Category Archives: How To

S.H.I.E.L.D

Use of nipple shields is controversial in the world of breastfeeding and for good reason – you shouldn’t need them. Nipple shields should be a short term solution – if your baby can’t latch or breastfeeding is painful then nipple shields help in that they allow the baby to latch and allow the nipples to heal, but they can’t resolve the problem and that problem really does need to be identified and resolved. And I think that is the crux of the problem not so much with nipple shields themselves – in reality they are an amazing device which would otherwise have prevented me from breastfeeding – but because they are recommended without due care and attention.
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I was told to use them because my nipples were flat, I used them and it was only six weeks later when I thought I should wean Elphie off them that it was discovered that my nipples in fact were not flat, Elphie was tongue tied. But by then it was too late – Elphie was hooked on them and although physically she could nurse normally after the revision, she didn’t want to – she was used to the silicon nipple and didn’t want this weird fleshy nipple that required a slightly different technique (wider mouth, less just sucking it in).

I battled to get her to breastfeed normally – tears were shed (both hers and mine), breastfeeding drop-ins were attended, we reverted to skin to skin, and although sometimes she would latch on most of the time she wouldn’t and she would cry until I gave up and went for the shield.

I started questioning myself – why was I so desperate to wean her off the shields? She was feeding well on them, my milk supply seemed fine and she seemed to hate breastfeeding without them. The advantages of normal breastfeeding over doing so with the shields would be less sterilising and less risk of meltdowns if I forgot the shields and less of a dent in my pride due to an inability to breastfeed. But were these really reasons to upset her? Wasn’t I just being selfish trying to get her off them? I was trying to be responsive to my baby and led by her and yet here I was doing precisely the opposite, trying to get her to do something she obviously didn’t want to do.

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Perchance to wean

One session of my recent NCT postnatal course was devoted to the topic of weaning our babies.

What is weaning?

I think the word “weaning” in this context is slightly misleading, as it often tends to be paired with “off”; for example, “I weaned myself off cake”. The definition according to Google (my new favourite dictionary) is indeed a bit contradictory:

wean wiːn/ verb

  1. accustom (an infant or other young mammal) to food other than its mother’s milk;
  2. accustom (someone) to managing without something which they have become dependent on: “the doctor tried to wean her off the sleeping pills”;
  3. be strongly influenced by (something), especially from an early age: “I was weaned on a regular diet of Hollywood fantasy”.

In the case of weaning a baby, it does not mean automatically stopping breastfeeding, unless you want to or need to for other reasons. A baby is not supposed to have cow’s milk as a drink until they are a year old, due to digestive issues, so if you remove breast milk from the equation at any point in their first year you will have to replace it with formula. Weaning a baby means moving them “ON” to solid food, which is ingested alongside – not instead of – milk. I for one didn’t understand this until I became pregnant, and a couple of people I’ve talked to since have also assumed that any breastfeeding beyond six months is for kicks rather than any real nutritional purpose (one source of confusion might be the World Health Organisation’s recommendation of “exclusive breastfeeding” for the first six months – the key is in the word “exclusive”!)

When to start?

The class leader asked us when we thought a baby was ready to start eating solid food – in other words, an opportunity for her to explode some apparent myths around the subject:

“When he shows interest in me eating.”
Reaching out for and staring at your food looks he wants to eat, but babies show interest in everything you do, and you eating is no more exciting for a baby than you washing up or drying your hair. It’s also true, I suppose, that a baby would not necessarily connect your eating activity with hunger being satisfied. This does make me feel better that at the moment I usually eat breakfast while Pip himself feeds and grab lunch while he sleeps. However, it’s worth bearing in mind that babies also love to copy, so when weaning starts you can eat alongside your baby to encourage them.

“When he starts waking more at night.”
Understandably, one of my classmates suggested a baby starts needing food when milk does not seem to sustain them through the night any more (if it ever did!) – but the teacher pointed out that in terms of calorific content, the foods a baby eats at first are far less filling than milk. Bites of fruit and veg and maybe a spoonful of baby rice aren’t going to tank up your baby enough to make a difference. Apparently it isn’t until a baby is around 8-9 months old that the amount and nature of the food they eat can actually fill them up to the point where they do start to need less milk – more of which later.

The three main things you do need to ensure are in place before commencing weaning are:

  • Good head control;
  • Can reach out to something, pick it up and bring it to their mouth;
  • Baby is around six months old and definitely no younger than 17 weeks.

weaning

Essentially, there are two types of weaning, commonly known as parent-led and baby-led.

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How to: burp a baby

With poo a close second, I have found that wind is our number one obsession when it comes to Elphie – specifically how much we can get out of her through burps (we can’t influence the farts so much). The reason for the obsession is that I am convinced that when she decides to cry inconsolably for hours some evenings (unless baby whisperer Hester is around) that this is due to tummy ache caused by excessive wind that has built up during the day as a result of the significant and noisy guzzling that has gone on.

Wind should be less of a problem for a breastfed baby as the worst culprit for causing wind is the bottle as the fast flow of the teat means the baby has to gulp in air in between sucking and hence gets bubbles of air alongside its food. Apparently the obsession with burping is a very first world problem and a lot of the rest of the world don’t bother! In theory this is because they breastfeed more and do so in a more upright position and hence less air is taken in.

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How to: have tummy time

When Elphie was four weeks I thought I had failed her. Before that point I thought I was supposed to keep her on her back all the time to reduce the risk of SIDS (Sudden Infant Death Syndrome – more commonly known as cot death). But it seemed I was supposed to be giving her “tummy time” lying her on her tummy while awake to play and strengthen her neck, back and leg muscles to eventually help her to crawl. Doing this also apparently helps reduce the risk of SIDS as she can then move her head away from anything smothering her or roll away from it. Although back then the rolling just seemed to put her in danger as if laid on a slight incline she was determined to roll off the sofa onto the floor (I caught her before this happened luckily!).

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How to: bathe a baby

This post was eaten by BT a week ago! In the intervening time, we have been bathing Pip daily and I’m pleased to report that it has gradually become less stressful for all concerned. Mr Cath and I can now even bathe him by ourselves (initially, we needed each other there for moral support!) and we all are starting to – whisper it while touching wood – enjoy the little ritual.

We celebrated Pip’s one month birthday on 10th August by giving him his first bath using products. The hospital told us to just use water up until this point so we followed their instructions to the letter, although I’m sure it would have been fine to break out the soap before this! After researching all sorts of lovely organic things, I’ve gone for good old Johnson & Johnson (couldn’t resist the Asda baby event…) – he already has rashes/baby acne so hopefully it can’t get any worse! In fact, since starting to wash him “properly”, the spots seem to be clearing up nicely.

There is so much conflicting advice out there about how and when to bathe your baby. Some hospitals, like Elly and Elphie’s, give you a tutorial on the topic and you have to actually give them a bath before you can be discharged. Others, like ours, believe the umbilical cord stump should not be immersed in water until it has dropped off and fully healed – before this, you should just top and tail. Not that they told us how to top and tail either – they really didn’t tell us anything: our first foray into cleaning Pip involved propping up our baby book and reading out what to do (now it all just seems like common sense but when you are sleep deprived and don’t know what you’re doing, any guidelines at all are invaluable! We would probably have missed out his ears otherwise…) Here is a video from Gurgle demonstrating topping and tailing and then bathing:

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How to: save a baby, Part II

Continuing my series on first aid for babies…

Burns

My worst nightmare – dropping my cup of tea on Elphie. Especially given my track record, she’d only been in my arms five seconds in the hospital when I managed to drop my entire cup of water on her.

Interestingly another video I watched told you to apply the cling film lengthways along the burn i.e. if the burn was on the arm then you would roll the clingfilm down the arm rather than across it. No idea what properties the length of clingfilm has which is different to it width-ways!

Bleeding

I like the idea of gravity lending a hand if you move the wounded limb above the heart!

Obviously babies don’t have a lot of blood. By my calculations (using the University of Michigan Medical School tables for infant blood volume) Elphie has less than a pint of blood at the moment, so any loss could be significant.

Shock

A side effect of severe bleeding (either external or internal) can be that the baby goes into shock. This sounds less troubling than it is, as hypovolemic shock basically means the circulatory system is not providing enough oxygen via the blood, for example, if some of said blood is making a puddle on the floor. Oxygen not reaching your organs is not great and hence this can result in death. The following article from Nielsen Hayden describes the various stages of shock and what to do in each, but the Cliff Notes version from Dear Nurses shows you the symptoms and treatment for hypovolemic shock:
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Although an interesting caveat from Wikipedia is:
“Note that in children, compensation can result in an artificially high blood pressure despite hypovolemia. Children will typically compensate (maintain blood pressure despite loss of blood volume) for a longer period than adults, but will deteriorate rapidly and severely once they do begin to decompensate. This is another reason (aside from initial lower blood volume) that even the possibility of internal bleeding in children should almost always be treated aggressively.”

In any case, I reckon I would be getting myself and herself to A&E sharpish if anything like this happened! In the meantime, I think tea will be drunk with her at a distance.

How to: save a baby, Part I

A worry has been niggling at me – Cath and Mr Cath went to a baby first aid course before Pip was born, and I meant to go to one but for some reason haven’t quite gotten around to it yet. As each day passes I worry that I don’t really know what to do if Elphie is faced with a life threatening situation.

Yesterday I had a scare, I was sitting on the sofa with Elphie beside me happily, er, self-winding, when suddenly she was letting out a strange cry and seemed to be having difficulty breathing. I sat her up and rubbed her back and things returned to normal. I have no idea what it was – she hadn’t been fed for a while so I can only imagine that she was choking on a bit of vomit or spittle.

Either way, this was the wake up call I needed to do some research into basic baby first aid. As Stephen Fry’s favourite newspaper reports, choking is the third most common cause of infant death in the UK, after road traffic accidents and house fires; and even if resolved fast enough can result in brain damage.

The following videos cover responses to an unconscious baby and the second set to a choking baby.

CPR (loss of consciousness)

Choking

I found I needed to watch them twice to get the to sink in.

I am tempted to attempt the baby sandwich manoeuvre on Elphie… On second thoughts maybe I should use a pillow to practice on!

Coping: continued

Our first few days at home with Pip were emotional, overwhelming and above all exhausting. After the bubble of being looked after at hospital, it came as a shock to be suddenly fending for ourselves. It took precisely 24 hours at home before we called up my Mum to come stay with us! Although it was an incredible lifesaver having her there, it took me a few more days to pull myself together and learn my own coping mechanisms. I absolutely second all of Elly’s suggestions – in fact she was really helpful at the time – and would like to add a few more things that for me also made a significant difference:

1. Prioritise breastfeeding

Breastfeeding is such a challenge in the first few weeks – it hurts (especially if you have thrush like I had), it takes up an enormous amount of time and it makes you really thirsty and hungry. If you are exclusively breastfeeding, it’s pretty much a full time job! Seeing as you spend hours on this activity, it’s worth trying to nail it as early as possible.

A baby’s main way of communication is unfortunately crying. Life would be much easier (and quieter) if Pip was able to articulate his needs by saying “Mummy dearest, please may I have some of that delicious milk of yours? I appear to be rather peckish.” Instead, I’m treated to the most distressing sound in the world.

In the early days, I hated the slightest peep so much that I would immediately get them out and start feeding him just to make it stop. After a minute or so the plaintive cries – this time from Mummy – would begin: “can you get me my glass of water? And a footstool? And an extra pillow? …etc.” Depending where I found myself at the time of Pip’s request, this could require some running around on the part of Mr Cath, leaving me feeling a frustrated combination of guilty and petulant. I know the new mum is supposed to be waited on, but after a few days of this I wanted to take back control and stop continually making demands.

Now I have everything set up ready for a feeding session before I allow Pip to dig in, even if this means he has to cry for a minute or two. I figure that it’s more important to have a relaxed and tension-free Mummy while breastfeeding, as apparently stress inhibits milk supply. I have two main feeding stations, and so what if one of the footstools is a cardboard box full of books? It’s better than the upturned laundry basket, which I soon broke (cue more tears…) Whatever works and is comfortable!

My DreamGenii breastfeeding pillow has also been amazing, as I can now carry on almost as normal. The best thing is being able to eat while feeding – one stressful aspect of having my Mum looking after us was that she’d make this lovely dinner and then Pip would decide he was hungry too…

feeding pillow

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In the bag: the return

I’m pleased to report that my three hospital bags provided pretty much everything I needed during my stay. However, I did inevitably overpack and next time would definitely try to reduce it to one!

I was given drugs to lower my blood pressure which affected Pip’s blood sugar levels. This meant we had to stay in hospital for 48 hours for monitoring. In the end this was extended to 72 hours, or three nights. All rather unexpected! There were the usual items such as maternity pads and disposable pants that I’d luckily packed almost enough of – I did have to supplement these with NHS ones on the last day but by then I knew I was going home so it was fine. More interestingly, there were a few things that (a) I’d suspected might be useless but turned out to be essential and (b) vice versa. Here is my verdict on my hospital bag contents.

Things that were surprisingly useful:

1. Snacks

Although I was provided with three reasonably substantial meals a day in hospital, they were not quite enough for someone who had been through labour and birth! My appetite was insatiable. Mr Cath did get me my longed-for brie baguette from Pret and I also had a couple of takeaway pastas from Carluccio’s, but in between I topped up with the cereal bars, nuts and dried fruit I’d packed in my hospital bag. I’d thought these would just be taken straight home again, but like the very hungry caterpillar I munched my way through them all.

2. Towel

As suspected, the hospital did provide a towel, but it was tiny. It was great to have a normal-sized one. But make sure you wouldn’t mind getting stains on it (nice!) Even though my towel filled most of one bag, it would be an essential for next time.

3. Compact mirror

There were two bathrooms next to my ward and the one with the nicer shower had no mirror. While I didn’t feel the need to look at myself much (and trust me, I lost ALL vanity while in hospital), it was useful to check I didn’t have a white blob on my face after moisturising.

Things I thought I’d need but were unused:

1. Clothes in general

gown

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