"It was the oldest sound in the world. Souls flying away." The Secret Life of Bees

Sunday, August 10, 2014

breastfeeding is hard

As we are in the midst of breastfeeding awareness month and world breastfeeding week  just ended, I thought this is a good time to share a bit of my breastfeeding journey.

I always knew that I wanted to breastfeed.  I knew it was the right choice for me/us and it was never really a question.  During my pregnancy, I read Ina May's Guide to Breastfeeding and we spent a little bit of time talking about breastfeeding and practicing breastfeeding positions during our childbirth class.  Beyond that, I didn't do a whole lot to prepare.  I guess I just assumed that once baby was here, I would hold him up to my breast and he would eat.  Ha!  If only!  For some moms, that is the case.  Everything goes smoothly, baby latches well right away, and milk is plentiful.  Lucky mamas!  For me, and many other moms, the road is much more rocky.

When Hugo was born, we got lots of skin-to-skin contact right away, but getting him to latch for the first time was difficult.  Part of the problem was that due to my postpartum hemorrhage, it was very difficult for me to sit up (see my birth story here).  Because I couldn't sit up, we had to maneuver ourselves around and try different positions to get him latched on.  Eventually we got it, but it didn't come easy.  For the first 3-4 days postpartum, we had difficulty getting him to latch.  Sometimes he would latch fine, other times it seemed like he couldn't quite get it and we both would end up frustrated after multiple attempts.  Ben and and I spent lots of time looking up youtube videos of newborn babies properly latching on.  It was so frustrating to me because I really thought it would all come naturally.  I thought that I would/should instinctively know how to feed my baby.  When everything felt painful and awkward and I couldn't figure out how to help him latch on properly, I got so discouraged.

After a few days of this, my nipples were bleeding, sore, and scabbed over.  I cried during a lot of the feedings because it hurt so bad.  I cried because I was exhausted, because I couldn't figure out how to nurse him 'the right way' and because of the physical pain. The nurse that came to visit us at home 4 days after I gave birth gave me a nipple shield (this was also the day my milk came in).  This was a blessing and a curse - it was great because it helped Hugo latch on better and get more milk, plus it gave my nipples a little bit of a much-needed break.  We were desperate in the moment and this allowed us to make it through the day.  It was a curse because she unknowingly gave me  the wrong size, which made matters even worse and also because we would eventually have to wean off the shield and learn how to nurse without it.

At 6 days postpartum, we met with a lactation consultant.  This was one of the best decisions I have ever made.  She spent so much time with us understanding what was going on.  She was encouraging, understanding, and she made me feel supported.  She showed us different feeding positions (we practiced this in our childbirth class, but it is SO different when you have an actual baby in your arms who is hungry!), showed us what the latch should look like,  and gave me ointment and oh so soft nursing pads so that my nipples could heal.  We came up with a plan and she gave me the tools and support I needed to make it happen.  Ben went with me and supported me every step of the way.  He was able to see how the lactation consultant had us positioned and help me re-create that at home.  We even took pictures in her office so that we could reference them if needed.

Things definitely got better after that.  I would say that at about 2 weeks postpartum, my nipples had healed a bit and I felt like I could see the light at the end of the tunnel.  Each time we nursed, I got a little bit more comfortable and Hugo figured things out a bit too.  One thing the LC said is that not only is mama learning how to breastfeed, baby is learning too.  It takes time and practice.

          
Hugo's nursing sessions became longer and longer. By about 10 days postpartum, he was nursing for an hour+ every session (sometimes even an hour and a half). This was fine with me, but it made getting other things done really hard and I started to get sore from sitting in one positions so long/often. When Hugo was 2 weeks old, we went in to see my midwife for a check up. He was gaining weight fine (was 9lbs2oz at birth, dropped down to 8lbs2oz at 4 days old, and was back up to 8lbs9oz at 2 weeks), but she thought it would be a good idea to start some herbs to try to increase my milk supply since he was nursing for so long. We also discovered a very minor yeast infection on my nipples/his bum. That was easily treatable with ointment, but just one more thing to deal with.

When Hugo was about 4 weeks old we went back to see the lactation consultant. At that appointment we learned that Hugo was still not quite up to his birth weight and that he wasn't gaining enough per day (so he wasn't getting enough milk). I think somewhere in between weeks 2 and 3, my supply was not able to keep up with his demand. We also discovered that although Hugo was nursing for an hour+ each time, he was actually only eating for about the first 5-10 minutes and he was just comfort nursing after that. Once again, the LC was so very helpful. I told her that I would supplement if necessary but that I would like to do everything I possible could to get my milk supply up so that I wouldn't need to supplement. We came up with another game plan and she made sure I felt supported and equipped to carry through. We decided that I would:

* Nurse Hugo every hour that he was awake - I actually set an alarm on my phone to go off every hour. Sometimes he comfort nursed in between, but I made sure he ate every hour.
* Add in some pump sessions to stimulate more milk production
* Take a tincture that she prepared containing herbs known to help milk production (I don't remember all of the ingredients, but I know it had fenugreek and goats rue)
* Have my midwife prescribe me domperidone (a prescription medication known to increase prolactin which in turn increases milk production. Taking domperidone for low milk supply is something that is done very commonly in other countries. The medication is actually over the counter in many places. In the US, it's not FDA approved for milk production, but my midwife wrote the Rx for me to use it "off label". In my case, the pros definitely outweighed the cons.)
* Drink mother's milk tea
* Be very mindful about getting plenty of fluids/calories every day
* Pick up a scale form my midwife's office so that I could weigh Hugo every day at home


This was A LOT of work, but it paid off. We saw a change almost immediately and Hugo started gaining weight quickly. He was putting on about an ounce per day and he reached his birth weight at about 4 weeks (my midwife and LC were comfortable with this since he weighed a lot to start with. I ended up not needing to supplement). He continued gaining at that rate (an ounce per day) for quite some time and really packed on the pounds!

I started going to a breastfeeding support group every week. I can't tell you how helpful it was for me to be around other breastfeeding moms. I found out that I wasn't alone. It turns out that lots of moms have trouble breastfeeding. We were there to support and encourage each other, talk about solutions that worked for us, bounce ideas off of each other, and sometimes just listen to each other cry. The group leader was a lactation consultant and was great about answering my many questions along the way.

At around 12 weeks postpartum, things definitely shifted. Breastfeeding starting to feel easy! We had made it past most of our hurdles and I realized how much I enjoyed feeding and nourishing my baby. Things have only gotten better since then. I love breastfeeding because I love being able to feed my baby anywhere, anytime. The milk is always ready, always the perfect temperature, and always contains exactly what he needs right then. I love the bond that Hugo and I share. I love the way he looks up at me while he's nursing. I love that I can so easily comfort him if he's upset or trying to go to sleep. Even though we had a lot of struggles initially, I would do it all over again. It was all absolutely worth it.
Yes, I nurse Hugo anywhere, anytime he's hungry.  Even out in the woods while on a hike:)  Our doula said to me, "every time you feed him in public, you are making it just a little bit easier for the next mama who comes along who wants to nurse in public." Before I had him, I thought that nursing in public would make me uncomfortable, but it doesn't.  Not at all.  If he's hungry, I feed him.  
Here are a few suggestions if you are pregnant and planning on breastfeeding or if you are a new mama currently breastfeeding:
  • Prepare ahead of time.  Stock up on nursing tanks/bras/sleeping bras, nursing pads, nipple butter, etc.  See this post for some of my suggestions.  
  •  Do some research and fine a great lactation consultant in your area.  Have her number handy for when you need it - or better yet, go ahead and make contact and have a tentative appointment scheduled with her.  Even if you don't have big roadblocks like I did, you will appreciate having an expert there to give you tips, assess baby's latch, and just support you in general.
  •  Find a breastfeeding support group or LLL (Le Leche League) group to attend.  It is so important and helpful to be around other breastfeeding moms, even if you are not have trouble breastfeeding.  If you are having trouble, being able to talk to other mama's who have been there, or are there, is invaluable.
  • Make sure your partner is participating - they can be helpful in so many ways from helping you get positioned the correct way to making sure your water glass is always full.
  • When in doubt, nurse!  I was surprised by how often Hugo wanted/needed to nurse.  Even if baby wants to nurse every 30 minutes, do it.  Nurse, nurse,  nurse!  Things will regulate and you will fall into somewhat of a routine soon enough.  In those early days though, just nurse all the time:)