Feeding Your Preemie in the NICU

January 19, 2015 by ldecesare

Feeding your preemie in the NICU | MothersCircle.netThank you to Prolacta for this guest post on feeding your preemie in the NICU. It’s stressful, emotional, and challenging to have a baby who’s born early, and as parents, you want to learn about and do what’s best for feeding your preemie. Here is some science behind NICU infant nutrition.

In honor of the nearly 500,000 babies born prematurely each year (according to the Centers for Disease Control, that’s 1 in every 8 infants born in the United States), we’re sharing good news about the latest in medical advancements that are helping more preemies in the neonatal intensive care unit (NICU) survive and thrive.

Critically ill, premature infants have special dietary needs requiring higher levels of fat, protein and calories than full-term babies need. Mounting scientific research supports the use of an exclusive human milk diet for preemies and this has led to a rise in use among NICUs across the country. Based on this research, the American Academy of Pediatrics published a recommendation that all preterm infants receive breast milk, be it a mother’s own or donor milk.1

While feeding preterm infants a diet of 100% breast milk may seem like an obvious solution to those who breastfeed, the reality is that for generations, preemies in NICUs were fed cow-milk-based formula. Even if a mother’s own breast milk was available, it was typically “fortified” (to add extra nutrients) with a fortifier containing cow-milk protein.

A peer-reviewed analysis by Steven A. Abrams, MD, Medical Director of the Neonatal swaddled baby, soothing babies, learning about babies, learning to comfort baby, parenting classes, birthing classes, should I take a childbirth class?, dads and birth classes,Nutrition Program at Baylor College of Medicine, found that as the volume of milk containing cow milk-based protein fed to infants in the control group increased, so did the likelihood of developing necrotizing enterocolitis (NEC) or sepsis.2
Necrotizing enterocolitis (NEC) is inflammation which causes death of intestinal tissue. It most often affects premature or sick infants and occurs when the lining of the intestinal wall dies and the tissue decays. NEC affects up to one in six babies weighing 1250 grams (2.756 pounds) or less at birth who receive bovine (cow) components in their diets.3,4 NEC is one of the leading causes of mortality among preterm babies.5

Sepsis is a potentially fatal bacterial infection of the bloodstream resulting in widespread inflammation.

Leading hospitals across the country currently provide an exclusive human milk diet to preemies in their NICUs through the use of specially formulated human milk-based Neonatal Nutritional Products from Prolacta Bioscience that are clinically proven6,7,8 to improve health outcomes and decrease mortality9 for critically ill preemies in the NICU. Prolacta’s products are derived from 100-percent human breast milk and are formulated to meet the needs of extremely premature infants in the NICU. Some hospitals have also partnered with Prolacta for a donor milk program in which mothers can donate their excess breast milk to support their local community hospital.

The statistics on preemies are staggering: more than 40,000 babies are born each year weighing less than 2 pounds 12 ounces – so small one could fit in the palm of your hand. These fragile preemies are fed through a tube, and spend the first 70-90 days of their life in the NICU where specialized nutritional support is vital to their survival.

Another study published in the Journal Breastfeeding Medicine concludes that a diet of 100 percent breast milk results in lower mortality for extremely premature infants in the neonatal intensive care unit (NICU).10 It is encouraging that much scientific evidence demonstrates that an exclusive breast milk diet has the best health benefits and outcomes for extremely premature infants. With greater awareness for prematurity awareness, and the growing science in the field on human milk-based nutrition, the outlook for feeding preemies in the NICU is brighter than ever.

Citations:

1. American Academy of Pediatrics, “Breastfeeding and the Use of Human Milk.” Pediatrics. 2012;129:e827
2. Abrams S, et al., “Greater Mortality and Morbidity in Extremely Preterm Infants Fed a Diet Containing Cow Milk Protein Products.” Breastfeeding Medicine. 2014;9(6):281-285
3. Sullivan S, et al., “An Exclusive Human Milk-Based Diet is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products.” Journal of Pediatrics. 2010;156(4):562-567
4. Cristofalo E, et al., “Randomized Trial of Exclusive Human Milk versus Preterm Formula Diets in Extremely Premature Infants.” Journal of Pediatrics. 2013;163(6):1592-1595
5. Ganapathy V, et al., “Long Term Healthcare Costs of Infants Who Survived Neonatal Necrotizing Enterocolitis: A Retrospective Longitudinal Study Among Infants Enrolled in Texas Medicaid.” BMC Pediatrics. 2013;13:127
6. Sullivan S, et al., “An Exclusive Human Milk-Based Diet is Associated with a Lower Rate of Necrotizing Enterocolitis than a Diet of Human Milk and Bovine Milk-Based Products.” Journal of Pediatrics. 2010;156(4):562-567
7. Cristofalo E, et al., “Randomized Trial of Exclusive Human Milk versus Preterm Formula Diets in Extremely Premature Infants.” Journal of Pediatrics. 2013;163(6):1592-1595
8. Hair A, et al., “Randomized Trial of Human Milk Cream as a Supplement to Standard Fortification of an Exclusive Human Milk-Based Diet in Infants 750-1250g Birth Weight.” Journal of Pediatrics. 2014;165(5):915-9209. Abrams S, et al., “Greater Mortality and Morbidity in Extremely Preterm Infants Fed a Diet Containing Cow Milk Protein Products.” Breastfeeding Medicine. 2014;9(6):281-285
10. Ganapathy V, et al., “Long Term Healthcare Costs of Infants Who Survived Neonatal Necrotizing Enterocolitis: A Retrospective Longitudinal Study Among Infants Enrolled in Texas Medicaid.” BMC Pediatrics. 2013;13:127

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Reading With Robin is Back!

January 16, 2015 by ldecesare

RWRlogo_finalMy dear friend, Robin Kall, will be back on the air today with her Reading With Robin program after a two year hiatus. Lifetime lover of books, radio host, and entrepreneur, Robin works tirelessly to advocate for all things literary.

Affectionately referred to as the Fairy Bookmother, Robin connects writers to readers, hosts beloved authors events, and is never without a book. When we go out, I have to bring a notebook to record the names of authors I need to read and all the fun ideas we brainstorm together.

Please tune in today and every Friday afternoonReading with Robin, Robin Kall, RI Robin, book lovers, for the return of Reading With Robin, 4-5:00 pm eastern. You can also listen to AM790 WPRV on the i Heart Radio app.

On today’s show, I’ll be calling in to talk about Naked Parenting and my book signing next week on January 22nd at Symposium Books in East Greenwich, RI.

She’ll be sharing her favorite authors, telling stories and having a great on-air time. Today’s show is going to be a free-for-all so we’ll see what happens. After all, it’s LIVE!

Break a binding, Robin!

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More Favorite Books For Book Clubs

January 14, 2015 by ldecesare

More favorite books for book clubs | MothersCircle.netLast summer, I listed some of my favorite books for book clubs, after another year of reading, here are some more favorite books. At the end of this post, take a peek at some of the author’s I’ve met – and I absolutely recommend their books, too! Loved Ice Cream Queen of Orchard Street, The Baker’s Daughter, Those Who Save Us, The Beauty of Humanity Movement and others by the authors in the photos! ENJOY!

My newest Favorite Books for Book Clubs:

The Husband’s Secret by Liane Moriarty
I’ve loved Liane Moriarty’s work and this one was intriguing and left our book club discussing a lot of what ifs. The husband’s secret was nothing like I thought it would be!

Me Before You by JoJo Moyes
Get out the tissues! I couldn’t put this book down and loved the contrast of the two main characters one an adventurer but unable, the other able but inhibited. So many wonderful discussion points and seriously, even my friends who are non-criers, cried. Sign of a good book if you ask me!

Mr. Penumbra’s 24-Hour Bookstore by Robin Sloan
The paperback cover GLOWS IN THE DARK! Most fun discovery as I turned out my lights and saw it glowing on my nightstand! Hearing Robin Sloan speak was a blast, too. One of my favorite lines was when the protagonist is explaining developing a computer model of the book store and I was thinking, “Wow, that’s impressive.” The very next line in the book was, “And if you’re impressed by this, you’re over 30.” I fell over laughing! YUP! I am!

(Did you see my post 44 and Pregnant on Huffington Post? Tells you I’m way over 30!)

The Kitchen House by Kathleen Grissom and The Invention of Wings by Sue Monk Kidd
I loved both of these and couldn’t help but see tons of parallels and similarities from the importance of a tree in both and the main character being a red head with freckles. The stories are both written beautifully and I deeply enjoyed both.

The Language of Flowers by Vanessa Diffenbaugh
I love symbols and love gardening. This book both broke and warmed my heart. It also made me want to open a flower shop!

Theory of Opposites by Allison Winn Scotch
Read this over the summer in a flash, enjoyed it, fun story and well-written. It’s been months since I’ve read this and so as perimenopause steals  my memory (good excuse), I don’t recall if this had topics that are in-depth enough to spark lively book club discussions, but I do know I liked it!

good reads, book club books, what to read, reading suggestions, meeting authors, signed books

Not only do I love reading, I am crazy for meeting authors! I love to hear authors speak and to get my books signed. Here is a little photo gallery of some of the authors whom I’ve been lucky enough to meet. Many thanks to my friend, Robin of Reading with Robin, and the fantastic author events she plans for our small state with big readers!

© Copyright Leah DeCesare

Elin Hilderbrand, The matchmaker

Elin Hilderbrand, her latest book is The Matchmaker

Image Camilla Gibb, Camilla Gibb author, photo camilla gibb, Leah Decesare with Camilla Gibb, Leah DeCesare, book signing, author book signing, signed copy of beauty of humanity movement, beauty of humanity movement writer

Camilla Gibb, author of Beauty of Humanity Movement

those who save us, The Muse Jenna Blum, Storm chasers,

Jenna Blum is a treasure to writers! So supportive and encouraging! Read Those Who Save Us and Storm Chasers.

Love Sarah McCoy's book The Baker's Daughter. Reading her newest, not out yet, The Mapmaker's Children right now! LOVE!

Love Sarah McCoy’s book The Baker’s Daughter. Reading her newest, not out yet, The Mapmaker’s Children right now! LOVE!

Susan Jane Gilman, John Searles, Dani Shapiro, Leah DeCesare

Loved meeting Susan Jane Gilman (Ice Cream Queen of Orchard Street), John Seales (I want him to be my friend! Author of Help for the Haunted) and Dani Shapiro (Devotion).

saving grace, tempting fate, another piece of my heart

Jane Green writes two books a year! Her newest, Saving Grace, will be out in January.

Robin Sloan, Penumbra's 24 hour library

Author of Mr. Penumbra’s 24 Hour Bookstore, Robin Sloan

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Pain to Power Online Childbirth Program

January 7, 2015 by ldecesare

pain to power, online childbirth, debra pascali bonaro | MothersCircle.netI’m excited to introduce and support Pain to Power online childbirth program created by birth-powerhouse, Debra Pascali-Bonaro. Debra is a long time friend, mentor, and colleague, we worked together to revise and update Nurturing Beginnings, and I’m happy to share her latest project with you.

Debra is the Founder & President of Orgasmic Birth and creator of Orgasmic Birth: The Best-Kept Secret Documentary that explores the intimate nature of birth. She’s been a birth worker for over 30 years, helping new families all over the world unlock pleasure in birth and life.

Debra has trained thousands of doulas and birth professionals around the world in the practices of gentle birth support. And now, she’s bringing all of this knowledge to you through her latest creation.

Pain to Power, a 9-week online childbirth experience.Pain to Power with Debra Pascali Bonaro | MothersCircle.net

This enlightening, educational journey is going to guide you to awaken your inner wisdom and get in touch with your intuition. Debra is going to provide you with all the information you need to create a birth plan that will give you the intimate, controlled, safe birth experience you desire.

If you feel lost in the maze of childbirth information and struggling to find a way to make your childbirth experience enjoyable, this all new online childbirth experience is for you. Pain to Power will provide you with the knowledge, tips and tools you need to have a safe, pleasurable childbirth experience.

Through this 9-week program you will also have access to amazing bonuses like real-life birth stories, expert interviews, videos and resources from InJoy Video and Lamaze International.

Pain to Power with Debra Pascali Bonaro | MothersCircle.netAs a Mother’s Circle reader, you know I only share products and programs with you that I know deliver on their promise and I know you won’t find a program with this much value anywhere else. I believe in empowering yourself with education and that childbirth education is so important and this is a program with top birth professionals right in your own home.

Visit: paintopowerchildbirth.com now to register and receive access to a 
FREE 3-part video series.

If you want to unlock your power, unleash your pleasure, and experience birth in a whole new way, Pain to Power is for you and I’m honored to share this program with my Mother’s Circle community.

NOTE: Mother’s Circle is an affiliate because I believe in the value of this program.

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How to Make Clementine Granita

December 23, 2014 by ldecesare

How to Make Clementine Granitas | MothersCircle.netMaking clementine granita has become a Christmas tradition in our house. I first made it a few years ago for a fresh, festive, and light Christmas Eve dessert. Served with platters of rich Christmas cookies, clementine granita is the perfect balance.

Everyone loves it and now Anna requests and expects it as part of our Christmas preparations. She’s really the one who has made this a holiday staple, and she does much of the work to make these delicious and pretty desserts.

Ingredients:
12 clementines, plus 12 more for juicing
1/2 cup sugar
1 slice (1/2 inch) peeled fresh ginger
1 tablespoon fresh lemon juice

Here’s how to make clementine granita with pictures to guide you. We use Martha Stewart’s Clementine Granita Recipe.

Cut the tops off of twelve clementines, you’ll need to juice the insides of these as well as another twelve. You can use orange juice for the extra if you prefer. Also, juice the fruit that is in the tops.

cut oranges tangerines mandarins

Next, make a simple syrup with the water and 1/4 cup of the sugar, add a few slices of fresh, peeled ginger. Bring to a boil and mix so that the sugar dissolves completely. Set aside to let cool while you prepare the rest of the clementines. Before you add this mixture to the juice of the clementines, you’ll discard the ginger slices.

making simple syrup, fresh ginger,

Carefully remove the insides of the clementines and put the pulp into a sieve or colander. Try not to tear the peel as that will become your bowl. You can see that I did rip a few a little bit, I don’t use the ones I really mess up but will use a peel if it has only a small tear. You decide how particular you want to be.

hollow clementines, clementine peels empty, using orange peel as bowl

clementine pulp, juicing clementines,

Anna loves this part and uses a potato masher to squish and squash the clementine pulp so that the juice is pushed through into the bowl below the colander. If you have a better or easier way to juice the clementines, go for it! When the simple syrup is cooled, add it to the juice (add more orange juice here if needed), and add the lemon juice. You’ll freeze this mixture.

clementine juice, mandarins, orange dessert

Take the clementine skins moisten them before rolling them in sugar. Martha Stewart uses water to dampen the outside, but I like to swirl them in the sticky, juicy leftover pulp in the colander instead. I find that the sugar sticks to it better.

coating orange peel in sugar, using fruit as dish, refreshing light dessert

 

sugared clementine peels, orange peels for serving, using fruit as bowl, fruit desserts

Using a plastic container or a glass baking dish freeze them. Something with sides works best so the shells don’t roll around. Once the clementine granita mixture and the sugared clementine peels are frozen, use a fork to scrape the granita filling and scoop into each shell. Try to do this swiftly so that it doesn’t melt. Then refreeze the filled clementines.

shaved granita, homemade slushie, homemade italian ices, palate cleanser dessert,

clementine granita, orange desserts, martha stewart Christmas, Christmas desserts,

When you’re ready to serve your clementine granita, place them with a garnish or alone on individual dishes, or together on a decorative platter or pedestal. Enjoy!

clementine granita, mandarin desserts, tangarine desserts, orange desserts, cooking with clementines, cooking with oranges

© Copyright Leah DeCesare 2014

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Ali’s Birth Story

December 16, 2014 by ldecesare

Ali's Birth Story | MothersCircle.netIn writing and posting my kids’ birth stories, the youngest got to go first for a change. I wrote Anna’s birth story, a water birth, first, then Michael’s cesarean birth story second, now to honor our oldest, here is Ali’s birth story. She’s heard it every year for her birthday (click here for six birthday ideas for teen girls) so it’s not new to her, but sixteen years later, it’s time I wrote and shared it here.

Being pregnant with my first baby was truly my dream come true. I had always wanted to be a mother and I loved being pregnant. Every minute of being pregnant. I was ecstatic and I admit that, within the glow and growth, I was a bit of a looney first time mom in some ways.

I held my breath while passing a smoker on my way to work in New York City or when a bus spewed exhaust in my direction. I was hyper-aware of everything that I put in my body and every bite I took was to nourish my baby.

I even recorded my daily servings of green vegetables,  yellow vegetables, calcium and so on. Yes, I got teased about that – and still do by a few friends who were with me through it. I was in love with my baby from the moment the plus sign showed up on that stick and I devoured everything I could to learn about pregnancy, labor, and motherhood.

I had always trusted birth and believed in my body’s abilities.

It never dawned on me at that time to change providers, I just stayed with the doctor I’d been seeing for years, but as soon as Ali was born, I knew I’d made a mistake. At each visit I asked questions, I talked openly about things I envisioned and hoped for in my birth and specifically talked about avoiding medications, an episiotomy, and other interventions. In hindsight, I can see clearly that he verbally patted me on the head, reassured me, then in my labor, he did what he wanted.

It was the last weekend before my due date and Nick and I snuggled in bed on Sunday morning deciding to do something we never did. We planned to stay in bed all day, watch movies, and do absolutely nothing but enjoy each other quietly in advance of the unknown just around the bend. Many of my friends’ first babies arrived well after their due dates and I was in no hurry and even looked forward to having some time out of work and at home before I gave birth. So that lazy Sunday morning, I went to the bathroom and something was different, excitedly, Nick and I scoured the birth books to read about mucous plugs and determined this was it. We changed course, got dressed and ran out to finish all those last minute errands. No day in bed after all, and not again for a very long time after.

Over night I was feeling crampy, a dull ache and around 3:40 am, I had some long, low, cramps under my abdomen. I jotted a note that said, “feeling what I think are contractions.”

On Monday morning, Nick reluctantly went to work in NYC and I had an appointment with the doctor.  He told me I had a closed cervix and that I could still be a week away from labor. After that exam,  I spent the day with my sister cooking soup and experiencing irregular and far apart contractions. My sister had been living with us for three months and it was perfect having her there for me at such a special time. She and Nick had taken over the cooking for those months, pampering me, and she still teases me that the day I decided to prepare a meal was the day I was in early labor. It’s that nesting instinct, I guesslaboring in bed, stuck in bed during labor, epidural in birth, movement in birth, freedom of movement in birth, position changes in labor!

Nick came home early and contractions by evening were about 10-12 minutes apart. After 9:00 pm, my sister came with us to the hospital and in our eagerness, we did what everyone doesn’t want to do: we got there too early! I tell clients now that nothing happens faster when you get to the hospital but it’s true that there’s such a strong desire to have your baby and the excitement propels us forward.

The doctor asked the nurse to check me and she told me I was “a loose two fingers” which meant about 2 cm dilation. I had changed since the morning check but still wasn’t in active labor. They monitored me for an hour and a half, nothing changed so home we went.

The doctor prescribed me sleeping pills. You already know how particular I’d been with what I put into my body for the whole pregnancy, and now he wanted me to take pills? I talked to Nick and to my mom and we debated whether I should take them or not. After much deliberating, I decided to take half the dose he’d prescribed. Very quickly, I became dopey and fell into a deep sleep. It didn’t last long, however, and I was awakened by strong, steady contractions. We still chuckle about how I got up to go to the bathroom after being roused by a doozy, I was so out of it from the medication that I walked into the door frame stubbing my toe and Nick slept right through my agony. I let him sleep as I attended to my now strong contractions and passed out between them.

Around 2:00 am, my contractions were about 2 -3 minutes apart and we headed back to the hospital. All I remember was being in bed. Being stuck in bed. After being in the world of birth and babies for over fourteen years now, I see so much of this first birth in a whole new light. I remember being in bed, no freedom of movement, I was on my back, restricted. Of course it hurt more. I remember my doctor coming into my room in a tuxedo. I remember him suggesting medications to me. Didn’t he tell me I could have a medication-free birth? When he said that, I vividly recall thinking, not that he’s in a tuxedo, but I thought, “he sees women in labor all the time and if he’s suggesting medication, I must not be doing a good job.”

What I didn’t see was that it wasn’t me or my body, but it was his way of practicing, perhaps his impatience, that motivated his offer of medication. First he said we could try a narcotic. We did at 3:15 am. That did nothing except make me loopy again, and at 4:30 am, with me still in bed, he then stood there in his tuxedo recommending an epidural. His actions disregarded me. But not for the last time.

meeting great grandma, baby and great grandmother, baby named for great grandmother

Here my grandmother meets her great-granddaughter for the first time. Her namesake.

The anesthesiologist did his thing, but he wasn’t successful, so he tried again. When he placed the epidural the first time, it affected only the right side of my body, so he explained that he added more medicine and rolled me to the side in hopes of it helping my left side. It didn’t work and he started over. He redid it, then they immediately started a Pitocin drip. Less than an hour after the epidural was place, by 5:30 am, I was fully dilated and the baby had descended well. Soon after, they turned off the epidural to let it wear off before pushing.

We took a nap and I started to push at 7:00 am. The benefit of an epidural in this scenario is that my body continued to work to move the baby down while I rested, it’s called passive descent or laboring down. So that even though I was fully dilated, I waited to push.

The nurse who replaced our overnight nurse was a grouchy woman who treated me like an object. I remember being shocked that without asking me or even saying anything, she pressed on my abdomen into my bladder and made me urinate onto the pad on the table. She did it on purpose to empty my bladder but I felt violated.

My legs were so leaden and heavy that Nick and Nurse Grumpy had to lift my legs for me. I laid in that bed, in what I now know to be the single worst position for pushing, and I pushed with gusto. With each contraction, my assistants handed me my own legs and I moved our baby closer to my arms.

Nick was an amazing support. His encouragement helped me feel like I was making progress when I could feel nothing. As he expressed his amazement, it helped me press on. Not quite an hour later, without warning, against my wishes, as Nick watched, the doctor cut an episiotomy. Then he used a vacuum extractor. He pulled our baby out into the world.

Later, Nick told me that it looked like it might have saved me a push or two, Ali’s head was there, visible, and staying low between my legs. We had no understanding then of why he did that. I get it now. Sadly, I get that it had nothing to do with medical necessity, had nothing to do with me or my baby’s health. It had only to do with the doctor who’d shown up at my bedside from a party at two in the morning and he must’ve been tired by 8:00 am. Call me cynical, but I’ve read my records and have attended about 60 births since then. Of course, it’s in hindsight that I can see this all so clearly. This birth and each of my births have made me who I am and have made me a better birth educator and doula because of these experiences.

In that moment, at 8:01 am, as Ali was born and placed on my chest, I didn’t think about anything but her slippery body in my arms. In that moment, my birth had given me my daughter, had made me a mother. I was transformed forever.

baby and aunt, sisters with baby,

My sister meeting Ali. She has always been the best aunt to her and all of our kids.

Ali had gigantic eyes the color of ink, her black hair stood on end, and she was perfect. Nick described my look as one of “love and wonder” as I first gazed at our baby. It was a miracle, the fulfillment of our deepest desire. We were parents. Even as the pediatricians whispered and looked at her foot, I wasn’t worried. She was completely perfect.

They examined her and spoke to us with a seriousness in their voices. Her foot was bent back but they were

encouraged because it was moveable, unlike how a club foot would be. I remember feeling no sense of worry, only peace. She had kicked me vigorously in the same spot for a long time at the end of my pregnancy. I could see and feel her foot through my belly and as the doctors considered and discussed, in my heart I knew it was just from her regular pokes, I knew she was perfect. And, of course, she is. (Ask Nick, I’m always right!) ;-)

I couldn’t be more grateful for our Ali. She made me a mommy. She gave me what I’d always wished for and more. Much more. She’s a gift every day, a joy, a blessing, and a source of pride. Sixteen years later, my sweet baby, is still my sweet baby.

© Copyright Leah DeCesare 2014

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