Doctor Doctor

So tomorrow is D's NINE MONTH Doctor appointment!! I can't believe it. He officially turns 9 months on Saturday.

For some reason for the day or two leading up to the appointment I start freaking out about one thing or another. Sure, sure I have a list of questions to ask the doctor about things going on with D right now - and I know pretty much what to expect. I know there will probably be a shot involved, and that's a bummer too. However, I freak out about the things that he asks me. The main question I get grief from him about is the sleeping issue...and how he's still getting up in the night...and how I'm still nursing him back to sleep. This is all FINE with me, but the issue I have with my doctor is that he pressured me the last time about not being able to let D cry it out or figure out how to get to sleep on his own. I know these are my issues to deal with, not his...but I know it will come up again.

I don't mind where I'm at with D's sleep (or lack there of). Sure there are nights where I have to drag my butt out of bed and wonder how I will sit upright to feed him for a few minutes, but for the most part, I love it. I love that he "needs" me in the night. I love that I'm really the only way he can get to sleep. (I really have no idea how my babysitter does it, and I fear that she lets him fuss it out to sleep, but I've made it clear that I DON'T approve of that method and that's all I can do).

I know that I'm probably not helping D to learn to get himself to sleep - but he's a BABY and I honestly don't mind. The fact that I don't mind, however, doesn't mean that I don't panic every so often and ask people their experiences...which I did today via e-mail with my sister. I just get aggravated that my doctor makes me feel like my method may not be the right thing. I feel extremely confidant about my parenting choices - and don't like to second guess my instincts. The fact that I question myself even for a moment makes me flustered.

A website I used to frequently go to for breastfeeding "support" has a great article on it regarding the topic of frequent night-nursers, and babies who only fall asleep from nursing - and I'm posting it below. This is why I feel confidant about how things are going.

Many moms feel guilty for nursing their baby to sleep. Nursing your baby to sleep is not a bad thing to do! It's very normal and developmentally appropriate for babies to nurse to sleep and to wake 1-3 times during the night for the first year or so. Some babies don't do this, but they are the exception, not the rule. Many children, if given the choice, prefer to nurse to sleep through the second year and beyond. Nursing is obviously designed to comfort baby and to help baby sleep, and I've never seen a convincing reason why mothers shouldn't use this wonderful "tool" that we've been given.

"You are not a pacifier; you are a Mom. You are the sun, the moon, the earth, you are liquid love, you are warmth, you are security, you are comfort in the very deepest aspect of the meaning of comfort.... but you are not a pacifier!" -- Paula Yount

Am I creating a bad habit by allowing baby to nurse to sleep?

Your baby's desire to nurse to sleep is very normal and not a bad habit you've fostered. Don't be afraid to nurse your baby to sleep or fear that you are perpetuating a bad habit. Baby often will seek the breast when sleepy or over-stimulated because it's a comforting and familiar place to him. To associate the breast with wanting to relax enough to go to sleep makes perfect sense. As adults, we also do things to relax ourselves so we can go to sleep: we read, watch TV, get something warm to drink or a snack, deep breathe, get all snug under the covers, etc. Nursing does the same thing for your baby.

For many babies at the height of exploration or distractibility, nighttime or naptime can often be the ONLY time the baby will nurse well. Allowing him to nurse at these times when he is more focused on nursing and less intent on other things helps ensures that he gets enough milk, that your supply is maintained, and that the nursing relationship goes on. Don't be afraid to nurse at these times or fear that you are perpetuating a bad habit. Instead, take advantage of these times for better nursing.

The sleep issue is not merely a matter of good versus bad habits. It is much more an issue of culture and lifestyle and expectations. Here are three approaches to parenting issues:

* Forcing baby to change to fit the parent's lifestyle is one approach. Our American culture tends not to be very baby friendly, and rarely makes accommodations for nursing babies. The current trend, seen in many popular books and parenting magazines, is to force baby to do all of the accommodating so that we experience as little change in our pre-baby lifestyle as possible; for example, baby MUST sleep through the night so that we get unbroken sleep and a "good" baby is seen as one who makes as few demands on his parents as possible.
* Another approach is to try to approximate the mothering style of traditional societies and let the parents do all the accommodating. This approach can be very difficult to pull off without lots of support and changes of expectations in the people around us.
* A third approach is to do as much accommodating on the parental side as possible, and then to "ask" baby to accommodate the last part of the gap. This is an approach that can work for many families. With this approach, parents do all they can to be sensitive to their baby's needs, and only ask baby to accommodate when nothing else truly works.


What about letting baby "cry it out?"

There are two schools of thought about getting babies to sleep. One is a rather rigid method of "sleep training" where a baby is put down awake in a crib and left to cry himself to sleep so that he learns to "self-soothe" and doesn't develop sleep associations that require someone else to put him to sleep. This method has been around since the 1890's and was dreamed up by male university sleep laboratory researchers. Many of the popular "sleep training" methods of today are modified versions of this (allowing baby to cry for progressively longer periods without comforting him, instead of just leaving him to cry until he gives up and stops).
I can't, with good conscience, recommend the cry-it-out method for getting baby to sleep. Anyone who advises you to let your baby cry until he gives up and falls asleep is focusing on the baby's behavior (going to sleep by himself) and not on how the baby feels in the process. In my opinion, this "sleep training" often creates an unhealthy attitude about sleep: after going through this training, baby tends to view sleep as a fearful state to enter into and to remain in. Parents often need to "retrain" baby if there is any break in the usual routine. In addition, it can condition parents to ignore baby's cries, and break down the relationship of trust between parent and child.
Younger babies, in particular, do not have that sense of "object permanence" and if mom leaves them to cry, they are developmentally *unable* to realize that she is just in the next room. All baby knows is that he has been abandoned and that mom is not there. A young baby can only express his needs through crying. A baby who is left to cry alone will eventually stop crying because he has abandoned all hope that help will come: as far as he can tell, no one cares enough to listen, or come and provide comfort. In the book Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent, anthropology professor Meredith Small writes, "When signals are missed, babies stop signalling; they withdraw; they suck their thumbs; they turn away; they try to right the system themselves by not sending out any more signals." The baby protects himself by shutting down, and "accepts" the situation because he has learned that a response is not forthcoming. Crying is also hard, physically, on baby: it can lead to hoarseness that can last for days; the digestive system is upset; heart rates can climb to levels over 200 beats per minute; and oxygen levels in the blood are diminished.
Another school of thought, which I subscribe to, discourages viewing sleep as a state you can *force* a baby into. Instead, it's best to create a sleep-inducing environment that allows sleep to overtake the baby. The process of breastfeeding itself regulates baby's temperature and heart rate and lowers his blood pressure, and puts him to sleep. This helps your baby develop a healthy attitude about sleep, where baby views sleep as a safe, comforting, natural state.

I've been told that baby will NEVER learn to go to sleep on his own if we don't teach him...

Never?! It is normal, natural and healthy for your baby to fall asleep nursing. Nursing babies fall asleep so quickly - how can anything so perfectly designed be worrisome? I've read a lot about babies' sleep patterns, and I've talked to many moms about this. Both my reading, my personal experience, and the experiences of other moms has convinced me that falling asleep without nursing is a developmental milestone that your baby will reach when he is ready. The first step often comes when your baby starts to nurse to sleep then stops nursing, rolls away and goes to sleep on his own. Or perhaps he will fall asleep in Daddy's arms when he's walking with him. These incidents may not happen very often at first, but they are the first step and *do* make you realize that it IS possible for baby to fall asleep by himself.
There are many babies who have been nursed to sleep and nursed during the night from birth who eventually learn to fall asleep on their own without the breast. You don't have to teach them to do this. They reach this as a milestone - when they're physically, developmentally, and emotionally ready to. You can try to speed this process along by putting baby to bed before he's asleep, but always nursing him to sleep will *not* keep him from learning this on his own. My daughter started to occasionally fall asleep on her own (or with her Dad) when she was around 11-12 months. Knowing that she *could* go to sleep without me right there really helped, even though she didn't do it too often. As time passes, she's fallen asleep without nursing more and more. We did not "teach" her to do this, or even particularly encourage it. It has simply been a natural developmental progression that came about as *she* was ready for it.


How will baby go to sleep when I'm not there to nurse him, or after he weans?

Many moms are worried about how baby will go to sleep when he enters daycare or weans, and feel that they must teach baby to sleep independently before this time. This is really not necessary, and can add lots of stress to something that is already a big transition for baby . Babies are *very* adaptable and will find new ways to go to sleep when mom is not there. Baby and his other caregiver(s) will work things out just fine, and they will find new ways to comfort baby that work great for both of them. The same will happen when baby weans.


How can I gently encourage baby to fall asleep without nursing (and without crying)?

Try transitioning from nursing baby totally to sleep, to nursing him almost asleep; then to just really relaxed, and then eventually to no nursing at all to go to sleep. The process may take a long time, or it may not. If you'll start out taking it as gradually as you possibly can, it will probably work better and you'll avoid possible problems and frustrations for both you and your baby.
You might start by lying down with him in the bed he will sleep in for naps, or on the floor, etc. - wherever he will be sleeping. Don't insist that he sleep in the crib if he doesn't want to. Your goal at this point it to get him comfortable enough and secure enough to go to sleep on his own. You don't want that made more difficult by any fears of being alone in his crib.
After he is okay with nursing to sleep in this way, you might try nursing him till he's almost asleep; eyes closed, heavy breathing but not completely out. Then transition to nursing just till he is relaxed and settled from all the activity prior to the nursing session. When he has done well with you leaving after only nursing this long, then you can try to transition him to going to sleep entirely on his own. You might offer him a favorite toy, book, etc. Give him a kiss and a hug and tell him "night night" in a way that is upbeat and positive. Try to have naptime and bedtime at the same time every day with a routine that he can begin to recognize and expect. For example, have naptime every day after lunchtime or have bedtime every night after snack or bathtime. That way he knows what to expect. You might even remind him that naptime or bedtime are coming and talk excitedly about it. For an older baby or toddler, ask him what he would like to take to bed with him; talk about the place he will sleep, how neat it is, etc. Allow him to have the light on if he wishes or the door open or whatever he wants in the bed with him - don't fight him on the little things.
Again, your goal is to get him to a comfortable enough place that he feels secure enough to go to sleep without nursing and by himself.


My baby sometimes nurses for comfort, when he's obviously not hungry.
Is this a problem?

Comfort nursing is normal. If baby were not comfort nursing he would need to be sucking on his hands or on a pacifier. The breast was the first pacifier and the one that all others are modeled after, so don't be afraid to allow baby to use it in this way. There are studies that show that comfort nursing is healthy for your child, too. All babies need to suck - some more than others. It ensures that they survive. If your baby seems to be comfort nursing *all the time* and this is more than you can handle, keep in mind that this will probably ease some as time goes by. In the meantime, you may find that carrying baby in a sling or a carrier on your body will lessen his need to comfort nurse so much. He may just need to be close to you at times and seeks out nursing as a way to do that.
Comfort nursing serves a purpose, too. Studies seem to indicate that this type of sucking overall decreases a baby's heart rate and lets him relax. It seems to have a very positive effect on his whole physical and emotional well-being. Don't be afraid to allow this type of nursing. Breastfeeding is more than just imparting fluids and nourishment. It's a way to nurture your child as well.

In conclusion...

If nursing your baby to sleep and/or nursing baby for comfort is working for YOU and your family, that's all that really matters! Nursing is not only nourishing; it's also nurturing. Your breast is a wonderful place of comfort and security to your child, not just a feeding "trough". The time spent nursing your baby is a very short period in the total life of your child, but the memories of your love and availability will last him a lifetime. Trust that your baby will fall asleep on his own in time, and enjoy every sleepy moment while it lasts.


I DO :)