Booby For Life

I had to laugh when I read about this 'breast-feeding diet.'

Feed your baby the natural way and you'll look like Angelina Jolie! The bottom line from this article is the same ol' thing you'll hear in any diet debate: calories in needs to be less than calories out. The end.

I am not yet back to my pre-pregnancy weight. I have those last 10 pounds to go. When I was breastfeeding I did use that as an excuse to say, finish off an entire box of cookies, or more. Well, it's a new me and a new year. Time to get on the stationary bike and watch what I eat.

Getting thin is different from getting into shape. There are so many obstacles stacked up against mothers, though. We're extremely busy, have fluctuating hormones, and told "don't lift anything heavier than your baby" at discharge. -The perfect storm.

I've noticed that the first thing that goes is the lumbar/core strength, which is key for happy living. What's the number one reason for a doctor's visit? Back pain. How do we remedy that? I actually found the perfect solution online, no joke. If you follow these magnificent instructions from the Mayo Clinic I, Resident Mommy, promise you better quality of life.

Don't wait until you have spinal arthritis, I'm serious. Otherwise you'll see me coming at you with one of these.

Breast is Still the Best

Don't get me wrong from my previous post.

Breastfeeding is still the best choice for mother and baby. I would not have struggled as I did if that weren't true. Breastmilk gives babies their greatest nutritional support, decreases their chance of infection, while lowering mommy's cancer risk.

My goal was to make it to six months. Whenever I felt like giving up, I thought about the following two examples of perseverance:

• Dr.W: Another resident mommy, pumped for months in between 4+ hour orthopedic surgeries. When she got engorged, Dr.W wasn't allowed to adjust her bra because not only was she 'scrubbed in,' she also had a lead apron on top!
  
• Lanisa Allen: Had to sneak away to use a public bathroom to pump her milk and was fired for it. See her story here.

An Unfair Depiction

But I'm not tied down to my breast pump.

Y'know, when the Mormons were first asked to practice polygamy most of them went kicking and screaming into the practice. Then when they were commanded to stop, they had a hard time letting go. That was my experience with breastfeeding.

The gap in posts had to do with me being on my most demanding rotation while soaking in the reality of my academic situation. . . all the while working to save someone's life (I'll explain later, on 1/20/10). I had always said that I would stop pumping at the 6 month mark, but just before the finish line my supply went down. . . WAY down. It had to do with a ton of stress and my inability to find time during the day. I became all hung up on the idea of stopping on my terms, not because I was 'failing' to produce.

So I got all worked up, pumped more, fell behind in my work, this added stress, which produced less milk and the cycle continued! Until now, that is. Last week I produced 2.5 ounces, gave my boy this meager portion, and put my supplies away. The large box of nursing pads, bras, tubes, valves, shields, etc got sealed up and put into storage. Part of me was elated; the other part felt terrible for withdrawing this part of myself from my baby. The next week as my normal pumping hour approached I had pangs of regret and actually tried to collect whatever I could manually squeeze out. I came home quite upset when my husband finally said, "It's time."

He's right. 6 months of breastfeeding for a resident mommy is a lot. My baby is on solids now and I can help him to progress in other ways. I'm told I can still feed part-time, but the truth is I need every minute of the day (except for necessary sanity breaks such as this) to reclaim my life.

Herbal Help

Hey, this actually works.

Since I'm on my most demanding rotation now, I need all the help I can get to keep up the milk supply. My average output was on the decline and I decided to give this herbal tea stuff a try. The active ingredient is fenugreek, which can also be found in curry. The result? I went from 9oz to 12-15oz at the end of the work day (depending on how much I get to hydrate).

The taste isn't spectacular, but it's fine with a drop of honey. The downside is that I think my sweat now smells like tandoori chicken.

Sidenote: As a follow-up to my neck injury, it still hurts! One of the young male nurses called me Dr. Batman. -Which I thought meant I was heroic in all my doctorly pursuits. Alas this is not the intent. It's in reference to the rigid mask Michael Keaton wore, which didn't allow him to turn his neck during Batman's fight scenes.

"That Girl is Poison"

They're singing about my milk.

I'm doing another out-patient rotation this month and thought I had the perfect setup for pumping. Unfortunately, the private clinic rooms were all in use last week and I had to search for a new spot to do my thing. I asked a young woman who works as a medical assistant where I might go and she said, "You have no where to go, everything's taken, there's a bathroom around the corner."

If there's one thing I'm firm about, it's that breastmilk should NOT be expressed in the bathroom. I politely declined, and set out to continue my search for a place to pump. At a point of desperation I decided to use the common room for hospital employees. I wasn't excited about this, since people (both men and women) come and go through, but it was my best option and I was literally about to burst.

As I was getting set-up, the same medical assistant comes in and looks at me like I have leprosy. "You're not doing THAT in here! Why don't you go to the BATHROOM?! People eat in here!" her words were dripping with disgust. It was then that I realized how offensive she found my milk to be. I said, "it's just not sanitary in there." To which her reply was: "Oh, like it's that much cleaner in here?" Without pause I stated "I'd like to think there's a lower fecal count where you prepare lunch, yes."

She left in a fury.

Today as I returned to clinic that woman gave me the stink-eye and conspicuously whispered something to a coworker while looking in my direction. I know she can't wait for me to move on to another rotation, and take my poisonous nipples with me.

The whole situation would make me very upset, except is reminds me of one of my favorite videos on the web.

The 15 Minute Pervert

May I re-emphasize to you just how difficult it is to be a resident and lactating mother?

I have explained how as a resident, I'm constantly going from place to place and don't have a steady location for pumping. Last week we had seminars in a new part of the hospital. We were given a tour and this allowed me to check out my prospects. In between lectures I returned to the one room with a manual lock. As I looked around to make sure I wouldn't be intruding, a man startled me from behind and angrily asked "can I HELP YOU?" The look in his eye was so vicious that I stood there almost unable to reply. I finally mumbled something like "sorry, was wondering if anyone needed this room. . ." His response was a condescending "YEAH" as he glanced at his beloved coffee machine.

At this point I was able to turn and face him, he then realized I was a doctor from my white coat and not some rapscallion out to take his treats. That's when I said firmly "I need to be alone for 15 minutes." The man's eyebrows raised when he heard that, and his cheeks pinked up as he looked upon my mysterious leather bag. Quickly he pulled out his keys to usher me into another room, no longer making eye contact with me. Now he was the one mumbling, "I'd put a 'Do Not Disturb' sign if I were you."

The man's reaction left me wondering, what the heck does he think I'm doing for fifteen minutes in a private room? Clearly he didn't want to know.

There were no materials to make a sign, so I found a place in the back of the room and barricaded the door with a chair and a foot stool. About five minutes into pumping I heard keys turning. . . "I'm in here!" I yelled out. No use, my words could not be heard over the banging of the door against my makeshift barricade. -Wouldn't that be a hint to most people not to come in?!

Finally a man pokes his head through and sees me sitting there with my back towards him and two tubes coming out of my torso that meet a strange machine, which happens to make a sucking sound. He might as well have seen a ghost, he was that mortified.

I can just imagine the conversation in the break room that day, the one about that pervert resident and her 15 minutes of shame.

Crying Over Spilled Milk

I think I'm entitled to shed a few tears over this.

Oh the irony, I tilted back the valves of my pump to get those last few drops that were sitting on the rim. Next thing I know I got a warm, sticky mess on my lap.

Now I know the following:

Hangin' with Mr. Cooper

There's not much natural support.

"You sacrificed your boobs, you know." I've been told that a few times since becoming a mother. My fellow residents are the only ones to say it that way. As doctors, we've seen a lot of boobies and the saggy grandmas leave an indelible impression that makes many hesitant to have kids and breastfeed.

The only thing keeping the breast suspended are Ligaments of Cooper that are very, very fine elastic fibers. With time and strain they can give out and cause, what we call, "T4* to the floor."

I'm a big supporter of breastfeeding, but I also don't want to carefully maneuver my cane around my boobs one day. So I take the following steps to fight the good fight against the sag.

• Rotate bras.
  If you wear the same bra all the time, it loses its support. Also, I invest in the good stuff.
  
• Wear a sleep bra at night.
  It doesn't have a strong hold, but it's better than nothing.
  
• Use the side-lying position for feeding.
  
• If I do breastfeed upright, I bring my baby to my boob and not the other way around.
  
• Pump before I get engorged.
  
• Not dance like this (courtesy of my friend, Brenda).

*T4 is the spinal cord level that innervates sensation in the nipple.

Wordless Wednesday: My Brest (Party) Friend

The Essential Scarf

From H&M, only $7ish

Let me tell you why I can't live without this accessory. I have used my scarf to:

• Look put-together, without the effort.
  It may seem impossible to look stylish when you have a child consuming all your time and energy, but adding something as simple as a scarf really does wonders to make an outfit.
• Cover myself during public breastfeeding.
  I have the standard shield, but in summer it gets unbearably hot under there. I discovered this use when I was in a parked car trying to feed my boy and my scarf, still around my neck, fell perfectly into place. It's very light and Philippe got a lot less sweaty during the feed.
• Hide nipple leakage.
  This was my initial reason for buying scarves.
• Block out smoke.
  A bonus! When I pass by cigarette smokers I hold my scarf to my face. Do you think that's rude of me? I don't, in fact when people have said something about my conspicuous dislike for tobacco smoke I say "Sorry, but I'm allergic to cancer."

This post is part of my follow-up to The Resident Mommy Makeover.

Tips for Pumping - Thanks Marketing Mama!

Check out this awesome how-to guide from Marketing Mama on how to pump successfully at work. It is an awesome resource!

I would like to add a few things from my limited experience. These are tips specific to being a doctor, but can be applied to any mother who is extremely pressed for time.

• Check in with the RN station beforehand = Get things in order first
  All residents quickly learn that if you want uninterupted time, you speak with the ancillary staff to find out if they need anything from you before you take care of yourself. Nothing cuts off a milk letdown like hearing your pager go off in the middle of pumping, and I imagine the same is true for moms who hear their children screaming for something when they've just gotten settled.

• Say it straight-faced = There's no need to get embarrassed over pumping
  Doctors hardly blink an eye when they hear about body parts and functions. The truth is, if you don't make a big deal about something it doesn't become one. In contrast, if you're red faced every time you say 'breast' that's going to have a positive feedback response from the person hearing it. So just say what you need to say to communicate with people your needs for pumping breast milk. -Tee hee.

• In case of a Code Blue = In an emergency. . .
  Detach the tubing from the breastshield and bolt. If you remove the tubing from the pump itself you will not be able to lay the bottles on a flat surface and run. And don't even think about spending the time to transfer your milk to another container when your adrenaline is pumping.

• Type progress notes while you pump* = Go hands free
  There's that goofy looking bra you can wear to hold the breast shields in place and many mothers swear by it (I'm not knocking them, but c'mon, don't tell me that picture doesn't make you crack up). I recently found, however, that my Playtex nursing bras have enough elasticity in them that they can be clipped around my pumping parts and actually hold them in place!

• Consider your rotation schedule when returning to work
  Don't jump back into residency with an in-patient month if you can help it. You'll be too tired and literally drained to get through it well. If your schedule has already been made, see if you can switch with another resident for an elective month.

• Create an involuntary pathway = Train your brain
  Repetition will limit the amount of time it takes you to pump, and hopefully limit mistakes that will eventually happen when you're sleep deprived.

• Build your reserve by the end of maternity leave
  This is really difficult as a resident because most of us get only 6 weeks off, the end of which usually marks the time when baby is going through a demanding growth spurt. But if you can push yourself to have a nice supply sitting in your freezer, a HUGE weight will be taken off your shoulders and you'll be a milk machine.

* Marketing Mama brings up a good point that you should just focus on your baby when you're still getting into pumping.

A 'Private' Place to Breastfeed

Have a good laugh on me.

Pumping at work requires a lot of preparation. As a resident, it's particularly difficult because we're on a rotating schedule and that means I'm moving from place to place.

I've saved a template for my requests to have enough time to pump, in a clean and private place, with access to a power outlet and fridge. I sent this to my current hospital site, but failed to realize that I would be spending time at my affiliate medical school for lectures. It's not my alma mater, so I'm not familiar with its layout. Almost frantically I called a male friend who is currently a student there the night before saying "I just realized I'm going to be at your school tomorrow for many hours, I'll need to pump my milk over there, where can I go?"

The poor guy felt bad for not having an immediate answer, but obviously he'd never had to think about this before. He called back to tell me that I could use an 'OSCE room.' Of course, I thought!

OSCE stands for Objective Structured Clinical Exams, and most med schools have rooms set up like actual doctors' offices so that students can be observed in a real life setting. It would be perfect because I could lock the door, plus there'd be a sink in the room.

I was glad everything worked out. As I got myself settled I pulled a privacy curtain around me to make me feel extra secure. After all, it's a vulnerable position one's in with plastic funnels gripping the breasts and both nipples pointing out like torpedos.

That's when my own OSCE exams played over in my mind. I used to hate having the video cameras hover over me to screen my performance. . . DOH! There they were, two lenses pointed right at me! I hoped no one was filming, and I nervously finished pumping with the assumption that there's not a lactating porn market out there.

(If someone calls me Dr. Galactasy one day, I'll know I've been had.)

Coming soon:

Scarves - The essential mommy accessory

Cancer prevention - Why breast-feeding helps

Residencies - Which are the most pump-friendly?

Dude, What a Diss

"Are you my mother?"

Remember that post about my sacred bond with my son during breast feeding? Well, this is a picture of Philippe mistaking the rounded end of a pillow for my bosom. He is trying his hardest to suck milk from it, even resisting me as I try to pull him away.

I felt like giving him that line from Beyonce's Irreplaceable: "Since I'm not your everything, how about I be nothing, nothing at all to you." Here, take your bottle! Two can play this game. From now on I'll spend time with my other child, Señor Pump-N-Style.

In a Word: Handy

Itzbeen too long without this gadget in my life!

OK, so I've had a newborn for only a week, but really this little device has greatly improved things. The post-partum nurses successfully scared me into scrutinizing every wet and soiled diaper with its time of arrival. Thus at one point I could be found juggling baby in one hand, and dry erase board plus flashlight in the other to record nighttime activity. -What a debacle!

Now that I have the Itzbeen Baby Care Timer, things are going relatively smooth. It keeps track of how long it's been since baby was last fed, diapered, or went down for a nap. There is a night light and it even has a tab to help you remember which breast was offered last. This device fits in one hand and can be clipped to your clothes.

You can also opt to set an alarm if baby sleeps past the time his feeding is due. This is not yet a problem for us, but I would certainly welcome that sound over the buzz of my pager going off.