take The Birth Survey reminder

For all you new moms out there, or mom of new babies, even if you've done this before:

Congratulations & don't forget to take The Birth Survey to anonymously share your ratings of your provider and facility with other local women.

Thanks for helping to make healthcare options open to every family!

newborns & H1N1

With all the H1N1 or swine flu news flying around lately, patients have been asking how to protect their newborn.

Here are my suggestions for decreasing chances of exposure in the early days:

1. Don't allow your baby to be bathed after birth. Your baby is coated with all kinds of great protective microbes for exactly the purpose of protecting them as newborns. Shampoos and other soaps, especially antibacterial cleansers, will wash these away leaving your newborn without a wonderfully protective coating. In addition to strengthening your baby's protection, when they haven't been bathed, babies are handled less frequently by the medical staff since they are not 'clean' (as if it can any cleaner than a newborn!), which is actually more of a benefit for your baby, the less potentially contaminated hands touching him/her, the better.

2. Initiate breastfeeding as soon after birth as your baby shows interest. Usually within the first 2 hours. Your colostrum provides many, many antibodies to your newborn. If your newborn has exposed to H1N1, chances are high you have been also and your body will respond by making antibodies. In utero, babies receive antibodies through the placenta, after birth, they receive them through breastmilk until their immune system is mature enough to take over the job.

3. Make sure everyone washes their hands before handling your baby. When I say washes their hands, I mean with warm, soapy water for at least 30 seconds, which can be followed by hand sanitizer. Hand sanitizer alone is not nearly as effective as hand washing, though the both combined is better than hand washing alone. Hand sanitizers are good when nothing else is available, but for a newborn, thorough hand washing is gold standard.

4. Be sure you are getting adequate nutritional resources and hydration following labor and birth and in the recovery period. Your stores will need to be refilled after the marathon of labor to allow your body to keep your immune system strong for yourself and your baby. You may also want to discuss vitamins, minerals or other supplements such as whether to continue your prenatal, Vitamin D, Vitamin C, and others with your care provider. Most of these supplements are safe to take while breastfeeding, if your caregiver is unsure of any supplement, dosages or the safety of a supplement during lactation, find a practitioner who is familiar with these

protocols such as a lactation or breastfeeding counselor or consultant or a naturopath with experience working with breastfeeding mothers.

5. Finally, give your baby lots of kisses! One reason we enjoy nuzzling and kissing our babies may be preprogrammed into us to ensure we are being exposed to the same pathogens to which they have been exposed. By putting our faces all over theirs, we are taking in these microbes through our nose and mouth causing us to make antibodies against them that will be passed via breastmilk to the baby.

Close to half of the births in Washington state are paid for by Medicaid. Until recently much of our medicaid dollars have gone toward paying for unnecessary, even potentially harmful cesarean sections. Recently, Washington state has decreased the reimbursement rate for uncomplicated c-sections to equal that of complicated vaginal births, a drop of approximately $2,600/birth. This is (conservatively) predicted to save the state and the federal government $2 million dollars each over the next 2 years, spurred by the economic crisis our state government has seen these past couple of years. The savings may be even greater if the cesarean rate actually begins to drop from close to 30% to the WHO standard of 10-15% (a debatable number itself, but better than 30%+).

Further, research by midwives has estimated that the state currently saves around $250,000/year by covering out-of-hospital births attended by midwives. That savings could be even greater if more women with healthy, uncomplicated pregnancies were encouraged to use birth centers or have home births.

Of course, if other states throughout the nation follow Washington's lead, both in equalizing the reimbursement rates for surgical & non-surgical births, as well as covering out-of-hospital, midwife attended births, the nation could be off to a great start toward truly cutting healthcare costs. However, it is yet to be seen whether this will have an effect on actually decreasing the number of c-sections performed.

Read more here:

• http://maa.dshs.wa.gov/News/fact/FS009-007Hospitalpurchasing-rates-C-sections4-8-09.pdf
• http://www.doh.wa.gov/ehsphl/chs/chs-data/public/CSectionsInWA.pdf
• http://crosscut.com/2009/08/06/health-medicine/19144/

world breastfeeding week day 7

Research reports that breastfeeding decreases obesity rates. The more a babies diet includes breastmilk and the longer a baby is breastfeed or taking breastmilk, the greater the benefit.

Excerpt from the CDC publication Does Breastfeeding Reduce the Risk of Pediatric Overweight?

"Does the duration of breastfeeding influence its association with pediatric overweight?

The duration of breastfeeding is inversely related to pediatric overweight. In Harder et al., the greater the duration of breastfeeding, the lower the odds of overweight. For each month of breastfeeding up to age 9 months, the odds of overweight decreased by 4%. This decline resulted in more than a 30% decrease in the odds of overweight for a child breastfed for 9 months when the comparison was with a child never breastfed.

Does exclusive breastfeeding have a strongerassociation with pediatric overweight thancombined breastfeeding and formula feeding?

Exclusive breastfeeding indeed appears to have a stronger protective effect than breastfeeding combined with formula feeding, but more research is needed. In Owen et al., the four studies that included exclusive breastfeeding groups showed a stronger protective effect compared to all their other studies combined (OR=0.76, 95% CI=0.70, 0.83). In the Harder et al. review, the two studies that documented exclusive breastfeeding also showed a stronger protective effect, decreasing the odds of overweight by 6% for each month of exclusive breastfeeding."

http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/breastfeeding_r2p.pdf

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As published in Pediatrics Feb. 2002 by Bulkow LR et al. the risk of hospitalization due to the common viral infection called Respiratory Syncytial Virus (RSV) is decreased in the breastfeed baby population.

Excerpt:

PEDIATRICS Vol. 109 No. 2 February 2002, pp. 210-216

Risk Factors for Severe Respiratory Syncytial Virus Infection Among Alaska Native Children

Lisa R. Bulkow, MS^*, Rosalyn J. Singleton, MD^*,,Ruth A. Karron, MD and Lee H. Harrison, MD^|| the Alaska RSV Study Group

"Results. Breastfeeding was associated with a lower risk of RSV hospitalization (odds ratio: 0.34), whereas underlying medical conditions (primarily prematurity) were associated with increased risk (odds ratio: 6.25). Environmental factors associated with a higher risk of hospitalization included household crowding (4 or more children in the household and crowding index greater than/equal to 2). The level of maternal RSV-neutralizing antibody was not associated with the risk of hospitalization.

Conclusions. In this region with extremely high risk of RSV hospitalization, several measures, such as encouraging breastfeeding and reducing household crowding, could reduce the risk of hospitalization attributable to RSV."

http://pediatrics.aappublications.org/cgi/content/abstract/109/2/210?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=breastfeeding&searchid=1&FIRSTINDEX=0&volume=109&issue=2&resourcetype=HWCIT

world breastfeeding week day 5

Breastfeeding decreases the risk for many chronic diseases.

Exclusive breastfeeding for at least 4 months decreases the risk of:

• diabetes in families with a history of diabetes
• asthma
• eczema
• bowel diseases such as Crohn's disease and ulcerative colitis
• Hodgkin's disease and other leukemias

world breastfeeding week day 4

Breastfeeding significantly reduces the risk of developing an ear infection or diarrhea.

• the risk of developing an ear infection increases in direct correlation with the amount of formula an infant receives.
• When compared with exclusively breastfed infants, those who are exclusively formula-fed have a 70% increased risk of developing middle ear infection.

According to an article published in Pediatrics June 1997 by Scariati PD et al:

Excerpt:

PEDIATRICS Vol. 99 No. 6 June 1997, p. e5
Copyright ©1997 by the American Academy of Pediatrics

ELECTRONIC ARTICLE:
A Longitudinal Analysis of Infant Morbidity and the Extent of Breastfeeding in the United States

Received Sept 5, 1996; accepted Dec 23, 1996.

Paula D. Scariati^*, Laurence M. Grummer-Strawn,and Sara Beck Fein^§

"Results. The risk of developing either diarrhea or ear infection increased as the amount of breast milk an infant received decreased. In the full models, the risk for diarrhea remained significant only in infants who received no breast milk compared with those who received only breast milk (odds ratio = 1.8); the risk for ear infection remained significant in the low mixed feeding group (odds ratio = 1.6) and among infants receiving no breast milk compared with those who received only breast milk (odds ratio = 1.7).

Conclusions. Breastfeeding protects US infants against the development of diarrhea and ear infection. Breastfeeding does not have to be exclusive to confer this benefit. In fact, protection is afforded in a dose-response manner. The more breast milk an infant receives in the first 6 months of life, the less likely that he or she will develop diarrhea or ear infection. longitudinal analysis, diarrhea, ear infection, breastfeeding."

http://pediatrics.aappublications.org/cgi/content/abstract/99/6/e5