Friday, December 23, 2011

That First Week: Basic Answers to Common Questions

My friends, Joe and  Sam (short for Samantha)  just had their first baby,
 Benjamin.  So, of course, I've been "all over that", ya know, seeing them 
before hand and the morning after he was born, on their way home from the 
hospital and through texting/facebook as well.  
Like most new parents, they had concerns and questions which I am used to.   So I thought I would share our dialogs which contain useful information but 
most importantly reflect the process and progress.  I cannot 
emphasize enough how important on-going support is to the breastfeeding 
family.   And if this is done well and in a timely fashion, the result: less fear and anxiety, lots of milk and a happy, content baby.  
For you veteran - lactivists:   I am sure this dialog will trigger some mammaries, oops!... I mean memories of those very first days. 

Sam: I honestly have an amazing husband....The last two nights have been 
really long and hard for me because I just couldn't figure out what Benjamin wanted...Today joe kept telling me to nap and relax, which I did and it has made a WORLD of difference 
tonight. Thank you wonderful husband/awesome daddy!

Maria's reply: First of all props to Joe!  Second, It's simple - Ben just wants you. Think about it: he was wrapped inside the warmth, security and comfort of your body for 9 months. You're still his home -he's just on the 
outside now. And so your breasts have taken over where the placenta left off nourishing and growing his body - it's basic biology,.....we often forget that we are mammals.

Sam:  Ben spit up once yesterday and twice this morning....not a lot.    Should we burp him? He does get the hiccups.
Maria: Spit up: just means he ate more than he had room for. Maria-ism: " it's a 
laundry problem, not a medical one." the valve at the top of his stomach 
(esophageal) is very loose and floppy -which allows a baby to regulate his 
stomach contents by spitting up excess milk. Quite ingenious really. It helps 
not to force feed - he does not have to nurse on both sides - don't wake him up 
to feed him and don't lay him on his back right after he feeds etc. You will 
notice it happens more when your breasts are extra full...he will adjust your 
supply over the next 6-8 wks
Hiccups are a "space" issue. Their abdominal organs are all squished in a 
very small space right now. When they eat and their stomach is full- it presses 
up against their diaphragm ( which lies above the stomach) causing it to go into 
spasm. As their body gets longer and wider- their organs will drop lower 
allowing more room and thus the hiccups go away - basically they outgrow them. 
You don't need to do anything -remember in utero he drank about a quart of 
amniotic fluid a day and had the hiccups often without any problems.

Sam: my boobs still seem a little hard after Ben eats. Can I pump and save 
it for night time so Joe can do a feeding?
Maria:Yes it's fine to pump if nec-on mild to mod setting w/ good massage during -do one 
breast at a time -for only 15 min - more is not better . As far as 2 nite is 
concerned : your breasts will not allow u to sleep more than 2 maybe 3 hrs. Your 
prolactin levels are highest @ nite to accommodate the freq nite nursing in the 
beginning. So u will have to get up and pump - Joe will be stuck with a fussy 
baby fed or not, who wants his mommy and u will end up nursing anyway. Like I 
have said before: u need to learn how to lay down and nurse - this is the most 
effective tool to make your nites the best they can be /. I am happy to teach u 
how.  Also, if your breasts r very warm u can use some cool compresses in b/w feeds just wet 
two disposable diapers and place them in freezer tuck in bra until they reach body 
temp then refreeze reuse I 'd rather not use bottles just yet if Joe feeds him I'd rather him use the 
syringes - I show him how - you are doing so well ! I just don't want to screw 
anything up.

Sam: I tried to pump and it didnt work so I'll stick to feedings. As far as laying 
down to feed, I can't get myself up bc of my surgery. So eventually I will 
take u up on laying down feeding lessons.
Maria: You just need to roll onto your side and stay there all night -honestly, you can 
do everything from there. I fear if u don't soon -u will crash and burn, sweetie

Sam: I crashed and burned this morning-tears and crying. But then took a two hour 
nap. Much better. I'm going to nap after lunch.
Maria: Normal hormonal stuff -this should pass quickly. Yes, your best time to sleep will 
be 7am-12 noon for the next 3weeks -that's when the babies sleep the most. So no 
waking him up, no phone calls, txt, visitors or appointments -this is your 
sacred time!!! Take advantage of it - u will feel much better if u do. 

Maria: It's annoying that I have an answer for everything, isn't it? Lol
Sam: Actually no....u r amazing. I'm sorry I have so many questions. 
Maria: Never apologize for asking questions ( I love playing stump the lactation 
consultant-lol) but honestly-most people do not know this information -it is my 
business to know it and share it 

Sam: We go to the Peditrican today :-)
Maria: Good -LMK how u do. Waiting on the slings-hopefully coming today

Sam: Sir Benjamin is now 6lbs 13 oz and grew a half of an inch!!!! Doctor said good 
job for ur breastfeeding instructions!!
Maria: Great job, people! That's 7 oz in 2 days! You should be so proud of yourselves 
-I know am!
Sam:  -) yay!!!   Instead of a peanut, he's a chestnut!

The "Corporate" Mindset - Are Women Thinking More Like Men?

Since Breastfeeding is not about control or perfectionism ( nor should it be) it
does not fit the "model" women have now become accustomed to.  Which I believe
is the corporate model set up by men. You know, constant micro-managing,
competition, over-evaluating, where A&B equal C,  more is better,  if it's free -how good could it be? and there is an agenda -always an agenda!   

Correct me if I'm wrong, but in order to effectively compete with men in the business world
-women have had to think like men.  This "corporate thinking" does not bode well
for breastfeeding and mothering in general.  But it works beautifully for the infant marketing industry!

In my practice demographic - mostly high socio-economic, two-income families,  control and
perfectionism runs long and deep.  This, of course, only sets one up for anxiety
and depression.   If one can't control it then it's too stressful and if it's not perfect immediately, it's deemed a waste of time-  Exhausted/ fearful/disillusioned/ disappointed and desperate -one reaches for anything that brings them back to their "comfort zone" of control.  In this case: bottle-feeding and/
or pumping.  And guess who's ready to swoop down when this happens?  We all know who those players are.

This pervasive mindset of control and perfectionism has set the stage for the most effective marketing strategy I believe history has ever seen - newborn product sales especially the infant feeding industry.

What can you do?  Put the "corporate" mindset aside (that's fine for work) and tap into the feminine/maternal side of's in there somewhere!  Don't fall for the capitalism, commercialism and undermining marketing, that is stealing you from your child.  Money does not equal love.  Success in business does not equal success in parenting.  Embrace and celebrate what makes us different as women.  The tenderness, patience and fortitude to do what's right by your child comes from your heart, not your head.....or wallet.

Alcohol, Holidays & Breastfeeding

I get many calls this time of year re: alcohol intake and breastfeeding.
Even though it is fine to "partake", I think it helps to remind ourselves that too much alcohol can impair one's ability to respond and safely parent as baby needs -- no matter how baby is fed.

So it is not as much the amount of alcohol present in your milk ( its too unstable to stay there very long) but the level of impairment you experience.  Most of alcohol-related consequences are not breastfeeding issues, per se. but impairment ones.
So be smart and responsible: pay attention to how much you've had and your body's reaction to it - eat and drink lots of water.
If you get intoxicated:  do not drive, have someone else care for your baby, do not co-sleep or nurse until you are sober.  Only pump if you need to and discard that milk (until you are sober)

Please do not waste your money on alcohol test strips as they are not at all accurate or necessary.

For further info: This article from Thomas Hale's Infant Risk Center site can be helpful, whether breastmilk is direct from the source or expressed):

Enjoy and be safe

Thursday, December 15, 2011

Wean Me Gently

I know I look so big to you,
Maybe I seem too big for the needs I have.

But no matter how big we get,
We still have needs that are important to us.

I know that our relationship is growing and changing,
But I still need you. I need your warmth and closeness,
Especially at the end of the day
When we snuggle up in bed.

Please don't get too busy for us to nurse.
I know you think I can be patient,
Or find something to take the place of a nursing;
A book, a glass of something,
But nothing can take your place when I need you.

Sometimes just cuddling with you,
Having you near me is enough.

I guess I am growing and becoming independent,
But please be there.

This bond we have is so strong and so important to me,
Please don't break it abruptly.

Wean me gently,
Because I am your mother,
And my heart is tender.

by Cathy Cardall

Happy Holidays & Healthy New Year !

Wednesday, July 6, 2011

Hormonal Contraceptives & Breastfeeding

I receive many calls regarding low milk supply, a sudden drop in milk supply or a baby's poor weight gain or sudden drop or standstill in weight.  One of my first questions is : "Are you taking any birth control pills?"  Many times the answer is "Yes".   Since many doctors are prescribing without warnings or just ill-advised, here is the "skinny" on Hormonal Contraceptives and their impact on breastfeeding.  So you are able to make an informed choice yourself regarding what type of birth control method to use.

In NeoReviews, the official journal of the AAP, Thomas Hale, PhD states in his article Pharmacology Review: Drug Therapy and Breastfeeding (2005;6;e233-e240)

"Birth control products probably produce more complications than any other medication used by breastfeeding mothers.  Estrogen-containing birth control products have been found to reduce human milk synthesis significantly in some mothers.  Therefore, progestin-only products are greatly preferred in this population.  However, even progestin-only products may reduce milk synthesis in some mothers, and great cautions should be used following their initial use.  All mothers should be advised that these hormonal products may reduce milk synthesis, and they should discontinue their use immediately if they note a decrease in milk production.  The use of medroxyprogesterone (Depo injection) early postpartum should be avoided until milk production has been established.  Some mothers anecdotally report complete shutdown of milk production following its use."

The Drugs and Lactation Database (LactMed) HYPERLINK ""  states that "nonhormonal (contraceptive) methods are preferred during breastfeeding".  The hormonal contraceptive choices in question are progestin-only oral contraceptives,
Depo Medroxyprogesterone (DMPA) injection, Mirena IUD, and Implanon/Norplant implant.
Estrogen-containing contracrptives continue to be contraindicated for breatfeeding mothers.

Progestin-only oral contraceptives (Micronor, Camila, Errin, Jolivette, Nora-BE, Nor-OD)
Although touted as the preferred oral contraceptive for breastfeeding mothers, in the 2010 edition of Medications and Mothers' Milk, Thomas Hale states that "recent reports claim that Micronor can be assocoiated with decreased milk production".  Also these drugs "may reduce lactose content and reduce overall milk volume and nitrogen/protein content, resulting in lower infant weight gain"  Milk levels increase for most of these women when this contraceptive is stopped.

Depo Medroxyprogesterone (DMPA)
Common injection given to clinic moms in the hospital during their postpartum stay.  Hales rates this as an L4 or Possibly Hazardous if given within 3 days of birth.  LacMed states that "Administration sooner than 3 days postpartum could inhibit lactogenesis and interfere with the establishmnet of lactation."
If if this injection is given later, it can be a problem for women sensitive to progestin since it cannot be removed or stopped.

Mirena IUD
Even though, Mirena produces the lowest plasma levels of progestin thus becoming more popular, it is not without concern.  Hale does note that "some caution is recommended as I've received three accounts of milk suppression following insertion of Mirena IUDs"

Implanon/Norplant implant
This involves placing six match-size, flexible capsules under the skin of a woman's upper arm.  These release a low dose of synthetic progestin continuously for up to five years. I recently saw a client who experienced a decrease in milk supply after receiving this contraceptive - which again is difficult to remove.

This is an extended-cycle oral contraceptive  but due to it's estrogen content , caution is recommended in breastfeeing mothers due to potential reduced milk supply.

Plan B, Levonelle or NorLevo
This is a post-coital emergency contraception.   The mother should not breastfeed for the first 8 hrs, or at the most 24 hrs to reduce the estimated dose to the infant via breastmilk.

So am not advocating no birth control but there are enough "red flags" to use them with great caution.
Milk supply and infant weight gain needs to be carefully monitored.  It is difficult to sit with a mother who is suddenly struggling with her milk supply and suspecting that her birth control method prescribed by her doctor may be responsible.  It has high-emotional, physical and economic consequences for the mother and baby that should not be ignored or placated.

Thursday, April 7, 2011

The Great Cloth Diaper Change 2011 - A Website I like!

Most of you know, I am not big on promoting websites. Simply because I feel people spend too much time on the internet looking for answers instead of with their baby (who has all the answers!).

But, I have to admit,  I am excited about this new one called,  No hidden agenda just a mission to bring natural parenting out of the "alternative" and into the mainstream.  (you know, I am all for the natural)

Looking for a midwife, birthing center, doula or breastfeeding expert ?- it's all there!  A great resource for anyone looking to formulate a natural childbirth plan and breastfeed as well.
Not only is It is an informative site but interactive as well, with experts (such as myself!) answering simple questions.

So check it it, tweet it,  post comments if u like and pass it on to friends and family.

Wednesday, April 6, 2011

The Concept of: Removal and Replacement

"Your baby owns the "feeding thing" - you just happen to have the milk."  How many of you have heard me say that?  Too many.  So I thought I needed to explain the concept of milk removal and replacement and it's impact on your milk supply.

First of all, the breast is not a passive container of milk but an dynamically active organ.   Milk production is infant driven rather than hormonal.  It is the removal of milk from the breast that facilitates continued milk production.  Your nutritional status, age, body composition have only secondary impact. 

So what does that mean? Inadequate milk removal or stasis (milk sitting around) tends to limit milk production. Know that It is the quality and quantity of the infant's  suckling or milk removal that governs your production.  Milk production reflects each individual infant's appetite rather than your own ability to produce milk.  Thus babies pick a feeding pattern that best suits them, not necessarily the sibling before them or you for that matter, but trust them they know what they are doing.

As long as milk is removed regularly from the breast it will be replaced, almost indefinitely.  But what happens when we try to control our baby's feeding patterns by schedule feeding, convenience feeding, supplementing or sleep training?  Our milk supply goes down!  The baby is no longer in control of it's food supply. We have messed with the amazing phenomenon of the supply-demand response - the very feedback control that regulates our production of milk to match the intake of our baby.   So if your milk supply is dropping, it's simply because less milk is being removed - this can be natural as with child-led weaning or unnatural as in parent-led weaning.

Since lactation is energy-intensive process there are natural safeguards against wasteful overproduction as well as mechanisms for a prompt response to your baby's needs.  Some examples are if your milk supply is huge, the baby may nurse quickly leaving more milk in the breast to send signals to the brain to reduce the supply.  If the milk supply is lower or the baby has a growth spurt, the feedings may be more frequent and longer.  

As they say, "there is a method to their madness".  So best to leave the "feeding thing" to the baby -as long as they have unlimited access to you, you will have enough milk for them....and then some!  

Monday, February 14, 2011

The Day You Were Born

Maria"s baby pic
Today is my birthday.  Yes. I am a "funny valentine girl" or sassy valentine woman whichever works for ya.

 So in saying that, I am feeling a bit reflective......glad to be alive: having survived breast cancer 6 years now, grateful for what I have: 3 wonderful children, amazing family and fabulous friends - more than I can count!  But most of all, my mind is flooded with memories of my mom who passed away almost four years now.  And oh boy, do I miss her!  Tears are running down my face as I write this. (sweet tears)

My Mom as a young grandparent-look familiar?

My mom had a great way of making you feel special.  Since, I was born on Valentine's Day (I was almost called Valentina!) my mom baked me a heart-shaped cake every year without fail - the last one being two weeks before she died.  I still have the cake pan which is 52 years old now (yikes!)

I often share with clients about a birthday tradition my mom started.  On our birthday, she would come into our room and sit on your bed and tell the story of the day you were born.  All the siblings would gather on the bed for the storytelling which as you might expect, was embellished more and more each year.  Mine was a tall tale of blizzard-like conditions and treacherous travel to get to the hospital just in the nick of time. But my favorite part was that my mom said I was the first girl born that Valentine's Day!  Which gave me celebrity status!

We all looked forward to the story, only our mother could tell, about the day we were born and she never failed to deliver it with drama, wit and love.
FYI- my mom was only "awake" for the birth of her last child #5 which my dad was present for as well.

For many years, I miss-interpreted the "first girl born that day" to mean that I was the first girl born in the whole world that Valentine Day! As a child, I used that assumed fact for bragging rights and leverage during heated neighborhood arguments about who's more special than who.  Rightfully so,  I was, hands down, the most special!  Now you know where Maria gets her ego from!!

I continued the tradition with my kids and honor them and my mother in this way.  To this day, my grown children (28, 26, 24) still get a big grin on their face when I tell them about the day they were born.  Cherished memories worth repeating and embellishing!!

Happy Valentine's Day!!!

Tuesday, February 8, 2011

Taming Tiger Mom

Discipline is derived from the Latin word, "discipulus" which means "learner".  That makes you, the parent  their "teacher". 

Before I go on to speak about discipline let's clarify that I am referring  to children over 2.5 years old.  Discipline and babies should never be used in the same sentence!  At that age it's more about distraction than discipline.

"The truth is, no matter how trying they become, babies two and under don't have the ability to make moral choices, so they can't be bad.  That category only exists in the adult mind."
- Anne Cassidy

 How many times have I heard?: "She's a bad sleeper." "He's a bad burper."  "She's a bad nurser." "He's lazy." "She hates my right breast."  "He hates my left." "She is using me as a human pacifier!" "He is killing me!"  "She refuses the bottle." "He won't  sleep on his own."  "She is spoiled" 

Honestly, people!  Listen to the language we are using in reference to our little babies who come into this world pure, loving and trusting!   Sounds silly now, doesn't it?   Babies are not villains, out to manipulate, outsmart us and ruin our lives yet we tend to refer to them as such. (whose the baby here?)    

Disciplining a child is a delicate process and is probably the thing that we feel most uncomfortable about, because why?  it's about power imbalance!  Not all of us are good at handling or managing power, probably because we didn't have the best role models ourselves. Discipline is woven into the fabric of who we are, it's a way of relating to the world, it is not a separate experience of parenting. It creeps into every aspect of the parent-child relationship and is reflected in every interaction. 
When asked what the chief differences between the western style of parenting and the Chinese style of parenting Amy Chua Yale law professor and self-described "tiger mother," answered: 
"I think the biggest difference is that I've noticed Western parents seem much more concerned about their children's psyches, their self-esteem, whereas tough immigrant parents assume strength rather than fragility in their children and therefore behave completely differently. … I think it goes without saying that love and understanding have to come first, without that it's nothing."
Frankly, it was difficult to find the "love and understanding" in most of her book which I felt was quite to the contrary -harsh.
Discipline is really about helping a child learn about the meaning of balance. When balance has not been integrated into a child's upbringing, disciplining methods are used to bring a situation gone awry back into a state of harmony. What we realize later is that poor discipline or introducing discipline too late in the day could send the situation into a serious mess. The root of all confusion is broken communication and lack of understanding.

Parents adopt different styles of discipline and punishment based on what they have learned in their childhood, or as a reaction to what they were exposed to. If one's parent was extremely authoritarian, inflexible and used physical punishment, then as a parent one might imitate that.  

For instance, the "Little White Donkey" incident that pushed many readers over the edge.  That was the name of the piano tune that Amy Chua, forced her 7-year-old daughter Lulu to practice for hours on end — "right through dinner into the night," with no breaks for water or even the bathroom, until at last Lulu learned to play the piece.01.20.11 Time Magazine  
In contrast, parenting can rebound the other way to become extremely lenient. Either way, you are not responding in a productive way to creating balance in your child's upbringing, or your parenting style. The art of discipline is something you can learn only by being able to discipline yourself in a wholesome, healthy, and compassionate manner; every style of parenting is a reflection of one's own self-perception. 
So is Amy Chua's style of parenting a reflection of her own self-perception?  I'm sure it is.
 "At its best I think it's not about achievement, but about trying to help your child be the best they can be and it's usually more than they think. It's saying “I believe in you so much that I know you can be excellent, and I'm going to sacrifice everything and be in the trenches with you and I don't care if you hate me while you're a kid and I'm just not going to let you give up.” That's, I think, a positive message. Amy Chua (Chew-Ah), Time Magazine interview 01.11.11

Most of us can agree that parents need to be firm and strict at times.  Children actually need to feel that you are in charge, it gives them a sense of security.  But discipline with love means to be caring, kind and considerate.  In the same respect, parenting with love doesn't mean crippling, enabling or co-dependency.  

The successful child is one who has learned how to overcome the inevitable losses and move on, not one who has been protected from all difficulties.  Resilience is a much better measure of a child's ability to thrive than a lack of bumps in the road.   

Just to "break it up a little" some comic relief from some famous people about parenting and kids. 
The truth is that parents are not really interested in justice. They just want quiet.
- Bill Cosby

It would seem that something which means poverty, disorder and violence every single day should be avoided entirely, but the desire to beget children is a natural urge.
- Phyllis Diller

There comes a time when a woman needs to stop thinking about her looks and focus her energies on raising her children.  This time comes at the moment of conception.  A child needs a role model, not a supermodel. 
- Astrid Alauda (author, Pippi Longstocking)

"When a child turns 13 you should put him in a barrel, nail the lid down and feed him through a knot hole. When he turns 16, plug the hole!" 
- Mark Twain

"When my kids become wild and unruly, I use a nice, safe playpen. When they're finished, I climb out.

If you have never been hated by your child you have never been a parent
- Bette Davis

Like all parents, my husband and I just do the best we can, and hold our breath, and hope we've set aside enough money to pay for our kids' therapy."
- Michelle Pfeiffer 

In all fairness to Amy Chua, I commend her honesty and integrity in explaining why she wrote her book: Tiger Mom. 
“I didn't write this book to tell people how to parent. In fact, I wrote this book in a moment of crisis. I was raised by extremely strict but extremely loving Chinese immigrant parents. To this day I adore them and I feel I owe them everything. I tried to raise my children the same way. My daughter rebelled against this kind of parenting and I felt like my family was falling apart.  So the book is about many of the strengths I see in that kind of parenting but it's also about the mistakes.”
Amy Chua (Chew-Ah), Time Magazine interview 01.11.11

We are all far from perfect and everyone has the right to voice their opinion and raise their family as they see fit.  I think we all learned something from the discussions that have taken place since her book came out.  It helped to  raise our awareness. Keeping us ever vigilant to pause and "check ourselves" from time to time. 

What did I come away with ?  Looking at discipline as simply instruction instead of punishment.  We are the teachers, they are the students.

"It is not your job to make your child happy; it is your job to teach your child appropriate behavior that will potentially foster his happiness." - Susan Merkel, MD

Friday, February 4, 2011

How to Have a Good Fight - 10 Rules of Engagement

This past Sunday in church, Pastor Clay Porr's  message was on How to Have a Good Fight. 10 Rules of Engagement.  
This is important stuff.  Pastor Clay said almost every fight a couple engages in has to do with: money, children or the having of children.  Sound familiar?  The important thing is not whether you fight or not because it is inevitable.  Disagreements are going to happen especially now that your lives have been turned upside down! 
So, I trust this will help and remember both parties need to follow the rules in order for it to work. All is NOT fair in love and war!

!0 Rules of Engagement
1. Don’t sweat the small stuff.
You don’t have to fight every battle. In fact, if you want to have harmony in your family, you need to overlook minor offenses whenever possible.
2. Don’t sweep it under the rug.
On the other hand, if you can’t overlook the problem, you have to deal with it. Don’t just sweep it under the rug. Otherwise, the pile will build up and become much more difficult to handle.
3. Look in the mirror.
Before you begin arguing, ask yourself, “How have I contributed to this problem?” In the hundreds of times I’ve helped people with relationship issues, never once have I seen a situation in which only one person was at fault.
4. Hold hands.
Even if you don’t physically hold hands, remember that you’re part of the same family. The person you’re arguing with is someone you love. Act like it!
5. Identify the issue.
If you can both agree how to describe the issue you’re dealing with, half of the battle is over. Agreeing on the problem doesn’t solve it, but you can’t solve it if you don’t agree what it is.
6. Seek to understand.
Seek first to understand, then to be understood. A great way to do this is to restate what the other person said and ask if your understanding is accurate. We’re so quick to want to make our own points. But, if we’re willing to make the effort to make sure the other person knows we’ve understood them, the problem will get solved much more quickly.
7. Keep it current.
If you keep bringing up the past, you’ll never be able to move forward in your relationships. We can’t change the past, and we can’t expect our loved ones to change it either.
8. Avoid absolutes.
Never say “never” again! Don’t say “you always.” Don’t exaggerate what the other person has said or done; and don’t minimize your own shortcomings.
9. Apologize sincerely.
Do you want to know the quickest way to end a fight? Surrender! Apologize sincerely.
Don’t just say “I’m sorry if you were offended.” Or, “I’m sorry, but I wouldn’t have done that if you hadn’t done this.” Don’t minimize your offense. Don’t shift the blame. Be specific. Own your junk.
10. Forgive fully.
Forgive and don’t bring it up again.
Forgiveness means accepting the consequences for the other person’s actions. If you lend me $1000 and I don’t pay it back and you forgive that debt, you’re out $1000. You’re bearing the consequences of my failure to pay that debt. It costs you something. The same is true when we forgive one another when we hurt each other.
We talk about forgiving and forgetting. The problem is that we usually can’t forget, and so we’re tempted to bring up the offense again. But true forgiveness doesn’t mean forgetting, it means not bringing up the offense again even when we can’t forget it. That’s pretty difficult to do. But necessary.

Thursday, January 27, 2011

Book Review: What Your Pediatrician Doesn't Know Can Hurt Your Child A More Natural Approach to Parenting by Susan Markel MD

What Your Pediatrician Doesn\'t Know Can Hurt Your Child: A More Natural Approach to Parenting
Well anyone that knows me will tell you I am not a big fan of most of the parenting/baby books out there.  Bonfire material mostly...I have been known to say, "That's why I haven't written my book would be one page long stating, "Don't read any books!"

Anywho,  low and behold I was sent a copy of the above book.  Title - right up my alley, of course.  The following was the gist of the cover letter accompanying it:  

It’s a really interesting book that encourages mothers to take a more natural approach, and to trust their instincts when it comes to raising emotionally and physically healthy children. As a pediatrician who has devoted her career to the support and promotion of breastfeeding, along with more accurate evidence-based information for parents, I’m quite gratified to see my book finally published and on bookshelves. It is the culmination of my efforts to create mindful and compassionate parenting, beginning with the best and most important start: breast milk and nothing but.  Further, throughout, the book I discuss ways for readers to respect the environment, to avoid raising a generation of super-consumers and to bring peace of mind into our lives without harming either our vulnerable children, or our surroundings. If you have ever been frustrated, or simply not satisfied, with traditional medical advice that is being given to new parents, or if you are eager for accurate information, you will likely find my book quite enlightening.  The first chapter, FROM BIRTH ONWARD, explains the real story behind standard (and often unnecessary) newborn medical procedures such as treatment of bilirubin, eye prophylaxis, hepatitis B vaccine and others.

Here is Dr Merkel's back round - I was impressed:
Board-Certified Pediatrician who has a private consultative practice special­izing in parent coaching and child health. A graduate of Tufts University School of Medicine in Boston, I became a fellow of the American Academy of Pediatrics in1981, and an International Board Certified Lactation Con­sultant (IBCLC) in 1997. For many years I was a medical liaison for La Leche League and a member of the research advisory counsel at Attachment Parenting International. You can read more about her philosophy, which is expanded upon in the book, at her website:

I have to say, "Love this book with the exception of Chapter 6 - The Good Enough Mother - which I recommend you just skip right over or since I have spurred your curiosity read it but please, don't practice it.

I received your book today and am about half way through.  So far, I absolutely love it except for chapter 6, not quite sold on the "Transitional object" in theory or practice. I think the introduction of such at 6 month is too early if at all. Don't you think as a culture we are too attached to objects instead of people? I feel if you wait for the child's readiness for independance they will do so without the need for an attachment object. If babies/children are neglected or left then yes I assume they would need something but otherwise it's a poor substitute for a person and scary when a child can go nowhere without the object. I just don't buy the theory even though I realize why it would "work"  but your basically pawning off your baby to an object.  If an older child chooses to drag a favorite toy around I don't think it should be discouraged but to reinforce the idea to a 6mo doesn't sit right with me That object will never do what a real person can.
Anyway just me feedback so far I will keep reading.

p.s. - Dr Merkel did respond to say that she will take it into consideration if the book goes into reprint.

Conclusion:  I am going to be very honest and blunt here.  I live in what I consider a poisoned environment every day (professionally), please do not take offense I don't mean you!  So, it is not always easy and sometimes very lonely, swimming against the current. Many of us have discussed socialogica/psychological reasons why people have to stick to their ways of thinking, but suffice it to say that it makes them feel safe that way, to have their team rules to play by and root for. This is addressed somewhat in the book, I have to give Dr Merkel credit for "sticking out her neck" although in general the tone of the book is very positive , but in being positive she brings out the fallacies of those poisoning ways of thinking.
(ie the AAP)

I think that most of you will really like the book and that it will help you to take a stand against the nay-sayers. Would it help to have them read the book? Probably not. It might make it worse as they would have to take a stand against the ideas in the book which make them feel uncomfortable. 

Hey, it is what it is....  Personally I felt somewhat vindicated since much of the book is information and ideas that I have been trying to circulate and share for years.  Frankly,  if it weren't for the wonderful books by Bill Sears MD, I would have surely jumped off a cliff by now!

Wednesday, January 26, 2011

This Month is Maria's Car Seat Challenge!

 Yes, that's right.  During the entire month of March,  I challenge you to LEAVE THE CAR SEAT IN THE CAR and CARRY YOUR BABY!  Of course you may use a sling, wrap or structured carrier.  Now, I don't want to hear, "What if he is sleeping?" Yes, even if he is sleeping!  Listen, 85% of the time I look into those seats the babies are awake;)  News flash - car seats are for cars!  When my kids were little (in the horse & buggy days-Lol)  we never took the car seat out of the car and nothing bad happened :)  I promise you, that if you left the car seat in the car and carried you baby to and from wherever your going, they would actually be accustomed to it and guess what ? ... Be a better and more flexible sleeper! 
I am not kidding when I say that the only advantage I'm ever told when I protest the bucket's ubiquity is that you can carry a sleeping baby in from the car. But, in my real-world observations, I've seen mostly awake babies carried around and set on the floor or the church pew or a table -- all those missed opportunities to attach, instead of detach, with your baby. Although, really, it would be fine to hold a sleeping child as well.

Here's another one: It's OK for your baby's face to feel the cool air or have the sun light shine upon it or even a rain drop or two to touch it.  How do these babies experience anything when the whole outside world is a zipper flap away?  

On a daily basis I see parents struggling to carry these infant car seats, and straining their bodies. I think to myself, "Why would someone choose to carry 20 lbs or more when they can carry 8 or 10?  Using your infant car seat as a carrier can be a killer on your wrists, elbow, lower back, and neck if you tote it by the handle or if you string it on your forearm like a handbag. “The greater the horizontal distance from the weight you’re carrying to your torso, the more stress on your joints, discs, ligaments, and muscles,” says Mary Ellen Modica, a physical therapist at Schwab STEPS Rehabilitation Clinics in Chicago, IL. “It’s equivalent to walking around with three or four full paint cans in one hand--something most people wouldn’t do, but they’ll carry a car seat that way.”

Come on, common sense tells us that neck, shoulder, rib cage, pelvis, knee and ankle problems can arise or aggravate old injuries from lifting a heavy load on only one side of your body repetitively. Similar strains occur when struggling to get the infant car seats in and out of cars.  It's not the breastfeeding positions or the holding of the baby.

 Trust me, being an ER nurse over the last 35 years, I know how important car seats are for infant safety but , for the car, not everything else!  New parents often look at me in shock when I pose the idea that they can actually carry their own baby instead of the bucket!  Like they never knew the option even existed!  Yes, the option does exist.  
 Now more about your precious cargo! Babies are very susceptible in early days of molding to their environment and a lack of movement results in decreased brain stimulation causing several long term effects.  Basic neurology states that the motor movement of the body drives the Sensory system which in turn develops the cerebral cortex(smart part of your brain). With the weight of a newborn's head on such a weak neck, lack of proper head support is very stressful on the nervous, skeletal and circulatory system. I have also observed new babies who have been left in these seats for too long with their heads becoming flat on one side, dropped over to one side or forwards.  Many parents comment, "He hates the car seat!"  Well, wouldn't you if you spent that much time in one?  Or If all you saw was a piece of fabric in front of your face instead of  the trees or clouds?  Honestly, what do we think we are protecting them from?  

Yes, a newborn's cranium or head is sensitive to flattening when left for too long in one position. This is not just an aesthetic point, the brain is resting within this cavity and the cranial bone movement determines how well cerebral spinal fluid circulates and bathes the brain and cord. A flattened occiput (back of the head) has been linked to SID's, nervous system, respiratory, digestive, cardiac and behavioural problems. I work with babies with colic, sleep issues, ear aches, breast-feeding problems and more and they always have cranial and upper cervical problems.    

Timothy R. Littlefield, MS is affiliated with an Arizona clinic that treats plagiocephaly (flattening of the skull).  In an article in the Journal of Prosthetics and Orthotics, he notes that 28.6 % of infants who attended the clinic spent 1.5-4 hrs daily in car seats or  swings and nearly 15 % were in them for more than 4 hrs a day.  Another 5.7 % were allowed to sleep in their car seats at night and for naps.
Littlefield observes that cranial distortion resulting from overuse of car seats and swings is more severe and complex than in children who develop plagiocephaly from back-lying on a mattress.

If that's not convincing enough read this story: Study: Infants Sleeping in Car Seats Could Be At Risk. It points out that the head flexion in car seats that are outside the car can restrict breathing in young infants. I believe that this is the study referenced in the article. A Google Scholar search turned up numerous other articles dealing with head injuries due to falls and overturning of the plastic carriers, plagiocephaly from spending too long in the seats, and many recommendations that these infant seats be limited to their proper use inside of cars only. Apparently, bringing them in not only exposes children to the dangers of falling out of them, but it also places them at more awkwardly upright angles that can threaten their airways.   

So listen to "the voice of reason" (maria)  and keep your babies moving, pick them up and carry them to and from the car and lay them flat in a bassinet or cradled in a sling. Or simply carry your baby in your arms, and your baby and you will both benefit. 

Infants transported that way use their head, neck, and shoulder muscles to stabilize themselves and establish stronger trunk stability. Those muscles develop sooner in babies who aren’t carried around in a car seat.  And then NO NEED for TUMMY TIME- that your baby dislikes.

With all of the physical, chemical and emotional stress that is on parents and babies these days, it is nice to know that we don't all have to "buy into" or subscribe to the incorrect use of these products. 
Conclusion: Products that are introduced to our western culture may be very convenient or look good but what is the long term cost to us and our environment?   Car seats are very good at doing what they are supposed to do: protecting children in the event of an accident .  But there is no evidence to suggest that staying in a car seat after the ride is over offers a child any benefit .