Friday, February 22, 2013

Magical Fixes

Breastfeeding was difficult for me at first, each feeding a challenge, sometimes painful, sometimes a lengthy and drawn-out ordeal.  We made progress in fits and spurts, tackling problems along the way, often with duct-tape solutions or trying things that had failed before.  After we had wired up a complicated hack for a problem, and then gotten used to it, it was hard to imagine any other way to do it, like when you're sick and can't remember what it's like to feel well.  Then, the problem would suddenly, randomly disappear.  (Or some unintended  consequence would appear that then needed its own solution.  Next post.)

An example of a "magically disappearing breastfeeding problem" was our stop-gap solution to nipple damage from sub-optimal latch: the widely dreaded or widely admired "nipple shield."  This is a very thin silicone cover that separates you from the baby and encourages the wide-open mouth necessary for a good latch.  Many people warn against their use because there is some evidence that it can reduce milk supply, but they are lifesavers for people facing serious breastfeeding hurdles like me.

After about 3 days of nursing a newborn, I had a lot of soreness, so we tried the nipple shield, which seemed to help with the pain and create a better latch.  The shield had to be washed and dried between uses, made pliable by a hot-water bath before use, positioned and applied carefully and correctly, and not knocked away or manually removed by a clawing baby or one of the many hands attempting to wrangle him onto my breast.  But it worked, and my nipples got less sore, so we went through this crazy dance at each feeding, make OK by the fact that it was better than pumping and syringe feeding, the next best option.

Eventually it became a kind of mental crutch--I could not envision being brave enough to nurse skin to skin.  The "crutch" then attained a mental permanency and I resigned myself to the ritual.  And then, trying to start a feeding one day, with the baby clawing at my breast and writhing wildly in my arms, the shield was propelled to the floor.  Out of what could almost be described as anger, or at the very least,  extreme frustration, I ditched our crutch and stuck him on my breast with fortitude and he nursed, painlessly, just like we were old pros.

Why?  Did the shield "train" him how to latch?  Does the newborn need a week's training before muscle memory kicks in?  Did he just get bigger?  I will never know.

We go from struggling, struggling, making our way slowly up the stairwell, until someone points out there's an elevator and we're suddenly whisked upward by a dozen flights all at once.

Friday, February 1, 2013

Docking the space shuttle

The key to early breastfeeding success is the latch.  What is "the latch?"  It is the way the baby connects with your breast to feed, and it is way more than just putting his mouth on your nipple.

In  our case, it felt a lot like docking the shuttle at the international space station, except you only have control over the station.  The shuttle has a brain of its own, and it is a person named Elliott. 

Components of my good latch:
  • intense, driving motivation to breastfeed
  • four adult hands
  • three human brains
  • plan of action written out prior to birth by lactation consultant (LC)
  • great support team and medical providers at birth
  • no medications during labor
  • smooth, problem-free delivery
  • healthy, hungry baby with a big open mouth
  • hospital that supports skin to skin, feeding within first 20 minutes, and rooming in
  • LC available the first night
  • another written prescription for action by LC before leaving hospital
  • baby's dad who would  not let me settle for an imperfect latch
Elliott, Day 1
That the nurses and LC could see on my chart the breastfeeding prescription--which included strategies to avoid soreness--meant that everyone around me was prepared to help.  The first day and a half I let the baby nurse and nurse and tried a few times to latch him myself.  It felt OK.  His mouth was huge.  Edema wasn't a problem since I had received no IV fluids and no medications. The nurses said, "That latch looks perfect.  Textbook."

It wasn't until I got to meet with the LC who prescribed my breastfeeding strategy, Suzanne, on Day 2 just before we were discharged that I realized I was on a course to repeat my mistakes.  She said,  "On a scale of 1-10, what is your pain level?"

I said, "Maybe two or three."

She said, "It needs to be zero.  Take him off and try again."

When breastfeeding hurts, the latch is not good enough, and breakdown of nipples begins, leading to more pain and more breakdown.  This is the cycle I got trapped in with Sam.  Suzanne was taking no prisoners this time.  She wrote another plan for us before sending us home.  We took pictures and videos of the right way to do it.  At home, Max emulated her helping hands and rigorous standards.  He insisted on zero-pain latch.

Our life was a jumble of nipple shields, pillows, tylenol, breast pump parts, ice packs, cabbage leaves, waterproof pads, and used tissues.  But we made it.  We nursed.