Newborn Care

There are some things about having a baby that seem so obvious that you prepare for in advance of the child's arrival. And then there are other things that you might not have been expecting.

I was not at all nervous about nursing when the time came, so Jackson and I were able to immediately establish a good relationship via my engorged chest. Most infants lose about 10% of their birthweight within the couple of days postpartum. Jackson only lost two ounces out of his nearly 10lbs of babyness (about 1%). On his fourth day in the external world, my MIL and I took him to the pediatrician's office where I got my first lecture on childhood obesity. In the two days since leaving the hospital, he had gained back the lost ounces and another three more ounces to boot. This is not typical. I was then told that he didn't need a breast in his mouth every time he cried.

Way to make me feel like some kind of pervert, right? I was proud of myself before that visit because I had realized that I had initially been holding him to a timed feeding schedule rather than letting him indicate when he was full--which was when the hour-long nursing sessions began. Twelve hours out of the day he was hungry and nursing. About midway through each meal he would blast his diaper with a previous meal that had been processed. Over time he got gradually faster at nursing. By 4 months he was down to about 40minutes per nursing, and by 8 months or so, he was down to about 10 minutes a feeding.

After the first visit, I have always tried to schedule Jackson's pediatric visits with the doctor who was there at his birth, since she wasn't quite so excitable about infant weight. Besides, Jackson was a 95th percentile baby. He has stayed consistently in the 90th and 95th percentile range for both weight and height, and he is a healthy, proportionate child. I figure I did the right thing to ignore the other doctor's kneejerk reaction to Jackson's scale measurement, and I feel good for trusting my own judgment on that call.

At any rate, I didn't have much choice about nursing him. All he had to do was cry and I was a milk geyser. Hot showers turned me into a fountain. Intercourse practically necessitated a shirt for the protection of Andrew's eyes--on the rare occasions that we were energized enough and willing to try some physical intimacy. If it had been 2 hours since the start of Jackson's last nursing session, I would get let down so hard that I would practically be begging to let him nurse to ease the pressure. Sometimes this was even strong enough to wake me from my occasional bouts of slumber.

I was getting about 3 or 4 hours of sleep in a 24 hour period for the first 2 months. By 4 months I was up to about 5 hours a night, and that continued and slowly grew to about 6 hours by Jackson's first birthday. I was a walking zombie. I had intended to work from home, but it became clear that I was not able to perform more than 2 hours a week and not at the level of quality my employer had come to expect of me. After a few months of valiant efforts, we agreed to call it quits, and they were nice enough to wait for me to be the one to say it first.

Changing 8 to 12 poopy diapers a day was fairly time consuming in its own right, but not because of any particular issue with smell. Sometimes it was because Jackson liked to spend half an hour talking to the painting I had hung above his changing table. But quite often it was due to an unfortunate consequence of an all-liquid diet--the diaper blowout.

Diapers are designed about as well as they can be to contain the things that babies excrete. The problem is that it's ethically irresponsible to duct tape the dang things to the child at the edges. Jackson was a pro at blasting his breastmilk poop, in that fantastic mustard yellow shade, all the way up to his shoulder blades.

Occasionally we were unlucky enough for this to occur while we were out at a restaurant or in the car.

He seemed especially prone to a blowout if allowed to lounge on my Boppy maternity pillow, presumably because he knew what a joy it was to try and clean it. But the worst part of diaper blowouts is the part no one talks about.

Let me say right now that your own hygiene is NOT something you should allow to slide. Andrew was unfortunate enough to come home for lunch one day just as Jackson massacred a diaper, an outfit, and some pieces of nearby furniture. We removed the material he had offended and cleansed it. We bathed the baby. Apparently somehow we were not careful enough with making sure our hands were sufficiently clean, and soon after we spent a rather unpleasant night missing sleep together. As we took turns vomiting and having diarrhea over a span of 6 hours during the night, Andrew and I recognized the source of the problem and vowed never to allow it to happen again. (n.b. Pros and cons here: one bathroom meant having to try to "hold it" when sick, but at least we weren't alone....)

Still, I much preferred the "dates" we went on during the early days to worshipping the porcelain god. I didn't leave the apartment for 2 months other than to go on a walk with Jackson from time to time, so Andrew and I used to take the trash to the Dumpster together and hold hands on the way back when the rugrat was napping. Romance had taken a backseat to life--as opposed to occurring in the backseat.

More Newborn Literature (An Overly Serious Post)

The baby is born, brought home, and the fun begins!  I've already compiled one list of literature that is pretty helpful to have before the baby arrives.  Yet that list is hardly complete.

When Andrew and I were preparing for our little guy to hop out, we had been attending classes at least once a week at our local hospital.  One class was on Newborn Care and lasted for two sessions.  The first session should have had its own name as the Harvey Karp class because nearly all we did in that class was to watch the video version of Dr. Harvey Karp explain his 5 Ss of newborn soothing.  Our initial impression of him was something along the lines of "Is this guy a pedophile?  Does he own any non-blue shirts?"  In time, though, I've come to see him as something of a Baby Whisperer.  Watching the video it was hard to deny that the man seemed to have supernatural powers for calming colicky babies.  The most wonderful part, though, is that he teaches others the tricks he uses--and there's a book that you can buy that talks all about it.

Now, I will be honest.  I never bought his book, "The Happiest Baby on the Block," though I did later go on to buy "The Happiest Toddler on the Block" because I was so impressed with his methods and how well they worked with Jackson.  Andrew and I learned enough to follow Dr. Karp's 5 part system for soothing newborns just from watching the video, so we thought the book would be extraneous.  After all, it was working just fine.  Jackson was responding very well to the shushing and swinging and swaddling and side-lying and sucking prescribed.  Our ignorance really showed, however, when our giant baby kept growing, and it was becoming increasingly apparent that at some point Jackson was going to need to be able to self-soothe--and we weren't allowing him much opportunity for that.

Andrew and I had become expert swaddlers.  Moms who saw me swaddle Jackson used to watch in amazement and inform me that either they were not good swaddlers themselves or that their children didn't like to be swaddled (which was almost always them not knowing they were bad at swaddling).  Andrew had developed a great technique which I adapted for my own.  Given that the weather was nice and cool for the first few months and that we kept the A/C set low, we found that using a double swaddle worked best:  two blankets swaddled individually around Jackson did the trick.  He was a VERY strong baby (think Superman as an infant; I do not exaggerate here), so this double swaddling helped increase friction and limit his motion.  Even still, with as tight as we used to wrap him, Jackson would manage to get his arms out almost every time, especially as he got older, but typically by that point he was either waking up or was sufficiently drowsy that he fell back asleep.

Jackson cried very, very little compared to the average.  I had heard statistics that say the average young baby cries about 3 hours a day in total.  Jackson was more on the order of half an hour a day (until teething began in full force and we weren't prepared to address it).  Why would we want to spoil a system in which we wrap the child in a blanket and he zonks out, almost instantaneously unconscious?

If I had it to do over again, I would have bought the book.  As it was, I found myself holding a 5 or 6 month old baby at the book store and hurriedly scouring The Happiest Baby on the Block for some idea of how to wean ourselves from the 5Ss while still maintaining a happy baby.  And there it was, a small unassuming paragraph, briefly delineating how to cut down over a period of time from using Dr. Karp's methods.  We were months behind this schedule, not having previously known that there was one.

It took us until Jackson was 7 months old (and about 23lbs!) before we were finally able to put him down without full-on swaddling, which was only accomplished via the use of afghans as an intermediary stage.  Since the afghan blankets (crocheted for Jackson by my wonderful mother!) had a lot of stretchiness to them, Jackson had some freedom of movement, but he was still restrained slightly, so it was comforting to him.  He also had a hard time unswaddling himself from the afghan because his little fingers would catch in the holes and end up holding the whole thing around him.

This brings me to another issue:  how to get your kid to sleep.  Andrew and I were very spontaneous people before we were parents.  We kept odd hours and traveled whenever we liked.  A lot changed for us when our little man hatched, and for several months we resisted changing our ways.  Jackson was giving us a heck of a time about staying asleep, and we couldn't figure out why.  What it boiled down to was that we did not have a bedtime routine.  Jackson napped sometimes 5 or 6 times a day toward later infancy, and there was nothing to distinguish between napping and bedtime for him.  There was nothing we were doing to signal to him that naptime or bedtime was approaching, so putting him down eventually became a struggle.

Then I read The No-Cry Sleep Solution by Elizabeth Pantley.  Everything she wrote just seemed so much like common sense, and a lot of it was stuff I had heard before.  I guess you could say that reading it finally guilt tripped me into recognizing that Jackson was not the one who was the problem:  his parents were.  With time and dedication, we were able to steadily make progress toward a bedtime routine.  Now that Jackson is 16 months old, he brings me his favorite Green Blanky and a pacifier to let me know he's ready for his story and snuggle.  Most naps and nights he is asleep within 2 minutes of going to bed.  And he sleeps in his own queen-sized futon bed (a story for another day!).

The main thing to get here is that kids have specific needs.  By recognizing what they are feeling and what you can do to address those feelings, your kid can be more responsive to your desires.  Overall, you can have a much happier child with no need to suffer the heart-rending sounds of a screaming child; no need to leave your baby shrieking, retching, and miserable in a crib because you are at a loss for what more you can do.

That being said, I want to take a moment to discuss colic.  The standard agreement most medical practitioners use these days for defining colic is crying more 3 hours straight, 3 days a week, for at least 3 weeks.  Most also agree that it's somehow related to the digestive tract.  Dr. Karp's methods can help soothe a colicky baby, but they will not address the root of the problem.

Through some research, we tried to resolve some issues Jackson seemed to be having, which I would call related to colic.  He didn't meet the criteria, because he didn't cry that often--but perhaps it's because we were using the 5 Ss to soothe him all the time.  But there were many, many times that we could not comprehend any other reason for him to be cranky other than something digestively related.

Consider this:  when a baby is born, he or she starts off with only what came through the placenta to the womb.  During birth, some bacteria might be contracted, but hospitals do as best a job they can of cleaning the child's orifices to prevent infection and irritation.  If the mother is nursing, the baby can potentially derive some bacteria from her skin--but only if she does not wash her breasts.  When babies go on to consume solids, they will need bacteria in their intestines to digest the food.  This is just how the system works.  Our world is so sterile that often children do not get exposed to enough germs.

Enter BioGaia.  My MIL serendipitously sent us some information on probiotic drops for infants, and we obliged.  It cost us about $37 for a bottle, which lasted about a month, and we did it for two months beginning when Jackson was just about 6 months old.  It helped him noticeably.  I can only imagine what these drops could have done for a colicky baby like Jackson's friend Corinne had been.  The poor little dear screamed her head off almost every night from 7pm until 1am or later until she was about 4 months old.  There are lots of remedies out there for colic that simply do nothing for the hurting children--or their parents who are rapidly going insane!  Check out these results for the BioGaia infant probiotic drops.  (I also have some PDFs saved somewhere after we requested more literature from the manufacturer, so if anyone is interested I can dig those up and share them.)

Hopefully you will read the literature I have recommended above.  There is much to be learned in the way of perspective from reading Dr. Karp's book, such as the idea that toddlers are essentially cave people and that they are emotional rather than rational beings.  Elizabeth Pantley's book provides some great insights into the idea of baby sleep cycles, as well as a great metaphor for helping parents to understand how a child feels when being put in a crib after falling asleep in a parent's arms.

As always, trust your own instincts.  You know your child better than anyone else does.  And whatever problems you are having now, remember that it's just a phase.  They will grow out of it--eventually!

Post Partem, Part II

Jackson and I finally met all of our requirements and were given notice to head home from the hospital.  We had had to stay an extra night because one of the doctors who examined Jackson was not going to be happy until my newborn son had pooped.  Apparently what he had done at birth was not enough; it had to be the real deal.  Our pediatrician came the next day and said that was ridiculous and that we could always just come back if he didn't have a bowel movement, and anyway, at that point there were only 2 days until his first office visit with her.

He appeased us all by defecating massively while we were still preparing to leave.  We had the nurse on duty "teach" Andrew how to change poopy diapers by example.

We soon learned that his BMs would nearly all be highly audible (often from 15 feet away, even) for the next several months--and very frequent.  Your own results may vary, of course, as every child is different.

They also will not allow a baby to leave the hospital unless it is within a carseat.  So, we buckled him into it for the first time, and the little dear fell asleep.  Awwww, how cute!  (And yes, he was fully buckled before being placed in the car, despite the status at picture time.)

I was sufficiently ambulatory though not precisely enjoying the experience of motion.  We loaded ourselves into the van and drove toward home.  As we passed the Women's Center building where I had birthed Jackson, a sudden pain struck me.  In time I became familiar with this new form of pain:  my milk had come in.

For my whole life, I'd never really been particularly well endowed.  I was not flat but "athletic" and had been reasonably content with knowing that I would never have to experience being whapped in the head with my own breasts.  I enjoyed that there were many things I could wear that allowed me to forego wearing a bra.  No more.

Somewhere in the process of leaving the hospital, my own body was swapped with Dolly Parton's.  In the middle of worrying about all the extra skin I had and how I could not pull on pants designed for someone much heavier than I was postpartum, I was strutting around the apartment checking out my new voluptuous profile.

[n.b. In time all good things (and bad things) must come to an end.  Stretch marks faded mostly.  My hips rejoined one another and allowed me to wear my pre-pregnancy jeans.  And my boobs deflated.  Two out of three ain't bad, right?]

I imagine that part of the reason my first let down was so soon and so intense was because Jackson had been nursing very well since shortly after birth.  The first few days, newborns feed on what amounts to a milkshake.  Colostrum is often described as being thick and hard to coerce out of the nipple.  Jackson was a champ.  He nursed a great deal, and at first, I was feeding him on a timing schedule.  After several days I recognized that this was wrong, that he should eat until he tells me he is done.  Nursing began to take longer, and for the next few MONTHS, I was nursing him for an hour straight EVERY OTHER HOUR.

So, how does one get anything accomplished when being enslaved as a dairy cow 12 hours a day?  Having a larger than average child was a bigger challenge than I might have thought.  Still, I had made attempts to mitigate the difficulties.  One way was having my mother-in-law stay for as long as begging would convince her.

During the first 10 days, Jackson's Nana spent most of her waking hours helping cook, wash dishes, and do the laundry.  She left the rest up to myself and Andrew, who was back to work as soon as we were home from the hospital.  Now, I love my MIL, but should I be in that situation again, I think I would try to be more explicit about my needs.

It was GREAT that Nana did the cooking.  It was NOT great that she kept cooking foods I do not eat.  Sure, I'm a picky eater, but there are foods that I do it, and many of them had been purchased well in advanced just for the postpartum period.  She spilled and charred foods all over the inside of my oven, which had been kept scrupulously clean, and removed some clean-keeping measures that I had had in place inside the oven, so that afterward it was more prone to messes.  She went out and bought new foods, cluttering my kitchen with extra containers of things we already had and various other items that would never get used--practically a crime for control freaks like Andrew and myself who have our own food buying system.  I ate fairly little food for the time that she was there.

She washed the dishes, bless her!  She cooked and cleaned up after herself; wonderful woman!  But...she only washed dishes while I was trying to nap.  The head of my bed was only about 10 feet from where she stood, clanging metal pans around a stainless steel sink.  I didn't sleep much while she was there.  She also would either leave a gigantic and precariously balanced pile of dishes in the drying rack or would put the dishes away in the wrong places, rather than asking for clarification.  It took me more than a month to get everything back in order afterward.

She did the laundry!  She folded it, too, and she refused to let me help even if I wanted to.  But she left the piles stacked all around our small living room and did not put anything away.

Having someone else run my household was making me very tense, particularly as it was not being run to my standards.  And her payment?  My dear MIL got plenty of eyefuls of about as much of her daughter in law as her own son had seen.  She bought me some postpartum clothing to help me cut down on my maternity-wear.  (GlamourMom nursing bra tanks are the best invention in clothing since underwear!)  She endured my complaints about stretch marks and concerns that I might remain hippo-sized in the hip region for all eternity.  Andrew and I were tough to please, and Nana bore it well, but eventually she left and I think we all felt some relief.  The lesson here is that postpartum doulas are wonderful; just be clear as to your expectations, and if you want things done your way without feeling guilt (self-imposed or otherwise) about being demanding, a paid doula may be a better bet than family.

Another week or so later I had finally allowed myself enough rest that the bleeding was slowed down and had turned the banana yellow color I was told to expect.  I finally braved some of the other measures provided to me by the hospital staff, such as a Sitz bath and the "epi" bottle.

The Sitz bath fit into the toilet and used gravity to spray warm water on my nethers.  It was a highly overrated experience that was overly complicated to implement and minimally beneficial.  Far better was the "epi" (episiotomy) bottle.  This little thing is still used in our home on a daily basis.  During my postpartum period, the little squeezable spray bottle helped keep me clean where my tearing had occurred and helped to flush out the area some.  Afterward, rather than tossing it in the trash, we repurposed it.  Turns out those bottles make great tools for helping bathe babies, especially for wetting and rinsing hair.  They also make entertaining noises when squeezed empty against baby bellies and are wonderful fountains for toddlers at tub time.

Post Partem, Part I

Since a few people have complained that the last few posts weren't gross enough...let's talk about postpartum issues.

Everyone tosses around the phrase "postpartum depression", but you rarely get the joy of hearing about the other stuff.  Perhaps because it's considered impolite?  Pardon me while I go off in a corner and laugh.  You know what's impolite?  Not telling the truth about the facts of life to those who are yet to experience some of them.

People have babies around just at the time they are least capable of handling them.  Consider the following:  Women spend months on end in discomfort, gaining weight and feeling exhausted, losing sleep and then, when pregnancy comes to a halt, there's labor and delivery and/or a C-section.  It's a grueling, painful, scarring, traumatic, and gory event.  When all that work is done, suddenly there's a cranky, crying little weasel of a thing demanding food about every two hours around the clock--for months on end!  And what's more, if the child accidentally oversleeps that two hour period (as long as 4 hours between feedings), the doctors say to wake them and feed them!  This little weasel also wants to be kept free from its own excrement, yet it insists on continually soiling itself.

And through all that, somehow Mom and Dad have to figure out how to care for themselves.  Mom is expected to try and remember to continue to nourish herself and get sufficient rest, and Dad is expected not to go insane while Mom is greatly incapacitated--and has comparatively paltry recourse for calming the child due to a lack of mammaries.

And Mom is sore.  Maybe she tore.  Maybe she was cut.  Maybe she had a large surgical incision made through her abdominal wall and has a belly full of stitches.  Walking is painful.  Sitting is painful.  Perhaps just moving at all is painful.  But that is secondary to the child because even more painful is listening to the sound of a crying baby.

And what's more:  the blood just never seems to stop flowing.  During pregnancy, Mom's blood supply increases by nearly half again what she had.  Well, she doesn't get to keep it all.  Sure, some goes with the baby, and some leaves at the birth, and some more leaves with the placenta and cord.  But there's more.  Lots more.  And it wants to come out as soon as possible.

Some wonderful people along the way designed some very long, hygienic, disposable pads for postpartum bleeding.  They are too small.  In order to be useful, they need to be chained so that one goes in front and overlaps somewhat a second that goes further toward the back.  If you are a particularly large woman, it's conceivable that you might need three at a time.  I'm not kidding.  At 5'8" (1.73m), I'm hardly what you'd call petite, but I'm not fat either, and to cover the span of gore, I needed this doubling.  Later, after 4 days or so, I was able to start substituting Poise and Serenity incontinence pads, which hold more fluid than the traditional feminine hygiene options.

And then there's the groin pain.  The hospital offered me pain killers.  I was allowed a strong dose of naproxen sodium (Aleve), and while it helped, it was more of a numbing than anything.  Same with the canister of pain-relief foam and the tube of hydrocortisone cream they gave me.  I was continually aware of the pain.  Thankfully, the hospital staff were also innovative.

Part of the pain in the groin is from swelling.  Anyone who knows much about first aid knows that ice helps to reduce swelling.  But who wants to put ice on their feminine delicacies?  Well, I did, though obviously doing so was tricky with all the red tsunami issues in the region.  The nurses did something very smart:  they took a disposable newborn diaper (which is, of course, absorbent and somewhat designed to prevent leaks) and found one end of the crotch region which was open like a pocket.  Ice was crammed into said pocket, and the diaper was introduced to my nethers.  Relief!

Now, another consideration.  We civilized folk understand that having blood all around is something of a health hazard.  And we aren't keen on handwashing a bunch of the stuff out after all that other work.  What does one wear?

While still at the hospital for recovery, I wore the Hospital Gown of Impossible Modesty again.  But obviously that wasn't going to hold my pads to the area of interest, nor was a newborn diaper going to fit around my thighs and hips.  Some genius whom I could kiss a thousand times over created some totally awesome underwear.  This underwear is purely a mesh of gentle elastic material.  It's lightweight and net-like, and super stretchy.  It's just strong enough to hold things together but sympathetic enough not to remind a new mom of her injuries.  I took home as many pairs as I could acquire and even managed to send them through the wash a few times and reuse them before finally donating them to a mom planning a home birth.  Part of me was tempted never to wear any other kind of underwear again...until I stopped needing pads.  Turns out the comfort level was dramatically reduced when mesh meets tender flesh.

The hospital staff gave me certain requirements before I could leave.  Immediately after I was done with the octopus and pony show, I met my first requirement:  peeing.  Owing to the extra hydration from the saline drip, I more than made quota there.  They also kept asking me if I had any gas.  Apparently you can't leave the hospital until you are farting properly.  Let me tell you, it's very strange to be regularly asked by strangers if you are passing wind.

One benefit that I experienced (and I'm not sure how common this is) was that I didn't have to have a bowel movement until 4 days postpartum, and it was relatively easy since I had stayed well hydrated.  Andrew and I drank an entire 24 pack of bottled water during our vacation at the hotel--er, I mean, our stay at the hospital.

Showering was tough, but I was not allowed to take a bath, nor did I want one given that I absolutely did not want to try getting back to a standing position afterward.  For the postpartum mom, I suggest disrobing (and rerobing) while in the bathtub.  I did not realize how keen gravity was to help me make a mess and ended up smearing blood on the floor in a vain attempt to clean up my drippings before more exited my person.  At least it wasn't my floor, so it was somebody else's problem in the end.

The Aristocrats.

Okay, just kidding, but seriously, the whole experience was full of all sorts of nastification.  Still, there were bright spots.  I was up and walking around immediately after giving birth.  I was able to take pictures of Jackson napping on Andrew for the first time, just a couple hours afterward.

My mother-in-law (MIL) and then, shortly thereafter, my own mother traversed their separate drives (each in excess of 2 hours) and gladly snuggled with their new grandson.  My mom had already been made a grandmother twice over via my sister's reproductive habits.  My MIL had not, as Andrew was an only child, and she dubbed herself Nana.

Nana and I had not had a great deal of time to get to know one another in the less than a year's time we had known one another, but she soon got more than her fair share of time with her only daughter-in-law as she stayed the next 10 days to help us adjust to our own new roles as Mama and Dada.

Next up, a review of nursing and postpartum doulas, and (I promise) an end to the postpartum grotesquerie.  We'll start a new kind soon enough.