Breastfeeding — Fundamental to Survival

…and yet, one of the hardest things I’ve ever done!

I lecture my patients about the benefits of breastfeeding.  For babe this results in reduced rates of asthma and eczema along with childhood obesity and diabetes.  Benefits for mom include more rapid weight loss following pregnancy and reduced breast cancer rates.  The science supports breastfeeding!

As a species, we’ve been doing it for millennia.  Babies in many countries are strictly breastfed.  How hard could it be?  I was not prepared for how truly difficult it could be!!  Why didn’t anyone tell me???

After my midwife handed me our new little bundle of joy, I recall asking, “now what?”  It all started with the fun game of trying to latch. I’d borrowed a Boppy breastfeeding pillow from my sister-in-law, which helped with support.  The latch was indeed a struggle but besides the intense pain, bleeding, and lipstick shape of my nipples (sorry, TMI) following feeding I thought he was at least getting something.

We continued to think we were latching just fine and since those first couple days only colostrum is produced, it seemed as though he was getting enough.  Likely, because I was an obstetrician-gynecologist the lactation consultant came in and checked, provided a mini lesion, and gave me a rapid seal of approval.  We thought things were going well except for the pain I was experiencing.  Just figured this was standard and onward we went, leaving the hospital 26 hours after his birth and admittedly, feeling a little lost.  I was used to just delivering the babies and handing them to new parents, what happened after that was beyond me.

Fortunately, because of our type of insurance we had a home health aid come to see us after being home for just two days.  I thought actually that those patients who needed this most probably wouldn’t receive a home health visit, because of their insurance (that is for another blog:).  We’d noticed he was looking a little yellow from our partly opened eyelids. However, in a state of exhaustion and shear overwhelmingness of bringing home this little creature that depends entirely on you, I wasn’t up to making medical judgments at that point.  His bilirubin was high, but not necessitating a trip to the hospital for bili-lights, just some window sunlight and working on getting more feedings in. He’d also lost more than 10% of his weight by this time so that meant we’d be seeing the pediatrician sooner.  It also meant we had to supplement with formula, which was a devastating blow to my well laid out plan.

The paper we were sent home with to record this information became too chaotic.  So, Kadin got his own iPhone to start recording on an everything-Kadin app.…time on each breast, which breast, weight before and after each feed (yup, we rented a scale), weight of each pee and poop, and keeping a timer set so he received his every two hour feeds.  I recall more than once being in the middle of feeding and the alarm would go off and it’d be time to feed again.  “But we’re still feeding”, I recall asking my husband tearfully, “What should we do?”  I’d already been curling my toes for the past two hours and he got, oh about 2 mL of breastmilk. (yes, that’s basically 4 drops).  In between the attempts at feeding I was pumping so that there was milk to supplement him with in addition to the formula.  I was also trying to stock up so that when I did have to go back to work at the end of the month, I’d be able to have a store in the freezer.

Ugh, feeling like you are a dairy cow your first days home with your new baby, while being sleep deprived, hormonal and stressing over how much your little one is getting made things a little rough in the beginning.  Thank goodness for a very supportive husband!  I could see how easy it would be to just say, “Okay, go ahead and give him formula.  I’m sleeping tonight”.  Ahhh, it would’ve been so easy but my husband believed in breastfeeding as much as I did.  It’s hard to deny the literature when you are scientifically minded.

There was a “Day One” center near our home in San Francisco and near daily trips filled our first week to get breastfeeding supplies.  Thank goodness for such a resource!  I’d love to be a resource for others in such a way.  A Medela Supplemental Nursing System was our first attempt.  That was no easy task to tape that to the nipple, wear a necklace with a small plastic container on it and get him to take it in.  It was constant feeding, weighing, diaper changing, weighing, and pumping, repeat.

I recall our first pediatrician visit.  Immediately before the appointment he had a pee and I cried, “that’s 30mL lighter he is going to weigh!”  The pressure to weigh in daily a pound or so heavier was intense.  Looking back, it was a lot of pressure that I put on myself to breastfeed.  How can I counsel my patients about it, if I couldn’t do it myself?

Our first visit was with a nurse practitioner who was a lactation specialist.  She helped us latch and yet he still only got a minimal amount.  I cried.  I’d asked her about a breast shield and she recommended we wait.  We sat in there an hour trying to get him to feed.  Our new assignment was to get additional breastmilk/formula mix via a syringe following attempts at breast feeds.  We’d see her tomorrow.  So, for the next 24 hours I remember stressing about getting enough into him and hoping he didn’t pee or poop right before our appointment weigh in.

So, the cycle continued.  This next 24-hour cycle, intermittently giving syringe feeds to get enough in.  I’d been pumping like mad in between feeds too so that we could get rid of the formula.  Oh, how obsessive we were about this whole breastfeeding thing.  It’s all recorded on Kadin’s App on the iPhone.  I’ll have to figure out if I can download this data at a later date, just to show.

We had an appointment the next day with another lactation consultant in addition to the pediatric nurse.  Thanks to syringe feedings overnight he got enough and made his weigh-in that visit.  We again tried to feed in the office and the amount was minimal, again she recommended we wait on the breast shield.  I wanted to try something and was beginning to feel more than a little frustrated.

Later that afternoon I had another appointment with a different lactation consultant.  She worked with us for nearly two hours and we had moments of success.  Again, I asked if a nipple shield will help and yippee, she gave me approval to give it a shot.

Thank you Medela!  The partial coverage nipple shield maintained a sense of contact with my little one and amazingly, once I figured out how to put it on, our feedings instantly improved.

We still had to supplement with syringe feeds and he seemed to always be feeding but by the end of the first week we were released from further regular weigh-ins and we returned the scale.  We finally got to enjoy our little one and stopped our obsessive recordings.

It took about a week to finally get rid of our “training wheels” so to speak.  One day when feeling particularly confidant I decided to pull it off mid-feed.  While I wouldn’t say it was comfortable exactly, I had nowhere near the pain I’d experienced before and it finally seemed he got enough during the feed, we both just clicked and it FINALLY, seemed like the natural thing to do.

Even with it being my Chief year of residency we actually made it nearly ten months of exclusive breastfeeding!  My goal was a year so I was shy of that goal but felt okay when the day came that production was down, the stores in the freezer were decreasing, and he was taking in more solid food.  However, the benefit of that effort was worth it!  He got all the benefits of breast milk and I got to bond with my child.  It’s hard when you are in the midst of a hormonal and sleep deprivation haze to be rational so I decided to write down for myself what I’d um, tell myself next time.

Basic Breastfeeding Recommendations:

  1. Don’t stress too much!  If you are pumping and feeding your little one breast milk, they are getting the needed nutrients and immune cells, even if it’s administered via a bottle.  It’s okay if you have to supplement with a little formula, it won’t kill them.  Plenty of children were raised on formula alone.  I even found out from my mom that starting with my second week of life she switched to formula only.  I like to think I turned out OK. Get support from family/friends!  Thank goodness for my husband who was so incredibly supportive and when Kadin and I would get frustrated, he was a calming voice.
  2. Get support from family/friends!  Thank goodness for my husband who was so incredibly supportive and when Kadin and I would get frustrated, he was a calming voice.
  3. Get outside help early!  It helped to know that I had appointments with lactation specialists.  Even if we weren’t solving all the problems yet I was checking in with someone else who always had some new suggestions to try.
  4. Breast shields may actually help!  I understand the concern of the pediatric nurse and Kadin not getting enough milk or using it as a crutch but once we started using it things seemed to dramatically improve.   At least I wasn’t in tremendous pain anymore and I could help express milk into the shield for Kadin to drink.  It was a crutch for just about a week but allowed us to get the feeding latch down so when I took it off we were both ready.
  5. Breastfeeding pillows can help!  Borrow from others and use your own cover until you find something that works for you.  I know people who bought a bunch of different ones.  Seems kinda wasteful to me but when you have a new little one you are just trying to find the best thing around.  I found the borrowed Boppy worked fine for me.  My sister-in-law ended up using My Brest Friend.

Since I’ve been reading more about organic products, while the Boppy and My Brest Friend have organic versions of their products, there are a couple of smaller companies that I wish I had known about before.  If you are thinking about buying one maybe support one of these smaller companies who practice a sustainable business model.

Holy lamb is a company with a great ‘feel’ when you read about them.  They produce essentially an organic wool Boppy.  They make their products in the United States using locally raised wool, re-use, recycle or compost all their materials, and subscribe to green practices in their facilities.

Another small company with sustainable practices and a small town feel is Blessed Nest.  ”Made locally by hand, by moms, aunties and grandmas” as their website proclaims.  They make an intriguing half-moon nursing pillow I would’ve liked to try, may be more comfortable for larger women or those who had a cesarean section and don’t want to put something around their middle.  It’s made from 100% organic cotton fabric and stuffed with buckwheat hull filling.  They claim the buckwheat hull filling latches and help it conform for support.

Just keep working at it and it will eventually click!  You may have to feel a little like a dairy cow, pumping to keep up your supply, but persistence really did pay off.  I feel like I gave my little one the best start possible and once we both got it, it was sooo worth it!

Friends of ours recent birth of a little boy, who are having difficulty breastfeeding, reminded me of our own experience, not that long ago and yet a lifetime ago.  This is dedicated to all mommies having a tough time breastfeeding and thanks to their support crew.  Keep it up; you’ll get there!!

Be sure to see your lactation consultant if you are having difficulties!

 

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