Barb's Daily Dose

Sleep When Your Baby Sleeps

You've heard it a million times, and that's because it's true. For new moms, lack of sleep is associated with postpartum depression. We've known this for years, and have seen the research evolve so that now, we're screening moms while they're pregnant for sleep disorders, since that too, is predictive of an increased likelihood of being depressed after the baby arrives.  

My friend, Pec Indman, who co-wrote the book, Beyond The Blues says, "Preventing people from sleeping is like torture. People's moods change and it's no surprise that new moms, who are getting up around the clock, have hormonal shifts and are trying to recover become depressed."  So, sleep as much as possible, you'll feel better.  

 

I have more tips on breastfeeding in my Personal Guide to Breastfeeding.

The Milk Fairy

Here's a question I received this week:

My baby is 5 days old, and my milk hasn't come in yet. She's latching on, but wasn't having any wet or poopy diapers so the pediatrician suggested that we supplement with formula.  How do I get my milk to come in?

It sounds like the Milk fairy hasn't made an appearance at your house yet.

Here's what I recommend:

• Please, as much as possible try to get plenty of rest

• Offer the baby your breast at each feeding, and after 10 minutes or so, offer her a bottle, to make sure that she's getting nutrition 

• Try to pump 4-6 times each day, after feedings and see if you're producing

• Most moms get the highest volume in the morning, when they've had a chance to rest a bit

• Try a safe herb, Fenugreek, 3 times/day to help increase supply

When to Call Your Pediatrician

I write lots of blogs, and advice columns for a variety of websites, like this one and receive questions every day from moms who need advice about their babies. Often, the best advice I can give is to:

Call Your Pediatrician

Here’s a short list of when to call them:

• Your Baby is spitting up all the time
• You’re thinking of switching formulas, and need a recommendation
• You don’t think your baby is getting enough to eat and isn’t gaining weight.

There are countless other questions. But these are ones, that are best discussed with your baby’s own health care provider. Please do give them a call.  Often you can get advice from a nurse in the practice or a phone call, without having to make an appointment.

Post Baby Dry Spell

I was just asked if there was a scientific explanation for the loss or decrease of sex drive or libido that some women experience after childbirth if women are breast-feeding? 

I think most moms would say, "Hello!  We're tired."  I think sleep deprivation for all parents is the # 1 factor for their completely normal decline in canoodling. 

There are other factors at play here when women breastfeed. The hormone prolactin that makes milk, inhibits the release of estrogen (our #1 hormone for sexiness and libido.) Remember that there are more estrogen receptors in the vulva (private girl parts, this is my scientific term) than any other place in the body. 

Women who breastfeed may notice that their private girl parts don't look the same as they did in the past. The labia shrinks and things are a little less moist. Some would say Desert Dry. This isn't from a vaginal birth, because it happens for women who had a C-Section. 

What happens is that mother nature doesn't want women to be hot for their partners too soon after giving birth. In order for that baby to have enough milk to survive, it's essential that a mom NOT ENJOY SEX and make another baby, which would decrease milk supply. 

In a nutshell

Prolactin inhibits Estrogen which decreases libido, makes areas Sahara dry, changes arousal patterns and frankly prolongs the time it takes to have an orgasm. Many breastfeeding moms find that having an orgasm takes Forever and they give up and get some sleep. (unless the breast stimulation overrides that, which is another story).

Choices

If you like to bet, when new parents are in the Casino of Love, and given the choice between Sex & Sleep, they choose Sleep more often than Sex. Read more on Sex Versus Sleep

Breastfeeding as Contraception?

Recently I was asked whether women who breastfeed need to worry about contraception. 

The answer is:

You sure can.  If you're lucky enough to have the energy and the hots for your partner right now, even though you're probably sleep deprived and craving a little time to yourself. If you're thinking about some cuddling and some intimacy with your partner, then please be sure to use some form of birth control. Although women who are breastfeeding might not have a period, they can still ovulate and get pregnant.

So, play it safe and lubricate, lubricate, lubricate.  Most women who are breastfeeding find that their vaginas are very dry and don't stretch like they used to.  Likewise, their sexual response might be slower. This is a completely natural side effect of breastfeeding.  You see, the hormone prolactin that makes milk, inhibits the hormone estrogen which helps keep our private girl parts moist and able to stretch.  So, no matter what you use for birth control, get yourself some lubricant, and have fun. For more on breastfeeding, see my Personal Guide to Breastfeeding.

After a C-Section

I like finding cool things for women that makes their lives easier. I didn't receive any payment or free undies for this endorsements. I just think it's great. You can check out these fun & flirty undies at www.czelablue.com.

Here's a guest blog from the fabulous Mom who created an innovative solution to what to wear after a C-Section: Czela Bellies

From Jennifer: It was three years ago, this Halloween that I found myself looking up at my nurses and doctor's, wearing googly antenna ears, and super hero capes prepping me for my second c-section delivery. 

Helping Babies Sleep

Before 6 months

Every baby is different.  Some only need 10-20 minute cat naps, a few times a day, and others thrive on 2 – 3 hour snoozes every few hours.  Babies who are less than 6 months of age are completely different beings from babies who are 6-12 months of age.  Before 6 months, babies change every 1-3 days and their sleep patterns are erratic.  After 6 months, in general if a baby is asleep past 4 pm, they will not go to sleep again until after 10 or 11 pm.  As hard as it is, try to get them to nap and wake before 4pm. 

Each Child is unique

My feeling is that each parent and child pair is different and that one size does not fit all.  Parents need to find the method to help their child sleep that they are most comfortable with. My number one tip is not to try anything unless both parents are completely committed to finding a method and then sticking with it, because it’s too tempting to change strategies in the middle of the night, when everyone is exhausted, cranky and just want to get back to sleep no matter what the long-term consequences are.

Sleep routines evolve as children develop

It is absolutely, perfectly normal for a 15 - 18 month old toddler to stop sleeping through the night and begin waking at 3 am.  As babies and children grow and develop, their sleep patterns also change.  This is to be expected and planned for.  As children’s brains develop in their toddler years, parents often have to re-visit sleep issues and try new techniques. They are developing more language and more ability to remember events which can lead to waking. Expect sleep disturbances again between age 3 and 4.

What about the 3 am feedings?

 Great question.  Unless your pediatrician has advised that you feed your baby through the night because they are small and / or need the calories, this is not the best way to preserve your sanity.  Sleep deprivation is a form of torture and creates anarchy in a home.  So prevent mood swings, irritability, and postpartum depression by getting enough sleep, and that may mean that you have to rely on the experts who will help you help your child learn to sleep through the night.

Postpartum Depression resources

3 Simple Questions may predict who's at Risk

Recently an article in the Journal of Pediatrics found that 3 simple questions might help providers identify new moms at risk for postpartum depression. For this new screening tool, new mothers were asked to answer "Yes, most of the time," "Yes, some of the time," "Not very often" or "No, never" to the following statements:

1. I have blamed myself unnecessarily when things went wrong.
2. I have felt scared or panicky for not very good reason.
3. I have been anxious or worried for not very good reason.

These questions are modified from a much longer screening questionnaire, the Edinburgh Postnatal Depression Scale (EPDS). I have used this with my patients in the past and found it very helpful. 

Now, we are using a different questionnaire, the Beck Postpartum Depression Predictors Inventory (PDPI). 

In any case, it's my experience that not enough practices use any type of questionnaire. Hopefully, this new shorter version will make it easier and faster to identify moms who are more likely to be depressed and not just experiencing baby blues. 

Codeine After Birth

Careful with Pain Relief

Recently, there have been disturbing reports of new moms who were prescribed codeine to help reduce their pain after giving birth. Sadly, some moms have a genetic variance that causes them to be rapid metabolizers of codeine. When codeine is rapidly metabolized it produces high levels of morphine in the blood and breastmilk which can leave babies very drowsy and difficult to wake. In 2007, in Toronto, one baby whose mom had taken her prescribed codeine for pain relief died after breastfeeding.

Rare

Thankfully the genetic variance that causes rapid codeine metabolism is rare. So taking codeine is not risky for most women and is worrisome for a few.

• The US FDA found that 1% to 10% of Caucasians and about 3% of Asian and African Americans are rapid metabolizers.

• Women from North Africa, the Middle East and Africa have much higher rates of this genetic variance, and it’s estimated as high as 28%.

Don’t stop Breastfeeding

The most important thing that we all have learned from this terrible tragedy is to ask women if they’ve ever used these medications in the past and whether they felt drowsy of more of the effects than expected. These moms should try non-narcotic pain relief first.

The Best Birth Plan Ever: Part 4

If you’ve been following the previous posts, you know that we’ve been talking about birth plans and how to talk to our OB provider. If you missed them, here are the links:

Part 1

Part 2

Part 3

Talking to your Midwife or OB

Once you’ve reviewed birth plans and made your list, it’s a good idea to bring the long birth plan full of the options to an OB appointment 4-6 weeks before delivery and review it with your provider.

Most OB providers have read countless birth plans and know all the variations. They’ve read them many times before and most of what you want, is now standard practice. Really, I’m not just saying this to reassure you. Pretty much, unless you want to hang upside down, or invite a high school marching band into the room, what most women want, is what we’re going to suggest or do anyway.

Sample Script

It’s helpful to start out with a communication strategy that engages and moves the dialogue forward while letting your provider know what you need. Here’s a sample script:

I know that anything can happen in labor, and that each woman’s experience will be unique. Like you, our goal is to have a healthy mommy and a healthy baby. There are some things that I have questions about, for instance, what you would recommend if……..were to happen.

I also want to let you know, that while I know there are no guarantees, it’s really important to me that ………….happen, if at all possible. Having…………. is one my of my highest priorities.

This script is helpful even when you’re in labor and talking to your Doula, the nurses, or anesthesiologist.