Parenting: The 24/7 Job

If you get all of your parenting info from TV shows, movies, and commercials, you would think that being a mom is something that happens during the day. Sure, we've all seen moms and dads staggering around in the dark with a screaming baby, but pay attention; the baby is almost always a newborn. The message is that of course a new baby cries at night, but within a few months, you are off the hook between 8pm and 7am. There are so many books and "experts" out there who will say that babies should be left alone all night. I've read tips about what to do if your naughty infant cries so hard in their crib that they throw up. You aren't supposed to clean them up!!! By tomorrow, they will stop trying to manipulate you, and there won't be a repeat mess. If you can't stand the vomit covered bed, you are to clean the sheets and change the baby WITHOUT PICKING THEM UP. God forbid you comfort a baby you have just tortured into vomiting!

I have known moms who are really nice to their babies/children during the day, but totally ignore them at night. What kind of a message does that send? If you are lucky enough to be a mom, you have to accept that your job will not end with the setting of the sun. This doesn't have to be such a big deal, but we have made it that way. Of course it's aggravating to get out of bed ten times a night, trudge over to the crib, pick up a screaming baby, nurse her to sleep, and carefully put her back down without waking her up. That's hard work, so it's no wonder that people have begun to justify leaving the baby to suffer "for their own good." None of that is necessary, or biologically appropriate. Babies are supposed to sleep beside their mother. They can nurse at will, have their temperature regulated by her body, and feel safe.

I have slept beside three different babies now, and except when one was sick, I have never had the classic sleepless night of modern parenthood. My babies didn't wake up crying at night. They began to wiggle and grunt, and got a breast before they were really awake. Their father had beautiful, uninterrupted nights, and mine weren't all that interrupted either. My youngest was sleeping for 4 hour stretches from the moment she came home from the hospital.

I won't go into the details of how to cosleep safely or why people stopped thinking it was normal. Go to http://naturalchild.org/articles/sleeping.html for that. There are tons of great articles, including ones from James McKenna, who is an infant sleep expert. "Our Babies, Ourselves" by Meredith Small also has great information.

I did mention in my previous post that I would list some co-sleeping products on the market that might make things easier for you, so here they are:

• a Snuggle Nest is a plastic rectangle with padding. You put it in your bed between your partner and yourself and place the baby in it. You get to have the baby in bed, without worrying that you will roll over and crush her (not a rational fear unless you've been drinking or taking medication). My problem was that when I got it for my second baby, I had to have an unexpected c-section. I could not prop myself up to nurse him over the side of the nest because of the excruciating pain.
• a bedrail for your bed is a great idea. Make sure to get one that won't leave a gap for the baby to fall through or get trapped in. I didn't have one with my first, which I thought was fine because she always stayed right next to me. When she was 14 months old, though, she became more active at night. She fell out of my bed once, hit her forehead on my bedside table, and bears the tiny scar to this day. That was stupid of me, and I never coslept another night with a baby without a rail.
• a co-sleeper bassinet looks kind of like a playpen with a high bottom. It attaches to the side of your bed and gives the baby her own place to sleep, while keeping her beside you. Since my babies have all slept with their heads at breast-level cuddled up to me, this wouldn't have worked well for us, but I can see it's many useful applications.

I'll end by pointing out that by just having your baby sleep in the same room with you, you lower their chances of dying of SIDS by 50%!!!! Also, the big study that came out a few years ago saying that babies are in danger when they sleep with their parents not only included shady numbers (www.askdrsears.com), but was conducted and put out by the people who make cribs. Talk about a conflict of interest!

Breastfeeding Tips or I've Been Nursing for 73 Months, So Listen to Me

I hadn't added up how long I've nursed until I needed to know for the title! That 73 months wasn't consecutive or with the same baby, so don't freak out. I nursed my first daughter for 22 months, my son for 34, and I'm still nursing my 17 month old daughter. None of them have ever had a bottle or formula (except for Kathleen who had a total of three formula filled bottles while in the NICU). I believe that gives me the credentials to dole out breastfeeding advice, don't you?

I'm about to reveal my true nerdy nature, but remember how Yoda told Luke that "There is no try."? I don't think that pertains to everything, but it certainly does in the realm of breastfeeding. A mammal's body is designed for nursing its offspring. Unless you have something seriously wrong (like no breasts), you can breastfeed your baby. Saying that you'll try is like saying you'll try being pregnant or try breathing. It's natural.

That doesn't mean that you won't need to practice or that you are a failure if you need help. Chimpanzees and gorillas in zoos who were not raised by their mothers or in the company of other mothers do not know how to nurse their own babies. I've seen footage of a new gorilla mommy putting the back of her baby's head to her nipple! The zookeepers had to take the baby away and bottle feed it. When she was pregnant for the second time, the zookeepers decided that the only way the mother would know how to nurse her new baby was if she observed other mothers breastfeeding. One of the keeper's wife was nursing their infant. The human mother would sit on a chair in front of the gorilla's indoor area and breastfeed without her shirt on so that the ape mom could see what she was doing. I'm not sure how many sessions it took, but the gorilla successfully nursed her second baby.

In an awesome book written by an anthropologist (Our Babies, Ourselves by Meredith Small), she talks about "Insufficient Milk Syndrome." It turns out that even though doctors in our society use that term all the time, it is not actually real. Women across the world who live in countries where formula is not readily available never report this problem. We in the West have created a "syndrome" to ease mothers' guilt over not breastfeeding. Does that mean that women never produce too little milk? No, but the reasons western women sometimes have low milk production is created by the way they are told to care for their new babies.

Modern western mothers are told that these things are choices, that you can breastfeed on a schedule or "on demand" a term that makes you sound like you're spoiling your baby from day one. Nature, on the other hand, does not give us a choice. Breastfeeding is a supply and demand system. Due to the nutritional makeup of breastmilk, babies need to nurse often, especially in the beginning. They aren't getting too little if they want to eat every 1-2 hours! If your doctor has told you that they should be eating every 3-4, then you will assume that your milk isn't good enough. If it was, why would your baby want to eat more often than the doctor (or baby book author) said that they should? What is the brilliant medical solution to this problem? Instead of admitting that the baby needs to nurse more often than is popularly dictated, the doctor will tell the new mom to supplement with formula. Genius! Formula is not the same thing as breastmilk. It takes longer to digest (because it is unnatural for a baby's body to digest anything other than breastmilk in the beginning). The baby won't be hungry as often. What a relief! Of course, the baby will also not nurse as often because it is full of lab created formula, so your breasts will be called upon less often. Remember in a supply and demand system, if you don't demand, then there will be no supply. As their milk supply diminishes, the mothers begin giving more and more formula. They feel that their suspicions about their insufficient milk were correct and eventually stop nursing altogether. If they had ignored the incorrect information about how often newborns need to nurse, they would have never lost their supply. The baby would grow and slowly begin to space out its feedings. Try telling that to a mom whose doctor has "diagnosed" her with this syndrome, though. Denial is a powerful thing...This is only one example of how lack of knowledge can lead to breastfeeding failure.

There are many products out there that claim to be crucial to breastfeeding. All you actually need are breasts and the confidence to do what's natural and normal for your baby (and yourself). I think that the more products that are marketed to breastfeeding mothers,though, the better off we'll be! One of the reasons formula feeding is so popular is because it is a BIG business. They make billions of dollars off of misinformation and ignorance. If companies realized that they could make money off of breastfeeding, then it would become more popular. It would be featured in tv shows, movies, commercials, etc. There are plenty of these products that are actually useful when you are nursing a baby, and here are some of my favorites:

• A breastfeeding pillow (I've always used a Boppy, but that's because I was given one as a gift). A newborn is tiny, so being able to sit back on the couch and nurse without having to hunch over the baby is a backsaver. If you're comfortable, you will be able to relax.
• A nursing bra (I like the ones at Target and Wal-mart over the one I tried from Motherhood Maternity). These are especially useful for nursing in public because you can access your breast with one hand, which is both discreet and fast if you have a howling infant in your lap.
• Nursing pads (if you can keep up with the laundry, buy the cotton, washable kind at your local discount store). Milk is sugary, so you probably don't want it leaking all over your clothes. Plus, walking around the mall with two large wet patches on your chest won't put you in a great mood!
• Nursing tops (Motherhood Maternity has great inexpensive stuff both online and in their stores) I've always been pretty modest, so feeling covered up while nursing in public was important to me. I often wear a tank top with a button down shirt (open), but sometimes, I want to wear only one shirt at a time. I've purchased plenty of shirts that no one would even know were for nursing that worked perfectly.

I'll go into the connection between co-sleeping and successful breastfeeding next time. There are lots of shiny new products to promote that too!

Another Way To Sabotoge Breastfeeding

This past week, I've been frantically searching for information on whether or not a prescription facial gel is safe to use while I'm breastfeeding or not. I went to a dermatologist because I've had a red rash on my face since I was pg with Grace, and it hasn't gone away. She couldn't prescribe the antibiotic she wanted because I'm nursing, but she gave me something else. She looked it up on her Palm Pilot for me, and said it was safe.

After I got home, I read through the pamphlet that came from the drug manufacturer. It said that if a nursing mother wants to use it, then they have to stop breastfeeding! Even though I knew they were probably just trying to prevent any possible lawsuits, I went on a search for more info. I decided to call my kids' pediatrician for advice. I left her a message with whomever answered the phone at her office. I gave the woman the name of the drug and the fact that it was a cream not an oral medication. No one called me back that day (Friday), so I called them again on Monday. Meanwhile, I looked at the kellymom website. She has a drug page on it (http://www.kellymom.com/health/meds/index.html). It references the AAP and Dr. Hale. He's the man to go to with medication while breastfeeding questions. He writes an updated book every year on that very topic. Apparently the gel I have is classified as L3 (moderately safe). Dr. Hale said that so little of it gets in the breastmilk that you can't really even detect it.

The pediatrician's office finally called me back, but it wasn't the doctor on the phone. The office manager said, "Dr. Smith says that everything you eat, drink, and all medications you take go into your breastmilk." Duh! After a long pause, I said, "Okay, but this gel is classified L3. Can I use it?" She responded, "Dr. Smith says that if you need to use this medicine, you should not nurse until you're finished." I said again that it was topical and that I guess I wouldn't be using it. I was so angry because obviously Dr. Smith didn't even bother to look up the medicine! She didn't pay attention to the fact that it is topical! She didn't consider my baby's age (17 months) or her weight (24lbs)! She also didn't look at the breastfeeding as something important to preserve! The AAP clearly states that a doctor has to weigh a mother's needs for medication against the fact that stopping breastfeeding takes away something beneficial to the baby.

At this point, I was stuck. Even though I knew my child's doctor had done no research into my specific drug, the seeds of doubt that had been planted by the drug companies pamphlet began to sprout. I decided that I had one more option, so I logged onto the La Leche League's website (http://www.lli.org/). They have a help form that allows you to email your problem to a volunteer. Within two days, I had a response from a wonderful woman in California. She gave me lots of info and that based on the research and my child's age and weight, the gel was fine to use.

You might say that I should have just gone along with the dermatologist when she said the gel was okay to use while nursing. I was gun shy, though because of what happened the last time I saw someone about my skin. I had a bout of bad acne after the birth of my first daughter. She was eight weeks old when I saw a dermatologist for it. He prescribed $90 worth of creams, and when I mentioned breastfeeding, assured me that they were all perfectly safe. Within a week of using them, Kathleen developed a weird rash of circles of peeling skin all over her body! When I checked to drug info that had come from the pharmacy with my creams, I discovered that was a side effect of the medicine! It could happen to the user who put on topically, and my poor baby was actually ingesting the stuff! I threw it all away, and my skin eventually cleared up (post-pregnancy hormones anyone?).

My experience is a classic example of the medical establishment's ignorance of breastfeeding; its importance and how to help sustain it. How many new moms would go to the lengths I just did to research a medication? I didn't when I had my first baby. If everyone around you makes it seem like switching to formula is no big deal, and then a doctor tells you that you can't take a medicine that you might need while you're nursing, what are you probably going to do? It turns out that many medications are safe while breastfeeding, but you wouldn't know that if you asked someone like my pediatrician...

Why Do You Think Babies Like Pacifiers?

I read posts on parenting bulletin boards on various websites, especially ones dealing with breastfeeding. It's nice to read about other moms having similar experiences to mine, and every once in a while, I offer advice to someone with questions. The most popular question/complaint recently has been the issue of the infant "using me like a pacifier." Many of these moms aren't really upset with their infant nursing so often, but they are being pressured by people in their lives to only allow access to their breasts when the baby is definitely hungry. It's just another example of people's ignorance of the actual processes involved in nursing a baby and the expectations the baby has of it's mother. We have evolved to this point over millions of years; I hardly think that a misinformed grandmother is going to convince an infant that it needs to adapt to the modern world in the space of a few months.

Kathy Dettwyler is a well respected anthropologist who has studied parenting and breastfeeding in many cultures around the world. She has written many books and maintains a great website with lots of information about natural human breastfeeding (http://www.kathydettwyler.org/dettwyler.html) Here's a little of what she has to say about the frequency of nursing in humans:

"Continuous contact species have milk that is low in protein and fat and high in carbohydrates. The offspring tend to nurse very often, but not take much at any one nursing. The low protein and fat content of the milk make it quick and easy to digest, and the baby is quickly hungry again, but mom is right there, so it just nurses again."

"From the composition of human milk, it is clear that human babies are designed to nurse several times an hour, around the clock."

Putting an infant on a 3-4 hour nursing schedule is counter to our biology. It can lead to underweight babies, low milk supply, and a quick return of the mother's fertility. Perhaps many of the times a new mom thinks she's being "used as a pacifier" she is in fact nursing her baby exactly as often as the baby expects/needs to be nursed.

Babies observed in natural societies do not suck their thumbs (read about it on Dettwyler's website). They have unrestricted access to their mother's breasts, so they don't need to satisfy their sucking instinct on anything else. In our increasingly unnatural society, moms don't spend their time in constant contact with their babies. They have other things to do that don't involve caring for their children. Some babies don't fill in and suck their own thumbs, thus freeing their mothers up. Over the years, people have come up with lots of ways to get the baby interested in sucking on something else. I looked up pacifiers on wikipedia(http://en.wikipedia.org/wiki/Pacifier) and found that they have been met with resistance from the beginning, but not from the perspective of natural breastfeeding:

"in 1909 someone calling herself "Auntie Pacifier" wrote to the New York Times to warn of the "menace to health" (she meant dental health) of "the persistent, and, among poorer classes, the universal sucking of a rubber nipple sold as a 'pacifier'."[4] In England too, dummies were seen as something the "poorer classes" would use, and associated with poor hygiene. In 1914 a London doctor complained about "the dummy teat"

In response to a new mother who is worried that she is being used to replace a rubber or silicone nipple attached to a plastic shield, I would point out the obvious. That plastic pacifier is actually being used to replace YOU. Your baby wants to suck that often because she is supposed to. You are not spoiling her by letting her nurse as often as she needs; you are meeting her needs. She will not need to nurse that often forever. Weaning is actually a process that occurs over years, and will begin when she starts taking some of her nutrition from solid food. Nursing isn't all about food, though. It gives the baby antibodies and comfort (did you know it lowers the baby's blood pressure and heart rate?). Will your baby be doomed if you use a pacifier? No, but there are always trade offs when you tamper with nature. They're not all bad, but I find that many modern mommies won't even acknowledge that they exist.

In the spirit of full disclosure: I gave my two youngest pacifiers in the car. I weighed the unnaturalness of riding in a car seat without the warmth of their mother against the comfort a silicone nipple could give. Both refused them after about five months. If I wasn't driving, I sat in back and figured out how to nurse in the carseat without having to unbuckle myself either ;)

I'll Give You Challenges

Breastfeeding has become such a hot button issue in our culture that I have begun to hate all references to breastfeeding challenges. They crop up in every single edition of every single mainstream parenting magazine on the shelves. They are included in email newsletters from parenting websites and brought up on internet bulletin boards and parenting email lists. To say you had a breastfeeding challenge is the American mother’s “Get Out of Jail Free” card. No one would dare judge you for not breastfeeding if you’ve had a challenge. You tried, right? Fill that baby up on formula and don’t give breastfeeding another thought.

There are women who have faced challenges that could not be overcome. I read about one such a mother in a recent edition Mothering Magazine . The mom had triplets, all with cleft lips and one with a cleft palate. She managed to nurse the two with intact palates (against all advice and odds). After six months of nursing two babies and pumping for the third, her supply began to diminish. That mother should feel absolutely no guilt for eventually switching to formula; her’s is the exact type of situation formula was originally designed for.

If more articles and stories were written about women who faced obstacles to breastfeeding and overcame them, they could benefit women all over the country. Instead, we have a population trained (or brainwashed if you prefer) to cut and run at the first sign of difficulty. It is often too late to correct misinformation once a woman has already had a baby because she will see it as criticism. The rare mom will actually learn from her mistakes and not repeat them with her next child, but that’s not the norm. Since becoming a mother myself, I have heard so many different “breastfeeding didn’t work for me” stories that I could write a book. I feel armed to counter their claims (depending on how well I know the people involved) because I too faced some unusual breastfeeding speed bumps.

Kathleen was born after a twenty-four hour labor and two more of pushing. I breastfed her for the first time before she was taken to be checked in the nursery. That night was one I will never forget. I snuggled next to my little angel the whole time, and she nursed repeatedly. I barely slept because I was so excited to finally be a mother. In the morning, a nurse came to take her back to the nursery to be seen by her pediatrician. About an hour later, the doctor came in to tell us that Kathleen’s white count was too high. She had been sent to the NICU for antibiotics and the nurse’s there would call me when we could come and see her.

Until that moment I first visited my daughter in the NICU, I had no idea that IV’s could be placed in someone’s head. Kathleen had one lodged in her scalp; they had even had to shave off some of her hair. Before her stint in intensive care was over, the IV would infiltrate three different times. Kathleen left the hospital with only the hair on the back of her head, but that was the least of our concerns.

The doctor’s orders were for me to be allowed in to nurse the baby in the NICU whenever necessary. They gave me a rocking chair and a pillow in a small storage room off of the main unit. Imagine learning to breastfeed on a hard chair in a tiny room, with the pressure of knowing that if you weren’t finished in a certain amount of time, they would come and get the baby. I did that twice before my mom, a neonatal nurse-practitioner at the hospital, stepped in. Since Kathleen only had to be hooked up to the IV pump five times a day to get her doses of antibiotics, she got the doctor to agree to leave the baby with me the other parts of the day. That made things easier for the next day and a half.

Kathleen’s white count still wasn’t normal that Sunday, but my insurance was kicking me out. The hospital told me that I could stay until midnight. I had already discussed breastfeeding with the NICU nurses. My plan was to come back every two to three hours round the clock. Andy and my mother convinced me to skip one feeding in the middle of the night so that I could sleep, since we would have to drive to and from the hospital every time. If I had it to do again, I would probably have spent the night on the couch in the waiting room. The nurses offered to give Kathleen “gavage feeding” for that one time a night, which meant sticking a tube down her throat and into her stomach to deliver formula. I was pumping like a fiend in the hospital, but had gotten nothing yet. The idea was to avoid nipple confusion, but I asked them to give her the formula in a bottle. After all of the needles and suffering she was already dealing with, I didn’t want to add to it with another medical procedure.

At ten o’clock that Sunday night, Andy loaded my things into the car while I held and nursed our daughter. At five minutes until midnight, we buzzed Kathleen’s nurse to come and get her. That was the most horrible feeling I had ever experienced. Andy and I walked out of the room after the nurse, who was pushing our baby in her isolette. She turned right towards the NICU, and we turned left towards our car. Unlike every TV show and movie I had ever seen, no one came to wheel me out. There was no fanfare or Hallmark moment. It was like my part was over, and I had no more value. I still cannot believe that we had to drive home without our daughter, but we did. I pumped and cried myself to sleep so that I could be up at six to go back and nurse her.
The next few days were a blur. Andy drove me to and from the hospital all of the next day. The nurses were nice; they could call me if Kathleen was crying before her scheduled feeding so that we could rush over there. A few times, one of them was even holding her while they did paperwork so that she wouldn’t cry.

It wasn’t all bearable, though. On the first day of our separation, a nurse came into the little room with a bottle of formula in her hand. She told me that the doctor wanted me to give it to Kathleen before I nursed her. When I asked why, she said that the baby was jaundiced and the formula would help. Luckily for me, my mom was in the next room working. I ran out nearly crying and told her what was happening. She agreed that my milk wouldn’t come in well if the baby was already full of formula at every feeding. She told me to only offer the bottle after nursing, which I did. Kathleen didn’t even want a sip. They also introduced the pacifier to my baby while she was there, but I didn’t complain as they were using to soothe her when I wasn’t there to comfort her. By the next evening, I was thouroughly depressed. I was lying on my parents’ couch, waiting until it was time to go back to my baby. She was days old, and I had never changed her diaper or bathed her; she had nurses to do that for her. I think that in that moment, my strong commitment to breastfeeding was forged. I realized that if I didn’t nurse my child and provide her with a form of nourishment that only I could give, then I wasn’t really crucial to her survival. Other people could change her, hold her, rock her, and give her a bottle. I was dispensable. Since then, I have learned even more about the importance of breastfeeding for my children’s health (both mental and physical) and my own health, but at that instant, all I thought was that this was something no one else could do for her.

My baby didn’t come home until Tuesday night. I never gave her another bottle. She was not interested in the pacifier anymore once she was with me. Despite my challenges, I managed to exclusively breastfeed (not counting the three bottles of formula she drank in the hospital) my first baby until she was twenty-two months old, and I was pregnant with her little brother.

To our immense relief, Alexander was totally healthy at birth. After only a four hour labor, I began pushing. That went on for two and a half hours, and his head never engaged in my pelvis. He was “sunny-side up” as the doctor called it, and he ended up being born via a c-section. I nursed him for the first time about an hour after his birth, and we never experienced any problems. My breastfeeding challenges with my son didn’t begin until his third month.
I had been diagnosed with gallstones during my pregnancy. I suffered from about nine “attacks” while I was pregnant, but managed to avoid surgery. When Alexander was three months old, I finally went to a surgeon because the problem was persisting. She told me that I would have to have laparoscopic surgery to remove my gallbladder. I immediately began researching anesthesia and breastfeeding. I used an online help form to talk to a Le Leche League expert. She sent me several articles to read. I also called the lactation consultant at the hospital to ask her advice. She was very reassuring that I would be able to nurse as soon as I wanted after the surgery.

I breastfed Alexander minutes before being wheeled away to the OR. The anesthesiologist came in to speak with me at that moment and said that he’d make sure to use meds that were safe for the baby. My operation only lasted about twenty-five minutes, and I woke up easily. Alexander didn’t even miss a feeding.

When he was nine months old, I found out that I would need outpatient surgery again. This time it was to drain an ovarian cyst that had developed during my pregnancy. I was nervous about the prospect of another operation, but I was confident that breastfeeding wouldn’t present any challenges. I woke up in the recovery room to a nurse who informed me that the doctor had had to make a large incision, and that I would have to stay overnight. I immediately thought of my baby and how I was going to nurse him. After finding out that I'd had to have my entire ovary removed, I had to deal with an idiot of a nurse who yelled at me for breastfeeding a nine month old! The nurse seemed to sense that she was facing a resentful audience because she muttered something about the baby being able to spend the night and left. He did spend that night with me in my hospital bed. Andy slept on a cot beside us and Kathleen spent the night with her grandparents.

I am happy to say that (so far) everything has gone smoothly with nursing my third baby, who is now seventeen months old. She latched on an hour after another c-section, and has been going strong ever since. I use my stories of the breastfeeding challenges I have faced not to gloat over my success, but to encourage other mothers to overcome whatever may be trying to prevent them from successfully breastfeeding their own babies. I believe that we have to stop politely nodding when a new mom says she can’t nurse because she had a c-section or a sick baby or sore nipples. I’ve had all three, and my children have all managed to breastfeed well into toddler hood.