We too, have tried Dr. Jay Gordon’s method, but modified it exactly as you would, and had great success… until those molars started coming in! Now we are back to about two nursing sessions a night. It is a bit of a bummer, but I know the extra waking is due to the teething and will pass with time. My question, though, has to do with naps. For every nap since she was born, my 27 month old has fallen asleep nursing, she sleeps about thirty minutes, and then cries for me. I go in and nurse her back to sleep, which takes anywhere from fifteen to thirty minutes. She then sleeps another half hour to forty-five minutes, cries for me, and I go in and nurse her back to sleep. It is impossible to get anything done, and I am so beside myself about her not being able to get a solid nap in, that even if I stay in bed with her I can’t fall asleep! I’ve tried the suggestions in The No-Cry Sleep Solution for Toddlers, but to no avail. Today I even tried completely separating the nursing from the nap and that totally backfired because she never took a nap! I am feeling pretty hopeless about this and any thoughts or advice would be greatly appreciated.

I feel your pain Rachael! I have been there and in fact today my 16-month-old napped for 30 minutes, nursed back to sleep and slept another five minutes. It’s amazing I get any blogging done

When I had just the one nursling, I had the luxury of sitting in the rocker while my daughter napped on me for three hours. If she woke I’d nurse her back to sleep and continue reading my book or watching all the television shows I had taped. Of course, I couldn’t get anything else done that way, but at least I got a “break” of sorts. That wasn’t really an option when my second child came around, and in fact it became even more difficult to juggle nap time as I was trying to coordinate the naps of a 2.5-year-old and an infant.

I have a few thoughts for you and then I hope other moms will chime in with comments on what they do for nap time.

1. Use a sling to carry your nursling to sleep. Get the right babywearing gear and you can comfortably carry a toddler to sleep. While that might not result in longer nap times right away, it is at least a start at separating nap time from nursing. Once you’ve carried your toddler to sleep, you have two choices — very carefully lay your child down and slip yourself out of the carrier, or continue carrying your child while you get a few things done with your two free hands.

2. Go for a walk. Many, many of my children’s naps have taken place in a Baby Jogger. I felt a lot better when my child napped and I accomplished the important task of getting some exercise. In nice weather we would walk outside and both get some fresh air, and in bad weather we would walk at the indoor mall. Again, this technique has the benefit of separating sleeping from nursing. It also works well even when you have more than one child.

3. Go for a drive. Okay, so this isn’t the most environmentally-friendly method of getting your child to nap, but desperate times call for desperate measures. And hey, I have often mentally justified such activities by weighing the effects of burning gasoline against the effects of the anti-depressants I might need if my child didn’t get some sleep during the day! (You think I kid….) Seriously though, once my toddler converted from Child Who Hates Car Seat to Child Who Sleeps in Car, I would go for a drive just long enough to get my toddler to sleep, then go home and transfer her from her seat to her bed.

4. Try the No-Cry Nap Solution. You mentioned The No-Cry Sleep Solution for Toddlers. Elizabeth Pantley also has a book dedicated entirely to naps (obviously we are not the only ones to struggle with this issue!) You can read my book review of The No-Cry Nap Solution here.

5. Give it some time. As with all things, time makes it better. I do not mean to minimize the frustration of having a child who cat naps and/or needs to nurse back to sleep. What I do mean is to offer hope from the realization that one day your child will sleep well again at nap time. I found that pre-school wore my three-year-old out. Same with a day at the park or a playdate. There will be times when your child sleeps poorly, but the times your child naps well will slowly increase.

Moms, what do you do for nap time? Have you faced the same nap time dilemma and what solutions have you found? Please leave a comment!

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The workbook is divided into 12 chapters with accompanying audio portions for each provided on two CDs. The audio exercises take you through 12 different sample conversations featuring doctors, nurses, lactation consultants, WIC peer counselors, and breastfeeding support group leaders. The woman’s voice is pleasant and clear. I found the vocabulary exercises particularly helpful and was pleased to see tear-out quick reference sheets for common words and phrases. By working through the exercises, IBCLCs can earn up to 12.8 L-CERPs.

In addition to the comprehensive instruction in the Spanish language, the book provides a solid base of current and accurate breastfeeding advice. It demonstrates how to offer both informational and emotional support. It works as a self-guided course or as a textbook in a classroom setting. Spanish for Breastfeeding Support is a gorgeous book and an excellent reference guide!

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I have put a hold on the book at one of my county libraries (25 cents gets it shipped to my local branch!) and I can hardly wait to get started reading next week. The timing is good because I just finished reading Animal, Vegetable, Miracle: A Year of Food Life by Barbara Kingsolver (quite a dense and informative read — one worth plowing through. Oh, did I just go with the farming pun? )

The Wet Nurse’s Tale is a historical novel set in Victorian England and it features a heroine who unexpectedly finds herself in the occupation of a wet nurse. I won’t say more because I never like to have the plot to a book spoiled before I get a chance to read it. But I laughed when I read the review from Carolyn See at the Washington Post’s Book World:

From the title and the cover, this book seems a little dubious — lots of breasts and steamy sex and way too much romping. But “The Wet Nurse’s Tale” turns out to be informative, unusual and intelligent.

Sounds good to me! So, are you in? Let’s read The Wet Nurse’s Tale together! If you want to get your thinking cap on ahead of time, here is a link to some sample discussion questions from the Penguin.com reading guide to the book.

Post from: Breastfeeding 1-2-3

It’s refreshing to see evidence- and practice-based breastfeeding recommendations from a doctor. While most physicians receive very little education in breastfeeding, Dr. Neifert has many years of experience practicing breastfeeding medicine as a pediatrician, co-founder of one of the very first breastfeeding centers in the United States, and co-founder of the Denver Mothers’ Milk Bank (among a long list of credentials, not the least of which is having breastfed her own five children!)

The book strikes the perfect balance between informative and accessible, enthusiastic and non-judgmental. It gives women the tools and encouragement to get breastfeeding off to a good start and to continue breastfeeding through any challenges or changes in the breastfeeding relationship. It covers common breastfeeding problems, working and pumping, special circumstances such as medical issues or multiples, toddler nursing, breastfeeding during pregnancy and tandem nursing. I liked the tone of the book and agreed with the vast majority of the breastfeeding and parenting advice presented in it. The only issue on which we part ways is bed-sharing/night-time parenting (I’m a huge fan of co-sleeping to maximize sleep for mother and baby and to help maintain a good milk supply for the mother especially if she plans to return to work), but I was still pleased to see Dr. Neifert offer some guidelines for safe co-sleeping.

I very highly recommend Great Expectations: The Essential Guide to Breastfeeding. What about you? Have you read the book? Please leave a comment with your own book review!

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Just a Few Weeks Early
Breastfeeding Challenges in Late-Preterm Infants

Marianne Neifert, M.D.

Until recently, babies born a few weeks early — between 34 and 36 weeks gestation — were referred to as near term infants. However, the designation, near term, implies that an infant is almost term or almost fully mature, and the misnomer has often caused health professionals and parents to underestimate the medical risks in this large, vulnerable population of infants. Recently, the American Academy of Pediatrics has recommended that infants born at 34, 35, or 36 weeks gestation be referred to as late-preterm infants to emphasize that these babies are physiologically immature and have special health care needs compared to full term infants (born between 37 to 41 weeks). In addition, the mothers of late-preterm infants are more likely to have medical complications themselves, such as gestational diabetes, high blood pressure, or C-section delivery.

The Rising Incidence of Late-Preterm Births

The proportion of all U.S. births that are late preterm has increased over the past 15 years. Late-preterm infants now comprise over 9% of all births, and account for more than 70% of all preterm births (<37 weeks gestation), representing nearly 400,000 babies each year. Although the reason for the increase in late-preterm deliveries is not well understood, one explanation is the increased use of fertility treatments, which has lead to a rise in pregnancies with twins and higher multiples. Half of all twins and 90% of all triplets are born preterm. Other possible contributors to the rise in late-preterm births include the rise in cesarean section births (now 30% of all deliveries), the need to deliver some infants early due to medical complications, and more pregnancies occurring among women at an older age. In addition, performing elective labor inductions or elective cesarean sections for no clear medical or obstetrical reason sometimes leads to the unintentional delivery of a late-preterm infant. Both expectant mothers and obstetricians need to know the importance of avoiding late-preterm delivery unless it is medically necessary.

Medical Complications among Late-Preterm Infants

Because many late-preterm babies are the size of infants born at full term, health care professionals may not always give these at-risk infants the special treatment and careful screening they deserve. Instead, hospital personnel and parents tend to treat these apparently healthy infants as if they were developmentally mature. Late-preterm infants have been called imposter babies because many of these “slightly early” newborns masquerade as full-term infants, appearing to need no special care after birth and being discharged as early as term babies. Yet, babies born even a few weeks early have an increased risk of medical complications after birth and may require a longer hospital stay than full-term infants. Late-preterm infants are more likely to develop low blood sugar, severe jaundice, breathing difficulties, and infections; to have difficulty maintaining their body temperature; and to experience feeding problems and excessive weight loss after birth. Late-preterm infants also are more likely to be re-admitted to the hospital in the early weeks of life for medical complications, including newborn jaundice, breastfeeding difficulties, dehydration, and possible infections.

The brain and nervous system are among the last systems to mature during fetal development, and some studies show that late-preterm infants have a higher risk of developmental and behavioral problems compared to full-term babies. Late-preterm infants also have a higher rate of birth defects and an increased risk of sudden infant death syndrome. For all these reasons, late-preterm infants require close monitoring, evaluation, and follow-up after birth.

Breastfeeding Challenges among Late-Preterm Infants

The initiation of successful breastfeeding can be especially challenging for smaller, developmentally immature, late-preterm infants. These babies often have trouble latching on to the breast correctly and may be unable to breastfeed effectively at first because of their lower muscle tone and tendency to tire easily. Inadequate breastfeeding increases a newborn’s risk for severe jaundice and excessive weight loss.

Providing your baby with skin-to-skin contact immediately after birth and as often as possible while you are rooming-in will help promote infant feeding behaviors and successful breastfeeding. Your hospital lactation consultant can offer valuable assistance with your breastfeeding technique during your hospital stay. Sometimes, using an ultra-thin, soft silicone nipple shield can help your late-preterm baby latch on and stay attached to your breast. Ask to be referred for extra help with breastfeeding after discharge, since it often takes several weeks for a late-preterm infant to be able to breastfeed effectively.

Late-preterm infants seldom are able to drain their mother’s breasts well at first. Ineffective breastfeeding not only increases a baby’s risk of medical complications, a mother’s milk supply can rapidly decrease if her baby removes little milk. If you deliver a late-preterm infant, you can help assure that you bring in and maintain an abundant milk supply by using an effective electric breast pump to express the extra milk your infant leaves behind after breastfeeding. Removing the milk remaining after your baby nurses is known as “insurance pumping” or “prevention pumping” because it helps keep your milk supply generous until your infant is big enough and mature enough to drain your breasts well on her own. Having an abundant milk supply also helps your immature, smaller, less-vigorous baby obtain more milk when she attempts to breastfeed because she can “drink from a fire hydrant” instead of having to work hard to get enough milk. Furthermore, the extra milk you remove with the pump makes the ideal supplement if your baby temporarily requires supplemental feedings. Your surplus pumped milk can be stored for later use (in the refrigerator for 3-5 days; in a separate door freezer for at least 3 months; in a deep freezer for at least 6 months).

After you go home from the hospital, arrange to have your baby followed closely and weighed often to monitor her progress with breastfeeding. Her first pediatric visit should occur 24-48 hours after discharge. A lactation consultant or your baby’s doctor periodically can weigh your baby (identically clothed) before and after breastfeeding to measure how much milk she drinks and monitor her progress with breastfeeding. As your baby matures and gains weight rapidly and becomes able to breastfeed effectively, you gradually can decrease your pumping regimen. Your extra investment of time and effort to safeguard breastfeeding in the early weeks after your baby’s birth will pay off in a thriving infant and a plentiful milk supply that will set the stage for a long-term successful breastfeeding experience.

©2009 Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding

Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding, also known as Dr. Mom®, is a popular pediatrician, nationally recognized expert in breastfeeding management, and celebrated author of child-rearing books and magazine articles. In 1985, Dr. Neifert co-founded the Lactation Program in Denver — one of the very first community breastfeeding centers in the nation, sponsored by the Colorado Health Foundation. She is also clinical professor of pediatrics at the University of Colorado Denver School of Medicine. A long-time leader in the field of breastfeeding medicine, Dr. Neifert is a co-founder of the Denver Mothers’ Milk Bank, founding member of the American Academy of Pediatrics Section on Breastfeeding, the International Lactation Consultant Association, and the Health Advisory Council of La Leche League International. Dr Neifert has addressed audiences in forty-six states and has been a guest on countless radio shows and national television programs, including Today, Good Morning America, The Early Show, 20/20 and CNN. She has written for numerous publications, including Parenting, BabyTalk, American Baby, and ParentLife.

For more information please visit http://www.dr-mom.com/

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Mary collected monetary donations to send with Sophie to Ethiopia, and the doctor with whom Sophie works suggested that Sophie fund and run the feeding program. You can imagine my worry when I read “feeding program.” I really hoped that did not mean that the money was going to be used to buy f*ormula! I was pleasantly surprised to read this in Sophie’s letter:

Adults can get on the feeding program if they are desperately poor, and that poverty is validated by their malnourished appearance, and by the confirmation of others in the community. Infants are also a part of this program. Currently, we have 3 sets of twin babies that are “fed.” The high-protein granola is given to the infant’s breastfeeding mother so that she can produce enough milk to feed them. In order to get a refill (every other week), the babies are weighed to ensure that they are getting the benefit of the food.

Sophie goes on to tell of one success story:

Two of the twins currently on the program are now 4 months old, and the fattest little Ethiopian babies I have ever seen! It’s always so fun to weigh them because their mom is so proud, and the babies are so smiley and adorable. [Dr.] Mary says that when they started 3 months ago, mom was completely emaciated, and the babies were not looking any better. She gave the mom the granola, and the next week, she looked less emaciated, and the babies were vigorous and bright-eyed–they were a whole different family because of their little tin of granola!

What a wonderful story and a powerful “advertisement” for the benefits of breastfeeding! Thank you Mary and Sophie for sharing that inspirational account of the (breast)feeding program!

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Post from: Breastfeeding 1-2-3

Now is your chance to win a copy of the new breastfeeding book Great Expectations: The Essential Guide to Breastfeeding which has come out just in time to celebrate National Breastfeeding Awareness Month. Author Marianne Neifert, MD, is well qualified to write a breastfeeding guide in light of her experience as a pediatrician, co-founder of the Denver Mothers’ Milk Bank, founding member of the Academy of Breastfeeding Medicine, and member of the American Academy of Pediatrics Section on Breastfeeding.

In an easy-to-read format packed with helpful information, the book addresses everything a nursing mother needs to know, including getting ready for breastfeeding, the first weeks, breastfeeding problems, adjusting to parenthood, and working and breastfeeding.

How to Enter to Win a Copy of the Book

This contest is open to entrants with a United States mailing address. To enter, simply leave a comment on this post! For a second chance to win, mention this contest on your blog — and this is the key part for a second entry — come back and leave another comment with a link to your post. For a third chance, mention this contest on Twitter @breastfeed123 and come back here to leave an additional comment. The contest is open until the end of the day PCT Friday, August 28, 2009. I will use Random.org to select the winning comment number which will be announced here on Saturday, August 29, and by email. The winner will have until Tuesday, September 1, 2009 to reply to claim the prize or another winner will be selected. Good luck!

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Book Review

The sturdy 5″ x 6″ board book features 12 gorgeous images on six (front and back) pages. The pictures include nurslings ranging from a 4-day-old newborn (make me cry will you?!) to a 3-year-old toddler. The pictures stand alone without captions or other text.

I was curious to see how my children would like the book. My 7-year-old, too old for board books in general, was completely unfazed by the book. She thinks it’s perfectly normal to see images of breastfeeding mothers and babies. My 4-year-old was enchanted. “Ooh, a book about mamas and babies!” (note how the fact that the mamas and babies are breastfeeding is completely secondary!) She later picked the book up again on her own and started making up a story for it. “Breastfeeding is good. If you want to breastfeed, here is how you do it.” Yes!

My 1-year-old gave the book the true test. She liked the pictures of the babies, and being a baby herself, she liked trying to gnaw off the corners of the book! It’s a well-made, sturdy board book that stood up to her playing with it.

You can see more breastfeeding pictures from the book here and you can order a copy of the book here (I have no affiliation with the book so you’re getting my independent review). At $29.95 the price might seem high but the quality of the photography and the quality of the book are high too!

What do you think of the book and pictures? Do you have a breastfeeding photo you would like me to feature on the blog? Email me a breastfeeding photo of your own for future publication in a post at Breastfeeding 1-2-3.

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Mary shares her wisdom and wit in this practical and accessible book. Through her experience raising her ten children and through stories culled from other mothers of many, Mary demonstrates how a large family can be rewarding for the parents and satisfying for the entire family.

I have long enjoyed reading Mary’s blog Owlhaven.net. Mary breastfed and pumped for her four biological children and practices attachment parenting with all of her ten children including the six she and her husband John adopted from Korea and Ethiopia. Even though I do not share Mary’s religious convictions, I appreciate her openness and the way she conducts herself as a mother. I have learned many things about attachment parenting older children from her examples. I also like how she freely admits that maintaining patience is a daily struggle. Her approachable and generous style of writing means that even as I filed away ideas from her book, I felt reassured that I, too, could maintain sanity and happiness in raising a large family.

(Note: Mary also has a cookbook coming out this September. Family Feasts for $75 a Week is available for pre-order on Amazon.com now!)

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