Breast milk is the best food for all babies. It contains all the essential nutrients and immune benefits babies need – except for Vitamin D and iron. Most full-term infants are born with enough iron stores to last until iron-rich solids are introduced at 6 months of age.
However, infants may not be born with enough Vitamin D stores. Studies have shown that giving mom extra Vitamin D does not always increase the Vitamin D content of breast milk predictably and it’s unclear if the high doses necessary to get more in mom’s milk are safe for moms long term.
Doctors have been seeing more cases of rickets among breastfed infants in the U.S. due to Vitamin D deficiency. Vitamin D is made by the body when there is enough exposure to sunlight. There are many factors that affect this process and lead to low levels of Vitamin D:
- Living at high latitudes, particularly in winter months when Vitamin D can’t be made
- Air quality, i.e. high levels of pollution
- Weather conditions – dense cloud covering (Pacific Northwest!)
- The amount of skin exposed to sun
- Use of sunscreens- public health effort to decrease skin cancer risk by limiting sun exposure
- Darker skin pigmentation
In 2008, the American Academy of Pediatrics issued the following recommendation:
A supplement of 400 international units (IU)/day Vitamin D is recommended for all breast-fed and formula fed infants (consuming less than I liter formula/day) beginning in the first few days of life.
Infant liquid multi-vitamin products or vitamin D only products can provide the recommended amounts of Vitamin D. These are available without prescription. Most term infants should need Vitamin D only.
The AAP and FDA recommend choosing products that deliver 400 IU in a 1 ml dose.
NOTE: Avoid products for infants that deliver very high concentrations of Vitamin D in 1 or 2 drops. There is a high risk of overdose and this may lead to serious health problems.
Overlake received an “A” score from The Leapfrog Group and excellence awards from various other regional and national public reporting parties due to our success and commitment safety of moms and babies (Healthcare Business Insights, 2015). We have used safe practices for many years, including eliminating early deliveries. An early elective delivery means choosing to have a baby born before 39 weeks of pregnancy without a medical reason. Research has told us that babies that are born between 37-39 weeks do not do as well as babies born between 39-41 weeks unless there is a medical reason. Therefore we remain committed to not taking the risk of delivering babies early unless there is approved reason to.
Healthcare Business Insights Cost & Quality Academy. (2015). Improving Patient Safety Measures by Reducing Risk and Focusing on Quality Initiatives. Efficiency & Effectiveness, (May), 1-4.
Having a baby is an exciting event, involving tremendous changes for the parents (as well as the baby). In the midst of welcoming a new family member, however, about 10-20% of women (and approximately 10 % of men) will experience postpartum depression, now more commonly called post-partum mood disorder (PPMD).
Years ago, this was not a recognized condition, and people struggled through it in silence and guilt. It is now recognized that many of us are prone to develop this condition, particularly if there is a past history of anxiety or depression, a birth that didn’t go the way we planned, and lack of at least two or three solid hours of sleep at a time during the post-partum period. There are also other contributing factors. Symptoms of PPMD (among many) can include physical symptoms, such as muscle tension, irritability or anger, restlessness or shortness of breath.
Information and assistance is available at no charge through the “Postpartum Support International of Washington.” They have a helpful, comprehensive web site at www.ppmdsupport.com. There is also a toll-free support line a 1-888-404-7763. The web site included risk factors, signs and symptoms, free support groups and the toll free “warm line.”
One of the most surprising elements of taking a new baby home is how much they love to sleep all day and party all night. This can be extremely challenging especially after an all-night labor that capped off weeks of poor sleep associated with common discomforts of late pregnancy. Sometimes it helps to understand why babies are awake at night and how their night schedule is actually helpful.
While you were pregnant, you rocked your baby to sleep all day because you were moving. You were probably so happy to feel him/her start kicking around when you finally got off your feet in the evening. Unfortunately, this wake-up time is often when your baby starts to wants to feed frequently in the evening because that is what he/she is used to. There is good news though; if you are breastfeeding, your body is programmed to respond to feedings easier than during the day. This helps you to build up the hormones required for a full milk supply. Your baby is actually partnering with you so that there is enough milk for feedings to space out a bit. You are a great team!
Add a portion of patience to your understanding and soon your schedules will be more in synch. In the meantime here are a few tips that may help:
- Wake your baby for daytime feedings. “Never wake a sleeping baby” is not a good rule to follow if he/she is sleeping all day and feeding all night. He/she will still need night feeds but the more you feed during the day the sooner nighttime feedings will space out.
- Establish a nighttime routine. This keeps bedtime and naptime different. This routine needs to be portable-you do not want to be spending the night at grandma’s house and realize you forgot to bring the glow light lullaby toy you use along with you.
- During naptime and nighttime keep the room dark and quiet and allow light and noise to penetrate only when you want them to be awake – 2am is not time to start playing peek-a-boo!
- Be prepared for change. Many babies will take a stretch of sleep one night and then not again for a few nights. Remember, he/she is immature in every way and as his central nervous system matures, he/she will sleep more at night.
Sleep is a common topic at our After Baby Comes Groups. If you are a new parent and want to interact with other new parents register today at http://www.overlakehospital.org/classes/
The “Overlake Medical Center is Bananas for Babies” banner was personified on May 2 when more than 100 Neonatal Intensive Care Unit (NICU) graduates, Childbirth Center staff, physicians, families, friends and dogs took to the streets of Seattle to march in the annual March of Dimes March for Babies. The 3.1 mile walk celebrated a two month effort to raise funds to support the March of Dimes Mission to improve the health of babies by preventing birth defects, premature birth and infant mortality.
Overlake partnered with March of Dimes because we share that vision as we care for preterm infants in our state-of-the-art level III NICU every day.
We were recognized by March of Dimes as one of the top five fundraisers for last year’s walk and set lofty goals to increase participation and dollars raised by 25% this year. Our love for babies was demonstrated by exceeding both goals; having 119 walkers sign up and raising more than $25,000. Multiple staff members, physicians, and NICU graduate families were included in the Circle of Champions having raised more than $1,000 individually.
We are enthusiastically planning for next year’s march knowing that the babies we serve are worth all that we give.
You still have an opportunity to partner with us in this very worthy cause at: https://www.marchforbabies.org/march//s_team_page.asp?seid=2178309
Obstetrical simulator “Noelle” is administered oxygen by the anesthesia team in preparation for surgery
Overlake’s Childbirth Center had the amazing opportunity to participate in twenty-seven multidisciplinary postpartum hemorrhage (PPH) simulation training sessions during the month of March. Using a state of the art obstetric birthing simulator, approximately 300 staff participated in the simulations, recreating a “mock” PPH. PPH is an obstetrical emergency that can be sudden and unexpected and requires prompt recognition and action. The unique opportunity with the simulations was having each team member sign up to participate in their own role – to have the added value of the entire team that works together, train together – just as in everyday clinical situations. This included anesthesiologists, obstetricians, midwives, scrub techs, postpartum and labor nurses, patient care techs, health unit coordinators, blood bank and several guest observers. The opportunity to practice how to successfully manage PPH after delivery included hands-on skills, situational awareness, identification of team roles and responsibilities, and how to communicate with the patient and other team members during such a critical and stressful situation. Sessions were digitally recorded, viewed by the team, debriefed and then erased. This has provided us with an amazing opportunity to simulate PPH, a leading cause of maternal mortality and morbidity, and to collaborate with the entire team to discuss our current practice and process and opportunities for system improvement.
Obstetric hemorrhage affects 2.9% of all births in the United States and is one of the top causes of maternal death. (Callaghan et al, 2010; Berg, Callaghan, Syverson, & Henderson, 2010; Bingham & Jones, 2012)
Join us for the March for Babies on May 2, 2015! This year, it’s for Kaitlin, Makenna, Ty and Carson, this year’s Overlake’s March of Dimes Ambassadors, and all the NICU graduates.
Chilbirth Center staff, along with family and friends, will be walking. If you would like to join our team or donate, please go to www.marchforbabies/teams/overlake. It really is a lot of fun with some good exercise!
Many people don’t realize how complex infant feeding can be, as it is often so effortless for most babies. Premature infants are often asked to be able to perfectly feed by mouth before they are biologically able. This can present some extra challenges. In the old days, we used to think that preemies had “weak sucks” and that we needed to help them with special bottle nipples that provided the milk very easily. However, we now know that preemies typically have rather strong sucks, and the main difficulty that preemies face is how to coordinate breathing with swallowing. We know that by giving premature infants a slower flow rate, preemies can feed more comfortably and are better able to progress their oral feeding.
So, the main question is- how can we reduce the flow rate? First, we can use a slow flow bottle. In the NICU, we may use a disposable slow flow nipple or a Dr. Brown bottle with a Preemie nipple. The Preemie nipple is even slower than the standard newborn level 1 that comes with most bottles. In fact, for preemies that still cannot handle that flow rate, the company has recently developed the “Ultra Preemie” nipple. Another technique is to feed babies lying on their side, which reduces the impact of gravity on the flow rate of the feeding. Sidelying is also a very comfortable and stabilizing position for infants. If we can provide this support to their body, the infant can then focus on the feeding. Lastly, some infants benefit from “external pacing”, where the bottle is tipped down to stop the flow rate of milk, encouraging these important breathing breaks.
Breastfeeding can be a little more comfortable for many preemies because the flow rate can be more modulated by the infant. However, for those infants that are still overwhelmed by the flow rate at the breast, we can sometimes change the position of the mother/baby and/or bring the baby to the breast at a time that the breast is less full.
When premature infants are provided with oral feedings in a positive and supportive manner focused on quality of feedings and not quantity, we can help them develop the necessary skills to be successful oral feeders.
The demands of nurturing a newborn can be exhausting. It is important that parents find ways to feel nurtured so they will have the energy and empathy required to respond to their baby’s multiple needs. Here are a few tips to nurture the nurturer:
- Don’t’ sweat the small stuff. Good enough can actually be healthier than “perfection”. Ask is my baby safe? If the answer is yes; it is probably okay. Dirty dishes will not self-ignite and jammies can be appropriate all day long.
- Rest when baby sleeps. Put your feet up and close your eyes. Don’t stress out if you can’t fall asleep – just rest.
- Find your village. Some of the sweetest words to hear are, “that is what we are going through too”. Support groups are a great way to get out of the house, meet other new parents, and feel that you are not alone.
At Overlake we offer After Baby Comes Groups for parents with infants from 0-12 months of age. Sign up today at: http://www.overlakehospital.org/classes/.
- What do you enjoy? Do it in small bits. You may not get a huge knitting project done or a 600 page novel read but take (yes, you can be the receiver and still be a good parent – probably a better parent) the time to enjoy small portions of favorite activities.
- Go outside. A walk outside is relaxing for both you and baby no matter how exhausted you feel. A change of temperature, scenery and activity will help you from the outside in.
- Reset expectations and let go of guilt. You will not be the first perfect parent no matter how hard you try. You will fail. Forgive yourself, dust off and try again.
- Prepare snacks ahead of time. Keep healthy snacks in the diaper bag for you. Your energy levels will stay more level if you feed yourself every time you feed your baby.
Parenting isn’t for the weak of heart or body. Take care of yourself – want you and your baby to thrive.
As you can see of this recent photo of Sue Gadau, Clinical Dietitian, the donations continue to come in at Overlake’s Milk Donation Center. The donations assure that Overlake Medical Center has priority access to the milk to support fragile, premature infants in the hospital’s Neonatal Intensive Care Unit. For more information about Overlake Medical Center’s new mother’s milk depot and to learn about how to donate, call 425-635-6150.