Monday, May 25, 2009

Tandem Nursing: 7:36 pm

I am tandem nursing. True, my son has yet to be born. Right now my fifteen-month-old daugther has exclusive nursing rights. Yet I have recently realized that tandem nursing begins the moment a nursing mother becomes pregnant with a second baby. Suddenly you are eating for three. Even if my toddler takes one sip of mama's newborn milk and decides that it is not for her, toddler and newborn will have been nourished together for the entire duration of the pregnancy.

Tandem nursing, nursing more than one baby at at time, happens most often when a mother has twins. This seems natural. Both babies need to be nursed by mom and so she nurses them either one at a time or at the same time as needed. Perhaps less well known is the practice of tandem nursing a toddler and a newborn. Most babies in the States are weaned from the breast at or before one year of age. Rarely then does a mother need to consider tandem nursing. For moms who practice nursing past the first year, however, tandem nursing becomes a possibility.

I had planned to nurse my daughter for at least one year. It was a struggle. Getting started was rough. Then my second pregnancy when she was eight months old decreased my milk supply just as she neared the one year mark. She was having trouble gaining weight and my pediatrician recommended weaning. She showed no signs of wanting to wean and I decided to encourage her on all nutritional fronts after she turned one: eating as many solids as possible, drinking whole milk, and allowing her to nurse as she wished. She is still "small" but vibrant and eating/nursing like a champion.

Some babies wean when a mom is pregnant again due to decreased milk supply (usually in the fifth month) or a change in the taste of the milk as the colostrum develops (the high density "pre-milk" produced by mom for newborns in the first few days). Other babies are quite happy to nurse even though they don't get any milk at all. They are comforted by the physical relationship, the cuddling and the sucking. It is a ritual they enjoy. At first I was waiting for my daughter to wean herself, but at 32 weeks into my pregnancy (about 8 months), she shows no sign of losing interest.

This is fine with me. More than fine. It was rough going for a few months when it was only mama who could comfort her or put her to sleep. But now I see that she is still a baby who needs me. Especially with baby # 2 coming so soon, nursing is an important tool I have to communicate with her about our physical bond. I can't rationalize with her. I can offer her my breast. There are other ways to comfort her as well. But if she is willing to nurse, I see no reason to stop offering her such comfort.

The conundrum, however, is how to offer my breast to two babies with very different needs. Baby # 2 will need to nurse on demand. My daughter will sometimes have to wait. Tell that to a seventeen-month-old. The tricky part is sleeping.

For the first ten months my daughter and I slept together. Now she is nursed to a drowsy state and then placed in her crib where she sleeps at night. She wakens, but most often can fall back asleep quickly. Many, many of my friends have babies that waken and nurse frequently through the night. Miss Iza prefers to nurse during the day. Actually she prefers to nurse and nap. By this I mean that for her nap or naps she prefers to nap while I rock her in our chair and she nurses. She stays attached throughout the entire nap. This was fine in the early months of my pregnancy as I would simply nap right along with her. And now in the later months it gives me time to nap myself and/or read a novel on my iPhone. Here is the snag: I can't possibly give her an hour or two hour nap on my breast when baby # 2 arrives. (Can I?)

Thus I have been trying to break the association between nursing and napping. She can nurse all she wants, but she needs to learn how to sleep without nursing. Try explaining that. You don't explain, of course. You do.

You develop an alternate ritual for the baby. I did this with the help of the book THE NO-CRY SLEEP SOLUTION FOR TODDLERS AND PRESCHOOLERS by Elizabeth Pantley. I was resistant to this book for quite some time (there is one for newborns too). For some reason I thought it was a sleep-training book, one of those that suggests that babies should just cry it out alone and learn to be independent. I was wrong.

Pantley gives useful advice that takes into account various parenting styles and is considerate of those who co-sleep. Basically her idea is that babies, like big people, thrive on ritual. They need a dependable pattern to anticipate. Izabella's ritual had been pure breast--it worked all the time, even if sometimes it took longer. Yes, I darkened the room, played soothing music, and told her "sleepy time" and "sh, sh, sh" each night. But each evening and every nap culminated in nursing her off to sleep.

Pantley suggests that babies can learn to fall asleep in other ways, but that it is important to be consistent so that they begin to form a habit that can be predicted and repeated by others if need be. This is key for me: the need for others to step in when needed. If baby # 2 was not on the way, I would probably be happy to nurse her to sleep for naps and in the evening. But now that I will have two nurslings, I think that it will be best for my daughter and my family if we have another way of putting her to sleep.

During the first week of trying to break the association between nursing and napping, I practiced what Pantley calls "gentle removal." I allowed Iza to nurse and as she got drowsy I would count backwards from ten to one (a suggestion from another mom) and then break her latch. The idea is to not allow her to fall asleep while nursing. She would cry and protest. I would allow her to comfort herself on the breast and repeat the removal. Tears, struggles. Repeat. When she finally began to sleep off the breast I would say "bye bye nursy" (to signal a complete end) and then place her in the crib. This worked about once. Mostly we ended up with her falling asleep in my arms, but not on the breast. This was an accomplishment. However it still meant that I had to sit with her for the entire nap time. As soon as I would try to transfer her to the crib, she would awaken and the nap would be over. A cranky afternoon was sure to follow.

This week I decided that perhaps we should work on the evening ritual. She sleeps great at night and I hate to mess with her sleeping pattern. Yet perhaps if I can remove the nursing to almost-sleep association at night, she might fall into a better napping habit. Our old habit looked something like this: dinner, bath, playtime on the bed with Tata, pajamas, then off to nurse in her room with pulled shades and soothing music.

Pantley suggests parents actually write down the new plan, giving great thought to the goals and how the new pattern will achieve those goals. As my husband is often away, I needed a plan that I could follow alone. (I probably would have tried to nurse her and then hand her off to Tata for the final cuddle off to sleep. He has on occasion put her to sleep on his own.) My new plan is this:

1. Dinner at 6 pm

2. Bath at 6:30

(eliminate play time on bed)

3. Pajamas/wearable blanket

4. Nurse in our bed practicing gentle removal

(no more nursing in her room)

5. Go to her room and together set the stage for night by a) closing shades, b) turning on music, c) saying goodnight to her bunny and her teddy, who sleep in the crib with her (these are transitional objects, i.e. comfort objects, whose use Pantley suggests)

6. Sit in our chair and read stories, drink milk from sippy cup if she wants

7. Say "sleepy time," "good night," "sh, sh, sh"

8. Place in crib, patting her and saying, "sh, sh, sh"

9. Turn off lights and leave room at 7:30

If she cries, go to her and pat her and say "sh, sh, sh."
If she continues to cry, take her to nurse on our bed and then return her to crib and pat her.

I actually had to consult my written plan before the pajamas stage to remind myself of the steps. I stuck to the plan. She did cry. I did take her into my room again to nurse. And, imagine this, she was asleep by 7:36 pm. And she slept this morning until 7:14 am. (I heard her wake and fall back asleep only once.)

I can now report that the first two days we ended up nursing back in our bedroom before she could be transitioned back to her crib. By the third night, she feel asleep around 7:30 after I place her in her crib with no need for me to return to comfort or nurse her. The fourth night we took a risk. We visited friends who live on the seaside about an hour away. We took her travel crib, bunny and teddy, pajamas/wearabable blanket, and story books. Amazingly, she went to sleep with no crying right after story time. We were then able to transfer her to car seat and later into the crib with no crying. Last night she did cry after story time and I sent in Tata to comfort her one time. Currently she sleeps from 7:30 pm to at least 7:00 am. That means this pregnant mom can get her much needed sleep before the new baby arrives!

My plan is to mimic her evening ritual in a shortened version for the naps. Perhaps she will be able to transfer her story-time-to-sleep ritual from the evening to her daytime naps.

I am doing my best with this attempt to break the association between nursing and napping because I think it may be helpful for us as a family when the new baby arrives. I don't want my daughter to wean unless she is ready. If my almost-toddler (still no walking yet!) decides to continue to nurse, then I am open to that as well. I never imagined such a thing. Yet now it seems the natural thing to do.

When I first mentioned tandem nursing to my mother, she reminded me that I had seen her tandem nurse. I had no memory of this. It turns out that she nursed my little sister and a foster child at the same time. I was four or five years old at the time, which is old enough to remember. I suppose that it was so natural at the time that my brain did not store is away as a profoundly unique snapshot. Instead it programmed my brain to see tandem nursing as something that mothers can do.

To learn more about tandem nursing--positions? timing? sleeping for mama? nutrition for mama and babies?--I have read ADVENTURES IN TANDEM NURSING: BREASTFEEDING DURING PREGNANCY AND BEYOND by Hilary Flower. It is published by La Leche League International. My local La Leche League group has been supportive as well. These woman don't bat an eye when you mention tandem nursing. For them it is not "news" like it was to me!

Note: For all you mothers who have tandem nursed, I would love to hear about your experiences! and publish your stories here if you wish.


Emily K said...

Bravo for you and Iza! My 3 year old still wakes up at night & can't get back to sleep without Mommy. (He weaned at 36 months.)

Tandem nursing is such a natural activity. You'll fall right into your own groove once little Baby B comes along.

István Albert said...

We hope it all works out well. I would guess that once the new baby arrives the right "schedule" will emerge on its own. I think babies are quite adaptable.

I have had to deal with a situation, where Reka left for a day then flights got cancelled and she got stuck in an airport thus being away for two nights.

Agnes deeply distrusts the bottle (very rarely was I able to feed her, only if she was asleep or very tired). And she's usually nursed to sleep, then she wakes up at least once during the night and wants to nurse ... did I mention she won't take the bottle? Given my mission I guess one could say: Good Luck With That.

First night was really rough, I've tried different things - starting with a bottle of course - which was simply a way to say "I got nothin'". That did not work, followed by crying, no way to console her, she did not want to be held, kept making sucking noises with her lips ... finally I stumbled upon some iced tea in the refrigerator that my son likes to drink, I would say it's a semi junk food/soft drink, pretty sweet, gave her that from a sippy cup. That calmed her down and she fell asleep.

I feared the next day but as it turns out it wasn't worse but easier. I made her wild berry zinger tea, gave her that, and when she started waking up I slipped her the sippy cup with some water before she would cry. That did the trick. And ever since we had this event she sleeps longer on her own, we can hear her going back to sleep when she wakes up.

Just a personal experience on how things can resolve themselves.

DJ said...

thanks for sharing, little janet! a lovely piece.

Gretchen said...

Good for you Janet!! I also read the book--but I was never serious enough to actually write out the plan and follow through!! But it all worked out in the end--we discovered with our 2 1/2 yr old--give up the nap and he was sooooo tired he would fall asleep without nursing and early !!!!

Réka Albert said...

How is tandem nursing going now that baby Leo is here? I'd love to read more about your children.