I think that the thing that gets the worst rap from the breastfeeding community is probably formula, but really it should be growth charts. Growth charts don't seem to bother formula feeders much and what it boils down to is the issue of control. It is very easy to see how much formula a baby drinks, and so if weight gain doesn't meet some lofty ideal, not getting enough milk is easily ruled out.
Boobs don't come with a built-in metering device, meaning that input is completely unmeasurable. In a culture that trusts information over instinct, breastfeeding parents are left to measure output for peace of mind. New parents, fathers in particular, don't do well with disposing of direct output, let alone weighing it, so instead we measure indirect output by popping our get on a scale and plotting their weight on a weight-for-age chart.
Consider Baby A: Born at 40 weeks on the dot, weighing a lovely average 7 lb, 100% formula fed on demand, milk input carefully logged, maintains a steady growth through the first six months and weighs in at 14 lb. Great job, big pat on the back. After 6 months, solids and water are introduced, baby starts to crawl, pull up, cruise, sleeps for ages at night and weight gain remains perfectly on track for 21 lb at 12 months. Ah what beautiful sense it all makes.
Now Consider Baby B: Born at 41.5 weeks weighing nearly 10 lb, 100% boobfed on demand, grows like a Russian body builder on steroids and doubles birth weight by a mere 4 months. His weight on the growth charts was always above the top line, but continues to diverge. By 6 months baby is crawling, pulling up, cruising and waking every 2 hours for a suck and getting in loads of delicious hind milk and not at all interested in solids in any shape or form. By 12 months baby is only 2.5 times birth weight, below the top line on the chart, still waking for milk every 3 hours at night and has only just showed an interest in solid food. None of it makes any sense at all.
Or does it? Breastfed babies often gain weight very well in the first 4-6 months. That is to say, they gain weight well compared to healthy formula fed babies, which thanks to lots and lots of data seems to have become some kind of yardstick. It makes a lot of sense that breastfed babies should gain more early because breastmilk is used almost 100% efficiently and their stomachs are very small. For the same milk volume, an infant digestive system is able to make more productive use of breastmilk.
After six months, tummy volumes have increased and solid food comes into play, so the playing field starts to level off. Breast and formula fed babies seem to end up in the same place by 12 months, but their paths to get there are often quite different.
I find it puzzling that people think they have control over their baby's weight. Traditional guidelines such as "double by six months, triple by twelve" are based on birth weight, which really is based on gestation period. In the final trimester, your little one gains about half a pound a week, so the difference between being born at term (37 weeks) and two weeks overdue (42 weeks) is a whopping 2.5 lb. By 6 months that's 5 lb and by 12 months that's 7.5 lb, which seems unlikely to me.
At some point a baby moves away from its growth pattern being determined by its birth weight and begins to follow the growth pattern that will see it end up in its adult size. It makes sense to me that this point is somewhere in the middle part of the first year, when the baby has gained enough weight for survival purposes. A baby may make a jump across several weight-for-age percentiles in either direction, depending on birth weight and adult size. This means that growth charts really are not a reliable means of measuring how well a baby is doing, which is not surprising considering early humans didn't have scales or statistics.
The most reliable indicator of whether your baby is thriving is whether your baby is happy, healthy, making progress towards milestones... colic, child care viruses aside, of course. Good news for those of us who like to measure things is that the WHO even has a gross motor milestones for age percentile chart!
Tuesday, April 15, 2008
Friday, April 11, 2008
Unhappy Beginnings
If you ration yourself through the pregnancy books, not reading ahead, you get to Week 37 and they say "Congratulations, your baby is now full-term!" The end. So there you are, with 3 to 5 weeks left to kill and nothing new or interesting to learn about pregnancy except the very ominous "half a pound a week" that your baby will continue to gain.
At that point, if you're anything like me, it dawns upon you that any day now you will have a newborn baby thrust in your arms and you've no idea what to do with it. You rock back and forth, preparing to haul your big self up off the couch or bed and dash out to get What to Expect the First Year, and everything else you can find on the topic.
I don't remember when I decided to breastfeed. I suppose, like going to university, I always understood that I would. My mom had tried, but couldn't due to lack of milk, but two of my cousins did nurse. One didn't say much about it but did pump and freeze milk; the other battled early mastitis and continued pain, but stuck it out for 15 months.
I was left on my own to learn about teaspoon sized tummies, latches and let-downs. Between trips to the loo I learned science, like breastmilk is more easily digested. I learned economics, like supply and demand. I learned sociology, like nursing will help you keep your bond when you go back to work. I learned witchcraft, like immunoglobulins protect against disease and mothers who don't sterilize. I learned culinary skills, like how to skim to tide over for an hour and how to double cream to eek out an extra hour's sleep. I even learned religion, like supplementation and taking home the free formula samples were the road to hell. I don't know that all this knowledge gave me confidence, but it did give me perspective.
Despite not getting to hold Johnny until he was 3 hours old, missing that "2-hour window of alerness," things started out pretty well. He seemed to be getting loads of colostrum as production on the bottom end was five times the norm.
When he was a day old they came and took him for his circumcision, which is when things started going downhill. They say newborns don't really feel pain and that a few drops of sugar water and some topical anaesthetic is all they need. Bull. My little boy screamed if I held him close to nurse so when he went to sleep and stayed that way for 6 hours I just left him to it, poor guy.
The delivering doctor's words that welcomed our son into the world were "It's a toddler!" and by two days old, he was ready to eat like one. The lactation consultant came around as my nipples were ready to fall off and pointed out the tell-tale line showing he was latching onto nipple and not areola, but also that he was swallowing on the third suck so definitely getting something to eat. I persevered. Every hour I nursed him 15 minutes a side and then he spent the next half hour crying until I nursed him again.
It's ironic that the narcotics for the c-section pain did nothing at all for the nipples. I was ready to sue Medela for falsely advertising their lanolin as it did absolutely nothing either. The cherry on top was that my father-in-law had decided that the day before bringing the baby home was when he and my husband should install the kitchen cabinets, countertop and sink, so I was also all alone.
One of the books had forewarned that eventually there would be a point where both mother and baby would be crying, but when you read something like that you think "Not me! I'm prepared." I just don't think there is any preparation for the feeling that you're starving your newborn, even if the nurse and the pediatrician and the lactation consultant and every book on the planet say Do Not Supplement Your Baby, He Is Okay.
Thank God for the pediatric nurse who picked up the phone and deciphered through my sobs "please bring me something for my son to eat." I'm really grateful for the little bottles of formula she brought me and the half ounce that was all it took for Johnny and I to get some sleep, but I'm most grateful for her advice. "It's your baby, do what you think is right."
My milk eventually came in late on the 4th day. That wasn't the end of my woes, though. We never did get the latch right in the beginning and it was my husband who saved us there by discovering nipple shields, the $6 wonder that makes your baby latch on correctly and dulls the pain. It took 2 months for the initial few minutes of pain to cease and for me to brave giving up the nipple shields. Once I did, though, I was very pleased to see that Johnny had a perfect latch and finally lying down to nurse was simply heavenly.
At that point, if you're anything like me, it dawns upon you that any day now you will have a newborn baby thrust in your arms and you've no idea what to do with it. You rock back and forth, preparing to haul your big self up off the couch or bed and dash out to get What to Expect the First Year, and everything else you can find on the topic.
I don't remember when I decided to breastfeed. I suppose, like going to university, I always understood that I would. My mom had tried, but couldn't due to lack of milk, but two of my cousins did nurse. One didn't say much about it but did pump and freeze milk; the other battled early mastitis and continued pain, but stuck it out for 15 months.
I was left on my own to learn about teaspoon sized tummies, latches and let-downs. Between trips to the loo I learned science, like breastmilk is more easily digested. I learned economics, like supply and demand. I learned sociology, like nursing will help you keep your bond when you go back to work. I learned witchcraft, like immunoglobulins protect against disease and mothers who don't sterilize. I learned culinary skills, like how to skim to tide over for an hour and how to double cream to eek out an extra hour's sleep. I even learned religion, like supplementation and taking home the free formula samples were the road to hell. I don't know that all this knowledge gave me confidence, but it did give me perspective.
Despite not getting to hold Johnny until he was 3 hours old, missing that "2-hour window of alerness," things started out pretty well. He seemed to be getting loads of colostrum as production on the bottom end was five times the norm.
When he was a day old they came and took him for his circumcision, which is when things started going downhill. They say newborns don't really feel pain and that a few drops of sugar water and some topical anaesthetic is all they need. Bull. My little boy screamed if I held him close to nurse so when he went to sleep and stayed that way for 6 hours I just left him to it, poor guy.
The delivering doctor's words that welcomed our son into the world were "It's a toddler!" and by two days old, he was ready to eat like one. The lactation consultant came around as my nipples were ready to fall off and pointed out the tell-tale line showing he was latching onto nipple and not areola, but also that he was swallowing on the third suck so definitely getting something to eat. I persevered. Every hour I nursed him 15 minutes a side and then he spent the next half hour crying until I nursed him again.
It's ironic that the narcotics for the c-section pain did nothing at all for the nipples. I was ready to sue Medela for falsely advertising their lanolin as it did absolutely nothing either. The cherry on top was that my father-in-law had decided that the day before bringing the baby home was when he and my husband should install the kitchen cabinets, countertop and sink, so I was also all alone.
One of the books had forewarned that eventually there would be a point where both mother and baby would be crying, but when you read something like that you think "Not me! I'm prepared." I just don't think there is any preparation for the feeling that you're starving your newborn, even if the nurse and the pediatrician and the lactation consultant and every book on the planet say Do Not Supplement Your Baby, He Is Okay.
Thank God for the pediatric nurse who picked up the phone and deciphered through my sobs "please bring me something for my son to eat." I'm really grateful for the little bottles of formula she brought me and the half ounce that was all it took for Johnny and I to get some sleep, but I'm most grateful for her advice. "It's your baby, do what you think is right."
My milk eventually came in late on the 4th day. That wasn't the end of my woes, though. We never did get the latch right in the beginning and it was my husband who saved us there by discovering nipple shields, the $6 wonder that makes your baby latch on correctly and dulls the pain. It took 2 months for the initial few minutes of pain to cease and for me to brave giving up the nipple shields. Once I did, though, I was very pleased to see that Johnny had a perfect latch and finally lying down to nurse was simply heavenly.
Tuesday, April 8, 2008
Expressing Milk
I was going to do these in some kind of chronological order, but a bit stuck on what to do next I'm jumping ahead to put together a how-to on expressing milk as it seems to be a common problem for many moms.
The real key to expressing milk with ease is ensuring that you get a let-down. There are two ways to do this; you can buy a very expensive electric pump that has two-stage pumping in order to simulate what your baby does to get a let-down, or you can use a manual pump. Cheap electric pumps are a waste of money. I bought the most expensive pump I could find (Medela PumpInStyle double electric with bells, whistles and a nifty backpack to carry them all in) and it cost less than 3 months' supply of formula. Well, the bags probably cost another 3 months' worth of formula but I could've used bottles and either way, over a year into the pumping game, I'm ahead.
Without sounding too much like a Medela sales rep, I have to say I really am a huge fan of my PumpInStyle. I have pumped a phenomenal volume of milk with it, and the motor is still going strong. I have donated 9 and a half gallons plus the shipment that was destroyed, and that's not counting what Johnny drank, which admittedly wasn't much for about 6 months. Some crude math tells me I've pumped somewhere on the order of 3,500 ounces or 25 gallons or 100 litres, rounding off.
Well it's lovely that my Medela, with it's let-down-inducing two-stage fanciness works great, but what about doing it with a manual pump? Well the trick is that you have to do what the PumpInStyle does. I suppose you have to do what the baby does, which is what the PumpInStyle tries to simulate, but it's a lot easier to learn from the PumpInStyle. I've heard that you can put your finger under your baby's chin to feel the pre-let-down rhythm, but I've tried that and it's not very easy to do.
I'm full of anecdotes and to spare you all the parenthetical hell I'll just abruptly start a new paragraph. I learned the other day that when doing CPR, it is now the accepted standard that, if someone is in cardiac arrest (not to be confused with respiratory arrest, where they stop breathing before keeling over), you no longer do mouth-to-mouth. The recommendation now is just to do chest compressions, as the blood moves so slowly when doing chest compressions that it's still pretty well saturated with oxygen and the stopping to do the breathing was doing more harm than good. Stick that in your back pocket for next time you're on the Waterloo-and-City Line, but keep this part in your pump bag: the tempo for chest compressions, and for stimulating a let-down, is 100 beats per minute, or the beat of the BeeGees' Staying Alive.
When it comes to pumping, brute force is not going to be any help at all but will almost certainly cause you pain. When you start out, hum along to Staying Alive and keep the beat with your pump handle. Within about 60 seconds you should have a let-down. If not, go a little faster. Those of you who have an mp3 player might want to make a 10-minute track to pump to, starting with a 60 second techno 100 or 120 bpm track and followed by some nice, relaxing 60 bpm rendition of Row, Row, Row Your Boat (I am partial to the Stephen Fry/Hugh Laurie version from Blackadder Goes Forth) for those of you who need to focus on your little one to keep the milk flowing.
Once you achieve let-down, the milk should start spraying. If it has been a while since you've pumped, you may find that you have to do very little. If I'm engorged I can pump once every 3-5 seconds initially. Once the fore milk is gone, you have to work a little harder (1 second long pumps) to get the hind milk out. A little breast compression with your free hand will prevent hand cramp in the pumping hand.
The real key to expressing milk with ease is ensuring that you get a let-down. There are two ways to do this; you can buy a very expensive electric pump that has two-stage pumping in order to simulate what your baby does to get a let-down, or you can use a manual pump. Cheap electric pumps are a waste of money. I bought the most expensive pump I could find (Medela PumpInStyle double electric with bells, whistles and a nifty backpack to carry them all in) and it cost less than 3 months' supply of formula. Well, the bags probably cost another 3 months' worth of formula but I could've used bottles and either way, over a year into the pumping game, I'm ahead.
Without sounding too much like a Medela sales rep, I have to say I really am a huge fan of my PumpInStyle. I have pumped a phenomenal volume of milk with it, and the motor is still going strong. I have donated 9 and a half gallons plus the shipment that was destroyed, and that's not counting what Johnny drank, which admittedly wasn't much for about 6 months. Some crude math tells me I've pumped somewhere on the order of 3,500 ounces or 25 gallons or 100 litres, rounding off.
Well it's lovely that my Medela, with it's let-down-inducing two-stage fanciness works great, but what about doing it with a manual pump? Well the trick is that you have to do what the PumpInStyle does. I suppose you have to do what the baby does, which is what the PumpInStyle tries to simulate, but it's a lot easier to learn from the PumpInStyle. I've heard that you can put your finger under your baby's chin to feel the pre-let-down rhythm, but I've tried that and it's not very easy to do.
I'm full of anecdotes and to spare you all the parenthetical hell I'll just abruptly start a new paragraph. I learned the other day that when doing CPR, it is now the accepted standard that, if someone is in cardiac arrest (not to be confused with respiratory arrest, where they stop breathing before keeling over), you no longer do mouth-to-mouth. The recommendation now is just to do chest compressions, as the blood moves so slowly when doing chest compressions that it's still pretty well saturated with oxygen and the stopping to do the breathing was doing more harm than good. Stick that in your back pocket for next time you're on the Waterloo-and-City Line, but keep this part in your pump bag: the tempo for chest compressions, and for stimulating a let-down, is 100 beats per minute, or the beat of the BeeGees' Staying Alive.
When it comes to pumping, brute force is not going to be any help at all but will almost certainly cause you pain. When you start out, hum along to Staying Alive and keep the beat with your pump handle. Within about 60 seconds you should have a let-down. If not, go a little faster. Those of you who have an mp3 player might want to make a 10-minute track to pump to, starting with a 60 second techno 100 or 120 bpm track and followed by some nice, relaxing 60 bpm rendition of Row, Row, Row Your Boat (I am partial to the Stephen Fry/Hugh Laurie version from Blackadder Goes Forth) for those of you who need to focus on your little one to keep the milk flowing.
Once you achieve let-down, the milk should start spraying. If it has been a while since you've pumped, you may find that you have to do very little. If I'm engorged I can pump once every 3-5 seconds initially. Once the fore milk is gone, you have to work a little harder (1 second long pumps) to get the hind milk out. A little breast compression with your free hand will prevent hand cramp in the pumping hand.
Saturday, April 5, 2008
Osama Boob-laden
I am a fundamentalist lactator. Don't get me wrong, I believe in God and Jesus and all of that salvation stuff, but I have only been to church once since arriving in the US and a religion is something you practice. It would seem that lactation is the closest I come.
Just like Osama, I prey on the lesser-educated, obfuscating and distorting the seminal text (that would be Gale Pryor's Nursing Mother, Working Mother) to bend them to my will. I do claim some moral higher-ground over Mr. bin Laden, though, and I don't mean because nursing is a just cause. At least I martyred my own boobs first.
Now hang on a minute, I'm very grateful for formula; I wouldn't be here if it weren't for the stuff. When I see parents formula-feeding their babies I don't feel smug superiority, I feel empathy, and a pang of regret that society has let another family down. I thought I had it bad in the beginning, but clearly that mother had it much worse or she'd still be nursing, if you see what I mean.
The only people who make me feel stabby are the ones who never even gave nursing a chance. Even if you only give it the good old college try while you are in hospital with your newborn, your baby gets most of the colostrum. One in five orphaned calves that don't get colostrum within 12 hours dies. The stuff is some kind of magic elixir.
Just like Osama, I prey on the lesser-educated, obfuscating and distorting the seminal text (that would be Gale Pryor's Nursing Mother, Working Mother) to bend them to my will. I do claim some moral higher-ground over Mr. bin Laden, though, and I don't mean because nursing is a just cause. At least I martyred my own boobs first.
Now hang on a minute, I'm very grateful for formula; I wouldn't be here if it weren't for the stuff. When I see parents formula-feeding their babies I don't feel smug superiority, I feel empathy, and a pang of regret that society has let another family down. I thought I had it bad in the beginning, but clearly that mother had it much worse or she'd still be nursing, if you see what I mean.
The only people who make me feel stabby are the ones who never even gave nursing a chance. Even if you only give it the good old college try while you are in hospital with your newborn, your baby gets most of the colostrum. One in five orphaned calves that don't get colostrum within 12 hours dies. The stuff is some kind of magic elixir.
Friday, April 4, 2008
Babies Prefer Boobs
If there's one thing my son has taught me it's the fact that babies prefer boobs. Well, until they find a Cadbury Creme Egg in your handbag and are able to use their new teeth to break through the foil, but that's not really something a baby can do; it's more in the domain of the toddler. But as all rules have exceptions, I think it's safe to say that most toddlers also prefer boobs, and who can blame them? What's not to like about boobs?
Thursday, April 3, 2008
Subscribe to:
Posts (Atom)
