Birth Control

One possible reason for my weight gain that I haven’t focused on are my progestin-only birth control pills.  It’s of course been something I’ve wondered about.  But I didn’t want to be one of those people.  I have patients who swear some random symptom is caused by their IUD, and I tell them that I think it’s unlikely.  Sure enough, they have the IUD removed and the symptom remains present.  I didn’t want to necessarily blame my weight gain on the pills, when the fact is I have had poorer eating habits and haven’t been exercising.

But the fact is that progestin-based methods of birth control are known to cause weight gain.  I spend a lot of time counseling patients about birth control methods, and I see it all.  It’s amazing how differently each method affects different women.  With any particular method, some women love it, and some women hate it.  There are certain side effects that are common or expected, like weight gain with the Depo-Provera injections.  But even then, sometimes I have women who don’t gain weight with it.  Once I had a woman who said she lost weight with a method- I can’t remember if it was the pill or what, but that was the reason she didn’t like it (and she wasn’t super thin).  Um, ok.  Everyone else would be all over that method if that worked for them!

Prior to pregnancy, I was on the birth control pills.  I’m lucky that they work really well for me.  I don’t have any of the unpleasant side effects, and if anything I have the good side effects.  Supposedly studies have not shown birth control pills to be effective at treating PMS.  But with my N of 1, I can tell you they’ve definitely helped with mine.  I used to get all moody and extra hungry and such prior to my periods.  On the birth control pills, even when I had regular cycles on them, I no longer had the PMS symptoms.

Better yet, I learned in residency that there is no benefit to having my periods.  So I started trying the continuous regimen.  In other words, I would continue taking the active pills for longer than 3 weeks to avoid having periods each month.  A lot of my patients think it’s bad not to have a period each month.  They are correct, in that if you are skipping periods on your own, that is not normal.  If you have oligomenorrhea, and are one of those women who don’t have periods for several months or more at a time, it can put you at risk for developing endometrial (uterine) cancer if left untreated.  Don’t worry, this usually takes years to occur.

But if we gynecologists are causing you to skip periods, that is perfectly safe.  That is because we are giving you hormones that make your uterine lining thinner.  That process, in addition to making periods lighter and/or less frequent, also helps prevent endometrial cancer.

Initially, I tried a couple types of pills, and every time I reached the 6 week mark, I’d start spotting.  So I’d have to give myself a short period every 6 weeks.  Finally, I found a pill that worked to stop my periods altogether.  Hooray!  So prior to trying to conceive, I didn’t have any periods for years.  And since delivering, I haven’t had one yet.

Now, this also works for me because I’m able to take my pills consistently daily, so my lack of period was never a fear that I might be pregnant and not know it.  For my patients who have difficulty with a daily pill, this is not ideal.

So after having WZW, I switched to the progestin-only pill or mini pill, which contains norethindrone only, as opposed to the regular pills that have a progestin (norethindrone or a different type) plus estrogen (ethinyl estradiol).  I chose it because it doesn’t affect milk supply like the regular birth control pills.  Especially now that I’ve breastfed, I understand how anything that might affect milk supply should be avoided if at all possible.  The downside is that unlike the regular pills, they have to be taken at the same time each day.  You can’t be late by more than an hour, or you’ll risk unintended pregnancy.

The other reason I avoided the regular pills is that my own doctor/colleague/friend said that she looked into it when she had her first child, and was concerned about some excretion into the breast milk.  I figured she was a reliable enough person to listen to.  If she didn’t feel comfortable taking it, then I certainly didn’t.

Just now I decided to check the drug information.  The package insert with the drug information says (I’m paraphrasing slightly) that some of the medication gets passed on to the child in the milk.  A few adverse effects on the child have been reported, including yellowing of the skin (jaundice) and breast enlargement.  It also says it may decrease the amount and quality of your milk.  You should consider starting oral contraceptives only after you have weaned your child completely.

Based on hearing that alone, it’s not a comforting thought to potentially risk those adverse effects.  I’ve had patients get pregnant not long after having one baby.  Sometimes because they stopped breastfeeding, sometimes because they thought they’d still be protected due to breastfeeding.  I certainly didn’t want to take any chances.

Since I knew I wouldn’t be waiting super long before trying for baby #2, I didn’t think it would be worthwhile to try the longer-term methods like the IUDs or implant.  Nexplanon, the implant that goes in the arm, is a very reliable method that lasts for 3 years.  While some women do great on it, it is also a progesterone-based method that tends to cause irregular, unpredictable bleeding for the entire 3 years.  Also, like the Depo-Provera injections, a lot of women gain weight with it, and/or have other hormonal side effects.  So it’s not my favorite, but it is good for women who really need something reliable, because it’s nearly impossible to mess it up.  Plus, many women don’t feel comfortable with the thought of something in their uterus like an IUD.

I think after baby #2, I would consider the Mirena IUD.  I haven’t needed to try it before, since the pills have always worked so well for me.  But taking the mini pills around the same time each day is a pain.  One trick I found is that if I anticipate waking up late on the weekends, I can take an extra pill in the evening Friday, and that way it doesn’t matter if I take the pill later than usual on Saturday morning.

The nice thing about the Mirena IUD is that the progestin hormone mostly acts in the uterus.  That means it thins out the uterine lining, causing periods to be lighter and less frequent.  For some women, it stops cycles completely.  As I mentioned before, this process decreases one’s risks of endometrial cancer.  The hormone activity is much lower systemically, so the side effects are less common compared to the other methods like the Depo-Provera injections, Nexplanon, and progestin-only pills.  Therefore weight gain is less likely.  And once it’s in place, there is nothing to remember daily.

You can keep it in for up to 5 years.  And actually, good research has shown it to be effective up to 7 years.  So sometimes when I use it for menstrual control in my ladies in their late 40s or even 50s, I have them keep it for up to 7 years.  Especially for the morbidly obese patients whose excess fat tissue has increased estrogenic activity- these patients are at higher risk for endometrial cancer, so the Mirena helps reduce that risk.

Overall, I love the Mirena for my patients and place many of them.  The downside is that either type of IUD can sometimes expel spontaneously.  It doesn’t happen that often, but it’s not something you can control.  Sometimes it moves down too low in the uterus and into the cervical canal, or comes out completely.  In that case, one would not be protected from pregnancy.

The ParaGard, or copper IUD, is just as effective at preventing pregnancy as the Mirena, but doesn’t have hormones.  So you still have your normal periods, but they will tend to be longer and heavier.  I personally wouldn’t want that, even though my periods were normal.  So I find that it’s less popular.  But like all methods, there are some women who are very happy with it.

I’ll never know how much of my weight gain was due to the progestin-only pills versus breastfeeding, since I’m stopping both concurrently.  In any case, I’m hoping I won’t be as hungry and can work on my weight control.  This week, I was looser on the pumping schedule, and then over the weekend I minimized the breastfeeding.  It seems like despite not pumping during the day, I did continue to make some milk when he would breastfeed.  It makes me a little sad not to continue at least breastfeeding without pumping, but mentally, I have decided that I need to stop completely.  I need to get back on the regular pills and attempt to get back on track with my own health, before I reach the point of no return.

I took a pic of his last breastfeeding session yesterday evening.  It was getting dark, so the picture came out more grainy- which is probably better, so you can’t really see my boob.  He’s grabbing onto my nursing bra.  He was finally starting to enjoy it more, so I will miss that.  But I can also see how weaning an older baby who gets a lot of comfort from breastfeeding would be challenging.  My mom once told me that her mother, who breastfed 8 kids, would put a little wasabi on the nipple to wean.  Yikes!  Not sure I’d recommend that, but I guess it worked.

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Dwindling Milk Supply

When I went back to work several months postpartum, my supply dropped, and I relied on my frozen milk supply to get to 6 months.  I thought that it would stabilize after that, but unfortunately in recent weeks, my supply has dropped further.  Since I haven’t been pumping as much as WZW drinks, I knew after 6 months that we’d need to give him formula as well as breastmilk.  But my goal has been to practice what I preach to my patients and to continue to breastfeed for a year.

The good news is that WZW has been sleeping longer.  I don’t know if it’s from doing our version of the Ferber method or just his normal development, but he is stretching out his sleep at night.  He doesn’t sleep through the night every night, but he does sometimes.  And when he does wake up, it’s usually brief.

While that is a godsend for most parents dealing with chronic sleep-deprivation, it’s contributed to my milk supply declining, since previously I was breastfeeding once each night.  Plus, my work/pumping schedule often doesn’t align with my son’s schedule.  I’ll pump in the afternoon around 3:30, but these days WZW often goes to sleep in the evening, and will get up briefly to feed at some point before we go to bed, like 9:30.  But not consistently, so it’s a gamble.  It’s annoying if I pump, then shortly after he wakes up hungry.  So I’d delay pumping in order to wait to feed him.

Well that meant that I was stretching out my feeding/pumping times not just at night, but also between my afternoon work pumping session and the evening session at home.  My supply plummeted to the point that WZW would get upset if I tried to breastfeed him when he was hungry, because it wasn’t enough.  I made the mistake of trying to get him to breastfeed once in this state, and he cried and cried for like 10 minutes and wouldn’t even take the breast.  It left me in tears and wanting to give up at that point.

I had to start giving him a few ounces of formula first, then putting him on the breast.  That seemed to help.  In light of how I’ve been feeling as I mentioned in my last post- feeling like my body has been taken over by the breastfeeding, gaining weight, and just being tired- I feel like it’s so much work already.  So to not be making that much milk, it was really frustrating.  I started to wonder if I could do it for much longer.  And honestly, I had fantasies of having my life back, since it’s become such an invisible leash.

Funny aside- my husband and the nanny had typically been the ones to mix up the formula.  A couple of weeks ago was the first time I had to mix up some.  I guess my tired brain read the instructions wrong, because it wasn’t until recently that I realized I’d been putting twice the powder I was supposed to.  Whoops!  Funny thing is, WZW didn’t seem to mind his milkshakes.

I called a lactation consultant, and she recommended that I do what she called marathon pumping- breastfeeding or pumping 8 times in 24 hours over the entire weekend.  In other words, I spent last weekend pumping or feeding like every 3 hours.  At night, I spaced it to 4 hours.  But still, pretty tiring.  I think that helped salvage my supply a bit, and I’m back to being able to put WZW on the breast first, but I often will give him a few ounces of formula afterwards.  When I pump at work, I only get a grand total of 2 oz per pumping session, if that.

My friend’s mom was gracious enough to not only share a lactation cookie recipe, but to make me a batch to make sure I liked it.  They are delicious, whether you’re lactating or not!  My said friend is one I’ve known since the first grade, and also has a baby boy who is 5 weeks younger than WZW.  Here is her mom’s recipe:

Lactation Cookie Recipe

Ingredients:

  • 2 Tbsp flaxseed meal
  • 4 Tbsp water
  • 1 cup butter at room temperature
  • 1 cup light brown sugar
  • 1 cup sugar
  • 2 eggs
  • 1 tsp vanilla or almond extract
  • 2 cups flour
  • 2-4 Tbsp Brewer’s Yeast
  • 1 tsp baking soda
  • 1 tsp salt
  • 3 cups steel cut oatmeal
  • 1 package dark chocolate chips
  • 1-1 1/2 cup coconut flakes

Directions:

  • Preheat oven to 350 degrees.
  • Mix flaxseed meal with 4 tbsp water and let sit for 5 minutes.
  • In a mixer bowl, beat butter and sugars.
  • Add eggs and mix well.
  • Add the flaxseed meal and extract, beat well.
  • In a separate bowl, sift together flour, yeast, baking soda, and salt.
  • Add sifted dry ingredients to butter/sugar mixture.  Mix well.
  • Stir in oatmeal, chocolate chips, and coconut flakes.
  • Drop tablespoonful on a parchment-lined cookie sheet.
  • Bake in preheated oven for 12-15 minutes.
  • ENJOY!

I can’t say it’s increased my supply a huge amount, but I figure it can help some.  And it gives me an excuse to eat cookies.  In order to feel less guilty about eating a ton of cookies, I have made some adjustments to the recipe.  Because of the oatmeal, it’s not exactly Paleo, but I made the recipe a little more Paleo.  I substitute the regular flour with tapioca flour (tapioca starch).  And then I cut the sugar in half by using only 1 cup total.  Instead of using regular/brown sugar, I use coconut sugar.  The cookies come out more crumbly, and you have to be more careful shaping them into the flat patties before baking.  But they come out well considering.

The Brewer’s Yeast is a specialty product that can be found at a store like GNC.  It does add a certain bitter taste, but since it’s supposed to help with lactation, I add the full 4 tablespoons.  Adding less will make the cookies taste better.

I came across a breastfeeding store in my neighborhood, and noticed they sell packaged lactation cookies.  They contain the same ingredients that are supposed to promote lactation: oatmeal, coconut, flax, and Brewer’s Yeast.  The store also had various other products that are supposed to promote lactation, like supplements, teas, even fenugreek bars.  I decided to give one of the teas a try.  I just bought it, so we’ll see.  In the past, I’d gotten lazy with taking fenugreek, but now I’m doing my best to remember taking it multiple times a day.

At this point, I’m desperately trying to hold on to my milk supply.  Ultimately, the main thing I need to do is to make sure I’m diligent about breastfeeding or pumping regularly.  But lately it’s been feeling like such a chore.  Just a little while ago while I was typing, I was debating whether to wait for him to wake up or just pump.  I decided to pump since it was getting past the 4 hour mark.  Halfway through pumping, the little guy woke up.  Of course.

Sigh, the things we do for our babies.  Lately when a patient is interested in getting her tubes tied, I stress (more so than I did before) that she should try to convince her partner to get a vasectomy.  I mean really, it’s the least he can do after all that we women go through!

 

My Body: Currently Out to Rent

As someone with little experience with babies (outside the uterus) before having one, I had a lot of misconceptions.  Like I knew I’d get woken up a lot at night with a newborn, but I had this image that I would feed him, put him back in his bassinet, and he’d sleep there while I was in the bed nearby.

The reality was that he’d wake up to get fed, but then he’d require a lot of holding and soothing to go back to sleep.  And he never slept flat until he was 5 months old.  By the time I was able to go back to sleep, it would be approaching an hour, by which time I’d be hungry and need a snack.  The reality of it all was very different than I’d envisioned.

I also naively thought that I wouldn’t be one of those women to gain a ton of weight after having a baby.  Especially since I’d done well gaining the recommended amount of weight during my pregnancy, I thought I’d be fine, and go back to my Paleo ways.  A good number of my patients are close to their pre-pregnancy weight when they come in for their postpartum appointment about 6 weeks post-baby.  So I was hoping to do the same.

The pregnancy weight initially came off quickly, then I plateaued at about 10 lbs heavier than my pre-pregnancy weight.  I came across this article, which granted isn’t the most scientific source ever.  It says that although breastfeeding does burn 300 to 500 calories a day, it can require you to keep ON an extra 10 lbs or so:

http://www.purewow.com/wellness/Breastfeeding-myths

When I read that, I felt vindicated.  YES!  I knew there was a reason I wasn’t losing those last 10 lbs.  I thought, ok I can deal with 10 lbs until I stop breastfeeding, and then I might have to work a little to get it off.

But then what I discovered was that the combination of chronic sleep-deprivation, being extra hungry all the time, and not having any free time is a deadly one.  It’s a well-known fact that lack of sleep is associated with weight gain, and there’s nothing like having a new baby to mess with your sleep.  Thanks to breastfeeding, I am always hungry- I’ll eat a meal that is a normal size, and then still feel hungry and end up snacking on more.  And with the lack of time (and energy), I don’t want to put any effort into food prep.  Plus when WZW is awake and needing attention, I can’t spend forever eating.  My husband makes fun of me for how long I spend chewing a salad- I definitely don’t have time to be eating one if I’m alone with the little guy.

Thanks to all of the above, my weight has slowly creeped back up, which is depressing as my clothes have been getting tighter.  I am now the heaviest I’ve ever been non-pregnant.  The small scrub pants that I was able to fit into until 30-something weeks are now tight after eating a large meal.  And frankly, after a large meal, I look like I’m still pregnant.  I can’t help but feel gross not just because of vanity, but also because I know my habits are less than healthy.

I struggle between reminding myself that this is common, and that working my full-time plus job and taking care of my little guy are already enough to test my limits.  It’s tough expecting to be able to do much more.  So when food is available, I’m happy to eat it, carbs and all.

And exercise?  Forget about it.  I haven’t done anything regularly since I was pregnant.  Thanks to my long work days, I need to come home as soon as I’m done with work, and there is definitely no time to exercise after.  If I don’t have a meeting at lunch, I’m trying to catch up on work so I’m not there as late.  So going for a walk at lunch is possible on some days, but probably means a longer work day.

What I also worry about is that at some point, we would like to have another child.  At 35, I don’t exactly have forever.  So I’m potentially looking at breastfeeding for a year, then getting pregnant again at some point in the not-too-distant future after that.  And then going through this whole process again.  I would definitely like to get healthy again before conceiving baby #2, but I also don’t want to wait so long that my fertility declines and I have trouble getting pregnant.

I didn’t realize until having WZW that it’s not just with the pregnancy that my body is taken over by the baby.  Breastfeeding is causing significant changes in my body as well.  If I end up having two children fairly close in age, that’s quite a bit of time that my body will be “out to rent” for the sake of the babies.  What I initially thought of as a brief temporary state is potentially going to turn into like 4 years of being pregnant or breastfeeding.

I know I should stop worrying so much and getting too ahead of myself.  I’m lucky to have a healthy baby, supportive husband, and a stable job.  But it’s funny how women and men react so differently to weight gain.  My husband gained about 20 lbs from all of the lifestyle changes post-baby, and his response was- I haven’t even been pregnant and I feel great!  In reality, he does intend to work on eventually getting back into running & cycling and eating better.  He looks forward to the process of getting back in shape.  Whereas for me, it sounds like a lot of work.

So, we’ll see.  It’s definitely too much for me right now to go back to eating strictly Paleo.  But I do want to see if I can work on not being quite so free with the carbs and sugar.

First Week Down

Mommy survived her first week back at work, and Daddy survived his first week with WZW 24/7!  High fives all around!  Turns out December was a good time for me to head back to work, since the patient load was more manageable.  Sure, I had some busy days that were just like old times, but it wasn’t every day.

I’m lucky that my work has given me one less patient each morning and afternoon so that I have time to pump.  I realized that it’s easier to have an entire pump and supplies at work so that I don’t have to worry about taking things back and forth from home.  Which means no risk of forgetting things at home.  So I have a second pump and accessories, drying rack, dish soap, dish sponge & brushes, and breast milk storage bags.  I’ll discuss my choice of pumps in my next post.

It’s a little tough during a busy day to squeeze in the pumping, but it’s not terrible.  The issue is that due to time constraints I will sometimes just pump for 10 minutes instead of 15 or 20 when I have more time.  I’ve already noticed that due to the pumping instead of breastfeeding, my supply is decreasing.

The challenge more so is that WZW is still not on a regular feeding schedule.  It would be great if I could feed him in the morning before I leave, but that doesn’t always happen.  And at night, the challenge is that I want to breastfeed to keep my supply going, but I also need enough sleep to function at work.  I don’t exactly have the kind of job where I can half-ass it.  So I’m improvising as I go, trying to breastfeed in the evenings and in the morning when timing works out.  In the middle of the night, if I wake up with my breasts feeling full and uncomfortable, I’ll get up and pump.  Last night, I went to bed early, then had my husband wake me when it was time to feed him, and then went back to bed.

I also don’t want to go too long between feedings/pumping and get mastitis again.  I started noticing a little redness, and thought NO!! Not again!  So I breastfed that night instead of pumping and thank goodness it went away.

Since I still have a similar routine at work, it’s easy to notice differences like how much hungrier I am now.  I made the mistake of not snacking during my pumping session one afternoon, and I started feeling really hypoglycemic later in the middle of seeing a patient.  Now I never skip a snack.

Even then, I’m still hungry all the time.  Case in point- the other day, I had a normal-sized lunch.  Then I had some Paleo bread as a snack during my pumping session.  Even then, I was still hungry and ended up eating a Kind bar before my last patient.  Then a second bar as I was finishing up charting.  On my drive home, I was STILL hungry so I ate a bag of plantain chips.  I breastfed as soon as I got home, and then I proceeded to scarf down a full dinner at 7 pm.

I’m also thirsty all the time.  One of the lactation consultants told me while I was still in the hospital to drink lots of water.  She herself noticed a difference in her milk supply on days she was busy and didn’t drink as much.  Well that hasn’t been a problem.  Unlike during pregnancy when regular water was often unpalatable, now I feel like I have an unquenchable thirst.  I am constantly drinking water.

During the pumping or breastfeeding itself, I have a weird drained sensation that makes me feel like I need to drink water and snack.  So much for trying to get back to my pre-pregnancy weight.  You’d think with all the extra calories burned by breastfeeding that it would be like the equivalent of working out daily (which I don’t have the energy nor time for these days).  But since I’m so hungry, I end up eating enough to make up for it and then some.  Hence I’ve remained stable at about 10 lbs. over my pre-pregnancy weight.  I wonder if my body wants me to be in that range right now, given how hungry I am all the time.

Everyone asks if I miss my son.  Of course I do, but as I suspected it hasn’t been extremely hard for me emotionally.  One of my coworkers once told me she looked forward to coming back to work after maternity leave.  She got tired of the baby care.  While I can’t say I’m at that extreme, I do relate.  The 24/7 baby care is really tiring and repetitive.  In contrast, I now get more sleep than I used to and I’m back into my old routine.

I have to say that it’s gratifying to realize that I enjoy my job.  Even though we’d all rather spend time with our kids than be at work, it’s rewarding to see familiar patients again, and help new patients.  It’s great to have a job that I find fulfilling, where I don’t dread being at, and away from my son.  Sure, I have busy days that stress me out and make me hate life in that moment, but it took being on maternity leave to confirm that I’m still very happy with my career choice.

Having my husband at home also makes it easy since I have zero worry about WZW’s care.  When he goes back to work, we’ll have a nanny two days per week.  We had a trial session this week with her, and as we suspected, WZW had major “stranger danger.”  He had done it over Thanksgiving at my parents’ place.  Even though he was fine two days before, on Thanksgiving he suddenly cried when anyone besides me and my husband held him.

Our poor nanny did well handling his incessant crying upon being with her.  Eventually he calmed down.  As tough as it is when he gets so upset, there is also an element of relief for me and my husband.  It’s reassuring to see that WZW does differentiate us from others; that we’re not just his servants who feed him and provide warm comforting bodies.

And now, back to my weekend.  Nowadays, they won’t be as restful- gonna breastfeed all weekend to try to keep my milk supply going.

Mommy Can Drink Again!

WZW is 8 weeks old now.  He’s going to have his official weigh-in later this week, but a couple days ago we checked his weight using the poor man’s baby scale.  I weighed myself without him, then with him, and the difference was 11.5 lbs (our bathroom scale goes to the 1/2 pound).  Recently, his feedings have spaced out to 4 hours, which has been great.  At night, he’ll even sometimes go 5 or 6 hours.  The problem is, he doesn’t sleep the entire time between those feeds.  But still, we’ll take it!  I think now that he’s putting on more weight, he’s able to withstand more time between his feeds.

The nice thing about the greater spacing between feeds is that we can more easily take him out of the house without worrying about hurrying back as quickly.  Thus far, other than breastfeeding at friends’ houses, I’ve only had to breastfeed in public once, in the car in a parking lot.  Otherwise, we’ve regularly taken him out for short excursions, but we’ve always timed them right after his feeds.  So that’s how I’ve been able to avoid having to feed in public.

The other nice thing about the spaced out feeds is that I can drink alcohol again without worrying about it passing to WZW through my breastmilk.  I found out I was pregnant last New Year’s Eve.  Weird to think that a year ago, he hadn’t even been conceived yet.  We were having a New Year’s Eve party at our place, and I was expecting my period to start.  My boobs were tender, and I was having mild cramping so I totally thought I was just having signs that my period was about to start.  But since we were trying, I wanted to double-check that it was safe to drink that night.

I’d gotten one of the specimen cups from work (after realizing it’s not that easy to pee on a stick for 5 seconds as directed), so I peed in the cup and let my husband do the honors with the test.  So we were both in the bathroom together when we saw the plus sign appear.  Imagine our shock- even though we were trying, it was definitely still unreal to actually see the positive test.  We had to quickly gather our bearings and continue preparing for our party.

That night, I played bartender and made the cocktails.  But I managed to just take little sips and no one noticed that I wasn’t really drinking.  Initially after that, I did miss being able to drink fancy cocktails at some of my favorite restaurants and bars.  But soon after, probably thanks to the nausea of pregnancy, I can’t say I really missed alcohol.  I would take an occasional little sip of my husband’s drinks, but didn’t feel deprived.

Even after the pregnancy ended, even though my eating finally went back to normal, I didn’t immediately feel the need to drink alcohol again.  Also, on a practical level, since I was initially feeding often, it wouldn’t be recommended.

I didn’t find any specific recommendations from ACOG (the American Congress of Obstetricians and Gynecologists), but at my institution they’ve stopped telling breastfeeding women that they must completely abstain from alcohol.  They found that it was too restrictive, and frankly a lot of women were probably drinking anyway.  So they recommend drinking no more than one drink per hour, and to try to time it right after a feed (or pump and dump if it exceeds that amount).  My husband got me a product called Milkscreen which tests breast milk for alcohol.  You dip the strips in breast milk for 2 minutes, and it will change color with alcohol.  It’s similar to the urine dipsticks we use in the office for a quick urine check.

So far I haven’t tried the Milkscreen strips because I’ve avoided drinking enough alcohol for it to be a concern.  Initially, I would have a few sips of my husband’s wine after a feed.  Certainly nothing that would still be hanging around at the time of the next feed.

More recently, I just started having an interest in drinking wine again.  I think it’s because I tried a red wine that I really liked.  My husband had been drinking a lot of rosé, which I’ve never been a fan of.  He admitted that he still can’t tell the difference between different rosés, but it was more nostalgic for him since he drank it a lot while he was in Provence this past July.  There, because it’s so hot in the summer, it’s normal to drink it with ice cubes.

All of a sudden after trying a great red wine, I had this inclination to drink again.  Plus with WZW’s feeds spacing out, I now had the freedom to drink a glass right after a feed and not have to worry about it still being in my system by the time his next feed came around.  In addition to drinking wine at home, I had my first cocktail when we went out to dinner with a friend this week.

Spending time with my son is so fun and I wouldn’t trade it for the world.  But it is tough, and life is very limited compared to the good old days- I’m usually with him constantly and particularly on the days my husband is at work, it’s hard to so much as shower when I’m alone with WZW.  He likes to be in a carrier much of the time.  At home, I’ve been using the Boba wrap and my husband likes the Infantino carrier that we received as a shower gift.  The latter is definitely much easier for taking him out in public.  I’m sure most parents relate- we’ve definitely had to use the restroom (yes, #2 as well) while we have him attached to us on a carrier.  Being able to drink alcohol again more freely- just a glass of wine or one cocktail instead of sips- gives me some semblance of my old life before WZW.

Mastitis

The last time I posted, I had finally gotten one good night’s rest.  Well, later that night I developed mastitis.  I had all of the classic symptoms.  First, I noticed one area of my breast still hurt despite finishing feeding and the breast having been emptied.  I tried massaging the area to see if it would help.  I’d also been dealing with engorgement, so I iced it briefly.  I then noticed it getting a little red, but wasn’t sure if it was from all of the manipulation.

Shortly thereafter, I started to feel like I was coming down with the flu.  At that point, I knew I must be either getting sick or developing mastitis.  The area of my breast was still red, and now it felt warm.  I spoke to an advice nurse by phone, who agreed the symptoms were consistent with mastitis and they had the antibiotic prescription ordered.

My first reaction was [expletive]!  Then I thought- I finally get a good night’s rest and this is what I get?!  The things we breastfeeding women have to deal with!  I’m quite sure that not letting my breasts empty overnight contributed to the infection.  That side had been getting engorged already, so going 8 hours without breastfeeding or pumping was a bad idea.  But the sleep was so great!

Next thought was the antibiotics- I didn’t want to mess around and develop an abscess.  Definitely don’t want a collection of pus in my breast.  I knew that antibiotics were indicated for this infection, and that the dicloxacillin (a standard treatment for mastitis) was safe to take while breastfeeding.  But I couldn’t help but worry about how it would affect the normal flora in my body, and if that might affect WZW.  Guess I’ll need to take probiotics and eat fermented foods afterwards.  The levels of the medication being excreted in my breast milk should be minimal.

And then I started to feel a little guilty about all the carbs I’ve been eating.  In my haze of sleep deprivation, I definitely haven’t been staying strict Paleo, and of course I wondered if some of that sugar had made me more prone to infection.  I tried to eat better the next day, and also had the fortune of my husband being home and able to cook.  But when it comes down to it, I’m too tired to go back to eating strictly Paleo just yet.  I just can’t bring myself to do it.

Thankfully, the mastitis has improved upon starting the antibiotics.  I always knew that medications that are to be taken 4 times daily can be difficult to adhere to, and I’m aware of that as a prescriber.  But with some conditions like mastitis, I want to go with the standard treatment that I know will generally treat the condition and is also safe with breastfeeding.  At least since WZW gets up every few hours or so to feed, it makes it easier to take the antibiotic regularly.

One thing that I didn’t realize about the medication until I got it is that the instructions say to take it with an empty stomach.  It says to take one hour before a meal or 2-3 hours after a meal.  Now, taking a medication 4 times a day (approximately every 6 hours) and on top of that avoiding mealtimes?  That is next to impossible to do it consistently for 10 days.  I’m sure it will still work fine to try to adhere to it as best as possible.  But to follow the instructions precisely is a tall order, even for someone as anal as me.

I realize there are worse complications that can occur postpartum, and in the scheme of things this ended up not being a big deal.  And let me tell you, that grand night of sleep was still worth it!  But going through all of this does give me a new appreciation for how much work and unfortunately pain (literally and figuratively) goes into breastfeeding.