Tuesday, August 30, 2011

NBAM: Breastfeeding in Context

I thought this article was very interesting (ignore the title... horrible title that doesn't really relate to the content of the article.)

I have long believed that the greater society/culture has a much more profound impact on breastfeeding than the health care system. Why? Travel in any developing nation (most of my travel has been in Africa), where there is virtually no access to health care for mom or baby, no information about breastfeeding, no lactation consultants, no infant weight checks or jaundice checks, etc... and women almost exclusively breastfeed, and do it well! Why is this? Because the greater culture/society accepts this as normal and expected behavior.

Even in situations where a mother is unable to breastfeed due to health or separation from her baby, the baby is generally successfully breastfed by a relative or neighbor. Women don't need to be "taught" how to breastfeed because it's as natural to them as any other function of motherhood... because they have been constantly exposed to it from the get-go! Men don't need to be made to understand breastfeeding because they, too, have been constantly exposed to the practice since they were small children. There is no one barking about modesty and appropriateness because it is viewed as the natural, and often ONLY way of feeding a baby.

When breastfeeding is placed into the realm of a medical event, our minds process it like a medical event: is it better to treat my cancer with radiation, chemo, or a combination of both? Is it better to breastfeed, bottle feed, or a combination of both?

Removing it from that realm and placing it into the realm of "normal" function/activity removes the questioning: Is it better to breathe or not breathe?  Silly question, right? Of course we do the normal, natural, life-giving thing. Doctors and nurses don't have to be taught that patients are better off breathing, that it is a better option than not breathing- they just have to be taught ways to help people with breathing problems have better breathing patterns.

We need to view breastfeeding in the same way: is it better to feed my baby or not feed my baby? Of course, it's better to feed them in the way nature intended. Healthcare professionals can be taught to assist in this process.

The barrier to this is the greater society/culture that continues to view breastfeeding as "not normal" rather than "normal." Which, of course, begs the question: how do we change societal and cultural norms?

Monday, August 29, 2011


Remember when I was at my breaking point?

I wanted to give you an update. God is good, and He provides. And He has provided.

There is still so much about this whole situation that is just out of control. It's frustrating to not be able to guess at what the future holds. But this practice in patience and trust is, I am sure, another less from my Heavenly Father (or, maybe just another version of the same lesson. Because patience and trust seems to be a theme.)

I still don't know what's going to happen with my cervix, and if this baby is going to be premature. I have no idea what preterm labor will mean for our baby and our family. I am still scared by the idea of a NICU stay, although I am reassured by the fact that I am now 26 weeks and 3 days. Every day matters. Every day counts.

And my dear friend Laurie (our Realtor! Seriously, if you need a Realtor, call her! I would not have hesitated to recommend her before, and even moreso now!) has arranged her Bible Study group to take turns helping me in the mornings. I didn't have to find and hire a Mother's Helper because these sweet ladies have taken it upon themselves to give up their free time and come help take care of JohnAndrew, run errands, carry laundry baskets, and just provide some company for me. Laurie and all of these ladies are so sweet and kind.

And we have carpool arranged, so that Anna has a ride to and from school. One less thing to worry about- one less thing where I might have to lift JA.

And Anna has blossomed at school. I think she has learned more in the past 10 days of K4 in Mississippi than she had in the past year of preschool in Pennsylvania! Not to mention that she is asking to go to school, asking to stay for Lunch Bunch (an optional lunchtime program), and asking to have playdates with friends! This is a huge breakthrough socially for her. She is still shy enough that even when it's her turn to be "leader/helper" in class, she still won't speak in front of the other children, but her teacher said she has been having actual conversations with her daily! This is HUGE!

And Abigail is thriving in school as well. She came home with at least 5 quizzes/tests with 100% scribbled across the top! She has made several friends, and is even getting a little better about the 5:45am wakeup call:)

Not to say that the kids are perfect. Because they aren't. And they won't be. They are kids. But it's nice to see these positives.

Oh, and have I mentioned that we found a babysitter we like? Yes, indeed. That means we were able to go on a date night:) Wonderful Lebanese food, and then to a new friend's birthday party:)

Which brings me to 2 questions:

1. Who knew that fresh parsley was such a prominent ingredient in Lebanese food? I didn't. Is this regional?

2. I bought and wore a pair of black leggings for date night. I haven't worn leggings in probably 20 years. I had mixed feelings about this. What do you think of the whole adults-wearing-leggings trend?

There's the bump. I don't think I've given you a picture of it lately... what a difference from when I was pregnant with JA, huh?

Also, did I mention that he got his first tooth? Yes, on the 23rd. At age 10 months, 1 week.

Anyway, I have so much to be thankful for... and truly, I am. 

Friday, August 26, 2011

NBAM: Thoughts on Nipple Confusion

Nipple confusion. There's a nice, simple topic. No heated opinions or anything. Right?

My Boob Nazi Lactation Consultant instilled a healthy fear of nipple confusion in me when Abigail was born. So, when Abigail wanted me to be the human pacifier, I was.

Even when that meant I had no more than 45 minutes to myself to shower, dress, use the bathroom, rest, and eat, I powered through (how did I manage without sleep? Oh, the joys of giving birth at 20.)

And when I got nipple damage and it hurt to nurse her, I kept on.

And when my nipple damage progressed to the point that pea-sized open sores developed on my nipples, and I cried through every nursing session and I was on the verge of giving up because it was just that bad... well, then my Boob Nazi Lactation Consultant relented and agreed that maybe it wouldn't be awful for me to try giving Abigail a bottle. I was scared, but I did it.

And then, the unthinkable happened.

She was just fine. She didn't really like bottles, but it was fine. She got it. She wasn't confused. She knew the difference between Momma and the bottle and adjusted accordingly. (I always knew she was brilliant.)

Then... then something absolutely life-changing happened.

I gave her a pacifier!

And suddenly, a long, hot shower without the wails of my daughter torturing serenading me became a reality!  A nap for an hour or 2 without the very vocal displeasure of my baby ripping me from unconsciousness gently calling me from slumber was possible. A drive in the car without the constant distraction of my darling's very empty mouth made driving manageable! Literally, it was life-changing.

Now, I am not a breastfeeding educator nor have I had training in breastfeeding medicine. So these thoughts are strictly opinion. But I've thought about this a lot. And I want to say a few things.

First, if you want to breastfeed, the most important thing you can do is work hard to establish good breastfeeding right away. Put the baby to the breast ASAP after birth. Nurse frequently- as often as the baby will- during the first 2 weeks. Be the human pacifier (although, those first 10 days? Yeah, the baby isn't awake much then...) Establish a good milk supply and make sure baby has a good latch. But once you have established good nursing habits and a good supply, don't be afraid.

The muscles and suck-swallow patterns needed to suck a breast are different than a bottle, for sure. But the skills necessary to suck a pacifier are not that much different than nursing. So, when nursing is well-established, try giving your baby a pacifier. Chances are, they won't like it (most BFed babies don't seem to like them at first.) If your baby seems confused the next time they are at the breast, don't offer the pacifier again.

When you feel confident that the pacifier is okay, offer the bottle. (Or reverse the order and offer the bottle first.) With the AAP recommendations for breastfed babies to receive an iron supplement starting at age 4 months and for breastfed babies to receive Vitamin D supplementation (my pediatrician recommended a multivitamin/mineral supplement to meet both needs), being able to give your baby a bottle of expressed milk with the supplement diluted in it is helpful (that stuff tastes pretty nasty.) (NOTE: supplements can also be diluted in expressed milk and given via droppers, spoons, or cup. I just found the bottle easier as JA swallowed all of it, instead of spitting/spilling a good portion the way he did with a spoon and cup.)

Either way, pacifier or bottle first, whether you give a vitamin/mineral supplement or not, the convenience of being able to give your baby a bottle (even if you are a full-time stay-at-home-mom) is helpful, and beneficial when you are sick (what if I couldn't breastfeed after my car accident for a time?), hurt/injured (bottles and pumping after my accident was MUCH less painful on my fractured sternum than BFing), unexpectedly separated from your child, or just want to involve your husband and other children in caring for and bonding with the baby. (My girls loved being able to feed JA, and John was thrilled... much more than I thought he would be. Even aunts, uncles, and grandparents took turns and got to enjoy special moments with the baby. )

The key to success and avoiding nipple confusion remains in knowing and responding to your baby. Establish good breastfeeding and then monitor how your baby responds to pacifiers/bottles. Don't rush him/her, but don't be afraid, either.

Thursday, August 25, 2011

Hair Care and Attachment

When I was in the adoption process, one of the things I quickly learned was that hair care for a black child is much different than hair care for my white child... not only in terms of technique, but also in terms of it's importance in AA culture. And I got worried.

I looked at websites, blogs, and youtube videos. I bought books. I talked to AA women. And while I knew that a lot of the actual care of my daughter's hair would depend on the type of hair she had, I was given two basic pieces of advice on hair care that were supposed to be true regardless of hair type:

  1. Your love for your black child is directly measurable by the state of their hair.
  2. You must never cut length from your daughter's hair. Ever.
  3. (You must never loc your daughter's hair.) (This was something I learned after bringing Anna home.)
So, just weeks after arriving home with Anna, I did something that I will regret for the rest of my life. 

I combed out that poor baby's hair.

Now, let me first describe to you the state of Anna's hair. 5 months before picking her up in Ethiopia, her head was shaved (common, due to fungal skin infections requiring treatment.) During those 5 months that she was in care, her hair grew about 2 inches in length. Because she was very malnourished/protein-deficient, the hair that grew was fragile, unhealthy, and lacked her natural curl pattern

And I don't think it was ever combed out. Not once.

Let me show you:

See how her hair looks like it's in little "curls"? Well, those are little knots. 

Little knots of 2-3 inches of hair.

I will be the first to admit that my cluelessness about AA hair only made the situation worse... I didn't realize that every day they were left un-combed, the knots were getting worse. To be honest, I had no clue what would happen if I combed out her hair, and I kind of thought they were cute!

But then I was reminded that I needed to "do" her hair. So armed with conditioning spray, detangling spray, and a comb... I attacked my child's head. 

And I 100% regret that.

It was painful and traumatic for her. And sure, having hair= needing to take care of your hair= combing hair. I get that. I was as gentle as possible, until it got to the point where I realized no matter how gentle I was, it was going to hurt. Then I wasn't as gentle, in favor of trying to be quick. Neither way made her happy. It hurt, she screamed, and it was my fault.

Or, at least, that's how she saw it.

I was hurting her. The person who was supposed to be helping her... who was supposed to be taking care of her. The person who she was supposed to be learning to trust and love... Me, her Momma, was hurting her.

Now, I am not going to pretend that Anna's hair and our situation is typical, because it's not. Her malnutrition was severe. Her hair type is uncommon. Her lack of a hair care routine is not the norm for children in any type of care in Ethiopia. 

But what I do think is typical is the idea that how we treat our children in terms of caring for their hair is outside of how we treat our children in terms of fostering bonding and attachment.

Because, you see, if I was most concerned about our bonding and attachment, I would have let her hair alone.

Or shaved her head. 

And I think either of those responses would have been better for our bonding process than what I did do... even though they break the 2 rules that were ingrained in my head.

Now, my process of bonding/attaching with my child is different than yours, so I am not saying you should do the same. In fact, if your child is old enough to understand and value their hair, I would never suggest ignoring the state of it or cutting it off. But Anna was not. She didn't care about her hair one whit (although, she did like having "pretties" in her hair.) She was 18 months old, and hardly even knew her hair was there, let alone care what it looked like!

All of the growth that she had when she came home ended up being cut off at her very first trip to the salon because it was so damaged/unhealthy. And then? Her hair started growing like a weed! Those few inches lost meant nothing in the grand scheme of the overall appearance/length of her hair (although, while they were still there, they made her hair much more difficult to style because the hair was so unhealthy.)

But that attack on those knots? That meant something. It meant a lot, actually. And to this day, I still regret it. Because she doesn't remember that hair, but she remembers that the first time Momma touched her hair, it hurt.

So my advice to adoptive parents? Remember the importance of hair and hair care. Do the things that you need to to properly care for your child's hair. But first and foremost, foster the bond/attachment with your child, even if it means caring for their hair in nontraditional ways.

Monday, August 22, 2011

Revised Family Code

As adoptive parents, we often become educated about the laws that govern adoption and the rights of adoptees within the US. We educate ourselves about different kinds of visas, re-adoption, citizenship (and proof thereof), name changes, and a whole host of other laws regarding our adopted children.

But for internationally placed children, do we ever take the time to educate ourselves about the laws that govern adoption in their country of origin? It's probably rare, unless we run into a major snag in our adoption process.

By failing to educate ourselves, we are doing a huge disservice to our children and their birth families. We don't always know/understand the legal implications of relinquishment and abandonment for our children in their country of origin, or the rightful and legal expectations that the birth family may have of us.

I recently happened across this link to The Revised Family Code of the Federal Democratic Republic of Ethiopia. This is a hugely important piece of law for all families who are considering or in-process for international adoption from Ethiopia. I encourage you to read it; adoption-related statutes start in Chapter 10, Article 180. Here are some things I found interesting (although, I may be reading this wrong- feel free to correct me if I am misinterpreting something!)

  • Article 183 states that the adopted child shall retain his bonds with the family of origin. So relinquishing families legally should expect and anticipate communication and visitation with the child after the child is adopted.
  • Article 190 says that the agreement for adoption is between the adopter and the guardian of the child... meaning that when a child is relinquished, the appointed guardian (which is often an orphanage) is the person with whom you make a contract for adoption. Can you see where this could be a conflict of interest for NGOs that are supposed to be working for family preservation while being the legal guardians of children who are a "hot commodity" for international adoption?
  • Article 193 seems to indicate the court may not approve an international adoption unless they have a positive letter from "an authority empowered to follow the well being of children" (MOWA?). I know of at least one case where the court did grant an international adoption in the absence of a positive MOWA letter... seems like the court broke it's own law to me.
  • Article 193 also says that even with a positive letter, the court can reject an IA if they do not feel it is in the best interest of the child.
  • Article 196 indicates that even after an adoption is finalized by the court, a child welfare party/organization (MOWA?) can petition the court to revoke the adoption under certain circumstances. I think that could very well explain the situation that may be faced by these 5 families (and rumored to be faced by all families who had children at Mussie Orphanage in Hosanna when it had it's license revoked in July of this year.)
What's your take?

Friday, August 19, 2011

Traveling with Siblings for Adoption

At least once a month, I see the question come up as to whether siblings should travel to meet/bring home a newly adopted sibling/siblings. There are a lot of things to consider and there is no "right" or "wrong" answer. In our case, having Abigail along was a great decision, but there are cases where it's not worked out well for the family. Here are some things to think about as you make that decision:

Is your child(ren):

  • Okay with being away from mom/dad for more than a night or two?
  • Used to traveling?
  • Able to sit still for at least a few hours (those flights are long!)
  • Able to deal with changes in schedules/routines/diet?
  • Used to sharing mom/dad's attention?
  • Able to entertain themselves if you need to direct your attention to new brother/sister or other aspects of adoption process (ie- embassy interview)?
  • Excited about new sibling(s)? Experiencing mixed feelings about new sibling(s)?
  • Old enough to "get something" out of the experience of international travel/old enough to remember the experience?
  • Comfortable around strangers?
Are you:
  • Worried about splitting time between new child(ren) and other child(ren)?
  • Traveling with a spouse/other adult or by yourself?
  • Comfortable traveling? Or do you tend to get sick/nervous when traveling?
  • Anxious when separated from your child(ren)?
  • Planning to be the sole caregiver for your newly adopted child/planning to practice attachment parenting?

There are those who would suggest that your newly adopted child needs 100% of your attention and should not have to "compete" with sibling(s) for your attention. Others may suggest that the process of caring for more children other than your newest child(ren) would slow or hinder your bonding/attachment process. While these are valid thoughts and certainly are something you should consider, I think another thing to consider is that your newest child is part of a family. And that family, all of it, is important to this child(ren)... and this newest child is important to them in return.

In my experience, having Abigail along during my time in Ethiopia definitely helped my bonding process with Anna. I believe this is because Anna could see that Abigail trusted me, and this helped her to be able to trust me... she could see that Abigail and I loved each other, and that I took care of Abigail- she learned to expect that I would do the same for her. Because she had been hurt by adults in her life, she was able to relate to another child in a way she didn't quite relate to an adult. Not to mention, kids are goofy, and laughing together over the goofy things Abigail (and eventually Anna) did helped to create some common ground, despite language barriers.

Abigail was great during our travel. Having my mom along to help meet some of Abigail's needs helped relieve the pressure of parenting 2 while only knowing 1 of them (not to mention, Abigail loves time with Gaga!) Having my mom along also helped me to feel okay when I needed to take a break or when I was stressed. But the success of traveling with Abigail had a lot to do with Abigail herself- her personality, her age, her development. While I believe she would have been (emotionally) fine to stay home, I think it was great for her (and Anna, and I) to come along. 

What are your thoughts on traveling with siblings for adoption?

Wednesday, August 17, 2011

Breaking Point

Yesterday, I was at my breaking point.

For those who know me IRL, I am not a crier. It's unusual for me to cry, and when I do cry, it's generally out of a sense of anger and frustration rather than sadness. But yesterday, we were only half way through the day when I felt thisclose to losing it.

I won't lie. The past few weeks have been rough. Really rough.

We've had behavior issues from the girls. My husband went out of the country for a week. I was told that I basically have only a 10-15% chance of carrying #4 to term, and that there is little I can do about it. What I can do essentially involves not being a hands-on mom, even to JohnAndrew. My little dude is feeling the loss of the play and cuddles and is cranky and out of sorts. We have no idea what we will be doing to get help with JA once my mom leaves on Monday night, and 2 people have already fallen through. Life in Mississippi is turning out to be a lot more expensive in some areas than we had budgeted, and now we have the additional expense of hiring a Mother's Helper, plus someone to do the heavy cleaning. We are struggling to get our girls the help that they need for the issues they are having. We can't find a church that where we feel comfortable with their theology and style, that also has a children's/family program and is racially diverse. We have absolutely no plan for what will happen if I am forced to go into the hospital for bedrest. I am torn between googling blogs of parents of premies and micro-premies, wanting to know the worst, but fearing it at the same time, typing my phrases into the search box over and over, before madly hitting the backspace button. I'm not even sure what it is that I think I will find... certainly, no promises of what our baby's life will be like.

I told John yesterday "maybe, if just one thing was working out- if we just had the answers for ONE of these issues, it would feel better, not so wild, not so out of control."  I feel like I have no answers whatsoever. And my ability to adapt to one more stressor is gone.

It's raining, a soft pitter that is hard to hear while the air conditioning is cycling to quell the 95 degree heat. The sound of distant thunder is soothing, and already the water has turned the world a vibrant green and drowned out the dusty brown that has been common in these past few weeks. The girls are at school, and the baby is asleep. #4 is turning summersaults with the occasional karate kick.

Be joyful always. Pray continually. Give thanks in all circumstances; for this is God's will for you in Christ Jesus.

1 Thessalonians 5:16-18

Water Balloon Fight!

During Teta's visit, we had a water balloon fight!

Loading up on "ammo"...

Ready, aim, FIRE!

It took Anna a while to figure out what to do with the balloons

Action shot!

Cleaning up afterwards.

Our fight did not go exactly as planned, partially because our water balloons didn't want to break! The girls spent a good amount of time chasing down the balloons that they had tossed at each other but had bounced and rolled down the driveway:) They also had to throw them pretty hard and at close range to get them to burst. But, still, they were having a blast!

Thanks Teta for our very first Mississippi water battle!

Monday, August 15, 2011

NBAM: Myths about breastfeeding

More than anything else, the most frustrating thing about breastfeeding is the misinformation that is out there about breastfeeding.

And it's everywhere.

When pregnant with JA, one of my RN co-workers told me she had heard that you shouldn't breastfeed because your baby won't sleep at night. Others chimed in to say they had heard things such as "you'll give your child a complex" or "they won't bond to their dad/other family" or "they don't get as much calories and nutrition from breastmilk as they do from formula" or "breastfeeding goes better if you supplement for nighttime feedings."

And beyond the misinformation, there is also a lot of just plain bad, or at least outdated, advice.

Here are a few links to articles that can clear up some of this misinformation and bad advice (NOTE: I don't agree with all the advice offered in these articles, and again, I think you need to find the right method/pattern of feeding that works for both you and your baby, but you shouldn't be hindered by false information!):

10 Pieces of Breastfeeding Advice You Can Ignore

Common Breastfeeding Myths (lots of links to research articles if you have specific questions)

American Academy of Pediatrics Family Resources for Breastfeeding

Friday, August 12, 2011

Fun at the Farmer's Market

Our local Farmer's Market has a great water slide for the kids. They say they want fresh produce, but I think it's really a desire to play like this:)

That's Teta on the left- these pics were taken during her visit last month.

It's so hot down here, I really can't blame them!

Here's a list of Mississippi Farmer's Markets if you are trying to find a local one!

Wednesday, August 10, 2011

NBAM: Adoptive Breastfeeding

I really had never heard of adoptive breastfeeding until well into my adoption process. I knew it was not something that was for me at that point in time, but it is certainly something that families can consider when making choices about their adopted child.

There is a plethora of evidence demonstrating that the nutritional and bonding elements of breastfeeding are beneficial to children, whether adopted or biological, but the psychological benefits can be especially helpful in adopted children.

Of course, the process of induced lactation can be difficult and even expensive, but this post by adoptive breastfeeding mom, Faith, helps lay out some of the things she found helpful, as well as some of her own experiences with adoptive BFing.

I'm certainly no expert in this field, but I wanted to share these thoughts during National Breastfeeding Awareness Month as this brings together 2 of my passions: adoption and breastfeeding!

Monday, August 08, 2011

NBAM: Third time's the charm?

So, #4 is going to be making his or her way into the world in the next few months. And I plan to breastfeed. But this time around, I really want to focus on what I know to be true, and reduce the stress/anxiety I always seem to have about breastfeeding.

I'm going to remember the 4 things I've already learned:

  • One experience of breastfeeding doesn't necessarily predict your outcome with a subsequent experience of breastfeeding. This time, it's a fresh start. I'm sure this baby and my body will present some challenges as well as some areas where we do really well!
  • Set realistic and reasonable goals- it's just as important as your personal convitions/dedication to breastfeeding... My goal this time will be to breastfeed exclusively for one year or as long as possible/acceptable to the baby and I. I think this represents a more realistic goal than simply saying "for one year." (FYI- I'm not opposed to nursing longer if it is still satisfying for #4 and I.)
  • Find what works for you and your baby... Traditionally, I've had success using the Babywise method, but I remain open to the fact that each child has different needs and may need a different approach.
  • Find a helpful, supportive lactation consultant who is willing to work with you and your baby, your individual personalities and needs, and help you find solutions to the issues you are facing. The Mississippi Breastfeeding Medicine Clinic looks like it will be a great resource.
One thing I do want to try is using hand expression. In all my time with lactation consultants, breastfeeding classes, and  BF support groups, this is something I was never really made aware of, let alone taught. Although, interestingly enough, if you ever watch the Babies movie, you'll see that the mom from Mongolia uses this technique (and I think the Namibia mom, too...) This technique was taught to new moms at Stanford University/LPCH by their lactation consultants and seemed to help establish a good milk supply from the get-go. Here is a clip explaining the technique (Warning: NSFW. But totally appropriate from an educational standpoint.)

If I have an over-abundance of milk (as I did with Abigail) I would love to be able to donate to my local milk bank.

Friday, August 05, 2011

NBAM: Twice is nice

After my experience breastfeeding Abigail, I really looked forward to breastfeeding JohnAndrew. I knew what worked for me, I knew what the "worst" of it could be, and also knew how wonderful and rewarding breastfeeding was for me.

And then I had a baby. 

And he was such a different baby than Abigail! I think in his entire life he has not fussed as much as Abigail fussed in a week. 

But I also had 2 other kids who had to go to school and ballet class and gymnastics and have homework checked. Plus I had this thing called a house to manage. And once in a while, all these crazy people needed to eat.

And despite the fact that all evidence suggest everything was working properly and JA was happy as a pig in mud, I felt anxious about my abilities. I think it was "transferred" anxiety, because of all the other stuff that was going on in our lives, but it exhibited as anxiety about breastfeeding.

So I found ways to deal with that (I had this notebook... ask my sister;) And I breastfed in public a lot more. And it was good. My pediatrician marveled at my lovely boy who grew and grew and was just so happy (thank you Jesus for his sweet disposition!). 

And then, I got my period. When JA was 8 weeks old. And my boobies didn't do so well with that. I definitely had a temporary decrease in my milk supply. When I got my period again, I knew what to expect, and tried to work with that (increased fluids, pumped to increase production, etc.) But it wasn't great. I knew I needed a better plan... herbal supplements or something. Because my body was just not meeting JAs needs during that time of month.

And then, I got pregnant with #4.

And despite multiple interventions (think herbal supplements, pumping every 2-3 hours around the clock- even when JA was sleeping through the night, drinking literally gallons of fluids) I couldn't get my milk production to be anywhere near his demands. After a week, I was making less milk, not more. 

And my reproductive endocrinologist (you know, the one who said we would probably have difficulty getting pregnant with JA, and who thought maybe no more babies would happen after our little "miracle") was not supportive of me taking any more drastic measures. She even said "you know, the very reason this pregnancy isn't requiring the hormonal supplements you needed with JA may be the very same reason you are making less milk. Your body might not be able to do both."

And that made sense to me, because most people don't do both... or at least don't breastfeed a 4 month old while pregnant (it's a little different to BF a 2 year old while pregnant.) And historically, BFing usually does suppress a return to fertility, so that your body doesn't need to try to do both.

So we started supplementing. He needed it, and he was so much happier when we started giving him the calories he desired. 

The unintended consequence was that he totally lost interest in the boob. (See, he's NOT just like his Daddy. John would never lose interest in the boob.)

And so we weaned when he was 6 months old. It was so hard those last few weeks, because he just didn't want to nurse. And the added stress of him rejecting my breast was decreasing my milk supply even more.

Even though I had totally valid reasons, I still felt like a failure for not exclusively breastfeeding for 12 months. No one around me made me feel that way- in fact, everyone was incredibly supportive and told me to take it easy on myself and just focus on having a healthy pregnancy.

But I had so desperately wanted to breastfeed. For JA, but also for me. And my body was not able to do it- I failed.

In the months since weaning, I have come to appreciate how great it is when your baby looks forward to taking a bottle. JA took bottles of expressed milk from fairly early on, but he was never "excited" about it. It was always his second best. But since weaning, he looks forward to taking a bottle from his Daddy. Or sisters. Or grandparents, aunts, uncles... They all get to experience his smiles and contented little sighs. And that has has been fantastic for our bonding as a family.

Also, there is the fact that my (bigger this time around) belly is already making cuddling with JA difficult, and his (huge) size is already causing pain and limitation in movement in my back/pelvis, which is complicated by pregnancy... having already weaned has helped limit some of this, I am sure.

So in this time of "earlier than expected" weaning, I have come to peace. I see now that God had a plan all along, and that this is not a failure, but rather a blessing in disguise. I've also learned two valuable lessons.

First, I learned that setting realistic and reasonable goals is just as important as your personal convitions/dedication to breastfeeding. I thought breastfeeding exclusively for 12 months was a realistic goal, but I know I would have felt less of a "failure" if I had made it my goal to breastfeed exclusively for 12 months or until it is no longer working for JohnAndrew and I. Because his wants, needs, and desires... as well as the external stresses and internal physical changes that occurred within my body, were important factors in how we chose to meet his nutritional needs. And as long as we were both healthy and happy and tried to do what we thought was best, I think this experience should be viewed as successful.

Secondly, I learned that one experience of breastfeeding doesn't necessarily predict your outcome with a subsequent experience of breastfeeding. Your relative success/lack of success with each endeavor does not determine the outcome of subsequent efforts. Because each child is different and their needs are different. And you, Momma, you are different... your experience and commitments and stresses are different. All these things factor into your success with breastfeeding goals. So approach each new experience with grace for yourself and hope for your success!

Thursday, August 04, 2011

Week 23 Update: The Good and The Bad

Tomorrow I will be 23 weeks. And I will not be going to India, the way we had planned for months.

So, there is good news and bad news.

The Good News: The baby is healthy and active! I am healthy and as active as you would expect in a heat index of 114+.
The Bad News: My cervix is not so healthy. By ultrasound it measures only 14mm when there is pressure on it. By manual exam, it is "very, very thin" even without pressure That's not so good during pregnancy, especially when you don't want to go into labor soon.

The Good News: My cervix is not dilated, and I have no evidence of pre-term labor! That means that while the cervix is thin, it is not opening up to let the baby out, nor is my body trying to push the baby out yet.
The Bad News: There is basically nothing we can do to prevent the cervix from thinning more, or to prevent pre-term labor.

The Good News: I am not on bed rest! Besides being incompatible with my lifestyle as a mom to 3, bed rest carries particular risks for me because I have a clotting disorder. Bed rest is not something I want to do, so yay! that we aren't at that point.
The Bad News: I am on restricted activity. Officially, I am not allowed to lift items greater than 10 pounds, engage in vigorous activity (run, etc), or do anything to cause "undue stress or irritation to the cervix" (ahemsexahem.) The vigorous activity and undue irritation are not such a big deal. My nearly 25 pound 9 month old is pretty displeased that I can't carry him around on my hip all day.

The research shows that in women with a cervical length less than 15mm, the risk for pre-term labor is 6-8 times greater than the baseline. In someone with cervical trauma (I have had 2 big surgeries on my cervix), the risk is even higher. While the short cervix was a concern when I was pregnant with JohnAndrew, all of my measurements were fine. However, it's possible that because the pregnancies are so close together, my cervix is "tired/weak". The standard treatment, a cerclage, is not an option for me due to my cervical anatomy being very different than most ladies.

The one treatment option we are pursuing is a special weekly injection of 17 hydroxy-progesterone. This has been shown to reduce the risk of pre-term labor in women with a history of pre-term labor. I do not actually have a history of pre-term labor. The drug has not been studied in women with my history, so we don't know if it will have any protective benefit. However, we know it cannot hurt me, and may possibly help, so we are going for it.

The main intervention will be modifying my lifestyle... namely, taking it easy, not lifting, etc. If I were to have any signs of pre-term labor, the plan would change. But for now, we are just going to trust that things will go well.

I am at that horrible part of pregnancy where the word "viability" is tossed out. A week from now, our baby will be gestationally viable (although maybe not weight-wise.) The whole decision-making process becomes muddled, as I wrote about this time last year. Each day, each week changes the decision-making, because each day, each week this baby changes immensely. By 28 weeks, the ability of this baby to live a full and healthy life is not questioned the way it is at 24 weeks. These next 5 weeks are crucial. I need to keep this baby in my belly where he or she belong.

And so, even though my favorite little dude is unhappy with this plan, I'm doing all that I can to avoid lifting him. Which became much more challenging when my husband walked out the door 45 minutes ago. He is driving to New Orleans tonight, and tomorrow will board a plane. By Saturday evening he will be in India to celebrate the wedding of his best friend. By lunch tomorrow, my mother-in-law will be with me to help me take care of the kids, but for now, JohnAndrew is asleep in my bed so that when he wakes in the morning, I don't have to lift him out of his bed. Abigail is an invaluable help to me right now, as she is big enough to carry him around and even get him into his car seat. I am so thankful to have her help!

Tomorrow I have to figure out what will happen after my mother-in-law leaves. I think we are going to have to find a part-time mother's helper or something, unless we put JA into daycare (no thank you!) Any ideas? I just can't be alone with him for very long, because inevitably I will need to lift him/carry him. And I can't run JA and Anna to preschool and errands and whatnot, because lifting is a huge part of that... need to come up with a plan.

But anyway, tonight I am thankful that #4 is kicking and flipping up a storm. Hearing that racing heart at my OB visit today reminded me how much I already love this little bundle of unexpected blessing. He or she is worth the trouble, by all means, and I am privileged to be able to sacrifice my convenience to help this little one grow.I am privileged to have this little life entrusted to me, to carry in my womb.

Guest Post: First Families, Searchers, and Ethics

I have come to believe that the only way we can know our children's true story is through using a searcher/private investigator, because lying, unethical practices and corruption can occur at point in the process of a child becoming available for adoption. We cannot assume that just because we use an ethical agency, our adoption was ethical. Here is a story that highlights that.

I started looking at Ethiopian adoption in the fall of 2007.  I had recently completed an adoption from Guatemala and was watching that program close due to corruption involved in the process there.  It was important for me to find another program and one that I thought would be more ethical and transparent.  I also wanted to find one where the children were well cared for.  Ethiopia seemed perfect.  I researched agencies and finally chose one that had a small Ethiopian program that was geared towards older kids and with a good reputation as far as ethics go.

As my process moved along, I accepted the referral of a little girl who was said to be 5 1/2.  I was reminded by my agency multiple times that she would probably be older but it was hard to know for sure.  Her paperwork said that she'd been relinquished by her grandfather because he was elderly and unable to care for her any longer.  It said that her father was unknown and her mother died when she was one.  

Between referral and court, I was able to send over additional questions for the orphanage staff.  I asked about her mother and was told that she did not seem to be aware that her mother was dead.  

Time passed and we passed court and I traveled to Ethiopia to meet my new daughter.  During our time in Ethiopia, she told me repeatedly that she was 7.  She didn't know her birthday but she was adamant that she was 7.  

We traveled back to the US and started to build our lives together.  Her English got better and better.  We talked about her age and went back and forth as to whether she was 5, 6, or 7.  She continued to maintain that she was 7.  She also started talking a lot about her family in Ethiopia.  She talked about her mom as if she were still alive.

I asked probing questions over time, trying to figure out the story about her mom.  I never could.  Finally, one day I asked her directly, "you know how your adoption paperwork says you were 5 and a half and you said you were 7?  Well, it also said you mom is dead."  She immediately replied, "my mom's not dead."  Okay.

Soon after, I hired a private searcher to investigate my daughter's story.  It took the searcher a day to find her family, including her living mom.  Just one day...

Finding my daughter's family was like lifting a huge weight off my shoulders and off my daughter's shoulders.  I didn't realize how much she had been worrying that she'd been lied to, that maybe her mother really had died and no one had told her.  I had many questions answered by the searcher and more answered when I later traveled to meet my daughter's family.  From everything I've learned, I do not believe the agency I used was involved in falsifying my daughter's story.  I don't even think her first orphanage was involved.  I believe it came from her family, lying to relinquish her, and the local officials who took the story.  

While I don't blame my agency for the actual falsification of my daughter's paperwork, I do blame them for not investigating.  They knew my daughter "didn't seem to be aware that her mom was dead" and they did nothing about it.  It's not like the investigation would have been difficult since, with the paperwork I was given, it only took one day to find my daughter's family.

My daughter's story falls into what would be classified as benign corruption.  Still, it is corruption.  Without searching, my daughter would have completely lost her true story.  There is nothing that makes that okay for a child that has already lost everything else.

This story, once again, highlights the ways in which the entire Ethiopian adoption system not only passively allows corrupt and unethical practices, but actually facilitates these practices. Lack of family support by the government and NGOs will result in families that feel they have no other options than placing their child for adoption. And desperate families will do whatever it takes to make sure their children are okay. Can you blame them? Or the local government officials who see their plight, have no help to offer, and "go along" with the story to get the child help? Even though that "help" means the child is ripped from their birth family?

I believe there is a true need for children in Ethiopia who do not have families to be placed in families. I don't believe the current system assists these children the way it should, because the system is overloaded with children who do have families- they just need a little help.

So, what can we do? I wish I had more answers. In the mean time, here are ways we can support family preservation in Ethiopia.

If you want to learn more about the range of unethical practices occuring in Ethiopian adoption, check out this new blog, which shares stories from families who have received placement of their children, and then discovered the truth about their story.

Wednesday, August 03, 2011

NBAM: My first time

When I found out I was expecting a baby, I knew I would breastfeed. I can't remember a time when I thought I would do otherwise. My Bradley method classes included a 3 hour breastfeeding class, as well as a review at the end of each class. There were videos and we even had a "guest speaker/guest breastfeeder." I felt prepared. I felt ready. I knew I could do it!

And then I had a baby.

And I was tired. And depressed (I had pretty bad PPD after Abigail's birth.) And I went on DepoProvera which made my post-partum bleeding endless (like, 12 weeks) so I was anemic and lethargic on top of it.

And I lived with my in out-laws (ex-laws) who were anti-breastfeeding and who thought that every time Abigail cried, it was because I was giving her the boob instead of the bottle.

Unlike many moms who have difficulty establishing a supply, my milk came in and I swear, I made enough to feed an army of babies! Poor Abigail couldn't keep up! The advice from the lactation Crazies consultants was to keep nursing, nurse more frequently, etc. I was nursing, literally, every 30-45 minutes.

I dropped 60 pounds in 6 weeks, weighing 10 pounds LESS than my pre-pregnancy weight (hint: I was slightly underweight before I got pregnant, so this was really NOT a healthy weight for me.) I looked haggard, and I had horrible nipple damage despite using proper nursing technique... (Have I mentioned how thankful I am for my sister, Faith, who was a post-partum nurse and an invaluable source of information and support?)

Long story short, despite having a great supply and doing everything I was advised to do, breastfeeding just wasn't working for us. I was unhealthy, and my little girl was not happy, healthy, or gaining weight.

And then, my friend told me about Babywise. And I put my baby on a schedule (which was hard!) And suddenly, breastfeeding started working.

My nipples healed, and I gained back a little weight. I looked and felt healthier and more energetic, and my post-partum bleeding stopped. Abigail became less fussy and started gaining weight like it was going out of style (she ended up tripling her birth weight by 6 months, and quadrupling it by a year- the "norm" is double by 6 and triple by a year.)

I ended up breastfeeding exclusively (with the exception of starting solid foods) until Abigail was a year old. We weaned completely at 18 months. Breastfeeding was such a soothing, relaxing, connected time for us, especially in the midst of going through my separation from Abigail's bio dad, returning to work/starting day care, etc. I was so happy I had stuck with it.

This experience taught me many things, but most importantly, what I learned about breastfeeding is that you have to find what works for you and your baby. What works for your sister or best friend or the author of the book you read may not be right for you. And that's okay. Every baby and every mom are different, and your baby's health and your health (including your mental health!) are most important.

A close second in importance is this: there are lactation consultants, and there are lactation crazies. Find a helpful, supportive lactation consultant who is willing to work with you and your baby, your individual personalities and needs, and help you find solutions to the issues you are facing. My experience was so horrible in the beginning, partially because the lactation crazies were just giving me the "feed her more" advice that they give basically all other moms, and didn't try to brainstorm to help me figure out how to meet the specific needs that Abigail and I had.

I'm so glad I learned these lessons, as they came in so handy with my next breastfeeding experience.

Monday, August 01, 2011

National Breastfeeding Awareness Month

August is National Breastfeeding Awareness Month... did you know?!

Let me begin by saying that the choice of breast vs. bottle is a very personal choice, and while I feel very strongly about breastfeeding, I hope I never isolate someone based on their choices about how they feed their baby. Advocating for breastfeeding is never about condemning the choice not to breastfeed.

That said, I want to put up a few posts about breastfeeding during the course of this month. To start at the very beginning, I think it's good to know the facts about breastfeeding. Some of them, I didn't even know, so here's a review:

  • Breastfeeding can lower mom's risk of breast and ovarian cancer, postpartum depression, and type 2 diabetes
  • Breastfed babies are less likely to be sick, and have fewer "sick days"
  • Breastfed babies have a lower risk for many illnesses and diseases than formula-fed babies, including asthma, obesity, type 1 (juvenile) and 2 diabetes, childhood leukemia, lower respiratory infections, and SIDS
  • Breastfed babies are protected in environmental disasters when water supplies are not safe
  • Breastfeeding benefits the environment by eliminating the waste of bottles, formula containers, etc.
  • Source (check out all the great info there!)

I want to share my breastfeeding experiences (and goals for #4) in an upcoming post, as well as some resources that I have found to be helpful. I might even address that big, controversial topic: breastfeeding in public!

But I would love to hear from you. What do you find to be the biggest roadblocks to breastfeeding? What do you love most about breastfeeding? What is one thing you want people to know about breastfeeding?
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