But what this particular photo stirs in me is the amazement that even in hardship, life simply must go on.

Thanks to The Motherwear Breastfeeding Blog for posting this photo from Wikimedia Commons.

Please don’t buy us anything!!!

And yes, I’m being totally serious. As irresistible as baby shopping can be (believe me, I have had to restrain myself a lot recently), we have just about everything we need. We’re having another girl, and we have soooooo many cute baby girl clothes in all sizes that to buy or receive more would just be ridiculous. The same goes for stuffed animals, baby blankets, teething toys, bibs and just about every other imaginable category of baby goodies.

But please, don’t fret. There IS something you can do for us. I won’t tell you what it is yet, but rest assured, I’ll be having a little virtual baby shower on my personal blog sometime soon. And when I do, you’ll have the opportunity to give us something we really, really want as a family of four to be!

A nursing mom’s milk supply can also be a huge source of anxiety. A lot of women only breastfeed a few weeks, and there’s definitely a lack of readily available information about how your milk and your breasts change if you continue to nurse for 3, 6, 12 months, never mind if you nurse for years. The information is out there, but you have to look for it.

That’s what this post is about: infant growth charts and milk supply.

The background: last week, one of my best friends wrote me an email. Her first child is roughly 4 1/2 months old, and at her last well-baby check-up, registered in the 20th percentile for weight. My friend was concerned, wondered whether her milk supply might be dwindling, and she asked me for my thoughts. I sat down and wrote her a loooooong email (I had a lot of thoughts on the subject!), and I thought I’d share it with you, too. Of course I’ve taken out personal details regarding my friend and her baby.

Spend 2-3 days in bed with baby and just sleep, eat and nurse, nurse, nurse!

Here were my first 2 pieces of advice:

1. First of all, Don’t Panic! Your milk supply hasn’t disappeared. If it has diminished, there are plenty of ways to increase it. And most important of all: 20th percentile is still normal. It just means that 20% of normal babies are at about that weight. And baby’s being at the 20th percentile for weight at her age doesn’t necessarily have anything to do with your milk supply.

2. An extension of Don’t Panic! is that this is not a reason to supplement with formula. Don’t do it. Your milk supply really would drop if you did.

Okay, that said, there are really 2 separate issues here: baby’s height/weight and your milk supply.

Let’s start with baby’s growth.

1. Do you know which growth chart your doctor uses? If not, find out. Check any paperwork for sources. Call the office. Basically, what you want to know is whether they’re using the CDC’s infant growth chart from 2000 or the WHO’s revised growth charts, which became available in the US in 2006. Why do you need to know? Because the CDC’s charts are based largely on formula-fed infants, who grow at different rates during different stages of development. This means that while breastfed babies are likely to be in the upper percentiles from birth to 3 months, they are likely to drop, percentile-wise, in the months thereafter. If your doctor uses the CDC charts, this drop could be considered totally normal and appropriate for an exclusively breast-fed baby (and you might as well consider baby exclusively breast-fed since she’s not eating significant amounts of solids). Here’s a graphic that shows where breast-fed babies tend to score on the CDC chart.

And here’s what Kellymom herself says on the subject:

I have heard of many breastfed babies (including my own) whose doctor was disturbed at some point because the baby wasn’t gaining weight quickly enough, even though the baby was well within the above parameters for weight gain. The problem is that many doctors are not familiar with the normal weight gain patterns of breastfed babies, and rely too much upon standard growth charts.

And the parameters for weight gain are the percentile charts we’re talking about. Unless a baby really drops off the charts, the chart alone is no reason to get worried. You can download the WHO’s charts from their website.  (Scroll down to “indicators” and see “length/height for age” and “weight for age.”)  Just keep in mind that weight is indicated in kilos, so you have to convert (1 kilo = 2.2 U.S. pounds). See where baby falls on this chart. If you do this comparison yourself, you can probably save yourself the trouble of calling your doctor’s office for the information.

2. Oh, and while we’re on the subject of growth charts, I can tell you that at Marie’s last check-up, she was in the 1st percentile for height. Our doctor didn’t even try to be nice about it. She just said, “Hmm, she really just falls off the chart.” And I must say she said it in a rather accusatory tone of voice. It turned out, though, that they measured Marie wrong. Marie wouldn’t stand still at the measuring stick, and so they missed 1 1/2 cm, which made all the difference. Suddenly, she was in the 10th percentile – short, but not alarmingly so. So keep in mind that doctors can be exceptionally good at destroying a parent’s confidence, even good ones.

3. Lastly, have you asked your mom whether you and your siblings tended to be bigger or smaller than average? What about the father’s mom? Genetics could be a factor here.

4. There are other questions to ask yourself when considering whether baby is growing appropriately, namely:

• Is she still gaining weight, even if she’s gaining more slowly that she used to? Gaining more slowly and not gaining at all are two entirely different situations.
• Is she meeting developmental milestones within the appropriate age range?
• Is she alert? Happy? Active?

Okay, now let’s move on to baby’s milk intake:

1. You can’t measure her milk intake, but there are certain signs of adequate milk intake for infants (beyond the newborn stage), and the state of your breasts is only one of those signs.

• Is she thoroughly wetting 4-5 or more diapers a day? If you’re using disposables, do this test to see what a “wet” diaper feels like: pour 6 tablespoons of water into a clean diaper. Use that as a guideline. If you’re using cloth diapers, it’s pretty obvious what “wet” means.
• It’s hard to rely on how much a baby poops, since every baby is different, and stooling patterns tend to change over time for all babies. If baby’s poop is still soft and easy to pass, then that would be a positive sign (since breastmilk has a laxative effect).
• Again, is she meeting milestones?
• Is she alert and active?
• And finally, do your breasts feel soft after a feeding?

2. If you can answer yes to these questions, and if you aren’t giving her any liquids other that breastmilk (like juice, tea or water), then chances are, she’s getting enough, even if you feel like your breasts just aren’t as full.

And finally, on to your milk supply:

1. It’s normal to have too much milk in the beginning and for your supply to then slowly adjust to your baby’s needs. This first adjustment happens some time between 6 weeks and 3 months. You no longer feel “full” most of the time and now get used to that feeling of your breasts feeling full and taught when your baby hasn’t nursed for a few hours and them feeling soft and squishy after a good nursing session. When the transition is complete, you should rarely feel full at all.

The feeling of fullness (sometimes even engorgement) that nursing mothers notice during the early weeks of breastfeeding is really not the norm at all, but means that mom’s breasts haven’t yet adjusted to the amount of milk that baby needs. At some point, typically around 6-12 weeks (if a mom has oversupply it may take longer), your milk supply will begin to regulate and your breasts will begin to feel less full, soft, or even empty. You may stop leaking, you may stop feeling let-down (or feel it less), and if you pump you may notice that you’re not getting as much milk. This doesn’t mean that milk supply has dropped, but that your body has figured out how much milk is being removed from the breast and is no longer making too much. This change may come about gradually or seem rather sudden. Many people are not aware that these breast changes are normal because so many mothers stop breastfeeding early on and never see this change (or mistakenly interpret this change as a sign that milk supply has dried up and wean because of this change). (kellymom)

Do you really have a milk supply issue?

In my case, I had the initial adjustment, but I didn’t totally “lose” that feeling of fullness until Marie was about 7 months old, shortly after we started solids (at 6 months). Until then, my breasts were still fairly taught when Marie hadn’t nursed for a few hours. For a short time around 8/9/10 months, we supplemented a little with formula so I could do more translation work without taking so many nursing and/or pumping breaks. It was then that I got my period again, which probably would have happened much later if I hadn’t started giving Marie formula once a day. That’s when I really noticed a drop in supply; the week before I got my period, I could hardly get anything out with the pump, and Marie seemed finicky at the breast. Then I got my period and everything was normal again. This happened every month from there on.

2. Not only will your breasts start to feel softer, but they will probably also get smaller over time, as you continue to nurse. I was a C/D-cup before pregnancy, a D/E-cup during pregnancy, and an F-cup in the early days of nursing. By the time I weaned Marie, at 22 months, I was a B-cup, and it’s taken a while for my breasts to grow again, even though I’m pregnant again. So the size of your breasts is not a reliable indicator of anything!

3. Keep in mind also that babies have growth spurts, and they tend to start nursing more frequently, get fussier at the breast and often seem to never want to let go of the breast.

Common times for growth spurts are during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). Babies don’t read calendars, however, so your baby may do things differently. (kellymom)

4. If you’re worried because baby is nursing less frequently or her nursing sessions are getting shorter, then it’s probably an indication that she’s just gotten much more efficient at pulling milk down. This is normal, too.

So, at this point, I may have given you enough reasons to reassure you that you have enough milk. But then you might say, “Steph, that’s great that you’ve given me all this information, but I still think I don’t have enough, and even if I do, I still want to know what I can do to boost my supply.” And if that’s what you’re thinking, I’m right there with you. When I noticed the soft breasts and then the low pumping output, I pretty much Freaked. The. Eff. Out. and started looking for all the ways I could combat a low supply. So, here are my best tips for giving your boobs the support they need:

1. First, eliminate possible reasons for a low supply. Kellymom has a comprehensive list, but here are the ones that I think could potentially apply in your case:

• Supplementing with liquids: if you’re giving baby water, juice, tea or formula, then Stop. Right. Now. Unless it’s 120 degrees outside, your milk can totally quench her thirst. Really.
• Supplementing with solids: baby isn’t even 6 months old yet, so there’s no reason to push solids. Until 6 months (and some think even beyond), your breastmilk provides all the nutrients she needs. Supplementing won’t make her sleep through the night any faster, and it could be interfering (a little) with your supply. So don’t make solids a big priority right now.
• Scheduled feedings: are you trying to stretch the time between feedings? If so, it could be contributing to a low supply. Go back to feeding on demand round the clock and see if it makes a difference after a week or two.
• Sleep “training”: as much as it pains me to say it, getting a baby to sleep through the night at an early age can contribute to a supply problem. If you’re going many hours without nursing, your body isn’t getting the message to make more milk. Trying to make night nursings as comfortable and uneventful as possible, and just go with the flow until baby’s at least 6 months old.
• Ending feedings prematurely: even though it seems like some feedings would go on forever, you should let your baby decide when she’s done. Make sure you offer both breasts at every feeding, and don’t cut it off until you can really tell that she’s not actively nursing anymore.
• Diet: there’s no special nursing diet, but make sure you’re eating enough overall. Try to eat something healthy at least once every 3 hours. Make sure you’re getting enough proteins and fats, not just carbs, and try to eat at least one hot meal a day. It doesn’t matter whether it’s breakfast, dinner, or a before-bed “snack.” Hot food nourishes us while also calming us. If you’re eating bagels and sandwiches and salads all day, you need to add a hot meal in there somewhere. Seriously, some women see pregnancy as a license to eat, but if there was ever a time to indulge, breastfeeding is it (unless you’re overweight or you have other medical reasons to restrict your diet). Don’t spend the day eating doughnuts, but there’s no reason to deny yourself a cheeseburger, as long as you’re getting enough fresh fruits and veggies as well.
• Stress: this was a huge factor for me. Making milk is hard work. It uses up far more calories than being pregnant does. If you’re stressing out about your work, your family, housework and whatever else is on your plate, it can affect your overall health, which can affect your supply. At the moment, I’m living through the effects of immense stress on my pregnant body, effects larger than I had imagined possible. And it’s pretty damn humbling. I tend to let myself be practically crippled by stress, and my body certainly suffer. If you have big projects and goals that seem overwhelming, or you wonder when you’ll ever get to your goal, maybe it’s a sign that you should rethink those goals. There’s nothing wrong with modifying, postponing or completely changing your priorities. If you decide to do that, make sure you really accept your decision so you can allow yourself to enjoy the time with baby now. Or, if that option freaks you out too much, try setting small, manageable goals each day. Try using Simple Mom’s pocket docket. Sit down every night and figure out your 3 most important tasks for the next day. Write it down so you’re not fretting about it while you’re trying to sleep. I could imagine a day’s 3 goals looking like this: 1. Take shower, 2. Take baby for a walk, 3. Get X amount of work done on project Y. Taking a shower is an accomplishment for busy moms, so instead of saying, “but I can barely manage to take a shower every other day,” tell yourself, “I’m proud of myself for fitting in a shower today.”
• Herbal teas: most herbal teas are great, but there are a few that are known to diminish supply: lemon balm (Melissa officinalis), peppermint, spearmint, thyme, and yarrow are the milk-decreasing herbs most likely to show up in teas.

2. If you’ve covered that list, and you want to take some positive steps to increase your supply, here are some ideas:

• Go back to nursing basics: review all the stuff you learned in the early days about latch, positioning, supporting baby, supporting mom’s back, etc. Basically, you want to make sure that baby is nursing efficiently. A lot of veteran moms have found that they’ve gotten lazy with these techniques, and revisiting them has helped. The more milk baby removes from your breast, the more milk you’ll make.
• Nurse on demand: nurse as often as baby wants, for as long as she wants. If you have a sling, use it to take her outside when you can’t stand your own four walls anymore. Leave the stroller at home (or use it to schlep groceries!). When things get back to normal, you can reintroduce some restrictions, but be aware that any restrictions could lead to a lower supply.
• Switch sides: instead of offering each breast only once during a feeding, switch back and forth several times, each time baby falls asleep or loses interest. The “fresh” flow of milk could recapture her interest in nursing and help her remove more milk.
• Take a few days off: set aside 2 or 3 days where you will focus on nursing. If baby isn’t 6 months old yet, she might still be young enough that this is feasible. Basically, take her to bed and just nurse, sleep and eat all day. This might give you and your milk supply a boost.
• Drink a good nursing tea: I think teas are better than supplements simply because the act of brewing and drinking tea can become a calming ritual not offered by swallowing a pill. I found a wonderful nursing tea here in Germany that really seemed to help. Unfortunately, you really have to read labels, because some nursing teas include herbs that actually interfere with milk production. Sadly, Traditional Medicinals’ Mother’s Milk is guilty of this.  Sooooooo annoying! If you have trouble finding one, try mixing your own. Buy the following herbs in bulk at a health food store: Verbena officinalis (NOT the same as lemon verbena), Fennel seeds, Fenugreek seeds, Anise and Caraway seeds. Mix them in roughly equal amounts and use one heaping teaspoon to make one cup of tea (steep for 10 minutes). When you find a tea, drink 3 cups a day.
• And of course, if you feel the need for more help in any of these areas, contact a lactation consultant! Visit La Leche League’s website or use this search engine.

In my experience, minimizing stress, eating well and frequently, and drinking a good nursing tea made up my recipe for boosting my supply. I actually suspect that you don’t have a supply problem, but if you think you do or you just want to be on the safe side, these tips for boosting your supply are all safe, gentle and effective. Above all, repeat the following mantra daily: “What’s good for me is good for my baby.” If you’re doing well, baby will do well. It’s not that uncommon for babies to do well while mom is barely coping, but the best recipe for success (under normal conditions) is healthy mom = healthy baby. I know that some of us moms (myself included) are not that great at taking care of ourselves, but it’s something we should keeping working on, anyway. It’s definitely a worthy goal.

For more information, see:

Kellymom’s info on infant growth

How does milk production work?

If you suspect you have a low milk supply, see this page to learn more.

Review the WHO’s growth charts, which are more realistic for exclusively breastfed babies! Remember to convert from kilos to pounds!

La Leche League explains why the WHO charts are better.

A collection of articles on milk supply from La Leche League.

Check out this list of foods to boost your milk supply.

Need to review baby’s latch? There’s a great video to help you help your baby nurse more efficiently.

Want to look for a lactation consultant? Here’s an international search engine to help you find one.

But three weeks ago, I had a hankering for chocolate chip cookies, and I thought it might be a good time to try letting Marie help. It was wonderful! What a difference a few months makes!

I measured the ingredients, and Marie dumped them into the appropriate bowls. We took turns mixing, with Marie doing most of it at the beginning, and me taking over at the end, when the dough became to thick for her. And then I showed her that when you’re done, you can lick the bowl. You should have seen the look on her face – it was as if she had suddenly seen the light.

Anyway, since then, we’ve baked on one day each weekend, and I must say that I look forward to it as much as Marie does.

The real action was too much fun to stop and take pictures, but here’s Marie, hangin’ out with the cooling rack, hardly able to wait for the first batch to come out of the oven:

And here she is at another crucial moment – “cleaning” the bowl:

And here she is after today’s baking fun, modeling one of my aprons:

Her regular Daily Docket fills an entire 8 1/2″ x 11″ page (or A4 for you Europeans), and I have to admit that it’s a little too much for me. If I get up in the morning and my to-do list fills an entire page, it just overwhelms the hell out of me. But she now has a smaller edition which she calls her “Pocket Docket,” and it fills just half a page. This is the perfect size for me. I can keep track of my to-do list, any appointments, what’s for dinner and any notes I need to make along the way. And it keeps me from constantly flipping through my day planner, family planner and the inevitable multiple to-do lists fluttering around my home.

I don’t use the Pocket Docket all the time, but I go through phases where despite my good intentions, I am so disorganized that I seem to forget at least one Very Important Thing nearly every day. At times like these, I print out a few Pocket Dockets and get things back on track. Right now, for example, I’m using them to prioritize my tasks as I’m slowly but steadily recovering from my sinus infection – I want to make sure I don’t do too much, but I want to get the most important things done.

Check out Tsh’s explanation of her Daily Docket: My Daily Docket is My Daily Lifesaver

Also, take a look at her other very useful downloads!

I don’t know how they do it.

Do you?

I have to remind myself from time to time that no one “does it all.” Even if it seems like they do, it’s probably just what it looks like to someone on the outside. And even when you scratch beneath the surface and it still looks like they’re “doing it all,” they’re not.

Anyone “doing it all” is neglecting something, usually themselves.

I have to remind myself of this because it helps keep me from despairing when I feel like I’m failing as a mom, wife, translator or member of society. In fact, I have to remind myself in general of the deceptiveness of the feeling of “the grass is always greener on the other side.” For example, some of my favorite blogs include Soule Mama, Betz White and Angry Chicken. And when I read their thoughts and see their pictures, it’s easy to think my life would be easier and more harmonious if I didn’t live in a big metropolis. So many of the things I value in family life seem so much easier to include in said life when you live somewhere a little quieter. And then I have to remind myself that a) I’m not seeing the whole picture of any of these women’s lives, and b) there are things about living in a big city that I would miss horribly. I see my Ozzie friend Amanda raising her two young children while her husband jets around the globe on business, and I see her do it with such seeming effortlessness, that I wonder if I’m just plain incompetent.

But if I really stop and think about it, I’m not incompetent, and while city living does make certain family rituals much harder to establish and uphold, it’s not the reason I feel like a failure sometimes.

I am, quite simply, overwhelmed right now.

Why, you ask?

• I have a two-year-old;
• I am six months pregnant;
• This pregnancy, while not high-risk, has been very hard;
• I have been laid up with a sinus infection for the last seven days;
• My social network in Berlin has shrunk to miniscule proportions;
• We’re going through a major financial rough spot (oddly enough, totally unrelated to the global financial crisis, but I’ll address this whole can of worms in another post);
• And lastly, alas, after 28+ years of life in this body, I still tend to bite off more than I can chew.

I have a very spirited daughter who is incredibly intelligent but also seems to epitomize the “terrible twos.” She’s growing up bilingual, and that seems to have slowed her speech development a little. Her comprehension is excellent. She also has a fairly large vocabulary, but if you don’t speak both German and English, it’s pretty hard to understand what she says, and even if you do, it’s still not easy. This communication barrier does not exactly serve to diffuse the many little conflicts we have on a day-to-day basis. We’re also going through a rather difficult potty learning phase. She HATES wearing a diaper or having her diaper changed. She shows all the physical signs of readiness for potty learning, including telling us she has to go right before she does go, and she seems willing enough to use the potty at daycare. But at home, she has no interest in sitting on her potty for longer than about 2 seconds. And inevitably, the pee ends up streaming down her legs (if she’s not wearing a diaper), and she gets very, very upset. Now, please don’t tell me it won’t be long before she connects the dots and becomes willing to use the potty – we’ve been at this plane for about 6 months now. Oh, and when I change her diaper, she kicks me – and I mean hard – in my 6-months-pregnant belly.

Which brings us to the next part. I’m pregnant. And this has not been an easy pregnancy, nor is it likely to get any easier. It started out as a twin pregnancy; I lost one of the twins due to a hormonal imbalance. When this condition was identified, I began taking supplementary hormones, which was no fun. Months of exhaustion and nausea later, recent lab tests revealed that I’m anemic (no surprise there – I was last time, too) and that I have ketonuria, which basically means that my body is malnourished and therefore dipping into its own reserves to keep me going. Okay, so I suppose that explains why I still feel so incredibly run down and weak, and it may help explain why I’m still experiencing morning sickness at 28 weeks. It also proves that it’s not “all in my head,” like I’ve sometimes wondered in moments where mind-over-matter thinking has got the better of me. It also doesn’t help that my blood pressure is regularly around 100/55 and sometimes even lower. Put all these factors together, and there’s simply no way I could feel physically fit.

Fortunately, I have an awesome midwife, and together, we’ve come up with a plan for strengthening my body and mind from inside and out. A lot of it has to do with nutrition, a lot of it has to do with yoga and massage, and a lot of it has to do with me filtering out some of the junk in my head so that I can focus on what I need and want right now, both for myself and my family. I had a good start on this, a couple days of truly nourishing food, a less hectic schedule that still allowed me to feel a sense of accomplishment, but then I went and overdid it.

One morning last week, I was picking up a package at the post office when I had a sudden fainting episode. A postal worker called my husband, who picked me up right away and told me to take it easy for the rest of the day. But I wouldn’t listen. I rested for the first couple hours, but then I insisted on shopping for some essentials we needed for some home improvement projects. Toffi insisted on coming with me, since he didn’t want his wife collapsing again, and so off we went. On our way back home, I could feel my right sinus cavity closing up, a very strange and very unpleasant sensation. Once we were home, we picked up Marie from daycare and had tea and cakes with Toffi’s sister and her boyfriend. By the end of all this, I was completely spent, and when I woke up the next morning, I was in Sinus Infection Hell.

That was seven days ago. I seem to have gotten over the worst of the sinus infection and to have avoided the dreaded prolonged bacterial infection, but I’m still not feeling well. I have spent seven days in bed, and I’m still too weak to do any normal activities, but at least I can get up and do a few simple things around the apartment. After the first three days were over and I was no longer sleeping 18 hours a day, one of the hardest things was to just lie there and not go crazy thinking about all things I needed and wanted to get done. I hate feeling so powerless.

But I’m trying to focus on the plan my midwife and I put together:

• more rest
• whole foods nutrition
• no caffeine (or at least no more than a cup of green tea per day)
• yoga, one class a week and at least one hour a week at home
• massage, both professional and from my husband
• being more present when I’m spending time with Marie, giving her more loving attention so she doesn’t have as many reasons to “act out”
• working on my social network

The last point is crucial, I think. I made a lot of friends in the first couple years I lived in Berlin, but I’ve devoted less and less energy to meeting new people in the past few years. While I’ve kept up my friendships with a lot of people from my early days, quite a few of them don’t live in Berlin anymore. So I have a lot of long-distance friendships and not very many friends whom I can see in the flesh very often. This also means I don’t have the best support network when it comes to finding someone to help me out with something at the last minute. Although it’s not the same thing, being out there in the blogosphere had been very helpful, but I haven’t really been around in that sense lately. So I’m really going to try to work on my virtual and real friendships, and hopefully make some new friends. Maybe the next time I go to the playground with Marie… whenever I get over this damn cold.