The news of a new baby is accompanied by a range of emotions, from excitement to anxiousness, with a lot of questions in between, shared by new parents, experienced parents, and grandparents alike. When I welcomed a new addition to the family just a year ago, I came to the realization that the whole experience had changed drastically in the three plus decades since I was born and even in the four years since my first baby was born. Watching the documentary, The Business of Being Born, I was struck by the film’s assertion that women spend more time researching a major investment than they do preparing for baby. With a little time and the right information, pregnancy can be something that women should be able to experience with joy and confidence, as it should be.
Thinking about having a baby?
Ideally, every pregnancy is a planned pregnancy. However, whether you’re considering pregnancy or suspect you may be pregnant, the first step is to schedule an appointment with a health care provider. Alice Hirata, MD, explains this saying, “Checking in with a health care provider allows for a basic physical exam and the opportunity to review your medical history and your family’s, your vaccination status, and menstrual cycle, as well as a time to discuss medication and [if you’re not pregnant yet] optimal timing for pregnancy.”
One thing that can be confusing to keep up with is the list of foods to avoid. Both prior to attempting conception and during pregnancy, caffeine and sweeteners should be limited, and alcohol should be avoided as it can cause fetal alcohol syndrome. Once pregnant, caffeine and sweeteners should be limited. Additional foods to avoid during pregnancy include deli meats and cold cuts which may contain listeria, soft cheese which can introduce bacteria if not properly pasteurized or heated, and certain fish which contain high levels of mercury and may cause problems with baby’s nervous system. Visit the American Congress of Obstetricians and Gynecologists at ACOG.org for a helpful list.
Congratulations! You’re pregnant.
One of the first unpleasant confirmations of pregnancy that many women, but not all of us, experience is morning sickness. However, there is relief available for morning sickness. Eating smaller meals more frequently, physical activity within reason, vitamin B6, wristbands, prescription Zofran, and the counsel of a good provider can all help. Dr. Hirata says, “Women need to have a partnership with the practice they’re going to and need to choose to deliver in an environment that encourages their birth plan and wishes.”
You should also consider whether you want to use a midwife or doula. These trained professionals offer expectant mothers care and support throughout pregnancy and labor. Visit midwife. Org to learn more. Writing for ACOG, Irene Frederick, MD, and Cynthia Salter, MPH, said the benefits of using a midwife may include: decreased use of analgesia and anesthesia; lower rates of operative birth; increased success with breastfeeding; increased infant attachment; decreased postpartum depression; satisfaction with the birthing experience; and subsequent increased confidence and self-esteem as a new mother.
So how should you begin your search for a provider? Whether you’re interested in seeking the services of a traditional OB/ GYN or a midwife or doula, seek recommendations from trusted friends and family members. You’ll also find a helpful list of questions for potential providers at mymidwife.org. Under the About Midwivery tab, select Questions for your Midwife. Trust me, this is a good resource whether selecting a midwife or OB. If you choose to use a midwife, there are several considerations. First, you will need to explore cost and whether your insurance will cover this expense. Second, ACOG urges that you become informed about several additional key factors. These considerations include whether any licensed midwife, but particularly home-birth midwives, have hospital privileges, medical liability insurance coverage, the policy limits of such coverage, and a protocol for home-birth emergencies, including transportation to a hospital, that is particular to each patient.
When it comes time for labor and delivery, it is important to stay informed. In short, be your own advocate. For example, according to Michael Brodman, MD, department chair of the OB/GYN division at Mt. Sinai Hospital, there is a correlation between inductions and caesareans. About inductions, Dr. Hirata says, “While there is a time and place where inductions are appropriate, a good caregiver will allow the natural process its time because this increases a good outcome.” Dr. Hirata serves on a committee with doctors and nurses at Bon Secours St. Mary’s hospital, a group united to explore and incorporate evidence-based practices that are safe and more effective to give women a lower intervention birth experience. She maintains that “the more moms can move, the better” and that having more fl exibility improves a birthing woman’s outcome, both for herself and the baby.
The new arrival is here. Now what?
The latest research indicates that breastfeeding, for any amount of time, is beneficial for babies. Many Richmond area hospitals support this with rooming in, or having the baby sleep in the same room with mom as opposed to in the nursery. I chose rooming in with both of my children and a host of wonderful nurses, pediatricians, and lactation consultants were available to provide lots of help. Lactation consultants are breastfeeding pros who are expert at helping moms through a process everyone says is very natural, but frankly, isn’t always easy. Moms can also rent hospital-grade breast pumps, which i found to be much more effective, often from the hospital or many other providers to which the hospital can direct you. Visit gotmom.com to learn about breastfeeding and to review tips to help make this a successful endeavor. Whatever you do, don’t become discouraged if breastfeeding isn’t an option. Your OB/gYn and your pediatrician can discuss alternatives with you and provide resources.
If you’ve given birth to a boy, one of the first questions you’ll be asked is whether you wish to circumcise. In the richmond market, circumcision is typically performed by the OB/gYn while the baby is still in the hospital nursery, on the first or second day of life. At this time, if the baby’s pediatrician notes any abnormality with the penis, a referral will be given to the family with a recommendation that a pediatric urologist perform the circumcision. Boyd Winslow, Md, pediatric urological surgeon and founder of Children’s Urology of virginia, prefers that infants who are going to be circumcised be between two and four weeks old, as typically, by this age, they will heal better.
According to dr. Winslow, babies are comfortable and tolerate the surgery well at this age, or, in the case of a preterm baby, around 44 weeks after conception.
“if the baby is young and little, there’s no reason to perform a circumcision because he is already struggling with enough other issues,” says dr. Winslow. “Blood clotting may not be up to snuff, his structures may be too small for the clamp, and the physiologic stress from the circumcision can get in the way of progression to proper eating and weight gain.”
After circumcision, at every diaper change, push the skin back and dab a small amount of ointment in this area. Lastly, if you have questions about the procedure or the after-care, ask them. The concern may only take a few minutes to resolve, which is always preferable to letting the child suffer or allowing the problem to worsen over time.
Once you’ve brought baby home in a rear-facing infant car seat that meets all requirements for the state of virginia, you will most likely discover the number one issue about which pediatricians receive the most questions from parents. I’m talking about sleep. When? Where? And how much? One of the most important points to be aware of is the recommendation that newborns need to be placed to sleep on their backs, not their tummies, to significantly reduce the risk of sids. Oftentimes, grandparents or older siblings are helping out with baby and telling mom or dad how, in the past, baby was put to sleep on his tummy to avoid choking or to relieve colic. New parents should be armed with the statistics that show this simple change in sleep positions – back to sleep; tummy to play – has been proven to have saved thousands of infants’ lives.
Beyond new baby’s sleep schedule, remember that new mothers (and fathers!) Require sleep, too. Parenthood comes with many firsts, some exhausting and some rewarding. Recognize that this is normal, but if you experience extreme symptoms, also be aware that you may be experiencing postpartum depression and that you’re not alone. Talk to your healthcare provider as he or she can make recommendations to alleviate your symptoms and help you enjoy all of the aspects of parenting.