Friday, May 29, 2015

Weaning Before You Expected

Breastfeeding my daughter has always been something so special to me. I feel blessed to be able to provide such perfect nourishment, not to mention comfort, for her. I always knew I wanted to allow her to self wean, especially because she had such a strong attachment to her nursies. However, sometimes things change and we have to adapt.

I found out I was pregnant when Nora was around 19 or 20 months. In the beginning there was expected discomfort during nursing. I always found ways to distract myself and push through it. At this point, she was nursing a handful of times during the day as well as 4-5 times each night. Once some of that pregnancy exhaustion set in, it was so difficult to keep waking up so many times. We also decided it might be a good idea for Nora to slowly and gently transition to her own bed (we were still bedsharing) so that it wasn't a sudden change when her sibling arrived.

As time went on, nursing became more and more awful for me. I started feeling so bad every time she wanted to nurse! I developed a pretty severe nursing aversion that I never would have expected. I mourned the loss of our enjoyable nursing relationship while struggling with feelings of guilt over the way I was feeling. There were times when I wanted to rip my skin off and push her away from me when she was nursing. After trying to battle through this for some time, I decided the current relationship wasn't healthy. I was starting to resent her and have very little patience with her. When I stepped back and took a hard look at the situation, I realized holding out for a goal of self weaning wasn't best for us when I was so resentful and really struggling. Breastfeeding is a tandem relationship and should continue as long as mom and baby/toddler are mutually happy. When one isn't, it may be time to reassess.

I utilized the book Nursies When the Sun Shines to help us with the transition. Before we started, I spent about a week talking to her about nursies going to sleep at night and everyone sleeping all night long. We read the book consistently, then jumped in one night. Of course she was extremely unhappy and let me know it, but I continued to snuggle with her in her bed and provided comfort in other ways. It was hard on both of us and took some time, but she finally got to the point where she would easily accept when I told her "nursies are sleeping and mommy needs to sleep, too."

The day weaning was a little tricky, but I also had other ways to distract her. I would also gently tell her "nursies are hurting mommy right now. It's time to be all done with nursies." It was heartbreaking when I would deny her something she had been used to her entire life and she would be distraught, but we worked through it.

Today she is a vibrant little two year old awaiting the birth of her baby brother. We talk about how baby brother will eat nursies, and she doesn't seem phased by that at all. Of course she may be more interested once her actually arrives, and we'll cross that bridge when we reach it. My advice for anyone struggling with a nursing aversion is to give it a little time to see if things improve for you, then decide if you need to change course. Try not to let yourself feel guilty. I think many times as moms, we forget to take care of our needs and they get put on the back burner. While I'm not saying to become selfish and only consider yourself, you must make sure you are a happy mother to be the best you can be for your family. Be kind to yourselves, mamas!

Napping with baby brother

Enjoying a beautiful day on the lake

Thursday, March 19, 2015

Breastfeeding Twins - An Interview

I recently had the pleasure of interviewing Deborah, a mom from my local LLL, who breastfeeds her twins. They are almost 20 months and still going strong. Wow, how amazing! Deborah didn't plan on having a caesarean section, but developed HELPP (a severe form of preeclampsia) one day shy of 39 weeks. With one baby transverse and the other breech, it was decided that delivering via c-section was the safest thing for everyone. Many women think that having a c-section will reduce their odds of successful breastfeeding, but Deborah proves that wrong. She shares some information that is helpful whether you are breastfeeding multiples or just one nursling. Thanks for sharing your wisdom and story, Deborah!

Q: Many moms think they can't breastfeed with multiples, but you're proof that's not true. Tell me what it's like nursing twins?
A: I think the best statement for breastfeeding multiples is to be flexible and open to change. As they grow their needs change, and being flexible and open to change makes things much less stressful. I exclusively breastfed my twins and my two older children. I remember while pregnant my own mother asking me if I was planning to breastfeed. When I answered yes, she was astonished and asked how I would be able to do that. I just said "Luckily God blessed me with two boobs for two babies!" This is how I breastfed - I would switch breasts with babies. If Baby A fed on the left breast, then the next time Baby A ate, I would switch that baby to the right breast and vice versa with Baby B.

Q: How did you maintain good supply?
A: I wasn't really focused on milk supply, per se. I made sure (along with my husband) that I ate and drank plenty of fluids. Also, I nurse on demand and allow the twins to nurse until they are done. As long as they were growing as expected, I left the stress of trying to figure out if I was producing enough milk for others to worry about. As a mom with newborn twins, a two year old, and a fourteen year old, I had enough to be concerned about. So if an issue presented itself, then that would have been dealt with. Now every momma has something that they are concerned with and even though, for me, this was not a concern, there were many other things that did come up as concerns. Concerns go with the parenting territory and what is easy for one may be hard for another. This is why we need each other for support and help!

Q: We all know that we can reach a point of feeling touched out. What do you do when you have two babies who need to nurse and you just want some alone time?
A: Many times I have to assess what is really wrong with me. Why am I cranky, upset, or spent? I had to build a short list of things to check off to help me quickly determine what my issue(s) may be so I can be available for these babies that don't know anything about what momma might need. Short checklist - When did I eat? When did I have something to drink? Am I still sleepy? If I am irritated, when did I start feeling this way, because that timeframe is where the trigger is and what about the circumstance irritated me. I give myself permission to not solve the problems at that time but if I at least know what the problem is, I am able to give myself and my babies a little more needed grace because I know what the problem is and that I may not be able to address once I have taken care of the babies.

Q: What is the most difficult and most rewarding thing about breastfeeding two babies?
A: I think the most difficult thing about breastfeeding two babies has been when we are out in public and they are nursing multiple times back to back. You know they are nursing for more than just eating, but sometimes it is hard to address those needs in that situation when it's both of them at the same time. I usually have to tell myself to focus on baby and not on other things going on so that I don't get stressed because most times, the babies are just sleepy, teething, or not feeling well. So when I focus on them and figure out the issue, the situation is easier to deal with.
The most rewarding thing is having that alone time with them. Gazing at them while they nurse, sometimes to sleep, snuggling and cuddling, because once they are on the move they don't slow down for long. Plus, it is such a short amount of time when you look at it in the grand scheme of things that it reminds you to slooooow down and enjoy the moment!

Q: What advice can you give to moms wanting to nurse twins?
A: The advice I would give is to determine what your true "goal" is; don't worry about a length of time; don't worry if everything is perfect; and enjoy the time, because it is only a moment in time. If your children live to be 80 years old and you nursed them for 1 year, that time is so small in comparison.  Make sure you surround yourself with as many supportive people as possible. Build your breastfeeding support network prior to your babies arriving. Attend LLL meetings, get in contact with a local lactation consultant, join a mom's group or playgroup, determine which family members are supportive and have them around in the early days. Most times, whether a mom of multiples or a singleton, most breastfeeding issues or questions come after visitors are gone, in the middle of the night, or some seemingly inconvenient time. If you have these relationships already established, you will be more comfortable calling on these people during these times. Most times they can help bring a stressful situation to a place where you can see yourself through it.

Q: In the early weeks of no head control, what advice/tips do you have for tandem positioning?
A: The things that helped me were a wide rocking recliner, pillows, and a twin breastfeeding pillow. I spent many nursing sessions in the recliner. I would cradle one twin in my arm, then lay the other on a pillow that rested on the recliner's arm. If I nursed on the couch, I would nurse them using the twin breastfeeding pillow in a football hold. If I were nursing in the bed, I usually added a couple pillows to help me and the babies get comfortable. I would also add that for night nursing, having a dimmer switch for your lamp is essential. You don't have to have extremely bright light, but enough to see what's going on and to make any adjustments. The dim light keeps you and the babies from "waking up" completely and is less disruptive.

Q: What was most comfortable for you - couch, floor, recliner, etc?
A: The recliner was the most comfortable as long as I had an extra pillow. I could cradle one baby in my arm and nurse the other while they laid on the pillow on the arm rest. It left an available hand/arm for adjusting, drinking water, stroking baby's face, etc.

Q: If you nursed simultaneously, what advice do you have for keeping them on the same schedule? If you nursed separately, what worked for you?
A: I did both as I nursed on demand. I think the advice I would give for those that nurse separately is to consider nursing simultaneously at night, at least so that as a parent you are able to get as much sleep as possible while nursing both babies. Nighttime nursing twins separately was lots of lost sleep as one would wake up and by the time I was done nursing and putting that baby back to sleep, the other would wake up. The caveat to that is my twins have two different sleeping patterns, and even when I nursed them at the same time, one would notoriously still nurse at a different time later. So I guess I would say as before, remember to be flexible because what works for one mama/baby may or may not work for the next mama/baby.

Q: One mom asks "I did A LOT of nursing in the car when we were out and about in the early weeks. Is that even possible with twins and how do you manage?"
A: I nursed wherever I was. I rarely made a beeline to my car for nursing. The thing I found out in the early days of being out and about was that, for me, it was easier to nurse them separately because when I nursed them together in public, I felt like all eyes were on me even if they were just sideways looks. Those thoughts made me extremely uncomfortable and nursing in public uncomfortable. So instead of waiting for the twins to realize they were hungry, I would just somewhat anticipate when they might be ready to nurse and initiate the nursing, then nurse the next twin. Because they weren't at the point of "needing" to nurse, it was easier for the other baby to "wait their turn" or be distracted by the world around them.

Monday, March 9, 2015

Adventure 2.0

Early in the morning on February 15th, after weeks of prodromal labor and wishing she would arrive, she did. She came fast and furious and is absolutely perfect. C2 was born in three pushes with the help of my amazing husband, a nurse who I was reluctant to have at first but ended up being one of the best labor nurses I have ever met and my OB who I don't know how to have babies without. The birth story itself is for another time and place but I will just say that it could not have been more perfect.

Once she was born and placed on my chest, aside from a brief pause so I could visit the loo, my amazing 7 pound 9 ounce princess stayed on my chest and nursed for about 2 hours after she was born and remained there snuggling for another hour or so before they weighed, measured, footprinted and otherwise processed our new addition. This labor and delivery were so much different than the 11 hours of pitocin, continuous fluids and for the most part being bedridden in labor with my son to then be draped and put in stirrups for delivery. This delivery was so much less traumatic on me since I had fewer interventions and less traumatic on my daughter for all sorts of reasons, including her being in a better position than my son was during his delivery. I really believe that all of this contributed to me having a better supply and establishing a better breastfeeding relationship with her right off the bat than I had with my son.
Remember when I said that I was fairly certain I made skim milk with my first? Guess what - full fat, full force this time around. My son was a few weeks earlier and about 3/4 lb smaller than my daughter. He was constantly on the breast and never....ever slept. The princess eats, gains and sleeps! She was discharged from the hospital weighing just shy of 6 oz less than birth weight and was back up to her original weight before she was two weeks old!

I'm not saying all of this to boast or to get atta-girls on the birth, my supply or even my wonderful daughter. I am saying all of this because it is NIGHT AND DAY from one child to the next. I suffered with slow weight gain, jaundice, low supply, pumping, supplementing with pumped milk daily and the lack of sleep with my son, plus the post partum anxiety and depression for months after. By the grace of God, we haven't had to deal with any of that this time around. To the mothers who had awful breastfeeding experiences with the first child and are debating giving it a go for another round: please do. Please don't be discouraged by the rough patches that come with being a first time mom, a first time nurser and all of the things that come along with it. Please don't decide to deny your second child the most amazing gift of your milk, snuggles and the things that go along with it because you are afraid of having the same experience the second time around. I can tell you that I haven't and I am so grateful. I'm not giving any sort of guarantee, but there is hope, I promise.

I kind of wondered what I was going to write about this time around. I thought I was going to have the same issues but I'm definitely not. In the year to come, I hope to write on tandem feeding, over supply, diet, returning to work and whatever else comes our way.

I'm truly looking forward to sharing the second chapter of my Adventure with you all.

Til next time mamas - 
Keep Calm and Nurse On

Monday, March 2, 2015

A Letter to My Sister

I love being pregnant. This second time around has been even more joyous because my sister is pregnant, too. We've been best friends for nearly 29 years and have shared so many milestones with each other. So far this one is probably my favorite.

Even though you and I don't share that kind of history, we have both experienced the fears and hopes that are part of anticipating motherhood. I'm hoping you'll hear my heart in this letter and tuck away the bits that resonate with you.

Dear sister,

I've been ruminating on so many things that it's difficult to sort through them and find words that are as cogent as the way they seem when they are just thoughts in my head. I will do my best though.

I remember so vividly the day you called me to tell me your big news...and the day I called to tell you mine. Lots of "aghhh!" and "oh my word" and "I am SO EXCITED!" And in the months that followed there was lots of "What do you think about..." and "What did you guys do for..." Your firsts have often followed mine, but the exciting thing about this first is that it's not just my footsteps you can use as a guide. You are being ushered into an ancient legacy, one much bigger than the sisterhood we share. Women the world over have experienced this anticipation and though each of our experiences is unique, they are all the same, too. It's a beautiful gift, one I know you thank God for daily. It's also an enormous responsibility, one that can seem heavy at times. You have so much on your mind these days; there are a few things I want you to know.

You think about labor and delivery being just around the corner. I know how strong you are. No matter what happens, I have complete faith that you will kill it in that delivery room while the rest of us wait outside, praying and cheering you on. Natural birth, medications, c-section, will come out the other side as a mother and none of it will matter.

You think about what you'll need as you sift through gifts and check off your list. Pack your bag. All the other sorting and organizing is nice to have finished, but not a necessity. Be sure to slow down these last few weeks and savor some alone time with your husband, some alone time with yourself, and relish the ability to run into Kroger for 2 minutes to grab a gallon of milk.

You think about the hard seasons you've seen me and other moms go through, especially at the beginning. I know the stories of raw nipples and sleepless nights can seem intimidating, but those tough days are temporary and far outnumbered by days full of joy. In anticipation of the challenges you may face, I promise to tell everyone that if they truly love you, they will bring you food. Tuck away this little gem and this one...they are two of the most helpful resources that kept me sane in those chaotic moments when I doubted myself. It felt like such a relief to know I wasn't alone...that what our new little family was experiencing was normal.

You think about whether you will be a good mom. I know without a doubt the kind of mom you'll be. You're an enthusiastic aunt, a genius game player, a compassionate listener, an affectionate friend. You see people's problems as an opportunity to love them better. Your best qualities will be just what your little guy needs to learn about the way he should go, and your shortcomings will be an opportunity for all of you to grow.

You think about the love you know now...the love of your creator, your husband, your family, your friends. Just wait. I know the feeling you'll experience when you meet your sweet baby will help you understand true love better. Like a friend told me once, it's Big Love.

You think about the unknowns, the big decisions, the uncertainty ahead. I know that you are blessed to have a steady and supportive husband and many loving friends. Surround yourself with people who know you well and respect your goals and dreams, whether they are about breastfeeding, parenting, nutrition, etc. I want you to know that I am here, too. I am ready to listen, to pray, to advise, or simply just be with you whenever you need me, as only a sister can.

Sister power 4 lyfe.

Love you,


Monday, February 9, 2015

Lactation in Court: Your Rights at Risk (and One Case to Watch)

Last week, I was directed to a headline that read, "Supreme Court lets stand ruling that firing woman for breastfeeding not sexist because men can lactate." I immediately thought "that doesn't sound right," and set off to investigate. The heavy partisan bias of the site and the lack of sources induced further skepticism, but I felt that such a claim must have originated somewhere, so I followed my diligently-Googling fingers to an ACLU blog post that had been heavily quoted in the first article. The headline was likewise sensational: "Firing a mom because she's breastfeeding is sex discrimination." Again, the ACLU post referenced the court's supposed claim that lactation is not unique to women (more on that in a minute), but again, no sources for this opinion were provided. What's more, the original headline of the first article has since been changed, possibly in response to a Snopes article that points out the misleading language.

What WAS certain was that a breastfeeding woman had lost her job, the circumstances pointed to possible discrimination, and a petition appealing the case had been submitted to and denied by the Supreme Court. Given the massive consequences this could have for breastfeeding mothers, really ALL mothers, I jumped down the rabbit hole to find the truth.

Don't start raging yet. Soon, I promise, I will give you a reason. Probably not the reason you think, though.

The Case: Ames v. Nationwide

First, a quick overview of the case, Ames v. Nationwide (yes, that Nationwide):

Angela Ames was a Nationwide Insurance employee who gave birth to her first child after seven months at her job, and discovered her second pregnancy five months after that. At this point, she claims she became the target of mocking and derogatory comments from her direct supervisor, Brian Brinks, and the head of her department, Karla Neel, regarding the intended length of her maternity leave, her weight and appearance, and her medical need to go on bed rest as a result of a difficult pregnancy.

Ames's second child was born prematurely, and during her maternity leave, Neel called to inform her that the length of her leave had been miscalculated, and she would need to return to work sooner than originally planned. Though further unpaid leave was available to Ames, Neel suggested this would send up "red flags," and offered a compromise of an extra week beyond paid leave. Ames, who was breastfeeding, called a disability case manager to ask about available pumping facilities, and was told that lactation rooms were available.

Upon her return to work, Ames needed to pump, and sought out the lactation room. After receiving an indifferent response from Neel, she was directed to the company nurse, who informed her that she needed to fill out paperwork that would take three days to process before she could be permitted access to the lactation rooms. Since Ames had not pumped in hours and was in considerable pain, the nurse offered an alternative room, but it was not immediately available and did not comply with federal guidelines for a suitable pumping space.

While waiting for an available room, Ames met with Brinks, and claims he told her that none of her work had been completed while she was on leave and that she was responsible for completing all of it within two weeks, even if that required overtime and at the risk of official discipline if not finished. Now fearing for her job and in even more pain because she still had not pumped, a visibly distraught Ames again sought out Neel for help. Neel then handed her a pen and paper, saying, "You know, I think it's best that you go home to be with your babies," and dictated a resignation letter to Ames, instructing her to sign it.

As a result, Ames brought suit charging sex and pregnancy discrimination, and later a claim of constructive discharge, on which much of her case depended. Constructive discharge means a forced resignation, usually because working conditions are made deliberately intolerable with the intent of causing an employee to quit rather than be terminated.

How is the Supreme Court involved?

Second, a grossly-oversimplified layperson's explanation of the case's route to the Supreme Court:

The case was initially tried in District Court in Iowa, where the events occurred. This trial court ruled against Ames, with two primary arguments: one, that she was unable to prove that she was treated at all uniquely for being a woman (particularly a mother and lactating woman), and two, that she did not adequately seek available redress prior to her resignation, as a "reasonable person" would. It was in the footnotes of this court opinion that the odd reference to lactating men was included, to support the assertion that lactation is not a sex-based condition and therefore could not prompt sex discrimination.

Next, Ames appealed the decision, taking it to the Eighth Circuit court. This appellate court affirmed the decision of the district court, but did NOT reference any of the more outrageous claims found in the original opinion, including the men-can-lactate-too argument. However, the decision of this court carries considerable weight, as its ruling is now binding for the entire Eighth Circuit, and may be referenced as precedent in cases before other circuit courts.

Now gaining the support of the ACLU (in an excellent little brief, I might add: well-worth the read), Ames petitioned the Supreme Court for a review of the case. Her attorneys sought this both for an appeal of the ruling and because several of the Eighth Circuit's opinions regarding constructive discharge conflict directly with readings by the other circuit courts, meaning only the Supreme Court can settle the dispute. The Court denied the petition, which means they will not hear arguments at all and there are no further avenues for appeal available to Ames. However, this does NOT mean that the Supreme Court has affirmed the circuit court's ruling as the Eighth Circuit did, and its denial should not be taken as approval of or agreement with any arguments made by Nationwide.

"Reasonable persons" and lactation as a choice

Is this fair? Are these bad rulings? Were Ames's rights infringed?

It's hard to say, because lawyers are good at what they do and, with scruples or without them, they can make a case. Even as a legal-illiterate, I can follow the logic that led to this outcome. But I can also see an equally logical path to the opposite conclusion. Some context that I think was overlooked:

The courts made much of Ames's failure to report her harassment and ill treatment to HR as a "reasonable person" would, citing that as their primary reason to reject her claim of constructive discharge:

"The Court is not insensitive to the burdens and stresses associated with parenthood, particularly those experienced by new mothers. Being under stress, however, does not excuse Ames from doing what any reasonable person in her position would have done. Therefore, the Court concludes that no reasonable fact-finder would determine that the unavailability of a lactation room on July 19, 2010 would lead a reasonable employee in Ames’s position to believe that her only option was to resign."
This ignores several important points:

One, that Ames had been a victim of a sustained campaign of harassment and intimidation throughout her pregnancy, both from her direct supervisor and from the department head. As it was a physically challenging pregnancy, Ames would have been suffering from physical discomfort, fear for her unborn child, the need for constant medical care that would interfere with her work, the mockery of colleagues and superiors, and of course fear for her job. Also, she already had a baby at home, and though other stressors are not cited in the court documents, it is also possible that her health insurance and her family's financial stability depended at least in part on her job with Nationwide. Any of these factors, combined with pregnancy and postpartum hormones, could easily and understandably make Ames less reasonable than she might be otherwise.

Second, Neel demonstrated a clear pattern of manipulation in her behavior toward Ames: First came her comments that were evidently intended to make Ames feel guilty for her need to go on bed rest during her pregnancy. Then, when she called to let Ames know that her maternity leave had been miscalculated and she would need to return to work earlier than originally planned, she made threats to Ames' job should she choose to take a longer unpaid leave. After thus putting her on the defensive, she then magnanimously offered an extra week of leave to Ames, assuring that Ames would return to work both fearful for her position and indebted to Neel for her apparent graciousness. Finally, it was Neel who suggested Ames resign and who offered her the pen and paper and dictated her resignation letter to her.

Third, though there are several references to Ames's "considerable pain" or discomfort of engorgement from going so long without pumping, it is very clear that no one who ruled on this case has any idea what that feels like. While of course judges are called upon to be as objective as possible in their rulings, the physical sensations Ames was experiencing, coupled with her extreme fear for her job that had been systematically instilled by her superiors, would have seriously affected her ability to make considered decisions. Engorgement can be agonizing, tortuous even. If you were in terrible pain, and someone offered you a pen and paper that would bring you relief within the hour, would you choose that, or wait hours longer to attempt to resolve the problem "reasonably," even knowing you might be unsuccessful? Of course not: you would take whatever option would allow you to end your pain sooner, and to expect otherwise is ludicrous.

Furthermore, the courts seem unable to understand why Ames could not simply wait the three days required for her paperwork to use the lactation room. As mentioned above, it would be extremely painful and very distracting to her, making it difficult to do her job. Remember, she had just been informed that she needed to complete eight weeks worth of work in only two, after months of harassment and direct threats to her job from Neel. She knew she couldn't afford to be distracted. Moreover, having to go three days without pumping would likely lead to early breastfeeding cessation for Ames, since lactation is a supply-and-demand system. The courts surely don't care since, in the judges' minds, there's always formula, but this shows a clear bias against breastfeeding women. They expected Ames, as a "reasonable person," to simply stop breastfeeding if that was what was necessary to keep her job, even though federal pumping laws were written to prevent exactly that.

Indeed, the rulings define lactation as a "choice," and not as a medical condition associated with pregnancy. Despite the fact that lactation is a natural biological feature of pregnancy and birth, even for unfortunate women whose babies do not survive, the fact that its continuation requires effort apparently disqualifies breastfeeding as a medical condition. No protections for it are therefore recognized. In fact, the court documents even mention that because federal pumping laws include no provision for enforcement, the law is essentially invalid.

What does it mean for me?

So, that's where we've landed with this case: regardless of whether these particular rulings were correct, there is now a strong precedent in favor of employers who do not support breastfeeding mothers. Employers like Nationwide can exploit the physical and psychological condition of mothers like Ames, set unreasonable expectations for their use of lactation resources, and if they happen to overstep federal pumping laws, it's no big deal because those laws have no teeth anyway. While the headlines concerning this case are grossly misleading, it's absolutely true that the outcome of this case could have tangible negative effects on breastfeeding moms.

One last thing: there is a related case that ALL MOMS should follow for the effect that it might have on us. In Young v. United Parcel Service, a woman is suing because her doctor ordered a weight-lifting restriction during her pregnancy, but UPS did not honor it and demanded that she continue with the same duties as before. She refused, so she spent much of her pregnancy out of work, and ended up losing her insurance coverage. The Supreme Court DID take this case, and is currently deciding whether pregnancy and related conditions can be classified as temporary disabilities and accommodated accordingly, or whether mothers being treated as equals means they must perform the same work they would do if they were not pregnant. Since the status of lactation as a pregnancy-related condition is still in question, it could potentially fall under whatever ruling the Supreme Court makes. The outcome of this case will have significant consequences for working mothers, so keep an eye on it!

As always, we welcome your comments! Do you think the ruling in favor of Nationwide was fair?