Choosing Your Pediatrician for your Baby

presented by Angel J. Miller, MSN, CNM

The following is an excerpt of a chapter from the book Raising Your Child in Washington, DC, a resource for parents available in local bookstores.   by Dr. Michele R. Berman

 

One of the most important tasks a parent must undertake is the selection of a pediatrician for their baby or older child.  Besides being a place to take a sick child, or a place to get “baby shots,” a pediatrician’s office is an important resource for new or experienced parents.  Today, many families find themselves without the traditional support systems that their own parents had available to them.  Family members are often separated by many miles.  For these families, the pediatrician provides advice and encouragement, as well as basic child-care knowledge.  Many pediatricians see patients from birth through adolescence, so picking the right pediatrician may well be the beginning of a “long term relationship.”

Pediatrics, in general, is a preventive health care specialty.  Well-care visits provide the framework of information to keep your child happy and healthy.  A typical well-care visit starts with weighing and measuring the child and plotting those measurements on a growth chart to follow their progress.  The pediatrician will then ask several questions about your child’s eating, sleeping, and bowel habits, and about what new developmental milestones have been passed.  Then it’s your turn to ask the doctor about any questions or concerns you may have.   Write them down as you think of them at home, and bring the list with you.  After examining the child, the pediatrician may discuss a variety of topics, such as immunizations, safety issues, or behavior issues.  Some will also have handouts to supplement the discussion.  On average, there are seven well visits in the first year, three in the second year, and one every one to two years thereafter.

The Prenatal Appointment

If this is your first child, the decision as to who the baby’s pediatrician will be should be made well in advance of your due date.  (Remember – babies often come earlier than expected!)  This allows the pediatrician you choose to give your newborn its very first exam in the hospital, and to support you during those joyful, yet overwhelming first days.  Although all pediatricians are dedicated to helping you raise healthy, happy children, each has his or her own approach.  You will, therefore, want to meet with several pediatricians so that you can pick the one with whom you feel most comfortable and whose approach is most consistent with your own ideas about child raising.

Most pediatricians encourage parents to come for a prenatal appointment.  This is your opportunity not only to meet the pediatrician but look at the office itself.  If possible, both parents should be present, so you will both agree on your choice.  When you set up the visit, find out who you will be seeing (one or more doctors? Office staff?), about how long it will last, and if there is a charge for the visit.  If the visit consists of a quick hello by the pediatrician while the office staff shows you around, there may not be a fee.  However, there may be a charge if the pediatrician sets aside a block of time specifically to talk with you and answer any questions you have.  Many insurance companies will pay for this, but check with your plan first.

During the interview you should first find out about how the practice works.  What are the office hours?  Do they include evening or weekend hours?  How are after-hours calls handled?  Who are the doctors in the practice and what are their qualifications?  Can you see any of the doctors in the group, or are you assigned to one doctor?  How far in advance do you have to call to get a well child appointment?  A sick child appointment?  To what hospitals do the doctors admit their patients?  Do the doctors come to the hospital where you are delivering?  Who handles phone calls during the day and after hours?  What is the schedule of visits and immunizations?  Most pediatricians follow the guidelines of the American Academy of Pediatrics for these.

Secondly, try to get a feel for the pediatrician’s personality.  How does he/she respond to your questions?  Does he/she seem open to your concerns or does he/she seem to shrug them off?  Are they stiff or relaxed?  Distracted?  Do they have a good sense of humor?  Observe how he/she interacts with the patients that may be in the office at the time of your visit.  The feelings you get during your visit will set the time for the relationship you will develop with the pediatrician you choose.  You want to feel comfortable and confident about someone who is going to help you take care of that special baby of yours.

Ask the pediatrician questions about topics such as: What is their thoughts about circumcision, breast feeding, or the use of antibiotics or other medications?  If you are going to breastfeed, what kind of support can they give you?  What is their philosophy about the role of a pediatrician?

Lastly, look around the office.  Does it seem inviting to children?  Are there things for the children to do if they have to wait to see the doctor?  Will older children and adolescents also feel comfortable here?  Are there ways to separate sick from well children?  What kind of feelings do you get about the office staff?  The nursing staff and front desk personnel are also important in making a trip to the doctor a pleasant experience.

Looking for Dr. Right

So, where do you find your dream pediatrician?  There are several ways.  First, ask your friends and neighbors who they use.  Are they happy there?  What do they like about the office?  Is there anything they don’t like?  Next, ask your nurse-midwife for a list of pediatricians they frequently recommend and on whom they have gotten positive feedback.  Your internist, family practitioner and other medical professionals can also be good resources.

Increasingly, families find themselves as part of health plans that limit their choices to physicians who are members of the plan.  In this instance, start with the list provided by the health plan and see which physicians are available in your area.  Then ask the resources listed above what they know about those physicians.  Make an appointment with the pediatricians you’d like to know more about.

Pediatrician’s fees may vary widely.  Don’t be afraid to ask about fees before you go to the office.  Ask if you will have to pay for services at the time of the visit, or whether they will bill you or submit the insurance claim for you.  If you are a member of a health plan, and the pediatrician is a provider for that plan, they will file for you, but you must usually pay a small co-payment at each visit.  Look at your health plan or insurance coverage carefully.  Not all insurance plans cover well-child care, or you may have to meet a deductible, or they may only cover a certain number of well visits.  For these financial matters, it’s best to know what the office policies are before you get there.  If you anticipate a problem with payments, many offices will work with you, as long as you talk to them up front.

As mentioned earlier, many families find themselves using the same pediatrician for many years, so you want to choose one with whom you feel comfortable, and in whom you have confidence.  Shop around.  Ask questions.  Use and trust your instincts.  Remember, your decision does not have to be a final one.  If you are unhappy with your choice, there are many other fine physicians in the area.  Good luck, and happy parenting!

Dr.Berman practiced pediatrics in the Washington, D.C. area until the year 2000 She currently is co-founder with her husband of www.celebritydiagnosis.com.

2011 in review

The WordPress.com stats helper monkeys prepared a 2011 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 2,300 times in 2011. If it were a cable car, it would take about 38 trips to carry that many people.

Click here to see the complete report.

Preconception Counselling

Becoming a parent is a major commitment in life. It can be met with challenges, rewards and informed choices. Before you conceive, be sure to incorporate a healthy life-style to ensure optimal health for mom and baby. Receiving preconceptional counseling and care can lay the ground work for a healthy lifestyle and healthy pregnancy. Good health before pregnancy can help you cope with the stress of pregnancy, labor and birth. Obtaining good health care before you conceive will help you throughout your pregnancy. It also provides you with the opportunity to find out your risks, treat any medical problems that may affect the outcome of your pregnancy and adopt or continue a healthy lifestyle.

If you are planning to conceive, schedule a preconceptional visit with your healthcare provider. Included in your visit is a comprehensive history of your health including: Family history and risk factors, your medical history, surgical history, medications that you are presently taking including vitamins, supplements, OTC (over-the-counter) meds; your diet and lifetstyle and any past pregnancies.

Your preconception visit is a time for you to ask questions. Do not hesitate to seek advice, discuss your concerns and your options. Your healthcare provider is there to provide information and guidance to help you make informed choices in your healthcare to help you obtain and maintain a healthy pregnancy.

Women who are planning to conceive should stop their form of birth control several months in advance. Even though methods vary in use, it may affect when your menses resumes and becomes regular. During this time you may also want to start taking a prenatal vitamin daily to ensure you are getting added vitamins and increased folic acid.

Your lifestyle includes diet, exercise, weight, substance use, living/working environment and infection history. Current immunizations are important to prevent any infections during your pregnancy that can harm you and your baby, even if you were vaccinated as a child (measles, mumps, rubella, polio, tetanus), you may not be immune now. If you are vaccinated prior to conceiving, you will be protected. The vaccine for mumps, measles and especially rubella should be given at least 3 months prior to conceiving. During this period of time, you should use a reliable method birth control.

Optimal health at any time during your lifetime involves a healthy diet and the proper amount of exercise. Ideally, you should be in good physical shape and follow a regular exercise regimen before your conceive. If you are not used to being active, you should start an exercise program gradually.

Tobacco, alcohol and recreational (illegal) drug use is addictive and can harm you and your baby that can last a lifetime or even result in death. They can have detrimental affects on the organ formation, causing damage. The misuse of prescription medication can also harm the fetus. For the sake of your own health and that of your baby, now is a good time to cut back on smoking and alcohol and quit all recreational drugs. It takes time and patience to quit a habit, especially if you have had that particular habit for a long time. Ask your healthcare provider to suggest ways to get through the withdrawal state or quitting and to refer you to support groups. Your decision to quit may be one of the hardest things you have ever done, but it will be one of the most worthwhile.

Does your work environment impose any hazards? If you are trying to conceive, it is a good idea to look closely at your work place and surroundings. Are you exposed to toxic substances, chemicals, or radiation? Discuss your level of exposure to specific substances with your employee health division, personnel office or union representative.

Exposure to lead or certain solvents, pesticides or other chemicals can reduce your partner’s fertility by killing or damaging sperm. Unlike women, who are born with a complete supply of eggs for their entire lifespan, men make new sperm on a daily basis for most of their lives. Unless the damage to a man’s reproductive system is very serious, he will probably be able to make healthy sperm against a short time span after his exposure to the harmful material stops.

Healthy lifestyle choices during pregnancy are essential. Your health care provider will likely discuss the importance of a healthy diet, regular physical activity and keeping stress under control. If you’re underweight or overweight, your health care provider may recommend addressing your weight before you conceive.

Questions to Consider…
• Do I or a member of my family have a disorder that could be inherited?
• Do I need to gain or lose weight to prepare for pregnancy?
• Should I make any changes in my lifestyle?
• Could any medications I am taking cause problems during my pregnancy?
• Can I continue my present exercise program?
• Does my work expose me to things that could be harmful during pregnancy?
• Do I need to be vaccinated for any infectious diseases before I try to conceive?

What about your partner’s lifestyle?
If possible, have your partner attend the preconception visit with you. Your partner’s health and lifestyle — including family medical history and risk factors for infections or birth defects — are important because they can affect you and your baby.

The Benefits of Red Raspberry Leaf Tea in Pregnancy

Red Raspberry leaf tea is one of the safest and commonly used tonic herbs for women wanting to get pregnant or for women who are already pregnant. Red Raspberry Leaf (Rubus idaeus) tones the uterus, improves contractions and decreases constipation. Most tonics need to be used regularly, for a tonic is to the cells much like exercise is to the muscles; not much help when done irregularly . But you will still benefit even from occasional use of tonics during pregnancy, since they contain nourishing factors. The herb comes in forms of leaves to make teas or tonics as well as pill like capsules you can swallow.
Most of the benefits given to regular use of Raspberry lea tea throughout pregnancy can be traced to the strengthening power of fragrine, an alkaloid which gives tone to the muscles of the pelvic region, including the uterus itself; and to the nourishing power of the vitamins and minerals found in this plant. There is rich concentration of Vitamin C, the presence of Vitamin E and the easily assimilated calcium and iron. Raspberry leaves also contain vitamins A and B complex and many minerals, including phosphorus and potassium.
When to use: There are two basic points of view on the subject. There is agreement among many clinicians that in the 3rd trimester frequent (2- 3 cups per day of tea or 1 – 2 cups per day of infusion) is beneficial to the uterine and pelvic muscles.
The more radical point of view is that drinking one cup of tea per day in the 1st trimester and 2 cups in the 2nd trimester and switching to the infusion in the 3rd trimester ensures a strong uterus, is good for you nutritionally and prevents miscarriage. Some say it is advised to not use it in the first trimester, particularly if you have a history of miscarriage. If a mother is prone to miscarriages she may feel safer avoiding raspberry until the third trimester. This is an herb with centuries of safe use behind it, there is usually little cause for concern, but check with your healthcare provider before using.
According to Susun Weed, author of “Wise Woman, Herbal for the Childbearing Year,” the benefits listed below for drinking a Raspberry leaf brew before and throughout pregnancy are as follows:
• Increasing fertility in both men and women. Red Raspberry leaf is an excellent fertility herb when combined with Red Clover.
• Preventing miscarriage and hemorrhage. Raspberry leaf tones the uterus and helps prevent miscarriage and postpartum hemorrhage from a relaxed or atonic uterus.
o Use raspberry leaf infusion to help facilitate placenta delivery. Chips of frozen raspberry leaf infusion sucked throughout labor help keep the uterus working strongly and smoothly.

• Easing of morning sickness. Many women attest to raspberry leaves’ gentle relief of nausea and stomach distress throughout pregnancy. Drink a cup or two of raspberry leaf tea or infusion each day. Sipping the infusion before getting up or sucking on ice cubes made from the infusion increases the strength of this remedy.

• Reducing pain during labor and after birth. By toning the muscles used during labor and birth, Raspberry leaf eliminates many of the reasons for a painful birth and prolonged recovery. It does not counter the pain of dilation of the cervix.

Red Raspberry Leaves do not start or encourage labor. It can help the contractions to be productive once true labor has begun because it strengthens the uterine and pelvic muscles but it is not an oxytonic herb (one that would induce labor). That being said, it’s important to talk with your midwife, obstetrician or herbalist before beginning drinking red raspberry leaf tea or taking a supplement. Some will recommend you wait until you are 36 weeks along before incorporating the tea into your health regime while others may encourage you to begin right away. Each situation and pregnancy is different so it’s best to get other’s opinions before beginning red raspberry leaf tea.

Tea recipe: To make a tea, pour 1 cup boiling water over 2 teaspoons of herb and steep for ten minutes. Strain. During the first two trimesters, drink 1 cup per day. During the final trimester, drink 2-3 cups per day.

Excerpts from Weed, Susun. “Wise Woman Herbal Childbearing Year.”
http://www.motherandchildhealth.com/Prenatal/raspberry.html

What to Do When your Bag of Waters Breaks

It is common to be in labor without your water breaking. Actually, only thirty percent of women experience their water breaking before the start of labor.

What Is My Bag of Waters?

The bag of waters—or amniotic sac—is a bag or “membrane filled with fluid that surrounds your baby in your uterus during pregnancy.” The bag of waters is very important to your baby’s health. The fluid protects your baby and gives your baby room to move around. The bag itself protects your baby from infections that may get into your vagina.

Is it urine or is it amniotic fluid? If you are leaking, it can be difficult to determine if your membranes are leaking or if it is urine. In most cases, it is probably urine. There are several ways to tell the difference, but there is no definite answer. When in doubt, smell it! Urine has a distinct smell and color. You will leak urine when your bladder is full, when coughing , sneezing or laughing; even when you are exercising. Only 3 percent of pregnant women will go into premature labor (before 37 weeks) as a result of ruptured membranes.

In most cases your membranes will rupture as you are nearing the end of your pregnancy, and this is definitely one of the early signs of labor. If your water does break in public, and you have visions of a huge gush of water running all over the floor, then you have probably been watching too many movies. It is most likely going to occur as a slow trickle, or at most, a small gush of fluid of colorless and odorless amniotic fluid. Call your healthcare provider if your water breaks and the fluid is green or brown. This is an indication that your baby had a bowel movement in utero.

What Should You Do When Your Water Breaks

First, don’t panic! Follow the instructions your healthcare provider discussed with you if and when your water breaks. Immediately after your water breaks, know that nothing should be placed in your vagina at this point. This will help prevent infection.
•Wear a maxi pads, not tampons, to keep the amniotic fluid from wetting your clothes
Keep your vaginal area clean
When you go to the bathroom, be sure to wipe from front to back
Sexual intercourse is officially off-limits

Call your healthcare Provider immediately if:

Your due date is more than 3 weeks away from today
•The water is green, or yellow, or brown, or has a bad smell
•You have a history of genital herpes, whether or not you have any herpes sores right now
•You have a history of Group B strep infection (“GBS positive”)
•You don’t know if you have GBS or not
•Your baby is not in the head-down position, or you’ve been told it is very high in your pelvis
•You have had a very quick labor in the past, or feel rectal pressure now
•You are worried.
•If you feel something in your vagina, or see any of the umbilical cord at the vaginal opening, get medical help immediately

Call your health care provider within a few hours if:
•Your due date is within the next 3 weeks and
• You are not in labor and the fluid is clear, pink, or has white flecks in it
• Your baby is in the head-down position
•Some health care providers will want you to come in to the office to confirm that the bag of waters has broken and listen to the baby’s heartbeat as soon as you notice that the bag of waters has broken. Others will suggest you stay home for several hours to wait for labor to start.

What Do I Do Until Labor Starts?

Most women will go into labor within 48 hours. If you are waiting for labor to start and your bag of waters has broken:
• Put on a clean pad
•Do not put anything in your vagina
•Drink plenty of liquids—a cup of water or juice each hour you are awake
•Get some rest
•Take a shower
•If there is any change in your baby’s movements, call your health care provider right away

Check your temperature with a thermometer every 4 hours—call right away if your temperature goes above 99.6.

For more information regarding this topic visit:

www.acnm.org

www.webmd.com

Delaying Umbilical Cord Clamping

Clamping and cutting of the umbilical cord should be delayed for three minutes after birth, particularly for pre-term infants, suggests a senior doctor, Dr. Andrew Weeks, in the British Medical Journal. 28/08/2007.
Early clamping and cutting of the umbilical cord is widely practiced as part of the management of labor, but recent studies suggest that it may be harmful to the baby. Dr Andrew Weeks, a senior lecturer in obstetrics at the University of Liverpool, looked at the evidence behind cord clamping. For the mother, trials show that early cord clamping has no ill effects, he writes. But what about the baby?

At birth, he says, the umbilical cord sends oxygen-rich blood to the lungs until breathing establishes. When a baby is born it must transfer from receiving oxygen from the placenta to receiving oxygen from its lungs. For this to happen, the baby’s lungs must first expand, and the burst of blood from the umbilical cord helps to get the newborn’s lungs to expand properly. So as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21 percent of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth. For babies born at term, the main effect of this large autotransfusion is to increase their iron status.

This may be lifesaving in areas where anemia is endemic. In the developed world, however, there have been concerns that it could increase the risk of abnormally high levels of red blood cells and bile pigments in the bloodstream often leading to jaundice. But trials show this is not the case.

Umbilical cord blood is a baby’s life blood until its birth. It contains stem cells, red blood cells, and more recently scientists have discovered that umbilical cord blood contains cancer-fighting T-cells.
For pre-term babies the beneficial effects of delayed clamping is greater, he says. Delayed clamping is consistently associated with reductions in anemia, bleeding in the brain, and the need for transfusion.
He proposes that in normal births, delaying cord clamping for three minutes with the baby on the mother’s abdomen should not be too difficult. The situation is a little more complex for babies born by caesarean section or for those who need support soon after birth. Nevertheless, it is these babies who may benefit most from a delay in cord clamping. For them, a policy of ‘wait a minute’ would be pragmatic, he says.

The World Health Organization’s (WHO) policy supports delayed cord clamping, stating:

“The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth).”

They continue:
“Clamping the umbilical cord immediately (within the first 10 to 15 seconds after delivery) prevents the newborn from receiving adequate blood volume and consequently sufficient iron stores.
Immediate cord clamping has been shown to increase the incidence of iron deficiency and anemia during the first half of infancy, with lower birth weight. Waiting to clamp the umbilical cord allows a physiological transfer of placental blood to the infant which provides sufficient iron reserves for the first 6 to 8 months of life, preventing or delaying the development of iron deficiency …

For premature and low birth weight infants, immediate cord clamping can also increase the risk of intraventricular hemorrhage and late-onset sepsis.13 In addition, immediate cord clamping in these infants increases the need for blood transfusions for anemia and low blood pressure infants and infants born to iron-deficient mothers being at particular risk …

Numerous research studies and experts are also confirming that waiting to clamp the cord offers significant benefits. Among them:
• In the Journal of Cellular and Molecular Medicine, researchers say delayed cord clamping is “mankind’s first stem cell transfer and propose that it should be encouraged in normal births.”
• In a BMJ editorial, James Neilson, professor of obstetrics and gynecology, states that delayed clamping should be practiced.

Resources, Support:
“Early versus delayed umbilical cord clamping in preterm infants”. Rabe H, Reynolds GJ, Diaz-Rosello JL http://tinyurl.com/4w63wv8 (Cochrane Review)

http://academicobgyn.com/2009/12/03/delayed-cord-clamping-should-be-standard-practice-in-obstetrics/

What are Braxton Hicks Contractions?

True Labor is characterized by contractions that come in regular intervals and increase in frequency (how often contractions occur), duration (how long contractions last) and intensity (how strong the contractions are) over time. As time progresses, the contractions come at closer intervals.

What are Braxton-Hicks contractions?
Braxton-Hicks contractions are smaller contractions or “practice contractions” that can occur as early as the 2nd trimester, but more commonly occur in the third trimester. Unless they follow a pattern they are what we call “false” labor. Not everyone will notice or experience these contractions, and some will have them frequently. Some moms say they notice them more in subsequent pregnancies than in their first pregnancy. Don’t panic if you don’t notice them. Some women only notice them because they find them to be uncomfortable or annoying.

Braxton Hicks(named after English gynecologist, Dr. John Braxton Hicks in 1872) are described as:
• Irregular in their intensity
• Infrequent
• Unpredictable
• Non-rhythmic
• More uncomfortable than painful
• They do not increase in intensity, or frequency
• They taper off and then disappear altogether

What triggers Braxton Hicks Contractions?
• physical activity or exertion
• sexual intercourse
• dehydration
• touching your abdomen
• your baby moving inside your uterus

Braxton Hicks contractions help your uterus practice for your upcoming labor and birth. They help to soften your cervix and exercise all the muscles that you will need to push your baby out. Without the help of Braxton Hicks contractions, labor would actually be much more difficult and painful.
If you are experiencing Braxton Hicks contractions, you really don’t need to do anything unless they are causing you discomfort. If they are making you uncomfortable try the following:

• Change positions; lie down if you have been standing or go for a walk if you have been sitting or laying down.
• Get some sleep or rest.
• Empty your bladder with first urge to void. A full bladder can trigger Braxton Hicks contractions.
• Relax.
• Drink water, juice, or herbal tea. Dehydration can make your muscles spasm, bringing on a contraction.
• Eat a snack or small meal.
• Get a massage.

Oversupply of Breast Milk-What to Do

Concern about not having enough breast milk to feed your infant, is the number one reason that mothers wean their babies early, but having too much milk can also be a problem. When you consider the fact that a small percentage of women don’t have the capacity to produce enough milk for their babies no matter what they do, then
having too much milk is a relatively good breastfeeding problem to have, and is usually fairly easy to resolve.

When a mother has more milk than her baby can handle, the following behaviors may be common:
• Baby cries a lot, and is often very irritable and may become restless
• Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
• Baby may seem to bite or clamp down on the nipple while feeding
• Milk sprays when baby comes off, especially at the beginning of a feeding
• Mom may have sore nipples
• Baby may arch and hold himself very stiffly, sometimes screaming
• Feedings often seem like battles, with baby nursing fitfully on and off
• Feedings may be short, lasting only 5 or 10 minutes total
• Baby may seem to have a “love-hate” relationship with the breast
• Baby may burp or pass gas frequently between feedings, tending to spit up a lot
• Baby may have green, watery or foamy, explosive stools
• Mother’s breasts feel full most of the time
• Mother may have frequent plugged ducts, which can sometimes lead to mastitis (breast infection)

Moms who produce too much milk may experience a few seconds of intense pain as the letdown (or milk ejection) reflex occurs, because it is so forceful. The cause of the problem is usually a combination of an overactive letdown reflex along with a foremilk/hindmilk imbalance. Let’s say that the ‘average’ mother has one half ounce of foremilk (the thin, sweet milk produced at the beginning of the feeding that is high in lactose but lower in fat) and two ounces of hindmilk (the higher calorie, thicker milk that is produced as the milk lets down and moves through the ducts, collecting fatty particles). This ‘average’ mother’s baby will get a total of about five ounces of milk if he nurses on both breasts. The mother with too much milk, on the other hand, may have an ounce of foremilk and three ounces of hindmilk in each breast. This
means that the baby may get four ounces of milk on the first breast, and if you switch him to the other side, he may be so full that he will only get the ounce of foremilk that comes out at the beginning of the feeding. This results in a disproportionate amount of foremilk. Why is this a problem?

Foremilk is high in lactose, a normal and necessary milk sugar that in large volumes causes gassiness and discomfort, frequently with green, watery or foamy stools. Over a period of time, undigested lactose can irritate the lining of the intestines, causing temporary secondary lactose intolerance and possibly small amounts of bleeding into stools that can be misdiagnosed as a food allergy. Adjusting breastfeeding to increase the amount of fat the baby receives (“finishing” the breast before switching) usually corrects the problem.

Here are some tips that can help you reduce and cope with an overabundance milk supply:
1) Offer only one breast at each feeding. Let your baby nurse as long as he wants to on that side. If he has nursed less than 15-20 minutes on that breast, and wants to nurse again in less than an hour or two, put him back on the same breast until he has stayed on for at least
15-20 minutes.
2) If he does nurse for 15 minutes or so on one side, don’t offer the second breast unless he seems to want it. He probably got all the milk he needed on the first side. Many babies (especially newborns) will take the other side if you offer it, not because they are hungry, but just because they love to suckle. If the other breast gets uncomfortably full before the next feeding, express just enough milk to relieve the discomfort, but not enough to empty it completely.
3) Try altering your nursing position. Lean back slightly, and hold him so that he is facing your breast, and straddling your leg, with his head elevated above our nipple. Lying on your side may be helpful as well. You also may try lying on your back, with your baby lying on top of you. In all of these positions, the force of gravity will reduce the flow of milk and let your baby control his intake more easily. If your baby is very small, try using the football hold, but make sure that his head is higher than the rest of his body. In any of these positions, you may want to use a towel or cloth diaper to catch the leakage,
because there will probably be some as the excess milk dribbles out of his mouth.
4) Try to relax during the letdown. Usually the milk will spurt out in forceful sprays in the beginning, and then slow down. You may want to catch the initial forceful sprays in a towel, put him on the breast after the sprays have settled down into steady drips. You many also want to express a little milk into a cup before you put him on the breast. Save this milk – it’s great for cereal later on. If your baby starts to choke or gag during a feeding, take him off the
breast, express a little milk, and then put him back on after he calms down.
5) Babies who gulp and choke when their mom has a forceful letdown will often swallow air. Burp him often, especially if you hear him continuing to gulp during the feeding. Don’t be surprised if he spits up a lot, especially while your supply is adjusting. Spitting up most often occurs in babies who are gaining weight well, but are taking in too much milk at a feeding. It’s usually more of a laundry problem than medical problem. However, if your baby spits up forcefully after every feeding, isn’t gaining weight well, or has other signs of illness such as fever or diarrhea, it may indicate a medical problem and you
should consult your healthcare provider.
6) Try to avoid pumping or expressing your milk unless you absolutely have to. Pump or express only if you need to relieve the fullness, because if you pump to empty your breasts, you may be more comfortable temporarily, but you will be sending your body the signals to make more milk.
7) Drink a cup of sage tea at bedtime. Sage contains a natural form of estrogen that can decrease your milk supply. Discontinue use when your supply begins to level out.
8) Usually within a week, you will notice a significant decrease in your supply as it adjusts to meet your baby’s demands without overproducing. You may findthat you need to use a pacifier if your baby wants to do a lot of ‘comfort sucking’.

If you do have a fussy baby who needs to nurse for comfort, offer the same breast during a two- hour period instead of switching sides every few minutes. Five minutes on one breast, then five on the other can result in him taking in too much foremilk, leading to symptoms of intestinal discomfort.

Usually, the problem of too much milk will resolve as your baby matures
and is able to handle the flow better, and also as your body settles down to make the milk your baby needs and not a lot extra. Like all other breastfeeding problems, this too shall pass.

excerpts from breastfeedingbasics.com

It’s Flu Season Again- Recommendations For Pregnancy

The Advisory Committe on Immuinization Practices (ACIP) recommends that pregnant and postpartum women recieve the seasonal influenza vaccine this year, even if they received the 2009 H1N1 or seasonal influenza vaccine last year. Lack of awareness of the benefits of vaccination and concerns about vaccine safety are common barriers to influenza vaccination of pregnant and postpartum women. To overcome these barriers, some key points have been provided in this document.

Influenza is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in their immune system, heart, and lungs during pregnancy make pregnant women more prone to severe illness from flu as well as hospitalizations and even death. Pregnant woman with flu also have a greater chance for serious problems for their unborn baby including premature labor and delivery. Flu shots will protect pregnant women, their unborn babies and even protect the baby after birth.
The Flu Shot is the Best Protection Against Flu
Getting a flu shot is the first and most important step in protecting against flu. The flu shot given during pregnancy has been shown to protect both the mother and her baby (up to 6 months old) from flu. Pregnant women should receive the inactivated vaccine but not receive the live attenuated vaccine (nasal spray). Postpatum women, even if they are breastfeeding, can receive either type of vaccine.

The Flu Vaccine is Safe for Pregnant Women Flu shots are a safe way to protect the mother and her unborn child from serious illness and complications of flu. The flu shot has been given to millions of pregnant women over many years. Flu shots have not been shown to cause harm to pregnant women or their babies. It is very important for pregnant women to get the flu shot. The flu vaccine can be given in any trimester.

Pregnant women respresented 5% of the 2009 H1N1 influenza deaths in the U.S., while only about 1% of the population was pregnant. Severe illness in postpartum women was also documented. 2009 H1N1 is expected to continue to circulate this flu season and is included in the seasonal trivalent influenza vaccine this year.

It is best to get your flu vaccine as soon as it is available in your community. That’s because it can take two to three weeks for your body to develop antibodies to the flu virus after vaccination. If you get vaccinated in the fall, you will be protected by the time the flu season peaks, which is usually December through March. You will also be better prepared for the start of the flu season, which can begin as early as September or October.

One common myth about the flu vaccine is that it can actually cause the flu. Although the live vaccine does contain viruses, those in the flu shot have only inactivated pieces of the virus, and therefore, cannot cause infection.

Other Preventive Actions
In addition to getting the flu shot, pregnant women should take additional everyday preventive actions. Keep your distance from those who are ill; avoid crowds during peak flu season, if possible. That’s because flu viruses travel through the air in droplets when someone with the infection coughs, sneezes or talks. You can inhale the droplets directly or pick up the germs from common objects such as tabletops or doorknobs. Frequently wash your hands and avoid touching your eyes, nose and mouth. It is best to wash with soap and warm water for 15-20 seconds. YOu can also use an alcohol-based gel containing ast least 60 percent alcohol. Eat right and get enough sleep. A poor diet and lack of sleep can lower your immune system and make you more prone to infections.

Be sure to get your Vitamin D!! Get some sun exposure. A few times a week, 10 to 15 minutes of sun exposure on your face, arms, hands or back can help your skin create vitamin D naturally. The best dietary sources of vitamin D include liver, egg yolks, oily types of fish (salmon, tuna and sardines) and fortified milk. If you want to take a supplement, the US National Institutes of Health recommends the D3 form of Vitamin D which is much more effective than other types. D3 is a safe flu remedy and is available in 1,000 iu increments, over-the-counter, and at pharmacies and online retailers. Take 5,000 iu of D3 per day, for adults, when healthy to boost the immune system and prevent flu. Increase the D3 dose at the first sign of illness to 10,000 iu for adults. Drink water while taking D3. While unconfirmed, there have been rare reports of kidney stones as a result of vitamin D supplementation. This can be avoided with adequate fluid intake to maintain proper hydration.

Early Treatment is Important for Pregnant Women. If you get sick with flu-like symptoms call your healthcare provider right away. If needed, your provider will prescribe an antiviral medicine that treats the flu.
Having a fever caused by flu infection or other infections early in pregnancy can lead to birth defects in an unborn child. Pregnant women who get a fever should treat their fever with Tylenol® (or store brand equivalent) and contact their provider as soon as possible.

When to Seek Emergency Medical Care
If you have any of these signs, call 911 right away:
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• High fever that is not responding to Tylenol® (or store brand equivalent)
• Decreased or no movement of your baby

Talk to your healthcare provider if you have any questions or concerns about the influenza vaccine.

Info provided from www.CDC.gov/flu
Mayo Clinic Women’s Health Source, Oct. 2010,. Volume 14, number 10

Water, Water Everywhere-How Much should you Drink?

Your water needs depend on many factors, including your health, how active you are and where you live.
Most individuals seem to know that drinking water is good for them, but maybe don’t know exactly why and have a hard time reaching their intake goals each day. We know all the excuses:

- I don’t like the taste
- I simply forget
- I can’t drink that much
- Who has time for that many bathroom breaks!

Well, we are going to inform you on why you should always have a water bottle nearby, how much you really need to drink and some tips to help you reach that goal.

Why You Should Be Downing That Water

Water is the most important nutrient for your body. From flushing out toxins, transporting nutrients throughout your body, and other vital actions, water necessary for every single system in your body needs water to function.

On average, water makes up 60% of our body weight. Even slight dehydration can prevent your body from carrying out normal bodily functions, draining your energy or even causing a headache.

5 reasons why you should have a glass of cool, refreshing H20:

1. Drop a few pounds: Remember just a moment ago when we said water is necessary for every function in your body. This includes breaking down fat for weight loss. Also, water is calorie free and is often an appetite suppressant. In fact, most people often confuse hunger for thirst.

2. Drink for your health: Drinking the right amount of water improves the health of your heart, and can even lower your risk of a heart attack. Also, increasing your water intake can improve digestive health by aiding in the breakdown of food. And, most of you probably already know that drinking water is one of the best things you can do for healthy skin – giving it a glow from the inside out.

3. Energy: The first all natural energy drink is water! Test it out next time you’re feeling a little sluggish by having a couple glasses of water.

4. Headache prevention: Know those dull headaches that come in the afternoon, especially after sitting at your desk all day? You’d be surprised how many of those headaches are caused by a slight dehydration.

5. Cleansing: Flush out all those unhealthy toxins!

Now that you’re sold on why to drink more water, let’s talk about how much – and how!
For years we’ve been told to follow the “8 by 8″ rule – drink eight 8-ounce glasses of water per day, but for some people that just is not enough water. Here’s a new formula to use when calculating how much water you need. Simply divide your weight (in pounds) by two to give you the number of ounces of water you should strive to drink each day. For example, if you weigh 160 lbs., strive to drink 80 ounces of water daily.

Dietary recommendations: The Institute of Medicine advises that men consume roughly 3 liters (about 13 cups) of total beverages a day and women consume 2.2 liters (about 9 cups) of total beverages a day.

If you drink a lot of caffeine, exercise or your job requires a lot of physical activity, you may need to consume even more water to replenish your body.

Whoa, that’s a lot of water!

Need some help reaching your new water intake goal? Try these tips:

1. Get a reusable bottle and figure out how many times you must empty it through out the day to reach your goal.

2. Have a glass of water before (and with) every meal.

3. Keep a pitcher of water in your office, at your desk or in the fridge – this will also help track how much you’ve already had for the day.

4. Add lemon or lime slices, or mint leaves to give your water a light, refreshing taste. (Hint: the mint may need to soak in the water up to 12 hours to give it any flavor.)

5. Set a daily alarm on your cell phone to remind you of your water intake goal.

6. Go slow. If you rarely drink water and just the thought of your recommended intake makes your bladder a little uneasy, take a few days or even a week to work your way up to that magical number.

Even apart from the above approaches, if you drink enough fluid so that you rarely feel thirsty and produce 1.5 liters (6.3 cups) or more of colorless or slightly yellow urine a day, your fluid intake is probably adequate.

Factors that influence water needs
You may need to modify your total fluid intake depending on how active you are, the climate you live in, your health status, and if you’re pregnant or breast-feeding.

Environment. Hot or humid weather can make you sweat and requires additional intake of fluid. Heated indoor air also can cause your skin to lose moisture during wintertime. Altitudes greater than 8,200 feet (2,500 meters) may trigger increased urination and more rapid breathing, which use up more of your fluid reserves, thus increasing your fluid intake needs.

Illnesses or health conditions. Signs of illnesses, such as fever, vomiting and diarrhea, cause your body to lose additional fluids. In these cases you should drink more water and may even need oral rehydration solutions, such as Gatorade or Powerade. On the other hand, some conditions such as heart failure and some types of kidney, liver and adrenal diseases may impair excretion of water and even require that you limit your fluid intake.

Pregnancy or breast-feeding. Women who are expecting or breast-feeding need additional fluids to stay hydrated. Large amounts of fluid are used especially when nursing. The Institute of Medicine recommends that pregnant women drink 2.3 liters (about 10 cups) of fluids daily and women who breast-feed consume 3.1 liters (about 13 cups) of fluids a day

Other Sources of Water
Although it’s a great idea to keep water within reach at all times, you don’t need to rely only on what you drink to satisfy your daily fluid needs. What you eat also provides a significant portion of your fluid needs. On average, food provides about 20 percent of total water intake, while the remaining 80 percent comes from water and beverages of all kinds.
For example, many fruits and vegetables, such as watermelon and tomatoes, are 90 percent to 100 percent water by weight. Beverages such as milk and juice also are composed mostly of water. Even beer, wine and caffeinated beverages — such as coffee, tea or soda — can contribute, but these should not be a major portion of your daily total fluid intake. Water is one of your best bets because it’s calorie-free, inexpensive and readily available.

Staying safely hydratedIt’s generally not a good idea to use thirst alone as a guide for when to drink. By the time you become thirsty, it’s most likely you are already dehydrated. Further, be aware that as you get older your body is less able to sense dehydration and send your brain signals of thirst. Excessive thirst and increased urination can be signs of a more serious medical condition. Talk to your healthcare provider if you experience either.

To ward off dehydration and make sure your body has the fluids it needs, make water your beverage of choice. Nearly every healthy adult can consider the following:
 Drink a glass of water with each meal and between each meal.
 Hydrate before, during and after exercise.
 Substitute sparkling water for alcoholic drinks at social gatherings.
If you drink water from a bottle, thoroughly clean or replace that bottle often.

Though uncommon, it is possible to drink too much water. When your kidneys are unable to excrete the excess water, the electrolyte (mineral) content of the blood is diluted, resulting in low sodium levels in the blood, a condition called hyponatremia. Endurance athletes, such as marathon runners, who drink large amounts of water, are at higher risk of hyponatremia. In general, though, drinking too much water is rare in healthy adults who consume an average American diet.

If you’re concerned about your fluid intake, check with your healthcare provider or a registered dietitian. He or she can help you determine the amount of water that’s best for you.

Posted by Living Well Today on June 17, 2009
Excerpts from Mayoclinic.com/health/water