Thursday, October 14, 2010
Just Another Way to Fight? When Breastfeeding Doesn’t Work
I’ve been helping women breastfeed for over twenty five years. I love watching mothers learn to read their baby’s cues, and help them figure out how fun and easy it can be to breastfeed. Here in Vermont and New Hampshire, most babies begin their lives breastfeeding. (In 2005, 78% of Vermont babies began their lives breastfeeding, at 6 months 54% were still breastfed. In New Hampshire the numbers were 75% and 47%.)
Fun and easy? Well, maybe – by around three months of mothering. But I hate it when everything seems to go wrong, especially when I’m helping a first time new mom in the hospital.
Here’s a scenario, the one that makes me want to cry. Mechelle.was 42 weeks pregnant, the baby’s head was still high, and she had a birth that started with cervidil and ended two days later with a cesarean section. She had pitcoin via IV in-between, and came out of surgery exhausted, with feet and hands swollen, and breasts she swore she had never seen before. And that was before the milk came in!
Mechelle’s baby, Roger, was very coneheaded. He acted like he had no idea what to do when he came to breast. The first day, he slept most of the time. Mechelle had a hard time moving into a position where he could latch on. When Mechelle’s OB discharged her to home, Roger had lost more than ten percent of his birthweight and was jaundiced, so he needed to stay in the hospital and go under the bilirubin lights. And it seems like her milk hasn’t come in yet. And the baby still isn’t nursing well.
Mechelle had never seen anyone breastfeed. Her girlfriend Kylie told her that breastfeeding really hurt but it was good for the baby, and she herself “toughed it out” and Mechelle should, too. So the breastfeeding must be going okay – after all, her nipples certainly hurt.
Now, maybe Mechelle will tough it out too. As far as she’s concerned, this breastfeeding stuff is starting to look like hocus pocus, and the baby just cries and cries when he comes to breast. He’s still pooping meconium at day 5. If you were Mechelle, what would you do? She really wants to do what’s best for her baby and it sure seems like he’s not eating well.
When I began, I knew that anyone could breastfeed a baby, if they just got good help. I determined that I was going to provide that help. But sister, let me tell you, what I sometimes want to provide is a breast full of milk, and the chance for everybody to cry a little bit and eat a little bit, and get over this temporary hump.
Because for many, it IS a temporary hump, and if we just can apply some tincture of time things will go fine, Now, that I can help to provide.
But over the years, I have come to know that there are times when we may end up changing the definition of breastfeeding, to cover the creative ways we are feeding babies. Here’s a couple of real life examples.
• A baby with a cleft palate, exclusively fed with breastmilk by bottle. The mother was given a hard time in downtown Brattleboro for using a bottle. Must she explain everything to the concerned bystander?
• A mother with a history of polycystic ovarian syndrome, who used IVF to get pregnant and didn’t have any breast tissues changes during pregnancy. She breastfed formula with a supplementer taped to her breasts.
• An adoptive mom who got milk from all her girlfriends – when AIDS/HIV was a new problem (we still advise not sharing milk)
• A baby with a very high palate who was unable to latch well enough to get a good supply of milk, and ended up formula fed because his mom was going back to work soon and felt she needed the very most to just fall in love with the baby – and the breast stuff was not helping.
• A mother whose baby’s blood type was a funky match for hers, who was told they could leave the hospital sooner, and the jaundice would go away faster, if she gave the baby formula for a day or two.
• A childhood sexual abuse survivor who had flashbacks when her baby came to breast.
I could go on. Which of these mothers should we blame? Which one was the bad mother who “chose” not to breastfeed?
The mother who is unable to breastfeed or who has to wean before she wanted to, experiences the loss of something very important to her and her baby. She may experience the same stages of grief as the person who is coping with the loss of a loved one: denial (I’ll just take herbs and my milk will come in….), anger (Why does my body not work right? Why is this baby so stubborn?), bargaining (If I can just nurse this baby, I'll never ask for anything again.) depression (It makes me so sad to see other mothers nursing their babies) and finally, acceptance (I know that this is not something I can control, and I did everything I could. I’m still a nurturing, good mom, who just happens to need to use formula.). It is good to know that these are normal stages of grieving, and allow for time to work through each one.
Too often, moms don’t get the help and support they need. That’s how La Leche League and the International Lactation Consultants Association came about. We need to support breastfeeding, to make it easier for moms and babies to get safe breastmilk supplies for supplementation when it is needed, and to make sure we do everything in our power to help it work.
And when it doesn’t work, we need to be good to each other and to ourselves, to help breastfeeding and formula feeding mothers who are feeding their babies with a bottle establish the intimate relationship that breastfeeding makes so easy, and to know that we are doing the most important work in the world: nurturing and nourishing a new human being. And a new mother!
I’ve been helping women breastfeed for over twenty five years. I love watching mothers learn to read their baby’s cues, and help them figure out how fun and easy it can be to breastfeed. Here in Vermont and New Hampshire, most babies begin their lives breastfeeding. (In 2005, 78% of Vermont babies began their lives breastfeeding, at 6 months 54% were still breastfed. In New Hampshire the numbers were 75% and 47%.)
Fun and easy? Well, maybe – by around three months of mothering. But I hate it when everything seems to go wrong, especially when I’m helping a first time new mom in the hospital.
Here’s a scenario, the one that makes me want to cry. Mechelle.was 42 weeks pregnant, the baby’s head was still high, and she had a birth that started with cervidil and ended two days later with a cesarean section. She had pitcoin via IV in-between, and came out of surgery exhausted, with feet and hands swollen, and breasts she swore she had never seen before. And that was before the milk came in!
Mechelle’s baby, Roger, was very coneheaded. He acted like he had no idea what to do when he came to breast. The first day, he slept most of the time. Mechelle had a hard time moving into a position where he could latch on. When Mechelle’s OB discharged her to home, Roger had lost more than ten percent of his birthweight and was jaundiced, so he needed to stay in the hospital and go under the bilirubin lights. And it seems like her milk hasn’t come in yet. And the baby still isn’t nursing well.
Mechelle had never seen anyone breastfeed. Her girlfriend Kylie told her that breastfeeding really hurt but it was good for the baby, and she herself “toughed it out” and Mechelle should, too. So the breastfeeding must be going okay – after all, her nipples certainly hurt.
Now, maybe Mechelle will tough it out too. As far as she’s concerned, this breastfeeding stuff is starting to look like hocus pocus, and the baby just cries and cries when he comes to breast. He’s still pooping meconium at day 5. If you were Mechelle, what would you do? She really wants to do what’s best for her baby and it sure seems like he’s not eating well.
When I began, I knew that anyone could breastfeed a baby, if they just got good help. I determined that I was going to provide that help. But sister, let me tell you, what I sometimes want to provide is a breast full of milk, and the chance for everybody to cry a little bit and eat a little bit, and get over this temporary hump.
Because for many, it IS a temporary hump, and if we just can apply some tincture of time things will go fine, Now, that I can help to provide.
But over the years, I have come to know that there are times when we may end up changing the definition of breastfeeding, to cover the creative ways we are feeding babies. Here’s a couple of real life examples.
• A baby with a cleft palate, exclusively fed with breastmilk by bottle. The mother was given a hard time in downtown Brattleboro for using a bottle. Must she explain everything to the concerned bystander?
• A mother with a history of polycystic ovarian syndrome, who used IVF to get pregnant and didn’t have any breast tissues changes during pregnancy. She breastfed formula with a supplementer taped to her breasts.
• An adoptive mom who got milk from all her girlfriends – when AIDS/HIV was a new problem (we still advise not sharing milk)
• A baby with a very high palate who was unable to latch well enough to get a good supply of milk, and ended up formula fed because his mom was going back to work soon and felt she needed the very most to just fall in love with the baby – and the breast stuff was not helping.
• A mother whose baby’s blood type was a funky match for hers, who was told they could leave the hospital sooner, and the jaundice would go away faster, if she gave the baby formula for a day or two.
• A childhood sexual abuse survivor who had flashbacks when her baby came to breast.
I could go on. Which of these mothers should we blame? Which one was the bad mother who “chose” not to breastfeed?
The mother who is unable to breastfeed or who has to wean before she wanted to, experiences the loss of something very important to her and her baby. She may experience the same stages of grief as the person who is coping with the loss of a loved one: denial (I’ll just take herbs and my milk will come in….), anger (Why does my body not work right? Why is this baby so stubborn?), bargaining (If I can just nurse this baby, I'll never ask for anything again.) depression (It makes me so sad to see other mothers nursing their babies) and finally, acceptance (I know that this is not something I can control, and I did everything I could. I’m still a nurturing, good mom, who just happens to need to use formula.). It is good to know that these are normal stages of grieving, and allow for time to work through each one.
Too often, moms don’t get the help and support they need. That’s how La Leche League and the International Lactation Consultants Association came about. We need to support breastfeeding, to make it easier for moms and babies to get safe breastmilk supplies for supplementation when it is needed, and to make sure we do everything in our power to help it work.
And when it doesn’t work, we need to be good to each other and to ourselves, to help breastfeeding and formula feeding mothers who are feeding their babies with a bottle establish the intimate relationship that breastfeeding makes so easy, and to know that we are doing the most important work in the world: nurturing and nourishing a new human being. And a new mother!
Thursday, April 29, 2010
Please Do Not Disturb: Is birth a celebration for the whole village?
My son was born during a very big snowstorm, at the very little hospital in Bellows Falls. Clean-up had barely started the next day when a woman I barely knew popped her head in before breakfast and said, “Hey! I was getting my blood drawn and I heard you had your baby! I thought I would come say hello!”
Privacy rules have changed, so that might not happen today. But over the past fifty years or so, there have been lots of changes in hospitals. Here’s a walk back in time, and some thoughts about the up side and down side of open visiting hours. I’d be glad to hear your thoughts and stories!
OB Visiting-circa 1952 – Visiting hours were usually an hour or so in the afternoon and another hour or so in the evening. Babies were generally brought to mom only for feedings. Dad held his baby for the first time after they got home. Visitors would crowd around the nursery window for a brief glimpse of the baby as the nurse would either hold it up or wheel the crib to the window. Children under 12 were not allowed on the OB floor, or anywhere in the hospital. Moms would wave to their other children out the window. They would not see those children for up to ten days (while they “recovered”)!
OB Visiting-circa 1977 – Rooming in was a new concept. Dad and immediate family (though not always young siblings-they were still often banished from the OB unit) had longer visiting hours – say, 10 AM to 9 PM. They could be in the room with baby. There were still general visiting hours much like in the 50’s with baby whisked back to the nursery during that time. Nurses often had to function as “visitor police” being sure that only family members were in room with baby.
OB Visiting-2000 – How things have changed! Anyone can visit any time (including not only siblings, but other small children as well), twenty four hours a day. Babies stay in the room and any visitors can hold baby. Nurses no longer serve as “visitor police” – after all, birth is a celebration. Why not invite the people who love you to the party?
OB Visiting – 2006 – Moms are exhausted. There are a couple of outbreaks of pertussis (whooping cough) in the area, and bird flu looms on the horizon. Hospitals begin re-thinking their open visitors policy, not just in OB but throughout the hospital. Immediate family members are still welcome any time of the day or night, at the new family’s discretion, but friends and other family are asked to visit during hospital visiting hours.
Are these changes for the better or not? Certainly it is nice to be able to have your visitors come when it is convenient for them so they don’t have to schedule a visit during very limited times. Dad and the rest of the family have the opportunity to get to know the baby before discharge. On the other hand, with increased hours available for visitors, it seems the number of visitors often increases to fill the time available. Just because they can visit almost any time doesn’t mean that it is appropriate to have a roomful of visitors all day long!
During the short time a new mom is in the hospital after delivery, there are two very important goals she must achieve. The first is to get a good start on her physical recovery. The second is to learn to care for herself and her baby. These needs should take precedence over visitors. Admittedly, a new mom loves to relate the story of her labor and birth. In addition, it feels good when everyone “oohs and aahs” over the baby. However, as a result of too many visitors, mom often misses out on opportunities to get some much-needed rest during the day. Then when her baby needs her at night she is too tired. New moms are often too overwhelmed and exhausted to speak up for themselves. This is an important role for mom’s primary support person.
Another problem is the entertainment factor, and the way it interferes with learning your baby’s signals. Aunt Lucy is holding the baby and the baby is fussing. Aunt Lucy knows why – the baby needs a burp. After all, that’s what she did with her kids. But wait! The baby has been eating her fists for ten minutes, and Aunt Lucy has been ignoring her early feeding cues. And now, can we clear the room while mom breastfeeds? (Don’t get me started. I’d be glad to teach the whole room about breastfeeding, and if you don’t mind being part of the show, let’s do it!)
Plan Ahead
Plan ahead now about how you want to handle the question of visitors.
Do you want them in the hospital waiting room while you are in labor? Should they be in the hallway waiting to hear the baby’s first cry? We have had nurses feel threatened by the hallway family when we say, “You can’t go in there!” If the placenta isn’t born yet, keep out!
After a cesarean, your birthing center room is your recovery room. This is very confusing for the hallway family. “Why can’t we see her?” Well – she’s in the recovery room! Let’s make sure she’s breathing and her heart rate is regular and she knows her name before we all go in. And maybe she’d like to see her baby alone for a while!
You are under no obligation to entertain all of your local relatives and friends in the first day or so after giving birth. Select a few of those most important to you to visit briefly while you are here. (One family even had a “lottery” and drew names to see who could visit first.) Let the others know you look forward to seeing them and showing off your new baby, but you need some time by yourselves at first to get your new (or newly enlarged) family off to a solid start. They certainly should be able to understand. If they don’t, it’s their problem, not yours.
Don’t be afraid to ask visitors to leave if you are feeling exhausted or if baby needs to nurse and you aren’t comfortable nursing in front of the company. In addition, your nurse needs to be sure you can care for yourself and baby at home, whether it’s new to you or you need a quick review. When possible, nurses try to arrange these teaching sessions around your visitors, but if you “always” have visitors, she will either have to ask them to leave or do the teaching with them in the room.
Take advantage of the times when baby is sleeping to catch a short nap for yourself. Put the “Do Not Disturb” sign on your door. You can take it down when you are ready for company. You might want to let your nurse know you will be napping. There may be some things she needs to do with you at a particular time (like vital signs or giving a medication). Most things can be done a little earlier or a little later to allow you time to rest. By letting her know you’ll be snoozing, she can plan around your needs.
Once you get home, you will probably still want to avoid having either a steady stream of visitors or a whole houseful. Tell your friends and family you will let them know when you are up to having company. It wasn’t too many years back that women stayed in the hospital as long as 2 weeks after an uncomplicated delivery. This is certainly not necessary now, but you might want to think of yourself as “recovering at home” for that same time.
Some new moms find it helpful to have a bathrobe handy by the front door. Even if you get dressed during the day, put the bathrobe on before you greet company. It serves as a subtle reminder that you still need your rest. Otherwise they may expect you to entertain them, serve tea and cookies, etc! In fact – don’t offer refreshments!
Another suggestion is to have an “admission price” to see the baby. The admission consists of doing a small task to help you out. It might be running a load of laundry, washing up the pile of dishes in the sink or stopping at the store on the way to pick up a loaf of bread. Don’t be afraid to put a “sleeping, do not disturb” sign on your door or take the phone off the hook when you get the opportunity to nap during the day.
It’s wonderful when friends and family are there to help your baby discover a wonderful word full of love and caring. Plan now to help them remember that’s what they’re going to do!
Privacy rules have changed, so that might not happen today. But over the past fifty years or so, there have been lots of changes in hospitals. Here’s a walk back in time, and some thoughts about the up side and down side of open visiting hours. I’d be glad to hear your thoughts and stories!
OB Visiting-circa 1952 – Visiting hours were usually an hour or so in the afternoon and another hour or so in the evening. Babies were generally brought to mom only for feedings. Dad held his baby for the first time after they got home. Visitors would crowd around the nursery window for a brief glimpse of the baby as the nurse would either hold it up or wheel the crib to the window. Children under 12 were not allowed on the OB floor, or anywhere in the hospital. Moms would wave to their other children out the window. They would not see those children for up to ten days (while they “recovered”)!
OB Visiting-circa 1977 – Rooming in was a new concept. Dad and immediate family (though not always young siblings-they were still often banished from the OB unit) had longer visiting hours – say, 10 AM to 9 PM. They could be in the room with baby. There were still general visiting hours much like in the 50’s with baby whisked back to the nursery during that time. Nurses often had to function as “visitor police” being sure that only family members were in room with baby.
OB Visiting-2000 – How things have changed! Anyone can visit any time (including not only siblings, but other small children as well), twenty four hours a day. Babies stay in the room and any visitors can hold baby. Nurses no longer serve as “visitor police” – after all, birth is a celebration. Why not invite the people who love you to the party?
OB Visiting – 2006 – Moms are exhausted. There are a couple of outbreaks of pertussis (whooping cough) in the area, and bird flu looms on the horizon. Hospitals begin re-thinking their open visitors policy, not just in OB but throughout the hospital. Immediate family members are still welcome any time of the day or night, at the new family’s discretion, but friends and other family are asked to visit during hospital visiting hours.
Are these changes for the better or not? Certainly it is nice to be able to have your visitors come when it is convenient for them so they don’t have to schedule a visit during very limited times. Dad and the rest of the family have the opportunity to get to know the baby before discharge. On the other hand, with increased hours available for visitors, it seems the number of visitors often increases to fill the time available. Just because they can visit almost any time doesn’t mean that it is appropriate to have a roomful of visitors all day long!
During the short time a new mom is in the hospital after delivery, there are two very important goals she must achieve. The first is to get a good start on her physical recovery. The second is to learn to care for herself and her baby. These needs should take precedence over visitors. Admittedly, a new mom loves to relate the story of her labor and birth. In addition, it feels good when everyone “oohs and aahs” over the baby. However, as a result of too many visitors, mom often misses out on opportunities to get some much-needed rest during the day. Then when her baby needs her at night she is too tired. New moms are often too overwhelmed and exhausted to speak up for themselves. This is an important role for mom’s primary support person.
Another problem is the entertainment factor, and the way it interferes with learning your baby’s signals. Aunt Lucy is holding the baby and the baby is fussing. Aunt Lucy knows why – the baby needs a burp. After all, that’s what she did with her kids. But wait! The baby has been eating her fists for ten minutes, and Aunt Lucy has been ignoring her early feeding cues. And now, can we clear the room while mom breastfeeds? (Don’t get me started. I’d be glad to teach the whole room about breastfeeding, and if you don’t mind being part of the show, let’s do it!)
Plan Ahead
Plan ahead now about how you want to handle the question of visitors.
Do you want them in the hospital waiting room while you are in labor? Should they be in the hallway waiting to hear the baby’s first cry? We have had nurses feel threatened by the hallway family when we say, “You can’t go in there!” If the placenta isn’t born yet, keep out!
After a cesarean, your birthing center room is your recovery room. This is very confusing for the hallway family. “Why can’t we see her?” Well – she’s in the recovery room! Let’s make sure she’s breathing and her heart rate is regular and she knows her name before we all go in. And maybe she’d like to see her baby alone for a while!
You are under no obligation to entertain all of your local relatives and friends in the first day or so after giving birth. Select a few of those most important to you to visit briefly while you are here. (One family even had a “lottery” and drew names to see who could visit first.) Let the others know you look forward to seeing them and showing off your new baby, but you need some time by yourselves at first to get your new (or newly enlarged) family off to a solid start. They certainly should be able to understand. If they don’t, it’s their problem, not yours.
Don’t be afraid to ask visitors to leave if you are feeling exhausted or if baby needs to nurse and you aren’t comfortable nursing in front of the company. In addition, your nurse needs to be sure you can care for yourself and baby at home, whether it’s new to you or you need a quick review. When possible, nurses try to arrange these teaching sessions around your visitors, but if you “always” have visitors, she will either have to ask them to leave or do the teaching with them in the room.
Take advantage of the times when baby is sleeping to catch a short nap for yourself. Put the “Do Not Disturb” sign on your door. You can take it down when you are ready for company. You might want to let your nurse know you will be napping. There may be some things she needs to do with you at a particular time (like vital signs or giving a medication). Most things can be done a little earlier or a little later to allow you time to rest. By letting her know you’ll be snoozing, she can plan around your needs.
Once you get home, you will probably still want to avoid having either a steady stream of visitors or a whole houseful. Tell your friends and family you will let them know when you are up to having company. It wasn’t too many years back that women stayed in the hospital as long as 2 weeks after an uncomplicated delivery. This is certainly not necessary now, but you might want to think of yourself as “recovering at home” for that same time.
Some new moms find it helpful to have a bathrobe handy by the front door. Even if you get dressed during the day, put the bathrobe on before you greet company. It serves as a subtle reminder that you still need your rest. Otherwise they may expect you to entertain them, serve tea and cookies, etc! In fact – don’t offer refreshments!
Another suggestion is to have an “admission price” to see the baby. The admission consists of doing a small task to help you out. It might be running a load of laundry, washing up the pile of dishes in the sink or stopping at the store on the way to pick up a loaf of bread. Don’t be afraid to put a “sleeping, do not disturb” sign on your door or take the phone off the hook when you get the opportunity to nap during the day.
It’s wonderful when friends and family are there to help your baby discover a wonderful word full of love and caring. Plan now to help them remember that’s what they’re going to do!
Wednesday, February 3, 2010
Getting ready for a new baby
o Plan care for “the big kids”
• Arrange for a friend or relative to come to your house
• Or, the kids may go somewhere for a “special” overnight
• Let your childcare provider or your child’s teacher know if a new person may appear to pick up your child
o Talk to your child about your plans.
• Tell a story: “One day, Melody was at school. And who came to meet her at the van? It was Aunt Laura! Not Mom! Mommy went to the hospital so our new baby could come out.”
• Play “What If” (good for 4-5 years and up): “What if you woke up one morning and Aunt Laura was there?” “What if mommy made funny noises like this – Waaa-oooo!”
o Get the kid stuff packed – including a “lovey,” special toy, pillow, clothes, pj’s. Many children love to help with packing – and it’s a great opportunity to make some decisions and have some time together. To them it feels like let’s pretend!
o If the caregiver is coming to your house you can:
• Make a box with favorite foods – whether it’s Kraft Mac & Cheese or a new jar of organic peanut butter, don’t leave this important detail to chance. Put a couple of frozen juices in the back of the freezer. Put $10 emergency money in an envelope in the box – did anyone ever go into labor with plenty of bread and milk at home??
• Make a list with important info (“Joey needs his blanket for his nap”), phone numbers, where the breaker box is, who your pediatrician is.
o Discuss your plans about visits to the hospital. Some children come while mom is in labor – some never visit at all. They are welcome 24 hours a day – but think about what will be best for your older child. An active boy may want to spend a lot of time looking at toilet plumbing. Is that the best use of everybody’s energy?
o Pack your bag for the hospital. Consider including a new toy or book for the older child – or a gift they can have when you leave the house.
o Plan how YOU will get to the hospital.
o Get your infant carseat ready to go – you can have it checked at Rescue or the Brattleboro Police Department on the Vermont side of the river, or at the Keene Police Department if you’re in New Hampshire.
o Pat yourself on the back for a job well done!
• Arrange for a friend or relative to come to your house
• Or, the kids may go somewhere for a “special” overnight
• Let your childcare provider or your child’s teacher know if a new person may appear to pick up your child
o Talk to your child about your plans.
• Tell a story: “One day, Melody was at school. And who came to meet her at the van? It was Aunt Laura! Not Mom! Mommy went to the hospital so our new baby could come out.”
• Play “What If” (good for 4-5 years and up): “What if you woke up one morning and Aunt Laura was there?” “What if mommy made funny noises like this – Waaa-oooo!”
o Get the kid stuff packed – including a “lovey,” special toy, pillow, clothes, pj’s. Many children love to help with packing – and it’s a great opportunity to make some decisions and have some time together. To them it feels like let’s pretend!
o If the caregiver is coming to your house you can:
• Make a box with favorite foods – whether it’s Kraft Mac & Cheese or a new jar of organic peanut butter, don’t leave this important detail to chance. Put a couple of frozen juices in the back of the freezer. Put $10 emergency money in an envelope in the box – did anyone ever go into labor with plenty of bread and milk at home??
• Make a list with important info (“Joey needs his blanket for his nap”), phone numbers, where the breaker box is, who your pediatrician is.
o Discuss your plans about visits to the hospital. Some children come while mom is in labor – some never visit at all. They are welcome 24 hours a day – but think about what will be best for your older child. An active boy may want to spend a lot of time looking at toilet plumbing. Is that the best use of everybody’s energy?
o Pack your bag for the hospital. Consider including a new toy or book for the older child – or a gift they can have when you leave the house.
o Plan how YOU will get to the hospital.
o Get your infant carseat ready to go – you can have it checked at Rescue or the Brattleboro Police Department on the Vermont side of the river, or at the Keene Police Department if you’re in New Hampshire.
o Pat yourself on the back for a job well done!
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