Sunday, February 08, 2009

Survival With Babies

I think it is rather strange, really, that I have been a La Leche League Leader for ten years (newly retired), I am a certified lactation consultant, and a mom of two who breastfed for a grand total of 7 1/2 years, and I honestly never blog about breastfeeding or babies. Well, since there really is no one who has to subject themselves to my vast resources of knowledge at meetings anymore, maybe it is time that I wrote about it here. I've lately found myself surrounded by babies at hey, while it is on my mind, I'll write the things I've always meant to write:

1. Breastfeeding is awesome. It gives the baby the perfect food...changes not only depending on the time of life for the baby, but the TIME OF DAY. It provides nutrients exactly as needed (thorugh a biological feedback loop that they think occurs because the Montgomery glands are sensitive to certain enzymes in the baby's saliva), immunological protection (that again, through the Montgomery glands, the mammary glands can produce antibodies to germs the MOTHER HASN"T BEEN EXPOSED TO), and I could go on and on and on and on.

2. Just because breastfeeding is awesome, doesn't mean it is easy. Especially the first several weeks. Actually, in a couple of months it is so easy that you'll wonder why people ever mess with bottles or formula. However, in the first weeks, the baby has never had to eat before it was born, just as the new mom has never had to figure out how to feed a baby through her breasts. Positioning can be a big deal. When the baby is 3 months old, it can be doing backflips while nursing and it doesn't hurt. When the baby is little though, leaning over just a tad can cause pain. A lip could get tucked in, a tongue might be in the wrong place. But it shouldn't hurt and nipples should not crack and bleed. If it does hurt, find someone (a La Leche League Leader, a lactation consultant, or even an experienced mom). There are ways to make it better, and often better VERY quickly. 90% of all breastfeeding pain is positioning. It helps to have someone take a look.

Some people just expect it to come naturally. Occasionally it does. But not very often. I tell moms that it is like learning to drive. The first time I got behind a wheel, all of a sudden, 25 miles an hour felt FAST, and keeping track of the speed, the mirrors, the guy next to me, and everything else was dang hard. Now I do it without really thinking about it. New moms have never breastfed before and it is hard to get a stiff, flailing baby to your breast and get everything right. It takes loads of practice. And as I said before, the baby has never done this before, either. I find that most moms find it gets easier somewhere around 6 weeks.

Learning to nurse in public helps with feeling tied down. Most states have protected the right (and none have prohibited it). It is not indecent, even if skin shows. A blanket over the shoulder often advertises the fact that you are nursing rather than hides it, and my kids would not tolerate a blanket between me and them. However, it generally is possible to nurse discreetly by pulling up your shirt from the waist and letting it sit on the breast where the baby's head meets. It is very hard to even tell that the baby is nursing. With a button up blouse, unbutton from the bottom rather than from the top - that way the neck and breast isn't fully revealed, and again, let the shirt flap hide the top of the breast (lots of moms I know wear belly bands - knit bands around the belly that keep the breezes out and hide skin). Practice by sitting in front of a mirror. (though babies will at certain times grab the shirt and pull up). Baby slings can help, too. Nojo, Maya Wrap, and Over the Shoulder Baby Holder are the big brands -- but there are others...Google them. Slings take practice, and sometimes when a baby doesn't like it, he will like it in a couple of weeks. Or he will like a different position.

3. As I said, the baby has never had to eat before it was born. Out of any system, the baby's digestive system is the most immature. Nourishment went straight into the blood stream through the umbilical cord, and the stomach and intestines and such just sat there biding their time. So often, it takes a baby time to learn how to get that digestion thing down...and often it is the same time as they are kind of getting that breathing thing it takes a while...and it is hard to do both at the same time. When it is extreme, we call it colic. Colic is loads of screaming from 3 weeks to 3 months, usually in the evening, for about 3 hours straight.

4. But even when it is not colic, babies are often very fussy in the evening, during the same phase of life. There are lots of reasons for that. "THEY" (the omniscient "they") seem to think that it is said immature digestive system. Also, it tends to be the busy time at night. The electric lights are on, which may bother the baby more than we know. Everyone is stressed after getting dinner done and dishes done (or if they aren't doing it, they are stressed that they aren't doing it).

5. Babies do sometimes show reactions to foods (more often than most parents know, really). Shadows under the eyes, stuffiness (newborns do not generally get colds), clicking while nursing, abdominal pain, a rash between the buttocks that is smooth and burnlike, green, mucusy stools -- can all be signs of a food sensitivity. Chances are, if you bring your baby to the doctor, he will look at you like you are full of it. Dairy is the most common. Cowsmilk (at least pasteurized cows milk) has huge proteins and passes through the milk and causes problem. It is the protein, not the lactose. A baby that is truly lactose intolerant is in serious trouble. Real lactose intolerance doesn't show up until 7 or 8 years old, because human milk has more lactose in it than any other milk, and lactose is VERY important for brain growth.

But taking foods out of the mothers diet (one at a time) can help. Eliminate one type for two weeks and see if there is a change. Dairy is the first (and you want to eliminate anything with casein, sodium caseinate, or whey is important. Look at all labels, you'll be amazed what it is in); followed by soy (and 1/2 of all babies that react to dairy will react to soy...same problem with that huge protein); followed by eggs (and look at labels for albumin; wheat (avoid all gluten); and citrus. Chances are, if you had a lot of it when you were pregnant...that is your culprit. But it might not be. That is the first place to look, though. If you notice an improvement, you probably are pretty sure you found your culprit. If you are not sure, reintroduce a bit to see if the baby reacts again. With dairy, some babies will tolerate cheese and yogurt (somewhat predigested) but won't tolerate milk, cream, or ice cream (sigh)

6. Moms in our culture are expected to do way too much too soon. In many cultures, mothers get breaks of several weeks before they are expected to be out in public, or even allowed to be. Jews have 40 days of uncleanness before the mother is expected to keep a kosher kitchen or participate in prayers and the lifestyle again. Muslims, the same thing. Even in Orthodox Christianity, it is common to treat the mother as a shut-in and bring communion to her until six weeks. The only time she comes out with the baby is for the baptism. This sabbatical is merciful....the most important thing at this time is the baby and the mom getting to know each other and figure each other out and only deal with the basics of life. When family is around, they are obligated to help...not be entertained.

Often, we expect the mom to be up and moving and have her act together within the first week or two. That's not right. She is recovering from the birth, her hormones are all over the place, and the baby is adjusting to life outside the womb. It is a stressful, life-changing time. Dad and mom need to do all they can to ensure a quiet adjustment and being as available to each other as possible, as well as support from outside the immediate family. If you are a friend, offer to clean something, do a load of laundry, or hold the baby while mom takes a shower or a nap. However, most of her instinct are going to be that she wants to stay close to the if she turns that down, just offer to help anyway possible. Some feel guilty for sometimes saying "I AM bringing over some food and would like to help you while you relax" can help.

6. Family bed is a lifesaver when it comes to caring for a baby, especially a breastfeeding baby. But what I would've liked someone to tell me was that it is really hard during the first several weeks. The baby is just too small to latch on easily from that side, and latching on even in a regular position and nursing is still a skill being learned. However, getting past that first growth spurt at around 5 or 6 weeks makes a HUGE difference. That is also about the time that breastfeeding gets easier on the whole. Turning on the light to see what is going on also kind of defeats the purpose and wakes the baby up completely. A lot of moms recommend having a small flashlight by the bed or a booklight. But be careful of shining an LED right into the baby's eyes.

7. Oh yeah...that growth spurt that occurs around 5 or 6 weeks (sometimes 4). All of a sudden, the baby wants to nurse CONSTANTLY...when you put him down, he wakes back up again and is fussing and gets scary. Often, when I've had a mom tell me "I just didn't make enough milk" I find that it happened at six weeks. What happened was the baby hit a growth spurt, the mom panicked that the baby was nursing all the time, gave the baby a bottle, and baby got full and went to sleep after downing a whole bunch of formula. But then baby didn't need to eat again for 3-4 hours, and when the baby went to the breast, the same thing ensued, until the baby was getting a lot of formula, and not nursing much, so the breasts slowed down on making milk.

The way it actually works is the mother gives up any hope of a sane day and surrenders to a day on the couch, nursing constantly. What goes in has to come out, so she watches the diapers to make sure that there are 5-7 wet disposables (bowel movements count) and at least one bowel movement). If that is happening the baby is getting enough. But what he is doing is stimulating the breasts to increase milk production, because the baby is growing. This goes on for one to two days, and then every body catches up. You stimulate milk production by frequency of nursing, that is why the baby gets back on soon after he gets off. And that is why also, if you are trying to increase your supply, you put the baby to the breast more often instead of longer, or pump halfway between feedings rather than right at the end of one.

But very few pieces of breastfeeding literature talk about growth spurts or frequency days. So I am.

8. Some babies nurse a lot or are just plain fussy. These are called "high need babies." And there is nothing wrong with them. They are just better at asking for what they need than some other babies are. All babies should be held most of the time, nursed frequently, and sleep close to their mom. It is how babies have been raised for most of history. By being close, they are safe. They crave contact, your breathing regulates theirs, and breastmilk digests quickly so they need to do it again soon (and sometimes they are just thirsty) -- not to mention it is soothing, and this big world is pretty overwhelming to a little baby.

But high need babies let you know they need it and they are not going to easily tolerate not getting it. From experience, high need babies tend to be very intelligent, very emotional, very in tune to others emotions, and very sensitive to their environment as they grow. Chances are, you can look at (at least) one of the parents and see that coming. Some babies seem to need time to adjust to life in this world. Others, kind of need ways of coping with it throughout the rest of their life -- but do pretty well all the same.

One thing that really helped me was something I read in The Discipline Book by Dr. William and Marth Sears (I recommend any book by the Sears'). They said something that really took the load off for me. They said that sometimes there is nothing you can do with a fussy baby but hold him and let him know that you love him even when he's fussy. And that is enough. You don't have to stop the fussiness (as much as you want to), but just love him through it. The fact that you are not leaving him to deal with it alone is exactly what he needs. That freed me from having to solve the fussy problem with my son and just love him through it. He did get through it - at least 90% of the time I think he did. But boy was it a huge relief when he smiled at me, because he was so fussy the first several weeks that I swore he thought I was an idiot. Oh wow did that smile make it better.

I'm sure I forgot a lot...but I'm sure some of you wise women out there can add to it. Warning: I delete Ezzo stuff (strict inflexible schedules, cry it out training). It's my blog. I don't like it.


Raggedy Lamb said...

Me, too. I've been a LLLeader since 1990. Just this morning I was thinking that it's time to retire as I have not been able to be active in my group or area. Too bad, because the Future Area in Asia and Japan is having their Conference this month in Hong Kong. But, much more than getting to go to Hong Kong, is helping mothers and babies stay together as they are meant to be. I loved seeing not only the babies grow, but the mothers, too.

Elephantschild said...

Re #2. I wish people were better at being honest about that up front. I felt like I was "sold" on bfing, and felt so much like a failure when it was such rough going at first. No one told me that it's actually quite normal to have a rough start.

Also, I'd add: as much as people are afraid they won't have enough, it's possible to have problems with having TOO much milk. Oh, the leaking I suffered, way, way beyond normal leaking, and it went on for WEEKS. After i finally went about reducing my supply intentionally, Sparkle was *finally* able to attach nicely, she stopped getting angry, and I finally stopped flooding the bedroom!

The Rebellious Pastor's Wife said...

Great point, EC!

There are lots of ways to reduce milk supply...the most common to just nurse on one side for several feedings, then switch, rather than doing both sides in a feeding. Plus, having the baby higher, or even have the mom recline and the baby be on top of the chest so that gravity helps fight the force.

One thing we found in L.A., is frequently, moms with overabundant supply also had babies with food sensitivities. Taking the offending food out of the diet not only helped the baby, but often the mother's milk supply became more manageable as well.

That probably isn't always the case...but it was something they found over and over again.

It's nice not to get soaked every feeding though.

The Rebellious Pastor's Wife said...

Raggedy Lamb,

That sounds like a wonderful is really great to see moms grow in this.

The best thing that breastfeeding does, when it follows its course, is that it makes it so much easier for the mom to really know her baby.

Elephantschild said...

Wish I'd known about the possible food sensitivity thing. Very interesting. Given that my kid is generally highly sensitive, that may have been a contributing factor.

The Rebellious Pastor's Wife said...

It was one that surprised me when I heard about it. I think there is a geographic difference too. In California where I was trained, we focus a lot more on nipple confusion and food sensitivities than they do here. I don't think the problems are any less common (especially the food sensitivities)...the training just seems to focus on it less.

Beth said...

Ack on the Ezzo stuff. Our LCMS church is offering a parenting class during sunday school time (DH objects but that's a different subject) and the used Ezzo's "Let the children come along the virtuous way" as a reference.
Of course, my only exposure to Ezzo was the Babywise books my DH and I railed against while leading API meetings in Seattle, so I'm not sure how this book compares.
But all it takes is the name in the reference to get my hackles up about the whole class!

Joy said...

Where were you when I had my first? My lactation consultant was NO help. I was bleeding on both sides before I left the hospital and she just kept saying, "She's latched on correctly; it shouldn't hurt." I finally said, "Have you ever nursed a baby?" Nope. We made it, though. I am living proof that you don't *need* antibiotics with thrush.

I wish people understood that nursing is 90% comfort, 10% hunger. People see me nursing every 30 minutes when we're not at home, and think there's something wrong with me or my baby. No.... Most of the time when she's nursing she's not actually eating. She's nervous about a new place, or overstimulated, or too hot/cold, or needs to touch base because people have held her. I know so many women who give up because they become convinced that they aren't making enough milk to keep up with baby. You're never truly empty, and it's okay to be a human pacifier.

Lora said...

Joy -- EEEK. No you shouldn't have antibiotics with thrush. It should be treated, but with an antifungal, whether something over the counter like Gentian Violet or GrapeFRUIT seed oil (not grape seed oil) or with something like Nystatin or stronger...depending on the case. (diet can help, but if it goes ductal, it needs help, since the yeast feeds off the natural sugars in the milk).


I really do hate the fact that a Lutheran Church, clinging to the cross and knowing how God loves us despite the fact that we are whiny and crying and rebellious, thinks that we can "train" the sinfulness and neediness out of babies through withholding love. If anybody SHOULDN'T be teaching that, it should be us.

Elephantschild said...

I had 3 rounds of thrush, both me and baby.

Not. fun. Imagine a baby latching on to what feels like second-degree sunburned skin...


Joy said...

EC, that's EXACTLY what it feels like! I just kept ignoring that lovely can of Enfamil in the back of the pantry and pumped my guts out.

I'm bothered by our synod's lack of testicular fortitude on this subject to preach the Order of Creation. Don't get me wrong--formula saves lives. But to shun breastfeeding (and all its miraculous components) simply because mom doesn't feel like trying is, I believe, a slap in God's face. To have to deviate from God's Order because of the fall is one thing (can't b-feed due to mastectomy, for example). But to deliberately deviate from what God ordained?... I think we Lutherans call that "sin". Besides, I can't imagine looking at my child and saying, "I was capable of giving you the very best, but I wasn't willing."

Elephantschild said...

Joy - there are some women who have suffered childhood (or adult) saxual abuse who are extremely uncomfortable w/ bfing.

We have to respect that. We cannot lay breastfeeding as a law thing on the hearts of Christians sisters, even though it is in fact the best thing for babies, and the way that God intended babies to grow.

I'm not going to condemn the lack of wanting to breastfeed as sin even though I strongly differ with women who chose to not even give it a try past the first few days.

Husbands can be jerks about breastfeeding, women can be isolated without good help, they can grow to adulthood without ever having seen a baby nursing, even mothers of grown daughters can be wickedly unsupportive. An aunt of mine loudly condemned her d-i-l's nursing as "disgusting" and "perverse" every time she saw her d-i-l. Far be it from me to tell that women she's to be blamed for not wanting to continue nursing past the first few days in that kind of environment!

I would have quit at the second round of thrush if I hadn't had my mom literally cheering me on thru my tears of pain. Not all women are so blessed to have that kind of support.

We don't live in Eden. Many women struggle with breastfeeding for a host of reasons. We hope that all can persevere. But not all do or can. They still love, cherish, and nurture their babies.

Joy said...

I don't have a jerky husband, thank God, but I am the ONLY person on both his side and mine to bfeed. Int he hospital with #1, I told the m-i-l (that's monster-in-law) I was having trouble, and she said, "That's okay, you have nothing to give her anyway." After the birth of my third daughter, she was still at it--this time saying she felt sorry for breastfed babies. I dont' expect everyone to agree or even see the theological side to it, but when you deviate from the Lord's Order, there are consequences, plain and simple. Apparently there are consequences for living within his plans as well.

I also understand your first paragraph all too well. One therapist told me that allowing a schmuck to *make* me feel uncomfortable or embarrassed with my body was allowing him to control me. There's no magic time limit for healing, and I wil never "get over it" (another thing the m-i-l says), but I also refuse to be a victim.

The Rebellious Pastor's Wife said...

Honestly, I'd have to say that I agree with both of you. I think on the whole, to vocation of motherhood is very important to address, and the blessings that God gives us and our babies through breastfeeding. It is one of the MANY things that we don't want to address because we are interfering in people's privacy.

If women were more able to take up their roles in helping younger women in the congregation, educating them in the beauties of modesty, marriage, nurturing children, then through love we can possibly overcome a lot of the hurts and awkwardness that are involved with marriage and breastfeeding in our very bizarre culture.

I agree that we really can't take a theological "thou must" stance on it. But working as the Body of Christ in love might work much better, serving as examples and loving mentors might work so much better.

Joy said...

Well said, RPW. Ater two days of thinking, I may be able to articulate what I wanted to say all along.

Formula is the result of the fall. The real question and issue is, am I using it to compensate for the fall because I truly can't breastfeed, or am I perpetuating the fall because I refuse to acknowledge and obey the Lord's Order?

I'd wager ther are plenty claiming to fall under the former when in fact they resemble the latter. It's phenomenal what we can endure when we have no choice.

Ruthie said...

Neat post! Thanks. Some moms and I started a Breastfeeding and Attachment Parenting support group at our church (LCMS). We named it "Nursing and Nurturing". We are different than LLL in that we have a Christ-centered devotional and discuss attachment parenting issues. It has been a blessing to many.
I encourage you (and readers) to consider starting a similar group in your church.

orrologion said...

What about during teething? biting?

Beth said...

I'm currently nursing through teething and there have been a few jaw-clenching moments (for both of us!) but every time she clamps down I just calmly say "no no" and unlatch her. If she seems like she's not done, I'll let her back on, but always removing and/or ending the nursing sesion if she "bites" (clenches).
This has worked with all my other girls and they've stopped doing it before the teeth came through.
The only exception is occasionally when they are falling asleep and clamp down as they hit deep sleep.