Overactive letdown/Oversupply

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

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

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

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

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

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

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

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

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

Going Dairy Free for a Happier Baby

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

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

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

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

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

And yet.

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

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

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

Oops.

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

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

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

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

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

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

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

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Using Kosher Symbols to Help You Avoid Dairy


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

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

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

I hope this helps!

Your Birth, Your Choice

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Breastmilk works!

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

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

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

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

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


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

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

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

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

The Things They Don't Tell You...

There's a lot of things people will "warn" you about when you are pregnant or thinking about having kids. They'll talk about the sleepless nights, their worst "poop" story, the endless diapers, illness, worry, expenses. They'll talk about the joys, the highlights, and the lows. They'll tell you all about the births, the pregnancies, and the pain. So, you'll go into pregnancy and childbirth thinking you're prepared for what life with kids will be like. You'll be expecting incredible feelings of love, stressful nights of crying, and worry worry worry.

But there is one thing no one ever warns you about when it comes to kids, and it's something that will become a major part of your life. I am here to fill you in!

The number one thing people should warn you about when it comes to having kids is laundry. You probably have a laundry routine for yourself. Maybe you do laundry once or twice a week, or maybe you have enough underwear that you can go two weeks between loads. You probably have a load or two of clothes, plus the occasional load of sheets and towels. Once in a while, you run a delicates cycle. My point is, laundry is not a major part of your week.

Until you have kids.

Now, granted, babies' clothes are small and don't take up too much extra space. But I've had days where my newborn goes through three outfits in 12 hours, so they generate way more than one or two additional items of clothing per day to your laundry basket. Then there's the burp rags, the receiving blankets, the bibs, and your clothes that get pooped on, spit-up on, or peed on (or, if you're very lucky, all three!). If you have the baby in a crib, you have his sheet to wash in addition to your own. If he's in bed with you, you'll probably be changing your sheets more often, due to various bodily fluids he will be kind enough to emit all over your bed. You have his bath towels and washcloths to wash.

And after the infancy period, you have a toddler. Toddlers get DIRTY. You'll have food-covered shirts, mud-covered pants. And the socks! Let me tell you about the socks! You can tell your socks from your spouse's, presumably. You can tell yours and your spouse's socks from your baby's. But can you tell your three-year-old's socks from your five-year-old's socks? Word of advice about socks: Give each kid completely different kinds of socks, or you'll forever be hearing, "Mom, why are my socks in his drawer?" or "Mom, I don't have any socks!" even if you've just done the laundry. (Although this phenomenon may also be attributed to the problem of socks jumping off of feet and landing directly under the couch, rather than ending up in the laundry basket. We have this problem at our house. Do you?)

And, with each additional kid, you have all of this additional laundry! Suddenly, you can't do all the sheets in one load; you need two. Suddenly, you have two loads of kids' clothes to do, not just one. And the guilt you'll feel if you go one too many days between loads of laundry and your son runs out of school uniform shirts (not that that could ever happen at my house...)!

So yeah. Laundry. Lots and lots of laundry.

Just One Bottle?

The latest hullabaloo in breastfeeding blog-land is the controversy over hospitals' supplying formula freebies to new moms, specifically in the context of the take-home bags. There are two issues under discussion here.

The first is that by handing out free formula, hospitals (and doctors) are advertising a product, which many feel they should not be doing. The reason hospitals give out free formula is that they have agreements with the formula companies that if they give (read: endorse) free formula to outgoing new moms, then the formula company will in turn provide free formula to the hospital to use in the nursery. The idea is that once a family starts using a particular brand of formula, they'll stick with that brand for fear of adverse reactions from switching (despite all formulas being essentially the same, and generics costing approximately half of what the identical brand-name product goes for). So, by giving a mom $30 worth of formula as she walks out the door, Enfamil or Similac or Nestle has just gained a new customer for at least the next 12 months, or so the formula companies' thinking goes.

The second issue is that studies show that mothers who have formula readily available at home are more likely to stop breastfeeding sooner or to supplement when it isn't necessary. Thus, mothers who are sent home with formula samples endorsed by the hospital are less likely to breastfeed exclusively for six months and are less likely to continue to breastfeed to a year and beyond, just because the hospital or pediatrician gave them a can of formula.

The first point is more of an ethical argument: Should hospitals be endorsing or advertising one brand over another (essentially identical) one? The second is a health issue: If the goal is for women to breastfeed their babies, then hospitals are undermining their own efforts at promoting breastfeeding by handing out formula as patients walk out the door. An associated problem is that if the hospital gives you formula, then the hospital is tacitly stating that you "can" or "should" use it, even if said hospital is otherwise trying to promote exclusive breastfeeding. It sends mixed signals.

There is one more, less controversial, issue as well. If you go home intending to breastfeed but decide to use formula for whatever reason, simply being handed a can of powdered formula with the hospital's blessing isn't enough. You need to know how to properly prepare and use formula, and if you don't do it correctly, it can be unsafe for a young baby. So if a hospital or doctor is going to give formula freebies, they should also give instructions on formula's proper use.

Okay, leaving that third bit aside, I want to talk about the other two problems from my own experience.

I've mentioned a few times now, if you're a long-time reader, that I had gone into the birth of my first son with the intention to exclusively breastfeed him. However, a difficult birth and lack of preparation on my part led to his being formula-fed. They asked us which kind of formula they should give the baby, and we, not having looked into formula at all, shrugged and asked what they suggested. They told us many moms liked the Enfamil Lipil, so we said sure, why not. When we left the hospital, they were "kind" enough to give us as much free formula as they could (a case of ready-to-feed bottles). When we ran out of those, we hesitantly bought a can of powdered stuff from the store and read the instructions carefully on how to prepare it. Naturally, we bought the Enfamil Lipil, because that's what they gave us in the hospital. He wasn't super-happy on it, so we eventually tried Enfamil Gentlease, which he did very well on. It wasn't until the baby was about 4 months old and I saw that Walmart carried a generic version of the Gentlease for about half the price that we got savvy and started using the generic, especially when we saw that the baby didn't care what brand was in his bottle! It didn't ever occur to me to buy Similac or Nestle, because, by golly, they'd given us Enfamil in the hospital, and that's what we were using! In fact, we were even convinced by Enfamil's excellent marketing that our son needed the additional nutrients found in their toddler formula, and continued using formula until our son started refusing it at about 16 months, at which point he was weaned to exclusively solid foods and cow's milk.

My second son was born at a hospital that gave out custom bags with no formula branding or free formula. I did get some free samples in the mail from Similac, and Enfamil and Gerber generously sent coupons regularly. I kept the Similac samples around but never touched them and eventually gave them to a friend who was formula-feeding. I was so gung-ho and had so few problems with my second son's breastfeeding that, even when I was frustrated, the thought of using formula never even crossed my mind. So having it in the house was not a temptation for me, but only because I was so committed (and obsessed? Maybe). If I had been slightly less so, the difficult times might have been just difficult enough to make "just one bottle" seem very attractive.

My third son was born at the same hospital as my second, and, as mentioned in his birth story last month, the breastfeeding support there was stellar. I again received a very nice, custom bag with no formula branding or freebies. I had intentionally signed up with some baby products mailing lists so I'd get free stuff, but the only free stuff I've gotten is formula. (I was hoping for a diaper bag or something!) There was a can of Similac sitting on top of my fridge for a while, until I moved it to the garage. I have to figure out who to give it to. So far, I don't have any formula-feeding friends this time around! (Not that I'm complaining.)

We brought our third son home on a Tuesday afternoon in September, on the first day of an awful, four-day heat wave. It was 92 degrees and humid. (This is quite unusual here in southern California, especially in September!) We don't have A/C, and the house was sweltering. The baby wouldn't stop nursing, probably because he was uncomfortably hot. His latch was not very good, and my nipples hurt so badly every time he latched on. (If that hadn't improved promptly, I would have gone to a lactation consultant for help!) And he latched on a lot! If I put him down, he'd scream. This went on into Wednesday, also 92 degrees and humid. I asked a friend to come over to meet the baby and keep me company, because I was all alone. She was a Godsend. She played with my other two boys, got us lunch - in the midst of my postpartum hormone surges, figuring out how to handle lunch actually had me in tears - held the baby, and was generally awesome. (You know who you are. THANK YOU for saving my sanity that day!) And the baby just kept on screaming whenever he wasn't nursing. We decided he was just so thirsty because it was so hot, and I had nothing but colostrum.

It was in that moment, the 674th time he latched on that day (okay, I may be exaggerating), that I understood the temptation of "just one bottle." I hadn't understood it with my second son, probably because it was December, I had fewer problems with his latch, and I was so worried that something would go wrong that I was afraid even to think about formula. This time, though I knew I wouldn't actually give him a bottle of formula, I understood why someone might. I needed relief. The poor baby wanted something to drink. If he had something other than my colostrum, maybe he would be happier, and my nipples could recover for an hour or two. Just one bottle... just one bottle...

Another friend of mine, who has a four-month-old, came over briefly to drop off some food for me and held the baby for a minute. He started rooting and screaming (of course). She jokingly said that she did have what he was looking for, but she wasn't sure how his mommy would feel about that. Truth be told, I actually almost asked her to nurse him for me!

Thank G-d, my milk came in Wednesday afternoon, and the baby got a good, long, satisfying feed, and he was suddenly the most content and happy baby you could ask for. It was a miracle. I had started to think that he would be a screamy, hungry monster for six months, and there was no way I could handle that, not with two other kids. I was in tears just thinking about it.

But once he had something to drink, he was fine, and he's actually been incredibly easy-going as a newborn nursling, giving me as much as two to three hours between feedings sometimes, which feels like a great luxury. My second son nursed, almost literally, every hour, so two hours feels like an eternity sometimes! It's nice.

But those first two days, with that can of Similac sitting up there on top of the fridge... Yes. I understand. Just one bottle. Just one. Just two hours of relief. Give me time to shower, apply some Lansinoh, close my eyes. Just one bottle. Just one. You know what the problem would have been if I had decided to give him that one bottle? I didn't have any bottles! (Ironic, eh? I had the formula but not the bottles.)

So, about those free formula samples interfering with breastfeeding in the early days? Yes. They can. Because another mom who had two days like I did, whose baby wouldn't stop screaming when he wasn't nursing, whose nipples were on fire, who had two other boys at home, who was all by herself on her newborn's third day of life, another mom who wanted to breastfeed but maybe didn't know quite as much as I do about how bottles can be a problem early in the breastfeeding relationship, that mom might give in and use "just one bottle."

Now, obviously, anyone can run to the store and buy some formula in such a situation, but it's less convenient, and she might be scared off by the price of a can. Or, in my case, she actually might not be able to run to the store, because she's all alone! But a free sample already in the house, given with the implied endorsement of the hospital, is very easy to tear open and use.

I'm not trying to paint formula or formula companies as evil. It's just business. And if a mom decides she does want to use formula, or wants to try to combination feed, or must supplement because of supply problems or weight-gain issues, then those free samples can be really helpful to have around! But if we're talking about supporting exclusive breastfeeding, which I am, then free formula samples really do get in the way.

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.