Feeding baby

Our little girl is definitely getting hungrier and more interested in our mealtimes.  She's desperate to join in and I can no longer deny the existence of the signs.  Her sleep patterns have altered, she is breastfeeding more and she's very curious about what I'm eating and takes a good swipe at my plate or bowl when she is on my knee.

As per my previous post, I had been wondering about when to introduce a few first tastes.  I was thinking about some sort of sweet vegetable, but happenstance we were having steamed asparagus the other evening and we decided on the spur of the moment.  Easy to hold, nice and soft.  Whilst she didn't consume much, it was obvious that she really appreciated joining in.

Since then, steamed carrot and broccoli have been a success, but swede a bit more uncertain.

In keeping with my efforts to raise her in a 'biologically appropriate' way,  because she is pretty hungry, I'd like to introduce a bit more, but I'm less keen on the idea of bland old baby rice.  So, I've decided to try offering pre-masticated food. (But, "Yuk!")  I have thought about this and there are some advantages to/reasons for using this method:

1) It's very natural and what humans have done for thousands of years, therefore we must be adapted to it
2) She will gain added nutritional benefits in digestion through the presence of my salivary enzymes
3) She will also benefit from my salivary immune factors (secretory IgA etc); therefore, it seems a logical complement to breastfeeding
4) No effort involved (no separate meals to prepare, no blender to wash), food is warmed and moistened to the right consistency


I can address all but one of the potential disadvantages:

1) Transmission of disease - there is no significant risk of disease transmission (eg HIV) in our family. (NB The risk of HIV transmission through saliva is very low, perhaps lower than via breastfeeding).  If I am harbouring any Herpes viruses or H pylori, I have remained asymptomatic or in a state of latency.  These viruses are so common, she will be in a small minority if, ultimately, she remains uninfected.  If I become ill with any orally transmitted bugs, I will simply feed her separately. 

2) Increased risk of dental caries - Strep mutans (one of the main bacteria sp implicated in initiating carious lesions) aren't found in edentulous (toothless) mouths.  Even when her teeth begin to erupt, she won't become colonised for another year or two.  I have my theory about this.  This 'window of infectivity' probably occurs as a result of a tailing off or loss of protective factors from breastmilk.  No gum disease in our family either.

3) Social - this is the one I will struggle with, I think.  Not everyone wants to see a mother shoving a bolus of pre-chewed food into baby's mouth, either with fingers or, perhaps more so, with her own mouth.

I guess it's a new idea I have to come round to.  With breastfeeding, I feel totally comfortable breastfeeding in any situation and am quite ready to address any criticism or condemnation therein.  However, I have grown up in a germ-aware family where sharing so much as a cup was considered dirty (although strangely, my dad thought nothing of spitting on a hanky and 'cleaning' my face with it).  I can understand how this concern has come about, for my parents' generation.  Finding myself explaining the potential immunological benefits of pre-mastication to anyone but a microbiologist could be somewhat awkward though.

I would welcome any comments on anything I may have missed, but so far, to me, this feels like the right way to go.  When our children grow up and I imagine myself looking back, I will probably say to myself, "What was all the fuss about, they're fine now?"  I guess when you're living the moment with a young baby (and it hasn't changed with having two), you always worry and wonder what exactly is the right thing to do for their optimal health and development.

6 months exclusive breastfeeding: good advice?

Over the past week, Aruna has been hungrier than usual.  I have been reassuring myself that this is just a growth spurt, however, since I've never noticed any of her other growth spurts (or indeed, if she has had any), I have begun to suspect it could be a signal for greater nutritional needs than breastmilk alone can provide for her.  She is now 4 months old.  

I always accepted on good faith the WHO/NHS advice that exclusive breastfeeding for 6 months is the ideal.  I am well aware of the risks associated with introducing formula milk and breastfeeding cessation, but what is the actual evidence against introducing solids before 6 months while continuing to breastfeed? 

An interesting analysis in the BMJ recently (Fewtrell M et al 2011) raises the issue.  Evidence for the advice is apparently quite weak, especially as 6-months-exclusively-breastfed infants represent less than 1% of infants.  Also, there are risks to waiting too long to introduce solid food, the most well-known being iron-deficiency.  It may even be that there is a 'critical window' during which to introduce foods in such a way as to minimise risk of development of allergies, ie not too early, but not too late either.  A couple of studies point to increased incidence of coeliac disease when gluten was introduced before 3 months or after 6 months.  They make the interesting point that prolonged exclusive breastfeeding may affect the window of opportunity to introduce bitter foods and later dislike of vegetables.

Since I was somewhat anaemic in the latter stages of pregnancy, although cord clamping was delayed, I am a little more concerned about Aruna's own iron stores.  I am not now so keen to follow guidelines to the letter if they aren't backed up with sound reason. I liked this:

"Signalling of hunger by the infant is probably an evolved mechanism that individualises timing of weaning for a mother-infant pair" (from Reilly & Wells 2005)

So I'll give it a little more time but perhaps we will venture into a few first tastes sooner than planned.  Oh, and I intend to breastfeed for as long as possible. 

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(1) BMJ 342: 209-212
(2) Reilly JJ, Wells JC (1995) Duration of exclusive breastfeeding: introduction of complementary feeding may be necessary before 6 months of age. Br J Nutr 94:869-72

A Christmas Baby

Aruna Anemone Esther, our beautiful baby girl was born on Christmas Day at 5:01am.  The birth experience was so much more than I could have hoped for, perfect, an incredible journey that I will remember and cherish for the rest of my days. 

My mum and brother arrived on Christmas Eve to stay.  William was excited and we had all been enjoying the preparations for Christmas.  After a good supper and William tucked up in bed, I arranged the presents around the Christmas tree and got some stockings ready.  Eventually, we all retired to bed, I at around 11 pm.  Sleep did not come easily.  Around 1:15 I started feeling some cramps and noted their regularity, and just quietly observed for a while.  Several loo visits and some time later, I allowed myself the realization that I was in true labour and gently wakened Raj.  He got up and set to on preparing the pool in the lounge downstairs while I moved around and listened to some birth affirmations by Marie Mongan.

Raj had lit some candles and the oil burner with some lavender fragrance in the lounge and everything felt calm and peaceful.  Around 4 am I made a call to the Womens' Hospital Delivery Suite from the kitchen to alert the on-call midwife to my situation.  By now, I was seeing colours and hues like I'd never appreciated them before, beautiful, although the smell of the rubber hose filling the pool was strong.  Julie called back 10 minutes later and I let her know how I was feeling, which at this point was well, with slightly stronger cramps.

She reassured me she would be here in half an hour.  Raj then phoned Paula, our doula and she set off straight away.  The pool was ready, and in good time because I was ready to get in.  We exhausted the hot water capacity of our ancient heating system, so could not have the water to optimal depth, but I was comfortable.

Perhaps I should've been more prepared for the speed with which things eventually progressed, having had a precipitous labour first-time round.  (With William, my waters suddenly broke almost without warning and I reached transition in less than an hour.)  Of all my preparations for this birth, visualising a slower, more gentle pace to labour was foremost in my mind.  In fact, I did have more warning this time, with things progressing gently between the onset of labour and my getting into the pool about 3 hours later.  However, once I was in the pool, what I previously describe as 'cramps' soon became more all-encompassing contractions and I became very inwardly focused and lost my sense of time.  A tap on the door at about 4:30 indicated Julie had arrived though, and, after a quick scan of my birth plan, she noted my remark that I was now experiencing a lot of pressure: she could see the vertex of Aruna's head.  I was very excited to meet her, so soon now... 

This last half hour or so became the most intense physical experience I will probably ever know.

Julie phoned the second midwife at 4:46 and I overheard her explaining that she didn't think she'd get here in time.  At 4:50 am I gratefully accepted some Entonox, and, it seemed in just a few minutes and 3 or 4 contractions, Aruna was born.  At the first big contraction, the membranes released.  I could see the whole of my abdomen tightening with the contraction and felt an overwhelming urge to push, although I focused on breathing her down.  Her head was born.  After another contraction passed without further movement, Julie gently assisted because Aruna didn't initially achieve restitution (one of the cardinal movements of the baby as it negotiates the pelvis during delivery).  This was easily overcome with a turn of her head and during the next contraction, she was born.  I guided her up out of the water onto my tummy and she gave a lusty cry.

Paula arrived moments after Aruna was born.  (In the end, we hadn't called her early enough as she lives an hour's drive away, but at 4 am, I didn't expect to be looking at Aruna an hour later.)  I was sorry that she had missed being there during the birth but she spent some precious time with us all in those early hours of Christmas Day.  Ann, the second midwife arrived and the others awoke early to find the newest family member resting serenely in her father's arms.  I delivered the placenta sans chemical inducement, gave Aruna her first breastfeed and went upstairs to be sutured after a second-degree tear and rather ragged laceration to my perineum.  All that remained was to rest, celebrate and enjoy an extraordinary Christmas as 4.