Selena Turns Four

Selena had been anxiously awaiting her fourth birthday for a long time.  On her birthday she was very surprised that her clothes still fit, and she couldn't reach the toilet paper in the bathroom without getting off the toilet (maybe when she's five), but she was a much better twirler.  She was also overheard telling a boy at the children's museum that she was almost five as well.

We went roller skating for her party.  It was a lot of fun, but it was way too long.  Most young children cannot skate for 2 hours (my niece and nephew were the exception).  We made chocolate cupcakes and blue Jello cake for the party, so her friends could choose what they wanted.  She used candy to "draw" a picture of herself on the cake.  She said that when she blew out the candle she wished for summer to come soon.

She has finally throughly memorized every Bob the Builder episode and thus rarely requests them.  However she once again enjoys Curious George even though she remembers all the episodes "from when she was two."  Dora and Diego have also joined the mix, and now she is speaking Spanish to me, but I do not understand until she translates for me.

She continues to amaze me with her writing and reading skills. She enjoys writing letters to people and is constantly pestering me to spell words out for her.  She really enjoys writing to her baby cousin Issac, who is so cute.  She did manage to sound out his name the other day as Isic.

She and her sister continue to frustrate me with their fighting.  Selena is constantly calling Allie names.  Allie hits her, she hits Allie back.  They don't want to share toys.  They always want to snatch the toy from the other person.  It is very frustrating.  But then they have their moments of sweetness where one will say please and they will take turns.  Or they will kiss each other's bonks.  Or Selena will hold Allie's hand in parking lots (and Allie refuses to hold mine).  One morning Selena woke up and made up a song about how cute Allie was.  Or they play hide and seek together.  It is just amazing how they go from sweet to sour and back to sweet so quickly.

Preschool is going well.  It is a mystery to Floyd and I what goes on there.  Every day we ask and she says she doesn't remember, but then slowly details come out over time.  Today she played super hero's with a little girl, and they traded costumes when she said her cape was too long.  She has identified kids who are close and play together often, but she says she just plays with whoever asks her.  Her teacher tells then, "You get what you get and you don't throw a fit."  Floyd asked her if they just spend all their time licking each other (because of all the sickness she brings home) and she says, "No, there is no licking at preschool."  Surprised Floyd asked if this was a rule the teacher's actually specified, and she says, "No, but there's no kissing at preschool, so there isn't licking either."

Bedtimes seem to be going a bit easier.  She seems to fall asleep faster which makes things much less frustrating.  She comes up with the best conversations and questions at night.  One night she asked me, "How does the earth spin all on its own?"  I honestly have never even thought to ask such a question.  She decided there must be an earth spinning machine.

Complications Associated With Fetal Macrosomia

This is part five in my Pregnancy and Birth Outcomes Analysis based on the Washington State birth certificate data.  This is my final post exploring fetal macrosomia. Sorry it has taken so long to get it written, but I just kept getting sucked into a whole bunch of different ways to analyze the data, and spent a lot of time making sure that the data was correct plus, you know, taking care of my kids, starting a vegetable garden, and training for a half marathon.

Edited To Add:  I reorganized the post to start with the conclusion, followed by the results, then the method as internet surfers usually will click away if the important stuff isn't immediately viewable.

Conclusion

Having a large baby does slightly increase your chance of having complications especially having an initial cesarean.  The two biggest indicators that I could find for having a large baby were having diabetes, and carrying the baby at least a full 40 weeks.  Gaining a lot of weight during pregnancy, having gestational diabetes, or having a lot of extra weight before getting pregnant did seem to increase your chances of having a bigger baby, but only by a few ounces.  

Common methods to try and prevent a big baby is restricting a mother's food intake and inducing labor.  I think the evidence here tends to argue against restricting what the mother eats.  The stress and emotional and physical frustration this causes is not worth shaving a few ounces off the baby's weight.  

In general induction carries its own risk.  I know this from analysis that I have not yet posted.  In this specific case baby's born from a labor that was induced did suffer more complications, even than babies who were born 42+ weeks, but because this sample size was small it was mostly not statistically significant¹.     

In this specific case there also was no statistically significant difference in the rate of initial cesareans between women whose labors were induced or not.  In other words a woman who was induced at 39 weeks was just as likely to have a cesarean as a woman who went into labor spontaneously at 39 weeks and being induced at 39 weeks did not make you more or less likely to have a cesarean than a woman who went into labor spontaneously at 41 weeks (basically the confidence intervals were large at every gestational age for both the induced and not induced groups that it really didn't provide any useful information). So in this case I would say that the evidence does not argue for or against the increased safety (both baby's and mother's) in inducing labor on the sole basis of the baby potentially being "big".   

In general I would say this validates my general opinion of let nature take it's course, and listen to your body and provide it with what it says it needs.  If you do end up having a big baby and there are complications, there wasn't a whole lot you could do to prevent it.  It is what it is.  If you are diabetic you should strive to maintain your blood sugar, which I'm sure you already do, not only for your baby's potential size, but because there are other potential complications due to diabetes.

Results:

Analyzing Complications Related to Fetal Macrosomia

(Click to make larger)

Raw Data

• There are increasing complications in all categories except the death of the baby associated with big babies.  
• The rate of cesarean birth was 9.2 percent higher among large babies (roughly 1 in 4 vs 1 in 6).  

Lauren at HoboMama wondered about scheduled ceseareans, and I also wondered about inductions so I calculated some further figures.

• 13.3% of the time women with large babies had their first cesearean, without a trial of labor compared to 8.8% of women with babies less than 4200g.  So of the 9 percentage point increase roughly 5 of those percentage points were from scheduled cesareans.
• 27% of the time women with large babies had their labor induced versus about 22.4% of women with babies less than 4200g.  So there was an increase of about 4.6 percentage points in inductions.  But the increased rates in complications for bigger babies compared to smaller babies remained almost exactly the same even when the mother's labor was not induced. 

Method:

Click here to see information about the data.

• I calculated the average weight for babies in Washington and then calculated what weight range would fall above the 90th percentile.  I had the understanding that this was the definition for fetal macrosomia, till I went back and looked at the wikipedia article that qualified 90th percentile for gestational age.  Oops forgot that last little tidbit.  But I don't want to go back and do the calculations so I'll just stick with babies who are in the 90th percentile for full term babies (37 weeks or more gestation).  I could have used the entire population.  The average weight was less (7.45lbs vs 7.6lbs), but because there is more variance in size, the 90th percentile calculation was actually higher (9.4bs vs 9.3).  I rounded the 9.3lbs to 4220 grams and called it good.  
• I grouped babies into the above 4220 grams, and 4220 grams and below, and both groups the babies had to be full term (though I accidentally forgot this stipulation at first, and it did not change the results by much)
• I calculated the rate of occurrence for various groups of complications:
• Adverse Baby
• Assisted Ventilation Required Immediately Following Delivery
• Assisted Ventilation Required for More Than 6 Hours
• NICU Admission
• Newborn Given Surfactant  Replacement Therapy
• Antibiotics received by the Newborn for Suspected Neonatal Sepsis
• Seizure or Serious Neurologic Dysfunction
• Significant Birth Injury
• Moderate/Heavy Meconium Staining of the Amniotic Fluid
• Fetal Intolerance of Labor such that One or More of the Following Actions was Taken:  In-utero Resuscitation Measures, Further Fetal Assessment, or Operative Delivery
• Adverse Mother
• Maternal Transfusion
• Third or Fourth Degree Perineal Laceration
• Ruptured Uterus
• Unplanned Hysterectomy
• Admission to Intensive Care Unit
• Unplanned Operating Room Procedure Following Delivery
• Initial Cesarean
• The mother had her first cesarean.  I didn't include repeat ceseareans because many times they would have happened regardless of whether the baby was big or not (due to not many hospitals allowing VBAC's).  
• Death of the baby
• This one is a difficult statistic (both emotionally :( and as far as how accurate it is) as it is a field that was calculated by the WDHS where they took the infant (1 yr and under) death certificates and tied it to the birth certificates.  Thus the death of the baby may be totally unrelated to its birth. I also added baby's that were stillborn to this statistic.
• I calculated the confidence intervals in the same manner as this post.
• Due to the rarity of the events I calculated the confidence intervals for the death of a baby using a Poisson-Distribution via the tables in Appendix 2 of this document.

Future Posts:  I think the next topics I am going to tackle will be epidurals, augmentation and induction.  But I might wait a bit first and give myself a break.

Foot Notes:
1- If you compared rates of complications per weeks gestation most of the confidence intervals overlapped but they didn't at 39 weeks and 41 weeks, in those weeks not inducing had less complications and it was statistically significant.  I am not posting the graphs of these results because I think induction needs its own post and I get off on too many tangents

Baby Birth Weight and Mother's Pre-pregnancy Weight

This is part four  in my Pregnancy and Birth Outcomes Analysis and continues to explore fetal macrosomia.

 Pre-pregnancy Weight vs Baby's Birth Weight

Conclusion:

It does not seem that a mother's pre-pregnancy weight is a huge factor in determining how much their baby will weigh, except in the case of women who are considered underweight, their babies do tend to be a bit smaller.  

Results

• There seems to be a statistically significant trend in a mother's pre-pregnancy weight and the birth weight of her baby, however the confidence intervals do start to overlap above 200lbs.  
• The steepest increase in average baby weight is seen in the 90-140lb range after that the increase is very small (the average baby weight increases by approximately .5-1oz for every 20lb group).  

Mother's Pre-pregnancy BMI vs Baby's Birth Weight

• This is similar to the above analysis.  Each mother was put into a group based on her pre-pregnancy BMI (Body Mass Index), which is a height to weight ratio, that some health professionals use.  I used the common groupings of: 
• Less than 18.5 (underweight), 
• 18.5 - 24.9 (normal), 25-29.9 (overweight). 
• Commonly 29.9+ (obese) is all lumped together, but I decided to further categorize it and added 29.9 - 39.9 
• 40 - 49.9 
• 50 - 59.9 
• Over that the sample size was too small and the confidence intervals too large.

• A baby's birth weight is higher for women who had a higher pre-pregnancy BMI.  It is statistically significant till you get a BMI over 40.
• The greatest difference  (5.6oz) is found among baby's born to mother's whose BMI is considered underweight compared to mother's whose BMI is considered normal.

Method:

See here to see information about the data.

• The mother's are grouped by their pre-pregnancy weight in 20lb increments (starting at 90-110lbs, ending at 320-340lbs).  The average baby weigh (in pounds) is calculated for each group.  For the groups of mother's weighing more than 340lbs the confidence intervals were wide due to the small sample size.
• The data is to full-term babies (at least 37 weeks)
• The confidence intervals were calculated in the same manner as this post.

I'm going to wrap up the exploration in fetal macrosomia by comparing the rates of complications of baby's who are large versus babies who aren't.  

Natural Cleaning Ideas - Top 10

Welcome to the March Carnival of Natural Parenting: Natural Parenting Top 10 Lists

This post was written for inclusion in the monthly Carnival of Natural Parenting hosted by Hobo Mama and Code Name: Mama. This month our participants have shared Top 10 lists on a wide variety of aspects of attachment parenting and natural living. Please read to the end to find a list of links to the other carnival participants.

***

I swear everything we use is out to poison you.  Look at the cosmetic database and you can see all the toxic chemicals in all the lotions, soaps, etc. that we spread all over our bodies every day.  Also everything in our environment leaches toxic chemicals.  Plastic water bottles leach BPA into our water, tin cans leach BPA into our food, our mattresses leach fire retardants into our skin, the cleaners we use leave residue all over our house, our carpets, our walls, our furniture, our clothes. They are all leaving trace toxins for us to absorb in our skin and breathe through our lungs.

While I’m sure that the minute amount from one single thing probably won’t hurt you, but when you add up all the small amounts from every single thing, I believe that we are slowly poisoning ourselves.  So I do what I can, and sometimes I stress about it, and feel helpless, and other times I just figure that is the way things are.  But these are the things I’ve done to help reduce the chemicals in our house

1. Vinegar:  Vinegar can be used (1 part vinegar – 1 part water) as a disenfectant on countertops, bathrooms, and floors.  It can be used undiluted to wash windows.  It can be put in your laundry as a fabric softener and sanitizer, and you can use it to cook with!  So obviously it is non-toxic.  My husband always complains about the smell, but honestly I can’t handle the smell of commercial cleaners.  They make me sick.  So, I think you just get used to it, and the smell dissipates pretty fast.  
2. Baking Soda – Baking soda works great when you really need to scrub.  It also does a great job absorbing moisture and odors when set out.  I sprinkle it on the carpet when one of the children have an accident, and vacuum it up when it dries. 
3. Plunger – This is one item I discovered that I haven’t seen on any (or maybe many) green cleaning lists and really is the inspiration of this list. If your sink (bathroom or kitchen) is clogged with mold or hair use your plunger to unclog it.  It works much better than any chemical concoction you can pour down the drain (but you can pour some vinegar down there too after you are done) and is completely safe. 
4. Laundry Brush – Another useful tool for cleaning bathroom drains is a dryer brush.  I found one at the store that was advertised for cleaning out the lint in your dryer (it's got a small brush on a long twistable handle).  I shove this down the drain and find it works great to prevent clogging.
5. Biokleen Diswasher Soap – This is what I use for cleaning dishes.  It works well.  It is supposedly safe.  I also use it to fill up the soap dispensers for washing hands. 
6. Castille Soap – Another general purpose soap that works well for hand soap dispensers and bubble bath, and general purpose cleaning.  Bronners is the brand that is most easily found.  Their labels have bizarre, preachy, carrying on, but the soap is simple.
7. Baking soda and Castille Soap – Mix these two together and you get a real good scrubby paste to get tough stuff clean.
8. Old cloth diapers – I have a bunch of old green mountain prefolds (the best prefolds for actual diapering) and they are awesome rags to use for mopping the floor.  They get damp, but not too wet.  I just get them wet and use a squirt bottle with vinegar and scrub away.  
9. No dryer sheets – Dryer sheets coat your laundry “in something” so that they aren’t staticy.  Floyd has sensitive skin so I just stopped using dryer sheets one day, and sometimes my clothes get static, but not that often.  When we got a new dryer it said that as long as you don’t dry your clothes more than they need to, they shouldn’t get static cling. You can get wool or plastic dryer balls, but honestly I don't think you really need anything.
10. Uhhh did I say vinegar?  The stuff is magical. J

Note:  I have had a hard time finding a laundry soap that works really well.  Sometimes our fleece clothes are still smelly.  Actually I have used Allens Naturally and it does work great, but at $50 for a gallon (with shipping), it is quite expensive.  I’ve tried/use soap nuts,  Seventh Generation and Biokleen, but none of them have been that great. 

***

Visit Hobo Mama and Code Name: Mama to find out how you can participate in the next Carnival of Natural Parenting!

Please take time to read the submissions by the other carnival participants:

• Attachment Parenting in the NICU — Erica at ChildOrganics shares some strategies to help you parent naturally in some unnatural circumstances.
• 10 Reasons to Choose Baby Led Weaning — Luschka from Diary of a First Child shares ten reasons to choose Baby Led Weaning when it comes to solids.
• Choosing to Breastfeed — From selfishness to self-giving, CatholicMommy at Working to be Worthy lists reasons why breast is best for her and her family.
• Ten Things I Wish I Knew About Before Little Man — In this reflective post, The ArstyMama discusses ten things she wishes she knew more about before the birth of her son, Little Man.
• 10 Things That Helped Me Become a Natural Mama — The Accidental Natural Mama counts down ten things that helped her find her moderately crunchy inner mama self.
• Top 10 Reasons to Breastfeed Your Toddler — Extended breast-feeder Kate Wicker of Momopoly makes her own top 10 list for why she loves nursing her 2-year-old.
• Top 10 Tips on Authentic Grandparenting — Mamapoekie of Authentic Parenting offers a list of tips to make the grandparent-parent-child relationship flow smoothly.
• Top Ten "Dad" Things — Liam at In The Now talks about his favourite ways to spend time with his children.
• Top 10 Natural Strategies for Conception (aka How to Get Pregnant!) — Despite facing plenty of health issues, Jessica Claire at Crunchy-Chewy Mama found her way to two first-try pregnancies thanks to these natural strategies.
• Top Ten Reasons Why Home Birth Rocks — Lucy at Dreaming Aloud shares her passion for birthing at home - the natural place for natural birth.
• Top 10 reasons why cloth nappies are fun — Tat at Cloth Nappies Are Fun shows how using cloth nappies can brighten up your day.
• Top Ten Ways to Be Present With Family — Amy at Innate Wholeness shares how to make the most of parenting and family life through being present.
• Top 10 Things In My Arsenal of Kitchen Witchy Mama Tricks. — Joni Rae at Tales of A Kitchen Witch shares with us the simple things she would never want to be missing from her cupboards.
• Top 10 ways I'm not very good at natural parenting (and why I keep trying anyway) — Jenny at Babyfingers shares the ways she is imperfect as a natural parent, and why she embraces natural parenting anyway.
• Top 10 Ways to Know You Are a Natural Parent — So what makes us "natural parents," anyway? A lighthearted look at the Top 10 Ways to Know You Are a Natural Parent by the editors and readers of Natural Parents Network.
• The Top 10 Things Every Natural Household (with children) Should Have — Amanda at Let's Take the Metro shares a list of the most common natural products and remedies she uses for health and cleaning.
• Top 10 books for raising loving, spiritual children — In her 'food for the soul' post, Mrs Green from Little Green Blog shares her favourite spiritual books. No matter what religion you practise, there's something for everyone!
• Top 10 Things No One Told Me About Natural Parenting — Adrienne at Mommying My Way explains that the best things about natural parenting are things she never expected.
• Top 10 Flower Essences for Families — Kim of Nature Baby Bloggings lists her pick of the top ten flower essence which can help ease families through the ups and downs of life.
• My Top Ten Parenting Tools — Amyables at Toddler In Tow names the top ten tools that have been helpful to her while learning to parent respectfully and successfully.
• Ten Ways Families Can Enjoy Nature (for free!) — Spring is nearly in the air, and Jenn at Monkey Butt Junction is dreaming of the fun and frugal ways that her family is going to get out and enjoy nature this summer.
• 10 Reasons We Unschool — Patti at Jazzy Mama explains why unschooling is the right choice for her family.
• Must Read: Natural Parenting Top Ten — Amy at Anktangle wants you to do a little reading! She shares her top ten favorite books to help parents prepare for pregnancy, birth, and parenting.
• Top 10 Breastfeeding Misconceptions — Sheila at A Gift Universe examines ten reasons women give for why they didn't breastfeed as long as they wanted, and shows how these obstacles can be overcome.
• Ten Reasons to Plan a Home Birth — Since a home birth can be an incredibly empowering experience, Leslie at Lights and Letters outlines ten reasons why you should plan to have your baby at home.
• Top Ten Books for Birth, Breastfeeding and Parenting — Megan at Just Me(gan) writes about the ten books that have helped her the most in her natural parenting journey.
• A Top Ten Letter To Me... — Kat at Loving {Almost} Every Moment writes herself a letter of reflections and bits of wisdom she would have liked to know as a new mama.
• Top Ten Mama Necessities Money Can't Buy — Buying baby gear is fun, but Emily at Crunchy(ish) Mama knows real parenting must-haves can't be bought in stores (or even on Amazon).
• Top 10 Books for a Natural Mum — Isil at Smiling like Sunshine talks about her Top 10 Books for a Natural Mum.
• Ten Great Spring Activities To Do With Preschoolers — Kellie at Our Mindful Life and her family have come up with a great list of activities to do together this spring.
• 10 Ways to Reuse Yogurt Containers — Acacia at Fingerpaint & Superheroes keeps the stacks of yogurt containers out of her recycling bin by reusing them in both practical and creative ways.
• Top Ten Ways To Have a Harmonious Home — Jennifer at Hybrid Rasta Mama shares her natural parenting-inspired methods for maintaining a harmonious daily life with her toddler.
• 10 Natural Baby Items I Love — Charise at I Thought I Knew Mama shares product ideas to support your natural parenting.
• The Pandas' Top Five Crunch-osophies — Top five crunchy philosophies, as employed at the Panda Residence by Ana at Pandamoly.
• Top 10 Reasons to Leave Your Son Intact — Mandy at Living Peacefully with Children has shared 10 reasons why you should leave your newborn son intact.
• Ten things everyone should know about unassisted homebirth — Olivia at Write About Birth shares practical tips for women considering an unassisted homebirth and debunks some common myths
• 10 Most Popular Ways To Treat Cloth Diaper Stains — Chante at My Natural Motherhood Journey gives ten easy tips to make your diapers like new.
• 10 Lessons in 1 Year — Abbie at Farmer's Daughter shares 10 parenting lessons that she has learned throughout her first year of motherhood.
• Top 10 Ways to Get Breastfeeding Off To a Good Start — Sheryl at Little Snowflakes shares 10 effective ways to ensure breastfeeding gets off to a good start.
• Top 10 Ways to Avoid a Time-Out — If you are uncomfortable using time-outs in an attempt to control your child's behavior, try one of these gentler alternatives. Dionna at Code Name: Mama shares her Top 10 Ways to Avoid a Time-Out.
• My Top 10 Parenting Scriptures — Dulce de leche is learning to integrate faith and parenting. Whether it is breastfeeding, babywearing, comforting her children, or gentle discipline, she finds that the Bible has beautiful passages to encourage her on her journey.
• Natural Cleaning Ideas - Top 10 — Laura at Laura's Blog lists the ways she keeps her house clean and clear of chemicals.
• My Top Ten (plus two) Life Altering and Growth Inspiring Books — A top ten list of books from MJ at Wander Wonder Discover that changed her life as an individual, a parent, and an earth dweller.
• Top 10 Ways to Use Natural Parenting for Children with Special Needs — Danielle at Mommy Makes Cents feeds the needs of her family and special needs child through the use of Natural Parenting.
• Ten Fundamentals — Seonaid at The Practical Dilettante gets philosophical with a list of the fundamentals that drive her natural parenting.
• 10 reasons why I chose breast over bottles — Becky at Old New Legacy writes a quick list of why she chose breast over bottles.
• Top Ten Natural Tools for the Work of Play — Lori at Beneath the Rowan Tree offers insight into 10 natural toys that will span the early years (and save you money).
• 10 differences between pregnancy and parenting in Japan and the US — Megan at Ichigo Means Strawberry gives her impressions about differences in pregnancy and parenting in Japan and the US.
• Natural Parenting Benny & Bex Style — Pecky at Benny and Bex explains why Natural Parenting principles work best for her boys.
• Top 10 Reasons to Co-Sleep — 10 practical, emotional, and completely selfish reasons to co-sleep and share a family bed from Lily, aka Witch Mom.
• My Top Ten New Mommy Moments — Melissa at The New Mommy Files recounts the ten most memorable moments of her daughter's first year.
• Top Ten Things Every Breastfeeding Mother Needs to Know — Kristen at Adventures in Mommyhood believes knowledge is power and wants all moms to be well informed.
• Top 10 Nursing Positions / Situations — Momma Jorje uses her 5½ years of nursing experience to share her Top 10 Nursing Positions/Situations. She includes some adorable photos of her youngest daughter at the breast.
• Ten Top Ways to Connect Kids with Nature — Terri from Child at the Nature Isle offers 10 ways to immerse ourselves in the natural world and develop a love affair with the Earth.
• Top 10 Slacker Ways to Natural Parent — Guavalicious is happy to show you how to parent naturally the slacker way.
• Simply what it looks like — Andrea!!! from Ella-Bean & Co. offers a glimpse into natural parenting through the eyes of mama and babe.
• Top Ten Reasons Why Natural Parenting Dads Are So Attractive — Nada at miniMOMist sure digs her husband, but it's not just his good looks -- it's his parenting!
• 10 Family Systems and Routines That Work for Us — See what routines, organizational systems, and parenting approaches work for Kristin at Intrepid Murmurings to help avoid conflict and maintain sanity in a family with three young children.
• Top 10 reasons to choose midwifery care — Lauren at Hobo Mama lists the features that drew her to midwives' care for pregnancy and birth.
• 10 Ways to Cloth Diaper on a Budget — Michelle at The Parent Vortex shares her best thrifty cloth diapering tips.
• Ten Reasons it Felt Sew Good To Make My Own Play Food — Brittany at Mama's Felt Cafe lists her 10 (OK, 11) favorite reasons to grab a needle and start sewing your own felt play toys.
• Top10 Ways to Spark Interest, Learn, and Have Fun With Everyday Tasks! — Bethy at Bounce Me to the Moon gives you her top 10 ways of incorporating fun and lessons into everyday tasks and chores.
• Postpartum Gift Ideas — Alicia at I Found My Feet suggests a top 10 list of gifts for mother's after giving birth.
• My Top Ten Shows Worthy Of Screen Time — Tree at Mom Grooves shares her top ten list of shows that she believes are positive, educational, kind, joyful, and a nice way to share some downtime with your children.
• The Top 10 Ways to Succeed as an Working Attachment Parent — That Mama Gretchen shares tried and true ways to succeed with attachment parenting even when working away from home during the day.
• Top Ten Books for Natural Parenting — Pregnancy, herbs, cooking, and healthcare the ten books Asha at Meta Mom the most.
• Preparing for a Hospital VBAC: My Top 10 — Thomasin at Propson Palingenesis shares 10 ways she's preparing for her upcoming hospital VBAC.
• Top Ten New Mom Survival Tools — Wolfmother shares her most beloved motherhood survival tools at Fabulous Mama Chronicles.
• Top 10 Montessori Principles for Natural Learning — Deb Chitwood at Living Montessori Now gives her top 10 list of Montessori principles parents can use to encourage their children s natural learning.
• Going Granola — Tashmica from The Mother Flippin' Blog describes the 10 ways that natural parenting sneaked up on her. She never expected to go all granola on the world.
• Step Away From the Amazon List — Stefanie at Very, Very Fine wishes she hadn't bought so much useless stuff.

Relationship Between Baby's Birth Weight and Diabetes

This is part 3 in my Pregnancy and Birth Outcomes Analysis and continues to explore potential relationships of fetal macrosomia.

Comparing Average Fetal Weights for Women With Diabetes, Gestational Diabetes and No Diabetes

Conclusion

 It seems that either women who have gestational diabetes are doing a great job controlling it, or that gestational diabetes does not affect baby birth weight by that much.  However having diabetes pre-pregnancy does seem to influence the baby's birth weight quite a bit more. 

Results:

• There was an approximate 1.5oz difference in weight between babies whose mothers had GD versus those whose mother's did not have diabetes.
• There was an approximate 4.6oz difference in weight between babies whose mothers had diabetes before they got pregnant versus those whose mother's did not have diabetes.
• There was an approximate 3.2oz difference in weight between babies whose mothers had GD versus babies whose mother's had diabetes before they got pregnant.
• The confidence intervals do not overlap so the differences are statistically significant.

Method:

See here to see information about the data.

• I used sql server to calculate an average baby weights for women who's baby's were full-term (37 weeks or later and were put in the following groups

• Had diabetes before they got pregnant (did not distinguish between Type 1 or Type 2)
• Diagnosed with Gestational Diabetes
• Did not have diabetes

• The confidence intervals were calculated in the same manner as this post.

Dear Sweet Allie

Allie is 21 months and learning new things every day.  However, it has been a really rough winter for our poor little girl.  She has had fevers, colds, coughs, stomach bugs in an endless succession.  Most of them don't affect her ability to play and run around, but sometimes they affect her (and mine) sleep and overall just aren't fun.  Its also frustrating because I feel like we shouldn't do many things so that her immune system can get a break.

We joined the Y a few months ago, and were excited to be able to do some classes, and use the treadmills, and put the girls in the childcare.  Unfortunately Allie does not like it at all.  She was okay the first few times.  She moped, but didn't cry.  But then they told her she couldn't go up the slide, and since then she starts crying as soon as we walk in, and says she wants to go home.  Sometimes she's okay if someone holds her the whole time, but even then they have had to come get us because she's crying too much.  It is very sad.  So we'll take a break from taking her there for a couple months and see if she does better then.

Some of the things Allie is been up to, or says:

• If she hears the word crazy, she says, "Allie's crazy.  Mama's crazy.  Dada's crazy, Seenuhs crazy."
• She'll say something and then say, "Allie's joking."
• If she's mad she'll say, "I'm mad!"  I guess all the empathetic labeling feelings stuff kind of works. ;) 
• She runs around in circles when she gets excited.
• She knows most of her letters, shapes, and colors.
• She loves to go through books and point to stuff and ask, "What's that?"  But if you answer "incorrectly" she adamantly corrects you.  "Not n. U!", "Not panda, Bear!", "Not bird. Penguin!", "Not. j. i!" etc.  When you agree she nods, and goes on to the next one, "What's that?"  Floyd tries to argue with her.  I don't even bother. 
• If she gets bonked she has to come over and have me kiss it.  I have magical kisses. :)
• She gets very angry when Selena takes stuff from her, but is very good at sharing if Selena asks nicely.  
• She doesn't like it when Selena crys, and she always tries to make her feel better.  Sometimes she'll even give Selena the thing she was trying to take from her.  She'll also go and give her kisses.  
• She knows to say "Bless you" when someone sneezes.  Once she heard Selena sneeze in another room, and she looks up and says, "Selena.  Bless you!" then gets up to go tell her.  
• She likes the rhyme, "Round and round the garden."  Once I even caught her doing it to Dyna.
• She has taken over the task of feeding Dyna.  When she notices Dyna doesn't have food she gets the bowl and asks me to open the garage door.  She carries the bowl down the stairs and scoops the food, and then brings it back in, and puts it back where it belongs.  
• She is always trying to get Dyna to sit in her lap.
• When she first started talking she called all 4 legged animals Dyna.  Now she calls Dyna Dog.  
• She is starting to get into puzzles.
• She likes building.  She lines up and stacks all of our different types of blocks into complicated constructions.
• She likes to draw.  She'll draw pictures and then if I ask she'll tell me what they are.  Sometimes she'll draw a shape, that does actually look like something and she'll say, "Allie draw a boot." and sure enough the shape she drew looks like a boot.  She also is constantly asking for you to draw dogs, cats, and girls for her.
• She picks her nose and eats her boogers.  She gets mad if you tell her to stop.  Ugh. Sometimes you catch her with a finger in each nostril. 
• I bought a NookKids book, "Pete the Cat" for my Nook Color and now every time I have my Nook out she comes over and pushes the button to get the menu and then pushes the "cat book".  Then she enthusiastically "turns" the pages.  When I read it to her and say, "Did Pete cry?", She says, "Goodness no.  Keep walking."  It's very cute. 

Baby Birth Weight versus Gestation

I got some positive responses so I'll keep posting my analysis of the birth data.  So this is part 2 in my Pregnancy and Birth Outcomes Analysis and further explores possible relationships between various variables and fetal macrosomia.

See here to see information about the data.  

Method:

• Calculated the average birth weights for full term baby's born grouped by how long their gestation period was.
• Confidence intervals were calculated in the same manner as this post.

Results:

Comparing Average Baby Birth Weights 
to Their Gestation Time

• The confidence intervals did not overlap except for babies born at 43 weeks (there were only 117).  
• It is not statistically significant that babies born at 43 on average weighed less.  
• The increase in difference in average weight is not linear.  

Conclusion

I thought these results were really interesting.  I'm not sure if you can really use this information to determine fetal growth, but knowing the uncertainty involved in estimating weight via ultra-sound I can't think of a better way to estimate fetal growth than this, so I'm going to go with it.

I had the understanding that a baby gained about half a pound per week the last month of pregnancy.  I'm not sure where I heard this.  I read a lot, so it must have been somewhere, but it doesn't seem to be true.  The average weight gain is just less than 6oz (so just less than 1/3lb per week) per week from 36 - 40 weeks, and it isn't a linear gain, meaning it isn't the same amount of weight each week.  Their growth rate seems to slow the longer they gestate.  I was pregnant with my second child four weeks longer than with my first and as every week passed by I remember thinking that my baby just gained 1/2lb and despite trying not to be, I was a bit concerned. My second ended up being just 3/4lb heavier than my first.  This information would have been nice to know.

It seems like there could be contradictory conclusions about this data in regards to whether inducing labor is okay.  On one hand you could say, well the baby isn't going to grow that much more anyway, so you might as well induce early (for convenience), on the other hand you could say the baby isn't going to grow that much more, so you might as well let them stay till labor happens spontaneously (to contradict the "big baby" argument).   I agree with the latter conclusion, because I believe that there is other important development that happens at the end that happens better in-utero.

Edited To Add:  There is quite a large difference between 39 weeks and 41 weeks (11oz), so I guess there may be some basis to assume that waiting could result in a much larger baby.  But there is always the unknown of how much longer it will be before labor starts on its own... 

* Please leave me comments if you found this interesting.

Does a Baby's Birth Weight Correspond With A Mother's Weight Gain?

This is part one on a series of pregnancy and birth outcomes.

I've been messing around with the birth certificate data, but hadn't formally prepared anything to be posted because honestly that is the least fun part.  But Lauren at Hobomama (great blog!) had a post about her midwife harping on weight and she questioned whether a mother's weight gain really influences the weight of their baby.  So I thought, "Hmmm lets see".  Here are the results:

Conclusion

On average, the more weight a mother gains, the more her baby will weigh.  However, the average difference in a baby's weight, between a mother who gains 25lbs versus a mother who gains 70lbs, is only 1/2 lb.  There seems to be more involved in fetal macrosomia than a mother's weight gain.  If you feel comfortable that you eating nutritiously and are being as physically active as you can, then you are probably fine. If a provider tells you to eat less to avoid having a huge baby, this statement is based on exaggerated evidence at best.

Results:

Click to make larger

• You can see that in general as a mother gains weight her baby on average is larger. The exception is when weight loss occurs or only 0-9lbs of weight gain, however the confidence intervals overlap in this range so it is not statistically significant.
• The results are significant till you get to fifty pounds and over, or when the mother lost weight then the results become less relevant.  
• Babies born from women who gain the recommended 20-29lbs weight on average 7.51bs (7lbs 8oz).  
• Babies born from women who gain 30-39lbs weigh on average 7.66lbs (7lbs 10oz).  The 2oz difference is statistically significant.  
• Babies born from women who gain 40-49lbs weighed on average 7.82lbs (7lbs 13oz).  The 3oz difference is statistically significant.

Just for curiosity sake here is the entire chart in a mostly full range of weight gain and loss.

• It seems that baby weights rise when women lose a lot of weight, but the confidence intervals for this are large and thus the information isn't really meaningful.  

Method:

• I summarized the data of all women from 2003 - 2007 who carried their babies full term (37 weeks), whose starting and delivery weights were provided and seemed reasonable (above 90lbs).  I did not use the weight gain field calculated by the WSDH because it did not include mother's who lost weight.
• I excluded data when the weight gain was above 79lbs or whose weight loss was below 9lbs because the results were not statistically significant. 
• I grouped all women in 10lbs ranges so 0-9, 10-19, 20-29, etc and calculated the average weight of their babies in grams, and converted it to pounds by multiplying the weight by .0022.
• I used sql server's stdev function to calculate the standard deviation for each group.  To calculate the confidence interval I used the instructions from here and summarized as:
• CI is the confidence interval
• avg - is the average baby weight
• SD - standard deviation
• N - number of mothers in the sample

• I graphed the results in Excel.  I included both the confidence intervals and the actual results.  To determine statistical significance I use the simplistic logic that if the confidence intervals overlap then the results are not statistically significant, if they don't overlap, then they are.  This logic is per the recommendations from the Washington State Department of Health.

Future Posts

• Rates of fetal macrosomia compared to mother's weight gain or loss
• Rates of fetal macrosomia compared to mother's initial weight or bmi
• Fetal weight and fetal macrosomia compared to whether a mother has gestational diabetes or not.

These posts take a long time to write up, so I'll get to them when I can.  Please leave me a comment if you find this information useful or interesting so I know if it is worth my time and effort to write up my analysis. 

Pregnancy and Birth Outcomes

A couple years ago I requested all the birth certificate data from the Washington State Department of Health.  ETA:  Here is a link to the form that providers fill out after a baby is born. I am geeky and like databases.  I like researching pregnancy and birth and I wanted to see if I could get some more interesting results than the ones they post on their website.   At the time it was very simple.  I signed a paper saying I wouldn't give the actual data to anyone else and a CD came in the mail very quickly.  Granted the data was not in a format that was user friendly at all, but I got the data easily.  Now however is a different story. I asked for an update that included the 2008 and 2009 data, and the infant death data as well, and I am told that they are now charging $30 a file.  (I would have been charged $420 for the data I had previously received).  I am now thinking this is illegal because there was an article in the Seattle Times saying that they are trying to get legislation (but haven't yet) to allow them to charge because "civic gadflys" are wasting taxpayer money.  How rude.  I am not a gadfly.  On one hand I want to make a fuss on the principle of the matter, plus the freedom of information act is important, on the other hand maybe it really does take them a long time to get the data rounded up and they really are overwhelmed.

My plan is to do a series on this blog based on the resulting analysis.

METHOD:

I've taken the data from 2002 - 2007 (I have 2000 and 2001 as well, but the information collected changed in 2002 so its easier for me just to ignore the earlier data instead of trying to combine it somehow) and wrote a script to parse the fixed width delimited data and input it into a SQL Server database.

I've also written a script that allows me to execute a SQL query and import the results into Excel and create a chart of the data.  I have to admit I feel pretty studly that I have been able to do this.  I find it much easier to interpret the data visually and this makes it a lot easier to do.

I'm doing my best to be careful, accurate and use statistically sound analysis.  However I have no one checking my work.  If you find any errors PLEASE let me know.  

MY RESUME AND BACKGROUND:

Most often when "studies" like this are done they are either done in a university setting, or are research funded by some interest group.  I belong to neither.  I have a B.S. in Computer Science and a minor in Math with a year of that being in statistics.  I've often thought that if I weren't a computer programmer I'd love to be a statistician, however it was quite a while ago since I've done any statistical analysis, so I'm doing my best.  I am currently unemployed and my primary responsibility is raising my children.   I was formerly employed at small company that makes exercise software for physical therapists.  

Besides being nerdy and enjoying analyzing data I have an interest in childbirth and pregnancy.  I believe in "evidence based" medical care and am an advocate for unmedicated birth, the midwife model of care, birth centers, and home births.  My first child was born at a birth center and I delivered her without medication.  My second child was supposed to be the same, but I ended up transferring to a hospital where she was born via cesarean.  My experiences made me wonder exactly what the rates of complications are for various situations, and are the risks and/or benefits exaggerated in the debate on what the best prenatal care consists of.  My goal is to provide some hard numbers that give women some more information so that they can do a risk/benefit analysis on the type of care they receive and their decisions regarding labor.  There is a lot of useful information in the birth certificate data, but there is also a lot of missing information that would make analysis better.  Some day I hope to create my own "ultimate birth survey" but till then, this will have to suffice.  

All posts in this series

Part 1 - Mother's Weight Gain Compared to Baby's Birth Weight
Part 2 - Baby's Birth Weight Versus Gestation
Part 3 - Baby's Birth Weight and Diabetes
Part 4 - Complications Associated With Fetal Macrosomia
Is Home Birth Safe?