Tuesday, November 15, 2011

Overactive letdown/Oversupply

Last week, I was certain I had discovered the source of GI's evening and morning fussiness. It was dairy! And caffeine! And chocolate! And maybe soy?

Except he would be better for a day or two, then fussy. Then okay. Then fussy. Perhaps there was something else going on, either in addition to or instead of food sensitivities?

It occurred to me to look up on Kellymom about overactive letdown and oversupply. GI tends to prefer to nurse on the left side. When I nurse him on the right, he pops off constantly, and whenever he comes away from the nipple, the milk continues to spray out without any squeezing or pressure. I could see how the constant dribble would annoy him, and that he would pop off so he could catch his breath! The left side doesn't do that. Only the right. According to Kellymom (Kelly Bonyata, who runs the site, is a respected IBCLC), overactive letdown (OAL) and oversupply can cause problems such as gassiness and spitting up. I assume this is due to gulping air while swallowing and the abundance of foremilk, which is the thinner, more sugary and watery milk that begins each feed. Too much foremilk can cause gassiness. (Some foremilk is good. Only foremilk can cause problems. You want the baby to get the full spectrum of milk at each feeding. If your milk supply is normal, this will happen without any work on your part.)

I also realized that he would often be fussy and gassy in the mornings. I tend to nurse him only on the right side at night, just for convenience. He usually only nurses once or twice in the night (yes, I'm VERY lucky), so it's not a big issue to use only one side. Well, if the right side is the one with the OAL/oversupply, and he's only nursing on that side at night, then it would make sense that by morning he'd be gassy and uncomfortable.

So I did an experiment. On Sunday night, I nursed him only on the left side through the night. My right boob felt like it was going to explode in the morning, so I expressed some milk in the shower just until it wasn't sore anymore. The left side was still happily supplying milk, but was quite soft. And the baby? Happy as a clam.

I investigated methods for decreasing supply to make a happier baby. Seems odd to want to decrease supply, but really, you want neither too much nor too little milk. You want the right amount of milk. Basically, I need to tell the right breast that it doesn't need to make so much. The way to do that is not to empty the breast. If I take less milk out of it, it will produce less. Throughout the day yesterday, I'd start him off on that side just to get letdown. I'd make him nurse on that side just until he got frustrated, then switched to the left. I didn't want to not use that side at all, because then I'd become engorged and risked plugged ducts and mastitis. Not a path I wanted to go down. By evening, the right side was noticeably less full. I went ahead and nursed him on that side through the night and woke to a very full left breast! He was a little bit gassy and fussy, but not as bad as he had been. I'm hoping that within the next few days, the supply on the right will settle down, and I can alternate sides normally without a problem.

Then I'll try reintroducing dairy to see if that was really a problem as well! I won't go overboard, as I would expect that too much dairy could be problematic, where just a moderate amount would be okay. Same goes for caffeine, chocolate, and soy. I did have a little tofu the other night and it didn't seem to bother him.

My husband commented, "Imagine if he was on formula" and had these problems. You can't selectively eliminate one ingredient. You have to completely switch formulas and hope. And try different bottles. And maybe you can't solve the problem. On the other hand, you can eat whatever you want. I suppose there are trade-offs however you look at it.

I'm sure I'll be updating on this further, as we try to figure out the age-old question of, "Why is my baby fussy?" Also, he's 10 weeks old, which means he should be growing out of the evening fussiness in the next few weeks anyway, if it's just the "normal" baby fussiness as opposed to being food- or OAL-related. Definitely an interesting ride around here!

Tuesday, November 8, 2011

Going Dairy Free for a Happier Baby

First things first, a little housekeeping. I'm going to take the suggestion that I use my kids' initials to refer to them from now on. So, my oldest is NJ. He's five. Then comes SB, who'll be three next month. And finally, my newest little guy, GI, who's just two months old.

Pretty much everyone will agree that babies cry, they spit up, and many are fussy or "colicky" in the evenings. This is considered just a fact of life, they'll grow out of it, and you just have to make it through the first three months or so and everything will get better. This is essentially true. Babies do cry, to let you know that they need something, that they are uncomfortable, or that they are hurting. Babies do spit up. Many experts attribute occasional spit-up to the immature esophagus and epiglottis, which allow some of the stomach contents to come back up. Most of the time, we don't consider spit-up to be a cause for concern, unless it's really excessive. Often, the baby will then be diagnosed with "acid reflux." More and more babies are receiving this diagnosis and being prescribed medications such as Zantac or Nexium to reduce acid production and spit-up. For some babies, this works. For others, it makes no difference.

Similarly, many babies are fussy or "colicky" in the evenings. They cry for no apparent reason. They pull their knees in as if their stomachs hurt. They can't settle themselves to go to sleep. And we, the parents, have to carry them around, bounce them, swaddle them, or nurse them constantly in an attempt to keep them calm. And most of us are familiar with the last-ditch "put them in the car and drive" solution for colic or fussiness.

There's often a reason for the spit-up and fussiness, though, and it doesn't just have to be "because he's a baby." It's hard for us to admit that something the baby is eating might be upsetting his still-developing digestive system. After all, if I'm breastfeeding, then that means that something I'm eating is upsetting his little tummy, and that means I have to start the detective work of finding and eliminating said item.

My baby spit up sometimes, and some evenings he was very fussy and could take hours to finally calm down and fall asleep. Because I assumed this to be normal ("because he's a baby"), at first I didn't want to believe that there was something in my diet that he didn't like. I never had this problem with SB, or at least, I don't think I did. So I didn't anticipate any problems with GI. After all, I've read over and over again that it's very rare for a breastfed baby to truly be reacting to something in the mother's diet. Kellymom says so. Numerous other articles say so. I tend to believe what I read when it's written by a respected IBCLC!

And yet.

I have several friends who are experienced breastfeeding mothers. And they all insist that they had happier babies when they stopped eating certain foods. For one, it was cabbage, eggplant, and broccoli. For another, it was dairy, eggs, and wheat.

Could this be my baby's problem? Could I be eating something that isn't agreeing with him? Was it worth the effort to identify and cull out this item, or could we live with the fussiness (and could he live with the fussiness!) for a few months until he grew out of it? It just didn't seem fair for the baby to be in such distress if there was something to be done about it. One of the most common culprits is dairy, so I decided to try to see if dairy might be causing a problem.

One evening, I ate quite a few pieces of pizza. Not only was my stomach a little upset (I don't have pizza very often), but GI was definitely more unhappy the next day.


I wondered if caffeine might also be causing him not to sleep as well. One day, I had coffee in the morning, and then forgot I'd had the coffee and had a 20-ounce Diet Coke at lunch time. Wow, was he wired that evening. Yes, caffeine appeared to make a difference, too!

I decided, let me try avoiding caffeine and dairy for a while and see what happens. It's not so hard. And while I do pine for my Starbucks here and there, it's really not been that big of a deal. I noticed improvement within three days! And the change is so incredible! I'll do this until he's three months old and then try some dairy again and see what happens. Sometimes once the digestive track matures, you can re-introduce foods that were previously bothersome. I can wait. My family went out for pizza the other night, and I got the salad bar. Carefully. I did break down one rainy day this week and get a hot chocolate from Starbucks. Not much caffeine, but covered with dairy. (I forgot I could order soy.) I had a fussier baby that evening, although not too bad after just the one exposure.

The clincher was this Sunday. My husband and I had a renewal of vows/wedding ceremony, and I knew I wouldn't be able to nurse the baby on demand. (Have you ever tried to nurse a baby in a wedding dress? Because I have!) So I took along some expressed milk and bottles, just in case I wasn't available when he got hungry. Sure enough, he chose the moment when we were standing under the chuppah to express his desire to eat. So someone gave him a bottle from one of the bags of expressed milk I'd brought along. Fortunately, we had tried giving him a bottle a few evenings before, and he'd taken it happily, so we knew he would drink it if offered. (Some babies won't. It would have been a problem if GI were such a baby!)

Well. Sunday night and Monday he was a major fusspot and kept spitting up. The milk he drank on Sunday came from before I was avoiding dairy and caffeine. Today, Tuesday, he's been all smiles and took a three-hour nap in the middle of the day! Definitely makes a difference!

How do I avoid dairy? Well, I admit it's a bit easier for me than for some people, because I'm kind of used to not having much dairy in the house anyway. We only buy foods that have a kosher label on them as it is, and kosher labels make it very easy to identify if there are dairy products in packaged foods. Kosher items are labeled not only as kosher, but whether they contain dairy or meat or neither. We don't buy any products marked with a "D" or listed as "dairy" next to the kosher symbol. When I go out to eat, I just try to be extra careful. (See below for more detail about these symbols.)

We use a lot of soy and rice milk in place of cow's milk. We use Earth Balance or Fleishman's margarine instead of butter. Also, we use a lot of Pam spray, canola oil, or olive oil for cooking. No parmesean cheese with our pasta. No pizza for me. It's really not as hard or as terrible as it sounds, and this comes from someone who loves a good mac & cheese as much as the next five-year-old.

I tell you, it's stressful having a fussy baby. The change that has come over this guy since I've made these slight changes to my diet makes it all worthwhile. He sleeps better, he smiles more, and he's just generally more content. It's worth the effort. Especially since I know it's not forever! I'll try some dairy and some caffeine in a month or so, if I feel the need, and see how he is. If he's fine, then I'll go back to eating what I feel like eating, but I'll probably try not to overdo it. If he seems to react, I'll wait until he's six months and try again. It's not so long.

Using Kosher Symbols to Help You Avoid Dairy

When you shop, look for one of the following symbols on the food packaging. Not all foods will have a kosher symbol, of course, but you'll find many common items that do.

These are a few of the many kosher symbols out there, but these are easy to remember and some of the most common ones. If there is no word or letter under or next to the symbol, or you see the word "parve" or "pareve," then that means that the product is guaranteed (under strict rabbinical supervision) to have no dairy in it, so you can eat it to your heart's content. If you see a letter 'D' or the word "dairy" along with the symbol, avoid it! If you see the word "meat," then it will also certainly have no dairy in it.

Of course, there are many other non-dairy products out there that don't have a kosher symbol. You can find many tips on the web for reading ingredient lists in order to determine if a packaged item has any dairy in it.

I hope this helps!

Wednesday, November 2, 2011

Your Birth, Your Choice

The birth of a child is a dramatic, life-changing event. I'm not just talking about the impact a new baby has on your life, but how the birth itself affects you. I think often a new mother's feelings about the birth itself are overlooked or minimized. A woman may be reluctant to admit that she was in any way emotionally harmed by the method in which her child came into the world or by the circumstances surrounding the birth. It's as if  coming out and saying that she is dissatisfied, angry, depressed, regretful, or unhappy about any aspect of her baby's birth is tantamount to saying she is not happy to be a mother, or not happy to have a new baby.

This isn't fair, and it isn't true. It does women a great disservice to tell them that their feelings don't matter. If such feelings must be buried, ignored, or hidden then they can't be dealt with. Not only that, but these feelings must be aired so that they can be separated from the feelings about the child. You can absolutely unconditionally love your child but not love the way he was born. You can be over-the-moon happy about motherhood but still be angry about not having the birth you expected or wanted.

Pregnancy and birth change a woman. There are, of course, the obvious physical changes. There are the crazy hormones. And there are actual changes in the brain that prepare a woman to care for, love, nurture, and protect her offspring. Pregnancy and birth change your body and your soul. Those changes may carry emotional consequences, some positive, but some also negative. It's no secret that some women are very uncomfortable in their postpartum bodies, that we spend years after giving birth hoping to return to our "prepregnancy size." For many of us, that simply never happens. Our post-pregnancy bodies have stretched and expanded in ways that cannot be undone through any amount of diet and exercise. This is especially true if there was any surgical involvement in the birth!

While postpartum diets, our "prepregnancy" wardrobe, our flabby tummies and floppy breasts, our widened hips and bigger feet are common topics of discussion among new mothers, the emotions we have attached to giving birth are less often brought to light. The result of this lack is that we are hesitant to bring up issues like "birth options," "alternatives," "unnecessary interventions," and so forth, especially after the fact. We feel we are stuck with what we get, unable to discuss our reactions to the unexpected c-section or the emergency induction we didn't want, because, "at least you have a healthy baby!"

Not everyone is affected by birth in the same way, of course. For some women, birth is a major spiritual event, connecting her back through the generations to all the women who came before, empowering her, grounded in thousands (millions?) of years of evolution and nature, filling her with all the magic of womanhood. For others, birth is simply the vehicle by which the baby goes from inside to outside, without any particular emphasis on spirituality or life-giving. Some don't know how they will feel until they've done it. Others have built up a great deal of expectation about what giving birth will be like.

All of these women have a right to be heard, and all of these women have valid feelings. There is no "right" way to feel about birth.

I have a friend who has two kids. Her older child was born via emergency c-section after a long, hard labor. When she was ready to give birth to her second, she decided on a scheduled repeat c-section. Describing this, she says there's no better way to give birth. You show up, get on the table, and an hour later, you have a baby! No labor, no pushing, no work. She usually punctuates her description by rubbing her hands together like brushing off dirt, as if to say, "All done! Quick and clean."

On the other hand, I have a friend who has one child, born via emergency c-section after a long, hard labor. I still haven't heard her entire birth story, because the experience caused her so much emotional trauma that she has trouble talking about it. She is healing, and she is more open about both what happened the first time and what she'd like the next time around than she was even a few months ago. She most definitely does not want a scheduled repeat c-section!

Then there's me. I had no idea that five years later, I would still be so affected by my first son's birth that I would be writing a blog about it! I, too, had a c-section (although not classified as "emergency") after a long, hard labor. For many months, I assumed future children would be born by c-section as well, not because I wanted it to be that way but because I thought I had no choice. I thought my uterus had been permanently damaged and that labor would put undue stress on my imperfect organ and cause me and my baby harm. It was only when I began to learn about VBAC, and that I might actually be a viable candidate for a vaginal birth in the future, that I began to process my feelings about the c-section and understand why I so badly wanted a vaginal birth.

At first, it was simply that my recovery from the c-section was very hard, and I saw friends who had had vaginal births having much easier and faster recoveries. That seemed to be the way to go. (That's what convinced my husband!) Then I started to learn about the risks of c-section and the benefits to both mother and baby of a vaginal birth. My attitude was still very clinical, but I was starting to acknowledge that there was an emotional aspect to my desire as well. But it wasn't until my second son was born vaginally that I fully recognized the power of getting the birth you want. As that baby slid easily out of my birth canal and was put on my chest, an incredible flood of joy and relief surged through me. This was my birth. I had done it. I was in control.

In a c-section, you have to give up control of the process and place your and your baby's bodies in the hands of others. In a natural birth, you are in control. You do the work. For me, that was very important, because I was able to put my trust in my own body instead of others' hands. I was able to get over the idea that my body was somehow imperfect. I could deliver a healthy baby on my own. I didn't need surgery to get him out. I am a mother. I am meant to be one. The revelation of motherhood didn't come with the first birth. It came with the second. (That's not to say I wasn't a mother to my first child before his brother was born, or that I don't love him and nurture him and care for him and protect him! It's just that I didn't feel like a mother, truly like a mother, until my second was born.)

When the time came to have my third baby, I knew without a doubt that I wanted a VBAC, and I was fairly certain I wanted to have the baby without any interventions, if I could. That is, I wanted no Pitocin and no epidural. I wanted to be in total control. I wanted to be able to ask for what I needed and refuse what I didn't need. And it turned out that the circumstances of his birth allowed me to have total control. I had no complications, and he was a full-term, healthy baby. I went into labor spontaneously and was able to fully dilate and push the baby out with no medication, although an episiotomy was helpful at the end. (This is in contrast to my second son's birth, for which I required an induction two weeks early due to pregnancy-induced hypertension. The intensity of the contractions caused by the Pitocin made it impossible for me not to have an epidural, although I was able to have the baby vaginally.)

Interestingly, despite having all of the power in this third birth, I didn't feel as powerful a sense of accomplishment as I had when my second was born. Partly, I felt I wasn't as strong as I could have been, because though I did end up having him without an epidural or other pain relief, I had broken down and asked for it repeatedly. My husband tells me over and over again that I'm being silly, that I was amazing and strong, but I think maybe I expected to feel more empowered, and instead I felt weaker than I wanted to be. I'm not at all disappointed. In fact, I'm thrilled to have been able to give birth in this manner, and my baby is as much a joy as anyone would expect. But, I think it's important to speak of feelings like these, just as it's necessary to express the anger, frustration, disappointment, or trauma of a birth that didn't go as hoped.

I bring up my third birth experience in order to make my final point. Going into this third pregnancy, labor, and delivery, I felt that I finally was fully informed. I knew what my choices were. I knew the possible consequences of any given option. I knew that sometimes an induction or c-section is unavoidable or absolutely necessary. And I felt that I would be able to make peace with however this birth happened, whether I got the natural birth I was planning or if I (G-d forbid) ended up needing an emergency c-section for whatever reason. I knew how to avoid unnecessary interventions that might lead to what would otherwise have been an unnecessary c-section. I knew what I didn't want (which I think was more important than knowing what I wanted). I'm sure that if the birth hadn't gone as "planned" (although I use that term loosely), I would have had some emotional consequences, especially if it ended up being traumatic as well as undesirable. But at least I would have known that I'd made all the "right" choices, that I'd known going in what my choices were and how various scenarios might pan out.

Thus, in conjunction with giving women the space to discuss birth trauma, to express any "negative" feelings that might be associated with their given birth scenarios, it is also important to discuss birth options. It is important to go into birth knowing what possible outcomes there are, depending on what choices are made. It is vital to understand when something is necessary and when it isn't. That's not to discount those times when we simply don't know what the right thing to do is, and we simply have to make a choice based on incomplete information, of course. But going in knowing that A may cause B, or that C is a direct result of A can help guide our decisions throughout the birthing process, and going in armed with information can at least alleviate the pain of thinking you've done something wrong if events don't play out as expected.

Five years after my own traumatic birth experience, I looked into the bathroom mirror and examined my recent postpartum belly. Under the little "shelf" of belly fat left over from being sewn up from the c-section is my external scar. I noticed, that day, that the scar was quite faded. It was no longer an angry red or purple. It no longer stands out brightly against my pale skin. It's there, but it's become a part of the landscape of my body. It no longer angers me. And I realized that along with the fading of the external scar came the fading of the internal ones, the emotional scars that I'd been left with because I thought I had made a series of bad choices that had led me to end up in a place I didn't want to be. Over the years, I have played out those couple of days of labor and delivery, trying to figure out "what went wrong." I shouldn't have gone to the hospital so soon. I should have walked around more. I shouldn't have gotten the epidural so early. I shouldn't have let them give me Pitocin. I should have been mobile so I could have pushed in a different position. It's easy to go over and over all the "bad" choices I made. For a while, I thought I might write out the "timeline" of the birth and go through and pinpoint each moment where I was led farther down the path to a c-section. But now, as I learn even more about the birth process, I have come to feel that a c-section may ultimately have been necessary no matter what choices I made to begin with. You see, the anger and guilt I felt didn't come from the fact that I had a c-section. It came from the impression that it was my fault I'd had a c-section. That I'd made the wrong choice when presented with an option. I no longer feel that way. I know I didn't have all the information going in. I now know that I couldn't have made good decisions based on what I knew at the time. And beyond that, now that I understand better how a normal birth should progress, I can see that it's entirely possible that my son was simply stuck, that there was no way he would ever have come through the birth canal no matter what I did, or that if I had tried to get him out that way, he or I might have been injured in the process. If that is the case, which I am more and more willing to believe, then thank G-d for the c-section, because I got a healthy baby and a healthy mom out of that decision.

My friend who had the scheduled c-section was describing the difference between the major surgery of a c-section and the major surgery of having her thyroid out. You see, "You get the door prize!" after the c-section. You get to take home your baby. Having your thyroid out isn't nearly as rewarding.

In the end, then, only you know how you feel about birth in general, about your birth experience(s), and about what you want to get out of having a baby. It's not anyone else's job to tell you how you "should" feel, or what choices you "should" make. I do believe, very strongly, that you need to know your options, you need to know the possible outcomes, you need to understand the process before you can make an informed choice. Because when you've made an informed choice, at least you aren't left with the "what ifs." I think it's the "what ifs" that are the most difficult to heal from.

Tuesday, November 1, 2011

Breastmilk works!

Today my baby had his eight-week well checkup. I think I can claim Mommy-milk bragging rights when I tell you about this baby. He was born 8lbs., 3.5oz., you may recall. At two weeks (actually, 17 days), he was 9lbs., 14oz. And today? 14lbs., 14.5oz. (Probably if I had fed him before being weighed, he'd have broken 15 pounds!) He's off the charts for weight!

I realize that having a big baby doesn't mean I'm a better mom or anything. It's all genetics, after all. It's just very satisfying to know that I'm giving him everything he needs. He's being fed exclusively breastmilk, and I don't think you'll find anyone who will say he's not getting enough to eat! You should see his thighs!

Just for an interesting comparison (although, as my preschool-teacher mom always says, slightly facetiously, "You shouldn't compare children!"), my first son, who was mostly formula fed, was born 9lbs., 1oz. I apparently didn't write down his two-week weight, but at eight weeks, he was 14lbs., 13oz. So, almost the same as his baby brother. But he started out bigger!

The middle boy was on a slightly different trajectory, since he was born a couple of weeks early. He was born at 7lbs., 6oz. At two weeks, he was 8lbs., 1oz., and at eight weeks, he was 13lbs., 1oz. So his weight gain was similar to the baby's, but he's smaller overall (still is!).

I think this interesting study, with a very small sample of three genetically similar individuals, shows that breastfed babies grow faster in the first couple of months than formula-fed babies. Or maybe it's just genetics. But still, it's cool to really be able to see that breastmilk works.

Speaking of breastmilk working, my middle son randomly came down with croup. He's on the mend, nothing serious, but he's congested and coughing a lot. I thought I'd try giving him some breastmilk to drink tonight, to see if it might help his throat. Croup is the inflammation of the voice box and windpipe. Breastmilk has anti-inflammatory properties. So... would it help? I expressed about an ounce or two into a paper cup and gave it to him to drink. He drank it down and asked for more. I wonder if he has a residual memory of the flavor of breastmilk. He only weaned in January, but he says he doesn't remember nursing. When I'd attempt to give breastmilk to my first son when he was sick, he generally wasn't a big fan, so it's possible his palate developed more attuned to the flavor of formula.

I did have a breastfeeding-isn't-working moment today, though it's not exactly what it sounds like. I'm a big believer in using nursing as comfort, when necessary. The baby had his first round of shots today, and I'd planned on just nursing him afterward to soothe him. I did that, and he went to sleep and was fine for several hours. Unfortunately, he woke up crying. I assumed he was hungry, as it had been several hours since he'd last eaten. I tried to get him to nurse, but he wouldn't nurse! He just cried and cried. How was I to comfort him if he wouldn't take the boob? I remembered my middle son doing the same thing after his first shots. The only thing that helped was to give him some infant Tylenol and let him go back to sleep. When he woke up, he was fine. Same thing happened with the baby today. But it made me feel so helpless that he was too upset to nurse. When he woke up again, he ate very well, slept some more, nursed some more, slept some more, and right now he's playing happily, staring up at his "friends" - a mobile of a zebra, giraffe, and lion - smiling and cooing. Too cute.

There's really nothing that compares with the expression on a baby's face when he's done nursing, pops off, and looks up at you with glazed eyes and pure bliss. They call it being "milk drunk," and I can think of no better description. What could be better than getting your fill of warm, sweet milk?

P.S. I'd like some input on how to refer to my kids here. I'm usually pretty open with my name and my kids' names on the internet, especially on Facebook, but somehow I feel that on this blog, whose viewers I have less control over, I maybe don't want to use my kids' real names. It's becoming awkward trying to refer to them as Son #1, the oldest, or what-have-you, so I'm thinking maybe they need blog nicknames? What are your thoughts? Nicknames, numbers, real names? What's the best way to do this?