On Breastfeeding

If you don't want to read my long personal story, scroll down to the bottom for my list of advice on breastfeeding.

A couple weeks ago, I wouldn't have been able to predict if this entry would be called "On Breastfeeding" or "On Bottles." I was pretty close to giving up on doing things the "natural" way.
Funny, how misleading the word "natural" can be. Yes, breastfeeding is natural. But so is walking...and it takes a lot of time and development and strength to be able to do it. Babies have to learn how to walk. They have to take small steps with a lot of help. They have to fall down many times before they can do it properly. Yet there is no denying that it is, in fact, natural.


Breastfeeding...ahhhh...breastfeeding. How confident I was telling people, "Yes, I'm going to breastfeed." Just saying it seemed natural. I heard it was painful at first, but most accounts seemed to limit the discomfort to the first few days. No problem.



How cute I was with that confidence. LIttle did I know what was ahead.







As you know, my daughter was born a month early. The hospital had a "protocol" for premature babies. They offered her my breast right away, but she was too small and sleepy to nurse. The pattern was this: Breast, bottle, pump. Offer her the breast. Supplement with the bottle. Pump for 15 minutes to stimulate your milk supply. Let me tell you: 15 minutes is a long time to have something tugging at your knockers.







While we were in the hospital, Aleida didn't do much with my breasts. So, we started off giving her formula (I heard the collective gasp from all the La Leche Leaguers out there). It was nice because both Dave and I could feed her. Daddy liked that. Not what I wanted or expected, but I knew she needed nourishment. And the nurses assured me that she would be able to breastfeed eventually.







I used to see breasts as a feminine, sexual thing. That's why women wear necklaces and low-slung tops, right? To flaunt the boobage. To showcase the tatas?







Cue the breast pump. If you've never seen one, it's like this: A funnel shaped piece of plastic is placed over each breast. You have to hold it there- no handsfree contraptions. I've heard they exist, but the hospital did not offer... These funnels are connected to a splitter. One end goes to a collecting bottle. The other end connects to a tube which runs to the pump. Turn it on and you get a nice "whirrr, slump, whirrr, slump, whirrr."







In essence, I became a cow. Hook me up to a milker and collect. At first, it's a painful tug that for me brought not a drop for almost 24 hours. Once the milk started, the yield was little drops and trickles of milk. After a couple days, I was getting a stream. I had extra milk. More than AJ needed. By day 3, she was on nothing but breast milk, but not from the breast. Had I been more informed, I would've been more proactive in getting her to latch. But I had lots of other things on my mind, and the lactation consultant was clearly not aggressive.




Jump ahead 7 weeks. Today I'm going to my 4th appointment with a lacation consultant. These appointments will outline for you the general points of difficulty that I've encountered on the journey.



1st Visit: Aleida 1 week old. Routine Visit to Kaiser's Mother-Baby program. She was weighed. Lactation consultant watched her try to latch. She gave us a "nipple shield." It's a plastic dome that covers your nipple. It's usually used for flat or inverted nipples. I don't have this problem, so I think she gave it to us as a transition from bottle to nipple. I was advised to try the shield, but continue to pump and supplement with the bottle.



2nd Visit: Aleida 3.5 weeks old. Back to Kaiser's Lactation Specialist. Originally, I made the appt b/c we were really struggling at the breast. Aleida would cry and pull away from my breast, but happily finish off a bottle. Feedings often ended in frustration, sometimes tears. Aleida was still small, still premie, so my expectations might have been a bit unrealistic. Still, I just wanted to breastfeed her. I didn't want to struggle with it. Between making the appointment and going to it, things improved dramatically. Aleida was taking more from the breast. We were still using the nipple shield, but I was okay with it b/c it was better than the bottle. At this appt, Aleida was again weighed and still gaining like a champ. We also did a before and after weight. Weigh her. Feed her. Weigh her again to see how much she was getting. AJ proved to be efficient. In about 14 minutes of nursing, she took in close to 3 ounces- more than her nutritional need. Everyone was happy and I thought the worst was over.



3rd Visit: Aleida 5.5 weeks old. I wanted to wean off the nipple shield. Though my husband continues to warn me away from the blogosphere, I continue to turn to it for advice. I saw that nipple shields have been shown to decrease milk supply and can be very hard to wean off. So, I started nursing without the nipple shield, and started having some pretty major pain. I'd heard breastfeeding caused pain in the early days, so I suffered through, thinking that this was my equivalent of the early days. I started to have anxiety associated with breastfeeding, b/c I wasn't sure how she was going to latch on, and I anticipated pain. I would often have to give myself breaks from nursing. Even when I wasn't nursing, I would have intense soreness and even acute pain in my breasts. I started to worry about infection and I had no idea if this was normal. I called a different lactation consultant under my new insurance, and made an appointment. I was skeptical that anything could be done, and worried that I would be giving up shortly after the visit.

Fortunately, Aleida was still gaining weight. And this consultant was much more knowledgeable than the last. She showed me that with some very minor technique changes, I could get AJ to take more of the breast in her mouth. Before, she was really just nursing off my nipple and I thought "latching on" referred to her grip on my nipple. What "latching on" really means is that the baby's lower lip is latched on below the nipple, towards the bottom of the areola, taking much more into her mouth. She again did the before and after weight, and again we saw that Aleida is an efficient sucker. I felt good. I was equiped with good information.



I asked about the pain. My consultant did suggest that I might have Reynaud's Syndrome. This is the same syndrome that causes people's fingers to turn white when they are cold. Apparently, you can have it just in the breast, and that could be a cause for pain, especially when your nipple is already traumatized. The blood vessels in the area actually constrict, so it feels like a spasm. Yep, I was having nipple spasms. I often referred to these episodes as "nipple attacks" and affectionately described them as "cheese-grater nipples." Lovely, no? Don't worry, this is an outlier symptom- not among the scope of "normal" breast-feeding adjustment.

**24 hours have elapsed since I started this entry**

4th Visit: Aleida 7.5 weeks old I made this appointment because while my pain has greatly diminished, Aleida is inconsistent with nursing. Sometimes she will be on and off in 5 minutes and I can't convince her to go back on. In the last few days, she's been fussy at the breast, squirming around like she's uncomfortable and sometimes crying. Since she's not a fussy baby by nature, I'm worried that something's wrong. And I'm worried that she might not be getting enough milk with her quick feeds. Again, the blogosphere has me worried about foremilk/hindmilk inbalance, insufficient weight gain, etc.

Good news from the visit- Aleida now weighs 8 lbs 14 oz which means she's been gaining about an ounce a day since birth--over an ounce a day since my last appt. She's also a total Hoover- sucks down 2 ounces in about 5 minutes on my boobage. The consultant said I'm doing everything right. She said AJ's latch is great, I make it look easy, I'm a good mother. Shucks...I thought...keep going... The only question is the fussiness. 6-8 weeks is one of the more fussy periods across the board- so it could be that. She also said the buzz word in lactation circles is acid reflux in babies and they are actually treating babies with antacids. She isn't buying into it, and neither am I. I checked the blogosphere and most babies suffering with reflux have many more and much worse symptoms than my AJ.

So, I'm trying new positions and just in the last few feedings, I've noticed a big improvement. Part of the problem could be my overabundance of milk and therefore my fast let down. I think it's probably just creating gas. So, I'm trying more upright nursing positions. I prop AJ up beside me- almost in a sitting position, and offer her the breast that way. She hasn't fussed this morning, so I think it's working. And there's validation in her weight gain and the words of the consultant. So this time...fingers crossed...I do feel like the hard part is over, though I still hope to get more consistent feedings, and I want my milk to regulate so I don't feel so swollen.

In summary...here's my advice to anyone attempting to breastfeed:

1. Lower your expectations. This is a difficult process for a lot of moms. Some lucky people transition w/out much trouble, but from what I'm hearing, it is totally normal to have a bumpy start.

2. Do what's best for you! For me, pushing through was the right decision. The disappointment of not breast-feeding would've outweighed all the pain and frustration. On the other end, I'm glad I suffered through. But this is not true for everyone. If you need to pump and bottle, pump and bottle. If you need to go to formula, go to formula. Don't let frustration hurt your relationship with your baby, or your body. In the end, a happy bottle-feeding mom is going to be much better for a baby than a miserable breast-feeding one.

3. Forget your cans as anything but functional milk-makers. They are as big and pretty as they are going to be, but they are not your boobs anymore. Nor are they your partner's. They are your baby's. It's temporary.

4. Use lactation consultants. The minute you feel frustrated, call and schedule an appointment. I wouldn't be breastfeeding now if it wasn't for the help I got.

5. Beware the blogosphere. Keep reading my blog...of course...but watch out for the info out there. Every baby is totally different. So when I was reading that babies should nurse for at least 15 minutes on each breast, I was totally insecure. My baby gets what she needs in under 10 minutes (that's right, suckas). But advising others to stop at 10 minutes could be harmful. You will learn what works for you and yours.

Breastfeeding is hard, but I must say, there are few things more precious than my daughter nursing. It's a beautiful, amazing thing that our bodies can be the sole producers for our offspring. Oh yeah, and you burn 500-800 calories a day breastfeeding- that's more than during pregnancy- so eat away!

Final piece of advice: Be gentle and patient with yourself, your baby, and the process. Remember, it's all temporary.

a matter of the heart

Pregnant women (and I speak for all of us here) can't help but worry that their children will turn out okay. We hear enough about Downs Syndrome and Cystic Fibrosis and Fetal Alcohol Syndrome to freak anyone out. I worried about the careless 2 doses of NyQuil I took after conception but before my knowledge of it. When my dad joked that he would be happy with a "grandson, granddaughter or friendly alien," I laughed, but had nightmares about giving birth to something that looked like an extra terrestrial. You worry about the missing toes, the cleft palate, the hair lip, the deafness, the blindness, the deformation. Once baby is born and you count the fingers and note the proper placement of her nose, you breathe a sigh of relief. All that worrying for naught, you think.



So, on day 2 in the hospital, when the pediatrician came in to check my perfect daughter, I was confident. Even after she told me she heard a heart murmur, I didn't despair. "Lots of babies are born with murmurs that go away in a day or so, so I'll be back to check her tomorrow," she'd said.



Dave listened to her heart, heard the murmur, but didn't seem worked up, so I calmly waited for the next check up.



On day 3, the pediatrician still heard the murmur, so she ordered an echocardiogram. The technician came in with a big machine and ran a wand over my darling as she lay sleeping on my chest. Dave was watching intently; he had some training in these mysterious images, after all. I just watched my daughter and occasionally glanced at the screen or my husband to see if I could make sense of anything. I couldn't.

The technician, knowing Dave was a doctor, said, "I can't really tell you what I'm seeing. You'll have to wait until the doc looks at the images," but he proceeded to point out major landmarks anyway. Words were tossed around between the tech and my husband that made little sense to me, but piqued just enough worry to raise my own heart rate. When the procedure was over, I asked my husband what he knew.



"Nothing really," he said. "It could be *insert gibberish words* and it could not be, we'll have to wait and see what the doctor says." I know now, he was protecting me. He knew that our little baby had a hole in her heart.



Those gibberish words can now be defined as "tetralogy of Fallot." For a while, I thought they were saying "tetralogy of flow" which made sense since we're talking about the heart. But no, Fallot is the guy who defined the condition. Tetralogy refers to 4 key anatomical features of the condition, but my understanding is that only 2 of them matter. 1. A hole between the left and right ventricles. 2. A narrowing of the pulmonary valve. In a nutshell, oxygenated blood can mix with deoxygenated blood, meaning that not enough oxygen gets taken throughout the system. In an even smaller nutshell, this means babies can turn blue.



Our baby is not blue. She's not even purplish. She's pink and rosy and beautiful. She's currently considered "mildly affected." She has the same oxygen levels in her blood as any other baby. You look at her and you have no idea that she has a congenital heart defect.



In the end, she's going to need surgery. Open heart surgery. Probably before she's 6 months old. Right now, we go to the cardiologist every 3 weeks to check her stats. We watch for "blue spells." We wait and let her grow and get strong. We enjoy her and forget that there is anything wrong. Truly, as far as heart conditions go, this is a best-case scenario. She's otherwise perfectly healthy. We discovered the condition via the murmur- not a "blue spell" (can you imagine how scary THAT would be if you weren't expecting it?). We have the means and resources and attitude necessary to get her the required care. We have good health insurance. Once she has the surgery, she'll be fine. Follow up with the cardiologist throughout life- but no limitation to her activities. Shaun White- the Olympic snowboarder- had this condition. So AJ can be an Olympian if she wants to.

Still...open-heart surgery on a baby. My baby. You can imagine what it's taken for me to come to terms with this. But I have. I had to accept a few truths to get there. First, this has nothing to do with her being a month early. Second, there is no known cause of this. It is congenital, but not hereditary. Dave and I are no more likely the have another child with this condition than any other couple. Third, this doesn't define her. She is beautiful and healthy. We'll fix this, but until then, she's just a normal (well...exceptionally adorable and smart and perfect) baby.

Finally, I've accepted that this is not my fault. Of course, I could go into how I've wracked my brain to come up with something I used or did or ate that could've caused this. If I was a religious person, I might see this as God's punishment to Dave and I for having premarital sex. The most spiritual I'm going to get about it is this: Balance. I have a fairly charmed life. This is a challenge, an obstacle, but I can handle it. We can handle it. AJ won't even remember it.

Dave summed it up best. We were still in the hospital. I'd been crying as I realized what had to happen to fix my baby's heart. "Now that I've met her, I wouldn't exchange her for a baby without this problem." I said. "I mean, she's pretty perfect, except for this hole in her heart."

Dave looked at her, then looked at me. "She's pretty perfect with it."

80/20

It is hard to justify writing in my blog with so many other things to do. But my goal is to complete at least one entry--however short--a week. We'll see.

This morning was a bit rough. My mellow angel baby who sleeps well and rarely cries has been super fussy. She's refusing to nap- though I can see she's tired. She's crying more, and I'm a little scared that this is the beginning of a trend- though there is no logic considering the past 6-weeks have been suprisingly fuss free. Everyone has bad days. This is one of hers.

Couple that with one of my bad moods and you get a mess. Baby crying. Mommy crying. Daddy confused. A bit of a wasted morning.

Here's what it comes down to. 80% of the time, I feel so privileged to be the mommy. I get to breastfeed her (though this comes with challenges and frustrations too- but that's for a later blog). I am the sole care-taker, even though my husband is more involved than 99% of dads out there. But, he works full time. AJ is my full time job. And I spend probably about 6-8 hours a day just feeding and changing her. Usually, I love it- even the poopy diapers. She's beautiful, pleasant, interesting and a part of me. In fact, most of the time, I'll tell you this is easier and more fun than people say it is.

This morning was part of the other 20%. As I work to feed a fussy baby and my husband goes outside to work out and play around in the garden, I start to feel sorry for myself. This is my life, and my first responsibility. On days when she doesn't nap, I don't get a chance to work out or even shower when I want. It's hard to fit in meals some times. Dave's trying to help me. "Let me take care of her while you go workout."

I'm in an unreasonable mood and frankly, a bit too tired and frustrated for working out to sound like a good idea, though I'd just complained about not having time to work out. "Well, do I work out? Eat breakfast? Shower? Which of these important things do I choose, because I don't have enough time to do all three? And what about you? I was hoping to spend some quality time together."

Dave throws out several logical options that hit at least 2 of the 3 activities, but I shoot them all down. I'm just set on feeling sorry for myself. This is my life now. Catering to the needs of a small little human being with moods and demands and a personality that I'm still trying to figure out. I love her, but I don't always get her.

Truth is, I'm ashamed of these moments of self-pity. I want to be the always on, always happy mama bear that has no trouble putting the needs of her young above all else. And believe me, I know this is a privilege and most of the time it feels like one. But occasionally, I have a little pity party. I envy my husband the part-time nature of his role. He gets a kick out of her when she's fussy, because then he goes to work and sees much more fussy people in the ER.

A pregnant friend asked me for my best piece of advice after a month of motherhood. Here it is: Expect the 20% moments. Roll with them. Know they will pass. Forgive yourself for being a little selfish. Your life is about to change in a major way. It is amazing, beautiful, meaningful. But it's hard and at times scary and frustrating. No relationship is perfect- so you're bound to have down moments with this new little person at the center of your life. But the ups much outweigh the downs. 80% to 20% at least. Maybe more like 90% to 10%, now that my little angel is napping. And after a successful, long feeding, I got a smile. Totally worth it.