Thursday, July 28, 2011

Baby Acne

I keep thinking of a particular Seinfeld episode whenever I hear folks comment on "how cute" my newborn looks.  Right now he looks like an adolescent with so many pimples all over his cheeks and forehead.

So baby acne is fairly common.  Here is the quick 101:

What does it look like?
Usually you will see little red bumps or pustules on the cheeks, chin, and forehead.

What caused it?
Mommy's hormones during pregnancy!  It is more common in boys (I don't recall this with my girls) and looks worse when baby is fussing and crying.

How do you treat it?
There is really nothing you can do to prevent it and the best treatment is to just wait it out.  Scrubbing and washing too hard or too often and using a lot of soap and lotion can actually make it worse.  Usually it will go away on its own in a few weeks but can linger for up to 6 months.  In very bad cases, something like benzoyl peroxide may be prescribed but definitely check with your pediatrician first. 

So in the meantime:
  • wash baby's face with warm water 2-3 times a day;  use mild moisturizing soap several times/week
  • pat skin dry
  • do not pinch or scrub the acne
  • avoid lotions and oils

Sunday, July 24, 2011

Cheap Diapers

It is a crazy time because we are going through diapers so fast.  It is hard to believe that my newborn is almost 1 month old now.  In these early weeks, they void pretty much with every feed (so that is every 2-3 hours).

With that said... I love amazon mom!  I wish I knew about this sooner.  Here are the reasons:

1)  FREE SHIPPING!  The diaper comes right to my front door so I don't have to lug my kids out and carry a heavy box of diapers to the car then into the house... (or in my case, 2-3 boxes since two of my three kids are still wearing diapers) I actually haven't figured out how and where to put everyone yet if I ever go shopping with all three of them alone.

2)  CHEAP BRAND NAME DIAPERS!  I've pretty much stick to Huggies or Pampers because other brands I've tried leak ( like Luvs and other generic brands).  So to be able to get Huggies or Pampers at 10 cents per diaper is pretty darn good.  I thought I was doing well buying bulk with 3 or 4 dollar off coupons but this is definitely a better deal...

3)  AUTOMATIC and FAST.  I can set it up so the box of diapers comes at whatever interval I choose. I love that I can cancel the subscription anytime with no penalty.  I also love that I can order the diapers to be shipped right away when I am running out faster than anticipated.  After the order, the box of diapers arrives 2 days later.  It is convenient and fast

So moms, dads, and caregivers out there... if you haven't already, sign up and start saving =)  There are other baby products that you can save on other than diapers but in my opinion, the diapers are the best deal!

Tuesday, July 19, 2011


I am sure there are a million sites online about breastfeeding.  When I had my first child, I think I read almost every one of those sites.  I really had a very hard time nursing.  As a physician, I was taught to give breastfeeding advice, but when I became mom, I was in serious shock!  I knew it was difficult and was taught to cheer the moms on and tell them to hang in there... but really... I had no idea just what that meant.

So issues encountered included...
1)  Positioning
Initially, it was very tricky to figure out...  football hold, cradle hold, using a boppy vs not...  I say experiment and go with what is most comfortable for you and your baby.  Poor kid.. sometimes he ends up in the most awkward positions as we're trying to figure this out.  Plus, being so close after delivery is an added challenge depending on type of delivery and rate of recovery.  Moving around is painful and hard enough, let alone having to do so while trying to hold a tiny newborn.
2)  Latching
Again, it takes some practice holding this tiny little body and his or her loosey goosey head rolling all over the place while trying to position their little mouths to open just right and clamp down without tearing off the nipple... But then BRACE yourself because it hurts like the dickens every time they do latch on and begin sucking.  With my first child I had to pre-medicate myself with ibuprofen about 30 min before I nursed to take the edge off.  I've since found that with subsequent pregnancies... the intensity and duration of pain is less and less.  With my first, I had a very difficult 3 months... then 3 weeks with my second, and about 3 days with this one!
3)  Engorgement
So at about day 3 when the milk actually comes in one may experience a whole new level of pain.  This time not just isolated to the nipple but the entire breast.  Engorgement occurs because the body is adjusting to know exactly how much milk to produce.  When there is an overproduction, the breasts feel full (and engorged) which may become very painful.  At this point, many are tempted to pump, however, I learned the hard way that that is not the answer.  Ironically, very little milk will actually get pumped out because the ducts swell shut when the breast gets so engorged.  At the same time, the pumping will stimulate your body to think that it needs to produce even more milk which will compound the issue.  Instead, one should use heat before feeds and try to massage towards the milk flow.  Then use ice to help with the discomfort after feeds.  After a couple days, the body really should adjust.  However, the transition is a challenging period because baby will sometimes have a hard time latching on and may get frustrated when not much milk is being produced.  Therefore, there can be a lot of crying.  Crying will then cause stress which then further decreases milk production.  Crying also can cause lack of sleep which also decreases the milk supply.  To get through this tough time, persevere and keep in touch with your lactation consultant who can often offer good tips and encouragement.  At the end of the day, do what you can... most lactation consultants will tell you that everyone can breastfeed if you try try and try... That may be true, however, I know that the amount of discomfort, pain, and even milk supply can vary to such a degree from person to person.  Whether the reason is medical, emotional, or both, do not feel like a horrible mother if you have to supplement with formula for a little while or even for the remainder of baby's infancy.
4)  Blocked Ducts
So this is what happens when the engorgement issue does not get resolved and supply is surpassing demand.  One or several areas of the breast can become rock hard and extremely painful.  A lot of heat, hard massage, and vigorous sucking will eventually relieve this.  Baby's suck is stronger than a pump but if baby is too upset to latch on (since latching is generally more difficult when the ducts are this blocked and there is this much swelling) then gotta pump.
5)  Mastitis
You know you have mastitis when in addition to painful hard swollen breasts you now also have a fever and feel unwell.  Your skin may also become red, warm, and tender.  Call your physician if you suspect this because you will likely need antibiotics.
Sounds fun, eh?  Well...  here is what I've learned to do after putting medical knowledge and experience together...
  • Introduce the breast early after delivery to get the baby to latch on properly before engorgement 
  • Medicate with motrin or tylenol if necessary to take the edge off the pain associated with latching/sucking (and use lanolin on nipples if sore/cracked)
  • Right before nursing either run hot water in the shower or use baby diaper filled with hot water to soften and increase milk flow
  • During nursing massage as baby sucks to ensure all milk is getting emptied
  • Do not limit baby to 5-10 min per breasts.  Instead, nurse as long as baby wants on one side to avoid incomplete voiding and avoid imbalance of foremilk vs hindmilk (which is another topic but can cause gas and green stools!)
  • Ice if necessary at the end of the feeds for comfort (frozen vegetable bags work well here)
  • Wear loose fitting bra
  • Pump if necessary from other side that did not get nursed
  • Try to nap before, during, and/or after nursing because sleep helps decrease engorgement and increase milk supply
  • Finally, drink plenty of fluids... try to finish a glass of water before, during, and after each feed
The whole experience was definitely the hardest when I was a first time mom... boy was there a lot of crying from baby and me both!  With each subsequent pregnancy, nursing became easier and I had fewer issues with engorgement/blocked ducts.  But even with the first pregnancy, once I got past the initial hump (maybe 3 weeks to 3 months)... nursing became such a wonderful and intimate experience that I had a hard time weaning.

So if you are a first time nursing mom... frustrated and discouraged and surfing the web for answers...  hang in there!  Most of the sites give similar information... at the end of the day, turn off the computer and get some rest... then try and do what you can.  Time is the real answer and if you persevere long enough it will all click... but if it doesn't don't lose heart, it'll still be all good.

Monday, July 18, 2011

Labor & Delivery

Long time no write!  I just had baby #3 about 2 weeks ago.  Thankfully all went well, but as I was going through the whole ordeal I kept thinking how it is true that doctors make the worse patients...

Since my due date was approaching and there were still no signs of baby wanting to come out, my induction was scheduled so I'd have him on his actual due date.  The plan was to go into the hospital at night to check for change and if there was no change to get induced with a medication called, cervidil.  Then the next morning the actual labor and delivery would occur.  So I decided to work my last shift (saw patients till 7pm) then go into the hospital by 930pm.  Yes, I took a chance that I'd go into labor during my patient hours and would have to rush to the hospital.  But I figured if I worked to the end, it would give me one extra day to be with my newborn on maternity leave.

I was actually contracting on and off all that entire afternoon.  In fact, right before my shift started, I actually believe I lost my mucous plug.  To me that was the first sign that my body was preparing to have a baby.  The contractions were not that intense and seemed far enough apart.

By the time I finished my shift and was gathering my things at home, I believe I was contracting probably about every 10-15 min or so.  Again, they were not intense so I did not feel an urgency to run to the hospital.  But I figured this is going to happen so the sooner we get in the sooner we'd have this kid... otherwise we are looking at a long night.

Well, the check-in process is routine.  I actually feel one of the worse parts of the entire labor experience is getting the IV put in!  My veins are actually not that bad and I feel for the patients who get poked and poked because nurses cannot find an adequate vein.  So what is it for anyways?  Since I am able to drink fluids, why do I need liters of fluids pumped into me?  Physicians like to be able to control as much as possible... and especially in obstetrics when something bad can happen very quickly and very suddenly... having access to a vein to give medication, fluids, or blood right away instead of trying to find a vein in an emergency situation can sometimes save a life.

Now it really is pretty uncomfortable just laying there on the hospital bed.  There is the IV stuck in one arm which actually really burned and was irritating every time I moved that arm.  Then the other arm has a blood pressure cuff that goes off every 15 minutes squeezing so hard at times that it numbs the fingers!  The pulse ox on a finger is a pain as well.  On top of all that, let us not forget the tight band wrapped around the contracting belly holding down two monitors, one for the baby's heart rate and the other to measure the frequency of contractions.  So every time if I move too much (and it is really hard to stay still in exactly the same position especially as the contractions got stronger) the monitor falls out of place and the nurse has to come in to adjust it.  I ended up just sticking a hand on the monitor and adjusting it myself so she didn't have to make so many trips.  Now imagine the ordeal that takes place every time I need to go to the bathroom (which is very often given all the pressure from the baby and then even more often once they start running the fluids)!

It really is no wonder some folks choose to deliver with midwives and in hot tubs etc

Now if one has a high risk pregnancy, it may be wise to be closely monitored.  In my case, I felt it was total overkill but protocol is protocol and nurses/docs/hospitals like to follow protocol.

From a physician point of view,  it is nice to have continuous monitoring which gives all this information instantaneously.  That way if something does go wrong, one can know immediately and can act quickly and decisively.  I'm sure it has saved many lives... both mom's and baby's!  However, as a patient it really can be a pain and I wonder if there is not a more intermediate way of things.

In any case... there I was stuck to the hospital bed with all these things attached.  When my OB came to check me, I was sure I was somewhat dilated because of all the contractions I was already having.  Nope.  I was completely unchanged and still pretty much closed.  However, because I was contracting so much on my own I can not get the cervidil.  Instead, I was to get pitocin, which helps make the contractions stronger and more frequent.  My OB's plan was to put me on the lowest dose pitocin and not increase until 4am.  He was planning on going to bed and coming back in the morning to deliver me.  He told me to try to get some sleep.  Ha.  He obviously has never been in labor before... how can one possibly get any sleep with contractions going off even if it was only every 10 minutes at the time?  I had a gut feeling that once the pitocin was started, it would just kick me into active labor.  I told my doc to not go to far, I had a feeling I was going to have this kid before morning and I was right!

Waiting was the hardest part.  OB left.  Husband pulled out the hospital chair bed and to try to get some sleep before all the action began.  I laid there, staring at my strip trying to calculate the frequency of my contractions... making sure my baby had adequate heart rate accelerations... and wondering when to call for the epidural.  I have to time it right because I knew it would take a while for the anesthesiologist to be called and for all the paperwork etc to be done before the epidural can actually be put in.  If I call too early, it may slow down labor.  If I call too late, they may not put it in if I'm too close to delivery.  Especially since this is kid #3, things can go very fast very suddenly.  Now, I know some women choose to labor "naturally" and prefer no pain meds whatsoever.  I am not one of those.  I rather have my med put in under somewhat controlled circumstance rather than rushed in case of an emergency.

Well, not to bore you with all the details (probably too late for that)... I did finally call for my epidural and pretty soon after that I was "complete".  The putting in of the epidural in my opinion was the worse part of the entire labor experience.  I found it almost impossible to sit still with my back arched while contracting so intensely and frequently.  But I really did not want the anesthesiologist to mess up her landmarks so I tried very hard, in fact so much so that I developed a terrible muscle spasm afterwards.

Then to make matters worse, I had to lie completely flat for what felt like an eternity.  They say it is so the medicine can be distributed equally.  I could barely breathe lying there with what felt like a ten pound bowling ball on top of me!

So soon enough... epidural was in... medication started to kick in... I was fully dilated and ready to push...  Had to wake hubby up at this point because he actually did fall asleep.  OB came back into the room.  I think I pushed probably a total of five times or so before baby came out.  It was 230 in the morning!  Overall, uneventful and routine... thankfully there was no need for forceps or vacuums or episiotomies.

Now into the postpartum period.. which will be subject for a different post...