CHILD-LED WEANING - What is it and why do it?

Child-led weaning, by it’s very definition describes a mother/child dyad who discontinue the breastfeeding relationship when and how they feel most comfortable to do so. These days it is an extremely rare event and while many mothers and babies love their breastfeeding pairing, they don’t realise that the benefits to both continue long after solid foods are introduced around the middle of the first year. For some, it is also a worry about be “found out” and having to listen to the opinions of others.

Sometimes, when our babies are still quite small we envision child-led weaning will mean that our 4 year olds are going to be dragging us to the bench in the mall for a quick “nurse.” Generally speaking, and of course I am speaking in HUGE generalizations here because each family is unique, children over the age of about 18 months-2 years understand that there need to be limits on when they can have time with mommy to sit down and breastfeed.

Some mothers love the idea of continuing to meet their child’s needs by breastfeeding past infancy yet worry about the stigma associated with it. One of the best parts of the evolution of this relationship with your child is their growing maturity and comprehension about what is and is not acceptable with regard to people outside of your immediate family or friends.

You may find it most helpful to come up with a “code word” that your child can use to let you know that they feel they need your private and undivided attention. My youngest signed a grossly modified version of the ASL sign for milk. People around us thought he was waving good-bye and I knew that he felt he needed some time with me to re-group. He was also the kind of child who was happiest in smaller groups of people and so when we took him into situations where there was more of a crowd than he was comfortable with, he was able to ground himself by having a quick nurse in the sling.

By 15 months my eldest figured out that he could “nurse” with mommy when she was there and not when she wasn’t. Daddy could soothe him in the sling and snuggle him for naps but if mommy was at work he never once asked to breastfeed. It was certainly my fear that my poor partner wouldn’t have a way to comfort our baby while I was at work but the fear was absolutely one sided.

Continuing to breastfeed when you return to paid work often smoothes the transition for mommy AND for baby. Time set aside where you have to focus on your child and sit with him/her before you leave in the morning and upon returning in the evening becomes something that the two of you both look forward to. Not to mention the breastmilk will continue to be robust with antibodies to whatever illnesses your child may pick up in the group setting of a childcare environment. This will mean she or he feels well more often than not and you will miss less time from work once you return.

One of the most important things to remember, physiologically, is that you always, regardless of age, want your baby/child to latch properly. This is probably the most common call I get about extended breastfeeding. Moms call me to talk about their babies who are 1-2 years old who are hurting their nipples/areolas/breasts more than they had when they were infants. Remember to keep the baby in tight, head tipped back, no nose on the breast, and that the nipple should be level with or just above the top lip. This is especially important as your child teethes because the rubbing of the breast tissue over the tender gums can feel soothing to baby, not to mommy.

A quick and easy tool/trick to use when you have a teething child/toddler is to take a normal (not baby) face cloth and fold it in four. Now dip the common corner (essentially the middle of the cloth when it is unfolded) into cold water and wring it out well. Leave the majority of the cloth dry and put it all in the freezer. Once frozen it makes a GREAT teether that has warm/dry parts that are easier for your baby to hang onto. Babies often dislike traditional teethers for two reasons. One, they are too cold to hang onto and two, because they are smooth (even the plastic ones with nubs are too smooth) so they aren't able to stimulate the gums the way they want to.

At the end of the day, children who are weaning according to their own schedule are allowed to be told “no.” You are allowed to set boundaries and that doesn’t mean that you are not meeting the basic needs of your nursing toddler. It means that you are modelling respect for yourself by taking time to put your needs first when necessary and explaining to your child why this has to happen. Don’t go “cold turkey” on them. Explain the situation and ask them to help you set a time in the near future when it would be more appropriate for you to sit down with them and reconnect through breastfeeding.

Some of you may find the decision to continue breastfeeding your toddler and child makes itself when you learn about some of the risks to moms and babies when we wean too early.

Risks to baby when mom does not breastfeed beyond six months include:
• Increased risk of developing Chron’s Disese, Ulcerative Colitis, insulin-dependent Diabetes, Heart Disease, and obesity
• Increased severity of childhood illnesses including colds, influenza and more
• Increased risk of severe allergies to foods and the environment

Risks to mom when breastfeeding does not continue past the first six months:
• Increased risk of degenerative bone disease in the form of Osteoporosis
• Increased risk of female hormone-based cancers, i.e: breast cancer
• Increased risk of developing insulin-dependent Diabetes

Some additional resources:
BOOKS
Mothering Your Nursing Toddler. Norma Jane Baumgarner, 2002.
How Weaning Happens. Diane Bengson, 1999.
Adventures In Tandem Nursing: Breastfeeding During Pregnancy and Beyond. Peggy O’Mara, 2003.

WEBSITES
http://www.kellymom.com/bf/weaning/how_weaning_happens.html
http://www.kathydettwyler.org/detwean.html
http://www.myntoddler.com/
http://www.llli.org/NB/NBJanFeb04p4.html

**The picture at the top of this post is of my two children who led their own weaning process.**

Posted by Sam

A wee NIP in the park!!

Welcome, Carnival of Breastfeeding readers!

When @Blacktating asked her Twitter "tweeps" what we thought the June Breastfeeding Carnival should be about I admit that it was me who suggested focusing on the experiences of mothers Nursing In Public (NIP) and outdoors. It wasn't long before others had grabbed onto the idea (and perhaps there were others who offered it as their suggestion as well) and before we knew it the decision had been made to run with our idea and here we are.

Some of my VERY favourite memories involve breastfeeding my children outside. When my boys were wee I was especially grateful that they were spring babies. My parents had a wonderful little cottage on Georgian Bay and we spent MANY weekends sitting at the water's edge and relishing our good fortune at having this small sanctuary where we could celebrate the heat of summer, the cool of fresh water and the joy of time with family.

With friends always coming a going from our little piece of perfection I was delighted to be able to sit outside, feet playing in the soft sand (yes there are some sand beaches along Georgian Bay, just not many) and continue to visit while my baby breastfed, slept and snuggled in my arms. As Fergus grew and then Quinn joined our family I remember being thankful for the convenience of breastfeeding because I didn't have to worry about leaving Fergus at the water's edge while I went inside to prepare other food for his baby brother.

In fact nursing outside was something that I was often glad for when there were two boys in my family. Fergus' life didn't have to change with his little brother on the scene. Quinn slipped happily into the sling, leaving my hands free to play with Fergus and when Quinn needed to eat he would breastfeed in the sling.

We sat on many park benches and educated curious neighbourhood toddlers about the fabulousness of feeding a baby at the breast. I loved that children always seemed interested in what I was doing (especially since, even though my breasts are quite large, they couldn't really see anything "inappropriate") and came up to watch and to ask questions.

Last summer, just before I retired from my role as La Leche League Leader in my community, I chose to help three other moms work their way through the accreditation process. We sat chatting at a local park/splash pad and their toddlers ran free, coming back to their moms to nurse if they fell, felt lost or just needed a second to reconnect with their mom. It was so wonderful to watch the newer generation of LLL Leaders mothering their babies through breastfeeding and doing it, as I had done, where anyone and everyone could see them and could learn from their dedication.

Pictures of me nursing my babies are all on film and until I get my scanner set up in a way that I can use it that is where they will stay. I certainly wanted to be able to add a photo of a mom nursing in an outdoor setting to this post but I didn't have any. As luck would have it last weekend we were with friends so all of the boys/guys could go dirtbiking. While we were there my friend Ela had to breastfeed her son. I hadn't been planning to take this picture but I had Doug's camera with me so I asked if I could take advantage of this wonderful opportunity! This is Ela and Jr. and he is a healthy and robust 10 months!

Breastfeed . . . Anytime . . . Anywhere!

Other bloggers in this carnival:
Lucy and Ethel Have A Baby: The Adventures of Shrike & Whozat & Peeper
PhD In Parenting
Dirty Diaper Laundry
Kim Through The Looking Glass
Grudgemom: Learning To Be A Mom One Diaper At A Time
Mum Unplugged
Massachusetts Friends of Midwives
Mother Mary's Soapbox
Tiny Grass
Mommy News & Views Blog
Breastfeeding 1-2-3
Stork Stories . . . Birth & Breastfeeding
Chronicles of A Nursing Mom
Warm Hearts, Happy Family
Blacktating
Musings on mamahood
Motherwear's Breastfeeding Blog
Mama Knows Breast: Adventures In Breastfeeding
Tales of Life With A Girl On the Go
Breastfeeding Moms Unite
Never a Dull Moment ...
Breastfeeding Mums: Bumps, Birth, Babies & Breastfeeding
Hobo Mama

Vaginal Breech Birth? Can you do it?

With cautious (read: terrified) eyes a mother lingers in my classroom after her peers have filtered out. She watches as I take down posters and I wait for her to decide she feels safe enough to approach me with her question. The fear is rolling off her body and I am sure I know what she wants to talk about. Her question is one I have heard a hundred times before. And her anxiety is the same as every other expectant mother who has stood where she stands now.

She makes her way to me and timidly asks if I have a minute to speak with her about breech birth. Of course I do. Friends waiting to have coffee with me at the local Starbucks will happily wait a few more minutes when I explain that a mom hung around after class to have a few extra questions answered.

Caesarean birth is probably the single most frightening possibility facing expectant moms I meet. No one wants to have vacuum, forceps or episiotomy used at their births either but caesarean sections are the one procedure that leaves most moms-to-be feeling vulnerable and terrified.

These days we know that there are precious few moms who birth their breech babies vaginally. It is no wonder then that I am greeted with eyes brimming with tears and a voice that breaks when just uttering the word: breech.

Moms want to know if there is anything that can be done to encourage the baby to turn from a breech presentation before their scheduled caesarean birth date. Absolutely! And, in cases like mine, sometimes you can find skilled practitioners who, if other therapies are unsuccessful, are willing to turn the baby manually. This manual manipulation is called External Cephalic Version (ECV) and my youngest was lucky enough to subject me to the experience TWICE!

There are a significant number of opinions (and websites, ugh!) about ECV, it’s efficacy, the pain involved, risks to mom/baby, etc. I am lucky to have been birthing with midwives who have an excellent working relationship with ECV-skilled OBs and mine was absolutely painless. Wait to form YOUR OWN opinions about the procedure instead of reading other people’s horror stories!

Acupuncture with moxibustion may be all you need and perhaps regular appointments with a chiropractor using the Webster Technique will encourage baby to move into a head-down position. Many moms find success with homeopathic remedies, herbal supplements, physiologic position changes or something as simple as cold/hot packs used strategically on the belly. Suffice it to say, there are a considerable number of strategies around that have been successful over the years in helping babies find the optimal position in the pelvis for a vaginal birth.

What prompted me writing about this subject in the first place? The article in today’s Globe and Mail indicating that, FINALLY, the Society of Obstetrician and Gynaecologists of Canada recommend re-introducing teaching in medical school the skills necessary to catch vaginal breech birthed babies. The article starts off by letting readers know that current research actually indicates that “many women are safely able to vaginally deliver babies who enter the birth canal with the buttocks or feet first.” (Let’s not even discuss that a woman BIRTHS her baby, she doesn’t DELIVER it – that would be splitting hairs, right?)

As far as I know there is only one OB in the Toronto area who regularly attends vaginal breech births. He is skilled and he has people travel from all over the GTA to have him catch their baby so that they can reduce the likelihood of requiring a caesarean section. He will even attend moms who have never birthed a baby before. This, for those who are not aware, is extremely uncommon. Many of the moms who birthed their breech babies vaginally in the past were only able to do so because they had successfully had a vaginal birth previously and were therefore considered “capable” of passing a baby vaginally.

What have your breech experiences been? Anyone have a successful vaginal breech birth? Anyone try ECV? What about alternative therapies? How many have used pulsatilla successfully? Or an ironing board? Anyone? Your feedback is appreciated!!

Posted by Sam

To Epidural Or Not to Epidural, It's Not a Question

**IF YOU HAVE COME TO THIS ARTICLE THROUGH FACEBOOK PLEASE LEAVE ME A COMMENT TO LET ME KNOW WHAT OR WHO DIRECTED YOU HERE. I HAVE HAD MANY HITS FROM FACEBOOK RECENTLY AND I WOULD LIKE TO FIND OUT WHO IS SENDING YOU HERE! THANKS!**

Of course these posts seem to write themselves perfectly and eloquently when I am lying in bed at night, trying to go to sleep. Let me see now if I can conjure up the gist of the thoughts I had last night.

When it comes to labour, as I noted in my most recent post, it is essential for moms to be surrounded and feel supported by people who not only believe in her ability to birth a baby but also who will do and say what she needs them to in order to create HER safe birth environment. This basic element is necessary to have present in order to allow for the other coping strategies to shine in their effectiveness.

When I first started attending births, in 1998, I had a huge bag of “tricks” I brought with me each time. I carried tennis balls, massage tools, a rebozo, a rolling pin, hot/cold packs and more. This wasn’t including the change of clothes, toothbrush and deodorant I still have with me – although I usually leave them in the car. I brought the “tools” because that is what I was told I would need when I took my training to be a labour support provider.

As I attended more and more births I came to realize that the tools were handy in some, rare, cases but that most of the couples I was working with already had all we’d need. I needed, instead, to keep my calm voice, my understanding of how a woman’s body works and information about what is and is not typically normal. I needed to know my stuff but I didn’t need to have special physical skills.

It became quite apparent that couples were hiring me because of my experience and my intrinsic belief that they were capable of birthing their baby. Many of my past clients have come from the prenatal classes I have taught over the last ten years. That said, most of my clients have come back to have second and subsequent babies with me so something I did must have been right. By the end of a 6-week (or two day) prenatal class series couples know about my personality, the way I talk and how I perceive the birth process.

They also know what I think about epidurals. That is likely why 80% (+) of my past clients have birthed without medication in place. They wanted to know what their bodies could do and they knew that I had every faith in them.

Unmedicated birth isn’t always easy when there are people popping in to advise a labouring mom that “the anaesthetist is around just now and so do you want an epidural while s/he is here so that you don’t have to wait when you ask for one later?” (You would be amazed at how often this question is asked.) I have even been to one Toronto-area hospital where a client of mine was openly laughed at and mocked when, in triage, the nurse asked her when she was hoping to get the epidural. Mom replied that she hoped to avoid one. The response of this extremely unprofessional nurse was (and I quote): “Yeah. Okay. Good luck with that. It’s your first baby, isn’t it? Uh huh. Okay, well let me know when you change your mind.” (Yes, I took notes AND a name to reply to that one.)

When I teach classes I let the couples know some of the potential risks and benefits of having an epidural. These may include:

PROS
May offer pain relief
May offer mom the chance to rest
May be medically necessary
CONS
May not work the way mom wants
Mom will be unable to get up to urinate
Some moms complain of long-term back ache at the epidural site**
May slow labour
May drop mom’s blood pressure (an IV will be administered)
May increase the need for surgical interventions (i.e. vacuum, forceps, episiotomy and/or caesarean section)
Will increase the risk of tearing
May give mom a spinal headache
May affect the baby
May result in an allergic reaction to the narcotic (mom would need more medication)
Is cumulative (results in increasing physical disconnection the longer it is in place)
Limits options of positions for pushing in second stage labour

**An epidural leaves a scar on the back still visible many years after giving birth. Don’t let anyone tell you that an intrument capable of creating such a large scar isn’t also capable of causing long-term trauma to the back.

As often as not I see epidurals not offering moms the relief from discomfort during labour that they were hoping for. Usually it just changes location, moves to the hips, low back or pubic bone. Once it becomes localized like that, there isn’t anything mom can do other than have someone use counter-pressure in that spot to try to relieve some of the pain. The nerve endings are frozen from the medication and the body stops releasing the endorphins necessary to help moms cope.

It is also, usually, a fallacy that moms will get a chance to rest while they are medicated. Most moms are so wound up from labour and from the process of getting the epidural that they can’t sleep. Their partners can (and this usually furthers moms’ frustrations) but mom is rarely able to get much rest however, she has likely added considerable length to her labour so she will be more hours, overall, without adequate sleep.

Somehow movies, television and other people have managed to create this illiusion that getting an epidural is euphoric, painless, risk-less and necessary. Expectant women get the impression that they will be able to smile and file their nails (yes, I have seen this happening on more than one episode of the show on TLC in the afternoons) while they labour. It is implied that all pain and discomfort will totally vanish.

Did you know that, even with a regional block, you WILL feel considerable pressure in your bottom (often felt as pain) when the head of your baby is quite low? If you can’t feel it then something about your epidural is not the way it should be. You are supposed to feel the pressure so that you “know where to push.” (Not that you’ll be able to make that determination because there is a big void area between the top of your uterus – which you should feel – and the pelvic floor.) Many moms are not expecting the pain to come back (in any form) and are therefore taken by surprise when the pressure continues to build and they find themselves uncomfortable again. If they haven’t had a chance to rest then they have even fewer reserves to draw upon for coping.

Because of the increased risk of a mom requiring the use of a surgical intervention with her epidural she also increases the odds that the baby will need to be assessed by a respitory therapist, paediatrician or other neonatal specialist at the time of birth, decreasing the speed with which we can unite mom and baby, skin-to-skin, the way our babies require.

The potential delay in bringing baby skin-to-skin with mom after the birth has the potential to impact how soon a baby is able to breastfeed (and the mother’s feelings about being able to breastfeed) as well as resulting in the baby having higher cortisol levels (stress hormones) then their unmedicated peers.

It isn’t going to have an impact on my life what choices a labouring mom makes for herself, and by extension for her baby. I feel it needs to be said however, that it is imperative for a woman to make a truly informed decision about how she wishes to progress through the process and birth her baby. We, as a society, have made epidurals synonymous with giving birth and that creates unacceptable pressure on a labouring mom to try to “defy the medication odds.”

If a woman is going to ask for an epidural, obviously it is her choice. However, let me leave you with the thoughts of Dr. Christiane Northrup as she spoke about the use of “pain relief” in the 2008 movie, “Orgasmic Birth.” She said:

Epidurals cause you not to be able to feel your sensory nerves in your pelvis. Now think of it this way, the sensory nerves in your pelvis are the highway that your baby is traveling out on. What if you numbed your feet and then you were supposed to walk down a highway? You’d have difficulty walking down the highway. Let’s say your motor nerves work, your muscles work the motor nerves that move the feet. Without the sensory [nerves] if your feet are numb they don’t work the same way. So if your birth canal is numb [with an epidural] it doesn’t work the same [it is supposed to].

Posted by Sam

Peaceful, positive birth.

Peaceful, painless, fun, wonderful, empowering, calm, good for baby as well as for mom . . . the list goes on and on. I asked the couples in my prenatal class to tell me what words they would use to describe a dream birth experience for themselves and this is, in part, what they offered to me.

We spent some time talking about why achieving a great birth without trauma, fear, danger, risk, excruciating pain is more common and easy than many people think. And then we went on to discuss what these moms (and their partners) need in order to create such an experience.

Where does the fear and negative expectation come from? Well, I have written here before about the reality that many a-birth story is embellished for effect and that there isn’t any humour or “drama” in watching the way birth usually unfolds on the big or small screen. We have been programmed to believe that birth is horrifying and yet, once we find ourselves pregnant or decide we want to expand our family, there are very few options around it.

The primary means to find your way to positive and exceptional birth experience, from what I have witnessed over the last ten years of attending births, is to do what you need to do to eliminate or, at the very least, reduce your fears about the process. Most people have a considerable amount of faith in an immeasurable number of entities, processes, procedures and histories but what they lack is the fundamental, base belief that their body can birth a baby.

Caesarean rates, epidural numbers as well as the use of other invasive techniques and strategies visited upon expectant and labouring women is considerably higher than all of the “overseeing” medical communities recommend and yet we see no reduction in their use. If anything, we see their numbers continue to soar.

It can be difficult for a pregnant woman to believe her body is designed to bring forth life if those caring for her don’t even think it possible or likely. And let’s not forget that a considerable number of these care providers don’t know how to help mom have a straightforward, unmedicated, unencumbered birth experience.

I have yet to be in the room of a labouring woman to hear her obstetrician recommend that she get out of the bed, get up on her feet, lean forward with each contraction, sway her hips from side-to-side and relax. I am certain that there MUST be obstetricians who DO provide such care but I have not yet met them.

So, how do we reduce our fears about the process beyond finding care that supports us and acknowledges, “we can do this?” (Admittedly this is not an easy goal to achieve depending on the types of care offered in various areas, cost of said care and the overall practice structures set in place wherever we are birthing.)

Gather as much positive information about the birth process as you possibly can. Read books that support the reality that you can birth the way you truly want to birth. Some excellent examples of fabulous books include a newly revised Canadian beacon of birth hope: “Pregnancy and Birth: a Guide to Making Decisions That Are Right for You and Your Baby, 2nd Ed.” by Teresa Pitman and Joyce Barrett. Or seek out suggestions offered by Ann Douglas in: “The Mother of All Pregnancy Books,” another Canadian gem. More than that there are tonnes of resources available at Parentbooks – a wonderful bricks and mortar store in Toronto with a great on-line purchasing department.

Don’t forget your local library also. My biggest point here is that while virtually all of the most common books out there are negative in their approach, usually very subtly, there is a vast selection that focus on nothing more than helping you make your birth-day the very BEST day of your life.

Who you invite to your birth is another way to help you reduce your fears about the journey. Do not ask (or allow) your mother, mother-in-law, sister or best friend in with you if they can’t support you 100% and believe, unequivocally, in your ability to birth your baby. If you don’t feel you can be naked in front of them, swear while they are within earshot or moan without them trying to quiet you then they probably the best people to have at your side offering suggestions of ways to make the journey more pleasurable for you.

YES, I said pleasurable! There are an immeasurable number of women who have actually loved giving birth to their babies. I am one of them. I LOVED feeling my son slip from my body. I LOVED the power I felt about my body being able to carry a child and then physically manoeuvre him through my bone structures to ready him for life on the outside of my body.

This post isn’t about coping through labour. That comes next. This is simply a reminder that you can do this and that you need to believe that you can. Whatever you need to do to create the environment around yourself which actually allows you to BELIEVE you can do it is how you need to begin. Strategies come after that.

I hope to have time this weekend to write up a post about the use of epidurals (usually a potentially dangerous or sabotaging way to labour although necessary from time to rare time) and some thoughts presented by Dr. Christiane Northrup, M.D. on the way medications will impede the ability of a mother to birth her baby. These thoughts are voiced by Dr. Northrup in the 2008 movie: “Orgasmic Birth.” If you haven’t watched this empowering movie, then what are you waiting for. You need to see it!

Posted by Sam