Bariatric surgery may improve pregnancy outcomes - mostly

Many women opt for bariatric surgery in order to increase chances of maintaining a healthy pregnancy.  A recent study suggests that weight loss surgery can help a woman do just that, but there are risks.

Personally, my full term post bariatric surgery pregnancy was different than my pre-WLS pregnancies.  I was at a more normal bodyweight at the time of my daughter's gestation, and I did not seem to suffer the ill effects of obesity on pregnancy like I had with my prior children.  I had no high blood pressure, no high blood sugar, nor did I land on bedrest - which I had with previous babies.    My post RNY pregnancy offered me anemia and rampant hypoglycemia.  I was not well. 

She was born healthy, but small, in comparison to my earlier babies.  I noted a lack of body fat at birth.  This is several weeks old.

My post bariatric surgery baby - my smallest birthweight baby.

 

New York Times - 

While the study found some risks for women who had surgery, including more babies born too small and a greater likelihood of stillbirths, experts said that overall the results were better.

The findings have implications for an increasing number of women and children, especially in the United States, where nearly a third of women who become pregnant are obese. Obese women have more problems in pregnancy, including gestational diabetes, pre-eclampsia, and stillbirth. Their babies are more likely to be premature, overweight or underweight at birth, have certain birth defects, and develop childhood obesity.

The study, published Wednesday in The New England Journal of Medicine, sought to find out if surgery could safely mitigate some of those effects. Swedish researchers, led by Kari Johansson, a nutritionist at the Karolinska Institute, evaluated records of 2,832 obese women who gave birth between 2006 and 2011, comparing women who had bariatric surgery before becoming pregnant with women who did not.

They found that women who had had surgery were about 30 percent as likely to develop gestational diabetes, which can lead to pre-eclampsia, low blood sugar, birth defects and miscarriage. They were about 40 percent as likely to have overly large babies, whose challenges can include lung and blood problems.

The outcomes were worse in some categories. Women who had surgery were twice as likely to have babies who were small for their gestational age, suggesting the need for better nutrition for pregnant women with surgically-reduced stomachs. And more of their babies were stillborn or died within a month after birth, although the number of such deaths in each group was very small and might have been due to chance, experts and the authors said. There was no significant difference in rates of premature births or babies with birth defects.

The study via NEJM -

BACKGROUND

Maternal obesity is associated with increased risks of gestational diabetes, large-for-gestational-age infants, preterm birth, congenital malformations, and stillbirth. The risks of these outcomes among women who have undergone bariatric surgery are unclear.

METHODS

We identified 627,693 singleton pregnancies in the Swedish Medical Birth Register from 2006 through 2011, of which 670 occurred in women who had previously undergone bariatric surgery and for whom presurgery weight was documented. For each pregnancy after bariatric surgery, up to five control pregnancies were matched for the mother’s presurgery body-mass index (BMI; we used early-pregnancy BMI in the controls), age, parity, smoking history, educational level, and delivery year. We assessed the risks of gestational diabetes, large-for-gestational-age and small-for-gestational-age infants, preterm birth, stillbirth, neonatal death, and major congenital malformations.

RESULTS

Pregnancies after bariatric surgery, as compared with matched control pregnancies, were associated with lower risks of gestational diabetes (1.9% vs. 6.8%; odds ratio, 0.25; 95% confidence interval [CI], 0.13 to 0.47; P<0.001) and large-for-gestational-age infants (8.6% vs. 22.4%; odds ratio, 0.33; 95% CI, 0.24 to 0.44; P<0.001). In contrast, they were associated with a higher risk of small-for-gestational-age infants (15.6% vs. 7.6%; odds ratio, 2.20; 95% CI, 1.64 to 2.95; P<0.001) and shorter gestation (273.0 vs. 277.5 days; mean difference −4.5 days; 95% CI, −2.9 to −6.0; P<0.001), although the risk of preterm birth was not significantly different (10.0% vs. 7.5%; odds ratio, 1.28; 95% CI, 0.92 to 1.78; P=0.15). The risk of stillbirth or neonatal death was 1.7% versus 0.7% (odds ratio, 2.39; 95% CI, 0.98 to 5.85; P=0.06). There was no significant between-group difference in the frequency of congenital malformations.

CONCLUSIONS

Bariatric surgery was associated with reduced risks of gestational diabetes and excessive fetal growth, shorter gestation, an increased risk of small-for-gestational-age infants, and possibly increased mortality. (Funded by the Swedish Research Council and others.)

PS.  Post RNY baby is eight years and four months old now.  She's fine.

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When?

Dana just asked if I have my babies before their due dates.  I really wouldn't know - I've been induced three times.  Baby #1, induced near due date, with high blood pressure.  She was 7 lbs. 12 oz.  Baby #2. induced at  not quite 39 weeks, high blood pressure & rapid heartbeat.  He was 8 lbs.  Baby #3, induced at 38 weeks, high blood pressure & rapid heartbeat, 8 lbs. 12 oz.  I don't know what would have happened had I been just allowed to go into labor, I've been generally "sick"  and sent to the hospital at my prenatal appointment and induced the next day.  I'm not dealing with high blood pressure this time, which seems to be what causes problems.  I'm more than 100 lbs. lighter than previous pregnancies, so there's the cure for the high blood pressure, huh?  Anyways - other than the anemia, I'm "healthy" - so whenever it happens, I guess... it happens.  Though, tommorrow would be nice?

I should have at least gotten a dinner first.

Because, I was violated without so much as a glass of wine.  No news, really.  Dilated two centimeters and baby's head is ready to go.  OB says she's dropped and in place.   She made it sound like I'd go right there - she was all, "Well, she was six and a half pounds two weeks ago, and she's in place... so..." 

We did have a quick non-stress test, because the baby's movement wasn't really frantic today, but she's fine.  (She kicked the monitor off.)  I also got a quick blood sugar check, since I never had the prenatal diabetes testing done. (Remember, I refused to take the glucose drink or the jelly bean test back when it was required, due to the gastric bypass and the side effects of eating that large amount of sugar.)  My blood sugar was 77, and I had eaten prior to the appointment, so it's good.  (I didn't tell her WHAT I ate, but it was a post-meal blood sugar level.  (I had eaten 4 oz. cottage cheese, a peanut butter cup & 4 oz. sugar free pudding within the morning before the appointment. )  I think I tend to be more hypoglycemic than diabetic anyway since WLS.  I have hypoglycemic symptoms much much more since WLS.  Oh, and I'm actually down a couple of pounds!  I weighed in with shoes on and was less than last week/same scale.  So, anytime, baby, you can come out to play.  Now is more preferred than later, since my main sources of baby-sitting Are Going On A Cruise Ship for like, ten days, at my due date.  So, Right Now would be acceptable.  I just need one good full day of labor that produces an infant, with babysitters, and they can go to the Bermuda Triangle or wherever it is they're going.  My nine year old daughter is concerned about this - she wants to make sure that her younger sibs are with grandma, because "they'd be scared at the hospital, Mom."  As for her, I think she'd like to be there, and I'll let her, if she wants to, at the very least the moment the baby arrives, she's seen it all in full-color on TV anyways - she knows what's up.

Taking bets.

Sure, I'll take bets on the baby.  It's not like I'm going to see money from it, so g'head, place yer bets. 

• Date:
• Time:
• Baby's Weight:
• Length:

Winna gets, uhh, my undying affection? 

Though, the bet I'm more interested in - is how many pounds will *I* drop just after she's born?!  I'm betting on twenty pounds.  The rest, I'll claim responsibility for.  As soon as I get home, get un-IV'ed and lose all the water I'll undoubtedly have in the hospital (along with any other freebies, like a blood transfusion!), I'll add a weight ticker back up.  I'm thinking I'm going to be starting at about 175 lbs for my "re-diet."  It Could Be Worse.  Really.  I was really close to pushing that before I got hugely pregnant anyway.  My previous 150 lbs as goal, 130-135 lbs after plastic surgery goal.  The smallest I ever saw was 147 lbs for like, a day.  I hovered near 160-165 lbs for the longest time pre-two-pregnancies, so it's all very do-able.  Nursing a baby steals about 500 calories per day, and I can't physically eat too too much, so it means I will still be able to eat actual FOOD as long as I'm a moo-cow for the babe, and probably will lose weight just by that.  I do plan on eating better (bye bye empty calories, at least most of 'em), and charting my meals on Fitday again.  I may sub some meals with protein bars or shakes, which I gave up completely during pregnancy (depending on chemicals in them, and if I'm making enough milk...)

It's all in how you look at it.

Thanks to an email from MySpace - the name I picked* now has a teasability factor added.  Thank you.  Although, this one is funny.

*- because it's always subject to change.

Baby Alien.

The other day I posted a "photo" of the fetus on my MySpace page.  I thought for certain it would was obviously be understood as a joke - since it was, you know, an ALIEN, like from space?!  Well, it wasn't.  I had a few people ask me if the photo was "one of those 4-D ultrasounds or something?" because it was slightly disturbing.  The whole thing was that the actual ultrasound scans from a couple of weeks ago freaked ME out, because they looked slightly alien-ish, and it's been a joke in my little world since.  I always have this fear of giving birth to a Something rather than a Someone, and at the end of pregnancy I have actual nightmares about pushing a baby out, only to look down and be greeted by this:

Anyway, I should know better, since the last two times I've had a baby girl, they've been very non-alien-like and very human.  I only hope we're so lucky this time.

No news.

Weekly appointment at the OB today.  I actually saw my old midwife (who delivered my children) since I was late in making this appointment, so I just had a quickie appointment with her instead of one of the doctors.  So, nothing new, blood pressure was good, see ya in a week.  Interestingly, no internal exam - is this something new?  I remember being repeatedly checked in previous pregnancies after 36 weeks?  It doesn't matter, since knowing how dialated or effaced I am makes no change in when labor will actually begin anyway.  Babies come when they want to, damnit.

Tommorrow, weekly blood appointment... I plan on telling the blood doc that I can't breathe anymore, since that might be related to the lack'o'blood.  There's really nothing I can do, I just want her to know that it's gotten increasingly worse.

Uh, I think that's it - I'm brain-dead now.  We've got Capturing the Friedmans' from Netflix here, and I'm just, like, ugh, so I'm gonna go fall asleep on the couch. 

It looks like you have a basketball in there.

...was one of the comments heard yesterday, along with:

"When are you due, now, right?"
"Are you trying again for another boy/number five?"
"Are you going to get on the dance floor and push that baby out?"

I spent most of the night behind my own camera, so I didn't get one photo of myself in the least flattering state of human condition, well, besides me at 320 lbs, but nine months pregnant is a close second.  The professional wedding photographer definitely got me in the wide angle lens at some points,especially since I was trying to get some candids at the same time as she was taking the real pictures.  The boy child did get me in one photo, and as you can see, (but luckily not really because it's a terribly blurry shot) I'm the size of a house.  I had a size XL maternity dress, and I was terrified it wasn't going to fit - I didn't try it on - just hoped it would slip on.  I'm very lucky it did - because it would NOT go on feet first.  I got stuck in it and had to try for head first.  The shoes?  Ha.  I found a pair of work shoes with a strap at the ankle, yeah, you can see how THAT looked within a half hour, I had swollen ankle flesh bubbling over the straps.  Bob looked anorexic in my shadow - since I'm now at least 25 pounds heavier than him.

As for dancing, no.  Not so much fun.  It hurts to move.  Bob got lucky and only had to dance once, because the DJ didn't really play anything he'd move to, and by the time he did, Bob had a child sleeping on him at the table and got out of it.  Not that we'd dance anyhow, it's more like me leaning on him and trying not to fall asleep while swaying back and forth.  It was a rough night, and I'm still beat.

The kids did fantastic and looked great, and considering how late it was, I am surprised we didn't have any more major meltdowns.  (More, because we got one, but then she fell asleep and we left soon after.)

I thought I might drop her on her head today.

She's not coming out to play today, but I thought so, for at least a few hours today.  I was at the mall with the girls to get our nails painted for the wedding tommorrow, when I got hit with some serious contractions.  They didn't go away with liquids, so I called Bob home from work and we took a little field trip to the birthing triage.  Apparently I am not laboring, but it hurt enough to make me think I was.  Like I said before, I've never gone into spontaneous labor before, so I don't know what to expect.  The laboring I've had the three previous times has been quick, intense, painful and quickly medicated while already in the hospital in bed.  The OB says the baby is still high, at minus two, and I'm a "fingertip" dilated, and not in labor.  Well, of course things have slowed down now, and I'm not feeling pain, but if this baby is trying to turn back upside down, she's grounded.

Yeah, but...

He tells me to remember, "Beth, they're images from soundwaves. Duh."  Okay, fine, but I still think I'm going to give birth to ALIEN now.

I'm a Float.

I made blood.  How exciting.  My hematocrit level went up one point.  My blood pressure spiked a little bit yesterday, and the nurse didn't like my pulse much, so she gave me an EKG.  The hematologist said something about the possibility of my respiration rate causing a temporary change in my heart rhythm.  I'd say so, since I can't breathe if I sit up fully forward!  I assume that I passed the EKG because they still hooked me up to the IV for the ferrlicit infusion after the doctor reviewed the test.  I noticed after I left that my ankles are swelling again, especially the left, and a bit on the right.  I hadn't been swelling much at all since I noticed it, what, a week ago?  Now, it's back, lovely sausages. 

I've given up on getting shoes for the wedding this weekend because I'm going to have to take them off anyways - with sausage ankles.  I went to get a pair of black maternity tights yesterday - and found that the freaking dress I bought online really WAS just a Motherhood store clearance item, and of course, I overpaid and paid shipping for this stupid thing.  I suppose as long as I'm clothed during the wedding, we're good.  Also, I'm apparently going to dance with my husband for the bridal party dance (although I'm not in the line-up, the bride has set this up so I can go up for that I guess?) which is fine - but... uh... I'm going to have to stand sideways to do so.  That isn't too far from our own wedding, where I was over 300 pounds (even though now I'm still less than an elephant, but blowing up like a Thanksgiving Day Float) and he was well over 300 pounds also, and now he's in a 34 waist tuxedo, but, I'm just saying... sideways.

Oh, but when I got home, I found more diapers at my doorstep - how exciting is that, eh?  The wee newborn size ones came, a case of what some company calls 1/2, and a stack of wipe refills.  Yahoo.

Wait, no, I change my mind, I think.

I've been cleaning up, getting things ready for our little baby party tommorrow.  I talk to Bob at work about some things I need him to bring home from the store.  He asked me if I told the girl at the bakery the baby's name to add to the cake I ordered there last week.  I didn't, because I didn't know what in the heck to write on the cake, since we're having our own get-together, and writing "Congratulations" or something doesn't make any sense.  So, Bob says we should add the baby's name, in the form of "Welcome/See You Soon/Come On And Hurry Up Damnit Baby _________!"  That does make more sense than a blank cake, so I was thinking about the wording.

Then it occurs to me, I've missed a very basic problem with this name.  You can easily poke fun at it with our last name.  I was sitting here mentally illiterating the name, and realized that it's got the potential to be made fun of.  Just giving the name to a group of 7-11 year olds and telling them to repeat it would bring out the tease quality.  I don't know how I missed it.  Of course, you have to intentionally (or unintentionally, because every salesperson that calls here says it wrong) say the last name wrong to cause the problem... but...still.  Ugh.

Target Baby (Sucks.)

So I have the fetus registered at Target, since I thought it was less expensive for products in general than, say, Babies-R-Us, and that it's close-by.  Also, I figured that it would be easier for Bob to go, physically, to the store while I'm in the hospital to pick up whatever we didn't acquire pre-baby from a list, since he's better knowing exactly what to get as opposed to just picking stuff up that he likes or whatever at the last moment.  This way, he can go and get what's left on the list when it becomes absolutely imperative that we get it - like - when a head is emerging from my body.  Now I thought this list was a good idea, but it's turned into a pain. 

First, something silly, but that I don't understand?  Why can't a person register for diapers?  I really wanted to put the cases of dipes on the list, but you're not allowed to add diapers or wipes.  Is there a reason for this?  It makes sense for me to place dipes on a registry since this isn't my first baby (duh!) and people are more likely to gift me with things LIKE diapers because they ARE a necessity, right? 

I've had a couple people ask me what we "need" for the baby this week,  (A. because we're having a baby party on Saturday.  B.  The baby is going to arrive no later than 29 days from this very moment!) and I've told them about the baby list, but it's been met with frustration because half of what I'd added to the list is either unavailable, out of stock, online-only, in-store only, discontinued, or plain old MIA.  My mother in law went today to another Target location, with the list in hand, and couldn't find what she wanted from the list.  She had asked me to even circle the Items Of Most Importance, which I did, and they weren't available.  I mean, I went to a store an hour away and found one stroller/cassat combo in a ripped up box, and grabbed it because it WAS the only one, and a cassat was one of the absolute first necessities on the list.  It's just frustrating that the stuff isn't available, especially when there are customers willing to purchase product from a list, but they're turned off by the lack of supply.  Lesson learned, don't register with Target.  They suck.

I might not wear a sheet.

I spent a very long time last night online looking for a suitable dress to wear to my brother-in-laws' wedding that is happening, uh, very soon.  I was avoiding the dress-purchasing because I had a feeling that I might be post-partum at the date of the wedding, (albeit like, three days post-partum, and depending on how this baby makes her entrance, head or foot-first, I may not be so much fun dancing at a reception, so...) I was waiting to see. 

Well, one trip to the mall let me know there isn't anything that will fit my newly expansive ass that I'd be able to buy the day before the event and just put it on.  Not only that, I'm cheap, and spending money on an outfit I will only wear once kills me.  (Well, technically it kills HIM, but he's wearing a tuxedo that was rented FOR him.)  I'm the hot date of the Best Man, so I will be on camera, and I don't WANT TO BE WEARING A MUU MUU.  It took me a year not to have to order my special occasion outfits from Lane Freaking Bryant, I refuse to do it now.  Even though, technically, I'm in the size range again, I won't do it.  No. You. Can't. Make. Me.  So, I searched Motherhood, and all of those online maternity shops, to find that what I need, would cost hundreds of dollars.  Uh, no.  I'm never going to be large enough to fit into a "XL Maternity Special Occasion Dress" EVER again.  If I can't wear it twice, it's not worth the money.  Sorry.  I ended up finding a "little (big) black dress" on clearance at one of the maternity shops online.  I'll still need me some Spanx Mama (didn't know they had these?!?!) hose, some cute shoes, and a shawl, wrap or fancy cardigan to cover my chicken flap arms, but I won't be wearing a sheet!

34 weeks 6 days.

34 weeks and 6 days today.  I went to my OB visit, and I showed the doctor my swollen leg, ankle & foot.  She didn't think much of it, and even measured the right leg to show that it really isn't all that much bigger than the left side, although it is swollen, and measured like a half-inch bigger.  My blood pressure was okay, 118/80, so the bottom number has been going up a bit.  I do have a slight amount of protein in my urine, so I'm watching for any further signs of pre-eclampsia, since these are the early signs of it.

The baby seems to be breech, still.  The OB went to find her heartbeat and got nothing but my smooshy loose skin and fat belly where there is no baby.  I told her to move up, since the baby is all crunched up very high and upside down.  I've now got an ultrasound to determine the position on October 3rd.  If she's not in firing position, we're scheduling a c-section at 39 weeks.  The OB recommended trying all I can to get the baby to move, because cutting me where I do have all that loose fatty skin will be a bad deal, since it's unlikely to dry out and heal, especially once I'm sans fetus and not stretched out.  I never really even thought of that, I just don't want to be out of sorts after the birth and I really hate pain medication, it makes me sick.

Oh, the good news?  No weight gain. 

Foot Fetish.

So I look down.

I'm suddenly swollen on my left side.  Lovely.  What a good day we're having.  What's next?

Because we can't call her The Fetus.

We may or may not have a name for The Fetus.  I came up with a suitable suggestion - and most everybody has dug it.  I say "most" because the husband immediately made fun of it, but then cocked his head to the side and repeated the name, Rainman-style, until it sounded better to him.  When I explained to him further how I "came up with the name" - it was more appreciated for what it is.  ::sigh::  What a pain in the ass this naming stuff is.  Since my name is all over the Big Bad Internet already,  I suppose "announcing" a name here isn't going to change anything.  I've already sounded it out over on my other page - but it's not a done deal yet.  It's still liable to change, because the baby may not look like a ____________, also, what if the Fed-Ex Man's DNA really stands out and the baby really really doesn't look like a ___________.

Blub.

This morning I had my weekly IV iron infusion.  My hematocrit level is down again, so perhaps last week was a flukey higher (but still anemic ) reading due to dehydration?  I was at 24 (blood transfusion level),  then last week at 29 (better, fluke?) now today barely pushing 26 (better still than 24, so maybe the IV is helping a wee bit.) 

The doctor asked if I was having any trouble breathing.  I told her that it feels as if the fetus is now large enough that she's cramping my personal space and that it's interfering slightly with the breathing business.  Like, if I'm running laundry up the stairs, I most definitely have to catch my breath once I'm back up.  Sometimes, I have to stop and literally "take a breather."  This doesn't seem to be anything other than the pregnancy, but I could be wrong. 

In every other pregnancy I was in excess of 250-320 lbs., so I don't know if the size THEN also made it hard to breathe - because I was just winded being super-morbidly obese AND pregnant.

I'm "obese" technically now, too, but having little to no oxygen in my blood cells may also contribute to lack of breathing.

Hematocrit levels:  The normal hematocrit range in pregnant women may be as low as 34% (normal for a non-pregnant woman is 37%-47%). This discrepancy has been explained by hydremia (dilution of the blood), or the physiologic anemia of pregnancy.

• In the first trimester, a pregnant woman at, or near, sea level, is anemic when her hemoglobin level is less than 11 g/dL or her hematocrit level falls below 37%.
• In the second trimester, she is anemic when the hemoglobin level is less than 10.5 g/dL or the hematocrit level falls below 35%.
• In the third trimester, she is anemic when the hemoglobin level is less than 10g/dL or the hematocrit level is less than 33%.

My blood pressure was 120/80, which has been the same level at that office for three weeks.  My pulse, 88, also the same as it's been for those three weeks.  Before that, the pressure was slightly lower, and at times gets really low.  I suspect I may spike in the next few days/weeks with just 37 days until my estimated date of delivery. 

Tommorrow I have a regular OB visit, it will be nearly the beginning of the 36th week.  Whee.  I really hope she schedules an ultrasound to check on the true position of this child, as she still feels ass backwards in there.  Everything I've read has said that most breech babies will have turned by now if they're going to be in the optimal position for a vaginal birth.  I will not have a external cephalic version (physical turning of baby via hands-on in hospital bed, while it CAN work, there are risks and you can end up in an emergency situation due to the actual procedure),  so do a little voo-doo for me that she's turned already.  A c-section would just not be good for me, I don't want to have major surgery with my blood situation.  Yeah, a tubal ligation would be a bonus if they're gonna cut me open, but... I don't want to bleed any more than is necessary for a regular childbirthing here, since I'm so low on supply.

Otherwise, I think I get the Strep-B test done tommorrow, and I usually am a carrier, so that means I'm already hooked up to an IV during labor and delivery anyways to take in antibiotics.

I'll post more tommorrow when I see the OB and hopefully will have news regarding what's next.

 

To Everything Turn, Turn, Turn.

Last night, I awoke to one of "those" phantom pregnancy pains that make you sit up straight in the bed and consider waking somebody up to drive you to the hospital.  It went away quickly, probably a  couple of really good Braxton-Hicks contractions, which in a fourth pregnancy are much more intense.  For a moment, I seriously thought to myself, "Well, I guess this is it.  Let's go."  Then, once I realized it was the middle of the night, and I've still got a few weeks to go, and that I do NOT want to be going into any sort of pre-term labor, I got a drink and went back to sleep.  I think it's just the fact that this is a fourth pregnancy, and my body is all like "We know what to do, let's get it done."  The contractions are so much more frequent and intense than in any other pregnancy, it makes me wonder daily how I'm still holding this fetus in.  It feels as if she's clawing her way out.  I'm hoping that the OB schedules a looksie ultrasound for the next week or two, because I really want to know if she's still in a breech position or if maybe she's turned head down.  I truly don't think she's moved, since I feel like she's got all four limbs in one spot on top.
"Transverse: A baby in the transverse                         position is sideways, usually with his shoulders or back                         over the cervix. Sometimes referred to as a shoulder or                         oblique position, a transverse position occurs in 1 in                         2,500 births. The risk for having a baby in the transverse                         position increases if you go into labor prematurely, have                         given birth four or more times, or have placenta previa.                         Your doctor will deliver the baby by cesarean section,                         either right when you start labor, or a little earlier.                         A vaginal birth would be too risky for you and the baby.                         If there is a long labor period before the cesarean is                         performed, there is an increased risk of uterine rupture                         and umbilical cord damage." 

That sounds fun.  I don't want a cesarean, so I'm off to hang upside down before bed.

This is probably why...

...I have 3.99 children.  Because, look what happens when he gets his hands on a new baby.  (Click to make it larger)