Archive | May, 2014

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Stand, sit or squat – Hulda talks about positions

Posted on 27 May 2014 by Kristrun

Common delivery scene: Woman, lying on her back, screaming, swearing and sweating profusely as she pushes her baby into the Untitledworld less common, but more pleasant scene: Woman, sitting up, silent, serene and sweating profusely as she breathes her baby into the world. Less pleasant than the second – the more common one, the one always pictured in movies and TV shows? After all, there is more than one way to give birth, ways that are far more comfortable and relaxing for mother and baby. Lying on your back in labour may seem like the most obvious position; however, taking this position can cause contractions to slow down and become more painful, and, as your body is working against gravity, to make your labour a lot longer than necessary. Assuming your personal choice
and circumstances allow for a natural you might consider.

 

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sassyHelpers

Tips for training your helper to care for infants

Posted on 27 May 2014 by Kristrun

In Hong Kong, achieving a work-life balance can be tough, especially when you’ve just had a baby but are feeling the pull from thesassyHelpers office after just a few weeks. Most working parents in Hong Kong have no choice but to return to work full-time, despite wishing they could spend all day at home with their new precious bundle! Hiring a helper is often essential, so it’s best to be as prepared as possible for the upcoming transition:

1. Stay organized and plan ahead

It’s best to hire your helper well in advance of the new baby because if things don’t work out, you still have time to find a replacement, and if things do work out, you have time to get her up to speed! It’s also a good idea to set up some training courses for your helper that teach caring for newborns.

How do you find the right helper? Well, only time can tell if it’s a perfect fit, but I advise trusting your initial instincts and not forcing the relationship; after all, you can teach almost anyone to look after your baby, but you can’t create the chemistry if it’s not there! Get to know your helper, communicate a lot and try to understand her strengths as well as her weaknesses. You will soon know if she is the right person or not to look after your baby.

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stimilatingGeo

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Stimulating baby, naturally

Posted on 27 May 2014 by Kristrun

We know that the first eight months of baby’s life are prime time for learning but many of us are stumped for ways to stimulate and “play” with a baby. The usual fall back is to invest in some educational toys but the good news is that baby will do very well (if not better) if you use the world around you to help develop baby’s social and sensory skills.stimilatingGeo

The secret is to look at the world as your baby looks at it. Everything is new and interesting and who better to show baby how everything feels, sounds and looks than you.

Stimulating the senses

  • Tummy time and rolling is beneficial for any baby. Let your baby play on a play mat after each feeding; sometimes even just a few minutes will be sufficient as babies get tired quite quickly.
  • Keep shoes and socks off at least 50% of the time so your baby can move his or her toes and feet freely, and feel the textures of the mat or the floor.
  • You can also take nappies off regularly to allow for the free movement of legs and hips.
  • Babies respond very well to being massaged and it is a useful way to calm a fretful baby. Try massaging your baby at least once a day. You can use a light touch on the ears or head, or give him a full-body massage before a bath to help him relax and bond with Mum.
  • Go out every day and give your baby a chance to experience different types of weathers, see different things (far away and close up) and explore different textures, colours and movements.

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SolidsGeobaby

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6 months old and it’s time for solids

Posted on 27 May 2014 by Kristrun

SolidsGeobabyBy starting solids at around 6 months, you have an ideal opportunity to set your baby on a path of healthy eating patterns that will hopefully stay for life, ensuring a healthy attitude to food,” explains Conchita Amende, health visitor from Annerley the Midwives Clinic.

The WHO and UNICEF guidelines suggest starting weaning a baby onto solid food at about 6 months old. However, the child should be able to sit up and hold their head up unsupported.

You can commence weaning at 17 weeks but 6 months is recommended as before this, your baby’s digestive system is still developing and weaning too soon may increase the risk of allergies, obesity and fussy eating.

Signs that your baby is ready to try solids include:

  • Sitting up
  • Showing an interest in other people’s food
  • Reaching and grabbing accurately

At 3 to 5 months old, babies often start to wake up in the night, even if they previously used to sleep through them. Parents often interpret this as a sign that their baby is ready for solids, but waking up is not necessarily a sign of hunger, and starting solids will not necessarily make the baby more likely to sleep through the night again.

If your baby seems hungrier at any time before 6 months, then he or she may be having a growth spurt, and extra breast or formula milk will be enough to meet their needs.

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Epidural during labour

Epidural during labour

Posted on 16 May 2014 by hulda

How much pain people can tolerate varies considerably and this is affected by a number of physical and emotional factors. During labour, this is particularly interesting as for some women, labour is quite easy and not experienced as painful and for others, it surprises them how challenging it is. 

This article is not to educate about what is best or worst, but it is evidence based information about epidurals. These work by blocking the painful stimuli from the contracting womb (uterus) to the nerve endings. In this way, the woman no longer feels her labour contractions, but her ability to move around can be affected.  Although epidurals are the most effective way of ensuring a pain-free labour, they are also complicated to set up and require the woman to be under constant monitoring until the baby is born.

Epidural during labour can give good pain relief but requires monitoring throughout

Epidural during labour can give good pain relief but requires monitoring throughout

  • An epidural is an injection of local anaesthetic or pain relieving drugs (or both) into the lower back to block the nerves that come from the uterus and the surrounding muscles.
  • These are the source of the pain felt during contractions in labour.
  • An epidural takes about 10 to 20 minutes to work after you have had the injection.

It’s useful to note that the Neuropathy Relief Guide wrote this to help everyone involved: To have an epidural you will be asked to sit up or lie on your side. It is usual for you to have an intravenous fluid drip started if you do not already have one. This will be placed in the back of your hand or your lower arm. If you do not know what a drip is and how it works, please ask the midwife. To start the epidural an anaesthetist will come and see you to explain what is involved. The basic procedure requires a small hollow needle to be inserted through the skin in your lower back. The skin is made numb first. A very fine soft plastic tube (catheter) is threaded through the hollow needle; this catheter stays in place for as long as you have the epidural but once this is in place, the needle is taken out. The catheter is long enough to reach from your lower back to your shoulder and this is secured with tape onto your skin. The local anaesthetic and pain-relieving drugs (if used) are then injected through the catheter. 

There are three ways that these drugs might be given:

  1. by top-ups, which you ask for when the last dose begins to wear off, this is the usual way in private hospitals in Hong Kong. 
  2. all the time (this is called a continuous epidural infusion), in which case you will not need top-ups, – this is the usual way in Hong Kong Government hospitals.
  3. through a special drip which you control yourself (patient-controlled analgesia) by pressing a button on a handset that is attached to this drip.  This is not common in Hong Kong.

Advantages of having an epidural:

Currently, about one in four women in labour will choose to have an epidural.  Most women have said that it gives great pain relief; many say they would have one next time; only a small number of women find epidurals give little or no pain relief.  As far as we know, epidurals have no long-term effects on the baby.  When labour is induced (usually between 41 and 42 weeks), epidural is often a great pain relief to counter act the otherwise sometimes strong contractions from early on. 

If your labour has been very long and you are either very tired or in need for augmentation, epidurals may be a good choice.

The disadvantages of having an epidural

·        it has been estimated to add an hour onto the time that you are in labour. It is also more likely that you will need a drug to speed up your contractions;

·        it is more likely that you will need help to give birth using forceps or a ventouse (assisted birth). About half of first-time mothers who have an epidural in labour need this kind of help, because the effects of the epidural can make labours longer and it can be difficult to “feel” where to push. Your midwife may suggest stopping the epidural when it is time to push; this means that although you will then feel the urge to push, you will also feel the pain of your contractions;

·        your mobility may be restricted – if your legs feel too numb, you may need to stay on the bed during labour as it would be unsafe to walk about

·        the drugs used in the epidural can make your blood pressure drop and your midwife will check your blood pressure regularly. If your blood pressure drops, you may feel sick or dizzy and you should tell your midwife if this is the case.

·        because the epidural makes you feel numb, it may be difficult to pass urine and you are more likely to need a small tube (catheter) put into your bladder to help with this;

·        the epidural drugs can make your skin itch and you should tell your midwife if this is the case.  If the itchiness is persistent, the doctor can change the drugs used in your epidural;

·        sometimes the epidural only works properly on one side, so you may continue to feel the pain/discomfort from contractions on the other side. If this happens, the anaesthetist should be told, so that they can check the position of the epidural and the drug dosage prescribed;

·        a small number of women get a bad headache as a result of the epidural and over half of these women have a very severe headache. You should tell the midwife if this is the case as it can be treated. Although many people believe that epidurals cause more backache, most research has not shown any link;

·        some women still have small patches of numbness on their legs after they have given birth. This is quite rare, only one in 550 women suffer this and the problem does tend to get better on its own though it can last for up to 3 months. Permanent damage, such as paralysis (complete loss of sensation and movement), is extremely rare;

·        very rarely a woman has a life-threatening problem because of an epidural. The midwives and doctors on the labour ward are trained to deal with this.

Mobile epidurals

Some maternity units offer women low-dose (mobile) epidurals, which mean women are able, with help, to walk around during their labour. The injection for a mobile epidural may be given in two parts and a mixture of drugs can be used; otherwise they are similar to ordinary epidurals. Some types of low-dose epidurals may slightly increase your chance of having low blood pressure in labour or a headache afterwards. The anaesthetist may offer to give you a smaller dose of local anaesthetic in your epidural, so that you are comfortable during contractions but are able to move more easily and feel the urge to push. A lower dose of drugs can also make it easier to pass urine on your own without needing to have a catheter put into your bladder.  In a private hospital in Hong Kong it depends a lot on your obstetrician what kind of epidural is available to you.  In the public hospitals, they usually give a standard dose that does not offer much mobility but you are also not fully numb in your legs.  It means that you can usually move about in the bed, but it is hard to be more mobile than that. 

Delaying pushing

Your midwife may suggest that you don’t start pushing until your contractions have moved the baby’s head low down in the birth passage. If you start pushing once this has happened, there is less chance that you will need help with forceps or a ventouse to give birth to your baby.

Your choice

Epidurals are the most effective way of ensuring a pain-free labour, although there are other ways of managing the pain. This information is based on research and we are trying to be as non-biased as possible. Epidurals, whilst being effective, are complicated to set up and there can be some drawbacks to having one. It is important to make the right choice for you. Some women decide that they want to have an epidural before they go into labour, while other women prefer to wait to see how they cope with their labour contractions. For some women, the idea of needles might be very off-putting or they feel adamantly against the whole idea of having an epidural. However, you may change your mind in labour and that is why it is a good idea to know as much as you can about what is available. You can talk to your midwife who will understand that you may want to change your mind at any time. There are, however, a few situations when the doctor might recommend that you have an epidural, such as if your baby is in the breech position or if you are expecting twins.

Based on MIDIRS database with added information about Hong Kong by Hulda Thorey, midwife. / Annerley 2014.  

 

 

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Is my breastfed baby getting enough milk?

Is my breastfed baby getting enough milk?

Posted on 16 May 2014 by Kristrun

breastfeedingonbedFor many parents, the main concern after the birth of their baby is whether he or she is getting enough to eat. It is often quite difficult to tell, and the only thing you can really go with is if the baby is gaining weight or not and how many wet and dirty diapers they have. For breast fed babies this is not an exact science and it is often more pertinent to look at how concentrated the urine is.

It is normal for all babies to lose up to 7-10% of birth weight in the first few days after birth and it can take up to 2 to 3 weeks to gain this back. An adequate weight gain per week for breastfed babies is 150-250 grams. In the first couple of weeks your baby should be breastfeeding 8-12 times a day and then this will usually reduce as your baby grows and becomes more efficient on the breast.

For first time mothers, and sometimes women with older children, it is often difficult to know in the beginning what is a good feed and what is not since they’ve either never done it before or maybe did not have a good experience breastfeeding their older children.

Signs to look out for that give an indication of a good feed are when you feel a deep, strong pulling sensation. It might be a little uncomfortable when the baby initially latches on, but you shouldn’t feel a strong pain throughout the feed. Your baby should suck consistently with only brief pauses, you should hear swallowing after the milk comes in and notice milk in the baby’s mouth. To begin with your baby should feed quite vigorously for 15-20min per breast or 20-30 minutes for single breast feedings.

If your baby has a difficult time latching on and staying on, you hear clicking sounds when your baby sucks or you notice dimples in her cheeks, if he has inadequate wet diapers and stools or doesn’t seem satisfied at the end of a feed, we do recommend you have a consultation with one of our midwives or health visitor. This also applies if you are experiencing pain for more than 30-40 seconds at the beginning of a feed or excessively damaged/cracked nipples. Even one single consultation with a specialist can improve the situation enormously and it may be that a simple change in feeding position or a few tips on encouraging a good latch will be enough to help.

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DADWITHBABY

Tips for fathers to be – from Hulda

Posted on 15 May 2014 by Kristrun

Most men are incredibly happy about becoming fathers and look forward to this new stage in their lives.  How they view DADWITHBABYthemselves as a father depends on many factors such as  their own upbringing, what kind of role models they have, their social group and even just the current trends about parenting etc.

Nontheless, there are some that are stressed, worried and have no idea how they should best take on this new role, both to support the mum and baby but also to enjoy it themselves.  Rarely is there a  perfect time to have a baby. Obviously, once baby is on the way, you are not going to change if this is convenient or not, so better get prepared and informed, and learn to enjoy all of what is coming.

I want to share some of my insights into this, after having supported families here in Hong Kong for many years.

I hope that these tips will be useful for you as you navigate through the next few months of your life.

Common feelings

Research shows us that the most common feelings amongst dads-to-be are:

·      Relief (if trying for some time), happy, not prepared, stressed.

·      Worries about the financial burden, sometimes coming from being the breadwinner.

·      Worries about not being a good dad.

·      Worries about not knowing how to play /bond.

·      Worries about changes in the relationship, and you / your partner changing, both in regards to time spent together, interests and even physical changes during pregnancy and after the birth (partner and you).

·      Loss of interest in sex and concerns about hurting / affecting the baby, even if you have read that it is safe.

·      Feelings of helplessness  if your partner is sick, tired or unhappy in the early days of pregnancy.

·      Concern about lifestyle changes, for example, can your partner exercise, have sex, fly, eat their usual diet?

·      Concern about the future regarding balancing work and family life along with personal time, social commitments. How will I manage it all?

I guess what all of this means is that first of all, you are human.  Second, perhaps if everything is not 100% in order physically, emotionally, relationship wise, work wise, financially, etc…….well, pregnancy is 9 months long and you have time to start to get organized. This is a perfect opportunity for a  kick in the butt and to get to work putting in place some things which have been ignored or delayed for a while.  We all need that every now and again.

Struggling with depression

New mothers suffer from postnatal depression in 10 to 15% of cases.  It is usually not very severe, but it can be.  Less known to most is that dads can also suffer from this (in around 10% of cases) and many of those experience depression well before the birth. You can read about it online if you are worried about it, but you may well find that some of the signs apply to you even if you don’t class yourself as depressed. Your life will change and this can be hard to come to terms with.  It is very important to recognise these feelings and to respond to the stressful or unbalanced factors in your life. Whatever you don’t seem to be able to help yourself with easily, or by talking to those closest to you…..get help.  Often, it is just good to sit down with your family doctor (Dr. David Owens for example, 28253181), and express your feelings.

Express yourself

Women naturally talk about their feeling more than men do, and men often do not talk about such personal issues with their other male friends.  But we have had great success with our “Dads” class which makes up the final session of our ante-natal courses here at Annerley. In this session we get the male partners together with our midwife and encourage a discussion about their feelings on becoming a father, the changes that may occur within their relationship, and how best to support their partner as she becomes a mother. Often they have many questions and it is a great opportunity for them to discuss these feelings in a safe and supportive environment, when so often the spotlight is on the woman.

Recommended reading for dads:

The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions – By Penny Simkin

With 398 pages devoted to detailing every childbirth scenario, The Birth Partner is an impressive textbook-like resource for dads-to-be who want to be knowledgeable and involved in the delivery room. Four information-rich sections (Before the Birth, Labor and Birth, the Medical Side of Childbirth, and After the Birth) cover topics such as prepping for labor, epidurals and other medications, non-drug pain relief techniques, interventions, C-sections and other complications, breastfeeding, and newborn care. A number of helpful illustrations and easy-to-navigate charts make digesting and retaining the medical jargon a bit easier.

Dad’s Pregnant Too! Expectant fathers, expectant mothers, new dads, and new moms share advice, tips, and stories about all the surprises, questions, and joys ahead.  By Harlan Cohen

Built on personal accounts and real-life anecdotes from hundreds of interviews, Dad’s Pregnant Too! is an everyman’s guide to pregnancy, labor and delivery, and the early days of parenting, filled with sensible information that’s easy to understand and quick to read. More than a hundred topics are presented through trivia, tips, Q&As, and sidebars, including what to expect when it comes to doctor appointments, sex during pregnancy, mood swings, prepping for birth, spoiling mom-to-be, shopping for baby gear, push presents, and Baby’s weekly development.

Best of luck,

h

For further support, book a private consultation with a midwife, contact Dr. David Owens or book into our antenatal courses. Our courses encourage the father to be involved as much as he wishes, and we set aside a specific time for our “Dads” session.

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Homemade toys and games

Homemade toys and games

Posted on 11 May 2014 by hulda

 

We have all been there, in Toys´R´Us and our kids begging for more.  And we even want to give it to them, we get excited too.    My helper regularly comes home from playdates and tells me about all the wonderful toys that other kids have.  “A full room of toys” and my kids too, are very happy after such trips.

Yet when I buy toys for them, as soon as the first hour has passed, the excitement is usually gone.  If the toys were not of good quality to begin with, they are trashed and pieces missing from the kid, making it unusable next time round.

Sun shelter and tent and more

Sun shelter and tent and more

So through these last 6 years of having my second lot of kids, I have not really bought any toys.  We get given a lot and many of our toys come from when I was little or from when the older kids were small.
And the biggest joy comes from all the homemade “toys” or games.

The homemade toys in our  household are always a big hit.  An old sunbrella that broke, the outdoor table and the cars for example produced laughter fun and happiness for hours last month.   Now it has become a regular setup.  Who would not want to live inside a table if they are 3?

 

Just make sure that the setup is safe

Just make sure that the setup is safe

Have fun creating.

Hulda, (who´s biggest outburst happen when the children are ungrateful).

 

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