I think you're all done nursing. Tonight when I offered it to you at bedtime, you took each nipple in your mouth and did one suck, then you let go and giggled at me like the whole thing was terribly babyish. A part of me wishes I'd known when the last time would be, but I did a good job cherishing those last overnight nursing sessions. I'm sorry that we ended this early because of the new baby growing inside me - I would have loved to nurse you longer. I love you I love you I love you.
Love
Mama
Monday, November 14, 2011
Monday, September 26, 2011
14 months 15 days
You said your first word, I think. "Duck." We were at the library downtown, and there were three little rubber duckies on a table. You went to them immediately and grabbed them all, and put one in your mouth, and showed one to me, and I said, "Yeah! You have a duck!" and you said, "Duck!" and I said "Duck!" and you said "Duck!" I brought the library assistant over to confirm, and you said it again while holding out the little rubber ducky. I called your grandma, who is in England for vacation, and then I called your Daddy. This was on Friday. Today is Monday.
Yesterday you pointed at a little chihuahua and said, "Dog." Word number two.
Tonight you didn't nurse. You tried for a second or so, then tried veeeery briefly a couple more times. Then you pushed the boobs away to get your sucky. Maybe you're too big of a girl now, and you're about done nursing. Maybe your teeth are coming in, and they hurt when you do the kind of deep sucking you have to to nurse. I love you, and I love nursing you. I don't want to stop unless you're really done. It makes me cry to think about never nursing you again. I know i'll still be your mommy, and I'll still be special, and you'll still need me. But wow, not ready to leave that part of your babyhood behind. I wonder if I ever will be, though. Oh, how I love my girl.
Love,
Mom
Yesterday you pointed at a little chihuahua and said, "Dog." Word number two.
Tonight you didn't nurse. You tried for a second or so, then tried veeeery briefly a couple more times. Then you pushed the boobs away to get your sucky. Maybe you're too big of a girl now, and you're about done nursing. Maybe your teeth are coming in, and they hurt when you do the kind of deep sucking you have to to nurse. I love you, and I love nursing you. I don't want to stop unless you're really done. It makes me cry to think about never nursing you again. I know i'll still be your mommy, and I'll still be special, and you'll still need me. But wow, not ready to leave that part of your babyhood behind. I wonder if I ever will be, though. Oh, how I love my girl.
Love,
Mom
Sunday, July 10, 2011
1 year minus 1 day
Tomorrow you turn one year old. It's incredible. We have loved you and watched you grow from a lovely lump of baby into our gorgeous, squawky, smiley, busy, smart girl. You're still our baby. You don't speak any English yet, but you do understand a little, and you have definite opinions about things. You are becoming a toddler. You don't always sit by quietly while we buckle you into the car seat or stroller, fussing and crying and arching your back and trying to roll over. You love your life, you love your parents. You love your pacifiers, your new play food, your wooden puzzle, sippy cups and glasses of water, little fruit like grapes and blueberries. You went to the beach for the first time this weekend, in Sea Girt New Jersey, and you thought it was great. You ate sand, daddy held you in the waves and you laughed as one broke over your chest. You are fearless Adventure Baby. You love the baby swings. You babble and make wonderful noises, like "ah-ya-ya" and "Gabla!" You squawk at people to say hi. We strap you into high chairs now because otherwise you first turn around and pull your legs in strange directions, then you eventually try to crawl onto the table. You love food. You tried gnocchi this weekend, you ate calamari, lots and lots of blueberries and watermelon. We took you to a small aquarium on the boardwalk and you tried to swim with the sharks and big fish. Our friend Catherine and her husband Paul and her parents Barb and Les got you and your daddy a birthday cake this weekend with your name on it! Your first one. A few weeks ago, your grandma made you your first cake. It was a confetti cake with gorgeous deep pink (almost red) icing. You loved it. You also eat ice cream with us, and you yell at us for continual spoonfuls until it's gone. Sometimes when something you love is gone, you cry. You also cry if we walk past the driveway to next door and don't go play. Next door is your favorite place, because they have a little yard with the slide you like to climb up, and Silas lives there with doggie Milo, and they have a big pool to play in the water, and a water table where you first were introduced to ice. It has been the deepest joy of my life watching you learn and grow during this first year. It is everything I always hoped it would be.
I love you so much, more than you'll ever understand until you have your own child.
Love,
Mama
I love you so much, more than you'll ever understand until you have your own child.
Love,
Mama
Wednesday, June 29, 2011
11 months 18 days
First steps!
You took two steps. Then you stopped. We were playing next door at Amy and Silas's house. Everyone was there - your dad, me, Silas's dad Ryan, Silas's mom Amy, and our downstairs neighbors Lisa and Kim. You were carrying the top of a sippy cup and chewing on it, and you wanted to follow Silas but not stop chewing. You've been spending lots of time standing still. This morning you used one hand to push the walker toy we borrowed (also from Silas) all over the place. Maybe it all connected. We all whooped and jumped and clapped for you! Then you went back to crawling with your butt straight up in the air. I'm so proud of you!
Love,
Mama
You took two steps. Then you stopped. We were playing next door at Amy and Silas's house. Everyone was there - your dad, me, Silas's dad Ryan, Silas's mom Amy, and our downstairs neighbors Lisa and Kim. You were carrying the top of a sippy cup and chewing on it, and you wanted to follow Silas but not stop chewing. You've been spending lots of time standing still. This morning you used one hand to push the walker toy we borrowed (also from Silas) all over the place. Maybe it all connected. We all whooped and jumped and clapped for you! Then you went back to crawling with your butt straight up in the air. I'm so proud of you!
Love,
Mama
Tuesday, June 28, 2011
Green Journal v118 no1 July 2011
Castle - Editorial - HPV testing. IT is not being done very well. Estimated that over half the pap smears done in 2010 were unnecessary.
Lee, Berkowitz et al. Low-Risk HPV testing. Level III. Many providers use pap and HPV tests incorrectly. This is absurd.
Chou, Krill, et al. Disparities in HPV vaccine completion. Level III. 33% of women at one institution (likely JHU) finished the series. Younger age plus urban location was the lowest completion rate.
Semere, Ko, et al. Endometrial intraepithelial neoplasia. Level II. Didn't read past first couple paragraphs.
Barber, Lundsberg et al. Indications contribution to increasing c/s rate. Level III. Primary c/s accounted for 50% of increase. More subjective indications contributed more than objective indications. [STUDY DONE AT YALE]
Miller & Grobman. Interbirth interval with frequency of c delivery. Level II. Retrospective cohort study n=2528 multips at a tertiary care ctr. Those with birth interval of over 5 years were more likely to have a c/s at next birth. [Not surprising since c/s rate keeps going up.]
Batton, Burnett, et al. Extremely preterm infant mortality rates and c/s in the US. Level 3. Big increase in c/s rate for preterm before 28 wks did not improve infant mortality for these babies. c/s rate went from 43% in 19999 to 54% in 2005. Mortality rate did not change at around 33%.
Edmonds, Fager, et al. Predictors of c/s for periviable babies. Level II. Retrospective cohort study for state-level data in 3 states of babies between 23 and 24 6/7 wga, 1995-2005. c/s did not differ by race in this group. Medical indications were higher predictors.
frozen section analysis in adnexal masses. Level 3. did not read.
Shah, Missmer, et al. Effect of obesity of egg and embryo quality in IVF. LEvel II. Obese women had fewer normally fertilized eggs, lower estradiol levels, lower pregnancy and live birth rates. All got worse with increasing BMI.
Sobl, Bozkurt, et al. Early poss. risk factors for diabetes after GDM. Level II. Age over 35, waist over 88 cm, impaired glucose tolerance, and HDL under 50 were best predictors of diabetes after gestational diabetes. [Not terribly clinically useful, as far as I'm concerned.]
Salim, Zafran, et al. Single-balloon compared with double-balloon catheters for IOL. Level I. Equally effective for starting labor, double balloon may have more operative deliveries. Double balloon also had other yucky adverse events, like IP fever, cord prolapse. [Stick with single. Less uncomfortable, too!]
Glantz & Bertoia. Preterm nonstress testing. LEvel II. no difference btw 10 beat and 15 beat criteria in predicting outcome. Variable decels also showed no effect.
Breathnach, McAuliffe, et al. Definition of intertwin birth weight discordance. Level II. Threshold for discordance is 18% for dichorionic and monochorionic with no TTTS. More than 18% doubles risk of adverse outcome. Mono twins more dangerous in all risks.
MacKay, Berg, et al. Changes in pregnancy mortality ascertainment. Level II. Using 1999-2005 data. Changes in death certificate after 03 led to more maternal deaths reported.
Malm, Artama, et al. SSRIs and risk for major congenital anomalies. Level II. Fluoxetine is associated with more isolated VSDs, and paroxetine is associated with right ventricle outflow defects. Small absolute risk, but perhaps should not be first line in 1st trimester. Alcohol use in women on SSRIs seems to affect fetuses more.
study about makeup of amniotic fluid "eicosanoids." They differ in preterm vs. term births.
Wiberg-Itzel, Akerud, et al. Association btw adverse neonatal outcome and lactate concentration in amniotic fluid. Level IIII. Similar conclusion. High lactate concentration and fetal bradycardia in 30 min before delivery increased risk of adverse outcome.
Review. Rodriguez, Edelman, & Kapp. PP sterilization with titanium clip. Ti clip is less effective than PPTL.
Review. Berghell and Mackeen. Cervical length screening with u/s-indicated cerclage vs hx-indicated cerclage for ptb. Looks like cerclage should only be done if the cx starts to shorten. Otherwise, u/s is sufficient monitoring for prior preterm birth.
IUD Practice bulletin
Implant is most effective form of long acting reversible sterilization! 0.05 percent pregnancy in first year.
Lee, Berkowitz et al. Low-Risk HPV testing. Level III. Many providers use pap and HPV tests incorrectly. This is absurd.
Chou, Krill, et al. Disparities in HPV vaccine completion. Level III. 33% of women at one institution (likely JHU) finished the series. Younger age plus urban location was the lowest completion rate.
Semere, Ko, et al. Endometrial intraepithelial neoplasia. Level II. Didn't read past first couple paragraphs.
Barber, Lundsberg et al. Indications contribution to increasing c/s rate. Level III. Primary c/s accounted for 50% of increase. More subjective indications contributed more than objective indications. [STUDY DONE AT YALE]
Miller & Grobman. Interbirth interval with frequency of c delivery. Level II. Retrospective cohort study n=2528 multips at a tertiary care ctr. Those with birth interval of over 5 years were more likely to have a c/s at next birth. [Not surprising since c/s rate keeps going up.]
Batton, Burnett, et al. Extremely preterm infant mortality rates and c/s in the US. Level 3. Big increase in c/s rate for preterm before 28 wks did not improve infant mortality for these babies. c/s rate went from 43% in 19999 to 54% in 2005. Mortality rate did not change at around 33%.
Edmonds, Fager, et al. Predictors of c/s for periviable babies. Level II. Retrospective cohort study for state-level data in 3 states of babies between 23 and 24 6/7 wga, 1995-2005. c/s did not differ by race in this group. Medical indications were higher predictors.
frozen section analysis in adnexal masses. Level 3. did not read.
Shah, Missmer, et al. Effect of obesity of egg and embryo quality in IVF. LEvel II. Obese women had fewer normally fertilized eggs, lower estradiol levels, lower pregnancy and live birth rates. All got worse with increasing BMI.
Sobl, Bozkurt, et al. Early poss. risk factors for diabetes after GDM. Level II. Age over 35, waist over 88 cm, impaired glucose tolerance, and HDL under 50 were best predictors of diabetes after gestational diabetes. [Not terribly clinically useful, as far as I'm concerned.]
Salim, Zafran, et al. Single-balloon compared with double-balloon catheters for IOL. Level I. Equally effective for starting labor, double balloon may have more operative deliveries. Double balloon also had other yucky adverse events, like IP fever, cord prolapse. [Stick with single. Less uncomfortable, too!]
Glantz & Bertoia. Preterm nonstress testing. LEvel II. no difference btw 10 beat and 15 beat criteria in predicting outcome. Variable decels also showed no effect.
Breathnach, McAuliffe, et al. Definition of intertwin birth weight discordance. Level II. Threshold for discordance is 18% for dichorionic and monochorionic with no TTTS. More than 18% doubles risk of adverse outcome. Mono twins more dangerous in all risks.
MacKay, Berg, et al. Changes in pregnancy mortality ascertainment. Level II. Using 1999-2005 data. Changes in death certificate after 03 led to more maternal deaths reported.
Malm, Artama, et al. SSRIs and risk for major congenital anomalies. Level II. Fluoxetine is associated with more isolated VSDs, and paroxetine is associated with right ventricle outflow defects. Small absolute risk, but perhaps should not be first line in 1st trimester. Alcohol use in women on SSRIs seems to affect fetuses more.
study about makeup of amniotic fluid "eicosanoids." They differ in preterm vs. term births.
Wiberg-Itzel, Akerud, et al. Association btw adverse neonatal outcome and lactate concentration in amniotic fluid. Level IIII. Similar conclusion. High lactate concentration and fetal bradycardia in 30 min before delivery increased risk of adverse outcome.
Review. Rodriguez, Edelman, & Kapp. PP sterilization with titanium clip. Ti clip is less effective than PPTL.
Review. Berghell and Mackeen. Cervical length screening with u/s-indicated cerclage vs hx-indicated cerclage for ptb. Looks like cerclage should only be done if the cx starts to shorten. Otherwise, u/s is sufficient monitoring for prior preterm birth.
IUD Practice bulletin
Implant is most effective form of long acting reversible sterilization! 0.05 percent pregnancy in first year.
11m 2 wks
You have 11 teeth, and I think the 12th may appear before you are 12 months old. That's a lot of teeth for a little girl. You use them well, you're a great eater. Right now some of your favorites are blueberries, chili beans, cheese, meat in many forms. You're a wonderful, vocal girl.
Saturday, May 28, 2011
Green Journal v117 no6 June '11
Editorial: Makena. TUrns out that neonatal outcomes aren't different with progesterone injections for women at risk for preterm birth. Suggestion is to offer either injections or vaginal suppositories, that they are about equally effective. Vaginal suppositories, in either gel or capsule form, are much cheaper.
Shoulder Dystocia study, Hoffman et al: Level III evidence. Of 132K births, 1.5% had SD. 5% of those had an injury. Delivery of the posterior shoulder seems like the way to go after McRoberts with suprapubic. Fewer injuries. Also, the more maneuvers you have to do, the higher the risk of injury. (Women whose babies were injured tended to be young, black, and nullips. Babies who were injured weighed 92g more on average.) Midwifery management led to fewer injuries, resident management led to the most injuries. Vacuum babies were more likely to have SD than SVD babies. Gaskin maneuver was used 22 times, with 1 injury.
Early term births, Reddy et al: Early-term babies do more poorly than later-term babies. Surprise, surprise.
Risk of c/s by BMI among nullips, Fyfe et al: Level II evidence. Higher in 1st stage only, not 2nd stage.
Change in BMI and GD in 2nd pg, Ehrlich et al: Level II evidence. Increase in BMI between pg increases risk of GDM
Comparing IUGR mesurements, Tuuli et al: Level II evidence. second tri is better than 1st and 1st-to-2nd-lag for SGA prediction.
Echogenic bowel on U/S, Goetzinger et al: Level II evidence. Echogenic bowel is associated with IUGR and IUFD risk. Retrospective cohort study, from 1990-2008, n=260 with echogenic bowel, 0.4% of the population. Of those 260, 13 were downs, 1 trisomy 18, 2 trisomy 13, 1 chromosomal mosaicism, 5 CMV infection, 6 cystic fibrosis, 1 cystic fibrosis and chromosomal mosaicism. 579 IUFDs (0.9%), and 12% IUGR. Echogenic bowel were 8.6 times more likely to have IUFD. RR 1.6 of having IUGR. Increased risk of IUGR and IUFD remains even if all follow-up testing is normal, 1.9 OR for IUGR and 6.2 OR for IUFD.
Who in the US uses long-term birth control, Kavanaugh et al: Level III evidence. Compared 2002 data to 2006-08 data. Use increased from 2.4% to 5.6%. Women born outside the US and those who started sex early are more likely to use implants and IUDs. Women who've had a baby or two and Hispanic women also use them more than others.
Changes in abortion rates, Jones & Kavanaugh: Abortion rate declined from 2000 to 2008. Rate increased for poor women. Women who are cohabiting, ages 20-24, and black, are more likely to have abortions.
Shoulder Dystocia study, Hoffman et al: Level III evidence. Of 132K births, 1.5% had SD. 5% of those had an injury. Delivery of the posterior shoulder seems like the way to go after McRoberts with suprapubic. Fewer injuries. Also, the more maneuvers you have to do, the higher the risk of injury. (Women whose babies were injured tended to be young, black, and nullips. Babies who were injured weighed 92g more on average.) Midwifery management led to fewer injuries, resident management led to the most injuries. Vacuum babies were more likely to have SD than SVD babies. Gaskin maneuver was used 22 times, with 1 injury.
Early term births, Reddy et al: Early-term babies do more poorly than later-term babies. Surprise, surprise.
Risk of c/s by BMI among nullips, Fyfe et al: Level II evidence. Higher in 1st stage only, not 2nd stage.
Change in BMI and GD in 2nd pg, Ehrlich et al: Level II evidence. Increase in BMI between pg increases risk of GDM
Comparing IUGR mesurements, Tuuli et al: Level II evidence. second tri is better than 1st and 1st-to-2nd-lag for SGA prediction.
Echogenic bowel on U/S, Goetzinger et al: Level II evidence. Echogenic bowel is associated with IUGR and IUFD risk. Retrospective cohort study, from 1990-2008, n=260 with echogenic bowel, 0.4% of the population. Of those 260, 13 were downs, 1 trisomy 18, 2 trisomy 13, 1 chromosomal mosaicism, 5 CMV infection, 6 cystic fibrosis, 1 cystic fibrosis and chromosomal mosaicism. 579 IUFDs (0.9%), and 12% IUGR. Echogenic bowel were 8.6 times more likely to have IUFD. RR 1.6 of having IUGR. Increased risk of IUGR and IUFD remains even if all follow-up testing is normal, 1.9 OR for IUGR and 6.2 OR for IUFD.
Who in the US uses long-term birth control, Kavanaugh et al: Level III evidence. Compared 2002 data to 2006-08 data. Use increased from 2.4% to 5.6%. Women born outside the US and those who started sex early are more likely to use implants and IUDs. Women who've had a baby or two and Hispanic women also use them more than others.
Changes in abortion rates, Jones & Kavanaugh: Abortion rate declined from 2000 to 2008. Rate increased for poor women. Women who are cohabiting, ages 20-24, and black, are more likely to have abortions.
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