Thursday, March 03, 2011

Adventures in Breastfeeding - Part I

I'm really hoping the subtitle for Breastfeeding-Part II is "we exhibit total and complete mastery" and not "fail: we give up."

Actually I'm just being dramatic, today wasn't so bad at all. But the babe and I have put quite a lot of work into this breastfeeding venture in the last 10 days. I knew from reading a lot and from talking to my girlfriends that breastfeeding is 'hard' but I didn't really GET what that meant. And of course, every experience is different so I had no idea what was in store for me.

Phase I: Baby latched on immediately, probably 15 minutes after being born. This amazes me! At this point he knew much better than I did what to do. After a hospital lactation consultant helped me with my positioning, we were off - he fed really well for about 4 days.

Phase II: Then my milk came in. My boobs were hard as a rock and baby had no idea what to do. Suddenly he wouldn't latch and was obviously upset and very hungry. I tried taking a warm shower, applying a warm washcloth and continued to try and offer the breast. We were both getting more and more upset, since the hospital had told us to feed every 3 hours OR ELSE. Unfortunately I wasn't sure what OR ELSE entailed or what to do if I couldn't get him to eat. I don't know why I didn't just offer him some formula to take the edge off, but I didn't. Finally on day five we got the breast pump stuff cleaned and ready to go, and I figured out how to use it. He had gone for 6-7 hours without much food and was pretty cranky, as you can probably imagine.

Phase III: Meltdown time. Thankfully we had our first pediatrician appointment that morning. I was exhausted and worn out, and baby was still hungry. I was trying to hold it all together but started sobbing once we got into the exam room. Baby was screaming uncontrollably, was all chappy from us trying to console him with the pacifier, and was wearing an outfit that was probably 3 months too big - obviously we were all a mess. THANK GOD for our doctor: she ignored the chaos and was like, 'CHILL guys. Your first priority is to feed this baby. However you can. Give him formula if you need to, and keep pumping every two hours to maintain supply and ease engorgement'. Then she gave us three huge bottles of formula for free and told us to come in for a weight check in a week.

It was exactly what I needed to hear. I had been so focused on breast feeding, and avoiding giving a bottle (I had read to wait until 3 weeks of age to do that) that I had basically starved our baby in the process. Looking back I can see that I was obviously hormonal, but at the time I felt so ashamed and angry at myself.

There was one bright spot during our horror show of a ped visit: two moms in the waiting room. Both were there with their second kids; one was a toddler and the other baby was only 2 weeks old. I think they could tell I was about to fall apart and both made a point of saying 'hang in there! It totally gets better! We've been there!' Such a little thing... but it meant a lot.

Phase IV: So on day 5 I start pumping like crazy and supplementing with formula. At first it seems great because I feel so much more in control and can give formula if necessary. Plus my husband is now able to feed him too. Baby is finally getting food and it is obvious that he is much more content and happy.

Then I notice that baby is gulping from the bottle, which gives him a lot more gas. I also notice that he doesn't seem to know when to stop - he just keeps eating, and then eating more. I can only get him to latch on and breastfeed once on day 6 and another time on day 7... then not at all. So now we have another problem: how to get him back to breast feeding exclusively.

Phase V: After doing a little reading online I try for a day or two to get him back on the boob (making sure to remain as calm as possible, NEVER forcing the breast, bottle feeding near the breast so he gets used to positioning, etc). I didn't want to troubleshoot this issue for too long, and ended up setting up a consult with a lactation specialist at The Breastfeeding Resource Center (which is like 10 minutes from our house!). I met with Colette, who worked her magic and seriously had him breast feeding again after 10 or 15 minutes. She suggested a change in position and nipple shields (which feel more like a bottle nipple) and came up with a written plan for us to follow. I was also to pump as much as possible to try and increase supply.

So that was Tuesday, and I'm happy to report that we are doing much, much better. On Wednesday I was able to get him to breastfeed, and only had to supplement with formula/bottle a few times when it seemed like he was still hungry. He has been exclusively breast fed since Tuesday night; we are still using the nipple shields but every once in a while I can get him to latch without them.

Now he's feeding constantly, which can be hard since he's attached to me basically day and night, but we've made such good progress that it hardly matters. I'm hoping our winning streak continues... I'm just glad I stuck with it for this long, and asked for professional help when I needed it. No wonder so many people quit!

Whew. What a week.

AAO 2-21-11

Despite concerns that I might be pregnant forever, our baby boy arrived on February 21st at 4:08 PM. He was (is) a little guy, weighing in at 6lb3oz and 19 inches.

On Sunday the 20th (at 40w5d), we decided to visit the art museum, thinking that walking around a bit might help things along. I had lost my mucus plug the Friday before, but there were no other signs of labor at this point. I was huge, swollen and cranky. I was scheduled for an induction on Feb 25th, and was feeling so fearful of what an induction might bring and hoping hoping hoping for a vaginal delivery.

Around bedtime on Sunday night, I started dripping a little fluid. I went to bed, and felt two stronger drips while laying down. Contractions started around midnight, and I woke my husband up around 1 am. After talking with my ob, we decided to head to the hospital to see if my water had broke (there was no dramatic gush on our couch, in our bed, or in the car, as my husband feared).

I arrived in triage around 2 am, where the nurse determined that I was indeed leaking amniotic fluid. I was admitted and they wheeled me to the birthing suite, where we would remain until baby joined us. At this point I think I was 2-3 cm dilated, easily breathing through some mild contractions. They felt like menstrual cramps and were felt mostly in my lower back. The nurse gave me a little pitocin to move things along. I was scared that it would ramp things up uncontrollably, but it was such a slow drip that I didn't notice anything like that.

I started having more regular contractions and politely enquired re:epidural around 8 am. The doctor wanted a more defined contraction pattern and more dilation. I worked through contractions until 5 cm dilated, at which point things were starting to ramp up a bit. The ob broke the amniotic sac to release the rest of the fluid.

At this point they administered the epidural. I felt some odd pinching sensations and muscle twitchiness as the catheter was going in, but it truly wasn't that painful. Certainly nothing compared to the contractions I was having.

Once the epidural kicked in I felt fantastic - warm, calm and totally pain free. It was heaven. I made sure that friends and family knew it was game time:

Around 7 cm or so they decided baby was sunny side up - which explained why I was feeling a lot of pain in my back. I started to notice that I could feel some of the contractions on my right side, and wondered if the epidural was wearing off a little. This scared me... I started to get the chills.

A resident on duty came in to see me and had my lay in this "spider man" position - sort of on my stomach/side, right leg up and left leg down - in an effort to turn baby so that his head was facing toward my back. As you can see I'm starting to feel rather miserable:

At some point I was 10 cm dilated, but at zero position - meaning the baby wasn't far enough down the birth canal yet. They wanted me to wait a bit longer to see if he progressed.

Happily there are no photos of the next stage, where I got the shakes accompanied by painful, intense contractions. In the progression from 5cm to 10, the contractions had changed - they now felt like extreme pressure and pain in my rectal area. I started to whimper with each passing wave, and my incredibly calm and reassuring husband started pressing on my lower back to try and ease the pain. I'm truly not sure how long this phase lasted, maybe an hour?

Finally I couldn't take it any more and had my husband tell the nurse I had to start pushing. Pushing actually felt good (better than trying to breathe through a contraction, anyway). I pushed, and pushed, and pushed... I know there was a point about 30 minutes in where I was exhausted and feeling totally demoralized - is all this pushing doing anything??? I'm tired.

I kept going, my husband holding my right leg and a first year nursing student (his first day on the labor and delivery floor) on my left. At some point, they broke down the bed and my ob appears in hazmat gear - face shield, knee high booties, the works. I can start to feel what I think is the baby's head further down along the canal, and work to push against the pressure. I get a surge of energy everyone in the room cheers when the top of baby's head becomes visible.

It's all a blur after that, I pushed for an hour and 5 minutes total. Once the head was out, baby's body slid out immediately after. I tore pretty badly in the process, but thankfully was still a little numb down there so as to blunt the pain a bit. There was meconium in the amnoitic fluid, so my husband wasn't able to cut the cord. They whisked baby away immediately and started to make sure he was ok. Once I heard him cry I relaxed a bit and delivered the placenta. Then I tried not to crawl out of my skin when the ob started to stitch me up - OUCH.

Finally they brought him over to me - such a cute little guy. He was really calm in those first few moments. I'm feeling really good at this point, chatting with the doctors and nurses and trying to get a good look at the new addition.

Afterwards we were moved from labor and delivery to the post-natal ward, where we would remain for the next two days. Both sets of parents arrived to meet the baby, it was all so surreal.

I feel so lucky that everything went the way it did and that the baby is healthy and happy. My husband was seriously like a superhero - anticipating my needs and staying calm the entire time. I'm sure none of this was easy to watch!

We've been home now for about a week, enjoying this quiet time where it's just us. I have lots to say about what we've learned in that time, and what we're trying to figure out. Next time...