Life after....

photo by wellcome images

Now that Eden is four months old, I figured it was time for a post on the subject that originally launched this blog: natural family planning, or life after birth control.

Coincidentally, I'm currently taking a women's health class (basically, gynecology) in midwifery school right now and am delighted to report that one of our main textbooks, Contraceptive Technology (19th ed.), is far from the dry, medical, and, well, technology-focused tome it might initially appear to be. Instead, it's engagingly written and easy to read, and a book I would recommend for anyone who is or might someday be in the position of considering contraception of some kind. (Which is to say, just about everybody.) The thing that surprised me the most about this book was its unabashed cheerleading for breastfeeding and its respect for natural methods of birth control, such as fertility awareness-based methods, withdrawal (almost as effective as condoms when used correctly--who knew?!), and lactational amenorrhea method (LAM).

While just about any maternity discharge teaching I've ever seen has included the phrase "you CAN get pregnant right after you have a baby, even if you are breastfeeding," and we're all familiar with the argument that pre-ejaculate contains 'millions of sperm,' " along with the joke about couples who use rhythm-based methods (what do you call them? Parents!), this book deconstructs those myths and gives success-rate statistics for all of them. In fact, pregnancy is highly unlikely for the first six months of exclusive breastfeeding (however, you have to understand and practice what is really considered exclusive breastfeeding), pre-ejaculate does not contain sperm, and fertility-based awareness methods are highly effective when practiced correctly. Here are the statistics on these three methods, all of whom share the advantages of being safe, completely free, and relatively effective:



(from Contraceptive Technology, 19th ed., Hatcher et al.) Except for LAM, this information is available from the authors here.

When it comes to breastfeeding, it's generally understood that breastfeeding slows the return of a woman's menstrual periods and therefore suppresses her fertility for a time. This occurs because the hormone prolactin is released during suckling, and prolactin suppresses hormones needed to induce ovulation. This effect has recently been quantified by the lactational amenorrhea method, which consists of the following three questions:

1) Is your baby less than six months old?
2) Is your baby exclusively or very nearly exclusively breastfeeding? (Generally, this means feeding on demand, day and night, no more than 4 hours between feedings during the day and 6 hours at night, with no or very little supplemental substances given.)
3) Are you amenorrheic (no periods since the birth of your baby--or, more specifically, no bleeding after 56 days postpartum)?

If you can answer "yes" to all three questions, your risk of pregnancy is considered to be less than 1%--equal to perfect use of highly effective methods such as the pill, and in fact better than rates of typical use (since you can forget to take a pill much more easily than you can forget to breastfeed your baby).

Here is a good source of information on LAM.

What about when you don't quite meet those criteria, though? Having a four-month-old, I can tell you that those six months after the birth of your baby are going to fly by.

Then what?

Also, what about breastpumping? Can you use lactational amenorrhea if you are pumping? Most sources are very clear that only "very little" supplementation (ie formula or solid foods) are acceptable for maintaining LAM. What if your baby receives no supplementation, but is occasionally or regularly given your breastmilk in a bottle (or spoon, or cup)?

And what if your baby sometimes sleeps through the night?

Obviously the waters get a little bit murkier. It's all well and good for statistical purposes to set rules like the above, but very few of us will meet those criteria for very long. Does that mean we should give up the idea and, perhaps unnecessarily, choose another method?

Pumping is an area most sources don't address directly, and some decry altogether, but it appears as though pumping full-time only drops the success rate of the methods from 98-99% effective to 94-96% effective. Hello! That's still a lot better than typical use of most contraceptives, it's still free, and it gives considerably more leeway to those of us who are pumping some, but not full-time. Personally, I think this is the information to present to women, rather than "No, it doesn't work." If I chose to go it on nothing but LAM, and were pumping all or some of the time--I would be aware that fertility might return sooner, but if I was still feeding breastmilk exclusively and still amenorrheic, I'd be willing to chance it (with some additional precautions--see below).

As someone who works part-time (probably pumping for 6-8 feedings a week) and whose baby sometimes sleeps through the night, whose baby is rapidly approaching the 6-month mark and who has successfully used natural family planning in the past, it seems like combining the methods would be a useful way to extend lactational infertility for the duration of its natural course. As a result, I monitor fertility signals (mainly cervical fluid--though I'm trying to get back in the saddle with basal body temperature (BBT) measurements too) even though I'm still amenorrheic (I find the "65 days postpartum" rule a helpful cutoff since I experienced postpartum lochia for ~6 weeks following birth, a dry spell of about a week, and then a couple more days of spotting--but have been amenorrheic ever since).

In the past month or so, I've had the odd isolated day of stretchy mucus here and there, helpfully pointed out to me by practicing NFP. On those days, we either abstain, or... use the newly-exonerated withdrawal method.

So far, it's a system that has worked well for us. I would love to see studies done on the triangulation of these three methods because I have a hunch that they would be pretty solidly effective, especially in women who are breastfeeding up to a year or two or even three--particularly since these women are likely to be the type who would be interested in safe, natural, and effective birth control which doesn't affect one's milk supply. I also enjoy the liberation of a method that is completely within our control, which involves bodily awareness and cooperation, and which capitalizes on practices that were already important to use anyway. The addition of withdrawal is also a handy one for new parents, who will inevitably find that their "safe days" with NFP don't coincide with the days that the baby falls asleep on time! I should point out that some NFP methods allow using a barrier method OR abstinence on fertile days , others are very fervent about the point that if you choose to use a "backup" method on days you are known or suspected to be fertile, you are not practicing natural family planning. You are relying on the success (or failure) rate of the method you are using (be it condoms or withdrawal or a diaphragm or whatever), making it anything but a backup since you are using it precisely when you are most likely to become pregnant. Meaning that you are looking at the 4-27% rate (depending on how perfect your use is) of withdrawal, not the high rates of success boasted by perfectly-practiced (meaning periodically abstinent) NFP. Clearly, this may not be a method for couples who would not want to risk a pregnancy for whatever reason; however, being as we know that we want more children and have preferences but not absolute contraindications as to when, it works well for us.

The book Breastfeeding and Natural Child Spacing is an excellent one about what the author calls "ecological breastfeeding," which includes on-demand and through the night but also the concepts of babywearing, near-constant togetherness, and cosleeping as important, the proximity of the baby contributing to hormonal changes which suppress fertility as well. However, she's very strict on these matters, moreso than modern life unfortunately permits for most of us, so I am happy to see statistics on LAM alone that show a high efficacy even when these activities--though definitely a part of our lives-- are not completely constant.

Elimination Communication: How it's going

In a word: well. In three words: Incredibly, surprisingly well. While I had lapsed for a week or so after I wrote the last post, diving into Diaper Free: The Gentle Wisdom of Natural Infant Hygiene by Ingrid Bauer proved to be just the inspiration I needed to get back into it. And while it took us a little while to get reattuned to Eden's signals, I'm happy to report that it's going really well now.

Per Bauer's book, we picked up a Baby Bjorn infant potty for less than $10 on Amazon and we LOVE it. While we occasionally still use the toilet or even a sink depending on what's handy, this sturdy, ergonomically-shaped little potty can travel room to room with us, and it's also good to give Eden a consistent place to go. However, we've even embraced wholeheartedly the idea of pottying her while out and about. Previously we'd only been EC'ing at home, but recently we've taken her to potty when it was convenient (the ladies' room at a restaurant, a friend's bathroom, the great outdoors while we were out for a walk) and it had gone so well that I wondered why we hadn't been doing it all along. After all, grownups go to the bathroom when they're out and about without resorting to crapping in their pants--why should it be any different for babies?

What I do is put Eden on the potty and cue her to go just before we leave the house. Then, if she's showing any signs of fussiness before or when we get to our first destination, I put her on her "travel bowl". I also put her on when we come out of a store or if I nurse her while we're out. While it might sound like a lot of trouble, pulling down her pants and putting her on a bowl is actually less trouble to me than listening to her fuss when she has to go, cry hysterically when she's wet, and attempt to change her wet or dirty diaper in her carseat while she's frantically wiggling--not to mention then taking care of the dirty diaper.

While she occasionally wears a diaper during her fussy time in the evenings or on a long outing, for the most part, she's wearing these 2T training pants (a little baggy, but comfy and absorbent). For clothing, dresses were an easy option in the summer, and her sleep sacks are nice at night (though she hasn't gone at night since she was about a month old, but they're good for those early-morning piddles), but pants are a good easy-up-and-down option too, especially now that the weather is cooler. Some sleepers have snaps that allow strategic access; some don't unsnap in a helpful location, and some have zippers (which require getting her totally undressed to go to the bathroom--fairly impractical). So pants and undies are what she wears most of the time. When we're outside on a walk or coming and going from somewhere, it's incredibly easy to squat down with her, slide her pants down a little, and pee her in the grass. Probably not an option during a cold midwestern winter, though!

So how do we know when she needs to go? Timing is one way: we always put her on the potty and make her "psssss" cueing noise when she first wakes up and right after she eats. I've found that if I have her in a carrier during a nap and pay attention to when she first starts to seem restless, I can often potty her without completely waking her up, and she'll return to sleep and sleep another 30 minutes or so. This wasn't the case with diapers, when she would wake up wet, angry, and have to be changed and wiped (and thus fully awakened). We also pay attention to when she seems distressed, wiggly, or even just distracted--she'll be playing with toys or breastfeeding and suddenly get a faraway look in her eyes, and generally it means she needs to go potty. Sometimes it's just been awhile and it seems like she might need to go. And every once in awhile, as I'd read but not quite believed in various accounts of EC--I just "know" she needs to go. Finally, in addition to the obvious timing of peeing when she wakes up or eats, she has her own patterns that I've come to know. She seems to have a few distinct "wringing out" periods during the day when she'll go as often as every 20 minutes. One occurs around 11am, another sometime between 2:30 and 5, and another shortly before she goes to bed. We try to be especially conscientious about watching her signals and just frequently putting her on the potty during those times. As a result, the rest of the day tends to be pretty predictably dry, so we often take her on walks or even short trips without needing a diaper bag!

At home, we average about 1-3 "misses" per day. These might be times when I don't get a clear signal from her, or times when I miss it because I'm distracted (I've gotten peed on a number of times while talking on the phone or watching a movie. Once, even, while writing this post). She's even pottied when friends of ours are watching her. There are also times when our signals are fine but we end up with a wet lap or bed because we spill the potty or don't get her on at the right angle. However--I'll take my accidents when her pee and poop are totally benign, versus when she's two or three and eating solid foods!

Home girl

Matt and I recently made the decision to try to keep Eden as close to home as much as possible. While we've always been big fans of long country drives, Eden decidedly is not. When she was a newborn, she'd sleep peacefully in her carseat, but that time is no more. She's been growing progressively more agitated in her carseat for the past several weeks, and after a car trip out to Shenandoah during which she screamed at an ear-splitting volume for over an hour, we've decided it's in everybody's best interest to limit ourselves to things within walking distance as much as possible.

And that's really fine with us. We like to be at home and we knew that having a baby was going to change things. The big difference is that where we previously ran all of our errands together, now one of us will likely end up staying home with Eden. But it's probably best for her health anyway, and we know it's best for her comfort. And we know it won't last forever.

I'm pleased to announce

...the ringing in of a new era.

Ladies and gentlemen, for the first time in six months...my rings fit again!

Stuff we love: Rescue Sleep Remedy

I'll be the first one to admit that the philosophy behind the Bach Flower Essences sounds pretty wacky to me. Unnamed substances distilled from flowers used to balance complex emotional problems? Kind of farfetched even for people like us. But when we tried them ourselves about a year ago, we were particularly pleased with the results of Rescue Sleep, which we found calming and sleep-enhancing.

So it's only natural (at least for us) that when we found ourselves with a restless, fussy baby, we gave a couple of squirts to her. It stopped her crying, anyway, as she tasted it with a funny and amazed look on her face. It didn't knock her flat out or anything, but within minutes, she was calmer, and then--asleep. Over the past few months, we've repeated the process a number of times a week and always been really impressed with the results. Even with her teething pain, we've actually found it to be more effective in calming her down than Hyland's Teething Tablets, a homeopathic remedy lots of parents rave about.

It could be the flower essences, or it could be the 27% alcohol solution they're preserved in (grape brandy, to be exact--and brandy is a time-honored remedy for teething babies). Either way, I'm not arguing with success. The bottle runs around $8-10 and lasted us over a year with occasional use; the next one will probably only last about half that long or less, since we're using it more often with Eden. Still, probably not much more expensive than something like Children's Tylenol, and we don't like the idea of giving our baby drugs unless absolutely necessary (and that stance finds more support every day). We get it at Whole Foods, but you can also order it online. Amazon has it for under $8 with free shipping! And right now, Mambo Sprouts is offering a $2 off coupon. Effective, natural, and a coupon to boot--what more do you need to know?

Krill oil: My cure for baby eczema

A number of weeks ago, to my dismay, Eden started developing rough, red patches of eczema on her arms and legs. Having struggled with various bouts of itchy scaly skin throughout my life, I had hoped she would be spared. Alas, she apparently was not. I rubbed coconut oil on it in vain--while it might have kept it a little softer, the angry pink outlines were still there.

It wasn't until a bottle of Omega-3 krill oil capsules arrived in the mail from my mom that I had an epiphany. I'd taken either fish oil or cod liver oil pills throughout the pregnancy, and had continued doing so since Eden was born. However, I get them through my mom, who is some kind of vitamin dealer, and I had run out and was waiting for her to send more. It wasn't until I started up again that I realized that the period during which I'd run out was exactly when Eden had developed her skin trouble. I hardly dared to hope that taking them again would rectify the problem, but it did! Within about a week after starting up again, her patches of eczema were all totally gone, and so far they haven't recurred. I'm convinced that was what did the trick, since it was the only thing about our diet and lifestyle that changed--both when she flared up and when it went away. Below you can see the difference:

The great thing about breastfeeding is that I don't have to try to figure out how to get her to take fish oil--just take it myself. But when she strikes out on her own, foodwise, you can bet that I'll be sure to figure out a way to do so.

Natural remedies for breastfeeding first aid

Michele at Frugal Granola has a great post up about how to create a natural Breastfeeding First Aid kit and her experiences with clogged milk ducts. I am crossing my fingers and feeling fortunate that I haven't had to deal with these yet, but based on the experiences of other nurses I work with (we don't exactly get predictable--or even regular--breaks sometimes), I know it's probably only a matter of time, and so I've bookmarked this excellent resource! I love Michele's blog because it lives up to its name: affordable, natural solutions to all kinds of issues in family life.