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Archive for February, 2012

Eliza at 4 months

Miss Bear’s repertoire of tricks now includes blowing raspberries, grabbing toys and getting them into her mouth, and playing with her feet.  This month Eliza has started giggling, though goodness knows what she thinks is funny.  We spend a lot of time making asses of ourselves trying to get her to giggle, usually to no avail, and then she’ll bust out laughing at something unexpected (like the snot sucker, hoo boy!).  She can prop-sit unassisted for a while, leaning forward with her hands on the ground, but she’ll fall over if she tries to grab anything.  She wants to stand up all the time still, and loves to be in her bouncer.  Her hand-eye coordination and motor skills improve visibly every day, which is really cool to watch.  She is still remarkably laid back – if she is crying, 99% of the time it’s because she is hungry or tired, and it only lasts a moment.  We’ve had a minor sleep regression the last week or so (right on cue – 4 months is a big growth and developmental spurt!), so she’s been waking once in the night for a snack.  Funny how painful that’s been for me and Kevin – the newborn days are apparently a distant memory!  

E has gone snowshoeing twice, hiked Badger Mountain once, and has gone to frisbee many times this month. She has been pretty agreeable for most of our adventures, tolerating long car rides fairly well (sleeping mostly, and occasionally requiring a buddy in the backseat) and kind of hit or miss with hiking/snowshoeing.  Sometimes she just doesn’t want to be in the carrier, other times she passes out or quietly looks around.   We are still resisting putting her on any sort of schedule – she sleeps and eats whenever and wherever the mood strikes her – so that we can continue going on adventures.  This is working well for us for now, probably just because she is so laid back, but we’ll take it!  

Stats at 4 months:
Weight: 13.94 lbs (58%)
Length:  24.5” (60%)
Head Circumference: 16.5” (75%)
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Playin’ with Squish, a.k.a. starting to pull her weight.

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Continued from Part One – breastfeeding hurts, and maybe I have Reynaud’s – and Part Two – is that a light at the end of the tunnel?

TL;DR version: ouch that hurts real bad, vasoconstriction is for lamers, drugs are good and so is sleep and books and growing babies with bigger mouths.

Around the middle of January, I seemed to reach a place that seems fairly sustainable.  I pump four to six times a day, while reading books on my shiny new bribe kindle.  I nurse the baby when it’s convenient – when she is hungry and I don’t feel like going upstairs, when we are somewhere where I can’t pump easily (like a frisbee tournament, or on a long car ride).  We are both a lot better at the mechanics, but she still doesn’t stay full for very long – usually no more than a couple hours on the outside.  We always give her a bottle before bed because she’ll sleep all night that way, and I usually have to pump before she wakes up in the morning due to discomfort.  In terms of pain, we have reached a much better place.  75% of the time, pumping doesn’t hurt at all.  It doesn’t feel good at all either, but it doesn’t hurt.  I’m not sure why it hurts the other 25% of the time, but it’s usually no more than a 4 on the pain scale.  Nursing is pain free but unpleasant about 50-75% of the time.  I do not enjoy the sensation, I don’t experience warm fuzzy bonding feelings.  I spend the time thinking about when we should get a bottle ready for when she is still hungry, or wishing I’d remembered to grab some ice water before I sat down.  

I have a host of issues relating to breastfeeding – I hate pumping at work, I feel some degree of shame when I have my door closed, thinking about how everyone can hear the pump working as they walk by.  This was compounded after a janitor walked in on me (my door doesn’t lock, he knocked and entered in one single motion).  I was incredibly anxious about breastfeeding in front of people, which I did for the first time at a frisbee tournament in January, out of necessity (the baby was hungry, and full boobs meant I was very uncomfortable).  It ended up being no big deal, but I still get stressed about breastfeeding in public – I won’t do it in front of people if I can help it, even with a cover.  I hate how I have to plan every little thing around my breasts – pump right before leaving the house, which means I have to factor in an extra 30 minutes to everything I do.  If I forget anything for work (cooler, flanges, valves, bottles), I have to go home.  I get a three hour window to accomplish anything, unless it’s exercise – then I get an hour and half before I get uncomfortable.  between pumping, breastfeeding, and my full time job, I have maybe 1 or 2 hours not accounted for, in which I play with the baby, do chores (dinner, house cleaning), and have me time.  As I try to get back into shape (previously I played a good bit of sports, frisbee and soccer), I find that I don’t have time.  Breastfeeding (or, having to empty my boobs) makes planning adventures – out of town trips, day trips to snow shoe or ski, etc. – much more challenging.  

I’m also absolutely terrified of what will happen to my body when I stop.  I lost the baby weight easily, without trying, I assume because that’s just how my body reacted to nursing.  I’m about five pounds under my pre-pregnancy weight, or at about what I weighed when I started college.  I like my body more than I ever have – it’s not perfect, but I’ve always liked its lumps and bumps best when it is doing something for me.  That used to mean when I was doing best at sports, but apparently extends to carrying, birthing, and nursing a baby.  I have friends who gained significant weight as soon as they stopped nursing, and I’m scared of that happening to me.  I’ve always had a pretty tenuous relationship with my body image, so it wouldn’t necessarily be a win, trading in the fretting I do over hating breastfeeding for fretting about my body. 

And yeah, I still spend a lot of time wanting to throw in the towel.  But I feel very guilty about it – like, it doesn’t hurt that much anymore, sometimes not at all, so it would be entirely selfish if I stopped.  There are bright spots, or advantages – sometimes I relish the luxury of reading (13 novels since Eliza was born!!), and sometimes when I don’t feel like doing something else I have used pumping or breastfeeding as an excuse to zone out.  Both of these bright spots actually make me feel worse – the only good things I can come up with are actually bad!  They are selfish too!  And then the sillier ones: maybe it hurts and I hate it, but if I do it, I can eat cookies without gaining weight!  And, maybe it hurts and I hate it, but if I do it, I don’t have to make formula and clean as many bottles and I hate formula!  

It’s like my brain is kind of warped, at this point. I think I am motivated to continue by this guilt over feeling selfish, worry over what other people think, and some degree of wanting what is best for my child.  That last part – only some degree – that’s because, as a scientist, studying what I study (toxicology, physiology, and development), I know that the effects of breastfeeding are quite subtle even at the population level.  That is, if I switched to formula, or had only ever fed formula, there would be no measurable effect in Eliza herself, because the sample size is just too small.  I know this – I understand it, and I could probably convince most people of it.  But on some irrational level, I still feel like I have to keep doing this if at all possible because it’s so much healthier for my baby.  Like the reasons that make me want to stop are all about me, and now I need to be all about her.  

But lately, I’m feeling like even if it is a ton of tiny little reasons, nothing so huge all by itself (like the initial pain was), it still adds up to something big.  And that over time, if I keep it up, it’s akin to putting her oxygen mask on while ignoring my own. 

I just wish there were an obvious line, a clear point at which I could say “enough is enough,” quit doing it, or at least quit worrying about it, and get on with the rest of this parenting business.  

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Continued from Part One – breastfeeding hurts, and maybe I have Reynaud’s. 

I didn’t have maternity leave – I only had about two weeks fully off from work, at which point I returned part time, and ramped up to full time by five weeks (mid november).  So Eliza and I only got to try nursing in the evenings, between 5:00pm and 9:00pm – which was also the time of day when she was crankiest.  At the time, I thought it was possible she had some nipple confusion, but in retrospect, I think it was more the time of day and her mood.  We were both pretty clumsy with the positioning – I had a boppy pillow but didn’t find it very helpful.  I’d usually get Kevin’s help getting her into position, stuffing pillows and blankets everywhere, holding her arms down.  She would inevitably get angry and start to holler, and then I’d get upset and have to hand her off to Kevin.  Milk would get everywhere.  This would all take at least half an hour, longer if we were remotely successful, and by the end, I’d need a shower and a change of clothes (and a hard drink).  And then I’d need to pump.  

I went back to the LC several times to work on positioning and latching, the latter of which is still impeded by Eliza’s tiny tiny mouth.  The pain is very intense still, radiating back from the nipple, and it didn’t go away completely when I wasn’t nursing or pumping.  It didn’t get better over time, despite the medicine (nifedipine for Reynaud’s, and an anti-fungal for thrush).  The LC is more and more convinced the problem is Reynaud’s, because my nipples never stop being purple even when I don’t nurse for days.  She was totally geeking out over my boobs – calling in her LC friends to look at them, and even taking a picture to show some folks in Seattle (with my consent, of course).

After a few weeks with no improvement, when Eliza was about six weeks old, my doctor upped my dosage of nifedipine, the vasodilator.  The pharmacy screwed up the prescription, so that instead of doubling the dose, I was suddenly taking SIX TIMES the dose.  For two days until I figured that out, I could barely stand up without passing out, and had a raging headache, but I could nurse 90% pain free.  So I was finally convinced the main problem is Reynaud’s. 

I was relieved to know what is wrong, but still not sure what to do – I couldn’t keep taking that dosage of medicine, and even when I did, I had to nurse Eliza literally every hour because she couldn’t get enough milk to stay full longer than that.  Also, to even try nursing exclusively while I was at home, I had to break my regular pumping schedule.  This was a huge mental leap, as I was so terrified of what would happen to my already inadequate supply.  So basically, I was ready to throw in the towel, and that was what made me able to nurse her even somewhat effectively – so that she was hungry at the same time my breasts were full.  In order to let myself try, I did a lot of data analysis… we have this phone app, baby connect, where we had been keeping track of everything – diaper changes, bottles and amounts, and I had been using it to time my pumping sessions (and record the volumes).  So I analyzed my pumping.  The effects of duration of and interval between sessions on the volume.  And I found that they had little effect – I basically always produced half a mL per minute of breastmilk, about 700 mL per day, whether I pumped ten times or six, it was about the same.  
Once I cut back to the correct dose of medicine, the pain came back – varying between a 2 and a 6 on the pain scale during nursing or pumping, which was a huge improvement …. but still pretty bad, considering what percentage of my day I spent feeling like that (two to three hours a day actually pumping, and another hour or so washing pump parts, getting set up, etc.).  I’d also get clogged ducts every few days, which would ramp the pain back up.  I spent every day vacillating wildly between wanting to stop, hating it, and thinking I could manage to keep doing it for a long time, another week, another month, maybe this is going to work out just fine.  
Around this time, when Eliza was six to seven weeks old, a number of things happened.  First, Eliza starting sleeping in longer chunks – first four hours, then five, then one night – nine.  I still woke up every three hours, whether by an alarm or from engorgement.  Resentment was building towards my husband, who was getting to sleep as long as the baby, and towards the baby, for…  sleeping?  for having a tiny mouth?  I don’t know.  But it reached some boiling point and I decided I didn’t care – I wasn’t setting an alarm any more, and I would cut back to pumping less.  So I started getting more sleep, and was pumping four to six times a day, with only maybe a 10% decrease in my supply.  Also in this time period, I realized the baby was far better at unclogging my ducts than the pump was, even though the pump was better at fully draining my breasts.  Then, the headaches I’d had as a side effect of the nifedipine started getting less severe. Finally, I had been downloading books to read on my kindle app on my iPhone, and found that I could ignore the pain much better, and actually almost looked forward to pumping, if I were in the middle of a good book.  So that’s: sleeping baby, sleeping Susie, hoover baby, improved headaches, and good books.  
That winning combination, along with Eliza’s increasingly large mouth, has seen me through a slow decrease in pain over the last two months.  At some point I stopped taking the nifedipine – I kept forgetting doses, and then didn’t take it on a trip.  That basically brings us to now, which I’ll write about in a final installment.

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I’ve decided to write up my thoughts on breastfeeding, so that I might be able to remember what happened and know what to expect if I end up trying it again with future babies.  So here we go, in several installments.  

My daughter, Eliza, was born in October.  Prior to her birth, I was much, MUCH more worried about breastfeeding than I was about labor, or really anything birth/child related – I have had non-cyclic breast pain as far back as I can remember, not bad, but bad enough: my boobs have always been off limits in intimate situations, I never ever stand facing a shower.  Exercising has always been a tricky business – how many sports bras can I wear at once without making it impossible to breathe?  (Answer: two, sometimes three.).  I own probably 20 sports bras in a variety of colors because I wear them almost exclusively, to minimize movement and friction.  So, going in, I am terrified, and have been voraciously consuming breastfeeding information on the web.  And frankly I thought the majority of it was crap guess work (relevant: I’m a research scientist, and very little of the breastfeeding info out there is remotely evidence based). 

In the hospital shortly after she was born, I latch Eliza on and commence squirming in pain, but I expected it to hurt, so I just deal with it.  There is blood, there is crying (me and Eliza), I can’t really hear the baby swallow, but I know she does because later she pukes up blood.  BLOOD from my BOOBS.  I keep trying for the first 24 hours.  The lactation consultant is called in on her day off, takes one look at my nipples, and tells me to not even try for four days because they are so purple and unhappy.  We start giving Eliza formula when she is hungry, and I commence worrying about nipple confusion and the fact that if we were nursing, she’d only be getting a few milliliters at a time, versus the two ounce portions she is now wolfing down.  The LC helps me get started with my pump, which hurts just as badly as the baby – I remember yelping in pain when I turned it on the first time, at the lowest setting.  I pump every three hours, getting only a single milliliter or two of colostrum.  I remember feeling proud and excited when I realized I could use a 1cc syringe to  feed it to the baby – antibodies!  My milk finally came in on day 5 – I figured that out after my mom accidentally elbowed me in the breast and my my milk let down hard and painfully.  

Five days later at my post-partum check up, I meet with the LC again.  She said the baby’s mouth is too small, and informed me that I have enormous nipples (who knew?).  She said it could be six weeks before the baby will be able to latch well.  She said I should try to nurse the baby once a day if I can stand it, and pump 8 – 10 times per day to keep my supply up.  She was surprised that the bruising hadn’t abated more – my nipples are still aggressively purple.  I wonder if they weren’t always that color, as I hadn’t paid a lot of attention to them before.  My breasts hurt all the time – though much worse when I was pumping or trying to nurse.  I’d say it was about a 1 – 3 on the pain scale most of the time, 3 – 5 during let downs (which happen every hour and half or so), and 6 – 8 when pumping or nursing. 

At the beginning of week two, I went back to the LC.  She remained surprised about the bruising and the pain that wasn’t getting better.  It’s a deep, radiating pain.  She mentioned thrush, and I mentioned Reynaud’s disease, which is a vasospastic disorder that has previously affected my fingers.  Basically, when I am cold, the circulation to my fingers occaisionally shuts off.  My fingers blanch white and go numb – like a limb that falls asleep – and when they warm up, I get some pins and needles, but it doesn’t hurt.  I had read that this can happen to nipples and breast tissue, and though I have trouble associating the painless phenomenon I have observed in my fingers with the incredibly painful issues I was having with my breasts, I felt it worth mentioning.  As soon as I said it, the LC’s eyes lit up.  She was convinced that is the problem, and sent me immediately to my doctor for a prescription for a vasodilator, nifedipine.  He also put me on an aggressive two week course of anti-fungals for possible thrush, as the two issues have overlapping symptoms (deep, radiating, intense pain).  I also started taking fenugreek and blessed thistle to attempt to increase my supply, as well as doing power pumping sessions in the evenings – 10 minutes on and 10 minutes off for an hour, instead of the normal 15 minute sessions I did the rest of the day. 

I did not get any immediate relief from the nifedipine, but I did get a wicked headache as a side effect.  I continued to pump every three hours, and attempted to nurse the baby once a day for fear of her developing nipple confusion.  She seemed thankfully content to suck on anything near her mouth hole.  I reeked of maple syrup from the supplements.  I randomly burst into tears at least once every day. 

I was determined not to let breastfeeding make me crazy – early on I read the whole “step one, feed the baby.  step two, enjoy feeding the baby.” credo and at least the first step stuck with me.  Eliza got about 25% formula and 75% expressed breast milk from the day my milk came in.  I remember wanting to delete all the photos where you could see her drinking formula, or out of a bottle, in the first few days because I felt judged (by WHOM??).  I was very glad that my husband could (and would) help feed the baby – I would pump every three hours, and he would feed the baby on approximately the same schedule (determined by her).  I was so glad that he could do it, enjoyed it, but I was also PISSED because he got to hang out and bond with the cute little baby, and I got to hook my tits up to a machine that HURT.  Even after the initial trauma to my nipples healed, it hurt.  It hurt so much that I would cry the entire time I pumped, and eventually I would start crying before I pumped because I knew how much it was going to hurt, every three hours, every day.  I thought about stopping constantly, how much longer could I handle this, but I wanted very much to make it work.  If it had been a matter of flipping a switch, if there were an off button instead of the necessity of ramping down the milk production, I would have stopped.  But I really wanted the bonding experience I’d heard so much about, I wanted the immune system boost for my daughter.  I was worried about the impact on her future – obesity risks, intelligence, things I knew were absurd except at the population level.  

More than any of that, though, I wanted simply not to fail.  

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