Parenting & New Baby Advice Blog

Archive for November, 2007

The most important thing you can do to prepare for breastfeeding is to learn all you can about it. There are many good books that discuss breastfeeding exclusively. They range from “how to” manuals to those that discuss the benefits and the more technical aspects of breastfeeding.

You should discuss your decision to breastfeed with those who are important to you. It is much more difficult to succeed if your husband, parents, or children don’t understand why you want to breastfeed your new baby. A young child may be concerned that his new brother or sister is actually hurting you. Your other children may become jealous of all the attention you are giving the new baby. Preparing them for what’s to come will make it easier.

Some men become jealous of the new baby, and breastfeeding may make matters worse. Discussing your decision ahead of time is one way to lessen the feelings. Making the father a participant in routine baby care is important.

Learning the Techniques of Breastfeeding

There are still many misconceptions about breastfeeding. Many women find it frustrating if they don’t breastfeed easily and instinctively- they don’t realize that they need to learn the best way to breastfeed. Years ago, women would learn breastfeeding techniques from their mothers, older sisters, and other women who were breastfeeding. This isn’t as likely to happen today. Chances are reasonably good that your mother did not breastfeed you, so she can’t readily help you with your own breastfeeding.

Classes in breastfeeding techniques are available. Organizations such as the La Leche League offer support and encouragement for women having problems with breastfeeding. If you should experience remember that the treatment for most breastfeeding problems is to continue breastfeeding. Rarely does stopping help the problem.

Getting Started

Most women are now offered the opportunity to breastfeed their newborns shortly after giving birth. Unless you are so exhausted from the delivery that you can’t stay awake, you should try nursing your new baby as soon as possible. Often this is done on the delivery table. Don’t be discouraged if your baby isn’t interested-remember that he has been through a tough and tiring process, too. He may be too worn out to be interested in feeding. Don’t take this as a rejection. Some women’s breasts don’t seem to have milk in them right after the delivery; don’t be discouraged-your milk will come in. Feel free to ask questions of your doctor or obstetrical nurse about breastfeeding. Very few new mothers cannot breastfeed. Most who feel they have to discontinue just give up to soon. As mentioned before, the best treatment for most breastfeeding problems [for example, blocked ducts or insufficient milk supply] is continuing to breastfeed.

When you start, your nipples may be a little sore. This is natural; they aren’t accustomed to this type of work and need some time to “toughen up.”

Breastfeeding and Your Diet

You need about five hundred calories a day more than your pre-pregnancy intake if you are breastfeeding. These additional calories, plus the calories from the three to seven pounds you stored in pregnancy for lactation, supply enough calories to make milk.

Once you reach three to seven pounds above your pre-pregnancy weight [including two to four pounds for the weight of your lactating breasts], let your weight be a guide to the number of calories you consume each day. Your activity level and the amount of milk you are producing for baby will affect your weight.

In addition to extra calories, your breastfeeding diet should include extra protein for milk production, more calcium-rich foods, more vitamins, and more fluids than your normal diet. Here are some simple guidelines:

• Continue to take your prenatal vitamins [unless your doctor tells you otherwise].
• Drink more milk than when you were pregnant [drink about five glasses a day]. If you have a milk intolerance problem, calcium supplements may be necessary. Let your doctor advise you on this.
• Eat a balanced, good quality diet.
• Pay special attention to fluids, making sure you drink enough to quench your thirst.
• Avoid junk foods and “empty” calories.

Are you prepared for feeding your baby? Better stock up on baby bibs and all the essentials!

Our attitudes towards pregnancy and childbirth form over a lifetime shape by the values and beliefs of our families and our culture. The way a baby is born reflects not only personal and family beliefs, but also, the prevailing cultural attitudes.

Since the turn of the century, the ways of birth has undergone continuous change, as has society itself. When you talk to your mother and grandmother about childbearing beliefs and practices when they were having children, they probably will not tell you it was wonderful in the good old days. Most people believed that childbirth today is better managed than it was one or two generations ago.

In looking back, we see that until the mid-1930’s childbirth was truly dangerous. High percentages of women and their infants died during or soon after childbirth. Determined to correct this persistent problem, organized medicine took many steps to lower mortality rates.  A new medical specialty called obstetrics, was founded, and an aggressive effort was made to eliminate risky practices [for example, lack of cleanliness and infection control, and overuse of drugs to speed up labor and obliterate pain] and to improve the training of physicians. Prenatal care also gained recognition for its benefits in preventing death. Childbirth moved from home to hospital with the promise of more efficient and controlled conditions for birth.

With these efforts, along with general improvement in public health [for example, improved working conditions, public sanitation, family nutrition, and better control of some chronic illnesses], came a reduction in the danger of death in childbirth.

The 1940’s brought such advances as antibiotics and blood banks, as well as improvements in surgical techniques and anesthesia, which further increased the safety of childbirth.

But by the 1950's, routine maternity care originally designed to improve safety, had become almost too rigid; for example, the fear of infection, a major killer of mothers and babies, led to such practices as taking away all a woman’s personal belongings when she entered the hospital, shaving all hr pubic hair, administering large uncomfortable enemas, prohibited fathers and other love ones from entering the maternity area, keeping babies in nurseries away from their mothers, and handling babies as little as possible. Bottle-feeding was believed more sanitary and superior in almost every way to breast-feeding.

In addition, heavy use of pain medications took away mother’s ability to control their behavior and to understand and remember labor. They often remained drugged and sleepy for hours or even days after birth.

In response to these hospital routines, women protested that such practices were not necessary or beneficial; and they began seeking other, more satisfying ways to give birth. Fortunately, concerned and enlightened joined them in their quest.

Thus began the natural childbirth movement and the movement of toward family centered maternity care. The 1960’s was a time when national and international organizations were founded to make these changes. Women and men wrote and read books describing more humane, satisfying ways to give birth to their little infant gifts. Mothers attended childbirth classes, involved their loved ones in their support and care, breast-fed their babies and spent more time while in the hospital caring for their babies.

These improvements in care and safety have continued until the present. As the individuality of each woman was recognized, so was the uniqueness of each labor. It became clear that not all women need or want the same kind of care.

The 1970’s saw the re-emergence of the mid-wife as a popular and trusted caregiver for healthy women wanting more participation in their own care, more emphasis on prevention of problems, and more recognition of their emotional needs. This was also the time when alternative settings for birth-at home, or in a birthing center-surged in popularity.

Hospitals also joined the ranks, offering more flexible family-centered care and more comfortable home-like rooms for birth. The role of the physician changed from being in complete control of the birth to being more sensitive and responsive to each woman’s needs and wishes.

All this is to say that today there are many different approaches to maternity care. There is no single correct way. In this chapter we will describe and discuss many of these choices to help you decide what kind of care you think will be best for yourself during your pregnancy and birth.

Informed Consent

There is one concept that you should understand because it is an important principal underlying health-care in the United States, and Canada today. The legal concept of informed consent designates the patient as the decision maker in medical care.

What is informed consent? It means simply that a patient understands and agrees to any treatment or procedure that is done for medical purposes. Her care-giver is legally responsible for giving her full information about any procedure before her consents to it. This is because there are often risks as well as benefits associated with medical treatments, and the patient [who has the greatest stake in the decision] has the right and responsibility to decide whether the risks are worth taking.

The principles underlying informed consent are really the features of any good relationship between patient and physician. Discussion, understanding, and agreement are the hallmarks of optimal care. Many of us, however, feel we do not know enough to have an intelligent discussion with our caregivers, and are a little insecure trying to do it. There is no need to feel that way, however, and the following general guidelines for discussion may give you more confidence in discussing your care.

1.        If your care-giver [doctor or midwife] suggests a test, a treatment, or procedure, the first thing you should know is why.

a.      Is it because you have or may have a problem? If so, what is the problem, and why does it need to be detected and treated? How likely is it that you have the problem-one chance in ten? In a hundred? In a thousand?

b.      Is it a routine procedure or your care-giver always uses? Why?

2.        Then you want to know about the procedure itself. What is it, how is it done, and what does it cost?

3.        What are the benefits and advantages of the test or procedure and how will the results influence your care-giver’s management? In other words, what will happen next if a test result is positive or a procedure or a treatment is done?

4.        What are the risks and disadvantages of the test, procedure or treatment? How reliable or successful is it? Is it painful? What problems can it cause and how often?

5.        What are the alternatives to the test, procedure, or treatment [including doing nothing]? The risks and benefits and the advantages and disadvantages or the alternatives should be discussed also.

When you have discussed these issues, then you can make an informed decision.

All this may seem very complex and time consuming. It occasionally is, especially if it is a major procedure or you have a serious condition. Usually, however, this kind of discussion is fairly straightforward and not to time consumed, especially when care-givers are in the habit of informing their patients or clients as they go along, discussing what they are doing and why.

Of course, there are situations when it is not possible to become fully informed. If a mother is in an emergency situation, or if she is unable to comprehend the facts due to medication or illness, then a family member is consulted for consent or the care-giver simply does the procedure because of the need for speed.

The concept of informed consent is based on the principle that you have not only the right but the responsibility to make decisions regarding your care. This is not to say that you have to make these decisions all by yourself. Besides asking your care-giver what he or she thinks ought to be done, consult family, friends, consumer groups, childbirth educators, or other care-givers for help.

By choosing your care-giver and the place where you will give birth, you will have made the two choices that will most greatly affect your birth experience. Besides those, however, there are others that also make a big difference. For example your choice of childbirth classes will influence your feelings of confidence and readiness as you approach the birth and early parenthood. So put the itty bitty adorable baby clothes aside, and take a second to consider taking a childbirth class.

The idea of formal classes to prepare women and their partners for childbirth came to North America in the early 1960’s when the work of Grantly Dick-Read, an English obstetrician, became publicized. Dick-Read was the real pioneer of natural childbirth techniques in the Western world. As a young man in the 1920’s and 1930’s, he presented a new approach to childbirth management. He used education, relaxation, slow abdominal breathing, and caring labor support to combat the three-way cycle of fear, tension and pain that fed on itself and escalated during labor to the point where the woman had to be heavily medicated. His belief that childbirth pain is unnatural and unnecessary guided him in the development of the Read method.

In France in the 1940’s and 1059’s, Fernand Lamaze developed another quite different system of childbirth preparation, which was widely practiced in France and later in North America. Lamaze called his method psycho prophylaxis-literally “mental prevention”. He emphasized complex distraction methods and the dominant role of a professional “couch” to reduce a laboring woman’s pain.

Both the Read and the Lamaze methods thrived, although there has always been some competition and rivalry among proponents of the two different methods. They thrived because they appeared at a time in our history when many women were heavily drugged and unconscious through labor and delivery. These methods of “natural” childbirth appealed to women who wished to be more in control during labor.

Childbirth education has evolved over the years, with major modifications contributed by prominent childbirth educators and obstetricians. Among them is Robert Bradley, the American obstetrician who brought the father into the birth situation as a labor couch. Fathers had traditionally prohibited from attending births, but Dr. Bradley felt not only the father’s presence was his right, but also that his role as labor couch was an appropriate one for him to play helping his wife through the labor process.

Sheila Kitzinger, A well known British anthropologist and childbirth educator brought a woman’s perspective to childbirth preparation emphasizing body awareness. Innovative relaxation techniques and breathing patterns will harmonize the intensity of a woman’s contractions. Rather than distracting the woman from her labor pain, Ms. Kitzinger said that labor pain is nothing to fear; it is pain with a purpose. By accepting her pain and working with it, a woman can cope successfully and reap great psychological rewards from her active participation.

The popularity of natural childbirth led to the founding of several national and international organizations devoted to promoting family centered maternity care, parent participation in childbirth, and childbirth education classes. The International Childbirth Education Association, [C.F.A.] the American Society for Psycho prophylaxis in Obstetrics [A.S.P.O.], and the American Academy of Husband-Coached Childbirth [A.A.H.C.C.] were founded in the early 1960’s to give parents a greater voice in maternity care. A closely related issue, the promotion of breastfeeding, became the cause of La Leche League International [L.L.L.I.], also founded in the early 1960’s. These organizations and others contributed to effective change in maternity care in favor of more consumer involvement and choice.

In the 1070’s, Dr. Frederic Leboyer drew our attention to the newborn baby and what he or she goes through during the birth process. He promoted “birth without violence”, or gentle birth. He said that the baby should be helped to a gentle and calm transition from life in the uterus to life outside the mother’s body. He advocated a warm, quiet room with dim lights for the birth and a warm bath for the baby shortly after birth.

Also during the 1970’s, the term “bonding” was coined after it was discovered that when newborn babies stayed with their mothers for extended periods of time, the behavior of the mothers seemed to be more loving and maternal than that of mothers whose babies spent more time in the nursery. The work of Leboyer and others focused the attention of parents and caregivers on the early care of the newborn and early introduction between parents and newborns.

In the 1980’s, investigators with training in psychotherapy focused on the heeling potential [and, conversely, the attention for emotional trauma] of the profound experience of childbirth, and incorporated counseling and stress reduction measures into childbirth preparation. Some have urged more spontaneity and less emphasis on intellectual preparation and prescribed responses to labor contractions. Childbirth education continues to evolve as we learn more as people’s taste’s change and as maternity care changes.

Finding the right childbirth classes for you may require some comparison shopping. Some classes only teach one method [Lamaze or Bradley, for example]. Others provide a broader, more individualized preparation, drawing from these methods and other innovations to provide a framework of relaxation techniques, patterned breathing, massage, visualization, music, sound, and other pain reduction methods, along with guidelines for adapting them to suit the individual. The goal of these classes is to enable women and their partners to discover their own style for labor.

Many communities have independent, consumer-based childbirth education groups that provide classes. Most hospitals and some groups of physicians or midwives also sponsor childbirth classes for their patients or clients.

When you become pregnant or suspect that you are your first decision will be what care-giver to go to [the word care-giver refers to a person-physician or midwife-who cares for pregnant and laboring women]. This decision is more important than most people realize. Care-givers may differ vastly in their philosophies and beliefs about pregnancy and birth and in their level of skill. This section provides a description of the specialists who provide maternity care and the type of care after. You will also find a list of questions to ask as a way to help you decide if a care-giver will be right for you.

Physicians

Medical doctors [those with a Doctor of Medicine or M.D. degree] provide most of the maternal care in North America. All medical doctors have completed college and medical school; most have further residency training. Those who care for pregnant women specialize in perinatology, obstetrics and gynecology, or family medicine.

Obstetrician-gynecologists provide most of the maternity care in the United States, while in Canada it is the general practitioners and family physicians. In order to become a specialist in obstetrics, a physician has to pass a board certified examination administered by the American College of Obstetricians and Gynecologists or the Royal College of Obstetricians and Gynecologists in Canada.

The most highly specialized obstetrician is the perinatologist. Beyond medical school and obstetrics residency, the perinatologist takes further training in the care of high-risk pregnant women, those who have underlying illnesses, such as diabetes, heart disease, and high blood pressure, and those who have complications during their pregnancies or who had complications with previous pregnancies. Perinatologists tend to practice in large cities. Most of their patients are referred to them with complications requiring not only their special expertise but also the facilities of a large hospital with all the latest technology.

Family physicians care for pregnant women as well as other family members, from infancy through old age. They tend to refer difficult maternity cases to obstetricians or perinatologists. While the family physician is the practitioner who provides most of the maternity care in Canada, the number of family physicians in the United States who provide maternity care is relatively small and seems to be decreasing.  People who choose family physicians for their maternity care appreciate the fact that the physician can take care of them throughout pregnancy and birth and then continue to care for the baby and family members.

Osteopathic physicians [those with a Doctor of Osteopathy or D. O. degree] also provide maternity care and care for the entire family. Osteopaths differ from medical doctors in training and practice and have about the same legal scope of practice.

Midwives

The other large category of care-giver is the midwife. In many countries of the world, midwives are the primary care-givers for pregnant and laboring women. In North America their place is not as well established. All states have provisions for the legal practice of midwifery. In Canada, most provinces have active midwifery promotion groups who have made significant efforts in establishing midwifery as a legal form of maternity care.

The emphasis of the midwife’s training is that birth is a normal physiologic event. They learn methods for supporting and promoting women’s physical and emotional health to optimize the reproductive process. The care they give consists of thorough physical assessment and prevention of complications through education in self-care, emotional support and nurturing of the woman throughout her pregnancy and labor. Midwives do not care for women with complications of pregnancy, underlying illnesses, or other high risk conditions. Should any of these problems arise; a midwife will refer the woman to an obstetrician.

Within the broad category of midwife, there are several subcategories. In the United States certified nurse midwives are the most numerous. They are registered nurses who have taken additional one or two years of training in midwifery. Many receive master’s degrees when they complete their nurse-midwifery training. They usually practice in close cooperation with physicians in hospitals, birthing centers, and the home setting. Nurse-midwives are certified after passing an examination administered by the American College of Nurse-Midwives.

In some states other types of midwives are recognized and are licensed to provide maternity care. Licensed midwives practice in at least seven states. They receive training that is more compatible with that in midwifery training programs in Europe. They are called direct-entry midwives and do not necessarily possess a background in nursing. They usually have received some college education followed by a two or three year program in midwifery training. At present most midwives practice outside the hospital providing care for home-births and birthing center births. Their orientation and pattern of care are similar to those of nurse-midwives.

In addition, lay midwives, sometimes called empirical midwives, practice in a number of states. Most of them have received informal training-apprenticeship to an experienced midwife, participation in short courses or study groups, or extensive independent study. Their qualifications, experience and standard of care vary; some practice within the law, and others practice without legal sanction. Lay midwives emphasize the spiritual aspects of birth, as well as the physiologic and psychosocial.

If your midwife goes above and beyond the call of duty, don't forget to send her a little thank you gift to show her how much she is appreciated.

Have you been eating too many baby cookies? Above and beyond the physical benefits, there are many emotional and social benefits to be gained from joining an exercise program, especially for pregnant women and new mothers. Pregnancy fitness classes build a marvelous sense of camaraderie and support. They help you keep your sense of humor about your rapidly changing body and bolster your commitment to exercise because of the structure and community spirit.

In evaluating a pregnancy fitness program, use the following checklist questions:

1. Do the women consult their physician before enrolling in the exercise class? Do they have to present their physician’s consent in writing before participating in the first class?
2. Are they told that if they have any bleeding, cramping and other symptoms, they should stop the exercise or activity and consult their physician immediately?
3. Do the exercise classes start with a warm-up period consisting of mild to moderate stretching and light exercise?
4. Do the exercise classes’ end with a cool down period consisting of less strenuous exercises and stretching or relaxation exercises?
5. Do the exercises stress correct posture and body alignment?
6. Do the exercises avoid severe stretching? [ligaments in pregnancy loosen and joints are less stable]
7. Are participants encouraged to breathe deeply and not hold their breath during the floor exercise?
8. Do the exercises include calf- stretches to help prevent and help treat leg cramps?
9. Are pelvic floor [Kegel] exercises incorporated into the class exercise?
10. Are abdominal strengthening exercises included? [they should not be strenuous] are the women told to protect their lower backs during these exercises by doing a pelvic lift and by using slow, controlled moves? Is there prolonged exercising while lying on the back? [Such a movement should be maintained for one minute at the maximum, by the clock, and then the position should be changed].
11. Do the classes include aerobic or cardiovascular exercises [twenty minutes at the maximum] along with muscle strengthening and stretching? [If not, the class is incomplete].
12. Is the exercise program pulse monitored? If not, why not?
13. Are the women taught correct body mechanics and energy saving techniques [for example, for lifting, walking, standing, sitting, cleaning and getting out of bed]?
14. Are any exercises done with the women on their hands and knees? [This is an excellent position to relieve back pressure and to increase circulation to both mother and fetus. Abdominal and hip exercises can be done in this position. The abdomen should be kept tight-don’t let the baby hang down.].
15. Are exercises included to strengthen the pectoral muscles? [This is important to lend support to the breasts, and to aid in lifting the baby later.]
16. Does the class include exercises to stretch inner thigh muscles and to limber up the hip joints [which will allow a woman to be more comfortable in the lithotomic position - on the back with the feet up and knees spread wide apart-if it is used during delivery.]?
17. Are shoulder stretches or relaxation exercises taught? Did the instructor complete a training program to qualify her to teach exercises? Where? How long was it?
18. How long has she been teaching pregnancy fitness classes?
19. Who designed the exercise program? Who is responsible for safety?
20. What is the cost of the exercise program? How many classes are included in a series?