Monthly Archives: January 2012

What is Normal?

“Is this normal for a breastfeeding baby/breastfeeding mom?” In the early days, even veteran breastfeeders can need some reassurance because every baby is different and what is normal varies from baby to baby.

“What is normal?” “Help! My mother/brother/sister-in-law/best-friend/pediatrician said this isn’t normal!” “Is my baby eating too much?” “Is my baby eating too little?” “Should I wake baby up to eat?” “Shouldn’t baby be sleeping longer?” “My breasts are hard!” “My breasts are soft!”

Chances are pretty good that it’s normal. “Normal” does not necessarily mean “The experience that most/all people have”. It means that it’s normal for your baby and for your body, and for your nursing relationship.

So let’s address “what is NOT normal”.

It’s not normal or healthy if your baby is making too few wet diapers per day. Before your milk comes in your baby’s diaper count for the day should match the day of life. So on day one, one wet. On day two, two wets. On day three, three wets. You might see more wets if you had an IV while in labor or if your baby were born via c-section. (Expect these babies to “lose more weight”- it’s water weight.) Once your milk comes in, baby should start making 6-8 wets per day. A “wet” diaper for a newborn (birth to six weeks) is considered  at least 3 tablespoons of liquid. A “wet” diaper for a baby after 6 weeks is 4-6 tablespoons of liquid. Not sure if your baby’s diaper is “damp”, “wet” or “soaked”? Pour either 3 or 4 tablespoons of water into a clean dry diaper, and see what it feels like. That’s wet. More than that is “soaked” and counts as two wets. A poopy diaper is also generally counted as a “wet” diaper.  Sometimes if baby’s been sweating a lot, or has been ill, diaper count can go down for a day or so without being a big issue (especially if baby’s older). But consistent low diaper count can be a sign that baby’s not getting enough milk and that mom might either have some supply issues or that there might be a “milk transfer” issue caused by a weak/ineffective suck, high palate, poor latch, or a severe tongue tie.

It’s not normal or healthy for your baby to have strong smelling concentrated or dark urine. Sometimes baby’s urine might have a slight tinge of color (my son’s always turned a bit pinkish if I ate a lot of beets). Strong concentrated urine can be a sign of dehydration, though. “Brick dust” in the diaper is also considered a worrying sign.  Before jumping to conclusions about if your baby’s urine is strong and concentrated, make sure that they have not been sitting in the wet diaper for a period of time. Normal urine will become strong and smelly too if it’s left in a diaper for too long.

Once a baby has regained birth weight it’s not normal for baby to lose weight or not gain weight consistently instead of gaining weight. If baby’s losing weight, there’s a problem somewhere. Often the problem is an incorrectly calibrated scale. Make sure your provider checks that the scale is properly functioning before each weight check. If the scale is properly functioning and baby is being weighed the same way each time (ie: in a clean diaper or diaper-free), make sure that the weight difference can’t be accounted for by something as simple as “baby hadn’t pooped in a week at the last weigh-in, and just had three blow-out diapers in a row just before this weigh-in”. If baby’s absolutely losing weight, there’s a problem that needs to be addressed. If baby’s making enough wet diapers, baby might have an intolerance to something in your diet (such as dairy or soy which are common culprits). Baby might have a metabolic disorder which is causing low weight gain. There might be a milk transfer issue caused by a high palate or a tongue/lip tie or another physical issue with baby or mom. Mom might have over-supply or foremilk imbalance. Seek support in breastfeeding forums if your baby is losing weight. Find out about things such as breast compressions, block feeding, nursing frequency, things to increase supply, etc. Formula MAY be needed as a last resort, but before that you can try things such as pumping your milk, refrigerating it, skimming the fat off the top and spoon-feeding the fat to the baby after each nursing.

Weight loss can sometimes be totally normal, too. Most babies will either level out on the growth charts or lose a bit of weight once they become more mobile. Or during teething. Or if they’ve been sick. Formula is not the answer to any of those causes of “weight loss” or “slow gain”.

Other Non-Normal Things

Sometimes there are definitely issues, such as reflux or silent reflux. Genetic disorders such as PKU or galactosemia. Sensitivities to something in mom’s diet. Thrush. There’s a lot that can be “abnormal” so it’s always a good idea to seek out more information if you’re in doubt or if your motherly instinct says “there is something wrong here.”

What IS normal, though?

A lot of things. It can be perfectly normal for a newborn to nurse constantly while awake- and even while asleep. It can be normal for a newborn to sleep through the night immediately, and only nurse every 3 hours during the day. It’s DEFINITELY normal for baby to completely change things around on you every once in a while. It’s normal for baby to scream for random reasons during/before/after a feed. Cluster-feeding where baby will nurse for hours and want to switch breasts constantly.. Normal. Baby having a preference for one breast over the other? normal. Baby having absolutely no schedule at all? Totally normal. (And more common than not.)

It’s also totally normal for your baby to do things that absolutely drive you stark raving mad.  Humans are illogical beings that learn to mostly pretend to be logical for social reasons. Infants have absolutely no desire or ability to be logical. They’re likely going to drive you insane at various points. Breathe deep. It’s normal.

Focus less on “normal” and more on “Is baby healthy? Is baby meeting milestones? Is baby making enough wet diapers? Are there things about this nursing relationship that I think could possibly be improved?”

If there are things that you’d like to change, classify them as “goals” rather than as “things that may not be normal”. Seek advice from experienced breastfeeders, see if there’s anything that you can do to help you feel better about the situation, or if there’s possibly something that you can tweak to make things feel a bit more like they’re running smoothly. You’ll discover things that you might not even imagine existed. Things like hypoallergenic infant probiotics, ring slings, “one ounce per hour” rules of mom/baby separation.. All sorts of advice exists out there to help make your life easier without involving bottles, formula, weaning, etc. A lot of advice out there makes breastfeeding easier with breastfeeding advice, not with weaning advice.

Just make sure you’re seeking advice in the right places. Find people that had experiences similar to yours. (If you think you have low supply, don’t accept advice from someone who could squirt milk across the room and hit a bulls-eye/pump 10 ounces in 5 minutes after nursing triplets. Seek someone out who had low/normal supply.) Find people that had similar goals to yours and that MET them. (If you want to nurse for 2 years, ignore advice from the woman who nursed for 3 months and quit. )

Breastfeeding can generate a lot of questions even from supportive people who mistake normal infant behavior for a problem. Reassure yourself about the reasons behind your baby’s behavior and you’ll feel better.

[originally posted at the now defunct custommademilk blog, updated for nurshable.com]

Overfeeding a Baby with a Bottle vs. the Breast

Picture this: A hose.

A bottle is a hose that is uncapped. Water turned on? Water comes out. There’s very little that can be done to control it. It comes out fast. Take most bottles and turn them over. The milk streams out of the nipple. with some bottles you have to apply slight compression to the nipple, but not usually.

A breast is like a hose that has one of those sprayers attached. The water’s there. It requires that the water be released. And there are multiple ways in which the water can be released. Baby learns to control the flow by nursing differently for different purposes. Take your shirt/bra off. Lean over. Does milk pour out until your breasts are empty? Chances are.. No. At most you might leak a bit.

The reason why you can overfeed a baby with a bottle very easily but can’t easily overfeed a baby at the breast have two components:

1- Baby-controlled flow.

2- The difference between how “supply” functions within the breast and how “supply” functions with a bottle.

Babies are programmed to suck for a variety of reasons because their instincts evolved alongside breasts and not bottles. Breasts require stimulation to produce milk and to maintain supply.

In the early days when baby’s just learning to nurse, isn’t very efficient, is at risk of starving, etc. mom’s breasts release milk VERY easily and baby needs this. As baby gets more efficient mom’s supply slows down, baby learns to suck harder to get more milk, suck more shallowly to get less milk, and baby learns non-nutritive suckling that provides comfort, communicates with mom’s immune system to get antibodies for pathogens baby’s exposed to, and helps maintain supply where baby needs the supply to be.

Breasts and babies are also in a delicate dance. It’s a conversation. Baby needs to work for food otherwise there will be no food. So baby constantly works to keep supply up to meet baby’s growth requirements and to increase supply during growth spurts. Mom’s body on the other hand has a vested interest in lowering supply. Too much milk means mom’s at risk for mastitis, plugged ducts, etc. It also means that mom’s nutritional reserves are basically leaking out into her bra instead of feeding her baby or nourishing her body. Nature doesn’t like this and works to lower mom’s supply while baby works to increase it. The human breast creates a protein that inhibits lactation. It creates this protein when mom’s breasts have mik in them. This means that if mom goes for a longer period without nursing, her supply will drop. Bottles have no “decrease in supply” and adults are habit driven and tend to fill bottles with the same amount all the time always, or increase it.

Since baby has to work for the food that baby consumes, baby’s sucks are going to be harder and stronger when baby’s hungry or upset. As baby calms down and is no longer hungry baby’s sucks will become more relaxed and turn into non-nutritive comfort sucking.

Again- turn a bottle upside down. Poke at the nipple. Chances are you’re gonna get milk streaming out like there’s no tomorrow. Take baby’s calmer non-nutritive comfort sucking that is biologically engineered into baby and instinct driven and you’re still pouring milk into baby.

Combine that with a caregiver that doesn’t understand a breastfed baby’s hunger cues, that believes in large bottles, or that feeds baby at every given opportunity and suddenly you have a baby that is eating 6oz bottles every 3 hours which essentially is double baby’s needed intake. Many caregivers also feel that baby needs to “finish the bottle” and will continue to offer the bottle to the baby even if the baby is turning away.

It IS possible to over-feed a breastfed baby at the breast. It’s just uncommon and it requires that both mother and baby have something out of the norm. Ie: A baby with reflux and a mother who is taking a medication that increases supply and that has hyperactive letdown. A baby who is in this situation is not going to be asymptomatic though. And this type of situation is pretty rare, whereas a situation where baby’s over-eating from a bottle is more the “norm” than the exception.

Another issue is that bottle feeds tend to be constant across a 24 hour period. Mom’s supply tends to be variable across a 24 hour period. Breastmilk is very easy to digest. Baby will take what baby needs from the milk and poop or pee out the rest. So if baby’s eating 6 oz bottles of pumped milk every 3 hours, baby’s going to poop a ton, gain weight very rapidly, have a stretched out belly, and will be eating 48oz of breastmilk per day that mom has to pump vs. if baby was eating directly from the breast where the average intake for meeting the needs of a breastfed baby is 25oz/24 hours (varying from 19 oz-30 oz.) Drastic over-feeding. Baby doesn’t need it, baby will poop it out, and baby will learn to over-eat and associate “very full” with “done eating” rather than “no longer hungry”. This perpetuates the cycle of drastic over-feeding and often makes mom feel that she “isn’t making enough” because baby learns to prefer the fast flow and easy food of the bottle.

Best practice for mom’s supply and for baby’s health is this: When a bottle feed is necessary,  limit bottle feeds and provide smaller more frequent bottle feeds rather than large feeds. This allows baby’s system to use everything in the milk rather than just flushing it out quickly. It allows mom’s supply to function at more normal levels, and it enforces healthy eating habits in baby.

References: http://www.kellymom.com/bf/pumping/milkcalc.html

Breastfeeding in the Beginning is Different from Breastfeeding at the End.

(from the archives dated May 19 2009)

Sometimes I let myself think about what the other person must be thinking when I say that I still breastfeed my two and a half year old. A two year old looks so big, so independent. And since most people only have experience with babies that nurse as newborns or as 6 month olds, their idea of what “breastfeeding” means is very limited to a certain phase. A time consuming phase. A possibly painful phase. A phase of leaking, of engorgement, of panicking over low supply. Of diaper-counting, elimination diets, and night waking.

Nursing a two year old is very different. The parallel I always think of is that of picking your child up. Picking your child up when the child is an infant often means long periods of holding. You have to support the child’s head when the child is an infant. You have to carry them, hold them, and they want to be held constantly. A newborn does not sit on your hip or support his own weight when held. If someone stopped picking their child up when their child was 3 months old or 9 months old, they might look at someone with a two year old and say “You STILL pick the child up?” thinking about how difficult it must be to hold 36lbs of child. Thinking about how big and independent that two year old looks. Thinking about it through their own experience, where the “picking up” relationship ended very early when the child’s needs were very different. “But the child is strong now. Doesn’t it hurt when he punches you in the face when you pick him up?” they’ll ask, flashing back to the flailing newborn limbs.

With a two year old nursling, they imagine that the teeth bite just as the flailing limbs would hit. They imagine that the child nurses constantly, doesn’t consume food, and is intertwined with you as only a newborn can be.

Because that is what they have experienced.

But it’s not like that. The child nurses or doesn’t nurse. Accepts postponements (usually). Asks politely (usually) instead of wailing. The child seldom nurses for comfort anymore (at least my son), and usually only nurses a few times a day. My newborn son would nurse 8-12 times a day, or sometimes 15 times a day, and for long periods of time. 30 minutes, 40 minutes, and hour.. Two.. Nursing was a full time occupation some months.

A toddler doesn’t nurse that way. Even if he nurses frequently, it’s for shorter amounts of time. You can do other things when a toddler nurses because you’re not supporting all of their weight, you’re not focused on the latch, you’re not leaking and engorged. A nursing session may last 5 minutes, or it may last 3 minutes. But I can’t remember the last time that I nursed for 15 minutes or longer. I can’t remember the last time my son didn’t sleep through the night. I can’t remember the last time I was engorged, the last time I leaked. I can’t remember the last time he bit down while nursing.

Child-led weaning is gradual. Not only for the child, but for the mother. It goes the way all of childhood goes. Like sand through a sieve. Slowly. Feedings space out, disappear, the child separates and becomes independent. Weaning is a milestone that is reached slowly, not a sudden destination.

Nursing a two year old is very different from nursing a newborn. I imagine that nursing a three or four year old is different from nursing a two year old. Maybe I’ll find out what that’s like, or maybe my son will have weaned himself by then.

Whatever it is, I’m in no rush. I enjoyed nursing my infant, and I’m enjoying being here for my two year old. It’s not without its frustrations and embarrassments, but ultimately it’s worth it to witness this beautiful miracle of seeing my son toddle off to independence at his own darned pace.

From a Mother to a Daughter

Dear Daughter,

You are currently 101 days from your due date, squirming around and kicking me as your big brother nurses himself down to sleep on my lap.

You are my third child and first daughter. With my sons I was passionate about giving them the best, and because of my experiences with early breastfeeding I was passionate about helping others past what hurdles I could. I wanted to normalize breastfeeding so that they would understand the breast to be a comforting source of nutrition long before they became aware of the way in which society has sexualized women. I wanted their right to eat in public to be protected and free from harassment. I wanted them to grow to be strong supportive men like their father is so that one day they could reassure and support their wives through those early sleepless days and nights of motherhood.

You, however, have given me an extra goal.

You see, the mothers of my mother’s generation had to relearn breastfeeding from the ground up after their mothers were sabotaged by the “formula era” where women were discouraged, injected with medications to dry up their milk, and lied to about the needs of their babies and the quality of their milk.

They never experienced the cultural flow of breastfeeding from mother to daughter. They remember things dimly from decades ago, and fumble while trying to help us. Often the best they can offer is the reassurance that things seem okay.

For you, daughter, I want you to have a community rich with mothers who have inherited the information they needed from others and who are continuing the tradition of support.  I want breastfeeding to be normalized so that it is no longer looked upon as something to be hidden. I want the infighting and guilt tripping and negativity to fade, and the judgement to wither as women learn to mother each other and be gentle with one another while helping them provide for their baby’s needs.

It is my goal to help other mothers, discuss the controversies surrounding breastfeeding, reduce the attacks, and to encourage moms to help one another.

I want to be a contributor to this particular layer of the foundation of your future support network as a mother.

I love you and your brothers dearly. I, as we all are, am deeply imperfect and am blessed and honored by your existence in my life. You are my life’s most precious moments. While I cannot give you perfection in every area of life, I can give you the best where I can, and when I can I will.

Love always,

Mahmie/Mommy/Nursh/Mom/Mummy and all the various names I have been called thus far.

(Who started this letter last night while nursing your brother and finished it this morning because he ended up biting me and rendering me unable to use my cell phone. 😛 One bit of advice to you: Nursing manners do not always work with teething children. :p)

The Child Led Weaning “Controversy”

There are those that believe in “full term” or “child led” breastfeeding, and there are those that believe that a child must be weaned at a certain age. What each mother does is up to her, her child, and the child’s family. If child led weaning is for you, kudos. If you wean at an earlier age I’m a firm believer that no one is entitled to question your personal choice. (Although if you disseminate myths as solid facts, please stop damaging other people’s breastfeeding relationships. No one should ever judge you for your choices, but fear of judgement does not justify propagation of damaging and incorrect information.)

Certain words come up in discussions about weaning age irritate me, though, and I’ve basically taken this stance about the whole idea that it is somehow a “debate of right and wrong”:

Those who believe full term breastfeeding is normal quote studies and information and generally mention the same age ranges for when different milestones occur that naturally lead to weaning.

Those who believe that breastfeeding past a certain age tend to cite social influence, arbitrary milestones (“able to ask for it”… In what way? My babies ask for it from the moment they’re born by rooting around.. And linguistic milestones have nothing to do with a child’s nutritional or physical needs.) They also tend to choose different ages. 6 weeks, 6 months, 9 months, 10 months, one year, two years.

Those that believe that breastfeeding somehow becomes “wrong” at a certain point are largely in conflict with each other about the exact details or point where it becomes “wrong”. (Other than the full-term breastfeeding advocates who say “when mom or child is ready to stop it’s time to stop.”) This makes it REALLY hard for me to swallow that there is somehow a “must” age for weaning. Especially since the experts on the matter (WHO, AAP) all agree that there is nothing detrimental to nursing past those arbitrary ages and that there are many benefits to be had.

So my challenge is always this: If you feel that breastfeeding past a certain age is wrong, please provide studies and evidence. Otherwise please tone down the words that you are using to describe another person’s parenting. Words like “sick” and “gross” are full of judgement that you quite simply do NOT have the evidence to support. Your discomfort with the idea is due to social conditioning and not what is or is not healthy for the child. If there was a problem with it, there would be studies that clearly show problems and the major health organizations of the world would be speaking out against it. At best there are a few rogue pediatricians who have succumbed to substituting their own personal bias for an informed opinion.

I do not believe that a mother, fully armed with all of the many studies and information SUPPORTING child led weaning should be allowed to guilt trip a mother who has weaned her child earlier. And just as no one should be allowed to use a plethora of evidence to guilt-trip the mother who wishes to wean earlier, NO ONE should be allowed to use strong negative words like “sick” or “perverted” to back an opinion that not a shred of evidence exists to support.

The Advice That I Give to New Moms

There are some things that I’ve learned from others through commonly repeated advice. Other things I’ve had to learn on my own. The following is a short list of things to keep in mind about some common situations that new breastfeeding mothers frequently face, and that I wish I had known in the very very early beginning of things. This advice is much less about the “how to” of breastfeeding and more the “how to” of dealing with how everyone around you contributes or detracts from your breastfeeding experience.

1- Everyone will have advice. Most of it will be terrible. Only accept help from those who have met or exceeded your minimum goals. You wouldn’t learn to drive from the uncle that failed his driving test three times and still doesn’t have his license. Don’t accept advice from the people that gave up after 3 weeks, 3 months or whose babies “weaned” before a year. Unless their advice comes in the form of “I learned after the fact that I was sabotaged by xyz. AVOID DOING THAT AT ALL COSTS!” Tip learned: Only take advice from those that managed to do what you wish to manage to do.

2- Nurses are NOT lactation consultants. And often hospitals that say they have a lactation consultant on duty 24/7 are lying. Test the theory. On a hospital tour? They say they have a LC on duty 24/7? Ask to meet her. She busy? Ask to lay eyes upon her in all of her LC-glory. And ask about what certification she has. Lactation Consultants are not all created equally and people are pretty lax on what they call a Lactation Consultant sometimes. I learned this the hard way when on night two with my second son who was refusing to latch after a non-LC nurse “helped” him latch on with the most terrible and aggressive methods.. I walked down to the nurse’s station and asked to see the LC and was told that if I was worried I could just give formula. Right. 24/7 LC. Perhaps there was and I just got Nurse Cranky. I shall never know. My son never got formula. I hand expressed and finger-fed him until my mother got into town the next day, and latched him on as best as I could. My mom helped me relax and once we were out of the hospital the booger latched on and went on to nurse for 3 years. Tip learned: Nurses are not LC’s. You will likely have to hire your own LC. Bring phone numbers. Or be otherwise-well-educated. And stubborn.

3- Any family member that claims that they cannot bond without a bottle will not bond WITH the bottle. Some people are insecure and have been tricked/conditioned into believing that they have to provide nourishment for a baby to like them. Bogus. This mostly guarantees that mom’s going to end up dealing with all sorts of issues with supply, nipple confusion, shredded nipples, bottle/flow preference, etc. And that family member that needed the bottle to bond? Chances are pretty good that their bond is going to involve them handing an angry screechy baby back to you after the bottle milk runs out. No. Bonding is EVERYTHING BUT the feeding. It’s the comforting, the rocking, the dancing, the soothing, the singing, the reading-to, the baby-wearing, the offering of the pinky as a pacifier, the holding, the loving, the talking-to, the walking-with, the snuggling, and baby understanding that if they cry that family member will come to pick them up, will recognize their feeding cues (rooting, mouth o’s) and will bring baby to the source of baby’s food. Mom. The most bonded people I have ever seen are those who didn’t feed the baby from a bottle. The only person that I ever pumped for “for bonding purposes” was the least bonded person that I ever witnessed in my life. Tip learned: Bottles do not equal bonding.