Breastfeeding fashion: What works for me

Since I'm planning to breastfeed Eden for a long time, probably into an overlap with our next baby, it was imperative to me that I find a breastfeeding wardrobe that was comfortable and efficient as soon as possible.

I started out wearing my maternity tops, since they were what fit best postpartum anyway. Even once the maternity shirts got put away, I continued to use these maternity/nursing tank tops from Walmart, which were cheap and surprisingly durable. (I bought one in white and one in black--mediums--and for size reference, I was 140lbs/B cup prior to pregnancy, 190lbs/D cup while pregnant.) While many commenters noted the annoyance of having the strap fly away after unsnapping it (vs more expensive nursing tanks, such as the ever-popular Bravado, which feature a strap which anchors everything nearby), I found them stretchy enough to just pull down for nursing, as opposed to having to actually unsnap them. I was also lucky enough to get a couple of Bravado tanks as hand-me-downs, and they are awesome--flattering, sturdy, stretchy. They're $45 a pop new (though you can often find them for less on eBay, Craigslist, etc). They do contain a very supportive internal bra (vs just a shelf bra on other tanks/camis, although I have found a shelf bra to be plenty, even at my new cup size), and so while $45 for a tank seems like a lot, if you use it like I do as the foundation to bridge your regular wardrobe into a nursing wardrobe, it might not be so bad.

As far as a nursing bra, I had ordered one of these from Walmart.com and wore it toward the end of my pregnancy. I found it supportive (if with somewhat unnecessarily wide straps--but it was comfortable) though some sort of hidden tag or something left the middle of my back itching like crazy, but that could have just been a fluke. Early on I decided a nursing bra was too much to fumble with, and since it was summer, I was largely wearing my tank tops and camisoles anyway, and so I started wearing those either alone or under another top, basically using them like a nursing bra. Worked like a charm and saved a ton of money!

A few weeks postpartum I invested in some nursing tops from Expressiva. We were taking Eden to church and other places where being able to breastfeed easily and somewhat discreetly was nice. While I can't speak highly enough about doing business with Expressiva, as they're great with returns and exchanges and ship quickly (and props to them for their organic line), I did find much of the clothing to be overly heavy (for many of the shirts, the "nursing option" is a whole second layer of cloth with boob cutouts) and actually somewhat more awkward than just pulling down a regular (V-neck or stretchy) shirt. (Especially if I was also wearing the nursing bra.) Getting the second layer to lie right without looking awkwardly bunchy (like I had a dishtowel under my shirt) , not to mention fishing through the hidden openings to try to hook and unhook a nursing bra with one hand, wasn't easy and usually wound up taking more effort and drawing more attention to myself than the simple maneuver I used with regular shirts. Unfortunately, as a result, I've largely quit wearing them and will probably go ahead and Craigslist them soon.

As noted above, I've now evolved into a system that is based around wearing either one of my hand-me-down Bravado tanks, maternity tanks, OR any reasonably stretchy camisole with a shelf or other built-in bra (I have a number of my sister's castoffs from American Eagle, Express, Target, Maurice's; you can also get them at Walmart.com--never thought I'd be their spokesperson!--for around $5 apiece) under either a top that is a) stretchy, b) low-cut, c) V-neck, or d) button-down; OR under any other top that is loose enough to pull up from the bottom. For the first bunch, I pull the top and the camisole down to nurse, then pull it back. That's it. No snapping, rearranging of layers, or anything like that. Yes, the top of my breast (gasp) is exposed while I nurse, but I'm comfortable with that. For the second group of tops (this includes things like Tshirts and pullover sweaters), I pull the shirt up and the tank down. While not quite as quick and easy as feeding from the top, I like this option for its ability to let me wear a lot of my pre-baby tops without flashing around a bunch of belly and back (which is sort of awkward, and hey, it's December now!).

I'm also lazy and so I like that at the end of the day, I can take off whatever I'm wearing over it and voila: easy nursing pajamas!

If you utilize this system, you can easily take your maternity/pre-maternity wardrobe through nursing with only the addition of a few camisoles (ranging from $5-$45). Compared to $30 and up for a single nursing top, and the fact that this system is overall much more convenient for me, I feel like I've landed on something that really works.

What about breast pads? Personally, I never got used to wearing them. I found them itchy, uncomfortable, and ridiculously obvious under just about anything. I wore While I was sometimes leaky, especially early on, I personally preferred to deal with a few drips on my shirt (which can happen even with breast pads, depending on how messy an eater your baby is) than trying to yank around and readjust uncomfortable breast pads. I also learned quickly, as I'm sure most others do, that clamping my opposite arm over the breast I wasn't feeding with prevents it from spraying through my shirt when my milk lets down. On the whole, I just figure that I am a breastfeeding mother and there is bound to be evidence of it (besides the baby attached to my breast, that is), and I'd just as soon that evidence be milk as giant breast pads showing through my shirt. If I were going to wear them (say if I had a more formal job, and/or an expensive or dry-clean-only wardrobe vs scrubs, tshirts, and tank tops)? I'd definitely go with these wool ones.

From one of my favorite blogs by a breastfeeding mom, her own tips for a breastfeeding wardrobe, along with an excellent post on how to be comfortable around a breastfeeding woman. She's currently breastfeeding a toddler, and is a source of information and interesting anecdotes about that.

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.