Which comes first: Nursing to sleep or a baby demanding to nurse to sleep?

Little J has just recently fallen in love with nursing. Yes, it took him almost 5 months to decide that his one job was super awesome, but he's now finally comfort nursing and nursing to sleep. I haven't weighed him, but he feels a bit chunkier, and his diapers are looking a bit small on him, which relieves some nagging worries I had regarding his weight gain and fussy nursing.

Here is a photo of a nursed-to-sleep baby. 

I'm sure you've heard someone say "Don't nurse them to sleep! They'll NEVER learn how to self-soothe!" I'd like to point out how little sense this makes.

• "never" - I'm sure there are many parents, sending their kids off to college, who wish their 18-year-old still needed them to settle in for the night and sleep peacefully.
• "self-soothe" - What does self-soothing look like in an infant? Infants are designed for self-preservation, and they are very good at hollering when things aren't right. Even though you sometimes can't figure out what they need, and meeting their needs looks like pacing with a fussy baby, you can usually figure out what they need simply by holding them. You pick them up, hold them close to your chest, and very often figure out in the process that they have a full diaper or want to nurse. This is how babies soothe themselves: by demanding and receiving comfort from mom or dad. And sometimes, in the early months, dad "the boob-less" just doesn't cut it. Thumbs and pacifiers can sometimes be a momentary distraction, but whenever possible, nursing should meet the suckling needs, not a pacifier and not a thumb.
• "nurse them to sleep" - So it's time for baby to sleep. He is fussy, he is tired, and you know by the clock that it's most likely time for a nap. You cuddle him, sing to him, and pop him into bed. He drifts off to sleep all by himself, and you think you won the baby jackpot. A week later, maybe even a day later, you do the same routine, and instead of drifting off to sleep contentedly, he fusses and talks and screeches, so you try to cuddle them back to sleep. While cuddling him, he aggressively smashes his face on your boobs. Hint, hint, mom, can you guess what he wants? You nurse him to sleep, and he konks out hard, for a good solid nap. So the next nap, you try to put him down without nursing, and he again tells you specifically what he needs. And the next nap, and the next, until it's been a week and he's taking great naps, growing well, and nursing to sleep. You've had some good down time while he sleeps, he's been happy and reaching new milestones...and so what's the problem with nursing to sleep in this stage? 

Breastfeeding Facts I Can't Keep to Myself

There are a few women dear to me who are pregnant, and since I am not about to talk at them for hours about what I know, here's everything I know about breastfeeding. I'm sure there's more, but these include some of the most common misconceptions. And even though my philosophy on advice giving has changed to waiting until advice is asked for, I felt compelled to write it all down for when I am asked.

• Babies are born programed to do one thing: eat. If they are not eating well, or fussing at the breast, then something can be fixed or adjusted, and they CAN breastfeed successfully in most cases.
• Full breasts make high-sugar, bluish milk. Less full breasts make high-fat, creamy milk. 
• A mom's supply is established in the first few months of breastfeeding. In order to establish a good supply, it is best to nurse and nurse and nurse at every cue and then in between those first few months.
• Saying a mom's milk "hasn't come in yet" is confusing and not accurate. The first milk, which is ready during the 3rd trimester, is called colostrum, and is the exact milk the baby needs. The colostrum gradually changes to thinner milk that is in larger volume.
• Studies have shown that proper weight gain in infants is correlated with volume of milk consumed, not the fattiness.
• Lactating breasts are never empty; the fattier milk that a less-full breast makes is continuously produced.
• What is in your bloodstream is in your milk. If caffeine is in your bloodstream, trace amounts of caffeine will be in your milk until your body as a whole processes it out. This means that pumping and dumping does not remove the affected milk, and allow "clean" milk to refill the breast. Pumping and dumping can preserve your supply if you need to be on a medicine that passes into breastmilk and will negatively affect your baby.
• Regardless of maternal diet, breastmilk remains constant (except in certain, very small cases). Vegans and junk-foodies alike make "good" breastmilk.
• It is important to eat well because your body prioritizes milk production, and will deplete your vitamin reserves to make milk. If you eat poorly, you will sacrifice yourself, not your baby's health.
• Breastfed babies (of all ages past the first few days) on average drink 25 ounces a day (with a range of 19-30 ounces). The composition changes as the baby ages, but the volume does not.
• Plan to leave about an ounce for each hour you will need to be away from your baby. If you are gone for 8 hours, leave 8 or 9 ounces. Doing this will preserve the breastfeeding relationship by allowing the baby to demand that your body makes more when you are together. In other words, to preserve your supply, it is important for baby to demand more from the breast and not from the bottle.
• It is impossible to overfeed a baby at the breast; it is possible to overfeed a baby with a bottle.
• Nursing at night doesn't cause tooth decay; formula and other liquids at night can.
• The most common causes of fussing at the breast or refusing to latch are:
• Mom has a fast letdown. 
• Mom has an oversupply (usually feels like engorgement).
• Baby is mad about having tried new nipples (aka nipple confusion).
• Baby is not hungry.
• Baby does not like the speed of the flow of milk: too slow, too fast, etc.
• Baby is teething and it hurts to latch.
• Baby is having an undefined nursing strike.
• The least common causes of fussing at the breast are:
• Baby is allergic to something Mom ate.
• Mom doesn't have enough milk.
• Babies don't wean naturally before toddlerhood. Most times a baby seems to wean, it's just a nursing strike or another temporary problem.
• I have milk stored in the freezer! I know breastmilk changes in composition as the baby ages, so is it okay to give my 6-month-old milk that was expressed when he was 3-months old? Of course! Even though breastmilk does change, it doesn't change so dramatically as to become useless, and not even less than good. Think of it this way: Formula stays the same THE WHOLE TIME, so "younger" breastmilk will always be a better option than substituting with formula.
• If a baby will only calm at night by nursing, nurse. If a baby will only fall asleep by nursing, nurse.
• Breastfeeding on demand 
• Protects Mom's supply. When babies go through growth spurts, they will spend more time nursing, which will cue mom to produce more milk. It's supply and demand, so if a baby is supplemented with something other than pumped milk, then Mom's body is not given the chance to increase the supply to meet the baby's demand.
• Soothes baby, and not just feeds. 
• Means you don't need to budget for formula.
• Gives baby sleepy-hormone-laced, fatty milk at night, and sugary, thirst-quenching, energizing milk in the morning.
• Releases calming hormones in Mom.
• Passes on immunities, both from Mom's vaccinations and current assaults on the immune system. 
• Know your goals, and clarify them with a lactation consultant (IBCLC is best). Do you want to breastfeed for a year? Two years? Do you want to exclusively pump? Pump and breastfeed? There are ways to be successful regardless of what plan you choose.

How Do You Respond to Difficulties? Part of My Breastfeeding Story

If you know me well, you most likely know I'm a fighter. If you're in my family, you most definitely know that about me. If you know me and don't really like me all the time, well, I'm assuming it's partly my pig-headedness.

I have a hard time taking "no" for the final answer. My mind always scrambles for an alternative when I run into a wall, or someone tells me it can't be done. Even if I agree that we've run into an impossibility, I want to push through and figure out what can be done instead to solve the problem or get me what I want.

Motherhood, and specifically breastfeeding, certainly has plenty of challenges and difficulties. Since frustration makes me fight, I've been able to fight through some of the challenges without thinking twice.

When Big J was sent to the NICU and fed formula "because my milk hadn't come in yet" (That phrase needs to die. Seriously, it's so damaging and so wrong.), I pumped and pumped and pumped. When I was sent home and Big J wasn't, I left the hospital as late as they would let me so I could nurse him at 11pm or so, then I pumped every 3 hours overnight, then I got to the hospital again in the morning so I could nurse him first thing.

Nursing in the NICU

I only had to do this for 2 nights, so I don't know how my strategy would have changed if I would have had to do it longer, but I was determined to breastfeed, and not pump for every feeding.

My goal was clear, but there were many things standing in my way, mostly hospital policies. That first day, when Big J's blood sugar was "low" (here is Dr Jen explaining why I put "low" in quotations) and they took him away, instead him getting a few milliliters of colostrum, they fed him 30ml of formula. THIRTY. Then, they said, with concern in their voices, "He's not digesting the formula. It's just sitting in his tummy, not helping to raise his blood sugar."

With my worry, I felt even more driven to pump. At first, it took 15 minutes to pump a few ml of colostrum. Those tiny little vials of golden first-milk were so precious to me! The nurses insisted he still get 30ml of food, so incrementally, his meals were increasingly more breastmilk and less formula.

When my mature milk started to flow, I could easily pump 8-10 ounces in a sitting. HELLO oversupply! I didn't know that pumping so much would create a struggle with oversupply, which made my letdown very aggressive and my supply overwhelming. What's the problem with oversupply and an aggressive letdown? When my breast was full, the full mammary glands would put pressure on the back side of the areola and nipple, making it very difficult for a tiny mouth to make a sealed latch. Once the milk started flowing with the letdown, it was kind of like trying to drink from a hose by putting your mouth entirely around it. Poor Big J! It's not surprising he came to prefer bottles!

If only I would have known then what I know now. Engorgement happens. Once the mature milk starts being produced, your hormones tell your body to make milk like crazy, and your breasts don't pay much attention to the demand (yet). They tend to feel full and heavy, except for right after your baby nurses. If I would have gotten help from someone who really knew what they were talking about, they would have helped me shape the areola and nipple so a tiny mouth could create a good latch. It's called reverse-pressure softening, and it really works. I put a towel loosely over my nipple to catch the inevitable spray, and you gently press the areola with your thumb and index finger, squeezing out the milk that is overfilling the glands right below the areola. The idea is to make a nipple surrounded by indented areola so the baby can latch onto the areola and not just the nipple.

Also, after my milk had switched over to mature milk, I wish someone would have told me to pump only what Big J was eating. Babies eat only 19-30 ounces in a day, so pumping 8 every few hours was waaaaay too much! Not only is it hard for a baby to nurse when a mom has oversupply, it can lead to plugged ducts in mom, and the dreaded mastis. *shudder* The baby can also experience reflux-like behavior because the quick flow can cause them to gulp air or eat too much too fast.

So how did I eventually wean Big J off of bottles? Determination, and trying and trying and trying again. There were many days that I looked to N and admitted that I didn't know if it would ever work. Finally, I found a strategy that worked: Pump a bottle, start a hungry Big J drinking from the bottle. After he had gotten into the groove on the bottle, and was calm and in "serious newborn eating mode" (eyes closed, rhythmic swallows, little fists tightly balled up), I would deftly pop out the bottle nipple, and pop mine in. He protested this for a few days, but then one day, he complained, then tucked right back in to nurse on me. ON ME! It took a few times of back and forth, tricking him to just take me, but he finally did, and I quit pumping. My oversupply fixed itself at one of the hormonally-regulated checks, and we nursed for the next 11 months.

I thought for a long time that at 11 months, he just weaned himself. We had introduced solids, and he was a good eater, so I thought it was normal. Nope! In hindsight, it was a very aggressive nursing strike on his part. You see, he had a very bad cold, and couldn't breathe through his nose while nursing, and so refused to nurse (since babies will always choose breathing over eating, every time). If I would have known then what I know now, I would have pumped and offered him milk in a cup. I was pregnant with Middle E, so he might have also been frustrated with a supply change or a change in taste.

I also would have tried to keep up a supply for Middle E, who weaned at 14 months. I was pregnant with Little J, so I assumed my milk had dried up. It's possible it did, but if I would have worked harder to preserve that breastfeeding relationship, my body would have eventually started to make milk again, and Middle E would have benefited from a reinvigorated supply. Plus, since she's the most spirited of my babies so far, it would have been great to be able to calm her furies with a nice cuddly nursing session!

At birth she already had an aggressive latch!

Today, Little J had one of his many nursing strikes, where he would not be interested in nursing unless very sleepy. Any little noise or annoyance that would make him more alert would remind him that he was more interested in everything other than nursing. And he also refused take a bottle, either.

So here's how I finally got him to take some milk.I hand expressed into a shot glass (it was a Vegas shot glass and everything), then slowly gave him a few drops at a time with a dropper. Sound like a pain? It certainly was. The big kids (shown circling in the picture) were hungry and crabbing and ended up down late for nap, but Little J sucessfully drank about an ounce drop by drop.

When he woke up from his nap, he was sleepy and thirsty and forgot he was on a strike, and nursed very well, finally. I have no idea why he went on strike, but I know he's not trying to wean himself or something, and that it's my job to support him through whatever difficulty he's experiencing, now and for the rest of my life.

Learning and relearning the ropes.

General Things I've Learned and Tried - Baby #3

• I am not sure that I have any control over how a baby sleeps. You would think that I'd be having some effect, but I'm not sure it's up to me. I think it's all up to the baby. How do we "do sleep" in our house?
• Feed on demand all day and all night. When the baby will take the boob, give the boob. 
• Sleeping babies or sleepy babies are put to bed in their crib, swaddled from the start to keep their flailing arms under control. It's magical when you can take a sleepy baby, lay them in their crib, and watch them fall asleep. 
• Not all babies do this often, though. Some babies, especially the more spirited ones, need to be wrestled to sleep. They need shushing and nursing and rocking and bouncing and gentle jostling (like jello, not a bounce house) before they can find a comfortable and slip into sleep. And sometimes your calm, slow-to-scream babies need lots of help, too. And then your spirited baby will end up being able to fall asleep anytime, anywhere when she needs to. Go figure! Babyhood and childhood seem a bit difficult for everyone involved, and as parents, it's a part of our job to walk our children through the difficulties of life.
• Nursing to sleep sometimes will not doom you to be a "human pacifier." The Boob is magical, and pacifiers are just "plastic boobs," and it's not the other way around. Pacifiers are best used when baby wants to nurse 24-7 and mom needs a bit of a break. I recommend other options before using a pacifier, because:
• Pacifiers can cause nipple confusion, or nursing strikes. I would much rather deal with sore nipples and fatigue than looking for signs of dehydration and wondering how I could force my baby to drink, please, it's been almost 12 hours without a good nursing session.
• Pacifiers are addicting, both for parents and baby. It's easy to miss other needs (poopy diaper, cold/hot discomfort, lonely, etc) when you can just pop a paci in and move on. Also, my constant nurser and screamer, Baby #2, is almost 2 and still addicted, mostly because I haven't wanted to give it up yet. 
• Breastmilk digests very quickly (faster than formula or solid foods), and babies can regulate not only how much they want to drink, but how long and aggressively they drink can determine the content of what they get. 
• Learn your baby. Although there are many people and resources to help you troubleshoot, you are the expert of your baby, and the resources can help elicit solutions that you think could work with your child. 
• White noise, oh how I love thee. Having white noise in our kids' rooms is most likely why we already have three of them. White noise not only replicates the noise of the womb and is therefore soothing, it can drown out the noises of the house (or neighbors, or traffic, etc) after bedtime. Not all of my kids are deep sleepers, even though I tried to acclimate them to noises at an early age, so it's great to be able to walk down a creaky hall or watch a movie without worrying about waking them up. And it's important for tired babies to get the sleep they need. When a baby wakes up earlier than he should have, he can be too crabby to eat well, and then spends his entire awake time even more crabby because he's both tired and hungry. One crabby rotation can throw off the entire day, because over-tired babies just can't deal.
• I could write pages and pages about nursing. For right now, I'll note one peculiar nursing habit of Baby #3 that was puzzling at first: Upon wakening, not being interested in drinking more than a minute. "Why aren't you hungry?!" I worried. "I was just a bit thirsty right now. You'll be here later, so I'm in no rush to eat!" When he nurses for just a moment after waking up, I try to offer him another drink when he starts to get tired. He usually drinks deeply and calmly then, and I put him down for a nap when he stops swallowing. 

Products I Recommend, and Why

• Video monitors
• We bought Summer Infant Video Monitor for both kids!  The cameras are a room apart, and the screens are right next to each other, and we haven't had trouble with interference (they are each on a different channel).  The first one we bought came with a wireless, audio only monitor in addition to the video monitor, but the second one didn't, and was cheaper. They aren't the flashiest on the market, but they did a great job! If you have a little extra to spend, a wireless, mobile video handset would be nice, since it's kind of a pain to have to move the larger video monitor around.  We were just fine without one, though, so it's not bad if you need to save a few ($50-100!) bucks. I really recommend some sort of video monitor, though. We really like being able to peek at our kids without opening the door, which is why we still use the monitor in our toddler's room.
• Update: We have one for the big kids' room, and one for the baby's room. We attempted to have 3 set up, but there was too much interference and none worked well.

• Baby Carriers
• We have used the Peanut Shell, the Moby, and the Baby Bjorn.  Update: With baby #3 on the way, we finally bought the Ergobaby. In a nutshell, carriers like the Peanut Shell are great for quick carries, but make my back and shirt hurt for long periods. The Moby is awesome, albeit a bit cumbersome, but it's by far my favorite: packs down small, durable in the wash, comfortable to wear for newborns to toddlers, and can be worn under sweaters. The Ergobaby is so great for carrying crabby toddlers while cooking.

• White noise, oh how I love thee. Having white noise in our kids' rooms is most likely why we already have three of them. White noise not only replicates the noise of the womb and is therefore soothing, it can drown out the noises of the house (or neighbors, or traffic, etc) after bedtime. Not all of my kids are deep sleepers, even though I tried to acclimate them to noises at an early age, so it's great to be able to walk down a creaky hall or watch a movie without worrying about waking them up. And it's important for tired babies to get the sleep they need. When a baby wakes up earlier than he should have, he can be too crabby to eat well, and then spends his entire awake time even more crabby because he's both tired and hungry. One crabby rotation can throw off the entire day, because over-tired babies just can't deal.

General things I've learned and tried - Baby #1

• Wear a bikini top in the shower the first few weeks.  It protects you from the spray, and then stops you from dripping all over as you towel off.
• Eat-Play-Sleep really does work, and makes for a predictable, happy baby! 
• Sometimes, babies go on "nursing strikes."  Mine has started to go on one if I don't nurse him in a quiet area!  I used to be able to talk on the phone, watch Hulu, or listen to a podcast, but now that Mr. Social is more aware of his surroundings, he will not eat well if there is something else going on!  Who knew?!
• After delivery, hormones change, and hair goes into a resting phase, then falls out!  I'm losing so much hair right now (for me, I noticed the hair loss right after my son started losing his baby hair, around 3 months postpartum)!  *Update: I noticed it coming back around 5 months.  Phew!  
• Three-month old babies are a lot easier than 2-month olds, and moms are also more confident then (at least I am)!
• Currently: My son was sleeping great (9-11 hrs a night!) for about a month straight, and I thought I was the luckiest mom ever!  Then he began to roll from front to back a bunch, and would wake up when he did it while he was asleep (I know, scandalous, I let him sleep on his tummy) .  He almost seemed to go back to sleeping well, but then for the past month (5 mos-6 mos) he stopped sleeping through the night (back to 3 hr chunks, it seemed).  I thought maybe he was just learning new things, or that he was teething, but it didn't stop and baby Tylenol didn't seem to make a difference.  My current theory is that his little tummy isn't quite ready for solid food - During this bad-sleep month, I had started to feed him one veggie/fruit & rice meal a day (only about an ounce).  He was a great little eater, but I think it was bugging his digestion.  I have him back on only breastmilk for 48 hours now, and he's slept great and been happier for 2 days now (he just went down on night 2, and he went to sleep easier than he has been).  I'm going to continue skipping the solids for a few more weeks, and see if his night sleeping gets better again.  
• To help him learn to be comfortable sleeping on his back, I've been doing what I call "cuddle feeds" that allow him to fall gently to sleep on his back: Instead of sitting in a rocking chair to feed him, I will lay down with him, and let him nurse away while I doze (I'm a super light sleeper, so no smother worries here).  Not only is this the BEST THING EVER because I get to take rests multiple times a day, if he needs more sleep, he will nod off after eating, and will end up sleeping on his back.  Amazingly, I think it's working, because he just squirmed/talked himself to sleep tonight, ending up on his side, and now his back!  Yay!