2/3 OBGYN Clinical Guidelines Not Evidence-Based
Emily: Posted on Monday, August 15, 2011 11:15 PM

From The Big Push for Midwives and ACOG:

Chantry CJ, Nommsen-Rivers LA, Peerson JM, Cohen RJ, Dewey KG. Source University of California, Davis, Medical Center, Department of Pediatrics, 2516 Stockton Blvd, Sacramento, CA 95817, USA. caroline.chantry@ucdmc.ucdavis.edu

Abstract
OBJECTIVES: The objectives were to describe weight loss in a multiethnic population of first-born, predominantly breastfed, term infants and to identify potentially modifiable risk factors for excess weight loss (EWL).

METHODS: Data on prenatal breastfeeding intentions, demographic characteristics, labor and delivery interventions and outcomes, breastfeeding behaviors, formula and pacifier use, onset of lactogenesis, and nipple type and pain were collected prospectively. Logistic regression analyses identified independent predictors of EWL (≥10% of birth weight) by using a preplanned theoretical model.

RESULTS: EWL occurred for 18% of infants who received no or minimal (≤60 mL total since birth) formula (n = 229), including 19% of exclusively breastfed infants (n = 134) and 16% of infants who received minimal formula (n = 95). In bivariate analyses, EWL was associated (P < .05) with higher maternal age, education, and income levels, hourly intrapartum fluid balance, postpartum edema, delayed lactogenesis (>72 hours), fewer infant stools, and infant birth weight. In multivariate logistic regression analysis, only 2 variables predicted EWL significantly, namely, intrapartum fluid balance (adjusted relative risk for EWL of 3.18 [95% confidence interval [CI]: 1.35-13.29] and 2.80 [95% CI: 1.17-11.68] with net intrapartum fluid balance of >200 and 100-200 mL/hour, respectively, compared with <100 mL/hour) and delayed lactogenesis (adjusted relative risk: 3.35 [95% CI: 1.74-8.10]).

CONCLUSIONS: EWL was more common in this population than reported previously and was independently related to intrapartum fluid balance. This suggests that intrapartum fluid administration can cause fetal volume expansion and greater fluid loss after birth, although other mechanisms are possible.

The whooping cough epidemic is receiving a big “ahem” in the media but we’re not hearing the whole story. There is probable reason to believe that the new virulent strain is a result of the pertussis vaccine, yet the blame for the spread is directed at those who won’t vaccinate. More alarming, is the very recent call for pregnant women to run out and receive a whooping cough vaccine booster during their late second to third trimester.

Why? Because the Advisory Committee on Immunization Practices says so. They believe the immunity will pass on to their unborn children before they will have to receive it within two months of their birth. They also want teens and adults nearby the newborn to receive the vaccine to form a family “cocoon” of immunity. The panel also voted to recommend that babies receive a bacterial meningitis vaccine within nine months of birth.

~Health Freedoms

Whooping Cough Epidemic Caused by Virulent New Pertussis Strain—And It’s the Result of Vaccine The CDC and NIH keep pushing the pertussis vaccine, in spite of info that it’s causing the new whooping cough epidemic that is 10 times more deadly than the old whooping cough. The Centers for Disease Control (CDC) and the National Institutes of Health (NIH) would prefer that you remain unaware of a couple of highly significant facts about the whooping cough resurgence. It is most likely caused by the pertussis vaccine and it’s ten times more deadly than the original variety.

To top it all off, they are blaming the unvaccinated for the new more lethal strain of whooping cough, and they are pushing people even harder to be vaccinated with the same vaccine that’s almost certainly responsible for it!

More than one new strain of Bordetella pertussis has been found. However, the one that seems to consistently pop up in different countries is called ptxP3.
Continue to article.

To the untrained ear, a baby's cry is simply a baby's cry: It's loud, it's uncomfortable, it's interminable. Once you're a mom, though, you learn that your child has a whole repertoire of shrieks, sobs, and wails. And just when you think you've figured out what her cries mean, she uses them in new ways. Here, what triggers the tears, and how to handle them.

Infants: Birth to 6 months
Your newborn's wet? She cries. She's in pain? She cries. Wants milk? She cries. Newborns can't control their crying any better than you can control your hiccups. In the first few weeks of life, crying is sometimes a reflexive behavior. But it gives us that panicky feeling: "What's wrong? How do I stop it?" It's important to step back, take a deep breath, and remember that infants are supposed to cry. Their crying isn't inherently good or bad, says Laura Jana, M.D., coauthor of Heading Home With Your Newborn: From Birth to Reality. "A baby isn't always attaching emotion to the crying -- she's crying because she has no other way to communicate." Thanks to some amazing growth in the brain and nervous system around 6 weeks, a baby gains more control over her crying -- not much, but enough to make the connection that when she cries, you'll come to her with a diaper, a meal, or a cuddle. With every passing month, she'll make more sophisticated connections between her crying and your reactions. Oh, the fun you can look forward to!

What to do: Give your baby a systems check. If you're not sure why she's crying, work through the top culprits. Is she fed? Check. Burped? Check. How's that diaper looking? Oops. Problem solved.

Swaddle, sway, shush. Your baby just spent nine months in a cozy, temperature-controlled environment. No wonder many infants respond to swaddling, swaying, and shushing, which mimic the feelings and sounds experienced in the womb. Since a newborn has no control over her muscles, swaddling keeps her arms and legs snug to her body and lets her get the uninterrupted sleep she needs.

Stop trying so hard. One day when Elaine Appleton Grant of Strafford, New Hampshire, had exhausted every idea to get her son Teddy to stop crying, she put the 2-month-old down in a quiet, dark room. "It was amazing," she says. "The crying stopped immediately. He just needed to get away from any stimulation."

Expose your baby to the real world. Some moms tiptoe around their newborns, thinking that peace and quiet are always what they need. In fact, she might be craving the sounds of the world she heard in the womb, like your voice, your spouse's singing, or music you played. Read aloud in a normal tone of voice, sing, or get creative. Suzanne Thiele of Livonia, Michigan, says her daughter Katie went through crying jags at 3 months but calmed to the sound of U2.

Babies: 6 to 12 months
Around 6 months, your baby starts to figure out that he can cry to get a reaction from you. It's sort of like when he hurls his squash across the room and coolly watches you clean the mess, or when he extends his arms to be picked up. He's amassing an internal database of causes and effects. This is also a time when you can see some personality changes: A big crier might be a lot happier these days, but a formerly placid infant can turn into Oscar the Grouch. My husband and I got to see a whole new side of our easygoing son Oliver around this time. We couldn't figure out why he cried so much more until he nipped me during a feeding (ouch!) and we noticed how irritated his bottom gums looked. Babies typically get their first teeth between 6 and 10 months, which can cause a lot of pain. And pain = tears. Your baby is also puzzling out a psychological concept called object permanence. He was fine if you left the room when he was an infant, because he couldn't really comprehend that you were missing. Now when he sees you leave, he may be confused about where you are and whether you're coming back. Since he can't call out for you or ask where you're going, he uses the only tool he has -- crying -- to get your attention. After all, his early experiences prove that when he cries, you come running. By now you may be able to distinguish between his different kinds of cries. But don't stress if you can't. It's a myth that all moms learn to tell what their babies want by the sound of their cries. "Neither my husband nor I really ever figured it out," says Sue Yuhas of Chelmsford, Massachusetts, mom of Stevie, now 6. "He was a cranky baby. All his cries sounded the same to us."

What to do: Teach him to self-soothe. One cry you might be able to distinguish more easily than others is a tired cry: It comes in starts and stops. "Let him soothe himself -- you'll be giving him a valuable lesson," says Dr. Jana. If he cries every time you leave the room, simple games like peekaboo will help him learn the concept of object permanence, and eventually he'll realize you're still nearby. He'll still cry for you, but probably not every single time.

Change one thing at a time. Sometimes all a baby wants is to look at the other wall or try out a slightly different toy. So when he wails, don't go into a frenzy and give him five new things to absorb in the space of five seconds. Take it slow.

Try signing. Sign language can help babies communicate their needs without resorting to tears. Charlene Rucker of Coldwater, Michigan, taught her son Eric how to sign when he was 9 months old. At 13 months, he can sign "drink," "eat," and "more," which means he doesn't have to cry when he wants those things.

Give him something to chew on. Some babies don't give any physical signs that they're teething, like excessive drooling, biting, or irritated gums; they're simply more teary than usual. Try a chilled teething ring or a washcloth (first dampen an edge and then freeze it).

Young toddlers: 12 to 24 months
Now your baby's on the go, gaining and refining her motor and communication skills at an astonishing pace. Toddlers are excited by exploration but afraid of getting too far from you. That's a lot to handle -- no wonder they resort to tears. Your child probably also is starting to talk but doesn't know how to express frustration when, say, a playdate pal "borrows" a toy. She may start to exhibit concrete fears, too -- the dark! dogs! fireworks! -- that test her coping skills. And while toddlers are getting better at controlling their tears, sometimes parents expect more than they should. "Going to bed may not be a big deal for you and me, but for a child there's a lot going on in her brain. She just can't shut it off," says Dr. Jana. And since she doesn't know what to do, she cries. The good news? Crying is actually pretty productive (and expected) for toddlers: They learn they can get through the tears, then move on.

What to do: Prepare for a more sophisticated adversary. As with babies, if your child is hungry, tired, or sick, you can often cure crying (and sometimes prevent it) with a snack, a nap, or TLC. But because toddlers know they can manipulate adults with their outbursts, they go for it with gusto. As Dr. Jana says, they're "like sharks in the water. They smell blood." So stay calm -- and never let them see you bleed.

Focus on your child, not her audience. Few things are more embarrassing than being in public with a screaming toddler. As hard as it is, don't worry about the people who are throwing you dirty looks or unhelpful comments. Otherwise you risk doing something -- anything -- to stop the flood, which isn't the best strategy for the long run. Find a quiet place and deal with your toddler's tears one-on-one.

Introduce "Use your words." You'll have to say this a bazillion times over the next few years, but it's important for children to attach words to their emotions. Assign words to what you're feeling, too: "I'm feeling grouchy today because my tummy hurts." Misha Sauer of Los Angeles taught her daughter to say "I need help." "Now when she's frustrated, she can say that and know she'll be understood," Sauer says. And being understood is really the biggest thing that babies and kids -- and, hey, adults -- want when they cry.

Diana Burrell is the coauthor of The Renegade Writer's Query Letters That Rock.

This easy-to-read publication provides women the how-to information and support needed to breastfeed successfully. It explains why breastfeeding is best for baby, mom, and society and how loved ones can support a mother's decision to breastfeed. Expert tips and illustrations help new moms learn how to breastfeed comfortably and how to overcome common challenges. The wisdom of real moms is shared in personal stories that reassure and encourage.

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