Married to Medicine

Married to Medicine

Thursday, January 16, 2014

Five Mommy Myths I Believed.

Looking back at the start of my motherhood journey, I could have saved myself some stress by doing a little fact-checking.  Even though I'd cross-examined plenty of witnesses during my lawyering years, I started motherhood out pretty much believing everything I heard or read from other moms.  See, to a new mom (or at least to this new mom), experienced moms are like gods.  (Or goddesses).    

Most of these experienced moms are well-intentioned; they believe what they heard or read somewhere and are just passing it along to be helpful.  Or perhaps they did "verify" their information... but they were looking at a non-scientific, biased source.  Either way, there are quite a few Mommy Myths floating around out there that simply aren't true.  Here are five of them:    

1.  Getting an epidural increases your chance of having a c-section.  

I give myself a pass for having believed this one because it does seem to make a lot of sense.  If you're able to get up and walk around throughout labor, and try out different pushing positions, wouldn't that make your pushes stronger?  Or wouldn't an epidural make them weaker?  Or something?

As it turns out, there is no dispute that once you hit 4 cm dilation, an epidural doesn't increase your chance of having a c-section.  Here's a brief overview of the "gold standard" on this topic, a 124-page meta analysis (meaning, a study of studies - in this case, a study of 38 other studies).  It came out in December of 2011 and was provided to me by a friend who holds an MD and a PhD in anesthesiology; I wish I could provide you with the full text but I'd be infringing copyright.  My friend's career will be anesthesiology research and Harvard wanted him for residency, and he's a super nice guy.  And he was looking into this for his pregnant wife - who did get an epidural - that makes him my gold standard.

It is also not clear that epidurals have any impact on your chance of successful breastfeeding, which makes sense since the medication goes into your spinal fluid, not your blood stream - I was on an epidural for 18 hours with my first and he was not groggy and nursed just fine.  But this topic is probably too nebulous to really be a complete "myth."  

Please see my own comment to this post, below; I am not arguing that there is no benefit whatsoever to not getting an epidural, I am simply dispelling the myth that you increase your chance of a c-section by doing so; you don't.  

2.  You must have a supply issue if [insert any number of things].

You must have a supply issue if (a) your child loses interest in nursing before turning two (or three... or thirty); (b) your child starts sleeping through the night (better wake up anyway ... and pump!); (c) Your boobs feel flat; (d) you don't get much when you pump; (e) your child ever cries ...

Nope.  The truth is that the only way to tell you have a supply issue is if your baby stops gaining or starts losing weight.  With both my babies I went through phases of being positive I had major supply issues... my breasts felt totally flat, I only got 1-2 ounces when I pumped (even if it was time for a feeding), and my child was only nursing 1-3 minutes per side, 3-4x/day, and not at night.  But thanks to KellyMom I just kept on keeping on and I nursed both babies, waxing and waning (probably depending on their growth spurts) until about 15 months.  At that point they lost interest.  Even in the morning, which was the only time of day it actually was clear that I had some milk.

It's strange to me that many of the people who so strongly believe that almost all moms are capable of exclusively breastfeeding their babies are also hyper-obsessive about supply maintenance... 

3.  Inductions should be avoided at all costs; your OB is only trying to up her chances of a lucrative c-section!  

When I got to be 38 weeks along and my OB wanted to schedule an induction for 41 weeks, I knew just where to go for some "real" medical advice:  My local mommy list serve, of course!  I asked, and I read the archives, and it didn't take me long to find plenty of threads amounting to "I learned in my 'natural childbirth' class that you should almost never allow induction" and "my midwife says inducing before 42 weeks increases your chance of c-section" etc.  Now there was one comment by a mom saying that she pushed her OB to wait until 42 weeks and it backfired, since by then her baby was too big to deliver vaginally.  But I discounted her opinion since everybody knows that the size of the baby doesn't matter, duh!

But seriously, I was completely distraught; did I need to find an OB or switch to a midwife this late in the game?  Would my insurance even cover that??  It's humorous in retrospect but it was downright miserable at the time.  Thankfully my (physician) husband was able to research the issue for me... and find that induction at 41 weeks does not increase your chance of c-section like earlier inductions do - and in fact, it's safer than waiting!  This is presumably because having a macrosomic baby (8 lbs 13 ounces or more) actually does double your chance of a c-section - along with other complications - and your baby is only getting bigger the longer he cooks.  I never did need that induction, but when my OB told me she was impressed that my macrosomic son came out vaginally (he was 9 lbs 10 oz, 99th/100th percentile head ... and I'm 5'3" and petite; he was delivered with forceps assistance) I secretly thought she was just saying that to pad my ego or something.  Because at that point, I still knew that "the size of the baby doesn't matter."

You can click here for a list of 124 peer-reviewed studies on Fetal Macrosomia.  Or click here for an excellent article by a renowned obstetrician that will probably clear up some other misconceptions you might have, too.  If you've seen "The Business of Being Born," click here and here

Actually, size does matter.  This was me somewhere around 40 weeks with my first.
(Please, I beg you:  Ignore the shoes).

After laboring at home for 15 hours overnight, I looooOOOooved me some epidural!
I just want to thank my OB, the hospital staff, and the scientists who made my birth as unnatural as possible.
They saved my baby's life and my own life, and saved me from what would have been unimaginable pain.
With my #2 I got past a 9 before they got my epidural in... it was a breeze.
And seriously - check out his head - he was 6 weeks in this pic, his head not all that much smaller than ours!!

4.  If you're doing it right, nursing shouldn't hurt.

Being the ever-diligent, slightly-crunchy mom that I was, I obviously signed up for a breastfeeding prep course taught by a Certified Lactation Consultant ("CLC").  Adorably, my husband even came with.  There, I learned that breastfeeding was nothing but dreamy - unless you were doing it wrong.  No problem, how could I possibly do it wrong after learning about something so "natural" for three solid hours ... to the tune of $70.00??

Fast-forward to the birth of my son.  Nursing in the hospital was pain free and my milk came in right away.  My son was a great nurser and the only problem was getting myself positioned in a way that wasn't excruciatingly painful to the nether-regions that delivered him.  All the nurses were so impressed, one even told me that "my problems [with delivering a huge baby] were ending, right when all the problems usually begin."

Then I got home.  And holy MOLY did it start to hurt.  It hurt so badly that I walked around for days - weeks even - in a nursing tank with the flap pulled down.  I even answered the door that way, it was so second-nature to me (thank God it was a female neighbor).  People:  I flashed my father-in-law.  There were lotions and soothies and "airing out" and everything else I could possibly think of or get my hands on.  I called pretty much every other mom I knew, even though I am a professed phone-hater.  The worst part was, I lost a lot of the intense bliss I was otherwise feeling and a lot of the family time I'd have had on my husband's 2-week paternity leave (which was pretty much the last time I ever saw him awake until residency was over) frantically trying to figure out "what I was doing wrong" - because I was so worried that I was sabotaging my nursing.  I watched youtube videos, I googled, I emailed, I even drove to a friend's house to show her my nipples, and I went all over town to "nurse teach-ins" with CLCs.  At the nurse "teach-ins" all I got was further confirmation that it shouldn't hurt, and the suggestion that my son was likely tongue-tied ... so I had better set up a private consult, stat!

I was on the verge of caving even though we could not afford a private consult at the time when I thankfully asked my son's pediatrician about it.  In under 10 seconds he gave me the best advice I'd yet received.  He said "I really think there's too much 'dogma' out there about nursing; The proof is in the pudding, and he's clearly getting plenty of milk."  Then my own OB gave me a script for APNO (a prescription nipple ointment for nursing - that was never once mentioned in my $70 CLC class) and it rocked my world.  As it turns out, I was doing it right all along - it just still hurt like a mother!  (no pun intended).  And it hurt even more with my second born!  Maybe because she was born tiny (6 lbs 10 oz) and gained weight at lightening speed?  The postpartum hospital nurses and the hospital CLC were all scratching their heads about why my nipples were so torn up.  I nursed through all the pain and nasty scabbing, and some thrush, and eventually it all came along.  I've always had really sensitive skin.

My experience made me really skeptical of some CLCs:  Pay lots of money to learn about nursing, learn that it shouldn't hurt, when it hurts, be told to pay more money for a private consult.  I have no doubt that there are amazing CLCs out there doing a world of good for new moms, but my particular experience seemed kind of like a racket.  And my dad told me that over the course of his (40-year) career as a pediatrician, he's found the lactation world a bit "trendy."  For example, he said tongue tie is the current hot ticket, whereas it was all but unheard of until recently - and so now he's gets lots of patients who have been told their child has or might have a tongue-tie, where that's clearly not the case.

And so yeah, vulgarity aside I pretty much completely agree with this Jezebel article:  Far from blissful, nursing is often excruciating.  Physically, mentally, and emotionally.

5.  Any of this really matters.  

It's really easy as a new mom to get all wrapped up in the first few parenting choices we make.  You're overwhelmed with the newness of being responsible for another human being, and you want to get it right.  Plus, there's an enticing sense of "safety" in every decision you can convince yourself is monumental.  "Well, I don't have to worry about obesity/ADHD/allergies because I did X, and 'studies' show that X blah blah blah blah blah."

But the truth is that ten years from now we'll hardly remember or care about fleeting things like whether we birthed vaginally (well, unless we're still peeing when we cough) or even whether we nursed.  By then, we'll have made approximately 1.3 billion other parenting decisions; parenting is decision-making, it's hundreds of mostly small decisions day by day and hour by hour, and even minute by minute, that add up to your relationship with your child.

This isn't to say that you shouldn't be proud of the struggles and sacrifices made for your baby, whatever they may be; I am, and you should be too.  But if you do find that new-mom stress is getting to you, it might help to envision that fast-forward button for some perspective.  Ask yourself whether you ever suspected that the success of an adult you admire was due in any part to having been born vaginally.  Query whether you've ever watched someone accept an award and thought "That's totally because his mother nursed him the full twelve months."  And if your grown son needs therapy one day, do you think it will have anything to do with exactly when and how you introduced solids - or even whether you circumcised?  These baby-days might seem the be-all, end-all but in reality they fade quickly as our children grow and develop.  At that point, it becomes obvious what really matters:  How we raise our children and how we love them - in other words, how we parent (not how we birth).  The memories we make with them.  How we function as a family.  And who we are - who we model for our children to be.

video
This super boring video shows all you need to be an amazing mom:  Love.  That's it.

23 comments:

  1. Well done! I love this, other than cringing for your poor nipples! Thank you for sharing!

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  2. My Granma could have saved you that 70 bucks ! Coming from a generation that had to nurse, because no one could afford formula made her the best 'just get on with it any way you can" consultant. She taught me & my sisters to feed when you want, for as long as you want and where you want including getting back into bed.
    My Mom's generation messed it all up. She actually used a baby-book sponsored by a formula company where the baby health nurse had noted "5 mins each side, baby not happy, recommend supplementary feeding"

    I'm not a Breast Nazi though. Do it if you can, as long as you can is all I tell people. Because the majority of benefits are delivered in the first 3 days. After that it's just more convenient, portable and a great way to make people get you things while you control the remote.
    Bottle feeding Moms are just as capable of reading to their kids, making healthy snacks and establishing a bedtime routine: all the things that are attributed to higher intelligence and better progress in school.
    Correlation does not equal Causation - and the breast evangelists need to remember that when they are attributing supposed benefits of the boob.

    As for C-section vs the Zipper job* I had as a result of 'natural' birth? (30 friggen hours of natural birth) - When it comes to that first wee after birthing, I know where I'd rather have stitches.

    *zipper job = episiotomy

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  3. I'm not sure I understand the "AVOID A C-SECTION AT ALL COSTS" mentality of some natural childbirth activists. Looking at c-section rates is really not helpful to mothers or babies. We should be looking at perinatal mortality rates and the rate of children born with brain damage caused by oxygen deprivation at birth. A low c-section rate is nothing to brag about if a few children died or had brain damage because of the quest for vaginal birth.

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  4. I put this on facebook, but figured I'd put it here as well -

    "It's strange to me that many of the people who so strongly believe that almost all moms are capable of exclusively breastfeeding their babies are also hyper-obsessive about supply maintenance..."

    This doesn't seem strange to me at all - Yes, the majority of moms would be capable of exclusively bf'ing their babies. IF there were no formula. But once women encounter problems they are, in general, quick to rush to formula. Once formula is introduced, your supply goes down in response (unless you were pumping for those missed feedings, but even then the pump doesn't get as much milk as the baby does). LCs don't want women to go over to formula because the usual progression is that more and more formula replaces the breast-feedings and eventually women give up b/f'ing and go over to formula entirely. I've watched this cycle happen with several of my friends who had originally planned to EBF.

    But I would agree that yes, the biggest mommy myth I believed, at the beginning, was "you're not making enough milk." - It turned out it just took me a week or two to catch up with my very hungry son's needs. A baby losing or not gaining weight is the only reason to worry that you're not making enough milk. No one seems to know that beforehand!

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    1. Copying my FB response here - PS can't get coffee today but next week??

      "But Sarah, my point is that women are worrying that their supply has dropped *without* or *before* introducing any formula. I think we're both saying the same thing here."

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    2. I interpreted that quoted part as being about LCs or b/f'ing activists rather than the moms themselves so I was responding to it that way. But the rest of the section I totally agree with, as that was my experience as well. I messaged you on fb : )

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    3. this is interesting to me, too - when g wasn't gaining weight fast enough, our doc urged me to use formula. i talked her into letting me live a hellish week attached to baby and pump, and it worked out fine. in retrospect, i don't think i had ANY supply issues, i had a baby who, as i read in a book later, is one of the few who just doesn't complain about being hungry, and i didn't know how often breastfed babies ate. nobody told me every 2 hours, they told me "she'll let you know." i'm glad i talked our doc into letting me try w/o formula, for several reasons, not the least of which is the expense.

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    4. Yeah, I truly don't know and am not pretending to know the real deal on initial supply issues. I'm just making the point that there's a lot of fear of milk supply dropping later on, which to me doesn't seem to mesh with the line that we're all perfectly capable of producing enough as long as we don't supplement.

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    5. There is also evidence that in certain circumstances, supplementing with formula can actually help the mom and baby to achieve exclusive breastfeeding later.
      http://well.blogs.nytimes.com/2013/05/13/how-formula-can-complement-breast-feeding/
      This was definitely the case with my baby. She lost a little too much weight in those first crucial days, and we had to start supplementing in the hospital. We supplemented for two months and then never needed the formula again. Believe me, nobody was more surprised than I was. The important thing is that she got enough calories and grew properly before we got the hang of nursing.

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    6. That is EXACTLY what happened to my sister-in-law, too. Everyone is surprised by the story but my milk supply waxed and waned, as I described above, seemingly dependent on my children's growth spurts. Babies take in more milk volume as they grow so our breasts must be able to produce more as we go along, to at least some degree. Mine seemed to produce more and less, depending.

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  5. As someone who had such problems and guilt with nursing, thank you for this comment: "And so yeah, vulgarity aside I pretty much completely agree with this Jezebel article: Far from blissful, nursing is often excruciating. Physically, mentally, and emotionally."

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  6. I just watched your cuddle video and thanks for reminding me about those precious moments of pure love that I shared with my own kids as babies.

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  7. I'm commenting on my own blog now based on a question asked on Reddit. The first point of this entry dispels the myth that getting an epidural will increase your chance of a c-section. It won't. From the study:

    4. Caesarean section
    Twenty-nine trials (Bofill 1997; Chen 2000; Clark 1998; Dickinson 2002; El-Kerdawy 2010; Evron 2008; Gambling 1998; Grandjean 1979; Halpern 2004; Head 2002; Hogg 2000; Howell 2001; Jain 2003; Lian 2008; Long 2003; Loughnan 2000; Lucas 2001; Muir 1996; Muir 2000; Nafisi 2006; Nikkola 1997; Philipsen 1989; Ramin 1995; Sharma 1997; Sharma 2002; Shifman 2007; Thalme 1974; Thorp 1993; Volmanen 2008), in- volving 8895 women, reported this outcome. Data were not avail- able to include in an analysis from two trials (Chen 2000; Lian 2008). In the remaining 27 trials (N = 8417) there was no evi- dence of a statistically significant difference in the risk of caesarean section (RR 1.10, 95% CI 0.97 to 1.25, Analysis 1.3).

    -and-

    "Nor were there effects of the epidural on the baby soon after birth."

    That said, epidurals have side-effects all discussed in the study I linked to, most of which are anticipated and easily dealt with (urinary retention, low blood pressure) and risks you'll have to sign off on if you choose to have one. And while not increasing your risk *of* a c-section, there is an increased risk of a c-section for "fetal distress." Fetal distress is a common reason for c-section, for example, the OB feels the baby's heart rate is dropping too low. In fact, many natural child birth proponents oppose fetal monitoring because they believe it results in unnecessary c-sections, but for obvious reasons most people want their baby monitored. It isn't clear even in the full 124 page version of the study why that would be. I have heard it speculated that because maternal exhaustion is another big reason for c-section, perhaps those with epidurals have fewer exhaustion c-sections, and that's why the overall rate isn't any different. I don't know, but again, the point was to dispel the myth that you increase your chance of a c-section by getting an epidural.

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    1. It's also worth noting that there are risks to *not* getting an epidural as well. Epidurals given later in labor can relax your pelvic muscles to help you dilate - here's a link on that from a midwife, and another link to a book on this topic that explains that many natural childbirth courses teach outdated information on outdated forms of anesthetics. With my epidural I got to control how much I felt, by clicking a button if I wanted more medication or not clicking it if I felt too numb.

      http://thestir.cafemom.com/pregnancy/163076/everything_youve_ever_wanted_to

      http://www.amazon.com/Epidural-Without-Guilt-Childbirth-Pain/dp/0975993933/ref=sr_1_fkmr0_2?ie=UTF8&qid=1394652918&sr=8-2-fkmr0&keywords=pregnancy+childbirth+pain+medication

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  8. Thank you for this. As a second time mom-to-be, when I went back to the baby boards I realized just how much mythology there is about birth and it started to drive me a bit batty! My biggest pet peeve is the "if you are doing it right, nursing shouldn't hurt." My nipples were on FIRE for several weeks and I was using ice packs on my boobs after most feeds just so I could make it to the next one. No fun. But my daughter was gaining weight, was healthy, and clearly was getting what she needed from me. We were doing it right and it still hurt. I think this myth actually backfires for those who want to increase breastfeeding. It makes women feel they are failing at it and they then give up. There needs to be honesty in the discussion of what to expect when breastfeeding.

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    1. YES! Thank you Maria, I couldn't agree more. Honesty is always the best policy. Knowledge is always empowerment, and giving women "choices" without giving them the *real* facts isn't giving them choice at all.

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  9. Thank you so much for this post. My baby just never came on its own (42 weeks and still no dilation and the baby hadn't dropped!), and although my OB let me wait past 40 weeks - he said induction was unlikely to work because my body had done little to prep on its own. After a lot of research and a second opinion, we ended up with a C-section and no labor. It drives me nuts when people come at me with things they've heard in natural birthing class. "Your due date must have been wrong." (pretty sure it wasn't for many reasons) "Our bodies don't make babies that are too big." it just drives me nuts! Thank you for this post.

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    1. Thank you for your post, and that would drive me nuts too! My mom went into "labor" with me but after two days had no cervical progress. Once there was meconium (one indication of fetal distress) and she was dehydrated from exhaustion, I was delivered by c-section. The myth that all births work out perfectly if left to nature is simply not true, and is grossly ignorant of how dangerous childbirth was for women (and their babies) up until relatively recently. It's a false and increasingly dangerous myth, propagated by an industry targeted to new moms. Here are two important links for anyone considering a home birth:

      http://hurtbyhomebirth.blogspot.com

      http://whatifsandfears.blogspot.com/2014/01/7-myths-about-home-birth-no-for-real.html

      http://whatifsandfears.blogspot.com/2013/07/home-vs-hospital-equipment.html

      The latter two links are from the blog of a friend of mine who is a doula and who almost became a home birth midwife, until during her training she watched a child almost die and got no good answers for the questions it raised from any of her home-birth superiors.

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  10. Thank you so much for this post. I agonized over getting the epidural (until I was in so much pain that I didn't care) but shouldn't have since I went into the hospital at 4cm and was 6cm when they gave me the epidural. I felt amazing, dilated the remaining 4cm within an hour of getting the epidural, and was able to feel my contractions before the monitor picked them up so pushing was a breeze. So much for epidural definitely slowing down your labor and taking away your ability to help push.

    Also, amen re: breastfeeding. All the LCs I've encountered are well intentioned but the myth of "it should be a painless miracle that requires no effort" may inadvertently make women give up on EBF when it doesn't happen that way for them. In my case, it made the first week of getting established and waiting for my milk to come in even more emotionally fraught than it would have been - I felt so guilty / incompetent, to the point of thinking that I had post partum depression, then my milk came in, we figured out the latch with the help of a nipple shield, and my little guy is gaining weight and EBF-ing like a champ.

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  11. Loved this - thank you!!!!!

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