In NICU, attempting to breastfeed for the first time

Welcome, Readers of February’s Carnival of Breastfeeding! After you read this, check out the other great posts on the theme of “Overcoming Breastfeeding Challenges” linked at the bottom of this post.

I’ve spent more than enough time dwelling on all the things I did wrong after my son was born, as you can read in my earlier post, When breastfeeding begins badly, and what I should have done about it. Here’s what I’ve learned from my experience, and in the work I’ve done with breastfeeding moms since then:

1. Many (but not all) breastfeeding problems can be prevented.
2. Nearly any breastfeeding problem can be overcome with help from an International Board Certified Lactation Consultant (IBCLC),  enough support at home, and determination.

I did it.  Here’s my story about how we fixed our breastfeeding problems.

But wait. It’s really important for me to write a disclaimer here. Every mother-baby couple is unique. What was recommended for me might not work for you. I share my story not to give advice, but to let you know that if things are going badly, there is still hope! Don’t give up; get help. If you’re having problems, don’t put off seeing a lactation consultant. The sooner you get help, the easier it will be.

Our breastfeeding problems, in a nutshell

My son nursed very poorly for his first few days of life. Then, I developed serious postpartum complications and my doctor advised me to stop breastfeeding for a week (I  “pumped and dumped” to keep the milk coming) while on medications. When I tried to resume nursing after a week of the bottle, my baby would arch his back, cry, and push away when I offered the breast. We went on for what felt like ages like this, while I was heavily supplementing my baby with formula and crying at nearly each nursing attempt.

There was no single, quick fix, but rather a succession of measures prescribed over a period of several weeks by the lactation consultants I saw. Here are the steps we took, under professional guidance.

Get the baby on the breast ASAP. Even though that meant using a nipple shield.

I was adamantly opposed to nipple shields at first, but I learned that sometimes, these are just the right tool. Not only was he barely latching, but my nipples were bleeding from the failed attempts. Taking the breast with a nipple shield is infinitely better than no breastfeeding at all. So we got my son onto the breast, while I pumped after feedings for his supplements to try to build my milk supply. But this wasn’t enough- after awhile my milk still wasn’t increasing and he wouldn’t take the breast well without the nipple shield. Back to see the lactation consultant.

Get a really, really deep latch.

The lactation consultant said I was doing a pretty good job of bringing him onto the breast, but his latch could be even better. She showed me what she called “the deep latch technique” that helped my baby take more breast in his mouth than I thought possible. Having him on so far was more comfortable for me, and it helped him draw out more milk.

But my baby didn’t like how it felt. The breast reaches farther back into the throat than a bottle, and he wasn’t used to it. I had to hold him forcefully to prevent him from pulling  his head backward and weakening the latch.

So we finger-fed. After breastfeeding, instead of giving a bottle of supplemental milk, I would bring him to my mother or husband for a finger-fed supplement while I pumped. They would stick their index finger waaaay back in his throat while injecting supplemental milk into the corner of his mouth with a special syringe. When he sucked the finger, they would release milk. When he paused, the milk flow stopped.  He gagged at first. This was hard to do, (my husband says this is a huge understatement!) but it helped him learn to accept the breast.

But he sucked lazily at the breast, perhaps because he knew more milk would be coming after the breast to fill him up. And because I still wasn’t making enough milk.

Make more milk.

My milk supply was low from the very beginning, for a number of reasons. At 5 weeks, the lactation consultant’s scale told us that he only took 1.9 oz from both sides after 45 minutes of nursing.  I took herbal supplements to increase milk supply and pumped with a hospital-grade breast pump after feedings to stimulate milk production. By 6 weeks, I had enough milk that we stopped the supplemental formula. His supplements after nursing were nothing but pumped breast milk.

But by 8 weeks, he still wasn’t nursing efficiently enough to get a full feeding at the breast. The lactation consultant taught me how to use a supplemental nursing system (SNS), a contraption that delivers supplemental milk through a tiny tube at the breast while the baby nurses. It speeds up the flow of milk,  making him suck more vigorously, which in turn stimulates more milk production.

Happily ever after

So there you have it. I gradually increased the number of un-supplemented breast feedings until he was off all supplements and taking nothing but the breast at the age of 4 months. At 6 months, I went back to work, pumping milk for his bottles, and nursing while home, and now at 14 months we’re still breastfeeding mornings, nights, and weekends. My son loves to nurse, asking for “nuh-nuh”, although he’s so busy playing and his tummy gets filled with solid food, so it’s not as often anymore.

Was it worth it? Yes. Many, many times, I nearly gave up. It was really hard. I couldn’t have done it without help from family and encouragement from my pro-breastfeeding friends. But this is what motivated me to stick with it. Knowing that my baby would be as healthy as possible. That once we got the hang of it, nursing at the breast would be so easy; ready anytime, anywhere with no preparation or cleanup. That I would have this special way to comfort and soothe him throughout his infancy and beyond.

Again, my story is not a formula to solve the problem of breast refusal. There are a number of approaches to coaxing a bottle-drinking or supplemented baby onto exclusively nursing at the breast. Read a great article about that here. And if it’s just not working, a lactation consultant may have a solution.

Did you have difficulties in breastfeeding? How did you overcome them? What motivated you to persevere?

Other Carnival of Breastfeeding Posts:

Breastfeeding 1-2-3: The importance of a babymoon

The Motherwear Breastfeeding Blog: Which obstacles have you overcome to breastfeed?

Hobo Mama: Supplemental feeding techniques for a breastfed baby (some of the same techniques I used!)

Whozat: A rough start

Maman A Droit: Clueless!

Jessica Montalino: Motherhood: Week 7 and our breastfeeding experience

Breastfeeding Moms Unite: I’ll be brief: How to overcome breastfeeding challenges

Living Peacefully with Children: When nursing takes longer

Good Enough Mum: Tounge tied and twisted

Mama’s Herb Garden: Nine things your nipples wish you knew about them

Enjoying a day with my son at the Rose Parade

Hello, readers! I do realize it has been 20 days since my last post. There’s more coming, I promise. But first, I want to give you a personal update.

When I started this blog, I was working part-time while mothering my 8-month-old baby, but now I work full-time.  I’m not complaining: although it’s financially necessary, (my husband is a full-time graduate student) I truly enjoy the work I do. But the work schedule leaves me with an hour and a half every weekday evening with my son before his bedtime. It’s not enough. As soon as he’s in bed, I’m preparing lunches, laundering or packing cloth diapers, washing breast pump pieces, and packing everything up for the next day.

One post per week is challenging for me. I wish I could write faster, spend more time blogging, and post more. I’d love to interact more with the blogs I enjoy and admire. To answer the great questions some friends and readers have emailed me (sorry guys, I haven’t forgotten, especially about those milk-supply and pumping questions). I just haven’t found a way to do it all without cutting into my sleep or family time.

I’ve just had a burst of encouragement from three sources: a friend/fellow blogger who I admire recently told me she wished I posted more often; a company contacted me to do a review/giveaway of their product, and I just discovered links to some posts I have written on message boards and discussions. So I’m inspired to spend a little more time here and to let you know that The Milk is still flowing. . .

Helping Mama unpack the breast pump

My son is a year old now, and we have officially entered the world of “extended breastfeeding.” In my last post, I explained a little about my decision to continue nursing my son.

But as a full-time working mom, a big part of breastfeeding is pumping. I’m away from my son for over 10 hours at a time on my working days. For the past several months, I have faithfully pumped breastmilk 3 times every day at work.

Nearly all the working, breastfeeding mothers I have known have stopped pumping by their child’s first birthday, if not before. “If you’re ready to ditch the breast pump or pricey formula, you’re right on schedule,” I read today in my daily What to Expect email, targeted to the birthdate of my son.

In our society, fully breastfeeding to a year is a rare accomplishment, but pumping beyond a year is even more unusual. Nursing a toddler at the breast is often as much, or more, about the close relationship and enjoyment of breastfeeding as about the nutrition of breastmilk. In comparison, pumping milk is strictly business. There’s little enjoyment in sitting hooked up to a machine and washing pumping equipment through the day. Since at a year, babies can drink cows milk, mothers who have been pumping can quit without having to use infant formula.

I don’t love pumping. But I DO love breastfeeding my son when we are together. With long workdays, my milk supply might drop quickly without daytime pumping.  I intend to breastfeed to at least 2 years, and I want to maintain an ample milk supply. Drinking pumped breastmilk gives my son the best nutrition possible, and that’s important, but what motivates me the most to keep pumping is that it helps to maintain our nursing relationship.

So my decision is to keep pumping, but now I don’t have to pump quite as much. There were times in the first year when I thought I would run out of milk, and now I no longer have to worry about milk supply. If there is an office party during the lunch hour, I will skip pumping without guilt or stress.  I will probably drop gradually to pumping twice a day, then once a day, over the next year.

I would love to hear from other moms who have pumped milk. How long did you pump? Did you continue breastfeeding after you stopped pumping?

“So, how long are you going to breastfeed?”

My response changes every time, because the truth is, I have no idea.

One year old is the age at which babies can safely digest whole cow’s milk, so non-breastfed babies may transition off formula. It’s also the age when many babies are weaned from the breast. The American Academy of Pediatrics recommends at least 1 year of breastfeeding.  But there is a wealth of evidence that toddlers continue to benefit from breastfeeding beyond one year.

Here’s why I’m not weaning at one year:

• Breast milk continues to give my baby protection against illness. The American Academy of Family Physicians position paper on breastfeeding states “If the child is younger than two years, the child is at increased risk of illness if weaned”.
• I’m not ready for another baby yet. The hormones of breastfeeding supress fertility, and so far, I have no signs of ovulation. At some point, it’ll come back whether I wean or not, but I’ll take as long as I can get.
• The longer I breastfeed, the more I’ll lower my future risk for breast, uterine, and ovarian cancer.
• I’m thinner now than I was before pregnancy, despite eating more and exercising less, because of breastfeeding.
• My son loves nursing and he is comforted by it. He now asks to nurse in the morning and when I get home from work. He looks sweetly at me and holds up his hand, making the “milk” sign that I taught him. I love cuddling with him and how he melts in my arms when the milk starts flowing.
• Twice now, he’s been sick and refused to eat or drink anything. But he still wanted to nurse. A LOT. I’m sure it was because he felt miserable and wanted comfort, not because he was hungry. It was such a relief to have a way of keeping him hydrated and nourished. I like having this emergency food supply for him.

For more on these reasons (and more) for breastfeeding beyond a year, check out Kellymom.com’s resources about breastfeeding after the first year, with several articles and fact sheets; and Dr. Jack Newman’s article Breastfeed a Toddler – Why on Earth? addressing the normalcy and benefits of extended breastfeeding.

So how long will I breastfeed? All I know for sure is that neither of us are ready to wean yet. I hope to breastfeed at least another year. Ask me again when he turns two!

How long did you (or will you) breastfeed? How did you decide when to wean?

A new use for my breast pump?

Playing around after dinner, my husband pretended to call our son on the phone, saying, “Ring ring . . .Ring ring.” The baby scanned the room for the nearest phone-like object to pick up his end of the call, chose his new “phone” and started babbling into it while I snapped this picture.

Related Post:   Meet my new breast pump

]]> http://themilkmama.com/2009/12/09/breast-pump-telephone/feed/ 1 http://themilkmama.com/2009/11/29/76-gallons-of-breast-milk/ http://themilkmama.com/2009/11/29/76-gallons-of-breast-milk/#comments Mon, 30 Nov 2009 04:27:01 +0000 Christina http://themilkmama.com/?p=556

Some milk in my freezer

As my son approaches his first birthday, I sat down with a calculator and figured out how much breast milk I have produced. You guessed it: I came up with 76 gallons.

There’s no way to be exact about it, but with various calculations, I’m fairly sure it’s between 74 and 78 gallons, so I’m settling on the middle. This is based on a combination of how much I pump when I’m working, and how much he ate during the times when we took his pre-and post-nursing weights on the special scale.

But this little exercise was just to satisfy my curiosity and to celebrate. You really don’t need to know how much milk you make. For the most part, if the baby is peeing and growing normally, then whatever amount the baby takes from the breast is enough. If you are used to seeing babies bottle-fed, this can be unsettling. You want to measure the ounces with the marks on the bottle and feel satisfied that the baby has taken enough at every feeding. I understand. I’m a numbers-oriented person who likes to measure things. I crave visual, numeric proof of progress toward my goals.  I’m a dietitian who knows how many calories my baby is “supposed to” eat. And, as a new mother, our bad start at breastfeeding shattered my confidence. I learned to trust my body slowly, with the help of a lactation consultant who repeatedly assured me that even though some of his feedings were very small, I was making the right amount of milk for him.

So I’m celebrating the first year’s worth of milk given with love to my baby. The accomplishment of weaning him off the formula we had to use in the first few weeks. Overcoming my worries about milk supply. Seventy-six gallons is a lot of milk!

Welcome, Readers of November’s Carnival of Breastfeeding! After you read this, check out the other great posts on the theme of “Breastfeeding Experiences in the Hospital” linked at the bottom of this post.

It is a beautiful gesture when friends and family come to the hospital to be among the first to see and hold the new baby and congratulate the parents. But the best way to support the new family may be to stay away, at least for the first few days.

I don’t want to be antisocial. The birth of a baby is a huge cause for celebration, and it’s important for the new parents to feel support from friends and family. But the reality is, mothers and their newborns need some space for a while, especially while in the hospital. Here’s what new moms and babies need to be doing in the first few days, and how visitors (birth partner not included) can interfere.

Skin-to-skin contact

A baby needs to be with its mother. Not down the hall in the newborn nursery, not in a bassinet across the room from its mother, but snuggled up to the warmth of her bosom. There is rapidly growing evidence supporting the importance of skin-to-skin contact (cuddling the naked baby on mother’s bare chest), especially in the first several hours after birth. This close contact obviously increases access to breastfeeding, but it also reduces crying, helps regulate the baby’s temperature, aids in bonding, and improves success at breastfeeding. Babies held skin-to-skin for the first 3 hours are much more likely to leave the hospital fully breastfeeding. (For more on skin-to-skin contact and breastfeeding, I highly recommend reading this handout by Dr. Jack Newman.)

Most moms will cover up when visitors arrive, keeping a barrier between herself and the baby. Visitors can also interfere with skin-to-skin contact simply by holding the new baby. There’s nothing like holding a newborn, but a visiting Auntie’s or great-grandfather’s arms just can’t compete with Mama’s breast for the warmth, comfort, and nourishment that are so vital in the first few days of the baby’s life.

Rest

Whether she had a vaginal delivery or a c-section, the mother’s body needs to heal and recover. She needs every moment of sleep possible. Newborns don’t make this easy, nor do they sleep on a predictable schedule. When baby sleeps, mom had better close her eyes and follow suit. Recovering from childbirth in a hospital is challenging enough with interruptions for medications, the infant hearing screen, paperwork, bloodwork, food service workers taking your meal order, etc. Add visitors, no matter how important they are, and you are left with literally no time to rest.

Breastfeeding often and on-demand

Babies need the comfort and nutrition of the breast. Newborns can take a looong time to nurse, and they need to nurse often. Breastfeeding can take some work and practice, and in the first few days when the baby is learning, it can demand the mother’s full attention. It’s hard to breastfeed modestly when you’re both learning what to do. When my son was born and we were struggling to get started breastfeeding, I couldn’t use a nursing cover. I needed full view of my own breast, and had to repeatedly break my son’s latch and try again and again. I’ve talked to many mothers who delayed breastfeeding because they weren’t comfortable with this level of exposure.

A word of advice

If you are a mother-to-be, consider delaying visitors until after you are settled at home, or limit it to just one or two close people who are supportive of your breastfeeding plans. It might feel rude and selfish to turn away well-meaning friends and family. But they should understand. You might enlist a husband or mother to act as gatekeeper, as my friend did, thanking visitors for coming but gently sending them away to allow the new mother and baby to rest.

If you are a friend or family member, find out what the mother’s wishes are regarding visitors. Before the baby is born, if possible. If your presence is going to prevent her from keeping the baby at her breast, consider delaying your visit.

My husband and I didn’t allow any visitors other than my mother and his father. I couldn’t wait to see friends and show off my son, but I was glad we made that decision. We had a hospital birth, but I wonder if it’s different with a home birth. Without all the interruptions from hospital staff, and a bit more control over your own schedule, I imagine visitors might be easier to accommodate.

How do you feel about welcoming, or turning away, new-baby-visitors in the hospital? Did visitors hinder, or help, your early breastfeeding experience?

Other Carnival of Breastfeeding Posts:

Breastfeeding 1-2-3: Breastfeeding experiences in the hospital

Momma’s Angel: My hospital experience in Norway

Hobo Mama: Breastfeeding support: A tale of two hospitals

Whozat: The nipple intervention

The Beautiful Letdown: Breastfeeding in the hospital

Motherwear’s Breastfeeding Blog: Had a good or bad experience in the hospital? Tell them!

Breastfeeding Mums Blog: Breastfeeding experiences in the hospital

Showing off my new pump

I was thrilled to hear from Judy at A Mother’s Boutique Mommy News Blog that I won a giveaway for an Ameda Purely Yours breast pump. The giveaway was part of her Blogiversary Celebration, with several more great giveaways you can still enter.

I will soon have to return my borrowed hospital-grade pump (a Medela Lactina) that I’ve been using since my son was 3 days old. I pump 3 times a day at work during the week, and every night before going to sleep. Every day, I carry the heavy pump with me to work, and bring it home at the end of the day. It has traveled with me twice on cross-country flights to 3 different states. It’s been a big part of my life, especially in the early months when I was pumping exclusively, then when I was using it 8 times a day after breastfeeding to build my milk supply. But I’m ready to say goodbye.  I no longer need a hospital-grade pump, and the thing is so heavy and awkward to carry around.

For the past 3 days, I have used my brand-new Ameda Purely Yours breast pump. It’s working great for me.

Here are some of my favorite features:

• It’s small, very lightweight, and it’s so easy to carry. The bag is attractive.
• I love the ability to control not only the suction (the only control I have with my former pump), but also the speed. Who knew. . .slowing the speed all the way down actually empties the breasts faster!
• The parts are easy to clean. There aren’t many crevices in the collection pieces where, in my former pump, milk would get stuck, and no finger, brush, or sponge could reach in to clean it out.
• The bottles fit securely into holders on the pump. This feature is good for me: I have knocked over bottles of my freshly pumped milk more than once because there was no secure place to set them down.

My baby is turning 1 soon, so I won’t be pumping quite as often, but I plan to keep pumping once or twice a day for many more months!

Thanks, Judy! I love the pump.

(this one's much nicer than the bathroom I pumped in)

The other day, I pumped milk in a public restroom. I was out of my normal routine, and there was no one to ask for better accommodations within a reasonable timeframe.

My choices were either the bathroom or the industrial kitchen, sitting on the cold cement floor in the dark, or skip pumping and become engorged. The bathroom was a single stall, with an electrical outlet, toilet with a tank and closing lid, and a cement floor. I chose to pump in the bathroom, and I will never do it again.

Yet many women find the bathroom the only private place to pump milk at their workplace, like the woman in Ohio who was fired for her unscheduled pumping breaks  (see the CNN video here, including discussion of using the restroom to pump). Before I tried it myself, I thought it would be unpleasant, but I didn’t realize how unsanitary it can be. Let me present to you my analysis of the disgusting details I hadn’t considered before I was faced with this experience myself.

Bathroom surfaces are filthy.

We all know about the aerosol effect of toilet flushing right? You may not see or feel it, but the contents of the toilet spray out with every flush. The little bacteria-laden droplets go airborne. Here is a quick video showing the spray out of a toilet bowl. It is safe to assume that all surfaces surrounding the toilet are coated with droplets of urine, fecal matter, and bacteria or mold present in the toilet bowl.

Pumping in the bathroom is a juggling act.

While pumping in my home or in the office, where I have plenty of clean space, I hardly think about this, but here are the dilemmas I went through in the bathroom at each step of pumping :

1. Where to place the pump: The toilet in this particular bathroom had a tank with a level top, so that’s what I used, although it was  small. Most public toilets don’t have this feature. Alternatives would be resting on the toilet paper rolls, or (if your pump has long tubing) on the floor. There’s no good option.
2. Where to sit: This bathroom had a lid that covered the toilet bowl, so I closed it and sat on it. Most public restrooms don’t. You’d have to sit directly on the toilet seat. People pee on the toilet seat. Maybe you could stand up. I don’t know about your breast pump, but the tubing on mine won’t reach that far.
3. Assembling the collection pieces: Between leaning forward to pull pieces from my pump bag, pressing the flanges into the connectors, turning around backward to plug everything into the pump, I found it difficult in this small space to assemble the pieces without brushing my arms or the tubing against some surface of the bathroom. And where do you set down the first side while assembling the second side?
4. Where to set down the bottles/bags full of milk: At some point you have to set the bottles/bags down while you button up and pack everything away. In my office, I place the bottles full of milk on my clean desk until I’m ready to carry them to the refrigerator in the break room. In the restroom, I guess the best option is to put it in your lap and hope it doesn’t fall into the toilet or onto the floor.

Other mothers might experience it differently, depending on what kind of pump and case you have. Mine doesn’t have any special holders or compartments that helped with bathroom pumping.

It ties up the bathroom for others who need it.

Especially if there’s only a single-stall restroom available. A pumping session takes longer than your typical bathroom break, and it’s hard to rush. It’s awkward to walk out and face the other women lined up, waiting for you.

It’s unpleasant and uncomfortable.

This isn’t the worst thing in the world, but still, who wants to spend all their break time in the bathroom? It smells bad. It’s ugly. Whether pumping standing or sitting on the toilet, it’s hard to relax, which can inhibit the milk ejection reflex.

Sanitary lactation space should be a working mother’s right.

In many US states, it is a right. Several states have breastfeeding laws that require employers to provide facilities for pumping milk, “other than a toilet stall” which you can see in this compilation of state breastfeeding protection laws. Women should not have to pump in a bathroom to provide food for their babies. Some workplaces may not have the luxury of setting aside an entire room for pumping, but there must be some space that could be partitioned off when the pumping employee needs it.  I have been in two offices that used cubicle dividers to create a small pumping room. The room I pumped in while on jury duty was actually a  large closet adjacent to the restroom, and that worked fine.

If you are a mother who pumps milk in a bathroom, please don’t be offended. I commend you for enduring the unpleasant surroundings to provide the best food for your baby. I realize that, where there are no laws to mandate a designated pumping area, you might not have any choice. Maybe you’ve found a way to keep everything clean and you’ve got the routine down. But you should be entitled to a better space.

Moms, have you had to pump milk in a public bathroom? How did it work out for you?

Lawson: “Someone once said to me that vanillin (which is the thing that makes vanilla smell like it does) is present in breast milk, [Inskeep reacting in the background] so we have some very primitive desire to be comforted by the taste of vanilla ….[laughing in the background, 'I'm sorry'] ….I’m just telling you…. so you could say it’s a kind of Freudian self-indulgence.”

Inskeep: (laughing) “I had a mouthful of it while you were saything that! It’s really more than I needed to know, but thank you anyway.”

I was surprised by his reaction. Was that disgust I heard in his voice? And a twinge of embarrassment? It was subtle, instinctive. It was only a few words, laughs, and then the conversation moved on. But the reference to breast milk obviously made him uncomfortable.

What’s wrong with breast milk? Is it gross and unappetizing because it is a bodily fluid? I’ve heard similar reactions of disgust, amusement, and discomfort when breast milk enters conversation. This makes me sad. For one thing, I am a producer of this substance, and I am proud of it. Unlike certain other bodily fluids, breast milk is not a human waste product. It is the most clean, most sanitary, most natural food that a human will ever taste. Children old enough to talk and retain memories before they are weaned tell us that is is delicious. It is sweet, sweeter than cows milk.

I suspect that his reaction, though, was deeper than that. I think it was because her mention of breast milk implied that what he was eating was, in some way, like breast milk. And that enjoyment of vanilla could be related to a human desire for comfort from breast milk, or the breast itself. And Steve Inskeep sure was enjoying that doughnut french toast.

In response to Lawson’s statement about vanillin: As far as I know, breast milk doesn’t naturally taste like vanilla, but vanilla in the mother’s diet (as well as garlic, mint, and some other distinct flavors) passes easily into breast milk.