Tex has arrived!

March 14, 2007
14:25
9 lbs 15 oz
(oh, let's just call it 10 lbs! Everything is bigger here in Texas!)
21 inches

Happy, healthy and at home with mama, papa & big sis Peanut

More older moms, cesearans and other US baby trends

A Babycenter newsletter highlighted recent baby trends in the US:
The teen pregnancy rate in the United States is at an all-time low, while the rate of caesarean deliveries is at an all-time high.

At the same time, the birth rates for mothers aged 30 and older rose in 2005 to levels not seen in nearly 40 years.

These findings are part of the Annual Summary of Vital Statistics: 2005, published in the February issue of Pediatrics.


The data in the report comes from U.S. vital statistics records, birth certificates, fetal death reports and death certificates. Here are some of the report's other findings:
• A record number of unmarried women are having children. The total number of births to unmarried women rose by 4 percent, to 1,525,345, in 2005.
•Slightly more than 1.7 million people were added to the U.S. population in 2004, or 5.8 persons per 1,000 population.
• The preliminary estimate of births for 2005 was 4,140,419, an increase of 1 percent from 2004.
• The general fertility rate in 2005 was 66.7 births per 1,000 women aged 15 to 44 years, the highest level since 1993.
• The infant mortality rate was 6.79 per 1,000 live births in 2004, not statistically different from the year before. The report also found continued differences in infant mortality rates by race and ethnicity. Non-Hispanic black newborns were more than twice as likely as non-Hispanic white and Hispanic infants to die within a year of birth.

Making a down payment on Tex

At our recent 20 week prenatal visit, we were stopped at the receptionist on our way out. It was time to discuss insurance and payments for Tex.

The receptionist pulled out a worksheet where it outlined the "global obstetrical fee" (ie, the package deal for prenatal care + delivery of baby + postpartum 6 week check-up for mama. It excludes possible anesthesia (epidural) and post delivery hospital costs for mom and any baby-related care costs. Since we have chosen an in-network doctor and hospital, we got a special discounted rate of $2,369.00.

After we pay our annual deductible ($300.00), our insurance covers 80% of the remaining fee leaving us with a balance of $714. The entire amount has to paid by the 28th week of pregnancy though we could make interest-free payments up to that date.

As we tried to understand what else we could be billed for, the receptionist joked that anyone who enters your room will leave you with a bill, even the guy who sweeps the floor. She added that often the bills will beat the mama and baby home!

It was a very different approach with Peanut's delivery in Finland where a bill for 130 euros arrived weeks later in the mail. On the surface, it looks virtually free, but let's not forget the generous contributions Peanut's papa & I made through the years in taxes. I have no idea what the hospital charged KELA for the delivery so its really hard to compare the real costs. If I'm suddenly overwhelmed with free time, I'll let you know how it works out, but don't hold your breath :-)

What Delivery and Recovery are like at Kätilöopisto

Our Peanut was born at Kätilöopisto in Helsinki and a recent visit to friends who just had a lovely baby daughter reminded me of our stay there.

A few memories that came to mind

Delivery Preparation
> When we arrived, we went to a waiting wing since labor had not yet started. It was busy enough that we had to share a room with another couple also waiting for labor to progress. We chose to go take a walk to help us relax. The midwives asked only that we let them know when we leave and return. Sharing the room was rather uncomfortable and luckily for that night we were able to make use of another room they reserve for observation.
> During the time there, midwives check in periodically and used a machine to measure the timing and intensity of contractions and the babies heartbeat. Usually the measurements took about 20 mins during which you had to stay close to the machine (sitting or standing was fine).
> The doctors make their rounds in the morning and suggest actions (in our case it was a prescription for a move to the delivery wing and insertion of an oxytocin drip to help start the contractions and a fetal heartbeat monitor attached to Peanut's head)
> I was offered an enema.

Delivery!
> Our delivery room contained a delivery table and rocking chair as well as a bathroom with a shower. There was also a dispenser for nitrous oxide (laughing gas) and equipment again for monitoring the contractions and baby's heartbeat.
> The midwives also brought in a birthing ball at my request.
> When we met the midwives, we presented our birth plan and reviewed it with them. We had to do this with several shifts of midwives.
> You are welcome to labor in any position, posture, etc that you want. Even the delivery can take place either on the bed in whichever position is most comfortable or a on a birthing stool on the floor. The midwives were very helpful in trying out several options.
> If you want an epidural, be sure to make your wished known well in advance of when you think you will need it. It takes time to bring in the ansthesiologist and to prep you for its insertion. The epidural is not instantaneous, but takes effect over a few minutes (ie more contractions!). The epidural usually lasts for 1.5 - 2 hours after which the midwives like for it to wear off completely and letting you labor for a while before topping it off. After the third refill, we were beginning to wonder if it was time to consider a C-section since I was getting tired (and had a fever for which they gave panadol), but the midwives said they prefer to try and give it a bit longer. The big surprise was that they do not want to give you an epidural as you enter the final stretch (no pun intended)!!! The reason is that the actual pushing phase is more effective if you can feel the contractions and can push with them. And, honestly, the pain at that point was not 'pain' as much as a sensation of muscles working to move the baby.
> The laughing gas is available for your use as a pain reliever whenever you want.
> After the baby is born and her nose/mouth are cleared, she is placed immediately in your lap for you to hold her skin-to-skin as they (or dad) cut the umbilical cord and carry out a few other tasks (I'm not sure what all happened down there in addition to a sample of Peanut's blood being taken since I'm Rh negative).
> Dad and the midwife then moved to the other side of the room to bathe, measure and bundle her. Her hospital band was also put on and she receives her Vitamin K injection.
> Another midwife helped me to the hospital bed where the placenta was delivered with some assistance. You can have a look at it if you like. The midwives assess its condition and take it away.
> Then with the numbing assistance of an antiseptic spray, the midwife stitched me up.
> An assitant midwife came in to help me to the shower and to put on a clean set of hospital clothes.
> In the meantime, dad is encouraged to hold the new bundle of baby and in the background paper work is being filled out.
> The assistant midwife returned with a cart of food - sandwiches, yoghurt, cookies and juice. I was surprisingly not very hungry...
> Suddenly after all the hustle and bustle, we found ourselves alone with Peanut. They gave us about 30 - 45 mins of quiet time before asking if we were ready to move to the recovery ward.
> Our midwife escorted us and our rolling baby basket to the fourth floor.

Recovery Time
> it was also busy there so we did not immediately get a family room where dad could have stayed overnight and instead had to share a room with another mom and fresh arrival (with a set of lungs!). We did immediately put our names on the list for a family room when one became available.
> I remember laying in bed with Peanut in her clear plastic basket next to me watching her through the night. All babies room-in because they want mothers and fathers to get used to life with baby right off the bat rather than having a shock when they go home alone. On one hand a good idea, but it would have been nice to have one last night of rest! If the baby is particularily fussy and crying alot, you can request to have it moved to a 'nursery' for a few hours.
> A nurse came in to quickly review the basics, gave me the blue handbook to babies and brought me a canister of water.
> The call buttom was right next to the bed and help with anything was at the other end (from diaper changing to breastfeeding, etc).
> Meal time was held in the common area. An announcement over the intercom reminded you to come for breakfast, lunch, afternoon coffee (!!), dinner and an evening snack. At first I wasn't sure what to do with Peanut during the meals - most mothers roll their baby cribs with them. Peanut slept so I just went out and brought the tray to our room. After every meal you had to drop your namecard back in the box to make sure you got a serving of the next delicious course. If you have a family room, the dad also gets his own namecard.
> the hospital gowns and robes all new moms are wearing as they wander the halls. They come in three colors - hot pink, baby blue and hospital green - and have a nifty row of buttons all the way to the bottom, making it easy for breastfeeding. They also provide socks and slippers, but its recommended you bring your own slippers --> more comfortable :-)
> and the special underwear! How can I accurately describe them? Imagine these currently popular 'boyshorts' underwear made out of a stretchy white mesh fabric with thick green seams on the sides. Available for all new moms. They were comfortable and airy that's for sure. At Kätilöopisto they are not disposable, but once used are washed and available for pick up in the bins in the hallway.
> In the common area where baby kits from Libero diapers that you could pick up for free.
> Dismissal comes after you've been cleared by the doctor :-)

Midwife visited us at home following the delivery

After the delivery of our baby, the first visit with the midwife took place in our own home. A few days after we came home, I called my midwife at the Neuvola and set up a time/date about two weeks after Peanut's birth. It was very nice that we didn't have to go anywhere because at the point, its still a large production to get everyone out the door and mom is still in her early recovery period. Though it created some anxiety as we tidied up a bit and wanted to make sure we had all the baby equipment in order.

On that day, she came to our home with a small bag of supplies to give both me and Peanut a check-up. My medical information is basically all in the 'Maternity Card' I've carried with me since my first visit. I also had a printed out report from the maternity hospital describing the birth, my recovery and Peanut's first doctor's visit at the hospital. The information is not shared electronically among the health centers and hospitals even though they are both public services.

The midwife asked us some questions about general well being, nursing, sleeping and my mental health (occasionally weepy!,but to be expected, she said). She then undressed Peanut and checked her skin condition, eyes, mouth and reflexes. The midwife then produced fish weighing scales from her bag and wrapped Peanut in a diaper cloth before lifting her up by the scales to weigh her. She then took a look at my breasts to see how the nipples were and if the breasts were still engorged. Then, I undressed the lower half and she did a quick visual exam to see how everything was healing.

I had a long list of questions to review with her before she left. Our next appointment will be a childcare nurse at the Neuvola.

Delivery from a dad's point of view

Sure, it is kinda late for me to post this now, Peanut is 7 weeks old. No, it did not take me 7 weeks to mentally recover from the delivery, we have recently moved and getting the new place up and running has taken quite some time. Anyway, this article is specifically for the non-physically-pregnant part of the couple. In most cases you will probably be "dad" like me - but this applies to anyone entering the maternity clinic to support a delivery.

So, in modern times in Finland, the dad is expected to play an active role in the delivery room. In all honesty, the thought of being there scared me. I don't handle blood well and the prospect of seeing my lovely wife in pain just made me feel like I did not want to be there. Which is silly really, because she probably needed my presence more than at any time before in her life [except for conceiving the baby :-)].

Despite your active role, do not expect the maternity hospital or the delivery room to specifically cater to the husband. You will have to bring your own food and drinks. Make sure you get some filling foods that will slowly release energy. A delivery can take quite some time (36 Hours in our case). Some caffinated drinks such as coke/pepsi might be good. Don't eat only sugar based energy boosters. They will give you a sugar rush, leaving you more tired than you were before you took it. We had our baby in Kätilöopisto and they have a small relaxation room for dads with a microwave, coffee maker and some other basics. Check it out on one of their tours.

In case of a long delivery, you are also going to make sure you get a break and some rest. When Peanut's mom got an epidural during the delivery process, she fell asleep. I took that time to quickly go home, freshen up and call my mom to get some support. You need to be in shape to support your wife when she gets back to feeling pain and in the final stages of delivery, so you need to manage your own energy levels to make sure you can do that. If the hospital is very full, like when we were having Peanut, you wont be able to sleep in the hospital during your breaks in the birthing process or after the birth. If the hospital is far from home (>20 mins) make sure you can crash at a friend's place close to the hospital or book a nearby hotel. If you are going to Kätilöopisto in Helsinki, there is a Holiday-Inn hotel next to "Messukeskus", close to Hartwall Areena, about 10-15 minutes from the hospital by car.

In the delivery room there really is not that much you can do. The midwife will take care of all the essentials. Ask her to explain what she's doing so you know what is going on. Most midwives speak decent English. Note that a midwife in Finland is really an educated health worker. She's authorized to give injections, install drips etc.

Way before delivery, discuss with the soon to be mother how she would like to give birth. Go through the birth plan if she has one. If she doesn't have one, make one with her. See a previous article on this blog for details. This way you can help in directing the delivery in the way that the mother to be would like. Once the contractions start coming thick and fast, she wont be able to talk or concentrate much, but decisions will need to be made. Other than that, you can help with pain relief, for instance by helping her take the laughing gass in time, applying a hotpack to the lower back and wiping her forehead with a cold cloth.

Once in the pushing stage, your need to support her will depend on the birthing position. If she's on her back, there probably isn't much you can do. If she's ona birthing stool, you'll have to physically support her, which makes for an intense and involved experience. But let that not dictate what position to use, the most important thing is that the baby makes it out quick and safe, the 2nd most important that mom-to-be is as healthy and comfortable as possible.

Finally, giving birth is not a clean, clinical process. There is pain, blood, liquids, needles etc. But you will not be bothered by any of this. You will hardly remember it afterwards. I am probably the least suitable person to enter the delivery room when it comes to these things, but I survived and that means you can do it too. And it is a great experience!

And your total hospital bill will be --- 130 EURS

Only?! When will we be billed for the rest? I was pretty surprised when the hospital bill for Peanut's delivery arrived - and it was only 130 EURS!

We were in the hospital for several days before and after the delivery. I made liberal use of the pain killers available - including having an epidural and two additional injections. There was loads of monitoring equipment used during the delivery -- not to mention many other medications. Peanut's dad also stayed overnight in the hospital with us in a private room. We saw a pediatrician for Peanut and I had a post partum check-up with a midwife. We ate lots of hospital food.

Yet, it really all cost only 130 EURS - it was the food that got us in the end.

The bill really only was for the meals we ate - about 22 EURs a day for each of us. In addition to breakfast, lunch and dinner, we had afternoon coffee and a snacktime in the evenings. The fare was bland and seemed surprisingly low on veggies. But, I guess for breastfeeding moms you want to keep it simple, but filling. The afternoon coffee break seemed ususal since I thought we shouldn't have too much caffine, but in a country of ardent coffee lovers, it would be hard to imagine a day without a coffee break!

We had selected on of the public hospitals - the Kätilöopisito - and did not use any private health insurance. I can only imagine what all this would have cost in the US for someone without insurance! Here it was a case of a good return on the oodles of taxes we pay. I suspect we'll continue to see more benefits of the system as we venture with Peanut. So far, all of our pre-natal visits were entirely free and our post-natal vists will also be - as long as we make use of the public clinics and doctors.

Peanut born

Peanut was born on April 14th. She's 3.6kg and 50cm. Peanut and her mom are doing well. We are very happy. Peanut's mom will be back with an update early next week.

All packed with nowhere to go - yet!

Its 40 weeks + 9 days - we're still waiting for a reason to head to the hospital.

In the meantime, our bags have been packed for a few weeks. We have two bags - a backpack with the items we think we'll need during the actual labor and delivery and a big duffle bag for the hospital stay. Oh - and the bag with the videocamera tripod - NOT to be used for the delivery, but afterwards so we can get video with all three of us :-)

Here's what in our bags:

BACKPACK for labor and delivery

• 2 pairs of socks for Peanut's mom
• washcloth
• water sprayer - like the one you'd use for spraying a mist of water on plants
• L'Occitane Olive Oil lotion for massage
  
• a paperback for both Peanut's mom & dad
• 2 techies magazines for Peanut's dad to flip through
  
• 4 CDs - mostly quieter tunes
• notebook and pen
• copies of the birth plan (in English) + a list of key words in Finnish/English
  
• hard candies - Werther's Originals and fruity lollipops
  
• a bar of Fazer chocolate

And, mainly to sustain dad

• peanut & raisin mix
• box of instant soup mixes
• salty crackers

All topped with a note to remember to bring:

• the camera
• eyeglasses
• sports drink bottle for water or juice
  
• Peanut's mom's slippers and
  
• to put out extra catfood & water

The duffle bag for the hospital stay

• 6 pairs black cotton grannie underwear in my pregnancy size (bought especially for possible ruin) + 3 pairs cotton underwear
  
• 2 cotton nursing bras
• 4 pairs of socks
• 12 disposable nursing pads (for leaks!)
• package of night-time strength sanitary pads
• make-up bag with shampoo, conditioner, shower gel, face wash, etc, etc....and even a bit of make-up
  
• 4 days supply of pre-natal vitamins and iron supplements that I've been taking through pregnancy
• 3 PJ sets - one in extra pregnancy size, one with button-down top and one with a big t-shirt top
• sweatpants with drawstring, nursing t-shirt and sweatshirt. I imagine this will be my dressy outfit to receive guests :-)
  
• going home outfit for mom = maternity pants + maternity top - I'm trying to not have any delusions of being slim or trim at this point!
• socks & underwear for dad
• Oh Oh - clothes for dad are still missing!! But, I guess he could come home to change - ?
• slippers for dad
• dad's toiletries bag
  
• going home outfit for Peanut - short sleeve onezie, pj with footies, hat, 2 pairs of socks, outerwear outfit
  
• extra hat for Peanut - so dad can bring it home early for the cats to get accustomed to her scent
  
• snacks for middle of the night or whenever - granola bars and barley crackers
  
• bag of prunes - oh yes!!!
  

The three 'S's - sauna, siivous ja seksi

As our due date came and went last week without any indiciation from Peanut that she was ready to head out anytime soon, we gained some local advice from work collegues and friends about how to hurry along the process.

The solution lay in the Three S's - sauna, siivous and seksi.

Sauna - the most Finnish of institutions - its our local steam bath. A standard feature in virtually every home and apartment complex, the sauna holds a mythical place in solving many - almost ANY - problem that we face through life. Even at our wedding party, we were given guidance that our marriage would survive any bump along the way that could be solved with Sisu, Spirits or Sauna (another magical threesome!).

Sauna's also have played an important role in childbirth in the years before everyone lived in cities or near hospitals. It was often the most sterile and cleanest environment in the home, thus serving as the place where many babies were born.

But, I don't know that I'm completely sold on the idea of a very, very hot steamy room in relaxing me at this point. Nine+ months is not a comfortable state to be in no matter the temperature. Heating up above the 60C seems like the wrong way to go. There would be sweat rolling into all those new pregnancy induced wrinkles, dimples and corners. Yewww....

Then again, I have yet to try it. Maybe its just what is needed to relax the back aches and still loosening ligaments. Unfortunately, we don't have a sauna in our apartment so a hot shower will have to serve as my substitute!

Siivous = Cleaning. Yes, I admit the 'nesting' instict took over at some point in the last weeks of pregnancy - for both me and my husband. I've been driven to organize, sort out and rearrange nearly every shelf, closet and box in our home. He's diligently vaccumed and mopped every last corner and put his handywork skills to work building a changing table top and creating a bathtub hanging system. Last week, I found myself ironing everything in my husband's closet and even shining his shoes (they were looking so dusty in the recently mopped hallway!). Now the only thing left are our two kitty-cats who don't realize how close they are to getting a bath.

Evidently, the cleaning is either supposed to get mom moving enough to get baby out or its just a sign of the impending birth. Either way - I'm still in one piece and running out of things to clean!!! Ahh, but, the windows - I haven't washed the windows yet.....

Seksi - yes, sex. When I first heard this idea, I thought this must be a list created by men. Supposedly there is something in the semen that stimulates the hormones that start labor. So goes the wives tale that is not exclusive to Finland.

Now, my husband has shared several males views he has heard about sex with a highly pregnant woman - somewhat incestuous, concerns about disturbing the baby and requires creative navigation. And certainly from the highly pregnant woman's point of view its not too much more exciting since at this point its very difficult to move in any direction in any position . I'm not sure who's idea this was!

And, should all that fail, a collegue of my husband's suggests a PlayStation2 to help the time fly by.....