Before I get into the details of this, I have to say that I'm a little wary about posting about this topic. The last three weeks have involved an onslaught of information from a ton of different people, many of them experts in the field, and much of it conflicting or at the very least involving incompatible suggestions and approaches. This is one of the very few topics where I feel that Google has failed me; every website contains such different information that it is impossible to get any clear understanding of best practices, and instead research becomes overwhelming. At this point I feel totally maxed out on suggestions, resources, and new approaches. I have hit the limit of new websites I'm willing to check out and new people I'm willing to turn to for advice.
However, I'm posting about it anyway for several reasons: a) we now have a lactation consultant we trust and a plan that is working for us and that seems to be sustainable in the long term; b) when I first posted on Twitter about our breastfeeding issues, the outpouring of support was so helpful and encouraging, and I think that this supportive blogging community is the one place that I am not yet maxed out on discussing this issue with, even if this post does generate a few comments that I'm not prepared to deal with; and c) this has been a very important, if challenging, experience for me and I want to record it and share it in hopes that others can relate.
So! That giant disclaimer out of the way, let's talk about my breastfeeding experience.
At one day old Callum was diagnosed with a mild case of jaundice. The way to get rid of jaundice is for the baby to pee and poop out the excess bilirubin in his system. The newborn has 24 hours to pee before the doctors start getting concerned, and Callum didn't pee for the first time until more like 36 hours. And, even when he did start peeing, it wasn't very much or very often, and his bilirubin levels stayed elevated. Meanwhile, I was producing only a couple drops of colostrum at a time. I thought this was totally normal; everything I'd read said that you only produce a bit of colostrum until your milk comes in, but that it's all the baby needs. But the hospital seemed to feel otherwise. One nurse told me that I should be producing multiple teaspoons of colostrum at a time. The lactation consultant came in and pronounced that there were several "red flags" about my ability to breastfeed: the low colostrum production; the fact that I have a thyroid issue (though it is well-controlled); the fact that my breasts are "widely spaced"; the fact that my breasts didn't grow during pregnancy, although my nipples did. (Others have since told me that all of this information was actually inaccurate.)
There were also some positive signs: when I nursed, we could hear Callum swallowing, though not that often; his glucose levels remained stable; he only lost 3% of his birth weight before discharge. But nobody focused on those. Because of his jaundice, the baby needed to eat; I wasn't producing food to give to him, so we started him on formula supplements. I refused to give him a bottle because of everything I'd read about subsequent latch issues and nipple confusion, so first we tried a supplemental nursing system (SNS).
The SNS seemed like a great idea--basically it's a bottle of formula with a very small tube that is taped to the mother's breast so that when the baby suckles at the nipple, he also pulls in formula from the bottle. That way he is still stimulating the mom's milk supply and getting the nursing experience, but also getting the extra nourishment that he needs. But in practice, it was a huge pain in the ass. We only had the disposable one, which required two people to work: me to nurse with the tubes taped to my breasts, and Torsten to hold the bottle upright and pinch off the flow to the tubes whenever Callum stopped suckling so that milk wouldn't keep pouring into his mouth and all over his face. It was really hard to attach the tubes correctly so that they ended up in the right part of Callum's mouth when he latched. The tubes were also incredibly narrow so that the formula passed through them very slowly, meaning that every feeding took an hour or more. Plus, as we discovered later, Callum wasn't getting enough food through them, so he kept waking up hungry even shortly after being fed. You can imagine how fun it was for both of us to get up every hour or two all night long our first night home and spend an hour trying to feed our baby together.
The day after our first night at home, Callum had a pediatrician appointment at which we discovered that he had lost another 5 ounces since his discharge the previous day. The pediatrician was not happy about this, even though he had still lost less than 10% of his birth weight overall, and started talking about switching to a bottle. This was after Callum had been screaming in the waiting room because he was hungry, and I had been trying to nurse him and he kept latching and pulling off because there was no milk yet. We did this over and over again while he screamed and eventually he was crying and I was crying and then the pediatrician was talking about bottles and that just sent me over the edge.
So, on the way home from the pediatrician I called our Bradley childbirth class instructor, who is also a lactation consultant, and she totally saved my life. She talked me off the ledge and gave me a workable plan. She suggested that we dump the stupid SNS and switch to syringes, which would allow us to feed him more efficiently without worrying about nipple confusion. So we did that, he ate great, and when we went back to the pediatrician for a follow-up appointment the next day he had gained 5 ounces, so that was good news.
Then we started the process of trying to nurse him as often as possible to get my supply to come in, and cut down on his formula in hopes of weaning him off it entirely. At this point my milk seemed to be in, sort of: there was definitely something, but it was hard to tell how much. I wasn't engorged, I wasn't leaking, I never felt let-down, I didn't feel pain or fullness. We rented a Medela Symphony from the hospital, but when I pump, almost nothing comes out. I could hear Callum swallowing when he nursed, but not that much. And he hadn't pooped in several days, though he was peeing regularly. It was also hard with the syringe because it felt kind of like we were fattening up a goose--we were basically shooting formula directly down his throat, and while he happily took all that we gave him, it was really hard to tell how much he actually needed and how much he was eating just because we were pumping it into his mouth.
At 10 days old, with my milk supply still in the same questionable state, we went back to the pediatrician for Callum's two-week visit. Having not loved the first provider we'd seen, we switched to someone else, who we liked much better. She was great and very supportive and spent over an hour with us, discussing the situation. Callum had lost two ounces since his previous appointment, so that wasn't good, and she suggested a new feeding plan: nurse him every 2-3 hours, and not more often, because if he snacks all the time he will never fully drain my breasts and they won't be fully stimulated to refill, and give him a bottle after every other feeding. At that point he seemed to have a good enough latch that there was no concern about nipple confusion.
So, we went home and started this plan, and it worked pretty well. By the beginning of last week, he was back to his birth weight, which made the pediatrician happy. He had no latch confusion issues, but his nursing still wasn't awesome. Sometimes he would happily latch and suckle for 15 minutes each side. Sometimes he would be really sleepy and not willing to latch. And sometimes (and these were the worst times) he would scream and scream and scream and be in total hysterics and it would take me 45 minutes to an hour to calm him down enough to latch. And no matter which of the three it was, I always had milk left after he was done, and he would always drink several ounces of formula afterward, which was very disheartening. But at least he was eating.
So, last Wednesday I took the pediatrician's referral and went to see a new lactation consultant, who is also an MD, at the local children's hospital. And it was like FINALLY there was someone who listened, who paid attention, who saw what was happening, who was encouraging and helpful and suggested a truly sustainable plan of action. And things have been SO MUCH BETTER since then.
First, she took one look at Callum's latch and said it was way too shallow. He wasn't latching on deep enough to pull down a lot of milk, which is why I always had milk left even when he was nursing for 15 minutes per side. She was very surprised to hear that I hadn't experienced any pain while he was nursing, given how shallow his latch was. She checked in his mouth and said that his lingual frenulum was too tight, preventing him from opening his mouth wide enough to latch properly, and also from sticking his tongue out far enough to suckle properly. The convenient thing about having her be in the hospital is that she was able to page the ear-nose-throat doctor on call and he came down and cut the frenulum that same day. She also had us start using a nipple shield to teach him to open his mouth wider when nursing.
She also said that in general he is a very laid-back baby, which is great in a lot of ways but not when he's nursing. He is very lackadaisical about nursing, and will often stop nursing entirely and every effort I make to stimulate him to start again won't work. Lactation consultants, nurses, and doctors had suggested all different ways of stimulating him: his face, his ear, his clavicle, his hands, his belly, his feet--but this lactation consultant suggested pulling gently on his arm and moving it back and forth, and that is the only thing of all these suggestions that has actually worked.
She did say that I have a somewhat compromised supply--and we may never get to an exclusive breastfeeding relationship--but that I definitely have enough milk to make it worthwhile for both him and me, and that even if we always have to supplement with formula, I should definitely keep nursing too. And it was so encouraging to hear that. By the time I met with her, I was mentally preparing myself to be told that I had no milk to speak of and should just give up on the nursing thing altogether. And it was really nice to be told that I do have milk, even if it's not a ton.
AND she told me that if he screams, it is absolutely not worth trying to get him to nurse. She said if he is hysterical we should give him a bit of formula and see if that takes the edge off and makes him willing to nurse. If not, just try again later. So far since then he has only had one screaming fit, and after half an ounce of formula he was perfectly happy to settle in and nurse for half an hour.
She told me something that has really stuck with me: the first rule of feeding is that the baby needs to be fed, and the second rule is that the parents need to enjoy feeding him. This principle is so helpful to refer back to whenever we are struggling with the feeding. Callum is fed, he is gaining weight and he is healthy, and after that the goal is to find an approach to feeding him that we are all comfortable with.
So since then things have been so much better. His latch is much wider and with the arm thing I have consistently been able to motivate him to be a much more efficient eater. He pretty much always nurses for half an hour, and I know that he's getting milk, even if it's not a ton. He's still eating plenty of formula, but that's totally OK.
The thing about these struggles is that I wasn't expecting the emotions that would come along with them. When I was pregnant I read this great article about breastfeeding vs. formula feeding, and I thought after reading it that if breastfeeding ended up not working for us, I would be OK with that. I didn't realize how emotionally attached I was to the idea of breastfeeding, or how much of a failure I would feel when I thought that it wasn't going to work for us.
But the thing is that when I sat down and tried to work through my feelings about the whole thing, I realized that the vast majority of reasons I wanted to breastfeed had a lot more to do with me than with Callum. Breastfeeding is great, and it's good for the baby--but formula provides everything that he needs. I do want him to breastfeed so that he can get my antibodies, especially while he's too young to be vaccinated. But most of the other reasons are really about me. I like the convenience of it, and the fact that it's free. I like the relationship that comes from it--but I think that same relationship, or a very similar one, can be built through bottle-feeding. And honestly, I wanted the weight-loss benefits of the extra calories burned.
I had a conversation with Nilsa (who's been through something similar) last week about this whole experience and she pointed something out that really resonated with me: this is just the first of many times as parents that we will need to take a step back and ask if our concerns are actually about our child's health and well-being or if they have more to do with our own expectations. It's a lesson that we all have to learn, as parents, and while I certainly would have been thrilled if we'd been able to have a straightforward exclusive breastfeeding setup, and would not have minded learning this lesson just a little bit later, I do think the experience has been good for me. Though I still wouldn't choose it.
I'm still hopeful that now that Callum can open his mouth fully, and now that he's nursing more efficiently, my milk supply will increase. But an exclusive breastfeeding relationship doesn't seem to be in the cards for us at the moment, and I'm OK with that. I still feel a pang every now and then when I hear another mom say that her baby has never eaten anything but her breast milk, but that's just not how it's going to be for us. And that's fine too.
And lastly, some more photos, because I hear that it's a prosecutable crime to write a post about a baby and not include pictures:
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