Monday, November 29, 2010

When to Reign In Your Birth Team

As most of you know, I teach a 10-week course on natural childbirth.  The first night of class, the number one question is, "When do we go to the hospital?"  Line-upon-line here.  We don't hit that until Class 5!

Over the years, I've learned that this question is really asking, "When can the professionals take over?"  It usually is asked by a dad-to-be.  It's interesting to watch these expectant parents learn and grow.  Education and information is unbelievably empowering!  Several years ago, I was teaching "emergency" (ie. unattended) childbirth.  By the time we get to that point, we've spent countless hours together, watched more than a dozen birth videos, and everyone has a very good idea of what normal childbirth involves and what to do -- or not do!  I asked this particular father-to-be how he felt about the possibility of this happening.  I should preface his answer with the fact that he didn't speak to me until Class 5 and was totally depending on his mother-in-law to help his wife at the birth.  He despised that he was forced into attending this class.  So, when asked this question, I was amazed at his cool reply:  "On the one hand, totally terrified, but on the other -- bring it on!"  I should also mention that the mother-in-law didn't make it to the birth and they were only at the hospital for 22 minutes before the baby was born!

The answer to the question "When do we go to the hospital?" often changes as you get more information.  Let's back up for a minute.  You know how I feel about hiring a doula.  Do it.  Who are the people you are inviting to your birth?  A sister?  Mom?  Mother-in-law?  Other children?  Your best friend?  Do you call them all the minute you have your first "real" contraction?  Of course not.

There is nothing like being pregnant with your first baby.  Not that the other pregnancies and labors aren't exciting, but they are undeniably different.  You've done it before.  You have distractions now that you didn't have the first time around.  Regardless of what baby number this is, enjoy early labor with your spouse.  I love early labor!  Get into a rhythm together.  Figure out what works, what doesn't.  Practice different positions.  Nap.  Eat.  See a movie.  Enjoy this time together.

Everyone's labor is different.  You may have several hours of early labor -- this week I had a mom that did this for several days! -- or it may not exist at all.  You may jump right into active labor and need your doula right away.  There is no way to know beforehand. 

But let's assume that you do have early labor -- you are contracting regularly but are able to talk, walk, or sleep during and/or between contractions.  If your husband is sleeping, and it's 2:00 a.m., let him keep sleeping.  A lot of moms don't like it when I say that.  Here's the thing -- yes, labor is exhausting, but it's also exhausting for your birth team.  This often doesn't get a lot of sympathy from moms, but if your labor is on the longer side, you are going to need your birth team to be able to step it up, and they may not be able to if they are utterly exhausted.  If you don't need his help, let him keep sleeping.  You'll both be glad later.  You may find yourself enjoying those early contractions, just you and the baby.

As things progressively get harder -- and you feel like you need some extra help -- think about who you want to reign in.  Maybe it's your sister or mom or maybe it is your doula.  Whoever it is, be sure that you are ready for the help.  And perhaps even more importantly, be sure they will be a positive influence on your labor.  For example, the mom who is freaking out that you didn't go to the hospital with the first contraction or the minute your water broke may not be the best person to be with you and your husband.  She may not be someone you want at your birth at all!  In the end, if you don't need help yet, you may feel like a watched pot, which won't be good for your labor.

There's not a set time that is right for all couples.  I hate it when couples are told to head to the hospital when contractions are 5 minutes apart lasting 60 seconds.  You could do that for hours!  It's really hard to explain, but there will come a time in your labor that you will know who you need.  With my 2nd baby, I had no early labor and wanted my friend there immediately.  It was a very fast labor.  But with my 3rd and 4th babies, no one was there until about an hour before the birth, including our midwives.  But I knew when I needed them.

Again, it's hard to explain, but there will be an urgency felt to be with your birth team as labor progresses, whether you are in the hospital or at home.  This will be different for each woman.  Some women feel this urgency earlier than others.  This is their emotional relaxation -- how they feel about where they are giving birth, who is there, are their wishes being honored?  I remember with my first homebirth -- 3rd baby -- the minute the midwife walked through the door, I felt like crying.  I felt such a release.  She wasn't there more than an hour and my baby was born.  My body held back until my birth team was in place.

I often think of it as involving people according to their skill set:  my mom was needed because I needed help with the other kids (1st called).  She cleaned up, made food, changed sheets -- a good one to have around!  Anyone else helping out with the kids was next.  They'd usually help my mom too.  One of these people was usually on video duty.   As labor progressed, if I had a doula or doula-friend, they'd be called in to help me and David.  Your chiropractor is also a great person to call in for a period of time.  Eventually, you'll want someone to catch the baby, so either calling your midwife or heading to the hospital will be necessary!  You'll know when this time is.  You'll be very serious, eyes closed, not talking or smiling.  Some women will be sounding out contractions and others won't make a peep.  Either is fine.  One is not better than the other.

My ultimate answer to the question "When do we go to the hospital?"  Alright, here it is.  There will come a point when she (talking to dad because mom won't remember this or be thinking logically) will not want to walk anymore.  She will still get up and go to the bathroom when you encourage it, but she doesn't want to.  She has to wait till the end of a contraction to get up and she will move quickly so she doesn't get caught standing up during a contraction.  Contractions are stronger and longer when she stands up.  Still willing to move, but not wanting to.  This is usually a good time to mosey on down to your birth place or call in your midwife.  Labor is very well established at this point.

Most of all, enjoy your labor.  Choose your birth team carefully and reign them in as you need them.  So many women wish for a fast labor, not understanding how hard a fast labor is -- just to get it over with.  A longer labor is not a bad thing.  Like I always say, labor and birth serve as a bridge between pregnancy and becoming this baby's mother and father.  Enjoy it.  These hours are unlike any in your whole life.

Monday, November 22, 2010

BabyWise vs. Attachment Parenting

Most of the people I know, or have known, that have "done" the Baby Wise method of parenting have gotten into it because other couples at their church do it. The people I have encountered have been interesting for me to observe. They tend to watch the clock instead of their baby. For example, baby is fussy, and instead of putting the baby to breast, mom looks at the clock and announces that he shouldn't be hungry yet, not for another 20 minutes! By the time she feeds him, he's hysterical.

I had someone in class explain how the method is actually suppose to work, and I must admit, if I didn't have children, I might think it sounds like it makes a lot of sense. Here's the idea: You want your baby to learn to get good sleep and sleep for longer periods of time, because, like adults, they will learn better, grow better, etc., if they get good rest. They talk about the possibility of developing ADHD and having learning difficulties when the child doesn't get enough rest. (Have you been to Walmart at 10:00 at night and seen all the crying kids and frustrated parents? I'd have to say that I agree -- kids should be in bed when they have school the next day.) You are not to let the baby fall asleep at the breast, but keep the baby awake longer so that he will sleep longer. Baby Wise also does not want baby to always breastfeed to go to sleep.

My favorite part though was not having a baby that is a "snacker." The idea is that if you "let" your baby breastfeed whenever he wants to, he isn't getting "good protein" -- WHAT?! Whoever came up with that has no idea how breastfeeding actually works. Baby gets "good protein" at every nursing, long or short. They advocate for the baby to have "meals" instead of "snacks." Dr. Sears, in The Baby Book, talks about all the different types of nursing babies. Having breastfed 4 babies for more than 7 years of my life, I will tell you that all babies are different. My first did not ever nurse for less than 40 minutes at a time. His little head would sweat like crazy. I'd have about an hour, maybe 1 1/2 hours, before we'd do it all again. He is my healthiest child!

My 2nd baby was finished with nursing five minutes after it began. She would go 3-4 hours between feedings. I could never have made her nurse longer. I would have had a very frustrated baby, not to mention a very frustrated mom. She slept more than any of our other babies. She was the only baby who would not fall asleep nursing. She wanted to be left alone to go to sleep. Sounds like what every parent hopes for, right? Think again. She was not a cuddler. She has been my only child prone to ear infections. She is almost 10 years old and very smart, a very deep thinker. She likes to spend her time alone and has lots of self-soothing techniques that have become very disruptive in her life -- so much so that we are seeking counseling. Don't leave your child to soothe herself. My "squeeky wheels" seem to have more "normal" ways of dealing with life. I don't want to see parents do this type of parenting on purpose.

My other two babies were more in a classic category, as far as breastfeeding.

Some babies, especially newborns, will want to breastfeed every 20 minutes! This is a good thing. You will establish a good milk supply. It is the frequency of breastfeeding, not the duration, that stimulates your milk-producing hormones. So, snacking is great! Babies have very intense sucking needs those first few weeks. This is not a coincidence. It helps establish a good milk supply if your baby is at the breast very often. You absolutely cannot spoil your newborn baby! What will spoil this wonderful relationship is giving your baby a pacifier or bottle. Babies are built to breastfeed and so is the mother! Let yourself enjoy this time by following your baby's cues. He will let you know exactly what he needs if you will listen to him and not some kooky book that tells you your baby needs to teach himself how to go to sleep.

As far as sleeping goes, you cannot force a baby, or anyone, to fall into certain sleep cycles. Sleeping is an absolute basic need. Food, water, sleep, shelter. Honestly, no one needs to be taught how to sleep. Babies have very different sleep cycles from other age groups. A good book to read on this topic is "Sweet Dreams" by Dr. Paul Fleiss.

I was completely obsessed with sleep with my first baby. And then one day, I was trying to make him take a nap, and my aunt said to me, "You know, he will sleep when he's tired. He must not be tired. Let's go play!" This was so freeing to me. He was 3 years old at the time. He quit taking naps shortly after that, but his bedtime was moved to an earlier time. He is such a great sleeper since I quit obsessing over it. He's 12.

We had a big sleep progression over the years. I wish we could have just started with baby #4. We never even set up a crib with her. When we had a crib, we felt obligated to use it. (Dr. Sears tells a story of being in a foreign country and was asked, "Is it true that American mothers put their babies in cages at night?) Yes, it is true.

Let me tell you about sleep with Darcy: I nursed my baby to sleep every time she was sleepy! I would never recommend not doing that. It was stress free. I knew she'd fall asleep and if she didn't, we'd try again later. I knew this was my only time of her life that we would have this opportunity. I loved to nurse my sweet baby to sleep, to smell her milky breath as her mouth opened once sleep came and extra milk ran down the side of her cheek. I never had to pick her up and take her to her bed. Our bed was her bed. I simply laid her down and felt her body mold to mine. Unless you have experienced this closeness to your baby, you just cannot understand or imagine the sweetness. David and I both treasured that time, knowing it is too short.

Darcy was never afraid of sleep. It was a comfortable, safe, warm, happy place to be. What is wrong with nursing your baby to sleep, even every time your baby is tired? Why is this frowned upon in our society? I promised, it will not last forever! You will not create a monster.

Our bed sits high up. We taught her early on how to get off the bed -- "feet first" was a phrase all of our kids learned early on. When she was very small, we would put a monitor on the bed and get there as soon as we heard her wake up.

There were some sleepless nights. Sometimes, she'd be wide awake in the middle of the night and want to talk. Sometimes she'd kick David in the back. Sometimes we slept in the "H" position. This would have happened no matter what bed she was in. It would be very easy to ignore her if she were in another room. Usually, however, she would simply nurse back to sleep. I was her mother in the daytime as well as the nighttime. We have a king-size bed, and really, that is a better investment than a crib.

I hear parents say they are afraid the baby will never leave their bed. Of course they will. When Darcy was about 20 months old, we were trying to get her used to sleeping in another bed in our bedroom. We were going on a Tim McGraw cruise in a few weeks and wanted things to be easier for my mom who would be staying with the children. That was such a stressful time to try to make her sleep somewhere she wasn't comfortable with. After a few weeks of trying, I decided it just wasn't time for her to be out of our bed. What a relief.

She moved into her sisters' bedroom when she was 28 months old. We talked about it beforehand and felt that she was ready. She did not try to come out of the bedroom even one time! Again, sleep was never scary for her. It was an easy transition. She quit breastfeeding around the same time. She'll be 4 in March and is still a great napper, which always takes place on my bed. It's my favorite time of the day to snuggle up with her and feel her breathing sync with mine as we drift off to sleep.

Let's go back to the Baby Wise idea of not letting your baby fall asleep at the breast. First of all, I say this is nearly impossible. There are some major problems with this philosophy. When I am talking with a breastfeeding mom who has a baby that is not gaining weight, the first thing I ask her is, "Who is ending the feedings?" The baby should be the one ending it, usually because he falls asleep! Mom should not be ending it because the longer the baby stays at the breast, the more hindmilk the baby is getting. This is the fat, or "dessert," after dinner. Baby needs this to grow. Second, mom's body produces a hormone called prolactin which the baby also receives during breastfeeding. It is often called "the mothering hormone" because it causes her to be calm, even sleepy. Same effect on baby. Why would any mother not want to have this wonderful hormone surging through her body and her baby? Again, I ask, why is it bad to let your baby fall asleep at the breast?

Follow your baby's cues. Don't be a clock watcher. Don't schedule your baby. Together, you will fall into a natural routine. Routines are great. Schedules, not so much. Think of what is best for your baby. If it's best for your baby, it's most likely best for you too in the long run, even if it seems inconvenient right now.

Monday, November 15, 2010

Social Circumcising

We had a great meeting and discussion this week at the Tarrant County Birth Network meeting.  One of our topics was circumcision.  I've written quite a bit on the blog about circumcision, but I haven't addressed the social reasons that I hear so frequently regarding the decision.  So let's talk about them.  If I miss any, please comment below and we'll try to address them all.

If you have not read about the purpose of the foreskin previously, I want you to do that now.  Click here.

The foreskin is obviously not just a flap of skin.  It has many purposes.  So why are 50% of American males still being circumcised?  It's these social traditions or concerns that need to be addressed.

1.  We want him to to look like his dad.  A little boy looks no more like his dad than a little girl looks like her mother.  Things grow bigger and grow hair, which, in my opinion, is much more distracting than the foreskin!  Mostly, after the first couple of years of life, when does a boy ever see his father naked?  My 14-year-old intact son has no idea what his father looks like and vice versa.  Frankly, in my opinion, it's a really odd and disturbing argument.

2.  What about the locker room?  Won't he be made fun of?  Maybe 20, 30, 40 years ago, but with 50% of males not being circumcised, it becomes a matter of education in my opinion.  When my son went to 5th grade we knew he would be dressing out for PE.  We sat him down and told him about circumcision.  He was, to say the least, appalled -- very much the same way you were when you found out about episiotomies.  We explained that we researched it and felt there was no reason to do it and that most parents do it because of tradition.  He knows that those kids' parents probably just didn't know any better.  He politely thanked us for "not doing that" to him.

Last year, in 8th grade, I asked him if it was ever an issue, and he laughed.  He said, "No one is looking!  Creepy!"  As a side note, as a boy grows into a man, it becomes less and less obvious that he is not circumcised, especially when it is erect.  This is, again, in my opinion, an argument made by (jealous?) men envious of their intact friends who are, on average, 25% longer than the circumcised male.  Just saying.

3.  Isn't it cleaner to be circumcised?  There has been misconception about smegma, the tiny, white, ball-like substance that the foreskin produces.  In the past, by those that don't understand it's purpose, it's been thought to be unclean.  In fact, just the opposite it true.  The foreskin is self-cleaning, as smegma is antiviral and antibacterial.  No soap is required, just warm water in the shower, later, when the foreskin retracts on its own.  Next time you hear someone say in regards to circumcision, "I guess, as long as he is taught how to properly clean himself..." you can let them know that remaining intact is not unclean.  That is part of the misconception, created by a society that wanted males circumcised because they believed it prevented masturbation.  Seriously?  I guess when 20,000 nerve endings are removed...  Mostly, he'll just never know what he's missing.

4.  Circumcision was a law in the Old Testament so we should follow that law.  It must be noted that circumcision was nothing in the Old Testament like it is in America today!  Removing as much as 80% of the penile covering is not what was going on back then!  It was more like a nick in the foreskin.  Of course, circumcision is still a part of religions today, so I am mainly addressing those of the Christian faith at this point.  If you continue reading the New Testament, it's very clear that the law of circumcision, along with many other laws, were done away with through the blood of Christ.  I'll encourage you to search that out.  For my LDS readers, it is stated many other places as well -- The Book of Mormon and the Doctrine and Covenants.  

5.  Circumcision prevents being sexually active at an early age.  Seriously? 

6.  His future wife will think it's ugly and wish he was circumcised.   Who comes up with this stuff?  Very likely, she won't even know the difference.  I have friends that had no idea their husband wasn't circumcised until he told her. 

 7.  I'm leaving it up to my husband to decide.  Why?  It's not his penis in jeopardy!  Your baby cannot speak for himself and he needs his mother to advocate for him.  This is where we get into informed consent issues.  I'm convinced that one day a boy/man will sue his parents over this issue.  If you think that "he has a penis, he knows what it's like," it's a different time today than it was 30 years ago.  Parents are educating themselves and questioning (foolish) traditions.  This is surgery for your baby.  Both parents should be making this decision, not one or the other.  What about letting your son decide for himself?

8.  Better to do it now since he won't remember it.  Babies feel pain more acutely than adults, they just can't say so.  This argument also implies that it will have to be done later, which is highly unlikely.  See the argument below.

9.  It's better to do it now than later when it's more painful.  I compare this argument to elective cesarean (surgery that is not needed) and cesarean with an OB or midwife who has an extremely low cesarean rate (only doing surgery when it's truly required).   Some doctors or pediatricians have no idea about the intact male.  They try to pull the foreskin back at each appointment because they haven't researched it or know any better.  They are looking for things to go wrong.   We all know what happens when you have an OB like that -- you have surgery.  The same is true for an intact male.  It is very important that you have a pediatrician/family practice doctor who is up-to-date on the intact male.  If they are supportive of not circumcising (supportive, not compliant) and for whatever reason believes that your son needs to be circumcised (extremely rare), then you won't need to second-guess that decision.   It's always best to get more than one opinion, regardless.

10.  His brother(s) is circumcised, so we have to keep doing it.  Two wrongs don't make a right.  The cycle has to stop somewhere.  I've had guys in class tell stories about some of the boys in their families being circumcised and others not, and not once have they made it to be a big deal.  They all knew why some were and some weren't.  I even had one guy say that he and his brother didn't know that one was and one wasn't until they were adults and their mom was talking about it as they were making the decision for their baby.  As far as who is envious of the other, I can't help but think it will be the circumcised male that is envious of his intact brother.

Just a couple other things to touch on:  Female circumcision has been in the news quite a bit lately.  When we mentioned it the other day at our meeting, everyone cringed.  Why do we do that when we are talking about females, but not males?  Why?  It's the same thing.  Think about it.

I like to see parents take this bold step in protecting their sons.  Some are breaking tradition and bucking the system.  Chances are, if you are reading this blog, this isn't the only area you are breaking out of the mold!  When we chose not to circumcise our son, 14 years ago, we had no friends that didn't circumcise their sons.  As the months went by, we found out that most of his male cousins aren't circumcised either.  We found it was more prevalent than we had thought when we made the decision.  That is great, but it is so important that we share this information with expectant parents.

The 9th step to the Mother Friendly Childbirth Initiative is to discourage non-religious circumcision.  Discourage is an action word!

Monday, November 8, 2010

TCBN Meeting this Week -- Newborn Testing & Procedures including Circumcision

This Thursday, November 11th, is our monthly Tarrant County Birth Network meeting.  We meet on the Texas Wesleyan campus in the Sid Richardson building on the 2nd floor from 7:00-9:00 pm.   We invite all expectant couples to come learn about newborn testing and procedures, no matter where you are planning to give birth. 

We are excited to hear from Christy Martin, a member of TCBN and Certified Professional Midwife, speaking on newborn procedures under her care either in a birth center or your home.  We will also hear from a nurse from one of Tarrant County's hospitals as to what to expect with newborn testing and the different procedures that take place when the baby is born in the hospital.  When do these things take place?  Why is it done?  Are they optional?  Come find out.

We strongly encourage fathers-to-be to come to this meeting this week.  Very often, it is the dad who is with the baby at this very important time, and we want him to be informed about what is being done to his baby.

In addition, we will have a great discussion about circumcision at this meeting.  Again, I hope you'll encourage the men in your life to attend this meeting.  So often, brand new parents just go along with tradition -- testing, bottle feeding, immediate cord clamping, eye ointment, vaccinations, and of course, circumcision -- because they simply don't have the information about why these things are being done. You may find that one or both of you is not okay with certain procedures.   It's a lot for mom to have to go home and explain all this information to her husband, so just bring him with you!  Then, the two of you will be able to make informed decisions in regards to your newborn.

Last month, it was so fun to have all the babies and toddlers at our Babywearing meeting.  With all the kiddos, we had 75 people in attendance!  This month, however, we are back to our usual request:  Please only bring immobile lap-babies.  We hope that expectant couples can get the information they are looking for, and sometimes it gets quite noisy!  (Remember what it was like before you had children!)  I am on the prowl this week for a microphone for future meetings, so that will help tremendously. 

Just a reminder, it's only $25 for a Consumer Membership and there are some fantastic benefits offered by our Professional Members if you are a member of TCBN (pick up a Resource Guide to check them out). You can join online.  Thanks for your support of TCBN and Mother-Friendly maternity care.  See you Thursday.