Sunday, February 7, 2010

This is a Very Easy One!

Everyone wants to know what to pack for the hospital, and when to pack and where to put the bag (s) and even what to do if they forget something, really, really important. So I am going to make this answer an easy one. The less you pack the less you have to worry about bringing home. And it's often overwhelming bring a newborn baby home. So in this case, you sweat the samll stuff, your baby, and forget the rest.

Everything you need is readily available in the hospital. They have toothbrushes and soap and lots and lots of giant sized Kotex, with bloomers to keep 'em on. The hospital gowns may not be the latest in fashion but they are ready to wear, in unlimited supply and someone else will wash them. Please remember your glasses as you may not want your contacts all the time. Your baby's layette also is supplied at the hospital. Diapers, wipies, undershirts, booties and mittens and caps plus receiving blankets for swaddling tight. Please remember that you are paying for all the extra baby supplies on the isolette so take that home for sure. Those big blue plastic-backed liners are fabulous to lie on the changing pad at home so you aren't changing the cloth one all day long. And they work just as well in the bassinette and pack-n-play too. All the extra diapers are yours and the wipes and the individual foil-wrapped alcohol and neosporin. Don't forget your peri-bottle: it's yours.

There is a gift shop in most major maternity hospitals that sells essentials and even specialty shops that sell nursing bras ( you can be fitted properly by an expert after you deliver )and cute little nursing gowns and pajamas. The hospital provides socks with traction soles and they feed you too. But snacks are nice and money for your significants comes in handy for the cafeteria and all the deliveries you may want to order.

You should be pre-admitted to the hopital but it's probably a good idea to have your insurance card and driver's license. Take your addresses and phone numbers so you can call all your eager folks. And you can take a camera and CDs of your choosing. You may take your own pillows and your boppy. Just remember what you take with you, you'll want to take home and with all the extras from the hospital, that's a gracious plenty with a baby on board. The CAR SEAT should be installed and ready for its passenger when you are about thirty-six weeks pregnant. You can't take baby home without a regulation car seat in the car. So put it the primary vehicle ( the one you know that you are taking with you ) and that's whewre the hospital bag should go too, probably before you know that you are in labor. Remember to take underwear and socks and a clean shirt or two for your significant other. But if all else fails, after you are safely delivered and settled in your post- partum digs, someone can bring you whatever y'all might want or need.

Remember to have someone on stand-by for pets at home and it would be good if there is some food in your house for your hungry arrival back to reality. I suggest that you leave flowers and plants in the hospital for family waiting areas and nurses stations. You don't need the hassles of transporting them home and you won't have time to water them anyway. Pop the balloons and trash 'em. You'll have some stuffed animals and gifts: clothes and blankies that you need to get home with you. Have your partner get all that stuff in the car before it's brought around for you and your most precious package.

You will most likely wear home what you wore into the hospital, when you were in labor. Unfortunately, your skinney jeans won't fit quite yet. And the baby needs clothes to come home in, with blankets of appropriate weight depending on the season. Remember that it is just a few short days that you are hospitalized. Usually 48 hours after you deliver vaginally and another 24 for 72 total, if you have a Cesarean Section. Pain medicines can be filled with your discharge prescription at any pharmacy. So please, pack light and get home safely.

Saturday, January 30, 2010

The Trouble with Number Two

So, the bane of a pregnant woman's existence is gas, bloating and constipation and no one wants to bring it up. Early in the first trimester, gas is really bad. It's embarrassing and painful and inconvenient and it HURTS and so it's scary, because the woman, newly pregnant, thinks something is wrong with her pregnancy. Gas gets trapped when peristalsis slows down and that might just be a result of the early pregnancy. The smooth muscle of the colon and the female reproductive tract can often mimic each other. So there is cramping with the pregnancy, which is a very commonly reported symptom and then there's the added discomfort of the gastrointestinal symptoms. Take Gas-X or Phazyme and eat yogurt and all the products that are now in vogue as probiotics. Safe in pregnancy, all of them and effective, all of them.

Bloating is also the female complaint of the century and it doesn't get better with pregnancy. It is trapped gas and retained fluids and it can make the waistline of your jeans stop coming together too early for you to even begin to think of wearing maternity clothes. The measures for gas should relieve the bloated feeling too. And as always, keeping those bowels moving: lots of fluids and roughage ( my mother's word for fiber ). Fiber Con, Citrucel and Metamucil, Benefiber and the list goes on isn't just for keeping us "regular" ( which we need to do anyway ) . The benefits of fiber keep coming up for a myriad of healthful reasons like reducing the incidence of heart disease and colon cancer and breast cancer and who knows what, next week. And it really helps with bloating.

And fiber is essential for the relief of constipation that many females seem to be born with and most pregnant women complain about. First of all, we need a lot of water as human beings. We are made of water and we need water to stay alive. Our intestinal tract really needs water when we're pregnant because if we don't drink enough water to help build our 50% increased blood supply, then our body "steals " water from our intestines to make up the shortfall. If we don't have enough water in our intestinal tract, we get constipated. Keep it moving with water. Add stool softeners, as needed. Everyday is okay. You can find softeners in lots of prenatal vitamins ( and the cheaper over-the-counter brands are fine ). Take gentle laxatives, if you need to: Senekot, Miralax, Dulcolax won't hurt a pregnancy and can really be necessary sometimes, especially if you don't drink the required water ( 64 ounces, minimum, everyday . And when you use the fiber of your choice, in pill, powder or even cookie or cracker form, you MUST add water to the mix so you don't get hard, dry stools, that don't move. I liken it to the brick effect. Very hard ( pun intended ) to pass those.

Drink water, eat foods high in fiber, supplement fiber, add softeners, use a gentle laxative as necessary. Non-prescription relief for gas and bloating is safe in pregnancy. Probiotics like yogurt are full of beneficial bacteria and calcium and protein too. Probably all great remedies for all of us, whether pregnant or not. Makes it a lot less uncomfortable, embarassing, inconvenient and much more pleasant for us and everyone around us too. It all comes back to our mothers, doesn't it? An apple a day ( fiber ) and drink your water. Mothers are so smart.

Sunday, January 24, 2010

Gestational Diabetes

I have a patient who was just diagnosed with gestational diabetes. Many pregnant woman are diagnosed with the disease and every pregnant woman should be tested. Testing is accomplished with a one-hour glucose challenge generally done in conjunction with a routine prenatal office visit. If a woman has a history of insulin resistance or a previous diagnosis of gestational diabetes, she may be tested earlier in the pregnancy and then again at 28 weeks, if she hasn't already been diagnosed. The test do not require any preparation. The patient is given 50 grams of a sugary drink ( very sweet ) and then her blood is taken for glucose metabolism after one hour.

If the value on the blood test is under 130, no further testing is required. If it is above 130, a three hour test with 100grams of the sugary drink is administered. Preparation for the three hour test is fasting after midnight the night before the test. A fasting blood sample is taken and then after the drink, three consecutive blood tests to come up with four values and if two or more are outside the acceptable window, the diagnosis is made: Gestational Diabetes Mellitis.

Gestational Diabetes is defined as a carbohydrate intolerance. It is due to the alteration of maternal metabolism caused by the hormones of pregnancy. It happens only in pregnancy but it does increase a woman's risk factor for developing Diabetes Type II or Adult Onset Diabetes. Younger woman, obese women, women who don't engage in exercise and some ethnic groups are at greater risk for developing the diabetes.

Much is published about the risks associated with Gestational Diabetes. The important thing to remember is that it isn't the diabetes, per se. If if it diagnosed and managed, all the "bad" things you hear about it shouldn't necessarily be a problem. So don't be afraid of the tests and DO be COMPLIANT, if you are diagnosed.

If you are diagnosed with Gestational Diabetes you will be taught how to monitor your blood sugar and you will be taught how to manage the disease with diet and exercise. Insulin is usually not needed. The baby will be carefully monitored as well.

So please don't dread the test and welcome the results, whatever it is. It means that you are being proactive about your baby's and your health. A woman with Gestational Diabetes can have a very healthy pregnancy and a wonderfully healthy labor, delivery and newborn.

Sunday, January 17, 2010

Haiti

I heard this morning that this may be the largest natural disaster in history. Please visualize and pray, whatever you do to release energy into the universe, so that all the pregnant women and newborns and their families find the strength and resolve to cope with the devastation that their lives have become. Send money if you can, but send hope anyway you can. We are all one, when all is said and done. God bless us everyone and please keep Haiti and all those suffering in the forefront of our thoughts.

Friday, January 15, 2010

Open Letter to Parents of Prospective Siblings

Parents of Prospective Siblings:

Your child is about to become a sibling. That may mean that he or she is no longer an “only”. It may mean that for this child, there is another sibling on the way to take up more of your time, already stretched thin and in much demand.

Please refer to this new addition as our baby.
Please reassure your child that all he has to do is ask for your time with his words and that you will make the time for him, as soon as you are able to.
Please have a present at the hospital visit from the baby for him and he should bring a present for the baby, a present of his own choosing. It can be an old toy that he doesn’t need anymore.
Please reassure him that he doesn’t have to love the baby, until he is ready.
Please reassure him that although people will talk about how cute the baby is, he is a lot more interesting and fun.
Please allow him to help, in any age appropriate way. Getting you a burp cloth or running for a bottle. He may be able to rub lotion on a tummy. Or give some really good help burping.
And please let him sit next to you, while you are feeding the baby. Put on a CD or DVD, or just talk about how much you loved taking care of him when he was a baby, but it’s even more fun now.
Please don’t let him breastfeed or go back to the bottle. No more pacifiers, if they have already been given up. Let him know that some things are meant for babies, only, and some things aren’t.
Please have a doll, whether your child is a boy or a girl, which is suitable for washing and changing when you change your real baby.
Please allow the baby to be held, with supervision, and remember that babies should be kissed on the tops of their heads or bottoms of their feet. Not their hands.
Let your youngster know that he can choose the toys he wants to share, when he is ready, and he doesn’t have to give his toys to the baby. He may use the baby’s toys and books because the baby doesn’t mind sharing (until he does!!).
Please give him plenty of time when you can and you will want to start reading books, right now about babies coming home to live with you and the rest of your family:

Wilbur Waited
Cornelius P. Mud, Are You Ready for a Baby?
Baby Baby blah blah blah!
Vera’s Baby Sister
Peter’s Chair
The New Baby, by Mr. Rogers (it’s at the library)
I’d Rather Have an Iguana
Will There Be a Lap for Me?
Julius, Baby of the World
A Baby Sister for Francis
What Baby Needs

And there are many, many more
Because when a baby comes to your house, it’s a BIG deal and no body wants to be forgotten or overlooked or taken for granted. Babies just take a lot of time and trouble but they don’t have the feelings that their big siblings have. So take care of baby, but make time for the big kids.


Readybirth.com
404-812-0774

Friday, January 8, 2010

Breastfeeding

Breastfeeding your baby reduces your lifetime risk of breast and ovarian cancer by perhaps fifty percent. So breastfeeding is great for you. Breast milk is designed for human babies the way that cow's milk is designed for calves. So it does make sense that breastfeeding is good for your baby. The colostrum ( the precursor to actual milk ) is full of immunities that your baby needs and when the baby sucks hard those first few days of life to get out that golden goodness, it encourages your milk to shift into production mode.

Not only does the nutrition and immunities from breast milk promote your baby's health but just the physical act of suckling is important for the baby's development: jaws and tongue that are essential for later speech. The skin to skin contact is vital to your baby's first developmental task which is establishing safety and security. It feels very comforting for a newborn to put it's face next to your warm breast as opposed to a plastic milk recepticle.

It is not easy however to always establish breastfeeding. In the first few weeks it can be very uncomfortable. Nipples need to toughen up and just air-drying or using a hair-dryer can speed up the process. You can start to air-dry your nipples way before the baby is born. Make sure that the baby is latched-on correctly. The brown aureola should be in the baby's mouth. Not just the tip of the nipple. And when it's time to take baby off the breast, break the suction created by inserting a finger into the baby's mouth to break the seal. Never pull the baby off the breast.

It's important to hydrate really well. You cannot produce the milk if you don't have the fluids necessary to do so. Dehydration and breastfeeding are in direct opposition to the process. And nutrition is just as important as when you were pregnant. For you and for the baby.

After you deliver, make sure to request a visit from one of the lactation specialists at your facility. They can teach you all you should know about latching and suckling and they will provide you with a plan so that you know how often to feed and how to make you feel secure about whether the baby is getting enough.

The La Leche League is a lay organization that has chapters all over. Google them up and you can contact them for help. The lactation consultants at the hospital will talk to you 24/7 and will even make an appointment to have you come back to the hospital for more help. There are private lactation consultants available. Some will even come to your home. The Womanly Art of Breastfeeding is a great resource guide published by La Leche, available at every book store and Amazon too.

I always say give it your best effort, if you want to breastfeed. Ask for support. Now there are mom's chat groups on-line available for cyberspace sharing. Your pediatrician's office may have a lactation consultant on staff. In fact, it's a great question when you go to a practice's meet and greet. Your obstetrician's office should have a nurse who helps with questions about breastfeeding and they are the people to contact if you think you might have mastitis. That's a breast infection that can be treated with antibiotics and the baby can continue to nurse while you are being treated. Symptoms include a fever and flu-like symptoms.
It is possible to breastfeed while you are taking many medications, including antidepressants. Just check with your pediatrician about their preferences for you.

If after you have given it that best effort and you still have reservations about breastfeeding: you just don't like it or you are too uncomfortable or you just have "had it" then remember that you did your best and put a bottle in that baby's mouth. Feed your baby, one way or another.

Monday, January 4, 2010

Manipulation; it's Human Nature

I was reminded that even little kids can manipulate pretty effectively when I stayed with grandchildren on New Year's Eve. The manipulation isn't malicious; it's human nature. It can be endearing and also exhausting.
It can become just another power struggle. And a reminder that limits and boundaries are important for any relationship.

I have been told recently that I should "do whatever, to survive" in reference to changing the limits while staying with my grandchildren. This is a huge boundary issue since grandparents are supposed to do what their kids wish when watching their offspring. And it's hard and it is frought with mixed messages. So instead of "following the rules" of the household, being able to bend the rules means grandparents have some license. And that is often necessary to survive. So, thanks to my son and boy, do I bend the rules. Really cuts down on the power struggles on both ends and it is a lot less fatiguing for the babysitter. I don't have to set-up those ridiculous scenarios where anybody has to pretend that the rules are enforced and I can use my judgement and my own experience and wisdom and tolerance levels for how the encounter plays out.

It is interesting to see a three year old in manipulative-mode. First, there is the parting, such sorrow. "Don't leave me; why can't I go? " and the crying and the teeth-gnashing. The minute the offenders leave however, it's "party!! ", complete with the announcement and the dance and the requests for all those off-limit activities. Chips and cookies, juice ( not diluted ) and then there is the remote.
I can use my best judgement about what is appropriate to watch and I can even bend the proverbial rules about what time to turn it off. But the problem is often finding the saved video that is requested. Thankfully, the three year old knows just how to use the complicated technology. And we are installed in front of a fascinating and well- watched Disney story. So well- watched that the songs are memorized and so are the scenes, line by line. Boring but for watching the three year old revel in what she perceives as a major coup in the manipulation. She doesn't know that it's all okay with the adults, parents included. Movie over, the biggie is bedtime.

So the bedtime has been moved from 8:30 to 11:00pm and it's okay. "Grandma, you have to come to bed with me now." I have coaxed with lights out and plenty of blankets, in front of that T.V. " just shut your eyes and we can listen to the story and songs " to no avail. We move to the youth bed. It's a good thing that I am not a BIG grandma. We are down for the count, after exactly re-arranging every lovey and sleeping pal that will fit in there with us. Next comes the talking, pretty much non-sense because it IS after 11:00pm after all. I think I forgot to mention the last pee-pee and of course she didn't want to go but boy did she need to. And the last glass of warmed -up milk and then the teeth-brushing, again.

So I put on the CD player and the music is inviting me to sleep. But every time I move, there is a little hand that grips on tight. Finally, I hear baby number two crying for his next bottle and I have to go pee-pee too. I wait quietly for that heavenly steady breathing which is the signal that I can depart and as I gingerly move one leg over her, of course I have the wall- side ( the better to trap you in here, Grandma ), I hear in a very self-assured tone, " Grandma, I am not through with you yet. " "Okay, baby, I will be back after I go to the bathroom ( and feed your brother )".

So mission accomplished. No hysterics and the rules have been broken and I have not betrayed my kids because they gave me permission to bend the rules. Everyone is back in their own sleeping quarters and fed and peed and I get a great big thanks when Mom and Dad finally get home. I report on the splendid evening and hear, " But you have no idea how difficult it is with these two kids." I know just how difficult it is, because I did the same thing thirty years ago and it doesn't get any easier and the manipulation, on all ends, really doesn't change. Not a bit. The beat goes on.....