Wednesday, February 11, 2015

Breastfeeding: it's hard, Part 2

As I indicated in my previous blog post, part of what caused me to struggle with the early weeks of breastfeeding was that Ruth was a tiny baby, and a slow gainer. She was born at 6 lbs, 5 oz, then dropped to 5 lbs, 12 oz before we left the hospital (a very interesting conversation took place on my Facebook wall about trying to breastfeed premies). This was an okay amount of weight loss, the max that was considered normal, so Ruth was ready to come home with us two days after her birth. Then it took her nearly three weeks to get back up to her birth weight.

At 11 weeks out, looking back at those early pictures I can understand why people were worried about her weight. She was all skin and bones, no fat whatsoever. Having very little experience with babies, I didn't know any different.

This is where I'm extremely grateful our pediatrician (who's actually a nurse practitioner) gave me the appropriate referral to a lactation consultant rather than insist that we go straight to supplementing with formula. A lactation consultant visited Ruth and I three times at home before things really picked up. I was instructed to take fenugreek (a galactagogue--a substance that increases milk production), and also to pump to increase my milk supply. Every ounce I pumped was to be fed to Ruth after she finished nursing from me. I was also told to let Ruth go no more than three hours at night without feeding (early on she was inclined to sleep slightly longer at night), and she was to wear a hat as much as possible (so she wouldn't burn extra calories trying to keep warm). We did everything we could to boost my milk production and ever so slowly she gained back the ounces.

In the meantime, while Ruth remained below her birth weight, I was in a near constant state of anxiety. Why wasn't my baby gaining fast enough? She was producing plenty of wet and dirty diapers (the best marker for whether a breastfed baby is consuming enough besides weight gain), and she seemed happy, but that wasn't enough. Tears emerged during more than one hour plus night feed because I felt I was failing to provide Ruth with what she needed. If we had extra pumped milk Andrew often offered to take over the feed, but I rarely consented.

Ruth is now up to 9 lbs (as of Saturday), putting her firmly in the bottom first to second percentile. She's happy, she's healthy, and we love her.

Here's where I kind of go against medical opinion/advice. Pediatricians seem to want all babies (I'm talking full-term babies) to gain an ounce a day, but after listening to other mothers I feel like this goal simply isn't practical (in terms of the stress parents go through trying to get their infants to gain that much).

It isn't, in fact, even possible.

According to the WHO growth curves (girls, boys) the baby gaining an ounce a day is growing on the fiftieth percentile curve, which means not every baby can gain that much (because not every baby is ON the mean). Some, at the top of the curve will gain more, some at the bottom, like Ruth, will only gain around two-thirds of an ounce a day, and that's just fine. So why physicians get all antsy over a baby gaining at a slower, but healthy rate is beyond me. It only makes parents anxious, possibly pushing them to supplement with formula when they don't need to.

I noticed one other thing when looking at the methods for how the WHO growth curves were developed. The research team used data from a variety of populations (US, Norway, Brazil, Oman, Ghana, and India), which is good, but right there in the second paragraph it says that greater than or equal to 20% of woman followed the WHO guidelines for feeding. Greater than or equal to 20%...that's a lot of room there. And when they say the WHO feeding guidelines, I believe they mean the one that says that infants should be exclusively breastfed for the first 6 months of life. So, if possibly as little at 20% of children were breastfed exclusively for 6 months in some of the sample populations, might that mean that these growth curves aren't necessarily accurate for breastfed babies?

I don't know, I'm just guessing here. Certainly, exclusively breastfed babies can be on the ninety-ninth percentile, but perhaps it shouldn't be too surprising if they aren't.

Well, that's all my thoughts on breastfeeding. It IS getting better. Ruth's growing, and I plan to keep it up for several months to come. I'll try to find something other than my baby to talk about in my next blog post. Snow, perhaps? It's a rather popular topic here in the Boston area (NOT!).



Thursday, February 5, 2015

Breastfeeding: it's hard, Part 1

So after saying in my last post that I wouldn't be turning this space into a mommy blog, I'm immediately following up with a post on breastfeeding. Being Canadian, I'm inclined to apologize about this, but as a new mom who wants to share a challenging experience, I won't. To contain the size of this post I'll split it into two: 1) the challenge of the actual act of breastfeeding; and 2) the challenge of the outcome of breastfeeding, the baby's weight gain.

Before I go further, I don't mean this blog to be a resource for how to deal with breastfeeding difficulties. If you're looking for help, two online resources I've found useful are: Kelly Mom and Le Leche League. Rather, I hope that by sharing my experience, others might feel reassured that what they're going through isn't all that uncommon.

I knew breastfeeding wasn't going to be a walk in the park. Prenatally (and maybe even postpartum while I was still in the hospital), people want to talk about how a newborn, when placed on it's mothers chest immediately after birth, will wiggle it's way up to it's mother's breast and latch on. I don't doubt that this is true. I had Ruth nursing while we were still in the delivery room; however, getting her to actually breastfeed effectively afterwards was quite another matter.

I recall thinking during the second night on the postpartum ward, after I don't know how many hours into a feed, exhausted and probably in tears (Ruth was likely crying too)--"I completely understand why women give up so quickly and switch to formula. This is hard."

So, what makes the physical act of breastfeeding hard?

First, this is a whole new sensation to get used to. You need to get the latch just right, because if you don't, it's going to hurt and you're going to destroy your nipples. When I was in the hospital one of the nurses asked if the latch felt 'pinchy' (bad) or 'pully' (good) and my answer was I didn't know. I understood why there was a difference, but having never breastfeed a baby before, I didn't know which one I was experiencing. The in-hospital lactation consultant spent a lot of time with me trying to figure out what position would work to improve Ruth's latch (not football, and definitely not side-lying), and we tried a breast shield--it felt awkward too. I'm not sure I felt terribly confident heading home and facing the first night without a nurse on call.

Beyond getting the latch right there's also the fact that a tiny human is repeatedly compressing your breast, which can leave one feeling a little 'sensational.' My breasts felt tingly, and raw (at this point I'm used to it). Let's just say I was glad we didn't have any visitors at home since it considerably lowered the dress code standards around our apartment.

The second issue I had is, Ruth is a small baby, and was even smaller when she was born (6 lbs, 5oz). Now, I'm not large-chested, but there's still a lot of tissue to get in a tiny mouth (this probably didn't help with latching). Feeding in the first several weeks could take an hour or more--every feed. I was told in breastfeeding classes that babies should get the bulk of the milk in about 15 minutes of sucking, and anything after that was non-nutritive. This didn't appear to be the case with Ruth. If tried to let her feed for only 15 minutes on each side she wouldn't be full and I'd be feeding her again in short order.

It's both exhausting and boring to be feeding a baby for more than an hour. Exhausting because you're not sleeping much, and boring because you're stuck in your bed, on your couch, wherever, waiting for your baby to fill up their stomach. I didn't want to spend my days watching TV shows or movies (not that I haven't done some of that), so we purchased a touch screen laptop for me to use while nursing--I've typed most of this blog post one handed. There's not much you can do to speed a baby up either. You can do breast compressions to make it easier for your baby to get your milk, and you can try a few techniques to help increase your milk supply (again making it easier for your baby to feed). I've been taking fenugreek, and pumping after each feed (a rather unawesome experience in and of itself).

At first, getting in the pumps was difficult. I'd put Ruth in her baby recliner right in front of me, but often she'd be crying within minutes, so I'd have to pick her up. If you've ever used a breast pump, you know they're rather awkward, so I'd be trying to calm my baby, possibly feeding her milk I'd already collected, while connected to the pump. One particularly bad afternoon I had to call Andrew and ask him to come home early--I was distressed over our tiny, slow to gain daughter, and my seeming inability to feed her sufficiently. I wanted to be a successful breastfeeding mother, and in those early weeks the idea of having to supplement with formula was an upsetting possibility.

Still, for the first 6-7 weeks Ruth took over an hour to feed, and talking to other mothers, this doesn't seem so uncommon with newborns as it felt at first. Several friends have told me their children were slow eaters, and many women at the new parent support group I attend seem to have had a similar experience. I would guess in many of these cases the babies were fairly small, like Ruth--but that's purely speculative on my part. Furthering my surmise, I would say it seems like small babies just need a little extra time to sort themselves out.

Somewhere around the 7th week of Ruth's life she started to pick up her game. Her feeds dropped to more along the lines of 45 minutes, which makes a huge difference. And she seems to 'practicing eating' after some feeds by sticking out her tongue and sucking on her lips (it's really rather cute).

And people say by 6 months she'll be finishing a feed in 5-10 minutes. That will be amazing.

These are my thoughts on the act of breastfeeding--still a pretty long post as it turns out. When I write next I'll discuss the anxiety of having a slow eating baby who is also slow to gaun her birth weight back.