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Wednesday, May 22, 2013

That Boob Post

Somehow I wrote this post months ago and never published it, 
but it's got some good information, so I'm publishing it now. Whoops!
**Since writing this, we've weaned, so I added weaning info to the end.**

15 months and 10 days. That's how long I've nursed Carys, as of today.  It was a hard (let me emphasize: HARD) journey at first, but the last year plus has been amazing.  Our nursing relationship is slowing - we're down to a few times a day - and I can't lie; I'm going to miss it like crazy when we're done.

When I look back, I'm mostly just so grateful that it worked for us and grateful for this time with her. I know far too many people who struggled hard and had to make the gut-wrenching (but baby saving!) decision to stop, and we were so close to being there.  I'm eternally grateful for whatever tiny graces allowed me to continue. Now, Carys is a busy little girl, and nursing gives us time to reconnect and be still together. Well. Kind of. Nursing a toddler is more gymnursetics than quiet stillness, but it's still a moment to stop together.

Nursing in the Hospital
I had hoped so much when she was born that I'd get to nurse her immediately, but the logistics of it at the time made it impractical (I had a c-section). I have some plans in place for next time and hopefully the next kiddo will get the benefit of my experience. Though I wasn't able to do immediate skin to skin contact with her, we were never apart. She was in the operating room with us as they finished, and we all went to the recovery room together. Once there, they tested her glucose level, because she was 9 pounds. She failed. (I did not have gestational diabetes.) Without really asking for permission, they gave her a bottle of sugar formula. I was and still am thrilled that Chris got to bond with her so quickly and feed her (and he loved it), but next time that will not happen. I knew at the time that I didn't want that (and had read what a nursing mother "should" do in that situation), but didn't know how to advocate for myself. Hearing one of the nurses say that she would never give her baby that disgusting formula solidified it for me.  Next time, I will ask to nurse first and then have her re-tested before consenting to the formula. She failed her next one and received another bottle as well, but passed the third. In the end, it was okay - she was a hungry baby, and latched on immediately after finishing the first bottle. We were nursing and doing skin to skin within an hour of her birth, which is great for a c-section baby.

The remainder of the stay in the hospital was a blur. I wasn't super confident in my nursing ability and I wasn't sure it was happening correctly, but none of the lactation consultants that we talked to seemed to see any issues. At this point, it wasn't painful, but it just didn't feel right. I actually stayed in the hospital an extra day (taking the full four days allowed for a c-section) in the hopes that I would be able to leave feeling confident.  I do remember that she wanted to nurse all. the. time. Which, you know, newborn. That's what they do.

Newborn Nursing (aka The Worst Days of Our Lives)
For the most part, the first month or two of her life, I wouldn't even wear a top. I was always taking it off to nurse, anyway, why bother? Plus the feeling of clothing against my skin was torture. I'm sure that the UPS guy really appreciated it when I answered the door topless on accident one morning! (It was not a pretty sight; poor guy!).  She was nursing every two hours, night and day, and would usually pass out right after nursing. She would also usually pass out WHILE nursing, so it took quite a bit of effort to get her to stay awake long enough to finish a meal. She was what they call a lazy nurser. 

Sometime in the first eleven days of her life, it went from not feeling right to being painful. Incredibly, incredibly painful. More painful than anything I'd ever experienced - and I'd just had major surgery! I would put off nursing her as long as I could in order to prolong feeling that pain. Toe curling, foot stomping, sobbing pain. I would cry through our nursing sessions, especially at night.  One of my friends came to do our newborn shoot, and she was totally alarmed at how much pain I was in because of it.  Once she was latched on, it wasn't bad, but the process of getting her latched on was quite literally torture.

Because of the pain (or maybe the pain was because of this) I got clogged ducts and mastitis.  Because of the antibiotics for the mastitis, I got thrush.  Thrush felt like a million needles being stuck in my nipples each time I nursed. Mastitis made me feel run down and like I had the flu - just overall sick.  I went through the mastitis-thrush cycle at least twice (I have tips and tricks for beating those now if you need any!).

I went to a La Leche League meeting and finally was able to get someone to agree that her latch wasn't right. She would open wide, but then as she latched on, close her bottom jaw.  They gave me some tips to work on it, which helped to some degree.  However, it was there that someone mentioned tongue tie, and, as I was desperate to blame SOMETHING for the issues we were having, I called the doctor they mentioned who specialized in nursing issues.

So when she was about five weeks old, we saw the special doctor. She confirmed that Carys had a slight case of posterior tongue tie. She could clip it, but warned me that clipping it doesn't always work for that type of tie, and since Carys was older, her latch was already well established so it was even less likely to work. I made the decision to clip it out of desperation (it wasn't too bad!).

They also weighed Carys, and I discovered she'd lost three ounces since her doctor appointment two weeks prior. She clearly was not getting enough from me - the mastitis and my avoidance of nursing on that side (I'd pump instead) had drastically affected my supply. The doctor had me start a nurse/bottle/pump routine. I would nurse Carys, she would have a bottle of pumped milk, and then I would pump. I quickly ran out of pumped milk doing that, so she did get some bottles that were a mix of breastmilk and formula, but I am lucky that we never had to do straight formula. This routine continued for two or so weeks, and it was miserable. I was *always* nursing, feeding her a bottle, or pumping. As soon as I would finish pumping, she'd be ready to nurse again. And I was pumping at least twice in the middle of the night as well. But then! She started taking less and less of the bottle after nursing, and eventually she'd refuse it altogether. At that point, we stopped offering the bottle and I nursed her exclusively.

At the meeting, the doctor also discovered I had vasospasms, and the soothies I'd been using to try to help the pain were actually making it worse.  I started taking vitamin E and using a heating pad after each nursing session, and putting a wool breast pad in my bra, and that helped to some extent.

We did have one more scary setback when she was around six weeks. I found a bottle that had been left out, and it had turned pink. Literally highlighter pink! And her diapers were turning pink too - after she'd poop, the wetness that would leech out from the solids would turn pink after a day (I noticed it as I was washing diapers). I finally found some information about a scary infection that could cause milk to turn pink (from, of all places, an episode of "Mystery Diagnosis"), so at a well baby visit, the family doctor we see decided to do a milk culture and see what she found.  Well, she found the bacteria that causes that scary infection (serretia marcesens). And clearly it was in Carys's system, too, since her poop was turning pink.  This was terrifying, but also confusing, since neither of us had symptoms of being sick. I had to go see an infectious disease doctor (two of them!) to see what was going on and get more information. In the long run, since we never got sick, they decided to let it run the course without drugs (treatment is a very aggressive course of antibiotics that would have required me to stop nursing). 

When I was first having so many difficulties, I kept reading that it would improve at around six weeks. That's what really got me through the difficult parts. I'd think, "Okay, I can do one more day. I just need to make it two weeks nursing, and then if I need to stop, I can." When she turned two weeks old, I thought, "Ok, one month. I can do this one month." At a month, I looked forward to that magic turning point of six weeks. Once we hit it, there was no improvement. It was still awful and painful and I was devastated. But I kept telling myself that any day it would get better, and then suddenly....it was.  When she was eight or nine weeks old, it just stopped hurting. I don't know what changed. I don't know if she (and therefore her mouth) got bigger so she was able to take more of the breast in while nursing, or if my nipples finally gave up and turned off their nerve endings, or what.

Besides the pain and issues, I remember most how she would pass out every time she nursed. I remember when she stopped doing that (I don't even know how old she was) I had no idea what to do with her...before, she'd pretty much be eating or sleeping. Now she was awake? And wanted to be entertained?

Why didn't I stop during any of that? I honestly don't know. It's the hardest thing I've overcome with parenting yet, and I know that she would have been fine not nursing and having formula instead. But it was important to me, and I really wanted to do it - and, other than the pain, I really, really liked it. I loved sitting with her and cuddling her and comforting her and being able to provide that for her. I wanted to continue. I REALLY wanted to continue. So I did.

Infant Nursing
Around three to six months, we hit our nursing prime. She was fast and efficient, I didn't have to carry around a million nursing accessories, and we had really hit our groove. Carys nursed every two hours during the day and 2-3 times at night at this stage.  And I was fine with that. She was actively eating, so she was clearly hungry, and she was still sleeping in our room (using the Rock N Play sleeper), so I didn't have to get out of bed to feed her.

I went back to work full time in October, when she was 12 weeks old. I pumped 3-4 times a day at work, and she had bottles while I was there.  No issues there.  That, however, didn't last long. After about a month, I realized that working full time away from her was not what I wanted and it was not what would make me happy. I stepped down from my management position and started working part-time - two four-hour days and one eight-hour day. I pumped once during my four hour days and twice during my eight-hour days. My employer let me use (and still lets me use) an intermittent FMLA, which allowed me to pump off the clock without penalty.

At around six moths, she went down to waking up just once during the night. She also was rolling over at night and escaping her swaddle. We decided to transition her to her crib at that point. She did wonderfully, and slept from about 9 p.m. to 8 a.m., and once a night I would go in and nurse.  We also introduced solid foods at this age (using BLW), but that didn't have any effect on her nursing schedule.  When I was home, she'd still nurse every two or three hours. It was also about this age that she learned the sign for "milk."

That pattern continued until she was about eight or nine months old, when she suddenly started sleeping through the night on her own.  (Don't get me wrong - there were a couple of REALLY rough nights! It wasn't all puppies and rainbows!) She also started eating a lot more during the day. I could see my supply had dropped a bit, and she started dropping a session or two during the day.

Toddler Nursing
We now nurse in the morning, before nap, and before bed when I'm home. The nap and bedtimes ones are cursory and just part of the routine; she really doesn't take in much. Depending on the day, she may want to nurse once or twice more or not at all. The morning is where she really nurses. We joke it's her morning coffee. We lay in bed together after she wakes up for an hour some days nursing (which, YAY, because I can sleep!) and then once she is awake awake, she might want to nurse once or twice more before she's ready to face the day. It's like her coffee.

Nursing now is fast and kinetic. She doesn't usually hold still except for when she's going to sleep, and she will move around and look around and kick and stand up and flip over and sometimes try to walk away with a nipple in her mouth.

I'm still grateful for our nursing relationship for many reasons, but one is because I don't have to worry as much about what or how much she eats, since she's still getting my milk, and that gives her a perfect mix of nutrients.

Nursing in Public
Ugh, yes, I'm one of THOSE. I nurse her in public, without a cover. I know, I know. I try to do it somewhat discreetly, but come on, I have big boobs, so that's a relative term. She will not abide use of a cover. And I'm not about to sequester myself away every time she needs to eat, so that equals nursing in public. Lots and lots of nursing in public.  Anyway, in my mind, if it's an appropriate situation to give a baby a bottle, it's an appropriate situation to give a baby a boob. And I won't nurse in a bathroom. Come on, that's just gross.

So yes, it's been quite the journey, and I'll be quite sad when we're done with it. I'm hoping that the knowledge I gained with Carys will help the next time go more smoothly and more pain-free, and I hope that some day Carys looks back at this, and after puking in her mouth a bit reading about my nipples, will appreciate how special this time was to both of us. Even if she can't remember...I always will.

Night Weaning  and Full Weaning
Since originally writing this post, we've weaned, so I thought I'd add a bit about that process.

She slowly started dropping nursing sessions and was down to 4-6 times a day, always including first thing in the morning, nap, and last thing at night (unless I wasn't home to put her to bed).  I was still nursing her to nap and to bed.

We were struggling to conceive and I wasn't getting pregnant, and I knew that nursing could be impacting that, so I knew that I wanted to start weaning her. I initially did “don’t offer, don’t refuse”, then moved on to offering her a snack, a glass of milk, a book to read, or anything I could think of to distract her from nursing. That worked maybe 30-40% of the time.  To push it further, I started limiting her sessions by singing a song she was familiar with (we used the ABC song). I'd let her nurse for a bit, then say, "Ok, I’m going to sing the ABCs, and when the song is all over, we’re done with milk.” I’d sing the song, then break her latch and let her repeat this (complete with the song again) on the other side. Soon enough, she’d anticipate the end of the song and finish on her own.  After a little bit of that, I moved to a shorter song, or would sing faster. This helped cut us down to just the three “big” sessions – morning, nap, and night. I think at some point she realized that she was nursing for such a short time that it wasn’t worth it to stop playing for such little gain.

The nap and night sessions were the next to be cut, and they both came at the same time. We went on a trip to Des Moines to meet my mom (who lives in Dubuque, IA during the school year). Because I had other plans the evening that everyone else was going up, my dad and sister took Carys and drove her up to the hotel. She was awake when they took her (right at the start of nap time) and fell asleep in the car – so she didn’t nurse to nap. Then, they put her down to bed in the pack-n-play at the hotel, so she didn’t nurse to bed that night. Now, that’s not entirely unusual – she wasn’t nursing to nap or bed with sitters or daycare or Chris, just with me. However, I was the one that usually put her to bed, and she insisted on nursing if I was the one to do it. So she didn’t nurse to nap or bed that day. I arrived later that night, stayed the night, and then nursed her in the morning as usual.  That day, she again fell asleep in the car during her nap, and I transferred her to the pack-n-play to finish her nap, so she skipped that nap session also. That night, we were out late, and she again fell asleep in the car, and I again transferred her to the pack-n-play without nursing. That marked two days in a row that she didn’t nurse to nap or bed. The next day, I nursed her in the morning, and in the afternoon we left to drive home. We again left at naptime so she’d sleep in the car (nap number three in a row she didn’t nurse). However, I was nervous about that evening. She’d be back in a familiar place and, I assumed, she’d want her familiar bedtime routine back. To avoid that, I had Chris put her to bed (I actually pretended to leave the house). Night number three without nursing. The next day, I continued to nurse her in the morning as usual, but when it came time to nap, I tried laying her down without nursing (since Chris was at work). And…holy crap. She did it. She asked, I said, “no milk!” and she just went to nap without it. That night, I again had Chris put her down to bed. The next day would be the REAL challenge – Chris had school in the evening so wouldn’t be home until after bedtime.  I nursed her in the morning, said no milk again at night (again no fight), and then….said no milk at bedtime, and that was it. She was fine with it.  

If you don’t have the ability to pack up your life and go out of town, I highly recommend having your partner (or even mom or sister or sitter) put them to bed and/or nap as you’re cutting the bedtime session. It definitely helps. That, and disrupting the routine.  If you can’t stand crying or begging, I also highly recommend actually leaving the house. I swear to god the kids know we are there and turn it up to 150% just to make us feel more guilty and break down and give in!!!

The morning session was the hardest to break, for personal reasons. Namely, I got to lay in bed for an extra hour each morning and sleep while she nursed. We called it her morning coffee, because she’d be grumpy and tired, and then after the morning session, she’d be bright eyed and bushy tailed and ready to go.  For this session, I just had to really suck it up, meaning instead of going and laying down in bed with her, I got up and got fully dressed (to make the boobs harder to see/access) before getting her, then immediately started the day as soon as I got her.  The first couple days, I actually took her out of the house after changing her diaper and clothes – she was so distracted she didn’t even realize we’d skipped nursing. After that, when she woke up, I’d get her a glass of milk, we’d eat, we’d play, we’d go outside…anything to get her moving and take her mind off nursing.  

We officially weaned about four months ago, but even now, she occasionally asks to nurse (instead of “milk”, she now calls it “mommy’s milk…ADORABLE).  Probably about 90% of the time, she accepts a glass of water or milk in exchange, although there are a few rare times she tries to nurse. She gets nothing, but it’s still clearly a comfort to her. However, I’m definitely hoping to have it completely cut out at least six months before the new baby arrives, to try to avoid any jealousy or issues between her and the new baby. I’m also trying to prepare her, by calling her a big girl and reminding her that mommy’s milk is for little babies.   Because we went so slowly, I never had any problems with engorgement or pain with weaning (although I did have that after my milk came in with Caleb – TIGHT sports bras 24/7, even in the shower, no hot showers or water on them, no stimulation, cabbage leaves!).

If you’re in the process of weaning – good luck! It’s not easy, and I miss it, but it’s nice to have your body back to yourself. For a little while, at least.

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