Tuesday, August 23, 2011

Breastfeeding and Sleeping

Big topics! Topics that I've been reluctant to talk about because there are so many different approaches and the issue is so personal. I've been afraid to share our approach because I don't want to be judged for it, nor do I want anyone to feel judged for their approach, simply because it's different from our approach.


But with parenting (and wedding planning and life), I personally believe that the best we can do is expose ourselves to lots of different options and then pick the ones that resonate with us. Once we make our choice and implement it, then we should continuously collect information about how it's going and make adjustments as necessary. In my teaching life, I call it Assess-->Analyze-->Act because I like alliteration.

So, here it goes. Here's our approach to eating and sleeping at our house with our little boy, Henry Jones.

But, first, a few caveats:
  1. There are a lot of different kinds of babies. We only have one baby, so we do what works for him. I have no idea how our approach will be similar or different if we have another child.
  2. I personally believe that it's important to balance the baby's needs with the family's needs. Yes, it's important for the family to recognize that babies are very needy and we need to sacrifice a lot of our wants in order to take care of them properly, but I don't believe we can compromise our needs entirely. If the parents aren't healthy, then it's going to be much, much harder for the baby to be healthy. I believe that the family is a system and you have to keep the various elements working optimally in order for the whole system to be healthy.
  3. I am--to my very core--a planner. Most of the time, I don't consider it a neurosis (but maybe I'm delusional?); I consider it my temperament, my preferred way to live, my hobby. So of course my approach reflects who I am.
  4. At the end of the day, the best measure of any approach is the baby and the overall health of your family. I think our approach works for us because a) Henry is healthy b) Henry is happy (unless he's hungry or tired) and c) we're doing well as a family, despite the incredible stress that Henry has introduced into our lives (I say "I think" because we have no idea how Henry will turn out in the long-run).

Okay, I'm finally ready to talk about our approach (I just want to state again, for the record, that our approach is not a judgement of your approach. We're just doing what feels right for us).

So, when Henry was born, our midwife encouraged me to breastfeed Henry right away. If he had been born at home like we planned, I would have breastfed him on and off for something like two to three hours while the placenta finished delivering blood to Henry. As it happened, the back-up physician at the hospital clamped and cut Henry's cord right away, the nurse took him to the warming station, and then we got to bond and breast feed.

After that, my midwife encouraged me to feed him whenever he wanted for the first two weeks, so that my milk supply would get well established. At that time, Henry was essentially only eating and sleeping. He would wake up, I would feed him, and he would fall back asleep. If he would start to fall asleep at the breast, I would touch his cheek or rub his back to encourage him to finish eating. My nipples were too sore for him to just hang out there, and I tried to soothe and comfort him in other ways.

For the first three weeks, I was still in healing mode, so I spent a lot of time on my bed. I would feed Henry there and he would sleep there. Since I didn't want him to stop breathing, I pretty much sat next to him through every nap. We shared our bed with Henry at night, too. He would root around my breast frequently in the night, but I would wait for him to let out a little cry before I would feed him. I have definitely read books that say crying is a late sign of hunger, but when I tried to respond to just his rooting, he would often be back asleep before I could even turn the bedside lamp on.

If Henry wouldn't go back to sleep in the middle of the night after a feeding, Matt or I would have to carry him around in the Moby or the Ergo with Infant Insert to get him back to sleep. And when he was asleep, it was a nightmare trying to transition him from the carrier to the bed without waking him up. Ugh!

After three weeks of healing, I was ready to get out and connect with other mamas. My first visit was to see a friend from my prenatal yoga class. She welcomed her second baby into her home two months before Henry, and she recommended that I read Baby Wise to learn about creating a rhythm to the day. At the time, I did not know that Baby Wise was extremely controversial or that it had been linked to "failure to thrive." I just knew that it was an approach that was recommended by my good friend. I borrowed the book and read the chapter called "Establishing Your Baby's Routine."

The chapter really resonated with me. It explained that the first week to ten days of your baby's life, you feed your baby whenever s/he wants but you try to ensure that they baby gets a full meal instead of just snacking. If you do that, it is highly likely that they baby will transition into a rhythm of needing the eat every 2.5 to 3 hours.

Without knowing it (by following my midwife's advice and my own desire not to have a baby sucking on my breast for soothing rather than nourishment), I had been following the author's advice, and he was right in Henry's case. Henry was on a pretty predictable rhythm of wanting to eat every 2.5-3 hours.

The author also recommended a simple rhythm of eating, playing, and then sleeping. When Henry woke up from a nap, I would feed him (which took a loooonnnng time!) and then he would have awake-time until he started to exhibit the signs of sleepiness.

At the time, I was reading another book (Healthy Sleep Habits, Healthy Child, which was recommended to me by another dear friend). The author of that book explains that young babies usually become tired within one to two hours of wakefulness (which includes the time they spent breastfeeding). I also read (I think in the Baby Whisperer book) to watch for yawns. By the third yawn, it was time to put the baby to sleep.

For the first three months, Henry pretty much only sleep in the Moby, strapped to our chests. Although we were worried about creating bad habits and we are eager to help Henry cultivate his independence, there really wasn't anything we could do. If we tried to move him out of the Moby, he would wake up and cry himself back awake.

So at first, we would walk Henry in the Moby to put him asleep, which wasn't too bad. If we wanted to go out to eat, for example, I would feed Henry, we would drive in the car during his awake time, and then Matt would walk him around to get him to fall asleep while I would read in the car (since my midwife advised me not to walk until my bleeding stopped). Then we could go into the restaurant and have a glorious, peaceful meal.

If Henry started to stir before the 2.5 to 3-hour mark, we would try to soothe him back to sleep because our working hypothesis would be that he still needed to sleep. The vast majority of times, he would fall right back asleep. If he didn't, then we would feed him early, since he was clearly hungry.

I feel like the author of Baby Wise gets unfairly criticized by parents who "feed on demand." Yes, the author does argue that most young babies need to eat every 2.5-3 hours, but he clearly says, "The first rule of feeding states: Whenever your baby shows signs of hunger, feed her!" He agrees there are times when a baby will need to eat sooner than 2.5 hours.

What this meant for us was that Henry was on a very predictable rhythm: I would feed him, he would have awake time, he would exhibit signs of drowsiness, I would put him to sleep in a carrier. Around four weeks, we introduced the use of a pacifier because I was still bleeding and I couldn't walk him around to put him to sleep. With the pacifier, I could just swing him to sleep on the front porch swing. Then, eventually, I could just sit and type on my computer while he fell asleep. It was very easy to read his cues and respond accordingly with this rhythm in my mind. If he was playing for a while and started to get fussy, I didn't try to feed him because my first hypothesis was that he was getting tired. In this way, I feel like we had a hybrid approach. We did feed him "on demand," but only when the issue truly seemed like hunger. I didn't feed him if he was just tired or needed a diaper change (although feeding him would have stopped his crying, even in those cases).

We repeated the cycle all day long. He would even nap around 9:30pm, as part of the cycle! At night, around 10:30, I would feed Henry and he would fall asleep instead of having awake time. That's how we knew it was time to go to bed.

When we went in for our 2-month appointment with the pediatrician, he explained that Henry should be going approximately 3-4 hours between feedings (which lined up with what Baby Wise recommended for that age) and that he should go approximately six hours at night without eating. When Henry woke up in the night before six hours had passed, our first response was to give him the pacifier. Most of the time, that strategy worked. If Henry persisted in crying, then I fed him. Again, our strategy was always, "Let's try other things first; if those don't work, then we'll feed him."

We read in one of the books that "sleep begets sleep." The idea runs counter to intuition. Everyone always says, "Keep the baby up a lot, so s/he'll sleep at night!" But we agree with the book that the more rested the baby is, the easier it is for him/her to fall asleep when they're tired. If they're over-tired, they can be extremely ornery and difficult to soothe.

At some point, Henry stopped developing according to the Baby Wise plan. He simply wasn't sleeping through the night the way the book said he would. So we just kept doing what we were doing and stopped following the book. We moved his bedtime to an earlier feeding when he seemed ready for it. At three months, Henry was ready to start taking naps on a flat surface. Since he still woke up before the full cycle had passed, I let him sleep on the bed while I worked on my computer. That way, I could easily soothe him right back to sleep.

At four months, the doctor said he should be going 8-10 hours without eating at night, so we put him to bed at 8pm and use the pacifier to soothe him if he wakes up before 4am.

At five months, I transitioned him to sleeping in his own floor bed for naps. He sometimes wakes up early, and I go in to help soothe him back to sleep.

At every stage, we always keep independence at the forefront of our minds. Even when we had to carry him around for every nap when he was in the "fourth trimester," we carefully watched for the opportune time to move him to sleeping by himself. Then when he was sleeping on our bed for naps, we watched for the opportune time to move him to his bed. We try to give him just as much support as he needs but not more.

So now, at almost six months, this is what our day generally looks like:
  • 7-8am = Wake up and feeding
  • 8:15-9:30ish = Play time, cuddling, or walk
  • 9:30-11:00 = Nap
  • 11:00-11:15 = Eat
  • 11:15-12:30 = Play or excursion
  • 12:30-2:00 = Nap
  • 2:00-2:15 = Eat
  • 2:15-3:30 = Play or excursion
  • 3:30-5:00 = Nap
  • 5:00-5:30 = Eating solids and then breast milk
  • 5:30-7:00 = Play (sometimes a short little nap)
  • 7:00-7:30 = Walk (because Henry is seriously too cranky to do anything else at this point)
  • 7:30-7:45 = Bath
  • 7:45-8:00 = Stories
  • 8:00 = Feeding and sleeping

Our schedule is always evolving, based on what Henry needs. When he turned four months, I went back to read Healthy Sleep Habits, Healthy Child (which, by the way, is much easier to understand once you hit the four-month mark). It recommended that he sleep at 9am, 1pm, and maybe once more in the afternoon. We tried that for a while, but Henry was just too tired. So now we're back to three, sometimes four, naps.

Also, Henry will no longer sleep in a carrier while we're sitting still. So no more peaceful restaurant meals! We either do take-out or invite our friends over after Henry has gone to bed or try to eat outside, since Henry is mesmerized by trees. I also try to be at home as often as possible when Henry needs to nap.

In other words, we've managed to find a rhythm that has provided us with some structure and predictability, while simultaneously adapting to meet Henry's needs.

Definitely let me know if you have any questions!

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Jessa Mc said...

I'm a mama-to-be in a big city (Chicago) and am curious about this idea of letting the placenta pump blood for longer than a few minutes after the baby is born. The plan for us is to go to a birthing center at a hospital (great midwife/md integration program here, best in the state) and they wouldn't 'let' me sit there with the placenta for a couple hours because of risk of infection. Is this something that can only be done in a home birth? Trying to find good info on it and I'm not having much luck.

Love your blogs, been following you since the 2000 wedding and this one is just perfect for where I am in my life, so thank you for posting and hosting such a great blog ;-)

My partner was raised Montessori and I was raised Waldorf so hopefully that informs our own parenting with our daughter due to arrive in November. Thanks for all the Montessori links too, because I am teaching myself more about it while doing the other million things to prep for baby.


Carrie said...

Great job, Sara! Sounds like you've discovered what YOUR baby needs. :) I like the Healthy Sleep Habits book. The part that really resonated with me was finding that sweet spot when the baby is tired but not yet over-tired. That bit of advice also works for 2 1/2 year olds, too, by the way--they have an uncanny way of appearing "not tired," then the next minute all hell breaks loose! Enjoy that little guy. :-)

Michele said...

Henry is thriving and kudos to you for figuring out what works for him and for the entire family. With my first (who followed no path in any book) I found myself believing for several months that I had to be doing something wrong (or everything wrong actually...) because she didn't sleep or eat at all like any book I read said that she should. At about three months I looked at her, decided she was an exceedingly healthy baby and got rid of every last book. From then on I was remarkably happier and healthier. I so wish that in those early months I trusted that my own instincts were good. Of course, as Carrie mentions, its an ongoing process and sometimes I have to relearn that lesson even with a 5 and 3 year old.

Sara E. Cotner said...

Hi, Jessa! All I know is that my midwife thinks it's very important to let the placenta stay attached for an extended period of time, so she recommends this for all her home births. I have no idea what is allowed in birthing centers. Sorry I can't be more informative!

Kelsey said...

Thank you for sharing! I think your approach sounds very balanced and healthy: for Henry, for you, and for your family. I will (one day) take a very similar approach of doing lots of research and then tailoring that to fit our life and baby.

Julie said...

Thank you, thank you! As an AMI Primary teacher, and a strick routine follower (or leader, I suppose) for my soon to be one year old, I have felt many an internal battle for the 'right' path. But, as with you, independence has always been my guide. All in all, we have a usually happy, well slept baby and mom around these parts!

Anchor's Aweigh! said...

thanks for posting an honest review of the Babywise Book. I have read the book and plan to use it with my newborn, once he makes his exit. like you said, parts of it make complete sense and its about finding your own rhythm with your child.
common sense begets common sense sometimes.
ps: i love the montesorri items you have been posting. our babys room is more traditional for we had purchased a crib, etc prior to becoming aware of the montessori methods, but i plan to incorporate them as time goes one....

Gretchen said...

How does sharing your bed with Henry work? I've read several bloggers saying that they're doing that, but I can't understand how it works. I would be worried I would smoosh my baby!

liezl said...

Lovely photo of Henry! SO ridiculously cute!!

Sara E. Cotner said...

Hi, Gretchen! When I shared my bed with Henry, I would lie on my back and he would basically sleep in my armpit with my arm either straight out or hooked around him. Does that makes sense? Henry was constantly rooting around or moving a little, so I don't feel like I was ever fully asleep. Therefore, I wasn't really at risk for squishing him.

Meghan said...

What kind of pacifier did Henry use? My son will be six weeks old tomorrow and we can't get him to take a pacifier. (It's too painful for me to continue to be a human pacifier!)

Sara E. Cotner said...

Hi, Meghan! Henry used the one they gave him at the hospital. It was called a Soothie (you can order them on Amazon). Sadly, not all babies like pacifiers! If I were you, I would by a ton of different options to see if your baby has a preference for one.

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