Your Life with Baby
You know what is really hard to find? A book that tells you about the practicalities of daily life with your new baby.
Other than stating the obvious (you should never shake your baby ~ REALLY?), reading What to Expect the First Year only tells you all the terrible things that could possibly go wrong with your baby. This is not helpful. At all. In fact, they should rename that book In the Rare, Unfortunate Case of (fill in the blank). Horrible.
Anyhoo, there are a lot (a LOT) of books out there on the subject matter. You could (and should) pick up a couple of them to read what these authors have to say. It’s sort of like traveling: reading a few different guidebooks and you will see some consensus on the best things to do on a trip. Baby books are no different, just don’t take any one of them as gospel.
The most important thing to remember through this whole experience:
** There are no rules **
It's like Fight Club: the only rule is that there are no rules. Everybody and their mom (literally, their moms) will be giving you advice. You should take all the advice you get as mere suggestions. Whether it concerns sleeping or nursing or playing, you need to try a bunch of different things. You are not going to break your baby by trying something once or twice.
Because every baby/momma combo is soooooo different, you will soon learn what works for you – and at the end of the day, you DO what works for you, your baby and your partner. That’s it. There are no rules. Ok, point taken, the horse is dead. Sorry, horse.
I know a lot of expectant moms want to have everything nailed down and dialed in. I think it is an admirable goal, but really the best thing you can do is simply to know what your options are. Ok, let’s get started.
To Co-sleep, or not....
If you're not sure whether you want your baby in your room or in her nursery, don't sweat it. I suggest trying a little of both to see what works for you and your partner (when your hubby is losing sleep too, they suddenly become a very prominent stakeholder in this debate).
For the first 3-4 months. we had Lucie in our room in the Pack N Play. For us, it was the right thing to do for many reasons. Allow me to paint a picture for you....
It's 2am and baby wakes up hungry and crying. You roll out of bed, trudge down the hall in the dark and stumble into the nursery. You nurse (or feed) your baby and put them back in their crib to sleep. You trudge back into your room and fall into bed. Right as you drift off to sleep, waaaaaaaaah! The baby is up again. You get out of bed, walk back down the hall (you trip over the dog this time) to see what's up. Hey guess what? Baby doesn't want to sleep right now, baby wants to party. So you pick her up and walk around, maybe trying some shushing or some lullabys. You stub your toe on the bed while walking back in. Damn you, bed! You think you've got it so you put them back down in the crib, start to walk away and... waaaaaaah! No dice. Rinse and repeat.
At about 3:25am, you are dizzy from lack of sleep, so you say... screw it -- I will put her in bed with me. Your put her in bed and she finally falls asleep. But you? do not. You're afraid you're going to roll over and squish her. Or that your partner will. Or at the very least, you'll do something to wake her up, which is completely unacceptable considering all the trouble you just went to. So what happens? You carefully transfer her to her co-sleeper or Pack N Play in your room. Ah, finally. Everyone's happy. If she cries again, I'm right there.
This has happened to every parent in the history of the world and it will happen to you too. It's a LOT easier, logistically, to have your baby in your room during the first few months. Now: if your husband is losing a lot of sleep and has to go perform brain surgery the next day, eh.... this may not work so well. He may end up sleeping in a different room altogether and that's okay too. Do what you gotta do. Remember that it is a short-term issue.
The other reason to have them near you is because 0-4 months is the danger zone for SIDS. Having baby near you apparently decreases this risk. Read more about safe sleeping here.
Daytime Napping: Decoded
The need to nap (your baby, that is) is the #1 monkey-wrench that will be thrown into your daily life.
I'm a huge believer in respecting your baby's naptimes by anticipating when they will need to nap and providing a quiet, comfortable environment for it. If you do this, your baby will be repay the favor by being happy, well-rested and ready to go anywhere. It's a win-win.
I have a fairly easy method that I use to predict time naps with a fairly good amount of accuracy. It all boils down to one thing:
Respect Thy Intervals.
This is where the dreaded 'S' word is making its first appearance: SCHEDULES.
I believe in a loose 'schedule' of sorts. Here's a rough guide:
Newborns ~ weeks 0-6
In the first month of life, there is no schedule. Don't even try. It's just too chaotic. In my opinion, you should feed your baby on demand, which means "whenever they want it" - eek!, and let them sleep on demand, within the parameters of The Great Shift. You can try to implement a schedule during this time.... good luck with all that.
Mind you that your baby can sleep through a rock concert in the first month and barely take notice. In fact, you may be surprised that your baby is completely oblivious to a loud thunderstorm or a barking dog. This is because their hearing is not so good yet: they can only hear a limited range of frequencies. Enjoy it while you can, it won't last long....
1.5 - 3 Months
After the first 6 weeks have passed (or fairly soon thereafter), hopefully your baby will be sleeping a lot at night. If this is the case (and believe me, you WANT this to be the case), he will take about 3 naps during the day which can range from 45 minutes to 2 hours. Some will take 4 naps a day, but for most it's 3. This will remain the case until about 7 months of age when they drop down to 2 naps/day.
The Morning Interval: 45-60 minutes. Starting when she wakes up in the morning (the first wake-up after sunrise), she will only be awake for a short while before taking her morning nap, typically about 45 minutes to an hour. So, if your baby wakes up at 7am, you can expect her to go down again around 7:45 to 8am. Weird, huh? If you've been up a lot the night before, this is a great time for you to go back to sleep too. Stay in your jammies, hold off on the coffee and get some extra shut-eye. You will feel like a new person.
The Midday Interval: about 2.5 hours. She'll wake again in about a hour and a half and will be up for roughly 2.5 hours this time.
The Afternoon Interval: about 3 hours. After her mid-day nap, this will be her longest stretch of being awake: about 3 hours. This is when you can run errands and do things with your baby that take a longer amount of time: grocery shopping, going to the mall or having a playdate. Your baby will be most alert and playful during this afternoon stretch.
Bedtime: 2.5-3 hours. "Bedtime" will occur 2.5-3 hours after she woke up from her afternoon nap.
In that last hour before bedtime, she will probably be at her crankiest. This is a great time to have a warm bath, a boob (or a bottle) and some snuggle time before going down for bed. Keep stimulation to a minimum.
4-6 Months
As time goes by into months 4, 5 and 6, your baby will really start consolidating sleep at night. These daytime "awake" intervals will widen and nap durations will shrink. The morning interval will widen to 1.5 and then 2 hours. The midday and afternoon intervals will widen to about 3 hours each, and pretty soon.... he will drop the midday nap altogether ~ sometime around 7 months.
As a general rule of thumb, a baby this age will rarely be awake for more than 3 hours at a time.
Starting around 4-5 months, your baby will become more finicky about where he will/can sleep. If junior is a light sleeper, you may want to plan on being home during naptimes. If you need to do something that lasts longer than 3 hours, just be sure you can provide him a decent place for a nap, like riding in a quiet car or napping in a quiet room at a friend's house. You can bring your Pack N' Play along to ensure that you have a sure-fire sleeping spot. Some babies can and will sleep anywhere. If you are one of these moms... I hate you.
** Your baby's intervals will vary, this is just a rough guideline.
How To...
Starting around 6 weeks, start writing down when he goes down and when he eats. If you observe and document your baby's natural intervals, you will quickly learn and anticipate when he will naturally go to sleep and for how long. Look for patterns. Then, you simply reinforce this nap schedule by putting him down 'on time' -- and sometimes, by not letting him sleep too terribly long. Some people call this "the baby putting themself on a schedule", which is true... but you need to reinforce and uphold it.
You will now have the ability to (somewhat) predict and plan your day, all while knowing that baby is getting enough sleep. Yay - this is our goal!
This is the self-dubbed interval method: observe, record, reinforce.
Monkey Wrenches
Now is a great time to tell you that this is NOT a 100% fool-proof method. Your baby will frequently throw you a curve ball.
The most common curve ball is the abbreviated nap. This is when you are expecting a 1.5 hour nap and junior wakes up after about 20 minutes (Great! Right in the middle of Oprah - thanks, baby). If your little guy or girl wakes up crying prematurely, don't rush in right away. Most of the time, she will go back to sleep on her own. You can usually tell if she is REALLY awake by looking at her eyes. If they're open, she's awake. If they're still closed, STEP AWAY FROM THE BABY, mommy. Let her go back to sleep. Give it 5 minutes and re-check.
If baby wakes up prematurely, don't sweat it. You will have to mentally adjust the next interval, though. If she had a shorter than usual nap, subtract about 30 minutes from her next nap time (does this make sense? man, I hope so ;))
The other curve ball is the earlier/later than usual wake-up. Lucie usually wakes up around 7am, but sometimes she wakes up at 5:30am. When this happens, I put her in bed with us and use my Jedi mind tricks to will her back to sleep. This ALWAYS works and I highly recommend it >:-)
On the other hand, sometimes she sleeps until 8:30am. This kinda sorta blows away the schedule for that day. Two options: 1) Wake her up at 7 (are you insane?) or 2) Cut her naps short so she is ready to go to bed at the usual time. Or some mixture thereof.
Two Mistakes to Avoid
I have to get up on the soapbox just a little bit here. Don't hate. There are 2 things I see mommies do all the time that I consider catastrophies, for lack of a better yet equally-as-satisfying word.
1) No schedule whatsoever (a.k.a. the Chaos schedule). Baby sleeps and eats whenever, wherever. Mommy can't ever go out because she can't predict when baby will want to nap, eat, etc. Mom and baby are hostages to their own insanity (mwaaaaaaa!).
Me: "Hey, do you want to get lunch?"
Friend-whose-baby-is-on-the-Chaos-schedule: "ummm, yeah I can't. He might need to nap.... sometime, but I'm not sure when. I can never tell when he's going to be napping."
Me: Sigh.
I will tell you that MOST PEOPLE DO EXACTLY THIS. Baaaaah! I find this highly annoying, so don't do it, k? Just kidding (sort of).
Look, you will never have a perfectly predictable schedule; there will ALWAYS be variability. But for the love of god, please provide your baby with a little structure in his day. Just a little. You will both be the better for it.
SORRY I'M USING SO MANY CAPS, I'VE HAD TOO MUCH COFFEE.
2) Never giving a bottle
Laureen: "Oh my god, I'm going back to work next week and Hailey (4 months old) won't take a bottle."
You want to talk about real stress? THIS is a disaster. In this situation, you are screwed. So don't screw yourself.
Lots of people will tell you: don't give your baby a bottle (or a paci, for that matter) until they are 2 months old, else she will develop nipple confusion and there will be a Gamma Ray burst and the universe will explode.
WRONG.
In my opinion, give your baby a bottle in the first 3 weeks at the latest. Do this about twice a week - even if you are exclusively breastfeeding - to keep your baby from rejecting the bottle. I don't care what your lactation consultant says. They are wrong. Sorry, lactation consultant. I've just seen it too many times and it sucks way bad (and it's very avoidable!).
The problem with LCs and some of the literature that you read on the internet is that it's all very scientific. Which is great... except that it's not practical at all. In a perfect world, we wouldn't ever give our babies a bottle because we'd never leave their side, blah blah blah. You see where I'm going with this.... you can always remedy "nipple confusion", if such a thing even exists, but you can't force a baby to take a bottle if he doesn't want to. Pick your poison.
PS. If you find yourself in this situation, try offering brown latex nipples on a Playtex drop-in bottle. That seems to be the secret remedy...
Cabin Fever: Emerging from your Cave
I’m stealing the campaign slogan from Barack Obama 2010. I don’t think he would mind:
Yes You Can.
After the first month or so, it will behoove you to get back to the normal things in your life – especially those things that make you happy. Your partner has gone back to work, your family has left town (if they don’t live in the area) and there you are. Just you and baby. All day. Sittin' around staring at each other.
If there is one thing that new moms agree on, it’s that this time period can be very, very lonely.
You will start to wonder: what the hell do moms DO all day? You love your child to death but you may find yourself staring at the clock. A lot.
A lot of moms get stuck in the rut of thinking they have to stay at home all day to tend to baby’s needs, but really – baby is quite happy to get out and about and see his new world.
In the first few months, you have about a 2.5-3 hour time window between naps to get out and DO stuff – and lots of young babies can even sleep while out and about. When baby wakes up from a nap, nurse or feed him, change that diaper, then hit the road. The clock has started – tick tock!
Start with short, easy errands that are close to home and won’t stress you out. Hit up the coffee shop or the drugstore. You don’t have to pack the whole nursery into the diaper bag: if something goes wrong, you’re close enough to head back home.
Experiment with different ways of baby carriage – driving with the car seat, then plopping it into the stroller base works very well for most errands without any need for annoying buckling/unbuckling. If you’re dealing with snow/ice or stairs or crowds, you may find it easier to switch to a baby carrier or sling once you arrive at your destination.
Grocery Shopping
Grocery shopping, in particular, can be a little tricky. Tricky's not the word, actually, how about... goddamn annoying. There, that's better.
The easiest thing is to make your husband do it. The next easiest thing is to do 1 of 3 things:
1. If you're using the infant car seat, you can usually snap the car seat directly into the shopping cart. It doesn't leave a lot of room for your GROCERIES, but oh well. It's also "not recommended" because it's "not safe" -- blah blah blah (kidding). You may have to experiment to see if your seat fits into the cart securely. If it doesn't, try...
2. Puting your babe in a carrier, like the Moby or Ergo. This leaves you lots of space in your grocery cart, but you might feel a little hindered from bending over, reaching up, picking up large cases of water or a 50lb bag of dog food, etc. Meh.
3. You can use your car seat/Snap N Go and put your groceries directly into the huge undercarriage basket. This is hard because a) grocery stores think you're stealing from them and will follow you around b) not everything fits down there and if it does - you have to play a bit of Tetris. Oh well. They can't all be winners, kid.
None of these is ideal and that's why grocery shopping with a newborn sucks (sorry, but it does). Remember - once again - this problem is temporary. Once your baby can sit up on her own (around 5.5 months), you can put her directly into the grocery cart -- and then grocery shopping is kinda fun for them.
Lucie's first time in the grocery cart
Me Time
In my experience, there is only a very short list of things you can’t really do with your baby (without help).
This odd list includes: getting your hair/nails done, going to the dentist, going to the gym and vacuuming.
It’s really important to make time for yourself, but you will be surprised that once-simple things now require some more advanced planning. If you are breastfeeding, you won’t be able to go far without having to pump every 3 hours or so, so make sure you have a simple hand pump in your bag so you aren’t tethered to your house. This is also critical for traveling.
Schedule a day where you line up a hair and nail appointment – and maybe a massage. Arrange for daddy to babysit so you can have some much-needed time to decompress. Weeeeee!
** Breastfeeding **
Since I have started this site, I have learned a LOT about breastfeeding.
I took a poll on a popular baby site asking those moms who didn't intend to breastfeed what their reason(s) were. I was shocked by some of the responses I got. Yes, some women don't want to be inconvenienced by it -- and of course, there are those who simply can't because of medications or previous breast surgeries or other physical problems, but these people were, by far, in the minority. More than any other reason, MANY women are simply not physically and emotionally comfortable with the concept of breastfeeding. Period. Some even wrote to me privately and said they had been a victim of sexual abuse and breastfeeding is not something they could reconcile, etc, etc.
The concept of feeling ashamed of their body and breasts - or thinking that their breasts are for sexual use only -- was definitely a predominate theme. Some people even said it was perverted or simply "gross" (are you 9?). How sad.
Do you know why women have breasts? Why? To breastfeed and provide life and sustenance for your offspring. Summbitch, who knew?
I feel like all expectant moms should educate themselves before making the important decision about whether or not to breastfeed - and I believe that 95% of expectant FTMs definitely do not have good (and complete) information on the matter.
I have attempted to write an argument about why breastfeeding is better. If you read this information and still don't want to breastfeed because of personal reasons, I totally respect that. I have not walked a mile in your shoes.
So, here goes:
YOU were probably not breastfed by your mother. Not many of us in the past 2 generations were. Doctors used to think that formula was a superior food source. Doctors also used to cut out part of people's brains who had mental illness (that's allright, frontal lobes are soooo overrated). They also used to tell parents not to hug or show affection to their children for fear of spoiling them. The 1950s were chocked full of great stuff like this.
Now? We know better.
Do you hear that world? WE KNOW BETTER now. Yaaaaay science.
Even if you think science is for the birds, ask yourself: do you have $2,200 to waste? This is the average cost of formula feeding an infant in the US. Ouch. And the interesting thing is that women is lower economic classes tend to be the ones who formula feed more. Make sense? No.
These days, over 70% of moms leave the hospital breastfeeding, and this number is rising every year that we become better educated on the topic. If you want to buy stock, Medela would be a great pick right now ;-)
We now know these things to be irrefutable truths based on scientific studies.
I. Infant Health
A. Diarrhea: When compared with exclusively breastfed infants, infants who were exclusively formula-fed had an 80% increase in their risk of developing diarrhea.
B. Infection: The incidence of any infection and sepsis/meningitis are significantly reduced in human milk-fed infants compared with exclusively formula-fed infants.
C. Middle Ear Infection: Infants who were exclusively formula-fed had a 70% increase in their risk of developing an ear infection.
D. Pneumonia: Infants who were not being breast fed were 17 times more likely than those being breast fed exclusively to be admitted to hospital for pneumonia.
E. UTI: Breastfed infants have 1/3rd of a relative risk of developing a UTI compared to formula-fed infants.
II. Childhood Illnesses
A. Cryptorchidism (Undescended Testicle) There is a significant association of cryptorchidism and lack of breastfeeding. Just tell your son that testicles are so 2009. I'm sure he'd be cool with it.
B. Reflux: Breastfed babies demonstrate significantly less gastroesophageal reflux than formula fed babies.
C. SIDS: Not breastfeeding at discharge from an obstetric hospital at any stage of the infant's life was associated with an increased risk of SIDS.
D. Wheezing: Children who had EVER been breast fed had a lower incidence of wheeze than those who had not (59% and 74% respectively). The effect persisted to 7 years of age.
E. Asthma: The introduction of milk other than breastmilk before 4 months of age was a significant risk factor for asthma as measured in a group of 6 year olds. A significant reduction in the risk of childhood asthma at age 6 years occurs if exclusive breast feeding is continued for at least the 4 months after birth.
F. Eczema: Eczema was less common and milder in babies who were breast fed (22%).
III. Intelligence and Psychomotor and Social Development
A. Intelligence: A review of 20 published studies on the effects of breastfeeding on infant IQ found that breastfed babies' IQs are 3 to 5 points higher than those of formula-fed babies and 8 IQ points higher for preemies. THAT'S A LOT OF IQ POINTS!! (Sorry you didn't get into college, junior, you never got enough fatty acids for your brain to develop. Breastfeeding was such a drrrag, you understand, right?) (BTW, that's a total joke, I don't mean that at all).
B. Motor Skills: Infants who were exclusively breastfed for 6 months crawled sooner and were more likely to be walking by 12 months than infants who started solid foods at 4 months.
C. Eyesight: Breastfeeding is associated with enhanced stereopsis (depth perception) at age 3.5 years.
V. Long Term Effects
A. CANCER!!! Omg -- read this! Women who were breastfed as infants, even if only for a short time, showed an approximate 25% lower risk of developing breast cancer, compared to women who were bottle-fed as an infant.
Children who are artificially fed or breastfed for less than 6 months are at an increased risk of developing cancer before age 15. The risk of artificially-fed children was 1-8 times that of long-term breastfed children, and the risk for short term feeders was 1-9 times that of long term breast feeder. This also holds true for Hodgkins, Leukemia, and Lymphoma.
B. Diabetes: Children who were exclusively breastfed during their first three months of life had a 34% lower risk of developing diabetes than those who were not breastfed. Children given cow's-milk-based formula in their first three months were 52% more likely to develop diabetes than those not given cow's milk formula.
C. Bonding and attachment: Children who were breast fed for a longer duration were more likely, at age 15-18 years, to report higher levels of parental attachment and tended to perceive their mothers as being more caring and less overprotective towards them compared with bottle-fed children.
VI. Maternal Effects
A. Cancer: AGAIN, wow!: Women who breastfed a child for more than 24 months had a 54% reduced risk of developing breast cancer compared with women who breastfed for no more than 6 months. Holy shit. Mothers who breast-fed are also at decreased risk for endometrial, esophageal, ovarian, thyroid and uterine cancer. Yes please!
B. Emotional Health: At one month postpartum, women who breastfed their infants had scores indicating less anxiety and more mutuality than the women bottle feeding their infants.
C. Weight loss: Since nursing burns an additional 500 calories per day, mothers who breastfed exclusively or partially had significantly larger reductions in hip circumference and were closer to their prepregnancy weights at 1 month postpartum than mothers who fed formula exclusively.
*All of this data is summarized from http://courses.washington.edu/nutr526/news/biospec.htm#_Toc516479357 and compiled by: Jon Ahrendsen MD, FAAFP
Have I convinced you yet? Awesome.
Getting Started
If this is so natural and easy - then why is it so damn hard?? Yes, you will say this to yourself at some point in the beginning. Getting started is not without its challenges, as I'm sure you've heard already. I feel there is a certain hump that one must get over before really hitting your stride. But don't worry, with a little persistence and perseverance, you will get there. You WILL get there, mom-eee. Point being: almost everyone struggles in the beginning. You are not alone.
In my opinion, the key to a successful start is all in the latch. It's too bad this isn't something you can practice at home before the baby arrives, because DAMN it would save a lot of headache. However, you CAN educate yourself:
If your baby has a bad latch, breastfeeding will hurt. A lot.
Start when you are in the hospital: make sure to have the nurses or lactation consultants observe your baby's latch.
Essentially, you want you baby's mouth to be open very WIDE in order to scoop as much of the nipple and areola in as possible. Depending on your baby, the whole latching procedure requires some precision - like trying to re-fuel an F-16 mid-air. If your baby's mouth is not open wide and he is only sucking on the nipple itself, this is where the trouble starts.
How to latch:
1. Put on your Boppy or Breastfriend (in the early days, you may have to use pillows because your Boppy may not fit around your still-bulging belly). Get comfortable and take a deep breath. Find your happy place.
2. Have your partner hand you the baby. Put baby on his side, cupping his body around you so he is in the shape of a Capital 'C'.
3. Since he will have no head control, grab the base of his head as shown below:
4. Bring your baby's nose to your nipple in order to get him to root around and open his mouth. Some babies do this instantly without hesitation, others need more encouragement. Rub your nipple or finger on baby's lower lip in order to tease it open (this is where the patience and practice comes in...).
WAIT UNTIL BABY'S MOUTH IS WIDE OPEN BEFORE GETTING HIM ON. At all costs. Whatever you need to do to get that mouth open, do that thing.
** As a practical matter, this part is hard. The reason is because your baby will be crying out of hunger and possibly flailing around. Your instinct will be to get him latched on a soon as humanly possible because OMAGAH, he is starving - just listen to that crying(!!) - and I need to get him food, STAT! Resist this urge to rush through it. It's hard, but resist. Have someone talk you through it to keep your head straight. Remember that baby is not going to die by having to wait an extra 30 seconds to get milk (although it will feel this way).**
5. When his lower jaw is gaping open, pull him onto your breast, scooping as much of the lower areola in his mouth as possible. Scoop, SCOOP! This is where you will fail or succeed.
6. Ouch, I know. NOW: count backwards from 10 to 1. When your baby first latches on, a little pain is normal. However, if the pain is not improving after you've reached 1, you need to start over. This process can be very frustrating and requires a LOT of patience and a little bit of bullet-biting. The problem, you see, is that unlatching your baby can also be painful. Dang, that suck is strong!!! It's like having a little pirhana attached to your boob.
To unlatch your baby, wedge your thumb or you pinky into the corner of his mouth or under his lip in order to break the suction. Yes, he will freak out and cry. IT'S OKAY. If he's latched on poorly, he can cause a lot of damage in a very short amount of time, so do get him off asap and try again. Yes, it's frustrating. You might cry out of pain and/or frustration. It's okay. This is all normal (sorry). Keep your eyes on the prize.
This is what a successful latch will look like (below). You will also know because it won't be very painful after the first 15 seconds or so.
There is so much to say about breastfeeding, but I really wanted to focus on the latch. For more information about how to get started breastfeeding, check out La Leche League. Another great reference on getting started is KellyMom.
Next, what I've learned about...
Why People Don't Breastfeed or Quit Prematurely
There are, in my experience, 3 main reasons why moms don’t breastfeed or give up prematurely. If you understand this and expect some of these obstacles along the way, you will have a much better chance of long-term success at nursing, which is SO overwhelmingly rewarding.
A. Pain and/or other physical problems
Breastfeeding can be really hard in the beginning. There, I said it. It's true. Many newborn babies do not latch properly or at all. That’s ok, we TEACH them (see above). In more cases than not, you have to guide your baby to a proper latch. Start in the hospital where you have free help. Let the nurses and lactation consultants observe your baby’s latch. If nobody offers this help, you need to ask. Don’t be shy: it’s too important. If you leave the hospital with wounded nipples because of latching problems, your chances of continued breastfeeding are greatly diminished.
Pain is ubiquitous among new nursing moms. However, it should improve over the first couple of weeks. If you get home and can’t manage your pain, call a lactation consultant to come to your home. Please don’t give up before you do this! Some people (like me) need a little extra help getting over the hump.
MANY (most?) moms will go on to develop blocked ducts, mastitis and/or thrush at some point in their nursing career. These are the Big 3 hairy monsters of nursing. Learn how to prevent them and how deal with them when they happen. Don’t give up nursing because of this. You will get better in a day or 2. Remember you’re in it for the long haul.
B. Social Awkwardness about Nursing
If you have any hope of leaving your house to do anything, you’re probably going to have to get comfortable with nursing outside of your house. This can be really intimidating if you live in a conservative area (the Midwest, the South) where nursing is not commonly accepted. With a nursing cover, however, you can nurse anywhere discreetly and comfortably. You can practice with your nursing cover at home so your baby gets used to it and you're not figuring it out for the first time under pressure.
Yes, it can be nervewracking the first few times. I'll never forget our mommies group meeting at Starbucks for the first time with our 2-month old babies. Some of the babies were getting hungry, but everyone was waiting for someone else to be the first one. Finally, Sara put on her nursing cover and said "let's do this". Everyone breathed a collective sigh of relief and gradually followed suit. Boy, we must have been quite the sight! After that, though, it was easy. Nobody gave it a second thought. And no one else around us looked or cared.
You think everyone is staring at you, but they're really not. And if they ARE... fuck ‘em.
If you're really shy and just can't do it, you can always just pump a bottle and bring it along. The downside is that you now have to warm up the milk somehow, depending on your baby. Lucie would never take a bottle unless it was very warm, but every baby is different. And by the way, the sooner you get your baby used to cold milk, the better.
Once you get used to nursing anywhere, you get a great sense of empowerment.
After your baby is a few months old, this is a moot point because they don't have to feed as often. You can more easily plan your outings around feedings.
C. Lack of confidence/support
My baby isn't getting enough milk – gah!
I can’t tell you how many times I've heard this. Yes, it is extremely worrisome to think you are starving your baby, but only 3% of women actually have an inadequate supply. - and about 90% of women THINK they do. This self-doubt can really mess with your head.
Two things you can do to put your mind at ease:
1. You can always PUMP your milk to see exactly how much you are producing. Is it enough? Then feed your baby in a bottle. Don’t worry about nipple confusion unless you do this very frequently.
Your baby is getting enough if he isn't freaking out after finishing a nursing session and has 5-6+ wet diapers in a 24-hour period (after the first week).
2. You CAN augment with formula if you really need to. The purists will say NO! Don't do this, but - oh my gawd - isn't this SO MUCH BETTER than stressing about your baby starving? We have to be reasonable -- and getting nutrients to your baby is the number one priority here. The key is, if you give formula: YOU MUST PUMP in order to maintain/boost your supply. If you’re trying to increase your supply, pump for a few minutes AFTER you run dry.
Pitfall: the slippery slope begins when moms start giving the baby formula and then DON’T pump. Do this a few times and you will diminish your supply. Don’t fall into this trap. Have someone remind you to pump if you are feeling too bleary-eyed and braindead. Augment with formula only if/when you really have to. 90% of moms won't have to do it at all.
The Big 3 Hairy Monsters of Breastfeeding
I don't know many moms who have not dealt with at least one of these issues at some point in her nursing career. It comes with the territory. Know how to recognize the symptoms so you can treat it quickly to minimize your angst.
1. Thrush
Thrush is a yeast infection of the nipple and/or breast. It's the result of a fungus that thrives on milk on the nipples and/or in the milk ducts. Your baby can get it too. In fact you can pass it back and forth to each other (sweet!).
The hallmark symptom of thrush is red, shiny, itchy and burning nipples. You may also experience shooting pains during or after a feeding, which may indicate a ductal invasion <-- this is kinda bad news. You may also have nipple or breast pain when you are (correctly) using a pump.
Many, many, many nursing mothers get thrush, especially if you are already prone to yeast infections.
In your baby, look for a shiny or "mother of pearl" look inside the cheeks. There may be creamy, white patches that cannot be wiped off on the inside of the mouth, along the inside of the gums, inside of the cheeks, roof of mouth, or tongue. It may also spread to the diaper area. "Diaper rash" that doesn't respond to regular rash cream but responds to anti-yeast cream is a yeast infection. Your baby may also be completely asymptomatic.
How to Treat
You can run down to your OB's office, but honestly, most women try to treat it at home first. You can use regular anti-yeast cream from the drugstore, such as Monistat or Lotrimin AF. Apply this to your nipple before your longest stretch of sleep (which is hopefully at night) and BE SURE TO WIPE IT OFF BEFORE NURSING. Do this for several days and if it doesn't clear up, see your doc.
When the infection is ductal, causing shooting or stabbing pains within the breast, things get a little more complicated. Your doctor will probably prescribe Difulcan and may even suggest a low-yeast diet. Some ductal infections can be really, really gnarly and hard to beat.
Nursing can (and should) be continued through treatment.
Prevention
The best way to prevent thrush is by keeping your nipples dry. Change your nursing pads promptly when they become wet (this is also why I hate Lilypadz). Also, make yogurt (with acidophilus) a part of your daily diet. Acidophilus helps keep yeast growth in check.
2. Blocked ducts
Jeez, I could write a book on this topic. I get them so bad that I have scoured every nook and cranny on the internet, talked to lactation consultants, doctors, other moms…. you name it. When you get blocked ducts, you can get a little desperate for pain relief.
A blocked duct can really be felt when you bend over at the waist and the weight of your breasts falls forward. I don’t know why but this position always makes them hurt.
A blocked duct presents as a painful, swollen hard mass in the breast, sometimes accompanied by surface redness. It is caused by insufficient drainage of your milk, either because of engorgement, a bad latch, missed feedings, wearing a bra, bathingsuit or even a baby carrier that is too tight around your breasts, sleeping in the wrong position, or by sneezing (ok, that one's a joke). Sometimes, you can feel the actual blocked duct itself and sometimes, like in my case, the whole area or an entire side of the breast is sore and you can’t pin it to a specific location. This is really frustrating. Sometimes the whole damn breast feels like a clogged duct! (Confession: I threw a book against the wall one time, I was in so much pain. It takes a lot for me to throw a book against the wall.....)
Bad news first: there isn’t anything your doc can (or should I say, is WILLING) to do for you, except perhaps prescribe a kick-ass painkiller like Oxycodone, which I highly recommend. You have to work these bad boys out on your own. It sucks, but here’s how:
- Prepare a heating pad for the affected breast. Apply heat for about 5 minutes *right before* nursing.
- Your best weapon is the SUCK (for lack of a better word) from your baby’s sucking. Yes, it can be incredibly painful! Take pain meds if you need to (seriously) to get you through the pain. You need to keep nursing or else you’re screwed.
Now that you’ve applied heat to get the blood circulating, get the baby latched on (owwww, I know). You want her CHIN to be pointed in the general direction of the affected duct. Do acrobatics if you must. It’s important for her suck to draw from the affected duct(s). You gotta bite the bullet on this one, my dear. - Right after nursing, you want to use massage to try to work it out. Think about kneading bread dough. You can also try to do this while you are nursing, but the logistics are difficult -- you need about 4 arms for it to work properly. First, apply some lotion or olive oil to the area to make it slippery. Then, you want to massage the area of pain *toward* your nipple, as though to push the milk toward the nipple. Ouch, I know I know I know. Do it for as long as you can stand it.
- Pat yourself on the back and take a deep breath because that hurt like bloody hell. Now go put a cold cabbage leaf on your breast – any variety will do. It’s very Adam and Eve-esque.
Repeat several times a day until you work it out. Two more important things. You need to take your lecithin, (1,200mg) 3 or 4 times a day with a blocked duct. Lecithin has emulsification and lubricant properties – it’s like Drain-O for your milk ducts. Taking too much can make you nauseated, dizzy and depressed (no joke), so don’t O/D on it. Also, you need to drink boatloads of water to thin everything out. Fill up the huge 32oz. water jug that you stole from the hospital and drink several refills per day. Are you feeling like a camel yet?
Desperation
Didn’t work? Sigh. Yeah, me neither. I have 2 tricks for desperate souls. You will feel ridiculous, but this technique works really well:
You need to nurse your baby while hovering.
That’s right, you will be on all fours and down on your elbows so that your bubbies are dangling down. Do this on a soft place like your bed – it’s actually not that bad. There is something about the gravity in this position that helps break up the blockage. You can also do this while pumping if nursing is too painful, it just won’t be quite as effective.
The second thing I learned from a great lactation consultant… for a freakishly stubborn blockage, you can use vibration to work it out. You can seek out an ultrasound tech at a physical therapy office or…. you can try a Sonicare toothbrush or anything that vibrates (ahem). Lube it up, press the vibrator as hard as the pain allows, pushing toward the nipple. This worked on stubborn blockages for me. Mine always took several days to resolve, which is very uncommon. Stay the course. You’ll beat them, I promise.
Another thing to note is when you finally do break up the blockage, you may not be able to tell until the next morning. If you still feel the blockage after an extensive workout session, don’t be too discouraged. You may not know that you succeeded until a little later.
3. Mastitis
As if the pain of blocked ducts wasn’t bad enough, many women will go on to develop mastitis. I am writing this bit after just recovering from a giant blocked duct situation which then caused mastitis. It was so awesome and fun. I got to spend the whole weekend in bed with a major headache and fever.
Puerperal mastitis is the inflammation of breast associated with breastfeeding or weaning. It is thought to be caused by blocked milk ducts, excessive supply and engorgement. It is relatively common among nursing moms: about 1 in 5 will get it. Symptoms usually appear suddenly and include:
A fever is really the hallmark of mastitis. If you have plugged ducts and you have a fever, you probably have mastitis. You don't have the flu. The perpetrator is usually the bacteria staphylococcus aureus (i.e. staph) which enters your system through the nipple or a skin lesion. Your doctor will prescribe an antibiotic, although it can go away on its own (mine did). Delayed or inadequate treatment may lead to the formation of an abscess within the breast. An abscess is…. you don’t want to know. Google it. It’s gnarly and you don’t want it. Don’t delay in talking to your doctor.
So there you have it: the 3 big gremlins that you can get while nursing. I think of this as the "nursing tax".... it's just a price that you must pay to provide your baby with the best food in the world (although feel free to curse me while you are suffering).
MORE TO COME...
