the hold just pull tight again, there is no need to redo the step. The tightness should be just above the baby's elbow and any looseness below is okay - it is all about stopping the elbows from bending upwards.

Tip 4: When Folding Left or Right Create an Angle
When you do your first fold left or right, wrap or angle the blanket downward and around the shoulder, rather than a 90 degree angled fold. This will create a lip or curve around the shoulder that will hold the baby into the swaddle, in the event the baby wants to inch-worm his or her way out. This angle combined with the tension ensures the baby stays in. When you are making the second fold left or right do the same with the tension and angle.

Tip 5: Folding the Bottom Point Up is Optional
Folding the bottom tip up creates a wrap around the feet which can be good to keep baby's feet warm. I have found that with my baby it is less about the movement of the feet and more about the movement of the arms - imagine you are falling - this is the sensation baby's feel from the Moro reflex - since the first thing that reflexively happens is your arms go up. If you decide to leave this unfolded or loose, performing tip 6 can create a wrap around the legs.

Tip 6: Spiral Excess Around Baby Starting At the Elbow
To ensure a tight hold around the arms and feet, on the final wrap left or right wrap the excess blanket in a downward spiral, starting from elbow going to the feet.




Saturday, July 28, 2012

DIY high contrast flash cards

Instead of paying for store bought flash cards,with just a couple sheets of poster board and paints you can design your own high contrast flash cards. These cards are great for early stages of infancy when they cannot see colors and darker shades are easier to differentiate. It isn't until around 6-8 weeks that a baby will begin to focus on items (although you can start using them at birth), so you can feel free to make only a handful (your time for crafts, like mine, may be limited) and then expand as baby ages.

Here are 6 flash cards I painted on black and white poster board cut-outs:

Later I may add upper and lower case lettering as I plan to create a card for each letter of the alphabet.


Friday, July 27, 2012

Generation to generation: all doing their best

My true thoughts and feelings come out when I am writing to my close friends. I approach writing for this blog as if I am talking directly to one of my friends.

After writing a text to another new mom my text touched my heart, and while I don't choose to edit the grammar of this text, I share it with you here:

"I truly love our healthy eating and living lifestyle. I think back to the processed microwave foods I ate and diet coke I drank as a teenager and think how happy I am that Alexandria is going to be so healthy and fit. And I think back to how sedentary my growing up was sitting I front of tv then I look at how busy we are getting out and trying new things. I like our weekly routine. We are going to plan one big outing a year to have her look forward to a family trip. As a kid we rarely traveled and parents were not good about exploring new places. I guess I am looking forward to giving Alexandria all that I wish I had and more because I've made the life that I wish I had growing up. It is what it is my past life. I am so happy to be living my life now. And it just keeps getting better."

Bigs hugs to you, me and all moms out there for doing their best! That's all a kid can ask and appreciate.

Wednesday, July 25, 2012

My new job as a food provider

During my pregnancy I was talking to a co-worker about being a mom and going back to work and she said, she personally needed to go back at least part-time, so she had additional responsibilities other than being a professional milk-maker. At the time, I thought that was a good point, but the magnitude of that statement did not hit me until after the baby was born.

I understood going into motherhood that a baby eats, sleeps and poops, but I did not grasp how much they eat. The first couple weeks after baby was born the answer to all fussing was she must be hungry - which amounted to a total of anywhere from 2 to 4 hours a day breastfeeding. Then, the baby settled into feeding 8 times a day for 20 to 30 minutes at a time, which made it predictable and manageable. It was not until I started pumping the third week, that my lady friends received the names Mildred (left) and Bessie (right). In a playful way, my husband and I check in on how Mildred and Bessie are providing. It is true, I have become a professional milk-maker. How do I know that? I strive to do my best to produce healthy and adequate supply* of breast milk for my baby.   


* exclusively breastfeeding or drinking my milk and baby has adequate weight gain.

Birth control post-baby

After six weeks of postpartum recovery, it's time to think about birth control. Breastfeeding is said to ward off a period, but not a proven birth control. After all ovulation happens before a period, and that's not easily detected, so time to think of a birth control method.


IUDCPCopperT380A.gifWhen I decided we wanted to get pregnant, I went off the birth control pill at least two months in advance in preparation for "trying" to get pregnant. After about 15 years on the pill it took a year for my cycles to regulate to the point that I could confidently know when I would ovulate. After that experience, I decided to never go back on the pill or any other hormone for that fact, so I had a non-hormonally-based intrauterine (IUD) inserted called a Paragard, or copper IUD. It is comforting to know that it is 99% effective and if I decide to have another baby I can start trying the day it is removed. I know that the later is true because I had the Paragard prior to pregnancy and had the IUD taken out a week before ovulation and we got pregnant that same month, with no complications. So six weeks postpartum and I went with the Paragard again. Now back to having sex...


Picture of a Paragard was found on wikipedia

Wednesday, July 18, 2012

Postpartum recovery complete

Per the recommendation of my midwife, I have completed six weeks of recovery following the the c-section birth of my baby girl. I agree that I am healed from the surgery and ready to be more active. I do look forward to losing the remaining 20 pounds I gained during pregnancy, however according to my midwife I should expect to lose 10 more pounds and keep the remaining 10 on until after breastfeeding is complete. Well, 10 pounds seems achievable and I bet that will mean I can fit into my pre-pregnancy jeans (there will be a celebration when that happens.)

Week six is a turning point for me, not just in the means of being more active, but in motherhood and beyond. I have gained more confidence in these areas:

  • A better understanding of my baby's cues, schedule and needs. 
  • Ability to leave the house with baby and all of her needs packed. 
  • Resuming pre-baby activities with and without baby. 
  • Producing breast milk enough to satiate baby.
I understand that it took nine months to put on the weight, however I am not excited about it being said to take nine months to take off the weight. With that I am resuming my healthy eating and active lifestyle. You will find me riding my bike (how young can I attach a baby to the back of my bike?), in the yoga studio, walking, and on the soccer field. You will not find me eating cupcakes or sweets, except for once a week. Sweets were among my biggest craving during pregnancy, well basically anything I did not eat very often prior to pregnancy. 

I will leave you with a recipe for a healthy organic juice that I am drinking daily this week. It has protein, omega-3's and fiber from 2-3 servings of fruits and veggies. Combine the following ingredients into a blender (I have a Blendtec which juices, otherwise you would use a juice machine), in the following order, and run the juice mode:
            3 organic kale leaves
            1 banana;
            1/3 organic pear;
            3 stalks of organic celery 
            1/4 cup soy protein isolate powder;
            2 tbs. flax seeds 
            Handful of organic baby carrots
            Water - fill to cover half the ingredients
            Cup of ice

This recipe makes ~40 ounces or 5 cups of juice. You can also substitute water for coconut water. Or optionally add 1/4 tsp. of ginger powder and 1/8 cup of nutritional yeast. Flax seed and nutritional yeast are said to improve lactation. 



Monday, July 16, 2012

My birth plan

A birth plan is a list of accommodations and preferences that contains all of your wishes for the birthing process. This list is made for the ideal situation, but should also include your preferences for dealing with complications in the event that things don’t go as planned during the birth of your baby. As a new mom, it is best to have a good idea of what you would like, but don't get too set on the birth going according to plan - sometimes nature has its own course of events in mind. However, not getting too attached to the plan is easier said than done. I have to admit that this was the case for me (not to get ahead of myself, but my baby's birth did not go at all according to my birth plan).

To create my plan, I used a BabyCenter birth plan template and then typed it up into Microsoft Word so that I could share this electronically with my midwife. I also printed a hard copy of my birth plan and placed this in my hospital bag, which is important in case you are transferred to a hospital or a new doctor.

Here is a copy of my birth plan to give you an idea of what I wanted to have for the birth of my baby girl:

Birth Plan for [Insert Name] (I like to be called Jen), to a baby girl

Summary: I plan to have a vaginal birth with no medications or interventions at a birthing center. If needed, I will be informed of measures needed and make a call from there. Post-birth I plan to have my placenta encapsulated. I prefer to be told what is happening as it happens and have two-way feedback on how things are progressing.  

Attendees - The only people that will be allowed in the room during the birth will be:
·       (husband) 
[       (doula)

Fears
·        I have never been in an ambulance and I get anxiety at the thought of going in one. But, if needed I will go in one, with reassurance that it means I am getting help, not that I am helpless.
·        I do not want to see needles as they are injected. I prefer not to have an IV.
·        I do not wish to have medicine, to have my placenta as clean free of medicine as possible, but if need be I will accept medicine.
·        No cutting unless medically necessary

Amenities:
·        I will bring my own music (which may or may not be played)
·        Dim the lights and have candles (if oxygen is not on)
·        I will wear my own clothes during labor and delivery
·        husband or doula will be taking pictures/video

Birthing location: Puget Sound Birth Center

If I am transferred to a hospital:
·        My husband will stay with me and baby at all times
·        Only my practitioner, nurse, and attendees will be present
·        I want to eat if I wish
·        Stay hydrated with clear fluids instead of an IV
·        Be able to walk around and move around as I choose
·        To have a cot provided for my husband
·        All newborn procedures will take place in my presence
·        Delay clamping the cord by at least 5 minutes.(important)
·        Save placenta for encapsulation. (important) Do not fold placenta.
·        Have skin to skin post-birth
·        To breastfeed as soon as possible & only method of feeding (if not an option than a wide/slow flow nipple on a bottle is preferred) (important)
·        Have the baby sleep in room (24-hour room-in)
·        To stay in private room
·        I’d like to be discharged as soon as possible

Other interventions - If my baby and I are doing fine, I’dlike to:
·        Have intermittent rather than continuous fetal monitoring
·        Be allowed to progress free of stringent time limits and have my labor augmented only if necessary.

During my vaginal birth, I’d like:
·        Cheering and encouragement
·        Be able to view the birth using a mirror
·        Give birth without an episiotomy
·        Try multiple labor props:
o  Birthing stool
o  Birthing chair
o  Squatting bar
o  Birthing tub

After birth, I’d like:
·        To hold my baby skin-to-skin, or have my husband if I am not available to do so
·        I want to breastfeed as soon as possible
·        To wait until the 5 minutes at least to cut the umbilical cord before it is clamped and cut. I am not be donating my cord blood.
·        Not to get oxytocin (Pitocin) after I deliver the placenta unless it’s necessary
·        My placenta will be placed in a gallon Ziploc bag (I will provide), double bagged and placed in a brown paper bag for us to put on ice and return home with us. Do not fold the placenta, must lay flat.

Postpartum:
·        All newborn procedures will take place in my presence
·        My partner to stay with the baby at all times if I cannot be there
·        To stay in a private room

Pain relief:
·        Bath/shower
·        Acupressure
·        Breathing deep/soft lions/meditative breathing
·        Hot/cold therapy
·        Meditation/self-hypnosis
·        Massage
·        Yoga (cat cow, squat, squat on a chair etc)
·        No light touch or tickling
·        Please don’t offer me pain medication
·        Walk/sway/humming

Pushing:
·        If I am comfortable and ready, I want to be able to push when I feel it needs to happen, & in my own time as long as my baby and I are doing fine.
·        I do not want to hold my breath during pushing
·        If I need to be coached, I will ask for instruction.
·        I’d like to try the following positions for pushing (in order of preference):
o  Squatting
o  Hands & knees
o  Side-lying position
o  Whatever feels right at the time

Feeding – I want to breastfeed exclusively. Do not offer my baby formula or a pacifier. Ask before you provide sugar water.  

Circumcision – We are having a girl, but if it turns out to be a boy, he will not be circumcised.






Saturday, July 14, 2012

When did you last breastfeed?

In the first few weeks to a month after your baby arrives, you will be learning baby's hunger cues. The feeding schedule may vary from 8-12 times a day. As a helpful reminder, knowing the last time you fed will give you a general sense of whether the fussiness, rooting, etc. are hunger cues.

To help, a friend made me a breastfeeding bracelet and imparted on me her wisdom as a new mom: your sleep-deprived mind will lose track of time and this bracelet will help you remember when your baby last fed and which boob was used for the last feeding.. Being six weeks into mommy-hood, I agree with her and thank her for making me this beautiful bracelet.

This breastfeeding bracelet has numbers 1-12 to represent the hours and 4 beads in between the hours representing 15 minute blocks of time. To use the bracelet, place the clasp (this one happens to have a charm that says "made w love") to the time your baby last fed and place the bracelet on the wrist that corresponds with the boob that was used for the last feeding. The bracelet is beautiful and to the passing eye it is just that - a bracelet. Little do others know it serves a purpose, too.

I prefer this low-tech way over using a smartphone application because it keeps things simple. The first week I used WebMD Baby (free app you can download at http://tinyurl.com/7qstdpy) to track the exact minute I started and stopped breastfeeding, which provided a log of how long and how frequent feedings were. It was interesting to know how many hours a day were spent breastfeeding, but I found switching away from the mechanics of it all allowed me to focus on learning my baby's cues instead.

Friday, July 13, 2012

Birth Story Part 1: Deviation from the plan

I had a smooth pregnancy. I was active walking and doing yoga up until my 40th week. I did not have back pain or morning sickness. My mood was steady and I gained appropriate weight per my midwife. I planned to give birth at a birthing center with a midwife and my doula. Only catch was I needed to remain in the category of non-high risk pregnancy, which I was up until the 40th week...

At my 39 weeks the concern was raised about my elevating blood pressure. I started pregnancy at 102/68 and never had a history of high blood pressure. Today my blood pressure is 128/90, but went down to a bottom number of 86 as the doctor appointment went on. While the concern was raised we were just watching it as it started to creep the last 3 routine weekly appointments. I was to take calcium magnesium and return in a week, or have a baby by then. I felt fine. I was told to let them know if I experienced headache, abdominal pain, sudden increase in swelling, visual changes, or changes in baby's movement. I never felt any of those warning signs of pre-eclampsia, so I returned at 40 weeks. 

At this appointment my blood pressure rose to 138/92 and discussions around me potentially moving into the high risk category. The conversation became elevated when my reflex test came back abnormal, with what I call a double kick - instead of moving out smoothly it felt like I had a twitch or a double movement of my leg as it extended. From there out I was counseled on hypertension and what my next steps would be. We had a phone conference to include my husband, and my midwife went through the effects and complications of hypertension including decreased blood flow to the baby, intrauterine growth restriction, fetal distress during labor, maternal strokes and placental eruption. At this point, I had blood drawn to retest for pre-eclampsia and Group B Strep (Group B Strep was a routine retest at 40 weeks and not too much of a concern for how to proceed with pregnancy, just an issue when delivering vaginal whether to give antibiotics). The concern was the hypertension or high blood pressure, not pre-eclamsia. My midwife consulted an OB and within a matter of hours I was put on a waiting list for a hospital bed at University of Washington Medical Center (UWMC) labor and delivery unit specializing in hypertension. My blood tests had come back as showing the first signs of pre-eclampsia, which the only way to cure is to deliver the placenta, ie the baby. With hypertension and now the elevated concern of pre-eclampsia, 

The first thing I did upon meeting my nurse, was to hand her my hard copy of my birth plan and start discussing which parts of it could be met in a hospital setting. I was happy to learn that all of it could be met! The highlights of what I wanted: I had a tub to labor in (not give birth in), cloth diapers were available, skin-to-skin is encouraged, baby can room in, there was a long, soft window seat that doubled as a bed for my husband and a pull-out cot for my doula, formula is looked at as medicine, delayed cord clamping could happen and placenta was able to come home with me. The hard copy was placed in my file and was read by each nurse and doctor as they started their shift.  

Birth Story Part 2: All stages of labor

Day 1 at 11 pm - Check-in at the Hospital
Due to hypertension and beginning signs of preeclampsia, I checked into UWMC to be induced. The baby was full-term and the only way to cure my symptoms was to give birth to the baby. My first cervical exam showed that my cervix was closed or 1 cm dilated, in need of effacing or ripening of the cervix before pitocin, and the baby was at a -3 station. A intravenous tube was inserted and I was started on magnesium to lower my blood pressure. Two monitors were placed externally on my stomach, one to monitor the baby (an electronic fetal monitor or EFM) and another to monitor my contractions; both of which were able to be wireless to allow for mobility.  

Up until the time that I had the contraction monitor attached I thought I had no signs of labor, mainly no Braxton Hicks contractions. I was wrong! On the monitor, I was having contractions. The pain level was a zero Face of Pain and what I had said for the past month or more was my "silly baby moving around." It had always been described to me as menstrual cramp like feeling and I was having none of those. Or, another description is a hardening of the stomach - which is really hard to explain or understand, so in the end the contractions did actually feel more like a hardening of the stomach. Hardening of the stomach feels like to the touch that you contracted your abs, but you did no such thing. When the contractions are light, the surface of that contraction will be smaller. Internally it feels like a full body movement by the baby. 

Day 2 at 2 am - Induction Process Started
My cervix was unfavorable for induction, so medicine was needed to mimic prostaglandin, the hormone the body releases to ripen the cervix. With three options to ripen the cervix: a pill placed next to the cervix (misoprostol), a gel attached to a string placed next to the cervix (dinoprostone), or a non medicinal approach of a Foley balloon catheter; we had to start with Cervidil due to the rate at which I was having contractions. Cervidil was inserted into my cervix where it would sit for 12 hours. Upon reexamination at 2 pm, I was not fully effaced, so we went with misoprostol which would take 4 hours of waiting, however while waiting for the doctor to insert, my contractions picked up and we had to proceed with balloon insertion as a result. After four tries of inserting the speculum and two insertions of the balloon - both fell out prematurely, even though they are to fall out when the cervix is ripened - we had to change pace and insert the pill instead. My preference from the beginning was to have the balloon catheter inserted since this required no medicine and mimic the pressure that the baby's head otherwise would have been placing on my cervix to naturally ripen the cervix. I knew from the beginning that I otherwise had no say in what would happen, but could make decisions as they happen; this is something that I dealt with well as the laboring process continued, as there were many decisions to be made as the day continues.

Day 3 at 2 am - Contractions Pick-up
After the gel and pill did its job at ripening my cervix, I was ready for starting labor/contractions with the use of Pitocin. In waiting for the doctor to place the order for pitocin, my body started to have more frequent and intense contractions. My doula came into the hospital at 2 am, which was good because the show was just getting started. As I was sitting in bed, I felt what I thought was the baby punching my vagina and in a playful way I said just that to the nurse, doula and husband. A few minutes later as I adjusted myself to prepare for a cervical exam, it felt like I was urinating, and the doctor confirmed with a medical stripe that the fluid was amniotic fluid. I was only 2 cm dilated when my water broke. From that point on when I would move, I had to adjust myself to ensure I was not causing the baby's heart rate to drop (due to her contact with the umbilical cord). In addition there was another level of discomfort as the loss of fluid made it the baby's movements more pronounced, as I was now aware there was a baby in my belly - it felt sharp. I was administered antibiotics since my water broke so early and there was the risk that meconium poop could be expelled by the baby into the amniotic fluid. 

Contractions picked up to the point that when the Pitocin order was finally filled, the nurse waited on administering it until the contractions slowed down. The whole time I was in the hospital I did not track the timing of my contractions, this was told to me by the nurses to be their job and not something that I would need to be concerned about; the contraction monitor was doing the job for me. I did lose track of time and had no sense of time from that point on. My doula would tell me that that one lasted a minute and a half or two minutes, and I thought it was a matter of seconds. I was doing textbook style deep breath in and moan out as the pain came in and I washed it out. I envisioned the pain coming from the top of my head and rushing down through my lower half of my body. I did my best to not tense up as this increased the pain. For most of it I was lying on my side with my doula massaging my lower back/pelvic area. My husband was placing pressure on my mid-back. I was having back labor, and what later would be confirmed due to the position of the baby. As the sun came up, I moved to my hands and knees to encourage the baby's position to change and the pain to lesson; however it did not.  As contractions picked up, I experienced a Face of Pain of 10 with pitocin, so the nurse backed off the pitocin as myself and the baby could not endure consistent intensity of contractions. When I was asked if I wanted the epidural, I was ready and willing - something I was unsure I would accept going into this as I had planned a non-medicated birth. The joy that came over me when I heard the epidural man wheel in his cart, it was like hearing the ice cream truck signing a tune through the neighborhood, was noticeable as I hurried to get out of the bathroom (where I was when he came in) and had a leap in my step as I got onto the bed. 

The insertion of the epidural was not as painful as the stories I had heard. The pain was the extent of lidocaine to numb the spinal area, which I thought was no big deal after having my IV inserted three times (starting with lidocaine) before the line was established. Going into it I was fearful of how I could manage to be still during insertion of the epidural while having contractions. This too was not so bad thanks to my amazing doula and nurse: my doula was right there in eye-sight talking me through it with focus, it was like we were playing "let's see who could flinch first" and my nurse had her forehead to mine during contractions for me to use counterbalance to get through the pain. After two contractions, the epidural was in and I was feeling relief. What contractions? I was having contractions on the monitor, but could not feel them. I was told that the IV would administer the drug, so I would not feel anything all the way up until the placenta was delivered and if I did need more "juice" I could push a button to add more to the line every 10 minutes to self-manage the pain. For now and the next two hours, I would take a nap and enjoy the next two hours, when the epidural is the most effective, and be examined after that time. 

As I sipped my broth and drank Ensure - no solids during an epidural - my body all-over started to shake and developed cold sweats. This was a good thing, as my body was ready for labor. This was confirmed with a cervical exam that put me at 10 cm dilated and a station of 1+. 

Day 3 at 2 pm -  Active Labor Begins
With my oxygen mask, to benefit the baby, I geared up for pushing with a sync between my doula, husband and nurses in terms of my wishes for active labor (per my birth plan). I took deep meditative breaths and visualized a smooth, quick birth. With a wish to start in squatting position (which I had done many times during prenatal yoga with the idea of birthing this way), active labor started off with a bust. I guess I had wanted to have progress fast after hearing stories of 15 minutes of pushing the baby came out. Well that position did not work, so on to the next...one leg up on a bar, the other leg pushing into my husband who is counter-balancing my strength, both hands pulling myself up doing an abdominal push-up, and pushing. Okay seriously, it has been 10 months since I had done ab work and now I am asked to do an intense crunch! This position was encouraging as the room got excited when we could see her head. I had to shift position whenever the baby's heart rate would drop. The nurses had a constant monitor on her from the external monitor, but half way through put a probe on her head to monitor since the external kept shifting. I was monitored via regular blood draws and vital checks. The doctor kept coming in to check on my progress. The chief of staff came in to check contraction rate, the strength of my pushing and position of baby. The external monitor was replaced with an internal monitor (catheter) to track the true intensity of the contractions. The question was coming up, can I continue to push and get this baby out. There was enough room and I was pushing well, so we continued. However, as the time passed my condition continued to decline. I developed a fever and was feeling like I could pass out at any point. I started pushing with no feeling of where or if I was pushing correctly, so I let up on the epidural to feel the contractions. It was a good thing we did because I was started to understand the whole concept of holding your breath while giving three good pushes. I was on hands and knees and really giving it my all to push down, but nothing. I was thankful for the oxygen mask because I felt horrible. I wanted to give up, but knew there was no option. Then, the baby's heart rate started to drop with every contraction, so I was told I needed to stop pushing. The pain was beyond what the epidural could do for me. I could not breath through the contractions like in early stages of labor and I could not push to relieve the pain, all I could do was sit in it. I managed the pain through moaning and displacing the pain by smacking my doula's hand (thank you doula!). After an hour and a half of this, I called it quits with the decision to go forward with a Cesarean delivery. I guess I was not the only one with this idea as the doctors presented this to me as their plan of action too. This whole time the doctors had said that I was getting more sick, but it did not register what that meant. It was not until they had told me that they had blood on-hand in case I needed a blood transfusion during the c-section for my blood plate-lattes had dropped so low that I ran the risk of not clotting blood. I was very thankful that from the time I made the decision for c-section to the time I was prepped for surgery, it took only 30 minutes. As soon as I signed the consent paper, I was given pain medication through the epidural and two contractions later I had sweet relief! Her position remained at 1+ station. In five and a half hours of pushing she had not moved any further down in my pelvic. 

Day 3 at 8:03 pm - C-section baby girl is born
Off to surgery I went, nauseous from the pain medicine. I was put on the operating table with my arms out to my side and my body curtained off, just like you see on television. I am the type that does not like to see the needle when giving blood as I may pass-out, so the idea of being awake for the surgery was scary. I did not want to hear what was going on, which I was able to tune-out; 1. I felt like I was going to pass-out and 2. my doula kept me talking so I could hear my baby's first cry. There were so many people in the room, two sets to care for me and her. I saw my husband come into the room as the baby was pulled out. There was no cry at first as she was limp, but she came around (APGAR score of 4 then up to 7). I was hoping for delayed cord clamping, but that was not an option with an emergency c-section. Because my water broke so early, at 2 cm, and time had passed, the baby had her first bowel movement while in the womb; it was mot an issue as it was a small amount, which they were able to remove. and antibiotics were already administered to me in the event this happened. There was not much body space of my own for skin-to-skin, so my husband put the baby on my cheek. Seeing my baby staring back at me was beautiful! She was so close to me that I was seeing double, but it did not matter; she was very alert and already I felt a connection to her. I will hold with me forever the picture of her looking at me, with big eyes. 

The experience of having a c-section was traumatic to say the least, but one question lingered with me - why did it feel like my incision was by my ribs? I wanted to know what went on in there. A few days after delivery, I spoke with the OB who performed the c-section and this helped put my mind at ease. I could not feel pain during the operation, but felt pressure in my upper abdomen and plenty of movement thereabouts. All-in-all the reason for my back labor and the movement I felt during the c-section was due to the position of the baby - the baby was in an occiput posterior (OP) position, but she had her head craned back, instead of having her chin tucked under. Due to a combination of her position and how well lodged she was, it took three people to back her out of my pelvic. Then, due to her position, they could not deliver head first through the incision they made, above my pubic bone. Instead they had to turn her around and deliver her breech or feet first. And, this turning movement was what I was feeling in my abdomen. I felt at peace knowing what happened. 

I had planned to take my placenta home for encapsulation, but pathology confirmed that my placenta was infected. In addition the idea of ingesting the placenta, which essentially caused my sickness, or needed to be delivered for me to feel better just did not sit well with me. My placenta was discarded; just another thing that did not go per plan. 

I was wheeled off to recovery with my baby. I would spend the night with my nurse tending to me and my baby. Thankfully I was able to nurse and co-sleep with her as my nurse was monitoring us 24/7. My baby girl immediately found my nipple and we were able to intimately bond nursing. After four days of recovery I was able to go home with a prescription for blood pressure medicine and the most precious baby girl!

For information on why an induction process was needed, my birth plan, and my feelings around deviating from the birth plan, see Birth Story Part 1: Deviation from the plan. Or, for information on how to create a birth plan and what my original plan was for birth, you can read My birth plan.

Friday, July 6, 2012

DIY Hands-free pumping bra

As a new mom, most of your time will be spent feeding your baby. You will be a professional milk maker, seriously I call my boobs Mildred and Bessie. When newborns eat 8-12 times a day and anywhere from 5-45 minutes a feeding, the time can add up. Then, add on top of that 5-10 minutes post breastfeeding to pump or express to stimulate more milk supply - the time adds up! To save yourself time, you can double pump and cut the time in half. If you are only pumping, your will especially love the time savings!

Hands-free bras can run anywhere from $25 to $50. You could go cheaply ($18) with the hands-free attachment to a nursing bra using Pump-A-Pair, but I have found the set-up to not be ideal (loose I would say or not secure enough for my comfort that I found myself holding onto the pumps anyways).

To save money you can take an old sports bra, pre-pregnancy or snug, and turn this into a hands-free bra for no money. .

How to make your own hands-free bra:
1. Put on the sports bra
2. Mark where your nipples are (Tip: align your nipples straight before marking)
3. Take off the bra to cut an X where you marked the spot, large enough to fit the size breast shield



I found it easy to lube the ladies after I put on the bra, but before the shields. And it was simple to place the shields on them and slip them through the snugly made openings, then attaching the other pump parts. 

What will you do with your extra time?! Brush your teeth, take a shower...necessities are must do, try a fun to do too. Happy pumping!

Tuesday, June 26, 2012

GumDrop Pacifier: used by hospitals

The word around the office and breastfeeding support group is the GumDrop pacifier is the pacifier to buy. It comes in both newborn and full-term sizes, but after speaking with the company's customer service department these are the same size (0 to 6 months and come in original or vanilla scent). I also learned that the hospitals are the only ones authorized to get the smaller size (color green) for preemies and poor suckers. In addition, the pacifier is only recommended to be used up until 6 months as a baby with teeth may be able to bit off parts of the pacifier.

Per the product description, they are distributed to hospitals nationwide, constructed with durable, latex-free silicone and shaped to baby's face while staying clear of the nose.

I've used it for my newborn to soothe her when she just wants to suck and so far good results. Introducing a pacifier at 3 weeks has not interfered with her breastfeeding latch, which was my fear, and allows her to suck on something besides my breast or finger when she just wants to suck.

Sunday, May 20, 2012

Baby Shower Idea: Painting the Alphabet

I found a couple design ideas I liked for hanging the alphabet on the nursery wall. From there I started to dream of what my wall of letters would look like. I went in search of unique letters at my local Sunday market and kept an eye out as I went antiquing or to the craft store. An individual letter can range from $2 to $10+, which when you do the math for 26 letters it can get pricey, almost as pricey as buying a framed picture - but where would the fun be in that?! Luckily, when I was browsing my local Habit For Humanity ReStore I came across a shopping cart full of wooden letters, all the same size, for 25 cents a piece. Jackpot!

Now for making them individual...I got out my acrylic crafting paints and started with painting colors: B would be blue, O would be orange and so on. It dawned on me that after I had gotten out my graphing paper, colored pencils and enlisted the help of my husband to craft the design of the alphabet that I created a layer of control that took the randomness out of the whole project. At that moment I put away the pad of paper and thought of another way to make it personal, yet individual. I relinquished all control and gave the painting/decorating over to my friends.

At my baby shower, a painting station was set-up and every lady, that wanted to, painted a letter.












As a follow-up to the baby shower, I sent an email to all my ladies with a picture of the finished result:















Adding this painting activity to the baby shower, made me feel a special connection to my friends - I get to share them with my baby girl everyday she plays in her room. It also allowed the shower to have an activity that was not centered around identifying candy bars melted in a diaper or tasting horrible baby food.

Few notes: In this instance, all letters except for her initials are different. And, the majority of letters are painted, with some having been decoupaged or added scrap booking embellishments to them to add variety.

Thursday, April 5, 2012

Paintings for my midwife

On my last prenatal appointment, my midwife had moved into a new office within the practice, but had yet to decorate. Being the interior designer at heart, I decided to offer up my painting skills to spruce up his office. I also have to admit I gave him a good time picking on him for the room being so sparse - he only had up a 5x5 calendar on the wall!

With his blessing and knowledge that he started to bring in decorations focused around robots and their robot babies, I went to work and this is the final result:

Maternity Clothes: what not to buy

When I found out I was pregnant I shuttered at the thought of buying maternity clothes, mainly because of the price - I mean you where the clothes for very little amount of time. I've managed to use most of my pre-pregnancy wardrobe (more on how to manage that in another blog post) and picked up only the necessities...

* Maternity pants - 3-4 pairs of pants, with elastic that covers the belly
* Properly fitting bra
* Maternity tanks (black and white)
* A cute maternity shirt that you can take your bump photo in time and time again
* About 5 maternity shirts, mainly ones that will fit in your last two months of your pregnancy
* bathing suit if your bikini does not fit your growing boobs

The rest you can get from your current closet. Think stretchy pants, shirts that already have pleats, dresses, sports bras, t-shirts that were a size too big and so on. I promise you, don't freak out, it is possible to use your existing clothes and find maternity close at bargain prices. More on how to manage within your closet, to come!

Maternity underwear are not necessary. Belly bands sound like a good idea but they can be a bit tight. If you have yoga pants with a soft band, these can fit through pregnancy without needing to by workout pants.

Here is a top I would stay away from buying:
I mean really, if I wanted to look like my belly does not fit in my top shirt, I would have put on a maternity tank and layered my favorite smaller pre-pregnancy shirts over it.