In general, I don't talk about my personal life on this blog, unless it pertains to pregnancy/birth/breastfeeding/parenting issues. That's a pretty big "unless" there, I know, as I just totally spilled my guts about postpartum OCD, and have told both my birth story and nursing journey in graphic and harrowing detail, but I see these as having context that applies to the content, if that's not too wordy. But I need to get something off my chest.
There are some blogs out there that are pissing me off in their extreme awesomeness.
First of all, there is Mila's Daydreams, first recommended to me a few weeks ago. What do I do when Lily naps? Well, I'm pretty much doing it right now. This, or getting my social fix for the day on Facebook, or trying to catch up with overdue posts for my food blog, or sometimes studying for a certification, or eating, or racing around the house to try and straighten up while I have a chance of not having my work immediately undone by the Tasmanian Toddler following behind.
Then there's Lucy & Ethel Have a Baby: The Adventures of Shrike, Whozat and Peeper. They're a lesbian couple who had their adorable baby (Peeper) almost two years ago. Their entire story is fascinating, from the conception and birth through a difficult yet inspiring nursing story and even Peeper's open heart surgery, but what grabs me in my guilty bits is the letter she writes to Peeper each and every month.
These posts detail what she's doing, what she's eating, what she's interested in, what's been going on, and just generally are filled with awe and aww and abundant affection. They are loving and detailed and exactly the kind of thing I set out to do when I purchased a pregnancy journal about 3 years ago. Oh, I wrote in it, rather lengthily, too - twice. And never again since - it's one of those things, you know, how the longer you go without writing in it, the harder it is to start up again. I've sporadically posted pictures and some commentaries in a baby blog for Lily, but it has been overrun with kudzu-like spam of late, and I haven't even included a link to pictures there in months. Lucy & Ethel also post pictures every day. Literally every day, in "The Daily Peep". My long distance family would seethe with envy at the disciplined devotion.
Finally, we have Enjoying the Small Things. This one first came to my attention (and many others) when this stunningly gorgeous mother gave birth to her second daughter, only to discover that Nella has Down syndrome. The post that tells this story is a masterpiece of blog form, and one of the most moving things I have ever read. I dare you, try reading it with dry eyes. Go ahead.
The posts that follow that, as Kelle and her family come to terms with - and beyond that, embrace and celebrate - this unexpected development, are equally wonderful. I'm blown away by the whole experience, and deeply grateful that she is willing to share this with all of us. It's a tremendous gift.
But then she has to go and live her normal life, which on an infuriating DAILY BASIS appears to consist of nonstop adventures with her girls, who are always dressed to the nines, right down to the accessories and matching pedicures for all. I haven't gotten a pedicure since I was about 7 months pregnant, and Lily's lucky if remember to nibble her nails off in her sleep. There are endless delightful treats, crafts, parties, trips, beach days, all seeming to be have a crew of stylists behind them, and (did I mention she's a talented photographer, on top of everything?) photographed in expert, crystal-clear, perfectly composed Technicolor. And did I mention she looks like a supermodel 100% of the time? In every single frame?
Seriously, it's not like she saves these things up and posts a collection of fabulous once in a while. I subscribe to her blog. It's like every. freaking. day. How can this be? How can someone engineer the amazingness that is their life AND be that put together all. the. time? For me, getting to take a shower without cutting one grooming task short due to whining and/or destruction taking place outside the shower curtain is, like, a monthly event, and I only have one child. Are we the same mom species? Are we even on the same mom planet?
Stop being so dang great, all of you!!! *shakes fist*
Not really. I think you're wonderful. Keep on keepin' on. But if you're ever in the mood to share your secrets on how to be so infuriatingly awesome (and no one would blame you for protecting your hoard), do drop a line here!
And in the meantime, I can try to start with some baby steps. Perhaps one craft a week. One dress-up day. And maybe I can write another letter to Lily - I can never make up for not having done so every month, but perhaps I can write about our first 2 years, and then try to do so annually after that. If I go beyond that, then I'm an overachiever. RIGHT?
I've been shopping around looking for videos to use in my childbirth ed classes. Many have spoken highly of this one: "Everyday Miracles". I plan on buying the DVD, but handily, it's also available to view via the excellent, resource-laden Mother's Advocate site.
I'd love to hear your thoughts on it. I think it could be good as an introductory video - it's a good overview, and I like that it shows some supportive, natural practices in a hospital setting (since, realistically, that's the majority of whom I will be teaching). It's only 8 minutes in its entirety, another advantage for class.
What do you think?
I do want to find videos that are a little more, well, graphic. While being more liberal than you might see on basic cable, these deliveries are still pretty sanitized, and I think it's a good idea to get both mom and partner very comfortable and accustomed to the realities of birth. Thoughts from a Doula had a great post about this - I do hope to follow her example! A sliced-up excerpt:
A few of the dads in my last series came in with some squeamish reservations, putting on a brave face but doubting their ability to view and supportthe act of birth without some sort of visceral or fear-based reaction.I had a lot of questions on the first day about the emotional repercussions that couples experience in their postpartum sex lives as a result of the dad’s ‘trauma’ by seeing the birth, and also a lot of questions about what exactly they would have to see, and if it was possible for them to see little, less, or none of it at all.I heard about fear of blood, and being afraid to watch their partners be in so much pain and not being able to do anything about it—the old adage that partners of laboring mothers are ‘helpless’.These are not uncommon questions, and I get them all in some form with every group.
I start slow, showing things on the more modest end of the spectrum, and work my way up to a few more ‘extreme’ births.Starting slow is no consolation to many dads, as they have never seen a birth in their life, and it seems so PRIVATE and INVASIVE and INTIMATE and PAINFUL to watch.To say they are uncomfortable when viewing these films is quite an understatement.
So, we start slow, but I don’t pull any punches.This is desensitization.I will explain exactly what they are going to see, what they need to watch for, and what I want them to learn from watching each film.My goal here is for them to see so much birth that it starts to look familiar, and no longer sounds the alarm in the part of your brain that detects danger.This same part of your brain produces anxiety as a fight or flight response to perceived ‘danger’.By watching these videos week after week, I take away the threat that theses birth images pose from the men in my classes.It’s a slow and subtle process, but it works.Even if they make faces, or turn away, they slowly acclimate to the images before them, so that when their partner is laboring, he has nothing left but the knowledge of what to do to comfort and support her, and his own emotions of anticipation, excitement, empathy, and perhaps a little sleepiness.
I perform my weekly ‘exposure therapy’, where we see bodies and births and babies galore.Eventually their responses grow less physical, and I see fewer and fewer grimaces, even as I start to show videos that are VERY graphic, and more intense than anything they are likely to see at their own birth—like the unassisted home birth of twins, where the second one is a footling breech.They may not enjoy the videos, but they don’t bother them much anymore. And since I have 12 weeks to do this, it’s quite effective, and in the end, they almost all thank me for showing the videos I did, realizing that this allowed them to attend their birth without fear—something birth classes often only focus on for the mother.
So for those who are more experienced teachers, what videos do you like? There's another classic childbirth ed video I've heard good things about called "Special Delivery", but I don't know if it's worth the higher price, especially if it seems dated. I'm also reluctant to use "Birth into Being"/"Birth As We Know It" since I worry about the freaky hippie alienation factor (though I myself appreciate the lessons therein). Can you tell I'm extremely picky? I do plan to use YouTube, for sure, so either formal DVDs or public YouTube videos are all fair game.
By the way, I'm definitely opening with this, a.k.a. contender for the best birth captured on film of all time:
Just when the disgruntlement over her Tweets that criticized women nursing in public finally subsided, Kim Kardashian steps in it again with a short piece on her latest news in Allure magazine. The Lact-Signal is being activated as we speak (I was alerted by Blacktating, myself), and I'm sure the response will be widespread and vehement. Despite my respect for her sister, I realize she's ultimately just an heiress who lucked into her life. I also realize that if anyone based any decision, much less a parenting one, on what she has to say, that decision would be just as idiotic as her remarks. But when high-profile people like Kim say things like "They say after a year there's no nutrients [in breastmilk]," it DOES have an impact, especially on young women.
To be fair, it's nice that she says she plans to breastfeed for 6 months, which, to clarify further, is the AAP and WHO minimum recommendation for exclusive breastfeeding; a distinction often lost. The AAP recommends a minimum of one year of breastfeeding in general (starting to add solids or any other substances no earlier than 6 months, in other words), while the WHO recommends a minimum of two years. Is it picky for me to quibble over these finer points? Maybe. But I see it all the time, all over the net in particular, the perception that the official recommendation is "no more than a year", when in reality just the opposite is true.
Sorry, I got distracted there. Point being, Kim is not a public health official and is not responsible for promoting (or even just providing accurate information about) breastfeeding, no doubt. But I really wish she would refrain from making completely baseless and uninformed statements about it. Likewise, MTV is not a public health organization, either, and promoting (or even just providing accurate information about) breastfeeding is not their job. But between "Teen Mom" portraying formula as the norm to its impressionable audience of young women and statements like this, we've got our work cut out for us.
Thank the gods for campaigns like Best for Babes. I wonder if we could convince Kim to send them a donation in penance? (KIDDING about the penance.) (Or am I?) (Yes, I am.) (But a donation would still be nice.)
Time to wrap up quite the prolific World Breastfeeding Week already! I'd like to share my own essential must-reads. Part are from this week, and some are just all-time favorites. First off, Dr. Jennifer Thomas on the utter normalcy of breastfeeding. Turns out it's actually NOT new, but being passed around like crazy this week, and it was new to ME, so I'm including it here. Dr. Jen, we need more pediatricians like you, with a "IBCLC" following the "MD" (or we could just improve medical schools so additional training in human lactation was not a special bonus one has to seek out externally, but instead integrated from the beginning, but I'm a crazy dreamer like that).
On that note, here's a great open letter from a woman to her school, taking them to task for teaching her and her classmates absolutely nothing about lactation, whether human or any other mammal. She's a biologist, not a doctor, but the pre-med students were in the exact same classes she had. Can you tell this is a major peeve of mine? This HAS GOT TO CHANGE.
Two posts on social factors influencing breastfeeding were featured on Blacktating, one by Elita and one a guest post. "Bye Bye Breast Burka" talks about the broader ripple effect that nursing covers have on society, and then Elita asks a damn good question of our own community: "Where Are The Images of Black Mothers?" (Hint: They're sure as hell not where they most need to be.)
On the research front: There's ALWAYS new research coming out revealing more infreakingcredible properties of breastmilk, but one study happened to pop up in everyone's feed this week, about the newly discovered purpose of certain milk sugars in human milk that were previously thought of as having no real benefit. Turns out they help protect the gut! Snip:
Dr. German sees milk as “an astonishing product of evolution,” one which has been vigorously shaped by natural selection because it is so critical to the survival of both mother and child . . . Such findings have made the three researchers keenly aware that every component of milk probably has a special role. “It’s all there for a purpose, though we’re still figuring out what that purpose is,” Dr. Mills said. “So for God’s sake, please breast-feed.”
Also popping up in many a feed over the last few days is today's Weekend Movie, "Prescription Milk" a documentary on the vital importance of human milk for preemies. Please check this out, and consider donating if you can!
Finally, some classics:
Addressing the many internet brouhahae that erupted after a study earlier this year broke down the cost of our low breastfeeding rates in both the financial sense ($13 billion) and in terms of human life (almost a thousand a year), two women kicked particular ass: The Feminist Breeder and Melissa Bartick herself. Bartick puts particlar emphasis on the impact of maternity care on breastfeeding, which is to say, she had me at hello.
Speaking of birth practices influencing breastfeeding, this roundup would hardly be complete without Best for Babes' campaign to Beat the Booby Traps. It's a genius approach and I'm thrilled they're doing what they do.
Annie of PhD in Parenting lays her motivation out in "Why I Blog About Breastfeeding", to which I hereby add an eloquent "DITTO"!
An article that I referenced in my own post on early supplementation addresses a risk that doesn't get talked about nearly as much as nipple confusion and supply issues: the impact foreign, non-human proteins have on a baby's gut: "The Case for the Virgin Gut". Exclusive breastfeeding should be clearly defined, and should be the goal for a minimum of 6 months whenever possible, according to both the WHO and the AAP, and this goes a long way toward explaining why. Kellymom's page on delaying solids breaks it down well too.
And finally, the one article I implore all women who want to advocate for breastfeeding in any capacity to read, the classic "Watch Your Language" by Diane Weissinger. She talks at length about why the language we have all come to habitually use in our conversations about breastfeeding is actually counterproductive. Breast is NOT best. If you haven't read this or heard this argument before, you're probably flinching at the statement. What?! What are you talking about? Breastmilk has so many benefits! It's the perfect food! It's the ideal way to mother! I thought you were a lactivist. Are you kidding?
Go read it. I still have to make a conscious effort to change my own language, and sometimes doing so with compassion involves treading very carefully, but the effort IS worth it. Here's a recent WIC campaign that puts Weissinger's position into action. Look how powerful and simple the result is.
I hope you enjoyed reading these as much as I did! Special thanks to The Leaky Boob for hosting so many great pieces of work.
And so the stage was set. An intense case of baby blues, which dissolved into a few days of still-concerned but mostly oblivious reprieve, which then segued into the full-blown crisis of our multifaceted nursing situation.
From here, I could continue the narrative from where I left off in part one, but much of the details would be redundant, as I've told most of that tale already (though without as much elaboration on the early days as I just did). Rather, I want to start with an excerpt from an excellent post by Postpartum Progress: The Symptoms of Postpartum Depression (In Plain Mama English).
You may have postpartum anxiety or OCD if you have had a baby within the last 12 months and are experiencing some of these symptoms:
Your thoughts are racing. You can't quiet your mind. You can't settle down. You can't relax.
You feel like you have to be doing something at all times. Cleaning bottles. Cleaning baby clothes. Cleaning the house. Doing work. Entertaining the baby. Checking on the baby.
You are worried. Really worried. All. The. Time. Am I doing this right? Will my husband come home from his trip? Will the baby wake up? Is the baby eating enough? Is there something wrong with the baby that I'm missing? No matter what anyone says to reassure you it doesn't help.
You may be having disturbing thoughts. Thoughts that you've never had before. Thoughts that make you wonder whether you aren't the person you thought you were. They fly into your head unwanted and you know they aren't right, that this isn't the real you, but they terrify you and they won't go away. These thoughts may start with the words "What if ..."
You are afraid to be alone with your baby because of the thoughts. You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague.
You have to check things constantly. Did I lock the door? Did I lock the car? Did I turn off the oven? Is the baby breathing?
You may be having physical symptoms like stomach cramps or headaches, shakiness or nausea. You might even have panic attacks.
You feel like a captive animal, pacing back and forth in a cage. Restless. On edge.
You can't eat. You have no appetite.
You can't sleep. You are so, so tired, but you can't sleep.
You feel a sense of dread all the time, like something terrible is going to happen.
You know something is wrong. You may not know you have a perinatal mood or anxiety disorder, but you know the way you are feeling is NOT right. You think you've "gone crazy".
You are afraid that this is your new reality and that you've lost the "old you" forever.
You are afraid that if you reach out for help people will judge you. Or that your baby will be taken away.
She did an additional Plain Mama English post on postpartum psychosis, both of which I encourage you to read, bookmark, and share liberally as needed, especially if you work with new mothers in any capacity.
Anyway, reading that list was an epiphany for me, one of two major ones that led to the titular self-diagnosis. There are so many bullet points that describe my state for months on end. I'll go through some of them specifically:
Your thoughts are racing. You can't quiet your mind. You can't settle down. You can't relax.
How I relate to this. I had to spend so much time both pumping (every 3 hours around the clock, 2 alarms were set for overnight) and on feedings themselves, and both required me to more or less not be doing anything else, at least on a physical level. The various techniques we used differed depending on her progress over time, but they all required effort and focus and some combination of equipment. There was no wearing my newborn in a sling and going about my business as she suckled away, no reading books, no idly jotting down precious newborn memories into a keepsake journal, no relaxing and snoozing as we nursed in sidelying repose. Nothing I had pictured my life as a breastfeeder would consist of. Every feeding, 8 times a day, was a major Process.
Pumping, which I did for 15 minutes immediately after every feeding, took less mental energy once I got myself set up (I will describe my pumping station setup* in the footnotes; I thought it pretty ingenious and it could be helpful for anyone trying to fit pumping into their routine), but I was still immobilized. And I vividly remember how my mind would just SPIN, thinking of everything I should be doing and would be doing as soon as I could leap up and into action. I would think and rethink, order and reorder, everything. Label milk, put into refrigerator, rotate the stock and transfer oldest into storage bags, relabel, put in freezer, clean pumping shields and collection bottles, change diaper, put amount she drank and the diaper onto the logs - NO, WAIT, log the amount she drank first, then put the leftover into the milk rotation, then change her diaper, then . . .
You feel like you have to be doing something at all times. Cleaning bottles. Cleaning baby clothes. Cleaning the house. Doing work. Entertaining the baby. Checking on the baby.
There were the normal mothering chores and the extra lactation-related tasks I had on my plate, both carried out in a sense of focused franticness, but even healing things became tools of obsession. My lactation consultant (the second one, the IBCLC with whom I worked for months) was very holistic, and she recommended a number of associated things that were meant to support the process. All of them good things, like cobathing, flower essences, homeopathy and EFT, but my own growing mania twisted them. The feeling that I always, always had to be doing SOMETHING was constant.
And it went on like this. One of the things that saved me, in several ways, was actually television. I am not a major TV watcher normally, though I don't abstain entirely either - I have select shows that I love and cherish, but don't usually indulge every day, much less for hours on end. But this season of my life? The TV was on for almost all my waking hours. It's the one thing that could help to quiet my racing mind while I sat motionless in the glider, the pump wheezing and groaning away. It didn't quell my the jungle drums (to quote Anne Lamott) completely, but it helped.
I started watching Top Chef, Project Runway and some other Bravo reality series, knew the Food Network lineup by heart. I watched Roseanne reruns at the 3 AM feed & pump and Angel reruns at the 6 AM one. I watched the Planet Earth documentary series. When nothing in particular was on, I turned it to CNN. Not only did this help with the mind mania, but it helped me feel somewhat - somewhat - less isolated. And, ironically, tethered to the real world, even if it was a fictitious one on the surface. The isolation was by far the most damaging factor, though, as a major risk factor for all types of PPMD. This was hard for me to accept, as I've always enjoyed time alone, even thrived on high-quality, productive introversion, but for new mothers, solitude quickly turns malignant.
At this time, my relationship with Lily's dad was still long-distance, with him visiting us an average of one long weekend a month - occasionally a week or a bit more, but usually less. Long story slightly shorter, in order to be a little bit closer to Boston and New Hampshire, where he would do work when in the area, I had moved 50 minutes away from where my work and friends and life had been centered, to a nice but very much isolated little cabin on a lake. Though meant to be temporary, it was obviously still a frustrating situation for both of us, and I know he agonized over the questions on what the best choices were as much as I did. To top it off, around month 3 or 4, Lily suddenly decided she hated the car after being perfectly content or instantly asleep during all trips for the first few months, and given the distance from anything relevant, this compounded the isolation.
I don't waste much time on regret, and grueling as some of my experiences have been, I still cherish their lessons, but if I could change only one thing about the whole experience, the decision to live in such solitude would probably be it. (I mean, I'm talking about things I can control, conscious decisions that I've made - obviously if I could magically have skipped the whole ordeal and nursed without difficulty, I'd choose that, despite the character-building-ness of it all.) After the initial few weeks of help, partly covered by Lily's dad being in town and partly by my visiting relative, a few midwife visits and such, I was pretty much on my own most of the time. One good friend, who had been my doula and lived a bit nearer than most other friends 45 minutes away, came by twice a week at first, bearing meals and a shoulder, and eventually leveled off into once a week, very understandably considering the busy nature of her life.
And the time stretched on. I would go for days without seeing another adult, sometimes days without even leaving the house. Daddy did the best he could from afar. My weeks were built around Lily's regular chiropractic/craniosacral therapy and the nursing support group run by my second lactation consultant, IBCLC Jennifer Tow, the one who finally figured out what was really going on. This was a group made up of women who had faced or were currently facing severe difficulties; it was not uncommon for women to have seen several other lactation consultants who had been unsuccessful in helping them to resolve their issues before coming to Jennifer.
NOTE: In my case, in case you were wondering what the hell HAD been happening during the mystifying prologue that made up part one: Lily was tongue-tied, first of all, and also had some serious reflex depression due to her extreme molding. Check it out:
My poor little squishy, about 2 hours old.
Anyway, some molding is normal of course, and even dramatic molding will eventually be resolved - and a huge part of that process is: nursing. But because Lily was unable to latch due to her posterior (and thus elusive to many well-meaning but underinformed practitioners) tongue tie and her inability to open her mouth widely, this was not happening. Cranial nerves, as her first therapist explained to me, were being compressed, in layman's terms. This is why she never rooted and never sought the breast herself. Here she is, all blissed out from craniosacral work:
So, because my milk came in (a combination of luck and pumping**), during that first week, she was able to get enough nourishment to get by just from my letdown, even though she was basically doing nothing to actively draw milk out of the breast. Then, the 10 day growth spurt hit, and she slept more than usual. My supply started to adjust. Suddenly Lily wasn't getting the effortless outpouring of milk anymore, and the descent into hell began.
The first lactation consultant, Judy, was exceedingly kind and caring and DID help me to the extent she was able; she got me pumping, without which I would would likely have had low supply issues on top of it all, and taught me to finger-feed. This got breastmilk to the baby, always priority one. And she also treated me with kindness. But in my last phone call, I could tell she had basically come to the end of the line. So I floundered on my own for weeks, until I finally saw Jennifer at almost 6 weeks. She was a major godsend, and that group was a godsend too. There were two other moms who were currently in the midst of a similar nightmare, and they became lifelines both in the meetings and on the phone. Again I'm at risk of becoming redundant, so I refer you to this epilogue on the nursing saga, where I acknowledge some of the lessons.
Back on the topic of the OCD madness: other bullet points that resonated, and by resonated I mean slapped me upside the head:
You are worried. Really worried. All. The. Time. Am I doing this right? Will my husband come home from his trip? Will the baby wake up? Is the baby eating enough? Is there something wrong with the baby that I'm missing? No matter what anyone says to reassure you it doesn't help.
I mentioned one experience in part one when Lily had peed on a heating pad and I completely lost my mind over it. That was the first incident, but it somehow set a theme in motion, I believe. The first time she threw up I was utterly terrified that she was critically ill (I'm talking actual vomit, not just spitup), and every time it happened thereafter it would plunge me into absolute hysterics all over again. The first time I had to drive her anywhere alone was an hour-long drive to the chiropractor/craniosacral therapist, and I may have had the first panic attack of my life merging onto the highway. I think I drove about 40-45 mph the entire time, often on the shoulder, heart pounding, dumbfounded by the fact that other parents seemed to manage to do this all the time, putting their precious babes into shiny metal boxes and hurtling along at what now seemed like impossibly irresponsible speeds.
Those are just a few examples. Suffice it to say that everything panicked me, everything - most of all, her input and output. Repeating from that last bullet point:
Is there something wrong with the baby that I'm missing?
I described in part one the experience of having my fears about Lily's issues dismissed only to later be proven right - you can imagine how this affected my parenting and my management of the situation. Actually, you don't have to imagine it - I have pictures. This says it all, in its way:
Can you guess what those are? Here's another shot:
Yes, readers, those are my logs. ONE FULL YEAR'S WORTH. I logged every single feeding and every single diaper for her entire first year. I'm not exaggerating when I say "every single". I never went anywhere without them, perplexing my loved ones. No matter what, I could not change a diaper without noting it. I literally felt physically unsettled, queasy, blood pressure rising, until it was recorded, by time (after the first few weeks, if it was poo, it was noted as such, otherwise simply writing the time indicated a wet one). No, Lily, you don't have a lovingly crafted scrapbook of your first year, with locks of hair, longhand memories and milestones recorded, but you do have a pile of chicken scratch on paper documenting every nuance of your digestive function. Precious.
And feedings? Oh, how I obsessed over the number of ounces she got per day - something no breastfeeding mother should ever need to do if things are going well. I tracked the number of ounces per feeding and added them up, and if it was less than what a normal breastfed baby was estimated to eat, I was despondent, set off into a whirlwind of worry about what was going on now on top of still not being on the breast. Eventually, when we transitioned to the Lact-Aid, I also tracked minutes spent with tube in use, minutes without, and total ounces consumed. It was positively algebraic.
Were we scheduling feedings? To a degree, yes, we were. Because I had to pump every three hours, and because we often were working on some means of getting her on the breast during every feed (i.e. offering it at the end of a feeding, with or without a shield, hunched over her, pleading and pleading. Please. PLEASE latch on. Please.), I wanted to make sure my milk was plentiful while we were working at trying to latch, and this was best done right before pumping. If she seemed hungry earlier, I absolutely would move the feeding up. But there's no denying that my life was built around 3 hour blocks of time. No denying it at all. When my alarms went off to pump overnight, I fed her first, out of a dead sleep. Every time.
And - true, shameful confession time - I do believe I overfed her for a while, especially during the phase where we used bottles in the "paced feeding" technique. This is a common pitfall of feeding via bottle even when there's breastmilk in the bottles. There's a perception out there that you can't overfeed a baby with breastmilk - this is just patently false. If it's coming from a bottle, you can all too easily overfeed. It can be avoided, but this takes a lot of mindfulness. In our case, she wasn't reclined with me pouring it down her throat, as she needed to develop the strength to suckle***, but I found ways to get her to continue eating if she had only finished 2 ounces instead of 2.5 or 3. I tickled her under her chin. I wiggled the bottle in her mouth. I overrode her own self-regulation by attempting to get her to "finish the bottle" instead of being guided by her satiety cues. I'll forever feel terrible about this, and I even worried about it at the time, but after the scarring experience of her weight loss, I'm sorry to admit that that number on my log was more important to me at the time. (Please forgive me, Lily.)
That leads me to another part of that one bullet point:
No matter what anyone says to reassure you it doesn't help.
Many of my late night phone calls (during which various members of the nursing group, Lily's father, my friends, and Jennifer herself would take turns talking me off the ledge) were absolutely helpful. It lessened the despair, at least for the length of the call. But I know they must have been frustrating for them at times, because I had to run through the same conversations over and over and over. And over. And over. The same reassurances would be offered, and somehow I just could not let them sink in. This particular symptom came up not long ago, when a CLC-in-training and I were working on a case together, where the same information was being given to a mother, over and over, from multiple sources, and somehow it just could not get through. The CLC mentioned this aspect of postpartum OCD being discussed at her training, and I immediately recognized myself in it.
I remember railing to Jennifer about my terror that Lily just was not eating enough, she couldn't be, she only got 23 ounces yesterday, how can this be happening? and on and on. Jen patiently kept bringing me back to her weight gain, which had been totally fine from week three on, and diaper output, which was more than adequate. This was just not enough to convince me. I'd repeat myself, again and again, she would respond with reason and evidence in the form of diapers, rinse and repeat. Finally, understandably exasperated, she said "Anne, it's not like she's taking it from the atmosphere!"
This broke me out of it, at least momentarily, and I laughed, and had a bit more self-awareness come back. My obsession with the logs wasn't over, I couldn't let go of them until she was just over a year, but my recollection was that after that conversation, I DID ease up on my fears a bit, as I was always able to come back to the idea that my baby had found a way to metabolize the moisture in the air just to throw off the diaper logs and mess with my mind.
(I am forever after indebted to Jennifer not only for her wisdom, but her patience, and the group for their empathy.)
Logs, man. They are a double-edged sword. Proceed with serious caution. They are useful to get an idea of what's going on at the beginning, especially if you suspect something's amiss. They're also helpful for twins, maybe for a little longer. But I strongly recommend that if everything seems to be going well, DON'T. And even if there are issues, once they start to be resolved, give them up as soon as possible. It just becomes lunacy in the wrong hands. Same goes for scales - I used one to weigh her before and after feeds for a few especially tedious weeks, and fortunately was talked out of continuing. That way lies madness.
You are afraid to be alone with your baby because of the thoughts. You are also afraid of things in your house that could potentially cause harm, like kitchen knives or stairs, and you avoid them like the plague.
You feel like a captive animal, pacing back and forth in a cage. Restless. On edge.
You have to check things constantly. Did I lock the door? Did I lock the car? Did I turn off the oven? Is the baby breathing?
You feel a sense of dread all the time, like something terrible is going to happen.
Yep, these too. I never had repetitive thoughts of intentionally harming her, luckily, but I did fixate on the possibility of accidentally harming her, in every conceivable way. The OCD manifested primarily in the logs and the whole ritual that was built up out of the 3 hour cycle of feed, pump, clean and prepare next supplement, then do everything else there is to do in life in between, but these other typical OCD thought patterns were there, too.
You can't eat. You have no appetite.
You can't sleep. You are so, so tired, but you can't sleep.
On these physical symptoms, well, in the first case, I had just the opposite reaction, but this is not uncommon if there's a history of eating disorders, which there is (gosh, I'm just letting it ALL hang out here, aren't I?). I initially dropped about 25-30 pounds very quickly in the early weeks, but then I stalled, and eventually, I actually gained a bit of it back. Eating, along with Bravo, Buffy and The Soup, was one of my only sources of solace, and I gave in to it. Even this was not free of effort, as we discovered that Lily had some sensitivities, requiring me to give up gluten and a couple of the other common protein culprits as well. I know eliminating foods can be unpleasant for many moms, but for me, honestly not a big deal after the initial adjustment, especially compared to everything else that was going on. I still found plenty to indulge in, believe you me. Primarily nutritious food, yes, but far, far too much of it.
If you're thinking I should have been working out, then, at least, well, sure, that would have been fabulous. I was originally a dancer, after all, and had thrived on yoga and Pilates for years as well. I love exercise. If I have it to do over with another baby someday, you bet I'll find a way. But aside from walks every few days, I couldn't bear to have another demand placed on me, especially a physical one, and that's just the way I felt at the time. Judge me as lazy if you will.
The sleeping, I managed most of the time, though my racing mind would often cause me to take a long, long time to drop off (which I could never do unless EVERYTHING was done and set up just-so). Naps? Forget about it. I could be so exhausted that I was literally fighting off falling asleep at the wheel in the middle of the day, on the way back from nursing group (this happened far too often), and still I couldn't follow the oldest new parent adage in the books: "Sleep when the baby sleeps." Impossible. There was just too much to do, and no one else to do it.
One final bullet point of note:
You are afraid that this is your new reality and that you've lost the "old you" forever.
This one cut pretty deep. This was the crux of so much. One of the most affecting things Judy did for me in her first visit, when I was at my most despondent and vulnerable, was to grab my hand, look me in the eye, and say firmly, "It is not always going to be like this." And though it took longer than usual for us, eventually, she was right. In a broader sense, I'm still working on this in a way, as integrating parenthood into one's identity is a process, not an event. But compared to the freefall of the first 6 months to a year, I can assure other moms from experience that the best qualities and passions of their former selves are still there, even if on the back burner; hell, even if in cold storage.
So by now, some of you may be wondering, especially if you don't self-identify as a lactivist or breastfeeding advocate: MY GOD, WOMAN. Why didn't you just stop? Trying to breastfeed was literally driving you CRAZY. You tried. Sometimes it just doesn't work. Your baby needs a sane and happy mother more than she needs your milk.
I can see why people might feel this way, and yes, I do agree that children need truly happy parents more than anything (I actually have a draft of a post addressing that very matter). But I don't believe that letting go of the breastfeeding would have helped me at all, and it most certainly was not the cause. In a way that's hard to articulate, I think it's exactly what kept me afloat.
I could have tried to continue to pump exclusively, in order to avoid formula, and I did in fact consider it on many an especially difficult day, but that is extremely challenging to sustain in the long run (massive kudos to the moms who need to do it), and I would also always wonder: What if I had tried for just another day? Another week? Another month? What if we were on the verge of a breakthrough? How could I sell Lily short when we had worked so hard, when SHE had come so far? I couldn't live with that on my mind.
Also? I am stubborn. To say the least. Some who believe in the theory that children choose their parents have pointed out that Lily needed someone who was unusually, even hyperbolically, stubborn; and so if my persistence was literally pathological, perhaps that was part of the plan.
She finally began nursing at five months old, but it took a bit longer for the OCD to fully recede. We eventually emerged, slowly, as she neared her first birthday, partly because nursing eventually became so successful that even I, with all my doubts, couldn't deny that all really was well at last, and, not coincidentally, because we moved to live with her daddy full-time.
Another difficult admission: It took a long time for me not to feel gripped with jealousy every time I heard a new mother describing her blissful babymoon with little to no relative difficulty, and I still occasionally get pangs, if I'm to be completely honest. But as much as I think is possible, I've grown to accept that this was my experience, and that it has its own gifts, especially in the form of my drive to help other new mothers, in various contexts, as my true life calling. (This is also emphatically NOT to suggest that in the absence of challenges like mine, motherhood is always a breeze. Far from it)
The irony is not lost on me. The OCD manifested itself in the things I had to do in order to make nursing work. Breastfeeding was thus both the means of its expression and the very thing that saved me . . .
. . . along with Lily herself, who gave me glimmers of hope all the way through, who continued to draw out my love with her glorious baby self, and who never, ever, ever gave up on me.
Please check out these links on Postpartum Obsessive Compulsive Disorder:
Postpartum Progress: Rate of Postpartum OCD May Be Much Higher Than Current Statistics
*Pumping setup: I plan to devote a post to the handy pumping setup I devised, using a glider, a Boppy and a pillow. It would be best illustrated with pictures and more description, and as this post is already ludicrously long, I'll put it up next week sometime instead. (Handsfree pumps and pump devices are making this much easier for everyone these days already!)
**Pumping and My Left Boob: Also to be elaborated upon next week. Stay tuned.
*** Another post on paced feeding and other best practices for bottle-feeding when necessary, will also be forthcoming.
Jimmie Lynne Avery, age 65, of Athens, TN, died Monday, October 26, 2009 at her home, surrounded by family and loved ones. Succumbing to a life long lung birth defect and resulting lung disease of which most of her Lact-Aid mothers and babies never knew she had.
As I've written before, both here in my unabridged story and on countless message boards where advice on optimal supplementation is inquired about, the Lact-Aid was a significant contributor to my eventual success in nursing. Having tried both, I feel strongly that it's far superior to its mass-produced counterpart, the Medela SNS - and I said so long before I had an inkling about some of Medela's questionable business practices (a complex issue, of course).
But her passing away is even more personal than that, for me. When I called the company to order some parts - a friend gave me a partial unit to use, as we were beyond strapped - I spoke to Jimmie Lynne directly. I expected to simply place my order, give my credit and shipping info, and be done with it, but her friendly voice inquired gently about my situation. I gave it to her in as much of a nutshell as I could.
"You must be exhausted," she said - such a simple statement, but the compassion and sincerity in her voice came through so clearly that I instantly burst into tears. She continued to listen and offered more kindness, telling me a little more about how the device would work and to make sure I called back if I needed any help at all, any time. This was our only conversation, but I'll never forget it. The human touch (well, so to speak, via telephone) was indelible.
It turns out this personal connection was part of her entire philosophy. From the memorial on the site:
She was still helping and counseling mothers four days before her death. Jimmie Lynne helped countless thousands of mothers and babies with a sweet touch that only she had. For nearly forty years Jimmie Lynne would not let any one else at Lact-Aid answer the phone or take orders. She would say that was the most fun job there was “ talking with and helping mothers and babies”.
When Lily was about a year old, I sent the company a thank you letter with an abridged version of our story and got this back:
Anne,
Thank you for sending us your story about your experience nursing Lily. We are so happy to know that Lact-Aid had a helpful part. Thanks for sharing with us, and with others out there on the web. If anyone asks, let them know we love to hear from them, whether it is for questions, support, suggestions, whatever.... The best part of being involved with Lact-Aid, to me, is the contact with so many wonderful people who care deeply about their babies and families, and contact with the LCs and other health professionals who do their part to support breastfeeding.
Give Lily a big hug and kiss from us.
Warmest regards!
Jimmie Lynne
I pray that the company continues on without Jimmie Lynne, and in her spirit. I'm going to offer free advertising on my site, in fact - something I thought of and should have done a while ago.
Thank you for your legacy. The lives of mothers and babies have been forever changed for the better because of you.
World Breastfeeding Week is generating a panoply of incredible writing. Touching, inspirational, galvanizing, fascinating. I plan to do a round-up of my favorites, both from this week and of all time, on Friday, after I post part 2 of my story about postpartum OCD, but for today, I thought I'd post something more rudimentary, to contrast with all the eloquent boobsmithery out there right now. It's a bit dry, but something that's been on my mind.
Even the most rudimentary breastfeeding information usually contains at least a mention of "nipple confusion", the most commonly cited reason to avoid introducing bottles too early. No matter what the supplement happens to be, this is indeed to be approached with extreme caution in the early weeks. Some lactation consultants feel the issue is more accurately dubbed "flow confusion", and it's a fair distinction. Either way, the site Breastfeeding Basics explains it quite well:
The mechanics of breast and bottle-feeding are quite different. When a baby nurses, his tongue and jaws must work together rhythmically, cupping his tongue under the areola, and pressing it up against his palate. This flattens and elongates the tissue around the nipple. He then drops the back of his tongue to form a groove for the milk to flow from the nipple to his throat. He swallows, then takes a breath. His lips are flanged out tightly around the breast to form a tight seal.
When a baby drinks from a bottle, the milk gushes out (you’ll notice that the milk drips out if you hold a bottle upside down). In order to keep from choking, he lifts his tongue uses it to block the flow of milk. He purses his lips around the hard rubber nipple, and he doesn’t have to use his jaws at all.There is a constant flow of milk that he doesn’t have to work for, unlike during breastfeeding, where the milk ‘lets down’ initially, thenslows to a trickle, and the process repeats as the baby sucks harder and longer. This occurs several times during a feeding, and is one of the reasons breastfed babies are less likely to become obese than bottle-fed babies: they regulate their own intake by how long and vigorously they suck. Bottle-fed infants will often finish a bottle not because they are hungry, but because they love to suck, and the milk flows so easily.
The risk of nipple confusion , whether by introducing a bottle or pacifier, is greatest during the early days of nursing.The longer you wait to introduce artificial nipples, the less risk there is of confusing your baby.Breastfeeding is a learned behavior, in most cases, although there are some babies who seem to be born knowing exactly what to do. Although sucking is a newborn reflex, the mechanics of effective latching on aren’t.It usually takes a couple of weeks, and sometimes longer, for mothers and babies to get really good at nursing.
The whole article is quite thorough and worth a read. Should supplementing become necessary early on, while the issues (whatever they are) get worked out, it's far better to use an alternative method such as cup or syringe-feeding, or using an at-breast system like the Lact-Aid (preferable) or the SNS.
Many sources will also go a step further and talk in greater detail about the impact that each instance of supplementation will have on mother's supply, the second common reason often given to avoid supplementing unless absolutely necessary. In the simplest terms, every feeding that does not come from the mother's breast is a message to that breast to not make as much milk. Continued supplementation without working to make up for it WILL impact mom's supply (and in fact, pumping is not as effective at removing milk from the breast as an efficiently nursing baby is, so this decision is not to be made lightly). This is particularly critical in the first 2-3 weeks, when supply is being established in the first place. If supplementation is truly indicated, even if it's done in the best possible way to avoid nipple/flow confusion, pumping will have to be done to make up for it.
Poor early lactation management is so often to blame for this in the hospital - it's one of the all-time biggest Booby Traps. You can see how quickly the vicious cycle takes hold. On the second day, a new mom's milk hasn't yet transitioned from colostrum to breastmilk, despite baby not needing anything else. Supplementation is then recommended by a staff member without adequate training in breastfeeding. Mom accepts the recommendation from this staff member, believing them to be the voice of authority, and supplements with a bottle, wanting to do what is best for her baby. Her supply adjusts itself accordingly and produces less milk, creating a need for more supplementation. And on it goes. A very real problem is created when there was no problem in the first place.
But there's a third reason to take care when supplementing that DOES have to do with what is actually being used, and that has to do with the impact that artificial milk has on a baby's gut. Many people are unaware of the significance of this, even in small amounts, the intestinal flora is dramatically altered. If the supplementation is temporary, it is possible to return the gut to health with weeks of exclusive breastmilk. But if it continues, the impact is permanent. Ann Calandro, RN and IBCLC, wrote the must-read article "The Case of the Virgin Gut: Why Even The Occasional Bottle of Formula Has Its Risks", and I implore you to read it now. A taste or two:
Many babies who are breastfed begin their lives in hospitals that routinely supplement with artificial formulas. Sometimes babies are given artificial milk for medical reasons such as low blood sugars or because their mother is very ill. More often, they are given artificial milk for non-medical reasons, because nurses offer it to keep them quiet, or because mothers are concerned that their babies are hungry because they are nursing so often. Some mothers want to sleep and leave their baby in the nursery all night, so they ask the nurses to feed the baby formula.
Innocent enough reasons – and common. So common, in fact, that very few babies leave the hospital with their virginal guts. But what happens when breast milk is not the only food in that little gut? The truth is very interesting and also very scary.
When babies are born, they have sterile gastrointestinal tracts. If babies are exclusively breastfed, they develop a natural healthy gut flora. This means that the major flora in breastfed babies has reduced numbers of bad types of bacteria and increased numbers of good bacteria. Formula-fed babies have increased numbers of bad bacteria, leaving them at more risk for illness.
It takes many weeks for the baby's gut to close up the leaks in order to seal off germs and to develop the ability to shut out allergenic proteins. If given formula in the early weeks, this closing up is delayed and the risk of allergies and illness increases. The type of bacteria in the gut becomes less protective. In other words, Baby is more at risk for illness.
Just one bottle of formula - given for any reason - can sensitize babies who may be allergic to cow's milk protein or soy protein.
Of course, special circumstances arise, and Calandro addresses them here:
Sometimes the addition of artificial formulas to infant diets is unavoidable for a variety of reasons. If this is the case, there is very little that can be done to remedy the situation and save the virginal gut. Some hospitals provide banked human milk for babies that must be given supplemental food until mother's milk is available. The majority of hospitals do not. Recent studies have shown that giving hydrolyzed formula to a baby born in a family with a history of allergies may be the best alternative if formula must be given.
Marsha Walker, RN and IBCLC, addresses this, along with the aforementioned risks, in her similar and much more technically detailed "Just One Bottle". Walker spoke at a 2005 La Leche League conference in her session "Resisting the Tide of Early Supplementation and Other Selected Barriers to Breastfeeding". The WHO guidelines have long established that the hierarchy of infant feeding is 1) direct breastfeeding, 2) the mother's breastmilk via supplementer or bottle, 3) donor milk, and finally, 4) formula. Walker breaks it down even further:
Marsha notes too that when supplementation is necessary, a hierarchy of foods should be used. The first supplement used should be the mother's own fresh milk, if at all possible. If not, the following choices could be used, listed in order of what is best for the baby:
Baby's own mother's refrigerated milk
Baby's own mother's frozen milk
Baby's own mother's fortified milk (for preterm babies)
Banked pasteurized human donor milk
Hypoallergenic or hydrolyzed formula (the proteins in these formulas have been subjected to a splitting process that reduces their allergy potential. Examples are Nutramigen, Pregestimil, and Alimentum)
Elemental formula (specialty formulas consisting of basic amino acids that are used in more extreme situations)
Cow's milk formula
Soy formula
Water or glucose water
Interesting to note that as of the above conference, though breastfeeding rates had risen, so had supplementation. "For example, in 1982, the overall breastfeeding rate was 61.9 percent, with 55 percent of babies exclusively breastfed and 6.9 percent breastfed along with supplements. By 2003, the overall breastfeeding rate was 66 percent, with 44 percent of babies exclusively breastfed and 22 percent breastfed along with supplements." I'd be curious to see this breakdown today. YES, some breastmilk is absolutely better than none. But we can do better than this for our moms and babies. Much, much better.
[A fourth reason that can hardly even begin to be covered here is the complex influence that supplementation, for any reason and in any form, has on maternal confidence in her body and her ability, but I have to resist the temptation to wax philosophical on that for the moment.]
This is not about being 100% anti-bottle. In our current collective lives, many, many mothers who are devoted to breastfeeding their babies must return to work, and bottles will have to become part of their baby's life in some way. Their commitment to pumping and continuing provide breastmilk during the times they're separated is awe-inspiring, especially if it helps them to get to the minimum guidelines for exclusive breastfeeding recommended by the AAP and WHO. Extenuating circumstances of all kinds do exist - the point is simply to introduce them as carefully as possible, and only use anything other than human milk as a last resort.
It's also worth discussing some of the ways to optimize bottle-feeding, maximizing the bonding opportunities and minimizing some of the potential pitfalls; just because a bottle will sometimes be necessary for some babies part or even full-time doesn't mean the caregivers should give up, figure all is lost, and start propping bottles. Another topic for another day. I leave you with these resources:
Links on how to tell if your baby is getting enough milk and info on true supply issues:
PD: Now about Josie. MD: We are so thankful. It could've been much more serious. We're grateful that it was a diet change that made the difference for her. We changed from breast milk to a predigested formula that has no lactose, and within 12 hours she was better. And, within a week, she was pooing on her own, without us having to give her an enema. She was a totally different baby a week later.
PD: Wow, breast milk was the culprit? MD: Typically, they never want to take a preemie off breast milk, but in her case the lactose in my milk was causing a problem. Her body was not producing lactase, which breaks down the lactose.
PD: Whose idea was it to suggest a possible lactose intolerance? MD: Dr. [Robert] Arrington, he is such an ace doctor. And he encourages moms to breast-feed, so for him to resort to this was a big deal. He wanted to try this, and he asked me if it was okay and I said, 'Yes, anything to help Josie.' He said that breast milk intolerance is a rare occurrence for babies, maybe one percent or less, but he said we're going to try it for a week and see.
The pros in the thread, including author Diana West, pointed out that yes, preemies are often not YET able to produce lactase, as Michelle herself states - but the better course of action is to add lactase to the preemie's breastmilk feedings until he or she can produce it on their own, rather than jumping immediately to formula.
West elaborated: "While it's possible that the parents were given incorrect information, it's also possible the parent misunderstood what they were told. This could be galactosemia where the baby can't metabolize the sugar galactose. It's life threatening in some situations and may (but not always) require weaning to a special formula. It is impossible for a baby to be 'lactose intolerant.' Lactose is a milk sugar that babies need for brain growth and an intolerance to it is only developed in adulthood when the enzyme lactase stops being secreted in the stomach."
At least Michelle Duggar added this much, from the interview above: "He said that breast milk intolerance is a rare occurrence for babies, maybe one percent or less, but he said we're going to try it for a week and see." Even if is is a misrepresentation, and the issue of why they didn't look into the alternative of adding lactase to the breastmilk was not addressed, AT LEAST the doctor wasn't all, "Oh yeah, we see this all the time, formula's just as good, etc."
A mixed bag at best. As West said, "I think it's hard for us to know what is going on in this situation, but the tough thing is that it's now in the media that human milk is dangerous for some babies."
At long, long last, it's finally viewable online: the episode featuring (gasp) a home birth with (squee) Amy Romano, midwife extraordinaire, writer for Science and Sensibility and Rh Reality Check, and all around righteous babe. Not to mention her eminent colleague and partner Vicki Marnin. It takes skills far greater than I possess to be able to embed this kind of video, but just click here to view on the Birth & Beyond site. Ignore the silly, overwrought intro and enjoy.
This was great to see, and I thank TLC for broadening beyond their standard issue cascade-of-intervention fare. Also of note on the same page (belonging to Romano's past practice, Birth and Beyond) is a wonderful slide show of another mother's home birth. I've seen some truly lovely ones, and this is right up there with the best of them. The photographer (Mellissa DeMille of SmileBaby Photography) does a wonderful job of telling the entire story - it's amazing to see just how much narrative detail you get.
True story: I came THIS CLOSE to going with Birth and Beyond for my own birth - though I didn't know who Amy was at the time, I lived in Connecticut during my pregnancy and for the first 7 months of Lily's life. I did a consultation with Vicki, really liked her, and was completely torn between them and midwives I eventually went with, Nancy Farr and her apprentice Gengi Proteau. It just came down to distance - Birth and Beyond was just too far from my area to be practical for prenatal visits. Two roads diverged in a wood . . . Of course I completely adored Nancy and Gengi, but it's always interesting so see those crossroads in retrospect.
