Elimination Communication – It’s Amazing Shit! Sorry…

What the hell is elimination communication (EC)?  It is parents learning their babies’ cues when they need to do a poo or wee and acting upon them so that the baby doesn’t have to go in a nappy.  Because, to be honest, who would be happy to soil themselves if they don’t have to? Babies feel the same way.

I heard about EC when I was pregnant and thought that it sounded like an excellent idea.  You can start from birth, but what with our baby being in hospital for a few weeks and then having so many problems with breastfeeding and weight gain, it slipped of the radar a bit.  Until a few weeks ago.

I was a bit sceptical, to be honest.  However, a month down the line I am seriously impressed.  We started off looking for poo cues, as this is a lot easier than wee cues (although actually they’re quite similar in our girl).  Our little cheeky chops tends to go red between the eyebrows and pauses for a few moments, looking (and sounding!) as though she is visibly straining.  When I saw her doing this, I would very quickly pop her on to our special small potty and as she did her poo I would make a straining noise.  Sometimes she would do a wee at the same time as a poo and I would make a ‘pssssssst’ sound too.

Fast forward a few weeks and because of her horrid teething and stealth poo nappy rash, the small one has been mainly nappy-free this week except for sleeps.  We have had two small wee accidents, but that’s it.  She will do all her poos on the potty and most of her wees.  She even cried yesterday when I put a nappy on her before bed.  I got the feeling she was trying to tell me something and so I popped her on the potty and she did a massive wee.  I just make sure to put her on the potty frequently and ask her if she has a ‘straining noise’ or a ‘psssst’. She then strains a little and if there’s something there……out it comes.  Result!

Some people think that EC is about early potty training.  It isn’t really.  It’s more about understanding your babies’ cues and then training them to associate the sounds you make with doing a wee or poo.  Follow this up with giving them plenty of opportunities to do their business on a potty and there’s a good chance they will oblige.  I think Rosa really appreciates not being in a dirty nappy so often.  You can do EC on a full or part-time basis. I think for us in the day when we’re at home is right for now.  Maybe we’ll do more when she’s older. Having a 9 month old baby who regularly uses a potty is astounding, and so much better for her and us!


Goodbye, My Silicone Friends!

Me feeding Rosa at 8 months with no nipple shields – hurrah!

It’s not what you’re thinking. Although this post is boob-related. After 8 months, we have finally stopped needing to use nipple shields to breastfeed.  I never thought that this would happen, so I’m over the moon!

When Rosa was born, she couldn’t latch on properly. There was a lot of licking and rooting going on, but she just could not latch on to my rather flat nipples.  Added to this, she was ill and in SCBU and had a naso-gastric tube fitted for a while so it was always going to be a bit more difficult for her to breastfeed well.  A nurse in SCBU suggested we try nipple shields so we bought some Boots own-brand ones and although it still took up to about 20 attempts each time, we managed to achieve a workable latch.  Then after leaving SCBU we got some new Medela nipple shields and never looked back. I could get Rosa to latch on first time every time and I was thrilled.

If you look through breastfeeding information, virtually everything you read about nipple shields is negative.  They can affect milk supply, stop babies receiving as many antibodies in breast milk and make feeding last a lot longer.  However, the research quoted in these articles mainly focuses on the old-style nipple shields which were a lot thicker and often made of rubber.  The Medela Contact shields that I used (tee hee, past tense!) are thin silicone with a cut-out area at the top. This is so that the baby’s skin can make contact with your skin, as it’s not just removing milk from the breast that stimulates supply, but the skin to skin contact involved too.  Silicone shields affect the milk transfer rate much less than the old rubber ones.

I will always be immensely grateful that the lovely nurse, Sonia, suggested nipple shields. If it had not been for her, and them, Rosa would never have been a mainly breastfed baby. It was very hard work getting Rosa to breastfeed, in fact the hardest thing I’ve ever done, but so worth it.

From my experience, I would say the following about nipple shields:

  • Do seek out breastfeeding support as soon as you experience problems. Expert peer supporters from La Leche League, the NCT or the Association of Breastfeeding Mothers might be able to sort out your attachment and positioning issues very quickly and you may not need to use nipple shields.
  • Nipple shields are not evil and can save the breastfeeding relationship, as in our case.
  • They should only be used as a short-term measure if possible, as they can make it more difficult for the baby to get the hang of latching on to a bare nipple. But with the new silicone type it’s so not the end of the world.
  • They did not affect my milk supply, but then for the first few weeks and months I did express a lot.
  • Feeding Rosa with nipple shields took a long time.  For several months it took me an hour to feed her.  This is because the milk transfer rate is lower as babies feed from nipple shields using just suction rather than suction and tongue action, which is how normal breastfeeding occurs.  Feeding her without the shields is a revelation.  Often less than 10 mins each side.
  • Breastfeeding in public with nipple shields is a faff and makes it harder to feed discreetly.  Use a pashmina or breastfeeding shield if this bothers you.
  • If you do end up using nipple shields, keep trying to feed without them every few days or weeks.  I would often manage one or two feeds without them but it would become too painful after a few goes.  In that eventuality, whip the shields back on, let your nipples heal again and forget about trying without for a little while.  It could be that a few weeks or as in our case, months later, your baby’s mouth may have grown enough to overcome any issues.
  • They don’t need to be sterilised after every use, as breast milk is naturally anti-bacterial. I would wash them with hot soapy water between feeds and then sterilise them each night.
  • Buy 2 pairs, so that you always have spares, because you will lose them temporarily!
  • On a stranger note, be aware that for some reason kids LOVE nipple shields and the bright yellow case that came with the Medela ones. Whenever toddlers or older kids were around, they pretty much always picked up my freshly washed nipple shields to have a closer look.

How To Survive The Special Care Baby Unit – Part 2

After having shared our experience of the Special Care Baby Unit (SCBU) in my last post, I thought that in this post I would give our top tips for surviving a SCBU stint.

1) Get all the support you can. Ask your partner, parents, extended family and friends to come in and visit, bringing anything you or the baby need in addition to offering emotional succour.  In common with many, our unit had a ‘grandparents and siblings only’ rule for visitors. It’s for infection control purposes, so you can understand that. Bless ’em, my parents came every day bar two out of nineteen. Every day they would call and ask if we needed anything.  Our unit asked that you provide your own nappies and cotton wool balls, so getting top-ups of those was a perfect grandparent task.  It was so good to see my parents each day. Richard and I really appreciated them having made the effort, and Rosa seemed to enjoy their company too.  Randomly, they would bring us nice desserts sometimes, which was a small gesture but meant a lot to us, especially after days and days of hospital food.  As for the ‘grandparents and siblings only’ rule, in the event that parents of a poorly baby did not have living or involved parents themselves, it was possible to negotiate and nominate someone else for those daily visitation privileges.

2) Get out of SCBU sometimes.  Although we wanted to be with Rosa 24/7 when she was in hospital, the Special Care Unit was small and overwhelming. At times when it became claustrophobic and oppressive, Richard and I would escape for an hour or two. This could be a trip to the chemist’s to buy something Rosa needed, or a visit to our home, or lunch or dinner at a nearby restaurant. It was wonderful to get out and get back to the normal world just for a short while, no matter what the nature of that time away was. There was also a room with a TV and tea/coffee-making facilities attached to the unit, which we would go to for a drink and some time out at least once a day. We would return to Rosa feeling refreshed and able to cope with the intensity of the unit once more. And in the words of one of the nurses, “You might as well make use of the best babysitters you’ll ever have!”.

3) Be assertive. As your baby’s parents you have choices when it comes to medical treatment. You do not have to passively accept what is suggested.  When the doctors wanted to perform a lumbar puncture on Rosa, but said that the results would not have any effect on their course of action at that point, we declined the procedure.  Why inflict that on her when it wouldn’t affect what they were going to do?  Also, when the ward manager of the post-natal ward wanted to discharge me after 10 days, Richard told her I wasn’t leaving as we didn’t know if our baby was getting better or not.  If, as I was, the new mum is feeling too weak to stand up for herself then she needs to find someone who can do it for her. If not a partner then another family member or a friend.

4) Resist crazy feeding. When Rosa came out of SCBU, and for the entire duration of her stay there, our feeding regimen was completely bonkers.  Every 3 hours or so, I would attempt to get her to feed on the boob, followed by feeding her my expressed breast milk by bottle, then a formula top-up. Then I would express breast milk for 40 mins. This process, punctuated by a nappy change and winding would take me 1.5 – 2 hours.  I have really mixed feelings about what happened with regard to feeding in SCBU. Rosa being given bottles of formula by the nurses in the first few days is the likely cause of her not being great at breastfeeding.  On the other hand, 2 of the nurses suggested nipple shields as a means of getting Rosa to latch on to the breast.  This worked and although we are still using them 8 months later, if it hadn’t have been for that advice Rosa would not have been breastfed. However, I was staggered to learn months after discharge that there is an Infant Feeding Coordinator at the hospital whose role it is to promote breastfeeding.  In 3 weeks there, we did not see or even hear mention of her!  I would strongly recommend that any mother with a baby in SCBU who is determined to breastfeed gets expert advice immediately if she is having problems.  And by expert advice I mean either from someone like an infant feeding coordinator within the hospital, or from someone from the outside, like a La Leche League or NCT breastfeeding counsellor. Don’t get sucked into the kind of crazy feeding schedule that we did. It is not sustainable and could interfere with establishing breastfeeding.  As soon as we left, I stopped this madness and we established a routine where Rosa is breastfed apart from one bottle of formula each day.  This has worked for us and although I have never managed to breastfeed exclusively, at least 80% of her daily milk is breast milk and that is pretty damn good given the start we had.

5) Do not get freaked out by doctors. It’s worthwhile pointing out that doctors work by ruling stuff out.  For us, this meant that, on one particular awful day in SCBU, Rosa was seen by 3 separate sets of doctors.  One set was concerned that she might have an infection in the bone of her elbow, one set thought that she needed a lumbar puncture to determine whether she had a brain infection and another set thought she had a heart murmur.  We were distraught.  Anyway, we declined the lumbar puncture for the reasons above and the elbow and heart were scanned and no problems found.  I think we found it very difficult because the paediatricians at our unit were not great at communicating.  I would advise any parent struggling to understand what the doctors are saying to ask the nurses to translate.  One thing that we found stressful was that tests were performed on Rosa, but we would not be informed of the results unless we chased them up.  We found that the nurses were generally excellent on SCBU and were a great source of useful advice and information.

Having an ill baby is always going to be a very difficult experience for the parents of the child. But hopefully, some of the things which we found helped us through our time in SCBU may be useful in helping other parents to cope too.

How To Survive The Special Care Baby Unit – Part 1

It has taken me several months to feel like I can write this post.  After Rosa spent 3 weeks in SCBU after birth, with a mystery infection that didn’t respond to the first lot of antibiotics, it felt too raw to write about it for a long time.  However, our little munchkin is seven months old now and has thrived ever since her discharge from hospital so there is enough emotional distance now. I thought it might be of use to other mums and dads with a newborn in SCBU to share our experiences and how we coped.

I won’t lie.  After the euphoria of the birth, the 3 weeks that Rosa was ill in SCBU were the worst experience of our lives. We hadn’t expected that she would be ill and we certainly never thought that she would be in SCBU for 19 days.

Here’s our story:

I developed a temperature during labour, after my waters had broken a few days earlier. We had declined augmentation of labour because I was having contractions and was dilating, and the baby and I were fine when monitored. But the contractions kept stopping. In the end, because of the temperature I did agree to go on the hormone drip and I had IV antibiotics during labour. When Rosa was born she was whisked away by the paediatricians and her blood was tested. The level of a protein which indicates infection, CRP, was abnormally high and she was started on IV antibiotics.  It broke my heart to see my newborn with a cannula in her hand within 2 hours of birth.

Rosa seemed to be doing ok until 2 days later, when we had the scariest day ever.  I had gone over to SCBU from the post-natal ward to feed Rosa at about 6am and then went back to have breakfast and shower at about 7.30am. When I left Rosa she seemed really well and I was feeling optimistic about getting her home soon.  I went back to SCBU at 9am to find that Rosa was no longer in the main nursery.  One of the nurses told me she had been moved into the intensive care room and had a tube in her nose, because she had started vomiting bile.  I was really upset and Richard wasn’t due to arrive for another hour. When the doctors came and did their ward rounds at 10am they spoke to us and said they wanted to perform a lumbar puncture on Rosa to determine whether she had any infection in her brain i.e. meningitis.  We were horrified. They also said that the results of a lumbar puncture would not change their course of action at that stage.  Therefore, we declined the lumbar puncture and asked the doctors to proceed with the next stage of treatment.  This turned out to be IV antibiotics five times a day for 14 days.  After this, it was a waiting game.  Our poor baby had to have a new cannula inserted every couple of days because babies’ blood vessels are so tiny cannulas blow very quickly. It was all very scary, and we found the doctors to be very uncommunicative.  This may have been because she was a bit of a mystery to them.  All the tests performed on her and me came back negative.

Another of the worst times came after 10 days when the post-natal ward wanted to chuck me out. There would have been nowhere else for me to go within the hospital, so I would have to have returned home. For me this was simply not possible. My baby had a severe infection, was on her second lot of IV antibiotics and we didn’t know at that stage if she was getting better. The best thing for her was my breast milk on demand, as the doctors had told me. How could I possibly achieve this, feeding every 3-5 hours in a crazy cycle (more of that in part 2) that took 2 hours, if Rosa was in hospital and I was at home? We live a 10-minute drive from hospital, but that would have been completely unsustainable. Unfortunately, at that point, I wasn’t my usual assertive self.  I had just given birth and my baby was dangerously ill.  I could pretty much only make milk and cry during our period in SCBU.  Thankfully I have an amazing partner who was able to stand up for Rosa and me. The Ward Manager was awful to us when we said that we felt that I couldn’t leave. She said that we were selfish and unreasonable and should be paying £250 per night to stay there. He told the Ward Manager on the post-natal ward that I wasn’t going anywhere and they would have to get security to throw me out.  I would have stayed anywhere in the hospital – a broom cupboard with a blow-up mattress, nurses’ accommodation, anything!  The NHS website says that parents of babies in SCBU should be offered accommodation, so I really do not feel that we were being unreasonable. I’d rather feel like a slightly bad person than a bad mother any day, that’s for sure.  Thankfully, the one room for parents attached to SCBU became available and we were able to stay there for the last week of Rosa’s time in the unit. This was wonderful, as I had been on my own at night in hospital for 2 weeks by this point and some of my loneliest and most vulnerable times were feeding Rosa in the wee hours.

When we were over the accommodation hurdle, things got better. Rosa seemed to be doing well and we just had to get through the 14 days of the second course of antibiotics. Life in SCBU became a routine of feeding, nappy changes and cuddles, interspersed with desperately trying to fit meals, sleep and personal hygiene in!  With Rich in hospital with us for the last week, the situation was a lot brighter.  After what felt like a very long time, we were finally allowed to take Rosa home.  I am very happy to say that although Rosa’s time in SCBU was extraordinarily stressful, she received excellent care and now it seems like it was all a very long time ago.  It did take a few months for me to be able to relax enough to fully enjoy being a mum without worrying constantly though and I’m sure that was a legacy from our time in SCBU.

Baby-led Weaning – A Daily Miracle!

A couple of weeks before she was six months old, Rosa started taking food off our plates when we were eating and putting it in her mouth.  It was a clear signal that she was ready to start exploring food. I had heard about baby-led weaning and bought the book by Gill Rapley.  It was a revelation!

I had not been looking forward to giving Rosa baby rice and purees.  The idea of giving her what we eat, cut into pieces or pre-loaded onto a baby spoon that she can grab by herself, just seemed right. Richard and I love cooking and eating and really want Rosa to share our enjoyment of a wide range of foods.

The first day we started, it was with some trepidation.  We put the baby in her high chair at dinner time and gave her a rice cake spread with soft cheese with a steamed stick of carrot and a floret of broccoli.  She set about them with gusto, sucking the cream cheese off the rice cake and sucking the veg too.  She seemed to enjoy the experience and it was lovely to sit together as a family and eat.   I was unsure of how much she had actually eaten, but her next dirty nappy had visible bits of broccoli in it.  I think they eat more than we imagine.  As she has no teeth, Rosa just sucks the food or gums it at the moment.  She can’t cut meat in her mouth without teeth, but sucks the meat juices out of strips of meat which provides her with that valuable iron.  If we eat purees or soft food that she can’t pick up in her hands, then we pre-load a spoon and offer it to her.  The very first time I did this, Rosa picked up the spoon and inserted the correct end into her mouth with the mashed potato on it.  It was amazing!

Before finding out about baby-led weaning, when I thought of introducing solid food to a baby, I thought of mealtime battles. The baby spitting out purees or baby rice and an increasingly desperate parent inventing games to try to hoodwink the child into eating more. The ethos behind baby-led weaning is that the baby will need the same amount of milk until they are one, so any food eaten will be complementary to that milk. You always feed the baby a milk feed before offering food, so that they don’t fill themselves up with solid food when milk is still the priority.  You then trust the baby to take as much food as they want.  Your job is to offer as much food as they want and they will take what they need. It just completely removes stress about eating.  Rosa has enjoyed every mealtime and has eaten everything we have ever put in front of her.  This includes home-made curry and chilli con carne!  She clearly gets excited about eating when we put her in her high chair.  It really is a miracle and is so different to how I had expected (or rather feared) it to be.

It means that she can see us eating what she is eating, so she knows that it is safe. She can work out how to move food around her mouth safely, because she is the one controlling how much and how food enters her mouth.  Choking is often mentioned as a risk with baby-led weaning, but actually as long as your baby is 6 months old and is always kept upright when eating, the risk is less than when spoon-feeding, because the baby is in control.  They do sometimes gag, which is alarming, but that’s a normal learning behaviour.  It’s your child learning how to not choke!

A fringe benefit of the baby-led weaning approach is that my 4-year old step-daughter, with whom meals were becoming a bit of a battle, is now much easier to feed.  Scarlett had, for the past year or so, started asking what we were having for the next meal purely so that she could say she didn’t like it or didn’t want it. Now, we cook whatever we planned and put the constituent parts in separate bowls for everyone to help themselves.  We let Scarlett help herself and she knows that there won’t be anything else so she needs to eat an adequate amount. It’s working a treat!

Many friends and family members who have witnessed Rosa eating have been amazed by what they have seen.  She sits there, eating away, making lots of noise that clearly indicates that she’s enjoying herself and she fully shares in the social aspect of eating. There is nothing so far that she hasn’t tried and enjoyed! I would heartily recommend baby-led weaning to anyone. It makes introducing solids fun and easy for parent and child. The only negative is that it is messy, but those long-sleeved bibs (£3 for 2 from Sainsburys) and a plastic play mat under the high chair help a lot!

The First Night Out!

For the first time since New Year’s Eve 2010, 6 days before we found out I was preggo, I went out! For drinks….with friends…..and no baby.  It was my friend Cath’s birthday and Richard encouraged me to go out and offered to look after the baby through the night.  I wasn’t sure if I was ready.  I’m not organised enough to express in advance, so that would mean that my baby would have three bottles of formula in a row, rather than her usual one a day.  I would still need to come home and express some milk, but throw it away (pump and dump).

On the day, I was really tired.  My baby had had her third lot of immunisations the day before and had slept fretfully.  I was shattered from the word go and then had a really busy day with Richard, my step-daughter and the baby.  I was seriously thinking I should just forget about it and get some sleep instead.  But after dinner I got my second wind and decided I would go out after all.  I had said to my friend that I’d come out and I was really looking forward to seeing her.  The issue of the formula still remained.  I felt very guilty at the prospect of giving her three consecutive formula feeds.  However, as Richard said, it’s not like she hasn’t ever had it or anything and it was just for one part of one day.  I think you do need to get a sense of proportion about these things.  My daughter is nearly 6 months old and against all odds her main source of nutrition by a long way has been breast milk.  So I really should be able to go out and  enjoy myself for one night without feeling guilty.

How was the first night out?  It was great.  I really enjoyed myself and it was lovely to see my friends and celebrate Cath’s birthday.  I was able to wear a nice dress that didn’t need to be selected for easy boob access! I wore make-up!  I drank booze! Only 3 drinks, mind, and I did feel really rather tipsy being a complete lightweight these days.  Although I missed  Richard and my little one, it was great to be out and to enjoy a little time to myself.  So, if you’re feeling nervous or guilty about going out for the first time, then please don’t.  If you’re ready to go out, you’ll know and you will enjoy yourself.