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Ovulating While Breastfeeding

Ovulating While Breastfeeding

A friend of a friend recently asked me a question that I couldn’t answer. She’s in her late 30s, has a two year old daughter, and has been breastfeeding on demand for the past two years. She and her husband have been trying to have another child, but she just recently learned that she miscarried after their first attempt. She has only recently started getting her period again, and was wondering if the breastfeeding could negatively impact her body’s ability to get pregnant again. I speculated that the high levels of prolactin which occur during breastfeeding might inhibit ovulation, just as high levels of oestrogen inhibit breastmilk supply by competing with prolactin for binding sites in breast tissue, but I told her I wasn’t really sure and that I would investigate. I thought that somehow oestrogen and prolactin were counter opposites: one could not exist in high levels while the other was around. Turns out I was waaaaay off base. Here’s what I found:

During pregnancy, the corpus luteum, acting on instructions from the placenta, secretes the oestrogen and progesterone necessary to maintain the pregnancy. These high levels of steroid hormones simultaneously suppress Follicle Stimulating Hormone (FSH) and Leutenizing Hormone (LH), the two hormones most responsible for ripening an egg and then triggering ovulation—after all, if you’re already pregnant, there’s no need to ovulate. After delivery, once the placenta is removed, the high levels of oestrogen and progesterone no longer exist, and the levels of FSH and LH gradually begin to rise again, preparing the body for ovulation. Eventually, as the levels creep up, the pituitary takes notice again, and begins to release more FSH and LH through a negative feedback loop, which eventually will trigger ovulation.

“Most nonlactating women resume menses within 4 to 6 weeks of delivery, but about one-third of the first cycles are anovulatory, and a high proportion of first ovulatory cycles have a deficient corpus luteum that secretes sub-normal amounts of steroids. In the second and third menstural cycles, 15% are anovulatory and 25% of ovulatory cycles have luteal-phase defects…Lactation, or breastfeeding, further extends the period of infertility and depresses ovarian function. Plasma levels of FSH return to normal follicular phase values by 4 to 8 weeks postpartum in breastfeeding women. In contrast, pulsatile LH stimulation is depressed…in the majority of lactating women throughout most of the period of lactational amenorrhea.” [1]

In other words, after not menstruating for so many months, it takes the body a few tries to get the delicate hormone balance back up to speed again. The first few cycles either don’t release an egg, or if an egg is released, the corpus luteum, which is responsible for secreting enough progesterone to maintain the pregnancy until the placenta can take over, isn’t quite up to the task. This is called a luteal phase defect, and it’s a very common cause of early miscarriages. In women who are breastfeeding, the process of returning to normal ovarian cycles takes even longer.

In breastfeeding women, FSH, the hormone responsible for ripening an egg, returns to normal pre-pregnancy values fairly early, but LH, the hormone responsible for triggering egg release, continues to be suppressed due to the breastfeeding. (However, contrary to popular belief, prolactin is not at all responsible for this suppression. It’s the constant suckling and stimulation of the nipple itself which actually suppresses ovarian function, which is why on demand breastfeeding is so essential to maintaining lactational amenorrhea.)

So, there you have it. To answer the question: it will probably just take a few more cycles for your body to get back into full swing in terms of ovulating, but continued breastfeeding did not contribute or cause the miscarriage in any way, and will not prevent conception. Most likely, the miscarriage was caused by a short luteal phase or corpus luteum that just wasn’t quite ready to maintain a pregnancy, and this will no longer be a problem once your body goes through a few more cycles and gets used to ovulating again.

[1] Hatcher, R.A. et. al. (2011) Contraceptive Technology, 20th Revised Edition. Ardent Media, Inc.: New York.

Gentle Mother-led Weaning

Gentle Mother-led Weaning

 

 

Letting Go

First you hold them like a secret
you only suspect is true.
Then soft knockings from within
tap out messages for you.
Slowly the body allows escape,
you hold them in your arms,
dazed and milky, full of love,
pledged to defend from harm.
Then you  hold them to your heart
and put them to the breast.
but they learn to walk away
like any other guest.

Angela Topping, Musings on Mothering (2012)

When IS the right time to wean?  Before I even start, I need to acknowledge the fact that MANY women wean before they want to, without having met their breastfeeding goals, and often feel like they didn’t have a choice in the matter. This is usually due to a lack of breastfeeding support when they most needed it, and I can understand how articles about women choosing to wean when the breastfeeding is going well might be difficult to read. As a lactation consultant, I hear so many stories from heartbroken women who wanted to breastfeed, but weren’t able to for so many reasons, many of which might have been preventable if they had had the right support earlier in the process. In January 2016, the Lancet published a chilling review of breastfeeding rates around the world, and sadly the UK was at the very bottom of the pile, even worse than the US (which is rather astounding, given that many women only receive six weeks of maternity leave in the US, versus the much more humane 6-12 months that most women get in the UK). In the UK, 81% of women want to breastfeed at the start of their postnatal journey, but by 6 months, the numbers of women successfully breastfeeding have already dropped to 34%, and by 12 months only 0.5% of all women in the UK are still breastfeeding. Which partly explains why extended breastfeeding is viewed as such an aberration in this country.

BUT, if the breastfeeding has been going well, and you’ve been enjoying it and carrying on past the 12 month mark, then at some point the question will arise: when IS the right time to wean? To help answer that question, we can turn to the data. The World Health Organization recommends breastfeeding at least through the first two years of life. Numerous professional organizations, including the Royal College of Paediatrics, UNICEF, the Royal College of Midwives, the American College of Nurse-Midwives and the American Academy of Pediatrics all recommend breastfeeding for at least the first year of life, and then carrying on for as long as desirable for both mum and baby.  New research suggests that there is a link between gut health and brain development, and that nursing well into toddlerhood gives your children a boost in cognitive development and mental/ emotional health. The advantages of extended breastfeeding are numerous and well documented, and carry on well beyond the first year of life. From primate research and indigenous cultures we know that the natural age of weaning for human mammals is probably between 2-5 years of age. If the breastfeeding is going well AND you’re still enjoying it, there’s no reason to stop, and I personally know many, many people who have happily and joyfully breastfed their children until they were 3, 4 or 5 (or even older). I’ve also read and heard so many beautifulbeautiful stories about women who were able breastfeed until the point that their child was ready to stop, a process often referred to as natural term breastfeeding, or child-led weaning.

But what happens if you’re no longer enjoying it? And what happens once you get beyond two years of age? I doubt there’s a standardized answer to that question any more, and I’d imagine that, as with everything, it varies from nursing dyad to nursing dyad. Since I’ve found many accounts of child-led weaning online, but relatively few (if any!) examples of gentle mother-led weaning in toddlerhood, I thought I would share my experience here. The course my son and I ended up charting was a bit different than the one I had originally expected for us, but I am finding a way to make my peace with it.

So, this is the story of how I weaned my second son.

With my first son, I stopped breastfeeding at 15 months. At the time, I had just started a new job as an independent home birth midwife in New York City, and I was convinced that I wouldn’t be able to keep up with the breastfeeding while also being on-call and away at births for hours at a time. Looking back now, the flaw in this thinking seems so obvious to me. OF COURSE I would have been able to continue to breastfeed if I had wanted to, especially as he was only feeding a few times a day at that point, and was fully night-weaned. He would have been fine with a cup of cows milk at bedtime now and then if I was away at a birth, and happy to have a nurse and a cuddle whenever I finally made it home. But at the time, my breastfeeding goal had been to make it to 12 months.  After 12 months, anything beyond that felt like icing on a cake–nice to have, but not really necessary.  So at 15 months, I figured I had breastfed enough, and my (rather self-imposed) perceptions about work pressure convinced me to stop. I weaned him abruptly because I really didn’t know any better.  My husband and I went away for a weekend wedding, and he stayed behind with the grandparents, and when I came back, I didn’t resume breastfeeding him again.  And he rolled with it, of course, because he was only 15 months and couldn’t even talk yet, let alone protest.  But I’m sure he missed it, and I’m sure he would have happily carried on if I had let him, and I’m sure that if he had had a say in the matter, he would have wanted to continue. I was a midwife at the time, but had not yet started down the path towards becoming an IBCLC. I didn’t even know how little I knew.

“Do the best you can, until you know better. Then when you know better, do better.” –Maya Angelou

With my second son, I wanted to do things differently.  I was an IBCLC by the time I was pregnant with him, and I had a much better idea about exactly how important breastfeeding is into the second and third year of life. My goal was to make it to 2 years this time, minimum, and perhaps continue until he was 3 (or maybe even older). I had lots and lots of friends who were “positive deviants” (in the words of Allison Dixon from Breast Intentions), i.e. people who were still breastfeeding their two and three year olds (and in some cases four and five year olds) despite our rampant anti-breastfeeding culture.  Breastfeeding a two year old didn’t seem like a strange idea to me any more. And my attitude had changed as well. Things that I used to worry about with my first son–getting him on the “right” schedule, getting him to sleep through the night (as if this was actually something I could have controlled!), not creating “bad habits”, not letting him “use me” as a dummy/ pacifier–didn’t really stress me much at all with my second. He wasn’t fully night-weaned until 18 months, whereas my first son was night-weaned by 6 months (granted, this was because I was working as a midwife again at 4 months, thanks to the completely INHUMANE maternity leave policies of the United States of America, and I was terrified that I would make a mistake or dangerous decision during a shift because of exhaustion, so the night feeds were phased out quite early). My second son co-slept with us from the get-go. He was in and out of our bed for many months even after he had begun to sleep in his crib. Things were just a lot more relaxed, and he was (still is) one of the most chilled, easy-going and confident kids I know. Of course, I can’t prove that this is because of our more easy-going attitude, or the extended breastfeeding, but in my mind they’re linked.

And then we made it to two years old–huzzah! And the breastfeeding was still going well, and had become a very easy thing to do. As Sarah over at Nurshable points out so eloquently, nursing a toddler is very different from nursing a baby. As the amount of solid foods he was eating began to increase, he began to nurse less frequently throughout the day, and I gently encouraged this by offering liquids, snacks and cuddles during the times that he might otherwise have wanted to nurse. By around 22 months, he was only consistently nursing about twice a day–when we first woke up in the morning and right before he went to bed–plus the occasional emergency nursing session when he had hurt himself or was otherwise having a really difficult time.  But also right around two years of age, there was a change in the way that he nursed which suddenly made things a lot more unpleasant. First, there was a change in his latch. I’m not sure why or how–perhaps it had to do with the changes that were occurring as his speech developed–but suddenly the latch became incredibly tight and clamped. No matter how wide the latch was initially, he invariably changed the shape of his mouth to a very narrow and shallow latch. I tried all kinds of tricks to encourage a wider latch. I talked about it with him, I explained that it hurt, I would take the breast out of his mouth when he did it and re-latch again (and sometimes resorted to just taking the breast away altogether, especially if he had bit me), I switched positions, I used the nipple flip when latching, at one point I even gave nipple shields a try, but as the weeks dragged on, it seemed like this new change was becoming a permanent fixture in our nursing experience. Whenever we finished nursing, I always had a tight little ring of teeth marks around my nipple. He also began the usual (and very normal) nursing tricks that lots of toddlers play–nursing gymnastics where he wanted to nurse upside down and from every conceivable angle, or have his legs on my shoulder while nursing, or his feet in my arm pits. He began twiddling the other side, which I know from my nursing friends and online forums is a very common thing that many women experience and often find incredibly aggravating, and I could usually prevent this by covering my other breast with my hand whenever he was about to reach for it. He did the popping on and popping off game, and talking with a breast in his mouth (ouch!), and ultimately began to want both breasts out at the same time, so that he could switch rapidly between them at his own pace, five sucks from one side, four from the other, then back to the first side again (I suspect my supply must have been dropping a bit at this point, so that he had begun to instinctively switch nurse, which is a great way to boost supply).

Maybe one of two of these changes on their own would have been easier manage, but somehow all of these changes combined meant that I began to approach nursing sessions with dread, and found myself counting the milliseconds until they were over. It wasn’t that it was awful, but it was no longer the cuddly, lovely, snuggly breastfeeding that I had been enjoying prior to this. I began to think that maybe something was wrong, especially as I kept hearing stories from my positive deviant friends about how much they still loved breastfeeding their three or four year old, and how snuggly and comfortable it still was. I began to wonder if maybe they were just having a very different experience to what I was going through, as I usually came away from a nursing session feeling as if I had just been used and pummeled; I often felt annoyed by it, and sometimes I even felt a bit resentful about it, and this was not at all how I wanted to feel towards my child! I also felt a sort of secret shame about these feelings. How could I feel this way, when as an IBCLC I was supposed to be a breastfeeding guru? How could I dread nursing myself, when one of my favorite things in the world was promoting breastfeeding and helping others achieve their breastfeeding goals?  I knew that for many mothers a nursing aversion can be a phase, so I resolved to grit my teeth and carry on as long as I could–in part because I felt like I should be doing natural term breastfeeding, like any good IBCLC would.  If it was a phase, though, we didn’t seem to be coming out on the other side of it, and the months kept dragging on.  I also began to recognise that I was putting a lot of pressure on myself because of the ‘shoulds‘.  If a client had come to me with the exact same situation, there wouldn’t have been any ‘shoulds’ involved at all! I would have been incredibly supportive, and advocated that she listen to her heart and do what felt right to her. And yet, when it came to myself, I had a much harder time letting go of my own (self-imposed) expectations to nurse to natural term.

At about 27 months, I met up with a good friend of mine who was still nursing her five year old son, and in the midst of setting the world to rights, breastfeeding came up. I spoke with her about my aversion towards nursing, and how I was carrying on through the aversion with gritted teeth but not at all enjoying it, and she talked about how she had certainly gone through many phases like this during her long breastfeeding tenure (though never quite as long an aversion as I had experienced at that point). It was lovely because she was able to normalise the experience for me, so that I no longer felt like I was alone in feeling touched-out and resentful towards my child instead of feeling loved-up and oxytocin-blissed out after a feed. But she also said something which I had never really thought about quite in those terms before: nursing is a relationship.  Well, duh!  I was very well versed in all the ways that the breastfeeding relationship is incredibly important to a baby’s bonding and emotional and psychological development and attachment, but I had somehow forgotten that there are always two people in a relationship. I had never quite stopped to think about the ways that my own needs and desires factored into the equation as well. I began to think that I had a say in the matter too; that maybe the right time for us to wean wouldn’t just be when he was ready to stop, but at a point where I was ready to stop, and when stopping wouldn’t be too detrimental to him.  I began to think of it as a compromise between the two of us–I would carry on through the aversion until we came to a point when he could at least be gently persuaded to cut-down and/or stop.

And thus began our very slow and gradual weaning process. I began to think of the entire process as nudging, rather than weaning. I was gently nudging him towards less and less breastmilk, bit by bit, but doing so very slowly, and as gently as possible. For the record, though, this was definitely my idea, not his, i.e. mother-led rather than baby-led.  He would still be nursing right now, if I had been willing to continue. I had to find a middle ground between his desire to continue to breastfeed, and my desire to stop, and hopefully do so in a way that was gentle and respectful of his desires (while still honouring mine).

We began by cutting down the bedtime nursing first, helped by the fact that we have an older child who drinks cow’s milk at bedtime.  It was easy to offer him a little bit of mommy milk first, and then slowly cut-down the amount of time we were nursing, and finish with cow’s milk and books, just like his older brother. There were also a few nights when I was away from him, and he was perfectly happy to have cow’s milk and books with his grandparents or babysitters. He no longer nursed to sleep, and was able to go to bed without me there, so the nursing was no longer the nightly fixture that it had once been. Over the course of a few months, the night nursing became a cuddle and a minute or two of mommy milk, and then occasionally there was a night or two when he didn’t even ask for mommy milk in the first place (and I was operating under the ‘don’t offer, don’t refuse’ policy), so he began to go to sleep with cuddles and cow’s milk, just like his older brother.

The morning feed was a bit more difficult to cut down on. My supply was much larger in the morning than in the evening, and he was in the habit of waking up and coming to crawl into bed with us and having his mommy milk then.  Slowly, though, I began to gradually shorten the length of the feeds, making it up with lots of cuddles and persuading him to come down to the kitchen with me for a drink of almond milk or cow’s milk while continuing the cuddles. Over time the morning feeds became shorter and shorter affairs, finally down to about 5 minutes in the end, but I began to realise that he wouldn’t voluntarily give them up.  I decided I would probably just need to pick a date, and work towards it. Knowing that he couldn’t keep more than a week in his head at one time (his concept of time is still rather shaky), I began to count-down the days with him. Every morning, as we were breastfeeding, I talked with him about how much bigger he had gotten. I talked to him about all of the things he was capable of doing now that he couldn’t do when he was a little baby. I talked to him about the foods and drinks he could enjoy now that he was so much bigger.  I talked about how his older brother had had mommy milk for a long time too, but that eventually as he got older he began to drink cow’s milk instead of mommy milk. And I talked to him about how much I had enjoyed breastfeeding him, and how special it was to me.  And at the end of these little conversations, I explained how we would be stopping the mommy milk in six days…four days…two days…tomorrow. He took it all in stride, and began to count down with me (“no more mommy milk tomorrow” etc.), but of course I wondered how much he actually understood what that meant.

And then, the day finally arrived. “Tomorrow” became “today”, and when he crawled into bed with me in the morning, I explained that the mommy milk was finished. He cried, of course. We both cried. But I held him and talked to him again about how much I had loved breastfeeding him, and about how sad I was that it was over, and about what a special time it was for both of us. And then I talked about how much I love him, and all the ways that I can still comfort him, with cuddles and snuggles in bed, with hugs during the day, with stories on my lap, with kisses when he hurts himself, with tickles and sniffs and rough-housing. And he was comforted, in the end, and we went downstairs to get him some almond milk or cow’s milk, cuddling all the while.

That wasn’t it, of course. He continued to ask for mommy milk in the coming days, but there were fewer and fewer tears involved. We had the same conversation many times, about how lovely the breastfeeding had been, and how it was sad that it was over, and all the ways I could still comfort him, and how much I loved him. And we had lots and lots of cuddles, to try to make up for it, but I have to admit that he was a lot clingier than he normally was for the first several weeks. I felt incredibly guilt-ridden about my decision. Also, in retrospect, I realize now that I could have picked a better time to do this, as I ended up weaning him about 2 months into starting my midwifery course, which meant I was no longer around as much as I had been before. It was a big adjustment for him—to end our breastfeeding relationship at the same time that I was also away from him for the first time—and it would have been an easier transition if I had held on for just a little while longer, giving him the comfort of nursing through my transition to school.

But, after these first few weeks, he did begin to find his equilibrium again. He sometimes cheekily asked for mommy milk at random times throughout the day, even asking for “bonus milk” at one point, which I think was a way of testing me to see if there were any loopholes in our new relationship. And one morning many weeks after the weaning, while I was getting dressed in front of him, he plaintively asked if he could try one more time, and without giving it much thought, I let him. I was curious to see what would happen. He was amazed and delighted that I had relented, and gave it proper go (he still had his latch, for the record), but the milk was no longer there. After a few sucks on one side, then a few sucks on the other, he declared that “the milk was all gone.” And since that day, he’s asked for it a lot less (although he has also suggested that we should have another baby, so that the mommy milk will come back). He’s also asked to put his hand on the “milks” a few times when he’s snuggling me and wanting comfort, which I’ve let him do.

And so, at 31 months of age (2 years and 7 months), we ended the breastfeeding chapter of our relationship. Even preparing for it as I have been, even talking about it and cherishing the last few weeks of it (amidst the gritted teeth and sore nipples), even wanting it to end, I have been amazed at the mix of emotions this has caused in me. It’s been incredibly bittersweet. I have been simultaneously incredibly proud of him, and also crying inside, particularly as he’s my last baby, and I’ll never breastfeed again. In some moments, I feel inordinate relief that it’s over. In other moments, I feel incredibly guilty about it, particularly in the moments when he’s being clingy. Like so many things with motherhood, there is a lot of self-doubt and uncertainty. I wonder if I made the right decision, I wonder if I should have held on for longer. These things keep me up at night, sometimes. But by and large he seems to be taking it all in stride, and aside from the initial clinginess, he’s returned to his normal, happy, relaxed self. We keep having lots and lots of cuddles, and still talk about it now and then. It was a beautiful, magical time in our lives, and I knew, even as it was happening, that it wouldn’t last forever. Now that it’s over, we’ve moved on to the next beautiful, magical time in our lives (as these toddler years are also way too brief). Our relationship continues to evolve and grow, as it always will, and I will weather these changes as he grows up and needs me less and less. But for now I still sniff his head (which still has that sweet, intoxicating baby smell now and then) and watch him when he’s asleep (he still looks so small) and marvel at all of the new things he’s learning and doing every day (he’s begun asking about using the potty like his older brother, so I can guess what’s coming next). The days are long but the years are short, and the seasons of motherhood continue on.

Sleep and “Self-Soothing” Roundup

Sleep and “Self-Soothing” Roundup

There is so much conflicting information out there on sleep, and so many messages you’ll hear on why having your baby “sleep through the night” is the holy grail of parenting and that if your baby isn’t hitting this milestone by (insert whatever age you like here), it’s a disaster or they’re not a good baby or you’re not a good mother or you’re allowing them to create bad habits etc. etc.  But the truth is that every baby is unique, sleep needs vary tremendously between kiddos, and learning to “sleep through the night” is a developmental milestone that you can’t really force a baby to hit before they’re ready, just like you can’t force them to sit up or crawl before they’re ready. Also, it’s important to remember that even as adults we wake up several times in a night (because we’re thirsty, or hot, or cold, or have to use the toilet, or had a bad dream, or heard a loud noise, or are stressed about something, or uncomfortable, or or or…), but the difference is that as adults we have learned to roll over, self-soothe and go back to sleep. Babies are still learning this skill.  It takes years for them to fully master it, and until they do, they often still need our help, input and reassurance to fall back asleep. Meeting a baby’s needs is not “creating bad habits”; it’s being responsive and attentive to the baby’s needs, which in the long run will create more security and independence.

Strangely enough, discussing sleep and self-soothing is a very “controversial” topic. On parenting boards and facebook groups and public forums, there are strong advocates for sleep training, using either “controlled crying”, “gradual extinction” or “crying-it-out” (CIO) methods as a way of teaching a baby to sleep through the night. There are equally strong advocates against these methods. Because every parent is exhausted (EXHAUSTED!), there is an unending market for books, sleep gurus and training methods as desperate parents (understandably) look for ways to get more sleep. And not surprisingly, the message you get from mainstream sources, news articles and “how to get your baby to sleep” books suggest that a baby who isn’t sleeping through the night by (insert whatever age you like here) is a problem that needs to be fixed. But what I am more interested in looking at is the actual science behind these differing approaches. Research into sleep, such as what Professor Helen Ball at the University of Durham is doing through the Infant Sleep and Information Source, is still a relatively new field, but there is a growing body of evidence which is beginning to refute the claims of the many (insanely popular) sleep experts and authors and gurus who recommend this or that sleep training technique.  The following is a round-up of some of these articles.   

First, Sarah Ockwell Smith has a great article on realistic sleep expectations for babies. As you can see, there is A LOT of normal variation in this, and even if one baby is ready to sleep through the night at 8 months, another baby might not be ready to do so at all. Each kiddo is unique and has different needs. 

Sarah Ockwell Smith also has a good article on what’s really happening when you teach a baby to “self-soothe”. Unfortunately, sleep training methods don’t really teach our babies to self-soothe. This is a developmental skill which they can only learn with time and maturity. Instead, it teaches a baby to stop signaling her distress. Babies are smart and they very quickly learn that if crying doesn’t bring a response, it would be better to conserve their energy instead and not use a method that doesn’t work. A study done in 2012 by Middlemiss et. al. monitored the cortisol levels (i.e. stress levels) in 25 mom+baby pairs and found that at the beginning of the study, the mom and baby were synchronised in their stress response, meaning that when the baby was stressed and signaled this to the mother, the mother responded to this with a rising cortisol level of her own. In other words, if baby was distressed, mom was distressed, and their cortisol levels were in sync. By Day 3 of the study, after using a gradual extinction sleep training method, the researchers found that the baby was no longer exhibiting stressed behaviour, but the baby was still distressed (as demonstrated by high cortisol levels). Meanwhile, because the baby was no longer signaling its distress, the mom’s cortisol levels had decreased, indicating that she was no longer in sync with her baby (at least in terms of cortisol levels).

Calm Family wrote a very detailed response to the BBC One’s recent airing of Panorama, Sleepless Britain, which addresses many of the ways “sleep issues” are portrayed in the media.

The Analytical Armadillo, another IBCLC blogger, has also written a good analysis on what happens during self-soothing, and that even though it works (and it does work), it’s not necessarily harmless.

Evolutionary Parenting looks at the science behind exposing our kids to stress, and what’s actually going on neurochemically in their brains when this happens. 

Uncommonjohn also looks at the science behind self-soothing

The Milk Meg writes about the many reasons our babies wake so frequently in the night.  

And while this doesn’t actually get into the science behind it, Mama Bean Parenting documents quite…succinctly…the many, many, many messages we receive in our society which tell us that a baby that doesn’t sleep through the night is a “problem”.

Finally, Dr. Sears has some good suggestions on ways to get more sleep without using CIO methods, as does Dr. Jay Gordon in this article. The Milk Meg also has some ideas on ways to gently night-wean breastfeeding babies.

And one final disclaimer, since I know this is an incredibly sensitive subject for many parents. I understand the desperate need, the overwhelming desire, to somehow find a way to get more sleep! We’ve all been there. Many of us are still “there”.  Parenting is exhausting, and waking frequently with our babies in the night is not at all conducive to our modern lifestyles. I absolutely get it. And I have many clients and friends who have used sleep training methods, sometimes with very good results–hell, I’ve attempted a few of these methods myself with my first son out of sheer desperation (but wasn’t able to follow through with them). I am in no way judging the reasons why parents might turn to these methods, and I have nothing but empathy for the desperate exhaustion that makes these methods seem like the only answer. Getting more sleep is a positive thing for everyone involved, and allows us to be better parents, and in our bleary, sleep-deprived states figuring out how to get more sleep seems all-consuming and anything promising a quick fix seems like mana from heaven. But it’s important that we as parents do careful research and make informed decisions before deciding on a parenting course of action. Our media and society is saturated with messages about sleep and ways to “fix” it, and nearly all of these messages usually recommend some form of sleep training. That is one side of the debate. All of the articles I have posted here are the other side. It’s important to understand both sides before making an informed choice.

As a midwife, asking “Is your baby waking regularly and feeding regularly?” is a much more supportive and useful question for new parents instead of “Is your baby sleeping through the night?”. Most likely, a normal and healthy baby who’s feeding regularly and growing well will NOT be sleeping through the night, so rather than make parents feel like there’s something wrong, it’s much better to emphasise what’s absolutely right about this scenario. And then look for other ways to support exhausted parents to sneak a bit more sleep into their lives.

Breastfeeding News Roundup

Breastfeeding News Roundup

Breastfeeding has been in the news a lot the last few weeks. Here’s a quick roundup of some of the most interesting and exciting new articles regarding our first food, and why it’s so important.

First, a viral post about the microbiology research of a Vicky Green, a Biosciences student at South Devon College, who demonstrated the power of breastmilk by placing it in petri dishes cultured with some of the nastiest bugs around, including MRSA and E. coli. In the picture in the link, you can actually see clear rings surrounding each drop of breastmilk on the petri dish where the bacterial growth was halted by the breastmilk proteins. What’s even more remarkable is that she’s using the breastmilk from a mum nursing a 15 month old and a mum nursing a 3 year old, which just goes to show that breastfeeding DOES continue to play an important and vital role in nourishing our children and providing optimal health for them well past the first 6 months of life. Unfortunately, as an IBCLC, I hear all too often from clients that they were told by a (presumably well-meaning) GP or Health Visitor that there’s no benefit to nursing a baby past 6 months. Absolute nonsense, as this research so clearly demonstrates! And who knows, perhaps the protein in breastmilk will hold the key to defeating bacteria like MRSA in the future.

And speaking of nursing babies beyond infancy, Tamara Ecclestone recently posted a lovely photoshoot of herself nursing her 2 year old daughter Sophia and just about broke the internet in terms of controversial backlash, as people reacted so negatively to the photos that she was actually forced to defend her decision for posting the photos in the first place. Which honestly is just a very sad state of affairs. Also, the BBC article linked above doesn’t provide 100% accurate information. UK guidelines for breastfeeding are in line with WHO guidelines, and state that babies should be breastfed exclusively for six months and then continue to be breastfeed for a minimum of 2 years OR BEYOND, in addition to the food they’re eating. For the record, the right time to wean is whatever feels right for mom and baby, but the biological norm for our mammalian species is to breastfeed for anywhere from 2-3+ years, and as with all phases of growth or development, there’s a huge range of normal in terms of the right time to wean depending on the mother and baby dyad. It’s irresponsible to suggest that the UK guideline only encourages breastfeeding for the first 6 months. As for the controversy, unfortunately that’s nothing new. People are often outraged by the thought of breasts being used for purposes *other* than sexual, and sadly we hear of stories all the time of women being shamed for nursing in public, or told to use the toilet instead. And not surprisingly, most likely due in part to these cultural perceptions, the UK has one of the worst rates of extended breastfeeding of any developed nation in the world–even lower the the US’ rate of extended breastfeeding, which is quite surprising given that women in the UK routinely have 6 months of maternity leave (and often a year) compared to women in the US who often receive a scanty 6 weeks, if they’re lucky enough to receive anything at all. Clearly there’s still A LOT of room for improvement, and personally, as someone who’s still nursing her own two year old, I applaud Tamara Ecclestone’s decision to share her beautiful photos, which is an important part of how we can begin to normalize breastfeeding in the first place. The Milk Meg also has a wonderful article on this entitled: 9 Reasons my child is not “too old” to breastfeed.

And finally, this is a fascinating article by Kathleen Kendall-Tackett, IBCIC (who I saw at the LCGB conference last year, and is a fantastic speaker), discussing all of the ways that breastfeeding doesn’t just provide the optimal food for our babies, but also provides the best emotional and neurological foundation for their mental health. Breastfeeding encourages responsive parenting, promotes sleep (which in turn supports better parenting, as well as lowering the risk of postnatal depression–and breastfeeding is an independent factor for reducing maternal depression as well, regardless of sleep). Breastfeeding also promotes nurturance, attachment and bonding. As I often tell clients, breastfeeding is 10% about the FOOD we’re feeding our babies (and what incredible food it is!) and 90% about THE MANNER in which we’re feeding our babies, setting them up for healthy brain growth, emotional processing and psychological attachment in addition to optimal nutrition.

The Wasted Hour

The Wasted Hour

We’re mammals. We like to ignore this most of the time, but when you attend births, it’s something which is impossible to forget. And like all mammals, we’ve been programmed to perform an elaborate bonding dance in the first hour after birth, often referred to as The Golden Hour*. During this time, babies are primed to respond to their mother’s voice, to look for her face, to root and nuzzle and find their mother’s nipple, to fix in their mind the image of their primary care-giver, and to breastfeed. Simultaneously, mothers are primed to fall in love with their babies. In fact, the hormonal cascade of labor is actually designed to change the brain chemistry of the woman who just gave birth, increasing her desire to nurture her newborn. Oxytocin, the hormone of love (and breastfeeding), peaks at its highest level immediately after the delivery, ensuring that motherly love—strong enough to move mountains, to fight like a tiger for your cub, to throw yourself in front of a moving bus to save your child without thinking twice—is cemented into place.

Bonding is crucial to survival; evolution has demonstrated this again and again. It’s well documented that in nature, if an animal fails to bond with her baby, that baby’s chances of surviving, let alone thriving, are pretty slim. With humans, it’s not as clear cut. Obviously strong bonds can form even without sharing the very first hour of life together, as adoption and chosen family (as opposed to biological family) demonstrates again and again, but it takes a lot more work. The beauty of the Golden Hour is that the wheels have been so perfectly greased—all you have to do is show up and be present, and falling in love is just about guaranteed.

Or was guaranteed, even just a few years ago. These days, it seems as if we’re almost willfully trying to shoot ourselves in the foot, having gotten way too meta about the entire experience. Since nothing has really actually happened until it’s been posted on Facebook, the very first thing new parents are doing these days is whipping out their phones to share the good news with the world. Gazing in wonder at the new human being who’s just entered their lives is often done through the lens of the smart-phone camera. It’s all about the stats—weight, height, name, time of birth—which is then texted to all the anxious relatives, ensuring that in addition to their parents’ voice, the very first thing the baby will hear is a barrage of beeps, vibrations or ring-tones heralding the arrival of each new text or tweet; their parents are often lost for 10-15 minutes at a time as they respond to the deluge of sms congratulations.

When I first started my career back in 2003, smart phones didn’t exist yet. Parents brought cameras with them to the hospital and maybe snapped a few photos before cuddling with their baby, but that was it. How refreshingly quaint that now seems! These days, I find myself frequently reminding parents to put their phones down. The updates can wait, the baby needs your attention now. Back in New York, when my husband and I tuned in to an episode of the American version of One Born Every Minute, we watched a well-intentioned new father accidentally drop his phone on his sleeping infant while trying to take a picture. Phones have become so ubiquitous now that no one in that delivery room even blinked—except the startled baby.

Right now we’re in the middle of giving birth to the first generation who will come into the world with smart phones as a given. My two year old son seems to think everyone has a phone the same way that everyone has a nose. He’s already quite adept at unlocking mine. The other day, in an unguarded moment, I caught him queuing up Winnie the Pooh on my Netflix app. While the American Academy of Pediatricians and Royal College of Paediatrics have warnings about this, recommending that television and other entertainment media be avoided for the first two years of life, it seems impossible to enforce. Media is everywhere we turn.

Evolution is a very slow process. Birth and bonding hasn’t changed that much in the last two thousand years, nor has our mammalian hard-wiring, while technology seems to move at the speed of light by comparison. Who knows what will happen to our species over time if we continue to squander the Golden Hour*? Put down the phone. Falling in love will never be this easy again.

*For the record, it’s not just a Golden Hour…it’s more like a Golden First Six Weeks! The many benefits of skin-to-skin contact–increased oxytocin release for both mum and baby, improved breastfeeding success, comfort, stable newborn core temperature, bonding etc.–can still occur well after the first hour of life. So even if the first hour wasn’t that golden (because you were separated from your baby, or under anesthesia, or in too much pain during a repair to be able to hold her) you can make up for it by putting your baby skin to skin as soon as possible. And for as much as you’d like to in the weeks to come!