Delayed Cord Clamping at Birth

In recent years, there has been ongoing debate regarding the optimal time to clamp the umbilical cord at birth. The current practice at many centers in the United States is to immediately clamp the umbilical cord at time of delivery. However, numerous studies have demonstrated safety and advantages to delayed cord clamping (DCC), a practice endorsed by the American College of Obstetricians and Gynecologists Committee Opinion statement published in 2012, which recommended DCC in preterm neonates, when feasible. In term infants, DCC is typically considered clamping 60 seconds after birth, typically at 1 to 3 minutes after delivery. In preterm infants, DCC is considered clamping between 30 to 60 seconds after birth. When DCC is performed, a newborn receives a placental blood transfusion that may increase their blood volume by up to 40%. Over time, this transfused volume of red blood cells naturally gets broken down, leaving iron for the body to use by developing cells. In the brain, iron is essential for normal development and is important in helping form the insulating sheaths around nerve fibers, a process called myelination, which increases the speed at which nerve impulses travel.

Based on multiple randomized controlled trials, there are many potential advantages to performing DCC compared to immediate cord clamping in preterm babies, including decreased overall mortality, blood transfusion incidence and the risk of intraventricular hemorrhage. DCC reduces the incidence of intraventricular hemorrhage by nearly 50%, thereby preventing one case of intraventricular hemorrhage for every 15 neonates treated.  While more studies are needed to better understand the long-term impact of DCC on neurodevelopment, emerging studies continue to demonstrate safety of this natural and cost-effective practice.

As part of the birth plan, I encourage all parents to discuss with our obstetricians and midwives how to optimize their birth experience, which should include a conversation discussing the possibility of performing DCC to promote the benefits of placental transfusion for their baby.

References

1. Committee on Obstetric Practice American College of Obstetricians and Gynecologists. Committee opinion no. 543: timing of umbilical cord clamping after birth. Obstet Gynecol. 2012; 120(6): 1522–1526.

2. Backes CH, Rivera BK, Haque U, et al.  Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstet Gynecol. 2014;124(1):47-56.

 

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Poem for Parents: The Last Time

This poem has been around for years. The author is unknown, but the thoughts and feelings are timeless.

The Last Time
From the moment you hold your baby in your arms,
You will never be the same.
You might long for the person you were before,
When you had freedom and time,
And nothing in particular to worry about.
You will know tiredness like you never knew it before,
And days will run into days that are exactly the same,
Full of feeding and burping,
Whining and fighting,
Naps, or lack of naps. It might seem like a never-ending cycle.

But don’t forget…
There is a last time for everything.
There will come a time when you will feed your baby
for the very last time.
They will fall asleep on you after a long day
And it will be the last time you ever hold your sleeping child.
One day you will carry them on your hip,
then set them down,
And never pick them up that way again.
You will scrub their hair in the bath one night
And from that day on they will want to bathe alone.
They will hold your hand to cross the road,
Then never reach for it again.
They will creep into your room at midnight for cuddles,
And it will be the last night you ever wake for this.
One afternoon you will sing ‘The Wheels on the Bus’
and do all the actions,
Then you’ll never sing that song again.
They will kiss you goodbye at the school gate,
the next day they will ask to walk to the gate alone.
You will read a final bedtime story and wipe your
last dirty face.
They will one day run to you with arms raised,
for the very last time.

The thing is, you won’t even know it’s the last time
until there are no more times, and even then,
it will take you a while to realize.

So while you are living in these times,
remember there are only so many of them and
when they are gone,
you will yearn for just one more day of them

For one last time.

– Author Unknown

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Happy-Mothers-Day

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Introduction of Complementary Foods

Breastfeeding is the best nourishment for infants. The World Health Organization recommends exclusive breastfeeding until 6 months of age. At the same time, the American Academy of Pediatrics (AAP) states that many families introduce “complementary foods or solids” earlier than 4 months of age. Many parents perceive that introducing solids would reduce fussiness. Complementary feedings mean giving baby solid foods that complement breast milk feedings or formula feedings.

The AAP website for parents recommends waiting to start solid foods until the baby is developmentally ready. It depends on the baby’s digestive readiness and developmental readiness.

You’ll know your baby is ready when they:

  • Are able to sit up with minimum support
  • Are able to keep their tongue inside the mouth
  • Their tongue thrust reflux is gone
  • Are eager to participate in mealtime and watch parents and others during mealtime
  • Are able to pinch or grasp things and put it into the mouth
  • Are able to refuse and turn away when not interested in feeding
  • Are able to take pureed food presented from the spoon

Two advantages of introducing complementary foods are that it reduces the risk for iron deficiency, and it lowers the risk for food allergies. In fact, the American Academy of Allergy, Asthma and Immunology recommends introducing complementary foods between 4 and 6 months of age to decrease the risk of developing any food related allergies. Signs of allergies are hives, skin rash, facial swelling, vomiting, diarrhea, wheezing and difficulty breathing. If baby shows no signs of allergic reaction, then a second ingredient food may be added.

When you choose what to give your baby, use a wide variety of food. Baby foods can be prepared at home under clean, sanitary conditions or store bought. The food you give to baby should be rich in iron like iron fortified cereal, meat alternatives or meat. Introduce single ingredient pureed foods like vegetables, fruits, cereal or meat. Babies do not need juice or any added seasoning like salt or sugar.

If baby is uninterested in trying complementary foods, wait and try again in a few weeks. It is a new experience for the baby and should be enjoyable.

Be sure to have a discussion with your child’s pediatrician before introducing any foods.

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What the Affordable Care Act Means For Breastfeeding Moms and Their Families

Lactation Consultants and other health care providers have been lobbying and pressuring lawmakers for breastfeeding protection and promotion for years. Now it’s here, but legislation jargon can be very confusing. Here’s what you need to know:

The Patient Protection and Affordable Care Act of 2010 (ACA) provides provisions to encourage mothers to achieve and exceed their breastfeeding goals, including:

Health insurance benefits to help cover costs associated with providing breast milk to infants, including coverage of breastfeeding education and supplies in non-grandfathered health insurance plans.

Prior to the ACA, the IRS agreed to include breastfeeding supplies as an eligible expense for health savings accounts (HSAs) and flexible spending accounts (FSAs) thanks to the promotion of the American Academy of Pediatrics (AAP).

Coverage for breastfeeding education: As announced in the Health Resources and Services Administration (HRSA) 2011 guidance, breastfeeding benefits for non-grandfathered health insurance plans include pre- and postnatal counseling by a trained provider in conjunction with each child. Women may access comprehensive lactation support and counseling from trained providers. The benefits are available at no cost share to consumers.

Breastfeeding supplies benefits: The ACA requires non-grandfathered health insurance plans to cover the cost of breast pump rental or purchase at low or no cost to consumers.

Insurance Coverage: The breastfeeding coverage applies to all health plans except grandfathered plans. Under the law, 23 preventive health services for women are to be covered with no copayment, co-insurance or deductible in non-grandfathered plans. Many private employers already cover these services. For more information about Women’s Preventive Health Services visit healthcare.gov.

The National Breastfeeding Helpline: The National Breastfeeding Helpline from the U.S. Department of Health and Human Services’ (HHS) Office on Women’s Health has trained breastfeeding peer counselors to provide support by phone. The counselors can help answer common breastfeeding questions. They can also help you decide if you need to see a doctor or lactation consultant. The Helpline (800.994.9662) is available for all breastfeeding mothers, partners, prospective parents, family members and health professionals seeking to learn more about breastfeeding. The Helpline is open Monday through Friday, 9 a.m. to 6 p.m., EST. Help is available in English and Spanish.

What can expectant or new mothers do? 

  1. Set your breastfeeding goals.
  2. Find a pediatrician who is supportive of your breastfeeding goals.
  3. If you are working outside the home, talk to your employer about returning to work. Develop a workday plan for pumping while away from your baby. See a lactation consultant, and plan to attend our Strategies to Provide Breastmilk Through Pumping While Returning to Work class.
  4. Contact your insurance company and ask what exactly is covered and where to go to obtain breastfeeding education and supplies. Some insurance companies let you go anywhere and then get reimbursed, while other companies require patients to go to a specific provider or retailer.
  5. Enroll in a breastfeeding class
  6. Obtain a breastpump through your insurance, if able. We recommend obtaining your pump after baby arrives as you may need a hospital grade rental pump, and some insurance companies only cover use of those pumps if you have not already obtained a personal use pump. Please contact a lactation consultant at 425.688.5516 to see what pump is best if your insurance gives you multiple options.
  7. Once your baby is delivered, put your baby skin to skin and breastfeed your baby within the first hour. Continue offering your breast often.

Enjoy your baby, and ask for help with breastfeeding if needed. Overlake offers prenatal breastfeeding classes and prenatal lactation consultations. Once your baby is born, you will receive education and assistance with trained nurses and, if needed, lactation consultants in the hospital. After you go home, support continues with your post-partum follow-up appointment. You can also make appointments for one-on-one visits with Outpatient Lactation for further assistance with any breastfeeding issues and needs for returning to work. Additionally, we have a great support group for new mothers called After Baby Comes.

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Overlake’s March for Babies Team Raises Money With Bake Sale

March for Babies_ambassadors

Kaitlin (9) and Makenna (5) are Overlake babies who were both born 4 weeks early; Kaitlin spent 10 days in our NICU, and Makenna spent 11 days there.

Overlake Childbirth Center’s March of Dimes Team hosted a bake sale on the Overlake campus this past Wednesday and raised $1,389 toward their goal of $25,000!

Last year, Overlake’s team received first place for fundraising.

The March for Babies is an annual event that raises money for The March of Dimes. The 2016 walk will be held April 30 at Fisher Pavilion at Seattle Center. Registration begins at 8 a.m.; the walk begins at 9 a.m.

Click here to donate to the Overlake team.

 

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Pregnant? Get the Tdap Vaccine to Protect Your Baby from Whooping Cough

The first few months of life is when a baby is most vulnerable to serious complications from whooping cough (pertussis). Babies cannot get their first DTaP (diphtheria, tetanus and pertussis) vaccine until two months of age, leaving them vulnerable to exposure if the mother has not been vaccinated. In fact, about 30 to 40 percent of babies who get whooping cough catch it from their mother.

The best time for a pregnant woman to get the Tdap (Tetanus, Diphtheria and Pertussis) vaccine is during the 27th through 36th week of pregnancy. In addition, it is recommended to get the vaccine during subsequent pregnancies.

Why? Even if you have received the vaccine prior to pregnancy or during previous pregnancies, the amount of pertussis antibodies decreases over time. When immunized during one pregnancy, the antibody levels may not stay high enough to provide enough protection for future pregnancies. There are no blood tests that can test for adequate immunity against pertussis.

By breastfeeding, antibodies pass to the baby in response to the vaccine. When vaccinated during your pregnancy, antibodies will be passed to breast milk as soon as your milk comes in. However, the baby will not get protective antibodies immediately if you wait to get the vaccine until after delivering your baby. It takes about two weeks for the body to create antibodies.

Read more about the Tdap vaccine and pregnancy from the CDC.

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NICU Grad Caitlin Pays it Forward

Caitlin and her lamb, with parents James and D’Anna, along with one of their original NICU nurses, Diane

In February 2007, baby Caitlin surprised her parents by arriving quite early – at 31 weeks. Born weighing only 2lbs, 11ozs, this precious girl spent about five weeks in our NICU before she and her family went home together. During those weeks, Caitlin grew and got stronger in the company of a small stuffed animal – a lamb that shared her isolette.

We were excited to have Caitlin (and her lamb!) visit us this year for her 9th birthday. And, Caitlin had a surprise for us. Instead of asking for birthday gifts for herself, this year she requested preemie and newborn baby-sized clothes she could give the babies who are currently in Overlake’s NICU. She, along with mom D’Anna and dad James arrived carrying a rather large “birthday bag” bursting with clothes, hats and blankets for our babies. While they were here, we had the privilege of giving the family a tour of the room where they stayed nine years ago, and were moved by the welling of memories of that time.

We love each and every one of our NICU families, and couldn’t be more proud see our graduates growing up to be so kind and generous. Thank you Caitlin, D’Anna and James for keeping alive the spirit of “paying it forward!”

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Celebratory Meals for Mom

After you deliver your baby, you may feel like you’ve run a marathon, or two! You may have not had very much to eat, and need to rest and regain strength. To celebrate this amazing milestone in your life, Overlake’s Executive Chef, Chris Linaman, has created an exclusive celebration menu for our new moms and their partners.

Grilled Lamb Chops

Each menu option includes your choice of the following entrées, plus a dessert, and a choice of sparkling water or sparkling cider.

Grass-fed lamb chops (pictured top right) served with roasted vegetables and mint chimichurri.

Antibiotic-free pork chop (hand-cut by Organic Red QuinoaLinaman every other day), served with roasted veggies and apricot-pear chutney.

Organic red quinoa (pictured bottom right) with kale and yams, topped with spiced pepitas and feta cheese.

For dessert, you’ll have a choice of a forest berry tart – creamy vanilla custard topped with a mix of fresh berries, or fresh lemon curd topped with browned meringue.

Linaman uses high-quality ingredients, such as grass-fed, antibiotic-free meat and fresh, organic vegetables and fruits.

“Seasons Dining’s desire is to add just one more special touch to an already amazing day in the life of a growing family,” says Linaman.

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Save the Date – March for Babies 2016

March for BabiesOverlake Medical Center was the proud recipient of the award for First Place Fundraising team for the 2015 March for Babies Walk with a total of $25,442. We were joined in this photo by the emcee at this morning’s 2016 kickoff event, DJ AJ from WARM 106.9 Radio, who told all in attendance his baby was recently born at Overlake and had an amazing experience!

The 2016 March for Babies will be held April 30, 2016 at Fisher Pavilion at Seattle Center. Registration begins at 8 a.m. Walk begins at 9 a.m.

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