Tuesday, July 31, 2012

About Those Formula Freebies and Mayor Bloomberg...

By now, just about every breastfeeding blog I read has made some kind of commentary or another on New York City Mayor Bloomberg's new program for breastfeeding promotion in NYC hospitals. Part of the Latch-On NYC initiative, this voluntary program requires that participating hospitals lock up formula, not routinely give out formula samples and formula-branded paraphernalia to new parents, prohibit the display of formula promotional materials in the hospital, and conform to the New York State hospital regulation that exclusively breastfed babies not be given formula supplementation unless medically indicated. The program is expected to raise breastfeeding rates in participating hospitals because research shows that women who are given formula samples by their doctors or in the hospital are 3.5 times more likely to be supplementing with formula by two weeks of age. If formula is kept under wraps, and new mothers receive education about breastfeeding before their babies are given any formula, the thinking goes, breastfeeding rates will rise and the overall health of the population will improve. Hand-in-hand with this is news of an AAP resolution that pediatricians should not routinely hand out free formula samples to patients, for the same reasons.

I have been reading every blog post I've been linked to, taking in almost every comment on all the major breastfeeding and parenting blogs I frequent, and I still don't quite know how I feel about this initiative. It sounds like they're basically trying to get NYC hospitals to conform to the Baby Friendly Hospital Initiative standards without going through the BFHI certification process. I gave birth to GI in a Baby-Friendly hospital, and I felt that the breastfeeding support there was excellent. Of course, I went in intending to breastfeed. If I had gone in less certain, uneducated, or sure I wanted to use formula, I'm not sure how I would have felt. I didn't need or want to ask for formula, so I don't know what kind of "lecture" or "education" I would have gotten had I made the request. I didn't have any problem nursing or producing milk, so I don't know how I would have been treated had I genuinely felt my baby was starving and needed formula supplementation. Because I've been lucky enough to be able to nurse with relatively few problems, and because I'm extremely pro-breastfeeding, well educated about breastfeeding (I literally wrote a book on it), and because I wasn't going to let anything or anyone stand in my way of breastfeeding, I didn't need to think about "the other side."

I often wonder whether I would have been able to breastfeed NJ had I given birth to him in a hospital like the one where I had SB and GI. Rather than jumping straight to formula when there was the slightest hint of a problem, if they had been more supportive of breastfeeding and, more importantly, had been more supportive specifically of me in my situation, would I have left the hospital breastfeeding instead of with an extra case of formula? It's very hard to say. My husband and I were discussing this last night (in the context of the above-mentioned controversy). His perspective and memories of those early days are different from mine, but we both remember that the lactation consultants who visited me were quite unhelpful. While it may have been true that many women who experience postpartum hemorrhage have difficulty with their milk supply, and while it may have been true that pumping often would help bring in my milk, what I really needed was to spend lots of time skin-to-skin with NJ, nurse him on demand, and be forced to care for him. Yes, I was weak. Yes, I had lost a lot of blood. Yes, I was in pain. But NJ was healthy and strong, had a great latch, and, with a little help, I probably could have initiated breastfeeding while in the hospital and breastfed him several times a day during that four-day stay rather than allowing the nursery nurses, my husband, my mom, and my visitors to feed him for me. It's probable that he would have needed a few bottles (or to be fed via syringe, perhaps?) on the first day when I was fairly down-and-out from blood loss, but on the second day? The third? Through the night? I do remember some good practices, such as telling me to save whatever I did pump and that they could give him that in a bottle instead of formula. They did provide me with a pump and show me how to use it. They did have lactation consultants come every day. But I constantly feel, looking back, that the advice the LCs gave me was, while not necessarily wrong, unhelpful or misleading. If you straight out tell a woman she won't have enough milk, why should she even bother to try? And if you don't tell her or her husband that formula is not, in fact, equal to breastmilk, then why shouldn't she just go straight to formula to begin with?

What's missing in all of this, to me, is that education prenatally is vitally important. The decision to breastfeed can't necessarily be made in the postpartum haze. The desire to stick with it is lowest when in the throes of newborn nursing, and the temptation to use that free formula is highest at the most critical period in the breastfeeding relationship. I know this. I've lived it. You need to walk into that hospital determined to breastfeed. You need a supportive hospital staff, from the OB or midwife to the delivery nurse to the postpartum nurses. You need lactation consultants on hand 24/7 (not just during business hours!). You need good, solid breastfeeding information. And you need to know that you are going to be respected for whatever choices you make.

The loudest complaints against this program seem to be from two basic viewpoints. One is the women who never wanted to breastfeed and don't liked feeling "shamed" or "guilted" by the hospital for their choice. The other is the women who desperately wanted to breastfeed but, for whatever reason, needed to supplement with formula in the early days and struggled long and hard with the decision. Both feel that formula samples are helpful, especially those that only needed a can or two of supplements before being able to go on to exclusively breastfeed. Both feel that being lectured or educated by hospital staff before someone will go get them a bottle for their starving babies is shaming and unfair.

The thing is, I agree with them, too. If my baby is starving because I can't produce enough colostrum or milk to satisfy him (please note that this is rare), then I need to be able to give him something else. If the hospital staff balk at giving me a bottle of formula to feed him, and I have to sign a form or justify my request every time my baby gets hungry, it's going to make me feel even worse and more inadequate. Support doesn't mean just patting a woman on the back and telling her she's doing a good job breastfeeding. Support means sitting down with a woman and figuring out what she wants, what her goals are, and then helping her get there. A good IBCLC knows this, and a good IBCLC will know when formula supplementation is necessary and how best to introduce, use, and wean off of those supplements, if possible. Having a nurse who's had a little bit of lactation training come in and tell you once again that formula isn't as good as breastmilk, and maybe you should have another go at feeding from the breast before you give a bottle, is only going to make a frustrated mother more flustered and upset. We need a balance.

I'm in favor of locking up the formula, but I'm also in favor of giving it to any mother who asks for it. I'm in favor of banning the gift bags and the formula-branded handouts, but I'm also in favor of giving unbranded formula to mothers who need it (in the hospital). I'm in favor of good breastfeeding support and information, but I'm also in favor of education in the proper preparation and use of formula, if a mother chooses to use it. I'm in favor of pediatricians having formula samples on hand to help out mothers who need it, but I'm also in favor of pediatric offices having lactation consultants on staff to help mothers who are struggling. Balance.

We need a more comprehensive solution. While restricting access to free formula will increase breastfeeding rates among those who are on the fence (that's been proven), it will not help those women who truly need it or who adamantly refuse to breastfeed. We need information and education throughout women's lives, and especially during pregnancy, to help them learn about breastfeeding before there's a squalling baby in their arms. We need postpartum support, especially for those women who are going back to work. We need support for pumping in the workplace. We need better, longer maternity leave. We need a cultural shift.

If there is one thing I know, unquestionably, it's that the more babies who are breastfed, the better. Banning formula freebies in hospitals and pediatric offices is a step in the right direction, but it's not the only step.

Monday, July 30, 2012

"Curing" Birth

I'm a huge fan of modern medicine. I'm grateful every day for antibiotics, life-saving surgeries, well-trained emergency room staff, ICU's, NICU's, and PICU's. I find it miraculous that conditions which used to kill us are now easily treated, cured, or managed by medications, surgeries, or simple monitoring and lifestyle changes. Where an illness like strep throat once might have been fatal or cause life-altering disabilities such as deafness and heart disease, now it requires a simple trip to the doctor, a throat culture, and antibiotics to knock it right out and get on with our lives. Appendicitis used to be 100% fatal, and now it can be taken care of with a simple laparoscopic surgery. We can fix or replace teeth so they look better than new. We can repair complicated broken bones with surgically placed pins and help them heal with custom-made splints. We can give people new hearts and lungs and livers and kidneys. We can remove brain tumors with an outpatient procedure using a gamma knife, with no need to even cut through the skull. Modern medicine is a great blessing that has lead to better quality of life, decades-longer life expectancy, and a healthier population.

The problem is that modern medicine is so good at finding and fixing problems that sometimes it seems we're actively looking for things to fix that may not actually need fixing. Or, we go way overboard trying to improve a situation that can be managed with less intervention. For example, often high blood pressure or diabetes can be managed by lifestyle and diet changes, without the need for medications, but we automatically jump to the "quick fix" of medications that may have unknown or unexpected side effects.

Nowhere is this phenomenon more obvious than in pregnancy, labor, and birth. Until about 100 years ago, birth did not take place in hospitals, attended by doctors, hooked up to monitors, using medications. Birth was the territory of women, specially trained midwives, with experienced mothers and grandmothers for support. Indeed, even today, in many other countries, obstetricians only come into the picture if there is a complication or emergency situation where the mother and/or baby need advanced care, made possible by modern medicine.

Statistically, the ability of a woman to safely have a vaginal birth is quite high, possibly over 90%. According to research, the optimal c-section rate (i.e., the total percentage of women who give birth via c-section) should be between 5% and 10% of all births. That is to say that in potentially 90% or more of cases, a woman will not need surgery to help her deliver her baby. Right now, in the United States, the c-section rate is around 32%, meaning that almost one in three women gives birth via c-section. Obviously, there is some disconnect between the optimal and the actual, and the question is, why? It is thought that the high rate of medical interventions during birth, including continuous fetal monitoring, epidurals, and Pitocin, do contribute to the high c-section rate. The bottom line is, in most births, a laboring woman given the proper support will eventually have her baby vaginally using nature's time-tested, age-old methods of contractions to open up the cervix and coax the baby down and pushing to encourage the baby through the birth canal and out into the open. It's primal. It's painful. It's hard work (hey, they don't call it "labor" for nothing!). It involves a lot of bodily fluids and parts of our bodies we don't normally have out in the open. But it's basic. It's biological. And it's a system that has worked to propagate the human race for a very, very long time. I mean, there are, like, seven billion of us. Obviously, we're doing something right.

I'm not saying, by the way, that emergencies don't happen. I'm not saying that interventions, drugs, and surgeries are never necessary. I'm not saying that modern medicine and obstetrical practices haven't saved numerous lives, both mothers' and babies'. I'm not saying that hospitals and doctors don't have a place in the labor and birth process. There's a reason that hospital birth is the norm in the United States and many other Western countries. We feel safe there. We know that if there is, G-d forbid, some kind of emergency, we're right there in a place that can tend to us. I know plenty of stories that end with, "If I hadn't given birth in a hospital, my baby would be dead," or, "If I hadn't been in the hospital already, I would have been infertile after my first birth," or, "Without the c-section, both me and my baby would have died." These stories are true, absolutely. Plenty of mothers and babies died in childbirth in years past from issues that we can now either prevent, treat, or handle because of modern medicine.

The trouble is that because we can make birth "easier" on women, sometimes it seems like we ought to. Obviously, if we have the choice between pain relief and pain in any kind of medical procedure, we typically opt for pain relief. I wouldn't want an appendectomy or tooth extraction without anesthetic! So if we know how to "take away" the pain of childbirth, it makes sense that we would want to. Pain is not typically seen as a good thing, and if we can make it go away, we'd like to do that. I'd rather take an Advil than suffer a headache; I don't know about you.

But birth is different. The pain of childbirth is not a "bad" pain. The pain doesn't mean something is wrong. The process of labor and delivery is part and parcel of bringing a healthy baby into this world. By jumping ahead and providing interventions that may or may not be necessary before finding out if those interventions might be causing problems, we have produced generations of people who were not born "naturally." It's only in the past few years that doctors and researchers are positively identifying real problems that are directly related to interventions during childbirth.

One of the biggest culprits is induction and/or c-section before 39 weeks, which has led to many, many beds in the NICU being taken by "late-term preemies," those born between 37 and 39 weeks, who were not quite ready to be born. Many of these inductions and c-sections were not done for medically indicated reasons but rather for convenience or because the mother was uncomfortable. Hospitals that have started banning non-medically-indicated inductions before 39 weeks are seeing a significant reduction in NICU admits, leaving those beds and resources available for babies who truly did need to come into the world before they were fully developed, in order to save their lives or the lives of their mothers. The use of Pitocin to start and/or "augment" labor is very common, and most women are not told about the risks both to herself and her baby that Pitocin may cause. The use of Pitocin is associated with fetal distress, postpartum hemorrhage, newborn jaundice, and possibly even neonatal brain damage. New studies show that at least half of induced labors lead to delivery by c-section - if the baby is not ready to be born, there is a high chance that induction simply won't work and a c-section will be the only way to get the baby out. Even when labor has started on its own, Pitocin is often used to "speed up" or "augment" the labor, and the risks of the use of Pitocin still apply in these cases.

The fewer interventions and less interference a woman has during labor, the more likely she is to give birth safely and vaginally. And, concurrently, researchers are finding that babies born vaginally tend to suffer fewer neonatal complications and lifelong health problems, such as asthma. Vaginal birth is safer than c-section, and spontaneous labor is more desirable than artificially-induced labor.

The root of the problem is that pregnancy and childbirth are viewed by the modern medical establishment as diseases that need to be treated or injuries that need to be fixed, rather than natural, biological processes that can continue on their own without interference. As more women advocate for their births to be supported rather than treated, the outcome is becoming more positive and healthier for mother and baby.

I'm not advising any woman on how and where she "should" give birth. This post isn't about what choices we as women should be making. Rather, it's about looking at how modern medicine sees birth and to address the changing tides of medical opinion toward better, safer births for all women. We as women need to know our options so that we can have useful, intelligent discussions with our care providers about how, when, and where we want to give birth, and, in return, our care providers need to be sensitive to the changing attitudes toward birth, back to letting nature take its course rather than trying to "improve" upon a system that works better without interference.

Just as we don't try to make our kids grow faster by administering human growth hormone willy nilly, just as we don't try to force our kids to walk before they're ready, or make their teeth start to fall out before the permanent teeth start coming in, just as we only turn to surgery for weight loss as a last resort after trying lifestyle changes, we can look at pregnancy and birth as normal processes that we need to wait out, rather than medical conditions that we need to treat.

Friday, July 20, 2012

Kids Need to See Women Breastfeeding

The other day, we were at a community barbecue at the Rabbi's house. I wandered into the living room of the house, where several of my friends were sitting around and chatting. One friend said she was sorry, but she thinks she made a faux pas. I couldn't imagine what she could have done. She explained that NJ had come in while one of the other mothers was preparing a bottle of formula for her daughter. (Not that she needs an excuse for this, but her daughter is 2.5, autistic, and has feeding issues, so she takes a bottle of formula to supplement her food intake.) He said something along the lines of, "I didn't have that when I was a baby!", to which my friend replied that he had. He argued, and she wasn't going to push the issue, so she just said, "Okay."

I shrugged and said, "No big deal. He doesn't know that he was formula fed." It's not that it's a big secret or anything. It just hasn't come up as a topic of conversation. He watches me nurse GI, and I think he has a vague awareness of my having nursed SB, and he's seen several of my friends nurse their babies, and he has always just assumed that (a) that's how you feed a baby, and (b) that's how he was fed. I call him my little five-year-old lactation consultant because he's very interested in breastfeeding and knows that it's the best choice for a baby. I haven't made a big deal of it, just exposed him to it by feeding his brothers. It has imprinted as "normal" on his brain, and I hope he carries that image with him into fatherhood so that he can be an awesomely supportive husband when his wife (G-d willing) has a baby (G-d willing).

I told my friend not to worry about it and that, if he asked me, I would talk to him about it. Apparently the whole episode didn't make much of an impression on him, because he hasn't mentioned it. It does make me wonder if I should sit him down and have "a talk" about it with him, but I mostly feel that it just isn't that important. At some point, it will come up in conversation, or he'll ask, and I'll explain that when he was born, Mommy wasn't as well-informed as she is now, and she was also very sick, and it was very hard for her to nurse him, so he got bottles of formula instead because he had to eat something. I'll tell him that we don't need to judge other mothers for how they feed their babies. (I wouldn't want to deal with the embarrassment of having him say something rude to a mother giving her baby a bottle! And he's the type who would say something, too, if it occurred to him.). I'll just say that some mothers decide to feed their babies formula from a bottle instead of nursing them for whatever reason, and that's their choice to make.

I'm glad that my sons are growing up exposed to women nursing. I think the image of a baby drinking from a bottle is so ingrained in our society that many girls (and boys) grow up thinking that's the only way to feed a baby. I know that when I had NJ, I didn't even really know what breastfeeding should "look like," or how it worked. I didn't know much about bottles, either, granted, but I think if I had grown up with more exposure to breastfeeding women, the idea of breastfeeding might have come more naturally to me. I didn't wrestle with the decision to breastfeed - I had intended to, before the circumstances of NJ's birth led me down a different path - but I didn't educate myself, and that was the mistake.

I think growing up knowing that babies are fed from the breast will serve more than one purpose. First, it will make breastfeeding normal, and that means that when they have their own babies, these children will think first of breastfeeding rather than bottles. Second, they will know how breastfeeding looks. How to hold the baby will come more naturally, because they'll have seen it live. They'll know how it should sound, and what the baby needs to be doing. They might even have talked to someone about how it feels or what problems she might have had. Certainly, they or their wives will need help and support from friends and relatives and medical providers and society as a whole in order to start and maintain a successful breastfeeding relationship, but they'll be motivated to breastfeed and motivated to seek out such support, knowing that their breasts were designed to feed their babies.

Growing up seeing breastfeeding as a regular and normal thing will also decrease the "breastfeeding in public" debate. If breastfeeding is just another thing you see every day, then it is no longer sensational or controversial, so there will be no need for debate. Feeding a baby is feeding a baby. It's not sexual or indecent or offensive. And if a baby suckling from a breast is as ordinary a sight as a child eating french fries, women will feel more confident in starting and continuing to breastfeed because it won't seem weird or unusual or "out there" or uncomfortable.

So, to my little five-year-old lactation consultant, my son who is so concerned for the welfare of babies, thank you for already being so supportive of breastfeeding. Thank you for showing that a child can process the idea of breastfeeding as normal, take it in stride, and establish a vision of baby feeding that will encourage him to champion breastfeeding for his own babies one day. Kids are not offended or put off by breastfeeding. It's kids who will become the next generation of breastfeeding supporters because they have been exposed to it as children and don't find it exceptional at all. And that's what we want.

And, if my son asks me how he was fed as a baby, he will also get to learn that sometimes we do need to use formula, and we don't think less of a mother just because she isn't breastfeeding. Maybe the next generation of "Mommy wars" won't include a breastmilk-versus-formula category at all.

Thursday, July 19, 2012

Happy Book-iversary

One year ago today, I published my e-book on breastfeeding. In that year, I've sold approximately (numbers as of July 18, 2012 at 7:00pm PDT) 173 copies of the book in the US and UK Kindle markets. I consider this a huge accomplishment and am very excited to be able to make such a report!

I would like to do something to celebrate my one-year bookiversary. I'm thinking about some kind of giveaway or promotion. I'd love some suggestions. I'd also like to raise the visibility of this blog as well as continue to get the word out about my book. If you enjoy this blog, please share it with your Facebook and Twitter friends. Link them to a post or page you especially like or share the whole blog. If you already own my book, consider leaving a review at the Amazon page. I'd love more feedback!

And to liven up the blog as a whole, if you do read a post and have something to say, leave a comment! I'm always checking back here for comments and I'd love to get some discussions going.

Tuesday, July 17, 2012

Pain (and Pain Relief) in Labor

I love reading birth stories. They're incredibly cathartic, emotional, thrilling, even the "boring" birth stories. In fact, I wish everyone a "boring" birth story, because no excitement means no complications and no scary situations! So whenever a friend has a baby, I wait anxiously to read or hear her birth story, because I want to share the experience with her, to empathize, sympathize, commiserate, and celebrate with her. Reading other birth stories lets me understand my own births in a broader context, gives me insight into how other women perceive and experience birth, and demonstrates the attitudes of other practitioners and other facilities.

In reading a birth story the other day, I was amazed by how often she mentioned the pain, how she couldn't wait to go to the hospital and get the epidural, and how she mentioned the agony and doubling over and how excruciating it was. Now, I've given birth three times, and, yes, it hurts. A lot. No question. But she seemed so focused on the pain, so obsessed with getting the pain over with by getting her epidural.

I totally understand. I really do. Birth is intense, contractions sometimes feel like they're never going to end, and pain trumps reason. And when I had my first baby (as this was her first), I'm pretty sure I was quite focused on getting to the hospital and getting the pain over with.

I don't mean to belittle her experience. Indeed, some women experience pain more acutely. Some women have lower pain tolerance than others. And I'm sure that some women experience contractions as more painful or have more intense contractions than others. And reading her story, it sounds like her water had broken and was slowly leaking over the course of several days, and I well know that contractions without the bag of waters intact are far more powerful and intense than those that are cushioned by the amniotic sac.

All of that said, the reason I bring it up is this: I think that if you fear the pain of labor, or if you are focused on when you can have relief from that pain, the more painful you will perceive those early labor contractions to be. And if those early ones are "that bad," how much worse will the later ones be?

Again, labor is painful for most women. There's no getting around that. But there's a psychological element to pain, and I think that's where childbirth classes and preparing for labor and getting your head in the right place can really make a difference. There are many techniques out there for handling labor without medications. There's the well-known Bradley and Lamaze methods. There's Hypnobirthing. You can take classes or read books or listen to podcasts to learn about these methods. But even if you don't use a specific method (as I didn't), you can still prepare yourself emotionally and psychologically to expect and handle the contractions and associated pain.

Even with my first labor, I felt some obligation to delay the epidural for some time. I don't remember why, except that, even then, the limited knowledge I had was enough to know that getting the epidural too early can cause problems. As it was, I got it far too early, at only 4cm dilation. It probably would have been smart to be mobile longer in that birth, although there's no way to know if I would have been able to give birth vaginally to my large-headed, OP child. I do remember that I opted for the narcotic pain relief first, so that I could delay an epidural, even though I had been in active labor for quite a few hours by then and was very tired of it.

My self-education after that birth led me to consciously delay the epidural even longer with my second birth. I think knowing pain relief wasn't something I could have made me willing to work through the pain rather than resent it. Every contraction, after all, leads you closer to the prize. Every contraction is worth it.

I'm not saying that every woman should or wants to experience a drug-free, natural birth. By the end of my third birth, I didn't really want to, either! It happened that way almost by accident, because I had decided that I wouldn't have an epidural long enough that there wasn't time to get one. My mindset was such that this pain was something I just had to get through, and there would be a baby eventually as a reward. There's nothing wrong with getting an epidural. It doesn't make you weak or less of a woman or mother. It doesn't make your child's birth less meaningful or less enjoyable. Indeed, it might make it more enjoyable, given that you can relax a little and not be in so much pain!

I do want to stress that the longer you are mobile and not lying on your back, the more likely you will successfully give birth vaginally, so if you don't need the epidural, put it off a little longer. The reasons are basically that being upright will help move labor along, the pressure of the baby's head on the cervix will encourage it to open and efface, and being able to change positions can relieve pressure on the umbilical cord, increasing blood flow to the baby and reducing the risk of an emergency situation. To put it succinctly: Lying on your back is about the worst possible position for labor and delivery.

What it comes down to is, don't be afraid of the pain of labor. Don't dread it. Don't go in worried about how much worse it's going to get. Be aware that there will be pain, and learn about ways to relax in between contractions and get through each surge. Know that you have the option of an epidural if you want one, but don't think you have to rush to get it. It will be there when you're ready.

I can compare it to the aftermath of surgery when they give you pain meds and tell you not to take them more than every six hours. You sit there, watching the clock, waiting for the six-hour mark so you can pop another Percocet, because the previous dose wore off an hour ago. If you're sitting there watching the clock, just waiting until you can take another pill, those minutes will be excruciating. But, if you're distracted and doing other things, you might be aware that the pain is returning but not be focused on it until you glance at the clock and realize that it's been six hours. At least, that's how it is for me.

Everyone experiences pain differently, and, as I said, for some it is less tolerable than for others. But if there is a psychological aspect to pain, which there usually is, then you can reduce the pain by reducing the expectation of pain. And the most important thing to remember is, eventually, it will end no matter what you do! You will have your baby, and labor will end.

Thursday, July 12, 2012

Calling All Writers!

I am soliciting guest posts to enhance my site and increase the content base. I am especially interested in posts on the following topics, which I either have little or no experience in or on which I would like other perspectives.

  • Non-hospital births (home birth, birth center birth, etc.)
  • Unusual breastfeeding circumstances
  • Raising a special-needs child
  • Exclusive pumping
  • Work-out-of-home moms - pumping at work
  • Partners' perspectives on pregnancy, birth, breastfeeding
  • Birth trauma (birth stories, recovery from birth trauma)
  • Other birth stories
  • Medical perspectives on pregnancy, birth, breastfeeding - especially would like personal pregnancy/birth stories from medical professionals in OB and pediatrics, i.e., what's it like to be on the other side of the bed?
  • Parenting multiples (twins, triplets...)
  • Religious perspectives on pregnancy, birth, breastfeeding (laws, traditions, customs)
  • An article from a CPST (Child Passenger Safety Technician) about car seat use would be excellent
If you would be willing to write a guest post or reproduce an article you've already written, please let me know. 

I've added a menu of links to specific types of content at the top of the page so it will be easier to jump to specific topics of interest. Your articles, when applicable, will be added to those pages as well as featuring in the main blog stream.

If there are any other topics related to the Jessica on Babies focus that you'd like to write about as a guest poster, please feel free to make suggestions. Also, if you have thoughts about topics you'd like me to cover in my blog, I'd love to hear those ideas as well.

And, finally, if you have a product you'd like to provide either as a giveaway on this blog or to become a sponsor of this blog so that we can expand content and readership, please contact me.

You may comment directly to this post with your ideas or questions, or you can email me directly at jshaham (at) gmail (dot) com.

Wednesday, July 11, 2012

Breastfeeding Is Not Always Easy, But Neither Is Raising A Child

Breastfeeding is not always easy.

There, I said it.

Breastfeeding is not always easy.

But it's also not always hard.

And bottle-feeding isn't always easy, either.

See, that's the thing. Caring for a baby is not easy. It's not always hard, but it's not easy, either.

In the beginning, breastfeeding takes effort. For some women, it takes a lot of effort. For others, it comes with only a shallow learning curve.

I don't think most people need to be convinced, nowadays, of breastfeeding's health benefits to both baby and mother, that breastfeeding is more natural, that breast milk contains all sorts of incredible ingredients unmatched by any commercial formula. We know this. And yet, because we have a choice, we still feel there's a choice to be made.

That's fair. We make a lot of choices when it comes to baby care. Start solids at 4 months or 6 months or when the baby shows interest? Commercial baby purees or homemade baby purees or table foods? Cloth diapers or disposable diapers or elimination communication? To swaddle or not to swaddle? Which car seat to buy? Which stroller? Should we baby-wear? What carrier or carriers should we use? To vaccinate on the CDC schedule or delay vaccinations or not to vaccinate at all? To send to daycare or stay home with a parent or hire a nanny or a part-time baby-sitter?

When we have choices, we feel we need to make choices. And the existence of formula means we do have a choice when it comes to how we feed our babies. Thank G-d for that. Thank G-d that babies whose mothers are unable to feed them due to a medical condition, absence, or tragedy have an alternative. Thank G-d that mothers who are suffering from a medical or emotional condition that is incompatible with breastfeeding can still feed their own babies. Thank G-d that working mothers who are unable to pump enough to meet their babies' needs have a backup.

But why is it that so many women want to make the choice about infant feeding based on which one is easier? Because, let's face it, the easiest thing would be to let someone else care for the baby entirely! Come and visit when she's happy and content, and as soon as she starts crying or needs something, hand her off. Wouldn't that be great?!


Of course not.

When we have a baby, we take on the responsibility of caring for her. We expect to have difficult times, but we also expect to cherish the good times. We are filled with love. Every smile melts our hearts. Every cry hurts. Becoming a parent means taking the hard times with the easy, making difficult decisions, caring. And it's not like they're babies forever, when feeding and diapering are our biggest concerns. What about when your 12-year-old tells you that his friend is thinking about suicide, or your eight-year-old expresses concern about her weight? What about when your 16-year-old comes home drunk from a party or your six-year-old asks where babies come from? Things really don't get easier. I heard it put very succinctly, once: "Bigger kids, bigger problems."

We may as well get used to the idea right away that raising kids is not easy. Being a parent is not easy. We will always have difficult decisions to make. Sometimes, we will be confronted with two options, neither of which is easy, and sometimes we will get to choose between two easy actions. Sometimes the right choice is obvious and easy. Sometimes it's obvious and difficult. Sometimes it's neither obvious nor easy. Sometimes there is no "right" choice. Sometimes there is no "easy" choice. And, yes, sometimes there is no choice.

So when it comes to breast milk versus formula, breastfeeding versus bottlefeeding, does it matter which is easier? Is that the only determining factor? It's easier, so that makes it the right choice?

I don't know. Maybe for some parents, that is the major deciding factor. But I hope that when it comes to raising a child, we don't always go with whether something's easier, but rather what's the best thing we can do given our situation.

Tuesday, July 3, 2012

Sometimes, You Just Have To Keep Going

I'm so sorry for my rather long silence here. It's been busy, busy with my day job and kids and it being summer, and I haven't had much time or energy for blogging. But I'm brimming with thoughts, so hopefully I'll have some articles coming at you one after another for the next few weeks, if things calm down.


Last Sunday night was one of the best nights I'd had in a long time. GI didn't wake up an unreasonable amount of times, and in between I felt like I really got some good sleep. Monday, he took two great naps, and I got tons done while he slept. I was highly optimistic for Monday night, as a result. Instead, he literally did not sleep the entire night, and, thus, neither did I. It was after 6:00 a.m. before he (and I) finally dozed off, and by 7:00, I had to be awake for the other two kids, breakfast, etc. I don't know why he was awake. He wasn't fussy, didn't seem to be in pain, wasn't playing. He was nursing, nursing, nursing, eyes open. It felt a lot like the night back in December where I drank several cups of cream soda at dinner, not realizing that it was caffeinated, and then simply lay there the entire night, not asleep but not fully awake, either. I'm certain I hadn't given GI any cream soda that night, though...

Needless to say, Tuesday was rough. But, I couldn't just take a day to rest and veg a little. No, Tuesday we had an appointment with SB's speech therapist, whose office is about 45 minutes away. I had promised the kids to visit a neat cafe on the way back, called Java Mama, which is a coffee shop specifically catering to parents with small children. They have gourmet coffee drinks, yummy food for adults and kids, and a supervised play area for the six-and-under crowd. It's pretty fantastic, but it's far enough away that I don't go there unless I'm in the area anyway or have a meeting or something there. The point is, we had things to do on Tuesday, so I had to swallow my fatigue, bury my exhaustion, and power on. We made it through the day, even through a thorough shopping at Walmart, and got home in time to make dinner. And that's when I crashed. I opened the pantry and couldn't fathom the idea of cooking dinner. I could feel the muscles in my neck and arms twitching. I'd had it. I'd exhausted my reserves (what little I had). I gathered my wits enough to pull out a box of potato pancake mix and whisk up the batter. I set out the first batch to fry and had to go sit down. It was like that for the entire dinner-making: flip pancakes, sit down; remove pancakes, put on next batch, sit down; flip, sit. I finally brought a chair into the kitchen so I could sit down between bursts of activity. It was that bad.

I so looked forward to bedtime. I'd put the two older ones to bed, nurse down GI, who would surely be tired enough to sleep well, and go to bed early after enjoying the quiet for a little while. I always take time to enjoy the quiet; it's what keeps me sane sometimes. Only, when I finally did go to bed, I lay there, eyes open, not quite awake but not really asleep, for at least four hours. Seriously. Not okay.

I did get some sleep, eventually, and GI slept his usual way, waking frequently to nurse but sleeping in between, so if I had also been asleep, it wouldn't have been any worse than I'm used to at this point. I couldn't fathom how I could be lying there awake for hours upon hours when I was that tired, but lay there I did, hour after hour.

Things were back to normal Wednesday night, and it's been basically fine since. I don't know what was keeping him up on Monday night, and I don't know what kept me up on Tuesday (the extra shot of espresso at lunch, maybe?), but it happens sometimes. It's part of parenting. Sometimes, you have a sleepless night or two. Sometimes you're sick. Sometimes you have a million things to do and all you want to do is lie down. But as parents, as mothers, sometimes we just have to power on. We don't get sick days.

There's no secret to it, really. I get that a lot lately, "How do you do it? You make having three kids look easy! I don't know how you manage with the baby and the other two, and make dinners and work!" and so on. Hey, I bask in the occasional compliment, when the mother at the park mentions how polite or cute my kids are, when the manager at a restaurant is amazed by my corralling all three at once, when a fellow parent is envious of how fast I can get all three into the car and buckled up. But if they ask how I do it? There's no secret. You just do it. You just do it. You don't have a choice, so you just do it. Got three kids? Hold the baby, have the other two grab some part of you or your clothing, and start walking across the parking lot. Put the baby in the shopping cart and the littler of the other two in the cart basket and go. Give the oldest a job to do, like grab items from the lower shelves. Bring something for the older two to do while the baby gets his checkup. You just do what needs doing. And I don't really think I'm such an expert. I get impatient. I get irritated. I handle things badly, especially when I'm tired. I think it only looks incredibly difficult to those who have fewer kids than I do.

When we have some bad nights, I try not to think in terms of "trends." I don't say, "Oh, it's been better lately," or "The past three nights have been horrible!" I take it one night at a time: "Tonight sucked, but tomorrow will be better," or "Wow, what a great night. I feel so much better today." I have the luxury of knowing that it will eventually be decent most of the time, even though that time seems very far off right now. I think that for first-time parents, it's harder, because you don't have that perspective.

Just keep going. Enjoy the silence when you have it, enjoy the sleep you get, and think how fleeting this time really is in the grand scheme of things. I've gotten through 10 months. I can go a bit longer.