Tuesday, August 20, 2013

Geek Girl, Loud and Proud...So why am I still embarrassed?

I'm a Marvel Girl.  Except for Batman.
Dark, mysterious, sexy and has a
butler.  I can get behind that.  
So I wear my Nerdiness on my sleeve.  I do not make any attempt to hide it.  I consider it one of my defining characteristics.  Yet still when someone calls me out on it, even in a "That's awesome!  We're in this together!" kind of way it makes me kind of shy and embarrassed.  I do not understand why!  This weekend my phone rang while I was in a patient's room.  The dad listened intently to my ringtone and said, "Is that from Skyrim?"  In fact it was. My ringtone is From Past to PresentChosen specifically because it is my favorite song from the soundtrack and I thought it would be less recognizable than the main theme.  I embarassedly nodded yes to which he replied, "Ah now I get it." pointing to my lanyard.  Some of you may remember that I had to replace my "I Love Boobies" lanyard a few months ago.  I replaced it with one featuring Marvel Comics characters.  I was able to get over my initial embarrassment and have a lovely conversation with them about gaming but I continue to be embarrassed by my initial...embarrassment.

(Link in the background.)
I do know I am trying to raise my next generation of Geek Girls without this particular trait.  Now don't get me wrong, if my girls want to be sporty or feminine or whatever, I'll celebrate that too but no doubt about it, they're little mini-nerds.   The boys too but I'm talking girls today.   I don't make them watch Doctor Who, they choose to.  I may have introduced them to Dungeons and Dragons but they're the ones that beg to play.   And trust me I wish my 7 year old had never uttered the phrase, "You're watching The Walking Dead without me!!!" which I've heard multiple times as I sneak watch since I think zombies are not so much appropriate for little girls.
Super Hero!
Mini-10th Doctor with capable companions.
At a recent foray in a Comic Book store my 11 year old noted that we were the only females in the store.  It was pretty full store too because they were having a Magic The Gathering tournament at the time.  My response to her was, "You'll get used to it and you'll love it when you're 16!"  But she was right.  It was a little weird.  I'd say that my discomfort is about feeling like a minority but I have it when talking with other women too, be they fellow Whovians or gamers or anything else.  This leads me to believe that it must be a holdover from my childhood when nerdiness wasn't cool.  It was punished by isolation and taunting.  You kept it hidden except among the most trusted of friends.  I'm going to keep trying to conquer those childhood issues.  I'm pushing on and going try to be a role model for my daughters.  I won't be changing my ringtone or my lanyard.  I want them to be proud of their quirks and obsessions.  That's part of what makes them who they are.  I want them to be confident in that.

Monday, August 19, 2013

Breastfeeding Master Class Episode 2: Birthday!!!

In our last episode we discussed the importance of skin to skin right after birth. Today we're going to focus on what happens next.  Baby needs to stay skin to skin until after the first breastfeeding.  In the first hour or two your baby is more awake than he or she will be for the next 24 hours.  Get some good feeding in during this time.  If baby feeds well right after birth it's an excellent predictor of future breastfeeding success.  Those first little neuron connections formed in your new baby's brain will be all about feeding.  That's a good thing.  They'll remember what to do once they're ready again.

Gratuitous show-offage of my youngest's first feeding.  Ignore
the wrapped up baby and poor breast holding technique.  I wasn't 
a Lactation Consultant yet.   Much since then have I learned.  And 
yes, I know they're huge.  My boob was bigger than her head til 
she was two.
Now it is important to note that there are things you can do to help make learning to breastfeed easier in the first days.  First, plan for a natural delivery.  Epidurals and narcotic pain medicines can increase baby's sleepiness.  Pitocin and IV fluids can make your areolas swell up and swallow your nipples whole.  Bathing of baby before 6-8 hours of life is also a bad idea.  It makes them cry, cold, and exhausted.  They need to stabilize on mom's chest for a good long time before that kind of trauma.  I know that sounds overly dramatic but remember that nice idyllic life baby is used to.  That's not to say that if you have to have a medical delivery or baby gets a bath quickly that breastfeeding can't go perfectly well but these are a few things you can do to improve your chances of a successful breastfeeding experience.

So while baby is sleeping off his or her dramatic entry, keep them close.  Preferably skin to skin but at least in your room and within eye sight.  That will help so that when baby gives you those little cues that she might be ready to try to feed, you'll see them right away.      
Too Late!!!
Feed Me!!!

What to look for:

                                 *1st-moving around in his/her sleep
                                 *2nd-lip licking/opening and closing the mouth
                                 *3rd-rooting/sucking on hand

Now if you have a baby that has no interest in feeding the first day and won't wake up at all, it's OK.  We have a plan for that scenario.  We call it manual breast expression which is just a fancy way of saying you squeeze the milk out of your boob.  You can
Your milk "coming in" literally only means
there is an increase in the amount of milk.
It doesn't mean you didn't have any before.
collect it in a cup or spoon to feed to baby but I prefer just putting the drops right in the baby's mouth. It's a good idea to do this every 2-3 hours.  The reason for this is two-fold.   First it sends the message to your brain that it is milky time and in 48-72 hours your milk will "come in".  Second it will get some nutrition to baby.  Plenty of it.  In the first day babies will only get 3-5 ml each feeding.  That's a teaspoon or less and is all those little tummies can handle at first.  So all you ladies who are worried that you don't have enough milk at first, don't be! You have plenty.  And you'll continue to have plenty with lots of stimulation in the first few days.  For more information on manual expression watch this video from Dr. Jane Morton at Stanford School of Medicine.

Once you start closing in on the 24 hour mark you'll notice that baby is starting to show more interest in feeding.  It will probably start out with a few sucks then maybe 5 minutes and pretty soon it will be 20-40 minute nursing sessions.  Next time we'll talk about latching and how to know baby is getting enough!

Sunday, June 30, 2013

Anti-Body Guard

There seems to be a misconception out there in the wide world regarding antibodies in breast milk.  I cannot tell you the number of times I have heard people say something to the effect of, "I couldn't breastfeed the baby but I was able to a little in the hospital so at least he got all of the antibodies!"  True that colostrum has a higher concentration of antibodies.  That's because its concentrated.  A wise LC friend likes to explain to new parents that colostrum is like orange juice concentrate.  It has all the same components of breast milk just without the added water.  Milk
                                                                                       "coming in" just adds that water.

So I'm just wanted to throw this out there kind of explaining how this all actually works.  Human children are born incredibly immature compared to other mammals.  That's because we have to manage to fit a big brained head through a narrow upright-walking pelvis.  I guess sometimes evolution doesn't fully think these things through.  But I digress.  Just as those little brains and bodies are immature, so are babies' immune systems.  It takes approximately 12-14 years to reach full physical maturity, way longer than that for mental and emotional maturity, so the relatively short span of 5ish years to reach immunological maturity is pretty fast!
Well, in this case...

Baby is getting antibodies from mom through the placenta prior to birth.  Those will stay with baby for several months.  Breastfeeding infants continue to get antibodies from their mother's breast milk, not just for the first few days but for as long as the baby is nursing.  So any germies mom comes in contact with, she's going to make an antibody for it and pass it on to baby.   Even more amazing if baby contacts the pathogen first there are special receptors in mom's breast that start synthesizing antibodies for it right away.  By the next feeding, boom antibodies!

It's no mystery why most kids will wean somewhere between 2 and 5 years when left to their own devices.  They aren't just using mom for comfort.  Moms don't just not want babies to grow up.  Breastfeeding is comforting but also continuing to give kids significant health benefits.  Your breasts don't have a magic expiration date when they stop manufacturing antibodies until they just stop manufacturing milk.  Older children start getting their nutrition elsewhere but they still need the boobie tap for the immunity.  When I was nursing my youngest at nearly 5 I would joke that there was nothing left in there but dust and antibodies because my production had dropped down to not much above colostrum levels.

So there's my novel about the misconception that only colostrum contains antibodies.  Not true at all.  And it pains me to hear even other health care professionals perpetuate this myth.

Here is a great link with more in depth info from breastfeeding guru Dr. Jack Newman.


Wednesday, April 3, 2013

Breastfeeding MasterClass Episode #1: The Nicest People in New York City

Breastfeeding MasterClass Episode #1:  The Nicest People in New York City

This is just a little anecdote I use to show the importance of skin to skin contact (AKA cuddle care) with mom directly after delivery.

So imagine you've lived your entire life in a beautiful tranquil place, a secluded farm house or deserted island, comfortable and secure.  One day a helicopter comes in and picks you up and drops you into Times Square in New York.  It's loud, busy, terrifying!  That's what it's like for a baby being born.  From a happy tranquil place to a loud room full of strangers and lights as they lay crying on a warmer bed being measured and assessed.  But imagine if instead of Times Square, you are brought to a nice, cush Park Avenue apartment with the two nicest people in New York.  It would still be a difficult transition but those people are there to help you through.  That's what it's like when baby goes directly onto mom's chest after birth.  Baby is able to deal with the transition much easier because he is surrounded by the hands, love, and voices he recognizes.  That's not even taking into account how much warmer babies stay and how much less they cry when they have cuddle care with their parents.

But lets not even think about baby right now.  What about those sweet New Yorkers waiting for their new arrival?  If they can't see him, he's lost in the crowd, imagine their worry!  When you see your baby across the room with nurses and doctor's surrounding him, of course you will be distraught!  Also, we are undermining your parenting abilities from the very start by basically telling you we can take better care of your baby than you can.  When baby is placed on your chest everything else in the room goes away.  The focus is like a laser on your baby and your partner.  Most women barely notice delivering the placenta and any post delivery maintenance that needs to be done.  And baby is right there ready for his first meal!  Most babies will breastfeed sometime in the first hour after delivery and if given that opportunity, do a better job with breastfeeding in the long run.  And moms, if you are not feeling well enough to have the baby on your chest after delivery, dad is the best substitute!  Babies can do this skin to skin care on dad's, grandma's, or any other support person's chest.  Anyone can keep baby warm and comfortable, the only thing that will have to wait is feeding.  But be careful daddies.  Babies don't care that your nipples are just decorative.  They may still try to latch!

I hope you enjoyed our first MasterClass episode!  Any questions or comments welcome below.

Boobie MasterClass

The whole reason I started this blog originally was because I had had a few patients recommend that I put some of my wise teachings in YouTube form.  Since I have a face for radio, I'm not super comfortable with that.  So I will occasionally be using this platform to post some of he tidbits I use in my education of patients. These will have the MasterClass designation in the title, so look for it if you want some excellent educational morsels pushed directly into your face holes.  First one coming later today!
Just because this is awesome.

Thursday, March 21, 2013

Intellectual Pap

Hey kids!  I know it's been a while.  I fell down a Skyrim rabbit hole that I'm just now emerging from.

But emerge I must to rant about the inability of media sources to responsibly present medical study data. This is the study we're going to talk about today.  However you can pretty much pick any medical study from any medical journal and see the same thing.

The study in question discusses one hospital trying to become Baby Friendly, a designation that tells people "This hospital supports breastfeeding!".  They took away pacifiers as a step to become designated and their breastfeeding rates dropped.  OK on the surface that does look bad.  So if all you see is that headline you get articles like this and this and especially bad ones like this and this.  As a responsible Boob Nerd I refuse to take information like this at face value.  I like to actually go and read the study.  I know that's a difficult concept for some bloggers or journalists to consider.  Actually reading the source material they are going to report on sounds like it might be too much work.  However it might be a good idea anyway.  I'm not even suggesting they read the WHOLE study.  Even just the abstract is sufficient enough to tell them what they've written is utter bullshit.

This particular hospital had banned pacifiers but there was still full access to formula and the nurses had not been taught how to teach the mothers to soothe babies without using feeding or pacifiers yet.  Those are two equally important steps in becoming baby friendly.  The study tells you nothing more than nurse education and formula restriction should come before pacifier restriction in the Baby Friendly Designation process.  It upsets me greatly how the media has twisted this study to say "See!!!  We should use pacifiers!!!"    No!  That is not what this is advocating at all!  This study conclusion was that we need to do more studies.  Most hospitals are required to use evidence based practice.  If we used this article as our "evidence"  for not restricting pacifier use, our hospital would be a laughingstock.  I'd also like to note that Baby Friendly does not deny parents the ability to use pacifiers.  They just restrict the hospital's ability to hand them out for free.  If the parent's want to use a paci, by all means bring one in from home and use it.  I just can't give you a hospital freebie.  We continue to recommend use of pacifiers after breastfeeding is well established as a SIDS prevention tool.

So I guess what I'm really saying here is, if you see an article citing medical studies, it would behoove you to look up the study and read it yourself.  You cannot trust anyone else to spit the predigested informational pablum directly into your brain.  They nearly always get it wrong.

On a lighter note I also found breast shaped plush animals?  Dolls?  Thingies?  Um, I'm  not sure what to call them.  They are from Japan.  I know that's shocking because nothing weird EVER comes from Japan.
I have not yet figured out how to purchase these.  I cannot find the website.  But I need them.  All of them.  Now.

Sunday, February 10, 2013

It's probably only me...

I spend way too much time thinking about breastfeeding for someone who is no longer nursing herself.  I get that.  That's why I consider myself a Boob Nerd.  I'm obsessive about it, which for my job I guess is a good thing.  For my personal life, maybe not as much.  I know my childless girlfriends are like, "OK we get it.  Now shut up about it!"  But it informs the way I look at the world in a very specific way.

Take The Walking Dead for example.  I was so looking forward to Lori's death because I just hated that bitch so hard. (Sarah Wayne Callies you are a truly amazing actress to get me to want to punch your character in the face for an hour each week yet still love the show so much.  I have loved it even more for my hatred of Lori.  Carl too at first, but he's redeemed himself for shooting his mom in the face.[I know, I'm a terrible human being.])  But with all my looking forward to Lori's demise, I was pretty sure they wouldn't kill off the baby in the TV show.  You can build so much drama around children in danger, it would have been wasteful to kill off mom and baby at the same time.  So that lead to much concern on my part about how this kid would get fed.  Literally I thought about this.  I know.

Hershel says they have to go out to get formula--Me: NO!!!

But I know I'm in the minority.  Normal people do not think
about those things when they are watching escapist television.

Put the baby to breast!!!!  You CAN make the milk!!!!
Of course Ganger babies probably don't need  milk

I also worried about poor baby Melody/River's ability to nurse in Doctor Who.  Because that's how I roll.   Luckily I was saved from that worry because The Doctor speaks baby and she wouldn't call Amy "big milk thing" if milk didn't come from her.  Mind eased.

Then there are thing like this that make me very happy.  From The New Normal:

And the episode of the office when Jim and Pam have their first baby and the lactation consultant is a man.  Awesome.  I love the subversion of putting a man in a role primarily filled by women.  The Mindy Project did the same with the male midwife brothers.  Love that.  But back to the office.  The episode is called The Delivery Part 2 and also in the middle of the night she nurses the roomate's baby on accident.  A fun cameo of The Big Bang Theory's Melissa Rausch as the roomate.  Of course it's all completely fictionalized and you have to take it with a grain of salt but still one of the best comedic breastfeeding portrayals in television.  Points for realism for the "bottles are fine, send the baby to the nursery" nurse.  That really happens.