Tuesday, June 14, 2011

Misinformation's Role in Breastfeeding

A friend of mine is a doula as well.  She had a client deliver a baby in an uncomplicated, unmedicated full term birth last week.   There were no complications, the baby latched on within the first hour of birth, and was nursing every 2-3 hours in the first days after birth.

Everything was going about as perfect as it could be.

Until she went to the doctor when the baby was three days old. 

The baby, who weighed about 7  pounds at birth, had lost a few ounces.  Mom's milk wasn't in yet. 

The pediatrician recommended formula supplementation due to the concerns about the baby's weight.   The baby, who again, was full term and was not experiencing any problems with blood sugar or jaundice.

This is an example of a place where the medical system is failing families.

Did you know that most medical schools provide very little, if any education at all, about lactation?  How exactly are the physicians supposed to teach patients about nursing if they've had little education in it themselves?

Most pediatricians and obstetricians are given huge supplies of free formula to distribute to their patients as "gifts".  What's the harm in taking a sample, right?  The harm, I would argue, is tremendous. 

The truth is that healthy, term infants almost never need supplementation.

Babies are supposed to drink only the colostrum the mother produces for the first few days.  This early milk is incredibly nutrient rich, and serves as a laxative to help the baby purge the meconium from their system to help avoid jaundice.

It is those first few days, with only the colostrum, and the increasing hunger of the baby, that causes the mother's milk supply to come in adequately.  Giving a bottle here or there will interfere with the supply being established correctly.

Feeding a newborn a bottle will teach them that food comes immediately.  In my experience, this will interfere with nursing perhaps more than anything else.   It is because in nursing, the baby has to latch and suck long enough to trigger the let down reflex.  The milk does not start flowing immediately.  Giving the baby a bottle, which works immediately, interferes with the baby's natural feeding process.

Thousands, if not millions, of well -intentioned first time moms have reluctantly supplemented after being told their babies were losing weight in those first few days.  Trouble is....THIS IS NORMAL.  Healthy, term babies can easily tolerate losing up to 5-10% of their body weight in those days.  It isn't a cause for alarm, especially before the mother's milk comes in.  Unfortunately, this is where doctors begin to show concern and mothers start to doubt their body's ability to nourish the baby without artificial assistance. 

Once that doubt sets in, it's a recipe for disaster.  Loss of confidence in nursing undermines the overall confidence in parenting.  Moms can start to feel like they are failing their baby.  They give a bottle, then the baby gets frustrated quickly at the breast.  They eventually give up.  And for what reason?  The loss of a few ounces that the baby is designed to lose anyway? 

The better guideline is that a newborn should be nursed on demand, but not less frequently than every 3 hours, timed by the start time of the feeding.  They should not lose more than 10% of their body weight, and should return to their birth weight by two weeks.  If those goals are not reached, it still does not automatically mean that formula is the solution. 

Often, the best way to reassure a new mother that the baby is eating well is to weigh them before and immediately after a feeding.  Many breastfeeding support groups have scales available for this purpose.  This reassure mothers that they are indeed producing an adequate supply. 

Another big misconception is that pacifiers will create nipple confusion.  I do not believe this to be true for the simple reason that pacifiers do not feed the baby.  A baby will learn quickly that milk does not come from a pacifier, and will use it for sucking needs that exist outside the need to eat.  I encourage new mothers to wait until nursing is established and the milk supply fully in before giving a pacifier.  Beyond that, if the baby has a high suck need, by all means, use a pacifier. 

Bottle feeding can be a great way for the father and other family members to bond with the baby.  Again, as with pacifiers, once nursing is well established, it can be added to the routine without major incident.  Wait until the milk supply is fully established, then give a bottle every other day or so at one feeding.  For the first few months, the mother should pump during every bottle feeding.

When bottle feeding, it is important that breast milk not be combined in the same container as formula.

I could write books about this subject, but I will stop here for now.  I will address pumping, milk insufficiency and formula feeding in later posts.  If you have any specific questions, please feel free to ask!

Sunday, June 5, 2011

Am I in labor?

Labor is the culmination of months of gestation, the precursor to birth, and the turning point of the greatest significance in a pregnancy. 

Yet, it's often one of the hardest things about pregnancy to define.

In this day and age, most women go into their pregnancies, particularly their first ones, with expectations about how it will go.  They've been brainwashed by television and movies, about the sudden arrival of labor, usually by a dramatic burst of water.  Screaming and yelling ensues, and shortly thereafter a baby arrives.

Trouble is, it hardly ever works that way. 

I'd like to try and clear up some of the misconceptions about labor here, and help you determine when labor actually begins.  It's not usually a black and white issue, more shades of gray.

- Only about 10% of women will have their amniotic sac rupture prior to the onset of labor.   Far more likely, you will experience hours or even days of contractions prior to a spontaneous rupture.  Left alone, most women will not have their water break until they reach about 5 or 6 cm dilation.  If your water breaks, even if you aren't in labor, you need to go to the hospital or call your midwife.

- You only have a 5% chance of having the baby on your actual due date.  Some babies come early, some babies come late, very few of them actually show up on the day you circled on that calendar.  Most women should be prepared to labor anytime after 37 weeks, though it can begin earlier for some.

- Your due date isn't an expiration date.  Left alone, most first pregnancies would go postdates.  What this means is that if you get to your due date, then pass it, and still don't have a baby, it doesn't mean that there is anything wrong.  The average first pregnancy left alone would be closer to 41 1/2 weeks, not the 40 we are accustomed to.  Healthy women with uncomplicated pregnancies can go two to three weeks past their due date without medical concern usually.

- You may not know when you are actually in labor, especially if it's the first time.  Assuming that it begins on it's own, labor is a very gradual process.  You experience an increase in Braxton-Hicks contractions, which eventually turn into pre-labor contractions.  Those eventually turn into early labor, and it's often difficult if not impossible to know when you've crossed the line for good. 

- Many women have false alarms, particularly as the Braxton-Hicks contractions increase.  They can occasionally become a little painful even.  It is normal to have these false alarms, but still frustrating.

- The hallmark of true labor are contractions that do not go away with changes in activity.  Towards the end of your pregnancy, you may notice that you have contractions when you are tired or have over-done it.  Dehydration can also trigger contractions.  Getting rest and staying adequately hydrated will lessen these type of contractions eventually.  If they keep coming no matter what you do, it is more likely to be true labor.

- Most women have digestive problems prior to the full onset of labor.  You may become nauseous or have diarrhea.  You may not feel like eating at all, but should focus on light meals.  Many women also have headaches and backaches before labor.  Nesting is common, a sudden urge to clean or organize the baby's room.  None of these are slam dunk signs that labor is near, but they often are precursors.

- Early labor can last for hours or even days for some women.  At this stage, you have decent breaks between contractions, and they still may be somewhat irregular.  You aren't too uncomfortable and can go on with your normal activity levels.  Many women never realize they are in this stage, particularly with a first baby.  In this stage, you should focus on resting when you need to and eating lightly. 

- The average first labor is 14 hours.  This is the time that mother perceives labor, though in most cases it has undoubtedly been longer than that.  The natural labor process brings with it a gradual increase in endorphins, which enables the mother to tolerate the increasing discomfort from the contractions.  Having said that, 14 hours is an average.  Some women have very rapid labors, some have very prolonged labors.

- It is common to wake up in full blown labor or having had your water break.  This is because of the fact that it's often possible to sleep through the earliest stages of labor.  Your body is in a relaxed state during sleep, and the contractions are often far more effective than they are when you are awake. 

- I don't rely on any time frame or charting to decide when to go to the hospital.  From my personal experiences, and those of my clients, they are good tools generally, but seem not to apply more often than they do.  I'm referring to the 1 minute contraction, every 5 minutes, for 1 hour rule.  Some women have extremely effective contractions every 10 minutes.  Some can contract every 5 minutes for 12 hours with almost no cervical change.  I look to the other symptoms for guidance of when to go.
    * Drastic increase in discharge, or bloody show
    * Increased pressure
    * Back pain with contractions that increases over time
    * Inability to talk during contractions

- You really can't judge how you will do with tolerating labor until you've been there.  Some women have astonishingly high pain tolerances, others sense every twinge and it becomes unbearable quickly.

- Most hospitals will not admit you unless you are 3-4cm and having regular contractions at least every 5 minutes. 

If you aren't sure you are in labor, it never hurts to call your doctor or midwife.  Chances are that they will want you to come in and be checked.  Good luck!!! 

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