Book report: Mothering Your Nursing Toddler

Bumgarner and La Leche League International, Mothering Your Nursing Toddler, 2000

My score

8/10

Amazon link

Mothering Your Nursing Toddler

My review

A handy reference! This is like 300 pages of things to tell people when they question a mother that is nursing her child "too long." List of benefits of breastfeeding? Check. Historical evidence of late weaning? Check. Comparison to other large primates, and extrapolation of weaning age? Check. This is the book mothers under scrutiny should read for support. What it really comes down to is if the mother is enjoying it, the children are enjoying it, and it works for the family, then more power to ya. The author provides strategies to keep breastfeeding going as long as the children want -- child-led weaning is the main topic here. If you are looking for a book that encourage weaning, look elsewhere. The purpose of this book is to make you, the reader, feel good about your lengthy nursing relationship.

The American Association of Pediatrics (AAP) recommends breastfeeding for at least one year. The World Health Organization (WHO) recommends breastfeeding for at least two years. That should keep me covered for a while. After that, here are some comebacks I plan to employ.

• The Jewish Angle: In ancient Israel, prophets, merchants, and shepherds alike nursed for two years. Sarah and Abraham weaned Isaac at two, but Moses was nursed for three years.
• The Primate Angle: Large primates wean when the young has either tripled its birth weight or is a quarter of its adult weight (for humans, that translates to between 2 years and 6 years, respectively). Or, large primates nurse for around six times the length of gestation of their young (six times 9 months = 54 months, or over 5 years for humans). Or, weaning in primates can be predicted is when the first permanent molars come in (in humans, that happens around 6 years old).
• The Health Angle: A human child's immune system is mature around 6 years old. Until then, children continue to benefit from the antibodies present in breast milk.
• The Average Angle: A 1989-91 study of La Leche League conference participants in the United States reported an average weaning age of 3 years. That's the same as the minimum natural weaning age in cultures that allow self-weaning.

Although, at times, a little on the defensive side, the book does bring up good points about the benefits of continued nursing, especially for working mothers, and the practical implications thereof. In the end, there is a thorough discussion of weaning, as well as several gentle weaning strategies. A good support book, it has a very -- I don't know -- compassionate approach to childrearing in general and nursing in particular.

Milestones: Birth to 6 months

When you're a new parent, the days are long but the weeks fly by. People say it gets easier... and it does. Here are the milestones that were monumental for me -- when it really did get easier, seemingly overnight.

1. Nursing (3 1/2 weeks): They say that 3 weeks is a really hard time for new parents. Sleep deprivation is at its peak, the novelty of a new baby has worn off, visiting relatives have left, and the parents are left with a cold, stark realization of their new life. It sounds grim, but sometimes it is that bad. By now, nursing patterns have been established. For me, nursing was one of the more painful things I have ever done. I do not want to say that we had trouble nursing. We had a consistent child-driven schedule of nursing every two hours, and he was gaining weight beautifully. His latch was perfect. I was overproducing. He had a voracious appetite: his little limbs were filling out with delicious baby fat. But for me, nursing was excruciatingly painful. At times, I thought it was worse than labor. With the help of our lactation consultants, we worked out a way to let my poor nipples heal. This was a turning point for me, because I could start enjoying nursing and looking forward to my son's eager meals.
2. Smiling (6 weeks): Until he learned to smile, our interaction was largely one-sided. I would talk to my son, play with him, sing to him, change him, and nurse him, but he never responded. The days he was learning to smile were indescribably beautiful: he was really trying. Over the course of several days, he learned to master his facial muscles, and each day his small smile would widen until he could produce a huge toothless grin. I would joke that when he saw his dad, my son would smile, but when he saw me, he would open his mouth really wide. In any case, it was a sigh of relief for me when I finally got some feedback for all the hard work I had been putting in.
3. Rolling back-to-tummy (5 1/2 months): Suddenly, tummy time became much more enjoyable. When he mastered rolling to his tummy, I could place him on the floor on a blanket surrounded with toys, and he could occupy himself -- without me! -- for several minutes at a time. Just enough time to wash the dishes or compose an e-mail or post to my blog. On the other hand, as he was learning to roll to his tummy, he would wake up every 20 minutes throughout the night in a panic: "Help! I'm on my tummy!" (He grew out of this as his mastery increased.)
4. Sitting slightly supported (6 months): Bath time is so fun when you can sit in the tub with the baby, and support him with one hand while eating berries.

I went to the small babies (0-3 months) support group this morning with my six-month-old son. I placed him, belly down, in the middle of a blanket and he amused himself for almost two full hours by slowly turning around in a circle on the blanket and watching all the little babies. I even got to hold his milk-brother for the first time while my son was engaged in cooing at one of the moms. It felt like we were showing off a little... and I suppose we were. We deserve a few minutes of fame after the last six months, right?

Book report: Cesarean Section

Moore, M. and de Costa, C., Cesarean Section: Understanding and Celebrating Your Baby's Birth, 2003

My score

5/10

My review

After reading Pushed (see review), I wanted to pick up a book specifically about c-sections. This book is written for the moms of nearly one-third of the babies born: by Cesarean. Unapologetically and reassuringly, the authors try to cover the medical side of c-sections: why they happen, and what the doctors do while performing a c-section. The book lightly discusses the risks and benefits of the options available during Cesarean section, such as the methods of anaesthesia and postpartum pain management. In each chapter there are several quotes from moms having undergone c-section and their thoughts and feelings on their birth experience.

Happily, the book is supportive; the authors repeatedly express that it is not the mother's fault that she had a c-section, that she did not fail in labor, and that Cesarean is just another way to birth a baby. In fact, a baby born by c-section, just like a baby born vaginally, is born head-first, followed by the shoulders and then the rest of the body. I am giving this book a high score for the supportive attitude alone. Women having undergone a c-section need all the emotional support they can get, especially if they were planning and preparing for a vaginal birth.

There is a brief chapter on vaginal delivery after c-section (VBAC), which may be a welcome read for some women having undergone a Cesarean.

Appendix A, Questions to Ask Your Doctor, includes a comprehensive list of questions as well as the reasoning behind each question. These questions are well thought-out and, though perhaps an unpleasant topic for an expectant parent going for a vaginal birth, hopefully elicit some truthful answers from the doctor.

My criticisms of the book are as follows.

The mothers' stories are unconnected; they do not flow with the rest of the chapter of passage in which they fall. Even in short, three-sentence-long birth stories, everyone has a name (half-way through the book, I feel as though they're running out of simple names to choose from), and the individuals are referenced later in the book -- but it's hard to remember everyone. "You remember Jan and Paul from the introduction?" the tenth chapter begins. No, not really.

The birth stories leave out the difficulty of coping with major abdominal surgery as well as an infant in the first weeks post-partum. One birth story relates a mom coming home with her third child (all three by c-section) as well as a torn bladder. After the catheter was removed ten days after the birth, her bladder and urinary tract were "good as new." And the catheter? Oh, it "saved [her] having to get up to pee at night." Score one for positive thinking, score zero for the reality of a torn bladder, third c-section, and infant at home.

The whole book reminds me of a short pamphlet, maybe with the name So You're Going To Have a C-Section. Or the transcript to a fifteen-minute informational film: "These mothers have one thing in common: they delivered their baby by c-section." Dum-dum-dahhh.

Ways to reduce the risk of c-section are not discussed. Several of the birth stories, ending in c-section, have the mom arrive at the hospital too early (before 3cm dilation) -- that is, right after her water breaks, just like in the movies -- and, after a Pitocin drip does not dilate her fast enough (she nearly always asks for an epidural after the Pitocin is started), she is wheeled to the OR. The book would be smart to encourage women, with the support of their doctor or midwife, labor at home until active labor.

The book leaves out (in my opinion) some important details. The doctor puts some medicine in the IV. He is trained in fixing the problem with a special tool. What medicine, what tool? Please don't dumb down the information I feel is required.

Finally, for all the pages spent on the actual operation, the book barely touches on the postpartum healing period. Hire a doula, eat well, exercise a little, and -- controversially -- put out for your partner even if you do not want to. Wow, really? The point is hammered in a subsequent, lengthy chapter on contraception.

Wear the baby

Wearing the baby has always seemed like the right thing to do. And I've really been trying. Through the last five months, I have tried several baby carriers, with one notable exception: the ring sling, which has been highly -- highly! -- recommended by the Attachment Parenting book (see my review). At first, I did not have one, and now my son weighs around 17 pounds (less if he has pood recently)... which, although within the guidelines, is too much for my poor shoulders to try.

Baby Bjorn Air

Lent to me by a friend, I tried the Baby Bjorn Air as soon as my son was 19.5" long, the minimum length at which you can wear a child in the carrier. Happily, I followed the instructions to the letter on how to adjust the device and put it on simultaneously with the baby. Finally in, he grunted, startled awake, and cried. He hated it.

I tried again a few weeks later. This time, my son liked the carrier much more, but I was concerned: all his weight was placed on the little area between his legs. Granted, he did not weigh much at the time, and prior to that he had all his weight pressing down on the top of his skull, but nevertheless I was worried. Was I smushing his balls?

We went around the block and ran some errands. Near the end, my back was killing me -- after only an hour, and the baby weighing in at under ten pounds, I was done with this device.

My score
4/10

Pros

• Inconspicuous under a jacket
• Easy assembly
• Quiet buckles -- almost too quiet, if you know what I mean
• Allows the baby to face towards the chest or away

Cons

• Holy moly, my poor back -- places the weight directly on the shoulders
• Probably some ball-squishing going on for small infants
• Can not breastfeed with this carrier -- have to remove the infant, and possibly the carrier too, to get at the breast
  

Infantino SlingRider

This was a very kind baby shower gift. Actually, I had seen this exact baby carrier in Japan, when I was just weeks pregnant with my son. The padding on the strap, the soft Velcro on the inside (there is a Velcro safety belt for the baby), and the elegant design caught my eye. How my friend knew to get this very thing for me at the shower, I do not know, but he kind of read my mind.

I used this carrier almost exclusively in the first weeks of my son's life. I took him to class with me up on campus. When he was awake, I would let his head peek out over the side. When he would fall asleep, I would tuck his head in and let the sling wobble at my thighs as I walked, like a heavy purse. However, he wheezed in his sleep when in the carrier. I asked my lactation consultant about that; she suggested a rolled-up receiving blanket behind his neck. She said perhaps he is too small for the carrier. I tried that, but it did not help. Oh well, he did not spend much time asleep anyway.

The biggest bonus for the SlingRider is the ability to take off the carrier with the baby still inside, without waking him. Take off the sling, put it on the bed, and enjoy the ten minutes of peace before he figures out that his mom is not there.

My score

5/10

Pros

• Ability to remove the carrier without waking the infant
• Large padded strap
• Can breastfeed in the carrier
• Has a strap for the infant so he cannot roll out (is it necessary?)
• Can switch sides easily to avoid muscle fatigue
• Looks nice

Cons

• Hard to adjust
• Did I say hard? Dang near impossible to adjust
• Wheezing problems with the sleeping infant
• Prolonged use leads to shoulder pain on one side -- again, no back support
  
• Has a pocket for a cell phone right next to baby's genitals... great idea, guys

Ergo

All this talk about back support leads us directly to the Ergo. We have the organic kind, a couple of seasons old. The Ergo has thick, padded straps and a thick, padded, wide waist band that hugs the hips. If you are limber, you can adjust the Ergo one-handed. If you possess alacrity, you can get your baby into it without help.

For infants smaller than about four months, Ergo recommends the Infant Insert. I watched the video that shows the infant being placed into the donned Ergo ("...and now I accept my baby.") and scoffed: "That thing looks like a blanket!" So I grabbed a thick blanket and my infant and accepted my baby into the front-pouch.

I wore the Ergo for almost five months. What started out a diagonal pseudo-reclining position with the blanket, at first, later evolved into a squat for the baby. I would roll the blanket up on the bottom of the pouch and shove his little feet into the blanket, into a little squat. He stayed in there all day as I went from class to class, and from bus to bus. He slept; I ate; it was a great symbiosis. Eventually we removed the blanket and he continued his kneel. Sometimes he would stick one foot out and let it flop around in the breeze, in rhythm to my constant walking. Nothing hurt.

Then, something happened. I think it was the magical 15-pound mark. I would try to get him to sit normally in the front-pack, legs askew, but he would cry so I would stop and try again in a few weeks. But at 15 pounds, he was able to sit normally. But he did not like it because he could not see. I would sit him on top of the pack, facing out, legs dangling over the sides. The straps would have to be loosened all the way. All the weight was on my shoulders and none on my hips; the straps would fall off my shoulders one at a time; moreover, the tab that holds the straps together in the back would dig into my spine at the base of my neck. Ouch!

Any normal person would say, "Just sit him properly, and you will not have this problem." Yes, that is very true. But neither of us enjoyed that. He would get hot and grumpy; I would have to take him out to soothe him.

But for four months, I loved this pack. I nursed with it on the bus. I even nursed in it while walking several times.

My score
8/10

Pros

• Great back support
• Great shoulder support
• When worn properly, can be worn for hours without pain or discomfort
• Great nursing capabilities
• Can be worn improperly for short periods
• Easy to adjust
  

Cons

• Only one way to wear the infant (toddlers can be worn as a backpack)
• Baby can not see out
• Is it really OK to sit the baby in the splits like that?
• Does not work well for smaller-framed people

Moby Wrap

I saved the best for last. After my son's five-month birthday, after I had had enough of the Ergo and the perpetual bruises on the back of my neck and the straps falling off my shoulders, I decided something had to change. I had just been to a support group at the local birthing center, and talked to the four out of six women that were sporting various-colored Moby wraps. (The fifth had an Ergo, but did not bring it.) They swore up and down that this was the best wrap ever. Meanwhile, a local baby shop had a sale on Moby wraps... and I was sold. I bought the standard Moby wrap in Sienna, which is a fantastic bright orange color (my favorite)!

This carrier provides the best of all worlds. There is ample back support as the wide fabric spreads the pressure across the shoulders, back, and hips. The baby can face in, out, be cradled, or even be on the hip. I was a little worried about not being able to figure out the wrap, but after one attempt I had it down -- it is very simple. The important thing is to make sure the fabric does not twist too much.

You do not have to re-tie the wrap on your body every time you take the baby out.

The cuteness factor of my son has gone way up. When I took him out in the Ergo, even when he was front-facing, contrary to the Ergo instructions, he would get maybe 6 awws or coos from passer-bys as we walked to the coffee shop from my house and back. Using this distance as a metric, with the Moby, he gets closer to 18. The Moby more than doubled the cuteness factor!

My biggest regret is that I did not get the Moby when my son was first born. Dang, I love this thing.

My score

9/10

Pros

• Holy moly comfortable
• Fashionable -- looks like a shawl
• Comfortable for baby
• Versatile -- the basic wrap can face the baby in, out, cradle; feet covered or exposed
• Can wrap baby to the parent when the baby is asleep, and go about the day (I have not tried this; my son no longer falls asleep on me)
• Can do a hip-hold for older babies (I have not tried this, but plan to)

Cons

• A little tricky to breastfeed in the wrap -- not having mastered this, I take the baby out
• Need to use a mirror at first to make sure it is on comfortably for everyone
• Hand wash only? Really?

Movie review: Breasts

Spadola, M., Breasts: A Documentary, 1996

My score

6/10

The continuum: Theatre - Matinee - Rental - Discount rental - Library

I would rent this movie with a coupon or discount.

IMDB link

Breasts

My review

For a 50-minute film, this has spunk. It's just short enough that the interviews are entertaining -- women talking about puberty, older ladies discussing sagging, women with implants, a woman with reduction surgery, a stripper, and even a man -- each interviewee discusses her relationship with her breasts. I love the 40s and 50s cartoons and footage throughout the film. However, I wish the interviews were longer; I wish more topics were covered; I wish there were more women... and more boobies.

Book report: Pushed

Block, Jennifer, Pushed: The Painful Truth About Childbirth And Modern Maternity Care, 2007

My score

7/10

My review

"The painful truth" indeed. Starting out as a lesson in current events and history, the book takes a heartbreaking turn somewhere mid-way through. Near the end, the book is a depressing commentary on the dismal childbirth system, with no hope for the future.

Maybe the author sought out the most extreme cases for her examples of unassisted home birth, maternal mortality, newborn resuscitation, and forced c-sections. But the more I read, the sicker I felt about our national maternity and childbirth system.

The biggest problem for maternity care is the insurance. Insurance companies can choose who and what to cover. If an insurer refuses to serve midwives, or refuses to cover vaginal delivery after cesarian (VBAC), in the end, it's the expectant parents (and mothers in particular) that face the brunt of the decision. Mothers that are forced into having procedures that are arguably riskier than the uncovered alternative; procedures they do not want.

It is clear by research that the average low-risk woman with a low-risk pregnancy is better off with a midwife than an obstetrician. Maternal and infant mortality rates are lower with midwifery care, and maternal morbidity rates are much, much lower for women that choose midwives. However, midwives are few and far between, and only 8% of women deliver with a midwife nationally.

The final chapter of the book discusses the legal implications of fetal rights. The author reframes the age-old question of when does a fetus become a human, with human rights, as follows: When does the expectant mother cease having rights -- when is it OK to disregard a woman's health and livelihood to exctract her unborn child? I think this is a question for the rabbis.

My opinion on the matter of the state of the childbirth system? The expectant parents should have access to information and the freedom to make their own informed decisions. Their doctor or midwife should discuss with them the pros and cons and offer their professional, legal, and personal opinions (which could all be different). Then, for a low-risk, healthy pregnancy, it is the doctor's duty to follow through with what the parents have decided. A doctor is a hired professional. If he or she cannot or will not, for whatever reason, do the job, the parents should be free to find someone who shall.

As a doula (in training), it is my duty to give to the parent(s) the birth experience they desire. All things being equal (that is, having made safe decisions, and having been informed), why should a doctor's duty be any different?