Posts Tagged ‘healthy baby’
Tuesday, August 23rd, 2011
Smoking during pregnancy is a well known risk factor for increased morbidity and mortality for the fetus. Smoking has been associated with premature birth, intrauterine growth retardation and congenital malformations. Knowing that active smoking presents an increased health risk, the question arises as to whether there are also any increased health risks to the fetus when a pregnant woman inhales smoke generated by others?
What is second hand smoke?
This is the passive or second-hand smoke that may be present in an office setting, restaurant, or home environment. Secondhand smoking exposes a pregnant woman to all of the same toxins and carcinogens, but at lower dosages than smoke inhaled directly.
Sidestream smoke is the major component of second hand smoke that is considered most harmful. This is the smoke coming off the end generated by a cigarette, cigar, or pipe. Sidestream smoke is considered four times more toxic than than directly inhaled smoke due to its higher content of carcinogens. Some of the carcinogens include tar, nicotine, ammonia, benzene, vinyl chloride, arsenic, acetaldehyde, formaldehyde, lead, carbon monoxide, phenol, styrene, butane and toluene.
What harm can second hand smoke present to the fetus?
A recent study published in the March, 2011 issue of Pediatrics by Leonardi-Bee, claims to be the first world review to examine the effects of second hand smoke exposure during pregnancy. They did a combined review of 19 other studies from North America, South America, Asia, and Europe and found a 23% increased risk of stillbirth, 13% increased risk of having a child with congenital anomalies and a higher risk of having a decreased birth weight in newborns by 33 gm.
Spontaneous abortion (miscarriage before 20 weeks gestation) and perinatal and neonatal death (20 weeks to within the first 28 days of life) was not significantly increased by second hand smoke.
How much second hand smoke is dangerous? Currently available studies do not tell us. The effects of second hand smoke at the various stages of a woman’s pregnancy have not been definitively studied and conclusions are not available.
What type of congenital anomalies were found with second hand smoking?
The congenital anomalies that are associated include heart defects, clubfoot, cryptorchidism (failure of descent of the testes), neural tube defects, anencephaly (defect in formation of part of the brain), spina bifida (defect in spinal formation), cleft palate and craniosynostosis (premature closure of the sutures of the skull).
Some of the defects may be due to the exposure of the fetus to toxins through inhalation of sidestream smoke. Other theories have implicated the father’s active smoking causing damage to the genetic material at the time of conception.
Conclusion:
Preventing second hand smoke exposure is important for women both before and during pregnancy. There is no doubt that second hand smoke has deleterious effects on the fetus with both higher risks of stillbirth and congenital malformations. This blog stresses the importance of obstetricians asking and advising, not only the direct smoking history of a patient, but also the passive smoking exposure that a patient experiences during the pregnancy. This includes emphasis on paternal smoking habits, with all efforts being made to suggest programs for smoking cessation and maintaining smoke free workplace and home environment.
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Tags: birth defects, cigarettes and pregnancy, damage to the fetus, health, healthy baby, healthy pregnancy, passive smoke exposure, safe, safety, second hand smoke and pregnancy, Sids, smoking, smoking and pregnancy, smoking while pregnant, Sudden Infant Death Syndrome
Posted in Birth Defects & Infant Disorders | 3 Comments »
Wednesday, October 27th, 2010
 Cesarean Section Delivery As a busy OB/GYN, I embrace any technology that assures that pregnant patients have safe deliveries. But with the rates of C-sections rising dramatically, I fear that one day women will not be allowed to delivery vaginally anymore. That is why I am happy to present you with this news from ACOG.
The American College of Obstetrics and Gynecology in August 2010 has just issued brand new guidelines for allowing women with previous cesarean sections to undergo a trial of labor for a vaginal delivery. (VBAC) These “hot off the press” new recommendations were created in an effort to reduce the escalating cesarean section rate that has been plaguing American hospitals recently. Rates have spiraled from 5% in 1970 to 31% in 2007. Along with this statistic, it was found that VBAC rates have plummeted from 28.3% in 1996 to 8.5% in in 2006.
Of particular interest is the finding that although cesareans have increased in all states, there are large differences between the states. The lowest rates were found in Alaska, Idaho, New Mexico, and Utah. The highest rates were noted in Florida, Louisiana, Mississippi, New Jersey, and West Virginia.
What are some of the reasons behind this trend?
- Fear of liability on the part of the physician.
- Electronic fetal monitoring with recording of minute to minute fetal heart activity.
- Decreased training and use of forceps on the part of physicians.
- Refusal to do vaginal breech deliveries.
- Refusal of obstetricians to attempt turning babies to head down positions from other non deliverable positions (called external cephalic version).
- Hospitals refusing to allow doctors to allow a vaginal birth after cesarean section.
What are the risks of attempting a vaginal birth after having a cesarean section?
The biggest reported risk of vaginal birth after a cesarean is separation of the previous scar on the uterus (dehiscence) or complete rupture of the uterus which causes significant risk to both mother and fetus. The incidence of this is between .5 to .9%. Risks with rupture include maternal hemorrhage, need for transfusion, potential hysterectomy, and severe consequences for the newborn including possible death.
What are the risks of having a repeat cesarean section?
The risks of a cesarean are similar to the risks of any abdominal surgery. This includes:
- Hemorrhage
- Infection
- Operative injury to other organs (bowel or bladder).
- Blood clots
- Transfusion
- Hysterectomy
- Multiple incisions in the uterus can result in a placental problem in future pregnancies if the placenta attaches to the previous scar.
How does one choose which women are more likely to be successful candidates for a vaginal birth after a cesarean?
The chance of success for a vaginal birth after a cesarean in a well chosen patient can be as high as 60%–80%. Patient and physicians should consider the following important questions when making a decision.
- What were the original indications for the cesarean?
Women that had a cesarean for an inability of a baby to fit through the pelvis (dystocia) are more likely to be unsuccessful compared to a woman that had a cesarean for a non-repeatable cause such as breech, or abruption (separation of the placenta).
- The physical characteristics of the woman
Women who are older, heavier and with large babies (4000 to 4500 grams) that are overdue are less likely to be successful.
- Did the woman have a vaginal birth in the past?
Women that had a previous vaginal birth but underwent a more recent cesarean are more likely to be successful.
- The number of cesarean sections or previous uterine surgeries a woman has had in the past.
There is increased risk in a woman who has had more than one previous cesarean, extensive surgery in the uterus such as a large fibroid removal, or a large uterine scar that travels longitudinal in the muscle of the uterus rather than a thin lower uterine horizontal scar. There is no increased risk with a previous low vertical uterine scar. Previous history of a uterine rupture should preclude a woman from a vaginal delivery in the future because of the high rate of recurrence.
- Does the facility or hospital have the ability to do an emergency cesarean section should it be necessary?
The ability to provide emergency cesarean delivery should a crises occur is essential when contemplating an option of vaginal birth after a cesarean section.
- Will there be more pregnancies in the future with a clear advantage of having a vaginal delivery and avoiding future cesareans or, will she be having abdominal surgery anyway for a tubal ligation after this current delivery?
NEW RECOMMENDATIONS
After careful counseling between patient and health care provider, early in prenatal care, more patients can now be considered potential candidates for trial of labor.
New recommendations by the American College of Obstetricians and Gynecologists include allowing a trial of labor in:
- women with 2 previous cesarean section scars.
- women with a previous cesarean that now have twin birth.
- women that have an unknown previous uterine scar.
- women can have the option of taking on added risk associated with a trial of labor, even if they will be delivering in an institute without the capability of emergency cesarean if they are fully informed and well counseled.
- Use of certain inducing agents, such as misoprostol (a type of prostaglandin) should not be used to induce labor in women with a previous cesarean because of the increased risk of rupture.
Tags: abdominal incision, ACOG, c-section, cesarean section, emergency delivery, forceps, healthy baby, labor and delivery, The American College of Obstetrics and Gynecology, vaginal delivery, VBAC
Posted in Labor & Delivery | 5 Comments »
Friday, October 1st, 2010
Things change quickly in the baby biz and, after you read this blog, you will better understand why accurate developmental information can be so difficult to come by. Please feel free to post a comment about your own child’s development and how those skills compare to the infant development charts I have posted on this blog in the past few weeks. We would love to hear from you.
A leading journal entitled Developmental Medicine and Childhood Neurology published an article in 2008 entitled “Is my child developing normally?”: a critical review of web-based resources for parents. The aim of this article was to review all the websites that were readily available to parents on the web that pertain to early childhood development and assess their quality on reliability and accuracy. It was determined that after reviewing forty-four relevant websites, much of the information was incomplete and difficult to understand. There was a clear need to make a concise, informative, relevant resource for parents. The purpose of these charts the last three weeks has been to try and fulfill that need.
The final chart will summarize the ninth through the twelfth months. This is an important transition from baby to early childhood. The motor skills are perfected and impressive gains are also made in language and social interaction. Rivalry begins as babies infringe on the territory, possessions and attention of older siblings. Parental attention often has to involve not just physical safety but also emotional and social safety at this time. Jealousy and attention seeking as well as squabbling behaviors are occurring at this time which allow a child to develop social skills in protecting themselves and their possessions. The child needs to learn to work in a cooperative fashion with others. Learning these important life skills begins at this age, so clearly a balance needs to be achieved between too many constraints and too much freedom in both social and physical development.
Click this link to download a PDF file of the charts below that you can print. We have left space on the right side so that you can add your own developmental notes and photographs. Feel free to add the completed chart to your baby’s scrapbook to be enjoyed for years to come. Keeping a calendar or diary of some of these important landmarks can be special memory for a family and a record that a grown child will treasure forever.
NINTH MONTH
TENTH MONTH
ELEVENTH MONTH
TWELFTH MONTH
Tags: 10 months old, 11 months old, 12 months old, 9 months old, baby development, child development, diagnostics, healthy baby, Infant Development, motor skills, nutrition, predictor
Posted in Infant Development | No Comments »
Monday, September 20th, 2010
 This blog is a continuation of last week’s important developmental milestones and will cover from 5 to 8 months of age. Remember, babies differ greatly in the order and speed with which they learn and develop skills.
Some babies will first start learning skills at a certain age that others have already mastered. Some babies are advanced in motor skills but more average in social skills, all of which fall within the range of “normal”. What is important for a parent to do is to be aware of the wide range of skills and be encouraging by challenging your baby through language, games, toys, and exercise. Providing a safe environment during this period cannot be overemphasized. Exploration and learning are often fraught with real danger and while we as parents do not want to thwart intellectual learning and development, we must also be wary of the dangers that can occur in the process and must always be on the alert.
Click this link to download a PDF file of the charts below that you can print. We have left space on the right side so that you can add your own developmental notes and photographs. Feel free to add the completed chart to your baby’s scrapbook to be enjoyed for years to come. Keeping a calendar or diary of some of these important landmarks can be special memory for a family and a record that a grown child will treasure forever.
FIFTH MONTH
SIXTH MONTH
SEVENTH MONTH
EIGHTH MONTH
Tags: child development, healthy baby, infant, mother
Posted in Infant Development | No Comments »
Tuesday, September 7th, 2010
 Every day after the birth of your child is a new and exciting adventure. As you enjoy your baby’s stages of growth, there is certain information that is essential to know as reassurance that your baby is on the right track of development.
We all know that there are vast differences between children and that each child develops skills and behaviors at different times. A baby will still be considered normal as long as the timing of a developmental event is within a specific range and knowing some basic information about what to look for at different ages will give you confidence that everything is moving along as it should. This knowledge will also spare you needless worry when your best friend’s baby lifts his head two weeks earlier than your baby decides to do the same.
At the same time, information like that on the charts below will enable parents to tune into any developmental delays at an early stage, perhaps allowing medical or psychological intervention earlier to prevent a minor problem from becoming a major one.
All babies are born alone. Interaction is key.
Development is how babies slowly start interacting with their surrounding environment after they are born. We as parents must provide a stimulating environment filled with love and caring to enable a child to develop to their fullest capacity.
This weeks blog will deal with the first four months of life. After reviewing some of the categories in the chart below, a new mother should be able to answer the following questions.
- When should my baby be able sit with support?
- When should my baby be able to roll over front to back? back to front?
- When should my baby be able to support his own weight when lifted?
- When should my baby be able to completely lift his head 90 degrees from lying flat?
- When should my baby be able to follow an object from one side to the next?
Click this link to download a PDF file of the charts below that you can print. We have left space on the right side so that you can add your own developmental notes and photographs. Feel free to add the completed chart to your baby’s scrapbook to be enjoyed for years to come. Keeping a calendar or diary of some of these important landmarks can be special memory for a family and a record that a grown child will treasure forever.
FIRST WEEK
FIRST MONTH
SECOND MONTH
THIRD MONTH
FOURTH MONTH
Next weeks blog will review age 4 months to 8 months of age.
Tags: baby development, healthy baby, mother, nutrition, pregnancy calendar
Posted in Infant Development | No Comments »
Tuesday, August 31st, 2010
 As an OB, my patients ask me just as many questions about breastfeeding as they ask about pregnancy itself. I don’t mind at all because it is such an important topic. Over the years, I have scribbled many of these questions in my notebook so that I could research the most current information for new mothers eager to learn how to feed their babies the natural way.
 Now, these questions are the basis for this week’s blog which is written just for you, with a completely different mindset and format than all my previous articles. Before writing however, I decided to interview the head lactation consultant, Ms. Renate Abstoss at Stamford Hospital in Connecticut, to get a second opinion and gather her responses. Ms. Abstoss sat for the first International Board Exam for Lactation Consultants in 1985 and has continuously worked in the field since that time in California, New York, Germany, Austria, Switzerland, and Connecticut. She was the first lactation consultant appointed as State Certified Teacher for Bavarian Midwifery schools.
There are probably many variations of responses to these questions so please consider this information helpful, but not absolute. I welcome any additional “pearls” from other lactation consultants or experienced moms so we can share the knowledge and promote the best nutritional health for babies everywhere.
- What are the most common problems that women encounter when pumping?
Dwindling milk supply is probably the foremost problem that women encounter when pumping milk. This can be attributed to many different factors.
- Infrequent pumping
A working woman should try and pump every 3 hours for 10 to 15 minutes or at least for every missed feeding.
- Inefficient pumping
Pump being used may have inadequate pressure or not enough cycles per minute causing a decrease in the milk supply.
- Lack of breast feeding
Even when mom is home from work, she should try and breast feed the baby to stimulate milk production. For convenience, babies may be bottle fed too frequently.
- Painful nipples
This can be due to a bad pump due to excessive suction pressure, pumping for too long a period of time, or poor latch when the baby does breast feed.
- Fatigue and exhaustion
The stress of taking care of a newborn along with pressure from work and home can result in exhaustion and fatigue which can decrease the milk supply.
- How do I increase my milk supply?
There are several medications and herbal products available to help with increasing the milk supply. To increase an existing milk supply, one can take two herbal supplements in combination fenugreek and blessed thistle, both of which are available in health food stores and have no known contraindications.
The two most commonly used prescription drugs are Metoclopramide and Domperidone both of which were designed as stomach medications but were found to increase prolactin production in the brain. The medication Domperidone, (Motlium) is not approved for use in the United States and the FDA has issued warnings against the use of this drug as a galactagogue because in higher dosages, when given intravenously, Domperidone it was associated with cardiac arrhythmias and cardiac arrest. However, the small dosages that are used when given orally to increase lactation (30–40 mg/day) and for the short duration of three to six weeks does not seem to be a great concern. Patients generally obtain this medication from Canadian pharmacies or from Mexico and Europe where it is over the counter. Studies are now being conducted by ILCA (International Lactation Consultant Association) regarding the safety of domperidone.
Metoclopramide (commonly known as Reglan), used to treat severe nausea in pregnancy, has been known to have a side effect of depression so its use has to be carefully monitored in the postpartum mother. The drug can be detected in breast milk and the long term side effects to infants is unknown.
- How do I treat plugged milk ducts?
Milk ducts that do not drain can cause the milk to back up resulting in a plugged milk duct. Often the the surrounding breast tissue becomes hardened and inflamed. This area can eventually become infected resulting in a mastitis requiring antibiotic therapy. Plugged ducts often occur when:
- Mom misses feedings
- Mom fails to pump frequently
- The breast fails to empty
- Nursing more frequently
- Changing positioning
- Improving the latch of the baby (sometimes a shield is necessary). A lactation consultant would be very instructive in this situation.
- This can be a result of incorrect positioning, inadequate pressure from a pump, or restriction of milk flow from poorly fitting bras or any kind of breast trauma that damages the duct. Fatigue, stress, or failure of the baby to latch on properly can also contribute to this problem.
- Standard Treatment consists of moist heat beforehand for approximately 5 minutes, empty breast as much as possible, cool compresses afterwards, and reduce swelling in between feedings. Massaging the duct towards the nipple may also be helpful. If the plug comes out, it may look like dried milk in a string. One should continue to nurse to fully clear the plug. Apply cold compresses via an ice pack or a plastic bag of frozen peas for approximately 15 to 20 minutes. Fresh cabbage leaves to the area is another herbal remedy that can be used in between feedings to help with engorgement. Cabbage leaves can be left in the bra for approximately one hour until it wilts. It is important to avoid the nipple area when applying the cabbage leaf because the cabbage is caustic and can cause irritation.
- Other helpful treatments include:
- What do I do if the baby does not latch on?
Latch problems can depend upon the situation causing them:
- It may be due to a newborn who is just learning how to latch.
Assistance from a lactation consultant can be very helpful in making sure the baby is latched deeply with a mouth very wide to get all the breast tissue. The baby should be latched well beyond the tip of the nipple. Often latching problems occur because the baby fails to flare the bottom lip.
- Is it due to flat or inverted nipples?
If the problem is due to flat or inverted nipples, a suction device, pump, or nipple shield may be used to avoid engorgement by expressing the milk. This will avoid a lowered or disappearing milk supply. Different lactation consultants and hospitals may prefer one modality over another, however all agree that care has to be taken when using any device that serious trauma or damage does not occur to the nipple.
Once the baby is “educated” that the breast is his or her “food supply”, generally the baby will nurse fine. It is helpful to try and get beyond the first few days when only colostrum is present, until the milk comes in. Try and avoid avoid artificial nipples at the very beginning.
- Is the baby not hungry at this time?
- Is there a nursing strike?
A “nursing strike” can occur if a well nursing baby, beyond the newborn period suddenly refuses to nurse. This can occur often after 4 months of age when a mother will state “my seven month old baby just suddenly weaned herself.” These babies are not weaning but are actually facing a situation where nursing has become unpleasant, boring, or painful. Often these infants need to be taught to return to a functional breastfeeding pattern with increased skin to skin contact, trying to nurse in a quiet, calm environment without distractions, such as nursing at night in bed. Bottles should be avoided but spoon or cup feeding with expressed milk is acceptable. If the underlying cause is treated, most babies will happily go back to their normal nursing pattern.
- Is the baby getting sick?
Causes of poor latch can be an undiagnosed ear infection, a urinary tract infection, or an upper respiratory infection. Check with your pediatrician to be sure an illness is not being missed. Maternal stress can also cause this problem.
Regardless of the problem, it is important to remove the milk as efficiently as possible if an established supply exists to avoid engorgement which will lower or cause the milk supply to disappear.
If the baby is not latching, it is important to stimulate the establishment of milk production through use of a pump.
- How do I wean the baby when I have decided to transfer to a bottle?
Weaning is the time the baby transitions away from the breast. Time frames for weaning can vary from weeks to months.
Slow weaning is always more optimal. Some mothers will use the pump for weaning and stop breastfeeding entirely. One option for weaning would be to reduce the time per pumping, ie instead of pumping for 15 minutes, reduce it to 10 minutes. This can gradually be dropped down to 2 to 3 minutes per session. An alternative way to wean is to increase the interval between pumping sessions, ie from every 3 hours to every 4, 6 or even 8 hours. If desired, one can use ice packs after pumping for comfort. Also, Motrin can be used for anti-inflammatory pain relief. A comfortable, tight bra can also help with support and relief. Nursing pads can be used to prevent excess leakage. A recommended herbal remedy can be drinking 3 cups of sage tea which is available in health food stores. It has a strong and astringent taste so adding honey makes it more palatable. Do not use this if currently pregnant since it has abortive action.
On occasion, sudden weaning becomes necessary. Discomfort is generally greater since the breast continues to make milk and the breast remains engorged. Nursing can be replaced with pumping but only pump the breast to allow comfort and not to completely drain. Increase time frame between pumpings.
Three days of Sudafed can help dry up the milk production. The milk supply decreases as you feed less. The milk quality also changes becoming more salty and colostrum-like which many babies do not like. Consequently, this also helps diminish the nursing.
Tags: Bavarian Midwifery school, bfeeding, bottle feeding, breast engorgement, breast engorgment, breast feeding, breast milk, breast pump, Breastfeeding, breastfeeding FAQ, cracked nipples, doctor answers questions on breastfeeding, Domperidone, drug can be detected in breast milk, engorged breasts, galactagogue, healthy baby, increase lactation, International Board Exam for Lactation Consultants, International Lactation Consultant Association, is the baby latching, la leche league, lactation, lactation consultant, latching on breast, Metoclopramide, Motlium, Ms. Renate Abstoss, nipple gel, nursing an infant, nursing mother, painful nipples, pumping milk, questions on breastfeeding, Reglan, sore nipples, Stamford Hospital, weaning the baby
Posted in Breastfeeding | 4 Comments »
Monday, August 23rd, 2010
 Let’s face it. A breast pump is not the most romantic, or glamorous, piece of equipment ever invented. They can be bulky and uncomfortable, hard to clean and very expensive. Even worse, when lifted out of their boxes, they may seem extremely intimidating to use on something as delicate as our breasts. Personally, I would rather spend this kind of money on a cute Kate Spade purse, or a nice pair of Gucci pumps… not a breast pump!
Does a breastfeeding woman really need one of these things?
The answer is maybe…
It’s a well known fact that breast feeding has significant benefits to both mother and baby. (Breast Feeding Experts Weigh in on SIDS)(Breastfeeding Cuts Breast Cancer Risk)(Breast Feeding Can Reduce the Risk of Heart Disease) Previous blogs discussed how over 60% of the 4 million pregnant women in America are currently employed and the majority will want to return to the workforce soon after delivery. (Is Pregnancy a Disability?)( Breastfeeding and the Law) This should not be a deterrent for breastfeeding and therefore, it becomes extremely important for women to be encouraged to continue to breastfeed their newborns in a safe, efficient, and effective way while still carrying on their daily work lives. Since women are not available for demand feeding, it becomes vital to know how to use a breast pump so another caregiver can provide milk for the newborn. The blog this week will deal with the nuances of choosing the correct breast pump.
Who should use a breast pump?
Learning how to use a pump is important in the following situations:
- Women returning to work and not available for feeding.
- Premature infants lacking a good suck reflex can benefit from breast milk that is pumped making it easier for them to feed.
- Mom is unable to breastfeed due to sickness.
- Infants having difficulty removing milk from the breast due to anatomy when other techniques to correct fail (flat or inverted nipples of the mom or a facial abnormality in the infant).
How does the breast pump work?
Pumping milk from the breast has its origins from the dairy industry in the 1950”s by Einar Egnell. Pumps have been designed to simulate the sucking action of a nursing infant by mimicking both the suction pressure and the frequency of a baby’s suckling. Pumps are designed so that the amount of pressure and the cycle frequency can be regulated by the mother.
The volume of expressed milk with a breast pump is higher compared to manual expression.
Pressure
The pump has to have enough pressure to extract milk from the breast but not so high that it causes pain and skin trauma. The pump relies on the physics of a fluid moving from an area of higher pressure to an area of of lower pressure. The breast pump creates a pressure differential with negative pressure on the breast reducing the resistance to the outflow of milk from the milk ducts of the mother, which is at a higher pressure. Babies breast feed with a suction pressure of 50–220 mm Hg so the pumps are designed to suck at maximum negative pressures at about 220–250 mm Hg. Levels at less that 150 mm Hg are ineffective in emptying the breast and pressures greater than 220 mm Hg cause nipple pain which will result in the mother terminating her breast feeding.
Pumps can vary in the configuration of the flange (cup applied to the breast). The smaller the cup, the more pressure is exerted over a smaller area of space.
Frequency
The other important factor is the length of time the vacuum is applied. Babies suck at a frequency of between 40 and 126 sucks per minute and pumps are designed to mimic the breast by pumping at 40–60 cycles per minute.
How do you select the proper breast pump?
There are so many pumps available today with countless cycle and suction settings, different sizes, power sources, single vs. double set-ups and varying prices that it becomes a great enigma in choosing the right one for an individual. Important considerations in choosing a breast pump include baby’s age, mother’s work needs (full time or part time), support from the mother’s work environment, mother’s finances,and family’s health insurance. Price differences can be based on the durability of the motor, length of the manufacturers warranty, style of packaging, personal amenities, and have single or double set-ups.
Talking with a lactation consultant before you leave the hospital can help you sort through the morass of information. Many pumps are generally not refundable once used so trialing in the hospital or through a lactation consultant may be a good idea. Here are some of the factors to consider when deciding .
Price
The cost of a breast pump is approximately 1,500 dollars for a hospital grade variety to about 150–350 dollars for a personal use style. Prices will increase depending upon the accessories that are packaged with it. Pumps can also be rented for from 30 to 75 dollars per month. but mothers will need to buy all the accessories which include bottles, tubing, and breast flanges for about 50 dollars. If plans are to pump for several months, it may be more valuable to purchase one. Personal breast pumps in the long run are cheaper than formula which can run over 2,000 dollars a year.
Single vs. double pumping
Bilateral pumping is quicker and use more powerful machines with greater cycles per minute and use more pressure to express a greater amount of milk in less time.
For women that use a single pump, the breast should be switched every 5 minutes. It may take 15 to 20 minutes as opposed to 10 minutes with a double pump.
Power source
Electric pumps produce the most milk, followed by battery operated pumps and finally hand pumps. Some pumps have car adapters. For a non-working mother who does occasional pumping, a hand pump or small battery operated pump can work well. Try to make sure the pump has a one year warranty on the motor.
Other factors to consider
Noise level, ease of use and assembly, and difficulty in cleaning are also variables that must be considered when choosing a breast pump. Also ease of obtaining spare parts is a consideration.
Other accessories
Some pumps have more discreet carrying cases to make for easy transport. Also some packages contain gel or ice packs to keep the milk cool.
Different Categories of Pumps
Hand pumps
Two different types exist:
 Milk can be pumped from many kinds of mothers. This one has four spigots instead of two.
- Cylinder pump—Has a double cylinder set-up with suction created by pushing and pulling one cylinder inside the other.
The main problem can be the gasket inside which may need replacement because of shrinkage or its inability to maintain a seal after continued use. The gasket can also harbor bacteria.
- Hand squeeze pump— Suction is created with a hand lever that is squeezed and released.
The advantage is that it is portable, easy to use, quick to assemble, no need for electricity, and is inexpensive.
The disadvantage is the difficulty in obtaining a good milk supply due to difficulty in cycling at baby’s normal suck reflex. Many have a poor suction or excessive suction. Women can also fatigue easily with continued use, especially those with wrist problems or carpal tunnel syndrome (very common in pregnancy.)
Semi-automatic pumps
These pumps can be used manually, with a battery or with an electric adapter. The motor is generally small and not meant for frequent use.
The advantage is that they are portable, lightweight, small and do not require electricity. They can be double and often come with a cooler case.
The disadvantage is that they are not meant for heavy use and are not very durable. The short battery life can be expensive. The cycle frequency slows as the battery wears down. Some can also be noisy.
Personal use electric double pumps
These are automatic, light weight, durable, portable, and double-pump with controls to regulate the pressure and frequency for comfort. They generally include chill packs and storage compartments. They are run by electricity but can have battery and adapters included.
Hospital grade rentals
These are the most powerful and effective with different control settings for suction and frequency. They are the most expensive. Physically, they are large and heavy, and not meant to be portable. Therefore, there is no carrying case and no compartments for storing milk. They run on electricity. They are designed to be multi-user and you must supply your own collection kit which generally must match the pump brand.
Are there FDA standards for breast pumps?
In the United States, there are currently no standards for breast pumps to ensure the safety and quality of the products. However, the FDA does consider personal (not industrial) pumps to be used by one person only. Unfortunately certain pumps are impossible to clean and can produce high bacterial counts making a woman more prone to infection which is a reason not to buy or share a used personal pump.
Summary:
Choosing the right breast pump depends upon the individual needs of each mother. Factors to consider include the home and work situation, the amount of use, and cost factors. The assistance of a qualified lactation consultant is indispensable in guiding a new mom in choosing what works best for each given situation.
Tags: breast feeding, breast milk, breast pump, Breastfeeding, cracked nipples, healthy baby, nursing mother, working mothers
Posted in Breastfeeding | 3 Comments »
Wednesday, July 21st, 2010
Dear Friends, Parents and Customers, Pregnant or Not,
 Baby, it’s warm outside. If you are pregnant or traveling with a newborn and/or a breast feeding baby, please take the time to read this great information about how to make your own, natural insecticide. Exposure to insect repellents has always been a source of concern with regard to adverse outcomes to the infant because they contain the chemicals DEET (N,N-diethyl-m-toluamide) or permethrin which can cross the placenta and are considered toxic in high doses. Generally 6 to 8 % of the repellent is absorbed when applied topically to the skin.
If you want to remind yourself regarding all the reasons to remain natural against bugs, read my previous blog on pesticides here.
Charts and information provided by Abdelkrim Amer and Heinz Mehlorn(2006)
*Many of these essential oils, although natural and herbal, are not designed to be ingested or used during the first trimester of pregnancy when all the organs of the fetus are forming. The compounds mentioned have not had any harmful effects noted in pregnancy but we recommend that pregnant women should still avoid insect infested areas and not use these essential oils on a daily basis.
If you must use a repellent with insecticide:
- Never spray insect repellent in an enclosed area. This might cause breathing difficulties for your baby.
- Never spray the repellent directly on the baby’s face. Instead, first spray the repellent on your hands and then apply to your baby’s face and exposed skin.
- Before trying any insect repellent for babies, apply a small patch on the baby’s arm to check if the baby’s skin is sensitive to it or not.
- Do not use insect repellent near the baby’s eyes, mouth and avoid applying the insect repellent on cuts.
- Avoid, using insect repellent on the baby’s hands as most babies have the habit of putting their hands into their mouth.
- Avoid applying the insect repellent on the baby’s skin more than once a day.
- Once you and your baby are back inside the house, wash off the insect repellent immediately with unscented soap and water.
- Never use insecticide on your breast or chest if you are breast feeding.
Best regards,
Dr. Michele Brown,
OBGYN and Founder of Beauté de Maman
You can purchase our nipple gel at drugstore.com
Tags: breast feeding, bug spray, healthy baby, insecticide, mother, nursing mother, pesticides, safety
Posted in Environmental Issues & Pregnancy | 1 Comment »
Tuesday, July 6th, 2010
 This week, let’s pretend we have a different 26 year old, newly-pregnant woman sitting on the exam table in her obstetrician’s office. She is also excited about her pregnancy but she is more verbal and is telling her physician about the terrible nausea and vomiting, anxiety, difficulty sleeping, and general fatigue. The obstetrician can easily see that she seems to be suffering the normal symptoms of pregnancy but is also a bit worried that it may be something else. Even if nausea and vomiting occur in 50–80% of all pregnant women, especially between the 5th and 13th week, a good obstetrician will go a bit further to make sure it is not something more serious before suggesting a medication, or a supplement, to reduce the symptoms of nausea and vomiting.
Is it possible that this woman is experiencing something more severe than the normal, early pregnancy symptoms? Could it be hy-PO-thyroidism?
Quick Review:
As I wrote in my last blog, one of the great masqueraders for pregnant women is thyroid disease. Many of the symptoms that women experience in the early stages of pregnancy are the exact symptoms that occur with thyroid problems. Women will commonly experience fatigue, weight gain, constipation, insomnia, and lethargy. Health care providers will often reassure patients that this is normal and these symptoms are due to the hormonal and physiological changes that one expects with the early stages of a healthy pregnancy. However, one must be on the alert that these same symptoms could be representative of a much more serious underlying problem; one that could have major, negative ramifications on the pregnancy and the newborn infant. Left undiagnosed and untreated, hypothyroidism (low thyroid hormone) could result in serious, high-risk conditions during the pregnancy. Prematurity, preeclampsia, placental separation (abruption), and/or serious consequences in the child such as congenital cretinism (mental retardation, deafness, muteness).
This weeks blog will focus only on hy-PO-thyroidism. (when you have too little thyroid hormone) and its effects on pregnancy.
Just as HYPERthyroidism can be the great masquerader, so too can hy-PO-thyroidism. Symptoms often mimic a normal early pregnancy, such as weight gain and lethargy with a decrease in exercise ability. Hypothyroidism is defined as the inability to manufacture thyroid hormone by the thyroid gland. Missing this diagnosis can have grave irreversible neurological consequences for the fetus.
How frequent is HYPOthyroidism in pregnancy?
Hypothyroidism occurs in .1 to .3% of pregnancies. It can be associated with other autoimmune disorders such as diabetes. It is often a cause of difficulty in conceiving since women with this condition have difficulty ovulating.
What are the symptoms of hypothyroidism?
- fatigue
- constipation
- intolerance to cold
- muscle cramps
- hair loss
- dry skin
- carpel tunnel syndrome
- weight gain
- intellectual slowness
- voice changes (hoarseness)
- goiter
- insomnia
- lethargy or decrease in exercise capacity
- prolonged relaxation of deep tendon reflexes
- concentration difficulties
What are the dangers to the mother and fetus with untreated hypothyroidism?
- preeclampsia
- low birth weight
- placental abruption
- intrauterine growth restriction
- congenital cretinism (growth failure, mental retardation, deafness, muteness)
- miscarriage
- prematurity
- stillbirth
- postpartum hemorrhage
What are some of the causes of hypothyroidism?
The most common cause of hypothyroidism in pregnancy in the United States is Hashimoto’s thyroiditis. This is when the body produces antibodies against the thyroid gland rendering it unable to manufacture the hormone. However, the most common cause of hypothyroidism world wide is iodine deficiency. Iodine is essential for the manufacture of the hormone.
Other causes include subacute thyroiditis (viral illness of the thyroid gland), certain drugs (ferrous sulfate, phenytoin, rifampin), pituitary or hypothalamic disease, or prior treatment with radioactive iodine to treat Graves Disease (see previous blog).
How is hypothyroidism diagnosed?
The diagnosis of primary hypothyroidism in pregnancy is made by an elevated TSH (made by the pituitary) and a corresponding low thyroid hormone level (T4). One can also measure antibody levels in the thyroid hormones (antithyroglobulin, antithyroid peroxidase). Measurement of antibody levels is important because women who have antibodies are at increased risk of pregnancy complications and also increased risk of postpartum thyroid dysfunction. Women can have a goiter or large swelling in the neck area. Having one autoimmune disease increases the chance of developing another. Women with type I diabetes have a 5 to 8% chance of developing hypothyroidism during pregnancy and a 25% chance of developing postpartum thyroid disease.
How do you treat hypothyroidism?
The treatment of this disease is to replace the thyroid hormone with levothyroxine till the TSH levels are normal. Generally levels are followed each trimester of the pregnancy since the demands of pregnancy may necessitate an increase in dosage. If the cause of the hypothyroidism is due to iodine deficiency, replacement with iodine is essential not only during pregnancy but also after birth. Also, women who take iron during pregnancy due to anemia will have difficulty absorbing their thyroid hormone so these medications should be spaced at least 4 hours apart.
What is subclinical hypothyroidism?
This is a subgroup of thyroid impairment found in 2–5% of pregnant women. Generally the T4 is normal but the TSH is elevated. Subclinical hypothyroidism has been linked to faulty placental development. There is a three fold increased risk of abruption, higher miscarriage rate, and a two fold increase in the incidence of preterm birth leading to impaired neurodevelopment in the child. There is currently a great debate on whether women who present with this condition should be treated since studies have not shown a benefit with replacement. These patients should be followed after delivery because of the increased incidence of developing overt thyroid disease postpartum.
What course does pregnancy have on a women with already diagnosed thyroid disease prior to becoming pregnant?
Pregnancy has a beneficial effect on women with preexisting thyroid disease. Due to the suppression of the immune system, the antibodies found in Hashimoto’s disease decline but, immediately postpartum, there can be a resurgence with marked worsening of the condition. There can be a noticeable reduction in goiter size during the pregnancy.
What is the importance of fetal and neonatal hypothyroidism?
Congenital hypothyroidism occurs in one in 4,000 births. There can be multiple etiologies from genetic, immunologic, environmental, and drug induced causes. It is critically important not to miss this diagnosis in the infant since developmental retardation can occur if the condition goes untreated. Often infants appear normal at birth but deteriorate over several months. Infants can have severe retardation, deafness and muteness. This is the most common cause of mental retardation worldwide. If delay in treatment of congenital hypothyroidism is beyond 3 months, the chance of normal development is low. Currently there is mass neonatal screening programs for all babies in all 50 states prior to leaving the hospital.
Summary:
Hypothyroidism in pregnancy is a condition that should be recognized and treated so severe maternal and fetal complications can be avoided. If thyroid disease exists prior to pregnancy, women should be followed closely and adjustments made to medication throughout the pregnancy. Care should be taken not to miss postpartum thyroid problems which can be transient but have a tendency to reoccur in subsequent pregnancies. Thyroid dysfunction during pregnancy both overt and sub-clinical can predict later thyroid disease. There is also a corresponding six fold risk of diabetes later on in life. Please see my blog on crystal balls in pregnancy for more information on this.
On the other hand, most pregnant women and their babies will not experience significant problems if the hypothyroidism is mild to moderate and, if properly treated, the pregnancy can be expected to progress normally. When treatment is complete, most women feel much better than before their treatment and are able to do more and to enjoy the activities of their daily lives.
Tags: diseases, healthy baby, hormone, hyperthyroidism, Hypothyroidism, morning sickness, nausea and vomiting, predictor, thyroid medication
Posted in Conditions & Diseases | 2 Comments »
Tuesday, June 22nd, 2010
 We all love to watch an adorable baby sucking on a bottle, but breast fed babies, although less likely to develop cavities compared to formula fed babies, can develop baby bottle syndrome when feeding is done on demand. Until recently, a child would only visit the dentist after dental disease occurs. Sadly, some children with decay developed pain, infections, abscesses, chewing difficulties, malnutrition and low self esteem. Others experienced malocclusion, poor growth, difficulty in speech, bruxism (grinding) and decay of the permanent teeth. Delayed treatment was expensive and often children required general anesthesia and/or frightening restraint for needed repairs.
As if these outcomes were not terrible enough, many people have had to endure mouthful’s of fillings, crown’s and bridges later in life as the conditions worsened over time. I suppose this all may seem better than the infamous wooden teeth of the George Washington era, but honestly, not by much.
Now that dentistry has, thankfully, shifted to prevention of cavities by proper oral hygiene and treatment with antibacterial and tooth protecting substances, I thought it would be important to write an article focused on oral care guidelines for the newborn infant. This very new information, based upon many years of research, will crown my series of blogs focused on dental guidelines focused on pregnant mothers (and how to avoid gingivitis and periodontal disease and their possible associations of poor obstetrical outcomes). Now it’s time to turn to the babies.
But my baby has no teeth yet!
Not true! Although a baby is born without visible teeth, development of two sets of teeth has begun in earnest by the 6th week of gestation. By the time the baby is born, both the primary and permanent teeth are present below the gums in an early developmental stage.
Now that you understand that all your baby’s teeth are “in there”, it’s clear why early preventative care will help prevent traumatic dental care issues from cropping up any time during life.
What will a good dentist do?
Believe it or not, children should be visiting the dentist by 1 year of age and be seen twice a year after that. Dentists should discuss diet, provide oral hygiene instructions and detailed directions for fluoride intake. They should also offer behavioral recommendations including the use of pacifiers, the ramifications of thumb sucking and the prevention of baby bottle syndrome.
Will my baby’s diet affect her teeth?
Nutrition continues to play an important role in prevention of tooth decay. Cariogenic foods such as crackers, teething biscuits, fruits and fruit juices, sweetened and acidic soft drinks should be limited. Carbohydrates, broken down by the enzymes in saliva along with bacteria in the mouth leave acid residue that dissolves the tooth enamel. Gums and newly erupted teeth should be cleaned after eating these types of foods. Dairy foods, especially aged cheese, can be protective.
Is flouride good or bad for my baby?
Fluoride use, which prevents tooth decay by increasing the density of the enamel, helps the teeth resist acid dissolution and is recommended after birth to limit cavities (caries).
Fluoride content of water should be tested and fluoride given by 6 months of age if the water is not supplemented or if the supplementation is less than .6 parts per million. Excessive intake of fluoride is not recommended because it produces mild dental fluorosis. This can also occur when children swallow large amounts of toothpaste that is supplemented with fluoride.
Fluoride use during pregnancy is controversial, with broadly divergent opinions.
The opinions range from “absolutely not” to “absolutely, positively yes” based on studies, some of which are interpreted to find that there is great benefit provided by the use of fluoride supplements during the pregnancy, to commencing fluoride use with the eruption of the infant’s teeth, to those who express the greatest concern about the generation of fluorosis and other undesirable or even dangerous conditions. Please consult your physician and your dentist for the recommendation in your individual case. Be sure to tell those you ask whether you live an an area that has a fluoridated water supply or well water.
Pacifiers and Thumb Sucking
Pacifiers have both advantages and disadvantages. Pacifiers, which exert less abnormal pressure on the teeth than a thumb or other fingers, might prevent thumb sucking and thereby reduce the risk of developing severe malocclusion (overbite) and abnormal growth patterns of the structures that support the teeth (the maxilla and the mandible). If thumb sucking continues after the permanent teeth have erupted, it has an even higher probability of causing permanent damage. Pacifier use can be controlled in a child in contrast to an appendage such as a thumb. Pacifiers have also been associated with a reduced incidence of SIDS.
It has been shown that long term use of pacifiers can cause dental problems. Misalignment of the teeth or malocclusions have been reported when infants use them beyond the age of 4. There is also a higher risk of otitis media with their continuing use. Limiting the use of pacifiers to the first 6 months or limiting their use to sleep times is recommended. Continuous use of pacifiers may also stunt speech development.
There is little evidence that orthodontic pacifiers are any better than conventional ones.
Choose pacifiers made of a more durable substance like silicon rather than latex, and be sure that the pacifier is made in one piece to avoid smaller parts from being detached and swallowed.
Pacifiers have not been associated with cavities but pacifiers should not be coated with sweets. Contrary to popular belief, pacifiers do not shorten the duration of breast feeding.
What is Baby Bottle Syndrome?
This syndrome that results from excessive baby bottle use is characterized by the development of severe tooth decay with pain and infection leading to extractions and extensive dental treatment. Bacteria in the mouth use milk and other sweetened beverages for metabolism and create an acidic environment in the mouth causing the destruction of tooth enamel and creating cavities. Children suffering from baby bottle syndrome feed poorly and often fail to thrive. The damage initially appears as white lesions on the teeth and then later progresses to brown or black discoloration. When the damage is severe, the crowns break down and permanent teeth may also be damaged. Malnutrition, with deficiencies in calcium and Vitamin D, may also lead to tooth enamel defects which predisposes the teeth to caries. The overall incidence of baby bottle syndrome varies from 3% to 6% in the general population but can go up to 72% depending upon the population. The teeth most affected are the maximally and mandibular primary incisors followed by the primary molars.
Breast fed babies, although less likely to develop cavities compared to formula fed babies, can develop baby bottle syndrome when feeding is done on demand. Breast milk does not support the growth of bacteria, doesn’t lower the acidity in the mouth and is therefore not as destructive. This is another reason why all mothers should be encouraged to breast feed their infants. Proper use of nipple gels, such as the Beauté de Maman Nipple Gel, will heal the chapped, sore breasts that often prevent women from continuing breast feeding.
Summary of DOs and DON’Ts of Proper Infant Dental Care
Things to Do
- Mouth cleaning in infancy should be part of a daily routine.
- Clean gums, newly erupted teeth, (after 6 months of age) and tongue, with clean washcloth, piece of gauze, or very soft moist toothbrush after feedings and before bed.
- Clean mouth with toothbrush or washcloth after giving sweetened medications.
- Introduce solid foods after 6 months of age and avoid cariogenic foods.
- Bottles should only contain plain water if being given for naps, bed or pacifier.
- Schedule first dental visit after the first year of life.
- Encourage breast feeding, especially for the first 6 months of life when fluoride is not recommended.
Things NOT to Do
- Do not allow the infant to sleep or nap with a bottle filled with juice or milk.
- Do not dip pacifiers in sweet or sweetened foods such as honey, sugar, or juice—sugars will feed bacteria in the gums, causing tooth decay even before teeth have erupted. Do not give fluoride supplementation till 6 months of age-the American Dental Association does not advocate use of fluoride at this age because there is an increase of fluorosis (white spots on the teeth) in infants who are supplemented.
Like so much about having a new infant in the house, dental care may seem daunting. My advice to new parents is to find yourself a reputable dental professional, carefully follow the advice given, and then watch your baby’s teeth arrive sparkling, white and pain free.
Tags: Breastfeeding, cracked nipples, dental care, gingivitis, healthy baby, nipple gel, nursing mother, periodontal disease, teeth
Posted in Oral Hygiene | 2 Comments »
Wednesday, May 20th, 2009
The debate over circumcision is centuries old. Worldwide, about 25% of males undergo this procedure. In the United States, over 60% of males are circumcised. New evidence has recently emerged that brings forth additional benefits of this procedure, making it more appealing to new parents.
(more…)
Tags: healthy baby, obstetrician, pregnancy
Posted in Conditions & Diseases, Infant & Pregnancy Safety | 3 Comments »
Wednesday, May 13th, 2009
It has been well known that breast feeding has significant health benefits to the baby. Recently it has been found to afford benefits to the mother as well. This short review will summarize the existing information and present some of the new studies.
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Tags: Beauté de Maman, Breastfeeding, colostrum, healthy baby, heart disease, immunity, nursing mother
Posted in Breastfeeding | 1 Comment »
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