In honor of National Car Seat Safety Week here are the 10 most common misconceptions caregivers have with car seats. Please find a clinic to have your car seat(s) checked to make sure they and your child are properly secured. Check out our Certified Car Seat Installation service, we can meet you anywhere within our service area. It REALLY can make the difference between life and death!

1. What do you think the most common question parents ask about car seats?
“What is the best car seat?”  We would assume the most expensive one or the one with the most bells and whistles would be best.  In actuality, the best car seat is the one that fits your child, fits your vehicle, and you can install it correctly every time.  Is isn’t necessarily the most expensive.

2. Where do you think car seat straps should be?
I have four kids.  When I went through the car seat certifying class, this was one thing I had never heard before.    Do you think they should be below, at, or above the shoulders?  It actually depends on what kind of car seat.  For rear facing, the straps should be at or below the shoulders.  For forward facing, the straps should be at or above the shoulders.

3. Do you uses the LATCH system (I’m not talking about a breastfeeding latch)?
(If you have no idea what it is, it stands for Lower Anchors and Tethers for Children. Go here for a further explanation)Two of the most commonmistakes are about the LATCH system and how it works.  Do you think it is safer to use both the seat belt and LATCH system together?  Do you think you should only use one?  You would think, at least I did, using the LATCH system and the seat belt together, should double protect the child, right?  Nope, using both together actually compromises the other.  You should only use one belting system.  The next logical question is…….

4. “Which one is the best?”
Whichever one can be properly used each time you put the car seat in the vehicle.  This goes along with using the LATCH on the outboard seat positions.  The safest place for a car seat is the center position.  Some vehicles only have LATCH on outboard positions.  If this is true, a properly used seat belt is safer in the center than LATCH on the outboard.  Some cars only have LATCH in the center position so if you have more than on child, using a seat belt is more realistic.  Because of the various models of cars, it’s best to check the car manual for the most accurate information on how LATCH works for your car.  Just remember, you can’t share the hooks.  Only one clip per hook.

5. The one message I want to shout from the mountain tops.  I tell EVERYONE who has a baby.  Keep your baby rear facing as long as possible. If you choose an infant seat as your first car seat, purchase a convertible one next.  It can handle more weight rear facing and then you can turn it forward facing once the child has reached the maximum rear facing weight.   My 16 month old is still rear facing in a convertible seat. Usually people look at me like I have grown another head and I hear the “Yea, but the law says 20lbs and 1 year old”.  It is almost like a rite of passage for the family to forward face the baby.  I tell them, if you saw the crash test difference between the same size child rear facing versus forward facing, you will keep your child rear facing until their legs are crossing.  Children have died from being forward facing when they could/should have been rear facing.  The state law is the minimum, but not necessarily the safest.  That rear facing baby is the safest person in the car.

6. How do you know when the straps are tight enough?
My personal philosophy, when they are buckled in and tightened, give it one last tug.  My husband always tells me how uncomfortable our child must be.  My response, “they aren’t crying so it must not be painful.”  Do you want to know the test to tell if the straps need another tug?  Try to pinch some slack up at the shoulders.  If you can pinch any slack, tighten it up.  You shouldn’t be able to pinch any slack.

7. Where do you think the retainer clip should be?
At the nipples or at the arm pits?  Correct answer, at the arm pits.  You want the child snug.  If there was a crash, you don’t want the child slipping out the top and flying out the top.

8. For older children wearing seat belts with or without a booster, the proper placement is crucial. It is important that the belt hits the 2 strongest parts of the body.  The shoulder strap should hit the shoulder.  The lap portion should be over the hip bones.  This is also true of an adult. Make sure to adjust the belt every time you put it on and remind older children each time you get in the car to correctly adjust their belt too.  If the belt is close to the neck, the child needs to be higher in the seat. If the child is legally ready to go without a booster and the belt is too close, they aren’t safely ready to retire the booster seat just yet. For a pregnant mama, make sure the belt is at the shoulder and the lap belt is under the belly across the hips.  We do not want the lap belt across the belly because in the case of a crash, the unborn baby can be severely injured or killed.  Seat belt safety for kids starts when they are still growing inside mommy.

9. One of the biggest misconceptions is how tight the car seat needs to be buckled in. Did you know it can move up to 1 inch?  Most people grab it at the top to test it.  It actually needs to be tested at the belt path.  Give it a little shake.

10. We must  be very conscious of what we have in the car as well as what is around the baby. We want the baby as close to touching the back of the car seat as possible.  If it’s cold, buckle in the baby then put the blanket over them.  Many times our newborns are too small for even an infant seat.  It is ok to roll up receiving blankets and place them around the child and in between their legs (create an upside down U shape where the sides of the blanket are on each side of the buckle).  Also, with some cars, getting the right angle of the seat can be a little tricky.  Having the perfect angle is incredibly important with a newborn.  They don’t have the head control yet and depend on the seat to give them that.  If the baby is tipped to far forward, it can cut off their airway.  This is why we aren’t supposed to keep them in their seats to sleep or for a long period of time.  To get that perfect angle, we use pool noodles.  You can cut them to the perfect length for your car and place them in the crease or byte of the car.  Keep in mind every loose object in your vehicle can become a projectile during a crash.  I will spare you the math of figuring out how fast something can travel.  Look in your car, pick up a loose object, and imagine someone throwing that at your head as hard as they can.  Many people are killed in crashes by projectiles rather than from the actual crash.

Let me know if you have any questions.  I’d be more than happy to answer them!

We know that pregnancy isn’t a condition and we CAN lift a box, really I promise, we can!  It’s actually good for us, really!  We know how important exercise is to our overall health, but what is ok while we are growing a little one?  Heather Johnson at Nurtured Moms, a doula service in the Gresham and Greater Portland Oregon area, has done some research for you.  Here is what she has to say…….

I’m a runner, and I remember being SO worried about losing my running fitness when I became pregnant with my daughter. One of the first things I asked my OB was whether or not I could keep running. Fortunately, she thought it was a great idea, and even encouraged me to continue my regular workout schedule. I kept running until I was about 26 weeks and my belly became too cumbersome; at that point, I climbed on the elliptical trainer and continued working out until the day my daughter was born. The fitness paid off big time: the difference between how I felt at the end of my second pregnancy — worked out every day — and my first — gave up the workouts and gained 70 lbs. — was astounding. I had plenty of energy, felt great, and the swelling and back-aches were minimized. Not only that, but I was back to my pre-pregnancy weight by the time I came home from the hospital (before you start hating, remember this weight includes the weight I never lost from my first pregnancy).

Evidence for Exercise Throughout Pregnancy

Obviously the carefully compiled anecdata of one pregnant woman does
not constitute scientific evidence, but there is, in fact, actual evidence that seems to point to exercise being a great thing for people in general, and pregnant women in particular. One study of 131 women, published in the American Journal of Obstetrics and Gynecology, found that women who continued a regular running or aerobics program had shorter labors and less frequent fetal stress than those who discontinued their exercise program in the first trimester. While their labors tended to begin earlier (277 +/- 6 days gestation vs 282 +/- 6 days), the exercise group had similar rates of pre-term delivery and also had a lower incidence of surgical delivery than the non-exercise group.  Unfortunately, most of the studies on pregnancy and exercise are small. The one Cochrane Review of the subject concluded that, while there is evidence that pregnant women who engage in vigorous exercise at least two to three times per week improve or maintain their physical fitness and that — contrary to what was once thought — prenatal exercise does not cause pre-term labor, larger studies are needed to be more definitive on the subject.

In spite of the dearth of evidence, the American College of Obstetrics and Gynacology (ACOG) has decided there is enough to recommend that ‘‘[i]n the absence of either medical or obstetric complications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is recommended for pregnant women.’’  But what makes for a good and safe workout?

The FITT Principle of Training
One of the best ways for anyone, not just pregnant women, to exercise safely is to follow theFITT principle of training, which stands for frequency, intensity, type and time. Pregnant women can use the following guidelines, adapted from a study published in Current Sports Medicine Reports:

Frequency
Your body needs time to recover between any kind of exercise, both cardiovascular or resistance-based. For a sedentary woman, 3-4 sessions of cardiovascular exercise a week is probably an appropriate frequency, where a woman who has been exercising regularly, 4-5 times may feel better. An elite athlete would probably be fine training 5-6 times a week, but even she would need to make sure her body has time to rest. When it comes to resistance exercise, or lifting weights, it all depends on what you’re doing. If you’re doing a full body workout each time, you will need to leave a day of rest between sessions. I like to break up my resistance workouts and do one body part on each day. This means I can lift five days a week and still give my muscles the rest they need between workouts.

Intensity
Intensity is a measure of the amount of effort you are exerting when you exercise. You can measure this in a couple of different ways; you could rock a heart rate monitor, or you could use something like the Borg Rate of Percieved Exertion Scale, which is easier for those who are not technically minded (and also free!).  For sedentary women, working out with a rate of perceived exertion (RPE) of moderate to moderately hard would be appropriate. For women who are used to exercising, an acceptable range of RPE would be moderately hard to hard. For an elite athlete, a hard RPE or heart rate of 70%-80% of maximum would probably be fine.

Type
Type refers to the kind of exercise you choose in order to achieve the results you want — in this case, health and fitness. In order to improve your fitness, you need to choose exercises which are continuous in nature and use your large muscle groups, like running, cycling, circuit training, walking, etc. Novice exercisers should choose something low impact, like walking, biking, or swimming. Women who are already into fitness and elite athletes should also choose low impact exercises when trying something new, but can probably safely continue any exercise their body is already used to, such as running or dancing. In general, as long as your body is feeling good while you’re doing it, an exercise is probably ok.

Time
Time is pretty self-explanatory — it refers to the length of time spent on any given workout. Beginning exercisers should start with no more than 30 minutes, but can increase that time slowly if they feel comfortable. Regular exercises will probably do well with 30-60 minutes of continuous exercise, while elite athletes can tolerate 60-90 minutes.

When Exercise is Not Safe in Pregnancy
While they promote exercise for most pregnant women, ACOG does leave some women out. In their opinion on exercise during pregnancy, there are some absolute contraindications to exercise and also some relative contraindications.

Absolute contraindications are:

• Significant heart disease
• Restrictive lung disease
• Incompetent cervix or cervical cerclage
• Multiple gestation with risk for preterm labor
• Persistent second or third trimester bleeding
• Placenta previa after 26 weeks of gestation
• Premature labor during the current pregnancy
• Rupture of membranes
• Pregnancy-induced hypertension

Relative contraindications are:

• History of sedentary lifestyle
• Intrauterine growth retardation
• Poorly controlled hypertension
• Poorly controlled seizure disorder
• Poorly controlled insulin-dependant diabetes
• Severe anemia
• Chronic bronchitis
• Maternal cardiac arrhythmia
• Poorly controlled thyroid disease
• Extremely overweight (morbid obesity)
• Extremely underweight (BMI 12 or lower)
• Orthopedic limitations
• Heavy smoker

Another important caveat they give — if you should encounter any of the following problems while exercising, stop immediately and contact your care provider:

• Vaginal bleeding
• Difficulty breathing before you start working out
• Dizziness
• Headache
• Chest pain
• Muscle weakness
• Calf pain or swelling
• Pre-term labor
• Decreased fetal movement
• Amniotic fluid leakage

In the absence of these conditions, exercise can be safe and enjoyable during pregnancy. There is an ever-increasing body of evidence in support of exercise during pregnancy, and for most women, it is clear that the benefits far outweigh any theoretic risks. The risks that may exist are small when proper guidelines and precautions are followed. And here is where I make my disclaimer: I am not a medical professional. Make sure you are seeing your health-care provider regularly and discuss any fitness regimen with her. As a your body changes throughout the pregnancy, you may need to to adjust your workouts to ensure continued safety. Happy Exercising!

Sources:
ACOG. Committee on Obstetric Practice. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion 267. Obstetrics & Gynecology 99:171–173, 2002.

Kramer, M.S. Aerobic exercise for women during pregnancy (Cochrane Review). In: The Cochrane Library, Issue 4. Oxford: Update Software, 2002.

Paisley T.S., E.A. Joy, and R.J. Price. Exercise during pregnancy: A practical approach. Current Sports Medicine Reports 2:325–330, 2003.

That age old debate, to be a stay at home mom or go back to work.  I recently came across a poll on a pregnancy website.  The question: Will you go back to work after the baby is born?  One of the options was ‘Yes!  I would get bored’ while at the other end was ‘I can’t afford to leave my job’.  I would venture to say those at the latter end would choose to stay home if they could.  It is amazing how many things can be cut from the budget to accomplish this (also, figure in crazy daycare costs).  It does take some sacrifice (what part of motherhood doesn’t?).  If it is important to your family, you CAN do it!  Our family certainly has for the last 7 1/2 years and we make below the average income for our area.  The following ideas are ones we use.  If you have some (other than coupon clipping because my bored meter goes through the roof), please share!

Here are some ideas:

- Become a one car family ( we were one for 7 years until recently).  Add up the cost of gas to and from work, insurance, up keep i.e oil changes, car payments, etc for that second car.  Also, the money you could make if you sell it.

-Cut back on cable.  I know what you are saying; WHAT?!  I WILL MISS _______(fill in the show)!!  There is netflix and the vast world of online viewing (fancast.com for example).  Trust me when I say, I don’t miss it much.  I find myself much more productive.

-Eat at home more.  What a gift to your kids to eat together with them in a calm setting where you don’t have to worry about how long they can be entertained.  Also, they can become more involved in the cooking process and possibly eat healthier because they get to help pick and and prepare the ingredients.

-Plan meals.  This is such a saver because you aren’t making those last minute trips to the grocery store for one item while coming out with a few bags full.

-Make your own coffee.  Not only cheaper but healthier because you control what goes in.  You can even get a variety of sugar free syrups.

-Buy children’s clothes second hand and shop Craigslist (it’s amazing what people sell and the deals!).

-Remember we want to raise well adjusted kids, so having all the latest and greatest isn’t the best for them anyways.  Teach them how to save and earn things they really want.  They will appreciate what they DO have more and will more likely be givers.

-Start a garden and plant those foods that are a little more spendy like blueberries and tomatoes.  It’s a perfect way for your kids to have an appreciation for healthy food and they understand where food comes from.  If they are a little older, perfect weed pickers (and a great way to earn some extra money)!

-Did you know that many generic items have the same ingredients as the name brand?  Want an amazing example?  We need seasonal allergy medicine in our house.  The name brand was almost $21, the generic brand (with the same ingredients and dosage amount) almost $6!

-If you have a gaming system, find some friends with the same one and trade games.

-Go to your local library and search out book on the subject of money/budgets to become an expert on your personal circumstances and goals.

Above all, remember your kids spell love T-I-M-E.  They won’t say you were the greatest because you gave them everything, they will say you are the greatest because of how many kisses, hugs, and games you played with them. When you start looking for creative ways to live a full, frugal life, they will find you! I promise because we are proof.

There are a few things I wish I knew then that I know now.  This is one of them.  I often wonder what her life would have been like.  What is “this” you ask?  The value of breastfeeding and where to go for support.

See, the journey with our little girl began quit rocky.  About 10 hours after her birth she was whisked to the NICU in a flurry of activity and we were left with no explanation other than that she was very sick and needed immediate care.  This chaos became our lives for her first year.  I had successfully breastfed our first child and thought round two would be cake also.  Because she was in the NICU, our bonding was interrupted and breastfeeding was a rough road.  I struggled for 2 weeks to breastfeed her exclusively after we came home.  This little child whom I was supposed to love and care for had me so flustered I wanted to give her back.  Yes, you did hear me right, I didn’t want her anymore.  I then felt guilty for feeling this way (a whole different journey).  After two weeks I called a friend beside myself with tears streaming down my weary face.  She encouraged me to buy some formula and give up breastfeeding because it had me so stressed.  I did.  I didn’t reach out for professional help (such as a lactation consultant), I did no research, nothing (I am ashamed to say).   This choice of formula created many more problems looking back in retrospect (20/20 always seem so clear, huh?).  To make a long journey short so you don’t get bored by the details, she ended on Nutramagin (a hypoallergenic formula) and we tried every medicine and technique to help with her projectile vomit to no avail.  She still has eczema, is the one who gets the most colds that last the longest, has digestion issues, and my only child to have enviromental allergies.  Granted, this poor baby had 3 blood transfusions and numerous tests/scans which we are sure compromised her little system, then not being breastfeed I am certain contributed to her current health.

Photo by Mike.HanlonLooking back, I wish I had sought more support from someone who was trained in postpartum issues and breastfeeding support, such as a postpartum doula or lactation consultant.  Knowledge is power and through my training to become a postpartum doula I have gained the knowledge that would have helped me back then.  I truly believe that first year would have been a more enjoyable time for the whole family.

I do not judge those who exclusively use formula.  I feel sad because I know they just don’t have the knowledge and are robbing themselves of such an amazing opportunity.  Did you know that breastfeeding causes the brain to release happy chemicals into your body?

Here are some amazing, evidence-based facts about breastfeeding that you may not have known(if you want the sources, let me know):

• There is less waste product produced from human milk i.e easier diaper changes.  In my experience, less, shall I say, pungent too.
• Zinc and iron are more effectively absorbed from human milk than from formula milk
• Breastmilk conforms to the needs of your baby.  A cold running through your house?  Your breastmilk will pump up the antibodies to help out babies little body.
• If your baby is premature, your breastmilk will have a makeup similar to colostrum for up to a month in contrast to a full term baby which is a couple days.
• Human milk has a laxative effect, while formula milk can cause constipation.
• Formula  fed babies have an increased risk for allergies and allergy related conditions such as eczema.
• Formula increases the sensitivity to infections which can result in the dreaded diarrhea.  Again, another practical easier diaper experience:).
• Babies weaned before 1 or formula fed have a higher risk of speech-language disorders.
• Diabetic mothers who breastfeed are more likely to need less insulin.
• Your belly shrinks quicker and you can zip up those jeans faster postpartum.
• The risk of osteoporosis goes up for mother and child when formula is used.

These are just SOME of the benefits for mom and baby.  Amazing, huh?  According to a Parent’s Network poll in American Baby, 32% of first time moms plan to use a lactation consultant, while 57% actually hire one.  If you are a first time mom or have had previously had breastfeeding difficulties, search out local lactation support before you birth so you are prepared if breastfeeding becomes a bumpy road.  Remember the portrayal of establishing  breastfeeding being this natural and easy process is just that a portrayal and not always reality.  Sometimes your body isn’t compatible with breastfeeding.  These instances are very few and very far between.  Most of us just need a little expertise to get us going.

To start you on your search:

• LaLeche League
• International Lactation Consultant Association
• Check your local hospitals
• Kelly Mom
• Search google or bing using lactation consultant or postpartum doula along with your city and/or state
• Ask other moms you know
• Find local support groups and check them out before you birth
• Near Portland or Salem? contact us.  Near Newberg or McMinville?  contact Laura Dunn
• Ask your Childbirth Educator

Those ideas should start you on your way to finding help locally.  I wish you all success in this amazing journey of bonding with your baby.  If you are local

I HAVE gone on since to successfully breastfeed two more children.  You can be successful too if that is your goal!

The birth world is all a twitter right now.  One of our roles as a doula is to provide evidence-based information to our clients when they have questions or concerns.  We (at least all the ones I have come in contact with) believe a woman’s body was made to birth a baby and only under special circumstances is a cesarean surgery needed.  Most of the time, the surgery is preformed because of lack of information to the pregnant mama.  If she knows the risk and benefits of her options, she is more likely to have a vaginal birth.  There are so many benefits to mama and baby after a vaginal birth versus a cesarean surgery.

ACOG (American College of Obstetricians and Gynecologists) just released an update on their stance about VBAC’s (vaginal birth after cesarean).  They now say “Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans…“.  Now the leading source of information doctors trust is on board with what studies have proven.  This is certainly a step in the right direction back to what birth should be, an empowering, joyous, natural experience.  Here is the full press release if you would like to read it.

The one aspect that has always concerned doctors is uterine rupture at the previous incision site.  While the risk is there, it is low.  Henci Goer (a leader in the birthing world) wrote a great article posted on iVillage about the facts of a VBAC from an evidence based view point.  This is what she had to say about uterine rupture:

Symptomatic scar separation: The main fear with labor after a cesarean is that the scar will open enough to cause bleeding or for the umbilical cord or the baby to pass through the opening. Among thirty studies totaling 56,300 VBACs, the rate of symptomatic scar separation was 4 per 1,000 (15,30). Even so, few instances where this occurs result in harm to the baby, which is the real issue. The perinatal mortality rate (stillbirths and newborn deaths together) from this cause was 3 per 10,000. This did not differ from the perinatal mortality rate of 2 per 10,000 in 29,900 planned cesareans. Nor does planning a cesarean eliminate the risk of the scar giving way. Several large studies reported scar separation rates ranging from 2 to 3 per 1,000 with repeat cesarean, not much less than the 4 to 6 per 1,000 reported in VBAC labors (17,21,30).

Now, the next step is preventing the need for a VBAC in the first place.  The more we speak up and are informed, the quicker we can create change.  Birth is natural and normal, not a condition to be treated.