"Nothing prepares you"

"Nothing prepares you" is the title of one of the chapters in the new book "What Mothers Do, especially when it looks like nothing" by Naomi Stadlen.
This is the phrase she most often hears from new mothers when they discuss how they feel about becoming a mother. They often say that it was " a shock" to find out what mothering really entailed. Another article called "The reality of motherhood: What Nobody Tells you discusses how we usually underestimate how much our lives will change when the baby arrives. We have read the books, taken the classes, watched the videos, yet there is an underlying feeling that perhaps there was something missing in our preparations...surely it wasn't meant to be quite like this???

Recently Setagaya ward's volunteer bureau in Tokyo held a seminar where the speakers discussed their experiences of being mothers in a foreign country. Many of the Japanese women in the audience reported similar experiences when their families were posted overseas. The consensus was that in addition to culture shock, there should be a whole separate category called "new mother shock". Compounded with some degree of pre-existing culture shock, it can leave a new (foreign) mother feeling quite overwhelmed. Even if you expected your baby to bring some degree of change to your life, the extent of the real impact of baby's arrival on your life and your emotions can far outstrip what you anticipated. You may indeed feel that "nothing prepares you".

The first newborn baby you ever held may have been your own baby. Few of us have spent time with newborn babies, so we may not know instinctively what is normal. We may not have family or friends nearby to support us. So that is when we turn to the books or the internet to get some perspective. There is a huge market in writing for new parents, because everyone is worried, and lots of unqualified "experts" are cashing in on these vulnerabilities, telling us that they have the answers, their methods are the secret to unlocking the mysteries of parenthood.

How do you know your baby is doing OK? Is it normal to have a baby feeding frequently every evening? How can it be normal to poop so much? When is spitting up too much? What will I do if there is an emergency? Will I even recognise there is actually an emergency? What if I don't speak Japanese well (or at all)? Where can I find the help I need? How long before life returns to "normal" and I can "get things done" again? Why am I so forgetful now, even though before the baby arrived I was a highly competent and organised business professional? These are just a some of the things that might run through your mind.

And to top it off, all this occurs while you are recovering physically, emotionally and mentally from your birth, possibly replaying the experience over and over in your mind, adjusting to living with interrupted sleep and hormones that are in flux, and being totally responsible for this new little person, 24/7. Learning to breastfeed, learning to recognise your baby's signals, getting to know your baby's needs and how to satisfy them, dealing with the nights, coordinating feeding, changing, sleeping, eating meals yourself, maintaining yourself, your relationship with your partner, your home...this intense on-the-job training happens when you may feel at your most vulnerable, and at times it is hard to pick out the exact bit of information you need from all the things you have heard, read and stored for future reference.

If we were all parenting our new babies in extended communities, we would probably have been exposed to little babies and the things they do while we were growing up. We might have some inner sense of "this is what babies do". In an extended family or community, other women may
be able to share their wisdom and experience when our babies are born, help us out with the myriad of tasks we are learning, and support us in a positive way as we learn to become mothers. But being in Japan, you may find yourself more isolated than if you were in your home country.

During pregnancy, most first-time mothers are focussed on the birth. It can be so all-consuming that we tend not to think about what comes after: we trust the next part will all come naturally, and look after itself. Compared to the birth, how hard could it be???

Before the baby arrives, many women say they are determined to keep some sense of routine and order after the baby is born (which explains the appeal of those books with carefully planned daily schedules). They start from the premise that being in control is essential to being a parent. "No baby is going to run my life!" Having a baby is the beginning of a life-long relationship. What other relationship in your life is based on "control"? Each baby is an individual, each wired differently, and a control-based one-size-fits-all approach to parenting can make life very stressful for a new mum. It is easy to think that because your baby doesn't do everything that the book says, or doesn't respond to the methods in a particular book, there is something wrong with your baby. Maybe there is something wrong with the book???

By not anticipating and preparing for the reality of life with a newborn and the changes that will arrive in your life, new motherhood can come as a massive shock. Before your baby arrives, read some books on gentle parenting, attend La Leche League meetings or join a new mothers group in your area where you can see mothers and babies in action and hear their stories, join online discussion forums where you can have your questions answered sensitively. Do this at a time when you are still able to think straight, and be open to different suggestions...you never know what might work for you in the future! These links are just somewhere to start to help lessen the new mother shock, and then after the birth these same places may be able to offer you support as you adjust to your new life as a mother.

Our babies truly benefit from us being flexible, spontaneous and open to new ideas as we learn to be their parents. If we listen to our babies, and watch them, and grow and learn with them, our lives can be so enriched, and sometimes just a little less stressful!

Making milk is easy!

Download the flyer "Making milk is easy! 10 steps to make plenty of milk " from the Massachusetts Breastfeeding Coalition - available in English, Spanish, Portuguese, Italian & French.

Breastfeeding in Japan photos!!

Would you like to share your breastfeeding photos? Babycafe Japan is going to start a gallery of breastfeeding photos on our blog. You don't need to have your name included, nor your face if you don't want to, but we know that if everyone can see more babies breastfeeding, it makes everyone more comfortable that breastfeeding is the normal way to feed your baby. You could send us your picture of breastfeeding in the park, on the subway, in a restaurant, visiting a shrine, while hiking in the countryside, at the pool, while wearing your baby in a sling: happy breastfeeding babies ...anytime... anywhere!

Send photos here, and include any story you'd like to share about breastfeeding...maybe we can put them all together in another format. Just one thing to note: the photos must be owned by you.

Epidurals and breastfeeding

There is more and more evidence that breastfeeding is affected by birth practices, particularly the epidurals mothers receive during labor.

Epidural use is not all that common in Japanese hospitals, but if there was a survey done on the non-Japanese mothers' use of epidurals, the rates would definitely be higher than for the local mothers.

This video gives an interesting discussion of the situation being seen in North American hospitals where epidural use is much more common. The doctor describes how babies born to mothers who have had epidurals during labor are having more difficulties getting breastfeeding started. Their behaviour is affected by the medications. They are usually sleepier, may have disorganised sucking patterns and are often subject to other kinds of interventions, as are their mothers.

One thing to note is that the comments she makes about the medications passing into the mother's colostrum are not supported by the evidence. Dr Thomas Hale who specialises in pharmacology and lactation, reports that the fentanyl transfer from epidural anesthesia during labor into mother's milk is poor and probably clinically unimportant. The milk is not the concern: more important is the effect of the epidural on the baby during labor, and the different breastfeeding behaviours being observed when compared with babies whose mothers had unmedicated births.

I think what this all means is that all mothers should be informed of the potential risks of epidurals and other birth interventions, and if possible you should take childbirth classes here or in your local area to learn about resources for coping with labor. Read some good birth books and ask lots of questions.

Ideally, staff in the hospital or clinic should be well versed in how to help mothers and babies get breastfeeding off to the best possible start...lots of skin to skin contact with baby on mum's chest, keep mother and baby together at all times, give baby time to come to the breast, if baby is having trouble, you might need to express some of your colostrum and feed it by syringe or spoon, very sleepy babies may need to be woken for feeds and gently encouraged to continue feeding for long enough and so on. Unfortunately, we cannot control what level of skill the staff have, nor how supportive the hospital or clinic will be of breastfeeding.

The best idea then, is to learn as much as possible about breastfeeding during pregnancy. Mothers-to-be can attend La Leche League meetings, both parents can take classes here if they are available in your area, so everyone knows what to expect with normal breastfeeding, and can recognise if things are going well or not after your baby arrives.

For a more technical review of epidurals and breastfeeding see here where the author states "There is evidence to show that epidural anesthesia probably does diminish the neonate's early ability to suckle. " A recent breastfeeding journal article concludes "women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour."

Make sure you get the support you and your baby need.

Nagoya breastfeeding seminars

Just came back from a weekend of breastfeeding seminars in Nagoya. So much new stuff to share with everyone.

By the way, who knew that a baby's head grows 7.5 cms on average in the first year of life?! To grow another 7.5 cms after that, it takes 16 years.

When mum is sick

Can you still breastfeed when you are sick yourself? With cold, flu and tummy bug season upon us in Japan, this is a common question.

There are very few illnesses which would require a mother to stop nursing. You may feel tired, run down and unable to be much of a good mother, but the recommendation is to tuck yourself in bed with your baby and continue breastfeeding, rest, keep up your fluids, and if you need to take medications, let your doctor know you are breastfeeding. Most medications are compatible with breastfeeding, but here in Japan the doctor often says you will need to wean for three (or more) days while taking any medications, even simple antibiotics. The research shows that this is basically not true in most cases, and it is not hard to find this information through a simple google search. And remember, if it is a cold you have, then antibiotics aren't going to do anything for you anyway! If it is mastitis (a breast inflammation), it is crucial to continue nursing while taking the medications to avoid the risk of developing an abscess.

Think about the logistics and agony of weaning just for three days. During those three days, your breasts will become engorged and painful if you don't express your milk. Your milk supply will diminish if you don't express your milk regularly because of the "use it or lose it" prinicple. Your baby will need to be fed an alternative which is not without health risks. Most likely they will be fed by bottle, which they may not have experienced before...and without the built-in comfort of nursing directly, a normal part of life for your baby till now, your baby may also become quite stressed. This is not what you need while you are sick!

Your doctor may not have mentioned any of these things to you while handing you the medications. Is your doctor really supportive of breastfeeding? Did he/she mention that not continuing breastfeeding and substituing infant formula presents a greater risk to your baby's health than the risk of the transfer of a small amount of medication in your milk?

Dr Thomas Hale, pharmacologist and author of Medications and Mother's Milk (a book which all doctors should have on their shelves) tells us that in order for medications to transfer into human milk, they need to be highly lipid soluble, attain high concentrations in maternal plasma, be low in molecular weight, low in protein binding and pass into the brain easily. After those considereations, then we look at the bioavailability of the medication in the infant. He says :"numerous medications are either destroyed in the infant's gut, fail to be absorbed through the gut wall, or are rapidly picked up by the liver. Once in the liver they are either metabolized or stored". (p9) So factors like whether the medication passes freely into the mother's milk and the half life of the drug all need to be considered before we can really tell whether the dose the infant would receive via the milk is harmful to them. And we should not ignore that there are larger risks associated with formula use.

For more information see the articles on breastfeeding while mother is sick at kellymom. There are lots of references there for further reading too.

If you decide to use a herbal remedy, remember that just because it is herbal doesn't always mean it is safe while breastfeeding. This book has more information on herbs and nursing.

Note: Antihistamines or contraceptives containing estrogen have been linked to low milk supply.

To supplement or not?

Some doctors are not as supportive of breastfeeding as you would wish. If you are having problems, and the doctor advises supplementing with formula without really investigating how and why breastfeeding is not going as well as it should, you may like to check out the information from the Academy of Breastfeeding Medicine. These are protocols written by doctors for doctors on important topics like supplementation (in English and Japanese) based on protecting the breastfeeding relationship. You might even consider sharing the information with your doctor.

Of course your doctor wants to see your baby growing and thriving, but in Japan the supplements are too often a quick-fix solution. Somewhat surprisingly, supplements are routinely offered at many hospitals if a mother complains she is too tired and wants to sleep after the birth. This is just bad practice. Everyone is tired after having a baby...but you learn to breastfeed by breastfeeding, not by having someone else take care of your baby and feed supplements. Then the mothers complain they don't have enough milk, but your breasts don't continue to produce milk if you don't use it! This is known as the "use it or lose it" principle.

Supplementation with formula changes the gut flora in the baby, and can seriously affect your baby's health both now and in the future (allergies, diabetes, ear infections...the list is very long) so it is not something that should be approached lightly. Supplementing with the mother's own milk is always a better first choice, and if supplementation is indicated, mothers need good advice and support on how to express and use their own milk. "Just one bottle won't hurt "...or will it?

To increase your baby's breastmilk intake, also see Dr. Jack Newman's recommendations and contact a local Lactation Consultant or your local La Leche League Leader.

glad to be breastfeeding...!

A reason to be glad you are breastfeeding.

That's pretty scary, isn't it?
Here's another and another and the list to end all others here.

And just after I posted the above, into my mailbox today came the new WHO report on Enterobacter sakazakii and Salmonella in powdered infant formula.

Seriously makes you glad you are breastfeeding!

Breastmilk: clean, safe, immune-boosting, the right temperature, attractively packaged, makes your baby healthy and bright and satisfies all their needs!
Human milk for human babies.

World AIDS Day

December 1st is World AIDS Day. The International Lactation Consultants Association released a position paper on HIV and infant feeding
There is also Bono from U2's (RED)campaign where companies are making their products (RED) and donating part of their profits to the Global Fund for drugs for AIDS. Buy (RED) and make a difference.
And you can put yourself on the map by joining the Global Fund's "Hope spreads faster than AIDS" initiative. If you sign up on this page and invite your friends, you can see the way the hope spreads. The Global Fund was created to finance a dramatic turn-around in the fight against AIDS, tuberculosis and malaria. These diseases kill over 6 million people each year, and the numbers are growing. Support the Global Fund here.