Category Archives: Op Ed

Breastfeeding: Why Is It So Hard To Breastfeed A Baby?

This is the first in a multi-part series Ask Moxie is going to run on breastfeeding. My guest expert is Jamie. She’s a lactation consultant, mother of four, raconteur, and tireless supporter of all things boobular. She’s the person you want to talk to when your tits are in a vise (literally or not). In addition to writing these articles for Ask Moxie, she’s written an amazing series of posts on breastfeeding, breastfeeding support, and breastfeeding in U.S. culture on her own blog. You should check them out.

And now, on with the show:

Why Is It So Hard to Breastfeed a Baby?
 
One
thing that complicates breastfeeding for new mothers is the abundance
of myths steering her in the wrong direction (or at least in unhelpful
directions) as she’s getting started. 
 

Myth #1: It’s so much easier to learn about breastfeeding these days.
There is a ton of breastfeeding information floating around out there.
Unfortunately, a lot of it is bad. My copy of the Sears & Sears Baby Book
instructs mothers to center the nipple in baby’s mouth and RAM the baby
on. Some babies are fine with that. Others will respond with the same
indignation I would feel if someone shoved my face into my plate and
expected me to eat that way. So choose your sources carefully to find
current, research-based recommendations. (I am partial to kellymom.com and LLL myself.)
      
Myths #2 and #3: It won’t hurt if you’re doing it right vs.  Early breastfeeding is painful and you just have to suck it up.
If breastfeeding hurts a lot, something isn’t right. It may be that a
tiny adjustment in the baby’s latch (usually helping him to latch more
asymmetrically, taking a deeper bite with his lower jaw — details on these pages)
will make a vast difference. The problem may be an anatomical varation
like a tongue-tied baby or a mother with larger-than-average nipples
(technically known as "oro-boobular disproportion"). Significant pain
should signal you to get help pronto, before your nipples turn into steak tartare.
 

On the other hand, a lot of women experience a little pain. Your
nipples have never been stretched so far; your ducts have never been
distended to such a degree. Sometimes, especially before the milk
starts flowing, it makes a person say ouch. According to The Breastfeeding Atlas, this
type of pain should last about 20-30 seconds per feeding and resolve
within a week. But if you hear that you shouldn’t be saying ouch, you
may worry that you’re doing it wrong. Motherhood presents many and
varied opportunities to worry that you’re doing it wrong. Whenever
possible (this is just such an instance), decline them.

 
Myth #4: A lactation consultant is a lactation consultant.
As far as I know, no state in this country regulates lactation
consultants. You can get tired of your career in furnace repair one day
and hang out your shingle as a lactation consultant the next. This is
part of why lactation support in hospitals is so uneven. You can find
some wonderful nurses and LCs with a magic touch — and, more
importantly, the ability to transmit same to you. You can also
encounter nurses whose idea of evidence-based practice is "Good Enough
For My Baby In 1982 Is Good Enough for Yours in 2006." If you need
breastfeeding help, you can search here for an IBCLC. You might also call a local LLL Leader (start here).  If you need more assistance than she can provide, ask her whom she would call if she had a stubborn breastfeeding problem.
      
Perhaps most pernicious is myth #5: Breastfeeding has to get off to a good start or it won’t work out. A good start is a big help, but here’s what you do if you get a rocky start instead (courtesy of Linda Smith):

  1. Feed the baby. If possible, your own expressed milk, given in whatever way works for your family. If you opt to use a bottle, this is a helpful article  on using bottles to transition a baby back to the breast.
  2. Protect the milk supply. To bring in a milk supply, rent a hospital-grade pump. If your insurance company balks, an LC should
    be able to drop them a letter explaining why it’s important.
  3. Fix
    the breastfeeding. If you can keep something relaxed happening at the
    breast, offering the baby a chance to nurse when you’re both calm and
    he’s not too hungry, many babies will catch on all on their own. Most
    will figure it out in time, with assistance from an experienced LC.
One last note: many of the women who read and comment here are
infertility veterans. Lactation consultants report, anecdotally, a
higher rate of breastfeeding difficulties among women with a history of
infertility. Sometimes the cause is physical (PCOS can be related to
supply issues); sometimes the reason is unclear. I mention this not to
alarm anyone, but because forewarned is forearmed. The same tenacity
that brought you to motherhood can also help you, given good
information and support, to get past most breastfeeding hurdles. Good
luck!

Quick and Dirty on Sleep

I’m opening up Sleep Week with what I know about sleep. Remember, none of these are unique ideas!

First of all, kids sleep the way they sleep. Most of it is individual
personality. I thought that when I only had one kid, but now that I
have two, I’m absolutely sure it’s the case. There’s only so much a
parent can do to influence the way a baby or child sleeps, so you can
stop feeling either guilty or smug right now.

Following from that, don’t believe the "bad habit" hype. Think about it: If you had to switch job schedules so you slept a completely opposite schedule, you could do it if you had a week or two to make the switch. And you’re a full-grown adult with years of sleeping experience and full-blown preferences. Babies are way more flexible, so they can certainly make a switch in sleeping styles/locations/times/etc. You just can’t expect it to happen overnight. But given a week or two, you can make changes.

Therefore, in the first 12-14 weeks of parenthood you should take your lead from Malcolm X: By Any Means Necessary. If your baby only sleeps on your chest with his/her head wedged up into your neck*, do it if you can sleep that way. If your baby only sleeps in the swing or sling or Amby hammock thing or car seat or car or front carrier or laundry basket or between you in bed or holding onto the cat’s tail or on the bathroom floor or in a tent in your backyard, do it. If you have to run the hairdryer, clothes dryer, white noise machine, "La Vida Loca" CD, or any other noise, more power to you. Whatever gets the maximum number of hours of sleep for the maximum number of people in your household, that’s what you should do. And when anyone asks you how your baby’s sleeping, just lie and say everything’s great.

Once you’re past that initial period, figure out what’s happening, and what you wish was happening. Pick the thing that bugs you the most, think about what you could do to change that thing, and try it for a week. You’ll either fix it, be on your way to fixing it, or realize your kid simply won’t do that. If you’re on your way to fixing your problem, keep going. Otherwise, pick a different thing you want to change, figure out how to try to change it, and try it for a week. Rinse and repeat. In a month or two your kid should be sleeping the way you want. Then a month later everything will change again.

Now, for the important principles of sleep:

1. Babies older than a few weeks can’t stay awake during the day for more than a couple of hours at a time. (Apparently there are at least two sleep experts pretending this is a novel idea. It’s not. Both of my grandmas know it.) If your 3-month-old seems chronically cranky, try putting him/her down for a nap two hours after waking throughout the day, and see if that helps.

2. Once babies hit 6 months or so, many of them will settle into a 2-3-4 pattern. That means that they’ll take their first nap 2 hours after waking up in the morning. They’ll take their second nap 3 hours after waking up from the first nap. They’ll go down for the night 4 hours after waking from the second nap. Not all kids do this, but a surprising number of them seem to.

3. Despite what many peds say, plenty of kids still need to eat at least once during the night until they’re a year old or older. There’s no truth in the "s/he’s x weight so s/he should be sleeping through the night" myth. OTOH, if your kids sleeps through the night on his/her own, don’t wake a sleeping baby.

4. Most of the babies I know had sleep regressions at 4 months, 9 months, and 18 months. That means that no matter how well or how crappily they were sleeping, they’ll sleep worse for a month or so at those ages. You can try to "fix" it or just wait it out–it doesn’t seem to make much difference. You’ll feel like hell anyway. And then they go back to sleeping as well or better than they did before the regression.

5. Teething sucks. And for some kids it really seems to disrupt sleep.

6. Someday your child will sleep through the night. I promise.

*And you thought your baby was the only one who liked to sleep that way at the beginning.

I’m Here To Help

A few days ago I was reading a friend’s blog. She’s a new mom, and she posted that she’d read something in a book that helped her figure out an aspect of her child’s routine. A few commenters posted that they were glad she’d had this insight, etc. But others started falling all over themselves to declare their total devotion to the author of the book. One mom said the author was her "hero." Another said she had "undying love for" the author and saw him as almost a benevolent relative to her children.

I don’t think they realize that he’s not the only person who knows this particular bit of information about babies.

When my mom was here after El Chico was born, she was reading my copy of a popular parenting book by a different author. About five pages into it she screwed up her face and said, "Does this guy think he invented this? We were doing this back in the 70s, only we just thought it was normal."

That’s got to be the thing I hate third-most about parenting: No matter what path you take, there’s someone who’s written a book telling you that there’s only One True Way, and if you deviate from it you’re going to raise children who have no control/are too tightly controlled/are too dependent on you/aren’t attached to you/won’t ever sleep through the night/won’t be good Christians/will turn into fundamentalists of one sort or another/will wet their beds until they’re teenagers/won’t come visit you when you’re 90/won’t be able to learn Latin/will only speak in Pig Latin. And they act like this dogma is a huge revelation that only they’ve had. So not only do you have to do what they say, you have to think they’re the only ones who could have come up with their position.

All this is a really roundabout way of saying that none of us has unique information. Sears doesn’t, Weissbluth doesn’t, Ferber doesn’t, Leach doesn’t, Spock didn’t, Hogg didn’t, Pantley doesn’t, Supernanny doesn’t, even Ina May doesn’t. Dobson doesn’t, Cohen doesn’t, Karp doesn’t, Faber and Mazlisch don’t, and Gary Ezzo certainly doesn’t. Your MIL doesn’t. My mom doesn’t. Your pediatrician doesn’t. And I don’t. All these people (including me) have done is gathered the wisdom of the universe, digested it, and spit it out with their own personal biases.

So before you read what anyone else says about raising kids, stop and think about the fact that you know your child best. Not me or any of those other people. We can give you ideas, or help you see things in a new way, or make you feel better or worse about what you’re doing. But you’re the one who knows. So trust your instincts. And keep on rocking the mama thing.