9/28/10

Mother Nature’s hormonal blueprint


Ecstatic birth - nature’s hormonal blueprint for labor
by Dr Sarah J Buckley 2005: http://www.sarahjbuckley.com/

This article has been previously published in Mothering Magazine, issue 111, March-April 2002, and in Byron Child, issue 5, March 2003. This version updated March 2005.

This material has been further expanded as“Undisturbed Birth: Mother Nature’s hormonal blueprint for safety, ease and ecstasy” available in Sarah’s book, Gentle Birth, Gentle Mothering: The wisdom and science of gentle choices in pregnancy, birth, and parenting.


Giving birth in ecstasy: This is our birthright and our body’s intent. Mother Nature, in her wisdom, prescribes birthing hormones that take us outside (ec) our usual state (stasis), so that we can be transformed on every level as we enter motherhood.

This exquisite hormonal orchestration unfolds optimally when birth is undisturbed, enhancing safety for both mother and baby. Science is also increasingly discovering what we realise as mothers - that our way of birth affects us life-long, both mother and baby, and that an ecstatic birth -- a birth that takes us beyond our self -- is the gift of a life-time.
Four major hormonal systems are active during labor and birth. These involve oxytocin, the hormone of love; endorphins, hormones of pleasure and transcendence; adrenaline and noradrenaline (epinephrine and norepinephrine), hormones of excitement; and prolactin, the mothering hormone. These systems are common to all mammals and originate deep in our mammalian or middle brain.

For birth to proceed optimally, this part of the brain must take precedence over the neocortex, or rational brain. This shift can be helped by an atmosphere of quiet and privacy with, for example, dim lighting and little conversation, and no expectation of rationality from the laboring woman. Under such conditions a woman intuitively will choose the movements, sounds, breathing, and positions that will birth her baby most easily. This is her genetic and hormonal blueprint.

All of these systems are adversely affected by current birth practices. Hospital environments and routines are not generally conducive to the shift in consciousness that giving birth naturally requires. A woman’s hormonal physiology is further disturbed by practices such as induction, the use of pain killers and epidurals, cesarean surgery, and separation of mother and baby after birth.

Hormones in Birth:

Oxytocin

Perhaps the best-known birth hormone is oxytocin, the hormone of love, which is secreted during sexual activity, male and female orgasm, birth, and breastfeeding. Oxytocin engenders feelings of love and altruism; as Michel Odent says, “Whatever the facet of love we consider, oxytocin is involved.”1

Oxytocin is made in the hypothalamus, deep in our brains, and stored in the posterior pituitary, the master gland, from where it is released in pulses. It is a crucial hormone in reproduction and mediates what have been called the ejection reflexes: the sperm ejection reflex with male orgasm (and the corresponding sperm introjection reflex with female orgasm); the fetal ejection reflex at birth (a phrase coined by Odent for the powerful contractions at the end of an undisturbed labor, which birth the baby quickly and easily2); and, postpartum, the placental ejection reflex and the milk ejection, or let-down reflex, in breastfeeding.

As well as reaching peak levels in each of these situations, oxytocin is secreted in large amounts in pregnancy, when it acts to enhance nutrient absorption, reduce stress, and conserve energy by making us more sleepy.3 Oxytocin also causes the rhythmic uterine contractions of labor, and levels peak at birth through stimulation of stretch receptors in a woman’s lower vagina as the baby descends.4The high levels continue after birth, culminating with the birth of the placenta, and then gradually subside.5

The baby also has been producing increasing amounts of oxytocin during labor;6 7 so, in the minutes after birth, both mother and baby are bathed in an ecstatic cocktail of hormones. At this time ongoing oxytocin production is enhanced by skin-to-skin and eye-to-eye contact and by the baby’s first attempts at suckling.8 Good levels of oxytocin will also protect against postpartum hemorrhage by ensuring good uterine contractions.

In breastfeeding, oxytocin mediates the let-down reflex and is released in pulses as the baby suckles. During the months and years of lactation, oxytocin continues to act to keep the mother relaxed and well nourished. Oxytocin expert and researcher Professor Kerstin Uvnas Moberg calls it ‘…a very efficient anti-stress system, which prevents a lot of disease later on.’3 In her study, mothers who breastfed for more than seven weeks were calmer,when their babies were six months old, than mothers who did not breastfeed.

Outside its role in reproduction, oxytocin is secreted in other situations of love and altruism, for example, sharing a meal.9 Researchers have implicated malfunctions of the oxytocin system in conditions such as schizophrenia,10 autism,11 cardiovascular disease,12 and drug dependency,13 and have suggested that oxytocin may mediate the antidepressant effect of drugs such as Prozac.14

Beta-endorphin

As a naturally occurring opiate, beta-endorphin has properties similar to pethidine (meperidine, Demerol), morphine, and heroin, and has been shown to work on the same receptors of the brain. Like oxytocin, beta-endorphin is secreted from the pituitary gland, and high levels are present during sex, pregnancy, birth, and breastfeeding.

Beta-endorphin is also a stress hormone, released under conditions of duress and pain, when it acts as an analgesic and, like other stress hormones, suppresses the immune system. This effect may be important in preventing a pregnant mother’s immune system from acting against her baby, whose genetic material is foreign to hers.

Like the addictive opiates, beta-endorphin induces feelings of pleasure, euphoria, and dependency or, with a partner, mutual dependency. Beta-endorphin levels are high in pregnancy and increase throughout labor,15 when levels of beta-endorphin and corticotrophin (another stress hormone) reach those found in male endurance athletes during maximal exercise on a treadmill.16 Such high levels help the laboring woman to transmute pain and enter the altered state of consciousness that characterizes an undisturbed birth.

Beta-endorphin has complex and incompletely understood relationships with other hormonal systems.17 In labor, high levels will inhibit oxytocin release. It makes sense that when pain or stress levels are very high, contractions will slow, thus ‘…rationing labor according to both physiological and psychological stress.’18

Beta-endorphin also facilitates the release of prolactin during labor;19 prolactin prepares the mother’s breasts for lactation and is thought to be important in preparing the baby’s lungs and heat-regulating systems for life outside the womb.20 21

Beta-endorphin is also important in breastfeeding. Levels peak in the mother at 20 minutes,22 and beta-endorphin is also present in breast milk,23 inducing a pleasurable mutual dependency for both mother and baby in their ongoing relationship.

Fight-or-Flight Hormones

The hormones adrenaline and noradrenaline (epinephrine and norepinephrine) are also known as the fight-or-flight hormones, or, collectively, as catecholamines (CAs). They are secreted from the adrenal gland above the kidney in response to stresses such as fright, anxiety, hunger or cold, as well as excitement, when they activate the sympathetic nervous system for fight or flight.

In the first stage of labor, high CA levels inhibit oxytocin production, therefore slowing or inhibiting labor. CAs also act to reduce blood flow to the uterus and placenta, and therefore to the baby. This makes sense for mammals birthing in the wild, where the presence of danger would activate this fight or flight response, inhibiting labor and diverting blood to the major muscle groups so that the mother can flee to safety. In humans, high levels of CAs have been associated with longer labor and adverse fetal heart rate patterns (an indication of stress to the baby).24

After an undisturbed labor, however, when the moment of birth is imminent, these hormones act in a different way. There is a sudden increase in CA levels, especially noradrenaline, which activates the fetal ejection reflex. The mother experiences a sudden rush of energy; she will be upright and alert, with a dry mouth and shallow breathing and perhaps the urge to grasp something. She may express fear, anger, or excitement, and the CA rush will cause several very strong contractions, which will birth the baby quickly and easily.25

Some birth attendants have made good use of this reflex when a woman is having difficulties in the second stage of labor. For example, one anthropologist working with an indigenous Canadian tribe recorded that when a woman was having difficulty in birth, the young people of the village would gather together to help. They would suddenly and unexpectedly shout out close to her, with the shock triggering her fetal ejection reflex and a quick birth.2

After the birth, the mother’s CA levels drop steeply. A warm atmosphere is important; a new mother is very sensitive to temperature and if she cools down significantly, the cold stress will keep her CA levels high, inhibiting her natural oxytocin release and therefore increasing her risk of postpartum hemorrhage.26

Noradrenaline, as part of the ecstatic cocktail, is also implicated in instinctive mothering behavior. Mice bred to be deficient in noradrenaline will not care for their young after birth unless noradrenaline is injected back into their system.27

For the baby also, birth is an exciting and stressful event, reflected in high CA levels. These assist the baby during birth by protecting against the effects of hypoxia (lack of oxygen) and subsequent acidosis.28 High CA levels at birth ensure that the baby is wide-eyed and alert at first contact with the mother. The baby’s CA levels also drop rapidly after an undisturbed birth, being soothed by contact with the mother.

Prolactin

Known as the mothering hormone, prolactin is the major hormone of breast milk synthesis and breastfeeding. Levels of prolactin increase in pregnancy, although milk production is inhibited hormonally until the placenta is delivered. Levels decrease during labor but then rise steeply at the end of labor and peak with birth.

Prolactin is a hormone of submission or surrender--in primate troops, the dominant male has the lowest prolactin level--and produces some degree of anxiety. In the breastfeeding relationship these effects activate the mother’s vigilance and help her to put her baby’s needs first.29

Prolactin has been associated with nurturance from fathers as well as mothers, earning the additional label “The hormone of paternity”30. New fathers with higher prolactin levels more responsive to their babies’ cries.31 Animal studies show that prolactin release is also increased by carrying infants32.

The baby also produces prolactin in pregnancy, and high levels are found in amniotic fluid, secreted by the baby’s membranes as well as the mother’s uterine lining.33 Prolactin is also secreted into breastmilk, at least in the rat. 34 According to one researcher,“… there is evidence that prolactin plays an important role in the development and maturation of the neonatal [newborn] neuroendocrine [brain-hormone] system.”35

Undisturbed Birth

Undisturbed birth is exceedingly rare in our culture, which reflects our ignorance of its importance. Two factors that disturb birth in all mammals are firstly being in an unfamiliar place and secondly the presence of an observer. Feelings of safety and privacy thus seem to be fundamental. Yet the entire system of Western obstetrics is devoted to observing pregnant and birthing women, by both people and machines, and when birth isn’t going smoothly, obstetricians respond with yet more intense observation. It is indeed amazing that any woman can give birth under such conditions.

Some writers have observed that, for a laboring woman,having a babyhas a lot of parallels with making a baby: the same hormones, the same parts of the body, the same sounds, and the same needs for feelings of safety and privacy. How would it be to attempt to make love in the conditions under which we expect women to give birth?

When I gave birth to my fourth baby, Maia Rose, I arranged a situation where I felt very private, safe and undisturbed, and had my easiest and most ecstatic labor and birth: one-and-a half hours with an unexpectedly breech baby. I believe that this birth proceeded optimally because of this lack of disturbance, and because of my freedom to follow my own instincts.

Undisturbed birth is possible in a variety of settings, but must always involve a feeling of emotional security for the birthing woman. A familiar and supportive companion, such as a midwife or doula, can play an important role in creating and protecting a private space for the laboring woman, especially in a hospital setting.

Impact of Drugs and Procedures

Induction and Augmentation

In Australia in 2002, approximately 26 percent of women had an induction of labor, and another 19 percent have an augmentation--stimulation or speeding up of labor—through either artificial rupture of membranes or with synthetic oxytocin (Pitocin, Syntocinon).In the US in 2004, 53 percent of women reported that they had Pitocin administered in labor to strengthen or speed up contractions.36

Synthetic oxytocin administered in labor does not act like the body’s own oxytocin. First, Pitocin-induced contractions are different from natural contractions, and these differences can have significant effects on the baby. For example, waves can occur almost on top of each other when too high a dose of Pitocin is given, and it also causes the resting tone of the uterus to increase.37

Such over-stimulation (hyperstimulation) can deprive the baby from the necessary supplies of blood and oxygen, and so produce abnormal FHR patterns, fetal distress (leading to caesarean section), and even uterine rupture.38

Birth activist Doris Haire describes the effects of Pitocin on the baby:

The situation is analogous to holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air, but not to breathe.39

These effects may be partly due to the high blood levels of oxytocin that are reached when a woman labors with Pitocin. Theobald calculated that, at average levels used for induction or augmentation/acceleration, a woman’s oxytocin levels will be 130 to 570 times higher than she would naturally produce in labor.40 Direct measurements do not concur, but blood oxytocin levels are difficult to measure.41 Other researchers have suggested that continuous administration of this drug by iv infusion, which is very different to its natural pulsatile release, may also account for some of these problems.42

Second, oxytocin, synthetic or not, cannot cross from the body to the brain through the blood-brain barrier. This means that Pitocin, introduced into the body by injection or drip, does not act as the hormone of love. However, it can interfere with oxytocin’s natural effects. For example, we know that women with Pitocin infusions are at higher risk of major bleeding after the birth43 44 and that, in this situation, the uterus actually loses oxytocin receptors and so becomes unresponsive to the postpartum oxytocin peak that prevents bleeding.45 But we do not know the psychological effects of interference with the natural oxytocin that nature prescribes for all mammalian species.

As for the baby, ‘Many experts believe that through participating in this initiation of his own birth, the fetus may be training himself to secrete his own love hormone.’29 Michel Odent speaks passionately about our society’s deficits in our capacity to love self and others, and he traces these problems back to the time around birth, particularly to interference with the oxytocin system.

Read The Rest of the Article Here: http://www.sarahjbuckley.com/articles/ecstatic-birth.htm

9/13/10

Beautiful Vernix Caseosa

vernix
















The vernix caseosa is the waxy looking white substance that covers your newborn baby. When you see videos of a birth on television, you may see the doctors wiping off the “dirty” looking baby. Don't rush to rub off this wonderful stuff off your brand new baby... it has been found to have some fantastic properties...
STUDY: ANTIMICROBIAL PROPERTIES OF AMNIOTIC FLUID AND VERNIX CASEOSA ARE SIMILAR TO THOSE FOUND IN BREAST MILK


Akinbi, H. T., Narendran, V., Pass, A. K., Markart, P., & Hoath, S. B. (2004). Host defense proteins in vernix caseosa and amniotic fluid. American Journal of Obstetrics and Gynecology, 191(6), 2090–2096.

Summary
In this study, researchers analyzed samples of amniotic fluid and vernix caseosa (vernix) from healthy, term gestations to determine the immune properties of these substances. Participants were pregnant women admitted for elective cesarean section after 37 weeks gestation with no prior labor and no signs of chorioamnionitis (intrauterine infection). Women with a history of prenatal fever or premature rupture of membranes, or who received steroids prenatally or antibiotics while giving birth were excluded, as were women whose babies passed meconium in utero, had congenital malformations, or required prolonged resuscitation after birth. Amniotic fluid was obtained by amniocentesis to determine fetal lung maturity prior to elective birth. Vernix was gently scraped from the newborn's skin with a sterile implement immediately following birth. The researchers obtained 10 samples of amniotic fluid and 25 samples of vernix.

Tests (Western analysis and immunochemistry) revealed that lysozyme, lactoferrin, human neutrophil peptides 1–3, and secretory leukocyte protease inhibitor were present in the amniotic fluid samples and in organized granules embedded in the vernix samples. These immune substances were tested using antimicrobial growth inhibition assays and found to be effective in inhibiting the growth of common perinatal pathogens, including group B. StreptococcusK. pneumoniaeL. monocytogenesC. albicans, and E. coli.

The authors point out that the innate immune proteins found in vernix and amniotic fluid are similar to those found in breast milk. As the baby prepares for extrauterine life, pulmonary surfactant (a substance produced by the maturing fetal lungs) increases in the amniotic fluid, resulting in the detachment of vernix from the skin. The vernix mixes with the amniotic fluid and is swallowed by the growing fetus. Given the antimicrobial properties of this mixture, the authors conclude that there is “considerable functional and structural synergism between the prenatal biology of vernix caseosa and the postnatal biology of breast milk” (p. 2095). They also suggest that better understanding of these innate host defenses may prove useful in preventing and treating intrauterine infection.

Significance for Normal Birth

Routine artificial rupture of membranes increases the likelihood of intrauterine infection because it eliminates the physical barrier (the amniotic sac) between the baby and the mother's vaginal flora. This study suggests an additional mechanism for the prevention of infection when the membranes remain intact: A baby bathed in amniotic fluid benefits from antimicrobial proteins that are found in the fluid and in vernix caseosa.

The results of this study also call into question the routine use of some newborn procedures. Early bathing of the baby removes vernix, which contains antimicrobial proteins that are active against group B. streptococcus and E. coli. Delaying the bath and keeping the newborn together with his or her mother until breastfeeding is established may prevent some cases of devastating infections caused by these bacteria. The fact that preterm babies tend to have more vernix than babies born at or after 40 weeks might mean that healthy, stable preterm babies derive even greater benefit from staying with their mothers during the immediate newborn period.

Finally, this study illustrates how the normal physiology of pregnancy and fetal development is part of a continuum that extends beyond birth to the newborn period. The immunologic similarities between amniotic fluid, vernix, and breast milk provide further evidence that successful initiation of breastfeeding is a critical part of the process of normal birth.


So mamas, rub that vernix in instead of rubbing it off!



Sources:

Wonderful Vernix & Amniotic Fluid: http://sheffieldhypnobirthing.co.uk

9/3/10

A Guide to Extended Rear-Facing Safety

Last Tuesday around 5:30pm my husband was driving our son home after picking him up from daycare. It had been raining lightly and he was passing through an intersection when a driver failed to stop at a stop sign and hit him almost head on, the impact sliding his car across the road. John quickly checked on Jude to see that he was okay. They will both be receiving chiropractic care but thankfully weren't critically injured.


When I met John on the scene of the accident I unbuckled Jude out of his car seat and as I was pulling him out of the seat I noticed that his legs were locked together, he wouldn't or couldn't open them for several minutes. It was as if his legs had taken the force of the collision. This force that would have been felt in the neck and spinal cord had he been in a forward facing car seat. These sorts of injuries can lead to paralysis and death. In fact, in the US, motor vehicle crashes are the number one cause of death for children. The extra protection offered by rear-facing seats is something that parents should take advantage of as long as possible.

I am so grateful that my boys are okay and I wanted to share this guide for families that may not be aware of the significant safety benefits when a child remains rear-facing as long as the seat allows. For most children, rear-facing can and should continue well into the second or third year of life.

Some of the articles below are from CPS Safety

Why should your child rear-face past 1 year and 20 lbs?



Every milestone in a child's life is exciting! First steps, first word, first day of school. Even car seat milestones seem exciting. The truth is, they should be looked at with a certain sense of dread, not longing. Every step in car seat "advancement" is actually a step down in your child's protection.

Rear-facing is much, much safer than forward-facing. Child safety seats: Rear-face until at least one year discusses the reasons why children should remain rear-facing for a FULL year and 20 lbs. In it, Kathleen Weber states, "In the research and accident review that I did a few years ago, the data seemed to break at about 12 months between severe consequences and more moderate consequences..." This does not mean that there are NO consequences. The consequences may no longer be death from a completely severed spinal cord, but simply life-long injury, including complete paralysis. Research studies suggest that until children are at least four, they are incapable of withstanding crash forces as well as adults - and should remain rear-facing. In a crash, life-threatening or fatal injuries are generally limited to the head and neck, assuming a child is in a harnessed seat.

When a child is in a forward-facing seat, there is tremendous stress put on the child's neck, which must hold the large head back. The mass of the head of a small child is about 25% of the body mass whereas the mass of the adult head is only 6%! A small child's neck sustains massive amounts of force in a crash. The body is held back by the straps while the head is thrown forward - stressing, stretching or even breaking the spinal cord. The child's head is at greater risk in a forward-facing seat as well. In a crash, the head is thrown outside the confines of the seat and can make dangerous contact with other occupants, vehicle structures, and even intruding objects, like trees or other vehicles. 


Rear-facing seats do a phenomenal job of protecting children because there is little or no force applied to the head, neck and spine. When a child is in a rear-facing seat, the head, neck and spine are all kept fully aligned and the child is allowed to "ride down" the crash while the back of the child restraint absorbs the bulk of the crash force. The head is contained within the restraint, and the child is much less likely to come into contact with anything that might cause head injury.


Notice the difference in stress on the child's body in the videos below:

Forward Facing


Rear Facing


The American Academy of Pediatrics (AAP) recommends that all infants should ride rear-facing starting with their first ride home from the hospital. They should remain rear-facing until they reach the highest weight or height allowed by their car safety seat’s manufacturer. At a minimum, children should ride rear-facing until they have reached at least 1 year of age and weigh at least 20 pounds. However, AAP News April 2009 recommends keeping car seats rear facing until 2 years of age (if they car seats are designed for such use).

Children can also comfortably ride rear facing up to 3 and 4 years of age!

Aaron, still happily rear-facing at 3 years old (36 months)

Won't my child be uncomfortable? Where do his legs go?



Many parents have the misconception that children are uncomfortable or at risk for leg injury by having their legs up on the vehicle seat or bent when kept rear-facing. These concepts are completely incorrect. First, children are more flexible than adults so what we perceive as uncomfortable is not for children. Think about how your child sits in everyday play. Do they sit with their legs straight out in front of them? When they sit on the couch, do they purposely sit so their legs dangle out over the edge? No. In real, everyday life, toddlers and preschoolers CHOSE to sit with their legs folded up - that IS comfort to them.


Second, there is not a single documented case of children's legs, hips, etc. breaking or being injured in a crash due to longer rear-facing. There are plenty of cases of head and neck injury in forward-facing children that could have been prevented if the child had remained rear-facing. However, even if a leg or hip were broken or injured, it can be fixed. A damaged spinal cord (from forward-facing too soon) cannot be repaired and subjects the child to lifelong disability or death.


What if I am hit from behind? Won't my child be safer facing forward?

Frontal and side impacts are the most common type of crashes. They account for 96% of all crashes. They are also the most deadly type of crashes (especially side impacts) and rear-facing children have MUCH more protection in both types of crashes than forward-facing. In the 4% of rear impact crashes that a rear-facing child would be in, they have at least the same amount of protection that a FF child would have in a frontal impact, with the added benefit of less crash energy being transferred to them, and the fact that the rear impact is usually not as severe.


The forces in a rear impact crash are much different from the forces in a frontal impact crash. In a frontal impact, the forces are much greater because the vehicles are usually traveling in opposite directions. Experts suggest that a frontal crash is the same as hitting a concrete barrier and the vehicle and all occupants come to a dead stop within less than 1 second.

When you are struck in a rear impact, the vehicles involved are traveling in the same direction, and the vehicle that is hit in the back has room to move forward. The crash force on the occupants is much less than in a frontal impact. The movement of the impacted vehicle, in addition to the crush zone, absorbs a lot of the crash energy, so it is not transferred to the child. Additionally, the majority of rear impacts are at low speeds.


In short, if your child is rear-facing, he has optimal protection in the types of crashes you are most likely to be in. If he is forward-facing, he may have optimal protection in a rear-end crash, but statistically, that is the least likely to happen and he is 60% more likely to be injured or killed in the types of crashes (frontal, side impact) you are most likely to be in.


You can learn more about the physics of rear-facing at http://www.car-safety.org/rearface.html

Different types of Infant Safety seats:
There are 2 types of rear-facing car safety seats: infant-only seats and convertible seats.
When children reach the highest weight or length allowed by the manufacturer of their infant-only seat, they should continue to ride rear-facing in a convertible seat.

Infant-only seats
  • Are small and have carrying handles (and sometimes come as part of a stroller system).
  • Are used only for travel (not for positioning outside the vehicle).
  • Are used for infants up to 22 to 35 pounds, depending on the model.
  • May come with a base that can be left in the car. The seat clicks into and out of the base so you don’t have to install the seat each time you use it. Parents can buy more than one base for additional vehicles.
Infant-Only Car Safety Seats


Convertible seats (used rear-facing)






  • Can be used rear-facing, then "converted" to forward-facing for older children. This means the seat can be used longer by your child. They are bulkier than infant seats, however, and do not come with carrying handles or a separate base.
  • Have higher rear-facing weight and height limits than infant-only seats, which make them ideal for bigger babies.
  • 5-point harness is ideal-attach at the shoulders, at the hips, and between the legs.
The Basics of Rear-Facing Seats - A correct use checklist created by CPS Safety

The seat must be designed for use rear-facing and must actually face the rear of the vehicle.
  • Be sure you check the labels and manual for the seat to find out whether the seat can be used in the rear-facing position. If the seat can face backward and forward, be sure you locate the belt path that is required for rear-facing and use it. Infant seats, those that double as carriers, can ONLY be used in the rear-facing position and should never be used forward-facing. For infant seats with a base, the vehicle's seat belt must thread through the belt path on the base, not the belt path on the infant seat. Only use the belt path on the infant seat if you are using the seat without the base. All rear-facing seats should have a label indicating that it meets motor vehicle safety standards.
The seat must be tightly installed in the vehicle.
  • After installation, grab the seat at or near where the car's seat belt threads through the car seat belt path. Give a firm tug, not a yank, from side to side, and from the back of the car towards the front. The seat should not move more than 1 inch in either direction, and preferably as little as possible, or not at all. The same policy that is the foundation of Aviva and all other insurance providers holds true: better safe than sorry! It only takes a minute to check. A rear-facing seat will have normal movement throughout the top of the seat - towards the back of the car and from side to side. This movement is part of the seat's safety design, and should not be a concern.
The seat must be reclined at no more than 45 degrees
  • For newborns, a 45 degree angle is necessary to keep their air passage open. For older babies that are able to maintain head control, a more upright position is okay. Although some seats come with "level indicators", these are not always accurate due to any incline the vehicle may be on. If you use the built-in level indicator, be sure the vehicle is parked on a flat surface (even your garage floor has a slight incline). An easy way to check for a 45 degree angle is to take a piece of paper and fold the shorter top edge over to meet the longer side edge. You'll get a triangle with one long side. Place the longest side of the triangle against the seat where baby's back normally rests. The top of the paper should be parallel to the floor of the car.
The safety harness must fit the child snugly.
  • "As snug as a hug" is a good guideline. You don't want your child to have problems breathing, but a too loose harness could have devastating results. Many instruction manuals suggest that only one or two fingers fit under the harness at collarbone level, but this could be too loose, depending on the size of the fingers. Instead, use the pinch test: grabbing the harness at shoulder level, try to "pinch" the harness together from top to bottom. You should not be able to pinch a vertical fold on a snug harness.
The safety harness must be in the slots that are at or below the child's shoulders.
  • In a rear-facing seat, the harness will hold the child down and in the seat in a crash. The harness must be at or below the shoulders to do this properly. If the harness is above the shoulders, the child can "ramp up" or rotate toward the top of the seat, exposing the head and neck to possible injury. For newborns and very young babies, the bottom harness slot may still be above the shoulders. As long as the harness is in the bottom slots, and the harness is snug, this will protect the baby.
Chest clip must be at armpit level.
  • The chest clip is designed to keep the harness straps properly positioned on the shoulders before a crash. This clip is ONLY for pre-crash positioning. A chest clip that is too high may interfere with the child's ability to breathe. A chest clip that is too low could allow the straps to slip off the shoulders before a crash, leaving the child free to slip out of the seat.
The carry handle must be in the correct position, usually either curved around the top of the seat or under the seat.
  • Many people mistakenly think that the carrying handle will perform as a "roll bar" in a crash, but in reality, most handles are not designed to withstand the force of a crash. Upon impact, the handle can shatter or break, sending sharp, jagged pieces towards baby or other occupants in the car. CHECK THE INSTRUCTIONS. Most seats require the handle to either be around the top of the seat or underneath it. Only a few seats allow the handle to up over the baby during travel.
NEVER place a rear-facing seat in front of an active airbag.
  • The airbag is protection designed for adults, not children and especially not babies. The rear-facing seat sits too close to the airbag, and when it inflates, it does so rapidly and violently, causing massive head and neck injury. EVERY REAR-FACING CHILD WHO HAS BEEN IN FRONT OF AN ACTIVE AIRBAG IN A CRASH HAS BEEN SERIOUSLY INJURED OR KILLED!!!
The back seat is the safest place.
  • This doesn't just apply to rear-facing seats. Everyone would be safer in the backseat - in the middle, if possible. The back seat is safest because it is farther from any point of impact. A front seat passenger is 30% more likely to be injured or killed than a rear-seat passenger. Use the back seat position that offers the best installation. A good fit in an outboard position is safer than a poor fit in the middle. *NOTE* In mini-vans, the safest position may be in the MIDDLE seat, as the rear has less "cargo space" to absorb a rear impact.
Avoid using add-on products
  • Anything that did not come in the box with the seat could potentially put your child at risk. Adding strap covers could cause the chest clip to be positioned incorrectly. An added head support cushion could compress in a crash, introducing slack in the harness and allowing the child to be ejected from the seat. In general, you want nothing under baby or between baby and the straps that is any thicker than a placemat. Adding NOTHING under, behind or between baby and the straps is the best. Also, keep in mind that any product you add that is not included with the seat can release the manufacturer from being responsible for any injuries your child may suffer in their seat.
The child must fit properly in the seat
  • There are several conditions that must be met for a child to fit correctly in the seat.
A child is too small for the seat if:
  • The child weighs less than the seat's lower weight limit.
  • The harness can not be adjusted to snugly fit.
A child is too large for the seat if:
  • The child weighs more than the seat's upper weight limit.
  • The top of the child's head is less than one inch from the top of the hard plastic shell of the seat.
  • Some manufacturers used to state that the child must use a forward-facing seat when the child's feet are touching the vehicle seat back. All manufacturers have now removed these instructions, as there is no real-life data to suggest that the feet touching the seat back would cause injury, but there are cases of children who have been turned forward-facing too soon and suffered life-threatening or fatal head, neck and spinal cord injuries.
Used seats may be dangerous
  • Never use seat that is damaged, under recall*, over 5-6 years old, or has an unknown history. Check out Not New? for more information on any seat that is not brand new before using it.
  • *Some recalls do not affect the safety of the seat (for instance, a recall on the handle of the seat when used as a carrier), and the seat may safely be used to transport your child until the problem is fixed. You will need to contact the manufacturer to find out whether any recalls on your seat must be fixed before using it for transporting your child.

GET YOUR SEAT CHECKED! Find a certified CPS Technician. Lists of certified CPS Technicians and Child Seat Fitting Stations are available on the NHTSA Web site at www.nhtsa.gov or at www.seatcheck.org.You can also get this information by calling 866/SEATCHECK (866/732-8243) or the NHTSA Vehicle Safety Hotline at 888/327-4236.





Car Seat Shopping Guides

The following Convertible Models for Extended Rear-Facing have above average height and/or weight limits for rear-facing use. These may allow children to face the rear for safety longer than many other models. Also listed are the rear-facing weight limits according to the manufacturer. Most of these models are taller than average, with the possible exception of the Cosco Scenera that is listed primarily as a value option. Please verify these yourself in case of errors. Please note that nearly all convertibles can be used for extended rear-facing beyond 20 pounds and models not listed may have ratings similar to the examples below.
  • Britax Marathon/Decathlon/Boulevard/Advocate (33 or 35 lbs)
  • Learning Curve / Compass True Fit (35 lbs)
  • Cosco Alpha Omega Elite (35 lbs)
  • Sunshine Kids Radian XTSL (45 lbs)
  • Graco MyRide 65 (40 lbs)
  • Evenflo Triumph Advance (35lbs)
  • Evenflo Titan Elite (35 lbs)
  • Cosco Scenera (35 lbs)

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