Wednesday, October 28, 2009

Walk, Move and Change positions

 This blog will join the many others in Lamaze International's Carnival Birth Blog, promoting Lamaze's 6 healthy birth practices. This one is #2.
This is a re-vamp and re-post from "Birthing positions and their effect on labor" posted earlier this month.

Walk, move, and change positions

This blog will discuss walking,moving around and changing positions throughout labor and why this is so beneficial.
Birthing positions will also be discussed. I am aiming to educate Aruban women especially, that they do have a say in choosing the position that eases the pain and facilitates the baby's birth.

In Aruba, especially when a women is under the care of an obstetrician, she is automatically put in the Lithotomy position. A Certain ob/gyn absolutely refuses to let you go in another position, such as on hands and knees because he doesn't want to have a rear-side view. With midwives however, there are infinite possibilities, and most if not all, aim to comply with your wishes, and even suggest alternative positions that help the labor along. Here are Birthing positions 101. Included are the advantages and disadvantages for the mother, fetus and birth attendant.

Moving around during labor is important and beneficial because
  • When you walk around or move around in labor, your uterus works more efficiently
  • Changing positions moves the bones of the pelvis to help the baby find the best fit through your birth canal
  • Upright, side-lying, and forward-leaning positions allow plenty of blood flow to your baby, so he may be less likely to show signs of distress
  • Actively responding to labor may help you feel more confident and less afraid. By feeling in control of your birthing process, you may be empowered and experience less pain due to less anxiety because of not being a "by-stander", so to speak, during childbirth.
  • Research shows that moving freely in labor improves a woman's sense of control,may decrease her need for pain medication, and reduced the length of labor

Lithotomy Position


  • Some women say they like the security of stirrups for their legs, particularly if they have used them    previously

Fetus :
  • Easy to listen to Fetal heart rate

Birth Attendant :
  • More control of birth situation
  • Obstetric intervention easiest should it be necessary : forceps episiotomy, repair of lacerations, anesthesia     
  •  More comfortable, less back strain
  • Asepsis                

  •  Adverse affects on blood flow : The weight of the uterus compresses large blood vessels so as to decrease blood flow to the uterus and ultimately decrease oxygen to the baby.
  • Less active participation with baby and birth attendant
  • Stirrups can promote blood clots if legs are in them for a long time
  • Decreased ability to push
  • Sense of vulnerability
  • Possible inhalation of vomit
Fetus :
  • Changes in mother's blood flow can cause fetal distress or a depressed baby at birth
  • Difficult for mother to see or hold baby after birth
Birth Attendant :
  • Cannot easily interact with woman and is less able to elicit her cooperation

 Standing position


Mother :
  • Reported improved uterine contractibility for First Stage of labor 
  • Avoidance of negative hemodynamic changes  
  • Can watch Birth
  • May increase help of gravity
Fetus :

  • Uknown
Birth Attendant:
  • Ease in interacting with women

Mother :
  • Fatigue
  • Needs two supporters
  • Hypothesized increased blood loss, uterine prolapse, edema of cervix and vulva
  • May fall to the ground unless "caught"
Birth Attendant:
  • Difficult to control baby's head and watch perineum 
  • Difficult to assist with delivery

Sitting Position



  • Shorter second "pushing" stage
  • Most efficient for expulsive efforts
  • Maintains some advantages from squatting ; increases pelvic diameter
  • Easy to interact with baby and others
  • Grunting may aid delivery
  • Probably less negative hemodynamic effects than lithotomy thus less fetal distress
  • Easy to listen to fetal heart rate
Birth Attendant:
  • Good access to perineum for control of delivery
  • Able to use interventions should it become necessary, such as episiotomy, forceps or pudenal anesthesia easily should it become necessary

  • Needs back support
  • Might induce edema of vulva or cervix 
  •  None
Birth Attendant:
  • Some attendants may not want the mother's active participation in the birth

Hands and knees


  • No weight on Inferior Vena Cava; thus probably less fetal distress
  • Advocated for aiding delivery of shoulder 
  • Useful for relieving pressure on umbilical cord if trapped or prolapsed 
Birth Attendant:
  • Good visualization of perineum and control of expulsion of presenting part
  • Optimal control for breech delivery, according to some practitioners.


  • Very tiring : Bean bags and pillows useful for maintaining position or for rest between contractions                      
  • Difficult to interact with baby and birth attendant, but can turn immediately after delivery and hold baby
  • Cramps in arms and legs
  • Difficult to monitor baby unless one uses fetal scalp electrode ( which will leave a beautiful bald spot for ever on your baby's scalp)
Birth Attendant:
  • Must reorient landmarks and adapt hand maneuvers for delivery
  • Usually turn woman to recumbent position for delivery of placenta, repair of lacerations and rest

Dorsal Recumbent 


  • Less tension on perineum
  • Less pressure on legs
  • No stirrups, thus less likely to develop thrombosis
  • Easy to listen to fetal heart rate
Birth Attendant:
  • Easy access to perineum
  • Able to do pudendal anesthesia or episiotomy easily should these become necessary



  • Same blood flow changes as lithotomy
  • Difficult to participate in birth
  • decreased ability to push
  • Fetal distress can occur because of restricted blood flow 
Birth Attendant:
  • Cannot easily interact with woman
  • Forceps delivery more difficult to do since there is less counter pressure on fetus

Lateral Recumbent


  • Corrects or avoids adverse hemodynamic effects of lithotomy position
  • May prevents some perineal tearing because of less tension on perineum
  • May help to rotate occiput posterior presentations
  • May be helpful in relieving a Shoulder dystocia 
  • Comfortable for many mothers and conducive to resting in between contractions
  • Promotes maximum uterine blood flow and thus fetal oxygenation
Birth Attendant:
  • Conducive for controlled delivery
  • Preferred by some British practitioners

  • Least efficient for expulsive efforts, this may be desirable to avoid a precipitous delivery (delivering in an unusually quick amount of time) for a repeat mother
  • Needs someone to hold leg up for the delivery
  • More difficult to listen to fetal heart tones
Birth Attendant:
  • Some practitioners consider this position akward
  • Unable to see and interact with mother as easily, cannot see her face directly
  • Difficult to repair episiotomy or use forceps in the event that these would become necessary

  Squatting Position


  • Good expulsive effort: shorter second "pushing" stage
  • Pressure of the thighs against the abdomen may aid in expulsion by increasing intra-abdominal pressure and promoting longtitudinal alignment of the fetus with the birth canal
  • Improves pelvic bone diameter. Anteroposterior diameter of outlet increased by 0.5-2 cm :Transverse diameter is also increased ( opening of vagina made wider with less perineal trauma and tears as a result)
  • Avoids adverse hemodynamic effect of lithotomy
  • Facilitates interaction with birth attendant and baby and others present
  • Promotes fetal descent and rotation
Birth Attendant:
  • Some visibility of perineum
  • Maternal effort is maximized in accomplishing the birth

  • Legs can become fatigued, especially if woman is not supported
  • Uterine prolapse may be more likely due to strenuous bearing down effort
  • May promote increased perineal and cervical edema (swelling)
  • Rapid descent and expulsion of fetus may be accompanied by vaginal and perineal lacerations
  • Increased blood loss possible
  • Rapid expulsion may result in sudden reduction in intracervical pressure and cause cerebral bleeding in the brain of a premature infant whose skull bones are not yet firm.
Birth Attendant:
  • Cannot intervene easily in this position to help control the expulsion of the baby or to administer an episiotomy or pudenal nerve block should these become necessary

Partner Tip
During active labor, some women have a hard time deciding how they want to move. The media has ingrained in most women a sense of "capture" and "helplessness" during the birthing process and so they think they are expected to stay in bed. Labor partners do well to educate themselves along with the pregnant woman about different labor and birthing positions to help "guide" the laboring woman. The labor partner would do well to offer suggestions and tips especially when the mother seems discouraged, frightened or uncomfortable. 

Leaving you now with a video of healthy birth practice #2 out of 6 from Lamaze International

For more information on Lamaze's other 5 healthy birth practices visit Amy Romano's blog : Science & Sensibility

All images courtesy of: Google Images

Monday, October 26, 2009

The birthing experience - Does it affect who you are as a mother?

Courtesy: Google Images

I was perusing through the different blogs I follow when I noted a kind of back-and-forth topic going on. I think this topic could be similar to the one about Breastfeeding and guilt and then some. Thank you Hannah Rosin and Fearless Formula Feeder. (I'm not even going to post all the links to those discussions because I'd be here all night) This topic however, centered on birth. On Jan Tritten's blog ,the following impacting statement can be found:

"This is what I want to say to every young woman in the world: your birth is the most important event in shaping your life as a mother. It is imperative that you be properly cared for, nurtured and, in this culture, educated. You need a loving midwife, because the effects of the birth year—positive or negative—will affect your whole life, your baby’s whole life, and indeed society, as your decisions reverberate through her story."

The above mentioned illicited a response from  Sweet Salty which says in part :

"Sometimes, motherhood is destined, and yet the experience of birth is not. Are those women lesser mothers?

Are women who are indifferent to method lesser mothers? Lesser feminists? Or just unenlightened and pitiable, even if they’re content with their experience? ..  Birth is absolutely not the most important event that shapes my life as a mother. It’s just not."

I must say, I do agree with  Stand and Deliver. While I do think that a birth can be a very positive and influencing factor in a woman's life that can build her up or traumatize her (in either subsequent births or other facets of life), I do think that who we are as mothers is constantly being re-defined by our current mentality, actions, standards and many other factors. Even though we may plan our birth to the tee and do our homework and search out all our options, time and unforeseen occurence does befall us and can make all our diligent efforts and planning go awry.

Does settling for an elective c/section make us lesser mothers? Does not looking up alternatives or standing up to our health care providers when our interests conflict make us bad mothers? Does accepting what comes without asking, who, why or how doom as as incompetent moms? I don't think these questions nor their answers are as simple as a "yes" or "no". I consider myself a breastfeeding advocate, but how could I dare tell a mother that she's a bad mother because her doctor said she had to have that c/section and the mom nodded and practically raised her hands saying "I surrender, take me". How can I tell a mother who after having 4 kids with highly unnecessary interventive births that she is incompetent and ignorant for never learning even after having 4 kids! 

Did the highly interventive birth of my daughter make me less of a mother and impact my life as that mom? Not completely. While I wish I had the proverbial "Undo" button, I recognize that, the birth has happened, it has shaped who I am in the sense that it woke me up to get it "right" next time. To do things the polar opposite way. My daughter's birth made me question my "I'll trust you, you're a doctor" mentality and made me see things in a stark contrast. This doesn't always occur. How many women go through childbirth in less than ideal ways and yet see nothing wrong with the way things worked out. How many women see absolutely no problem with social induction or elective c/section. What is the difference between that mother and myself? Is it ignorance? Is it a difference in personality? Is it carelessness? Or maybe a calm acceptance of what was? What role do I personally play in determining the actions of others? None. Personally, I do not feel that it is my place to tell you what sort of mother you are

I like to be in between, I like balance. I recognize that when us advocates start pushing our "ideals" on others who really don't want to ever learn, rather than focusing our attention on those who do want to see things differently, it creates friction. Lots of friction. People start feeling guilty, people start feeling offended and defensive and backed into a corner, on both sides of the "issue". This is not my purpose. I am a childbirth and breastfeeding advocate. Not a hate monger pushing my opinions down someone elses throat. I would much rather spend my time with a mother or mother-to-be , informing, guiding, and explaining to them how they can respectfully stand up for what they want and believe in.

Back to the topic on hand

As we can see, all these things, birth, breastfeeding, bottle feeding, parenting choices and so forth occupy a big place in our mind, and let's face it , who wants to be told that they're a bad mother for letting that doctor induce you when you well knew your body was not ready... Come on... Has it come to the point that we have to belittle others for the informed/uninformed/wise/unwise choices they've made? Does it make us better parents? What line to we draw when our activism becomes detractivism? Although not related the the topic of birth, the principle behind it surely counts. In her article When activism becomes detractivism, Dani Arnold-Mckenny states in part:

Courtesy: Google Images

Everyone has something that they are passionate about. Everyone has a cause that owns a special corner of their heart. Whether its saving the rain forests, freeing Tibet, going "green", equal rights for women, pro abortion, anti abortion, pro capital punishment, anti capital punishment, etc , ........Everyone has at least one thing that they are willing to stand up for, that they will jump into the fray with both (metaphorical) fists swinging, debating their passion till the wee hours of the morning.
Passion burns brightest in the middle of a heated debate. And it can be beautiful in its eloquence, or scarred and ugly in its words of condemnation and accusation. Is the message getting lost because the flame is blinding? Is the message getting lost because the fire it possesses is burning everyone it comes in contact with?
Should I play the part of the Black Knight and tell her that she is wrong, that her decisions were wrong, that her doctors were wrong, that the formula she is using is poisoning her baby and killing our environment?
Or shall I play the part of the Enlightened One. Listening attentively, offering sympathy for the hard road and rocky journey that she has travelled?

It has been my experience that accosting a new mother with facts and figures and recriminations, and railing against the society that has caused the ultimate downfall of civilization through the production of infant formulas, will do nothing more than add to the woman’s justifications and worse, turn her away. It creates the stereotype of the hardcore Lactivist, who preaches damnation to all that succumb to the idolatry of the golden baby bottle.

But by offering my quiet support and sympathy, I create a bond of trust with a new mother. As that bond grows I may yet have the opportunity to explain to her about the misinformation she was fed. and maybe even have the opportunity to explain to her about re-lactation, milk banks, or even prepare her for the birth of her next child .Thus a new mother suffering misery, self-doubt and guilt, becomes assured that failure is not hers to shoulder alone, that there is support and help available to her, whatever the outcome is. Advocacy doesn't have to be spoken words or printed pages. Advocacy can also just mean setting an example. Sitting quietly and nursing your happy healthy baby can be the biggest show of support. Bonds of friendship and trust can grow through quiet acceptance.....which later leads to open conversation. Who knows where those conversations will lead?

Is our activism crossing over into detractivism and actually stifling those who are willing and ready to listen and be enlightened to make better choices the next time around?  I sure hope not... or else.. what good is this blog.....................?


Aruba's mother-to-mother breastfeeding support groups

This week we are having our monthly mother-to-mother breastfeeding support group meetings. I especially enjoy these meetings because of how many different experiences and stories you hear from mothers. Our support group is organized by our local non-profit breastfeeding organization Fundacion Pro Lechi Mama Aruba. We always enjoy an attendance of many pregnant women too, this is very good and important because the decision to breastfeed is made long before a woman conceives, and the more information she gets during her pregnancy, the better her chances are of succeeding at breastfeeding. Such support groups are essential because this is where a mother can go to find accurate, up-to-date information from breastfeeding professionals. These meetings are important too, because it can be a great struggle to find acceptance with our choices to breastfeed our infants among people who do not support our choices and/or who do not understand them. These support groups are valuable because mothers can come and find like-minded women and find validation and feel good about her choices. Depending on the topic for that month, I bring along some of my breastfeeding paraphernalia to show moms and give them an idea of what is handy to have. I bring along my breastfeeding pillows, Boppy and My brest friend. I also bring along my sling and nursing cover for the moms and moms-to-be to check out and see if they want to buy one. This month's topic will be about introducing a breastfed baby to solids. This is timely seeing how many a moms get confused (I was one of them!) when it comes to introducing solids. How many times a day? How much do I start with? What do I start with? How can I detect an allergy? and many more questions will be answered.

We are trying to encourage mothers to bring their babies and children with them! One of the reasons we have this support group is not only to dispense correct breastfeeding information but also to give mom some socializing time too where she can bring her babies without having to worry about a babysitter! We also encourage mothers to bring their partners or whomever is their "breastfeeding supporter" along with them especially during pregnancy. It's not only the mom who needs to be well informed but her support-system as well because they will excercise a great influence on her decision to stick it out or throw in the towel..

On behalf of Fundacion Pro Lechi Mama Aruba, I would like to invite you and bid you welcome to this month's Moedergroep!

                     Mom trying out sling for the first time with her 10-month-old

Friday, October 23, 2009

Homebirth - Revisited

What is it about homebirths that freak people out... What is it about hospital births that make people feel safe. I ponder these questions often times, even asking myself, why should I be afraid to birth my next baby at home? I've already told my mother about it, and she responded with "Well, when you're done, and everything's cleaned up, then you can call me and I will come over". I didn't get the, 'you're nuts!' that I usually hear, but I knew that's how she felt. My father one the other hand, well, if there were 135 different ways to say, 'are you crazy', you better believe he'll find 136.

People always cite their fear of homebirth because of what can potentially go wrong. Of course, who can blame them, it has always been that time and unforeseen occurrence befell all of us, and unanticipated events during childbirth is not to be excluded. But I always follow up with a question such as "How many babies and mothers die in the hospital, yet the majority don't even think twice about giving birth there." As I mentioned in yesterday's blog on homebirth, although hospitals and obstetrical care would like to take full credit for improving statistics on maternal and fetal outcomes in comparison with centuries ago, the truth is that, these better results come not from more c/sections and higher intervention rates but because of better nutrition, hygiene and disease control. A dear friend of mine that is in his eighties told me of a time that many women stopped dying because the birth assistants learned to wash their hands before handling the laboring woman. So as long as hospital births are seen as normal and obstetricians are seen as the "real deal", homebirths will remain the 'hippie, hedonistic' approach to childbirth.

 Why, despite so many success stories do people hold on to that one horror story of a homebirth and deem all other homebirths just as 'dangerous'? Why do so many mishaps and tragedies happen with mothers and babies in the hospital yet no one says, "hospital birth?! NO WAY!".

I was fortunate enough to have a folder in front of me with statistical data about Aruba from the year 2001. The section of homebirth is very modest and straightforward. It shows us that in 2001, 96% of births took place in the hospital and 4% took place at home. It also tells us about the prenatal care, or at least the care during childbirth. 75% of all births in 2001 were overseen by an Obstetrician and 21% were under the direction of a midwife and 4% were 'other'. It doesn't mention what they are referring to specifically.We see that from the ages of 16-24
  • 67% of deliveries were by a midwife
  • 33% of deliveries were by someone else (nurses more commonly)
From ages 25-44
  • 86% of deliveries were by an obstetrician
  • 14% of deliveries were by a midwife
In 2001
  • 83% of births were vaginal births
  • 17% were c/section births

Why this drastic leap from 67% to 14% with midwife assisted births? Is it because of the increased maternal age and the subsequent complications? In Aruba it is protocol for a woman 35 and older to automatically fall under the care of an ob/gyn.  There she will automatically have an ob assisted hospital birth. It's nice to see a c/section rate at 17% however, back then, we were an island of 100,000 inhabitants ( now it's like 110,00, somewhere in that range). A midwife friend of mine told me that after completing her midwifery studies in Holland, upon arrival on Aruba, she came to find out that Aruba had the third highest c/section rate in the world, and that when a particular ob/gyn retired, all of a sudden the c/section rates dropped significantly. It was a known fact that, that obstetrician cut primips up at the drop of a hat. Oh, is  my day shift nearly done? Let's get you to the OR, oh? Is it Friday today? Let's get you to the OR, oh? Is tomorrow a holiday? let's roll you right into the OR, Oh? Is my vacation coming up a few days from now? Well then, by all means, let's schedule that "birth" of yours! NO vaginal birth for you! You know the soup Nazi from Seinfeld? Well he was the vaginal birth Nazi.In any case, I've veered off enough with my anecdotal stories. Back to the homebirth.

I will dare to mention that 4% homebirths are, well, they're something. It's not so high, but I'll take it. Of the many women who have homebirths, many are multip women (women who've had more than one child). I enjoy reading and hearing homebirth stories of primips ( first time moms). One of those stories was a friend of mine. She had her first daughter in the comfort of her own home, with her midwife present and her CBE turned Doula present. Her birth was uneventful in that there were absolutely no problems or complications. She and her baby girl turned out just fine and enjoyed a wonderful breastfeeding relationship.

Why, despite so many success stories do people hold on to that one horror story of a homebirth and deem all other homebirths just as 'dangerous'? Why do so many mishaps and tragedies happen with mothers and babies in the hospital yet no one says, "hospital birth?! NO WAY!". Why? Well, I already answered that question in part in the blog before. Midwives are 'bush doctors', and obstetricians are 'life-savers'. Now while, the latter is true in the sense that, an OB can save your baby's and your life if a deadly complication arises and immediate cesarean is needed, an OB will also be more impatient with your labor, deeming your labor as "failure to progress" in need of a c/s when he has a busy day and an overfull practice.

Many will deem women who are searching for a better birth experience the second, third or even fourth child around as, "those" mothers... You know, A "birth nut". A mom more concerned with having birth balls, candles, and serene music than with having a healthy baby. I've often heard mothers tell birth stories that involved a health-care provider who clearly believed the mother was being reckless with her baby's life, and that the provider was the only one interest in a good outcome.

But there is the thing: Sometimes, we in the natural birth community give our physicians, friends, families, and neighbors reasons to be leery of our motives. Our talk about the 'experience' of childbirth peppers our conversations and affirms to doubtful audiences that women who want low intervention or natural birth are selfish, compromising the health and safety of their babies for that 'mountaintop' experience. But how then can we get through to those 'mainstream' moms who agree to a laundry list of interventions in their births, never once suspecting that they may be receiving second-rate care?

When reading "Hitting the right notes",my attention was drawn to a website that lists 35 reasons to choose a home birth . They listed reasons suchs as, "Your pets can attend. Seriously. Pets are family, too." and "You don’t have to sign out when you leave your house" and not to mention " Having a home birth is different. Different is cool." and lastly but certainly not least " You can have as much sage, incense, candles, whatever, as you like." Of course, for us "birth nuts" we can read this list and be ok with it, but for a first time mother who is apprehensive about her upcoming birth in any setting, she will easily read and dismiss this article thinking 'but what if something happens? The candles aren't worth it' and will go on to look up her "safe hospital birth!". Many times, when women describe their homebirth or their home waterbirth they'll speak and make a lot of mention of the emotional aspects of it and how healing it was to them, making up for all the past trauma of the birth(s) prior to that one.

While none of these messages are wrong, we know that the emotional aspect of birth is undervalued or even negated. However, our emotions affect our physical state, so when we talk about the emotional well-being of mothers, we are actually talking about creating optimal conditions for a physically safe birth. Taking into consideration that a woman who is not yet on her "quest" for a positive birthing experience, will have a short attention span. Having said such, we must choose our words wisely. Displaying both the emotional aspects giving birth naturally at home, and the many physical benefits to mother and child.

It's not easy to get people to see the safety of home births and the reailty of hospital births. But with kind persistence and patience, mothers will come around and more will warm up to the idea. It will no longer be necessary for a woman to experience a bad first or second birth to wake her to the realization of  wanting to be in control of her subsequent birthing experience. Birthing at home will be the norm for all low-risk pregnancies....

Wednesday, October 21, 2009

What's the deal with a homebirth?

I've managed to have almost fanatically talked my co-worker into giving birth to her (not yet conceived) second child at home- in a birth tub. She's excited about it, she looked up information on it and is basically set and ready : mentally. When our boss walked in one day and heard her, he put on this look of utter dismay and horror. 'At home?!' He cried out. 'Are you nuts?!?!?!' Then I set out to talk myself blue in the face to even try to get him to listen. I know his type, the ignorant type who know of ONE homebirth gone wrong and doesn't care if there are an octillion studies saying that homebirth is safe.

Which prompted me to ask on my Facebook. What DO people think about homebirth...? I have a considerable amount of birth advocates on my facebook so I knew I would get facts out of their answers... however, I wanted to know what others think, what young people think about Homebirths. Here are some responses:

  • This is a great option that should be more widely available to new moms-to-be, but dare mantion to family and friends your plans :"what are you crazy??" will be their response
  • I really prefer giving birth at a hospital...for in any case of emergency........although...if there where good midwife and good good planning I would consider. but then again I'm still up for giving birth at a hospital.....or a birthing home I will do for sure.....where they have everything available to help you. Because at the hospital you are limited in many doing what suits you best to ease the pain (you're stuck on the bed) and how many people can come in to support. Maybe since it is not usual here in Aruba, people will have to be informed about this.
  • The way the population is growing.... I think it should be a possibility... If something should go wrong, there's always a hospital an Centro Medico... Aruba is a small island so it won't be difficult to reach in time!!! I'm planning for my next baby, a water birth @ home!!! So 2 in 1!!!!
  • My sister had her daughter at home on July 31st. I was lucky enough to get to be there, in the other room. It was incredible.
  • I think I'm still a little far from being very very very certain I will accomplish it (next time), it takes some support. I didn't really have it, my husband was worried something BAD would happen to me so though he was Yes-mamming me for the home waterbirth; he secretly agreed with my mom and was relieved when it didn't happen that way... (I knew all along which made my resolve less strong of course). 
  •  My midwife has a 2% transfer rate--for all reasons--complications, fear, etc. Knowledge is power! And the hospital is far from empowering! And I had an absolutely wonderful perfect birth at home in the water with my daughter, born at 37 weeks after 6 hours of labor and 2 real pushes!
  • For women that trust their bodies, it is a great option. For ones who rely on the medical field to birth their babies, not so much.
  • I think a lot of people don't realize that 99.9% of complications leave plenty of time for transfer to a hospital. In Utah 3 in 10 "first time mothers" transfer, and 1 in 10 of second time mothers. Not necessarily because of complications, but because of fear.

    So, what can help a woman make her choice to have a homebirth? Where can she turn for reliable guidance? How will an expectant mother know that a homebirth is the choice for her? I went to to get the facts - not the scare-you-into-a-hospital-birth nor the -sensationalized-birthing-experience. Just hard facts, straight up. Here's what I found of interest

    Until recently, homebirth has been the natural mode of delivery since the beginning of humankind. It has only been in the last century that out-of-home birthing became the norm, a change engineered by ambitious men during a time when it was believed best to bring the natural world under control. What resulted in the birthing world was a surge into the hospital. It started with a fad, developed into a sign of prestige, then became pervasive when fear took over. With it came the inevitable spiral of cause and effect: the more intervention was introduced, the more it was needed, until birth was no longer recognizable as a natural process in human experience. Instead, it had been orchestrated into an assembly line procedure complete with time constraints, quotas, indifferent workers, procedures manuals, and loss of individual rights and autonomy.

    The advent of obstetrics in this century had a tremendous effect on childbirth customs in the United States. The birthing process became segregated from mainstream family life. Many were led to believe that the only safe birth was a hospital birth. Though doctors and hospitals took credit for statistics that indicated that birth was more successful than in previous centuries, in reality better nutrition, hygiene and disease control improved outcomes. Hospitals have never been proven a safe place to have a baby.By the 1950s, most births in the US were taking place in hospitals. Cesareans, epidurals and heavy doses of pain medication became the norm. Women were denied feeling and experiencing birth through their bodies, and the drugs were having adverse effects on mothers and babies.In the 1960s and '70s, women began to question and challenge the way obstetricians were treating them—as though childbirth were a sickness. Women began to reclaim their power, and the homebirth movement was born. The 1990s became a time of maternity awareness. People were concerned with making all of pregnancy and birth a family experience. Today, a carefully monitored homebirth has been proven to be very safe and successful for women who have been helped to stay low-risk through nutrition and good prenatal care.

    A woman feels in control of her birth process when she births at home. In the hospital, institutional standards are in control. It's hard to believe that most women would choose the latter. But fear of supposed consequences and fear of responsibility and one's own power seem to discourage a lot of today's expectant women.

    Even though research has validated its efficacy, homebirth is still seen as unsafe. Cultural trends, an overzealous media, clever marketing, power mongering, rumors and fear perpetuate that view

    One of the main concerns about homebirth voiced by many women is the lack of emergency care readily available if the need should arise. A good homebirth midwife, however, is well trained in avoiding and handling complications and performing neonatal resuscitation. She has the proper tools with which to control hemorrhage if the need arises. She is well versed in normal birth and is willing and ready to transport a woman to the hospital if it becomes necessary. Because she has come to know the woman on an intimate level, having done all the lengthy prenatals herself, she is well equipped to handle emotional issues that may arise during birth. Her intuition and instinct are consciously developed and their use is a priority in the kind of care she gives. She is comfortable with offering massage and hugs and cradling the woman in her arms. When a homebirth midwife follows these simple and practical standards and techniques, statistics on homebirth outcomes look very sweet indeed.

    Obstetric Myths Versus Research Realities by Henci Goer presents statistics gathered worldwide that clearly demonstrate the safety of homebirth with a trained attendant. Yet even though research has validated its efficacy, homebirth is still seen as unsafe. Cultural trends, an overzealous media, clever marketing, power mongering, rumors and fear perpetuate that view.

    A mother choosing a homebirth must, above all else, deeply desire to give birth at home. The most successful homebirthers are highly committed and trust their body's natural ability to birth. They devote time and energy to finding the right birth practitioner, doing their own research and taking care of themselves.Families that choose homebirth may be confronted by family members and friends who, conditioned by a society afraid of out-of-hospital births, challenge their decision, feeling it is both unwise and unsafe. Again, a strong inner commitment is required to stand up for the right to birth as the family chooses. Showing family members the evidence is sometimes helpful.

    Planning your Homebirth

    The first step in planning your homebirth is to find a provider that will suit your needs. This is important to do as early on in pregnancy as possible, as it will give you time should you not find anyone yet to support the idea. We are fortunate here in Aruba that atleast two of the four midwife practices here on Aruba, do homebirths. And atleast one does waterbirths as well. So finding a caregiver that will support your wishes are not an issue at all. It must be noted though that, if you are looking to have a HBAC ( home birth after cesarean) this will be a probable impossibility unless you are planning an unassisted home birth. When contemplating and searching for the "right" midwife for your homebirth you can ask questions such as :

    • What is your philosophy of birth?
    • What are your policies on homebirth?
    • How many succesful homebirths have you had so far?
    • How many failed homebirths have you had so far?
    • Would you consider me a candidate for homebirth? No, why not?
    • What equipment and back up plans do you have should a complication arise?
    • Do you have and maintain good communication with the Ambulance and hospital should the need arise to be tranported to the hospital in the event of an emergency?    

    These and other such questions will help you to asses whether you and your current midwife (because ob/gyn will never do homebirths) are on the same page.

    The homebirth Scene

    Homebirth allows for full participation of family members. Under the guidance and assistance of the midwife, husbands or partners have an opportunity to "catch" their child as it is born. These moments can be very powerful and transformational in the lives of the new parents.
    At homebirths, babies are usually placed on the mom's stomach or breast immediately, providing security, warmth and bonding between mom and baby. In the rare case in which the baby has difficulty breathing on its own, midwives are fully trained in infant CPR. Usually, putting the baby right to the breast and having mom talk to her baby will encourage it to take those first breaths.
    Putting the baby immediately to the breast also helps reduce any bleeding the mom may have. The sucking action stimulates the uterus and causes it to contract. This closes off blood vessels and reduces bleeding.
    After a hospital birth, things can get very busy, with bright lights and many people carrying out procedures on the baby. This can cause a baby to shut down or shy away from people.
    At home, on the other hand, there is time to be quiet, calm and peaceful. Those first moments are sacred-baby's special bonding time with parents. A new baby wants only love and nurturing. This early bonding allows the baby to relax and feel secure.

    What us Birth Advocates hear over and over again is about how "when you're in a hospital, if something goes wrong, your baby's life and your life can be saved". And while the fear of something going wrong and complications arising are very real, for a low-risk pregnancy the chances are very small. Think about it this way, Imagine you're in the hospital with your midwife and a true emergency arises in which you need a c/s. You won't get it right that minute. The hospital has to contact the surgeon, the anestesiologist and get everyone geared up and scrubbed in. By the time you're actually in the operating suite, it has been about the same time it would have taken you, your unborn child, and midwife to get to the hospital. In the instance of being in transport to the hospital after a failed homebirth, you're operating team is already in place ready to receive you and start working on you. Since Aruba itself is so small, it would not take the recommended 30 minutes from "decision to incision".

    Want to see studies on the safety of homebirth? Go here or here
    Of course there are a plethora of studies supporting planned homebirth, and I will post more next time. 

    Tuesday, October 20, 2009

    Aruba & VBAC / HBAC / VBAMC

    In the past few weeks, I've been doing some reading up on VBACs ( Vaginal birth after cesarean). I was spurred on to write a blog about Aruba's situation with VBACs, which I think is not much different than the U.S.'
    A friend of mine told me her birth stories of all three children and her subsequent fight to obtain a VBAMC (Vaginal birth after multiple cesareans) during her third pregnancy.I thought naively to myself, why she would have to go through so much trouble for something so natural. Then... I started making some calls to midwives and gynecologists.. and I found out why..

    As it turns out, Aruba's health care providers for pregnant women are against a vaginal birth after many cesareans. One told me quite frankly "It's just not a possibility". I thought, 'oh ok', then I went to look it up. What I found was nothing short of interesting. I was shown tons of studies and links to websites that support VBACs and VBAMCs.I had a mission then as I set out to see how far a mother must go to obtain her precious VBAC......

    This blog will take some weeks to complete as I have to sit with as many midwives and OBs to interview them and ask their thoughts and their policies. Stay pending!

    Sunday, October 18, 2009

    The Gill Rapley method & Baby-led weaning

    About two months ago I met and befriended a very interesting dutch woman. She and her family moved to Aruba and she became Pro Lechi Mama Aruba's newest board member. One night as we were driving together, heading toward our mother-to-mother support group, she was telling me about something I had never heard of before... the Rapley method. At first I didn't quite grasp it, but as she explained it more extensively I got it. And then, recall our daughters' play date together last month? Well, at that same play date, I saw the implementing of the Rapley method. My eyes grew wide with astonishment and amazement at an eight-month-old with barely a few teeth feeding himself and chomping down on avocado and watermelon cubes. Where's the puree? Where's the plate? Where's the little infant feeding spoon that I had in an array of colors at my home?? He sat in his adorable modern wooden high chair with his cloth diaper turned bib around his neck, and he so graciously picked up the dices of food and fed himself leaving only two pieces fallen on the ground next to him.

    I set out to look up this Rapley method that Noortje raved about. Noortje is a wonderful mother who looks up and does extensive reading and research into parenting strategies and what is fact against what is fiction. So when she told me about this new found method, I set out to look it up and help inform mothers about its benefits.

    Gill Rapley is the world authority on baby-led weaning. She worked as a health visitor for 20 years and has also been a midwife and breastfeeding counselor. She came up with an approach called Baby-led weaning, which basically entails, watching out for cues that your 6+ month-old baby is ready for solids. Not just puree "solids" but, solids diced up in cubes the size of a baby's fist, big enough to grasp and chew on. When people hear about a baby getting "big chunks" to eat, it sends a practically automatic panic-response to their brain which then signals them to tell you in a harsh tone "What are you doing?! The baby is going to choke!!" However, this method of infant feeding is actually more beneficial to the infant than if they were spoon-fed puree gulping babies. Why? Well, at the Rapley website there is an almost over-abundance of current up-to-date information on why this approach is far superior and should be the norm of follow-up infant feeding at 6+ months. Reading this for the first time, you may be wondering, ok, well how do I do this? What is involved? Are there guidelines? Yes there are! The below mentioned were taken from the webiste.

    Rationale for a baby-led approach to the introduction of solid foods
    1. Breastfeeding as the basis for self-feeding
    Exclusive breastfeeding is recommended for the first six months of life. Breastfeeding is the ideal preparation for self-feeding with solid foods. Breastfeeding babies feed at their own pace – indeed, it is impossible to force them to do anything else! They also balance their own intake of food and fluid by choosing how long each feed should last. And, because breastmilk changes in flavour according to the mother’s diet, breastfeeding prepares the baby for other tastes.
    Normal, healthy breastfed babies appear to be quite capable, with the right sort of support from their parents, of managing their own introduction to solid foods. However, although it is the self-feeding which characterizes breastfeeding that underpins the theory of baby-led weaning (BLW), many parents whose babies were bottle-fed have found that this method works equally well for them. The only significant difference is the need to ensure that the baby is offered drinks other than milk.
    2. Understanding the baby’s motivation
    This approach to the introduction of solids offers a baby the opportunity to discover what other foods have to offer as part of finding out about the world around him. It utilises his desire to explore and experiment, and to mimic the activities of others. Allowing the baby to set the pace of each meal, and maintaining an emphasis on play and exploration rather than on eating, enables the transition to solid foods to take place as naturally as possible. This is because it would appear that what motivates babies to make this transition is curiosity, not hunger.
    There is no reason for mealtimes to coincide with the baby’s milk feeds. Indeed, thinking of (milk) feeding and the introduction to solid foods as two separate activities will allow a more relaxed approach and make the experience more enjoyable for both parents and child.
    3. Won’t he choke?
    Many parents worry about babies choking. However, there is good reason to believe that babies are at less risk of choking if they are in control of what goes into their mouth than if they are spoon fed. This is because babies are not capable of intentionally moving food to the back of their throats until after they have developed the ability to chew. And they do not develop the ability to chew until after they have developed the ability to reach out and grab things. The ability to pick up very small things develops later still. Thus, a very young baby cannot easily put himself at risk because he cannot get small pieces of food into his mouth. Spoon feeding, by contrast, encourages the baby to suck the food straight to the back of his mouth, potentially making choking more likely. It appears that a baby’s general development keeps pace with the development of his ability to manage food in his mouth, and to digest it. A baby who is struggling to get food into his mouth is probably not quite ready to eat it. It is important to resist the temptation to ‘help’ the baby in these circumstances since his own developmental abilities are what ensure that the transition to solid foods takes place at the right pace for him, while keeping the risk of choking to a minimum.
    Tipping a baby backwards or lying him down to feed him solid foods is dangerous. A baby who is handling food should always be supported in an upright position. This ensures that food that he is not yet able to swallow, or does not wish to swallow, will fall forward out of his mouth.
    Adopting a baby-led approach doesn’t mean abandoning all the common sense rules of safety. While it is very unlikely that a young baby would succeed in picking up a peanut, for example, accidents can and will happen on rare occasions – however the baby is fed. The normal rules of safety while eating and playing should there be adhered to when the transition to solid foods is baby-led.
    4. Ensuring good nutrition
    Babies who are allowed to feed themselves seem to accept a wide range of foods. This is probably because they have more than just the flavour of the food to focus on – they are experiencing texture, colour, size and shape as well. In addition, giving babies foods separately, or in a way which enables them to separate them for themselves, enables them to learn about a range of different flavours and textures. And allowing them to leave anything they appear not to like will encourage them to be prepared to try new things. General principles of good nutrition for children apply equally to young babies who are managing their own introduction to solid foods. Thus, ‘fast foods’ and foods with added sugar and salt should be avoided. However, once a baby is over six months old there is no need (unless there is a family history of allergy or a known or suspected digestive disorder) to otherwise restrict the foods that the baby can be offered. Fruit and vegetables are ideal, with harder foods cooked lightly so that they are soft enough to be chewed. At first, meat is best offered as a large piece, to be explored and sucked; once the baby can manage to pick up and release fistfuls of food, minced meat works well. (Note: Babies do not need teeth to bite and chew – gums do very well!)

    There is no need to cut food into mouth-sized pieces. Indeed, this will make it difficult for a young baby to handle. A good guide to the size and shape needed is the size of the baby’s fist, with one important extra factor to bear in mind: Young babies cannot open their fist on purpose to release things. This means that they do best with food that is chip-shaped or has a built-in ‘handle’ (like the stalk of a piece of broccoli). They can then chew the bit that is sticking out of their fist and drop the rest later – usually while reaching for the next interesting looking piece. As their skills improve, less food will be dropped.
    5. What about drinks?
    The fat content of breastmilk increases during a feed. A breastfed baby recognizes this change and uses it to control his fluid intake. If he wants a drink, he will tend to feed for a short time, perhaps from both breasts, whereas if he is hungry he will feed for longer. This is why breastfed babies who are allowed to feed whenever they want for as long as they want do not need any other drinks, even in hot weather. This principle can work throughout the period of transition to family foods if the baby continues to be allowed to breastfeed ‘on demand’. A cup of water can be offered with meals as part of the opportunity for exploration but there is no need to be concerned if he doesn’t want to drink any. Babies who are formula-fed need a slightly different approach, since formula has the same consistency throughout the feed and is therefore less thirst-quenching. Offering water at regular intervals once the baby is eating small quantities of food is all that is needed to ensure a sufficient fluid intake. Continuing to give milk feeds ‘on demand’ during the weaning period will have the added advantage of allowing the baby to decide how and when to cut down his milk intake. As he eats more at shared mealtimes, so he will ‘forget’ to ask for some of his milk feeds, or will take less at each feed. There is no need for his mother to make these decisions for him.

    Many mothers that are reading this blog may already have read or heard or even done all of this. Why I'm writing it is because, in Aruba, there is a silent fear of a baby becoming malnourished if he isn't fed solids at the eve of his 6th month. This belief is perpetuated by stories of mothers who were arrested for refusing to give their babies nothing but breast milk which resulted in the child becoming severely malnourished. ( as the story goes, the "baby" that became malnourished was not actually a baby but a toddler of 2 years). Many Aruban mothers are paralyzed into believing that a 6-month or a 7-month-old baby must be eating solids already. I've heard horrific ( to me, but not to the mom) stories about 6 week-old babies being given soup, and 3-month-old babies being given bread and baby food. I'm horrified when mothers listen and blindly trust their pediatrician's advice to give their 4-month-old fruit puree ( a 4-month-old that suffers from horrible reflux).Mothers in Aruba must be told that a baby, especially a breastfed baby, does not consume solids at 6+ months because there is a sudden deficiency in breast milk. Actually, a breastfed baby's primary source of nourishment throughout their first year should be breast milk. Mothers who are hell bent on arbitrarily sticking to the American Academy of Pediatrics and many other sources' recommendation on when to start with complementary foods are setting themselves up for a big head-ache and a big mess. I've read and heard of countless mothers who listened and followed their  baby's cues on when they were ready to start solids. Some babies were even exclusively breastfed for 11 months inconsequentially. The baby did not become undernourished, or lacking in anything, the baby simply wasn't developmentally ready for solids. 

    I don't think there's anything wrong with listening to advice, but I'm a big believer in, if what you say sounds questionable, especially against my mothering-instincts, you better believe I'm gonna look it up and do some thorough research, and if what you say goes contrary to what I found, you better expect a hard copy of all the information I found.  Is this attitude wrong? Is this attitude disrespectful? Absolutely not. Mothers don't have to speak in a rude manner when addressing such topics with the baby's health care provider, but a mother must be firm, or else she'll be easily pushed and forced into believing that the practices that are "the norm these days, are the most beneficial". 

    Aruban Mamas..breastfeeding or not... enjoy and decide accordingly...

    Friday, October 16, 2009

    Birth practices of the early 1900s

    At the turn of the 20th century many experiments were being made on laboring women. Gynecology and Obstetrics took on a more sterile and stoic look. The natural was discarded for something controlled, for the metal and cold. In 1902, a German named von Steinbuchel introduced obstetrical analgesia and what became knows as twilight sleep, which is a combination of scopolamine hydrobromide and morphine sulfate. The method was considered successful if the mother remembered nothing about birth. Three American women wrote an article that was published in McClure Magazine in 1914 about visiting Germany and seeing women give birth safely and painlessly. In the same year, the Journal of the American Medical Association rejected twilight sleep because of its dangers. This action led to the formation of the Twilight sleep Association. This social movement organized rallies in major cities to demand that doctors accept this technique to end maternal suffering during labor. The Twilight sleep Association lost the interest of women and the press after negative reports on the use of scopolamine on newborn infants and the death of a well -known leader during childbirth.

    Twilight Sleep relied solely on amnesiacs (substances used to cause temporary amnesia). These amnesiacs produced in a woman a sort of "twilight sleep" from which she would awake with a baby and virtually no remembrance of labor except perhaps a vague concept of occasionally surfacing in a bad dream. The combination of scopolamine and morphine was most commonly used for this purpose. Unfortunately, many women suffered from delirium and hallucinations, necessitating close monitoring. Also, because infants were often depressed and with both the mother and baby sleeping for hours or lethargic after the birth, the mother-infant interaction that is so important in the development of a bond between mother and infant was negatively affected.

    Currently, amnesiacs are seldom if ever used. Their importance lies in that they shaped the view of labor by women and the public for a generation. That view lives on in the oral history of many families. For example, grandmothers who received scopolamine have no concept of finding their strength in labor or experiencing ecstasy; grandfathers may have sat down the hallway and listened to their wives scream for hours. These experiences may then shape the view of some of today's expectant parents through what families do or do not say about birth. The scopolamine era also contributed to the public's vision of an infant needing to be spanked at birth to breathe as compared with being warmly welcomed. Such imagines Live on in the public for generations after they are no longer a reality....

    Ask an IBCLC

    Our International Board Certified Lactation Consultant is Marlene Giel, a RN here in Aruba at The Horacio Oduber Hospital. She's been a L&D Nurse since 1995 and did her specialization in Obstetrics&Gynecology. She Graduated in 2002 from the Erasmus Medische Centrum Rotterdam. Always having had a passion for breastfeeding, she took on a new title that of Certified Lactation Consultant since beginning her studies in 2006. She is in the course of completing absolute certification for IBCLC.  

    Question: My baby finally got her first two teeth! But recently, she's gotten into the habit of biting me! Every time I have to nurse her, I become very anxious because she always ends up biting me! What can I do to make her stop? Is this her way of telling me she's ready to wean?

      Answer : Babies typically cut their first tooth between 6 and 8 months, and sometimes anywhere between 4 and 14 months.
    A bite from your baby can be painful and it keeps you tense in the fear that it will happen again. It's hard to relax and enjoy breastfeeding when your baby has bitten you.
    Babies who bite are seldom asking to be weaned.
    There are many reasons for a bay's biting, but the most common is teething. Other reasons could be a cold or an ear infection.

    Here are some ideas to help reduce and eliminate biting. Remember: THIS MAY TAKE PERSISTENCE ON YOUR PART. Your baby may not stop biting immediately but it will pass.

    - When your baby is latched on correctly and nursing actively, getting milk from your breast and swallowing it is then impossible for him to bite. This is because the baby needs to stop sucking in order to bite. When latched on properly and nursing, your nipple is far back in his mouth. In order to bite the baby has to adjust his tongue and allow your nipple to slide forward towards his teeth. When your baby is about to bite, try and watch for a moment. Often the tension in your bay's mouth will change just before this happens.
    - As soon as you notice this change, slip your finger into the corner of your baby's mouth, between his teeth, and let the nipple come out all the while keeping your finger in your baby's mouth to protect your nipple. Puling your baby straight off is a very natural response, but it may cause soreness on your nipple.
    - Baby's position is important, and that means helping your baby stay in a close breastfeeding position, so that he can't pull off very easily.So, pull the baby closer to the breast, at least momentarily. If your baby begins to position himself away from your nipple, be alert for a possible bite.
    - When the cause of the problem is a cold, a more upright position can help your baby to breathe easier.
    Your baby may breastfeed better if you offer the breast while walking.
    - Allow your baby to choose when to breastfeed. If baby is distracted and pulling off frequently, try breastfeeding in a darkened room or begin a new activity with the baby.
    If the baby is biting he probably is not hungry enough to nurse at that time.

    Send in your questions to Wendy Martijn on Facebook, or to my email and have your questions answered in next week's segment of "Ask an IBCLC"

    Wednesday, October 14, 2009

    A father's role in the breastfeeding relationship

    This morning as my husband and I awoke, he turned to me and said, "today's blog will go about fathers and breastfeeding". With the biggest grin on my face I rolled my eyes and accused him of mocking me and my blog. Then, with the most serious tone he said  "No! I mean it, talk about the father's role now!"
    I thought..'actually..I think I will'. So I proceeded to ask on my Facebook what people thought about the father/partner's role in this unique and close bond that a mother and child shares, i.e. breastfeeding. Here are some responses:

    • An extremely important role: one of supporter. W/o emotional support, it is easier to just give in to the taunts from formula-promoting family & friends.
    • My grandfather once told me that the best father to a child is one that loves the mother of his child. SUPPORT, SUPPORT, SUPPORT!!
    • A big role! It is not just a mother/child bond, you've become a family now.The father is essential in providing mental as well as practical support. I would have never been able to continue breastfeeding for so long without Xander's help.I frequently hear fathers (and mothers) saying that a man cannot help much when a mother chooses to breastfeed, because they themselves cannot breastfeed the child, but nothing is further from the truth! Dads can change diapers, bathe and cuddle with the baby and provide mom with moral support! Breastfeeding (in our case) was a family affair.
    • I like the role my DH plays, if I don't wake up when our baby's hungry, he puts the babe to the breast. Who says dad can't help in breastfeeding! Showing appreciation for doing what's best, and freeing me up doing chores while I'm busy feeding too.

    Many a fathers express becoming "invisible" or even useless because the majority of the new mother's and baby's time is spent breastfeeding. Especially during the first tumultuous weeks of getting the hang of breastfeeding, a father can feel like the "servant" having to hurry and fetch a glass of water while mom is nursing, or pick up the older children from school, because mom is busy nursing, or cook because mom is too busy getting a fussy baby too latch on.Dads do well to understand that breastfeeding a newborn, be it the first second or third time around, will always remain time consuming particularly in the postpartum period. So what can fathers do to feel like they are still a "legitimate" and contributing part of the family unit?

    Even the baby that breastfeeds very frequently can enjoy a satisfying relationship with his father. Try letting your full breastfed baby lie on her father's chest. Rocking baby on the father's shoulder is often a favorite activity. Many fathers find rewarding times with baby by showing the baby this big, wide world we live in!

    The support of a baby's father can help the breastfeeding relationship succeed. The father can head off discouragement, deflect negative comments from friends and relatives, help calm a fussy baby and bring the new mother food and drink while she is breastfeeding. Most importantly the baby's father can remind the new mother that breastfeeding is one of the most important things she can do to get their baby off to a good start in life.Especially in the first few weeks, when lack of sleep and hormonal changes can sometimes make new mothers waver in their determination to breastfeed, a father who suggests, "let's try that one more time," or who reminds his partner that, "they say babies space out their feedings after the three week growth spurt," can be invaluable.

    "Babies benefit just as well from close, personal and warm shirtless affection from dad too! This can be a crucial aid in helping babies "connect" so to speak, with their dads and learn to recognize him quicker than just by his voice"

    Many times, mothers and fathers underestimate the essential role of the partner. As the aforementioned demonstrated, a father's presence and support is one of the biggest determining factor on whether mom continues to breastfeed. What I find so lovely is when I do house visits by mothers experiencing breastfeeding problems, I sometimes hear "the baby's father said I must persevere with breastfeeding". This is not a harsh, domineering stand, rather it is a much needed "pillar of support" that comes from the man's side. These moms experience relief of having their partners back them up and may give them added determination when problems threaten the breastfeeding relationship.This is not to say that if you don't have a husband/partner or if your husband/partner is anti-breastfeeding you're doomed to fail ... not at all! I brought my daughter up in my parent's house as a single mother and my father was pretty much anti-breastfeeding. When guests would come over, I would have to go nurse my daughter in my room. Still... undeterred, I continued. There were some incidents where, when we were out in a restaurant and my daughter wanted "mum-mums", I was forced to go in the bathroom and nurse her. I sat there nursing her in the restroom with tears rolling down my cheeks, but I knew I was doing what was right and not just what was easy. 

    So... what can dads do then? Like was mentioned, moral support and encouragement in the face of difficulties with breastfeeding. Dads can also provide much needed relief and help with older children and/or household chores. Perhaps baby is fed and still fussy and mom needs a well-deserved nap, formula for success? Baby + Sling+ vacuum cleaner's white noise = Rest for mom, bonding time for dad and baby, calm fussy baby, and a clean house. My colleague had such a supportive husband that, when she had gotten sick after a few weeks after the delivery, during the "night shift", when it was the baby's time to nurse, the husband would get up, change the baby's diapers and latch the baby on to her breast to nurse. Wow! Kudos Geraldine...

    Note : I don't recommend these types of baby carriers, but you get the point of the picture..

    One other very important point I want to emphasize is skin-to-skin contact for father and baby. When we hear and talk about the benefits of skin-to-skin contact after birth, all we hear or may think of is mom and baby. But babies benefit just as well from close, personal and warm shirtless affection from dad too! This can be a crucial aid in helping babies "connect" so to speak, with their dads and learn to recognize him quicker than just by his voice.As was mentioned in a post last month, skin-to-skin with dad too, helps stabilize baby's temperature and breathing pattern. In the latest Mom & Baby issue, they point out that a father's touch is more "rough" and hands on, because fathers tend to be more physical and engage in more touching and bouncing up and down kind of play, whereas a mother's touch is more gentle and her focus is more on engaging in speech such as cooing and humming. So dads! Don't despair! Your presence is important and certainly appreciated. After breastfeeding has become firmly established and mom gets back on her feet ( to some extent),you will definitely see the fruit of your arduous labor.

    Note to mom
    During the postpartum period, hormonal changes and breastfeeding problems can claim your patience and at least 3/4 of your sanity. If you have older children, double that. It may become easy to let tempers and emotions flare and get entangled in heated arguments. Even though fathers do not give birth, they too go through the postpartum period, especially  if it is his first child. Dad is also trying to navigate through the winds of change and is basically threading on unfamiliar ground. He may be unsure of himself and this in turn may manifest itself as a "lack of interest". Give dad his own time and space to let him figure out what kind of dad he is. Give him the opportunity to display that he is just as hands on as you thought he would be! Instead of leaning over his shoulder and critiquing his every "mistake", offer sincere commendation and show your appreciation for whatever effort he displays, be it much or little. Tell him something to the effect of "You're so good at calming the baby when he's in his all-out crying fit!" "I definitely learned a thing or two from watching you bathe the baby!". These comments play up on their soft nurturing side while still letting them be true to their manliness. It lets them feel that they are getting it right.

    Frankson, you are a wonderful exemplary father....

    Monday, October 12, 2009

    Co-sleeping,Bedsharing, or putting baby to sleep in the nursery... Which do I choose?

    Many a mothers, grandmothers, fathers, aunts, doctors,and pediatricians feel strongly about this topic : Bed sharing/ co-sleeping / baby sleeping in their own room. I asked on my Facebook what people thought of this. What guided them to make the decision that best suited their circumstances.

    Let us first define for clarification what is :

    Co-sleeping :Baby in the same room/ in a side car attached to the adult bed
    Bed-sharing: Sleeping in the same bed as mother
    Baby sleeping in their own room : Self explanatory

    Here are some responses :

    • In the same room is Ok but I think in the same bed could be not safe. New mom's are so so tired and a little one could suffocate easily.
    • I couldn't imagine not sleeping with my little ones. I've co-slept with all three from birth. There are ways you position yourself to make it impossible to turn over.....and when nursing you are so in tune to your baby, you know when they are moving around and just roll over to nurse. Both mom and baby sleep better and babies are able to thrive. I think it's one of the most important things for mom and baby especially.
    • Well, one thing I do know is that once you let the baby sleep next to you in your bed, he will want to sleep that way well into his childhood, but then again, sleeping in the same room would also be conducive to baby waking up and parents putting the baby back to sleep in their bed.
    • we love sleeping with our baby!!! it's easier to breastfeed through out the night,u just put her on in the sideways position and fall asleep next to each other and she's more likely to stay asleep all night that way instead of in her crib..... i know i couldn't put my baby in a seperate room I wouldn't be able to sleep all night, even if she's in her crib beside my bed i don't sleep cause I keep peeking in to see if everything's ok!  but of course, i don't recommend sleeping with your baby if you know you move a lot and could possibly roll over your baby!
    • Co-sleeping if you have only a queen bed. Especially if you like a lot of space. Though I often found myself accidentally bed sharing because I would fall asleep while nursing and not wake till the next nursing session.

      I've heard so many people say  "I know a mom/dad who put their baby in their bed to sleep and rolled over on the baby" . Or you hear " There was this mom who was nursing her baby at night in her bed, and her breast smothered the baby and it died". While these accidents are sad and true and it certainly cannot be excluded that these things can happen when you bed share with your infant, how many incidents are there out there about a baby dying in their crib because the blanket that was not supposed to be there suffocated or overheated the baby, or the stuffed animals that don't belong in the crib to begin with, smothered the baby when they rolled over on it. Or the newborn infant that was put to sleep alone in his crib, crying his eyes out to no avail of getting their sleeping parents' attention and died in the middle of the night.These are accidents that occur but are conveniently not peddled around

      But now you must wonder, what do the statistics say? What does the current evidence available prove? All you hear from the American Academy of Pediatrics is, no bed sharing, bed sharing bad, bed sharing NO NO. Here are the facts - just the facts.

      Statistics taken from a friend's blog : 

      The Consumer Product Safety Commission (CPSC) and the Juvenile Product Manufacturers Association (JPMA, the crib manufacturers' lobby) recently launched a campaign to discourage parents from placing infants in adult beds or sleeping with them, based on data showing that infants have a very small risk of dying in adult beds.1,2 The CPSC implies that infants in adult beds are at greater risk than infants in cribs, but as we know, and as they know, babies also die in cribs. What we need to do is calculate the relative riskiness of an infant sleeping in an adult bed versus a crib. We can do that by dividing a measure of danger for each situation by the prevalence, or frequency, of that situation, and then comparing them. (Oddly, the CPSC never presents relative risks.) Using government figures, we can perform a rough calculation to show that infants are more than twice as safe in adult beds as in cribs. This is aside from the many other advantages of co-sleeping or bed sharing, such as increased breastfeeding and physiological regulation, the experience of having slept well, parents' feeling of assurance that their child is well and happy, the enhanced security of psychological attachment and family togetherness, and family enjoyment.3
      Let's begin by looking closely at the CPSC data. The anti-cosleeping campaign is based on a dataset that contains the 2,178 cases of unintentional mechanical suffocation of US infants under 13 months old for the period 1980 to 1997. CPSC-authored articles about these data reflect only the small portion of deaths that occurred in adult beds.4 However, these data also have been published with summaries of the cause-of-death codes on all 2,178 cases.5
      Of these 2,178 infant suffocation deaths, we are certain of only 139 occurring in an adult bed. For 102 of these, we know that a larger person (presumably a sleeping adult) was present, because the cause-of-death code is "overlain in a bed." That does not tell us exactly what caused the death-that is, whether the baby died and then was lain on, or died as a result of being lain on. We can assume that the 37 deaths involving water beds occurred in adult beds, since few child water beds exist. That gives us a total of 139 infant suffocation deaths known to have occurred in adult beds in these 18 years.
      The same data show that 428 infants died due to being in a crib. It is likely that there were preventable risk factors (such as using a crib in need of repair) involved in these crib-related deaths. But that doesn't change our calculations, because the deaths did occur. Similarly, our calculations do not change due to the preventable risk factors (such as intoxication) involved in adult-bed deaths (and other overlying). Note that advocates are raising public awareness to increase the safety of both these sleeping arrangements, with the hope that all these deaths will decrease.
      We can't use the other 739 bed- or bedding-related cases in our analysis, because the place of death is not specific enough; these deaths may have occurred in a large adult bed, a single-size adult bed, a child's bed, or a misused crib. Nor can we include the remaining 760 deaths, as we have no idea whether they took place in a sleep situation at all. We also know nothing about the presence or absence of an adult, although a nearby, aware caretaker could have prevented many of these deaths.
      So for only 567 (139 plus 428) of the deaths do we know whether they took place in an adult or infant bed. Thus, from 1980 to 1997, 75 percent of the mechanical suffocation deaths of US infants with a known place of occurrence took place in cribs, while 25 percent took place in adult beds.

      While it is tempting to make the observation that three times as many babies died in cribs as in adult beds, if three times as many babies were actually sleeping in cribs as in adult beds, the risk would be the same in either place. Based only on this crude death-certificate data, we do not know which is safer. We still need to know how many babies were actually in adult beds or cribs-that is, an estimate of how common co-sleeping was.
      To estimate co-sleeping prevalence, we can turn to the CDC's Pregnancy Risk Assessment Monitoring System (PRAMS).6 PRAMS has been surveying mothers of infants, usually between two and six months of age (but occasionally up to nine months), since 1988. Approximately 1,800 new mothers are sampled each year in each participating state. The sample is rigorously selected to represent essentially every birth in the state, and the response rates are high (70 to 80 percent). Most of the 100 or so PRAMS questions involve prenatal and well-baby care and stressors.
      States have the option of adding their own questions and have asked about co-sleeping. The basic question asked is, "How often does your new baby sleep in the same bed with you? Always; Sometimes; Never." (Some states add "Almost always.") PRAMS data, therefore, can be used to ascertain co-sleeping prevalence in participating states and may be the only data of this kind.
      From 1991 through 1999 (the most recent data available) we see that roughly 68 percent (100 percent minus the 23 to 43 percent who "never" co-slept) of babies in these states enjoyed co-sleeping at least some of the time. Data from the United Kingdom are similar: Helen Ball's Sleep Lab found that around 7 percent always co-slept, 40 percent did so for part of the night, and 33 percent never co--slept.6
      Now let's try to estimate a single co-sleeping prevalence rate from these data. Let's say that babies who "sometimes" co-sleep do so about half the time. Over all the years of this sample, around 42 percent of babies co-slept "sometimes." Let's also say that "always" or "almost always" means 90 percent of the time. Roughly 26 percent of infants co-slept "always" or "almost always." Adding "always/almost always" (90 percent of the time x 26 percent of babies) to "sometimes" (50 percent of the time x 42 percent of babies), we get 44 percent of babies ages two to nine months who were co-sleeping at any given time, presumably in an adult bed.
      Now we can use these figures based on CPSC and PRAMS data to calculate the riskiness of these two sleep arrangements, although it's important to understand the limitations of doing so. For example, these PRAMS data are from only five states (although more will be available in the future), while the CPSC data are from the entire US. The years in which the PRAMS co-sleeping data were collected are not the same as those covered by the CPSC dataset, although they overlap. The CPSC covers infants zero to thirteen months, while PRAMS asks about infants two to nine months. The CPSC collects demographic details such as state, income, race, and age of mother (as does PRAMS), as well as time of the death, but they are not easily available to do a more detailed analysis. One or both of these data sources lacks information on impairment of caretaker and other known sleep risk factors, exact sleeping and furniture arrangements during different times in the night, overcrowding and other motivation for co-sleeping or crib sleeping, clinical pathology findings, previous health of the infant, etc. Plus, a complete risk analysis should include all causes of infant deaths, including SIDS.
      Nonetheless, these data are important population-based sources of information on sleep risks that we would not have otherwise. So let's go ahead and use them to estimate a risk ratio for co-sleeping. We take the 25 percent of the suffocation risk in the CPSC data linked to being in an adult bed and divide it by the 44 percent of babies who were actually in adult beds. Then we divide that fraction by a similar fraction for cribs, i.e., 75 percent divided by 56 percent. (If we multiplied each of these fractions by an overall infant death rate, we would have the actual risk for each group.)
      This result shows that it was actually less than half (42 percent) as risky, or more than twice as safe, for an infant to be in an adult bed than in a crib. Based upon these calculations using the CPSC's own data, we can say that crib sleeping had a relative risk of 2.37 compared with sleeping in an adult bed.

      As we have read, bed sharing is not as un-safe as many deem it. However, when bed sharing, all the safety pre-cautions should be followed, such as, not smoking, or letting anyone sharing the bed smoke. Do not let the baby bed share with a person who is substantially obese, nor one who is taking any medications that cause sleepiness. Avoid loose bedding and fluffy puffy comforters as these may increase suffocation in the infant. Keep all pillows and pillow covers away from the infants face and body. (Yes, you can still sleep on a pillow)

      When a child is placed in their crib to sleep, this does not automatically exonerate them from all suffocation and SIDS incidents. Safety precautions should also be followed closely : Avoid covering the baby with a blanket. If room temperature is too cold, try either lowering the temperature or adding more layers to the baby's sleep-wear. A sleep sack is also a genius invention that allows you to "cover" your baby with a "blanket", so to speak, that will not even have the possibility of covering their face. I myself, co-slept with my daughter, she in her crib and I in my bed. I always put a blanket on her because the temperature was always very cold in the room. One night, for some reason I awoke to find the blanket on my daughter's face... in horror I quickly grabbed and pulled it off of her, and I swore to never use a blanket to cover her again! That was a close call and I hope it serves as a warning to all the moms reading this blog.

      Personally, I am against putting babies (especially under the age of one) to sleep alone in their room. There are so many benefits when you have your baby sleep next you to in a side car or on your bed. As was mentioned before, the baby's temperature and breathing pattern is regulated because the baby will mimic its mother's breathing. Many a moms note that when their babies sleep in their bed with them, even though they are in the deepest stage of sleep, they can feel and are keenly aware of any movement that the baby makes. Moms have this subconscious awareness of their baby. And because of this, it is implicated that babies can wake more easily from a prolonged apnea (episode when the breathing stops) which in turn, prevents and protects the baby from SIDS.Best of all, bed sharing, or having the baby in a side care attached to your bed, facilitates night time nursing, especially for moms with newborns that need all the sleep they can squeeze in.

      What's the conclusion of this article? Let the well-informed minds of each one of you make the decision based on facts, that best suites your situation.