Thursday, July 31, 2008

Looking back

My friend just told me of her friend’s first experiences with breastfeeding and I found myself wishing that nurses and hospitals were more educated on the matter. If you have had your child in a hospital it is very easy to see why breastfeeding is not a normal practice in America. The night Emily was born I tried to feed her, but of course she was too tired from being born. Then started the parade of nurses every two hours, “Did she eat yet?!?” “She has to eat!” Of course she wasn’t hungry yet. Breastfeeding is something mother and child has to learn how to do together maybe with the help of an experienced mother who has been there and done that. Not a 22 year old, childless nurse who has the rule memorized if the baby doesn’t nurse feed it a bottle. I had no idea what I was doing and was so worried my baby wouldn’t eat we gave her a bottle. Seeing her chug that milk down was so satisfying I can see why most moms give-up. Breastfeeding you can only see the time go by, there is no mL measurement on your breast showing it full and then empty; just our own mothering instincts. Unfortunately as a new mother the nurse’s insistence on feedings drown out the quiet whisper of our divinely appointed instincts and more often than not we relinquish to the louder noise.

My daughter took three bottles of formula total; one in the hospital and two at home in the middle of the night when I was desperate to get her to sleep longer. It was so difficult getting the formula made and warmed up while she cried and cried I finally gave in and just nursed. To me it was easier; I couldn’t stand hearing her cry because it just seemed to pierce my heart. The real motivation for my continued breastfeeding success was the advice I got from a nurse as we parted ways, “buy The Breastfeeding Book by Dr. Sears, it will tell you all you need to know about breastfeeding”. Well the day after we got home my husband was sent out to buy it, I was having such a difficult time getting started it seemed hopeless to me, but somewhere beneath the postpartum blues I felt a deep need to breastfeed my daughter. I read The Breastfeeding Book in about a week, I looked forward to late night feedings to read which fed my desire and gave me the power to overcome all the obstacles I was to face; bleeding, mastitis, a nursing strike, thrush upon thrush with more thrush, pumping at work, and even two weeks apart.

Of course there are plenty of moms out there who overcame those problems with no help other than their desire to breastfeed. Those are truly amazing moms.

Monday, July 28, 2008

Toddler nursing

Anyone who has nursed a toddler knows how fun this is :)
Milk seems to taste better upside down.

Two week seperation

Speaking of the reserves, I decided to do a research project/case study to see if my daughter would continue nursing after being apart for my two week active duty training. Here are my findings minus the research which I am still working on and will write up for publication in Attachment Parenting International's newsletter next spring.

The topic of my study was decided upon because I was required to take a two week business trip at a time when my 16 month old daughter was still an avid breast feeder. I spoke with a coworker who had similar experience a year earlier with her then 16 month old son and she had decided the absence meant they had to wean and so she weaned him about a month before leaving. When she returned her son had a readjustment period where he would not go to her and then after that she told me how he still fell asleep holding her breast as if it was a source of comfort. My hypothesis was based on her experience; if I continued nursing until the day I left and then offered to nurse upon returned (keeping up my milk supply by pumping) then my daughter would readjust to my return quickly, have a less traumatic separation, and continue the breast feeding relationship.
I began preparing two weeks before leaving. Up until then I had only been pumping milk once a day while at work and then nursing her on demand while we were together. At two weeks prior to leaving I started pumping twice a day and then with only one week until I left was pumping three times a day. This was based on knowledge that it is easier to produce milk the more I am around my daughter. Before I left I was pumping 300mL of milk during the weekdays and nursing on the following schedule; 10 to 20 minute sessions at 430am, 330pm, 530pm (this is usually for 20 to 30 minutes), 730pm, and then throughout the night averaging about 2 times between 900pm and 415am. As my daughter was 16 months old she was supplementing solid foods and juice or water during the day. She had refused taking any form of milk other than directly from my breast since she was 12 months old and at that same time refused the bottle.
I left on Sunday morning and provided my husband with 6 bags of fresh milk (pumped during the earlier week). He offered her this milk throughout the first week in a bottle and then from a cup and she refused it every time. Throughout my absence the only contact I had with her was over the phone (voice only) or over the internet (voice and video) via a webcam. My husband noted that each time we spoke she would calm down and I noticed she recognized me and would smile during our online conversations. Several times over the two weeks she would be upset and then hear my voice over the phone and calm down. I believe a lot of this was separation anxiety. Our first day apart my husband noted that she did not sleep well (we practice co-sleeping) and when she woke up she immediately went walking through the whole house as if searching for me. Our sitter noted that when her grandmother picked her up that day, which is the routine, she was very excited. I believe that was in anticipation of my scheduled pick up from her grandmother’s, which the routine was before I left. My husband noted this anticipation behavior lasted the first two days we were separated. While we were apart my husband tended my daughter during the evening, morning, and weekends and her usual sitter (my husband’s cousin) and my mother-in-law tended her during the day. She kept her normal routine while I was absent except I work 6am to 3pm and would pick her up by 330pm and my husband works 8am to 5pm so he could not pick her up until 520pm.
On a personal level I would be tempted to argue this separation was more difficult on me then on my daughter. I not only had to deal with the daily tasks required for my work, but also pumping at least six times a day, and the stress/guilt/separation anxiety a mother feels being away from her child. The first day was especially difficult and I found that pumping forced me to take time to reconnect with my daughter in my mind and relaxed me. I used pumping as a form of relaxation the first week as it seemed I was calmer after I was done than before I had started. Notably I noticed my heart rate seemed to lower and my mind clearer and able to focus better. The contact over the phone and internet also helped me to stay connected with my daughter during this time.
The first three days were the most difficult. It seemed as if my breasts were accustomed to the nursing schedule my daughter and I had established and when that changed I suffered from engorgement (from not nursing or pumping at night). I had not anticipated this so I did not plan to pump during the night and only did so early in the morning if I woke up in pain. The first day I was unable to sleep and found that two times I had to massage the milk ducts in order to get milk flowing during pumping times. The second day I felt some nipple pain most likely caused by the pump so I applied lanolin cream and turned down the setting on my pump. The third day was the most difficult, I work up at 320am with severe engorgement and pain and was only able to pump 60mL which did not relieve the pain. I also noticed I had a low grade fever, 100F which I associated with the engorgement. When I woke up at 610am I immediately pumped again hoping to relieve more of the engorgement and found I was not able to pump any milk. This was very distressing so after 5 minutes I stopped for a warm shower and used the warm water as a way to relieve some of the pain from engorgement. After that I was able to pump 100mL and felt considerably better not only physically, but emotionally seeing that I could still produce milk boosted my moral. I felt some of my symptoms may be mastitis so I contacted my OBGYN and discussed the symptoms with the nurse and was told to alternate warm and cold compresses and watch to be sure my fever does not go over 101F. While this was the correct information to get I felt somewhat distraught over it because I felt my pain was severe enough that it was an infection and I was concerned that without antibiotics it would not get better. Since I did not have access to cold compresses I used the shower as my warm compress and began expressing milk during my showers starting that night. This step alone relieved nearly all the fullness and engorgement I had been feeling. I found during this separation the pump was not as adequate at emptying my breasts as my daughter’s nursing was.
On the 5th day I felt my supply was dwindling in spite of my pumping efforts so I began drinking whole milk in hopes it would help my supply. This first day I noticed a dramatic increase after drinking milk and began drinking 3 to 4 glasses each morning. My supply became steady after this day and I felt very confident that I could continue the supply until returning to my daughter. I believe the milk was positively affecting my supply as I noticed my daughter had a reaction to the whole milk I had been drinking even though I had my last glass Friday morning and did not nurse her until more than 12 hours later and after several pumping sessions.
After the fourth day my body seemed to have adjusted to the change and I did not feel as engorged in the morning as I had been. I continued pumping 6 times throughout the day until the day I returned home.
There was an exceptional amount of stress related to this project in addition to the physical pain and difficulties I experienced I ran into many difficulties finding time and places to pump. My two week separation was to serve two weeks of active duty as a Navy Reservist so I may have experienced more difficulties than others might have in this respect. I was the only female in my group to ever request time to pump and found the course leaders were not as understanding as I expected they might be. I found it easier not to mention and just disappear for my own pump time throughout the day after discussing it with one of the administrators of the course I was taking. Several days I was unable to pump on a regular schedule so I had to supplement with two pumping times close together before and after the scheduled events.
I also was distressed to have to throw away the milk I was producing and was so concerned this might affect my supply (my breast feeding experiences thus far showed a lot of it is mind over matter) I would close my eyes and turn on the water in the sink before throwing it away so I could not hear it and would not see the milk being dumped. This was not as much of a problem the second week as I felt I had made it far enough that my supply was not in danger of drying up and the time was nearing when I would be reunited with my daughter.
At the end of these two weeks I found for my case my hypothesis was correct. My daughter continued nursing and I even found she nursed more than she had before and I felt we were able to reestablish our bond as mother and daughter easier thanks to continued breastfeeding. The day I returned my daughter recognized me right away at the air port and came running to me. She then insisted I only hold her the rest of the time we were at the air port. She did not immediately request to nurse, however after I asked if she wanted to nurse she requested it twice and nursed for 5 minutes each time within a 20 minute time frame. I did not feel as though she was getting much milk at that point, it was almost as if she was testing to see if there was still a milk supply after so long. Once we returned home she nursed long enough to start the flow of milk and continued nursing for 30 minutes. The next two weeks she nursed more intently then she had before I left. After two weeks being home she has gotten back into the same nursing routine we had previously established and seems to feel comfortable that I will not be leaving again soon.

Thursday, July 24, 2008

For as long as you both shall nurse…

I’m a Navy Reservist and yesterday I had a 6 hour physical. Aside from being extremely fun (not) it was long enough that I had to pump at least once less I make a puddle on the floor and soak the little gown they gave me to wear while waiting for the doctor. I asked the nurse if, since the wait would be at least 30 more minutes, I could sneak out to pump milk for my daughter and then come back. We’ll this caused a very big commotion that surprisingly ended every nice. I expected to get lectured about why nursing my 18m old daughter was not needed and even if I was, why was I pushing do to it right then. Instead I found an understanding gentleman that mentioned to me “It is a shame that breastfeeding is looked upon so negatively in the US. In other countries it is normal to see women walking down the street and feeding their baby.” He then let me borrow his office so I had a chair and not a toilet to sit on and even let me keep my pump in his office instead of the baggage area. That was a pleasant surprise; I was ready for a fight.

There is only one thing that can be said about the length of time you nurse, it should be according to you and your child’s desires not your in-law, parents, best friend, or neighbors. The World Health Organization recommends two years and I honestly believe I can see the difference between my daughter and other children that weren’t nursed as long and the benefits (I feel) are far beyond medical in nature.

Extended breastfeeding may not be for some people, but let’s be less judgmental and more understanding. We are only trying to be the best parents we can be.

Tuesday, July 15, 2008

My daily pumping sessions. Mooo…

I already went over the schedule of my pumping sessions, but I thought I would add this funny story. A while back a purchased a hands free pumping bra “dohicky” it wasn’t really a bra just a Velcro strap I would wear when I was pumping that held the bottles in place.
Well I was carrying it to my little pumping closet at work one day and my friend asked me what the white Velcro strap was for, I told her and she laughed and said “mooo”. At first I thought, hey I’m not a cow just a milking mama, and then while pumping I looked down at my hands free kit milking away and pictured in my mind a photo of a milk cow getting milked by the machines at a dairy farm. I laughed outloud and even did a little “moo” myself.

It’s all mind over matter…

As far as supply goes I have found it is a case of mind over matter. Just like the Little Engine That Could, you can provide enough milk for your baby if you believe you can. I have to note there are exceptions to every rule, but for the most part this is true. If you want a good supply then nurse a lot especially at night. Co-sleeping works great to build up supply, or if you not comfortable with that then you can pump on one side and nurse off the other at each night feeding. I did this for about a month and it not only increased my supply, it also helped me build up a good supply of froze milk for when I returned to work.

For keeping up a supply at work it is all about your commitment to pumping, the more you pump the more you’ll make. The first few months are hard and exhausting. Some days I would finish pumping and feel like I had just ran a race. Depending on how long you are at work you should set up a schedule and stick to it. Even if you are busy pump for 5 minutes, everyone can take a 5 minute break to regroup and it’s very relaxing. This commitment to a pumping routine will help keep your mind on your baby helping build a deeper bond.

Here’s my pumping schedule and how it changed as my daughter grew:

3 months to 10 months old
4 times a day, once before work at about 630am, once at each 15 minute break (9am and 2pm) and once at lunch (1200pm)

At 10 months I dropped the pre-work pump and went to 3 times a day because my daughter was eating solids and just not interested in my frozen milk.

Once she turned a year old I dropped it down to twice a day, once in the morning and once in the afternoon. I only did this to keep up my supply; all the pumped milk gets donated. I tried going to just once a day pumping in the morning, but my supply really dropped and my daughter would get upset with the lack of milk when she would nurse at night.

When I am with my daughter we nurse whenever and wherever she wants for the most part.

My grandmother tells me that working moms are special and I truly believe that. I’m happy to talk to anyone who wants to work on building up their supply or has questions about working and nursing. It helps to have a friend who’s been there and done that.

Monday, July 7, 2008

What I wish I knew before I started breastfeeding…

There are two things that helped me get through the first few weeks of nursing which turned out to be very painful and trying thanks to my lack of knowledge; first was reading and learning all I could about breastfeeding and second was actually an add for breastfeeding in a parenting magazine (I can’t remember the name or the exact words) basically it was a mom talking about having a very painful experience nursing and promising her husband to keep it up for the first 6 weeks and by the time that came around it was hurting much less and at two months she was completely healed and loving nursing. I decided after reading that I could stick it out for two months and it was true, at two months nursing was no longer a painful sacrifice I was making for my child it was actually an indulgence and something I loved doing (especially when my daughter would fall asleep at my breast).

Now here’s my list of what I wish I knew before I started breastfeeding:
Nursing doesn’t always come naturally so learn all you can about it before you start.
Get support, any nursing mom would love to give you advise or tell you it’s going to be ok, there are groups too and I highly recommend joining and attending meetings with your local Le Leche League group.
It’s ok to ask for help and cry, if only I’d known this. I was such an emotional wreck and so clueless I didn’t seek out support and ask questions until my daughter was 1 year old.
It will take time, but if you figure how long it takes to get a bottle ready and then clean them after nursing is big time saver, not to mention the milk comes pre-warmed at 246am.
Don’t set a time limit for how long you will nurse, originally I said three months and that’s it. My daughter is 18 months old and we still both lover our nursing sessions. If you do the other four steps you’ll find it will be worth going as long as possible.
Hide the clocks for the first few weeks. You can sleep whenever you baby sleeps so don’t worry if it’s 246am and this will work even better if you co-sleep.
The house will get dirty so stop fussing. Nursing is such a commitment on your part that other things have to be let go or you just can’t keep up and something will give. Ask a relative to help, or just stop worrying about it. There will come a day when your house is always in order and spotlessly clean and you will miss the days when it was a disaster because you were spending all of your energy and time holding a brand new baby.

Wednesday, July 2, 2008

A Begining


This is the story of my nursing experiences in hopes it may help others.

To introduce myself; I am a premed student and married mother of one. My breastfeeding started off on the wrong foot (or nipple if you prefer). First I had NO idea what I was doing. When my mom asked me (less than a week before my daughter was born), "Do you have any nursing bras?" My reply was, "why would I need a special bra, I was just going to use the ones I have?" So you can see how clueless I really was.

Over the past 18 months my relationship with breastfeeding has transformed from clueless to lcativist. My purpose for pursuing medical school is to promote breastfeeding. I truely believe the best start for all children is at a loving mother's breast and that start should be encouraged and supported by the medical profession.

I will have more posts to come on anything and everything breastfeeding related. Please feel free to visit often and leave comments on what you would like to see next.

-AJ Lewis