Showing posts with label lactation consultant. Show all posts
Showing posts with label lactation consultant. Show all posts

Thursday, March 13, 2014

10 Tips for Success at Breastfeeding

Check out this Ask-Me Monday video from this week, in which a reader wanted tips for being successful at breastfeeding when she has her second baby.


10 Tips for Success at Breastfeeding:

  1. Avoid problems instead of having to fix them later. 
  2. Learn the four basic rules for good positioning and latch. (Tummy-to-tummy; ear, shoulder, hip in a straight line; baby to breast, not breast to baby; support back of neck not back of head.)
  3. Be determined.
  4. Take it one feeding at a time.
  5. Remember that frequent feeding is normal and desirable. 
  6. Worry only if your baby does not start regaining weight by the third or fourth day of life or starts losing weight again after starting to gain. 
  7. Be confident. 
  8. Educate yourself.
  9. Hide the formula.
  10. Get your partner on board!
Watch the video for more detail!

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Friday, May 3, 2013

Four Kinds of Breastfeeding Support: Emotional, Practical, Improper, and Unhelpful

I can't emphasize enough that when you have a new baby, you need support. Going it alone is unnatural and stressful. They say it takes a village, and while you may not have an entire village to help you, I hope you at least have your partner and a few trusted friends and relatives who are there for you.

When it comes to breastfeeding support, you need to make sure that (a) you have some, and (b) you have the right kind.

I've identified four types of support for new mothers. Each description below contains suggestions for the new mom herself and for the support people around her.

1.  Emotional Support

For Mom: Emotional support is crucial. You might also call this moral support. This kind of support could come from your partner, your mother, your sister, aunt, cousin, best friend, a random person you meet in the park, or even someone on the internet. When someone is offering emotional support, it's those encouraging words when you're at the end of your rope; it's the, "You're doing great!" when you feel like you're doing everything wrong. Emotional support helps you keep going, push through the rough spots, and lets you know that others have been where you are, and it does get better.

To Support Mom: Even if you don't have personal breastfeeding experience, you can be there for her. Let her vent, listen to her concerns, and offer an encouraging word, whatever comes naturally to you. Some of us are more comfortable with being cheerleaders, while others are better at simply listening and being a sympathetic ear. Avoid trying to give advice she isn't asking for, but offer to help in any way you can. For example, "Can I do something around the house for you so you can rest? I'm a great laundry folder! Do you need anything from the store? Diapers? Snacks? Juice? Can I get you a glass of water?" Make specific offers, not a general, "Is there anything I can do to help?" because she may not be able to think of something in particular, or she may feel uncomfortable making a request.

2.  Practical Support

For Mom: Practical support is also crucial. As much as you think you might know going in (and I say this as someone who's nursed a few babies!), it never hurts to have someone you can call upon when you have a practical question about your baby's latch, strange nursing behaviors, or other concerns. Every baby is different, and every nursing relationship is unique, and you'll want to know someone you can contact who has seen lots of  mom-baby pairs and helped solve many types of problems. It's important that whoever you lean on for practical support actually knows what to say or do to help. This may be a La Leche League leader, a breastfeeding peer counselor or other trained breastfeeding support person, an International Board Certified Lactation Consultant, or even just your mom who's nursed four kids. You need to know that the advice you're going to receive is correct advice. If you get advice you're not sure of, feel free to double check it on a reputable site like Kellymom.com, or contact a lactation consultant.

To Support Mom: Unless you're sure you know what you're talking about - i.e., you're a lactation consultant, peer counselor, CLC, La Leche League leader, or you've at least done your breastfeeding research, it's best to leave the advice to someone who is one of those people. If you do know how to help, make the offer. "Hey, I'm a lactation educator. If you want, I can come sit with you and check out your baby's latch." If I'm not absolutely certain what to say or do to help a new mother with her question, I will always recommend that she meet with a local lactation consultant. If you don't know of one, you could help her find one. If you do, give her the number!

3.  Improper Support

For Mom: Many friends and relatives will mean well, and they probably really do want to help you. However, sometimes you get tips and advice from people that is not what would be recommended by a lactation expert. For example, just because your best friend introduced a bottle of formula every night but continued to nurse for a year doesn't mean it's a good idea or that it will work for you. People improvise, get lucky, or make decisions based on unique situations that may or may not apply to you. Make sure you've done your own research and have consulted with someone trained in lactation before you supplement unnecessarily or make a decision that could harm your breastfeeding relationship.

To Support Mom: It's important not to give advice willy-nilly. Every mom will have different circumstances, and unless you are a trained lactation support person or have an educational background to go with your personal experience, you can end up doing more harm than good, even if you're trying to help. Simple suggestions like, "Maybe you want to get his latch checked," or, "My son had a tongue tie and I had the exact problems you're having" can be very helpful and give her a starting point for finding assistance. Thoughts based on your own experience that may make her life easier such as, "My daughter was really fussy, too, and babywearing really helped us on the bad evenings." It's best not to begin supplementation or take drastic measures without being seen by a lactation expert, however.

4.  Unhelpful Support

For Mom: The least helpful kind of support is from people who think they're being supportive but are actually making you feel worse. A great example of this would be, "I'm can see that you're trying really hard to nurse your baby, but if it's this stressful, I would totally understand if you wanted to switch to bottles. A happy mom makes for a happy baby!" This kind of advice, while usually well-meaning, does not help the mother who sincerely wants to exclusively breastfeed but is in the throes of the two-week growth spurt or is battling thrush or mastitis. It's hard, but as a new parent it's important to not allow unhelpful comments like these to affect your mindset.

To Support Mom: Rather than trying to deter her from a path you think may be causing her stress, it is more helpful and more supportive to try to understand what her own goals are. A better comment in the above situation might be, "I can tell you really want to make nursing work, and you're doing an amazing job. I heard of a great lactation consultant in the area. Do you want her number?" If the mom really wants to breastfeed, suggesting that she stop will not make her feel supported. Helping her attain her goals will improve her mood and situation.

Preparation and Education

As new parents, we need to be prepared to avoid the improper and unhelpful advice and to call upon our emotional and practical support people whenever we need to. Gather your support system around you before you give birth, and be ready to discard information and advice that isn't what you want to hear.

As supportive friends and family members of new parents, it's our job to say the right words and be prepared with the right information. It doesn't hurt for others besides the new mom to learn a little about breastfeeding so that we can help in a way that the new parents will appreciate. It's important to know what the parents want and how to help them achieve that. Parents are bombarded by advice, some of which is contradictory, and knowing they have people to lean on who will simply be there to say, "I know it's hard now, but you're doing great, and it gets easier" will be invaluable.

How have you supported friends or relatives as they begin their parenting journeys? How have you been best supported when you've had a new baby? When we came home from the hospital with my third son, it was an incredibly hot and humid day, he screamed whenever he wasn't on the breast, and I was completely emotionally drained. A friend texted me just to say I was doing great, and it felt so good to hear that, even though it was my third baby. What is your favorite thing to tell a new parent, and how do they usually respond?

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.

Tuesday, October 4, 2011

Breastfeeding Support: The Disconnect from the Hospital to the Pediatrician

I promised a post about the hospital after my third son was born, and I might actually have found some time to sit down and write it. You forget pretty quickly what a time-suck having a newborn is. Everything takes longer, from getting out of the house to doing laundry. Just when everyone's got their shoes on, or just when you've finally found the energy to fold that pile of clothes, oops, baby's hungry! Be ready in 20 minutes (if we're lucky). It goes by so fast, though. He's four weeks old already, if you can believe it (I can't)!

I was very, very impressed with the breastfeeding and normal-birth supportive environment at the hospital where I gave birth. If you read my second and third sons' birth stories, you know that I was very pleased with my treatment. Both were at the Kaiser Foundation Hospital/San Diego Medical Center. Before giving birth to Son #3, I could only hope the hospital experience would be at least as good as it had been when I had Son #2, and I was pleasantly surprised to find it even better. The first improvement, and the one I liked the most, was that they are converting to all private rooms on the postpartum floor. I had a roommate for a few hours after Son #2's birth, and I didn't like the feeling of intrusion (I'm sure she didn't like it either!). The second improvement, and by far the most important, was the amount of breastfeeding training they had given all the maternity nurses.

From the moment my son was born, I truly felt he was under my care, not the hospital's. They were there to help me. They let me hold him and nurse him until I was ready for them to take him to be weighed. They didn't even give him a bath or dress him until I said it was okay (later in the day, in my hospital room!). They didn't take him out of my sight except for the hearing test, and then only for a few minutes. I was encouraged to keep him skin-to-skin. Every nurse who came to my room was able to help me with breastfeeding, armed with up-to-date information. Not one nurse gave me "bad" or "wrong" advice. The most negative thing any nurse said to me (and only if you take it in a negative context) was a fairly neutral, "He's using you as a pacifier!" I didn't exactly take it as discouragement - she didn't say, "Don't become a human pacifier!" - but I still felt it was an unhelpful comment. The nurse on duty both mornings was clearly well-trained in breastfeeding support, even had a lanyard saying as much, and was able to give me very helpful, hands-on advice about positioning. She was very supportive. When I half-complained about how often he was nursing, she said, "He's just doing what he needs to to get your milk in!" No comments about supplementing or hunger. No comments about pacifiers or taking a break. Just a "this is normal," and "you're doing great" attitude. I was very pleased.

When we were getting ready to leave, I had to detach him from my nipple so we could put him in the car seat. He wasn't too happy about this and started to cry piteously. We had a 45-minute drive, and I was so afraid he would scream the entire way. We tentatively asked the person who was helping us get ourselves ready to go if we could have a pacifier to try to calm him. She said they actually didn't have pacifiers, because giving a pacifier that early can interfere with breastfeeding (which is absolutely true!). I was disappointed but happy at the same time. As it turned out, he calmed down after a few minutes and slept the whole way home, so a pacifier wasn't necessary anyway.

Kaiser has a custom-made diaper bag that they give out. It's a very nice, high-quality bag. (We still regularly use the one we got when Son #2 was born, and now we have a new one to use as well!) It doesn't contain anything remotely formula-related. They gave me some samples of Lansinoh lanolin, lots of diapers, baby soap, alcohol wipes (for his umbilical cord), and anything else we wanted to take from the bassinet. They gave me discharge instructions with more breastfeeding information. And, a really nice baby blanket! No pacifiers, no formula samples, no bottles.

I don't know how I would have felt about the push for breastfeeding if I had not gone in intending to breastfeed. Perhaps it would have felt too pressuring, or I would have felt ashamed if I decided not to breastfeed, but I don't know. I'm actually curious to know how other new mothers feel about the way breastfeeding is presented there. I'm sure that my nurse-midwife and the maternity nurses all got the vibe from me pretty quickly that, (a) I was going to breastfeed, and (b) I pretty much knew what I was doing.

I fully intend to write to the hospital expressing my delight about my experiences. But I also intend to write to the Kaiser general offices about my disappointment upon taking my newborn son to the pediatrician for his 3-day checkup.

The hospital was so supportive of breastfeeding, and the OB/GYN offices were full of breastfeeding literature and posters (and no references to formula), and so I naturally assumed that that breastfeeding-supportive environment should also continue into the pediatric offices.

The breastfeeding support that had so impressed me through my pregnancy and delivery completely evaporated when I entered the pediatrician's office. The initial form I was given to fill out asked me if I was feeding my baby formula in such a way that I felt like I ought to be. The nurse asked how often he was feeding, and when I told her it had been basically nonstop, she said, "Oh, getting sore already, Mama?" The doctor informed me that breastfed babies needed Vitamin D supplementation (which is true, according to the latest research), but that if I started giving formula, and at least 50% of his diet was formula, then I didn't have to give extra Vitamin D anymore. What? Throwing around the words "formula" and "supplementation" next to a mother who had had as rough a second day home as I did might have been enough to drive her to start using formula right away, since the doctor had implied it was "okay." (That's not to say it isn't "okay" to use formula if that's what you need to do. It's just that it is not supportive of breastfeeding to imply that formula would be in any way "better" than breastmilk.)

At the two-week checkup, upon seeing that my son had gained over two pounds in two weeks, the doctor (a different one this time) said, "Whatever you're doing, keep doing it!" So that, at least, was encouraging. But I wouldn't have made it two weeks if I wasn't me, in the sense that I was already well-educated and gung-ho about nursing my babies. I wouldn't have made it two days if I wasn't me. I get the feeling that the pediatricians at Kaiser are fairly autonomous, so support for breastfeeding (and knowledge about breastfeeding) will vary from doctor to doctor. I happen to very much like and respect the doctor I usually take my kids to there, the one I saw at the two-week appointment. The doctor I saw at the first appointment was very personable and friendly, but his breastfeeding support was not good. One positive comment I have, though, is that when my baby turned out to have jaundice, they didn't jump right to suggesting formula supplementation to clear the bilirubin; all of the doctors (three!) I saw over those few days just said, "Feed, feed, feed!" So there was some trust in breastfeeding!

A few days ago, Kaiser sent me a survey asking me to rate my experience at the hospital. I gave them very good marks. It is clear that breastfeeding initiation and continuation is very important to them, as several of the questions on the survey asked about the breastfeeding education and support offered during prenatal visits and in the hospital.

If they are truly so invested in Kaiser members breastfeeding their babies (as well they should be), then that support needs to continue into the pediatric offices. They need to have lactation consultants on staff. They need to train the pediatrics nurses in basic breastfeeding education, just as they did for the postpartum nurses. And they should insist on a uniform attitude toward breastfeeding among their pediatricians and possibly offer basic breastfeeding classes to the MDs, so that mothers who come in desperate for help will be able to get the support they desire.

For those who are unfamiliar with Kaiser Permanente, a brief explanation so this post will make sense: Kaiser Permanente is an HMO health insurance plan. If you are a member of Kaiser, all of your healthcare needs are attended to within the Kaiser system, which includes general practitioners, specialists, hospitals, physical therapy, pharmacy, etc.

It seems to me that if Kaiser as a whole has a philosophy of care, such as with breastfeeding support, then that philosophy should carry over from practitioner to practitioner, from prenatal care all the way through to pediatrics. If enough mothers write in with my above suggestions, maybe we will continue to see positive change throughout the Kaiser system.

Wednesday, April 20, 2011

My Nursing Story

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tuesday, March 8, 2011

My First Birth - Part III - The First Weeks Home

I won't go into excruciating detail about the next three weeks of my son's life. Rather, I'll give some highlights. Basically, we came home with this newborn who was still jaundiced and needed to continue to be on the bililight. We were given a Wallaby, which is a portable bililight that you wrap around the baby. This makes it hard to hold him, hard to swaddle him, and hard for him to get comfortable. Thankfully, it was only needed for one very long day before his bilirubin levels came down into an acceptable range. He slept in the Pack 'n' Play bassinet in the living room. I slept in the bedroom. My husband slept on the floor beside the bassinet and got up to give him his night feedings.

To be honest, I barely remember those first few days home. I was in pain, pale, weak, and confused. I tried to pump, but the baby was getting mostly formula. I couldn't even really take care of him by myself, although over the next couple of weeks, I started to do things like laundry, wash bottles, make bottles, hold him, feed him, change his diapers... all the things you do when you're caring for a baby. I began to heal, and life got a little easier. My husband still took care of most of the night wakings. I remember one night when he was changing a diaper and the baby decided to continue to poo during the diaper change. I heard a "Ugh! Oh my God!" and went into the bathroom to find baby-poo had squirted clear across the room. Welcome to newborn baby care!

The first major event after coming home was the baby's bris (circumcision ceremony) when he was eight days old. I don't remember much about the day itself, but one conversation in particular comes to mind. A friend of mine, who was in the natural-birth and breastfeeding camp and had two kids of her own, actually offered to nurse the baby for me while I watched so I could see how it should look. I found this strange, somewhat creepy, and a little bit intrusive at the time, although now I appreciate what she was trying to do. She was trying to help. She wanted to see me succeed at breastfeeding, and she didn't know exactly what was going wrong, but she wanted to do what she could. And she could nurse. I declined, said that I knew his latch was good but that I didn't have much milk. She offered to put me in touch with a local La Leche League leader who had helped her out. I declined this offer as well. Frankly, I don't know why I was so resistant to offers of help. I think my attitude was, "They told me what to do in the hospital, and now I'm just trying to follow directions. I've got this." Which, obviously, I didn't. And, as it turns out, what "they" told me in the hospital was not the be-all and end-all of breastfeeding advice, and I still sometimes beat myself up over not letting go of my own ego and asking for help.

I did ask his pediatrician for advice. She said that sometimes women who don't have enough milk will breastfeed and then "top off" with a couple of ounces of formula. She suggested that maybe I could do the opposite - give him most of a feeding from a bottle, then "top him off" with a breastfeeding. That way, he wouldn't be frantically hungry while breastfeeding, so he might be more willing to latch and suck. I don't have to say that this is really not very good advice, do I?

Finally, when the baby was three weeks old, I made an impassioned post to my LiveJournal called "Thoughts on Feeding My Son," in which I lamented that the baby was only getting about three ounces a day of breastmilk, and did that little amount even matter? I asked, plaintively, if I should just try putting him to the breast next time he was hungry and see how he did. I asked for advice, finally, but I didn't want "biased" advice. I wanted "objective" advice, whatever I meant by that. I think I was very disillusioned by the "help" I had gotten in the hospital from the lactation consultants there, and I was hoping someone would just go ahead and tell me what to do. In fact, I think I'll copy here some noteworthy quotes from that post, so you can get a sense of what was going through my mind.
"I didn't have the dedication in those first couple of weeks to pump and nurse often enough and for long enough to boost my milk supply once I recovered from the blood transfusion, so now when I do pump and I only get 2 or 3 ounces from both breasts combined, it's very discouraging. Not to mention that I'm only pumping 3 times a day on a good day, and not actually nursing at all. It's no wonder I have such a low supply." 
This quote is interesting. I was convinced I had a "low supply" because I "only g[o]t 2 or 3 ounces" at each pumping session. I didn't know two very important things, and I only wish someone had told me. The first is that pumping is not an indicator of supply. In other words, I might have only been pumping three ounces, but he might have gotten a lot more if he actually nursed. Secondly, some women just don't respond well to the pump, and though they may have plenty of milk, they only pump an ounce in 15 minutes.

I was convinced I had a "low supply," by the way, because the lactation consultants in the hospital told me I would. I'm pretty convinced now, 4+ years later, that I actually had plenty of milk. Especially after nursing my very healthy second son and pumping extra besides, but only when I felt like it. (When I felt like pumping that is, not nursing. I nursed, um, a lot. But we'll get to that story in another post.)

Another quote:
"When he gets hungry again in a few minutes, should I simply put him to my breast and see what happens?"
As a matter of fact, I did decide to do this, he did latch and suck, and I felt like it actually went pretty well. In the next post, I'll get into why that was the last time we breastfed.
"I want a totally practically-minded opinion, and I feel like an LC would push me to try breastfeeding, when I find it so discouraging. It's the lactation consultants who first told me to pump 8 times a day, and I didn't manage to do that and it just made me feel bad."
I'm not sure if I wanted someone to tell me it was "okay" to formula feed, or if I wanted someone to tell me that breastfeeding would get better and easier if I just did it, or what. I'm not sure what I meant by a "totally practically-minded opinion." But the second sentence says it all. I somehow thought that all LCs would be as unhelpful as those in the hospital. I somehow thought that I didn't want someone to "push me" to try breastfeeding. Maybe I didn't at the time.

And, finally:
"Breastfeeding is the one thing only I can do for my son, and I'm not even sure I want to do it. I know I'm not alone. I know there are other mothers out there who tried to breastfeed and just didn't want to. But I never thought I'd be one of them. I never thought I'd find it so difficult or, frankly, unpleasant."
I want to go back to Jessica of November 2006 and pat her on the back and tell her it will be okay. I want to go back to her and say, "Yes! You're the only one who can breastfeed your son. So go for it! You'll do it! And you'll grow to love it." But, unfortunately, that isn't possible. So instead, I hope that other new mothers and mothers-to-be will see these words here and see a reflection of how she's feeling and know that "Yes! It will get easier!" and "Yes! You can do this!" and "Yes! It's so worth it."

The most important message I want to send, though, to those new mothers and mothers-to-be is ask for help. Don't be afraid of the advice you'll get. Ask for help. (But ask the right people!)


I put a teaser up there for the next post, in which I will describe what happened not three hours after my last breastfeeding attempt, and the definitive reason I ended up not breastfeeding. The drama continues...

Sunday, March 6, 2011

My First Birth - Part II - Four Days in the Hospital

Picking up where I left off in my previous post, I had just had what at the time seemed to be the relief of a c-section, which ended a 29-hour labor and produced a large, healthy baby boy. I had made clear my intention to breastfeed, and they said my son would be brought to me, and that they would send along a lactation consultant to help, once I was settled into my room on the maternity ward. I was wheeled back to the L&D room for recovery, where I had apparently been given morphine on my husband’s consent, and where we met back up with my mom. I was very groggy and exhausted, very weak, and really had no idea what was going on. I do remember telling my mom our son’s name.

Over an hour after the delivery, I was taken up to the maternity ward and into my room. A nursery nurse came to report that sometimes large babies have problems with maintaining their blood sugars, and if our son did, would it be okay to give him some formula? My husband and I had no idea, so we said, sure, if that’s what he needs, go ahead. Then she asked what kind. We also had no idea. We hadn’t “researched” formula (any more than we had researched breastfeeding, to be honest), so we just asked what they recommended, and they said many mothers liked Enfamil with Lipil. We said okay to that.

The baby had been taken to the nursery, where he was cleaned and given all the initial pokes and prodding. It turned out his blood sugar was fine, so they brought him to me to attempt breastfeeding. He was lethargic (as was I!), and it was difficult to get him to wake up to want to feed. The lactation consultant taught us about stripping him down to his diaper and tickling his feet to try to get him to awaken, and he did latch and begin to suck. He had a very good latch and a very strong suck reflex, and she said he should have no trouble nursing. I was tired and weak and in pain and having trouble so much as holding my 9-pounder, and we didn’t nurse for very long before they took him again.

I, however, was not doing as well as the baby. I was white as a sheet. It turned out I had lost a LOT of blood in the delivery. Not long after my abortive attempt at nursing, I began feeling sweaty and hot and very strange. Alarms started going off, and nurses rushed in, and they told me I was tachycardic (my heart rate had shot up to 160) and was going into shock. I had lost so much blood that my hemoglobin had dropped to 6.8. The normal range is 12 to 15, and I had been slightly anemic while in labor, with a hemoglobin count around 11.

They sent a crisis nurse to sit with me and help me calm down and took some readings with some kind of heart monitor (EKG machine, I guess?), which they only sort of knew how to hook me up to. In spite of the trauma of the whole matter, I was almost amused at how they couldn't get the leads to stick to my sweaty skin, and they weren’t exactly sure where they were supposed to go. It wasn’t exactly encouraging, but I guess they got the readings they needed.

It was determined I needed a blood transfusion to restore my blood count, and I was quickly typed (for the umpteenth time) and cross-checked and two units of blood were brought up from the blood bank and hooked into my IV. My veins were so sunken that they had to call in a special IV team even to get the IV started, and even she had trouble finding a vein! But eventually, I was recovering with someone else’s generously donated blood dripping slowly into my body.

I didn’t see my son much that day. He could really only be in the room if someone else was there with me, as I couldn't even get out of bed to tend to him. I was told that I probably wouldn't be able to start making milk until my blood supply was restored.

They told my husband to go home and sleep at night and kept the baby in the nursery, feeding him formula from a bottle when he needed it. They told us if we wanted, we could provide our Avent bottles for him to use, instead of the disposable rubber nipples they had in the hospital, in the hope of preserving his latch. So my husband brought some. I have no idea if it made a difference.

They had me stay in bed all of Monday as well. My husband stayed with me most of the day. He fed the baby, was taught how to change his diaper and swaddle him, and held him. I watched. I remember just being so tired and having absolutely no connection to this baby I had worked so hard to deliver. I did get to try nursing again, this time with a different lactation consultant who man-handled my breasts and tried to teach me two different ways to hold him. I felt clumsy, weak, and bullied. I was discouraged that he was so big and heavy and I was so weak and drained. Somehow, I thought it would be easier, or make more sense, or that I should instinctively know how to do this. Watching someone else open a bottle of ready-to-use formula and feed it to him was much easier than this craziness.

Monday night, I woke up crying in the middle of the night. The nurse on duty insisted it was because I was in pain, said I should tell them right away if I was in pain so they could give me more Dilaudid. I said that wasn’t it, and that I didn’t know why I was crying. No one had told me about the “baby blues,” the ebb and flow as pregnancy hormones suddenly stop and other hormones take their place. It wasn’t helped by my sheer exhaustion, pain, and trauma of the surgery.

Tuesday, I was finally starting to recover a bit. They let me get out of bed and take a shower, which was both scary and wonderful. They wheeled me to the “mandatory baby bath demonstration,” where a nurse, who was also one of the lactation consultants, bathed one of the other new babies to show us how to do it. (I still wonder that they had this mandatory baby bath demonstration where they went into excruciating detail on how to give your baby a sponge bath, which is hardly the most complicated baby-care task, yet there was almost no instruction whatsoever on breastfeeding!)

The lactation consultant came back up to my room with us and brought along a hospital-grade breast pump so she could show me how to pump. She told me I’d need to pump eight times a day – every two to three hours – to bring up my milk supply. I could save my colostrum and they would give it to the baby at his feedings so he could benefit from whatever I managed to extract. The idea of hooking myself up to this machine eight times a day seemed ridiculous. I had visitors, and nurses in and out, and most of the time had no idea what time it was. I think I pumped maybe three times that day, and nursed the baby once. This made no sense at all, but I took her word for it.

Tuesday night, I woke up in the middle of the night with my left hand extremely swollen. I had been on a saline IV to keep my hydrated, and apparently after 48 hours or so on an IV, the vein can just collapse, so saline was dripping into my hand. It wasn’t a big deal, health-wise, but it was scary and a little painful. They moved the IV site and gave me a warm compress to help bring down the swelling. They said the saline would just drain out. Still, I already looked like I had been hit by a bus, and now my left hand was swollen to twice its usual size.

Wednesday I was able to pump eight times, as instructed. I still didn’t have any milk, and I had no idea that this was perfectly normal after a first baby and c-section. It was discouraging, however, and exhausting, and I didn’t want to do it. Plus, washing all those pump parts so often? What a pain! I did try breastfeeding again, and still felt like a moron who couldn't manage this simple task of holding my baby to my breast and letting him suck. How complicated could this be?

The baby also started to show signs of jaundice, and he had to be on a bililight any time he wasn’t being fed or changed. This was… inconvenient, at best.

Thursday morning, my OB came to check on me and told me that I could go home that day if I felt ready. She said if I was still too weak, she could probably get me another day in the hospital, saying I wasn’t sufficiently ambulatory because of my anemia. But another of my OBs came later that morning and strongly suggested we go home. The nurses concurred. They said we weren’t doing ourselves any favors staying in the hospital longer.

I was told it would probably be a good idea to rent a hospital-grade pump, so I could continue pumping eight times day at home. I had purchased an Avent Isis double breast pump ($300) before the baby was born, assuming I’d need to pump when I went back to work, but they said it wouldn't be able to handle the amount of pumping I’d need to do in the early weeks to bring up my supply. I took their word for it. They had given me the name of a woman I could rent a breast pump from, and she came to bring me the pump, wheeling her sixth child in a stroller. She also sold me a hands-free pumping bra and some milk collection bags.

Then, Thursday afternoon around 2:30, we packed up, changed the baby into a “going home” outfit, put him in his car seat, and went home.

And if you think that’s the end of this saga, well, wait until Part III!