One Year Of Nursing

I've said plenty here about nursing over the last year. I'm not going to rehash all of it - you're welcome - but it seems like I should say something to commemorate one year of nursing.  After the first 3 weeks, I was sure I wouldn't make it to 6. At 6 weeks, I didn't see how 3 months would be possible.  Finally, at 10 weeks, we found our groove - the Fidg and me - only to face new challenges around 14 weeks when I returned to work and quickly learned that pumping wasn't going to come easily for me. 

The pumping problems created unanticipated challenges.  Like a reverse-cycled baby.  And a co-sleeping family.  And a grandmother deeply concerned about the co-sleeping family.  I don't think I'd be reading "The No-Cry Sleep Solution" now if my breasts had made better friends with the pump and my child had adequate daytime food for months 3 through 8.

Prior to co-sleeping, of course, I thought I had a sleep problem on my hand. I chose to look at it as a condition, however, and my stress level decreased significantly and my sleep increased by equal measures. A win for all involved - except for the frequent attempts by some to solve the problem that was no longer a problem. Oh well, if that's the worst problem, we're okay.

Select some of the tags associated with this post to see previous posts about nursing challenges.  I still believe breast feeding classes set women up for failure by not being more open with the pain of initial nursing.  By not being more honest about the time commitment and toll.  And while I appreciate Sutter's lactation consultants and would recommend them without reservation to anyone, I think the LC field needs to spend more time on pump problems.  I have 1001 ways to increase milk supply, but supply was never my problem. Solutions for pump problems seemingly don't really exist and I have to figure there are droves of frustrated working moms like me who suffer the stress of low yields or just give up on EBF and supplement with formula.

Here's the question that I've been really mulling, however: would I do it again?

D-MER?

This is fascinating. A mother noticed that every time she fed her baby, she felt sad, nearing on a panic attack, even.  Cut to some research and LC involvement and they've given the condition a name - D-MER, short for “Dysphoric Milk Ejection Reflex." 

I don't get sad or anxious when I breast feed (at least not now, those first 10 weeks, however . . .) but I DEFINITELY get agitated and angsty when I use the breast pump - and not just because of my pump frustrations, I don't think. It's always been a visceral reaction, sometimes more pronounced than others. I even remarked to Rob about it a time or two.

The theory - it's hormones:

Simply put: D-MER is physiological, not psychological. It is hormones, not past experience or repressed memories, that cause it.
We’re quite sure now that D-MER is linked to a drop in dopamine that seems to occur whenever milk is released. In a mother with D-MER at the time of letdown dopamine falls inappropriately, causing negative feelings. All of the suggestions made for treating D-MER are based on our belief that transiently inadequate dopamine is responsible. Milk release itself isn’t caused by dopamine dropping; it’s caused by oxytocin rising. In D-MER, the MER (milk ejection reflex) is a result of rising oxytocin (needed to move the milk out of the breast) but the D (dysphoria) is a result of inappropriately falling dopamine. Dopamine gets involved because it inhibits prolactin (which is what makes the milk,) so dopamine levels need to drop for prolactin levels to rise in order to make more milk. Normally, dopamine drops properly and breastfeeding mothers never knew it even happened, in D-MER mothers however, it doesn’t drop properly and causes a negative emotional reaction.

Wait, you're telling me someone investigated a possible medical condition at work instead of just advising a lady that her silly lady mind stress is to blame? Crazy!

I hope this leads to more research into let-down problems. 

Language, Biology, and Boobs

This is an interesting piece on the language of breastfeeding and, somewhat counterintuitively, how the phrase "Breast is Best" might reinforce artificial feeding instead of that best breast product.

The thrust of the article is this: we all would love to be the best, most perfect, ideal parent and give our children the best, most perfect, ideal things. But that's probably not going to happen. So good enough is, well, good enough. And formula is good enough.  If we instead phrased the options as breastmilk = normal, formula = substandard, then the discussion takes on a very different tone and mothers get a substantially different message.

(Note - does this post conflict with post immediately prior? Maybe.  But regular readers of my other blog will know that I love little as much as I love a good linguistics discussion.)

One point that I liked - where's all the milk banks at?  There are some, but you need a prescription to get the goods.

There is a need for standard formula in some situations. Only because we do not have human milk banks. The person who needs additional blood does not turn to a fourth-rate substitute; there are blood banks that provide human blood for human beings. He does not need to have a special illness to qualify. All he needs is a personal shortage of blood. Yet only those infants who cannot tolerate fourth best are privileged enough to receive third best. I wonder what will happen when a relatively inexpensive commercial blood is designed that carries a substantially higher health risk than donor blood. Who will be considered unimportant enough to receive it? When we find ourselves using artificial milk with a client, let's remind her and her health care providers that banked human milk ought to be available. Milk banks are more likely to become part of our culture if they first become part of our language. . . .

.... All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances. A vital first step toward achieving those goals is within immediate reach of every one of us. All we have to do is...watch our language.

Things that should go without saying usually should be said

I found a website today about proudly formula feeding mothers. And why wouldn't there be a blog for that - there's so many damn militant lactivists sites.

It's hard to talk about infant feeding without becoming defensive - arguing that formula isn't so bad or that your promotion of breast feeding isn't meant to put anyone down.

Sooooo much wasted energy. 

Formula isn't bad. Mothers who feed their infants formula aren't bad.  It isn't poison.  Telling mothers it is poison is mean, wrong, and stupid.

All mothers, regardless of whether their kid is clamped to a boob or a bottle, should turn their energy toward the culture and PUBLIC POLICY* that guilts them for formula feeding but does nothing to build the community, public interest, or public policy support to enable sustained nursing relationships between moms and babies.  We're not enemies, that's our enemy.

The same site, above, posits that maybe in trying to promote breastfeeding and hide the potential problems from poor, easily dissuaded mothers, we're ignoring actual medical problems that could be remedied with accurate, timely diagnoses or additional research. Here's a long quotation pulled from an even longer post:

What if our initial failure to nurse altered my second stage of lactogenesis, so that my casein/lactose was out of whack? (This might explain why certain kids with MSPI can tolerate breastmilk, while others cannot, despite their moms cutting all potentially offensive foods out of their diets.) I can't help but wonder if we are not just "missing the diagnosis", but missing the mark altogether. Breastfeeding might be natural, but our lives are not. We have children later, are exposed to all sorts of chemicals and toxins, and spend years filling our bodies with synthetic hormones and altering our menstrual cycles. Many of us were only able to conceive with help from medical science. Is it really that impossible to believe that these factors might be increasing lactation problems, or creating new ones altogether?

The Complete Birth Story Series

It's all up there now.  For something so seared into my memory, I'm kind of amazed at how a lot of the time runs together.  Guess you shouldn't wait 6 months to write up these sorts of things.

The Birth Story

Part I: My Daughter's Birth Story (Why Intervention Is Fine With Me)

Part II: Checking-in, Dosing-up, Waiting.

Part III: sh*t gets serious.

Part IV: People Normally Push For How Long?

Part V: "We're Crashing 61."

Part VI: You know where you can put your full experience?

My Daughter's Birth Story Part VI: You know where you can put your full experience?

You may recall that part I of this series was parenthetically titled "why intervention is fine with me." What does that mean? That I don't subscribe to the idea that introducing medicine or medical intervention into the birthing process results in a less authentic experience.

This is one of the many mommy-war battlefields out there - and one of the many that's largely trumped up by media and the echo chamber of blogs and media generally. It's a war of natural childbirth vs. whatever the opposite is: unnatural? Medicated? Industrialized. Evil. whatever.

Of course, it's a perceived war that may not bear out in real life between actual moms, save a few. Like nursing in public, where the anecdotes of public shaming have yet to prove out in my experience, there may not be as much judgmental opposition to medicine in births as you might think.

But there are some loud voices that make women feel bad and less whole for certain decisions in the birthing process and even if they are presented in a "can you believe this" fashion, the message is insidious and sneaks into a worried mom's thoughts. And, as I think I mentioned before, this is the firstyist of first world problems - where and how to deliver a baby. Everyone should be so lucky as to have options.

But here's an example of "can you believe this" that helps make my point.

My Daughter's Birth Story Part V: "We're Crashing 61"

After seeing something she didn't like and putting an end to the pushing, the doc crashed the room.

Sounds dramatic right? "Crashing" a room.

Guess what - it totally was.

My Daughter's Birth Story Part IV: People Normally Push For How Long?

I started pushing at 12:47pm.

I asked how long the pushing part lasts.  They wouldn't let me go longer than three hours, I was told.  I set my sight on the wall clock and thought, okay then.

Pushing must not be that easy because it can take some time to push correctly.  Otherwise it's just wasted time and  pain.

What? Did I say pain? But what about the epidural?  Oh, I still had that in place and was still medicated but you can't NOT feel what's going on. I'll address this again later when I attempt to debunk this notion that women with epidurals don't EXPERIENCE their births. Fuck you, I experienced plenty.  But more on that.

For awhile it was just the L&D nurse and my husband, each with one of my legs and pulling.  R counted, I pushed, the nurse tried to coach my best pushing.

And on it went.

My Daughter's Birth Story Part III: sh*t gets serious.

By about 11pm on Sunday night - 30 hours into my hospital stay and about 25 since I started having contractions - it stopped being fun.

Okay, it wasn't fun before, but it really stopped being fun around then.

There was much gripping of the bed rail - which was far too shaky - and breathing through was cutting it anymore. I wanted some relief but was waiting for the magic 4cm mark. I was effaced, but still no-cm wide. I hoped the uptick in pain meant things were moving but a check from a phenomenally awesome nurse confirmed: no dice.

The on-call doctor recommended another round of whatever pain meds I'd had the night before. Those gave me about an hour of strange, confusing dozing.

Between the checking and the meds, it was now approaching 1am and I was done. D.O.N.E. I don't think I was crying because I couldn't get past the pain to do so. I was still 0cm but I didn't care anymore. And Awesome Nurse said "as soon as you get that epidural, I'll get you to 2."

Enter anesthesiologist. There was a last, difficult walk to the restroom and back to bed. Then I had to - haha - hunch over a pillow and hold still - hold still?- DURING contractions while they administered the epidural.

It didn't hurt. Maybe it did, but contractions hurt wayyyy the fuck more, y'all.

I asked how long it would take to feel any relief and was told 10-15 min max. Okay, I can do that. They cleared the room, the lights went down and R went back to his sleeper chair.

Twenty minutes later I was wimpering and scared to hell that I was the one person an epidrual wouldn't work on because nothing was any less contracty.

My Daughter's Birth Story Part II: Checking-in, Dosing-up, Waiting

On Saturday morning, we tried to sleep in a bit. The biggest debate as we fought off wakefulness was where to have brunch. This town may not have a lot of stuff, but what we do have is great breakfast choices. Ultimately, we went for a pub breakfast - I ordered wrong and was disappointed. Oh well. It was hard to act normally when - hello - I was causally going to check into the hospital that evening.

I can't remember all that we did that day, aside from the breakfast, but I know a lot of it was boring housework and cat litter stuff. My sister came over.

And then it was close to 5pm and we were late getting out of the house. Naturally.

As my husband loaded the car and my sister left, I took a moment to stand in the hallway, alone, and think - this is the end of this time. This is the last time we leave this house as a couple on our own. When we come back, we'll have a baby with us. Thoughts of "last" hung heavy in my mind. And then it was time to go.

My Daughter's Birth Story (Why Intervention Is Fine With Me)

Along with BOB strollers, Sophie Giraffes, and Moby Wraps, birth guilt and uncertainty is a hallmark of modern yuppy parenting.

And before we proceed, let's call the debate over at-home vs hospital births the firstest of First World Problems. Can we agree on that? That millions of women don't have the option for medical intervention even when necessary, so the luxury of selecting a birth experience (I'd scare quote that last word if doing so weren't against Strunk & White) should be identified as such?

You can't get through pregnancy these days without contemplating natural vs. well, whatever the opposite of natural childbirth would be - medically intervened birth? Epidural-assisted birth? No drugs vs. drugs, how about that. Second to that is contemplation of a home birth - a way to really (close your eyes and say the word with me) experience your child's birth.

For many reasons, the notion of natural - that is to say - non-medicated childbirth didn't sit well with me. In fact, it sat on top of me like a stone, pressing from my psyche nearly any joy or excitement over my baby's impendind debut. Then I took an anesthesia class at the hospital where I'd be delivering and OH BOY suddenly I felt confident enough to proceed after all.

After fantasizing about how to tell my husband I was pregnant, the next most fantasized about moment was the "honey, it's time," and frantic dash to the hospital. Alas, for me, that moment never came and probably never will on the improbable chance we have more children.