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In the Guardian today, Jessica Valenti wrote an excellent piece about breastfeeding, bottlefeeding and judgement.  It was a lovely article, making making points well.  But it’s central point – namely that all parents are making the best choices for their families – is flawed.  Hang on, before you grit your teeth to prepare to read a bottle-feeding smear article, hear me out.

Choice in infant feeding is a myth

Valenti asks why we clamour to celebrate breastfeeding and why we don’t show the same adoration for bottle feeding.  The fact is, breastfeeding is still the underdog.  If you doubt that, simply look at the numbers – in Canada only one quarter of infants are exclusively breastfed for the recommended six months.  In the United States that number is below one in five.  Feeding artificial milk is thus the normalized, if simultaneously derided, ‘choice’ simply by virtue of the numbers.

The real question though, is whether or not bottle-feeding is a choice.  Do we think that nearly 70 percent of the mothers who first ‘chose’ breastfeeding simply switch their choice to artificial milk a few weeks later?

In her article, Valenti gives us this beautifully personal and detailed account of how her feeding decisions were made”

In my case, when my daughter Layla was born, nearly three months early and weighing just 2lbs, breastfeeding wasn’t on the table. Instead, she was first fed intravenously and then later by feeding tube with milk I had religiously pumped. But the stress of having a very sick child does not do wonders for milk production and, by the time she came home two months later, I had to supplement breastfeeding with formula to make sure Layla got all the nutrition she needed. I felt like a failure and a terrible mother.

I enlisted the help of a lactation consultant and started pumping 15 minutes every hour (six hours a day!). Even as I cried in pain and was thrown into a horrible depression, I kept it up because I fully believed not only that “breast was best” but that formula was ruinous. It was only when I stopped – in part, because of the legitimate concerns raised by, among others, my extremely worried husband – that I truly bonded with my daughter. I had to give myself permission to be okay with bottle-feeding for nutrition and still breastfed Layla for comfort, for both our sakes.

Valenti sandwiches her story in sentences about her supposed choices, but her words make it incredibly clear that although she certainly made decisions, the circumstances were entirely too constrained to call those decisions choices.  When your traumatic premature birth leaves you unable to produce enough food for your baby, you are not ‘choosing’ artificial milk, it’s simply the only feasible option available to you.

A friend and I once co-wrote a blog post about our nearly identical early feeding journeys and their very different ends.  Ultimately we both made different feeding decisions, she bottle-fed her beautiful daughter and I’ve gone on to breastfeed both of my children.  Did either of us ‘choose’ the diverging routes we took?  No.  I got adequate professional support for my challenges and Kelly did not, that’s it.  In the early days of parenthood, when our bodies are recovering from the intense, and often traumatic, exertion of birth; when we are on a hormonal roller-coaster; when we’re abruptly left without a primary health care provider for either us or our babies; when the care providers we do seek out dole out bad advice on a topic they have absolutely no training in, are we really at liberty to make choices?

Going forward, our feeding decisions continue to face constraint.  In Canada, if we are conventionally employed, we enjoy 50 weeks of paid parental leave.  But in the US, the number is as low as six weeks and without any financial support.  I am as determined a breastfeeder as anyone, but I’ll be the first to admit that I wouldn’t have spent two weeks struggling to get breastfeeding to work if I knew that it would probably go out the window four weeks later anyway.  I would have bottle fed and enjoyed my meagre time at home, then left for work free of the stress of finding the time, physical space and bodily ability to eject milk into a whirring machine.  It would have been my reality, but certainly not my choice.

Then there is the social treatment of the two feeding methods.  It sickens me to hear of bottle-feeding mothers being scorned.  It shouldn’t happen, yet we live in a world where we think we can know a person, their history and thoughts from 140 characters or a sepia-toned snapshot.  We’re ready to not only form an opinion in an Instagram, but are desperate to voice it.  But here again, breastfeeding women are still at a disadvantage.  Not only is their feeding method critiqued, those critiques are often encased in an additional and disgusting layer of sexualized commentary.  Anywhere from comments about the size, shape or desirability of the breasts, to accusing the woman of an act akin to public masturbation.  I have often heard women name anxiety about such harassment among their reasons for bottle feeding and if their inner sphere of family and friends isn’t supportive enough to counter this, it becomes a serious factor.  If fear of sex-based harassment is a motivator for a decision, that decision cannot truly be called a choice.

The myth of choice leaves us with no one to blame but each other

The crux of Valenti’s article is to beg us all to accept each other and the choices we make.  Her final sentence is one of support for parents “making the choices that are right for them and their children”.  I fully support the sentiment, but I firmly believe that the real solution is in repositioning the discussion.  We do need to fully support every parent for the decisions that are necessary for them and their children, but we need to stop masking the external influences on those decisions under the guise of choice.  Those of us who ‘succeed’ at breastfeeding need to admit that it was help and luck more than choice that created that success.  Those who wanted to breastfeed but switched to bottlefeeding need to feel able to say that it was not their choice, it was the necessary route and that sometimes we do what we must instead of what we wish.

It’s complicated and messy to say in the same breath that artificial milk is not optimal but that it’s certainly preferable to starving and that using it gratefully doesn’t preclude us from using it with a degree of sorrow.  It’s hard to say that babies who are fed formula are going to be OK but we need to fight for good and accessible breastfeeding supports so that fewer of them need to be given formula.  It’s a lot easier to say “This was my choice so back off!”.  But that conversation keeps the focus on our internal debate about who is a better mother, and stops us from working together for the things that all mothers need.  After all who wants to talk honestly about the risks inherent in using artificial milk if we’re asserting that those who use it are doing so by choice?  The theme of choice is what leads us to deny the fact that affiliations between healthcare providers and formula manufacturers creates an obscene conflict of interest that lowers breastfeeding rates.

If we don’t start having the messy complicated discussion, then we’ll keep writing articles asking why Olivia Wilde gets more praise than a bottle feeding mother, when we should be asking why some women get paid to breastfeed their babies in couture when other women are too busy worrying about how they’ll stretch their minimum wage to pay back the exorbitant hospital bill from the birth, especially after missing six weeks of pay, to have much time or energy left for worrying about making the feeding ‘choices’ that are right for them.  If we don’t start having that discussion and writing those articles, then we’ll keep having this blame war instead of lining up collectively to make a better reality for us and our babies.  And choice will continue to be a myth, rather than becoming a reality.

 

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When I meet with expectant parents who have hired me to be their Doula, I give them what may seem like a very odd warning coming from a breastfeeding advocate: avoid pumping.

Pumps can be great tools.  I use mine almost every week as I drive to school, as many drivers on Toronto’s roads can confirm.  I am by no means anti-pump.  But pumps, like any other birth or breastfeeding intervention have a time and place and if not used correctly can do more harm than good.  The trouble is that the buzz about pumps seems to have elevated them to the level of a panacea for breastfeeding problems.

“Should I start pumping to make sure I have enough milk?”

“My nipples hurt so my doctor told me to pump.”

“She wasn’t gaining weight so they told me to pump.”

“I was tired/depressed/you name it, so they told me to pump.”

Pump, pump pump.  And whenever someone asks me if they should pump, for whatever reason, I always reply with “And then what?”  Invariably, I get a blank stare.  It’s absolutely vital that if you’re integrating pumping into your breastfeeding relationship that you have a clear plan for what you need to achieve and how to make it a part of your long-term feeding goals, not an impediment to them.

Know when not to pump.

There are times to pump and times NOT to pump.  It may not be what a mother wants to hear when she’s in pain from sore or cracked nipples, but the only way to fix the majority of breastfeeding challenges is AT THE BREAST.  Compare your new nursing relationship to a fledgling romantic relationship for a moment.  If you’ve just met the man of your dreams and you send your sister on all of your dates, do you think he’s more likely to marry you or your sister?  She may be very inferior to you, but he won’t know that because he doesn’t know you.  Unless your baby is completely unable to feed at the breast, whether from severe mechanical latch issues or due to separation, then it’s important to develop your feeding relationship at the breast.

Feed the baby, not the pump.

But let’s say that you are pumping, the next key is to make sure that you’re feeding the baby first and not the pump.  It sounds ridiculous, but believe me it’s not.  If you’re pumping exclusively due to a separation, this is straightforward enough, but most women I encounter are pumping in conjunction with feeding at the breast and it can be incredibly easy to mismanage this kind of situation.

Example number one: you’re told to pump after feeds to increase supply.  So let’s say it’s your first daylight feed of the day.  Baby starts to nurse at about 7 a.m.  By the time you let her finish the first breast, change her diaper and offer the second breast, she dozes off so you enjoy the quiet for a couple of extra minutes.  Then you hand her to dad or doula while you go pee and grab a super quick shower.  You sit down and hook up your pump and you’re ready to boost your supply!  Except, hang on, it’s 8:30 now.  If your baby is only a few days old, then he’ll be ready to eat again very soon.  Probably the second you’re done pumping, and maybe even before you’re done.  We know that breasts are never truly empty so technically this won’t actually cause a problem.  You can put baby to your recently drained breast and the milk will come.  The thing is, it is also true that when the volume of ready-and-waiting milk is low, the flow can be very slow.  Baby fusses and since you are already nervous about how much milk you do or do not have, and because you’re a new mama and hearing your baby cry for milk hurts your heart, you feed her the milk you just pumped.  Since you just pumped it, you may not think to pump again right away…  Repeat this several times a day and your breastfeeding relationship can easily turn into a bottle-feeding relationship at the same time that you deride yourself for not making enough, even though you are, you’re just feeding it to the machine instead of the baby.

Example number two: you’re told to pump every three hours.  This recommendation usually comes when mom and baby are having intermittent separations, like mom sleeping at home while baby remains in the hospital, but I’ve also seen it advised for supply increase, in between feeding the baby on cue.  So let’s say you’re with baby and again she has her first morning feed at 7 a.m.  You’re good about pumping right after she eats, so that’s at 8 a.m.  You continue on with your morning and babe eats again at 9 ish and then falls asleep.  Now it’s 10:45 and you’re just hooking up your pump because it’s almost been 3 hours, but baby wakes up cuing at the exact same time.  So often I see moms try to hand the hunger-cuing baby to dad or grandma or me to hold while she pumps because, after all, she’s been told that pumping is what will boost her supply!  The trouble is that baby’s natural feeding interval has been unnaturally stretched for the sake of maintaining the recommended pumping interval.  Pretty soon you can get a baby who is slow to gain.  Meanwhile, the pumping that was supposed be added on top of nursing in order to boost supply has actually just replaced the feeding at the breast.  Mom is trying so hard to do the right thing, but the outcome can be the opposite of what she wants.

Have a plan for your pumped milk.

If your instructions to pump are coming from someone who does not have lactation training – read: most family physicians and paediatricians and even (as I’ve sadly discovered) many midwives in Ontario – then they often don’t give you any instructions about how to deliver the pumped milk.  That’s because they don’t know any way to deliver the milk other than by bottle.  The truth is, if you want to resume your breastfeeding relationship, then you need to deliver the milk in a way that protects that relationship.  My personal favourite is to use small feeding tubes because they can be used at the breast or, if necessary with a finger.  But there are many ways to deliver milk other than bottles and it’s important to explore those options.

Understand the demands of pumping.

Like with so many things, the media has a tendency to distort the reality of pumping.  It’s often made out to be the secret to getting your pre-baby freedom back.  Movies show moms sleeping blissfully while their partner drags himself out of bed to pull a bottle of pumped breastmilk from the fridge.  Moms who pump, we’re told, can leave the house for hours without a care in the world.  It is absolutely crucial to understand that feeding the baby pumped breastmilk is still feeding the baby with your body and it places just as many, if not more, demands on your body as feeding at the breast does.

The first thing to know is that pumps are much less efficient at withdrawing milk than skilled breastfeeding babies are.  And even with the best pump, not all breasts will release milk readily.  So pumping often takes longer than breastfeeding.  Sure, you may have slightly more flexibility about the pumping intervals, but that’s a scheduling benefit, not a time savings.  And when I say slightly more flexibility, I really do mean very, very slightly.  The number one question moms ask me is “Can I pump during the day so someone else can do the night feed.”  Technically, the answer is yes, but there is a long list of caveats.  The first being that, as I’ve said, when you’re mixing feeding at the breast with pumping, you have to be very careful to feed the baby, not the pump.  And it’s important to know too, that most moms don’t actually sleep through that feeding time.  When that baby that you love so much cries, it will make every molecule in your body vibrate.  Warming bottles takes time and during that time, baby is likely to be crying, waking you up, not to mention stressing you out.  Even if you do manage to sleep through it, your body has been awake making milk for that feed.  So it’s possible you’ll wake up an hour later anyway but with full, sore breasts.  If this is happening before your supply is established, it’s very likely to signal your body to make less and less milk.  Believe me, I know it’s important for mom to rest, but there are so many better ways to achieve that than skipping feeds.

I don’t mean to paint a horrifying picture, many moms do manage to pump, either exclusively or when separated from baby.  Like I said at the start, I’m one of them.  After returning to work when Lady Fair was 6 months old, pumping was a work-day reality for me.  So let me paint you a real picture of what it’s like to be pumping when you’re away from baby.  When I get in the car to rush off to a birth, I take a gigantic enormous bin with me, full of the stuff I need.  More than half of the contents of that bin are not for the birthing mama, but rather for pumping and storing milk.  Sometimes I take more luggage into a birthing room than the woman who is giving birth.  And even though I pack and check my kit ahead of time, things go wrong.  I’ve had to recharge my pump in a birthing room before.  I’ve had to dump perfectly good milk down the sink because I ran out of freezer bags to store it in.  I’ve had to dump perfectly good milk down the sink because I dropped part of my pump on a scuzzy hospital visitor bathroom floor and didn’t trust that the subsequent milk wasn’t contaminated (blech!!).  I’ve had to do my best to focus on supporting my client while remembering not to put my right arm down because my work duties didn’t allow for regular pumping breaks and now my super-producing breast is engorged.  Only the one breast, mind you, so I’ve also had to walk around in public with one boob that’s twice the size of the other!  And probably my personal favourite, I’ve had strangers walk in on me pumping because I forgot to lock the door.  Oops!  It’s absolutely wonderful that I can provide breastmilk for my babe while I’m away and when it’s all said and done, these little hiccups make fun stories, but while you’re doing it, it’s challenging, and it’s important to be realistic about that.

So what am I supposed to do if pumping is out of the picture?

Really, there’s nothing magical.  Know that most of the time, you and your baby only need each other to breastfeed successfully.  Focus on feeding frequently and supply will follow.  Focus on finding a comfortable position and chances are, a good latch will follow.  Surround yourself with people who know about and value breastfeeding and confidence will follow.  And if you do need to intervene, do it with a clear plan and good support.

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So last week, I attended my first birth as a doula.  An incredible, difficult, tiring, miraculous, and wonderful birth that took a total of 32 hours, 22 of which I was there for.  This week, I’m back on call for my next client and next month – over the holidays, as a matter of fact – there will be yet another.

I left my house at 1 am last Wednesday morning, and didn’t get home until 11 pm, meaning I didn’t see my son from the time he went to bed Tuesday night until he woke up Thursday morning.  My daughter, meanwhile, had a dream feed about an hour before I left, and another right after I crawled back into bed with her.  The hours in between were spent having (more or less) the first bottled meals of her 7 month long life.

I was nervous, obviously, about how all of this would go down for her, but it worked well and I can sum up the reason why in just two simple words: Attachment Parenting.

Thanks to the attachment practice of cosleeping, I didn’t unnecessarily lengthen our separation.  As I said, I didn’t set eyes on my son for 36 hours, but he’s two and a half and not only sleeps in his own room (with Dad joining him as needed), he’s already spent several happy weekends with his grandparents.  But Lady Fair is only 7 months old.  Frankly, even 22 hours felt too long to be away.  Thirty-six hours is just inconceivable.  If we didn’t share sleep, it could have been 36 and the additional hours would have been completely unnecessary.  If we didn’t share sleep because we were trying to follow a book-prescribed sleep program, then an already difficult situation would have been rendered more difficult by a person who has never met me or my child, and who has no actual knowledge of our situation or needs.

Thanks to attachment parenting, I was able to leave at a moment’s notice without worrying that a messed up ‘routine’ would throw the kids into some kind of coping tailspin.  You see, aside from the major time markers of breakfast, lunch and dinner, our daily routine is this: child has need, child expresses need, caregiver meets need to best of caregiver’s ability.  That’s a pretty easy one to follow, and it depends only on a loving caregiver.  Mr Fair, as co-parent, certainly fits the description of loving caregiver and, when armed with a freezer full of booby juice, has every tool he needs to parent solo without trauma for anyone.  The kids obviously felt my absence, but not to the same degree as if a missed snack of 1/4 cup rice gruel at 10:17 am led them to a missed nap at 10:36 am which then made them too tired to focus on their Baby Einstein flashcards from 11:46:30 to 11:59:59.  Their day remained exactly the same as normal, just with a hairier chest to snuggle on.

As an extension to the above, taking an attachment-based approach with my kids meant it was much easier to come home again.  I’m not under the illusion that a human being will have the exact same needs at the exact same time of day, every single day, so when Lady Fair expressed a need to reconnect after my absence, it was no big deal.  She spent the next two days almost constantly in-arms (yay ring sling!), sleeping only at the breast.  And that was lucky for me because, guess what?  I was exhausted!  I couldn’t have spent the day trying to stay awake to reestablish a schedule even if I wanted to.  Instead, I just enjoyed the snuggles without worrying that it was the oft-feared ‘bad habit’, a harbinger of chronic dependence that is sure to persist into adulthood.  And of course, it wasn’t a habit at all, just a need.  One that passed away once it had been filled (she’s upstairs asleep in bed as I type this), and one which I was able to fill thanks to attachment parenting.

It’s not easy transitioning back to work when you have little ones.  The logistics and emotions can be complex and unpredictable.  But for the good of our family as a whole, and my mental health specifically, reestablishing a career is something I have to do.  I’m just grateful that we have so many tools on our parenting workbench that I can do it with few side-effects.

How does attachment parenting help you cope with life’s challenges?

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You’ve heard about why.  And you’ve heard about how.  Now do you wanna see what it looks like??  Well feast your eyes.

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Dropping the F-bomb

BLW Part I: The Whys

BLW Part II: The Hows

 

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This is part two of a 3-part series on baby-led solids/weaning (BLW) in honour of Lady Fair’s half-year birthday and consequent move away from exclusive breastfeeding.  In part 1 we talked about some of the great reasons to do it, and now we’ll go over some practical tips.  The thing about BLW is that it really doesn’t require instructions beyond “give food to the baby”, but people who are used to pureeing usually want some more details, so here they are.

Size & Shape

The main thing about BLW is that the kids are putting the food in their mouths themselves, and they’re starting well before they work out that little pincer grip.  In other words, dicing is no-dice.  It’s all about the long-skinny so that they can wrap their whole adorable little fist around it and still have an end poking out to get in their mouths.

My favourites for novice eaters are bananas halved lengthwise, avocados cut into longitudinal wedges and broccoli trees.  Once they get older and more coordinated, brussels sprouts and scrambled egg yolks are pretty grabable.

Meat always seems to present a difficulty.  Some people cut it into really narrow long strips, but my kiddo couldn’t figure out how to flop it into his mouth.  He also had front teeth very early, so he’d bite a chunk off and then not be able to chew it and problems would ensue.  So I went Alicia Silverstone on it and pre-chewed, then propped it up in a little pile on his plate.  Gross, but effective.

Grip

As scary and weird as it seems, try to leave peels and rinds on when possible.  Bananas are a perfect example.  If you take the peel off, that nanner will fly out of baby’s hand like the escargot out of Julia Roberts’ in Pretty Woman.  Apples with a skinless landing strip around the equator and peel at each pole are easy to hold onto and run your gums over.  If you’re into grains you can also try dusting food with some sort of cereal crumb.

Out & About

First off, BLW makes travelling way easier, and being lazy, that makes me very happy.  But what you need to plan/bring changes more rapidly than with pureed food.

If baby is only a few days/weeks onto solids then the biggest question is really whether or not baby actually needs to eat (other than nursing, obviously) while you’re out.  Remember the rule of thumb “before 1 it’s just for fun.”  Kids really don’t need to be having three squares a day.  In fact, in the first couple of weeks they’re unlikely to swallow enough to make the endeavor calorically worthwhile anyway.  So there’s the nothing option.

But if your wee one is firmly into the eating world, avocados, bananas and brussels sprouts all travel well and make relatively little mess.  For more adventurous babies, order the soup and bread and share dipped bread with them.  Alternatively, bits from a garden salad or side baked potato do wonders.  And my all-time food court favourite? Sushi rolls.  They’re mouthful sized, nutritious and TIDY.

IKEA Antilop Highchair

Bibs = useless. Think ‘full coverage’.

Clean-up

And speaking of tidiness… you know all of those little wee bibbies you were given?  Forget them.  Truly.  So useless.  If you must use a cover, then the IKEA full-body smock is the only rational option, but I prefer to strip baby bare.  Much easier to swab a baby than wash and fold a stack of smocks.  And while we’re at it, the more elaborate your high-chair, the more crevices there are to stick food in.  IKEA comes in handy here again with their smooth plastic, single piece, TWENTY DOLLAR high chair.  Can’t be beat.

Safety

These really should go for all early experiments with food, no matter how you introduce it.  The first item on the safety list, is to know the difference between gagging and choking.  Both look horrible and can make you panic.  One – gagging – tends to be noisy, while the other – choking – is silent.  So don’t ever turn your back on baby and assume you’ll hear her choking because you won’t.  Ultimately, the qualifier is air.  If baby is gagging, he can still breathe in between gags, which makes noise.  If baby is making noise (and thus breathing) you should NOT go smacking her on the back because that could make the offending bit of food block the currently unobstructed airway and cause choking.

Item number two is to leave baby UNBUCKLED while feeding.  This probably seems a bit counter-intuitive, especially since highchairs these days come with enough snaps and harnesses to rival a carseat, but the reality is that if baby does happen to start choking, you can’t help without removing her from the chair.  The harder it is to get her out of the chair, the longer it will take to help her.  Here is where we loop back to the previous paragraph and remind you not to turn your back while baby is eating, lest she somersault over the tray.

The final item on the list is to master ye old finger swipe and it is a bit more BLW specific.  If a bad gagging fit does hit, or even if you foresee trouble clearing an item from the mouth, the easiest way to help is to reach into the mouth and clear it with your finger.  Don’t be alarmed if this actually triggers gagging – you would too if someone reached into your mouth.  Also don’t freak out if all of this gagging triggers puking.  That’s the body’s way of making sure stuck objects get pushed up and out.
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So there you have it.  Baby-led weaning in a nutshell.  What tricks did you use to make it even easier?

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Dropping the F-bomb

BLW Part I: The Whys

BLW Part III: The Cuteness

 

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To bring you this video I just found in the archives that has me sitting up at the computer at midnight hitting replay.

I was about 38 weeks pregnant and Little Man was giving the belly some love while he nursed.  Although this was the phase when he insisted it was a piggy, not a belly…

 

I promise, the rest of the BLW series will be back when my ovaries stop tingling for another baby (which we’re NOT having).

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It happened the other day.  My beautiful, squishy, delicious baby girl had her first experience with the four-letter word that starts with F:

F-O-O-D

Yes, that’s right.  At just 3 days shy of 6 months old, with a stack of ripe organic bananas on the counter, I dropped the F-bomb on my baby.  And she promptly dropped it on the floor 🙂

It was a spur of the moment decision to start.  The beauty of baby-led solids is that the prep is virtually non-existant.  But I’ll get into that in my next post on why we do babyled.  Up after that, some of the practicals for how to do it.  Stay tuned.

Half a banana, anyone?

 

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