7 Facts about Maternal Depression

With depression in the news this week, we wanted to join so many others who are trying to address misinformation about depression and mental health issues. Before I say anything more, I want to say that I am not an expert (in any way) about postpartum depression nor am I qualified to diagnose any mental health condition. But, here are some basic facts that expectant moms, new moms, and loving friends and family should know about maternal depression.

1. Maternal depression does not have a timeline.

We hear most about "postpartum" depression occurring in the early weeks and months after a baby is born. But depression can occur during pregnancy, early in the postpartum period, and after the baby is older. Any mother showing signs of depression needs to seek help and she should not wait to see if she "gets over it."

2. Depression is not the same thing as sadness.

Because "depression" is used so freely to refer to everyday feelings of sadness or low energy, people can be confused and expect that mothers who are depressed must cry everyday. It is important to consult the resources below if you are unsure of what it means to be depressed.

3. Maternal depression is not a choice or something that women can be "strong enough" or "brave enough" to avoid.

For so long, mental health disorders have carried a stigma because they were so poorly understood by those who had no personal experience to draw from. Because there are people who write about "beating" their mental health issues on their own, there can be an expectation that it is a matter of strength or perseverance. Don't believe it and don't wait to get help for yourself or any mother you love.

4. Maternal depression can happen to anyone but is more likely to occur among women with a history of depression.

If you or a mother you love has had a history of depression or other mental health disorders, it is important to have a plan or step in sooner should you become concerned. Having challenges earlier in life does not always mean that you will have a recurrence during or after pregnancy but the risk is high enough that you want get the resources in place so you can get help quickly if you need to. Tell your doctor, get informed, and make a plan.

5. Depressed mothers may not ask for help.

Depression is so disempowering that those who suffer most are least likely to seek help for themselves. If you are concerned about a mom you love, don't assume that you should give up if your offer for help is turned away. Use the resources below to get better informed and strategies to support moms who can't yet see that anything can help them.

6. Treatment takes time and may take multiple efforts.

Every human being is biologically unique. There is no one medication, treatment, therapy, or experience that turns depression on or off. Be prepared that recovery can take time and several different strategies. Any person going through this process needs support by people who are well informed and prepared to make sure that giving up is not an option.

7. Helping moms with depression, can have a huge impact on children's lives.

You may have wondered why the "Secrets of Baby Behavior" has a blog post about maternal depression. It is because there is no doubt that maternal depression can have a terrible impact on babies and young children. In homes where trusted and loving adults are supporting moms who are struggling and making sure that babies and young children get the care they need, many of the negative outcomes can be prevented. Helping families in these situations is not easy but the right support can change children's lives.


Special Note to Moms and Friends and Family: There are excellent online resources for anyone seeking more information about maternal depression (see below), but we think it is really important that you talk to a qualified person if you are worried about yourself or someone else who might have depression. Start with your health care provider, a qualified therapist, or a community helpline. If calling one of these resources seems overwhelming (and that is not strange or being weak) ask a trusted friend or family member to do it for you, but you will need to be close by to verify that you are seeking help.

More is known now about depression and other mood disorders than ever before. Reach out, now.

Mayo Clinic - Basic Information

Office of Women's Health - Answers to Questions

Information for Dads and others supporting mothers at risk

Postpartum Support International - dedicated website and helpline

Infant Communication: Learning in the Womb

Over the next few months we will introduce several posts about communication. Today’s post will focus on communication between caregiver and baby while baby is still in the womb.

Babies can hear and respond to sound prenatally and can even develop a preference to a particular sound, voice, or song after repeated exposure. Several studies have been conducted trying to explain how babies and caregivers begin their first communication. Although there is still a lot that is not known, and more research is needed, we’ve learned some interesting details that shed light on prenatal language acquisition.

·         Familiar rhymes are calming: One study measured changes in fetal heart rate in response to a rhyme that the mother recited during weeks 33-37 of pregnancy. When a recording of the rhyme was played at 37 weeks there was a noticeable decrease in the baby’s heart rate. There was no change in the baby’s heart rate when a different rhyme was introduced, indicating that a familiar rhyme was calming to the unborn baby.

·         Infants “recognized” stories heard in the womb: In a separate study, a 3-minute passage was read out loud twice per day for the last 6-weeks of pregnancy. After the babies were born the familiar passage and an unfamiliar passage were played for the baby. Infants preferred the recording of the story heard in the womb more frequently than the unfamiliar story. No preference was seen in a control group of infants not exposed to any story prenatally. From this study, authors concluded that babies do remember stories they heard while they were in the womb.

·         Listening to a familiar song changed babies’ states: A study of 2-4 day old babies monitored the infants as they listened to the theme song of a soap opera that their mothers reported watching prenatally. Compared to infants who were not exposed to the theme songs prenatally, infants who were exposed experienced a lower heart rate, a decrease in movements and transitioned to a more alert state while listening to the songs.

This information doesn’t tell us anything about the long-term effects of the sounds babies hear before they are born, but there is evidence that reading, singing, or playing music for your baby while you are pregnant can be calming both before and after birth.  Authors, however, warn against outside devises such as putting headphones close to the your pregnant belly, because it may effect  auditory development and interfere with behavioral state regulation.

Did you have an experience where your infant recognized a voice, song or story that they heard while you were pregnant? We’d love to hear your stories!

Reference: Moon CM, Fifer WP. Evidence of transnatal auditory learning. J Perinatol. 2000;S37-44.

Successfully Breastfeeding After a Rough Start: Part 2

By Karolina Gonzalez, MAS

Last time, I shared the exciting news that my baby, David, was born and that my goal to breastfeed him exclusively was more difficult to achieve than I had expected.

After meeting with the lactation consultant on day 4 postpartum, I felt someone was actually supporting our breastfeeding goals. More than anything, her words were amazingly encouraging! I started using the breast pump to stimulate milk production and the nipple shields to be able to nurse the baby as often as he wanted to. However, two days later David’s weight gain didn’t improve at all.

On day 7, I noticed his tongue was not moving forward enough for him to effectively breastfeed. The tongue plays an important role in breastfeeding! In order to extract milk from the breast, the baby needs to move his tongue forward to cup the nipple and the areola. When he draws his tongue back, he presses the tissue against the roof of his mouth. This compresses the ducts behind the areola and allows the milk to move into the baby’s mouth. Babies with ankyloglossia, commonly known as tongue-tie, might have difficulty latching onto the breast and the mother may experience nipple pain and/or trauma. These conditions can lead to other breastfeeding problems, such as slow weight gain and/or failure to thrive in the baby and ultimately a poor maternal milk supply and untimely weaning (Ballard JL et al, 2002).

Everything indicated to me that some level of ankyloglossia could have been the cause for David’s low weight gain and constant fussiness, as well as my sore nipples and perceived low milk supply. Researchers have also reported that inadequate milk supply may be rooted in decreased ejection reflex as a result of maternal nipple pain or in suppressed lactation as a result of the infant’s inability to drain the breast (Ballard JL et al, 2002). I had already heard about that while pursuing my Master’s Degree in Maternal and Child Nutrition, but now looking back, I think sleep deprivation and pain prevented me to take that into consideration in the first place!

We left to the hospital again to discuss my observations with the lactation consultant. She agreed with me and scheduled a procedure to get his tongue clipped that same day. It was a fast and I think painless procedure, since the baby didn’t even cry! Right after that, I put him to the breast and everything was different! From then on his feedings were short but he seemed satisfied and not fussy anymore. This indicated to us that before having his tongue clipped, he needed to stay at the breast longer to get some milk. He was probably nursing more because his suck was less efficient. Over the next few days, my milk started flowing much more easily and breastfeeding was not painful at all! And the most important result was that, David achieved a normal rate of weight gain within 2 days after the procedure. Our efforts were definitely worthwhile! We were successfully breastfeeding!

I really hope sharing this experience will help those moms who want to breastfeed their babies to keep on trying despite the obstacles you might face at the beginning. For those moms-to-be who are still waiting for the baby, my advice would be to keep in mind all the resources you have at hand once you leave the hospital. And make sure those around you know about them, so they can act proactively when needed! Also, by clicking here, you can read some tips to get through your baby’s first week of breastfeeding...successfully, that we published some time ago.

References:

Ballard JL, Auer CE, Khoury JC. Ankyloglossia: Assessment, Incidence, and Effect of Frenuloplasty on the Breastfeeding Dyad. Pediatrics. 2002;110:5, e63.

For more about tongue-tie, click here.

Pregnant? Keep Moving! Part I

By Karolina Gonzalez, MAS

The Centers for Disease Control and Prevention and the American College of Sports Medicine (CDC and ACSM) have recommended 30 minutes or more of moderate intensity physical activity on most, and preferably all, days of the week for the general population.

But what if I’m pregnant?
In 2002, the American College of Obstetricians and Gynecologists (ACOG) published exercise guidelines for pregnancy. They suggested that despite the fact that pregnancy is associated with profound anatomical and physiological changes, in the absence of medical or obstetric contraindications, 30 minutes or more of moderate exercise a day on most, if not all, days of the week is also recommended for pregnant women.  This will allow them to get the same associated health benefits from being physically active during pregnancy as before pregnancy. Exercise maintains fitness, strengthens muscles, and boosts circulation. It also prevents varicose veins and constipation, improves emotional well-being, and helps prevent excessive weight gain. However, these recommendations did not define ‘moderate intensity’ or the specific amount of weekly caloric expenditure from physical activity required for pregnant women to maximize the benefits of being physically active.

As a former dancer, I love the thrill of moving my body to the music I love. I got used to moving around, and I try to get some physical activity every day. Once I got pregnant I asked myself: How safe it is to keep my normal exercise routine? Will it be harmful for the baby? Should I make any modification?

Researchers in Denmark examined the relationship between physical exercise during pregnancy and the risk of preterm birth. Self-reported data on physical exercise during pregnancy were collected prospectively for 87,232 singleton pregnancies included in the Danish National Birth Cohort between 1996 and 2002. Results showed a reduced risk of preterm birth among the almost 40% of women who engaged in some kind of exercise during pregnancy in comparison with non-exercisers. The type of exercise did not affect the association, and the results were not altered when the degree of preterm birth was taken into account (Juhl et al., 2008). Another group of researchers conducted a prospective observational investigation at the Naval Medical Center, in San Diego, California. They evaluated the influence of exercise, by level of activity, on maternal and perinatal outcome in a large low-risk healthy obstetric population of working women. Based on their findings, exercise does not appear to affect antenatal, intrapartum, or postpartum complications, even after evaluating these women for confounding variables such as maternal age, race, gravidity, parity, maternal illness, height, pre-pregnancy weight, weight gain during the pregnancy, prior preterm delivery, smoking, and stress (Magann et al., 2002). These findings do not contradict current recommendations.

However, current ACOG guidelines are based on studies published before or during 2002. According to a recent review, healthy pregnant women can benefit from exercising at a moderate intensity for a longer duration than recommended in the current ACOG guidelines. Researchers found that increasing physical activity energy expenditure to a minimum of 16 metabolic equivalent task (MET) hours per week, or preferably 28 MET hours per week, and increasing exercise intensity to ≥60% of heart rate reserve during pregnancy, reduces the risk of gestational diabetes mellitus and perhaps hypertensive disorders of pregnancy, such as gestational hypertension and pre-eclampsia, compared with less vigorous exercise. To achieve the target expenditure of 28 MET hours per week, one could walk at 3.2 km (nearly 2 miles) per hour for 11.2 hours per week (2.5 METs, light intensity), or preferably exercise on a stationary bicycle for 4.7 hours per week (~6–7 METs, vigorous intensity). The more vigorous the exercise, the less total time of exercise is required per week, resulting in ≥60% reduction in total exercise time compared with light intensity exercise. They also found that light muscle strengthening performed over the second and third trimester of pregnancy has minimal effects on a newborn infant’s body size and overall health (Zavorsky & Longo, 2011).

Please consult with your doctor on how to safely exercise during pregnancy

It is not advisable to start a demanding regimen during pregnancy, though. Excessive or improper activity can be dangerous to the woman and the baby. Every pregnant woman should be carefully evaluated before recommendations on physical activity participation during pregnancy are made. We should also take into account that certain obstetric complications may develop in pregnant women regardless of the previous level of fitness, which could preclude them from continuing to exercise safely during pregnancy (Artal & O’Toole, 2003). All active pregnant women should be examined periodically to assess the effects of their exercise programs on the developing fetus, so that adjustments can be made if necessary. Work with your doctor to make sure you and your baby are not at risk for possible complications derived from your workout plan.

Next time: We'll share some information about safe exercises during pregnancy

References:

1.         Juhl M, Andersen PK, Olsen J, Madsen M, Jørgensen T, Nøhr EA, Andersen AM. Physical exercise during pregnancy and the risk of preterm birth: a study within the Danish National Birth Cohort. Am J Epidemiol. 2008; Apr 1;167(7):859-66.
2.         Magann EF, Evans SF, Weitz B, Newnham J. Antepartum, intrapartum, and neonatal significance of exercise on healthy low-risk pregnant working women. Obstetr & Gynecol. 2002;99(3):466-472.
3.         Zavorsky GS, Longo LD. Exercise Guidelines in Pregnancy. New Perspectives. Sports Med. 2011; 41 (5): 345-360.

Even in the womb, an active baby is a healthy baby!

Even though fetal movements begin at about 7 to 8 weeks’ gestation, it isn’t until between 16 and 20 weeks into pregnancy that moms start feeling the baby twist, stretch, and kick (Hijazi & East 2009). Starting around 25 weeks, babies make movements to expand their lungs, practicing for life outside the womb.

There can be great variations among healthy babies as to how often and how hard they "kick". You may notice that your baby prefers a particular position or has a favorite time of the day to be most active. Generally, moms find their babies are most active after eating a meal, drinking something cold, or after physical activity. More pronounced body movements also are easy to notice when you change from a sitting to a lying position. When you shift and need to adjust a little bit, so does your baby.

The baby's movements will also change as he or she grows bigger and gets into position for birth. You will feel fewer big turns and twists, but more kicks and jabs as your pregnancy progresses and your baby has less room to move.

Sometimes it’s just calm…

Your baby will sleep many times in the course of a day. Around 28 weeks gestation, your baby has developed a regular wake and sleep cycle. Unfortunately, it may not be the same as yours. For instance, I find my baby to be very active late at night, between midnight and 2:00 am! You’ll notice, though, your baby’s periods of sleep last longer as your pregnancy goes on. Researchers have found that beginning at around 36 weeks’ gestation, babies normally pass through sleep cycles of deep sleep and light sleep. These cycles last about 70–90 minutes. During deep sleep your baby may not move at all, but during light sleep he may move a little bit or even suck his thumb or finger (Van den Bergh & Mulder 2012).

What the baby is telling you with his kicks is important!

Each baby is unique and will move in his own way. Your pregnancy check-up will help you keep an eye on your baby's well-being, but you are the one that "knows" your baby best before he is born. Though strongly recommended for high risk pregnancies, the American Congress of Obstetricians and Gynecologists (ACOG) consider beneficial for every pregnant woman to count fetal movements beginning at 28 weeks. At this point, you should feel your baby move several times every day. Setting aside time every day when you know your baby is active to count kicks, rolls, and jabs may help identify potential problems and could help prevent stillbirth (Saastad et al. 2010).

Your doctor or midwife will explain to you how to count your baby’s kicks every day. Being attentive to your baby’s movements will help you notice any significant changes. Once you start feeling your baby kick every day, it is important that you notice when it kicks much less than usual. If you have any concern, call your doctor for advice.

You can practice feeling for kicks! 

It’s generally easier to feel the kicks when you are lying down than when you stand, walk or are busy. Some mothers have more trouble feeling their babies’ kicks than others. If the placenta is on the front side of the womb, or if you are overweight, you will feel the kicks less (Hijazi & East 2009). Start by finding a comfortable position during a time when your baby is usually most active. Some moms prefer sitting in a well-supported position with their arms holding their bellies. Other moms prefer lying on their left sides, which they find most comfortable and most effective for monitoring their babies. Lying on your left side also allows for the best circulation which could lead to a more active baby.

If you are pregnant, soon you will be spending a lot of time caring for your baby. We encourage you to devote a little time each day during your pregnancy to get to know your baby by his movements. Taking time to do your kick counts will allow you to rest and bond with your baby!

We’d love to hear about your own experience feeling your baby kick! Send us your comments!

References:

Hijazi ZR, East CE. Factors Affecting Maternal Perception of Fetal Movement. Obstet Gynecol Surv. 2009; 64(7): 489-497.

Van den Bergh BR, Mulder EJ. Fetal sleep organization: A biological precursor of self-regulation in childhood and adolescence? Biol Psychol. 2012; 89(3): 584–590.

Saastad E, Holm Tveit JV, Flenady V, Stray-Pedersen B, Frett RC, Bordahl PE, Froen JF. Implementation of uniform information on fetal movement in a Norwegian population reduced delayed reporting of decreased fetal movement and stillbirths in primiparous women - A clinical quality improvement. BMC Res Notes. 2010; 3(2).

Let's Talk About Twins (Triplets, Quads, etc.) Part 1: Getting Ready for Multiples

With multiple births on the rise, we thought we would share a short 2-part series on parenting twins, triplets, and higher order multiples. While multiple births represent only 3% of all deliveries in the United States, they account for 15% of preterm births (babies born before 37 weeks gestation), 20% of low-birth-weight births (less than 5.5 lbs.) and 19 to 24% of very-low-birth-weight births (less than 3.3 lbs.) (Goodnight 2009). Although each multiple birth experience is unique, one thing is universal: there is a lot of preparation needed to get ready for this wonderful yet challenging experience. Part one of this series will provide tips for families pregnant with multiples. Part 2 will provide insights into both the mother-infant bond and the twin-to-twin bond. Let’s start with some tips for getting ready for a multiple birth in your family.

Tip 1: Form your support group early

Having a support system in place is important for any pregnancy, but it’s essential for parents of multiples. Having two or more infants to care for will be overwhelming. Recruiting your family and friends to help you during this time will take some stress off of you and give you more time to focus on your new babies.

With this new experience it may also help to enlist the support of others who have parented multiples. Signing up for a local Mothers of Twins Club (http://www.nomotc.org/) or another similar organization could prove to be an invaluable resource for you. They offer support group meetings, newsletters and opportunities for education and networking.

Tip 2: Make nutrition a priority

Eating a well-balanced diet and getting enough calories can have an impact on the outcome of your pregnancy. Although there is a higher risk of preterm deliveries and low birth weights with multiples, the likelihood can be reduced by eating a well-balanced diet while you are pregnant. In one study, mothers eating a well-balanced diet with enough calories to support appropriate weight gain for a twin pregnancy were more likely to gain the proper amount of weight at 20 and 28 weeks gestation. They also experienced fewer complications with their pregnancies, including lower rates of low birth weight, very low birth weight, preterm births, and NICU (Neonatal Intensive Care Unit) admissions. (Goodnight 2009) Talk to your doctor or a registered dietitian to make sure you are eating what you and your growing babies need. Pregnancy weight gain goals vary depending on your pre-pregnancy weight and the number of fetuses you are carrying.

Tip 3: Prepare for your hospital experience early

Keep in mind that twins and multiples often deliver early (on average 35-36 weeks gestation for twins and a few weeks earlier for higher order multiples). (Goodnight 2009, Evans 1993) While you can’t entirely plan ahead for your birth experience, there are a few things you can do to prepare for the big day:

• Take a tour of the hospital where you are planning to deliver. Check out both the regular labor and delivery floor and the NICU for high risk babies.


• Talk to your doctor about what to expect when you go into labor. It is also possible that your babies will come home at different times as one baby may need to spend more time in the NICU.


• Talk to other parents of multiples to learn about their birth experiences. Even though every birth is a unique experience, you can ask them to share any tools that they found useful or helpful.


• Do your research: Reading books and articles (and this blog!) to learn more about what you can expect and how you can prepare for your babies will be valuable.

Tip 4: Prepare siblings & close family members too

Older siblings and other family members need to prepare for the new babies too! If you have other children, talk to them about what to expect when their new siblings arrive. Helping siblings feel connected to their new babies can make the transition easier for them. One idea is to let the older brother or sister pick out or make little gifts for the babies or make something for them. You can also give something to the older sibling from the new babies to foster a positive relationship between them (Bryan 2002). For more information about helping older children deal with your growing family, click here.

Tip 5: Give yourself time to adjust to the news

Finding out you are pregnant is big news, but hearing you are pregnant with twins or multiples can be quite an unexpected surprise and overwhelming. Take some time to mentally prepare for the new additions to your family. Talking to someone (whether it be your spouse/partner, your doctor, a friend or a counselor) can help you deal with the emotions you feel or concerns you have as they arise.

We hope this post was helpful for those of you out there who are parenting (or preparing to parent) multiples. Many of the topics we discuss in our posts, including this one, are based on comments from readers like you. Continue to let us know what you think and what questions you have! We also encourage you to share this post with any new parents of multiples in your life! Then, stay tuned next week for part 2 where we’ll discuss the art of bonding with multiples.

Next time: Multiple Births Part 2: The Art of Bonding

References:

Bryan E. Educating families, before, during and after a multiple birth. Semin Neonatol 2002; 7: 241–246.
Evans, M. I., et al. Efficacy of transabdominal multifetal pregnancy reduction: Collaborative experience among the world's largest centers. Obstetrics and Gynecology 1993; 82: 61-66.
Goodnight W, Newman R. Optimal Nutrition for Improved Twin Pregnancy Outcome. Obstetrics and Gynecology 2009; 114, 5: 1121-1134.
The American Congress of Obstetricians and Gynecologists: http://www.acog.org/publications/patient_education/bp092.cfm (accessed 8/31/10)
The National Organization of Mothers of Twins Club: http://www.nomotc.org/ (accessed 8/31/10)

*Special thanks to Kassandra Harding for her hard work on the research that allowed us to write this post!*

When Motherhood Doesn't Go According to Plan (Part 1 of 3)

Operation Baby Banuelos
I am a planner. I plan out the next day at night before I go to bed. I plan out the week's meals on Sundays. I even made a pregnancy plan. I sketched out exactly what becoming a mother would be like. Here is how "Operation Baby Banuelos" worked in my mind:

1. Decide to have a baby
2. After only 1 month of "trying," see 2 blue lines!
3. Look and feel great for 9 months
4. Have an easy, fast labor at 40 weeks
5. Bring beautiful, healthy baby home and live happily ever after!

I soon discovered that being a parent rarely goes according to plan. Here is what "Operation Baby Banuelos" taught me:

1. Deciding to get pregnant is the easiest part!
2. Getting pregnant right away isn't always as easy
3. Being pregnant isn't always fun
4. You can't plan when labor will start
5. Newborns don't always get to come home right away

Looking back, I realize I was more than a little idealistic. But for me, being a mother was something I had always dreamed about. Sure, I knew about morning sickness, premature labor, and the increasing prevalence of infertility. I was pursuing a Master's Degree in Maternal and Child Nutrition, so I knew more than most people about pregnancy and all of the possible risks. I just never considered that complications would be part of my story. They weren't part of my plan.

In this post, I will share my experience with early labor and the birth of my daughter. Next time I will describe what it was like leaving the hospital without my baby. Finally, in Part 3, I will share tips for coping and making the best of a difficult situation.

Briefly: Steps 1-4 of my story
For us, step 1, deciding to have a baby, was the easiest part. But it took 2 years to get to step 2. Once I finally got pregnant, I was determined to do everything right. I stopped moving heavy boxes; I left the house when my husband was painting; I bought more fruits and vegetables; I planned (there is that word again!) to go for walks in the evenings. Unfortunately, following a plan is hard when you can't even keep water down. I was so sick that I lost 10 pounds during the first 3 months of my pregnancy and I struggled to get to work each day. Just as I thought step 3 was a lost cause, I started to feel better. I had more energy, could eat real food, and I started to enjoy being pregnant. I began to feel my baby move and we found out we were having a girl!

Unfortunately, step 4 came much earlier than we expected. At 24 weeks, I noticed a little spotting and even though my doctor assured me that it was nothing to worry about, I made an appointment. What started out as a quick check-up over my lunch hour, turned into immediate admission into the hospital. At first, everything happened so quickly that there wasn't much explanation about what was going on. All we knew was that I was already dilated to 3 centimeters and we had to stop the labor. I was taken to a hospital equipped for high risk pregnancies and things improved. I wasn't having contractions, the labor didn't seem to be progressing, and I came to terms with the fact that the best thing for my baby was for me to stay in the hospital for as long as possible. But, on my 6th day in the hospital, my baby flipped over and started kicking downward. We couldn't wait any longer. Olivia was born 15 weeks early, at 25 weeks gestation. She weighed only 1 pound 15 ounces and was 13 inches long.

Step 5: Bring beautiful, healthy baby home and live happily ever after
Needless to say, with step 4 going so wrong, step 5 was thrown out the window. We knew that babies born so early faced an uphill battle and that our daughter would struggle just to survive. According to the March of Dimes, 1% of babies in the United States are born before 28 weeks and of those born at 26 weeks, 80% survive. Olivia was born at a time when research shows that things could go either way.

There are 2 things I remember clearly about those first few days. First, I remember how excited I was to take a shower! It had been 8 days since I was allowed to shower and it felt so good! The other thing, even better than the shower, was the first time I was able to take some of my breast milk to the NICU! I started pumping just a few hours after getting back from the recovery room because I knew how important my milk would be to Olivia. Since she was too small and weak to nurse, I needed to pump frequently to stimulate my the milk to come in. By day 3, the doctors had decided to start feeding her through an OG-tube, which is a tiny tube that went into her mouth and down to her stomach. I remember the first time I got any milk out, I had less than 1 milliliter of colostrum to take to her, but I was so excited. I carried it over to the NICU in a tiny syringe. It was the first time I felt like I could do something to care for my baby, and that was the best feeling I had had in days!

Just a few days after Olivia was born, it was time for me to be discharged from the hospital. I had mixed emotions about going home. On the one hand, I was glad to be leaving the hospital. I had been in bed for over a week, so the idea of being able to go outside (or even to the kitchen to get something for myself) was thrilling. On the other hand, I knew that I would be leaving my baby in the hospital and home was 30 miles away. Because I had a C-section, I was not allowed to drive for a few weeks after the surgery. My friends and family were very supportive and worked out a system to make sure I always had someone to take me back and forth. But, even though all of their support was appreciated, they couldn't make me feel any less helpless.

Next time I will continue the story about Olivia's time in the hospital and what it was like when we were finally able to bring her home.

Preparing for Maternity Leave

The last few months of work before going on maternity leave are a difficult time for mothers. You’re probably dealing with lack of sleep, an uncomfortable body, a kicking baby, and the stress and worries surrounding child birth. You also have to plan your maternity leave, get the nursery ready, and prepare yourself physically and mentally for the big day!


When I first started planning my maternity leave, I was about 6 months pregnant. I remember thinking “why do I need to start this now when I have so long to go?” At my last job, I didn’t have any flexibility with my work schedule. I had a hard time just getting time off for scheduled doctor appointments! If you have a hard time getting time off work, try scheduling your doctor appointments ahead of time so your employer has enough time to prepare.


One of the things I learned is the further along you are in your pregnancy, the more you don’t want to do anything; especially when it comes to dealing with lots of paperwork! Taking care of your maternity leave early is beneficial. If for some reason you had to go on disability early, it is one less thing you will need to worry about.


In the end, I was lucky. I was able to take 14 weeks off when I had my daughter, Elisabeth. I qualified for 8 weeks of state disability (California)* for having a c-section and 6 weeks of baby-bonding (California part of FMLA). Search the internet for more information about maternity leave benefits in your state or country.


I decided to leave work 3 weeks prior to my due date, although I didn’t end up delivering for 5 weeks. I guess that was lucky on my part; it gave me some extra, much needed time off. I was busy going to weekly doctor’s appointments, resting, and getting everything ready for the arrival of our first baby.


I almost forgot, now is a good time to start looking for childcare! I know it seems early, but it could take a long time, and most programs will have a waiting list (that could last for up to 2 years) for infants. Where I live, you probably have to start looking for child care before you get pregnant!


Here is an article about maternity leave benefits that I found to be helpful:

http://www.associatedcontent.com/article/1434648/frequently_asked_questions_about_maternity.html?cat=17

*Talk to your employer regarding any extra policies they may require for maternity leave.



Next time: How to prepare to come back to work after your baby is born.