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!!!!!!