Book Review: The Big Book of Birth

Review of The Big Book of Birth

Full disclosure: I know Erica Lyon, author of The Big Book of Birth,
personally. She taught the newborn care class I took before the birth
of my older son, and the sibling preparation class we took before the
birth of my younger son. I know her to be a funny, sympathetic, and
super-knowledgable woman.

Which is why it’s no surprise to me that The Big Book of Birth
is such a stellar book. Seriously, this is the book I’ve been wishing
for years had been written about birth. I wish I’d been able to read it
before I had my first, and you can bet that this is the book I’ll be
recommending here on Ask Moxie and giving to all my pregnant friends as
a shower gift. Here’s what I love about it:

It’s unbiased. Erica
covers all the current options for birth–location, pain management,
interventions. She gives positives and negatives of each option
(including some stuff I’d never heard of) and includes stories from
women who experienced the things she discusses.

It’s practical. She
acknowledges that birth doesn’t go the way we plan, so we need to be
informed so we can make the best decisions possible within the
available options. And no judgments about what options you choose.

It’s inclusive. This
is the only book about birth that I’ve seen that gives both practical
and emotional tips for both the mother and the partner. It’s not just a pat on the head for the partner, but a real resource. The sections on
counterpressure/massage during labor alone are worth the price of the
book. And it’s all written in an accessible (but not patronizing) way.

It’s smart. I haven’t
read any other analysis of the increase in the number of c-sections
performed in the US that looks at so many different factors
and–surprise!–doesn’t lay it all at the feet of ignorant women or
money-grubbing doctors. She’s really looked at the total landscape of
health care, the birth industry, societal attitudes, and women’s
choices and illusions of choice to do an analysis that ultimately helps
the reader prioritize a number of different factors.

It’s encouraging.
Rather than scaring you about how dangerous birth is or patronizing you
about how easy it is, Erica emphasizes that it’s hard and long and can
be scary, but you can do it and the baby will come out one way or
another. I mean, you know it, but reading it throughout the book really
helps it sink in that this is a job you can and will do.

Of all
these positives of the book, the one I think is most important is the
lack of bias. Anyone who’s read two books from the
pregnancy/birth/parenting section knows that everyone’s pushing an
agenda. It would be silly to say that Erica has no agenda–she does.
It’s just that her agenda is to make sure every woman is as
well-informed as possible to make the choices that are right for her
and her baby (and partner, if any) within her own circumstances. And
that’s an agenda I wish more birth professionals would embrace.

If you haven’t had your baby yet, I highly recommend buying
this book. And I found it interesting even after having given birth to
two babies.

Q&A: baby with compromised immune system

This is going to be more of a reader call, because I’m at a loss. We really need help from anyone with experience with anything like this. Kim writes:

"I’m hoping you can help with an issue with my
baby.  He was 11 months old on Friday and has been consistently sick
throughout the first year.  Severe colic, acid reflux and after an
anaphilactic reaction diagnosed with severe food allergies at 5 months. 
Lately (since Christmas) he has been sick almost non-stop with several different
things, one was a double ear infection but the others we more confusing. 
He has had two viral infections (sores on the throat) and two fevers with
vomiting a week apart.  The throat thing he has has about a half a dozen
times in six months but twice in the last month.  When he has vomiting by
itself we assume it’s tied to the allergies but when it is accompanied by a
fever it indicates some sort of infection……he has no other symptoms….just
fever and vomiting.  We have a three-year-old that hasn’t been sick since
last summer.

My worry is that his immune system is somehow
compromised……maybe because of the allergies.  He is allergic to beef,
all dairy, eggs, shellfish, tree nuts, celery, green beans and cantelope (also
house dust & dogs).  He has no environmental allergies so spending
time outside doesn’t seem to effect him at all.  We live in a mild climate
(Arizona).

I have tried some natural remedies for the viral
stuff but the only thing that seems to give him any relief is
Motrin.

He was 9 pounds at birth, breastfed until this
past weekend (he weaned on his own) and is 26 pounds now.  He has a very
hearty appetite and we buy all his food fresh from the natural food market and
blend what he can’t eat on his own."

I’m definitely out of my depth with this one.

It doesn’t seem to be environmental, since the 3-year-old isn’t affected.

It’s not a reaction to his diet, since you’ve diagnosed the food allergies and are eating as clean as possible. And the viral infections wouldn’t have anything to do with food allergies.

It sounds to me like you’re right, and his immune system is weak. Unfortunately, I don’t know exactly what to do to help you improve it. I’d definitely start with probiotics and also cranio-sacral therapy. The probiotics will help him get good flora in his stomach, and the cranio-sacral therapy will help release anything blocking his nerve and lymphatic flow. But after that, I don’t have any other suggestions.

Anyone else have any insights into this tough situation?

Q&A: baby keeping herself awake to fall asleep with her father

New magazine The Father Life is out now, and looks pretty testosterone-intense.

Jesse writes:

"Our baby girl is almost 14 months.  For the past week we have been
trying to put her to bed in her crib, which is next to our bed.  She
has coslept with us 90% of the time since birth.  She is desperately
tired, especially as time wears on, of course.  We started this course
of action after a year or more of sleep regressions, difficult sleep,
night nursing, etc– she has never been a great sleeper.  We have
always rocked and nursed her to sleep.  After the i love to walk
regression and the 11 month regression and the xmas cheer regression
and the i got a new toy at 4 pm today and i am stoked regression, with
a few days of easy sleep inbtween, we were at the end of our rope with
trying to nurse and rock her to sleep.  The nursing and rocking, and
then me in the family bed nursing her some more has in the past two
months NOT been working anymore, unless it is 60-90-even sometimes 120
minutes of continuous rocking or nursing until the clock strikes about
10:30 when her body is so tired she finally falls asleep out of
exhaustion.  No fun.  So we decided to try putting her in the crib
after about 30 -45 minutes of her usual rocking/nursing at about 8:30,
then coming up every so often to comfort (and gradually tapering that
off) her until it was time for bed for the adults, who bring her into
the bed with them.  Well, actually, I night weaned around xmas, and
that has gone ok– but i am afraid to come back into the family bed
from the extra bedroom, because i love my sleep SO MUCH, after a year
of not having it.  So E goes to bed with her dad at the moment.
 
The
thing is, she is getting into a routine of just sitting there,
clutching her bear, in relative silence (with an occasionaly yelp of
protest) after pissed off crying for about the first 5-10 minutes, for
up to 2 HOURS until her Dad comes up to bed.  He and I both work, and
he loves this cuddle/sleep time with her, and they have really gotten
in sync since I have been downstairs.  Since I have the almighty
breast, it is a special bond and special time for them to have the
sleeping together.  I don’t want to suggest that he not take her into
the bed, but I am afraid she is training herself to tough it out and
stay awake and wait it out for Daddy.  I can’t even go back to rocking
and nursing because it wasn’t working (in the true sense of putting her
to sleep at a reasonable hour) anymore.   She is simply not getting
enough sleep for a 13 months–10 or 11 pm til 6 or 7 am is NOT
enough.   

I am out of ideas.   Any thoughts???"

So now we know that there’s no guarantee that a child will actually fall asleep if you leave the child alone in the crib, contrary to what your MIL might say. Two hours? That’s some serious determination to stay awake and wait.

I don’t think it’s uncommon for nursing kids to stop falling asleep on the breast by 11 months. Neither of mine would nurse to sleep by that point, and I’ve heard it from other moms that the babies wanted the other parent to go to sleep by then. So that part doesn’t sound at all unusual, and it sounds nice that you get to sleep all night and your daughter and husband get to snuggle.

I think if you could figure out why she’s staying awake you might be able to fix things. Is she afraid that  she’s missing something if she goes to sleep? Is she afraid that if she goes to sleep she won’t get to go in with your husband?

Maybe a little reinforcement during the day and right before bed will help. During the day, you can talk about how she’s a girl who falls asleep in her crib but then sleeps the rest of the night with Daddy. While you’re getting her pajamas on, talk about how she’ll go to sleep in her crib and then Daddy will bring her in to sleep with him. The more you rehearse it with her, the more she’ll understand that first she goes to sleep in the crib, and then Daddy will get her, so she can let herself fall asleep and not risk missing out on sleeping with Daddy.

I’m not sure what else to suggest. It seems clear that she’s keeping herself awake on purpose, not because of any physical issue or spurt. Identifying and assuaging the fear that’s keeping her up is probably the only thing that will resolve this situation.

Anyone else have this problem? What did you do about it?

Q&A: going overseas with a 6-month-old

Zaimah writes:

"My husband and I are planning a trip to Pakistan for next month.Most of our family is there and are anxiously waiting for us to come
and see them. By the time we travel our son, R, will be 6 months old
and we are dreading this trip. We are dreading it for many reasons
including the typical comments such as "You’re spoiling him" "What?!
You haven’t started solids yet?" "Why isn’t he sleepong through the
night?" etc. But what we are dreading most is the jet lag. We will be
there for 3 weeks and it takes us 2 nights to get over jet lag. What we
wonder is how will it affect R? He is an average sleeper I would say.
He sleeps for about 11-12 hours at night but every 2-3 hours he wakes
up to nurse. By the time we get there he will most likely be
experiencing the 26 week regression anyway or just coming off it (he
was 2 weeks early) and so I know sleep will be crappy. But what will
happen when all of a sudden day turns to night and vice versa? Should
we just accept that it will be a miserable 3 weeks for us and then a
few more miserable weeks when we get back? Or is there some way that we
can help him adjust to the time difference?

We have a bedtime routine for him which we will continue over
there plus we will make sure he gets in his naps but will he be
sleeping through the day and keeping us up at night? I want to know
what are realistic expectations in this situation so that I can prepare
myself and come up with a game plan to handle our family’s comments
about his crankiness or sleepiness or whatever. Oh and one more thing,
our bedtime routine starts between 7.30 and 8 with R asleep by 8.30-9.
We have been doing this for about a month and he is so used to it now
that if we miss it one night then he doesn’t sleep so well and has a
crappy day the next day. How can we make our family understand (cause
they won’t) that it is important for us to be home by a certain time
because life in Pakistan is different. Dinner is usually at 8 which
means bedtimes are normally at around 10 or 11. I know that we will get
flack for it but still it is very important for us to keep that as part
of his routine there. Any thoughts on how to handle all of this?"

There are two entirely separate issues here, but I think one is going to help you deal with the other.

The first issue is the cultural differences between how you’re raising R and how your family thinks you should be raising R. This has something to do with going to another country, but not everything. "Cultural differences" manifest even if you live a few blocks away from your family if you and they have different ideas about child-rearing. It’s going to hit you particularly hard, though, because you’ll be with them for 3 weeks and you won’t have your usual routines and resources to support you so far away from your home.

It’s going to be tough on this visit. But the good news is that it’ll get easier for other visits. It never stops surprising me how food becomes the focus for so much of our emotional issues around children (all family relationships, really), and that’s one thing you can "give in" on very easily with an older child (assuming no food allergies). Once R is older you’ll be able to hold the line on things that are actually important to you by allowing your family to feed him whatever they want to. When he’s 1 1/2 and 3 and 5 it won’t matter if he eats junk food for a few days (and he’ll just refuse to eat anything he doesn’t want).

But back to now. You obviously can’t give in on feeding issues with a 6-month-old, but there might be some things that you’re willing to release for a few weeks. Think about it and talk about it with your partner, and keep it in mind in case you need to carefully-consider-their-advice-and-decide-that-they-may-be-right. You might not have to, but it’s nice to have a Plan B.

Now, the logistics. I don’t know where you’re flying from, so I don’t know which direction you’ll be flying. In general, kids seem to have fewer problems adjusting when going east than when going west. So you could be in for a really rough week or so. But I have two pieces of good news about that.

The first is that you have a really solid bedtime routine. You’ll be amazed at how much easier that makes things. Even if his body has no idea what time it is, you can do the routine and he’ll cue to get closer to sleep. And you can use the jet lag to your advantage. Since you aren’t moving to Pakistan permanently, it doesn’t matter if you get him on his home schedule at all. So you could try to move him to a later schedule, so that he goes down for the night right before you eat dinner (or right after, if people want to see him during dinner). His body is going to be confused anyway, so you might as well pick something that avoids conflict for the weeks you’re there instead of trying to get him onto an identical schedule as at home just to have to go back in a week or two.

The other thing is that he’s not going to be a happy kid for at least a few days because of the time change. But even once he’s feeling better, you have a free pass for as long as you can milk it because he’s a baby with jet lag. Don’t hesitate to play that card as much as you need to. He’s nursing too much? Oh, he’s just needy because of the flight. He wants to be held all the time? It’s the jet lag. He wakes up all night? Oh, poor baby has his days and nights mixed up. You’re not giving him solids? Oh, he was eating them until the flight–maybe he has some kind of stomach thing from all that recirculated air.

It’s my feeling that this is going to be the worst trip you take back to Pakistan, because once he’s older many of these issues will have evaporated or changed. And even if you travel later on with a second young baby, R will be older and will distract your relatives from your "strange" baby-care choices with the little one. So knowing that these three weeks are kind of the penalty you’ll have to pay to be able to have good visits later, and also the first time you’ll be negotiating your boundaries as parents with your family (which will set the tone for the future) might help you be able to deal with it without losing your mind completely.

As far as the flight itself, wear the baby through the airport so you don’t have to worry about his being snatched, and use the stroller (if you bring one) as a luggage cart for your carry-ons. Check everything else. Nurse or pacifier on the way up or down. Depending on what kind of mood R is in, either preboard (if he’s sleepy or cranky) or wait until the end to get on so you can parade your happy baby down the aisles so people will see him and think of him as a happy kid. That way when he cries on the flight they’ll think, "Oh, that sweet little baby is unhappy about something" instead of "Whiny little brat!"

Anyone else have ideas for Zaimah?

Judgment

Can we talk about judgment? I’m not talking about Mommy Drive-Bys, because I know we’re all too mature and kind to actually say anything, but I know we’re all thinking it. I’d like not to be judgmental, but I wonder if it’s just human nature.

(Sorry about no Q&A today, but I’ve been almost obsessed with this judgment thing for days and have to get it off my chest.)

For the second week in a row, I’ve noticed a little girl in one of our activities. She’s biracial (black and white), with unkempt-looking hair. I can’t stop wondering how her parents let her out of the house like that, knowing she’s going to be the recipient of disapproving looks from all directions. Her nanny is latina, and may or may not have any idea about the significance of neat hair for black/biracial children.

So I was twisting myself around about this. How could her parents put her in this position out in the world? Do they not know how to take care of her hair? (And how would they not know, unless she’s adopted and her parents are from a different ethnic group, in which case why didn’t they educate themselves at some point?)

And then I looked down at my son and realized I’d missed with the washcloth and he had a big hunk of egg yolk under his left nostril.

I started thinking about my own hypocrisy at breakfast today. I forgot to buy both butter (so no toast) and milk (so no cereal) so we went across the street to get bagels with butter from our local deli. First they boys talked me into buying a fun size bag of potato chips, so they were eating bagels and potato chips for breakfast. Then the manager gave us two donuts that got mushed in transport, so he couldn’t sell them. So my kids ate bagels, potato chips, and Boston cream donuts for breakfast.

And yet I was worried about a stranger’s hair.

I don’t know whether you guys want to talk about judgment or not. Maybe it’s more present here in NYC, where people have too much money and put too much pressure on everyone? Or does it affect everyone either from the receiving end or the judging end? Is there anything we can do about it? I’m not talking about judging people for doing things that are actually dangerous (like driving kids around with no carseats or doing crystal meth or [insert Britney Spears’ latest cry for help here]). I’m talking about things that are truly not our business.

Q&A: 4-year-old holding food in mouth

Ali writes:

"Our 4 year old DD has thrown a new and
less than delightful issue our way – she’s started holding her food
in her cheeks. It’s not an issue of liking the food – she does it
with everything, including her favorites. She’ll chew it up, and then
forgo that final swallowing step. Eventually we end up telling her she has to
swallow or spit; mealtimes have become really unpleasant, and I’m
starting to dread giving her any food at all. I tried ignoring it, and she kept
some masticated waffle in their for over thirty minutes before nearly choking
when she coughed with a mouthful.

Most of the stuff I’ve come across
on the web seems to be either an issue of the child not liking their food, or a
muscular issue. That isn’t the case here. DD is a very independent minded
child, and loves nothing more than a power struggle, so I’m leaning
towards a control thing – but in the meantime, what on earth do we do?!?"

Eew.

My almost-2-year-old does this (and it drives me nuts), but I haven’t heard of a 4-year-old doing it before. I think you’ve hit it directly on the head when you say it’s a control issue.

It seems like you have a few choices:

1. Ignore it some more. See what happens if you just steadfastly ignore it for 3 days in a row. It’s going to kill you, but she’ll figure out how not to choke, and she may well completely lose interest in this idiotic food-storing scheme.

2. Find some pictures on the internet of what will happen to her teeth if she continues to hold food in her cheeks. Don’t click here if you’re squeamish. Show her this pictures, and tell her it’s her choice, but holding food in her mouth could result in teeth like that. If you’re lucky, it’ll scare her straight.

3. Ask her to help you come up with a way to get her to stop holding the food in her mouth. Kids that age can be surprisingly rational about this stuff, and she just tell you exactly why she’s doing it, and how to get her to stop. Either that or she’ll be so surprised that you asked her to help you come up with a plan that she’ll just swallow without realizing she’s started swallowing again.

Those are the three things I’ve come up with that aren’t going to to get you into a fruitless power struggle. Does anyone else have any ideas to stop the hoarding that don’t involve any showdowns?

Your comments on sleep regressions

You guys are smart, and very, very kind. I’m going to pull some of the comments and we can talk about them some more.

First, though, let me list the posts about sleep that people seem to think are helpful:
Quick and Dirty on Sleep
11-week-old and self-soothing (about using "props" and teaching your kid to soothe himself)
What are sleep regressions anyway?

If you don’t have time to go in and read, the developmental leaps (according to The Wonder Weeks) are at 5, 8, 11, 19, 26, 37, 46, and 55 weeks. (Remember to add or subtract weeks if your child didn’t gestate for 40 weeks.) It seems like the ones at 19 (4 months) and 37 weeks (8-9 months) are the worst, followed by the 26 (6 month) and 12 week ones.

Also, if you care, here’s the big post I wrote on CIO. I was a dedicated anti-CIOer (and still hate the idea of setting out to break your kid by letting them scream for as long as it takes). But after having my second child I came up with this theory that there are kids who release tension by crying (so they need to fuss or cry for a few minutes in order to release enough tension to fall asleep) and kids who gain tension by crying (so if you let them cry for more than a few seconds you’re screwed because then it takes forever to calm them down again). If you know which kind of kid you have (or how they are for nighttime sleep vs. naps, for example), your path with regards to crying vs. soothing becomes a little more clear.

J said: "That’s the problem with expectations. They always let you down." This made me laugh, because it’s so true about baby and toddler sleep. And Valentine’s Day.

Davida said: "But I do know that YOU are the one there with your daughter, not any of
the experts, and so they mustn’t be allowed to make you feel guilty." Seriously. And that’s my big beef with this culture of expert-worship. Everything’s great as long as your kid conforms to their set pattern, but if not, you feel like it’s your fault. Yes, there are some things that you might be doing that could hurt your kid’s sleep (like mainlining those caffeine or ginseng/guarana energy drinks, or not having a regular routine of some sort), but if you’ve got a decent structure and set the stage for sleep, it’s not your fault.

Shandra said: "I personally decided that I wouldn’t do anything at night that I wouldn’t do during the day." I did, too. It’s extremely hard, sometimes, although easier now that I’ve relaxed my daytime standards. (Ha! I’m my own best audience.) Anyway, it was important to me, and once I identified that as one of my core values (congruence in actions) I was able to release some of the anger at the nighttime egregiousness.

Marsha said: "our babies are not enjoying whatever sleep disruptions, tantrums, or
whatever else is making us parents want to pull our hair out in
frustration/fatigue either." Yeah. It’s so hard not to get all adversarial in the middle ofthe night, but you and your child really have a common enemy, which is baby insomnia. You and your baby can work together (OK, so you do most of the work) and you’ll stay in a better frame of mind than if you sink into that tempting-but-empty mindset of battling with your child.

Charisse said: "There are various things you can try, but no one of them is necessarily
right for you, and sometimes the idea that you "should be doing
something about this" is worse than just getting through it." Dude. Yes. Which is why I spend half my time here saying, "There’s probably nothing you can do about this now, so just try to split things up so neither you nor your partner are taking the full hit." And one day, yes, one day you will be annoyed because your child forgot to brush his teeth when he put himself to bed, and woke up at 7 instead of 7:30 in the morning.

Laury said: "It seemed to make a huge difference smiling (I know this sounds hypocritical) and telling him, knowing that he could do it." I don’t think it’s hypocritical at all. Think about it–if you were supposed to be doing something you weren’t sure you could do and were a little scared of all by yourself, wouldn’t you feel much better about it (and maybe even be able to do it) if the person you most loved gave you a smile and encouraged you before leaving you to do the task? Contrast that with having her scowl and tell you to "Just do it!" and leaving angry. The pleasant way sets a person up for success.

What other sleep wisdom do you guys have? I don’t really mean techniques (because those are a dime a dozen and won’t work for everyone anyway), but ideas and concepts and attitudes that have helped you get through the long nights.

(Mollyball, if you’ve checked all the physical stuff–like silent reflux, etc.–I’d try either the Calms Forte 4 Kids homeopathic pellets, or finding a pediatric chiropractor or cranio-sacral practitioner.)

Q&A: 4 1/2-month-old not sleeping

I need to create an easier way to search for topics by age. Today’s question is a classic. Zakhele from South Africa writes:

"I would like to find out what is bothering my baby. He is 4 1/2 months old and everything was all good with his sleeping up until recently. He started this new thing which me and his mom don’t understand. He was sleeping the whole night including weekends, and now he only sleeps on weekends the whole night and during the week it’s a mission. I was wondering whether there was something wrong with or not, bcoz his mother takes him with her to work and she feeds him every 4 hours during the day and we give a bath at 9 pm every night and then she feeds him between then and 10 o’clock and then we go to sleep. I don’t know–do you think what’s affecting him is bcoz he does not feed well, and he plays a lot now and sleeps less even during the day? Sometimes, like yesterday, he didn’t sleep at all during the day. I worried bcoz he is not like this. I mean the past 4 months were the happiest months of our lives and we were even boasting about it to our friends that our baby manages to sleep on his own the whole night without any hustle. Please help doctor do have any suggestion for me and my wife?"

You said it–you were boasting about it to friends, and that’s what made him stop sleeping.

Just joking! (But it kind of seems that way, doesn’t it?)

I
think it sounds like he may be about to go through a developmental
spurt
and gain some new skills. There’s one that happens right around
19 weeks, and another one that happens at 26 weeks. While the baby’s
brain is working on learning and practicising the new things for that
spurt, their bodies can’t really stay still. It’s like those times when
you have something big on your mind–sometimes you just can stay still,
and you have to get up and walk around to get the excess energy out.
The same thing happens to a baby. It can last anywhere from a few days
to a few weeks. Once the baby’s brain works through the new skill,
he’ll go back to sleeping again.

There’s not much you can do about it until he goes through the
spurt on his own. The only suggestion I have that might work (and I
really mean "might," as it has no effect on many kids) is to try to
tire him out physically during the day. Play the kinds of patty-cake
and motion games that will get him excited and trying to move with you,
or dance around with him a lot.

You could also try an earlier bedtime. In the US, 10 pm would be a really late bedtime for a kid, starting at around 3 1/2 months or so. We tend toward bedtimes for babies at that age in the 7-8:30 pm range. But I have no idea what time you are getting up in the morning, so 10 pm might be the perfect time. You could always play around with the bedtime and move it earlier if it makes you feel like you’re doing something productive.

Basically, though, I think you’re seeing what happens when your baby’s mind and body starts developing. Everything just goes haywire for a few weeks, and the only thing you can do is stand back and watch. It’ll get better again (and then worse, but then better, and then worse, and then at some point he’ll move out of your house and it won’t be your problem anymore). So while you’re waiting for this sleep regression to resolve itself, just don’t mention anything about it to your friends.

Ohhhh

Stomach flu. We all have it. In place of a question, I’ll leave you with this story my friend B told me this weekend:

Her friend D is a WOH mom, and was doing the normal rush one morning last week, getting everything ready for daycare and to leave for wrk. She brewed her coffee and couldn’t find any of her travel mugs. So she took her coffee on the road in a sippy cup.

Hee.