Free Range Children

I am so excited for these kids' futures.

Toxic Baby

I just watched a really interesting, eye-opening TED Talk about chemical exposure in-utero. Penelope Jagessar Chaffer, film maker of "Toxic Baby" aka coolest pregnant woman ever, and scientist Tyrone Hayes, who is most notably a frog expert, talk about the effects of atrazine in particular and other frequently encountered chemicals in general on the developing fetus. Apparently, most of these chemicals pass freely through the placenta (and breastmilk) and can affect not just the fetus but also future generations:



I don't think anyone would argue against limiting chemical exposure during pregnancy and lactation. The problem is, and I have always felt this, that it is damn near impossible to gather all the relevant information necessary to inform our decisions AND that information is slow forthcoming.

Which chemicals do we stay away from?

Fortunately, most of us have heard by now of the effects of and warnings against BPA and a lot of manufacturers are taking care to exclude that from their products. But in an effort to produce BPA-free stuff they may very well be introducing a new, worse chemical into our daily use and we have nothing to do but wait and see, as it will take time before the adverse population effects of that bubble up to the surface. Scary!

Random Thought of the Day

On one of my recent grocery trips to Whole Foods, I bought these organic apple puffs for Holly. They are supposed to be a good first finger food for a baby because they are nutritious and they melt in the baby's mouth thus posing no choking hazard. (The latter is especially important to those of us who don't practice the baby-led weaning approach.)

As a baby that has had limited practice with finger foods, Holly is finding it quite challenging to use the puffs as intended. A lot of them end up getting mushed up in her fist or thrown to the ground. But, little by little, she is improving and we celebrate every small, painstaking victory. Today she managed to eat TWO! Yay! She also melted 2 in her little hand and dropped 3 on the ground and in her seat...

The packaging for the puffs recommends: "Use within one week of opening for optimal freshness." This package contains 675 (SIX HUNDRED AND SEVENTY FIVE) puffs. It took me one week just to get Holly to eat 2.

Could this product have been offered in a smaller package so as to support the learning curve of a baby and minimize waste? No, because then Happy Baby company would not have been able to write "Best value: 40% more puffs" on the package! And everyone knows that 600 stale puffs is so much better to have than 400.

Thank you, Happy Baby, for making me choose between offering my baby stale food and wasting food.

Book Review: Building Better Families

I just finished reading Matthew Kelly's "Building Better Families: A Practical Guide to Raising Amazing Children". I thought there were a lot of great insights in it and that's funny because I approached the book with some cynicism due to the fact that Matthew Kelly was neither married nor a parent when he wrote it. However it appears from his anecdotes in the book that he and his 7 brothers enjoyed a good family life and upbringing with remarkable parents. As it turns out, this makes him qualified to speak on the subject.

Matthew Kelly is known for being a motivational Christian speaker. He talks to companies and individuals about becoming the best version of themselves. In "Building Better Families" he takes this familiar concept and applies it to the family. Specifically, he talks about how important it is that children see their parents working toward becoming the best version of themselves and that parents guide and encourage their children to make personal decisions with this goal in mind. He offers practical examples of how framing a disagreement between parent and child around this ultimate goal cools down conflict and makes the interaction more engaging "morally, ethically, spiritually" for the child in contrast to, for example, saying "No, because I said so."

Here are just a few of Matthew Kelly's prescriptions for parents: be authentic (share failures as well as successes with your kids), model the behaviors and character traits you wish to see in your kids, select good role models for yourself, and read books on leadership (because, he claims and I agree, great parenting is about great leadership).

I've never been so motivated to become the best version of myself as when I was pregnant with Holly. Knowing that everything I did could affect my baby's growth and development made me determined to do the right things, particularly in the domains of diet, exercise, stress, and emotional well being. I was pretty amazed at the things I was able to accomplish with this added sense of responsibility. But as soon as I gave birth to Holly, I relaxed my efforts: I started drinking coffee again, exercising less, and eating more junk food, to name a few.

Clearly, I should have continued bettering myself, and not just for Holly's sake. Thank you, Matthew Kelly, for helping me to regain that vision. I'm sure that my family will benefit from it.

Opinion: Baby Led Weaning

While researching weaning strategies, I uncovered an interesting concept: Baby Led Weaning.

This is the idea that a baby should be weaned directly to finger food rather than being spoon fed. It is my strong opinion that this strategy was invented by mothers who are lazy to puree their babies' food and want to nurse into toddler years. 

Admittedly, I have been giving Holly sliced apples to nibble on since she was 6 months old and she loves it. She used to grind her gums on the slice and just suck the juice out; but now that she has two teeth she is starting to break off pieces of the apple. In most cases the pieces are too big for her to swallow. So, I have to be on high alert when she's got an apple in her hand. This is incredibly stressful! 

The good news is that in most cases she doesn't try to swallow a piece that is too big. She actually opens her mouth toward me as if to show me and ask for my help; it's super cute! The bad news is that she still occasionally misjudges her ability to swallow a piece. I can't commit to a parenting strategy that makes meal times so stressful. And why would I? I also can't see the long-term benefit of skipping the spoon*.

There are a lot of resources for and a variety of acceptable strategies when it comes to weaning. I think it is a mistake to look at weaning to finger foods versus weaning to purees in terms of "baby-led" and "mother-led." A baby weaned to purees is a driver in the process as much as a baby weaned to finger foods, with the major difference being that the former manages to ingest more nutrients sooner! 

I think that, when all is said and done, every mother intuitively knows how best to wean her baby. And every baby is capable of communicating what works for him and what doesn't. It is a mother's job to read her baby's signs and amend her strategy appropriately. 

* There isn't any.

Opinion: Nursing in Public (Perspectives Encouraged!)

One of the biggest challenges for me as a nursing mother has been deciding how I feel about nursing in public. As a high school debater, I became very good at seeing reasons for and against just about anything, so I have been cognitively stuck running in circles trying to figure out what reasons to use in my decision-making and general attitude toward nursing in public.

I have been breastfeeding for seven months. I’ve nursed in restaurants, at board meetings, at Mom’s Club meetings, at family and friends’ homes, in malls and retail stores, in the car, and in bathrooms when I’m unclear about whether it would be appropriate to do it out*. I started out pretty conservative and, with time and the increasing need to just get out and get things done, I have begun to push myself repeatedly outside of my comfort zone. Now, I am pretty consistently overriding my natural instinct to hide and, for my peace of mind, I need to rationalize this. So here it is:

Reasons for (nursing in public):

1.      Freedom to leave the home as needed, regardless of how long ago the last feeding was and when the next is to be expected: When I was breastfeeding in private every three hours for the first several months, I felt chained to the nursing chair. Nursing would take about 20 minutes (thankfully, that is relatively short because *TMI alert* my baby is a guzzler) and then the mandatory burping would take up to 20 additional minutes. Before nursing, a diaper change would take anywhere from 5 to 15 minutes, depending on the magnitude of the mess and whether redressing was required. So, as I usually took these things to be a package deal, that is up to 55 minutes that I would spend with Holly for each feeding. If I have 3 hours between feedings and 55 minutes are already used in the process of each feeding, then that leaves me with 2 hours and 5 minutes to “do stuff”. I’m pretty efficient at packing, but still, anytime I want to go anywhere I have to get Holly into the infant seat and get her bag, my bag, and anything else I need and lug it down 3 flights of stairs; that’s 15 minutes easy. If I have to drive any considerable distance, that reduces my available time even more. So let’s say that I have 1 hour and 30 minutes before I have to head back home. Not only is that depressing, but how much can one woman do in that time?!

2.     Fostering cognitive control (in particular, the ability to block out distractions) in the infant: Because I spent the first several months breastfeeding in perfect quiet**, now Holly has a difficult time nursing in noisier environments. If I say something or try to have a snack during her meal, she stops and looks up at me like I am interrupting. Cute as she is while she is doing this, that concerns me. I think it is very important for a baby that’s hungry to be able to eat when given food. Higher cognitive control (fostered through nursing in public, among other things) would give her the ability to do this and would also correlate to greater later academic success for her.

3.      Being able to promptly respond to baby’s needs without feeling resentful or alienated: Meeting the baby’s needs is very important, especially in the beginning, which is why doctors now encourage breastfeeding on demand***. So where do you meet those needs: do you bare it where you are sitting, perhaps around company or amid complete strangers, or do you run to the bathroom or the car or another accessible room? It is my strong feeling that leaving the scene is disruptive and personally alienating. If you have friends over for only a couple hours, you may be resentful of your baby for making you miss out on half that time. If you are at a restaurant and you’ve placed your order, you will likely return to a cold meal. Unless you’ve ordered a salad, that is not okay. I consumed a lot of cold meals early on. Was I resentful? Yes. ****

4.      Delighting in the convenience of ready-to-drink milk for your baby anywhere, anytime: Bottle feeding takes forethought, resources, and preparation. Nursing takes unhooking a strap. Enough said.

Now that we all know that breastfeeding in public is awesome, I really want to hear some perspectives on when (if at all) you think it is not “proper” to do so.

Here are the considerations that I struggle with:

1.      Married men: I am very discreet, but even being discreet, sometimes my baby is squirmy and/or garments move, so (for a split second until I correct it) you may be able to see a nipple or part of a boob. I’m not so worried about men sneaking a peak*****, what concerns me is whether their wives are worried about it. I don’t want to step on any toes! Married women and anyone else who is able to empathize with married women, I would love to hear your perspectives on this.

2.      Single men: Here, again, I am not so worried about someone sneaking a peak, what concerns me is whether single guys, particularly male friends of mine, are comfortable with seeing me nurse and whether my husband is comfortable with it. Luckily, we’ve got some of those on the blog too! Please share your perspective!

3.      In-laws, particularly those which are married and conservative: I don't know if the cues I have observed so far (like males evacuating the room when nursing is imminent) are an expression of respect for my privacy or an expression of unease with being around me for this. This is of no consequence when we're in someone's home, but what about when we go out to a restaurant? Am I free to choose to nurse at the table? If they were merely respecting my privacy, then that should be fine. But if they were leaving the room because they are uncomfortable with this, then I am putting them in an awkward position. What to do?!

Thank you all for reading and I look forward to hearing your perspectives!

* A practice I have discontinued since realizing that bathrooms are gross. Would you eat your dinner in a public restroom? I wouldn't... why should my baby be expected to?

** Inference

*** The main opposition to breastfeeding on demand is that it encourages “snacking”. In the seven months I have been nursing, I have not encountered this; but maybe my baby is that awesome.

**** By this time, maybe you are wondering if I’ve heard of this wonderful invention called the breast pump and the accompanying equally awesome invention called a bottle. Yes. My baby rejects the bottle and I don’t have any interest in forcing it on her. I’m sure with repetition and patience, I can teach her; but I see that as a net negative: high cost for little gain.

***** At least right now, I find it hard to think of boobs as sexy because they are food!

"Pushed" to Iatrogenic Prematurity

I am currently reading Jennifer Block's expose on modern maternity care titled "Pushed." It's a nice wrap-up from the midwifery and obstetric literature I have been scouring for truths and perspective over the last two months. It's an eye-opener, but that's mostly by design*. Still, it's a great book because it is bursting out the seams with information, from the history of maternity care to the new fashions and practices. The information is not organized like a boring textbook either; it is presented in a gripping writing style, weaved through stories, and neatly packaged under attention-grabbing subtitles.

Basically, there exists a clash of opinions in American modern maternity care**. The clash is between the obstetricians/gynecologists (representing the organized, insured, medical community as a whole) and the midwives/doulas/women (representing the people who feel that childbirth is a natural process: those who say that most women left to their own devices will be able to deliver their babies and survive without the aid of modern drugs and healthcare). With medical advances have come myriad interventions into American women's childbirth experiences; the perspective held by the midwives is that these advancements and the resulting adopted unnecessary procedures are harmful to women, specifically, and society, as a whole. 

The midwives will have you believe that the hospital is a horrible place to deliver because you will be vulnerable to hospital policies and routine interventions. The doctors will have you believe that you are not safe delivering anywhere else (because, as I have heard now at least three times from my OB, your baby could die).

The more I read, the easier time I have balancing the two perspectives. I am realizing that the true state of modern maternity care is somewhere in the middle: hospital procedures are being reformed to be more "mother-" and "baby-" friendly while American midwives are finding out that they are susceptible to (and influenced by) the same insurance pressures that have made OBs so focused on the active management of labor. 

In order to avoid malpractice suits, OBs are driven to act on, rather than support, the labor and childbirth process. This is one of Block's major points: active management of labor and delivery is defensible in the case of a bad outcome; waiting to see what happens is not. So, at the first sign of trouble, an OB must take action. This starts a cascade of interventions, which too frequently ends with a scalpel to the abdominal cavity. 

How does this relate to my experience? Three weeks ago, my OBs came to the conclusion (based on poor measurements taken by their bad sonographer) that my baby is growing asymmetrically*** and is four weeks smaller in the abdomen than she should be. They immediately referred me to a perinatologist (basically an OB for high-risk pregnancies). After much research and deliberation, I decided to see the perinatologist, if only to remove the categorization of "high-risk" from my pregnancy. At the perinatal care office, I learned that my baby is perfectly symmetrical, but small (measuring three weeks behind her OB calculated gestational age, which is wrong by the way). The perinatologist reviewed the measurements and recommended that we induce labor at 38 weeks. I found this to be quite befuddling. I have a small baby - she clearly needs more time to grow - so my recommended course of action is to take her out early??? 

We asked him why. He looked at me, and then at Kyle, and said "it's very likely that the baby is small because of genetics," however, he continued, with babies that are small for gestational age, sometimes this is due to inadequate nutrition in utero. Since there is no way to know with certainty why a baby is small, we recommend induction for all small babies. Huh.

The doctors have to protect themselves; they simply cannot not recommend induction. Why? Because if my baby is born at a deficit due to insufficient nutrition in utero, then I could sue them for not acting on information indicative of a problem with my pregnancy. I understand that, so I politely decline; it is my decision to make after all.

Iatrogenic prematurity is premature birth caused by the physician, usually via labor induction or scheduled cesarean. The popular belief is that, rather than waiting for labor to start spontaneously at an odd hour, OBs like to induce in the morning, deliver by dinnertime. My OBs have been gritting their teeth to induce me since the first ultrasound measurements came in to suggest that Holly may be growing asymmetrically (see IUGR). Thwarted on that front, now they want to induce me because she is small****. I won't let them.

Opposing the doctors (not taking their "serious" recommendations): that has been challenging, to say the least. They are forceful, persistent, and they have all sorts of nifty diagnostic gadgets on their side. I know that I haven't yet heard the end of the induction talks. Now I am just counting down the days (and appointments) left until my estimated delivery date, hoping that my labor starts spontaneously before the doctors find yet another reason to induce. After that happens, then the medical community and I can move on to battling about something else, like whether I stay strapped to the monitor and/or whether I push in a lithotomy position. 

Bring it on, medical community.

* Block is a journalist, after all. I would not openly call her credibility into question, but I don't think it's unfair to suspect that the information she presents is slightly shaded or exaggerated to heighten its impact on delivery. Furthermore, I trust the data she presents, but also know she may well be withholding data as well in an effort to strengthen her position. As my college suite-mate once remarked, "statistics will tell you anything if you torture them enough"; that is, the analysis of raw data still requires choice (of what's included, what's not, what's meaningful, what's not, etc) and interpretation. By tweaking the variables, thresholds, and analytic methods used, one can significantly alter the outcome of an analysis.

** What follows is a very simple interpretation of the current "issue". It's much more nuanced than what I will deliver here; but I want to make sure to get the basic point across (and I don't want this post to turn into a novel). I am happy to further discuss any aspect of modern maternity care and my findings with any interested readers.

*** At the time, the OBs insisted that it is the asymmetry that worries them, not the size. 

**** At 37 weeks, she weighed 5.5 lbs. That doesn't seem small to me...