My Son's Brachial Cleft Fistula

This was originally written on Monday, June 23, 2008:

June 18th was Logan's two month birthday and also his two month pediatrician's appointment. When Joe came home from work to go with me, I said, "I have bad memories from the last time we were there and we kept having to go to the hospital for his jaundice. Hopefully this trip will be more positive." We had no reason to think otherwise--Logan's been thriving and doing excellent. Weeks 2 thru 8.5 were the best weeks of my entire life! Now, of course, I've come down from my high.

The appointment started off well. Logan was weighed and measured, ending up in the 90th percentile when it came to his weight (13 lbs, 6.5 oz!!!) and 55% when it came to his height (23 inches) and 45% when it came to his head (15.5 inches). All of the nurses said he was pretty solid--he has a lot of muscle--and after the PA checked his heart, lungs, eyes, nose, ears, mouth, etc. she said that everything looked really healthy.

Then our pediatrician came in the room and did a more thorough check of everything. I noticed that he kept focusing on Logan's neck. Joe & I both thought maybe we hadn't cleaned it well enough, haha. But the doctor pointed to a dimple on Logan that Joe's mom had first shown me when I was in the hospital after giving birth. During Logan's first couple of days of life I really didn't inspect his body. He was just so fragile-looking that I was scared to touch him much! In fact, I didn't even kiss him until day 3. After his jaundice experience, though, I realized that babies aren't as fragile as they first appear, and so since then he's had kisses galore! :-) Needless to say, that's why it was my mother-in-law who first pointed out the pit on his neck. I had been holding Logan in my hospital bed and she said she'd looked for unique features and the only thing she'd found was a tiny little dimple. The way she said it sounded concerning (she might have even used the word "hole"), but I assumed that if it was anything serious a doctor or nurse would have said something--so I just brushed it off.

For the past two months I've seen it, my parents have seen it, Joe has seen it, etc.--and none of us thought it looked like anything that needed special attention. So when our doctor focused on it, I was surprised. Joe and I moved closer to him and were shocked when he said, "Do you see this hole? It's a brachical cleft." Obviously that went right over my head, but he continued, "Do you see how there's fluid around it? That's not supposed to be there."

Sure enough, the area inside the dimple was wet. I knew right then that this appointment was not going to be any better than our last. The pediatrician explained that at first he'd thought maybe the wetness was caused by one of Logan's tears (Logan was crying at the time) but every time he wiped it away it reappeared. We had never noticed the area getting wet before, probably because the liquid never dripped down--it was the smallest amount you can imagine.

The doctor said that as our heads and necks develop they fuse together like a zipper down the middle. A brachial cleft occurs when it doesn't finish at the end and leaves a hole above the collarbone. Sometimes this happens and it's just something to keep an eye on, but when there's fluid leaking it's serious because that is a sign that it's only a matter of time before infection will occur. He said that unfortunately Logan is going to need surgery to fuse the area together and so we needed to call his plastic surgeon as soon as possible to meet with him within the week.

Of course tears started to form in my eyes, which must have been what the doctor had expected because he talked directly to Joe and didn't look at me at all until the very end, when he was very sympathetic and gave me a box of Kleenex. He also wrote down the name of Logan's condition since I was speechless at that moment and didn't know what questions to ask.

I couldn't believe this was happening--surgery on my two month old baby? Did this mean he wasn't going to be "normal?" I thought about a little girl who had been in the waiting room before our appt--she was deformed and I couldn't help but worry Logan's neck now would be. A million depressing thoughts ran through my mind as the doctor left and the nurse came in with vaccinations. For those of you who read my pregnancy blogs, you know the vaccines had originally been the part of the appt. I'd been dreading.

During my all-day sickness period I watched a lot of television and read several magazines, and there was a lot of stuff about vaccinations and their link to autism (esp. in boys), ADD, hyperactivity, other brain disorders, and immune disorders (why children get sick more now than when my generation was growing up). At first I didn't want to hear or read about it (my mom was actually the first to bring it to my attention a couple of years ago when it all first came out, but the controversy was too complicated to think about when I wasn't even planning to get pregnant at that time). I had hoped that by the time I had a baby I could just trust the American Academy of Pediatrics because there wasn't an easy answer for me to make on my own, and I didn't want to make the wrong decision.

Unfortunately, the evidence is coming out at an extremely slow pace since the studies are basically on an individual basis (why are some children affected and others aren't?), and so in the meantime the American Academy of Pediatrics is still giving out the vaccinations because otherwise the alternative is an outbreak of the diseases.

But, after doing my own research, I couldn't ignore the facts. I'd never forgive myself if my son was negatively affected by the vaccinations since now I knew better. At the same time, I'd never forgive myself if Logan ended up with a deadly disease. Therefore, Joe & I didn't want to NOT vaccinate AT ALL, but rather compromise so that we can know we did the best we could if either scenerio happened.

Just like how I chose my birthing hospital (the one that does the most births in my city, as well as the one most medical personnel choose to have their own babies in), it was important to me when I was finding a pediatrician to select one that was knowledgeable about both sides of the vaccination controversy. There are a lot of biases BOTH ways (half of the pediatricians here will not allow parents to choose their own vaccination schedule, while there are holistic doctors who don't encourage parents to give any vaccines at all). I wanted someone who was open-minded and would tell me the truth of both sides.

Fortunately, my actual pediatrician specializes in autism and so he knows that many of his patients' parents are adament that the vaccinations were to blame (because their babies were perfectly normal and responding intelligently prior to the vaccines) and he can not argue with them. No matter how much the American Academy of Pediatrics stands by their vaccination schedule, they can't prove that their vaccines aren't risky. Therefore, our pediatrician told us right away that he is not going to insist that we do things his way as a doctor, but rather he will give us the freedom to do what we feel most comfortable with as parents. With that said, as more and more parents are choosing not to vaccinate at all, children are starting to contract more diseases.

So, we asked him what he recommended for parents like us. He said to wait on the "controversial vaccines" until after the age of two. By that time the brain is done being formed, so it's not as likely for children to develop these brain disorders, and childrens' immune systems are stronger and better able to handle the vaccines so then they're not as weak and susceptible to contracting viruses and other illnesses. They are also still young enough when getting the vaccines that they're not likely to be exposed to the diseases (especially babies like Logan who aren't in daycare).

Since, fortunately, thimerosal has been removed from vaccines (what started the controversy, as it is mercury--which, even the small amount in vaccines has been linked to late walking, talking, abnormal neurological scores, and nueurotoxicity in infants), now most of the controversy lies with the vaccines that have more than one dose in them, such as DTaP, which Logan was supposed to get this time but did not because it contains the vaccination for Diphtheria, Tetanus, AND Pertussis all in one. (Plus, I got the tetanus shot when I was pregnant and I read we should both be safe for five years). He also did not get the Hep. B vaccine (just like he didn't get it at birth) since it's basically an STD, or polio since there hasn't been a case of it in the United States since the 1970's. Instead, Logan received the Hib, Rotavirus, and Pneumococcal Conjugate. (The Hib and PC were shots, while the Rotavirus was a drink.)

By the time Logan is five yrs old and ready for school, he will have caught up to the standard schedule and will have all of his vaccinations. But in the meantime he'll be on a delayed schedule, where we'll do just half of his vaccines each time. I feel good about this, as it is more in line with the schedule that was followed when I was growing up (now kids are given triple the amount of vaccines).

Hopefully soon the American Academy of Pediatrics will come up with an entire new schedule and parents won't have to make these tough decisions ourselves. I pray Logan won't be exposed to such diseases as measles, mumps, and rubella--as the MMR is the most controversial shot of them all, usually given at 12 months, but Logan will definitely not be getting that until way after the age of two. Especially with his surgery coming up I don't want to make him weaker and more susceptible to brain and immune disorders.

Anyway, but the vaccines ended up being the last thing on my mind on Wednesday. Once we came home from the pediatrician's appt. I realized I had a lot of unanswered questions about brachial cleft, and so I looked up on the internet to see what I could find.

I was disappointed by the lack of information. Because it is rare and there are several types (it's something adults can get, too--only as an actual cyst/growth on their neck) it was hard to find facts about the kind Logan has. What I did determine from several websites was that it is something that occurs within the first four weeks of development within the womb and also that it is genetic.

Yesterday I learned that my mother-in-law, her dad, Joe's sister, two of Joe's nephews, and one of their babies all have this on their ear, so it appears Logan inherited the same trait but ended up with it on his neck instead! Joe's mom said that her dad's drained fluid as well, and one of Joe's nephew's has been infected; maybe it's not as serious when it's on the ear. So at least I'm not beating myself up about it anymore. At first when I learned it was a birth defect I was like, but I followed all of the rules to avoid them while pregnant, what did I do wrong?!

Also, when my pediatrician said that we needed to make an appt. with the plastic surgeon within the week I was thinking this was something urgent/emergency that needed to be done ASAP. But we called the plastic surgeon's office that afternoon and they said the doctor was out of town until July 1st and would be back for two days and then gone again until the 24th. They said we could come in on the 1st to get our questions answered, find out his opinion on what we should do, and probably schedule the surgery for the end of the month. When we called our pediatrician's office and asked if this was okay, they said "yes." In the meantime, we are also getting a second opinion from an Ear, Nose, and Throat doctor that our pediatrician recommended, and then will choose between the two as far as who does the surgery. I still have a lot of questions.

The fluid is from the sinuses, and surgery always corrects the problem, so I'm glad that it is fixable and that afterwards it should be like it never happened. There are definitely a lot worse conditions Logan could have and it has helped a lot to hear from family and friends who have had babies or have known other babies who've gone through surgeries and have turned out okay and are now happy & healthy.

I'm sure the week Logan has surgery will still be emotional for me, though. I'm glad that he's too young to know what's going on. . .he won't know beforehand, or during (since he'll be "out"), and I'm sure they'll give him something for pain afterwards--so the surgery will probably be harder for me than him. At least he is a strong baby so that should work to his advantage, and by the time he has it he'll be a month older which means he'll be that much tougher.

Of course I've been obsessed with watching the hole now, like when he's drinking from a bottle I do notice the area becoming wet. I was hoping maybe the fluid draining was a one-time-thing that just happened to be at the ped.'s office (because then he wouldn't need surgery yet) but it seems to be getting more regular.

I'm trusting God that everything will be okay. Hopefully this will be it for hospitals for Logan!!! He couldn't possibly have any more love in his life so that's the main thing.

On a brighter note, Logan met his first friend on Friday, June 20th. You might remember me mentioning that Joe used to work with a guy (Matt) whose wife coincidentally also found out she was pregnant on Labor Day. They were due a couple of weeks before us but ended up having their baby six days later. Even though Joe doesn't work with Matt anymore, they golf every now and then with the company's league and compared stories while us wives were pregnant. We all thought it'd be fun to get together for a playdate once the boys were born, and so they invited us over last weekend--but that's when Joe went to his class reunion. Originally, I had thought about going to my class reunion this past weekend, but decided not to, so we invited them over to our house to grill out. It was so much fun, we've decided to do it regularly and watch the boys grow up together :-) They have their two month check up on Tuesday and are guessing Jaxson is in the 90th percentile with his weight as well. He was almost 9 lbs at birth and was--and is--taller than Logan, but feels equal in weight when holding him.

On Saturday, we invited Nick & Heather over. (Like Matt, Nick used to work with Joe at his old place of employment.) I haven't scrapbooked since the end of March so Heather brought over her stuff and we did that while the guys installed our second garage door opener. The last time Nick was here was when we installed the first garage door opener on Labor Day. . .just hours before I found out I was pregnant :-) Hopefully I can return to the actual scrapbooking nights at the store in July. Also, my neighbor Jenn said she's still doing every other Thursday at her house, so maybe I'll re-join her in July as well. I need to get going on Logan's scrapbook!!!!

Anyway, it was the first time for having Heather over at our house so she got to meet my doggies and we ordered Gambino's pizza and chatted while the guys played guitar hero before calling it a night. I was glad I had these distractions on Fri & Sat, and am getting together with Lisa P for lunch this Thursday (she & her husband used to work with Joe as well) so am very much looking forward to that as well!

Otherwise, that's about it for my update. I went back and read my blogs so far and there are some things I accidentally left out, so I'll conclude with them:

1) For my first two weeks after giving birth I kept waking up in the night drenched in sweat. I was never hot or sick so I thought it was really weird. But on day twelve I went to get my hair high-lighted and my stylist asked, "Have you had the night sweats?" I was like, "OMG yes! I didn't know what they were!" Apparently it is normal in the couple of weeks following birth to sweat, as your body's hormones return to normal. Ironically, it stopped after that.

2) I also leaked breast milk constantly at night from two weeks up until around my "Breastfeeding Rollercoaster" blog. Now that I'm basically just breastfeeding, I'm not waking up drenched if a feeding is delayed. I think it's because Logan doesn't really have a pattern or schedule, so my milk holds off until I pick him up or take off my shirt--then it starts SPRAYING which can be crazy when I'm not prepared. Like, when I get out of the shower I have to hurry up and cover my chest with a towel because it will just go all over the bathroom! Ah, the things we never knew. . .

Anyway, when I pumped all of the time, my breasts hurt & leaked every two hours on the dot. Logan was taking his bottle like clockwork (pretty much the same minute, every two hours). But brestfeeding has made him much less predictable. He might want to eat an hour after the last feeding--but then not again for 5 hours! At first this made me uneasy because I'm a structured person and liked the predictability, but since Logan has been so content and doing so well with breastfeeding (and obviously isn't lacking any nutrients) I realize that I need to just let him guide me and not force him to be on the time-table that I'd prefer. I've learned that he knows more about himself than I do and so I trust his signals as far as what is best for him. I don't want to take that away because hopefully that will help him to continue to be assertive and in tune with himself as he gets older.

Don't get me wrong--this doesn't mean I'm going to cater to his every need as he gets older, but right now it appears that nature is taking more of its course than Logan trying to be spoiled--and I think its like that for a reason so that he is at his healthiest.

I don't quite understand it because on average he nurses for only ten minutes at a time, while when I pump it's for twenty minutes and he always demands the entire bottle (so when nursing, the amount has to be half that and yet he's okay with it). But there's no reason to complain, he's even been sleeping better and longer during the night since breastfeeding all of the time.

Except for last Monday night, however. I was up with him for 5 hrs straight (from 2-7 AM)--ICK! I felt very run down and was worried I was going to get sick. Last night, though, he only got up twice from 11 PM to 11 AM. (He was very awake earlier that day when Nick & Heather were here, but not at all when Matt & Stacy were on Friday.) I ended up pumping the most I ever have--10 oz in one sitting! But he slept six hours straight. So even though each day is different, as long as the majority of the night Logan is sleeping, and the morning & evening he is awake (which seems to be the case) I don't mind. (FYI babies at this age generally sleep 15 hrs total a day.)

He appears to be a morning person (unlike me) and is at his most active between 7-10 AM. He is full of smiles and laughs and curiosity. He especially LOVES his mobile. Every morning I turn it on and his entire face lights up and he grins from ear to ear. It brings him so much joy and happiness, it really melts my heart and is the highlight of my day!!!

Every now and then we'll have a relapse with breastfeeding (for example, once in awhile he seems addicted--like he just wants to breastfeed forever--but an hour is my limit so I usually keep one bottle in the fridge each day incase of times like that) but 99% of the time it is easy now, I can't believe it. It's how I always imagined & hoped in the beginning!!!

3) Logan has outgrown his first outfit (a onesie that says "Nothings wrong, just testing you") and has almost outgrown another (the shirt & pants he wore home from the hospital that's in his hospital picture). Considering 0-3 month clothes are for up to 14 pounds, I'm guessing he'll be in the 3-6 month clothes any day. He's already worn two of those--it's bittersweet :/ I love that he's going on to a new phase in his life (more interactive and fun) but I've really loved the newborn phase (he's just the sweetest thing ever, he can do no wrong) and I don't want his childhood to go too fast!

4) Logan has started scooting (actually moving, but with his limbs straight out) already when he's on his tummy! He also has waved and said hi. Hear me out, LOL! The first day was at four weeks old. I said "Hi Logan" and he went, "Hi!" I told Joe and he was like, "Um, I think you need more sleep." Of course he didn't believe me. . .until he heard it for himself. Obviously I know Logan isn't seriously saying "hi" but you know how all babies have a favorite sound they make? Well, his is "hi." He says it every day, sometimes it's a happy "hi," other times it's a mad "hi" and other time it's just a regular old "hi." He'll be in his pack n play and we'll walk by as he says "hi," so we'll say "hi Logan"--it's so funny. As for the wave, the first time happened at seven weeks old when we were back in Iowa at my dad's house. My grandma waved to him and he waved back. I actually didn't see it, but four other people witnessed it. But I had my own experience just this past week. He was in his carseat looking at me so I waved and he brought up his hand and waved it. Once again, I know it wasn't real, but the timing of these make it fun. :-)

5) He has both Joe & my cowlicks, poor guy, haha! I have one in my bang area (although it's not as bad now as when I was little) and Joe has a Dennis the Menace one in back. Both of Logan's are small, but it's cool to see our traits in him (since we still can't really pick out his other features).

6) I've started cutting his fingernails! This is a big deal, I've been scared to do it my entire life. I remember thinking in high school that I dreaded when I had a baby and would have to do it. But from the day Logan was born he's been scratching his face and so I knew I'd have to get over my fear. For the first eight weeks the doctors recommended we just file them, but we couldn't seem to do it often enough because when he got frustrated he still scratched his face pretty bad (as well as me--and it hurts). My stepmom had bought me some baby safety clippers for Christmas and so I got them out this past week and went for it. . .and it was so easy! I don't know why I was so chicken. In fact, I think I'll probably do it every day now because even just a couple of days after I did it last week he scratched his face again. They grow a mile a minute.

As of last night (Sunday) we're also giving him a real bath every night. Up until then we were just doing wet washcloths irregularly (which doctors recommend for the first two months). I'm hoping the daily shampoos will get rid of his cradle cap because he still has the newborn dandruff. He seemed to like the "real bath" much better (I think it was like a hot tub for him)--he actually smiled a few times when normally he cries.

7) We're supposed to keep Logan pretty covered when he's outside. Our pediatrician said that he can't wear sunscreen yet, and even so it isn't enough to protect babies' skin before six months of age. We've still been taking our walks about three times each week in the evenings so that's been fun. I've only done my aerobics that one day I mentioned, though, but fortunately I still lost my final two pounds of my pregnancy weight by Logan's two month birthday!

8) Just a random thought--I really don't understand child abuse. Not that I really did before having Logan, but now it's even more insane to me that anyone could hurt a baby. Even when he's fussy it's not something that could provoke anger in me--he's too innocent!!! What is wrong with people? I can't stand to hear the news of shaken baby syndrome or parents murdering their children.

9) Joe & I have come to the realization that we need godparents and have no clue who to put in our wills if something was to happen to us. Hopefully it never happens because right now we don't know who we'd want to raise Logan. We either don't know the people in our family well enough or we know them too well, haha. But we're going to try to make a decision by the time of his dedication in July.

10) Sarah S. (another wife of one of Joe's old co-workers, who is due in November) found out this week that she's having a boy! Welcome to the club! Joe wasn't surprised because there's a jinx at his old office (where Sarah's husband works) that makes everyone have the sex that they are. Maybe Lisa P. will break that jinx if she has a boy (since she works there). . .

Breastfeeding Rollercoaster

This was originally written on Monday, June 9, 2008:

If you have found this blog due to the issue of jaundice, you can read my two posts about my experience here. If you are here for the issue of breastfeeding, you might be interested in my other posts on this subject, found here.

In the Preparing to Breastfeed blog, I wrote, "I am planning to breastfeed. There really doesn't seem like any other option. From every book I've read, every doctor and lay person I've talked to, etc. there's no reason NOT to."

I included the facts about how much better breastmilk is than formula and how to overcome common breastfeeding problems. I even took a breastfeeding class because I'd heard that despite it being something that women have been doing since the beginning of time, it isn't necessarily easy.

But, I figured that by me being a stay at home mom free & able to nurse whenever, and truly wanting it to be a priority, it was in my favor to do it. Surely something so natural wouldn't be THAT difficult. I had pictured breastfeeding my children my entire life, as I knew my mom had nursed me (as well as my husband's mom with him).

So, when my son was born, one of the first things that came to my mind was the tip at the top of my breastfeeding class notes: Nurse within the first hour of birth. (In the PTB blog I also included the rest of the tips I’d learned during class.)

Unfortunately, Logan was in intensive care during his first hour of birth. Even though we'd been told at 30 min. post-birth that he could be released, it took two hours before he was in the regular nursery. During those hours I asked several nurses, "When can I breastfeed? I want to breastfeed!"

Finally, four hours after his birth, a nurse brought him into my room and put him to my left breast in the football-hold position. I was relieved when Logan latched on, as that is the first--and often hardest--step. Not only that, but he began sucking strongly right away. The nurse cheered--and I thought that was the end of any concern. I'd had the wrong assumption that breastfeeding was either easy or hard, and so since it'd started off well for us, my experience would be easy. I didn't realize that many women have an issue that develops and THAT'S part of what makes it hard--that the whole experience can be a rollercoaster.

But, even when after only a few minutes Logan stopped nursing and fell asleep, I wasn't worried. The lactation consultants came to check on me and explained that newborns really only need a few teaspoons of colostrum, as nature has given them the ability to actually survive with nothing for a couple of days after birth! So, although Logan always fell asleep before the full twenty minutes that is recommended, I continued to be optimistic. Especially, since he'd had a rough birth--of course he was going to be tired. The main thing was that he was latching on, sucking properly, and having the correct number of wet & dirty diapers per day.

Still, by his third day (Monday, April 21st) he'd lost nearly a pound (from 7 lbs, 13.7 oz, to 6 lbs, 15 oz). While this is normal for newborns, for babies with jaundice weight loss is incredibly dangerous as it makes the jaundice worse. My pediatrician said I had one week to bring his weight back up through breastfeeding but then otherwise he'd need to be on formula. (Which my ped. didn’t want as he is very pro-breastfeeding.) I was crushed--and determined to nurse 24/7 if need be.

However, later that day we had to admit Logan to the hospital because his jaundice level was 21 (in the emergency range). This meant he had to be in an incubator and hooked up to IV fluids. Therefore, I was only able to take him out every now & then to nurse. :-(

Meanwhile, my breasts entered the engorgement phase. The nurses had all been asking me, "Has your milk come in?" (Changing from colostrum to real milk) I suddenly knew what they meant--not only were my breasts incredibly sensitive and SORE, but HUGE!!!! I hadn't thought it was possible for them to get as big as they did (it was rather creepy).

I didn't realize how important that day was. While I was preoccupied with Logan in his incubator, my breasts were basically asking me, "Do you want this milk? If not, we're going to dry up." If I had it to do over again, I would have pumped like crazy that day and asked the hospital staff if I could nurse Logan even more frequently. It wasn't until that night that they finally let me borrow their electric pump to relieve my milk for the pain (and then my milk was discarded!). I was surprised at how little came out, but the nurses said not to worry, that Logan was only 3-4 days old and that was all he needed at this point.

Until then I had only nursed Logan on my left breast--but that one was so engorged that it nearly made me cry to have him on there that night, so I decided to try my right breast (in a cross-cradle position). It turned out that Logan did a better job over there. . .and after that he would no longer take my left side at all! When I pumped on Tuesday (April 22, day 4) there was barely any milk on the left (not even 1/4 of an oz)--but my right picked up, as if it was over-compensating.

The lactation consultants at that hospital checked on me, and noticed that my left breast had become so engorged that the nipple wasn't as easy for Logan to latch on to anymore, so that's why my milk was drying up on that side. They gave me a nipple shield which was a miracle worker; Logan began to take that side again. They also checked to make sure that he was swallowing (which he was)--which meant that he was indeed getting milk from me. The only complaint as we left the hospital was that he still wasn't nursing for the full twenty minutes because he was still very sleepy. They said that was to be expected for a jaundice baby and just to nurse as often as possible and he would improve.

When I went home, I made sure to put him to my breast every two hours no matter if he woke up or not. My breasts had passed the engorgement phase so they didn’t hurt anymore, but to my shock they were actually smaller than before I was pregnant! (Since I'd only pumped a few times at the hospital and Logan wasn't sucking enough, my milk was drying up.)

Unfortunately, Logan stopped taking my left side again even with the shield and would still not stay awake on the right. Even though his weight got slightly better, his jaundice (bilirubin levels) did not. Therefore, as those know who read my blog about his first week, he was required to stop breastfeeding on Friday, April 25 and be on formula for four days.

The internet explains: ". . .enzymes in mom's milk allow bilirubin to be reabsorbed into the blood from the intestines, the baby processes fatty acids in mom's milk as a priority over processing the bilirubin. If the mother stops nursing, substituting formula, the bilirubin levels will drop rapidly. They will not rise again when the nursing is resumed."

This was true--in just 24 hours (by Saturday, April 26) Logan's bilirubin level went from 17.5 to 14.4 to 11.9. By Monday, April 28 he was considered recovered and the pediatrician said he could go back to breastfeeding.

During his four days on formula I had become concerned again about our future with nursing. The last tip on my breasfeeding notes had read: Wait four weeks before introducing the bottle. (As many babies will never take the breast again once learning how much easier the bottle is.) Logan was introduced to the bottle at exactly ONE week old.

Also, after leaving the hospital I did not have access to an electric pump. I had a manual, as I had only planned on pumping to relieve engorgement or on a rare day that I was away from Logan--which would have been fine if I hadn't had to cease nursing those four days. Just because I couldn't nurse, didn't mean that milk didn’t still need to be released. As I mentioned before, the combination of Logan not getting enough breastmilk when he did nurse (due to his sleepiness) with me not pumping enough inbetween his feedings, decreased my milk supply.

The good news was that he remembered how to breastfeed when he took to it again after formula, but the bad news was that I definitely didn’t have enough milk for him. Sure enough, he was never satisfied. So, I bought an electric pump (when he was almost two weeks old) and began pumping (in addition to nursing) and putting my breastmilk in a bottle because I could get more to Logan that way since he was still falling asleep every time and had never made it to the recommended twenty minutes. My pediatrician also recommended I buy More Milk Plus, an herb to help with lactation, which I did on the day of his two week check-up, Friday, May 2nd.

Both the pump and the herb worked. Within two weeks (when Logan was 4 weeks old) I'd finished the More Milk Plus and my milk supply had gone from 1-2 ounces (both breasts combined) after 20 min. of pumping to 7 ounces these days. (FYI: Newborns generally need 2-3 oz. every 2-4 hours, by one month old they should be eating 4 oz every 4 hrs, and by six months usually 6-8 oz. 4-5 times a day. Logan is 7.5 weeks old and still eating every two hours, but wanting 4 oz each feeding.)

I really thought during "week three" I was going to get burnt out. The lactation consultants were calling me daily to check in and give me advice, which was wonderful. . .but one day I broke down in tears on the phone because I didn't think I had anymore energy, as I was both pumping and feeding EACH twelve times a day, which meant I wasn't getting any breaks in 24 hours!!!!

I was glad that from Logan's perspective everything was great (we hadn't had to formula-feed him since his second week of life, so he was at least getting breastmilk each time), but I had always planned on nursing for 9 months to a year--now that thought seemed way too exhausting and draining!

It was nice that Joe and others could help out with Logan's feedings (especially in the middle of the night), but I couldn't help but feel like a failure since bottle-feeding hadn't been my ideal. I remembered how when I wrote the Preparing to Breastfeed blog I had felt so strongly about wanting to work as hard as I could to breastfeed. I'd written: "It is important for me to not give up if the going gets tough."

So, I started talking to women I know who had breastfed successfully to find out if they had any suggestions before I threw in the towel. Kendra said it often takes six weeks even for women without problems--so not to make any decisions until then. Lisa P had recommended undressing Logan when he fell asleep in the middle of his feedings to wake him up. Kim talked to me for an hour on the phone. I began to have new motivation. After hearing and reading so many success stories, I realized that the majority had dealt with at least one difficulty and had still ended up breastfeeding easily in the end. It was not too late for Logan & me, we weren't a lost cause, there was still hope. Despite the setbacks, there were also a lot of great signs that we were still on the right track. I hadn’t been aware that breastfeeding is just often something that takes a couple of months to get going. (No wonder it is the first topic written about in the popular What to Expect The First Year, which I'm currently reading.)

In fact, my mom even pointed out that she & I had gotten off to a similar start. As a premie, I'd had to be in the hospital for a month which meant I could only have breastmilk in a bottle (since premies generally are unable to nurse). When she brought me home, she had to wean me off the bottle and so I was fed both formula and put at the breast (because she didn't have a pump at home), and pretty soon I was just breastfeeding for six months. That helped me take the pressure off myself. I realized that being on both the breast AND the bottle hadn't been negative for either myself or my mom--and if that was my worst case scenerio with Logan, it would be alright. He would still get all of the antibodies and immunities and extra nutrients found in breastmilk, whether I gave it to him straight or pumped. And, if for some reason I couldn’t pump, I shouldn’t feel guilty for supplementing with formula as there is nothing "bad" about it.

Once I relaxed, there was more improvement: the pumps and bottles were cut in half--to six each a day! At a month old (May 18), half of the time Logan nursed flawlessly but the other half of the time he was still lazy. His sleepy time was also mine, as in the middle of the night I’d no sooner lay him down after he fell asleep while nursing, when he’d cry & indicate that he wanted more, but then fall asleep again, only to repeat the cycle every ten minutes--and so those were the times I'd end up giving him the bottle.

As he got farther away from when he had jaundice, I started noticing that he was getting more vigorous with both the breast AND bottle (despite the bottle being easier for babies, Logan had never acted like he loved it. In the beginning he didn't take it very well, and even after a month old he was sometimes slower on the bottle than on the breast--sometimes taking 40 min!)

So, after Sarah visited from Seattle, I had the energy again to try and cut down his bottles/pumps in half again—to 3 each a day! I finally understood what people meant when they'd asked, “Do you feel the let down?” I could tell the difference from when Logan was getting good milk and when he was just using me as a pacifier.

The downside was that he started getting more rough. He’d always been active while he ate, but now sometimes he pulls/yanks, bites with his gums, and digs his fingernails into my breasts!

Still, I knew it was worth it. As the six week mark approached (Friday, May 30th), my goal was to stop the bottles & pumps completely. The lactation consultants had stopped calling me, but their last advice had been that he might be relying on the bottle during his lazy hours and so the only way for him to rely on my breast instead was to not give him the bottle at all anymore. This meant I was probably going to have a rough week (because he’d get frustrated), but just as babies aren't going to overeat, they're not going to starve. (My cousin-in-law, Kim, said the same thing.) It was also going to require ME to not be lazy (so I’d need to continue to put him back to the breast even if he’d just been there ten minutes ago).

So, on Thurs, May 29th, I rented a movie, sat down on the couch, and decided I would just keep Logan to my breast for as long as he wanted—no matter how slow he was or how long it took—so as to get him used to not having the bottle during his sleepy hours.

Two-and-a-half hours later the movie was over, but he was not finished nursing!!! I was so bummed. My nipples were obviously sore and I felt like I had no more milk left. Worst of all, since I hadn't pumped all that day there was no breastmilk in a bottle to feed him when I finally broke his latch, and he began screaming for more. So, we had to resort to the formula sample we had left over from his jaundice. (Now I have a couple of bottles of breastmilk in the freezer for if there’s ever an emergency again.)

I felt better the next day when he weighed in at twelve pounds already (I didn't need to be worried anymore that he wasn't getting enough by just breastfeeding; it's hard to be confident when you've pumped and are able to see how much there is verses nursing—especially since my breasts often still felt full after breastfeeding but always felt empty after pumping). So I planned to go cold turkey on him again. . .except that for the next week he went through a growth spurt (as is common at this age). Going from three bottles to none last week was not going to work, since he suddenly wanted to eat every hour and was sometimes having up to 5 ounces at a time! Once again I began pumping and nursing continuously all day.

On the bright side, I've noticed the following from nursing more:

1) My breasts have finally gotten big. Not as huge as they were when they were engorged, but bigger than normal—so at least I can finally have that perk, lol.

2) Somehow Logan nursing on my right side has begun stimulating my left side so that it's producing more milk when I pump. (Still not the same as my right, but about half as much--which is an improvement.) Best of all, for the past week Logan has been taking the left side now for as long as five minutes (without the nipple shield)!

3) The more he nurses, I’ve had more spotting since my last post, which means I don't think pumping has the same benefits to contracting the uterus (i.e. making it smaller)

4) Finally, nursing more often has made my milk come out like a sprinkler system! On day twelve, my breasts started hurting and leaking if I was late for a feeding (for the first time), but by leaking I mean just a tiny drip. Now I can hardly get my bra unfastened before it's shooting straight out and I have to clamp Logan's mouth around it to prevent milk from getting everywhere! And, whichever breast I'm on, the other one is literally pumping out milk. So this has benefited Logan when he is sleepy and not nursing as well (it comes out easier for him). When he does nurse well, it tends to run out of his mouth because it’s flowing so fast and he can’t even always swallow it.

Breastfeeding is a lot messier than pumping, so I have to keep burp cloths nearby (plus, opposite of what some say, Logan spits up a lot more nursing than with the bottle. . .one night he actually threw up all over me three times in a row--spraying me--so I had to take off my drenched night gown & underwear, as well as his outfit). I think it’s because he prefers to take the bottle in a sitting up position but that’s harder to do while nursing.

This week he seems to be slowing back down as far as his frequency of eating/his growth spurt—and so tonight I'm going to try to go cold turkey on him again! He's seven-and-a-half weeks old and we are so close to having this issue not be one anymore. Nine times out of ten Logan nurses excellent nowadays. He appears to prefer breastfeeding to the bottle, as he tries to do it anytime I'm holding him, wraps his hands (and even sometimes feet) around my breasts and cuddles close, makes noises, and smiles :-) I prefer breastfeeding as well, not only for the bonding experience, but because it's easier, more convenient, and takes less time. (Plus, I don't feel like a cow like I do when pumping, haha.) Also, I'm getting tired of washing bottles all of the time.

I'm glad that Logan can do both because the bottle is convenient when we're on a trip, for example, over the weekend we went to Iowa but with his growth spurt it would have been extra stressful to nurse without the time and environment on my side—so Logan did have mostly breastmilk-bottles. But I want to know that on a typical day at home I don't have to rely on pumping/a bottle AT ALL anymore—that he can nurse at anytime (and my milk supply won't dry up). I believe we're almost there. On Saturday night the electricity went out and so I couldn’t pump during those hours, and yet he nursed flawlessly during his usual sleepy time. (Another benefit to breastfeeding--it's always there, even in times of emergency.)

So, I'm keeping a video diary for the next 24 hours to hold me accountable (especially since this might mean I'll have to be up all night, so I've rented another movie). . .I’ve posted it at the end of this blog.

Otherwise, not a lot has happened in the week since my last post. My days are still zooming by. . . As I said earlier, Joe & I traveled with Logan for the very first time Friday thru Sunday (June 6-8) because my half brother came back to Iowa and I hadn't seen him since last year's Memorial Day weekend! Logan did really well on his first trip!

Joe golfed on Friday after work, so we didn't get to my dad & stepmom's house until almost 11 pm. My paternal grandma was also there, so everyone got to meet Logan for the first time (aside from my dad who had met him in the hospital).

On Sat. afternoon I was able to see my brother's DVDs that he's done while out in Hollywood the past year-and-eight months so that was very cool. Then, that evening/night Joe & I went to an old college friend's wedding reception.

My brother came back over on Sunday morning from his mom's house and we ate a yummy brunch. Finally, Joe & I went over to my mom & stepdad's house for a couple of hours before heading back to Omaha.

While at the wedding reception I talked with a girl who expressed interest in natural childbirth so I told her about HypnoBirthing because she wasn't familiar with it--but couldn't wait to now buy the book. I'm glad I can "pay it forward." :)

There had been a tornado in Omaha while we were gone which did damage to some homes, but fortunately ours is okay. We did pass a chemical explosion on the interstate, though. Apparently a semi blew up—and we came upon it right as the firetrucks were first arriving, so we were delayed a bit getting home. Thankfully, no one was injured.

Tonight Joe and I went out to eat. It was nice to dress up and go out on our first date since Logan was born!

Afterwards, I gained the courage to try something my doctor had given me the “okay” for ten days ago. . .but it was only ¼ success. In other words, it looks like there’s going to be another post-pregnancy challenge. :/ I knew my luck would run out after 4 hrs of pushing and a quicker-than-average recovery (not feeling any soreness after three days, bleeding after a week, and looking exactly back to normal "down there" when I looked after one week). But last night made up for that. . .um, to warn you the first time after baby is worse than giving birth!

BUT ANYWAY--here is my cheesy breastfeeding video diary. (Notice how Logan smiles when I say that we’re just going to only breastfeed for the next 24 hours, haha!) I apologize for my appearance, this was not a hair & make-up day!!!!!!

History of Breastfeeding in America

Not long after I gave birth to my son and began nursing for the first time, I read the excellent novel by Kim Edwards, The Memory Keeper's Daughter. There was a line on page 42 that said: "in 1964 breast-feeding was radical."

It had already crossed my mind that none of my grandmothers had breastfed my father, mother, or stepdad--but I'd been too busy with my new baby to wonder why. By the time I read The Memory Keeper's Daughter four months later, life wasn't quite so crazy and I became very interested in researching this topic. Why would all three of my grandmothers buy formula when 1) None of them were rich (wouldn't they want to save money?) 2) They were all stay-at-home moms during the time their kids were babies (wouldn't it be convenient with more time to nurse?) and 3) They all complained of gaining a lot of weight, LOL! (wouldn't they want to lose it easier?)

I asked my grandmas three months ago and learned that it was the doctors during that time--yes, doctors, who told women to buy formula rather than breastfeed! Back then scientists hadn't tested breastmilk yet to discover how special it was, let alone the effects on metabolism. Formula companies and doctors (who worked together) were convinced man-made milk (which they could control and monitor) had to be better than something from a woman's body (since many women weren't in top health). They didn't realize until decades later that a woman didn't need to be in top health; nature still made her milk the healthiest source possible for her child!

Thankfully, these days breastfeeding is much more wide spread, and is gaining more acceptance by society--although there is still room for improvement. My favorite magazine, Mothering, had an article in their September-October 2008 issue titled "Reel Milk." It discussed how Hollywood tends to shy away from breastfeeding, and if specific messages are repeated often and strongly enough in society, they can begin to feel like "the norm"--and norms, as most sociologists argue, often dictate behavior.

The author (Sarah Rubenstein-Gillis) believes we are influenced from childhood. She found only three films with G ratings that come close to depicting breastfeeding. The first is a nursing Pegasus foal in Disney's animated classic Fantasia (1940); the others are the suckling pigs in Charlotte's Web (both the 1973 animated and 2006 live-action versions). She writes, "A typical media-exposed child might logically conclude, especially if he or she has not seen breastfeeding at home, that nursing is for animal babies and bottles are for humans."

For films with a PG, PG-13, or R rating, "Most seem to be shot from a heterosexual male perspective, emphasizing the sexual ojectification of breasts that permeates American cinema. In addition to sexually intriguing portrayals, breastfeeding is depicted variously in these films as funny, disgusting, fascinating, shocking, heart-wrenching, triumphant, and, very occasionally, mundane." Many may be left with impressions that reinforce confusing, discouraging, or negative attitudes about nursing.

In November 2006, real-life mom Emily Gillette was kicked off a Delta/Freedom Airlines flight for breastfeeding her 22-month-old daughter.

Rubenstein-Gillis found "only two American films that go against the grain by normalizing public breastfeeding. One was made more than 70 years ago, and the other is set more than 70 years in the future. James Cagney's The Mayor of Hell (1933) shows a working-class mother matter-of-factly feeding her baby under a blanket in a courtroom as an older child looks on. In the sci-fi thriller Imposter (2001, PG-13) set in the year 2079, a nursing mother gazes into her child's eyes while riding in a futuristic public transport vehicle. In both scenes, those who surround the nursing duos either ignore them or look on in a friendly way."

Even in most hospitals, staffers distribute free formula samples and promotional "goody bags"--something that has been demonstrated to negatively affect breastfeeding rates. Medical personnel receive minimal training in lactation initiation and support.

I can attest to this. I falsely assumed after giving birth to my son that my nurses were going to consider breastfeeding a priority and be on top of it for me since I'd never breastfed before (and now I realize how little I knew about it). Nope, I learned right away I was on my own. No one ever asked me how I was doing or offered to help me. I discoverd it is up to women to figure everything out before they have a baby. . .which can be pretty hard when you've never had the experience! I'd taken a breastfeeding class while pregnant so at least I was aware of a few "rules"--but I still didn't like having to initiate everything, whether it was at my original hospital just to nurse for the first time, or at Children's Hospital later that week--as, not long after my son was born he had to be admitted due to high levels of jaundice. He was hooked up to an incubator and on IV fluids. A million emotions and thoughts went through me that week--I am amazed I even asked for help! If I hadn't, I now know my milk supply would have dried up and that would have been the end to my breastfeeding. I remember my breasts getting severely engorged as I waited for the hospital's breast pump. A nurse quickly walked me through it and then left the room. . .I remember feeling so clueless and insecure. I hadn't even figured out breastfeeding yet, let alone the whole pumping thing (especially since before my son was born I hadn't planned on ever pupming--or at least so soon)!

One of the nurses got a bottle of my milk ready for Logan, even though he was only 3 or 4 days old and I'd remembered learning that you shouldn't give a bottle to a baby that soon (if you're wanting to exclusively breastfeed). Thankfully, the superb lactation consultants showed up at that moment and they turned out to be my saving grace. They got me off to a better start and are the reason I was able to breasfeed at all! They were angels on earth. (For my complete breastfeeding rollercoaster story, click here.)

I can only imagine how hard it was for women before lactation consultants worked in hospitals. I'm sure there were many women in the mid-twentieth century who used to have a gut instinct that they should breastfeed but instead trusted their doctor who gave them formula. It is another example of how we need to remember that our doctors are human and not necessarily what they say is true. We should never take what they say as gold--without doing our own research and looking inside ourselves first. If we come back with the same answer, then we will know in the future if we made a mistake that we did the best we could and there is no reason for regrets. Same with if you ever look back at a situation and wish you had listened to your doctor. But, at least with the example of breastfeeding you won't find a doctor nowadays who won't tell you that "breast is best!"

But in the baby boom era, aside from thinking that formula was healthier, it was also seen as a status symbol. Middle-class women were talked into splurging on formula so as to feel more like wealthy women rather than the poor. Even prior to when formula was offered, higher class women didn't breastfeed--instead, a lower-class lactating woman would nurse several upper-class babies from her community (wet nursing). According to the pregnancy.org article: A Look At Breastfeeding: Past, Present, and Future, the role of a woman was to be delicate and refined--not a "cow!":

[Breastfeeding may have been natural once], but we don't live in that time now, and we must adapt our doings to the age in which we were born.......Let no mother condemn herself to be a common or ordinary cow unless she has a real desire to nurse..... Women have not the stamina they once possessed.

Mrs. Panton, Circa 1860

According to Activity Village.com: "Wet nursing declined around about the same time as other, artificial means of feeding emerged. . .For women who did breastfeed their own children, during primitive and ancient times infants were breastfed until they were five, six or seven years of age in the Middle Ages."

During the 1800s, breastfeeding for longer than one year was actually considered harmful. (I wasn't able to find out why.) Activity Village.com went on to say: "The first artificial baby milk was produced way back in 1850. In 1867, Henri Nestlé was mass producing artificial infant food, and by 1873 half a million boxes of Nestlé’s Milk Food were being sold in America, Europe, Mexico and Argentina. Until this point, only those who had access to a cow could give their baby cow’s milk – and many did!

Links between the advertising of baby food and a decline in breastfeeding led to an enquiry by the American Medical Association (AMA) in 1924. Enquiries such as this would continue in many forms for the next five decades.

By 1948, the World Health Organization (WHO) had been formed to look into public health and nutrition all over the world. At about the same time, the American Academy of Pediatrics (AAP) came out and recommended breastfeeding as the best way to feed a baby.

In 1975, Nestlé sued Bern Third World Action Group (AgDW) for translating a report about the effects of artificial baby milk into a publication with the title “Nestlé Kills Babies”. AgDW were found guilty of libel, but Nestlé were also told to improve their marketing practices.

1991 saw the World Alliance for Breastfeeding Action (WABA) formed, along with the first ever World Breastfeeding Week. Today, we are advised by midwives and health professionals all over the world that breastfeeding is the best way to feed our babies."

As far as statistics go, in 1982 there was finally an increase in nursing--approximately 62% of women were breastfeeding in the hospital and 27% were still doing it at six months. In 2000, 67% of women were reported breastfeeding in the hospital, and at the last report in 2006, 77% were! (However, only 30% percent were still doing it at 6 months of age. If you want to see the statistics broken down, click here.)

It appears that in regards to "status," society is opposite compared to a hundred years ago; breastfeeding rates in 1999-2006 were significantly higher among those with higher income (74%) compared with those who had lower income (57%).

I posted a blog while I was pregnant titled "Preparing To Breastfeed" that said: "One of the outstanding benefits of human milk is that it is custom-made for each infant. Mothers with premature infants make milk that is specifically composed for their infant with extra antibodies and proteins. Breast milk contains not only carbohydrates, fats and proteins, but also has growth hormones and special substances that enhance visual and brain development, as well as antibodies to fight infection. Scientists are unable to put these valuable substances into formula. Studies have shown children who breastfeed have fewer instances of ear infections, diarrhea and upper respiratory infections. The advantages carry over into later periods in life. Adults who were breastfed have lower cholesterol and fewer occasions of heart disease. Studies have also shown that women who breastfeed have lower rates of breast cancer and cervical cancer. In addition to experiencing fewer common illnesses and diseases, breastfed children have higher IQ's."

So why doesn't everyone breastfeed? According to "A Look At Breastfeeding: Past, Present, and Future":

First, the promotion of breastfeeding without practical help and knowledge has led to many frustrated, unsuccessful breastfeeding attempts with subsequent backlash.

Second, a much shorter hospital stay does not provide adequate time for mother's milk to come in or for appropriate education and support. In Australia in 1993, a country which is known for its support of breastfeeding, the average hospital stay for vaginal delivery was still 5 to 7 days, and for C-section, 7 to 10 days. Australia also has the foresight to send home health visitors once the mother is discharged to offer further assistance and support.

Third, the continued increase of women in the workplace, many times by necessity and not by choice, has influenced the incidence and duration of breastfeeding. A nonsupportive work environment makes breastfeeding difficult at best.

In my "Preparing To Breastfeed" blog, I summarized several common problems women face (and gave tips for all women on how to breastfeed). Aside from sore nipples, infections or painful lumps, yeast infections/thrush, and engorged breasts (all which I wrote about in that post), I also briefly mentioned in another post that some babies are affected by a mother's diet through breastmilk.

As you already read, my biggest problem was having a baby with jaundice. There are many babies, who for a variety of reasons, are slow learners and this can be very frustrating--and scary. No mother wants to starve her baby. Some are born with a tied tongue that make it impossible for them to latch. Fortunately, a pediatrician can recognize this immediately and perform a very simple surgery before you even leave the hospital. Also, 20% of women have inverted nipples. Nipple shields and nipple shells (two different things) can work wonders, as well as icing nipples prior to feedings, or a breast pump can be used to at least give a baby breastmilk in a bottle.

In my case, my son latched perfectly but wouldn't suck long enough. On the bright side, my son is now 6.5 months old and we're still hanging in there!

Breastfeeding has come along way since the beginning of time--we even have a Breastfeeding Awareness month in August now! Since 1956 we've had groups like La Leche to help women, and many places of business boast about being "breastfeeding-friendly." The Healthy People goal for 2010 is to have 25% of babies breastfed to a year old. Currently the statistic is around 16%. I hope I've encouraged you to get on board to help America reach that goal!