Breastfeeding: This shit ain’t easy

I made it fairly clear when I had Aleesia how difficult I found breastfeeding to be. Said difficulty did not leave a warm fuzzy feeling for me during this experience with her. Yes, there were moments that were sweet and I did enjoy the calm when she would have a good non-frustrated feeding. But as a general rule, I was doing it because I wanted to try it and then I was committed to giving it the best effort possible, which was 6 months.

When I was pregnant with Vivian I knew I would do the same thing – give breastfeeding a try, maybe it would be easier. Maybe she wouldn’t have lip and tongue ties or issues with weight gain. I was especially interested to see how things would play out since I would be working at home and not having to pump full time. (for the record, the working at home/feeding on demand thing is great!)

As soon as she was born, I checked her for ties – which she had. I even mentioned them to the lactation consultant who saw us before we left. She blew me off and told me they were no big deal. I knew they could be a big deal, but decided to use some of the tricks I learned from Aleesia to try and make things work.

We battled through the initial discomfort and it seemed that her latch was okay – not great, but she was a new human so I was giving her some slack! She then started to do a lot of things that I knew were not good including using a chewing motion v. sucking, pulling off so far that she usually had no areola in her latch, and she was getting so frustrated. Also, she did not seem to bet getting bigger. But, unlike Aleesia (and Gianna, for that matter), Vivian is such a generally happy baby! I figured I was being paranoid all that time…

But eventually I used my mommy instinct and took her to a breastfeeding group so I could do a weighted feed, have her evaluated, and validate what I already knew – her lip and tongue ties needed corrected. All of which happened . That particular day I ended up feeding her from both sides over 40+ minutes and she transferred about 2 ounces of milk. Cue all the guilt. We got her to the pediatrician for a weight check, and while both G and A were similarly small (they were all really close to the same weight at the same age!), Vivian was born the biggest and had the lowest gain over the same time period. Our pediatrician agreed with our plan to have her ties revised and thankfully a wonderful dentist much closer to us was available to do it.

We saw Dr. Milton who let me know that her lip tie was fairly bad but her tongue tie was very bad (like an 8/10 on the “this is the worst I’ve seen” scale)! He fixed her up in about 3 minutes and we could already tell the difference. She did great with the procedure, we have about a week of stretching left and then she will be REALLY happy!

before and after pictures

Along with having the ULT and PTT’s revised we started some cranial sacral therapy (CST) which she hates but is helping! We had a one-on-one consultation with an IBCLC as well – she is still not transferring much milk per feeding. The IBCLC confirmed the chewing v. sucking situation and we think that is likely the cause of the poor milk transfer at this point. So, we are trying to do some suck training, a different way to position her when she latches, and basically doing everything we can to break the bad habits she has formed/help her to learn to suck the right way.

A lot of little problems that might be a big deal on their own but are all compounding together to lead this happy little girl to maintain her portable, peanut status.

This all seems like so much to go through when giving her a bottle would be so much easier. But now I am committed to doing my part in making this work for at least 6 months, or longer. She does take bottles sort of okay most of the time when I am out of town or away for any reason, so that’s not the issue. I have enjoyed the experience with her slightly more, maybe because I feel more empowered or knowledgeable on how to maneuver these crazy situations. Maybe because she is such a happy baby? Maybe I enjoy it more simply because I don’t have to pump full time on a regular basis.

The moral of the story, breastfeeding is probably not going to be easy but it doesn’t have to (and shouldn’t) be miserable for you or your little – so go with your gut.

If you think something is wrong, seek advice/answers/help. Lip and tongue ties are considered midline defects, they can (and often do) have a detrimental affect on breastfeeding but they also affect other things, like digestion. Our pediatrician sometimes thinks I am crazy, but does support me in my efforts to do what is necessary to make this work. I would say something is helping, she had a 3 ounce gain in 3 weeks, which for her, is a lot! She is up a full 2 pounds from birth at 4 months – we’re taking this as a win for the moment (despite what that pesky growth chart says).

Also, at the end of the day, we all know that it only matters that you feed your baby in whatever way works for you and your family. I have no idea how long I’ll be able to breastfeed for, it’s up to Miss Vivian, I suppose. (and for the record, my other kids had formula and they are awesome, so obviously I have no bias there!)

One Third {of the first year}

I have been desperately trying to figure out how to slow down time for the last four years, and that has never felt more true than the past four months.

Apparently when you add another child to the equation of life, it picks up at close to warp speed. I can’t always keep up with everything I NEED to do, let alone all of the things I WANT to do! But remember the small things is important to me, so here we go.

It has been a crazy four month. Let’s recap Aleesia’s first four months of life, shall we?

She was born after an amazing 19 hour labor/delivery. Giving birth to her without medical intervention was the most amazing thing I have ever experienced.

We hid out at the hospital for 25 hours and came home so she could meet her big sister.

We have been figuring each other out for the past few months.  We have had a busy four months, but I managed to steal some time with just her every once in a while.  We worked hard at breastfeeding at first, and are still working hard to make it work for us.  I’m back to work.  She stays home with daddy and Gianna.  Aleesia has been a bit of a challenge and Mike and I make screamy tiny people – no big deal, really – but it can be exhausting for all of us.

In general, the past four months have been a whirlwind!

We enjoyed lots of snuggling.  With mommy and sister.  Aleesia is a snuggle bug.

There were many meetings of other tiny people – mainly her cousin and new friends.

She endured plenty of goofy photo shoots with mommy.

We all experienced too many hours of crying (an intolerance to milk/soy, breastfeeding problems and a terrible infection were just a few of the culprits. and general newborn crankiness).  And despite the pictures of Aleesia sleeping, there isn’t always a lot of that going on! I just try to capture it when it DOES happen.

We had just a few very special parties to attend.

And even her first holiday - Easter!

We can’t forget to mention that she has been through a few of the most bizarre (at least to me) health issues in her short little life. (MSPI, GI Reflux, ULT, PTT, VUR, that’s enough right?)  And a little hospital stay. (thankfully everything is mostly okay now).

Aleesia figured out her lovie (lovies, if you count her wubanub!)

She has decided outside is fun! (which is a good thing considering her sister never wants to come inside!)

Despite all of the things that have gone against her in her first four months – she learned to hold her head up! and, we get a lot of smiles these days.  And if we are lucky, a giggle!

One thing is without question, somebody here has a big sister who ADORES her and worries about her all the time.  It might have only been four months, but the bond that they have is so special already.  It might be one of the most fun parts of the past few months – watching these two learn each other.

Aleesia in a nutshell is our petite, sensitive, snuggler who doesn’t always feel the best but tries not to let it show. (except, when she does let you know she feels bad – there is no question!)

I wouldn’t know what to do without this girl.  I barely remember what life was like before she came.

Pump Pump (again)

Tomorrow is my first “official” official day back to work. Every day of the week.  Which, whatever, it’s fine – I actually like working and OMGAH we need to figure out a routine around this place.  I am going to miss the hell out of my kids (and my husband, for that matter) – but it’s part of life and I get to drink my coffee & eat my lunch in peace five days a week so it’s not all bad.

The past few weeks where I have only been working 2-3 days I haven’t been pumping what the baby has been eating.  But I had a decent freezer stash.  Or not. Because it is pretty much non-existent anymore – which happens when you take one bag out a day and don’t put anymore in.  We have had to supplement some with formula when I am gone but are obviously hoping to make that an occasional thing, not a rule.

Again, we still need to work on our routine during the day.  But I feed her before I leave for work and I try to feed her when I get home – but sometimes she can’t wait until 6 so I just pump and then feed her before bedtime.  So far it has worked out the best to pump twice at work, three times if I can squeeze it in, 15 minutes per session. I have my reminders set in my calendar so I don’t get scheduled for any meetings, etc. I realize that isn’t always when she eats, but it’s the best I can do at the moment. Before bed is always the easiest option – or it would be if I wasn't so freaking tired! But I am also throwing around the idea of pumping on my way to (or even from) work since I have a long commute.

It has also been a bit of a challenge to figure out exactly how much she needs during the day.  I have tried to do weighted feeds with her to see what she gets while she eats as a baseline.  Sometimes it appears she gets 2-3 ounces, sometimes it appears she gets 1/2 an ounce.  She nurses for a LONG time (25-40 min a side, thankfully she only eats on one side at a time!) and just likes to take her time.  Apparently she also enjoys pounding down her bottles since it is super easy for her. I am constantly hearing “well, she pounded down that X ounces and probably was still hungry” – I am loosely throwing around the idea of switching her to an even slower flow nipple.   Regardless of how long it takes, or doesn’t take, her to eat – she still takes more than I pump in a day so I know that I (begrudgingly) need to work to squeeze in an extra pumping session somewhere.

I am looking for any other tips on helping increase production!  I recently started massaging while pumping, and that has helped a little bit with production as well as leaning forward a little bit so I can use gravity to my advantage.  I also recently got pumpin’ pals flanges which are SO SO SO much more comfortable!  I haven’t used them enough to notice a huge difference in production, but I am hopeful.  I do have a hands free bra thing so that helps too.

I am also looking for any other tips related to efficiency when pumping!  I always feel like it is such a process to set up (even though I do leave my pump set up all day) and clean up.  I have some medela steam sanitizer bags which are really nice.   I think it is always just going to be a bit of a process, by nature, but any tips anyone has I’ll take! 

And lastly, and this is going to sound totally ridiculous – how do you dress for pumping? I am a dress person, which is obviously not the easiest thing to maneuver when you have to hook your boobs up to a machine several times a day and don’t necessarily want to get undressed each time!  Clearly shirts/pants/skirts are the easiest bet and I almost always wear a nursing tank.  Any awesome wardrobe tricks that make pumping (and direct breastfeeding, for that matter) less of a clothing challenge? 

There have been so many challenges to this breastfeeding journey in the barely three months of Aleesia’s life between her MSPI, lip/tongue ties, her being sick, my low output, a million blocked ducts (and now a milk blister. fun.) but I can’t quit it – and really, I haven’t even thought about quitting to this point.  It helps that there is so much support available though, so thank you for supporting me and entertaining my questions and neurosis.

another type of reflux

It was Gianna’s birthday and we were taking both girls for their well checks.  No biggie, besides the whole shot business.

I got home with Gianna from preschool and went to feed Aleesia who felt like she was on FIRE! So I got out the temporal thermometer (love that thing) just for kicks.  Except it said 103.1! So I did it like, 4 more times and then got out the rectal thermometer.  It said 101.somethingthatIforget. 

Good timing since we were walking out the door to the doctors office.  So, of course we told them about her fever and totally threw the resident off his game.  She looked fine – ears were good, not stuffy, not coughing etc.  Scrawny (she had only gained 2 ounces in 6 weeks – and I am sure that gain came after we had her lip and tongue ties corrected) and feverish for no good, obvious reason.

The pediatrician told us “you know, they keep babies this young in the hospital sometimes for fevers”.  And I rolled my eyes – there was NO TIME FOR THAT! My sister was getting married. In 2 days. Lots going on.  But he really felt strongly that we needed to have blood and urine cultures done on her, and perhaps an LP, and the ER was the best place to go.

So we went.  And my sister waited with me for many hours while Mike took care of things with Gianna. (who hung out with both sets of grandparents and really didn’t realize we weren’t there!)

She loved the crinkly paper on the table.  She did pretty well with the blood draw and the straight cath.  And we waited for the results.  Which were that this little peanut had bacteria in her urine and her blood. She had to have a spinal tap (which, I did not stay in the room for because I couldn’t. it was hard enough to be outside the room). And we were not going home.  I am not sure if I cried because she was sick or because it was Gianna’s birthday and I had spent most of it in the emergency room or because my sister’s wedding was in TWO DAYS!

Either way, I cried a little, but knew she was in the very best place she could be.  We have a fabulous children’s hospital in our area. 

They ran the first round of IV antibiotics while we were in the ER waiting for a room. (which took approximately 3 more hours)

We got up to our room after midnight, did the whole admission thing.  And tried to sleep.

Doctors came in and out, just as soon as both of us fell asleep of course.  Friday was kind of a blur – but after that second round of antibiotics that morning she looked SO MUCH BETTER.  She was able to rest and the infection that had been brewing for who-knows-how-long was on its way out.  They also had her on continuous fluids which helped as well.

Her pediatrician rounded in the afternoon and he had mentioned that she might not go home until Sunday, depending on how thigns went.  And I tried not to cry right then – remember, WEDDING!! But we also saw infectious disease who told us her official diagnosis would be urosepsis secondary to pylonephritis.  (so, she had a blood infection from a UTI and kidney infection) – however he did say that with the right antibiotics she could go home the next morning. Urology came and checked on her and did a renal ultrasound (it looked ok) as well.

I made sure everyone was on board with us getting the heck out of dodge before noon on Saturday and praise the lord (and thanks to many prayers) we were out of there and on our way to the wedding day festivities by 11 on Saturday!

Tuesday we went for a VCUG to check out her bladder/kidney function.  The urologist, pediatrician and infectious disease doctors all thought the likely culprit was kidney reflux.

She did great during the test and it immediately showed VU reflux.  We saw the urologist right after who graded it as a Grade III – middle of the line in severity, basically.  We will follow-up closely with the urologist over the next year (and hope she grows out of this!) and she will be on a daily antibiotic to help prevent future UTI’s.  The reflux itself isn’t necessarily the problem – it’s when infected urine enters the kidney’s and lead to a UTI that causes the problems. 

So – she has some MSPI, some GI reflux, some VU reflux and now that they are under control – she is literally a different baby.  It’s pretty astonishing the difference in her personality.  But everybody is allowed to cry when they don’t feel good, right?

While it was pretty frustrating having her in the hospital, and the timing could not have been worse, I’m glad we were there, figured out the problem, have a treatment plan in place and it isn’t anything more than this.

ULT & PTT

Let me paint a picture for you:

We take Aleesia to her one month well check, discuss her extreme screamy-ness and very clear reflux issues with the doctor.  Decide to try going dairy/soy free to see if we notice any changes in her behavior.  I noticed some changes, she was very obviously more upset if I ate cheese than if I didn’t but she was still screamy and obviously uncomfortable.  So we gave zantac a try to see if it would take the edge off for her.  And it really didn’t.  So, I made the general assumption that I make tiny little girls who really like to cry and get really uncomfortable when they eat.  I also made the assumption that breastfeeding must be okay, she had gained some weight at that appointment and I figured that the discomfort I had and the length of time she spent at the breast were normal because I had no idea otherwise. 

I had overheard a conversation between two moms at a jewelry show about driving 4 hours to have their kids upper lip tie (ULT) and posterior tongue tie (PTT) revised with a laser.  I had NO FREAKING CLUE what they were talking about so I asked!  They told me about these things and I listened.  And didn’t think much of it after that.  Until Aleesia was about 7/8 weeks old and I looked at her one morning as I was getting her dressed and jokingly said “hey peanut, are you shrinking?” because the onesie I put on her looked bigger than the last time she wore it.

I remembered the conversation from a few weeks prior and reached out to one of the girls just to get a little more information.  she pointed me to a local midwife who is really really knowledgeable on the topic and I started reading and researching.  And a big HUGE light bulb went off over my head.

I was reading the symptoms commonly associated with ULT/PTT’s. Symptoms you might see in a baby include:

• Colic (had it)
• Reflux (had it)
• Gagging, choking when feeding (she actually “clicked” because she couldn’t maintain any suction at all)
• Snoring/open mouth breathing (had it)
• Prolonged nursing sessions/too frequent nursing sessions (nursing 25+ min on one side!)
• Excessive Crying (re: screamy baby!)
• Foul smelling/odd color bowel movements (yes, but could be from the MSPI too)
• Termination of breastfeeding/refusing the breast when hungry  (she would get angry at the breast, actually. because she wasn’t transferring hardly any milk)
• The baby failing to thrive/slow weight gain (yep)
• Poor bonding between baby and mother
• Sleep deprivation
• Problems with introducing solids

Things that might be experienced while trying to breastfeed a tongue/lip-tied baby may include:

• Pain (yes! I totally thought it was normal too)
• Poor milk supply (apparently so)
• Nipple damage, bleeding, blanching or distortion of the nipples
• Mastitis, nipple thrush or blocked ducts (blocked ducts)
• Severe pain with latch or losing latch (yes and yes)
• Sleep deprivation caused by the baby being unsettled
• Depression or a sense of failure

So I did what anyone would do – I looked at her lip and tongue to see if she had a tie.  And yes, yes she did.

 

class IV upper lip tie

really hard to see, but she has a severe posterior tongue tie – her tongue could not touch the roof of her mouth

I actually contacted this midwife directly to discuss and get her clinical advise – and after seeing Aleesia’s pictures she said based on the thickness of her ties - we should visit a dentist that could fix these problems with a small laser.  We also discussed how these ties are midline defects that tend to have a profound effect on a baby’s GI system once fixed.

I would do pretty much anything to make the screamy baby a happy one – so we made an appointment to get this little problem taken care of.  We saw the nicest man who was so knowledgeable about ties – and really committed to helping women successfully breastfeed which was kind of a cool thing.  The whole procedure took about 3 minutes.  It was SO simple and easy. The worst part, hands down, is the stretches we have to do on her lip and tongue to make sure everything heals right and doesn’t reattach.

The difference in feeding after the procedure was night and day. 

less than an hour after, fed and satisfied!

I had NO IDEA how uncomfortable I was until I wasn’t any more! her upper lip was swollen for a few days, but she has healed so so well. 

same day – little upper lip swelling

She doesn’t get so angry when she eats (probably because she is actually able to hold suction and get milk out!), her gas pains are greatly diminished and her reflux seems less severe.  I have taken her to a chiropractor for a cranio-sacral adjustment since she was basically only using her lips to suck with – that has helped her facial muscles become stronger and her latch/suck mechanism to improve. 

I just happened to be nosy enough to ask for more information when eavesdropping on someone else's conversation and found this solution that has potentially made my baby much less screamy, much happier and MUCH more satisfied.  I fully believe that this was the right decision for us – breastfeeding is so hard on it’s own, when a baby literally can’t latch or feed it is obviously that much harder – and it is such a simple fix.  However! I did go to my pediatrician and to a lactation consultant – neither of which checked her mouth because it just isn’t something they look for.  The dentist that did the procedure? He put his finger in her mouth to feel her suck and in literally 2 seconds knew what the problem was and why we were having the problems we were. 

It’s amazing the information that is out there and the information that is not – this is a real thing, that causes real problems – if you are looking for more information on upper lip and tongue ties – leave me a comment or shoot me an email, I’d be happy to chat with you about it/share more of our experience.