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The Three Days in the Hospital#

If you have a natural birth, you may need to stay in the hospital for two nights; if you have a cesarean section or encounter other delivery difficulties, you may need to stay for 3 to 4 nights. Historically, women once had to stay in the hospital for a week or even 10 days to recover, but that era is long gone. Nowadays, insurance companies are particularly strict. A friend of mine suggested that I wait until late at night to give birth so that I could stay in the hospital for an extra night (although the doctor might indeed come late to check your dilation, I certainly don’t have the self-control my friend mentioned).

Depending on individual personalities and the conditions of the hospital, some people think giving birth in a hospital should be quite nice, while others may feel more frustrated. One benefit of staying in the hospital is that there will always be someone to take care of you and help you with questions about your baby. If you want to breastfeed, the hospital will provide lactation consultants, and nurses will come to check on you constantly to ensure you haven’t lost too much blood and that your baby is doing well; the downside is that a hospital is not home, and you can’t have everything you want, so you may feel constrained, and hospital food is usually not very tasty.

Bathing the Newborn#

When a baby is born, their body is covered with a layer of substance. I don’t want to go into detail about what it is; most of it is blood, along with some amniotic fluid and vernix, a waxy substance that protects the baby from infection in the womb. After the baby is born, someone may suggest that you give them a wash.

I still remember a nurse trying to teach us how to bathe the baby in a tub about a day after Penelope was born. We watched very carefully, but we felt that we definitely wouldn’t be able to do it ourselves, so we thought we would wait until she was older to bathe herself. We held out for two weeks, but ultimately succumbed to the dirty milk stains on her little fists. I still remember that bath; that poor little baby, probably still hasn’t forgiven us.

In the past, it was quite common to bathe a baby even before handing them to the mother. This practice has changed for two main reasons:
First, it has become increasingly common to allow the baby to have immediate skin-to-skin contact with the mother after birth, letting them spend a few hours alone together. One benefit of mother-baby skin contact seems to be the stimulation of milk production. Perhaps for this reason, the success rate of breastfeeding has also increased with the delay in bathing the newborn for a few hours. Since there is no urgent reason to bathe the baby, waiting a bit longer is perfectly fine.

The second reason is the concern that bathing may affect the baby’s body temperature. When a baby is born, they cannot regulate their body temperature very well. Bathing the baby, especially when taking them out of the water while they are still wet, may cause them to catch a chill. There is no data to prove this claim. Studies that have focused on bathing newborns have not found that bathing has a lasting impact on the baby’s temperature. However, some data suggests that using a sponge to bathe a baby can cause their temperature to fluctuate during and shortly after the bath, as the baby is exposed to air for a longer time while being wet. Temperature changes themselves are not a major issue, but they could be misinterpreted by parents as an infection, leading to unnecessary medical interventions. Therefore, bathing the baby in a tub is the standard practice in hospitals.

Bathing is not a bad thing, but aside from a few factors that can be largely ruled out, we haven’t found any particular reason to bathe the baby. A cloth can wipe away most of the blood on the baby, and Finn didn’t bathe in the hospital.

Circumcision#

Male circumcision is the surgical removal of part of the skin at the tip of the penis. The history of circumcision can be traced back to ancient Egypt, and it remains common in many societies today, although the reasons for the need for circumcision are still not very clear. Many stories circulate about it, the most interesting of which is said to be about a country’s leader who was born without a foreskin, so he ordered all men in the country to be circumcised as well.

People in different places circumcise boys for different reasons. There are also varying opinions on when boys should be circumcised; in some places, it is traditionally performed as a rite of passage at the onset of puberty, while in the United States, it is usually done shortly after birth. Jewish boys undergo circumcision at eight days old. Besides traditional practices like circumcision, your child may need to be circumcised within a few days before or after returning home from the hospital.

In principle, once you confirm that the boy’s penis is functioning normally (usually by observing how they urinate for the first time), it is about time for circumcision. Circumcision is not a necessary procedure, and not everyone will undergo it; Europeans typically do not circumcise.

Another risk is known as “aesthetic risk”: the remaining skin at the tip of the penis may require further surgery to remove later. Although this risk seems greater than that of infection, we are not sure how common this condition actually is.

Less common risks include urethral stricture, which is caused by pressure on the urethra leading to difficulty urinating. This condition is more common among circumcised boys, so it is likely related to circumcision, but it is extremely rare. Urethral stricture can be treated surgically, and limited evidence suggests that applying petroleum jelly to the penis for six months after circumcision can prevent urethral stricture.

Some people (especially those opposed to circumcision) believe that circumcision can lead to decreased sensitivity in the penis, but there is no evidence to support this claim. A few small studies focusing on men (some of whom are circumcised and some are not) measuring penile sensitivity have shown inconsistent results.

The general conclusion is: whether circumcised or not, men do not particularly enjoy having their penises touched by others.

This is a discussion of the risks associated with circumcision, but it seems there are also benefits. The first is that it can prevent urinary tract infections, as circumcised boys are less likely to get infected. About 1% of uncircumcised boys will experience a urinary tract infection during childhood, compared to only about 0.13% of circumcised boys. Because this difference is significant, many believe circumcision does indeed provide a protective effect. However, I must remind you that this benefit is not very meaningful in numerical terms; you would need to circumcise 100 boys to prevent one case of urinary tract infection. Uncircumcised boys can also have phimosis, which is when the skin at the tip of the penis cannot retract. This condition requires appropriate treatment, usually involving steroid ointment or waiting until the child is older to circumcise. Overall, only 1% to 2% of boys may need circumcision later due to the aforementioned conditions, so it is rare but not entirely absent.

The last two benefits of circumcision for children are reducing the risk of contracting HIV or other sexually transmitted diseases and penile cancer. In studies on HIV and other sexually transmitted diseases, much data suggests that circumcised African men have a significantly lower risk of contracting HIV, but this conclusion is based on the premise that HIV is transmitted through heterosexual intercourse.

Blood and Hearing Tests#

Doctors and nurses will conduct two more tests on your baby before you are discharged: a blood test and a hearing test. Newborn blood tests can screen for many conditions. The number of conditions screened varies depending on which state you live in the U.S.—California has the most, with 61 conditions. Most of the conditions screened are related to the baby’s metabolism; the hospital will test the baby’s ability to digest a specific protein and produce enzymes in their body. This screening method is similar to many other disease detection methods, a good example being phenylketonuria. This is a hereditary genetic disorder that occurs in about 1 in every 10,000 newborns. Patients lack phenylalanine hydroxylase, which prevents the conversion of amino acids in food. Because protein contains a lot of phenylalanine, patients must maintain a low-protein diet. If a child is diagnosed with phenylketonuria, their diet must be adjusted to avoid severe consequences.

If a diagnosis is not made quickly after the child is born, they could suffer brain damage from feeding (as both breast milk and formula contain a lot of protein). If not screened, you won’t know until it’s too late. Tests like this are especially important right after the child is born. These tests only require a small blood sample from the baby’s foot and do not affect them at all. If your child has no concerning issues (which is likely so far), you may never hear about these conditions again.

The hospital staff will also use a huge and complex machine to conduct a hearing test on the baby. Sometimes they will bring the equipment to you, and other times they will ask you to go to another room for the test. Hearing impairment is relatively common among newborns, with about 1 to 3 out of every 1,000 infants experiencing this condition. Early hearing screening is increasingly emphasized so that interventions (such as using hearing aids) can be implemented sooner, improving their language development and reducing the need for later interventions.

You can imagine that giving a hearing test to a child is different from giving one to an adult; they won’t raise their hand when they hear a “beep.” Most babies will be asleep during the test. During the test, the doctor will use sensors on the baby’s head and ear to monitor whether there is a response in the middle and inner ear when a sound is emitted. These tests have a decent accuracy rate (about 85%), but there can also be false positives.

Rooming-In#

During the days you spend in the hospital after giving birth, you will frequently see your baby, but the question is whether you want to see them every moment. Giving birth is exhausting, and for many women, sleeping with a newborn can be quite challenging. In the past, hospital nurses had ways to separate mothers and babies for a while so that mothers could regain some strength and rest for a few hours. But that’s not the case anymore; over the past few decades, many family-centered hospitals have emerged. We certainly hope that all hospitals are family-centered, but family-centered hospitals have more details to adhere to, especially a set of guidelines known as the “Ten Steps to Successful Breastfeeding,” aimed at increasing the rate of breastfeeding. These steps include: no formula feeding unless medically necessary; no pacifiers; educating all expectant mothers about the benefits of breastfeeding, etc. I won’t elaborate on breastfeeding here, as it will be discussed later, and I will also delve into the controversial practice of avoiding pacifiers.

In addition to these recommendations and avoiding formula feeding, another rule that must be implemented in family-centered hospitals is rooming-in. This means that unless there is a medical reason for the baby to be in another location, the mother and baby must stay together 24 hours a day. This may be fantastic for you! Who wouldn’t want to be with their child? Being with the child is certainly wonderful.

Women who have just given birth are usually particularly tired, and staying in the hospital allows for more professional care compared to being at home. Sending the baby to the nursery allows you to take full advantage of the hospital’s facilities to rest well. Data does not completely support rooming-in, allowing many mothers to relax. Additionally, there may be some risks associated with rooming-in; many mothers fall asleep while breastfeeding due to exhaustion. The more tired you are and the less rest you get, the easier it is to fall asleep, which can potentially harm the baby.

Breastfeeding babies may fall. In my opinion, the most important point is that you have the option and freedom to send the baby to the nursery for a few hours, and you should not feel ashamed or embarrassed about it. If breastfeeding is important to you, there is no data suggesting that sending the baby away for a few hours will disrupt your plans. If you find that you and the baby have fallen asleep together, be sure to ask for help.

Baby Weight Loss#

Many new parents do not realize how much emphasis doctors place on changes in a newborn’s weight. If you safely deliver your baby, most of your conversations with the doctor will revolve around the baby’s weight and feeding. You certainly want your baby to thrive, and weight is an important parameter. When you first start trying to breastfeed after giving birth, discussions about the baby’s weight can be very frustrating. You feel like a failure; your baby was growing very well while in your belly, but now that they are born, you feel like you are doing terribly (you are not! It’s just how you feel).

The hospital will constantly monitor the newborn’s weight, checking it every 12 hours and informing you of the approximate changes. The day after I gave birth to my daughter, they came to tell me at 2 a.m. that her weight had dropped by 11%, and we had to start supplementing her feeding immediately. I felt isolated, unable to keep my eyes open, and confused, with no clue what to do. The lesson I learned from this was not to let my husband go home to rest, or at the very least, you should know that letting him go home carries risks.

Since the baby’s weight is so important, we need to be prepared. First, we need to know that almost all babies will lose weight after birth, and those who are breastfed tend to lose more weight. This physiological mechanism is easy to understand; while in the womb, the fetus absorbs nutrients and calories through the umbilical cord, and after birth, they must figure out how to eat. This process is relatively complex for both you and the baby, and in the initial days, your milk supply may not have come in yet. Lactation consultants may still have high hopes for those few drops of magical colostrum, but the amount of colostrum is indeed very small, especially when you are having your first baby.

You need to be cautious about the baby’s weight loss, but at the same time, do not overly worry about this design mechanism of the human body. The purpose of monitoring the baby’s weight is to detect problems early so that we can find ways to solve them. To effectively monitor a newborn’s weight, we need to know how much weight newborns typically lose. Overall, we only want to focus on the parts that exceed the normal range. Biology will not tell you that a 10% weight loss indicates a problem; if most babies lose 10% of their weight, then we do not need to worry.

I created a website www.newbornweight.org where you can input your child’s birth time, delivery method, feeding method, birth weight, and current weight to see where they fall on the distribution chart.

After I gave birth to my daughter, the hospital’s standard was that if the baby’s weight dropped more than 10%, we had to supplement her feeding. But you can see from the chart that whether this standard is reasonable largely depends on when the weight was measured and the specific situation of the baby. A weight drop of 10% within 72 hours after birth is normal, but if it drops after 12 hours, that is a bit serious.

Among breastfed babies, those who are formula-fed tend to lose less weight (unlike breast milk, formula can be consumed whenever desired). Comparatively, breastfed babies typically lose an average of 7% of their weight by 48 hours after birth, while formula-fed babies only lose about 3%. It is very rare for weight loss to exceed 7% or 8%.

What if you find that your baby has indeed exceeded the normal range? Usually, the hospital will recommend that you supplement with formula or use donated breast milk. In the past, they would have let the baby drink water or sugar water, but that is not advisable. If you use formula, you may worry that breastfeeding will become more difficult, and I was very concerned about this at the time. There is no data to support this, as it is difficult to isolate the impact of that little bit of formula used for supplementation. However, existing data indicates that there is no need to worry that using formula for supplementation will have long-term effects on breastfeeding.

Hospitals rarely recommend using formula within 48 or 72 hours after the baby is born or providing other supplemental feeding; it may be more useful to pay attention to the baby’s weight changes before that. If the baby’s weight starts to drop quickly, you should consider where the problem lies.

Lastly, it is important to note that one significant reason for weight loss in babies is dehydration, but you can directly observe whether the baby shows signs of dehydration. If your baby has a normal urination frequency and does not show signs of dry mouth or tongue, they are likely fine. Conversely, if you see some signals, even if their weight has not dropped too much, it is better to provide supplemental feeding in a timely manner. The excessive focus on the baby’s weight and feeding has already caused many new parents to panic (including myself), and data provides some comfort on both sides: significant weight loss may be completely normal, even expected. So don’t panic; if you must supplement feeding, don’t panic, just do it.

Jaundice#

Jaundice is a symptom of the liver's inability to break down bilirubin separated from red blood cells. Not only children, but all of us need our livers to break down these substances, so theoretically, anyone can develop jaundice. There are many reasons why infants are more prone to jaundice. When babies are born, they have a higher number of red blood cells, thus putting more strain on the liver to break down bilirubin. At this time, the liver is not fully mature and cannot metabolize such a high load of bilirubin into the digestive system. Additionally, in the first few days after birth, babies generally do not eat much, so bilirubin remains in the digestive system and is reabsorbed back into the bloodstream. If bilirubin levels become too high, the nervous system can be damaged (meaning the brain can become poisoned), so in extreme cases, jaundice can be a very dangerous condition. Severe jaundice, if untreated, can develop into kernicterus, causing permanent brain damage. It is indeed frightening, so we must take jaundice seriously. However, in many cases, jaundice will not develop into kernicterus even without treatment. Jaundice is too common, especially among breastfed newborns: about 50% of newborns will have some degree of jaundice.

It is important to note that the transition from jaundice to brain damage is not a gradual process; when bilirubin levels are at low or moderate levels, it cannot cross the blood-brain barrier, so it has no destructive power. In relative risk terms, there are only about two to four cases of kernicterus in the U.S. each year, but thousands of infants require treatment for jaundice every week. The treatment for jaundice is also quite aggressive; doctors will actively treat many newborns, even those who would recover on their own, to avoid any cases of brain damage. So if aggressive treatment is the standard reliable practice, you don’t need to worry too much about the worst-case scenario.

The main symptom of jaundice is that the baby’s skin will appear yellow (depending on the child’s skin tone, it may sometimes look more orange). A baby’s yellow skin does not necessarily mean treatment is needed; the color itself cannot be used as a diagnostic standard. When my daughter was checked four days after birth, our pediatrician, Dr. Li, said, “Some may say she looks a bit yellow, but don’t worry.” For many babies, jaundice will resolve on its own as they gradually start eating and growing. Whether jaundice has reached a level that requires treatment depends on the results of the tests. Many hospitals will first use a special light to shine on the baby’s skin to estimate the bilirubin level in the body, and then decide whether further blood tests are needed to confirm the bilirubin concentration. They may skip the light test and go straight to blood tests, which do not require much blood, usually just a small prick on the baby’s foot. The higher the test results, the worse the situation.

Similar to the weight loss in newborns, how to interpret these numbers depends on the baby’s age. In the first few days after birth, bilirubin levels usually rise, so doctors will compare your child’s numbers to the normal range based on their age. A key decision for the doctor is whether the bilirubin level is high enough to require light therapy—also known as phototherapy. This treatment requires the baby to be undressed (with only a diaper on), have their eyes covered, and be placed in a box emitting blue light. This light breaks down bilirubin into other substances that are excreted through urine. Depending on the severity and the baby’s response to light therapy, they may stay in the box for several hours to several days (during which you can take the baby out to feed). Doctors will update the situation through daily (or perhaps more frequent) blood tests.

In general, high concentrations of bilirubin are harmful, but how high does it need to be for treatment? The answer varies depending on the baby’s age and other factors. Specifically, doctors will first look at whether the baby is at low risk (gestational age over 38 weeks or under 38 weeks but healthy), moderate risk (gestational age 36 to 38 weeks and healthy, or over 38 weeks with other symptoms), or high risk (gestational age 36 to 38 weeks with other symptoms). Once they confirm the risk level, doctors will use a chart similar to the previous one to determine whether the baby needs light therapy. If bilirubin exceeds the standard line, then treatment should begin. Charts 1-3 apply to low-risk infants. For example, if a baby born at 72 hours has bilirubin over 17 mg/dL, then treatment is necessary. For high-risk babies, the standard line is set lower, and doctors may adopt more aggressive treatment methods.

Similar to the website for checking newborn weight loss, there is also a website www.bilitool.org that tells you whether the baby needs treatment for jaundice based on bilirubin levels; this is for doctors, but you can check it out if you’re curious. It is worth mentioning that some suggest that the criteria should be slightly relaxed, and jaundice treatment should be more gentle. If you are facing this situation, you can ask your doctor which criteria they are using. Very severe or untreated jaundice rarely requires other treatment methods beyond light therapy. The last resort is a blood exchange, where the baby’s own blood is replaced. This process can be life-saving, but with timely and proper monitoring, it rarely reaches this point. Some babies are more prone to jaundice, such as those who are exclusively breastfed, Asian infants, or those with different blood types from their mothers. Blood disorders can worsen newborn jaundice, but this situation is extremely rare. Similar to fetal bruising during delivery, excessive weight loss in infants is also a risk factor.

◆ Early bathing of newborns is unnecessary, but it is not harmful either. Bathing in a tub is better than using a sponge.
◆ Circumcision has some benefits, but there are also small risks. The final decision usually depends on personal preference.
◆ Rooming-in does not have convincing effects on breastfeeding (whether positive or negative). However, it is important to note that if you decide to stay with the baby, do not fall asleep with them.
◆ Baby weight should be monitored closely and compared to expectations; you can check this website: www.newbornweight.org.
◆ Jaundice is monitored through blood tests, and if the results exceed the normal range, treatment should be administered; you can check this website: www.bilitool.org.
◆ The general recommendation is not to rush to cut the umbilical cord, especially for premature infants; vitamin K supplements are good and should be used; antibiotics for the eyes are unnecessary for most babies, but in some states, this is a mandatory step, and there are no known downsides to doing so.

Crying#

Swaddling promotes sleep because it reduces the occurrence of awakenings. Babies who are swaddled are less likely to transition from the first stage of awakening (indicated by yawning) to the second stage of startling or the third stage of full wakefulness compared to those who are not swaddled.

Colicky crying, whether it fits the definition or not, is oppressive and overwhelming for new parents. Part of the reason is that this type of crying cannot be stopped; it is not like crying due to hunger or a wet diaper, or because they are tired. During colicky crying, the baby’s back often arches, and their legs curl up, as if they are experiencing great pain.

If your child cries a lot, regardless of whether it is truly due to colic, the most important thing is to take care of yourself. Crying is associated with postpartum depression and anxiety. Parents need rest, so try to find a way to rest, even if it means letting the baby cry in the crib for a few minutes while you take a shower. They will be fine, really, they will be fine.

Feel free to take a shower; if you really can’t leave them, call a good friend to help hold the baby for a bit, or reach out to those mom friends with older kids; they will help you. At the same time, understand that colic is self-limiting; it usually fades away around the time the baby is 3 months old. Colic doesn’t just go away instantly, but everything will gradually improve.

Some practices may help alleviate colic, but given the unclear causes of colic, solutions are not easy to find. Many theories stem from the digestive perspective, such as underdeveloped gut flora or an inability to digest proteins in milk. While this is the currently dominant theory, it is still just a theory. Many recommendations are related to these theories; a common practice online is to use simethicone, a medication that promotes gas expulsion (the Gerber brand sells this type of drops), but there is no evidence that this is effective.

Relevant experiments are limited; two studies compared an experimental group using this medication with a control group, and the results indicated it had no effect on the baby’s crying. The same can be said for other herbal remedies sold on the market, such as gripe water, which also appear to be ineffective. There are two treatment options that have some evidence of effectiveness for colic. One is the use of probiotics; a series of studies have shown that using probiotics can reduce crying in breastfed babies.

This treatment is also not difficult; just give the baby a few drops of probiotics orally. Brands like Gerber and others produce similar over-the-counter medications, and there are no known side effects, so it is worth trying. Another proven treatment option is to adjust the baby’s diet or switch the formula brand; if breastfeeding, the mother can adjust her own diet.

Although formula designed to prevent colic is usually more expensive, switching formulas is relatively easy. One suggestion is to switch from soy-based formula to hydrolyzed formula (most formula brands, like Abbott or Enfamil, have this version). Most of the data supporting the effectiveness of switching formulas comes from studies funded by formula companies, but if you are willing, this method may be worth trying.

If you are breastfeeding, changing the baby’s diet can be a bit more challenging, as it means changing your own diet. Some data supports the practice of mothers choosing a “low-allergen” diet. Randomized trials have shown that after mothers start a “low-allergen” diet, the incidence of crying in infants decreases.

The standard for a low-allergen diet requires avoiding all dairy, wheat, eggs, and nuts, which is a significant dietary change. Coincidentally, we do not know which of these ingredients causes the change, and overall data related to this is quite limited (this certainly does not apply to everyone). If this diet is effective, we can usually see results quickly, within a few days after the mother starts changing her diet, so it may be worth trying.

One obvious problem is that this approach is not very friendly to mothers and may even lead to malnutrition. Since it is not suitable for everyone, it should be recommended cautiously to others. However, this is not the time for mothers to start exploring new recipes, so if you have no other choice, it is still worth a try.

No matter what you do, the baby may still cry inexplicably. At the moment, you may find it hard to convince yourself, but eventually, this situation will pass. As the baby grows, you will be able to understand or guess the reasons for their crying; first, you need to realize that relieving your own stress is just as important as alleviating the baby’s crying.

Recording the Baby’s Data#

When we were leaving the hospital with Penelope, the doctors and nurses suggested that we keep track of her bowel movements. If the baby does not urinate, she is likely dehydrated, so it is essential to monitor her output closely. This is a good suggestion and not difficult to implement. The doctor did not suggest that we make a chart to record the data, but Jesse insisted on doing so. Jesse’s idea was to record all the details of Penelope’s feeding and elimination. Below is our record from the fourth day after her birth:

You will notice there are precise and rough records of breastfeeding times; the rough ones are noted by me. Jesse also made a little note here: Dad set up a very detailed data recording system for feeding and bowel movements, while Mom was not as precise with the timing as Dad and preferred to round off.

When the baby was two weeks old and we went to the hospital for a check-up, we showed our data records to the pediatrician, who told us it was unnecessary to be so meticulous. Of course, at that time, we were relatively amateur compared to other parents; my friends Hillary and John designed a complete statistical model with charts to observe the relationship between their child’s breastfeeding and sleep duration.

For those who love data, seeing numbers in black and white is very tempting. You can find patterns: one day the baby slept for 7 hours; why? Was it because they were fed for 23 minutes beforehand? Should I try feeding for 23 minutes again next time? Collecting data also has some rather tenuous justifications. It is easy to forget when the baby last fed, so recording feeding times can be helpful.

There are some excellent mobile apps that allow you to record which breast the baby last fed from. I know you might think, “How could I forget that?” Trust me, you won’t remember. I once pinned a safety pin on my T-shirt to remind myself which breast to use next, and I don’t recommend you follow my example; I accidentally poked myself many times.

When the baby’s weight is rising slowly, recording their feeding frequency and volume is useful (in more extreme cases, weighing the baby before and after each feeding). But most babies do not need this record. As the baby grows, recording their feeding times can help establish a regular schedule, but setting a feeding schedule in the first few weeks after birth is somewhat unrealistic. If you want to create some nice charts with data, go ahead, but understand that this is just an illusion of control.

Does Exposure to Bacteria Improve Immunity?#

In general, there is a theory called the “hygiene hypothesis,” which I will summarize: over time, the emergence of allergies and other conditions is due to insufficient exposure to bacteria during childhood. Increased exposure to bacteria in childhood can help improve their immune system’s ability to differentiate between viruses and not overreact to known viruses.

For this reason, many doctors will reasonably relax restrictions on children’s exposure to bacteria after infancy. However, almost all doctors recommend avoiding any exposure to germs during the first few months after the baby is born. One reason is that younger children are more susceptible to severe diseases; another reason is that very young children, especially those under 28 days old, require more aggressive treatment for diseases.

What does this mean? It means that if your 6-month-old child has a fever but appears to be fine, even if their temperature is high, the doctor may say it is a viral infection after examination, and they will still send you home with Tylenol (fever reducer) and water. In fact, unless you are extremely worried, many times doctors will say there is no need to bring the child to the hospital. In contrast, if your 2-week-old baby has a fever, even if their temperature is not high, you must take them to the hospital.

Doctors will conduct many tests on the baby, likely including a lumbar puncture, administering antibiotics, or hospitalization. When faced with very young infants, doctors find it difficult to distinguish between high-risk and low-risk fevers. Babies at this stage are more susceptible to bacterial infections, including very dangerous meningitis. About 3% to 20% of infants under one month old visit the doctor due to bacterial infections, most often urinary tract infections, which require prompt treatment.

The high-risk and difficult-to-diagnose factors make aggressive treatment seem reasonable, but most febrile children are actually fine.

For infants aged 28 days to two or three months, how to treat a fever becomes less clear. Some doctors may still perform a lumbar puncture as a routine, although there is less data supporting this, and it may not be beneficial.

The treatment process for children of this age or younger is quite different. Two key points are whether the child appears ill (this sounds absurd; of course, they are ill because they have a fever! But if you are a pediatrician, you will understand what this means) and whether they have had obvious exposure to a virus.

If you take your 45-day-old child, who has a low fever but appears to be fine, to the doctor while standing next to their 2-year-old sibling who has already caught a cold at preschool, their treatment will be different from if you brought in a lethargic sick child alone.

What does this have to do with children’s exposure to bacteria? Exposure to bacteria after birth, or more specifically, exposure to sick children, has a significant downside: it may trigger a series of treatment measures. If your child is indeed ill, these treatments are necessary, but if your child simply caught something from a 2-year-old with bacteria who touched them, many of these treatments may be unnecessary. Therefore, it is best to keep your child away from older children who may have germs as much as possible.

Once the child reaches over three months, especially after receiving their initial series of vaccinations, treating a fever is basically the same as treating older children: give them some Tylenol, plenty of water, and wait for the fever to subside. At this point, exposure to bacteria may only cause some discomfort for the child rather than leading to extensive and aggressive medical examinations and treatments.

◆ There is data indicating that swaddling can reduce crying in children and improve their sleep. It is important that babies can move their legs and bottoms while swaddled.
◆ Excessive crying in babies is referred to as “infant colic.” Colic is self-limiting, meaning it will resolve on its own. Data suggests that switching formulas, changing the mother’s diet, or giving the baby probiotics may help.
◆ Collecting data on your child is interesting! But it is not necessary and may not be useful.
◆ Early exposure to bacteria increases the risk of illness, and doctors tend to take more aggressive measures when treating a febrile infant, often performing lumbar punctures. Avoiding exposure to bacteria may be a good idea, even if just to avoid these treatments.

In the Delivery Room#

The baby is born, and the placenta is delivered. Whether through natural birth or cesarean section, if everything goes smoothly, the nurse will likely let you start holding your baby and encourage you to try breastfeeding. Meanwhile, the delivering doctor begins to stitch you up.

If you had a cesarean section, the doctor will stitch up the incision, which is a standard procedure that is fairly similar for all mothers; if you had a natural birth, it is a bit different. During natural delivery, mothers commonly experience tearing, with the most common area being between the vagina and anus, but it can also occur towards the clitoris. The extent of tearing varies from person to person; some mothers may not tear at all (most mothers will tear a little, especially during their first birth). If tearing occurs, it is classified into first to fourth degrees. First-degree tears are small and do not require stitches, healing on their own. Second-degree means it affects more of the perineal muscles, but the anal area is not involved. Third and fourth-degree tears involve the entire area between the perineum and anus, with the difference being the depth of the tear; a fourth-degree tear can reach the rectum. Third or fourth-degree tears must be stitched, and the stitches will gradually fade over the weeks.

Most tears are minor, but about 1% to 5% of mothers experience third or fourth-degree tears. More severe tears usually occur in assisted deliveries (i.e., when forceps or vacuum extraction are used). Data suggests that applying heat to the perineal area while pushing the baby out can reduce the likelihood of severe tearing. The stitching process may take a while, depending on the extent of the tearing.

If you had an epidural, you should not feel the pain of stitching at all; if you did not have an epidural, the doctor will usually use local anesthesia. Additionally, you will experience abdominal massage that lasts for several hours after the delivery. In the initial hours after giving birth, the uterus will contract back to its pre-pregnancy size. If the uterus does not contract, there is a high risk of hemorrhage. Massaging the uterus or pelvic floor can help with contraction and reduce the likelihood of bleeding. A strong nurse will periodically come over and press down hard on your abdomen, which can be very uncomfortable (calling it a massage is an insult to even the worst massage therapist).

Once you are moved to the recovery room, after your body has “healed,” you will begin the effort to return to normal (aside from having an additional child), of course, you are no longer the person you once were.

Continuous Bleeding#

Regardless of the delivery method, you will bleed a lot in the first few days. Before I gave birth to Penelope, I always thought that bleeding would only occur if something serious happened, but that is not the case (or even if nothing serious happens, you will still bleed). In fact, bleeding indicates that the uterine lining is beginning to shed. In the first couple of days after giving birth, this bleeding, especially with large clots, can be a bit frightening. You may discover a large clot of blood on the toilet or on your sheets when you sit down to urinate or get up from bed. Doctors will advise you to watch for clots the size of a fist or larger (some doctors will use fruit as a metaphor, like the size of a plum or a small orange). This means that not too big or too small clots are quite common. Passing these clots is painless but can be quite scary.

Hemorrhoids are another possible postpartum symptom that can cause a lot of bleeding. You can expect to bleed, but it is difficult to determine how much is too much; if you are unsure, ask your doctor. If you see a clot and wonder: is this about the size of a fist? Or is it not that big? Don’t try to estimate it yourself; call the nurse over.

After a few days, the bleeding will gradually decrease, but you will still continue to bleed, starting like a very heavy period and then tapering off over the following weeks. By the time you get home, the bleeding should continue to decrease over time. If you suddenly start bleeding heavily again and the blood is bright red, contact your doctor immediately.

Various Elimination Issues#

Many women will have a catheter inserted during delivery (a tube connected to the bladder for urination); if you had a cesarean section, you would definitely have one, and if you had an epidural, it is also likely you would have one. This tube will be removed within a few hours after giving birth, and you will need to regain the ability to urinate on your own. From now on, everyone’s experience will vary depending on your delivery situation.

If you had a natural birth, it may hurt to urinate. Even if your delivery was relatively straightforward, your vagina will still have some damage, and you will feel a sting while urinating. If you are dehydrated, the problem will be worse, as dehydration can lead to concentrated urine. Many hospitals will give you a bottle that allows you to spray water down there while urinating to dilute the urine, making it less painful. This thing works well; a professional tip is to definitely not use water that is too cold.

You may also experience pain while having a bowel movement, depending on your delivery process. A common practice is to give mothers stool softeners to help with their first postpartum bowel movement. You may not feel like having a bowel movement for several days after giving birth, and that’s okay. Perhaps the bowel movement won’t be as bad as you imagine. Regardless, you will need to have a bowel movement.

If you had a cesarean section, the situation will be a bit different. First, you may not be able to hold your urine until your bladder “wakes up” from the surgery, so you will need to have a catheter. Whether it hurts to urinate depends on the specifics of your labor and delivery. If you had a long labor, you may experience discomfort while urinating due to vaginal swelling, but this is less likely to happen with an elective cesarean section. After a cesarean, doctors usually want you to either have a bowel movement or pass gas before you are discharged to confirm that your intestines are functioning normally after a major abdominal surgery. This usually takes a few days, and you may also need to use some stool softeners to ease the process. Compared to the pain of vaginal delivery, having a bowel movement should not be too uncomfortable, but sitting down may cause pain at the abdominal incision.

The Mommy Belly That Won't Go Away#

A few days after giving birth, you can go home from the hospital. The excessive bleeding and extreme discomfort during your first urination will gradually improve, but at this point, you still won’t feel like you have returned to normal. First of all, you still look pregnant. This body shape will last for several days or longer, and then your skin will suddenly start to loosen, but eventually, everything will return to normal (eventually meaning weeks or months later, not days).

When you look down, you may still feel a bit worried because even if your skin is not loose, most of us mothers will find that we have developed a “mommy belly,” a lump of flesh on the stomach that seems to not go back. I can’t find any studies on this, but I can tell you for sure that no amount of Pilates training will get rid of it. (I do an hour of Pilates every week, and most of my Pilates instructor's clients are overweight middle-aged women!) If you had a natural birth, the most obvious issue is your vagina; the medical description is that after giving birth, the mother’s vagina will become very wide.

Many things are different after giving birth. You may have stitches from the doctor, and the entire vagina may hurt, feeling off in every way; this is not the vagina you are familiar with. Given time, these symptoms will heal. But most women cannot fully return to their pre-pregnancy state (not necessarily worse, but just different). Your vagina will not return to normal two weeks later; perhaps other parts of your body may feel normal by then (aside from the belly and huge breasts, plus your deep fatigue), but you may need more time for everything to return to normal. After all, you spent 40 weeks stretching your body, and it will be difficult to recover quickly.

If you had a cesarean section, you will face other issues. Depending on the surgical process, your vagina may have been minimally or not at all damaged. A friend of mine who had a cesarean section told me, “They didn’t touch my vagina at all.” But not everyone is so lucky; if you had been trying to give birth for a long time before the surgery, your recovery process will be similar to that of mothers who had natural births. Every planned or unplanned cesarean section is considered major abdominal surgery, meaning that any actions that may involve your abdominal muscles will be painful, including walking, climbing stairs, sitting down, lifting things, and turning over; basically, everything will hurt.

For example, if you are lying in bed at night and suddenly feel very thirsty, the pain medication has worn off, and you reach for water, it will be extremely painful. The pain will gradually improve over time, but generally speaking, women who have had cesarean sections take longer to feel normal compared to those who had natural births.

Regardless of the delivery method, having someone to help is always good, especially after a cesarean section. You will need someone to help you get up, assist you to the bathroom, and carry out daily activities. Even if you can take care of the baby yourself, someone still needs to take care of you. Depending on your recovery speed, it may be difficult for you to pick up the baby during the first few weeks after giving birth. If there were other complications during the cesarean section (or even during a natural birth), it may take several weeks before you can get out of bed to take a shower.

Natural births and cesarean sections have other similarities and common residual issues, such as hemorrhoids and urinary incontinence. Many women find that after giving birth, they leak urine when they laugh or cough, or even when they do nothing. Like other situations, leaking urine will gradually improve over time. Regardless of the delivery method, the recovery process for women varies from person to person.

I was relatively lucky; the day after I gave birth to Finn, I walked out of the hospital with his car seat, but that is not the norm. Even so, I could not immediately run a marathon or anything; your pelvic structure and a bit of luck determine how easy or difficult your childbirth experience is. Perhaps the most important thing is to have someone to help you when you need it and to not have unrealistic expectations of yourself.

In many countries, women do nothing for a month after giving birth, and older women in the family will take care of the new mother full-time. This is not common in the U.S., but at least we can understand what this period is generally like. It is not typical for a fitness-focused online influencer to return to exercising just 10 hours after giving birth.

Severe Postpartum Complications#

Some rare and severe complications may occur postpartum, including hemorrhage, dangerously high blood pressure, and postoperative infections. Risks vary from person to person; for example, postoperative infections are a common risk faced by women who have had cesarean sections. Your doctor will inform you of what to watch for based on your individual delivery situation. Here are some specific situations that mothers should be alert to:
● Fever
● Severe abdominal pain
● Increased bleeding, bright red in color
● Foul-smelling vaginal discharge
● Shortness of breath

Additionally, be aware of any changes in your vision, severe headaches, or persistent swelling in any body part (such as joints), especially if you have had a history of preeclampsia. It may be difficult to remember these warning signs in the fog of just having given birth, but if you feel something is wrong, please seek medical attention immediately.

When Can You Resume Exercise and Sexual Activity?#

When you are still struggling to turn over to get a drink of water, feeling exhausted every day while also caring for a crying baby, exercise and sexual activity may not seem like a priority. Before you had children, you may have exercised regularly and had an active sex life; now, as you work to regain your postpartum body, you also want to resume exercising and intimacy. Despite many obstacles, many of us still wonder when we can get back on the treadmill or resume sexual activity.

Regarding exercise, there is little research on when postpartum women can resume physical activity. The American College of Obstetricians and Gynecologists recommends that women can generally resume exercise within a few weeks after a normal vaginal delivery; this does not mean you should start exercising one week after giving birth, but you can take short walks.

They also remind you that if you had a cesarean section or experienced significant vaginal tearing during delivery, the situation is different. For cesarean mothers, the standard recommendation is to try walking within the first two weeks postpartum, introduce some abdominal crunch exercises or other related activities by the third week, and resume your regular exercise routine around the sixth week.

I want to reiterate that this varies from person to person; the aforementioned is just a rough estimate. If you had a natural birth and experienced tearing, under appropriate measures to ensure everything is normal, you may be able to return to exercise quickly. Almost everyone, including professional athletes, amateur athletes, and those of us who are used to walking or running for exercise, should be able to resume pre-pregnancy exercise around six weeks postpartum, and you can engage in some modified light exercises within six weeks after giving birth.

If you are a professional athlete, waiting these few weeks may feel like an eternity, and you can discuss with your doctor how to return to training as soon as possible given your current situation. In fact, for everyone except athletes, the body is often ready much earlier than the mind is. When you can start exercising, you will find that finding time to work out is another challenge, and you will need to overcome this difficulty and stick with it. Exercise can help prevent postpartum depression and improve your overall mood. I know your time may be filled with other things, but taking care of yourself is also important.

As for when you can resume sexual activity after giving birth, there is a common saying: couples should avoid sexual intercourse for six weeks after childbirth until the first postpartum check-up is complete. Because this saying has been cited many times, I always thought it was supported by data, and I even thought there was a biological theory explaining why a six-week wait is necessary. In fact, this saying is entirely fabricated. There are no established guidelines or standards for when to resume sexual activity after childbirth. The six-week waiting period seems to have originated from doctors themselves to prevent husbands from asking for sex, and this strange tradition has persisted.

When I went for my first postpartum check-up about six weeks after giving birth to Finn, the doctor (not my midwife, but the doctor on duty that day) told me I could resume sexual activity and asked if I needed her to write a note for my husband saying I wasn’t ready yet, which made me very uncomfortable.

The timing for resuming sexual activity after childbirth is not entirely without scientific guidance. From a physical perspective, if you have experienced tearing, it is best to wait until your perineum has healed before resuming sexual activity. Depending on the severity of the tearing, mild cases may not need six weeks to heal, while severe cases may take longer. The doctor will check your recovery during your first postpartum check-up (which is around six weeks postpartum), but you can also assess for yourself whether you have healed before seeing the doctor.

Additionally, you need to consider two points: first is contraception. Even if you are breastfeeding and just had a baby three weeks ago, you can still get pregnant. Most people do not want to have another child ten months later, so unless you want another child, you need to ensure you take contraceptive measures (be sure to think about which contraceptive method to use, as some birth control pills can interfere with breastfeeding). The second point to consider is whether you are psychologically ready for sexual activity, as the medical manuals suggest you should be prepared to resume sexual activity. Whether you want to resume sexual activity varies from woman to woman and depends on their partner’s situation; you must ensure that both you and your partner are ready before starting.

Giving birth is an unusual and significant physical challenge. Even if your delivery was easy, your body will still endure some pain during the first few weeks after giving birth. Additionally, by the third or fourth week postpartum, your family will also be exhausted. The baby needs to be fed every 2 to 3 hours, and the idea of having sex during the intervals between feeding, instead of taking the time to shower, sleep, or eat, sounds quite absurd.

Of course, this is just the general situation; it is undeniable that not only husbands but perhaps wives may also want to start having sex within a few weeks after giving birth. So if your body has recovered and you want to have sex, then go for it. In this case, looking at the data is not very useful; the key is whether you want it.

Most couples will resume sexual activity around the eighth week postpartum; those who had smooth natural births average around five weeks postpartum, while those who had cesarean sections average around six weeks. For those with severe tearing during natural births, it is around seven weeks. Nevertheless, data shows that it takes about a whole year for couples to return to their pre-pregnancy frequency of sexual activity, and many couples find it challenging to return to their pre-pregnancy frequency.

One last point: sexual activity after giving birth may be uncomfortable for you. Breastfeeding can cause vaginal dryness and decrease your libido. Additionally, injuries sustained during childbirth can have a lasting impact on the quality of sexual activity, and many women may not even want their husbands to touch them after giving birth. Most women need to use lubricants during postpartum sexual activity to alleviate vaginal dryness, so you may need to take it slow.

Many women continue to experience persistent pain and discomfort during intercourse long after giving birth; you should not ignore this situation or grit your teeth and tell yourself you just have to endure it for the rest of your life. These issues can be treated, such as through physical therapy. If sexual activity is painful for you, talk to your doctor. If you feel uncomfortable discussing this with your current doctor, find one who makes you feel more at ease.

Postpartum Depression, Anxiety, and Psychosis#

So far, we have mainly discussed the physical toll childbirth takes on women. However, varying degrees of postpartum depression, anxiety, and even postpartum psychosis are also quite common among women. I want to say to those women who are silently enduring all of this: it must stop.

In the first few days after the baby arrives, your hormones will experience rollercoaster-like changes, and many women find themselves becoming very sensitive during this stage. I remember when I took my one-week-old Penelope out for brunch at a friend’s house. I hid in the guest room for two hours, nursing the baby while crying. Even though nothing happened, I just couldn’t stop crying. Perhaps it was because I realized the hat I painstakingly knitted for Penelope was a bit too big, and by the time she could wear it, the weather would have started to warm up; just this little thing could make me cry for hours. I was so grateful that all my good friends were there; they brought brunch to my room, and their kindness made me cry even harder.

These early postpartum experiences are sometimes referred to as “postpartum blues.” Because a mother’s hormones peak in the days following childbirth but gradually stabilize over the weeks, this condition is self-limiting. However, true postpartum depression or other postpartum mental health issues can accumulate during this period, with symptoms potentially manifesting later, even months afterward.

Many women believe that depression appearing long after childbirth cannot be classified as postpartum depression because they think postpartum depression should occur immediately after giving birth, but that is not the case. Even focusing only on diagnosed cases of postpartum depression, this phenomenon is quite common. About 10% to 15% of women will experience postpartum depression, and most obstetricians have received professional training to monitor the emotional state of pregnant women. What we rarely hear is that about half of these women actually began to show signs of depression during pregnancy, which many find hard to believe.

Postpartum depression is usually (but not always) diagnosed within four months postpartum. The risk factors for postpartum depression mainly fall into two categories: personal history and environmental factors. The most significant risk factor is a mother’s history of depression or depressive tendencies. While we still have much to learn about mental health, it is clear that many genetic and behavioral factors can influence a person’s mental state. If you have experienced depression before, it is likely to recur during pregnancy or postpartum. You should be vigilant for signs and seek help immediately if you notice any.

Another contributing factor is the surrounding environment. Some environments can be adjusted, while others cannot. Women who lack social support, face financial difficulties postpartum, or have children with health issues or other problems are more likely to experience depression. The child itself can also lead to parental depression; parents of children who do not sleep well are more likely to be depressed, and this is almost certainly due to their lack of rest.

How is postpartum depression diagnosed? Ideally, every woman should be screened during their six-week postpartum check-up. Several widely used questionnaires are available in medicine, the most common being the Edinburgh Postnatal Depression Scale. This questionnaire is straightforward, with scores ranging from 0 to 3 for each question, with the worst-case scenario scoring 3 (the first option for most questions and the last options for questions 1, 2, and 4). Doctors typically use a score of 10 or 12 as a reference for mild depression; a score above 20 indicates severe depression.

Some questions in the questionnaire are so obvious that it is hard to imagine we need to specifically create a questionnaire to figure it out; can’t doctors just ask patients if they feel sad or lonely? But data shows that using this questionnaire is indeed very effective. Researchers have proven that using this questionnaire can improve the accuracy of postpartum depression screening, leading to better follow-up treatment; about 60% of women see a significant reduction in depressive symptoms after a few months of diagnosis and treatment.

Your doctor will give you this questionnaire, but you can also self-test to detect your emotional state early.

Treatment for postpartum depression is staged. For mild depression, the first focus of treatment is to avoid using any medications; some data suggests that increasing exercise or massage can help mothers, but more importantly, sleep is crucial. For new parents, lack of sleep is a major contributor to mild depression. This is not surprising; even without children, if you haven’t slept well for several nights in a row, you will lose interest in everything, and you will definitely experience emotional breakdowns.

Although mothers are at a higher risk of experiencing these harmful mental health symptoms due to the dual pressures of hormonal changes and caring for the baby, postpartum depression can also occur in those who have not given birth, such as fathers, grandmothers, grandfathers, and adoptive parents. Because the questionnaires usually focus more on mothers than on others in the household, the symptoms of these individuals are often overlooked. In the weeks following the birth of a child, it is best for everyone in the household to undergo a depression assessment, and family members can also be screened regularly. If you are concerned about your own or a family member’s situation, call your doctor immediately; do not wait until the sixth week. The sooner you resolve these issues, the sooner you can enjoy happy moments with your child, which is beneficial for everyone.

Postpartum mental health is just as important as physical health. You just had a baby; shouldn’t you feel very happy? When people come to visit you and ask how you are feeling, everyone wants to hear “The baby is great, and we are all so happy,” rather than “I am very depressed and anxious, and I have a third-degree vaginal tear.” Because these issues are rarely discussed openly, it seems that we are the only ones experiencing pain, and we should suppress these emotions. That is not the case; I believe that open communication can help women who have such experiences. It is not to say that we should tweet about our vaginal recovery process (though I have no objection to that), but I think we should openly discuss the physical and mental changes and feelings women experience postpartum.

◆ Postpartum recovery time.
○ You will bleed continuously for several weeks.
○ You will have vaginal tearing that takes several weeks to heal.
○ A cesarean section is a major abdominal surgery that takes a long time to recover from.
◆ When you can resume exercise postpartum depends on your delivery process, but generally, you can start within a week or two after giving birth; most women can resume pre-pregnancy exercise routines around six weeks postpartum.
◆ There is no established standard for when to resume sexual activity postpartum, but you should wait until you are fully ready (if you do not want to get pregnant, remember to use contraception).
◆ Postpartum depression (and other related postpartum mental symptoms) is common and treatable; do not delay seeking help.

The First Year After the Baby is Born#

Breastfeeding, sleep training, co-sleeping, vaccinations, whether mom should return to work or be a stay-at-home mom, finding daycare or hiring a nanny—these significant issues will determine what your first year as a parent will be like. If you were not a parent, you would never think about these things, and there are no standard answers.

Because the choices you make will affect your life as a parent. Whether to breastfeed, whether to let the baby sleep in your room (or bed), whether to do sleep training—these are all situations you will face daily. Many of these things will make your journey into motherhood exceptionally frustrating and challenging.

Breastfeeding brings many warm moments, but none of the hundreds of breastfeeding mothers I have spoken to have ever said, “Having to carry a pump everywhere makes me feel incredibly accomplished as a mother.” Feeding a baby four times a night before they turn one (maybe one and a half, maybe two and a half) is exhausting; it can affect your mood, work, and social relationships. But not breastfeeding or letting your child cry to sleep makes you feel guilty and uneasy. Others will point fingers at your choices, and to be honest, you will criticize yourself as well. Letting the baby cry to sleep does work; most babies will gradually sleep better, and parents will sleep better too. But are you sacrificing the child’s interests for your own selfish reasons?

As with anything in the parenting process, there is no perfect predetermined choice that works for everyone. Consider your preferences and limitations first, then make a choice that suits you. If you took six months off and do not plan to return to work, sacrificing your nighttime sleep to take a nap during the day will be easier; compared to those who have to stop working at any moment to pump milk according to a scheduled appointment in a small room (hopefully not in the bathroom), if your office has an opaque door that allows you to pump while working, you will be more willing to continue breastfeeding for a longer time.

Breastfeeding#

The benefits of breastfeeding in the U.S. or other developed countries are well-known, but formula is also very safe in these countries, made with pure and uncontaminated water sources; however, in some developing countries, the benefits of breastfeeding are more significant and meaningful because there are no pure water sources to make formula. The list is long, and I will categorize them into several parts:

Table 4-1 Various Benefits of Breastfeeding (Part One)#

You will notice that one of the benefits is enhancing friendships. Is this serious? I admit that new mothers can feel very lonely and isolated, and meeting and chatting with other mothers can be very beneficial, which is why there are social activities like mothers doing yoga together while pushing strollers. But I really can’t figure out which part of my friendships was enhanced by trying to feed a screaming baby in a hot closet. Indeed, I can’t find any peer-reviewed reliable data to prove that breastfeeding enhances friendships.

Because mothers who choose to breastfeed are different from those who do not, most studies on breastfeeding are biased. In the U.S. and most developed countries, women with higher education or wealth are more likely to choose breastfeeding.

But it hasn’t always been this way. Over the past century, the popularity of breastfeeding has fluctuated. In the early 20th century, almost all women who were physically able chose to breastfeed, but by the 1930s, the invention of modern formula led to a sharp decline in the number of breastfeeding mothers. Considering the difficulties of breastfeeding, this trend is understandable. By the 1970s, most women were using formula, but it was also during this time that public health began to promote the benefits of breastfeeding to counter the trend of formula use. In response, formula manufacturers also began to encourage breastfeeding, and since then, the breastfeeding rate has started to rise again, with the fastest increase among highly educated and wealthier mothers.

The relationship between breastfeeding and education level, income, and other variables is a research challenge. Even without considering breastfeeding, a mother’s education level and available educational resources are linked to her child’s performance, making it difficult to deduce that breastfeeding benefits children.

Breastfeeding and Sudden Infant Death Syndrome#

When discussing breastfeeding, it is hard not to mention its relationship with Sudden Infant Death Syndrome (SIDS). SIDS refers to the unexpected death of an infant in their crib, and it is a very sad topic. Although the relationship between breastfeeding and SIDS has been widely studied, it is difficult to clarify.

Infant death is one of the most heartbreaking things for parents.

We will discuss many heavy topics here, but none can compare to the death of an infant. Even if there is a slight connection between breastfeeding and infant death, such research can provide emotional comfort.

SIDS is rare; otitis media and colds are common, and regardless of whether you breastfeed, your child will certainly catch a cold. In contrast, SIDS occurs in about 1 in every 1,800 children, while among those without other risk factors (such as prematurity or sleeping on their stomach), it may occur in only 1 in every 10,000.

Benefits of Breastfeeding for Mothers#

For some women, breastfeeding makes them feel more empowered and happier. Being able to provide food for the baby anytime and anywhere is very convenient, and they feel relaxed and warm while nursing. For other women, breastfeeding makes them feel like a dairy cow; they hate having to carry pumping equipment everywhere, and it is even harder to tell if the baby likes breastfeeding or if they are full. Their nipples may be painful from nursing, and the experience of breastfeeding can be terrible.

All of this tells us that the claims that breastfeeding benefits mothers are very subjective. I felt that breastfeeding had its pros and cons for me, and most of my friends felt similarly.

Of course, there are moments when I feel that breastfeeding is an incredibly convenient choice, especially when I gave birth to Finn; there are also times, like when I was pumping in the bathroom at LaGuardia Airport, when I felt that breastfeeding was an absurd farce.

One point that everyone who supports breastfeeding will mention is that it saves money, but this really depends on many factors. Yes, formula is expensive, but the clothes needed for breastfeeding, nipple creams, breast pads, and the 14 different nursing pillows bought to make nursing easier can also be quite costly, and more importantly, your time is valuable.

Another claimed benefit of breastfeeding is stress relief. Does breastfeeding enhance mothers’ stress resilience? This is also a very subjective claim. Stress is often associated with sleep disturbances; if you choose to breastfeed, can you sleep a little longer? This depends more on other factors besides breastfeeding. As I mentioned earlier, enhancing friendships is another widely promoted benefit of breastfeeding. You need to carefully consider whether breastfeeding strengthens your friendships (this may depend more on your friends).

These are just completely unsupported claims about the benefits of breastfeeding; other claimed benefits of breastfeeding do have potential factual foundations. The first is that breastfeeding is a free contraceptive method. The fact is that you are unlikely to get pregnant while breastfeeding, but I must emphasize again that this is not a completely reliable contraceptive method, especially as your child grows and you can go several hours without needing to nurse or pump. I don’t want to list all the people I know who got pregnant while breastfeeding (for example, my medical editor Adam and his wife’s second child came about this way); if you do not want to get pregnant again, you must take some solid contraceptive measures.

The second evidence-supported benefit of breastfeeding is weight loss. I regret to inform you that even in the most optimistic view, the help breastfeeding provides for weight loss is minimal. A large study in North Carolina found that at three months postpartum, the weight loss of breastfeeding and non-breastfeeding mothers was quite similar; by six months postpartum, breastfeeding mothers lost at least 0.6 kg more.

The issues with this study suggest that the conclusion likely exaggerates the effects of breastfeeding on weight loss, but in any case, this weight change is quite small.

You might be thinking, doesn’t breastfeeding burn calories? I have heard that breastfeeding can burn 500 calories a day! It can, but breastfeeding women also tend to eat more. Only if you do not eat back the calories will burning calories be an effective weight loss method. When I was breastfeeding, I set a rule for myself to eat an egg and a cream cheese bagel sandwich every morning at 10:30, which basically ensured that I was eating back the calories burned from breastfeeding.

The evidence regarding breastfeeding preventing postpartum depression is also not very convincing. The research results on the relationship between the two are inconsistent, and considering that the causal relationship can be bidirectional, it is difficult for us to assess how they relate to each other. Mothers with postpartum depression are more likely to stop breastfeeding; it sounds like breastfeeding alleviates postpartum depression, but it may actually be the opposite.

Table 4-2 Various Benefits of Breastfeeding (Part Two)#

I am a loyal follower of Dr. Spock’s book “The Common Sense Book of Baby and Child Care.” This book was first published in the 1940s and has been regularly reprinted since then; I have a version that was published in the mid-1980s.

◆ Although there is less evidence than commonly claimed, breastfeeding does have some benefits for the early health of children.
◆ Breastfeeding may benefit women’s physical health (for example, preventing breast cancer).
◆ There is no evidence supporting the claim that breastfeeding has long-term benefits for children’s health and cognition.

The Breastfeeding Manual#

I remember the first few weeks of breastfeeding Penelope were incredibly frustrating. I felt like I encountered every possible problem with breastfeeding, such as incorrect latch and low milk supply. I was constantly nursing her, but still needed to give her a large bottle of formula every night. Watching her gulp down the formula seemed like a criticism of my meager milk supply (perhaps that was just my imagination).

Then there was the issue of pumping: when to pump? How often to pump? When to start? How do I relax and pump when I go back to work? Can I pump during a conference call? Is it enough to just mute the call?

It felt like I was the only one in the world facing these issues; trying to breastfeed in the first few days after giving birth was incredibly challenging. Those moments when new mothers and their newborns are in the same room, desperately trying to nurse, can feel very lonely and hopeless. If you see another mother calmly nursing her baby while shopping at the farmer’s market, effortlessly holding a bag of corn in one hand and pulling her 3-year-old away from the cookie stand with the other, you might feel like you are the only failing mother in the universe.

No, you are not.

Some mothers experience excruciating pain from breastfeeding, with cracked and bleeding nipples. One mother even had a particularly gruesome experience: part of her nipple fell off from breastfeeding.

They complain about their low milk supply, so one mother had her husband take a half-hour bus ride to buy lactation tea bags immediately. They keep nursing the baby, hoping to increase their milk supply, and after each feeding, they immediately pump 12 times. What about the mothers with an oversupply? Their milk leaks everywhere, and the mattress soaked in breast milk smells like Parmigiano cheese, while their clothes become stiff from the splattered milk. One mother told me that she usually has low milk supply, but every time she hears her baby cry on the bus, her milk just sprays everywhere.

How to Increase the Success Rate of Breastfeeding#

If you are struggling with breastfeeding like many women, you have likely heard many different coping strategies and methods. Some methods sound reasonable, while others are not reliable. What does the data say? Research on the reasons for successful breastfeeding can be broadly categorized into two types. Some studies focus on very specific issues, such as whether nipple shields are useful or whether eating fenugreek (an herbal remedy) can increase milk supply. Others address more common research questions, such as whether there are any methods to help with successful breastfeeding before delivery.

If you plan to breastfeed, the first challenge you will face is the baby’s latch. For a baby to successfully extract milk from the breast, they need to open their mouth wide enough to take in the entire nipple, then suckle with their tongue and lips. Contrary to what I imagined, babies do not carefully suck from the tip of the nipple; as my friend simply put it, “You need to press the baby’s head completely against your breast.” Although you don’t have to literally do this, Figure 5-1 illustrates that the baby really needs to take the entire nipple into their mouth. I think it is hard to imagine this process unless you have personally experienced how a baby nurses.

Many babies struggle with latching; if they do not latch properly, they will not get enough milk, which can be very painful for the mother. How do you know if the baby is doing it right? You will know after nursing for a while. You also need to recognize some strange signals that may occur once the baby is doing it correctly. It is said online that if the baby latches correctly, you should not feel pain while nursing. This is indeed the case afterward, but it is not true at the beginning of breastfeeding.

For many mothers, regardless of whether the baby is latching correctly, the first few weeks of breastfeeding are painful, so you cannot solely rely on whether you feel pain to judge. Why might a baby have difficulty latching? Prematurity, illness, or injury at birth can all be reasons. It may also be an issue with the mother’s nipples; some mothers have inverted nipples, making latching more difficult. Lastly, some babies may have oral structural issues, such as a condition called tongue-tie, which makes latching difficult. Or maybe your baby just hates you! Haha, I’m joking. But it can certainly feel that way.

One solution is to keep trying and seek help. This is where lactation consultants or others who can assist you come in; most mothers learn to latch after some effort, so be patient with yourself. If the baby has persistent latching issues, there are two common interventions you can try: one is for the mother to use a nipple shield, and the other is surgical treatment for the baby’s tongue-tie.

Many mothers find nipple shields very helpful, especially at the beginning. The name of this device basically describes what it is: it looks like a nipple, usually made of silicone, with a small hole in the middle. You place it over your nipple and let the baby suck. Theoretically, this helps the baby latch successfully and reduces the mother’s pain. Aside from being difficult to clean, one major downside of nipple shields is that they can affect milk supply.

The question of whether nipple shields can help the baby latch correctly is currently more about ensuring the baby latches properly rather than increasing the mother’s milk supply. Unfortunately, there is not much research to prove whether using nipple shields results in the baby drinking more milk compared to babies whose mothers do not use them; one study found that babies whose mothers used nipple shields drank four times more milk, which is an encouraging finding.

One disadvantage of using a nipple shield is that once you start using it, it can be hard to wean off. If you and the baby become accustomed to it, stopping its use can be challenging. If you think it’s okay and the baby is still getting enough milk, that’s fine, but using a nipple shield does add an extra step to nursing. Therefore, it is best not to use it right away; consider it only when breastfeeding is not going smoothly.

Another common intervention is to surgically address the baby’s tongue-tie issue. This only applies if your baby indeed has a tongue-tie. The tongue in our mouths is connected to the lower jaw by a small band of tissue; some people have a shorter band, making tongue movement difficult. Since nursing requires flexible use of the tongue, if a baby has this condition, it will affect breastfeeding.

Tongue-tie is relatively common among babies, and if severe, it can impact their language development later on. Lip-tie is