Boise Doula Pregnancy, Birth, and Postpartum Information and Inspiration, for the Treasure Valley

5 Tips for Finding a Caregiver for your Baby

12/27/2018

Finding a caregiver who respects your parenting choices is key

Whether you are looking at a return to work after maternity leave, or just need a sitter for an occasional date night, leaving your baby in someone else’s care for the first time can seem like a daunting task.

Will they be safe? Will they get the same level of attention as they get from you? What if they don’t take a bottle? Will they cry? Will you cry?

Here are five things to consider when finding a caregiver for your baby:

1. Determine the type of care you need and want. You will have different expectations of an occasional babysitter than that of a full time caregiver. It may not matter that an occasional sitter has a little trouble putting your child to sleep at his usual time, because his routine isn’t greatly affected by one late nap. However, you may want a regular caregiver to follow the same routine as you do at home.

Depending on your budget, your child’s needs, and your personal preferences, you may be looking at the following types of care:

A postpartum doula works in your home, caring for you and your entire family. While postpartum doulas typically don’t watch your children while you work or leave the home, they do help in caring for babies and older children while you are in the home so you can sleep, shower, exercise, or take some time for self-care. They are trained in all aspects of the postpartum period, from newborn care, to breastfeeding support, to help in spotting the signs of perinatal mood disorders. They support the entire family, and typically work with a family on a short term basis.
A mother’s helper does not usually have formal training, and works at your direction to care for your children while you are in the home. Mother’s helpers are usually employed on a part-time basis.
A babysitter is similar to a mother’s helper, only a babysitter usually watches your children while you are outside the home. Some babysitters have taken child care courses and some are CPR certified. They usually care for your children on an occasional or limited basis.
A nanny works in your home, caring only for your children while they are there. (Some parents nanny-share, where the nanny works part-time for their family and part-time for another family). A nanny can be an independent contractor or a household employee. A nanny should follow all of your parenting preferences. They are not licensed by the state, but may have independent training or certification in CPR and basic first aid.

An in-home day care is typically smaller than a day care facility, and may or may not be licensed by the state. When licensed, there are regulations regarding caregiver to child ratios. There may be only one caregiver on site, or there may be multiple caregivers depending on the number and ages of children. Each in-home day care varies on their policies regarding illness, vacation closures, and their ability to accommodate your preferences for feeding, sleep schedules, and parenting style. Your child will likely be exposed to children of various ages.
A day care center provides full time care in a facility outside of the home. The caregiver to child ratio is highest in this setting, as they care for more children. The facility will be licensed by the state; caregivers will be screened by the daycare operator. Depending on the facility’s capacity and policies, they may or may not be able to accommodate your preferences for individual attention, feeding, and sleep schedules. Your child will likely be exposed to other children her own age, as children are usually grouped by age.

2. Get referrals and check references. When looking for care, ask your friends, family members, and neighbors for referrals. No matter what kind of care you are looking for, if you can get a referral from a family who has had personal experience with a caregiver, you may have more peace of mind about leaving your child with them.

If you can’t get personal referrals, you can get referrals from local parenting groups, or you can view ratings on child care sites like care.com. You can use a child care agency; they screen their caregivers in advance, conduct background checks, and may require them to have a minimal level of experience or training.

When you find potential caregivers, ask for references from families with whom they have worked in the past. If they can’t or won’t offer references, this can be a sign that they are inexperienced or have had negative experiences you may want to avoid.

3. You make the decisions. You have the right to choose a caregiver who will respect your parenting choices, including how and when to feed your baby, how to respond to crying and other cues, how their sleep is structured (or unstructured), how often they are held, how they comforted, how they are disciplined, and more.

Look for child care providers who will work with you to accommodate your preferences. Sometimes they may have limitations due to the number of children they care for. Know which areas are the most important to you, and find a care provider who can meet your needs in those areas.

When your care provider is a family member, your parenting choices should be respected. A family member who ignores your instructions may not be the best person to watch your child, even though they may be more emotionally attached to your baby than a professional caregiver.

Also consider an out-of-home caregiver’s policies on dropping in to see your child. If a facility limits your ability to visit your child, or requires advance notice, this may be a red flag that they will present a different picture to you of the care your child is receiving when you are not around.

4. Ease into a schedule. If you have the flexibility, consider leaving your baby for small increments of time with their caregiver, and build up to a regular schedule over a period of weeks or months. This period of transition will help both you and your baby get used to being apart.

A slower approach can also apply to occasional or part-time care. Have your sitter watch your child in your home while you are there before you leave your baby alone with them for the first time. The sitter can become familiar with your home and the baby’s routines, the baby won’t consider the sitter a stranger, and you will get a sense of how the sitter will care for your baby when you are gone.

If you are breastfeeding, easing back into work may help you maintain your breastfeeding relationship while you pump to build up a supply. It may also give a baby who is reluctant to take a bottle time to adjust to a new method of feeding.

5. Consider alternatives. Sometimes, the needs and priorities of your family change after your baby is born. When pregnant, you may have had a plan to return to work after six weeks but now that your baby is here, you feel you need an extended maternity leave. Or maybe you planned on hiring a nanny, but you found an in-home daycare that seems like a better fit.

Some families re-evaluate their need for a two-income household, and one parent decides to stay home to care for the baby full time. Or one parent transitions to work from home for a time, to be more available to help with child care.

If you find yourself re-thinking your child care needs, there are many options available to parents these days. Start a discussion with your employer about what flexible options may be available to you. Examine your family budget to see if one or both parents can stay home with the baby, or work from home for a while. See if a family member is available to help out on a regular basis.

Make the choices that are right for you new family, even if those choices are different than what you thought they would be when you were pregnant!

I am a certified labor doula (birth doula) and postpartum doula serving clients in Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley.
Planning for birth and postpartum can be just as stressful as choosing child care. Find out how a doula can help you as you bring your new baby into the world.

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What You Need to Know About Nitrous Oxide in Labor

12/12/2018

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Curious about nitrous oxide as pain relief in labor?

If you are pregnant, sooner or later you will think about how to manage the pain of labor. Some clients know they want to get an epidural, and others would prefer to either forego pain medication entirely, or see how they feel in labor and make a decision in the moment.

Pain management and comfort measures are topics I discuss at length with my clients in our prenatal meetings. When clients want to avoid or delay pain medication, we talk about natural pain relief methods like counter pressure, hydrotherapy, heat therapy, and position changes.

When clients are open to pain medications, but want to avoid or delay an epidural or narcotic medication, nitrous oxide can be a great option.

Nitrous oxide has been used by laboring people in the United Kingdom, Australia and Canada for decades. The ACNM (American College of Nurse-Midwives) supported its use in a 2011 position statement, affirming nitrous oxide as a pain relief option that fits into the midwifery model of care.

While nitrous oxide was once frequently used in United States, in the 1970’s its use declined as epidural analgesia surged in popularity. As of 2017, one report stated that nitrous oxide was available in only around 150 hospitals and 50 birth centers nationwide.

Fortunately for those in the Treasure Valley, both major hospital systems, St. Lukes and St. Alphonsus, offer nitrous oxide, also known simply as “nitrous,” in their labor and delivery rooms.

With all interventions, there are benefits and risks. Here’s what you need to know if you are considering using nitrous oxide in your upcoming birth:

The Benefits of Nitrous Oxide in Labor

It doesn’t affect the normal progress of labor. Often with an epidural, pitocin (artificial oxytocin) is used to compensate for reduced uterine contractions. Nitrous doesn't interfere with the normal course of labor. It can also be used at any stage, from early labor to the pushing stage.
Your movement is not restricted. Although you may have to remain close to the nitrous tanks to utilize the gas, you can labor in any position: standing, squatting, bouncing on a birth ball, on all fours, etc. While you can lie in bed while using nitrous, you aren't limited to the bed as you would be if you were administered an epidural.

You are in control. You administer the nitrous oxide yourself by holding your own mask; when you don’t want it anymore, you remove the mask. With other pain medications, like narcotics and with the epidural, if you have a negative reaction you may have to wait until the medication runs its course through your system, or you may not have the option to discontinue its use until after your baby is born.
Its effects are immediate. As soon as you breathe in the gas (which is actually a 50/50 mixture of nitrous oxide and oxygen), you begin to feel its analgesic (pain relieving) effects. As soon as you remove the mask, the gas dissipates quickly and its analgesic effects stop almost immediately.
It may help you breathe more efficiently. Often people tense up during contractions, and they forget to take the deep breaths which help them more effectively manage their pain. Because you have to take deep breaths into the nitrous mask to get its full effects, you may be better able to regulate your breathing, ensuring you get enough oxygen and helping you to remain calm.
It does not affect infant alertness at birth or interfere with breastfeeding. Pain medications like narcotics and the epidural can cause your baby to be “sleepy” at birth, which can delay the initiation of breastfeeding, or result in lower Apgar scores. These effects are not seen with the use of nitrous oxide.

No drop in blood pressure, so no need for an IV. Epidurals cause a decrease in blood pressure. An IV is required when you get an epidural to help keep blood pressure stable.
No catheterization is required. When you get an epidural, a catheter is inserted into your urethra to catch urine. There is no such need when using nitrous.
No risk of maternal fever. When you get an epidural you are more likely to experience hyperthermia, or a rise in body temperature. Sometimes this manifests as a clinical fever, which can pose risks to the baby.
Continuous fetal monitoring is not required. When you get an epidural or narcotic medication, you will be continuously monitored for signs of fetal distress. (With narcotic medication you can usually revert to intermittent monitoring after a time). While this monitoring is usually external, sometimes internal fetal monitoring becomes necessary. No additional monitoring is required when using nitrous.

The Risks, or Downsides of Nitrous Oxide in Labor

Nausea or vomiting. Some people don’t tolerate the gas well, and find that it makes them feel nauseous. If this occurs, you can discontinue its use and move on to another method of pain management. Know that nausea and vomiting are common symptoms in active labor, whether or not you utilize any pain medication.
Dizziness. Some people experience an uncomfortable dizziness or lightheadedness. You may choose to stop using the nitrous, and this feeling should go away.

Nitrous oxide doesn’t completely eliminate pain. My clients who have used nitrous explain that they can still feel their contractions, but they feel more relaxed when managing them.
You must hold the mask yourself. The laboring person is required to hold the nitrous mask to their own face as a safety measure. If you become too dizzy or faint, the hand holding the mask will naturally fall away from your face, and the nitrous will dissipate. Some people find holding the mask cumbersome or tiring.
Long term effects on fetuses and newborns are unknown. While the use of nitrous oxide has been shown to have no effect on newborn alertness, the long term effects of exposure are unstudied. One study showed neurological dysfunction in rodents when given at high doses, and there have been some concerns about harmful reproductive effects from prolonged exposure in heath care workers.
Certain populations may have negative side effects. Those with Vitamin B12 deficiency, the MTHFR gene mutation, acute asthma or lung disease, or bowel obstruction are at risk for harmful side effects from using nitrous oxide. Consult your care provider if you fall into one of these at-risk groups.

I am a certified labor doula (birth doula) and postpartum doula serving clients in Boise, Eagle, Meridian, Nampa, and the Greater Treasure Valley.
Are you considering using nitrous oxide in labor? Would you like more information about it?

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5 Tips for Finding a Caregiver for your Baby

What You Need to Know About Nitrous Oxide in Labor

The Benefits of Nitrous Oxide in Labor

The Risks, or Downsides of Nitrous Oxide in Labor

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