The first week: things no one talks about (but should!)

When my first child was born, I remember thinking "labor was nothing compared to the pain of recovery". I also remember that I had felt completely unprepared. No one had talked about my own physical recovery, they only spoke of the pain of labor. None of my classes or books covered it either. In what I have seen in postpartum topics, it seems like everyone typically talks about the possibility of postpartum depression, breastfeeding, and then getting back into your pre-baby body. Which, while some of that is helpful, they do not talk about the normal healing process.

As a result, my mental image of bringing the baby home from the hospital was this rosy picture of me sitting in my rocking chair, nursing, and cuddling my baby as we both blissfully fell into our afternoon nap. I thought the pregnancy aches and pains would be over, the pain of labor behind me, and I would be into baby bliss. Ha. I was mistaken.


Lately, I have been thinking about those first two weeks of baby bliss: the emotional/hormonal breakdowns as your hormones try to re-balance, the stitches I had because I tore in two places, the fact that I couldn't walk up and down the stairs, the menstrual cramps you have because your uterus is shrinking back to it's former size, the insecurity of when you first start breastfeeding, the hemorrhoids from pushing with an epidural, and the tiredness from waking up at all hours of the night. Where was all that reality in the baby books?

Now, don't get me wrong. It is all COMPLETELY WORTH IT. These are things that once you get into the 3rd-4th week you begin blissfully forgetting and don't cross your mind until you are preparing to go through it with subsequent children. BUT, I would have liked to been more prepared the first time, and I thought I would share so that other first timers could get a little more mentally/physically prepared for their own recovery (since most of our energy is focused on getting prepared for the little ball of joy we are growing in our tummies).

Here are some things to consider:

1. Where is your baby stuff in relation to where you will be spending most of your time? Do you have to take stairs to get to all your baby stuff? The first week or so, you may not be ready for many trips up/down the stairs. The first week I had Sam, I could only make 1 trip per day up the stairs (in the evening to go to sleep). Therefore, we needed to set up a mini camp in the living room or a side room on the first floor so I could still be near a bathroom and the kitchen throughout the day.
   
2. Do you have someone who can be home with you the first week (or preferably 2)? If your husband/partner can't be there, a friend or relative would be very helpful while he/she is away or at work. This person will be invaluable helping you around your house, bringing you a glass of water, helping you lift the baby. They can also run to the pharmacy if you need anything. Then you can focus on healing and on nurturing your new baby. It is good to work this out ahead of time. This is vital in cases where you give birth by cesarean and have even more healing to do.
   
3. Can you prepare meals ahead of time or have a sign up sheet for loved ones to bring food for the first week or two? Think about how much you'll want to be up and down getting yourself water/food much less cooking after giving birth. You will be tired and sore. You will also need good nutritious food/energy. Don't be afraid to ask for help and support. No one expects you to do it all on your own. If people offer their help and support, practice saying "Yes please, that would be great".
   
4. Who can you call? Post phone numbers for the nursery, local lactation consultants, other new recent moms, and a local postpartum group. Make sure you feel supported and do NOT be afraid to reach out to other people. If you begin feeling isolated or overwhelmed, you will need people to call who have been there before. You are NOT alone! If you are the first one of your group of friends to have children, be understanding that they may not necessarily know what you need because they haven't been there before. So either tell them what you need, or be prepared with other phone numbers to call!

Next, while you are getting ready for baby, prepare a Survival Kit for your own healing/recovery needs. You may not need any or all of what I list here. I have met some women who have natural births and are up and around a day or two later. The trouble is, you cannot predict if that will be you. So this is nice stuff to have on hand, and then you can always save the receipt and send your hubbie/partner/mom/friend to the pharmacy to return whatever you didn't use or need.

• Sitz bath: you will need this if you develop hemorrhoids from pushing or if you need stitches from a tear or episiotomy (or if you are lucky enough to have all of the above!)
  
• Pads: The overnight, long kind. You know that period you haven't had for 9 months? Well the first few weeks more than make up for it. Do NOT use tampons.
  
• Cotton rounds: You can soak these in witch hazel and use as a compress.
  
• Witch hazel: to use as a compress and to clean areas...
  
• Donut pillow: It is sore to sit. It feels better to sit on a donut for a few days.
  
• Stool softener that is approved by your doctor/midwife or some kind of guidance on what to eat to ensure soft passage of stools. Things are going to be all sore down there, you do not want any more trauma.

Now, hopefully I am not scaring you, that is really not my intention. I think it is just really easy to miss this stuff when the cultural focus is on the cutesy stuff like new clothes and decorating the nursery, which is clearly more fun! So, I hope you enjoy bringing home your new bundle of joy. It truly is a remarkable part of life. Hopefully feeling more prepared and supported will make it even smoother and more enjoyable for you!

In health and wellness,

Nicole

"I'm good, but I wish I could poop the way I used to..."

It is funny to me that whenever I see anyone that I haven't see for a while, they always ask "How are you feeling?". And it is not necessarily funny that they ask (they are just being sweet and polite), but my reaction is always funny to me. Of course, I typically answer the obligatory "Oh, I am feeling pretty good" or "Good, but a bit tired". In my head, I laugh at myself for telling another little white lie. No one really expects you to run through the little aches and pains that typically accompany pregnancy and no one ever really wants to hear that your pipes are running slower than usual. Just once, I would like to say "Good, except I wish I could poop the way I used to" or "Good, except the lower back pain I am encountering whenever I stand longer than 20 minutes" or "Super, but I wish I could get some sleep without having to go to the bathroom 3 times in the middle of the night"....

Funny though, several months ago, I went to a concert with my husband and some friends and one of the girls was late in her first trimester. It was our first time meeting, and I thought she was hilarious and refreshingly honest. Like me, this woman eats very healthy and, as a result, is used to a comfortable level of regularity. When I (politely) asked her how she was feeling so far, one of her first complaints was that she felt nauseous, but the worst thing was how she wishes she could go like she used to! Oh, I think of that story now, and think that woman is braver than I!

The truth is, that more than half of pregnant women experience constipation. So you are not alone! Much of it is due to the increased iron supplementation. However, it is also caused by the natural relaxation of your intestines, which causes everything to move a bit slower. Another thing that may contribute is that cup of coffee that you may have given up that used to help you go more reliably. Great, so it is a normal part of many pregnancies...so what can we do to help move things along?

• Eat high fiber diet. Especially fruits, veggies, and whole grains. Prunes and dried fruits can also be very helpful. Dark leafy greens are high in magnesium and will also be helpful.
• Avoid constipating foods. Maybe just for a while, pass on the cheese and bananas until you feel better.
• Drink a lot of fluids (mostly water). I'll admit, this is my pain point. Part of me dreads drinking too much at this point of the pregnancy because I am literally going to the ladies room every 30-45 minutes. But, not only is the fluid good for constipation, it is good for a lot of other things too. So drink lots of water (and prune juice if you are already constipated). Hot water in the morning can also be helpful.
• Relax and manage stress. Stress, worry, and anxiety can contribute to constipation.
• Eat good fat and oils. Avocados, olive oil, nuts to name a few. Fish oil and flax also can help move things along for you.
• Watch your iron supplements. Take iron in small doses spread throughout the day if you need to supplement. Experiment with other types (floradix or brewer's yeast for example).
• Watch your calcium intake. Calcium can be constipating. So try to get it in high fiber forms (like broccoli). Eating too much dairy (high calcium and low fiber) can also be constipating.
• Exercise. Nothing intense. Just a quick walk during a 10 minute break at work, maybe some yoga and/or stretching before bed.

So I hope you have enjoyed this post or at least found it useful. Constipation is not your friend, and if it gets really bad it can lead to other problems like hemorrhoids--which is really not pleasant to bring up at the work picnic. So, truly do not ignore it. If you have really bad problems, bring it up to your doctor or midwife before turning to any laxatives or things of that nature, because many of them are not safe in pregnancy.

In health and wellness,

Nicole

Beef up on your iron (literally) and Recipe for Beef, Lentil and Tomato Stew with Greens

Typically during your 28 week appointment (or closest one), your doctor/midwife will give you the lovely orange drink for glucose testing (for gestational diabetes screen) and will also recheck your hemoglobin levels (they typically check it with your first bloodwork too). Hemoglobin is your red blood cell count and typically lets the doctor/midwife know whether or not you are low in iron. The interesting thing is that in your last trimester of pregnancy, your blood volume gets much larger, so the hemoglobin will naturally become diluted and your iron levels will lower accordingly.

Doctors/midwives will diagnose anything under 11 "anemia" and recommend a supplement. "Your iron is borderline" is result I got in both pregnancies. Since I am normally "borderline", that answer was not surprising to me. Upon further inquiry, I find that my iron is a 10.7. I recommend that you find out what yours is, if you are told you need iron supplementation because you should know how much to take (keep in mind that you get some in your prenatal too if you take one). I say this, because iron supplementation is very constipating, and who needs MORE constipation during pregnancy? I vote no to constipation.

When I asked if there are other options, the midwife then explains that I can eat more iron-rich foods, more vitamin C with the vegetarian forms of iron, and we can recheck closer to my due date. I like that option better. Maybe a burger a day will keep the doctor away...

So what does a diet look like when you are trying to increase your iron levels? First, get yourself a cast iron pan. The iron leaches into your food and increases the iron substantially. You can get one for a decent price. Just follow the directions on seasoning it and use it! Then use the lists below to increase iron rich foods and foods that enhance iron-absorption, and decrease foods that inhibit iron-absorption or eat those at different times of the day.

Iron-rich foods that have highest absorption because they contain the heme form of iron:

• Red meats like beef, pork, lamb, liver (limit liver to 1/week because of high vitamin A levels)
• Chicken, duck and other poultry
• Fish and shellfish

Iron-rich foods that have lower absorption because they contain the non-heme form of iron (but should still be considered):

• Unsulphured or black strap molasses
• Green leafy veggies (kale, chard, broccoli, spinach, beet greens, etc)
• Dried Beans and lentils, and legumes
• Dried fruits like raisins and appricots (which have the vitamin C in there too!)

Foods that enhance iron-absorption:

• Foods high in vitamin C which includes fresh/raw fruits/vegetables, fruit juices (read the labels 100% juice with no added sugars!)
• Foods high in folate (folic acid) which are dark leafy greens, dried beans, wheat germ and orange juice

Foods that inhibit iron-absorption:

• Whole grains with phytic acid. Soaking grains can neutralize it's effects
• Calcium-rich dairy foods and supplements (eat at different times of the day)
• Tea with tannic acid
• Some herbs, including peppermint and chamomile
• Coffee
• Cocoa

If supplementation is needed:
However, if after talking to your doctor/midwife, they find it absolutely necessary that you supplement your iron or you feel uncomfortable relying on your diet alone: consider using Floradix or Brewer's Yeast instead of a synthetic vitamin. They are more easily absorbed and will cause less constipation. Do not supplement if you are not anemic, iron is not excreted easily and you could become iron toxic, which you do not want either.

Recipe: Beef, Lentil and Tomato Stew with Greens
I adapted this recipe from a basic lamb stew recipe I got from Epicurious.com. I have used lamb in it as well and it also works nicely. The beef, lentils, and greens will give you a big iron boost.

Ingredients:
Olive oil
1 pound of beef stew meat
1 onion chopped up
2 cloves garlic
1 tsp minced, peeled fresh ginger
1-2 carrots, diced small
1 stalk of celery diced small
1 Tbs curry powder (or more if you like)
2 cups beef stock (or water is fine)
1.5 cups jarred diced tomatoes with juices or a chunky tomato sauce
1 cup dried green or french lentils
2 cups chopped greens (kale, collards, spinach or chard would work nicely)

Directions:

1. Brown the beef in the olive oil.
2. Add onions, garlic, ginger, celery and carrots. Saute until onions and carrots get cooked down a bit.
3. Add the curry powder and mix it in for about 30 seconds.
4. Add the stock or water.
5. Add tomatoes and lentils.
6. Cover the pot and let simmer for 45 min to 1 hour until the lentils are tender.
7. Toss the greens in and cook down until tender.
8. Serve in bowls by itself or serve over brown rice (soak the rice for several hours before cooking to neutralize the phytic acid. Phytic acid will block the iron absorption).

Don't take shots in the dark. Know your options.

Can you tell that I have been lazy and less creative on the food front? Everyday around 5PM I get pretty low-energy and so coming up with new recipes hasn't been by biggest priority.

So today, I just wanted to pass on information for books that have been helpful to me in case you were interested. I remember when Sam was born that every doctor appointment I went to, Sam needed to receive vaccines, which my doctor and I spent very little time discussing. It seemed really scary to be giving him 3 or 4 shots in one day when he was such a little baby, and without knowing what my options were at the time, I just did what the doctor ordered.

However, knowing that doctors receive their orders from the CDC, FDA, and the government (who have interests/are subject to lobbying by pharmaceuticals), I am increasingly aware that doing your own research about the topic helps you feel more comfortable with any decisions you make about your baby's health--with either way you go.

I have always been a "middle of the road" person when it comes to vaccines--and can see points of view from both sides. You obviously do not want to eliminate vaccinations and expose your child to deadly diseases. But, you want do vaccinate in such a way that there are less risks of developing autism, ADD, ADHD, and other autoimmune diseases that may be related to over-vaccinating children before they can developmentally handle the ingredients. So, while I do plan on vaccinating the new baby--I plan on doing it on a modified schedule that I will develop based on research and with my pediatrician and (hopefully) pose less risks.

So, in case you are interested, here are 2 books that were recommended to me--that present both sides of the vaccine debate and that both are written by doctors.

What your Doctor May Not Tell you About Children's Vaccinations by Stephanie Cave, MD with Deborah Mitchell: I am currently reading this one and finding it fascinating (because I am a dork). But it is helpful to see that I can delay some of the vaccines until the baby is a bit older--without risking him getting some of the diseases, etc.

The Vaccine Book by Dr Sears: I haven't read this one yet (it is next on the list), but my doula recommended it. She said if she had read it, that she probably would have given her son 1-2 of the vaccines recommended instead of abstaining from them completely (she didn't vaccinate at all because of fear of the controversies). So I am pretty sure it gives a picture of both sides of the debate--when the vaccines are neccessary and when they can be delayed.

In any case, it is something to think about before your baby is born, especially since the first vaccine is scheduled on the day of his/her birth (Hep B). If not those books, you should read a little bit about it so you feel comfortable with any decisions you make. You should also talk it over with prospective pediatricians to see what they think about the topic too, since their philosophy on it will be important to align with your own.

Hope this helps to bring up (yet another) thing to think about when preparing for your little one.

In health and wellness,
Nicole

What is BPA anyway?

While I try to make it a habit to avoid instilling fear into mommies (especially first-timers) and while worrying about every little thing will drive you nuts as a new mom-to-be, there are instances where a higher level of concern and care are healthy. Such is the case when dealing with BPA. So, I do warn you, that this post is kind of scary, but should be taken into consideration while pregnant and caring for your little baby.

When you go buy (or register for) your baby bottles and breastfeeding gear or whatever you are planning to use, there is this claim on the boxes for "BPA-free". Many people probably do not know what it means, but it sounds good right? Well, it is something every pregnant/nursing/mothers for children under 2 should be very concerned with (and really anyone for that matter) and I thought I should take the time to explain why for people who may not know or may not necessarily be taking it that seriously.

Back on August 3rd, 2009 (approx 5-6 days before I discovered my exciting baby news), the Massachusetts Department of Health released a public health advisory to consumers concerning bisphenol A (BPA). The full advisory can be found here: http://www.massmedboard.org/public/pdf/bisphenola_advisory.pdf. The advisory actually states in bold letters "The DPH is specifically advising parents and caretakers of children up to two years old to avoid the use of products that contain BPA for making or storing infant formula and breast milk. DPH is further advising pregnant and breastfeeding women to avoid products that may contain BPA."

Red flag. This concerned me. This organization rarely sends statewide warnings about public consumer products to doctors, etc; so it is something that really got my attention. I did a bit of reading on the advisory and about BPA in general and thought that other people should know about other sources of BPA other than baby bottles so you can protect yourself and your loved ones. On a side note, I think it is really sad that we need to do this, instead of the government taking strides to ensure that none of the products contain a harmful substance, but sigh...how long did we use lead paint and asbestos? And now formaldehyde and BPA? And can we please do some things to get the mercury out of our tuna fish? OK, done with politics. Back to BPA.

Basically BPA is is an organic compound that is a building block of several plastics and plastic additives. Apparently according to Wikipedia, there have been concerns over its safety for humans since the 1930's (sigh again). It is an endocrine disruptor (which means it acts like a hormone in your body) and is linked to a whole host of problems--disrupted fetal development of thyroid and reproductive systems, obesity, thyroid dysfunction, reproductive issues in both men and women, breast and prostate cancers, and sadly the list goes on.

So, something we want to avoid, right? So what are the sources of BPA, and what should we do to avoid BPA exposure?

Sources of BPA:

• BPA is used as a liner in some food and beverage cans to prevent spoilage
• Transparent (clear or colored) plastic containers or baby bottles with the recycling number 7 and the letters PC, which stand for “polycarbonate” plastic
• Liquid baby formulas

How to Avoid BPA exposure:

• Avoid eating canned foods/beverages while pregnant/nursing. Fresh/frozen foods are better choices. Jarred food in glass bottles is fine. Thank goodness we can still eat our pickles.
• Drink out of stainless steel or glass containers. Avoid plastic bottled water and canned soft drinks.
• Replace Tupperware and other food storage with glass containers.
• The most effective means of reducing BPA exposure to infants is to breast feed. If formula is needed, avoid liquid formula. Dry powder has not been shown to contain detectable levels of BPA.
• Use BPA-free products to store breast milk and formula.
• Do not heat or pour hot liquid into plastic bottles.
• Do not put plastic bottles or containers into the dishwasher.
• Do not use harsh detergents and soaps on plastics, which also causes leaching.
• Pay attention to the types of plastics used on sippy cups, teething rings, pacifiers, etc.

So, I hope you aren't freaking out and thinking that the past few months you have been doing everything wrong and have done harm to your baby. The past is the past and I didn't know any of this with my first son. You can only do something about today and days ahead. So having anxiety about the past is useless. The same can be said about all those people with mercury fillings. You cannot control what you do not now. So, now you know, and you can take action!

Start by reviewing the state of the union: all of your baby's gear, your food pantry, and the beverages you drink (and your registry). Return or toss all the items you suspect to contain BPA. Replace your tupperware and other food storage containers with glass (I keep all my dry bulk goods in mason jars, which works really well and each one is $.50-1.00 at AC Moore or Micheal's). Get yourself a cute stainless steel water bottle. Toss or give away all your plastic water bottles. Stick to glass bottles or fountain drinks when you are out and thirsty. And basically do the best you can. Any action you take will reduce the amount of exposure and that is all anyone can ask of you. I have listed some resources for you to get more info. And while my post is focused on pregnant moms and babies, it isn't that good for anyone really, including your husband or partner!

Resources:
http://www.massmedboard.org/public/pdf/bisphenola_advisory.pdf
http://www.mass.gov/Eeohhs2/docs/dph/environmental/exposure/bisphenol_a_brochure.pdf
http://en.wikipedia.org/wiki/Bisphenol_A

In health and wellness,
Nicole