If I asked myself if pumping was being used as a magic fix for common, yet easily managed, breastfeeding concerns I would have to say "yes, it is". The idea to pump instead of, or in conjunction with, breastfeeding is often suggested to mothers by their support people. These support people include other new mothers and experienced mothers at places like Mommy and Baby Yoga, Mommy and Me time, Kinder Music, Baby Signs, the museum, StarBucks, online support groups, mommy chats, any place mom's and babies hang out together; you all know where mommy's go. Other support people are their mothers and mother-in-laws, sisters, sisters-in-laws, aunts, grandma's, that old family friend; again, you know who these people are. Of course, other new mother's support people include Health Care Providers like doctors, nurses, midwives and the complementary support people like doula's and childbirth educators. And, in case you are not aware, these people include many that did not breastfeed themselves or were not successful in their attempts to breastfeed.
Most new moms have the intention of breastfeeding, as so as expected, it comes up in conversation. People feel the need to ask new moms how breastfeeding is going, new moms feel compelled to seek out support in these early weeks or health care providers are following up mom and baby. When moms are asked about breastfeeding they share the concerns they have with breastfeeding in hopes that someone can help them. Here is the list of common complaints and one likely answer they will receive to alleviate that concern.
Sore Nipples -> Pump and bottle feed
Baby not effectively sucking -> Pump and bottle feed
Thrush -> Pump and bottle feed
Engorged -> Pump between feeds
Plugged Duct -> Pump between feeds or pump and bottle feed
Needing to feed in public -> Pump and bottle feed
Over Active Let Down -> Pump before feeding
Low supply -> Pump between feeds or after feeds
Baby not sleeping -> Pump and bottle feed or have someone else feed
Colic -> Pump and have someone else feed
Foremilk/Hindmilk concerns -> Pump before feeding
It appears that pumping can be a common suggestion to alleviate the most probable breastfeeding issues. We need to be aware it is not a magic fix, it is most likely to be a band-aid, and it does not "fix" anything. We also need to be aware that pumping can create more issues.
These are just a few ways this pumping band-aid could create more issues for mom and baby.
With sore, bleeding, cracked nipples, generally the most common concern, generally easy to fix, pumping only results in double the work. Why would a new mother want to add in all the extra work of pumping and bottle feeding when getting some assistance with position and latch could make the problem go away, in even the very next feed? Or one of the many other solutions with have to help with the pain and healing. Often long term pumping is not going to sustain a babies needs and milk supply like breastfeeding directly from the breast would. Often breastfeeding relationships end far sooner than mother's intended due to supply issues because it leads to supplementation or another feeding method all together. This might not be the case all the time, as some mothers, do exclusively pump, but there is unique difference between a mother who makes the decision to exclusively pump compared to one who is trying to get baby nursing pain free at the breast and needing to pump in addition to.
How about that baby that just is not sucking effectively or will not latch? Let's see, how do people learn? We learn by doing. If we take baby away from the breast, how does he learn? Again, we need to support moms and babies in positioning and latch and innate instincts that babies have to feed and let them learn together. If habitual placement is still not getting baby latching and sucking, we need to further evaluate what might be going on with that baby. Ignoring the difficulty baby is having and turning solely to the pump does not make the original issue baby was having go away.
Thrush is no reason to stop feeding at the breast. The reality with pumping with thrush is that mothers now have more parts and equipment to treat or throw away. Thrush can sometimes take time to clear up but it spreads so easily, we need to restrict what comes into contact with the thrush to stop the spread of it, not add more to it. There are medication and alternatives that we can use to treat thrush and the discomfort of thrush as we are trying to eliminate the nasty little bug it is.
Milk supply works on supply and demand so as well as pumping to relieve engorgement seems like a good idea right now, later on the fullness comes back and generally more full then the previous time, as a mother's body thinks that is milk that baby needed. If moms are engorged because a baby is not eating or draining the breast, then the answer is to get the baby eating and draining the breast, not pumping. The more baby is at the breast the less engorged mother's will be, assuming baby is eating well. Again, back up to latch and sucking. If baby is not waking to feed and mom is starting to fill up, mom can put baby to breast and encourage that baby to eat, to play his role in this breastfeeding relationship. Another concern with engorgement is that as much as it may seem logical that when mothers are engorged, it means they have a good, healthy milk supply, in fact the opposite can occur. The more often a women is engorged, the faster her milk supply will start to decreased. When breasts are full it sends a signal to the part of moms brain responsible for milk supply to slow production down and milk making cells start to shut down, resulting in less milk in the days ahead. Pumping when engorged can also pull more fluid, and not just milk, into the breast, resulting in edema. Often that fullness or edema is confused for milk and "good supply".
Plugged ducts are uncomfortable, in fact down right painful, and yes moms want them out, but pumping is not the most effective way to unplug a plugged duct. In fact it can lead mom right back to the engorgement stage and create the spiral onwards from there, when the easiest way to get rid of that plug is by using baby, again, or some other strategies that are much more effective.
I am starting to see a larger amount of women pumping so they can feed their baby while out and about. First, people that want to go out in public just need to accept that mothers and babies go out in public, too, and mothers and babies use breasts to feed. Secondly, mothers need to be informed about how this "solution" really is only one that is feasible for a small time. Each feed mom misses at the breast impacts that supply and demand mechanism again. If mom is out and is not feeding baby or replacing a feeding session without pumping again her body and brain communicate this to each other and the process of milk supply slows down. This again goes back to what I mention early about keeping up supply, supplementing and ending the relationship early than expected.
Over Active Let Down is a problem that some moms struggle with but again pumping can just aggravate this problem. It is an easy problem to aggravate as it can lead to the engorgement issue and when baby is ready to feed, mom is ready to burst with milk and when the let down occurs it is like opening up a dam. Baby gets flooded with milk, has trouble managing flow, staying latched, becomes upset and this all causes frustration in mom and baby. Positioning, latch and frequent feeds are the easy fix here. On the other side of it, some babies have a hard time handling a normal let down, but it mimics and over-active let down. We need to be sure that we know if we have a baby that is struggling with a normal flow or a true over active let down. Another strategy I will mention here is block feeding. Block feeding used to be a common strategy for overactive let down but in more recent years, we have come to learn this is often detrimental to breastfeeding, as well. It appears to create a downward spiral of low intake, low weight gain and low milk supply. Always have what appears to be an overactive let down assessed by an IBCLC.
For the healthy, full-term infant pumping for perceived low supply should be the last resort. Babies truly are the best solution here again; baby to breast = more milk in breast. Secondary low milk supply is a different issue and does not fall into the category of common yet easily managed breastfeeding concerns., which is what I am addressing here. I am also not addressing primary low milk supply which are maternal factors in less than 5% of mothers who do not make enough milk. These conditions should be determined with through evaluation with an IBCLC and primary health care providers. I am talking about common breastfeeding concerns that most mothers face.
Pumping to top up or to force more milk into that non-sleeping baby:. Fuller tummy does not equal more sleep in babies. Babies have very small tummies, breastmilk is readily absorbed and digested so babies feed frequently. The issue here is not the amount of milk the baby takes, but rather unrealistic expectations and misunderstandings babies. If babies are really struggling with sleep, it is worthwhile seeking out a feeding assessment to ensure all the things above are not an issue. If baby is not gaining weight well and is also struggling with sleep, this is a different story.
Colicky babies are much better soothed at the breast than any other way, pumping to feed another way removes that comfort source from this already high needs baby and can make the baby even more upset. There is no real understanding behind colic and why some babies are colicky and some are not but there is good understanding that skin-to-skin and mothering at the breast calms these babies best. Again, all things above should be ruled out before we just assume we have a colicky baby. I have also come to believe colic is an umbrella to other providers. I think sometimes we can seek some clarity on these babies and get past colic, rather than waiting it out. If you have what appears to be a colicky baby, perhaps booking for a breastfeeding session will give some of that clarity.
Foremilk/hindmilk imbalance or what is being perceived as such seems to be rampant these days. It seems like a viral condition that has spread. So many moms seem to feel they have this issue, when in fact it is very rare. However, if a mother thinks this is an issue she has and pumps to get to the hindmilk, we go back to the engorgement cycle where mom has too much milk, can have a forceful let-down and then babies do get more foremilk than hindmilk, they are upset by the flow of milk and we end up in a vicious cycle. Worst case scenario, in fact, this could create that colicky baby we all fear. Foremilk/ hindmilk is best controlled by frequent feeds, proper positioning, good technique, etc.
Mom's please seek out appropriate, knowledgeable, support when you encounter these easily managed breastfeeding concerns.
Guest post by Rhonda Young-Pilon
Tired of being tired? Look no further! We have a solution for you! Non-Sleep Training (not a registered trademark) is the LATEST solution to all that ails you.
Step one of this innate process is to start considering even before you’ve started your path to parenting that your life may not be shrinkwrapped into a perfect and neat little package. You did it through the late years of high school and maybe even through college – studying into the night, slamming back coffee at 4am and cramming in three more hours of studying, writing the big exam, and then PARTYING because it’s done… followed by waking up in a tousled mess of blankets, books, and coffee cups and THEN going into work for the weekend and doing it again the next week. You made it. Even though, at your wedding or celebration of domestic partnership your grandmother whispered into your ear that having children would be this wonderful, golden, perfect start to your perfect white fence life and EVERYTHING hinged on routine, routine, routine. You thought you were set, right? Well, look no more – step one is ALL about breaking the rules of the grandparents and friends around you who are bragging about their perfect little bundle of joy who sleeps all day, all night, and even allows for time to Kon Marie your entire life! What’s the evil baby meme say? “You will never sleep again”. It’s partially correct.
Step two of this process is to, of course, design your cave. Kon Marie is partially right – you need to get rid of things. Or, in our program, you need to find a place to put things until you can slowly release them back into your home once your screaming bundle has become a compliant pre-schooler (ha). Your cave needs to have darkening capabilities. Maybe two o’clock in the afternoon is when you will catch a nap – just like you did after the long exam, during the bad hangover, or when you’ve had a tough week at work. Does the laundry pile matter? Not necessarily. It’s merely one of the many tasks that you can assign the adoring baby-doting family who comes over. Letting them see your postpartum stained undies is optional with our system, of course. Other assigned duties may include – vacuuming or floor maintenance, walking your dog, dropping by meals, or even partnering with another family to do some weekly trade-off of cooking. The cave, in itself, needs to be designed as such that sleep can occur at any time, and that entertainment exists when there is a need for the other partner to rest for work purposes. Maybe your cave has a jar full of ear plugs and a written agreement that each parent shall split the sleep into shifts. Entirely up to you. Fred Flinstone-style beds are optional (if you recall, sometimes they slept together and sometimes they did not).
Are you NOTICING that none of these sleep regiments involves the baby? That’s step three. If the caregiver is set up to be able to function around the baby, to keep the anxiety related to not having perfection, then this tiny little bundle of joy will get there. Humans tend to enjoy darkness for sleep, but it’s a process that takes time, patience, and definitely not $10,000 and a personal consultant to dole out advice that is essentially well known to be true. The strategy is to not buy stuff or professional services – but maybe looking to gain support if that’s what you feel you are lacking. Maybe you could be spending your money on professional services like a IBCLC to come in and help establish breastfeeding so that isn’t another factor, or a loving house keeper to come in once per week and help you to tackle the laundry pile. Maybe that money could be put into trust for your little night owl’s college education, because, let’s face it, someone needs to stay up all night and catch babies, engineer products, and write the next big hit.
Step four would involve strategic sleeping, enjoyment, and something called pillow therapy. Some people recognize the term “pillow therapy” as a method of smothering… however, in this case, it references when you go into your bedroom and shout insults into your pillow. Sometimes, you need to escape your emotions somewhere that isn’t the face of your partner, or in the face of your baby. It’s been two days since you’ve slept more than a two hour stretch, your partner has been away for days on a man-cation/woman-cation, and you desperately need to shave your legs… it’s time for a release of that emotion. Beware, it may cause tears, a desperate call to a friend to come by for a few hours so that you can nap, and a strategically scheduled glass of wine later in the evening. It all comes back to support. Single mothers – I hear you. This sleep solution involves recruiting a well trusted friend who loves babies to snuggle while you snore. There are many local church groups who may have a wonderful grandmother who just happens to have recently retired and is missing out on baby cuddles due to empty-nest syndrome… there may just be someone, in your community, who can fulfill the position that you need for temporary solutions.
Moms often ask if napping is required in order to establish routine. Certainly, in utero, your baby could be lulled to sleep with gentle swaying, darkness, or following a long day of movement. As soon as you reach the fullest complement of pregnancy, your skin stretched to its height of stretchiness and your baby was able to have it’s first exposure to light. This is what initiates the pattern of knowing that change existed. Of course, our wish is that our baby will have one to two excellent naps through the day, have a period of play and wakefulness in the evening (and contentment, which is basically a ruse historically), and then a long period of sleep through the night. Babies are wired to require things like closeness, suckling at the breast, quiet, and little stimulation in order to accomplish these things. Hence the design of your cave. If the cave presents itself for opportunity, you’ll probably get there. Of course our caves aren’t designed with boobies strategically placed next to the crib or computerized baby swing – so we are bound to be attached to our infant to provide these needs. There are several baby carriers on the market which can allow moms to enjoy hands free, baby to enjoy the boob and nap, and for all to get to those important places that we are required to be during those first months of life. Maybe your $10,000 fee for a consultant could go towards purchase of the best lazy-boy recliner on the market and a well-stocked side table?
Step five includes the warranty. Manufacturer’s guarantee, that humans can survive on strategic sleeping (grown up humans, that is). This may extend well beyond the first year of life, and into toddler and preschool and school age years. Children have complicated wiring that comes to life – and some of our kids sleep less than others. You’ll start to load up your arsenal as life goes by – with tips and tricks like the evening walk, the warm bath before bed, the “fill’er up” healthy bedtime snack, and even the occasional night at grandma’s house. It comes with time and patience, and knowing and trusting that a normal infancy may create a new life for you. Many humans before you had to leave the cave at some point to tackle a tiger, collect water, and to visit friends. It’s all part of essential survival.
Step six of our survival kit includes some optional equipment. Many parents have employed the tools of distraction – these may include things like make up tricks, hats and scarves to cover up mis-placed hairs, coffee makers and even coffee to go into the machine, and the best sweat pants on the market. These days, messy hair is in. Men have pointed out that women in yoga pants may be more appealing anyway. Dads may also feel the need to sport a sleek black Ergo baby carrier while their wives crack open the tool kit. It is well known that there will be a community of people who, like them before, also sported the exhausted looks and will usually signal their commiseration if they are privy to the reason for the bags under your eyes. Sometimes, your husband/partner will come home from work and tell you that their dazzling co-cubicle partner also struggled with the sleepless nights. Who knew that the tools and tricks of the trade meant that the “perfect” parent seated next to you survived by guzzling two litres of coffee and crying in the car on the way to work!
The idea of this essay is to normalize what parents believe should be categorized as abnormal. In my opinion, as a parent of three sleep-disabling children, this world is too focused on perfection. It’s also an example of what we are expected to be, which isn’t fair to this earth. I do not see it a fair trade to pay a consultant thousands upon thousands of dollars in return for kids and parents who don’t ever experience hardship. The secrets to raising kids who are well rested shouldn’t cost money, and should not result in parents having to stop comforting their babies, or to sacrifice breastfeeding in order to survive. The idea is that we all work together to bust down the brick walls of our homes to support each other through those terrible days. If mothers opened their doors and yards to supporting their neighbours, then we would see a better rested society. Traditionally, in a tribe mentality, grandmothers, aunts, and other women would support a new family so that everyone got what they needed. We don’t live in a tribal society, and therefore we need to seek out the same sources of support.
The real trick of the trade is to seek out rest and support where needed. The early days really are hard, and mothers need to know that they are at an increased risk of postpartum mental health crisis when support is not given. It doesn’t mean that mother in law needs to move in – but, for you, it may mean that mother in law needs to stay in a hotel near by and deal with the rest of the house so that you can stay in bed with your baby and enjoy life. Maybe it means that your husband needs to dedicate his evenings to honing his skills at cooking and that weekends are when the house gets worked on. It may mean that a friend may step in as a caregiver for your other children so that you can be skin to skin with your baby. The long lagging months and years with little bits of sleep do affect us cognitively, however, with some peace and relaxation – we can all be on the hammock in the warm back yard having an afternoon nap. Nobody wants to “sleep when baby sleeps” when there is chaos. It’s ridiculous to expect us to never leave our houses or experience social time because the regiment will be thrown off. We need to find the balance, and as a community support new parents in their journey. That’s worth $10.000/parent.
Disclaimer: I am not a mental health care professional or provider. If you think you are suffering from any sort of mental illness I recommend seeking medical attention as needed. I will also add in that I do take mental health concerns seriously and this blog post in not intended to down play medical concerns.
Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes. - William Gibson
When I first came across this quote, I immediately identified to it as an adult, as an individual and as I related to other adults. More and more I have been thinking about this in the context of my work, my work with new families, young babies and children & different relationships forming in homes.
The rate of postpartum mood disorders is on the rise. Baby blues, anxiety, depression and psychosis are a very real reality for many new mothers and fathers. We mostly see it in the context of mothers but more and more research shows our fathers are impacted by mood disorders as well.
Let’s, however, just step back for a minute and think about the above quote. “Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes.” I don’t want to be rude but let’s face it, babies are assholes, toddlers are assholes and kids can remain like that as they grow up. They certainly don't mean to be but they are incompetent & demanding, they can be obnoxious and rude, they interrupt your every meal and all your sleep. You can’t even think about peeing without baby waking up and crying, let along move an inch to try to get up and pee. They need to be fed constantly, hanging off your breast, YOUR breast no longer belongs to you. When they are not feeding, they need you to hold them or they will turn the reddest of red and blow horrible smoke from their ears. They pee and poop ALL.THE.TIME. Rudely, they sometimes don't even wait for the new diaper to get on before they shit all over you or shower you in pee. You imagine stuffing that thing back inside you, because as awful as it was to have that watermelon come out the lemon, they are way easier to take care on the inside, right? Well, too bad, there is no turning back. There is only moving forward with this asshole in your life.
By now you know I am not serious in calling babies assholes, but you can see my point. Life is HARD with a new little person to care for. The real assholes of the world are hard enough to put up with, but now you have to put up with the smallest of them all, ALL the time, because YOU created it after all, YOU wanted this. Now you have to do it when you have zero sleep, zero nutrition and probably zero clue how to actually take care of this baby - I can guarantee you it did not come with a manual. Add in some hormones and everyone’s opinion of what you should be doing and it is easy to see why one would end up with signs and symptoms of a mood disorder or postpartum depression.
So, how about we get serious about what we can do about this baby and get through what will be one of the most challenging times of your life.
Self-care is big. You don't want to lose yourself in this. Having a baby WILL change you, but doesn’t need to consume you. What do YOU need? What does your partner need? Make a plan to have that happen. 15 minutes in the shower, making two sandwiches instead of one when your partner leaves for work, tea out with friends. Asking friends to bring you food when they come visit the baby. By the way, when they come visit, the asshole will switch personalities and put his nice guy face on. Have someone come help with light house work and laundry once a week. It’s the small things that make a massive impact.
Communication is huge. Tell each other how you are feeling about the changes in life and the new demands. If you are reading this before having your baby, start that conversation now. Brainstorm the different ways to achieve self-care that will work after baby. Be open and flexible in changing those plans, if needed. Just talk to each other and others about what is happening in your new world. Just keep the conversations going. And find others who will listen to you both. Just someone who will let you get it out. I promise, they won't mind.
Support. SUPPORT. SUPPORT. This is a must. You need to build a team of support people. Before baby is ideal but may not have happened and you may now just be building a support team. Who are we talking about? Family, friends, community resources - your health care providers, doula’s, peer support groups. Everyone’s team is going to look different depending on the needs they have. What is important to know is that support is going to make one of the largest impacts in how you feel about everything and how stable your mood will be, how you will interpret your experiences and what the outcome of the situation is. It is important to identify your needs and equip yourself with the tools to get there. It is vital to know what your support options are because without options you have no choices. So, start now by identifying your needs and making a list of supports. If you get lost and have a need but don't know how to get the support you need to have that need met, please ask! I am here to help in this time of transition in your life.