Breastfeeding a Newborn

I'm back in the "breastfeeding a newborn" phase of life. Actually, the new baby has been amazingly good to me. I've written about how my second son was a snacker, eating every hour. This new guy, he eats very enthusiastically, sometimes only for 10 minutes, other times for 20, but he cluster feeds for a bit, then takes a nice long nap, sometimes close to two hours. (Not that I can make any definite statements about his habits at 17 days old, but this is sorta how it's been so far.) It's kind of amazing. I was prepared for another every-hour eater, so this is pleasant.

Before my milk came in, his latch was horrible, it was hot as heck here (no A/C), and he would not let go of my nipple without screaming. I dreaded latching him on, I cried, thinking I couldn't possibly handle a baby like this, I despaired. And then my milk came in, and he became the most content, easy-going guy. I'm very lucky.

I read a very good article yesterday - which I wish I'd read two weeks ago! - about how positioning is more important than how the latch looks, and how the latch feels is more important than it looking like they describe in the books, and suddenly he's latching better, with just a few simple tips. Hold the baby tummy-to-tummy with you, so his ears, shoulders, AND HIPS are in one line. Bring the baby to your breast, with the nipple in line with his NOSE, and let your breast brush his CHIN. This will stimulate him to open his mouth, and then you can drop the nipple in. If it doesn't hurt, you're fine. Also, it helps keep him latched comfortably if you recline a bit. This is called biological nurturing, or laid-back nursing, and it helps keep the baby from flinging his head backward and coming off the nipple in a rather painful way.

I would like to brag a little at this point. Baby was born 8lbs., 3.5oz. By day three he had lost about 6 ounces, and was down to 7lbs., 12oz. The very next day, day four, he was up to 7lbs., 15.5oz. (yes, he gained 3.5 ounces in one day, once my milk came in). Today, he had his two-week appointment, and at 17 days old, he's 9lbs., 14oz. Yes, folks, he gained over two pounds in two weeks. He's a good eater, that one!

Anyway, I have mastitis. I've preached up and down, here and in my book, about getting rid of plugged ducts and avoiding mastitis, and here I wake up yesterday morning with a horribly engorged right breast, chills, achy joints, and a hard, sore spot on the outside of said right breast. Damn. I tried my usual tricks, massaging the spot while nursing, nursing a lot on that side, letting the hot water from the shower help open up the duct, massaging some more. I thought I'd taken care of it, until my 600mg dose of ibuprofen wore off and the chills came back last night. I spent the night alternately having chills and sweats, so I called the doctor this morning and asked for antibiotics. If you can't clear the infection with home remedies within 24 hours, it's not worth taking any chances. Mastitis can be serious stuff. I was hoping to avoid antibiotics, because that can lead to thrush, which is its own ball of trouble. Ah well. I got some probiotics to take along with the antibiotics, so hopefully this will be the end of it.

And, finally, I've decided to start pumping and storing breastmilk again, like I did with my second son, in order to donate it. I have someone in mind to give it to, if she wants it. A friend of my housekeeper's had a baby who was in the hospital for a few weeks after birth. She desperately wanted to breastfeed him, but she didn't have good support, and she didn't have a full supply established. I tried to pass along some tips, but I think it was too late. At three months old, now, her milk is dried up, and her son has had four ear infections already. She's terribly upset. I asked my housekeeper if she thought her friend might take donated milk, and said I'd be very happy to start pumping for her. I won't be able to give her enough to get him off formula, but even one bottle a day may help. Poor baby.

My Third Son's Birth!

Hello out there. You may have gathered from my longer-than-average hiatus that I've been indisposed. You were right. I gave birth to my third son on September 5 (Labor Day!), and I've finally had an opportunity to sit down and write about the experience. I'm very excited to share with you my birth story!

For over two weeks, I had been having strong, recurrent bouts of contractions. They weren’t painful, but they were strong enough to make me stop and wonder, then look for other signs of labor. And then they’d stop. Starting at 36 weeks, at each appointment with my nurse-midwife, she’d check my cervix (per my request), and each week, I had opened another centimeter. Each week, we were both certain that I’d give birth before the next appointment. But I was there, still pregnant, at 37 weeks… 38 weeks… By my 39-week appointment, I was 3cm dilated and 80% effaced, and still no labor. I was getting antsy. Very antsy. But I knew baby would come when he was ready, and I sincerely wanted to let nature take its course. I was determined to have a spontaneous labor and successful second VBAC.

It was the Sunday of Labor Day weekend. I was due the following Wednesday. I had convinced myself that I couldn’t possibly have this baby before 40 weeks, because otherwise I was going to lose my mind. On that Sunday, we went to the park with the boys and had a picnic, then to a community barbecue. The whole afternoon, I’d have occasional strong contractions, much like before, but they didn’t come to an end. I started to toy with the idea that maybe, just maybe, they meant something this time. But, by that point, I’d had so many, “Maybe this is it!” moments that I was not ready to commit.

Around 10:30 that night, I decided the contractions were actually getting stronger, and I started timing. Five minutes apart. Well, that’s the tell-tale sign, right? But, they didn’t hurt as much as I thought they should, and I could walk and talk during each one, so I still wasn’t totally convinced. I decided to take a bath and see if I could relax them away, then try to get some sleep. If I was going into labor soon, I should try to get a few hours of sleep first.

I took a bath, and they didn’t stop. I got ready for bed, laid down, and WHAM, I had a really strong contraction. My thought was, "Well, I won't be able to sleep through these!" Five minutes later, another one. Okay, I said. This is it. I put clothes back on and told my husband I thought it was for real this time. We called someone to come stay with the kids and called the hospital to make sure it was okay to come in (it was). By the time everything was arranged, the hospital bag was double-checked, and we were ready to go, it was about 12:30am, Labor Day. We took off for the hospital. We didn’t want to wait at home too long, because the hospital was 40 miles away, and I didn’t want to take the chance that we would be “too late,” as it were. I also didn’t want to be too early and hang around in the hospital for more hours than necessary, or to get there and find out it was false labor again, but I was pretty certain. I was completely certain about halfway there when I realized I was no longer able to carry on a conversation during a contraction. Whew.

My husband drove… er… rather fast, and I think we got to the hospital in about half an hour, around 1:00 in the morning. To my delight, the nurse-midwife on call that evening was none other than the one I’d been seeing for my prenatal appointments. We were mutually excited, since that rarely happens at Kaiser. They triaged me and checked my dilation, and I had gained another centimeter and was having regular contractions. Time for baby!

My nurse-midwife told me I could have the epidural whenever I wanted. I wasn’t sure that I wanted one at all, and I said I knew I could have it, and that I’d ask for it if I wanted it. I definitely didn’t feel that I “needed” it yet. The contractions were definitely growing in intensity, but the five minute break in between was enough for me to catch my breath. My husband knew I was hesitant to have any medications during labor, and I’m really glad we talked about that beforehand, because the idea of the epidural becomes very, very tempting at 3:00 in the morning in active labor, let me tell you.

Sidebar: I wanted to avoid epidural and Pitocin during this labor, if possible, because I was intent on having another VBAC and because I knew that any interventions could lead to further interventions, which might eventually lead to c-section. Additionally, I had Pitocin with each of my previous deliveries, and in each of the previous deliveries, I had postpartum hemorrhage, and both boys had jaundice. Pitocin is a risk factor for both postpartum hemorrhage and jaundice in the baby. I did NOT want Pitocin, and, by extension, I did not want an epidural, in case it created a “need” for Pitocin.

They kept offering to break my water to move labor along, but I kept refusing. The amniotic sac protects the baby from the brunt of the contractions, and it also lessens the intensity of the pain. Once the water is broken, everything gets ramped up. I didn’t want that. I wanted my water to break naturally. I think they really wanted to do it, but I didn’t. I really really didn’t. So I kept refusing. Besides, labor seemed to be moving along quite quickly!

I had dilated to about 6cm when labor went crazy. I was managing the every-five-minutes contractions reasonably well, but all of a sudden they went from every five to every 1.5 to 3 minutes! There was no break in between to breathe or relax. One ended and the next began. The nurse, who was wonderfully attentive, strong, and worked with me very well, was coaching me to blow and breathe, which is NOT EASY. At the end of each breath, I desperately wanted to push, but I couldn’t, because it wasn’t time. I started to hyperventilate a bit, and they gave me oxygen. I’m not sure if it helped. I had to breathe so fast to stay ahead of that “push” feeling, I barely had time to exhale before I had to inhale again.

And that’s when I said, “I want the epidural!”

The nurse and my husband both knew that I wasn’t so sure about it. I knew I wasn’t so sure about it. They asked if I really wanted it, and all the fears about what might happen if I got one surfaced, and I backed down. And then said I wanted it. And then backed down. I just couldn't make a decision. Between them, my husband and my nurse were very good about putting me off without making it seem like they were. I did want it, in that moment, but then I didn’t. I was so tired. I think my feeling was that if I could just rest a little, I’d be okay to continue, and an epidural would let me rest.

The other nurse-midwife on call came in, because mine was taking a break until I was ready to deliver (she was staying around because she wanted to deliver me, but I think she was technically supposed to be off). She suggested that I try the shower. So I got in the shower for a bit, and the hot water felt really good, but the contractions were just coming and coming and coming, and I was so tired. I hadn’t expected it to hurt quite so much, and I hadn’t expected the contractions to be so close together or so intense. How much longer did I have to endure these? Hours? I couldn't do hours. I just couldn't. I got out of the shower and returned to the bed, somehow hoping that sitting or lying down would help. Maybe I was just tired of standing.

I think the nurse realized that I must be close, because she said to me, “Jessica, listen. I want to tell you something about the epidural. I’m happy to get you one if you want it. But by the time we get the anesthesiologist up here, and we sit you up and do it, it will still be 20 minutes before it kicks in. By then, you might be ready to push, and you won’t even get to enjoy the epidural.”

That convinced me to keep going, and, sure enough, I was almost fully dilated. At 4:40am, my water broke with a pop. The nurse checked and found that I had just a lip of cervix left. She said I was absolutely NOT to push until she got my nurse-midwife up there. I distinctly remember saying, “Tell her to RUN!” She got there quickly, checked me, and said the words I’d been longing to hear, “Go ahead and push!”

I pushed. Boy did I push. I wanted this labor OVER WITH. I wanted that baby OUT. Besides, it hurt a lot less when I was pushing then when I wasn’t. I heard the nurse-midwife call for a local. She said my perineum just wasn’t stretching quite enough. She made a little cut, I made another few pushes, and I felt that baby slide out. I had never felt that before. My previous VBAC had been with an epidural, and I’d had a c-section before that, so I had no idea that you could actually FEEL the baby slide out. Wow. He was born at 4:57am, just 17 minutes after my water broke!

They put him right on my stomach, whereupon my first words were, I believe, “I made a baby!”. They dried him off, but otherwise waited, per our request, for a couple minutes to cut the cord, and then we brought him right to my chest to nurse. At the same time, there was a flurry of activity around me, administering medications by injection in each leg, Pitocin to contract my uterus - I had actually YANKED my IV out of my hand while pushing, so first they were frantically trying to put a new one in while I was trying to hug my new baby - and stitching up the episiotomy. They were working furiously to prevent a hemorrhage, and, you know what? I had blood loss within normal limits! Spectacular!

They waited until I felt he was taking a break from nursing before weighing him. He came in at a healthy 8lbs., 3.5oz. Pink and strong. They gave him right back to me.

Just before we were ready to head up to the postpartum ward, they made me go pee. I had never been ambulatory right after giving birth before. This was all so new to me. I sat in a wheelchair (rather than lying on a bed) to go up to my room, and I got to hold the baby while we went up there. So cool.

My stay at the hospital was really good. The breastfeeding support was phenomenal. I was actually told that I should sleep with him skin-to-skin on my chest! I will be writing a separate blog post in more detail about the hospital, so I won't get into it too much here.

We went home the next day at noon. The baby did become jaundiced, but his numbers came down on their own, rather than his needing phototherapy like my first two had. I don’t know if the method of birth had anything to do with the jaundice or not.

The second day home was very hard. We were in the middle of a heatwave. It was 90 degrees, and I had no milk yet, just colostrum. The poor baby was so thirsty. I couldn’t unlatch him for two minutes without him screaming. My nipples were sore beyond belief. I was having horrible hot flashes, crying jags, the postpartum hormone surges. It was pretty awful. But I’m already feeling better. My milk came in Wednesday afternoon, and the change in the baby was incredible. He became so content!

Overall, I feel that the birth went just about as well as you could ask for. Only 4 hours of labor in the hospital? Wow!  Natural birth (even if it was kind of by accident), immediate and constant skin-to-skin. I got pretty much everything I wanted out of this birth. If we have another child in the future, G-d willing, another birth like this one would be just fine!

Sitting Around Waiting To Go Into Labor...

No baby yet. I still hope to be posting a birth story soon. (Like, really soon? Maybe?)

I'm very happy to report that this pregnancy has been my "healthiest," in terms of weight gain and overall feelings of well-being. The very beginning was rough. I didn't have much morning sickness, but I had some other weird symptoms that were apparently hormonal, and I also had a lot of trouble with my sciatic nerve until the middle of the second trimester. However, I haven't gained nearly as much weight as I did in my first two pregnancies, and, in even better news, my blood pressure has been very stable! Every week now when I see my CNM, I wait anxiously for the blood pressure monitor to display my numbers, and every week I heave a great sigh of relief when the numbers are in the normal range once again. My biggest worry since the beginning of this pregnancy would be that I would have high blood pressure again and need to be induced or c-sectioned.

I am now 38 weeks, and delivery seems imminent. For almost two weeks, now, I've been having intermittent contractions, strong but relatively painless. I can feel that the baby is moving down, and when I told my CNM that I had showed up to the hospital dilated 4cm with my second son, she decided to check my dilation at my office visit just to see what was going on. As of Wednesday, I was 3cm dilated and 80% effaced, and she could just feel the baby's head! She swept my membranes, saying that if labor was on the verge of starting, doing so could get things going. And yet, here I am, five days later, still no baby. Amazing how pregnancy can fake you out even right at the end.

I wrote out a "birth plan" and then decided not to print it. I have just a few desires for this birth, the main one of which is "have a vaginal birth." My intention is to avoid all interventions (IV, Pitocin, epidural) not because I have any kind of "earth mama" thing going, not because I'm altruistic or hippy or crunchy, not because I have any kind of "I am woman, hear me roar" complex (I'm more likely to whimper than roar), but because, to be honest, I'm more afraid of the drugs than I am of the pain of labor. Now that I know as much as I do about how interventions can negatively affect the birth outcome and the health of the mother and baby, I'm afraid of them.

I know this sounds a bit silly. I've had Pitocin and epidural with both previous deliveries. How can I now be afraid of them, when I consented to them before?

Well.

My first birth did not go at all as I'd hoped, ending in a rather unfortunate c-section as it did. I went into that birth wholly uninformed about what epidurals and Pitocin really do. My second birth went phenomenally well, but even so, I avoided the epidural as long as I could because I knew being mobile might be key to having the VBAC I wanted. As for the Pitocin in that second birth, when they present to you your option of "have a stroke or give birth right now," it's sort of a no-brainer.

So why am I so afraid now? Well, I learned that the use of Pitocin is linked to increased risk of both postpartum hemorrhage in the mother and jaundice in the baby. Both of my sons were jaundiced enough to require home phototherapy, and both births resulted in postpartum hemorrhage for me. I don't think it's unreasonable to want to avoid Pitocin, knowing that! And I'm more likely to avoid Pitocin and get the baby out more easily if I also avoid an epidural, which would require me to spend the rest of the labor on my back, which I'm really not that interested in doing. I figure I'll play it by ear, though.

This time, my blood pressure is steady, my weight gain is good, the baby seems to be average size (I've been measuring right on target for fundal height, at least), and everything is progressing normally. I get to have a spontaneous labor, and I'm GBS (group B strep) negative, which means they won't require IV antibiotics during labor, which means I get to choose, well, pretty much everything. Having so much choice, in a way, is scary. I admit that part of me was hoping my blood pressure would spike and they'd tell me they had to induce (a very very small part of me, of course). Part of me was hoping that when she did that internal check and swept my membranes, labor would start. The biggest part of me, certainly, keeps reminding the rest of me that "He'll come when he's ready" and "Don't be in such a hurry." Really, I'm just uncomfortable.

I think what gets me is the uncertainty. I've been so sure, every evening, that tonight will be the night. And then it isn't. But surely tomorrow? No? I keep reminding myself that I haven't even reached my due date, but when you've been having contractions for almost two weeks, the due date starts to seem a little irrelevant. Why won't the contractions build into labor?

Because?

Because either the baby or my body just isn't quite ready. I'd venture to say my body is quite ready, which leads me to believe the baby has just a little more growing to do. And I want to let him do that.

Did you know that in the last few weeks, the lungs and brain are still developing? That's why medically unnecessary scheduled inductions and c-sections before 39 weeks are not recommended. In fact, some hospitals are banning them. Babies born between 37 and 39 weeks are being called "late-term preemies," and quite a few beds in the NICU are taken up by these babies who were born, unnecessarily, before they were quite ready.

So I'll stick it out a bit longer. I'll be 39 weeks on Wednesday, and then I'll have a serious talk with the little guy inside, because, really, I'm kind of tired of all this almost-labor business. I've reached a point where when I sit on the toilet, I'm sure I'll go to wipe and find his head crowning. In some ways, that's pretty cool. In other ways, well... My preferred hospital is 45 minutes away, and I'd like a little warning before the whole crowning thing!

So, here's hoping my next post will be a birth story. In the meantime, anyone else out there who's almost in labor, like me, hang in there! We won't be pregnant forever, and a week isn't really that long.

The Three-Across Car Seat Adventure

I'm in a place right now that I hope my next post after this one will be a birth story (mine!), but it could still be a couple of weeks. In the meantime, I bring you, The Three-Across Car Seat Adventure!

Even before we managed to conceive Baby #3, I started worrying about how we were going to fit all three kids in our little Toyota Corolla. See, we had a Rav4, which might have been wide enough to fit three car seats across, but when Baby #2 was about 11 months old, we traded the Rav4 for a Corolla to save money, figuring we wouldn't want a third for at least three years. We'd worry about a bigger car, preferably a minivan, when the time came.

Except, we got baby fever a little earlier than anticipated, and even as we hoped every month to see the positive result on the pee-stick, I worried about the car seat situation.

Our first son is not yet five, although he's big for his age. I really wanted to keep him in a five-point harness as long as possible, and he's not even close to the 65-pound limit on the Graco Nautilus he was riding in, so I had assumed he'd just stay in that until he hit the limit. Then there's our second, who's now 2.5, and average size for his age. He had plenty of room to grow in his Britax Roundabout. But in between those two massive car seats wedged into the backseat of our tiny Corolla was... not enough space for even a skinny person, much less a car seat. Yikes.

Knowing I had at least nine months to solve this problem, I started asking around. What I found out is that there are two car seats on the market that advertise themselves as being narrower than all the others. One even claimed you could fit three across in a Toyota Corolla! That is the Combi Cocoro. Problem? It's a small convertible seat, with an upper weight limit of 40 pounds. Fine for the baby, but certainly not for the 4.5-year-old, and the 2.5-year-old probably wouldn't get much use from it either. The other option is a Sunshine Kids Radian convertible seat. They have models that go to 65 pounds and 85 pounds. Awesome, right? Could I do a Cocoro and two Radians?

Well, cost was an issue, of course. The Cocoro runs anywhere from about $160 to $230, depending on sales and color. (I didn't much care what color it was, so I'd take the cheapest if I could.) The Radian runs between about $180 to $250. Similar price range. And to buy three of these? I wondered if there was a better way.

There was also the pesky problem of not being able to take any passengers with us, ever. If all five of us were in the car, the car would be packed to the brim. Even with only the two kids, the car was cramped when full. It was livable, but not fantastic.

When the then almost-2-year-old's birthday approached, Grandpa asked what he wanted. I said he really, really wanted a Radian 65. I figured, I could get one and see how it fit. If it looked like it might work, I could splurge for two more. And... the two-year-old refused to use it, wanting to stick with his old seat, but the 4.5-year-old wanted to use it. Fine. I put the bigger kid in the new car seat and the smaller kid got to stay in his same Grace Nautilus. (At some point, I'd switched him out of the Britax and into the Graco. I can't remember when.)

The Radian was definitely narrower, but there still wasn't nearly enough room for a third seat. The Nautilus is also quite wide, meant to accommodate a child up to 100 pounds, so it wasn't going to be viable anyway. I spent an afternoon testing out different configurations with the Radian, out there in the backseat of the Corolla with a measuring tape, trying to figure out if I could fit three Radians across. I came to the conclusion that I could, but only if I could make the car about two inches wider. Obviously, this was not an option.

I was skeptical that I'd have any more luck with the Cocoro. I scoured the Web for any evidence that someone had actually put three Cocoros across the backseat of their 2010 Corolla. I couldn't find a single article, blog post, or forum question that addressed this problem. Most people who put three car seats across had mid-size cars, SUVs, or minivans. All much wider than my little Corolla. See? I needed those two inches!

Wonderful.

By the time I was five months pregnant with Baby #3, I was quite concerned. I was beginning to think that we only had two options: Put the oldest child in the front seat (legal if you have no other option, but I was not comfortable with this idea) and never have all five of us in the car, or never have all three kids in the car at the same time. Obviously, not very practical.

We broke down and admitted we needed a bigger car. A minivan would be ideal. If we could get a bare-bones, bare minimum, used van, our car seat (and passenger!) problem would be solved.

We couldn't find much in our price range. Plus, the arrangement we had cooked up in order to afford such a purchase was not very viable. So, in a last-ditch effort at solving this sticky sticky problem, I went back to the dealership where we'd bought the Corolla. We'd bought three cars there, and we hoped our loyalty would buy us a favor.

Lo and behold, it did! They found us a used Toyota Highlander, seven-seats, in brilliant condition, and were able to finance it for us and take back the Corolla. It was a miracle! I'm actually very happy with this car, car seat problem or no car seat problem, so that worked out well.

But I still had to actually, you know, fit three car seats somehow. The third row in the 2006 Highlander is quite utilitarian and not ideal for installing a car seat. Plus, if you have the third row unfolded, you have basically eight inches of trunk space. Not exactly enough for a stroller and groceries. Not exactly enough for just groceries. Plus, whoever was in the back had to get there somehow, either by climbing in through the trunk or over the second row, which would involve folding down the second-row seat... hard to do when there's a car seat attached to it! I was determined to fit three across in the second row, so we'd only have to put up the third row if we needed to take additional people besides the five of us.

I came to the conclusion that the simplest option was to put the oldest in a booster seat, so he could buckle and unbuckle himself. Plus, simple boosters seemed to be narrower than most of the car seats out there. So, I bit my lip and purchased a Graco Turbobooster. If he was going to be in a booster, it was going to have a back, at least, to properly position the shoulder belt and offer more head protection.

It was narrower, but was it narrow enough? I spent another few hours arranging and rearranging the car seats, trying to figure out how I was going to get the booster, the Radian, and either a rear-facing something or, preferably, the Chicco KeyFit30 infant bucket-style car seat I already had. My preferred arrangement would have been the bucket in the middle, or, failing that, the booster in the middle, but neither way worked! I finally managed to squeeze the booster behind the passenger's seat, the infant seat behind the driver's seat, and the Radian in the middle. Talk about a challenge! I tested my car seat prowess with that configuration, let me tell you.

I don't love the arrangement, but it works well enough, and I got everything else that I wanted out of the deal. The biggest problem now is that the oldest can't actually buckle his seat belt because the booster and the Radian are so close together. He has to move the booster over, get in, buckle, and then I have to shove the booster back into the correct position. He can, thankfully, unbuckle himself and get out. Buckling the 2.5-year-old into a five-point harness in the middle seat is uncomfortable, especially with my large pregnant belly, but it's not unmanageable, and the low profile of the Radian allows my short-ish toddler to climb in and out of the seat with relative ease, so at least I don't have to lift him into it. And, because I'm using the bucket-style car seat for the baby, it will be easy just to plop him in last, once the other more complicated kids are taken care of.

I shudder to think what gyrations I'll have to perform when the baby is ready for a convertible seat, though. I'm thinking I'll have to buy a Cocoro at that point. Maybe with three narrower seats, it will be less of a problem. I'll let you know when that happens!

In the meantime, think good labor thoughts for me. As I said, I'm hoping my next post will be a birth story! If not, it'll probably be about something new and different, like breastfeeding.

--------
Also, please check out my breastfeeding book for Kindle, The "Yes, It's Normal!" Guide To Breastfeeding!

Mothering Isn't Just About Feeding

The worst sin of breastfeeding advocacy is pushing breastfeeding to the exclusion of all other parenting values and choices. Certainly not all breastfeeding advocates are guilty of this, but sometimes we harp on breastmilk vs. formula to the point that it seems like if you don't breastfeed, there's nothing else you can do to create a strong bond with your baby, give your baby the feelings of emotional and physical security he needs to develop healthy attachments, or prevent your child from becoming an asthmatic, diabetic, obese adult.

So for the rest of this blog post, I will not talk about breastfeeding at all. Instead, let's explore some other choices we can make as parents that can help our children gain some of those benefits even if they've never had a drop of breastmilk.

To be perfectly clear: I don't mean you have to do any or all of these things to achieve the above-stated goals. Indeed, in the interests of full disclosure, I have not done all of these things with my children. You don't even have to do any of these things all of the time!

I tend to think the number one thing your child needs from you is love. If your baby knows he is loved, and is shown love through affection, caring words, and active demonstration, then everything else is really just a matter of preference.

Babywearing


Babywearing is the practice of using a carrier of some kind to keep your baby with you as much of the time as possible. There are many types of babywearing devices, such as slings, wraps, and carriers. The idea of babywearing is that babies need to be held, much as they were in the womb, in order to adjust to the rhythms of your life, regulate breathing and heart rate, feel secure in knowing that you are always quite nearby, and watch you as you go about your day. Babywearing is found all over the world in many different forms. Using a carrier or sling simply frees up your hands so you can keep baby with you and still get things done. The beauty of babywearing, too, is that not only Mom has to wear the baby. Dad and other caregivers can certainly wear the baby on just as easily. You can "wear" your baby as you perform chores around the house, go for a walk, shop (much safer than propping a car seat atop the shopping cart!), hike, even use the toilet (with a little practice...).

Bottle-feed In A Way That Mimics Breastfeeding


One of the reasons breastfeeding (okay, I said I wouldn't mention it; I lied) helps to prevent obesity and associated diseases is that it teaches the baby to regulate his own hunger. When you breastfeed on demand, you teach the child to eat when he's hungry. Because the child can choose when to stop eating, he learns to stop when he's full. The trouble with bottle-feeding (whether it's expressed breastmilk or formula), is that the baby finds it much more difficult to self-regulate. Because of the effort, time, and money involved in preparing a bottle, we as parents (I include myself) tend not to want to "waste" any of the precious liquid in the bottle, so we try to make sure the baby is very hungry before feeding (which usually results in putting the baby on a feeding schedule), and we try to make sure he finishes the bottle. As long as a bottle nipple is in the baby's mouth, it is hard for him to stop eating, because the nipple constantly drips into the baby's mouth, forcing him to swallow, which creates a vacuum that draws more milk from the bottle, which forces him to swallow again. We may be inadvertently forcing the baby to take in more calories than he needs, stretching the stomach and setting the stage for overeating later in life.

Breastfeeding also fosters bonding because you are forced to be in physical contact with the baby while he eats. We also naturally switch sides while breastfeeding so the baby can get milk from both sides. This switching back and forth stimulates both of the baby's eyes and both sides of the body. Often when we bottle-feed, we only hold the baby on whichever arm is more comfortable, so he doesn't get that back-and-forth advantage.

But, there's a way around both of these problems. Take a look at this article. If we bottle-feed in a way that mimics these two major benefits of breastfeeding, we can help to eliminate at least one of the risks of bottle-feeding.

Co-sleeping


Co-sleeping, or bed-sharing, is when your child sleeps in the same bed with you, rather than being placed in his own bed to sleep. You can co-sleep "part time," meaning you allow the child to sleep in your bed for part of the night, or "full time," meaning your bed is the only place the child sleeps, or something in between. Perhaps you sleep with your child in his bed for a while, and then slip away, or you start out in separate beds and at some point in the night end up together in the same bed. Perhaps you put your baby in a co-sleeper attached to the side of your bed, rather than directly in your bed with you.

Co-sleeping gives a baby or toddler a great sense of security at night. Humans are social animals, and we crave company, even at night. It is natural for us to share sleeping space, especially children. If the baby wakes up at night, the parent is right there to comfort him. You keep each other warm on a cold night. The rhythms of your breathing and heartbeat help to calm and regulate your baby's breathing and heartbeat. Your body heat helps baby to regulate his own body temperature. Your baby can sleep comfortably knowing that you are keeping an eye out for danger on his behalf. And you have an awareness of your baby and would know quickly if he were to wake or stop breathing (G-d forbid!).

If you do co-sleep, you should try to make your bed as safe a space as possible. If you are on medication that makes you sleep deeply, or you have been drinking and are not sure that you will wake up for the baby or be aware of him in bed, you should not co-sleep.

Baby-Led Weaning (BLW)


Baby-led weaning is a method of introducing solid foods to your baby that allows the baby to control what and how much he eats, rather than being fed purees with a spoon. You can use BLW whether you bottle- or breast-feed. When you're ready to introduce solid foods (at or after approximately six months of age), you can sit the baby in front of chunks of soft foods that he can easily pick up. Allow him to explore textures and flavors and offer him real foods. He will learn to feed himself, eat as much as he wants to, and stop when he's full.


When we look at parenting, we need to look at all of the choices we make and how they benefit our child. Whether we baby-wear or not, co-sleep or not, whether we breastfeed or bottle-feed, our main job as parents is to show our children that we love them, give them skills to cope with the world, and teach them that, no matter what, they are loved and we are there for them.

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.

-----

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!

Breastfeeding Basics - Part VI: Over One Year

I hope you've been able to keep up with my Breastfeeding Basics series and have found it helpful in some way. If you haven't been following, here are the previous parts: Intro, Part I, Part II, Part III, Part IV, Part V.

Just by chance, this final post in the series coincides with World Breastfeeding Week, so happy WBW to all the current, future, and past nursing moms out there. Keep up the good work!

If you're reading this, it's because you've reached or will soon reach that magical one-year mark, that first birthday, that amazing milestone that says, "We're still alive after a year! We survived infanthood!" Now you've got a toddler on your hands. Maybe she's not walking yet, or maybe she's been walking for a few months, but a one-year-old is, as I'm sure you've noticed, very different from a six-month-old or a three-month-old!

I'm going to call the period from one year to three years "toddlerhood" for simplicity.

Let me start by saying, "You did it!" You did it! You made it to a year!

Toddlers are busy little creatures. They're mobile, they're curious, and they want to get out there and explore. This means that during the day, they likely don't want to sit on you and nurse for long periods of time. Your toddler will be more of a snacker when she's busy, stopping by for a quick cuddle and some yummy milk, then off to find new ways to try to hurt herself or destroy your house. When she's sleepy or unhappy or missing you, she'll probably want to cuddle longer, and at times you'll love it and at other times you'll just want her to go away and leave you alone for a bit.

The difficulty with nursing a toddler is that toddlers tend to be busy even when they're nursing. They try out strange and uncomfortable positions. Many of them have the annoying habit of "twiddling," which is when they play with one nipple while nursing on the other. This can be very annoying. You don't have to let your child annoy you. If your toddler is displaying nursing behaviors that you don't like, it is absolutely your right as the mother to discourage that behavior.

This is the time to introduce "nursing manners." Just as you are beginning to teach your toddler about the right way to act in other situations, you can let her know that she needs to be respectful of you when she nurses. I highly recommend getting her in the habit of treating you nicely when she nurses, or you'll start to resent nursing her.

You may want to start to teach her how to request to nurse, if you haven't already, either by introducing a hand sign such as the ASL sign for "milk" (opening and closing the fingers as if milking a cow), or by teaching her a word to use for nursing. Some kids pick up on the word "boob" or "breast," while others come up with their own term. My son called it "nu" or "nur." I guess he was trying to say "nurse." It's probably smart to come up with a term that wouldn't be embarrassing if it were, for example, yelled at the top of someone's lungs in a busy restaurant. Hearing "baba! baba!" is far less humiliating than having your 18-month-old yell "boobs!!!" in the middle of dinner.

You may also decide that now is the time to cut back on nursing sessions, since breastmilk is no longer your toddler's only source of nutrition. I discussed weaning in the previous post. You may find that your toddler naturally starts cutting back on his own, since he's so busy much of the day learning and exploring. He will probably go through phases of deep attachment, wanting to nurse often, almost like a newborn, and other phases where you'll swear he's ready to wean completely. Both are normal developments of toddlerhood. You can take advantage of the slower periods to start weaning, if you want, or you may want to try offering the breast more often during these slower times to encourage him to keep nursing, if you are not yet ready to wean.

At this point, you'll want to assess your goals. By now, you probably have a good sense of whether you want to keep nursing for a long time or whether you've really had it. If you're not sure, I encourage you to keep at it for now. The WHO recommends nursing until at least two years of age. This is a good place to stress that the benefits of nursing and breastmilk do not vanish when your child reaches one year old. Breastmilk continues to evolve and change as your child grows, and the milk your body makes for your toddler is specially suited to toddlers' quick nursing sessions and higher caloric needs, and it still provides the antibodies, anti-inflammatory agents, and antibiotic substances that have made it so valuable ever since your baby was born.

There are also benefits to you, the mom, of continuing to nurse. The benefits you gain from nursing a baby are cumulative - that is, the longer you nurse, the lower your risks of certain cancers and other diseases. So it's worth continuing if you want to.

The biggest challenge for many moms nursing toddlers, though, is the judgment from others. Some will say that a child is too old to be breastfeeding once he can "ask" for it. Others may tell you that you are doing some kind of harm to your child by continuing to nurse. You may hear that breastfeeding has no benefits after one year, or that you'll never get the baby off the breast if you don't wean, or some other such "wisdom." None of this is true. In fact, around the world, many mothers continue to nurse their children even until four years (and some even longer than that!), and there is absolutely no evidence that it causes any psychological harm. Most children will "self-wean" (choose to stop nursing on their own) between two and four years of age, and it's up to you and your child (and no one else) when it's time to stop.

Lastly, if you plan to have more children, you may start thinking about it while you're still nursing your toddler. While breastfeeding does have contraceptive properties, it's far from 100%, and the less you nurse, the less pregnancy protection you get. If your period has returned, likely so has your fertility.

If you do conceive while you're still nursing, don't feel pressured to wean. It is safe to continue to nurse during pregnancy as long as it doesn't cause contractions or preterm labor. Your OB or midwife will let you know if she thinks it's dangerous for you to continue nursing. The flavor of your milk may change and become unpleasant to your toddler, and he may decide to wean on his own because he doesn't like the taste. Some women find that their milk dries up when they are pregnant, although some continue to allow their toddler to "nurse," even when there's no milk, just for comfort. Many women find that nursing while pregnant is very uncomfortable, either because of breast and nipple soreness caused by the hormonal changes of pregnancy, or just because they generally don't feel well. If your toddler does continue to nurse through your pregnancy, your milk will change back to colostrum sometime late in the pregnancy. Your toddler will likely enjoy this new milk very much. You can even continue to nurse both your toddler and your newborn after the birth. This is called "tandem nursing." Remember that milk production is based on demand, so if you have two children demanding milk, your body will make enough for both. Be forewarned that newborn milk may have laxative properties for your toddler!

Nursing a toddler can be both rewarding and frustrating. The frustration may be in the nursing gymnastics, the twiddling, the demands. But the reward is in the special cuddles, the smile, and, when he starts talking, the compliments! Older toddlers may even tell you what your milk tastes like to them (ice cream?), although whenever I asked my son, he always said my milk tasted like milk. Can't argue with that!

That concludes this Breastfeeding Basics series. I'm happy to answer any questions you have in the comments. Also, remember to check out my new book, The "Yes, It's Normal!" Guide to Breastfeeding!