new Beginnings lllusa.org Breastfeeding in Page [04] Combat Boots [10] Mothers’ Stories 10 Medicine for Body and Soul 12 From Tube-fed to Breast-fed 14 My Breastfeeding Journey 16 A Relactation Tale 18 My Greatest Life Achievement [20] Toddler Tips [21] Making It Work [26] Giving Birth [28] Speaking Out About Postpartum Depression [31] Mothers’ Poems [32] Eating Wisely Cookies, Cookies, Cookies! [34] WBWC Editor’s Note new Beginnings lllusa.org Issue 5-6 | 2010 | Volume 35 Number 5-6 © 2010, La Leche League United States of America Managing Editor | Amy Nelson Contributing Editors | Brenda Carroll, Cathy DeRaleau, Gina Kruml, Karen Smith, Norma Ritter, Lesley Robinson, Sara Walters, Winema Lanoue Review Board | Alice Barbiere, Carol Kolar, Diane Jeffer, Fran Dereszynski, Gwen Gotsch, Judith Gibel, Judy Torgus, Kathleen Whitfield Art Director | Ronnelito Larracas Cover Photo | shutterstock.com Advertising Manager | ReNata Bauder Web Development | Dave Davis, Shelly Stanley Ronnelito Larracas Acceptance of paid advertisements does not constitute an LLL USA endorsement of the product advertised. Mailing Lists: LLL USA fully supports the WHO (World Health Organization) International Code of Marketing of Breastmilk Substitutes. LLLI Board of Directors, (1981,1988,1993,2006) New Beginnings is published by La Leche League United States of America, 957 N. Plum Grove Rd., Schaumburg, IL 60173. Visit our Web site at http://www.lllusa.org/. When La Leche League began more than half a century ago, the seven founders may never have imagined that one day it would be commonplace for mothers to have careers in the military and be faced with the challenge of breastfeeding while serving our country. Today, and in particular over the past decade, many modern mothers serve as active duty military personnel and prepare for their baby’s arrival by planning how they will be able to continue breastfeeding and/or pump in the military. Robyn Roche-Paull shares an excerpt from her recently published book, Breastfeeding in Combat Boots, offering information and tips for the military mother’s return to active duty. Our Mothers’ Stories include tales of a mother who was told her baby wouldn’t survive beyond the first days and now, months later, is thriving on breast milk, and another mother who decided to give breastfeeding a second chance after a friend told her about relactation. More mothers share their experiences and ideas in our regularly featured columns Toddler Tips, Making It Work, and Giving Birth. Karen Smith, editor of Toddler Tips, and Sara Walters, editor of Giving Birth, both end their tenures as editors with this issue. We thank them for their time and the effort they’ve put into collecting your responses and making sure other mothers are able to read your collective wisdom. If you are interested in one of these contributing editor positions, send your query to [email protected]. Rita Brhel, a mother of two from Nebraska, is intent on spreading the word about postpartum depression after experiencing it with the arrival of her second daughter. In her article, Brhel not only recounts her story but also shares information about recognizing the signs of postpartum depression and seeking help. We have a special treat in our final issue of 2010, sharing poems from mothers celebrating the joys of mothering and breastfeeding in our Mothers’ Voices feature. Rounding out this issue is a World Breastfeeding Week Celebration (WBWC) story from Savannah, Georgia and a successful outreach program started by an LLL Group in Mississippi thanks to a WBWC Grant. As we close out the year 2010 and look ahead to 2011, the staff of New Beginnings looks forward to another year of sharing your stories and providing a variety of informational articles to help you along your breastfeeding journey. Amy Nelson Amy Nelson is a La Leche League Leader in the small Missouri River town of Yankton, South Dakota, where she lives with her husband, Cory, and four children: Accalia (11), Cole (8), Ella (5) and Tylan (2). 2010 | Issue 5&6 | New Beginnings 3 Robyn Roche-Paull, IBCLC Breastfeeding in Combat Boots An Excerpt from Chapter 6: Planning Ahead Editor’s Note: While the number of New Beginnings readers who are breastfeeding and are active duty military may be small, the information provided by Robyn Roche-Paull in Breastfeeding in Combat Boots and, in particular, the following excerpted chapter can be helpful to all mothers who are returning to work and will need to prepare for separation from their nursing infant and making arrangements to pump while on the job. Whether active duty military or civilian, these issues are just some that many modern mothers face each day. Military mothers who choose to continue breastfeeding while on active duty do so not only because it is good for their babies’ health and it provides ease of feeding when off duty, but also because it makes them feel close to their babies, even when they are separated for long periods at work. It is well worth your time to plan how to combine breastfeeding with your military commitments. Some job specialties and ranks within the military will be able to combine breastfeeding and working better than others. Every situation is different, and this section aims to help you evaluate your breastfeeding goals and work situation, while giving you practical information on military 4 New Beginnings | Issue 5&6 | 2010 policies and pumping basics. The more prepared you are, the more confident you will be upon your return to duty. Planning Ahead The first and most important item of business to take care of, preferably before your baby is born, is to determine your work environment and facilities available to you. Do you have a separate room that is unused at your workplace, such as a supply room? Or will you be in field conditions in a tent, on a flight line, or in a medical facility? Do you have the option of on-site daycare where you can go to your baby on your lunch break? Military mothers have become very creative at converting areas into pumping stations: requesting a corner of an unused supply room with a curtain and couch or chair, cordoning off a corner of a tent, or using the back of an ambulance to pump. Speak with your direct supervisor in your chain of command. You will need to let them know that you plan to continue breastfeeding when you return to duty and will need a clean, private area to pump and some flexibility in your work schedule to pump (lunch and two 15-20 minute breaks). If you feel uncomfortable speaking with Robyn Roche-Paull, IBCLC your supervisor, you may request that another female be present with you when you make your case for breastfeeding upon your return to duty. You may work in a field that is mostly male, but do not let your feelings of embarrassment or shyness deter you from making the best choice for your baby. As this Air Force Captain says: Don’t be afraid to talk about it, especially with your supervisor—most men (if fathers) at least know that breastfeeding is an option. Your boss will probably be more uncomfortable with the conversation than you are. But in the long run, most bosses and coworkers will support and defend your right to breastfeed. You might be surprised at the answer you will receive and you won’t know unless you ask! (See the section on Speaking with Your Supervisor below). Bring in copies of your service’s policy regarding breastfeeding and a plan for pumping that includes how often you’ll need breaks and where you will pump. You can also ask your child’s healthcare provider for a note stating that breastfeeding and breast milk expression must take place for your child’s health. You might also bring in an article or two regarding the benefits of breastfeeding along with this book. Talk to women at your workplace about their experiences with pumping and breastfeeding. Find out what worked and what didn’t work for them. You may even decide to form an informal support group for one another to share tips and stories. Find a mentor who has breastfed on active duty and ask her questions about what did and didn’t work for her. You can also look for formal breastfeeding support groups for active-duty breastfeeding mothers (many bases worldwide offer them) and some La Leche League groups meet on or near military bases as well. Purchase or rent the best quality breast pump you can afford. If breast pumps seem expensive, remember that a year’s supply of formula can be as much as $1500$2300. Check with your Military Treatment Facility (MTF) or clinic, as some military hospitals (mostly Army) either loan hospital-grade pumps or sell double-electric breast pumps. Local WIC (Women’s, Infant’s and Children’s Program) offices on base, the New Parent Support Team, or Visiting Nurse programs also sometimes offer low-cost or loaner pumps, or can point you in the right direction to locate one. It goes without saying that getting breastfeeding off to a good start greatly increases the chances that you will be successful at breastfeeding once you return to work. Oftentimes, mothers assume that breastfeeding will go smoothly during their convalescent leave, and that all they need to do is learn how to pump, only to be blindsided by on-going problems that never resolve. Early breastfeeding problems such as sore nipples or low milk supply that are left unresolved can make it much more difficult to combine working and breastfeeding. All is not lost, however. With a little preparation, you can have breastfeeding well established before you go back to work. Remember the following: • Take a breastfeeding-basics and a return-to-work class. Get as much information prenatally as possible. • Practice skin-to-skin, nurse your M ilitary mothers have become very creative at converting areas into pumping stations: requesting a corner of an unused supply room with a curtain and couch or chair, cordoning off a corner of a tent, or using the back of an ambulance to pump. baby immediately after birth, room-in with your baby, and feed him on demand. • Get expert breastfeeding help while in the hospital and a referral to an IBCLC for additional help after discharge. Early help makes all the difference. Delay your return to duty if at all possible. You can bank your leave time and, with your commander’s permission, add it to the six weeks of convalescent leave you’ll take after the birth of your baby. Every week that you can stay at home increases your chances of long-term breastfeeding success. When you do return to work, do so gently, and try to return at the end of the week. Easing into your new routine slowly makes it easier on you and your baby. Policies and Regulations Perhaps the most important information to know is your service’s policy on breastfeeding. From this information, you can speak with your supervisor and co-workers and formulate your plans for continuing to breastfeed and/or express breast milk after your return to full duty. Overriding all the policies and forming the basis of the various regulations is the Department of Defense (DOD) Directive 1010.10 Health Promotion and Disease, which states that the Department of Defense and all of its employees must maintain military readiness by implementing and adhering to the goals of Healthy People 2010 (Department of Defense, 2003). One of those goals is exclusive breastfeeding for the first six months of life for the health of both the mother and baby. These policies vary widely between the services-from the Army, which has no policy and the shortest deployment deferment, to the Coast Guard with a two-year “sabbatical” after the birth of a baby and the guarantee of return to the same job and pay grade. These policies provide you with legal justification for making a request to breastfeed or express your milk while at work, while also allowing your supervisor to cite regulations when authorizing time for breastfeeding. However, none of these policies are foolproof or ironclad. Keep in mind that operational commitments will ALWAYS have precedence over your right to breastfeed or pump: the mission always comes first. See the sidebar for more information regarding military policies. Speaking with Your Chain of Command The vast majority of respondents to an online survey of military mothers stated that being upfront with your supervisor about your need to pump is the best policy. You need to be proactive about your need to pump, and in this case, it is better to ask permission beforehand than to hope for the best upon your return from convalescent leave. Don’t be afraid 2010 | Issue 5&6 | New Beginnings 5 Robyn Roche-Paull, IBCLC to speak with your supervisor. Communication is essential! No one likes to be surprised, and you can’t assume that your supervisor is thinking about how you are going to feed your baby. The policies regarding pumping and breastfeeding have been out long enough that most, if not all, supervisors should have a passing knowledge of what is expected of them in granting you breaks and providing a place to pump. It doesn’t hurt to have a written plan ready that outlines your work schedule including: PT, lunch, and pumping breaks; a consult with Occupational Health, if needed; the private space you plan to use for pumping; a back-up plan for duty days, watch standing or emergencies; any required storage needs for your milk; and your POC information. At least in the Navy, the policies concerning breastfeeding have changed (for the better!), so my advice to everyone would be to read up on what the policy states. Then you can go to talk to your supervisor BEFORE you start to pump at work. That way, he or she isn’t blindsided and wondering where you are at certain points in the day. Petty Officer 2nd Class, USN I was lucky in that my supervisor’s wife had given birth to their second daughter the day before I gave birth. She was also active duty and planned on breastfeeding, so I basically just told him that I was going to “disappear” to take care of things twice a day. He didn’t need any more info than that. Captain, USAF Don’t be afraid to ask for what you need--and you may have some unusual needs. I’ve found that if I treat it matter-of-factly, others do, too. You do what you’ve got to do. Major, USAF When, Where, and How Long How long you should breastfeed and pump is something only you can decide based on many factors, such as your work environment, schedule, possible deployments, and level of support you receive. No matter what, your attitude and commitment to breastfeeding is I told my supervisor my intent to pump at least two months prior to having my daughter. That way when I got back it wasn’t a surprise. Just talking to them and having the policy printed out in case they do not know about it would be the first step. Senior Airman, USAF When I was pregnant with my middle child, there was another nursing mother, so it was easy to tell my Officer in Charge (OIC). With my new unit, I told my OIC I was planning on breastfeeding. The office is supportive of it, and once they got used to the sign on my office door, they call if they need anything instead of knocking on the door. Captain, USA 6 New Beginnings | Issue 5&6 | 2010 vitally important to whether you will be successful at breastfeeding on active duty for however long you choose to continue. Having a goal in mind for both breastfeeding and pumping (they may differ) will help you stay determined and focused. You’ll need to decide what the minimum amount of time that you want to provide breast milk to your T he vast majority of respondents to an online survey of military mothers stated that being upfront with your supervisor about your need to pump is the best policy. baby is and see how that feels as a goal (remember to leave time to get any initial problems worked out). With that in mind, here are a number of goals in the first year that you may want to consider. Birth to Six Weeks Consider breastfeeding to at least the end of your six weeks (42 days) of convalescent leave. At six weeks, you will have made it over the initial hurdles of getting breastfeeding off to a good start, and given your baby an important boost by providing his or her first “immunization” via your milk. Having weathered the worst of the initial difficulties, you can better see how easy breastfeeding really is. Remember, if new moms had to decide whether to breastfeed for a year based on the first few days and weeks of breastfeeding, many would never want to! If your military work environment or schedule will preclude any pumping, then you can know that you eased your baby through those critical first few weeks. Six Weeks to Four Months Because you’ll be returning to work at six weeks, four months is a good first goal for pumping. Providing exclusive breast milk for the first four months has been shown to have a significant impact on your baby’s health. However, this is also the most challenging time, when most military mothers struggle with the demands of returning to active duty and managing a baby, home, and everything else. Your baby will be taking in a lot of nourishment during the day and having a few growth spurts as well. This can be the toughest time of all, so take it slowly, and try to keep your baby on exclusive breast milk for as long as possible. If you can make it past this hurdle, it really does get easier! Robyn Roche-Paull, IBCLC Four to Six Months Your baby’s intake can be quite high (he is more active now) and you may be struggling with supply issues and being able to pump enough to keep up with his demand. If you are finding that you cannot keep up with your baby’s demand at four months and have tried the suggestions later in this chapter on increasing your milk supply, you may want to speak with your lactation consultant, health care provider or a local La Leche League Leader about further options. Six to Nine Months The next goal to aim for might be your baby’s sixth month of life. The American Academy of Pediatrics (AAP) and World Health Organization (WHO) both recommend six months of exclusive breastfeeding to realize the majority of the benefits of breastfeeding. Your baby will still be drinking a lot of breast milk. But you are no longer solely responsible for all of his nourishment, which gives you some flexibility and eases the pressure of pumping enough during the day. You can continue to pump at work (and begin to taper down how often) and increase solids while you are gone. Breast milk is vitally important to your baby and should remain the majority of his diet throughout the first year of life. Nine to Twelve Months Having a goal of nine months means that your baby will be eating a variety of foods which can substitute for more breast milk, lessening even further the amount of pumping you’ll need to do. Remember, though, that breast milk remains an important part of your baby’s diet. Most babies still want to and enjoy breastfeeding in the mornings, evenings, and at night (nighttime nursing equals higher milk supply). Continuing to breastfeed at nine months can help combat some of the separation anxiety he will be feeling and provides an on-going boost to his immune system. A note: some babies get so “busy” at nine months, especially if they have mastered walking, that they forget to nurse. This doesn’t mean they are weaning. Rather, they need a gentle reminder from you that the “milk bar” is open. Don’t hesitate to offer the breast if you are determined to make it to 12 months or beyond of breastfeeding. Most babies will happily oblige! Over a Year The final goal to aim for is your baby’s first birthday or beyond. Breastfeeding for a year or beyond is recommended by the AAP to maximize the benefits of breastfeeding. Breast milk continues Each of the branches of the Armed Forces and the Coast Guard has its own policies regarding breastfeeding (the National Guard and the Reserves follow their parent services). Here is a brief synopsis of each and a link to the policy online. Air Force: Air Force Instruction 44-102 authorizes 15-30 minutes for pumping every 3-4 hours. Deferment from deployment is 6 months. http://www.af.mil/shared/media/epubs/AFI44-102.pdf Army: The Army does not have a breastfeeding policy authorizing break time for pumping. The deployment deferment period is 6 months. to offer immunities from illness and provides proper growth and development well into the second year of life. By this point in time, your baby will be getting most of his nourishment from other foods, and breastfeeding will be more about comfort and reconnecting with each other. At this point, you can stop pumping completely and transition your toddler directly to cow’s milk. Breastfeeding to the age of one year or longer is the most pleasant time for working mothers. The hassle of pumping is over and gone and only the joy of nursing remains. A number of women have successfully breastfed, or even tandem nursed (nursing two children of different ages), for two or more years, as recommended by the WHO, while serving on active duty. It can be done! My littlest son just stopped. He was three and a half years old. Tech. Sgt., USAF I have been on active duty, Marine Corps, and breastfed/pumped for my youngest daughter throughout my service time. I occasionally tandem nursed, too… my youngest, now 4, occasionally nurses, and it has been an adventure! Major, USMC Marine Corps: Marine Corps Order 5000.12E (MARADMIN 358/07) authorizes a clean, secluded space for pumping. It does not specify allotted break times, but leaves it up to the supervisor and service member. Deferment from deployment is 6 months. http://www.awhonn-af.org/resources/MCO5000.12E.pdf Navy: OPNAVINST 6000.1C authorizes a clean, secluded space for pumping. It does not specify allotted break times, but leaves it up to the supervisor and service member. Deferment from deployment is 12 months. http://tinyurl.com/2pmz9b Coast Guard: COMDTINST M10000.6A does not specify allotted break times, but leaves it up to the supervisor and service member. Deployment deferment is 6 months. Separation for the Care of a Newborn Policy authorizes a one-time, two-year separation from active duty. http://www.uscg.mil/directives/cim/1000-1999/CIM_1000_6A.pdf 2010 | Issue 5&6 | New Beginnings 7 Robyn Roche-Paull, IBCLC Your breastfeeding and pumping goals should be what works for you and your situation, both at home and at work. Set a goal that is doable for you, and then meet it. If you find that you are not ready to stop, set another goal. It feels better to set a goal and reach it, rather than set it too high and feel as though you failed. On the flip side, the breastfeeding goal you choose should never leave you feeling like you wished it had lasted longer. Studies have shown that women who feel forced or pressured into weaning (whether by circumstances out of their control or a goal set too high) tend to have ambivalent and guilty feelings about breastfeeding, while those that made a goal, met it, and are satisfied with their breastfeeding experience, have positive feelings when their breastfeeding relationship comes to an end (Hills-Bonczyk, Avery, Savik, Potter, & Duckett, 1993). I think it is important for new moms to understand that ANY amount of breastfeeding is beneficial. It is OK to stop after one week, one month, one year. The decision is a completely personal one, and you should be applauded for even one day of breastfeeding. Captain, USAF It’s Not All or Nothing When deciding how long to breastfeed and pump, you also should consider how to combine breastfeeding and pumping in your workday. There is no right and wrong variation to this. Your decision will be based on the type of work you do, hours you will be away, what kind of time and place you have to pump, future deployments, and other factors. Whatever choice you make about pumping, you’ll be surprised at how fulfilling it can be to nourish your baby with your milk. The decisions you make about expressing your milk will be as individual as you, your baby, and your work environment. Here are some various ways to combine breastfeeding and active-duty work that other mothers in the military have used successfully. • Exclusive breastfeeding: With exclusive breastfeeding, you go to your baby at daycare or your baby is brought to you during the workday. There is no pumping during the day or use of expressed breast milk while at daycare. Exclusive breastfeeding is a luxury afforded to very few activeduty mothers, as it is just not practical given the work environment and hours. • Full breastfeeding and pumping: Full breastfeeding and pumping means you will breastfeed at home and provide pumped breast milk to your baby while at daycare. You will need to pump at least two to three times during an eight-hour shift, if possible; more often for longer shifts. This combination of breastfeeding and pumping is most suitable for those military mothers who can pump on a regular schedule while at work. • Partial breastfeeding and pumping: Much like full breastfeeding and pumping, with the exception of some formula given at daycare, in addition to pumped breast milk. Mothers in this situation pump as often as possible at work and breastfeed while at home (a single pumping session at night can also yield extra milk for the next day). This combination is most suitable for those military mothers who cannot pump very often at work 8 New Beginnings | Issue 5&6 | 2010 due to their schedules or environment. Mothers with a small storage capacity may find that their milk supply falters without regular expression. • Partial breastfeeding: With this combination, mothers breastfeed when at home and give formula while at daycare. There is no breast pumping or use of pumped breast milk. This is the most practical option for those military mothers who cannot pump at work at all. It is important that breastfeeding remain unrestricted when at home to maintain a milk supply. This combination generally only works for mothers with a large storage capacity. • Reverse-cycle feeding: Reversecycle feeding is a change in some babies sleeping and nursing patterns to better reflect mom’s availability. You may find that your baby breastfeeds more in the evening and during the night, while taking fewer feedings during the day when he is separated from you. It is very normal for babies of working mothers to reverse-cycle and shows a deep, well-adjusted attachment between you both (Frederick & Auerbach, 1985). Most often, babies do this naturally by breastfeeding much more frequently when home with mom and sleeping when they are at childcare. A nice perk of reverse-cycle feeding is that you need to pump less, or maybe even quit pumping completely. If you are finding that day after day your baby is not drinking all the pumped milk you leave with the daycare provider, you may be able to adjust your pumping schedule. By five to six months, with the addition of solids foods, you may be able to reduce pumping further or quit pumping altogether. Reversecycle feeding works, in part, due to the higher hormone levels at night for milk-making. So it may or may not work for those whose shifts are on nights or mids (graveyard shift, typically midnight to 6 a.m. or 8 a.m.) It is important that you practice unrestricted breastfeeding when you are with your baby, and co-sleeping facilitates mom getting some sleep and letting baby nurse often during the night. Remember, when it comes to breastfeeding in the military, any breast milk your baby receives is better than no breast milk at all. It is OK to supplement and keep breastfeeding. It is not all or nothing. Your body is amazing. It learns when to make milk and when not to. If you can only nurse your baby in the evenings and at night, then your body will make milk at those times. Robyn Roche-Paull is the author of Breastfeeding in Combat Boots and of the companion website www. breastfeedingincombatboots. com, she is also an IBCLC in private practice, and has been an active La Leche League Leader since 2000. Robyn is not only an advocate for active duty military mothers who wish to combine breastfeeding with military service, she is also a US Navy Veteran who successfully breastfed her son for over a year while on active duty as an aircraft mechanic. She is the mother of three breastfed children now 14, 11 and 7, and has been married for 17 years to a Chief Petty Officer in the US Navy. Mother’s Stories Medicine for Body and Soul Before I became a mother, I knew that I would breastfeed my baby. I believed breastfeeding was natural, beautiful, and healthy for both of us. I never anticipated the emotions that it would stir in me. Breastfeeding is more than nourishment for the baby. It quenches her thirst for mother’s comfort, sense of security, and a closeness between us that will forever set the foundation of our mother-daughter relationship. When I’m at work, I long for my daughter’s snuggles and smiles. When we are together at the end of a very busy day, I see her sweet face. She turns her head and opens her mouth to drink in my scent and the sweet, warm milk while I soothe her by stroking her soft face. We look into each other’s eyes and relax. We are making memories and enjoying the moment. Breastfeeding is more than just milk. It’s medicine for the body and the soul. My daughter is a healthy six-and-a-half-month old exclusively breastfed baby. We’ve dabbled in “tastes” of solid food since she turned six months. I’m cooking my baby’s food instead of buying commercial to introduce her to tastes from the family table. I breastfeed in public without a cover because it’s easier and I’ve learned to be discreet. We cosleep because it helps us stay connected and get more rest at the same time. I carry my baby in a pouch sling and carry her with me wherever we go: walks, the zoo, the grocery store, or the library. 10 New Beginnings | Issue 5&6 | 2010 As a full time working mother, I’m grateful for a supportive work environment, not only for pumping milk during the day, but also for the support of my individual coworkers who know that I run into the Mother’s Room several times a day between meetings to pump while multitasking. Even my male manager understands the nursing relationship because his wife has breastfed their two children. He understands that I prefer not to travel overnight for work, leaving my young baby without her mommy for more than a single work day. My husband is loving, and he and our daughter are bonded. Moms and babies aren’t meant to be separated biologically, but in this modern day of mortgages and college-savings plans, I have to work. I’m so blessed to have a work-life balance that allows me to work from home two days a week to help continue our nursing relationship. My baby and I fought for this relationship. We are survivors. Breastfeeding did not come easily for us in the beginning because I had flat nipples. A lactation consultant/nurse quickly introduced a nipple shield for our second time nursing. Nursing helped to draw out the nipples, just as my doula had predicted. Our first night home from the hospital brought me to tears. With the support of my husband and mother-in-law (a longtime La Leche League Leader), I worked for hours to try to get the baby to latch. Mother’s Stories Finally, I pumped and fed her a bottle. She was starving. I learned over the next several weeks to try to nurse the baby with early hunger signs, before she cried. It taught me to be fiercely in tune to my baby girl. I knew when she was hungry because of a full breast. Now, my husband and I watch out for our baby’s early hunger cues like a high-pitched whimper, burying her head in our chests, and “nursing” our shoulder. I’m very fortunate to have a highvolume supply of milk. When my baby was only one week old, I was so engorged and realized that I should pump. I pumped four ounces of milk from one breast! This abundant supply has given me from their mothers that they’re growing up and ready to take on the world more independently. I blogged in my third trimester about how I prepared my body for having a baby years before, which paved the way for a very healthy pregnancy. I shared that I’ve always seen the cycle of childbirth as four phases: fertility/conception, pregnancy, labor and delivery, and lactation. I feel many mothers skip or cut the last step short because of societal pressures. Because of my blogging and sharing breastfeeding in my everyday conversation, people ask me questions about it. I’m thrilled to have questions from my friends who are not parents. Now my pregnant B reastfeeding is more than nourishment for the baby. It quenches her thirst for mother’s comfort, sense of security, and a closeness between us that will forever set the foundation of our mother-daughter relationship. the confidence to donate my milk. I freeze tons of extra milk that I pump while I’m at work and store it for future donation. My baby eats just enough at daycare and nursing constantly when we’re together. I am honored to share my milk with premature and sick babies in need by donating to the Indiana Mother’s Milk Bank. So far, I’ve donated over 600 ounces of milk. People ask me all the time how long I plan to continue nursing. I think to myself, it’s not up to me alone. Nursing takes two. I’m planning to nurse as long as she wants to because that is biologically natural. Babies wean when they’re ready, with support and encouragement friends ask me for advice and tips. Groups through LLL and my hospital gave me immeasurable support that got me through the first, tough four to six weeks of nursing. But, as breastfeeding mothers know, you need support all along the way with the changes in the baby’s development. I feel at home with these mothers. I’m proud to be a nursing mother. I’m proud to be Ava’s Mom. Amanda Berkey, Indianapolis, Indiana Editor’s Note: Amanda’s story can also be found on the LLL of Broad Ripple (Indianapolis, Indiana) website at http://lllbroadripple. org/2010/10/07/one-mothersjourney-through-breastfeeding/. Reprinted with permission of the author. La Leche League International (LLLI) offers guidelines for mothers interested in donating their milk. This information can be found on the LLLI website at http://www. llli.org/NB/NBmilkdonation.html The LLLI Board of Directors revised their statement about human milk donations in March 2007. Below is their statement, which is included in the LLLI Policies and Standing Rules: La Leche League International fully supports the use of human milk for babies. The first priority of LLLI is to help mothers breastfeed their babies. Babies benefit from human milk donated by other mothers when their own mother’s milk is unavailable. When a mother contacts a Leader seeking donated human milk, the Leader shall respond with information and support. This shall include information about induced lactation and/or relactation. The Leader shall also suggest the mother dialogue with an appropriate, licensed health care provider and contact a licensed human milk bank or other regulated and medically supervised human milk collection center. The Leader shall inform any mother interested in using donated human milk for her baby, whether on an occasional or on a long term basis, of the documented risks and benefits connected with this form of infant feeding. If a mother is interested in donating her milk, a Leader shall provide contact information for licensed human milk banks or other regulated and medically supervised collection centers. A Leader shall not ever pressure a mother to donate or to continue donating her breastmilk. A Leader shall maintain confidentiality of mothers’ information entrusted to her (relating to any potential donor or potential recipient). A Leader shall remind a potential donor mother that her own baby has a natural priority to her milk. A Leader shall inform a potential donor that: 1)the donor may request complete information from the milk bank or collection center about how her milk will be used; 2) the donor may inquire if she may restrict how her milk will be used; 3) she may make her decision about donation in the light of the information she receives from the milk bank or collection center. A Leader shall not ever suggest an informal milk-donation arrangement, including wet-nursing or crossnursing. If a mother wishes to discuss these options, the Leader’s role is to provide information about the risks and benefits so that the mother can make her own informed decision based on her situation. (Aug 76; rev Oct 92, Mar 07) Safe Sleep Tear-off 2010 | Issue 5&6 | New Beginnings 11 Mother’s Stories From Tube-fed to Breastfed When I found out I was pregnant, I immediately started researching natural birthing options in my area. Unfortunately, the last birthing center was shut down a few years ago due to lack of use, so it seemed my only options were hospital birth or home birth. We decided to brave it and go for a home birth. Once the idea set in, it grew on me, and I started to get really excited about having a home birth. I would tell people with pride that I was planning on having my baby at home, and I was almost smug about the fact that I was going to do it without drugs. It was important to be prepared, though, and to be prepared we needed to get educated. We started taking childbirth classes from a local instructor who had birthed ten children in her home! We were expecting to learn how to relax, how to breathe, and how to support one another. What we weren’t expecting was to learn so much about breastfeeding. I knew breastfeeding was important, and it had always been what I expected to do. I had no idea, though, that it was such an art. We watched videos about latch techniques, hand expression, and the importance of avoiding nipple confusion. And as it got closer and closer for me to have this baby, I became really excited to breastfeed her. I couldn’t wait to hold her close, skin-to-skin, and look in her eyes and know that I am all she needs in the world. Enter reality. My pregnancy was perfect. My labor was uncomplicated, but my baby came out in distress. She didn’t get enough oxygen in those first few minutes, which led to some permanent brain damage. The details of all this aren’t as important as the fact that as I looked at my little one lying in the Neonatal Intensive Care Unit (NICU) barely alive, I was grieving over many things, one of which was that I would probably never breastfeed my baby. In fact, in the beginning, it was looking like there were a lot of things I’d never get to do with my baby, and breastfeeding was not highest on the list. But, even while spending endless hours at the hospital, I faithfully pumped, getting hardly anything at first. I remember proudly handing my little bottle of breast milk to the nurse every three hours, basking in her praise and amazement at how much I could get out, even though I thought I should be getting more than an ounce and a half! I was told over and over that they were keeping every drop of this milk because it was like liquid gold for my baby once she could start eating. The day my milk came in was the day I said goodbye to my baby. We were told she would never be able to breathe on her own, and we made the horrible decision to unplug her ventilator and say goodbye. But she’s a fighter, and she is strong, and she wasn’t ready to go. We couldn’t believe that after a couple of days, we started having conversations about 12 New Beginnings | Issue 5&6 | 2010 taking her home! We thanked our lucky stars. We learned how to insert her nasogastric (NG) feeding tube (through her nose all the way into her stomach) because she had no suck, swallow, or gag reflex, and we took home two full boxes of expressed milk. We were told she probably wouldn’t make it through the week so if we didn’t want to feed her, that’d be okay. I hated that tube so much that I was okay with this. That sounds horrible, but her kidneys weren’t working and she had little to no brain activity, and we were told she was going to die anyway. My husband told me to just hang on, and soon we were seeing improvements. She made so many gains, that before long we were certain she was going to make it. Even with so much to be thankful for, I was still mourning the loss of nursing. I was starting to hate the pump. I didn’t see how I’d ever be able to leave the house since I had to pump every two to three hours. I was dreading having to feed Sadie in public because of the tube. I just kept thinking how much easier everything would be if I could just breastfeed! We were told I could give her a pacifier and see if we could strengthen her suck, but that babies with this kind of injury were known to aspirate and end up with pneumonia, so it wasn’t safe to try to nurse her yet. I was militant about the pacifier. I even gave it to her when I was tube feeding her because I wanted her to feel her tummy getting full Mother’s Stories while sucking. But, the nurse kept telling me we needed to test her suck/swallow before we could try to give her any milk orally. Fortunately, I didn’t listen to the nurse, because Sadie STILL hasn’t had the suck/swallow test! Exactly a week after we brought her home--her two week birthday--I decided it was time to try to breastfeed Sadie. So, we got in the tub, we cuddled up with a warm, wet towel, and I put her to my nipple, but she couldn’t quite get the hang of it. Then my husband suggested trying the other side. It took a few tries, but she did it! T (oh, what a relief that was!), and soon enough, I was comfortable nursing in public. Sadie is now six months old and she is a champion breastfeeder. She has nursed in restaurants, in the car, on an airplane, in bed, on the couch, at a baseball game, and anywhere else you can imagine. Teaching my baby (and myself) how to breastfeed has been one of the most rewarding things I’ve done in my life. I love to sit and nurse her (especially since she’s not a particularly cuddly baby) and sometimes fall asleep eaching my baby (and myself) how to breastfeed has been one of the most rewarding things I’ve done in my life. I was surprised at how different it felt from the pump! It wasn’t only the feel of the suck that was different and surprising, it was the hormones I felt releasing. I felt instantly closer to my baby even after just three or four sucks. I didn’t want to do it too much, though, because I was still afraid of her aspirating. The next couple of days I spent pumping, feeding her through the tube, then letting her suck a little. I attended a La Leche League Series Meeting because she was having trouble with the shape of my left nipple. We began using a nipple shield and that helped a lot. Soon we were trying to breastfeed before I pumped, and using the tube as a last resort. After five days, she was exclusively nursing! I didn’t tell the nurse at first, because I was afraid I’d be reprimanded, but when her lungs were checked and were clear for two consecutive visits, I figured it was safe. Actually, the nurse was impressed and proud of us for learning how to breastfeed! But we weren’t done learning. together. I love knowing that she knows what to do when I hold her a certain way, and that she has a specific cry to let me know she’s hungry. I feel like I’m giving my baby the very best. Despite her other deficiencies, I know that she’s getting the best from me now. I really feel I’ve fulfilled my purpose in life, in being a mother, and I don’t plan on giving this up any time soon. Maybe once it’s time to enroll her for kindergarten I’ll get the hint! Christie Beck In another couple of weeks, we were able to take away the nipple shield. A few weeks after that we could nurse lying down in bed together 2010 | Issue 5&6 | New Beginnings 13 Mother’s Stories My Breastfeeding Journey As a young girl, I remember my mom talking about the wonderful closeness of breastfeeding my two sisters and me, describing it as the best time of her life. I never questioned how I would feed my children. During my pregnancy, my mom gave me a copy of The Womanly Art of Breastfeeding and I read it cover to cover. My sister, who was two months further along in her pregnancy than I was, went to a La Leche League Series Meeting with me while we were both pregnant. I had a medication-free, natural birth with a full term yet small (6 pounds, 2 ounces) baby in July. She was put to my breast right away but did not latch on. While we were in the hospital we met with several different lactation consultants but did not really get any help. One lactation consultant sat with us for 20 minutes and gave me a nipple shield. She left saying “I sat with you for 20 minutes and don’t know what to tell you.” When we were discharged from the hospital, Jocelyn still hadn’t wet a diaper and I don’t think had gotten more than a few drops of colostrum. When Jocelyn was four days old we had a check up with our physician. She had dropped to 5 pounds, 8 ounces and would not latch on. Our physician referred us to a non-profit breastfeeding center. We met with a wonderful International Board Certified Lactation Consultant (IBCLC) on a Friday afternoon. She thawed some banked human milk and 14 New Beginnings | Issue 5&6 | 2010 finger-fed Jocelyn with a syringe. Jocelyn was very tired and disorganized. We put her on my breast, but she was confused and did not even try to latch on. We left the center with a hospital grade breast pump and another jar of banked human milk as well as a galactagogue (an herbal or pharmacological substance to increase milk production). I began pumping at least every three hours around the clock, initially only removing tiny amounts of breast milk. Within a week, I was able to pump enough milk to feed Jocelyn without any banked human milk. We continued to work on latching. Finally when she was about two weeks old, she latched on without the nipple shield. We continued to meet with the IBCLC twice a week and weighed Jocelyn before and after nursing to measure Jocelyn’s breast milk intake. I continued to pump eight to ten times a day. I nursed her for 20 to 30 minutes each feeding, pumped 15 minutes and then bottle-fed her pumped milk. I really believed she would learn how to nurse effectively before too long because I was told most babies learn by six weeks and, if not by six, then usually by eight. When she was five or six weeks old I promised her I would pump for 12 months if I had to, but I truly didn’t think I would have to pump for one year. When Jocelyn was six weeks old, the IBCLC suggested we try to “tough love” her to nurse without my pumping or giving her a bottle. For six days I nursed her for hours, weighing her before and after each side. I only pumped morning and night, and we were hoping this would be enough to help her breastfeed without supplementing with pumped milk. At the end of the week she had lost weight and was lethargic. My milk supply had increased when Jocelyn was two weeks old and now it dropped for the first time. From mid-September through January, I struggled with borderline low supply. We went back to pumping 8 to 12 times a day and began power pumping (pumping 12 minutes, off 12 minutes, pumping 12 minutes, off 12 minutes and then pumping 12 minutes) once every morning to encourage my body to make more milk. Initially, I supplemented my milk with extra frozen milk. Then my sister gave me some of her milk. When I was down to her last two ounces of milk, I went to a breastfeeding support group at Mother’s Stories the breastfeeding center. I felt very sad that I would probably have to give Jocelyn formula soon. A mother I had only met once before offered to give me her milk, and two other mothers also offered me frozen milk. I read the risks of accepting human milk and decided that it was worth it since I trusted these women. At seven weeks, Jocelyn had a frenotomy* for a posterior tongue tie** in hopes that it would improve her milk intake. It didn’t seem to help her, but at least we knew that we were I viewed the relationship aspect of nursing as at least half of the benefit. Plus, I made a promise to my baby to pump if necessary, and I had to keep my promise. The IBCLC was very encouraging and I continued to pump, nurse and give Jocelyn my milk in a bottle. Around her three-month birthday, we had a new problem. Jocelyn began a nursing strike and would scream and push away from me, refusing to nurse any time she was awake. I learned that I could nurse her if she was just barely awake, I t took a team of incredible people to help Jocelyn breastfeed beyond one year. I look forward to the next year and plan to continue our breastfeeding as long as Jocelyn wants. doing everything possible. At two months, I was exhausted and discouraged and talked about giving up. My sister encouraged me to continue until she was three-months-old. One of my dearest friends also encouraged me to continue even if it meant just pumping and bottle-feeding for a week without all the nursing. When Jocelyn was eight or nineweeks-old, the IBCLC told me that mothers in my situation had three options: One, I could continue to pump and offer the breast like I had been. Two, I could pump and bottle feed without trying to nurse. My third choice was to give up and feed my baby formula. I didn’t want to quit because I had seen that sometimes the breast was comforting to Jocelyn and before her eyes were open, during naps or at night. We had decided to cosleep around six weeks of age to encourage breastfeeding. For the next four months, I had a goal of nursing four times a day, just by catching her asleep. I continued to pump and give her breast milk in a bottle. We stopped meeting with the IBCLC since Jocelyn wouldn’t nurse while awake. I continued to talk with the IBCLC on the phone for advice and encouragement. Mid-January while I was changing her diaper, Jocelyn grabbed my shirt like she wanted to nurse. I took her to the rocking chair and she latched on, fully awake, and nursed for about five minutes. I was so excited she was nursing again. That month she nursed three times fully awake and by February she was back to nursing and very rarely refusing. I quit setting my alarm for middle of the night pumping and just pumped six times a day. In March we experimented with nursing more often and pumping less. In June I dropped down to only pumping morning and night, which I have continued through her birthday. She is now one year old and receives a bottle of pumped milk morning and night from her daddy and nurses about 10 to 12 times a day and four to six times at night. She loves her “num nums” and lifts up my shirt to nurse. I am so thankful for all the support I have received. My husband has encouraged me, washed pump parts and given many bottles of pumped milk to our daughter. My mother stayed with us for Jocelyn’s first two weeks to help and has listened to me for many hours. I’m also so thankful for my breastfeeding support group at the breastfeeding center and my incredible IBCLC. When people see all the work I’ve done, I want them to know that I did not do it alone by any means. It took a team of incredible people to help Jocelyn breastfeed beyond one year. I look forward to the next year and plan to continue our breastfeeding as long as Jocelyn wants. with a pump or in the rocking chair to give him or her your milk. I see breastfeeding as a long-term investment in Jocelyn’s and my health as well as an investment in our relationship. I consider every pump session and hour spent in a chair working on nursing more than worthwhile. Julie Schmoll, Lincoln, Nebraska *A frenotomy is a minor surgical procedure to release skin under the tongue that is anchored too tightly to the floor of the mouth. ** Posterior tongue-tie, also called posterior ankyloglossia, means there is tissue in the middle or rear of the tongue that keeps the tongue from moving the way it needs to. Babies with a posterior tongue-tie don’t have a notched tongue tip and they can extend their tongues over their gums, but the middle or rear of the tongue is tethered tightly to the bottom of the mouth. This type of tongue-tie is much harder to spot and many lactation professionals and doctors are not trained to recognize it. If you are having difficulty breastfeeding, I would highly encourage you to keep working with it. Maybe your baby will get the hang of nursing in a few weeks, and maybe he or she won’t. Even if your baby never nurses efficiently, I think having a healthy, very attached baby is worth all the hours you may spend 2010 | Issue 5&6 | New Beginnings 15 Mother’s Stories A Relactation Tale On January 16, 2010, I decided to relactate. What prompted me to do this? A very good friend of mine had educated me on the benefits of doing so and provided me with gentle encouragement. She had the faith and belief in me that I didn’t have in myself back then and guided me back into a wonderful and fulfilling breastfeeding relationship with my son, Braeden. I had told her how I wished I had been able to breastfeed and she informed me of a process called relactation. Much to my surprise, I learned that although I hadn’t breastfed in about seven weeks and my breasts were now completely dry, I could work toward bringing my milk back in. With my friend’s support, I started the process. I had stopped the breastfeeding process early in my son’s life- -not because I didn’t want to breastfeed--but because of an array of issues. In fact, I had dreamed of breastfeeding my baby since the moment I knew I was pregnant. My son was born six weeks premature via cesarean section due to risks with my pregnancy. All of the problems made for a very stressful pregnancy. Braeden spent more than two weeks in the Neonatal Intensive Care Unit (NICU), and my milk never did fully come in. I worked with a lactation consultant and pumped faithfully so that I could increase my supply and bring milk to the NICU to put in his feeding tube. I spent long 12-hour days at the NICU with my son, pumped by the side of his incubator and woke every three hours during the night to ensure I was sending my body all the right signals to keep making milk! 16 New Beginnings | Issue 5&6 | 2010 While at the hospital, I also made sure I did as much kangaroo care (lots of holding skin-to-skin) as they would let me. The problem was that I wasn’t getting much milk. After a 25 to 30 minute pumping session, sometimes I would only get 15 to 20 milliliters. I would put my breast milk in a syringe and put it into my son’s feeding tube and continue pumping regularly. I was determined to ensure that Braeden had the best--my breast milk. The lactation consultant had said that maybe my body had not caught up with the birth of my son since he was born so early and to give it time and continue pumping every three hours. I followed her instructions exactly but my milk supply did not increase. The lactation consultant suggested I meet with my obstetrician and request a medication to help increase my milk supply. I began the medication about a week into my son’s NICU stay and continued pumping every three hours. My milk supply did increase, but I was still only getting one to two ounces for every 25-minute pumping session. I was feeling very discouraged as well as exhausted from the process of trying to increase my milk supply and from the long days spent at the NICU. Also, once I left for the day, I had another son at home waiting to see me. During this time I also began having difficulty with my cesarean section incision. It had opened in two different areas, became infected, and required a lot of care. Initially, I had to attend a clinic at the end of my 12-hour day at the NICU and to have my incision packed. I also had to take antibiotics to cure the infection. Because I could not stand to have my son in the NICU alone, I continued my long days there with my stomach bandaged and so sore that I could barely walk. Eventually the nurse started coming to my home in the evenings after I had returned from the NICU, which thankfully prevented me from having to attend the clinic. This packing process lasted for six weeks before the incision healed. I became so overwhelmed with the issues surrounding my incision, the physical pain and the fact that I wasn’t seeing enough results from all my work to increase my milk supply. Combined with the fact that my baby was in the NICU, I gave up pumping on day 12 and asked the nurse to start bottle-feeding Braeden. I think it’s important to note that I also knew that the faster Braeden was eating on his own, the faster he would come home. The point came when he no longer required any oxygen or an intravenous (IV) site. He was just there to learn how to eat. I wanted my baby to come home! After all, it just felt very wrong to have my baby and then leave the hospital without him. Braeden slowly learned to feed from a bottle and was finally discharged on November 23 after 16 days in the NICU. When he was discharged, home care for my incision continued. I did not continue to pump. My milk supply still didn’t appear adequate after all the pumping I had done and the medication I had taken. I was so overwhelmed and exhausted that I decided to give up. I realized later that this was a mistake and I regretted the decision. I yearned for that Mother’s Stories closeness to my baby—for me to provide his food. When my friend mentioned relactation, she sparked my interest and I thought there might still be an opportunity to breastfeed my baby. I was so tired and worn out from the NICU experience and issues with the incision, though, that I questioned if I had the energy. I thought long and hard and decided since my baby was premature and had so many struggles in his first days here on earth, I wanted him to have the very best he could have, and that meant my breast milk, not formula. So with my friend’s support I began latching Braeden on again and pumping. To my surprise, he latched like a champ, like he had always been at the breast! I had been advised that sometimes after a baby had been bottle fed, it may be a learning process for the baby to learn how to suckle at the breast, but he did it without any trouble at all. This was the first step to a beautiful nursing relationship with my son. I continued latching and pumping, began taking medication to increase my supply again, and this time added the herbs fenugreek and blessed thistle. My milk came back! At first it was small amounts, but it gradually started to increase. Braeden initially used my breast for soothing himself to sleep. It didn’t matter, though, because any amount of suckling at the breast stimulated milk production. So, as often as I could I put my son to the breast and he would suckle like a champ! I also tried a supplemental nursing system (SNS). I didn’t have a lot of luck with this tube and bottle system, but I have heard of women who do. with her once weekly, sought support through my friend and started attending the monthly La Leche League Series Meetings. I surrounded myself with a network of support and, looking back, I truly could not have done it without each and every one of them. My friend informed me of a support group called La Leche League and advised me to seek the support of a local breastfeeding clinic as well. I Googled La Leche League, found the Group in my area and called a La Leche League Leader. I received great support from her and continued to utilize my friend as much as I could. She made herself available to me almost constantly, and I never felt like I would be judged if I didn’t continue. What a true friend! I love the close and nurturing relationship Braeden and I have, and I love being his sole source of food and comfort. There truly is nothing like the bond of a nursing relationship with your little one. I wanted to write my story for every woman struggling with her supply or contemplating relactation. It is a lot of work, I won’t deny that, but it is a truly rewarding and worthwhile experience. Braeden is seven months old now and I plan to continue to breastfeed for as long as I can. I hope my story encourages other mothers to forge ahead--even through challenging times-because both you and your babies will reap so many benefits. I also found a breastfeeding clinic and connected with a fantastic nurse/lactation consultant. This nurse worked with me for several months and provided strong encouragement and the positive reinforcement I needed. She is truly fantastic at her job, always going the extra mile to make sure I felt supported, encouraged, but not pushed or judged. I met Over the course of my time at the breastfeeding clinic, my milk supply increased to the point that I was almost able to exclusively breastfeed my son. I had to supplement every other day with about three ounces of formula, but the rest of Braeden’s diet was breast milk! I couldn’t believe the progress I had made and was thrilled that my son could reap the benefits. Kelly O’Neil, Rome, Maine 2010 | Issue 5&6 | New Beginnings 17 Mother’s Stories My Greatest Life I’ve heard over and over again that a baby will change everything, and in my case that turned out to be completely true. I used to think that big careers, high academic achievements, awards, and other credentials were what mattered in my life. But on February 18, 2010, all that seemed to matter was the birth of my son William. I had every intention of returning to work after he was born. I planned on pumping, finding adequate childcare, and somehow balancing my life again, except William had different intentions for me. A little after William had arrived, we were napping next to one another and awoke at the same time. I looked over at him and we locked eyes with one another. I remember wondering what he was thinking about or what he wanted to do with the rest of the day. I offered my pinkie finger to him to grab and he grasped it smiling a tight-lipped smile. I was hooked, and I slowly began to realize that all my little guy wanted was his mama right beside him, and all he probably thought about was how cozy and relaxing it is to cuddle up and breastfeed. Bottles of pumped breast milk were not the same for him. As the weeks went on I learned I could cuddle with him for days, look at him for hours, and never leave his side. Six weeks after he was born I made a decision that surprised even me. I decided not to return to work. When I look at him now I can’t imagine spending a day without him. All it takes is one tiny smile and I’ll forget it took three hours of on again, off again nursing to get him back to sleep or about the loads of stained clothing I still need to wash. I don’t have to worry now about finding time to pump since I give him his breast milk right from the source. The cost my husband and I saved on childcare and formula is tremendous, and I know that by breastfeeding him I am giving him food and comfort. When I do leave for an hour, my arms don’t know what to do without holding my William. I feel lost and empty without William smiling and babbling back at me. I lose a part of myself when he’s not with me, despite all of the challenges a new baby brings. In my current job as a mother I don’t get sick time or holiday pay. I don’t have fifteen-minute breaks or half-hour lunches built into my day. Some days it’s even hard watching my husband go off to work where I think he’s doing all sorts of exciting projects or talking to interesting people all day. I know some day I’ll probably resume a career or even have time to take a long, hot shower. The nights when I nursed William lying down in bed and the way he looked up at me with trust and happiness, the giggles I hear after I tickle him in just the right spot: those will be the times I’ll miss. William will only be this little for so long and I want to spend as much 18 New Beginnings | Issue 5&6 | 2010 W hen I look at him now I can’t imagine spending a day without him. All it takes is one tiny smile and I’ll forget it took three hours of on again, off again nursing to get him back to sleep or about the loads of stained clothing I still need to wash. time with him as I can when he’s so young. Careers, jobs, raises, and high academic awards will come and go, but my biggest life achievement is that I am a breastfeeding, sling-wearing, attached stay-at-home mother, and I couldn’t be more proud of my greatest life achievement, my son William. Susanna Carlson, Glendale, Wisconsin Toddler Tips Mother’s Situation: Does anyone have any tricks to get a child to sleep in until later in the morning? My daughter, who is 30 months old, is waking really early every day after going to bed at a reasonable time and sleeping through the night. It doesn’t matter what time she goes to bed she always wakes too early. Although she is often in bed by seven o’clock, I’m so tired myself after being up so early that I’m ready for bed too and my husband and I aren’t getting any quality time together. Response This has happened two years in a row to our older son. Every thing seems normal and then suddenly he starts waking up earlier and earlier, and my husband and I are bewildered and exhausted. On both occasions it has been in summer as the days lengthen (and start earlier) and he has been sleeping in an east-facing room. The mini-blinds just aren’t enough for him but when I went out and got a set of curtains for his windows as well, the double insulation kept it nice and dark and he started sleeping to his report that at age six, that little person is an amazing sleeper. She goes to sleep soundly in her own bed each night at around 8:30 p.m., and wakes on her own at around 7:30 a.m. rested and happy. Know that these times don’t last forever! Karen Smith, St. Charles, Illinois usual wake-up time again. If that’s the problem it’s a really easy fix. Best of luck! Elizabeth Cook, Rochester, New York Response Over the years, I have found my children’s sleeping habits have changed from month to month, season to season, and as they age and reach developmental milestones. The change in the seasons affects how much light falls into each of their rooms, so I have had to make some adjustments in how I set their blinds to minimize morning sun. During the co-sleeping years this meant adjusting my bedroom curtains so they block out the maximum sunlight. I have also had problems where my children were waking up early because, after a nap and early bedtime, they were just done sleeping by that time of the morning. There was a time we reached with each child where we decided (as a family, since this impacted all of us) to eliminate naps in order to lead to a more restful overnight sleeping period. While this was an adjustment and required 20 New Beginnings | Issue 5&6 | 2010 some careful planning so as to not be running errands in the afternoon (they were champion car-sleepers, both!) it was something we decided to do and once we eliminated the afternoon naps, we noticed a significant improvement in both how the kids went to sleep in the evening, as well as their total overnight sleep--fewer overnight wakings, longer morning sleep. I am not a morning person! I want to sleep as late in the morning as possible, so some of this was recognizing my own limitations as a parent and looking for solutions that would work for all of us. We also discovered with our youngest that she was sensitive to a number of things--certain laundry detergents made her itchy, my menstrual cycle made her wake more often at night, and any caffeine I had consumed seemed to directly impact her ability to sleep or stay sleeping. I had to be much more thoughtful about the environment in which she slept than I had to with my older child. It was a good reminder that each little person is just that--a little person with his or her own unique needs and sensitivities. I am pleased to New Mother’s Situation: My two-year-old has always been such a calm and laidback toddler until recently. Now we can’t get together with friends without my daughter melting down over anything--from seeing another child with a toy she wants to not being able to be the first one in the sandbox at the playground. I’ve even turned my back once or twice only to have my daughter hit or even bite one of her little playmates! Is this just a phase? What is happening to my daughter? Please help! “Toddler Tips” is edited by LLL Leader Karen Smith in St. Charles, Illinois. She and her husband, John, have two children, Liam and Anastasia. Karen speaks and writes on parenting topics as well as writing fiction. Please send responses and new situations to toddler.tips@ lllusa.org. Making It Work Mother’s Situation: My baby is almost three months old and I have to return to work in about two weeks. I am concerned about my milk supply, as I have had to work very hard to keep a sufficient amount (I take herbs and feed him often) because of not getting off to quite the right start. I feel like I have been successful, and I’m very proud of both of us because he is healthy and growing well, but I’m really worried about what will happen to my milk supply when I am working all day! I expect to be able to pump several times per day but I still am a little nervous. How have other mothers kept their supply up when working? Response Congratulations on your baby! I returned to work when my daughter was seven and ½-months-old. Despite having a good supply before, I ran into supply problems until I followed several guidelines: 1. Pump when my baby would nurse. It’s not always possible but aim to do so. 2. Prioritize. Even a short pumping session (five minutes) is better than none at all. I feel that my baby is my priority and is reliant on my prioritization of pumping for her optimal health and development. Socializing with colleagues takes a distant second place. Anything non-essential or possible to do after a pump session should be done then. This was hard for me because everyone wanted to know about the baby and had not seen me since before maternity leave. Of course, I was also keen to talk with adults at work. Disciplining myself was essential. 3. Safe cosleeping and continuing to breastfeed on cue outside of work was very helpful to maintaining my supply.* 4. A high quality, electric, double pump, preferably hands-free with a dedicated battery, is ideal. It’s as important to working part- or full-time as is a watch, or proper clothing. The reality is that once we begin working we have more things on our plate, not less. Pumping has to be convenient, easy to do, and efficient. Double pumps cut pumping time in half and are thought to stimulate the release of milk-making hormones 2010 | Issue 5&6 | New Beginnings 21 Making It Work (prolactin), which in turn will also cut down pumping time. The battery option will enable you to pump in whatever location your workplace is able to provide, regardless of whether there is an outlet or not. You won’t be tethered to an outlet and you’ll be free to move around while pumping. My first week back at work I had to wake up early to pump each side while I sat on the couch. After buying a new double pump, I slept in later and pumped while putting on make-up, styling my hair, and even while making lunches for my husband and myself. pumping place may be your right as a breastfeeding mother. But your milk supply may drop while you wait for a better solution. Also, you might be very tired managing your new role as a working mother and not have the energy to take on issues like you did before. Take what you can get and if it’s not sufficient, continue to look for improvement. Keep your sense of humor. My workplace asked me to pump in a common office of 25 plus people without cubicles, but with a sense of humor I was able to get 15 minutes in a private office with blinds. 5. I admit this one is controversial, but I’m trying to see the big picture. A drawn-out fight with management to get a perfect 6. A door block to keep a door shut to outsiders may be very helpful if others have access to the room. 22 New Beginnings | Issue 5&6 | 2010 Enjoy combining motherhood with work. Count your blessings and stay relaxed. Things will fall into place. K.C., Brussels, Belgium Response I worked full time with my third son. At first I pumped every two hours and started weaning down to three times a day after six months. At about nine months I was only pumping twice a day and at 12 months once a day. I just recently weaned from the pump at 15 months. I think keeping up the strict pumping schedule and making it a relaxing time helped keep my supply going. I also cosleep with my little guy so his continuous nursing through the night gave my supply the extra boost it needed.* Early on I brought oatmeal cookies to work with me to snack on. The oatmeal really helped milk production. On the days I didn’t eat any cookies, I could tell the difference--milk output was less. Michelle, West Carrollton, Ohio Response My initial sense is that your rocky start might not necessarily have any impact on your milk supply at three months. After six months back at work, I typically supplement what I pump with 1-2 ounces per day from my freezer Making It Work stash. I expect that I might be able to get more if I pumped longer but don’t have the time in my day. The best thing is that pumping/ working has had no discernible impact on my supply when I’m with my son, and he’s healthy and growing fine. P.S. Since my only “supply” issue is with providing enough for daycare, I’ve been utilizing frozen milk I expressed on maternity leave. I think it’s important to remind mothers going back to work that they should look for a caregiver who is used to feeding breastfed babies (or willing to learn), who will not try to rush a feeding or overfeed. Provide slow flow nipples to the caregiver. This can help mom’s pumping keep up with the feeding technique that the baby receives from the caregiver. “Manatee”, llli.org Mother-to-Mother Forums** Response You can keep your milk supply up but will need to be faithful about frequent removal with a good double electric pump. Aim to pump at least 15 minutes every three hours while you are away from your baby. Also, encourage your baby to nurse often when you are together. Many babies will “reverse cycle” and nurse more often at night when separated from mother during the day. Do not try to get your baby to sleep through the night if you are concerned about your milk supply. Cosleeping works for many mothers to encourage more frequent night nursing.* Try to relax! Many mothers successfully breastfeed while having to pump. Stress will just make it harder to give your baby your precious milk. Julie Schmoll, Lincoln, Nebraska Response I have had to exclusively pump with both of my children for various reasons. Neither of my children have gone without breast milk. When I was nursing my first child, my employer was not very friendly about pumping. I was initially told that I could pump whenever I needed to, but then was told I had only two times during the day to do so, and they weren’t very well spaced out. For someone who was pumping every three hours around the clock to have to suddenly move to a different schedule was miserable, but here is what helped: First and foremost: Get a good double electric pump. I swear by my double pump! It has a “let down mode” that I love as it really seems to help with my initial let down. I’ve heard other mothers say they like to use this mode midway through their pumping to get another let down (which helps them express more milk during the sitting). Secondly: A comfortable place is, in my eyes, essential. If you are uncomfortable or worried someone is going to walk in on you it can really stress you out, and a stressed mother is not good for pumping! I’ve heard bringing recordings of your little one, a picture, or even a blanket they sleep with can help, though I personally have not had to do that. Thirdly: You really need to pump (in most cases) for at least 15 minutes. Even if at ten minutes you’re only getting dribbles for milk. This will help tell your body it needs to make more milk during that period. This also means that in general you will need 25-30 minutes to pump. Figure about five minutes to get to your location and set up, 15 minutes to express, and 5-10 minutes to clean up and stash your milk. Many women skip the clean up part and bring a storage bag to put the removable parts of the pump into, then toss that in the refrigerator for the next session. Since your milk stays good in the refrigerator for three to five days, this works well and isn’t unsanitary. I’d advise rinsing the removable parts with warm water before using them again. You also might want to look into getting a hands-free bra or bustier. You can find these online. This means you can do other things, such as read a book or even work (provided you have your own office and can securely close the door while you pump). You’d be surprised how much milk you can get when you’re not sitting there staring at the pump the whole time. Another thing that can help is to try to add a pumping session in the early morning. Typically, the hormones that allow you to make milk are highest in the early 2010 | Issue 5&6 | New Beginnings 23 Making It Work morning, which frequently means more milk can be pumped. For me, I’ve noticed that if I’m going to get more than usual, it’s either when I’ve gone longer than normal between pumping (which I definitely try to avoid because it’s very uncomfortable and can take a little time to recover from) or in the early mornings. I’ve even heard of some women nursing on one side while expressing from the other. It all depends on when your little one nurses and how much they need, so you may have to adjust accordingly. look at pictures of my son, as well as having something that smelled like him also helped. I was able to make enough for each day until I decided I wasn’t willing to keep up the pumping at home. Now my son is almost one year old and I’m in the process of weaning from the pump. In my opinion, whatever amount of breast milk you are able to pump at first is wonderful, and not letting it become a significant source of stress is important. I think you should celebrate the time you spend nursing and not let it become a negative force by worrying about it all the time. Good luck! If possible, try to pump at work when you would normally nurse your little one as you may find this will help you get more milk. The pump is not the same as your baby, and not nearly as efficient, so this can help. Marbles, LLLI.org forums** If this doesn’t work and you find it difficult to keep up with your little one, you may need to add a few pumping sessions over the weekend. If you put your milk in a deep freezer (zero degrees or lower) your milk should keep for six to 12 months. Once defrosted the milk is good for 24 hours. Most importantly, try not to worry too much as this can be counter productive. Yes, you will hear about women who can pump six or more ounces in a sitting, but this is unusual. In general, it is normal to get much less when you pump. Also, look into hand expression. When it got near the end for me and I was having a harder time keeping up in general, I found that I could hand express some milk after pumping. Sometimes I could get as much as an extra ounce from each side. Last but not least, feel free to come on over to the forums on LLLI.org and ask questions. We’re a friendly bunch, and there are some mothers like me who for one reason or another have exclusively pumped. There are others who nurse when at home and pump when at work. Erin, Grand Rapids, Michigan 24 New Beginnings | Issue 5&6 | 2010 Response Congratulations on working so hard and making it through to continue breastfeeding. I also returned to work around three months. The most successful approach for me was to pump in the mornings after nursing, as that was when I produced the most milk and it allowed me to supplement what I was able to get at work. Making myself take the time to relax and Making *Families have many different ways in which they choose to parent their children during the night. La Leche League recommends that you address nighttime parenting in the way that works best for you and your child. Cosleeping is one option that many families choose, and you may be surprised to learn that it does not necessarily mean bedsharing! For many, it is considered cosleeping when you have the baby near enough to you that you can quickly respond to his or her needs during the night. In the Frequently Asked Questions topic “Should I Sleep With My Baby?” on the LLLI website, cosleeping is described as follows: There are many ways of cosleeping. Some mothers keep their babies in bed with them all the time. Other mothers set up the crib or bassinet in the mother’s room; their babies are brought to the mother’s bed when they wake. Other mothers sleep with their babies on a mattress in the baby’s room. There are as many options as there are parents and babies. As babies grow and change their sleep patterns, families often respond by changing sleeping spaces. The only right choice is what works to give the whole family as much rest as possible. Dr. James McKenna suggests these safety guidelines: • Cosleep only on beds, not on couches or recliners. • Bedding should be tight fitting to the mattress. • The mattress should be tight fitting to the headboard of the bed. • There should not be any loose pillows or soft blankets near the baby’s face. • There should not be any space between the bed and adjoining wall where the baby could roll and become trapped. New Mother’s Situation: I have been working full time since my daughter was four months old. She stays with my husband two days per week and my mother-inlaw three days per week. I am very grateful that I don’t have to pay for daycare and that she gets one-onone attention from family members who love her, but I find that I feel jealous and a little resentful that they get to spend so much time with her and that I do not. I love my job and don’t really want to quit, but I sometimes feel marginalized when I hear about all the things they do together all day. I pump at work and nurse her often at home (she nurses several times at night) and that is going well, but I would like to hear how other mothers deal with their feelings of loss and/ or jealousy when away from their babies. • The baby should not be placed on its stomach. • Do not cosleep if you drink alcohol or medications that make you sleepy, take drugs, or smoke. Some parents are concerned that their children will never move into their own rooms. Be assured that while every baby and child is unique and has different needs, they all eventually become independent. Cosleeping can be a safe and warm way to parent babies. We encourage each family to make an informed decision about what will work best for them. La Leche League International, Should I Sleep With My Baby? 2007, http://www.llli.org/FAQ/ cosleep.html **The LLLI.org Mother-to-Mother Forums can be seen as an online extension of the kind of support that you can find at a local La Leche League Group. In the forums, mothers can ask questions and receive answers from other mothers and La Leche League Leaders. If you’d like to join the online discussions, go to www.LLLI.org and click on the tab that says “Forums”. Please read the “Welcome and Getting Oriented” message in the “Forum Announcements” section before you begin posting and answering questions. “Making It Work” is edited by LLL Leader Winema Wilson Lanoue. A writer and avid knitter, she lives with her husband, Eric, and two boys, Ezra and Zeb, outside of Blacksburg, Virginia. Please send responses and new situations to making.it.work@ lllusa.org. 2010 | Issue 5&6 | New Beginnings 25 Giving Birth The journey of Sebastian Octavius Olschewske: Another look at a premature birth experience In April 2009 when I was about 31 weeks pregnant, I was admitted to the hospital as I was leaking fluid. I was told by the obstetrician that I could not leave my room because my “baby could fall out.” By the following week I was getting very depressed. I missed my family. I begged daily to just go outside. I finally “got permission” to be able to go to church to attend Mass and to go outside one morning. However, they wouldn’t let Ryan, my husband, take me out, and we were yelled at when he tried. A few days later, I was told that if I left my room again or the ward they would call child protective services because I was endangering the life of my unborn child. I was also told if they felt my baby was in danger of infection I would have labor induced. The next day ultrasound showed the fluid levels were very low and the baby was not acting as they liked. The perinatologist explained to me that he wanted me induced at 34 weeks. After much prayer, Ryan and I decided we did not have a choice; I just wanted out of there. I was informed I would not be allowed to leave until the baby was born; therefore, I could be there until June. On May 4, I was induced at 10:30 a.m. It was a long day. By midnight I began telling Ryan, “I do not think I can keep doing this all night,” something I would never have said in previous labors. I understood then why so many induced mothers may be given epidural anesthesia. Then sometime after 12:20 a.m., I gradually started making what Ryan calls my “pushing sounds.” It all happened quickly. As I leaned forward to push, the baby’s head was already crowning. At 1:39 a.m. Sebastian Octavius flew out onto the bed. He was so tiny compared to my other children, weighing exactly six pounds. I 26 New Beginnings | Issue 5&6 | 2010 held him and tried to get him to nurse, but he was not yet ready. At 2:30 a.m. I was told he had to go to the Neonatal Intensive Care Unit (NICU). I was so sad as he was starting to show signs he was ready to nurse. I was finally allowed to see him at 4 a.m. I held him on my bare chest. His blood sugar was low because he hadn’t been able to nurse. I was insistent that he not receive any formula. At 6:30 a.m. we had to leave due to a shift change, but I was now pumping every hour. I tried to sleep for a few minutes but knew I would not sleep till he was safe at home. I continued kangaroo care all day and night, and I pumped every hour for 20-30 minutes. One of the NICU doctors was not supportive about me nursing Sebastian. The doctor preferred for me to pump and give him the colostrum in a bottle! I explained how breastfeeding was easier for Giving Birth a baby than bottle-feeding. When Sebastian was rooting at my breast and I placed the nipple near his mouth to hand express a few drops, a nurse reprimanded me. But on May 6 a lovely NICU doctor told me I could try to nurse him because he was doing so well. I was shocked and thrilled! It was hard at first, but after a couple of tries he latched on! I was allowed to nurse him every three hours that day and night. I was still pumping every hour for about 30 minutes, and the nurses thought I was pumping too much. I told them this was how often I normally nursed my newborns. By May 7 he was off oxygen and was allowed to room in with us that evening. He was on a bilirubin blanket, too, because he was jaundiced, but his count was 14 and rising. I continued to pump since Sebastian was very sleepy. A knowledgeable lactation consultant reminded me I could use a syringe to feed while I nursed at the same time. So Ryan would slowly administer my pumped breast milk in the tiny corner of his mouth while I nursed Sebastian. On May 8 we went home with Sebastian but with the proviso of a nurse coming over to check his bilirubin count and weigh him. The nurses all told me it was rare for newborns of 34 weeks’ gestation to go home so fast. The nurse came out later that evening bringing a bilirubin bed, with strict instructions that I had to have him on the bed 24/7, and was only allowed to nurse him every two hours for 30 minutes. I bit my tongue. Instead, I spent a lot of time in the sunshine. I tried to use the bed as instructed, but I just could not allow him to cry. I continued to pump every hour because I knew he was not nursing as well as he should. We also continued to administer the breast milk in his mouth while he nursed, as this kept him sucking. On May 17 the bilirubin bed left the house. Sebastian was having regular bowel movements, he had gained 10 ounces, and his bilirubin count was normal. Seven months after Sebastian’s birth he is still doing great! He now weighs 17 pounds 6 ounces--all on mother’s milk. He does not look like a preemie, although he is slower in the milestones than his siblings. Lisa Olschewske St Augustine, Florida “Giving Birth” is edited by Sara Walters, who lives in Carmarthen, South Wales, Great Britain. She has had two American hospital births (Rebecca in 1999 and Jonathan in 2002) and one British homebirth (Catrin in 2006). Please send submissions to mailto:[email protected]. 2010 | Issue 5&6 | New Beginnings 27 Feature Article Speaking Out About Postpartum Depression Many first time mothers can be caught off guard by their emotions after giving birth to the baby who joins their family after anticipation for months or even years. It’s completely normal to feel a letdown after the big day. After all, childbirth is a life-changing experience in every way. What can help new mothers and their partners is to understand how to recognize the “baby blues” and what can help until they go away, usually in a couple weeks. However, some mothers find that symptoms are lasting much longer, are overwhelming, or are accompanied by feelings of hurting the baby or themselves. In these instances, see your doctor immediately. Mothers with intensely sad or angry feelings could have postpartum depression, or even more seriouspostpartum psychosis. These symptoms are very serious and can even be classified as medical emergencies. However, they are treatable; it doesn’t take long until you’re feeling normal again and are able to enjoy the bonding time with your new baby that both of you deserve. I know this firsthand. With my first child, I experienced the very common “baby blues.” My main symptom was bursting “Baby Blues” This common mood disorder is not considered a mental illness since the majority of new mothers experience it. The “baby blues” occurs in 50 to 70 percent of new mothers, coming on within the first week after the birth and lasting, at most, three weeks. Symptoms include: mood swings, weepiness, sadness, anxiety, inability to concentrate, and feelings of dependency. “Baby blues” are caused by rapid hormonal changes, along with the stress of birthing; physical discomforts; an emotional letdown following the pregnancy; anxiety about the increased responsibility of caring for a newborn; fatigue; and disappointments about the birth, support from the partner, nursing, or the baby. 28 New Beginnings | Issue 5&6 | 2010 Postpartum Depression/Anxiety More serious than the “baby blues,” postpartum depression/anxiety occurs in 20% of new mothers and can happen any time during the first year postpartum. Symptoms include: excessive worry or anxiety, sadness, hopelessness, irritability or short temper, feeling overwhelmed, difficulty making decisions, feeling guilty, experiencing phobias, insomnia or fatigue, discomfort around the baby or indifference toward the baby, inability to concentrate and forgetfulness, loss of interest in hobbies, decreased libido, and loss of appetite or overeating. Risk factors include: previous postpartum depression, depression, or anxiety during pregnancy; personal or family history of depression or anxiety; abrupt weaning; social isolation or poor support; history of premenstrual syndrome or premenstrual dysphoric disorder; history of mood changes while taking birth control pills or fertility medication; and thyroid dysfunction. Postpartum Obsessive-Compulsive Disorder A variant of postpartum depression, postpartum obsessive-compulsive disorder occurs in 5% of new mothers. Symptoms include: intrusive, repetitive, and persistent thoughts or mental pictures, often about hurting or killing the baby; sense of horror and disgust toward these thoughts; behaviors accompanying these thoughts into tears at odd times and for no apparent reason. I wasn’t prepared. No one had ever told me about the blues, but the medical team at the hospital recognized the signs right away and helped me through them. The blues only lasted a couple weeks, and one day I woke up feeling normal again. With my second child, I was prepared for the “baby blues,” but what I experienced was far worse, except that I didn’t know what I was feeling. It also started during my ninth month of pregnancy. I was sad and angry, yelling at my husband constantly and feeling overwhelmed by the demands from my children and from the housework. At times, I felt like I couldn’t take care of my baby. I never had thoughts of hurting myself, but I would leave my baby to cry and hours later wake up to her still crying. I would feel so frustrated that I had to leave her with my husband because I was afraid of my next reaction. I also experienced severe paranoia, mostly in relation to something hurting my children. I fretted that I Feature Article didn’t know what was wrong with me or, rather, that anything was wrong at all. I thought I was normal. the new furnace was leaking carbon monoxide. I called the repairman five times one day and bought three carbon monoxide detectors for my baby’s room. I obsessed about rabid bats, believing that there was one scratching at the corner of the window trying to get in to bite me and the baby. I heard tree limbs rubbing on the roof and believed it was a cougar ready to pounce if I walked outside. I would stay up all night, worrying that if I went to sleep and the house started on fire or someone broke in, that I wouldn’t be able to wake up in time to save my children. I didn’t know what was wrong with me or, rather, that anything was wrong at all. I thought I was normal. At two months postpartum, my marriage on the rocks, I sought help after experiencing a strange sensation one day--joy--and knowing for the first time that what I usually felt was definitely not right. I visited the website of Postpartum Support International, www.postpartum.net, and was connected with a free phone call to a local counselor who specialized in postpartum depression. I was suffering from postpartum psychosis. It didn’t take long for the treatment to work, but it could’ve been devastating to the relationships in my family if I hadn’t sought help. It took another two years before I was diagnosed and treated for the underlying condition that contributed to the postpartum psychosis--bipolar disorder. to reduce anxiety (i.e. hiding knives); and counting, checking, cleaning, or other repetitive behaviors. Risk factors include: a personal or family history of obsessive-compulsive disorder. attack, the mother feels like she is going crazy, dying, or losing control. Risk factors include: a personal or family history of anxiety or panic disorder; and thyroid dysfunction. Postpartum Panic Disorder Postpartum Psychosis A variant of postpartum depression, postpartum panic disorder occurs in 10% of new mothers. Symptoms include: episodes of extreme anxiety, along with shortness of breath, chest pain, sensations of choking or smothering, dizziness, hot or cold flashes, trembling, palpitations, and numbness or tingling sensations; restlessness, agitation, or irritability; and excessive worries or fears. Panic attacks may wake the new mother, often with no identifiable triggers. During the This illness is marked by a “break in reality” and is a medical emergency. Call 911 if the new mother shows signs of having postpartum psychosis; she is a danger to herself, her baby, and others. This disorder has a 5% suicide rate and a 4% infanticide rate. Postpartum psychosis is very rare, occurring in only 1 to 2 new mothers per 1,000. It usually begins two to three days postpartum. Symptoms include: visual or auditory hallucinations, delusional thinking (i.e. about Because I found parenting support during that time through the La Leche League Group in York, Nebraska, and Attachment Parenting International resources, the postpartum depression did not have any lasting impressions on my family. Postpartum depression is real, and it is something that all expectant mothers, new or experienced, should know about. Not enough people tell their stories. I didn’t know I had postpartum depression because I had never encountered anyone who let me know that there was something wrong. No one, not even medical professionals, could give me a specific example of thoughts and behaviors that would signal a problem. The only information I had coming home from the hospital was a bullet-point list on infant’s death, denial of birth, need to kill baby); and delirium or mania. Risk factors include: a personal or family history of psychosis, bipolar disorder, or schizophrenia; and a previous postpartum psychotic or bipolar episode. Reference: Postpartum Support International 2010 | Issue 5&6 | New Beginnings 29 Feature Article the discharge sheet that directed me to report any unusual emotions to my doctor. But what defined “unusual?” Furthermore, until that point, I had no history of mental illness and had always been a very stable, loving person. Before my experience with postpartum depression, I thought it was something that only happened to people who weren’t stable in the first place. Postpartum depression, just like the “baby blues,” happens because of a hormone imbalance and can be aggravated by the pressures of adjusting to a major life change. Before having my second child, I was dealing with a recent move and the leftover medical issues from my oldest child’s premature birth. Postpartum depression is not something that happens because you are an unfit mother or because you’re weak. After your child’s birth, if you have feelings of sorrow or anger that seem to permeate your life and that you don’t feel you have control over, seek medical help. It’ll save your marriage and your relationship with your children, and you’ll feel much better being able to feel happy again and back in control of your life. Rita Brhel lives near Fairfield, Nebraska, with her husband, Mike, and their daughters, Rachel and Emily. Rita works as a freelance writer/editor, a childcare provider, and a caregiver for the developmentally disabled. Editor’s Note: In addition to the resources shared by the author, readers can find additional information as well as past articles from New Beginnings and LLLI’s Leader publication, Leaven, about postpartum depression and postpartum psychosis on the LLLI website at www.llli.org/NB/NBdepression.html. Printed Resources Depression in New Mothers by Kathleen KendallTackett The Hidden Feelings of Motherhood by Kathleen Kendall-Tackett, Phyllis Klaus, and Marshall Klaus Tips for Handling the Baby Blues (LLLI tear-off sheet) Websites www.mededppd.org | www.postpartum.net 30 New Beginnings | Issue 5&6 | 2010 Tips for Handling the Baby Blues: •Rest! Rest! Rest! Enjoy this time with your new baby. Let others wait on you. Enjoy being pampered for the first few days you are home (longer if you underwent a cesarean or experienced complications). • Bring baby into your room or bed to get more rest. • Avoid fixed or rigid schedules, they place undue stress on new mothers. Go with the baby’s flow and your own intuition. • Avoid overexertion. Limit the length and number of visits from friends and relatives. When you do have guests, don’t feel as if you need to play the perfect hostess. In fact, if guests find you in a robe, they are less likely to over-stay their welcome. • Whenever your baby sleeps, rest or sleep yourself. This is NOT the time to jump up and do those 40 chores you have been thinking about! • Eat right. Have healthy snack foods on hand. Nutritious, easily prepared foods are helpful. (Send the donuts home with grandma.) Make sure to eat some complex carbo- hydrates (bread, corn, rice, rye, potatoes, oats, whole- wheat crackers, etc.) every three hours to keep your blood sugar up. • Drink lots of fluids. Your body is healing and extra fluids are essential for breastfeeding. Drink lots of water. Unsweetened juices are also terrific. Avoid caffeine and empty calorie sodas. Avoid or conscientiously limit alcohol use. A Nursing Rhyme My Empowerment Ignoring the “advice” I don’t want, deciphering nonsense from fact Following my heart and never looking back. My Reasons After hours of labor a warm little baby is laid on my chest Head bobbing around in search of her food, a moment of pure tenderness. My Reward Full and heavy breasts, my milk has officially come in Colostrum has worked its miracles and now the full feedings can begin. My Relief Lounging in bed skin-to-skin with my sweet baby girl Snuggling and nursing the day away, feeling so content with my world. My Vacation Attending my first lactation tea and La Leche League meetings, leaving feeling so confident and strong Surrounded by likeminded women, great advice, and a place for us to belong. Wires and tubes surround, Pumping noises all around. Measuring liquids regularly, Drinking fluids thirstily. Complexities and Hurdles in the Early Weeks My Knowledge A sleepy head nestled at my breast A chubby hand that I hold and caress. My Absolute Job Watching my tiny baby plump up with only my milk to help her along A half of a year has passed and she is so healthy and strong. My Achievement Middle of the night and nursing my tired baby back to sleep Not having to get out of bed and a baby who rarely makes a peep. My Secret Weapon A little girl who is literally attached at my hip, we do everything together So much more than mother and daughter…already best of friends forever Our Bond Nicole Love Weber, Wellington, Florida Life Support Hooked up I am! Mothers’ Voices Afflicted for Eve’s sin, Beneficial to my kin. Worthwhile liquid gold, Wondering ‘till how old! Sara H. Eichler, New York, NY Your tongue-tie was clipped while you slept, not even a flinch. The cranial sacral therapist worked your palate, jaw, temples and neck and you actually could lie on your left side without a fit, and opened your mouth wider than before. Amazing. She said you were complex, which made me smile. This is only the beginning. Sore back, sore shoulders and beat up breast, I try to remember to breathe and relax. All this will pass and you will grow plump and change so rapidly. These days of newness are so short, even when they last all night. Kara Marsee, Ann Arbor, Michigan Oh, sweet baby at my breast please open your tiny lips wide and keep my nipples from these cracks that burn. Your entrance into this world came fast in peace and water and love at home. Thorough midwives noticed a slight tongue-tie and asymmetry that warranted cranial sacral evaluation. But weight gain was going well, so mama shrugged off recommendations and bit her lip through latch pain. A bear cub with hands that don’t understand you scratch and claw at my sore nipple while I fling my breast here and there dodging blows and confusing the target. Sweat and milk dripping, you arch against my hand and split into a scream, and I try not to join in. Speaking with a soft voice, I try to reassure you that it’s OK, while dreading the shallow latch I sometimes thrust into. Football hold was our only answer to nursing on one side it was as if you could not tolerate laying that way. A Father’s Work Alice Ziring, submitted this photograph of her son, Jon, snuggling his newborn daughter, Katherine Amaya, while looking up information for his wife in the newly revised eighth edition of The Womanly Art of Breastfeeding. Alice Ziring, Mercer Island, Washington At two weeks old, mastitis struck, sending mama to bed and to the phone to seek out help and those ignored recommendations. 2010 | Issue 5&6 | New Beginnings 31 Eating Wisely Baking Cookies: Healthy, Yummy and Educational! Lesley Robinson Ottawa, Canada Cookies don’t have to be overly sugary or full of unhealthy fats. That’s because they don’t have to come from a store. Baking cookies is a wonderful activity to do with young children and, as well as providing fun and togetherness, baking can provide lessons in math and science. Measuring ingredients or calculating quantities if a recipe is modified can afford wonderful learning opportunities. You can take the opportunity to talk about where the ingredients come from and how flour is produced from grains or how butter is made from cream. You can even make your own butter by putting cream in a closed jar and taking turns to shake it until it becomes solid. Oven temperatures and timers need to be set while magical things happen in the oven, which illustrate scientific principles. Of all the stories I used to tell my children, their favorite was the one about three little bears (with names remarkably similar to their own) who helped their mother bake cookies with disastrous results! They particularly enjoyed the fact that their own efforts were usually successful and they took great pride in their culinary skills. For me it was worth putting up with a little extra mess and spending a little longer than usual in the kitchen in order to spend a productive and educational afternoon with my children; after all, the cleanup was part of the fun. 32 New Beginnings | Issue 5&6 | 2010 Before you start Mixing I don’t know how many times I said it, but my children would always roll their eyes when I asked, “What’s the first thing you have to do when you bake cookies?” They knew that the answer was “Wash your hands!” That, too, was part of the fun. Everyone had their own apron to wear and the chef of the day would wear the chef’s hat. We would read through the recipe together and make sure that we had all the necessary ingredients and equipment on hand, and we would remember that the second thing to do would be to set the oven temperature and turn on the oven. Mixing takes much longer by hand than with an electric mixer (and more might get tasted along the way), but it gives little chefs the opportunity to get a real feel for the work of mixing cookies. If I used the electric mixer, the children would learn about adding ingredients gradually, so the mixer wouldn’t send a “poof” of flour all over the kitchen, although when this happened it would cause great delight among the onlookers. Measuring Liquids can be measured in glass or plastic measuring cups with spouts. You can teach your child how to set the cup on a level surface and get their eyes at the right level to read the marks accurately, like a scientist. Here’s where the math lesson comes in. If a recipe requires 1½ cups of milk, for instance, you can use a one-cup measuring cup and fill it first to the one-cup line, then again to the ½ cup line to add up to the amount you need. The same goes for dry ingredients, using plastic or metal measuring cups or spoons. Forming the cookies Rolling out dough is lots of fun, and every one can participate. Each child can choose his own cookie cutter and will know his own cookies by their shape. Here’s another educational opportunity to learn about shapes and sizes. For drop cookies, the children learn how big a spoonful will be needed for each cookie and how far apart to space them. If you make bar cookies, you’ll be able to talk about fractions when you cut them. Baking This is when mother really needs to take charge to keep little hands from getting burnt on hot ovens and cookie sheets. However, children can participate by setting timers and, if you have a window in your oven door, they can watch the magic as the cookies rise, spread, and brown. Eating Wisely Gingerbread People from the Kids’ Cookbook section of Whole Foods for the Whole Family You will need Large bowl and spoon Measuring cups and spoons Cookie sheets Cookie cutters Table knife Smaller bowl Rolling pin (optional) Potholders or oven mitts Cooling rack or brown paper Pastry bag or cake decorator (optional) Can you Turn on oven? Set timer? Use measuring cups and spoons? Mix ingredients in a bowl? Press or roll out dough? Use cookie cutters or knife? Use pastry bag for decorating (optional)? ¼ C. honey 1 C. molasses 1 large egg ½ C. oil 1 ¼ t. cinnamon 1 ¼ t. ginger 4 C whole wheat flour 4 t. baking powder ½ t. oil or butter for greasing For decorating (optional) raisins, currants carob chips coconut nuts and seeds other dried fruits, cut-up cream cheese thinned with honey (can be colored with natural fruit juices) 1. Mix honey, molasses, egg, oil, ginger, and cinnamon in large bowl. 2. Into small bowl measure out flour. Add baking powder. 3. Add flour to wet mixture. Mix well until dough is stiff. 4. Use hands to form dough into ball. Chill in refrigerator for 1 to 2 hours (the colder the dough, the easier it is to work with). 5. When ready to use dough, preheat oven to 325° F. 6. Grease cookie sheets with oil or butter. 7. Press out pieces of dough by hand or roll to 1/8” thick right on cookie sheet, using a little flour on rolling pin or hands to prevent sticking. 8. Use cookie cutters or knife to cut out any number of shapes. 9. Decorate as you like before baking. Or use cream cheese and honey icing after cookies are cool. Use a pastry bag or just ice. Decorations will stick to icing. 10. Bake for 10 minutes; bottom of cookie will be light brown. 11. Remove from oven with potholders. Transfer with pancake turner to cooling rack or brown paper. Oatmeal Cookies Whole Foods for the Whole Family ½ C. oil or butter 1 C. brown sugar or ¾ C honey 1 egg ¼ C. water, juice or milk 1 t. vanilla 1 C. whole wheat flour ½ C. dry milk powder ¼ t. salt (optional) ½ baking soda 1 t. baking soda 1 t. ground cinnamon (optional) 2 C. rolled oats 1 C. wheat germ ¼ C. bran (optional) ½ C. chopped nuts, seeds, coconut, dried fruit, or carob chips (optional) Thoroughly beat oil, brown sugar, egg, water, and vanilla. Add flour, dry milk powder, salt, soda, and cinnamon. Beat well. Mix in oats, wheat germ, and optional bran, nuts, seeds, etc. Drop by teaspoonfuls onto greased cookie sheets. Bake at 350° F for 10 to 12 minutes, or until lightly browned. “Eating Wisely” is edited by LLL Leader Lesley Robinson. She lives in Ottawa, Canada with husband, Mark. Her three grown children have flown the nest. Please send stories and photos to [email protected]. 2010 | Issue 5&6 | New Beginnings 33 World Breastfeeding Alabama Celebration Inspires Georgia Leader To Raise Awareness school. I was always disappointed in myself as October came to a close and I had missed another year of raising awareness in my community and raising money for the local Group. This year was looking just like the past years for me. I felt I had too much to do and too little time in which to do it. Then something really cool happened. A Leader friend in Alabama, Sue Rickman, who got her start as a Group member in Savannah, started posting about the event she was planning for LLL of the Shoals. She was having a huge daylong celebration in a local park with kids’ activities, a silent auction, a bake sale, and live music. I was inspired. Wendy Cohen, Savannah, Georgia “La Leche League of Savannah hosted a free family picnic and carnival on September 13 in Hull Park for World Breastfeeding Week. Children’s activities, a silent auction and a raffle offered an afternoon of fun for the dozens of families who attended.” The above was published in the Savannah (Georgia) Morning News, September 21, 2009, on me in the right direction with links to the WBWC kit, which is on the LLLUSA Web site at http://www. lllusa.org/wbw/index.php. Next, I sent out press releases and posted the event on every online community calendar that came to mind. To say I was busy and overwhelmed during this time would be true, but I was also very excited at the possibilities. Could we get news coverage? Would they print a story in the paper? Would I be interviewed on the news? the front page of the “Accent” section. Included were four beautiful color photos taken at the event by the newspaper photographer. First, I started a letter writing campaign to solicit funds for our event. I sent letters to friends, family, and local businesses explaining LLL of Savannah’s purpose and what our plans were to celebrate WBWC. I wanted to cover the estimated expenses of the event before I started planning. Within a few weeks I received $500 in donations! Finally, I started making calls and sending e-mails to vendors that were on lists I obtained from Stephanie Jordan and Megan Topper. They had planned silent auctions for LLL of Georgia before, so why should I recreate the wheel? Megan even sent me a copy of the letter she used to solicit donations from companies. What a help that was! Co-Leaders Phoebe and Leia had their own contacts as well and were able to secure donations for the auction. We were even able to get an “organic milk for a year” donation from Organic Valley. Here’s the story of how LLL of Savannah came to have a large World Breastfeeding Week Celebration (WBWC). For a couple of years I had thought about planning a WBWC event for LLL of Savannah, but the timing never seemed right. I was busy with my family and volunteering at Then, I rented space at a local park and secured an inflatable bounce house. The owner of the inflatables company gave us a break on the price because we were using this as part of a fundraiser. I contacted Melanie Garland, the WBWC Coordinator for LLL of Georgia. She pointed In the end, we had a three-hour long celebration at a local park. Our World Breastfeeding Week Celebration boasted an inflatable bounce house/slide combo, balloons, face painting, a silent auction, raffle, and food sale. We had over 100 participants and grossed almost $1800. 34 New Beginnings | Issue 5&6 | 2010 World Breastfeeding Our event raised over $680 for our Group expenses and to purchase copies of The Breastfeeding Answer Book for pediatricians’ offices, in addition to another $680 for other LLL entities and programs, including WBWC Grants to Leaders. I was interviewed on an early local morning news show a few days before the event and two news stations came out on the day of the event to get film footage and interviews. Pictures of the event made it into the “Accent” section of the local newspaper with a nice big headline. Fun fact: A few days before the event I went to see my hair stylist for routine hair therapy. I had her put a nice, blue streak in my hair for breastfeeding awareness. I love it and will probably keep it in my hair for quite some time. People ask me about it all the time and are interested to hear that I’m promoting breastfeeding awareness with my blue hair. One WBWC Grant + One Fundraiser = One Amazing Outreach Program Linda Parry, WBWC Grants Team, Matthews, North Carolina They were awarded a 2010 World Breastfeeding Week Celebrations Grant of $875 which would pay for 145 bags. Their goal was 400 bags, so they had a campaign to raise enough money to produce the rest. They distributed letters to the local obstetricians and pediatricians and raised $1050. Then they decided to include their breastfeeding mothers by posting a letter about the project on Facebook, sending to all LLL email contacts and setting up a PayPal account, raising $405. Leaders hosted yard sales on two separate weekends, bringing in $180. The finished bag contained a letter explaining how and why the bags were produced (with the Group Meeting schedules on the back), LLL Breastfeeding Tips tear-off sheet, a refrigerator magnet with contact numbers of Group Leaders, and the DVD “Breastfeeding: You Can Do It!” by Pamela Wiggins, IBCLC. They were able to keep the cost down by getting discounts for several items in the bag. Many thanks to LLL Leaders Christina Chunn, Jennifer Shaw, Linda McGrath, Jennifer Collins, Juli Stockwell and Bonnie Myers. They considered their campaign to be a World Breastfeeding Week Celebrations event, so they are giving back to WBWC Grants, making funds available in 2011 for other Groups. THANK YOU TO THE WORLD BREASTFEEDING WEEK CELEBRATIONS 2010 PRIZE SPONSORS! PLATINUM Dual Elite LEVEL ($5,000+) Mothering Magazine Motherlove Herbal Company Sleepy Wrap/Boba PLATINUM LEVEL ($4,000+) Mother’s Milk Tea by Traditional Medicinals AMYTHEST LEVEL ($2500+) ERGO Baby Carrier, Inc. SILVER LEVEL (200+) Platypus Media Science Naturally! BRONZE LEVEL (Cottage Industry) Fresh Baby Mama Knows Breast Mommy Necklaces Over the Shoulder Baby Holder The Umbilical Card Wrapsody La Leche League of Starkville/Columbus, Mississippi, had a goal of reaching mothers during pregnancy by connecting with local obstetricians to spark conversations between expectant women and their doctors regarding breastfeeding. To accomplish this they wanted to assemble prenatal breastfeeding information bags and deliver them to obstetricians in three counties. 2010 | Issue 4 | New Beginnings 35 To Honor and Remember To Honor Diva Rumina She who watches over nursing mothers and suckling infants. From an anonymous donor in Brooklyn, NY Melissa Kacalanos To Melissa and Baby Thelma, with love from Grandma. From Reeva Miller, New Paltz, NY LLL USA Interim Council To Honor my hardworking sister Leaders on the LLL USA interim council. From Judith Gibel Nancy Miller Nancy is a wonderfully dedicated volunteer. I wanted to make this donation in appreciation for the time and support that she has given me, and in honor of all of the energy that she and the other LLL volunteers and Leaders have invested in support of breastfeeding women. From an anonymous donor in Seattle, WA To Remember Emil L. Hopf In memory of Emil L. Hopf, June 24, 2010 Husband to Teresa, a retired LLL Leader, and father to Edward and Eric. He will be missed by many. From La Leche League Dubois and surrounding area, Indiana Leaders in Miami-Dade County To honor our wonderful co-Leaders in MiamiDade County. From LLL South Central Miami NEW TRIBUTE Submission GuidELines! For significant events in the life of someone you care about, have you considered a tribute gift? You can make a donation to La Leche League USA (LLL USA) in the name of a family member or friend to Honor or Remember them. Your tax-deductible donation will show that you care about them while also helping LLL USA further its mission to help mothers breastfeed. community whose main focus is helping mothers to breastfeed. While we can respect personal beliefs reflected here because of the nature of the tributes, this column is not intended for social commentaries outside the focus of La Leche League International. For a minimum gift of $50, New Beginnings will publish your special message of congratulations, encouragement, appreciation, or condolences; limit tributes to 20 words. Please keep in mind that La Leche League is a diverse To submit a tribute gift, please send a check and the tribute wording to LLL USA, 957 N. Plum Grove Rd., Schaumburg, IL 60173 36 New Beginnings | Issue 4 | 2010
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