Women in Control of Epidural During Labor Use 30% Less Anesthesia


Epidurals have become the “drug of choice” in maternity wards across the United States. As of 1997, “nearly two-thirds of all women who give birth in hospitals with high-volume obstetric units had an epidural during labor. In many hospitals, epidural analgesia is routine and is provided to more than 90 percent of all women who are in labor in that hospital.” Yet epidurals are not without potential risks for both mother and baby, which is part of the reason the findings from a new study on laboring women are so promising.

new study reports laboring women given control over their epidural anesthesia resulted in a 30 percent reduction of the amount of anesthesia used and were “basically as comfortable” as women on a continuous dose. Researchers also report a trend toward fewer deliveries that required instrument assistance, such as forceps, in the patient-controlled group.

Dr. Peter Benstein, a professor of clinical obstetrics and gynecology and women’s health at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, said:

“My personal belief is that epidurals tend to slow labor down. So, if you can get away with less medication with patient-controlled analgesia, I think it’s a wonderful thing.”

“And, it’s not a surprise to me that women used less anesthesia. If you can titrate your own medication, you’re probably not going to give yourself a lot. An anesthesiologist will tend to give you a little bit more because they want to make sure there’s no pain.”

The author of the study is Dr. Michael Haydon, a perinatologist at Long Beach Memorial Medical Center in California.

Generally, epidural anesthesia is given on a continuous basis, according to Haydon. But patient-controlled devices that can control delivery of the anesthesia are widely available, he added. Patients are given a button to push when they feel they need more medication. The devices are programmed to only provide a specific amount of medication for specific time periods to ensure that people don’t give themselves too much.

The study randomly selected first-time mothers for one of three groups: “the standard dose given as a continuous infusion; a continuous infusion with an additional patient-controlled option; and patient-controlled anesthesia only.” The first group used an average of 74.9 mg of anesthesia during labor. The second group used an average of 95.9 mg, while the patient-controlled group used the least anesthesia of all, an average of 52.8 mg, according to the study.

Women in the patient-controlled group did report slightly higher pain scores when they got to the pushing part of the delivery, but also reported being satisfied with their pain relief overall.

Women’s Views On News says:

This is good news because epidurals, despite having made labor more bearable for scores of women, have their pitfalls: they can lead to prolonged labor and an increase in vacuum and forceps deliveries. They can also result in more C-sections, which is far from ideal.

Rebecca on Babble writes:

Less meds with the same level of relief? What’s not to like here? A lower dose of medication with adequate pain management would benefit both moms and babies. I find this study so exciting because it opens up new possibilities for women as active participants, not just passive patients, in hospital births. It’s ideas like these that may help us progress toward a hospital birth model that takes into account the needs of both babies and the mothers who give birth to them.

Laura Nelson at Think Baby writes about the study’s findings and how they might impact maternity care in the United Kingdom.

Patient-controlled epidural analgesia is currently only available in one-fifth of hospitals in the UK due to the expensive costs of the equipment needed. Experts are now looking into whether the positive effects outweigh the costs.??“The technique reduces the need for anaesthetic which in turn reduces the need for forceps delivery – and it gives women a feeling of control. The question is whether the small clinical advantages are enough to justify the cost of new equipment and staff training,” Dr Elizabeth McGrady, a honorary clinical lecturer in anaesthetics at Glasgow University said to the BBC.

Personally I’m all for empowering women to be, as Rebecca said, “active participants” in hospital births. Although I did not have an epidural with either my daughter’s hospital birth or my son’s home birth, there was a point during my induced labor with my daughter that an option like this would have appealed to me (had I not had complications including low platelets that prevented me from getting an epidural anyway). I hope this study leads to hospitals adopting patient-controlled epidurals as standard practice for women who choose to have epidurals.

Related links:

  • Over at Women’s Health and Pregnancy, there’s an informative post with diagrams and pictures about how an epidural is given, as well as the pros and the cons.
  • At Anticipation and Beyond, there’s another informative post about the dangers of epidurals. The author writes, “This blog isn’t to insult those who have made this choice, but to increase your knowledge, so you can make informed choices for the future.”

Photo credit: Women Health and Pregnancy

Cross-posted at BlogHer

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Americans STILL Aren’t Eating Their Veggies

Last month, The New York Times reported that despite 20 years of “public health initiatives, stricter government dietary guidelines, record growth of farmers’ markets and the ease of products like salad in a bag, Americans still aren’t eating enough vegetables.”

The Centers for Disease Control and Prevention issued a comprehensive nationwide behavioral study of fruit and vegetable consumption. Only 26 percent of the nation’s adults eat vegetables three or more times a day, it concluded. (And no, that does not include French fries.)

These results fell far short of health objectives set by the federal government a decade ago. The amount of vegetables Americans eat is less than half of what public health officials had hoped. Worse, it has barely budged since 2000.

The government recommends four and a half cups of fruits and vegetables (which equals nine servings) for people who eat 2,000 calories a day.

People know that vegetables are good for them and can improve health, but they are also seen as a lot of work and have a much quicker “expiration date” than processed foods. Even if you buy veggies with the best of intentions, if you don’t consume them fast enough, they are doomed to rot in your refrigerator. I think this is something we’ve all been guilty of at one time or another. A survey of 1,000 Americans conducted by White Wave Foods indicates that almost half of us leave our fruit in the refrigerator until it rots. I can only assume that even more vegetables suffer a similar fate.

At Mother Nature Network, Katherine Butler asks, “what is the price of not eating vegetables?”

Mostly, it means that Americans are lacking in vital nutrients. Antioxidants and fiber fill vegetables, as well as key nutrients such as potassium, beta-carotene, iron, folate, magnesium, calcium and vitamins A, C, E and K. Fiber can reduce cholesterol; potassium, found in foods like spinach, helps blood pressure. Vitamin C helps gums and teeth, while vitamin E fights against premature aging.

Apparently, orange veggies are something we should be focusing on too. According to The Ohio State University Extension blog:

Orange vegetables, like pumpkin, squash, carrots, and sweet potatoes contain nutrients and phytonutrients found in no other group of vegetables. That’s why experts recommend we eat at least 2 cups a week of orange vegetables. How many do you eat? If you’re not eating enough, now is the perfect time of year to start!  All types of winter squash — acorn, butternut, hubbard, etc. are in season and cheap.  Pumpkins and canned pumpkins are stocking the shelves. Carrots and sweet potatoes are found commonly throughout the year.

I’m not sure there’s a solution for getting adult Americans to consume more vegetables. They know they are healthy, but they still don’t eat them. Even with convenient options like prepackaged servings of broccoli and bagged salads available, they aren’t biting (pun intended). Until Americans make eating vegetables a priority, it’s not going to happen. After all, you can’t force feed them. Maybe we could hide vegetables in french fries? Hmm. Probably not. Although that is a technique some people use to get children to eat their veggies (remember Jessica Seinfeld’s book Deceptively Delicious?), though not everyone agrees with it.

Organic Authority points out the important of fruits and vegetables for children. “A diet high in fruits and vegetables is important for optimal child growth, maintaining a healthy weight, and prevention of chronic diseases such as diabetes, heart disease and some cancers—all of which currently contribute to healthcare costs in the United States,” says William H. Dietz, MD, PhD, director of the CDC’s Division of Nutrition, Physical Activity and Obesity.

Lisa Johnson mentions that some high schools have added baby carrot vending machines next to the typical junk food machines and wonders if the packaging (designed to look similar to a potato chip bag) will entice kids to buy them. Lisa says, “I have to say I think it’s a good idea. It might seem a little condescending to some but we are visual creatures and we react positively to colorful items that grab our attention while glossing over the ho-hum stuff. Shouldn’t we just capitalize on human nature to achieve a greater good?”

The Huffington Post reports “The U.S. Department of Agriculture recently announced what it called a major new initiative, giving $2 million to food behavior scientists to find ways to use psychology to improve kids’ use of the federal school lunch program and fight childhood obesity.” Some schools are employing psychology tricks in hopes of getting teens to make healthier lunch choices in the cafeteria. Cornell researches have dubbed these little tricks a success: “Keep ice cream in freezers without glass display tops so the treats are out of sight. Move salad bars next to the checkout registers, where students linger to pay, giving them more time to ponder a salad. And start a quick line for make-your-own subs and wraps, as Corning East High School in upstate New York did.”

Perhaps the veggie avoidance can be traced back to infancy. I wrote in 2007 about a study that showed breast-fed babies are more likely to like fruits and vegetables (if their mother ate them while breastfeeding) than their formula-fed counterparts.

Senior author of the study Julie A. Mennella, PhD said, “The best predictor of how much fruits and vegetables children eat is whether they like the tastes of these foods. If we can get babies to learn to like these tastes, we can get them off to an early start of healthy eating. … It’s a beautiful system. Flavors from the mother’s diet are transmitted through amniotic fluid and mother’s milk. So, a baby learns to like a food’s taste when the mother eats that food on a regular basis.”

However, regardless of whether your baby is breast-fed or formula fed, the article points out the importance of offering your baby “plenty of opportunities to taste fruits and vegetables as s/he makes the transition to solid foods by giving repeated feeding exposures to these healthy foods.”

What’s the answer to get Americans to eat their veggies? I vote for focusing on the children. Perhaps if Jamie Oliver’s Food Revolution continues, not only will children start eating healthier, but their new habits may rub off on their parents too.

Photo via Masahiro Ihara on Flickr

Cross-posted on BlogHer.

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BPA Exposure ‘Much Higher’ Than Believed & Proposed BPA Ban

Bisphenol-A or BPA — a chemical used primarily to make plastics — has been under scrutiny in the United States since 2008 when its safety was called into question. Most recently, a study published Sept. 20 in the online NIH journal Environmental Health Perspectives “suggests exposure to BPA is actually much greater than previously thought and its authors urge the federal government to act quickly to regulate the chemical that is found in baby bottles, food-storage containers and many household products.”

One of the researchers, Frederick vom Saal, professor of biological sciences at the University of Missouri, said in a news release that the study “provides convincing evidence” that BPA is dangerous and that “further evidence of human harm should not be required for regulatory action to reduce human exposure to BPA.”

According to a New York Times article, the U.S. Environmental Protection Agency says “it is OK for humans to take in up to 50 micrograms of BPA per kilogram of body weight each day. The new study, published in the journal Environmental Health Perspectives, suggests that we are exposed to at least eight times that amount every day.”

In August, Canada placed BPA on a toxic-substance list under the Canadian Environmental Protection Act. The country first banned BPA-containing plastic baby bottles in 2008, “but the new move will see BPA removed from all products on store shelves. As a result, Canada will become the first country in the world to declare BPA as a toxic substance.”

Five states in the USA – Connecticut, Massachusetts, Washington, New York and Oregon – have limits on BPA, particularly in children’s products, but California state legislature recently failed to pass a bill that would have eliminated BPA from baby bottles, sippy cups and infant formula cans.

Senator Dianne Feinstein (D-CA) believes BPA should be legislated on a national level and wants to amend the Food and Drug Administration Food Safety Modernization Act currently under consideration in the Senate to ban BPA from children’s food and beverage containers. However, Republicans and industry representatives are pushing back, saying that research hasn’t conclusively proven that the chemical is harmful. Sen. Feinstein said, “In America today, millions of infants and children are needlessly exposed to BPA. This is unacceptable. If this isn’t a good enough reason to offer an amendment, I don’t know what is.”

What is BPA and Why Should You Care?

Bisphenol-A is “a synthetic estrogen used to harden polycarbonate plastics and epoxy resin.” It is found in many plastic containers as well as in the lining of canned goods. According to the Environmental Working Group:

Over 200 studies have linked BPA to health effects such as reproductive disorders, prostate and breast cancer, birth defects, low sperm count, early puberty and effects on brain development and behavior. BPA leaches from containers like sippy cups, baby bottles, baby food and infant formula canisters into the food and drink inside where it is then ingested by babies and children. The CDC found BPA in 93 percent of all Americans. Just last year EWG research revealed BPA in umbilical cord blood of newborns, which demonstrates that babies are exposed to this toxic chemical before they are born.

The Environmental Working Group has some tips to avoid exposure to BPA. Raise Healthy Eaters also has a post about How to Become a BPA-Free Family. Maryann Tomovich Jacobsen, a registered dietician, recommends things such as:

  • Switching from plastic food storage containers to glass
  • Reducing your canned goods use
  • Using stainless steel water bottles and more.

Take Action:

If you’d like to urge your Senators to support the FDA Food Safety Modernization Act and Senator Feinstein’s amendment to ban BPA in baby bottles and other children’s products, you may send them an email.

Related Posts:

Photo via nerissa’s ring on Flickr

Cross-posted on BlogHer

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Preparing for a Wedding vs. Preparing to Give Birth – How Much Time Do You Invest?

I read a Tweet this week by Kristen (@OmahaBabyLady) that made me take pause. She said, “Why will people plan for a year for their wedding but 12 weeks of childbirth classes is too long? WTF?” I’d never thought of it in that way before, but it resonated with me. Many people spend a year or longer planning and preparing for their wedding, but how much time do they spend preparing for the life-changing and life-giving event of giving birth to their child?

Kristen, who is a Bradley childbirth educator and doula, was prompted to Tweet and blog about this after a potential client reacted to the news that the birth classes Kristen offered would be 12 weeks long. “Twelve weeks!,” she exclaimed. “You expect me to spend 12 weeks on something so simple as giving birth?” Kristen was at a loss for words and reflected on this for a few days before she made the analogy between preparing for a wedding and preparing for a birth. She said on her blog Baby’s Best Beginning that she planned for her wedding for more than 15 months, including visiting wedding message boards, interviewing people and spending “countless hours agonizing” over all of the details and says most of the people she knows did/do the same. “Of course at the end of the day all that really matters is that they are able to marry their partner but very few people say ‘well, the minister/priest/rabbi etc. is the expert on marriage I will just do whatever they say in regards to my wedding,’ yet when it comes to birth so many couples simply defer to whatever their doctor tells them is best even when there is no medical evidence supporting those choices.”

So is 12 weeks too long to spend preparing to give birth? Kristen obviously doesn’t believe so. She feels, “When it comes to bringing your child into the world this is truly not a case of less is more.”

Not everyone agrees though. @SybilRyan argues that the two events (wedding and birth) are “not even remotely similar” and shouldn’t be compared. Genevieve is taking Bradley classes now and thinks 12 weeks is too long, but eight weeks would be perfect. “I love my teacher, the other parents, etc., but 12 weeks is a really long commitment when you have so much else to do to prepare for your baby.” @Reecemg who blogs at Metagestation said she took an eight-week class and it was the perfect length. Others, such as Heather who blogs at Christian Stay At Home Moms thinks an intensive four to six hour one-day class would be good, as “its difficult to find time to go to a class 1x per week for 12 weeks.”

Mary, who blogs at One Perfect Mess, said on Twitter, “The length [of the class] probably depends on the quality. For us four meetings was plenty.”

Merry With Children also commented on Twitter and said, “I know there are things to learn but so much of it [birth] is going to go how its going to go. Too much info is just scary.”

Rebecca thinks people put more time preparing for their wedding than childbirth for exactly that reason — fear. She commented on Twitter, a “wedding is fun, childbirth is scary. ‘Experts’ will take care of everything when you show up at hospital.”

Andi who blogs at Confessions of a Judgmental Hippy agrees with Kristen and thinks, “if a woman can commit to 12 prenatal appointments (average) then 12 weeks (sessions) of [childbirth education] should be easy.”

Whitney blogs at The (Un)balancing Act of Motherhood took Bradley classes and thinks the length of time was “perfect,” although admits she gave birth before attending the last two classes. She added, “I can’t imagine learning about what happens in birth, what to expect, what to do, etc. in one class or even four classes. But like I said, that’s just me. Others would be fine with one or four classes.”

What do you think? Can the two events – a wedding and a birth – be compared? What is the “right” amount of time to prepare for giving birth?

I planned for more than a year for my wedding, and although I didn’t attend a 12-week Bradley Method session, I feel like I put a good deal of preparation into childbirth. I took Hypnobirthing classes before my first child was born, which were six two-hour classes if I remember correctly. I also read a lot and practiced the Hypnobirthing techniques.

I agree to some degree with Merry With Children in that no matter how much one prepares, birth is “going to go how its going to go.” But I also think the more you know and understand about birth, the better informed you will be to make choices along the way. Knowledge is power.

Photo credits:
Bride – http://www.flickr.com/photos/diannadesign/486944603/
Maternity – http://www.flickr.com/photos/mcgraths/3656184801/in/photostream/

Cross-posted on BlogHer

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FOX News says Infant Co-sleeping Deaths Linked to Formula Feeding

The internet has been abuzz lately about a recent FOX News report that has linked co-sleeping deaths to formula feeding. The report, which I found to be quite balanced (though somewhat sensational), is based on a number of co-sleeping or bed sharing deaths in the city of Milwaukee and the city’s message that there is no such thing as safe bed sharing.

I first read about the report from a Tweet by Allie from No Time for Flash Cards. Annie from PhDinParenting quickly posted the FOX News video for all to view and discuss.

The City of Milwaukee Health Department is currently running this ad – with a headstone in place of a headboard – to discourage ALL parents from co-sleeping with their babies. “For too many babies last year, this was their final resting place.” I guess they figure fear mongering is better than educating. As a mother who made an educated decision to co-sleep with my children, I find it quite offensive.

Then there is a TV ad that the state of Indiana is running (more fear mongering) to convince parents that they only place a baby should sleep is in a crib which is plain disturbing.

The FOX News report does a good job of representing both sides of the co-sleeping debate and even interviewed Dr. James McKenna, who literally wrote the book on safe co-sleeping.

The report revealed (although not until the very end of the video) a surprising finding, that in all of the Milwaukee co-sleeping cases they reviewed for 2009 and so far in 2010, 100% of the babies were formula fed. McKenna predicted the outcome and even goes so far as to state, “I really actually think that breastfeeding is a prerequisite for bed sharing.”

The blogger at The Babydust Diaries qualifies the formula finding:

This isn’t to say that the formula caused the death or that formula fed parents don’t care but there are some specific circumstances that can make these kids more prone to bed-related deaths2. The video mentions positioning and waking of the mother but also the frequent wakings of the child. Formula takes longer to digest and thus those children sleep for longer stretches than breastfed babies and often sleep deeper – causing an increase in SIDS deaths as well.

The Fearless Formula Feeder wrote about her thoughts on the Fox report in Cosleeping and formula feeding: a tale of two scapegoats. She particularly took offense at “the immediate and inaccurate battle cry against formula and formula feeding” on Twitter. She suggests rephrasing Tweets from things like:
“FORMULA FEEDING, not alcohol or soft bedding, at root of bed-sharing baby deaths!”
and
“Formula feeding was the common factor in these poor babies’ deaths!”
to:
“Breastfeeding could protect against cosleeping deaths”
or
“Formula feeding parents should be alerted to cosleeping risks”

The Fearless Formula Feeder adds:

If you watch the video, it is clear that bottle feeding was indeed associated with 100% of the cosleeping death cases in Milwaukee. …

However, the sensationalist news report also mentioned, in passing, some other important factors. Like that the majority of the babies lived in low-income, black families. And that 75% lived in households where smoking was a factor, and many had parents who engaged in drug use or drank frequently. Or that a number of the cases, though originally classified as cosleeping deaths, were later ruled as other causes of death, like SIDS.

Although the City of Milwaukee Health Department would like it to be a black and white issue, there are clearly shades of gray. The medical examiner reports in Milwaukee County showed that the vast majority of co-sleeping deaths were African-American babies living in what the Black Health Coalition calls “chaotic homes.” McKenna agrees that there is an “overwhelming predominance of deaths in the lower socioeconomic environment.” Yet the city refuses to acknowledge and address the complexities.

The Baby Dust Diaries blogger commented on this as well:

The other issue brought up in the piece is about socioeconomic status. Statistically, more bed-related deaths occur in poorer and often unstable homes. Once again this is a correlation not a causal relationship. I was flabbergasted at the health department woman’s assertion that she shouldn’t even have to think about different types of people. Seriously? How do you serve a population and remain blind to the demographics? I really liked the woman from the community program [Black Health Coalition]. She, correctly, points out that ignoring the reality of the situations at home only drives these already under-served people further away from the services that can help them.

She also points out that there’s a difference between a mom who brings her baby into bed as a last resort and falls asleep and a mom who has done her research and knows how to safely bed share – like she did, as did I. “It isn’t a last resort of the exhausted, but a well-thought out, planned, and safe situation.”

So is it fair, as the city of Milwaukee and the state of Indiana suggest, to say nobody should ever co-sleep? Or how about what James McKenna said, that only breastfeeding moms should be allowed to co-sleep? Or should we instead try to raise awareness about the risks AND benefits of co-sleeping for both breastfed and formula-fed babies and the increased risk for formula-fed babies so that parents can make decisions based on research rather than on fear?

For more information about safe bed sharing, visit:

Cross-posted on BlogHer

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Cesarean Awareness Month: Why is it so hard to get a vaginal birth?

April is Cesarean Awareness Month. You may wonder why an entire month needs to be devoted for raising awareness about c-sections. Here’s why. The c-section rate in the United States is on the rise at an alarming rate. It’s estimated that in 2008 over 1.3 million babies in the US were born by c-section, accounting for 32.3% of all births. It also marks the 12th consecutive year the Cesarean birth rate has risen, despite a number of medical organizations — including The World Health Organization (WHO) and American Congress of Obstetricians and Gynecologists (ACOG) — urging medical care providers to work on lowering the Cesarean birth rates and increase access to Vaginal Birth after Cesarean (VBAC).

Cesarean Awareness Month - April

My Gentle Birthing Blog discusses that while VBAC is often suggested as an option to a woman who has had a c-section, in reality, VBACs are hard to come by due to the fact that many hospitals no longer allow them.

According to the National Center for Health Statistics, the C-section rate in the United States has risen 53% since 1996. Cesarean birth is being overused, and VBAC (Vaginal Birth After Cesarean) is being grossly underused, at about 8%, because many hospitals are outlawing VBACs. Because of bans on VBACs, women have been denied access in over 40% of hospitals in the United States. The National Institutes of Health has found that VBACs are reasonably safe for women who had a previous cesarean birth and are low risk for uterine rupture.

Andrea Owen says, “Fighting for my own VBAC has changed my life. I don’t use that term very often, only when I truly mean it. It opened my eyes up to the world of American obstetrics, and how far we’ve come away from birth as a natural process. In my opinion, we’ve shoved a big, fat middle finger in Mother Nature’s face.”

And in the sometimes the truth is stranger than fiction category, the Keyboard Revolutionary wants to know how it is that “a woman can waltz in off the street, say she’s pregnant and wants a Cesarean, and everyone leaps to her command….yet a woman who IS pregnant has to jump through hoops and fight tooth and nail just to give birth vaginally?” Yep, in 2008 in Fayetteville, NC, a woman who was NOT even pregnant was given a c-section.

So how can a woman avoid a c-section in the first place? Knowledge is power. Here is a list of Five Essential Questions to ask your care provider. My Gentle Birthing Blog also has a list of the risks with cesarean birth as well as a list that might help you avoid having your first c-section.

On Live Your Ideal Life guest blogger Pamela Candelaria who writes over at Natural Birth for Normal Women discusses the risks of a c-section as described on a typical consent form and says, “what isn’t on the form may be surprising.”

Heather of A Mama’s Blog provides a lot of information about The Reality of C-sections.

And Breastfeeding Moms Unite posted What to Expect of Your Body after a C-section.

Bellies and Babies has a great round up of posts in honor of Cesarean Awareness Month.

There is one victory worth celebrating regarding Cesarean birth and women’s health in general. Thanks to the Health Care Reform, c-sections, giving birth and domestic violence can no longer be considered pre-existing conditions and used to deny insurance coverage. It’s a step in the right direction, but so much more needs to be done to lower the c-section rates and allow women access to VBACs, so that they don’t have to travel 350 miles just to have a vaginal birth. And that’s why an entire month is needed to raise awareness about cesarean sections.

Additional resources:

Photo credit: Flickr – Grendellion

Cross-posted on BlogHer

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Health Care Reform Lends Support to Breastfeeding Moms, But Is It Enough?

If we’ve heard “breast is best” once, we’ve heard it a thousand times. Health experts agree the benefits of breastfeeding for both the baby and the mother are numerous. A study published earlier this week by the journal Pediatrics points out just how valuable breastfeeding can be. “If 90 percent of new moms in the United States breastfed their babies exclusively for the first six months, researchers estimate that as many as 900 more infants would survive each year, and the country would save about $13 billion in health care costs annually.”

It seems that while everyone gives lip service to the importance of breastfeeding, there isn’t a lot of support for women once they make the decision to breastfeed. Women have been asked to cover up or leave restaurants, water parks, airplanes, and stores when they try to give their baby what’s “best.” Maternity leave in the United States is, at best, 12 weeks. Women who work outside the home have often been forced to pump their breast milk in bathroom stalls, hide under a desk, or sit in their car just to get a little bit of privacy because rooms for nursing/pumping mothers just don’t exist. So yes, breast might be best for baby, but until there are more regulations in place that allow moms to breastfeed without so many roadblocks, how can breast be “best” for moms?

There is, however, a bit of good news on the horizon. Health Care Reform is lending some support to breastfeeding moms with the Reasonable Break Time for Nursing Mothers law.

  • Section 4207 of the Patient Protection and Affordable Care Act (also known as Health Care Reform), states that employers shall provide breastfeeding employees with “reasonable break time” and a private, non-bathroom place to express breast milk during the workday, up until the child’s first birthday.
  • Employers are not required to pay for time spent expressing milk, and employers of less than 50 employees shall not be required to provide the breaks if doing so would cause “undue hardship” to their business.

Tanya from The Motherwear Breastfeeding Blog thinks this is a step in the right direction. “I’m not thrilled that it extends the right for only up to 1 year (I pumped longer for my son), but what a huge difference this would make for mothers in the many states, mine included, that do not extend this right under state law!”

Currently, only 24 U.S. states, Puerto Rico, and the District of Columbia have legislation related to breastfeeding in the workplace. Yet women now comprise half the U.S. workforce, and are the primary breadwinner in nearly 4 out of 10 American families. The fastest growing segment of the workforce is women with children under age three.

Doula-ing is excited about the new law and calls it “a giant leap forward for mother’s who want to continue to breastfeed their babies once they return to work.”

Kim Hoppes, who doesn’t appear to be a fan of Health Care Reform is, however, pleased with this change. “Well, something good came out of the health care reform nightmare. Places now have to give breaks to nursing moms so they can pump.”

Lylah from Boston.com Moms seems to think the new law is not enough and asks, “How can we expect 90 percent of new moms to breastfeed without support in the workplace?”

One thing seems pretty clear: If it’s in the country’s best interests to have new moms nurse their infants exclusively for at least six months — and the billions of dollars in health care savings indicates that it may be — then new moms should get at least six months of paid leave in which they can do so. The United States and Australia are the only two industrialized countries in the world that do not offer paid maternity leave. And moms in the Outback have a sweeter deal than we do: In Australia, your job is protected for a year, but in the United States new working moms only get that guarantee for 12 weeks.

What do you think about the Reasonable Break Time for Nursing Mothers law? Is it too much? Not enough? Just right? None of the government’s business?

Photo credit: http://www.flickr.com/photos/tundakov/2550864384/

Cross-posted on BlogHer.

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Potty Learning with Patience and Praise

Like most everything related to parenting, when it comes to potty learning (or training) there is not a one size fits all approach. Just as every child is different, every family is different and what works best for one will not work for another. However, since potty learning is a hot topic in our house these days, I thought I would share what we have found to work best for us.

When it comes to potty learning and my kids, I approach it similarly to the way I approach weaning from the breast. I trust that when the time is right and the child is ready, it will happen. I know this is not a method that would work for every child or every family, but so far its been working for us.

My oldest Ava was completely out of diapers (including at night) somewhere between ages 2 1/2 and 3. Julian became interested in using the potty earlier than Ava, but the transition to using the potty full time has been much more gradual. He’s currently 3 years and 2 months and mostly potty learned during the day, but not for the occasional nap or at night.

While I say, “it (potty learning) will happen,” that’s not to say I (and my husband) don’t do things to encourage the kids. The process is not left entirely up to them, but I do let them take the lead and guide how fast or slow the transition takes.


Photo courtesy of juhansonin

Here are some of the techniques I used with my kids to facilitate potty learning

Naked “Training”
One of the first things I like to do that helps them get more familiar with their body and elimination sensations is allow them to be naked from the waist down while at home. If it’s particularly cold, I’d suggest the kiddo wear BabyLegs or something similar on his/her legs, though my kids don’t seem to mind the cold at all.

Another benefit of being pant-less is that they can run to the potty and use it without having to worry about getting clothes out of the way first.

Since I’m at home with my kids this technique has worked well for us. Obviously though, isn’t for everyone.

Amber from Strocel uses the naked time technique as well. “During toilet training I … allow lots, and lots, and lots of naked time. Because it’s much more obvious to both you and the kid that they’re peeing when they aren’t in a diaper.”

Annie from PhD in Parenting said, “Being naked helped him (her son) to feel what was going on, it felt different from having a diaper on, it saved on laundry significantly, and it also made it quicker when he did rush off to the potty because there were no snaps and zippers and things to deal with.”

Keep a potty (or two or three) nearby
I try to keep a potty in the room wherever the child is playing. In our house that’s usually in the living room. I think having the potty where they can see it and have easy access to it helped my kids learn to use it. When they move off into another room and the potty isn’t right there, that’s usually when the accidents happen. (If you can invest in a few potties to scatter around the house, all the better.)

Once they have mastered using the potty in the living room, I would either move it into the bathroom or just encourage them to transition from the potty to using the actual toilet.

Praise, praise and more praise
My husband and I offer a lot of praise when our child uses the potty or toilet. In fact, in the beginning there’s often a lot of cheering, clapping hands, silly dances, etc. to encourage the new behavior.

Read books about going potty
The book I loved for helping my kids learn more about their bodies and using the potty was “Once Upon A Potty” by Alona Frankel. There are two versions of the book – one for boys featuring Joshua and one for girls featuring Prudence. I have to confess, one of the reasons I loved this book so much was the way Ava would say “Pwudence.” So cute.

There are many books available on this subject.

Patience
If my child didn’t seem to be ready for using the potty, we’d take a break and come back to it another time.

I remember having a success or two with Ava and the potty at a young age and I thought, “Yes! This is it!” But then she didn’t do it again so I figured it wasn’t the opportune time for her and we tried again in a few months.

Julian, who turned 3 in November, has been going through the motions of potty learning for over a year now. When naked and at home, he would use the potty or toilet about 90% of the time. It wasn’t until just the past couple months though that he would start asking to go potty while we were out of the house (and this was while wearing a diaper or a pull-up). Now he is using the toilet consistently when he is awake. If he’s napping or asleep at night, that’s not always the case and he wears a diaper or pull-up during those times. I’m not in the hurry to get him night “trained,” but trust that it will happen when he’s ready.

In Annie’s post about potty learning, she references a potty training readiness quiz by author Elizabeth Pantley, which is a great place to start if you are contemplating potty learning. Ask Dr Sears also has a wealth of toilet training information – from tips to know before you start to helping the child who won’t go to traveling while training.

Going commando
I have to admit that Julian isn’t in underwear full time during the day yet. He still either wears a pull-up or, if at home and is not half naked, goes commando under his pants. I think we are getting to the point where he could wear underwear regularly and be fine, but it’s just recently that we’ve gotten to that point. It seems like if he has pants on but no underwear, he is more easily able to feel when he has to pee.

With regard to poop
Once I noticed my kids’ pooping cues – both either went into a corner or behind a couch, it was easy to transition from pooping in a diaper to pooping on the potty. Thankfully neither of them had any poop resistance (where kids refuse to poop unless in a diaper), but I know that is common for many kids. Annie wrote a bit about how they overcame poop resistance with her son.

Potty learning at night
When the kiddo starts consistently waking up in the morning dry (i.e. you check their diaper as soon as they wake up and encourage using the potty), that’s a good indication they are ready to go all night in underwear.

It took a while of Ava waking up dry before I felt ready to take the plunge and let her go overnight without a diaper, but she was obviously ready and did well with it.

Techniques other parents swear by

The reward method
We never tried the reward method (yet?), but I know others who have had success with offering an M&M or something similar for each successful trip to the potty.

EcoMeg is currently using the M&M system for potty training her son.

Much More Than a Mom has also been using the reward system (chocolate chips or stickers) to help with potty learning her son.

Elimination communication
Hilary Stamper wrote an informative post explaining how elimination communication (EC) – the process of observing one’s baby’s signs and signals and providing cue sounds and elimination-place associations – worked for her and her baby.

Hobo Mama also has a great post chock full of information about using elimination communication with tips from her experience with her child, but also many links to other sites about EC.

Related links:
Angela at Breastfeeding 1-2-3 wrote Potty Training the Easy Way. She describes her method as somewhere between Potty Training and Elimination Communication. “The ‘easy way’ in my mind does not mean the fastest way or the least messy way. It’s an investment of time that respectfully helps my child learn to use the toilet.”

Previously mentioned, but very informative is Dr. Sears section on toilet training.

How did you go about toilet learning/training with your kiddo(s)? If you have any tips to share, we’d love to hear ’em.

Cross-posted on BlogHer

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Got breast milk to spare? Denver milk bank is in desperate need.

The freezers are nearly empty at a Denver milk bank, which is experiencing its lowest supply ever in the bank’s 25-year history. The Mother’s Milk Bank at Presbyterian St. Luke’s hospital is one of only 10 milk banks in the country that collects breast milk from mothers across the country and delivers it to sick and premature babies. The shortage has been due in part to a rough flu season and an increased need from hospitals and parents seeking breast milk.

If you are wondering in this day and age, with formula readily available, why milk banks are so important, there’s information in this Breastfeeding.com article, Banking on Breast milk. The majority of milk from the milk banks goes to babies who are sick or need milk because of medical conditions such as formula intolerance or feeding issues related to prematurity. Unlike formula, breast milk contains immunologic properties to help fight infection and illness.

Milk banks exist because many babies will not thrive without human milk. Infants with failure to thrive (FTT), formula intolerance, allergies and certain other medical conditions may require real human milk for health and even for survival.

A typical candidate for donor breast milk might be a formula-fed infant that exhibits prolonged episodes of inconsolable crying, ongoing vomiting and classic allergy signs such as purple or black circles under the eyes, pallor, skin inflammation, lethargy and frequent or bloody stools. Another typical candidate might be a premature infant whose mother cannot (or cannot yet) supply breast milk.

All donors to Human Milk Banking Association of North America (HMBANA) member milk banks undergo a screening process that begins with a short phone interview. Donor mothers are women who are currently lactating and have surplus milk. Donor mothers must be:

  • In good general health
  • Willing to undergo a blood test (at the milk bank’s expense)
  • Not regularly using medication or herbal supplements (with the exception of progestin-only birth control pills or injections, Synthroid, insulin, pre-natal vitamins; for other exceptions, please contact a milk bank for more information)
  • Willing to donate at least 100 ounces of milk; some banks have a higher minimum

The Denver milk bank welcomes donors both local and out of state
For donating mothers who don’t live near Denver, the milk bank ships supplies and a box with dry ice to mail the milk. Mothers are not paid for donating. Also, the HMBANA milk banks will often loan pumps to donor moms if they don’t have one of their own.

I donated milk to the Denver milk bank when my son Julian was a baby and had previously donated to a local mom directly when Ava was a baby. I’ve been blessed with a plentiful supply and was happy to do what I could to help others. Although I wasn’t able to collect as much as I had hoped, it all adds up.

Brandie also pumped her milk for the Iowa milk bank. She describes the process she went through when she donated nearly 400 oz.(!!) to the milk bank in 2003. As she packed up the cooler to mail her milk in, she couldn’t help but get emotional.

I was sending a piece of myself off in that cooler. Lots of hours of pumping (or at least what felt like lots of hours). I cried. As silly as that sounds, I did. I thought about how that milk might go to feed another baby and help another family – who for whatever reasons needed breast milk for their baby and couldn’t provide it themselves. I thought about how when so many around me thought breastfeeding your own baby was gross, disgusting, something only to be done behind closed doors where no one would have to actually see it, there were people out there who so firmly believed in it that they would use my milk to feed their babies.

Jodi, Milk Donor Mama, and Cate Nelson have all been milk donors too.

Emily from Et Cetera recently found herself with a surplus of pumped milk. As her freezer stash grew, she began to get concerned that it would expire before it was consumed. That’s when she learned about breast milk banking. She’s signed up to be a donor and encourages others to as well. “Why let your extra breast milk go to waste? Share it with a baby who desperately needs it. And even if you can’t donate, you can get involved. The more people know about milk banks, the more babies will thrive.”

A doctor’s prescription is required to receive breast milk from a HMBANA milk bank.

Deanne Walker of Colorado Springs received donor milk from Mother’s Milk Bank at Presbyterian St. Luke’s hospital for her twin boys who were born 10 weeks premature. In addition to the babies being born early, Deanne had several infections which dramatically affected her milk supply. I spoke with Deanne via email where she pointed out the importance of breast milk for preemie babies.

When babies are born prematurely the mother’s milk is different – it’s called super preemie milk loaded with even more protein, antibodies and dense nutrition than regular breast milk. Preemies need the extra nutrition because their digestive tracts are not fully developed, they are so small and need to grow more rapidly, and also because they are so much more prone to infections in those early weeks. Formula just cannot deliver the nutrition and antibodies provided by nature.

Deanne is thankful for the donor milk her now thriving 3 1/2 year old sons received until her supply was established enough to provide full feedings for them, but wishes it was covered by her insurance like formula was. (Note: Medical insurance sometimes covers the cost of donor milk when there is a demonstrated medical need for the milk on the part of the infant.) She and her husband had to cash in their retirement account to pay for the milk. The cost of breast milk from the Denver milk bank is currently $3.50 per ounce (which covers the donor screening, processing of the milk, etc.), which adds up very quickly especially when feeding more than one baby.

Please see the information below if you have breast milk to spare and would like to help babies in need. Or if you are looking for a worthy place for your tax-deductible donation, please consider making a donation to a milk bank. The HMBANA milk banks are non-profit organizations and depend on community and private donations to keep the doors open.

Information on donating or receiving breast milk:

Edited on 1/26/10 to add:
This morning the United States Breastfeeding Committee released a statement and urgent call for human breast milk for premature infants in Haiti. The first shipment is getting ready to go out to the U.S. Navy ship Comfort. You can read the entire statement and find out how you can donate by reading Give Them Roots blog about it: URGENT: Milk Donations for Haiti Infants. Thank you!

Cross-posted on BlogHer.

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Time magazine advocates “tough love” approach to infant sleep

Time magazine recently published a section called The Year in Health, A to Z in the Dec. 7, 2009 issue. The letter B is for Babies and what Time advised regarding babies, “tough love” and sleep has many people shaking their heads in disagreement.

The article states:

When a baby has repeated problems falling asleep, Mom and Dad may need to show some tough love. Lingering with cranky babies too long or bringing them into the parents’ bedroom can make them likelier to become poor sleepers, according to psychologist Jodi Mindell, who gathered data on nearly 30,000 kids up to 3 years old in 17 countries. “If you’re rocked to sleep at bedtime, you’re going to need that every time you wake up,” she notes. Her advice: have children fall asleep 3 ft. away. “If they’re slightly separated, they sleep much better,” she says.

Parents, pediatricians and proponents of attachment parenting strongly disagree with Time’s advice.

On Attachment Parenting International, Samantha Gray, executive director of Attachment Parenting International, and Barbara Nicholson and Lysa Parker, founders of API, published the letter to the editor they wrote in response. Here is a bit of it:

Contrary to the very unfortunate and detrimental advice on sleep in Time magazine, API’s Principle outlines the need to be responsive to children during the night and not to brush aside their needs as inconsequential to them or to their development in the name of “tough love.” The magazine and this proponents’ advice is framed in such a way to alarm parents into unfounded fears about their children being poor sleepers if they respond in loving ways such as rocking their child, breastfeeding, or lying down with the child. We know, in fact, that these practices are not only healthy for the child, but, for the very short period of a child’s life that needs are met in this way, parent and child benefit.

Science indicates that a comforting nighttime approach helps children achieve healthy sleep habits. Research and the experience of parents throughout the ages have proven that effective nighttime parenting includes prompt, calm response, as well as holding, cuddling and soothing touch.

We pray no one takes to heart this advice you have quite surprisingly chosen to publish, all the more in the midst of the availability of substantial quality parenting information. This advice goes against parents’ good instincts to care for their very young child in the ways their inner knowing tells them to.

We implore Time to urgently correct this harmful information in such a way to command even greater attention than received by the original article. Our children are worth it, and so are their parents.

At the time of this posting, Time had not responded to API nor published any sort of correction.

Pediatrician, father of eight, and author of numerous parenting books Dr. William Sears suggests in his own letter to the editor to Time:

Rather than issuing rules or cautions about being “over attached” concerning nighttime parenting we should be encouraging parents to sleep safely and closely with their babies. In my experience and that of others who have thoroughly researched the issue of co-sleeping, namely Dr. James McKenna, babies who sleep close to their parents sleep physiologically healthier and a mutual trust develops between parents and child.

Remember, we have an epidemic of insomnia in this country necessitating a mushrooming of sleep disorder clinics. When babies start out life with a healthy sleep attitude, that sleep is a pleasant state to enter and a fear-less state to remain in they’re more likely to grow up with a healthy sleep attitude and both children and their parents will sleep better later on.

On his website, Dr. Sears has 8 Infant Sleep Facts Every Parent Should Know including:

  • babies have shorter sleep cycles than adults
  • there are developmental and survival benefits of nightwaking
  • and as babies grow, they achieve “sleep maturity.”

Kayris who blogs at The Great Walls of Baltimore said, “considering the amount of adults who suffer from sleep problems or use sleep aid medications, I’m truly surprised at the amount of people who expect sleep to also be easy for children.”

Micki AKA ADDHousewife is one of those people who has trouble sleeping and said in response to the Time article, “That’s pure crazy. Some kids are just lousy sleepers. Plain and simple. I am still a bad sleeper!”

Hannah Gaiten, owner of Natural Choices, had this response to Time’s article:

That type of position is based on what is perceived to be best for parents, not taking into account what is truly best for the kids, in my opinion. Heaven forbid a child need to nurse to sleep…why is it regarded as such a “problem?” We do it everyday, every time my daughter needs to sleep, she needs to nurse. Sure, it’s not the most convenient at times, but if I were looking for convenience, then perhaps being a parent wasn’t the best road to take.

To make a blanket statement like, “If they’re slightly separated, they sleep much better” is unwise, in my opinion – each child is different and instead of this author telling parents how to parent their child, they should give unbiased information and encourage the parents to do what is best for their family (not just what is in the best interest of the parents).

Susan, who blogs at Two Hands Two Feet agrees, “I hate it when ‘experts’ tell parents what is best for them and their kids. You need to do what is right for your family, not what an expert says. This stuff caused me a lot of grief when my girls were tiny. I read books because I didn’t feel like I knew what I was doing. But what I really should have done was just gone with my instincts.”

Suzanne at The Joyful Chaos who co-sleeps, but also says she’s “not actually an advocate for co-sleeping,” drives the point home that you have to do what works best for your family in her post The Cosleeping Edition of my Attachment Parenting Freako-ness and sometimes that may very well differ from child to child.

A Mother In Israel Hannah asks in her post Sleep Training at the 92nd St. Y:

Are our babies robots? Or dogs that we need to train? No, they are very small people who can’t understand why everyone ignores them once the sun goes down, even when they cry hard enough to throw up. A baby’s cry is intended to be disturbing. If we train ourselves to ignore it, we lose our instinctive rachmanut (compassion). And a baby whose cries are ignored learns that his feelings don’t count for much. Eventually he will give up and go to sleep, but pay a steep price.

Who are we to say that our need for a solid eight hours (which we usually don’t get anyway for all kinds of trivial reasons) trumps the baby’s needs? Adults can learn to cope with less sleep and babies need concern and sympathy no matter when they are in distress. Trust your baby; she will tell you when s/he is developmentally ready to fall asleep without your help.

As for my opinion, I think it’s very irresponsible for Time to make a blanket statement like that, especially when there is evidence that proves the contrary is true. I do believe it is up to each family to decide what works best for them and their children. While I don’t think it’s for everyone, co-sleeping worked for my family for years. Nowadays my children are still co-sleeping with each other at age 3 and 5 and sleep side by side in a room together. Just as they have different personalities, they are very different sleepers. My daughter has a harder time falling asleep than my son, but both are parented to sleep in a way that works best for them.

There’s nothing that is convenient about being a parent. It is a physically, emotionally and mentally taxing job. Parenting doesn’t end just because the sun sets. It’s a 24/7 365 days of the year job.

Instead of trying to put more distance between parents and their children, I think Time should be encouraging more connections. The time that our children are infants and toddlers is so fleeting in the grand scheme of things, we should be embracing them, not pushing them away.

Jan Hunt, director of The Natural Child, points out, “As the writer John Holt put it so eloquently, having feelings of love and safety in early life, far from ‘spoiling’ a child, is like ‘money in the bank’: a fund of trust, self-esteem and inner security they can draw on throughout life’s challenges.

Children may be small in size, but they are as fully human as we are, and as deserving as we are to be trusted to know what they need, and to have their voices heard.”

There is a wealth of information about infant sleep on Attachment Parenting International’s Baby Sleep Strategies page, including infant sleep safety, co-sleeping, nighttime parenting and more.

Annie at PhD in Parenting also has an informational post Gentle Baby and Toddler Sleep Tips that “provides tips for sleep deprived parents that want their babies to sleep better and… do not want to use the cry it out approach.”

If you’d like to respond to Time about “B” for Babies, please do so online using their letter to the editor web form or snail mail to:
TIME Magazine Letters
Time & Life Building
New York, N.Y. 10020
“Letters should include the writer’s full name, address and home telephone and may be edited for purposes of clarity and space.”

Cross-posted at BlogHer.

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