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ask the experts
sarah j. buckley

Sarah J. Buckley GP, MD
Pregnancy and Birth, Family Planning, Co-sleeping

I had a baby 17 months ago, and my first period since baby was five cycles ago. The first three [cycles] were anovulatory, and during the fourth I ovulated. All were about 42 days long. On the fifth cycle I got pregnant. Now my question is about my due date. My fifth cycle started January 27—that was the first day of my period—and I ovulated on February 22. I got a positive pregnancy test 12 days post-ovulation. I have been charting on Fertility Friend, and they say my due date (going from ovulation) is November 14. I just saw my OB/GYN today and she didn't want to hear anything about when I ovulated, just when my last period was. Going by that date (January 27), she calculated my due date as November 3. I know doctors go by the last period, but not all women ovulate on day 14! So how can she give me the textbook due date instead of really looking at my 42-day cycle and seeing that it would [be] almost two weeks off? I only ask this question because I know that if I go past my supposed November 3 due date to my real due date of November 14, she's probably going to want to induce me, and I will not induce. What do you think?

This is a great question, Lisa, and it comes from our historical way of calculating due dates—estimated day of delivery (EDD) or estimated day of birth (EDB)—based on the last menstrual period (LMP) rather than on the date of conception. (Actually, this method counts the first two cycle weeks before conception as pregnancy, which is rather crazy.)

This method suggests that we cannot trust women's own calculations, although, of course, it may be easier to remember a period date than a conception date for women who are not charting their cycles.

Because of this ingrained method, it is possible that your OB/GYN doesn't know how to adjust her dates, which are from a chart or wheel that uses LMP. You could try to talk to her again, and print out your chart if you have it, which may help her see what you are saying. The wheel charts can be set to put your ovulation day as day 14, which would give you correct dates, as you calculated.

Personally, I would be feeling a bit concerned about choosing a [caretaker] who is unable to trust your own [knowledge] of your body and is not able to be flexible in [her] approach. You are right to be concerned that the date disparity may cause problems later in the pregnancy, but by then it may be too late to change her mind or your options.

You may want to consider other options or care providers. It is much more likely that a midwife (CPM or CNM) will understand your situation and be able to adjust your EDD accurately—and also respect your knowledge, perspective, and choices for yourself and your baby.

Many blessings to you, your baby, and your growing family,

I currently have two children, ages five and two. I have experienced symptoms of light-headedness (low blood pressure), tiredness, and muscle weakness. I have been diagnosed with Adrenal Fatigue and have been treating it holistically (Vitamin C, Vitamin Bs, adrenal glandulars) for about six months. My symptoms have improved by about 60 percent. My husband and I would like to have a third child. The timing is right for us but my question is if my body is up for it. I am 34, work full-time, and I have a very helpful spouse. Is it unwise to get pregnant until my body is at 100 percent? I'm concerned that [I] might [have to wait] a while, and I prefer my children to be spaced closer together. If I get pregnant now, how will I feel during pregnancy? After pregnancy? Can I continue taking my supplements while pregnant? While breastfeeding? If my Adrenal Fatigue worsens to the point of needing to take physiological doses of hydrocortisone, is that safe during pregnancy? And during breastfeeding? Please advise.

Adrenal Fatigue is a naturopathic diagnosis that is outside my expertise and involves treatments (e.g., low doses of hydrocortisone) that are also outside my experience and knowledge, so I am unable to give you specific advice for this condition.

That said, I would always recommend that a woman's body is in peak condition before conception. Your health before pregnancy has a greater impact on your child's lifelong health and well-being than anything that you do (or any supplements that you take) during pregnancy. With this in mind, I would recommend that you do all you can to regain your health and especially build your nutrition before you consider conceiving another baby.

In your case, I also would recommend having a hair mineral analysis done, as the sorts of symptoms that you describe could also be due to toxicity. This will also determine your levels of minerals. Ideally, your partner should check his hair as well.

I would highly recommend the book Healthy Parents Better Babies by Francesca Naish and Janette Roberts for a comprehensive guide to preconception care, or see book The Natural Way to Better Babies at www.fertility.com.au. See also the UK foresight program www.foresight-preconception.org.uk.

You can also read my previous advice about preconception nutrition, which would also apply to your situation www.mothering.com/sections/experts/buckley-archive2.html#fertility44.

I would be extremely wary about taking any drug or hormone during pregnancy, especially [during] the first three months. Hydrocortisone is not recommended at any time during pregnancy, except when there is absolutely no alternative for mother or baby, and may have long-term effects on the baby.

My 7 1/2 month old son has been having bouts of sleep crawling since he learned to crawl several weeks ago. He will crawl a few paces, and then sit down and become discombobulated and upset. He sleeps with me, so I am right there when this happens, and am quickly able to try to help him resettle. I have read that sleep crawling is sometimes part of an infant's developmental process—they are practicing their new skill in their sleep. Is this just a phase that I need to ride out with him, or is there something I can do to help him help himself?

This is a fairly common event for newly-crawling babies, and I would not be concerned at all about it. I expect that it will pass within a couple of months.

Your son is very fortunate to have your presence at night, so that you can help him as soon as it happens. This saves you sleep, and the effort of getting up to help him as well. I trust you are not leaving your son alone to sleep on your bed at any time, as this could be hazardous, especially with his unpredictable movements—see my article 10 tips for safe sleeping at http://www.naturalparenting.com.au/articles/issue4/ safesleeping.htm.

I co-slept with my parents until I was seven. I might have even stayed with them longer but I decided to co-sleep in a sibling bed with my younger brother. I am now 25 with a 14-month-old daughter who we co-sleep with. She has never slept without my husband or me. My parents would like her to spend the night with them and plan to co-sleep. Do you think that it is safe for grandparents (age 52) to co-sleep with grandkids, or do you think that they have lost the ability to be aware of a child in their bed?

You are indeed blessed to have had such security as a young child through sharing sleep with your parents and brother. Although unusual in Western cultures, sleeping with family members has been normal through most of human history and is still practiced in many non-Western cultures.

You are also lucky to have parents who are open to sleeping with your little one, which I imagine would help you to feel good about leaving her with them overnight. Actually, in many cultures this is also normal. In Hong Kong and in rural China, around one in five babies sleep with a person other than their parents (with extremely low rates of sudden infant death syndrome, SIDS) This is likely to be the baby's grandmother.

I would not be concerned about a child over one sharing sleep with other people, as she is old enough to keep herself safe from the hazards that small babies may encounter—such as entrapment and overlaying. The recommendations made by SIDS organizations to keep babies safe apply to infants less than one year, after which SIDS does not occur. (By definition, SIDS only applies to children less than one, and this type of death is extremely rare after this age).

You may, however, want to check that your parent's bed will be a safe environment for your baby. Check (and ask your parents to check) especially for risks associated with falling off the bed, and for hazards in the general environment that she could encounter such as medicines, poisons and small objects that she could choke on in drawers or cupboards. It is probably safer to not allow a child of this age to sleep in an adult bed unsupervised, partly because she may awaken and need supervision to avoid hazards.

Wishing you all a good nights sleep!

Resources SIDS recommendations for safe sleep http://www.cdc.gov/SIDS/sleepenvirnoment.htm

We have a 17 month old son, Max, who wakes three to five times a night and needs help getting back to sleep. Sometimes all he wants is a drink of water but it always has to come from his mom or dad. We all shared our queen-sized bed until Max was about 13 months old. At that point he became too restless to sleep with—neither Dad nor I were sleeping well. We successfully transitioned him to his own bed (a queen-sized futon) and his own room but he still wakes several times a night and needs help getting back to sleep. Max has been teething since he was five months old, continuously it seems, and I know that contributes to some restlessness. But after reading Elizabeth Pantley's book, The No-Cry Sleep Solution for Toddlers and Preschoolers, I'm wondering if he's just used to us being there when he wakes up and is unable to get himself back to sleep without our help. My husband has suggested that perhaps cosleeping has caused Max's inability to sooth himself and honestly, I have a hard time arguing with him. By sharing a bed with Max for so long, have we taught him that he needs help getting back to sleep? We're expecting our second child in September and I plan to share our bed with him/her as well, at least during the period of intense breastfeeding. But I want him/her to know that he/she doesn't need anyone or anything to get back to sleep.

Congratulations on your sensitive parenting for your son. I can also understand your own needs for sleep, and concerns about arrangements with your new baby.

First, I would like to reassure you that you have not caused your son's need for night-time reassurance.

One way to look at his needs is to consider that, through human history, over 100,000 generations of children have grown up in the wilds, compared to maybe 500 generations living in settled agricultural villages and less than 10 generations in modern multi-bed roomed housing.

Therefore, our children's brains are still hard-wired for night-times where adult protection and reassurance was crucial for survival. Imagine a 17 month child sleeping alone in the wild: it would certainly risk his life. So it is very normal for a young child to protest at being alone at night: their instincts are telling them that they are in a life-threatening situation.

If we consider this perspective, we can understand that any child who is not old enough to defend them selves against a nocturnal predator (lion, tiger) may feel scared at night.

For example, my six year old daughter (who has been co-sleeping and now wanting to move to her own bed) told me one morning that she awoke in the night and was so terrified that she couldn't more, or even call out. Her brother (aged 11) said he remembered having the same experience. I realized how lucky I am that my children can share this verbally; the experience for younger children is likely the same (or scarier), and they can't articulate it, and therefore parents don't appreciate the depth of these hard-wired fears. (As I say in my book, ?the monsters that our children see under their beds are real, although possibly extinct by now.')

You might also consider that most parents don't sleep alone either, and I often find that I don't sleep as well when my partner is away.

So any method that attempts to get a young child to sleep through the night alone is going to be up against millions of years of human expectations. This is the reason why most sleep training techniques do not produce lasting effects, and why most children will wake regularly for comfort in the pre-school and sometimes school years. This is normal.

There are several solutions, and you will have to see what will work best for your family. Some families cosleep, which is the norm in most non-western cultures throughout childhood, with older siblings often sleeping together as well.

Parents who do not want to cosleep may have a separate close by bed in their room that children sleep in, or can come into in the night.

You may have found yourself that the most difficult time for a child is falling asleep, so lying down with children at this time can be very helpful. Some families (our included) have double beds for young children so that a parent can come in during the night and sleep comfortably with the child for some time. When I had younger babies, my husband had this task with the older children, and it was very sweet to find him, snuggled up in a double bed with several children around him, the next morning.

It is also worth considering what our goals are with our children's sleep. Generally the goal is for the parents to get adequate sleep so that they can do what they need to do in the daytime. Children's sleep is usually only problematic if it disturbs the adults. With this in mind, we could also consider if there are other ways that we can care for ourselves so that we are well rested.

Personally, I recommend that all mothers of young children—especially those who are still taking a daytime nap—ensure that they also nap as much as possible. You will find this a great habit with your new baby too.

I have found that over the years I have come to enjoy cosleeping more and more, appreciating the sweetness (and cuddliness) of my children at night and realizing that this time is really very brief. I have also relinquished any expectation of nighttime independence (which is very much a cultural expectation), which has helped me to become more sensitive to their needs.

On a practical note, I also find that my children sleep most peacefully when their nutritional and emotional needs are met, including the need to ?let off stream' with rough play and/or sometimes a tantrum before sleep. See Aletha Solter's book for more about this.

Many blessings to you and your expanding family.

Resources

I am seven weeks pregnant with an IUD still in place. My question is should I have it removed or leave it in place for the duration of the pregnancy? I am finding it very difficult to find any information or stats on this type of pregnancy.

An IUD is a reasonable form of contraception for women in a stable relationship. Effectiveness is around 95-99%, which means that for every 100 women using an IUD for one year, between three and five of them wil become pregnant. This is similar to the Pill.

However if you do become pregnant with an IUD, you need to have a medical check as soon as possible.

The IUD makes an ectopic pregnancy—where the pregnancy begins to grow in your tubes rather than your uterus—more likely. An ectopic can cause significant problems, including severe but hidden bleeding. You need to have a scan to check this, and also to see where the IUD is, as sometimes they can fall out without you noticing, and leave you at risk of pregnancy.

It is likely that your doctor will also advise you to have the IUD removed, as it can cause miscarriage left inside. There is also a chance of miscarriage when removing it, so neither course of action is risk-free. In a very few circumstances, it may be judged safer to leave it.

Are there any risk factors evolved with swimming or bathing during pregnancy? I've heard that it is not advisable for pregnant women to be immersed in water. Is there any truth in this?

Many women are naturally drawn to water during their pregnancies, and it is very safe for pregnant women to use water immersion. Before labour, the baby is protected by the amniotic membranes which ensure that no contamination from the outside can reach the baby. Swimming, bathing and exercise in water can all be enjoyable and beneficial for the pregnant mother.

Note however that it is not advisable to spend long periods in very warm baths and hot tubs in the first three months of pregnancy, as elevated maternal temperature is a risk factor for birth abnormalities in the baby.

During labour, after the membranes break, we need to be more cautious with what we allow inside our vaginas because there is the risk of infection passing to the baby (even with vaginal examinations), especially if there is a long interval between the membranes breaking and the baby's birth.

However the use of water in labour does not seem to cause harm. It is prudent to pay attention to cleanliness of the water and tub, and to limit the number of vaginal examinations after rupture of the membranes when using water immersion or when labour is long.

Further reading:

  • Balaskas, J. & Gordon, Y. (1990). Water Birth. London: Thorsons.
  • Buckley SJ (2005) Jacob's Water Birth: a gentle start. In Gentle Birth, Gentle Mothering, the wisdom and science of gentle choices in pregnancy, birth and parenting. One Moon Press, Brisbane Australia www.sarahjbuckley.com.
  • Harper, B. (1994). Gentle Birth Choices. Vermont: Healing Arts Press, Inc
  • Odent, M. (1996). We are All Water Babies Berkeley: Celestial Arts.

See also:
www.waterbirth.org

My husband and I have been using Fertility Awareness to avoid/achieve pregnancy. Our baby is due soon and I will be breastfeeding exclusively. I know that breastfeeding can alter the signals that normally would alert me to the fact that my fertile time is approaching, so I'm wondering if it is pretty much impossible to use FA while breastfeeding...or do I just need to be on the lookout for different signals?

Your question is important because, as you imply, fertility awareness (FA) can be more challenging while nursing.

This is because, while breastfeeding, your body is producing hormones to inhibit your fertile cycle from returning, but this effect will fade with time. The time when you resume your fertility is not generally predictable, and while nursing, you may be on the edge of fertility for some time before you actually ovulate. It is also tricky because you can ovulate (and even conceive) before you first menstruate, although this is very unlikely in the early months.

Breastfeeding may also alter your cycles, making them longer than previously, although generally they will come back to your normal pattern over months to years, depending on how long you breastfeed. Some women find that, with long-term breastfeeding, their cycles do not return for one to two years after birth.

The first six months
You can be 98% certain for the first six months that, if your baby is not receiving supplementary foods or fluids and your cycle has not returned, you will not be fertile. This has been called "lactational amenorrhea method" (LAM) and is Mother Nature's means of ensuring that pregnancies are well spaced for the health of mother and baby. The failure of LAM is around 2%

The three criteria for LAM are:

  • Your menses have not returned.
  • Any bleeding after 56 days postpartum should be interpreted as menstruation and therefore a sign of resumed fertility. Bleeding before 56 days is interpreted as the normal postpartum lochia.
  • You are fully or nearly fully breastfeeding. Basically, the more suckling your baby does, the more signals your body gets to keep your fertility on hold. For LAM, you need to breastfeed at least every four hours in the day and every six hours at night. Some research has suggested that supplementing up to 15% of all feeding may not interfere with LAM: if you are supplementing and want to prolong your infertile period, make sure that you breastfeed your baby before offering any sort of supplement, including water.
  • Your baby is less than six months old

After six months
After six months (or before six months, if your cycle has resumed) you can use FA methods to check your fertile status, but note that you may have prolonged periods of fertile mucus, as your body gets to the verge of fertility, but then recedes without ovulation. This makes it difficult to know whether this mucus pattern actually signals impending ovulation or a 'false start.'

Extra information that may help is the state of your cervix, which is also a useful adjunct to any FA method. You can feel your cervix with your clean index finger high in your yoni (vagina): if it's hard to find, try squatting, putting one foot on a chair, and/or bearing down a little.

For most of your cycle, your cervix will be low in your yoni and firm, like the tip of your nose with small dimple in the center. As ovulation nears, your cervix softens and rises in your yoni, opening a little and also getting a slippery feeling from the fertile mucus. This makes it feel more like your lips than your nose, and is sometimes called SHOW: soft, high, open and wet.

After ovulation, your cervix changes rapidly over 24 hours or so to become firm, low, closed and not wet or slippery. (As per FA, you need to wait three days after this change before you can presume that you are in the infertile part of your cycle). I recommend that you use the extra information from your cervix to complement your other FA observations (temperature, mucus)

You may find that it takes a bit of practice to recognize these changes. It may be helpful to take the opportunity to check your cervix at least daily in the shower or bath, and on the toilet. While you are breastfeeding, you will likely notice no change until after your first ovulation, although your cervix may alter in position depending on how full your bowel is.

Note that fertile mucus can nourish sperm for up to five days, so that any sign of fertile mucus should be regarded as a potential forerunner of ovulation, even without changes in your cervix.

Personally, I have also found that more information about my fertile state can come from dreams, my feelings about my body, how attractive I find my partner (and how attractive I find people generally!)and even comments from friends and strangers. See Conscious Conception, below for more about this. Note that this answer is intended as a supplement to FA information. For a full explanation of FA, please see Taking Charge of your Fertility or A Cooperative Method of Natural Birth Control or, better still, get personal instruction in FA from local practitioner.

More reading

Taking Charge of your Fertility: the Definitive Guide to Natural Birth Control, Pregnancy Achievement and Reproductive Health, Toni Weschler (HarperCollins 2002) A Cooperative Method of Natural Birth Control, Margaret Nofziger (The Book Publishing Company 1992) Conscious Conception: Elemental Journey through the Labyrinth of Sexuality Jeannine Parvati Baker and Frederic Baker (Freestone Publishing/North Atlantic Press 1986) http://www.freestone.org/publishing/

See also:
http://www.fwhc.org/birth-control/fam.htm

I am trying to conceive and live in a very small town in which the doctors do not practice natural birthing methods (believe me, I've searched)! The closest city that would offer these methods is approximately 75 miles away. Would it be wise to travel that far for the care that I believe in? Please help... I am torn!

I am presuming that this will be your first baby, in which case I think the care that you choose is very important, as first births tend to have higher rates of intervention. Traveling this far in labor is also more feasible, as it is likely that labor will be longer with a first baby.

However, it is difficult to advise you, as it depends a little on your specific situation and how possible it will be to travel that far for your care, especially the weekly visits that most practitioners require in the last month or so of pregnancy.

It also depends on the local availability of other supporters such as doulas, who may be ale to help you to get the birth you want even in a more medicalized setting.

My suggestion is that you interview the people who would be giving you care in your home town and also use your local networks (or in a neighboring town) to see if you can find any support such as doulas. Then go further and interview the practitioners that you are drawn to 75 miles away.

I also suggest that you look for midwives who may be willing to travel to care for you in labor. Try http://www.midwife.org/find.cfm to find a midwife close enough to you. Interview midwives by phone or in person.

Here are some questions that you may want to ask your proposed carers:

  • What training and experience do you have?
  • What is your basic philosophy of birth care?
  • What prenatal care do you provide?
  • Do you work with other practitioners? Am I likely to meet them or to have them care for me during labour?
  • What back-up arrangements do you have?
  • What care and observations will you do during labour?
  • What assistance can you give if labour is difficult or prolonged?
  • Are you experienced and trained in resuscitation of mother and baby?
  • What postnatal care do you provide?
  • What are your rates of interventions and of complications such as perineal tears and postpartum haemorrhage?
  • Do you have children yourself and, if so, what was your experience of birth?
  • Do you offer any alternative skills such as herbs, homeopathy, and/or acupuncture?

If possible, take your partner or another trusted friend, and make notes afterwards. Above all, use your intuition and gut feelings about the practitioners, and how you might feel about having their care during labour.

Also, remember that you can almost always change your mind later in pregnancy, which is important because sometimes your situation can change, and/or you may discover more information about your choices. Keeping your options open is always good in planning for labor and birth: this will allow you to respond to your instincts as well.

Wishing you well in your journey.

My daughter was born in August of 2004 and we put her placenta in the freezer with the best of intentions to encapsulate it for homeopathics later on. However, it has been almost 17 months and it is still in the freezer. Can it still be encapsulated and taken or does a placenta go bad?

I know how things like this can get forgotten in the busy-ness of the early months and years with a new baby! At this stage, 17 months after birth, there are things that you can and probably can't do with your baby's placenta.

You need to consider that your baby's placenta is essentially a piece of flesh, similar in texture and keeping qualities to animal liver. I would not advise anyone to eat animal liver that had been kept for this long in the freezer, so I don't think that ingesting your baby's placenta at this stage, in any form, would be a good idea.

However, there are some other nice options that you could choose, to honor your baby's placenta. Many people bury their child's placenta in a significant place, and plant a tree that becomes special to the child. You may wish to have a small ceremony as you do this. Your daughter may even be interested in the fate of her placenta, and you can thaw it and show it to her before you bury it—and maybe to yourself as well.

Depending on how 'fresh' the placenta was when you froze it, you may be able to make a placenta print, using the blood from your baby that will also thaw with it. (Wipe it a little to ensure there isn't too much blood) Press the thawed placenta to a large sheet of good-quality acid-free paper—you may want to have a practice first—and allow it to dry naturally. Alternatively, you can completely dry the placenta and cover it with ink to make your print. A placenta print, which highlights the placenta's branching vessels, reminds us why it is sometimes called the 'tree of life'. See resources for more information.

Another option, even with a frozen placenta, is to cut off a piece of the cord and let it dry straight and naturally in the air over days to weeks. In some cultures (including Native American) a piece of this is given to the child in a small container, or sewn into a pouch, and worn as an amulet around the neck.

For more information read my articles The Amazing Placenta and Placenta Rituals and Folklore from around the World.

More about placenta prints:
Pregnancy and Childbirth Art Placenta Imprint Kit

For an in-depth look at the placenta, from placental psychology to lotus birth (non-severance of the cord), see the book Lotus Birth available at www.sarahjbuckley.com/shop.

We are planning for the birth of our second child; our first child is almost two. We are hoping he can be present at the birth (at home) and are also trying to plan for sleeping issues as we are still co-sleeping. Do you have suggestions, tips, resources or thoughts on how to help prepare our child and help him be present for the birth without trauma? Also, how can we co-sleep comfortably with a two-year old and a newborn?

Congratulations on your pregnancy and upcoming home birth. Homebirth gives a wonderful opportunity for older bothers and/or sisters to be involved and maybe even witness the birth of their new sibling. My older children have all been present (by their choice) at the birth of their younger siblings. There are several things that may be helpful to consider.

Firstly, most young children can deal with events at birth with more equanimity than we expect, especially if they have been prepared and involved. I am sure you have been talking about the new baby for months, maybe letting your toddler feel, listen and even gently prod your belly, and your growing baby will be familiar with the voice and presence of your son as well.

You can also talk about what might happen at the birth, with an emphasis on listening to your son's words, if he is talking, to help you to understand his perspective. Playing birth games, eg putting your child up your sweater (or between your legs) and replaying his birth is a fun as well as interesting, and may help him to remember his own experiences, and you can talk about it if it seems appropriate. (I have found that my children have clear memories of their birth from age 2 to 7 or so)

Making noises, especially those you might use at birth (however loud!) will also help him to know how it might be, and to feel whether he wants to be there, as below.

I have also found it useful to play birth videos with my children, to give another perspective for them, and to help me gauge how they will cope with birth energy and noises. Before the birth of my third baby, I played Channel for a New Life by Elizabeth Noble which shows some of her short but intense labour, to judge my children's comfort with this, and it was amazing. Emma, then 4, found an old sleeping bag and crawled in asking me to hold the top and let her push her way out. Her sister Zoe, almost 2, did the same thing, but played out being a^??duck' (stuck) as she was in her labour. Both emerged posterior (face up) as they had been at birth!

Secondly, I think the key to making birth arrangements of any kind, especially with siblings, is to keep options open, so there is freedom and flexibility to choose what feels right at the time for you as well as your son. Birth can bring up some unexpected feelings and preferences. I would suggest that you arrange to have a trusted caregiver who can be with your son at home, or take him away, according to what your and his choices are.

You will need someone who is also comfortable with birth energy, and with your choice of homebirth, as well as being sensitive to your son's needs. I suggest that this not be your husband, unless you would be happy if he spent all the labour with your son, rather than you, as might happen.

As above, make this arrangement flexible, maybe you will go into labour at night and not need to call your son's support person. Your son may also make his own choices. I attended a homebirth where the son, aged 2 or so, woke when his mother was in strong labour at night, saw what was happening and took himself back to bed and sleep, which was very unusual. He woke several hours later, soon after the birth, and said hello to his new sister!

Lastly, there are some wonderful books and resources that tell the story of birth from a siblings perspective. My favourite is the book Welcome with Love by Jenni Overend (available from Amazon), which is a homebirth story told through the eyes of an older brother. The illustrations are gorgeous, and very realistic, as is the description of birth.

Rgarding co-sleeping, there are some possibilities to consider, and as above, you may find that you make different or unexpected choices at the time. You can choose to keep co-sleeping, bearing in mind that it is not considered safe to sleep an older sibling next to a baby under one year old. Maybe your son could move to your husband's side of the bed, or between you. If you need extra space, you can consider a king-sized bed (one of the best investments for a co-sleeping family!) and even turn it sideways to get the full 6'6a^?? width for you all. You could add a single bed alongside for extra space. I recommend this excellent and safe co-sleeper for a newborn in a family bed: www.humanityinfantandherbal.com/humanityfamilybed.html.

Alternatively, some children may be happy in a separate bed in the same room, or even to move to their own room at this age. You can talk to your son, and try some different scenarios, bearing in mind that it is biologically normal for a small child to want adult company and protection at night.

Another option is to have a double bed elsewhere that your husband and son can share for a few months. Personally, I found that I needed my space with a newborn, and this arrangement worked well for our family. In later years, our children slept together in the double bed, sometimes with my dh wedged in there too! For more about co-sleeping, see my article and book below. I wish you joy on your journey to an expanded family.

Resources
Website:
Getting a good night's sleep, another perspective, Sarah J Buckley. http://sarahjbuckley.com/articles/articles.htm

Books:
"Getting a good night's sleep - gentle approaches to night waking"
"The cosiness of co-sleeping"
Both in Gentle Birth, Gentle Mothering: The Wisdom and Science of Gentle Choices in Pregnancy, Birth and Parenting by Sarah J Buckley
See www.sarahjbuckley.com

I am 40 weeks pregnant and I have been leaking fluid for a week now. I am a little worried about my amnioic fluid being low but my OB/GYN isn't concerned. He hasn't checked my cervix or done an ultrasound the past several weeks. How concerned should I be that I'm leaking regularly for a week now? I use a pantyliner and change it through the day. After I urine, the fluid continues to drip. The OB/GYN said not to worry as long as the fluid is clear. Is that true? What about the fluid becoming low? How do I know when that happens? What do I look for?

While you are pregnant, your body is constantly making amniotic fluid to surround and cushion your baby and to provide sealed protection against invading bacteria. The fluid is held in place by a two-layered sac, commonly called the membranes. When your membranes break 'rupture') the amniotic fluid 'waters') will leak out.

The membranes can break in several different ways, Most commonly they break at the very bottom of your uterus (called the forewaters), due to pressure from your baby's head with labor contractions, and there is usually a big gush. This most commonly happens towards the end of labor but can also signal the beginning of labor.

Membranes can also rupture higher up, commonly called a hindwater rupture or leak. A hindwater leak dose not usually gush, but can be a slow, prolonged trickle, which is most likely your situation. For around 10% of women, the membranes will rupture at term but labor does not begin. This is called a prelabor rupture of membranes (PROM).

If your waters break, your body will still continue to make more amniotic fluid, which is constantly replenished. In this case, it is important to drink adequate fluids, which will help to keep your baby's amniotic fluid levels healthy.

However the major concern for you and your baby is the risk of infection entering your uterus and baby, who will not have the protection of intact membranes. There is also a small risk of your baby's cord prolapsing through the hole in your membranes, if you have a forewater leak. The higher placement of a hindwater leak makes it harder for bacteria to enter or for the cord to prolapse.

Different hospitals and physicians have different approaches to a prelabor rupture of membranes (PROM). Some want to ensure that the baby is delivered within a certain time after your membranes have ruptured, and will want to induce labor after 18, 24, 48 or 72 hours. Others, especially those with a low-tech philosophy, may be comfortable with a wait and watch' or a^??expectant' approach.

The best medical evidence suggests that there is some benefit from induction, although 50 mothers would need to be induced to avoid one serious case of infection in a baby. Ideally, you will make an informed decision for yourself, based on adequate and accurate information from your carer.

It is important to know if you are a carrier of group B strep (GBS), as this bacteria can cause serious harm to your baby. If you have not had a swab in pregnancy, you should have one soon after your waters break, if labor is not looking imminent. Your carer needs to be very careful to keep germs away from your cervix and uterus while doing this. If you know that you are GBS positive, or your swab comes back GBS positive, I recommend that you consider induction and/or having antibiotics to protect your baby in this situation.

If you are not GBS positive, 'wait and watch' approach may suit you and your carer. This is most appropriate, as below, if you stay at home. There are some very important guidelines if you are following 'wait and watch' approach.

Firstly, anything that is put into your vagina will increase the risk of infection. This means that you should avoid having vaginal examinations, baths (even a shallow-hip bath), sex and using tampons. Generally you are more likely to avoid infection staying at home, although some doctors want women in your situation to be admitted to hospital for monitoring, as below. Multiple vaginal examinations are one of the biggest risk factors for infection.

Your personal hygiene is important also. You want to keep bacteria away from your vagina, and this may be helped by scrupulous toilet hygiene. Keep your bathroom clean, consider having one toilet for your exclusive use, if possible, and also have a shower or wash your perineum well after a bowel movement. It may also be beneficial to not wear underwear or a pad, as much as possible, or at least change your pad frequently. Don't use chemically treated pads: clean cotton diapers are a good alternative.

Monitoring is important, so that you can pick up an infection as early as possible. Most midwives would suggest that you check your own temperature in the morning and every four hours during the day , and report to your carer of it is over 100.4 degrees F (38 C). You also need to pay attention to your baby's movements and report if your baby is moving less than usual. You can also check your fluid, which should be clear with a sweet-salty smell: if the odour becomes unpleasant, or the fluid cloudy or green, also report this to your carer. Many carers will want more intensive monitoring. This may include blood tests every day or two and fetal heart monitoring (either listening or by machine) every day.

Some experts also suggest that you take supplements to reduce the risk of infection. Midwife Anne Frye suggests Echinacea 1/4 dropper four times daily plus vitamin C 500 mg daily and a good prenatal multivitamin. There is some evidence that good intakes of vitamin C in pregnancy make the membranes tougher and less likely to rupture before labor.

Hopefully you will, like most women with PROM, have already gone into labor and had a safe birth and a healthy baby.

References
Anne Frye Holistic Midwifery Volume 1 Care during pregnancy Labrys Press. Portland OR, 1998
Association of Radical Midwives Archives Prelabour / Prolonged Rupture of Membranes http://www.radmid.demon.co.uk/prom.htm
Gentle Birth archives http://www.gentlebirth.org/Midwife/prom.html

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