Dear Friends,

I had planned a cheery holiday introduction for this month’s newsletter. Then last week the Centers for Disease Control released their most recent measure of statistics on pregnancy outcomes in the United States, and I felt compelled to switch gears to devote space to one of the more troubling statistics in this report. The U.S. cesarean delivery rate rose in 2006 to a record high of 31.1 percent of all births, a 3 percent increase from 2005. The percentage of all births delivered by cesarean has climbed 50 percent over the last decade; more than 3 out of 10 births now occur surgically. Some areas, including Richmond, are experiencing even higher rates of cesarean delivery.

While cesarean delivery can be a necessary and life-saving procedure, it can cause more harm than good when overused. The World Health Organization states that a c-section rate in excess of 15% carries with it a higher risk of maternal infection, hemorrhage, and death, as well as a greater likelihood that babies will be born prematurely. Cesarean surgery also impacts women’s future pregnancies by decreasing fertility and increasing the risk of complications such as ectopic pregnancy and problems with placental implantation. Women who give birth via cesarean are more likely to experience breastfeeding difficulties and their babies have a higher incidence of respiratory difficulties around the time of birth and asthma in childhood and as adults.

The reasons for the rise in the cesarean rate are multi-faceted and complex. Many of the common technological interventions that accompany typical birth in our country, such as continuous fetal monitoring, labor induction, and augmentation, carry with them an increased risk of surgical birth. Modern medical care typically under-uses forms of care such as continuous labor support by an experienced companion, or upright postures and movement during labor that are associated with higher rates of spontaneous vaginal delivery. Inductions scheduled for the perceived convenience of the care provider or mother may also play a role: this is borne out by the fact that birth rates are higher on weekdays and before major holidays, something that can only be attributed to induction. (Click here for an interesting charting of this effect).

If you would like to reduce your chances of having an unnecessary C-section, there are a number of organizations and individuals that have done an excellent job of providing suggestions to help you do just that. Here’s are several helpful websites:

Childbirth Connection is an organization that has worked to improve maternity care since 1918. Its website is full of evidence-based information and tools to assist you in making informed decisions about your maternity related care. A particularly helpful tool is their booklet What Every Pregnant Woman Needs to Know About Cesarean Section which can be downloaded here. This booklet, endorsed by over thirty organizations, is a thorough and well-organized starting point for exploring the ramifications of the different methods of birth, and includes a section on how to discuss your concerns with your care provider.

The Lamaze Institute for Normal Birth has published a formal response to the CDC report . You might want to check out their section on Six Care Practices that Support Normal Birth for approaches that enhance the birth process with a minimum of intervention.

You can also read the International Cesarean Awareness Network’s response to the CDC report and explore their links to other useful resources. Finally, there are a number of useful links on our own Resources page.

Because Cesarean birth is so common in today’s birthing environment, I believe it’s important to educate yourself about this procedure. Knowing what's involved in a cesarean birth will not increase its likelihood, but will help you to have a better experience if this turns out to be the way your baby comes into the world. A helpful resource is Penny Simkin’s article on The Best Cesarean Possible. Her website also has a variety of articles and presentations that may be of interest to pregnant women and their care providers.

The nine months of pregnancy provide a wonderful opportunity to explore your feelings about various birth approaches and take actions to facilitate a safe and satisfying birth experience. Spending the time to make sense of the information and issues surrounding birth requires time and energy, but the result is that you will be a more informed and pro-active parent.

OK, enough on that topic. Check out our Prenatal Article for my favorite books and CDs for the childbearing year. The Postnatal Article presents Elizabeth Pantley’s take on Air Travel with a little one. And you’ll find helpful tips in the Yoga Practice section and in the Nutrition Tip.

And just in case you’ve forgotten why we do all this advance preparation, click here for a reminder of the joy and delight that children bring to our lives.

Namaste,

Leslie

If for any reason you do not wish to receive this newsletter monthly, please follow the unsubscribe link at the bottom of this email.

Recent Arrivals!

Congratulations to:

• Donna S and daughter Sydney Freed (10/10/07)
• Katie G and daughter Chaimaa (10/26/07)
• Angella S and daughter Lilliana Taylor (10/30/07)
• Monica J and daughter Leah Katherine (11/12/07)
• Jill S and son August Lane (11/15/07)
• Debbie P and son Beckett Jonathan (11/26/07)
• Jessica L and son Alexander Lucien (12/2/07)
  

Submit your birth announcements and stories on ommama.com!

What's New

• No Prenatal or Baby & Me classes between December 25th and January 1. Regular schedule resumes January 3, 2008.
• Register Now! Itsy Bitsy Yoga classes start January 9th.
• New! Itsy Bitsy Class for Newborns starts January 10th.
• New! We’ve added a Tots Itsy Bitsy Class on Thursdays, 3:30 – 4:30 pm. Starts January 10th.
• Register for Conscious Birthing Class January 26th.
• Price Increase Effective January 1, 2008
  Fees for the Prenatal and Baby and Me classes will increase for the first time in several years on January 1, 2008. You may lock in the current rate by purchasing classes prior to January 1. New prices are as follows:
  8-session package: $110
  Single class: $ 15
• Healthy Mamas Monument Avenue 10k Team Meeting on January 27th, 5 pm. More info to follow in the January newsletter.
  

Birth Story

August Lane arrives into this world . . .

"Babies are bits of star-dust blown from the hand of God.  Lucky the woman who knows the pangs of birth for she has held a star."

—Larry Barretto

What an incredible experience giving birth is. As most of you know from my last yoga class, I was having mild pregnancy induced hypertension and the doctor wanted to induce me on Thurs. am, Nov. 15th . . .

Read Full Birth Story

Prenatal Article

Essential Reading & Listening for the Childbearing Year

Over the years of working with pregnancy and postpartum, I’ve had the opportunity to review a lot of books on the topic. Although many excellent books have been written, there are a few that I find myself reaching for again and again when I have a question or need inspiration. I’ve also benefited from the cumulative experiences of my students, who make wonderful recommendations on books and products that have helped them through their pregnancies. If I were to create a birth and early parenting survival kit, here are the top ten books and CD’s I would have in it:

1. Ina May's Guide to Childbirth is a wonderful mix of birth stories and down to earth advice for getting the best possible birth outcome in today’s highly technological birthing environment. A midwife for over thirty years, Ina May Gaskin does a superb job of reinforcing the notion that women’s bodies are, in general, well-suited for the challenges of birth. The statistics from the births she and her sister midwives have attended since 1970 attest to the wisdom, safety, and cost effectiveness of their approach: their cumulative Cesarean rate from over 2000 births is 1.4%, which compares to a current national Cesarean rate of over 30%. Nearly 70% of their moms delivered over an intact perineum (i.e. without tearing). Much of their method of care appears to be intuitive common sense that includes observation, support, listening, and patience - but that common sense approach leads to profoundly positive outcomes, both in terms of safety and satisfaction. This book has an honored place on my bookshelf.
2. Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation is another favorite. I have had the wonderful opportunity to study with Pam England, and love the depth of awareness her approach fosters. The Birthing From Within, or BFW approach is a multi-sensorial, holistic approach to childbirth education that emphasizes childbirth as a rite of passage and self-discovery process rather than a medical event, even when medical intervention is part of the birth. The BFW approach helps parents mobilize their innate coping skills in the face of challenging and sometimes unexpected events through the use of birth art, journaling, and pain-coping practices that foster the ability to stay present and connected when the going gets tough. England includes a section on the special needs of fathers too. Because birth is a predictably unpredictable process, skills developed through the BFW approach will serve you well no matter what kind of birth you are anticipating.
3. Pregnancy, Childbirth, and the Newborn: The Complete Guide is the book to have if you’re purchasing just one. A great all-in-one text to have handy on your bookshelf, it covers preconception through early infancy in a practical, well-organized, evidence-based format. Included are helpful descriptions of common prenatal examinations and tests as well as charts outlining typical labor variations, complications, and the benefits/risks of common obstetrical procedures. The book also has an exceptional blueprint for birth and postpartum planning.
4. I’m a big believer in the power of guided visualization and affirmations for building confidence and trust in the birth process. Belleruth Naparstek is one of the tops in her field in producing guided visualization scripts for specific concerns. Her CD, Health Journeys: Meditations to Support A Healthy Pregnancy & Successful Childbirth (Health Journeys) is hands down one of the best in this genre. Because the ability to consciously relax is so important during pregnancy and birth, and because structuring a home relaxation practice can be so challenging, I highly recommend the use of this CD to assist you in developing a daily “pause.” Contains two sections: one with affirmations and visualizations to support a healthy pregnancy, and one specifically oriented toward developing confidence in your body’s capacity for labor and birth.
5. Continuing with an audio focus, I never attend a birth without a copy of Todd Norian’s lovely CD, Bija: Soothing Music and Mantras for Yoga and Relaxation, in my birth kit. You are probably already familiar with this one as I use it frequently in the relaxation portion of the class. I love this CD because it invokes a mood of quiet introspection that calms everyone in the birth environment, from laboring mother to care providers. Use it to ease your transition from ordinary reality into “labor land” and set a peaceful tone in your birthing room.
6. It’s great to have intellectual knowledge about the physiology of pregnancy and birth, but the process of becoming a parent also alters our hearts and minds. For this, there is nothing better than reading about other’s experiences of pregnancy and birth. The Spirit of Pregnancy : An Interactive Anthology for Your Journey to Motherhood is a compilation of award winning writers and poets reflecting on the experience of pregnancy. The book also provides questions and space for you to reflect on your own journey. A great book to have by your bedside or when you’re in need of some inspiration.
7. When you’re pregnant, particularly for the first time, it’s not uncommon to be so focused on the pregnancy and birth that you forget that there’s life after labor – oh and by the way, it includes a little being that is quite capable of bringing you to your knees. After the Baby's Birth: A Woman's Way to Wellness : A Complete Guide for Postpartum Women is a gentle, well-written guide to caring for yourself during the early postpartum phase. It’s easy to be so engrossed with your baby that you forget yourself during the first few weeks and months of parenting. This is a great book to reach for when you find yourself flooded in milk and tears.
8. New parents are deluged with a considerable amount of advice, often unsolicited, about how to care for their babies. When you’re new at the game, all this information can lead to confusion and feelings of inadequacy. Anthropologist Meredith Small’s book, Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent helps to relieve the pressure by providing cross-cultural and biological perspectives on how humans (and other primates) parent their babies. This broader context can help you feel more secure with your own parenting choices, particularly when those choices conflict with prevailing cultural norms. A fascinating read, this is a great one to have handy beside your nursing station.
9. The first few weeks and months of caring for a new baby can put you in a spin cycle fueled by elation and exhaustion. When you’ve reached your wit’s end, Anne Lamott’s refreshingly honest and irreverent book Operating Instructions: A Journal of My Son's First Year, can help pull you out of a spin and get you back on track. I read this book during my own son’s first year, and it helped me slog through those grace-filled and graceless months with its wonderful combination of humor and insight. A must-read for any new mother.
10. Another book that chronicles a year in the life of a mother and babe is Louise Erdrich’s lyrical reflection on her pregnancy and early months of her middle daughter’s life, The Blue Jay's Dance: A Birth Year. This is a moving, thoughtful book by a writer who delves deeply into the balancing act inherent in taking on the simultaneous occupations of mother, wife and writer.

Postnatal Article

Airplane Travel with a Baby
By Elizabeth Pantley, author of Gentle Baby Care and The No-Cry Sleep Solution

Question:

We’re about to take our first airplane trip with our one-year-old. We flew quite a bit before she was born, but now we’re not sure what to pack or how to make this trip successful.

Learn about it:

Even if you racked up your share of frequent flyer miles before your baby was born, forget what you know of travel so far. Flying with a little one is a whole different story.

If you fear turning into one of those families we've all met aboard planes — those with squalling, unruly, squirming children who tend to bring out the same traits in their fellow passengers — take heart. My oldest child, Angela was just 14 days old when she took her first flight, and since then, I’ve taken many more trips with my four children. I know that you can travel with your little ones and enjoy the process. Forethought and preparation are the keys.

Planning the trip

The details of your trip often can mean the difference between success and disaster. Keep these ideas in mind as you plan:

• Examine all aspects of the journey when you book your flights. Aim for direct flights so that you can avoid changing planes. If you have to make a change, avoid short layovers that give you too little time to get from gate to gate, and conversely avoid long layovers that require lots of idle time in airports.
• When you make your reservations, give the agent the ages of all passengers. You may learn some important rules such as:
  • FAA regulations allow only one lap-child per adult. If you are traveling with two children, and only one adult, one child will require a seat of his own. (Not that you would want to travel with two children on your lap!)
  • Some airlines do not allow newborns to fly, check on age requirements.
  • Some airlines offer discounted prices for children’s tickets.
  • Most airplanes have only one extra oxygen mask in each row, which means you can only seat one lap-child in each row. If two adults are traveling with two children, consider sitting across the aisle from each other, or two behind two.
  • Some airlines count carseats or strollers as extra baggage.
• If your child falls asleep easily and stays asleep, try scheduling travel for during your child’s nap or sleep times. If you have a finicky sleeper, on the other hand, avoid traveling during usual sleep times, as your baby may just stay fussy and awake.
• Reserve your seats in advance to be sure your entire party sits together.
  • If you have an infant, ask for the bulkhead (front row) and request a bassinet.
  • Contrary to popular advice, I think it’s best to avoid the bulkhead with older babies and toddlers, because these seats offer neither under-seat space nor seat pocket, so you'll have to store all your toys and supplies in the overhead compartment. Also, in the bulkhead, the food tray pops up from the armrest, effectively trapping you in your seat when your table is laden with food.
  • Don’t put your child in the aisle seat, as the food cart and passengers carrying luggage could injure your child.
• Ask what special features your airline offers for families. Some companies offer children’s meals, bassinets, gate check for strollers, or early boarding privileges.
• If you can afford to do so, buy a seat for your child and bring along his carseat. Your baby is used to being buckled into his carseat, and the familiarity may make it easier for him to sit still and even sleep. This only works though when your child is able to fit comfortably in the tight seat compartments. A toddler with long legs will be scrunched between his seat and the seat in front of him. The added benefit of bringing a car seat when you can, is the safety feature of having your child in a protective seat on the airplane. Make sure your carseat bears a sticker that says it's FAA approved for air travel, so that it’s not turned away at the gate. You’ll need that seat anyway to get to and from the airport at home and at your destination. (Carseat rentals are typically expensive, and availability is often limited.)
• Visit your baby’s pediatrician a week or two before your trip to be sure your little one isn’t harboring an ear infection or other illness. If possible, avoid exposing your child to other children the week before the flight so he's less likely to catch one of those many kid-carried bugs.
• If you will be visiting relatives at your destination, make a family photo album and "introduce" your baby to these new people via their pictures prior to the actual meeting.
• If your baby will be taking any medication on the day of the trip (such as a decongestant or pain reliever), be sure to test it out before the day of travel to gauge any side effects.
• Decide if you’ll need a stroller at your destination. If you don't think you'll need a conventional one, at least consider bringing a lightweight portable type for use in airports; this will give you a free hand as you tend to tasks such as luggage check-in and pickup, while keeping your child safe and close by. If you opt to take your regular stroller, you can usually check it at the gate or right at the door of the airplane.
• Alternatively, a sling or soft-pack carrier can be very helpful if your child still likes to be carried and is light enough for you to carry this way for long walks through the airport.
• Dress yourself and your child in comfortable layers of clothing. Airplanes are often cramped and hot, but sometimes too cold.
• Use these checklists (and make lists of your own) to ensure that you don't forget anything.

Packing your carry-on
The right carry-on bag can be a lifesaver. Make sure that your bag is easy to lift or roll, and that it falls within the airline's size limitations. Pack an organized bag that carries:

• Lots of diapers. Plan for an unexpected layover or delay.
• A baby blanket, which is good for multiple uses.
• A diaper-changing pad in case you end up changing your baby on the floor or on a dirty changing table.
• Plenty of snacks. Often the only snacks on airplanes are peanuts, which are a major choking hazard for babies. Also, snacks are a great distraction for a bored or antsy child. Even if you’ve ordered a child’s meal, it might show up when your child is asleep or isn’t hungry, or your child may not like the menu. A few ideas for easy-to-tote snacks include:
  • Baby food
  • Dry cereal
  • Pretzels
  • Crackers
  • Bagels
  • Bread or rolls
  • Dried fruit
  • Lollipops
• Drinks. Bring along favorites in a sippy cup, drink-box, or bottle. You may even want to pack these in a soft lunchbox cooler.
• Infant pain reliever in case of ear pain or other discomfort. (But don’t try anything new; make sure it’s something your baby has tolerated well already.)
• Lots of new toys, or old favorites that have been hidden for a few weeks. Avoid noisy toys that will annoy fellow passengers. Great travel toys include:
  • Crayons and a small pad or sticky notes
  • Stickers and sticker books (Sticker books have the advantage here; their stickers are reusable if stuck on their specially surfaced pages, whereas a sticker placed on paper is there for good — which is fine, too, but a sticker book prolongs the activity.)
  • Building toys like Legos™ or Duplos™
  • Paperback books
  • Puppets
  • Tiny plastic animals, cars, or dolls
  • Playing cards (Go Fish or other games that feature interesting cards)
  • Tape or CD player with kid music or books on tape
• Bib
• Extra pacifiers, or your baby’s lovey, special blanket, or toy
• A book, magazine, or activity for you when baby is sleeping or playing, should you be lucky enough for that to occur!
• A small medical kit with bandages
• Wet wipes for diaper changes and cleaning baby’s hands and face
• Empty plastic bags for soiled diapers
• If your baby uses a bottle, bring several. It’s usually easier to take along premeasured powdered formula and small bottles of water for mixing.
• A complete change of clothes for baby and an extra shirt for you (spitup and spills happen).
• Toothbrush and toothpaste for unexpected layovers.
• If you're traveling as two adults with two children, divide up the children’s supplies into two separate bags in case your seats are separated on the airplane.
• Consider packing toys in a small child’s backpack for any child old enough to carry one.
• A small belt-bag (fanny pack) is handy for tickets, ID, and cash. Wear it on the front of your body, not the back.
• Test your bag in advance to be sure it’s not too heavy!

The night before the trip

• Get a good night’s sleep so that you can be more relaxed during your trip.
• Pack all of your bags and put them in the car or near the front door so you're not scrambling when it's time to leave.
• Review your checklists.

At the airport

• Get to the airport early.
• Check as many pieces of luggage as possible. Avoid overloading yourself with things to carry.
• Keep in mind that most airport rental carts have to be unloaded to go through security, and that your child may have to be taken out of the stroller or backpack when you go through the metal detector.
• When you check in, tell the desk attendant that you are traveling with a baby. Let her know if you have a stroller or carseat with you.
• Change your baby’s diaper immediately before boarding the airplane.
• Avoid breastfeeding or bottle-feeding your baby just before boarding as he may fall asleep and wake up crying as you struggle to carry him and your belongings to the gate. Wait until you are seated and unloaded, then feed him and maybe you’ll be lucky and he’ll take a nap!
• Avoid feeding your little one just prior to boarding. Save food and drink for when you're on the airplane, as these carry great entertainment value.
• Consider bringing your stroller and checking it at the gate. This way you can carry baby, the carseat, and all your belongings right up to the airplane gangway. Smaller strollers can be brought on as carry-ons, and an attendant will take bigger strollers as gate-checked items. (Find out where to retrieve these.)
• If traveling with two adults and multiple children, ask at the desk if one adult can do the early-boarding and set up your carry-on bags and carseat(s). Usually the pre-boarding time is extremely short, and you’ll have to rush to get the carseat secured and carry-on items organized before all the other passengers begin to board. This will also allow your little ones some last-minute exercise before boarding with the second adult.
• If you have a connecting flight, go straight to the gate upon landing. Sometimes it takes longer to get gate-to-gate than you expect. Any waiting time is best done closer to your next gate.

On the airplane

• To help your baby’s ears adjust to changes in cabin pressure, encourage swallowing during takeoff and landing. You can do this by breastfeeding, or offering a bottle or pacifier. Toddlers can take a drink, nibble on crackers, or suck on a lollipop. (Look for those without a gum or chewy center, which can present a choking hazard.) Use the feeling in your own ears to determine when to give your baby something to swallow, or feed your baby when you see the flight attendants preparing the cabin for takeoff or landing. If your baby is sleeping soundly, don’t feel you need to awaken him; he’ll be fine.
• Flying in an airplane can cause dehydration, which occurs much more quickly in a child than with an adult. Keep your baby well hydrated with water, juice, or milk.
• Changing diapers can be a real challenge. Some airplanes have changing tables, but these are typically very small, and while great for newborns a tricky challenge for bigger babies. You can ask the flight attendant for the best place for changing. A small baby can be changed on your lap on or the pull-down tray table. (Be sensitive to the people seated near you if you do this.) Some airlines will allow you to use the flight attendant’s jump-seat; some will let you change your baby on the floor near the galley or in the bulkhead area. If you have an older baby, consider using pull-up disposable diapers on the flight, as these can be pulled up with your little one standing. Use a plastic bag from home or the airsickness bag for disposal in the bathroom trash. Remember that, since flight attendants handle food, they can’t handle dirty diapers. (And they probably don’t want to, either.)
• The flight attendant will usually heat a bottle for you. Be sure that you shake it well and test it thoroughly, as the galley system often makes things very hot.
• If your baby is unhappy and begins to cry, take a deep breath and focus your attention on your baby. Fellow passengers who are unhappy about the disruption may forget that you have as much right to be on the airplane as they do. They also may not know, or may forget how difficult it is for a baby or young child to be patient during a long flight. Your best defense against an unpleasant stranger is to say with a smile, “I’m doing the best I can.” And then tend to your baby.
• Unless you have to, don’t rush off the plane. Let your child play until most of the passengers have disembarked. This will prevent you from standing in the slow-moving line in the aisle while carrying an armload of luggage and trying to keep your baby happy.

International travel

• If only one parent is traveling, make sure you bring a letter of permission from the other parent. This should be signed and assert that the parent gives permission for the child to leave the country. You may not need this, but it’s an easy document to bring along just in case.
• Get passports for all travelers. It’s easy to obtain a passport for a baby. Passport application forms and instructions are available at your local post office. Plan ahead though, as this can take weeks to obtain the passport after making application.
• Take advantage of the room available in a larger airplane by taking your baby for walks when it’s safe to move about the cabin.

At your destination

• Determine in advance where your baby will sleep, and find out if you can rent or borrow a crib, if you need one. If you plan to co-sleep you may need to move the furniture around, or even pull the mattress off the bed to make a safe sleeping situation. (Most hotel housekeeping staff will help with this if you ask politely.) Other equipment such as carseat, stroller, highchair, and safety gates often can be rented or borrowed.
• Find out if your brands of diapers and formula are available at your destination. If not, send a box ahead of time.
• Ask if your accommodations have been childproofed. If not, bring along some outlet protectors and a role of duct tape for on-the-spot childproofing.
• Pack a child-safe nightlight to make those middle-of-the-night potty runs and diaper changes safe.
• Make sure that the vehicle you’ll be picked up in or that you are renting has enough seatbelts for everyone, plus room for luggage and your stroller.
• Upon arrival, you might want to collect your luggage and then send one adult for the car while the other stays at the curb with the bags and children.
• Remember to keep your carry-on bag organized, including snacks, for your return flight home.

For the frequent flier
Make a master list of those items you typically take along. Be sure to include those you're more apt to forget. Keep your list on your computer, if you have one, so it's ready to print out when it's time to pack.

This article is a copyrighted excerpt from Gentle Baby Care by Elizabeth Pantley. (McGraw-Hill, 2003)

Featured Community Service Organization: You!

Current and former prenatal students donated enough baby gear to the Mother’s Gift Circle in November to provide more than thirty overflowing gift bags for Richmond’s teen moms. These gift bags will be given to teen mothers throughout the year through the Department of Public Health. Your generous gifts spread joy and help keep girls involved in programs that educate them about pre-natal health, labor, caring for a newborn, birth control and the importance of staying in school. Thank you for your kindness and stay tuned for future clothing/baby gear drives in spring of 2008.

Prenatal & Postnatal Resources

OmMama’s website features one of the best compilation of local and national resources for expecting and new families. Click here to view our online resource list.

Do you provide a service or business of interest to childbearing families in the Richmond Metropolitan area that you would like to list here? Please email info@ommama.com for information about our listing guidelines.