Saturday, February 12, 2011

Breastfeeding: the first days

In the first days following birth, there is an awful lot for a new mother to contend with. Not only are you exhausted from the marathon that is labour, but you may be recovering from your epidural, stitches, and the general pain that is associated with the initial post-partem period. On top of all of that is a tiny person who needs to be held and nursed every two hours around the clock. It's a lot to handle! Of course, no new mother wants to be seen as a complainer, or worse- incapable, and so we tend to keep the fact that we may be struggling to ourselves.

When I first came home with dear baby, I was in a lot of pain. I neglected to take the advice of my midwife when she had told me to stop pushing. Stop pushing? No way, I thought. As a result, I had some nasty tears that required stitching. Forget going to the bathroom every two hours as the nurses were urging, I could barely walk! It turned out, the difficulty walking also had to do with my pelvis being a bit twisted from labour (thankfully that was sorted out by a quick adjustment at the chiropractor, about ten days post-partem). I was beginning to notice a lot of redness around my nipples and it was becoming increasingly difficult to get through a feeding. The first blow to my nursing confidence came from the night-time nurse at the hospital. She told me that my dear baby had "the jitters" which was a symptom of low-blood sugar caused by ineffective nursing. He was taken to the nursery to have his blood tested. The first of three tests came back low. The nurse told me to continue nursing to see if it helped. "What if it does not go up?", I asked her. "He will be given formula", she answered. I was upset by this. I told her I did not want to give him formula and expressed my wish for him to be exclusively breastfed. She told me that if the test showed low sugar, I most certainly would be giving formula, otherwise he would be taken away from me to the second floor and put on an IV drip. I nursed him for 1hr and a half straight, trying feverishly to get his blood sugar up, crying the whole time out of fear and pain from the poor latch. It didn't do any good, the nurse was back an hour later with a tiny bottle of formula and a very stern expression that told me she wasn't fooling around. I didn't realize it then, but this was the beginning of my breastfeeding trauma. I knew the latch was bad, but I kept going because I was afraid of this nurse taking my son away. I was home only a few short hours before I wound up on the floor of the nursery, crying my heart out because I could not stand the pain. Unfortunately, it was merely the first of dozens of similar nights. Afraid that my baby was starving, I tried to pump the colostrum for him. When a mere 3/4 oz dribbled into the bottle, I felt panic. I did not know at the time that I was producing more than enough colostrum. Even though the books confirmed that a newborn baby has a stomach the size of a tiny marble, I was sure that he would perish by morning if I didn't get more food into him. I kept asking everyone if they thought he looked "jittery" until, finally my mother, bless her heart, phoned up the hospital to find out what what kind of formula they used and then promptly went out at 3am to pick some up for me. I didn't care if he had formula anymore, I just wanted him to be full and safe.

I tell this story, not to scare anyone, but to inform my fellow women that it is not all stars and lullabies and sunday walks when your motherhood adventure begins. I saw almost a dozen different lactation consultants and the conflicting information was very discouraging. Many, including my midwife, advised me against pumping because it would confuse my breasts as to how much milk to make. Almost everyone told me that bottlefeeding would create nipple confusion and negatively impact breastfeeding. Their opinions made sense, of course, breastfeeding is hard work for babies, especially new babies- so spoiling them with a bottle which requires hardly any effort to drink from- would surely sabotage my desire of exclusive breastfeeding. Some said use Lansinoh, others said skip Lansinoh. Some said use side-lying position because it's good for women with larger breasts, others said side-lying almost always guarantees you a poor latch. It was difficult, frustrating and overwhelming to sort through all of the information. I felt like nothing helped and every day led to another failure.

There was, however, one woman who did truly help me. Her name is Shelly and she works at The Early Years Center at my local mall. I told her that I was pumping milk and bottlefeeding mostly, while trying to breastfeed a couple times a day so dear baby didn't forget how to do it. She was the first person to tell me that it was fine. If I remember correctly, she said, "You do whatever you have to do to get to the next day. If you need to pump, then pump. If you need to bottlefeed your breastmilk, then do that too; don't worry about the "rules", just get yourself from one day to the next". She helped me with positioning. She helped me with my nursing confidence. She suggested I get myself some Dr. Jack Newman's All-Purpose Nipple Ointment. I was, and still am, very thankful for her help and advice.

Yes, I pumped milk. Yes, I gave my dear baby formula twice (once in hospital, and once that first night at home). Yes, used the nipple ointment for longer than was recommended. I did a lot of things that nurses, doctors, midwives and lactation consultants alike told me would ruin my chances at exclusive breastfeeding. Yes, it took 16 painful weeks, but I am happy to report that, despite the odds, I have been exclusively breastfeeding for two months now and I plan to continue for at least a year.

The following is a list of things that worked for me and helped me to finally achieve success:

1. Pumping. Yes I know. You're told not to. I also was told not to. The fact is, when you're at the point where you dread feeding your baby so much that the ticking of the clock brings fearful tears to your eyes, you need to give yourself a break. During the period of engorgement after my milk came in (about day 3), I would use a hand-pump to express just enough milk to soften my breasts a bit. I found that this helped dear baby latch better. If I tried to nurse with rock-hard breasts, dear baby would try to latch and slip off, causing me excruciating pain, so I stuck with it. Eventually, the damage to my breasts was so severe that I had to stop breastfeeding completely for about three days to give my breasts a chance to heal. During this time, I pumped and bottlefed the expressed milk exclusively. At first, I wouldn't get much milk and I would be stressed that dear baby would wake up at any minute and I wouldn't have enough milk for him. However, as I got used to it, I found that I was able to pump enough milk for two feedings in one go. So eventually, I was able to start storing milk away in the freezer It's very important to relax as much as you can when you are pumping in order to achieve a let-down and collect enough milk in the bottles to satisfy your babe. It is key to drink a lot of fluids, remember to eat nutritious meals and snacks and take your pre/post-natal vitamins.

2. Fenugreek and Domperidone

Domperidone is a prescription medication typically used to treat gastrointestinal problems, however, in high doses, it can really boost your milk production. I took three doses of dom (as I affectionately call it) three times a day and I really credit it as one of the reasons I was able to pump so successfully. Everyone knows that baby is the best pump and that an electric pump wont express the milk as effectively, but taking the dom makes your milk flow much faster and more freely, allowing you to express much more than you would be able to otherwise. I have talked to many a woman who has said that ultimately it was a lack of supply that ended the breastfeeding game for them and so anything that gets you to the next day is a good thing. Fenugreek is an herb, sold in capsule form that also increases milk supply. Once I stopped pumping every day, I no longer felt that I needed domperidone, and so I switched to fenugreek (two capsules, three times daily). Fenugreek has been very effective for me as well, as long as I have been taking it, I always feel full by feeding time. It's very convenient that it doesn't require a prescription, so you can pick it up any time. An added bonus- after taking fenugreek for a few days, you'll begin to smell like maple syrup, now who doesn't like that?

3. Sleep. Your body needs rest in order to produce milk. For some reason, new mommies always seem to feel as though they need to stay on top of everything. All you should be responsible for, especially in the first days and weeks post-partem, is dear baby's needs. My mother has this little saying, "Settle down cobwebs, dust go to sleep, I'm rocking my baby, and babies don't keep!". I do feel that this is excellent advice. Don't worry about laundry and dinner, when your baby is asleep, you need to be asleep too. I would get myself so horribly stressed over how I was failing at breastfeeding that I would lay wide awake in my bed worrying about the next feeding. The thing is, it's much harder to have the patience and persistence required to achieve a good latch when you are tired. An exhausted mommy is much more likely to just nurse through the pain rather than re-latch the baby and who could blame her? It's hard to find the energy when you're running on empty, so sleep, sleep, SLEEP.

4. Visit a lactation consultant. I've said it before and I'll say it again, breastfeeding is a confidence game. Having someone who can look over your latch and positioning, let you know what you are doing right and guide you in the right direction can be just what you need to build your confidence. Yes, it can be a bit of an easter egg hunt finding a lactation consultant that you truly gel with, but it is worth it to have that confirmation. Shelly was the only one who helped me achieve a good latch. Of course, six hours later, I was crying and unable to reproduce it, but it proved to me that it was possible- and so I continued trying and persisting until I got back there. It's true that I was never able to solve my problems with a visit to the lactation consultant. It's true that I ended up pumping every day until my son grew a little and got better at breastfeeding on his own. But it's also true that the positivity, encouragement and confirmation that I was doing the right thing did wonders for my self-esteem as a mother and sole provider of nourishment to my son.

5. Get yourself some Jack Newman's All-purpose Nipple Ointment. If you are experiencing excruciating nipple pain, as I did, or if you are suffering damage to your nipples, as I did, then I recommend that you get yourself a prescription for this nipple cream. By the second week of breastfeeding, the damage to my right nipple was extensive. I had three cracks, one of which was a full-blown, oozing, open gash that would stick to my nursing pads and bleed every time I tried to nurse/pump. It was beyond painful and no matter how much lansinoh I delicately dabbed onto it, it just would not heal. A lactation consultant recommended the APNO and my poor little nipple was healed in three days. I used it sparingly after every feed/pump and it helped a lot with the pain. It is available with or without ibuprofen and I would suggest that you get it WITH the ibuprofen, as it helps to relieve the pain as it heals you.

Those first days are wonderful, hectic, exhausting, satisfying and full of love. You are discovering yourself as a mother. You are experiencing a love like no other. There are many emotions that swirl around a woman in those first days and weeks after delivery. One moment you may feel that you have finally got it figured out, the next you may feel completely lost to the world. With so much going on, the initial struggles of breastfeeding can leave you feeling doomed, but it's important to remember that you can only do as much as you can do. Babies are born loving their mothers. They are born with the instinct to nurse and feel a closeness to their mothers. I feel that there is a lot of fear-mongering that goes on in the nursing community, threatening nipple confusion and nursing derailment to women who want to pump and bottlefeed to give their bodies a break from nursing pain, or offer a pacifier to calm a screaming child. I personally don't believe in nipple confusion. My mother said to me all along that a child who knows the breast will always go back to the breast. My dear baby was fussy at the breast for a few days once I tried full-time nursing again, but it was only a few days and then he took to it like he had never left. Of course, I would never wish my situation on my worst enemy, but listen dear mamas- don't beat yourself up. Take Shelly's advice and do what you need to do to get to the next day. There were many times where I couldn't see a light at the end of the tunnel, but I persisted, I did only as much as I could and I now nurse my son as often as he likes, pain-free. If even one woman benefits from the advice in this post- I will be happy, as I know how hopeless it can all seem in the beginning.

Diadima xo

The miracle of life- twice in one day!

This past Thursday, two new, little Canadians arrived on the scene.

In the morning, A- friend, funnygirl and Prince Edward Island Princess welcomed her son Hudson in to the world...11lbs 1oz (yes, you read that correctly), Hudson is already sporting chubby cheeks and beautiful eyes, sure to be well-loved by his big sister. Congratulations to A and the new, little man in her life!

Then, in the evening, R- university pal, stage-manager extraordinaire and fellow cloth mama brought little Isaiah into the world...7lbs 7oz (the same size as my dear baby, a very good size ;-), Isaiah is warming the hearts of all who lay eyes upon him. Congratulations to R, a first-time mommy- you did it, girl!

I'm so pleased and proud of both mommies and look forward to meeting both of their little angels.

Diadima xo

Wednesday, February 2, 2011

Mother's Milk

As I have mentioned before, breastfeeding was an incredibly difficult part of motherhood for me. The road to full-time nursing was rocky, painful and took sixteen long weeks to traverse. However, today's blog post is not about re-hashing my breastfeeding trauma. Today's post is about informing nursing mothers of the three-month milestone and how to push on through.

What is the three-month milestone, you ask?

Before I explain, I want to go over a few little facts about milk production. After giving birth, your body experiences a flux of hormones, in particular, oxytocin. Oxytocin is often referred to as the "love hormone". Your body releases a burst of oxytocin as your uterus contracts and your cervix dilates; it helps to facilitate labour and breastfeeding. Prolactin is another hormone that facilitates breastfeeding. Oxytocin causes lactation to begin and your breasts to fill with milk. Prolactin regulates milk production in the breasts. So for the first several weeks post partem, milk production (which is triggered by your baby's first suckling at the breast) occurs as a result of your hormones.

During this time, your boobs will be full almost all the time (except for right after a feeding) and feel heavy and probably a bit sore. The thing is, your body knows you have given birth, but doesn't know how many babies there are, so you will be storing far too much milk for one babe for the first couple of months. It takes some getting used to, for sure. Like most things, once you get used to it, it changes. After months of waking up in the morning to full, heavy breasts, you will wake up one morning to find that they seem empty and flaccid. And you will feel worried. And you will fear that your milk is drying up. And you will wonder how there could possibly be enough to feed your baby...

This is what I call the three-month milestone.

For me, I have very sensitive milk ducts that get easily backed up. If I didn't pump or nurse every couple of hours, my breasts would get very hard and small, tender lumps would form. So imagine my surprise when I woke up after nine hours of rest (my wonderful dear baby slept the night) and my breasts were not full. I was panicking. I took a double dose of domperidone and drank glass after glass of water and juice. I took bags of milk out of the freezer to thaw on the counter. I was seriously concerned that just as I was finally able to start nursing dear baby full time, it was all going to come crashing down due to lack of production.

It was around this time that I had a little conversation about my situation with my friend, S. S gave birth to a little baby boy just two weeks after me and the two of us have been discussing pregnancy and motherhood since we were twelve weeks along. She confided that she was also concerned about low supply and a lack of fullness, especially in the evening and first thing in the morning. After consulting with her midwife, she told me that as long as dear baby is nursing, seems happy and has lots of wet diapers, then milk supply is fine. The thing is, even when someone tells you this, you will still experience doubt.

It is important to remember that your body is designed for motherhood. With so many books, resources, the internet and advice, it's easy to mistrust your own instincts but the fact is, your body IS designed for motherhood. Have faith that you have everything you need to nourish your baby and your baby knows instinctively how to get it.

So when the three-month milestone rolled into town for me, I took S's advice and continued nursing on through, trusting that my baby was getting enough milk. It turns out that, like your mothering skills, your milk matures over time. As you go along on your nursing adventure, your milk will change more in quality than quantity. It will become richer and more nutritious. You will notice that your baby feeds for less time, not because there is no milk, but because he, too, has honed his breastfeeding skills and become much more efficient. Ever since the three-month mark, my breasts have rarely felt full, even after a full night's rest.

The big physical change that occurs during the three-month milestone is largely hormonal. Up until now, your milk production has been a result of hormones. After the three-month milestone, those hormones start to back off and your milk is produced based on how often your baby nurses and how much he requires. Your body recognizes that there is no longer any need to store lots of extra milk and so production becomes tailored to baby's needs.

And so to all of my nursing mamas who are worried that their milk is in jeopardy, I hope this bit of information helps you to trust in your body and keep on nursing. You may feel worried and wonder if you need to supplement your dear baby with formula to ensure that he is properly nourished. Of course, it is always best to consult your doctor or midwife in these matters, but if your baby is well and happy and has plenty of wet diapers then you don't need to worry. Just keep on keeping on and have a little faith in yourself.

Diadima xo