Wednesday, March 28, 2007

Part 3: Home, and breast battles

(Part 1, Part 2)

It has taken me a full month to write this (seriously, I started it the first week of March), partly because, duh, I have a newborn, and partly because the emotions are still so raw, and I'm still in the middle of this. So, deep breaths, this is a long one.

We came home from the hospital with loads of formula samples, which frankly was a good thing, because we were completely unprepared for bottle-feeding. Despite all my fears and worries about breastfeeding, and despite the fact that I knew Bat Girl would need to learn to take a bottle when I went back to work, I had not purchased a single bottle or nipple. I had a breast pump, but I hadn't done more than take it out of the box and stare at the instructions in mild confusion. Denial, maybe? Who knows.

Luckily our postpartum doula arrived less than an hour after we got home, and she boiled all the pump parts and helped me set it up. The good news was that in my inaugural home pumping session, I discovered that my milk had finally come in, mere hours after I left the hospital (coincidence? I think not). The bad news was that 15 minutes of pumping yielded barely enough milk to coat the bottom of the collection bottles.

Even worse, Bat Girl was now adamantly opposed to nursing. Though she'd fought in the hospital, I'd always been able to get her on the boob eventually. Now, even when she did latch on, she put up with it for only a few seconds before pulling away and screaming. I'd battle it out with her for 10 or 15 minutes before giving up in tears--usually, both of us sobbing fiercely--and handing her to my husband for a bottle. I knew exactly what the problem was. When my husband said, holding one of the sample formula bottles, "I don't understand, what's the difference between this nipple and yours?" I took the bottle from him and turned it upside down. Formula came pouring out of the nipple. After 24 hours of that, who could blame Bat Girl for not wanting to do the work to eke a few measly drops from my breasts? (Thanks, giant formula company!)

That first weekend home is just a blur of crying and hopelessness. After a day, I developed large, hard, painful lumps in my armpits, which were either plugged ducts or some kind of weird engorgement (because my actual breasts weren't engorged at all). I applied heat and massaged while I pumped, but I couldn't put my arms all the way down for days. My c-section incision was spotting blood. I was desperately tired and still in pain from the surgery. Bat Girl wouldn't nurse, so I pumped as often as she ate (every three hours), in the hopes of building my supply and having some expressed breast milk to feed her. But since I pumped, at most, 0.25 oz. per session (usually less), it took half a day to accumulate enough milk to even be worth putting in a bottle. And while my husband was starting to feel more comfortable handling this strange creature we'd brought home--thanks to all the baby care he'd shouldered while I was flattened post-surgery in the hospital--I was scared to even change Bat Girl's diaper for fear of screwing up somehow. I felt, frankly, worthless as both a woman and a mother.

Clearly, professional intervention was in order, so I called the local LC I'd spoken to before giving birth and had her come for a home visit. She helped us establish a better latch--or at least know what one looked like--and also taught me how to recognize when Bat Girl was actually swallowing, i.e. feeding effectively, which was HUGELY helpful, as I really had no idea if she was eating or not. After helping me put Bat Girl to both breasts twice, she weighed her and determined that she'd gotten 0.4 oz.--not a lot, but it was reassuring to know that she was eating something. The LC also recommended I consider fenugreek and blessed thistle, and that I continue pumping after every feeding to help increase supply.

So I did. I started taking the herbs (3 capsules of each, 3x/day--that's 18 capsules a day, people), and I started back on metformin, after much deliberation. I "offered" (in the LC's words) the boob to Bat Girl at most feedings, and sometimes she took it, sometimes she didn't. I pumped. Oh, I pumped. I pumped for 15 minutes after every feeding, and got up in the middle of the night to pump some more.

And I cried, every single day. I wanted to give up, every single day. Because Bat Girl was so sleepy, routinely dozing off mid-feeding, it was taking me up to two hours to feed her, what with boob, then bottle, then pump, and she was supposed to be eating at least every three hours. And I had (still have) my husband home full-time to help give the bottles, and I had a doula 15 hours a week for the first couple of weeks. As I wrote to Pru, it felt like 99% of my life revolved around feeding the baby, and the other 1% was spent washing stupid bottles and pump parts. (And that's after the LC told me I only had to wash the pump parts every six hours, not after every pumping session.) Worst of all, I was so consumed by our breastfeeding woes that I had trouble taking pleasure in my baby. I questioned even having a baby in the first place.

To add insult to injury, I leaked constantly. When Bat Girl cried--hell, when a baby on TV cried, or when I just looked at Bat Girl--I suddenly had two giant wet spots on my shirt front. I woke up in the middle of the night with my shirt front and sheets wet with milk. When I nursed Bat Girl on one side, I'd have to tuck a burp cloth between her body and my other breast, or I'd soak right through her clothes. I'd be standing naked in the bathroom after my shower and feel actual spatters of milk hit my feet. As I told my husband, it actually offended me that I leaked so damn much and yet couldn't produce enough milk for my baby.

I don't know how I kept going those first few weeks. Sheer stubbornness, perhaps--hey, Bat Girl had to get it from somewhere. Intellectually, I knew that there was nothing wrong with giving my baby formula--but emotionally, I hated this choice that was forced on me. I hated seeing the row of formula containers lined up on my kitchen counter, hated the endless washing of bottles. My heart broke every time my screaming baby beat and clawed at my chest and pushed away from my body in what felt like a personal rejection. I hated choking down the herbs, hated every minute I was chained to the pump, hated having to put down my baby to go pump when all I wanted was to cuddle her.

And I was wildly, insanely jealous of women who did breastfeed. When a friend mentioned that his wife had breastfed their son until he was 3 ("I never spent a penny on formula"), I wanted to cry. When a woman sitting across from me in the pediatrician's waiting room casually opened her shirt to soothe her fussing baby, I actually did cry--teared up with anger and envy, especially when a minute later Bat Girl started fussing and I had to pull out a bottle of cold formula. I imagined the breastfeeding mom silently judging me--because, let's be honest, if I had breastfed successfully, I would totally have been one of those icky judgy breastfeeding moms, tsk-tsking at women who formula fed. (No more, that's for sure.)

But slowly, things did get better. With the help of the herbs, or maybe just because my body was healing, I began producing 0.5 to 1 oz. per pumping session. Bat Girl got better and better at latching, though we still struggled. My doula cheered me on constantly, and my husband somehow found exactly the right thing to say at the right moments--like when, after a long battle, I finally managed to get Bat Girl latched on for about a minute, I tearfully told him I thought maybe I should give up nursing and just pump. "Well, she seems to enjoy it," he said, pointing at Bat Girl, lolling on the nursing pillow with that boobed-out dazed look on her face.

Rereading this helped a lot, reminding me that I wasn't alone. Also, hearing from other women who struggled with breastfeeding and supply, like Pru (who talked me down from the ledge when I was feeling particularly low) and Momo and Miss W. Although everything you read about breastfeeding tells you that "real" low supply is extremely rare, I found out that there is a secret sisterhood of women who never made enough milk. Not just online--since I had Bat Girl, I've talked to five other women I know IRL who had to quit breastfeeding due to low supply. But the thing is, you never hear about it until you go through it yourself, because there's this horrible shame women feel about having failed at this basic female function--hey, just like infertility, how about that! (Side note: I think the lactation community does women a real disservice by insisting that true low supply is rare and implying that if you don't have a medical reason for low supply, like PCOS and/or breast hypoplasia, it's because you're doing something wrong. No matter what the cause, women who aren't producing enough milk for their babies feel crappy enough about themselves without all the breastfeeding resources telling them that it's their fault.)

Most importantly, I slowly gained more confidence in my abilities to care for my child. And, I hesitate to attribute my feelings to hormones, lest I devalue the very real emotions I was experiencing, but as my postpartum hormones settled down a little, I cried less and had fewer crazy "my baby hates me" and "my baby wouldn't even notice if I disappeared" thoughts. And as this what I now recognize as a pretty serious case of the baby blues slowly began to lift (and boy am I grateful that I seem to have dodged the PPD bullet), I found that I could take joy in moments of my day with Bat Girl, and that I felt a fierce deep love for her despite the fact that some days I still wondered what the hell had happened to my life.

Another turning point came when Bat Girl was three weeks old and we had a consult with the fabulous Dr. Mona Gabbay, a local MD who specializes in lactation issues. I'd first heard of her ages ago on Ask Moxie, but she'd also been recommended to me by everyone with a clue, including our pediatrician and the local LC. Dr. G. was actually really optimistic about my chances of increasing my supply, which gave me a huge boost. She said that my breasts appeared normal, not hypoplastic, and the fact that I leaked so much was a good sign; that perhaps it was the bad start I got in the hospital more than anything that made things go all haywire. She talked to me about domperidone and gave me tips on power pumping to build supply (there are a lot of different ways to do it, but in this case, adding one or two pumping sessions between feedings so I'd be pumping every hour or hour and a half, first every other day, and now twice a week). She told me I only needed to pump for FIVE MINUTES at a time, which saved my life, seriously, and made it so much easier for me to keep going. But the best thing she did: When I expressed some doubt about my ability to take on power pumping, she said, "Well, of course if it prevents you from being able to enjoy your baby, then don't do it." Having that permission was enormously freeing--and it made me feel like I could do it after all.

That was four and a half weeks ago. So where are we now? I'm still pumping, much to my astonishment. In those first dark days, I initially set myself a goal of making it to six weeks, not thinking I could possibly hang in there that long, so I'm pretty proud that Bat Girl is over seven weeks old and I'm still at it. Also making me proud: With the help of an even higher dose of herbs, plus domperidone (and hell, maybe the met helped too), I'm pumping as much as 8.5 ounces a day, which may not sound like much, but considering I started with just 1.5 ounces a day, I consider that a real accomplishment. Bat Girl is up to about 40-50 percent breast milk now, mostly via bottle. Because I'm still not producing a ton of milk, Bat Girl still resists nursing, especially in the afternoons and evenings when my supply is lowest, but I manage to get her on the boob 4 or 5 times a day, including one longish session first thing in the morning, so she's getting at least a few ounces more that way. It's hard to still be battling it out with her, but the times when she does latch on easily and nurse for a long time are so rewarding that I don't want to give it up (though on bad days, I still consider it).

My dream would be to get my supply boosted enough that she'd feed more effectively and eventually be able to get all or most of her breastmilk directly from the boob, without me needing to pump so much. Even if we still had to supplement (which I've accepted will likely always be the case, no matter what), that would make me happy. Dr. G. thought there was a chance I could get there, and I do still have hope. But I'm going back to work at the end of April, and that deadline is looming over my head like a dark shadow. Because if I weren't going back to work, I could maybe keep this up indefinitely, pain in the ass though it may be...but since I definitely am, I will have a tough decision to make. If I can't continue to make significant strides in building supply by then, it simply won't be worth it to me to pump at work for the 5-6 ounces I'd get during work hours, and I'll have to wean. I don't know what I'm going to do. I'm trying not to think about it.

This post is already way too long, so I'll stop here and do a Part 4 soon, including: Why is breastfeeding so important to me? Why am I still committed to pumping? How has pumping totally fucked with my life? And more!

Wednesday, March 14, 2007

Quick question

Have any of you taken domperidone, or know someone who has? Or just have thoughts on the subject? I'm considering starting it--in fact, have the meds on hand, ordered all the way from New Zealand--but am interested in hearing about other people's experiences.

(Hey, when I said the breastfeeding got better, I didn't say it was going great.)

Tuesday, March 06, 2007

Notes from one month

I'll get to Part 3 of my birth and homecoming story soon, promise, but it's taking me a while to process it, as it encompasses the real breastfeeding struggles and challenges and I'm still sort of in the middle of it. (However, for those of you who are worried about me: It does/did get better. Sort of. Mostly.) Meanwhile, though, a few observations on the first month of motherhood:

(Yes, technically Bat Girl turned one month old yesterday...I meant to post then but life with a newborn being what it is, I haven't had a chance to post until now.)

• We've been getting a lot of congratulatory cards with messages along the lines of "Thank heaven for little girls"/"Sugar and spice and everything nice..."/etc., and they always make me snicker a little, because frankly, a newborn baby, boy or girl, is more feral animal than human. The grunting, the pooping, the desperate lunging at the boob or bottle, the ultrasonic high-pitched keening, not to mention the projectile bodily fluids from every orifice...nothing hearts-and-flowers-and-sugarplums about that.

• The liquid forms of fenugreek and blessed thistle are supposed to be more effective than the capsule forms. But they taste like ass.

• When your baby foils your expectations by waking up at 6 am instead of 8 am (she last ate at 4 am! She finally went down at 5:30! She should have slept another three hours!), your consolation will be that after feeding her, you can bring her back to bed with you and your normally anti-cosleeping husband will not make a peep of protest. You will not be able to sleep for fear of accidentally crushing her, but you will snuggle her warm little body and all will be right with the world. Until she wakes up and wants to eat. Again.

• Bat Girl is just four weeks old and already she has changed so much. She has chunked up considerably and I do miss my tiny little baby. I notice it the most in her hands--they are sweet and dimpled and chubby, but they have lost that newborn delicacy. I suppose this is how I will feel the rest of my life--always happy to see her grow, always delighted by each new stage, but always aching a little for what's past.