Rear-Facing Car Seat Safety - a video this time!

I know I said I was on holidays until mid-September but I couldn't help sharing this. I heard from a lot of parents after my post two weeks ago both in support of my opinions about keeping children rear-facing for as long as possible and against them. I want to remind all parents that your decisions and choices are yours alone and you are entitled to make them. It is my role, professionally speaking, to inform new, expectant and established parents of the various options available to them to make themselves and their babies as safe as possible.



It is babyREADY's position, and therefore my position as well, that we should keep our children rear-facing as long as it is safe to do so by the height and weight guidelines presented in the instruction manual of the car seat. If your child outgrows the rear-facing infant carrier (and most do in length by the time they are about 6 months old) then they need to move to a convertible infant/child seat and remain rear-facing.

What you do with the information I present here is entirely your choice. I would argue however, as this video does, that your child is better to be unhappy rear-facing but alive as opposed to happier and much less safe forward-facing. That is my opinion. That's all it is. Please understand that I won't condemn you for making different decisions then what I recommend here. You have to do what works for your family. Mine is not to make you feel guilty, it is simply to offer you food for thought.

Posted by Sam

Please Take Note

As I sit down to spend some time catching up on work that is WAY overdue to be completed I am compelled to address something that I hear in my classes from time to time. Last night we were talking about the products our parents used on our bodies/bums/hair/clothes, etc. when we were babies and how well each grandparent remembers clearly the recommended products of the day.

(Forgive me if I appear to be heading off in a tangent. Already this post is starting in a different direction than I had anticipated . . .)

How successful was the marketing of the day if our parents remember the kinds of products doctors and advertisers promoted some 25, 35, or 45 years ago? (I can't begin to guess what age you are so I am brushing with broad strokes here.) It goes beyond artificial baby milk (often called "infant formula") and "No Tears Shampoo." Our parents remember almost everything they bought and used when we were small and they remember why they made the choices they did.

Where am I going with this? What they don't seem to remember is the stuff that actually means something. Is it *really* important to you to know that your mother slathered your bottom in Penaten cream instead of Desitin?

So what is important? How many of you who are expecting your first baby (or have had a baby and remember back to before the first birth) had questions for your mother that she couldn't answer? (I don't mean to exclude those of you who can't/couldn't ask your mothers because of physical or emotional inability to have the questions answered.)

My solution? You know you can't make your mother remember these things but it is important to think about the questions that you wanted to know that answers to but couldn't get. Then take notes. Write down a few thoughts as you go through the process:

What time of day was it when you first started feeling contractions?

How did you feel when it started? When did you know "this is it?"

Where were you and who was with you at this time?

What kind of coping strategies did you use through the process?

Where did you give birth?

Who was your care provider?

Did you have a "doula" with you?

What was the weather like when your baby was born?

Did you have music playing in the background?

What song was your baby born to?

Who cut the cord?

Did you look at the placenta?

Did your baby go skin-to-skin immediately after the birth?

Did baby latch well right away?

There are an endless number of questions that can be asked and answered. Some of them will be more important to you than others. That's the beauty of this exercise.

When I am at a birth I try to take notes. Sometimes I don't get a chance to. I almost always transcribe those notes for the parents I work with so that they have a record of what I witnessed through their birth experience. It is a list of numbers I've been able to compile so they know pieces of their birthing puzzle which I was the only one who could easily answer.

When I give the "story" to the family I ask them to wait to read it until after they have had a chance to record their own thoughts and perceptions. I don't want my memories to BE their memories as much as I want them to fill in the holes.

This way, when your baby asks you about your transition to life as a parent, you will have the answers to their questions. And . . . you have something of a record for yourself when you get far enough past it (as I am) that it starts to become fuzzy in your own memory bank.

Have a great couple of weeks! I am off for some time with my husband and boys (ages 11 and 8) before they start school on September 9th. This will be a new venture for all of us as they have been homeschooled up until this point. I will be back the week of the 14th of September!!

Posted by Sam

Rear Facing Car Seats to the Age of 2!!

When teaching prenatal classes I spend a lot of time talking about car seat safety; how long children should be in specialized car seats, when to move from one seat to another, how to ensure the seat is installed correctly, etc. I talk about it for two reasons: being safe in cars is something that has always been in my mind, as the daughter of an auto body technician whose shop was on our property while growing up AND because I am a certified child restraint technician and virtually every car seat set up that I have inspected has had something about it that wasn’t safe.

Now I have read that the American Academy of Pediatrics (AAP) would like to mandate that all children should remain rear facing until the age of two. It is WONDERFUL to learn that they are finally placing the safety of the infant/child over the outcries of the parents. How often have I heard parents complain to me that they think their child needs to move to a forward facing position because they are “bored” facing backwards? What I want to know is why their baby finds the back of the front seat more entertaining than the front of the back seat? It isn’t as though a baby can see out the window.

WHY IS A REAR FACING CAR SEAT SAFER FOR A CHILD?

The research in the AAP report indicates that “children under 2 years of age are 75% less likely to die or experience serious injury when they ride in a rear-facing car seat and, toddlers between 1 and 2 years of age are 5 times safer than toddlers who ride in a front-facing car seat.” As parents we want our children to be safe.

Why would parents not want to keep their child rear facing? One reason I can think of is that it *is* more frustrating trying to get them into the seat. It takes more physical power to get our babies over the seat’s edge and into place. Also, tightening the straps can be slightly more challenging when the seat is in the way of the leverage needed to pull the straps tighter. Beyond that my only guess is that a parent is able to feel more confident that their baby is okay while riding in the car when the parent can look in the mirror and see them. Fair enough, I guess however, the reality is that if we can see the baby in a mirror then we are more likely, especially in the event that our child is unhappy, to pay more attention to the baby then to driving safely. That reason alone is precisely why parents should NEVER have a little mirror attached to the head rest behind baby or the rear window so that baby can be observed by the driver. Statistically speaking the risk of an auto collision caused by the parents is higher when they have the opportunity to pay more attention to the baby than the road.

Why is it safer for baby to remain rear facing for as long as possible? The AAP’s findings note: “When an accident occurs and a child is rear facing the force of the accident is distributed evenly over the entire body, forward facing children, because the force of the car crash is concentrated on seat belt contact points, can suffer from neck and head injuries because children’s necks are weak and their heads are disproportionately large for their little necks.”

Now the question becomes where to find rear-facing seats that will support the weight of a two-year-old toddler. There are several convertible infant/child seats on the market. When shopping you would do well to consider the following:
• Upper weight limit for the rear-facing position **
• Price range and warranty
• Ability to change/re-thread straps as needed
• How easy it is to tighten the straps while rear-facing

WHAT IS THE AVERAGE WEIGHT OF A ONE OR TWO YEAR OLD CHILD? **

How heavy is the average one year old? Usually they are anywhere from 18-22 lbs although I have met many very healthy 30 lbs one year olds. What about a child at the age of two? It is conceivable that a two year old – although usually not more than 30-35 lbs and sometimes not even that heavy – could be as heavy at 40 lbs. Because you do not know what to expect in terms of weight of your child you have to consider all possibilities.

Some examples of seats and their weight restrictions for rear facing positions include:
Safety 1st Air Protect Complete Air Car Seat – rear facing to 35 lbs (not available in Canada until 01/09/09)
Britax Advocate AND Britax Roundabout – Rear facing to 35 lbs.
Britax Diplomat, Britax Boulevard AND Britax Marathon – Rear facing to 30 lbs.
Evenflo Triumph Advance AND Evenflo Titan – Rear facing to 30 lbs.

The seats listed above are some that are available here in Canada. I can’t speak to product availability or restrictions in the US or in other countries.

Suffice it to say that I am VERY excited about the news that an organization whose whole focus is to make our children as safe and healthy as they can possibly be has decided to tackle this important issue. I hope they continue on this path and strive to educate the masses about how to make safe car seat choices for children.

I also hope this investigation in the US spurs some movement and reconsideration about safety standards here in Canada as well. Let’s see if we can bend the ear of Transport Canada and the Ministry of Transportation here in Ontario and bring them on board with the new, safer way of thinking!

For more car seat safety information please feel free to comment here or send me an email: info@babyREADY.ca

PS - I open this post with a picture of a baby in a car seat. His name is Steven and he and his brother are of the lights of my life - their mother is a VERY amazing woman and a close friend. They are together in the shot at the end of this post too (just because I wanted to be able to include both of them)!

Posted by Sam

Wordless Wednesday for WORLD BREASTFEEDING WEEK

Thought these two videos might capture the essence of WHY it is still important to designate at least one week a year to BREASTFEEDING recognition and acknowledgement. (In Canada it is early October and I will re-post this then too.)



Again, if you haven't seen these before, please share them around, offer your feedback and help get the word out!

Wordless Wednesday for WORLD BREASTFEEDING WEEK

If you haven't seen these before, please share them around, offer your feedback and help get the word out!

Is It Fear Then?

Is it fear then? A labouring woman’s fear that she can’t continue to cope, even when she is coping just fine? A doctor’s fear, increasingly these days, of legal action if they choose a different path? Of the nursing staff, if they misinterpret the signs? It would appear that there is fear on every side and the person in the middle of all of the fear is the infant himself (or herself). In part three of Kirkey’s investigation surrounding the increase in caesarean section births in the recent past, she looks what seems to be causing these numbers to soar.

In my career as a labour support provider I have had the honour of being invited to more than 200 births. I have had the opportunity to witness pretty much every possible intervention used for labouring, birthing and newly postpartum moms as well as those used on or for a newborn infant. All of that said, I am proud to boast that less than 5% of the moms who have birthed with me, have done so without requiring a caesarean section.

WILL A DOULA HELP PREVENT A C-SECTION?

I have to agree with “Dr. Larry Reynolds [who] says many complications of labour that can lead to interventions are relieved when women are comforted, supported, and aren't feeling kind of terrorized.”

I didn’t respond to this article on the day it was published (as I had with the previous two) because I was at the birth of a lovely wee boy. At one point during the labour the mother, an editor of on-line courses, said to me that having me with them was like “having their own personal textbook but one they didn’t have to open and flip through to find the right page.” As we laughed together at her analogy she went on to tell me she felt better knowing she could ask me any question and that I would be able to answer her. And she DID ask questions. She wanted to know what was happening with her body, her baby and her birth and she strove to make the best possible decisions she could with the information she had. Of course I wasn’t her only resource but I did listen to her, ask her questions and make her feel as though she was capable to deciding what was best to do.

In Kirkey’s piece Reynolds goes on to say that "the environments of birth can be quite intimidating for women and their partners. . . . We know that women who have continuous one-to-one doula support in labour have half the caesarean section rate, half the forceps rate. They have much shorter labour, half the length of labour."

I can’t know Reynolds information to be true, personally, because all of the labours I’ve been to (short of those for my own two children) saw me in the role of labour support. I will say that I have been amazed on more than one occasion, when a couple has looked to me after the birth of their baby, only to tell me that they couldn’t have done it without me. Of course they could have and WOULD have. What I always interpret their words to mean are that they were glad they didn’t HAVE to birth without me present. That is extremely gratifying.

I enjoyed reading about the research of Professor Ellen Hodnett who, in her pilot study, changed the layout and overall feel of the labour room in two teaching hospitals in the Toronto area. She moved the bed out of the centre stage location where it usually is and created a more relaxed atmosphere. Her findings certainly indicate that she is likely on the right track as the study patients received fewer induction/augmentation tools and saw mom-to-be spend significantly less time in her bed. Why is this significant? As Kirkey outlines, “Research has shown that women who labour in an upright position -- standing, crouching, propped up or sitting -- have shorter labours, and fewer medical interventions, including C-sections.”

If, as Dr. Jan Christilaw suggests caesarean sections occur most often due to “dystocia” or some part of baby not fitting well through mom’s pelvis leading to a stalling-out of the labour or “failure to progress,” then why is this happening? We know, quite certainly, that extremely small women can have considerably large babies vaginally. Why do some babies not fit? Perhaps we need to go back and look again at how the labour has been managed.

MOMS ARE EXHAUSTED BEFORE LABOUR EVEN BEGINS

If moms are induced (for being past their due date, having a large baby, etc.) then they are more likely to need to rest a lot during labour. Why? It is physically and EMOTIONALLY more intense to have labour started artificially. In almost every single case of the induction of one of my past clients I can tell you they go into the labour process with significantly smaller reserves of energy due to the stress they have been experiencing leading up to the induction itself. Not to mention guilt at not having been able to go into labour on their own and frustration for being subjected to an intervention they don’t want. Oh and let’s not forget the guilt at having been upset about being induced because we all want “what is best for baby.”

It is not my place NOR my inclination to make anyone feel guilty or upset at all about the birth that they have experienced. It IS my desire to have care providers in general look at the overall picture and examine a little more of the psychology moms bring with them into the labour room. If they have been filled with fear (by their care providers, their friends, their family members or the shows on television) then I really believe those fears need to be met with compassion and understanding and NOT with the condescension and self-righteousness I often see moms receive.

I can and will support a mom with whatever decision she makes. I will provide her with the best information I can find in response to her questions. I will offer her results on both sides of an issue. I will let her make up her own mind, even when I worry because it isn’t a decision I would make. I voice my concerns and ask that she hear me out. However, it is HER body and her fears are just as valid as anyone else’s.

POSTED BY SAM

Emotions After Caesarean Birth

Today the Ottawa Citizen followed Saturday’s article about WHY so many mothers are giving birth by caesarean section by spending time outlining some of the ways in which a surgical birth might affect mother-infant bonding.

Overall I thought Kirkey's "C-Sections And Motherhood" did a good job of highlighting points that I don’t think many, who haven’t physically gone through the process themselves, would even consider. I did feel as though there was one component missing (or was barely touched upon) and perhaps it is being considered for the final article in the three part series. In case it is not, I want to give a little bit more about my thoughts here.

I worry that one part of the reasoning behind some of the emotions new moms feel comes back to “mother guilt.” If a woman REALLY wanted to birth vaginally (wanted to feel empowered by the process, wanted to avoid major surgery, want to feel the emotions of going through that physical process) and then requires a caesarean section, there can be a considerable amount of guilt about not having been able to do it. Then we, as a society, add the further guilt on her shoulders by saying things like “at least you have a happy, healthy baby” or “it’s no big deal. Women give birth this way all of the time.” The mothers who are already feeling guilty for not having been able to birth their baby the way they wanted and believed to be best for their baby NOW feel guilty for not being grateful for the reality that their baby is here, healthy and happy. Some also feel extremely guilty for not embracing the idea that it is a common and accepted method of bringing forth baby, for having thought “less” of moms who weren’t able to birth vaginally.

I love that there are now support networks both online and in person for the mothers who want to be able to talk about their surgeries without the worry of being overheard by mothers who have not had the experience. I am glad that Kirkey made an effort to open with comments from Claudia Villeneuve, president of the International Caesarean Awareness Network of Canada. I would have preferred she spend another line or two on ICAN so that moms who have experienced Caesarean birth know more about how this organization might help them.

The topic for tomorrow’s final article is titled: “The Push to Push.” Now if there is an article that may get me going, I suspect that may well be it!

POSTED BY SAM

Why So Many Caesarean Births These Days?

In this day and age it is WONDERFUL to open a newspaper and see an article more focused on educating than on fear mongering. It’s true that I didn’t actually open the physical paper this time; I was told about it from a friend in the Ottawa area and immediately set about tracking in down online. She told me to check it out and then right away I was hearing about it all over the internet.

The entry in discussion here is the Ottawa Citizen’s August 1, 2009, “Why So Many C-Sections?” article. It is to be the first in a three part series. Perhaps author Sharon Kirkey will be better equipped to answer the question that has plagued many health care providers over the past decade or two; why indeed are so many women giving birth in a surgical fashion?

Something I have witnessed myself, in the role of labour support, over the past decade is well expressed by Dr. Michael Kline, emeritus professor in the departments of family practice and paediatrics at the University of British Columbia. He believes part of this increase is due in part to the “industrialization of childbirth, where, in today's risk-averse society, women in labour are being treated "as an accident waiting to happen" and where doing something is always better than doing nothing.”

MOMS-TO-BE MAY BE DISCOURAGED FROM TRUSTING THEIR INSTINCTS

I see it when I work with moms who steadfastly know their due dates, who understand that there may be a risk to postponing induction and who are interested in waiting to see if their body can have a chance to begin labour on its own. It isn’t just the medical establishment who encourage moms to begin with cascade of potential interventions; it begins with friends and family members too.

We have long believed that we don’t know our own body well enough to make the best decisions on its behalf and that our health care practitioner knows more than we do. It is true that they do in MANY cases however it should not be overlooked that we are the “masters of our own destiny.”

If we expect labour not to hurt, therefore employing an epidural to numb the labour sensations, then we have to expect that there may be ramifications for those actions. If we decide we need labour to start before contractions have begun on their own then again there are bound to be consequences for setting that course. We lack the intrinsic faith required to know that our bodies will do what they are created to do. And those around us, including care providers, often feed our lack of faith.

Klein goes on to say: “Physicians and society have helped women basically believe that childbirth is no longer a natural phenomenon, but an opportunity for things to go wrong . . . But the fundamental issue is, we aren't improving outcomes by doing more C-sections. For the first time in Canada, we are seeing the key indicators for mothers and babies going in the wrong direction."

VBAC RATES VARY ACROSS THE COUNTRY

And don’t even get me started on the VBAC rates in this country. For those moms who ARE told they have to have a caesarean birth (and YES it does happen for valid reasons too) the numbers of Vaginal Birth After previous Caesarean section are astoundingly low. In hospitals where VBACs are supported and are even encouraged the success rates are often well over 80%. “But less than one in five women in Canada with a previous C-section delivered vaginally in 2007-08. Eighty-two per cent had a subsequent C-section.”

If this is not the first of my blog entries you have read then you know that one of my primary frustrations is our lack of ability to believe that we can do what we set out to do. In this case what we are setting out to do is to give birth to our children. Yes, as I have said, caesarean births to happen for very valid reasons, sometimes. Further reading of Kirkey’s article will enlighten you to some of the reasons that they happen when, perhaps, they didn’t need to.

If you have a few minutes to check out the article, I would recommend you do. Kirkey promises that the subject on Sunday, August 02nd, 2009 will be about the “after effects” of having birthed by Caesarean Section.

POSTED BY SAM