Breastfeeding is easy!

What!, you ask?  The momma who so struggled to breastfeed that she wrote a tome on the subject and called it "Babyfood" now says breastfeeding is EASY?

Feeding Elliott is easy, now.  He is 7 months old and a total pro.  He loves nursing, is super efficient, and is even learning that turning his head while attached is a no-no.  Once we got past 2 months, and then 3 months, it just became easy.  No bottles, no ice packs, no pump.  Just put the baby in the car and leave the house.

Elliott, 6 months

It makes me feel even more astonished that I exclusively pumped for Sam for 20 months.  20 months!  More than 1 1/2 years of pumping, day in and day out, in the middle of the night while Sam's dad fed him with a bottle, in the middle of the night awake alone, in the middle of the afternoon when everyone was outside playing, at work at my desk, in my car, in bathroom stalls, in hotel rooms, on airplanes, pumping, pumping, pumping.  And never, ever nursing my sweet baby boy.

It makes me feel astonished, and sad, and disappointed in myself I didn't try again, try harder after the initial failures to nurse at 2 weeks, at 3 months.  Disappointed I didn't call every LC in my state to find a way to fix the latch.  Disappointed that I was resigned to being an "EPer."

I know why I was resigned.  Pumping, like driving a moving train, was much easier to keep going with than to stop and reverse directions. And I felt proud that I did the next best thing health-wise.

So now, I will try to leave it behind and enjoy nursing my other sweet baby boy and be thankful I have a chance this time.

Baby-led feeding

A day came in the first few weeks of breastfeeding when things clicked for us.  This happened after we discovered that he was fighting against our efforts to manually manipulate his mouth into the right place (see last post).  It occurred to me to look back at what I learned about nursing in the first hour after birth--about the "breast crawl" and ways that baby learns to latch on.

I rested his cheek against my breast like on a pillow, and he would do this kind of sweeping motion of raising and turning his head and opening his mouth very wide.  At that moment I could bring him in and latch him on.  With a little practice we got the timing and aim down, kind of like hitting a baseball, and this method worked almost every time.  I used this method for many weeks until we didn't need to focus so much on the perfect latch (next post: breastfeeding is easy!).

Unintended consequences

One of the key components of a good latch is a big, wide open baby mouth that takes in as much mama as possible.  Pain can occur when baby slips down on the breast and treats the nipple like a straw.

One way to combat this tendency for newborns to "slip" is to have a partner help manipulate baby's lower jaw into better position after he has latched on.  We used this technique at almost every feeding to reduce pain and improve latch for the first week or two of nursing, and it worked well at first.

But at some point, Daddy had more and more trouble pushing down on Elliott's jaw, and in fact, it seemed like Elliott was actually fighting him, causing the problem to be worse--MORE clamping down--rather than less.  I found an article on kellymom that seemed to suggest that jaw manipulation may have not only diminishing returns, but the unintended consequence of actually making the pain worse after awhile. 

Why?  Consider would happen if you approached your partner, or parent, or friend and tried to physically open his or her mouth.  Or even if you tried to push him or her gently backward?  No matter how trusting the relationship, he or she would probably automatically exert energy in the opposite direction of your pushing.  Indeed, Elliott and his dad were experiencing their first power struggle, and in between was the tender skin of my nipple.

Is there a lesson in this idea that could help with my original idea?  Yes.  Try to push his mouth closed, not open, during latching on, and benefit from the reverse effect.

Even better, could we somehow tap into Elliott's natural instincts to get that wide open mouth we needed?  Yes.  Next post.

Problem, duct-tape solution, unintended consequence, aha moment, learn, succeed, repeat.

Magical Fixes

Breastfeeding was difficult for me at first, each feeding a challenge, sometimes painful, sometimes a lengthy and drawn-out ordeal.  We made progress in fits and spurts, tackling problems along the way, often with duct-tape solutions or trying things that had failed before.  After we had wired up a complicated hack for a problem, and then gotten used to it, it was hard to imagine any other way to do it, like when you're sick and can't remember what it's like to feel well.  Then, the problem would suddenly, randomly disappear.  (Or some unintended  consequence would appear that then needed its own solution.  Next post.)

An example of a "magically disappearing breastfeeding problem" was our stop-gap solution to nipple damage from sub-optimal latch: the widely dreaded or widely admired "nipple shield."  This is a very thin silicone cover that separates you from the baby and encourages the wide-open mouth necessary for a good latch.  Many people warn against their use because there is some evidence that it can reduce milk supply, but they are lifesavers for people facing serious breastfeeding hurdles like me.

After about 3 days of nursing a newborn, I had a lot of soreness, so we tried the nipple shield, which seemed to help with the pain and create a better latch.  The shield had to be washed and dried between uses, made pliable by a hot-water bath before use, positioned and applied carefully and correctly, and not knocked away or manually removed by a clawing baby or one of the many hands attempting to wrangle him onto my breast.  But it worked, and my nipples got less sore, so we went through this crazy dance at each feeding, make OK by the fact that it was better than pumping and syringe feeding, the next best option.

Eventually it became a kind of mental crutch--I could not envision being brave enough to nurse skin to skin.  The "crutch" then attained a mental permanency and I resigned myself to the ritual.  And then, trying to start a feeding one day, with the baby clawing at my breast and writhing wildly in my arms, the shield was propelled to the floor.  Out of what could almost be described as anger, or at the very least,  extreme frustration, I ditched our crutch and stuck him on my breast with fortitude and he nursed, painlessly, just like we were old pros.

Why?  Did the shield "train" him how to latch?  Does the newborn need a week's training before muscle memory kicks in?  Did he just get bigger?  I will never know.

We go from struggling, struggling, making our way slowly up the stairwell, until someone points out there's an elevator and we're suddenly whisked upward by a dozen flights all at once.

Docking the space shuttle

The key to early breastfeeding success is the latch.  What is "the latch?"  It is the way the baby connects with your breast to feed, and it is way more than just putting his mouth on your nipple.

In  our case, it felt a lot like docking the shuttle at the international space station, except you only have control over the station.  The shuttle has a brain of its own, and it is a person named Elliott. 

Components of my good latch:

• intense, driving motivation to breastfeed
• four adult hands
• three human brains
• plan of action written out prior to birth by lactation consultant (LC)
• great support team and medical providers at birth
• no medications during labor
• smooth, problem-free delivery
• healthy, hungry baby with a big open mouth
• hospital that supports skin to skin, feeding within first 20 minutes, and rooming in
• LC available the first night
• another written prescription for action by LC before leaving hospital
• baby's dad who would  not let me settle for an imperfect latch

Elliott, Day 1

That the nurses and LC could see on my chart the breastfeeding prescription--which included strategies to avoid soreness--meant that everyone around me was prepared to help.  The first day and a half I let the baby nurse and nurse and tried a few times to latch him myself.  It felt OK.  His mouth was huge.  Edema wasn't a problem since I had received no IV fluids and no medications. The nurses said, "That latch looks perfect.  Textbook."

It wasn't until I got to meet with the LC who prescribed my breastfeeding strategy, Suzanne, on Day 2 just before we were discharged that I realized I was on a course to repeat my mistakes.  She said,  "On a scale of 1-10, what is your pain level?"

I said, "Maybe two or three."

She said, "It needs to be zero.  Take him off and try again."

When breastfeeding hurts, the latch is not good enough, and breakdown of nipples begins, leading to more pain and more breakdown.  This is the cycle I got trapped in with Sam.  Suzanne was taking no prisoners this time.  She wrote another plan for us before sending us home.  We took pictures and videos of the right way to do it.  At home, Max emulated her helping hands and rigorous standards.  He insisted on zero-pain latch.

Our life was a jumble of nipple shields, pillows, tylenol, breast pump parts, ice packs, cabbage leaves, waterproof pads, and used tissues.  But we made it.  We nursed.

My breastfeeding support survival guide

I've already chosen a hospital and a doula who have great track records for breastfeeding success.  But I need to have a reference guide in case things don't go smoothly: my breastfeeding support survival guide.  I have some research to do to fill in the blanks, but this will be filled in and in my overnight bag when we leave for the hospital.  Am I missing anything?

In-hospital lactation consultations:

• List of all hospital LC's and their availability (Cost: covered by insurance)
• Who can help if they aren't available (are nurses trained to assist?)
• Outline of routine postpartum care I can expect at my hospital ("magical hour" skin-to-skin contact, minimal intervention, etc.)
• Training and qualifications of other staff to help, such as nurses

After-hospital lactation consultations:

• List of 1-3 providers and phone numbers who travel for in-home visits (cost: covered by insurance if affiliated with a hospital--be sure to get prior insurance approval)
• List of local hospitals and phone numbers that offer lactation appointments (cost: covered)
• List of 1-3 Skype services (cost: $45-$75/session, not covered by insurance)

 Pediatrician:

• Postpartum pediatrician's office, phone number and hours of operation, and services (traveling nurses? Same-day appointments?)
• Local pediatrician's office, phone number and hours of operation

References:

• List of feeding cues and signs of a well-fed baby
• List of favorite information sites (kellymom.com)
• List of recommended YouTube videos on latching
• List of books and DVD's on hand  
• Printouts of medical protocols for most common breastfeeding problems (http://www.bfmed.org/Resources/Protocols.aspx)

Support groups:

• List of 1-3 local breastfeeding support groups, their phone numbers, and schedules
• List of online forums

Other lifelines:

• Doula phone number
• List of friends and family who are breastfeeding supporters

Battle Babyfood: Round 2

The bell is about to ring on Round 2 of Battle Babyfood: I am expecting baby #2 in just over 2 months.  I've spent the last 3 years training and conditioning, and I am now a mommy of steel: nothing is going to stand in my way this time.

OK, so that is me psyching myself up.  But it is true that the knowledge I gained from trying to breastfeed a baby, having major problems and not having nearly enough help, finally finding a stopgap solution on my own (exclusively pumping for 20 months), and then asking a lot of questions and doing a lot of research and writing afterward, has me much better positioned to beat the barriers this time around.

My thinking in July 2008 was: If I can get through labor and delivery, I can get through anything, and breastfeeding will come naturally.

My thinking now is: I will be supported in labor and delivery by a slew of dedicated helpers at my hospital.  I will be supported in breastfeeding--which could be even more difficult and painful than labor and delivery--by no one except the team I build for myself.  And by support  I mean people professionally trained, experienced, and ready to provide medical guidance and intervention if needed, as well as emotional supporters.

So I'm getting started building my network of pros to make this happen, including a breastfeeding-friendly midwifery/OB practice, a breastfeeding-friendly hospital (that has incidentally made strides in its lactation support practices since Sam was born there almost 3 years ago), a great childbirth educator and doula, at least one great lactation consultant willing to do home visits and/or work with me via Skype, and a breastfeeding-friendly pediatrician.

Let the battle begin!

The other side

All last week as my body was gently reminding me that it COULD still breastfeed, if I wanted to.  I resisted mightily, and now am officially on the other side!  I feel sad and excited at the same time.  Sam is such a big boy lately, eating and talking.  Just last week, he began to say "I like it" and "No like it," taking a new level of control over his own diet.


So what will  become of babyfood, the blog?  Looking back, there seems to have been a trajectory of shock, desperate search for answers, tons of research read, realization of the higher level of barriers (not just physical) I was caught in, and then finally, a sense of calm.   Last week, I went back and tagged my posts by baby's age so those mothering infants can find posts relevant to them.  I will continue to post about toddler feeding, especially as we enter the potentially picky-eating phase, and also reflect on my year and a half of baby feeding. 

I'm also thinking of two close friends who embarked on their own babyfeeding journey nearly the same day that I ended mine, sending them good luck and best wishes.

On to the next phase!  Thank you for sticking with me.

Letting go

I have just expressed the last breast milk for Samuel.  I feel the mix of pride and heartache that I now know is exclusive to mothers letting go of their children.  I felt it when he was born and his umbilical cord was cut, and I'm feeling it now for the second time, since once again he is no longer dependent on my body for survival.  I am sure I will feel it again and again throughout his life as he makes leaps toward independence, each one seeming to arrive too quickly and each one bigger than the last.  We're only just getting started.

Time to Retire

Samuel will be 20 months this Sunday, May 15.  It’s time to retire from pumping milk.

When he was two weeks old, I gave up nursing despite never having wanted anything more in my life, thinking formula would be it for us.  Then, I had some luck: the pump worked.  The first few months were difficult, seven or more sessions a day, literally hours stuck in a chair hooked up to a machine.  But it worked, and Sam got breast milk.

Then I got lucky again, in that I was able to donate extra milk to one adopted baby and again to a milk bank for premature and sick babies.

Even better, pumping got easier and I cut back to four, then three times a day, two.

Then, just last month, Sam stared eating some serious solid food.  I kept it to one pump for the past few weeks, getting a tiny bit of milk.  Sam kept eating, and he sprouted his eye teeth.  And last night, he ate a huge plate of food--fish, vegetables, cous cous--just ate like a champ.  This is the message I’ve been waiting for. 

 So, on May 15, I’ll call it quits.  My baby is a little boy now, healthy and smart, and I can only take a deep breath and appreciate how lucky I am. 

One ounce of milk; Happy Mothers' Day

A few weeks ago, I reduced to one milk pumping session a day and saw a big decrease in supply--down to less than two ounces total.  I was a little sad, since I'd hoped to continue at once a day for a little while, but it just didn't seem worth it for so little.  But then, of course, I found myself reading about the benefits of even a tiny bit of breast milk per day.

From Kellymom.com:  "Even 50 ml of breastmilk per day (or less - there is little research on this) will help to keep your baby healthier than if he received none at all."  So, an ounce a day it is, for a little while longer! 

A second topic: today is Mothers' day.  My guys made today very special for me, and I've been thinking about how each of the people who are "moms" in my life have given me something very special--and how lucky I am to have THREE of these.

Waiting for signs

I received this text from Max, exclusive provider of most of our toddler's meals:
1. carefully select most expensive organic foods  2. cut into tiny pieces  3. pick up tiny pieces off floor  4. throw away
Baby-led feeding naturally leaves me looking for signs of change in Sam's eating habits.  But, much like signs of spring this year, they're just not showing up.  Sam tries lots of foods but still throws most of it on the floor  and drinks milk by the gallon. 

Signs of increasing appreciation for solid food would encourage me that it's OK to reduce pumping milk.  Absent these, I reduce pumping milk anyway because I'm tired of doing it.  The result is that instead of feeling like we're moving forward, I feel like I'm giving up on the effort.  Reducing to two pumps a day has decreased my supply to less than 8 oz. a day.  We make up the majority with cow milk.

The WHO's "minimum two years of breastfeeding" talks into one ear, while the voices of my many sensible friends and family who think it would be perfectly fine to wean talk into the other.  I'm pretty confused right now.

Baby-unfriendly hospitals, baby-unfriendly country

We know that only 3% of hospitals meet the requirements set forth by Unicef's Baby-Friendly initiative.  Actually, this might be reflective of the portion of our country that's baby-friendly.  I just got back from taking an air trip with my 17-month old and have had my eyes opened to this ugly reality.

• Why isn't breastfeeding in public accepted in most of the US?  Grownups are perfectly welcome to eat their species-appropriate food in public, but not babies.
• Why aren't there family areas in airports and train stations?   The facilities in the airports I visited for things like pumping and baby/toddler play were nonexistent.
• Why aren't there spaces for nursing moms in hotels?  I spent two days at a conference at one of the most famous and elegant hotels in the country, and couldn't find a suitable place to pump.  I ended up sitting on the floor of the handicap stall in a ladies' room.

The attitudes of people we met on our trip reflected this, too.  People looked at him and smiled or called him cute, but when it came to being helpful or even understanding to a mom traveling alone with a small child, they declined.  Sam ran off some energy around the gate area where we waited for several hours due to a delay; reactions ranged from blank-faced stares to outright scornful looks.  He cried and his nose ran, and people cringed.  When we look extra time getting through security, people behind shoved their plastic buckets onto the belt before I had time to get my kid out of his carrier and get his shoes and jacket off him.  One flight attendant took a look at me with a baby on my back, diaper bag over my shoulder, and toddler car seat in my hands as we were boarding the plane and went right on shoving Cokes into the plane's drink cart.

And I won't even get started on the recent debate about the no-brainer of making breast pumps tax-deductible devolved into a shocking political debate about whether nursing moms should work at all.

It's almost as if we Americans love the idea of adorable babies--we are quite comfortable using them to sell products, but back away from a real commitment to doing the best we can for them, from nutrition to childcare, maternal support, and education.  We can and have to do better on all.

Scenes from a Baby-Unfriendly Hospital

Before my baby was born, I thought that women who didn't breastfeed chose not to.  In fact, most women who don't breastfeed wanted to, but were unable for reasons already mentioned.  In my view, getting things right in the birthplace is the key to fixing this problem, with far-reaching benefits including better health for moms and babies.  Here is one excerpt from a forum post by a new mom:

"How long will I be in mourning over the loss of breastfeeding? I feel so cheated and disappointed in myself. I should have NEVER let the lactation consultant give her a bottle. I should have taken her home and looked up other methods of supplementing her. I should have taken responsibility, taken charge, NOT trusted them. This is why I had a midwife! I never trusted medical people, and this is why. They didn't even let me see her for 2 hours after she was born, and I was so exhausted and out of it I couldn't even bring myself to argue. It was all I could do to yell at my husband to make sure she knew he was there... I know I just have to get over it and "let it go," and be happy that I have a now-healthy baby, but sometimes it is overwhelming and I can't help but sob. Every time I see something about how much better breastfeeding is for your baby I re-live that guilt, anger, frustration, disappointment."

I see a shocking FIVE violations of Unicef's 10 Steps to Succesful Breastfeeding by this new mom's hospital:
4 - Help mothers initiate breastfeeding within one hour of birth.
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6 - Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7 - Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
9 - Give no pacifiers or artificial nipples to breastfeeding infants.

As a result of the hospital's failure, this baby is at increased risk for common health problems such as obesity, asthma and respiratory infections, despite her mother's commitment to breastfeeding--not to mention the effects of guilt and anger on the mother and the family.

674 Ounces Donated!

Is it good enough?

I used to worry that reading my experience would scare expecting moms.  But now I realize that while breastfeeding skill doesn't always come "naturally," if you are on the lookout for these "Breastfeeding Booby Traps,"  you have a better chance of overcoming problems. Here's my list of tactics for pre-emptively overcoming the "breastfeeding booby traps" at your birthplace (in my opinion, the place where we need the most help).

You call your hospital and ask about lacation consultants.
Their answer: "Yes, we have a lactation consultant."
Is it good enough?  No. You need to hear, "Yes, we have full-time international board certified lactation consultants available to you around the clock during your stay." 

You ask them about breastfeeding after Caesarian, and what their intervention rate is.
Their answer: "We don't have a protocol to support breastfeeding; the doctors treat the babies on a case by case basis.  Our intervention rate is average."
Is it good enough: No.  You need to hear: "Yes, our breastfeeding after ceasarian protocol is to give no baby any nutritional supplement, unless medically indicated and approved by you or your representative.  And the chance of your having a Caesarian to begin with is much lower than average."

You ask if they routinely give healthy babies formula or other supplements.
Their answer: If it's anything other than a resounding, "No," it's not good enough.

If their answers aren't good enough, call around to see if there are other hospitals in your area that give better ones.  If there aren't, plan to to find supplemental help on your own from a traveling lactation consultant and be vigilant and unapologetic when asking everyone caring for you and your baby to abide by your requirements--verbally and in writing when possible, and plan to have your partner, doula, or support person be responsible for tracking what's happening with your baby at all times.

What Gerber doesn't want you to know

We never bought a single jar of baby food for Sam.  And given the aggressive marketing by baby food manufacturers (just search for "baby food" and see what comes up), they don't want you to figure this out: you don't need it.

Since the World Heath Organization recommends exclusively breastfeeding for six months, solids need not be introduced until six months at the earliest.  And until one year, breast milk or a substitute is still the biggest source of nutrition for baby.  That means eating solid food under the age of one is just for learning.

What, then, is the point of teaching them to eat mashed "baby food?"  The object of feeding solids initially should be to develop motor skills, teach chewing and swallowing, get a feel for different types of foods, and have fun.  This means we should serve babies soft foods mashable by baby's gums in non-chokable-sized pieces.  You don't even need a food processor or ricer--it's quite easy to do with a fork right at the dinner table off your own plate.  Caregivers can do this easily, or stick to milk during the time the baby is in their care.  An added benefit is that you are in complete control of all ingredients in your baby's solid food. 

Then, by the time baby is one, ideally, he will be well practiced with feeding himself and be accustomed to different flavors and textures, rather than expecting only certain flavors and textures to be delivered all the way to his mouth.

OT: A note on diapers

I couldn't say my blog on babyfood was complete until I covered all points of the infant digestive system, so I thought I'd post a note on diapers.  Or, maybe it will just be fun!

Having a baby is, generally, a pretty environmentally unfriendly thing to do.  Reusable cloth diapers have been a manageable way for us to reduce our load on the planet, since disposable diapers have a big "footprint." 

Sam in his handknit wool soakers, 5 months old.

We started out with simple "prefold" diapers (Gerber) underneath plastic pants (Prorap seconds) or wool "soakers" that were knit for us by Sam's crafty grandmother.  These were inexpensive and didn't leak, but we had some problems with diaper rash, and they took more time to put on than disposables.

Later we tried something called a pocket diaper (Fuzzibunz) that had a waterproof outer part sewn to a soft fleece inner part, and between them you stuff a prefold diaper or special absorbent insert.  These were wonderful for quite awhile--very soft on baby, comfy and no rashes, easy and quick to put on--but once he started moving, they were a little bulky.  Sadly, the fleece eventually got some kind of buildup presumably from our hard water and now they repel the pee, and I haven't figured out how to "strip" them to make them absorb again.

After the repelling problem we started using Gdiapers, which are a sort of fabric undies with a little waterproof sling inside that holds something absorbent, either a washable insert or a compostable absorbent pad.  (There are a small truckload of these in my compost bin right now; we will see how well they degrade.)  The Gdiapers have been great--no leaks, quick and easy, and slim and unbulky for my crawler/walker.  Downsides: probably a pricier option than some, they still use resources to make the compostable inserts, and I sometimes worry that the velcro or snaps on the "Gpants" are uncomfortable for him.

I also made my own baby wipes from cut squares of old cotton baby blankets and a solution of water, shampoo and olive oil.  The wipes work better than store bought and get washed up with the diapers.

As for washing, all the diapers go into a separate laundry bin and get washed in hot water, one or two extra loads per week, no soaking or dunking or spraying.  And we keep a pack of unbleached disposables (I like Seventh Generation) for moments when the clean diapers haven't made it to the drawers.  Cloth diapers have been easy, especially compared to other parts of being a new mom, and I would do it again in a minute.

A great resource on cloth diapering is Karen's Cloth Diapering site.

Resolution: Keep going

Most people's new year's resolutions have to do with making some kind of positive change in their lives.  My resolution is to keep things the same--to keep pumping breast milk for my 15 month old son.  But in other ways, it is like other resolutions, there are strong forces fighting against the thing you are trying to do--otherwise you wouldn't need a resolution to do it!  The main force I am dealing with is a constant evaluation of how much Sam needs his milk versus how inconvenient and uncomfortable I am.  I often think how wonderful it would be to slip into bed at night without having to sit up for 20 minutes, or to get that extra sleep in the morning, or to quit washing pump parts day after day.  Comfort and convenience are strong forces!  But I resolve to fight them for awhile longer and keep bottle-feeding breast milk, because Sam still loves and will benefit from breast milk.

Tale of Two Births

Melissa Bartick, MD, chair of the Massachusetts Breastfeeding coalition, wrote a great series on breastfeeding in the US.  I recommend this article that describes two hypothetical births--one in a baby-friendly hospital and one not, because it shows how our society, communities, and medical system all come together to set a new mom up for success, or failure.