Check out: Practical Nutrition for a Healthy Pregnancy.

Some people have heard that continuing to nurse will jeopardize the pregnancy. The truth is, if you have not had trouble maintaining a pregnancy before, then it is very unlikely that continuing to breastfeed will increase your risk of miscarriage.

I have nursed three of my children through the following pregnancy, and am still currently tandem nursing my youngest two, a toddler of 2 1/2 and an infant of six months of the time of this writing. Since nursing past the age of one, not to mention tandem nursing itself, is so rare these days, you may be wondering how it works in reality. Before I myself had experienced it, I found that the only items I read about it spoke of tandem nursing in glowing, romantic terms. While there are definite advantages and some tandem relationships are idealistic, reality should not be glossed just to promote this choice.

The following comes from an email post I wrote on an NFP list to which I belong, several months ago. It describes the realities of each of my experiences of tandem nursing in detail.

Well, it’s been very different with each of the tandem pairs I’ve had. With the first, they would contentedly nurse alongside each other, and I tandemed them for a year. The older boy wouldn’t nurse necessarily every time the baby did, but probably 3-4 times a day. Oliver was 23 mo when Simon was born, so it wasn’t so much nutritional as comfort and habit for the most part.

The next set was our hardest. Simon was 20 mo when Paul was born. I’ve noticed that when the milk switches to colostrum during pregnancy, they tend to cut back on nursing a bit. There just isn’t as much quantity either. But once my milk came in, Simon wanted to nurse every time Paul did, and if I told him no, he would become very angry and demanding. It was quite surprising, as this is not his usual temperament at all! After 2 months, my husband finally put his foot down and told me to wean him. My husband being who he is, this was very unlike him so I listened and weaned. Also, Simon is our skinny-minny and he was losing weight because he was nursing so much and not taking solids. So it was best for all of us to wean. The interesting thing that happened with this experience, NFP-wise, is that I was nursing SO much I ended up having a very fluid discharge for a couple weeks right around 8 weeks after birth. After consulting the NFP-professional list, we decided it was a sign of completely shutting down my ovaries, and my amenorrhea ended up lasting the longest with Paul.

Currently I’m nursing Paul and Eliza. Paul was 27mo when Eliza was born a month ago. I let him nurse roughly twice a day, in the morning after breakfast and in the afternoon after he wakes from his nap. He hasn’t shown any jealousy that Eliza nurses more than he does. Sometimes, if he’s close and Eliza comes off the breast he’ll try to push it back into her mouth. I don’t reserve a breast for each of them. I usually try to nurse Eliza first so she has her fill, and then Paul can nurse. I was careful not to nurse Paul too much through my first engorgement after birth either, because I didn’t want to stimulate too much production. My intention is to let him nurse twice a day, so I kept with that during those days too.

Though tandem nursing can be a struggle at times, what parenting choice doesn’t also have it’s struggles? It is completely worth it! Positive benefits include potential lengthening of postpartum infertility, thus increased child-spacing naturally, and strengthened bonding between siblings and continued closeness between the older child and Mommy.

I have witnessed the increased bonding that others who have tandem nursed claim with their children. My youngest 4 who have tandem nursed alongside their siblings are extremely close. Closer than the oldest three are. We also home birth, which I’ve also seen increases the sibling bond, since Mom didn’t disappear to a hospital for 2-3 days and then reappear with a strange new member of the family.

Also, none of my tandemed children have been dependent on a pacifier or their thumb past the first year and a half. They are soothed through closeness to Mom, until they can self-soothe in a healthy manner.

As with any childrearing advice, your mileage may vary. The uniqueness of each child is what keeps this world beautiful. I hope, though, that reading the realities of a not-so-common relationship can encourage others to try, or keep with it until both Mom and the children are ready for weaning.

Purchasing a breast pump is made all the more difficult for the fact that they are almost always a nonreturnable item. A good pump is not inexpensive, either. After doing a little internet searching, I stumbled upon a model of breast pump I’d not heard of before–the Whittlestone (there is also a Dr. Brown’s pump that looks virtually identical, except for the shape of the collection bottle). It looks very similar to the Isis which is a good, though not great, pump. It appeared to have remedied many of the qualities I found inferior about the Isis, namely lots of separate pieces making assembly and cleaning a chore, also increasing possibilities for cracking and breakage because of repeated assembly and disassembly. My biggest complaint with the Isis, though, is that I’ve never been able to achieve a let down while pumping with it. Also, with the shape/size of my nipples, I’ve incurred damage due to too much suction. While I am not an avid pumper, after six years of ownership, I’ve certainly had enough time with the device. At some points, I’ve even preferred manually expressing my breast, since the Isis wasn’t relieving the engorgement I was suffering having been away from tandem nursers through more than one feed. The trouble with expressing, however, is that I can be a little too harsh on my breast through a combination of impatience and efficiency.

The Whittlestone claims, like many pumps, to more closely imitate the suckling action of a nursing child. Unlike other pumps, this pump has minimal suction, and a adjustable dial to control even what little suction it offers. It’s main method of operation is the shape of the silicone inserted into the plastic flange. With the squeezing of the trigger, this flange collapses a little around the areola in an almost identical replica of a baby’s sucking, compressing the milk ducts and actually triggering the milk-ejection reflex! Within moments of pumping with this device, I had achieved let-down, and continued to repeat it over the course of pumping both breasts. While the action of the silicone may result in some friction on the nipple that some will find uncomfortable, it is nowhere near as much as the suction on other breast pumps I have tried. Not even as much discomfort as one might feel with nursing a toddler with a full set of teeth.

Other improvements over the Isis: the pump design has fewer parts, and the base of the collection bottle is wide enough that it can be set down without toppling the whole assembly. Anyone who has experienced a pump falling over, with the resulting loss of that liquid gold, can vouch for the importance of the latter quality.

As you can tell, I highly recommend this little pump, though of course cannot speak to the electric counterpart. The design is similar, though, so it might be worth the cost to someone needing a more sophisticated pump. I believe the Dr. Brown’s model is even in the process of marketing a double model. For the manual, prices are competitive with the Isis, though I managed to score a brand new one on eBay for $20 plus shipping.

The Business of Being Born tells the history of birth and obstetrics in America in a humorous and captivating way. I could even hear my husband chuckle, especially at the Monty Python hospital sketch and the cartoonish portrayals of a typical experience of hospital delivery. However, in the evolution of the film, the product becomes personal as the director finds herself in the very midst of making her own decisions regarding her first pregnancy and birth, and choosing to film her journey even through its unexpected end.

The Business of Being Born makes a thought-provoking case for the resurgence of midwifery care in America. To date, a very small percentage of pregnant women will choose the care of a midwife, and even smaller yet will these women choose an out-of-hospital birth experience. The midwives model of care is a key element which differentiates the most successful maternity cultures in the developed world from those which, like ours, have fallen short of expected goals. Through striking and sensitive birth footage, The Business of Being Born depicts the very real differences through the different potential avenues of giving birth, from home to birth center to hospital, and even cesarean surgery.

The Business of Being Born is available now through Netflix, and is being released in a limited number of theaters nation wide. Every pregnant mother in America deserves to see this film!

Recently when my sister became pregnant, and she was trying to decide between two very different options, I finally discerned an effective way of discovering the type of knowledge that will help a consumer evaluate the actual type of care a Birth Attendant gives and their beliefs and philosophy of birth. Using questions we developed together, she was able to make a clear decision based on information she gathered, rather than a feeling about a particular care giver, or suppositions at the beginning about what may happen at the end.

My list of questions is substantially shorter than most lists you will find. The important point may not even be the questions themselves, but the purpose behind each question and that they are all open-ended. I recommend you tell the practioner as little about yourself and your desires as possible before discussing these, to avoid having the Birth Attendant tailor her answers, either consciously or not, to your own desires. Keep in mind, however, that if you are interviewing a Birth Attendant in group practice, you may not be interviewing the individual who will actually attend your birth. You may want to follow up some questions with how it relates to the practice as a whole. There can be a widely divergent set of views on any particular topic in one practice.

1. What does a typical birth under your care look like? If you are as lucky as my sister, this one question will answer most of the usual questions about practice. It will also uncover the underlying philosophy of birth, to which you can decide how well it parallels your own beliefs. A practitioner who quickly launches into what may be done about this or that complication probably has a higher degree of expectation for complications than one who describes their practices or enumerates your choices.

2. How do you feel about doulas? Whether or not you desire to have a doula present, asking a practioner how she feels about them will tell you a great deal about her views of a woman’s need for support during labor or pain relief.

3. How do you feel about home birth/unassisted birth? If you are interviewing a hospital- or birth center-based practice, ask both questions; if you are interviewing a home birth practioner, ask the second. Both these questions help to define the level of trust a practioner has in the birth process. Again, it is up to you to evaluate whether their beliefs are in line with your own. Asking the question does not indicate your own level of comfort with either of these choices.

4. What are your personal statistics regarding…(cesareans, episiotomies, VBAC, breech, twins, or any procedure you are particularly concerned about)? Personal statistics are preferable to hospital statistics in determining the type of care a practitioner provides. You may desire to follow up with the hospitals statistics because hospital statistics can give you insight into the nursing care at a particular facility. How a nurse conveys the progress of labor to the Birth Attendant can have a great impact on the course of action or inaction decided upon by the Birth Attendant.

5. What are my options regarding…(Group B Strep, IVs, Rhogam, eating and drinking in labor, labor positions, birth positions, assisted deliveries, pain relief, or any other topic you are particularly concerned about)? This question should elicit the typical informed consent conversation a practioner would have with you concerning these particular topics, without the pressure of having to make a care decision at that point in time. The best thing would be to pick one or two that have not been previously addressed and that you may know a lot about. Determine how thorough the practioner discuss the options and pros and cons of each, and whether or not she leads you to a particular option.

6. When is the best time to cut the cord? The answer to this question sheds light on where the practioner believes the focus should be after birth, whether on the newly forming relationships, or on speedy completion of the birth process. Additionally, this question identifies the practices of a Birth Attendant during the third stage of labor. There is controversy over immediate clamping versus waiting for the child’s full transfusion of blood, with pros and cons in both camps.

These questions should facilitate a thorough and helpful conversation with your potential Birth Attendant(s). You may or may not have to use them all, or you may want to develop your own. Whatever you choose to do during your interview, remember that achieving satisfaction in the birth is largely a matter of choosing a Birth Attendant in line with your own beliefs and desires. You are purchasing the type of care they practice. Is it the care you want? If not, keep looking until you find what you want.

Teaching your baby to sleep well can be one of the most stressful periods of parenting. A parent can handle so much more when getting adequate sleep, and conversely, so much less when not. Here are some things that I have discovered in parenting my five. Some were good sleepers off the bat and didn’t require much effort on my part, and some were not.

Develop a routine and stick to it. Doesn’t matter what it is, as long as it’s used consistently for bed and nap.

Put baby in bed as soon as he gives any signals of sleepiness. Sometimes you have to be persistent in catching these little signs for awhile so baby will fall asleep quickly and easily in bed, then after awhile, the baby will learn that bed means sleep.

Make sure that baby has an early bed time. Even if that is 6 or 6:30 pm. 8 is usually too late for little kids. If you follow tip #2, you will often find the baby showing signs of sleepiness around 6:30.

A little late for her, but for anyone else reading that needs tips for helping kids sleep well, try to put your baby in bed while awake, even from the little itty-bitty brand new period. If you ALWAYS nurse baby to sleep, baby will not learn to fall asleep by himself. Doesn’t mean you never nurse to sleep, but let baby learn sometimes. If baby looks sleepy, put him in bed.

Tell baby you expect him to go to sleep now. Let him know that if he can’t sleep, you will come comfort him, but now is the time to sleep. When baby cries, lift him, hug him, pat him, and PUT HIM BACK. Next time, just pat his back or rub him (if baby sleeps on tummy, a really good method of soothing is to push him up and down on his bottom in a rocking motion). Allow him time to cry and then settle himself, so maybe check every 5-10 min, and leave. After an hour, if baby hasn’t settled, then nap is over. Try again in a couple hours.

Set up a consistent nap schedule. Young babies should be asleep again about 2 hours after they wake in the morning, and then roughly three hours in between naps/bed. Older babies will be able to stay up a bit longer after waking in the morning, but at a year, should still be able to get two naps in a day. Depending on waking time, I’d try a nap at 10 am, and then 1 pm or so.

Sometimes a lovey helps. It can be anything from a teddy to a blankie. By 1 year, the child may have already shown an attachment to something. You can foster an attachment by keeping the lovey between you while breastfeeding, or sleeping with it yourself for a few nights, so that it comes to smell like you (I’ve even heard of moms using one of their own t-shirts, but keep safety in mind). Then, always put baby to bed with the lovey. Don’t forget it at home if you are going out for the day and baby will nap elsewhere. The lovey will help baby be able to sleep anywhere.

Sometimes baby needs help falling asleep, and you may find yourself doing very strange movements. One of my children needed to be rocked front-to-back, swung side-to-side, and bounced all at the same time. But it worked. Be creative!

I hate turning to antibiotics unless absolutely necessary. And especially on the weekend, it is my goal to avoid seeking medical help, since I’d have to go to the ER in the next county, 30 minutes away–a long, dreary and painful ride when one is suffering chills of fever. So far, I’ve managed to battle four incidences of mastitis with nary a prescription med yet.

It’s important to identify true mastitis, though, because if traditional treatments fail, it is important not to delay medical treatment too long. There are three “level” of breast maladies that may befall a lactating woman. The first is a plugged duct, commonly caused by inefficient emptying of the breast, or too restrictive clothing. This is characterized by an achy spot in the breast, with a reddened area of the breast over it. If not removed, the plugged duct may become mastitis. Mastitis is accompanied with fever and flu-ish feelings. Mastitis is frequently a rapid onset, though, while a plugged duct evolves more slowly. Occasionally the breast may secrete pus. This is a breast abcess, and is the most serious of the three conditions.

There are three key components to successful treatment of mastitis, whether one chooses medicinal or non-medicinal treatments: rest, emptying of the breast, and reducing inflammation.

Often mastitis occurs because the mother is overdoing. Infection forces her to rest. While treating the breast infection, and for a day or two following, the entire focus should be on breastfeeding. Take baby to bed, and call someone if necessary to take over the running of the household and the care of older children. It seems the greater number of children one has, the greater the potentiality for mastitis…because it occurs when the mother is overdoing.

When the breast is infected, there is usually a blockage somewhere. It is important that the blockage is removed. While the baby nurses, massage the spot(s) towards the nipple, seeking to expel the blockage. Baby should nurse on the affected breast first, because the suck is strongest at the beginning of a feed. It is often helpful to drain the breast in the bathtub. Fill the tub with hot water, lean over until the breast is fully immersed and then hand express. The water equalizes the pressure within and outside the breast, and the milk will flow more easily. Sometimes it will take a couple of attempts to fully express any blockages.

To battle the infection itself, we need to treat the body systemically. To reduce fever and inflammation, I usually turn to a faster acting OTC medication, preferably Ibuprofen. Tylenol should be avoided as it is damaging to the liver. To support the bodies natural processes, though, I also use high dose Vitamin C therapy. I have been told that Vitamin C in excess of 4000 mg reaches anitmicrobial levels. Vitamin C has also been shown to be safe at levels far above RDA. From the onset of symptoms, I will dose about 500-1000 mg of Vitamin C, 4-5 times daily. These levels should not be used long-term however. Other methods I’ve used of supporting the bodies natural defenses while creating an anti-microbial environment include ingesting raw garlic (I’m told green olives stuffed with garlic slices are yummy) and grape seed extract. I prefer Vitamin C simply because of ease of use, lack of unpleasant side effects, ease of storage and low cost.

If these methods show no signs of relief within 24 hours, it is highly recommended to get medical evaluation. An abscess can occur in which the pus cannot be stripped from the milk ducts, which can jeopardize the current milk supply, as well as ability to make milk in that part of the breast in the future. If this occurs, the breast can be drained by an incision, and breastfeeding on that breast need not be hampered, but it needs to be done in a timely manner.

Don’t let mastitis be the end to your breastfeeding relationship with your child. It is a temporary, albeit painful condition, but it is best resolved by continuing to breastfeed. If antibiotics become necessary to treat, bring your body back into natural balance by supplementing with probiotics, most easily found in yogurts with live cultures. Take this impediment as a sign to slow down, relax and spend more time with your baby. Your body and baby will thank you.

Unquestionably, the best way to ensure your odds of achieving your goals through your child’s birth is to hire a care provider who already practices in line with your beliefs. Sometimes it can be hard to determine what your care provider’s beliefs might be at the start of care (but see “Interviewing a Birth Attendant” for tips), but usually throughout the prenatal process, one gathers a feeling for what they may expect of their provider. It is good to keep in mind that if you feel your provider is not going to serve your needs, you always have other options. If you need assistance with determining these options, I’m here to serve you.

Also, in some respects a birth plan may too deeply root a certain picture of what your particular birth is going to be. Birth is not predictable, or controllable, really. I’ve found that no matter what a family’s desires are, whether they intend a natural birth, or have already requested an epidural at their 38 week visit, when birth does not go as “planned” there can be disappointment, regret, and even feelings of failure, even when everyone comes through in good health.

So with all of that in mind, I have included for my clients some helpful tools and ideas for reviewing your birthing options. The primary intention of those who prepared these was for the creation of birth plans. Instead, I would encourage you to think through these, pray about them if that is your belief, and create a document to share with me, listed from what is most important down to what is least, but still desirable. Keep in mind that you need to consider the unexpected as well, and what your desires might be if labor does not follow along with your expectations.

If you still desire to include an official birth plan in your medical chart, I will certainly help you create one that is positive and oriented toward your desires. The simpler, the better, to create an effective birth plan.