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Dear BabyShrink,

I fully intended on breastfeeding my first baby. But after trying hard for six weeks, we had to give up. We had 3 lactation specialists, moms, friends, and my doctor helping. But my baby was not gaining weight and crying all the time. I just never made more than a half-ounce of milk at a time, despite pumping and nursing all day (and night). But the specialists all told me to keep trying. That eventually, I would make more milk. I never did, and I could not stand to know that she was hungry. I had to feed her!

Feeding my baby formula felt like a failure as a mom. But she is developing into a wonderful and healthy little girl. Now that I am expecting my second baby, I still think back to that time and I worry about it. It makes me so depressed that I still get teary-eyed every time I think of trying to nurse again. All my friends and my sister were able to nurse. Why not me? People are urging me to try it, but I just can’t go through that again. I was so stressed out at a time I wanted to be enjoying my new baby. Now I will have a toddler to care for as well.

How do I handle this? Any thoughts are appreciated.

Sign me Anonymous
Atlanta

Dear, Dear Anonymous Mom,

I asked you if I could post this letter because so many moms out there are experiencing this same thing right now. Terrible guilt and angst because of being unable (or unwilling, for what can be excellent reasons) to breastfeed their babies. Let me say this immediately: as a psychologist, I want you to be as happy and stress-free as possible during the early months with your baby. Your baby’s development and happiness depends very much on YOUR emotional state at that crucial time. If breastfeeding is causing you too much strain and guilt…it’s just not worth it.

OK, I said it! Let the breastfeeding police come and take me away. But it has to be said.

Some of you are about to get angry at me. So before that happens, let me state a few things as fact:

· Breastmilk has absolute advantages, nutritionally, over formula

· Nursing has been shown to be beneficial in many ways, to both mother and baby

· I support the ability of Moms to nurse their kids anywhere at any time

· I nursed our three kids

But the pressure to breastfeed can be harmful to many Moms. It’s hurting some of you (and by extension, your babies). While I accept the fact that some Moms simply may not understand the benefits and simplicity of breastfeeding, and I do wish more Moms would at least try it out, I don’t accept the patronizing (matronizing?) attitude that often goes along with judging Moms for their choice not to nurse…or their physical inability to do so.

As a licensed psychologist, I also see many Moms who feel inadequate, uncertain, and self-critical because of society’s pressure to breastfeed. They in turn transmit those feelings to their babies.

Although we are told that virtually all mothers can (and should) nurse their babies, consider the following real-life examples of Moms who simply can’t breastfeed:

· The Moms who, like Anonymous above, went through several lactation specialists, medications, and weeks of stress, only to find her breasts simply won’t produce milk (and her baby wasn’t gaining weight)

· The Moms who need to take medicine for postpartum depression (or other life-threatening illness) and want to protect their babies from the medication

· The Moms who have no breasts, either because of an accident, illness, or congenital condition

These are cases where Moms CANNOT breastfeed. Yet in each case, these Moms are criticized and judged by others who have the nerve to ask them, “Why aren’t you breastfeeding?”

But I must maintain that there are also situations where Moms CHOOSE NOT to breastfeed, and that choice must be respected. Who are we to judge the choices other parents make about feeding their babies? Who are we to impose our decisions on them?

I would rather see a happy mom and baby with a bottle of formula than a stressed out mom (and baby) struggling through nursing. To me, the most important thing is that Mom feels comfortable in her decisions as a parent. If Mom is happy, everyone’s happy. I actually stole the term "Good Enough Mother" from one of my shrink heroes, Dr. Donald Winnicott. He was the first to say, "back in the day", that you should not strive to be a perfect parent….just a good enough parent. If you want to get the scoop on him, read more here. (It’s a little technical, but if you’re into psychology, Winnicott is a classic.) 

And it extends to the “I’m a better parent than you” kind of competitiveness that continues beyond the baby stage. Who’s toddler is smarter/cuter/faster/going to the “better” preschool? Who is watching the least TV? Who has the better diet?

Our expectations of being “Good Enough” mothers have gotten completely out of whack. And the very strong pressure to breastfeed our babies does not help.

Again, this is all about expectations. It’s important for parents to have realistic expectations of their parenting. Parenting decisions have to be made with the best interests of both parent and child in mind. Breast or bottle? Your choice is best.

Aloha,

Dr. Heather

The BabyShrink

There is a strain of
pregnancy propaganda out there that sets new moms up for failure. It says that
unless you “achieve” some particular kind of delivery perfection, well,
then…you haven’t quite made the cut, as a Mom. And that makes me angry.

It’s in all the standard
pregnancy books. Something along the lines of, “Create your own birth plan. Be
in charge of your delivery. Don’t let that mean, nasty doctor force you to
deliver in some way that’s NOT in your plan. Decide in advance if you want to
use pain medications for the delivery….or not.”

What they don’t say is that
the birth process is usually so unpredictable that your carefully crafted
“Birth Plan” gets left at the bottom of your carefully packed “Going To The
Hospital Bag”…that got left at home, in a panic, as you rushed to the hospital.

Now, I’m a recovering control
freak, so don’t get me wrong. Anything that’s called “a plan” looks fabulous to
me. I did it myself, with our first baby. Here were my rules, when I was
cluelessly buying into the notion that I could actually control the birth
process by planning for it in advance: No induction. Lovely, inspirational
music playing in the background. No pain meds. No pitocin. No c-section. (Oh
yeah: no binkies or bottles for the baby either, but that was a different
lesson for me to learn, for a different post!)

What happened, you ask? Oh,
surely you must have guessed by now. I had it coming to me, big time. The
control freak gets hammered. The doctor wanted to induce labor, since the baby
was getting big, and she was overdue. But oh no, that was not in my Birth Plan.
So we waited. And waited. When labor finally did begin, the early stages went
well. But when it came time to push…not so well. I pushed and pushed and
pushed…and nothing happened. I stood up to push. I squatted to push. I pushed
and pushed for hours. The doctor wanted to add pitocin in order to add strength
to the contractions, to help me along. No way. Not in the birth plan. She
wanted to add an epidural, to relax me. No dice, doc. Finally the doctor had to
go and do an emergency c-section on another lady. I had some time. The nurse
convinced me to have the epidural and the pitocin, and then our baby was
finally born. After four solid hours of
pushing.

I was so sore after the
delivery I had to sit on two huge pillows for weeks, and I still was miserable. Here are some other examples
of “Birth Plans” that didn’t “pan” out:

· The
alternative-medicine-practitioner who swore she’d never use pain meds, who
begged for (and got, with huge relief) an epidural after 12 hours of
excruciating labor

· The Maui-Hippie-type who
arranged to have a birthing bath (with doula) brought to her home, only to need
an emergency c-section at 34 weeks

· My pain-fearing friend who
hoped for every drug in the hospital, but delivered in the hallway of the ER
while her husband was parking the car

Now, I’m all for planning, to
the extent that planning is possible.

But I’m really against the notion of
feeding new mothers the idea that there is somehow an ideal birthing situation
that they should be aiming for…other than the delivery of a healthy baby, with
a healthy mother. Because that sets us up for comparisons, judging, and disappointment.
The labor and delivery process is so unpredictable, and so individual and
varied, that you really cannot plan for every possibility.

Many of you have expressed
sadness, even a sense of failure, because you had to have a c-section. Or if
you “caved”, and got an epidural.  Unrealistic
expectations can lead to big problems. For some, this disappointment can even
lead to postpartum depression.

Lamaze Shlamaze; use whatever
works.

The breathing techniques I
learned in yoga and exercise classes helped me way more than anything I learned
in the actual preparation to have a baby. That said, I still pushed for four
hours! The only thing that is important in delivering your baby is that both
you and baby are healthy. I don’t care if a Martian comes down and performs
some kind of weird alien delivery for you, as long as you and your baby are
healthy at the end of it.

Did you have any surprises in
your delivery? Do tell!

Dear BabyShrink,

My 8-month-old Lehua is going through a real burst right
now, and among other things has just figured out how to get herself up to a
sitting position. This is great, but it’s really messing with her naps.
Previously, she would fuss for 5 or 10 minutes, and then fall asleep. But now,
she’ll push herself up to sit and then seem to get "stuck" there.
Fussing turns into sobbing and screaming, and she never gets to sleep. This
morning she stayed like that the full hour until we went to get her. This
afternoon she dozed off for about 20 minutes and then woke up very fussy but
wouldn’t go back down because of the sitting thing. What to do? My instinct is
that she needs to learn how to do it herself and we should just tough it out a
few days until she gets it. But I don’t know. My mom disagrees of course.

Related question: what to do when she wakes up after only 20
minutes of a nap and is still fussy? Go and get her even though she hasn’t
gotten enough rest, or leave her in there fussing until she goes back to sleep?
She is taking short naps lately and it is clear she’s not rested.

In my experience, it is just so much easier to create good
habits than to break bad ones. I think our sleep situation is an example of
this, because from the beginning I was super militant about laying down good
nightime habits — never taking her out of her room once we put her down,
keeping a regular bedtime, putting her down awake and letting her fall asleep
on her own. The goal was for her to be independent in her sleep habits. But I
think I dropped the ball on naptime — I’d often let her sleep in the car, in
my arms, or in the stroller. Anyway, I’m sure there are other reasons she has
more trouble sleeping during the day, but I can’t help believe that was a
factor.

Still, it’s good to be reminded of the need to be flexible
and have a little "grace period" in times of upset. I’m kind of an uptight person, so when
things are getting shook up, I tend to cling even harder to my routines and
"good habits." I agree that, while moving in the direction of good
habits, you still need to "go with the flow."

I guess the real answer here is what you’ve talked about
before — trusting your instincts about what your own baby needs. But it’s hard
when you’re not sure what your instincts are telling you!

Ilima
Maui, Hawaii

Dear Ilima,

Wow! I can really
relate. Once you have the routine down pat, they go and change on you. I wish I
had "the answer". But since this is sort of an unavoidable part of
development, all I can do is give you some general information, and you can use
your Mommy sense to see what might work for Lehua. (You can also read my "Babies and Sleep" article here.)

First, yes, sleep is super important. BUT, a few days’ disruption does not make
for a "bad habit". I know she’s cranky, but your goal is to gently
nudge her back in the direction of sleeping through. In the meantime, one of
the things she’s looking for is some comforting through all the wild and wacky
changes she’s experiencing.

That’s one of the reasons she is waking….to look
for you. She is entering a phase where she will be more aware of you, and when
you’re gone. Separation anxiety will crop up during sleep, when she is
away from you. That’s part of it.

So: what to do when she awakens after 20 minutes, and you
know she’s still tired? There are not really a lot a great choices. I say, be guided by practicality. See
how you’re feeling that day, and see how she sounds. Is she just a little
cranky? Then let her fuss a bit. Is she just way over the limit? Hold her awhile and
see if she might go back down. If not….that’s OK. Perhaps an earlier bedtime
later that evening is called for. All is not lost. Pick her up and go on with
your day, albeit with a cranky girl.

You will also be letting her know that
flexibility and adaptation is one important way you will be helping her cope with difficult times.

(Lots
of my readers have asked about this, and it has been a discussion online here. Can
you be flexible….and still have good limits? Yes. Absolutely. More on that topic soon.)

Also, she’s not too young to start talking to her about
what’s going on. "Lehua, I know you know how to sleep nicely in your crib.
You’re tired! Mommy’s tired! Let’s sleep MORE today, ok? I know you’ll feel so
much better when you sleep. Mommy will be here when you wake up today. I know
you miss me. You’re safe, we’re here." Just a short little pep-talk is enough. She may not understand 100% of
your words, but she’ll start to get the gist, over time. And it will condition
you to start talking to her about these developmental challenges, and how you
are going to help her get through them.

So much of young babies’ sleep is constitution and temperament, not the
environment. That’s a concern I have with some of the popular baby sleep
books; the shrinks who wrote them mostly dealt with really severe sleep
problems in their practices, and developed their approaches based on those
cases. The "run of the mill" cases like yours and mine would just
never present to a sleep clinic at a major university. If we generalize
to the normal, general public, you get worried and educated parents like
you and me thinking that our kids are under-sleeping, developing bad habits,
etc.

It doesn’t take much to provide a generally "good
enough" environment for sleep for your baby. Anything beyond that is
likely to make you nuts, and waste your precious parental energy. And when baby #2 (or #4) comes along? Forget about it! You won’t be able to control the environment very well at all. But those babies still tend to sleep fine. In our house, our third is the best sleeper of the group, and let me tell ya, this house is not a quiet, predictable place!

Your point about independence is well-taken, though, as that
certainly is our ultimate goal in child-rearing. But there are developmental
capacities that need to be considered. How much independence can be tolerated
by the child at each particular age and stage? And how do we allow for the normal, needed
regressions in independence that occur regularly? True independence comes out
of a solid bedrock sense that one has a strong foundation, and that strong
foundation can only be established though reliable dependence in early
childhood.

Your baby depends on and "borrows" your care, love and strength until those feelings become internalized.
That’s the beginning of true independence.

Good luck, and keep us posted!

Aloha,
Dr. Heather
The BabyShrink