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!


Anonymous Kath said...

Dear Electriclady, it's so good to hear from you. I'm so sorry that breastfeeding is so trying; that must be so very frustrating. Congratulations on the strides you have made already, and please remember to be kind to yourself. You are doing everything you can. And I agree wholeheartedly that breastfeeding proponents can often add to the guilt and feelings of failure that women with a low supply feel anyway, which is terribly unkind. You're doing great, my dear. I hope things continue to go better and better.

5:52 AM  
Blogger K77 said...

"I felt, frankly, worthless as both a woman and a mother." I was in tears from here onwards, reading your post. That sentence sums up infertility so succinctly as well. I'm sorry BFing has been so challenging, you seriously deserve a break! Good on you for keeping up with it.

7:45 AM  
Blogger MsPrufrock said...

It has to be said - you, my dear, are a fucking champ. I am so proud of you for sticking with pumping for so long in the face of all that trouble.

It's wise to take things one step at a time. Don't set unrealistic targets for yourself, because you have done so very well already.

The tone of this post seems a bit more cheery than some of the others, which is a relief. I hope things continue to get better!

7:52 AM  
Anonymous Meira (comments AT voirdire DOT org) said...

OK, I almost died laughing when your husband said "I don't understand, what's the difference between this nipple and yours?" I mean, I don't want to inquire about your sex life in a public forum, but, HELLO?

The supply thing is an interesting topic -- I've read that the average output per pumping session is .5 - 1.5 ounces, which was certainly true when I tried to pump while nursing my singleton (9 years ago). But that average seems so contrary to what you read on the blogs, it makes me wonder what the parameters of that study were. Also, when I nursed my first I never worried about supply because it never occurred to me that supply could be an issue (ignorance is bliss and all that) -- with the twins I was much better educated about breastfeeding and (coincedently? lol) terrified about supply. It makes me wonder to what extent supply concerns are a 'normal' part of the breastfeeding learning curve, and is that part of why the lactation community pushes the "true supply issues are rare" doctrine? The sociologist in me is fascinated, lol.

In any event, I'm very very sorry this has been so difficult. But I am SO GLAD you dodged the PPD bullet. And Dr. Gabbay is so right -- the most important thing is enjoying your baby. If breastfeeding (even with all the struggles) contributes to enjoying your baby, wonderful. But if not: you've worked super hard for her, and that's worth a gazillion mommy bonus points.

On a sidenote, one of my closest friends supplemented with all her kids, and the way she did it was really cool to me. If you want to hear about it, you can email me.

10:01 AM  
Anonymous Crystal said...

I am a lurker who only occassionally comments. I just have to commend you for all of the effort you are putting in. It's very evident that you are truly dedicated to your little girl's health and well-being. I know it's not easy to stick with breastfeeding (it was just 8 months ago when I was wondering if I could even make it 6 weeks!) but the sense of accomplishment is so large when you stick with it. Any breastmilk at all is just fantastic for your little one. It's a lot of sacrifice to pump and work so hard, missing out on that time with your child. You will make up for it, though, and it will get a lot easier.

I also wanted to add a little insight as to why the BFing community says that low supply is rare. There is a large portion of the population that quit BFing because they *thought* they had low supply. Many of the people seeking help for low supply actually have a different issue going on - growth spurt, tongue tie, sometimes even oversupply. In my eight months of breastfeeding, I have had major oversupply, 3 cases of mastitis, regularly plugged ducts, thrush, and even low supply - I can't imagine what an easy BFing relationship looks like. I have talked to mothers who were overfeeding their babies because they had more experience with formula and weren't aware of the latest research showing that 25oz in a 24 hour period was average. They supplement when they really didn't need to.

I think the real tragedy is the lack of support that modern mothers have. Back in tribal days, community was big and mothers helped eachother out. There was no formula, and yet people survived. I think this is included in the idea that low supply is rare.

You might be pleasantly surprised when you return to work. It's easier to pump when you aren't breastfeeding a baby in between sessions. In my case, my son is at daycare for 9.5 hours each day and takes in about 8 ounces during that time. Two to three pumping sessions a day usually yields enough for that 8 ounces, and then we breastfeed in the evenings and during the night a few times.

Hang in there. Things will get easier, the baby will become more enjoyable, and you will gain more confidence.

12:56 PM  
Anonymous Anonymous said...

I've just found your blog recently, and I'm de-lurking to hopefully over some encouragement. You are doing your best, which is great. Some day, you will tell your daughter the same thing.

Don't give up when you go back to work. Try nursing your baby when you can be together and pumping when you can't. If that doesn't work, nurse her when you can be together and supplement when you can't. Your body will adjust and you will get the best of both words - nursing your baby and none of the pumping in the office hassle. Nursing my baby was the best way to start my day and the best way to end it, when I went back to work.

I hope things continue to get better for you! You've come a long way already and so many things do get easier with time.

5:20 PM  
Blogger Isabel said...

Wow, you are working so hard at this: you *are* a great mother and a wonder woman. You rock!

5:49 PM  
Blogger MoMo said...

Oh I feel your pain. Just like you I am attach to my breast pump 24/7. It sucks, but I keep telling myself, just one more week...and guess what 12 weeks later I am still going at it. Hang in there...take it one day at a time. She is getting the breast milk and all the benefits from it-and that is the most important thing. When my pediatrian told me to think of the formula as extra calories and he is getting the all the benefits of the breast milk, I felt like a cloud was lifted over me. Email me if you want to chat about it. And btw, have you discovered the bra with the holes for pumping? That save my life! I felt so liberated once I got since, at least I can do other stuff while pumping! I am thinking of you and sending you a big hug!!!

9:25 PM  
Anonymous Anonymous said...

Electric Lady - Your story is my story. Dr. Gabbay also totally kept me in for another few weeks with her kind words. I still think about quitting every day, too! We are at 7 weeks today.

7:05 PM  

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