Saturday, August 6, 2011

Breastfeeding Story #2 - Tongue-Tie, Bottle Addiction & Other Fun Stuff!

In honor of World Breastfeeding Week, here is the story of our battle-to-breastfeeding with our youngest (or rather, now middle!) child. I started writing this story when he was eight months old and am finishing it when he is now 23 months old (procrastination, anyone?), so you will understand any discrepancies in times mentioned.


Here goes! The trials and triumphs of breastfeeding with our youngest, now age 8 months (and who is sitting on my lap making succulent slurping noises sucking on his fingers). And thankfully, I wrote all my dates down, so it will at least be somewhat accurate!

September 1st - Baby arrived! My labor time from water breaking (with immediate onset of labor contractions) to birth was 7 hours 11 minutes, a classic and short second-baby labor.

We started out with a few issues. Firstly, baby was a slow starter. His heart rate plummeted during second stage, necessitating a hurried pushing phase, and he needed quite a bit of stimulation and suctioning to get him going. He had a rough couple of first days, and scared us to death his second night, when he started having coughing/choking fits that made us afraid he was going to asphyxiate. Somewhere around midnight or two in the morning, we were alarmed enough to call both our midwife and our pediatrician, and at one point (when he turned himself black before starting to breathe again), DH nearly packed us into the car to drive to emergency. Thankfully, soon after this my milk came in, which for some reason cleared up most of baby's problems - his choking episodes stopped, his skin cleared up, and he was a lot happier. So were we!

But then our real problems started! Although I had committed to a two-week lying in (or babymoon) in order to rest and get breastfeeding established, nursing did not go well. Baby would not stay latched on or nurse well, and our nursing quickly stretched out into frustrating hour-long sessions. Furthermore, his weight at his pediatrician's visits was not looking well either. When we saw Dr. M on day nine, he was concerned about baby's weight and told us to focus on good breastfeeding. When we came in for a weight check two days later, baby's weight had not only not improved, but had dropped further.

And this is where good medical care steps in and saves the day. Most pediatricians would have said quite firmly, "It's time to head to the store and buy him some formula. Now." Our wonderful pediatrician, on the other hand, said "It's time to head to the breastfeeding store and rent a breast pump. Now." And with that, he single-handedly saved our breastfeeding relationship. Ladies, care providers are so important! They can make or break a situation - whether it's a birth or a breastfeeding relationship or anything else. Be so, so careful whom you choose to shepherd you through life transitions and medical issues.

When we left the pediatrician's office, though, I was in a state of shock. I had just recently concluded a 33-month breastfeeding relationship with our eldest, and I thought that I knew the ropes. This couldn't be happening to us!

By the time that we had driven halfway to the breastfeeding store, I had talked myself into thinking that I didn't really need the breast pump. Instead, I convinced my husband to rent a baby scale, by which method we could keep an eye on baby's milk intake, and thus ensure that he was getting enough.

That was Friday. Thereafter followed one of the most stressful weekends of my life.

By his weight, baby should have been taking in about 2 1/2 ounces of breast milk at each feeding. With the scale, I soon found that our little dude was falling horribly short of this - most of the time he was taking in an ounce at most - sometimes half an ounce, sometimes nothing. And that would be after more than an hour of trying, with multiple breaks for weighing. It was utterly exhausting, horribly frustrating, extremely frightening, and in the end, futile.

By Monday, when our midwife visited to check on us, I was near tears and ready to cave. When she left, we followed her out to the driveway and drove directly to the breastfeeding store, where we rented a breast pump and bought all the necessary paraphernalia (bottles, breastmilk bags, etc.). We headed home and I did my first ever pumping session. Immediately after pumping, we poured the milk into a bottle and fed baby - he took a large amount of milk and was extremely happy about it. The relief was exquisite. And from then on, he ate well from the bottle and began to fill out properly and gain weight again.

After that, my life revolved around pumping! Prepare to pump, pump for 20 minutes, process milk (store, freeze, etc.), attempt to breastfeed baby, feed bottle to baby - and repeat every two hours, all while trying to look after the house and an extremely active three-year-old. Oh, and I should mention that at this time my husband also sustained a serious back injury when slipping in our flooded kitchen - so I was doing single parent duty as well!

Not fun.

A couple of notes:

I was supposed to pump around the clock, but sheer exhaustion kicked in and I was unable to do so. My willpower at 2:00 a.m. was non-existent. I was told that my supply would drop as a result and would eventually dry up, which freaked me out, but as a matter of fact it didn't - I was in oversupply and was able to freeze a full 12 ounces of extra milk a day (plus that which had to be thrown out when it didn't get used).
Additionally, I did a big no-no - I co-slept and bottle-fed at the same time. Apparently this is hideously dangerous, because a bottle left propped in a baby's mouth while the mother sleeps can wick milk out into the baby's mouth and drown it. I didn't know this, and I didn't realize that until there was a bottle-prop drowning case a year or so later, and I read up on it. I felt very blessed! Of course, I had noticed that the bottle would slip out of baby's mouth and wick all over the sheets, leaving a huge mess, but I didn't make the connection. All you mamas out there - now you know.

Continuing on:

Breastfeeding continued to be an utterly frustrating flop. I tried, but it just was not working. I began to talk on the phone with the breastfeeding store's IBCLC lactation consultant, and she mentioned that it would not be catastrophic if I gave up breastfeeding for the time being. As long as baby was being fed and my supply was kept up through pumping, there was always the chance to reintroduce breastfeeding in the future.

And so, while it was hard to do, I gave up attempting to breastfeed, and it was truly a big relief. With pumping, bottle-feeding, trying to breastfeed, and processing milk, I was spending almost all of my daylight hours on feeding time - it was more than I could handle. So for the moment, we were just pumping and bottle feeding.

I made an appointment to see the breastfeeding store's lactation counselor, and when we went in, she immediately diagnosed tongue-tie and advised getting it clipped. Finally, a diagnosis!

So I headed back to our pediatrician - only to find out that he didn't do tongue-tie clipping. Being extremely non-interventionist (which normally was wonderful), he preferred to leave things to nature and give an older kid exercises to do if he still had a tight frenulum when older. But since we needed something to be done now, we got a recommendation for another pediatrician who did tongue tie clipping (Dr. A in Phoenix), and we went to see him.

We had baby's tongue-tie correction done when he was five or six weeks old. The pediatrician told us that it was rather late to have had it done, and afterwards we found this to be true. Breastfeeding attempts after the procedure quickly showed that while baby could nurse, he had no intention of doing so! He was good and bottle-addicted. We were again at an impasse.

At this point, we received advice from two different quarters that was directly conflicting:

Advisor #1, the lactation consultant - We went and saw the lactation consultant. Baby refused to nurse even with her help. The advice we received from her was to spend a lot of skin-to-skin time with baby, and never to let him get upset at the breast (to avoid negative breastfeeding associations) - coax him into breastfeeding.

Sounded nice, but (1) I had no success with it, (2) with the way life was going, I had almost NO time to sit around doing skin-to-skin time. It just wasn't possible.

(I should also mention that she gave me breast shields to try. No dice.)

Advisor #2, our pediatrician - Later the same week, we saw our pediatrician, and he told us that our only hope was to make baby get upset at the breast - i.e. to withhold the bottle and let hunger do the job.

Talk about conflicting opinions! 

Well, it sounded a bit nerve-wracking, but since method #1 had turned out to be a total dud, we decided to give method #2 a go. The following Saturday, November 7th (baby was about 9 weeks old), I cleared my calendar, prepared to stay in bed all day with baby, and gave him his last bottle at 8:00 a.m.

Then we waited.

Baby would wake up, fuss, I would offer the breast, he would refuse, and go back to sleep. Repeat and rinse.

This continued for seven hours, until 3:00 p.m., when he finally caved. Beautifully and magnificently. Not only did he breastfeed, but he had an enormous feeding and never refused the breast again.

And he has not had even one bottle since then (in almost two years). Score one for the pediatrician!

The only unpleasant side-effect was engorgement, the end-result of being in over-production and having to slow down to baby's needs. I had never experienced engorgement before (or nothing like this!), so that was a surprising and unpleasant experience. I pumped once or twice for relief, but thankfully it only lasted a few days. Good thing, because it's no fun having red-hot watermelons taped to one's chest.

I learned a lot of lessons through this experience. First of all, I learned - again! - how difficult breastfeeding initiation can be, and how necessary and essential it is to be surrounded by breastfeeding supportive caregivers. With almost any other caregivers, this story would have ended in a formula-fed baby. Please, please, please choose your caregivers wisely.

Before anyone shoots me an indignant email: Yes, I know there are some situations in which breastfeeding is indeed physically impossible or where mothers do indeed have to supplement (I have had several friends in this situation), and I'm not trying to deny that or to put down mothers who cannot breastfeed. But this was not one of those situations, and good care got us over the hurdles rather than sabotaging our best efforts unnecessarily.

Secondly, with as much as I had learned in 33 months of breastfeeding our eldest, there were still unplumbed depths to breastfeeding that remained completely unknown to me. And there are still many breastfeeding difficulties that I have not yet encountered! Never underestimate your opponent.

Lastly, touchy-feely methods aren't always best. Sure, it sounded great to be all mammal-ish and snuggly with baby, but it wasn't getting us one bit closer to breastfeeding. The cut-and-dried method of our ever-realistic pediatrician did in seven hours what the touchy-feely method probably would never have accomplished. (And he had accomplished similar success using a similarly cut-and-dried method with our eldest son, for different problems.) I have found this to be true in much of parenting. Good lesson.

Oh, and as a side note, I also learned personally the effectiveness of the "dead baby card." Traditionally, the dead baby card is when an OB (or nurse or midwife or whomever) says something along the lines of "No, you don't have to consent to [procedure X], but if you don't your baby will die!" It's used quite commonly, unfortunately and it's almost 100% effective in coercing compliance. Well, I experienced this! And not even in a bad way. When I was talking to the IBCLC, she mentioned offhand something along the lines of "well, you just need to make sure that the baby is being fed, because if you don't, there won't be any baby to feed." She wasn't even being malicious! But being under the immense amount of stress that I was (not to mention sleep deprivation and being newly postpartum), that almost put me into hysterics. It's no wonder that the technique is so effective.

So that's our story! Hopefully it can help someone out there. I am hoping beyond hope that our 3rd baby will be an easy nurser, because I have had quite enough of breastfeeding crises! I'll report back on that later.

Happy World Breastfeeding Week!

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