Tuesday, 22 March 2016

Breastfeeding Support Starts at Home

A few months after I was hired by the Ob/Gyn department of a local hospital, I received a letter indicating that I had been assigned to work on a committee. Apparently, it was a requirement to maintain my privileges that was buried in the fine print of the application. My assigned committee was focusing on how to support breastfeeding on the postpartum ward. I resented being on this committee as I would have rather been in the clinic seeing patients and I didn't understand why there was such a great need to be "breastfeeding friendly." I found that the proposed breastfeeding initiatives (remove formula samples from the take home bags, only offer formula to the mother and baby if recommended by the pediatrician), seemed to stigmatize the woman who couldn't breastfeed, or one who was struggling. "What about breast cancer survivors? Women who are HIV positive?" I really enjoyed raising the counter point as I couldn't stand the nurse who led this committee. I also noted that conversations among the committee members seemed to be more directed on how we could advertise how our hospital was more supportive of breastfeeding than hospitals in the area. There seemed to be little discussion on how we could benefit an actual postpartum mother.

I found that the nurses on the postpartum ward during my stay were very helpful to get breastfeeding started, without being too in your face about it. They observed Kate's latch, gave me some position tips and when she didn't seem to be getting enough calories, they recommended using the supplemental nursing system to administer formula and they suggested trying to pump my colostrum. They sent us home with some samples of formula, which was most appreciated as we just needed it a few times and were able to avoid buying a whole can. It was just what we needed to get started, but I feel what most strongly influences breastfeeding success is the support received at home.

Prior to becoming pregnant, I had heard about the father's role for supporting breastfeeding and I probably rolled my eyes. In particular, I recall having one patient who at night months was really ready to be done with breastfeeding, but her husband was adamant that he wanted her to breastfeed for a year. The tone of his voice was chilling. I had to ask the patient for a fake urine specimen so I could get her out of the room discretely and ask questions about possible intimate partner abuse. It just felt that if he could be so coercive about breastfeeding, he may be controlling her in other ways. I don't know if it was something he read in his Manual for New Dad's book, as Husband would regularly ask me, "Do you need anything? Can I bring you anything?" while I was nursing. At first I resented it a bit, I felt like an invalid; that I couldn't take care of myself. Then I realised that if I didn't respond, he'd probably stop asking. So I learned that it was okay to ask for a glass of water, or a cup of tea. Mostly I came to appreciate that while checking in on my needs, he was participating in the nursing process.

Until I became proficient at getting Kate to latch and watching her cues, I really didn't feel comfortable breastfeeding in front of anyone else. I still won't say that I'm entirely comfortable breastfeeding in front of my father, but we've both moved on. I didn't feel comfortable at all breastfeeding in front of my in-laws, but I didn't want to have to leave the room every time she needed to feed. I would sit in the corner of the room and use my modesty cover. "Would you like a (burp) cloth?" my mother in law would ask about every five minutes. "No, thank you" was my answer every time, but that really translated to 'No, just please leave me the fuck alone!' Sometimes recognising when she needs privacy is also an important component of support.

Interestingly, while I won't go as far as to say that she was unsupportive, the one person who gave me a hard time about my breastfeeding, was my mother. It started when she first criticised how often I was feeding, and suggested that I should be taking Kate for a walk or rocking her when she cries, rather than nursing. While we were driving from Connecticut to Pennsylvania to visit my aunt, I needed to hand pump during a rest stop just for relief (there was no way I could feed Kate milk that was pumped in a rest station bathroom, but I made Husband pour the milk out, as I couldn't bear to do so). When I walked out of the bathroom stall, my mother was waiting with her arms folded across her chest. "Can we go now?" she demanded in a huff. Clearly, my need to pump for the purpose of comfort was an inconvenience to her.

We went stopping with Kate while my mother was visiting us for Christmas and I suggested stopping at Star.bucks for a coffee and so I could nurse Kate. "Oh, do they have a room?" my mother asked. I laughed to myself. Surely she didn't think that California was so liberal that each Starbucks was equipped with a breastfeeding room. Later that day, we met up with my Dad and Husband for lunch. While we were waiting to be seated, I announced that I was going to change Kate and I grabbed the diaper bag and headed to the rest room. When I returned, my mother asked "Did you feed her?" I couldn't believe that she would think it would be acceptable to feed my daughter in the bathroom, but more so ...how? She had been in the bathroom of that restaurant before. It's two tiny stalls and a sink. I used the modesty cover while I fed Kate at the table. I sort of had the volition to flash my mother just to try to piss her off. Yet her most aggravating action came while we were visiting my friend Amy and her husband Sheldon. Amy had a baby two weeks after Kate and we were both comfortable feeding in front of each other and our families. I started to nurse Kate while Sheldon was on the other side of their large open concept living and dining room. My mother grabbed a muslin blanket from Kate's infant seat and walked over to me and draped it over Kate without saying a word. She didn't need to; her message was clear. I needed be covered as if I were an inappropriately dressed teenager. I felt stripped of autonomy. It's my body, my breasts, my modest, my comfort level. I decide if I want to cover. I responded to her passive aggressive actions with one of my own. I took the blanket off and dropped it on the floor.

So, I admit that much of my intention for this post was to have a good rant about my mother, but it feels interesting to note that although I've become so much more enlightened about breastfeeding through my own experience, some of my prior perspective is validated. I feel the role of the hospital staff was to help us start breastfeeding though teaching and trouble shooting, but the support received when you leave the hospital is far more important for continuation. I enclosed my list of tips to help with breastfeeding.

1. Work with the nurses in the hospital to make sure your baby gets a good latch. Kick visitors out until you feel comfortable flashing your boobs.
2. Do what ever position feels best. My nurses kept advocating the football hold, as it's supposed to be easier for C/s mammas; but we both hated it, so I asked the nurses to stop setting it up for us.
3. If you need to give formula, ask about SNS (Supplemental Nutrition System also called Supplemental Milk System). You get baby to latch on the nipple and then slip a small flexible catheter into baby's moth and deliver formula through a syringe. It's great as you both get to work on nursing and she gets the nutrition she needs. (Medela sells a SNS kit)
4. Plan to bring your Boppy/My Breast Friend to the hospital. Not all will provide and it's best to get familiar with yours
5. Don't panic (right away) about whether baby is getting enough to eat with each feed (after milk is established and the eight is going back up). Babies are smart and will take what they need. Some times it will be a big feed, other times it's just a snack. Listen for your baby to make gulping sounds and watch their hands, if the hands are relaxed, it indicates satisfaction. Count the wet diapers (urine is a better indicator than poop) We used the app MammaBaby, which allows you to track diapers, feeding times (and which breast) and sleep.
6. Go to a Lactation support group in the early days, even if things are going well. You'll gain confidence that you're doing the right things and will pick up some tips and may offer help to someone else.
7. Make sure your nursing bra fits properly. If it's too tight, it can constrict milk supply.
8. Also make sure your pumping flanges are fit to your nipples
9. The term 'nipple confusion' is a bit of a misnomer. It has less to do with the distinction between a human versus a rubber nipple and more do to with the amount of effort required by the baby. Milk flows from the bottle much quicker and easier for a baby, where as baby has to work harder to remove milk from the breast. However, if you are planning to have baby use a bottle, the best time to introduce a bottle is between 3-4 weeks. Be sure to use low flow nipples and continue to offer at least one bottle every 1-2 days.
10. Get a hand pump. It's great to keep in your diaper bag and you can pump without worrying about noise or where to plug in. Plus when baby nurses on one side, you can quickly pump on the other.
11. Hands free pumping bra. Must have hook and latch closure. The zippers break too easily and don't adjust for your changing chest size.
12. Drink Mother's Milk tea 3-5 cups while waiting for milk to come in and then 1-2 cups a day. I also do daily beer (avoid feeding 1 hour post consumption) weekly pint of ice cream and lots of oatmeal cookies.
13. As baby sleeps longer at night, consider getting up to pump. My feeling is 'tap the gold mine while you can'. I've built up quite a frozen stash, plus lots of manipulative points with my husband "I got up to pump all those nights the least you can do is X" or "I can afford to buy [something] because I saved us the expense of formula." Oh yeah, that one will get used a lot...
14. When you go back to work, order more sets of phalanges and pump parts. It avoids needing to wash the same set between pumping sessions (and the awkwardness of washing your pump parts in the breakroom of your office).
15. Playing Tetris the the best way to pass time while pumping.

Monday, 14 March 2016

Eight Months

Wow. I didn't mean to go an entire month without posting, but in fairness, February was a short month. At eight months, it feels like we're hitting our stride and have fallen into a good routine. Our week looks something like this:

Monday: My late night at work. I drop Kate off at day care at 7:30 AM and I'm home around 7:00 PM just in time to put her to bed. Dinner is reheated leftovers from Sunday's meal.

Tuesday: After she demonstrated her planking abilities, I started taking Kate to Baby Yoga. I was hoping there would be some 'Mommy Yoga' in this class, but it's mostly working babies through a few poses and there's a lot of sitting around in a circle singing songs. My younger self vowed that she would never participate in a Mommy and Me singing play group, but I have to admit that I think the class is good for Kate. The instructor is very energetic and she explains the benefits to each activity. She teaches some baby signing, brings in music and leads purposeful play. Plus, it's reasonably priced at $10 for a drop in class or $25 for three classes. I use the excuse that I have a horrible singing voice (which is accurate) to evade singing any of the songs in class. I'm somewhat being true to my younger self. After yoga, we'll meet Husband at the gym. Kate will usually sleep through the first part of the WOD, then we'll tag team baby care and doing our workout. It's the epitome of teamwork parenting. While Kate takes her afternoon nap (hopefully) I'll work on meal prep for the rest of the week. Mixing dry ingredients, cutting up chicken and freezing it in pieces, I look for any shortcuts to make preparing a healthy meal quicker. As much as I love having a day off, I try to get so much done that I feel exhausted at the end of the day and I return to work feeling more tired, but I am not complaining.

Wednesday; Regular work day. Wednesday is also the night to put our garbage and recycling bins in front of the house. I'm not sure why this activity is so time consuming.

Thursday: Another regular work day and my gym night. Home in time to put Kate to bed.

Friday: My early morning. I've started to appreciate that it's been getting lighter during my drive. Now that will change again after Day Light Savings.

Saturday; Baby sign class, then take Kate for a jog in the running stroller. Clean the bathrooms when I get home.

Sunday: Another gym day for me, sometimes Husband and Kate will join. After the gym, we hit the Farmer's Market and Tar.get. I mention this because the market is right in front of Tar.get. There are many signs indicating that there is no Farmer's Market parking in the Tar.get garage. I argue that if I shop at Tar.get [in addition to going to the market] I am legally parking. Plus, I see many other people using the Tar.get parking lot while shopping at the market. Once we make it home, I do my lunch prep for the week and make dinner.

At times it feels that most of my week is consumed with work, followed by planning meals for the upcoming week, shopping for food and preparing to cook. Please note, not every week is like this. For instance, this past weekend Husband was away both days for a hockey tournament, on Tuesday I had to take Kate to the doctors, Thursday I had to teach a class after work, and on Sunday morning I was too exhausted to work out after being up multiple times with Kate during the night. Boom. I haven't been to the gym in 10 days. I'm learning to get over it. Any week that I get to be Kate's mother is a good week.

Stats: 18 lbs 5 oz 27 inches

Teeth: Nope. Still None. I've accepted that she's never going to get any teeth. Nor hair. My baby will forever be toothless and bald, but we'll still love her. Next.

Feeding: My Australian friend Kylie shared with me that her milk supply suddenly dried up around seven months, so I was wary of approaching a seven month drought.  In the hay day of my over supply, I could pump 6-7 ounces per session, a few times hitting a PB of 8 ounces. When I went back to work, the milk slowed a bit, but I could still pump 5-6 ounces on a regular basis. Earlier this month, I had a day where I could only produce 4 ounces per session. I tried not to panic, but three days later, I was struggling to get 4 ounces. This also coincided with our decision to increase her bottles up to 6 ounces. I went to my usual routine to promote milk production; 5 cups of Mother's Milk tea per day, Power.ade, a beer (or two), lots of water and a box of oatmeal raisin cookies. This only yielded a modest increase, it was time to be more proactive. I went to a health food shop and purchased some Fenu.greek. It didn't really work, as I was still just barely getting four ounces and apparently, if it is effective, it makes your urine smell like maple syrup, which never happened.

I consulted Kelly.Mom for some advice; try adding an extra pumping session. I had been getting up every 3.5 to 4 hours at night to pump, but to fit in an extra session, I started getting up every three hours. I was able to accumulate more milk, but still wasn't producing a higher volume. Maybe I needed a new pump, as I channeled my inner Tim the Tool Man Taylor. More Power! [insert grunting noises] As I didn't go through my insurance to purchase my current pump, I decided to use my benefits provided by the Affordable Care Act, to acquire a hospital grade pump. The new hospital grade More Power! pump required a longer period of time to produce less milk than my Med.ela Pump in Style Advance.

Then, while pumping on a busy Friday morning at work, I produced 7 ounces. My next two pumping sessions each yielded 5 ounces. Bessie was back! For how long -who knows? While I was pregnant, I had promised myself that I would pressure my breasts into feeding for X amount of time, but when things were going well, it seemed reasonable to set short term goals. 3 months. 6 months. 9 months. Ideally, I'd like to get as close as I can to the one year mark, but I have to ask myself at times; do I really feel it is necessary to make it to one year, or do I just like the sounds of saying that I made it to one year? If we were to start using formula, she'd be just fine. We actually have 5 or 6 cans that my aunt gave us, so it would cost anything to use. Maybe I just like working towards a goal; or I'm not ready to give up just yet. I know I don't want to breastfeed beyond a year, and I'm not sure how to wean Kate from the breast. I want to make sure I stop before she can ask for the breast, or undo my shirt. One of my patients described that at nine months, "my son fired me". He just lost interest one day. I would appreciate it if Kate were to decide for herself when to stop breastfeeding. My current plan is to continue to push through March and April to pump as much as I can, if we're able to keep adding to our freezer stash, then I can ease up a bit in May. I'm planning to do a Whole 30 Challenge in June, and whatever happens to my milk supply during that time, is what happens. Yet, I have to admit that as anxious as I am to be finished with breastfeeding. I will miss it.

Sleep: We had to accept that her sleep would struggle while she was recovering from her ear infection, which seemed to be followed by a cold. Yet, even after she was feeling better, she would still wake up about three times per night. Sometimes as frequently as every two hours. Our slumber would be interrupted by a cry so gentle, it could be mistaken for a cat's meow. While hoping that the cries would quietly extinguish, husband and I would have to acknowledge that she was getting louder and more urgent. "What do you want to do?" he always asks me. I hate being asked that question, because what I want to do (go back to sleep) isn't an option for me. It's the dilemma that I face. Am I a horrible mother because I am letting my hungry baby cry? or am I a horrible mother as I'm only nursing my baby for comfort and habit. I'm guilty of the latter, because selfishly, it means I can go back to sleep sooner. Husband hypothosized that if we fed her more during the day, she shouldn't be so hungry at night. We increased her milk volume to 6 ounces per bottle and the first night, she only woke up once. Then she slept through the night three nights in a row. We thought we were so smart. but lately she's been waking up once a night again. I'm considering starting a planned dream feed to see if this eliminates her from waking on her own. If so, then I can work on cutting out the dream feed. She's also been waking a bit earlier around 5 AM. A few times, we've brought her to bed with us and she's fallen back to sleep. I'm trying to be very careful with this, as I don't want to invite a co-sleeping situation. It will be fun to see how she handles the Dayling Savings time change.

Milestones: One day she was sitting on her playmat and she reached her arms out to me. I held her hands and she proceeded to pull her self up to a stand and take two steps. Holy shit. We'll have a walker before we know it. We were not so impressed with early achievement of this skill when she pulls herself to a stand in her crib.

Her language seems to be on track. She's making "Ba-ba" and Da-da" sounds. Although, I don't think she connects that Husband is Da-da. The other morning, I made the banana sign, and was greeted with a big smile. I'm probably over-interpreting her reaction.

Likes: Now that she can pull herself to a stand, she wants to stand ALL.THE.TIME. She'll pull her self up on anything. The sofa. The drying rack. She'll even approach other parents at Baby Sign class and will try to enlist their help. She'll find anyway to stand up, even by pushing off her Activity Cube. The benefit is that she can play with the cube switched off. Seriously, the cube has to win the award for most annoying toy. The bird in the circle, sings a song that's wonderful. Tweet!Tweet!Tweet! The bird in the circle!

Apparently, she has a friend a Day Care. The baby with whom she spends most of her time is a boy named Grayson who is turning a year old this month. Husband is already keen to check out this boy and inquire about his intentions with our daughter.

Dislikes: The Pack and Play (aka 'Baby Jail'). We'll place her it in when we need to get something done, and she'll happily play for about 15, maybe 20 miutes before she's had enough and wants out.

Diapering: Oh, the Cone of Shame was a huge fail. It didn't stop her from rolling around, but it was helpful to keep her hands from getting messy. Until she figured out how to separate the velcroed pieces. Now it's just an expensive extra changing pad. I feel compelled to admit that we use a diaper service for our cloth diapers. It was the only way I could get Husband on board as he refused to wash the diapers. Plus, I know some make the argument that while cloth diapers aren't adding to the landfill, they do use more energy for washing. The people at our diaper service claim that because they are using industrial sized and strength washing machines, it takes the same amount of water for one toilet flush to clean a week's worth of diapers for one family. We're also under strict water restrictions because of the drought. Additionally, I feel that I'm helping to sustain cloth diapering by giving this service our business. Their staff was also super helpful when Kate has some skin breakdown issues in the beginning.

I recently met a mom who is so hard core about cloth diapering that she cleans her own diapers, uses them at night, and even used them while travelling. I could tell she didn't think I was a real cloth diapering mom, but I don't really care. We use disposables at night as they are just so absorbent. I swear the diaper must weigh close to a pound by the time we change her in the morning. So far, no leaks. We're still in size 3. Tar.get recently had a coupon $10 off if you spend more than $50 in diapers and they were running a promotion that if you bought (2) 124 count boxes, you would earn a $10 gift card. Boom! $20 in savings.  I hope we stay in this size for a while.
Clothes: Her wardrobe has been rather monotonous as I didn't want to buy any more 6 month sized pieces. She's still not quite big enough for the 9 month size, but her 6 month jammies no longer fit. Her pants have become capri lengths.

Health Issues: She recovered quite quickly from her ear infections as soon as we started her on antibiotics. Husband was concerned as she had a persistent cough, so we took her in to see her pediatrician. He reminded us that we are in cold and flu season, and for a day care baby, Kate was doing really well to escape with just two colds and an ear infection. For the record, I had said the same thing.

Looking forward to: My parents are coming for a visit! Kate's Day Care closes for a week in April. Husband has a work project that week, and two of my colleagues are also off that week, so my parents are going to be called upon for baby sitting. They are only staying for one week, and we both have unrealistic expectations for their visit. Husband wants my Dad to help with some DIY projects and I'm hoping my Mom and I can make some meals to freeze. I don't think my parents are going to want to do much beyond playing with Kate.