Here are details of how I do the improvised lactation aid system. I got the nasogastric tube from the lactation consultant, and have ordered a more commercial version of the system from Medela, they sell it. In Canada I got it from weefeeds in Calgary (weefeeds.com or something like that), they order from Medela for me. But for now all I have is the nasogastric tube (5 French, 25 cm) and a syringe to clean it with.
So let's walk through a night feeding. I wake up when Emma starts fussing and looking for food, she is usually awake at 3 or 4 am for the first night feed (the last one is at 11 pm or midnight). I grab her, I latch her on the LEFT boob, and I go pee while breastfeeding. (Sorry, I can't hold it, and if I don't give her the boob, she starts screaming and wakes up MrH, who is working in the morning). I wash my right hand, and hope that the other one is clean enough, but I only use one hand for the materials anyway. I walk downstairs, open the fridge with the right hand, take out the milk or the formula, depending on what I have on hand (it is not my milk, it comes from a friend of mine who is a SAINT), and I grab also a clean bottle (for pumping afterwards) and the nasogastric tube and the syringe (I put some stuff in my armpit, and some in my mouth if I have to). Then I walk upstairs where I usually feed and pump, I sit down on my glider, I put everything to my right hand side on a little coffee table, and continue feeding from the left breast until Emma lets me know that the flow has slowed down (she gets angry and starts making funny sounds, while biting and pulling on my nipple). I then do breast compressions, to try to milk more, but I don't have much left usually. I switch her to the right breast, and feed from there using breast compressions as well. When there is no more milk coming, I put her back on the left breast, and let her latch well, then I take out the cap from the bottle with one hand (this is tricky, don't screw the cap on too tightly or it is almost impossible), put the nasogastric tube in the bottle (or bag, like here in the picture), and hold the bottle or bag between my legs as I am sitting. I put the other end of the tube in Emma's mouth trying to enter at the corner and aiming upwards so as to not go under her tongue. Sometimes it takes three tries, sometimes I get it right away, sometimes she gets annoyed with me poking her and pulls away, in which case I put the tube along the areola and nipple and let her latch onto both when she does. Then she starts sucking, and I use my legs to hold the bottle, my left hand to hold her head, my left armpit to hold her body, my right hand to hold her hands that sometimes fly all over the place, and if her arms are pretty quiet and she is calm, then I use my right hand to surf the internet on the iphone while she is eating, because once she starts sucking the high flow of milk, she goes pretty quickly and in relaxed fashion, and the whole thing is on autopilot.
I hope this makes sense, email me with more questions if you need to, I will post pictures of the commercial system which you hang around your neck so it should be easier (sometimes holding things between my legs means I need to bend forward for the entire feed, and my back hurts).
This is by far the hardest way to do it, with finger feeding being way easier. For finger feeding I just lay her over my legs, with her head on my knees and her legs on my abdomen, I put my right index finger in her mouth with the nail side on her tongue and let her latch, and the tube goes in the same way (corner of the mouth). You have the whole left hand to use to hold the bottle and it makes it easier. You can also hold the NG tube between the thumb and middle finger, paralel to the index, and insert both the index and the tube in her mouth at the very beginning, it is even easier this way.
Once the feeding is done, I burp her if I gave her formula, otherwise no burping is necessary for breast milk, I pump a bit with her on my knees, then I put her down on the changing table, I wash the bottles with tap water and rinse the tube with the syringe, then I change her diaper, then we go back to sleep with the boob used as soother. In the morning I take the bottles downstairs to the dishwasher and I rinse the NG tube again with filtered water.
The only trouble is that my daughter has figured out that the milk is coming out of the tube, and she sometimes spits out the nipple and sucks just from the NG tube. It is very funny to see. She does not do it often though, only when she is pretty full and has enough energy to play and explore. When she is hungry she just does the latching and feeding with no questions asked.
I rarely do give her a bottle, if someone else has to feed her or if I am out of the house in a place where I cannot set up my lactation aid. But I try to avoid it, although she clearly still prefers the boob, despite receiving several bottles so far.
Saturday, September 10, 2011
trotting along
The milk is staying at 1 oz per feeding session for now, or in other words about 8 oz per day. That is good, but she eats 24 oz easily at this point, trying to catch up, and so it is hard to imagine that I will ever be able to supply all that for her. The tube system that I use for feeding her is hard to use, much harder than a bottle, as it requires someone to hold the bottle and me holding the tube and someone holding her hands that fly all over the place (and I am that someone and the other someone too, but I only have two hands and two legs and one set of teeth, all of which are getting used in this process), and I often just want to pop a silicone nipple onto the bottle and give it to her the old fashion way. But I don't. Not because I am holier than thou, which I am of course, but because if I give it the old fashioned way, she tends to spit up a lot more, and FORMULA STAINS! I had no idea until I used it myself, but it stains and it reeks. The stains don't come out in the regular wash. Any spit ups just about require a bath and a full change of clothes, and I am lazy. So tube system is here to stay. But man, is life ever complicated! I just wish my freaking milk was coming back through my nose.
Thursday, September 8, 2011
Got milk?
On day 27 of Emma's life I have started supplementing her feeds with a combination of donated breast milk from a good friend (for which I have enormous gratitude!) and formula. I realized that I had no more milk! I put her on the breast, and she was pulling off repeatedly and crying, and when I squeezed there was NOTHING coming! I was shocked. I tried pumping for the next few days, and got a grand total of 5 ml (1/6 of an ounce) out of the morning pumping session, and NOTHING out of any of the other pumping sessions during the day. The milk had completely dried up. When I saw that, and I first supplemented her, and she took 120 ml (4 oz) in one feed, I realized that I had starved the poor baby for the prior couple of days, as the process must have been gradual. I did not know why she was crying and not wanting to latch. Now, after supplementing, she slept like a normal baby, and did not want to continuously be held and sucking on the breast every five minutes. She actually has 3-4 hours where she is content, awake and alert, looking around, chatting with us, and is a completely different person.
I feel like such an asshole, for not recognizing that she was hungry all this time. I beat myself up tremendously for it, but in the end I did watch her much more carefully after seeing that she did not gain the expected weight. My doctor did not seem alarmed and told me to come back in 3 weeks, I am glad that I continued to weigh her and to worry. The supplimenting system that I use is actually a feeding tube (the kind that the hospital uses for nasogastric feeding of infants) which I sneak into her mouth while she is latched onto the breast, and put one end of it in the breastmilk or formula, and let her suck it up like if she were breastfeeding. I saw that in a book, and thought it was cool. She does take a bottle, but I wanted to have the closeness and the association of the breast with the food.
I did not lose hope though, I presumed that the milk dried up because of the hypovolemic shock that left my pituitary gland without much blood supply, and hence decreased the prolactin. I was not expecting that it would take a week for the effect to show, but it did. Hoping that maybe it is temporary, I keep on pumping, feeding, and taking domperidone (motilium) 80 mg /day, fenugreek capsules (12 per day) and blessed thistle capsules (9 per day).
This has been very stressful for me, not being able to feed my daughter, losing that bond, worrying about the effect of the formula as she seems to spit it up and get constipated on it, trying to find more donor milk (the Vancouver milk bank told me that they don't have any milk, and to try again in 2 weeks!), and feeling like I have failed Emma in a very basic way. I have tried to keep in mind that it is all about her though, and that she is lucky to have a live mother, the breastmilk vs. formula problem does not even compare to the immense luck that I have had to survive. (I found out today that I needed 10 transfusions in total, not 8 like I had thought, that makes me think of how bad the situation really was). She is lucky, and I am lucky. And c'mon, I mustn't forget that I am lucky to have her at all.
But sick with a mastitis of the left breast (from too much pumping) and worried about my daughter, and about my husband who is working way too hard, and about my bird who got a concussion that made him scary ill, and recovering after my blood loss (I am still very weak and tired), all of these burdens broke the optimistic camel's back for the past day or so, and I have been down. Today however, I went for a walk with Emma in my arms, and she latched onto my breast for comfort. We were sitting on a park bench, and the sunset was warm and beautiful, and I felt peaceful with her, I felt her precious body laying on my belly and realized how good everything is, how magical, how peaceful. Then I went home, and asked MrH to take me on a motorcycle ride, since my mom is still here and could look after Emma. We rode past wheat fields, past the river, and saw the moon starting to rise above the horizon, smelled the forest, and I felt really peaceful, really close to my husband, and felt like I was ok, like maybe I haven't failed, maybe it was just life, the way it is, imperfect, full of obstacles, but beautiful nevertheless.
Then I went home and pumped...and got one ounce of milk! That was enormous for me, especially at night. The mastitis suddenly improved, my breast started to drain, I pumped again another ounce three hours later, and felt on top of the world. Maybe my milk is coming back! Will watch and see. The important thing is that I have realized that there is much more to the bond I have with Emma than just the breastfeeding, and that I am sure we can be happy and peaceful no matter how the feeding goes. I am, however, certain of one thing: I will never let her be hungry again. I am going to top her off after every single feed, just to make sure. Even if my milk comes back. I cannot bear to think that she was hungry, and it will never happen again.
I feel like such an asshole, for not recognizing that she was hungry all this time. I beat myself up tremendously for it, but in the end I did watch her much more carefully after seeing that she did not gain the expected weight. My doctor did not seem alarmed and told me to come back in 3 weeks, I am glad that I continued to weigh her and to worry. The supplimenting system that I use is actually a feeding tube (the kind that the hospital uses for nasogastric feeding of infants) which I sneak into her mouth while she is latched onto the breast, and put one end of it in the breastmilk or formula, and let her suck it up like if she were breastfeeding. I saw that in a book, and thought it was cool. She does take a bottle, but I wanted to have the closeness and the association of the breast with the food.
I did not lose hope though, I presumed that the milk dried up because of the hypovolemic shock that left my pituitary gland without much blood supply, and hence decreased the prolactin. I was not expecting that it would take a week for the effect to show, but it did. Hoping that maybe it is temporary, I keep on pumping, feeding, and taking domperidone (motilium) 80 mg /day, fenugreek capsules (12 per day) and blessed thistle capsules (9 per day).
This has been very stressful for me, not being able to feed my daughter, losing that bond, worrying about the effect of the formula as she seems to spit it up and get constipated on it, trying to find more donor milk (the Vancouver milk bank told me that they don't have any milk, and to try again in 2 weeks!), and feeling like I have failed Emma in a very basic way. I have tried to keep in mind that it is all about her though, and that she is lucky to have a live mother, the breastmilk vs. formula problem does not even compare to the immense luck that I have had to survive. (I found out today that I needed 10 transfusions in total, not 8 like I had thought, that makes me think of how bad the situation really was). She is lucky, and I am lucky. And c'mon, I mustn't forget that I am lucky to have her at all.
But sick with a mastitis of the left breast (from too much pumping) and worried about my daughter, and about my husband who is working way too hard, and about my bird who got a concussion that made him scary ill, and recovering after my blood loss (I am still very weak and tired), all of these burdens broke the optimistic camel's back for the past day or so, and I have been down. Today however, I went for a walk with Emma in my arms, and she latched onto my breast for comfort. We were sitting on a park bench, and the sunset was warm and beautiful, and I felt peaceful with her, I felt her precious body laying on my belly and realized how good everything is, how magical, how peaceful. Then I went home, and asked MrH to take me on a motorcycle ride, since my mom is still here and could look after Emma. We rode past wheat fields, past the river, and saw the moon starting to rise above the horizon, smelled the forest, and I felt really peaceful, really close to my husband, and felt like I was ok, like maybe I haven't failed, maybe it was just life, the way it is, imperfect, full of obstacles, but beautiful nevertheless.
Then I went home and pumped...and got one ounce of milk! That was enormous for me, especially at night. The mastitis suddenly improved, my breast started to drain, I pumped again another ounce three hours later, and felt on top of the world. Maybe my milk is coming back! Will watch and see. The important thing is that I have realized that there is much more to the bond I have with Emma than just the breastfeeding, and that I am sure we can be happy and peaceful no matter how the feeding goes. I am, however, certain of one thing: I will never let her be hungry again. I am going to top her off after every single feed, just to make sure. Even if my milk comes back. I cannot bear to think that she was hungry, and it will never happen again.
Sunday, September 4, 2011
So much love
I cannot believe how much I love Emma... I want to stare at her and kiss her scrunchy face the whole day. In particular I want to kiss her mouth when she screams like a lunatic. It is so sweet. She has increased periods of quiet alertness, looking around with her big soulful eyes, and today she grabbed my nose twice and I think she wanted to put it in her mouth. She is starting to reach for things, and I have the feeling that her arm movements are becoming more purposeful. She looks into MrH's face, and into mine when breastfeeding, and we feel like we are melting. The best way to summarize this is that it's much much better than I thought it would be.
I don't ever leave her alone because she does not like it, and at this point in her life I don't see the purpose in doing things that she does not like. This means that my day goes something like this: wake up at around 7 or 8 (today at 10, I got spoiled) when Emma starts making I-want-boob sounds, feed her while wondering how and when I will get to pee, decide to go pee while breastfeeding her despite how gross and unnatural this sounds like, then on and off feed her for about one hour. Ideally I feed her on one side, and pump on the other side, to have some pumped milk just in case the evening meal is not enough (I have a lot of milk in the morning, and less at night). The best pumping session so far with the home Medela-mini has produced only one ounce, so I am waiting for a better pump to arrive in the mail, in the meantime struggling with the mini which is probably fine for someone with abundant milk, but not very easy for me to use. While feeding her with one hand and pumping with the other hand, I also try to eat breakfast with my third hand, and drink coffee with the fourth. After we both get fed, I pass her along to my mom and have a quick shower and do my make-up and hair. What will happen once my mom leaves this coming week is anybody's guess, but I am hoping to be able to shower in the morning before MrH goes to work, or if that fails then at night. I can always do my makeup and hair with her in the sling once she falls asleep.
Then, once I showered, I wash her in the sink. She enjoys her morning bath, and only cries once I dry her and try to dress her. She does not like getting dressed. (Undressed is totally fine). So I stopped dressing her after her bath, I just slap a diaper on (we use g diapers, a type of cloth diapers, with cloth inserts made by baby.love, a company in Alberta) and then breastfeed her again while we are both naked, she loves the skin to skin contact. Finally though, I manage to dress her and feed her again, this time while she is in the sling, so that once she falls asleep I can do some stuff with both hands, like make the bed and do the laundry. So far I have not had to cook yet, but I will once mom leaves, and I am planning on cooking twice a week, once on the weekend when MrH is around to hold Emma, and once during the week, probably on a Tuesday, and probably a whole lotta beans and rice.
She sleeps for three hours in the afternoon, and I often take her out during this time. We go for a walk in the stroller, but she wakes up frequently and wants to feed, so I end up pushing the empty stroller with one hand, while breastfeeding with the other (football hold rocks!). If we had a rough night, we both take a nap though, and she sleeps quite well. She usually wakes up cranky and we spend the evening trying to soothe her, usually by swaddling and constantly feeding/soothing on the breast, and if that does not work then we throw in bouncing on the medicine ball at the same time. She is starting to take a soother, for little short periods, but that is definitely a success, and I need to keep going, as she only soothes on the breast and that is stressful for anybody other than myself who has no boobs to soothe her with. Then, from nine pm onwards she sleeps for a good five and even six hours, cuddled in bed with me, warm and comfy, and for the rest of the night she wakes up briefly and feeds with us both lying down, then goes to sleep again. Only once through the night I get up to change her, and to give her a feed where I am sure that she has eaten well (if I feed lying down, then I fall asleep and can't supervise her properly).
Overall we do pretty well, but she is constantly on the breast, and that means that there is not a single person in my town who has not seen my boobs yet. I don't use a nursing cover since I would have to walk with one around my neck all the time. It just would not be practical. I even have a hard time wearing a BF bra, since I have to open and close it thirty times a day. The easiest is to wear the Lillypadz and a nursing top, or just the nursing top. Next thing I am going to buy Birkenstocks and grow my hair in dreadlocks, all while wearing long floral skirts.
I don't ever leave her alone because she does not like it, and at this point in her life I don't see the purpose in doing things that she does not like. This means that my day goes something like this: wake up at around 7 or 8 (today at 10, I got spoiled) when Emma starts making I-want-boob sounds, feed her while wondering how and when I will get to pee, decide to go pee while breastfeeding her despite how gross and unnatural this sounds like, then on and off feed her for about one hour. Ideally I feed her on one side, and pump on the other side, to have some pumped milk just in case the evening meal is not enough (I have a lot of milk in the morning, and less at night). The best pumping session so far with the home Medela-mini has produced only one ounce, so I am waiting for a better pump to arrive in the mail, in the meantime struggling with the mini which is probably fine for someone with abundant milk, but not very easy for me to use. While feeding her with one hand and pumping with the other hand, I also try to eat breakfast with my third hand, and drink coffee with the fourth. After we both get fed, I pass her along to my mom and have a quick shower and do my make-up and hair. What will happen once my mom leaves this coming week is anybody's guess, but I am hoping to be able to shower in the morning before MrH goes to work, or if that fails then at night. I can always do my makeup and hair with her in the sling once she falls asleep.
Then, once I showered, I wash her in the sink. She enjoys her morning bath, and only cries once I dry her and try to dress her. She does not like getting dressed. (Undressed is totally fine). So I stopped dressing her after her bath, I just slap a diaper on (we use g diapers, a type of cloth diapers, with cloth inserts made by baby.love, a company in Alberta) and then breastfeed her again while we are both naked, she loves the skin to skin contact. Finally though, I manage to dress her and feed her again, this time while she is in the sling, so that once she falls asleep I can do some stuff with both hands, like make the bed and do the laundry. So far I have not had to cook yet, but I will once mom leaves, and I am planning on cooking twice a week, once on the weekend when MrH is around to hold Emma, and once during the week, probably on a Tuesday, and probably a whole lotta beans and rice.
She sleeps for three hours in the afternoon, and I often take her out during this time. We go for a walk in the stroller, but she wakes up frequently and wants to feed, so I end up pushing the empty stroller with one hand, while breastfeeding with the other (football hold rocks!). If we had a rough night, we both take a nap though, and she sleeps quite well. She usually wakes up cranky and we spend the evening trying to soothe her, usually by swaddling and constantly feeding/soothing on the breast, and if that does not work then we throw in bouncing on the medicine ball at the same time. She is starting to take a soother, for little short periods, but that is definitely a success, and I need to keep going, as she only soothes on the breast and that is stressful for anybody other than myself who has no boobs to soothe her with. Then, from nine pm onwards she sleeps for a good five and even six hours, cuddled in bed with me, warm and comfy, and for the rest of the night she wakes up briefly and feeds with us both lying down, then goes to sleep again. Only once through the night I get up to change her, and to give her a feed where I am sure that she has eaten well (if I feed lying down, then I fall asleep and can't supervise her properly).
Overall we do pretty well, but she is constantly on the breast, and that means that there is not a single person in my town who has not seen my boobs yet. I don't use a nursing cover since I would have to walk with one around my neck all the time. It just would not be practical. I even have a hard time wearing a BF bra, since I have to open and close it thirty times a day. The easiest is to wear the Lillypadz and a nursing top, or just the nursing top. Next thing I am going to buy Birkenstocks and grow my hair in dreadlocks, all while wearing long floral skirts.
Thursday, September 1, 2011
behind in growth
Emma had her first checkup today, at three weeks of age, and she is not yet back up to birth weight. Her birth weight was 3.67 kg and she still weighs only 3.48 kg, about 200 grams below (7 oz). Theoretically she could catch up in one week. Practically, I hope she does. She has grown in length and head circumference, but the rate of growth is slower than expected in both.
Clearly this hemorrhage episode of mine has taken a toll on her. Her weight was about the same as it is now in week two of life, just before my bleeding episode, so for the past week she has probably done poorly, with me trying to establish my milk supply again. Not to mention that we had difficulties right after birth as well for a bit, with her losing almost 10% of her weight because I did not have much colostrum and then I took a while to build the milk up to meet her needs.
I did worry, and still do a little, but instinctually I feel that things are improving and that she will catch up. There is a big difference between the fussiness of yesterday, when all she wanted is to be on the breast, and the contentedness of today, when she slept for 3-4 hours at lunch, and had a bit of social time too. I think that the lack of gain is reflecting a past, not present, problem. That being said, I also struggle with the feeling that I am inadequate once again as far as reproduction goes, and that I am failing yet another basic human function, that of feeding one's infant. But those are my own feelings, and I don't plan on letting them interfere too much if I can. I know that supplementing would help with the growth in the immediate future, but I also know that in the long run it will deprive her as my milk supply will only go down once again, probably for good this time, and that she will not have the benefit of being breastfed like I planned for her.
I will weigh her again in one week. I am expecting a pleasant surprise.
Clearly this hemorrhage episode of mine has taken a toll on her. Her weight was about the same as it is now in week two of life, just before my bleeding episode, so for the past week she has probably done poorly, with me trying to establish my milk supply again. Not to mention that we had difficulties right after birth as well for a bit, with her losing almost 10% of her weight because I did not have much colostrum and then I took a while to build the milk up to meet her needs.
I did worry, and still do a little, but instinctually I feel that things are improving and that she will catch up. There is a big difference between the fussiness of yesterday, when all she wanted is to be on the breast, and the contentedness of today, when she slept for 3-4 hours at lunch, and had a bit of social time too. I think that the lack of gain is reflecting a past, not present, problem. That being said, I also struggle with the feeling that I am inadequate once again as far as reproduction goes, and that I am failing yet another basic human function, that of feeding one's infant. But those are my own feelings, and I don't plan on letting them interfere too much if I can. I know that supplementing would help with the growth in the immediate future, but I also know that in the long run it will deprive her as my milk supply will only go down once again, probably for good this time, and that she will not have the benefit of being breastfed like I planned for her.
I will weigh her again in one week. I am expecting a pleasant surprise.
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