Monday, December 17, 2007

Breastfeeding: story of a letdown

Warning: this is a 'gratefulness aside' post. Feel free *not* to read
about the one problem area I've experienced on the other side.

In brief: What is this engorgement you speak of? Milk production
issues, no solution found. A compromise: give formula at the breast.

One thing I was really looking forward to was breastfeeding my baby.
It felt like the natural thing to do for me, especially after having
been forced to give up on natural conception and a natural delivery.
Though these losses are not in the same league, they do all touch the
theme of womanhood.

To prepare myself, I had read the La Leche League Breastfeeding
Handbook, in a translated and localized version. This book notes that
a C-section ought not impede breastfeeding, though it may require a
little more effort than usual.

During the preparations for the C-section, I was asked whether I
planned to BF. With a vaginal delivery, the baby can be introduced to
the breast immediately after birth. Not so with a C-section, as all
the sterile drapes were in the way and my arms were tied down. About
an hour after delivery Linnea and I were offered the first opportunity
to try our hand - or I should say boob - at breastfeeding. She latched
on quite quickly and to all appearances seemed to suckle vigorously.
The midwife seemed pleased, and so was I.

It takes a few days for your milk to come in, that much I knew. Those
days were spent practicing, as advised by LLL and the midwives. Linnea
showed a strong suckling reflex and was always enthousiastic. After
each feed she went straight back to sleep. All was well, or so I

Her weight loss in the first days didn't overly concern me, this is
normal in breastfed babies. As a rule, full term babies are allowed to
lose 10% of their body weight before the doctors intervene.

In the third night something changed. After her feed, she would cry
with that heartbreaking cry of a newborn. She would only be consoled
by laying on my chest, so that's were she slept. I thought she was
suffering from cramps. Hunger did occur to me, but weren't newborns
supposed to have stomachs the size of a marble? And all that energetic
sucking had to be good for something? Right?

Wrong. On the fourth day, she had lost just over 10% of her birth
weight. Time for action. The pediatrician prescribed supplement
formula. Linnea would be weighed before and after each feed, and
depending on how much she had gotten from the breast would be given a
bottle of formula.

Being concerned about 'nipple confusion', I asked whether I could use
a soft cup to give Linnea her formula. Advice I had read in the LLL
book. The pediatrician brushed my concerns aside, claiming she had in
all her years never encountered 'nipple confusion'. (So, LLL is lying,
I thought?) I didn't protest, being a frightened new mom, besides with
the 2 midwives also on the doc's side I was pretty much outnumbered. A
bottle it was.

I was all for giving Linnea whatever she needed, but did have mixed
emotions as well. I was failing my little girl. I felt it all the more
when she collapsed into blissful sleep straight after her first
bottle. Poor girl had been wailing with hunger those times before.

The weigh-ins just increased my anxiety. The very first time, Linnea
supposedly weiged 60g more after her feed then before. Puzzling,
because that is a full meal for a newborn, yet a bottle of 50 ml was
given to her and she guzzled it down. I was reassured that things
weren't as dire with the BF, but the next weigh-ins proved the first
one to be a mistake. Over the course of 30 feeds, she digested
anywhere between 4g and 20g of breastmilk. This was way to little and
at no point was there a consistent increase. In the end, this achieved
nothing but increasing my stress and anxiety levels, 2 factors that
impede BF by the way. It also made me feel like I was under constant
scrutiny, that they didn't trust me to take good care of my child.

In an attempt to increase supply, I was told to pump after each feed.
A fancy heavy duty hospital pump was rolled into my room and I was
given instructions on it's use.
Me: "Right. So, can this machine do double pumping?"
Midwife: "Erm. Let me check with a colleague."
Me (to myself): Am I the first person to ask this?!
"The machine can do that, but we don't have the necessary parts."
Me : "What a pity." - (to myself) Are they serious? What kind of
half-assed policy on supporting breastfeeding do they have here?

The next day I sent my husband out to rent an electric pump with all
double pumping necessities. I think that's when it dawned on the staff
and pediatrician that I was serious about BF. Not that this changed

Though many of the midwives and nurses were brimming with good will
and did their best to assist me, still I was left with the feeling
that I was being set up to fail at BF - in particular by the
pediatrician who so easily brushed aside my concerns.

Arriving home was overwhelming. For one, there is the sheer sense of
responsibility for this tiny baby. Then there's the rush of hormones.
Adding BF trouble to the mix was just more than I could handle. I
wasn't ready to give up, but I had no idea what to do next. I needed
help urgently, with each bottle I gave her I expected her to reject BF
more. How could I blame her, the bottle is food for free, while BF
demands hard work.

Something had to be done, so I called a number of independent
midwives/lactation consultants until I found one that was available to
come over the same day. That's how I met Muriel, who was to be my
lifeline for weeks to come. She listened to me, gave me pep-talks and
advice. I needed that. She also took charge of the situation, and I
needed that even more.

Fast forward 8 weeks: BF is still not the main act (Sideshow Boob!
:o), but I can rest assured that I've tried everything. I know I'm not
the first and won't be the last to go through this, so let me describe
some of the things we did.

The bottle feeding - or more precisely the risk of Linnea no longer
accepting BF - was my biggest concern and Muriel tackled that on the
very first evening. She recognized my fear wasn't unfounded. Guzzling
down a bottle IS much easier for a baby than BF.
So she taught me how to supplement by finger feeding, using a syringe
with a flexible tube. You let the baby suck your pinky (your nail on
the tongue is most comfortable) and then slip in the tube next to it.
Each time the baby suckles you squirt in some milk. Just like on the
breast, the baby needs to work for it's food, but with the advantage
that you can control how much they get better. The amount of effort
required from the baby is in between BF and bottle feeding. Linnea
took to it immediately. Anyway, this approach took away the sense of
urgency in my mind.

Next step was to assess how much supplementing Linnea really needed.
As I thought, the 50 ml given by the hospital is more or less a full
meal for a newborn. Sure, babies 10 days of age are given bottles of
100 ml (says the pediatrician), but they're not expected to empty them
(says the midwife).
Muriel advised to supplement only 20 ml after each feed for a couple
of days while monitoring her weight daily. Unfortunately, Linnea
slowly lost weight again, so the supplement was increased to 30 ml.
Lather, rinse, repeat and we ended up supplementing 50 ml again.
Supply was definitely a problem.

We tried a couple of strategies to increase my milk supply. First I
pumped after each feed. Linnea was supposed to feed every three hours,
but very often she wouldn't wake that often. Sometimes I let her
sleep, other times I woke her up (generally taking a lot of effort and
costing me precious time to rest).
At first, I would set my alarm for a night feed at about 3 am, because
a night feed is supposedly extra stimulating. But after just a few
nights I was so tired, I just switched the alarm off without waking!
Whenever Linnea started stirring, I'd wake up without a problem, thing
is she would snooze until 5 am. And if a baby wants to sleep at night,
why would you discourage that unless absolutely necessary?

A week or so of this didn't yield any results in terms of noticeable
increase when I pumped. Then I started taking Motilium (domperidone)
in the hopes it would help boost supply. At the same time, I stepped
up the pumping. I aimed for pumping every 2 hours during the day,
while feeding Linnea every three hours. Two days of this madness ought
to have resulted in increased supply, but didn't.

I had my blood tested, specifically prolactin and thyroid function.
Both came back normal.

By this time, I had two LC's stumped (Muriel consulted a more
experienced colleague). Both assured me I had tried everything in my
power to make BF work. There's no obvious reason why it wasn't
working, though there were a number of contributing factors. The
C-section made for a bad start. On average this sets milk production
back a day or two.
Linnea was on the small side at birth. Small babies often don't have
enough energy to kickstart BF on their own. What about all that
enthusiastic suckling I saw? In hindsight, she played me for a fool,
or more accurately, used me as a dummy. What better pacifier than
mom's boob? So all that chomping on my breast looked impressive, but
did little to nothing in terms of stimulating milk production, and
caused me very sore cracked nipples.
I'm still wondering why all the pumping didn't seem to have any effect.

After about 6 weeks, I was pretty tired of the BF - supplement - pump
regimen. I bought a supplementing nursing system (SNS), so I could
give Linnea her formula at the breast. The SNS is a bottle you can
hang around your neck with two tubes that you stick close to your
nipples. Getting the baby to latch on to both nipple and tube can be a
bit tricky, but I got the hang of it quickly enough. Since switching
to the SNS, I haven't been pumping. Supply has remained stable, but
hasn't increased, unfortunately.

Failing at BF is a disappointment, not in myself or in Linnea, but in
the situation. I've felt sad, frustrated and angry. On the one hand,
such feelings are normal and it's ok for me to have them. On the other
hand, I feel like I have no right to feel them at all, after all I do
have a lovely little girl, breastfed or not.
I've been using the SNS for 2+ weeks and have enjoyed the peace it's
brought back to nursing Linnea. I've given up on exclusive BF and
feel I'm as good as over it. Compaired to the pain of IF, this is no

If anyone ever tells you that with enough support and/or effort anyone
can BF their baby, they're lying.


Monday, December 03, 2007

7 days in the hospital

Note: I started this post at least 2 weeks ago. I'm going to stop
caring about writing finished posts, and just post what I manage to

In brief: Some things I want to remember about my week in the maternity ward.

Once upon a birth plan, I wanted to stay in the hospital for 24 to 48
hours and then go home where I would be pampered by my husband, a
maternity nurse (2h per day) and a midwife (one visit per day). It was
nice when I dreamt it up. In my defense, all the pregnancy books tell
you to make a plan.

A C-section entitles you to an extended stay of 7 days in the
hospital. Here are some things I remember from that week.

The first 3 days after Linnea's birth were spent in a state of mellow
euphoria. Cloud number nine, with pink mood lighting. Maybe the pain
medication had something to do with that, but I don't know for sure.
The first 24h the epidural was kept in place, keeping me pain free but
also bedridden. Linnea's bassinet was right beside me so I could see
and touch her, but I couldn't lift her out myself. That's where the
red button above my bed came in handy. Room service!

Breastfeeding had not yet developed into An Issue. As soon as I had
come up to the maternity ward, we started our first introduction to
breastfeeding. Linnea was keen enough as she had been searching for a
boob to latch on to in the first hour after her birth - just like the
books say. Since she was in her father's arms at the time, there was
no boob to be found. This initial let-down didn't faze her though, she
did her best to latch on when a boob was finally produced and then
suckled with gusto. The midwife assisting us seemed satisfied, which
gave me reason to hope that breastfeeding would be straightforward.

The maternity ward is it's own little micro-cosmos. Being restricted
first to the bed and then to the room (spacious and nice) meant that I
experienced it in bursts each time the door opened to let in a
nurse/midwife/gynecologist/pediatrician/fysio-therapist. The bursts
would start at the unholy hour of 7 AM and teeter of towards noon,
with a smaller flurry of activity just before dinnertime. Afternoons
brought visiting hours. Fortunately for us, we never had too many
visitors at any given time.

Then there's that smell. Not disinfectant, no. It's the smell of new
mommy, actually the animal odour of 'new mother'. The heating was
cranked up high in the maternity ward, which made me feel sweaty and
sticky all the time. The first few days I got sponge baths, then
afterwards I could take showers. The refreshing effect of either
lasted all of one hour in general. Most of the time I reeked to high
heaven, I'm sure.
Deoderant, you say? Being the half-baked granola mom that I am, I
wasn't using any. I read once that babies recognize their mothers by
smell in the beginning and using deoderant interferes with that. Who
knows if that is true.
Anyway, to make matters worse, I never managed to take my morning
shower until just before lunch, because people kept coming in (see
list above). Once, during a quiet spell I decided to risk it, of
course the ob/gyn walked in just after I turned on the tap. Come back
later, you'd think? No way, she called me out of the shower and I
talked to her with my hair dripping all over the place. Sigh.

I was in the shower at that time in the hopes of improving my personal
bouquet before my husband returned from a restful night at home.
Partners were allowed to stay the night, and the first 3 nights DH
did. Since I was immobile the first two nights, I was glad to have him
in the room. It eased my mind, being a new and protective mother.
The rest of the week, I sent him home to sleep. He snored, loudly too,
and I couldn't poke him like I do at home because he was lying across
the room. Besides, he never woke when Linnea cried in the night, so I
ended up ringing the nurses to help. I didn't try hard to wake him, I
figured he could use his sleep and the nurses were getting paid to
come and help.

Whenever we managed to take a nap in the day time, he snored too (due
entirely to a cold). Snoring drives me up the wall. Leaping out of bed
to poke him was too much effort, but by chance I discovered that he
would stop when I turned on the TV. Thus, at naptime I turned the TV
on and put the sound on mute. Snore - unmute - quiet - mute. Snore -
unmute - quiet - mute. The closest I've ever come to remote controlled