Tuesday, June 24, 2008

Baby slings 101

I have been meaning to write a post on the various kinds of slings for carrying babies. Well, here it is! Please feel free to e-mail me (see my full profile, then click "Contact Me") with any questions you may have.

First off, let me warn you: most Moms who buy a sling never end up using it because they don't realize that babies only take to slings if they are used right from the start. It's kind of like swaddling - babies love it if you do it from birth, but probably won't if you try it for the first time when they are 4 months old. They also don't realize that it takes practice and dedication to figure out how to use a sling correctly. Since all our kids are two years or less apart in age, and they all love to nurse every hour or so, it was a necessity for me to make slings work (Either that, or the older kids would have nobody to care and cook for them because I would have my hands full of the newborn at all times.) Other methods of soothing a fussy baby, such as swings, bouncers, etc. are all more expensive, take up more space, and will not make you bond with your baby near as much. The baby will learn early on to depend on "things" for comfort rather than on Mom. If you let the baby sleep in the swing for three hours you will probably feel guilty, wondering if he gets brain damage from the motion (he won't!). But if he sleeps for that long in the sling snuggled up against you, you both will feel blissful. In fact, you can even lie back with the baby right on top of you and catch a nap yourself. Another advantage of carrying newborns most of the day is that it develops and trains their sense of equilibrium (which the aforementioned gadgets do not). All our kids started crawling around the time they were 6 moths old, and walking around 9-11 months - this is two months earlier than the average, but very typical of babies who are carried a lot as newborns. So whatever extra effort it takes in the beginning is made up for by the fact that the babies become independent sooner.

I would say that most of my baby-carrying is over by the time the baby is 6-8 months old. They don't care for it too much once they know how to get around, and I am glad to have my hands and back free. So I am not suggesting you carry your 3-year old on your hip everywhere you go, I am just saying that it is very beneficial for young babies, as well as older babies when they are sick or out of their element while traveling etc.

Before you go out and spend a bunch of money on a fancy sling, sew one yourself if you know how to. If you don't, do some research online, and talk to moms that you see in public carrying their baby in a sling. They will be more than happy to let you pick their brain. A great website that shows all different sling types and their carrying instructions, as well as sells every commonly available brand, is www.peppermint.com

There are basically 4 different types of slings available. (I am not talking about the typical baby carriers that you would find at a baby store, such as a Snugli or Baby Bjorn. None of our newborns ever liked these, are they are not suitable for breastfeeding.)

1) Adjustable ring slings - come in padded or unpadded

Basic design: A long piece of fabric, with two rings sewed into one end. The other end of the fabric is looped through the rings. You can make the sling tighter by pulling down on the "tail" (extra fabric) that will be hanging out the rings. If the sling in padded it will have a soft pad that goes across your upper back, as well as have padded rails (the long sides of the fabric). Personally, I have not found a difference in wearing comfort between the two types.

To wear: Place rings on front and side of collarbone (where you would pin a brooch), spread fabric over shoulder and across back. You can wear the sling on the right or left shoulder, whichever you find more comfortable.

To nurse: Some women use this standard position to nurse, but I find it does not offer enough privacy if the tail of the sling is sewn together (as is the case on ready-bought padded slings). Unpadded slings on the other hand often have a tail that can be pulled open as a nursing cover. In the 3rd picture below, I was using a padded sling with a sewn-up tail, so I put the sling on backwards to nurse. For example, if I want to feed the baby on the right side, I will put the rings on my left waist, with the widest part of fabric covering my entire front and back, and going over my right shoulder. This position does not support the baby as well, but if I have to I can still hold the baby with my right arm (inside the sling), walk around, and have my left arm mostly free. Vice versa if you feed on the left.

Advantages:
- easy to slip on and take off
- not too bulky
- great for breastfeeding discretely
- can be found at pretty much any baby store, as well as easily found used
- inexpensive
- doubles as a blanket when "unhooked"
- the unpadded type can easily be sewn

Disadvantages:
- weight is not evenly distributed across both shoulders
- baby is not held quite as securely as with other slings, so it's good to keep one hand on the baby at all times
- back carry is not feasible (in spite of what the manufacturer says)

Personal experience: Although not the most comfortable, this is certainly my most used type of sling because I am out and about a lot. Therefore, the fact that it is easy to put on and is great for breastfeeding, makes this my #1 choice for when I am away from home. It is a staple in my van.

The first three photos show Miriam at 7 months of age during our family vacation to California. The last two are of John when he was a couple of months old (taken in Indiana).






2) Non-adjustable tube slings

Basic design: Similar to the previous design, except there are no rings and the ends of the fabric are sewn together, creating a tube or pouch.

To wear: Slip tube over head, pull one arm through so that one end of the tube rests on one shoulder, the other end of the tube across the opposite waist.

To nurse: I would not recommend it unless you have a blanket to cover the baby with. The sling itself offers little discretion because there is no extra fabric to fan out over the baby.

Advantages:
- easy to slip on and take off
- very small and light-weight (easily fits in a purse)
- nice on hot days
- never needs to be adjusted (Note: As the baby grows larger, you will likely be losing the pregnancy weight. The two seem to cancel each other out nicely because although these slings are tailor-made, they will fit well even as the baby gets older.)
- can be sewn quite easily

Disadvantages:
- weight is not evenly distributed across both shoulders
- baby is not held quite as securely as with other slings, so it's a good idea to keep one hand on the baby at all times
- back carry is not feasible
- expensive if bought ready because they have to be tailored to your size
- not suitable for breastfeeding

Personal experience: My least favorite sling, although I do like to use it at home when the weather is hot and I don't want the extra bulk of a wrap.


3) Wraps

Basic design: A 13-15 ft length of fabric, about 30-45" wide. The fabric is usually light-weight and woven diagonally to give it some stretch while still being very strong.

To wear: There are dozens of ways to tie the baby to the front, back, or side, as well as for nursing. Lots of information can be found online.

To nurse: Lots of different positions. The positions for nursing newborns are the easiest and most discreet - they actually allow you to tie the baby to yourself and use the wrap as a cover for both mom and baby, so the little one can eat and sleep whenever they feel like it, and nobody will ever know. This is easiest if mom is wearing a nursing top.

Advantages:
- very comfortable because weight is distributed across both shoulders
- lots of different carrying positions to accommodate babies' preferences
- great for breastfeeding newborns around the clock while keeping your hands free
- holds baby VERY securely, allowing you to have both arms free at all times
- great for carrying baby on back
- doubles as a blanket (you can also buy special rings to turn it into a hammock)
- makes carrying an older baby or toddler easy

Disadvantages:
- the long fabric can be hard to handle, especially in public
- can be hot in the summer
- takes some time to learn different ways of tying the sling
- learning the back carry positions is a little tricky
- expensive
- usually only found at online specialty stores
- gives you an "ethnic" look
- hard to find the right fabric to sew yourself

Personal experience: Without doubt, I find this to be the most comfortable carrier. It is my favorite choice to use with newborns (both at home and on the go) because it leaves both my arms free and keeps the baby happy when all they want is to eat, sleep, and be held. As the baby gets older I only use it at home because tying it in public without dragging it through the dirt is a little tricky. (Alternatively, some positions allow you to wear the sling even when the baby is not in it, and you won't have to tie it in public. But people will give you funny looks because it does look a little strange. Not that I really care, though.) My favorite brands are Girasol and Didymos.

In the first 3 pictures below, I am carrying Miriam at 10 months of age quite effortless - she was sick and wanting to be held all day. The other pictures are from Isaac's 2nd birthday (in Indiana) at which time John was just a few weeks old. Not only did I carry John in the sling in the weeks before when I was decorating and getting ready for the party, but he also slept in there the whole party while I entertained about 30 guests, did games with the kids, painted their faces, etc.









4) Asian-style carriers (mae/mei tai wrap)

Basic design: Kind of a cross-over between a wrap and a typical baby carrier (such as a Baby Bjorn). Basically a pouch in the front, with straps that are tied around the back and waist rather than the clips of typical baby carriers. Straps can be as wide as a wrap.

To wear: Again, best to get the many different directions online.

To nurse: Not really feasible for older babies because not very discreet.

Advantages:
- less fabric than a wrap
- more comfortable than a sling because it uses both shoulders
- easy to put on in public
- lots of different carrying positions to accommodate babies' preferences
- holds baby VERY securely, allowing you to have both arms free at all times
- great for carrying baby on back
- makes carrying an older baby or toddler easy
- can be sewn fairly easily

Disadvantages:
- expensive
- usually only found at online specialty stores
- gives you an "ethnic" look
- not feasible for breastfeeding

Personal experience: None yet. I am in the middle of sewing one of these to try out with the new baby.

Saturday, June 21, 2008

Some thoughts on baby loss

My pregnancy is progressing well, and there are no reasons to be concerned at all. Yet, I am often reminded that this 9-month journey does not always turn out the way parents expect it to, something that is very little talked about. The following text in red is a "copy and paste" from the blog of the midwife that I had with Miriam (who has since moved to Mexico to train local midwives there). Please do not read this post if you are currently expecting and this would worry you too much.

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“Midwives don’t really talk about death…” Janis wrote me, and my first reaction was to defend my profession and peers. As my fingers hit the keys with all the reasons why a midwife wouldn’t talk about death (our pregnant moms would be too freaked out if we did?), I realized that I was writing excuses. Janis is right. Midwives DON’T talk about death much, not even among other midwives. We are always so busy and at times have superstitious or other beliefs that cause us to avoid this topic. Too, with the midwife persecution that occurs, we may worry that acknowledging baby death will have folks question our abilities or feel validated that birth with midwives or home birth is dangerous. Sometimes it plays into our own fears, too. I once had another midwife who had lost her own baby after a difficult home birth be angry at me and tell me she was offended by me in front of a room of midwives (years after her loss) because I had brought up some random legislation that reminded her of her experience – and, this was a birth I was nowhere near and had nothing to do with at any point. I was shocked at her outburst but recognized that this midwife had never healed appropriately – and, with the lack of support for women who lose babies, that is no surprise.

Parents always ask me about my skills and what emergencies I have or haven’t seen. I know what they are really asking me is if I can save their baby’s life. But, the few times that I have been honest and said, “Well, you know that death is a part of life. Babies die in the hospitals but you never hear about it…” the looks on the expectant parent’s faces are ones of shock and instant distrust, betraying that they didn’t want me to acknowledge this very real fact. Sometimes, I just get tired of always having to be ultra-sensitive to the ultra-sensitive nature of pregnant women. When my well-off clients (to me, well-off is someone who has enough money to buy expensive organic food and be able to purchase unnecessary stuff at whim) have deep episodes of anxiety because they are SURE their babies will die, I sometimes have to hold back the urge to give them a reality check: “YES, your baby REALLY can die. Death and Life are intertwined as part of the mystery and it does happen, although the likelihood of your well nourished, organic fed, vitamin given, yoga enhanced, first world baby dying is not the foremost thing you should to worry about and, indeed, worrying about it often does not change the results…” No, they want me to reassure them that it will not happen. Sometimes, I can’t dig deep enough to reassure women who have ‘everything’ that they will, also, have a perfect baby because I know that the truth about birth is that it happens in the shadows of death. I now work in a world where women expect pain and death to be a part of life (and birth), and they find deep joy in their lives (and births) regardless. Oh, now, really...don't get angry at me for writing all of that - I’m not being mean. I know that women must receive reassurance in a world that always plays on women’s fears (especially from her insensitive midwife!). I experienced the fear, too, that my babies would not be a part of my life story when I was pregnant. [...] This is, after all, a precious baby. So, I say nothing to my fearful clients of all these realities but give many reminders about how safe birth really is and how the will of babies to live is very strong – that, mainly, we need to trust our babies. Enough said. So, no, I don't often talk about the deaths I see as a midwife.

I asked Melissa if I could write about her story, and she wrote: “Hi Marinah,
That is ok with me to use my story on your blog. Thanks for offering and asking. We are doing ok. We just lost our 5th baby since Brock in February; he was born at 15 weeks. He was born at home as well, and I was by myself for most of my delivery. We had to wait about 3 weeks for him to come, after he died. I am glad I got to have him at home. We are looking into international adoption since we think the chance of us having a baby is very slim. We thought we had figured everything out. I was diagnosed with Thyroid disorder, and MTHFR gene mutation and Protein S deficiency, and even with twice daily heparin, baby didn’t make it. So, I am done as far as I know…”

When I met with Melissa the first time during her pregnancy with baby Brock, she and I talked a long time about her previous birth. She had lost twins at 20 weeks due to a rare twin complication. She shared her story of going to the hospital after being told one twin was dead and having the other die while in labor. Her contractions were augmented and she was given an unusual amount of medications that made her labor a nightmare of interventions. The one detail that was most significant to her was that the hospital took her twins and did not allow her to see them. In many states, if your fetus is less than 21 weeks or a certain amount of weight, the fetus is considered tissue – or, hazardous waste. Often, hospitals will also keep and use the placenta (and, sometimes the fetus) for testing if they don’t throw it away. She was not allowed to see her babies or to take them home and she still felt so much sadness at this trauma she sobbed telling me the story. She wanted me to know right off the bat that, no matter what, if this baby was to die she would stay home to birth her baby.

It was during a prenatal that we didn’t hear a heartbeat. When all the tests were done it was confirmed that Brock, as she had named her baby boy, was no longer alive. My firm belief in herbs for women and her loving belief in me led us to use herbs to help her body start the birthing process. We thought maybe that she would birth Brock in a few days after taking an intense combination of herbs. It didn’t happen. We spoke often and she found the strength to continue her intense herbal regimen and weeks went by – the waiting was painful but Melissa knew the alternatives and did not want the drugs, the hospital environment, and the lack of choice. Finally, she called to tell me she was in labor.

Her labor was intense and beautiful and peaceful. Brock was born in his shiny bag of waters and his placenta followed shortly afterwards. Melissa had me take lots of photos and we measured him and touched him lots and welcomed him. Melissa had chosen a supportive funeral home in the weeks before her birth and, when she was ready, I called them. When the man and woman arrived, they were so lovely – there is no better word. They collected the baby with words of kindness and sympathy. They took the baby from my hands (Melissa elected to remain in her room when they came) and wrapped him so carefully…it was like watching my midwifery teachers or the traditional midwives who have the hands of 35 years of births lovingly touching a newborn. That moment will always remain imprinted in my memory. They took Brock and Melissa was finally able to rest. The tears came when she heard them leave the driveway and she wept and wept.

There was a beautiful funeral and Melissa told me weeks later that after a powerful Miss Foundation conference on baby loss that she jumped the gates of the cemetery in the middle of the night to see her baby’s grave. She was so glad she had a place to visit her baby and that she had made the decisions around her birth. She also taught me that I needed to say that the baby DIED. Not, passed away or moved on or whatever, but DIED. “Use dead and died,” she said. And, I understood that for mothers it is true DEATH when her baby will never be in her arms again. Five months later, she had another baby die.

[...]

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Babies die at home, and babies die at the hospital. They can die during pregnancy, birth, or any other part of their life, and as mothers any of these scenarios would probably be equally painful. It is something that we can pray about, but in the end have little control over.

Women will go to great lengths and have "socially accepted" hospital births only to be somewhat freed from the stigma that comes with having a baby die. When a baby dies, other mothers who want to deny that death is a part of life, and who don't want to think it could happen to them, silently ask questions like "Was it the parents' fault?" or "Could anything have done to prevent this?" At least with the "normal" hospital birth, you are absolved from most guilt and shame.

I am reminded of a baby loss that occurred on my husband's side of the family about 10 year ago, a story that was told me over and over when I was considering home birth to show me why it was not a safe option. This lady had a baby die in the 9th month of pregnancy from an infection because, unbeknownst to the Mom, her bag of waters had broken. It was not a gush, just a minor trickle (because the baby's head often acts as a cork), and it was in the midst of a hot, muggy summer. At her next checkup a week later, there was no heartbeat. The baby's death had been blamed for years on the fact that the lady was cared for by a midwife. Even my husband used her as a bad example, back when he was skeptical of home birth. My immediate thought was wondering what would have been different with a doctor - they only have weekly checkups at that point. If the Mom didn't suspect anything was wrong, something I can very well relate to, why would the doctor call her in for an unscheduled checkup? The truth of the matter is that women want to defend their choices surrounding birth, so they will attack the "opposite" side in an attempt to make them look bad, while covering their own backs should something go wrong for them.

In reality, about the same amount of babies and moms die in the hospital as at home. Some statistics say the mortality rate is higher at the hospital. A lot of that has to do with the midwife's expertise, since they are not all equally knowledgeable and experienced. Basically, the worst midwife will have mortality rates close to that of hospitals, and the better the midwife the lower the death rate. But it is never zero. Yet, if one of our babies would die during a home birth, everyone would be sure to ask us about every painful detail, to either prove or rule out that it was our fault. Such is not the case when a death occurs at the hospital. People might ask those questions behind closed doors, but they would show the parents nothing but compassion and support.

The main difference between hospital and home births lies in the number of interventions and complications, both before, during, and after birth. Recovery at home is faster, safer, and better. Intervention rates are drastically lower, and women walk away from birth feeling confident that they can care for the child they just gave birth to without outside help.

I am not opposed to all hospital births. I understand that there are some VERY RARE circumstances where they would lead to a safer outcome because of some problem with the mom or baby. These problems can be detected during pregnancy, though, when there is still plenty of time to switch to a hospital. Sending all women to the hospital "just in case" is as ridiculous as saying "Let's give all women hysterectomies because some women will otherwise develop uterine cancer". I don't think women who go the hospital are bad moms, or that they are not concerned about their child's safety. I feel sorry for them because they have bought into the lies propagated by mainstream medicine, and they will be victimized by the doctors to some extent.

From the day I found out that I was pregnant for the first time (a baby that we lost), I have kept the knowledge in the back of my mind that things do not always turn out well. "Cautiously optimistic" would best describe how I feel about pregnancies, and about the lives of my children. The feeling never eases, only intensifies as there are more and more children to love, care for, and - yes - worry about. I am convinced that it will be with me until I die.

But instead of having it become a paralyzing fear, one that will make the helpless victim of a medical discipline that is 90% dominated by male perverts (= male ob/gyns), I have chosen what I believe to be the safest alternative.