Breastfeeding Twins

Breastfeeding has many benefits for both mom and baby, and naturally the benefits double when nursing twins. As you know, breast milk is uniquely designed to meet the specific developmental needs of your baby, and the breastfeeding experience fosters a very special bond between the two of you. Nursing twins can be a challenge in the beginning, but it can also be a wonderful experience when moms are given the support and encouragement they need. Also, breastfeeding twins is more economical, more convenient, and less time-consuming than preparing bottles.
For moms of twins, it will be most important to establish an adequate milk supply early on and to maintain the supply to meet the growing demands of the babies. This can be facilitated by early and frequent breastfeedings – at least 8 times in 24 hours for each baby. As is the case with all newborn babies, do not let more than 3 hours go between the start of one feeding and the start of the next feeding. If the twins are born prematurely and have an immature suck, mom will need to pump frequently until they are able to nurse at the breast. This frequent stimulation is necessary to ensure that mothers will be able to produce enough milk.
There are a number of options for breastfeeding twins and it may take some experimenting to find what works best for you. The babies may breastfeed separately or simultaneously and this can be accomplished with various positions. When babies are fed separately, mom can breastfeed one infant and then the other, or one can be breastfed and the other bottle fed. You may have to wake the second baby to feed, but this will keep them on a consistent schedule. It will be important to nurse each of the babies on both breasts, especially in the early weeks, so that they are both evenly stimulated, particularly if one twin has a more vigorous suck than the other.
Some moms prefer to nurse their babies at the same time which saves time and ensures that both babies are eating on a similar schedule. Remember to alternate breasts with each baby for even stimulation and drainage. You should comfortably latch the less vigorous nurser first and then the other baby. In the beginning, you may need help getting comfortable with extra pillows, and of course good back support.  
There are 3 nursing positions you can try:

1- Both babies in the football hold or the double football: This position allows for better head control with smaller babies and moms can support their breasts better when latching and during the feeding. Mom also has good visualization of both babies in this position, and it is easier on a mom who has had a C-section.

2- Both babies in the cradle or cuddle hold with their legs crossed over or next to each other. This position may be more difficult in the beginning since mom can not support the babies’ heads as well.  However, as the babies gain more head and neck control, mom’s hands will be freer and she will have better eye contact with her babies in this position.

3- One baby in the cradle hold and one baby in the football hold.

As your babies mature and need less support, nursing will get easier and more comfortable. Hang in there!
Frequent feedings that drain the breasts will keep your supply up and will decrease the likelihood of developing sore nipples, plugged ducts, and breast infections. A breastfeeding log will help you to keep track of breastfeeding sessions in these first few hectic weeks. You can also keep track of the number of wet and soiled diapers in your log which is the best measure of breastfeeding success. You will also want to share this information with your Pediatrician and/or lactation professional.
I do not have personal experience nursing twins, but I have two very close friends (who happen to be twins themselves) who nursed their twin sons happily and successfully. They wanted to share some personal advice with you.

Dee – Mom of twin boys that nursed for 12 months:
“I remember going to La Leche League and buying a ‘twin pillow’ so I could nurse them both at the same time. It was the best investment because you are nursing so much. It gave me a little break in between. Nurse them on demand for the first couple of weeks to bring your milk supply in and remember, what seems like non-stop nursing will end. New moms have to hang in there for the first 4-6 weeks! Nursing gets so much easier after that (babies go longer and learn to nurse more efficiently so they are not on your breast as long), and it becomes so much more convenient than bottle feeding. Have someone leave snacks out for you to munch on during the day, such as graham crackers with peanut butter, because new moms forget to eat and drink…you’re so busy nursing, but you need the nutrition to build your milk supply! I had a doula for the first couple of months which helped me immensely, and she had twins so she knew what it was like.”
Deirdre – Mom of twin boys that nursed for 14 months:
“I agree with everything my twin sister said, but I would like to add a few things. In the first couple of weeks my nipples were a little sore when the babies first latched, but I hung in there and it passed and I’m so glad I did! I nursed each baby separately with soft music playing in the background. My husband would sometimes hold the second baby while I nursed the first one who was a more active, vigorous baby. In the middle of the night I would just roll over and nurse them. There was no need to get up and warm a bottle. It was so easy. Sometimes at night when the babies slept a little longer, I felt fuller, so I would pump a little milk off to keep my supply up and save it for when I had a chance to go out. I kept a breastfeeding ‘clip board’ to keep track of which baby was on which breast so I could alternate them. I sometimes wore two breast pads in my bra to help absorb leakage.  I would tell new moms to accept help from family and friends, eat well, and get rest when you can.  If I had an hour off, I wanted to be by myself, so I would take a bath with a glass of wine, or I would go out for an hour of shopping! Breastfeeding was the most rewarding experience of my life.  It is an incredible bond. Don’t quit!” 
The first year of life for parents of a new baby is an adjustment, and for the parents of twins it can be very hectic, and at times it may seem overwhelming. Accepting the help of family, friends, and professionals if needed, will be essential in the first several weeks to ensure adequate rest and nutrition for mom. It is also a wonderful idea to contact other moms who have nursed twins for their support and suggestions. We are happy to be offering our own support group for mom of multiples beginning on January 30th. Below is a list of some additional resources to turn to for support.
Resources for Breastfeeding Support with Twins:

"The Gift of An Ordinary Day" - A Mother's Memoir by Katrina Kenison

Last month, I commented to my youngest sister that I would give anything to go back to the days of teaching a preschool boy to drown Cheerios in the toilet. She was lamenting a stubborn three year old completely uninterested in potty training. I was dealing with an obstinate, ungrateful 18 year old man/child. Two days later she brought over a book that she declared a must read for me, given where I am in my life right now. After sailing through it, I want to suggest that it is a must read for all mothers. Whether we are at home raising tiny little people, or getting ready to launch young adults off to college, the message is relevant.

“The Gift of an Ordinary Day” ~ A Mother’s Memoir by Katrina Kenison, starts with a family’s move from suburban Boston to rural New Hampshire. The author’s mid life crisis was the impetus for the move. Her desire to live in a slower-paced environment and have her family more grounded, starts the family on a house building adventure that doesn’t end until the oldest is off to college. Her family consists of her husband and two sons, one of whom is getting ready to start high school, the other just on the cusp of puberty. During this transition, she reflects on all the moments long passed that caused her so much anxiety, as she worried about whether her boys would turn out alright. She notices her parents’ calm demeanor and relaxed attitude toward her sons and their increasingly independent behavior. She remembers all the moments with her boys when they were little that were priceless and mostly unappreciated at the time. Mostly, she tries to live in the present,
and be truly aware of those ordinary moments with her family, cognizant of the fact that in 4 short years, these moments will be increasingly few and far between.

For me, the struggle that she writes of – the fine mingling of letting go and holding on – hits very close to home. I cannot make it through a single chapter without shedding a tear, all while trying to hide it from my husband. Each chapter offers up multiple quotes that resonate so strongly with my life, I feel like I could have written this book, although not nearly as eloquently. The description of the entire college application process, the pressure this age group is under and the reality that no kid can just be ordinary anymore, is something I am living daily. The uncertainty of how this will all end, and the desire to slow down the whole process, so I can have this delightful boy with me just a little longer, is ever present.

I also found it reassuring that another mother, and famous author at that, feels the way I do about so many things. The anxiety she experiences is something that I struggled with since I became a mother, but it did dissipate with time. My confidence in my ability to parent these boys to adulthood and in their ability to make good choices grew tremendously. Now, I am overwhelmed at times by all the struggles people in my age group are dealing with: divorce, illness, financial crisis, wayward teenagers and aging parents. My best friend’s mother always says “Little people, little problems; big people, big problems.” And she is so right! But this is the stage of life that I am in, and it will pass. And in so many ways, it is easier. I have time to myself. I get a good night’s sleep. I can go for a run when I want to. I can talk and reason with my kids. My husband and I can sneak out for a drink if we want to! I am lucky to have a job that I am as passionate about as I was about staying home and raising my boys. Really, even when it’s hard, it’s good. And this book reminded me of that on every

So for the next six months, I am going to cherish every moment with my oldest, even the difficult ones. I am going to revel in the times the six of us are all together, no matter what we are doing. I will create opportunities for them to have good memories of this phase in their life. And I am going to try hard to let go with grace, and trust that they will all wind up where they are supposed to be, with faith that I have done the best I can with the most rewarding, but hardest job in the world.

The Perfect Mother

Thanks to Brooke Shields (and unfortunately Tom Cruise), there has been much discussion in the last few years about Postpartum Depression. I’m glad the issue has attracted a lot of attention! Not only are people talking about it, more and more mothers are becoming aware of the symptoms, addressing it promptly and seeking help. It isn’t such a taboo subject anymore. Brooke’s book, Down Came the Rain, is a terrific book for mothers experiencing postpartum depression, those who want to prevent it, and people who are supporting a loved one suffering from it. I highly recommend it as a resource that gives hope and shows the light at the end of the tunnel!

Fortunately, I don’t see too many patients with postpartum depression in my practice. What I am seeing with increasing frequency, is mothers who are completely overcome by anxiety. These are women from all walks of life, who are crippled by their fears and doubt their ability to care for their baby. They are exhausted and spend the majority of their time questioning every aspect when it comes to the care of their baby. They read anything they can get their hands on regarding childcare and inevitably find something that reinforces their insecurity that they are doing everything wrong. They are tormented by all the different opinions out there and feel completely incapable of deciding what is best for their family. Their minds are racing with all the things they should be doing and how they can do them better. The expectation that they be perfect mothers is an all-consuming goal that none of them will ever achieve.

My experience in this regard has also been that the more educated and successful a woman is before she has her baby, the more significant the anxiety after the baby is born. It is almost as if these women have life under control and are confident before the baby. But once the baby comes, they are no longer in control of their situation (who is with a new baby?). In an attempt to regain some semblance of control, they go overboard, hoping to do an even better job at motherhood than they did in their career. They throw themselves into the new job, but make themselves anxious in their pursuit of doing it right.

I realize that I am making a lot of generalizations with nothing but my experience to support it. But I do find this to be the most heartbreaking aspect of my job: trying to help an obviously smart, capable, loving and devoted mother see that she is doing a wonderful job! No matter how hard I try to point out all the things they are doing right, they can find me a contrary opinion that says they are doing it wrong-breast or bottle, family bed or Ferber, to vaccinate or not, Gerber baby food or homemade, cloth diapers or Pampers? It is nearly impossible for me to provide the reassurance they need and I frequently find myself at a loss when trying to make them feel better.

The other difficulty is that these women are usually able to function rather well, compared to a woman who is truly depressed. It is usually several months after giving birth that anyone notices these mothers struggling, as they are relentless in their pursuit of the appearance of perfection. Because they are running on overdrive, only the people who are closest to them realize they are having difficulty and often don’t know what to do to help them. And I am not sure what the best answer is.

I do know though that there are people far more qualified than I am to deal with these sort of mental health issues, and that should be the first place to start. Counseling and medication do help, and it is not forever. We have to remember that many phases of motherhood are just that, a phase that will pass. Sleep also makes a big difference, and that should be a priority of every new mother and those who can help her. And I am not talking about an 8 hour night. But a good nap each afternoon or in the early evening works wonders to help your body and mind rejuvenate. In addition, socialization with other mothers is strongly encouraged. Isolation makes anxiety much more intense. Having other mothers to share your experiences with and who can offer insight into how they have handled similar challenges can make all the difference!

When visiting the lactation offices at Women and Infants Hospital one day, I saw quotes on their wall that I wish every mother could remember:

You’re the only mother your baby has, and she thinks you’re wonderful!

The good news is that you don’t have to be perfect!

How I wish every new mother knew that and took it to heart!

Trust Yourself

This New Year, make a resolution to trust yourself in all things related to your baby.   Trust myself, you are thinking?  I have no idea what I am doing.  I am winging this motherhood thing.  I just want someone to tell me what to do with this kid, and I will do it!  

Often, I am the someone you want the guidance from, and I am happy to give it. It usually involves seeing you and your baby in person, and spending quite a bit of time asking a lot of questions about what is happening.   I frequently apologize for the interrogation. But I am trying to get a handle on the situation, and you are the person with all the clues about what is going on.  I am just here to help you sort through it all.

Many times, I am confident I have it all figured out and start to tell you what I think is taking place. At that point, you might tell me all the things you have read and heard that contradict what I am telling you. You have read every book on the subject, consulted every girlfriend, your mother and mother in law, sisters, and of course, every website that popped up in your Google search. You also tell me how you tried each and every suggestion, and nothing worked.

I have addressed this topic multiple times- once about handling conflicting information and in another article about the “perfect” mother.  What I have come to realize is that in these situations, women don’t trust themselves.  They let the comments of passing strangers cause them to doubt themselves and their ability to care for their baby. They have somehow decided that a stranger that has never met their family, and is giving general advice online, knows more about their baby than they do. Nothing could be further from the truth.

And I know what I am talking about, because I have been that mommy. I have two vivid memories of my life with little boys.  One is of me freaking out because one of them (I believe boy #2 at about 7 months) fell down the stairs. (Very Bad Mommy-can’t remember how or why that happened!)  I called my husband at work, hysterically crying and asking him what I should do.  His calm response to me was, “I don’t know Kath, you are the neonatal ICU RN, what do you think you should do?”  Stunned, I examined him as any RN would.  He was fine.

The other memory is of a baby that wouldn’t sleep, unless he was on his stomach.  The AAP had just come out with the Back to Sleep recommendations.  So obviously, I couldn’t let him sleep on his stomach.  Exhausted, I stood over his crib crying, while he struggled, unable to be comfortable and sleep on his back.  I watched amazed as my husband got out of bed, rolled the baby over on his tummy, patted his bum and climbed back into our bed, both of them sleeping comfortably in a matter of minutes. That was the end of the Back to Sleep Campaign in our house.  I slept great from that moment on.

Please believe me when I say you really do know your baby best. You are the one living with him 24/7.  Sometimes, you are just too tired to clearly see what is happening.   That is where I hope to help.   I am usually telling you something you already know, you just didn’t trust yourself enough to believe it and act on it.

One of my MD friends posted a picture on Facebook of a coffee mug that said. “Don’t confuse your Google search with my medical degree.”  It gave me a good laugh, but I think I we all need to remember not to confuse our Google searches with our maternal instincts. Those instincts are pretty strong, and if we listen to them, instead of everyone else, our anxiety levels will dissipate, and our babies will be just fine. So please, make a New Year’s resolution to trust yourself and act on those instincts. Your baby, and probably the rest of your family, will thank you!

The Right Pump for the Right Reasons

The Affordable Care Act provided a benefit most new mothers were thrilled about - it mandated that insurance companies provide women with a breast pump with the birth of each child. This benefit that has been fought hard for, both nationally and in Rhode Island, so many of us were so happy to see it finally happen.  Imagine our surprise when the biggest insurer in Rhode Island decided to only provide a manual pump.  We have fielded many calls from women who have said no thanks to that option, and we don’t blame them.  For many, the manual pump isn’t going to help them while working full time and traveling away from their baby.   It isn’t the right pump for their situation, and we see situations like this all the time.

Some local hospitals are able to provide each postpartum room with a double hospital-grade electric breastpump. In doing this, every mother who needed a breastpump in that hospital has access to one in their own private room. Terrific, right? Initially, everyone thought so. But often, we see a few problems that we believe sabotaged the success of breastfeeding for many mothers.

The first issue is that since there is a pump in the room, many mothers assume they need to pump. Whether they need to or not, many mothers begin pumping as soon as they can, and feel if they are doing that, they don’t need to nurse their baby. Mothers who pump frequently, and nurse only occasionally, have babies that soon prefer the bottle. Other mothers believe that if nursing the baby was good, nursing and pumping is better. These moms start doing both right from the start and quickly became exhausted and gave up on both altogether.

Another issue is that mothers don't produce much milk in the first few postpartum days of pumping. A mother's milk typically comes in around day 3 or 4 postpartum and coincidently, occurs after most mothers have been discharged. While in the hospital, they only produced colostrum. This colostrum has everything a newborn needs, but is not produced in the same quantity as mature milk. For this reason, many mothers assume that they aren't making enough milk for their babies. We see many of these mothers in their home after discharge. They tell us, with great disappointment, that they are certain they don't have enough milk for their baby, because they barely got anything when they pumped in the hospital. They weren't supposed to get much, but they didn't know that. Mentally, that is disheartening for many women.

Anybody reading this newsletter knows HBHM Inc. is in the pump business. But really, we prefer to be in the business of getting people off to a great start nursing. The vast majority of mothers do not need a pump to do that. We wish that all moms knew that the most important aspect of nursing is getting your milk supply established and maintaining it. It is a challenging but easily accomplished task, provided you are doing the right thing from the start. The best way to achieve this, of course, is by nursing your baby. A baby with a correct latch is far better at establishing and maintaining a woman's milk supply than any pump.

In a situation where the baby is not nursing, whatever the reason, a hospital-grade double electric breastpump is essential to getting the milk supply established. It is also important that the mother pump frequently, as it is the frequency of pumping that will get more milk, not the duration of time spent pumping. Once the milk supply is established and maintained, most babies will eventually nurse successfully.

When a mom is pumping and not nursing, she must remember never to judge her milk supply based on what she gets from a pump. A baby that is nursing well will always get more milk from its mother than a pump will. Moms do not get the same hormonal charge from a piece of machinery that they do from their baby. These hormones are responsible for milk production as the baby is nursing. The body quickly replaces what the baby takes out. When a woman pumps, she is going to get what is in her breast. When a baby nurses, he is going to get what he needs because the body will keep producing milk.

So what is a mom to do when she finds herself in a challenging situation and has just spent $300 on a Pump In Style? Or her insurance only provides a manual?  Or her sister has an old pump she can use? She should rent a hospital-grade pump for a week or two, and once she is off to a good start, she can use the pump that she purchased. We always try to make it clear to each mom who purchases a pump from HBHM Inc., that these pumps are intended for women who are nursing without difficulty and whose supply is well established. They are not for women with preemies in the NICU. They are not for women with supply issues. They are not for women whose babies won't latch.

Have we seen a mother with a baby born 3 months early, pump for 6 months with an Avent hand pump and never need to give her thriving baby formula? Miraculously, yes! Have we visited with a mother of preemie twins who pumped with a Pump In Style Advanced and had an abundant supply for both babies? Definitely! Do we know a mother who was the third user of an Original Pump In Style while she worked full time and never had to supplement with formula? Yes, we have seen all those things.

But please remember that these are very rare exceptions, and not the rule. More often than not, we see women who are using the wrong pump for their situation, and have had their milk supply and nursing relationship compromised as a result. For most women, if you do not get your supply well established from the start, it is very hard to turn the situation around.

We at HBHM Inc. are in the business of getting families off to a great start nursing. We are not in the business of selling or renting pumps that aren't appropriate for a given mothers' situation. If you are at all in doubt about what is appropriate for you, please call us. Ask questions and make sure you get the help you need. We are happy to provide just that!


kathy sig

The Benefits of Breastfeeding

A few years ago I had the pleasure of attending a conference about the “Use of Human Milk and Breastfeeding Education for the Registered Nurse.” The speaker was Diane Spatz, RN PhD, an associate professor at the University of Pennsylvania and a clinical nurse specialist at the Children’s Hospital of Philadelphia. It was a fascinating day, and as usual, I learned a lot. Her most interesting lecture was her first one about the benefits of human milk. I thought I would pass this information along to all of you, as a reminder of the wonderful gift you are giving your baby!

Most women cite infection prevention as their number one reason for breastfeeding. Babies who are breastfeed have decreased incidence and severity of RSV, gastroenteritis, diarrhea, respiratory, ear and urinary tract infections. For premature babies, the benefits are life saving with a decrease in the incidence and severity of meningitis, blood infection, sepsis and necrotizing enterocolitis. ($200,000 is spent of each case of NEC alone!) These babies also have a decreased incidence of retinopathy of prematurity, SIDS, diabetes, and obesity. Their hospital stay is shorter and less expensive than formula fed preemies. Breastfeeding for these compromised babies is truly medicinal.

But do you know why that is? It is due to something called the “Enteromammary Pathway.” This is a maternal response in which anything the mom comes in contact with (microorganisms, food antigens etc.) travels thru her gut and lymphatic system causing antibodies to be produced that are then passed along thru her breast milk to protect her baby. It is for this reason that mothers of preemies are encouraged to touch everything their baby comes into contact with in the NICU.  Their exposure to everything their baby is exposed to protects their baby from hospital borne illnesses.

In addition to the infection protection, breast milk has a biological specificity that is exactly what the human newborn needs. The fat content of breast milk accounts for half the calories and it adjusts throughout the feeding and the day. Amazingly, the fat content is 30% higher in mother’s who deliver preterm infants, because those babies need it! The DHA and ARA in breast milk (which have now been artificially added to formulas) enhance the babies’ visual acuity and brain maturation.  Some fats are also anti-viral, anti-fungal and anti-bacterial. The lactose in breast milk enhances calcium absorption and is easily broken down to provide a constant nutrient flow to the brain.  Other carbohydrates promote the growth of healthy bacteria in the gut and decrease pathogens by increasing the acidity. Protein in breast milk is low in quantity but high in quality and is primarily the easy to digest whey protein. It is also immunologic with proteins that breakdown infectious agents.  Lastly, breast milk is full of antibodies, infection fighting white blood cells, hormones, vitamins and minerals that are essential for the general hydration and nutrition of your baby.

But you already knew all that didn’t you?  Keep up the good work!

Introducing the Bottle

Mothers frequently ask me “When is the best time to give a bottle and how do we do it?” For many women, it is source of anxiety, but a necessity at some point or another. Fortunately, it is fairly easy if you do it in a controlled and timely fashion, rather than at three in the morning when you are desperate!

Obviously, my goal is to help mothers breastfeed successfully, whatever that means for them. If mothers need to give a bottle, I hope to help them give a bottle of expressed breast milk instead of formula. The most important thing to know about being able to breast and bottle feed, which many women need/want to do, is that it can be done. However, it can’t be done in the hospital, right from the get go. If you want to nurse, you have to spend the time getting breastfeeding off to a good start. This process usually takes about 3 to 4 weeks of exclusive nursing. If you do that, and nurse exclusively through the three week growth spurt, your milk supply will be well established. In addition, your baby will have learned how to nurse correctly and giving a bottle at this time will not “undo” that!

Early bottle introduction causes a host of problems for the breastfeeding family. First, these babies are usually given formula and too much of it. Babies who are nursing get only a small amount of colostrum (mother’s early milk) at each feeding, which is exactly what they need. Bottle fed babies tend to get 2-3 ounces of formula, which is much harder to digest. It prevents the meconium (baby’s first waste) from being passed quickly, suppresses their appetite and keeps them from feeding frequently, which they need to do to bring their mother’s milk in. In addition, hospital bottles have a standard size nipple, which is much smaller than a mother’s breast. Babies learn immediately to position their mouth incorrectly for breastfeeding when they are given this bottle. When they replicate that on their mom, it hurts!

So, the first few weeks should be about getting a good latch and getting your supply established. If you want to give expressed breast milk in a bottle when the time comes, you can also use this time to collect some milk to give later. There may be several opportunities for this in the early weeks. If you get engorged, you can pump just enough to make yourself comfortable, which may mean only pumping a half ounce! You may also have times when the baby takes only one side, falls into a milk coma and doesn’t take the other. In that case, pump the side he doesn’t take and save that milk. You can mix the milk from several different pumping sessions to make one bottle. When you collect a total of 3 ounces, stick it in the freezer, and you have milk for your first bottle!

Develop a plan for the first time you give your baby a bottle and have someone other than you do it. I like moms to leave the house and do something for themselves. Arrange for dinner with a friend, a haircut, or shopping to get some clothes that you fit into! The reason for this is that first of all, you probably need a little alone time after three weeks of exclusive nursing. In addition, if the baby sees, hears, or smells you, the baby may protest and wonder why you are not feeding him/her. And if the baby protests at all, the person with the bottle may quickly give up and pass the baby back to you!

It is best to time it so that you leave the house right before your baby is due to eat, and pump just before heading out the door. This gives you a few hours to do what you want, and you can nurse right when you get back. This pumped milk can be used immediately, if necessary, or goes into the freezer for the next time your baby gets a bottle. When your baby gets a bottle, it should be a bottle with a wide base and nipple, not a standard size. Thaw your frozen milk, pour it in, and have it at room temperature or a little warmer for the baby.

When done this way, bottle introduction is usually pretty uneventful. Be prepared for a mix of emotions when you come home and find out everything went fine, which is after all, what you want! Then make sure that the bottle is offered every few days, especially if you will be going back to work. If you do that, though your baby will always prefer you, he will take a bottle without difficulty when he needs to!

When can I get my baby on a Schedule?

An oldie but goodie that we first shared in 2007.

This is the one question I am asked most often! Many new parents are anxious to get their baby into some kind of a routine and restore order to the chaos a newborn creates in their home. Unfortunately, imposing any kind of structure on a newborn that suits the parents’ schedule, usually results in a tired and cranky baby. Eventually, that baby will have tired and cranky parents and your family life will be anything but peaceful!

But what if you took a different approach to trying to get your baby on a schedule? What if you simply accepted that your baby has basic needs related to hunger and sleep that are beyond your control? What if, instead, you did everything you could to accommodate your baby’s natural schedule rather than trying to force him or her to follow yours? I can guarantee that if you did that, your life would fall into a very predictable routine. It would allow you to plan your day and actually feel as if you are able to accomplish things and in control. Why not give this approach a try? What have you got to loose, other than some more sleep?

A baby’s sleeping and eating pattern really does have some predictability to it throughout the newborn period.  Unfortunately, most parents of newborns are too tired to even realize it. I am certain at some point you will read this and think “That’s what my baby is doing right now!” Learning about it beforehand makes it much easier to recognize and deal with when it happens to you.

The first few days of a newborn’s life are full of sleep. The baby will usually be alert and awake for the first 4 hours after delivery, which is just one more reason to keep him with you and nurse in the delivery room! This is a great time for Mom, Dad, and baby to bond. After that, it’s lights out for days. Many parents tell me at this stage how good their baby is! I am constantly reminding them to make sure they wake the baby up every 2 to 3 hours during the day to feed him. If you don’t, he won’t eat. On or around day 4, Mom’s milk comes in and it’s a new ballgame! The baby eats all the time and is now vigorously demanding feedings. If he is doing this, you probably will not need to wake him anymore, provided he is voiding, stooling and gaining weight. Just feed him when he wakes up and asks for it! In addition, babies will start to have a fussy period that lasts a couple hours a day, usually in the evening. This fussiness usually peaks around 3-6 weeks and is almost always over by 3 months. This is a great cause of concern for mothers especially, who will begin to doubt their milk supply. It’s the perfect time to take a walk or ride in the car or break out the Snugly, swing, or vibrating infant seat. Don’t fight your baby’s fussiness! Feed him as much as he wants and do whatever else helps to make him happy. Nothing you do now is going to start bad habits and ruin him for life. You are simply giving him what he needs now, as any good parent would do.

At around 3 weeks of age, your baby will have a growth spurt. It is usually preceded and/or followed by a lot of sleep. He will nurse constantly for days, until you think you can’t stand it anymore! But when it’s over, he will fall into another predictable pattern. He may go as long as 3 hours between feedings during the day, and start sleeping for longer stretches at night. Another growth spurt happens again at 6 weeks and by that time, your baby should be sleeping from about 10pm to 4 or 6am. They usually nurse at that morning feeding and go right back to bed for a couple more hours. Another growth spurt then occurs again at 3 months of age, and is in many ways identical to the ones that preceded it. The best part about it is that when it’s over, the fussiness tends to diminish significantly and the sleep tends to become more regular and last longer. You may get a few good daytime naps and a good 8 hours of straight sleep at night!  It is at this time that I strongly recommend your baby is in his own crib in his own room (if possible of course!). I also advise parents to keep the baby in his bedroom from around 7pm to 7am, so he gets used to being in his room at night. The baby may go down at 7 and wake a few times throughout the night. But with a feeding and minimal stimulation (no TV, siblings, other adults) they usually eat and go straight back to sleep. This is usually a welcome relief to parents who have been up for hours during the night with their newborn.

Babies at 4 months of age generally are capable of and need to sleep from 7 at night to 7 in the morning. They may still wake once for a feeding anytime around 4 to 6, but they generally grow out of that rather soon. Problems at this age usually arise because your baby is now a little social being and has a pretty good idea that things are still going on in his family while he’s in his room and down for the night. At this stage, you may get some serious protesting at bedtime. But in my experience, babies who have been allowed to sleep and eat as they need to, are well accustomed to their crib and room, and have learned to fall asleep on their own, have no problem making this transition. And it is a very important one, because it now provides the parents with some quiet time in the evening for each other, other children, or additional sleep! In addition, once sleeping thru the night occurs with regularity, daytime naps start to happen with predictability as well, and your days get easier.

This routine of 12 hours of nighttime sleep and 2 daily naps in the morning and afternoon usually lasts from 4 months until about 15 months. At 15 months, your baby will start to phase out the morning nap, and tend to take one long nap in the afternoon. Many parents are happy to see that morning nap gone, as they are now free to leave the house in the morning and take the baby out for activities or errands.

Does this all sound impossible and too good to be true? I promise you it isn’t! If you think of sleep as something that your baby needs just as much as food, love, shelter and safety, it becomes something you feel the responsibility to provide for him as well. To learn more about this very important topic, I highly recommend the book Healthy Sleep Habits, Happy Child, by Marc Weissbluth M.D. He discusses this topic at considerable length and teaches you how to recognize fatigue in your baby. He also reveals many good habits to start before that 4 month mark that make the transition to a full night of sleep an easy one. He believes strongly, as I do, that a well-rested baby is a healthy, happy child, with a happy mom!

If things aren’t  going this smoothly for you, we offer a sleep class and even a sleep consult if you need one.  Just call our office at 401-884-8273 to let us know what we can help you with!

Rhode Island is the First US State to Support Breastfeeding Mothers by Becoming Bag-Free!

Through the hard work and dedication of many hospital employees throughout the state, and the gentle insistence of our Health Department, Rhode Island became the first “Bag Free” state in the nation. I realize it is old news by now, but for those who don’t know, this means “women who give birth in Rhode Island will no longer receive infant formula marketing packs when they head home from the hospital.”( In an event held at the State House on November 28, 2012 Rhode Island’s First Lady, Stephanie Chafee, Lieutenant Governor, Elizabeth Roberts, RI Department of Health Director, Michael Fine, and Marsha Walker from the Massachusetts Breastfeeding Coalition’s Ban the Bags campaign all celebrated this achievement and “spoke of their commitment to breastfeeding families and their support of the hospitals’ efforts in this giant step forward in removing the commercial barriers to breastfeeding.”(

I think that most everyone who heard about this knew that it was a good thing for the health of babies in our state. Some weren’t happy about it, but I really don’t think they understood what it means. And let me be clear: it does not mean that mothers will not be able to receive formula in the hospital if they choose not to breastfeed. The hospitals will still have formula, and will still provide it for your child if you want it. What they will no longer do, is routinely give out discharge packs with free formula to mothers as they leave the hospital. Dr. Melissa Bartick, a Boston MD, wrote in a very public debate with MA Governor Mitt Romney that giving formula samples to new mothers was akin to giving Big Macs to patients on a cardiac floor. As Marsha Walker has said many times, “Hospitals should market health, and nothing else.” When nurses send new mothers home with a bag of free formula, it is an implied endorsement of that product. “State health officials noted that studies link these giveaways to decreased breastfeeding rates, which is not in keeping with their efforts to promote optimal health for mothers and infants in Rhode Island.”(

We all know the benefits of breastfeeding. This information has been well promoted among the public health community for years. But “because breastfeeding is the gold standard infant nutrition that provides optimal healt
h for both mothers and infants, lactation experts have recently shifted to describing the risks of formula feeding rather than the benefits of breastfeeding. For mothers, not breastfeeding is associated with an increased risk of post-partum blood loss, post-partum depression, and ovarian and breast cancer when compared with women who do breastfeed. For children, risks of formula feeding include an increased incidence and severity of a wide range of infectious diseases as well as chronic diseases such as diabetes mellitus and obesity.” (MacNamara et al, 2012) When framed that way, doesn’t it make sense not to promote an unhealthy behavior? Especially in a hospital, where we really have the opportunity to help mothers get off to a great start establishing healthy habits with their baby!

So our tiny little state has really done a big thing for families who deliver their babies here. Next on our agenda: having Rhode Island become the first state in the nation with all birthing hospitals designated as Baby Friendly. “The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.”( Currently in Rhode Island, Newport, South County and Westerly hospitals have all achieved this status. Throughout the world, the majority of hospitals are Baby Friendly. It is only here in the USA, which is so heavily influenced by the business of formula marketing, that Baby Friendly hospitals are in the minority. Interested in helping to make this happen? Contact your local hospital and ask that they do everything they can to achieve this designation and deliver only at a hospital that has it. Consider joining the Rhode Island Breastfeeding Coalition (RIBC) and joining our advocacy efforts. You can read more about this wonderful organization and ways to get involved at the following link: We hope that you will join us!

The Effects of Birth Control on Breastfeeding

Some of you might remember this article, but I feel compelled to run it again as I had two instances of this last month. A mom will start the mini-pill and quickly watch it affect her milk supply, sometimes with a very dramatic decrease. I wanted to remind everyone of what I see clinically in some of my patients who take the mini-pill, so I can prevent other mothers from going through the same thing!  Please remember that this is my anecdotal experience, not at all backed by research, and is different from what the pharmaceutical companies and many doctors and midwives believe. Also, I see moms with issues, so my population is skewed!  There are many who have no problems with the mini-pill at all. But it is something for all moms to be aware of, especially if they have concerns about their supply. 

So much of my work is about asking the right question at the right time. I had a perfect reminder of this over the summer. I was sitting by the pool watching my boys play with some of their cousins. My sister’s sister-in-law was sitting next to me and we were talking about her beautiful little boy who was 9 months at the time. He is happy, chubby and very well nourished by his mom who has been nursing him. And he has rock star hair to boot! She was lamenting the difficulty she has had with maintaining her milk supply for this baby. It was an experience much different than her first child, for whom she felt she had an abundant supply. And of course, we had been in contact regarding this since the baby was born. She was doing all the right things: eating and drinking well, pumping when necessary, nursing on demand and trying to get adequate rest. But she really felt she had to stay on top of this with this baby and couldn’t figure out why. And frankly, neither could I.

Then our conversation went on to other things and we eventually got talking about plans for the future. Nosey me asked if and when this little boy would have a younger sibling. And his mom replied that she would love to have another one someday, but was on the pill now and they were waiting a little bit longer for all the usual reasons. “You’re on the pill?” I asked. “Yes, since he was 6 weeks old,” she replied. “Wasn’t that when you started having problems with your supply?” I asked.

She went on to say that she was assured by her MD that it was safe to take this mini pill while nursing. I told her that she received correct information. It is considered perfectly safe for babies  to nurse when their mothers take the mini pill. What she wasn’t told though, was that in the fine print of the drug literature, it clearly states that it can cause a decrease in your supply. In fact in light of this new information, I was absolutely amazed that she had nursed this baby as well as she had! Many mothers that I work with in this situation lose their milk supply significantly within about 2 weeks. It is usually a very sad situation, as they were told it was safe for the baby, but not told that the side effect is a significant reduction in milk supply. They had no intention of weaning, but it happened dramatically and much sooner than they would have liked.

How did I miss this in someone who is essentially part of my family? It’s all in the questions I ask and I honestly am learning new stuff every day. I will never make that mistake again, but will probably make a new different one! In the meantime, I hope everyone reading this has learned a little something about birth control pills and nursing. And also, please tell me or any other health care provider you deal with everything you think they might need to know, even if you think it is inconsequential.

It just might be the one thing they need to know!