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Sweet Pea Births

Chandler, Arizona

Sweet Pea Births

...celebrating every swee​t pea their birth

Blog

Birth News Roundup

Posted on October 17, 2013 at 12:18 PM Comments comments (0)


I hope you enjoyed our Mommy Con recap in lieu of a "Birth News" installment last week.  Here are the articles I have collected that I thought would be of interest to those of you TTC, currently pregnant, or getting close to welcoming your babies.  

This week was also Remembrance Day for families that have experienced the grief of loss.  I open this post with an event to honor their brief passage through our lives.


Remembrance Service for Miscarriage, Pregnancy Loss and Infant Loss
Memorial service for those lost through miscarriage, still birth or neonatal complications.
The Bereavement Support Teams at Chandler Regional and Mercy Gilbert medical centers, invite you to a service in memory of those little ones lost through miscarriage, stillbirth or neonatal complications. Join us in love, support and comfort, as we mourn and remember these babies.
The memorial service will occur on Friday Oct. 18 at 5:00 PM.  Mercy Gilbert Medical Center’s Healing Garden, 3555 S. Val Vista Drive.
To learn more, visit MercyGilbert.org 
Source: AFN http://bit.ly/1hHSVdt

FERTILITY
New Test May Spot Which Embryos Stand Greatest Chance of Survival
“Doctors have unveiled a new test for determining which embryos have the best chance of survival.

The amount of mitochondria found in the cells of an embryo appeared to be a marker of its health, doctors reported Monday at the International Federation of Fertility Societies and American Society for Reproductive Medicine annual meeting in Boston. Research presented at meetings is considered preliminary until published in a peer-reviewed medical journal.

Higher levels of mitochondria -- the "powerhouses" of cells -- seemed to indicate an embryo was under stress and less likely to successfully implant in a woman's uterus, said study co-author Dr. Dagan Wells, a scientific leadership fellow at Oxford University in England.”
Source: US News and World Report http://bit.ly/GX1A0z

Increase seen in donor eggs for in vitro fertilization, with improved outcomes
“Between 2000 and 2010 in the United States the number of donor eggs used for in vitro fertilization increased, and outcomes for births from those donor eggs improved, according to a study published by JAMA. The study is being released early online to coincide with its presentation at the American Society for Reproductive Medicine and the International Federation of Fertility Societies joint annual meeting.”
Source: Science Codex http://bit.ly/16i1SFf

PREGNANCY
BPA exposure may increase miscarriage risk in pregnant women
“A new study presented Oct. 14 at the American Society for Reproductive Medicine's (ASRM) annual meeting in Boston found women with the highest levels of BPA, or bisphenol A, in their blood were significantly more likely to miscarry than women with the lowest levels of the ubiquitous chemical.

"Many studies on environmental contaminants' impact on reproductive capacity have been focused on infertility patients and it is clear that high levels of exposure affect them negatively," Dr. Linda Giudice, president of ASRM, said in a statement. "These studies extend our observations to the general population and show that these chemicals are a cause for concern to all of us."
Source: CBS News http://cbsn.ws/16iirkz

Air pollution tied to high blood pressure in pregnancy
“Pregnant women who live in neighbourhoods with lots of air pollution may be slightly more likely to develop high blood pressure, a new study says.”

Caveat:
“Abbott, who was not involved in the research, said it had some key limitations. For example, some factors that affect a woman's risk of getting high blood pressure, such as her weight, were not taken into account. In addition, the study did not look at whether any women moved to a different neighbourhood while pregnant or spent most of their time away from home, where pollution was measured.

For those reasons, Abbott told Reuters Health, more research is needed to determine whether there are any blood pressure-related benefits to moving to an area with less pollution, or to staying indoors on high-pollution days while pregnant. "I would not make any recommendations to my patients based on this research," she said. The author is a student at the Boston University School of Medicine, and Abbott is a former professor of hers.”
Source: Health24 http://bit.ly/17p8qlI

Babies can be born dependent on drugs, even prescription medicine
"Neonatal Abstinence Syndrome is a medical condition that occurs when a baby has been exposed during pregnancy to opiates," Neonatal Nurse Practitioner Carla Saunders explained.
In Jason's case, his mother took a specific prescription medicine for chronic migraine headaches, one she was told was safe for her unborn child.”
Source: WBIR.com http://on.wbir.com/16i1Ddk

Maternal cardiac function may predict outcomes in preeclampsia 
“Women at high risk of early preeclampsia who show signs of abnormal hemodynamic function earlier in pregnancy may be more likely to have adverse pregnancy outcomes, new data suggest.”
My note: this is a very small study – only 36 women in sample size
Source: OBGYN News http://bit.ly/16iiVXU

Using Prenatal Corticosteroids does not Increase Children’s Death Rate
“Even though the majority of pregnancies result in healthy live births, pregnant women still have to take some measures to prevent complications from arising. For some women, taking prenatal corticosteroids is necessary to curb preterm births, which increase the infant's and mother's risks of having potentially life threatening problems during and post birth. Women who are at high risk of giving birth prematurely are usually recommended to receive one dosage of this type of therapy. According to a new study, receiving multiple courses of prenatal corticosteroids does not appear to increase or decrease the risk of death or disability for children.”
Source: Counsel & Heal http://bit.ly/GY1gP9

NATURAL BIRTH
Birth gets the brain ready to sense the world
"Our results clearly demonstrate that birth has active roles in brain formation and maturation," says senior study author Hiroshi Kawasaki of Kanazawa University in Japan. "We found that birth regulates neuronal circuit formation not only in the somatosensory system but also in the visual system. Therefore, it seems reasonable to speculate that birth actually plays a wider role in various brain regions."
Source: Medical Xpress http://bit.ly/16iftMK

Birth Prepares the Newborn Brain to Sense the World with Sensory Maps
“A lot of things happen during birth. Chemical processes change in the brain as children travel through the birth canal. Now, scientists have discovered that the actual act of birth in mice causes a reduction in a brain chemical called serotonin. This triggers sensory maps to form, which prepares the mice to sense the world and prepares mice for survival outside the womb.”
Source: Science World Report http://bit.ly/1by6YAE

Searching for the secrets behind anesthesia 
"Surprisingly, even though we use these drugs in easily 250 million patients every year across the world, and have been using them since about 1850, we don't know how they work," said Roderic Eckenhoff, a professor of anesthesiology at the University of Pennsylvania.

"There is concern right now, for example, that these drugs could have a durable cognitive effect, in other words, they might not leave the brain entirely unchanged," he explained."
My note: If this doesn't make people question epidural drugs, I do not know what will.  There is an appropriate use for them, however wholesale acceptance looks to be irresponsible.
Source: NewsWorks http://bit.ly/1fUyGgZ

My note: So between messing with birth and introducing drugs...we have to wonder if we are changing the incidence of depression by continuing to question the idea that Birth Matters:
Oxytocin Dysfunction Seen in Both Depressed Moms and Kids
"A dysfunctional oxytocin system may underpin the long-term harmful effects of maternal depression on child development, suggesting a potential for oxytocin-based interventions, researchers say.

"Infants of depressed mothers have long-lasting difficulties both in general and specifically in social and emotional outcomes, such as social engagement with others, the capacity for empathy, which underpin the capacity for intimacy," Ruth Feldman, PhD, psychology professor at Ban-Ilan University, Ramat Gan, Israel, who worked on the study, told Medscape Medical News." 
Source: Medscape http://bit.ly/16icnbN

BABY
Seattle Children’s researcher finds a clue to the mystery of SIDS
“A physician and researcher at Seattle Children’s Hospital made another breakthrough in his research into Sudden Infant Death Syndrome (SIDS), a mysterious disease that leaves grieving parents looking for answers that science has yet to provide.

The latest finding supports his earlier work, which indicates that SIDS babies don’t necessarily have a problem with their brain. Instead, Dr. Daniel Rubens’ research has indicated that problems with hearing and the inner ear may be linked to SIDS.”
Read the full article at http://bit.ly/GRzYdi

Screening for newborns a lifesaver
“Today every state tests babies at birth for PKU — but not just that. There are now more than 50 disorders that can be picked up through screening, 31 of which comprise the "core conditions" of the government's Recommended Uniform Screening Panel. Other conditions are likely to be added to the panel. All but two of them — hearing loss and critical congenital heart disease — can be detected by automated analysis of a few drops of dried blood from a heel stick done within a few days of birth." 
Source: Worcester Telegram & Gazette http://bit.ly/GY2YzP

BREASTFEEDING
This Is Breastfeeding In Real Life
“Turner started taking pictures of nursing moms around five years ago. Her shots were posed and “idealized,” she told HuffPost Parents over e-mail. But she wasn't interested in the improbable scenes of women on mountaintops in flowy clothing with happy and cooperative babies one sometimes sees: she wanted to represent real moms’ experiences. Gradually, she started to take her camera out into the world, where babies actually eat. “Most women I know are breastfeeding one child while sitting on a bench in the park or the mall and trying to fish crackers out of a diaper bag for another kid all while wearing an old t-shirt with a spit up stain on it,” Turner said.”
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson Source: HuffPost OnLine http://huff.to/GX1ZQA

Disclaimer: 
The material included on this site is for informational purposes only.  It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.


Info Sheet: Newborn Vitamin K Shot/Oral Dose

Posted on October 4, 2013 at 3:39 PM Comments comments (0)
Here is another installment in our Information Sheet series.  These info sheets are designed to give you information as a starting point for your own research to decide what is the best choice regarding this option for your family.  We are not medical experts or care providers.  We are informed consumers who want to help other families make informed consumer decisions when they say "YES" or "NO"
 
Definition: Newborn Vitamin K Shot/Oral Dose
A single injection containing .5 to 1 milligram of vitamin K is given in one of your baby’s thighs.
An oral form of Vitamin K was finally developed in the late 1990s and is now available for parents who prefer to give Vitamin K to their baby orally.
 
In 2003 the American Academy of Pediatrics recommended that vitamin K1 should be given to all neonates as a single, intramuscular dose of 0.5 to 1 mg29, and this recommendation was recently reaffirmed in 2009.
 
History
Why was it developed?
Research in 1937 found that prothrombin times (PT, the time required for blood to clot) in normal neonates were between 30-60% adult levels, falling to 15-30% on day two, and then gradually rising again until about day 10.  This research led to the continuing belief that these low levels in the newborn are a deficiency and need to be corrected.  
 
In 1939, vitamin K was isolated from alfalfa by Dam, for which he later received the Nobel Prize, along with Edward Doisy, who isolated vitamin K. Further research in 1939 by Waddell and Guerry found that low plasma prothrombin levels could be elevated by the administration of oral vitamin K.  
 
What was it supposed to treat?
"Armed with this 'proof' that vitamin K deficiency caused HDN (Haemorrhagic Disease of the Newborn) now known as VKDB (Vitamin K deficiency-related bleeding), vitamin K was synthesized and various trials were commenced to ascertain which was the most effective amount and route to use in prophylaxis.

It is difficult for us to assess these trials nowadays as they were mostly neither double blind nor well controlled.  The dosage of vitamin K given, the route of administration and the time of administration all varied.  In many cases, the conclusions did not seem to match the results.  
 
Occurrence of vitamin K deficiency bleeding (VKDB) in the first week of the infant's life is estimated at 0.25 to 1.7%, with a prevalence of two to 10 cases per 100,000 births."
 
"Some of the studies assessed the effect on neonatal vitamin K levels if the mother was given vitamin K during labour. Results varied, with the effectiveness of the vitamin K given depending on how soon the woman gave birth and the dosage given.  More recent studies have shown increases in cord blood levels where mothers were supplemented antenatally with vitamin K. Two showed a significant difference between the supplemented and unsupplemented groups and found that the effect of prenatal vitamin K persisted until the fifth day after birth.  
 
Because of the variations in results from these early studies, further research focused on treating the baby after birth.  One particular study done in 1942was intended to determine the minimal effective oral dose of Synkavite (K), a water-soluble synthetic form of vitamin K.  The results showed that very small daily doses were effective and that a dose of 5mg daily would probably prevent the development of HDN, except in early onset cases.  The study also found that 1.25mg was effective in lowering an excessively high prothrombin time to normal.  However, the author admitted that several workers found prothrombin deficiencies in babies with no abnormal bleeding.  
 
By 1950, most maternity units had a policy of giving infants oral vitamin K (usually Synkavite) immediately after birth. This prevented the fall in prothrombin levels that occurred in the first few days and, presumably, the risk of excessive bleeding.  This risk was higher in male babies because of routine circumcision, and, indeed, vitamin K proved to be of great clinical value in preventing post-circumcision bleeding. "
 
"According to the age of onset, early VKDB presents within 24 hours of birth and is almost exclusively seen in infants of mothers taking drugs [that] inhibit vitamin K. These drugs include anticonvulsants (carbamazepine, phenytoin and barbiturates), antituberculosis drugs (isoniazid, rifampicin), some antibiotics (cephalosporins) and vitamin K antagonists (coumarin, warfarin). The clinical presentation is often severe with cephalic haematoma and intracranial and intra-abdominal haemorrhages16. The incidence of early VKDB in neonates of mothers taking these drugs without vitamin K supplementation varies from 6% to 12%17,18.

Classical VKDB occurs between 24 hours and 7 days of life and is associated with delayed or insufficient feeding. The clinical presentation is often mild, with bruises, gastrointestinal blood loss or bleeding from the umbilicus and puncture sites. Blood loss can, however, be significant, and intracranial haemorrhage, although rare, has been described15. Estimates of the frequency vary from 0.25% to 1.5% in older reviews19 and 0–0.44% in more recent reviews20."
 
Has it been effective: as in, has the incidence decreased because of the intervention/procedure/test?
“Recent studies, using a standardized definition, seem to show that the condition is not now very common, even in communities where prophylaxis is not yet available. It is certainly not nearly as common as some authoritative reports claim. Two studies in Japan before the introduction of routine prophylaxis had suggested that one in every 6000 breastfed babies might sustain a late bleed when more than two weeks old. The true risk of bleeding in the first week of life (the “classic” presentation) remains less clearly defined.”
 
Source: E Hey. “Vitamin K – what, why and when.” Archives of Disease in Childhood Fetal and Neonatal Edition 2003; 88:F80.
 
 
Pros

  • VKDB is a rare but very serious disease. It affects about 1 in 10,000 babies if they are not given vitamin K at birth.  More than half of all babies who bleed have a hemorrhage into their brain (intracranial bleeding). This is likely to cause brain damage, and often the baby will die. [1]
  • Some babies appear to be at increased risk of VKDB and doctors believe these include [2]:
    • Babies born before 37 weeks of pregnancy.
    • Babies whose birth involved the use of forceps, [vacuum] or caesarean, where bruising might occur.
    • Babies who had trouble breathing and did not get enough oxygen when they were born.
    • Babies whose mothers are taking anticonvulsants, anti-coagulants, or drugs to treat tuberculosis.


 

Cons

  • The amount of vitamin K injected into newborns is 20,000 times the needed doseiv . Additionally, the injection may also contain preservatives that can be toxic for your baby’s delicate, young immune system. [1]
  • An injection creates an additional opportunity for infection in an environment that contains some of the most dangerous germs, at a time when your baby’s immune system is still immature. [1]
  • Hemolysis, jaundice, and hyperbilirubinemia in neonates, particularly those that are premature, may be related to the dose of Vitamin K1 Injection [2]
  • Injection contains preservatives and other ingredients.
  • Each milliliter contains phytonadione 2 or 10 mg, polyoxyethylated fatty acid derivative 70 mg, dextrose, hydrous 37.5 mg in water for injection; benzyl alcohol 9 mg added as preservative. May contain hydrochloric acid for pH adjustment. pH is 6.3 (5.0 to 7.0). Phytonadione is oxygen sensitive. [3]



Injection also includes following:
WARNING — INTRAVENOUS AND INTRAMUSCULAR USE
Severe reactions, including fatalities, have occurred during and immediately after INTRAVENOUS injection of phytonadione, even when precautions have been taken to dilute the phytonadione and to avoid rapid infusion. Severe reactions, including fatalities, have also been reported following INTRAMUSCULAR administration. Typically these severe reactions have resembled hypersensitivity or anaphylaxis, including shock and cardiac and/or respiratory arrest. Some patients have exhibited these severe reactions on receiving phytonadione for the first time. Therefore the INTRAVENOUS and INTRAMUSCULAR routes should be restricted to those situations where the subcutaneous route is not feasible and the serious risk involved is considered justified.
 
Additional Information



Please make sure to check out the other topics in the Info Sheet series as you educate yourself and prepare to write your birth, postpartum and newborn plan for your family.

What are your thoughts on the Vitamin K shot?
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Meet the Doula: Sue

Posted on June 30, 2013 at 10:41 PM Comments comments (1)

Sue Marquis, PCD(DONA) is new to the area, having just moved from Michigan to Arizona in the last month.  Welcome to the heat, Sue!!  Thank you to our friends at Modern Mommy for helping us make the connection!

When was the first time you heard the word, “doula”?
 I had probably heard the word previously but did not know what it was until my son told me that my first grandchild would be delivered at a birthing center with the assistance of a doula.

How did you decide that becoming a postpartum doula was part of your journey?
After my granddaughter was born, my son and daughter-in-law told me about postpartum doulas and what their role is. I absolutely loved the idea of becoming one, and I knew that it would be something that I could do well at - and be passionate about!

How long have you been a postpartum doula?
I have been certified since October 2012 and started working with families in January 2013. Regarding training, I completed the Professional Education in Breastfeeding training in September of 2012 and the Doulas of North America (DONA) Postpartum Doula Workshop in October 2012. My certification through DONA International is official as of today!

What do you enjoy the most about being a postpartum doula?
I love working with, and helping the families.  Just as each family dynamic is different, there are countless ways a postpartum doula can help a family.  A doula needs to be able to determine the needs of each family and help each one in the best way for them.  I find tailoring my approach to their specific needs to be very rewarding, and families are so grateful for the support and help.   Some of the areas a postpartum doula can help with are breastfeeding support and consultation, diapering, cooking, laundry, and family life adjustments to the new baby.    

What is your philosophy when you go into a family’s living space?
I try to get some background ahead of time so that I have an idea of what the family needs will be. My philosophy is to be non-judgmental and respect their right to parent in their own way. I make sure to respect their privacy and make confidentiality a priority.
 
How do you work with the new parents?
Since this can be a very stressful time in their lives as well as an exciting one, I try to be supportive, nurturing, warm and confident so they know they can trust me to be in their home and help them with their precious newborn.

What is the toughest situation you have ever dealt with?  How did you handle it?
I used to run a daycare, so my postpartum doula experiences have not seemed very tough in comparison! Nonetheless, one situation that sticks out in my memory was when a father questioned me about how a postpartum doula was different than a nanny. I think the reason he asked was because the couple had just had a set of twins, and all the mom wanted me to do was take care of the babies so she could sleep. To him, it seemed I was simply babysitting. I explained to him that what I do is much more than taking care of infants; I told him that a Postpartum Doula offers education, companionship and in-home support for families with infants. Basically, taking care of the babies was helping to take care of the mom. He seemed to understand better after my explanation.

What keeps you working as a postpartum doula?
I love the feeling that comes with helping and supporting others. I find that parents are, for the most part, very appreciative for the help they are receiving. And I love babies!

What does your fee cover – how many visits or hours?  Is there a different charge for a shorter or longer-term agreement?
I charge a fee of $18.00 an hour. That fee covers assistance with newborn care, family adjustment, nursing support and help with light household needs.  The number of visits and hours is up to the individual family. If it is a longer term agreement, I am certainly open to offering a lower hourly rate or a package deal.

Do you offer any other services to your clients?
I know some doulas have specialties in other areas, and I appreciate that. However, since being a postpartum doula is somewhat new for me, I am not yet offering any other services. That may change in the future. 

Just for fun, what do you do when you are not doula-ing?
I love to spend time with my family, especially my granddaughter, who turns 1 this month. I have been a hospice volunteer. I also like to bowl, and I enjoy watching most sports.

If you would like to contact Sue to arrange an interview, here is her information:
313-574-2080 Cell

313-586-8313 Alternate number
480-625-4816 Alternate local number

Website: lighthousedoula.com

Emails: [email protected] or [email protected]

Would you find the services of a postpartum doula to be beneficial?
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonPlease leave us a comment - it won't show up right away, however it will be moderated and posted.  
*I think* that the amount of traffic you so generously generate has led to a lot of spam posting.  In an effort to keep the spam to a minimum, I am taking the time to moderate comments now.

Disclaimer: 
The material included on this site is for informational purposes only.  It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. 


Labor Support: Meet the Monitrice

Posted on March 22, 2013 at 11:33 AM Comments comments (0)
I am so excited to announce a monitrice service for couples that want to have a natural birth outcome in a hospital setting.  Jennifer Hoeprich, LM, is now extending her skill set to families who want to stay home as long as possible before heading to a hospital for their birth.


What is a monitrice?
A monitrice is a professional, medically trained, labor support person, who provides clinical monitoring within the home environment, including cervical dilation exams, auscultation of fetal heart tones, and monitoring of general well-being of mother and baby, during labor. The monitrice helps couples to assess their progress in labor, to determine the best time to leave for the hospital, where the birth is to take place.


How does a monitrice differ from a doula?
The focus of a monitrice is to provide clinical and educational support, while the focus of a doula is to provide emotional, mental, and physical support. Our monitrice service only provides services within the home environment. She only accompanies the couple to the hospital if complications arise, whereas a doula remains with the client during their transition from home to hospital.

How is a monitrice different than a midwife?
In the role of monitrice, the practitioner does not provide services at the actual birth. She does not "catch" the baby, or provide immediate postpartum services. A midwife provides all prenatal care, all labor and birth care, and all postpartum care.

Who would find monitrice services beneficial?
Couples who have chosen to birth in a hospital with an obstetrician, but who wish to labor at home for an extended period of time would benefit greatly from monitrice services.  They might want to stay at home in order to avoid unnecessary hospital interventions (such as movement restrictions, food restrictions, Pitocin augmentation, breaking the water prematurely, epidural, etc.).  Although they are choosing to wait longer before "going in", they can have that feeling of "safety" with consistent, professional monitoring, 

How do you envision a couple utilizing monitrice care?
A couple would interview the monitrice at her office and determine that the services are in line with their birth plan. They would then have two prenatal visits to get to know each other, and for the monitrice to assess baseline vitals and good health in the pregnancy.

The monitrice would be on call for the couple, starting at 36 weeks. When the couple believes labor has begun, they would contact the monitrice to give her a head's up. They may request her services at that point, to help determine if this is the "real thing" or may wait to call her over, once a labor pattern is clearly established.

Once the monitrice has arrived at the couple's home, she will assess maternal blood pressure, pulse, signs of infection, and hydration level. She will also asses fetal heart tones, and upon request from the couple, the mother's cervical dilation. The monitrice may make recommendations as to positions that would be helpful, encourage eating and drinking, and may provide herbal, homeopathic, or flower essence remedies, as appropriate, and as desired.

She will perform clinical monitoring every 30 minutes or every hour, depending on the stage of labor and the client's wishes. She performs monitoring respectfully, and can monitor the woman in any position the woman’s choosing, including in the shower, or in the labor tub. Once the couple determines that they are ready to leave for the hospital, the monitrice wishes them well and departs.

The couple will have a follow-up visit, including assessment of mother's vital signs, stitches (if applicable), a check for any signs of infection, breastfeeding support, and baby weight.  These visits occur at 1 week postpartum and 3 weeks postpartum, as most obstetricians only provide one postpartum visit at 6 weeks.

In the rare event that a complication should arise during labor, the monitrice will accompany the couple to the hospital.  Once they arrive at the hospital, the monitrice will provide a report and labor records to the staff. 

What kind of care is included in your fee?
The fee is $625. This includes two prenatal visits in the office, four hours of labor monitoring, and two postpartum visits in the office. Labor monitoring above four hours falls to an hourly rate of $50.  I am happy to offer a discount of $200 to any students of The Bradley Method®; their fee for service is $425.

As an added service to our clients, our monitrice service also rents, which includes set up and take down, the Birth Pool in a Box  labor tub, for $200. 

For more information about Moxie Monitrice Services, please visit 
www.moxiemidwifery.com or call to set up a free consultation.  You can also search for "Moxie Midwifery" on Facebook and @moxiemidwifery on Twitter. 

More about Jennifer:
Jennifer Hoeprich is a licensed midwife and monitrice, who provides services in Phoenix, Chandler, Mesa, Gilbert, Queen Creek, Maricopa, and Casa Grande.  She attended her first birth at age six, when her dog Cinnamon had puppies. She was the only attendant and knew then that she had found her calling. In 2001, Jennifer obtained her Bachelor's Degree, Minoring in Women's Studies. She experienced a natural birth with her son, in 2004 and began her journey into midwifery, shortly after. In 2005, she became a certified doula, and in 2008, a certified childbirth educator. She then obtained her midwifery license in 2011, and began the practice, "Moxie Midwifery." In her spare time, Jennifer enjoys being with her family, playing guitar, crocheting, and doing yoga. 

What do you think?  Would you use a monitrice service?  Why or why not?
Please leave us a comment - it will be moderated and posted. 
*I think* that the amount of traffic you so generously generate has led to a lot of spam posting.  In an effort to keep the spam to a minimum, I am taking the time to moderate comments now.

Disclaimer:
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.
Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Keeping Sweet Pea Healthy 2012

Posted on December 11, 2012 at 3:30 AM Comments comments (0)
December is here and it’s time for my yearly PSA on protecting your baby from respiratory viruses.  When there is a newborn in the house, everyone wants to come over to meet the baby!!  They are pretty hard to resist.

Bruss and I are big advocates for our children, especially the youngest members of our family, during cold and flu season.  Our Night Owl had a life-threatening experience with RSV when he was three months old, and that has made us painfully aware just how fragile our sweet peas can be. 

We have three sweet peas from our Fall 2012 class that we have not met yet because we have been passing around a cold for the last month at the Bowman House.  Otter finally succumbed yesterday, and in her, this cold manifested as croup.  A sobering reminder that an infant’s health is so much more important than our selfish desire to see the babies – I shudder to think what would have happened if we had seen those babies over the past weekend when the virus was active with no symptoms yet.

You can click HERE to read last year’s PSA with a list of precautions you can take to minimize your sweet pea’s exposure to germs.  I list 5 concrete steps to Keep Sweet Pea Healthy in that post.  In a nutshell, limit exposure and practice good hand washing.

This year, I want to take some time this year to share polite ways to insist that people who are not healthy keep their germs to themselves and away from your children.  It is unfortunate that people really do not understand how devastating their “little cold”, sniffle or runny nose can be to a child with small airways and an evolving immune system.

THE Announcement
Here is wording you can work into the text of an announcement via email or social media:
We respectfully request that you keep our child’s health in mind when planning your visit with us. As much as we are excited to introduce [Sweet Pea] to our closest friends and family, we also need your help in keeping him/her healthy.  If you are feeling unwell, or have been exposed to a fever within the last 24 hours, we ask that you reschedule your visit.  We will understand if you choose not to come due to illness and will look forward to seeing you when you are in full health.

People Want to Meet Sweet Pea
Here is a polite way to screen people when you talk to them on the phone and they want to come for a visit.  The reason I suggest asking people to wait a couple of days from the call is because a person can be contagious before the symptoms of infection are obvious.
Q: When can we come see you?
A:  We are resting and recovering right now.  As long as you are in full health, we would be happy to see you in a couple of days.  We completely understand if that day arrives and you need to reschedule if you are not feeling well.  As much as we want you to meet [Sweet Pea], keeping him/her healthy is our first priority.

How about if you are planning a gathering with a mixed bag of guests and an infant is going to be in attendance?
You can either mention your position on attending in full health when people RSVP, or you can send out an email a few days before the event to the guests that combines the ideas listed above:
We are so excited to celebrate with you on [date, time].  Since we have infants in attendance, their health is our priority.  If you are feeling unwell, or have been exposed to a fever within the last 24 hours, we ask that you refrain from attending.  We will understand if you choose not to come due to illness and will look forward to celebrating [occasion] with you when you are in full health.

I hope that these sample phrases give you some ideas to tactfully ask your family and friends to put your child’s health needs first.  As for my favorite public request, this is still my favorite for the times when you need and/or want to get out of the house:

Sign for Car Seat or Carrier
Sign for Car Seat or Carrier
www.healthylittleones.com
 You can purchase your own boy or girl themed card HERE http://www.healthylittleones.com/OnTheGo.html

The unfortunate reality is that someone may take offense – and that is too bad for them if they put their needs ahead of your child’s needs.  Health is something we all take for granted until we are faced with the harsh reality of how fragile life really is.  Your baby is counting on you to be their voice until they find theirs.  It is hard to regret putting their needs first when you consider the alternative.


RSV
RSV
Day 4: By this time, some of Night Owl's tubes had already been taken out.
RSV
RSV
Nurses working to straighten the remaining lines
RSV
RSV
Unhooked and still sedated

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson



















So speak up and advocate for your children.  We wish you the best and a healthy season this year!




Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Preparing Your Birth Plan

Posted on January 17, 2012 at 11:05 AM Comments comments (0)
We talked about writing the birth plan in class tonight.  We had no idea what a birth plan was with our first birth; it was an entirely new concept.   Now we know that it is an important exercise for mom and coach to complete together.  This is not a static document – it is one that will go through many drafts until you and your care provider are satisfied that you have a document that you can take with you to your birth place to make your wishes regarding your care known to anyone who will be attending to you.  
In class, we offer the perspective that the “birth plan” is more of a wish list for your best birth.  These are the things that are likely to happen if both mom and baby are doing well throughout the course of labor.  The way to increase the likelihood of having your best birth possible is to practice excellent nutrition and exercise so that mom and baby are strong and well nourished so that they can better manage any variations of labor.  

We encourage our couples to take the time to explore the many options and interventions available to them during labor and delivery.  First we ask them to compile a list together.  Then we ask Mom and coach to work individually and rank the options from the most important (least negotiable) to the least important (most negotiable).  Then we tell them to come together and compare notes – what does the new list look like after they have finished ranking together?  The third step is to evaluate if the choices are realistic given their pregnancy history and the chosen birth setting.  The fourth step is to write their well-crafted wish list into a birth plan that they can present to their care provider.  

Once they are ready with a document they can take to their provider, they call the scheduler to ask for extra time on their next appointment to go through the birth plan.  Listen to the input from your care provider.  They are the person or group you hired to help you have a Healthy Mom, Healthy Baby outcome.  They have a background of training and experience that they will apply to your birth plan.  If they are open to dialogue and offer suggestions, consider their input because they are the final arbiters of what is going to happen at your birth.  

If they originally said they would support your desire for a natural birth and then they tell you no on many of the things that are important to you, you may want to consider asking around and finding another provider who is open to your reasonable requests and change providers.  We have had students switch as late as 39 weeks to find the provider who supported their birth choices.   

Side note: For our home birth, we wrote a description of our ideal birth for our midwives as our "birth plan" since all the things we had to negotiate for at the hospital were non-existent in a home setting.  We also wrote a separate plan in the event of a hospital transfer that outlined our preferences in a hospital setting.

Your birth plan will go through at least two or three drafts before you have a document that your care provider is willing to sign and put into your chart.  We suggest that you have an additional original signature plan that you keep with you at all times.  Make copies of your signed plan that you can share with your care team at your birth place and keep one in your purse and one in your car.  The goal is to make sure that should you find yourself in an unexpected situation and you need it, you have a birth plan readily available.   

Why a signed copy?  We learned from experience that hospital staff likes to do their job well.  If something on your signed wish list is not part of an approved procedure or protocol, there is a higher likelihood of having your wish happen if your doctor has given them permission to deviate from their protocol.  

Know that it is within your right to speak directly to the doctor on call regarding the information you are getting from your nurse.  If you want to do something or try something that comes up that isn’t covered under the outline of your signed birth plan, insist on speaking to the doctor and then making sure that information gets relayed to the nurse.  

Here is an example from our experience: Nipple stimulation helps the body create more oxytocin, the hormone that causes mom to have contractions.  We wanted to use a breast pump to augment labor during our third child’s birth since it had been effective in getting our second labor to progress.**  The message we got from the nurse was that since there was no hospital protocol, we were not going to get the pump we requested.  A few hours later, our doctor came in to check on us to see how it was going.  She asked if the breast pump had worked.  If it had been effective she was going to see about have other patients try that so those desiring a natural labor could use that for nipple stimulation instead of the drug Pitocin. 

I was so angry when I heard this (by the way, not a great emotion for labor).  Our nurse had decided that she knew better than our doctor just because there was no hospital procedure written down explicitly saying that this was an acceptable way to augment labor.  We lost out on our opportunity to augment drug-free; we also missed out on widening our doctor’s perspective on our amazing bodies and how it’s possible to augment without artificial hormones.  

We suggest that students put their wishes for mom on one side of a piece of paper; on the reverse side they should express their wishes for their newborn care.  Make sure that if you are in a hospital or birth center setting that your wishes are read by the postpartum team as well.  

The last step in executing your birth plan is to be flexible.  If you got the plan written and your doctor signed it, see how it’s working once you are in active labor.  You may find yourselves facing situations that come up through the course of labor that you didn’t consider on the birth plan.  Be ready to take the fork in the road – the most important evaluation tool is the Healthy Mom, Healthy Baby end goal.  

I have a great picture from an impromptu gathering of students from our last series that demonstrates five different paths to a Healthy Mom, Healthy Baby outcome.  With the parents’ permission, I hope to bring those pictures and birth paths to you on Friday.  

Expecting moms: Any challenges writing your birth plan? How are you addressing those? 

Already moms: What was your experience with your birth plan? 

**There are other ways to stimulate the nipples instead of using a breast pump.  You can have a birth partner orally stimulate the nipple, or you can use your hands.  We tried using the hand method and it was a no-go for us.  In a public setting the other method was out of the question for Coach.  Most literature on the subject suggests starting with one breast at a time, since it can be a very powerful and effective augmentation technique.  If one is not enough to get labor going, then add in both being stimulated. 

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.  


We are now enrolling for our
Spring Series
March 5, 2012 to
May 21, 2012  

For more information or to register,
please call us at
602-684-6567
or email us at

Keeping Sweet Pea Healthy

Posted on November 11, 2011 at 4:57 AM Comments comments (0)
RSV experience
RSV experience
This is on day four of hospitalization - many of the tubes had already come out.
RSV experience
RSV experience
This is on day four of hospitalization - many of the tubes had already come out.
RSV experience
RSV experience
Checking out all the meds and straightening out the lines.
RSV experience
RSV experience
Day 5 - Breathing is stabilized and now we just need oxygen to keep the levels up in his body.
As we enter cold and flu season, I am compelled to write about RSV and some protective measures you can take to protect infants from this vicious virus.  Bruss and I are big advocates for our children, especially the youngest members of our family, during cold and flu season.  Our Night Owl had a life-threatening experience with RSV when he was three months old, and that has made us painfully aware just how fragile our sweet peas can be. 

(Picture notes: Night Owl made a more rapid recovery than most children - he was only intubated four days.   We credit that to the fact he was covered in prayer across the country, and he got breast milk in his feeding tube!)
 
When someone with a cold coughs or sneezes, they spread droplets of cold germs on nearby surfaces.  Those germs can live for hours.  If they are near us, the germs can fall on our skin or clothing.  If they were in a space before us, we unknowingly touch the infected surfaces and then infect ourselves with the same cold virus.  While these viruses are around throughout the year, they thrive in the chilly, dry air of winter.  The critical mass makes the amount of people showing symptoms of a cold or a flu infection more noticeable during the winter months.
 
“RSV” stands for respiratory syncytial virus, a common, easily spread virus.  It causes excessive fluid build up in the lungs.  It is not devastating to an older child or an adult because they have the capacity for a strong sneeze, and the ability to blow their nose to clear the congestion. 
 
An infant lacks both of these mechanisms to clear the fluid from their lungs.  Therefore, the fluid builds up and the breathing gets more and more labored.  As we found out, higher altitudes add additional stress to the lungs and cause them to fail faster.  What we believed to be a simple cold turned out to be RSV.  Our son’s right lung collapsed and he spent four days at Phoenix Children’s Hospital fighting for his life.
 
If you have had a baby within the last year, please take this information to heart.  Do not be afraid to tell people they cannot touch or hold your baby if you haven’t seen them wash their hands before asking or reaching for your child.  Be courageous for your child – you are the only one who can speak for them when they do not have words to protect themselves.  You can help them get through this season in good health with some simple precautions. For some communication ideas to use with family or friends, READ THIS.
 
RSV Disease Symptoms to watch for:
     -    Coughing or wheezing that does not stop
     -    Fast breathing or gasping for breath
     -    Spread-out nostrils and/or caved-in chest when trying to breathe
     -    A bluish color around the mouth or fingernails
     -    A fever: in infants under 3 months of age, a fever greater than
          100.4 deg F rectal is cause for concern
 
If you see your baby exhibiting any of these symptoms, get them to the pediatrician's office or to a care facility right away.  A swab test can be done to determine whether your baby has been infected with RSV.  Early treatment can head off the worst effects of this disease and shorten your hospital stay, if not avoid it altogether.
 
Precautions we learned the hard way:
Wash your hands thoroughly before touching your baby and ask others to do the same.  This is especially important if you have been out in public touching shopping carts or other high-touch surfaces (handrails, ATM's, refrigerator handles, doorknobs, computer keyboards, telephone handsets).  I included some tips for hand washing from WebMD at the end of this post.  Don’t have access to a sink before unloading your groceries or after handling cash?  Have hand sanitizer readily available – attach a bottle to your diaper bag or keep some sanitizing wipes in your car that you can use before touching your baby.
 
Do not let anyone smoke in your home, or near your baby.  Second-hand smoke irritates the lining of the lungs; specifically, it has been found to damage the surfactant that makes breathing possible. (See Link 2)  Damaging that lining on top of dangerous germs makes for a sick baby who can’t breathe well.
 
Wash your baby’s toys, clothes an bedding often.  In order to effectively kill germs, the water temperature needs to be between 140 – 150 degrees F.  Most people don’t turn their water heaters up that high, and even if they do, that water temperature is hard on fabrics.  If you can, use bleach with your detergent when you wash clothing and bedding.  If you prefer not to use bleach on fabrics, you can run a cycle with hot water and bleach to clean your washing machine after washing 3-5 loads of laundry.  This will kill the germs in the machine and theoretically you have cleaner clothes since you aren’t washing germy items in a germy machine.
 
Keep your baby away from people with colds, crowds and young children.  Keeping away from a person with a cold seems pretty obvious.  However, when that person with a cold is the loving relative who came all the way to see the baby, it is harder to say no.  Head off the uncomfortable situation by making it very clear that people need to be healthy when they come visit your baby.  We let people know that if they have been exposed to a person with a fever or have had a fever themselves in the 24 hours before coming to visit, we would appreciate seeing them another time. 
 
Crowds and young children follow from that idea.  It is impossible to know who has been exposed to what and when that exposure happened in both situations, so the best choice is to avoid them altogether.  As the respiratory therapist at Phoenix Children’s told us, “Don’t go to church or [insert big box store name here] during flu season” since people will go to both places whether they are sick or healthy, and both places are frequented by young children. Between poor hygiene habits and exposure to germs through toy and space sharing with other children, these kiddos are walking germ factories during cold and flu season.
 
My favorite way to kindly ask people to keep their hands off comes in the form of a sign from Healthy Little Ones.  Click here to see what this mom-preneur has to offer.
 
Change your clothes and wash your hands when real life interferes.  You will have to venture out to the grocery store at some point this season, and some of us still do our holiday shopping in high-traffic areas.  When you do have to go out, take precautions when you come home.  If possible, arrange for another parent or caregiver to stay with your baby when you need to go out.  Anybody who goes out should change all their clothes when they come back from shopping.  Here is the way it goes down at our house: once we get home, we strip in the laundry room and get the clothes into the washer.  Then we wash our hands and put on clean clothes.  It makes for extra laundry; however, we have been fairly fortunate in avoiding nasty colds the last couple of years.
 
I hope these ideas help you avoid any emergency room visits and/or hospital stays.  We wish you and your sweet pea good health this season.
 
Do you have any cold-prevention tips to share with us? Please help us add to our list by leaving a comment below.
 
 
From WebMD:
Washing your hands for cold prevention
  1. Wet your hands with water, then apply soap. CDC guidelines advise using a plain,
    non-antimicrobial soap (no antiseptic ingredients).
  2. Rub your hands together vigorously for 15-30 seconds. Wash the wrists, between the fingers, and under the fingernails. When you have time, use a nailbrush, as bacteria often hide under the nails.
  3. Rinse your hands thoroughly and dry with a clean towel in a public restroom, shut the faucet off with a paper towel.
  4. Try to push the door open with your shoulder, or use another paper towel to turn the knob.
 
What if you are not near a sink?
Keep an alcohol-based sanitizer for hands if a sink is unavailable. Rub your hands until they are dry.  The alcohol in the gel kills the germs on your hands.
 
Reference and Related Links:
(1) RSV Information
 
(2) Second hand smoke research
 
(3) Tips on washing your clothes and cleaning your washing machine
 
(4) WebMD on Handwashing
 
Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
 


 

Newborn jaundice

Posted on November 8, 2011 at 2:58 PM Comments comments (4)
We are back from our babymoon!  It has been a wonderful five weeks of enjoying our baby instead of doing all of the regular day-to-day activities.  I didn’t do any blog writing or homeschooling through this time…we are slowly getting back to our routine.  We have continued on with our class series and all of our students have seen our baby grow into her 12-pound, 1-ounce weight and 24 inch length in the last five weeks.  Breast-milk is nature’s perfect food!!
 
Which brings me to one of the topics that we covered briefly at the end of class last night.  One of our Coaches asked if we are going to spend some time talking about jaundice.  The topic of jaundice has actually affected the care and breastfeeding relationship of three students in the last six months, up from absolutely none since we started teaching.
 
As with many things involving pregnancy, labor and newborn care, it is imperative that parents do their research and know where they stand before they arrive at the hospital.  Although complications from jaundice are rare, true complications lead to irreversible neurological damage to the child.  Because treatment is available and the damage is preventable, charges of substandard care or neglect are plausible.  Thus hospitals and pediatricians are pro-active and aggressive in their treatment of jaundice.

I have to ask myself why I am seeing red instead of yellow when it comes to jaundice treatment.  Answer: because pro-active and aggressive care that is not truly medically necessary can separate babies from the nurturing breast of their mother and the loving arms of their parents.  This can have a long-term and possibly negative effect on the breastfeeding relationship and family bonding.
 
“Bilirubin is a yellow pigment that is created as the body gets rid of old red blood cells. The liver helps break down bilirubin so that it can be removed from the body in the stool.”  (See Link 1 below)
Bilirubin in and of itself is beneficial to the body.  It is a bacteriostatic agent, meaning that it stops bacteria from reproducing.  This is a good thing in a newborn’s body – we want bacterial growth to be inhibited in our precious babies, especially if they are exposed to hospital germs.  It is also an anti-oxidant that inhibits the growth of free radicals in the body.  Free radicals cause damage or death to a cell, so inhibiting their growth is again, a good thing.
 
The condition known as jaundice is diagnosed because the skin, and maybe the sclera (the “white of your eyes”), look yellow-tinged.  An excess of bilirubin causes the condition.  It takes a few days for the body to process bilirubin effectively, however, as the newborn gets their systems “on-line”, the liver becomes efficient at processing the bilirubin and the yellowish pigment of the skin and eyes goes away.
 
Jaundice can be considered pathologic or physiologic.  The distinction in diagnosing which type of jaundice your baby has is determined by when the jaundice is noted in the newborn. 
 
Pathologic jaundice, which occurs within 24 hours of a child’s birth, needs to be treated immediately to avoid the neurological injury called “kernicterus”.  Kernicterus happens when an accumulation of bilirubin in certain brain regions causes irreversible damage to those areas.  It manifests as various neurological deficits, seizures, abnormal reflexes and abnormal eye movements.
 
Physiologic jaundice, which occurs on or around the second or third day after birth, is not generally considered dangerous and occurs in almost all newborns.  In the case of physiologic jaundice, the bilirubin levels never rise to the point of causing permanent injury to the child.  The bilirubin functions, as it should: ridding the body of bacteria and free radicals, and eliminating them through the baby’s stools.
 
There are two ways to treat jaundice.  If bilirubin levels are on what your pediatrician considers a safe increase, phototherapy may be the treatment of choice.  If the bilirubin reading is borderline dangerous or at dangerous levels, a blood transfusion is the quickest way to reduce bilirubin levels; and more than one may be indicated.
 
As I read up on jaundice in preparation for writing today’s post, I was so glad to read that many medical professionals agree that there is NO REASON TO STOP BREASTFEEDING your baby.  I put it in caps because I feel it is important for parents to know they are supported in their right and their desire to breastfeed their child.  Breastfeeding is not the same as supplementing with breast-milk in a bottle, or substituting with inferior formula products.
 
Since this is not a medical blog, I am going to add in some vocabulary words that you may want to add to your list of “things to research”, and listen for them as your baby is evaluated for jaundice. I will close with an excerpt from a site that delineates when parents should be concerned, and with some suggested links to serve as a starting point for additional reading.
 
Exchange transfusion – used to rapidly remove bilirubin from circulation
 
Hyperbilirubinemia - increased levels of bilirubin in the extracellular fluid
 
Intensive phototherapy – uses blue light for treatment of jaundice – can be an “incubator” or a blanket (note: you could hold your baby on your lap if you use a blanket)
 
Phototherapy – standard treatment for jaundice: at home, daily exposure to indirect sunlight; in a hospital setting, most commonly uses fluorescent white light 
 
TSB – total serum bilirubin
 
Transcutaneous – noninvasive techniques for measuring bilirubin levels
 
Note:
If the bilirubin concentration is found to be greater than 10 mg/dL in a pre-term infant, or greater than 18 mg/dL in a term infant, additional testing will be done.  Here is a list of what those additional tests might be: Hct, blood smear, reticulocyte (red blood cell) count, direct Coombs’ test, G6PD test, TSB and direct serum bilirubin concentrations, and blood type and Rh group of infant and mother.
 
When you are evaluating what course of testing or treatment to follow for jaundice, remember the following assessment tool.  I included some sample questions for this situation.

“BAR”
B – Benefits:  What are the benefits of this test over the other available tests?
A – Alternatives: Are there any alternative tests we could consider if we feel this is too invasive or the risks are too great?
R – Risks:  What are the risks or side effects of the test you are recommending?  How do you do this test?  What else will you do - or can we expect to happen - to our child if we agree to this test?
 
Excerpts from “The Merck Manual” (See Link 4 below):
Red flags: The following findings are of particular concern:
  • Jaundice in the first day of life
  • TSB > 18 mg/dL
  • Rate of rise of TSB > 0.2 mg/dL/h (> 3.4 μmol/L/h) or > 5 mg/dL/day
  • Conjugated bilirubin concentration > 1 mg/dL (> 17 μmol/L) if TSB is < 5 mg/dL or > 20% of TSB (suggests neonatal cholestasis)
  • Jaundice after 2 wk of age
  • Lethargy, irritability, respiratory distress

Pathologic hyperbilirubinemia in term infants is diagnosed if
  • Jaundice appears in the first 24 h, after the first week of life, or lasts > 2 wk
  • Total serum bilirubin (TSB) rises by > 5 mg/dL/day
  • TSB is > 18 mg/dL
  • Infant shows symptoms or signs of a serious illness

Some of the most common pathologic causes are
  • Immune and nonimmune hemolytic anemia
  • G6PD deficiency
  • Hematoma resorption
  • Sepsis
  • Hypothyroidism
 
Links for additional reading:
 (1) US National Library of Medicine
 
(2) U of Iowa Info – with a CHART to help with evaluation of severity of jaundice
 
(3) Pediatrician’s Info – IN SUPPORT of breastfeeding
 
(4) The Merck Manual – Jaundice

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
 
Now enrolling for our
Winter Series
December 5, 2011 to
February 20, 2012
 
For more information or to register, please call us at
602-684-6567
or email us at [email protected]
 

Choosing a Breast Pump and Its Parts

Posted on October 28, 2011 at 2:28 PM Comments comments (0)
Breastfeeding 101 Series

Welcome to this month’s post from Debbie Gillespie, IBCLC, RLC.  You can find her at Modern Mommy Boutique on Monday mornings at 10:00 am for a FREE Breastfeeding Support Group, and she will also be featured here on the fourth Friday of every month.  Please see the end of the post for Debbie's contact information if you are interested in reaching her for more information, or to find registration information for her Breastfeeding 101 Class offered on the 2nd Saturday of the month (October 8, 2011).
 
To read Debbie’s previous posts, please click on the “Breastfeeding 101” link on the left side of the page.

Baby is coming soon and you find yourself standing in the breastfeeding products section of the giant baby store.  Should you buy a pump now or wait?  Which pump should you put on your registry?  What’s the difference between the $60 pump from one company and the $350 pump from another company?  What should you look for in a pump anyway?

Buying a substandard pump or using the wrong pump for the job can jeopardize mom's milk supply or even damage mom's breast tissue, and don’t expect the pimply-faced clerk to steer you in the right direction on this decision.  What’s worse, if you do happen to pick the wrong pump but don’t realize it until you already opened the package, you aren’t able to return it like you could a pair of shoes.  Following are some guidelines to picking the right pump for the job.

"Do I need a breast pump if I’m going to breastfeed?" 
Some women would say that a pump is absolutely essential to breastfeeding success.  Other women point out that mothers have been breastfeeding their babies for centuries without ever using a breast pump.  The United States has the highest number of pumping moms in the world because our maternity leave policies require mothers to return to work so quickly, compared with other countries.  Fortunately breast pump design has come a very long way in the past 30 years, and pumping is now more comfortable and efficient than ever before.  If you need to express milk from your breasts for any reason – separation, baby won’t latch, problems breastfeeding – a breast pump can be your best friend, especially if you will need more than the occasional bottle.

"When should I buy a breast pump?" 
Some women want to have a pump ready to go before baby is born, in case they want to pump to relieve engorgement in the early days, express milk for separation or “emergency milk” for the freezer, or because they plan to return to work soon after baby is born.  Other moms prefer waiting until baby is born to be sure they choose the right pump for the job, or even to be sure that they are going to breastfeed long enough to need a pump in the first place.  If you do get a pump before baby is born, remember that pumping prior to baby’s birth can induce labor, so set aside your new toy until baby is safely on the outside.

All brands are not created equally. 
Cheaper pumps may look appealing, especially if you are concerned about all the other expenses that come with a baby.  The problem with the cheaper pumps is that they tend to break down unexpectedly, may not even be effective, can even cause tissue damage, and don’t offer a variety of sizes of parts to fit each mother’s anatomy.  Any money saved by purchasing one of these pumps is going to be wasted on buying another pump after that one breaks, or – even worse – the many expenses of formula after your milk supply has crashed.  The only two brands that are reliable, efficient, and versatile are Ameda and Medela; steer clear of other brands.

"I’m staying home full-time with my baby." 
If you’re only planning to need one or two bottles a week, a manual pump like the Ameda One Hand pump or Medela’s Harmony will fit the bill.  Any fancier pump is a nice luxury but not essential.

"I’m going to be working part-time, a few days a week." 
A manual pump may work if separation is only going to be for just a few feedings per week.  A safer option might be an electric pump that only pumps one breast at a time, like Medela’s Swing pump.  This handy little pump, about the size of a donut, can even clip onto mom’s belt for portable use.  It would be nice for this mom to have a pump that expresses both breasts at the same time, but not absolutely required in most cases.

"I’m going to be working full-time, plus commute." 
A pump that will allow you to pump both breasts at the same time is essential with this level of separation, to make pumping fast and efficient, and to maintain milk supply while away from baby.  Medela’s Pump in Style Advanced or Freestyle, or Ameda’s Purely Yours Ultra will do well.  These pumps are designed for use once breastfeeding is going well, mom's milk supply is well established, and baby is nursing well at least half the time (four+ times a day).  If a mom finds that she is pumping more than breastfeeding, I would recommend upgrading to the hospital-grade pump to protect her supply.  FYI both the Ameda and Medela pumps offer an A/C adapter so mom can pump during her commutes to save time and boost milk supply.

"My baby was born early and is now in the NICU."
If baby is not latching at all (in the NICU, for example) or is not breastfeeding strongly immediately after birth, it's important to rent a hospital grade pump to do baby's job of establishing milk supply.  Other pumps do remove milk, but they also leave milk behind and can’t stimulate mom’s milk supply in place of baby.  A good double electric breast pump can run $200-$350 to purchase; a hospital grade breast pump costs about $1,500-$2,000 to purchase.  The first few weeks after baby is born are most critical to a good milk supply for the whole time you’re breastfeeding, so don’t gamble your milk supply on trying to use your store-bought pump to establish milk supply.  It’s like trying to ride a scooter from Phoenix to New York: it’s not impossible to be successful, but it’s not very likely.

Which brand of pump should I rent? 
Hospital grade pumps come in Medela and Ameda brands.  Moms tend to rent whatever they used in the hospital since they already have the parts and are comfortable with the pump itself.  All of the East Valley hospitals but Mercy Gilbert and Chandler use the Medela Symphony in the hospital; Mercy Gilbert and Chandler use the Ameda Elite pump.

Where can I rent a pump? 
Chandler and Mercy Gilbert hospitals do not rent any pumps.  Modern Mommy Boutique (www.ModernMommyBoutique.com), conveniently located in front of Chandler Mall, rents both Medela and Ameda pumps for excellent prices.  Banner hospitals rent pumps, making it convenient to come home with the same kind of pump used in the hospital.  Hospitals tend to run out of pumps to rent, so have a back-up source lined up if this happens.  Two local companies offer free pick-up and delivery: Anything for Baby (www.anythingforbaby.com) and Serenity Feeding (www.SerenityFeeding.com).

Does one size fit all? 
Pump parts come in different sizes because mommies’ nipples come in different sizes.  The part that goes against the breast is called the flange and looks like a funnel.  Flange fittings are important to mom's pumping success and comfort, but I see many poorly fitted flanges.  Unfortunately you can't just "eyeball" the mom's nipple size and choose a flange, because many women's nipples usually swell during pumping.  A fitting should include pumping for at least five minutes before deciding on a flange size; flange size has everything to do with the nipple and nothing to do with the areola or breast size, and rarely changes between babies.  Also, a woman could very easily use one size on one breast and one size on the other.  I often do flange fittings at my consultations, and urge moms to bring their pumps when we meet for consultations to be sure that they are using the right size parts.

Is there anything that can make pumping easier? 
Yes!  A dab of olive oil on the inside of the flange helps eliminate any friction before milk flows.  Fully adjustable pumping bands can hold the parts in place so that mom can pump hands-free.  She can use her computer, read a book, talk on the phone, eat lunch...and allow her body to let the milk flow.  The pumping band holds the flanges in place comfortably and securely, so mom doesn’t have to worry about using too much pressure on the flanges.  The pumping band also provides some coverage for modest pumping.  Some moms even pump their milk while commuting to and from work using the pumping band, using the A/C adapter available on some models.  A nursing shawl can provide an added layer of privacy.  Other things that can improve pumping include photos or audio files of your baby, massaging the breasts before and during pumping, and smelling something your baby has worn.

"I found this pump on Ebay…" 
A good quality breast pump is going to cost a few hundred dollars so it’s very tempting to borrow a used pump from a neighbor, or pick one up at a garage sale or off of Ebay.  You may think you only need to buy new tubing and pieces to the pump, but there is no way to sterilize the pump’s motor and it may be growing a jungle.  Also, even high quality breast pumps are going to eventually die, and you don’t know how many hours a second-hand pump has worked, or how long it will continue to work before it leaves you stranded.  Ask for one at your baby shower, put together gift cards, return baby shower gifts you really didn’t need…a new pump just for you is a wise investment.

Parenthood is a whole new world, and breastfeeding is just one neighborhood of that new world.  If you have any questions about anything before, during or after baby is born, contact an International Board Certified Lactation Consultant (IBCLC).  It’s better to ask than to worry and wonder.  The best thing you can do is enjoy your baby.

To read Debbie’s previous posts, please click on the “Breastfeeding 101” link on the left side of the page.
 
With questions about this post, or to contact Debbie for a consultation:
Debbie Gillespie, IBCLC, RLC
Registered with the International Board of
Lactation Consultant Examiners
(480) 786-0431
 
Breastfeeding 101 Class
Join Debbie for a 90-minute comprehensive breastfeeding class once a month (2nd Saturday - 11:00 am) at Modern Mommy Boutique for only $10/couple.
Call Modern Mommy Boutique for registration: 480-857-7187
3355 W. Chandler Blvd #3, Chandler, AZ 85226 
 
Disclaimer: 
The material included on this site is for informational purposes only.  It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.



New class starting
December 5, 2011
for families with due dates around or after
February 20, 2012

Call 602-684-6567
or email us at
for more information

Preparing Siblings for New Baby

Posted on October 4, 2011 at 12:04 PM Comments comments (0)

We are officially on our babymoon - we welcomed our daughter
Angélica
on Saturday morning.  More about her birth story will follow soon!  In the meantime, I want to thank my fellow Bradley Method® Instructor, Rachel Davis, AAHCC for providing today's blog post.
Rachel Davis, AAHCC is the mother of two joyful children, a son born naturally in the hospital and a daughter born in the water at home.  She is also a Bradley Method® instructor and birth doula in downtown Phoenix.  To contact Rachel, please visit www.birthandearth.com.


When we were expecting our first child my husband and I felt that the baby was “ours,” a sweet being converting us from Rachel and Mark to Mommy and Daddy.  We had a lovely little boy named Jacob and he was the light of our life.  When we were pregnant with our second child, the focus was more on the conversion of our son from Jacob to “big brother.”  We carefully prepared him for the arrival of his sister (born 33 months apart), using the following tips.  My hope is that they may also be helpful for your children!
 
Pregnancy
Consider your child’s developmental age and how they might grasp the concepts of the length of pregnancy and the possibility of loss.  We had already had a miscarriage and didn’t plan to announce our pregnancy until the end of the first trimester, but I chose to casually tell Jacob right away because it brought me comfort.  We explained that the baby would come, “in the summer when it is really hot outside.”

We used picture books to help explain the changes in Mommy and how the baby is growing.  At his tender age, our son didn’t inquire how the baby came to be in Mommy’s belly but we had an explanation ready if the question came up.  My little guy was very understanding of my morning sickness and pregnancy discomforts and even acted as a little nurse for me.

Care Provider
My husband and son attended almost all of my prenatal appointments and Jacob became close with our midwives.  Sometimes he enjoyed trying to help with the fetoscope and blood pressure cuff, while other times he would play with the train set in the office.  He would talk about the midwives at home and was very comfortable with them.

We decided what role we wanted our son to play in the birth of his sibling and discussed our preferences with our care provider.  In our case, we wanted our son to be present during the homebirth and we made the decision to hire a separate doula solely for the purpose of assisting Jacob whether he wanted to be with Mommy or be in another room.  Some families prefer to have the children waiting away from the birthplace so there are no distractions.  Do what is right for your family, but realize that the parents and care providers will probably not be in a position to care for the child during the labor and birth.

Baby Preparations
Some people like to involve their children in the selection of the baby’s name.  For example, Krystyna and Bruss’ daughter helped to select the name of her baby sister.  In another example, our nephew pulled his sister’s name out of a hat when his parents couldn’t agree.  Some children like to give the baby a nickname during pregnancy, such as “Grape” or “Peanut.”

I involved Jacob in all of our physical baby preparations such as washing clothes and diapers, installing the car seat, gathering the infant toys, etc.  As we worked I explained where everything was going to be kept, what was off-limits to him, and shared memories of using each item with him when he was a baby.

We also discussed age-appropriate ways in which our son would participate in baby care activities.  We picked out a doll for him so he would have someone to diaper, wear in a sling, and even nurse (yes, he “breastfeeds” his doll!).  He practiced holding his baby cousins and we pointed out other kids who were big brothers and big sisters.

Birth Day
During your pregnancy, discuss the details of birth that you feel are important to share with your child.  If they will not be present for the birth then they may be comforted by knowing what Mommy and Daddy will be doing.  If they will be present for the birth then it would definitely benefit them to know what to expect.  Reading or telling birth stories (especially featuring siblings) and sharing birth videos are helpful tools.  Why not tell your child’s birth story and show their birth video?  Being a Bradley® instructor, I had plenty of birth videos on hand and my son enthusiastically requested to watch one every day of the last trimester.  As a matter of fact, our 2.5-year-old son was so well-educated that he once told a stranger, “The baby is in Mommy’s uterus and when it is born it will come out of the vagina!” 

Whether they will be present with you or not, it may be helpful to give your child a tour of your intended birthplace.  (Use discretion, you know whether your child will find fear or comfort in seeing the hospital or birth center where you’ll be.)  Explain at an age-appropriate level what will be happening.  If you are planning a homebirth then explain what rooms you are planning to labor in, where the tub will be (if you are renting one), and other info of interest to them.  We had a blessingway in our home and my husband and son participated in the blessing and watched as our tub received special words of intention, as that was where we planned to (and did) have the baby.

If your child will be present for the birth, make plans ahead of time so you and your birth team know what the little one’s role will be.  Would you like the child to cut the cord, or even catch the baby?  Perhaps your child will be in the tub with you, take photos, or rub Mommy’s back during a contraction?  Our son was very intrigued by the placenta and was an enthusiastic observer for the placenta print process.

Of course, be flexible and know that plans may change based on the child’s (or your) needs in the moment, and that is okay.  For myself, I found peace of mind in creating a back-up plan for our son.  We intended for him to be at the birth but if it didn’t work out then he was going to go to a relative’s house.  One family we know had a list of people to watch their two children during labor and birth and at 3:00am they called three people on the list, went to voice mail three times, and finally the fourth person picked up the phone and came over to provide childcare.  Have a back-up plan!

Regardless of whether your child will be present with you or not, I love the suggestion of packing a labor bag for the older sibling.  (Thanks to fellow Bradley® teacher, Wendy Diaz, for the idea!)  We had a bag packed with inexpensive toys, activities, and healthy snacks all individually wrapped and intended to be distributed at intervals throughout the birth.  Kids always enjoy opening a package and this can keep them occupied for a good amount of time.

After Birth
Consider having gifts for your children to exchange with one another.  Some children enjoy picking out a present for their new baby sibling.  In our case, I bought a special gift for Jacob (Duplo blocks) and hid it until the day after the baby’s birth.  As we snuggled together as a family of four, I pulled out the gift and explained that the baby, Leila, had brought this special present for Jacob.  It was a small token but it helped things get off to a good start.  While on the topic of gifts, another common suggestion is to have a few little things stashed away for times when guests come to meet the new baby and bring a present for the baby but not for the sibling.  We had Jacob open many of Leila’s gifts and he now enthusiastically picks out her outfits every morning.

Be prepared for a change in your family’s routine, and clear your schedule to accommodate the needs of a newborn.  You may need to take a break from XYZ activity that your older child was involved with.  Your children need a well-rested mother more than they need to go places.  It isn’t worth the stress on your family to try and operate at the same level you were on before the baby, and in time you will be in a new routine.  While you are at it, make plans with friends and family to take your older child on special outings after the baby’s arrival.  This is a great opportunity for Coach to step up and take on some additional childcare responsibilities while Mommy is on a babymoon.  You’ll appreciate the opportunity to snuggle with your newborn and nap, and your older child will be thrilled to have the spotlight on them for a little while.

Consider the language you use when talking about your children.  Talk about, “our new baby,” or, “Jacob’s little sister,” rather than exclusionary terms such as , “Mommy’s baby.”  When people compliment your new baby, proudly point out what a great big brother/sister the baby has.  Brag about your older child while they are within earshot.  On the flip side, know when it is time to change the subject and talk about something else that isn’t baby-related. 

Lastly, don’t expect everything will be perfect.  Despite your best intentions and efforts, your older child may experience jealousy or negative feelings about the baby.  Find healthy avenues for expressing these feelings (discussion, art work, or even hitting a pillow to get the frustration out).  Don’t overestimate your child’s developmental capabilities and behavior; your newborn’s safety comes first.  In our case, we are teaching our son to ask Mommy or Daddy for permission before he hugs or kisses his baby sister because he doesn’t quite understand how gentle he needs to be.  He is also never left alone unsupervised with the baby. 

Do you have any favorite tips for preparing children for the birth of a sibling?


Additional Resources
Friday's blog post will feature a list of picture books that may be of interest to children.

Preparing Your Family for a New Baby


American Academy of Pediatrics website with advice broken into different age categories.

 
Children at Birth by Marjie and Jay Hathaway
Book written by the couple who wrote The Bradley Method® curriculum.  Specifically intended for as a guide for preparing children who will be attending the birth.  This book is out of print but I was able to check it out through the Inter-Library Loan program.

 
About the author:

Rachel Davis is the mother of two joyful children, a son born naturally in the hospital and a daughter born in the water at home.  She is also a Bradley Method® instructor and birth doula in downtown Phoenix.  To contact Rachel, please visit www.birthandearth.com.
Rachel's next Bradley Method® series will be offered on Tuesday evenings from January 10, 2012 through April 3, 2012.


Disclaimer:
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.



Now enrolling for our
Winter Series
December 5, 2011 to
February 20, 2012

Mondays @ 6:30 pm

Call 602-684-6567 or
email us at