Pregnancy "Support" 101

Support bras, support socks, support tops, support belts…

Once you become pregnant it’s like you get sucked into this huge market of support goods that everyone is telling you you’ll need, and it can get almost as overwhelming and pricey as planning a wedding, ALMOST. Yet, here I am advocating for pregnancy + labor support.

What exactly does that even mean and why do you need it? Let’s start with the top 3 very basics that are MOST important.

  1. I worked in facility that I felt was very supportive to the birth I envisioned. I trusted my coworkers and above all felt safe. When I delivered my second, my husband worked there, I researched the hospital and (again) felt SAFE. Can you say the same about your hospital? Will you be delivering at a facility with a low primary cesarean rate, a place that will support your wishes and put you first? If you answered “no” to this, maybe you can take the time to reconsider.

    As evidence becomes more available to the public, it is no wonder more women are wanting to have more laboring and birthing options.

    But unfortunately it takes 15-20 years for evidence to come into practice in a hospital.

    If your hoping to labor in a birthing tub, but the labor and delivery unit does not even have one, or maybe the hospital you are delivering at has a high primary cesarean rate and low breastfeeding rate… that may be something to reconsider. Spend that extra time and do research. If you are in California, check out calhospitalcampare.org, or leapfroggroup.org. If you find your hospital isn’t what you thought it would be, call your insurance and switch! If you can’t switch, for whatever reason, know that you can still get an awesome birthing experience by having other “support” systems in place, for example, a great provider.

  2. As a woman, a mama, and a nurse, finding the “perfect” provider is a solid must. As a labor and delivery nurse I was able to indirectly audit, interview, and precisely choose a provider that I knew, trusted, loved, and who felt the same about me.

    How do you feel about YOUR provider?

    Do you find yourself completely comfortable with him/her? Are you able to ask questions without them shutting you down or making you feel silly? Do you completely trust them? If you answered “yes”, AWESOME- that is one of the biggest components of labor support. If you answered “no”… sistah, lets chat.

    In every profession, you will have those people (providers) that just blow you away with their amazingness, and how they put their heart into everything. If you find them, hold them tight, DON’T EVER GO!!

    BUT, there are also those who… well, those who don’t. There were moments I wanted to tell my laboring patients that the provider they chose was not one to honor the birth plan they spent hours preparing, would routinely perform an episiotomy, scoffed at doulas, or that they probably had the highest primary cesarean rate around… but couldn’t or I’d lose my job, the only thing I could do was involve the expecting parents in their care and encourage that family to use their voice and advocate for themselves.

    If you find yourself in a position where you don’t like your provider, you can call your insurance company and get a list of providers, ask other mamas for recommendations, or even look on yelp. Then meet with them until you find THE one.

    You have every right to change providers if you don’t trust or feel comfortable in their care.

    “OK, but Jessica, what if you think you like your physician at first but the closer you get to your due date you find that you are just not happy?” SWITCH.

  3. Have you considered who will be at the hospital or in your room while you are in labor?

    True Story, us Labor and Delivery nurses are never afraid to be the “mean nurse” to guests in the interest of our patients. Labor is an exciting thing, BUT, it doesn’t warrant a party with 15 people sitting around you as you labor, passing a box of pizza back and forth, speaking above each other, and shows like Maury (THE WORST) playing in the background. It is  amazing how much resetting the environment, asking everyone to leave, cleaning the room, turning off the TV and bright lights, actually helps contractions to get back on track and resume labor progression.

    Another question I get asked a lot is about having a birth doulas for labor or having another person available to provide continuous labor support in addition to your partner. A doula’s role is to provide physical support, emotional support, informational support, and advocacy to his/her clients. Evidence shows that women who have had some sort of continuous support show: (Evidence Based Birth®)

    • 25% decrease in the risk of Cesarean; the largest effect was seen with a doula (39% decrease)*

    • 8% increase in the likelihood of a spontaneous vaginal birth; the largest effect was seen with a doula (15% increase)*

    • 10% decrease in the use of any medications for pain relief; the type of person providing continuous support did not make a difference

    • Shorter labors by 41 minutes on average; there is no data on if the type of person providing continuous support makes a difference

    • 38% decrease in the baby’s risk of a low five minute Apgar score; there is no data on if the type of person providing continuous support makes a difference

    • 31% decrease in the risk of being dissatisfied with the birth experience; mothers’ risk of being dissatisfied with the birth experience was reduced with continuous support provided by a doula or someone in their social network (family or friend), but not hospital staff

While you don’t have complete control of how your pregnancy and childbirth unfold, you can control how you nest your mind and your heart for this momentous day. As a nurse and a wife to a pediatrician, we feel most comfortable delivering in a hospital setting. Knowing our options, asking questions, advocating for ourselves, and choosing a provider and a hospital that we know will support us gives us that certainty and that trust. Take the time you need and don’t be afraid to ask questions. You’ve got this!!

Big hugs and belly rubs from this mama to you.

Top 10 Items For The Best New Mama Gift Basket

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I love baby showers. Mostly because I love pregnancy and babies… alright I’ll say it, and “momosas” that have thankfully become a staple. As a mama myself, I spent so much time nesting by preparing the nursery, registering for baby items, washing baby clothes, and prepping a diaper bag. After I delivered I realized I forgot completely about me… specifically the things I would need at home after delivery. 

Back in the day childbirth was somewhat of community/mom tribe event, women supported women, delivery was not so medicalized or private, and there was not much fear around childbirth because you were very much exposed to it. What I loved about my role in labor and delivery was that I had the privilege to play a part in MANY childbirths, I knew what to expect, and I felt prepared and empowered in watching women give birth. It was such a beautiful experience. BUT, after talking to many millennials around my age, I realize THAT is not the case for everyone. In reality, there is this “unknown” that accompanies childbirth and it can be scary, and you can feel and be quite unprepared for the normal occurrences post-delivery.

Since then, my favorite thing to gift at baby showers are postpartum baskets. These baskets are filled with little things that prepare new mamas for postpartum paired with a card that explains each item… I also throw in a few things for the baby because, c’mon, who could resist. While my mama friends may blush a little when opening them, especially if they are first time moms, they hands down thank me after the baby is born.

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** Disclaimer: This post contains affiliate links. This means I may earn a small commission should you chose to purchase using my link. Please note that I only recommend products that I personally use and love and always have fellow mama's (+ baby's) interest at heart.

You can gift a few or all of the below, but the top 10 items are:

  1. A cute water bottle: Hydration for a new mom is key for milk production, healing, and because she lost lots of fluids during delivery, it helps with fluid replacement. 

  2. Pads: Postpartum bleeding can last days to weeks and having at least a pack of pads WITH WINGS at the ready just helps your new mama to care for herself, prevent infection, and feel good.

  3. Fridet the MomWasher: A perineal spray that helps to clean any laceration repair, prevent infection, soothes irritation, and honestly just feels great. If your mama is having a cesarean, a GREAT abdominal binder in leu of this would rock!
  4. Witch Hazel Pads: Witch Hazel pads AKA Tucks is used for hemorrhoids, and are cold and soothing. I recommended my patients placed them on top of peri pads for the same effect on the perineum. They are also very gentle for cleaning, and last forever!
  5. Stool Softeners: regardless of a vaginal delivery or cesarean, the first time pooping after is going to be quite uncomfortable. If she needs to take anything stronger than Ibuprofen for pain, constipation is inevitable. Stool softeners/Smooth Move tea will help with that discomfort and make that transition smooth... (get it?? ;])
  6. Ibuprofen: Postpartum cramping is very normal, but feels like bad period cramps, not to mention possible laceration repair discomfort, and the burning that often accompanies breastfeeding. Ibuprofen really helps to ease that discomfort and is safe for the baby. Having this at the ready literally can save a new mom from tears and stress.
  7. Nipple Cream: as I just mentioned, breastfeeding can be quite uncomfortable for the first 1-2 weeks, not only from causing you to contract but throwing nipple sensitivity on top of chapped nipples can bring a new mama to tears. Help prepare her with nipple cream or coconut oil. If that is a liiiittle too intimate for you, a great nursing tank would ROCK her world. Breast accessible clothing is a Game. Changer. Big Time.
  8. Bamboobies: Bamboobies are breast pads made from bamboo and are the SOFTEST breast pads ever and truly absorbent... that comes from someone who made enough milk every feeding to feed an entire NICU and leaked through EVERYTHING. They are my absolute favorite! 
  9. A nursing cover: I am all about "free the nip" but, I also prefer to use a light nursing cover when I don't want to accidentally spray down anyone who is in the way of my breastmilk. I love the ones that are just an easy strap like an apron with a rigid neckline for easy no-fuss breastfeeding.
  10. Prenatal/postnatal vitamins: After delivery a mama's body does not stop working. In fact, more calories are being used for breastmilk, there is more nutritional need for healing and to pass to baby. Encourage a new mama to continue to take vitamins after delivery to help with all of the above and to get back on her feet faster. She very well can get all the vitamins she needs from her diet, but just in case I definitely recommend a whole food vitamin option. 

Mommy-ing ain't easy, and it takes a village. Luckily if you are reading this, you are making that village pretty dang awesome. If you are a momma, no shame in sharing this post to your fam/friends... think of it as part of your registry. You've got this! 

Big hugs and belly rubs from this mama to you

The Natural Nipple: Guest Blogger

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Many people talk about the magical parts about becoming a mother. But so often we forget about, or avoid talking about the difficult, maybe embarrassing parts about being a mom for fear that we are abnormal or that we’re a failure.

One of those difficult parts is the challenges faced with breastfeeding. A significant part of being a mother with a newborn.

If you’re a new mom or expecting you’re probably no stranger to the studies that have been published on the incredible benefits of breastfeeding your children. Just to list a few, there is a greater resistance to developing things such as systemic autoimmune diseases, allergies, and neurodevelopmental disorders (Weng & Walker, 2013). Other findings from a recent study suggest that breast milk provides babies with diverse gut microbiome that helps protect them from harmful diseases (Stewart et al., 2016). These are just a few of the incredible things breast milk can provide.

But breastfeeding isn’t easy - with so many moms experiencing difficulties with latching, nipple confusion(after the baby is introduced to a bottle), nipple pain and discomfort, anxiety about whether or not they are producing enough milk, and so on. These are such common issues experienced among moms...but what solutions have really been offered?

That’s what we are trying to do with The Natural Nipple. Our goal is to pioneer the first study that explores women’s natural flow rate at different stages post-birth and differences in nipple shape and structure to develop a better breast to bottle solution.

We want to design a bottle and nipple that doesn’t disrupt your breastfeeding by providing you with a bottle and bottle nipple that mimics your natural shape and flow rate so you’re able to more easily go between breast and bottle.

What you’re doing is important, but life and other things can make it difficult. So for any mom who is trying to breastfeed but needs to get back to work, any mom who is experiencing extreme pain and needs to take a break from direct feeding, or struggling with breastfeeding in any other way we want to offer a solution.

We would greatly appreciate your input as well because we can’t do this without your help!

If you can, please fill out the survey below or donate a small amount to help us get this project off to a running start! 

Stewart, C. J., Embleton, N. D., Marrs, E. C. L., Smith, D. P., Nelson, A., Abdulkadir, B., . . . Cummings, S. P. (2016). Temporal bacterial and metabolic development of the preterm gut reveals specific signatures in health and disease. Microbiome(1). doi:10.1186/s40168-016-0216-8    
Weng, M., & Walker, W. A. (2013). The role of gut microbiota in programming the immune phenotype.Journal of Developmental Origins of Health & Disease, 4(3), 203. 

 

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team of clinicians, scientists, and mothers pioneering advancements to empower breastfeeding, promote bonding, and optimize wellness for mothers and babies worldwide

Your Perineum & Childbirth... my what?

So what IS a perineum? The female perineum is the region between the vagina and the rectum. It consists of layers of skin, mucosa and muscle.  This is the area, during childbirth that is most talked about when it comes to labor trauma/lacerations.

It seems like perineal trauma may be a big concern for many women, for good reason. I mean, no one wants vaginal trauma, EVER. 

One of the most common questions I get asked is, “does every woman ‘tear’ down there?”

The answer, no, not every woman will have lacerations from birth. Spontaneous lacerations that occur during birth are not always controllable, but there are certain techniques that can help slow down the birth of the baby’s head, and allow the stretching of the perineum to prevent injury, including “perineal massage, warm compresses and a “hands on” guarding of the perineum.” (World Health Organization, 2018)

The next question is almost always, “is it true everyone gets an episiotomy?”

The answer again, NO.

Lets take a step back... What IS an episiotomy? An episiotomy is a “surgical incision” of the perineum and vaginal wall done by an obstetrician during the last part of the second stage of labor (*translation: as the head of your baby is crowning). The purpose of this incision is to create more room for a safe delivery of your baby. Like any surgical incision, episiotomies should be performed under local anesthesia... like the shots the dentist gives to numb your mouth, only its your OB and your perineum.

While there are many reasons to have an episiotomy, not every woman needs one and not every woman will have one. 

duvet days episiotomy

It used to be common practice for obstetricians to perform episiotomies routinely because they thought it would help control spontaneous perineal lacerations from extending to the rectum (third and 4th degree lacerations), new evidence has shown that episiotomies should be performed only when deemed absolutely necessary and should be decided by the obstetrician.

In July of 2016, The American College of Obstetricians and Gynecologists (a professional organization that advocates for the highest standards of care, continuing education, and awareness of women’s health care issues) released a practice bulletin that strongly recommends certain prophylactic practices to reduce dramatic lacerations that extend to the rectum and prevent anal sphincter lacerations. These practices include NOT performing episiotomies routinely, applying warm packs to the perineum during pushing, and performing perineal massage in the second stage of labor to reduce 3rd and 4th degree lacerations.

While healthcare is continuously evolving to make childbirth a pleasant experience, and physicians should always strive to administer the highest standard of care, I highly encourage you as a patient, the significant other, or the support person to talk with your obstetrician about episiotomies, their practices, express your concerns, and have an open conversation to create a plan for your delivery.

Big Hugs & Belly rubs. 

 

references

“WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience.” World Health,              World Health Organization, 2018, www.who.int/reproductivehealth/publications/                            intrapartum-care-guidelines/en/.

“Women's Health Care Physicians.” Ob-Gyns Can Prevent and Manage Obstetric Lacerations                     During Vaginal Delivery, Says New ACOG Practice Bulletin - ACOG, June 2016,                                 www.acog.org/About-ACOG/News-Room/News-Releases/2016/Ob-Gyns-Can-Prevent-                   and-Manage-Obstetric-Lacerations.

 

Pregnancy & Skin Care

Pregnancy can often throw curve balls when it comes to your skin. You can either have that glowing beautiful blemish free skin ORRR you can have those breakouts that throw you back to your high school years, dark spots/darkening on various parts of your body, eczema flare ups, and/or red blotchy skin.

I was lucky/unlucky to experience all of the above. First trimester of my second pregnancy, I definitely broke out as much as I did when I was 15. I had a linea negra with ONLY my first pregnancy that extended from my navel to my pubic bone. I had an eczema patch on the inner corner of my eyelid that drove me nuts. The increase in blood volume + the mix of progesterone caused this increase in volume to my lips (which was pretty great), my face (not that great), and caused his weird blood vessel to enlarge on my face which is actually still there 4 years later (not great at all).

So, what is a girl to do when pregnancy gives you lemons?... you ask a legit source for some advice on how to make some strong, non-alcoholic, lemonade. 

I reached out to my friend, Jenn Rawson PA-C, who works in an obstetrics office affiliated with Hoag Hospital, and asked if she could lend some professional advice about skincare & pregnancy for all my radiant mama-friends, and she did NOT dissapoint!

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The thing to remember is, while it can be unpleasant, it’s actually normal.

There are many things that you can do for your skin, but the thing to remember when it comes to pregnancy and skin care is that most of these changes are hormone related and it is important to be aware of ingredients in the products you use, and check with your provider if there is any question.

When it comes to breakouts, Jenn explains, “the majority of acne is hormonal and doesn’t always respond to over the counter treatments, however there are pregnancy sage acne medications. Benzoyl peroxide wash, salicylic acid face wash (max 2%) and prescription azelaic acid.Pregnancy safe facials are allowed in the second trimester, however, I always advise to get it done by a licensed esthetician since they are more knowledgeable about pregnancy safe products.”

In addressing eczema flare ups, Jenn says that it is common, and that over the counter hydrocortisone is safe in pregnancy and for severe flares, a moderate level steroid under the supervision of a dermatologist usually for no more than a week is okay if necessary.

I mentioned earlier that dark spots are common during pregnancy due to hormones, and can be on various parts of your body. That includes dark spots on your face, upper lip, Melasma aka the pregnancy mask, darkened nipples, a darkened line that extends down your abdomen, and sometimes darkened labia. While there is not much you can do about Melasma, linea negra, and darkening of your “lady parts”, Jenn recommends to be proactive about decreasing facial spots by wearing wide brim hats and SPF 50 while in the sun.

With that being said, its also important to completely AVOID the use of retinol and hydroquinone. Hydroquinone is actually a category C medication, which means it is extremely harmful to your baby. These ingredients can be found in many “lightening” products, and one of the main ones Jenn counsels about is the very popular R+F’s REVERSE line.

Other things to avoid while pregnant are injectable blocks and fillers- although the increase in blood supply and progesterone should take care of all that plumping, laser treatments, and eyelash treatments. One of the main reasons for this is because there are currently not enough studies to deem these treatments as safe for your pregnancy.

Aside from her “secret weapon” aka coconut oil, the BEST thing to do for your skin during pregnancy is to make sure you are eating a clean diet, drinking 1-2 liters of water daily, taking prenatal vitamins, use over the counter face wash and creams, and last, but not least, “SUNSCREEN SUNSCREEN SUNSCREEN”.

Take a deep breath and smile, mama. These things, along with the many other unpleasantries of pregnancy, go away after delivery… you can do this!!

Big hugs & belly rubs from this mama (and Jenn)to you.

 

 

 

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Jenn Rawson PA-C

Jenn is a momma to two, a physicians assistant with a specialty in obstetrics, and such a wealth of information. She is one of those genuine people who truly cares, works to provide excellent and evidence based care to her patients, and continuously strives to increase her knowledge to better maternity care in her community. Send her lots of love as she embarks on her educational journey for lactation consultation.

Delayed Cord Clamping

photo by: Elizabeth with www.elizabethashdown.com

photo by: Elizabeth with www.elizabethashdown.com

Healthcare continues to evolve every day. No, seriously, there’s new evidence that comes out for EVERYTHING every day.

That is one of the reasons it is super important to stay up to date with these gold standards - as health professionals, but also as patients so we know what kind of care and what practices are best for us and for our family members… and in this case, our babies. A relatively new recommendation that became a standard of practice when it comes to labor and delivery, is delayed cord clamping.

Yes, it is exactly what it sounds like… delaying the clamping of the umbilical cord.

When I first started in nursing, the standard practice for cutting the umbilical cord was to clamp as soon as the baby was delivered, hand the scissors over to the partner, cut the cord… badda-bing badda-boom, pass the baby to the mom and wait for the placenta to be delivered. But since, that has changed…

Have you ever donated blood and sick afterward? I assume that is how babies feel after delivery, especially since the amount of blood they have after birth compared to the amount in utero depends on how long clamping was delayed. With every second that passes after the baby is born, more blood from the placenta can pass back to the baby. While holding the baby below the placenta will help this exchange faster, holding your baby on your chest or abdomen will have a slower, yet just as beneficial effect.

In 2016, the American College of Obstetrics and Gynecology released recommendations to delay cord clamping for at least 30-60 seconds because it has shown to be beneficial especially preterm infants, but also for term babies as well.  

These benefits include:

Increasing the baby’s hemoglobin volume.

Hemoglobin is the protein in red blood cells that circulate oxygen and iron throughout our bodies. An increased hemoglobin level will increase the baby’s iron stores for the first several months of life. This increase in iron can truly help the development of the baby in the months after birth.

For preterm babies, delayed cord clamping improves transitional circulation (when the responsibility of blood circulation changes from the placenta and umbilical cord to the baby’s heart, lungs, and blood vessels), and increases red blood cell volume.

In premature babies this is SO IMPORTANT because it reduces the need for blood transfusions and decreases the chances of premature brain bleeds (which a premie is at high risk for).

It reduces the risk of a very serious condition for premature babies, called necrotizing enterocolitis…which is actually a “medical emergency”.

The only known risk with delayed cord clamping is the increased risk for jaundice, which makes sense since the breaking down of red blood cells is what causes jaundice anyway.

Delaying cord clamping for as little as 30 seconds or up until the cord stops pulsing (usually 3-5 minutes) with your baby in your arms can truly benefit your baby. Talk to your care provider about your wish for delayed cord clamping BEFORE you deliver to  make sure you are on the same page. You’ve got this!

big hugs & belly rubs

 

Resources

Sloan, M., MD. (n.d.). Common Objections to Delayed Cord Clamping - What's The Evidence Say? Retrieved March 07, 2018,                from https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=526

Womens Health Care Physicians. (2017, January). Retrieved March 07, 2018, from https://www.acog.org/Clinical-Guidance-                and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

 

 

Takin' A Shot With Vitamin K

TRUTH: I have only ONCE hired a babysitter that was not my mom or siblings in my four years as a mom. WHY? Because I am terrified of the “what ifs”.

My two little monkeys are my entire life, my entire heart. When it comes to making decisions for them, it is my responsibility as their mother to learn the facts, weigh the risks and benefits and make a solid and educated decision for what is best for them. They can’t yet do it for themselves.

As a nurse, it is my honor and my privilege to be able to provide facts and evidence for you to help you make important decisions for your baby.

Which brings me to the point of this post…

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After delivery, completing that sweet skin to skin golden hour, and learning how to nurse your baby, the baby care team will then perform an assessment on your newborn, administer a Vitamin K injection, a hepatitis vaccine, and erythromycin eye ointment. While each one of those things is important and highly recommended by the American Academy of Pediatrics, the Vitamin K injection is probably most important to have administered at birth.

Vitamin K is a… well, it's a vitamin, and a very important one at that! It is crucial for activating certain molecules, called clotting factors, that are responsible for blood clotting. We don’t make it ourselves. We get almost all our Vitamin K through leafy green vegetables and a small amount of another type of Vitamin K (called Vitamin K2) through the bacteria that lives in our intestines. If we do not have enough vitamin K, we cannot activate the clotting factors when necessary, resulting in inability to stop bleeding.

While the baby gets everything they need from the mother during pregnancy, a very small amount of vitamin K transfers to the baby through the placenta, and after the baby is born, there is not enough bacteria in his/her intestines to make the other form of vitamin K. So basically, their levels are critically low.

Since babies have a critically low level of Vitamin K, they are high risk for suddenly bleeding anytime from the first 24 hours of life to 3-8 weeks post delivery. If your delivery included forceps or a vacuum, than the risk for a bleed is super high.  The most common time is 2-7 days after birth when the levels of Vitamin K are the lowest. Bleeding that occurs from Vitamin K deficiency in babies usually occurs in their brain, gastrointestinal system, umbilical cord site, skin, nose, and circumcision site and can be deadly if not treated right away.

What is the treatment for Vitamin K Deficiency Bleeding? The Vitamin K Injection.

How often does this even happen? Well, thankfully because of the availability, the need, and increase in education regarding Vitamin K, the incidences have become rare in countries that have access to it. Incidences in the Unites States range from 0.25 1.7 cases per 100 births…

While that may not seem like many, that does mean there STILL are babies that suffer from this. And, according to the CDC, one out of every five babies with VKDB dies

Please know, I am not trying to scare you by providing this information, I just want you to be aware of the seriousness and the reality of it.

Okay, Jessica are there any other ways to give my baby(ies) Vitamin K without the shot? What about breastmilk? That has, like, everything!!

GAHH, unfortunately Vitamin K is probably the only thing that breastmilk does not contain enough of. Most of the cases of severe vitamin deficiency bleeding have occurred to babies who have not been given the Vitamin K injection and are exclusively breastfeeding. On the other hand, formula is has a very high concentration of Vitamin K.

The best way to make sure your baby is protected against bleeding is through the Vitamin K injection. The Vitamin K injection is a very concentrated injection to your baby’s thigh, that will slowly release enough Vitamin K to protect your baby throughout the first few MONTHS of life.

*** UPDATE: While Oral Vitamin K has been shown to be effective in certain regimens, there NOT currently an oral form of vitamin K in the United States for newborn/infant use. Actually the availability of oral Vitamin K, is diminishing in other countries as well. Possibly because the injection route is a definite, one-time, preventative, and fool-proof method of protecting babies from Vitamin K deficiency bleeding. While you may find oral vitamin K on the internet, you should be aware that they are not regulated, meaning there is no third party testing these products to make sure they contain the proper dosage, that they contain exactly what they need to and exactly what they say they do, and that they are safe for newborn/infant consumption. Check out Evidence Based Birth's information on oral Vitamin K.

While the thought of injections to your sweet delicate baby can be heart wrenching, remember that the injection itself is fast and can save your baby’s life. In fact, the anticipation of the entire experience is harder on us parents than it is for our babies.

One of the best ways to comfort your baby during injections, heel pricks, or actually anytime they are fussing is to hold your baby, bring him/her to your chest for skin to skin, breastfeed, or allow sucking on a pacifier or clean finger... and then take a deep breath.

Parenting isn’t always easy, but I can promise it is worth every ounce of worry.

You’ve got this! From one parent to another, Happy Nesting!

 

References

Dekker, R., PhD, RN, APRN. (2018, February 19). Evidence on: The Vitamin K Shot in  

         Newborns. Retrieved March 01, 2018, from https://evidencebasedbirth.com/evidence-for-

        the-vitamin-k-shot-in-newborns/

 

Vitamin K Deficiency Bleeding. (2017, September 15). Retrieved March 01, 2018, from

         https://www.cdc.gov/ncbddd/vitamink/facts.html

 

Weighing In On Weight Gain

Gaining weight is sometimes an uncomfortable thing to talk about, yet it is important for a healthy pregnancy and healthy baby.

Are we really supposed to be eating for two? My friend gained only 15 pounds during her pregnancy and I have gained a little over 35 pounds, does this mean I am an unhealthy slob?? NO!

When I started as a new labor and delivery nurse, I learned the importance of weight gain during pregnancy, the importance of healthy calories, exercise, the increased need for water, the changes that occur in a woman’s body (like the fact that we create up to 3x more blood during pregnancy than we needed before), and that weight and caloric need varies for each person. But, even with learning that, there I was... pregnant and obsessing over the numbers that increased with every OB visit. There I was comparing myself to my friends who were also pregnant… friends who had different body structures and different caloric needs than I had. It’s so easy to compare.

But you can't compare when everyone’s body and everyone’s pregnancy is different.

While I easily gained what I needed to during my pregnancies, there are many women- like many of my patients, who suffer from hyperemesis (commonly known as morning sickness) all throughout their pregnancies and physically cannot gain much weight at all.

A STEADY and healthy weight gain during pregnancy is really important. While you should not obsess about it, or compare yourself to other pregnant women, you should be cognizant of your weight and strive for an active lifestyle. It’s okay to have a cupcake now and then, but maybe pass on the extra double-double with a milkshake. We don’t need to eat for two, we need to eat for one, and we should add 30 minutes of moderate exercise daily for a healthy pregnancy and healthy baby. What you consume from the moment of conception matters. A new study published in JAMA pediatrics concluded that significant weight gain in your FIRST trimester is highly associated with a baby’s weight at birth.

So how much weight should I gain?

The amount of weight recommended to gain DURING pregnancy depends entirely on your weight BEFORE pregnancy.

For example, if you are considered “overweight” with a body mass index (BMI) between 25-29.9 before pregnancy, it is recommended that you only gain 15-25 pounds. If you are considered to have a “normal” BMI of 18.5-24.9, the recommended weight gain is 25-35 pounds. And as you can imagine, if you are underweight with a BMI of less than 18.5, you should gain even more weight- approximately 28-40 pounds.

Where does it go??

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So yes, gaining weight is necessary and it should be gradual. It's also important to remember, just as weight gain is supposed to be slow and steady, weight loss after delivery will be the same, and that's okay. 

The things our bodies are capable of are absolutely amazing.

So today, instead of calling yourself a "beached whale" or looking in the mirror and letting yourself cringe, take a moment to thank your body for creating a home for your baby, call yourself beautiful, allow yourself to love your body for doing what it is supposed to do without you even realizing it. 

Big hugs and even bigger belly rubs.

-Jessica RN BSN PHN

10 Reasons To Take A Childbirth Preparation Class

I became a nurse so I could work in labor and delivery. It was “my thing”. I was always so amazed that, no matter how many births I had seen, not one was exactly the same. No matter how many births I had seen, the moment a new mom or especially a new dad would tear up, I would immediately start bawling with them.

I also began noticing which couples came in prepared, informed, and ready for delivery, and which ones …well… didn’t. Did the couples who came in prepared always get the perfect delivery they had planned? No. BUT, they did play an active role in their care. They were able to make informed choices so that they could make the best decisions for their care and their baby. Yes, I did my absolute best to educate and involve the couples who did not take any classes or were more passive about their care, but the amount of information I could give during a 12 hour shift or that they could retain while in active labor was not always enough.

Now, don’t get me wrong, I totally get why people don’t take “birthing” classes. I didn’t take one either. When my OB mentioned a “childbirth classe” I automatically thought of that whole scene from the movie, Baby Mama (click the link if you have no idea what I’m talking about) and was like, UMM “no, thanks I’m good”.

After all, I was a labor and delivery nurse, took many preparation classes, and my husband would be finishing his OB rotation in medical school... sooo, I figured we were solid, right? EEEERRRRRRR. WROOOOONG.

I always told my patients they would know when they were in true labor... yet, there I was second guessing every Braxton Hicks. Once labor really did come, and I needed that support to breathe, my husband couldn’t help me, he hated his OB rotation and checking cervixes was NOT his thing (and I definitely couldn’t reach mine anymore 🙄). Once I finally delivered and went home, I found myself getting annoyed that my husband (who had never been around babies before) wasn’t doing everything I had imagined him doing to help. It was something neither of us were prepared for.

Now, two babies, and an entire pediatric residency (for my husband) later, we still ask for help, we ask questions, and we have learned so much along the way. We recently sat down together and came up with.... 

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1.     Answer all the questions about your third trimester.

There are so many things that happen during in your last trimester and so many things to remember such as hormone changes, weight gain, fetal kick counts, exercise, braxton hicks, etc. Pregnancy brain is REAL and even IF you discussed these things with your OB it is so easy to forget!

2.     Feel empowered and eliminate fears.

Childbirth can sound scary. There is pain, there is about to be a baby, and wrapping your mind around the entire process if you’ve only heard horror stories form “friends” or family can make anyone fearful. A childbirth preparation class will give you the opportunity to get answers to all your questions, as serious or as silly as they can be... and not only for yourself, but for your partner as well. 

You are not the first person to go through this, and I can promise you won’t be the last. You absolutely can do this. Learning what to expect during labor and delivery and empowering your partner to be the best support they could be is the first step.

It’s also good to know that with delivering in a hospital - a medical model delivery, there are certain standard procedures that come along with it. BUT with that said, if you are a low risk, healthy woman, some of these standard procedures are not completely necessary and learning about them can really help you progress in your labor.

3.     Learn ways to effectively deal with labor contractions until you can get relief.

There’s no hiding that labor is painful.  But pain doesn’t always mean that you suffer along with it. It’s important to realize that there is a difference between pain and suffering. Our bodies were made for this. Yes, it’s painful- but this is pain with a purpose. There are many things you can do to keep you from suffering during those contraction until you either get your epidural or until you are able to delivery your baby. There is never a reason to suffer during what should be the most beautiful day of your life.

4.     Learn how to actively participate in your care through learning informed decision making.

Things don’t always go according to “Birth Plan”, and that’s okay. Birth plans should reflect what you envision for a perfect birth but they should be flexible as well. Learn what questions to ask so that you can be sure you are making the best choices for you and your baby.

5.     Create a support team who will truly support, encourage, coach you, and hold your hand during labor and delivery.

During labor mammals will naturally hide to a dark quiet environment to allow their bodies to relax as much as possible and, in turn, will allow proper hormone secretion to advance in labor. It is so important that the people you choose to have with you, during this time, support you, encourage you, and have all the information they need to properly help you.

6.     Learn how to decrease your chance of having a cesarean section.

While, there are things, such as your anatomy, the position of the baby or your placenta, and other things that you cannot control, if you have a low risk and healthy pregnancy, there are definitely things you can do such as changing positions, walking, squatting, and putting direct pressure on your cervix during the first stage of labor that are proved to shorten the 2nd stage.

7.     Prepare for postpartum.

There are so many changes that happen to your body over the course of 40 weeks, but there are a lot of changes that happen to your body after delivery that you need to prepare for and understand as well- such as bleeding, hormone changes, healing if you had a perineal repair, if you had a cesarean delivery, if you get hemorrhoids, nutrition if you’re breastfeeding, and overall resources available to you. 

8.     Understand the benefits of breastfeeding.

Breastmilk provides complete nutrition to your baby from the moment of birth. There were times when a premature baby was born and we would have the mother pump to get whatever colostrum we possibly could to take to the NICU for her baby. It is filled with antibodies, fats, nutrients, and the exact amount of calories your baby needs!

You should absolutely take a breastfeeding class if available to you, but a good childbirth preparation class will teach you the benefits of nursing, the basics, and be able to provide you with resources should you get a little stuck. Involving your partner in breastfeeding can seem a little tricky, but it's so important to be on the same page, to have that encouragement, and to have that support.

9.     Learn the basics of newborn care.

There are many newborn assessments and procedures that happen after the baby is born. Get information on vaccines, bathing your baby, car seats, pediatricians, and even ways to prevent SIDS for your baby. It can also help to learn how to deal with the unwarranted advice from family and friends!

10.  Learn way to decrease your risk of postpartum depression and know how to get help before it gets worse.

The drop in your hormones after delivery are so drastic that it is no wonder many women feel the things they do. "Baby blues" are real, but so is postpartum depression. Learning the warning signs, learning ways to prevent exhaustion, how to ask for help with your newborn, and feeling prepared are only some of the ways you could prepare yourself.
 

I hope these reasons empower you to take that first step in looking for a class or for asking the questions you need answered to help you prepare for your new journey.

Big hugs and even bigger belly rubs, from one Mama to another.