Weaning… A messy update!

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When I last wrote about our weaning journey we were just taking little fledgling steps with vegetables once per day and porridge for tea. I was successfully keeping feeding a relatively tidy process. Oh how times have changed!

We decided to go with mixed weaning – incorporating both pureed food and finger foods. I felt this way we got the benefit of her being able to try more flavours (food she perhaps would struggle to try as finger food yet the opportunity to try texture and feeding herself). To date she shows more interest in eating every other available object the world has to offer rather than finger food. She’s very intuitive and knows the difference between food, sippy cups and toys. She’s just chooses at present to nibble the non-nutritious options. In the last couple of days she has somehow learnt to shake her head to indicate no. I would like to know how she came to know this sign since I’m pretty sure we didn’t learn that at baby signing, and Mummy and Daddy don’t knowingly shake their head to indicate this mean no. Is the headshake an innate skill?

I have been following the Ella’s Kitchen first foods book, and more recently the cookbook version, for recipe and weaning ideas. After starting with single vegetables we moved on to combinations of vegetables, and the addition of fruits at lunchtime. She was accommodating of all flavours she was offered. What we realised is that she would probably happily eat porridge all day long. There was also a realisation that we needed to be careful to ensure we viewed all the food she was trying as equally tasty. As I watched someone feed her once, they indicated that she preferred the porridge because it was better tasting than broccoli. I realised that I was sometimes making faces and sounds to indicate what might taste better and those food that weren’t as great. So we have made a conscious effort to treat all food as wonderful! It seems to work as usually she pulls as face at whatever she is offered for the first couple of spoons and then she eats it regardless. She clearly favours the sweeter tastes as she can wolf down a whole meal sometimes and just a few spoons on other occasions when it’s a more savoury taste.

We have progressed in the last 3-4 weeks to enjoying beans, lentils, rice, and most recently meat and fish. My hand blender has never seen so much action! I have occasional weekends where I boil/steam/blend masses of food! Last week we all ate recipes from the Ella’s kitchen cookbook, with Amelia having the pureed version. The recipes were actually tasty. I found some stock cubes specifically for babies (with very low salt content) in Boots, and they have been a great addition. Now I am not being sponsored by Ella’s kitchen, but I like this brand and recipes due to the flavours. Lots of the recipes have some herb or spice addition to them, which just adds to the taste. We use a lot of herbs and spices in our usual cooking, therefore we are keen to introduce Amelia to these tastes. I did try some other brands and she didn’t seem to enjoy them. We tried them and they were bland. They were what I thought baby food might taste like, whereas the Ella’s kitchen foods are very flavoursome.

I do use the pre-made pouches for travel and when we are out and about due to ease of use. Amelia seems to know the difference, and does have a preference to the sachets much to my sadness when I have a freezer full of ice-cube sized portions of all sorts of food. She recognises the pouches and gets pretty excited at the prospect of what’s inside them!

What don’t we like? Banana and baby rice. These two ingredients often lead to constipation, and much time spent straining and putting effort into pooping a small stone sized lump of poo. What do we like? Pretty much everything else, and especially prunes. Prunes are great for counteracting the bananas or baby rice. It is a guaranteed way to get the poo on the move! We are just entering the world of increased texture and lumpiness. She’s getting in to it, having previously spat any lumpier bits back out.

I wrote this earlier today whilst she was napping. Today’s dinner reflects accurately the title of this post, as this has been the messiest mealtime to date!

A day in the life of Amelia, aged 7 months

 

thumb_IMG_8643_1024This is how I imagine Amelia would write a diary entry…

So I wake up looking at the mobile again. I have Nanny Mowl, Ewan and bedtime bunny keeping me company and my legs are confined within my sleeping bag. I now know the best thing to do is entertain myself a little bit first. I have found that if I start crying I am left for a while first. They do this to see if I’m really awake or still tired. After a short time of amusing myself I am ready to get up and have some company. So I practice my words. I can’t understand why they think it’s just noise and sounds because I’m pretty sure I am chatting about relevant things nowadays.

Daddy comes bounding in and smiles at me. I give him a really big smile back because I know they can’t resist my smiles. It’s a sure fire way to get out of this cot. I also know he will take me to mummy who’s got the milk I really want to drink! After a good drink I get to hang out with daddy whilst he gets ready for work. He usually gives me an elephant that has different textures and scrunchy sounds that I like to play with and chew. He then takes me downstairs whilst he has breakfast. Previously I was stuck in my high chair the whole time but now I have this new toy that I can stand in. If I feel like it I can move around the room in it. It’s opened up a whole new world of possibility for me. Mummy usually surfaces just in time for daddy to leave. It’s then time for our breakfast. I like to look longingly at mummy whenever she eats. I’d like to be able to eat what she does and drink cups of tea. She does try…she lets me have a scoop of her Weetabix, and some bread and cheese if she has a sandwich for lunch. Breakfast for me is a lovely porridge. I really love breakfast – it’s perhaps my favourite meal of the day. After breakfast we get dressed and I get to play about for a while. Then all the excitement and fun playing tires me out. So it’s naptime. Again, I am helped into my cot with the usual crew for company. This is generally my favourite nap because we don’t often skip it.

The next part of the day is variable – sometimes I wake up and lay about in the cot for a while, sometimes I wake up to find mummy watching over me as if she’s waiting for me to open my eyes, and sometimes I think she actually tries to wake me up. On those days I get scooped up and it all turns a bit wild. Everything happens really quickly and I get bundled into the back of the car, transported somewhere that I have usually been before and pretty much always there’s a collection of other babies. I sit and watch what’s going on – music, singing, lots of hand gestures, and other babies crawling and tottering about. Most of the time I will get into it but now and again I am just too tired and not into it. There’s usually toys and teddies and all these toys they call ‘instruments’ that make a lot of noise. To be honest, whatever I am presented with I mostly enjoy chewing and trying to eat. After these groups we head off home or on to somewhere else. The groups tire me out so after some lunch I am always ready for another nap. I have a bout three naps per day. But I need the sleep – it’s helping me grow so I can do even more stuff. I also find myself eating a lot. I have three meals per day and lots of milk in between. I heard mummy saying the other day that I am now supposed to be having three snacks as well. I’m not sure where we will find the time in between all of the other things I get up to! But it’ll make me bigger and stronger so I’m ready to take over the world some day!

The best part of the day in my opinion is after teatime. Why? Because I get to have a bath. I love bath-time! It’s so much fun. I get to splash around and I have so many bath toys to play with. Timothy the turtle (who speaks a different language, and has a funny accent. I have heard mummy saying something about ‘French’). Daddy usually gives me my bath and then gets me ready for bed. I don’t like getting out of the bath, and by the time I do get out I’m a bit tired and hungry, so I get a bit grumpy. But I soon calm down when I get to have my bedtime milk!

It’s then time for bed where I get to cuddle up to Nanny Mowl and bedtime bunny, and chat to Ewan again!

Losing control of the delivery

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I write this article knowing that this time last year I was still ignoring the fact that one day the baby making my bump get bigger and bigger was going to have to come out one way or another!

As December 2014 arrived and the 20-week scan had been reassuringly normal, I started to join some antenatal groups – Pilates and yoga. It was at these groups where I started to be exposed to other pregnant women, outside of my social group and my workplace. I was the new recruit, and as such the other women tended to be further along in their pregnancies. I’m not sure when most women start to think about the labour process and delivery of their baby but these women were all far enough along to be putting bags together, thinking about pain management in labour, etc. I admitted at these groups that I continued to live in blissful ignorance of how our little girl was going to arrive into the world.

That last sentence is perhaps not strictly true. As a medical student and doctor I did attend a number of labours – both straightforward and complicated, but mostly complicated.  I think I wanted to be completely ignorant to the birthing process but unfortunately knew too much to be in such a situation. Instead I was trying to block all my previous experience out and hide from the reality of the situation. I had tried to leave it a suitably long time between the last delivery I was in attendance of, and having my own child to help this situation. In my head I had visions of complicated labours, forceps, a ventouse, big needles, tears and episiotomies, and CTGs (electronic fetal monitoring).

So I eventually decided, around January time, that I might need to start thinking about this more seriously. There was a page in my maternity notes for me to complete my desired birth plan. Whilst many aspects seemed pretty easy to know what I did and didn’t want there were some more tricky areas. Things that I wasn’t too sure about what the answer should be. But in the back of my mind my greatest fear – being overdue and needing to be induced. A lot of the concern surrounded the little chart in my notes, produced at the scan. It gave a rough estimate of what the birth weight of my baby would be. If born 2 weeks late she was looking to be around 9lbs or so. I am 5”3’ and petite. I grimaced every time I thought about the prospect of delivering at 9lbs baby, and the ease with which such size of baby would pass through my birth canal! So my secret hope was that she would be delivered by 40-weeks. Another worry I had was the process of induction, and the success of them. In my time as a doctor I had seen many women being induced. I had done many weeks of on calls in the hospital, returning 12 hours later to find a woman still waiting for something to happen, seeing the drips they were given, the epidurals required to deal with the painful contractions that lasted for days, the need for assistance from use of a ventouse, to requiring a caesarean because nothings happening. I heard the experiences of friends and acquaintances who’d undergone inductions. I realised I just didn’t want that experience. My birth plan was for a labour that was as active as possible – I wanted to keep up and about for as long as possible. I felt that an induction had the potential to be quite the opposite. I worried that I would end up required an epidural early on to manage pain, and this would affect my ability to keep active. I also was very keen to avoid labouring for a long time, and then requiring a caesarean. I know that a labour that wasn’t induced could potentially be much the same but I really didn’t have control of when I would enter labour spontaneously, whereas I should have some control over being induced. I also knew that I wouldn’t be prepared to put my baby at risk, as may occur if you choose to continue to wait. Many sources agree that the risk of stillbirth is higher after 42-weeks of pregnancy. So I decided that should I be overdue I would wish for a caesarean to be planned on the date that I would otherwise be induced. I discussed this with my husband and he fully supported this decision. It was then time to broach the topic with my midwife.

I was nervous, as I know many midwives are keen for women to have as normal a birth as possible. However, my midwife was lovely. She asked a few questions to investigate my decision making process and offer further support in making such decisions. She then referred me to a consultant obstetrician for further discussion. I attended this appointment with my student midwife sister. We were there for more than an hour speaking to one, and then another, consultant. They questioned my decision making, the amount of experience I had in obstetrics, what my husband thought and his degree of experience, whether I had ‘tocophobia’ (the fear of giving birth!) and whether I wanted to have counselling. When in fact I had ‘melonophobia’ (the fear of giving birth to a baby the size of a melon!). They gave me statistics about induction and caesarean, they gave me other options – more sweeps for example. I took it all in, and felt that I was reasonable and listened to all other options. I just felt they couldn’t offer me what I really needed, which was reassurance that I wouldn’t be put through an induction, it be a long drawn out process and potentially end up having a caesarean anyway, in an emergency setting. I had prepared in advance of the appointment and knew that guidance stated maternal choice was a reason for caesarean.

In the end I was pencilled in for a caesarean for a date that would occur if I were 12 days overdue, with a plan that I would have cervical sweeps if they were possible at 40 and 41 weeks. My final decision was made because of my strong belief that I could live with any decision that I have made and is my own. In such circumstances if anything bad happened I could blame myself. However, had I been convinced to have an induction and anything went wrong I would hold the blame against those who convinced me to make the decision. I really didn’t want to live with such feeling. Throughout the appointment I kept reiterating that I felt this was all hypothetical and hopefully she would arrive on time. I was proved right, as the conversation clearly spurred her out and she came to the world safe and sound two days later!

To vaccinate or not to vaccinate…that is the question

Before I go any further I must declare my various interests in this topic matter – I am a mother, I am a doctor, I have had all my immunisations.

To date, Amelia has had all of the immunisations offered to her as part of the UK routine immunisation schedule, and she has recently had her Meningitis B vaccination. This latest vaccine was not part of her routine immunisations and we had to seek this out privately. It’s fair to say that Amelia had no choice in whether or not she had all of these immunisations. But then she currently has little choice in what she eats or wears, where she goes and what activities she participates in, etc. So should I allow her to choose whether she be immunised or not? In my mind the answer to this is a definitive no. If I look at it from a medical perspective, she clearly doesn’t have the competence or capacity to make such decisions. She doesn’t understand what it means to have, or not have these immunisations, she wouldn’t retain and understand the information if I gave it to her, and she certainly couldn’t repeat it all back to me. Hence, it is left to Daddy and myself to make such decisions on her behalf. Our approach is that we will do whatever keeps her most safe and well in life.

It is a stressful time taking your little baby for those first injections. She doesn’t understand why we are in a strange place, with strange people, and why she is being held so tightly (this is mainly for my own comfort!). She doesn’t understand why she’s being made to swallow something that isn’t her usual milk, and why suddenly she has one needle in either thigh, simultaneously! When she let out that cry of discomfort and worry I had a wave of sadness. But as quickly as the cry started, with a tight hug and some reassuring words, it was over. Though I’m not sure that she understood me, we had sat in the waiting room before the injections with me explaining that they were for the best, and to help keep her well. I reiterated this point after she’d had them, and that she was a very good girl, and I loved her very much.

I’m not going to spend time chastising parents who choose not to immunise their children. They have their reasons. But I can only hope those reasons take into account current evidence and fact, and are not influenced by rumours or inaccurate evidence. Through childhood immunisations we had got to a stage where we had almost eliminated many of those infections we immunise against.  The fact is that there are an increasing number of cases of such illnesses, which have arisen through an increased number of babies and children who have not been immunised. There is a reason that vaccines were developed, and not only for drug companies to make mega bucks! The principle reason is that these illnesses can make your little ones sick, and can cause potentially serious complications.  I have Amelia immunised, but to really help we need the majority of children to also be immunised.

When I heard about the Meningitis B vaccine becoming available it was great news. Meningitis B is the most common cause of bacterial meningitis and meningococcal septicaemia. In turn, meningococcal septicaemia is the commonest cause of death, from infection, in the under 5’s. Moreover, babies under 1 year of age are at most risk (see the Meningitis Research Organisation,http://www.meningitis.org/menb-vaccine, for more information). The vaccination is being introduced into the routine immunisation at 2 months, 4 months and 12-13 months of age. My first thought was ‘Hang on a minute, what about Amelia? Is there a catch-up programme?’ There is, but only for babies born on or after 1st May 2015. Therefore, Amelia is not eligible for the vaccine through the NHS.

We looked into her having it done privately. It cost around £100-150 per injection. This is a lot of money. Luckily for us we are fortunate enough to afford this, and our next decision was about whether she really needed it, rather than where do we get the money to do it. We talked to friends – some who’d already had their child immunised, some who’d not even thought about it, some who were doctors and some who were not. I talked to a couple of friends who are paediatricians, who confirmed that of the cases of meningitis they had seen, many had been related to meningitis B. It was when someone said “You have to ask yourself how you would feel if she did get meningitis and you hadn’t done all you could to protect her”. This comment made our decision easy – we would feel guilty, and that we had let her down, if we didn’t do all we could to protect her.

I feel frustrated that she couldn’t have this injection on the NHS. It annoys me that she falls outside the catch-up programme, yet she is within the age group at most risk. I do wish that they had set the catch-up programme to all under 1’s. I can, however, see why perhaps this is easier said than done. Perhaps, with some pressure, they may adjust the catch-up programme and more babies will be included. But as I write this I look at the positive point – we now have a way to protect our little ones from another potentially deadly disease, and even if your little one wont get it as part of their routine immunisations, just having other babies immunised may help to reduce the chances of your little one contracting the disease.

Again, just to reiterate – these are the decisions we have made for our little girl. Everyone makes their own decisions, based on their own views and research but if you choose not to get your baby vaccinated please think of the consequences to the rest of the herd!

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The picture is taken on the day of her first set of immunisations – that’s how little she was!