Infant Colic – What Can You Do?

Colic can make the new parenting journey grueling!  What can parents and care-providers do?

Babies are said to have colic if they cry for more than 3 hours daily on a regular basis. The cry is often high-pitched and relentless, accompanied by a red face and rigid body. It often happens later in the day or evening. Nothing seems to soothe the baby. Research shows 10-20% of babies experience colic. It’s heart-wrenching and exhausting for care-providers. 

There are theories about what causes colic but no certain answers. Colic resolves in most infants by 3-4 months, which is the entire “4th trimester”, when we expect babies to sleep a lot and when new families are typically bonding and getting to know each other.

The first thing to consider is your baby’s health. Is your baby gaining weight and soiling diapers as expected? Check out the handy Best Start Chart for signs that feeding is going well. Watch for signs of illness that require medical attention, such as lethargy (limp baby), fever, diarrhea, forceful vomiting.   

Is there a chance your baby is overstimulated? Some babies get overwhelmed by a seemingly low level of sounds, sights, and attention. Others can’t get enough. 

If your baby is fed, dry, healthy and the usual soothing techniques (rocking, walking, warmth, fresh air, holding, breastfeeding, singing etc) don’t help, then suspect colic. Here are some suggestions that can help an otherwise healthy baby who has colic. 

  • Infant Chiropractic care, from a Chiropractor who has specialized training and experience. Over 90% of colicky babies show improvement! It’s gentle and nothing like adult adjustments. I’ve heard countless stories from clients who’ve seen amazing results after only one or two treatments from their local baby-chiro.
  • Consult with a Lactation Consultant. Suggestions to help with latch and positioning can make a big difference, especially if the colic is related to swallowing gas while feeding. LCs spot all kinds of little or big things that can be easily corrected. 
  • Infant massage. There are classes and videos demonstrating how to do infant massage for colic. This can help move gas along, colic or not.  
  • Homeopathic remedies such as Cocyntal. I used to run the Vitamin & Supplement department of a busy health store and this was one product I could never run out of for fear of the pleas from desperate new parents. Many of our customers swore by this remedy. 
  • Fennel tea is a natural remedy for digestive issues such as gas, cramps, flatulence. It helps with colic too. Ready-to-use fennel tea is sold commercially; just add boiling water and steep for 5-10 minutes like any other tea. It can also be made by boiling fennel seeds (5ml seeds per 250ml water; 1 tsp per cup) for 10-minutes in a covered pot. The breastfeeding parent can drink 3 cups daily. For babies being formula fed, cooled fennel tea can be given to the baby orally with a dropper, 3-5ml (½ – 1 tsp) three times daily.
  • Break the stress cycle, if there is one. Never punish or shake a baby who won’t stop crying. Take 10. While it might go against your instincts, it’s better to put your baby down in a safe place and step away for 5-10 minutes to breathe slowly and deeply and regroup. Colic is one of the hardest parenting issues! 

I worked with one family who tried everything to no avail. Both parents were loving and kind but exhausted, distressed, anxious and at the end of their rope. Finally, in desperation, they asked a relative to come and stay for 2 nights so they could go sleep at a hotel. They figured they could go home to care for their screaming infant again once they’d restored some energy. When they went back home the colic was over. Done. Never came back. Coincidence or an environment of stress responses cleared up? We’ll never know but they sure were relieved. This is an extreme example but sometimes we have to ask for help and try something we’ve never done.

C-19 Updates in Birth and Postpartum Care in Regina

I’ve been keeping in touch with the good people managing the units at Regina General Hospital. Here are all of the recent updates of RGH Labour/Birth Unit and Mother/Baby Units here in Regina, Saskatchewan due to Covid-19. Please note that any of these may change on short notice due to the coronavirus pandemic.

Some additional tips for navigating your birth journey:

I lead RGH Tours live but online multiple times a month.

Article: How to Set Up your Birth Room (i.e. What Your Doula Would Normally Do!)

Easing Labour Pain: An online 2-hr class offered monthly that teaches partners how to provide hands-on birth-support, comfort, and decrease labour pain.

If anyone’s looking for online prenatal classes please contact me. I teach all the sessions live but online so you can ask questions.

*****

Hospital Update

March 2022. 

  • Due to Covid, the Nitrous Oxide (“laughing gas”) is not available. It may be available again, depending on some supply issues. 
  • The Mother Baby Unit now allows new families to have 2 visitors at a time (11am-8pm) and they can be anyone you want. (The “no-swapping rule” has been lifted.)
    That said, postpartum hospital stays are usually short – only 1-2 days. There are many benefits to just resting with your new baby and saving the visitors for once you return home.
  • Note: The Labour & Birth Unit remains as is – 2 support persons per maternal patient, no swapping.

Feb 2022. The proof of vaccination / negative test requirements have been lifted.  Support persons no longer have to show proof of anything. 
As of Nov 8, 2021, partners, visitors, doulas, support persons, everyone EXCEPT the patient being admitted, must show proof of double Covid vaccine or a negative test within the past 72 hours from an SHA approved tester in order to enter SHA hospitals. Anyone who is not double vaxxed and wants to attend the birth might consider serial testing every 72 hours in order to be ready anytime.  

ONGOING:

There are 2 support persons allowed in the BIRTH ROOM. From Saskatchewan Health Authority:

“Effective immediately, expectant mothers and families across Saskatchewan will now be permitted to have two designated family members/support persons present during their birthing experience. Designated family members/support persons are chosen by the mother and family and may include but are not limited to partners, family members, coaches, doulas or cultural support persons.

All maternal patients and their designated family members/support persons will be screened for COVID-19 upon arrival and be required to have a temperature check, wear a mask, participate in hand hygiene and follow physical distancing guidelines. Designated family members/support persons who are symptomatic for COVID-19 or who have other risk factors will not be permitted. The designated family members/support persons must be consistent during the duration of the patient’s stay. They may leave the facility but cannot be switched out for another family member or support person. Only designated family members/support persons will be permitted at this time, other visitors, including siblings, will not be allowed.

All maternal patients will be offered an optional COVID-19 swab upon admission. Family members/support persons will not be offered a COVID-19 swab.”

03A47318

◆ Support people coming in on their own, i.e. not with the labouring patient, can be screened 24/7 at the main RGH doors (14th St entrance). They do not have to go to the ER doors.
◆A 24-hr support person who’s joining a birth or going to MBU for a maternal patient that has already been admitted can enter through the main 14th St doors at any time, 24/7. No need to go through the ER.
◆ A support person entering the hospital with a maternal patient will be screened with the maternal patient.

Please note that while the 14th Ave entrance is open 24/7 with a security guard that can screen and let people in, the registration desk is only open from 6am-6pm. Support people can enter this door 24/7 because they are not patients (don’t need to go through the registration process).
 
If you’re in labour and going to RGH as a patient, then you’ll have to go to an entrance that has an open registration desk. On weekends, holidays and evenings/overnights, that will be the ER.
 

If you have to step outside and get back in, here’s how:

◆ 14th St main entry has a security person around the clock. If you have your proof of screening and are wearing a band it’s easy to get back in 24/7. If you’ve not been screened yet, I recommend you start at this door. If they are unable to screen you, they will send you through the ER doors instead.
◆ The ER can screen 24/7 but please save the ER capacity for people who need it.
◆ 15th St admitting doors are locked overnight. The doors below MBU at 15th St parking lot are locked 24/7. You can not enter the 15th St side of RGH overnight. If you go out those doors, you’ll have to walk around to the 14th St entry.

If your 2nd support person is not at the birth but is invited to MBU, they will be screened on their way into the hospital. They must be named when you are admitted to LBU so remember to tell your nurse. You must get a coloured bracelet for them. I expect someone has to meet them outside the unit to give them the band that will grant them access to the MBU, but ask your MBU nurse about this.

“If the patient fails screening, she becomes a Person Under Investigation (PUI), therefore the support person now becomes a PUI as they have been in ‘close, prolonged contact with a PUI.’ The support will be sent home, however, the patient may have an alternative support person or people who pass screening. ” That means anyone who has been with the labouring woman for more than 2 hours will not be allowed in if she is suspected of C-19/exposure.

Folks – you need to plan for this. Plan C. New support people who have not been with you for more than 2 hours AND who pass screening may be allowed into isolation. They will be gowned, masked, gloved throughout and will not be allowed to leave the isolation room. Food will be brought in.

◆ Again, it’s up to you to ensure that a 2nd support person has been named so they can enter the unit. Ask your nurse about this.
◆ Supports must be 19 years and older. (No, I’m not sure what happens in the case of teen pregnancy, young doulas and so on. This is just what I was told.)
◆ The health region is not on the same timeline of relaxing restrictions as the SK gov’t. Restrictions are still in place at health care facilities.
◆ You’ll see staff wearing masks throughout your stay.
◆ Bring what you would normally bring for your birth and hospital stay. Support people will be given a wristband so they can go to car later for extras and car-seat. You are still allowed to bring your pillow, clothing etc – whatever you need for comfort.

Doctor

◆ Labouring women are asked to wear the mask as long as they can stand to do so. Postpartum patients are asked to wear their masks when staff are in the room.

◆ Masks are mandatory for partners and support persons throughout the hospital, except for when there’s no staff present in the Mother-Baby Unit.

◆ People can wear whatever mask they want to enter the building. Public Health does have recommendations on personal masks (on the SHA site). However, once inside the building, people will go through screening and will be given medical masks to wear in the building (the blue ones with folds). The blue medical masks must be worn in all public spaces and the assessment area.

◆ Nitrous-oxide (“laughing”) gas is available for pain management. If a tank is being used (instead of the tubes that go directly into the wall), then the maternal patient must have a negative Covid swab done prior to use. 
◆ If you or baby are at high-risk for birth complications, you may be asked to use an epidural during labour to avoid the need for a general anaesthetic in case of an urgent/stat caesarean. Best to discuss this with your OB ahead of time so you can learn your options and make a plan.
◆ Waterbirth is currently not an option in the hospital. Midwives are not lending pools out for home birth. If you have your own then waterbirth at home is still an option (contact me for info on where to get one).
◆ The installed bath-tub is available for comfort in labour.
◆ Breastfeeding is still being supported at RGH.
◆ There are plans and protocols in place so that mother-baby can stay together if mom is at risk or has symptoms of C-19 in the immediate postpartum.
◆ Even though some community restrictions are being lifted, great care should be taken with newborns once the family is home. Physical distancing and being only with members of the same household are still recommended. Anyone who enters the house can bring in pathogens/bugs.

◆I always tell people to bring their own hot water bottle or Magic Bag to the hospital. That’s because the hospital does not provide any warm tools other than blankets from the blanket warmer. They are lovely but they are not the same as a hot water bottle. The new update is that the staff are not allowed to take people heating devices to the microwave or kettle. Therefore if people want to use heat it will have to be a plug-in device or they can fill the hot water bottle with hot tap water in their own room. Stay warm and stay well during your visit!

◆ Paid parking has resumed in the RGH parking lots. You will need cash for the main lot. Also, the 15th street parking is reserved only for people who have appointments or are being admitted to the hospital. Vehicles are being ticketed again on the streets around the hospital so no more free parking that way.

◆ There is nowhere for the second support person to wait as all waiting rooms are closed. The second support person should wait at home or somewhere outside the hospital until the labouring person is officially admitted and moved to a birth room.

◆ Partners/support persons will be provided with a mask at the entry doors. (Bring a big paperclip or string if you want to save sore ears.) Check out these tips for saving your ears from mask-pain.  Everyone must wear masks in the hallways. Labouring people do not have to wear a mask once they’re in their patient rooms in the birth unit and the mother-baby unit.

◆ Food outlets now allow people to sit in.

◆ Galleys are still closed to patients in both units. The nurses will get food for you in the birth unit but not in the mother-baby unit so people have to bring their own snacks. There is no access to the microwaves, kettles, food, water-ice machines. There is no access to the big fridges and freezers, but every room has a small mini-bar fridge.

Birth Room

𝐏𝐫𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞

● Attend appointments, diagnostics (ultrasound, lab) solo. Routine appointments might be done over the phone or spaced out. High-risk and special circumstances will still get the extra care they need.
● Midwifery offices are doing the discussion part of the consult by phone and then a quick in-person appointment for the hands-on part. They prefer pregnant patients attend alone but will allow partners. No other family members/friends/support are allowed.
● Anyone under midwifery or GP care who tests positive for C-19 at any point in their pregnant, birth or postpartum will be immediately transferred to OB care.
● If you’re an early-bird you may be asked to wait in your car until your appointment time.

𝐀𝐧𝐭𝐞𝐧𝐚𝐭𝐚𝐥 𝐂𝐚𝐫𝐞 (𝐋𝐚𝐛𝐨𝐮𝐫 & 𝐁𝐢𝐫𝐭𝐡)

● Early discharge is being offered as an option for those that are healthy and feel comfortable with newborn care. That means to go home a few hours after your birth instead of staying 24-36 hours.
● Anyone getting a cervidil induction will be monitored and then sent home to wait for labour to start, as per usual, then rescreened at RGH doors and LBU doors upon return.
● Support people are allowed at homebirths but must be screened. If anyone in the home (residents or support people) doesn’t pass screening, then the birth must be transferred to RGH. In that case, the one support person rule applies. Home birthers – screen your people before they come over!

𝐏𝐨𝐬𝐭𝐩𝐚𝐫𝐭𝐮𝐦 𝐂𝐚𝐫𝐞

● Doors that don’t have an admitting desk are locked tight; security will not let anyone in. That includes the convenient door just below the MBU.
● Families are being asked to stay in their room as much as possible.
● Support people may not visit any other patient areas.
● Food trays are being provided for new moms in the MBU.
● Breastfeeding class in the unit is still running but only birth mother and baby attend, and only up to 3 participants. If there are less than 3 maternal patients, then partners may be allowed to attend.
● Midwives and public health nurses are still providing postpartum home-visits. Some may be done by phone or video, depending on your needs.

Please contact me if you have any questions about this information or any of my services.

Angie The Doula – New Parent and Baby Essentials

What are the most important items for new parents and their newborns? Everyone has different opinions about this. Stores and ads would have us buy all kinds of things. What do you really need? Think about what you have to do with your baby. For example, a travelling family will have different needs than a family at home.

This New Parent and Baby Essentials list is from my experience along with comments from families with whom I’ve worked.  It’s biased toward being kind to the environment and keeping life simple.

Before we get started, I want to let you know that really all you need (other than love, food, shelter) is a warm safe place for your baby to sleep when they’re not in your arms, diapers (unless you’re doing EC) and a system for cleaning your baby, and a safe and comfortable way to transport them.  Note that babies will go from laying stationary to rolling over in the blink of an eye.  Save your babe from a fall and potential injury by never leaving them unattended on a flat surface such as a bed or table, unless they’re surrounded by little rails or something that will both prevent rolling and suffocation.

New Parent and Baby Essentials

Essentials:

  • For maternal postpartum recovery and wellness:
    • Bottom spray (postpartum perineum-saver!!)
    • Adult diapers for the first week – not pretty but awesome way to prevent postpartum leaks
    • See Breastfeeding section below
  • Something to wear or a way to hold the baby – sling, wrap, carrier or baby pack for newborn i.e. supports head
    • May need a couple of methods to accommodate different adults – sizes, abilities, preferences – and babies
  • For baby:
    • See Diaper section below
    • Car seat
    • Baby blanket or cover for car seat
    • Receiving blankets – 20
    • Mini-wash cloths can be used as wipes – 40-50 if you’re not using disposable wipes
    • Baby blanket for home
    • Digital thermometer
    • Q-tips, in case of care of umbilical cord
    • Baby nail clippers 
    • Saline-squirter or nose-sucker
    • Baby clothes – many people get much more than they need from family & friends
      • A few outfits including sleepers and undershirts
      • Socks & mitts
      • Outdoor clothing
      • For winter babes, outer clothing such as a fleece bunting-bag or something that covers hands and feet as part of the outfit.  Also a good hat that stays on.
      • For summer babes, a sun-hat, and thin clothing to cover up skin but not overheat
    • Baby ear-muffs (hearing protection), e.g. for music festivals, movie theatres
New Parent and Baby Essentials
  • For breastfeeding/chestfeeding:
    • Nipple cream or pharmaceutical grade lanolin (e.g. Lansinoh)
    • Nursing bras
    • Nursing pads (pref cotton, non-disposable)
    • For consideration: a little manual pump or milk collector device such as the Haakaa
    • Book: Womanly Art of Breastfeeding – quick answers for breastfeeding issues; easy to read and short fix-it suggestions
  • Diapering.  Set up a safe place and have supplies ready to use.
    • Change table with little rails, change pad (with sides) on a table or dresser, or towel on the floor
    • Diapers – what kind will you use?  Cloth or disposable (biodegradable, organic, or regular)
    • Wipes – washcloths / reusable, or disposable
    • If using cloth, you’ll need a storing, soaking and washing method.  Feel free to ask me.
  • Think about sleeping options:

CPS recommends baby sleeps in the same room as parents , ideally for the entire first year, but for a minimum of 6 months.

  • Baby blanket or quilt; no pillows needed
  • Some kind of washable pad for under baby – can be anything from a proper baby-pad to a folded sheet.  This goes under the baby-sheet to avoid scrunching and twisted bedding.
  • Family bed – a futon on floor, extra-wide bed against the wall, or 3 sided crib that attaches or goes against parents’ bed
  • Family room – a safe place for baby to sleep in your room but not necessarily attached to bed
  • Baby room – high quality crib with slats close enough so a pop-can won’t fit through 
  • In a pinch – box, drawer or laundry basket
New Parent and Baby Essentials

Other things that make life easier (and are worth every cent!)…

  • Really great nursing pillow 
  • Smart Medicine for Healthier Kids book has both allopathic and holistic advice on childcare from newborn to teens
  • Calms book – a short read with great tips for learning to communicate with your new baby
  • Medicine dropper – has many uses other than medicine
  • Stroller, or Burley/Chariot 
  • High quality and “clean” baby care soap and laundry soap

Nice to have but not essential

  • Swing or Rocker
  • Baby-bath or Tummy Tub but another option is to just have a bath with your babe to minimize buying stuff.
  • Baby monitor, depending on your lifestyle and home layout.
  • Breast pump and glass bottles in case of emergency or depending on lifestyle.
  • Playpen  

I teach a variety of Child Birth Education classes and prenatal workshops online for people all over.  I have been a birth doula since 2002, and have helped over 300 clients with their births and over 1000 through prenatal classes. Learn more about my birth doula services, and contact me with any questions you may have.

Delayed (Optimal) Cord Clamping

In spite of a mountain of evidence to support the benefits of leaving the newborn cord intact, immediate cord clamping is still routine care in many hospitals. At the time of birth, up to 40% of the newborn’s blood is in the placenta. Leaving the cord intact for at least 1-3 minutes ensures the baby gets the majority of their blood, including red blood cells, iron and blood volume. Iron deficiency can lead to anemia and neurodevelopmental delays. Adequate oxygenated blood is required to help the baby adapt to life outside the womb, including how their blood circulates and how well they breathe in the first minutes. 

The Cochrane Review, considered the highest standard globally in evidence-based health care information, contains countless articles on the benefits of delayed cord clamping. There are indisputable improved outcomes in babies born at full term and prematurely. 

The placental blood normally belongs to the infant, and his/her failure to get this blood is equivalent to submitting the newborn to a severe hemorrhage at birth.  (DeMarsh, 1941)

Yes, we’ve known since 1941!  Changing practise takes a long time indeed.

6 umbilical cords   Intact cord – birth to 15minutes (Elphanie, 2011)

Benefits of Optimal Cord Care

Benefits and positive effects last well past the newborn period!

  • 40% more blood volume.
  • 45-50% increased levels of red blood cell counts and blood iron levels.
  • Up to 45,000 stem cells (compared to 0 with immediate clamping). Stem cells provide therapeutic benefits to the baby, even into adulthood.
  • Protection from anaemia and iron deficiency for at least 6 months.
  • Better neurological development.
  • More stable vital signs; they thrive better.
  • Preemies are less likely to require blood transfusion, ventilation and oxygen therapy. 
  • Significantly lower rates and less severity of common, major newborn health issues in preemies.

 

What About Jaundice? 

Prevention of jaundice is often cited as the reason to rush the cord clamping. Leaving the umbilical cord intact does not lead to “pathological jaundice” (the kind that makes babies sick). The naturally occurring “physiological newborn jaundice” has no clinical significance, meaning it does not harm the baby. It is normal for healthy newborns to have some jaundice around day 2-3.

Objections by your medical care provider?

The World Health Organization recommends the cord stay intact for 1-3 minutes after the birth (WHO, 2014). 

The Society of Obstetricians and Gynaecologist of Canada (SOGC, 2021) states:  Delaying cord clamping for at least 1-3 minutes after delivery allows more of the baby’s blood to return from the placenta into the baby and is usually advantageous for the baby. Delayed cord clamping (anytime beyond 60 seconds after delivery) has benefits to the baby. This is because delayed cord clamping allows more blood to transfer from the placenta to the infant, which increases the baby’s red blood cells and iron stores, and reduces the risk of anemia.

“The WHO and the SOGC recommend that cord clamping should be delayed by ≥60 seconds in babies who do not require resuscitation, irrespective of the mode of delivery.” (Armson, Allan, Casper; 2018).

The practise guidelines of the Royal College of Obstetricians and Gynaecologists in the United Kingdom are to leave the cord intact for at least 1 minute and up to 5 minutes, and to leave it for longer than 5 minutes if requested by the birth mother (NICE, 2016).

Even the American College of Obstetricians and Gynecologists (ACOG) recommends a delay in umbilical cord clamping for at least 30-60 seconds after birth, “given the numerous benefits to most newborns” (ACOG, 2017).  It’s not enough but is a big step forward for ACOG, notoriously interventionist.

What About Stem-Cell or Cord-Blood Banking?

Delayed cord clamping can not be done with cord-blood banking.  Here’s some food for thought…

In British Columbia the maximum allowable blood draw volume in newborns is 5% of their total blood volume in a 30-day period. Other jurisdictions have the same guidelines. For example, a 7# baby has approximately 275ml of blood. Medical testing allows just under 14ml of that baby’s blood to be drawn and tested, total, in one month.  

The volume collected for cord-blood banking is normally 60-90 ml or more! That’s more than 5x the allowable monthly blood draws, taken all at once in the first seconds of the baby’s life. 

Have you ever noticed all the pamphlets for cord blood banking companies at your Obstetricians’ office? Have you ever seen any information on the benefits of optimal or delayed cord clamping beside those pamphlets?  “All pregnant women should be provided with unbiased information about umbilical cord blood banking options.” Society of Obstetricians and Gynaecologist of Canada (SOGC).

Did you know whoever collects the cord blood (usually a doctor or midwife) gets paid to do so by the blood banking company? 

Did you know cord-blood banking is a very expensive endeavor? You’ll pay for the kit, possibly for the courier, and then pay every year to store the stem cells. 

The Geeky Stuff: Basic Newborn, Placenta & Umbilical Cord Information

  • The placenta is nature’s neonatal life-support system.
  • The placenta will deliver oxygen to the baby until their newborn lungs transition to breathing air (30 to 90 seconds in a full-term infant).
  • Placental transfusion (blood moving from placenta to baby’s body) rate: 50% in 1 minute; nearly 100% over the next 2 to 5 minutes.
  • “Delayed” in research ranges from 30sec – 3min, depending on the researcher and study.
  • Newborns cope well with lack of oxygen for up to 20 minutes (only if the cord is intact) but low blood volume can quickly have catastrophic outcomes.
  • For comparison of the fact that up to 40% of the newborn’s blood is in the placenta, adults may go into shock and receive blood transfusions at 15 to 30% blood-loss.

References

ACOG American College of Obstetricians and Gynecologists. (2017).  Delayed Umbilical Cord Clamping After Birth. Obstet Gynecol 2017;129:e5–10. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth

Armson, B.A., Allan, D.S., Casper, R.F. (2018). Delayed Cord Clamping and Umbilical Cord Blood Collection.  Journal of Obstetrics and Gynaecology Canada, 40 (2), 155.

Asfour, V., & Bewley, S. (2011). Cord clamping practice could affect the ratio of placental weight to birthweight and perinatal outcomes. BJOG: An International Journal of Obstetrics & Gynaecology., 118 (12), 1539-40.

Chaparro, C. M., Neufeld, L. M., Alavez, G. T., Cedillo, R., & Dewey, K. G. (2006). Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. The Lancet, 367 (9527), 1997-2004.

CRYO-CELL International Inc. (2019). Cord blood collection instructions. Florida.

De Marsh, Q. B., et al. (1941).”The Effect of Depriving the Infant of its Placental Blood.” Journal of the American Medical Association (J.A.M.A.), 116(23):2568-2573. doi:10.1001/jama.1941.02820230012004

Fogelson, D. N. (2011). Delayed cord clamping grand rounds. USC School of Medicine, A.P. Dept. Obstetrics and Gynecology. South Carolina: Palmetto Health Grand Rounds.

Frye, A. (2004). Holistic midwifery, vol 2, Care during labour and birth. Portland: Labrys.

Garofalo, Milena; Abenhaim, Haim A. (2012). Early Versus Delayed Cord Clamping in Term and Preterm Births: A Review.  J Obstet Gynaecol Can;34(6):525–531.  http://www.jogc.com/article/S1701-2163(16)35268-9/pdf

Greene, A. (2008). How much blood is too much guideline. Retrieved from Dr Greene: http://www.drgreene.com/article/how-much-blood-too-much-guideline.

McAdams, R.M. (2014).  Obstet Gynecol. 123(3):549-52. doi: 10.1097/AOG.0000000000000122.

Mercer, J. S., Vohr, B. R., McGrath, M. M., Padbury, J. F., Wallach, M., & Oh, W. (2006). Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemmorhage and late onset sepsis; a randomized, controlled trial. Pediatrics, 117 (4), 1235-1242.

NICE National Institute for Health and Care Excellence (UK). (2016). Clinical guideline [CG190] Intrapartum care for healthy women and babiesPub Dec 2014, revised/updated Nov 2016.  https://www.nice.org.uk/guidance/cg190/ 

Reed, R. (2011). Cord blood collection: confessions of a vampire-midwife. Retrieved from Midwife Thinking: http://midwifethinking.com/2011/02/10/cord-blood-collection-confessions-of-a-vampire-midwife/

Richmond, S., & Wyllie, J. (2010). European resuscitation council guidelines for resuscitation 2010. Section 7. Resuscitation of babies at birth. J. Resuscitation , 1389-1399.

SOGC. (2021). Delayed Cord Clamping. Society of Obstetricians and Gynaecologist of Canada.  https://www.pregnancyinfo.ca/birth/delivery/delayed-cord-clamping/

Tolosa, J. N., Park, D.-H., Eve, D. J., Klasko, S. K., Borlongan, C. V., & Sanberg, P. R. (2010). Mankind’s first natural stem cell transplant. J. Cell. Mol. Med. , 14 (3), 488-95.

University of British Columbia – Children’s & Women’s Health Centre of British Columbia. (2013). Pediatric Blood Draw Guidance. Version 3.2.

Usher, R., Shephard, M., & Lind, J. (1963). The Blood Volume of the Newborn Infant and Placental Transfusion. Acta Paediatrica – Nurturing the Child , 52 (5), 497-512.

WHO. (2014). Guideline: Delayed Umbilical Cord Clamping – for improved maternal and infant health and nutrition. Geneva: World Health Organization.

Angie The Doula – Postpartum Warning Signs for Mother and Baby

CALL 811/DOCTOR/MIDWIFE WITH ANY WARNING SIGNS.  CALL 911 FOR EMERGENCY HELP!

If you call 911, have someone clear a path for EMT (halls, stairs etc), turn on outside light, put pets away, unlock door, clear driveway.)

Maternal Warning Signs

  • Vaginal bleeding heavy enough to soak a super-pad front to back in 1/2hr-1hr. Note: if blood starts to pour continuously, lay down immediately and call 911;
  • Foul-smelling bleeding or discharge
  • Passing clots bigger than a toonie
  • Temperature greater than 38C (100.4F)
  • Feeling flu-like
  • Uterus is painful to the touch
  • Uterus feels soft and is at or above the navel, and doesn’t respond to gentle massage
  • Sore, red, hot, tender area on leg or calf
  • Painful, swollen, red breasts or red / hot / lumpy spots
  • Sudden and extreme pain on nipples with feeding (may be thrush)
  • Persistent dizziness (call 911 if accompanied by bleeding)
  • Fainting (call 911 if accompanied by bleeding)
  • Feeling depressed, very anxious, unhappy or are crying without reason and cannot sleep or eat

Baby Warning Signs

  • Blue or grey in the lips, face or chest. Call 911.
  • Temperature of greater than 37.4C (99.3F) or lower than 35C (96.6F) (note: consider environment – e.g. is baby wrapped in layers in a hot room?)
  • Laboured breathing
  • Extra-sleepy and has not fed in the past 6-8 hours
  • Has not urinated or passed meconium (feces) in the first 24 hours
  • Yellow skin in the first 24 hours
  • Red patches, pimples or bumps
  • Vomits after every feed
  • High pitched cry or extremely irritable, inconsolable
  • Lethargic
  • Red, hot area around cord-stump; swelling of stump; discharge of pus, blood or meconium
  • Red blood in urine (note – some girl-babies get a little ‘period’ due to hormones)
  • Bright red diaper rash
  • White spots in mouth that don’t rub off (thrush)

Angie The Doula – Normal Postpartum Care of Mother and Baby

If you’re concerned, see Warning Signs for Postpartum.

In the first 24 hours after birth it is normal for birth mothers to:

  • Expect a fairly heavy flow for the first 24 hrs, like a heavy period in appearance and scent. Flow should gradually taper in the following few days, then continue lightly for approximately 4-6 weeks.
  • Pass small clots and gushes, especially after lying down for some time
  • Have a firm uterus that feels like a grapefruit below the navel
  • Experience night sweats
  • Urinate frequently
  • Feel exhausted and need rest

In the first 24 hours after birth it is normal for babies to:

  • Breathe irregularly, including pauses and some periods of rapid breathing
  • Spit up mucus
  • Have blue hands and feet with pink body, face and lips
  • Sleep for 4-6 continuous hours after birth then wake up every 2-3 hours to breastfeed
  • Pass stool (but may be within 48hours)
  • Urinate

Postpartum Care – Mother

  • In the first week, only responsibilities should be to eat, sleep and feed and cuddle baby
  • Sleep when the baby sleeps
  • Get assistance with getting up for the first day. Never get up while holding the baby (first 24hours), in case of fainting.
  • Do not lift anything heavier than the baby for 3 weeks after a gentle vaginal birth; 6 weeks after a Caesarean or traumatic birth.
  • Take temperature daily for the first 5 days; twice daily if membranes were ruptured more than 12 hours before birth or in case of traumatic birth.
    • Oral temperature: 15min after ingesting hot or cold, or being in hot water. Put tip under and against tongue to 1 side of frenulum, close mouth and wait for the beep (or 5min for glass thermometer; remember to shake well before use)
  • Light movement is fine during the first 6 weeks. Any increase in cramping, bleeding, or discharge going from brown to red means you’re doing too much!

Uterus recovery:

  • In the first 1-2 days, gently massage uterus (back and forth motion) several times daily to ensure it’s firm like a grapefruit
  • Urinate often
  • Breastfeed often
  • Nothing inside the vagina

Pain:

  • Take arnica to aid with tissue healing
  • After-pains are due to the uterine contractions and tend to be stronger with subsequent pregnancies and during breastfeeding. Lay or sit, apply pressure (e.g. pillow) and heat (hot water bottle), take extra calcium, and consider calling midwife for homeopathy.
  • It’s safe to take acetaminophen (Tylenol x-strength) every 6 hours (for pain) and ibuprophen (Advil) every 4 hours for swelling for the first few days after birth
  • Avoid aspirin, alcohol, herbal supplements with willow-bark as they promote bleeding

Perineum:

  • Keep area as clean and dry as possible
  • Use peri-bottle of warm water and 1 dropper of calendula tincture after using the toilet
  • Wear the lightest pad necessary and change it with every visit to the washroom.
  • Apply frozen calendula pads to perineum/hemorrhoids several times daily for 2-3 days
  • If any tears/suturing to perineum, soak in a clean bath each day with ½ cup of Epsom salts or sitz-bath herbs added. Keep knees together as much as possible, including while walking or on stairs.  Airtime helps speed recovery.
  • Begin light elevator-Keigels and pelvic floor exercises

Nutrition:

  • Drink plenty of water and nutritional drinks, including Pregnancy Tea Blend
  • Eat whole foods – 3 meals and 2-3 snacks daily (just like during pregnancy)
  • Continue prenatal vitamins, acidophilus, essential fatty acids for at least 6 weeks
  • Continue or begin to take iron supplements if they were prescribed

Normal Postpartum Care – Baby

  • Feed when the baby wants but a minimum of every 4 hours around the clock (see “breastfeeding” below). A breastfed baby shouldn’t be offered anything other than breast milk/ colostrum.
  • If baby’s definitely satiated and still wants to suck, it may save nipples to offer a clean pinkie; insert to first knuckle, pad up.
  • Keep the cord-stump dry (fold diaper below) and clean. No need to put anything on it, but calendula tincture is acceptable.
  • When changing diapers wipe from front to back, only once per cloth. Clean folds of skin but do not open genitals and never retract foreskin.
  • Clean baby’s hands, folds in neck, and face with a clean damp cloth daily
  • Bathing is recommended only once or twice weekly with gentle and “edible” soap
  • If fingernails are long then prevent scratching by cutting with newborn-clippers or gently chew them off
  • Keep the baby at a comfortable temperature. If concerned take baby’s temperature.  Put the end of the thermometer at deep centre of armpit, then the hold arm against side until thermometer beeps (or 5min for glass; remember to shake well before use).
  • For plugged tear duct gently but firmly press at the inner bridge of the nose with the pad of your finger beside the baby’s inner eye. Stroke up to remove blocked material, then downward 3 or 4 times to the nostril.  Repeat several times daily until it clears.
  • Sleep with the baby in your room. Baby should sleep on her/his back, on a firm surface away from puffy blankets and pillows.

Breastfeeding

  • Feed baby frequently, usually 10-12 times/24 hrs after first day or so. Baby may have long periods of sleep in the first 24 hrs so may feed less frequently. Feed the baby on cue, minimum every 4 hrs or so. Babies usually nurse for 15-20 minutes.
  • Baby’s mouth WIDE open before latching! If painful, retry the latch over and over until it’s correct.  This will prevent sore nipples. Don’t do even 1 feeding with improper latch.
  • Should feel a pull but not a pinch
  • Breast well supported in one hand, where an underwire goes, away from nipple
  • Baby position: skin to skin, belly to belly, nose to breast, pull in very close so that very little/none of areola is visible, with both baby lips open (not tucked in).
  • Nipple care: Expect nipples to be tender for a few days.  Express colostrums onto nipple /areola after each feed. Allow to air dry.  Do not use soap or chemicals on nipples.  In case of chaffed or dry skin, Lanolin or pure vitamin e-oil can be used (but try the colostrum first).  Change nursing positions
  • If breasts get engorged with milk (hard and full-feeling), apply refrigerated green cabbage leaves, and reapply new ones as they “cook”
  • Avoid the use of pacifiers or artificial nipples

PLEASE CALL IF YOU’RE TEMPTED TO USE FORMULA IN SPITE OF PLANNING TO BREASTFEED

Angie The Doula – Complications and Congenital Issues

It’s one of the worst prenatal scenarios parent-to-be’s may have to face – being told their baby will have complications or congenital issues (a disease or physical abnormality present from birth). Complications can range from a variation of normal (e.g. extra digit) to one that’s moderate but can be managed with medical care (e.g. club-foot, cleft lip/palate) to something that can range from mild to having the potential to completely change a family’s life (e.g. Down’s syndrome, spina bifida). 

This article addresses some considerations for families that are expecting a baby with complications.

How severe will the Complications and Congenital Issues be?

With the testing and ultrasound schedule commonly recommended during pregnancy, surprises are uncommon. In most cases of complications, people are made aware before the baby is born.  

Until the baby is born, it’s impossible to know for sure what the severity will be. It’s important to maintain hope and a connection with your baby. Dr. Sarah Buckley writes extensively on prenatal screening, which includes false positives (a screening or test result showing an issue when there isn’t one). In that case, a suspected problem is found to be non-existant or milder than expected. 

I’ve seen several of my clients go through this terrible roller-coaster, waiting for news, expecting the worst, and then finding everything is normal on the next ultrasounds and at the birth. It’s hard for them to ever believe their baby is OK. When parents-to-be are in limbo like this, it can lessen their attachment with their unborn baby, even after further testing confirms all is well. 

Photo by Topato at Flickr. This file is licensed under the Creative Commons Attribution 2.0 Generic license.

What do I need to be aware of?

As you learn about a condition, the list of risk factors can leave parents – especially the pregnant ones – feeling like they are to blame. Find a counsellor or other parents in the same situation to help you work through these feelings. In many cases, no one is actually to blame.

Another sad reality about having a baby with complications is that it can be very hard on the parents’ relationship. Knowing that ahead of time can allow you to find resources, strategies and counsellors to help. 

Keep in mind:

  • You can have a smart, beautiful, amazing baby that happens to have a congenital complication.
  • Many humans far surpass the limits put on them by stats and well-meaning medical care providers. Don’t limit your child! Their environment and how they’re treated can really make a difference in how their potential plays out. (Of course, that’s true for most children.)
  • Focus on your child’s strengths while also being aware of their circumstances.
  • There are countless people living normal productive lives and accomplishing great things in spite of being told they’d never be able to do it…
  • Healing and thriving happens in the community. Humans are not meant to fly solo. 
  • Almost all parents struggle with worry, exhaustion, uncertainty, feel the pain of their child when they’re unwell, are learning to navigate life with a baby, love their baby and will do anything for them, have hopes and dreams for their child. This is common to parenting no matter if your baby is healthy or not.

To Prepare:

  • Seek out support groups – in person or online. Social media can be a bit of a minefield and provides a much different experience than a setting where you connect with actual humans. It can be scary, especially for introverts, to join a group but most people are glad they did so.  
  • Find an excellent online resource or two – not 10!  
    • Good sites will describe the condition in clear, understandable and kind terms.
    • Those sites will have a section directed at parents
    • Links to articles and resources that resonate with you
  • Look at images online, only from those vetted sites, so you’ll know what to expect
  • Find out what the policy is at your birth-place regarding family bonding and skin-to-skin contact in case of known complications, and yours specifically.
  • Learn about local resources from your medical community. Many places have an excellent team of social workers, occupational therapists, medical people, therapists, geneticists that can help you navigate.
  • Find out about social and government resources. You may be eligible for grants, programs, respite plans, and all manner of assistance available for families that have extra challenges related to a child with complications. Sometimes they’re hard to find.
  • Learn as much as you can about the complication:
    • Best and worst-case scenario / mild to severe case
    • Learn the language – technical terms, acceptable language
    • What future treatments might your child need? When? Is treatment invasive or painful? Is it necessary?
    • You have choices!  What does the future hold for your child without treatment or by taking a different approach?  

How can I manage my Baby’s health?

You will be your child’s best advocate and may have to become somewhat expert in their condition. Keep a binder or digital folder of every test-result, procedure, appointment. Also, have a section for resources. Do not assume every medical care provider you meet knows the full picture of the specifics of your child. 

If necessary and if you’re able, look outside of your own geographical region for treatment options.

What words and terms should I use?

The way people talk about your baby can be unknowingly hurtful. It helps everyone if you address this with those close to you. Many people want to be helpful or at least respectful but don’t know how. They tend to either stay away or blunder through, possibly adding stress or misery to your situation. 

Here are some suggestions you can share:

  • Use language that puts the human first e.g. baby with Down’s Syndrome
  • “Birth defect” is inappropriate. Terms that might feel better: Complication, congenital disability, variation of normal, congenital abnormality. 
  • A list of acceptable terms in general and for specific issues:  https://www.ncbi.nlm.nih.gov/books/NBK64884/ 

Prepare a cheat-sheet for loved ones and those that will be in your child’s life.

  1. Unacceptable terms
  2. Acceptable terms
  3. What makes the condition better and worse
  4. Special treatment the child may need e.g. can’t digest a certain food, needs a special baby-carrier
  5. What can they do that’s normal? e.g holding the baby won’t hurt them
  6. What you need – how can they help? How can they normalize life?
  7. Welcome them to visit or participate in your child’s life
  8. Links with more information
  9. Success stories, anecdotes

Online Resources:

Cochrane Review – https://www.cochrane.org/ the gold standard for reviewing and analysing medical research 
Stanford Medicine https://med.stanford.edu/ 
Johns Hopkins Medicine https://www.hopkinsmedicine.org 
Mayo Clinic https://www.mayoclinic.org/ 
Health Link British Columbia https://www.healthlinkbc.ca/ 
March of Dimes:  https://www.marchofdimes.org/complications/ (trigger alert: great info but some harsh language)

I teach a variety of Child Birth Education classes and prenatal workshops online for people all over.  I have been a birth doula since 2002, and have helped over 300 clients with their births and over 1000 through prenatal classes. Learn more about my birth doula services, and contact me with any questions you may have.

Baby Movements / Fetal Kick-Counts

Awareness of your baby’s movement is an important and non-invasive assessment of fetal well-being.  Basically, activity is reassuring and decrease or cessation is worrisome.  “Kick count” is the counting and tracking of fetal movement – kicks, flutters, swishes, jabs or rolls.  Mothers learn normal patterns for their baby such as sleep cycles, times of activity and triggers.  It’s also a way to bond and connect.

If you’ve been busy or are unsure about movement relax and have a meal, a small glass of juice or some fruit.  Palpate your baby to induce movement.  Pay attention to the movements.  Babies sleep.  If your blood sugar is low then so is your baby’s.  You should feel at least 10 movements over 2 hours (it usually takes much less time), and at least one movement in the first hour.

Keeping a journal of kick counts beginning at 28 weeks provides valuable information.

Instructions

  • Be properly hydrated and fed.
  • Ideally start the kick count at about the same time daily; think of it as a baby-date.
  • Rest when you do the kick counts, by sitting or lying on your left side.
  • Note the date, start time and the time at which the 10th movement takes place.
  • Calculate the total time for 10 movements.
  • Keep notes in the same place to see patterns emerge. Any method works.  Below is an example of a chart and one of a log.

Contact your midwife, doctor, or go to the birth unit at your local hospital immediately if:

  • You have followed the recommendations above and have not felt 10 kicks in 2 hours.
  • There’s a significant change in the pattern over the 3 to 4 days.
  • Your baby has a significant or sudden change in movements.
  • You have concerns.

Example of a Kick Counts Log
Note the date/week of gestation, and start time.  Count or jot down a √ or x for 10 movements.  Note the finish time, and total time.   Keep an eye on patters with the total time.

Week #32
Mon 9:00 XXXXXXXXXX    9:32         Total: 32 min
Tues 12:00 XXXXXXXXXX    12:45     Total: 45 min
Wed 9:00 XXXXXXXXXX    9:55      Total: 55 min
Thurs 9:00 XXXXXXXXXX    9:45      Total: 45 min
Fri 9:30 XXXXXXXXXX    10:05      Total: 35 min
Sat 9:15 XXXXXXXXXX    10:05      Total: 50 min
Sun 10:00 XXXXXXXXXX    14:15      Total: 4 hr, 15 min

Note the significant change in total time.  In this case you would seek medical attention on Sunday.

Kick Count- Blank Tracking Sheet (pdf)

Kick Count Chart – example (pdf)

 

Golden Nuggets for Breastfeeding Early Days

Some little-known gold nuggets for breastfeeding in the first days (you may wish to print this and stick it on the fridge or by your feeding-nest):

  • Breastfeeding may take practise but is designed to work
  • Watch for feeding cues* and offer breast.  Crying is considered a late sign of a stressed babe.
  • Offer one cue, then pause to let babe work it out.  E.g. nipple to baby’s lips, then pause for 5 seconds to allow babe to sort out latch.  If she needs another cue, then give on, pause, and repeat if needed.  Baby is learning too.
  • Babies rest/pause with eyes closed.  If babe stops sucking but stays on breast, let him rest and resume feeding.  He’s likely not actually sleeping, so don’t take him off.  (Sleep test – lift and drop arm.  Sleeping baby’s arm will fall; wake baby’s arm will respond.)
  • You should feel a tug or pull, but no pinching.  Avoid the temptation to feed through a bad latch, no matter how demanding baby is.  Not even once!!  Break the seal (insert pinkie into babe’s mouth) and start again.  Even if it takes 10 tries.
  • Don’t hold baby’s head while feeding.  It may be sore from birth.  Sore or not, the stimulation causes baby to pull back from breast.  Hold head by putting hand on bones at top of neck if necessary.
  • Don’t “pet”, rub, stroke babe while feeding.  Holding and feeding baby is an act of big love in and of itself.  (Imagine if you were trying to enjoy a fine meal, and someone was petting and rubbing you all over.  Ok that might be fun, but not conducive to eating.)
  • After 3-6 weeks the effort of breastfeeding becomes way less than the effort of formula.  Keep going – it gets easier and is worth the early efforts.

Best Start has an excellent 1 page chart for the first days –  feeding guidelines, newborn stomach size, diapers and other info.  Print this!

* Here’s a great graphic to help you identify visual feeding cues.

 

 

Feeding Baby in the First Year

A baby’s nutrition in the first year has life-long effects.  Inadequate nutrition is responsible for more than 35% of child-deaths, and higher rates of illness and developmental delays (World Health Organization, 2009).  Even in affluent North America babies and children are malnourished, often due to misinformation and poor food choices.

Health Canada (2012):  Breastfeeding – exclusively for the first six months, and sustained for two years or longer with appropriate complementary feeding – is important for the nutrition, immunologic protection, growth, and development of infants and toddlers.  Several international health organizations such as UNICEF, WHO, and the American Academy of Pediatrics make the same recommendation. 

Birth to 6 months
Babies should be exclusively breastfed until at least 6 months of age. There are no nutritional benefits to early complimentary feeding, only risks.  Babies who are only partially breastfed (i.e. supplemented with formula or other liquids or solids) in the first 6 months are healthier than those who are not breastfed at all, but risks are significantly higher than in exclusively breastfed babies.

If you think your baby is ready for solids before 6 months then please see section below regarding signs.

Benefits of breastfeeding, i.e. why formula should be used only as medicine
Human breastmilk is uniquely designed for human babies and contains all the required nutrients.   It’s the only thing an infant’s gut is designed to digest and assimilate until at least 6 months of age.  Breastmilk contains substances that augment the immature immune system, and aid in digestion and absorption of nutrients.  Anything else is likely to ferment, lead to gas, colic, poor nutrient absorption (malnourishment), illness and food-allergies.

Babies who are breastfed:

  • Decreased risk of SIDS, less likely to die of other causes in first months
  • Lower rates and severity of diarrhea and pneumonia
  • Lower rates and severity of ear-aches, flu, meningitis, bladder infections, respiratory illness, and other acute infections
  • Decreased risk of childhood leukemia
  • Decreased risk of long term chronic illness such as asthma, diabetes, gastro-intestinal disease (celiac, ulcerative colitis, Crohn’s), cardiovascular disease, obesity
  • Higher cognitive function / greater intelligence

Benefits of breastfeeding to mother include decreased risk of post-partum hemorrhage, breast and ovarian cancers, late-onset diabetes, and heart disease; faster loss of weight gained in pregnancy, and delayed return of fertility (although this is not necessarily a birth-control method).

6 to 12 months
Baby’s weight / size has nothing to do with readiness for solids.  At 6 months a baby’s digestive & immune systems have developed enough to introduce solids.  Earlier is correlated with allergies, digestive problems, immune problems, and obesity.  After 6-8 months caloric and nutrient needs exceed those provided by exclusive breastfeeding.  Further delay of complementary foods may stunt growth.  Start with breastmilk then finish with solids from 6-12 months.  Do encourage – but do not force nor coerce – the baby to eat.

STEP-1:  6 months, or whenever baby shows interest in food (whichever is later)
Offer breast-milk first then finish the meal with solids.  Introduce 1 food at a time for a few days, in small amounts, and then try another.  This helps the caregiver be aware of allergies or intolerances.  Simple, natural, pureed, unprocessed, organic – whole foods, like they came from earth.  There’s no need to buy special baby food – healthy family food, properly prepared, is just fine.

  • 200 kcal/day (in addition to about 400 kcal breastmilk) of mushy or runny foods
  • Offer 30-45 ml (2-3 tbsp) food per feed, at 2-3 meals daily
  • Pureed, raw or lightly cooked, non-citrus fruits e.g. apples, pears, bananas, blueberries
  • Cooked & pureed veggies – start with avocados, roots (carrots, yams, beets) and squashes
  • Cooked whole gluten-free grains (rice, quinoa) or oatmeal
  • Egg -yolks (yolks are usually not an allergen; whites may be)

STEP-2:  7-8 months, or 1 month after beginning step-1 (which-ever is later)
Continue with step-1.  Increase portions gradually up to 125-250 ml (1/2-1 cup) per meal and the following:

  • As child grows used to solids can also offer 1-2 snacks daily
  • Organic meats, pureed
  • Other cooked, pureed veggies
  • Can start combining foods that are tolerated

STEP-3:  8-10 months, or 1 month after beginning step-2 (which-ever is later)
Continue with step-2 and add:

  • 300 kcal/day (in addition to about 400 kcal breastmilk) of mashed food or finely chopped that baby can pick up
  • Offer 125-250 ml (1/2-1 cup) per feed at 3-4 meals daily, and 1-2 snacks if needed
  • Whole eggs
  • More variety

12 months and beyond … or 2 months after beginning step-3 (whichever is later)

  • See general recommendations below
  • Baby can eat regular family foods but watch for allergy or sensitivity
  • 550 kcal daily (in addition to about 350 kcal breastmilk)
  • 175-250 ml (3/4-1 cup) per meal for 3-4 meals daily and 1-2 snacks
  • Continue to breastfeed until 2 years of age

Signs that baby’s ready to start complimentary feeding
Solids can be introduced when baby shows signs of being ready, but only after 6 months of age.  Some babies take longer than 6 months but most are ready for solids by 8 months.

  • 6 to 8 months of age
  • Can sit unsupported
  • Doesn’t automatically push solids out of mouth with tongue (a reflex present until at least 6m in most babies)
  • Willing and able to chew
  • Can pinch or pick up food or other objects between thumb and forefinger
  • Eager to participate in mealtime
  • Shows interest in food – e.g. reaches for food at mealtime, crawls to dog’s dish to steal food
  • Long-term increased need to nurse, unrelated to illness, teething pain, stress or growth spurt
    Note: this is only an indication if other signs are present; not a sign on its own

If baby shows signs before 6 months

Eagerness to engage in mealtimes doesn’t mean ready for solids.  It’s likely a social behaviour rather than a physiological one.  Baby can be included in family mealtimes without eating solid foods.

  • Join the family at mealtime in a lap, booster seat or high chair
  • Give a sippy-cup containing some expressed milk (if baby is more interested in playing with the cup than drinking the contents, you may wish to use water instead of valuable pumped milk)
  • Provide baby-safe cutlery and dishes to play with
  • Give baby an ice cube (baby-safe size & shape) or ice chips to play with
  • Offer a cube, popsicle or slushy frozen breastmilk to eat with a spoon

Food intolerance or sensitivity, allergy
Common allergens include soy, wheat, dairy, peanuts, egg-whites, food colouring, corn, citrus, strawberries, raspberries, kiwis, pork and shellfish.

The following correlate with food intolerance or allergy:  mucous conditions, ear infections, runny nose, rashes (including diaper rash), colic, green stools, digestive issues (diarrhea, constipation, gas, vomiting), undigested food in diaper, asthma, wheezing, and /or behavioural changes after eating given food.

Safety precautions

  • Proper food storage and handling
  • Foods that are choking hazards; can block or wedge into wind-pipe
    • Hard and small sized, smooth / sticky solids g. popcorn, meat chunks meat, hard pieces of fruit / veggies, candies, hot dogs (unless cut lengthwise and cubed), gum, whole nuts and seeds, fruit-pits or seeds, cough drops, raisins, fish-bones, food on toothpicks or skewers.
    • Thick creamy texture e.g. a blob of nut-butter
  • Always supervise infants when they eat or drink
  • Mealtime supervisor should be familiar with baby’s chewing and swallowing abilities
  • Upright and secured position
  • Do not allow baby to eat while laying, running, walking, distracted, nor eat in the car
  • Avoid sharp objects
  • Take an infant / child choking & CPR class to be prepared in case of choking

General Recommendations

  • Organic, whole foods i.e. how they come from nature e.g. baked potato rather than French-fries
  • Purified water, if water is used
  • If juice is used, then fresh & home-made
  • Baby stomach is about the size of her/his fist – portion accordingly, considering breastmilk
  • Take time for eating patiently – meal time should be enjoyable
  • Feed infants directly and assist older children when they feed themselves
  • Feed slowly and patiently, and encourage children to eat, but do not force them
  • Variety of foods
  • Iron fortified food or easily digestible supplement (e.g. Floradix) in case of immediate cord clamping or anemia
  • Whole spectrum salt – Himalayan, Celtic
  • The Kidco Food Mill is a brilliant device for creating baby food on the fly. It’s affordable, simple to use and easy to clean.
  • Ice-cube trays make perfect infant-sized meals – nice to have on hand for child-care or those busy days that run away from us. Puree a few foods and freeze for later use.  Best for 1-3 months in fridge-freezer, and 6 months in chest-freezer.

Avoid

  • Foods that are choking hazards; can block or wedge into wind-pipe (see “Safety”)
  • Common allergens (see intolerance section), foods with family history or allergies, or that baby reacted to in mother’s breastmilk
  • Processed foods – fried, unhealthy fats, high-sugar e.g. chips, crackers, French-fries
  • Chemical additives
    • Fluoridated water, artificial colours & flavours, MSG, aspartame & derivatives
  • Unpasteurized honey, as it may contain spores that can be life-threatening to baby (after 1 year these have no effect on a mature digestive system)
  • Sugary drinks – pop, store-bought fruit-juices
  • Caffeine – coffee, tea, chocolate
  • Under-feeding – babies let us know when they’re hungry (crying, fussing, listless); avoid portion-control as needs change e.g. growth-spurt, immune system fighting a bug
  • Rushing through eating
  • Avoid distractions
  • Strong tastes – spicy, salty, overly sweet
  • No store-bought goat/cow milk until 8-10m of age, and only if child has no sensitivities (but it’s best to avoid non-human milk at all stages of life)

Special Circumstances
In the rare case that a mother is not able to breastfeed her baby, the following options can be considered.  They’re listed in order of healthiest to least.

  1. Pumped mother’s milk, if inability to breastfeed is due to a “mechanical problem” e.g. cleft-palate
  2. Fresh donor milk e.g. close relative, friend in the community (not recommended by public health due to worries about disease transmission)
  3. Frozen human milk from milk-bank
  4. Home-made formula (this is not recommended by public health regions) with added high quality probiotics and fish-oil / ω-3 EFA
  5. Organic formula from a reputable company with added high quality probiotics and fish-oil / ω-3 EFA
  6. Regular store-bought formula with added high quality probiotics and fish-oil / ω-3 EFA

Note: if the inability to breastfeed happens after 6m (e.g. medical problem) then it’s preferable to start on real food and purified water rather than store bought formula (World Health Organization, 2009).

 

References

Gaskin, I. M. (2009). Ina May’s guide to breastfeeding. New York: Bantam Books.

Hass, E. M. (2006). Staying healthy with nutrition. Toronto: Celestial Arts.

Health Canada. (2012). Infant feeding. Retrieved from Health Canada (Government of Canada): http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/index-eng.php

KellyMom. (2011). Is my baby ready for solid foods? Retrieved from Kelly Mom Parenting & Breastfeeding: http://kellymom.com/nutrition/starting-solids/solids-when/

La Leche Leage International. (2010). The womanly art of breastfeeding. Ballantine Books: New York.

Ochoa, S., & Kline, A. (2011). BIOL404 Chemistry & nutrition student syllabus. SLC: Midwives College of Utah.

Stuebe, A. (2009). The risks of not breastfeeding for mothers and infants. Reviews in Obstetrics & Gynecology , 2 (4), 222-231.

World Health Organization. (2009). Infant and young child feeding – Model Chapter for textbooks for medical students and allied health professionals. Geneva: WHO Press.