Please Don't Tell Me I'm a Supermom

When I tell people I've gone to the store, or out to eat, or made dinner, or gotten a few hours of work done, or some other apparently monumental task while being responsible for all four of my kids, I get exclamations of amazement. "You're a supermom!", they'll say. Or, "I only have two, and I can barely manage most nights!" Or, "I don't know how you do it!" I know these are meant as compliments and are honest reactions to something outside their own frame of reference. And I appreciate them as such.

But it makes me uncomfortable just the same. Because secretly, deep down, it releases all kinds of insecurities. All I can think of is all the things I've done wrong, the mistakes I've made, the things I wish I had managed to do. I berate myself for not paying enough attention to the kids, for letting them fend for themselves while I work in another room, or, conversely, for spending a few hours with them instead of working a few more hours to pad my paycheck. Or, for neglecting both work and kids to sit on the toilet and play Candy Crush in private. I should hold my baby more, hug my five-year-old more, draw with my toddler more, and read with my seven-year-old more. I should put the phone down during dinner and make them tell me about their day. I should try harder to get the toddler to take a regular nap. I should get the middle two dressed before noon. I should take them to the park more so they can run around on sunny days. I should replace their bike helmets and let them out front to ride. I should fold their laundry. I should wipe down the kitchen counters, sweep the floor of the toddler's food-leavings, and change the baby's diaper and give him a bath.

I see other people accomplishing things I haven't been able to, and I think I have no right to those compliments. I'm not "doing it all." I'm not a supermom. And when you tell me I am, you're belittling yourself. You're negating all of the amazing things you've managed to do, like have a dance party in the living room and do an art project with your preschooler, like cook healthy meals all week long, get your car washed, and clean your toilets. Like sign your second-grader up for soccer, acquire all the gear he needs, and attend all his games. Like save up for two years to take the family to Disneyland. Like start your own business and run it successfully, work full time outside the house and still get the laundry folded and the lawn mowed, and remember to pick up a birthday present for the party this weekend.

I'm just a mom. Some things, I know I do well. Some things, I know I could improve. And, looking at you, looking at how well dressed you are, how neat and clean your house is, how you make healthy meals all the time and get your housework done regularly and limit screen time to just the weekends, and have money left in the bank at the end of the month, some things make me feel very, very inadequate. Not because I think you're judging me, but because I'm judging myself.

Please don't tell me I'm a supermom. I don't feel all that super, and I don't have a cape. Sure, I made it to the grocery store, but I nearly lost the stroller, forgot to buy half the things we needed, and left the reusable bags at home. Yeah, I got the oldest to school on time, but the other three are still in pajamas and the toddler's diaper needs changing. Absolutely, I made dinner and put the dishes in the dishwasher, but I didn't make them clean up their toys, there are shoes everywhere, and the baby is crying in his swing while I rinse the last of the dishes.

No one's life is perfect. I think as moms we only see our own shortcomings while we admire the accomplishments of all moms around us. I'm wondering how she can remember to put jackets on both of her kids and manage to keep them from running around screaming in the store, while she's wondering how I can load four kids into the car in half the time it takes her to put her two in. I'm wondering how she finds the time to make dinners from scratch every night and keep the living room free of clutter, while she's wondering how I can work part time from home with three kids in the house.

I'll tell you what, if you buy the capes, I'll wash them. But don't blame me if I forget to put them in the dryer.

Happy Birthday, NJ!

It is my oldest son's sixth birthday today. The past week or so, I've been reflecting on the last six years and how dramatically my life has changed. On this blog, I talk a lot about the impact of a child's birth, about choosing whether to breastfeed, about sleep training and car seats and other aspects of infant care, and sometimes I think it's not obvious that NJ is a big boy now. He's six. He doesn't need breastmilk or formula. I haven't just given birth to him. He's been out of diapers for years. He is still in a booster seat. And, now that my child is turning six, why do I still dwell on these six-year-old details?

After all, he doesn't remember how he was fed as an infant. He doesn't know how he was born. He doesn't know how I cried over not breastfeeding him, how I wrestled with the decision to attempt a VBAC with his brother, how my experiences with him have shaped my life. Six years have put me in a completely different place, a different mindset, and a different role than I ever imagined for myself.

At six, NJ eats regular solid foods, sleeps through the night in his own bed, showers and dresses himself, brushes his own teeth, is reasonably healthy, goes to school every morning, and talks a mile a minute. You can't tell, looking at my six-year-old, that he was formula fed. You can't tell that he was born by c-section. You won't see that I spent months of his infancy struggling with PPD because of the mode of his birth and my perceived "failure" at breastfeeding.

I remember baby NJ, and I remember giving him bottles, the pain of the c-section. But, as for him, you don't see a formula-fed baby when you look at him today. You don't see the perfectly round head of a baby delivered by c-section. You don't see the bottles or the cans of formula. That's not what makes a person. That's a year or two lived in the blink of an eye. That's not what you see when you look at my six-year-old.

What I hope you will see is a boy who knows he is loved, a boy who loves his parents and his brothers, a boy who is concerned for his family's well-being. What I hope you will see is a tall, handsome, red-headed boy full of curiosity and ideas about the world, optimistic and enthusiastic. What I hope you will see is an affectionate and talkative boy, a bright boy, an outgoing and uninhibited boy.

And he is a boy now.

He is no longer a floppy, perfect newborn.

He is no longer the charming infant.

Or the inquisitive toddler.

Or the bright preschooler.

Now he is a big boy. A first-grader. A grade-schooler, through and through. 

A few weeks ago, I watched him walking out of class with a friend, chatting about who-knows-what, backpack on his back, with no teacher ushering him from one place to another, unconcerned with looking for me at the gate, and I realized, he really is growing up. He's a boy, with his own ideas and interests, his own view of the world. He can come up with his own conversation topics and share his interests with friends. He is in charge of his own head, and while he still needs me to teach him right from wrong and how to behave, his opinions are his own (the occasional "right, Mommy?" tacked on to the end of a sentence notwithstanding). 

One day, I will watch this incredible child don the cap and gown and march proudly down the aisle to receive his high school diploma. One day, I will (G-d willing) see him wed under the chuppah. One day (G-d willing), I will weep tears of joy at holding his own little red-headed baby, who will look just like that tiny baby he once was. 

And, judging from how fast these first six years have gone, I have the feeling that it really won't be long at all.

Will I, 20 years from now, still ruminate about his birth? Probably. Though long ago in the great scheme of things, the facts will never change. I will always wonder what impact the circumstances of his birth and infancy had on his health, his personality, and my bond with him. I will always wonder what might have been different. I will always feel a twinge of guilt that his brothers have gotten something that I couldn't give him. Does it mean I love him less? No. Does it mean he's not as smart as he could be? I don't see how. Does it mean he's not as healthy as he could have been? Maybe. But we can't forget to keep looking forward. Thinking about the past is only helpful if it influences how we handle future decisions. I hope that I make good choices for NJ as he grows, and I know that I will be able to provide him with the support he needs when, one day, G-d willing, he is ready to enter this scary and unimaginably rewarding adventure of parenthood.

Happy birthday, my first born. Happy birthday, my dear, dear boy. May you always look forward and take the lessons you've learned and put them to good use. May I merit to see you called to the Torah as a bar mitzvah, wed under the chuppah, and grow into a mensch.

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.

Ear Infections, Asthma, and More: Breastfeeding and Baby's Health

When NJ was a baby, he had quite a few ear infections - six, I believe, in the first 15 months of his life. It wasn't enough for the pediatrician to recommend ear tubes, but not far from it. At four months, he contracted RSV, which caused his airways to become inflamed, necessitating treatment with albuterol using a nebulizer. It also appears to have conditioned him to respond to future colds with what was called Reactive Airway Disease (RAD), basically asthma symptoms that are triggered by a cold. Almost every time he'd get a cold, he'd end up with a wheezy cough that lingered for a couple of weeks. Treatment with albuterol and sometimes oral prednisolone usually had him breathing easily again within a few days. Eventually, thankfully, he grew out of his RAD and he hasn't had a problem with it in several years now.

His ear infections and asthma were yet more fuel for my guilt over not having breastfed him. Maybe if he'd been breastfed, he wouldn't have had so many ear infections. Maybe if he'd been breastfed, he wouldn't have gotten RSV. Maybe if he'd been breastfed, he wouldn't have gotten so many colds. Maybe if he'd been breastfed, he wouldn't have had the RAD.

Indeed, SB's relative excellent health as an infant made me a believer. There's plenty of research out there to show that not breastfeeding increases a child's risk of ear infections, upper respiratory infections, asthma, diabetes, certain types of cancers, obesity, and so on, although the mechanism of protection is not always clear.

I remember reading, when NJ was a baby, that the average infant got 12 colds a year. That's one a month! NJ was certainly at the doctor almost once a month throughout his first year of life, not even counting his well baby checkups. He was rarely "well" even at those. That's not to say he was sickly, just that he often had a cold or drippy nose or cough or ear infection. It seemed like he was either just coming down with something or just getting over something or right in the middle of something, with the rare week of respite. Having a sick baby is frustrating and wearing, even if it's not a serious illness (thank G-d) or chronic condition. (I can't even imagine what it must be like if your child really is always sick. G-d bless all you parents dealing with that kind of stress.) What I began to wonder was, if formula feeding (or not breastfeeding) increases the risk of colds, ear infections, asthma, etc., then maybe it isn't "normal" for babies to be sick every month. Maybe breastfed babies aren't sick nearly so often, and that it's actually not normal (as in, natural) for infants to go around with drippy noses and achy ears almost constantly. Certainly, the fact that SB was rarely at the doctor except for well baby checkups throughout his first year bore out my expectation.

When GI was born, I placed a great deal of faith in the power of my breastmilk to protect him from his two older brothers' constant germy contact. NJ is kind enough to bring home and share every cold that comes his way at school. I will say that he appears to have quite the robust little immune system now, having been exposed to so many viruses when he was smaller. SB, however, being exposed only through NJ to all these viruses, still has not built up the wall of antibodies that appears to be working so well for NJ. At three, SB seems to come down with every cold he's exposed to, but he bears it well, mostly just getting snotty and sleepy for a few days. Both NJ and SB have the terrible habit of having fingers (and toys) in their mouths almost constantly. They like to amuse GI by blowing in his face, giving him raspberries (as in, spitting all over him), touching his hands, letting him put his hands in their mouths, touching his face, eyes, nose, and so on. Still, I had high hopes that breastfeeding would preserve him from the fate of constant colds.

Unfortunately, it seems like GI is sick more often than not, lately. After his bout of bronchiolitis not too long ago, he was healthy and happy for a few weeks. Then, suddenly, he was sick again, with the same cold both of his brothers had. NJ recovered quickly. SB is still a bit snotty but otherwise himself. But GI was up all night a couple nights back, coughing and wheezing. I took him to the doctor yesterday, where the wheeze was confirmed, and I was sent home with a nebulizer machine and a vial of albuterol, as well as oral prednisolone, and instructed to give him a nebulizer treatment up to four times a day and the prednisolone twice a day for five days to relieve the inflammation in his lungs. This was eerily familiar, as the nebulizer and the albuterol and the prednisolone were all standard features around our house when NJ was a baby, too. It's helping, though. He's breathing much more easily, coughing far less, and seems to be himself again. The only problem is that the steroids make it hard for him to sleep. But that will be over with soon enough, thank goodness.

What strikes me with all of this is that despite being 100% breastfed for the first six months and still mostly (like, 95%!) breastfed still at eight months, GI is sick almost as often as NJ was as a baby. The only difference is that GI's only had one ear infection. The doctor gave me the nebulizer machine because he sees this happening again, so we'll be prepared next time. It looks like GI is in the RAD camp alongside his big brother.

I still firmly believe that not breastfeeding increases the risk of a host of problems. I still agree that breastfeeding is normal and offers babies protection from all sorts of germs. I find myself saying, "But I did everything right! He's breastfed! We delayed cord cutting! I'm taking a Vitamin D supplement, and he gets sun almost every day. California sun!" And yet he comes down with so many colds, has this asthma problem now, and has had an ear infection. Let's face it, when the numbers aren't 100%, some people are on the "wrong" side.

So, you have your parents who say, "My kid was formula-fed, and he's healthy as a horse!" And you have your parents who say, "My kid was exclusively breastfed, and he had six ear infections and three asthma attacks by the time he was one." And both can be true, absolutely. But the issue isn't whether your kid fell into the expected category; it's whether most kids fall into the expected category.

I still remind myself that, if GI gets sick this often while breastfed, how much worse would it be if he weren't?  Perhaps the asthma symptoms would have manifested sooner. Perhaps he'd have had more ear infections. Perhaps, G-d forbid, he would have been hospitalized when he had bronchiolitis instead of recovering on his own. Who knows?

Anyway, the one benefit of breastfeeding that absolutely cannot be overlooked when your baby is sick is it's ability to comfort. Being close to Mommy, feeling her skin, hearing her heartbeat, suckling, the warmth of the milk on a raw, inflamed throat, and the calm of being where he feels safest is certainly the best medicine when your baby doesn't feel well. And lying down with him as your baby drifts off into a healing sleep makes it easier for you to handle the stress of his being sick.

GI is sleeping peacefully now, where I just returned to writing after nursing him back down. When all else seems to fail, at least I know I have that to offer.

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.

Enthusiasm Does Not Equal Judgment

I sometimes feel that I'm treading a fine line between expressing enthusiasm about my chosen interests and the risk of offending friends who may feel I'm not being sensitive enough to their choices. Let me say this straight out, right now: I do not think you are less of a mother if you do not breastfeed. I do not think you are a bad mother if you use formula. I do not think you are abusing or poisoning your child with formula. And, finally, I would never judge you for making a parenting decision different from mine (unless there was clear child abuse involved, of course).

I consider breastfeeding another parenting choice we all have to make, just like we have to decide where the baby is going to sleep, live, go to school. Just like we have to choose a car seat and meals and whether we'll ever set foot in McDonald's with our kids. Just like we have to choose whether to cosleep until four years old or nightwean and cry-it-out at six months of age. Just like we choose whether to mostly use a baby carrier or a stroller, or to go 50/50 with it. Just like we choose whether our kids watch TV, and how much, and what. Just like we have to decide how to discipline our kids.

I happen to be very enthusiastic about breastfeeding and car seats. You may have noticed. I've also recently gotten very interested in birth practices (c-section versus vaginal, use of medications, etc.). Everyone has their "things." These are mine.

What it boils down to is, I just want to help. I'll never impose. I'll never jump into a Facebook discussion and tell you that I think you're doing something wrong. (I might jump in to defend you if I think you're doing something right, though!) But I do want you to know that I'm here with a sympathetic ear and a reasonable amount of information if you do want my help, and I'm very happy to help if asked.

I admit, it makes me sad when I see a kid buckled incorrectly in a car seat, or in a car seat that is too mature for his size or age. I'm sad because I know that child's life is at risk, when making him safer would be so simple, if only the parents would ask someone who knows how to do it properly. I'm not judging the parents' choice not to do it "right." I'm not labeling them bad parents. I'm not calling the police. It's their decision whether to properly educate themselves in car seat usage, and it's their prerogative as the parent to balance the risks and benefits to their child in using their car seat how they see fit, either for convenience or safety or somewhere in between. I know how I use my car seats, but I also know that I do things that other parents probably think are terribly unsafe, even if I think the risk is negligible. A lot of risk perception also depends on your own experiences.

It also makes me sad when I see a mother preparing a bottle of formula for her baby, but not for the same reasons as above. It makes me sad for the mother, because if she's using formula, it's likely because of a medical, psychological, or physical condition in her that makes her unable or unwilling to breastfeed, a medical or physical condition in the baby that makes breastfeeding difficult or impossible, or a case of the mother not having the support or information that she needed to initiate or continue to breastfeed. (In my case, it was that last reason.) Granted, there are women who decide, even when given all the information, that they simply do not want to breastfeed and start formula immediately after birth. That, too, is entirely their choice to make.

All I can do is provide information and support, give more "hands-on" help when asked, and offer advice when solicited. I certainly would not walk up to someone feeding her baby formula and confront her about it. But if I were sitting somewhere nursing my baby and someone asked me about breastfeeding, I would certainly be thrilled to offer any information she wanted, or even demonstrate if she were curious.

That's not to say I don't observe and wonder. If I see a baby being bottle-fed in a picture on Facebook, I may think to myself, "I wonder what the story is there." I don't ask. If she wants to tell me, she will. She knows I'm here to help if she wants help. If she's interested.

In the end, I just want my friends to take as much joy and love out of motherhood as possible, however that can be accomplished.

So, to make a long story short, I'm here with advice and assistance if you want it. That's all.

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Also, don't forget about my book! This book is targeted toward pregnant women and mothers with babies under three months old who have decided to breastfeed and want quick answers and support. It makes a great new-mom gift, and it's an excellent addition to your parenting library!

When We Know Better, We Do Better

I just learned this quote from Maya Angelou today, and thinking about it, among other things going on around me, prompts this post. It's also an apt title.

It's hard, sometimes, not to feel guilty about past choices we've made. To give an example totally removed from pregnancy, childbirth, or breastfeeding, I do transcriptions for a periodontist, among other people. He'll often mention in his letters that 20 years ago, or when his patient was younger, they had a particular dental therapy performed that we would never do today, as now we know it causes problems decades down the line; problems that my client, of course, tries to fix for the patient. To bring the point closer to this blog, doctors used to recommend that women smoke during pregnancy in order to reduce the size of their babies for easier delivery. We used to routinely give antibiotics for every ailment. We used to fire-proof using asbestos. Now we know better. Now we no longer do those things. "When we know better, we do better."

It's hard not to feel guilty for making choices in the past that we now know may have negatively affected our health or the health of our children, even if we didn't know better. This is especially true in childbirth and breastfeeding. Many, many babies in the 20th century never received a drop of breastmilk, because doctors and mothers were convinced that formula, because it was "scientific," surely had to be better than paltry breastmilk. Breastfeeding was for poor women who couldn't afford better, as was giving birth at home instead of at a hospital. Should our grandmothers feel guilty if they did not breastfeed our mothers? Should our mothers feel guilty if they did not breastfeed us?

Maybe "guilty" isn't the right word. Maybe a little guilt is all right, since guilt about a past error can be impetus not to repeat that error. But it should not be a stigma. I didn't "know better" when my first son was born. I followed the advice of the people I trusted - nurses and doctors. Maybe "we" as a society "knew better," but I didn't, so I didn't do the best thing I could. I did feel guilty about it for a long time. How could I have deprived my son and myself of something so precious?

But now I know better, so I do better. I did better, and will do more in the future.

My grandmother was 20 years old when my mother was born, back in 1953. My mother was born seven weeks premature. At that time, premature babies were routinely placed in pure-oxygen environments, as it was believed to help them breathe. It was found that this environment was not, in fact, healthy at all, and caused blindness and other problems for many preemies of the time. Thankfully, my mother was not given this particular treatment. When we know better, we do better. My grandmother wanted to breastfeed her daughter. She had no idea how, had no support from hospital staff, but she felt that it would be best for her baby. The doctors at the time said that surely what a preemie needed was specially developed formula, that breastfeeding her 4lbs-something baby could only be detrimental, and how could she be so crazy as to want to do that. So, bowing to the pressure of the wisdom of the 1950s, my grandmother acquiesced and gave her first daughter formula. My mother is a healthy grandmother herself, now. We don't know if she suffered ill effects from her precarious early days on this Earth. But we do know now that those doctors were wrong. A study released just two days ago by Johns Hopkins reconfirmed that the absolute best food for a premature infant is, shockingly, breastmilk, at least in the goal of preventing potentially fatal necrotizing enterocolitis (NEC).

When my mother's younger sister was born full term, 18 months later, my grandmother again wanted to breastfeed. Though my aunt was full term, she was quite small, barely 5 pounds, and, again, the hospital would not "let" my grandmother breastfeed her own daughter because of her size. She needed to put on weight, you see, and formula was the best thing for that!

Finally, 4.5 years after that, my mother's younger brother was born. I don't know if my grandmother even bothered to ask if she could breastfeed, or tried to breastfeed, after not being allowed to with her first two babies. My uncle, unfortunately, unlike his sisters, is not as healthy as they are. He has Crohn's disease. My grandfather told me that when my uncle was a baby, they tried formula after formula, but all of them caused him distress. My grandfather was a pharmacist, and "the Enfamil guy" promised to hook my grandparents up with the best of the best formula to be had in 1959. Still, this didn't work for my uncle, and he ended up being fed pure cow's milk before he was a year old, as that seemed to be the food he tolerated best. He is suffering from quite a few health problems now, most as a result of the Crohn's disease. I can't help but wonder, if he had been born in 2009 and "allowed" to breastfeed, would he suffer from such severe intestinal problems 40 years down the road? It will be interesting to one day see a study on whether breastfeeding in infancy reduces the risk of developing Crohn's or colitis in adulthood. (This is all speculation, of course!)

Should my grandmother feel guilty about not breastfeeding her daughters and son? Should she in some way feel that she "caused" her children's health problems, especially her son's? For that matter, should she feel guilty for smoking through all of her pregnancies (probably causing her babies to be premature and low-birth-weight, as we now know)? I'm not sure, frankly. I don't see what good it would do to feel guilty. She may have regrets. She may wonder, as I do, how things would have been different. But we can only move forward. We can only say, "Well, now we know that breastmilk is the best food for preemies. Now we know that breastmilk helps prevent intestinal diseases in babies. Now we know smoking during pregnancy can be harmful to the baby." We know better, so we do better.

And when we know better, we can educate the next generation. We can support them in making the best decision with the best information they have at hand. My grandmother fully supported her daughters in their desire to breastfeed their respective children. And she and my mother and aunt fully supported me in my desire to breastfeed my children. And I can send that information on forward to my future daughters or daughters-in-law (G-d willing!).

A friend of mine, in discussing our birth experiences, said that she does regret that she never got the home birth, all natural, water birth experience as she had planned. Instead, she ended up with four c-sections, although not by her initial choice. But, one day, when her daughters or daughters-in-law come to her and say that they want to have natural home waterbirths, of course she will be supportive of that, and will be by their sides if they want her there, and will weep with joy when her grandchildren are born the way their mother's want them to, the way, probably, nature intended.  We can regret. We can feel guilt. But we can use that regret and guilt to make the future better than our past.

Of course there's no sense in wallowing in what may have been. We can't change it. We simply can't. But we can start right now with doing better.