Nipple Shields - Don't Throw The Baby Out With The Bath Water

Modern Silicone Shield

Nipple shields, the word practically draws a gasp in some circles and to be fair perhaps with good reason.  For years nipple shields were used by many as the "solve all" to breastfeeding problems, rather like sticking a giant plaster over whatever was causing the problem - they either didn't help and feeding was just as painful, or did but mum's supply suffered, and if she got through all that it was often a long and arduous process getting baby to feed without them; techniques recommended ranged from "making baby go cold turkey" to "cut them down gradually" (really not recommended nowadays due to shields being made of silicone which can be very sharp when cut).

Dr Jack Newman himself states there is never a need for nipple shields - and perhaps in a perfect breastfeeding world where everyone can get the help they need instantly, he may be somewhere near the mark.  But at least where I am in the UK, we're simply not there at the moment.

But let's start at the beginning.


Nipple shields have been around since the 16th century, and have been made of lead, silver, wax, wood, pewter, tin, bone, ivory and glass.

Portia Shield

Glass Nipple Shield

More recently plastic, rubber or latex became popular and nowadays the typical shield is a thin piece of silicone worn over mum's nipple and areola - although there are still a few odd contraptions around, like the Portia nipple shield (on the right) endorsed by Claire Byram Cook (or so the packet says). The mum pops the "teat" over the plastic holder, and then puts the plastic holder over her nipple; I'll leave you to make your own minds up about that one, but I'm sure many will note the similarity between this and the image on the left...

Numerous studies demonstrate that shields can affect milk transfer and thus mum's milk supply, however these studies are examining older fashioned thicker shields, that would reduce stimulation to mum's nipples too.

Latex Shield

A 1980's study found latex shields reduced milk intake by a 22%, but had no significant effect on sucking patterns. But shields are now made of thinner silicone, so how applicable is this?

Not very in my opinion.

A 2006 study published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing, which examined use of an ultra thin shield found:

"Physiological results demonstrated no significant difference in maternal hormonal levels and infant breast milk intake for breastfeeding sessions with and without nipple shields."

I'm sure many are wondering where I'm going with this - surely we don't want everyone reaching for the shields do we?  Of course not - but we've gone so far the other way that they're seen as a huge cause of breastfeeding problems and something to be avoided at all costs.  They are no longer seen as a useful tool in the bag of someone suitably qualified, but a big no no.

A few months ago I suggested a mum considered the temporary use of shields, with the result being the local NHS Infant Feeding Advisor (midwife) was so upset, you would have thought I had suggested hanging the baby upside down from the washing line whilst mum latched him doing limbo.

I met the mum four days post-partum after what she described as an "horrific" labour and delivery, 48 hours resulting in an emergency section.  There was a long delay between birth and her holding her baby, who had promptly refused to latch - again she filled up as she described the past few days in hospital.  The baby had "screamed" every time she held him, trying to latch, pulling away writhing and twisting, leaving mum in tears.  Biological nurturing (leaning back) which they had suggested in hospital, she had found difficult due to her very large pendulous breasts meaning baby ended up somewhere under her armpit and even with pillows etc mum had felt extremely uncomfortable and the baby had just "pecked and bobbed".

Midwives had offered to take the baby, and as he settled with them (away from his "food source"), mum felt it was her causing the baby to become distressed.  She had managed to get him latched for four feeds the previous day, all of which had followed a 30-50 minute battle, a number of other feeds had resulted in them "giving up" because baby simply wouldn't latch and became either too upset or sleepy to feed.  Mum had been expressing since day one and cup feeding in hospital had been messy, with mum confessing dad had tipped a little in because they were so concerned he wasn't taking any milk (please note this is not recommended and can pose a choking hazard).  Even after the feeds that they managed baby was unsettled and rooting for more.

Lead Shields

Mum didn't hold her baby unless she had no option but to attempt a feed, because otherwise the whole rooting, writing, crying scenario would unfold again.  Mum was utterly miserable - just wanting to feed her baby without him becoming so distressed and frustrated first; she confessed if things couldn't be sorted today she didn't know if she could continue breastfeeding; as it was she was beginning to wonder what she had let herself in for having a baby!  She looked shattered, emotionally drained and desperate.

Before long it became clear why this dyad were having problems - baby had a tongue tie which was severely restricting tongue function (probably not helped any by the failure to progress and resulting section), and mum had flattish nipples that inverted with pressure; the combination proving frustrating all round.  Without adequate tongue function baby has cues missing from the feeding sequence he uses to latch, add to that retracting nipples and he can't even get by using a less effective technique.

When a feed was attempted and baby struggled and expressed his frustration, mum quickly became tense and distressed - "you see" she declared, ""we just can't do it".  Despite every trick to improve protrusion, breast sandwiches, deep latch techniques and nipple flips in almost every imaginable position, baby barely latched, he nibbled on the nipple maybe twice but nothing more.  Mum gave a little expressed milk via finger feeding (which both parties loved and the cup hit the bin!) to take the edge off and keep him interested - but just as she had described the cycle of them both ending up upset continued.

At this point mum sobbed, and everything came out from her "failure to birth properly", to her "failure to even hold her baby without him becoming beside himself", to her "failure to feed him".

Mum gave baby some expressed milk so he would settle, I made us a cuppa and we had a long chat, which resulted in me asking if she wanted to consider using a shield until the tongue tie could be further assessed, and so they could both do a little healing from the birth - some breathing time.  After a quick chat about pros and cons, how it may not help or may cause pain, dad popped out to the chemist.

Silver Shield

Mum popped the shield on, hesitantly put her son to the breast and within an instant he was latched and taking full advantage of her now abundant supply!  Mum cried again, this time with tears of joy - "I'm feeding him, I'm actually properly feeding him!!" she declared triumphantly.   She preened and stroked him as he nursed, telling him how clever he was, compressing her breast until before long he popped off satisfied and content.

How do we begin to measure the psychological boost that feeding her baby without distress gave that mum?  The renewed hope that she could breastfeed, that she no longer had to dread picking her baby up and that he only ever cried with her?  Was the latch perfect with the shield?  Nope, but did it actually at that point matter?  Baby got enough to feel satisfied, mum was happy and this was a short term intervention.

With a now beaming mum I called the Infant Feeding Advisor to ask the best route of referral for NHS division.  I was advised to speak to the midwife who as if on cue, knocked on the door.

That's not a tongue tie the midwife declared (after nothing more than a cursory look in baby's mouth) I will refer you but they won't do anything with that.  And what are those shields?  You should be cup feeding, our Infant Feeding Advisor would not be happy with you using those....When she spotted the syringe used for finger feeding, I thought she might actually pop there and then in the kitchen!

At this point mum looked about to cry again and dad quickly intervened to say they had had a lot of trouble cup feeding and this had worked really well.  I will get someone round to show you how to cup feed properly was the midwives reply, he will never breastfeed if you keep using those shields, new guidelines are they're not recommended at all.  Finger feeding shouldn't be used either once the baby needs more than 1 or 2 mls...

After the midwife had gone it was dad who reminded mum of her brilliant feed and that she should follow her instincts, mum decided to stick with the shields and see what panned out.

I received a phone call from her several hours later, telling me the area Infant Feeding Advisor (IFA) had arrived with her less than an hour after the midwife had gone (called in by the midwife) the IFA confirmed it was a tongue tie and referred the baby for division, but also agreed shields were against NHS guidelines and she did not support their use, nor the finger feeding which should not be used as the baby needed to "stretch their tongue attempting to cup feed" and it was not an evidence based method of supplementation (clearly Salisbury NHS disagree and guidelines do actually state cup OR finger feeding is fine).  By this point mum wasn't up for engaging in further discussion and politely told the IFA she intended to continue as was until division.

Long story short the parents waited several weeks for division, during that time they did not receive any information as to when, where or even if the division would take place.  She tried on numerous occasions without the shields, but the result was always the same frustrated crying and so she continued using the shields and feeding her baby!  After 48 hours solid of trying to obtain a date/time for division from the NHS, the parents decided to go private and contacted the IFA on the morning of their appointment to advise her of their plans - within 5 minutes they were advised to drive to a particular hospital where the tongue would be divided....

After the procedure, mum was again advised to expect difficulty stopping shield use, and so did not attempt it for 3 days whilst the tongue healed.  On day three half way through a feed mum removed the shield and never used it again.


Evidence?

Clinical Use of Silicone Nipple Shields, J Hum Lact. 1996 Dec;12(4):279-85:

"Use of nipple shields is controversial. However, when weaning is imminent, they may enable breast-refusing infants to transfer back to the breast."

Women's experiences using a nipple shield, J Hum Lact. 2004 Aug;20(3):327-34.

"An informal, retrospective telephone survey of 202 breastfeeding women was conducted over an 8-month period of time, assessing patients' perceptions regarding use of a silicone nipple shield. Sixty-seven percent of the women continued to breastfeed after transitioning off the nipple shield."

Now bear in mind we have no idea how many of these 202 mums may have given up breastfeeding entirely without the shield...

Long-term nipple shield use-a positive perspective, J Hum Lact. 1996 Dec;12(4):301-4.

"This report describes ten cases in which silicone nipple shields were used for two weeks or longer. In nine of the cases, shields were used to help babies attach to the breast. These babies had struggled to attach to the areola because of suck problems or the mother's lack of protractility of breast tissue. In the tenth case, the shield was used because of extreme nipple soreness. All babies were off the shield by 3.5 months of age; nine were feeding directly from the breast. All weights were appropriate or above for the age of the infant at three weeks, two months and four months."

Discussion:
Much of the focus surrounding nipple shields is about function - does it impact on milk transfer, mum's hormone levels, milk supply.  What about the psychological impact, did it empower this mum?  Absolutely, and I have no doubt in my mind at all that it preserved breastfeeding where it would otherwise have ceased.  Even if eventually we had managed to get baby latched, what happens at the next feed or at 2am?

I think before anyone even thinks shields, the key is establishing WHY a baby is struggling to feed well - without this it is just a sticking plaster.  They can be hard to stop using if the root cause isn't also addressed,  I think they should only be discussed by a lactation consultant or very experienced, competent breastfeeding counsellor and not as the solve all they used to be.  They're not the answer for all mums, and they're definitely not the answer to all or even most problems - but used wisely, I for one think they're a godsend.

Nine Good Reasons NOT To Use Baby Rice

1.  It's bland and tasteless, yet sweet - which may influence later food choices:  Try it - whilst the texture may be a new experience for baby, there's certainly no flavour enjoyment.  People mix things with it like apple or pear - why?  Why not just give the fruit?

Dr Greene in his paper "Why White Rice Cereal for Babies Must Go" states:

"Some taste preferences are hardwired. And different babies experience taste differently, in part because of hereditable differences in taste bud density.  But careful studies of human twins and of young animals suggest early exposures and social interactions outweigh genetics when it comes to food preferences.(11)"

"Indeed, up to 85 percent of the variability in eating patterns is due to environmental, not genetic factors.(12,13,14,15,16) 

We know in animals that the first bite of solid food can be particularly influential.(14) For human babies the moment of the first bite is laden with positive associations. The child has often been staring at the parents’ food choices, eager to learn what eating is all about. The child is the center of attention at an emotionally charged moment, often with a camera capturing the event.  The processed white rice flour is often mixed with breast milk or formula, giving it an even stronger positive association. 

Conversion of the white rice flour to glucose begins while the cereal is still in the baby’s mouth, lighting up the hard-wired preference for sweets (and the cereal is nearly 100% glucose by the time it is absorbed in the intestines). Given this “perfect storm” of extrinsic and intrinsic factors, both initially and throughout the formative months, it is easy to see how a preference for processed refined grain products could become firmly established, and later in life, challenging to change."

2.  It's outdated: back when guidelines suggested 3-4 month weaning (ie before the gut was closed) introducing what is considered to be a low allergen food that is easy to digest (due to the processing) was considered safest, otherwise food proteins can potentially provoke an allergic reaction.  If weaning commences when baby is ready ie they are reaching for food and putting it in their mouth, or at around 6 months as guidelines now suggest; the gut is closed and thus this is not an issue.  Furthermore, in small babies mixing with foods was to try and coax the baby to accept a flavour they may typically reject - a baby ready for solids is ready to enjoy full flavours too.  Those breastfed have already experienced a range of tastes via breastmilk, so why would they need a tasteless food?

3.  It's highly refined: and not in the elegant and cultured in appearance sense - but over processed like white bread which is stripped of nutrients by the processing   It is often then fortified with synthetic vitamins - some just with Thiamin (B1) whilst others are "enriched with 13 vitamins and minerals, like iron and zinc".  However these are less bioavailable to baby than those naturally occurring in foods.

4.  It can cause deficiencies:  consider that when a baby starts solids, the food is shown to displace total milk intake over a 24 hour period.  In a breastfed baby this means they are swapping calorific nutrient rich foods for a poor substitute.  Studies have also shown infants who received iron fortified foods (as some baby rice is) before 7 months, had significantly lower haemoglobin levels at one year than those who had not.  Excess iron also potentially causes harm to the body.

5.  It's high in sugar: Dr. Alan Greene, a paediatrician at Stanford University who started the campaign "white out" says:

"I have been studying nutrition very carefully for more than a decade now and one of the things that I have become convinced of is that white rice cereal can predispose to childhood obesity," said Greene. "In fact I think it is the tap root of the child obesity epidemic." 

Besides its touted digestion benefits, Greene said white rice cereal is also high in calories and made of processed white flour.

"The problem is that it is basically like feeding kids a spoonful of sugar," said Greene.

"The difference between white rice and brown rice is huge," said Greene. "White rice is basically 94 percent starch."

6.  It could be linked to diabetes: A 2010 study published in Arch Intern Med found Those who ate white rice 5 or more times a week had a 17% increased risk of type 2 diabetes compared with those who ate it less than once a month. Those who chose brown rice or another whole grain instead of white rice had up to a 36% reduced risk.

Another study entitled "Carbohydrate Nutrition, Insulin Resistance, and the Prevalence of the Metabolic Syndrome in the Framingham Offspring Cohort", found:

"Whole-grain intake, largely attributed to the cereal fiber, is inversely associated with HOMA-IR and a lower prevalence of the metabolic syndrome. Dietary glycemic index is positively associated with HOMA-IR and prevalence of the metabolic syndrome."

7.  It can contain Arsenic (yes really): From the NHS

"Rice fields are regularly flooded and arsenic is naturally present in the soil. Subsequently the substance is present at a relatively high level in rice. High levels of arsenic are reportedly linked to an increased risk of certain cancers. Researchers in this study tested levels in 17 samples of three unnamed brands of baby rice in British supermarkets and found that 35% of them contained high levels. The Food Standards Agency is reported as saying that there is no danger to infants, but that food regulations should be updated. There are currently EU and US legislations governing inorganic arsenic content allowable in water, but not in foods."

Brown rice is likely to contain more than white, so is not really a viable alternative.  There are currently no EU-wide regulations for arsenic levels in food after the European Food Safety Authority ruled that previous safety limits were inadequate.

8.  It can contain other toxic metals:  A study featured in the journal of Food Chemistry, found feeding infants twice a day on the shop-bought baby foods such as rice porridge can increase their exposure to arsenic by up to fifty times when compared to breast feeding alone.

Exposure to other toxic metals such as cadmium, which is known to cause neurological and kidney damage, increased by up to 150 times in some of the foods tested by Swedish scientists, while lead increased by up to eight times.

Researchers said:

"Alarmingly, these complementary foods may also introduce high amounts of toxic elements such as arsenic, cadmium, lead and uranium, mainly from their raw materials."

Read more 

9.  It's pointless:  Ultimately the question has to be - why use it?  Rather than why not.  There is no research or logic suggesting a baby needs baby rice, and given potential risks what are the benefits?

Breastfeeding Problems? Remember One Question...

The mantra of three year olds everywhere, "but wwwwwwhhhhhhhhyyyyyyyyy?", "why is the sky blue", "why do I have to put shoes one", "why can't I eat my sandwich doing a headstand next to the dog?".  Their pursuit of "why" is relentless as anyone who has been in that position will tell you - even when you think you have the best answer ever, they toss back a "why?" to that too!

A very common theme amongst the mothers I see are cracked/damaged/bleeding nipples (as those who read my last blog entry will remember.)  Yet bizarrely a huge percentage have also been told "latch is fine/good/great" - which sort of begs the question, why then is the trauma occurring?

If you bought a pair of shoes and got huge blisters, and the shop assistant said well the shoes fit absolutely fine - would you not ask why then you had blisters on your feet?

Breastfeeding is no different.

The other day it went like this (I paraphrase as I can't remember the exact wording):

Midwife: Your positioning and attachment is great, latch looks fine.
Mum: My nipples are very sore and bleeding
Midwfe: Ouch they look sore, put on plenty of lanolin
<Our Visit>
Mum (to midwife) The IBCLC I've seen has suggested my baby has lots of indicators of tongue tie
Midwife: No your baby isn't tongue tied (no examination/assessment) it's just down to positioning and attachment.

Woah, so we've gone from it looks great - to that's the root of the problem in the blink of an eye.

I wonder what the midwife would say if the conversation went like this:

Midwife: Your positioning and attachment is great, latch looks fine.
Mum: My nipples are very sore and bleeding
Midwfe: Ouch they look sore, put on plenty of lanolin
Mum:Why are my nipples bleeding if positioning and latch are good?

This can be applied to any area - why is my baby not gaining weight, why does he feel to be slipping off, why is she clamping/grinding etc, why does he never seem settled?  Then listen to see if you get an answer that satisfies you; it's normal or that's just what some mums experience does not qualify as an explanation, regardless of how nice the person is delivering it.

If you don't get an answer that makes sense and resolves the problem - be inspired by the  toddler phase of  "but why?".   Ask to be referred to someone who can help, or do your own digging to locate support, problems are never "just because", that answer is just as unsatisfactory when supporting a mum as it is to a three year old..

How I Think The Milwaukee Sleep Ads Should Look....

I'm sure most have now seen the Milwaukee Sleep Ads:

Here's how I think this one should look:

This is what the research shows, why demonise all bed sharing?

and

"You can say that half the deaths occurred while babies slept with their parents. You could also say that half the deaths occurred while babies were alone in their cots, he says, but: "I don't see anybody saying, 'Don't put your baby in a cot.'"

Professor Flemming, Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England BMJ. 2009; 339: b3666.


UPDATE: MAY 2012
Fox News investigate and report re Milwaukee deaths, a MUST watch!

The Duracell Bunny Baby

The Internet at times seems to have two distinct camps - the "expect them to sleep 12 hours" side, and the "it's normal for babies to only nap for half an hour, never want to be put down/sleep on a chest and wake every hour at night" side.

I (as usual) don't fit in either.

I often read from other mothers that very broken sleep must be normal, because their baby does it - some babies, even teeny weeny ones just don't need sleep!  If mums have had several children and some slept great, others not - this reinforces the belief it is personality; and in the past I would have agreed.  We call these babies "spirited" or "high needs", Sears writes a whole chunk about them here; and I think his descriptions are fantastic; but I think we can break it down even further and am not convinced personality is the whole explanation.  Yes babies are meant to be held close on a chest - does this mean that it's therefore normal they never want to lay down?  Babies are meant to sleep next to mum, but did cave woman sleep standing up?

Partly I think this has arisen as direct opposition to the "expecting 12 hours sleep camp", IE embracing baby's cues and being responsive.  But for me responsive parenting can also include exploring if there is a reason baby may be struggling to relax, if the parents feel that's something they need to explore.  That is not the same as suggesting not addressing the reason will lead to "bad sleep habits" or a baby that never sleeps better, babies change a lot as their brains and bodies grow.  Some will naturally iron things out as they mature going into the second half of the first year, some may be nearer 3 or 4 and some may continue to struggle to get to sleep/rise early, although the signs may become more subtle as sleep requirements reduce.

I'm not talking about training them to sleep, leaving them to cry or enforcing strict routines - but really watching baby's body language and cues to see if this is normal personality stuff, or, if he is desperately trying to convey something with constant waking and/or an intense need to suck.

Many parents I have discussed this with are those who have posted seeking advice - and they've mentioned replies are often to co-sleep, sling wear etc; but as they pointed out, what if they're already doing all that and still feel they have an issue?  Some say mum shouldn't ever expect a good chunk of sleep, that this is parenting and again I agree that there will be times baby is fussy and unsettled at night, certainly it's normal for babies to nightfeed - but does that mean therefore that it's typical for a baby to never be settled and sleep for longer than an hour or so?

With a first baby this may be easier, mum can nap when baby naps, head off to bed with baby at 6pm should she fancy - but throw 2,3,4,5 or more other children in to the mix, and/or work outside the home - and things can be very different, some mums are so exhausted they can barely function.

Whilst reassuring mums things are normal can be helpful, and there is a wide range of normal, there is also a range of what parents can cope with -  some may stop co-sleeping/breastfeeding/responsive parenting in a bid to save their own sanity or because their gut instinct is something isn't right, yet they have no idea what.  Whether these "work" in terms of changing behaviour or not is irrelevant, the impact to baby can be significant.

I'm of the belief there can be several reasons for consistently very disturbed sleep patterns or indeed a spirited/high needs infant, none of which involve bad habits, breastfeeding to sleep or baby needing to sleep in a cot to (say it with me) create positive sleep associations.  My feeling is that frequent wakers seek comfort, not that they wake due to a habit or reliance on said comfort to remain asleep; but what I want to focus on today, because it's a matter close to my own heart is the Duracell Bunny Babies (DBB).

How do you know if you have one of these?

Generally if the comment: "just go with the flow, babies will always sleep when they're tired" makes you laugh out loud, it's a pretty good indication; well they might, but no longer than 35/40 minutes in one nap (consistently), even if exhausted.  In exchange they might take lots and lots of little naps, day and night - or may stay awake for most of the day from a very young age and then wake frequently at night too.

The reality is that some babies do not sleep well despite being tired.  Nope, Nada no way - DBB are called such because they rarely seem to run out of energy!

DBB's according to Sears are:

"HYPERACTIVE"
"This feature of high need babies, and its cousin hypertonic, are directly related to the quality of intensity. Hypertonic refers to muscles that are frequently tensed and ready to go, tight and waiting to explode into action. The muscles and mind of high need children are seldom relaxed or still. "Even as a newborn, I could feel the wiry in him," one mother related."

Whilst many would recognise this in a toddler, being "tense and tight" are not characteristics we typically link with the label hyperactivity.  I like "hyper switched on/hyper alert", as I feel it's more descriptive.  Their muscles are often frequently tensed and tight - their muscles and minds do seldom relax, but is this always easy to recognise this in a baby?  I've put together some of the indicators I think define a DBB.:

Signs of a DBB:

• Baby appears very physically strong - many comment they head their head very early, sometimes from birth.  When they arch and push with their legs they feel strong and many are very early movers.  This is not related to size - baby may appear unusually strong for age/size.
• Baby is very alert from a very young age - being "very alert" is very difficult to describe, but many mums of DBB comment how alert their baby is (and often others have too) they are often described as "very switched on".
• They don't show tired cues - whereas when a typical baby starts to become tired, they slow down start to relax and show tired cues; the DBB is opposite.  They flip from awake to asleep without the relaxing/showing cues/unwinding.  One minute they can be playing happily, the next rubbing their eyes (an overtired cue) and if you have a tool like feeding to sleep/pram at this point, will typically suddenly zonk for a power-nap. Many DBB in my experience use either feeding/motion to sleep - not through habit but because it assists relaxation, they tend to be like marmite when it comes to  prams/carseats/motion, and either love or hate it.
• Hyper when overtired - some have a slightly longer window of doing the stage above than others, some flip straight to the almost hyperactive behaviour a very overtired baby displays.  They may struggle to keep still, fidget, fuss and cry a "tired cry".  Some resume play seemingly full of energy again although they may be short tempered or as one mum described "manic" flipping from laughing to crying in quick succession.  The parent ultimately feels the baby is tired yet wont sleep!
• Struggle to stay asleep - all babies have periods of unsettled sleep, for DBB's it's consistent and persistent month after month and comes with other signs here (as mentioned above babies can have unusually disturbed sleep for other reasons).  Baby may show signs of exhaustion with purple/blue bags appearing under eyes (whilst this may be a sign of food intolerance, lack of sleep will give you them too!) yet still no longer naps or stretches appear.  In fact often the more tired a DBB becomes, it seems the less they sleep!
• Co-sleeping makes no difference - baby still consistently wakes 1-2 hourly, it's likely to be more bearable but DBB's may want to be awake and playing in the middle of the night, regardless of where they are.  Others have an intense sucking need and are described as "Velcro babies who would stay permanently attached given a choice."
• Constantly moving - sit and watch a DBB and you will note they never keep still, even when tired  they do not relax.  A leg may be bouncing, an arm wiggling - but they're in some way always constantly on the move when not asleep.
• Mum feels baby is tired - some mums will acknowledge their baby isn't sleeping the huge stretches many mainstream books state they will, but that they are happy, settled and content with the sleep they are receiving.  Others though have a gut feeling their baby is just not getting enough sleep and desperately want to help them sleep better.
• Baby is very sensitive to mum's emotions - something I've noticed is that if you take an already tense baby, and you add a tense/frustrated mum, a lot of DBB's will become even more tense/unsettled and will struggle even more to settle; for some even just laying there willing baby to sleep seems to be enough to unsettle them!  If you're beginning to feel this way & are holding baby "change of arms" can help IE passing to partner can work, if no spare arms available laying down next to them on your bed or suchlike can be an alternative.  If you're "sleep willing", try and do some relaxation/breathing exercises yourself (great to teach DBB if they're still struggling in toddler hood too) to clear your mind and truly relax yourself, and you can sometimes be amazed how quickly this will help baby to settle too.  If all else fails taking a shower with baby is something many mums comment can be a good stress buster if home alone.
• May cry before sleep or upon waking - especially if tired, some DBB can seem prone to almost needing to cry to settle and again when waking ie they wake fussy and grumpy not happy and well rested.  Parents sometimes say he cries whether I'm holding him or not so I may as well put him down, but crying in arms is very different to crying alone.

Identifying why your baby is struggling to relax is perhaps the hardest piece of the puzzle because it can be several causes or just one, so finding someone to help work through things can be difficult; reasons can range from an undiagnosed tongue tie, food sensitivities, cranial or structural discomfort from birth and so on.  Something I believe can help these babies in the meantime is.....wait for it......*whispers* a rough sleep routine *sharp intake of breath".

Before you hit close hear me out!

Just because baby doesn't show sleep cues, doesn't mean they don't have a window of time in which it is easier for them to settle to sleep.  Some studies have suggested when a baby becomes overtired their bodies produce adrenalin and other "stay awake" chemicals, which is why they can appear to become suddenly energetic.

My own Duracell bunny had a predictable wake up time - OK so it was 5am, but it was predictable.  By playing with the gap from wake up to sleep, rather than watching her cues - I found trying to assist sleep at a particular time had more success than others; with the highest success rate before she showed any sleepy cues at all (the window was so small from this to overtired, she didn't get the "wind down" time she needed).  I started with the morning nap and then worked my way through the day, once I had a rough idea of times I then adjusted accordingly this based on how well she had napped earlier.

Of course the easiest way to do this with a younger baby is sling wearing - most sleep in a sling so they are "in position" for when they start to become tired.  Contact and movement can help many DBB's relax (some resist contact and the sling and arch away) and with many carriers a small adjustment can be made to manoeuvre material, and help cut out visual stimulation for baby (which some DBB seem to really need).  Some slightly older babies seem to prefer a back ride to a front carry; resting their head sideways on the wearers's back to nod off.

If this isn't possible/doesn't work/baby is older and wants to be down playing -  you can try putting baby in the sling at what you've worked out as the "optimum times".  Despite what any book tells you this will be variable for each baby. As an example when my daughter was taking three naps, she needed to be relaxed and ready to sleep two hours after she woke for the first sleep, despite books etc saying she should have a longer gap for her age.  

Clock watching is a total pain - if you have a baby that is happy without, I wouldn't recommend it to anyone!  But if you're struggling it's something you can try and which may help a little..

The last thing I would add is that the DBB can easily seem to get stuck in a cycle when overtired, the less sleep they get, the more frequently they wake.

Something that can sometimes help is "sleep cramming", which is doing anything and everything that works to maximise sleep for a day or two IE laying down with them when they nap, feeding them back off if they stir (and you're breastfeeding) long walks in the sling/pram.  Sometimes helping them catch up during the day can pay dividends at night/early morning wake up time - but with some it can be easier said than done.  White noise, reducing stimulation eg colours, sounds etc can also help "switch off", whilst I would never endorse baby napping in a dark quiet space as important (it's oftenblooming inconvenient)- for some DBB in my experience it does make a big difference; in my daughter even encouraging her to turn and face the wall instead of gazing around her room had a dramatic effect.

Above all remember your baby is not waking to manipulate you or because of anything you have (or haven't) done.   They're not trying to be spirited, or "high needs", or challenging, or whichever term you prefer to use,    in fact they're just as bewildered as you (if not more so).  Instead of being left to cry or trained, these babies in fact need more understanding and sensitivity than your average bear; whilst I've met many mothers who have regretted not responding more, I'm yet to meet one who wishes they had responded less - regardless of what the mainstream books say.

24 Hour Speed Raffle For Children In Need!!

RESULTS!


CONGRATULATIONS:


254, 216, 4, 338, 59, 139, 258, 209

I will email you in turn re prizes!

CLOSED

1 Ticket = 50p, 5 Ticket = £2

Upon receiving your donation we will reply with your ticket numbers.

Winners will be drawn using a random online number selector tomorrow evening, and results added to this blog post.

That's only 24 hours to buy a ticket!

Prizes: Each of the SEVEN winners will select a prize in turn until they're gone!  However one prize is a mystery prize....May be great, may be not great - that's the gamble!

Prize 1 = Pudsey Bear

Prize 2 = Pudsey's Beary Best Friend - Blush Bear 

Both from Build-A-Bear Workshop®

Following the success of last year’s campaign that sold over 11,500 bears, Pudsey and Blush Bear are back and now available at Build-A-Bear Workshop® stores nationwide.

Pudsey and Blush fans are able to make their beary own BBC Children in Need mascot at any of 55 Build-A-Bear Workshop® stores across the UK with £5 from the sale of each Pudsey and Blush Bear going directly back to the national charity Appeal. Blush Bear who is Pudsey’s ‘BBF’, likes playing the drums and dancing and is on hand to help Pudsey with his busy fundraising schedule, lending him a well needed paw when he needs it. Blush loves to have fun and comes with magnetic paws to help her cover her rosy cheeks.

In 2010, Build-A-Bear Workshop donated a bear-illiant £135,000 to BBC Children in Need through the sale of Pudsey and Blush Bear and this year they’re hoping to do even better with the addition of new clothing for the furry pair. Every penny raised helps to make a positive difference to the lives of disadvantaged children and young people right here in the UK.

Prize 3 = A triple chain of aventurine, sodalite and citrine gemstone chips, with a lobster clasp.

From Cluster Jewellery

Cluster jewellery produce handmade crystal & gemstone jewellery:

"Jewellery-making started off as a hobby of mine about 8 years ago and quickly turned into a mini-obsession! I really enjoy making pieces and go out of my way to source the best quality components: I only use silver- or gold-plated findings, some sterling silver as well; no nickeland nothing cheap and nasty. I use genuine Swarovski crystals, real gemstone chips, freshwater pearls and beads and some lampwork and glass beads."

Prize 4 = A custom twiddle buster nursing necklace 

From Monkey Mama Necklaces

Originally designed for nursing and babywearing mamas, Monkey Mama Necklaces are perfect for any mama who wants jewellery that offers style, safety and durability. The lightweight nature makes the necklaces easy and comfortable to wear.  Each necklace is created with handmade resin beads, with the lush colours of a candy store and the visual softness of seaglass

Monkey Mama Necklaces are created using super tough cotton cording and incorporate strong knotting techniques for extra security. The feature resin beads are completely non toxic and highly durable.  The beads that make up Monkey Mama necklaces are handmade in a small Indonesian craft business. They are fairly traded on every step of their journey to you.  Prize is a custom made twiddler in the colours of your choice!

Prize 5 & 6 = 2 x Brugo Mug

From Brugo Mug!

As I've given one of these away before, you can read the full lowdown on the mug here.  Brugo have in fact contributed numerous mugs to our mum and baby gift bags, so big thanks to them!

In short the mug  incorporates "Thermodynamic Technology", which in English means
not only does it keep drinks warm for several hours, it also cools some to the perfect temperature for you to drink....clever huh!

The lid has three options; lock, sip and tip and cool. When you first make your drink if you want to drink some straight away, you can twist the lid to the tip and cool setting. Tip the cup away from you for a few seconds and some of the liquid moves into the patented temperature control chamber.

You then swill with a "brandy" motion and that sip is instantly adjusted to the perfect temperature, while the remaining liquid in the main chamber stays hotter.

Prize 7......Mystery Prize......More details soon!

Why breastfeeding is NOT like taking a dump!

Earlier this morning whilst scanning the news, I spotted this article.  It outlines how a Michigan judge chose to publicly humiliate a mother; not for neglect, drug abuse or some other heinous crime judges like this must come across - but because she went to the back of the court room and began discreetly breastfeeding her fussing, unwell young baby.

When the mother defended her position by pointing out breastfeeding in public was her legal right, the judge claimed state laws did not apply in his court:

“Ma’am, it’s my courtroom, I decide what’s appropriate in here. Come on up, okay? You have to understand that a judge — the laws don’t apply in a courtroom. The judge’s law applies, do you understand that?

If this is indeed true, surely all attending should be given full details of what the the judge's whims laws are, otherwise how can anyone ensure they remain "judge's law" abiding?

Clearly anyone carrying a baby should be specifically told the  "breastfeeding is forbidden" rule - otherwise how are the mums supposed to know?  Given every health authority in the world (including the US) recognises the alternatives carry risks and so advise mums to breastfeed for a minimum of six months - why would anyone suspect a different US government building would defy state laws in order to prevent it?

The first comments that followed the piece were just as incredulous:

"Yes, breastfeeding is a natural bodily function vital for survival. 

So is taking a dump. 

But we don’t rail on about people’s right to do it in public. 

I’m sorry, as a woman and a feminist and a college-educated female feminist, I still think breast-feeding should be a private act and I fail to see why it’s such a horrible anti-feminist, anti-woman and anti-baby stance."

Had this been the first time I had ever had the misfortune to read such an ignorant rant, I would probably have just closed the page.  But comparing breastfeeding to toilet habits seems to be a pretty standard argument against public breastfeeding (particularly if you've ever picked up the Daily Mail) frankly it's crap, if you excuse the pun.

"As a woman and a feminist and a college-educated female feminist"

OK we get you're female and a feminist (twice) but it seems college clearly didn't adequately cover "bodily functions", so let's go right back to basics.

Feces

Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation. The word faeces is the plural of the Latin word fæx meaning "dregs".

The distinctive odor of feces is due to bacterial action. The perceived bad odor of feces has been hypothesized to be a deterrent for humans, as consumption or touching it may result in sickness or infection.[4]

Human breast milk

Breast milk is the milk produced by the breasts of a human female for her infant offspring. Milk is the primary source of nutrition for newborns before they are able to eat and digest other foods; older infants and toddlers may continue to be breastfed, either exclusively or in combination with other foods. 

After 3 to 4 days, breasts will begin producing milk that is thin, watery, and sweet. This quenches the baby's thirst and provides the proteins, sugar, and minerals that the baby needs. Over time, the milk changes and becomes thick and creamy. This satisfies the baby's hunger.[16]

The first contains potentially harmful pathogens that can cause sickness or infection, hands need thoroughly washing afterwards and thus a bathroom is a sensible idea; not to mention, where would you put a random dump in a court room?

The second is an antibacterial, antimicrobial substance that has been shown to actively kill infections - hands do not need washing post breastfeed; milk goes into baby.

I'm hoping I don't need to point out the differences between an anus and a breast!

Breastfeeding is no less hygienic than anyone else sat eating (and a great deal more so than some people's "washing machine style" of food processing that I frequently have to witness).  If the mum was sat squirting it around the room rather than into her baby's mouth, I could perhaps see the issue!

Next, does any one else see the irony in someone purporting to be a feminist, yet who also supports the suppression of women using their breasts for their intended purpose?

Isn't that rather like someone calling themselves an "advocate for same sex marriage", right before adding "as long as they are only a couple in private and don't rail on about wanting rights to be affectionate in public" ?  Then claiming they fail to see why that is an anti-homosexual stance....

Feminism

Feminism is a collection of movements aimed at defining, establishing, and defending equal political, economic, and social rights and equal opportunities for women

Yet men can even go topless in public right?

Breast Bottle

What makes it a private act, why is a real breast so much more inappropriate than a plastic replica of a breast and nipple, or just a nipple in the form of a pacifier? Would it have caused such a brouhaha had the mum pulled out either of those instead of the genuine article?

What should this mother have done? She presumably had to attend the court, she had to take her unwell nursling - had she denied his cues to feed, he would likely have cried, loudly; is that appropriate for a court room? Would that not have disturbed proceedings far more? No doubt then the "dump brigade" would have been tutting and muttering about how inappropriate the noise was.  Perhaps babies just shouldn't be allowed in public full stop?

Society needs to realise that milk of our own species is the normal way to feed a baby, and if it's a location a baby is permitted, a mother has a basic human right to be able to feed her baby as he requires without doing so in a toilet or a stinky nappy changing room.  Why should a hungry baby incapable of waiting, have less right to eat than an "educated female feminist"?

Related Posts: 
Breastfeeding mums should use a bottle in public!

Breastfeeding in public is offensive - see for yourself!

Let's do breastfeeding covers

Tips for breastfeeding in public if you feel self-conscious

Emma's Pregnancy Diary - Armadillo Style

When the lovely Emma (who helps as an admin on Facebook) rang me to share some news, I thought it would make perfect blog fodder to share with you all.  Ever modest Emma wasn't sure people would want to read her story, but after a little harrasement asking nicely, she kindly agreed <grin>.


Whilst we see lots of journals shared by first time mums, I thought hearing from a mum of two planning her third addition might be of interest to those who already have children and perhaps are thinking about more! :D

Over to Emma:

I'M PREGNANT....Well, it’s a good start. That was the plan. We’ve been “trying” for quite a few months, but as my periods haven’t started since the birth of son #2 and I’d had no signs of ovulation so I didn’t think that we were going to get anywhere fast.

The Armadillo is chuckling heartily at this point, because I recently rang her recently to discuss my nursing son’s fussy behaviour and tiredness. When she asked if pregnancy was a possibility, I assured her it wasn’t – because of course, I was sure it wasn’t.

Quite how I came to find out I was pregnant is another story in itself - so here’s what happened.

Given that I knew quite clearly I could conceive on my first ovulation, I was looking out for signs of egg laying (fluids, cervix position and Mittelschmerz, I wasn’t bothering with temperatures). I pride myself on being pretty switched on with this stuff; Which as they say, comes before a fall!

So I didn’t notice any signs of ovulation, and was assuming that they were still suppressed by son #2’s breastfeeding. I’d been chatting to my breastfeeding counsellor about ways to trigger ovulation, and we were aiming for a 5 hour gap within each 24 hour period as for some women this is enough to get things going.

However, given, I thought, that I may just miss that I’d ovulated, and given that I might just conceive on that first cycle, I thought I’d be very smart and be one step ahead of myself. So I ordered 20 cheapy ebay tests for about £2 so that I could take one test every 2 weeks, thus knowing for sure when I wasn’t pregnant, so I would then know how far on I was when I did get pregnant.

They duly arrived and I quickly did one, just to get a job out of the way, and nearly passed out with shock when the pink line appeared. It’s a good thing that I bought 20, as I used the next 10 straight away (well, you never know). It’s a good thing that hubby works from home so I was able to go straight up and tell him. That put a grin on his face.

So the next question is – how pregnant am I?

I’ve been really, really tired for about three weeks now and just not managing to keep up with my normal “stuff”. So, I’m guessing 7-8 weeks would be about right. I’ve obviously conceived on my first ovulation post delivery, which is great, which would make it about 13 months without periods. Good old breastfeeding.

Now to see if I’m right…


24th October

I’ve booked in with the midwife this Friday. I’ve actually moved surgeries to do so! I am a peer supporter and one group that I sometimes cover has a midwife drop-in at the same time. The midwife is really pro home birth, and a few months ago was running a big fun day at the local Children’s Centre to raise money for homebirth pools. I was very happy to be able to help, running a stand for our local NCT group. A friend made an amazing cake with a waterbirthing mum and baby on top! That went into the raffle and was very much admired including by one small boy (not mine!!) who decided to try to have a taste. It was a good day. I liked the midwife so much that I decided to find out which surgery she was at, so this afternoon saw me filling in new patient forms for me, Son #1 and Son #2 (hubby is sticking with his GP, thank you very much).

The receptionist asked me how pregnant I was and I was very embarrassed to say that I had no idea, but I guessed 7-8 weeks. Hopefully my midwife will be able to give me a better idea!

UPDATE TWO

28th October
Midwife booking appointment - she was as lovely as expected and delighted to take me on as a homebirth booking. We had a good chat about my last two births and how things didn’t go as planned, and why I was so determined to home birth this time. She explained about the Trust’s obligations to provide a home birthing midwife and how to be firm on the day should it be necessary.

We discussed some of my really big concerns, such as the PPH (post partum haemorrhage) that I’d had last time and how she would handle it and was extremely reassuring. In both my last deliveries I’ve aimed for an unmanaged third stage. With Son #1 they got very jittery and scared me after an hour had passed, and persuaded me into the injection. With Son #2 they were very encouraging and supportive, and all was fine, but then I did start to lose blood which was rather worrying for everyone and I ended up very weak after birth and anaemic for some months afterwards. It was all fine, but I think a bit less messing around with me and a bit more letting me get on with it would have ensured the contractions would have racked back up more quickly and limited the blood loss.

So after all of this, out came the pregnancy wheel and she asked me when my last period was. I don’t think that “2009” was helpful! So she then asked me if I’d any idea of my dates and I had to make a full confession: not only did I not know how pregnant I was, I’d not actually thought I was pregnant when I took the test!

Once we’d established that I for one couldn't help with dates, I popped up onto the couch and she had a rummage around.

Shock number two – she estimates 12-14 weeks. Aarrgghh!

31st October
Emergency scan at a private scanning clinic as the NHS can’t offer me a scan for another 2 weeks. We want the nuchal scan (Down’s Syndrome test) and if I’m really that far on then that might be too late for the nuchal. Despite been here twice before with Sons #1 and #2 it didn’t make it any easier. In a sense we didn’t really know why we were doing it because if it came up as high risk, what then? It’s not a diagnostic scan, just a screening giving a risk, not an answer. We really don’t want to have an amniocentesis with the risk of miscarriage. I think we’re both burying our heads in the sand a bit and hoping for the best.

On the other hand it all seems a bit silly, because there are so very many ways in which a baby may have problems, so why a low risk result would be reassuring I don’t know! Still, it was wonderful to see that the pink pregnancy test line had magically morphed into a cute little baby shape, complete with heartbeat and nasal bone (which apparently is a good thing on the Down’s test). Baby measures at 14 weeks! It seems to get longer every time! I have a blood test taken to get the most accurate screening results which we’ll get in a few days.

We drive home armed with lots of fuzzy piccies of a rather skeletal looking baby and memories of the sound of the heart beat, hugely happy and excited and just ever so slightly embarrassed. Or I am, at least. Hubby really can’t believe that I’m over 3 months pregnant and didn’t know. So much for me being “in tune” with my body. Much ribbing was undertaken.

3rd November
Flu jab. I’d been told in no uncertain terms that contracting flu could be quite dangerous for a pregnant lady so after some research I decided to go for it. I’ve never had one before so was hoping I wouldn’t have a reaction to it. Everyone seemed to be really pushing it at the surgery and saying that it was totally safe, etc etc, until I actually got to the nurse who did the jab who then proceeded to tell me that it was untested in pregnant women (because it’s unethical – but apparently quite ethical to just dole them out), we don’t know if it’s safe for the baby, blah blah. I made some comment about how it’s been around for a while now and we’d have heard about any significant problems to which she replied, “well we’d hope so” which didn’t fill me with confidence! I asked if my having the vaccination would pass any immunity onto Son #2 through my milk, which she didn’t know but she did then pull out all her documents to see if it was safe for lactating women (which it is, apparently. Either that, or untested!). Nice that she didn’t bat an eyelid that I am breastfeeding a toddler (who was with me causing havoc and destruction as is his norm).

4th November
UK Association for Milk Banking Trustees meeting today. We’re planning some awareness campaigns including one in May so I fessed up to the fact that I was likely to be busy on or around the 1st May. A fellow trustee with 3 children made it clear that I was totally nuts by joining the club J. Ah well, at least we know it’s not twins.

And we got the results from the nuchal scan! Excellent result – risk of 1:21,000 compared to my age-related risk of 1:175. It is a relief and yet I can’t help but wonder why. There are so many disabilities out there, so why did we put so much score on just one? And then there was the awful question of what would we do if the risk factor came back as a high risk? This is a screening test, not a diagnostic test. Would we then risk the diagnostic test with a miscarriage rate of between 1:100 and 1:200? And let’s say we did that, and it came back as positive for Downs. Then what would we do?

 
These questions, in one form or another, are questions that most pregnant mums or couples will need to work through, even if it’s only to decide that they’ll have no screening at all. For us, we chose to bury our head in the sand and wait for the screening results, feeling that there was no point in trying to resolve the “next step” questions unless necessary.

I feel very lucky in many ways that we have reached this point in this pregnancy without having the weeks of anticipation. I think one of the hardest things is finding people to discuss it with because of the high levels of emotions involved with all “options”. We can now close this door and move on – at least until the 20 week scan. But many people can’t, and that’s tough to think about.

I wish that a more open discussion about the euphemistic “options” was possible. I don’t think that anyone can imagine themselves being the parent of a child with a serious disability, but the idea of aborting one’s child is also abhorrent. For some it would never be an option and for others it would be the only choice. Emotions, quite rightly, run so strongly on both sides that to even think about mentioning it risks deep distress – and yet not talking about it leaves mums approaching screening in a state of confusion and worry. This is why I have written this post. I don’t have any answers but I know I’m not alone in wishing that there were some.


UPDATE THREE

7^th November
I took Son #2 for a cranial osteopathy session today.  He goes every 4-6 months after this was recommended by Milk Matters.  It seems that babies who are born with tongue tie are more prone to having cranial tension, and Son #2 had the additional problem that my waters had broken 5 days before he was born so without the cushioning effect in utero he got a bit more squashed than he might have been.  He was actually a “C” shape when he was born – I called him my little comma!  It took him a week or so to straighten out but there was definitely tension left in his little head.  The work now, though, is to ensure that as he grows the normal tension from just living and getting bigger is released a couple of times a year.  He’s got a high arch palate (related to the tongue tie) and these few things together mean that going just every so often seems to help. 


Afterwards he slept for 4 hours in the afternoon, then went to bed at his normal time and slept brilliantly overnight so clearly something positive happened!

24th & 25th November 
Could it get any better? I’ve just spent 2 days at UNICEF’s Baby Friendly conference in Liverpool That’s right – 2 days talking breastfeeding and child development!  Absolutely fantastic.  I travelled over with a friend who is a Breastfeeding Counsellor and we stayed overnight which was a bit scary as it’s the first time I’ve been away from Son #2 for that long.  I was planning on getting the first full night’s sleep for 2 years, only it was far more interesting chatting to my friend!  We eventually stopped nattering at 1pm.  But it was worth it.

The conference was fab.  There were some amazing speakers, perhaps most notably two speakers discussing the ways that babies’ brains develop and how they learn to love and have solid, positive relationships from before birth to just 6 months into their lives.  It’s a case of “use it or lose it” with the human brain, and if they don’t receive that love and care then it’s much harder for them to learn to give it.

Much guilt all round as each of us sat there and remembered our not-so-positive mummy moments, but of course there are extremes in all this and really what we are talking about is proper neglect and its life-long impact on a person.

Most tragic was the brain scans that were shown of babies born into a healthy, loving family and babies who were raised in those horrific Romanian orphanages.  It clearly showed the differences between the development of the babies born into the loving families and the virtual absence of certain areas of the brain for those who went through the most severe neglect.

More chirpy talks came from a lady from the US who was discussing the studies that she’s done in her hospital’s NICU into the ways that a mother’s own breastmilk makes a highly significant difference to the outcome of a premature baby compared to babies fed artificial milks.  She went into the science of how this works, from colostrum to mature milk, and how formula disrupts this process.  She works in an area with dreadfully low breastfeeding rates and they have achieved an initiation rate of 95% which is incredible!  They have paid peer supporters – including a fella – who work with the parents to talk through their mutual experiences and to encourage them to see their milk as medicine for their precious babies.  They do weekly discussion and support groups where they introduce specific topics so parents can not only go through things that are concerning them, but they’re learning about the science as well.

Sadly the rates of breastfeeding after the babies are well enough to leave the hospital aren’t so good due to the cultural pressures put onto these women.  However many of them leave with months of expressed milk so their babies can at least continue to be fed breast milk for quite some time.

One disappointing talk was by one of the founders of the website “Mumsnet”.  The topic was “What Mothers are Talking About” but a great deal of time was spent talking about Mumsnet as a company, and very few slides were dedicated to actual discussions from the site.  This was a shame as I feel that Mumsnet discussions are a great way for Health Care Professionals to see what’s being said from “the other side”.  She greatly emphasised Mumsnet’s support of the Nestle Boycott and their decision not to allow formula advertising but at the end of the talk she was asked why in that case their logo featured a woman holding a baby’s bottle.  She replied that it was filled with expressed milk which, to say the least, was not well received as an answer…

It was very exciting to meet two fabulous people at the conference – Mike Brady of Baby Milk Action and Gabrielle Palmer, author of the wonderful “The Politics of Breastfeeding” and the essential “ComplimentaryFeeding”.

On a personal note, I’d taken my pump with me in case I needed it, only I found I’d missed a critical part.  I’ve never been good at hand expressing so was a bit concerned, but in fact I was fine and didn't get too full.  By the time I got home late on the Friday night I was definitely ready to feed him, but he was also very happy to me my boobs so all was well!  Apparently he’d been signing “milk” at nursery in a rather sad way all day, but otherwise had been fine.  I was glad to be back together with him, his brother and my lovely husband though.  Getting a break was great, and coming back was even better! 

One final note to the conference, I did see a few people there who have helped me on my breastfeeding journey with son #2 and I did wonder how many people go to a conference and see 4 different people who have seen their boobs!

7^TH December

We’ve had a tough few days and I’m exhausted.  Son #2 has been unwell following the over consumption of oak milk (if allowed to he will drink gallons of it and he did a play-off between hubby and me where neither of us realised we were both filling up his cup”).

Following my night away at the conference we decided that we were going to have another go at night weaning him.  He’s 18 months and clearly doesn’t need the food, as he usually just has a quick suckle and he’s sleeping again.  Problem is that I’m getting pretty tired even though I’m only halfway through this pregnancy, and I’d like to see if him not getting a boob will encourage him to not bother looking for it if he wakes, and go back off on his own.

We’ve tried it before and he’s got upset so we’ve just let it go (neither of us being really bothered about it) and this time it seemed to be working well.  We had a cup of water for him in case he was thirsty and he did sometimes have a sip of that and settled straight back to sleep.

But, it’s all gone pear shaped since he’s been unwell, even though it was only one night of a poorly tummy.  Since then he’s been not only waking frequently from about midnight onwards but absolutely refusing to sleep again (even when given a boob) and I’m on my knees right now.

On a positive note I’m feeling lovely baby movements which I am really enjoying.  S/he’s doing little rolls and some quite solid kicks from time to time, and my favourite me-and-baby time is when I’ve just snuggled into bed next to a sleeping son #2 (hubby is currently consigned to the spare room with his snorey-coldey head) and I lie there in the darkness just tuning into my baby’s play.  I am so loving being pregnant and with this being the last time (or at least the last planned time!) I want to try to make the most of it.

I’m looking forward to a call from our region’s Independent Midwife tonight.  Hubby and I have decided that we are really nervous about trusting our homebirth to the NHS.  While our midwife is passionately supportive of homebirth, and the region is very good at providing good homebirth cover there have also been instances of women being told to come into hospital as there’s not enough cover.  While I know that I can fight this when the time comes, I feel that fighting’s not the best thing to be doing while in labour.

UPDATE FOUR

12th December

20 week scan!  It’s a bit scary going to these scans when the point of them is to check on the health of the baby, and I’m always a bit nervous about what they might find.  Of course at the same time it’s just so exciting to have the chance to see him or her!  Sneak previews are ace.


I made it very clear that “we” didn’t want to know the sex when we went into the scanning room, but then had to clarify that it was actually that I didn’t want to – poor hubby rather did!  But he went with it anyway, and didn’t look until she’d finished doing all the important checking of everything stuff and was able to give us a peek while keeping away from sensitive areas…  We got a beautiful photo where the little face is really clear.  All seems well from what they can tell, and the placenta is in a good location, so that’s all for now.


I was annoyed, though, to see a banner in the entrance which stated “it is dangerous for your baby to sleep in your bed…” especially given that the hospital is working towards Baby Friendly status, and this is absolutely not the guidance that they’re supposed to give.  They can say that the safest place for a baby to sleep is in a cot (etc) your room for the first 6 months but not that it is dangerous to bed share.  In fact, the evidence shows that safe bed-sharing by non-smoking parents who have not taken drugs or alcohol, and with a safe set-up of the bed, can protect against SIDS and it certainly helps to maintain breastfeeding which itself has a protective effect.

I’ve emailed UNICEF/BFI about it.  Will be interesting to see what they think.

13th December

Nights are improving!  Son #2 is taking to night weaning really well again.  He’s sometimes sleeping longer, too, but even when he wakes there’s no crying at all.  He will drop straight off again with a pat and a back rub – in fact probably quicker than on the boob really!  Feeling so much better about life.

19th December

It’s funny, I just don’t seem to have been focusing on this baby as much as I’d like to.  With my other babies I spent a lot more time thinking about them and preparing for them.  It’s partly because it’s not such a novelty, now, being pregnant, and partly because life is so busy with a toddler and young child! 

So I’m really making an effort to connect with the smallest one at least every morning and evening.  I spend time listening in to what s/he’s got to say, to his or her little wriggles and kicks, and thinking about how life will be when s/he arrives.  It’s lovely J

21st December

Breastfeeding is much more comfortable now, although I’m still getting discomfort on one side so I’m going to see someone about it in the New Year.  I think it’s an attachment issue but if not I want to get to the bottom of it before this one arrives.  I’m terrified of going through the pain and agony that we did with his undiagnosed tongue tie.  My milk supply is dramatically reduced by the pregnancy but he’s still loving his boobies.  He’s clearly not getting much from me and he comes off pretty quickly, but he’s asking maybe 4-5 times a day.  I don’t always say yes but sometimes it’s nice to have the excuse to stop and sit down for a few minutes!  I’m not worried about accidentally weaning him by not always letting him feed when he asks (a la “Never Offer, Never Refuse” method) as he seems enthusiastic enough and if he does slow down his asking I will begin to offer more.  We still have our lovely, snugly, early morning snooze feed and he usually feeds to sleep. 

I need to get together with some tandem feeders to work out positions for tandem feeding because he generally feeds in a cradle position, which will get in the way of the smallest.  Another job for the New Year!

But in the meantime, present wrapping.

1st January 2012 

Happy New Year it is then – or certainly a very busy one.  Christmas was quiet, and lovely, with a big kid well into the swing of things and a little kid who just loved the paper, boxes and the Christmas Tree decorations.  A lot.

I have such mixed feeling about handling “Santa” and all the Christmas “stuff”.  I hate trying to force Son #1 to write Christmas thank you cards.  I know he appreciates the gifts but like most children he just doesn’t want to take the time to say so.  I feel awkward about the whole “Santa” thing as we try (and often fail, to be fair) to be honest with him all the time, but to not go with it seems rather unfair too.  I tell myself it’s all a bit of fun, make sure that there’s gifts from us too (don’t want him to get all the credit!!) and just go with it.

It was fun seeing Son #2, at 1 ½, just starting to realise that something special was going on.  It was also the first time that we’ve been around a lot of family since he was tiny (the only seeing people at Wedding, Christenings, Funerals and the odd Christmas effect).  I was surprised that I was slightly uncomfortable about breastfeeding an 18 month old in front of people who didn’t know that I was “still” breastfeeding and who weren’t strangers.  It was fine but it wasn’t something I’d expected.

3^rd January 2012 

“Booking In” appointment at the hospital today.  Following this experience we’ve decided that we are absolutely, without question going down the route of hiring an Independent Midwife.

Although the midwife that I saw was really lovely, I’ve come away with “high risk” highlighted on my notes.  Why?  Because:

a)      Last time my waters broke at 36 weeks, and

b)      I had a PPH after the birth of Son #2 which was marked on my notes as 500Mls (not technically a PPH) but was in fact a lot more of this (judged by my doula (mum), a retired midwife herself and the fact that I was nearly given a blood transfusion a few days after birth).

This means that if I transferred to hospital, or indeed planned a hospital birth, I’d automatically be pushed to have continuous foetal monitoring, no waterbirth, a managed third stage, probably augmentation of labour if I didn’t progress “fast” enough (which is unlikely as my labours are fast).  I’m under “shared care” which means that I’m under a consultant as well as a midwife.  Now this is all very well, and I appreciate that the NHS wants me and the baby to be healthy and well, but this just is not the way to go about it.

My waters breaking early before does not make me high risk per se.  If they break early again then the risk is to be dealt with at the time.

The PPH was clearly caused by a combination of the following factors:

• I chose a physiological third stage.  This means that I didn’t want the artificial hormone to release the placenta which is given by injection to most women just after birth.  This then requires the uterus to continue to contract naturally which after a straightforward and non-augmented labour should be fine, but the Oxytocin levels need to be maintained after birth for this to work well.  This means keeping mum warm (very important), comfortable, relaxed and secure.  Not, as I was, pulled out of the birth pool, dripping wet, cold, naked and vulnerable which interfered with my body’s ability to contract and deliver the placenta.
• With a managed third stage the injection is given and then it is important to ensure the fast removal of the placenta to avoid it being trapped.  Certain interventions can happen at this stage including various bits of messing around with the uterus externally and sometimes even pulling on the cord.  It is very, very important to not do this as a matter of course with a physiological third stage but unfortunately in the hospital environment many midwives don’t understand this, and assume that a physiological third stage just means not having the injection, and getting on with everything else.  It is likely that the messing around that was done to me triggered excessive bleeding.

None of this makes me high risk next time round as long as my birth attendants ensure that my third stage is treated with the respect it deserves.

I found the book by AIMS (Association for the Improvement in Maternity Services), “Birthing Your Placenta - The Third Stage” to be extremely helpful in my understanding of what is likely to have happened to me, and what I can do to avoid it in the future.

January 18^th 2012 

Trustees meeting for UKAMB (UK Association for Milk Banking) today which was, as always, very interesting.  I’m a trustee of this brilliant charity and currently working with a wonderful volunteer web designer to create a new website.  I donated milk with Son #2 and I’m so glad that I did.  He had an undiagnosed tongue tie which was only found by Milk Matters when he was 6 months old.  I’d had a really tough time breastfeeding him as it was always painful, never a nice experience, at least for me (he is a major boob monster so I’m assuming he likes it!).  It was such a relief when Charlotte spotted his tongue and lip tie and the high arch palate which so often goes with it.  Because of the tongue tie he had to work extra hard to get milk which explained his ultra-long nursing sessions, but unlike some mothers in my situation whose milk production can be affected by inefficient milk removal, I’ve always had a strong milk supply.  It is likely that my daily expressing for the milk bank was enough additional stimulation to ensure a robust level of production.  Kind of a karma thing, I like to think!

January 19^th 2012 

I’m about 25 weeks pregnant now so certainly over halfway.  I really have mixed feelings at this stage about that.  I’m so determined to really enjoy this, my final pregnancy (or at least that’s the plan!).  I want to remember every moment of feeling my little baby growing and wriggling.  I’m getting bigger, just starting to feel a bit uncomfortable, and a bit fed up of peeing at night but on the whole it’s just lovely! 

At the same time I just feel nervous about the idea of my waters breaking early again and want to get to term as soon as possible so that I know my baby’s ok.  That was the trigger for a week of horrible stress and worry, with lots of pressure from the hospital to go in for induction but a real frustration that there was no information at all given about the risks of induction, or indeed the size of the risk of not being induced and the potential for infection.

We spent 5 days in front of the computer, going from no knowledge about PROM (prolonged rupture of membranes) to knowing an awful lot about it!  We ended up with a great consultant who was very happy to talk through what we were learning but despite him being the senior consultant in the region it seemed that he had huge gaps in his knowledge!

For instance, he told us that being induced was the same as natural labour because the same muscles were being used, so it was no more painful.  I pointed out that in spontaneous labour the body is also flooded with endorphins which counter the experience of pain, and it’s not the actual level of pain that is important, it’s the perception of that level of pain.  He did concede this but I wonder how many other mums have been given this incorrect view of induction?  We discussed the risks of induction such as an increased risk of C-Section, or instrumental delivery (which are very high), versus the risks of waiting for spontaneous labour in the absence of any sign of infection (which increases the risk of extremely serious, possibly deadly infection to the baby but the risk of this happening in any case is absolutely miniscule).  None of these things were offered for discussion; everything was brought up by us. 

He also had no knowledge of the risks to the baby’s gut of IV antibiotics in labour.  He did not mention at any time the risk to the life of the mother from anaphylactic shock, and that the number of women who die from prophylactic and almost certainly unnecessary IV antibiotics in labour is not hugely different to the number of babies who die following delivery when an infection is present.  He did not mention the diverse range of medical opinion over whether, indeed, the antibiotics significantly improve the outlook of babies statistically.  He did not mention the babies who die from infection post birth not from the birth itself but from contracting something completely separate within the hospital but with an bacteria that cannot be treated because the antibiotics given to ward off an infection that may have not been there in the first place have caused resistance in the bacteria that is now making the baby sick.  And he did not know about thrush, and how painful thrush in the milk ducts is, and that antibiotics can make the likelihood of contracting thrush much more likely.

There is no right or wrong choice when something happens such as premature and/or prolonged rupture of membranes, Group B Strep infection (although treated with IV antibiotics in labour) and other “higher” risk factors.  All parents must make their own choice for themselves.   What I find so upsetting is that the information to make these informed choices is just not given.  Waters break and mothers are “on the clock”.  They are told that induction is important “to avoid infection”.  They are not told why, and this, to me, is a travesty. 

24^th January 2012 

I decided to pop along to my NHS midwife to see if I could talk to her about borrowing one of the community birthing pools.  Unfortunately the surgery messed up and while I’d asked for an appointment specifically with the midwife that I’d hoped would be able to be at my birth, it turned out that she was on holiday.  So I saw her colleague – another community midwife who could just as easily be the one on call when my time comes.

I asked her about the birthing pools.  Her reaction?  “You have to speak to ‘M’ about that – she’s the one who is into that home birthing stuff!!”

Thank goodness we’ve signed on with the Independent Midwife.  I knew I was with the right person when we both sat nursing our toddlers at the booking-in appointment!

30^th January 2012 

Peer support update training.  Very useful but I was finding it hard to sit for the whole 2 hours in a low, “comfy” chair and had to switch to a more upright, firm one.  I’m definitely getting bigger!

4^th February 2012 

That’s it, I’m off to buy some maternity clothes!  I am alternating between a lovely, comfy pair of maternity trousers from last time and a seriously tatty pair of jogging bottoms.  I’ve not got enough tops, although finding nursing maternity tops is tough anyway!  We’re going to York to Paul Stride, a nursery shop which sells a really good range of rear facing toddler seats because I want to get ours checked for fit as we’ve bought a new car ready for the new arrival (it’s tough to find one with three proper seats at the back that isn’t an SUV!).  There’s a water park there which we’ll take the boys to, and afterwards I’ll go across to the retail park and do some shopping.  Wish me luck… I hate shopping!

Later…

Well hurrah, success.  Toddler seat was fitted properly (phew), water park was loved by all (note to self, swim more, it feels great to take the weight off the bump) and I’ve bought 2 nursing tops which are really long and cover my bump really well, a nursing tank which can be worn under a normal top but covers my huge belly, and the most comfy pair of maternity trousers ever created.  Nice one Mama and Papas.

Shame the rest of the store was filled with very, very pretty, very, very expensive and almost totally unnecessary “stuff” which shouts “buy me” very loudly.  OK, so most people want a cot.  Some babies never sleep in it, others use them from day one until well into toddlerhood.  We have a cot.  Son #1 slept in his cot from 2 weeks old, in his own room and Son #2 has never slept more than 5 minutes in it (once we managed to pop him in when he was deeply asleep but he almost immediately woke up and screamed blue murder).  Baby number three will join us in our bed and we’ll play it by ear from there – although if they do prefer their own space it will be in the cot next to us, not in their own room.

But is it really necessary to have a cot, all the trimmings, a matching moses basket, matching mobile, soft toys, curtains, floor mat, nappy changing mat, nappy stacker…? 

Don’t get me wrong, there’s nothing wrong at all with choosing to buy these things.  It can be such a huge pleasure to go and buy beautiful nursery items and have everything waiting for your baby to come and complete the picture.  But I just wish that it wasn’t seen as necessary.

9^th February 

I covered a breastfeeding group today as the peer supporter.  I get so broody looking at the little babies.  It’s a good job I’m pregnant!  I do really enjoy it but I really do feel that sometimes it’s frustrating when I can’t “fix” everything.  Fortunately we have a brilliant NCT breastfeeding counsellor/IBCLC in our region, and a small team of IBCLC qualified lactation consultants from the PCT as well as a large team of paid and volunteer peer supporters.  It worries me, though, how few people know the differences between the different people who offer help – although not surprising.  There is no legal protection for the term “breastfeeding counsellor”, few people know what the term “peer supporter” is so often they assume that a peer supporter is a breastfeeding counsellor and very few people know what IBCLC means.  Fortunately, Milk Matters have a useful page on it all here: http://milkmatters.org.uk/2010/11/12/whos-helping-you/

21^st February 

Midwife appointment again with my fabulous Independent Midwife, Debs from Wharfdale Independent Midwifery.  As always she stayed for well over her 1 ½ hours and went through all sorts of questions with me.  I was being called in for my 28 week blood tests and when I’d spoken to the NHS midwife about them, she just couldn’t give me any useful information about what was being tested. She did mention that it included rhesus antibody testing but I pointed out that I am rhesus positive and this is my last baby anyway, so, I asked, was there any need?  Her only answer was, “it’s up to you” which wasn’t at all helpful in helping me to make an informed decision.  Fortunately Debs was there to go through it all and help me to come to the right decision for us.  It’s a non-intrusive test (if you can call a needle non-intrusive), meaning that it’s not going to affect the baby or me in any way, but it’s another thing to fit into the diary and that’s not easy right now!

22 February 

UKAMB trustee meeting today.  We’ve decided to get the new website live by the beginning of March – eek!  Very exciting to actually get it up there though (to be seen at http://www.ukamb.org).  We are so lucky to have a fabulous volunteer who has done almost all the work on it for us (thanks Rebecca!).  Hoping to make it a really useful resource for all potential and current donors of breastmilk, hospitals, milk banks and health care professionals.

28^th February 

Hypnobirthing session!  Well this is new.  I did something relaxing!  And it was lovely.  I’m really hopeful that it will be useful in labour but finding the time to actually practise it (and practise is key) is going to be really, really tricky.  I definitely recommend it though!  As much as anything to just have a break in the day!

10^th March 

Sheffield Home Birth Conference! 

What a brilliant day.  I was on the UKAMB stand with Gillian Weaver (one of UKAMB’s founders) and also had the opportunity to listen to all the talks as well.  The visitors were mostly either midwives or student midwives and they all got to hear about the effects on the critical hormonal components of a natural birth of standard “interventions” such as just going into hospital, pain-relief drugs, artificial rupture of membranes and just being around people that the mum doesn’t know. 

It was a wonderful day with everyone learning so much about the way that birth is a hormonal event, using the analogy of sex.  If we had to “perform” under bright lights, in hospital, with random people coming in and out to check on progress and threatening us with drugs if we didn’t get on with it I’m not sure that many babies would be being born at the other end of it all!

We had loads of interest on the UKAMB stand with lots of people going away with information on donor breastmilk banking and why it’s so essential for the health of premature and sick babies.  We had an amazing boobie cake donated by my friend Victoria which we raffled off to raise funds for the charity.  A very successful day all round!  http://ukamb.org/2012/03/11/donor-breastmilk-focus-at-the-sheffield-homebirth-conference/

11^th March 

Eeek, lugging those boxes around and standing around all day has done nothing for my pelvis.  Ouch!

15^th March

Great.  I’m supposed to be giving a presentation today, together with one of our regional Lactation Consultants, for people who have passed the council’s “Eatwell” award – a way of encouraging catering outlets to offer healthy options on their menu.  The award includes asking the outlet to be breastfeeding friendly, but with the Wakefield Breastfeeding Welcome Scheme now launched we wanted to make it a bit more in depth, and also bring companies onto the scheme where possible.  However, I’ve pretty much lost my voice and I feel really rubbish.  Just a cold but still, it’s a nuisance.  Well, here goes, I’ll do my best.

Later… well other than sounding pretty odd the whole day went really well.  We got several companies signing up and lots of interest which is fantastic.  All we need now is some funding!  Off to bed – I’m shattered.

16^th March 

Had to cancel my hypno session today as I just feel rubbish.  Lots of Braxton Hicks going on and I’ve been finding it quite hard to sleep at night as well.  This cold I started with last week is really taking hold and I think I’m heading towards chest infection territory.  I usually shake things off quickly but being pregnant lowers your immunity to help to stop the body from rejecting the foreign genes in the baby.  Really feeling rotten and just exhausted.  Is it being ill or is it being very pregnant?

19^th March 

Went to docs this morning as I’m convinced I now have a chest infection, ear infection and probably a sinus infection.  I am exhausted and am sleeping 2-3 hours a day, and just can’t do anything without it wearing me out.  I’m in awful pain across my ear, around my eyes and a horrible headache and I’m coughing badly, too.  Doctor says it’s just a viral infection so I suppose I’ll have to wait it out.  I’m not the world’s best patient though!

Midwife back again this afternoon.  Slight concern that the baby, at just 34 weeks, is now definitely engaged which I’d thought was the case as my bump has dropped significantly and pressure has lessened on my lungs (good timing with my cough) but I can really feel it in the pelvic area.  Not good when I’m coughing a lot, having that lump on my bladder!

So all out now for getting the last few things sorted out.  Pool arriving in a couple of weeks and my friend is sorting some girls and boys newborn clothes out for me.  I’d always expected an earlier arrival but I really do hope it’s not just yet.  34 weeks is too soon L

22^nd March 

Feeling utterly terrible so my lovely hubby took some time off work and drove me to the health centre.  We were lucky to see a fabulous prescribing nurse, who knew about the Breastfeeding Network’s drugs in breastmilk line (http://www.breastfeedingnetwork.org.uk/drugs-in-breastmilk.html) and was able to ensure that what I was given was safe for both breastfeeding and in pregnancy!  She said that I was in fact right, I had a serious ear infection (no wonder I was so ouch), sinus infection and a chest infection.  Given me some antibugs and hopefully they’ll start to work soon.  Maybe I feel so rough because I really am ill, not just pregnant!

25^th March 

Finally, the antibugs are working and I’m starting to really, really feel so much better!  I can actually do things with my todder without feeling horrendous and we can turn Cbeebies off!  Definitely it was being ill, not being pregnant, although at nearly 35 weeks I’m starting to really feel the weight, not to mention that bowling ball in the pelvis sensation.  I’m getting nervous about tandem feeding again after a friend has had a gorgeous little girl and her toddler, a few months older than mine, has gone milk mad!  My son’s latch is pretty poor so I hope I can cope with it.

28^th March 

Birth pool arriving by the end of the week and my friend has given me my birth ball back and lent me her TENS machine.  Just need to get practising with the hypnobirthing now and hope that the little one hangs in there a bit longer…