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 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: 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.