Breastfeeding

A warning about this post: it might not be of any interest to you unless you are also a mother, and if you're queasy about this kind of thing, you might consider it T.M.I.


Probably the part of motherhood I was least prepared for is the heart-aching, painstaking process that is breastfeeding. Before Ruby was born, Steve and I took a class on breastfeeding at UCSF. While I highly commend the quality of prenatal education at UCSF, I do have bone to pick with this particular class because I feel it did not nearly prepare me for the difficulties I would face. The class in many ways was structured as almost an advertisement for breastfeeding. It began by listing the many advantages of a breastfed baby and followed with videos of happy mothers who breastfed their children into their toddler years. However, I didn't need to be sold on breastfeeding. I was already sure I wanted to breastfeed my baby, not only for the nutritional benefits to her, but because to me it seemed like an integral part of new motherhood and one of the best ways to form those initial bonds with the new baby. Therefore, I watched all the videos and read the books, and I thought that because I had educated myself and made the mental commitment to exclusively breastfeed, that it would all work out for us.

My first attempt to breastfeed Ruby just after she was born was unsuccessful. She wouldn't latch on and then quickly fell into one of her Deep Sleeps. Although I made several other attempts, I realize in hindsight that none were actually successful latch-ons and that she did not get any actual food until the following day when we were visited by the lactation consultant. When she saw the trouble Ruby was having, she recommended I use a nipple shield to aid with latch-on.



This is basically a soft, plastic shell that goes over the nipple and induces suckling by contacting the soft palate of the baby's mouth. Although the nipple shield allowed Ruby to latch on, she would only take a few sucks before returning to a comatose state from which she would not deign to be re-awoken. We were reassured by the staff that all babies were very sleepy for the first 24 hours of life, but the 24 hour mark came and went, and Ruby was still not nursing at nearly the recommended frequency. We were asked several times if she was delivered early, as this behavior was characteristic of late-term premies, but as you know, Ruby was full-term and 4 days late. We were asked if I had drugs during labor as they can sometimes make the baby extra sleepy, but I hadn't had as much as an Advil in 38 hours of labor specifically to avoid problems like this. There was nothing anatomically wrong with Ruby's mouth that would prevent her from breastfeeding, and she had a strong suck, as evidenced by the pain I was experiencing.

When we brought Ruby home from the hospital, I continued to nurse her as often as we were able to wake her for as long as she was able to stay awake. Despite all of my research and preparation, I did not know what successful nursing felt like, so I was surprised to hear from the pediatrician that at 5 days old, Ruby was losing too much weight. The doctor misdiagnosed the problem as being a lack of milk supply, and told us to start giving Ruby formula.

I had heard that much of the experience of being a first-time mom involves fear and guilt, and there is not much that can make you feel more fearful and guilty than hearing that your five-day-old baby is not getting enough to eat and that it's your fault.

A few days later, we went back to UCSF to see the lactation consultant. She weighed the baby using a very sensitive scale before and after nursing in order to determine exactly how much milk Ruby was transferring. We discovered that after 30 min. of nursing, Ruby had only transferred about 30 mL of milk, or about 1 oz. At that rate, she would have to nurse continuously for 1-2 hrs. in order to get a full meal. She then would almost immediately have to start nursing again in order to eat at the necessary frequency of every 2-3 hrs. This was hardly feasible considering she slept most of the time and could hardly be awoken every 3-4 hours to eat. The diagnosis was simply that Ruby was "ineffective" at breastfeeding.

Unlike the many other problems that hamper breastfeeding, there did not seem to be any solution for a baby being ineffective. Therefore, the suggestion was that I nurse her for 15 min. on each side, then pump while Steve fed her the rest of her meal from a bottle. While in theory this seemed like a reasonable plan, once we started giving Ruby the bottle, she stopped latching on to the breast alltogether. I would sometimes spend up to half an hour just trying to get her to latch, while she screamed and flailed about, knocking off the nipple shield over and over and over again. It seemed like the only time she ever cried was when I was trying to breastfeed her. Although I would have liked to continue trying to breastfeed, the amount of time it was taking was defeating the purpose of trying to get her to have her meals more quickly, and at that point the main objective was for Ruby to regain her birth weight. Therefore, we had no choice but to resort to exclusive pumping. At one week after birth, I could no longer breasfeed my baby.

Since that time, the breast pump and I have endured a bitter love-hate relationship. I know that without it, Ruby probably wouldn't have been able to get any breastmilk at all. However, for a long time, it was the bane of my existence. The first time I strapped on the pump, I was quite terrified. Even though the pump we had purchased was supposed to be the most convenient and effective, as illustrated by this happy working mom, I thought that it looked like I had a bomb strapped to my boobs.



For the first few weeks of pumping, I was not getting enough milk to meet Ruby's demand. This was probably due to several factors. First, milk production is all about supply and demand. The more the breasts are emptied, the more milk is produced. The first 2 weeks postpartum is the most important time for establishing milk supply. That is why it is recommended that moms nurse their babies frequently and exclusively during this time. However, for the first week after Ruby was born while I was exclusively breastfeeding, she was not able to empty the breasts, making my body think that the demand was less than it really was. Second, the body does not respond to the breast pump in the same way as it responds to the baby. While just thinking about your baby or hearing her cry can make you leak milk, it takes time to train your body to respond to the breast pump. Therefore, for the first few weeks of pumping, we had to supplement with 1-2 bottles of formula per day.

While I realize that formula is not poison, it did once again illicit the fear and guilt. Therefore, I did everything I could to increase my milk supply, including taking Fenugreek, a pungent herb the smell of which made me gag. In the end, the only method that was really effective was pumping 8-12 times a day at a frequency of every 2-3 hours around the clock. For a while my life was just a constant cycle of assembling the pump, pumping, and washing the pump parts. During this period while my supply was still catching up to Ruby's demand, I treated breastmilk like liquid gold. Even spilling a few drops made my insides hurt. One time late at night I was so tired that I knocked over half a bottle that I had just pumped. I know you're not supposed to cry over spilled milk, but I think that this is the exception.

After a couple weeks of exclusive pumping, I was starting to get the hang of the routine. Unfortunately, it was at this time that I came down with a case of mastitis. Mastitis is an infection of the breast tissue that is characterized by extreme pain in the affected breast and flu-like symptoms such as low-grade fever and fatigue. The treatment, in addition to antibiotics, is even more frequent pumping (at least every 2 hours around the clock). Ironically, the other treatment is to get plenty of rest.

The silver lining to all the pumping is that my supply slowly but surely increased until I was producing significantly more than Ruby could eat. This allowed me to build my freezer stock of breastmilk, which has now taken over our freezer.



Throughout this time, I continued to work with Ruby on breastfeeding. I would try to latch her on at least once a day, and I would hold her or have her sleep on my chest as often as possible so that she would associate it with a place of comfort. Around the time that I got the mastitis, Ruby all of a sudden learned to latch on again. However, when we went to see the lactation consultant again, we found out that Ruby was just as, if not more ineffective than ever. On that visit, Ruby transferred only 4 mL of milk in 15 minutes. The lactation consultant showed me how to use a Supplemental Nursing System, which is basically a bottle attached to a tube which you tape to your chest so that as the baby is nursing, she is also sucking milk out of the bottle through the tube. I had never imagined that this natural, beautiful process would involve so many whatsits and doodads.



When by one month of age Ruby had not become any more effective at breastfeeding, it seemed like the medical community began to give up on us. Our pediatrician told me several times that some babies were "just not into it" and that I could continue pumping, but if I wanted to give up, it was ok. When I discussed the problem with my midwife at my 6 week postpartum appointment she said, "Maybe with your next baby!" Despite the skepticism, I still held out hope. I just couldn't bring myself to give up the hope that one day, we could leave the house for more than 3 hours without having to pack bottles and a breast pump, and feeding the baby would involve just one step instead of two or three, and seeing women nursing their babies in the park would not fill me with an unreasonable amount of envy. Most of all, I could not give up hope for the kind of relationship I wanted with my baby, where she would want to nurse for both food and comfort and I would have an excuse to cuddle with her every few hours.

Because Ruby had her surgery when she was 4 weeks old, I held off on the nursing bootcamp until she was about 7 weeks old, when she was significantly recovered. Then, one weekend I nursed her exclusively during the day, never offering the bottle. Due to her ineffectiveness, we pretty much spent the entire weekend continuously nursing, but I still found it to be less work than our regular routine of trying to breastfeed, then bottle feeding, then pumping, then washing bottles/pump parts. I would have continued, but after just 2 days, the nipples couldn't take it anymore, and I had actually developed some serious blisters. However, when we once again visited the lactation consultant a week later, we discovered that Ruby was able to transfer 2.6 oz in 30 min. of nursing, which was by far the most effective she had ever been.

Greatly encouraged, I began to nurse Ruby 3 times a day, alternating with bottle feeding. When we both seemed to be doing ok, I increased to 4 times a day. Just in the last week, I started to exclusively breastfeed her during the day, so she receives just one bottle during her late night feeding. Although the breastfeeding is still not perfect, and some days are better than others, I now know what successful breastfeeding feels like. What once seemed impossible is now our daily routine.

Although it is true that we caught some tough breaks, I feel extremely lucky that we were able to make it work when for many women, through no fault of their own, it never does. I also realize that the only reason that it worked out for us was because I had support. In our household, breastfeeding was not just a two-person event. When I was too exhausted and hormone-crazed to think straight, I always had someone to wash and assemble the pump for me.

Now, seeing how much Ruby loves nursing, how it instantly comforts her, and how she gets chubbier every day, it all feels totally worth the trouble. Here she is, claiming her territory: