Category Archives: Breastfeeding

Q&A: tandem nursing blues

Lisa writes:

"I need some help to wade through a bucketload of postpartum tandemnursing emotions, and maybe some reader experiences and data points.
Help please!

My son is almost 2 1/2 and nursed throughout my
pregnancy, but at the very end would only latch for a few seconds at a
time, once or twice a day. Well, now that my daughter has arrived (2
weeks ago) and the milk is a-flowin, he's on me all.the.time.  I had
always thought I'd let him self wean (and even naively thought that
maybe it would be soon), and was game for tandem nursing, but now I'm
feeling really conflicted.

Some of it is just the sheer logistics of nursing two, especially
when he's so adamant and persistent and acrobatic.  He of course always
wants to nurse when his sister does, and trying to keep her latched in
the midst of his acrobatics is no small feat.  But a deeper part comes
from an emotion I feel really guilty about – he just seems so BIG now
compared to his baby sister and I feel resentful when he's groping at
me.  I love my son with every fiber of my being and I don't like
feeling resentful and annoyed about a nursing relationship that has
been so great for over 2 years. I've been trying to keep my cool but I
worry that I'm not going to be able to keep it up for long.

Not surprisingly, those around me think the obvious solution is
weaning him. But I think that pushing him to wean now is probably the
worst possible timing ever, with all the upheaval in his life.  But I'm
struggling to think clearly about how to change the behavior so that he
nurses a little less often, or a little less vigorously, or something.
Maybe it's the cluster of postpartum emotions + the figuring out of how
to be mom to two + oh did I mention his nanny had to leave us a few
weeks ago so I have no child care and am looking for a new babysitter
for him?  But I feel stuck.  Any insight?"

Then she wrote an update:

"The update is that I've started weaning my toddler by cutting out the
demand nursings; now we just nurse upon awakening, at naptime, and at
bedtime. Still too many for me but at least I can tell him "we only
nurse at bedtime" etc when he tries to attach himself mid day.

But I still feel the visceral resentment, and de-latching/detaching
him at the end of those 3 nursing times is getting increasingly
difficult. It's like he knows there are limits now so stretches each
time to the maximum possible. I'm going to keep on keeping on and
figure that my return to work at the end of maternity leave will be a
natural dropping of the naptime session and sometimes the morning
session too.

The piggyback question that this raises for me is re: the advice
everyone seems to give about making changes when siblings arrive.
"Don't move to a big kid bed/potty train/take away pacifiers when the
baby comes or the older child will associate the change with the baby
and this will fuel sibling rivalry." How true is this really? How long
is it true for? Keeping in mind that my son is exactly 2 1/2 so gearing
up in a big way for that half year disequilibrium.  We need to change
bedtime but I can't wait until he's three!!"

The first thing I want to say is that I never tandem nursed, but I have felt the feeling of wanting to jump out of my skin while a child nursed, and it's horrible. It makes you want to run away, and makes you feel guilty about wanting to run away. It makes you feel like a bad mother and bad person, because your child wants something and you resent giving it. It's a tough place to be.

But it's also natural. I'm not sure there are any women who've tandem nursed who haven't felt at least some of that feeling. I'm betting it also varies by the ages of the kids, and by how much the older one nurses and how often, etc.

Parenting is always about boundaries. And you can only prioritize your kids so much before it becomes unhealthy for you. One of the hidden gifts of nursing (that I never really figured out until I had an older child) is that you're forced to navigate the changing border of your needs vs. your kids' needs all the time, so that by the time things get really high-stakes you're already used to it.

FWIW, I never thought the reason not to change things when a new baby came was to prevent sibling rivalry. I thought it was because too many changes would overload your child and would make the changes less likely to succeed. So this is another case of a solution is only a solution if it's not worse than the problem–if weaning makes things better for you, and gives you more resources to parent both your kids, then that's the solution. If weaning causes you more stress (as it does for some people), then it's not a solution. Only you know which is the case for you and your family.

Plenty of 2 1/2-year-olds have been weaned when a younger sibling was born. Plenty of them have continued to nurse. Even more of them weren't nursing by that point at all. It's my strong suspicion that we wouldn't be able to tell the difference among them, and that their relationships with their siblings weren't affected by that at all. (If anyone's got any research confirming or negating that, please let us know.)

Your son is important, and your baby is important, but you are important, too. Raising good people is partly about teaching them how to respect other people's boundaries. If you can come up with a solution that makes all of you feel good, that would be a parenting utopia. But while you're figuring out who to prioritize here, remember that there's no wrong or right answer, and you and your son are going to get something valuable out of whatever decision you make.

Can anyone comment on tandem nursing? Suggestions or empathy? Virtual chocolate?

Q&A: oversupply causing strange feeding schedule

Normally I don’t diagnose a lot of breastfeeding issues because I feel like that’s something that’s tricky and also a little dicey to do when you’re not in the same room as the persona with the problem. Plus, I’m not trained in breastfeeding issues. But I got an email from Angel, who has a 5-week-old, and in her very long email she was convinced that she was somehow overstimulating her baby and making him nervous. As I read the email, it hit me that all the symptoms she was listing were classic symptoms of oversupply. I’m not going to publish the email because it was long and kind of made my heart hurt that she was blaming herself for creating a neurosis in her infant, when it was just a physical issue and easily resolved.

Instead, here are the symptoms Angel listed:

* nurses ravenously
* but for only about 10 minutes, and then he falls asleep
* eats every hour and is crying and starving if she tries to make him wait (and it was all day long, not just in the evening or late afternoon, which is classic cluster feeding and is comnpletely normal)
* he’d gained a lot of weight very quickly
* she also described a kind of “heh-heh” noise he was making that sounded like a “nervous tic” to her

All this sounded waaaay too familiar to me from my first son. Some of you may recall that he was 9.5 pounds at birth, so I just thought it was normal that a big baby would eat so often, so fast, and fall asleep in the middle of a feed. Then, I was hanging out at a breastfeeding support group (just to get out of the house and see some other human beings who wouldn’t judge me for being in maternity pants and not having any makeup on), and the lactaction consultant heard these little “heh-heh” baby goat-like noises he was making and diagnosed me with oversupply.

Apparently, when you produce a lot of milk, the baby gets the watery foremilk first, which is high in milk sugars. So the baby falls asleep while nursing from a food coma (the same reason we all fall asleep after a big meal), but it’s not fatty hindmilk so it runs through their stomach quickly and they need to eat again in an hour.

In the meantime, all the milk sugars make them grow really quickly.

The solution is to do “block nursing,” which means you pick a block of time, say from noon to 2, and every time you nurse during that block you nurse on the same side only. Then for the next block, nurse on the other side, no matter how many times you nurse.

Within a few days you supply will match up with your baby’s needs better, and the baby will get the right ratio of watery foremilk to fatty hindmilk.

Sure enough, Angel got back to me a few days later that he was going 3 hours between feedings and wasn’t making the “heh-heh” noise anymore.

For most of us who have it, oversupply isn’tr such a big problem that we’d even realize anything was wrong. But your quality of life changes radically when your baby can go longer than 60 minutes between feeds!

Also, I wanted to put this out there as yet another example of how many things with babies are NOT YOUR FAULT, and that you’re doing a great job.

Readers? Tales of oversupply or any other little odd things you thought you were doing wrong but were really just flukes or the way you or your child was built?

Q&A: bloody, mucusy stools

Rachel's got a question that's stumping me:

"My daughter is almost 5 months old and has had frequent bloody andmucusy stools on and off since she was about 6 weeks old. She is
exclusively breastfed.  Our pediatrician initially said it was dairy
and soy protein from my diet, so I cut those out. It seemed to make no
difference. I then cut out wheat, then eggs, until eventually the "top
8" allergens were out of my diet. Still no improvement. My pediatrician
says to wait it out, and since my daughter is gaining weight, seems
happy, and is meeting developmental milestones I shouldn't worry. I
just don't feel right about this, and since we are creeping up on
solids introduction age I really want to figure it out.  Do you have
any suggestions? We are so at the end of our ropes here."

Yeah, I just can't imagine that having blood and mucus in your poop is something that should just be ignored, so I'm kind of shocked that your pediatrician is telling you not to worry. Something is definitely not right.

You've dealt with the most obvious things: dairy, soy, wheat, eggs, etc.

Is this ringing a bell with anyone? I'm trying to think backwards through what I'd suggest if it were an adult suffering from blood and mucus in the stool, but I'm not getting anywhere with that in my head, either.

Was your daughter ever given antibiotics? That's the only thing that's jumping immediately to mind.

Please jump in with ideas if this is sounding familiar to anyone.

Q&A: breast pumps

Woo-hoo! Back to alleged reality for most everyone today. Over the break, my cats pried seven of the keys off my laptop, I had wacky hijinx involving airline flights, and I discovered that somehow all the crap in my apartment is reproducing so the more I get rid of the more there seems to be. I hope you're well.

Today's question is from Maria, who writes:

"Do you have any advice on picking out a breast pump? I feel lost trying to pick one out!"

This is when I confess that my breast pump knowledge kind of stopped in 2005, when it became evident that my second son was never ever ever going to drink my milk out of anything but me, so I gave up on pumping, and if I was out he just ate something else or waited.

But I do think the advice I've been giving all along is basically sound: You don't really need to have a pump ahead of time.

Here's the logic: Some women don't need to pump at all for the first month or so, and, in fact, pumping can screw around with their supply and get them overengorged and just cause all kinds of wackiness that's basically unnecessary. (Those of you who suffered from undersupply may not believe it, but oversupply can cause problems, too.) Plus it's just another task added to your overstressed brain and body, and why cause more headaches for yourself if there's no reason to do it?

If you are having actual supply issues (and by "actual" I mean that it's not just the normal "am-I-making-enough-how-can-this-possibly-be-working-when-I'm-not-actually-doing-anything-and-why-does-the-baby-want-to-nurse-from-3-9-every-evening?" stuff) then you should go directly to renting a hospital grade pump for the first few weeks until all that shakes out anyway. Sometimes supply issues are a matter of management and time (if you have edema, for instance, or got a bad start or had a traumatic birth) and you'll end up needing your own pump, but you can figure out which kind once you know what kind of pumper you are. Sometimes you're going to need to keep the hospital grade pump for the duration of your nursing experience. Sometimes you have issues that mean nursing isn't going to work, and having bought a pump is just going to add to the whole ball of suck that surrounds that discovery.

So. Upshot: Unless someone else desperately wants to buy you one, and will only buy it now, or you live someplace where you need lead time to obtain a pump, hold off until the baby's a few weeks old so you know what kind you'll need.

Having said that, I'll recommend the two gold standard pumps from a few years ago. Please, commenters, if there have been any new developments in pumping, put them in the comments.

For people who only have to pump once or twice a day, the universal favorite was the Avent Isis. It's a hand pump, but women said time and time again that they get more and have an easier letdown with the Isis than with an electric pump. I know first hand that their customer service is phenomenal, so if you lose a part or are confused about something (the white star disc has to go in facing down or you won't get any suction) they will fix you up cheerfully and quickly. (I would not use any other hand pump, no matter how cheap or available, because it just isn't worth it IMO.)

For people who need to pump more often, the Medela Pump in Style (PIS) was the winner. It's portable and reasonably quiet and has great, comfortable suction. Everyone I know who had to pump on the jobsite had the PIS and loved it about as much as anyone can love a pump.

And with that, I'm going to leave you with my own opinion, which is that pumping sucks. I don't know anyone who liked it, no matter how often or for how long they did it. It's one of those things we do for our kids if we can, but just counts as a sunk cost of parenting. 

Any new pumps out there that beat the Isis or PIS? Has anyone tried the new dual electric Isis and want to give a review?

Q&A: One side is tastier than the other

Look up for info about the service projects we're doing for December 2008.

Lisa writes:

"So this must be an odd question because I can't seem to find much ofanything about it anywhere online. The problem I'm having is that my
daughter (15mo.) is pretty much refusing to eat from my left breast.
The right one is fine and dandy, but she'll only nibble on the left
then back away and shake her head no. And I think the issue is that the
two taste different. Maybe this is gross to some people but I tasted a
drop from each breast and the right one is sweet as expected but the
left was kind of sour or salty. I couldn't tell exactly from the little
dribble on my finger but it was definitely different, and not in a good
way.

Do you know why this might be happening or what to do about it? I'm
stumped. I'm not pregnant (no chance), I started my period 2 months ago
and the timing kinda fits but not exactly, I don't think I've changed
anything in my diet, and I haven't been taking anything new other than
fish oil… and the timing might fit but why would it only affect one
breast? Any ideas Moxie?"

Yeah, I have no idea, but I do know this preference for one side over the other is not odd or unusual at all. It happened for awhile with my older son, and each of my boys showed a strong preference for one side over the other for periods of time.

(My first son liked my left breast better than my right for awhile, and I was convinced it was because I'm overwhelmingly right-handed, so maybe the right side tasted more gamey or something, like the difference between light meat and dark meat. Ah, sleep deprivation…)

I don't think there really is anything to be done about it, except to file it in the "Bodies Are Strange" file. At this age you don't need to be worried about your production, so you'll adjust and your right breast will produce what she needs. The biggest problem will be that your right breast might be larger than your left one until you wean. But since almost everyone is a little mismatched anyway…

Does anyone know why this happens, or have any stories, or remember where my original post was about this? I know I've written on this exact question before, but just couldn't find it.

We need data points on nursing to sleep

I’ve gotten some emails recently from moms who have been nursing their babies to sleep, but are getting lots of pushback from other people about how they need to stop or their kids will “never learn to fall asleep on their own.” I know we all know this is ridiculous, since no one goes off to college with their mom along. But I thought it would be helpful if we had some data points about what would actually happen if you just went with it.

My oldest needed to nurse to sleep, and abruptly stopped at around 11 months. He still wanted to nurse at bedtime, but couldn’t fall asleep that way anymore. Instead, he wanted his dad to rock him. (That lasted for a few months, then we went into a few months of someone lying down next to his crib, then that was over, and he started going to bed on his own, which shocked and delighted me at the time. You know how with that first kid it all seems so endless?)

My second kid never could nurse down to sleep, so he’s no use as a data point for this question.

I’ve heard of several other kids who stopped nursing down of their own accord somewhere in the 10-12-month neighborhood, but I’m wondering if this is common.

So, if you nursed to sleep at bedtime until your child gave it up on his or her own, how old was your kid?

If you pushed the weaning for that feed yourself, I’m glad you did what worked for you, but your results aren’t useful for the data we’re trying to get on this post today.

Also, you can give info about naps if you want, but I don’t think naps and nighttime sleep always have much in common timewise.

D-MER, or feeling crappy when your milk lets down

This just in from the “Who Would Ever have Suspected This” Files*:

“Dysphoric Milk Ejection Reflex

Defining D-MER:
What It Is

DysphoricMilk Ejection Reflex is a newly recognized condition affecting
lactating women that is characterized by a brief surge of dysphoria, or
negative emotions that peak before the milk ejection reflex, or
letdown, and then dissipate quickly after the milk release.

How D-MER Presents:
What Mothers Feel

The negative
emotions, or dysphoria, that a mother with D-MER experiences often
manifest “in the mother’s stomach” – a hollow feeling, a feeling like
there is something in the pit of the stomach, or an emotional churning
in the stomach. Mothers report varying types of emotions ranging from
dread to anxiety to anger, these emotions fall on three different D-MER
spectrums which are described in more detail below. The common thread
between the D-MER spectrums however, is the wave of negative emotions
or dysphoria, prior to letdown, that then lifts within another 30-90
seconds, and then usually repeats with each letdown.

A key piece of D-MER is that a mother with D-MER feels absolutely fine except just before her milk starts to flow….”

Ho-ly crap, people. I had no idea. I’m guessing right about now those of you who nursed for more than a day or two are either shaking your heads in surprise like I am, or reading this with your mouths open because this happened to you. Apparently all kinds of women have D-MER, no matter how easy it is for them to nurse, how soon their milk comes in, etc.

If this looks like you or someone you know, read the whole story at the D-MER website. Since this is such new information (and how did they even put it together?–I can’t imagine that most women with it would talk about it, because we’re not usually allowed to say anything even remotely negative about how we feel during breastfeeding), please go take their survey about it.

The tagline of the D-MER website is “Because Breastfeeding Shouldn’t Make You Feel This Way.” Seriously.

* Actually, it was an IBCLC (lactation consultant) who sent this to me. She herself had it with each of her kids, but had no idea it happened to other women!

Q&A: weaning earlier than you want to

Second half of yesterday’s post, on negotiating things with your mother, is getting bumped for this cry for help. Kirsten writes:

"I am sorry to be so pushy, but I am in a desperate, time sensitive nursing situation. My 13 month old who has been the nursingest baby ever got a cold, started teething and went on a 100% nursing strike. I have been working with a LC and am doing EVERYTHING I can. I have always had a meager supply and take Reglan and I don’t let down well for the pump, so even though I have a hospital grade Lactina, I am still only pumping about 6-7 oz. per day. I know I am going to lose my supply soon. The baby, I hate to admit, is no closer to getting back on the breast that she was a week ago, she just get furious whenever she sees a boob anywhere in the vicinity. I wake her up in the night to catch her sleepy, I try in different places/positions/noise levels. People keep saying that it is unnatural to wean this young, but it also feels unnatural that I am forcing my will on someone who seems to very much know that she wants no part of breastfeeding at this point. We are on day 9 of the strike. I wanted to nurse at least another year. I feel guilty, rejected and sad. What do I do?

It would mean the world to me if you would respond and allow other mothers to comment to my dilemma. My supply is only going to hold on another few days."

Who are these jackasses who are telling you it’s "unnatural" to wean this young? All other things being equal, if you lived in a tribal society 500 years ago your baby would probably still be nursing*. But, realistically, what control do you have over 1) a nursing strike that sounds serious, and 2) your supply?

Until we figure out if there’s anything we can do to reverse the effects of all the plastics and other things in our environment that are screwing with women’s supplies on a large scale, we all just need to back away from the guilt.

And, seriously, how much control can you have over a baby? If you’re working with a knowledgeable LC who knows all the tricks to help babies and moms through nursing strikes, and it’s not working, then it looks like it’s your time.

FWIW, I think a majority of us are conflicted about the weaning process, no matter how old our babies are. Two weeks, two years, three years…you always feel like you should be doing more. You wean and your baby gets a cold or ear infection the next week, and you think it’s you. Heck, my mom still feels bad that I weaned myself at 16 months or so–she’d wanted to nurse until two years. But you know what, 34 years later, we’re both healthy and happy and still close to each other.

Anyone who’s been through a rough nursing strike, who didn’t nurse as long as she wanted to, who wasn’t able to nurse at all, or has at any point felt disappointed in how things went with their baby or toddler, show some love, please.

* Or someone else in your tribe would be nursing your baby for you.

Q&A: Toddler losing his latch?

Heather writes:

"I don’t think you’ve addressed this before, and I’m having a hard time finding any info elsewhere. I have to attend a conference this summer and will be gone for 6 days. My son, at that time, will be 18 months old. I don’t intend to wean before that time, and I don’t intend to take him with me. I was wondering how long it takes for a kid to "forget" how to nurse or how to get a proper latch. I intend to pump during that time to keep up my supply, but wonder if he may wean himself in 6 days (which I am sort of ambivalent about, but would probably be sadder than happier). I was also wondering if there are some "data points" on the lengths of time women have been gone from their babies at different ages and what the effect was on nursing."

I’m not sure if there is much info about toddlers losing their latches out there. I know when I weaned my first son (at 2 1/2 years+), after about a week my mom (the former La Leche League leader) said to me casually, "Oh, and you know at this age they just forget how to nurse if they haven’t done it in a few days."

Um, OK.

So I thought that might happen when I was away from my younger son for two nights when I went back to work when he was 22 months, but it didn’t–he just ramped the nursing waaaay up. (Seriously. He was down to once a day for maybe 5 minutes, and I thought we were almost through, but then I went away all day M-F and he picked up the nursing to 3-4 times a day for longer sessions. I thought he was literally never going to stop nursing, and I would have to eat my own words about "you won’t have to FedEx your kid bags of breastmilk at college." But then miraculously he just forgot to nurse for a few days in a row while we were at my mom’s a few months ago, and that was that.)

So I definitely think there’s an age at which they forget how to latch if they don’t do it for a few days. But I don’t know what that age is. In my experience, it’s somewhere between 22 and 34 months.

Anyone else have data points about toddlers losing their latch?

And does anyone want to share experience about being away from a baby or toddler and how it affected nursing? None of my work trips affected my son’s nursing, but he was between 22 and 30 months when I went away, and the trips were all 2-3 nights long.

I suspect that it’s as much about your child’s personality as anything else, but would love to hear others’ opinions on that, too.

Q&A: fussy baby while nursing

N writes:

"My four month old and I got past the initial difficulty beginning nursing (pain, latch problems, mastitis, the usual suspects) and we were off to a really good start with the whole breastfeeding thing.  She is gaining well and healthy.  But she often does this thing at the breast that drives me crazy.  She kicks, screams and thrashes while nursing.  If I hold her where her feet can hit the back of the chair, she’ll kick against it, moving her whole body away from the breast while she’s latched on (not pleasant).   If I position her where her feet can’t kick against the chair, she’ll instead scream and whip her head back and forth while latched on (also not pleasant).  Taking this as a sign she’s not really hungry, I’ll take her off the breast, which is met with shrieks of protest.  Put her back on the breast, we get a repeat showing of Wrestlemania: Baby Edition.  It doesn’t seem to be a low supply issue as it’s always easy to express milk when she’s doing this, but I don’t really believe it’s that the let down is too strong for her either. Her older sister did this too when she was nursing, but this one is much worse about it.  I can’t quite figure out what’s going on here.  Any suggestions?  I’ve been stretched about as far as I can be – literally!"

Yeah, I remember this. I think it may be some kind of gastrointestinal growth spurt of some sort, but it was perplexing because there were no other symptoms of other gastric distress–no excess farting or crying 20 minutes after a feed (the classic symptom of a lactose intolerance) or anything like that. It sounds like you don’t ahve any of this other stuff either, just the donnybrook on the breast. I never did figure out what caused it, and it went away in about a month or so on its own.

In the meantime, what I did was try to put as much pressure on my son’s tummy as possible while he was nursing, and for whatever reason that seemed to work enough that he could finish an actual feed without going all Goodfellas on me.

The way I did it was by doing all my nursing (except for the middle-of-the-night nursing, which didn’t seem to bug him) reclining on the couch. I’d have him facing down on top of me, stretched across the length of my body, perpendicular to me. So we were a lowercase t, and I was the vertical line, and he was the horizontal line across me.

That meant that he was nursing face down, but he also had all his own body weight on his tummy on top of me.

I have no idea if this will work for your daughter, but it’s worth a try. Readers, can you offer up anything else that she can try if my tummy-pressure thing doesn’t do the trick?