Friday, December 19, 2008

New Mothers Support Circle: Postpartum Support Group

I'm so happy to announce that I'll begin facilitating a postpartum support group, NEW MOTHERS SUPPORT CIRCLE, in January!

About six months ago, I was talking to a client after her baby was born, and she asked if I knew of any postpartum support groups in our area. I asked around and looked online, but I couldn't find any. There are lots of playgroups, and helpful breastfeeding support groups (see this post), but I couldn't find any meetings that were specifically for NEW moms.

I started thinking about this lack of support for new moms, and decided to start a group myself!

We'll be meeting in Winthrop, on the 2nd and 4th Thursdays, from 10-11am.

The group is only for new moms and their babies, from birth to six months. At six months, babies and moms "graduate" and can form playgroups (if they haven't already!) with other moms they have met.

For more information, visit www.birthingyourbaby.com/postpartum.html!

If you have any suggestions, let me know!

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Friday, December 12, 2008

Ignorance Meets Knowledge: Extended Breastfeeding

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Tuesday, December 9, 2008

What If?

In an email on a list I read, the fabulously wise childbirth educator and doula, Joni Nichols, recommends that pregnant women "Choose a care provider who is congruent with the kind of birth you want. Everyone talks about the 'work' of labor. The real 'work' is the election of the caregiver".

And I read a terrific blog entry by Monica Dux this week, "Homework is the Mother of Prevention". Here is an excerpt:
"There seems to be a widespread culture of passivity when it comes to labour. Many expecting mothers do dedicate an enormous amount of time and effort to preparation, yet, in my experience, there are just as many who refuse to do adequate homework, preferring to sit back and see how things develop. It's not that these women are unsure about what sort of labour they'd like to have (almost always an uncomplicated vaginal delivery). They've simply decided that "waiting and seeing" is the only realistic approach. Why bother committing to a detailed birth plan when it will probably go wrong anyway? Perhaps other wait-and-seers are simply in denial, preferring not to think about an experience that is understandably terrifying. The end result is that they approach the business of labour with less preparation than they would bring to buying a new car."
It's a great post, and I highly suggest clicking the link to read it!

Many pregnant women, and their partners, spend a certain amount of time "preparing" for their new baby's arrival - especially if it is their first baby. There are the clothes to buy; the car seat and the stroller and the crib to pick out and set up and figure out; the fun yet overwhelming task of registering at various stores and websites. The room needs to be painted... decorated... organized. Feeding and diapering and bathing supplies. Toys.

What if most women put a fraction of the energy that they dedicate to amassing and arranging baby stuff into choosing a care provider and place to give birth, and discussing their options with that care provider? What if women talked - offered each other important, real information - about care providers and birth places - like we give each other useful information about our favorite baby toy or supply? Why don't more women stay away from A Baby Story and other birth dramas that are unrealistic and emergency-filled?

I think there would be big changes in birth if women insisted on accurate information about care providers and birth in general, especially if they shared what they learned with each other.

If women had access to information about doctors Cesarean birth rates AND information about the risks of Cesarean births, I think we would see changes. If women knew the benefits of laboring (and/or birthing) in water AND which birth places had labor and birth tubs, I think we would see changes. If women had accurate information about CPM midwives and homebirth, I think we would see changes.

Unfortunately, at this point, what I see are lots of inaccuracies - about the safety of homebirth, for example, or about the risks of Cesarean births. There are lots of barriers to making informed choices about doctors and hospitals: inaccurate information; vague answers; insurance issues. I think that for many women, it's just psychologically easier to do what "everyone" else does - to use the same care provider, at the same hospital, to read What to Expect When You're Expecting and watch A Baby Story on television.

Preparing to bring baby home is very exciting - thinking about dressing her or getting his room ready can be a lot of fun. This type of preparation, and the daydreams of snuggling that sweet little baby, are obviously important and wonderful.

But just as important is the responsibility to learn about care provider and birth place options... and then using what we learn to interview doctors and midwives and visit hospitals and birth centers. This work may not be as appealing. It may sometimes be challenging or uncomfortable. But in the long run, the time spent choosing a care provider is going to be a lot more influential in our lives as new parents than choosing a nursery theme or picking out a going-home outfit.

What do you think could change the balance of how women prepare for birth? I'm hoping The Birth Survey will help: results of the surveys are due out nationwide in Spring 2009. I can't wait to read about women's experiences in Central Maine and to be able to offer this resource to clients.

Christina @ Birthing Your Baby
Independent Childbirth Classes for Central Maine

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Friday, December 5, 2008

But I: A List of Reasons Why Women Don't Change Careproviders

There is a great list of reasons why many women resist changing careproviders during pregnancy in the Week 27 Lamaze newsletter:

"It’s not uncommon to resist making what feels like a drastic change at this point in pregnancy. But it is wise to explore your assumptions before you decide for good. For instance, you may think…

  • BUT I already have a relationship with my current provider. It is more important that you feel supported in your decision-making than have a limited, ineffective relationship with your care provider. Also, remember that your prenatal visits will be more frequent now. You can expect to have enough visits to get to know a different care provider.

  • BUT It’s too late in my pregnancy. It’s not too late if a new caregiver or birth setting does not have policies that prevent you from making a change at this time. Many care providers will accept new clients as late as 36 weeks or more, although it is best to make the switch sooner whenever possible. If you are not completely satisfied with your choice of care provider or setting, immediately explore your options. Interview other care providers before making this important decision.

  • BUT I don’t feel comfortable “firing” my care provider. Most midwives and doctors understand that their clients’ needs and wishes change during the course of pregnancy, and they don’t take it personally when a woman wants to make a change. Even if your care provider doesn’t react well, know that it is your decision based on what you know is best for you. Why risk having negative memories of your birth experience or receiving care that doesn’t meet your needs just to avoid hurting someone’s feelings?

  • BUT My provider knows what’s best for me. This is your birth and only you know best how you will feel supported. Unfortunately, many care providers practice in a way that serves their interests, not yours. Others practice “cookbook medicine”—applying the same care to all women regardless of their individual circumstances. If you don’t feel like you’re getting personal attention, or if you feel more like a “number” than an individual, it’s time to start looking elsewhere.

  • I have had several clients change careproviders mid-pregnancy - one as late as 36 weeks, but most of the others earlier in their third trimester. One changed from a hospital setting to a birth center, others from OB care to midwifery care. I think that, for many women, birth does not necessarily feel REAL until late in pregnancy. We realize we are growing a baby, and that is our focus, not how that baby will actually come OUT! I think this also might partially explain why I have so many moms wait until 32-34 weeks to call me for classes!

    Once moms start thinking more about how they will give birth, they start to ask careproviders more specific questions (will I be continuously monitored? what happens if I ______________? how often do you perform episiotomies? can I eat and drink during labor? can I labor in the water? give birth in the tub?). If the answers they get don't feel comfortable, some women start an internal dilemma around "what would it be like to change careproviders??". And that is when the "But I"s come in...

    If you find yourself in this kind of dilemma, carefully consider the information above. Put yourself and your baby first. Ask lots of questions - ask yourself, your partner, your careprovider, your potential careprovider. How does the care provider respond to your questions? Is this type of response what you would want during birth? Think about the setting where your doctor or midwife will attend your birth (hospital, home, birth center). There is some especially useful information on the Childbirth Connection website under Choosing a Caregiver.

    By the way, if you think it's too late to call for classes - call or email me anyway. I've always found a way to fit in someone who was motivated to schedule a class or classes!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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    Thursday, December 4, 2008

    Vitamins: A Few Additional Resources

    Over the past several weeks, I've written posts about folic acid, calcium, iron, and omega-3 fatty acids, as well as how to choose a prenatal vitamin.

    To close this series of blog entries, here are some additional links on prenatal nutrition:

  • Navalgazing Midwife's very informative post on Vitamin D & Its Role in Women and Children

  • A Good Pregnancy Diet according to Dr. Tom Brewer

  • Excellent articles on prenatal nutrition from the Drs. Sears

  • NutritionData.com offers lots of useful information on particular food items (processed and unprocessed) by typing in a food into the "enter food name" field at the top of the page. The site also has a Nutrient Search tool that allows you to select a particular nutrient and then view their list of foods that contain high amounts of the selected nutrient.

    If you can recommend any particularly useful or interesting books or websites on prenatal nutrition, please leave them in the comments!

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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    Wednesday, December 3, 2008

    Omega-3 Fatty Acids

    I tried to get this article written yesterday, but after visiting family in PA last week for Thanksgiving, and coming back with kids who promptly started vomiting from a stomach bug, I've had to adjust my expectations for the week!!
    Omega-3 fatty acids will be the last major nutrient in my prenatal nutrition series. When my daughter was born, in 2002, I don't remember reading anything about omega-3 fatty acids; there is no mention of them in the index of them in the Sears' The Pregnancy Book, published in 1997, either. Omega-3's are, I think, relatively new on the scene of nutrition in general, and prenatal nutrition in particular, which is why I wanted to include the following information on them.

    Omega-3 fatty acids are an "essential fatty acid". In The Family Nutrition Book, Dr. Sears explains that
    "fatty acids are the basic building blocks and the main nutritional component of fats. The body requires about twenty fatty acids in order to live and operate. It can make all but two of these: linolenic (omega-3) and linoleic (omega-6). These are two of the essential fatty acids, so called because they are essential for life and health. They can be supplied only by food or supplements" (4).
    In Having a Baby, Naturally, Peggy O'Mara theorizes that our proportion of omega-6 to omega-3 fatty acids has been reversed over the past several hundred years: instead of more omega-3 fatty acid and less omega-6, most of us now eat many more foods rich in omega-6 and have much less omega-3 fatty acids in our diet. Our ancestors long ago probably had diets high in omega-3 fatty acids from the variety of fish and wild game (who fed on grass and other plants) that made up a lot of their food. Now, many of us consume little wild fish, and the meat we eat has been fed corn (which is high in omega-6 fatty acid). She explains that "some expernts think this may explain the huge increase in heart disease in the twentieth centruy, along with other health problems such as depression, ADD, autism, Alzheimer's disease and more" (24).


    Why are omega-3's important?

    Omega-3 fatty acids have been linked to a variety of health benefits in the general population, including a reduction in the risks of heart attacks and strokes, lowering the level of bad cholestorol (LDL) and triglycerides, improving eye function as well as lowering the risk of macular degeneration, improving attention span, protection against many cancers, and a reduction in symptoms of inflammatory and autoimmune diseases.

    The benefits for a baby whose mother has a diet rich in omega-3 fatty acids during pregnancy, and during breastfeeding seem to revolve mostly around brain function. Having a Baby, Naturally author Peggy O'Mara writes that
    "omega-3 is particularly important for pregnant women in the third trimester, and for women who are breastfeeding. These are the times when the baby's brain is developing at an amazing rate. Babies deficient in omega-3 may have a higher risk of autism, attention deficit disorder, and depression or adult degenerative diseases like Alzheimer's or Lou Gehrig's disease" (24).
    Other sources suggested improved eyesight and possible benefits in baby's behavior, like less crying. I've also heard (anecdotally) that babies whose mothers have a diet high in omega-3 or take supplements sleep better the first three months.


    What are good food sources?

  • Oily, cold-water fish (salmon, sardines)
  • Canola oil
  • Flax seeds and flax seed oil
  • Walnuts and walnut oil
  • Pumpkin seeds
  • Soybeans (you can get these roasted as a tasty snack...)
  • Hemp seeds
  • Purslane, a leafy vegetable
  • Dark leafy green vegetables
  • Fortified eggs: eggs from hens fed diets that contain omega-3

    A note about flax seeds: flax seeds need to be ground in order to be completely digested. For this reason, flax seed is sometimes sold pre-ground, as flax seed meal. Consider storing the meal in the freezer, because it can turn rancid quickly. I put 1/2 cup of the meal in most bread recipes and many muffin recipes.

    The benefits from eating foods with omega-3's in them make me wish I like fish! What can you do if you don't like fish? These are my strategies:

  • I do feed my children salmon - high-quality frozen wild salmon patties, because I can't stand the smell to prepare anything else.
  • I do a lot of cooking with organic canola oil instead of vegetable oil.
  • I serve walnuts in snacks and trail mixes, as well as grinding them up in the food processor to make "walnut meal" for baked goods like cookies.
  • I sneak the flaxseed meal into lots of baked goods, especially sandwich bread and muffins (I bake our bread, so that's easy for me to do).
  • When I was pregnant and the children were younger, I bought the omega-3 eggs, but now I get our eggs locally from a friend.
  • I buy the omega-3 enriched pasta from Barilla.
  • And, we take supplements.

    If you do like fish, it is important remember that not all sources of fish are wise ones, espcially for pregnant women or young children, since some contain unhealthy levels of mercury. In fact, the FDA guidelines have sometimes been criticized by consumer groups for being "too soft". One of the only controversial "moments" in one of my classes was from a dad who was very well-informed about the dangers of mercury in fish, and who advocated that pregnant women avoid tuna altogether because of mercury concerns. Until then (especially because I do not eat tuna), I was unaware that the FDA guidelines were considered incomplete and/or too leniant by many consumer watchdog groups.
    If you eat a lot of fish, or want to view other guidelines, you may want to visit KidSafe Seafood or Pocket Seafood Selector for their recommendations. The Harvard Medical School Guide to Healthy Eating During Pregnancy suggests that
    "pregnant women should not cut fish out of their diets; doing so would leave out a prime source of nutrients that are important for a baby's development . . . in a perfect world, consuming fish every day would be ideal for boosting your omega-3 fats. As a compromise, I suggest eating a couple of servings of low-mercury fish per week and supplementing your diet with DHA or fish oil supplements or DHA-enriched eggs" (83).
    As for the tuna, the light canned tuna is frequently suggested as "safer" in books and websites on prenatal nutrition. However, as the dad I mentioned explained, independent testing has shown that some cans of light tuna are still dangerously high in mercury. Consumer Reports has a very helpful article explaining why they recommend no tuna at all for pregnant women, as well as what the dangers of mercury are for fetuses and young children.


    Supplements

    So, if certain fish can be dangerously high in mercury, are fish oil supplement safe, especially since supplements are not regulated by the FDA? According to The Harvard Medical Guide to Healthy Eating During Pregnancy, "there have been a few studies that suggest fish oil pills are generall safe. A Harvard group measured the mercury levels of five fish oil supplements and found that there were only negligible amounts of mercury in all of them, and the levels of organochlorines and PCBs were . . . below the detactable limit" (98). Other studies, by ConsumerLab.com and Consumer Reports, found similar results.

    Interestingly, The Harvard Medical Guide also mentioned that fish oil can affect how well blood clots, so supplements should not be taken by people who have had a stroke, or who take anticoagulants, or who are preparing for surgery. Expectant mothers may also wish to stop taking them for this reason a couple of weeks before their due date. Since no other book mentions this, it may be a question to ask your care provider.

    At my house, we use the Nordic Naturals brand, available at many health food stores. The kids either use the Junior softgels or the strawberry-flavored liquid . Both taste good (I've even heard of adding the liquid to smoothies), and I use them both myself, sometimes. I like the fact that I can buy them locally, at a reasonable price; the kids like them; and most importantly, they're phamaceutical-grade and third-party tested.


    Omega-3 and Breastfeeding

    One of the nutrients naturally found in breastmilk which cannot be replicated is DHA, or docosahexaenoic acid, an omega-3 fatty acid. The benefits of the DHA found in breastmilk are far-reaching for breast-fed babies, affecting visual development, intelligence, and even behavior.

    According to Elizabeth Somer, in Nutrition for a Healthy Pregnancy, "Babies fed breast milk from others from mothers who regularly eat fish concentrate more of these fats in their never tissues and are more alert and process information more quickly than babies who don't get enough of these fats" (216). She goes on to write that
    "the last trimester of pregnancy and the first year of a baby's life are critical periods for visual and nerve development. These processes requre deposition of the omega-3 fats into cell membranes for normal cell structure and function. If these fats are in short supply, which is in the case when a baby is formula-fed or a nursing mother consumes little or none of these fats, nerve tissue development might be jeopardized even though the baby is growing at a normal rate . . . the omega-3 content of breast milk reflects the mother's diet" (216).
    As you may have noticed, the formula companies have gotten in on the whole omega-3 and omega-6 trend lately, by adding DHA and ARA into some of their formulas. It is very important to remember that DHA and ARA formulated in a laboratory and added to formula is not the same as the omega-3 and omega-6 fatty acids found naturally in breastmilk. In fact, I have read recently in Mothering magazine that these additions (made from algea) can cause serious digestive issues for some infants. You can read an executive summary about the marketing of DHA/ARA formula and its health impact or this short article for additional information.

    Well, I've learned a lot from writing this particular post: my husband, who is at risk for macular degeneration because of his genetics, is going to get his own bottle of Nordic Naturals omega-3's, and I think I'll be more regular in taking them too. My parents, with high choloseterol, will be referred to this post, I think. And I'll be sharing the Consumer Reports article with my future clients!

    Below are the books I used to write this post:
    The Pregnancy Book, by William Sears, MD and Martha Sears, RN
    The Harvard Medical School Guide to Healthy Eating During Pregnancy, by W. Allan Walker, MD
    Nutrition for a Healthy Pregnancy, by Elizabeth Somer, MA, RD
    Having a Baby Naturally, by Peggy O'Mara

    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine
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    Monday, December 1, 2008

    In a recent New York Times article, "Scorpios Get More Asthma," the author suggests reasons why babies born in the fall are prone to asthma: the New England Journal of Respiratory and Critical Care Medicine has reported that babies born in the fall have a 30% increased risk of developing asthma. The author goes on to write that:
    "As for how a baby is born, Swiss researchers are reporting in the journal Thorax this month that a Caesarean delivery is linked to a much higher risk for asthma compared with babies born vaginally.

    In a study of nearly 3,000 children, the researchers found that 12 percent had been given a diagnosis of asthma by age 8. In that group, those born by C-section were nearly 80 percent more likely than the others to develop asthma. The explanation may be that a vaginal birth “primes” a baby’s immune system by exposing it to bacteria as it moves through the birth canal."
    Interesting, isn't it? Espcially since,
    "Asthma has emerged as a major public health problem in the United States over the past 20 years. Currently, nearly 15 million Americans have asthma, including almost 5 million children. The number of asthma cases has more than doubled since 1980. Approximately 5,500 persons die from asthma each year, and rates have increased over the past 20 years. Rates of death, hospitalization, and emergency department visits are 2-3 times higher among African Americans than among white Americans. The costs of asthma have also increased to 12.7 billion dollars in 1998."


    Christina @ Birthing Your Baby
    Independent Childbirth Classes for Central Maine

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