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The utter exhaustion of feeding the small person. And other small things. May 31, 2011

Filed under: Breastfeeding,Parenting — titchandboofer @ 7:21 am
Tags: , , , , ,

Way back a hundred years ago, in February, I wrote this lengthy post about the trials and tribulations of trying to make the small person bigger via the magic of formula. In the first few weeks following the commencement of the Forced Formula Regime things were looking pretty positive. Small was drinking about half his required amount of milky toddler delight, gaining motor skills at a great rate, sleeping like a champion and generally being a happy camper. As third world baby disappeared and cheekily fiendish toddler emerged I was having a brief reprieve from feeling like the worst mother ever (and yes, I shall exaggerate as I wish).

Four weeks into the FF Regime we checked back in with Dr Tactless. Despite my previous experience of his uncharming way with words, I was feeling confident. Small was drinking! He felt like he weighed a goddamn ton! He could take off his own jumper! Win! Win! Win! Or not. Dr Tactless was underwhelmed by small’s progress and even more underwhelmed by his measly weight gain of a microgram (or something equally inadequate). The only thing he was satisfied with was the raft of blood test results, showing no malabsorption problems, no vitamin D deficiency (Ha! Suck on that Tactless. Call my baby pale indeed.), no infections and only apparently borderline low iron stores. His assessment was that the iron would come up with the increased intake of magic toddler milk (stay tuned for more on this later). His advice at this point was that we should really be trying harder to increase his intake and that we should resume trying to get him to have solids. But don’t get into a battle. Make it fun! Obviously, being pretty defective parents, we had Never Thought Of This and Just Weren’t Trying Hard Enough. Equally obviously, Tactless had forgotten having the identical conversation just four weeks before. Anyhoo, home we go to continue the FF Regime and add in a little Eat Your Goddamn Weetbix Funly. On the formula front there were no dramas, but to say that progress on the EYGWF front was slow would be an understatement. Like a dead snail trying to navigate coffee grounds. A good day would see the small one actually swallow about six teaspoons of mashed/pureed something. More would go in and then have to be fished out by the beloved or I later so that he could open his mouth again. Similarly slow was the small one’s acquisition of actual words. We had brought this up with Tactless. His response was ‘He can make sounds, he’ll speak when he’s ready. I’m not concerned.’ (Remember this folks).

So, to the utter exhaustion part. I do sense that some of you may be thinking ‘Meh. Frustrating yes, but exhausting? Really? Other people have Much Bigger Problems.’ Which is undoubtedly true, but trying to constantly rank yourself on a scale of Other People’s Problems is an endless and fruitless task. Yes, other parents have to provide full time nursing care to children with severe cerebral palsy, others need to learn how to resuscitate a baby with persistent apnoea (look it up), others just get to faff around and feed their kids chips and get their nails done. Whatever. For me, the small one’s eating is exhausting. Remember the 100mls over 4 hours bit? Extrapolate that to 800mls of formula, three attempted meals and two attempted snacks per day. My world narrowed to Feeding Small. From 5:30/6:00 o’clock in the morning to 7:30 at night, I mostly tried to feed Small. This was not fun for either of us. I could sit with him for an hour over breakfast and see him swallow two teaspoons of weetbix. And that was on a good day, if the weetbix was absolutely the perfect texture. Too thick and he’d just get all gummed up like it was brown glue. Too runny and it would be everywhere but in his belly. I would try and manage his routine so he had time each day when he wasn’t being asked to eat, when he would get to do normal toddler things like play and climb and dig in dirt. And I would bitterly watch other mothers get irritated by toddlers who constantly harass them for food. That is the day I looked forward to, when small acknowledged hunger and sought food from me. So there was no blogging, no reading of lovely trashy novels, no baking of sugary delights. If I wasn’t feeding small or trying to brighten up his day with sand and buckets, or working, or sleeping, I was slumped on the couch watching reruns of 7th Heaven, wallowing in being worst mother ever and fighting off the gnawing anxiety of destroying small’s relationship with food for life. The weight of being told – and believing – that I had caused all of this by breastfeeding too long and too much was too heavy to shrug off.

Another four weeks pass in much the same way, April begins. We return to Dr Tactless, knowing already that we’re on the brink of firing him, that we shouldn’t be seeking help from and paying someone who consistently contrives to make us feel worse about our parenting. We know better now than to go into his office feeling confident about any progress small may have made. Again his weight gain is impossibly small, although he has grown in height amazingly. Still no words. Still we are Not Trying Hard Enough. Three exchanges during this visit confirm that we are done with this man:

1. It is a warm day and we are carrying a sippy cup of water for small.

Tactless – This is what I mean. You should be taking EVERY opportunity to get calories into him. I don’t recommend offering him water at all.

Me – But he gets very constipated with only formula.

Tactless – Water is what we give people who are trying to lose weight, not gain it.

*     *     *     *     *

2. On the topic of Small’s lack of talking

Tactless – I’m very concerned that he is not talking. At this age (nineteen months) he should have at least ten words. By two he should have fifty words! And I don’t think he’s going to swallow the dictionary overnight.

Me – Four weeks ago you weren’t concerned at all about his speech, what has changed?

Tactless – Now you do know that you should talk to him?

Me – ………………

*     *     *     *     *

3. Later, also on the topic of talking

Me – Should we take him to a speech pathologist?

Tactless – Well there’s no scientific evidence to back up that sort of thing.

Me – Surely his speech and eating are connected?

Tactless – I think it’s really his personality. He’s obviously very stubborn

Hmmmmmm. Done with this man. So. Very. Done.

Despite the supposed witchcraftery of speech pathology, our next step is to find whichever coven a good one hangs out in and take the small one there. Fortuitously, The Nanna and Coach know someone who knows someone and thither we go. And she is lovely, no cat or broomstick in sight, very cheerful, very positive (oh the blessed relief!). Within ten minutes of talking through the small one’s history, watching him interact with us, watching him sign and listening to what sounds he can make, she has a preliminary diagnosis. And it is not that I have breastfed too long or too much. It is….drumroll please…… Verbal and Oral Dyspraxia. The ultra brief, layperson description is that small knows stuff (like that he has to swallow what’s in his mouth) and he can do stuff (like swallow) but the pathway between knowing and doing is disrupted and not under great voluntary control. So he’s not just the world’s most stubborn baby. And it’s not that we’re Just Not Trying Hard Enough. And whilst no parent wants there to be something wrong with their child, I am indescribably relieved. I am floating with relief. I am overjoyed to have an answer that is not simply a way of blaming me or my child for not getting it all right. Want more good news? According to the speech pathologist, even if we did nothing, small will be fine eventually, just frustrated and delayed. And the something we can do? Speech training. And as his control over speech improves, so will his control over eating and swallowing. Just like that.

Interestingly, statistics suggest 10% of children will have a form of dyspraxia. 70% of these will be boys. Even more interestingly, Dr Tactless and the speech pathologist have shared many patients with this problem. Yet he never mentioned this.

Just last week we took small off to a new paediatrician. We shall call him Dr Lovely. I have worked with Dr Lovely on many occasions and have only ever seen him treat mothers and babies with respect. Why it didn’t occur to us to go to him before, I don’t know. Anyhow, Dr Lovely’s take on small?

– Number one issue: low iron. Supplement iron and he’ll sleep, feed, concentrate and generally feel better.

– Reduce formula.

– Increase food, even if it’s the few foods he can handle, like perfectly textured weetbix, rice and all it’s derivatives, nutella and peanut butter.

– Carry on breastfeeding if we fancy.

– Unconcerned re small’s size. Actually noticed my own smallness and – shock! horror! – related that to small’s genetic potential.

Lo and behold, within one week our lives have changed again. Small is eating! Meals! With minimal peanut butter related bribery! And small is speaking! Just a few words… for example: I say “you’re a cheeky boy” and he replies “I cheechee!”. And so I continue to float with relief, unburdened of a layer of mothering guilt, delighting in the further fiendish unfolding of small’s toddlerishness. Time once enslaved to Feeding Small can instead be devoted to Keeping Small Away From The Stove and buying bigger toddler shoes and, well, blogging.

*     *     *     *     *

Stay tuned for chapter two of “A goodly four months of procrastination” – The creation of a Whole New Person.

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No no, not abandoned

In brief, the top five reasons for my neglectful treatment of this blog:

1. The utter exhaustion of Feeding The Small Person

2. The creation of a Whole New Person

3. An unexpected Career Addition

4. An impulsive decision to Move House

5. I just wasn’t Feeling It

*      *     *     *     *

And so “A goodly four months of procrastination: A work of non-fiction in five chapters” is born…

 

Fun parent has left the building February 9, 2011

Grab your cup of tea and a large snack. This will not be brief.

Here I was almost six months ago, mother of a one year old who had zero interest in expanding his diet, and wrestling with the questions of follow versus lead, surrender versus control. My enthusiasm to embrace small’s transition to toddlerhood and our family’s transition out of the hazy circus of babyhood meant that the pendulum tipped to lead and control. And for a time all was well. Somewhat smugly, I felt I had achieved quite a coup: the small one ate a small amount of food and continued to breastfeed a large amount of the time. Huzzah  for extended breastfeeding thought I. Time whooshed by. My work hours stretched into two days a week, the beloved’s compressed to three or four. At some point, small let go of his hatred of bottles and cups. Freedom! The beloved could give him expressed milk and no longer had to plan their day strategically around small being brought in to work for a breastfeed. We could even (gasp!) go out without him, just the two of us.  Just look at us go! Embracing change left and right! Ah, the maturity.

Summer arrived, rainy, humid. Ate a lot of ice cream, lurched onto the mad pre-Christmas treadmill of catching up with friends, worked a bit, got chiropracted a lot (yes, well, if other people can make up words, I don’t see why I can’t join in), got sucked into the shopping frenzy, and expended a lot of energy secretively hiding and wrapping presents. And some time in there the small one just kind of stopped eating again. One day I realised I was still carrying around food for him every day, still offering him three meals plus snacks, but that it was all going uneaten. He was toying with his cereal, having the odd rice bubble or bran flake, crumbling his previously beloved fruit bars and mooshing them into the furniture, turning his nose up at toast, hiding his dinner under an upturned bowl, not really ever eating. He was breastfeeding as much as ever, maybe more, with night feeds escalating wildly to the point where once he grabbed on he wouldn’t let go until dawn. Bloody hell it was exhausting. What to do? I stopped expressing at work, reasoning that a drop in supply might increase his appetite for the alternative. I tried to reinject a little stability in his day, making sure we were at home for mealtimes and sleeps, not varying the food too much.  In the new year I made just one resolution: to night wean.

 

Oy, the trepidation. I had toyed with the idea of night weaning for a while, longing for sleep like a strung out addict. I talked at all and sundry about it. Predictions were dire and unanimous…night weaning and bed-sharing would not be compatible, small would not be off the boob until he was out of our bed and he wouldn’t get out of our bed until he was out of our room and presumably wouldn’t be out of our room until he bought his own house some time in 2039. What the hell, I thought. Can only give it a go. I struck a deal with the small one – you can have all the cuddles you want, all night, but it’s last drinks at 10pm then the bar will reopen when it is light outside. Miraculously, with just one night of outraged shrieking, we succeeded. Yes, he may sleep on my head, or at least on 70% of my pillow, and do a bit of break dancing and occasional squawking through the night, but it’s surprisingly easy to sleep with a toddler on your head and not on your breast. He even stopped the hopeful groping after a few nights. Smug parenting moment. Sleep. Bliss. But mysteriously no increase in appetite. Still no eating. And still attached to the breast at any opportunity through the day. It dawned on me one day that whenever I was stationary, he’d come for me like a homing missile. My latest theory is that the breastfeeding weight loss starts when you start running away from your toddler.

And then it was January. Lazy, sandy, lolling January. Still no eating. No talking. And not really growing much either. And then he got a virus, not a bad virus, just persistent enough for us to go to the GP. Unsurprisingly the GP said ‘small is too small, take him to a paediatrician…really, it won’t be that bad, he won’t bite you’. Coming not long after the new and disliked maternal child health nurse snippily said ‘well, I have to tell you to see a paediatrician, even if you won’t go’ and right on the back of a close friend having the courage to tell us that she didn’t think all was well with small and his food strike, it was the straw that broke this mama’s resolve. I’d grown hardened to the insensitive, offhand and sometimes plain ridiculous comments coming from any old schmo in the street. It’s hard to hear but even harder to ignore it when it comes from someone who loves you and your baby dearly.

So to the paediatrician we went. Grimly prepared, list of questions in hand, contents of Blue Book virtually memorised, I felt like I was going to sit a test for which I couldn’t possibly study well enough. Yes, this could be taking a healthy wariness a little too far, but the clawing anxiety was hard to suppress. What was my worst fear? Being told ‘you must wean and give your baby formula’. And what happened? I was told ‘you must wean and give your baby formula’. It played out like so:

Me – So, I have x, y and z concerns. I’m not really concerned about his size. Genetically, he’s going to be small.

Dr Notsochatty –  (after about twenty minutes of silently examining, weighing, measuring, charting and noting developmental milestones) None of x, y or z are concerning to me at all. These things will be fine. He is too small. It’s a very simple issue – not enough calories.

Me – Why doesn’t he seem hungry? Why doesn’t he take the abundant food or drink offered to him? I assumed he would instinctively take what he needs.

Dr Tactless – He is like a baby in the 3rd world. He’s just used to not getting enough so he doesn’t ask for more.

Me – Wow. That makes me feel great. So, I have been effectively starving him for months. But he seemed so happy.

Dr Slightlyobtuse – Lethargy can look a lot like contentment. The solution is to wean and put him on toddler formula. He needs to be having (tappity tappity of calculator) one litre a day.

Me – I’m quite devastated. (trying not to embarassingly cry) I don’t want to wean him completely. I still feel there is value in breastmilk for him.

Dr Sceptical – What’s your problem with formula?

Me – Urhh. That’s not really what I have the problem with. I have a problem with weaning completely.

Dr I’mdonenow – Well don’t then. Just make sure you give the formula first. We’ll see you in 3-4 weeks. If he’s not improving we’ll look at admission to a hospital or a mother-baby unit.

Me – ……………

That was that.

I thought ‘I could fight this, I could ignore this advice and carry on waiting for small. But why did I come here? Wasn’t I ready for something to change? Yes. We have tried it small’s way and that hasn’t worked. So we’ll try this other way’. And before I could get distracted by the competing voices in my head, I stamped over to the supermarket and bought a tin of toddler formula. On the up side, it is organic.

Then we went home and I was introduced to a new side of the small person – the you-thought-I-was-stubborn-before-ha-you-aint-seen-nothing-yet side. Again I say – goddamn genetics. Since before I was pregnant I was repelled by the advice given to always dominate your child, to show them who’s in control, to wield all the power, to not give the inch for fear of losing the mile. I so dearly wanted to respect my child’s individuality, to recognise the limited ways he has to voice his own wants, to honour his right to exercise his own willpower. I didn’t want to get into power struggles with him. I wanted to negotiate peacefully…….. It’s fine. You can get up off the floor now. Wipe away the tears of laughter. Oh ho ho ho. And yes, I have met toddlers before, but obviously mine was going to be special and different. Be careful what you wish for indeed. Small obviously feels that his right to exercise his own willpower is indeed honoured.

 

 

So, the formula. The first day I managed to cram 100mls into him. It took four hours. Mainly he did angry backbends over my lap, his face contorting in his efforts to escape what was effectively waterboarding with powdered milk. God it was dreadful. Not only was I the worst mother ever, with my third world toddler, but now I was torturing him. But as the week has unfolded, things have improved. Cooperation up, bodily restraint down. And despite my scepticism, and being completely aware of my ability to rationalise any decision I’ve made, the regime is working. This week has been like watching the small one come out of hibernation. He’s more vibrant, social, curious, vocal. His concentration span has soared. His sleeping has improved out of sight. He’s incredibly affectionate. It’s amazing to watch.

Yet painful. While I’m grateful that there’s nothing wrong with him that food cannot fix, it kills me that he’s been doing without for months. It challenges my faith in extended breastfeeding. It really challenges my faith in baby-led weaning/solids. It scares me that this could have gone on for longer. It makes me feel foolish for being so, so sure of my convictions.

 

Can’t you have a sandwich instead? Please? December 17, 2010

Filed under: Breastfeeding,Parenting — titchandboofer @ 8:14 am
Tags: , ,

As I’ve mentioned once or twice, I like breastfeeding. Personally, generally, physiologically, politically, ideologically. Whatever-ally, I’m all for babies getting human milk right from the source. To state the obvious, it’s free, convenient, healthy, soothing, comforting…. just better. And most of the time I love actually doing it, rather than just delighting in its betterness. In the first few weeks, despite the attachment pain, I wallowed in the satisfaction of the fact that I could do it. Not only that, but after a pregnancy of fretting that genetics were against me, I gloried in being the first breastfeeding woman in my family for at least three generations. A month or so in, the attachment pain disappeared, and the small one and I settled in to the comfort zone, curled up together, his tiny fist pressed into my breast, eyes blissfully closed. And he fed and he fed and he fed. Every three hours or so, round the clock, in every conceivable location, without pause. Somewhere in those early months I anticipated mourning the age when he would only want the ‘bookend’ feeds of morning and bedtime. I anticipated that this would be around 12-18 months (yes yes, laugh all you like, god knows I do). And so the months slipped by. Six months, small is still going strong, flirting with the odd morsel of food but reeling in horror at the offer of expressed breast milk in any vessel (bye bye Masters study, I’m staying home to breastfeed with a mixture of relief and regret). Eight months, still going strong, powered by breastmilk and three-four cornflakes per day. Ten months. Twelve months, still going strong, stretching out to all of four-five hours between feeds, handily allowing me to go back to work doing a weekly half shift of four hours. Twelve and a half months, reluctant mamas crack under pressure and force the food issue. Thirteen months, meals! Expressed breast milk in a cup or bottle! Naively, I assume that as small eats more he will breastfeed less. Not heaps less of course and I certainly don’t want to wean him, but a little less? One feed less? Ha! With his big brown eyes, his most solemn expression and one hand possessively clutching the neck of my t-shirt, the small one has no need for words to express the obvious… Oh mama, why would I want to do that? So, at sixteen months he’s still feeding like each feed could be his last, vigorously, desperately, every two to three to four hours, round the clock.

Mostly it is still deeply satisfying. It’s certainly not at all painful or difficult any more – small could feed upside down and tap-dancing if he felt like it. I can smugly report that he’s never been more sick than having the most minor of colds. It is a hugely convenient way to keep a now keenly mobile child still and quiet when I need to. And so on and so forth and blah blah blah. In itself, breastfeeding has not changed. It is still free, convenient, healthy, soothing, comforting… You get the picture. And mostly I continue to delight in it. Mostly I have adapted to sleeping in three hour intervals and expressing when I work and continuing to feed any time any place. Mostly I love dealing with the looks of horror when strangers seeing me feed ask me how old small is. And I certainly love the occasional looks of joy in the same scenario. That’s a buzz.

But sometimes, just sometimes, I’m over it. Really over it. Sometimes I think if my nipples get idly twiddled and distractedly bitten once more I will run out of the house screaming. Sometimes I think if I have to wake just one more time overnight to feed I will sneak away and hide in our spare room and leave the beloved to fend off small as he sleepily gropes his way across the bed. This week is one of those times. Early in the week we had a 24 hour interstate trip. Small fed through most of the outbound plane trip, through the night in a tiny hotel room, through part of every meal, through each of the five appointments we attended and through most of the plane trip back. (See above re breastfeeding being a convenient method of quiet immobilisation.) Not unreasonably I suppose, he now seems to feel that he cannot be within a five metre radius of me without being attached to my breast. It’s driving me bananas. Rationally, I know I have caused this. Rationally, I know I can’t spend 24 hours saying ‘Drink Up!’ and just as suddenly switch off the tap. But I don’t care. I just want to be able to go five minutes without a wailing limpet scaling my leg and pulling my top off. And you may say ‘Just Say No!’ or some such, but it’s not that simple. The small one, reveling in his emergent toddlerhood is very determined. Can’t imagine where he gets that from. Bloody genetics.

I know I want a lot. I want to demand-feed but I don’t want there to be too much demanding. I want an abundant supply without too much demand. I want to night-wean but I still want to co-sleep. I want to follow small and respond to his needs but I want him to be less needy. I want to complain about this without alienating everyone who’s ever struggled to breastfeed. Right now, at seven pm, I want to pack up my boobs for the night and not get them out until seven am tomorrow. I want to sleep the long, heavy sleep of my pre-baby years. I want a spare lactating woman, or two. I’m happy to return the favour*. Just not today.

 

*For an excellent discussion of  co-feeding, or ‘Informal Breastmilk Sharing’ look over here at PhD in Parenting

 

Dear Woman, November 16, 2010

Filed under: Breastfeeding,Midwifery — titchandboofer @ 7:17 am
Tags: ,

It’s a pleasure to meet you. No, really it is. I love the anticipation of peeking into your curtained cubicle at the start of my shift, not knowing you yet, not knowing whether you are crazy high on post-birth endorphins, wrung out exhausted, wary, pissed off, fretful and anxious, or just mellow and cruising. I want to know you, hold your hand through these next eight hours of your motherhood, listen to your rambling reflections on your birth experience, make you a decent cup of tea, kick out the visitors that you didn’t want, coo over your gorgeous baby, make your bed up with fresh, cool sheets. I want you to feel able to call on me for whatever you need, to feel cared for and mothered. Please don’t apologise for pressing your buzzer to call me…unless it’s just to tell me that your baby moved her arm. That is excellent and thrilling, but not absolutely buzzer-worthy. Good grief, I’m rambling already. It happens a lot, sorry. Anyway, before we get started there’s something I must show you. Look over here.

Let me gesture to my impressively enormous Bias – there it is, right out there on the table. I call it ‘Yay-Breastfeeding!’, or YB! for short. It’s quite large now, as I’ve nursed it well (no pun intended) over the years. We get along famously, my Bias and I. It’s like one of those friends you had as a kid. You know, the ones that your mum called a ‘bad influence’ because whenever you were together you were a little bit hyper, a bit wild and loud, prone to that screechy shrieking that six year old girls have perfected? My Bias follows me most everywhere and sometimes we get a bit rowdy. Often, Bias makes me get kind of wild-eyed and preachy, waving my hands around and gesturing helpfully at my own breasts. And sometimes, when we’re standing up high on our matching soap boxes, shouting ‘Breast Is Totally The Best!! Chuck Out The Rest – Of Your Tins Of Dehydrated Cow’s Milk!!’ I guess Bias and I can be a little bit intimidating.

So you’ve met my Bias, dear and lovely woman. You’ve met, the slightly awkward do-we-hug-or-shake-hands-or-just-kinda-nod? moment has passed. Now, just excuse me for a minute, while I escort Bias out of the room. She can wait in the tea-room and hang out with the other midwives when they’re on a break. I love her, but I do try not to let her distract me while I’m working. I know she’s not everybody’s cup of tea. Mmmmm, tea. Oh, sorry, easily distracted. In my fantasy world everyone would love my Bias and we’d all hold hands and sing and dance and be BFsF. But this is not my fantasy world. This is a public hospital. You have your own fantasy world, your own issues, your own hopes and dreams. You have your very own Biases, I’m sure, and you don’t have to be friends with mine. I’ll still be your midwife.

But I ask you just one thing – be straight with me. Don’t pretend to like my Bias. Don’t tell me what you think I want to hear. If you truly think you could love her, I will move mountains to get you well acquainted. I will pour my heart and soul into hooking you up. But don’t be all nicey nice about her to my face and then slag her off to the next midwife that comes along. Really. I mean it. Our time together is short. Don’t waste it.

Sincerely,

Your Midwife

 

Dreaming October 27, 2010

Filed under: Parenting — titchandboofer @ 10:07 am
Tags: , , ,

Entangled in a bed-sharing relationship with the small one, I have been following the comments on blue milk’s wondering post with rapt attention. Sharing our bed with small didn’t sneak up on us, like I know it does with some families. We planned for it long in advance. Much like with breastfeeding, I could envision all the heavenly closeness, the intimacy, not to mention the convenience of a family bed. At the end of pregnancy, as I lay curled around my weighty belly, I longed for the nights I would be curled around my baby, close enough to breathe in his warm-hay scent. And much like with breastfeeding I could picture it all so clearly, right up to the point of small being about six months old.

The beloved and I had thought ahead to some of the more practical concerns, like where small would sleep during the day when he outgrew the family bassinet and where he would begin his night’s sleep when his bedtime became earlier than ours. But we hadn’t ever wondered how either of us would sleep either side of a baby whose idea of resettling is not to sigh ever so gently and turn over, but to crawl up to the headboard, cling on to it and bounce loudly up and down, before falling onto my head. A baby who thinks our pillows are to beach himself on after a vigorous session of kick-off-the-doona. A baby who thinks 3am is as good a time as any to headbutt you into startling wakefulness.

We’d never planned for when small would depart the family bed. We’ve had the occasional flirtation with separate sleeping – trying the resettling in his cot post night feed thing, the sleeping in a different room thing, the resettling without a night feed thing. We haven’t tried these things to really end bed-sharing, though, but to break a pattern of constant feeding or constant waking. Mostly bed-sharing is still working for us. There are heart-melting moments, like the rare times when small lies down next to me, clutches my little finger and falls asleep as fast as a fingersnap. There is the simplicity of night feeding a baby who can pretty much organise it himself now. And there’s the ease of resettling the fratchy bladder-kicker when I don’t actually have to be vertical to do it.

I guess I have the vague thought that small will be out of our bed by the time the next baby comes along. A thought so sufficiently vague it doesn’t come with any type of plan attached. The anticipation of enacting any plan, with the near-certainty of wailing, sleeplessness and angst, is immediately sapping. But I know that, one day, something will have to change. Secretly, I dream of small just up and saying ‘Mamas, it’s been a hoot, but that bed of mine is looking mighty fine. See you in the morning. Not too bright and early now!’ Who knows? That could be his first speech. Like one of the commenters over at blue milk, all the chat about 5-9 year olds bed-sharing is making me a teeny bit nervous. On the other hand, there are some great comments about older kids bed-sharing with each other, which is a spark of hope. What to do? What to do? Probably procrastinate a little while longer. Watch this space.

 

Not in the zone October 5, 2010

I’m feeling very gloomy this evening. A bit short and snappish, preoccupied with the unfolding of events at work over the past two days. Usually it’s other people’s inadequacies and crappy decision making which send me home fuming, but tonight I’m just gloomy about my own.

I cannot count the number of times I have heard other maternity care professionals justify their decisions/refusals/interventions with the phrase “I’m just not comfortable with ______________” (insert any of the following: waiting for you to go in to labour on your own/allowing you to birth on the floor/you using the bath during labour/not giving you antibiotics/not doing this test/not giving this drug/letting you go home yet…). The list is endless and the language is always saturated with notions of permission-giving and implications of women being naughty, rule-breaking girls who don’t give a fig for their babies’ welfare. This notion of practitioner comfort as a guide for practice irks me as much as the statement “If it was my wife ____________ (having a breech baby/questioning the necessity of a test/being female and pregnant and conveniently oppressed by archaic obstetric care) I would advise her to _____________ (just do what I say even if it’s based on nothing but fear or financial incentive/not question me/just shut up already). Midwifery and obstetrics and having babies are not meant to be about being comfortable, not for anyone. As an aside, there is never a dumber question asked of a labouring woman than “Are you comfortable?”. This job of caring for women as they step into motherhood should be about understanding the normal and knowing the evidence for intervening in the abnormal. It should be about providing the information and honouring the woman’s ability to make decisions for herself and her baby. Should should shmould.

So, what have I done? I have run smack bang into the invisible wall of my very own comfort zone. Let me set the scene:

On Sunday evening, around seven o’clock, a woman gave birth to her first baby. I was not there, but I know she had a spontaneous, vaginal birth, using only nitrous oxide (the gas) for pain relief. She did not bleed excessively and is otherwise well. At birth, her baby was handed straight into her arms and lay, skin to skin, on her chest. She wants to breastfeed but her baby is not interested. Sensibly, she keeps her baby skin to skin with her, allowing him plenty of opportunity to breastfeed. Over night, the midwives help her to try and express some colostrum, but report that they are unable to express even a drop. By eleven o’clock the next morning her baby still has not been able to breastfeed. He has attached on and off a few times but hasn’t attempted to suck. He is settled and remains skin to skin on her chest. He has had a poo, but no-one is sure if he has had a wee (disposable nappies can be tricksy for detecting the teensy wee of a newborn). The woman’s husband is with her, anxiously attentive, lovingly stroking her and the baby. Her mother in law is sitting by the bedside, tutting and tsking as hard as she can, muttering about starvation and formula and glaring hard at everyone. The unit lactation consultant is off for a training day. All very helpful. The midwife looking after her asks me for help. I whip out my breastfeeding cure-all and show the woman how to position herself and her baby to feed lying down (really, it is a very useful skill). Baby has a go at attaching but still isn’t swallowing. He is starting to cry and is no longer easy to console. Together, we have another go at expressing some colostrum. Three glistening drops appear. I suck them up painstakingly with a 1ml syringe. It is twelve o’clock and has now been seventeen hours since birth. Conferring with my fellow midwife, we decide to finger feed the baby these three precious drops of colostrum mixed with 1/2 a ml of sterile water. Gently sliding a finger into his mouth and dripping the liquid in slowly, I hope fervently that this will trigger the switch in his brain – that he will start to connect sucking with swallowing with feeling something in his belly. As he starts to suck my heart sinks a little. His mouth is dry and he is so very uncoordinated, not sealing his mouth around my finger, not bringing his tongue forward but instead using it to push against my finger. But afterwards he turns back towards his mother’s chest and settles again, so we don’t give up hope. I step out of the room and back to into the relentless pace of another October day.

A few hours later, just before we morning midwives finish our shift, I check back with this woman and her baby. No change. It is now twenty hours since birth and he is starting to look truly hungry, crying and crossly pushing at her breasts. She is tearful, her husband more anxious. On the upside, her mother in law has tutted herself to sleep in the bedside chair. I step out again, seeking out the midwife who will care for her next. Hating the words coming out of my mouth, I suggest that while the woman should continue to keep her baby skin to skin and keep expressing, the baby may need a supplementary feed of formula. Then I go home.

Today, I’m back on the ward, every room full. Our lactation consultant is back on deck. She is frantically busy and she is furious – furious that this woman’s baby has been given formula with no medical indication. On paper this is true. The baby is not lethargic, jittery, under 1.5kg, admitted to the nursery, septic, hypothermic or hypoglycaemic (that we know of – no blood sugar measurement was done). His mother is not sick or absent. I feel horrible. I have great respect for our LC and we usually work well together. Usually she respects my professional judgement. Now, buffeted by the wave of her anger, I suddenly find myself questioning my decision. Should I have been more trusting? Should I have waited longer? How long? I ask this and the answer is firm – no medical indication, no formula. But really, how long? Until a medical indication arises. How do I feel? Uncomfortable.

And there it is. Discomfort. Have I really interfered unnecessarily because I wasn’t comfortable? I come home and haul all my breastfeeding textbooks off the shelf. Am I trying to justify my decision? Or can I find something to stretch the boundaries of my comfort zone a little? There are answers, sort of. Although the authors vary in how many feeds they feel should occur in the first 24 hours post-birth, they concur on one point: if a baby has not latched on and fed by 18-24 hours of age, the mother should be assisted to express colostrum and feed it to the baby by finger, cup or spoon. But none of these texts suggest what to do if there is no colostrum. In a perfect world, this woman would have a sister/cousin/friend who was breastfeeding, someone who could donate some breastmilk to tide her baby over until her own milk comes in. Or we could access donor milk from a breastmilk bank. But this world is far from perfect. This woman’s only family in Australia are her husband and tutting mother in law. And if they were here, the idea of sharing breastmilk amongst family and friends is disappointingly taboo. We will have a breastmilk bank up and running in Victoria soon, but even then it may not have enough to provide milk for babies not under nursery care. So what is the answer? How long can a baby wait?