Sunday, September 22, 2013

In which I try to dispatch a yeast rash

Hannah had a yeast diaper rash at the end of August.  We're not sure how she got it, but these things happen, so the ped prescribed nystatin. (we were there for a weight check).   Lily literally had one diaper rash the entire time she was in diapers so this is sort of new territory for me.

Disposable diapers are recommended when a baby has a yeast rash because unless cloth diapers are properly disinfected they can hang onto yeast spores and reinfect the baby.   Also, most diaper rash creams contain ingredients which will gunk up one's diapers, either ruining them entirely or requiring extensive effort to remove the residues.   The problem is that Hannah seems to be sensitive to the chemicals in most disposable diapers; her special snowflake skin can tolerate expensive unbleached Seventh Generation disposables but your run of the mill Pampers or Huggies just seems to cause more irritation.    So I was sending her to daycare in her cloth diapers with safe diaper cream, then giving her diaper free time at night and using the fancy disposables with Triple Paste, nystatin, Desitin, etc.   I disinfected her daycare diapers with bleach (since Cotton Babies recommends 1/4 cup of bleach in the wash once a month, it's OK) and then grapefruit seed extract.

We had two solid weeks where I thought we were finally free of the yeast rash.  The damned yeast must have been lurking in her bamboo fitteds (which I now realize I neglected to disinfect since I was putting her in disposables at night).  I used one of them on her on Friday night and when we got up on Saturday her formerly clear skin was back to yeast rash city.  Then I committed the error of thinking Aquaphor might help so I slathered it on before we went to bed last night.  My poor girl woke up this morning and screamed when I changed her diaper.  Clearly the Aquaphor just sealed it in and made the rash worse; mom fail, right there.

I let her be diaper free before church today and then put her in a BG4.0 with a healthy slathering of Motherlove Diaper Rash and Thrush.  The rash has improved but not enough to make me happy, so we're pulling out all of the stops to try to get the rash healing by the time we go to daycare tomorrow.

Since it's diaper laundry day anyways, I have ALL of her daycare diapers and the cloth wipes in a wash.    There are only a few ways to sanitize cloth diapers when baby has a yeast rash, and bleach is one of them but is not something I want to use often to help prolong the life of the diapers.   So we'll be using GSE (grapefruit seed extract) in every load of diaper laundry until the rash is gone, THEN will do the bleaching.

For Hannah we restarted probiotics (dip a wet finger into the probiotic container, then let her suck on it) and her cloth wipe solution has several drops of GSE in it so that she gets a mild disinfecting of her rear every time she's changed.   I was using those expensive disposables but then remembered that we have a boatload of disposable Flip inserts in the closet from when Lily was a baby, and that I should probably use those rather than expensive Seventh Generation disposables.  So I'm alternating two old Flip covers (so if they get demolished by non-cloth safe creams and ointments it's not the end of the world) with the disposable inserts and have brought out the big guns of Nystatin, Lotrimin, and OTC hydrocortisone cream mixed together and applied 3X/day with Motherlove Diaper Rash and Thrush at other changes.   If this doesn't knock it out, I don't know what will.

Saturday, September 21, 2013

My complete guide to pumping at work

This is a detailed outline of what works for me to pump breast milk at work.  I'm a fairly experienced pumping WOHM; I pumped for Lily from 10 weeks until a week before her 1st birthday when I pump weaned, and I intend to pump at work for Hannah until at least her first birthday.  I am fortunate to have a solid milk supply and therefore I'm generally able to nurse at home and only pump at work.

I have linked to some products via Amazon Associate links; in every case that I do this, the product is something that I purchased for myself (with the exception of the Ameda pump paid for by my insurance company).  These products have been used by me and I like them, or I wouldn't be recommending them!  If you decide to buy something through these affiliate links, that's cool and I thank you - if not, that's cool too.  My primary goal is to share what has worked for me, not to make money.

1. Plan where and when you will be pumping in the workplace.    I recommend starting this process before your baby is even born, when you are discussing maternity leave plans.  Many states have laws protecting the right of employees to pump or breastfeed in the workplace.  Additionally, federal law established in 2010 by the Affordable Care Act's amendments to the Fair Labor Standards Act (FLSA) obligates many employers to provide a private, non-bathroom location and reasonable break time for mothers to express breast milk for the first year of a baby's life.

However, the FLSA amendments from the Affordable Care Act do not apply to every employee in the US, despite what many breastfeeding advocates like to claim on the Internet!  I am a salaried professional employee who is exempt from both the minimum wage and the overtime pay provisions of the Fair Labor Standards Act, and therefore the amendments to the FLSA that provide for reasonable break time and a private, non-bathroom location to pump do not apply to me.   However, my employer is subject to Connecticut law on the matter regardless of my FLSA-exempt status, and Connecticut requires employers to make reasonable efforts to provide a private, non-bathroom location to pump and allows employees to use meal and break time to express milk or breastfeed.   (Note that this did not stop my organization from having me pump in a bathroom for 8 months with Lily, but to their credit when HR recognized that they weren't following state law they quickly established a suitable lactation room.)

I could write an entire post about negotiating use of a private space and having time to pump in the workplace, and I may do just that at a later date!

2.  You're probably going to need a pump.   The only exceptions would be if you are able to go to daycare to nurse the baby during your workday, or if the baby's caregiver can bring him or her to you during the workday.  Most full time WOHMs use a double electric pump, either a hospital-grade rental or a personal use pump.  Occasionally a mom will find that a manual pump or hand expression works well enough for her and her baby's needs.  The two pump brands recommended by many lactation consultants and pumping moms are Medela and Ameda, although Hygeia is rapidly gaining ground.

Also thanks to the ACA (aka ObamaCare), many insurance plans are required to cover lactation services and devices, including a breast pump.  Call your insurer for details on exactly what is covered and how to obtain your pump if one is covered by your plan.   Insurers vary widely in what they provide; some only shell out for a manual pump while others will cover a hospital-grade rental or a good quality personal use double electric.   You may be able to pay the difference to upgrade and you may be able to request a specific pump, but don't count on it. There may also be rules requiring you to get your pump from an in-network Durable Medical Equipment (DME) provider, and you may need a doctor's order to get it.  You may not be allowed to request your free pump until after your baby is born, or not until a month before your due date.  A lot of customer service reps at the insurance companies are pretty clueless on pump coverage so be prepared to call a few times before you get good answers.

I had some issues getting my ObamaPump, because I wanted a Hygeia and their DME middleman, Carecentrix, didn't want to accommodate that request even though there was an in-network DME provider who carries Hygeia pumps.  Carecentrix told me that neither my OB or I could specify a particular brand or model of pump, that whatever in-network DME they chose would provide whatever was in stock.  After repeated phone calls I finally gave up and went with the Carecentrix process.  I only learned later that I could have bypassed useless Carecentrix entirely and contacted that in-network DME myself - you live and learn, right?

I have never used a hospital-grade rental so I can't recommend one over another.  I'm on my second round of using my trusty Medela Freestyle, and the pump works for me although I worry if the motor will make it through another 9 months of pumping at work for Hannah.  My insurance company provided me an Ameda Purely Yours, which frankly I'm not thrilled with.  I would love to try a Hygeia Enjoye; Hygeia appeals to me because the pump is a closed system, is recyclable, and the company is WHO Code-compliant.

I also keep a Medela Harmony manual pump in my pump bag just in case of a problem with my double electric.  I use the Harmony on weekends when I only want to pump a bit and don't feel like washing all of the parts for the Freestyle.

3. You need a way to hold, transport, and store your milk before feeding.  To some extent, the method you use will be determined by your supply and your feeding strategy.   I prefer to feed fresh (refrigerated) milk as much as possible but I have excess milk beyond Hannah's needs while she's at daycare, so I am both collecting milk for the next day's daycare bottles and to go into the freezer stash for later use or possible donation.  Many double electric pumps come with four collection bottles and an insulated cooler tote with a reusable blue ice pack, and this works perfectly well for many working moms. You pump into the bottles at work, the tote works to keep the milk cool and make it easy to carry home, and then you can pour into the bottles that you will use for feeding.

Some moms prefer to use hard plastic or glass containers for long term storage.  In my experience, most prefer milk storage bags.  With Lily I exclusively used Lansinoh bags.  With Hannah I have tried milk storage bags from Lansinoh, Medela, NUK, The First Years, and Honeysuckle, and my favorite are the Honeysuckle bags.  The plastic is soft yet durable, the double zipper is easy to use, they have a gusset that allows the bag to stand up on its own, the price is reasonable, and they are oxo-biodegradable (which means the plastic won't be sitting in a landfill for 100+ years).  NONE of the milk storage bags have accurate volume markings; I don't trust them at all so if I want an accurate measurement I pour into a Medela collection bottle and then into a storage bag.   This volume measurement inaccuracy is also why I don't pump directly into storage bags, even when it's an option.

My personal process is to pump directly into a drop in liner in a nurser on the left side (using the Playtex pump adapter) and a Medela collection bottle on the right.  I do this because the right is my higher producing side and I would easily overflow a 4 oz drop in during my first pumping session of the day.  After my pumping session I pour milk from the Medela bottle into the drop in to make up the 3 or 4 ounces that the baby will take in a daycare feeding, and I cap the nurser with its nipple/ring/cap.  Excess milk goes into a milk storage bag.  Multiply by three pumping sessions and I have three bottles already prepared when I get home!  I simply have to label the bottles and pop them into the fridge for the next day.  The filled milk storage bag is labeled with date and volume and goes into the freezer.  This system has the additional bonus of reducing my washing-up every evening.

4.  You need a way to feed the baby your milk.  Barring some sort of special medical need or a persistent bottle refuser, this will probably be bottles.  We've used Playtex Nursers with Drop Ins as our bottle for both of our kids and have had zero issues.  My mom used nursers for my brother (who is in his late 20s - they've been around a long time!) and at the time I was pregnant with Lily, I figured we'd give them a shot.  They are inexpensive and available everywhere, and the collapsing liner reduces baby's air intake/spitting up.  I like that I can pump directly into Drop Ins using the pump adapters in the Playtex Breast Milk Storage Set.  Plus, I am lazy as hell and with nursers, you usually only really need to wash the nipples and rings between feedings - a lot faster than washing full bottles, especially bottles that have a bunch of extra parts (Dr. Browns, Breastflow, Calma, etc.).    We bought two 3-packs of 4 oz nursers (to let me pump directly into three of them at work each day while the other three are at daycare) and that will meet the baby's needs the entire time.

Cups, either sippy, straw, or open, are another option for older babies.  We transitioned to sippy cups when Lily was around 11 months old.  Again, this is a personal thing that depends on your baby; we ended up using a couple of different sippy cup brands.

5. You need a way to wash everything.  At work during the day I use Medela Quick Clean Pump Wipes to wipe out my parts, which I dry with a clean paper towel (I store my parts in the fridge during the work day, so a thorough scrubbing is not needed).   These pump wipes are a bit spendy but are big in size, so I cut them in half and keep them in a small Rubbermaid container.

At home we use Dapple Baby Bottle and Dish Liquid and either the Munchkin Deluxe Bottle Brush or the OXO Tot Bottle Brush to hand wash pump parts and bottle nipples/rings.  I sanitize my pump parts in the microwave using a Medela Quick Clean Micro Steam Bag.  Pump parts and bottle nipples and rings are dried on a Boon Grass drying rack - we have the Twig and Stem accessories and I prefer Twig for bottle nipples and rings, and Stem for pump parts.   When baby transitions from bottle to cup, Munchkin Dishwasher Baskets are great (and reduce hand washing substantially).

6.  You might want some accessories.  Strictly speaking you don't need any of this stuff, but they can make the entire process of pumping and feeding go more smoothly.

Pumping hands-free is the only way to go - I can knit, read, or do actual work while pumping!  I use the Simple Wishes hands-free pumping bra and love it.  If you don't want to spend the money, a lot of moms recommend the rubber band trick or cut slits in appropriate spots of a looser-fitting sports bra.

Daycare requires that bottles be labeled with the baby's name, and that each individual bottle is labeled with the date and quantity of breast milk or formula.   We use Mabel's Labels with the baby's name on each nurser and Label Once erasable food storage labels for date and quantity.  Both labels are super durable and hold up well to repeated cycles through the bottle warmer at daycare and hand washing/the dishwasher at home.   Our daycare encourages sending backup milk to keep in the freezer in case of a leak or an unexpectedly hungry baby.  I use the Playtex Breast Milk Storage Set to freeze 2-3 oz of milk in Drop Ins, which means that if and when backup milk is needed, the caregivers don't have to pour or transfer milk from a milk storage bag, further reducing the chance of spillage or waste.

I am blessed with slight oversupply and thus an ample freezer stash.  The First Years Breastflow Milk Storage Organizer is great to keep milk organized and protected in our chest freezer.  It fits most brands of milk storage bag, although rather than freezing in the organizer I freeze my milk bags flat and then load them into the organizer.

Monday, September 16, 2013

I would like to buy the entire contents of The Container Store

Because I think that's what will be needed in order to fully organize our two closets, our linen closet, and two dressers - not to mention the closet and dresser in the girls' room.  At this rate, my children will be wearing shorts in November due to an inability to get anything sorted and properly packed away/brought out from storage.

Mark is wearing mostly dress slacks and shirt and tie to work, sometimes a suit.  I have to admit that while I think he looks sharp in a nicely tailored outfit, this means that he has a surplus of casual khakis and golf shirts.  I suspect that a large donation to Goodwill is in our future; I finally caved and decided that anything I haven't worn in the last 2 years is also going to Goodwill.



Monday, September 9, 2013

I need a Sherpa

We have a lot of bags that need to leave the house with us every morning.  If I'm doing daycare dropoff, I find myself going out to the car with the luggage and then coming back to retrieve the children and lock up - you'd better believe that an attached 2 car garage is on the "must have" list for our next house!

Me:

  • Backpack - which itself contains my knitting bag and Kindle Fire
  • Pump bag and cooler bag for milk (thanks, Medela, for making an "attractive" tote that all of my coworkers recognize as a pump bag nonetheless)
  • Insulated lunch tote from Thirty One (love it!)
  • Purse and keys

Hannah:

Lily:
Mark:
  • Manly insulated lunch box of undetermined origin (he has the lightest load of any of us)

Sunday, September 1, 2013

Homemade cleaning solutions

As part of our overall efforts to live a more green lifestyle, we've started using more and more reusable cleaning products and homemade solutions that are safe around our kids and are easy on the wallet.  You too can do this!  In order to accomplish 90% of household cleaning in a more green way, most families would only need to follow two steps.

First, clean with reusable cloths rather than using paper towels.  This is how our grandmothers and great grandmothers cleaned house and it wasn't the end of our species!  You can always cut up your husband's ratty old undershirts, but that makes for thin cloths that can't hold up to a lot of scrubbing.  A more durable alternative would be that flannel shirt that's still hanging in the back of your closet after that 90s grunge phase - take some pinking shears to that bad boy and cut squares or rectangles in a size of your choosing.

Alternatively you can go fancy and choose microfiber cloths.  Microfiber is great dry for dusting, and you can scrub with it if it's wet.  I found microfiber cleaning cloths in the automotive aisle at BJ's for a very reasonable price and bought two 12-packs so that I can use them daily and only wash once a week, but Target, Walmart, and other retailers all carry microfiber cleaning cloths these days.   You simply wash them according to manufacturer's instructions and they're ready to go again.  We keep a stack of microfiber cloths in the closet with my cleaning products, and use a small wastebasket as a bin for the used cloths (we also use this bin for the IKEA baby washcloths that we use to clean Lily's hands and face after meals).




Second, replace your Windex or other all-purpose cleaner with a homemade solution.  You'll find all sorts of recipes on the Internet, but my tried-and-true option is made up of vinegar, baking soda, and water.   In the unlikely event that our 3 year old decides to drink it, she might have an unsettled tummy but there will be no need to call poison control!   My recipe for all purpose cleaning solution consists of 1/4 cup vinegar + 2 tbsp baking soda + warm water to fill a 32 oz spray bottle.

+= CLEAN!


Now, this cleaner doesn't disinfect, but we only disinfect surfaces 1) when raw meat, poultry, or fish has been in contact with them, or 2) during the weekly deep cleaning of the bathrooms.   For either of those situations we use a dilute bleach solution that we make up in a different spray bottle and keep on a high shef well away from the kids.    We don't surround ourselves with antibacterial products and we and the children have not been struck by any heinous diseases or viruses as of yet.   Plus, vinegar itself is a mild disinfectant.   

I keep some of this vinegar solution in a repurposed Windex Touch Up container in the kitchen and in each bathroom (although I think a pump dispenser like this would work well too, and could be decoupaged or otherwise decorated to blend in with one's decor) and use it for everyday wipe downs of countertops and fixtures.