Discussion points for parents-to-be

By: Christine Langlois

Author: Canadian Living


Discussion points for parents-to-be

By: Christine Langlois

When the first contraction signals that your baby is on the way, the decisions you will have to make come thick and fast in the following hours and days. Prior to that busy time and while it's still just the two of you, talk through some of the issues you know will arise. Remind each other that your decisions don't have to be carved in stone, that you'll most likely review them after you've had some input from the addition to your family.

Birth plan and newborn care plan
A birth plan, written by you and your partner, describes how you want your labour and delivery to proceed — insofar as you have control over these events. Your family physician, obstetrician, midwife, or doula can explain which options are open to you and could even help you prepare your plan. This is a good topic for your prenatal class, where other expectant parents as well as the instructor should have lots of ideas. The plan can be as simple or as detailed as you like. It should cover the medications you want or don't want, your preferences about moving around during labour, the roles your partner and support person will play, and what medical interventions you would prefer.

A newborn care plan should cover your wishes for how your infant will be treated while in the hospital, whether he will stay with you immediately after the birth, and whether he'll be allowed sugar water while in the hospital nursery. Discuss your plans with your family physician or midwife and take into consideration your hospital's restrictions for birthing rooms. Even though you should be prepared to accept changes as you move through the experience, the process of working through these plans ahead of time makes it much more likely they'll occur as planned.

What newborns look like
It's not uncommon for parents to think their newborn baby looks perfect in every respect. Yet most newborns show obvious signs of the laborious journey through the birth canal. Typically, a baby born vaginally will have a large pointed head, puffy eyes, and flattened nose. She may have a full head of hair or she may look bald. She may be covered in a white, creamy protective coating, called vernix, and in fine body hair, called lanugo. Newborns often have swollen genitals and breasts. Their nipples may secrete a white or pink fluid, and girls may have some vaginal secretions. Babies born by cesarean section will look less the worse for wear. You may wonder why every other baby in the hospital nursery is so odd-looking compared to your little beauty. But chances are, a few years down the road vhen you're looking at her birth photos, you'll be surprised to see how obvious are the marks of birthing to which you had previously been blind.

Banking the umbilical cord blood
Because the umbilical cord blood contains a very high concentration of stem cells (the basic units in the bone marrow responsible for producing all red cells, white cells, and platelets), it provides a perfect match for a bone marrow transplant should the baby need it in the future. It is also more likely to provide a good match for siblings with a blood-related illness such as childhood leukemia (one child in 1,000), or parents with another life-threatening disease. Also, because the stem cells have not yet built up antibodies, they are more compatible with a greater number of unrelated people in need of cell transplant.

You might consider either donating your newborn's umbilical cord blood to a cord blood bank or storing it for your child's or a family member's future use. The process of collecting the blood involves no risk or pain to mother or baby, since it's collected within twenty-four hours of the birth from the clamped umbilical cord that remains with the placenta. However, expectant parents who are interested in the possibilities should obtain information and counselling early enough in the pregnancy to make arrangements for testing and for the collection and storage of the blood.

The procedure has been adopted in several Canadian and U.S. centres. The Alberta Cord Blood Bank, associated with the University of Alberta in Edmonton, is a public resource that accepts cord-blood donations from hospitals across the country and makes it available to the general public. It charges no fees for collection or storage. The Banks phone number is (780) 492-2673.

Other private programs for collecting and storing this blood have begun in Vancouver and Toronto, offering parents a once-in-a-lifetime opportunity to store the blood collected from their newborns for future use. Your own hospital should be able to provide you with information about these programs or others that might become available in your area.

Should you or shouldn't you? Some choose to circumcise for religious reasons; others so that the boy's genitals will be the same as his father's. But the Canadian Paediatric Society states that there is no medical reason to circumcise a baby, and several provinces no longer cover circumcision under their medical insurance plans.

Circumcisions are generally performed without anesthetic because there is no general or local anesthetic safe enough to give to newborns and because, up until recently, the medical profession believed that newborns didn't feel much pain or that they wouldn't remember pain. Using the data from three separate studies, researchers from The Hospital for Sick Children in Toronto analyzed records on vaccinations given to eighty-seven infants between the ages of four and six months. The results of the study, published in February 1997, found that male babies who had been circumcised reacted to the pain of the vaccination to a greater degree than did the female babies or the male babies who had not been circumcised. Another related study concluded with a recommendation that, during the circumcision procedure, a topical anesthetic be used to provide adequate pain control. Circumcision does pose some risks: Infection, hemorrhaging, and improper healing affect from two to ten per cent of circumcised newborns.

Most Canadian newborns begin life as breast-fed babies for the clear reason that breast-feeding is best for both them and their mothers. Breast-feeding is a learned art that comes easily and naturally to many new mothers but, for others, the learning curve can be steep in the first few weeks. There are some women and men who, for various reasons, are not comfortable with the idea of breast-feeding. Now is the time to talk about your feelings, to read as much as you can about the subject, and to make your choice.

Sleeping arrangements
There are differing viewpoints on the topic of sharing your room and your bed with your baby, and you may revisit this particular issue several times during your offspring's childhood. Prior to the birth, you and your partner should discuss your feelings about safety, convenience, comfort, and privacy, but leave the topic open for reconsideration.

Diapers: disposable or cloth?
Fortunately, this is a decision that can be changed as easily as ... a diaper. Cost, convenience, and the environment are the factors you should take into consideration. Your baby may show a preference, but he will make his point later.

Disposables are certainly convenient. They're fast and easy to change, they're very absorbent, and they're easily disposed of initially. Although it's illegal to dispose of human feces in landfills, many people still roll up dirty diapers and toss them into the garbage. About 240,000 metric tons of disposable diapers hit landfill sites in Canada each year, the single largest nonrecyclable component of household garbage. But human waste dumped in landfill sites instead of sewers or septic systems contaminates our soil and groundwater, so discard any solid waste in the toilet before throwing the diaper out.

Disposable diapers can easily cost more than double the amount of cloth ones, even with the cost of laundering included. Though it's true that disposable diapers require less frequent changing because of their higher absorbency, sometimes parents change them less often than they should, which can cause the baby to develop diaper rash.

Because of environmental concerns, cloth diapers are regaining some of their popularity. You can now buy fitted cloth diapers, with Velcro fasteners or belts and in different sizes, which offer great improvements in changing efficiency and in protection over the old fashioned kind of cloth diaper. Plastic pants, the old ill-fitting, moisture-retaining bottom burners, are being replaced by diaper covers made of breathable fabrics that manage both to protect your lap and to be kind to sensitive baby bottoms. You can wash them yourself or, if your community has a diaper service, hire it to pick up, launder, and deliver on a weekly basis.

Be aware that some babies have sensitive skin that reacts to the chemicals used in the manufacture of disposables; others react to wet cloth. Your baby will let you know if he has a preference. And there's no reason why you can't use both: cloth diapers at home; disposables away from home.

Choosing your health-care team
The arrival of a new baby usually means that parents develop a much closer relationship with their family physician and perhaps add a pediatrician to their health-care team. In large cities in central Canada, there are more pediatricians to choose among, and parents don't usually require a referral from their family physician. But smaller towns and rural areas often don't sustain a pediatric practice, although specialists may make weekly or monthly visits to the local hospital or clinic.

As your child's primary health caregiver, your family physician usually brings her knowledge of the whole family and its medical history to bear in her treatment. She can handle day-to-day medical problems and make the appropriate referrals to specialists like a pediatrician, if necessary. For most Canadian parents, a pediatrician requires a referral from a family physician before examining a child.

If you wish to add the services of a pediatrician, it's important to choose one before your baby is born. Begin your search by discussing the question with your family physician or with other parents who share your childcare views. Set up an appointment with one or two to find one with whom you're comfortable and whose attitudes toward treatment match your own.

Although your child probably won't need to visit a dentist before the age of three, make inquiries about dentists who treat lots of children. Their experience with kids, their knowledge of children's growth and development and how to keep them comfortable may make dental check-ups fun instead of an ordeal.

Choose your complementary health-care professionals with the same thoroughness with which you choose your doctors and dentists. Chiropractors and naturopaths are licensed practitioners with their own colleges and professional associations. Your pharmacist is also an important source of information, someone who can answer your questions about prescription drugs and help you choose appropriate over-the-counter medications.

Maternity leave and parental leave
You will want to learn as much as you can about the options both parents have in taking leave from work to care for your newborn. To find out which standards apply to you, you might check first with your employer's human resources department, then with the Ministry of Labour or its equivalent in your province or territory. Minimum provincial employment standards regarding leaves of absence and job protection vary from province to territory.

At the federal level, the government pays mothers on maternity leave through Employment Insurance. If a pregnant woman has been employed for at least 600 hours in the last 52 weeks before she gives birth, then she is entitled to 17 weeks of maternity leave (which includes a 2-week unpaid waiting period). The benefits equal 55 per cent of the individual's earnings over a certain number of weeks up to a maximum of $413 per week.

Employment Insurance also entities either parent (adoptive parents are included) to 10 weeks of paid parental leave. Eligible employees may be entitled to 35 weeks of Employment Insurance parental benefits. The parental leave benefits can be claimed by one parent or divided between them. Whether you are a birth or an adoptive parent, the parental leave must be taken within one year of the child's birth. Information about these benefits is available at any Human Resources Development Canada (HRDC) office or Canada Employment Centre (CEC). Check the Blue Pages of your phone book.

Some family-friendly corporations or employers may offer benefits beyond the money and job protection offered by federal and provincial governments. You might be able to negotiate an extended leave with your employer, whether paid or unpaid, to stretch your time at home with baby. One partner might be able to secure a leave of absence or a sabbatical to start when the other's parental leave ends. Some couples save up vacation time and tack it on to their leave.

Childcare options
You might think it's a little early to be discussing childcare when your baby isn't even born. But good childcare, particularly if you want a daycare setting, can be difficult to come by in many Canadian communities. Some daycare centres have waiting lists for infant care that are 18 months long.

Ask your friends what worked best for their children, visit a few neighbourhood daycare centres and childcare providers to get a feel for what's available, and find out if a relative in the family could step in to take care of baby should you need her. Put your name on the waiting lists now. If it turns out you don't need or want the space, you've lost nothing or perhaps only a deposit.

If you decide to return to work after your maternity leave (and 80 per cent of mothers do return), your major concern will be securing good care for your baby while you're out of your home. The key questions you should ask a potential caregiver can be found here: Take good care of my baby. Once you've secured a caregiver for your child you might want to give them a printout of the Babysitter's checklist. You'll be glad you got a head start on the search.

Recording your child's development
Some of us know the delight of rediscovering our baby selves through the baby books and mementos carefully kept by our parents. Consider that you've become the keeper of your family history, and discuss together how you'd like to record the story of your child and your life together. There will be so many remarkable, funny, magical moments, but you'll be so busy and weary that your brain won't be able to retain them all. A memoir will be an invaluable keepsake. Baby books are a delightful gift to receive, but a scrapbook or notebook in which you can record special moments will be just as precious. Write in it often, even if it's only a few lines; add photos and special mementos. (You might drop an inexpensive camera into the baby's diaper bag for spur-of-the-moment shots.) If that's not your style, select a large box with a tight lid as your babys memento box and keep whatever holds meaning for you.

You may receive a Health Record booklet in the hospital or from your doctor. It contains specific sections in which to keep track of your baby's immunizations, illnesses, and injuries. It could prove an important source of information in the future, so you might also record in it any problems you experienced during pregnancy and a description of your delivery. Keep it up to date with charts of weight and height, results of dental and eye examinations, details of food sensitivities or allergies, and related notes on the familys health history.

Is there sex after baby?
If there werern't, there sure would be a lot of only children. But in the weeks or even months after a new baby arrives, you may wonder if passion will ever again come into the chaos called home life. Heed your doctor's warning to avoid intercourse for six weeks following a vaginal birth or four weeks after a cesarean. A new mother's body needs time to heal.

Both partners might worry that intercourse will hurt the woman, and sometimes it does -- nursing mothers have little natural vaginal lubrication. Most new mothers, whether adoptive or birth mothers, usually feel little desire for sexual intercourse. When she's short of sleep and has a baby glued to her body half the day and night, a woman may not feel like sharing more of her physical self. But both of you need to share your emotional selves. Talking to your partner about how you each feel may be the sexiest thing you can do right now. Don't deny each other the intimacy of touching and cuddling, even if that's all you're up to.

When you are ready for sex, take it slowly. Have a lubricant at hand, if
necessary, and don't forget contraception. You may ovulate even while you're nursing, and even if your menstrual period hasn't started again. Don't limit lovermaking to the evening when you both may be tired. Try to time romance for when your baby is asleep, but don't get too discouraged when she interrupts you. Babies seem to know when you would most wish not to be disturbed. Persevere. It will get better.

Excerpted from Growing with Your Child: pre-Birth to age 5 by Christine Langlois. Copyright 1998 by Telemedia Communications Inc. Excerpted, with permission by Ballantine Books. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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Discussion points for parents-to-be