I hypothesized I'd be reading more (wrong!) and I never imagined it would take me 4+ months to return to blogging! With two little ones, breastfeeding, and a husband who works out of town all week I'm a wee bit exhausted. My new favorite family photo hints at what keeps my partner so busy, and why my kids never cease to make me laugh:
Just because I haven't been blogging doesn't mean I've "only" been doing childcare. I've managed to write a bit, talk a bit more (including this very exciting interview and mention of PLAYING TO WIN in Parents!), and speak. With both boys able to put themselves to sleep by themselves and sleep through the night now, I have more energy!
What's that, you say? Your four-month-old puts himself to sleep and sleeps through the night? Why, yes, please don't hate me. I worked very hard for this. My children's sleep achievements have become somewhat legendary and among my group of friends I get asked lots of advice (in fact, I now get emails from friends of friends about how to do this). So, for my first post back I thought I'd share some of my most basic suggestions and hope it helps other parents, especially those with busy family and work lives.
Two disclaimers: 1) I had a lot of help learning this information-- from books, other moms, and the incomparable Kathleen Todd-Seymour. Kathy runs Mother& Child, a one-stop shop for moms interested in learning how to best take care of their newborns (she's a pediatric RN and certified lactation consultant). Kathy was recommended to us when I was pregnant and while I initially had some qualms (I will know what to do best, it's my child!) I realized that I've never had a newborn before and there are people out there who know *so much more* than I do because of experience and training in this realm. Now I can honestly say that if I have a parenting guru, it is this woman! If you live in the Boston area I can't recommend her highly enough, especially because she grounds her advice in science and research, with a gentle and respectful tone-- my cup of tea! Sometimes I think my kids would be safer with her than with me...
2) I made the choice to exclusively breastfeed for the first several months of life based on my own reading of the scientific literature and what worked for me and our family. Some might think I did it for too long, others not long enough. All of these choices/decisions are valid given the constraints of a woman's body and a family's needs. I'm just sharing what worked for me, and I know it has helped others already-- but if you disagree please just do so respectfully.
If you plan to breastfeed and you want your kids to sleep, you have to get that milk flowing (the conventional wisdom is that kids sleep better with formula, which I suspect is especially true if you haven't had a large supply so suddenly your babe is getting more calories, but I am proof you don't need it to get your little one sleeping). How do you do this? Well, in the first two weeks or so-- and especially until you get up past birth weight again-- you must feed every 2-3 hours. Sometimes you might even have to wake the baby, but it's worth it and it only lasts two weeks! Two weeks of less sleep potentially for years more with? I'll take it. I never fed earlier than two hours start-to-start to give the breasts time to fill, but didn't go longer than three. If one of the guys ever seemed truly hungry I would give a few CCs of breastmilk (or my hubby would) as a booster.
This leads to the second suggestions, which is that it helps to pump especially in the first week to really make sure your milk comes in. The first few days from the hospital I pumped for ten minutes after 1-2 feedings per day to make sure there was enough stimulation. I also added in early on one extra pumping session per day to start building up a frozen supply (I really did this with #2 and I learned to do this before bed so that the breasts were fully drained to promote a good night's sleep for me; with #1 I did before he woke up, which meant I got less sleep than I could have otherwise, even though it was more milk pumped in the morning).
Now this leads to the third point, which is that if you plan to nurse exclusively you must sleep and you must eat. I know it seems like there is so much to do, I KNOW! But sleep produces a hormone that makes you lactate more. Also, while I'd love to look like Gisele, I don't anyway. And when I nurse I want to eat everything in sight. But nursing is not the time to diet. While I complain about my weight I have the rest of my life to diet and I'd rather get the baby all the calories he wants now.
In addition to pumping I also catch my letdown to help build up a supply-- again, I learned to do this early on for #2 when you are AWASH in milk and four weeks in I had 20+ bags frozen- (which my husband almost destroyed all of, but that's a story for family lore and another time). I know some people don't agree with this (concerns about fore/hindmilk, perhaps pressure of catching increases oversupply, etc.), but it's never been a problem for us. I have a very strong letdown (though it eventually decreases after the first few months) and I can catch 1-2 ounces each feed. Think of all the wasted liquid gold if you didn't catch it. A friend (the wisdom of mommy friends!) told me about this while I was still pregnant and I had it ready with #1. It's called a milkie! For #2 I ordered two more and put them strategically around the house (nursery, kitchen, etc.) so I knew I always had at least two clean ones.
I try to ground most of my own life in research, but the thing I do to help with nursing that isn't for sure "proven" (though it's worked for centuries of women) is drinking fenugreek tea. Even if it's not a for sure thing, it's definitely NOT harmful and the more fluids when you nurse, the better. I drank pure fenugreek tea the first time, but couldn't find the same one for #2, so I've been drinking this nursing mother's tea that is mainly fenugreek and it's worked out great. I do 1-2 cups per day. I also put nipple cream/lanolin on pretty much every time after I nurse (and most times after I pump). I see this as a prophylactic measure and worth it (at early stages I use the Lansinoh, but after the first few weeks I prefer the Medela).
Just like you want to get your boobs and baby on an eating schedule, you want to try to do the same with sleeping as soon as you can. If people ask me for just one piece of advice re: newborn sleep I say, "Routine! Routine! Routine!" You must be ruthlessly consistent, which may not be the most convenient for you, but like I said before if you can make some accommodations early on, you reap the rewards for so much longer. You will also learn what your child wants and make this routine around their needs after the first few weeks. The first big clue is learning what time they get overstimulated (that scrunched up, red-faced, silent cry is what my boys do) and then slowing things down before that and ideally doing bedtime routine then.
I am a big believer in the fourth trimester, as popularized by Harvey Karp in The Happiest Baby on the Block. Essentially humans should gestate for longer, but the birth canal can't accommodate the size of the human brain very well, so we give birth at 9 rather than 12 months. That means that to the extent possible you want to recreate the womb outside the body for the first three months. That is why people have been swaddling for centuries. I swear by The Miracle Blanket (suggested by another mom friend). I own about 7 of them and when Quenton started rolling over it was a sad day to pack them away! Swaddling especially helps limit the impact of the Moro reflex, and other times when a baby might startle awake since they can't control their limbs well.
I also believe in sound machines both as a soothing sleep trigger and as a way to ensure you can do things around the house without fear of waking the baby. I use this one (heartbeat setting). Yes, recently sound machines have come under fire, but read this excellent close reading of the study and use COMMON SENSE (you wouldn't really put the machine on the highest setting right by the crib, would you?!).
Just like with nursing I have one sleep element that isn't necessarily grounded in fact. In this case it's what I call the "magic PJs." One of my closest friends' moms gave me these PJs from The Children's Place at my shower. The first night Carston wore them (at 4 weeks), he slept 8+ hours. Thus the myth of the PJs was born. I had four in rotation by the time Q arrived. Here he is sporting a set:
Now there may be some grounding in fact here, which is that these help the babe stay warm and that helps him/her sleep better. I also think the feel of this material helped him associate with sleep-- but he's now in the cotton stretchie and doing just fine, too.
This is Carston sporting a set of magic PJs and note (he is two-months-here, like Q was above) that he is sleeping in his crib, but inside a co-sleeper; in the next picture he is wrapped in his Miracle Blanket.
We tried co-sleeping in bed in the sleeper with #1, then in the same room, but by week 2 it became clear none of us were getting enough sleep around one another. But he looked so small in his crib and guru Kathy explained kids want to feel secure (again, the fourth trimester womb metaphor), so we placed the co-sleeper INSIDE the crib. This was a little nest for him and worked like a charm. For Q though he was out of it by week 5 because he wanted to move (he would turn 180 degrees in the night) and that was a key to his restful sleep-- a reminder not all kids are the same even in the same family!
Once you get a good routine and bedtime set, you can work on getting your babe to sleep for longer (assuming they are healthy, gaining weight properly, etc.). Now it's a skill to sleep on an empty stomach and something to be learned. It's easiest to do this in a gentle way using a bottle, or only feeding on one side. We have always started a bottle of breastmilk at two weeks so our boys always can use a bottle. Once they start sleeping through the night (at 4-5 weeks), we switch to one daytime bottle so they don't lose the skill. With the nighttime bottle you can start at 3-4 ounces then decrease by a half an ounce for a few days, then another half ounce, etc. As parenting guru Kathy explained, "If you get woken up to drink a Frappucino at 3 am, after three nights you will wake yourself up wanting it even if you don't need it!"The added bonus here is that your partner can then feed the baby too (my hubby wanted to) and eventually you can get more sleep. With #2 I understood this and would sleep until my boobs woke me, then pump. After a few nights I started pumping only 9 minutes, then 8 the next, 7, etc. Until I got to 4 and then I was able to sleep until Q woke up after his bottle. Heaven!
We've also used a technique called a slumber feed, which is picking up a sleeping baby a few hours after bedtime and giving a bottle to get them to sleep longer through the night. Finally, we always do a cluster feed before bed, which is two feeding 1-1.5 hours apart, to top up that belly and have it full for sleep.
My last bit of advice is not to pick up your baby every time s/he squawks or cries. I make myself wait at least 30 seconds-1 minute at first. As the boys get older I understand the difference in their cries (hunger, tired, annoyance, wants attention, etc.). Kids have to learn to self-soothe and get themselves to go back to sleep during the night, or at nap time. You have 4-6 months to get these patterns established and then you are pretty much stuck with that for the next 9 months or so. Again, might be tough in short-term, but it is well worth it in the long-term.
Of course, I understand you might disagree with some or all of this advice, but my results are that at five weeks Quenton did a ten-hour stretch. He has started doing 11 hours just before he turned four months. Since Carston was 2 months old we have never done a night feeding and at 2 years, almost 5 months we have only ONCE ever gone into his room after bedtime. Given no more than five minutes he puts himself back to sleep or he simply sleeps through the night. Both of our kids have reflux (Carston's wasn't treated until 16 months, but Q started at about 3 weeks), so it can be done even with that constraint! We tilted the co-sleeper a bit and gradually got them both sleeping flat fairly quickly.
Now, I'm still exhausted, especially with nursing and an extra pump session (now dropped). But I'm proud of my family even if I spell their names wrong once in awhile-- proving this time in life doesn't last forever, but a sense of humor will.
Happy blissful nights of sleep!