Not That You Asked: Breastfeeding (2)

Er... I had some things to say. I think. The brain, it is mush.

But first, a poll! Dear readers, tell me if I should kill the blog. It seems to be ailing.

*gone now*

More on breastfeeding: time for more unsolicited advice!!

**OH, I remembered what I wanted to say:
-Breastfeeding is boring. Netflix and a laptop and some headphones are your friend.
-Little babies usually can't nurse laying down. This is very frustrating if nobody told you.***

After a couple months, your baby will (probably) stop waking up every hour or whatever, demanding boob. Really. It gets better.

A nice breastpump is worth it. I got a Medela Pump In Style at a garage sale for, oh, $15 or something. Warning: Medela does not recommend reusing breast pumps. Ever. (Of course, then I left it in a closet for 6 months, boiled the living daylights out of all the bottles and stuff, and got new tubing. I, personally, am not worried about organism contamination, but it's a personal choice.)

If you get thrush, you really, really need to boil all the pump parts that touch the boob. Every time. Access to a microwave makes this a lot easier: wash out, run hot water over, stick in the microwave for 5 minutes on high. Voila! Or, if you have a coffee maker at work with a hot water tap, even better.

It is also worth it to raise hell at work until they provide a suitable pumping space. Preferably one you don't have to tote the pump in and out of because OH THE HASSLE. (I am lucky enough to have a private office.)

Nipple shields do help with the pain and agony of shredded nipples. They also decrease how much milk your baby gets, and, fairly soonish, decrease your supply as a result. My LCs recommended using them as little as possible, because if you use them too much, it'll just make all your problems that much worse.

La Leche League can be your friend. The leaders around here, at least, have a hotline you can call day or night. They don't know everything, but they're nice, and helpful, and free. (With the exception of the group that JP was unfortunate enough to encounter.) A group that meets at an after-work time is more likely to be working-mom-friendly.

Dr. Jack Newman's website is also extremely helpful. With diagrams! And everything! Likewise, his book (called something with "Breastfeeding Answers" in the title) has a reasoned perspective on breastfeeding, especially where medications are concerned. (My favorite quote goes something like, 'If you must use cocaine while breastfeeding, wait at least four hours.' Not that he's advocating cocaine use, mind you, quite the contrary.)

Motherrisk also has excellent, well-researched information on what is and is not safe while breastfeeding (or pregnant!) which, if necessary, you can use to enlighten your medical providers.

Much like any other kind of provider, lactation consultants vary in ability, experience, and knowledge. Seriously, I saw four. (I think the first one was a little miffed but... oh, too bad. My pain vs. her hurt feelings, pain wins.) If you really want to breastfeed, you may have to be your own best advocate; as I and some of our fine commenters have mentioned, most GPs are not very knowledgeable about breastfeeding.

The Pumpkin also ended up seeing someone who's basically an occupational therapist for babies, and it made a huge difference. Also a $200-sized dent in my pocketbook, but whatever. LCs and LLL people may know of someone in your area who could help.

A lot of people find it easier to co-sleep while breastfeeding and will tell you how wonderful it is. And it can be. My baby thrashes in his sleep and now? He has his own room. Co-sleeping is not for everyone.

And finally, however your baby latches on and eats, as long as 1) it doesn't hurt 2) doesn't drive you nuts and 3) gets the baby enough to eat... is FINE. Don't let anyone tell you differently.

Additions from my fine readers?

Not That You Asked: Breastfeeding (1)

Or: You Can (Probably) Do It If You Really Want
First in a series of 15-minutes-at-a-time-after-baby-bedtime posts on nursing!

Breastfeeding! That favorite contentious topic.

First, let me say, less than 20% of women are still breastfeeding at all at 6 months. Most people give over after a few months; only 14% of mothers still breastfeed exclusively at 6 months. And I can totally understand why.

I go to a LLL meeting. I have lots of friends who breastfeed. My sisters and I nursed until we could read. And yet. I have had three months of nothing but pain and agony, followed by about a month of moderate misery. Fortunately, Pumpkin seems to be managing fine.

Figure 1: My Pumpkin is a chub-ball.

I think everyone can probably breastfeed- and I'm including, pump a little if that's all you have, and use a bottle. I also think it's frequently painful, difficult, and unpleasant. (I have now seen four lactation consultants and two specialists.)

Here's what I wish I'd known beforehand:

• Yes, it will hurt at first, for at least a week probably. But if after a week, you're still thinking of having a stiff drink before every nursing session, gritting your teeth and barely bearing it, and wincing and pulling away, that ain't right.

• Someone told me, if it hurts, see someone. They didn't really specify, though. Well, here you go: fissures and divots larger than 1 mm are not normal, and your nipples should most definitely not be an angry red color. Nor should they hurt after the baby nurses, especially not like a rubber band is being snapped inside your breast.
  

• Not every good latch looks alike. That diagram of an 'ideal latch' may not apply to you and your baby. Particularly if you have shallow or flat or inverted nipples. Or especially if your baby has a tongue-tie, a high palate, or an especially receded chin.
  

• If your baby's lower lip is not flared out, no matter how good the latch looks otherwise or how well he or she sucks or anything else, chances are that something is wrong. And that it will, eventually, HURT.

• If your baby is making a clicking noise, or falling off the boob several times every time he or she nurses, or sliding down the nipple and losing the latch, something is wrong, even if it doesn't hurt. Fix it earlier rather than later, and save yourself a lot of pain. Because they get stronger, and suck harder, and then it really hurts.
  

• If you really want to breastfeed and you're having problems, it's worth it to keep seeing people until it gets better. Only think of the savings in formula.
  

• Persistent pain can be related to a staph infection. Antibiotics will cause thrush, though. But it may take you several rounds of fun drugs! Hurrah! (Fluconazole and penicillins- dicloxacillin is usually given- are both, generally, safe for nursing.)

• Unpleasant itchy burny feeling? Feels like you've been sandpapered? THRUSH.

• Chances are that your GP knows almost nothing about breastfeeding. More's the pity.
  

Please feel free to add your advice in the comments! The more the merrier.

Next time: Gee, Thanks For The Depressing Advice; What Now???

Not That You Asked: Birth

Or: In Which I Feel A Need To Express Myself

I'm sure many of my fine crop of 2 readers (just kidding! I know there's at least 5 of you!) have children. And I'm sure the rest of you have no need for my unsolicited opinions on giving birth. But, you know, my blog, my subject matter. (Potentially related side note: I have a friend on Medicaid, who has a potentially-dangerous-or-fatal complication, and her OB care is making me tear my hair and scream.)

Did you know that doctors often don't believe in evidence-based medicine? And even those who do tend to suck at it? (My favorite quote from the book that's linked: "The vast majority of surgeons believe the mortality rate for their patients to be lower than the average.")

(Another side note: Did you know that the Needed-Number-to-Treat for cholesterol-lowering drugs is somewhere between 100 and 300?)

Anyhow. About birth. What I think applies ONLY to low-risk, healthy pregnancies. I'm not talking about multiples, histories of bad outcomes, pre-eclampsia, gestational diabetes, or unmarried single mothers who use drugs. I'm talking about your average normal delivery.

-Remember that OBs are surgeons. To the person with a hammer, the whole world does look like a nail. OBs are trained primarily in intervention. Most low-risk births do not require interventions. Every unnecessary intervention is a risk.

-The average length of a first labor, according to my midwives, is 26 hours. Let me repeat: 26 hours of contractions. If it's been shorter than 26 hours, you're still doing great. If it's been longer, well, you and half of everyone else, dear. (Other places say maybe 15 hours or 19. Whatever. It takes a while. Don't be surprised.)

-Related: My midwives advised, upon having regular contractions, to go home, eat something light but sustaining (oatmeal, yogurt, fruit), have a glass of wine and a nice bath, and take a nap.

-The US government does not recommend continuous electronic fetal monitoring; intermittent works just as well. Continuous has a high false-positive rate and it causes unnecessary interventions; amnioinfusion can help prevent the need for C-sections. Also continuous EFM does not prevent cerebral palsy.

-Having the doctor break your waters probably doesn't shorten labor. And it's not recommended. It increases the risk of cord prolapse (very, VERY dangerous!) and, oh yes, doesn't help anything.

-You know what does shorten labor? Walking around. Laying on your back, unless of course you have a burning desire to do so, is not so great. Also, if your baby is posterior, bending over or going on hands-and-knees actually helps. (Personal note: spent three hours bent over at 90-degree angle in the shower with posterior baby; he turned. Plus, that was the only way it wasn't agonizing.)

-It's frequently hospital policy to strap every woman to an EFM and an IV. And then you can't walk around. Do you really need an IV? Chances are, no. (Unless you have GBS, and even then you don't need a continuous IV.) If you really need an epidural, they can push a bag. If, God forbid, you're having an emergency, an IV will be the least of your worries.

-It's also frequently hospital policy that women in labor shouldn't eat. In case they need to be intubated. There are a lot of studies showing that it doesn't increase risks. Anecdotally, women who don't eat get exhausted. I personally recommend fruit or yogurt.

-Episiotomy and associated interventions? Probably not a good idea.

-The antibiotic eye goo right after birth only prevents chlamydia, and can interfere with breastfeeding: how can baby find boob if baby can't see? It's great public health policy, but maybe not so good personal policy. If you don't have chlamydia (most jurisdictions require prenatal testing, or a signed waiver) and your partner doesn't have chlamydia, and neither of you has done anything to get it since you were last tested...

-The HepB vaccine, likewise, is given at birth as a matter of public health policy. However, it can also be given at 1-2 months. If you don't have HepB... well, see above.

-You should breastfeed within 1 hour of giving birth, unless there's an emergency. Someone who knows what they're doing should check latch and positioning.

Modern medicine is wonderful. It saves lives. The trick is to have a medical practitioner who knows when you need interventions, not one who thinks you look just like a nail.


Next Soapbox: Breastfeeding!