How and where to learn neonatal resuscitation

I've received some inquiries about how to gain neonatal resuscitation skills, especially for non-health professionals. If there's one kind of preparation I'd recommend for all pregnant women, it's learning the basics of neonatal resuscitation. Just like we all (should!) know how to perform infant resuscitation or adult CPR or the Heimlich maneuver, we should know the basics of neonatal resuscitation. Because--as Inga's birth story illustrates--you never know when you're going to need it.

Most likely your baby will be born healthy and will breathe on its own. Most likely you'll make it to the hospital or birth center on time, or your midwife will arrive before the birth. Most likely your baby won't be born in the car, or in the subway, or on your bathroom floor when you were planning otherwise.

But...what if the birth doesn't happen as planned? That's where having some neonatal resuscitation training can be a lifesaver.

So how and where can you learn these skills? If you can afford it, take a Neonatal Resuscitation Program (NRP) workshop. Before the course, you study the textbook and take an online exam. Then you come to the workshop--typically one full day--for hands-on instruction with life-size dolls and medical equipment. Since maternity care providers are required to stay current with their NR skills, the workshops are fairly easy to find. One problem a lay person might encounter is being able to register for the course; some are limited to health care professionals only.

In the States, the Neonatal Resuscitation Program is sponsored through the AAP; click here to locate a course or instructor. Canada's NRP program is sponsored by the Canadian Pediatric Society; click here to locate courses. Many instructors do not list their courses online, so also make inquiries through your local hospitals, birth centers, or home birth midwives. 

I highly recommend Karen Strange's Newborn Breath workshop. She travels all over the States teaching NRP from an out-of-hospital perspective. You'll learn everything you need to know to pass the exam and become certified, but you'll also learn these things with the assumption that you'll be in a home or birth center setting, that you won't be cutting or clamping the cord, that you'll be resuscitating on or near the mother, etc. Karen Strange is a quirky, fun instructor and keeps the class very lively. If you want her to come to your area, you can sponsor a workshop. Her workshop costs $220, plus the textbook (~$38 used/$55 new) and online exam fee ($23.50).

What if there is no NRP class in your area, or if you can't afford one? Hook up with local midwives and learn the skills from them. Buy or ILL textbooks and study as much as you can. At a bare minimum, learn how and when to perform mouth-to-mouth and chest compressions on a newborn--before your third trimester. Still, nothing can substitute for up-to-date, hands-on training, which is why I strongly suggest taking a NRP workshop.

My NRP baby...now in pigtails!

Why am I up at 2 am?

I'm sitting in the living room of my in-law's house, wrapped in a chenille blanket and eying a plastic bowl next to me. I'm pretty sure I have food poisoning. I didn't want to wake up the kids with my bathroom runs, so I'm distracting myself on the computer instead.

So because I have nothing better to do, I was re-reading an interview that Motley Vision did with my husband about his first book, a collection of short stories called Dominant Traits. It's set in southern Alberta, where I am currently visiting for a family reunion. Buy the book! So we can be rich and famous! (Just kidding about that last part.)

I keep staring at the bowl hoping to puke. I'm really tired and want to get it all over with so I can go to bed.

Later. 

World Breastfeeding Week Photo Contest

I wanted to announce a photo contest for World Breastfeeding Week (August 1-7), hosted by HealthConnect One, a national nonprofit dedicated to serving moms and babies during pregnancy and early parenting. HealthConnect One sponsors community-based doulas and breastfeeding peer counselors (more details here). 

Anyone can submit a photograph for the photo contest--whether you are a current breastfeeding Mom or breastfed your kids 30 years ago. You can also submit photographs of the lactation room at your workplace, or photographs of any other breastfeeding space established in your living room, baby's room, backyard, or anywhere!  Contest winners will be determined by popular vote.

Photo Submissions: August 1 - 7, 2012

Voting: August 8 - 15, 2012

Winners Announced: August 17, 2012

Prizes:  Camera, maternity lingerie, yoga class, and others yet to be announced!

More information here:http://www.healthconnectone.org/pages/world_breastfeeding_week/147.php.

Dutch bike on steroids

My friend sent me this link to a Portland woman--and mother of six--who transports her entire family using a Dutch bakfiets. It's pretty incredible.

I've been dreaming of adding Dutch child seats to my own bike so I can run errands on bike with all 3 kids. This woman takes it to the next level, though. Click to read the article: With six kids and no car, this mom does it all by bike.

If you want a cargo bike but don't want the cost or weight of a bakfiets, I love these Madsen cargo bikes. Some day...

Do any of you ride a bakfiets, a Madsen, or other type of cargo bike? What do you like or dislike about it?

Human Rights in Childbirth: Panel 5

Panel 5:

Perinatal Mortality in the Netherlands: 
Facts, Myths, and Policy

Panelists:

• Anna Myrte Korteweg: mother and author, Netherlands 
• Elselijn Kingma: philosopher and bioethicist, UK and Netherlands
• Ank de Jonge: midwife and researcher, Netherlands
• Manon Benders: pediatrician-neonatologist, Netherlands
• Mariel Croon: journalist and midwife, Netherlands
• Raymond de Vries (moderator): sociologist, Professor of Midwifery Science, USA/Netherlands

The morning began with a keynote speech by Raymond de Vries about having a baby in the Netherlands. I missed the first half (I slept in on purpose--I was exhausted). I listened to the rest of his presentation in the balcony while I pumped. I had been away from Inga for 48 hours at that point and was probably a full cup size larger, even after pumping a few times.

Panel 5 opened with Anna Myrte Korteweg, a mother who wrote a book about birth choices in Holland after her traumatic first birth. Her book is called Vrije Geboorte (Freedom of Birth), and she blogs here. She had planned a home birth but had to transfer to a hospital during labor. 
 

Elselijn Kingma, a philosopher and bioethicist from the UK and the Netherlands, addressed the relationhsip between science and policy. How we interpret the numbers from scientific studies isn't a given and is highly subject to variation. Our narrow focuson perinatal mortality shows that we don't equally value all members of society (i.e., we tend to gloss over mothers who are subjected to massive harms in the process of hospital births). Where people feel safe isn't objective or fact-based, ut determined by both policy and rhetoric.

Manon Benders, a pediatrician and neonatologist, presented her experiences with perinatal mortality. She works in a NICU and sees struggling babies on a daily basis. This, of course, influences her perspective on place of birth. I found a disconnect between her message--which was quite well-intentioned--and her audience. She called for what she saw as an innovative way to meet the needs of mothers who wanted to birth at home, while providing immediate access to medical and surgical care for mothers or babies who need it: a "multi-disciplinary birth center." I don't think she realized that this is exactly what a hospital is--a place where all providers are in one location--but that that very system fails to meet the needs of all pregnant women. I sensed some frustration among the audience that she didn't really get the main messages of the conference. 

Next, Ank de Jonge, first author of the large Dutch home birth study, spoke about perinatal mortality in the Netherlands. We should avoid jumping to hasty conclusions, she advised. She also noted that the intense focus on Dutch perinatal mortality is not mirrored in others coutnries with similarly high numbers. For example, Denmark has a higher term PNMR than the Netherlands, yet they don't question their maternity care system. However, because the Dutch maternity care system is different from most of Europe's, it is home birth that gets questioned and too often blamed.

Mariel Croon, a Dutch midwife and journalist, examined how money and the media in influencing attitudes towards home birth and midwifery in the Netherlands. The media has a very powerful role in this country, and midwives have been forced into a defensive role due to media reporting of recent studies. She recommended that midwives should use the media strategically and should take an offensive role the conversations about maternity care, much as Dutch obstetricians have already done. She also called for more women's voices in these debates, which are too often overwhelmed by professionals.

Unsolved mysteries

Mystery #1: Dead Birds
When we came home from France, there were two dead birds in our house. One was in the entryway, the other upstairs in our bedroom. I checked every single door and window, and all were closed and sealed tight. I have NO idea how these birds got into the house.

Mystery #2: Itchy Rash
I got a strange, horribly itchy rash when I was in France. I visited the doctor twice, took 3 prescription & 2 OTC medications, and spent almost 2 weeks in misery before it started to clear up. I suspect it was an allergic reaction (possibly a photoallergic eruption) to a sunscreen. Here are my reasons:

• the reaction showed up only where I applied sunscreen (face, arms, chest, and back of the neck) but not on any other part of my body
• the reaction wasn't immediate 
• I got a rash, which took a few days to appear, when I applied sunscreen to my torso as an initial test

To test my hypothesis, I drew 3 circles on my leg with a marker and applied each of the 3 sunscreens I had been using. Then I sat in the sun for a good half hour.

look at those lovely original "tomette" tiles in our apartment!

A rash started appearing 2-3 days later in the top circle, where I had applied Equate Kids Lotion. I compared its ingredients against the other two products I did not react to, but I wasn't much closer to a solution. Each sunscreen had 20-30 ingredients and very few were the same! I haven't solved this one entirely, but I've been staying away from any Wal-Mart brand sunscreens. So far haven't had any reactions to Coppertone brands.

Mystery #3: Early Miscarriage?
The day we flew home from France, my period was due to start. I had saw some red spotting before I got on the plane and figured that was it. But then, for the next 6 days, I only had very light spotting. I figured it had been a really weird period.

Then a week after I got home, I got a really heavy period. Torrential is a better word. I was completely filling a Diva Cup every 2-3 hours. My flow continued for 9-10 days, and spotting continued almost until the 14th day.

I took a pregnancy test a few hours before the heavy flow began. It was negative, but that doesn't really prove anything either way. I strongly suspect this was an early miscarriage based on the timing and volume; my cycle is always regular within +/- 1 day.

So, what do you think about these three unsolved mysteries? Any additional ideas?

At the lake

Pictures from our week at the cabin...

Wheelbarrow rides with Inga's cousin (I love my dad's shirt!)

everyone got a turn

My sister's biiiiiig pregnant belly...she's due in about 4 weeks

Dio screaming when I made him go on the waverunner...of course he loved it as soon as he and Eric started

Dio being attacked by his 16-month-old cousin

playing in the hammock

Inga's dinosaur face

 

we swam a lot

Zari loved going super fast on the waverunner

on the dock

me & mini me

water trampoline

Zari's first kayak ride