breastfeeding question?

[nursecompassion]

I figure since we discuss every body part here, why not my boobs? Actually, I was wondering if any current or past nursing students have ever attempted to breastfeed while in nursing school and how did it turn out for you.

I am due the second week of class (september 29th) with my third son, however I am going to be induced on september 24th after clinicals and as long as all goes well, be back in class by tuesday the 28th at the latest.

I breastfed my second son for four months and supplemented with formula when I returned to work, however I am concerned if I will be able to do this while in school.

Any suggestions or support is appreciated.

thanks julee

[klone, MSN, RN]

I caution you, however, on sleeping with your baby. Mothers roll onto them and smother them without realizing what happened.

It's actually quite rare for this to happen, outside alcohol/drug/sedative use. It's more likely for the father to overlie, which is why it's not recommended that baby sleep between the parents, especially as an infant, unless there is some sort of soft barrier.

I know that with both of my kids, I was EXTREMELY aware of where I was in relation to them, even while I slept. As someone else previously mentioned, there are safety precautions that need to be taken with regards to bedding. But cosleeping saved my sanity and allowed me to not be at all sleep deprived, even with a baby who would wake to eat 3-4 times a night. It's not for everyone, but it can be very helpful at maintaining the breastfeeding relationship, especially if mom works (or goes to school) and the breasts aren't stimulated very much during the day.

[christinemj]

Congratulations on your pregnancy, Julee!!!

We are in a very similar boat!!! I am due with my 4th child on September 23rd. I will be starting my last semester of an ADN program on August 27th. YIKES!! When I think about it, it's a bit overwhelming!!

I have been breastfeeding my 3rd child throughout this whole nursing school journey, which began as a required CNA program way back in 2002. It hasn't exactly been an EASY road, but it HAS been do-able. My instructors have always been understanding and have allowed me to take the time I needed to nurse the baby. I was lucky during my CNA program because my husband would bring the baby TO ME! (Go daddy! Of course, this means that I haven't had to PUMP. With this child, however, I will need to pump because we have full-day clinicals and it would be impossible to coordinate feeding times with patient needs (especially with 4 patients!) I have already ordered a Medela PIS and the hospital where I'll have clinicals even has a "breastfeeding room" where I'll go to discreetly pump every few hours.

I've been breastfeeding almost continuously since 1997 and the last 2 kids have never taken a bottle at all...so I am quite apprehensive about the pumping thing, and establishing a good breastfeeding relationship with my school schedule. But, where there is a will, there's a way!! We have class or clinical every day except Thursday. Hmmm, I hope the baby decides to arrive on a Friday afternoon, otherwise I'll miss too much class/clinical time!

Good luck to you!!

PM me if you'd like!!!

[BittyBabyGrower, MSN, RN]

You are going to have to be pretty on time with pumping...going back after 4 days...wow...I know that I couldn't have done that...tired, bleeding and boobs like something out of the Jungle Book...man..you go girl!

At our hospital, we have several employee lactation rooms that have pumps in them...you would just need the kit and if you have a NICU or even the floors might be nice enough to slip you a kit to use with the pump :)

Good Luck!

[mitchsmom]

Congrats on your upcoming arrival! Kudos to you for seeking information now :)

You have gotten good advice here, and as a bf counselor I would strongly reiterate to start attending La Leche League meetings and/or design a plan with a lactation consultant soon. La Leche League meetings typically run in a series of 4 monthly topics so now is a good time to start. As the others said, it is possible for you to bf your baby, but you will not have breastfeeding established when you return to school and that will present an extra challenge. I think that you really must talk with a professional about your particular situation so that you can learn the things you will need to do to achieve your goals. Don't wait until you are there - be prepared and you will be happy that you were when the time comes. If you would like to start reading a good book I would suggest: The Womanly Art of BF, The BF Book, and So That's What They're For! Breastfeeding Basics or any here: http://kellymom.com/bookstore/bf/index.html

I don't know if this is an option for you but if your baby will go into daycare, is there one on your campus? That would help a lot if you could go to the baby. Of course, as others said, if the caregiver can come to you for feedings that would be wonderful too.

Well that should give you even more to go on Also feel free to PM or email me if you'd like. Best wishes and have fun!!!

Find a La Leche League group: 1-800-LA-LECHE or http://www.lalecheleague.org (also working & BF here: http://www.lalecheleague.org/NB/NBworking.html)

Find a board certified lactation consultant (IBCLC): http://www.ilca.org

A great breastfeeding website:

http://www.kellymom.com

More (includes a "working and breastfeeding" section and also lists good bf books in the left-hand column):

http://www.geocities.com/breastfeedinglinks

This may be a big help to you: Pumping moms yahoo group:

http://health.groups.yahoo.com/group/PumpMoms/

[geekgolightly, BSN, RN]

There are great guidelines for co-sleeping on Dr. Sear's website. It is actually very safe and great for breastfeeding. The baby doesn't quite wake up to the yelling state that he would if in a crib in another room and you can just plop the nipple in and he will usually go right back to sleep. It is great for getting more sleep.

Just a few . . no soft bedding, no waterbeds, pillows, heavy blankets. Don't put the baby between you and a wall. NO alcohol or illegal drugs (duh) :)

I slept with all 4 of mine. They are 21, 19, and 14 and all sleep in their own beds and it wasn't hard to transition them. My toddler sleeps with his mommy and daddy. :) He is talking about a big boy bed now and probably will transition sometime this summer but my husband and I agree WE WILL MISS HIM.

Regarding the breastfeeding, you are only taking 4 days off from the time your induction is planned until classes start. That is going to be very hard to establish a good milk supply without pumping. I concur with others advice about the Medula Pump In Style . . it was a great and easy pump and very fast.

I feel for you going back to school so soon. Good luck.

steph

Offtopic a bit!

Can you talk a little bit more about transitioning? Was it child initiated? What are your older children like? I am curious because it's gut instinct to breastfeed with child led weaning, co-sleep, baby wear and respond to my babe rather than CIO etc, but as I don't know anyone who has grown children who did this kind of childrearing, I hae no clue about end result and if it does help with security. All I cna say is that it feels right to do what I am doing.

You rock for being so far ahead of the curve!

And I totally concur with how easy co-cleeping makes for breastfeeding. I would be much more racoon eyed if not for our decision to cl-sleep. I will also go get information and post here about co-sleeping nad how much SAFER it is for the babe rather than crib sleeping.

[geekgolightly, BSN, RN]

How the Stats Really Stack Up: Cosleeping Is Twice As Safe

by Tina Kimmel

Issue 114 September/October 2002

The Consumer Product Safety Commission (CPSC) and the Juvenile Product Manufacturers Association (JPMA, the crib manufacturers' lobby) recently launched a campaign to discourage parents from placing infants in adult beds or sleeping with them, based on data showing that infants have a very small risk of dying in adult beds.1,2 The CPSC implies that infants in adult beds are at greater risk than infants in cribs, but as we know, and as they know, babies also die in cribs.

What we need to do is calculate the relative riskiness of an infant sleeping in an adult bed versus a crib. We can do that by dividing a measure of danger for each situation by the prevalence, or frequency, of that situation, and then comparing them. (Oddly, the CPSC never presents relative risks.) Using government figures, we can perform a rough calculation to show that infants are more than twice as safe in adult beds as in cribs. This is aside from the many other advantages of cosleeping or bedsharing, such as increased breastfeeding and physiological regulation, the experience of having slept well, parents' feeling of assurance that their child is well and happy, the enhanced security of psychological attachment and family togetherness, and family enjoyment.3

Let's begin by looking closely at the CPSC data. The anti-cosleeping campaign is based on a dataset that contains the 2,178 cases of unintentional mechanical suffocation of US infants under 13 months old for the period 1980 to 1997. CPSC-authored articles about these data reflect only the small portion of deaths that occurred in adult beds.4 However, these data also have been published with summaries of the cause-of-death codes on all 2,178 cases.5 This complete dataset is further summarized in Table 1.

http://www.mothering.com/9-0-0/html/9-4-0/images/KimmelTable1.gif

Of these 2,178 infant suffocation deaths, we are certain of only 139 occurring in an adult bed. For 102 of these, we know that a larger person (presumably a sleeping adult) was present, because the cause-of-death code is "overlain in a bed." That does not tell us exactly what caused the death-that is, whether the baby died and then was lain on, or died as a result of being lain on. We can assume that the 37 deaths involving waterbeds occurred in adult beds, since few child waterbeds exist. That gives us a total of 139 infant suffocation deaths known to have occurred in adult beds in these 18 years.

The same data show that 428 infants died due to being in a crib. It is likely that there were preventable risk factors (such as using a crib in need of repair) involved in these crib-related deaths. But that doesn't change our calculations, because the deaths did occur. Similarly, our calculations do not change due to the preventable risk factors (such as intoxication) involved in adult-bed deaths (and other overlying). Note that advocates are raising public awareness to increase the safety of both these sleeping arrangements, with the hope that all these deaths will decrease.

We can't use the other 739 bed- or bedding-related cases in our analysis, because the place of death is not specific enough; these deaths may have occurred in a large adult bed, a single-size adult bed, a child's bed, or a misused crib. Nor can we include the remaining 760 deaths, as we have no idea whether they took place in a sleep situation at all. We also know nothing about the presence or absence of an adult, although a nearby, aware caretaker could have prevented many of these deaths.

So for only 567 (139 plus 428) of the deaths do we know whether they took place in an adult or infant bed. Thus, from 1980 to 1997, 75 percent of the mechanical suffocation deaths of US infants with a known place of occurrence took place in cribs, while 25 percent took place in adult beds.

While it is tempting to make the observation that three times as many babies died in cribs as in adult beds, if three times as many babies were actually sleeping in cribs as in adult beds, the risk would be the same in either place. Based only on this crude death-certificate data, we do not know which is safer. We still need to know how many babies were actually in adult beds or cribs-that is, an estimate of how common cosleeping was.

To estimate cosleeping prevalence, we can turn to the CDC's Pregnancy Risk Assessment Monitoring System (PRAMS).6 PRAMS has been surveying mothers of infants, usually between two and six months of age (but occasionally up to nine months), since 1988. Approximately 1,800 new mothers are sampled each year in each participating state. The sample is rigorously selected to represent essentially every birth in the state, and the response rates are high (70 to 80 percent). Most of the 100 or so PRAMS questions involve prenatal and well-baby care and stressors.

States have the option of adding their own questions and have asked about cosleeping. The basic question asked is, "How often does your new baby sleep in the same bed with you? Always; Sometimes; Never." (Some states add "Almost always.") PRAMS data, therefore, can be used to ascertain cosleeping prevalence in participating states and may be the only data of this kind.

Table 2 shows the results of this question on the PRAMS survey from 1991 through 1999, the most recent data available.

http://www.mothering.com/9-0-0/html/9-4-0/images/KimmelTable2.gif

We see from these data that roughly 68 percent (100 percent minus the 23 to 43 percent who "never" coslept) of babies in these states enjoyed cosleeping at least some of the time. Data from the United Kingdom are similar: Helen Ball's Sleep Lab found that around 7 percent always coslept, 40 percent did so for part of the night, and 33 percent never coslept.6

Now let's try to estimate a single cosleeping prevalence rate from these data. Let's say that babies who "sometimes" cosleep do so about half the time. Over all the years of this sample, around 42 percent of babies coslept "sometimes." Let's also say that "always" or "almost always" means 90 percent of the time. Roughly 26 percent of infants coslept "always" or "almost always." Adding "always/almost always" (90 percent of the time x 26 percent of babies) to "sometimes" (50 percent of the time x 42 percent of babies), we get 44 percent of babies ages two to nine months who were cosleeping at any given time, presumably in an adult bed.

Now we can use these figures based on CPSC and PRAMS data to calculate the riskiness of these two sleep arrangements, although it's important to understand the limitations of doing so. For example, these PRAMS data are from only five states (although more will be available in the future), while the CPSC data are from the entire US. The years in which the PRAMS cosleeping data were collected are not the same as those covered by the CPSC dataset, although they overlap. The CPSC covers infants zero to thirteen months, while PRAMS asks about infants two to nine months. The CPSC collects demographic details such as state, income, race, and age of mother (as does PRAMS), as well as time of the death, but they are not easily available to do a more detailed analysis. One or both of these data sources lacks information on impairment of caretaker and other known sleep risk factors, exact sleeping and furniture arrangements during different times in the night, overcrowding and other motivation for cosleeping or crib sleeping, clinical pathology findings, previous health of the infant, etc. Plus, a complete risk analysis should include all causes of infant deaths, including SIDS.

Nonetheless, these data are important population-based sources of information on sleep risks that we would not have otherwise. So let's go ahead and use them to estimate a risk ratio for cosleeping. We take the 25 percent of the suffocation risk in the CPSC data linked to being in an adult bed and divide it by the 44 percent of babies who were actually in adult beds. Then we divide that fraction by a similar fraction for cribs, i.e., 75 percent divided by 56 percent. (If we multiplied each of these fractions by an overall infant death rate, we would have the actual risk for each group.)

This result shows that it was actually less than half (42 percent) as risky, or more than twice as safe, for an infant to be in an adult bed than in a crib. Based upon these calculations using the CPSC's own data, we can say that crib sleeping had a relative risk of 2.37 compared with sleeping in an adult bed.

Therefore, cosleep with impunity-but, of course, be sure to follow the safe cosleeping guidelines described in this issue of Mothering.

NOTES

1. "CPSC, JPMA Launch Campaign about the Hidden Hazards of Placing Babies in Adult Beds," Consumer Product Safety Commission press release no. 02-153, May 3, 2002.

2. S. Nakamura et al., "Review of Hazards Associated with Children Placed in Adult Beds," Arch. Pediatr. Adolesc. Med. 153, no. 10 (1999): 1019- 1023.

3. Summarized in M. O'Hara et al., "Sleep Location and Suffocation: How Good Is the Evidence?" Pediatrics 105, no. 4 (2000): 915-920.

4. See Note 2.

5. Dorothy A. Drago and Andrew L. Dannenberg, "Infant Mechanical Suffocation Deaths in the United States, 1980-1997," Pediatrics 103, no. 5 (1999): e59.

6. Centers for Disease Control and Prevention, "Pregnancy Risk Assessment Monitoring System," http://www.cdc.gov/nccdphp/drh/srv_PRAMS.htm.

7. "The Sleep Lab Awakening," University of Durham (UK) press release, April 6, 2000.

Tina Kimmel, MSW, MPH, is a PhD student in social welfare at the University of California-Berkeley and is writing her dissertation on "The Effect of Welfare Reform on Breastfeeding Rates: Findings from the Pregnancy Risk Assessment Monitoring System." Previously she worked as a research scientist for California's state health department. She would like to acknowledge the state PRAMS epidemiologists who shared their analyzed data for this article: Rhonda Stephens, MPH (Alabama), Chris Wells, MS (Colorado), Ken Rosenberg, MD, MPH (Oregon), Melissa Baker, MA (West Virginia), and especially Kathy Perham-Hester, MS, MPH (Alaska) for her valuable insights. Tina has two children, Rosie (27) and Jesse (21), and one grandchild, Eli (4)-all born at home and all cosleepers.

[JoniL&DRN]

OK.. First ... you are going to school pregnant and with kids. Good for you! Second... planning to breastfeed and go to school at the same time.. very commendable. I have not breastfed while schooling but did while working full time (which was probably more time away than classes). I nursed in the morning before work (had to leave at 6:30). Pumped at work twice (in my office) and nursed as soon as I picked her up then basically nursed all night. I was very tired all the time and it wasn't easy BUT I'll tell you I really did feel better about having to leave her knowing I could do that for her. I did not have to supplement formula because she wouldn't drink it so she just got whatever I pumped. She spent a lot of the day NOT eating but she still weighed 30 pounds on her first birthday. I nursed her until she was 14 months. If you can use a double electric that would help and of course those are rentable (which I am sure someone has already posted). Good luck to you! And get some help honey! Congrats on the pending arrival.

P.S. I was induced three times ... all uneventful labors and deliveries