Getting started with breastfeeding

Breastfeeding has been a great joy - it's amazing to watch your baby grow and know that all of his nutrition is coming from you. After the umbilical cord was cut, I felt like this was another baby-mom link that we could enjoy. I also like knowing that as long as my baby is exclusively breastfed, he and I will always get private time together.

There are some frustrating things about nursing, especially in the beginning. For example, it's a little unsettling that you can't tell exactly what and how much is going in. But as long as he's gaining weight and what comes out in his diapers looks good, he's getting what he needs!

Here are some of the issues I encountered early on:

Cracked Nipples

My nipples definitely took some time getting accustomed to breastfeeding. They cracked and bled a little bit. It was painful when the baby first latched on during a feeding session, but the pain usually went away within 30 seconds or so. And let me tell you, having just recently gotten through labor, this pain felt like nothing. The good news is that the soreness didn't last long - after a couple of weeks, my nipples looked happier and didn't feel sore anymore.

I tried using Lansinoh once or twice to soothe the cracking. I didn't use it for too long, though - I didn't think it helped much. Also, one of the nurses at the hospital said that even though it's labeled as safe for the baby to ingest, she still thought I should wipe it off prior to nursing. I didn't want to be scrubbing at my painful nipples, so I just skipped the Lansinoh.

Another thing that helps keep nipples from hurting too much is to not get soap on them in the shower. After several months of breastfeeding, I still try to keep the soap away so as not to irritate them!

Primary Engorgement

Primary engorgement occurs when the breasts first start making "real" milk (after the colostrum). This is totally normal. Unfortunately, I didn't know it was normal, and I was pretty stressed out during this period. For me it occurred during the fourth night after the baby was born.

My breasts inflated to three times their normal size, they ached, and they felt really hard. It was difficult for the baby to latch on, which only compounded my stress. Plus, the worst of the engorgement occurred in the middle of the night, when it's harder to think clearly!

Luckily, we finally read about primary engorgement in our "What to Expect When You're Expecting" book. We were relieved to find that it was normal and that it should only last for 12-24 hours.

Sure enough, the next morning, my breasts were (slightly) smaller, less tender, and the baby was able to latch on again.

Clogged Ducts

I had three or four clogged duct episodes during the first month of breastfeeding. The first time it happened was the worst, and then I learned how to manage it. I found a lot of good advice at these kellymom websites:

General info: http://www.kellymom.com/bf/concerns/mom/mastitis.html

Milk blisters: http://www.kellymom.com/bf/concerns/mom/nipplebleb.html

You know a duct is clogged if your breast feels hard and possibly lumpy in one area. Once, I could actually feel the outline of the duct engorged with milk. The best remedy I found for the clogging was to have the baby nurse that breast longer, if possible, and to gently massage the tender area as he was nursing. Usually the clog would go away in one or two nursing sessions.

If the plug lasted longer, I would use a warm compress prior to nursing (to open things up), and a cold compress after nursing (to relieve soreness).

Latching On

The baby has the nursing instinct right away when he's born, but it might take him a little while to perfect the latch-on technique. For my baby, it was nearly a month before he could latch on the first try. Sometimes it would take several minutes, and that was frustrating.

This is where the hospital nurses' and lactation consultants' techniques come in handy. They help you learn how to gently flatten the areola to get as much as possible into the baby's mouth. They show you how to position the nipple and bring the baby's mouth in towards you.

My advice: ask all of your hospital nurses for help latching on, since each one might have a slightly different technique, and one might work better than the others. That helped me figure out what worked best for me and my baby.

During the first month or so, the baby's little fists would often get in the way of his mouth while he was trying to latch on. It helped to have someone hold his hands away from his face until he was successfully nursing. If I was alone, I would try to get him to hold onto my thumb to keep his hands out of the way!

We quickly developed our techniques, and soon the baby was consistently latching on the first try. Now, after about three months, all I have to do is get the breast near his mouth and he pretty much helps himself!

My Birth Story

I’ve been under the care of a midwife practice that works in conjunction with an OBGYN group. We learned so much from the midwives during the pregnancy, and they taught us ways to achieve a natural labor. All of their births take place at the city’s major hospital, we always had access to physicians, and we felt secure if any emergencies were to arise.

We know that being under the care of a midwife was a major factor in having my labor go as we hoped it would – natural and with no pain medications. We are very happy with how the whole birth day went. I am still amazed at how my body told me exactly what to do throughout the labor. Staying focused and relaxed helped me get through it.

The birth day began at 5:00 a.m., when I woke up to go to the bathroom and discovered my mucous plug had released. I was pretty excited and showed it to Devon! I went back to sleep for a bit, but at 6:30, I felt two big pulls in my abdomen. A relatively strong contraction followed, and then there were two more big pulls. I could feel liquid ready to spill out, so Devon got me a towel. Sure enough, my water had broken, and several big gushes soaked the towel… labor had begun.

The water was clear and odorless, so we didn’t have to worry about infection from meconium. I lay in bed a little longer to try to catch a few more winks, but contractions were coming stronger and a little closer together. We got up and made eggs for breakfast, to get some good energy into my body.

The contractions were coming strong, just strong enough that I had to start breathing through them a little. Devon started timing them, and they were about five minutes apart. I couldn’t focus on eating, and I felt like walking around was the best way to handle the discomfort. I was also still leaking a lot of fluid, so sitting on a couch made me nervous.

Three hours in (9:30), and the contractions were much less bearable. I definitely had to breath through the peaks, I was being much more vocal (i.e., yelling) during the contractions, and unfortunately I vomited the small amount of breakfast that I had eaten. We decided to call the midwife.

Juliane was in the office that day. Since the office was open, she suggested that we pack our things for the hospital but come in to see her first so she could check my progress. We got to the office around 10:00 a.m., and Juliane determined that I was 3 cm dilated and 100 percent effaced. My contractions were about 4 minutes apart at this point, and she said I was in pre-labor. Juliane said it was our choice to go to the hospital, but she suggested going home for several more hours to progress a bit further before checking into the hospital.

Even though I couldn’t imagine continuing with these contractions (especially once they got worse!), I knew Juliane's recommendation to labor some more at home was sound advice.

In the car, I realized that I was pretty comfortable sitting down, so I settled onto the couch at home. Less fluid was leaking now, but the show was bloody after being checked. Active labor had started, and it was amazing how my body took over and I settled into a rhythmic zone. I was very quiet and just focused on getting through each contraction. They were 3-4 minutes apart, and seemed to be getting stronger over time. I closed my eyes and dozed a little between contractions.

I decided to try sitting in a hot bath to ease the pain a bit. Juliane always called a hot bath a “liquid epidural!” Now, I do not like bathtubs. I haven’t sat in a bathtub without a bathing suit in a long, long time. But this bath felt great. I imagined the energy of each contraction being absorbed by the warm water. Devon poured water over my back and made sure the bath stayed hot. I labored in the tub for about an hour.

I got out of the bath after an hour because I’d read that labor can slow down a little with too much liquid epidural. I went back to the couch for about an hour. I mainly used deep breathing to get through the contractions, but sometimes I would use quick breathing at the peak of the surge. I also tried to imagine the energy of the contractions being dissipated over the rest of my body.

Devon was there for me, but during active labor I didn’t want any physical contact like I thought I would. I didn’t want to talk, I didn’t want to be touched… but emotionally, it was important that he was there. If he wasn’t in the room when a contraction started, I called him in to be near me.

We decided it was time to go to the hospital when my contractions were regularly 3 minutes apart, and they had become stronger. I felt like there was a lot of pressure happening between contractions, too. We also wanted to beat rush hour traffic! We left for the hospital at 3:30 and got checked into our labor and delivery (L&D) room around 4:15.

I didn’t want the sudden change in environment to affect my focus. I didn’t make eye contact with anyone except Devon, my midwife, and my L&D nurse. By ignoring most of the people and equipment around me, I was able to concentrate on breathing through each contraction.

Amelia was the midwife on call at the hospital. Amelia checked my progress; I was at 7 cm! I was hooked up to the electronic fetal monitor, and the baby was doing great. Then transition began for the last couple centimeters of dilation. I felt like being on all fours, and I was very vocal (this surprised me). I didn’t yet have a strong urge to push, but my body was doing a little pushing on its own during each contraction.

Around 5:30, I felt more of an urge to push. I was at 9 cm, and Amelia and my L&D nurse had me change positions. I ended up on my back, and they told me this would help get the baby under my pelvic bone. The nurse and Devon helped hold my legs, and I learned how to give three or four effective pushes with each contraction.

Pushing was not that painful, but the feeling of the baby’s head down in my pelvis was agonizing between contractions. I kept asking how much farther he had to descend, when would he be far down in the birth canal? I distracted myself by rubbing a damp washcloth over my face and neck. I also sipped water between contractions – Devon handed it to me.

The baby eventually moved into the birth canal, and it was time to push him out! Devon could start to see the baby’s head bulge in the perineum and move in and out with each push. Once the baby started crowning, a lot of people came into the room – nursery nurses, additional nurses to help out. Amelia was busy delivering another baby across the hall, but she came to evaluate the situation. She told me, “Irene, you are a powerful woman.”

The baby’s head crowned one final time, and he emerged facing my right thigh. I looked down and could see his head as Amelia helped deliver his shoulder and then the rest of his body. Then suddenly he was up on my chest! He made a few small cries and started breathing. His skin was grayish-pink but soon turned bright red and pink. His hands and feet were the last to turn pink. His little fingers immediately latched on to mine. The nursery nurse cleaned him up a little and suctioned out his mouth and nose.

Little Alden lay on my chest for a while as the nurses did their jobs. His Apgar scores were 9 and 9 at 1 and 5 minutes. At one point I asked, “is he definitely a boy?” We checked, and he sure was! After the cord stopped pulsating, Amelia clamped it near his belly button. Devon made the cut, and little Alden was officially operating on his own.

When it was time to deliver the placenta, the nurses moved Alden to the warming table and weighed him – 8 lbs 14 oz! Delivering the placenta was not difficult, but I didn’t like that Amelia had to push on my brlly to stimulate my uterus. The placenta came out and was intact. Devon held Alden for a little while, and then the baby went back onto my chest for some more bonding.

I had a tear that Amelia had to stitch up. She gave me a local anesthetic, but it was still a really uncomfortable procedure for me. It was over after about 20 minutes, and then the room emptied out.

The L&D nurse helped Alden and me nurse for the first time! He latched on well. He was very alert for about two hours after delivery, and we got to look at his eyes and make connections with him. We gazed at his head full of curly blonde hair. We took in his pouty little mouth and big blue eyes with long lashes. He is perfect, and well worth the wait!

Maternity Leave

My brother and sister-in-law, who are living in Germany for a year, recently learned about maternity and paternity benefits in one of their German language classes. After they described the generous leave policies, it made me think about American maternity leave. There are quite a few differences!

The U.S. Family and Medical Leave Act (FMLA) of 1993 states that new moms can take 3 months off with no pay and have their position and benefits status held for them. Dads can also make use of this leave policy, but I think this is rare. Prior to passage of this bill in 1993, leave policies were entirely at the employer's discretion.

If you look through Wikipedia's summary of countries' leave policies, the U.S. and Swaziland are the only two countries that do not offer some amount of paid leave time! Many countries also mandate the option of taking more than 3 months off.

I know that paid leave and extended periods of leave have economic costs and productivity implications. However, there are definitely costs associated with limited leave, such as lesser bonding time with your newborn, less time to establish and continue breastfeeding, not to mention the cost of extra child care.

At our final childbirth class, we all shared our plans for after baby's arrival. I was surprised and impressed that about half of the women said they were not going back to work at all. The rest of us said we'd be starting work again after a period ranging from six weeks to one year. There was one dad (a grad student at Princeton) who was planning to take a semester of paternity leave.

I would definitely support more generous family leave policies. I especially think fathers could benefit - they should be able to get a taste of life at home with Baby without having to worry about job security or loss of pay.

Cord Blood Banking

I had been going back and forth on cord blood banking, but now I feel that I have a pretty good handle on it. Cord blood is an excellent source of stem cells, and with the current research that's happening, there's a good chance those stem cells could come in handy some day to treat diseases. As with any relatively new medical advancement, though, it sounds a lot more simple than it is.

If you're having a baby, the first thing you'll get in the mail are flyers from ViaCord and other private cord blood banks. Their brochures say that there are currently over 70 diseases that are treatable with cord blood, such as leukemia and certain blood disorders. However, if you log onto their websites (I'm using ViaCord as an example), you'll find that the collection fee is around $2,000, and there is an annual $125 storage fee for your baby's cord blood.

That sounded pretty expensive to me and my husband. Then, we read some articles that affirmed that the expense is probably not necessary. This article from BabyCenter.com (link) makes some interesting points, including that "most people have a better chance of finding a stem cell match in the public cord blood system than in their own family."

We also figured that if the benefits really outweighed the costs of private cord blood banking, insurance companies would probably cover some of the cost.

But the idea of public cord blood banks sounded intriguing. These banks are sort of like public blood donation centers, except storing cord blood is less common and more expensive an endeavor. Some hospitals are set up to collect cord blood for public banks, but unfortunately ours is not.

This week we saw an article in Time Magazine (article, video) about kits that are available for hospitals that aren't set up to collect and transport cord blood on their own. An expectant mother can request a kit, take it in for collection after the baby's been delivered, and the specimen gets shipped to the cord blood bank. There is no cost to the mother.

This sounded like a great idea, but unfortunately I was too far along in the pregnancy to take advantage of it. Most public cord blood banks require enrollment between 28 and 34 weeks of pregnancy so that maternal blood tests can be completed prior to delivery.

I was disappointed that I had missed the opportunity to donate the baby's cord blood to a public bank. I didn't like thinking of wasting those potentially life-saving stem cells. However, I spoke with my midwife, and she gave me some more good information. She said that if you don't clamp the cord right away and allow it to continue pulsating after birth (which we had been planning to do), nearly all of the cord blood travels back into the baby's system. Thus, there is no cord blood left to collect.

So we feel good that our baby will be benefiting from his cord blood; it won't be wasted. Maybe with our next child, we'll look into public banking. By then, there might be more information on how useful these stem cells are, and perhaps more hospitals will be set up for public cord blood donations.

Strollers and Car Seats

Note: My final recommendation on strollers and car seats is DO NOT buy them based on recommendations from people who haven't used their stroller/car seat with a baby yet.... so don't take our advice until I've updated it when we've used our products with the baby!! Read on if you'd like to learn about our decision process :)

We've done a ton of research on strollers and car seats, mainly by reading reviews online and testing them at Babies R Us (BRU). Here is a summary of our BRU experiences:

• First visit: Spent three hours looking at travel systems, car seats, stroller frames and small strollers. Conclusion: Graco travel system plus a smaller Graco stroller for traveling.
• Second visit: Spent two hours re-testing strollers because we decided our first decision was not good. Conclusion: thought we'd never find a stroller we liked.
• Third visit: Spent two hours pushing around stroller frames with car seats. Conclusion: Stroller frame and car seat, purchased separately.

Our final purchases were the Baby Trend "Snap 'n Go" stroller frame and a Chicco KeyFit30 infant car seat. We plan to buy another stroller later when the baby doesn't like being in the infant carrier anymore. We feel this best fits our travel needs.

For background, here are some definitions:

• Infant car seat - A car seat that typically fits a baby from birth up to 22 or 35 pounds, depending on the model. There are two parts: a base that sits permanently in the car, and a carrier that snaps in and out of the base. (The carrier is what you see people carrying their babies around in.) It can only be used in a rear-facing position. You typically stop using this type of car seat at one year (or when the baby weighs more than the seat's limit) and buy a new front-facing toddler car seat. Price range: $70 to $180
• Travel system - A stroller, infant carrier, and infant car seat base sold as a package. The stroller is full-size (RE: heavy but very sturdy) and folds up so you can put it in your (large) trunk. The infant carrier snaps into both the stroller and the car seat base, so you can move your infant from one to the other without taking him out of the carrier. The stroller also accommodates a toddler up to 40 or 50 pounds. Price range: $200 to $300
• Stroller frame - A collapsible frame that accommodates an infant carrier (sold separately). The frame can only be used with the infant carrier; there is no seat for a toddler. Price range: $50 to $80

How we came to our final decision:

After testing the travel systems, we thought that was the way to go. This was despite recommendations from several parents that the travel system stroller is too heavy and impractical. Online reviews (by still-pregnant people) of the systems were pretty positive, though. And rightly so, because when you're just pushing the stroller around the store, it feels great! Very sturdy and safe-feeling. We knew the travel system stroller wouldn't fit in our trunk along with luggage and other baby supplies for a long trip, so we also picked out a small stroller to use for travel.

When we continued to hear accounts of travel system strollers collecting dust in the basement after a few uses, we changed our mind. We really wanted to like the stroller frames - they are lightweight, inexpensive and fold up pretty small. They just didn't feel quite as sturdy as the travel system strollers. After much hemming and hawing, we realized that comparing the travel system to the frame system was like comparing a Mercedes to our Jetta: the Mercedes has some extra features and feels ultra-luxurious when you're driving it, but we love the Jetta just fine when we're not actively comparing it to a Mercedes! (We technically haven't made this comparison. But we think it is accurate :) )

That meant we needed to purchase a car seat a la carte. We selected the Chicco KeyFit infant car seat because it gets excellent ease-of-use reviews by actual parents (including family members) and Consumer Reports. And indeed it was the smoothest-operating car seat we tried (we compared it to Graco and Safety 1st). Keep in mind that all car seats for sale have to meet strict government safety standards, so all brands at least start in a level playing field in terms of safety requirements.

There are two types of Chicco seats - one accommodates kids up to 22 lbs and the other up to 30 lbs (most brands have similar model choices). We preferred the 22 lb version because it's lighter and we really think our baby will not be much bigger than 22 lbs at one year - the 50th percentile baby at 12 months is 23 pounds. However, we found that it wasn't available without buying a travel system. So we went with the 30-lb version. I guess we're safe if he's a big boy!

I will post again after we've actually tried these things out with our baby.

Some other incidental notes:

• Try to avoid stroller shopping at 8 months pregnant. Not fun. Take water if you do.
• The best patterns only seem to be available in the travel systems. We think this is a marketing ploy to get you to spend more money: first up front with the expensive travel system, and then again when you decide you have to buy a stroller you can actually use.
• Shop around online once you've decided what you want in the store. There are often much better deals online. We bought our car seat from http://www.justkidsstore.com/

Comfortable sleeping

I've been lucky so far and have been able to get a pretty good night's sleep (most of the time). I had to get up in the middle of the night to use the bathroom during the first trimester and again now that I'm in the third trimester. It wasn't a problem during the second trimester, though!

To get comfy, I use a series of pillows. I highly recom- mend the Boppy pregnancy wedge pillow. You can get one for about $15 on Amazon, or at Motherhood Maternity. At first I used it between my knees. Then, as the belly got bigger, I started using it to wedge underneath the belly (which is its intended purpose). It provides some support so the belly doesn't feel like it's just hanging out there, or drooping onto the mattress. I usually have to flip over a few times during the night, and I bring the wedge with me to the other side.

I also put a full size pillow between my legs and knees. I think that helps with keeping the hip joints in line (although my hips still hurt when I wake up!). Finally, I have a small pillow that I put behind my back when I feel like I need support there.

So, each night I build a little nest and have a fairly comfortable sleep!

Skin on the Belly

Starting around 29 weeks, the skin on the top of my belly got very sensitive. Occasionally it's painful. I've tried a lot of different things to try to make it feel better! Starting at the beginning of the pregnancy, I've rubbed in Bath and Body Works Body Butter at night. I also have a sugar-based skin exfoliator that I use on the sensitive area in the shower. It's not too abrasive, and it leaves a nice oily feeling after the shower is done. I also put Jergens lotion on after the shower.

Those things didn't seem to solve the problem... I bought some Vaseline aloe lotion/gel. That provided some temporary relief, but then my skin felt a little taught. The thing that seems to work the best is Aquaphor ointment (made by Eucerine). I rub on a little bit when the skin is feeling tender, and it feels better right away. It doesn't last forever, but then I just put a little more on.

It's funny how it's only the top of my belly that has this problem. I'm hoping it will get better before the pregnancy is over, but if not, I don't have too long to go :)