Nighttime Mothering

nighttime motheringWhen I first became a new mom, I couldn’t believe the exhaustion that came along with having a little person depend on you for their every need. One parenting tool that allowed me to get more rest, and be slightly more functional than a walking zombie, was cuddling right next to my son during the nighttime hours.

Although well meaning relatives and friends may tell you that your child needs to sleep in their own crib, this just isn’t true. Babies are meant to sleep next to their mothers. Let me repeat that, babies are meant to sleep next to their mothers.
Throughout history, and throughout most of the world, babies sleep on their backs or side cuddled right up next to mom. Co-sleeping makes nighttime breastfeeding easier, and helps to keep up a new moms milk supply. When sleeping with your baby, you will find that your sleep cycles often sync with your child’s. This allows everyone to get more rest.

Usually when I talk to a new mother about sharing sleep with their baby, a few questions always seem to come up:

But what if I roll on the baby? Very unlikely. Just as you don’t fall out of bed during the night or kick your partner as you sleep, it is not likely that you would roll on top of your baby. Most mothers are very in-tune with their child and are aware of exactly where they are, even when asleep. Fathers do not always have this same sensitivity and awareness, so place baby between mom and the wall(or a bed-rail).

How will my baby learn to be independent? Doesn’t this question seem a little silly if you think about it? Babies are dependent by nature. So the question is probably better stated, “how will my baby develop into an independent child?”. Rest assured that this will happen. Children who form a strong attachment to their parents(and learn that their needs will be met), develop into independent, secure, and confident children.

What about intimacy? Where there is a will, there’s a way. Couples who share sleep with their baby often just take the romance into other rooms of the house. When baby is really little, you can simply move to the other side of the bed after baby is fast asleep.

If sleeping with your baby still makes you slightly nervous, try an arms reach co-sleeper. You might feel more comfortable placing baby directly in bed as they get a little bit older.

Weaning or Nursing Strike?

When talking to moms about their nursing experience, I often hear something along the lines of: “I breastfed my baby until they were 10 months old, when one day they just stopped nursing”. Hearing this story multiple times has led me to do some research on natural weaning age, and nursing strikes, and here is what I have found:

  • Between 9 and 14 months, children are often incredibly focused on developing new skills and can become easily distracted. They may seem less interested in nursing and this is often mistaken by parents as weaning. This should be considered a nursing strike. If you are wanting to continue nursing… simply offer the breast whenever you can, your child will come back around.
  • Natural weaning is a gradual process, any sudden halt in nursing should be considered a nursing strike. Although if you are wanting to wean your child, these “strikes” can be a convenient time to begin (after 12 months of age).
  • In cultures where children are nursed for as long as they desire, most will continue breastfeeding until at least 3 or 4 years of age.
  • A child’s immune system is not completely mature until about 6 years of age…breastfeeding will provide benefits for as long as it is continued.
  • Natural weaning rarely occurs before the age of 2.5 years.

Nursing Strike

nursing strikeI recently posted about how to tell the difference between weaning and a nursing strike; now I would like to talk about what to do if your baby is refusing to breastfeed. If your baby abruptly stops breastfeeding, chances are that you have a nursing strike on your hands(true weaning is usually very gradual). Nursing strikes happen for a variety of reasons and can be extremely frustrating and disheartening. One important thing to remember is that it is not your fault and with time you can get your baby back to breastfeeding. Use some of the following tips to help coax your baby back to the breast:

  • Nurse while sleepy – Try offering to breastfeed your baby when he is calm and sleepy. Reflexes often take over when a baby is sleepy; try nursing your baby when they have just woken up or even while they are still asleep!
  • Nurse in different positions – some babies may nurse in some positions and not others. Try nursing while standing up, in a sling, while dancing, or while laying down. I made it through a nursing strike when my son was 4 months old by only nursing laying down when he was asleep.
  • Skin-to-skin contact – spend as much time skin-to-skin with your baby as possible. Lay in bed without your top and with your baby wearing nothing but a diaper; take baths with your baby.
  • Wear baby in a sling – wear your baby in a sling during the day; this has many benefits and it allows you to quickly recognize when your baby might be ready to nurse.
  • Sleep with your baby- keep your baby close to you at night, preferably skin-to-skin.

Remember to keep your baby fed and to not pressure him to nurse. If your baby is not nursing at all you will need to supplement with expressed breast milk; consider using a cup or an eye dropper as bottles can cause nipple confusion (which could be the original cause of the nursing strike). Contact a La Leche League Leader or a Lactation Consultant if you suspect that there is a physical reason behind the nursing strike.

Thank You to the Surgeon General

The Surgeon Generals Call to Action to Support Breastfeeding document was released last Thursday, January 20th. The Surgeon General begins the call to action with the following statement:

“For nearly all infants, breastfeeding is the best source of infant nutrition and immunologic protection, and it provides remarkable health benefits to mothers as well. Babies who are breastfed are less likely to become overweight and obese. Many mothers in the United States want to breastfeed, and most try. And yet within only three months after giving birth, more than two-thirds of breastfeeding mothers have already begun using formula. By six months postpartum, more than half of mothers have given up on breastfeeding, and mothers who breastfeed one-year olds or toddlers are a rarity in our society.”

The Call to Action asks for all members of the community to support breastfeeding mothers in their own way. The document outlines the importance of breastfeeding and includes information on the health, psychosocial, economic, and environmental benefits of breast milk. The surgeon general explains the barriers that breastfeeding mothers in the United States face, such as lack of knowledge and support, and what can be done about them.

The following objectives are including in the document, along with implementation strategies for achieving each one:

  1. Give mothers the support they need to breastfeed their babies.
  2. Develop programs to educate fathers and grandmothers about breastfeeding.
  3. Strengthen programs that provide mother-to-mother support and peer counseling.
  4. Use community-based organizations to promote and support breastfeeding.
  5. Create a national campaign to promote breastfeeding.
  6. Ensure that the marketing of infant formula is conducted in a way that minimizes its negative impacts on exclusive breastfeeding.
  7. Ensure that maternity care practices throughout the United States are fully supportive of breastfeeding.
  8. Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community.
  9. Provide education and training in breastfeeding for all health professionals who care for women and children.
  10. Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians.
  11. Ensure access to services provided by International Board Certified Lactation Consultants.
  12. Identify and address obstacles to greater availability of safe banked donor milk for fragile infants.
  13. Work toward establishing paid maternity leave for all employed mothers.
  14. Ensure that employers establish and maintain comprehensive, high-quality lactation support programs for their employees.
  15. Expand the use of programs in the workplace that allow lactating mothers to have direct access to their babies.
  16. Ensure that all child care providers accommodate the needs of breastfeeding mothers and infants.
  17. Increase funding of high-quality research on breastfeeding.
  18. Strengthen existing capacity and develop future capacity for conducting research on breastfeeding.
  19. Develop a national monitoring system to improve the tracking of breastfeeding rates as well as the policies and environmental factors that affect breastfeeding.
  20. Improve national leadership on the promotion and support of breastfeeding.

If you are as excited as I am, you might like to read the entire thing for yourself:

http://www.surgeongeneral.gov/topics/breastfeeding/calltoactiontosupportbreastfeeding.pdf

Weaning

weaningWhen and how you decide to wean your breastfeeding child depends on whether you would like to follow a child-led weaning approach or a mother-led weaning approach. It is extremely rare that a child will self wean prior to the age of approximately 2.5 years old. Sometimes it can be difficult to tell the difference between weaning and a nursing strike. Know that real weaning is a gradual process and rarely happens abruptly.

Breastfeeding does not have to be an all or nothing thing. Consider the reasons you are wanting to wean. If you are going back to work, it is definitely possible for you to continue nursing during the times you are home. Breastfeeding is a powerful tool for reconnecting with your child after a long day of separation.

Weaning is a very personal decision. My only recommendation is that if you are going to follow a mother-led weaning approach, please do so gently and gradually. The following tips, meant for weaning children over 12 months of age, may help to make the transition a smooth one for you and your child:

  • Flexibility – Be prepared for weaning to be a gradual process and go into it knowing that you will need to be flexible while your child adapts.
  • Extra affection – Offer your child extra hugs, cuddles, and other forms of physical affection during the day and night. Your breastfeeding provides so much more to a developing child then just breast milk.
  • “Don’t offer – Don’t refuse” – Employ a “don’t offer don’t refuse” approach to weaning when you begin. If your child would like to nurse then by all means let him; but don’t offer when he is happily doing something else.
  • Drop one feeding – Start by dropping only one feeding at a time. Be prepared for nighttime and nap nursing sessions to be the last to go.
  • Avoid nursing spots – Avoid sitting in locations where your child is used to nursing, such as your favorite rocking chair.
  • Keep busy – Keeping your child distracted throughout the day will probably naturally limit nursing sessions.

Feeling Touched Out

There once was a time when I had complete control over my own body. Occasionally I would share this body with my loving husband, or a friend that needed a hug or a hand to hold. Shortly after the sharing, hugging, and holding was over, I was free to stretch out, go for a walk, or enjoy a nice long solitary shower.

The minute a woman becomes pregnant she truly learns what it means to share her body. The experiences shared between a mother and her unborn child are beautiful and life altering. Feeling those first kicks and hiccups are memories that will probably stick with someone forever. I have heard many new moms, in the last few weeks of pregnancy, exclaim that they “are ready to have their body back to themselves.” But hopefully the end of pregnancy marks the beginning of a breastfeeding relationship.

Although the baby is now on the outside, breastfeeding involves countless hours of putting another persons needs before your own. The benefits that come with breastfeeding your child are incredible, but it is completely normal to feel touched out, discouraged, and drained from time to time.

It is important to recognize these feelings so that they do not lead to resentment and a decision to wean that you might later come to regret. When I am feeling touched out, some of the following tips help to recharge my batteries so that I can once again enjoy and appreciate all of the positive aspects of breastfeeding my son:

  • Take breaks – Recognize the importance of taking breaks and make it a priority. Make sure you and your partner each have some time to yourselves each day, even if it is just 20 minutes. Sometimes it helps just knowing that there will be a window at the end of the day for you to soak in the tub or read a chapter of your book. I often find that after a short break I am recharged and can’t wait to cuddle up on the couch and nurse my son.
  • Free your hands – Sometimes just having your hands and arms free is a relief. Find a good arms free carrier such as the Ergo or a Moby Wrap. If you are having an especially hard day. Wear your baby on your back and go for a nice long walk, pretend you are alone!
  • Stretch – Take time to stretch your body out and feel the empty space around you. Stand up and stretch when your baby is on the floor for tummy time, or when your toddler is happily eating in their high chair.
  • Multitask – On days when it feels like all you are doing is breastfeeding, try to fit in other activities when you can. I used to often feel touched out when it took me a long time to nurse my son to sleep; now I bring a book with me and the second his eyes close I turn on a dim light and read. There are times when I stay in the room just to finish a chapter even after he is deeply asleep.

Breastfeeding Milestones

Like most breastfeeding moms, I always had a goal in the back of my mind for the length of time that I would like to nurse my son. This month, with my son at the ripe old age of 18 months, I met my initial goal of breastfeeding him for at least a year and a half! I will continue to breastfeed him until one of us is not enjoying it anymore; with my new goal being at least 2 years.

Among many new mothers, and some individuals who have yet to have children, it is a common belief that breastfeeding continues until the baby turns one year old – when they magically know how to self wean and suddenly become an independent toddler that is content with sippy cups and carrot sticks. It’s not that easy. Although one year is the goal touted by the American Academy of Pediatrics, several developmental milestones are taking place at the age of 12 months(such as learning to walk and talk). This can make it an emotionally difficult time for a child to give up breastfeeding.

Often parents set out with a goal of nursing their child until one year old. As that year approaches, it sometimes becomes obvious how much a 12 month old still needs the multiple benefits(nutritional and emotional) of breastfeeding. The World Health Organization recommends breastfeeding for up to two years of age or beyond

If you have met a breastfeeding milestone that you set for yourself and your child, whatever the milestone, you should be extremely proud!  Although incredibly rewarding and beneficial for all parties involved, breastfeeding is not an easy road to travel – especially in the beginning.

Zoloft And Breastfeeding

Postpartum depression is extremely common following child birth. This debilitating disease can make it nearly impossible for a new mother to tend to her baby. Many mothers opt for medical treatment in order to fulfill their new role as caregivers to their newborn child. However, there are certain risks associated with the use of antidepressants like Zoloft, also known as sertraline, while breastfeeding.

What Are the Risks Associated with taking Zoloft and Breastfeeding?

Any medication consumed by the mother may be passed on to her infant through breast milk. Several studies have shown varying results. In one, no Zoloft was found in the breast milk of mothers who were nursing while taking sertraline. However, two other studies showed detectable traces of Zoloft in breast milk and even traces of sertraline in the plasma of infants breastfed by mothers taking the prescription antidepressant.

The concern, of course, is that sertraline or its metabolite norsertraline, which has an antidepressant effect that is 10% that of Zoloft, may affect the emotional, physical, or mental development of the infant. In fact, a survey of published and unpublished studies indicated that mothers prescribed an average of 83 mg of Zoloft produced breast milk with an average of 45 mcg/L of sertraline. Considering the weight of the baby, these quantities would mean the infant ingested around 0.5% of the sertraline consumed by the mother.

Having established the Zoloft can, in fact, be passed from mother to infant through breastfeeding, it is important to consider the effects on babies receiving breast milk. In an Australian study, two infants showed possible negative side effects after receiving breast milk from mothers taking Zoloft. These included agitation and involuntary muscle twitching while sleeping. While both reactions were found to be benign and later resolved themselves, other studies have shown startling negative effects.

In one study, infants that consumed sertraline via their mothers’ breast milk did not react to pain as readily or quickly as expected for children their age. No control group was used, so it is impossible to rule out the effect of taking Zoloft and breastfeeding as the cause. Moreover, the results of a large study of over 900 mothers taking antidepressants while breastfeeding suggest that 10% of infants may show signs of withdrawal once they are weaned. Symptoms include disordered sleep, eating problems, irritability, and lower than normal body temperature.

What Can Be Done?

For those concerned about the effect taking Zoloft while breastfeeding may have had on their infant, there are a number of steps that can be taken. First and foremost, concerned mothers should consider consulting with a specialist in order to start any treatment that may be necessary. For those who have experienced problems associated with breastfeeding while taking Zoloft, a class action suit is currently underway. This is important for two reasons: 1) Compensation may be available for those affected, and 2) a class action suit also helps get the word out to others so that they can avoid the same problems.