Friday, February 25, 2011

Life with a Newborn: Days 4 & 5

A few weeks ago, I wrote about about the day my second daughter was born and my feelings and observations on days 2 and 3 postpartum. Last week, Taryn and Jane highlighted the research explaining both the "Mommy Science"and "Baby Science" behind my family's experience. By sharing my personal story, followed by the science behind what I was experiencing, we hope that we have highlighted some of the questions and concerns facing new parents. Today, I will continue my story with Days 4 and 5.

Day 4

The nurse came in to weigh Charlotte at about 1am (sounds like a strange time, but I wasn't asleep anyway!). We were having some trouble latching, but we were still feeding about every 2 hours and my milk had come in on Day 3. Charlotte had been losing weight, but I knew it was normal for newborns to lose some weight, so I wasn't worried. When she was weighed that night, though, she had lost a lot more than expected. The nurse explained that we wouldn't be able to leave in the morning if she lost any more weight.

A few hours later, I noticed that Charlotte's mouth was really dry and that she hadn't had a wet diaper in quite a while. Also, I was starting to feel engorged and the feeling didn't change when I'd feed her. Worried that she was getting dehydrated, I asked the nurse to bring me a breast pump to relieve some of the pressure and get some breast milk to feed Charlotte in case she wasn't feeding effectively. I also asked her to ask the lactation consultant to come in first thing in the morning.

By morning, Charlotte was lethargic and had lost even more weight, so it was clear she needed more milk than she was getting at the breast. The pediatrician suggested that we avoid feeding her at the breast until she stopped losing weight and the lactation consultant showed us how to syringe feed, which is basically just slowly squirting the milk into the baby's mouth.

Needless to say, Day 4 was very stressful. I had been looking forward to going home and I missed my older daughter. I was already having a hard time falling asleep and the events of the day made it even harder. Not only was I worried about my baby but I also knew that my husband wasn't getting enough rest (if my bed felt uncomfortable, how would that reclining chair feel for 4 nights in a row?). That night, I told my husband to go home to sleep. He protested at first, but eventually he was convinced that it was better for one of us to get some sleep!

Day 5

When Charlotte was weighed on Day 5 (at 1:30am this time), she had stopped losing weight, but hadn't gained any back. I mentioned to the nurse that I was worried that the syringe feeding was preventing us from resolving our latch problems, she suggested that we begin finger feeding until we could talk to the pediatrician and lactation consultant again. To finger feed, we attached one end of a small tube to the syringe and the other end to one finger and put the finger and tube into her mouth. We still had control over the flow of the milk (with the syringe), but she was able to suck on our finger at the same time.

My husband left to go home around 2:00am and Charlotte and I were fine until about 4:30 am. The nurse came in to check on us and when she asked me how I was doing, I just lost it. I had been getting less than 4 total hours of sleep a day and was frustrated that we were having trouble breastfeeding. She listened to my concerns and then suggested that she take the baby for a short time so I could rest. I was very hesitant and felt silly for sending my husband home when I clearly needed the help, but she assured me that she would be right across the hall and would bring Charlotte back as soon as she gave any indications of hunger. I let her take Charlotte and within minutes, I was asleep. I woke up 2 hours later and felt so much better.  Looking back, I realize how important it had been to share my frustration and that I probably wouldn't have done that if my husband had been there.

In the morning, when Charlotte was weighed again, she had started gaining back some of the weight she'd lost. The doctor gave the OK to start feeding her at the breast again and lactation consultant helped us weigh her to determine how much she ate. Around 10:00 am, the nurse came in to tell us we were being discharged. I was happy and terrified at the same time. I couldn't wait to get home, but I was worried that Charlotte would start losing weight again. We scheduled an appointment for the next morning to have her weight checked again and by 1:00 pm we were on our way home!

As soon as we got home, Olivia took Charlotte on a tour of the house (with Daddy's help, of course). She was so excited to have us home and was eager to take care of her new sister! When Charlotte wasn't latching well, we would finger feed her and she seemed more alert than she had been in the hospital.

Olivia was 2 1/2 months old when she came home from the hospital, so bringing home a newborn was a new experience for us. Being home relieved so much of the stress I was feeling! A friend brought us dinner and we spent the rest of the day just resting and getting used to having 2 children to care for!

Next Time: Mommy Science

Tuesday, February 22, 2011

Baby Science: The First 72 Hours

Recently, Jen B described the first 72 hours she and her husband shared with her new baby, Charlotte, Afterward, we shared the "mommy science" behind the experiences she described.  This time, we review the "baby science" related to those early days. Using Jen B's posts as a guide, we'll ask and answer some of the questions that many parents have about newborns. As usual, we have to remind you that not all babies will follow the timelines we describe but many will follow a similar pattern.

Why are newborns so sleepy on the first day?
I'm sure it is obvious that both babies and mothers are exhausted after their birth experience. After the first hour or so when adrenaline and excitement may keep babies relatively alert, they typically sleep for 2 to 4 hours before starting to wake more frequently. A few hours of deeper sleep on the first day helps mom recover and helps baby conserve calories while feeding is still being established. Most babies struggle staying awake on the first day, falling asleep off and on, even while they are feeding. That's why it is important to practice feeding during the first couple of hours and each time the baby becomes alert.

Why are newborns so fussy on the second day?
Many parents are surprised by the sudden behavior shift in their quiet sleeping newborns that comes along on the second day. Babies' alert periods are still very short but they are also likely to be fussy, even a bit frantic, when they are awake. While we know how hard it is to listen to your baby's crying, it is one of his most important baby-skills. Crying is an extremely effective mechanism to alert parents when they are needed. Without this skill, newborns would not be able to wake their caregivers when they need to be fed, diapered, warmed, or calmed. Babies cry out whenever they become uncomfortable or distressed and a quick response will minimize but not eliminate crying, especially during the first few weeks.

Brand new baby-tummies are so small that newborns typically consume only about a teaspoon of milk during a feeding. An average milk volume for the first 24 hours is about 50 ml (or a little over 3 tablespoons). During the second day, babies become more alert and they work hard to give cues (including hunger cues) to their parents. Being more alert means they are more likely to feed frequently enough to grow and stimulate mom's milk supply, But being alert also means they will be sensitive to all the discomforts of the new world they have entered. Some babies are better than others with dealing with stimulation and calming down when their parents try to soothe them. So, some babies will cry more than others independently of how they are cared for but all newborns do better when their parents are careful not to let them get overstimulated. Limiting visitors and using repetition to calm the baby can help new parents get through that tough second day.

Why don't babies breastfeed perfectly the first time?
In her sleep-deprived state, Jen B was frustrated that Charlotte seemed so "stubborn" about breastfeeding. She would cry out for feeds, not latch very well and then, when she did latch, fall asleep almost immediately. It is easy for parents to imagine their babies thinking like older children (like being stubborn) but Charlotte was only using instincts and reflexes that just weren't quite ready for her new world. Her body was overreacting to the world around her and her sucking reflex was sending her to sleep. She needed a few days to get better control over her responses to stimulation and to use all of her reflexes for feeding at the right time and in the right order. With practice, babies get better at feeding very quickly and by the time mom's milk supply is increasing rapidly (typically when babies are between 2 and 4 days old), they are ready to take in a much larger volume.

Next time: Jen B will share more of her early experiences

Thursday, February 17, 2011

Mommy Science: The First 72 Hours

By Taryn Barrette, RD 
Last week, Jen B shared her experiences after the birth of her second daughter, Charlotte. During days 2 and 3, she was surprised that she had difficulty sleeping even though she was exhausted. She also shared how she began to “project” motivations more common to older children on her newborn (despite all her education and knowledge) and how exhausting it was to orchestrate all of the visitors (including her 2-year-old daughter). In this post, we’ll describe the science behind her very common experiences. Next time, we’ll share the behind-the-scenes “baby science."

Giving Birth is Stressful (No! Really?!)

Whether you had a vaginal delivery or a cesarean section, the act of delivering a baby causes a cascade of shifting hormones that puts your body into a state of “stress.” It is important to remember that a C-section is a serious surgery – a stress (both surgical and emotional) that affects the body’s hormonal cascade in a similar way to other stressors but with the added burden of physical recovery.

You may have heard of the “fight or flight” phenomenon where in the presence of a stressor (which could be anything from running from a hungry tiger, barely missing a fender-bender, or taking a challenging test) your body adapts to ready your muscles and your mind to either fight or flee. This process involves ramping up certain hormones and decreasing others (for you science nerds out there, stress causes a dramatic surge in endorphins, catecholamines, cortisol and adrenocorticotrophic hormones). These hormones cause an increase in heart rate and faster breathing. Blood is diverted to the muscles that may be needed and away from organs like the stomach and intestines. The surge of these hormones makes you incredibly alert and aware of your surroundings - a huge benefit if there really were a lurking tiger but pretty annoying if you were trying to get some much-needed sleep!

Days 2& 3 Continue to be Stressful!

For many mothers recovering from C-sections, stress hormones remain high – and when combined with the mental stress of “how do I feed my baby?,” “how do I deal with so many visitors?” and “how can I entertain my 2-year-old?” it is no wonder that Jen B would have difficulty relaxing and sleeping.

The stressful feedback loop that occurs during those first 72 hours make for a few exhausting days. Not only is your body attempting to heal from a serious abdominal surgery, but worrying about your baby, your family, and your continued lack of sleep is going to keep the stress hormones around. You may feel irritable and find it difficult to be a gracious hostess to the continued influx of visitors. In such a stressful situation, it is easy for a new mom to forget the preparation, education, and planning she had done before and during her pregnancy. All of Jen B’s feelings and experiences were perfectly normal!

As these stress hormones begin to subside, others such as oxytocin (the companionship/ love hormone) and prolactin (the milk production hormone) will become more dominant. Initial stress can sometimes result in moms who have had C-sections to take a little longer to “feel” their milk coming in. It is important to discuss any concerns about milk supply with your doctor.

Some Quick Tips

It is hard to prepare for every little detail that will come up during those first few days, but as usual, working to have a game plan before going to the hospital will lessen the stress.

Visitors – Remember that you will be tired, stressed, and sleep-deprived during your first few days postpartum. Arrange for a few close friends and family members to stop by and ask your other friends to wait until you let them know you are ready before they visit.

Other Kids – If you have other young children, it will be important to find someone to occupy them while you are recovering. Hospital rooms are small and 2-year-olds are curious and rambunctious. Plan on having a family member or friend watch and play with siblings during their visits to the hospital.

You – Recognize and accept that you may not be your usual self during those first days and weeks. Arrange a support team that understands your situation and can help you keep things in perspective.

Next Time: Baby Science: The First 72 Hours

Tuesday, February 15, 2011

Life with a Newborn: Days 2 & 3

Last week, I wrote about my experience during the first 24 hours after giving birth to my new baby, Charlotte. Today, I’ll describe days 2 and 3.

Days 2 & 3
  • Even though Charlotte was more alert than she had been on the first day, she still slept a lot. On day 3, she seemed irritable, crying more than she had the 2 days before. She’d wake up about every 2 hours to eat and would be awake for up to an hour before dosing off again. Just like the day before, I was having trouble sleeping. Once I was able to shower and change into my own clothes, I was much more comfortable.

  • I remember saying “She is just so stubborn!” It wasn't until my friend laughed that I realized that I was projecting behaviors of an older child onto my newborn daughter. Even though it really felt that way at times, Charlotte wasn't being stubborn, she was just being a newborn baby, adjusting to a whole new world. When I kept that in mind, I wasn't nearly as frustrated!

  • Our hospital has a “rooming-in” policy, which means that the infants stay with the moms and are not taken to a nursery unless there is a medical need. Even though my husband and I saw this as one of the benefits of the hospital, there were times in the middle of the night that we found ourselves wishing we could send her to the nursery while we slept. Even though we were so tired, I noticed that we seemed to have the best feeding sessions in the middle of the night and those times helped boost my confidence about breastfeeding.

  • Charlotte had trouble latching well, so we met with the lactation consultant several times. When she did latch on, she would fall asleep soon after. I started to get discouraged and despite my professional experience, I still needed help.

    Charlotte and her big sister!
  • Our older daughter, Olivia, enjoyed coming to the hospital to visit. Even though I was happy to see her, it was hard having her there for more than 20 or 30 minutes. The room was small, but there was a lot for a 2 ½ year old to mess with and I noticed that it was easy for the adults to lose track of time paying attention to the baby. I recommend working out a system ahead of time to ensure that the sibling visits aren't stressful.
Next Time: Days 4 & 5

Friday, February 11, 2011

Life with a Newborn: Day 1

In December, we posted a special announcement! Charlotte is now almost 10 weeks old and we are getting used to being back to work. That’s right, I said we. Charlotte comes with me to the office a few days a week (watch for a post about bringing baby to the office in the near future)!
Charlotte Isabel Citlali Banuelos
7 hours old
Before I left, we introduced a new series that would chronicle Charlotte's behavior as it was happening. The plan was to take notes about her behavior (sleeping, crying, cues, etc) and how my family interacted with her and, in my spare time, post what we observed. Well, as many of you may have predicted (and as we mentioned in a previous post), I haven't had much spare time! We did take notes though, so now that I am back in the office, I am going to share our experiences. It is important to note that, unlike many of our research-based posts, this post is just an account of my family's personal experiences.

Day 1
  • The first thing both my husband and I noticed was how much more calm this day was compared to the day our first daughter was born. This time, I was 39 weeks along and had no complications that affected the delivery. It was such a relief to have a "typical" experience this time!

  • Charlotte spent most of her first 24 hours sleeping. Even though she wasn't awake often, we noticed her moving through the states that we've described on this blog many times. As I watched her move in and out of Quiet Alert, the state when babies are awake and ready to learn and interact, I noticed that she had about a 3 minute limit before she would either begin to fall asleep or start to fuss. It was so amazing to see her focusing on our faces so soon after she was born!

  • Even though Charlotte was sleeping so much, I found it hard to sleep in the first 24 hours. I noticed that I could sleep only about 20 minutes before waking up.

  • When we weren't sleeping (or in my case trying to sleep), we were trying to breastfeed. From the beginning, Charlotte had a strong suck and was anxious to eat, but she had trouble latching. When she would latch onto the breast, she'd quickly fall asleep, so we spent A LOT of time practicing! JenG's Tips for Successful Breastfeeding after a C-section really came in handy.

  • The nurse gave Charlotte her first bath several hours after she was born. While getting her hair and face washed, she was happy and calm, but when the nurse washed her body in the little basin, we got our first chance to hear how loud she could scream. As terrible as it was to hear her scream, we learned something that was very useful. She was calmed by us touching her face and made more alert when we touched her body. Over the next few days, when she was really upset, we would use a washcloth on her head and face to help her calm down and when we needed her to wake up, we would use it on her body!

  • We had very few visitors on the first day and the visitors we did have only stayed for a few minutes. I think this was very helpful in keeping everyone as calm and rested as possible. Although everyone was very anxious to spend time with Charlotte, we needed that time alone to recover and get to know our baby. I would definitely recommend limiting the number of visitors on the first day.

Next Time: Life with a Newborn: Days 2 & 3

Monday, February 7, 2011

Tips for Dealing with a Waking 9-Month-Old

Last time, we shared some reasons why a 9-month-old may wake and refuse to go back to his crib. In this post, we promised to share some tips to help the tired parents with older infants. Some of you may be expecting us to produce sure-fire ways to get that baby back into the crib, sleeping through the night - sweetly, quietly with no tears or stress. Well...most of you will know that we can't do that, because we tell you the truth.

Our reader asked:
"My 9-month-old often refuses to let my husband put him back in his crib at night. I have to go in and nurse him every time he's up in order for him to go back to bed and sometimes even then he doesn't want to go back in his crib!"

Since the beginning of our blog, we've had many posts about sleep. You can read through some of them by clicking here. These posts always seem to attract strong opinions and we realize that each family manages the night time hours in their own way. For some of our readers, "sleep training" may seem to be the logical answer to a baby's refusal to go back to sleep. We've already shared our reasons why that would not be our first choice. Other readers would tell any mom waking with an older infant to sleep with the baby. You may have noticed that we haven't talked about co-sleeping, which the American Academy of Pediatrics opposes. Co-sleeping is both a simple act and a complicated issue and we believe that others are better at examining the pros and cons of that practice and that our readers can make their own informed decisions. So, we'll stay focused on understanding, and working with, the baby's behavior (that's what we're here for after all).

It is important to understand that it is not unusual at all for a 9-month-old to wake once at night. Many mothers find the infrequent night nursing is fine for them, others search for ways to phase the night nursing out of their lives. This is a process that takes a little time.

Some ideas:

1. We're going to assume that this baby is growing well, feeding well, and not showing any hunger cues when he wakes at night. Growth spurts can cause babies to feed more frequently for a few days (even at night) so you might want to give it some time and see what happens. Some older babies may be uncomfortable and wake while teething. If you have any concerns about your baby's health, growth, or development, you should talk to your baby's doctor.

2. During the day, give your baby as much opportunity as possible to practice new physical skills, like crawling, pulling up, and climbing over things. The drive to practice these skills can cause older babies to wake. Make sure that the day time naps aren't stretching out so that you can get more done. It is easy to let that happen but you'll be up more at night that way.

3. Keep up a regular bedtime routine. Follow the same pattern of activities each night, ending with your drowsy (or sleeping) little one in the place where you would like him to sleep.

4. Trying leaving something small in the place your baby sleeps (like a burp cloth) that you've been handling or wearing (nothing big like a blanket or pillow - those objects aren't safe for babies). Sometimes anxious babies can be calmed by something that smells like mom (or dad) or other familiar objects.

5. Check the room for blinking lights or other changing sights or sounds that might stimulate your baby in the night. Consider a soft steady night light (turned on during the bedtime routine) and some low level white noise to cover any little sounds that might disturb your baby during periods of lighter sleep.

6. Your baby may want to nurse to go back to sleep because he is anxious or having difficulty calming himself. This would be quite normal for older babies because they don't yet have the skills to understand or control their emotions. While nursing may be both familiar and effective in helping him relax, it is not the only way to calm your baby (if you would rather not nurse). You or your husband can use "repetition to soothe" techniques like stroking, rocking, talking softly or singing to your baby. Your husband can establish a new calming routine that he uses at night when needed. Your baby will not like the change at first (so you might want to start the process when you've had a chance to get some rest or don't have to wake up early the next day) but if you gently persevere, your baby will adapt to the new routine.

Next time: JenB Returns!

Friday, February 4, 2011

Time Flies...

Can you believe it is already February? We started this blog more than 2 1/2 years ago, but it seems like just yesterday! We've grown from just a few readers to thousands each month. We'd like to thank our loyal readers for coming back and telling your friends.

For those of you who are new to our blog, we'd like to welcome you! If you'd like to know a little about who we are, click here. Over the last few years, we've posted more than 175 entries to help families better understand their babies. Everything we've posted is available to you and there are a few ways you can find what you are looking for. 
  • On the left side, in the section titled Blog Archive, you can find links to every blog we've posted (the titles of each blog are listed with the most recent at the top). 
  • If you have a specific topic you are interested in, you can use the keyword links, in the Labels section, to find related entries.  
  • If you just want to browse full entries, you can use the older posts link at the bottom right of the page. This link will take you through the posts, beginning with the most recent. 
We hope that you find the information we've provided useful. If you don't find what you are looking for or if you have any questions, please send us a comment. We love to answer our readers' questions and are always accepting new ideas for future posts! 

Next time: Ideas to Help with a Waking 9-month-old

Tuesday, February 1, 2011

Baby Behavior Mysteries: A 9-Month-Old Who Resists his Crib

Recently, we asked readers to share their "baby behavior mysteries" with us. In response, some of you posted questions on the blog and others asked questions at conferences and trainings. Over the next few weeks, we'll be sharing some "solutions" to these mysteries. We won't always be able to make suggestions that might change the babies' mysterious behaviors but we'll do our best to explain why the babies behave the way they do. In today's post, we'll share another one of those sleep-related mysteries that so many parents seem to share.

"My 9-month-old often refuses to let my husband put him back in his crib at night. I have to go in and nurse him every time he's up in order for him to go back to bed and sometimes even then he doesn't want to go back in his crib!"

Big Changes Bring Big Challenges

During the second half of baby's first year, physical, social, and emotional changes continue to accelerate. Your tiny, helpless, mysterious, unpredictable newborn is long gone. Your little one is now active, everywhere, experimenting, emotional, and exhausting! For several months, your baby has been sleeping for longer stretches and you might have had a moment or two where you felt, well...rested. Then sometime around 9 months, you are faced with two common challenges that leave you confused. First, your baby seems very clingy, not wanting to be separated from you even for a few moments and second, he starts to wake a little more often and is stubborn about going back to sleep. Both of these changes can be frustrating for parents but if it is all reassuring to you, these changes are also a normal part of babies' development.

The Explanation

As babies become more able to move away from their parents by crawling, pulling up, rolling, and taking steps, their minds and instincts tell them NOT to stray too far. They might even become anxious if you aren't within sight. "Separation anxiety" is used to describe babies' distress when they realize that mom and dad are not close-by. As your baby gets older, his emotions will seem more intense and you'll find he is less likely to be swayed or quieted by distractions. Complicating things further, babies tend to wake more often between 9 and 12 months for several reasons including changes in routine and the drive to practice new physical skills. So, from your baby's perspective, his desire to be in your arms makes a lot of sense. While playing with your husband may be wonderful and fun during the day, your baby knows that all his anxieties melt away while he's nursing. Therefore, you are the one he wants when darkness and separation become frightening.

So, mystery solved, right?

Except...that you probably want to know what you might do to get a little more rest. That's a lot tougher. We'll share some ideas next time.

Next time: Ideas to Help with a Waking 9-Month-Old