Letting go without giving up

A fellow doula called this week to ask for some advice about a client. As she told me the story, I couldn’t help but remember that I have heard this same story, or some equally sad variation of it, many times before. It goes something like this:

The story

A woman has a baby. It might be her first, but maybe not. The birth didn’t go exactly the way she planned and she struggles to come to terms with what she did wrong that caused the undesirable outcome. Her friends and family and maybe even her partner think she should just get over it because the baby is healthy and, after all, that’s really the only thing that matters.

She was not really prepared for how sleep deprivation would affect her. She feels irritable and moody most of the time. She loves her baby but it is an awful lot more work than she thought. Sometimes she just wants to curl up in a ball and go to sleep. Sometimes she cries for no reason, or out of frustration. Her partner has gone back to work and she hardly sees any adults during the day, or the ones she sees don’t agree with her parenting decisions.

She had really looked forward to breastfeeding but the baby lost 11 percent of his body weight in the first four days so her pediatrician told her to supplement with some formula. Of course she wanted her baby to get enough to eat so she gave him a few bottles, not realizing that getting a bottle in the very early days of breastfeeding sometimes interferes with the baby learning how to breastfeed. The baby began to gain weight but seemed to forget how to latch on properly, so she began pumping and bottle feeding with pumped milk.

Now that the baby is two months old, she’s seriously considering giving up trying to breastfeed at all, and maybe even giving up on pumping. It’s just so exhausting to try to feed the baby for a half hour, then give expressed breast milk, then pump so she has milk for the next feeding. She feels like breastfeeding is her last chance to prove herself as a competent mother and now she’s failing at that too.

The moral of the story

This story and its many variations should remind us of something very important: having a child is not a competitive sport. There is no “winning” or “losing” or “succeeding” or “failing.” As parents, all we can do is the best we know how to do in the moment. Certainly, we can be self-reflective and look into our own childhoods for what might cause us to believe or act in certain ways. But to connect our own self-worth to a particular outcome around our children is almost always a recipe for disaster.

For the parents of young babies my advice is to use the early years to practice, practice, practice the art of letting go. If you believe that whether or not your child breastfeeds reflects on the kind of parent you are, just imagine how you’ll feel when he comes home with an F on his report card or refuses to eat anything green or sneaks off and gets a tattoo.

The practical application of the story

But—and this is a big, big, BUT…

Just because you can’t control the outcome of something doesn’t mean you should give up trying to tip the odds in favor of the outcome you want. (After all, you don’t have to let your kid play video games instead of doing homework, stop serving broccoli, or give him a ride to the tattoo parlor.)

Before your baby is born, thinking about what you hope your birth experience will be like, preparing for it, and then letting go of any expectations you might have will help you avoid becoming too attached to any one particular way of having your baby. For early parenting, surrounding yourself with people who share your view of how you want to be a parent is incredibly important. For breastfeeding, arming yourself with basic knowledge before the baby comes can help you make decisions afterwards that are less likely to interfere with your aspirations. As your baby grows, seeking out other parents to share ideas with and muddle your way through some of the everyday challenges helps keep you sane.

The kind of person you are before you become a parent has a huge influence on the kind of parent you become. But that doesn’t mean you can’t use parenting as an opportunity to grow, change, and practice giving yourself the ultimate gift: self-forgiveness. I fervently hope the mothers whose stories sound like the one above can come to see parenting as just such an opportunity.

—Audrey

“Why do you need a class about that?”

My teenage son, who has grown up listening to me talking about birth and helping moms with breastfeeding on the phone, asked a great question the other day when I told him I was on my way to teach a breastfeeding class.

“Why do you need to teach a class about that? I think it would kind of mean there’s a problem for the human race!”

This is a great question. It’s one that many expecting parents also ask. After all, if humans hadn’t been able to figure out breastfeeding down through the ages, we wouldn’t all be here. What makes this time in history different? Or do those of us who teach breastfeeding just do it for the thrill and the money? (In case you’re wondering, it is thrilling, but the pay isn’t so great.)

The answer is yes, this time in history is different. Here’s why.

1) Most of us no longer live with extended family members close by, or even friendly neighbors. Chances are good that the first time a mom ever sees a breastfeeding baby, it will be her own. This means there are few opportunities for new mothers to have absorbed the “teaching” of experienced mothers who can both reassure them (“yes, that’s normal”) and pass along tips and wisdom. Classes–and good support groups–can take the place of this lost community.

2) Birth is more medical, and medical care is more fragmented, than in earlier times. When family doctors came to the house to deliver the baby, they were just that: family doctors. They cared for the mother and the baby. As birth moved into a hospital setting and medical professions became more specialized, one doctor became responsible for the mother (the OB) and another for the baby (the pediatrician). This has meant that OBs often have little incentive to think through how various birth practices will affect breastfeeding and the health of the newborn.

I am by no means saying that all OBs practice this way; many are extremely integrative in their care and do think ahead in this way. I’m just pointing out that the system is set up to separate mom-care from baby-care. The exception in our modern system is the midwifery model of care. Midwives are responsible both for the mother and for the baby during the first few weeks of life.

3) As a culture, we believe that “experts” must know better than we do about most things we have never done before. After all, we hire contractors to build our houses, tax preparers to do our taxes, and mechanics to fix our cars. If we are going to attempt any of these activities ourselves, we make darn sure we’ve read a lot of books and consulted a lot of web sites.

What’s different about breastfeeding is that, at some level–and particularly for the baby–it is an instinctive behavior. And while we’re very good at gaining book knowledge, we’re not usually great at “listening to our instincts,” or even figuring out that we have them. In combination with our lack of built-in community, this can be devastating for breastfeeding. Left to her own devices, a new mom sometimes, through no fault of her own, may fail to wake her baby frequently enough to feed. Or she may believe she must suffer with traumatized nipples because “that’s just the way breastfeeding is.”

You might think that this last point actually is an argument against classes, but I don’t see it that way. In my classes, I try to fill in the knowledge and support gaps that used to be filled in other ways, and then encourage parents to listen to what their babies and their instincts are telling them. Most often, when backed up with knowledge, this will be the right message.

I didn’t say this to my son, but I am hopeful that by the time he has a family, some of the factors that now make it a good idea to take a breastfeeding class will no longer exist. (If this isn’t the case, at least he and his partner will have their own personal information and support team… me )

–Audrey

Using the tools at the ends of your arms

I’ll admit, I like simplicity. Why go out and get a complicated piece of equipment when something simple will do?

That was the message delivered a few weeks ago by Dr. Jane Morton when she spoke to members of the Nursing Mothers Counsel. Now in private practice with Burgess Pediadrics, Dr. Morton conducted research at Stanford on how moms of preemies could greatly increase milk supply through the use of the “hands-on pumping” technique.

Her talk was titled Is Pumping Out of Hand? The Merits and Rationale of Hand-Expression and Hands-on Pumping. Dr. Morton’s answer to the question posed in her title is “yes,” and she is making it her mission to reintroduce moms to the two amazing tools at the ends of their arms while both simplifying their lives and increasing the success of breastfeeding.

The most common reason women give for stopping breastfeeding is insufficient milk supply. It stands to reason, then, that anything they can do to increase supply will increase their chances of successful breastfeeding. Dr. Morton’s “prescription” is simple: even for healthy, term babies, moms should hand express about 5 times a day for the first 3 days.

I had already been encouraging pregnant moms to watch her video on hand expression before having their babies. Now I’ve begun passing along her advice about early hand expression. As she explained it, working on your supply early is like money in the bank–invest a little now for a big payoff later. And we know that physiologically, it makes sense: in the first few weeks, the frequency of breast stimulation influences development of the hormone receptors that control milk production. The simple equation? More frequent stimulation=more hormone receptors=more milk.

Dr. Morton also encouraged hand expression for moms who might be suffering low supply later on (after several weeks or months). To help boost supply, a mom could hand express for a few minutes every time she gets a drink of water, or goes to the bathroom, or sends a text message (now that might be a lot of hand expressing!) The idea is similar to one we sometimes suggest of a “nursing vacation” for moms suffering with supply issues after weeks or months of breastfeeding: go to bed and nurse the baby as frequently as possible for a couple of days, just as you did during the newborn period.

I have only attended one birth since getting, and giving, the early hand expression advice, but the one mom who tried it has a great milk supply and breastfeeding was going well after just a couple of weeks. I can’t say for sure that the hand expression did it, but it couldn’t have hurt.

So I’ll pass along Dr. Morton’s advice to anyone reading this. Learn how to hand express effectively and do it early. It has the potential to make your breastfeeding experience a whole lot better.

–Audrey

The loneliness of breastfeeding the older baby (or toddler)

I got a call recently from I mom I helped about a year ago when her son was a newborn. She worked hard to resolve her early issues and breastfeeding has been going great since the then.

But now that her baby is a year old, she’s feeling lonely. In her peer group, most moms who haven’t already done so are beginning to wean. And she’s not alone in her loneliness. I remember looking around the park as I got ready to breastfeed my toddler and feeling distinctly out of place (but it didn’t stop me from nursing).

Despite the American Academy of Pediatrics’ official position–which is that breastfeeding should continue for “at least 12 months and for as long thereafter as mutually desired”–I often hear of moms going in for their babies’ 9-month checkups and hearing from the pediatrician that they should start to think about weaning.

I firmly believe that how long to breastfeed is completely up to each individual family. However, it’s a decision that, like deciding about whether or not to have pain medication during labor, can’t be made with partial or incorrect information. If an anesthesiologist says, “Oh, epidurals are very safe,” he or she may be correct in that very few mothers suffer the most serious side effects. However, because the anesthesiologist’s only patient is the mother, this assessment of risk may not take into account the effect on the baby and the mom’s experience of labor.

Unlike the anesthesiologist, whose information about risk to the mother is based on evidence, the medical professional who says, “There’s little benefit to breastfeeding after a year,” is misrepresenting or leaving aside a large body of research, summarized well at kellymom.com about just how beneficial continued breastfeeding can be. You may be surprised to learn that breastmilk continues to be a valuable source of nutrients and immunity-building compounds beyond a year. Children who are breastfed beyond a year are not more dependent. Nor is it more difficult to wean an older child.

Groups like La Leche League International and Attachment Parenting  International provide support for moms who are breastfeeding past a year. If a mom is lucky, she’ll be able to connect with other like-minded moms. But perhaps the most important support comes from within the mom herself, who knows she is doing what feels right to her and what’s right for her child.

– Audrey

Head and heart are not either/or

I recently came across two different discussions of breastfeeding that share a very important outlook. Rather than presenting breastfeeding as an activity to be mastered by the mom–like golf or gourmet cooking–both view it as an integral part of the relationship between moms and babies.

The recent posting by Diana Cassar-Uhl, IBCLC at The Leaky Boob takes the form of a letter from baby to mom in which the baby explains his/her behavior as a newborn. What I love about the post is how it blends the emotional connection of mom and baby with an explanation of the underlying physiology of baby behavior. This really resonates for those of us who view science not in opposition to emotion but in support of and inextricably bound to it.

The recently released DVD “Baby Oh Baby: Breastfeeding” also shows how understanding a bit about the physiological and biological underpinnings of the breastfeeding relationship can really help moms relax and feel confident. Again, it does this in a way that is intuitive rather than coming across like a biology class. 

I am happy that there is more information like this available now–information that doesn’t minimize either the “head” or the “heart” but recognizes that each influences the other in ways we are only beginning to understand as scientists and intuit as moms.

–Audrey

How much is enough? Thoughts on milk-making and motherhood

“I don’t have enough milk.”

In my work as a birth doula and a peer counselor with the Nursing Mother’s Counsel, I probably hear that lament a few times a week. Often, the statement is more accurately “I’m afraid I don’t have enough milk.” Talking more with the mom usually reveals that the baby is doing just fine (gaining weight, having plenty of wet and dirty diapers) but the mom is nervous.

This is understandable. What instinct is more basic to a parent than making sure our babies have enough to eat? Unfortunately, though, sometimes other forces are at work that may sabotage a mom’s commitment to breastfeeding. There’s the concerned grandma who, hearing the baby cry, suggests that maybe a little formula would help the baby sleep. There’s the pediatrician who suggests supplementation for every baby’s whose weight even gets close to dipping below an acceptable level rather than risk the health of the very, very few babies whose moms truly can’t make enough milk. Then there are moms themselves, who, in moments of sleep-deprived hysteria, reach out for anything they believe will help them get through the night–even if it’s the bottle of formula they really wanted to avoid and that might actually undermine their breastfeeding efforts.

Get educated

So what can these moms do? The first step is to get educated, particularly regarding where your pediatrician falls on the spectrum of support for breastfeeding. Pediatricians are wonderful medical caregivers, but their expertise and passion may not be around breastfeeding and they may or may not understand how important it is to you. You can ask some probing questions and a pose a few what-ifs, like “Under what circumstances do you suggest supplementing with formula assuming I am committed to exclusive breastfeeding? What if my baby loses more than 10 percent of his/her body weight in the first few days? What if my baby is jaundiced?” If you can have this conversation before your baby is born, you’ll know what to expect and can line up the support you need to get you through the first (sometimes tough) couple of weeks and get things off to a good start.

Understand the basics

You also need to understand the basics of breastfeeding: how frequently to nurse, helpful tips for positioning the baby, what to do if the latch is painful or if breastfeeding isn’t working. A breastfeeding class is a great way to obtain this basic knowledge prenatally. (Many are offered locally; I teach one at Blossom Birth in Palo Alto and the Nursing Mothers Counsel offers them in Redwood Shores.)

Get to know your baby

Then there’s another whole realm of education that doesn’t come from asking questions or reading books. It’s the on-the-job education of getting to know your baby. I always get a kick out of telling prospective parents that “The average baby will eat between 8 and 12 times per 24 hours.” Then I ask, “Who has an average baby?” Nobody! Just as adults have a huge range of “normal” in terms of food intake and timing, babies do too. And nobody can tell you what’s normal for your baby except–your baby.

Diane Wiessinger’s web site gives some good basic information about the wide range of feeding behavior you can expect from a breastfeeding baby. And the blog “Secrets of Baby Behavior”, produced out of UC Davis, is a wealth of information that can help you understand your baby’s behavior generally and feeding cues/behavior in particular.

What if it doesn’t work?

Now, back to that first statement: “I don’t have enough milk.” Yes, there are some moms who don’t make enough milk. These are the tougher cases. Sometimes there is a clear explanation–breastfeeding got off to a difficult start; mom is not feeding frequently enough; mom and baby were separated initially; mom goes back to work and stress levels rise and sleep decreases just as the baby is going through a growth spurt.

These problems can all be addressed, but fixing them might be a lot harder and might require a lot more commitment than a mom is willing to make. This is when the truly hard work of parenting begins: the balancing act of figuring out what is really important to you and how to prioritize sometimes-competing principles and desires. Do you work to build up your milk supply at the expense of cuddling and spending time with your baby? (Though skin-to-skin contact itself can help build supply, sometimes moms need the further stimulation of frequent breastpumping.) Do you fight for a flexible schedule at work at the risk of losing your job?

Nobody can answer these questions except you and nobody should judge you for the decisions you make. One thing I do know for sure from working with hundreds of moms over the last 11 years, some of whom were able to breastfeed exclusively and some of whom were not or decided not to, is that none of them loved or cherished their babies any less or more because of how they were fed.

– Audrey

Cure for the common vacation

Dictionary.com lists three definitions for the word “vacation.” The third is the simplest: “freedom or release from duty, business, or activity.

We have to amend the definition, however, when talking about parents of young (and even sometimes older!) children. Unless you leave the kids with Grandma or a neighbor, vacationing will be very different from vacationing as a single–or even married–adult. Your duty, business, and activity as a parent accompany you no matter where you go.

Depending on the age of your child, going on vacation means considering

• Where will I change diapers?
• Will there be a quiet place to breastfeed?
• How far is the nearest potty?
• Can all the toys/snacks/games/books I’ll need to keep my toddler amused during the 7-hour plane ride fit in the single personal carry-on I am allowed?
• Will my school-age-child’s mind rot if she is allowed to watch cartoons for 6 hours straight during the flight?
• Should I leave my cranky teenager alone in the hotel room while the rest of the family goes out sightseeing?

As you can see, the challenges don’t go away as your child grows; they morph and grow just as the tiny baby you once held in your arms morphs into someone who can look you in the eye and declare that he won’t go on the ferry ride.

One thing that also can morph is attitude. We invest so much in our vacations, imagining idyllic getaways during which everyone in the family will have fun, bond, and be culturally enriched. When the reality of tired, whiny children (and parents) sets in, we feel cheated. Add to this the inevitable unpredictability of traveling–the missed flight, the cancelled fireworks, the overpriced meal–and you have a recipe for disaster.  (Mark Brady offers some interesting thoughts on why vacations can be so stressful in a recent post on his blog “The Committed Parent.”)

There is different way. Vacations offer a perfect opportunity to practice presence. What if we left our expectations behind when we got in the car or boarded the plane? What if we regarded every moment as a chance to observe, or perceive, or behave in a way we have never done before? What if we let go of the things that irritate us most with a shrug and an “oh well!” and concentrated instead on the fact that we are moving, breathing, and with people we care about?

One amazing outcome might be that the urgent need to “get away on vacation” would evaporate, and with it, the intense expectations we place on the experience. After all, every day, whether at home or on the streets of Paris or climbing in the Sierras, yields just such opportunities for presence and thankfulness.

My summer holiday ended last week, but I’m planning on vacationing for the rest of the year.

– Audrey

The new parents’ not-to-do list

I see that more than the usual number of days have passed since the last blog post. Several times over the last week I have thought about sitting down to write something, but other activities have always taken precedence.

For me, the excuse is not “I was sitting on the couch feeding the baby.” Many new parents, however (especially new moms), have exactly that excuse for explaining with they did not [answer an e-mail] [return the boss's phone call] [send out the baby announcements] [fill in the blank with another task].

Sadly, many new mothers (especially in our get-it-done culture) feel guilty for not immediately getting “back to their lives.” I believe they do themselves and their nascent families a great injustice. There is a reason why so many cultures create a sacrosanct space around the first 40 days or so (about 6 weeks) of a mother’s time with her new baby. While the traditions can seem quaint or even backward (as described in a recent Slate.com article), I think modern moms would do well to follow the intention behind these customs. Here’s why:

1) REST. So many of us are unable to do what we need to do to take care of our health unless forced to do so. When you have a newborn–and especially when you’re breastfeeding–it’s not just your own health that’s at stake. My own postpartum doula told me something that has stuck with me for 13 years: “Sleep makes milk.” I liked the simplicity of it, and physiologically, it’s true. Your body produces greater quantities of prolactin, the milk-making hormone, when you’re sleeping.

2) HELP. As with self-care, too many moms are unable to ask for–or even accept–help with the tasks around caring for a newborn. I often encounter couples who want the first few weeks to be a romantic bubble around mom, dad, and baby. What they don’t realize is how grueling it can be to care for a newborn (sorry to those of you who have not yet given birth) and how this hope too often leads to dad morphing from a loving partner into the errand-runner. Take all the help you can get: from letting people make meals for you to tossing in a load of laundry and swabbing down the bathroom. If your relatives will be more of a hindrance than a help, have discussions with them beforehand about your expectations, and be prepared to set limits. If you can afford it, hire a professional postpartum doula.

3) NO SEX (!?) This prohibition is as likely to come from the medical community as from tradition. Your obstetrician or midwife usually recommends abstaining from sexual activity until after your 6-week postpartum checkup. Of course, even after you’ve been cleared for action, most moms don’t magically start feeling like their old frisky selves on day 43 postpartum. As with all the physical and emotional changes of pregnancy, birth, and postpartum, this is a process. Assuming you and your partner are in it for the long haul, there’s nothing wrong with waiting until you feel healed in more than the physical sense. And of course there is no prohibition against snuggling, cuddling, and smooching!

These “not doing” prescriptions can be hard to follow, especially if you have been accustomed to crossing things off your to-do list. If you absolutely must have a to-do list in the early weeks postpartum, please make sure it contains only these three items:

1. EAT
2. SLEEP
3. FEED THE BABY
   REPEAT AS NEEDED

I guarantee that sticking to this for the first couple of months will get you back to feeling like your old self sooner than if you try to act like your old self right away.

– Audrey

Cry me a river

Babies cry. It is a fact of life. Why? They cry because they need us and their other signals have failed to get our attention. (Yes, babies have lots of other methods of communication–just take a look at some information about infant states.) They cry because they are tired. They cry because they just don’t know what else to do.

As we grow older, we learn to get through life without crying. For boys and men especially, crying becomes not a natural expression of an emotional state but a sign of weakness. Some of us have learned to suppress crying to such a degree that we feel uncomfortable doing it even in front of our most intimate partners.

For women who don’t cry easily, the few weeks after giving birth can be a gift. The hormonal shifts that follow pregnancy leave you in an emotionally vulnerable place we often refer to as the “baby blues.” You might find yourself crying at almost anything (for me, it was a car insurance commercial).

The surprise for many people is that crying feels really good! In the years since my own postpartum outbursts, I’ve learned a lot about the emotional and physical release of crying. It works for adults. It works for kids. And it works best when you can let it happen, without judgment or censoring.

Because of our histories, many of us react strongly to our children crying. We respond to them, but we really want them to stop. This need in us can lead to all kinds of unhelpful responses, from overfeeding to inappropriately expressed frustration (the most severe of which might be shaking or otherwise hurting a baby). (For more on crying, see the Secrets of Baby Behavior blog.)

Embracing crying as a normal part of the spectrum of human expression helps us truly listen to our kids, as infants and as they get older. We fix what we think is wrong–the dirty diaper, the hunger, the boo-boo–and then, if the crying doesn’t stop, we simply hold them.

In the process, we may learn to let go a little more. Who knows–we might even end up crying too.

– Audrey

Get out of the house

I know how hard it is to get out of the house. Even after 13-plus years of being a parent and honing the morning routine, I experience many days when getting myself and everyone else out the door is a stressful, last-minute rush.

With  a newborn, getting out of the house can be even more difficult. I remember the days when every step toward the door seemed to be blocked by another obstacle: a diaper change, a hungry baby, or just plain inertia (I can’t get up off the couch).

I remember too, how great it felt to arrive at my destination, especially when the destination was a group of moms in situations similar to mine. My oldest son was only three weeks old the first time I ventured out to a new moms’ group. I  probably arrived late and I know I spent most of the time nursing. But I had my first encounter with a wonderful group of women who remain my friends to this day.

When I visit new parents postpartum and find them alone in their homes, I worry. You shouldn’t attempt parenthood on your own. Even if you’re capable of meeting your basic needs for food and sleep, becoming a parent–especially for the first time–cries out for community.

The Bay Area is blessed with many ways to build this community. Numerous city-based mother’s clubs, parent centers like Blossom Birth and Harmony Birth, hospital-based support groups, and gatherings like Peninsula Birth Companions’ Drop-In Breastfeeding Support group can give you a destination and a nudge out the door.

Yes, blogs can connect you with anyone anywhere anytime and YouTube and Skype are great. But there’s still no substitute for communing with an actual, in-the-flesh human being. Until women start having virtual babies, it will be worth the effort to get yourself and your little one out into the world, no matter how challenging it might seem.

–Audrey