breastfeeding

"Lactastrophes" -- what's up with your doc when breastfeeding goes wrong

A lot of what you read online about breastfeeding is divisive or superficial, unscientific at best, dangerously misguided other times.  One writer whose work I always admire, though, is Alison Stuebe, MD, MSc, who writes for the Academy of Breastfeeding Medicine.  Her latest post, about "lactastrophes" -- when breastfeeding doesn't work -- is terrific.  

All too often my students and clients say that they feel that, while "everyone" is pressuring them to breastfeed, "no one" (they mean, none of their doctors) are actually there at the right time and place to help them make it happen, or seem to care.  This is, in part, because physicians do not learn about lactation management in med school.

Dr. Stuebe notes that although obstetricians routinely screen for breast cancer, which is not strictly within their realm, they can be "reluctant to take responsibility for the functioning breast," and, consequently, kind of ignore breastfeeding. (In fact, when she tried to submit the essay to an obstetrics journal, it was rejected, with the reviewer saying it belonged in a pediatric journal, even though it is about lactation, which is, obviously, an adult's issue.) 

Meanwhile, pediatricians don't routinely consider lactation to be within their purview, either. Though some give breastfeeding advice, I rarely hear of pediatricians who observe and assess an entire feeding, and have never known a pediatrician to assess the mother's breasts, let alone take a thorough maternal history to try to understand how the mother's physiology is at play in a nursing relationship. Without looking at half of the dyad, how can they assess what's going on or why something isn't working?

Appropriate care of a breastfeeding pair involves looking at the baby, the mom and the way the two work together, over time. It involves understanding what happened in the pregnancy and birth as well as what's going on right now, and the mom's plans for the future. You have to consider the mother's learning style and access to resources. It's is more than a side issue to fit in during your 8 minute OB checkup or your 10 minute pediatric visit; it takes time.  

To thrive, it's imperative that new moms have access to competent, trained specialists in human lactation -- IBCLCs are the gold standard in clinical support of human lactation. But unfortunately, most new moms I meet, even ones who know about lactation support, haven't the faintest idea that there is even a difference between a L&D nurse offering breastfeeding advice, versus an IBCLC, a CLC, an LLLL, a CLE . . . there is a whole alphabet soup of lactation support personnel, each of whom is competent to handle different situations. Some docs think any lactation professionals are "woo woo," and ignore them (as though breastfeeding problems will resolve themselves when no one helps the new mom); some lactation professionals spend more time defending the legitimacy of their credential instead of being candid with moms about their scope of practice, and experience.  And way too many people all over the profession ignore the relationship between nursing and a mother's mental health, or fail to follow the mom over time to see how their "advice" has played out.  Mothers aren't generic; followup is essential for good care; success is not merely "baby gains weight." 

With this backdrop, and with posters everywhere saying "Breast is best!" and people suggesting, routinely, that it always works if only the mom tries hard enough, moms end up confused, and, if breastfeeding doesn't work out, resentful. What is "trying harder," anyway?  I remember the first time I encountered a situation Dr. Stuebe also describes in her piece: a new mom with classic, obvious signs of insufficient glandular tissue. Her breasts presented so clearly --  more than four fingers' breadth between the breasts, each breast long and tube-shaped with bulbous areolae, one about twice as long as the other, unchanged during the pregnancy -- she could have been the text book photo of IGT. Her baby had lost a lot of weight; she had been told by her caregiver -- who had seen her breasts many times and knew her menstrual history -- only to "make sure the baby nurses twenty minutes a side."  She contacted me because the baby was very sleepy and wouldn't stay at the breast for that long and she felt guilty that she couldn't get the baby to keep trying. Try harder, she had been told.  Try harder at what!?  Trying to keep a starving, exhausted baby active for an arbitrary number of minutes was not going to fix anything.  Recommendations that don't begin by asking: why is this happening in the first place? can result in moms who exhaust themselves without actually making progress. 

Breastfeeding does not always work. It works best when the mom has access to excellent prenatal, intrapartum and postnatal care and education, ideally with continuity of care so that the same people who get to know her prenatally can be of service after the baby is born. Excellent care reduces the number of problems that come up and increases moms' satisfaction.  

But, as Dr. Stuebe says, we must stop asserting that "all women can breastfeed." Grandiose claims 

about the infallibility of lactation are not cited about any other physiologic processes. A health care professional would never tell a diabetic woman that ‘every pancreas can make insulin’ or insist to a devastated infertility patient that ‘every woman can get pregnant.’ The fact is that lactation, like all physiologic functions, sometimes fails because of various medical causes.  

OBs, midwives and pediatricians need to work as a team with IBCLCs and other specialists to investigate what is going on when breastfeeding goes off the rails, and be candid that sometimes the honest answer is, "we don't know why this has happened." The network of clinicians around new moms can, together, ponder how best to either restore physiologic function or to support the breastfeeding dyad through weaning if that's not possible.  

If we work together, we can develop solutions to some of the physiologic problems, and we can insist on training for everyone who works with new mothers in how best to support those who cannot meet their goals.  We should be honest with mothers that the reason that this is not already standard is that it's costly and time consuming to appropriately train everyone, and we haven't made that the standard of care. Currently, it's mothers who pay the price in exhaustion and disappointment.  It's not the mothers that need to try harder, it's everyone else who works with them.

The lactating breast should not be ignored by the health care providers moms see most, her OB/midwife and the pediatrician.  "Too many clinicians treat the lactating breast as a hot potato," Stuebe writes, "leaving moms and babies lodged in the gap between pediatric, obstetric and lactation specialists. In an era where public health campaigns urge all mothers to breastfeed, we need to urge all health professionals treat breastfeeding management as an integral part of health care."  Let's do better for moms and their babies.

What you can do:

  • take a good prenatal breastfeeding class taught by an IBCLC.
  • have contact information for local breastfeeding resources.  Kellymom.com is a good place to start, and, if you're in New York, check out nylca.org.
  • ask your caregivers, prenatally, what their resources are for breastfeeding mothers.  If they have none, is this the right caregiver for you?
  • have resources for a good facilitated moms' group for after the baby comes, where you can get the support you need.  

More about germs! Yay germs!

Yesterday I blogged about the importance of gut microbes, and recent news showing that birth mode (vaginal vs c-section) and infant feeding (breastmilk vs formula) affect babies’ development of good bacteria for long term health.  Today there’s another piece about this in the Times.  The article covers a Canadian study which found, again, that babies born by c-section and those who don’t have a breast milk diet have less protective gut bacteria at four months old, and more of the harmful germs that make you sick.  The authors of the study believe that this is a pathway for various autoimmune problems in older people.  

You can read the full study here.  I don’t love this study because the total number of infants is low.  More importantly, it, like so many studies that start to examine the nursing relationship, doesn’t really clarify what “breastfeeding” means.  They differentiate “formula feeding” from “exclusive breastfeeding” and “partial breastfeeding” at the time they took the samples, but there’s no apparent guidance about how to use those terms. My concern is that without good definitions, we can’t properly interpret the results. For instance: if a baby was given one bottle of formula on day 1 in the hospital (as so many are) but went on to have nothing but breast milk for the next many months, is that baby “exclusively” or “partially” breastfed?  If we are looking at the effect of early exposure to nonnatural microbes, it seems wrong to compare that baby to one who has had nothing but breast milk from birth.  But if we are looking at whether a protective effect of breast milk is dose-dependent, it seems wrong to lump that baby in as “partially” breastfed with another who has had half breast milk and half formula for four months. These distinctions are rarely made in studies that purport to look at the ways infant feeding affects health outcomes.  But if we’re going to learn anything real, we need to look closely at what it is we’re trying to study. “Breastfeeding” isn’t just one thing.

Germs are Great

If you’ve talked to me in real life for more than five minutes this year, you already know that I am currently obsessed with bacteria.  

I’m not a germophobe — quite the contrary: a host of new research shows that “good guy” bacteria — and there are billions of them on us — are extremely important in keeping us healthy.  I blogged about this  about a year ago after a report came out indicating that babies born by c-section are twice as likely to be overweight later in childhood.  Apparently, the difference is that since those babies didn’t go through the birth canal, they weren’t exposed to the good bacteria that live there, which “paint” a newborn’s skin, and get into her nose and mouth (and down into her gut) in a vaginal birth.

More recently, an article in the New York Times outlined how bacteria may also explain why breast-feeding may be protective against celiac disease and gluten intolerance:  probiotics (“good guy bacteria”) in breast milk, and pre-biotic oligosaccharides in breast milk (sugars in breast milk that exist not to feed the baby but to feed the good-guy bacteria that live in her gut) apparently help protect an infant’s gut from developing an inflammatory autoimmune response to gluten.

So, and here, today is another good piece, at Double X Science, called The Vaginal Ecosystem, which talks about changes in the bacteria that live in your birth canal during pregnancy.  The plain language explanation is:  the goo that lives in you changes while you’re pregnant because your body knows that a baby will be passing through and he’ll need to get a good coating of all your good gunk to get the best start in the world.

I guess the idea that you’re covered in germs (and that that’s a good good thing) is gross to some folks, but I think it’s awesome.  Truly, you’re the Mother Ship, and your crew are the billion germs that keep you in good condition. Go hug and kiss your kid: he’ll be all gooped up with your protective good-guys!

How To Take Care Of A New Mom, With Chocolate

You know those moments where mom is desperately hungry, but so is the baby?  That’s when it’s time for the Mom-Food-Chain: you feed mom, mom feeds baby.  

mom food chain

Also, are they not completely adorable?!  And isn’t this the most discreetly nursing baby ever?

I particularly love that he’s feeding her chocolate and berries — all the major food groups represented.

Have you tried this?

(photo taken with permission)

What Not To Say To A New Mother: Eleven Ways To Get It Right

Recently, I wrote about undermining things I’d heard hospital staff say to new mothers, and I have been overwhelmed by the feedback. I have read over a thousand responses and comments, too many of which confirm the themes of my original post:  that moms can feel seriously undermined by even small thoughtless remarks by their caregivers, mixed messages, or misinformation, and they hold on to the pain of that for years to come.  This comment struck me particularly:

when my daughter was placed in my arms, I had an overwhelming feeling of confidence that I could take care of this child, no problem; this was slowly eroded over 4 days in hospital, getting contradictory advice and information — so confusing!

Ugh!  

Seasoned moms know that once the adrenaline of childbirth wears off – be it 24 hours or four months - taking care of a child is rarely a “no problem” thing.  We all doubt ourselves sometimes; no one has perfect confidence.  But in those first few days, moms need encouragement.  They need to be taught what to do when they feel doubt, and confusion; they don’t need more doubt and confusion heaped upon them.  

But!  Several people wrote in positive comments about their time in the hospital, too, and those stories are so moving – not just as a reminder that there are great, great hospital staff members out there, but as a reminder for all who encounter new moms: small positive comments and acts are surprisingly helpful, just as the small negative comments were surprisingly destructive. Years later, moms still remembered: 

  • how good it felt when a nurse congratulated her on how much she’d pumped, and 
  • when a L&D nurse brought a newborn who needed immediate pediatric care to mom’s belly for a kiss and hug before being rushed away, and 
  • the doctor who said “I can see you’re going to be great,” at a moment when the mom could not see it herself, and 
  • Nurses who knocked before entering, asked, “is this a good time?” or “do you need to pee before we do this?”

And there were several comments about caregivers who slowed down, sat on the edge of the bed and simply smiled.    

I don’t mean you should tell a new mom everything is spectacular if it isn’t. But if you’re a friend or loved one visiting a new mother, or if your work requires you to care for new parents – small things make a huge difference and are remembered for years to come. 

Helpers, loved ones, and all who interact with new moms can be memorable for the good they do with these eleven basics:

  • Put yourself on a five-second delay.  Helpers often “hit the ball back” with a response as soon as they hear a new mom’s question.  Whether you are a caregiver or a friend, take a pause before answering mom’s question, and think about what you’re about to say, and check the phrasing. 
  • Make sure you are qualified to answer.  (If not, there’s no shame!  You can say, “let me think about that” or “let me ask so and so”).  Then, get help for her.
  • Think about your tone.  If you sound bossy or defensive, New Mom may hear that, more than she hears your words.
  • You are responsible for your body language – If your shoulders are relaxed and you’re smiling, it’s easier for the new mom to hear the substance of what you’re saying, and to learn.  If she sees your eyebrows scrunched together and a frowny face and your shoulders up by your ears, it can drown out whatever you’re trying to tell her!  Even if you’re worried, don’t distract with your body. The most effective way to get the baby and mom cared for is not to scare them, but to use your brain and words to get them what they need.
  • SMILE.  It makes everything you say more absorbent.  Try not to behave as though there is an emergency unless there is an emergency.  
  • Stay away from hypotheticals (“if, by tomorrow, we don’t see a change in X, we will have to do Y” or, for friends: “if your baby starts doing A now, you’re going to be in for it when she’s B months old”) unless there is a clinical need to discuss them right now.  People do this to show off their knowledge and to spread their own anxiety around, but it’s not fair to the new mom.  Unless it’s clear you need to act, try to keep the mom to the present, and stick with her so you can jump in if need be.
  • Ask whether you need to say anything at all.  Sometimes a grin is truly enough interaction. 
  • Use open ended questions to get the mom talking.  ”Tell me how breastfeeding is going” or “How are you feeling today?” or “So, what do you think of your baby?” will get you more information than, “how many minutes did he latch?” or “has he pooped yet?” or “has he been crying a lot?” 
  • Observe the mom.  Find something she is doing well.  There will be something – the way she smiles at the baby, the way she holds him more confidently each time, the way she asks good questions or shows appropriate instincts.  Tell her, specifically, that you notice these good things.
  • Observe the baby!  Find something totally adorable, and tell them mom you notice.  I remember one client I had whose baby was in the NICU.  I saw them on day 2 and pointed out how adorable it was that the baby was gripping Dad’s finger.  The mom burst into tears, saying, “That’s the first compliment she’s gotten since she was born!  Everyone is only talking about all the things she’s not doing.”  
  • Friends and loved ones:  Help the new family develop a “home team” (and be part of it), to get their needs met and their questions answered once they’re home.

What about you?  Do you remember what helped in those early days and weeks?

What Not To Say To A New Mother: The Hospital Edition

The other day I was visiting a family and their just-born baby in the hospital, and in the few short hours I was there, I heard a bunch of surprising comments:

  •  A nurse told a new dad (who was standing up, holding his 20 hour old baby) to put the baby down in the bassinet, warning him that his son was safer in the bassinet — otherwise Dad might drop the baby.  
  • A different nurse told a new mom (who was holding her 8 hour old baby) that her daughter would be safer in the bassinet because Mom might doze off and “co-sleeping is not allowed.”  

These comments, by two different staff members to two different families, are, to me, eye-rollingly laughable — obviously babies can be safely held by parents, both seated and standing.  Obviously babies don’t need to lie in a plastic bucket all the time for fear of being dropped.   

Probably the first nurse meant: “if you did drop him, we’d end up with a law suit,” I.e., it’s potentially dangerous to us, the hospital, not: “it’s actually likely you’ll drop him.” 

And probably the second nurse meant, “I have been trained to warn mothers not to fall asleep with their babies in bed because for non-breastfeeding babies there are certain risk factors to bed-sharing, and I see so many new moms per day that I can’t be more specific on an individual level,”  and not:  “it’s actually dangerous to for you to hold her right now, in bed, with visitors in your room.”

And, happily, both families took the comments with a grain of salt.  (The mom paused, concerned for a moment, but then looked around the room for encouragement and said, calmly, “well I’m awake right now.”  The dad made a comment under his breath about Americans’ fear of liability.) Both families have older children at home.

Here’s what I worry about, though:  first-time parents who have no other experience, and those who don’t have visitors to help them remember common sense.  Or who are just so tired and impressionable that they can believe that their urge to hold a newborn is wrong; and that he’s safer in a plastic box.  

It’s not that I think one statement, in isolation is so damaging, but, rather, the tide of small comments like this, pervading the new parents’ experience in the hospital.  Because while I was there, I also heard: 

1.  by a pediatric resident, re: a well baby:  “we’re taking the baby’s temperature to make sure she doesn’t have a fever.” (which suggests that she might have a fever, or might develop one),

instead of: 

“we’re doing our well-check up of the baby’s vitals so we have a record of how healthy she is.”)  

AND

2.  by a nurse:  “Here’s the breast pump.  If you don’t get enough to put in a bottle, we can give it by syringe.” (which suggests that mom might not make enough milk — a common fear), 

instead of: 

"one-day-old babies can only handle a tiny volume of colostrum because their stomachs are so small, and there’s no bottle small enough to appropriately feed a baby this young — so, we’ll give you a syringe you can put in her mouth, to give her the precious colostrum you get.”)  

(Or even better: "I hear you asked for a breast pump, so we’re sending one over along with an IBCLC who can teach and advise you, and help you figure out your options.”)

AND

3.  by an OB, to parents being discharged early after a healthy birth (unprompted, without previous discussion of infant feeding):  “Definitely take home some of the formula. You can top him off after each feeding to make sure he doesn’t get dehydrated.” (which suggests that the baby will get dehydrated if “only” breastfed) 

instead of: 

"I’m not an expert on lactation, but if you have concerns about breastfeeding, let me get someone who can help you."

See how insidious this is?  Each remark alone might be a smallie (I don’t think this last one is a smallie, though), but the cumulative message, over and over is:  

Things are about to go wrong.  You can’t trust yourself, or your judgment.  That feeling of relief that the baby is healthy and in your arms?  It’s probably just wishful thinking and the rug is about to get yanked out from beneath you. 

Newborn parents, who, for the moment, are tired, sometimes overwhelmed, understandably confused and facing lots of new stuff, are more vulnerable to suggestion than the rest of us.  They need encouragement and support so that they can:

  • learn to take care of themselves and their babies, 
  • learn to distinguish “emergency, requiring medical care” from “common sense situation I can handle myself,” and
  • learn to cope with the normal new-parent anxiety.

They deserve to encounter staff who understand their concerns, worries and knowledge level. They deserve staff who don’t plant seeds of self-doubt and a culture of fear.  We patients pay huge sums of money to be cared for while we are vulnerable — it shouldn’t be “caveat emptor”: let the patient beware — any advice you get may be misguided.  

So, but here’s the thing:  I don’t think that hospital staff who say stuff like this mean any harm.  I don’t think they intend to undermine parents’ confidence or give faulty guidance.  At all.  I do think they may be influenced by the pressure to think about liability avoidance, and they may be too overworked to individualize service and attend to each new family’s particular needs.  Any of us can say the wrong thing when we’re under stress, because we’re human.

But I think it should be a priority, for all who work with pregnant folks and new parents, to try to get that tone right as often as possible.  To slow down, remember that that new dad holding his baby is, inside his head, probably worried, anxious and far more likely to be riddled with insecurity and self-doubt than he is to actually drop the baby.  It’s so unfair to saddle him with the hospital’s fear of a law suit, when what he needs is to be reassured that he is competent and has good instincts.  When we talk to him as though he already knows he’s competent, we are not reaching our audience. 

By the way, you know who *does* understand how to reach their audience?  You know who never gets so tired or busy with their other priorities that they get off message?  You know who’s really good at sending the message they mean to send? 

Advertisers.  

Advertisers think, all the time, about how their message will be received.  That’s what they’re paid to do.  And that’s why, when I see a sign like this (text at bottom)

bassinet sign

in every single baby’s bassinet in the hospital, with the Similac logo, and a completely horse-shit ambiguous message about infant feeding, I become pretty annoyed.  I have two Ivy League degrees, a pretty decent comprehension of English, and even got a full night’s sleep last night, but reading this message, I feel completely confused.  

That’s because the message is meant to confuse me.  I am meant to conclude that infant feeding decisions are very important and confusing and require far more complex micro-analysis than a normal person with normal breasts and a normal brain could possibly figure out, which is why, thank god, there are doctors, nurses, nutritionists (note absence of IBCLC in this list) and, most of all, Similac, bringing me this lovely “keepsake,” a reminder that I am completely incompetent.  

Note also that this solemn, authoritative missive about infant nutrition doesn’t mention breastfeeding.   

See how savvy this bit of marketing is?  Similac donates these advertising cards to the hospital.  The flip side of the card, which faces into the bassinet, says the baby’s name, age, and birth weight; the hospital accepts the cards so they don’t have to pay to make and print thousands of name cards.  The side with the Similac message faces out through the plastic and is positioned at eye level — it’s the first thing you see every time you look at the bassinet to check on your baby.

Unlike hospital staff who are, I think, unintentional when they undermine parents’ confidence, advertisers are cleverly exploiting parents’ fears.  This marketing message is aimed — visually — right at parents who are already a little confused, tired, worried that they don’t understand everything. The message is:  you can’t understand this stuff. 

It’s marketing designed to reinforce your worry and then sell you something to ease it.

Now look, we are lucky, in this time and place, to have ways to care for our babies if things do go wrong.  But we shouldn’t be starting there.  Scare tactics, and undermining messages should not be a part of routine patient care, whether by advertisers who do it on purpose, or by well-meaning, but careless, staff persons who do it because they’re not paid to prioritize anything else.

We can do better than this. 

WHAT YOU CAN DO IF YOU’RE AN EXPECTANT PARENT:

  • New moms should not be isolated for long stretches.  Have someone who knows and loves you with you, not only during labor, but to stay with you while you’re in the hospital postnatally, to hold the baby while you nap, tell you how awesome you are, and to help you make sense of everything else that happens.
  • If you’re feeling confused by what anyone has said, ask them to explain why they’re recommending whatever they’re recommending.
  • If someone is saying or doing something that’s making you feel nervous or anxious, ask for more information.  Explanations demystify a lot.
  • If you’re told something that sounds like it doesn’t make sense, entertain the possibility that you’re right and ask for more information until it does make sense.  
  • If you have a clinical question about breastfeeding, it should be directed to an IBCLC.  If someone is giving you breastfeeding advice, ask them what training they have had. Anyone can call herself a “lactation consultant.”  Is this person an IBCLC or not?
  • Take the damn card out of the bassinet and throw it away.  Put in a new piece of paper with your baby’s age and name and weight.  Or turn the bassinet so the card faces away from you.  If you’re feeling energetic, tell someone at the hospital that you don’t like the Similac logo in your face.  (After you get home, when you have the energy (and this could be months later) write to the hospital and/or your caregiver and let them know what you liked and what you didn’t like.  You can use these form letters as a model.  Things change when people complain. 
  • If you’re feeling like everything is desperately hard, it is a good sign that you need help, not that you’re a failure already.  Ring the nurse.  Ask for help, and if it’s not something she can help with, ask who can.  Ask for help finding local resources for new parents in your neighborhood.  

I am sorry if this feels like all the burden is on you to ask.  But until our world changes so that all these things are just the routine, expected care of new parents, you do have to ask for the help you need.  When you do, you’ll find that competent, compassionate care helps.

(You can read more “What Not To Say” posts here (grandma edition), here (why comebacks are hard) and here (general dumb remarks), and you can read a followup to this post (what TO say) here).

10/9/12 update:  I’m sorry some readers can’t see the photo clearly enough to read the text.  This is what the Bassinet Card says:  

Deciding what to feed is an important decision, one that should be made by those who know your baby’s nutritional needs best.  Don’t make any changes in the feeding that has been specified for your baby without talking to your baby’s doctor, nurse or nutritionist.

Provided as a keepsake from Abbot Nutrition, Makers of Similac

In addition to the other problems with this card, deciding what to feed is a decision that should be made by parents, even if they have no nutritional expertise.

Smile At Me

Sometimes, those first few weeks of motherhood are a bleary haze of exhaustion.  Especially if the birth was hard and now mom is stuck alone, trying to get the hang of things, with plenty of diapers and burp clothes, but no company.  (No adult company.  Newborns aren’t much company yet).  It can be hard to hang in there and know that things will eventually settle down.  

Many of us have heard “it gets better when the baby smiles” or “by about 3 months there’s a real turn around.”  When you’re in the early wilderness, it can be hard to imagine how that’s even going to make a difference.  But here’s some awesome photo evidence.  This pic I just saw by my friend Marcia Charnizon totally captures what’s so thrilling about it:

marcia bf image

(if my reading of Portuguese is OK, I think this baby is just 3 months old)

And look how the baby’s reaction affects mom:

marcia bf spray

Ain’t love grand?

Sadly for us New Yorkers, Marcia’s located in Belo Horizonte, Brazil, but you can enjoy her work on her website and blog.

On Brain Fog, Marissa Mayer and Maternity Leave

Did your brain sort of go offline when you had a baby?  

When I was pregnant with my eldest I was a lawyer.  One of my colleagues informed me that a really bad case of “pregnant woman brain fog,” which she clearly thought I had, meant you were carrying a boy.  In her analysis, having a boy made you stupid: “they steal your brain, since males are dumber than females  generally, so they need to sap the mother.”  

(Meanwhile my secretary was telling me that if “you” — she used a generic “you” but she clearly meant “me” — looked ugly during pregnancy, you were definitely having a girl because, “girls steal your beauty.”  I was obviously having a hermaphrodite!)

My childbirth students and the new moms I work with often complain about “brain fog.”  It doesn’t happen to everyone and it doesn’t happen the same way for everyone, but it’s common enough that I giggled, reading this piece by Elizabeth Beller, about brain fog, which, for her, continues through breastfeeding, so that for months her mind works like this:

Feed Baby!

Blank blank blank blank blank blank.

Blank. Blank.

Baby!

Blank blank blank.

Bottles.

Blank blank blank blank.

Breastpump. Full Boobs.

Blank.

SIDS! SIDS! SIDS! SIDS!

Blank blank blank blank blank blank blank.

Blank. Blank.

Walk. Stroller.

Blank. Blank.

Air. Sleep. Sleep. Please, for the love of GOD, sleep. 

Christ these poor people with small children caught in earthquakes, floods, tornados!! The world is terrifying!!! How can I protect my children?!?

Blank Blank Blank blank blank blank blank blank. Blank blank blank.

Sleeeeeeeeeeeeeep.

Blank blank blank blank.

STARVING!! FRENCH FRIES! POUND CAKE! CHEESEBURGER! ANOTHER CHEESEBURGER! Pound cake. A beer.

Blank.

Pump.

Blank.

I totally laughed out loud at this description, but it also brings up something serious.

I’m not an expert on the chemical nature of these brain changes during and after pregnancy; obviously progesterone and oxytocin play a role in how we think and feel, and of course the sleep disruption typical of pregnancy and new motherhood plays a role in how clearly we think.  But I am hesitant to just chalk this up to “pregnancy” or “breastfeeding” biochemistry.  And I don’t like looking only at what you’re not able to concentrate on, rather than on what you’re doing instead.

Being pregnant and, later, becoming a mother, is an identity transformation, a creative project.  Creative projects use up a lot of brain power.  Perhaps that sounds mushy and new-agey to you, so I’ll put it this way:

You’ve just added a new citizen to the world and your body is required to grow him, and then to keep him alive.  If you don’t figure out how to get him cared for, he will die. 

Assuming he does grow up, he may become Ghandi, or Hitler, or a random guy selling shaved ice in Tomkins Square Park, or someone with an awesome sense of humor or someone who has really bad taste in shoes, or whatever.

In addition to whatever else you do with your life, your mind, and soul, and decades of your time and patience and attention are now required to help shape that person into Ghandi or Hitler or a random guy selling shaved ice in Tomkins Square Park or whatever; in some ways, how you spend these years will be a major factor in which of these paths he follows. This is true regardless of your parenting style — the fact is, your relationship with him affects his development. 

You created him out of your own cells. 

By fucking!  

And he’s going to turn out to be one of the five most important people you ever know, one of the people who changes you most in all your life.  

But for now he cannot do anything for himself, and cannot survive without you. 

You will be the most influential person in his life, for decades at least.  

You cannot get out of this relationship.  

Ever.  

Oh, also, by the way, you’re flooded with hormones and not sleeping normally and, unless you’re super-rich, you’re probably spending weeks/months/years wiping his butt and cleaning up his vomit and considering emailing photos of both to your pediatrician to check that they’re normal, and also doing work that our entire culture considers menial, and doing it without pay or benefits, and only sometimes finding that unbearable. 

Now, tell us, who are you?

Is it a surprise that, for a while, as you’re getting used to all this, some of your brain power is diverted from your other activities and to your new project?  Really, it’s only if we ignore what it is to become a mother that we could be even slightly surprised by it.

Let’s stop thinking about it as a fog that impairs concentration, and note that what a pregnant woman or new mother is doing involves a huge amount of concentration and brain activity 24/7  — some of it conscious and the rest of it simmering back there, the creative project of learning to be a mother.  Just because it’s natural doesn’t mean it’s nothing.

I’m thinking about this today because I just read that Marissa Mayer, the new CEO of Yahoo, has announced that she’s pregnant with her first child and plans, this fall, to take “a few weeks of maternity leave” and she’ll continue to “work throughout it” (obviously she means “work for Yahoo”).  I don’t know her.  Most likely she is in that tiny fraction of a percent of American women who can afford to not wipe butts if she doesn’t want to.  

Many women who are great, wonderful, earnest and devoted mothers find it reassuring and calming to reincorporate their work-life as soon as possible after their children are born.  There is nothing wrong with that — it can be done with patience and support and appropriate balance.  But, as the world dissects Marissa Mayer and her maternity leave plans, it’s important to remember what maternity leave is — beyond the physical recovery from childbirth, there’s the creative transition to parenthood, which is not something that can be farmed out to nannies and nurses. 

I’m not saying that’s simple or easy to navigate — certainly if you’re a CEO or owner, you can’t fully “leave,” just like a mother of a second or third child can’t simply stop paying attention to her firstborn.  But I wish we’d stop thinking of maternity leave as a vacation — which you might choose not to take, just as lots of Americans choose not to take vacations (or weekends!).  And instead, that we think of the first word in that phrase — “maternity” — and focus what the mother is doing, for itself, and not *only* inasmuch as it takes away from her other things.  

My kids aren’t babies anymore.  Looking back, I remember having an awfully hard time concentrating on some non-child issues I had to deal with when I was pregnant.  That “fuzzy” feeling extended into the new-parent period. It was most intense while I wasn’t sleeping and was breastfeeding round-the-clock, but in truth, it has lasted years. 

Years!  During which my ability to attend to the non-motherhood details of life was reduced, somewhat, compared to what I was like before I became a mother.

Finally, I asked myself, why I was comparing myself to what I was like before I became a mother?  Meanwhile, now I was a mother — I would be, forever. 

And it was time to stop acting like that was a freaking impairment.

Today, my eldest is home sick.  Just having him in the house means my attention is a little diverted from writing this post.  Not just because he is complaining every five minutes, but because I am thinking about him, and not just this.  

Is that “mom brain”?  I am, after all, charged with his care.  Wouldn’t anyone — mom or otherwise — find that attending to something new takes away some of the resources you have for your other things?  

Lets stop thinking mothers ought to be just like childless women. 

Apparently John Cleese Knows Everything About Parenting, Birth, Work, Marriage And Life!

Someone sent me this link to a talk by John Cleese about creativity, which I watched, at first, because I figured there’d be a few good jokes.  But I realized, watching, that although he’s supposedly talking about creativity in general, the whole piece is a fabulous essay, indirectly, about the importance of creativity in parenting and birth.  And your career.  And your marriage.  And life.  Creativity is they key to happiness in all of these things, and it isn’t a talent but a mode of operating.  Anyone can get at it.

I couldn’t agree more.

Many of you who have taken my classes/workshops/groups have heard me talk about how important it is for mothers to maintain a playful sense of curiosity, humor, and faith that although pregnancy, childbirth and parenthood are very serious, they are not meant to be solemn. Curiosity, a willingness to experiment and be silly and get stuff wrong (because a wrong choice might be a stepping stone to something brilliant), a sense of humor … these are some of the ingredients of the creative mode, and Cleese’s speech is all about how to get at that mode more easily.

Scary things happen when you embark on parenthood.  The stakes can feel really high.  Scary things make us anxious, and anxiety can squash out the open, fun, confident feeling that lets us be our most creative selves.  John Cleese says that the “closed mode” (where we’re not able to be creative), is characterized by anxious feelings, impatience, attempts to be organized, focus on small trivial tasks, and, sometimes, manic pursuit of a goal.  In short, it’s where new moms spend a lot of their time. 

One of the problems is that anxiety makes us worry that we don’t know enough.  So we consult experts — too often we don’t consult the kind of experts who guide and support us in being authors of our own lives, but, instead, the kind who confirm our fears that we don’t know anything and solemnly tell us How To Do Everything Their Way.  But if you are a non-generic person with a non-generic child, generic advice — even from famous experts — will not work.  

What will work is a customized, creative, individualized approach.

To do that, you need to get into the creative mode, which he describes as expansive, less purposeful, more inclined to humor, and filled with curiosity for its own sake.  (Doesn’t that sound more fun?) 

Being there will help you figure out how best for you to handle: the challenges of labor, parenting a baby, the transition back to work. Tricky infant feeding and sleep questions.  Tantrums.  Choosing a new midwife or OB or pediatrician.  Unloading the dishwasher and other shared domestic chores.  Finding time to get to the gym and have your nails painted and groove on your partner and sometimes do decadent things. In short, you’ll need to get creative to handle being an adult with a real, complicated life, and kids.  

(Well, actually, you can get by without being creative, but you deserve a life where you’re not just getting by.)  

There are a bunch of key points in the speech, concrete ideas about how to get into the creative mode.  (hint:  you need time, and space, and some people you can talk to, and a sense of lightness — sounds like a new moms’ group to me!).  But you should watch him explain the whole thing, so you can look at him and think of laughing your head off at that Fawlty Towers episode with the rat.

Perhaps my favorite part is towards the end when he says that being creative requires being prepared to tolerate the anxiety of sitting with something we haven’t solved yet.  

How many of us has been there, with an annoying or worrisome problem with our babies/toddlers/work/spouse, insecure because we don’t know how to deal with it, and totally irritable that the problem is Not Fixed And What If It Never Gets Fixed And Just Gets Worse And Worse!!??!  

Being creative, and successful, and happy doesn’t mean never feeling that way.  But Cleese’s ideas about how to cope with that moment, and what comes before and after that are, I think, really inspiring.  I hope you contact me to talk more about how to apply these ideas to childbirth and parenting, one-on-one or in a group.  meredith (at) amotherisborn (dot) com (or click the “Ask” button at left and leave your contact info!)

Ban The Mommy-Bomb: Why You Shouldn't Read That TIME Piece With The Photo Of A Sexy Lady Nursing Her Preschooler

Sometimes I picture online publishers sitting around a room looking worriedly at a bunch of charts with lines heading down down down — waning readership on their sites! Dismal traffic!  Not enough clicks!  

Then one of them grins and says, “You know what we need to do.”  And they all smirk and don’t even have to talk about what comes next.  It’s time for a Mommy-Bomb.

 All they have to do is print the word “breastfeeding.”  

Or “Formula.”  

Or “Stay-at-home mom.”  Or “Daycare.”  

Or “Epidural.”  Or “Natural Childbirth.”

And then a subtitle that includes the words “Good Enough” or “Mommy Wars.” 

Done.  They all laugh and do five minutes of work looking for someone to be the Sarah Palin (that’s what they call the “feminist” they’ll use to take a nonfeminist position for the article).  

They then open some beers and laugh about how they can get women readers to do their work for them.  They drive up traffic and ad revenue by fomenting insecurity and divisiveness and discord among the readers who can’t help but get sucked in.  

So, it just happened again, with tomorrow’s cover article in Time Magazine (note I am not linking to it), which shows a model-thin woman breastfeeding her preschooler.  This one’s got extra cha-ching because it’s not only a Mommy Bomb, it’s also a SexyBoobs Shot.  The title is, “Are You Mom Enough?”  SexyBoob Lady is giving us a Mona Lisa smile in her tank top and skinny jeans, showing off her gym-toned arms while her three year old suckles.  She can bring home the bacon, fry it up in a pan, and squirt that shit with home-grown organic breast milk.  Can you?

The article is apparently, about parenting styles — whether “regular” moms can measure up to Dr. William Sears’ version of Attachment Parenting; whether Attachment Parenting is keeping women down.  

Except it’s not about these things, really.  

A group of real women, gathered together with an experienced facilitator can have an amazing discussion about parenting philosophies, nursing, working vs. staying home — the works.  But online, these topics don’t lead to discussion, they lead to a shitstorm.  They’re not published to inspire discussion and thought.  They’re published to create controversy.  The hope is that you’ll click and click and click, to be scandalized or outraged, not that you’ll think, contribute, learn.

Here are a few things I think we all know, and one I think we often forget.  

1.  There’s no one perfect parenting philosophy that suits every baby and family just like not all babies are the same.

2.  Babies are really needy and there’s actually no way to raise them without getting pretty mutually attached.

3.  New moms, finding their way into their new identity are vulnerable to criticism and guilt, and can become insecure and defensive when they’re lonely with no company but the internet.

And 

4. When you click on an ad-based website, you’re making money for that site.  

I think it’s shitty that publishers run stories that exploit the normal insecurities new mothers experience.  It feels predatory to me.  Please don’t add to it by reading the story or participating.  

Instead, I suggest you take a look at two really thoughtful pieces *about* the story:  Katherine Stone’s piece on Strollerderby collects comments by over a dozen bloggers (including me!) about how to support real life women, not generic philosophies of Motherhood.  

Rebecca Odes’ piece, also on Strollerderby, takes a look at the feminist issues in the photography of the cover picture.  These pieces are worth your traffic; take a look.

Weaning and Depression

Here’s a conversation I have not infrequently with former clients who contact me when their child is a bit older:

Me:  Wow, so nice to hear from you!  Your baby must be <several months or more older> now — how is everything going? 

Her: “I was doing fine, really, everything was settling down … but suddenly I’m just feeling … <sniff> … really … down <sniff, sniff>.  I don’t know what it is; things are totally OK with the baby, it should be good … but I’m just feeling, now … <sniff, sounds of tears> … . “

Now, look.  Parenting is never a cakewalk, and sometimes what’s happening in a call like this is that the mom is just having a hard week — that happens to all of us. And talking about it really helps.

But more often, when I get this phone call, I have two followup questions for that mom — (1) did the baby just start sleeping through the night and/or (2) have you just weaned.  And more often than not, the answer to one or both of them is “yes.”  

Usually it’s:

"Yes!  And I thought I’d feel so much better, but here I am feeling even worse … "

I’ve thought about writing about this for a long time, but I’ve resisted because I haven’t been able to find good research backing up my speculations about why this happens.  But last week an article on Huffington Post talked about the very thing I’ve observed for years.  In “Weaning and Depression Linked In Many Women”, Catherine Pearson bemoans the lack of empirical data on this, and calls for more research on the issue. 

Here’s the gist of the situation:  When a woman is nursing, her brain almost constantly is secreting a hormone called oxytocin.  Oxytocin does a number of interesting things in addition to letting the milk down.  It acts almost like a drug that makes you feel good.  It takes the edge off pain; it makes you a little high, a little trusting, a little floaty feeling.  During lactation, a mom’s body is flooded with oxytocin and another hormone called prolactin, and together, they activate the same receptors as the drug Ecstasy; actually, a better way to describe that might be to say that Ecstasy is popular because it makes people feel like they’re having an oxytocin high.

Even before you give birth, you’re familiar with oxytocin from other life moments it’s helped you — oxytocin floods the body when you’re falling in love and that’s what makes you feel that sparkly feeling that all is right in the world.  And it floods the body when you have an orgasm, which is what makes *that* sparkly feeling.  You get a hit of oxytocin from massage, and from hugs, and from situations where you feel safe, loved, loving, intimate.  It’s the hormone we’re all, basically, addicted to; it makes us like being with people who take care of us and keeps us coming back for more.

We all have our usual dose.  And that dose goes way up while you’re nursing and then back down when you wean, and that transition back down seems to be particularly hard on some women.  

(Wait a sec, maybe you’re nursing a baby but you’re not finding nursing and new motherhood to be like taking E?  I think most people don’t.  But underneath all the chaos of your day, there’s that baseline of oxytocin, helping you to get through it, while it’s hard, tiring and confusing.  Oxytocin takes the edge off.)  

Some folks think that oxytocin is what makes you “bond” with the baby; I find it a little silly to reduce something complex like love to a simple chemical reaction, but perhaps the oxytocin helps us get started, so that we manage to find the baby compelling and cute even though she screams and shits all the time and won’t let you sleep.  In fact, when you think about it?  The fact that we manage to love our kids is a little irrational.  You’d have to be a little high to keep coming back for more.  High on oxytocin.  I think it’s supposed to be that when the baby is first born, it’s all chaotic and hard, but you have this hormone that makes you feel OK enough to get through it.  And then gradually your life calms down and is easier and then you’re ready to cope with it without a mega-dose of a feel-good hormone. 

Oxytocin doesn’t leave you forever when you’ve weaned, of course, you still get it from touch and security and trust and love.  But that regular hit of it, many times a day, at regular intervals, triggered by breastfeeding, the baseline — that’s gone once the nursing is over.  And while lots of moms don’t love breastfeeding, and many are happy for the freedom of having an older child who doesn’t need the breast, there are some women who seem to go into a kind of withdrawal after the oxytocin isn’t there.  I’ve seen it happen at weaning, and I’ve seen it happen when the baby sleeps a long stretch at night, or during a nursing strike.  In these cases, the mom herself is weaning off the oxytocin she’s used to getting all day long.  

I don’t mean to suggest that every mom who feels sad or wistful after weaning is experiencing only a chemical withdrawal.  There are also cognitive reasons a mom might be sad or down, or just feel the poignancy of life, around any major milestone.  And many moms find that weaning is a non-event for their mood.  But it seems to me that some women are particularly sensitive to this hormonal change.  

And yet it’s totally under-discussed.  

In my observation, women who feel a real dip in mood around weaning often find that they “even out” after a few days or weeks, as their hormones rebalance.  There’s a great description in Joanna Goddard’s blog post about her post-weaning depression at Cup of Jo — her depression starts when she abruptly weans, and ends, spontaneously, six weeks later, when her period resumed.

Still, it can be a shock, and a serious downer, and for some moms, it’s the beginning of a slide into clinical depression that they won’t spontaneously snap out of in a few weeks.  Yet I never hear of OBs or midwives mentioning any mood changes around weaning.  Even for moms who see counsellors or therapists, these transitional hormonal changes are often unexplored.  Most moms are utterly surprised by it, and that surprise can delay getting help.

Here’s what does help, though.

  • Understanding the way oxytocin works, and the way the body responds, perhaps, helps you anticipate that this might happen, and prepare.  If ever there were an argument for weaning slowly and gently and only when mom and baby are both ready, this is it.  (If you’re having a weaning-mood-dip because the baby is on a nursing strike, pumping may do the trick).
  • Exercise, Fresh Air, Sunlight, Rest, Good food, Doing a little less work for a few weeks.  In short:  take it easy on yourself.  We are talking about a short-term transition; you can do some extra resting and pampering for a few weeks.  This doesn’t make you lazy.  As I’ve blogged about before I think it’s helpful to have a handy list of things that might help, in case your mind gets really fuzzy and you’re lying in bed moaning and devoid of ideas.
  • talk to a friend.  OMG, please tell people!  You have friends in your life exactly for these moments, where you can rely on them to love you and keep you company and remind you that your entire life is not, in fact, pointless.  
  • See your doctor.  Any sudden change for the worse is probably worth a check-up over.  Some new moms experience transient low thyroid function or anemia, both of which can make you feel seriously rotten.
  • some moms find it helpful to take evening primrose oil to even out mood during the weaning process. 
  • Think about other sources of oxytocin that you can use to replace what you’re missing :-).  I think that what topples moms’ moods is the quick drop in oxytocin.  In the meantime, it’s worth thinking about pampering things that smooth the transition — a massage, perhaps?  Or … uh … sex?  It might be the last thing you’re thinking of if you’re depressed, but it could be just what you need.  In fact, when you look worldwide, sex may be the real answer.  In many parts of the world where folks have what we call “natural child spacing,” mothers nurse for a couple years, and are then  pregnant again a few months. (here’s a great example of this from another blogger’s description of post-weaning depression followed by conception) 

(Keep an eye on this, though.  You probably don’t want a decades-long cycle of pregnancy and nursing!  At some point you have to ramp down off the Fertile Goddess Dose of Oxytocin.  And I’ve seen some pretty irrational behavior by more than a few moms at the end of their reproductive cycle who seemed desperate and a little manic to replace the new-mom feeling of “abundantly needed and physically in-demand but rewarded by the powerful feel-good hit of oxytocin” — including everything from adopting half a dozen new pets to having an affair to using some pretty serious recreational drugs.  The problem is, obviously, you just create a bigger mess for yourself to clean up that way. How about one cat and a massage.  And some chocolate.  And a bunch of date nights :-)  Keep an eye on yourself.)

  • I think for most folks, a mood shift around weaning is going to be something small, like a few bumpy blue days.  And even if it lasts longer, it will probably resolve itself as the body gets used to the new baseline.  But if you’re finding that your declined mood is changing your behavior, making you feel irrational or desperate or out of control, that’s a clinical issue.  In Ms Pearson’s article, she quotes one mom who says, 

"I never sought out professional help … I never felt like I was a danger to myself or children. The extent of my mood swings were sadness and irritation, and they seemed to vanish as quickly as they appeared."

and another who says:

"I wish I had committed to seeing a psychiatrist or psychologist, since that might have helped me feel more supported and comforted …  But during my depression, I didn’t feel confident that they would be able to help — I didn’t think anything would help."

It makes me so sad.  Because I think we all know that the major symptom of depression is “hopelessness,” but when you’re saying:  ”I didn’t think anything would help” — darlings, THAT IS WHAT HOPELESSNESS MEANS.  All too often folks think that if they’re not “a danger to themselves or their kids” it’s not bad enough to get help.  

No!  It’s bad enough if you’re feeling like crap.  

It’s bad enough if you’re sad and confused and irritable with mood swings that are currently f*cking up your life.

As someone wise once said to me (because I’m certainly no stranger to depression myself), “You don’t have to be lying on a stretcher in order to get help.”  It’s hard to do, but you really gotta do it, because as hard as it is to believe, when you feel better, you will actually feel better.  :-)

Company helps.  And honesty.  And treating yourself right.  And patience and time and breathing and sunshine and chocolate.  But when you need more, you need to reach out and get clinical help in the form of talk therapy or medication or both.  If you’re finding that impossible to do, ask your partner to help you take the first step.  Or please contact me and I’ll see whether I can help you find the help you need.

What about you?  Did you have a bumpy ride with weaning?  

Can You Breastfeed On The Moon?

I’m surfing the net while my daughter plays with stickers, and she sees an article I’m looking at about a woman breastfeeding in this month’s Italian ELLE.  Here’s the pic, courtesy of Babble:

italian elle on babble

My daughter’s four, and, at the moment, very interested in female beauty and fashion, so she comes right over to comment on the model’s hair and shirt and lipstick.  Then she says,

"What is she doing?"  

I say, “She’s nursing her baby.”  

Nina says, “Standing up??”  

I love that the question isn’t “Can a nursing mother look like a model?” or “Can you be in a magazine while nursing” but just the physical logistics — can you do it standing up?  I tell her that, yeah, you can basically do it in any position once you get the hang of it and the baby’s not a newborn. 

"Can you do it in a headstand??"

I laugh.  Because I’ve spent the better part of the past dozen years trying to get both legs all the way up in a headstand, without success.  (Additionally, during that time, I breastfed, and weaned, two children.)  

So, the answer is “no” — I personally could not.  But, as it happens, I know of  a perfect example of this very thing, so I can show her a role model even if I couldn’t be one:

http://youtu.be/WqZCYCUcfGs

We watch, and she’s barely impressed with the mom’s yoga moves.  Apparently it’s a given that moms can maintain an inversion.  We are on to the next:

"Can you breastfeed on the moon?"

Nina assumes that if men have been on the moon, women have, too.  

That if women have been there, nursing mothers have been there.

Kids today.  They think mothers can do anything.

Guess How Many Times A Day Someone Barges Into A Hospital Room On A New Mom?

Here’s one for the “I Can’t Believe We Needed A Study To Tell Us This” file: an article I read this morning from lactationmatters.org, entitled “Do Interruptions Interfere with Early Breastfeeding?”

I don’t mean that the article was stupid (at all!), and in fact, there’s something validating that someone actually recorded how frikkin’ often new moms and their babies are interrupted while they’re still in the hospital.  Want to know how many times? 

53.  Fifty Three interruptions in a twelve hour period.

This topic came up last week at the new MOMs group — I’d asked a group of new moms who’d just met to talk about what was most surprising since their babies’ births, and although that conversation can go lots of different ways, this group mostly talked about how the births had gone, and the first couple days in the hospital.  Several moms talked with annoyance about how frequently people barged into the hospital room, (“it felt like someone was constantly coming in to do something”) and how difficult it was to get any peace, privacy, or even just a little time to think straight.  

Well, they’re right:  The study found that over the course of a twelve hour period, mothers in the hospital were interrupted an average of 53 times.  There were more than twice as many interruptions as periods of alone time.  That means that a new mom had to deal with someone coming in to do something to her pretty constantly; and the study also found that the interruptions themselves lasted longer than the stretches of alone time.  In fact, half of the “uninterrupted” stretches were less than ten minutes long.

Guess what?  Moms didn’t love that.  

In my New MOMs group, many of the same moms were also complaining that they didn’t have enough help with getting the hang of nursing, or that they were “left alone” to figure it out by themselves.

These things aren’t at odds, at all:  New mothers are not supposed to be left all alone, isolated, without help or company or support.  They are supposed to have easy access to supportive, knowledgeable people who can help them, and who can attend to their needs as they learn to get the hang of dealing with the baby.  They are not supposed to be isolated and when they are, they languish.  And all too often, they not only don’t complain, they feel guilty and weak for not being able to figure everything out themselves.

Isolation is bad for mothers.

But isolation is not the same thing as privacy, and all interruptions are not equal.  One mom I spoke to described how frequently people came in to take her blood pressure and temperature, or to check on the baby, or to have her fill out forms.  Did anyone come in to just sit with her and keep her company?  No.  No one in the hospital is paid to provide company. Did anyone come in saying, “Good morning, what can I do for you that might help you feel more comfortable today?”  Of course not.  The hospital does not provide a concierge.  Did anyone give her a list of resources that might help or educate her if she wanted that?  No, the hospital is not a school that provides education for its customers.

Did anyone assess her breastfeeding before the baby was discharged and provide her with detailed, evidence-based guidelines about how to proceed?  No.  Apparently the hospital is also not concerned with infant growth and nutrition.  You and your boobs are expected to figure it out for themselves.

What did they do?

Well, lots of people commented that she should be breastfeeding.  People talk and talk and talk about how “best” breastfeeding is.  People gave varied opinions about how frequently she ought to nurse and how long the baby ought to stay on the breast.  Most of them disagreed with each other.  

And they got all the data they wanted, about her temperature and blood pressure and wound-healing, and her paperwork was all complete.  They did that on their own schedule, in the way that was most streamlined for the hospital, not for the woman who’d just done a day of labor followed by major abdominal surgery and whose nipples were cracked and bleeding and whose baby had lost a lot of weight.

This. Is. Not. Good. Customer. Service. 

Newborn babies need lots of skin to skin time with their mothers, but new mothers (understandably) often feel modest about showing skin to strangers.  Having the door of your room burst open while your shirt is off can throw even the most unflappable new mom, especially when it happens multiple times per hour.

New babies also need frequent feedings, but new moms getting the hang of nursing often don’t appreciate someone barging into the room just when they’re squeezing the breast and looking at the color of their colostrum.  New moms are human beings; they need privacy.  When they don’t get it, they cover up.

The study found that moms perceived that interruptions interfered with breastfeeding.  This does not mean that doctors and nurses came in and literally said “You need to stop feeding now” or that the moms were told to ignore their babies’ cues to feed if someone else was in the room.  What it does mean is that as a practical matter, the moms felt that being on the other side of a revolving door was getting in the way of learning to nurse.

Why aren’t we making it easier on new moms?  How about some hospital protocols that group necessary clinical interruptions together in a way that makes it a priority to get new moms longer stretches of privacy?  

And how about making sure that, if someone’s going to enter a new mom’s room, that person:

(a) ask the mom “were you about to feed the baby?” and offer to come back later if it’s easier for the mom, so that no mom leaves the hospital feeling like someone was barging in on her every five minutes, and

(b) be prepared, qualified, trained and equipped to ask about nursing, assess the breastfeeding dyad, and provide appropriate, supportive help OR ELSE SUMMON SOMEONE WHO IS, so that no mom is discharged from the hospital without a breastfeeding assessment by an IBCLC.

People like to feel like they know what they’re doing — that’s because we’re human.  And when you’ve just had a baby, you often feel the opposite.  No one wants strangers barging in on them constantly when they’re feeling like a big messy work in progress — that can make you feel like giving up on whatever you were working on.  Instead, what new moms need is enough privacy to get the hang of things, and enough help to be guided in the right direction.  

Here’s what you can do:  

If you’re pregnant and planning a hospital birth:  Make a sign for your door that says, “Please, Only Urgent Interruptions; I Am Feeding The Baby.” Hang it at will.  Feel free to ask anyone who comes in whether they can come back in half an hour.  Have contact information for an IBCLC who can help you out as you begin breastfeeding.

If you’ve just had a baby:  The hospital will contact you with a generic call or letter to ask how your experience was.  I know you have a baby and you’re tired.  But take the time to answer their questionnaire and answer honestly.  If you got lousy customer service and know what would have helped, tell them.  You don’t have to figure out how they should conduct all their business, let them sort out the logistics.  But you ought to let them know you have a complaint with the way they do it now.

If you are a friend of a new mom, and can see that she had a lousy hospital experience because of this: write to the hospital and complain.  

Things don’t change when no one complains.

New TSA Rules for Air Travel With Breast Milk

New moms in the MOMs group often ask about airline travel with their babies.  It’s challenging to deal with the packing, and the logistics, and figuring out what to do with the car seat, and pouring your mouthwash and shampoo into those ridiculous little 3 ounce bottles.  But for nursing moms, TSA anti-terrorism rules have sometimes made it even more confusing and complicated.  I think we’ve all heard of moms who were told to pour out the expressed breast milk they’d worked so hard to pump, or moms who had to “prove” that their breast milk was real (and not a bomb?  WTF?) by drinking it in front of the TSA Official.  I don’t think there’s anything inherently nasty or wrong with tasting your own breastmilk, but somehow being forced to do it while a snickering Security Dude watched always seemed totally humiliating and just weird and wrong.

But! here are new rules from TSA which seem to clear things up, and which specifically say you don’t have to drink your own breastmilk to get on board.  The new rules say that moms can bring breastmilk on the flight, even if the bottle has more than 3 ounces, as long as she follows a few procedures:

  • Separate these items from the liquids, gels, and aerosols in your quart-size and zip-top bag.
  • Declare you have the items to one of our Security Officers at the security checkpoint.
  • Present these items for additional inspection once reaching the X-ray. These items are subject to additional screening and Officers may ask you to open a container.

So that’s good.  Breastmilk is still “da bomb,” though. :-)

(Thank you, Ruth Callahan, for directing me to the new TSA guidelines)