And some are very, very bad.

One Fish, Two Fish, Red Fish, Blue Fish...

"Who is the bad fish in this picture?"

...I asked my husband, with a pit in my stomach, as I read to our 13-month old son.

He raised an eyebrow and said, "Uh, the red one, obviously."

I always thought it was the yellow one.

My whole childhood, in the thousands of times I've read Dr. Suess's wonderful book "One Fish Two Fish", I thought the bad fish on this page were the little yellow and blue fish.  The red fish, in my child's eyes, was their father.  The yellow fish was in trouble and had been "very very bad."  The little blue fish was smug because he'd gotten away with it and his sibling was taking the blame. The red father fish was spanking the little yellow fish.

I saw this page last night through adult eyes and decided, beyond any shadow of a doubt, that our home will never be a spanking home.

I was not raised in an abusive house, by any definition.  My parents are wonderful, kind, and supportive people who I am honored to have in my life.  As I have said before, they made the best decisions they could with the information they had, and always did what they believed to be right.  So, in keeping with the times, our home was a spanking home.  We weren't spanked for minor infractions; it was rare and reserved for only the worst offenses - things that could cause us real harm, like playing with fire or messing with dangerous tools, running away from our parents in an amusement park, darting out into traffic.  Offenses that, by conventional logic, were "deserving" of a spanking. We were only spanked if we were "very, very bad."

Spankings were never doled out in anger; they were measured, explained, and followed up by a hug.  Once the spanking was over, it was over and the world continued to turn.   My parents never left marks or bruises, and, presumably, the harm of the spank was less than the potential harm of the offense.  A spank certainly hurt less than an abduction or 3rd degree burn could have.

Spanking has an interesting history in the United States, but not as far back as you'd think.  While there are ancient historical examples of young adults being physically punished by their parents, the concept of disciplining small children "by the rod" is a relatively recent phenomenon.  Ancient Jewish law in particular is very clear in its opposition to causing harm to children.  The New Testament is even more definitive. Throughout history, spanking has been reserved for adults only, as a method for removing sin and allowing penance.

Spanking as a form of discipline for little ones seems to have come into fashion during the Victorian era (1837-1901), first in Europe and spreading to the USA, along with the notion that children should seen and not heard.  It began first with spanking young men and women to punish for sexual deviance (aka, masturbation), and slowly moved backward in age.  Spanking on the rear end was preferred because it could not accidentally cause harm to the internal organs, and on the naked bum because it would help the child associate pain with sexuality (sound familiar, intactivists?).

Books were published about the right way to spank, and the oft-used and always misinterpreted bible verse "Spare the rod and spoil the child" was used to support spanking small children for any offense.  This verse has many, many different translations depending on the version of the Bible.  While revisiting the earliest versions, the word discipline is a more accurate translation, and the rod is more like "Thy rod and thy staff, they comfort me" than "thy rod beats me when I mess up."

Notice that He is not swinging the rod at the wayward sheep....
The rod is hooked so the Shepherd can gently pull his flock into safety.

Spanking is seeing a gradual decline in popularity, but a majority of Americans still believe it is an appropriate and effective form of discipline.  In a 2000 poll, 61% of parents believed that regular spanking is acceptable, even beneficial to children.  An astonishing 37% believed that spanking a child younger than 2 is acceptable.  Not surprisingly, 56% thought that a 6-month old baby can be "spoiled" by too much attention.  More than 90% of parents report that they have spanked their children.

Frankly, these parents either haven't kept up with research or are ignoring it.  The American Academy of Pediatrics not only states that spanking can cause damage, they further illustrate that it doesn't work, long-term.  They are especially vocal about spanking children under 18 months of age, citing an increased of physical injury.  Children who are spanked occasionally as small children need to be spanked more and more often to "behave" as they age, and parents are left with very few disciplinary options with teens,

Another recent study by Pediatrics reported that children spanked at a young age were much more likely to be aggressive in the years following: ""The odds of a child being more aggressive at age 5 increased by 50% if he had been spanked more than twice in the month before the study began." 

Additional research has shown that children who are spanked are more likely to have social and emotional problems, are more likely to commit violent crimes, and are more likely to be involved in abusive relationships as adults.

For an in-depth review of corporal punishment studies, click here

Spanking emotionally harms the child and the parent, and can damage an otherwise trusting relationship.  Children who are spanked are less likely to confide their troubles to a parent, for fear of reprisal.  Instead, spanked children learn to be better liars to avoid consequence.  They learn to avoid being caught, not to make good choices.

9 Alternatives to Spanking

So, here is my question for you.... which fish is the bad fish?  Which fish will you be? 

More importantly, when your child reads the book, which fish will they think is "very, very bad"?

For more information about preventing child abuse, visit www.preventchildabuse.org.
To learn more about positive (non-hitting) discipline techniques, click here.

"Essential" baby stuff that might not be!

Despite recent media reports, kids don't actually have to be very expensive at all.

This particular article isn't advice - truth be told, we have a ton of baby stuff, most of the baby stuff on this list.  What can I say, I like to shop! However, I've discovered that a lot of the stuff we bought, we didn't use...and some families don't use any of it.  Basic things, that "everyone" told you was necessary to have before you have a baby - well, turns out, you might not need it after all.  If you *want* it, or it makes you and your baby happy, awesome.  Enjoy! You're not a bad parent if you have and adore any of these items.  Just don't feel like you have to rip out the credit cards and go bankrupt to prepare for your little bundle of joy. 

Stuff you can skip (if you want to)

#1 The Crib

Yep, that's right.  You can skip the crib.  Your kid probably won't want to sleep in it anyway.  Most babies would rather be curled up in your arms or on your chest.  Cribs are expensive!  You can skip the crib, mattress, mattress protector, sheets, mobile, crib toys, sound machine that attaches to the crib, bumpers (they're bad anyway), mesh fluffy stuff that goes over the crib - all of it.  $500+ saved!  

#2 Stroller
I dig my umbrella stroller, but use it mostly to carry groceries.  We bought one of those ginormous mega-strollers, and it's hanging in my mom's basement.  Just like the crib, my baby vastly prefers to be carried (and you can make your own baby carrier for about $5).  There's no law that says you have to have a stroller. 

#3 Bottles
Well, if you're me, you might need these.  If you work and pump, you're going to need them.  BUT, Boobs are cool and require no sterilization.  Even if baby isn't drinking directly from the tap, they can actually drink out of a cup.  Yep, a cup.

#4 Diapers
This one sort of blew my mind.  There's this super-cool movement a-foot called "Elimination Communication".  If you pay close enough attention to your little one's cues, you start to find patterns to their pooping and peeing...and you can hold them over the toilet.  For realz!  There are babies who have never worn a diaper in their lives.  Additional plus side... no toilet training!  Wipes... you will still need.  :)
http://www.diaperfreebaby.org/

#5 Baby Food

Again, cool but very basic idea.  Babies are people, and they can eat people food.  You don't need to give a baby purees.  When your little ones starts reaching for the food on your plate, just let him have some. My little guy has a deep appreciation for steamed broccoli, pasta, and blackberries. Bibs strongly recommended.
http://www.babyledweaning.com/

#6 Baby Bath Tub
When they're teensy, a sponge and the sink works perfectly.  After their umbilical stump falls off, you may discover the wonder of co-bathing.  Mommy + Fussy Baby In Tub = Happiness.  You figure out how to handle a slippery baby very quickly.  Wrapsody sells a water wrap that works for co-showering too, plus instructions.   Another note... you totally don't need the adorable baby hoodie towels; regular towels work just fine.  I have to say though...nothing's cuter than a baby in a hoodie towel.

 

#7 Swing, Bouncer, Vibrating Chair etc.
Now, I'm not going to say these aren't nice to have.  For some babies and parents, they might be a necessity.  BUT, from my observation, kids only like one of them and dislike the others.  You should go for some trial-and-error here.  Some kids don't like any of them.  None of them are "must have or CPS will be called."







Stuff you might consider spending real money on:

#1 A high-end convertible carseat.
Infant "bucket" seats have the bonus of keeping a sleeping baby asleep, but they will be outgrown quickly.  A convertible carseat can serve you from the first car ride through kindergarten.  Get one that rear-faces to the highest possible weight (Radian sells one that rear-faces to 45 pounds).   If you spend the money now on a good one, you won't have to replace it later.
Why you should rear-face as long as possible

#2 A King-Sized Bed
No, you don't "need" this, especially if you're a single parent or a set of smaller parents.  BUT, if you or your significant other are a substantial person (in my case, both), this will improve your life.  You can get a cheap one from Ikea for less than you could spend on the crib.  AND, you'll be using it long after your child has graduated to their own bed.  For extra safety, consider a bed that is low to the floor, or even on it!

#3 A nice baby carrier
Yes, you can make a stretchy wrap for $5.  I recommend doing so!  But for long-term use, a nice soft-structured carrier (Ergo Sport is my fav), a beautiful woven wrap (Girasol = Love), or a Mei Tai (ala Babyhawk)...or all three....will be worth it for you.  Especially if you skipped the stroller and the swing!  Like the carseat, a nice baby carrier will last you well into toddlerhood.

To learn more about baby wearing options, check out www.thebabywearer.com

 #4  A nursing pillow
This isn't a huge investment, but it's worth every penny.  A nursing pillow prevents stiff necks and arms that fall asleep while baby is at the boob.  You can use it as a floor pillow later on (for those moments when you definitely do need to put the baby down!), for "tummy time", or even for a nice neck pillow while pregnant.  I love my Boppy and have used it often, despite having to stop breastfeeding.

#5 A rocker-recliner
If you have a gorgeous wooden rocking chair from your grandmother in the baby's room, stick with it.  If you were debating on purchasing one of those expensive gliders from Babies R Us, consider this.  Get a rocker-recliner, ala La-Z-Boy.  Bob's has them for $299, or drop by your local Salvation Army.  Comfy factor cannot be beat.  You are going to spend a lot of time in this chair - and no fingers will be pinched!  .  Move it into the "man room" when baby's grown, or they can take it to college.


That's what I can think of for now... I'll add on more to either list if more come to mind - or if YOU add them in the comments!  Do you agree/disagree?  Are there more items that need to be in the "must-have" department?

Human Milk for Human Babies

"Breast milk is not a scarce commodity, it's a free-flowing resource."
Emma Kwasnica

I've recently become involved with an amazing group, Human Milk for Human Babies, formerly known as Eats on Feets Global.  This is one of the most amazing movements, and I am incredibly honored to be a part of it.

There are mommies like me who can't breastfeed their babies, or mommies who breastfeed but don't make enough milk.  When I was hospitalized, my breastfed baby needed food.  Formula is food, but not the food I would have chosen for him - breast milk is a superior food, made for baby humans.  Cow's milk is made for baby cows, and doesn't offer the same benefits, especially in a baby's GI track - which is of particular concern to me, since IBD can be hereditary.  I reached out to my local milk bank - but I found out that not only is the milk $4 per ounce ($120 a day!!), we couldn't have it, even if we wanted it.  My baby was healthy and full-term.  So, David got formula - and I'm glad it was there.  It was not an easy transition - his tummy was upset, and he really hated the taste.  But, food is food, and he eventually adjusted.  He's done well on formula - he's healthy, strong, and smart.  As my readers know, I don't have anything against people who choose formula as their baby's food.

If I'd had a choice at the time, though, I wouldn't have chosen to feed my son formula.

I learned about Eats on Feets through you, the readers of this blog.  I became friends with Emma Kwasnica, the group's founder on Facebook, and I was blown away by her passion and dedication.  At one point, she posted an amazing photo - a friend of hers was suddenly hospitalized, and she nursed her friend's baby while she was incapacitated.  The picture brought me to tears.  One image encapsulated the philosophy of milk sharing - that in an emergency, women could rely on each other.

Emma nursing a hospitalized friend's baby.  Don't like to see boobs?  Read this.

This is the heart of milk sharing and milk donation - that in an emergency situation, mothers who want their babies to be exclusively breastfed have that option, even if real life circumstances don't allow for it.  If a mother wants to use formula, fine by me - but if she doesn't, there should be a way for her to find an Emma!

Eats on Feets has become "Human Milk for Human Babies", a name that better describes its mission and can be translated across the globe (there's even a chapter in Kuwait!).   Mothers like me can meet local mothers like Emma, who have a surplus of milk to provide.  Not necessarily boob-to-mouth; most donation happens with the help of a pump and a freezer.  Some mamas overproduce, and they have mountains of bags of milk stored, more than their baby can consume before it expires.  Thanks to HM4HB and other milk-sharing connections, that milk can find its way to a local baby in need.

One of the coolest things about this is that HM4HB is not just getting babies milk, it's helping women connect and become friends.  While you can use milk sharing networks to just get milk and move on, I'm amazed at the real life connections that are happening.  Donor and recipient mommies are getting to know each other, having coffee, setting up playdates, visiting each other's homes.  There is a community growing as a result of the sharing.  Unlike donating to a milk bank, donor mommies can often hold the babies their milk is feeding, watch them grow and thrive on the precious gift of liquid gold.  In a world where technology so often distances, this is creating a village where none existed.

Are there risks to milk sharing?  Yes, of course.  There are risks to everything in life.  There are risks to formula-feeding (I fed my kid bugs, thank you Similac).  HM4HB isn't promising a risk-free solution, just a forum in which parents can have a choice - an informed choice.   Previously, the only choice moms like me could make was which brand of formula to buy.  Now, we can choose if we want to go check things out on the donation road.

As a recipient, ultimately, you trust that the woman who is donating is healthy and living a healthy life.  If she's breastfeeding her own child, you simply trust that she cares about her own baby enough to avoid things that could make her milk dangerous.  You can pasteurize the milk at home (instructions here), and many recipients ask for copies of their donor's prenatal medical records or request additional screening for safety.

Check it out!  If you have milk to donate, wouldn't it be nice to know exactly where that milk is going?  If you really hate feeding your baby formula, why not explore donated breast milk as an option?

Human Milk for Human Babies - Website
Find your local chapter here
Frequently Asked Questions

Vaccines and Decisions

I have never been so torn on an issue, perhaps in my life, as I am on the subject of vaccines.  Right now, I have the luxury of indecision.  Because of one of my meds (the immune suppressant), my doctors have decided it's best for my son to be unvaccinated for the time being, and I have the medical seal of approval to postpone the decision of vaccination.  My son did get DTaP before I went on these meds, and technically he could have inactivated vaccines, but we're holding off until I'm 100% sure.  You can't "un-vaccinate"; once it's done, it's done.

For those who do not vaccinate, a medical exemption is the holy grail of paperwork.  For those who believe in the importance of complete vaccination, my situation is a terrifying limbo of irresponsibility.  I see both sides of the issue, and I'm stuck.

Most parenting issues have become clear to me with research.  Breastfeeding, circumcision, spanking, co-sleeping, babywearing.  They're pretty clear-cut, and most research sits on one side or the other.  Vaccinations... eek.  Not so clear.  I have done hundreds of hours of research on vaccines, and I'm still incredibly torn.

Borrowed from Peaceful Parenting, in case you want to say "I'm vaccinated and I'm fine"
Our children are being vaccinated against many more things than we were.

I have reached 2 conclusions, both of which are controversial.  Isn't this whole topic?

1 - Vaccines are not useless.  They do work.  Maybe not as well as advertised, but they have value.  The rabies vaccine prevents the spread of rabies among dogs.  The influenza vaccine does actually reduce the incidence of flu it purports to prevent.  Since the widespread vaccination of the American public, the diseases for which we vaccinate have decreased precipitously.  I am still immune to measles, mumps and rubella, 25 years after my last booster, diseases I did not have naturally.  Vaccines generally do protect against the diseases they claim to, a majority of the time.

2 - Vaccines are not 100% safe.  They have risk.  Vaccine-related injury is real, adverse reactions are real, and to the rare number who experience them, the injury is often worse than the disease the vaccine is intended to prevent.  It is possible that vaccines damage the overall health of a person's immune system.  Unvaccinated children are, overall, healthier than their vaccinated counterparts, experiencing less chronic and acute illness during childhood and early adulthood (these studies are imperfect in design but still compelling).  Parents who consciously choose not to vaccinate are not morons; they are generally better informed and educated about the issue than those who vaccinate. 

Ethically, I am opposed to the concept of forcing a child to endure pain and sickness, against their will, to prevent potential future harm.   The child is not in immediate medical need or danger, like a child who needs stitches. I am opposed to sacrificing one child for the benefit of many; the herd immunity argument doesn't sway me.  One child should not die so that millions can live; that argument holds no water to the mother of the dead child, nor should it.  I believe in the inherent ability of the natural immune system to handle routine illness, and I believe that a bored immune system is a dangerous thing to have, increasing risks of allergies and auto-immune responses. 

Logically, I am opposed to the reintroduction of measles and polio into the general population, and I do believe that vaccines have something to do with the decrease of diseases (but not all - Polio in particular has a really interesting link to pesticides).  I don't want to see a Rubella outbreak.  I have heard the cries of a baby with pertussis, and they are heartbreaking.  If my son were to experience harm as a result of a vaccine-preventable illness, or worse, were to pass that illness on to another child, I would be devastated.

Emotionally, vaccinating feels wrong - no mother "looks forward" to a visit for shots.  On every other parenting decision, I have trusted my "gut" or "mommy instinct" and it's always been right.  Here, in this one circumstance and no other, I am expected to restrain my baby, cause him pain and potentially cause him harm, to avoid the potential of harm.  This isn't about fighting a diaper change or being annoyed about being in a carseat; the pain is real, the immediate harm is real (even if it's only a mild fever and a sore leg).  If you physically restrain an adult against his will and stab him with a pen or a thumbtack, it is called assault.  I spent a lifetime terrified of doctors and needles.  Babies today are mandated to have triple the number of vaccines that I had; every child I know is petrified of going to the doctor; their parents have to lie to them and bribe them to get them in the door. 

Intellectually, I realize that people used to die of vaccine-preventable diseases in great number, and that my ancestors would likely think I'm crazy for even debating this topic.  Vaccines are considered among the world's greatest medical discoveries, one of the greatest discoveries of human history, by minds greater than mine.  My pediatrician is in favor of most (but not all) vaccines; I respect her opinion as a medical professional.  I respect her years of experience and expertise.  I also know that the entire American pediatric business model revolves around vaccines, and without a visit every 2-6 months for a shot, pediatricians offices would be a lot emptier than they are now.  Money talks.  Vaccines make literally billions of dollars a year for doctors and pharmaceutical companies, both via direct and indirect sources.

Polio kills.  Mumps is bad.  Tetanus, Diphtheria, Hepatitis, pertussis, HiB, meningitis, all of them - this is bad stuff, and I don't want my baby to get any of them, if I can help it.  Hell, my double exposure of chickenpox (at 13 and 32, thanks immune suppressants) was miserable enough that I'd happily have taken a shot in the arm instead of 6 cumulative weeks of misery!  Regardless, I am too informed to respond to the "less mercury than a can of tuna" line. 

I am asking for feedback tonight, on what ultimately made your decision, one way or the other.  I don't have to make a decision right now (in fact, I can't) but I could use some guidance. 

Why did you decide to vaccinate your child, or choose to skip or alter the standard schedule?

Avoid formula "like the plague"?

I don't know why I read everything that comes across my facebook feed, but I have a rather unquenchable thirst for knowledge....so I do.  Even stuff that I know is going to "get my goat", and boy did this one! 

100 Reasons to Avoid Formula like the Plague

First, it made me incredibly sad.  I had just finished giving David a bottle of formula; I don't have a donor right now for breast milk, and our family decided that we would only take breast milk donation from people we know well (which is 2 awesome ladies with small freezer stashes).  There is another local baby, newborn and sick, who needs the milk more than my healthy horse of a toddler. The last comment had me crying into my colt's feather-soft hair as he slept in my arms.

"When you don't breastfeed you increase many risks and the child will never know it's true potential."

I cursed my body.  I hated my body for its failure.  I cursed my own inability to stay healthy enough to continue breastfeeding my son.  I kissed his petal-soft skin and tears ran down my face as I considered the list and its comments.  What if it's true?  What if my baby boy will never reach his true potential because my body failed him?


Then, of course, my brain kicked in.


You see, what this list forgot (and the list is not necessarily accurate or 100% truthful, I'll address that later) is that a healthy mother, in both mind and body, trumps every single reason on that list.  I am not a formula pusher.  I am a lactivist, truly told.  I don't think breast is "best"; I think it's "normal."  That is a very, very important distinction.  If you can breastfeed, you should.   If you don't breastfeed because you want pretty boobs or you want to party or because it's simply "convenient", I don't have a lot of respect for your choice.  Sorry.  Doesn't mean I don't respect you, or that you're a bad mother, it means we disagree.


Cesarean section is not "normal".  Vaginal birth is.  Does that mean vaginal is best in every situation?  No.  Everything is relative.  Guggie Daly, bless her amazing and insightful heart, wrote a wonderful piece recently about the need to end the Breast is Best campaign.  I agree with her for all the reasons she mentioned, plus one.  


I didn't take the medicine I needed after my son was born because of lists like The Plague.  I almost DIED.  I needed 2 blood transfusions.  I almost had my large intestine cut out of my body.  My large intestine is still bleeding, a year later, because I actually did avoid formula like the plague.  Smart?  No!  Stupid!  A miserable, sick, barely human breastfeeding mother is not ideal.  Dead mommies don't make milk, duh. 

I am not the only one.  I know 3 other mothers who also avoided medicine that was incompatible with breastfeeding, and who suffered serious health consequences as a result.  One was suffering from PPD, and it got so bad that she attempted suicide and had to be committed.  The low-level antidepressants she was taking weren't working, and the next level meant she couldn't breastfeed.   She avoided formula "like the plague", and slit her wrists.   I'm not making this up.


See, the funny thing is, when you've just had a baby, you just might not think straight, and lists like this haunt you.  I didn't.  Others didn't. 

I am an active member of many online mommy communities.  Lately, I have seen a number of mothers with supply problems, who are trying everything they can to raise their supplies, discuss giving their young babies cow's milk or soy milk, believing that it's healthier than formula.  There is a label now on the soy milk we purchased at Whole Foods - "not to be used as infant formula."  Why, do you think, does it need to be there?  It's not there for the mother who doesn't care what goes into her baby.  It's there so people know that other milks are NOT a viable alternative to breast milk or formula.   

Formula, while deeply flawed, inferior and imperfect, is better than giving a 3 month old baby cow's milk, which is made for baby cows, not baby humans.  Soy milk in particular is exceptionally dangerous for infants, lacking vital nutrients which are necessary to healthy development..


Don't avoid formula like the plague.  Don't avoid it like it's poison.   It is neither plague nor poison.  Avoid it if you have a breast milk alternative, be it pumped or from the breast.  Avoid it as a sub-normal, vastly inferior alternative and don't kid yourself that it's "just as good" as breast milk, because it's not.  It's not close to breast milk, no matter what the formula ads tell you.  But don't avoid it to the detriment of your own health, mental or physical.  Babies need a healthy mother more than than they need her breasts. 

[Related: this whole conversation goes away (or mostly goes away) if mothers who can breastfeed do, and if mothers who can donate do, and if mothers who can't have access to that donated breast milk.  Please support breast milk donation!  Check out Human Milk for Human Babies on Facebook!]

I was ____ and I'm fine!

One of the things I admire most about my mother is her ability to be painfully, boldly honest with herself about her own actions and mistakes.  It takes a deep level of courage, humility and flexibility to review your life's decisions, and not only admit to the mistakes that caused harm, but those that might have.  We were discussing parenting - her parenting of us, my parenting of my son, and how wanting to do things differently or even better doesn't make anyone who didn't follow those paths wrong.

Me and My Daddy, 1978

When I was a baby, my parents would visit their best friends on Fridays and play cards until late in the night.  I would fall asleep, and rather than wake me up by putting me in my carseat (what passed for a carseat in the mid-70s anyway), my mother would hold me in her arms in the front seat of the car for the 5 mile drive home.

I'm fine. 

My mother wanted to breastfeed me, but her doctor told me that I wasn't getting enough milk.  She switched to formula when I was 2 weeks old.  She always regretted the decision, but she didn't feel confident enough to argue with her doctor.

I'm fine.

 My parents were raised "by the rod" and followed suit with us, until I was about 10 and my mom's research led them in a different direction for discipline.  As a result, I was spanked more times than I can count, and the wooden spoon in the drawer doesn't remind me of baked goods.

I'm fine.

I wasn't a great sleeper as a baby, and my parents were told by their parents and doctors that the only way I'd ever sleep was if they left me to cry it out, which they did for a week straight.  It was such a miserable experience that they didn't repeat it with my brothers.

I'm fine.

My parents smoked until I was 8.  In the house.  Mom didn't smoke while she was pregnant, but a lot of her friends did.  I was around cigarette smoke constantly; I loved when my father would let me light his cigarette for him with his shiny Zippo.  My grandparents, aunts and uncles all smoked.


I'm fine.

1980's fashions never go out of style.

 Well, am I "fine"?  I'm a responsible citizen, a good parent, a kind person.  I pay my taxes, don't commit crimes, and try to be a respectable human being.  I have a high IQ, make over 100K a year, and sing professionally in my spare time.  I also have an auto-immune disease, occasional anxiety issues, and insomnia.  Are these a result of being formula-fed, crying it out, being physically punished and exposed to second-hand smoke?  Maybe, probably not - who can say for sure?  What if my parents had gotten in a car accident while I was in my mom's lap?

None of the examples above make my parents bad parents.  Quite the opposite - my parents are loving, caring and wonderful people who did the very best they could with the information they had at hand.  I have a close relationship with them; I am honored and lucky to have them.  If I could have chosen my own parents, I would not have chosen differently.  They are remarkable parents, and their willingness to admit to mistakes is one of the things that makes them so incredible.

The whole gang, Summer 2010

It bothers me when I hear people say, "I was _____ and I'm fine" as an excuse not try to for better with their kids.  When you know better, you do better.  Before you say, "I'm circumcised and I'm fine" or "I had peanut butter when I was 2 months old and I'm fine" or "My mom left me in the car while she went into the store and I'm fine", consider what might have happened.

I'm not a perfect parent.  I'll never be perfect.  There are already things I plan to do differently if I am blessed with another child (home birth and breastfeeding, to start the list!)

I can try to be the very best parent I can be, using as much evidence as I can to make parenting decisions, unhindered by the successes of the past.  Despite my un-carseated history, I made it to adulthood....but you'd better bet my little guy is staying in his (rear-facing) carseat!

Bedsharing Lessons from Twizzler

Everyone, meet Twizzler.

Twizzler, 6 weeks - goopy eyes and all.

 Twizzler's mother died in an alleyway soon after he was born.  Luckily, a kind soul found him and his siblings and brought them to the local shelter.  He was bottle-fed, and managed to survive, even thought 2 of his brothers didn't.  I got a call from a friend at the shelter when they died; she suspected that little Twiz wasn't getting all the love he needed to thrive and asked me if I could bring him home.

Twizzler was super-tiny, his eyes didn't open all the way, and he was weak.  I had to feed him with milk from a dropper.  He was helpless and fragile. When night-time approached, I made up a nice bed for him in the bathroom, right near his litter box.  I set him down in it, and he started to cry - tiny little sounds, calling for my help.  Calling to not be left alone in the dark, like he'd spent so many nights, alone in his cage.

I brought my tiny kitty to bed.  He snuggled up under my chin, purring away.  He actually tried to nurse on my blanket and even on my freckle (I've since learned that this is called "woolsucking" and often happens to kittens who are weaned too early).  I held him close and settled down to sleep.

I woke up the next morning to an energetic kitten who seemed to have blossomed overnight. Over the next few days and weeks, Twizzler slowly became stronger.  He was soon able to eat on his own, and could hop on and off my bed.  He moved from my neck to the foot of my bed, and in time, learned to sleep in the living room.

He's now a big, happy, healthy cat - and he doesn't suck on the blankets anymore.  He's independent, kind-hearted, and very friendly.

Mommy, Twizzler, and 1 week old David, napping

 When David #9 made his entrance, I couldn't help but be reminded of my helpless kitty.  Just like his feline companion, my little boy was fragile and depended on me for everything.  And, just like my kitty, we had made a beautiful nursery for him....that he wanted nothing to do with!  The first night he was home, I gently laid him on his back in his crib, and he immediately started to cry. 

But...babies are supposed to sleep in cribs, right?

So, I brought him into our room, and laid him in the pack-and-play next to our bed.  No dice.  My baby didn't just want to sleep *near* me, he wanted to sleep *on* me.  In my arms.  For the first 5 weeks of my son's life, my husband and I slept in shifts.  One of us would stay up holding the baby, and the other would sleep in the bed.  I missed my husband, and he missed me.  We were both sleep-deprived and I was getting sick.

As my regular readers have heard a few times, I landed in the hospital when my son was about 5 weeks old, for a little over a week.  So, here Dave was, with a newborn (breastfed) baby that he not only had to immediately transition to formula, but who refused to sleep on his own!  After one night of trying to stay up in the recliner, they fell asleep the next night, together, in our king-sized, firm mattress, with the blankets down by Dave's waist.

My son slept for 6 hours, the longest he'd ever slept.

When Dave told me about it, I was upset.  I'd read all of the warnings about SIDS and how horrific it was to sleep with your baby.  He was ready for me!  He presented me with research, printed (love that man) about the benefits of co-sleeping and how to bedshare safely.  I was still skeptical.  Babies are supposed to sleep in cribs!

When I got home, David started to sleep in his crib for the first part of the night, and would bedshare with us if he woke up.  Unless his Daddy put him to bed... in our bed.  I was still unsure.  

A couple of weeks later, when he hit teething for the first time, Dave looked at me and said:

"Honey... You'll let the cat sleep with us, but not the baby?"

DING!

Well, duh.   How silly of me.  Just like my helpless little kitty, of course my baby wanted to be close to us.  And, just like my kitty, I was happy to have him in bed with us.  I love waking up to his sunny smiles in the morning; I loved not having to schlep out of bed to get him.  

Nowadays, David sleeps with us most of the time.  He starts the night in his crib sometimes, when (ahem) Mommy and Daddy feel like having the bed to ourselves (if the couch won't do).  We practice safe bedsharing, and I wouldn't have it any other way.  

He belongs with us.  It just feels right.  We got him a tee-shirt for Christmas that says this:

And now, I really feel that way.  I don't "let" David sleep with us.  We are privileged to have him to snuggle with.  Twizzler thinks so too; he's usually curled up by my feet.  I know that's not on the safe bedsharing list, but I think he's earned it.

Moms with IBD: All About The Meds

This isn't as universal a post as my other stuff, but hopefully it will be helpful to those who find it relevant.  This is directed at mothers or would-be mothers with Ulcerative Colitis or Crohn's Disease.


When I was pregnant with my son, I didn't realize how much my (then latent) Ulcerative Colitis would affect my pregnancy, delivery, and recovery.  The information online is patchy at best, and every doctor seems to have differing opinions on how to treat UC or Crohn's in pregnant and breastfeeding patients, or in those who are trying to conceive.  It was difficult to put everything together, and there is a lot of bad information out there.  I was going to put this all in one post, but it's too much.  This post is about medication.  See Part 2 about additional concerns during pregnancy and breastfeeding.

I'm not a doctor.  This is the internet.  Don't be stupid.  Talk to your doctor about the best courses of treatment for your disease, and work with your doctor to assess the risks and benefits of any treatment.

Q: "Should I take medicine for my IBD while pregnant/breastfeeding?"


A: Work with your doctor(s).  Flaring while pregnant or lactating isn't good.  If you're pregnant, being malnourished can harm your baby.  If you're lactating, it can severely impact your supply and your ability to be a good mommy.  Don't neglect your own health because you're afraid of the medication.  Try non-medical stuff, but don't end up in the hospital (like I did) because you fear the necessary medications.

ALL ABOUT THE MEDS
I'll start here because it tends to be the thing weighing most on mommy minds.  Let's start with the safest ones, then go up from there.

Safe(r) for Pregnant and Lactating Women

Probiotics 
If you're not already taking these, I highly suggest that you start.  There have been numerous studies that show a strong positive relationship between IBD remission and the use of probiotics.  You can start simple - Kefir (sold at your local grocery store) has high levels of "good" bacteria.  Many folks make their own.

For supplements, the "top dog" is VSL#3, which is available online.  Alternatively, you can try Acidopholus, available at your local pharmacy or health food store.  Get the highest count you can, and keep the pills refrigerated for longest life and potency.  There are no known negative side effects to probiotics; even if they don't work for you, there is no risk in trying.

Vitamin D
I have done a good amount of research, and found that vitamin D deficiency can also contribute to possible flares.  I take 1000-2000IU of additional vitamin D in the summer and 3000-4000IU in the winter.  If you spend a lot of time in the sun, or eat a good amount of foods containing soluble vitamin D, you may need less.

Fish Oil/Omega3
Be careful to look for oils that are mercury-free.  Omega-3 fatty acids can really help your digestive system stay in balance.   If you're not flaring, you can get this from fish and some meats, but if you're flaring or pregnant some of these may be off limits.  Fish Oils also provide DHA and EPA, which reduce inflammation and are also good for the baby's development.

Folic Acid
You may not be able to take a "regular" prenatal vitamin (see below), but folic acid is of vital importance to your baby's health.  Ideally, you should start taking it before you are pregnant.

Vitamin C
Always a good choice.  Again, there have been studies that suggest improvement in IBD with increased vitamin C, and it's also good for the baby (some studies have even shown a link between increased vitamin C and lower SIDS risks).  It supports natural tissue growth and healing - you need healthy tissue and healing, right?

Potassium
If you get cramps (muscle, stomach, whatever), potassium can really help.  Flaring IBD can inhibit your body's natural processing of potassium, so you should pay special attention to this if you have diarrhea or vomiting as a regular symptom.  You can either take a supplement (I did), drink potassium-rich drinks (I kept a bottle of Gatorade in the bathroom; every time I ended up in there, I'd drink it), or eat potassium-rich foods like bananas, avocados, and potatoes.

Prenatal Vitamins - proceed with caution.
Many women with IBD are sensitive to the increased Iron in prenatal vitamins.   You may want to consider an iron-free multivitamin or a combination of other vitamins rather than standard prenatals.  There's a lot of (usually good) stuff packed into a prenatal.  I personally found it better to take everything seperately than in one package.  Less convenient, certainly, but easier on my system.  I find that I am very sensitive to all of the metals (zinc, copper, sometimes magnesium).

Dietary Stuff
This could be really long, but I'll keep it short.  Most doctors say diet doesn't have much to do with IBD.  Pretty much every patient I know wildly disagrees with their doctor on this matter.  Frankly, I think it's ridiculous to ignore diet as a part of treatment!  Personally, I'm very sensitive to sugar and white carbs, popcorn, nuts, and any oil but olive oil or butter.  Other people have other things.  One neat trick - right before you eat something, take your pulse.  20 minutes after eating (and relaxing), take your pulse again.  If it's much higher, you may be sensitive to that food.  Also notice if you feel flushed or anxious; these can also point to sensitivity.  Eliminate or limit the "bad" foods and you'll feel better.

PRESCRIPTION MEDS - LOW(ER) RISK
Many medications for UC and Crohn's are relatively safe during pregnancy (Category B-C).  

Lower risk doesn't mean no risk. But, flaring during pregnancy is certainly something you want to avoid.  You need to work with your doctor to determine what level of risk is acceptable to keep you healthy without causing risk to your baby.  Healthy mommies make healthy babies. 


Mesalamine - Pregnancy Category B
Rowasa, Asacol, Lialda, Pentasa, Apriso, etc.
If you have UC and it affects only your lower colon, the least dangerous (and often most effective) of these are suppositories and enemas.  Ick, yeah, but because they are applied directly to the site of inflammation, very little of the drug enters your bloodstream.   Lialda has the highest dosage of mesalamine per pill, at 1.2g per tablet.

Mesalamine is "bowel-specific", and even taken orally, only a small amount enters your bloodstream.  It does cross the placenta, but studies have not proven any evidence of harm to the baby (note: evidence of harm does NOT mean evidence of NO harm). There have been a few studies that showed a slight risk of cleft palates, but they were not statistically significant.

Mesalamine does pass into breast milk; there is potential that it may cause loose stools in your breastfed infant if they are sensitive to the drug, but most babies do not have a problem with this.   

If you are on Mesalamine as a maintenance drug, your doctor will likely suggest that you stay on it during your pregnancy and while breastfeeding.

Sulfasalazine (Azulfedine)- Pregnancy Category B
Similar to Mesalamine, this is considered another "ASA" med and has similar risks and benefits.  It is often used if you (or your baby) are sensitive to mesalamine.



PRESCRIPTION MEDS - MEDIUM RISK

Prednisone - Pregnancy Category B/C
This is a love it, hate it drug.  The side effects of prednisone are long, very real, and very serious - to you.  Being on prednisone sucks.  Flaring can suck more.  Long-term prednisone use causes adrenal dependency (it's hard to get off of) and even short-term, it causes insomnia, irritability, swelling, weight gain, headaches, and a slew of other annoying, destructive, and frustrating effects.  

That being said, it is probably the first thing your doctor will prescribe if you're suffering from an acute flare (bleeding a lot, really sick).  It works.  I sincerely hope you don't need this drug.  If you do, try to get off it as quickly, safely, and carefully as you can.  Prednisone should only be used in pregnancy if it is necessary, and if there is no safer alternative.  Flaring is not good for you, or your baby, either.  You need to carefully weigh the risks and benefits with your doctor before deciding if it is right for you.  The more you have to take, and the longer you take it, the greater the risks.  A 5mg dose is not the same as a 60mg dose.  Your doctor should prescribe the lowest dose that will control your flare.

There is an increased risk of cleft palates in babies whose moms took prednisone during the first trimester.  During the second and third trimester, there is an increased risk of low birth weight, and taking it in the third trimester has been linked to increased risk of preterm labor. Flaring IBD in the second and third trimester can also cause low birth weight and preterm labor - studies were not always able to determine if the cause was prednisone or IBD.

Prednisone can increase your risk of developing Gestational Diabetes.  If you are undergoing long-term prednisone treatment, your doctor or midwife will probably have you do the glucose challenge testing several times during your pregnancy.  Prednisone also decreases your ability to fight infection.

It is extraordinarily dangerous to stop prednisone abruptly.  If you are on it and want off, you need to work with your doctor to taper carefully.  Just stopping prednisone can cause adrenal failure and even death.

Prednisone has not actually been assigned a pregnancy category by the FDA.  Some brand names are B, others are C.

Other Corticosteroids (endocort, prednisolone, cortisone etc) all have similar side effects and risks to Prednisone, but they don't always work as well.  Some can be prescribed in enema form, which carries the lowest risk but also the lowest reward.

PRESCRIPTION MEDS: UNKNOWN RISK



Anti TNF Inhibitors: Remicade, Humira, Cimzia, Tysabri (aka Biologics)
These are scary drugs, big guns.  If you are on them, or your doctor suggests going on them, you need to do your research.  I am on Remicade, and it's right for me right now - but I'd be lying if I didn't say that it scares me to be on them.  Nothing else works for me; it's either Remicade or remove my colon.  Some people have chosen surgery over them.  With Crohn's, it may be biologics or the hospital.

Anti-TNF inhibitors (all varieties) suppress your immune system.  They all cross the placenta (when you're on them, so is your baby).  There have been very few studies on how they affect babies.  You will need to discuss this in depth with your doctor, ideally prior to becoming pregnant.  We're delaying our try for the next baby for a few years, until I can get off Remicade, or until better studies are available.

There may be increased risk of birth defects, an increased risk of miscarriage (maybe because IBD affects your body, who knows), but ultimately, not enough studies have been done to determine if they are safe or not.  I know a few people who have been on these during pregnancy and it worked out very well for them.  Here are some things to check out:

Remicade: http://www.otispregnancy.org/files/infliximab.pdf
Humira: http://www.otispregnancy.org/files/adalimumab.pdf

On the plus side, both Humira and Remicade seem to be safe for breastfeeding.  The molecules are huge and do not appear to transfer into breast milk.

EDIT: New research is ongoing, and it appears that Remicade is relatively safe during pregnancy.   I am trying to get copies of these studies, but I am told that the evidence is pretty clear, and that Remicade is being downgraded to category B.  The risks in smaller studies appear to be lower than the risks of corticosteriod treatment (aka prednisone).  It is important to note that no long-term studies have been done;  of Remicade has been linked to higher risks of certain cancers, and it is unknown if these long-term risks also pass to babies.

PRESCRIPTION MEDS: VERY HIGH RISK



Naltrexone - Category C/D (depends on brand).  Known to cause birth defects, smaller risk than the meds below.  May cause PPD and may disturb bonding with your baby.  Does pass into breast milk and may cause developmental delays, however, it may be possible to breastfeed on this drug.  More research needs to be done.  If Naltrexone is on your table of options, get to know Dr. Google.

Mercaptopurine (6MP) - Category D: It says right on the label that 6MP shouldn't be handled by women who might possibly be pregnant.  There may be extreme circumstances that warrant its use, but I would not personally take it while pregnant or breastfeeding in any circumstance.  It causes known fetal harm, including increased risk of miscarriage, birth defects and still birth.  It is also NOT safe for breastfeeding.  You will have to choose between breastfeeding and 6mp - I had to give up breastfeeding to stay healthy.

Azathioprene - Category D: Again, not safe for pregnancy or breastfeeding.  Causes known deformities and increases risk of fetal death.  Do not breastfeed if you are on this drug.

Methotrexate - Category X: REALLY bad.  MTX is used to treat ectopic pregnancy and causes early abortions.  This is the "abortion pill" used in clinics.  Do not take methotrexate while pregnant or breastfeeding under any circumstances.   If your doctor suggests it, find another doctor immediately.

Thalidomide - Category X.  Known to cause extreme birth defects.  Not safe for breastfeeding or pregnancy.  Also should not be used in the weeks prior to pregnancy, since it has a long life inside your body.  If your doc wants you on this while pregnant, seriously question their medical license.


OTHER MEDICATIONS

Metronidazole (Flagyl) - Category B, BUT.... the use of this drug in pregnancy is very controversial.  The FDA has given it category B, which is a "safe-ish"category.  There is evidence of toxicity in animals, but not in people. It definitely causes problems for baby mice, rabbits and rats, including cancer.  It has not been shown to do harm to humans, but there is real cause for concern, and a campaign to change the pregnancy category by some doctors and patients.  Breastfeeding is also not recommended on this drug - "pump and dump" for 24 hours after the last dose.

Ciproflaxin (Cipro) - Category C.  Oddly enough, the research on Cipro shows less evidence of harm than Flagyl, but it's got a higher catogory.  Who knows... anyway, breastfeeding is safe on Cipro.  There is a slightly higher risk of joint problems in babies whose moms took Cipro.

Sedation (for colonoscopies etc): Every doctor seems to use different drugs for sedation during procedures.  All of them have some risk for pregnant women.  Lactating women should pump and dump for 24 hours following sedation.   If you're going to undergo endoscopy or colonoscopy and want to be sedated (I'll write about that tomorrow), this is a good site to check out:
http://www.sedationfacts.org/sedation-complications/sedation-pregnancy

Pain Meds
Technically, the only "safe" pain medication during pregnancy and breastfeeding is tylenol.  Vicodin (hydrocodone) is sometimes prescribed if your pain gets out of control, but there are very real risks, including dependency and difficulty breathing in newborns, if taken close to delivery or for long periods of time. Other pain medications should be avoided.   When my pain got really hard to handle, my doctor suggested that I take Tylenol PM - the PM is Benadryl.  Really, look it up.  Sleeping through pain is better than being awake for it, if you're the sort of person that gets sleepy on Benadryl. 



Phew!  I think I covered most of the meds.  Feel free to comment or add your information!  I will happily edit any misinformation (again, NOT a doctor) and add anything you believe is relevant.
 CLICK HERE FOR PART 2