Thursday, August 14, 2014

Why you should spend more than you are planning on your infant car seat

Many of my clients and friends are well aware that I am very conscious of car seat safety. What is the big deal? 

Despite a 43% drop in road crash deaths of children 12 and younger from 2002-2011, more than 9,000 children in that age group died in crashes during that period, says a new report from the Centers for Disease Control and Prevention.  Researchers found that one in three children killed in crashes in 2011 were not buckled up, and that nearly half of black and Hispanic children who died in crashes in 2009-2010 were unbuckled, compared with 26% of white children. USA Today Article

300 children are involved in car accidents every day and 2 die. 75% of all car seats are installed incorrectly. It is important to remember these five points when selecting a car seat for your child and installing it correctly:

 According to Safe Kids Worldwide, these are the top five mistakes parents make installing car seats:

  • Right Seat. Check the label on your car seat to make sure it's appropriate for your child's age, weight and height. Like milk, your car seat has an expiration date. Just double check the label on your car seat to make sure it is still safe.
  • Right Place. Kids are VIPs, just ask them. We know all VIPs ride in the back seat, so keep all children in the back seat until they are big enough to ride without a booster seat.
  • Right Direction. You want to keep your child in a rear-facing car seat for as long as possible, usually until around age 2. When he or she outgrows the seat, move your child to a forward-facing car seat. Make sure to attach the top tether after you tighten and lock the seat belt or lower anchors.
  • Inch Test. Once your car seat is installed, give it a good shake at the base where the seat belt fits. Can you move it more than an inch side to side or front to back? A properly installed seat will not move more than an inch.
  • Pinch Test. Make sure the harness is tightly buckled and coming from the correct slots (check car seat manual). Now, with the chest clip placed at armpit level, pinch the strap at your child's shoulder. If you are unable to pinch any excess webbing, you're good to go. NBC Story

  • Things to consider when shopping for an infant car seat. Inexpensive infant car seats start at around $50 and range up to $200

    • An infant car seat is only usable rear facing and holds and infant until they weigh between 20-35 pounds. The car seat is easily removed from the car with a carrying handle to move a sleeping infant into the house or into a stroller system . INFANT CAR SEATS ARE NOT TO BE PLACED IN A SHOPPING CART. They are not designed that way and there have been multiple deaths recorded.
    • If you are using a hand me down or used car seat check to see it is not expired. Most infant car seats expire between 5-7 years. They expire even faster in our Southern Utah heat due to how the heat affects the plastic. Never use a car seat that has been in an accident no matter how small.
    • You have to be able to tighten the straps very tightly so that you can fit two fingers underneath the strap and you can not pinch any of the strap between your fingers.
    • Seat must be at 45 degree angle
    • No more than 1 inch of movement side to side when installed
    • No head rests of strap pads added to the seat as anything not included and tested with your seat can greatly affect the safety
    • Harness must be through the right slots in the seat. If rear facing the harness slots must be below the child's shoulders. If forward facing (which is not possible with an infant seat) they should be at or above the child's shoulders.
    • Chest clip must be at nipple level.

    • No coats, blankets, swaddlers or anything else between baby, seat and harness. Dress the baby in warm but thin clothing

    As you are looking at a car seat consider how long it will be in use for the child. Once breastfeeding is established, we expect babies to gain at a rate of about 5-7 oz per week (close to an ounce per day), for about the first 3 months. Between months 3-12, weight gain tends to slow down. It is normal for the rate of weight gain to slow down, but it is not normal for weight gain to stop completely or for babies to lose weight. The average breastfed baby doubles their birth weight by about 5-6 months, and at 1 year, they typically weigh 2.5 times their birth weight. So for a baby that weighs 7 1/2 pounds at birth on average s/he will weigh nearly 18 pounds by their first birthday. In my personal experience they often weigh much more. Many children also grow very tall quickly.

    So why bother with a more expensive infant car seat system?

    You buy the cheapest infant car seat that Walmart offers: Cheapest 

    Cosco Juvenile Light 'N Comfy Infant Car Seat, Dots:
    Rear-facing: 4 lbs-22 lbs; for child measuring 29"
    Side impact protection
    5-point harness
    4 harness heights for the best fit as baby grows
    Includes retractable canopy
    Latch equipped with convenient latch storage
    Cost: $47

    Problems with this seat:
    • Difficult to tighten harness because you can only access from the back of the seat. This is huge!!! That means every time you need to buckle your baby in you will need to take the seat out and turn it around to access the back to you can can tighten the straps enough. To get the baby out of the seat you will have to turn it around to access the back to loosen the straps.
    • Insufficient padding making many babies fussy and uncomfortable during the rides.
    • Harness made of cheaper material making it easier for them to twist and tangle. A twisted seat is not safe.
    • It has a latch that is difficult to use you must place one piece on top of the other before you insert it into the buckle.
    • No built in head support. 
    • 22 pound weight range means many babies will need a new seat before 1 year old. The average 12 month old male weighs between:19.8-22.9 pounds, 12 month old female weighs between:18.2-21.4 pounds.
    • 29 inch length measurement is also small. The average 12 month old male measures between: 29.2-30.5 inches, average 12 month old girl measures between:28.5-29.8 inches
    So based on height and weight you will have to get an additional rear facing car seat once your baby is about 12 months old on top of the other issues the largest of which is how difficult it is to get the harness tight enough.

     Let's compare to a more expensive infant car seat from Target: More Expensive

    Graco Snugride Click Connect 35:

    • Features: Adjustable Harness, Removable Seat Pad, LATCH Compatiblity, Level Indicator For Proper Installation, EPS Safety Foam, Rotating Canopy, Removable Head Support

    • Safety and Security Features: LATCH Equipped Car Seat, 5-Point Harness, Rear Facing Only, 2- Piece Chest Clip, Side Impact Protection

    • Rear Facing:Minimum Weight: 4 Lb.; Maximum Weight: 35 Lb. Maximum Height: 32 "

    Cost: $150

    Improvements made with this seat:
    • Easy to tighten harness as it is right in the front of the seat.
    • Adequate padding for comfort
    • Thicker less likely to tangle straps
    • Simple buckle
    • Built in head support
    • 35 pound weight range means it will fit most children until the age of 36 months (3 years) based on weight alone. Average male is between 29.5-34.3 pounds, Average female is between 28.4 -33.4 pounds
    • 32 inch height means it will fit most children until the age of 21 months (1 3/4 years) based on height alone.Average male height is 32.7-34.3 inches, average female height is 32.1-33.8 inches

    I personally had the Graco 35 for my last child and he (who was very small for his age) fit in it until he was 3 years old. If you have to replace your infant car seat earlier you will have to buy an additional convertible car seat. When you do get a convertible seat with a minimum of 65 pound weight limit. Keep your child rear facing as long as possible a minimum of 2 years but as long as 4 years. The large size of their heads in comparison to their bodies makes them much more likely to be injured in a car accident if they are forward facing.

    Many parents want to start out with an infant seat and there are some benefits. If you are really trying to save money it is best to just buy a convertible seat with a high weight limit to 65 pounds then your child stays in one car seat until they are ready for a booster seat.

    The best bang for your buck in my experience in this Diono-RadianR100-Convertible-Seat
    • The Diono Radian family of car seats are the only convertible+booster seats with a full steel frame making them one of the safest car seats available today
    • Rear facing 5-to 40 pounds. Forward facing 20-65 pounds (up to 57") in 5 point harness. Booster to 100 pounds.
    • Aluminum reinforced sides and energy-absorbing harness system for added safety
    • EPS foam for side impact protection
    • Folds flat for travel and fits 3 across in a mid-size vehicle

    You will only have to buy one car seat ever for your child-infant to booster. Because of the high quality of materials this car seat does not expire for 8 years in harness mode with an additional 2 years in booster mode. That is 10 years for one car seat. This is also the narrowest car seat around making it possible to fit three of these across in a sedan, SUV or minivan.

    Saturday, November 9, 2013

    How do I Know When I am Going to go Into Labor?

    How do I know when I am going to go into labor? 

    Oh how I wish I could answer this question for all of you. If I had a crystal ball and could I would be rich! This is such a common question in my practice. Women in the United States have been lulled into a false sense of planning by the medical community making them believe they can detect when they go into labor. 

    Here are a few things that will not detect that you will go into labor soon:

    1. You are dilating. But but but. Nope. Doesn't matter. I have seen women walk around at 7 cm for a couple weeks then go on to have a normal length labor. I have seen women go from 1 cm to baby in one hour. It is not a good assessment of when you will have your baby.

    2. It is your due date. See #1 below.

    3. Your baby has dropped. This can happen in labor.

    4. Your previous baby was born at 39 weeks (or 40, or 37). Your previous gestation amounts can play into the equation but based on 11 years of birth work I would never put money on it.

    For those of you (like me) who appreciate a good check list here are a few warning signs (party signs?) that labor may be on it's way in the next week or less:

    1. You are over your estimated due date. I tell every first time parent to add 8 days to their EDD based on their last period and count on baby coming no sooner that that. Make sure you share your new EDD with everyone. But what if the baby comes early you ask? You have your baby a few weeks early and no one raises an eyebrow, but go over your due date and the texts and phone calls won't stop until the baby is out. Even mom's who have had a baby before often hit their due date.

    2. You have had a seriously good cry. This usually occurs as a prenatal appointment after you come in puffy and glaring at your care provider that you are still pregnant. The cry often occurs from the build up of hormones in your body preparing you for labor.

    3. It has been one week since you have had a night of contractions where you were "Sure this is it."  and you almost called(or did call) your midwife.

    4. You have loose bowels. You have spent most of your pregnancy more blocked up than usual thanks to iron supplements and slowed down digestion which helps with greater absorption of nutrients that is typical in pregnancy. Suddenly things change the other direction. Emptying becomes the word of the week.

    5. You have lost your mucous plug although these regrow all the time and it is not uncommon to loose them a couple of times before baby comes.

    6. You get up in the middle of the night to fold baby clothes. Nesting anyone?

    7. Everyone in the family has gotten a really nasty cold, flu, or stomach virus and it now starting to feel better. It sounds crazy but  this almost always happens. Every one gets sick about a week before baby comes. Mom is super stressed about being sick or having sick kids while in labor. Everyone gets better and then the baby is born.

    8. Your toddler has decided s/he is ready to toilet train. Completely serious. You wanted to do it all your first trimester but didn't have the stomach for it. You tried to do it your second trimester but the child wasn't ready. You had given up hope the third trimester and were sure that they would be in diapers in college. Week before the baby comes and wamo they want to use the potty and you spend a week washing pee soaked underwear.

    9. Your mother-in-law who came into town to be here for the birth just caught their flight back home. Your body has a way of waiting to go into labor until it can be a private event. This can also be the sister, best friend, mother etc. I really do not have a vendetta against mother-in-laws.

    10. Baby is moving less. It is very important to pay attention to baby's movements in utero as this is a positive warning sign that baby is doing well. Often right before labor there is a moment of calmness from your little one as s/he prepares for birth. They have just plain run out of room and their head is wedging deeper into your pelvis. This comment usually comes up during a prenatal appointment, but more than a handful of times I have gone to a clients home to check on things because mom was concerned that the baby wasn't moving and there was something wrong only to arrive assure her everything is fine and she is in early labor.

    Regardless of everything above your baby will come when it is the right time for him or her. There is a point when almost every woman meets a point of surrender. She will be pregnant forever and she is ok with that. For now she will enjoy the joy of the baby growing with in her. Then the baby will come. The beautiful thing about birthing at home is that we get to follow the Divine plan and allow our bodies to do what they were meant to do, birth a baby perfectly.

    Monday, October 28, 2013

    Top 8 Supplements for Pregnancy- My Picks

    The majority of women who choose to birth at home have a healthy and varied diet. If they do not feel the need to take any supplements I support them in this choice and I require none in my practice. For thousands of years women have grown healthy babies. Many others wonder what else they can or should take to help them have a healthy baby, to feel well during the pregnancy, have enough energy for birth, and to recover quickly post partum. Below you will will find the eight most common supplements I recommend to my clients.

    1. Whole Food Prenatal
    The two brands that I recommend are Rainbow Light Prenatal and New Chapter Perfect Prenatal.

    As a general rule I recommend Rainbow Light because it is just one pill per day. I know when I was pregnant I struggled to even remember to take one pill a day never mind three. Rainbow Light does however contain Red Raspberry Leaf which some women are sensitive to so keep that in mind. New Chapter is also wonderful and easy on the stomach. It needs to be taken 3 times per day but contains no Red Raspberry Leaf.

    2. Vitamin D
    There are many symptoms associated to low vitamin D levels that are often attributed to pregnancy. 
    These are common issues from low vitamin D levels:
    • Fatigue
    • General muscle pain and weakness
    • Muscle cramps
    • Joint pain
    • Chronic pain
    • Weight gain
    • High blood pressure
    • Restless sleep
    • Poor concentration
    • Headaches
    • Bladder problems
    • Constipation or diarrhea
     Sunscreen, lack of foods high in vitamin D and lack of time spent outside contribute to our issues with not making enough vitamin D. Egg yolk, many types of oily fish and cod liver oil are good natural sources of vitamin D. Low vitamin D has also recently been linked in pregnancy to gestational diabetes, preeclampsia, and low birth rate.

    3. Omega-3- fatty acids
    These good fats are very depleted from the mother during pregnancy because they are used in fetal eye and brain development. Depletion in the mom often leaves her feeling low on energy, depressed and nutrient starved.

    4. Probiotic

    Probiotics are live microorganisms, good bacteria, and by the millions they live naturally in the intestines. They are introduced to our bodies during birth and with out the we would be prone to infection, vitamin and mineral deficiencies and a weakened immune system. When the gut has enough good bacteria is prevents bad bacteria and helps protect us from infections. Studies show that mothers who increase their probiotic intake during pregnancy reduce their child's risk of allergies  They also loose their baby weight faster and have fewer yeast and thrush infections.

    5. Chew-able Papaya Enzymes
    Heartburn and indigestion is a common ailment during pregnancy. A raw enzyme in papaya can help. The Papain enzyme may assist in breaking down food in the stomach which may reduce heartburn, acid reflux and other gastrointestinal conditions.

    6. Floridix
    Anemia is common in pregnancy. Floradix contains an herbal based iron supplament which is easily absorbed and less likely to cause constimation that synthetic iron. Having a low hemoglobin count can leave you feeling tired and lethargic during pregnancy and can affect how you feel after loosing blood during your birth.

    7. Chlorophyll
    Consuming liquid chlorophyll during pregnancy, labor and postpartum can affect your energy levels, milk supply, safe detoxification, constipation and much more. Let's face it who doesn't need more greens in their diet. The mint flavor tastes great.

    8. Red Raspberry Tea
    Red raspberry leaf helps to tone and contract the uterus. Strengthening the uterine muscle to prepare for childbirth. It has a mild taste.

    All of these supplements are included in my all inclusive midwifery package. Contact me to find out more about this option.

    Wednesday, May 22, 2013

    Haiti Days 6 and Days 7

    Day 6- Tuesday
    Woke up early and had breakfast. They prepared eggs with onions and peppers and pineapple. I skipped the eggs because peppers make my throat have issues. I had a piece of bread instead and a Luna bar. Midwifery meeting had me doing prenatals and being available for a birth if it came in with Marie as second. It was a very busy morning.  No labors came in so we just hung around the rest of the afternoon. A lunch of rice and beans and spaghetti for dinner.  We saw about 30 prenatals and 14 postpartums. I slept well outside again.

    Below are the native staff midwives. 

    Day 7- Wednesday
    I woke up at 5 am to rooster crowing and the power was on so I moved to my indoor bed under a fan and slept two more hours.

     Claudin woke me up at 7 to say a labor was here. It was Mediline, the woman who was here last week with false labor and bleeding. We  sent her home with orders for a HIV and syphilis test, these are free, and an ultrasound. She was back with her ultrasound orders, was 4 cm and in labor but still no test results. The ultrasound showed low amniotic fluid, a low reactant and small baby and a mystery as far as where the bleeding came from. Still no test results and she still had syphilitic type sores all over her body. We asked her why she didn't get her tests done and she said she didn't want to.  Marie, Mary, and I discussed all of the options and mostly due to the fact that she was non compliant we  decided to transport her. We started an IV and her friends came to be her support at the hospital. They were really upset that we were taking her but calmed down after we shared the reasons and nodded their head in agreement. They got into the MBH ambulance and headed out.

     Only 18 prenatals this morning.  I saw two interesting cases today. The day I arrived they had just transported a mom in preterm labor at 30 weeks.  She showed up today for her regular prenatal. They gave her some mystery pills to take daily and sent her home. They told her to come back if she needed to push or to come to MBH. She was complaining the mystery pills gave her heart problems. We didn’t know what she was on and so had no advice for her. It was really difficult to not know what to do do help. It made me thankful for being back home where co-care exists and is just a phone call away.  I sent her home with magnesium and calcium for her irritable uterus and told her to come back every week. 

    Another mom was breech and engaged at 35 weeks and a transverse baby at 36 weeks. A second time mom came in measuring 47 cm at 40 weeks. Major polyhydraminous confirmed by ultrasound with a small for gestational age baby. We referred her to the hospital for an induction. 

    We saw several postpartum moms. 
     A good number of them birth at the hospital or at home but come here for care as neither the hospital or the TBA do postpartum care. I saw two different mothers. The first was there with her 8th child. A beautiful little girl. They were both healthy but I did some cord care. The TBA's and the hospital just tie off the cord, cut them keeping them very long usually between 3 and 6 inches, and stick a piece of cloth to them. They are often stinky and infected from being pulled on and not having enough air circulation after a few days. Traditionally women wrap their baby’s bellies to keep them strong and from having big bellies. They have a fear of large distended abdomens in children as this is a sign of malnutrition. The only real problem it causes is lack of circulation for the umbilical stump and over heating so we try to discourage it.  They also don't use waterproof diaper covers so the babies always feel wet. The second mom had a listless one month old. She said he, although he was dressed in a pink dress, hadn't nursed in over 24 hours. We took mom to a private room and had her strip off her shirt as well as stripping the baby to his diaper. He nursed right away and continued for the next hour. Mom complained that her breasts were too full and she couldn’t get him to nurse in the morning. We talked about nursing 8 to 12 times a day and hand expressing to help the baby latch on. I finally figured out after quite a few discussions that nursing 8-12 times a day means nothing to most people who do not have a watch. So much to my interpreters aggravation I got in the habit of saying
     "Nurse first thing in the morning, nurse after you gather water, nurse after your first meal, nurse after the baby sleeps, nurse before you make another meal, nurse when it is getting dark, nurse when it is completely dark, nurse when you need to get up to pee at night. Repeat, repeat, repeat."
     I think she just wanted formula and felt too tired, hot and sweaty to nurse her baby. I truthfully didn't blame her. It was hot. We asked her to return tomorrow so we could check on him. We were done early around noon. Martha and I have gotten pretty good at working together and sharing an interpreter. In the afternoon we walked to the gas station for snacks. This bottle of vodka cost half as much as a Snickers bar. Made me chuckle.

     I got chocolate of course, two snickers bars. I put one in the freezer and it disappeared. I was pretty sure it was one of the workers children who took it. I didn't make a big deal about it because really I didn't need two Snickers bars and that child really did. When I was at MBH the only thefts that had occurred were food. Laptops and Ipods lying around go untouched but a candy bar in the fridge is fair game. Lunch was quinoa and black beans dinner rice with beans and sausage. We sat around and joked and talked then headed to bed.