newsletter Feb06

The newsletter, Feb 2007

The water breakage

During the period that precedes delivery, the body starts to prepare itself for the event and with a series of signals it "warns" you that your baby’s birth is getting closer. Among the various premonitory signs, the most evident one is certainly the rupture of the amniotic sac, event which is commonly described as "water breakage". The definition should not deceive you; it is not such a "disruptive" event, but a very simple painless physiological phenomenon which should not cause any worries. To avoid being unprepared, let’s try to better understand what we are talking about and what should be done when this takes place.

During the nine months, the baby grows and develops inside the placenta, a "sac" full of amniotic fluid which wraps and protects the baby in his mother’s uterus. During the phase which precedes delivery, the baby, who is now ready to be born, gets closer, usually with his head, to the neck of the uterus, which starts slowly to shorten pushing the foetus down. At this point the membranes of the amniotic sac, which are no longer protected by the uterus, are extremely delicate. The baby’s continuous pushes therefore could provoke their rupture and the consequent leakage of the amniotic fluid.

Therefore, the famous water breakage takes place. Differently from what is usually considered to be common conception, this is not a "waterfall". When the membranes rip, it is possible to leak all together a quantity of fluid which could seem huge, but which, in reality, never exceeds one litre. The water discharge could even be so slight and gradual to be easily mistaken for an involuntary urine leakage. However, the amniotic fluid distinguishes itself for the presence of white flecks which are similar to rennet. However, in doubt, you could verify by wearing a pad and check if it gets increasingly wetter and if it needs to be changed frequently.

Usually, the rupture of the sac precedes delivery by a few hours. However, it could also happen when labour has already started or it could even be delayed to the point that the rupture is artificially carried out. Rarely, the membranes could rip much earlier than the real childbirth, due to an excessive effort made by the mother or as a consequence of a violent impact to the big tummy. Fortunately this probability is very rare and it is more likely to happen when the pregnancy is at an advanced stage, when a premature delivery does not represent great risks for the baby.

In general if water breakage takes place, the first thing to do is to inform your gynaecologist or your obstetrician who will give directions on what to do. In most cases, even when the contractions have not started yet, it is nevertheless recommended to go to the hospital in order to monitor the situation. Whether the labour starts spontaneously or whether it is induced, the birth of the baby is, as a matter of fact, a matter of hours. Therefore, it is important to regain serenity which has been disturbed by the water breakage and to concentrate on the imminent delivery, trying to remember all the tips received during pre-natal classes. You will soon hold in your arms the baby that you have waited for and fantasized about for nine months.

The baby has been born? This doesn’t mean it is all over: it is just about to begin. This is why it is essential for the mother to rest as much as possible, also during the day if the newborn is sleeping, putting aside unnecessary duties and delegating the housework to others, especially during the first month-month and a half. This is the time the woman's body needs to recover from the psycho-physical stress of the birth. Rest is also important to overcome the normal, slight depression, that is shown tiredness and a tendency to weep, due to the hormonal changes that occur following the birth of a child.

During the first few weeks the woman has to deal with the pain caused by the episiotomy, the “little cut” to the perineum that is often made to help the baby come into the world. This goes away after five to six days: to alleviate the pain it is possible to use a “ring” (that is found in health shops) and use this on the chair when sitting down. Also correct hygiene, with frequent and lukewarm washes can relieve the pain. It is also possible to take a light analgesic, after asking the gynaecologist or midwife if you intend to breast feed.

Around 48-72 hours after the birth, in fact, the so-called “lactation onset” begins. When the mammary gland is stimulated by a hormone called prolactin and begins to produce milk. The woman realizes this because the breasts becomes swollen and tender. To help the milk come it is important to drink a lot, to apply warm-damp compresses and to try to attach the baby to the breast: suction stimulates, in fact, the prolactin secretion. In the meantime, it is important to prepare the nipples with softening creams or almond milk, to make the skin more elastic and supple. Nursing encourages uterine contractions, that accelerate the discharge of the blood after the birth (the so-called “lochia”). This discharge, first the colour of blood then colourless, will last around one month. During this period it is recommended to use cotton gauze sanitary towels and to change them and wash yourself often.

This vaginal discharge always occurs, even if the woman has had a caesarean birth. In this case, however, the mother has to try and get even more rest. She can naturally get out of bed the day after to cuddle the baby, to attach him to her breasts and to change him. It is necessary to take extra precautions though not to strain the abdominal muscles (such as when lifting the baby), but just for the first two or three days. In the meantime, check the wound on the abdomen, applying oxygenated water daily and leaving the skin uncovered as much as possible to encourage healing. If an pus can be seen, it is important to immediately visit your gynaecologist or the maternity outpatients. The stitches must be removed by the physician after around ten days and as the months go by, the wound becomes less and less visible.

When a child is very young, fever always represents a worry for the parents. Especially if he is the first child, above all if the fever is very high, which happens a lot in small children.

If the fever is not very high (if, therefore, it stays under 38-38.5 Degrees Celsius, measured as rectal temperature), it is enough to cuddle up with the child, keeping him in our arms, dress him with a light pyjamas to favour heat dispersion and give him lots of fluids. It is sufficient to give him a bit of water, breast milk, a bit of herb tea for children, diluted fruit juices or very light vegetable broth if he is a bit older.

If he is hungry, it is possible to offer him something very light, for instance a small portion of boiled potato blended with a bit of milk, a soup with small pasta, homogenized food made with fruit (if obviously you have already started weaning). When the fever exceeds 38.5 Degrees Celsius and the baby is already at least three months old, it is possible to use, after a proper consultation with the pediatrician, paracetamol in drops or even suppositories if the child refuses to open his mouth. This product should always be kept at home, but it is recommended not to exaggerate with the dose and offer it every six-eight hours.

For those who prefer natural remedies, it is possible to dissolve in half a glass of water two granules of Belladonna (a homeopathic remedy) and offer a teaspoon of the drink to the child every four-six hours. Even a lukewarm bath could help in lowering the fever and give relief. If the fever is high and it does not appear to be lowering and, besides, the child experiences vomit and diarrhea, it is better to consult a pediatrician. At night or on weekends it is possible to contact the on-duty pediatric medical unit (the number can be found in the White Pages, in the first section, before the telephone directory, under On-duty Medical Unit - Service of Non-Stop Assistance), or the closest pediatric hospital (even in this case the addresses can be found in the first section of the White Pages).

It is recommended to bring the child to Emergency when the fever exceeds 40 Degrees Celsius and it does not lower not even with medications, or if in the family there have been instances of febrile convulsions: the child could display this type of problem and it is recommended to be ready in case this situation occurs. Even if the child is very young, if he is experiences vomit and dysentery and he seems dehydrated, it is recommended to go to Emergency. How do we understand that? If the diaper remains dry for over an hour, he looks pale and he has hollow cheeks and if the fontanel appears more evident. It is recommended to rush to the hospital as fast as possible, especially when the child is really young.

We bring them to kindergarten, enough time for a quick kiss and then we rush to work: we will not see our child until late afternoon. This is the routine of thousands of parents with a full time job and lots of guilty feelings. Do I stay enough with him? Is it possible that he misses me too much? Isn’t it true that we should not measure the quantity of time that we spend with our children, but the quality? It seems to be this way: parents, especially mothers, who work, are attentive and present. For sure, they have to give up the pleasure to go and pick up their child or have a snack with him in the afternoon, but they give the best of themselves during the hours that they dedicate to their child.

A mother who works is often a woman that feels gratified, who has a role in the world, who has a social life and a place in which to pour her ambitions, bad moods and frustrations. When she dedicates herself to her son, in short, she lives her maternity with greater balance, as an important part but not the only one in her life.

However, the time spent with the child should be dedicated to him only. Therefore, when we come home, no arguments with our partner, no reading of the mail, and no TV. We leave problems behind, we keep eventual work-related issues outside the door, and we dedicate ourselves exclusively to our child. To make him feel our close presence, it does not take much: the best way is to read a story, if the child is at least one and a half years old. Or we can play a game together, sitting on the carpet or even cuddle on the bed. We can dedicate more time to bathing, making it special with a bubble bath or a new bath toy.

Household chores, from laundry to tidying up, should be postponed to after the child goes to sleep. For sure, dinner has to be made. And then, why not place the child in the kitchen, in the high chair (away from knives and the stove) and chat with him while cutting vegetables, offering him a bite of carrot or bread, perhaps listening to some songs?

If then the mother has to leave because of work, the father could and shall take some time to enjoy his child. The weekend, also, is the best time to stay together. Grocery shopping has to be turned into a fun time, choosing to go when the stores are not very busy and carrying the child on the shopping cart, pointing out colourful packages to him. Then, the afternoon can be spent doing something special: going to an amusement park, a movie theatre, enjoy a snack with his little friends.

A few surprises are allowed, while it is better to avoid covering the child with too many gifts: he will soon understand that it is a "trick" to make him forgive us for our absence and he will become naughtier. It is important not to forget it: a child only needs his mom and dad and not substitutes.

Snacking, a healthy habit

According to some recent studies, children tend to pick up the same food habits of their parents. In most cases, snacking, fortunately, represents an exception. If adults often give up this moment, which is crucial to recharge the batteries and face the day with the right energy, children, with their naïve wisdom, loudly ask for it twice a day.

They are right: even adults, as a matter of fact, should eat, without obviously exaggerating, every 3-4 hours. Small meals closely spaced are much better than our lunches and dinners eaten many hours away from each other and in a rush. The purpose of snacking and having small meals is that of not weighting down the organism and to place it in a condition in which it avoids drops or lacks of energy.

However, very often children’s snacking misses the opportunity of being a moment of healthy eating and it becomes a quick intake of a pre-packaged snack. Let’s say that it is really easy to give in to comfort and put a sealed pre-made snack in your child’s backpack before bringing him to kindergarten or school. And perhaps the child has free access to the pantry in a situation which is out of control.

Without wanting to demonize the consumption of industrial snacks, it is recommended not to exaggerate with this type of food and always control the situation in which the child is having them, because it is really easy that a small child in front of the TV could eat, without realizing it, a quantity of snacks that exceeds what is recommended, perhaps even in-taking salty snacks and gassy beverages. What has just been described is the classic food behaviour to avoid. These kinds of habits, if continued overtime, weight upon the risk of children’s obesity, with problems connected not only to the kids’ health but also related to self-esteem and relationships.

Therefore, educating children toward a healthy diet means that we guarantee them a balanced development. But in order to attain this aim, it is necessary for mom and dad to make some efforts. Especially concerning afternoon snacking, insist in offering your child healthy alternatives to pre-packaged snacks: fruit and yogurt are great and fast solutions. Taking some time during the weekend, it is possible to prepare home-made sweets: doughnuts, tarts and different kinds of cakes remain fresh for a few days and they could represent a great alternative to industrial snacks.

Take advantage of seasonal fruit to prepare jams, or offer your child a slice of bread with honey, to alternate with chocolate cream. If you have some time available, let your child help you in preparing the snack. The moment dedicated to snacking will appear to be longer and it will not only consist in eating a pre-packaged snack in a few seconds: it will turn into a daily short appointment made up by complicity and sharing. And, if you feel like it, take advantage of it to change your habits: partake of some snacking as well.

Is the first born more intelligent?

In different families it could happen that some differences of intellective nature occur between first and second born children. As a matter of fact, it seems that first born children sometimes appear more brilliant and capable compared to their younger siblings. This leads many parents to ask themselves if the order of birth of their children could, in any way, have an effect on their intellective abilities. Does being a first born child mean to be more intelligent? In reality, things are not exactly like this. But let’s try to better understand why.

Very often a first born child, as he does not have any "competitors", enjoys, during the first years of his life, greater care and attention by his parents and he is therefore more stimulated. When the other children come, it could happen that parents do not keep up the same level of attention, dedicating less time to the younger child and leaving him under the older brother’s educational influence. How many times we tell our children sentences such as: "follow your brother, he is older", "do as your older brother". The "older" child, forced to be a guide to his younger siblings, learns to be organized and more attentive earlier and better.

Therefore it often happens that first born children, since they were born first, take on a different role, compared to second born children, within the family’s dynamics. For this reason "being raised as the eldest" could sometimes determine a sort of intellective advantage, because they are more followed and stimulated compared to their younger siblings. On the contrary, the latter, being raised with less responsibilities and with fewer stimuli, sometimes appear to be "less intelligent". A lazy intelligence should not be confused with an intellective deficit problem. The child has the same potentials of his older sibling, but he has probably not been encouraged enough.

Being born first or second does not make a difference, but what makes a difference is the educational style chosen by parents and the family context which strongly affect children’s development. It is therefore very important that each child, first or second that he is, receives the attention that is due to him from mom and dad. Let’s try then to dedicate the necessary time to our children to stimulate them and try to bring out the beauty that is in them. We should not think that if we did it for one, it just applies to all.

Besides, an important recommendation is to absolutely avoid making comparisons and showing preferences among children. Sometimes, thinking to stimulate them, we are led to underline the older child’s achievements and abilities. This way, instead, we only run the risk to create in the younger child fears and insecurities that do not help him to grow peacefully. Therefore let’s learn to be more careful towards our children, above all towards those who were "born after": the education that we choose for them represents the main ingredient for their growth and the precious tool with which they will face life.