To medicate or not to medicate. -Fevers

All kids get fevers at one point or another, the question is what do you do? A fever can be a scary thing. Most people see them as bad. But are they really?

(I'm one of the lucky few with baby who is always happy, even when sick.)

What causes a fever?

• Infections are the most common cause of fever.
• Medicines such as antibiotics, antihistamines and narcotics. This may be due to an adverse reaction or may be the drugs design.
• Damage to tissue (surgery, heart attack, hemorrhage, etc.
• Other medical issues (skin inflammation, arthritis, cancer, etc)

What is the point of a fever?

                 A fever is the natural response to an illness such as a viral or bacterial infection. Fever allows white blood cells to proliferate faster, and helps them migrate through tissue better. It also increases the virus-fighting ability of interferon's  and may decrease the ill effects of some bacterial toxins. It’s also thought that an overly warm environment may be less hospitable to bacteria that have developed in a way to thrive best at normal body temperatures. In laymens terms, a fever fights impending sickness. A fever may be a good thing!!

How and When do you treat a fever?

            This is the tricky part. Not all fevers require treatment. Often, it is better to let the fever run it's course. This will allow the body to naturally (and quickly) rid of the sickness. 

The following are the recommendations for treating a fever:
Baby 6 weeks or younger with fever of 101 or higher, consult your doctor immediately.
Baby 7 weeks to 3 months with fever at or above 101, consult your doctor within a few hours.
Baby 3 months to 9 months with persistent fever at or above 101, consult your dr within a few hours.
Baby or child above 9 months with persistent fever at or above 103, consult your doctor.


Waiting out the fever:

• Stay hydrated (coconut water!!).
• Stay comfortable (baths, cool cloths).
• Keep track of how high the fever is.

Medicating:

• Contact your doctor to decide whether to use the drug of your choice (tylenol, motrin, ibuprofin).
• Stay hydrated.
• Stay comfortable.

Why NOT medicate automatically?

Fever reducers are considered a fairly safe drug now-a-days. But let's think about this for a moment. A fever is there to fight an illness. By administering a fever reducer you are disabling the body's natural process to help you get healthy. In addition, drugs are a foreign object. When you add a foreign object into your body, your body turns it's attention to ridding itself of said foreign object, thus turning it's attention away from the illness. Make sense? So not only are you stopping the "fixing" process but you are throwing a wrench into the works!!!

to quote Dr. Sears

"ARE FEVERS DANGEROUS?

No. Many parents have a misconception that fevers are a bad thing and a sign that there is some serious underlying illness. This simply is not true. Fever is a normal and healthy response of the body to an illness. The body's immune system releases chemicals that raise the body temperature. This is part of the normal infection-fighting process."

Medicine has it's time and place in the world. 

• If a fever of 103 or above is persistent (lasting 4 hours or more) the risks out weigh the benefits!! This is when we would contact our doctor. 

• It is SO important to know your kid. I am aware that there are exceptions to the rule. Some kids may have other complications forcing you to treat a fever you may not treat otherwise. Just remember you know your kid better than anyone else!

Without further ado... here are some responses from mom's to the question 

"What do you do when your kid has a fever? How old are they?"

Emily says... "my soon to be 3 yr DD when she gets a fever under 101- I watch and increase fluids, over 101, I think possible ear, viral, bacterial, etc. increase vitamins and supplements and if over 103 usually Motrin- safer more effective then Tylenol- we always try cool cloths, onion in socks etc too. 

However my other DD is one now. She has history of high fevers usually once a month of 105 highest was 105.6 she instantly gets Motrin- anything over 101.4 after we are seen in clinic. ( she had recurrent sepsis, kidney infections, breathing issues, epilepsy and cerebral palsy. Her health history has been h*ll and we don't wait anymore- if we do we wind up admitted to hospital. . Hard to say! Every child is different and pays to have a mom that knows their child and can decide difference from not feeling week fever to serious illness like sepsis."

Brandy says... "My 9 mo had a fever about three weeks ago as did I (no flu just cold); since we are gluten free and LO is allergic to corn (syrup and starch are in OTC meds) which means there are really limited options. We did a lot of keeping him wrapped FWCC and nursing as often is possible while I stayed hydrated with water, tea, and homemade chicken soup. It took about 24 hours, I took his temp about every 4 hours just to track."

Whitney says... "We say 'thank goodness' because it means her body is working like it's supposed to. A fever is a great sign and should not be feared. Of course, it's not great your child is sick but the fever is burning off the infection. Addy has rid herself of 2UTI's and a few colds due to fevers. We do skin to skin and nurse and within a day or two she is 100% better. One time she hit 106 and I took her to the ER. The Doctor's told me to never fear a fever and to let it run it's coure. We don't medicate either, she is 2.5 years old!"

(I) say... "A fever is very important in fighting off infection. We medicate if the fever is sustained for 12 hours at 104 or more. We always keep our doctor in the loop but feel that it is more important for our daughter to fight off the infection naturally instead of intervening with possibly harmful medications."

LeastWicked says... "Our son is 23 months and we cherish a fever because it means his body is working to destroy the cause. We don’t medicate unless it’s over 102 or he is saying he is uncomfortable. We half dose with Advil. Give him a Luke warm bath. Give him a cool sippy. If it climbs above 103 we call the pedi and ask her opinion."

Megan says... "I never medicate for a fever. Our pediatrician told us that no fever is too high and that medicating a child to reduce a fever can actually make them sick longer. Letting a fever run its course is important for fighting infection."


Kristal says... "I don't medicate until we hit 104. The purpose of a fever is to kill the bad bacteria."

You know your child better than anyone else. Do you research and make an educated decision based on your personal situation. DO NOT let anyone make you feel like a crummy parent because you are doing what you feel is best for you child. Education is key!

What do you do when your child has a fever? How old are they?

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A Guide For Parents-To-Be: Part 3 (Pain Management and Pain Medication)

Pain Management and Pain Medication in Labor

One of the things pregnant women fear most is whether they can handle the pain of labor. It can be scary when no one can explain to you what a contraction feels like and everyone just wants to tell you horror stories about long hard labors! I'm here to tell you, you can. It is a mental game and with someone to support you (whether that be a doula, a good nurse, or a prepared partner) you can do this!!!! But what if you don't want to handle it. What if it is worth it to you to just get pain medicine instead? That's ok too!! This is your birth and you have choices, including  whether you want to take pain medication or not. So lets talk about some of the options out there and the pros/cons for each.

First, lets talk about some non-invasive pain management techniques. These techniques are what most doulas will use to help relax mom and minimize pain.

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• Position Changes- 
• Every woman is different. Different positions will be comfortable for different mama's. But there is one universal position that DOES NOT HELP with pain management. This is lying flat on your back in bed. When a laboring mom gets stuck on her back, she often feels the contractions way worse than they actually are. 
• Many hospitals want to continuously monitor or even intermittently monitor your baby's heart rate and contractions while you lye in bed. There are other ways though!! Often you can sit in bed, lye on your left side, sit on a birth ball next to the bed, etc. Do not be afraid to mention these alternatives! They will help you minimize pain. 
• Out of bed there are many other positions you can try. You can kneel, rock, sit on a birth ball, lay over a birth ball, walk, squat, lunge, dangle, lap squat, etc. All of these position changes will help move things along and minimize pain. There aren't really any cons to position changes. It may take a few to find one you like, but it is worth it.
• Accupressure-
• Accupressure can ease anxiety, mitigate pain and help speed things along if labor is stalled. 
• It can help dad, help mom. It can help mom, help mom. Accupressure is a very simple technique that can take the edge off of those agonizing contractions. 
• 4 points that will help most during labor: GB-21, Hand Point, KID1, SP-6. 
• Check with your doctor before using these points. Some women react differently to accupressure.
• Breathing Techniques-
• This is the easiest and most basic technique. EVERY woman should know at least one breathing technique to help her relax and get through a contraction. 
• The simplest and most effective is take slow deep breaths. It's as simple as that!! Slow breath in 2, 3, 4. Slow breath out 2, 3, 4. 
• Breathing greatly help in pain management. If you are not breathing, you wont be able to handle  it. If you breathe too fast, you may hyper ventilate! Get your partner or a nurse to help you remain calm and breathe with you when you start to feel anxious! 
• Vocalization also helps. Whether singing, humming or moaning. (I took to moaning.) 
• Relaxation/Focusing Techniques- 
• Once again different things work for different mama's. So try a few! You can try visualizations, massage, music, counting, or focal points. 
• Your doula may help you relax with Roving Body Check. 
• Heat/Cold-
• I have mentioned hot and cold packs in a previous post with tips to handle labor pain. Hot packs feel amazing, especially if you have back labor. I carry around two rice packs with me in my doula bag just for this reason!! Cold packs keep you from overheating, I mean you are running a marathon here!!!
• The warmth of a shower can relieve pain too. During the birth of my daughter I spent countless hours with the shower head on my back. The heat gave me major relief.  Some hospitals/birth centers even offer labor tubs! If one is available to you, I would consider trying it out!!

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• Counter Pressure-
• A different kind of labor is back labor. It is when you feel the contractions in your back, instead of your tummy. In the case of back labor counter pressure is vital. You may like constant pressure against the pain or light massaging or heavy massaging! Be prepared (partner) to try different styles that work for the mama.

Now onto pain medication. After all, that's what most of you want to know about!!

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• Systemic Painkillers-
• Often narcotics or tranquilizer's. 
• Narcotics are used to take the edge off of the pain. You can still feel it, it just isn't so bad. They are usually given through IV or less often injected into muscle. Often, you cannot receive narcotics after 7 or 8 cm because it will effect the baby. These can make you a bit sleepy and nauseous. They take effect within minutes.
• Narcotics are often given with a tranquilizer. The tranquilizer is used to calm anxiety or nausea. 
• Pros- Narcotics often lessen the perception of pain for 2-6 hours and promote rest. 
• Cons- Don't eliminate pain. Often come with sleepiness, nausea and may temporally depress breathing for you or baby.

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• Epidural-
• An epidural numbs the lower half of your body. It is continuous pain relief that is delivered through a catheter (small flexible tube) inserted into the space just outside the membrane that surrounds the spine. It can be turned down or up if the dose needs to be adjusted. This is the most common pain medication used in labor. 
• Pros- Alleviates most pain. You are awake and alert (if you want to be hehe). Usually has little effect on baby.
• Cons- May decrease your blood pressure and lower baby's heart rate. It can cause temporary difficulty in breathing. You may need a catheter since you often cannot empty your own bladder. Fever, soreness and itchiness at the injection site are common. May make pushing more difficult and additional interventions such as pitocin, vacuum extractor, forceps or cesarean may become more likely. You must remain in bed which could stall labor. You usually must remain in bed after birth (per hospital policy). A headache in the days following delivery is possible. May cause some trouble latching on to breastfeed.

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• Spinal Block- 
• A spinal is very similar to an epidural. It has the same effect on your body however it differs in two ways. 1. It is delivered directly into the spinal fluid. 2. It is a one time injection instead of a continuous feed. This results in an immediate reaction but doesn't last quite as long. 
• Usually used late in labor when there is no time to wait for an epidural or more recently in combination with the epidural. 
• Pros- Complete pain relief in lower body for 1-2 hours. Medication is only given once and you will remain alert and awake. Usually has little effect on the baby.
• Cons- May decrease your blood pressure and lower baby's heart rate. It can cause temporary difficulty in breathing. You may need a catheter since you often cannot empty your own bladder. Soreness at injection site is common.  May make pushing more difficult and additional interventions such as pitocin, vacuum extractor, forceps or cesarean may become more likely.  You must remain in bed during labor. A headache in the days following delivery is possible.  May cause some trouble latching on to breastfeed.
• Local Anesthetic-
• A local anesthetic is often used during labor to numb the tissue in the vaginal opening if an episiotomy is needed. More often, it is used if your care provider has to repair a tear. It is injected into the vaginal tissue or perineum and takes effect very quickly.
• Pros- Temporarily numb a specific area. Negative effects are rare.
• Cons- An allergic reaction is possible. Not for labor contractions.
• Pudendal Block-  
• A pudendal block is usually given in the second stage of labor just before delivery of the baby. It relieves pain around the vagina and rectum as the baby comes down the birth canal. It is also helpful just before an episiotomy.
• Pros- Relieves pain in lower vagina and perineum for up to an hour. 
• Cons- May work on only one side of perineum. Cross placenta and can effect breast feeding relationship immediately after birth. Risk of hematoma and infection (although rare)

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Labor is a personal time and experience. Opinions, needs and wants differ greatly. If decide against or decide to use pain medication, do not let other people's opinions effect you. This is your decision! As always, I invite you to educate yourself further on these options. Decide what is right for you by making an educated decision. 

Sending Easy Birth Dust Your Way!!

Covered in part 1: Important Decisions to Consider -

                              (Vaccinations, feeding baby, circumcision, discipline, and routine procedures)

Covered in part 2: Interventions

To be covered in part 4: Making Decisions on Raising Baby
                             (Babywearing, Day Care, Montessori Method, Co-Sleeping, Introducing Solids)

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A Guide For Parents-To-Be: Part 2 (Interventions)

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Interventions in Labor

When you go into labor you will be so excited, THIS IS IT!!! Many women time every single contraction and anticipate the moment they get to go to the hospital. Lets talk about some things that may happen once you get there. What can you anticipate? 

Many interventions are used in Hospitals today. For example, About 81% of women who birth in a hospital receive Pitocin. Pitocin can double your chance of a cesarean birth. That's where education comes in. The more you know, the more control you can have during your labor. Below are common interventions used. I encourage you to do further research on your own in order to help make educated decisions. 

Always remember, you have choices.

1. Induction

2. Electronic Fetal Monitoring

3. Other Interventions

Here is a sample document to help you share how you feel about each intervention.

1. INDUCTION- Labor should only be induced if it is more risky for baby to remain inside the uterus than to be born. (American College of Obstetricians and Gynecologists)

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• Artificial Rupture of the Membranes (AROM)- AROM is when the care provider breaks your bag of waters.  The care provider will insert a tool called an amnihook and 'catch' the edge of the amniotic sac. This method is often used to induce labor, allow the care provider to see if there is meconium (baby's first poo) present, and for use of an internal fetal monitor. 
• Pro's- Labor may be shortened by an hour, allows amniotic fluid to be examined for presence of meconium which could cause fetal distress. 
• Con's- Baby could turn into breech position making birth more difficult and cesarean birth more likely (if head isn't engaged), umbilical cord could slip out first (prolapsed cord), possibility of infection increases, more intense contractions.

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• Prostaglandin Gel- Medication applied to the cervix prior to induction. Used to thin and shorten (efface/ripen) the cervix which prepares it for birth. There are three types, a gel, oral dose and a tampon-like dose . Prepidil is a gel while Cervidil is applied like a tampon. If over stimulation occurs cervidil can be easily removed, Prepidil can be wiped away but the oral form cannot be removed.
• Pro's-  Minimally invasive, No IV required, Can be an overnight administration (administered, then sent home).
• Con's- Ripens cervix but does not induce. Possible symptoms, oral form cannot be removed in case of over stimulation

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• Cytotec- Cytotec or Misoprostol is intended to soften, efface, and assist in dilation as a means of induction. The dose is given in pill form. The pill is placed vaginally against the cervix and cannot be removed once given. It is NOT approved by the FDA for use in labor but still used today. Below are two links, an FDA warning and the Cytotec label.
• FDA Warning
• Cytotec Label
• Pro's- Fast acting, considered reliable
• Con's- Not FDA approved for use in labor, Has highest reported incidence in all of induction methods, Used with continuous fetal monitoring, cannot be removed once administered
• Side Effects-  fetal cranial nerve palsies, fetal death, maternal death, severe postpartum hemmorhage, uterine tetany, decreased uteroplacental blood flow, uterine rupture, necessitating hysterectomy, amniotic fluid embolism, placental retention, maternal and fetal shock, fetal bradycardia, uterine tachysystole, higher incidence of infection vs Pitocin and higher incidence of c-section

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• Pitocin/Oxytocin- Pitocin is a synthetic form of the natural hormone Oxytocin. It is used to induce labor and is considered the safest method of induction as it can be regulated. Pitocin is administered through an IV to initiate and regulate contractions. It can be accelerated, reduced or stopped at any time. Many care providers will start an induction using Pitocin then turn it off when things get moving. Many others administer Pitocin after baby is born to stop/prevent hemorrhage.
• Pro's- Considered safest form of induction, can be mobile, low risk of infection, can stop post-natal  hemorrhage
• Con's- Aggressive and invasive, Continually administered (use of IV pole and bag), Usually used with continuous fetal monitoring or intermittent monitoring, Labor can progress quickly resulting in need of pain medications, Side effects

2. ELECTRONIC FETAL MONITORING- When admitted into a hospital you will typically go into triage and have monitors strapped to your belly to monitor babys heart beat (typically for about 20 minutes or so). If all looks well some will allow intermittent monitoring. If fetal distress is evident or if mom is high risk, continuous monitoring will be used. 

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• Continuous Fetal Monitoring- Continuous monitoring for low risk women has a lack of benefits. It has shown to increase use of other interventions such as vacuum extractor, forceps use and cesarean section. For high risk women though, continuous monitoring can be the safest way to labor. It can let the care provider know whether baby is in distress or an emergency may arise.
• Pro's- Safe way of monitoring baby in high risk women, can be reassuring to parents, lets doctors and nurses measure contraction length and duration.
• Con's- False positives are very common, confines you mom to bed, may be uncomfortable, sometimes machine gets more attention than laboring mom
• Alternatives- Intermittent monitoring, hand held doppler

Doppler Monitoring- Source

• Intermittent Fetal Monitoring- Intermittent monitoring is safer for low risk women. This involves monitoring baby for 15-20 minute intervals every hour. Mom is often confined to bed for the time of monitoring. Occasionally hospitals have mobile units but you must ask for them and the nurse must be compliant. 
• Pro's- Helps doctors and nurses keep track of contractions and determine whether fetal distress may be present. Can be reassuring to parents. Easier on mom than continuous monitoring.
• Con's- False positives are common, confines mom to bed for intervals, can be uncomfortable.
• Alternatives-Hand held doppler

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• Internal Fetal Monitoring- Requires the amniotic sac to be broken and at least 2-3 cm dilated. A scalp electrode is entered through the birth canal and placed on the baby's head. This from of monitoring is the most accurate. Often mom can be mobile with this form of monitoring. 
• Pro's- Most accurate form of fetal monitoring, can be mobile while in use, can  determine whether baby truly is in distress.
• Con's- Water must be broken, increases chance of infection, can be uncomfortable

3. OTHER INTERVENTIONS

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• IV (Intravenous drip)- An IV is a clear plastic tube inserted into a vein in the hand or arm. They are often given in labor to hydrate women and to keep the vein open for administering medication in case of an emergency(ICE). Some OB's and midwives routinely use an IV on all laboring women. 
• Alternatives include hydrating with clear liquids, ice chips, Popsicles, etc. (some hospitals have a nothing by mouth policy). Another alternative is using a Heparin Lock, which keeps the vein open in case of emergency but is not accompanied by an IV bag or pole. 
• Pro's- Keep mom hydrated, Keep vein open ICE, Easy access ICE
• Con's- Fluid overload resulting in fluid in mom and baby's lungs, diluted blood/anemia/reduced blood oxygen supply to baby, newborn jaundice, hinders moms movement in labor, usually used with continuous monitoring.

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• Heparin Lock- Also known as a Hep or saline lock. Most facilities require having at least a Hep lock when in labor. Usually it is inserted into the vein on the top of your hand. It can be uncomfortable at times but is a nice alternative to an IV. Like an IV, a Hep Lock is used to keep a vein open in case of emergency. It can also be used to administer pain medication, administer antibiotics if the Strep B test was positive, or Pitocin in case of induction or postpartum hemorrhage.  
• Pro's- No pole/bag unlike IV, Easy access ICE, Keep vein open ICE, Administer antibiotics then close for remaining labor.
• Con's- Can be uncomfortable

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• Vacuum Extractor- A vacuum extractor is used to assist in birth. This tool uses suction to either turn the baby's head or pull baby through the birth canal. As shown above, it looks like a suction cup attached to a handle. This is often used if the mother has an epidural, is physically exhausted, the baby is in a difficult position or the baby is getting a lack of oxygen.
• Pro's- Helps baby descend through birth canal in case of an emergency or if mom is not able to push him/her out on her own.
• Con's- Baby may have a red area or small bruises on face. Scalp may have blood blister or small bruises. There rarely can be trauma to the facial nerves.

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• Forceps- Forceps are also used to assist in birth. This tool looks a bit like salad tongs which are placed around baby's head and baby is gently pulled from the birth canal. These are often used if the mother has an epidural, is physically exhausted, the baby is in a difficult position or the baby is getting a lack of oxygen.
• Pro's- (See Vacuum extractor)
• Con's- (See Vacuum extractor)

If you really want to see an episiotomy, google it!

(I'm thinking about those with a weak stomach)

• Episiotomy- An episiotomy is a surgical incision used to enlarge the vaginal opening to help birth baby. At one time it was common practice to perform a routine episiotomy with first time mothers. Some old-school doctors still follow this procedure! Ask your OB or midwife how they feel about them to determine your chance of receiving one. 
• Pro's- Quicken delivery in case of emergency. Used in an assisted delivery (forceps/vacuum extractor). Easier to stitch up than a tear.
• Con's- Infection, bruising, swelling, bleeding, longer healing time, painful scarring, a period of remaining abstinent, incontinence. Raises risk of tearing.
• Alternatives- Place clearly in your birth plan that you do not want to have one unless absolutely necessary. Perineal tear. 
• Prevention- Kegals, exercise (including squatting), controlled (by mom) pushing, perineum massage, avoid  lying on back while pushing, warm compresses

If you really want to see a perineal tear, google it! 

(I'm thinking about those with a weak stomach)

• Perineal Tear- A perineal tear is a tear in the tissue found between your vaginal opening and anus. They range from small nicks to deep lacerations. Often, women would rather tear than have an episiotomy. 
• To illustrate: Try to tear your shirt in half, it is pretty hard to do right? You have to put forth A LOT of force in order to do so. Now put a little cut in it and try to tear it in half again. It happens so much easier now right? 
• Pro's- Heals faster than an episiotomy. 
• Con's- Can take longer to stitch up than an episiotomy. Uncomfortable or painful healing, Swelling, bleeding, bruising.
• Alternatives- Use prevention Techniques in  preparation of birth, Episiotomy.
• Prevention- Kegals, exercise (including squatting), controlled (by mom) pushing, perineum massage, avoid  lying on back while pushing, warm compresses

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Interventions aren't always needed. However, in case of an emergency it is best to be educated in what is going on. Doctors don't always clue you in so make sure your partner or support person is paying close attention in order to intersect any unwanted interventions. Knowledge is your friend. Don't forget to check out the free download above to help you convey your wishes!

Sending Easy Birth Dust Your Way!!

Covered in part 1: Important Decisions to Consider -

                              (Vaccinations, feeding baby, circumcision, discipline, and routine procedures)

Covered in part 3: Pain Management and Pain Medication in Labor

To be covered in part 4: Making Decisions on Raising Baby
                             (Babywearing, Day Care, Montessori Method, Co-Sleeping, Introducing Solids)

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A Guide For Parents-To-Be: Part 1 (Important Decisions to Consider)

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Once you get pregnant there are a million things to think about. It can seem overwhelming, especially when you do your research and find all the conflicting views. This guide is here to help simplify and organize those decisions neutrally! I urge you to take the following options and research each side. Try to find neutral articles and studies (I know it's hard to do), so you can make the decision for yourself and not feel bullied into it! A large part of making the right decision for you and your baby is education. I cannot emphasize enough that research is your best friend!!

Remember, There is no right or wrong here. What YOU decide for your child is what is right for your family.

Below is some un-biased information on:

1. Vaccinations

2. Feeding Baby

3. Circumcision

4. Discipline

5. Routine Procedures

Here is a sample document to help you express your wishes. (Enjoy!!)

1. Vaccinations: These can be very controversial now-a-days. Some decide not to vaccinate at all, some vaccinate on schedule, some make their own schedule and some partially vaccinate! As stated above, there is no right or wrong decision here. I urge you to do your research on EACH and EVERY vaccine. Talk to your partner and make the decision that is right for your family. Here are some sources that may help!

• Dr.Sears Vaccine Book, available at your local library! This book talks about the pros, cons and ingredients in each vaccine. He also recommends a schedule however I feel that each family should decide on their own schedule.
• Here is the recommended vaccine schedule for children birth-6 years.
• A break down of some ingredients in vaccines.
• ASK QUESTIONS. If you are concerned about a vaccine or have any questions, please ask a doctor you trust!! Remember, most of the vaccines can be seperated (ie dTap, Pertussis alone is available for you to order but most Doctor's wont order it themselves.)

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2. Breastfeeding vs Formula Feeding: Another controversial issue. Breastfeeding is natural and is made for baby. The health benefits it has outweigh formula feeding. However some woman cannot nurse or simply don't have the desire to. Formula is not poison, although some would have you believe it is. Formula is a good alternative for those who cannot nurse. I urge you to do your research on both and make an educated decision. Some will nurse until baby self weans, some nurse for a year, some nurse for the first week!! (HINT: Research the virgin gut) What works for you may not work for others so you must make this decision as the parents. Here are some sources that may help in making your decision:

• Le Leche League is a breastfeeding organization in which you can get breastfeeding support, answers to your questions and a lactation consultant's help! 
• Which is best and how to deal with the guilt if you can't successfully breastfeed.
• Some good articles from American Academy of Pediatrics on breastfeeding.

 (SORRY NO PICTURE FOR THIS ONE)

3. Circumcision: That's right, I said it. One of the most controversial subjects on the net today. When researching this one you will find a lot of "if you circumcise your baby you are MUTILATING HIM!" and even more "eww he needs to look like his daddy." I'm stating on record right now. Your baby, your decision. Just please make an educated decision. Here are some good articles on circumcision:

• American Academy of Pediatrics on circumcision. 
• CDC Fact sheet on circumcision.
• Facts.
• D.O.C.

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4. Discipline: This one can be tough. Parents don't always agree on how they want to raise their baby which can lead to a rift in their relationship and confusion for the child. It's best to talk about this before having the baby so you can get on the same page, if you aren't there already. Discuss whether you agree on the cry it out method, sleep training, spanking, time outs, positive reinforcement, etc. I'm not going to add any links to this one, I don't want to appear biased on any of these subjects. There is so much information floating around that educating yourself and following your intuition is the best thing you and your partner can do. 

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5. Common procedures at birth: These procedures are usually over looked by parents because they are so routine! Education is key. YOU HAVE CHOICES. You can refuse or delay each of the following even if they are routine in your medical facility. Consider each aspect and make an educated decision with each:

• Suctioning
• Cord Clamping
• Vitamin K Injection
• PKU Test
• Antibiotic Eye Ointment
• Hep B Vaccine
• Bathing baby
• Circumcision

A couple of these have been covered above but I am going to break down each bullet point.

*Suctioning- As soon as baby's head emerges most care providers will reach for the bulb syringe and suction the nose and mouth to reduce the chance of aspiration on mucous or meconium. This isn't always necessary though. I urge you to research pros and cons of suctioning vs not suctioning.

*Cord Clamping- When baby is born he/she is still connected to the placenta through his/her umbilical cord. The common practice is to automatically clamp and cut the cord. There are many medical advantages to delaying the cord clamping though. I urge you to research pros and cons of delaying the cord clamping.

*Vitamin K Injection- Each baby that is born in a hospital will receive an injection of a large dose of Vitamin K. When babies are born they do not have the ability to clot in the case of bleeding. Vitamin K is administered to prevent any significant bleeding. It is recommended to give the injection if you plan to circumcise or get the PKU test. Some disagree with this practice however. They feel it is an unnecessary shot of a very large dose of Vitamin K. It is also advantagous to look into alternatives such as the oral dose. Once again, I urge you to do your research. 

*PKU Test- There are many metabolic disorders that are tested for after birth. Each is tested for by a blood test via heel prick. This is one of the least controversial procedures as the benefits clearly outweigh the risks. You have choices however, so you may decide to delay or refuse after some research!!

*Eye Antibiotic Ointment- (Or silver nitrate drops) Each state has their own law concerning this ointment. Many of them require the administration of the antibiotic however, your baby, your choice. You have choices no matter what your OB/midwife tells you. The antibiotic is administered routinely to prevent an infection in the eyes that is caused by a bacteria that cause gonorrhea and chlamydia. Even if the mother tests negative for the STD's in her pregnancy this ointment is given routinely. If the baby does get an infection of the eyes it can cause blindness. The flip side, it is very rare to contract the infection, you can watch for symptoms of an infection and if they turn up give the ointment. This cream may cause burning, swelling and blurred vision in the first few days of life.  I encourage you to do your own research and make an educated decision.

*Bathing Baby- Bathing Baby is usually never considered an option by families. They think the baby is covered in goo, it's gross and it needs to be cleaned off. If that's how you feel, good for you! Go bathe that baby haha! Recent studies show that the white goo (called Vernix) is actually a very good moisturizer  that protects baby from infection if massaged into the skin. Bathing baby right away can also cause a sudden drop in temperature which may force baby to stay in the warmer and out of mommy's hand a little longer. Another thing to consider here would be skin on skin contact. You may want to delay the bath for an hour or so, so mama can get some bonding time with baby and have immediate skin on skin contact. This helps jump start milk production and a good latch right away (if breastfeeding). Once again, I urge you to do some research and make an educated decision. 

*(Hep B Vaccine and Circumcision covered above)

Source

These are some hard decisions to make. I emphasize researching and making an educated, personal decision.Don't feel guilty when other don't agree. These are all very controversial subjects and some people feel VERY strongly about each of them.

Did I miss anything? 

What were you concerned about while pregnant? 

Would you like me to discuss something more thoroughly? 

Let me know!

Covered in part 2: Interventions
Covered in part 3: Pain Management and Pain Medication in Labor
To be covered in part 4 : Making Decisions on Raising Baby
                             (Babywearing, Day Care, Montessori Method, Co-Sleeping, Introducing Solids)

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