Tag: breastfeeding

I have not written much on procreation since my one-month postpartum post. The primary reason for it is that I am, naturally, very busy taking care of the baby and trying to keep all my projects going while at the same time working part-time. However, it is also very hard to decide what deserves to be a subject of a post without being a reiteration of the information widely available in baby books. And so, I decided to write now, as I’m nearing 6 months postpartum, about my experiences and how they might differ from what I would have expected if I fully trusted the baby books.

Many books talk about “baby” as a creature that behaves in a certain way from birth to a year. Very few are making a distinction based on the age of the baby measured in months. When they talk about breastfeeding, the advice and descriptions of it are usually generic for any infant. Yet I found that the way my baby fed in the first (approximately) three months is quite different from the way he feeds now. Same goes for interactions, reactions to the outside world, and so on. Without knowing this difference based on the age, the changes observed in the infant’s behaviour would leave one uncertain in their approach to baby care.

Breastfeeding and distractions

During the first three months of his life, my baby could breastfeed for 20-30 minutes on end, snoozing satisfied against my breast. We started breastfeeding lying down within the first month and both found it the most comfortable. Later on, right around the three-month mark, he became more distracted by other things: play of light on the curtains, the cat passing by, sounds outside; and would not be content suckling for a long time. Now he also pulls away from the breast to smile at me and babble. He still seems to find breastfeeding the most comforting way to fall asleep, but it appears to be harder for him to fall asleep in general, since the big bright world around him is waiting to be explored.

Patience and meeting needs

In the first two months, the baby was crying loudly when he needed attention. We were very responsive: when his cries were demanding (as opposed to him lying in his crib upon awakening, cooing to himself) we attended to his needs right away, be that hunger, sleepiness, need for change or comfort. He would stop crying once his needs were met. He also started smiling socially early on, especially when we would talk or sing to him. Now, he has more patience when his needs are about to be attended to: he quiets down. He seems to understand when we acknowledge his distress and he stops complaining as he waits for what steps might be taken to rectify the discomfort. It seems, he connects certain places in the house with comfort: he stops crying when being carried to the change table (or if I bring a diaper to where he is) if he needs a change; when being put down on the bed with me lying down next to him if he is hungry; when being carried around and sung to if he is sleepy.

The baby also does not cry as much. He cries when scared or in pain, but if all he needs is a change or if he is bored, he complains instead by making sad noises, as if saying: I need some attention here, something is not right. Only if you repeatedly ignored his request, would he turn it into a demand made with shrilling noises or crying.

Interactions and entertainment

The baby’s array of interactions is growing: he smiles when sung to and played with, laughs when tickled or talked to in a silly voice, gets scared of loud noises and sometimes from what appears to be a bad dream. He is excited when photos are being taken and sometimes smiles at the camera being pointed at him or at the sound of the shutter clicks. He likes the sound of a phone dialing a number and listens attentively to the one-sided conversation, sometimes attempting to participate. He is experimenting with a range of motion, trying to roll from his tummy to his back and vice versa, and trying to crawl (although not very successfully at this point).

For a few weeks, he appeared to be very concentrated on observing his hands and what they can do: grasping things, swatting at moving objects, banging on surfaces, pinching people, looking at his fingers and palms in wonder. Now, for about two weeks, he is exploring what his feet can do. The socks come off as soon as they are put on, he grabs his feet, moves them around, and tries to stick one into his mouth. He is behaving much more like a little human than like a scared blind puppy.

The baby loves being entertained in the past three-four months. He is listening attentively and looking at a book being read aloud to him, listening to the songs we sing, recognizing certain songs by the first line or by the melody and smiling in recognition. I have been also listening to some lectures, and he quiets down and listens attentively along with me.

Tummy time and toys

He loves his tummy time: he is able to stay on his tummy without getting tired a lot longer than in the first couple of months, and usually expresses discomfort only when something else is uncomfortable: like when he is wet. Otherwise he can be on his tummy for long stretches of time, rolling over, wriggling around, and exploring toys and hands for much longer periods of time.

At first he looked at toys in passing, and did not play with them for long. Now he actively reaches for toys, can explore them for a long time, and greets his favourites with rapid leg movements and grasping hand gestures in excitement to grab the toy. He also does get bored with toys or activities and expresses it by throwing the toy away or complaining.

Plane flights and social occasions

We have taken his first airplane flight from Ottawa to Winnipeg to attend a family wedding when the baby was 5 months old. He took the flight quite well. I breastfed on take-off and landing, and my husband walked with him up and down the isle when the baby got uncomfortable, sleepy, or bored. The plane had a changing table (we flew by WestJet) in the bathroom at the back, which was quite tiny, but served its purpose. The baby seemed to be scared of the engine noise upon take-off the first time, so that he clung to me and looked at me with wide-open eyes. The breast and my reassuring tone seemed to have worked to calm him down, and he soon settled to sleep.

The wedding itself ended up being more stressful for the baby and myself than the airplane flight. The baby was bored and overwhelmed by so many people, so all he wanted to do was to be carried. We had a bouncy chair for him with toys, but he barely looked at them and demanded to be picked up. The loud music prevented him from sleeping which caused him to grow more and more upset. Sitting still was boring. Clapping after a slide show came unexpected and scared him. Even feeding would not get him more comfortable. My husband and I have carried him in the sling for the entire wedding, and came out of it quite drained.

A few times we hosted a get-together at our place and invited a few guests (from 1 to 17 people on different occasions). Those gatherings that occurred in the first three month were a trial on us. The baby would not settle down (unless people were quiet enough to let him sleep, which rarely happened) and we ended up taking turns attending to his needs instead of enjoying the company.

A few recent parties have turned out better: he was more involved in the proceedings, interacting with people, listening to conversations and music, and, when he was tired, being able to sleep in his own crib (noise levels allowing). So, in our case, it would have been better to limit the socializing in the early months to one or two people at a time, doing it later in the evening when the baby was mostly asleep, and with the people trying not to make too much noise. Living far away from family, however, limited our options, as we had to adjust to the times and numbers in which people could visit.

Starting in the early months and up until now, the best way to socialize with other adults has been going out for lunch. The baby is generally in a better mood earlier in the day, willing to take in new surroundings and interact with people, and does not mind sitting on our lap or lying next to us on the table and listening to the conversation. Sometimes we have to eat in turn, but that is not too hard to do during lunch as the portions are not huge and the lunch does not last for hours. And sometimes he just falls asleep on his papa and peacefully snoozes through a large portion of the outing.

Overall, the baby is now more comfortable in this new body of his, the respiratory and digestive systems are adjusted to the world outside the womb, and he knows that his needs will be attended to. Thus he is more willing to venture from his comfortable place at my side to explore the outside world, knowing that he can always retreat if the universe springs something too overwhelming on him.

Early on in my pregnancy, when my doula asked me whether I was planning to breastfeed, I was baffled by this question. Being raised in Russia, I did not understand what was being asked. I am having a baby, the baby needs to be nourished, that’s what the breasts are for, hence – yes, of course I would be breastfeeding.

After reading more literature regarding postpartum, I realized that in North America formula is for some reason considered a viable alternative to breastfeeding (and not just an emergency measure), and breast- versus formula-feeding is a hot political topic. Leaving out serious medical conditions (of which there are very few) that would prevent a woman from breastfeeding, most alleged benefits of formula-feeding presented in literature were “being able to tell how much your baby consumes” and “convenience for the woman”. The first sounds like an argument from the same way of reasoning as that encouraging incessant weighing of the woman during pregnancy, as if weight is the main gauge of the baby’s or the mother’s health. This information can be obtained from the number of wet and poopy diapers put forth by the baby. The second one never made sense to me: how can you weigh your baby’s health and optimal nutrition which are extremely important to the baby’s well-being against such a petty thing as convenience? Pregnancy is not exactly a convenient affair, yet we understand and bear the limitations placed on the woman to ensure the health of the offspring. Labour is not a very pleasant or convenient experience either, yet we go through it and endure needed interventions for the sake of a healthy baby. Now that the baby is born, suddenly our convenience takes precedence and their nutrition is a secondary consideration?

I will leave out the discussion of the benefits of breast milk, the inferiority of the formula, and the unethical practices of formula-producing corporations such as Nestle – enough information sources exhaustively cover these facts. I will also omit detailed descriptions of common issues such as engorgement, blocked ducts, mastitis, and tongue-tie, as they are described in detail in “Ina May’s Guide to Breastfeeding” which I highly recommend to have on hand to look up this information if and when it becomes necessary. I will cover a few tips to which I arrived through my experience and found helpful.

Tongue tie is a condition that can interfere with breastfeeding. A baby with a tongue tie has a hard time latching on and effectively getting milk. It is easily fixable with a simple procedure, but getting a doctor to perform it might prove a challenge. I cover it in Tongue Tie and Breastfeeding. There are many opinions regarding alcohol consumption while breastfeeding – my research and references to many sources are covered in Alcohol and Breastfeeding.

Correct latch is extremely important in breastfeeding, to ensure that mother’s nipples do not get sore, and that the baby can effectively draw milk from the breast. A number of educational videos are available at the Dr. Jack Newman’s site, showing babies from several hours old to several days old latching on. They also illustrate finger feeding, cup feeding, using a lactation aid, and a tongue tie release.

If you find yourself having a plugged milk duct or mastitis, look into echinacea as soon as possible: used in the first 24 hours it might prevent the infection (see “Ina May’s Guide to Breastfeeding” for detailed instructions). After that, if infection is developing, antibiotics might be necessary. Dr. Jack Newman recommends taking soy lecithin as a preventative measure against plugged ducts: “It may do this by decreasing the viscosity (stickiness) of the milk, by increasing the percentage of polyunsaturated fatty acids in the milk.  It is safe, inexpensive, and seems to work in some cases.  The dose is 1200 mg four times a day.”

Useful aids for breastfeeding include:

1. Nursing bras (I am quite happy with Bravado ones) of which you will need several, since at least one of them is going to be in the wash at any given time.
2. Breastfeeding pads – I have tried the organic cotton ones, and although they are environmentally friendly and all, they turned out to be extremely ineffective as they (a) tend to shift around, and (b) are soaked with milk in a very short period of time. I found that disposables work much better – they absorb the milk effectively, last longer, and are held in place better. I have settled on the Lansinoh pads. My doula also mentioned Johnson and Johnson as her pads of choice.
3. Lanolin ointment for nipples, which can be applied after a feeding and does not have to be removed before the next feeding as it is safe for the baby (such as Lansinoh lanolin recommended by La Leche League). In the case of cracked or sore nipples, expressing some breastmilk, applying it to the nipples, letting them air-dry and then applying lanolin can help them heal.
4. Breastfeeding cushion (such as Boppy) makes it much easier to breastfeed when sitting. Without it, you might need several normal pillows to achieve a comfortable position that does not put a strain on your back and arms. Considering that a baby breastfeeds every two to three hours on average, being comfortable during that time is crucial if you are to be able to perform any other tasks.

Learning to breastfeed lying down is one of the most useful things I have learned. It is easier on the back and arms, and allows the baby to easily drift to sleep after a feeding. During night-time feedings, neither the mother nor the baby has to fully wake up to feed. Combined with co-sleeping, some people find it the most comfortable way to breastfeed.

Breastfeeding in public

When breastfeeding in public, you have rights which include the right to breastfeed in any place where you are allowed to be with your baby, and not being required to cover up. These rights are protected under the Canadian Charter of Rights and Freedoms. There is a card you can carry with you to show to those people not educated on the subject that try to infringe on your rights.

Some people say that covering up is a matter of manners. Those people do not understand the issues that might be encountered by large-breasted women for whom it might be hard to fully cover up, by babies that will refuse to breastfeed with a “breastfeeding burka” covering them and separating them from their mother’s face, by babies that have trouble latching on and women not being able to guide them in a latch due to lack of visibility, by babies that pull away if the there is too much milk, and other possible breastfeeding issues. Let these people try eating their dinner under a blanket and see how they enjoy it. Same goes for those suggesting that you feed your baby in a bathroom – let them take their food there.

There are those who say that a woman should pump and bring a bottle to a public place instead of breastfeeding in public. However, a baby being in an unfamiliar place might want the comfort of the mother as well as food, and the bottle will not provide that. Would you rather endure a crying baby than a small amount of boob mostly covered by the baby’s head anyway? There are those who think that a breastfeeding woman should stay home or go out only without the baby. This implies having a second person at home watching the baby (which is rarely possible for those of us who do not have relatives living in the same city), the baby being fed on schedule (as opposed to on-demand), or the woman only being able to go out in no more than 2 hour increments, between feedings. These people can place themselves under a house arrest. Breastfeeding women need to be able to go out and share the world with their children, not be confined to four walls.

Magazine covers and scantily-clad women walking around show a lot more breast and thigh than breastfeeding women ever do, yet no one seems to object much. If the society finds that acceptable, it can survive an occasional reminder of humans being mammals.

The issue of alcohol consumption while breastfeeding is one of the most debatable ones and it is hard to find reliable information on it. However, I was able to dig out the following:

There is a rough calculator of the length of time that alcohol will be present in breast milk, depending on the number of drinks and the mother’s body weight. As a general guideline, it takes as long for alcohol to clear the milk as it does for the blood alcohol level to subside. Alcohol taken with food takes longer to clear out of the system. Motherisk provides a reference table that can be used for the calculation as well.

Motherisk also has a good article on drinking alcohol while breastfeeding, including references to several studies on the subject. They state that “Because alcohol elimination follows zero-order kinetics, drinking water, resting, or ‘pumping and dumping’ breast milk will not accelerate elimination. Unlike urine, which stores substances in the bladder, alcohol is not trapped in breast milk, but is constantly removed as it diffuses back into the bloodstream.” It takes longer to process high-alcohol drinks as opposed to beer or wine. The amount of alcohol passed to the baby through breast milk is around 2% of the entire alcohol content consumed by the mother, much less than the amount passed through the placenta in a pregnant woman.

The statement that alcohol increases milk production and stimulates let-down due to relaxing the mother appears to be a myth. Beer might increase prolactin levels and milk production, however this appears to not be due to ethanol, but possibly to barley. Thus non-alcoholic beer should do the trick as well. One study suggested that there was a 23% reduction in breast milk production due to alcohol consumption.

American Academy of Pediatrics provides a listing of drugs and their effect on breast milk.

La Leche League states that consumption of one drink or less per day has not been shown to have a negative effect on the baby. Excessive alcohol consumption is harmful to the baby and should be avoided.

Dr. Jack Newman says: “Reasonable alcohol intake should not be discouraged at all.  As is the case with most drugs, very little alcohol comes out in the milk.  The mother can take some alcohol and continue breastfeeding as she normally does.  Prohibiting alcohol is another way we make life unnecessarily restrictive for breastfeeding mothers.”

So, it appears that drinking one drink or less per day shortly after a feeding and waiting the appropriate amount of time (depending on the mother’s body weight) before the next feeding is the best approach if the mother does not want to avoid alcohol altogether.

If you are dealing with substance addiction, the Desert Hope resource page provides many studies and resources designed to help understand the basics of addiction and to offer guidance to help women safely stop drug and alcohol use.

The first issue I had to face was that my baby was born with a tongue-tie. This is a (often genetic) condition where the frenulum (the little piece of skin attaching the tongue to the bottom of the mouth) is too short and does not allow the baby to fully stick the tongue out. In severe cases, the tongue looks upside-down-heart-shaped and can prevent the person from being able to perform motions many of us take for granted, such as licking an ice-cream cone. In moderate and severe cases, the tongue-tie can interfere with breastfeeding by impeding the latch, and can lead to speech impediments later in life. In our case, the tongue-tie was moderate, but it did prevent the baby latching on correctly which lead to significant nipple soreness.

Tongue-tie can be fixed with a simple procedure: all that a doctor has to do is to clip the frenulum to allow for the tongue to extend further. The procedure is not painful as the part that needs to be clipped does not contain capillaries, and it takes less than a minute. Unfortunately, in Ontario, midwives do not have a right to perform this procedure (even though they can perform perineum stitching after labour which is much more involved), and doctors refuse to do it. Yes, you read that correctly. They can, the majority just chooses not to. One of the orthodontic surgeons, to whom we were referred as a specialist on the issue, told us that we should not do anything about the issue for a year! Add to this a virtual impossibility of finding a GP or a pediatrician for the baby (as most Ottawa doctors are not taking new patients), and you are stuck with a tongue-tied hungry baby who cannot effectively breastfeed.

I will spare you the detailed description of a range of emotions I went through while dealing with this frustrating artificial problem that could so easily be solved if people were reasonable. I had to pump first colostrum and then milk, and finger-feed the baby with a suringe. We got lucky: after a letter written by my midwife to a pediatrician at one of the hospitals, the hospital nurse called us (after we have called every place we could, had a lactation consultant visit, and went to a breastfeeding drop-in with a three-day old baby). She was very understanding since, as it happens, her baby had had a tongue-tie as well and she knew what we were going through, so she was able to get us an appointment the next day to see the pediatrician. The procedure did take less than a minute and the baby didn’t even cry – he was more uncomfortable with being held still than with the clipping itself. We were able to start breastfeeding effectively the same day. A video of a tongue tie release is available at Dr. Jack Newman’s site.

A tongue-tie can only be fixed by clipping. It is not painful and the baby can breastfeed right after the procedure. Without fixing the issue, the baby might not ever be able to latch correctly. Many doctors who are not educated about breastfeeding dismiss it as a minor issue easily fixable with bottle-feeding. Let them pump every two to three hours or feed their baby inferior food in the form of formula, and then maybe they will come to understand the issues involved. Alas, many are still ignorant of the issues surrounding the so-perceived feeding “choices”. If you find yourself in this frustrating situation, persevere to try finding a doctor to perform the procedure. Enlist the help of a lactation consultant if possible. I was told that some women drive to Toronto from Ottawa (5-6 hour drive) shortly after giving birth with a tiny infant, so they can get a tongue-tie clipped at the Jack Newman’s clinic, as that is easier than trying to find a doctor in Ottawa who would be able to do it without booking the appointment months in the future. Clearly, there is an issue here that needs resolution.

There is a comprehensive site at http://www.tonguetie.net/ that has loads of information on tongue-tie and its implications. Dispelling Breastfeeding Myths blog has another wonderful blog post on the politics of tongue tie.

He turned the stiff pages in horrified fascination. They opened into another world, a world of quite stupefying problems… It was amazing, he decided after reading a few pages, that a swamp dragon ever survived to see a second sunrise. Even walking across a room must be reckoned a biological triumph… They lived on a chemical knife-edge the whole time. One misplaced hiccup and they were geography… Omnivores or not, what they must really live on was their nerves, flapping apologetically through the world in mortal fear of their own digestive system. [Terry Pratchett, “Guards! Guards!”]

Below are a few tips at which I have arrived via research and experimentation. These strategies have helped me, although there is no guarantee all of them will work with your baby. Do check with your doctor or midwife if you have any concerns.

Addressing the baby’s needs

As long as you can meet the baby’s needs before his signals escalate to an ear-piercing cry, you can keep your baby happy and yourself sane. The key to address the baby’s crying is to try a change of state. If he is unhappy about something within his current environment, we have to change it to get him comfortable again. Checking whether he needs to be changed, burped, fed, held, rocked, or be in a different position is relatively simple, as long as you remember that the fact that you just changed him 2 minutes ago does not mean you should skip the possibility of him needing a change again.

If none of these work, there are some other tricky possibilities: for instance, the baby might have painful gas and not be able to get rid of it (burping sometimes helps, but might not). The gas problem stems from the digestive system being immature during the so-called fourth trimester (the first 3 months of the baby’s life), and just like a swamp dragon from the Discworld, the baby is bound to have all kinds of digestive issues often with explosive results. Trying to burp the baby, change his position, or rock him might resolve the immediate discomfort. Another thing that seems to work at times is a belly massage going in clockwise circles (to follow the direction of the intestines). If you have a bouncer seat, the vibration mode might also help dislodge those painful gas bubbles.

If the baby is overstimulted or exhausted (which can happen when he is in an unfamiliar environment, surrounded by new/loud/unexpected sounds or voices, too wound up after a bath, a play session, or any other energy-releasing activity), he wants to rest, but might not be able to get to sleep on his own. At this point, you can try holding and rocking him, or feeding him (as this provides comfort and allows him to fall asleep next to mom’s body with its familiar breathing and heart-beating sounds). Anything can interrupt the fragile state of being almost asleep, such as an inopportune phone call or a bout of hiccups. The baby is suddenly wide awake again, tired, and angry at not being able to rest. Unfortunately, there is no easy way to get him back to the sleepy state besides retrying rocking or feeding again. This can keep going in cycles as there are many unexpected distractions, external (such as a door bell) and internal (such as a painful gas bubble), that can jerk the baby awake again. It might be possible to stop hiccups by breastfeeding the baby. To get him back to sleep, you can try rocking him, singing to him, or going for a walk (fresh air sometimes helps) if the weather allows.

Getting things done

They say that when you are taking care of a baby, you can try planning one not baby-related thing  to accomplish in a day, and if by the end of the day you are half way through it, you should consider it a success. This is especially true with high needs babies that require constant attention and are not happy when you put them down for even a moment, day or night.

In our case, some days I’m able to do more than others, but that depends directly on the baby being happy and cooperating, something over which I only have a limited amount of control. Here are a few productivity tips I have learned so far:

1. Break up the activities into pieces that can be done in 10 or 15 minute increments, and can safely be interrupted and left half-done. Return to them when you have another 10 minutes.
2. Involve the baby in the activity you are doing: for instance, you can sing a song while sorting laundry or put the baby close to you when doing yoga, so he can observe your movements. This will prevent him from getting bored.
3. Have several projects set up and ready to be worked on: for instance, I have a belly cast set up in the basement that needs decorating, together with paints for it so I can paint a piece of the decoration whenever I have a few minutes; I have several books started which are strategically placed around the house to allow me to grab one when I’m feeding the baby or having a snack; I have a puzzle opened and set up on the table so I can put a few pieces in; the laundry bin is handy and all the dirty things are consistently put into it, so I can throw it into the washer at any time of day or night, etc.
4. Have a to-do list with your projects broken down in small sub-tasks. A glance at the list will allow you to quickly pick a sub-task that can be done within the time you have available with the noise level you can allow for (in case the baby is asleep you might have to avoid the extremely noisy activities). This list will also serve as a reminder of the tasks that need doing, since it is too easy to forget things when you are existing in a constantly-interrupted state.
5. Keep running shopping lists (by store) so you can quickly grab those and go whenever an opportunity arises to get to a particular store.
6. Combine tasks that can be performed in close proximity to each other (such as in the basement, or in the kitchen) – it will save you time.
7. Put things that need recurring attention to wherever they are easiest to remember. For instance, I have the infant vitamin D drops by the bed, so that when I feed the baby there I remember to give him his vitamin. If I had it stashed away in a medicine cabinet, I would rarely remember the vitamin or have a chance to retrieve it before a feeding.
8. Don’t pick up the baby at the first peep – when a baby wakes up he often is content babbling to himself for a few minutes, which might allow you to get whatever you are doing to an acceptable state before attending to the baby’s needs.
9. When you have a few minutes, do what is important to you first. If you cannot comfortably exist without a daily shower and your teeth being brushed, do it first so that you feel on top of things. If you are annoyed by clutter in your home, put things away, wash dishes, clean up – do whatever makes you feel more comfortable. If you would rather rest, exercise, read, watch a movie (be prepared to pause at any moment), do that, and do it guilt-free. The main goal is a happy parent and a happy baby (the latter is greatly affected by the former), so you should do whatever gets you there.