Wednesday, August 27, 2014

The Nursing Mother's Triathlon, Part 2: Got Milk?

Finding time can be the most difficult logistic thing to overcome when trying to get back to your normal fitness routine as a nursing mother, but once you have that part figured out, chances are you have stumbled onto the next hurdle- keeping up your milk supply while staying active.

The Science:
Pathophysiology of lactation
Our bodies have very low estrogen and progesterone while nursing and high levels of oxytocin and prolactin for lactation. I did finally find some studies on nursing mothers who exercise, but don’t be overjoyed just yet. The most recent studies I can find are from the year 2000, and they were on lactating cows!! So please email or message me if you are a nursing mother who exercises, a formula-feeding mother who exercises, or a mother who does either but does not exercise (we need controls) and are interested in being part of a study on all of this stuff! What we know so far based on what studies have shown:

1.       Oxytocin blunts the stress response that is normally produced during exercise.
This has been shown by studies on lactating and non-lactating women and measurements of cortisol and ACTH post-exercise. Pretty neat stuff.
2.       Exercise may attenuate lactation.
Rat studies only, so we obviously need more research on this to fully understand what is going on in the human body of a lactating and exercising woman. Theoretically speaking, extreme exercise could throw off the balance of the hypothalamic-pituitary-adrenal axis that controls all of this and cause a decrease in milk supply. I'm sure it's not true for every woman, since there are women out there doing Ironman races as nursing moms...not too many, but they're out there.
3.       Nursing mothers take longer to lose pregnancy weight than formula-feeding mothers.
Studies have shown that nursing mothers eat more calories than formula-feeding moms, and it is postulated that this is why nursing mothers take longer to lose baby weight than formula-feeding moms (6-9 months as opposed to 2-4 months). However, no studies have looked at weight gain in the baby as a measure of whether lactating mothers are or are not taking in adequate calories. 

Showing that lactating women retain pregnancy weight gain longer than formula-feeding mothers due to increased calorie intake is only the first step since this does not tell us if milk content is sufficiently caloric or nutrient-dense for the babies and whether they are gaining weight. It also doesn't help us know what calorie goals we should have as nursing and exercising moms to ensure that our babies are still getting the calories they need. I really want to study this, folks, but, moving on…

GOT MILK? What to do when you have problems with supply
If you have noticed a drop in supply following returning to workouts or after increasing workout intensity, here are some things to consider:

1. Are you well-hydrated?
You probably aren't. You know that hydration is always rule #1 with me, and until you are urinating a very light yellow color (almost clear), you could always use more fluids. See tips on hydration from last blog post here.

2. Are you sleeping enough?
Of course not. You are a nursing mother! But, are you sleeping enough to make the milk supply that your baby needs and to have enough energy to be the mom you want to be? These are the important questions. No one can tell you how much sleep you need, but most adults need 7-8 hours of sleep a night. Very few of us are getting that, but that's what studies show is healthy. To be honest, during Ironman training, I need 9-10 hours of sleep a night. That's just what my body needs to recover adequately from heavy endurance workouts. Hence, I'm not Iron-training with a newborn. Since my daughter's birth, I can count on one hand the times I have gotten the 7-8 hours recommended for adults even in the form of cumulative sleep in 24 hours. (A lot of that has to do with being a pediatric resident in addition to a mom, but some of it is just motherhood.) What I have found helpful is getting a larger chunk of sleep at night, up to 4-5 hours, and then trying to nap during the day. I don't really get to nap during the day when I am working or when I am off and taking care of Vi by myself because now she really doesn't nap during the day, so this doesn't happen often, but, if your baby and your schedule give you the opportunity to nap or sleep longer, then you take it! I know this sometimes means missing out on your one opportunity to work out that day or your one opportunity to clean up the wreck that is your house, but sometimes sleep is more important, especially if you are noticing a decrease in milk supply.

3. Are you eating enough?
Although nursing mothers are encouraged to eat an additional 300-500 calories per day, it is hard to know for each mother/infant combo how many calories are needed for nursing. Oxytocin, the hormone that helps your body produce milk, also works in digestion, and different women respond differently to this hormone. For some women, nursing may use many calories and make them lose all of their baby weight, and for others, it may make them more efficient at digesting food and getting calories from it, thus more efficient at making milk on less calorie intake. All I can say is that this goes along with what we learned about exercising during pregnancy- you have to listen to your body. In this case, listen to your body, to your baby, and to your milk supply! In general, try to maintain a healthy, varied diet rich in fruits/vegetables, high in fiber (That’s for you so you are not constipated!), and include some omega-3 fats. Remember you should be having liquids throughout the day and frequent snacks with lean protein. I have tried everywhere from 1700 to 2500 calories per day, sometimes with additional calories on harder workout days, and I have to tell you that what gives me the most energy and the best milk supply is eating a snack every 3 hours…which makes sense because it goes along with how frequently I am pumping while away from my baby. When I am with her and nursing her all day, she is my cute little milk monster and eats every 2 hours and I just try frantically to keep up :-P (Disclosure: not every baby eats like Violet does at her age; she is just sleeping a ton at night and has to get in calories when she is awake. Don’t hate me for having a baby that sleeps- I rarely see her. I also don’t anticipate this lasting long!)

On a more superficial note, I often wish my body was smart enough to take the fat that still lingers on my hips, belly, and thighs for Violet's milk, but it's just not; apparently oxytocin makes my body even more efficient at extracting calories from food than endurance training does! I have come to the conclusion that while nursing, you have to decide that yes, you probably could get in excellent shape and be super fit, but, milk supply and your baby's health are more important. If you don't come to that conclusion, then that's also fine, but you might need to supplement more with formula. Ask your pediatrician when you are making that decision.

4. Are you taking time to relieve stress?
If you have been reading this blog for very long, you know how I feel about stress and cortisol. They can help your body overcome amazing things, but when you are trying to lose weight or you are trying to pump milk, they can be real downers. If you are extremely stressed out, your milk production and your letdown reflex are going to suffer. Postpartum anxiety is a real thing, too, just like postpartum depression. If you are having trouble dealing with emotions or dealing with any of this (It's okay to have trouble. Parenting is a tough job, and so is nursing.), then make sure you tell your doctor. I can't tell you how to find balance for yourself any more than the next person can, but when you feel like it is all too much, chances are you need a break, even if it is a short walk without the baby, a light workout, or getting your nails done. Remember that a happy mommy means a happy baby. They pick up on our stress often before anyone else does, including ourselves! And stress does affect you physically, including your milk! Take care of yourself, so you can take care of your baby. It's really ok to do something for yourself regularly; I give you permission.

5. Avoid hormonal birth controls and medicines that can interfere with lactation.
Always ask your doctor if you are not sure if a medication you must take falls under this list.

6. Cluster feeding...
Sometimes babies feed every hour in the evening hours to store up on calories and fill up before going to bed. This does not mean you are losing milk supply, and it does not mean your baby is starving and not getting enough milk. Try not to supplement during this time because your baby is doing a great job of stimulating your body to produce more milk with this frequent feedings.

7. Growth spurts!
Maybe it seems like you are not pumping as much or your baby needs to nurse constantly, and you worry that you are having a drop in supply, but really it could just be that your baby is growing more and increasing his or her nursing frequency or milk intake over a few days to a week in order to take that next step up. It's hard to know for sure until the growth spurt is over, and it's more complicated when you are exercising, but this is something to consider. Major growth spurts generally occur at 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months, and 9 months. But, as a pediatrician, I have to tell you, they are just growing all the time that first year. It is a period of major growth. Nurse as frequently as you can to stimulate milk production and make sure #1-5 are taken of. After that, we can move on to ways to increase supply...

Methods to Increase Milk Supply

1. Mindful pumping
Violet watching Mommy doing her PT 
exercises. Looking at a cute picture like 
this, of course you will pump more milk!
 Make sure when you are pumping that you are giving your body the opportunity to get the most milk out of that time spent on the pump. Work can be stressful. It's important that when you go wherever you are going to pump that you make a mental separation for yourself. Grab a snack and some water, go to your pumping place, take a deep breath, and RELAX. Look at pictures of your baby or have a video of your baby to watch. If you continue to do your desk work while you are pumping, the amount you pump won't be nearly as much as it would be if you were thinking of your baby. Recorded cries from your baby are also helpful because our bodies are physiologically wired to respond to that.

2. Pumping frequency
When away from your baby, try to pump at least every 3 hours. You can get away with every 4 hours, and you should never go longer than 5-6 hours without pumping, but if you are trying to keep up with a baby in a growth spurt, or if you are noticing a drop in milk supply, then aim for every 3 hours. This also goes for night time- sorry folks, but you shouldn't go longer than 5-6 hours without pumping even at night. You get a better pump output and letdown if you pump when you wake up naturally, so try not to set an alarm to pump. I usually wake naturally at 3-4am, so that is when I pump and sometimes even workout because it gets trickier to fit that in later in the day.

3. Pumping technique and hand expression
Try changing the setting on your pump to increased frequency when your letdown slows on the pump and then go back to the slower frequency once letdown happens again; try to stay on the pump for a full 30 minutes if you have the time to ensure that you get multiple letdowns during the pump. (I have a really slow letdown at times, so I always get more if I stay on for 35-40 minutes, but I only do this during my morning pump when I have gone 5 hours between feeds/pumps.) Hand expression is also clinically proven to increase milk supply. You can hand express while pumping, and this has been shown to increase the amount you pump. However, it also helps get your baby to feed better on the breast for babies that are slow feeders. Go here for instructions on how to do breast compression while baby is feeding: There are also YouTube videos out there on this stuff, and your lactation consultant can also work with you to teach you how if you are having trouble.

4. Let your baby do the work
Pump on your way home and have whoever is watching your baby not feed in the hour or so before you are coming home, so that when you get home, your baby will be very hungry and stimulate milk production. If that sounds mean to you, just remember that your breasts should make milk while your baby is nursing. Another thing to try is a whole weekend or 2-3 days of high intensity nursing. Nothing stimulates increased milk supply like your baby! Spend a couple days with your baby and nurse for every feed (no bottles), so your baby can ramp up your supply. This works. Whenever I have a weekend off to be with Violet, I go back to work on Monday, and my boobs ache all day and I always look forward to when I get to pump because I am making so much extra milk.

5. Galactogogues
Galactogogues are substances that have been shown to increase milk supply in some studies. There are natural ones- almonds, oatmeal, fenugreek, milk thistle, etc. There is mostly anecdotal evidence to support these. Fenugreek has the most evidence, but anecdotally, it doesn't work for everyone. There are medicines that can be prescribed by your doctor, such as metoclopamide (available in U.S.) and domperidone (Canada only) that may also help. These work by blocking dopamine receptors and increasing prolactin levels. It doesn't hurt to ask your doctor if you have tried everything else.

Good luck, ladies!

On deck:
-Part 3
-pelvic floor syndrome and athletes
-running stroller safety


Altermus et al. Suppression of hypothalamic-pituitary-adrenal axis responses to stress in lactating women. J Clin Endocrinol Metab. 1995 Oct;80(10): 2954-9.

Brewer et al. Postpartum changes in maternal weight and body fat depots in lactating vs nonlactating women. Am J Clin Nutr 1989 Feb;49(2):259-65.

Noble et al. Oxytocin in the Ventromedial Hypothalamic Nucleus Reduces Feeding and Acutely Increases Energy Expenditure. J Anim Sci. 2000 Oct;78(10):2696-705.

Laatikainen TJ. Corticotropin-releasing hormone and opioid peptides in reproduction and stress. Ann Med. 1991;23(5):489-96.

Sadurskis et al. Energy metabolism, body composition and milk production in healthy Swedish women during lactation. Am J Clin Nutr 1988 Jul;48(1): 44-9.

Sohlström A, Forsum E. Changes in adipose tissue volume and distribution during reproduction in Swedish women as assessed by magnetic resonance imaging. Am J Clin Nutr 1995 (2):287-95.

More Info:

Saturday, August 16, 2014

The Nursing Mother's Triathlon: Pump-Run-Breastfeed

All nursing mothers who exercise are getting the triathlete stamp of approval from me. Working out while continuing to breastfeed my little angel has proved to be one of the more challenging but also rewarding aspects of motherhood. Men may not want to continue to read this blog, but if you know a nursing mom, I suggest you continue reading, so that you can understand just a little bit about what it is like for her and how you can be supportive of her endeavors and help her be a happier, healthier mom. If you don't want to read all the other stuff, skip to my blog post on Tips for Supporting an Exercising Nursing Mom.

Go run, Mommy, and have fun-
I'll be here when you get back! :-)
I haven't jumped back into triathlon in the traditional form yet since I'm focusing more on the mental health benefits of short workouts while learning how to be a new mom and being Ironsherpa to my husband as he develops his Irondad skills. But, I will say that fitting in some short workouts while being a nursing mother, although challenging, is very rewarding and rejuvenating, during a time when you need all the help you can get to stay upbeat and energetic.

It's not easy, though, and it gets very tricky to maintain your milk supply and feed your baby while exercising. The first step to being a mom, especially one who is breastfeeding, is to take care of yourself. But there's something in the set of 2 x-chromosomes that makes us want to do exactly the opposite--forget ourselves and take care of others. Everyone sites the airplane analogy--in a crash, put the oxygen mask on yourself first because if you pass out, you can't help your kids. Comparing parenthood to a plane crash doesn't feel too far off sometimes, but you get the idea. Your nutrition, your hydration, your ability to relax and allow your letdown reflex to happen--all of these things come together to help ensure your baby gets the nutrition, growth, and development he or she needs. I have my best milk supply and letdown when I am getting both sleep and exercise. It's a difficult balance to find both while working and being a mom to Violet, but when we are finding a way to make it happen, it seems to make a difference for both of us- we both just thrive by getting all of our needs met. She grows, plays, smiles, and is just the happiest baby, and I am happier and more energetic and able to be the upbeat mommy that I want to be for her. 

Why It's So Ridiculously Complicated

Being a nursing mother and finding a window for exercise is really challenging, even when you have someone supporting you and willing to watch your baby. The fact that I need to find a window of time that is good for Violet (i.e. when she is asleep or has just fed and will be happy for a while, ideally asleep so my husband can continue to sleep and doesn't have to get up and give her a bottle), a time that is good for my boobs (ideally pump for at least 30 minutes to empty the breasts entirely so my sports bra fits, for one, but also so that I am comfortable while running), a time that is good for me (preferably after getting 4 or more hours' sleep,  although sometimes I do it anyway on less, and after hydration and a snack), and a time that isn't a time when my husband has a planned workout since he is our family's main Ironman right now. This all amounts to me setting an alarm to pump at 330am and then exercising/running around 430-5...if Violet is still asleep and if Curtis is not doing an opening shift. The kicker is--babies change! A few times I was able to wake up and nurse Vi at 3 or 4am, put her back to sleep, pump, and then run, all before work. Now I have to get up and pump instead because she is sleeping longer in the morning...but today she didn't. You never know what these kids are going to do, so it's hard to plan around them and you may lose sleep trying being flexible is key. Whenever you feel like you are getting on a good schedule and have things figured out, chances are your baby will decide otherwise by entering a new phase of development or teething or getting sick.
Sometimes bike trainer is just easier than running! Out on
 our balcony I get fresh air but don't have to leave my baby,
and she loves watching Mommy and Daddy ride!

Just an example, the other day I ran at 6 after I pumped at 5, which seemed like it was working until later in the day I realized I'd only slept 2.5 hours and it was no wonder that I was feeling awful later. Sometimes your brain doesn't work as a new mom. More still, just so that all of that could work, my mother-in-law had to come over an hour earlier to watch Violet before I left for work. Then the saga of ridiculousness continues as I leave myself extra time to get to work so that I have time for all the mishaps that happen after fitting in a morning workout and showering and rushing out the door to go put on my pump in the car and pump on the way to work and get there early enough to discreetly take off my pump in the JMC parking lot (without being seen-HA) and have enough time to do it cautiously enough not to spill milk all over the place and start my morning crying over spilled milk. (That's a crazy run-on sentence, but motherhood is one long, run-on sentence, folks.) TRUST ME, fellas who are reading this, breast milk is totally worth crying over if you spill it. After all the trouble women go through to have enough milk for their babies, to keep up their supply even with the stresses of balancing childcare and work and whatever else in a woman's life, and to get that stuff out and store it properly and remember to bring all the pumping essentials wherever you are going--it's totally worth crying over. I have been livid coming home after a long day and realizing that instead of milk going into my collection bottle it is instead all over my scrubs. I guess that would be worse on the way to work, but it's pretty devastating either way. AND, lastly, there are all the bags--my work bag, my on-call/food bag, my gym bag if not working out at home, and my pump bag. I look like I'm going on vacation every day. Too bad it doesn't feel like a vacation very often.

So working out after work must be easier right? Ehhh...not really. I have always been a morning exerciser except when being on the inpatient service and winter force me to choose between working out at 4am in the dark or working out after 8-9pm after work. The problem with the after-work gym plans for a nursing mom is that by the time you finish work (for me, this timing is about as consistent as my baby's schedule), pump, get to the gym, change, exercise, shower, get back in the car and put on your pump for the ride home...congratulations! -another day of not seeing your baby, ever. And sometimes even if you choose the no sleep option and do a morning workout, who's to say you make it home in time to see baby then? But, you might see your husband. Remember that guy?

Without even throwing work into the mix, I think finding time for exercise as a nursing mom is pretty tricky. There is the childcare issue- yes, you can do stationary bike while your child is in a bouncer or pack n play, and we did talk about going for walks with your babies, but what if mom needs a little dedicated me time with some focused lifting or some find-your-zen-dont-hear-anyone-crying running? Not to make it more complicated for you, ladies, but you should not be running with your babies in a stroller until after 6 months at least because they just don't have the head control, but more on that in our stroller safety blog.

SO, the fact that exercising, nursing moms are making all this work--medal of honor, ladies...medal of honor.

Some Guidelines for the Nursing Athlete

Rule #1: HYDRATE.
Sometimes I drink 10 liters of water a day, no joke. Especially during the hotter summer months, I really don't think this is over doing it when you are working out and nursing. I also have more total body water percentage than most women because I am 6'2" and weigh...well, chances are, I weigh more than you do. But, still, 5-8 liters is not excessive for most nursing and exercising moms. I tell my patients to drink a tall glass of water every time they breastfeed their babies, and this is for women who aren't even exercising on top of that. Breastfeeding requires a ton of fluids. You are going to be constipated and vasovagal (fainting) if you don't drink enough water, and your milk supply may be affected as well. I can definitely tell a difference in how I feel and in my milk supply when I hydrate and sleep. But one out of two isn't bad, right? 

2. Nurse or pump prior to exercise.
This is especially for running (may not be necessary for swimming or biking depending on your workout clothes and how uncomfortable you feel when your breasts are full). It feels different, but I can bike and swim without pumping beforehand. However, by the end of the workout, I am looking for my baby or breast pump because it does become quite uncomfortable.

3. Choose workout gear appropriately and don't forget the BODY GLIDE.
All kinds of things are rubbing together that maybe didn't rub together before, so use Body Glide or Chamois butter, just sayin'. Please check out this blog on maternity workout gear that may be helpful for thinking about postpartum workout gear. This is my favorite sports bra super comfy for the nursing mom's boobies and great for coming in and nursing right after exercise thanks to the handy front zipper.

4. Empty your bladder prior to exercise.
Right before you run out the door, go back and pee. Trust me. Especially if you are already having a few pesky pelvic floor issues, the amount of Kegel-ing you are going to have to do (especially while running but really any kind of weight-bearing exercise) is really intense. My pelvic floor was sore after my first run back postpartum, and I only ran 30 minutes. Every step is an impact with the ground that your core and pelvic floor need to sustain and tighten to keep things were they need to be. (Sorry if that's TMI, fellas.) Help yourself out by having less urine in your bladder. If you did rule#1 appropriately, you'll need to urinate prior to exercise...and sometimes even during. I know, you thought you were done with that after pregnancy ended, but more on this in the pelvic floor syndrome blog.

5. Post-exercise nutrition.
You may need a snack depending on the time of day and how long you exercised. If you are doing endurance, for sure, you need a snack. You should be eating small and frequent nutritious meals with high protein while nursing anyway, so, chances are, it is time for one of those by the time you get back from working out, anyway, especially if your baby is ready to feed again. I know it seems to defeat the purpose of working out to lose baby weight, but think about it in terms of how endurance athletes train- you always need something after your workout with carbohydrates and protein to help your body recover. And those slackers aren't even nursing! Just think, you did whatever run/bike/swim you just did, and that whole time, you were also making milk for your baby. Amazing. Isn't the human body amazing?
Happy and fed baby, icing-knee mommy :)

7. Feed or pump post-exercise.
Your baby may be ready to eat again when you get back. If not, you don't have to pump again unless it is time for you to do so. You might not have made very much milk during your workout, so now is the time to replenish fluids and nutrition and rest, so you can fuel up for the next feed. That being said, I have definitely come back from running and fed Violet while still sweaty. She seems a little confused at first but doesn't care when she's hungry. Some women say that babies like that taste of salt. There's no medical reason not to go ahead and feed if your baby wants to eat, and there's no greater motivation to get home from your run/workout than knowing your baby is waiting for you. If you are trying to increase supply, it might help to have whoever is watching the baby wait to feed until you are back, so baby is hungry and you can stimulate more milk production...but more on that in Part 2.

It's worth mentioning again. Hydrate with every feed, hydrate when you first wake up in the morning, hydrate pre- and post-workout. Depending on how long you are going for, you may need to bring fluids with you, but let your thirst be the judge of that. If you are a nursing mom, and you are doing something at any point in the day that does not involve a cup of fluids, think again- and grab something to drink.

The Evidence

I put this at the end rather than at the beginning like I normally do because it's kind of a letdown. HAHA! Letdown... ;-)

Physicians these days are really big on evidence-based medicine. And I hate to say it, but after searching the literature comprehensively on this subject, I can't really find any good studies! There aren't any good ones at all! So any advice your obstetrician, your pediatrician, or your lactation consultant is giving you is mostly based on theory and scientific knowledge rather than clinical evidence. What a bummer, right? Didn't you think this blog post was going to provide you with all the answers?

1. Calorie restriction may play a role in weight loss for breastfeeding mothers.
Really? Amazing stuff. The one study* I did find was a literature review citing 6 other studies (who knows where they are because I didn't come across them) concluding that "weight management interventions which include an energy-restricted diet may play a key role in successful postpartum weight loss for breastfeeding mothers." Well, zippidy-doo-da. Obviously this is the case, but no one knows the specifics of how many calories lactating mothers need and it's even more complicated throwing exercise into the mix, and there are no studies on this AT ALL. Bummer. But more on that in our next blog post.

2. There is some anecdotal evidence out there that endurance exercise increases lactation.
I don't know about this, ladies. It's not a real study, so this is just women saying that they felt that their lactation improved with endurance training and some lactation consultants saying that they have noticed this in their practice with their patients. So really just take it with a grain of salt. My personal opinion (I can do this because this is my blog yay!) is that these endurance athletes who continued to train heavily while they were nursing were 1- doing so when they're children were already eating solids and therefore not needing as much breast milk or as frequent feeds, and 2- women who already had an abnormally high supply of milk to begin with. Some women just have a ton of milk. Yay for them. Can you tell I'm bitter? Moving on to our next segment on staying fit as a nursing mom, we'll talk about the challenges with maintaining milk supply while staying fit.

Going the Extra Mile

My conclusion to all this is:  we should study this! Who wants to be part of my study? To study it well, we would need women who are about to give birth and plan to nurse and exercise. To study it semi-well, we need women who did nurse their children and exercise and can remember a bit about what it was like...even better if you recorded your calorie intake and exercise each day...what, you don't do that? Am I asking too much? If you use a calorie app, I'd be very interested!!!

Need a Pep-Talk?

You can do it! 
How was that? ;-) Honestly, after writing all of this, I kind of need a pep-talk myself. It's important to realize that it's all worth it. It's worth it to feed your baby and help your baby fight infections and give him/her something that is very easy to digest and to have that mother-infant bond that everyone goes gah-gah about (It's actually really beautiful and amazing. I love nursing, which is why I'm writing 3 blogs on ways to continue to do it while you stay active). It's worth it to be healthy and exercise and to do something to take care of yourself when you aren't otherwise doing so these days. But, on the days that it's not worth it, when you haven't slept and you can't calm down and you've had an awful day, just go home and hold, walk, or play with your baby...
or, just sleep. Sleep is golden.

Stay Tuned...

Parts 2 and 3 in this series on staying fit as a nursing mom are coming up!
-Part 2: Got Milk? Maintaining Milk Supply 
-Part 3: So You Wanna do an Ironman? The Ultimate Motivation  

*Neville et al. The Effectiveness of Weight Management Intervention in Breastfeeding Women-A Systematic Review and Criticial Evaluation. Birth. 2014 Apr 21. 

Sunday, August 3, 2014

Tips for Supporting an Exercising Nursing Mom

Tips for the Fellas and Family/Friends Who Want to Help Us Help Our Babies...with our boobies... (and I promise the full staying active while nursing article is in the works! Bare with me while I do some more research for it!)

Today my husband and I celebrate 6 years of marriage. Two marathons together, countless triathlons, two Ironmans on different continents, and one amazing baby girl...
Six years later, he is still the love of my life and my Iron-partner. I wouldn't have it any other way. I love that he understands why I work so hard to be a pediatric resident, why I get up at 2:30 in the morning to pump, why Ironman is important to me. I could not ask for a better partner. But even my husband has struggled supporting me as I continue to maintain an active lifetstyle while also nursing our firstborn. It's hard, folks! It's hard for me to do it, it's for me to tell him how to help me do it, and it's hard for him to feel like he is taking an active role in feeding and caring for our daughter when...he just doesn't have boobs. In some ways, I'm sorry, guys, you will never get it. This was a really depressing realization to me when Violet was about 6 weeks old. I was totally sleep-deprived and totally exhausted and totally IN LOVE with my little girl, and part of me was so angry when I finally got it--men will just never understand what it is like to be women and mothers. But that's okay because we will never understand what it is like to be in their shoes. They'll also never have the boob-baby bond. It's not fair on either front, if that makes either side feel better. But, I will say, all of us ladies could probably get a little better at telling our men and other partners what we need from them and how they can help because of course the loving fathers and family members that they are--they totally want to. I think this article says it best. 

But a few more specific tips on helping the nursing athlete:

1. Bring me water and a snack.
Pretty much any time you do this, it will be helpful. But especially while I am nursing and especially when I come in after a run and don't have time to shower or get food or water before that wonderful child of mine needs to be on my boob.

2. Understand that I get cranky when I don't sleep but also when I don't work out.
A happy mommy is made when you watch the baby for a while so she can a) go workout, b) take a nap, or c) both!

3. Help me realize when it's important to sleep and hydrate.
Even when I feel bad because I went back to bed after feeding Violet at 4am when I finally got her back to sleep and probably could have squeezed in a pre-dawn run and given myself some happy endorphins, Curtis never makes me feel that way; he reminds me that I need sleep, too. Being women who have this notion that we can do it all (we can't; we need you, obviously, but we think we can do it all anyway), we sometimes forget that you can't just keep going forever and ever on no sleep. You need sleep to work out your mental stresses (HELLO crazy REM-sleep dreams!), to let your sore or tense muscles heal and relax, to help your body fight infection, and--here's the kicker--to make milk. Dads/partners- remind the moms in your life that they need sleep, too. And, if you're awesome like my husband, when he couldn't wake me up the other day to kiss me goodbye when he left for work and I had finally gotten Violet back to bed at 6am, he left me a cold glass of water to drink when I first woke up. BEST. IDEA. EVER...especially since the hung-over feeling of the nursing mom who is also fitting in workouts includes the need for immediate caffeine (RESIST. It just makes you more dehydrated in the long run, since most forms are diuretics.) and the worst cotton mouth imaginable.

4. Understand how hard it is for me to fit in these workouts and be supportive and tell me that the time away from my baby is time that will make me happier and healthier when I come back to him/her. 
This is something that I have to do now for my husband when he knows he has to go do his 4-hour bike ride for Ironman training but doesn't want to because he hasn't seen me or his child all week and he just wants to be with us. I hold Violet up to him and say, in my best Violet baby voice, "It's okay, Daddy. I know you want to stay, but you have to go ride so you can be my IronDAD. We can play later." And he does the same thing for me by yelling at me to go run when I am heading out the door with my shoes laced up but come back to the nursery when I hear Violet cry.

5. Love me for the mom and the athlete that I am and tell me that I am doing a great job.
My husband is amazing at this. I love him for it. Because being a mom is so hard but so awesome. It is even more awesome with a caring partner. 

And maybe it's not your husband...maybe it's your mom, your mother-in-law, someone in your family, a friend. Ladies, we need to thank all our family members who help us take care of our kids because heaven knows we aren't doing this sh*t alone. But more on that next blog.

On deck: Staying Active as a Nursing Mom

Friday, August 1, 2014

Dealing with the Postpartum Flab

There it is. I said it. We all love our babies, we love being moms (most of the time), and we love our bodies for the miraculous creations they are, BUT, what's up with the postpartum flab, and how long should you expect it to stick around? Even the happiest of moms start to wonder when they can start wearing their old clothes, especially if you're past the stage of dealing with pelvic floor issues. It's hard to remember to be thankful for your body's ability to heal and produce milk for your baby after those first couple months when the glam of motherhood wears off and the pregnancy fat lingers. Don't get bogged down, ladies. Let's talk about the flab. 

I recently went to hang out with some new and old mom friends of mine, and one of them spoke with me about her concerns about losing baby weight. This is something that is often in the back of the mind for a new mother. Obviously, your child's health comes first and foremost, but part of being a good mom for your child is being a happy and healthy person. A lot of us feel better about ourselves if we can fit into our old clothes, do the athletic things we used to do, like what we see when we look in the mirror, etc. All that is fine and good, but let me remind everyone (and myself included, we all need reminders) that getting back to your old body and self is something that is a process and nothing you can do in those first months after your child is born, for most people. It's not healthy to lose all your baby weight at once because your body is restoring essential nutrients, finding fluid and hormonal balance again, and trying to prepare for the next phase of life. The transition from pregnant woman to mother doesn't happen any easier physiologically within your body than does the mental and emotional transition from pregnancy to motherhood. They both take time, so allow yourself to take that time, and try to enjoy this miraculous journey!

All that being said, after 2 to 6 months postpartum, it's okay to start thinking about changes to your diet and activity plan that can help you lose the weight you gained during pregnancy. At this point, most moms may have about 10-20 pounds left to lose, and these can be the hardest ones. Nursing mothers face the greatest challenge because we are trying to eat and drink enough to provide our baby with the proper nutrition and hydration he or she needs to grow and develop. This is so hard ladies, but it is an amazing gift you are giving your child. Whenever I feel a little bogged down about the progress I've made in physique or fitness because I feel like I have made some changes but should be further along, I just look at my baby girl and remember how amazing she is and know that if I do nothing else in this world, at least I am doing my best for her. Sometimes that works. ;-)

I'm now 11 weeks postpartum and counting, with 10 pounds left to get back to my pre-pregnancy weight but still 18 pounds shy of Ironman weight. So I'm not back either, and like I said, sometimes it's hard, and we'll go into more specifics in the upcoming blogs, but for the most part I think my advice is to try to find something each day that will give you energy and make you happy so that you can be the best mom you can be, especially on those days when you're feeling a little down, a little tired, a little flabby. 

A few general tips for getting back into your old jeans (PLEASE don't try them on for the first 3 months. Just don't. I would even venture to say don't try them on for 4 months...6-9 months if you are nursing. Just give yourself a break!) 

***Nutrtion, nutrition, nutrition. As my obstetrician told me during pregnancy when I voiced concerns about putting on weight too fast, "Just cut out the crap." Eat healthy for you, healthy for your baby if you are nursing, and forget that other stuff. Get MyFitnessPal or a similar app and log calories, if that's your thing. It's a little more complicated than limiting your calories and can be tricky if you are nursing, so we will have a separate blog on that.

***Get SLEEP whenever possible (I know, IMpossible.) Cortisol is not your friend, and it ramps up when you don't sleep and are stressed out (Oh, so, every new mom, then, right?) and helps your body store fat. The problem with this is that maybe you don't want to store fat, you know?

***Find a way to get ACTIVE...even if that's just walking or dancing with your baby!

And in the meantime, fight the flab funk with these...

The Slim Six Subtle Ways to Trick Your Brain Into Feeling Better About the Flab!

1. Take a nap! 
Always a good idea to sleep since sleep deprivation makes reasonable people unreasonable and you'll feel better about yourself and your life if you sleep, plain and simple.

2 Take a walk! 
Walk away your worries, get fresh air, get your baby outside too...but remember sunscreen for you and protective clothing for your baby ;-)

3. Call a friend.
Venting or getting a fresh positive outlook- both are super helpful! Call a friend while walking = added bonus!

4. Dance with your baby
Sometimes for me, even when I don't have anyone to watch Violet and can't really fit in a workout at home while she is napping, just holding her and singing to her while we waltz or meringue around the apartment seems like the best thing in the world. If nothing else, play music and dance while holding your baby. I think the feeling I get from it could be bottled up and sold as an antidepressant.

5. Clean.
Vacuuming with Violet!
Can't get out of the house with baby because it's raining? Feeling dreary and overwhelmed by your home's chaos and mess and want a sense of control on how just ONE thing is going? Throw that baby (don't throw your know what I mean, gently place your baby) into a carrier and vacuum the house! This is the best. At almost 3 months of age, Violet loves it, and I'm pretty sure she would've loved it a month ago during that colicky time in the evening. White noise for the baby, being close to mommy, hearing her heart beat, gentle bouncing...this is golden. And it is golden for you because it's hard to feel down or fat when you start cleaning--the productivity is something that is better than the "selfish" act of going to the gym and being away from your child (maybe you struggle with this, I often do), and you will get your heart rate up, maybe even break a sweat, and definitely burn a few calories along the way. 

6. Try the following mom-baby workout :-)

I thought a sample workout plan for this point and also a few more pointers might be helpful. I forgot something REALLY important last time- BODY GLIDE. I didn't forget it; I just forgot to mention its necessity in the blog post! Triathletes will understand, but just so you know, there are all kinds of parts of your body rubbing together that maybe didn't rub together before, you know? So don't forget the body glide +/- chamois butter if needed!
I came up with this short workout for mom and baby a while back when I just didn't feel like leaving Violet any earlier before my 12-hour ER shift, so running just wasn't going to happen that day. It was also the kind of shift where if I wanted to go run beforehand, I would be leaving Violet with someone else during her colicky time, and you hate to leave your baby when she's unhappy, but you also hate leaving an unhappy baby with someone else, so that's how this workout came about. The bouncing really helped her colic, and it was fun to do something together. She actually loves it more now that she is older, but we did it for the first time at 8 weeks. Obviously this isn't as good as going for a run, and it's not as good as doing weights on your own once you are up to doing heavier weights, but for 8-12 weeks postpartum, why not? 
Ideally you would add stationary bike 15-20 minutes while your baby is in his/her swing/bouncer/crib...

warm-up then
3 x 12-15 front squat with baby upright and your upper arms parallel to floor
3 x 12-15 front shoulder raise with baby in same position
3 x 12-15 bench/couch push-ups (with baby in bouncer)
3 x 12-15 floor bench press (great for tri's and chest and fun for baby too!) with baby facing away from unless you want to risk getting vomited on haha (I have tried both ways and no vomit yet! You get to see the facial expressions if the baby faces you.)
3 x 30 sec plank (if you can do a true plank for 30 seconds at this point, you are awesome!) alternatively try crunches while holding baby
you can also do them as a circuit, ideally adding an agility section like mountain climbers or high knees :-)

In honor of the slim 6, I ran 6 miles today. Didn't wear body glide on my inner thighs. Big mistake. And for those folks who think I've managed to find some kind of life balance as a new mom, let me just assure you--I haven't. I really don't know if I brushed my teeth today, but I fed my baby, and I ran 6 miles (because Violet has an amazing Nana who came over for me to do that!). That is all. And today, that's enough.

Proof of how little balance I have is shown in the fact that although I have been working on several blog posts for you guys, this is the first one I have fully finished since July 1st. A month apart! Yuck! Hopefully we can do better than that!

On Deck: 
-the nursing athlete
-pelvic floor syndrome