Wednesday, April 27, 2011

The Emotional Side of the Traumatic Birth

I attended my third ICAN (International Cesarean Awareness Network) meeting today. "The International Cesarean Awareness Network is a non-profit advocacy and support group whose mission is to improve maternal and child health by preventing unnecessary cesareans through education, provide support for cesarean recovery, and promote vaginal birth after cesarean (VBAC)." It's a really lovely bunch of women who are there to be totally supportive and non-judgmental, to educate about unnecessary interventions leading to unnecessary cesareans, to provide information about VBAC and HBAC (home birth after cesarean), and to offer general support to those who have had c-sections, including recovery help. Today a few of us discussed how we feel there isn't a way to talk about a birth trauma, or how we felt about a less-than-ideal birth scenario, or how we felt if we weren't able to nurse successfully, or other feelings like that, because for most people, "Isn't having a healthy baby the most important thing?" is the only response that is allowed.

That, plus doing my day job, brought back memories of how I was feeling when my first son was about 4 or 5 months old. I didn't know how to process those emotions, because on the one hand, yes, my son was healthy and thriving and I was healing physically, and I should be fine with all that. On the other hand, was it "okay" to be feeling down, or discouraged, or (gasp!) like a failure because the birth and breastfeeding didn't go as I expected or planned? Was that "selfish" of me? Shouldn't it be about the baby, not about me?

My day job is transcription. I spend several hours a day at the computer typing various dictated reports, letters, etc., from doctors, psychiatrists, lawyers, and so on. A large percentage of my work is psychiatric reports, especially intake evaluations from pediatric psychiatrists. In their evaluations, they discuss the child's birth (as much as is known), and the language is usually something like, "John was born via a natural, spontaneous, vaginal birth. There were no complications." Sometimes, it was "John was born via a cesarean section due to failure to progress," or "...due to previous c-section," or whatnot. But the majority are of the first type. 

When I first started doing this job, and I was just barely physically recovered from my son's birth, typing these phrases sometimes would make me cry. I felt like, if these women could do it, why couldn't I? Most of the clients were lower class, on Medi-Cal (state medical insurance), parents unemployed, some of them teenagers when their kids were born. And yet, they were able to accomplish what I could not. Why?

Obviously, education, income and employment status, and even age, have very little to do with whether you are "capable" of giving birth vaginally. Having a college degree does not automatically guarantee you the birth you desire. Indeed, it's entirely possible that most of these mothers had no particular "birth plan" in mind at all. Maybe in some ways it's better that way, because then there's nothing to be "disappointed" about. And yet.

Here I was, in my nice middle class life, with my nice relatively privileged family, with my $120,000 diploma on the wall, and I couldn't even manage to pop a baby out the way nature intended! What was wrong with me? I'm a healthy adult female in my prime. I did all my prenatal care. I did everything you're "supposed" to do, didn't do anything you're not "supposed" to do. So why couldn't my body do what it was "supposed" to, and all these other women, some of whom were doing drugs while pregnant, some of whom had their babies taken away at birth, some of whom probably never even thought about epidurals and episiotomies before the minute they walked into the hospital, got what I so desperately wanted? So I cried because I'm not the type of person who fails at things that I decide to do.

I realize I sound elitist and that I'm somehow implying that intelligence or class situation has anything at all to do with birth. But I'm really trying to make the opposite point. My point is that all the education in the world, all the book-learning, all the money has nothing to do with birth! Nothing at all! And I think that's what I didn't realize. It's not about how smart you are, or how little caffeine you ingested, or how many pounds you gained, or how many prenatal appointments you attended. It's about letting birth happen, instead of trying to control it. 

I also think that knowing that almost any woman can give birth, that I wasn't personally anything special that I could do it, put things in perspective. Yes, most women can give birth vaginally. Even with interventions. Even without attending a single prenatal appointment. Even with health problems. Even malnourished. Even without reading a single book or magazine article about it. Even without knowing anyone else who has given birth. But many do not. Many allow their doctors to make poor decisions that do cause complications or less-than-ideal birth scenarios. And that meant I hadn't "failed" somehow, but that I had been failed. That I had been convinced that if I did what I was told and stopped eating sushi and drinking wine, that that somehow that guaranteed me the birth I wanted. I followed directions, did what the doctors and nurses said, and here I was, four months later, just barely healed from a very traumatic birth that I never in a million years wanted.

Learning what I've learned in the last 4-1/2 years has helped. Knowing that I can take control, that I don't always have to blindly follow directions, that my body can do what all those other women's bodies have done has helped me heal. Having the successful VBAC really helped! And writing this blog is helping. Getting it out, sharing, commiserating, and, most of all, helping other women who have been through it has helped the most. And time, as they say, is the best healer. I have distance and perspective now, that I didn't have in those early months.

I'm still angry, but it's a positive anger. I don't cry about it anymore. I get angry on behalf of other women who are mislead down the same path I was. I butt in (gently, if asked) and share. You can't go back and change what has already been. But you can look at your healthy son or daughter and your healing body and healing soul and know that going through this experience means that maybe you can help other women not go through it, and help other women heal who have gone through it. And that's the ultimate kind of power. That is  the opposite of failure.

Wednesday, April 20, 2011

My Nursing Story

First of all, on a totally unrelated note, I'm supposed to have my major anatomical ultrasound tomorrow (20 weeks!), and I'm terribly excited to find out if my boys are getting a brother or a sister. Hopefully baby will cooperate. I'll be sure to let you know as soon as I can. :)

Obviously, I don't have a nursing story about my first son, except what I've already written about. But I nursed my second son until he was 25 months and stopped because I needed to and he was ready. It's hard to remember all the details going back to when he was born, but I want to share with you my experience as best I can. I feel I had a fairly middle-of-the-road nursing experience. Nothing too dramatic, no major struggles, but some frustrations and idiosyncrasies that might make someone else in the same situation feel a bit better about what her baby is doing.

Because I'd had so much trouble the first time with not having all the right information, with my traumatic birth experience and hospital re-admittance, with my general dislike of the brief nursing episodes I had, and without someone to take the journey along side me and encourage me, I was terrified of what might happen the second time around. I had resolved to move mountains to make it work this time if I had to. I knew all about handling food intolerances, avoiding nipple confusion, and I was ready to take on whatever challenge was thrown at me. I hoped.

It turned out, most of my emotional girding wasn't needed, thank goodness. But it's good to know these things even if you don't need them.

When the birth went smoothly and he latched on to my breast for the first time and didn't let go, I knew I had experienced a miracle. The incredible differences between the births of my two sons still fills me with wonder. I think because I was so committed to breastfeeding the second time, I didn't let "difficulties" get me down. That's not to say I didn't get frustrated with marathon nursing sessions, or that I always loved that I couldn't be away from him for more than an hour at a time, or that I liked hardly getting to sleep through the night for over two years. But at the same time, every time I squirted milk at the shower wall in the morning, every time I woke up to a soaked bed (until I started sleeping on a towel), every time I found a new way to nurse more comfortably while I went about my business, I smiled. I smiled because I was so thrilled that my body was doing exactly what it was supposed to do, and I was giving my son exactly what he was supposed to have.

So. As I recall, for the first few weeks, he nursed pretty much every hour during the day. That is to say that sometimes I got no more than a 20- to 30-minute break in between nursing sessions. I had enough milk that he only needed to nurse on one side in any given nursing session, which was kind of nice. I did have a little trouble with his latch in the beginning - he was a bit lazy about always opening his mouth as wide as he should, and I was a bit lazy about correcting him. When you're nursing so often, you just want to let him eat and be done with it. I did go see a lactation consultant when he was about three weeks old, and she showed me how to fix his latch and told me more about the practical side of breastfeeding than I had learned in the two preceding years. I highly recommend taking an actual breastfeeding class before your baby is born, or scheduling a consultation with a certified LC if you think you're having any problems. Sometimes a simple 30-minute consult can make your life with your newborn oh-so-much more bearable!

I tried using a Boppy pillow for support at first but found it cumbersome. I' well-endowed, and therefore I was actually more comfortable just sitting cross-legged on the floor and letting his bottom rest in my lap than I was surrounding myself with pillows sometimes. As the baby gained strength in his neck and jaw, he was able to keep himself latched more easily, which meant I could nurse one-handed and surf Facebook or whatever while he nursed. I used to make sure to get in some computer time whenever he was nursing on the left side (so my right hand was free to use the mouse!). This was also a good time to sneak in a meal for me!

For the first few days, I swore I wouldn't co-sleep. I didn't want to get "trapped" into having him sleeping in my bed for three years. But most nights, I'd pull him into my bed to nurse him and fall asleep that way. I remember waking up an hour later and he was still there, latched and happily sucking. So I gave in and "admitted" that I was co-sleeping. He nursed a lot at night, but also a lot during the day. He was what they call a snacker. Lots of little meals instead of a big meal every few hours. It seems this is actually more biologically "normal," but it isn't exactly "convenient." As it were. He's actually kind of still that way, liking to eat snacks and small meals throughout the day rather than sitting down and eating a big meal for breakfast, lunch, and dinner. I guess it's just in his personality.

I did try introducing bottles of expressed breastmilk and a pacifier at four weeks of age (the recommended age to start introducing artificial nipples). He didn't take well to either, although I admit that I didn't push hard with the pacifier because my first son was still addicted to his and still used it 'round-the-clock when he was two years old. I didn't want that to happen again. So, though it resulted in my becoming a "human pacifier" (oh NO!), I did end up with a kid who doesn't use a pacifier. I'm still, 28 months later, not absolutely certain how I feel about that.

As for bottles of expressed milk, in the few weeks after introducing the bottle (and having my husband or mother-in-law feed him), he would drink fairly well, but after mostly being alone with me all day and not needing one, he pretty much rejected it. I still kept milk in the freezer on the off chance that he would take it once in a while if I had a baby-sitter, but mostly the milk collected in the freezer and didn't get used. I think I mentioned before that I donated a few hundred ounces to other moms, and I'm very proud of that and hope to do it again in the future. I also found that expressing and storing was a pain when I could just simply nurse him instead.

Digression: I know some moms like to take a bottle of expressed milk with them when they go out, so they don't have to stop and nurse while running errands, but I found stopping to nurse less trouble than expressing, so it wasn't for me. I'm not saying you shouldn't do it if it makes you more comfortable, though. The main thing to remember is that whenever you give a bottle of milk, you're signaling your body not to have a feeding at that time. If it's not a regular thing, then it shouldn't affect your supply. But, if you always give a bottle at, say, 10:00pm, then you might find that you don't have much milk at 10:00pm if you want to just nurse at that time instead. Most experts recommend pumping near a time when the baby is receiving a bottle so that your body knows to continue to make milk at that time. (Obviously, different advice applies to mothers working outside the home who have to pump to provide expressed milk for their babies to eat while they're at work! I'm not really talking about that here, although I may discuss it in a future post.)

Figuring out how to nurse in the mei tai (front carrier) helped immensely. One gloomy Sunday when my husband was at work, I was trying to figure out what to do with my two kids. We had a zoo membership at the time, so I decided to brave the zoo alone with two kids. I put the baby in the mei tai and took the stroller for the toddler. We were watching the zebras for a while, with no bench in sight, when the baby got hungry. I found a way to pull down my shirt collar far enough for him to get boob access, and I nursed him right there standing watching the zebras. That opened up a whole new world for me. First of all, no one around me even knew what I was doing, and it meant I was still mobile and accessible to my 2-1/2-year-old who wanted to continue exploring the zoo!

I wasn't squeamish about nursing in public (NIP) even though I expected to be. I found very quickly that my attitude was, "Baby's hungry. People would much rather see me feeding him (or avert their eyes) than to hear him screaming." Plus, I found that when we were nursing, I felt like I was in a little bubble. Even though I was aware that there were people around me, I didn't care what they thought. And you know what? I didn't get a single negative comment, a single impolite stare, I was never asked to leave or move to a more "private" location. My NIP experiences were always either neutral or positive. I'm grateful for that.

The couple of times I did manage to get away for more than a couple of hours, I ended up with a plugged duct after missing a feeding. OW! Fortunately, I was able to get them to release relatively easily. Only once, I ended up with the beginning of mastitis, but fortunately I was able to identify the symptoms for what they were and take care of it before I needed any medical treatment. Treating plugged ducts and mastitis deserves a post of its own. If you have a pressing question, though, please feel free to ask in the comments!

Anyway, people kept reassuring me that their babies nursed every hour like that for three months and then spread out their feedings after the three-month growth spurt. Or that they nursed like that for six months and then spread out their feedings. Or that once they started solids, you could put them off longer between feedings.  Well, my son continued to nurse about every hour until he was seven months old, when he finally stretched out to every two hours. He pretty much never slept more than a three-hour stretch, even past one year of age. I wasn't as proactive about giving solid foods as I thought I would be, finding it ever-so-much easier just to nurse than to set him up in the high chair to feed him. Plus, he decided he'd much rather feed himself "real" food than have someone shove purees into his mouth with a spoon, so it was hard to get a full meal into him until he was a bit older, anyway.

A few times, I attempted to teach him to fall asleep "by himself," i.e., without a nipple in his mouth. I failed every time. I finally decided that he wasn't going to stop nursing at night until he stopped nursing altogether, and by the time he was 25 months old (and I was one month pregnant!), he was really only nursing at night, and hardly at all during the day anyway. At some point, I realized he had started eating solid foods on a regular basis and only nursed mostly for comfort and not for nutrition. Sure, I enjoyed that he was still getting the benefit of my antibodies and the healing power of the milk, but he was nursing so rarely and getting so little that it ceased to matter. In fact, when he had a double ear infection on his second birthday (poor baby!), I knew he really wasn't getting much milk anymore. I prayed for a good night's sleep more often than once in a blue moon, and I knew that, being pregnant, I needed it more than ever. So, one day in January, he nursed at about 5:15am and then not again the rest of the day. When I put him to bed, I refused to nurse him and told him that the milk was "all gone." "All gone?" he asked, with wonder. How could there be no more? But I gently told him again that the milk was "all gone," and that he needed to go to sleep. I lay with him until he fell asleep. He awoke a few times during the night for the next few nights, asking to nurse, but he was finally convinced that there was no more milk (and there really wasn't after a point), and started falling asleep on his own. He still woke a few times during the night for another few weeks, but now, for the most part, he sleeps through and falls asleep on his own, with no formal "sleep training" from me. In fact, my two sons have about the same frequency of night wakings, and they were "sleep taught" very differently. It's kind of interesting. I'll probably talk more about sleep in another post, since it's an important topic that deserves more attention than I can give in this paragraph.

Anyway, he slept in our bed until he was a year old, at which point I put him in a crib in a room with his brother. That meant I had to get up and go to him every few hours, and we would nurse on the floor and then I'd put him back in his crib. That was hard, but the advantage was getting to sleep in whatever position I wanted in my own bed! It's a trade-off. I think a year was a fair amount of time for him to sleep with us, though, and it did get frustrating not to have the bed to ourselves.

The other reason I finally weaned was that I was getting recurrent bouts of what I think was thrush about every month for about a week. I would get it cleared up and then it would come right back. It never affected him, but it became very painful for a week or two out of every month to nurse him, and I got tired of not being able to completely get rid of the nipple pain, whatever might have been causing it. The pain of latching the baby on when you have thrush or other nipple pain is kind of indescribable and is enough to make you dread a feeding. This is another topic I'll cover more in-depth in a future post.

I'm not really complaining. Yes, I hope this next baby is "easier" in some sense. I hope that she or he nurses less often and likes food more and sleeps better. But at the same time, I know I can handle it and make it work for me if I have to, even with two other kids to chase around. Yikes?

I think it's all about attitude, really. I was so grateful to have a successful nursing experience, and I saw every ounce of milk I produced as a miracle. It was such a rewarding and wonderful time, and sometimes I do miss just cuddling up with him and letting him nurse. Sometimes I'm sad that he doesn't really even remember nursing and simply stopped asking for it after a reasonably short time. But, I'm looking forward all the more to nursing this next baby, for all the same reasons!

Wednesday, April 13, 2011

Do I Have Enough Milk?

One of the scariest things about breastfeeding is that you can't see how much the baby is getting. With bottle-feeding (whether formula or expressed breast milk), you know exactly how many ounces the baby took in a given day. You can track if he's eating more or less. You can actually see that she's growing because she'll gradually increase her intake.

But our breasts (oddly enough) don't have ounce markings on them. And sometimes breastfed babies eat unpredictably. And sometimes it takes them longer to feel full than other times. So how do we know if the baby is getting enough milk? How do we know that we have enough milk?

Well, the first thing I suggest is to trust your body. If the baby eats contentedly and seems satisfied, then you probably have enough good quality milk, and you have no reason to worry. A more scientific or clinical method to check intake, especially in the early weeks and months, is to count diapers. A well-hydrated baby should produce at least 6 wet diapers in a 24-hour period. The urine should be light in color, not dark yellow or orange. (If you see any crystals in the diaper, call the doctor immediately - there's a good chance the baby is dehydrated and may need immediate attention.) You can also tell if a baby is well hydrated by general observation. Is the skin moist and healthy-looking? Are the eyes wet? (Remember that young babies' tear ducts are not fully formed, so they will not produce tears when they cry. This is not a sign of dehydration.) Does she have moist lips and a wet mouth?

Remember that in the first few days after birth, before your milk comes in, the baby will lose some of his birth weight. This is normal. There is only cause for concern if the baby loses more than 10% of body weight before starting to gain. The baby spends the last few weeks in the womb putting on fat reserves to prepare himself for the first few days after birth. Ideally, a baby should at least regain his birth weight by about two weeks of age. Many regain it considerably faster (mine did!). For example, even if a baby is born at 7lbs., 6oz., he may be only 6lbs., 14oz. upon being weighed at 2 or 3 days of age, i.e., he lost 8 ounces since birth. Between 2 and 6 days after birth, the mother's milk should "come in," and the baby will be able to start putting on weight quite quickly. By the time he is two weeks old, he should weigh at least 7lbs., 6oz. again. If he has not gained weight, then there may be cause for concern. There is no need to supplement with formula in those early days unless the baby loses an unexpectedly large amount of weight. Colostrum is sufficient to satisfy her nutritional and caloric needs in the first few days after birth.

A baby should then continue to gain weight fairly steadily until about 6 months of age. At 6 months, things can level out a bit. My second son weighed about the same at 12 months as he did at 6, maybe at most a pound more. (He is considerably heavier now, at 28 months, however!) This is because the baby usually starts doing "tricks" by 6 months of age, including rolling over, sitting up, even crawling or scooting. This burns quite a lot of calories, far more than just lying around staring at things! As long as he is healthy, shows no signs of malnutrition or dehydration, then there is no cause for concern. And he will continue to get taller, even if he doesn't seem to gain weight as quickly!

Okay, so you're pretty sure you're making enough milk. You've got a healthy, happy, well hydrated baby who is growing as expected and producing lots and lots of wet and dirty diapers for you to change. Great! Is there anything to watch out for?

Well, if you're pumping, you may actually notice a fluctuation in your output throughout the month, especially if your menstrual period has resumed. (Many nursing women do not see a return of their periods until well into the first year postpartum and sometimes longer.) There is often a supply drop in the days leading up to your period starting. If you are not pumping, you may notice that there are days that baby seems to nurse more, or for longer, or is more agitated at the breast. Sometimes, you just have a sense that your breasts are "emptier" than usual. This can happen. Usually it's a short-term problem that the baby will solve for you - the more the baby nurses, the more your body will be stimulated to make milk, and you should find that within the next day or two, you have plenty again. It may be related to diet. I noticed that if I went a few days eating fewer whole grains, I seemed to have less milk, for example. Often, it's a maternal hydration issue. It takes a lot of water to make milk, so just drinking another couple of glasses of water per day can increase your supply.

Don't confuse growth spurts and supply problems, though! At the ages of three weeks, six weeks, three months, and then about every three months until about a year old, there are major growth spurts. The baby may nurse seemingly non-stop for hours a time, for two to three days, then suddenly spend a day or so sleeping more than usual. If this pattern occurs near those ages, it is most likely a growth spurt and not a supply problem. The baby is taking in extra nutrition and calories to fuel the major spurt that is coming, as well as preparing your body to produce more milk, since as he grows he will require more to eat! Even though it can be frustrating, can make your nipples feel like they are going to fall off, can be, at best, inconvenient, can make you feel like you're somehow inadequate, remember that it will only be two days, maybe three at the outside, and then everything should return to basically normal for you. There is no need to supplement with formula during a growth spurt - doing so can actually be detrimental to your milk supply. If it's a growth spurt, then the absolute best thing you can do is nurse the baby whenever she wants to.

You also cannot tell if your supply is good by how often or for how long the baby nurses. You should nurse on one side until the baby fusses because the milk is mostly drained, then switch to the other side until the baby is satisfied. Some women (like me) only need to nurse on one side per feeding. You do not need to follow any particular schedule (such as nursing for 20 minutes on one side, then switch, every 2 hours). This may actually be harmful to your milk supply or even to the baby. There is a wide range of "normal" for feedings, include 10 minutes per side every 2 hours, 45 minutes on one side every hour, 20 minutes on one side every 3 hours. A lot depends on how fast your baby transfers milk from the breast to his stomach, how rich your milk is, how quickly the milk starts flowing, and how old your baby is! Older babies complete feedings much more quickly and usually nurse less often than younger babies. Indeed, research into hunter-gatherer tribes shows that it appears the "natural" way for a newborn to eat is to be carried close to his mother's breast at all times and nurse for a few minutes hundreds of times a day, whenever he wants to!

The other thing to watch out for that is not actually a supply problem is around 12 weeks to three months postpartum. Assuming you've been nursing exclusively for that time, you likely sometimes were engorged and, you were pumping, had no trouble making lots of milk for the pump, too. Then, suddenly, around 12 to 14 weeks postpartum, suddenly you seem to have "less" milk. You're no longer getting engorged (unless the baby goes longer than usual between feedings, or randomly sleeps through the night), it's harder to pump enough, and you feel more "empty." This is not a supply problem. For the first three months or so, your body is learning how much milk to make. The baby's nursing is "calibrating" your milk supply. Then, by the time the baby is four months old, your body has figured out how much to make and when to make it, so you're no longer making "extra," or making too much at the wrong times. As long as you nursed regularly during those first three months or so, then you should continue to have enough to satisfy your baby, even after this change occurs. And don't worry, you can still increase supply if you need to by nursing more often and/or pumping after or between feedings.

And now, back to actual supply problems.

If the supply problem goes on for a longer period of time and the baby's health seems to be suffering, you should contact a lactation consultant (IBCLC - International Board Certified Lactation Consultant) or your local La Leche League leader. She can help diagnose a supply problem and give you ideas to help. Sometimes a very simple change can make a big difference. For example, as mentioned above, adding more water to your daily intake can help. There are foods, herbs, and medications that may decrease supply. Common ones are mint, sage, and the medication pseudoephedrine (found in medicines such as Sudafed). Eliminating these from your diet may help. There are also foods and herbs that can increase supply. These include good old-fashioned oatmeal, as well as brewer's yeast, fenugreek (an herb found in Indian cooking), and a few others. Having a bowl of steel-cut, real oatmeal for breakfast can make a big difference. There is also a recipe out there for "lactation cookies" which both taste great and help increase milk supply. For me, switching from white to whole grain pasta made a big difference (since I eat a lot of pasta)! You might also try other sources of whole grains, such as granola bars, whole grain bread for sandwiches, and whole grain crackers. As far as supplements, you can  find fenugreek in capsule form. You have to take a lot, usually something like 3 capsules a day, 3 times a day, and it can make your sweat smell like maple syrup, but it really works. There are a few other supplements you can try, as well, such as goat's rue. A lactation consultant can help you figure out exactly which supplements to take and how.

If none of this seems to help, or help enough, there are prescription medications than can increase milk supply. You would have to talk to your OB/GYN about those, and they sometimes have unpleasant side effects, such as depression.

There are, unfortunately, some women who, despite heroic measures, cannot manage to produce enough milk to fully satisfy their babies' needs. In those cases, a lactation consultant can work with you to diagnose the problem and give additional advice, such as when and how to supplement with formula or donated breastmilk.

The good news is, the vast majority of women have no problem making and supplying enough milk to meet their baby's needs. I would say, don't anticipate a problem or try to solve one that doesn't exist. Rather, just keep on nursing that baby whenever he or she wants, and only if you suspect a problem, try some of these remedies.

Thursday, April 7, 2011

Is Breastfeeding Really "Easier" Than Formula-Feeding?

Now that I've spent all this time expounding upon the wonders of breastfeeding and breastmilk, I want to look at it from a different perspective. This actually came up in a conversation I had recently with a friend, who is nursing her second baby and who, like me, had mostly formula-fed her first son. We, therefore, each have a firm basis of comparison, having done both.

As a side note, I'm speaking specifically of the choice between breastfeeding (from the breast) and feeding formula from a bottle. There is a third alternative, which is feeding expressed breastmilk from a bottle, but that is a completely different experience from either of the two more common options, and, I would venture to say, harder than either breastfeeding or formula-feeding. So that's not a part of this particular discussion, although I'm sure I will touch upon it in other posts down the line.

A lot of arguments when discussing breastfeeding versus formula-feeding is that breastfeeding is "easier." The breastfeeding advocate then goes on, informercial style, about how much trouble it is to bottle-feed. One can almost see the video, a poor bottle-feeding mother, filmed in black-and-white, spending all her time over a sink arduously washing bottle after bottle, steam sterilizing every bottle, shaking the bottle to mix the formula only to have it spurt out the top of the bottle all over her, spilling formula powder all over her kitchen counter, spending hours in the drug store perusing the formula selection hoping to find the one that is right for her child, spending hundreds and hundreds of dollars every month, etc., etc. Juxtaposed to that is the bright, colorful image of the happily breastfeeding mother, settling down into a comfortable chair, smiling with love and affection at her charming and healthy baby, rocking contentedly and singing while her baby nurses. What a picture! Why would anyone not breastfeed, if that is the reality?

But wait. Where's the breastfeeding mother with the three-week-old baby in the throes of his first growth spurt, attached to mom's breast for hours upon hours, mom still in her pajamas at 3:00 P.M., hair and face greasy because she hasn't found time for a shower in three days, dark circles under her eyes from the nonstop cluster-feeds, nipples sore and cracked, dirty dishes piled in the sink, laundry overflowing the hamper, mail left unopened, bills left unpaid, refrigerator empty because she hasn't made it to the grocery store because every time she tries to go, the baby gets hungry and she has had to stop and nurse him so many times that she can't bear the thought of having to find a place in the store to nurse umpteen times while scanning the frozen food section for whichever TV dinners are on sale so she doesn't have to cook, because who has time to cook? Juxtapose that with the new daddy fondly smiling down at his new baby while giving him a bottle, mom sleeping peacefully in the next room grabbing a much-needed three-hour nap, then waking happily to head down to the kitchen to wash dishes and cook dinner.

So which is easier?

All of the above scenarios are true, in their way. Bottle-feeding can be a hassle. Sometimes you have to try three or four or seven different formulas before you find the one that your baby actually manages to keep down. You (or someone) do have to wash five to eight bottles per day. Breastfeeding, especially in the early weeks, can be very stressful, time-consuming, and even painful.

I would argue that at different times, different feeding methods seem "easier." Certainly, when a new mom is at the end of her rope, trying to handle everything, and having to stop every 45 minutes to nurse again, she might stand helplessly in the formula aisle of the supermarket (if she makes it there) trying to fight the urge to just buy one can, just give one bottle, just to have a few hours' respite. On the other hand, the new mom who has ended up spending much longer at the car repair place than she expected and didn't bring enough bottles and formula to cover the amount of time she was there might find herself envying the other woman in the waiting area who is sitting and peacefully nursing her no-longer-fussy baby while she waits for her car to be ready.

And, of course, if you've already been at the supermarket for an hour, and you just want to go home, and you're in the checkout line, and your baby starts fussing because he's hungry, the last thing you want to do is get out of line to go find a relatively private place to get relatively comfortable and nurse. At that moment, the thought of just putting a bottle into the baby's mouth while you continue to stand in line and take care of your purchase is very attractive.

I'm not being sarcastic. I've been there, on both sides of the argument. I've been in the situation where the baby is hungry and I had nothing to give him because all the bottles were dirty and I'd run out of formula. I've been in the situation where I just wanted to finish my shopping, but I had to stop and nurse for 30 minutes on a bench in front of the pharmacy before I could continue on my way. Both are stressful. Both make you wish there was another way.

But, having bottle-fed for 16 months and breastfed for 2 years, I'm here to tell you that, over time, the very real benefits of breastfeeding far outweigh the conveniences of formula feeding. I promise. Let me tell you what I think those benefits are.

All of us, at some point, feel like we are in some way "neglecting" our baby in order to take care of other things, or just take a break for ourselves. Instead of actively engaging our baby every minute of the day, we dare to *gasp* spend 15 minutes on Facebook, or read a novel (well, maybe one chapter), or (G-d forbid!) eat dinner while the baby fusses in the swing. Maybe we plop the baby on a playmat to stare at the very interesting musical star so that we can answer emails and make phone calls. Maybe we are crass enough to pay a nanny or daycare center to watch our baby for a few hours a day so that we can work, inside or outside the home, or sleep, or pay bills, or have lunch with a friend sans children.

And then, suddenly, baby is hungry, and we stop what we're doing, pick him up, hold him close, and put him to the breast. Suddenly, we are forced to spend time holding the baby, looking into his eyes, talking to him, singing to him, cuddling with him. At worst, we continue to browse Facebook one-handed, or attempt not to drop spaghetti on the baby's head, or try to answer that work email by hunt-and-pecking with one finger on whichever hand is free. But the baby is there, in arms, skin-to-skin, receiving the ultimate in comfort, nutrition, and love. Mommy-guilt momentarily alleviated!

Continuing to nurse past newborn-hood gives the added benefit of having available, at all times, the perfect pacifier. If your baby is hurt, or sick, or unhappy, or having trouble sleeping, or agitated, generally all you have to do is put him to the breast, and he'll calm right down. Nursing will make him feel better - it actually has analgesic properties to help soothe a booboo or to calm him after or during immunization shots or blood draws. Breastmilk has all those amazing antibodies and healing properties that can help a baby recover faster from illness, and help prevent that simple cold from turning into an ear infection or lingering cough. Nursing is relaxing, and can help him fall into a deeper sleep, soothe him after a startled wakeup, relieve the tension of being in a new situation.

Nursing can calm a tantrum, provide a distraction, and (forgive me) shut the baby up so you can finish watching "American Idol."

Hey, let's be realistic, here!

I would even venture to say that nursing can calm Mom, too. I'll give you an example. When my second son was about 6 weeks old, nursing almost round-the-clock, I took an hour to go for a regular dental checkup and have a couple of minor fillings done, leaving the baby with my mother-in-law and a few bottles of expressed breastmilk. While at the dentist, I got a call from the daycare that my older son (a little over 2 years old at the time) had fallen and busted his lip and that at least one of his teeth was knocked loose. Now, in most cases, this news would have made me very anxious.  I would have been in a frenzy of "What do we do?" and "I'm in the middle of having a cavity filled! I can't come get him!" and "Oh my G-d, take him to the emergency room!" Instead, I discussed with my husband, over the phone, what we should do, and asked the dentist (since teeth were involved) what she thought. My husband said he'd pick up our son, and the dentist said we could just bring him straight to her (she also did pediatric dentistry) and she could examine him right away. (He's fine, by the way.) What struck me about myself in this whole situation was how calm I was. I'm not, as a general rule, a super-calm person. I'm easily agitated, especially in a new situation, and I'm can be fairly irritable. But not this time. Honestly, I credit all the oxytocin in my system from the constant nursing for helping me to stay focused and calm.

At other times, too, if I was especially worked up, holding my baby close and nursing him helped me to calm down along with him. It made me focus on one thing, evoked pleasant feelings of love and warmth, and allowed that wonderful hormone, oxytocin, to flood through me.

So, yes, I will freely admit that formula feeding isn't of the devil, and there are times that it can be very attractive. But I will also say with absolute conviction that no matter how difficult, no matter how stressful, no matter how much work it is in the beginning, (1) It will get better, and (2) It's totally worth it.

Tuesday, April 5, 2011

Let's Talk About Breastfeeding - Part II

I got a little clinical in the last post, and one of my goals for this blog is to keep it on a personal level. I do intend to bring in educational information when I find some that I think is interesting or important, and I will certainly include sources and quotes and useful knowledge when it directly relates to something I'm writing about, as with the Pitocin information a few posts back. However, I felt it was important to do a general post about breastfeeding before bringing it back over to my own experience.

Why did I want to breastfeed?

When I was pregnant with my first, I wanted to breastfeed, but I only had a vague notion of why. "It's better for the baby." (Better than what?) "Breast is best." (Breast, as opposed to what?) My mom and aunt breastfed, so of course I should too. It's just what you're supposed to do. Breastfeeding itself was a very abstract activity to me. I think maybe twice or three times in my whole life had I actually seen someone breastfeed, always when I was a small child, and the process and act had never really been directly explained to me. I didn't have a concept of how it worked, or what it should look like, or what the reality of it was. I had only heard how "I loved nursing," and "I nursed for 9 months," and "It's a really wonderful experience," without the accompanying truths, that it takes work in the beginning, that nursing a newborn is not like nursing a nine-month-old, that some people nurse into toddlerhood and beyond. I just didn't really know anything about it.

So when my first son was born and I expressed my desire to breastfeed, somehow I had this idea that I'd bring him to my chest, he'd start sucking, and we'd do that every few hours. I didn't know that milk supply is governed by baby's demand. I didn't know about proper "latch," and that what you eat can get into the breastmilk, and that there are specific ways to hold the baby. I didn't know about not giving pacifiers in the early days so as not to mess with the latch and sucking reflexes, or not to give bottles for similar reasons. I didn't, to be honest, really have a concept of what one might put into a bottle!

And yet, I wanted to breastfeed. Even after trying it, and not liking it, and not understanding it, and feeding formula for weeks, I still wanted to breastfeed. I still regretted "screwing it up" (as I thought of it). I regretted not having the information I needed in advance. I regretted not asking the right people for help. I wanted to breastfeed.

But WHY?

Honestly, I'm not even sure, now. I think part of it was that I felt like I had failed at something that should have been simple, and I'm not the sort of person who fails. I think part of it was that I felt like something was wrong with me, and I wanted to "fix" it. I also think that once I started learning about all the benefits of breastfeeding and breastmilk, once I talked to people in person and online about what breastfeeding is really all about, I really felt that I had missed out on something. Something big. Something important. And maybe, subconsciously, I realized that I had missed out on an important opportunity to bond with my son by not having to care for him in those vital early weeks.

By the time my son was several months old, I had tried and failed to relactate, although I did manage to give him a few weeks more of suckling (nursing is, after all, more than just for food), a few more drops of breastmilk. We moved across country and changed jobs, and I became a work-from-home mother, which meant I was with him a lot more often. I thought maybe at that point I could have been comfortable nursing him, except the one attempt I made to get him to latch, he looked at my breast like it was a UFO and had no idea what I wanted him to do. And that was that.

But, by then, too, we had learned that we had been blessed with a very picky bottle-feeding baby, who would only drink a full meal if it started out piping hot. He hadn't always been that way, but by the time he was about four months old, he literally would refuse a bottle unless it was hot. By then, we had learned the trick of warming the water before mixing the formula, which saved several minutes in the bottle-making process, but that wasn't always possible when we were out and about. We got pretty adept about asking for hot water in restaurants, but we were at a total loss if we were, say, at the zoo, or a gas station, or Walmart when he needed a feeding. Once I was near a Starbucks, so I went in and got a cup of hot water from them. For some reason, I remember that time very fondly. Anyway, my point is that my baby made formula feeding difficult. It also took us until he was 11 months old to figure out that we could carry hot water with us in a Thermos (duh). How nice it would have been to work that one out sooner.  (I realize that not all babies are so picky about bottle temperature, and many people can simply carry pre-measured bottles of water and a can of formula and quickly mix the formula and water and feed it. It wasn't this way for us, and he never grew out of it. He just eventually stopped needing a bottle, and our lives got so much easier.) Oh, also, he didn't digest the regular formula well, and it took us several weeks of trying in the beginning to find a formula that didn't make him terribly unhappy and gassy. It turned out that the kind of formula where the proteins are broken down more worked very well for him, and we were quite pleased to find a generic version of that particular formula, which saved us probably hundreds of dollars. But it was still about $14 per can, and by the age of four or five months, he was going through about two cans a week.

All of this added up to a lot of money and aggravation for feeding this baby. I now look back on that as somewhat of a blessing, because it made me very determined to breastfeed our next child. I had watched several mothers feed hungry babies by just opening up their bra and hooking them up, and I so wished it were that easy for me. Not to mention the number of times we got caught out longer than expected and didn't have a bottle or formula on hand. I once actually went to Walmart and bought a bottle and a can of formula so I could feed him while I was out. Very frustrating, and another problem I would not have had if I had been breastfeeding.

Combine this difficult bottle-feeding experience with everything I was learning about breastfeeding and breastmilk. I found myself spouting off all kinds of random information as I came across it, as if I were some kind of breastfeeding expert. I became a breastfeeding advocate even before I became a "breastfeeder."

It was no mystery, then, why I was so determined to breastfeed our second baby. I was obsessed with the idea. By the time he was born, I had read "The Womanly Art of Breastfeeding" cover to cover, had devoured articles about breastfeeding and breastmilk, had watched videos about how to obtain a proper latch, had learned all about milk supply and demand, how to know if your baby was reacting to something you were eating, growth spurts, night nursing, and why you shouldn't give a pacifier or bottle in the first four to six weeks. I had learned about how supplementing with formula often resulted in eventually terminating the breastfeeding relationship entirely, how feeding a bottle of formula before bed did not, in fact, make the baby sleep better, how formula actually messed with all the benefits breastfeeding had on the baby's gut, and even about things like oversupply and overactive letdown, which I may or may not have needed to know. In other words, I had all the book learning in the world, but I still hadn't actually nursed a baby for any appreciable length of time.

Well, book learning is great, but it's not the same as the hands-on (breasts-on?) experience, let me tell you right now. Having the knowledge is important - if you don't know the rules to basketball, you can't play it, but knowing the rules doesn't mean you can go out on the court and shoot a three-pointer. That takes practice.

So does breastfeeding. As much as I knew intellectually, when they first handed me my second son and put him to my chest, I had no clue how to actually do that breastfeeding thing. I was so determined to make it work, though, that I just nursed him. And nursed him. And nursed him. For the first six months of his life, that baby nursed every hour. (You measure the time between feedings from the start of one feeding to the start of the next, regardless of how long they are at the breast in between.) If I started nursing him at 9:15, he would need to nurse again at 10:15. In the early days, he was sometimes at the breast for 45 minutes. This meant I had 15 minutes between feedings to, say, pee, or eat, or type two-handed. This meant I couldn't so much as run an errand without having to plan to stop and nurse him while I was out. I learned to nurse in public very quickly, because I had no choice. I was going to nurse that baby. At about six or seven months of age, he finally stretched out to going two hours between feedings, and it only took about five to 10 minutes for him to complete a feeding, so things got considerably easier. But to this day, even though I'm not nursing at all, I am envious of those women whose babies start out going two or three hours between feedings.

I think if I had been less determined, the idea of letting someone give him some formula once in a while would have been very seductive. I can see how, despite having no big problems, like mastitis or thrush, bleeding and torn up nipples, low supply, or severe food intolerances, my son's nursing habits might have driven me, or someone like me, to give up. I did go a little crazy after a while, but I couldn't fathom any other option. And because I was with him almost all the time, he didn't even get very many bottles of expressed breastmilk (which I was more than willing for someone to give him if I couldn't be with him when he was hungry.) After a point, he wouldn't even take a bottle.

During the first several months, though, I did spend time every day expressing milk. Usually I did it once a day, obtaining between 2 and 4 ounces of milk between hourly feedings. I quickly learned to hand-express, mainly because setting up the pump, using it, and then breaking it down and washing it was really too much trouble when I didn't really have to do it. I also found hand expression to be more productive for me. I had a terrible, though not completely irrational, fear in those early weeks that something would happen to me like it had the first time around, and I would have to spend several days unable to nurse him. If that were to happen, I wanted to make sure I had a supply of breastmilk stored up in my freezer so that he would have something to eat.

As it turned out, not only was I healthy (thank G-d), but he rarely needed a bottle anyway, since, as I mentioned, I was almost always with him. I managed to store up a few hundred ounces of milk over time, much of which ended up getting thrown away. I gave a few ounces here and there to my older son when he was sick, figuring it certainly couldn't hurt, but he didn't really seem to like it. I did give 50 ounces or so per month to my housekeeper, who had had a baby a few months before me and couldn't pump enough for him when she was off cleaning houses or when her son was with his father. So her son got some of my milk, which makes me a little proud. I also shipped 75 ounces of milk from California to Florida to help out a woman whose baby, at four months of age, simply decided he didn't want to latch on the breast anymore. She was determined that he would not get formula if she could help it, but she was only able to pump about half of what he required and solicited milk donations to help make up the difference. I added my small contribution to her effort as well.

I can't say that I always "loved" nursing. I loved that I nursed, certainly. I love that I was able to provide that extraordinary benefit to my child.

So, why do I want to breastfeed my next baby?

I don't have to answer that one, do I?