Questions about Breastfeeding at our House

Q: Do your older boys make fun of your youngest son for continuing to breastfeed.

A: Absolutely not! Extended breastfeeding is the norm for my boys. Although I don't know anyone in real life who admits to breastfeeding a single child as long as mine go, my boys know that many of my friends nursed their friends 3 or 4 years. My older boys also see that breastfeeding is calming for their brother. There is also secondary gains for the older boys; it sometimes works to get their baby brother out of their way. :)

Q: Do you still produce milk?

A: I get mixed and very unreliable answers from David when I ask how much he gets. I can't express a drop. I suspect he isn't getting much if any. Yet, he continues to request to nurse. Several mothers of (young ) toddlers have concluded that it's time to wean because they don't produce milk anymore. I recently thought of an analogy; Kids still want Capri Sun even though not much is in that pouch. There's definitely more to both than just abundant liquid. Nursing meets other needs.

Q: Does David show any signs of weaning completely?

A: One night his really cool teenage babysitter stayed with him overnight when I went out-of-town. David shared that Nate was better than having night-nights.

I see Scott, nurturing his dog in AP style. We often talk about caring for a dog like we are taking care of a baby. That dog is worn out at the end of the day after the boys run him around and take turns playing. Last night Max got right into bed at 9:00. He's always quiet at night. I asked Scott if he liked having a baby that sleeps through the night rather than being real needy. I love Scott's answer:

As long as my dogs happy, it wouldn't matter how he sleeps at night.

The Direction of Medicine

Back when I was in high school, my mother envisioned for me a future in health care, with babies, and she was right. Not only did I wholeheartedly want to pursue medicine and be with babies, but as a plus, everyone, I mean EVERYONE, told me as a physician you can hang a shingle anywhere and have employment "because people will always get sick and need you." There is nothing like knowing job security exists in your chosen field. My mother added that once you have a degree no one can ever take it away.

At the time I worked in a small one hundred-something bed hospital. I could see the nurse’s station, nursery, postpartum and labor unit all from one place (well, almost). The general practitioner (not a Board Certified Family Physician), relied on his experience and was still birthing babies. He took care of his babies, he was still doing non-obstetric abdominal surgery, and he cared for his own floor and ICU patient, also. Now, those responsibilities are clearly divided among Family Practice, OB, Pediatrics, Neonatology, Surgeon, Internal Medicine, and Hospitalist. He was also Chief of the Medical Staff. This was only 25 years ago. The nursery supervisor was an LPN and the OB supervisor was also an LPN. I adored both for the opportunity they gave me for meaningful high school employment. I actually remember when they brought in new RN BSN's to replace their positions that my mentors held. This was big change going from experienced pioneers to recruiting academic types from the outside. It didn't seem fair that this replacement was occurring. Likewise, the GP recently gave up his cesarean privileges to the new OB's in town. I suppose accreditation organizations and insurance now required these new credentials. That was just the beginning of changes I’d witness.

To practice medicine privately, I studied 12 years in school, left 8 year hospital employment realizing I could never offer individualized care being employed, moved out-of-state to avoid non-compete, moved back, opened up a business, avoid influence by avoiding hospital affiliation and AMA membership, had my own babies, leave my babies to go to work, give up family time. I don't mean just my kids. Many times I tell my mom, sister, and in-law's I can't be there. I take my own telephone calls after hours. I’ve passed an intense Family Practice Board Exam three times. I maintain my IBCLC credentials which involves a separate set of testing and education. You wonder why more pediatricians and OB’s don’t get "birth" and "breastfeeding." We have much bigger problems. I love providing flexible care. But I seriously wonder is it worth practicing anymore? Can I provide individualized patient care as the conditions become more crippling? Honestly, I think my own family needs me recognizing my limitations more than me fighting a loosing battle. I think about staying home. Since I don’t see any benefit from working as a government employee, I am thinking about it even more. I know I could not offer the services I do now if I worked for the government. I couldn’t as a hospital employee.

The biggest area of flexibility my patients enjoy is our office's vaccination policies. Vaccination for school is mandated by the government. I get confused when those in my practice most adamantly opposed to mandatory vaccinations want to push for a 1900 page document written by the government controlling healthcare.

As wonderful as many think the Canadian system is, my current mentor Jack Newman in Toronto receives no funding. He solicits donations from his website to keep his breastfeeding medicine practice open. He gets no public funding and he is the world renown expert in breastfeeding medicine. What’s to happen to my little part-time practice under the forthcoming conditions? The new bill would not accommodate me soliciting donations to keep a clinic open. I couldn't compete and survive privately. I also happen to think the Canadian system and our system have actually benefitted from our differences. Theoretically becoming a like may not be beneficial.

It's my husband's part of the practice that holds us financially together and it’s because he is working super long hours with face-to-face patient care. (I guess I am lucky, I don’t have to work. :) ) I am not sure I would want us working here (in the USA) anymore if we have more "change." For the first time I find myself wondering where we can go ... like maybe to his family's apartment in Peru. (He says there is lots of whole organic food there!) I tell you it’s tempting. Right now, I really feel like very little is holding me here despite the huge thoughtful investment of time and energy I have put into getting where I am at. Once I was so full of hope. Well, I still am hopeful and ambitious, but I am really wondering if I need a new plan—- out of the country. And yes, we are remodeling, and I should feel very excited about finally having a house we’ve worked hard for, but anticipating the exponential rate at which government is taking over health care really sours me. I am not in the America that I learned about in high school.

Yes, we need reform. I agree.

We need obstetric reform big time. The health care bill offers no solution for the current obstetrical /VBAC issues. Tort (legal) reform would solve the problems of the defensive practice of medicine. Tort reform is a necessary part of a successful turn-around in medicine, but is not anywhere in sight. I know many people in America think that socialized medicine in America would lead to midwifery programs like in Canada or Europe. Reform is not offering that. In fact with the potential of cap and trade combined with nationalization of medicine, it will be increasingly very difficult to run a business. I don’t see how small birth businesses will survive.

We need insurance reform. There are several models posted on the internet. The health care bill is not the only model. Here is one of resource which makes individuals and families the key decision makers in their healthcare.

We also need social reform. That is where patients take responsibility for their health. Most disease is self-inflicted. We can prevent a lot of medical expense with nutritional, fitness, and tobacco (and sexual behavior) reforms. This is not addressed at all in the current bill. You’ve heard me say it before on this blog, book, and face-to-face and here it is again. Social reform won't occur now because the food and pharmaceutical lobby is very powerful in D.C.

I know this rant sounds all about me and my goals and my sacrifice. I had a Human Gold patient ask me, if I thought his insurance will be affected by all this? He thinks Humana Gold will not be affected? Seriously? Say somehow Humana Gold is not, but my practice definitely is. I am in a different place this year than last year when anticipating expansion opening a new office ... adding a nurse practitioner, and Dr. Coquelet Senior. We go into this new year tightnening our resources. This particular patient's care (and yours) will ultimately be interrupted. So called national health care bill affects us all. We have the right to question the 1900 page document.

Faceless Chainsaw Zombies

What I liked about this evening is how much my boys have been looking forward to being cast in Heathcote Botanical Gardens haunted gardens. Remember, my boys, particularly my oldest, likes nothing to interfere with his Xbox and food, so wanting to do something involving some creativity and getting out is a very welcome change. They recruited a friend to come along. Little David wanted to look just like the big boys with a dark cloak. Scott told David he was too small that he would never scare anyone. He actually did really good with young visitors because the big boys were almost overwhelming to young guests.

They tried some acting in the forest.

But where they finally ended up spending most time was in the graveyard (which had no cast members scheduled). They seem to fit right in and personally, I think, was the highlight of event.

William's 2nd Semester Essay: Chaos at Dinner

This is the last of the essays. It's funny and unfortunately it's mostly true. Which one of William's papers did you like the most?

Chaos at Dinner

by William Coquelet

Dinnertime in my house is full of chaos. Let me explain to you what happens at dinnertime. ‘A note to the wise’ this isn’t pretty. The kitchen is usually a mess. My brother, David, is usually screaming because he wants to watch T.V. and also everyone hates my mom’s cooking.

The kitchen is usually a mess so my mom cannot find a pot, or a pan. As the oldest boy in the house it’s my job to unload the dishwasher but I procrastinate and my mom gets mad. The sink is usually stacked full of dirty dishes by the time I get to the dishwasher. My mom first has to clean the kitchen when she comes home from work in order to have space to make dinner and find the pots and pans.

David, my 6 year old brother, is always screaming before dinner because he wants to finish watching his T.V. show. My mom hates when he misses out on dinner and he wants to watch something stupid like Icarly instead. Besides, David is always full because he eats snacks throughout the entire day. He has such a big temper when he is hungry that we can’t hold him off. When we have to turn off the loud T.V and drag him to the kitchen he starts to scream and knocks things down. My mom wants a master remote control to turn off all the TV’s and computer at mealtime so there will be peace.

Usually when my mom cooks everyone hates what she is cooking. She likes to cook organic vegetables and things like Quinoa. It smells horrid. My Dad demands meat in all his dinners otherwise he thinks it isn’t a meal. When he was a kid there was huge dinners with meat and whatever was served with it. That’s how he was raised and he’s not going to change. She switches small details in Grandma’s recipes that ruin the entire dish. She tries to make the classic recipes healthy. There’s a dish called “Chinese rice” and it’s awesome it has brown rice, eggs, turkey meat, and soy sauce. It makes my mouth water. A month later my mom ruins the recipe by adding small crunchy carrots and disgusting onions. I hope she never changes my grandma’s yummy empanada recipe.

So when the kitchen is a mess, my brother is screaming, and the cooking is nasty, every one may seem to hate each other. But there is one thing everyone agrees on. Hey! Let’s eat out!

The only thing not true is my agreement to go out and eat, but you get the drift. I also was thinking how chaotic the evening is because we have karate or Hebrew in the evening. We are coming and going at the same time.

William's Bio about ME

A Biography of my Mom

By William Coquelet

My mom, Denise Lynne Punger, was born in Queens, New York, XXXXX X, 19XX.

She’s lived in different states like Long Island, New York, all over Georgia, and Florida. She’s a New Yorker and still has that accent.

She has traveled to many Eastern states, the Islands, Washington, Vancouver, and Alaska.

She married my Dad on October 15, 1994. They had a double wedding at my Grandma’s house with her sister, my Aunt. My mom and dad met in medical school.

She became a doctor so she can teach people about babies. She also likes writing about her experiences. She authored a book, Permission to Mother. In her book she wrote about me and my brothers when we were babies. She likes to write about our births so other women can have better births. She compares the births of me and my brothers to what she was taught in medical school.

I hear my birth story a lot but it’s really my third brother’s birth that was amazing. She planned a homebirth. I was six. One of my jobs was to tell her what color the baby’s hair was when I could see the head. Well, I saw toes. “It’s toes!” I said innocently. My dad flipped out when he saw the toes. But my mother’s midwife acted like everything was normal and my brother was born just fine except he had a lump on his head. It went away on its own and he’s just a cute brat now. My other job was to take pictures and I took a picture of what I saw and it’s my mother’s favorite birth photo. I took better photos than my dad and her friends that were there. My mother also likes taking photos and taught me a lot about her camera.

My mother, already questioning the whole educational system, really questioned it after my brother’s birth. This might explain why she started homeschooling us. She takes me and my brother to the same karate and Hebrew school, but at home we are in different books and different curriculums. She never expected how differently each of us learns. I like computer stuff and virtual school. My 11 year old brother is dyslexic and she taught him to read and do math a totally different way. She wonders how you could put all kids in the same school system and expect them to be equal learners. She says I’d probably do okay in any learning system, but is convinced that my brothers would not adjust. She is very happy that there is virtual school. My mother also likes computer stuff. She also has a blog as the same title of the book.

She is inspired by her patients. She writes in her book about some unique lessons her patients teach her. In the book the stories are all related to birth and breastfeeding. Now that we are older she writes more about teaching us. She also is trying to feed us healthy. She tries to make us eat organic vegetables and salads. I prefer barbeque pork and chicken. Her next book will probably about older kids.

Even though she has a career she says that being my mom is best of all.

Special Time with David

Last night William and Scott both went to a sleep over birthday party. This was Scott's first time. He was pretty worried about missing Max. Scott said good bye to me, Max, and David. Scott of course, did fine, but I can tell Max really missed Scott being around. William goes right int his friends house. No good bye.

David was the only child last night. He did pretty good also. I took him and Max to the pumkin patch. David had a great time running around, picking out a pumkin and finding the right place for it on our porch. Then we took the old baby seat off my bike and attached the tandem bike, so David could ride right behind me. We went for a bike ride looking at decorated houses and to the playground.

David had fun helping me clip back some bushes and jumping in the pool.

David wanted to do a lesson like Scott does. I pulled out the first set of tile letters in Barton and with much repetition and Barton approach, David learned the sound that these letters make. yeah! he even sounded out S.A.T. We read a few books. He likes the book, Old MacDonald had a Farm.

David has been wanting to sleep right next to Max and he did last night.

Morning came fast and we went to pick up his brothers. Everyone missed each other and it was a quiet day. David was excited to show his brothers what he did. William missed his computer and Xbox games the most.

I also wanted to add that before the sleep over the boys and Max, went to the Mutt March sponsored byt the Humane Society. This was the boys first "walk-a-thon" type activity. They loved getting to see all kinds of dogs in real life.

William's Haiku

Xbox is like joy,
I like to play all night long,
My friends come over.

I was surprised to see him change topics!


Batman’s vehicle
Not an ordinary car
The swift Batmobile.

Here is an excerpt from his speech he presented to our family and than read to his teacher over the phone.

Let me tell you a story. For as long as I can remember I’ve always wanted a dog, since I was about five or six maybe. I would always ask my mom for a dog. She always said no and she said “If a dog comes in this house I’ll move out.”

I thought this was strange. My mom grew up around dogs in her family all the time. So did my dad. They both had dogs throughout their child hood. I just didn’t understand why my parents wouldn’t let me get a dog. It didn’t make sense. Now just about two months ago my brother asks for a dog. I was hoping my mom was going to say no to my brother. Luckily enough for my brother he got my mom to say yes. I was extremely mad. Not only because my brother is getting a dog. But because I’ve wanted a dog almost half my life and the first time he ever asks for a dog he got a yes from my mom.

William's Huge Allowance Essay

William was assigned a topic to write an expository essay... Notice how food and gaming is always on his mind.


My Huge Allowance

I have huge dreams for when I get a bigger allowance. My plans include adding a whole addition to our house and putting TV’s, Xbox’s, and surround sound in to the new room. I would decorate my room with a bunch of Halo and Call of Duty posters. This would be awesome if I ever get the chance to get a bigger allowance.

First, if I had a bigger allowance I would add an extra room in my house. To get in the room you would have to go through my bedroom. Then you would enter through a private door, and that would be the gaming room. But of course I would have a password so only my friends could get in and I could keep baby brothers out. On the other side of the gaming room there would be a secret slot in the wall like a bar and my mom could serve us food and refreshments.

The second thing I would do with all my allowance is buy four, fifty inch TV’s which would be the best quality TV’s for playing video games on. They would also be high definition. I would also buy four Xbox’s so I can have “all-nighter” Xbox parties.

The third thing I would do with my big allowance would be to buy a surround sound speaker system, like Bose or Digital Dolby. I would also buy a ton of Halo and Call of Duty posters to cover the walls. I would try to buy as my friends would say, “the most ‘epic’ posters ever”.

If only I had a bigger allowance and could afford all this stuff! I could actually have these ‘epic’ “all-nighter” Xbox parties. I’ll even host a gaming tournament in that room or a surprise birthday party for a friend, or something like that. My mom would make us a bunch of cookies and sweets. We could even order chicken wings. YUM! Oh, but of course I’ll do my daily Language Arts lessons before going to the game room!

William Coquelet

William's Writing (My Intro)

William is almost done with his 7th grade Language Arts class. I am going to share a sample of a few of his best writings. This was the introduction he wrote for class at the beginning.

My name is William Coquelet. I am an American child with some Peruvian ancestors.

It all started on September 18, 1996. I was a very cute baby boy. I immediately started into gaming and computers as a baby. I lived in Palm City in the community of Monarch in Florida. After a while of playing and growing my Mom and Dad told me we were moving to Georgia. I met a few good friends there. Then one day we found a school of Martial Arts and I had a test run there and I loved it! It was one of the best things about Georgia.

My Mom and Dad once again told me we were moving and I had to quit my Tai Kwon Do classes. I was very sad about the class, but we were moving back to Florida! It took a while, but we finally found a small house and we moved in.

The house was nice, but then things started to get a little messy. After a while my Mom said she found a new Martial Arts class and it was right in our community. My Mom got mad when I said that I didn’t want to do more Martial Arts. But she “enrolled” me and my brothers regardless. I’ve been in this class three years. I am almost a Black Belt.

So now it’s time to look for another house. This time it took two and a half years to find a house. In the house we are getting a dog and we can dock our boat in the river in the backyard. So we finally buy it and about a month later I start Language Arts 7th grade class. So then my teacher Karen Hoenstine asks me to write a biography about myself. So here I am!

Diary of a Wimpy Kid, Dog Days

Great News! Scott is READING the newly published, Wimpy Kid book. This will be his first chapter book he's read. He is reading it out loud (to Max) in a quiet mutter. Scott is reading at a nice comprehensible pace. I am totally enjoying hearing him read and hearing him laugh at the funny parts. I see him improving each night as he gets further along into it. It took to being midway in Level 6 BartonReading to have enough reading vocabulary to have the ability to read an ordinary book for kids his age.

Scott is also doing Math U See, Beta level. Although he could add and subtract (and multiply) in his head, he has never put it on paper before. So for the visual part of math (and his confidence), I chose to start him off at this level. He is doing excellent. He has a strong foundation now in both math, reading and spelling. Last year he could not read the directions on any work sheets, let alone do the math problem. When he started doing the Math U See sheets, he asked, if Math U See and BartonReading were a conspiracy working together to form a curriculum. ((No, I told him, its just called language :) !)) He reads all the directions and word problems himself.

Scott is so curious, fortunately he is able to pursue his curiosity now and teaches himself by watching documentaries, asking everybody questions, and the Internet. He browses non-fiction books, too.

William is moving a long in his Language Arts class. Since all the reading, spelling, and language arts both boys are doing doesn't leave me much of my own creative time, I may post some of William's best writings.

Both boys are still in Tuesday night Hebrew school to keep them involved and Karate. Karate is no longer being offered in my neighborhood. Now, I have to drive them across town to their instructors other class. In the long run, we were going to transfer to that program anyways. The class is longer and more intense.

David is on a Math roll right now, so I am going to go with that while the force is strong. I don't see much progress in reading, but he likes his Scratch and Sketch books and activity books. He doesn't let me read out loud to him much. He also likes Tic Tac Toe and Connect Four.

The boys are all enjoying Max.

Before and Not-quite-after Photos

Today, I finally feel like showing some photos of our remodeling project. We've never lived in this house. I've been taking lots of photos. Here is just a few. This WAS the wall unit in the biggest room of the house when we purchased it. Nice if you like Austin Power's stuff. There was a lot of eccentric shiny stuff. I was pretty excited to see what this unit taken apart and see what the room

would look like without the shelving.We found doors and paneling. It makes me wish I knew how the doors were used before covering them. I wish I had more history on this house. It's 35 years old. We got a photo album of the house at closing, but it did not show how this wall originally looked.

It's a gorgeous brick fireplace to the ceiling! Why was it ever covered? It's going to be cleaned this week and it works. When we first deciding if we should remove the wall unit, I never thought about removing the front glass doors (look back at the first photo).The glass and metal covered so much of this. I can't wait to see it cleaned.We knocked down a kitchen wall. Now you can see the fireplace across the house. Now, let me show you the foyer. The white door is a coat closet and it is going to become part of the laundry room which backs into it.From this view standing in front of the fireplace we have opened up that area and removed the jams closing in the foyer. We've opened up the separation from the foyer to the great room.

And notice the tile and ceiling is gone. The house is almost a shell only.

This is going to look SO different when we put it back together.

Maybe we'll be in by the end of the year?!

I can't wait to show final photos!

After The Cut

I took the boys to get their haircuts tonight. David went first, then William. In the meantime Scott entertained himself by reading the posters on the wall out loud, "Take Years Off in Just a Few Minutes." He analysed this. "How can a haircut make you younger. That's BS."

During Scott's haircut the other boys were getting restless and by the time they were all done they were running around (even William), getting louder and grabbing 5 lollipops instead of 1. (This was another proud mother moment. Not.)

"BE QUIET!!!" I insist.

Scott justifies their behavior. "Mom, it's true! You really do get younger after a haircut!"

They are darn cute, aren't they???

Feedback from new moms

I especially love hearing how my book Permission to Mother is still helping moms with new babies see things for the better of the baby.

Here's from two moms who shared their thoughts! (Click on the title to take you to the full review.)

5th Baby and we finally are figuring things out....,

It has made me a stonger mother.

It's a Dog's Life

You can see what kind of life this doggie has. He easily goes to William for shared sleep. He's had a good time with the boys in the pool.

I thought this long shallow step in the pool was good for toddlers, but its looking like a

good step for a dog with short legs (and large abdominal girth) to cool off.(This photo is horizontal, but it would upload vertical, weird.) The boys have taken him almost everywhere. He is quiet and rarely barks. Scott has taken him to the pet store and karate. He loves long walks. He rides in the car easily.I'd like recommendations for a Vet. So far no health problems,

but in case we have an emergency or if we do keep him permanently.

I'd also like recommendations for books or websites about dog nutrition and holistic care.

If processed food isn't good for me, I'd like to know more about feeding dogs. Interestingly,

he has been trained so well, he hardly begs or demands other food then what he's been on.