DISCLAIMER: This is kind of a negative post, but hopefully I’ll be able to balance it with a more positive one tomorrow. The lactation appointment mentioned herein went rather well, so I feel better about a lot of this :)
I feel like everyone has their own breastfeeding trial-by-fire story, but I never really understood why they felt compelled to tell it. Now that we have one of our own, I get it. Breastfeeding can be grueling and isolating, and there are just so many tiny things that can go wrong to derail the effort. By sharing these stories, we potentially connect with others who have been there before, and we possibly prepare others to steel themselves for their own stories. I’m not really convinced that ours will have a happy ending, but here it goes…
Once upon a time I thought I would breastfeed. Everyone says it’s what you should do if at all possible, and why wouldn’t it be possible for me? I’d been forewarned that breastfeeding takes some work, so I prepared by taking a class, reading a book, and filing away the contact information for a lactation consultant who I planned to call as soon as anything went awry. I probably should have gone to the La Leche League meetings that I looked up, but I guess I wasn’t ready to join the mommy club quite yet. I figured there’d always be time for that after the baby came and I had specific questions.
Breastfeeding developments over the past three weeks
Now that the baby is here, it’s very disheartening to admit that breastfeeding has been both the bane and the entirety of my existence. Our descent into breastfeeding insanity developed in the following phases:
- Hospital phase – I’d expected the hospital staff to help reinforce everything I’d learned about breastfeeding beforehand. Instead, every nurse had a different slant on the best way to proceed, and rather than teach me and explain what they were doing, they took over the whole latching process and just did things for me. Ultimately, this resulted in quite damaged nipples, setting the stage for an unhappy first week.
- Weight loss panic!!!! phase – Hospitals monitor newborns to ensure that they don’t lose too much weight. The cut-off for interventions is 10% of a baby’s birthweight. Talia lost 10.2%. Therefore, the nurses arrived with pumps and supplementary nursing systems (SNS’s) and formula and doomcasting. I didn’t know what hit me, particularly because the nurses’ explanations seemed nonsensical…something about conserving baby’s calories by pumping milk to feed her via the SNS, which made me think I shouldn’t breastfeed her. I asked the pediatrician and the hospital lactation consultant what on earth was going on, and they both said that we really needn’t be concerned by a 10.2% weight loss. But then a different nurse came in and told me that, by doctor’s orders, I needed to supplement with formula, so would we prefer Similac or Enfamil. It’s all a blur to me now, but all I can figure is that they weren’t really communicating with each other and everyone assumed that everyone else was on the same page…and they weren’t.
- Transition phase – When they were convinced that Talia’s weight wasn’t dropping further, they sent us home with permission to cease using the SNS but to continue pumping. However, I was still having trouble getting Talia to latch without hurting, so Jonathan set up an appointment with the private lactation consultant whose business card I’d stashed beforehand. Filled with hope that she’d help me avoid the pain and lay a foundation for success, we attended our 1.5 hour appointment…and came away with even more stringent instructions for interventions intended to help Talia regain her birthweight. We didn’t even talk about latches…she told me mine looked fine and that you can’t really identify a damaging latch until after the baby is done nursing.
- Insanity phase – For the past 15 days, we’ve been living in the eighth circle of breastfeeding hell. I believe it’s called “triple feeding”, and it goes something like this:
Every 2-3 hours, complete the following steps:
- Nurse the baby for up to 20 minutes (but for a minimum of 10 minutes) on each breast.
- Use the SNS to finger feed pumped breast milk if you’ve got it (nevermind that, 4 days into breastfeeding after a c-section, your milk might not even be in). If you’ve failed as a mother and don’t have enough breast milk, use formula and feel guilty.
- Pump for 20 minutes.
Yep. That’s what a “manageable” weight gain plan looks like. Seems easy, huh?
Why this progression is driving us crazy
As every tech writer can appreciate, consolidating a procedure into three steps like this should make it learnable and manageable. Except each of these steps has five million minor steps and chances to fail miserably…
- Wake baby (10-30 minutes)
- Position baby (1 minute)
- Latch baby (1-45 minutes, depending on how much the baby wants to scream at you for trying to feed her)
- Wait for baby to start to swallow (1-infinity minutes…babies don’t inherently know how to do this it seems)
- Hope that baby doesn’t fall asleep. If she does, rewake her (5-10 minutes)
- Hope that baby doesn’t bite you. If she does, relatch her (1-45 minutes, see above)
- Let baby eat (10-20 minutes)
- Warm supplement from refrigerator (10 minutes)
- Prepare supplementation device (3 minutes)
- Feed baby (10 minutes)
- Clean supplementation device (10 minutes)
- Set up pump (5 minutes)
- Pump (20 minutes)
- Clean and dry pump stuff (10 minutes)
- Extra as needed
- Change diapers (5-15 minutes, depending on how often she poops)
- Burp at various intervals (5-10 minutes)
- Lull baby back to sleep (15 minutes)
So, even though the consultant said this is a manageable plan because it’s just 20 + 20 + 20 minutes (I omit the 10 for supplementing because Jonathan can supplement while I pump), these steps can actually add up to more than the 3 hours you’re allowed to allow between the beginnings of feedings. Our routine seems to add up to 90 minutes given that Talia is VERY difficult to wake up and fusses a lot when we try to feed her. Our 90 minutes don’t even include 20 minutes/breast because Talia won’t nurse for that long anymore (though she used to).
Top this all off with recovering from major surgery, healing from damage caused by those initial bad latches, and enduring the general shock of new parenthood, and you get two emotionally fragile zombies. We were hanging in there with the near-promise that we’d be able to stop all this yesterday. Alas, Talia had gained only half of what she should have, thereby indicating that she still doesn’t really have the hang of breastfeeding. So we have to go back to the lactation consultant today to see if there’s anything else we can do. I betcha she says it’s the latch…
I can’t help but wonder what difference it would have made had Talia lost only 9.9% of her body weight and we’d been spared the time investment (and extended sleep deprivation) of all these different things. In that case, she still wouldn’t have known how to breastfeed well immediately, but I would have had more time to cuddle with her, watch her cues, and build an organic kind of breastfeeding relationship. We haven’t had time for any of that under this regimen. Ultimately, I’ve been able to find some positives to cling to (e.g. I know how to pump now?), but I think that tripling the initial frustrations of breastfeeding has made me thrice as likely to quit it altogether.
At any rate, we’re beginning to consider alternatives like maybe trying to exclusively pump for a while. Yes, “breast is best” when it comes to nutrition and immunity and lots of things I feel guilty about, but attention is obviously important when it comes to nurturing psychological development, and I honestly don’t have time to do both well right now. You might say “what about the attention she gets at the breast?” To which I might say “Well, if she weren’t screaming and/or falling asleep, that might be nice.” As it is, Jonathan and I spend most of our non-feeding time moping and/or sleeping, and that can’t be good for Talia. Furthermore, Jonathan has to go back to work eventually, and there is NO way I can do everything we’re doing without him. I’ll stop lamenting now, and we’ll see how our lactation appointment goes this afternoon and devise a strategy from there.
Non-sequitur: Problems we faced
In case you ever find yourself wanting a breastfeeding veteran to talk to, here are some of the issues we dealt with. I am deeply grateful to Laura, Kirstin, Nina, and Margaret for sharing their experiences with me, so I’d be happy to do the same for anyone else :)
- Bruised, cracked, scabbed nipples make breastfeeding painful. I’m mostly over this one, but it caused problems during the first week.
- My milk supply didn’t come in until 5 days after my c-section, so our introduction to breastfeeding during that first week was very frustrating.
- Baby is overly sleepy such that she doesn’t wake herself to eat and can’t easily be woken to make sure she gets enough feedings. This makes it difficult to make sure she eats frequently enough to get all the calories she needs to gain weight and stamina for more efficient breastfeeding.
- Baby’s lower jaw is tight such that she can’t naturally open her mouth wide enough to latch properly. This leads to a shallow latch that makes it harder for her to get enough milk with every swallow. It also makes it more likely to hurt. The consultant says that this problem will go away as Talia grows, but we probably won’t see improvements until she’s at least 12 weeks old.
- Baby’s palate is high and my nipple is small, so it’s difficult for the two to make contact in order to trigger the appropriate sucking mechanism. This contributes to the shallow latch issue.
- Baby doesn’t inherently lower tongue far enough to promote a deep latch. We’ve kind of trained her to be better about this.
- Baby is impatient. Sshe wants milk to be immediately available rather than waiting 30 seconds for a let-down. As a temporary fix, Jonathan finger-feeds her a little milk before I try to breastfeed her so that she has some kind of immediate gratification.
- Baby becomes frantic when eating such that she eventually can’t coordinate herself enough to suck appropriately. We think this might be reflux, so we got her some medicine to see if it helps.
- If baby doesn’t become frantic, she often falls asleep at the breast. Since sleep is her favorite thing, it takes us foreeeever to rewake her. Jonathan has certain magic powers regarding this, so I need to take lessons.
- Baby doesn’t swallow enough at the breast. Supposedly, she’ll naturally improve at this as she grows.
- Nipple confusion. As part of our various interventions, we temporarily used a bottle instead of the SNS to deliver breast milk. That was awesome until the baby started trying to apply the bottle sucking mechanism to the breast, which doesn’t work. So, no more bottle for now.
- When trying to combat some of these issues (particularly the shallow latch thing), I apparently forced the baby onto the breast too aggressively such that it made her dislike breastfeeding. Really, I don’t have psychic baby knowledge to verify this suspicion, but one of our lactation consultants thought this was the root of our issues. We’ve alleviated this problem somewhat, but I promise that our other issues are still there.
If we had just one or two of these problems, I’d have more hope, but as it is, these kind of compound each other. For example, to help Talia overcome her tight bite/shallow latch issue, I need to practice helping her get and retain good latches. In other words, I need to remove her from the breast when she latches too shallowly. However, every time I remove her, there’s a fair chance that she’ll start screaming, and then I won’t have any more chances to relatch her. Etc. etc.
Stay tuned for more hopefulness…as I mentioned, the lactation consultant was surprisingly helpful today :)