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The Comfort of Touch

I just read about a study describing how loving touch can ease pain. It’s not the first study of its kind, but it’s a good reminder that laboring women who have a partner, family member, or doula with them can cope better with labor through the simple use of human touch. For women who labor with a partner and a doula, the partner can be the primary emotional support, while the doula can attend to practical needs–including taking care of the partner!

Speaking of partners, my wonderful doula partner Julie Dubrouillet has a book all about what partners can do to support women during labor: Deliver! A Concise Guide to Helping the Woman You Love Through Labor. Check it out if you’re pregnant, or pass it along to friends if you’ve already given birth.

Julie Book Cover

And if you have given birth, I’d love to know what helped you cope physically and emotionally.

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For new moms: letter to your future self

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I have been following Sarah Rudell Beach’s “Left Brain Buddha” site for a while now. It’s perfect for me because I aspire to mindfulness but too often find my left brain running the show.

Sarah’s most recent post, “Dear Exhausted, Struggling Mama…,” is a great read for parents of children of any age, but especially if yours are in the earlier stages. I recommend that you go and read it. Even if the baby needs to be fed and the toddler is whining and you haven’t started making dinner. You’ll feel better. And if you’re past this stage, as I am, it will remind you of the huge reservoirs of compassion we need to maintain for parents and families.

Letters from camp.

This so beautifully captures the essence of parenting, especially: “It is a child’s job to explore. It is a parent’s job to provide safe boundaries for child exploration, to give limits that provide a sense of security, not restriction. It’s rather an impossible assignment, parenting. I’d offer that, for those of us who choose it, parenting is also the last stage of our own growing up, the ultimate test of independence in the context of full interdependence.”

jenny's lark

letter from camp Letter from camp, 2012

From the moment we master basic locomotive skills, we humans begin to pursue our independence and separate from our parents. It is as natural and ordinary and miraculous a process as any other in the animal kingdom – which is not to say that it is easy, for either child or parent.

No matter how many books, lectures, blogs or parenting classes contribute to decisions, the art of parenting is largely trial and error. No child-specific manual pops out with the baby. Some babies require extensive physical comfort while others will easily self-soothe. Some toddlers will cling and others climb. Some children will be content sitting in a corner, stacking blocks, while others will strip naked and run out the front door at the first opportunity. The work of growing up is hard; the work of parenting is even harder.

It is a child’s job to…

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Three beauties and a redefinition

I’m quite sure how I feel about reblogging my own blog post, but this one seems to have resonance for both of my professions. — Audrey

Audrey Kalman - Fiction with a dark edge

Thanks to August McLaughlin for hosting her Third Annual “Beauty of a Woman” Blogfest, which prompted this post. Visit her blog starting February 27 to read all the entries.

Beauty of a Woman Blogfest

The Beauty of the Known

It has always seemed to me that people I care about are more attractive to me than strangers.

Looking for confirmation of this, I found a couple of interesting videos. One was titled “How to Make People Think You’re More Attractive Than You Really Are.” Leaving aside the issue of how one assesses one’s own looks, I was interested to find that instead of talking about plastic surgery or makeup, it recommends such things as standing up straight, making eye contact, and smiling.

It seems that the idea of a known person appearing more attractive applies even to oneself, as the video below shows. Four ordinary women received professional makeovers and posed for…

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Benefits of Breastfeeding vs. Risks of Formula Feeding

“Women do not fail to breastfeed. Health professionals, health agencies and governments fail to educate and support women who want to breastfeed.”

I’ve been teaching breastfeeding for about nine years. For most of that time, I’ve started my class off by asking participants, “What are some of the benefits of breastfeeding you’ve heard about? Just call them out.”

I then write down what they come up with. The list usually looks something like this:

  • Bonding
  • Nutrition tailored to baby
  • Provides antibodies
  • Helps mom lose weight
  • Cheaper
  • Convenient

To that list, I often add

  • Protects against certain reproductive cancers in girls
  • Reduces mom’s risk of breast cancer
  • Fewer respiratory infections for babies
  • Lowers the risk of SIDS
  • Colonizes baby’s gut with healthy bacteria

Then I hand out my outline, which lists about ten more benefits. “Wouldn’t you be amazed if someone sold a product that could do all these things?” I ask. “Unfortunately, formula doesn’t come close.” Then I let the class know why I’m emphasizing benefits at the beginning of a class where everybody is already presumably dedicated to breastfeeding: So they can remind themselves of all the benefits if the going gets tough in the first few weeks or months.

Are benefits best?

By Erik Hans Krause [Public domain], via Wikimedia Commons
By Erik Hans Krause [Public domain], via Wikimedia Commons
The idea of reframing how we talk about breastfeeding vs. formula feeding is not new. But more and more, we as lactation educators and support people are encouraged to talk about the “risks of formula feeding” rather than the “benefits of breastfeeding.”

It’s a subtle difference. But introducing the idea that an alternative feeding method carries risk helps to establish breastfeeding as the norm, which is an important shift.

I’m all for that. I believe we need more cultural acceptance and support for breastfeeding. I have two thoughts, however, about the risk vs. benefit language:

1) We humans are not very good at assessing risk in our daily lives. We worry about threats of terrorism while giving hardly a second thought to getting into our cars. Which is more likely to kill us? We also have a hard time separating personal risk from societal risk. I would love to see a study looking at how the language around breastfeeding vs. formula feeding in education helps or hinders moms’ decisions to breastfeed. Does it matter whether you say “breastfeeding reduces the risk of a baby dying of SIDS by 73 percent” or “formula feeding increases the risk of a baby dying of SIDS by 42 percent.” (Someone please check my math on this.)

2) As a breastfeeding support person, I am an important–and very personal–link in the chain for many individual moms. I am very sensitive to the enormous differences among us in background, desires, and proclivities.

I think the concept of “harm reduction” has a place in the world of breastfeeding support. It’s a familiar concept in the world of public health. For example: as much as we might wish to put an end to all intravenous drug use, if we’re unable to stop someone from shooting up, it’s better that he or she has access to a clean needle from a needle exchange program. If we’re unable to stop teens from having sex, better that they should do so using condoms.

Similarly, helping a mom to breastfeed a little–for a month rather than a day, or 75% rather than 25%–is better than her not breastfeeding at all. In my role as a support person, I don’t want to present information that could alienate mothers-to-be and set up expectations that end up completely undermining their efforts. That’s what I might be doing if I take breastfeeding advocacy to the bedside. And that’s what I worry might happen if I adopt the language of risk.

As an educator, I will begin to shift toward describing the risks of formula. In my work with individual moms, I will continue to do what I have always done: meet the mom where she is, work to support her goals, and educate her in a way that will help her actually hear and absorb the facts.

Additional reading

In researching this blog post, I discovered several interesting articles and web sites. Among them:

  • From the Fall 2009 Reviews in Obstetrics and Gynecology comes a study titled, unequivocally, “The Risks of Not Breastfeeding  for Mothers and Infants.” That says it in a pretty straightforward way.
  • On the other hand, the American Academy of Pediatrics Policy on Breastfeeding and Use of Human Milk takes completely the opposite tack, mentioning only benefits of breastfeeding, with only one reference to the “risks of formula feeding” — that being to encourage pediatricians to “Communicate the benefits of breastfeeding and the risks of formula feeding to all of your patients.”
  • A fantastic article, first published in The Ecologist Magazine in 2006, detailing the personal, social, cultural, political, and commercial challenges around breastfeeding. My favorite part is a couple of sentences appearing toward the end: “Women do not fail to breastfeed. Health professionals, health agencies and governments fail to educate and support women who want to breastfeed.”
  • And finally, a blog post on exactly this “risk vs. benefit” language from a mother–and parenting expert–who regrets having been convinced to wean her two children at 16 weeks and 8 weeks, respectively.

Your thoughts?

What do you think? As a mom, do the words “risk” and “benefit” make a difference? What about as an educator, support person, or activist?

Rude at Birth? Moms don’t have to apologize!

Well said, Julie!

Deliver! Books

Today I went to visit a client who had an amazing birth last week, and she did something that many women do: She apologized for not being very nice during her labor.

Let me paint the picture. This was her second baby and she was hoping to have a vaginal birth after a previous C-section, so she was already pretty stressed. Her labor was progressing quickly, though, and she stepped out of the car like only a woman in transition does – like she was walking gingerly through a minefield.

We quickly got her set up in the delivery room. Her contractions were now 3 minutes apart and strong. She handled all of that wonderfully. But she didn’t have enough left to say ‘please’ or couch her requests in niceties. I would have described manner her as honest and efficient. She was getting it done.

And then the apology. I…

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Best birth partner

Three simple–though not necessarily easy!–tips for supporting a partner during labor.

Deliver! Books

Over the years, I have seen so many loving partners at births. But loving doesn’t always translate into supportive.

Many partners are unprepared for the realities of an average labor: the lack of sleep; the stress of the hospital; watching the woman you love going through intense emotional and physical strain. And often these partners’ natural inclination is to want to fix it all, to make it go away.

Of course, that isn’t possible, or even preferable.

Instead, there are some simple things that birth partners can do to offer real support when it is most needed. Even though they’re easy to describe, actually doing these things can be a challenge. But they’re worth trying, because they make all difference. Here are three:

  • Pay attention. Over the many hours that a typical birth will take, this can be one of the hardest things to do. But try to watch…

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Letting go without giving up

A fellow doula called this week to ask for some advice about a client. As she told me the story, I couldn’t help but remember that I have heard this same story, or some equally sad variation of it, many times before. It goes something like this:

The story

A woman has a baby. It might be her first, but maybe not. The birth didn’t go exactly the way she planned and she struggles to come to terms with what she did wrong that caused the undesirable outcome. Her friends and family and maybe even her partner think she should just get over it because the baby is healthy and, after all, that’s really the only thing that matters.

She was not really prepared for how sleep deprivation would affect her. She feels irritable and moody most of the time. She loves her baby but it is an awful lot more work than she thought. Sometimes she just wants to curl up in a ball and go to sleep. Sometimes she cries for no reason, or out of frustration. Her partner has gone back to work and she hardly sees any adults during the day, or the ones she sees don’t agree with her parenting decisions.

She had really looked forward to breastfeeding but the baby lost 11 percent of his body weight in the first four days so her pediatrician told her to supplement with some formula. Of course she wanted her baby to get enough to eat so she gave him a few bottles, not realizing that getting a bottle in the very early days of breastfeeding sometimes interferes with the baby learning how to breastfeed. The baby began to gain weight but seemed to forget how to latch on properly, so she began pumping and bottle feeding with pumped milk.

Now that the baby is two months old, she’s seriously considering giving up trying to breastfeed at all, and maybe even giving up on pumping. It’s just so exhausting to try to feed the baby for a half hour, then give expressed breast milk, then pump so she has milk for the next feeding. She feels like breastfeeding is her last chance to prove herself as a competent mother and now she’s failing at that too.

The moral of the story

This story and its many variations should remind us of something very important: having a child is not a competitive sport. There is no “winning” or “losing” or “succeeding” or “failing.” As parents, all we can do is the best we know how to do in the moment. Certainly, we can be self-reflective and look into our own childhoods for what might cause us to believe or act in certain ways. But to connect our own self-worth to a particular outcome around our children is almost always a recipe for disaster.

For the parents of young babies my advice is to use the early years to practice, practice, practice the art of letting go. If you believe that whether or not your child breastfeeds reflects on the kind of parent you are, just imagine how you’ll feel when he comes home with an F on his report card or refuses to eat anything green or sneaks off and gets a tattoo.

The practical application of the story

But—and this is a big, big, BUT…

Just because you can’t control the outcome of something doesn’t mean you should give up trying to tip the odds in favor of the outcome you want. (After all, you don’t have to let your kid play video games instead of doing homework, stop serving broccoli, or give him a ride to the tattoo parlor.)

Before your baby is born, thinking about what you hope your birth experience will be like, preparing for it, and then letting go of any expectations you might have will help you avoid becoming too attached to any one particular way of having your baby. For early parenting, surrounding yourself with people who share your view of how you want to be a parent is incredibly important. For breastfeeding, arming yourself with basic knowledge before the baby comes can help you make decisions afterwards that are less likely to interfere with your aspirations. As your baby grows, seeking out other parents to share ideas with and muddle your way through some of the everyday challenges helps keep you sane.

The kind of person you are before you become a parent has a huge influence on the kind of parent you become. But that doesn’t mean you can’t use parenting as an opportunity to grow, change, and practice giving yourself the ultimate gift: self-forgiveness. I fervently hope the mothers whose stories sound like the one above can come to see parenting as just such an opportunity.

—Audrey

“Why do you need a class about that?”

My teenage son, who has grown up listening to me talking about birth and helping moms with breastfeeding on the phone, asked a great question the other day when I told him I was on my way to teach a breastfeeding class.

“Why do you need to teach a class about that? I think it would kind of mean there’s a problem for the human race!”

This is a great question. It’s one that many expecting parents also ask. After all, if humans hadn’t been able to figure out breastfeeding down through the ages, we wouldn’t all be here. What makes this time in history different? Or do those of us who teach breastfeeding just do it for the thrill and the money? (In case you’re wondering, it is thrilling, but the pay isn’t so great.)

The answer is yes, this time in history is different. Here’s why.

1) Most of us no longer live with extended family members close by, or even friendly neighbors. Chances are good that the first time a mom ever sees a breastfeeding baby, it will be her own. This means there are few opportunities for new mothers to have absorbed the “teaching” of experienced mothers who can both reassure them (“yes, that’s normal”) and pass along tips and wisdom. Classes–and good support groups–can take the place of this lost community.

2) Birth is more medical, and medical care is more fragmented, than in earlier times. When family doctors came to the house to deliver the baby, they were just that: family doctors. They cared for the mother and the baby. As birth moved into a hospital setting and medical professions became more specialized, one doctor became responsible for the mother (the OB) and another for the baby (the pediatrician). This has meant that OBs often have little incentive to think through how various birth practices will affect breastfeeding and the health of the newborn.

I am by no means saying that all OBs practice this way; many are extremely integrative in their care and do think ahead in this way. I’m just pointing out that the system is set up to separate mom-care from baby-care. The exception in our modern system is the midwifery model of care. Midwives are responsible both for the mother and for the baby during the first few weeks of life.

3) As a culture, we believe that “experts” must know better than we do about most things we have never done before. After all, we hire contractors to build our houses, tax preparers to do our taxes, and mechanics to fix our cars. If we are going to attempt any of these activities ourselves, we make darn sure we’ve read a lot of books and consulted a lot of web sites.

What’s different about breastfeeding is that, at some level–and particularly for the baby–it is an instinctive behavior. And while we’re very good at gaining book knowledge, we’re not usually great at “listening to our instincts,” or even figuring out that we have them. In combination with our lack of built-in community, this can be devastating for breastfeeding. Left to her own devices, a new mom sometimes, through no fault of her own, may fail to wake her baby frequently enough to feed. Or she may believe she must suffer with traumatized nipples because “that’s just the way breastfeeding is.”

You might think that this last point actually is an argument against classes, but I don’t see it that way. In my classes, I try to fill in the knowledge and support gaps that used to be filled in other ways, and then encourage parents to listen to what their babies and their instincts are telling them. Most often, when backed up with knowledge, this will be the right message.

I didn’t say this to my son, but I am hopeful that by the time he has a family, some of the factors that now make it a good idea to take a breastfeeding class will no longer exist. (If this isn’t the case, at least he and his partner will have their own personal information and support team… me 🙂 )

–Audrey

Using the tools at the ends of your arms

I’ll admit, I like simplicity. Why go out and get a complicated piece of equipment when something simple will do?

That was the message delivered a few weeks ago by Dr. Jane Morton when she spoke to members of the Nursing Mothers Counsel. Now in private practice with Burgess Pediadrics, Dr. Morton conducted research at Stanford on how moms of preemies could greatly increase milk supply through the use of the “hands-on pumping” technique.

Her talk was titled Is Pumping Out of Hand? The Merits and Rationale of Hand-Expression and Hands-on Pumping. Dr. Morton’s answer to the question posed in her title is “yes,” and she is making it her mission to reintroduce moms to the two amazing tools at the ends of their arms while both simplifying their lives and increasing the success of breastfeeding.

The most common reason women give for stopping breastfeeding is insufficient milk supply. It stands to reason, then, that anything they can do to increase supply will increase their chances of successful breastfeeding. Dr. Morton’s “prescription” is simple: even for healthy, term babies, moms should hand express about 5 times a day for the first 3 days.

I had already been encouraging pregnant moms to watch her video on hand expression before having their babies. Now I’ve begun passing along her advice about early hand expression. As she explained it, working on your supply early is like money in the bank–invest a little now for a big payoff later. And we know that physiologically, it makes sense: in the first few weeks, the frequency of breast stimulation influences development of the hormone receptors that control milk production. The simple equation? More frequent stimulation=more hormone receptors=more milk.

Dr. Morton also encouraged hand expression for moms who might be suffering low supply later on (after several weeks or months). To help boost supply, a mom could hand express for a few minutes every time she gets a drink of water, or goes to the bathroom, or sends a text message (now that might be a lot of hand expressing!) The idea is similar to one we sometimes suggest of a “nursing vacation” for moms suffering with supply issues after weeks or months of breastfeeding: go to bed and nurse the baby as frequently as possible for a couple of days, just as you did during the newborn period.

I have only attended one birth since getting, and giving, the early hand expression advice, but the one mom who tried it has a great milk supply and breastfeeding was going well after just a couple of weeks. I can’t say for sure that the hand expression did it, but it couldn’t have hurt.

So I’ll pass along Dr. Morton’s advice to anyone reading this. Learn how to hand express effectively and do it early. It has the potential to make your breastfeeding experience a whole lot better.

–Audrey