Postpartum Depression

So many mothers  I have met have suffered from postpartum depression after the birth of at least one of their children.  Some mothers I have met have also suffered from depression during a pregnancy, which is much less talked about than postpartum depression.  This is a huge topic, and one that a blog post really can’t even do justice to, but my goal is to provide some places on the Web and links to  groups that make the support of mothers who are battling depression their main focus.

According to “Breastfeeding Answers Made Simple:  A Guide For Helping Mothers” by Nancy Mohrbacher, “More than half of new mothers have occasional bouts of crying, irritability, and fatigue sometimes referred to as “the baby blues.”  Postpartum depression refers to more consistent and severe symptoms and is also relatively common, with some estimating the incidence within the first year of new motherhood to be 12% to 25% overall and 35% or more among high-risk mothers.”

On a purely physical level, some research states the release of proinflammatory cytokines by the immune system have been found  to be a cause for postpartum depression, but there also appear to be  risk factors that can  predispose mothers toward this inflammation.  Continue reading

“I Have Done Everything and Breastfeeding Isn’t Working Out”

My last post was about the benefits of breastfeeding (http://theparentingpassageway.com/2010/11/16/why-should-i-breastfeed-my-baby/).  In general, breastfeeding and supplying infants human milk is always something that should be considered for immune health.  However, I find that bringing up the benefits of breastfeeding often can be met with anger and guilt on the part of some mothers.  That is never my intention, to hurt and polarize.  Anyone who has read this blog for any length of time would know that about me  and this space.

Continue reading

Why Should I Breastfeed My Baby?

(This post really is geared toward pregnant mothers who are trying to decide whether or not to  “try” breastfeeding.) :)

Oddly enough, I typed this into a search engine to see what would come up, and not much did. Maybe it was the way I worded it (ie, if I put in “benefits of breastfeeding”, I wonder what would have come up?)  However, I also wondered if perhaps we are not doing a great job in the medical world and the world of lactation consultants in getting the word out to the public about the very specific benefits of breastfeeding.  Many mothers seem to “know” that breastfeeding *might* be better than not breastfeeding, but I wonder if mothers can think of very specific targeted benefits.

On that note, I thought I would write a list and have it handy on this blog.  The references for this article came from the newly revised “The Womanly Art of Breastfeeding”, from Marsha Walker’s  “Core Curriculum For Lactation Consultant Practice” and varioud PubMed studies.

Continue reading

Breastfeeding and Dental Caries

These are some notes I have about this topic and thought I would share:

Early Childhood Caries (ECC)

  • -Formerly known as Baby Bottle Tooth Decay or Nursing Caries
  • -Defined as the presence of one or more cavities in the deciduous teeth in a child aged 71 months or less (LEAVEN, April/May/June 2006)
  • -Recognized as an infectious disease process caused by an overgrowth of microorganisms that are part of normal oral flora.
  • -Streptococcus mutans (S mutans) is thought to be the primary cause.

Three Factors Necessary for Dental Caries:

1. A susceptible tooth – A tooth becomes susceptible through genetics ( leading to pitting/grooving, poor tooth enamel, pH level of mouth low); pregnancy factors ( maternal fever, maternal malnutrition, iron deficiency, lead exposure, stress, antibiotic use). Other risk factors include infants born via cesarean section, prematurity, small for gestational age, infant of smokers.

2. Presence of cavity causing bacteria – Typically transmitted mother to infant or from other adult caregivers, siblings, playmates to infant.

“Reducing the level of bacteria in a mother’s mouth may reduce transmission to the baby.” (La Leche League’s LEAVEN, April/May/June 2006). Ways to do this may include xylitol ( a natural carbohydrate sugar substitute that interferes with bacteria’s ability to stick to teeth), chlorhexidine rinses (this is prescription only, may have side effects, discuss with HCP).

Be aware of the “Windows” of infectivity – 19 – 36 months (although with some children this window can start as early as six months), and 6-8 years of age.

3. Presence of Acid – Decreased saliva flow decreases the protection saliva provides of washing debris away. Children who are mouth- breathers, take antihistamines and/or asthma medications may be at higher risk for caries.

Problems Caused By Caries-

They can be painful and cause abscesses, the ability to eat and chew is compromised, children with dental caries may show “slowed growth rates or failure to thrive”, speech may be affected, if primary molars are lost to decay malocclusion may result, caries may affect self esteem of child. Having ECC is a strong predictor of decay in permanent teeth.

Signs of Decay – White spots on the surface of the teeth, usually on the front teeth, or white lines at base of teeth. This will later turn to brown spots and decay. Dentists recommend a child first visit the dentist by 12 months of age or within first six months of teeth erupting.

PREVENTION of ECC

  • -Non-breastfeeding infants are at higher risk of decay when compared to breastfeeding infants . One recent study of Jahalin Bedouin infants in Israel found that the children drinking bottles had levels of ECC almost two times the infants that were breastfeeding. (from Early Childhood Caries among A Bedouin Community residing in the eastern outskirts of Jerusalem by Livny, Assali, Sgan-Cohen, BMC Public Health 2007).
  • -Human milk is not cariogenic unless another source of carbohydrate is introduced for bacteria to feed on.
  • -Human milk does not decrease the pH of the mouth while almost all brands of artificial milk do – S mutans thrives in low pH
  • -Most artificial milks support high level of bacterial growth, while human milk supports moderate bacterial growth
  • -Components in breast milk, including secretory IgA and IgG play a protective role and slow the growth of S mutans and lactoferrin kills bacteria. Also, the calcium and phosphorus from breast milk are deposited on the tooth enamel.
  • -However, once first teeth erupt and additional foods and fluids are added to the diet, the breastfed infant can be at risk for caries just like any other infant
  • -Also, if the infant is receiving human milk by bottle the protective mechanisms of breastfeeding are compromised.
  • - Fluoride is controversial in treating caries. Some studies suggest flouride decreases the rates of caries from 50 to 70 percent, but other experts cite fluoride as a neurotoxin and that fluoride inhibits calcium absorption. Some holistic dentists are working with Vitamin D or combinations of Vitamin D, Vitamin C and calcium to try to reverse early decay. Vitamin D can be toxic at higher levels, so please discuss this with your HCP.

SOURCES

Early childhood caries:new knowledge has implications for breastfeeding families. Altshuler, A. LEAVEN, vol 42, No 2. April/May/June 2006, 27-30.

Avoiding dental caries. Fowler J. NEW BEGINNINGS, vol 19, no 5. Sept/Oct 2002, 164-7.

Big bad cavities: breastfeeding is not the cause. Reagan L. Mothering Magazine. July/August 2002.

Breastfeeding Beyond A Year

The facts:

  • The World Health Organization recommends nursing for a minimum of two years.
  • The United Nations Children’s Fund also recommends a minimum of two years.
  • The American Academy of Pediatrics recommends nursing for at least a year and for as long after that as is “mutually desirable”.
  • The estimated median age of weaning throughout the world is between three to five YEARS.

Why Breastfeed Beyond a Year?

  • At one year of age, a baby’s immune system is functioning only at 60 percent of the adult levels. A child’s immune system is not fully functioning at adult levels until six years of age. Nursing toddlers grow better and have better resistance to infection.  Some of the antibodies in breast milk actually increase after the first year.
  • Better skin.
  • There is no easier way to comfort a sick child.
  • There is no better way to get nutrition into a picky eating or sick toddler
  • Nursing may help improve the dental arch
  • Comfort nursing can be a fundamental part and advantage of nursing a toddler;  a true temper tantrum tamer!
  • Connection and closeness with your child!

The Myths Surrounding Extended Nursing:

  • “If a child can ask to nurse, there is something wrong with doing so.”
  • “Once a child no longer needs mother’s milk solely for nutritional purposes, there is no sense in breastfeeding.” Or “Your child would eat more solid food if you would just wean him.”
  • “After a certain point, the nursing relationship is more for the mother than the child.” (This is especially said regarding 4, 5 year olds who still nurse)
  • “Extended nursing will spoil a child.”
  • “A toddler who is still nursing is too dependent on his or her mother.”
  • “If you weaned your child, your child would not be (insert behavior here)”
  • “Comfort nursing encourages the toddler to turn to food for comfort”

All myths; if you need help in refuting these myths please, please contact your local chapter of La Leche League:  http://www.llli.org/

Handling Pressure to Wean:

Weaning deserves thought and respect as an important rite of passage in a child’s life.

Please see the other weaning posts on this blog:

http://theparentingpassageway.com/2009/06/25/weaning-a-child-who-is-over-the-age-of-4/

http://theparentingpassageway.com/2009/02/04/weaning-with-love/

Happy mothering,

Carrie

Breastfeeding, Fertility and Sexuality

I am always amazed that many women do not understand the impact of breastfeeding their child on their fertility and sexuality.  Here are some quick general notes I recently threw together.  Hope it is helpful!

Sexuality:

  • Some women report less sexual desire after the birth of their baby – taking care of a baby is intense work, and many women feel so much love and connection to their infant that the baby can consume much of the mother’s emotional energy. The couple may also be adjusting to being new parents and having less time alone.
  • Some women report they feel heightened sexual feelings while breastfeeding.
  • Masters and Johnson’s 1966 study pointed out that many breastfeeding mothers are more comfortable with their sexuality and are more anxious to resume sexual relations with their mate when compared to women who formula-fed their infants.
  • Low estrogen levels associated with breastfeeding can cause severe vaginal dryness and tenderness. Mothers can try water-based lubricants or also talk with their health-care professional  estrogen-based prescription creams or suppositories.
  • Lovemaking may stimulate a let-down
  • The father’s feelings are important. Unlike the mother, his hormone levels have not changed, and he may feel hurt and confused by lack of sexual interest from his partner. Mothers also may feel fatigued and “touched out’ by the end of the day. Open communication is important!
  • You do not have to “get away” from your baby in order to have a fulfilling relationship as a couple.  :)

Breastfeeding and Fertility

“If all breastfeeding were to stop, within a year there would be a 20 to 30 percent rise in the birthrate world-wide.”

The Lactational Amenorrhea Method (LAM):

A Mother has LESS than a 2 percent chance of getting pregnant if

  • A mother’s menses has not returned (no vaginal bleeding after the 56th day after birth)
  • The mother is not supplementing regularly OR going longer than four hours between feedings during the day OR longer than six hours during the night

AND

  • The baby is less than six months old.

THE KEY TO SUPPRESSION OF FERTILITY THROUGH BREASTFEEDING IS FREQUENT NURSING DAY AND NIGHT!!

Breastfeeding increases the likelihood that the mother’s first menstrual cycle will be anovulatory (Not preceded by ovulation), but the longer a mother’s menses are delayed by breastfeeding, the more likely she is to ovulate before her first menstruation. Even after menstruation returns, breastfeeding can reduce fertility. A woman’s own body chemistry also influences when menses return.

 

CONTRACEPTION Compatible with Breastfeeding:

  • LAM
  • Natural Family Planning  – classes available through Couple to Couple League
  • Barrier Methods –  do be aware spermicides can enter into a mother’s milk though no problems in babies have been documented and barrier methods with spermicides are considered compatible with breastfeeding
  • IUD (copper); for progestin IUD see below
  • Sterilization – hysterectomy does NOT affect breastfeeding
  • Progestin-Only Methods – seen as compatible with breastfeeding, although in my work over the years many mothers have reported they felt their milk supply dropped with progestin-only pills
  • Norplant maintains a lower level of hormones circulating than with the mini-pill, whereas injected contraceptives such as Depo-Provera result in higher circulating levels of progestin. Other time released progestin only methods include the vaginal ring, progestin IUDs, injected and implant. Timing of introducing these methods is still controversial – six to eight weeks is suggested by the WHO task force. No negative effects to the baby from the hormones (mainly studies have been done on the mini-pill)  have been found so far, and research has followed these children for up to 17 years.
  • Estrogen containing methods – decreases milk supply and duration of breastfeeding. It is recommended by the WHO Task Force that babies be at least six months of age before considering these methods. There are no case reports of long-term effects of estrogen on breastfed babies. 

Getting Good Fats Into Kids

Infants and children who are breastfed get their first source of good fats through human milk.  According to  Lawrence and Lawrence’s “Breastfeeding:  A Guide for the Medical Profession”, children who were breastfed show “more advanced development” at not only 1 year, but 8 to 10 years and at 18 years.  During the first year of life the brain more than doubles in weight with 85 percent of this growth in the cerebrum; 50 to 60 percent of this is lipids.

Much of this has been attributed to fatty acid and lipid components and has led to supplementation of formula with cholesterol (human milk is full of cholesterol and artificial baby milk typically has little to no cholesterol) and DHA.  Lawrence and Lawrence point out, “These compounds function in a milieu of arachidonic acid, lipases, and other enzymes, and no evidence indicates that they are effective in isolation or that more is better.”

We know cholesterol is important for cell membrane function and that infants who are breastfed have higher cholesterol levels than formula-fed infants.  Animal studies suggest this may protect against high cholesterol later in life.  We also know that in breastfeeding, the amount of fat delivered is not static and adjusts to the baby for a customized fat and calorie milk.

As children grow, we know that foods that contain essential fatty acids remain important – sources of these include fish, flax oil, seeds, nuts and nut butters, olive oil, avocado, hummus and wheat germ all provide good fats according to Dr. William Sears’ “The Family Nutrition Book.”  Obviously, eating too much fat regardless of the type of fat can cause obesity, but I find parents are mainly interested in replacing the “junk food” fats with “good fats”.

Some of my favorite good fats include coconut oil and avocado.  Coconut  butter/oil  got a very, very bad rap for year, but it is now known that the medium-chain fatty acids in coconut milk are an energy source and that coconut has powerful antibacterial and antiviral properties.  Coconut water, while not high in fatty acids per se, is high in Vitamin C, B vitamins, proteins and electrolytes.  Coconut milk is now being used in the United States to make coconut milk yogurt (very good in smoothies!), coconut milk that is sold in a carton just like bovine milk (great for folks with dairy allergies) and of course our friend the young Thai coconut (the white ones with the pointed tops) are more and more readily available.

Smoothies are a great way to get coconut water, meat or milk into your kids.  Coconut meat, water, lime juice, vanilla and a little sweetner can make an excellent smoothie for a snack.  My personal favorite involves coconut milk/yogurt mixed with frozen mango, some honey and banana.  Yum!

Avocado is another great source of fatty acids, and this can be made into a pudding by mixing it with cocoa powder,sweetner, vanilla, and coconut meat and water.

Happy eating,

Carrie

Breastfeeding, Pregnancy, Fish Oil Supplementation and Infant Allergies

(THE DISCLAIMERI am not telling anyone to take ANYTHING, any supplement, but looking at these studies has been interesting and may give you fuel to want to look on your own and speak to your health care provider regarding these studies.  There are many more studies coming out on this subject that you can search on the website PubMed, which has abstracts of medical journal studies). 

Here is something of interest I have been reading lately (yes, I love to read medical journal abstracts in my free time, don’t laugh).  Anyway, on the topic of human milk feeding, fish oil supplementation and infant allergies here is one study I just found:

This was published out of Sweden, I believe  in their pediatric journal June 1, 2009  (I found the abstract on PubMed):

Aim: To describe the effects of maternal omega-3 long-chain PUFA supplementation during pregnancy and lactation on the incidence of allergic disease in infancy. Methods: One hundred and forty-five pregnant women, affected by allergy themselves or having a husband or previous child with allergies, were included in a randomized placebo-controlled trial. Daily maternal supplementation with either 1.6 g eicosapentaenoic acid and 1.1 g docosahexaenoic acid or placebo was given from the 25(th) gestational week to average 3-4 months of breastfeeding. Skin prick tests, detection of circulating specific immunoglobulin E (IgE) antibodies and clinical examinations of the infants were performed. Results: The period prevalence of food allergy was lower in the omega-3 group (1/52, 2%) compared to the placebo group (10/65, 15%, p < 0.05) as well as the incidence of IgE-associated eczema (omega-3 group: 4/52, 8%; placebo group: 15/63, 24%, p < 0.05). Conclusion: Maternal omega-3 fatty acid supplementation may decrease the risk of food allergy and IgE-associated eczema during the first year of life in infants with a family history of allergic disease.

PMID: 19489765 [PubMed - as supplied by publisher]

This is not a huge study group (140 mothers), and this study is just one of the studies that are coming out on this topic.  You may consider doing your own PubMed search, and also talking to your health care providers regarding some of these studies.  I, of course, am not telling anyone to take or not take ANYTHING, I just thought these studies were interesting enough to share a bit.

I saw one study regarding how the introduction of eating fish itself seemed to be protective against atopic dermatitis (and again, I think this study came out of either Norway or Sweden).  Over here in the United States, fish is typically considered one of those foods mothers are advised to wait to start due to high allergic reaction and incidence.  Any of my Scandinavian readers, I would love to hear your thoughts regarding introduction of fish and allergy incidences in your country!

Carrie

Weaning A Child Who Is Over the Age of 4

This is another hard post to write as people feel so vehemently one way or the other about this subject. However, I am writing it because there is so little information available about this that applies to breastfeeding mothers nursing an “older child”  in an industrial society in our time, even though we know the “biological” age of weaning is two and a half to seven years of age.    Much of the work regarding nursing a child over the age of four looks at either non-Westernized societies (like I found a study on four-year-olds in Bangladesh who were nursing 8 to 9 times a day, many of whom  were assumed to be nursing due to being nutritionally stressed) or the work is more from an anthropological perspective, such as boys in royalty were nursed longer.

I am nursing my youngest, a  four and a half year old one to three or four  times a day right now.  My oldest child  nursed until she was a little over three years of age, weaned when I was on bed rest with  my second pregnancy, came back to the breast eight months later (and tried to remember how to nurse, LOL)  and attempted to nurse on and off until she was about four and three quarters.   Contrary to many people feeling uncomfortable about nursing a child over the age of 4, I don’t feel uncomfortable or badly about it.

I have many friends who have weaned children somewhere between the ages of 4 and 7.  People ask about child-led weaning; I have seen some children “wean  themselves” but the relationship there seemed to me to  always be a dance between mother and child with limits typically being set by the mother from an earlier age onward.  Many of the children who nurse frequently at the age of three or  three and a half seem to go on to nurse longer than those who are not nursing frequently at three and a half. 

I have one friend who wryly observes that her middle child, “was just sort of my experiment.  I set no limits on nursing at all, and he nursed until he was 7.”  (And this is a very structured, organized, limit-setting kind of woman!)    I have another friend who says that she feels most children after the age of 4 need some gentle assistance in weaning, and she feels there is no true “child-led” weaning unless you really do want to take that avid three and a half year old nursling and nurse them until they are 7 – and not everyone is comfortable with that.  There are older children over the age of three who do abruptly wean due to pregnancy or birth of a new sibling, but I have heard of these cases much less often than one would imagine.  However, these are not observations from a medical, scientific study – just what I have observed in my over ten years of working with breastfeeding mothers in lay groups and lactation settings.

Breastfeeding is a relationship between two people, and as such both parties deserve to have dignity and respect, especially the child.  The child may have high needs to be met, and some children have intense physiological sucking needs into the fourth year.  I am sure we can all remember children who sucked their thumbs until they were much older than four or five!  Some children have physiologic disease processes and truly need the antibodies that human milk provides.   The need for mother’s physical presence, for connection and the feeling of unconditional love and acceptance that comes from being at the breast is always there, always remains,  in these early years before adolescence.   The question becomes how comfortable one is using the breast to provide sucking, connection or closeness,  or  even antibodies,  as the child grows and matures. 

The question becomes how you feel in your heart.  Some mothers give a lot of “talk” to their child regarding weaning, “becoming a big boy or girl”, but truly feel conflicted in their heart.  They feel weaning is hard for the child, and they are not sure how to proceed without hurting the child or the child’s feelings, and they wonder how the relationship between themselves and the child will look once weaning is completed.  The mother and child have to find their relationship without that component of close connection, and this can feel challenging to both the mother and the child.

Instead of making this a time of conflict and ambivalence, I suggest several things:

1. Search your heart and see if you can see weaning as a process of opening the world to your child, of not “taking away” this precious relationship, but part of growing up, of expanding horizons.

2.  Do you love your child unconditionally at times other than when they are at the breast?  Does your love and warmth and respect for this child come forth?  If not, nursing may be how they are searching to fill this – that close and loving connection that occurs at the breast.  If you do want to wean, concentrate on your own positive thoughts toward your child and your relationship with that child first. 

3.  Search your heart and KNOW that your child (and you!) are going to be okay!  Find the positive ways your child can relax, go to sleep, handle the normal tensional outlets of each developmental stage and capitalize on that. 

4.  Work on discovering your child’s “love languages”.  If your child’s love language is “physical touch”, make sure you are filling their love tank with lots of physical touch at times other than nursing times.  If your child’s love tank is filled with “quality time”, do make sure you are providing lots of quality time to your child when you are not nursing.

5.  Have distractions ready for when the phone rings and that sort of thing.. ..I know many four-year-olds who still would like to nurse when mother is on the phone!

6. Look at your daily schedule and see how your child does with nursing when you are busy (some nurse less naturally then, but some nurse more because then they feel over-stimulated) versus when you are at home all the time (again, some children nurse less and some nurse more).

7.  If you are not comfortable nursing your child much past the age of 4 or 5, and your child is an avid nurser….  ….then it probably will be up to you to help your child cut down the number of nursings a day.  You have to be comfortable with this idea, and if you are not and want a truly child-led weaning, you may have to nurse until 5 or 6.    With some children the more you talk about weaning and cutting down number of nursings a day, the more anxious they become.  Many of the mothers I know had better success in just structuring their day so they were busy, daddy took over bedtimes in some cases, and other things that gradually and naturally  cut nursing down without a lot of explanation other than peacefully saying, “We can nurse at “X” time.  I am happy to (hold you now, get you a drink, get you something to eat, to play a game with you, to go to the pool, etc.) right now.”

8. Again, if you are ready to have the nursing relationship come down in intensity and you are helping your child grow, there may be some tears if the child is four and five and used to a certain rhythmical pattern of nursing to sleep or whathave you.  Again, this is where you must search your heart, see what you are comfortable with, feel okay that you truly are uplifting your child to the next level, that your child is growing up and it is going to be okay.  If you cannot believe this in your heart, then neither you nor your child is ready to wean. 

9. Some families do have a weaning party or provide a special weaning necklace or out to lunch to celebrate weaning.  Again, some children need help with moving on and need you to either decide it is okay to nurse until age 7 or they need you to be kind but not crumple. They may need you to  say after a weaning party or weaning lunch something to the effect of, “Nursing you was so special to me as well.  Today Daddy is going to take your little sister so you and I can do “X” together.”

10.  Work hard to examine how you feel about the joy of mothering.  If in your heart you feel enraptured with being home, with mothering, if you delight in your children, they are going to also feel joyful, happy, peaceful even without nursing and as nursing transitions and fades away.

If you continue to nurse your older child, be happy about it, be proud about it and know that when they are developmentally ready they will be done.  Whether or not “true” child-led weaning works for your family or not, whether you decide your child may need your help , cannot be decided by anyone but you and in your own observations of your child.  You can still respect your child and your child’s dignity whatever path you choose.  The path for the older child is not as clear as the path when nursing a small two or three year old, and that is okay, that is part of parenting.

Be comfortable with yourself and what your family needs from you, from the times when you do need to take the lead and the times when you need to surrender yourself.  That is the walk we walk in parenting a child that is a bit older.    But most of all, get clear in your own heart and decide.  That is what makes for a joyful family!

Love,

Carrie