Each time we became pregnant, I was both elated and scared as it reminded me that I don’t know anything about babies! My way of dealing with that anxiety was to read everything I could get my hands on. And since we were cumulatively pregnant much longer than nine months, I managed to read a lot! Some of the books were great, most were OK, and some were downright terrible.
Here are the prenatal books I read sorted by [my] rating, descending. And for the top books, here are my notes, because you may have other things to do than reading all the time! Caveat: these notes are not necessarily complete or good; they reflect what I took out of each book at the time.
Expecting Better (evidence-based analysis of “conventional” prenatal “wisdom”):
- obese women (before pregnancy) have more pregnancy complications
- up to 2-3 drinks / week first trimester
- up to 7 drinks / week rest of term
- avoid raw milk / raw milk cheeses / queso fresco
- avoid undercooked meat and deli turkey
- raw egg fine
- seek high omega-3 / low mercury fish, e.g. salmon, sardines
- 6 vomits average per pregnancy
- vitamin B6, ginger for nausea
- CVS and amniocentesis both safe, but CVS better/earlier
- Avoid raising body temperature to 101+ during first trimester
- Hair dye is probably fine
- Avoid gardening or at least wash hands thoroughly
- Gain 25-35 lbs during pregnancy but err on the high side
- Regular exercise good but don’t go above 90% HR
- Kegels good and reduce labor time
- Yoga probably good
- Sleeping on back probably fine unless you feel faint
- Medication – check safefetus.com and stick to A and B class drugs
- Bed rest not effective for reducing pre term labor
- Cervical effacement in addition to dilation a good indicator of labor readiness
- Intermittent fetal monitoring better than continuous during labor
- For labor augmentation, break water first then try drugs
- Just say no to episiotomy – cutting the vagina
- Vitamin K shot after birth is OK
- Having a doula is good
- Epidural has pros and cons
- Drink fluids during labor (including calories like Gatorade)
- Induction problematic so make sure fluid levels are measured deepest pocket, while well hydrated, and consider a second test
- Clapping effective sugar ineffective for non stress test
- Nipple stimulation and membrane sweeping work for inducing labor
- Vaginal birth preferred
The Informed Parent (same evidence-based approach, but extending beyond prenatal to the first few years of childhood):
- No evidence for benefit of eating placenta
- Pediatricians: personal experience, beliefs, staying current on literature
- use online questionnaire (including this book’s website) to interview pediatricians
- AAP (American Academy of Pediatricians)
- Induction: reduces risk of cesarean birth in late-term pregnancies
- Augmentation: combination of mechanical (e.g. forceps) and chemical (e.g. oxytocin) may help modestly speed along slow labor but either individually not effective
- Episiotomy not beneficial, often worse
- Pain
- Epidural works; combined spinal epidural (w/ local anesthetic) works faster
- Epidural associated with more cesarean and instrumented (e.g. forceps) births
- Nitrous associated with dizziness, nausea/vomiting
- Sedatives work but not as well as opioids
- Immersion in water and relaxation/massage techniques may work
- Acupuncture associated with fewer interventions and cesarean births
- Water injection, aromatherapy, biofeedback – insufficient evidence that they work
- Cesarean
- slightly higher risk for mom
- First stage labor: 0.5-0.7 cm dilation / hour (for first time moms – 0.5-1.3 cm/hour for experienced moms)
- Second stage labor: outcomes good for 3 hours pushing (first time moms – 2 hours experienced moms); labor augmentation like forceps or vacuum => < 3% need cesarean
- Fetal heart rate: stimulation of fetal scalp, mom position change, amnioinfusion (saline into uterus) may address HR irregularities
- Induction does not increase risk of cesarean delivery
- Breech position: external cephalic version => only 21% need cesarean
- Big baby: evidence does not support automatic cesarean
- Circumcision
- Very few risks, most of which go away in modern medical procedures
- Benefits reduce risk of penile cancer, reduce rate of STI contraction, reduce rate of UTI
- Disposable diapers about even with cloth diapers for cradle-to-grave environmental impact – compostable disposables have an edge
- Breastfeeding
- Wide variety of better outcomes for children (dose-dependent: the more, the better)
- Especially when fed at the breast (rather than pumped bottle) as breastmilk composition adapts to baby’s nutritional needs
- Exclusively breastfed babies need Vitamin K (shot) and sometimes iron and Vitamin D (supplement)
- Premature/underweight babies benefit so much from breast feeding that donated milk is prescribed over formula
- Up to 24 months of breastfeeding => benefits for the mom; after 24 months is understudied
- Not all women can breastfeed (primary lactation failure – unable to produce milk at all – vs secondary – something interferes with breastfeeding early on)
- Baby should breastfeed 8-12 times per 24 hours and should suck at least 10 min on each breast, feeling sleepy afterward
- Baby should have 6 wet diapers / day and 4 yellow, seedy, cottage cheese-like stools / day
- 44% of mothers don’t get milk w/i 72 hours of birth
- Nipple pain common in first week but may indicate a problem after that
- Vasospasm: nipple turns white then blue as blood returns
- Thrush: yeast infection causing red, sore nipples
- Clogged ducts: tender lump
- Mastitis: infection causing red, hot breasts with pea-sized lump
- Expressed milk helps relieve nipple pain
- Tongue tie in 3-11% of babies (mostly male) easily addressed with frenotomy (~100% success)
- D-MER is a condition that causes negative feelings for mom during let-down but passes quickly
- Low milk supply:
- Relaxation can help a little
- Metaclopramide increases prolactin levels for 1.5 oz more breastmilk per feeding but should only be used for 3 weeks
- Fenugreek (~600mg) helped in a small, poorly documented study
- Milk thistle helped in a very small study
- Shatavari helped in a small study
- Torbangun helped in a small study
- Moderate caffeine and alcohol probably fine while breast feeding (no need to pump and dump) but we don’t know much about marijuana
- LACTMED is a database of mom medications and their effects on breastfed babies
- Feed when baby is hungry; little/no evidence of benefits of feeding according to a schedule
- Feeding
- Teething usually 4-7 months
- No evidence that adding complementary foods at 4 months vs 6 months is beneficial (except slightly higher iron levels)
- One study shows better growth with meat as a complementary food vs cereal
- Preschoolers told to clean their plates ask for more food even when away from home
- Children for whom food is offered as a reward are more overweight
- Screen time associated with weight in children most likely due to mindless eating and advertising of unhealthy foods
- Inadequate sleep associated with childhood obesity
- Children who regularly drink sugary drinks are heavier and more likely obese
- Family meals reduce risk of obesity
- Portion size and plate size can reduce overeating
- CAN framework: make healthy food Convenient, Attractive, and Normal
- Vitamin D deficiency possible if exclusively breastfed – especially if Mom has it
- Cow’s milk promotes vitamin D but inhibits iron; two cups a day seems to be a good balance
- To address child’s resistance to new foods, eat variety of foods while pregnant and repeatedly expose child to new foods without comment, pressure, or urging. Also exclusive breastfeeding to six months helps.
- Allergies: small risk reduction when introducing potatoes before 4 months, oats before 5 months, meat and wheat before 6 months, rye before 7 months, fish before 8 months, and eggs before 11 months
- Tdap and flu vaccines recommended for Mom
- CDC vaccine schedule recommended for baby
- Private cord blood banking not likely to be helpful
- Normal birth weight 5.5-8.8 lbs
- Get the vitamin K shot
- Erythromycin not helpful if mother is STI-free
- Delay cord clamping 2-5 minutes to get lots of iron-rich blood to babies since breast feeding won’t get them much iron
- Mother-baby skin-to-skin contact immediately after birth associated with better breastfeeding outcomes, better mother-baby interactions 1 year later, improved blood sugar levels, decreased crying
- Either parent may not feel immediately bonded with baby – but fake it till you make it
- Crying
- Pain: rapidly escalating to maximum intensity with eyes squeezed shut (repeated like a siren at the highest level)
- Fear: rapidly escalating to maximum intensity with eyes open
- Anger: gradually escalating with eyes half closed
- Soothing:
- Swaddle
- Side/stomach
- Sway
- Shush (including mom singing)
- Suck
- Skin-to-skin (including breastfeeding)
- Pacifier benefits: pain relief, comfort, slightly lower risk of SIDS
- Pacifier risks: increased ear infection rate, increased risk of teeth misalignment after 18 months. No evidence pacifiers cause diads to stop breastfeeding sooner or nipple confusion.
- Sleeping:
- Mothers who spend awake time in front of screens (computer, TV, etc – phone?) are awake longer than those who don’t
- Infants sleep average 13 hours / day, wake up 3 times / night, tend to transition to more predictable sleep patterns ~3 months
- Research on bed sharing safety not great – not nearly as categorically unsafe as opponents claim (most studies don’t control for other risk factors, e.g. smoking, many blur the lines of what is considered “bed sharing,” e.g. including infant deaths on couches, many don’t consider whether parents routinely bed share and employ best practices)
- Increasing bed sharing risk: sofas, smoking, alcohol (or other depressant), multiple kids in bed, excessively tired parents, infant on pillow or blanket, premature infant, bed sharing with anyone other than parent, exclusive formula feeding
- Reducing bed sharing risk: firm mattress, infant on back without blankets / pillow / mother’s clothing, no strangulation hazards nearby, infant can’t fall out of bed or get trapped, no smoke / alcohol / drugs, mom is not a heavy or restless sleeper, only mom shares the sleeping surface, infant isn’t at risk of overheating
- Sleep training is effective in ~80% of infants (4 months +) and no adverse long term effects have been found
- Bed time routines helpful for sleep
- Mother’s emotional availability and responsiveness before bedtime helpful for sleep. Hypothesis: infant’s feeling of security at bedtime persists through waking times so infant is more able to self soothe.
- BPA has a high correlation (and likely causation) with negative biomarkers
- No cough meds for children under 4 (unless doctor says so); honey (for children over 1) helps symptoms
- Children’s acetaminophen and ibuprofen OK
- Avoid homeopathic and essential oils
- Melatonin can help autistic or ADHD children fall asleep with few side effects
- Keep guns out of the house; at worst, keep them unloaded and locked up. 1 in 3 parents of baby’s friends will have guns so ensure they do the same.
- Children don’t learn anything from things on screens until ~24 months old
- TV negative for children not just directly but also indirectly through less parental interaction
- Advertising on TV often leads to more childhood obesity
- TVs in child’s bedrooms associated with poorer sleep and greater obesity
- Media violence is associated with more aggressive children
- Developmental milestones
- 6 months
- Turns head when hearing name called
- Briefly sits without support
- Smiles
- Plays peek-a-boo
- 1 year
- Waves bye-bye
- Pulls to standing
- Might say “dada” or “mama”
- 18 months
- Follows pointing and also points
- Uses several words
- Walks
- 2 years
- Uses short phrases
- Can point to named objects
- Follows one-step instructions
- 3 years
- Uses sentences of 4-5 words
- Climbs
- Engages in pretend play
- Copies parents and peers
- 6 months
- Reading
- Infant reading programs don’t work
- Talk to child as early and as much as possible
- Keep books around and expose early/often
- Read stories to child; ask open ended questions about the story/characters
- Discipline
- Children unable to reason before ~3yo => negative reinforcement ineffective
- Give attention for positive behavior, praise more effective for already compliant children
- Withdraw attention for negative behavior
- Maintain consistent routines
- Consistent, immediate responses to behavior
- Model the desired behavior (and not the undesired behavior!)
- Clear, calm verbalization in age-appropriate language of what child did wrong and what he should have done
- Help child make choices and understand consequences
- The stronger the attachment to the parent, the more effective discipline is
- Effective negative reinforcement:
- Nonverbal (looks)
- Verbal (calm and firm, not harsh, which is counterproductive)
- time out or removing privileges to reinforce the reprimands
- time out only works if “time in” is something child wants to be part of
- time out is a removal of privileges, not a punishment (must be done calmly, no shaming)
- 1 minute too short, 4 minutes effective for children age 3-6
- some studies suggest a sliding time scale is more effective: time out ends after some time of good behavior; the clock resets with each outburst
- Corporal punishment associated with 12 negative outcomes and dose-dependent
- No evidence for long-term positive effects from corporal punishment
- Toilet training
- don’t rush, shame, or pressure
- 40-60% of children complete toilet training by age 3
- Girls usually master it (22 months) younger than boys (25 months)
- If child masters urination in the toilet but not BM, consider stool softening approaches
- Childcare
- Any effects of childcare are modest
- Family factors (home environment, socioeconomic status, etc.) have 2-3x more effect than childcare
- Quality of childcare matters a lot
- Childcare associated with very mild behavioral problems that fade away by 3rd-5th grade
- Childcare associated with stronger social skills, more self confidence, challenge management, self entertainment, more outgoing, less stress
- Higher quality childcare with better trained caregivers associated with better performance on standardized tests
- Daycare centers associated with independence, social skills, and higher test scores from age 2 through 3rd grade
- Regardless of childcare, least problematic children come from homes with sensitive fathers who encourage independence, mothers who let children decide their own activities, and parents who have a loving / emotionally intimate relationship with each other
- Families of daycare children lose an additional 13 days of sick leave (over the first 6 months?)
- These GI, upper respiratory, and ear infections are going to happen whenever the child first begins regularly interacting with other peers.
- Preschool offers academic benefits to lower class families, not much for upper-middle class families
- The home learning environment (being read to, exposure to computers, etc.) has a much greater impact on academic success
What’s Going On In There (detailed look at prenatal and postpartum neural development)
- Get purposeful prenatal winter daylight exposure for babies born april-june, who have a higher chance (18% vs 12%) of being very shy
- First hour skin to skin contact does not seem to have extraordinary bonding benefits
- Increasing variety of touch stimulation is likely to enhance brain development
- Loving touch, stimulation, and massage have shown to improve health of infants
- Bouncing, rocking, carrying stimulates the vestibular system
- Breast feeding babies smarter than bottle feeding even adjusting for socioeconomic factors
- Taurine in human breast milk (also in formula) probably helpful for brain and retina nerve development
- Human breastmilk provides not just the essential fatty acids but also the enzymes with which to break them down
- Breastfeeding babies prefer (suck longer) variety in tastes that come through breast milk
- Alcohol still present in breast milk 3 hours after ingestion
- Brain growth spurt through two years of age => especially important to have adequate fat in diet
- Visual acuity develops rapidly – from 20/600 vision at birth to 20/20 later. Initially babies can only detect high contrast (e.g. black on white) and only “where” vs “what” but these both change rapidly. The most crucial period of development is 6-12 months so, if there are any visual abnormalities (e.g. crossed eyes or cataracts), get them fixed within the first six months.
- First two months peripheral vision more developed than direct
- Binocularity onset happens rapidly between 2 and 5 months as the cortex takes over image processing
- While vision develops late and matures quickly, hearing matures early and matures gradually.
- Sounds above 85 dB can damage newborn hearing
- Newborns don’t recognize daddy’s voice until a few weeks
- Up to one year of age, best for baby to hear one thing at a time, not lots of noise
- Motherese good after high pitch response develops around 3 months
- Lots of tummy time recommended to develop upper body strength, coordination
- Walkers don’t help walking
- Holding baby upright to practice walking helps
- Gentle challenging helps
- Parenting style matters more than whether a child goes to daycare:
- Less sensitive mothers trend to have less securely attached infants
- Attached babies have lower stress response to unfamiliar stimuli
- Temperament is lower limbic system and is genetically determined while personality is upper limbic system and is experientially determined
- Parents must strike a balance between smothering attentiveness and fostering independence; children of always-attentive parents are less securely attached than those of parents who intermittently give them space to explore, fall down, etc.
- Babies distinguish speech (left brain) better with right ear and music (right brain) with left ear
- Toddler vocabulary usually explodes once they have 50 words
- Language development contributors
- Parents who talk to them more
- More positive feedback (in all areas, not just about language development); corrections not helpful
- Socioeconomic status of parents (Poor: 600 words a day directed toward baby, working class: 1200 words a day, professional class: 2100 words a day)
- Repetition (e.g., same nursery rhyme) to reinforce neutral pathways
- Repetition with substitution and expansion
- Books
- IQ physiology
- Head circumference correlated 0.14 with IQ (born more than 14″ average 7 pts higher than born less than 12.75″)
- Brain volume correlated 0.35
- Stimulus response time correlated 0.5
- Prefrontal lobes control wisdom and executive function, not IQ
- High quality daycare centers generally show better cognitive development than home care
- Student teacher ratio < 1:5 2yo, 1:7 3yo, 1:10 4yo
- Not the time for academic focus
- Iron helpful in second 6 months
- Breast feeding for a full year
- Rotate toys in and out weekly to combat habituation
- Exposure to other people and places associated with higher IQ
- But guard against overstimulation