"I Love But Do Not Like My Baby!"

I was rather shocked by the perspective of the young mother referred by my colleague, Gale. "Gale thought you could help me out," the young woman explains.

Eli was Samantha's second baby. He was a planned child, born healthy and full term. Labor and delivery had gone well, breastfeeding was successful, and Mom had two months of maternity leave. What could be that wrong? I wonder.

"He fusses all the time!" Samantha explains as she lays the baby on the exam table. "See, like now! Hear him making all those grumpy sounds!"

Eli is a robust, wide-eyed six-week-old. He is very busy in his movements as he wiggles and squirms on the exam table. His level of activity is a wonder to behold. He seems to wind up a second, then one arm shoots out to the side, both legs kick upward, and he arches his back. He is also very busy with his vocalizing—a grunt here, a groan there, or was that a coo? The activity and sounds coming from his cute little body are normal and even entertaining to me. But his activity level and his vocalizing seem to be off-putting to his mother who thinks Eli is fussing all the time.

"See Sarah there," Samantha says as she points to her four-year-old daughter coloring peacefully on the floor at our feet. "She is so calm and easy to be around. Both my husband and I had alcoholic parents, and we promised each other that we would have a peaceful household. But Eli just keeps on fussing," the new mother remarks as she hands me her baby.

What an opportunity and a challenge this moment is! Can I help this mother see her son through a different lens? As usual, when I feel challenged by a patient encounter, I simply report to the parent on the behavior of the baby (a technique well described by Dr. T. Berry Brazelton). I demonstrate Eli's normal reflexes and get excited when he brings his hand to his mouth and begins to calm down. I pick up the end of my red stethoscope and engage the baby in a little game of following its movement with his eyes. Of course, I finish with the grand finale of having the mother call out the baby's name. Eli hesitates only a moment before he turns toward his mother and—I believe he actually gives her a wink!

Samantha giggles and scoops up the baby from my arms as I discuss this high, but normal, level of activity and vocalizing. We talk about how each baby has a special temperament and style, right from birth. "His body activity and enjoyment of vocalizing are part of Eli's inborn personality," I explain. Mom smiles as she gives him a hug. “I guess he’s just a real go-getter,” she responds.

Eli is three years old now. Every time he and his family come to the clinic to see Gale, they stop by and say hello to me. "Eli's not really fussy anymore," Samantha explains. "But he's still a busy and noisy little guy!" Eli runs down the hall ahead of his mom who laughs out loud as his sister squeals in his pursuit!

"I worry all the time!" Mom says

Janine held her two-month-old as we spoke. Her arms were a bit stiff, and she looked uncomfortable. As little Johnnie looked up at his mom a smile began to spread across his face. Mom didn’t notice. She aims to keep Johnnie on a very rigid eating and sleeping schedule and describes how upset she becomes when her son doesn’t comply. She reads everything she can find on the Internet about baby care and is distressed because one person’s advise contradicts another’s.

Mom’s looked to me for reassurance, asking, “Are you sure he is growing ok?” Though Johnnie’s regular eating habits, his “output” (pees and poops), and his growth chart demonstrate a child who is growing well, Janine cannot be confident he is doing well.

Janine loves her baby deeply, but she is one of the 10% of postpartum mothers who suffers from postpartum depression.

Depression can present two ways in a new mother. Typically parents think of the “Baby Blues:” a mother who continues to be emotionally tender and tearful even after the first week of her child’s birth.

But Janine demonstrates the other face of postpartum depression: the hyper-vigilant mother who worries all the time. New parents normally present greater-than-usual vigor and intensity as they struggle with their early days of parenting, but a depressed mom cannot be reassured by those who are ready to help and give guidance. She finds very little joy in the job of parenting—and sleeps and eats poorly, even though her baby may do both well.

Postpartum depression research by Dr. Ed Tronick from Harvard University has identified behavioral changes in two-month-olds whose mother is depressed. While parenting has been described as a dance between a parent and a baby (a parent reaching out to understand and care for a baby, and a baby seeking care from a parent), the hyper-vigilant, depressed mother has difficulty participating in the dance. She doesn’t seem to see her baby’s efforts to connect with her, and she attempts to interact when the baby is shut down and unavailable. In this mother-baby dance, the partners are constantly stepping on each other’s toes!

Janine now understands what postpartum depression is, and she sees that without help she is putting both herself and her baby at risk. During the past month Janine has accepted both counseling and medication and now is smiling more. At Johnnie’s four-month-old visit with me, Janine is distracted when her baby starts to giggle. I’m happy to feel like an outsider for a moment as this “dance couple” linger in one another’s gaze.

"My Baby Doesn't Like My Milk!"

"Diane doesn't like my milk!" the young mother declared. "It must not be strong enough for her. I guess it's time for formula."

Her words were a surprise to me. Three-week-old Diane had regained her birth weight in just ten days and was growing at a great, 1/2-ounce-a-day clip. I could see her cheeks beginning to fill out, and she was "filling" her diapers with gusto. Why did this mother think that her breastfeeding was going poorly?

"She just doesn't seem satisfied," Diane's mother said. "Diane doesn't act like she's happy."

As a lactation specialist, I am trained to note weight gain, to identify the sound of milk being swallowed, and to document the number of wet and stooled diapers. Hearing this mother, my suspicion was that Diane's mom was responding to non-feeding infant behavior and projecting those concerns onto her breastfeeding experience.

In addition to noticing the physical signs of breastfeeding success listed above, I also am aware that research shows that a mother will see her baby as "satisfied" when she observes particular newborn behaviors. She wants to see her baby become alert and gaze deeply into her eyes. She wants to calm her baby effectively and doesn't want her baby to appear irritable or difficult to console. Mom wants to enjoy cuddling with her baby and to know that her baby likes to cuddle right back.

Understanding this, I picked up the baby to play some newborn "games." First I swaddled Diane to bring out the best in her ability to play. Next, I swayed Diane gently until her eyes became bright and alert. Then I shook a rattle and watched as Diane followed the toy intently with her eyes. She watched closely as I moved the rattle without a sound. Diane's mom giggled and glowed with the words, "She's really smart, I guess!" With my encouragement the young mother called her baby's name. Diane turned slowly in her mom's direction. With a big grin the mother lifted the baby from my hands and snuggled her face into the crease of the baby's soft neck. One of mom's hands went to her breast to suppress the unexpected let down of milk.

Now Diane's mom is a breastfeeding star and an advocate for other new moms. She comes to our breastfeeding class to discuss the challenges and joys of breastfeeding. "Babies are little people who have special ways of communicating," she says. "Don't just count their pees. Learn to speak their language, and you'll soon know how much they love your milk!"

A Tug-of-War between Mom and Dad!

Eight-day-old Tabitha is calm at the beginning of her visit with me, but as I undress her she starts to rev up. At first her hands shake, then her chin trembles and her face gets red. Her face now "clouds over" as she stares out into space. (See SOS "Sign of Over-Stimulation.) When I persist with undressing her, she starts to cry. I lean over Tabitha and softly call out her name. "Tabitha can you calm yourself down?" The baby clearly hesitates a moment when she hears my voice but then starts to cry again.

I finish the undressing and lay her back down on the table to listen to her heart sounds. She clouds over again when the stethoscope touches her chest, and once again begins again to cry. Dad scoops her up in his arms just as Mom mimics my earlier action by leaning forward to softly call her baby's name. I am witnessing one of the lovely adventures of early parenthood, the tug-of-war between parents who both are wanting so passionately to bond for their new baby.

Remembering what he learned about the "Rebooting Zone," Dad rocks her a moment which clearly comforts the baby. Mom presses on with her insistent, soft, sing-songly voice. Dad finally sighs with a smile as he hands the baby carefully over to his wife's arms. "Mom always has that magic touch."

Today's fathers are often (and preferably) involved in the decision to plan a baby, participate in the OB visit, help select the baby's new doctor, and often attend the well baby visits. Expectant parents anticipate that they will feel some competition with the mother-in-law who arrives at the child's birth, the older sister who stays a week to help out, or the doula who shows up for a shift or two. But as new parents they do not expect to feel competition between one another as they strive to care for their baby.

Research on new parenthood suggest that this competition is normal and, in fact, can fuel the attachment process of a parent to his/her child. However, if these feelings are not understood and appreciated for what they contribute to the developing parent-child relationship, such competition can undermine the parent's relationship with one another.

"I love to see you both working so hard to get to know and to care for your new baby," I say. "Some new parents even confess to a little competition with each other during the first few days of their baby's life."

Dad jokingly "complains" that "Mom has the breast which always trump what I can do!" But Mom quickly explains that "But Dad can swaddle and comfort Tabitha like nobody else!" Knowing this struggle is normal and healthy can actually bring couples closer together in these first precious days.

Babies quickly learn to attach to both parents and by their behavior "say" I know the difference between mom and Dad. How lucky is any newborn whose parents finds themselves in this tug-of-war (with themselves and each other) to be the best parent they can each be!

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