Stuff no one told you # 451 - dealing with a blocked nipple pore

This is something we'd all prefer never to have to know about, but if you are planning on breastfeeding then please read on.    A blocked nipple pore is easy to deal with if you know how but can cause major discomfort in the breast and lead on to more serious conditions such as mastitis if you don't recognise it when it starts and treat it appropriately.


The first time it happened to me was when C was six weeks old.  It was a beautiful day and we driving to Mount Usher Gardens in Wicklow.  I became aware of a hard area in my breast that I thought was a blocked duct  (when she was handing out boob blockages, Mother Nature was particularly generous to me so I already had considerably experience in the field despite my recent arrival in Mammyland).   I massaged and massaged but to no avail.  The hard area got bigger and lumpier and more and more sore.   I'm not quite sure why it dawned on me what the problem was but when we stopped for coffee I went into a toilet cubicle and searched my nipple thoroughly for the offending blockage.  Another unimaginably unglamorous moment in the life of a new mother.  


After a bit of scrabbling around in the folds of my own nipple, I located a white dot that was quite literally the troublespot.  Very relieved to find the source, I couldn't remember the treatment so decided we'd better head home and went to tell P.   As I sipped my coffee, my boob was becoming sorer by the second and so I went back to the bathroom to have another look.   I decided to give in to my urges and have a squeeze and then - whooooosh!!   The plug popped out and a torrent of milk gushed out like water out of a fire hydrant.   It kept going for over a minute as all the milk that had been backed up exploded out of the pore.   The relief was enormous and, I must admit, exhilarating (hey, I hadn't been out much that year).  So much so that it was actually worth the whole horrible experience.  I ran out of the loo to spread my good news, put C to the boob to finish off the job and ten minutes later I was good as new and off to enjoy my day out.


This ehow post on blocked ducts is a good thing to have in your bookmarks folder as it goes through a process that might help you to identify the sort of blockage you are dealing with.


With any luck you will never again have to refer to this stuff.   I sure hope I never do!   One way to keep pesky pore plugs at bay if you are prone to them seems to be to wash and dry your nipples after every feed.   Prevention is better than cure, and all of that.

SIDS and room sharing - the evidence

All new parents know (or at least they should) that it is recommended to keep their infants sleeping in the same room with them for the first six months of life.  This is because "research" shows that the risk of Sudden Infant Death Syndrome (SIDS) is lowered when your baby sleeps close to you.  Or to put it another way - when your baby is not sleeping in your room, they are at an increased risk of dying suddenly.    Scary, huh?

The problem is that many babies are noisy sleepers and keep their poor parents awake by grunting, snorting and farting through the night.   Other parents find that their baby sleeps lightly or startles easily and they end up creeping about the bedroom, dodging creaky floorboards in the blackness, afraid to cough, sneeze or even breathe wrong in case baby wakes and a terrible night's sleep for all ensues.   A loud snorer and a jumpy baby are particularly unfortunate roommates for a sleep-deprived mammy.


So it's common to see parents (generally mothers) ask on internet message boards about moving their baby to their own room before the recommended 6 months of age.   And generally, they find many parents who say they did so, to the benefit of all concerned.   But here's the thing - is it ok to move your baby just because others have done so?    And just how big is the risk to your baby if you do ship them out on their own?  


Rather than just accept that "research says...", I decided to take a closer look at some of the evidence relating to the current SIDS prevention recommendations.     A number of research papers cited by the Australian charity SIDS and Kids have shown that when a parent or other caregiver sleeps in the same room with a baby, the chance of the baby dying from  SIDS is reduced by up to 50% (1,2,3,5) when compared to babies sleeping in a separate bedroom (2,3,4).   Three studies reported that babies sleeping in separate rooms had three times the risk of SIDS (3-5),  while another study claimed that babies sleeping alone had a 10-fold risk of SIDS (2).     In fact, one of the papers also found that unsupervised day naps were equally as dangerous as solitary nightime sleeps (6).



The protective effect seems to be attributable to the parent or caregiver's presence in the room so the substitution of a baby monitor in loco parentis doesn't protect the baby in the same way.


Of course, it goes without saying that keeping your baby in your room with you is only one factor in protecting them from SIDS.   Nevertheless, it is a significant one.    It's funny how often you blindly accept guidelines because you hear that "research says....".   Having trawled through those papers,  I can say from an informed perspective that the evidence against moving your little one before the prime SIDS danger period is up is resounding.    I've had my scholars hat on this evening in order to stay objective while dealing with a highly emotive subject  - but I know that when my daughter calls for me tonight, I'll be going to her willingly and holding her a little more tenderly.

1. Mitchell EA, Thompson JMD. (1995) Co-sleeping increases the risk of SIDS, but sleeping in the parents' bedroom lowers it. In: Rognum TO. (Ed.) Sudden Infant Death Syndrome: New trends in the nineties. Scandinavian University Press: Oslo: 266-269.
2. Blair PS, Fleming PJ, Smith IJ, Ward Platt M, Young J, Nadin P, Berry PJ, Golding J and the CESDI SUDI research group. (1999) Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. British Medical Journal 319(7223): 1457-1462.
3. Carpenter RG, Irgens LM, Blair PS, England PD, Fleming PJ, Huber J, Jorch G, Schreuder P. (2004). Sudden unexplained infant death in 20 regions in Europe: case control study. The Lancet 363 (9404):185-91.

4. Scragg RKR, Mitchell EA, Stewart AW, Ford RPK, Taylor BJ, Hassall IB, Williams SM, Thompson JMD. (1996) Infant room-sharing and prone sleep position in sudden infant death syndrome. The Lancet 347(8993): 7–12.

5. Tappin D, Ecob R, Stat S, Brooke H. (2005) Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study. The Journal of Pediatrics 147(1): 32-37.

6.  Blair PS, Ward-Platt M, Smith IJ, Fleming PJ and the CESDI SUDI Research Group. (2006) Sudden infant death syndrome and the time of death: factors associated with night-time and day time deaths. International Journal of Epidemiology 35(6): 1563-1569.

Feel the burn and do it anyway

 

So I exercised yesterday for probably the third time since C was born.   Now, before pregnancy I was obsessed with Pilates and practiced most days.  I was pretty evangelical about it because I had taken it up after a back problem developed and persisted on and off for two years.    It was a dull nagging ache that meant I was always uncomfortable at work despite spending a considerable part of most days adjusting my chair in the several different ways it was adjustable.    I couldn't exercise and for a while couldn't even do anything that involved standing which was awful as gigs were a no-no.  Eventually I found the wonderful Aisling Harmon, a talented osteopath, who made it go away and I credit Pilates with keeping it away.    I continued to practice during pregnancy, right up until a couple of weeks before I delivered and was amazed to have no back problems at all.


One day when doing my stomach exercises, I looked down and saw a pyramid of muscle protruding from my abdomen.   You don't need to be a doctor to know that's not good.  After a bit of research, I realised it was  diastasis recti, a common condition in pregnancy where your six pack separates to allow the expansion of the womb.     This happens to most of us but I guess it goes unnoticed the majority of the time because there aren't that many of us doing Pilates roll ups at 20 weeks gone. 


I was convinced that once I had C, I would be back practicing within 6 weeks, during her morning nap.  I know those of you who have babies are having a good roll around the floor laughing at this point.  Obviously that didn't happen.    It's hard to find the time to have a pee, nigh on impossible to achieve the head space to commit yourself to a mind-body exercise like Pilates.   Anyway, a self-assessment of the damage to my stomach muscles post-natally revealed a hole where they used to be.  This is the diastasis after pregnancy.  I could fit three fingers between the left and right side which apparently isn't bad but it felt very strange indeed.    I read that time would bring it back together so I was able to vegetate with a clear conscience, knowing I shouldn't exercise in the meantime in case I strengthened the muscles in the "apart" position which would mean they would stay there.


Eventually things seemed fairly normal in the abs region and life with C had become slightly more predictable (this was probably somewhere around the 6 month mark).   During her nap one morning, I got out my Pilates mat, stuck on my dvd and started.  Or at least I tried to.  On my first roll-up, I couldn't even get my shoulders off the ground.  I was shocked.   I'd expected my mid-section to be weakened, not utterly decimated.



So what did I do?   Well, I didn't practice and practice every day until it got back to something approaching normal.   I just gave up.  I told myself it would never be back to normal anyway, so what was the point?   It wasn't until recently when C refused to go into the buggy and I realised that as a result I was getting zero exercise of any description that I made up my mind I would need to sort out my body.   I've always found exercise to be a great mood elevator and could feel myself falling into a bit of a hole for the lack of it.

Scared of trying Pilates again, I turned back to Cindy Crawford and her "A New Dimension" workout dvd.  The workout is aimed specifically at women who have recently given birth but when I first bought this seven years ago, I didn't realise.    Once I did, I didn't care, because it is one of the best total body toning dvd's I've  done.   In 40 minutes, you hit all of the usual problem areas, plus weights are used which I personally love.       So if you are looking to tone up and think you could find 40 minutes once or twice a week to do this workout at home, I would highly recommend it.
 

I'll admit that completing the workout after such a long hiatus wasn't easy but I felt like She-Ra afterwards.   The after effects were predictable considering my level of unfitness.  Walking for the next four days was a challenge and going upstairs nearly killed me.  The workout has strength exercises to tone your bum and thighs, push ups for your chest and arms,  a great toning section for abs, and weights to streamline your arms.  Each section is short and snappy so it doesn't get boring and the music is pretty decent for a workout dvd.  OK, so most of us could do without looking at a supermodel when we are trying to kick our post-birth bodies into shape, and she does look annoyingly fabulous, but if you look closely you will see a very strange distribution of fat around her hips which betray the presence of some serious control pants.   So even Cindy Crawford is not perfect. Yay!

I skip the abs section of the workout and substitute 10 minutes of Pilates core work instead, because I think it's a lot better for my back.  If you are really horrified with your mid-section and want to sort it out, I recommend this 10 Minute Solution workout.   Anyone with no kids won't understand why finding even 10 minutes a day is impossible a lot of the time, but think what a difference it would make if you could.   So stop thinking there's no point trying and just do it (cue a law suit by Nike).   You might be pleasantly surprised at the results.

Love, love, love Boutique by Jaeger

I was almost fatally trapped in Arnotts household department for about 15 minutes the other day, explaining to my husband why we couldn't afford to have curtains made-to-measure for our bedroom.  Narrowly escaping death-by-boredom, I revived myself with a wander in the fashion gallery and discovered a new label crush. 

Boutique by Jaeger is new to Arnotts and is amazing.   I just about managed to restrain myself from whipping out the credit card and splurging money I don't have and won't have for the foreseeable future on this silk tea dress.   Says it all really - curtains that would hang on my windows for likely 10 years or so were beyond our budget but I was willing to fork out twice that from my savings for a dress that would make it out of my wardrobe at most a couple of times a year because silk and toddlers are not exactly best friends.   


I spent a lot of my pre-recession earnings on my wardrobe - now the clothes hang there forlornly, wondering if they are ever going to have a chance to wow again.  The thing is though, it still gives me more pleasure to look in and see them waiting there than it would to have an exquisite pair of curtains framing the bedroom window.    It gives me hope that one day I'll be back out there living it up, drinking cocktails while draped in silk, far away from sticky chubby hands.  


But if you see me shopping for new window treatments while dressed head-to-toe in Primark, be kind and look the other way.

Why the Breast Milk Baby doll is so scary

The launch of a new toy called the Breast Milk Baby has, as anyone could have predicted, caused massive controversy on online forums.  It comes with a bib that has flowers on the nipple area and the baby doll attaches to these for a feed, then "drinks" and "burps". 


The American Christian manufacturers of the doll have created it to promote breastfeeding and claim that “the whole purpose of The Breast Milk Baby is to teach children the nurturing skills they’ll need to raise their own healthy babies in the future".


It's all a bit pointless though, because surely the only families who would buy such a doll are pro breastfeeding and this is what influences women in their feeding choices.    Anyone who has issues around breastfeeding would never buy this doll for their child so the message the manufacturers purport to be spreading is not going to get to those they are trying to target.   In any case, I know many little girls who happily mime breastfeeding their doll to copy Mammy so what's wrong with a little imagination?


Although negative comments about the doll are to be expected, some of the feeling it has generated is quite extreme and not a little bizarre.  On online forums, the doll has been called creepy, perverse and there has been much metaphorical wringing of hands with cries of "let them be kids" and "don't take away their innocence".    These sorts of comments speak to me of a deep-seated discomfort with the very idea of breastfeeding that is pervasive in our society although it's not PC to express it, so reacting to the doll is a free pass to voice these deeply held negative feelings.    Something you hear expressed often is "I've no problem with breastfeeding but...."   Well, ladies, don't worry.  Breastfeeding is unfortunately not infectious so you can happily let your daughter play with the freaky kid in number 55 and her perverted nipple bib and she could still grow up to make you proud by only using her nipples for the sexual pleasure of herself and others.


I bet the same women who think this toy will sexualise their little girls allow them to play with Barbie, who looks like she's heading off for a night of debauchery at the Playboy Mansion.   So it's ok for breasts to be part of little girls' play if they are pumped-up fetishised super-bazookas but not ok for nipples represented by pretty little flowers to enter into things.   


I understand that in a society where the threat of paedophilia is ever-present in mothers' minds that anything which relates children and sex  is scary but surely the sorts of comments above would be more justifiably directed at pop-culture rather than a harmless toy?


It frightens me that I am bringing my daughter up in a society where a tiny minority of women identify themselves as feminists, and the Playboy bunny is emblazoned on little girls' pencil cases.  And a breastfeeding doll is seen as threatening little girls' innocence.

When the wind blows (or doesn't)

There are many, many things no one tells you about babies before you have one, probably because you wouldn't believe them.   One of those is what noisy sleepers small babies are.  Lying in the dark, you could be forgiven for thinking a rhino had entered the room and eaten your baby because it's almost incomprehensible that someone whose head is smaller than your newly-inflated breast could actually make that sort of noise.

A lot of new mammies express concern about the amount of grunting, squirming and farting that goes on in the wee small hours, not least because it keeps everyone awake.    Trapped wind can be a problem with breastfed as well as formula fed babies, which I always felt as a terrible injustice!    Before you run out for infacol, or make arrangements to bootleg some gripe water, consider baby massage.   It's a lovely activity for you and your baby and has lots of health benefits.  If you can afford classes, which generally cost around €120 for a 4 or 5 week course, then they are a great way to build confidence with the techniques, get a full understanding of the benefits and also to meet other mothers.    However, with a small baby, participation in the class can be a bit hit-and-miss as I found out when I took my 2 month old, who didn't appreciate the change to her routine and spent every class except the final one either feeding, protesting or asleep on my shoulder.

Have a look at these videos for a natural way to release that troublesome trapped gas using massage.  I found the first one worked particularly well for us, especially if done at every nappy change. 

There's lots more of this sort of thing on youtube.    Try it - it could be a solution for a (somewhat) better night's sleep for everyone.

Enough of the breast-beating

You may have seen a segment on TV3 Midday on Wednesday where a recent article that claimed breastfed babies are more intelligent was heavily criticised.  I expected this piece was going to be reactionary and anti-breastfeeding as one of the panelists was Aileen Hickie, writer of an article entitled "Is Breastfeeding Really Best?" a number of months ago.  Quite why I feel the need to seek out and watch stuff that is guaranteed to get my blood boiling is a mystery to me,  but afterwards when I'd calmed to a gentle simmer, I thought of the long-term implications this sort of thing has on the health of the nation.  It seems that every time a study points to the benefits of breastfeeding, the media commentary around it involves such an outpouring of negativity that it probably turns more women off than on.    And this is very bad news for the HSE.


Ireland has one of the lowest rates of breastfeeding in the world.  We also have some of the highest rates of obesity, breast and ovarian cancer, heart attacks, osteoporosis and asthma (4th highest in the world!).  Breastfeeding provides protection against all of these illnesses, and more, via benefits to the mother or baby.    It obviously makes sense for there to be a national strategy to increase breastfeeding rates.  But this strategy is not backed up by the resources to make it happen and the efforts of those who are implementing policy are often falling woefully short of expectations.   Instead, women who don't want to breastfeed feel it is pushed at them by midwives while those who need help to get breastfeeding established often find it's not forthcoming because the post-natal wards are too busy or the advice they get is different each day depending on who is on duty.    Some public health nurses don't seem to be aware of current best practice around breastfeeding and are peddling misinformation that could damage a successful breastfeeding relationship.    Yes, there are wonderful midwives and nurses out there doing a great job but a lot of women seem to be angry about their experiences around feeding and this contributes to a perceived breast vs bottle divide which makes no sense in a country where breastfeeding rates to one year are so embarrassingly tiny that almost every mother will end up giving her baby formula at some stage anyway.

As things currently stand, the only way that breastfeeding rates will increase is through peer-to-peer support of those who want to breastfeed via organisations such as Cuidiu, La Leche League and Friends of Breastfeeding.   Everyone who breastfeeds successfully knows that it is up to us to promote it, because national policy alone isn't enough and in any case, we all need to contribute to creating a breastfeeding culture.  This is why we react against the likes of Aileen Hickie who casually frightens women on daytime television by talking about how trying unsuccessfully to breastfeed leads to post-natal depression.     She then views the backlash against such comments as militantism by what she calls the breastfeeding mafia.  Defending breastfeeding is not about bashing those who formula feed their babies, it is about trying to encourage those who might breastfeed in the future.  Promoting breastfeeding is not done to make anyone feel guilty, but the health benefits are proven and mothers-to-be need to know about them.  Improving our breastfeeding rates would impact on the incidence of the serious illnesses mentioned above and many more besides. 


Maybe,one day,  if  the country invests wisely in our long term health by requiring PHNs and midwives to regularly take refresher courses to update both their breastfeeding knowledge and their people skills, we can all be friends again.   Breastfeeding rates will soar and the nation will be slim and wheeze free.


Well, a girl can dream......!