Breaking the Water

Common during labor in the U.S., but is it necessary?

A study consisting of 4,893 women in the United States, Canada, and Great Britain found that the common delivery room practice of “breaking the water” or amniotimy doesn’t affect the length of the first or second stage of labor or the condition of the delivered baby.The practice is very common in the United States and according to Mark Nichols, M.D. professor of obstetrics and gynecology at Oregon Health & Sciences University, “most of us believe it works, so there will be a lot of skepticism about this”.

Many doctors in the United States believe that the procedure does quicken labor due to the release of hormones and chemicals which help with the mother’s contractions.

Some women want to have a delivery with the least amount of intervention and allowing a procedure which happens in about 20% of deliveries, keeps them from attaining that.

Hands on Knees

Helps relieve back pain but doesn’t change the position of the baby

A position where a pregnant woman stands with feet apart with arms extended and resting on the knees and the face downward, has been considered by midwives as helpful in shifting the position of a baby for easier delivery. Four studies made up of 2,700 mothers found that the hands on knees position eased back pain but had no affect on the position of the fetus. The studies focused on labor and the weeks leading up to delivery.

The study focusing on labor found that 30 minutes of “hands on knees” position did signicantly reduce the back pain associated with labor.

Support during Labor

Women have shorter labors and more satisfied births when someone is there for support

Researchers at the University of Toronto have studied over 13,000 women from 16 different studies which segregated them into those who had "supportive one-on-one care and those who had routine hospital care."

Women who had a midwife, doula, or supportive family member with them during labor, either at the hospital or somewhere else, were able to have shorter labors, use less pain killers, and have an overall better birth experience than women who received routine care from a hospital.

Also, babies who were allowed extensive skin to skin contact with mom after birth were better able to breast feed later on than those babies who were taken away to be washed, weighed, and swaddled.

Authors of the study concluded that, "Continuous support during labor should be the norm, rather than the exception." Supportive care included massage, encouragement, and intermediary/supporter to communicate the mother’s wishes to the medical team. Supportive care also worked best when it was begun early in the labor process by someone other than hospital staff.

Milestones for Infant Development

Let IMUA help you with these guidelines

Every parent waits with excitement for each of baby's newest and most glorious victories. Whether it is the first time baby recognizes a voice or a face, that delectable coo or smile at auntie or tutu, or the joyous first "bye-bye" wave, every child’s development occurs in very individualized and complex ways.

Sometimes, a child's development in a certain area may lag behind children of a similar age. For instance, a child may not roll over or sit up as quickly as other children. Or a child may not be 'using his words' to communicate his needs. These situations are not uncommon and often certain and specific kinds of play, exercises and interactions with mom, dad, family and friends can help a child move more quickly through that developmental phase and on to the next. Every child’s development is unique and being a diligent observer of your child milestones is an extremely important part of parenting. When a child is ‘on point’ with age appropriate milestones, the child is much more likely to be happier, play better with others and be a good learner.

What is typical development?
Gauging a child’s development against “typical development” can give parents and caring family and friends an important tool to assess if a child is on track. If the child is not meeting milestones, it is important to involve experts who can provide education, training and assistance to help a child achieve individualized goals, and be better positioned to thrive in late years.

At 3 MONTHS
Smile • Make cooing sounds • Turn and look at sounds, faces, and bright colors • Grasp rattles • Lift head and chest when lying on stomach

At 9 MONTHS
Say mama or dada • Sit up without support • Scoot on stomach • Bear weight on feet with support • Pick up small object with index finger and thumb

At 12 MONTHS
Use sounds and 1-2 words • Show affection • Wave goodbye • Pull to stand • Crawl Scribble • Turn pages of cardboard book
At 2 YEARS
Use 50 words • Kick large ball • Use a spoon • Turn pages of paper book • Hold crayon with fingers

At 3 YEARS
Use 2-3 word sentences • Ask questions • Identify body parts • Run • Walk up steps • Stand briefly on one foot • Put on shoes or slippers

A child not meeting milestones?
If a child birth to age 3 is not reaching age appropriate milestones, there is help available on Maui and Lanai through Imua Family Services Infant & Child Development Program. Areas of concern may include possible delays in communication, cognition (thinking skills), motor (big and small body movements), self-care, and social emotional skills. Once referred and after a careful evaluation, a team of therapists will provide functionalized and individualized strategies to help children increase skills throughout all routines and activities of the day. All services are based around 'play', having fun and joyful interactions. Early Interventionists on a team may include a speech therapist, occupational therapist, special instructions teacher or a combination, all carefully managed by a specialized care coordinator.

Services available at no cost for infants and toddlers

If you have questions or concerns about a child’s development please call 244-7267 to arrange for an evaluation for that child. Any child birth to three with developmental concerns may be referred to Imua. These services are provided at no cost to families. Visit www.imuafamilyservices.org for more information.

Positive Discipline Is Better Achieved When Parents Are Self-Aware

Positive Discipline starts with parental stress management. When looking for alternatives to spanking or yelling at children, the key component is self-care. Not until a parent can adequately take care of their own needs can a child learn that it is okay to get their needs met as well. For example, when a child tantrums, he is, in essence crying out for something that he feels he really needs or desires. When a parent lashes out in anger and shuts down this behavior without acknowledging or validating the child’s needs, the child learns that their needs are not important and this translates into “I am not important”. After acknowledging a child’s feelings and desires, it is entirely appropriate to teach other ways of getting their needs met besides screaming, hitting, kicking or other undesirable behaviors.

Above all else, it is important to notice our own stress levels and tolerance threshold. If a parent has eaten well that day, had a chance to take a shower and gotten a decent nights sleep, then maybe the 25 minute tantrum in the grocery store can be handled gracefully. If on the other hand, if a parent hasn’t had anything but coffee all day and was up half the night dealing with nightmares, bedwetting and/or the usual gamut of nighttime parenting, then that grocery store blowout might be the beginning to daddy or mommy meltdown. Without adequate care of life’s basic needs, stress levels dramatically increase.

As adults, our needs do not disappear. In fact, the needs list is probably even longer than when you were a child; especially if you’ve spent the better part of your adult life ignoring your needs. The scary reality of ignoring your needs is that you teach your children to ignore their needs. How many people want children to grow up into adolescence and young adulthood and not have the ability to say no; or know when their hungry or how to stop eating or to recognize when their angry or what to do about it? How many people skip meals, stay up too late doing laundry and never have a date night? How many of these same people would try a bit harder to take a time out if they thought it directly correlated to their own children’s erratic sleeping, addictions, anger issues and depression? The question is do you value yourself enough to listen to your inner needs so that you can have more empathy and be more nurturing in your parenting?

The good news is that you can think about it; you can even make requests in the world to get what you need. You have the power and control over your schedule and decisions. You can decide to take a nap today. You can even decide to eat ice-cream.

Just remember that you are human and everyone loses it once in a while. You might yell, scream or even stomp your feet around but the more you practice self care, the more ability you will have to use positive discipline methods and be a pro-active and happier parent. So, think about it… what’s your self-care plan for this week?

Jennifer Moss, iMFT is a family therapist and National Parenting Trainer/Consultant for Nurturing Parenting Programs Worldwide. She is also the mother of two daughters. For more information on attending a parenting class or to schedule a consultation in either her Wailuku or Kihei offices, please call #281-1494.

Mediating between Children

Use these tips to help work out differences and conflicts between children in a way where everyone’s needs are met

“Hey, that’s my game!’

“No, it’s not! I had it first. Give it back!”

“No. Hey! Ouch! MOM!!”

Does some version of this scenario ever happen at your house? Maybe the topic of the argument is different, perhaps the children are older or younger, yet the pattern is familiar: the kids are having a conflict and the parent is either called in or steps in to intervene.

Though we might wish it wasn’t so, some conflict between children is normal and unavoidable. However, how our children learn to deal with that conflict, whether they move towards peaceful resolution or towards more discord, often depends on how we as parents wield the power we have as larger, more experienced people on whom children are so dependent.

Do we use our power over them, coercing them to do what we want, and making judgments about who is right or wrong, to dole out punishment and reward as we see fit? From my experience, this is not only exhausting and unpleasant for parents, it frequently leads to resentment, resistance and even more conflict in the household. If we, however, use our power to act with our children in partnership and cooperation, to look beyond behavior to understand and address underlying needs, we may find that peace begins to blossom both in our families and in our hearts.

Peace and cooperation in our families: sounds wonderful, doesn’t it? So how do we get there? The following are some things that I’ve found really support the kind of peaceful relationship I want with and for my children, even when conflict arises.

Safety first: If someone is being physically hurt, move quickly and gently to protect the child’s safety. Remember: a child who is lashing out physically is often in emotional pain and really needs understanding and help to find a better way, rather than anger or punishment.

Slow it down: Stop. Take a deep breathe. Before you speak, blame, or yell, remind yourself you want connection instead.

Remember your long-range values: When tension mounts, it’s tempting to use force for short-term relief. Instead, try to connect with your long-range parenting values. Set an intention to be the change you wish to see, and treat your children with the love, cooperation and respect you want them to learn.

Who needs what?: Instead of "who did what" focus on "who needs what." What is each child trying to express behind his or her behavior? What are you, as the parent, longing for? All these needs are valid. They’re not good or bad; they are human and lead to what makes life wonderful.

Empathise with each child: Listen and offer understanding to each child. Assure each one that you care about what’s up for them and want to help. This teaches children to hear each other, as well as building trust.

Reframe the conflict as a dilemma: Help your children change the perception of a conflict between them into a dilemma to solve together cooperatively. "I see two kids and one toy. You both want to play. How can we figure this out together?"

Find solutions that work for everyone: When we work together to discover solutions that take everyone’s needs into account, children trust that they matter and that they are loved. This is the foundation that supports the learning, cooperation and peace we all long for in our families.

Ingrid Bauer is a compassionate parenting advocate and author who lives in British Columbia. She is certified by the global Center for Nonviolent Communication and has children ages newborn to 22.