Thursday, August 30, 2007

Breastfeeding in Public

I did it. I didn't whip it out and show everyone the facilities, but I didn't hide under a blanket, either. I learned to arrange my clothes and the baby so that I hardly ever flashed anyone. My oldest is in his mid-20's so it was a little less common then than it is now.

OK, it was a lot less common and people occasionally made suggestions that the bathroom was the most appropriate place for that sort of activity, because -- it's a body function.

I didn't get nasty with anyone. I just did the same thing I did with other unwanted parenting advice. I ignored them. After all, I didn't see THEM taking their plate into the bathroom to perform that bodily function in private.

We have a serious problem in this country, folks. There are still people who can say with a straight face, "It's a body function and should be private." They think their sensibilities are more important than the health and safety of someone's child.

I simply do NOT understand their problem. I know it's a cultural issue. They were raised to believe that breasts are for sex and that suckling = sex. For babies it equals food. The best possible food for babies - who can't wait until nobody with breast issues is looking.

"Nurse-ins" can be used to demonstrate that it is possible to breastfeed in public without unnecessary exposure - or they can be used as an in-your-face political statement that doesn't do much to further the cause of breastfeeding.

The breastfeeding statistics in this country are abysmal. The good news is that we're getting more than 70% of moms to at least try breastfeeding. The bad news is that most of them don't keep it up. Partly that's lack of support at the outset. Much of it, though, is lack of support - and sometimes outright hostility - when they get home.

Thursday, August 23, 2007

FDA Warning for Breastfeeding Moms

Last Friday, the US Food and Drug Administration released a warning for breastfeeding moms and their healthcare providers. A rare genetic tendency to metabolize codeine more rapidly than usual may put infants at risk. One infant death has been reported.

That mom was reportedly taking a relatively low dose of codeine when her 13 day old baby died of a morphine overdose. The mother was not taking morphine. She was taking codeine. It is normal for the body to change some of the codeine into morphine, but this should happen relatively slowly so that there is little risk to nursing infants.

Nursing moms need to pay attention to their babies whenever they are taking any medication or herbal supplement. A change in behavior, especially excessive sleepiness, lethargy, poor muscle tone, or difficulty getting baby to feed can indicate that the baby is getting an unhealthy amount of whatever you are taking. The same is true if the baby becomes very fussy, vomits, or has very tight muscle tone, color change, or increase in respiratory rate. Complicating matters, any of these can also indicate illness in a newborn.

Bottom line, if you are taking a medication, make sure it's approved for use with nursing babies (codeine is, in moderation). If your baby's behavior changes markedly - even if the medication is approved - check with the baby's doctor.

It is always possible to reach someone outside of office hours. If your baby's pediatrician hasn't given you other instructions, call the office phone number and leave a message with the answering service or follow the instructions on the office voicemail about reaching the pediatrician. If for some reason you cannot reach the pediatrician and/or you believe it is an emergency, the ER is open all the time.

Avoiding the problem? Take the codeine if you need it, but if over the counter pain medications like Tylenol or ibuprofen will do, that might be a better choice. Read labels. Some cough medications can contribute to the increasing morphine levels. If you're getting really sleepy after taking codeine, watch the baby extra-carefully.

Don't mix prescription pain medications unless your doctor tells you to. Many contain codeine and you could get a double dose. If you aren't sure what's in the medication, ask your doctor or pharmacist.

Your best source for information about medications and breastfeeding should be your doctor, the pediatrician, a lactation consultant, or a pharmacist, but here is a link with more information on breastfeeding and medications:

Dr. Thomas Hale - wrote the bible on the subject, called Medications and Mother's Milk. Make sure you're looking at the latest edition (12th). It's updated regularly and you shouldn't use a copy more than a year or 2 old. The differences can be huge. Absolutely do not waste your money buying an older edition.

has shared an excellent web resource it's called Breastfeeding and Parenting a site run by Kelly Bonyata, BS, IBCLC. She sources her information and tells you how current the information is.

The dates on many of the other links I found were nearly 10 years old. NOT ACCEPTABLE, in my opinion. The science on this changes. Yes, some medications are quite well studied, but you may drop a perfectly safe medication or "pump and dump" unnecessarily - or even put your baby at risk - if you don't have the most current information. Feel free to share any good CURRENT information in the comments.

Wednesday, August 22, 2007

Search terms - sometimes they make me laugh. Sometimes not so much.

"premature babies with blood on their brains, what do they do"

This one made me sad. They probably mean intraventricular hemorrhage (AKA interventricular hemorrhage). Bleeding into the ventricles can be relatively insignificant if there is only a little blood - but that depends on the location of the bleeding. Many babies with grade I or grade II IVH are completely healthy with no significant developmental delay - but not all.

Larger amounts of bleeding (grade III and grade IV) are more commonly, but not always, associated with developmental delays and cerebral palsy.

Sometimes there is so much blood in the ventricles that not enough fluid flows out of them. This causes increased pressure within the brain (hydrocephalus), which can also increase the risk of developmental delays. If the fluid persists, the baby may need a ventriculoperitoneal shunt placed. With the smaller babies, serial lumbar punctures (spinal taps) may be used to postpone shunt placement until the baby is large enough.

Sextuplet update

Actually, no news is good news at this point - and there isn't much. You won't be seeing the irate bloggers talking about litters for at least a few more days. Hopefully closer to 2-3 weeks.

Karoline Byler (more here) was admitted to the hospital over 2 weeks ago and is 28+ weeks now. The docs hope to get a few more weeks with medical management and bed rest, but the survival rate at 28 weeks is pretty good.

The Sodani family has been quiet, too. They should be about 27 weeks by now. The last update on Brian and Gracie's web site says that she's in the hospital - no date, but it's been there for a month or so.

The Masche's are all home and doubtless too busy to do much in the way of updates. I don't even see any new pictures in their photo gallery.

There hasn't been an update on the remaining Morrison baby. He was still in critical condition at the last update, nearly a month ago. He may well be in critical condition for another month. Possibly even longer. He was tiny and it takes a long time for those tiniest babies to outgrow their respiratory and feeding issues.

The families all still have their "how to help" links on their web sites. I hope they're getting what they need. I won't be contributing to any of the sextuplet families. There are plenty of families in need in my own community.

I also found a web site called MOST - Mothers of Super Twins.

This is how they describe themselves:

MOST is a network of families with triplets, quadruplets and more that provides information, resources, empathy and good humor during pregnancy, infancy, toddlerhood and school age

If I had the resources to donate outside my own community, I'd support their adopt-a-family program. With the upsurge in higher order multiples, people with 3-5 babies at a time just don't get the publicity (and the assistance) that they did a few years ago.

Friday, August 17, 2007

Is it possible to disagree about religion without calling names?

From a comment on a previous post:

your own child you would be willing to sacrifice to make a religious point.

To me, that is religious fanaticism.

Throughout the ages, people have been willing to die for their beliefs -- and yes, to allow their children to die also. I wouldn't call someone a religious fanatic simply because I disagree with them. To me a fanatic is willing to have someone over whom they should have NO control or responsibility die for their beliefs. Religious wars through the ages, some of the current terrorist acts, and many of the deaths during the Inquisition fall under that heading.

I am responsible to my God for my children. They are gifts from Him and I must answer to him for choices I make in raising them.

I realize that other people do not consider embryonic stem cell research to be evil. I believe that it requires destroying a living human. I would no more accept for myself or my child the results of that research than I would accept a donor heart from a living, breathing fully functioning human being (we're not talking brain death, here).

As I stated in a comment to that prior post. To me, the difference between the Jehovah's Witness believe about the proven benefits of transfusion and my belief about any theoretical benefit of embryonic stem cell research is that nobody dies when they donate blood. The rest is very much about our responsibility to God as we understand Him. I respectfully disagree with their position on blood transfusion, but I would not call them fanatics.

I also believe that our focus should be on the already successful cord blood stem cells and adult stem cells. That research has been beneficial already and should be expanded.

Wednesday, August 15, 2007

Religion and Healthcare - how much freedom should we allow?

I have given transfusions to children of Jehovah's Witness children. Virtually all of the parents consented tacitly by not opposing the court orders we obtained in order to give the transfusions. I never felt bad about that until I visited a web site which refers to JW teaching on the subject as "moronic"

That made me more uncomfortable than you might think, given that I believe they are misinterpreting the scripture.


Because I can see a battle coming. If ever there is any successful treatment from embryonic stem cell research, I would refuse that treatment. I would refuse to allow my child to have that treatment - even if it meant that my child would almost certainly die. I believe very strongly that life begins at conception and that destroying embryos for research purposes is a great moral evil.

I still think that the Jehovah's Witnesses are misinterpreting the scripture. If a child's life is in danger, and if we can get a court order for a transfusion, I'll still give it. I will have a great deal more sympathy for those parents, though.

Saturday, August 11, 2007

Religious beliefs in the NICU - Jehovah's Witnesses

My first experience as a NICU nurse with a Jehovah's Witness family was in the 1970's. The baby had severe hydrops fetalis because his mother was Rh negative and had developed antibodies to the baby's Rh positive blood. This sensitization very likely occurred prior to the introduction of Rhogam.

The baby was so critically ill and so unlikely to survive that our neonatologist opted not to request a court order to permit him to transfuse the baby. He felt that it would cause unnecessary pain for the family without any benefit to the baby.

Since then, I've had the opportunity to discuss blood transfusion with several families who are Jehovah's Witnesses. Their responses vary.

The very young moms who have been raised in the faith tend to say, "I can't give consent, but you can get a court order, can't you?" Not always the case, but they often have to balance their concern for the baby with their relationship with relatives.

The physician's answer is always the same. "We'll try to avoid transfusing your baby, but we can get a court order if needed." Care for those babies isn't significantly different than for our other preemies. We try to avoid transfusions in all of them if we can. The one difference is that the babies for whom we need a court order get an appointed guardian who has to approve any transfusions. It's not simply left up to the physician once the court order is in place. The guardian, who is generally a hospital administrator, has to be convinced of the need. I've only seen one transfusion refused, but the guardians take their responsibility very seriously.

Older Jehovah's Witness families don't always have the hard-line belief that all transfusions are prohibited for all members of the faith. Some believe very strongly that transfusion is always wrong. Others believe that it would be wrong for them to have a transfusion, but that their baby is not yet in a position to make that choice. They, like our appointed guardians, want to be convinced that each transfusion is actually needed, but they will sign the consent form themselves. Retaining control is probably an important part of choosing that path.

While doing some background reading for this post, I discovered a web site titled Associated Jehovah's Witnesses for Reform on Blood. The site says that they have members who are or have been elders or members of Hospital Liaison Committees. They disagree with stated positions of the Watchtower on the use of blood and blood products and say that they hope to educate Jehovah's Witnesses on what they call inconsistencies in doctrine.

I don't share the Jehovah's Witness belief that it is a sin to use blood or blood products, but I do appreciate the technological advances that have resulted from medical and surgical attempts to minimize or avoid transfusions. Transfusions save lives, but they're not free of risk.

Thursday, August 09, 2007

And one more thing

I know the nurses who took care of my husband must have been glad to see us go home. He's a notoriously poor historian with a couple of significant allergies. He remembers the one about the shellfish, usually, and nearly always forgets to tell them about the peanuts. At least the peanut allergy isn't an issue until they start feeding him. Then he remembers and they ALWAYS want to know what else he's forgotten. Can't blame them.

He can't remember the name of the drug that made his platelet count drop to 30,000.

And neither of us thought it would be a problem to simply give them a list of his medications without a list of "not allergic, but do not give" meds. We were trying to figure out which medications he'd been given prior to discharge and which he might need to take when he got home. Plavix, check. Toprol, check. Aspirin, check. Zocor. Yes, he got Zetia and Lipitor.

"Wait. He got Lipitor? You can't give him Lipitor...."

and then I remembered we hadn't told them about the whacko liver function studies when he was taking Lipitor. And he'd referred every single one of them to me to review his medications and history -- well, everyone except the house doc who wrote the orders and the nurse who'd given him the Lipitor without telling him the name of the damn pill. He'd have remembered if he'd been told the name of the pill.

One isn't going to kill him, of course, but it is aggravating - both that we forgot and that he had a nurse who couldn't be bothered to tell my husband the names of the pills he was handing out.

I need to do a little training: "Yes, honey, you need to ask the name of EVERY SINGLE PILL. I don't care who is giving it to you. Don't put anything in your mouth until you know its name."

Wednesday, August 08, 2007

Vaccine, Autism, and Statistical Nonsense

Since Med Journal Watch has comments turned off, I'm going to comment here.

He's right on nearly all his points, but he missed a BIG one.

The discussion of Autism related to the alleged prenatal exposure to Thimerosal from Rhogam requires a visit to the Rhogam web site

Since at least 2001, THERE IS NO THIMEROSAL IN RHOGAM. Scroll down. You'll find it.

Once again, statistical nonsense which totally ignores reality. Thimerosal must cause Autism, according to the anti-vaxers, so there must be thimerosal in Rhogam.

Even when there isn't.

Update: See Christian's comment. The only thing he missed was the date when the Rhogam (or similar product) was given. The study subjects were prior to the exclusion of Thimerosal.

I haven't been able to access the full text of the study yet. I'll keep trying, but I did a little investigation of the researchers. Christian, of Med Journal Watch, is quite right to be suspicious. The researchers definitely have a dog in this fight. Dr. Mark Geier is a paid professional witness in anti-vaccine trials. He has had his testimony stricken on at least one occasion because he did not have the necessary credentials to be an expert witness in that case.

Additionally, Dr. Mark Geier has been cited for attempting to breach confidentiality and had a different study suspended for that reason.

For some very interesting information on the Geiers, see this post on the Neurodiversity Weblog.

As an Rh negative mother of a young adult with ADHD (too old to have gotten prenatal thimerosal), I'd be interested in research that truly shows a higher incidence of any type of developmental issue in children of Rh negative women. The study population was only 53 and it truly was not a prospective study in the way I understand prospective studies. Further research would be interesting, but I'd want it done by someone who doesn't have anything to gain other than knowledge.

Making a difference

Abbie Armstrong comes from a family with a tradition of changing lives. She's carrying on the tradition - even before she graduates from nursing school.

While still in high school, she was invited to fill an empty seat at a fundraising dinner. The dinner was to benefit the people of the island of Sumba, a small island in Indonesia. No, I never heard of it before I read the story either.

The pictures Abbie saw at that dinner weren't the pretty tourist pictures on the first link. They were the pictures of the indigenous people of the island. The people who have very little in the way of health care - and often not much in the way of clean water or protection from malaria.

Abbie's life was changed forever that night. She decided that she must visit Sumba - and it was arranged. She decided that she could not go empty-handed, so she invited friends and family to donate money, not knowing how it would be spent before she left home. The rest of her story is truly inspirational. Abbie's life has been changed, but not only her life. Read the article to see how one person can make a difference - if they are willing to make the effort.

Tuesday, August 07, 2007

Surviving childhood -- your children's

My friend Pippa, of Pippa Said is having a little trouble with her youngest child. Said child likes to play in the street. And is being encouraged by the older siblings. Pippa could use some advice. Mine would be along the lines of "Have a glass of wine."

Drinking won't help, of course, but when your kids act like that, the neighbors already believe that you do. I should know. I have boys. 3 of them.

My oldest was fond of playing in the street. I didn't exactly encourage it, but blink and he was out there. It was the one infraction for which I routinely spanked - accompanied by the admonition, "If a car doesn't hit you, I will. Every time."

To which my son would respond, "That doesn't hurt!"

Kid never knew how close that put him to death. He did survive - his excursions into the street and his mother's wrath.

He's the only one of my kids I never put the "Mother's Curse" on -- you know, "I hope you have a kid just like you!" I was too afraid he'd ask me to babysit.

Want to know what life was like when he was little? I once told a co-worker that nobody who'd read Ransom of Red Chief, by O. Henry, would ever consider kidnapping him.

Part of his problem was that he had a significant speech delay. At age 3.5, I could only understand about half of what he was saying. This was quite frustrating for both of us. Only after his speech improved did I realize that it was actually a mixed blessing.

I also learned of the hazards of teaching small children the correct names for their body parts.

By age 3 3/4, after only a couple of months of speech therapy, he could very clearly (and very loudly) ask, "Mom! Mom, does that man have a penis?"

Loud. Every time he saw a man standing still in a public place.

I knew it was really about the attention, so I'd try to ignore him, because shushing just didn't work. So of course he'd ask again -- louder.

Eventually, I took a chance.

"I don't know, honey, why don't you ask him?"

To my everlasting relief, he did not.

Wednesday, August 01, 2007

Tiny Turtle update

Most of tiny turtle's meals consist of Romaine lettuce. He gets a little tomato, little bits of fruit, and as a special treat a tiny cricket to hunt or a bit of shrimp. We're still having a drought here, and worms are mighty hard to come by.

The turtle prefers his lettuce leaves large. He crawls underneath and nibbles from below. We're all entertained by the moving lettuce leaves. With most other foods, he hides until he thinks we're gone before he will come out to eat. With the shrimp, he just doesn't care. He'll eat in front of whoever happens to be around. He looks damp in the picture because I had just misted his terrarium to keep him from having a drought in there too.

He's grown a little. His shell is now 38 mm wide and 41 mm long. He seems to be healthy. He's quite active in the early mornings when there aren't many people around. His skin looks clean and his eyes are shiny. He's quit hissing at us, so I think he's getting used to us. He still likes to hang out in his little pool, but never when I'm looking. I can tell by the little turtle footprints he tracks into the water.