Saturday, July 24, 2010

Bigger is...better?

Or at least, not bad. I should give a disclaimer, I suppose. I am not a medical professional. Still, after the recent birth of our beautiful daughter, who happened to weigh 9 pounds and 6 ounces, I've been rethinking our view of appropriate sizes for babies in this culture, and I am wondering if perhaps it is just that: cultural.

The OB who assisted my midwife made several comments about potential size, which in retrospect were probably leading up to a warning about her being too big to be born vaginally. At the time, however, I was too focused on giving birth to read anything into it. She is our fourth, and in my experience, subsequent babies tend to be larger. She had measured on target, and I didn't have GD, so I wasn't going to waste energy worrying. Also, I had read so many accounts of home births where healthy babies were born weighing nine or ten pounds or more that I didn't see a large baby as being a problem.

Our society expects babies to weight around seven pounds. Of course, a couple of generations ago, we expected them to be around six pounds. I think there were a lot of things that influenced that: many women were still smoking and drinking during pregnancy, and they were limiting total weight gain to 15 pounds or so during pregnancy. The mothers themselves were smaller, not just in weight but also in height.

Now there are still many women who restrict their weight gain in pregnancy, not by following healthy diets, but by limiting food intake. The high number of false positives in standard glucose testing causes many women to go on diets in pregnancy, and there are still plenty of OBs out there who warn women against gaining much weight or who automatically schedule C-sections based on their best guess of the baby's size. Add to this the fact that most hospital births take place with the woman flat on her back, which causes her pelvic opening to be 30% smaller than in other positions, which likely contributes to the myths about women being unable to deliver larger babies.

In reading numerous accounts of homebirths where women followed healthy eating guidelines, but didn't otherwise restrict their caloric intake, and gave birth in whatever position they wished (almost never on their backs), I have been struck by the significant number of babies that were well over nine pounds. They were healthy babies, their mothers did not have diabetes, they were birthed naturally without complications, but they were generally larger than babies born under standard OB care.

What if that is actually normal, perhaps even optimal? What if smaller babies are more a result of our attempts to restrict birth weight rather than a reflection of what is most healthy for the babies and mothers? Anecdotally, I can say that the larger babies I've known of (including my own) tend to be more content, sleep better, are healthier and are easier babies than those who are born smaller.

It would be very interesting to see research comparing both models of pregnancy care, birth weights and outcomes.

Friday, July 23, 2010

FAs, PB&J, and BK

While I've been enjoying the fabulous cuisine in Puerto Rico (a very close second to Mexican food, which is also the food of Heaven), it has presented an interesting dilemma to a mom of food-allergic kids.

We first became aware of Ariana's food allergies about four years ago. Her reactions included hives, incontinence, eczema and behavioral symptoms. Once we eliminated her allergens, her skin cleared, she was diaper-free day and night, and her behavior went back to the calm little girl we knew was inside. I often wonder how many kids struggle with allergies that cause problems in toilet learning or behavior that the parents don't recognize--I wasn't familiar with those symptoms before.

The first year we were eliminating wheat, dairy, corn, eggs, peanuts, green beans, olives, and possibly some others that I've forgotten. Since she was breastfeeding, I had to avoid all her allergens, too. Later, she passed some food challenges, but Joel started breaking out in hives. He tested positive to black beans, pork, corn, and dairy. While hives are never fun, the only one who has ever gone to the hospital for a reaction is Elena, who is allergic to eggs, rice, cinnamon, berries and black beans.

We try to eat what we want as much as possible. I can make allergen-free versions of just about everything, especially desserts. The kids cook all the time and are very aware of what they can and cannot eat, and watch out carefully for Elena. Thankfully, many of the foods that they couldn't eat before are now safe for them. Right now, we only have to avoid Elena's allergens, as well as black beans for Joel, and eggs, green beans and olives for Ariana.

While we aren't as healthy as I would like to be, cooking from scratch and constant label reading has helped. We still do some fast food, etc. as well as some convenience foods. At the same time, the kids don't even bother to ask for things like turquoise cereal or yogurt, because "it has too many chemicals and weird things in there". And though we don't strictly avoid peanuts, with all the other allergy issues I have been reluctant to have them a regular part of our diet.

However, the first several days in Puerto Rico, Ariana was having horrible breakouts of eczema. It was the worst I had ever seen her. Puerto Rico uses olive oil in everything--one restaurant we went to told us that they didn't have a single thing that didn't contain EVOO. Usually, oils aren't as allergenic, but EVOO is. And because it isn't always obvious which foods contain, we have had to resort to fast food every day for her. I don't like a constant diet of BK or McD's, but at least they don't contain olive oil.

The hotel breakfasts were almost entirely egg-based, and it has been difficult for her to get any protein. Some days our excursions have meant that we have incredibly active mornings, and she really needed something substantial. So she has been eating PB&J every morning now. Elena and I have also done this many days. Even though Ariana's skin is clearing up, I still feel as if I am doing something forbidden.

So, our food world has turned upside down--we are deliberately seeking out junk food and PB. At least no one is reacting now.

Tuesday, July 20, 2010

Aventuras Boricuas

We have been having such an awesome time in Puerto Rico! I admit, I was a bit apprehensive about taking a ten day old baby on a trip out of the country, but the idea of staying home with all four kidlets *without* Carlos was far more frightening. It has worked out so much better than I anticipated!

Amaya is thriving. She is wearing all 6 month clothing, size 2 diapers, and is bigger than a two-month-old here at the hotel! Her cheeks are fully inflated again. :D Amazingly, she is sleeping through the night! The other kids didn't do that for months (or years). I'm getting more sleep than I did before she was born!

I remember sharing with Heather during labor a comment I had heard about giving birth naturally along the lines that birth without meds got the pain out of the way before the baby was there and that birth with meds was less painful during labor, but had a longer and more painful recovery. That has certainly been my experience. I've felt great, even on our very active days. Today I carried Elena up and down the streets of Old San Juan without a second thought. To be sure, she only weighs about ten pounds more than Amaya, but it was still cool.

Our days have been full of fabulous food, interesting excursions, swimming and relaxing. I've feasted on quesitos con guayaba (amazing pastries filled with cream cheese and guava), mallorcas from La Bombonera, mofongo and the incredibly decadent Cuatro Leches cake from Barrachina, all washed down with Puertorrican coffee. We went to the Yunque and the kidlets hiked the rainforest and played in the waterfall. We've explored El Morro, a fortresss from Colonial times, and shopped in the largest mall in the Caribbean. The kids have drunk fresh coconuts from the beach and been all over the cobblestone streets of Old San Juan. They have made friends with the wonderful students who joined us this year and Ariana woke up one morning eager to tell me about "the best dream ever" with all of her new friends. :)

Thankfully, we've never had to deal with the sibling rivalry scenario where the older child is mean to the baby. Still, I could tell that Elena was feeling a little lost the first few days after Amaya was born. She would start crying for no apparent reason. So I held her close and began singing her favorite little baby song from Yo Gabba Gabba, and she just burst into tears and held me as tightly as she could. It was so clear that she needed to still be our baby, too. Having Carlos give her lots of undivided attention (or hold the baby while I do) has been wonderful. She has been in a good mood pretty much the whole trip!

The weather has been about fifteen degrees cooler than home, which is really nice. It has rained nearly every day, but we love rain so that hasn't been a disappointment. We've had enough sunshine to enjoy the beach. :) Another nice surprise is that we get to go to Ponce, an excursion that we hadn't originally planned. We have family there and are excited about getting to see them.

I had expected this trip to be a lot more stressful, but it is very nice to be wrong!