7 month old Turkey

Big Decisions: Types of Providers

Hey future mamas!

As many of my friends in my community contemplate pregnancy or actually get pregnant, I'm thrilled to see that I've become a small but mighty source of information about making decisions in this process.  I love talking about it and I love helping people make educated choices about their health consumerism and their consumerism in general.  This week's posts are lovingly dedicated to multiple friends who shall remain nameless who asked me about this topic recently.  Best of luck to them and their partners in crime as they navigate these waters.

The decision of where to give birth wouldn't have even occurred to me as a decision until a couple years ago.  But as I began researching information about how to get pregnant, I realized that there were choices on where to be pregnant that I didn't even know existed.  I hope this week's posts will serve as a launching point for several of you who are doing your own research.

Types of Providers

A Doctor - This would typically be an OB/GYN but also could be a family practitioner, dependent on where you live.  They are typically affiliated with one hospital where they have "admitting rights" and that will dictate where you deliver.  OB/GYNs are surgeons by trade.  They are surgeons who have specialized in surgery required to deliver babies.  They are not typically well trained in natural child birth techniques, and are much more likely to recommend labor augmentation drugs, pain reducing medications like an epidural, and c-sections.  This is all, of course, statistically speaking, and should not be taken as a blanket comment about EVERY ob/gyn in the world.  They can provide both your prenatal care and your labor/delivery/recovery care.  Your insurance probably covers everything this provider provides.

A Midwife - There are two types of midwives... nurse midwives (CNMs) are trained first as nurses, then additionally as midwives.  In the state of MA where I live, they must practice in a medical facility (as opposed to in a home).  direct entry midwives are not nurses first.  They are more likely (in my limited experience) to work in people's homes.  Midwives are trained in vaginal childbirth.  They do not perform surgery, though they might perform small procedures like stitches necessary if you tear while giving birth.  They 'replace' the doctor in our typical view of pregnancy and childbirth... However, they are typically are affiliated with a doctor or facility who knows them well and will serve as a "back up" if your pregnancy or labor/delivery becomes high risk and you need more medical help than they are trained to provide.  They can provide both your prenatal care and your labor/delivery/recovery care.   Your insurance probably covers everything this provider provides.

A Doula - A doula is a completely separate type of provider.  I think it means "mothering the mother" in some language like Greek or Latin or something.  This person's job is not to deliver your baby, but instead is to help you through the process.  Think of them as a paid support provider similar to the role your husband or mother might serve.  They can be REALLY helpful, even if you have an active, involved husband and mother.  First, they have a wealth of knowledge that your husband and mother don't have because those people haven't attended hundreds of births.  Secondly, they probably know the venue and providers you're working with... so they can help you navigate the system while you're figuring all of this out for the first time.  And third, they are an objective 3rd party who can really help with decisions if you're in a rough spot.  Statistically speaking, women who hire doulas have FAR less c-sections than those who don't.  Your insurance probably won't cover this person, but the small amount they charge is totally worth it.  If I get pregnant again, I'm going to save up for a doula.  For sure.

Labor and Delivery Nurse - this provider is an 'assistant' to your midwife or doctor while you're in labor and delivery.  I didn't think they mattered too much when I was making decisions about where to give birth.  The thing is... on a busy night in the L/D unit, you might see more of this person than you do of your midwife.  And you CERTAINLY will see more of her than you'll see of your OB/GYN.  You don't get to pick this person.  You are picking a type of labor and delivery nurse by picking a facility.  So be sure to ask lots of questions about how L/D nurses act, provide care, etc while you're touring facilities to give birth in.  Ask how long their shifts are.  Ask how many patients they care for at one time.  Ask how they feel about drugs, lack of drugs, atypical positioning, intermittent fetal monitoring, etc... This person will become your/your husband's best friend or worst nightmare if you have a long labor/delivery.  Her services are covered by your inpatient hospital bill which is covered by your insurance.

Recovery Nurse - this provider is an 'assistant' to your midwife or doctor before you go home.  It might be the same as your L/D nurse if you're in a small facility.  Or you might not have one at all if you labor at home or in a small center and go home immediately.  I didn't think they mattered too much when I was making decisions about where to give birth.  The thing is... if you labor and deliver in a hospital and stay on the recovery unit for the average current stay of 2-3 days (4-6 for a c-section), you'll see a LOT of this provider... they give you your meds, they take your vitals, they check your bleeding, they make sure you do everything you're supposed to do before discharge... and they share a LOT of opinions while they do these things.  You don't get to pick this person (though you might be able to request the same nurse for several days in a row if you're lucky).  You are picking a type of recovery nurse by picking a facility.  So be sure to ask lots of questions about how nurses act, provide care, etc while you're touring facilities to give birth in.  Ask how long their shifts are.  Ask how many patients they care for at one time.  Ask how they feel about waking you in the night, caring for your child, co-sleeping while in the hospital, formula/breast feeding, etc, etc, etc.  Her services are covered by your inpatient hospital bill which is covered by your insurance.

How Will We Ever Afford a Child?

Because Ben and I teach a financial class for our church, we get the opportunity to hear from a lot of young individuals and couples who don't have kids.  And often times, what we hear is the lament that they feel they'll never be able to actually afford having children.  Let me remind you that children don't actually cost that much.  Sure, the marketing departments of all of our favorite retail stores want you to believe that babies cost money.  But they don't.  There are many things you can do to cut down the typical cost of having kids.  Today we'll focus on the clothing side of things...  There are so many sources of cheap and free clothing out there.  And when your little one is little, she's going to out grow the clothes before she can wear them out!

Earlier this month I had the joy of returning to the Needham rummage sale that I have spoken so highly of in the last year.  You'll remember that a year ago, I posted about my first trip to Needham here.  The deal for this sale is that dozens of families all pool together to create a huge sale.  So in the morning, they sell items at typical rummage sale prices.  But at noon, they have a bag sale, where they give you anything you can take in your brown paper grocery bag for $10.  So after we wandered around a little bit during the regular priced morning sale, we anxiously stood in line and each bought a bag... and...

I think she likes it!  :-)

Okay, seriously... below is a slightly better organized picture of what we brought home.  We spent $32 on 70 items.  Do the math, friend!  That's 46 cents PER ITEM!  To quote my mother, "she can wear it and then throw it away at that price!"  And she's right.  The clothes we bought are literally cheaper than some disposable diaper prices I've seen.  

This is an invaluable tool in parenting, in my mind.  Rummage sales, garage sales, craigslisting, clothing swaps... I'll say it again, children don't have to be expensive!  Now we just have to see if she's still as happy with her loot when she's 8 years old. :-)

5 tips for transitioning to bottle feedings

Some of you mamas out there might be lucky enough to never have to use a bottle (or maybe you'd consider yourselves unlucky?  But I would qualify it as lucky).  If you've got the opportunity to stay home with baby long enough to do 100% breast feeding (EBF or exclusively breastfed) until you're ready to move toward water in a cup, then this post probably doesn't apply to you.  But for moms in the world who need their kid to take a bottle, read on!

You mind find yourself wanting/needing to bottle feed your infant because you have to/want to go back to work.  Or maybe you want a date night with the hubby.  Or maybe you want daddy to feed baby while you sleep a little longer.  Whatever the reason, there's often a lot of anxiety around the transition.  Someone could (and people do!) write whole books about this process.  And I'm not gonna bother going into that much detail.  But here's my 5 quick tips... from the mouth of a feeding-therapist-turned-mommy... about bottle feeding.  Take it for what it's worth.

  1) Don't start too soon/too late - If your goal is to breast feed full time as much as possible, then in the first 2-3 weeks of life you really want the breast to be the only sucking experience baby has.  I don't believe in "nipple confusion" (the term often used to scare moms/dads into thinking that once baby does bottle, they'll be terrible at breastfeeding) in a typical, healthy infant.  But you do want to establish a good milk supply and a good comfort base with breast feeding before you add in other methods.  So if possible, breast feed only for the first several weeks.  If you find that being difficult, PLEASE consult a lactation specialist.  They're awesome.  And they'll help you figure out why it's hard.

On the other hand, if you know that returning to work is looming at 12 weeks, please don't wait until 11.5 weeks to try the first bottle!  In fact, if you wait too long, baby may be so used to breast feeding that you have a really tough time getting them to figure out or be happy with bottle feeding.  And then you have a whole different set of fights on your hands.  I'd say that ideally, you're doing at least 3-4 bottles spread out per week by 8-10 weeks old.  That way you know that baby will be able to take a bottle when/if you need him to when you return to work a few weeks later.

2) Don't do it just a few times and then stop if you need to continue at a later date- Sometimes I hear stories that people tried a bottle at 4 weeks old, it went well, so they didn't try it again until 11.5 weeks old... and the return to work was a nightmare!  All of a sudden, baby wouldn't take the bottle and we couldn't figure out why!!!  Your 4 week old infant is in one developmental stage and your 11 week old infant is in a different developmental stage.  So while it might have been easy at 4 weeks, please don't stop.  You don't have to do it every day, but you should keep going often enough that baby is gaining a skill set (and comfort level) with the bottle.  Again, 3-4 bottles a week (approx 1 every other day) worked nicely for us.

3) Don't stop pumping (yet...) - This will make more sense to current moms.  But if you're reading this pre-parenthood and thinking "oh yes, if the baby sitter can give a bottle, then I'll be FREE!!!  YAY!!!," sadly, you're wrong.  For each time your baby bottle feeds, you'll want to pump the same volume within a 24 hour period.  For example, little Ms. O takes 12 oz while she's at daycare, so I have to pump 12 oz while I'm at work.  If I'm short at work, then I need to pump extra when I get home.  The thing is, if you don't pump, then you're telling your body that your little one didn't need that extra 2 oz that day.  So the next day, your body produces 2 ounces less.  Please don't think that having a huge freezer stash gets you off the hook for feeding for a few days... you'll regret the changes to your milk supply when you try to go back to the previous volume you were doing.

(**CAVEAT** - I typed that last paragraph assuming that your goal is to keep your milk supply up.  Of course, if you've decided to replace breast milk with formula for any reason, then that might not apply to you.)

4) Have daddy (or another familiar caregiver) give the bottle - I heard this advice a lot before we started bottles.  And let me say, as a feeding therapist, it was hard.  I get so much benefit out of watching a baby feed WHILE i'm holding the baby.  I can feel how it's going.  I can see the swallows.  I can feel the way it feels as they breathe.  But I do think that for the average mom, choosing NOT to be the bottle feeder (if possible) reduces the pressure on you a little.  It also makes it a different task than nursing for baby-- they don't smell you or feel you while they're trying to bottle feed, so they won't be hunting around for the breast.  They can focus more on the bottle.  And no, it won't be perfect on the first try, but try not to tell dad it's his fault.  He's doing great-- he's on his first time too!

5) Brand is probably irrelevant - "What brand do you recommend???" is a question I hear a lot at work.  And let me tell you, for 99% of normally developing children, the brand of bottle/nipple is completely irrelevant, especially for the first bottle.  Yes, your baby will become accustom to one certain type of bottle and might, therefore, fuss with other types.  But a typically developing baby should be able to feed from any brand that you put in their mouth, given time to adjust to it.  So please don't spend a million dollars on the expensive one that "prevents colic."  And please don't spend a ton of time bringing home 20 different brands.  Just buy one.  One that you like the colors or shape of.  One that's priced right.  One that's BPA free or glass or made from recycled materials-- whatever works for you is great.  Heck, get used bottles from a friend and just buy new nipples!

What about you other moms... what tips would you add to my list?