Breastfeeding is easy!

What!, you ask?  The momma who so struggled to breastfeed that she wrote a tome on the subject and called it "Babyfood" now says breastfeeding is EASY?

Feeding Elliott is easy, now.  He is 7 months old and a total pro.  He loves nursing, is super efficient, and is even learning that turning his head while attached is a no-no.  Once we got past 2 months, and then 3 months, it just became easy.  No bottles, no ice packs, no pump.  Just put the baby in the car and leave the house.

Elliott, 6 months

It makes me feel even more astonished that I exclusively pumped for Sam for 20 months.  20 months!  More than 1 1/2 years of pumping, day in and day out, in the middle of the night while Sam's dad fed him with a bottle, in the middle of the night awake alone, in the middle of the afternoon when everyone was outside playing, at work at my desk, in my car, in bathroom stalls, in hotel rooms, on airplanes, pumping, pumping, pumping.  And never, ever nursing my sweet baby boy.

It makes me feel astonished, and sad, and disappointed in myself I didn't try again, try harder after the initial failures to nurse at 2 weeks, at 3 months.  Disappointed I didn't call every LC in my state to find a way to fix the latch.  Disappointed that I was resigned to being an "EPer."

I know why I was resigned.  Pumping, like driving a moving train, was much easier to keep going with than to stop and reverse directions. And I felt proud that I did the next best thing health-wise.

So now, I will try to leave it behind and enjoy nursing my other sweet baby boy and be thankful I have a chance this time.

Baby-led feeding

A day came in the first few weeks of breastfeeding when things clicked for us.  This happened after we discovered that he was fighting against our efforts to manually manipulate his mouth into the right place (see last post).  It occurred to me to look back at what I learned about nursing in the first hour after birth--about the "breast crawl" and ways that baby learns to latch on.

I rested his cheek against my breast like on a pillow, and he would do this kind of sweeping motion of raising and turning his head and opening his mouth very wide.  At that moment I could bring him in and latch him on.  With a little practice we got the timing and aim down, kind of like hitting a baseball, and this method worked almost every time.  I used this method for many weeks until we didn't need to focus so much on the perfect latch (next post: breastfeeding is easy!).

Unintended consequences

One of the key components of a good latch is a big, wide open baby mouth that takes in as much mama as possible.  Pain can occur when baby slips down on the breast and treats the nipple like a straw.

One way to combat this tendency for newborns to "slip" is to have a partner help manipulate baby's lower jaw into better position after he has latched on.  We used this technique at almost every feeding to reduce pain and improve latch for the first week or two of nursing, and it worked well at first.

But at some point, Daddy had more and more trouble pushing down on Elliott's jaw, and in fact, it seemed like Elliott was actually fighting him, causing the problem to be worse--MORE clamping down--rather than less.  I found an article on kellymom that seemed to suggest that jaw manipulation may have not only diminishing returns, but the unintended consequence of actually making the pain worse after awhile. 

Why?  Consider would happen if you approached your partner, or parent, or friend and tried to physically open his or her mouth.  Or even if you tried to push him or her gently backward?  No matter how trusting the relationship, he or she would probably automatically exert energy in the opposite direction of your pushing.  Indeed, Elliott and his dad were experiencing their first power struggle, and in between was the tender skin of my nipple.

Is there a lesson in this idea that could help with my original idea?  Yes.  Try to push his mouth closed, not open, during latching on, and benefit from the reverse effect.

Even better, could we somehow tap into Elliott's natural instincts to get that wide open mouth we needed?  Yes.  Next post.

Problem, duct-tape solution, unintended consequence, aha moment, learn, succeed, repeat.

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.

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.

My breastfeeding support survival guide

I've already chosen a hospital and a doula who have great track records for breastfeeding success.  But I need to have a reference guide in case things don't go smoothly: my breastfeeding support survival guide.  I have some research to do to fill in the blanks, but this will be filled in and in my overnight bag when we leave for the hospital.  Am I missing anything?

In-hospital lactation consultations:

• List of all hospital LC's and their availability (Cost: covered by insurance)
• Who can help if they aren't available (are nurses trained to assist?)
• Outline of routine postpartum care I can expect at my hospital ("magical hour" skin-to-skin contact, minimal intervention, etc.)
• Training and qualifications of other staff to help, such as nurses

After-hospital lactation consultations:

• List of 1-3 providers and phone numbers who travel for in-home visits (cost: covered by insurance if affiliated with a hospital--be sure to get prior insurance approval)
• List of local hospitals and phone numbers that offer lactation appointments (cost: covered)
• List of 1-3 Skype services (cost: $45-$75/session, not covered by insurance)

 Pediatrician:

• Postpartum pediatrician's office, phone number and hours of operation, and services (traveling nurses? Same-day appointments?)
• Local pediatrician's office, phone number and hours of operation

References:

• List of feeding cues and signs of a well-fed baby
• List of favorite information sites (kellymom.com)
• List of recommended YouTube videos on latching
• List of books and DVD's on hand  
• Printouts of medical protocols for most common breastfeeding problems (http://www.bfmed.org/Resources/Protocols.aspx)

Support groups:

• List of 1-3 local breastfeeding support groups, their phone numbers, and schedules
• List of online forums

Other lifelines:

• Doula phone number
• List of friends and family who are breastfeeding supporters

Battle Babyfood: Round 2

The bell is about to ring on Round 2 of Battle Babyfood: I am expecting baby #2 in just over 2 months.  I've spent the last 3 years training and conditioning, and I am now a mommy of steel: nothing is going to stand in my way this time.

OK, so that is me psyching myself up.  But it is true that the knowledge I gained from trying to breastfeed a baby, having major problems and not having nearly enough help, finally finding a stopgap solution on my own (exclusively pumping for 20 months), and then asking a lot of questions and doing a lot of research and writing afterward, has me much better positioned to beat the barriers this time around.

My thinking in July 2008 was: If I can get through labor and delivery, I can get through anything, and breastfeeding will come naturally.

My thinking now is: I will be supported in labor and delivery by a slew of dedicated helpers at my hospital.  I will be supported in breastfeeding--which could be even more difficult and painful than labor and delivery--by no one except the team I build for myself.  And by support  I mean people professionally trained, experienced, and ready to provide medical guidance and intervention if needed, as well as emotional supporters.

So I'm getting started building my network of pros to make this happen, including a breastfeeding-friendly midwifery/OB practice, a breastfeeding-friendly hospital (that has incidentally made strides in its lactation support practices since Sam was born there almost 3 years ago), a great childbirth educator and doula, at least one great lactation consultant willing to do home visits and/or work with me via Skype, and a breastfeeding-friendly pediatrician.

Let the battle begin!