Thursday, April 30, 2009

My Breastfeeding Story - Part 2

When Jude was about three weeks old, we met with our new LC Dora* for the first time. Jude had gained four ounces in four days. We were happy about his weight, and thrilled to find out that Jude was now getting more than a half ounce from a nursing session with me. Dora was amazing. I really think that working with her is what got me on the path back towards being able to breastfeed exclusively. At the time, that was the most important thing to me (since then, my perspective has changed somewhat - more about that later). She sympathized with the fact that pumping was so unrewarding for me, and suggested that we try tube feeding instead. Jude had begun to prefer the bottle to the breast (and why not? he got food with much less effort that way). It had gotten to the point where he wouldn't really bother to suck while I fed him - he was just waiting for the bottle. The tube solved that problem. Dora rigged up a bottle with a feeding tube - put the supplement in the bottle and stick the tube in his mouth towards the end of a nursing session. As far as he knew, he was getting the milk from me, so he worked harder and therefore increased my milk supply while nursing. Over the next few weeks, we managed to gradually increase my production to about four ounces per feeding by supplementing with the tube after every daytime feeding. At night, Jude slept for long enough between feedings that I always seemed to have plenty of milk for him. But while my supply was increasing, Jude's needs were increasing as well. It didn't seem like I was going to be able to stop supplementing anytime soon, and I really wanted to get to the point where I was providing all of Jude's food.

At some point, Dora made the observation that Jude seemed to have a tight frenulum. This means that the flap of skin that attaches the tongue to the bottom of the mouth was shorter than usual, which was preventing him from really being able to use his tongue to suck well. There's a good chance that this was the reason that my milk supply had dropped so low in the first few weeks of life - although I thought he was eating, he wasn't physically capable of extracting much milk. We took Jude to a surgeon who was able to correct the problem in less than a minute. I wasn't really surprised that Jude had this problem - I had had the same issue as a child and so did my father (and it is hereditary). The surgery seemed to help some, but not enough that we were able to stop supplementing.

We talked about medication again. The standard medication that is given to nursing mothers in the United States to increase milk supply is called Reglan. It works fairly well, but has some pretty bad side effects, including depression. I was already having some symptoms of postpartum depression; mostly due to feeding issues, I think. So I was reluctant to take anything that might exacerbate this situation. Dora suggested that I talk to my doctor about Domperidone. This is a drug that used to be prescribed to nursing mothers, but is no longer manufactured or sold in the United States. Domperidone is available in most other countries in the world, for the most part with no prescription required. We decided to try that route, and I convinced my doctor to prescribe it for me. There is a local compounding pharmacy that will make Domperidone if a doctor prescribes it. My doctor would only give me a half dose at first, because she wanted to see if that would work. Within a few days, I noticed a difference. Jude seemed to be eating more at each feeding and I could hear swallowing much more often. It took about two weeks, but we managed to get to the point where we were only giving him a supplement twice a day. I was still really motivated to breastfeed exclusively, and so I convinced my doctor to increase my dosage to the full dose. That did the trick - we were able to stop supplementing entirely within a couple of weeks.

Around this time, I started to think about going back to work, and so I wanted to build a supply of frozen milk to make sure we had plenty to feed Jude while I was away. I started to spend a lot of time pumping - in between feedings, at night after Jude went to bed, anytime I was away from him, etc. At this point, pumping was better than the last time I had tried, and I managed to collect two, three, and sometimes four ounces per session. By the time Jude was four months old, I was producing more than enough milk and had started to build a supply in the freezer. Around this time, we went on vacation to the East Coast for two weeks. Jude seemed less interested in eating, and often only wanted to nurse for 15-20 minutes at a time. This was fine with me since it took less time to feed him. But between his reduced nursing time and the fact that I stopped pumping while on vacation, my supply started dropping again. I got back from vacation and it was time to go back to work. Within a week or so, I wasn't able to pump enough during the day to keep up with his demands, so I had to resume pumping every night after Jude was asleep. Sometimes I would stay up just to pump, and I began counting the days until Jude started solid foods, hoping that he wouldn't need as much milk. We started giving him solids at around 5 months of age, but it didn't change his milk demands much. We had a vacation coming up, and I decided to stay on my medication until we returned so that I could nurse him on the airplane. He would be seven months old when we returned from vacation, and by then I was ready to let nature take its course and stop taking medication to keep my supply from dropping.

While Domperidone works really well, there are a few problems with using it. First, it is expensive and not covered by insurance. Second, I found that I had to keep taking it in order to keep my supply up. I tried tapering down a couple of times, and found that I started making less milk almost immediately. Finally, as I mentioned in my other post, I developed a voracious appetite and was unable to prevent myself from gaining weight while taking the medication. Despite these problems, I'm glad that I was given the option of taking Domperidone. I think that if I had never gotten to the point of being able to have an adequate milk supply, I would always feel that I had somehow failed Jude. Ironically, now that I've experienced "breastfeeding nirvana", I no longer think that it's as important as I once did.

Around this time, I read this article in the Atlantic Monthly. It really gave me a new perspective on breastfeeding. Pretty much everything that the author says resonated with me. I like her approach, which is that if breastfeeding works for you, that's great, but the benefits are not so dramatic that it's worth doing anything and everything to make it work. Formula may not be as good as breast milk, but it is a close second, and a perfectly acceptable alternative when a mother is not willing or able to nurse. Nursing is a huge commitment on the part of a mother, and sets up a dynamic of inequality when it comes to infant care, no matter how involved her partner may want to be. I know that there were times when I resented the fact that E Ben could disappear for hours at a time to do his own thing. Even when someone else was taking care of Jude, I had to be available to either nurse or pump every couple of hours, so I was never able to have true "time off". I now know that this was partly my own doing - it would not have been the end of the world to miss a feeding or use up some of my supply of frozen milk, but at the time it seemed like I had no choice. Hanna Rosin says it better than I - you should read the article.

I have been medication-free for the last month. I've noticed that my supply definitely has dropped. I used to be able to pump 8-10 ounces a day at work and now I'm lucky to get 4. I still nurse Jude 3-5 times a day, but he also eats three meals and at least one bottle of formula (right before bed). I no longer pump at night, or anytime except when I'm away from Jude for a full day. I'm sure that I'm not really making enough milk to fully satisfy Jude's voracious appetite, but we are lucky that he eats solid foods really well and seems happy to drink from a bottle when needed. Will I make it to a year of nursing? That was my original goal, and though I've revised it in my mind at this point, I can see myself continuing this level of nursing for the next four months, and perhaps even longer than that.

Up next: final thoughts about breastfeeding

* Not her real name...

Tuesday, April 28, 2009

Finger Foods

Something clicked, and Jude figured out how to eat finger foods this week.  This video was taken after he had eaten a full dinner and about 30 puffs/Cheerios, so he wasn't hungry anymore.  But I just had to document his technique...

Monday, April 27, 2009

My Breastfeeding Story - Part 1

I've seen a lot of "birth stories*", but very few "breastfeeding stories". Maybe, for most people, breastfeeding is so easy that it's not worth writing about or sharing the story, although I kind of doubt that based on the experiences I've heard from many of my friends. Anyway, I hope that my story can help someone having similar issues, or at least provide some hope that nursing can work out in the end, even it seems impossible at first!

Before Jude was born, my expectation was that I would breastfeed exclusively until he was ready for solid foods, and continue throughout the first year of his life. I took a breastfeeding class, read The Nursing Mother's Companion, and purchased a hospital-quality breast pump in preparation. There was some mention of low milk supply, but most books dismissed this as something that rarely happens and I didn't give it much thought. I did have some moments of worry that I would not be able to nurse, but mostly just hoped for the best and figured there was nothing much that I could do about it if that turned out to be a problem for me.

Jude swooped into the world on August 22nd at 10:52 pm. We had a great labor experience, and Jude was as healthy as could be following his grand entrance. I was able to give him his first meal within an hour of birth, and as far as I could tell, he seemed to be content. What did I know? I had never fed a baby before. Throughout the next few days, which we spent in the hospital, I attempted to feed him every few hours. He never seemed very hungry, and we had a lot of visitors, so sometimes 3-4 hours would go by without a meal. We had him circumcised the day after he was born, and the shock of the procedure suppressed his appetite for the next ~8 hours.

At some point the next day, we got the bad news that Jude had lost a significant amount of weight during the first two days of his life (more than 10%, which is the acceptable limit). The nurses wanted to start supplementing with formula immediately, but I resisted that proposal and chose to try feeding him every two hours around the clock instead. The next morning as we were getting ready to check out, we did one final weight check, and found that Jude was down to 7 pounds 11 ounces, a full pound less than his birth weight. Based on this, we were required to see a pediatrician the next day for another weight check, and to continue feeding every two hours. In case you've never fed a newborn every two hours around the clock, let me tell you that this is an exhausting experience. The baby eats for 30-40 minutes each time, then needs to be changed and lulled back to sleep. By the time the baby is down, you have about a half hour to rest until it's time to feed again. Luckily, I had a lot of help from my mom, sister, and E Ben, otherwise there is no way I could have done this.

The next day's visit with the pediatrician was comforting (perhaps too comforting, in retrospect). Jude's weight was the same as the previous day, which we took as a good sign (at least he had stopped dropping). She recommended seeing a lactation consultant later in the week, and sent us on our way thinking that our problems were more or less behind us. The next day at the LC's office, Jude had finally gained some weight, but we got the troubling news that he had only ingested about half an ounce of milk after a long nursing session in the office (he should have been eating at least two ounce per feeding at that point). The LC showed me how to use my pump and suggested that I pump for 5-10 minutes after each feeding in order to increase my production. That seemed like way too much trouble, and at that point we didn't know that we had a real problem, so I didn't follow her advice. Mistake #1. We made an appointment to go back two days later, at which point we found that Jude had gained two ounces in two days (an ounce a day is the goal during the first three months of life) but that once again his meal was very small (less than a half ounce). We looked at his weight gain and figured that he must be getting more to eat at most meals. Maybe I was nervous while nursing in the LC's office, we thought, and that explained the small feeding. As a result, we decided not to worry about it and declined another visit to the LC. Mistake #2.

During the next ten days, Jude was pretty fussy for a lot of the time he was awake, especially after feedings. We thought that maybe he had gas. He ate for 40 minutes every 2 hours during the day, but at night we didn't wake him to eat and he would often go 4-5 hours at a time without waking to eat. We thought we had a really great sleeper on our hands. We went in for Jude's two-week visit at the pediatrician's office on his 17th day of life. Bad news - Jude had only gained three ounces in ten days. He was screaming his head off during the entire visit to the doctor. We were told to make another appointment with the LC and to start supplementing 4-6 ounces a day. I was crushed. I was so opposed to supplementing and felt like a failure. That night, we made Jude his first bottle of formula at bedtime. He sucked it down like he was starving and immediately fell into a deep sleep. Turns out this was the first full meal the kid had had in his life! His crying during the past two weeks had mostly been cries of hunger. The reason he had slept so long during the nights was that he didn't have the energy to wake up and let us know he needed to be fed. We felt so bad, and yet we didn't want to give up on breastfeeding. It was really important to me that we try to figure out some way to make it work, but I just didn't see how to get there at that point. We hoped that the new LC would be able to help.

The first appointment we could get was three days later. During that time, we fed Jude an ounce of formula after each nursing session and also began to try pumping a few times a day. Pumping was depressing. I would hook myself up to this machine and after 10 minutes I was lucky if I had a few drops of milk in the bottom of the bottles. Over the course of three days of pumping, I managed to accumulate a grand total of one ounce of milk. I hated it. Jude, fortunately, took to the bottle immediately and drank his supplement enthusiastically. We met with the new LC and found that our efforts were helping. Jude had gained three ounces in three days, but my milk supply was not increasing much. We had a long talk about different things that we could try, the benefits of pumping even if it didn't result in any milk, and medication options. I wasn't ready to try medication yet, so we decided to try pumping and supplementing for another couple of days. We made another appointment for four days later, this time with the LC who was the most experienced one in the office. I guess we convinced someone that we needed more help than your average new parents.

Up next: the exciting conclusion of my breastfeeding story...

* By the way, if you want to read my birth story, send me an e-mail or leave a comment on this post and I'll send it to you.

Saturday, April 25, 2009

Breastfeeding Myths

I have a love/hate relationship with breastfeeding.  For me, nursing has been the most stressful part of having a baby.  It is also an incredible feeling to be able to nourish and comfort your baby using nothing but your body.  There is this strange tradeoff for me between feeling trapped by the never-ending nature of being the sole source of nutrition and loving the convenience of always having a ready supply of food for the boy.  You can't beat waking up in the middle of the night, rolling over in bed, and feeding the hungry baby without ever opening your eyes.  At the same time, it would be nice if some nights it was possible to let someone else do that job!  For today, I want to talk about a few "myths" about breastfeeding which have not been true for me.  I'll go into some more of my thoughts on the subject in future posts.

Myth #1 - Breastfeeding is less expensive than formula feeding

For me, this has not been the case.  Between buying a pump, numerous visits to lactation consultants and doctors, and the medication that I had to take for six months in order to maintain my milk supply, I estimate that nursing Jude costed us about $100 a month.  Since Jude has a stomach of iron and pretty much any kind of formula agrees with him, we would have had to spend about $60 a month to bottle feed (Costco formula, which is what we use now, costs about $2 a day).  

I completely understand that my experience here has been different than most.  Brand-name formula costs about $5 a day, and most women don't need either the medication I took or so many doctor's visits to make nursing work for them and their baby.  However, for me, it turns out that I had to pay an extra $40 a month in order to nurse Jude. 

Myth #2 - Breastfeeding is always painful at first

I was very lucky - I never felt pain when nursing Jude.  He had a good latch right from the start.  I think it really helped that I took a breastfeeding class and also had help from the nurses in the hospital.  I've heard many nursing mothers describe the pain they felt during the first few weeks, and although I had plenty of problems with nursing, I have to say that I never had that one.  I think it would have been a lot harder for me to stick it out through all of my supply issues if there had also been a lot of pain involved.

Myth #3 - Breastfeeding helps a nursing mother lose weight

It takes about 500 calories a day to produce enough breast milk to feed a baby.  So a nursing mother should be able to eat enough food to maintain her current weight and still lose about a pound a week, right?  Not for me!  Within two weeks of giving birth to Jude, I was down to a few pounds less than my pre-pregnancy weight.  I wasn't very hungry and I was exercising a little bit every day.  The only problem was that I also wasn't producing much milk.  Eventually, after trying pretty much everything else to increase my milk supply, I decided to start taking medication.  It worked - but my appetite went through the roof.  I gained twenty pounds over the next few months.  Every time I tried eating less or exercising more, my milk supply would drop and Jude and I would both be unhappy.  I decided to just go with it and worry about losing the weight once Jude was eating solid foods and no longer dependent on me for all of his nutritional needs.  I stopped taking the medication about a month ago, and I've started focusing on my fitness a bit more, but I think it's going to take some time (and a lot of work on my part) before I regain my former shape.  Even though I'm still nursing!

Up next:  my breastfeeding saga from birth to eight months...

Wednesday, April 22, 2009

Eight Months on Earth Day

Happy Earth Day! Jude is eight months old today. The last month has just flown by. Above, you can see Jude in his favorite position in "the jail". He started out just standing, but now will walk from one end of the deck to the other. He's also getting better at sitting, but his crawling progress has stalled. We probably should make him spend more time on the ground working on his crawling, but he is so happy when standing that we give in. Probably a mistake, but what can we say. We're first-time parents. Tonight Jude had a pretty bad fall and cut open his head. We felt terrible, but Jude seemed mostly unfazed.

Jude had his first ride in the back-facing Ergo this week. He did pretty well, and it was way more comfortable for me than having him on the front. I'm hoping that an evening walk when I get home from work can become a new part of our routine. Jude's routines are pretty stable these days for the most part. I'm still nursing 3-5 times a day, and he eats three meals and additional formula as needed. I was pleasantly surprised to find that I'm still able to maintain a (reduced) milk supply without medication. I pump much less than I used to, but Jude seems to get as much as he wants when he nurses. So we'll probably keep on doing this for a while longer.

After sleeping through the night a couple of times, Jude is back to his once-a-night waking. It's not too bad, actually. E Ben listens for him in the night and goes to get him when it's time to feed him, and that change alone has really improved my sleep quality. Before, when I was in charge of listening, I never really got any deep sleep until after I fed him in the night, but now I feel much more rested. A simple change, but it has made a big difference!

Jude spent some time digging in Greg and EMM's garden today in honor of Earth Day. Happy Anniversary, Hilary and Emma!

Jude and his Dad spend a lot of time together. They have a lot of fun pressure washing, visiting Home Depot several times a week, having lunch with friends, and running in the Bob. It makes it a lot easier for me to go to work knowing that Jude is in such good hands.

Here is a video to finish off this post. It gets very exciting in the last few seconds!

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Thursday, April 16, 2009

First Tooth!

Jude's first tooth is in! It is very sharp and he likes to bite everything, especially his parents' body parts. We managed to get through this teething process without too much upset. Jude barely even seemed to notice. We've been trying to get a photo, but Jude is very protective of his mouth and doesn't like to share his new addition. Maybe over the weekend!

After sleeping through the night twice in a row last week, Jude is back to his old pattern. He'll wake up at some point in the night and want to nurse. I don't think he's really hungry, because sometimes he barely eats anything before going back to sleep. I think we'll try to night wean him sometime next month. We don't want to do anything too stressful while he's getting his first teeth.

I hope to have some more time this weekend to work on my posts on nursing. Something else always seems to come up!

Wednesday, April 8, 2009


Jude slept through the night (unexpectedly) for the first time last night.  To bed by 7, didn't hear a peep until 7am the next morning.  I'm not expecting a repeat performance tonight...

I'm working on a series of posts about my nursing experiences.  Stay tuned...

I'll leave you with a video of Jude from Florida.  He seems to be following in Dad's footsteps.

Monday, April 6, 2009

The Couch, the Stabbing, and The Grease Fire

This weekend reminded me of some of the perils of our sweet little life. We took Jude to a community center pool, which involved dressing him in cute swim trunks and a swim diaper. Daddy was in charge of getting dressed, and for some reason thought it would be okay on the couch. This was but a prelude of things to come.

Jude did a great job at the pool, and even went down the BIG SLIDE and around the WHIRLPOOL. He is unfazed by the many dangers of drowning and choking and DROWNING and dying. His mother and I are far more concerned, so we do the worrying for him. At one point Jude crawled to the edge of his floating duck-shaped kickboard thing and PUT HIS FACE IN THE WATER. He was fine.
Jude is such a big boy that he has graduated to the new monster size carseat. This is great news for Daddy, who won't throw out his back anymore carrying the bucket back and forth to the house. We got the Cadillac of carseats, the Britax Marathon, but of course his safety-conscious parents took it to the carseat clinic so that TRAINED PROFESSIONALS could assist in the installation.

First one in line on Saturday morning, I got a Beaverton Police Officer to help guide me through this highly technical process. Everything was going great, until we needed a small, sharp object to open the center seatbelt latch. Thinking ahead, I had brought along my trusty six inch folding pocket knife. The next part is something of a blur. I raised the knife at the exact moment that the Officer grabbed for one of the straps. This is the part where I STABBED HIM. In the hand. He called me a menace.

Finally, I broke out the barbecue for the first warm evening grilling of the season. Grandmom had just given us two freshly caught salmon steaks and we fired up Old Black for some propane and fire. I really should have cleaned this thing last season, or maybe even the season before. It has been building up a fine char on the grill, but I had neglected to notice how much grease had accumulated in the pan below.
Somewhere toward the end of the cooking process, flames started licking out from the lid. This was a bad sign.

I pulled off the food, turned off the propane, and then opened the lid to let the fire die out. I checked the grill a few minutes later, and this is when I noticed that the grease pan was in full flame. I ran upstairs to check the Joy of Cooking for hints on grease fires. No advice listed. Linden looked it up on the internet and sure enough, baking soda. Notice the empty box and deck stains and blackened broom.

I would just like to say that we are not the kind of parents who suffer for anxiety over doom and gloom. We are not overworried about intruders, germs, or car accidents. We do not own handguns for our own protection. In many ways, there is something freeing about letting go of that control. Of recognizing that every day is a gift, and that we are SO lucky to have our good health and our full lives. There is definitely some kind of appeal to the idea that we are protected by our own positive energy, or momentum, or white light.

But it doesn't hurt to give the angels a hand. I'll be cleaning the barbecue this afternoon. With my toothbrush. :)
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Friday, April 3, 2009

Playing and Peas

Jude had a play date with Gryphon this week.  He's been working on his crawling this week, and every time he spends time with another baby who can move around, Jude has renewed motivation to get himself from one place to another.

He also had his first meal of peas.  More ended up on his face than in his stomach.

Finally, I had to post this video of Jude and me playing the other night before bed.  This was the tail end of about a half hour of playing and laughing.  He is so much fun these days!