Lactation Narration

At our 2 month well-child visit, our pediatrician likes to advise vitamin drops for the baby, specifically for vitamin D supplementation. I didn’t give Munchkin the vitamin drops more than a couple times though, because the popular knowledge in my breastfeeding-savvy group of friends said that we would get enough vitamin D from the sun.  When Sweets was a baby, I revisited the issue and found new information. This time I concluded that in general we probably don’t get enough sun (“we” meaning Sweets and myself as well as “we” in our general culture) to make enough vitamin D as we are meant to by nature. I know that I always use sun screen on myself and I keep Sweets in the shade and put a hat on her and such. New research is finding that we should have even more vitamin D than was previously thought too. But I was still reluctant to give her the vitamins because a) they taste bad, b) they make a mess and stain when she spits them out, c) I feel like she should be able to get everything she needs from breastfeeding, and d) I don’t like having to buy a product made by Enfamil.

So I decided I wanted to supplement myself enough to have it pass though my milk instead. My pediatrician told me that it wasn’t possible for me to supplement myself enough that it would transfer a high enough amount through my milk. That seemed wrong to me, so I dug deeper. I take a prenatal vitamin with 400 units of vitamin D, and I initially thought that should be enough. I had bloodwork done to test my levels and they were 48 in my blood – which is fine for just myself, but not enough to be sufficient for the baby to get from my milk (blood levels are the same as milk, so she’d only be taking in 48 units). The recommended daily dose for infants is 200 units, so I needed to get my milk levels up that high too. I emailed with Dr. Jack Newman and asked his recommendation. Here is his reply:

Actually, there are studies that show that if you take 4000 Units of vitamin D (another study 6400 Units), a day, the baby can get enough vitamin D in breastmilk to prevent rickets. This is relatively new information.

If you are vitamin D sufficient, the baby is born with a liver full of vitamin D which probably lasts him for at least two months.

And you can get plenty of vitamin D from being outside. The baby doesn’t have to be out in full sun in summer to get it. Late in the afternoon for a few minutes a day is fine.

4000-6400 units is WAY more than the 400 units that are in my multivitamin. So now in addition to my multivitamin, I also take a 5000 unit vitamin D supplement, giving me a total of 5400 units per day. That way my own levels will be high enough for Sweets to get enough vitamin D through my milk and I don’t need to supplement her at all.

I showed the research to my pediatrician, who found it very interesting and concluded that the reason that this isn’t routinely advised is because the published toxicity levels for vitamin D are only 2000 units and they can’t advocate taking more than that. My research leads me to believe that the published toxicity levels are too restrictive, so I am willing to take the risk.

I took my first course in Immunology when I was a junior in college. I remember learning about the immunities in breast milk, and I knew then that I would breastfeed my kids. I guess I had always known that my mom breastfed me, and I thought that I would do it too, but the knowledge from that immunology class really solidified it for me. It was important.

When I was pregnant with Munchkin, I knew I wanted to breastfeed for at least 6 months. I arranged with my boss that I would take my 12 weeks of FMLA unpaid and then come back to work part-time for the next 3 months by using my vacation leave for 4 hours each day. I didn’t want to come back to work full-time until Munchkin was 6 months old, specifically because I wanted to make sure that I could breastfeed that long. I knew that my mother had weaned me at 7 months when she went back to school, and I had the idea that it was nearly impossible to keep up breastfeeding while being separated from your baby during the day.

By the time my maternity leave was over, I decided that I would continue breastfeeding even after 6 months, and that if I needed to supplement with formula while Munchkin was at daycare, I could still breastfeed at home and pump as much as I could at work. My goal soon became to breastfeed until 12 months, with formula supplementation after 6 months if necessary. Within a few more months, my goal was to nurse until at least 12 months without using formula. And by the time 12 months came, my goal had changed again to nursing until at least 2 years old! Two years came and went, and now my goal with Munchkin is child-led weaning.

When Sweets was born, things were so much simpler. My goal with her is simply child-led weaning after a minimum of 2 years. Actually, I have upgraded my terminology – I now say that it is my priority (as opposed to my goal) to nurse Sweet for a minimum of 2 years.

For Munchkin’s third birthday, my in-laws got her a doll that drinks from a bottle and then pees into her diaper. They thought it was really cool because the doll does stuff, but I didn’t want my daughter feeding the doll a bottle. They told me that they had thought of that, but that you can’t really buy a breastfeeding doll, so what option did they have? If a baby doll is going to come with accessories, chances are good that it will come with a bottle.

When Munchkin has gotten dolls such as these as gifts, I have thrown away the bottles and let her keep the dolls. I do not allow doll bottles in my house. I want Munchkin to be socialized that bottles are the exception, not the rule, which I think is the opposite of what general society teaches. I feel that toy bottles normalize bottle-feeding, and I want to normalize breastfeeding.

I do work outside the home and therefore we do use bottles. Munchkin knows that bottles exist and what they are for, and she sees Sweets drinking from bottles at daycare. She also sees me pumping for the bottles and knows that mommy’s milk is in them. We acknowledge the presence of bottles as a way to feed babies, BUT we say that bottles are for when other people feed the baby. I take the approach that is in the Dr. Sears book What Baby Needs: “Or, when Baby is older, Baby might be fed Mommy’s milk from a bottle if Mommy has to be away.” In our family, baby nurses when mommy is around, and when mommy isn’t around, mommy pumps milk for someone else to feed to baby in a bottle. As a result, mommy never feeds the baby with a bottle herself.

When Munchkin is playing dolls, she is pretending to be the mommy, therefore she doesn’t feed the dolls with bottles, she nurses them. I suppose that if she decided that she wanted to play daycare center, then I would be fine with her playing with bottles in that case, but that’s not what she’s playing. Or, if I had boys, I would be fine with daddy feeding baby with bottles too, but I don’t have boys.

Munchkin doesn’t have the magnetic breastfeeding dolls, but she does have two dolls that look alike but are different sizes. She will lay the smaller doll on the bigger doll and tell me that the baby wants milk. Then she’ll put them down and leave them for a while, because I guess it is going to take a while to finish nursing!

Today my Sweets is one year old! That puts us into the category of what many people refer to as “extended” nursing now. “Extended” I guess, because many people in our culture think that 12 months is the time to wean, if you haven’t already. Others prefer terminology like “full term nursing” or “natural weaning” – terms that emphasize that biologically, humans are meant to breastfeed longer than just one year. I have heard several misconceptions about “extended” nursing that I would like to discuss here.

Shouldn’t a baby that age be able to drink from a cup? Shouldn’t that baby be eating solid food by now? I don’t want to have to go to his school and nurse him at recess.
Breastfed babies learn to drink from a cup and eat solid food the same way that formula-fed babies do. The frequency of nursing gradually decreases with age so that she is getting less of her nutrition through breast milk as she gets older. My babies started eating other foods at about 6 months old, and learning how to use a cup at around 12 months old, just like most other babies. Munchkin is still nursing, but only about once per day. The rest of the time she eats table food, drinks from a cup, and goes to daycare and other activities without me.

I weaned at one year because that’s how long the AAP says to breastfeed.
The AAP actually says “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child.” One year is the minimum recommended, not the maximum. The WHO recommends breastfeeding for a minimum of two years.

After one year, there aren’t any nutritional benefits to breast milk. After one year, cow’s milk is more nutritious than breast milk.
Human milk is specially made for human babies. Cow’s milk is specially made for baby cows. It’s a fact that is so obvious to me that I sometimes forget it is not obvious to others. If you believe that a child needs milk nutritionally, then you must see that cow’s milk is a substitute for breast milk, not the preferred nutritional source. At one year, a baby can tolerate cow’s milk, but that does not make cow’s milk the preferred choice. Cow’s milk is an adequate substitute for human milk when human milk is not available for some reason, but human milk is still the default and top choice for human babies (and toddlers!).

After one year, there aren’t any immune benefits to breast milk.
A child will continue to get antibodies in breast milk for as long as he is still nursing. In fact, the antibodies and other immunities become more concentrated in the breast milk to make up for the decreased frequency of nursing. In addition, some studies have shown health benefits to both mother (breast cancer) and child (leukemia, overweight, allergy) to be dose-dependent, meaning that longer breastfeeding leads to greater benefit.

After a year, babies don’t need breast milk anymore.

Well, to take it literally, I guess no child really “NEEDS” breast milk at all. After all, plenty survive on formula from day one right? And yet, most of us try to give our children more than just the bare minimum that they “NEED” to survive. Just as breast milk is superior to formula as a food for infants, it is also superior to cow’s milk for toddlers.

When a child is old enough to ask/walk/talk/have teeth, he is too old to nurse.
The only reason I can think of why someone would link the ability to ask with age appropriateness of nursing is that they associate nursing only with young babies, which of course is just a cultural bias rather than a biological indicator of readiness. The actual act of asking for something can’t possibly have anything to do with not giving it to them – you don’t say “if he’s old enough to ask for juice (or whatever) then he’s too old to drink it” because it makes no sense. What you are really reacting to here is just your perception of “what babies do” and talking/asking is apparently your cutoff between babyhood and toddlerhood. It’s similar to when others say that when he can walk he’s too old. There is no actual link between walking and nursing. You could say “when he can walk/talk/whatever, he’s too old to sleep in a crib?” After all cribs are for babies, yet many folks keep their toddlers in cribs too and nobody gives it a second thought. It makes no sense though because these things actually have nothing to do with each other!

The emergence of teeth at least makes a little more sense when discussing weaning age, however it is obvious that an infant with a few teeth would not be able to survive without milk, therefore the emergence of first teeth is also not a good biological indicator. A better indication if you wanted to use teeth could be a complete set of teeth, which may happen around 2 years old, or even the emergence of adult teeth (more like 5 years old).

I thought this would be a good topic to start with because it’s one that I see a lot online, and one that I was very concerned about when I went back to work when Munchkin was 3 months old. You see, we had tried giving her a bottle a few times before, starting when she was 6 weeks old, and she seemed to be okay with it. After missing a few weeks, when we tried to give her a bottle again, she wouldn’t take it – and she never did again! Sometimes she would just wail and sometimes she would kinda chew on it or push it around with her tongue, but she wouldn’t suck on it. I had taken off 12 weeks of FMLA leave, and it was time for me to go back to work, but how could I leave her at daycare if she wouldn’t take a bottle?!

What we tried:
My husband feeding her, me feeding her, grandma feeding her
Me in the room, me in the other room, me upstairs for 30 mins
When she’s hungry, when she’s not that hungry, after she just ate
When she’s awake, sleepy, asleep, just waking up
In the morning, in the afternoon, in the evening
In a cradle position, in a sitting position facing out, in a sitting position against your legs facing you, standing up and walking around
Using frozen milk or freshly pumped milk
Using room temp milk, body temp milk, warmer milk
Using many brands of bottles with various types of nipples, using various brands of sippy-cups – both with and without valves
I also tried nursing her until she was sleepy, then switching in the bottle without her realizing it

These are all different things you can try if you are having this problem, and one of these suggestions might help you. I’m sure that most babies will eventually take the bottle. Many people told me things like “Babies are smart enough to eat when they are hungry. If you let her get hungry enough, she will eventually take the bottle.” I left her up to 5 or sometimes 5.5 hours at daycare, and she never did.

What happend:
I nursed at the daycare at drop-off and pick-up. I also went there and nursed during my lunch hour. I pumped twice at work for my comfort and supply, and provided 2 bottles (or cups) to daycare each day which they would attempt to give her. Munchkin had been sleeping 10 hours through the night, but she started waking to nurse throughout the night (reverse cycling). Once she started solid foods, she ate all solids at daycare and nursed while at home. Daycare would mix some milk with her solid food to get a little more into her.

You can also use other methods of getting milk into your baby at daycare that may be less convenient – spoon feeding, dropper/syringe feeding, open cups, or straw cups. Don’t feel limited to just bottles.

Conclusion
It was stressful in the beginning to have a baby in daycare who wouldn’t take a bottle, but it was all okay in the end. While I am glad that Sweets takes a bottle at daycare just fine, I wouldn’t actually be that upset if she was like Munchkin and refused it, because now I know I could deal with that. And in the end, if my baby is going to have a preference and only take one, I would absolutely prefer if she didn’t take the bottle vs. didn’t take the breast.

Chances are good that your baby will eventually accept the bottle if you go back to work. But if she doesn’t, also know that you can get through that too.