Tandem Nursing

August 10, 2016

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Tandem Nursing means nursing two babies at once. This can be twins or it can be siblings born at different times i.e. an toddler and an newborn.

Many people believe that you cannot get pregnant while nursing or that if you are nursing when you are pregnant you need to wean.

You can get pregnant while nursing.

Breastfeeding can be birth control under specific conditions. There is the Lactational Amenorrhea Method (LAM).

LAM works like this:

  • No return of menses since birth
  • breastfeeding on demand, night, and day
  • baby does not take any food or other liquids regularly
  • baby’s sucking needs met primarily at the breast (no pacifier or bottles) baby is less than 6 months old.
  • baby does not go longer than four hours during the day and longer than six hours during the night between nursing

 

With LAM there is about a 1-2% chance of getting pregnant – similar to taking birth control pills.

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Many people get pregnant while nursing. Often moms are advised to wean their older baby if they become pregnant. There is no need to wean unless you are at risk for premature labor and you are advised by your health care provider to refrain from intercourse.

What can you expect while nursing while pregnant?

About halfway through pregnancy your milk changes from mature milk to colostrum. Colostrum is thicker and does not flow as easily as mature milk. Some toddlers get frustrated and wean. Others hold on for dear life!

One telltale sign of pregnancy can be sore nipples. Some moms find nursing painful or they become averse to nursing and they choose to wean their older baby.

Others will put limitations on nursing – one mom used counting as her strategy – “you can nurse for ten seconds – 10, 9, 8 . . .“ Another mom had a nursing chair where they could only nurse sitting in the chair in a quiet room.

Some advantages of tandem nursing can be:

  • nursing toddler can help relieve engorgement
  • older baby not feeling left out
  • mom doesn’t feel she is abandoning the older child
  • she still has her magic toddler wand
  • sibling bonding
  • stronger immune system of the toddler

 

Disadvantages:

  • mom may feel touched out
  • judgement from family, friends and health care team

 

When nursing twins it can be a good idea to alternate breasts for the twins. This can be every feeding or everyday – Twin A gets the left breast while Twin B gets the right breast for one feeding and then alternate the next feeding or on Monday Twin A gets left breast and Twin B gets right breast and on Tuesday Twin A gets right breast and Twin B gets left breast and so on. Many moms of twins will choose to nurse one at a time once they get older to have one on one time. In the early days it can be a time saver to nurse both at once.

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How does one manage tandem nursing babies of different ages?

Elizabeth Tandem nursing Read the rest of this entry »

“It is better to look good than to feel good.”

Many mothers tell me that their breasts are painful and they want to know why.

“It could be the latch,” I offer.

“No, it is not the latch, the nurse/doctor/lactation consultant/my mother . . . (fill in the blank) said the latch looks great.”

The problem is that the mouth and tongue are complex and the movements are complex and can be effected by various outside factors.

Do you remember Billy Crystal as Fernando? His mantra was:

“Dahling, you look mahvelous! It is better to look good than to feel good and, Dahling, you look mahvelous!

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I believe that many health care professionals were trained to assess latch at Fernando’s Hideaway.

The latch is NOT marvelous if the mom is in pain. It is NOT marvelous if her nipples hurt, if the baby is not gaining weight, if the baby cannot maintain the latch for a feeding.

What can cause this poor latch?

There are a number of things that can make the latch un-marvelous. They can include:

  • poor positioning
  • birth trauma
  • tongue-tie
  • weak suck

What are the consequences of poor latch?

  • breast infection
  • low milk supply
  • early weaning
  • gassiness in baby
  • fussy baby
  • poor weight gain for baby
  • engorgement

What can be done?

Understanding what makes a good latch. When there is a good latch both mom and baby comfortable and the baby moving milk appropriately.

Different remedies can help different challenges.

Positioning the baby close to mom is essential – the closer the baby the deeper the latch

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If the baby is tongue-tied, this is where the frenulum that attaches the tongue to the floor of the mouth is too restricted, this small piece of skin can be released by surgical scissors or by laser.

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This procedure is quick and can prevent a host of problems both immediately and down the road including poor weight gain, the need for orthodontia, digestive issues, premature weaning to name a few. Often when the tongue-tie is present there is also a thickened frenulum under the upper lip. This, too, should be evaluated.

If there is birth trauma healing can happen by bodywork by a practitioner skilled at working with babies.

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This can include a chiropractor, a craniosacral therapist, an osteopath or a physical therapist. These folks are trained to help relieve muscle tension and to release the fascia. With birth trauma there can be misalignment in the babies oral structures. Sometimes the roof of the mouth is highly arched which can make the latch very uncomfortable as the breast tissue can be pressed into this area by the baby’s tongue. If this is the case often the baby feels tension and this makes his sucking more “chompy.”

Releasing the tension can help alleviate this pain and help to reorganize the baby.

If the baby has a weak suck there can also be therapies to help as well as suck training.

If there is a breast infection the mom can continue to nurse but she must be treated.

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No matter what it is important to get the baby fed. It is also important to protect the milk supply.

When there is engorgement the mom can hand express, pump and/or nurse the baby.

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When needing help with breastfeeding please do not accept that if it looks good then it is good. It should feel good and it should function appropriately.

If someone says “It looks good,” this is time to seek help by someone trained to assess the latch, inside and out.

In most cases that someone is an IBCLC – International Board Certified Lactation Consultant.

Change and Magic

June 26, 2014

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Yesterday was my birthday. Today was the last day of school for NYC Public School children. This weekend all three of my children will begin their summer at camp in the Berkshires and Rob and I will be alone for four weeks.

My oldest child has one year of college under her belt. My second child will be researching high schools in the fall. My youngest will begin fourth grade.

This summer many friends are leaving New York. They are going to Portugal, Massachusetts, Portland (both East and West) Israel, and Phoenix. The list goes on.

Change is hard. I have trouble with change. I have a hard time packing. I am challenged to move things around like furniture and art on my walls. I am a creature of habit.

But I also have change envy. I am envious of all those friends starting out on new adventures. I feel a little left behind.

Working with breastfeeding moms and babies I get to relive those early challenges of motherhood, the dramatic changes in the body and the heart. As someone who advises about weaning I get to relive the emotions of that milestone.

I was talking to Finn on the way to school this morning and he told me he wishes he could perform magic. The first thing I imagined I would do if I was magic would be to bring back my mother. This year in October it will be ten years since she died.

If I was magic . . .

Oh, the possibilities.

For now, I will remain in New York. I will continue to mother my children through all of the changes they experience. I will nurture my relationship with Rob. And I shall seek change that is positive. I will embrace each day, each challenge, each wrinkle and gray hair.

You see, this is about getting older. Yesterday was my 49th birthday and I am thinking deeply about 50. It is such a milestone. When I was a kid I used to imagine a grownup being 35 years old. I am past that quite a bit. I have to consider what this means.

I walk down the street and I look at other women. I try to figure out how old they are. I try to analyze their state of mind. I try to figure out if they are happy and healthy.

I will take in this final year of my forties. I am happy and I am healthy. And I know deep down I do possess some magic!

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I have seen the documentary Breastmilk twice.

The first time around I was happy to see the diversity of the subjects, the inclusion of gay families and the normalization of milk sharing.

 

I came away knowing that Dana Ben-Ari is a true documentarian in that the viewer is brought into the scenes unobtrusively. We observed real life situations and outcomes.

The second time around I was sitting next to woman who nursed her child a decade earlier. She squirmed in her seat and whispered to me, “If I had seen this before having my son I would’ve been afraid because it seems so hard to nurse.”

 

Certain elements were left out that I believe only a seasoned eye would catch. Missing from the film: physicians trained to support breastfeeding, pre-natal education, support for the mom and baby and extended work leave. Were with these elements missing from the film because they are missing in real life?

 

There were a handful of subjects followed from pregnancy through the first birthday of the baby. In the end only one of those babies was nursing.

 

The moms who experienced premature weaning talked extensively about how was “really okay”, that “the doctors were right”, they “had their baby’s health in their best interest” and “thanked goodness that their baby was healthy.” What I saw behind those words was grief, defeat and lots of justification for their unplanned weaning.

 

The producers, Ricki Lake and Abby Epstein, say the outcomes of the subjects of their film align statistically in the United States with breastfeeding rates.

I believe documentaries are made not only to show real life but to affect a change or to educate or to inform.

 

There were experts talking about the cultural anthropological aspects of breast-feeding in the Western world but there was no real information on how to make breast-feeding easier or even pointing out what got in the way. We did see a bit on how our culture gets in the way: the boyfriend who not wanting to be patient as his baby nursed, the nurse not wanting to be patient as the parents wanted to baby to self attach, the moms who had to go to work and could not keep up making milk. Once again women, these new mothers, are at the mercy of the system, a system that does not support women or children.

 

In my documentary I would show women all of the world breastfeeding. I would show statistics on breastfeeding rates in different countries. I would show how birth practices impact breastfeeding, how working outside of the home impacts breastfeeding, how education and lack of education affect breastfeeding.

 

But I am not a filmmaker. I am a lactation consultant, a La Leche League Leader, a mom, a friend. I am working in the field daily to support mothers and babies one by one.

 

The longer I work in this field the more obstacles I see. What do you think? How do you see breastfeeding? Do you see it as easy? Do you see it as a privilege? Do you see it as impossible? How does a baby see breastfeeding? What if we asked babies? Would that change our outcomes? Would that change our culture?

 

 

The Myth of the Perfect Mom

December 30, 2013

We moms sure are sold a load of crap! All the images of mothers are glorified and sterilized and glamorized.Image

I am not talking about Giselle. We know she is glamorous and we also know she has a team that makes her look that way.

What about the rest of us, those of us in the trenches of motherhood? Why do we think we have to achieve some unattainable goal as high priestess of motherhood?

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Once in a while I may get what many would call a compliment – and frankly, I let my ego suck it all in for a while and I may hear, “Oh, Leigh Anne, you are an amazing mom!” or “You are a perfect mom!” If this comes from one of my children I will take it and toll around in it for days, even years because I know that it will be followed by some balancing statement like “I hate you, you are the worst mother ever!” And that will be followed by a hug or a request for mommy time. It is all in the job description.

Please, please, please do not throw that horrible label of PERFECT on me. I am imperfect and I embrace that.

But look at advertising for new parents and you see styled and glamorized images.

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What do we really look like after a new baby.

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This is me after my first baby was about two days old – see the look of bewilderment in my eyes? 

Most new moms are in a bit of shock. I hear repeatedly “No one ever told me . . . .”

We hide babies, we hide our breasts, we keep quiet about the dark side of parenting.

I wonder if the dark side would be so dark if people talked about it.

Did you know that breastfeeding in the beginning is very time consuming?

Did you know that newborn babies are not typically chubby?

Did you know that you can bleed from your vagina for days and weeks?

Did you know that sometimes you will pass a clump of blood?

Did you know that you may feel angry that you have a baby – not all of the time but some of the time?

Did you know that you would be riding an emotional rollercoaster?

Did you know that sometimes you will plan to take a shower in the morning and the next thing you know it is 7:30pm and you still have spit up and baby shit on you and you have only eaten stale leftover cake that wasn’t even home baked in a flavor you don’t even like?

Did you know that in all of that mess you will look into the eyes of your baby and feel a deep, confusing kind of love? A new protective kind of love?

Did you know that your baby doesn’t give a damn about your hair?

Did you know that your baby just wants to get to know you? He knows you from growing inside you but now that the courtship is settling in he wants to really get to know you. And he wants you to know him. Did you know that some moms fall in love immediately while others take time.

I think we all want to put on a good face when we go out with our babies. We feel a sense of accomplishment from just having gotten dressed and out of the house. Maybe we feel like we are failing so we have to put on a show and say all the right things. The problem is that other new moms believe what you say. Then other new moms compare themselves to you. Or maybe you are comparing yourself to the woman who says “childbirth was a breeze, my baby latched right on and has grown beautifully, she sleeps through the night and her poop doesn’t smell, also, my husband is a saint, he cooks every night and bought me this gold chain with my baby’s birthstone and a tiny haiku he wrote inscribed. He waits patiently for me to want to get intimate and my belly just seemed to pop right back into place.”

I play a game with myself. When I am feeling the stress of parenting and I really do not want to yell at my kids again or I do not want to scream at them in public, I pretend I am the subject of a documentary on parenting. I want to be prime example of keeping my cool. I stop and think: “what would be a productive action to take here.” I often fail at this game but sometimes I succeed. When I succeed I am setting an example for my children and possibly for other parents. But, I am not perfect, dammit!

One of the best gifts my mother gave me was the gift of imperfection. She let me see her flaws. I was not blinded by a sense of glamour and always being right. This was great because it made her accessible and it took the pressure off of me to not be a perfect mom. Don’t get me wrong – I do have my moments of genius. Mostly I am ordinary but to my children I am MOM.

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PPD – Libby

March 22, 2013

When Libby called and said she needed help weaning her 11-day-old baby I knew it was the right thing to do.

When I met Libby to work with her when her baby was 4 days old I saw she was an especially shaken new mom. When she told me she had a history of depression I knew I had to tread carefully.  She was so unsure of how she wanted to approach feeding her baby and I understood. Typically I make up a plan for a mom with directions to make enough milk and to get breastfeeding going well.  But with Libby, there were obstacles – the baby had been jaundiced, he had a tongue-tie, which tethers the tongue to the floor of the baby’s mouth and can cause a great deal of pain at every feeding.

While I was with her, Libby had a wild look in her eyes. She paraded around her apartment with only white cotton panties and her thick hair falling over her shoulders. Pacing back and forth like a caged animal, her eyes looking everywhere but in the room. Wanting nothing more than to be able to comfortably nurse her baby and feel at ease, everything caused her pain: the baby, the pump, hand-expressing. I think her own skin was causing her pain at this moment.

I gave Libby three plans: one to build a complete supply and get breastfeeding going normally, the second to mix feedings at the breast with bottles of formula and I gave her a plan to reduce her milk supply and wean completely. I asked if she was under the care of a psychiatrist. Yes, she assured me. I stayed with her longer than usual because I was afraid for her. I left after her husband came home.

When that call came seven days later I was at once relieved and saddened. The medication that had worked for her was truly incompatible with breastfeeding. I called the Infant Risk Center to clarify. The lovely woman on the phone in Texas felt the weight of my sadness and listened to me as we both mourned the loss of breastfeeding for Libby and her baby boy.

When I spoke with Libby a couple of days later she was calm and expressed her sadness at the loss of breastfeeding. As I hung up I thought of Kelly. At her funeral Joel told me that he saw how connected she and Katie had been whenever they nursed.  Those moments with Katie where when she was the happiest and most focused in the last five months of her life.

The part of me that ached for Libby found peace in knowing she was going to be well and that her baby was going to have his mom. And her would have her longer than five months.

PPD – Kelly

March 19, 2013

I have been exploring Postpartum Depression for a long time. I believe my mother had it when I was a baby. I believe I had it after my first and third babies were born.

So, I am sharing a few stories. They may come in quick succession or they may come over a few weeks or months.This first one is likely the most dramatic. I have been sitting on this story for some time. I decided it was time to share. In some of the stories I have changed some identifying details but the stories are real.

Kelly

I met Kelly in the late 1990’s at the Murray Hill Players on East 36th Street in Manhattan. Tuesday evenings, actors gathered to read new plays while the playwrights listened to their words spoken out loud. Kelly was a bit younger than I. She lived with her boyfriend. I was married with a toddler.  We both lived near the theatre so we would walk home together and we would talk.

I am a nurturer. I was a second mom to my little sister. I started babysitting in the neighborhood when I was eleven years old. When I went off to college I started really ogling pregnant women enviously.  I earned the reputation as Earth Mother in my twenties.  I cared better for some of my cousins than their own mothers did. When I finally had my own children I drank each of them in. I studied them. I nursed them. I fell in love everyday.  For my second career I chose to become a lactation consultant, a career that allowed me to guide other mothers to follow their instincts and build relationships with their babies. That I can guide some of these mothers to nurse their babies into toddlerhood is a great gift. But it doesn’t always go that way.

Kelly and Joel got married and I had another baby. Kelly’s office was on Wall Street.  On September 11 she was there. She stood outside of her office building.  She watched as papers blew about like confetti. She brought dust-covered people into her lobby for water and comfort, for safety. This triggered in her the desire to be a parent.   She was hesitant as she told me she and Joel were planning to have a baby.

She told me, “ I may not be able to breastfeed.”

“Why not? Of course you can,” I assured her.

“I have been on Prozac for six years,” was her reply.

“I will look into it,” I promised.

Summer 2002 was the time I would sit the exam to become a Lactation Consultant. I still had so much to learn. Soon Kelly was pregnant and still on Prozac.  I contacted my colleague whose husband was a physician with a special interest in suicide prevention. At that time there was not much research on breastfeeding and Prozac.  Margot assured me it was more important for a mother to be alive than to be breastfeeding. Her words were a foreshadow that I could not even imagine.

When Kelly was about seven months pregnant she asked me to be at her birth. I was so excited and honored. On July 30 Kelly called to say she was in labor and that I should meet her at New York University Hospital.  A bit past midnight on July 1 a rush of excitement pulsed through me as her baby crowned.  I watched as her dark, hairy little head seemed to soften and move with a gentle force as Kelly opened up like a tulip. The bolt of energy that rushed through me as I witnessed a life come into the world kept me flying for weeks. This was the first time I had been present at a birth other than my own.

The next day I bought a pink outfit and brought my girls to see the new baby. While I was there a young intern stopped in to go over her medical record.

“Are you on medication?” he asked her.

“Yes, Prozac,” she answered as she gazed into Katie’s new eyes.

“Are you breast-feeding?”

“Yes.”

“OK, then, no Prozac, “ he said as he turned and exited the room. I remember the sound of his feet echoing down the hall on the white tiles.

I didn’t know then what the impact of stopping Prozac could be. I didn’t understand the postpartum physiology. As it turns out Prozac is considered safe with breastfeeding.

When Kelly called a few days later and asked if Chloe and I could stay with her and Katie because “my doctor says I am racy and she wants to admit me into the hospital but I told her I did not want to go and that I would make sure I am not alone and that I will have a schedule full of people hanging out with Katie and me,” I did not understand that she really could not be alone. Not for a moment. I did not understand.

When Kelly talked faster than usual and laughed louder than usual and started finding coincidences in all the numbers in her life I did not understand.

Three weeks later, Kelly, Joel and Katie moved out of their Manhattan one-bedroom walk-up apartment into a newly purchased house in the suburbs of New Jersey. Kelly said it was good that Joel was getting his MBA. Even though it meant he worked all day and went to school three nights a week. I didn’t know that Kelly had a fear of driving. I didn’t know that all of her friends with babies were in Manhattan.

I worried that most every time we spoke on the phone she cried.  She told me, “I have told Katie I am so proud of her and I love her more than my own mom told me in my whole life.” I felt helpless being so far away.

I didn’t know that Kelly had started taking Prozac again at Thanksgiving. I didn’t know how long it takes for Prozac to move through the body and begin its balancing act.

I did know that when I received a phone call on December 11 telling me that someone named Kelly had stepped in front of a commuter train in New Jersey I knew that was my Kelly.