Hospitals May Overfeed Newborns

It seems that as breastfeeding continues to make its comback, we continually have to redefine "normal"; since for years "normal" was based on what was normal in babies fed artificial milk - everything from how fast babies grow, to how often they eat, how long they sleep, how often they poop, and even how much weight they loose after being born:

Physiologically appropriate infant weight loss is less for babies fed formula in the hospital than for those who are breastfed, suggesting that hospitals feed too much, researchers here said.

Formula feeding in the first few days of life may lead to later overweight and obesity by way of metabolic imprinting, Patricia J. Martens, Ph.D., and Linda Romphf, of the University of Manitoba, reported online in the Journal of Human Lactation.

Link

Gibbon learns parenting, breastfeeding from humans

Look, learn works for Sue the gibbon:

Since the birth of Intan, a baby siamang gibbon, staff at the Christchurch wildlife centre are taking a unique approach to teaching new mother Sue how to care for her gibbon.

The use of video technology, cue cards, and even real life demonstrations of how to breastfeed are being used to teach Sue correct parenting.

Breast-feeding patrons visiting the reserve have also been enlisted to help give Sue the right idea.

She was fascinated by it, said Monique Van Der Linden, head of Willowbank's zoo section.

Monkeys were able to "learn from people", she said.

The Potty Training Answer Book

I've posted a review of The Potty Training Answer Book by Karen Deerwester over on The Book Blawg.

Waterbirth on "Private Practice"

I've just learned that Wednesday's episode of Private Practice (ABC @ 8 PM CST; watch the trailer here) will include a water birth in a La Bassine tub. The La Bassine is the tub that my youngest son was born in, and which I currently rent out. Let's hope it is a positive/accurate portrayal of birth! But as they say, there is no such thing as bad publicity.

You can see a photo of me in the tub here. And for more information about the La Bassine, visit Yourwaterbirth.com , the US distributor. For general information on waterbirth, Waterbirth International is a great resource.

Birth & Pregnancy Briefs

US among worst in world for infant death:

The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.

The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom — but still had a higher rate of infant mortality than any of those nations.

And Memphis fights its infant mortality rate, nearly twice that of the national average.

The risks linked to caesarean births from a study published in the British Medical Journal:

They found that a woman having a caesarean delivery had twice the risk of illness and mortality (including death, hysterectomy, blood transfusion and admission to intensive care) as a woman having a vaginal delivery.

There was a five times higher risk of having to have antibiotic treatment after birth for women who had a caesarean delivery (elective or decided by clinicians) than those who had a vaginal delivery.

Risk of having to stay in a neonatal intensive care unit for newborn babies who were born head-first was doubled after a caesarean delivery compared to a vaginal birth.

The authors also found that the risk of neonatal death was also significantly increased (more than 70% higher) up to hospital discharge for babies who were born head first from both an elective and a clinician chosen caesarean delivery, compared to a vaginal delivery.

However, caesarean delivery had a large protective effect in preventing foetal deaths in cases of breech born babies and reduced overall risks in those cases.

Elective Caesareans put mums and babes at risk of death:

According to a new British study women who opt for non-emergency Caesareans double their risk of dying or developing severe complications following the procedure.

The study by researchers at the University of Oxford has also found that in some cases Caesareans increased the risk of death to newborn babies by as much as 70 per cent.

Common Drug For Stopping Preterm Labor May Be Harmful For Babies

Dozens of studies have been done, but none have had a large sample size or a definitive outcome on the effects of indomethacin. The new analysis of a collection of studies, or a metaanalysis, by University of Rochester Medical Center researchers pulls together enough data to conclude that there is an association between use of indomethacin and babies experiencing periventricular leukomalacia (white matter injury by decreasing blood flow in the brain, which may lead to cerebral palsy).

The analysis also showed an association between indomethacin and necrotizing entercolitis (a condition in which intestinal tissue dies, which can sometimes be successfully treated with antibiotics but can require surgery and even cause death), especially for those babies who were exposed to the drug within days of birth.

And, no surprise, Diet Affects Fertility.

Breastfeeding Briefs

New this week:

Breastfeeding reduces the risk of cardiovascular disease later in life:

Having been breastfed in infancy is associated with a lower average body mass index (BMI) and a higher average HDL (high-density lipoprotein or “good” cholesterol) level in adulthood, even after accounting for personal and maternal demographic and CVD risk factors that could influence the results,” said Nisha I. Parikh, M.D., M.P.H., author of the study and a cardiovascular fellow at the Beth Israel Deaconess Medical Center in Boston, Mass.

A lower BMI and high HDL both protect against CVD.

(link)

Breastfeeding & IQ are genetically linked - This study shows that breastfeeding increases I.Q. for most children. For around 10% of children, however, breastfeeding has no effect on I.Q. due to a lack of a particular gene variant:

This study looked at how long-chain polyunsaturated fatty acids (LC-PUFAS), which are present in human milk but not in cow's milk or most infant formulas, are metabolized. LC-PUFAS in breast milk, the authors said, is believed to enhance cognitive development because the fatty acids are required for efficient neurotransmission and are involved in neuronal growth and regeneration.

(link)

Cord Clamping

Soon after a baby is born, the umbilical cord is clamped, and then cut. Research continues to show what many have long believed, that delayed cord clamping is beneficial to the infant. However, current obstetrical practice is to clamp the cord right away. As long as the cord is pulsing, the baby is continuing to receive blood and oxygen from the placenta. For babies who are born healthy and crying, it may not make much of an apparent difference. But for babies who do not breathe right away, clamping the cord means that they must breathe - or else be deprived of oxygen. Delayed clamping eases the baby's transition into the world. In fact, cutting the cord at birth is not necessary at all - the cord will clamp itself off when it stops functioning.

For research into cord clamping, try these sites:

Gentlebirth Archives - Perhaps the most comprehensive list of resources on cord clamping available, but you will also get about 50 different opinions.

Cordclamp.com - Lots of good, technical info, but advocates the idea that premature cord clamping is responsible for autism, cerebral palsy, mental retardation, and the fact that more women than men get college degrees. Also contains the archives of the now-defunct, oft-linked-to cordclamping.com.

Cochrane Review information on Cord Clamping in Preterm Infants, Cord Clamping in Term Infants, and Topical Cord Care.

Lotus Birth from Answers.com

Lotus Birth from Wikipedia.

Umbilical Cord from Wikipedia.

And for the last word on the issue, a recent study published in the JAMA - Late vs Early Clamping of the Umbilical Cord in Full-term Neonates: Systematic Review and Meta-analysis of Controlled Trials (March 21, 2007):

Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign.

Breastfeeding Briefs

I'm hoping to make this a weekly feature. In the news:

Research confirms what breastfeeding and childbirth professionals have been saying for years, Breastfeeding Does Not Create Sagging Breasts:

However, there are some factors that increase the chance of sagging breasts. A higher BMI and larger bra size before pregnancy increased the chance that the breast would sag. Also, smoking history, the number of pregnancies, and age also affected the risk factors of getting sagging breasts.

Factors that did not affect whether or not the women had sagging breasts were the number of children that were breastfed and the amount of time spent breastfeeding each child. Also, the amount of weight gained during pregnancy apparently had no affect on long term breast shape.

Breast milk helps lungs but not if mom has asthma - "Breast-feeding seems to protect children from asthma later in life, but only when the mother does not have the respiratory disorder herself."

News of the weird - Breastfeeding smell linked to higher sex drive.

The USDA announced this week a new MyPyramid for Pregnant and Nursing Moms. The website feature allows you to put in some information about you and your baby or pregnancy, and get recommendations on what you should be eating. Unfortunately, the website does not allow you to input dates for babies older than one year of age, nor does it account for women who are tandem nursing, or who are pregnant while nursing. Furthermore, it does so in a rather rude way, by stating that the date you have entered is "invalid". A better approach would be to refer mothers of older babies to the regular MyPyramid feature. If this irritates you as much as it does me, feel free to let the USDA know.

Here is the UNICEF Policy on Infant feeding and HIV:

UNICEF and other UN agencies recommend exclusive breastfeeding for HIV-infected women for the first six months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe before that time. Such conditions are rare in much of the developing world. However, if they do exist, it is recommended that HIV-infected women avoid breastfeeding. [emphasis added]

The risk of a baby contracting HIV through breastfeeding from an infected, untreated mother is between 5-20%. However, the death rate of formula-fed babies in the developing world is approximately 33%. While formula feeding merely doubles the risk of death, compared with breastfeeding, for babies born in the US, babies in developing countries are ten times more likely to die within the first year. Given these numbers, a baby is better off getting milk from an HIV-infected mother unless the five UNICEF criteria can be met.

UNICEF also recommends exclusive breastfeeding of a baby already known to be HIV+.

National Blog Posting Month

Angela at Breastfeeding 123 has issued a challenge to Breastfeeding and Mothering bloggers to participate with her in National Blog Posting Month (NaBloPoMo). The idea is that you commit to write one blog post per day, for the entire month of November. Why do this? Cause, uh, you started a blog to make yourself write more often?

Anyhow, I'm in! If you haven't noticed, I am currently posting maybe every week or two. It's not that there's a lack of important things going which need to be blogged about, either. On the contrary; sometimes I feel overwhelmed by bad news and the amount of cruddy stuff still going on in the world.

I'm qualifying my participation by saying that since I have three blogs, I only plan to post to one of the three each day. Wish me luck!

Laudering your cloth diapers

Pinstripes and Polkadots has this great chart for evaluating laundry detergents. Based on their recommendation, we switched to Purex Free & Clear and have had no leaking or absorbency problems whatsoever.

Why Early Cord Clamping?

Andru Ziwasimon of to the teeth posted this insightful discussion about a year ago, on early cord clamping, which I am just now getting around to mentioning.

Water Birth a "valuable alternative" to traditional delivery

The maternal and neonatal infection rate and laboratory parameters showed no significant difference among the groups. There was no maternal infection related to water birth. There were five water born neonates and three neonates after normal vaginal delivery preceded by immersion with conjunctivitis. Significant differences were observed in obstetrical outcome parameters: less use of analgesia, shorter duration of first and second stage of labor, smaller episiotomy rate in water birth. In contrast no differences were seen in all observed fetal outcome parameters: APGAR score, arterial and venous pH, admission rate to neonatal intensive care unit. CONCLUSIONS: Water birth is a valuable alternative to traditional delivery. The maternal and fetal infection rate was comparable to traditional deliveries.

Source

Crib bumpers do more harm than good

According to a recent study published in the Journal of Pediatrics,

The research team found the reports revealed that 11 infants suffocated when their face rested against the bumper pad, 13 died after being wedged between the bumper pad and another object and three were strangled by a bumper tie.

An examination was conducted of 22 commercially available crib bumpers for potentially dangerous features such as excessive softness, a space between the bottom of the bumper pad and mattress, the width of the pads and the length of the ties that attach the bumpers to the crib slats.

All of the bumper pads were found to be hazardous because they left a space between the bottom of the bumper pad and mattress, an area in which an infant's head could become lodged.

The researchers say the bumper pads are not providing any benefit and do more harm than good and should not be placed in cribs or bassinets.

Link

1 Million Cribs Recalled

It's the largest crib recall in CPSC history, and now the one place parents are told they can safely leave their children without supervision is in question.

"Crib hardware failure is actually one of the most common causes of death in cribs," Nancy Cowles, a crib safety advocate, told CBS News correspondent Sandra Hughes.

In fact, according to Cowles' organization Kids In Danger, 30 children are killed and 1,200 are injured every year in crib accidents.

And while these cribs were made in China, in this case she says China isn't to blame:

"The problem is the design flaws that the U.S. manufacturers designed into the product," Cowles said.

Link to news article
Recall information

Keeping Your Placenta

Jodi Selander gives advice on Bringing Your Placenta Home from the Hospital:

Women who give birth at home have the luxury of being in complete control over the care and handling of their baby’s placenta. A woman who births in a hospital has to adhere to the guidelines and policies in place at their facility of choice. In some cases, there is no written policy, and mothers are then subjected to the whim of the staff on duty at the time they deliver. If you want to take your placenta home after its birth, you must have a plan before you walk through the doors in labor. Your chance of success will increase greatly.

New York Hospitals "Ban the Bags"; World Breastfeeding Week

Women's Health News reports that New York City public hospitals will "exclude free baby formula samples from gift bags to new mothers, will ban formula promotion materials from labor and delivery units and will encourage initiation of breastfeeding in the baby’s first hour as part of a campaign to increase exclusive breastfeeding and improve infant health."

Perhaps not coincidently, the theme for this year's World Breastfeeding Week (August 1-7, though local events may be held on other dates) is "Breastfeeding: The First Hour", emphasizing early initiation of breastfeeding. More information about WBW in the United States from WBW, La Leche League, and ProMoM.

Women given unwanted episiotomies

A CNN Health article, "5 operations you don't want to get -- and what to do instead", covers episiotomies:

It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.

"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"

Wow.

Caesarean risk higher when labor induced

A new Australian-based study shows that first-time moms are more likely to "need" a Cesarian when induced:

In a study of more than 37,700 women, Mary-Ann Davey, an epidemiologist at La Trobe University's Mother and Child Health Research, looked at all uncomplicated first births in Victoria between 2000 and 2005. The mothers were aged 20-to-34 when they were between 37 and 41 weeks' pregnant.

Of those, 9.4 per cent had their labour induced — 6.1 per cent of public patients and 14.1 per cent of private patients.

"These women had no medical indication recorded for induction of labour," Ms Davey said. "Common reasons given were 'social' or 'post dates' (but less than 41 weeks' gestation)."

She also found that more women who were induced had epidurals then those who weren't induced. Although her findings are still preliminary, Ms Davey said there was "a substantial and significant increase in the number of caesareans" following an induced labour.

Pregnancy vs. Childbirth

Baby Keeper posts 8 Do's and Don't's for a Safe and Healthy Birth.

Eating Durring Labor

A new study finds:

Women permitted to eat low-fat, low-residual foods during labor were no more likely than women who received only water to have labor, delivery, or neonatal complications in a randomized study conducted in the United Kingdom.

Moreover, women who ate rated their overall labor experience as significantly better than that of women who were only allowed to drink water, according to a study presented in poster form at the annual meeting of the Society for Gynecologic Investigation.

(link)

Liver function and Hyperemesis

Amy's Humble Musings has a great post on the subject (make sure to read the comments).

The Nursing Room Locator

Thanks to My Baby & More, check out The Nursing Room Locator. As the author states:

I firmly believe that every mother has the right to nurse her child wherever she sees fit, be it a bench in the mall or at the coffee shop down the street. That said, sometimes you just want a quiet place to feed your baby.

So she's compiling a list.

Birthing With Midwives

Here's a new site that may be helpful to the consumer as well as to those in the birth biz:

Birthing With Midwives

Breastfeeding and HIV-Positive Moms

Exclusive breastfeeding halves HIV infection risk for baby:

After three months, the HIV infection rate among the exclusively breastfed group was 4.04 percent.

Among the mixed group, babies who received formula milk in addition to breast milk were twice as likely to acquire HIV infection. And those who had solid food -- typically porridge -- ran 11 times the risk of infection compared with the breastfeeding-only group.

In addition, the death rate at three months among the exclusively breastfed babies was 6.1 percent; among children given replacement feeds, it was 15.1 percent.

New Email Address

Please note that I've changed my email address to (in standard format) mommyblawger at gmail.com. Thanks!

Traveling with Breastmilk

Mothering Magazine has a nice piece on Traveling With Breastmilk, including some creative tips on packing it and technical advice on how long it stays good:

When our country goes to orange alert at the airports, mothers who travel without their babies are not allowed to take their pumped breastmilk in the cabin of the plane with them. Women have traditionally been encouraged to keep pumped breastmilk on ice, so they often took it in their purse or carry-on bag. Now, however, toting breastmilk in your carry-on bag without a baby has become officially forbidden and deemed "suspicious." Of course, if you had the baby with you, you wouldn't need to pump and carry precious breastmilk. What is a mother to do? Get clever.

New research in the journal Breastfeeding Medicine has come to the rescue. The researchers took frozen breastmilk and thawed it, refroze it, refrigerated it and left it out at room temperature. Essentially, they beat it up. What did they find? Breastmilk is fairly robust and does not grow bacteria easily nor lose vitamins A and C or free fatty acids (FFA) to any degree that would harm a full term baby. Breastmilk fresh from the breast or thawed in a clean container can be left at room temperature for less than 8 hours. This means on a day trip, you can safely pack expressed breastmilk in your checked bag and take it home just as it is.

Delayed Cord Clamping

Delayed Cord Clamping at Birth May Reduce Neonatal Anemia

No Benefit to Fetal Oxygen Monitoring

This is an old article, but one that I think is important, and didn't get much press at the time:

New Childbirth Technology Tanks: A study finds no benefit from monitoring fetal oxygen during labor. The rate of Cesarean deliveries is not reduced.

Breastfeeding Benefits

According to recent studies, being breastfeed may increase one's social mobility and protect mothers from heart attacks:

[Study leader Alison Steube of the Harvard Medical School] said: "Pregnancy is associated with a number of things that you normally wouldn't want to happen to your body, including storing more fat and having higher than normal levels of fatty acids circulating in the blood.

"By breastfeeding, mothers can convert those energy reserves into nutrition for their infants. Breastfeeding isn't just good for babies, it's good for mothers, too."

Breastfeeding Enhances Children's Vison

According to a study in the January 2007 issue of American Journal of Clinical Nutrition, children between the ages of 4 and 6 who were breastfed as infants performed better on one test of visual acuity than did those who were formula-fed:

During the first six months after birth, the formula-fed children were randomly assigned formula either with DHA or without DHA added.

The researchers found that breast fed children were significantly more likely to have better stereo-acuity than formula-fed children. Among the formula-fed children, addition of DHA into the formula did not make any difference in stereo-acuity measurements.

Although DHA has been proposed to be the benefiting agent in breast milk, the fact that fortification of formula with DHA did not make any difference in stereo-acuity suggests that the added DHA may not work or there is something else in milk that enhances the vision.

(link)

Acupuncture for Childbirth

Here's something you don't see every day:

Doctors Experiment With Acupuncture During Labor

Doulas in the news

About once a week, some hometown newpaper interviews local doulas and does a (usually) nice story about them. This one out of Ft. Wayne, Indiana had this interesting tidbit:

While Indiana does not require doulas to be certified, the Starks say it is something they will look for in any doula they might hire for a subsequent birth. Fort Wayne area doulas charge $350-$500, depending on the extent of their role. In New York, the going rate is about $1,800, said Saalfrank, whose sister is also a doula and childbirth educator.

Wow, $1800 is the going rate for a midwife in many places.

The Next Breast Thing

Wet-nursing seems to be making a comeback.

As the article mentions, the World Health Organization "recommends a baby should be breastfed by its mother in the first instance, or drink her expressed milk. If that is not possible, the next preference is for human milk from a donor and formula should be a last resort."

Andrew at One Year

It has been quite a while since I've written an Andrew update. The little pea-pie punkin' guy turned one this week. And to celebrate the occasion, he is walking! Over the last couple weeks, he had been taking a few tentative steps. Just between pieces of furniture and such. But the day before his birthday, he was walking with a "walker" toy and it got hung up on a rug. So he just continued on without it, half-way across the living room. He still crawls most of the time, but he loves practicing his new skill.

Other amazing things that Andrew is doing ...

Yesterday I was emptying the dish washer and putting the silverware away. Andrew grabbed a spoon and, instead of sticking it in his mouth like he usually does, he stuck it in the silverware drawer. Later I was sitting in a chair next to the dryer (a trick I discovered while I was pregnant) folding laundry and stacking it on the open dryer door. Andrew cruised over to the nearby shelf where we keep clean kitchen towels, grabbed one, and placed it on the dryer door. He did this about three times.

Andrew is using about three signs - the signs for "more" (which he does by pointing his index finger to his palm, just like his brothers did) and "all done" (well, mostly just waving his hands around) and pat-pat when he wants milk. He doesn't say much, although he clearly says "Da Da". He can clap his hands and wave "bye bye". He will follow me around from room to room (as the mother of three, I don't stay put for long) and is quite social. When I put on my sling, he gets very excited. This is not new; he's done this for several months. But he's not clingy at all and rarely asks to be held when we are at home. He is a busy boy and has things to do. He doesn't like strangers, though.

He weighs just over 21lbs. which is a bit below the old adage of "triple their birth weight by one year" but on track compared with his brothers' growth curves.

I am actually writing his birth story this week. And I promise photos coming soon.

Triple Surprise

Dusty and Lynette Johnson of Tuttle, North Dakota, were planning a homebirth, but they got a little more than they were expecting:

The Johnsons thought they would be bringing a third child into the family, and so did everyone else. When she had Christopher, he weighed more than nine pounds at birth; Abigail was 10 pounds when she was born. Lynette Johnson expected to have another large baby, and her midwife said her measurements were on target for that, she said.

When she gave birth, however, her midwife quickly prepared for a multiple birth after Marissa was born and she realized Lynette was not done giving birth.

The girl babies were fine, but the boy had some trouble breathing and spent a couple weeks in the hospital. Friends and neighbors threw a fundraiser to help defray medical and living expenses.

Mag Sulfate for Preterm Labor

An editorial published in this month's OBG Management argues that obstetricians should stop using Magnesium Sulfate to treat preterm labor:

Data from trials never clearly demonstrated that magnesium has a clinically significant tocolytic effect compared with “control” treatments. In a Cochrane review of magnesium tocolysis, neither improvement in the risk of delivery before 48 hours nor reduction in risk of birth before 34 or 37 weeks was observed, compared with control treatments. More recent data also suggest that magnesium may increase the risk of adverse neonatal outcomes, including death, especially at the upper end of the magnesium dose range.

In the absence of demonstrated clinical efficacy and a concern over potentially negative neonatal effects, obstetricians should consider strictly limiting their use of magnesium for tocolysis.

Link: Is the end of an era here for magnesium sulfate tocolysis?