Breast Feeding vs. Infant Formula

  Whether you choose to breast-feed your infant or not, is a very personal decision. When I first started working on a Postpartum unit the lactation specialist gave me a list of 101 reasons why women should breast-feed. Most of them were completely ridiculous and several of them were listed two or three times. You have to choose what will work for you, your baby and your situation. I don't believe that you should let anyone try to convince you to do anything that you're not comfortable with or won't work for you and your infant. I'm not writing this post with the intent to make anyone feel guilty about their decision, but to go over some the facts about each side of the issue.

 The Case for Breast Feeding

• Breast milk is perfectly designed for your infant at each stage of his/her development.
• Breast milk is much cheaper than the alternative. (I won't say that it's free, because it requires way to much work to qualify as such.)
• Breast feeding helps the mother's body to heal. It makes her uterus reach its pre-pregnancy condition more quickly.
• Breast feeding decreases a woman's risk of breast, cervical and ovarian cancer. I mention this one because I've heard it numerous times and I feel that this fact is very misleading. Research shows that if a woman breast-feeds for 14 years of her life, it decreases her risk of cancer by 20%. So if iI have 7 kids and breast-feed them for 2 years each I will decrease my risk of cancer of my reproductive organs by 20%?! That doesn't seem like really good motivation for me.
• Breast feeding burns calories! During pregnancy our bodies are designed to store fat, so that we can feed a baby. What better way to get rid of those extra pounds?
• Breast feeding promotes bonding between mother and infant.
• Breast feeding provides infants with immunity against illnesses. It provides immunity against diseases that the infant is too young to be safely vaccinated for and for other diseases that the mother has immunity against where there are no vaccines available.
• Breast-feeding is environmentally friendly. Little or no packaging or containers required.
• Breast-feeding decreases a child's risk for allergies and auto-immune diseases.
• Breast-feeding makes for overall healthier children. I breast-fed Thing 1 & Thing 2 and the first time that I had to take either of them to a doctor for anything beyond a well-child check was when Thing 2 needed stitches at age 2.
• Infant formula just does not taste or smell that good. Yes, I have tasted it. I make it a point of tasting anything I force my patients to take (within reason).
• Breast-milk has antibiotic properties.
• Breast-feeding means fewer bottles to wash. (Unless you work and pump. Then you have to wash your bottles and your pump parts. :S)

 The Case for Infant Formula

• Infant formula has improved dramatically since it was first developed.
• It is very physically demanding to breast-feed an infant.
• It is sometimes inconvenient to breast-feed an infant. 
• Breast-fed infants are often resistant to taking a bottle when mother is unavailable.
• Breast-feeding is very time-consuming.
• Society (and sometimes family and friends) are unsupportive of breast-feeding moms. They are often intolerant of breast-feeding in public, yet most establishments do not provide a clean place to breast-feed in private.
• Some women for physical reasons can not breast-feed.
• Some women can't breast feed for a multitude of other reasons.
• No one is ever offended if you bottle-feed your infant in public.
• Some infants don't take well to breast milk.
• It's easier to wean infants off of formula versus breast milk. (Or so I hear.)
• Formula fed infants are less likely to come down with jaundice.
• Mothers of formula-fed infants have no additional dietary restrictions.

 I think that more or less covers it. Can anyone think of any points that I left out? And you don't have to be strictly one or the other. You can breast feed sometimes and bottle feed at others. It's up to you. I choose to breast-feed because it makes my children healthier. There is something so adorable about watching my babies breast-feed. I love it. I love to snuggle with them every few hours and listen to their satisfied eating noises. And it saves me a lot of money. I breast-feed exclusively because I have not been able to convince any of my babies to take formula on any occasion after my milk came in. Ever. (The first day that I went back to work after having Thing 2, it took him 11&1/2 hours before he was desperate enough to even drink pumped breast milk from a bottle, let alone formula. He always was a stubborn child.) Breast-feeding Cindy Lou-Who, with all of my diet restrictions is one of the most difficult things I have ever done, I have a hard time coping without food  but I do it because I love her and I feel breast milk is best for her. But after this experience I have new empathy for mothers who throw in the towel and switch to a bottle. I feel that breast is best, but there are plenty of good reasons not to breast-feed.

Varicose Vein Surgery

 When I was nineteen I started developing varicose veins. It's genetic. I started wearing support stocking religiously, but let's face it, I picked the wrong profession if I wanted to protect my legs and veins. And having three babies didn't help either. When I had Thing 1, I was told that I needed to wait until I was done having children before I did anything about fixing them. Technology has advanced since then. (Which is good because after my pregnancies and standing on my feet for so many years not only do my legs look terrible they hurt a lot too. Lots of burning, aching and cramping.) The first time I saw my OB he told me that I needed surgery on my legs and there wasn't really another answer. As soon as I could get in (after my pregnancy) I went to see a vascular surgeon. He said I that I have venous reflux disease and it's actually better to take care of it sooner versus later. What has been happening is that the valves in some of my veins aren't working effectively, which causes the blood to back up and some of the smaller veins to swell to the point that they are completely ineffective and not to mention ghastly looking. The longer I let it go the more damage will occur to the small veins.
 The solution is the VNUS close system. The surgeon inserts a catheter into the ineffective veins and irradiates them and as he pulls the catheter out they seal shut. That's procedure #1. On the second day he fixes the smaller swollen veins that possibly can be fixed and cuts out the others. They don't use general anesthesia, so there is less risk (and cost) to the patient. Just a Valium, a Keflex, a Percocet and some Lidocaine. (Although I still fell asleep half way through each surgery.) Each procedure takes less than an hour and has a pretty short recovery time overall. (It used to be that surgical intervention involved 'vein stripping', where the vein is literally removed through incisions in the groin and knee areas. It required general anesthesia and involved a long and painful recovery. Currently there are other options besides the VNUS procedure, but this is the one my surgeon prefers because it has the best outcomes.)
 So that's what I was doing Tuesday on my husband's lunch break. When I laid down on the table the tech said "Now there is proof positive that nurses don't just sit on their butts."  (That's right!) I felt very loopy for the rest of each day, but I was functioning fairly well by Thursday. Ok, ok my house was sliding even further down hill and I couldn't stand for very long, but my kids were happy and taken care of and that's what matters, right? I have to say that now my leg feels sooo much better. No more cramping, aching or burning. The staples and stitches are annoying, but they'll be gone soon. I've known people who have had it done and the scarring is pretty minimal too. So we're going to do this party again tomorrow! That's not the way I planned it, but while I was on the table the nurse mentioned to the surgeon that he had a cancellation that they needed to fill and I said that I would take. Probably crazy after the week I just had, honestly worst week in recent memory, and it had little to do with my surgery but my surgeon is good, busy and really hard to get into. Not to mention if I do it now, versus next February when he has openings it would save me several thousand more dollars. Yup, tomorrow is good for me.

 So here are some tips and lessons I learned from the experience:

1. If your varicose veins are causing you pain, you don't have to wait until you're done having kids to get relief. And you don't need an extended recovery time either.
2. Choose the surgeon that is hardest to get in to see and pray that someone cancels. He's the guy who knows what he's doing. I've heard scary stories of people who went to surgeons with less experience because they were easier to get into.
3. If your baby has reflux and you're having surgery, live it up and eat what you want. You have to pump and dump anyway, why not enjoy what you are eating for a couple days? (Although don't go to overboard, small amounts of those irritating foods will stay in your system for more than a few days.)
4. My surgeries on my leg didn't hurt nearly as much smashing my toe this weekend did. That's the real reason I walk with a limp.

Postpartum Depression

 Postpartum blues effects up to 85% of women in the period after they have given birth. Postpartum depression is a more severe condition that effects up to 25% of women. "Symptoms include sadness, fatigue, changes in sleeping and eating patterns, reduced libido, crying episodes, anxiety, and irritability." No kidding. Suddenly you have a bundle of joy who needs constant care and attention, doesn't let you sleep, siphons off your energy, doubles your load of housework and reduces the time that you have to do it. Not to mention it's a pretty big change for your body. Giving birth/having surgery and recovering from it is very physically demanding, and then there's the hormone imbalances too. And if you're like me there's a pretty big change in routine. I went from working full-time to spending my days sitting on the couch breast-feeding. Instead of seeing friends, coworkers and other people on a regular basis you stay inside because you don't want your baby to get sick and you feel like you are constantly breast-feeding. And you can kiss your personal time goodbye. No wonder women get depressed after having babies. This motherhood business is a challenging undertaking.
 I share my story in the hopes that it will help someone else. The first couple weeks after I had my baby I was feeling pretty good. I was so excited not to be pregnant anymore. No more sciatic pain, no more gallbladder issues, my back injury resolved, my varicose veins were improved, and no more of all those other pregnancy inconveniences. Not to mention my baby is so sweet and beautiful and I am so excited to have her here. At about two weeks things became more difficult. My baby stopped sleeping through the night, my three year old was turning from mischievous to terror. I was dropping weight fast because while trying to meet the demands of three small children I just didn't have the time time to make myself three balanced meals a day. People were complimentary, and I would be polite, but think 'Are you crazy? It's not healthy to drop 26 pounds in two weeks.'   I was discouraged with my inability to keep my house clean, and take care of the needs of my family. I thought 'What is wrong with me that I can't do this? Many of my friends have more kids, and they can still maintain a clean house.' I adore my children, but was struggling to cope with them. I craved peace, quiet and enough time to sit down and eat. At work at least there are federal laws that demand that I get a lunch break. One day I calculated I had about 700 calories in the entire day. (And normally I eat a lot more than that. In high school my husband nicknamed me "The Vortex" because I could eat him under the table at a time when he had regular swim practices.) That same day someone called to check on me and gave me some unrealistic advice. Not very helpful. It just made me feel frustrated and that people didn't understand what I was going through and had higher expectations of what I should be doing than I could possibly achieve right now. I started having thoughts of killing or hurting myself on a regular basis. I wasn't prepared to take any such actions, I just felt unstable. I thought about calling my doctor, but decided against it because I work with him on a fairly regular basis and I'd rather he didn't think that I was crazy. Besides that I was pretty certain that my problem could be better fixed by methods other than taking medication.
 I talked to my husband and let him know that I had a problem. I told him I needed more help with the kids and the house and that I just needed to eat better. He made a point of helping me out more and regardless of the chaos going on made sure that we had a regular date night. I found that as long as I could get three healthy and satisfying meals a day and few good snacks, I was happy and doing ok, with or without sleep. I made some energy bars and some meals with leftovers that could be reheated quickly (and also supplemented my diet with a daily dose of ice cream). When my baby was almost four weeks old, I started taking my kids to a weekly play group again. (With work, it had been over a year since I had had time for that.) It felt so good to talk to other adults again. I discovered that my neighbor who I have always thought of as one of those "supermoms", had struggled with postpartum depression too.
 Just when I thought I had this business under control my baby developed reflux. She was vomiting quite a bit and irritable. There's something about being covered in vomit on a daily basis that's just depressing. And there's something so frustrating about having your baby cry all the time and not being able to fix it. So I cut out all of the "naughty items" from my diet. There are more things that I can't eat, than items that I can. (This included my energy bars, because those had cranberries, peanut butter and chocolate chips.)  Once I made these adjustments she was a significantly happier baby, throwing up less and sleeping more, but I felt like I was starving. I looked at my very well-stocked pantry and felt discouraged because I could eat almost nothing in it. The few things I can eat are pretty bland and tasteless. Once I woke up to feed her in the middle of the night and cried myself to sleep afterwards thinking about the mint brownie ice cream in the freezer that I couldn't eat. Sometimes I would think about slashing my wrists or hurting myself in other ways, but would step back and realize "I don't really want to do this. I'm just losing my mind because I'm hungry." Not to mention that would just be an extra mess to clean up.
 Last week I had my six week check-up and mentioned that I was having struggles with postpartum depression. My doctor made a few jokes and asked if I wanted a prescription. I don't need drugs. I need FOOD and CHOCOLATE. Can you write me a prescription for a chef and a maid? Do you think you could clear that one with my insurance? (Not that there is anything wrong with taking medication if that is what you need, but I'm pretty sure that I need calories, not pills.) Oh well, too bad for me. My baby is seven weeks old and my diet is still a huge stumbling block. It's hard to have energy and feel happy when getting balanced nutrition is so difficult, but I am pulling through. Now that we have her reflux under control I am able to eat a few more things. I'm coming to terms with the fact that food is more about the nutrition it provides than actually having any taste. I don't feel like hurting myself anymore and  I know that I can get through this.

Here are some things I recommend trying if you are having struggles with postpartum depression:

• Talk to someone, your spouse, a friend, your doctor, someone. Talking helps. (If you have no one else, shoot me an email. I'll listen.)
• Get some sleep. Let your house go a little. It's ok. When your baby is sleeping, squeeze in a nap. Your physical and mental well-being are more important that the state of your house. (This one is hard for me. I have a hard time relaxing when my house is a mess.)
• Eat a balanced diet with plenty of water. If you are breast-feeding, you should continue to take your prenatal vitamin, drink two liters of water and eat an extra 300 calories per day.
• Don't try to be perfect. No one is. Supermoms are a fairy tale.
• Get out of the house. I highly recommend joining a playgroup. In talking to other moms you will discover one of three things: 1. The other moms are going or have gone through the same thing. 2 Other children are more difficult than your own, consider yourself blessed. 3. Your children are more difficult than your average child, consider yourself strong. 
• Exercise. I know this is hard to find time for this and I personally don't do enough of it, but if even if you can put your baby in the stroller and go on a walk, it helps. (Although don't overdo it, you just had a baby.)
• Try to do something for yourself on a weekly basis. I would say daily, but if you're like me that just ain't happenin'. Take a long bath, paint your toes, read a book, have a bowl of ice cream.
• Remember that this condition is temporary. If it doesn't go away, get some professional help. There is no shame in getting help so you can take care of yourself and your family.

If you are having problems with postpartum depression, let someone know. You need help and support (not to mention food and sleep). Being a mom is hard work. Being a mom to multiple small children is even harder.  Don't be discouraged if you can't do it all, because no one can. Find a friend, family member or neighbor who can listen, give you a break or even just do lunch with. It's amazing how therapeutic it is just to talk to someone else about the problem. For other resources go to www.depressionafterdelivery.com or www.postpartum.net

Book Review: Full of Life

It is my belief that just because this is my third baby and I have a BS in Nursing doesn't mean that I know everything there is to know about pregnancy and having babies. So I picked up Full of Life: Mom-to-Mom Tips I Wish Someone Had Told Me When I Was Pregnant by Nancy O'Dell, hoping for some new insights. This book is not an encycolpedia reference for pregnancy and motherhood, however it was more enjoyable to read than any of the other pregnancy books that I have read. It didn't tell me anything that I didn't know, but it does have some really good tips and is written in a style like you are talking to a friend. I would recommend it to first-time moms. Here are some the tips that I thought were most helpful.

• A typical fertile couple has a 20% chance of conceiving with each cycle and an 85% chance of becoming pregnant within one year.
• Your pregnancy is really 40 weeks, not just 9 months.
• Your cravings may be very specific and may change at a moments notice.
• When telling your boss the news, know your rights before hand. If you have worked for a company full-time for at least 12 months before your date of delivery the federal Family and Medical Leave Act (FMLA) entitles you to 12 weeks of maternity leave, during which time they have to hold your position for you. Whether or not you get paid during that time is another story.
• If you were exercising regularly before you were pregnant, it is safe to continue to do so while you are pregnant.
• It is not uncommon to have irrational, panic-inducing dreams while you are pregnant.
• If you are having constipation issues, try baking pureed prunes (yes, baby food will do just nicely) into a spice cake. It should take care of the problem without the taste and texture of actually eating prunes.
• When creating a baby registry, don't register for blankets, stuffed toys and smaller baby clothes. You will probably get enough of those anyway. Register for sizes 9 months and above, and items like a 2nd car seat base, strollers and baby socks.
• Sleeping on your left side is best for baby. It improves circulation. Sleeping on your back can cut off circulation (and oxygen) to your baby.
• Things that can prevent leg cramps: drink plenty of water, eat Potassium rich foods, take a warm shower and stretch your calves before bed.
• Things to relieve leg cramps: get you husband to massage your calves (yes, I realize these will probably occur at some ungodly hour, have him do it anyway), stretch and flex your calves repeatedly, get up and walk it off.
• Fetal hiccups show that baby's diaphragm is working.
• Your breasts can leak breast milk even before you have a baby.
• Bladder leakage can happen: wear a pad, do your kegels, limit bladder irritating beverages (those that are carbonated, acidic or contain caffeine), and cross your legs when you cough.
• Breast-feeding is not automatic. Take a class or read a book before you have your baby.
• Register at the hospital before the big day.
• In addition to comfy clothes, make sure that you pack your laptop, camera, extra batteries and camera card for your trip to the hospital.
• The most effective way to push a baby out is like you're pushing to have a bowel movement. Yes, it is true.
• Despite all of the discomforts and trials of pregnancy, it is all worth it in the end. :)

Folic Acid A Key To Healthy Babies

When I saw this headline on the cover of yesterday's paper (sorry I was going to link to the article, but for some reason the Sunday cover story isn't listed on the Salt Lake Trib's website, weird I know), I was a little surprised, I mean research proved this in the 1980's. The problem is that health care officials and educators assume that people know this and they stop harping on the matter, but every year a new group of women enter their child bearing years and need to hear this information. And even though I have gotten on this soapbox before, I am going to share a few important facts about folic acid and urge moms everywhere to share this with their friends and with their daughters.

• Folic acid occurs naturally in foods like fruits and vegetables, but our bodies absorb it best in it's synthetic form. To get your daily RDA of folic acid from your diet you would have to eat 200 red apples.
• Insufficient folic acid can lead to birth defects (or defects that result in miscarriage) including defects of the brain, skull, spine, heart, arms, legs, face, hard palate (cleft lip and/or palate) and urinary tract. A mother can reduce the risk of her child having these defects by 50-70% by taking 400 micrograms of folic acid a day.
• The most crucial time for you to be getting folic acid is in the first 28 days of pregnancy. Most women don't even know that they're pregnant in the first 28 days. 
• Hince why, EVERY woman in her child bearing years should take a folic acid supplement.
• Folic acid is used to create and repair DNA (necessary for cell production), which is why it is so vital during early pregnancy. The first 28 days are when your little bundle of joy goes from 2 microscopic cells to a something with a heart beat. Isn't that just phenomenal to think about?
• Folic acid is crucial not just for the growing baby, but mom too. During pregnancy folic acid demands increase because it is needed to produce the new cells that are making up the increased blood volume, and general increased everything that come with pregnancy.
• According to a March of Dimes survey in 2009, only 11% of women took folic acid before pregnancy.
• Apparently there is a myth going around that multi-vitamins will make you fat. This is false. However, if your multi-vitamin has iron in it and you're not drinking enough water, it can make you constipated which can lead to bloating and discomfort. Stay well hydrated and you should be fine. 
• Since 1998 the U.S. Food and Drug Administration mandated that folic acid be added to white flour, bread and pasta, which has resulted in about 1000 fewer children born with neural tube defects each year. 
• Many Hispanic women have genetic deficiency that interferes with the metabolism of folic acid. Which means that they should be taking even more folic acid.
• The average life-time cost of spina bifida per person in the United States is $532,000. 
• Currently the Center for Disease Control and Prevention, the March of Dimes, and the Spina Bifida Association along with corn and flour tortilla manufacturers are working with the FDA to supplement corn tortillas, a staple for many Hispanic diets. It is estimated to cost $3 million per year, but will save $145 million in direct medical costs for defects.
• If you are a woman living in Utah you can sign up for free vitamins at poweryourlife.org 

Helpful info for Moms who have had bladder issues after childbirth

 A few months ago I was talking with a good friend and I came to the realization that there are a lot of women out there who have been done a disservice by their post-partum nurses and OB-GYN's. She (and many others) have no idea what Kegel exercises are and how they are helpful in getting your body back to normal after childbirth. Perhaps many of my readers are already well-informed about this, but if I'm able to enlighten one woman who wasn't, than my time is well-spent.
 Pregnancy and child birth do a number on a woman's body. In order to grow a healthy child, the muscles get stretched out of place and weakened. The birth process is the most stressful on your body, because that 'not so little' bundle of joy has to fit through a comparatively tiny hole. Sometimes this results in tearing of the skin and muscles in the perineal area. Every woman who has delivered (or will soon deliver) a child should do Kegel exercises, but if you have given birth to large children, had difficult deliveries, had an episiotimy and/or torn during the delivery process, it is especially important that you do these exercises. And if you are pregnant can really decrease the perineal tearing during the delivery process by doing these exercises.
 So what are Kegel exercises anyway? They are exercises discovered by a Dr. Kegel to strengthen the muscles that control urinary flow. You're practicing squeezing and relaxing those muscles. And no one has to know that you're even doing them. There are two ways to determine if you are squeezing the correct muscles.

1. In the bathroom, stop your urine midstream. The muscles you squeeze to do that are the ones that you need to exercise.
2. Or lay on the floor and focus on squeezing the muscles around your urethra and anus. If you are squeezing your stomach or bottom muscles, you are squeezing the wrong muscles.

Now that you know exactly which muscles to exercise try this:

1. Squeeze for 3 seconds and then relax for 3 seconds. If you can't do that, build up to it.
2. Repeat this 10 to 15 times per session. Try to do this at least 3 times a day. These exercises are only effective if you do them regularly.

If you suffer from stress incontinence (bladder leakage when you laugh or sneeze), try these exercises. Doing these exercises can also help to prevent bladder, bowel and uterine prolapse (where the pelvic muscles are not strong enough to keep the pelvic organs where they belong). If you already have some prolapse it is important that you see a doctor to have it corrected before it gets worse. It is also important that you drink lots of water and get enough fiber so you're not straining in the bathroom and making things worse.

Ok, this part may be a little TMI, but I think it's helpful. I pushed for four hours (wish I were exagerating, but I'm not) with my first child, who came out the wrong way and would not be turned. Afterwards my CNM said "I am totally amazed that you only have a first degree tear." The reason is I had an hour commute to work each way, and every day I did Kegel's on my way to and from work. That was a good 2 (sometimes 3 with traffic) hours of exercise each day four days a week. Thank you nursing instructors who drilled that into me! It made a huge difference. Having strong pelvic muscles before your delivery can prevent a great deal of pain and suffering, and greatly improve your delivery experience.

Why You Should Probably Be Taking a Prenatal Vitamin Even If You Aren't Pregnant

The process of growing and breastfeeding a child for six months sucks out 5 years worth of nutrition from your body. This means that if you are not supplementing your diet while pregnant and/or breastfeeding your body will remove mineral and other nutrition stores from your body in order to create/ feed that little bundle of joy. Your body will actually take calcium from your bones and give it to your baby. This is one of the reasons women are more likely to suffer from bone loss. (There also another  bigger and more complex explanation that has to do with estrogen, but I won't get into that.) So if you plan on having a child in the next five years, or even if you have had a child in the past few years, you need to build (or rebuild) those nutrient stores by taking a vitamin. (This is a tidbit that I didn't learn until I had to start teaching it to people,  and is a good reminder for myself because I haven't been good about taking them lately.)

If you're pregnant or breastfeeding, prenatal vitamins are good for your baby. Taking a prenatal when pregnant drastically reduces your risk of having a child with birth defects. The problem with prenatal vitamins is that for many women the iron in them has a tendency to make pregnant women nauseated. When I was pregnant with my son, every time I took a prenatal vitamin I started vomiting. There is a method of getting around this. If you take prenatal vitamin with a glass of milk, the protein in the milk decreases indigestion, and your body also when given the choice of calcium or iron, will choose calcium. It can't effectively absorb both at the same time. (There's a long explanation involving chemistry, but brevity I'll fore-go that one too.) The downside is that you're not getting the iron. (But that's better than throwing up all of it, right?) If you can't handle that go for the gummi vites and some folic acid.
 Other good reasons to take a prenatal vitamin: They make your hair and nails grow stronger, faster and healthier. I started taking a prenatal vitamin when I was fifteen for this very reason. (and I took them consistently until I got pregnant, the irony) Also, prenatal vitamins are super cheap. However, you should be forewarned that the iron can make you constipated, so make sure you are drinking plenty of water.