Qn of the Month: I Had Gestational Diabetes in Pregnancy. Can I Forget About Blood Sugars Now That Baby’s Out?

Not quite – let me explain why.

Like me, you may have had gestational diabetes (GDM) during pregnancy, or you are currently experiencing it. Regardless, no one likes it, but it’s something we endure for the sake of delivering a healthy baby. The worst part I found was not so much that I had to constantly watch what I ate, but because I had to poke my finger to check the blood glucose level at least four times a day. The best part though is post-delivery when blood glucose levels often quickly improve and you can enjoy high carbohydrate foods again. But before you sigh with relief, forget all about blood glucose checking and throw away your testing kit, there are still a few things you should know now that you have a history of GDM.

As you may already know, gestational diabetes carries risks for both the mother and the developing fetus within the womb, as well as to the post-natal infant immediately after delivery. Women who have gestational diabetes are also at a higher risk of developing type 2 diabetes later in life. I was given some differing bits of advice from different countries. When I was in the United Kingdom (UK), a midwife told me that after the baby was born, to check my blood glucose level every year on baby’s birthday. In Singapore, however, my OBGYN doctor told me to randomly check my blood glucose level once in a while after a high carbohydrate meal.

So what should really be done now that baby’s out? In the United States, the American Diabetes Association (ADA) provides some guidelines for post-partum women who have had a history of GDM. Recommendations call for women with a history of gestational diabetes to be tested at the 6-12 weeks post-partum check-up for persistent diabetes. This should be done using the oral glucose tolerance test (OGTT) involving a standard glucose load and comparing the results to non-pregnancy diagnostic criteria. The reason for this is because while most women’s blood glucose levels return to normal post-delivery, some women may continue to have high blood glucose levels.

It is also recommended that women with a history of GDM should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. In those found subsequently to have prediabetes (i.e., results indicating they are on the borderline of being diagnosed with type 2 diabetes), ADA recommends these women to receive lifestyle interventions or the medication named metformin to prevent diabetes.

So if you’ve have a history of GDM, you can relax…but not too much. It is still important to take care of your health and body, and to a certain extent be somewhat mindful of what you are eating. This means being aware of and possibly limiting high carbohydrate nutrient poor foods, avoiding excessively large portion sizes, having regular spaced meals/snacks during the day and staying active. And you’ll still need to periodically have your blood glucose levels checked!

(Source: American Diabetes Association. Standards of Medical Care in Diabetes – 2014. Diabetes Care. Jan 2014; 37 Suppl 1: S14-S80. http://care.diabetesjournals.org/content/37/Supplement_1/S14.long#sec-22. Accessed May 30, 2014. Note that there is a correction published for one of the sections within this article at http://care.diabetesjournals.org/content/37/3/887.1)

Qn of the Month: What are Calisthenics?

Veering slightly away from the usual nutrition slant, this month I decided to answer a question of my own. This came off of the back of a health assessment I did recently (see post ‘Step it Up!’) which piqued my own interest in exercise and how to get more active (while being a working mother of a toddler). After all, real health is not just about nutrition. It’s nutrition plus being physically active. That’s when I discovered Calisthenics.

What is it exactly? It’s a word I’ve heard of sporadically and knew it was connected to exercise but never really took the time to delve more deeply into until now. Here’s a simple definition (courtesy of the Merriam-Webster dictionary):  “Systemic rhythmic bodily exercises done without special equipment.” Sounds good and simple to me! Calisthenics can be counted as part of strength training, which is recommended in a 10-20 min segment 2-3 times a week. Strength training (also called weight or resistance training) is just as important as stretching as it helps to build and maintain muscle as well as bone density (especially important for keeping strong bones ladies!).

I find calisthenics exciting because it seems easy to implement, doesn’t require much space or extra expensive equipment, and could probably also be done during toddler waking hours. The best part is, depending on the intensity and length of the session, doing a few circuits of exercises as part of a calisthenics workout daily should get the heart pumping and would probably also count towards the 20-30 minutes of moderate activity recommended every day! A great way to achieve two goals with one!

See these videos for many examples of different exercises you can do (with modifications if desired). Just pick a few exercises to put together your own Calisthenics workout routine. As always, start gradually and then build up the length and intensity of the routine over time. Enjoy!

Qn of the Month: I Need Breastfeeding Help! Who Can I Call?

If you are a new mother having trouble establishing breastfeeding, don’t feel discouraged. There’s help out there for you! Always check out your local hospital (or where you delivered) to access lactation consultants and breastfeeding help. In each country there are often many breastfeeding support groups and non-profit organizations providing resources and peer/professional support. Examples include the La Leche League (US and UK), National Childbirth Trust (NCT) in the UK, and the Association for Breastfeeding Advocacy (Singapore).  In the United States, you may also be able to get lactation consultant help from a Special Supplemental Nutrition Program for Women, Infants and Children (WIC) agency near you, and don’t forget to check out what may be available at the State level. For example, the Arizona Department of Health Services actually operates a 24 hour Breastfeeding helpline for breastfeeding questions.

Here are a few additional handy numbers and resources to take note of (by country):

UNITED STATES:

This is through La leche League (LLL) and is a toll-free number. If no one answers, leave a voice message. You can get connected to a local LLL leader and local LLL support group too.

UNITED KINGDOM (there are lots of phone numbers!):

  • National Breastfeeding Helpline: 0844 20 909 20
  • Association of Breastfeeding Mothers: 0844 412 2949 (9.30 am -10:30pm)
  • Breastfeeding Networks Supporterline: 0844 412 4664 (9.30 am – 9.30 pm)
  • La Leche League Great Britain: 0845 120 2918 (24 hour line)

SINGAPORE:

  • Joyful Parenting and Breastfeeding Helpline: 64880286 (Mon-Sat, 10.00am – 5.00pm)

Want more information? These websites might help:
http://www.abas.org.sg/information.htm
http://www.nct.org.uk/branches/southampton/breastfeeding-support
http://www.lalecheleague.org/nb.html

5 Simple Ways to Prevent Diaper Rash

No one likes nappy rash…least of all the baby. It was a surprise to me how easily babies can get it, and how difficult it is to get rid of it once it occurs! All I did was leave baby’s wet diaper on for a little bit longer than usual one night when she was about 2 months old, and then the next day I saw the dreaded red rash appear. Even though she only had a mild case of diaper rash, it still took more than 6 weeks with constant vigilance, diaper creams, airing out and frequent nappy changes before it got better. Even now, the affected area still turns a bit red whenever it is in contact with a more soiled or full diaper. It’s really true—prevention is better than cure! So here are 5 simple ways to keep your baby’s skin looking pretty and rash-free:

Use Cotton Balls & Water Instead of Baby Wipes.
In the UK, it was advised in the prenatal classes to use cotton balls with some cooled boiled water to clean baby for at least the first 4- 6 weeks of life. It was not recommended to use any wet wipes, but if these are used, then the advice was to choose the unperfumed version as baby’s skin is very thin and sensitive. Then after 4-6 weeks, you can slowly introduce products. The pediatrician I saw in Singapore was actually adamant that I shouldn’t use ANY baby wipes at all if I wanted to avoid diaper rash. I couldn’t bear the thought of not using any baby wipes, so I do use them, but very sparingly. I use a piece or two when baby’s had a real bad poopy diaper, and then move on to cotton balls dipped in water for the rest of the cleaning. Of course, we still use baby wipes when we’re out and about.

It’s really not that troublesome to use cotton balls and water to clean baby. Just keep a plastic bowl, a bottle of cooled boiled water, and a bag of cotton balls ready at baby’s bedside or changing table. Then after cleaning baby, gently pat the area dry with a piece of tissue paper or cloth, and let air dry for a couple of minutes before putting on the diaper cream.

Bare Butt Time.
Air out your baby’s butt as often as you can (this is easier at the stage when they can do tummy time, and can’t crawl much yet). Also let the skin air dry for a bit after cleaning, before putting on the diaper cream, and fastening up the diaper. I know the temptation is often to do the diaper change quickly, and to slap on the diaper cream right after cleaning and close up that diaper. But it’s worth a few extra minutes to let the skin dry properly and air out first. Babies love attention, so take this time to play with baby’s feet, hands, sing songs, play peek-a-boo or hand baby a toy to be fascinated with.

Choose a Thin Absorbent Diaper.
Not all diapers are created equal. Brands and products can vary. Sometimes the product marketed as super absorbent may be quite thick and not help matters. So when choosing one for your baby, test out diapers and pick one that is as thin and as absorbent as possible. You can also interchange disposable diapers with cloth diapers during the day if you want which may help.

Check & Change Diapers Frequently.
Before, after a feed, and after a nap. Check frequently and often! Boys can tend to pass more urine than girls, so may get a full diaper faster.

Use a Good Diaper Cream.
Not all diaper creams are created equal. The one I ended up using is called ‘Triple Paste’ but there may be other good ones out there. And you don’t have to wait till baby gets a nappy rash before you start applying the diaper cream. It often works well as a preventative measure, especially at night when you know baby might be wearing that same diaper for a longer period of time.

What You SHOULDN’T Expect From Breastfeeding

I was debating whether to put this under the ‘Milk Milk Milk’ section or under the ‘You and Your Body’ section, but finally decided on the latter. This has much more to do with protecting your body from the possible long term effects of breastfeeding than on milk production. Read on ladies!

Prolapsed Nipples.
Yep, that’s right. Prolapsed nipples. Over time, the nipples naturally change in shape slightly to adapt to continued breastfeeding. However, you don’t want your nipples to change in shape more than they have to. So ladies, always make a conscious effort to keep baby’s mouth on par with the nipple level when feeding and ensure a good latch. It’s so easy to forget this (especially when you’re tired, and it’s another night feeding), but doing so will prevent baby from pulling on the nipple and cause the nipple to gradually sag or droop a little over time due to the pressure from baby’s mouth and weight of baby’s body. Baby will get increasingly heavier too, so make baby adjust to you, not the other way around!

Lower Back Pain.
It’s very easy to get lower back pain from sitting prolonged periods in certain breastfeeding positions trying to breastfeed baby, and doing this multiple times a day. So it’s very important to get a good breastfeeding pillow and a comfy breastfeeding chair with pillows to support your back. And of course, elevate, elevate! Bring baby to your breast level and don’t try to bend over to meet baby’s mouth instead. If you need to, you can use another pillow on top of a breastfeeding pillow to support baby’s body and head. This will help bring baby up more to ‘breast-level’ while feeding. This will help your posture too. Also, keep stretching! A daily simple stretch routine (5-10 minutes) can really keep backaches from getting worse and soothe those strained lower back muscles at the end of the day!

Becoming a Hunchback of Notre-Dame (or Godzilla…).
When my baby turned 9 months old, I happened to look in the mirror and was horrified that I had turned into a kind of ‘Hunchback of Notre-Dame’ with my shoulders hunched over and my shoulder blades sticking out. Either that or I had become like Godzilla with the stooping small rounded shoulders. I had unknowingly let my posture go to the wayside over all these months because of my focus on taking care of baby. Of course breastfeeding made matters worse, because often in my efforts to maintain a good latch while baby breastfed, I wasn’t sitting straight with a good posture. Even my husband noticed (and he doesn’t even usually notice when I have a haircut)! So when breastfeeding, get yourself into a comfortable position first before latching baby on, and try to keep sitting tall and straight. If you find yourself hunching over or in an uncomfortable position, then detach baby and re-latch baby on, or try a different breastfeeding position. And as you go throughout your day, remember what your mother told you all along, “Stand up tall and straight, and keep your shoulders back!” Or like in the film Miss Congeniality, Sandra Bullocks was told by the beauty pageant consultant to, “Keep your chin parallel to the floor!”

Baby’s Home! Those Beginning Weeks…

Here are a few tips to help you through those first few weeks after baby comes home:

Keep things simple.
If you don’t have the luxury of having relatives, a church family or friends around to help out with meals during the immediate post-delivery period, then keep things as simple as possible. Stock up the pantry, fridge and freezer with lots of pre-cooked home meals, store bought frozen or ready-to-eat foods. Examples are frozen vegetables, frozen chicken tenders, fruit, yogurt pots, granola bars, bananas, cereal, canned soup, cheese, crackers, dried fruits. You won’t have time to think about what you will eat, let alone make it, and trust me, you’ll want all your spouse’s help with baby instead of grocery shopping or cooking. These energy boosters and quick snacks will also come in handy in the middle of the night!

Focus on healing.
The sooner you heal, the quicker you can be up and about, and the better you can care for baby. You don’t want to develop any complications (like I did)! It may be difficult with a screaming, crying, breastfeeding baby around, but really try to rest up as much as you can during this time. As mentioned before, accept ALL help you can get (cleaning, diaper changing, burping, soothing baby, meal preparation, etc.) from your spouse, family and friends.
 
Keep baby wrapped and warm.
The first night we brought baby home, baby seemed to keep crying without any seemingly good reason. We found out later that it was because she didn’t like to be unclothed and cold. Once she was snuggly and swaddled tightly with her arms wrapped in, she calmed down more. It probably gave her a sense of familiarity and comfort, after just being bound in the warm, tight quarters of the womb for the past 9 months!

Keep a baby diary.
At the beginning, your baby will only want to sleep, poop, and eat. But after a few weeks of allowing demand feeding, your baby will start to show you his or her unique feeding and sleeping patterns. What helped me to get to know my baby better was keeping a simple diary to jot down baby’s sleep and breastfeeds. I began to notice that at some point in each day my baby seemed perpetually hungry, like a bottomless pit. It turned out that my baby liked to be awake and cluster feed (feeding multiple times in a short space of time) for 4 hours in the evenings!

Keep sane.
I remember initially feeling overwhelmed, a bit depressed and out of control. Everything was so new, baby often had ear-splitting cries (especially during diaper changes), and I never really knew when baby was going to wake up, or when the next breastfeed was going to be. What allowed me to feel I had regained a little semblance of control (and helped me feel less depressed) was starting a loose basic pattern to baby’s day within the first month of baby’s life. This can be as simple as being prepared every 2-3 hours to be feeding baby, or trying to get baby to stay awake for half an hour after a feed once or twice during the day. This also helps to establish a basic rhythm to the day that you can keep practicing, and which baby can come to slowly get used to over time. As your baby grows, his or her feeding/sleeping patterns will also change, but because you have already established a basic pattern, you can adapt this to your baby’s changing needs over time.

What to Expect…Post-Delivery

Here’s some advice I wish someone had given me about the post-delivery stage:

Take care of those stitches!  Avoid sitting for long periods at a time the first few days and buy a swimming tube or circle that you can sit on to help ease the pressure on the stitches. The area where my stitches were got inflamed and swollen, because I was so focused on trying to breastfeed baby during those first few days home from the hospital and so was sitting too long in the chair at a time. I also didn’t know to get a swimming circle until someone told me later. It just made it harder to take care of baby properly, and took me about 4 weeks to heal whereas for most people it takes only about a week or two!

 It feels different down there…  It’s natural to feel really strange down there (like something’s open and not closing properly…) This can continue until about 6 weeks post-delivery. There will also be some bloody discharge which can continue for the same length of time. Although everyone recommends using heavy thick maternity pads, I’ve found that it is possible to use the maternity pads for the first 2 weeks then switch to using  a mix of maternity pads, regular pads and panty liners as the flow of discharge gradually lessens over the weeks. This helps you use up those leftover sanitary pads lying around!

 Help, I’m going bald!  It certainly feels like it. I shed a lot of hair at baseline, but even my husband was shocked at the three-fold increase in hair shedding I was experiencing post-delivery. Don’t worry though, it does lessen and stabilize by about 6 months after delivery, when the hormones are more back into balance, and when baby begins solids so breastfeeding starts to drop a bit.

 Losing that baby bump…  If you breastfeed for a period of time, this will help your body get back to its pre-pregnancy weight much quicker, because of the extra calories burned by the body to sustain lactation. However, I found that the ‘baby bump’ goes away much more gradually. I think it fully disappeared about 6 months after delivery, as I continued to breastfeed and began to be more active. So remember to continue to eat a healthy diet after delivery (keeping having at least 2-3 servings of calcium rich foods a day and take a calcium supplement, as your body’s calcium needs are much higher during lactation) and get moving with some activity and exercise as appropriate.

Lastly, expect a transition period.  Perhaps some people are really ‘born to be moms’, but I didn’t find that to be the case with me. Rather, I underwent a transition phase for the first 6-7 months, and part of that time was in a pseudo-state of ‘mourning’. Sure, it was definitely a great joy to hold one’s beloved child in one’s arms and to watch that little one grow and develop each day. But as a close friend put it, it was also a time of grieving: grieving the person you once were, and grieving your loss of identity and productivity. I was so used to multi-tasking and doing 3-4 things at once (like working full-time and exceling at my job, being involved in Christian ministry, catching up with friends) but now I found all my time consumed by one job—being a mom. I found my day eaten up by changing diapers, breastfeeding, burping, changing clothes or training baby to go to sleep on her own, so much so that I often don’t have time for myself to even check email or do some other work.  And since being a mom was a completely new job for me, I felt like I was swimming in deep water, and could only slowly build up my experience and learn how to take care of a baby that was constantly growing and changing. When baby slept, I was also busy catching up on some quick much needed shut-eye myself, and by the end of the day, I knew I had to get to bed as soon as possible to get a decent block of sleep before baby woke up again. I think it took a period of at least 6 months before I started to fully enjoy being a mom and having this new role in my life. So expect a period of adjustment and transition to your new role in life…and know that it’s ok to feel the way I did!