Breastfeeding: The Sequel

***Potential TMI warning***
(Parts of this have already been mentioned in prior posts but this one goes into the nitty gritty a bit more.)

Breastfeeding with Calvin was a debacle. He never learned to suck properly and I pumped so much, sleeping so little, I became suicidal. Even then, I never produced enough milk to fully feed him. I was determined that with Julian I would try to breastfeed but would prioritize my sanity above feeding method.

Like last time I researched breastfeeding but this time I took a different slant in my research. Before I was even pregnant I found a therapist and started meeting with her. I wanted to make sure I had a solid mental/emotional state throughout my pregnancy and postpartum. At Thanksgiving time I met with a lactation consultant to talk about the problems I’d had last time as well as figure out the best way to start this time. The lactation consultant came up with a “plan”. I like plans. Plans make me happy. In addition, I read Breastfeeding Made Simple, which my lactation consultant had recommended, and Guilt-Free Bottle Feeding.

Breastfeeding Made Simple had good information in it. However, I had read so many books last time that I don’t think I learned anything new from it. I was hoping that Guilt-Free Bottle Feeding would offer suggestions on proper bottle-feeding technique. In that regard, it didn’t work. However, I found its attitude toward bottle feeding very helpful and bought it just for emotional support.

Last time, because Calvin couldn’t suck, I spent a lot of time pumping. Looking back at that experience I felt like I traded bonding for pumping time. It’s really hard to sit and cuddle your child when you’re attached to a pump. As a result, I decided this time I would either breastfeed or formula feed. I wouldn’t pump.

Even though I decided not to primarily pump I wanted a pump to help with possible engorgement as well as when I might skip feedings. I looked at the pumps that my healthcare insurance were offering and didn’t feel inspired by any of them1 Eventually, I just bought a Spectra S2 off Amazon. Many reviewers compared it favorably to the Medela Symphony and it was very reasonably priced.

Julian was born via a planned c-section at 40 weeks and 6 days. It was wonderful having a planned c-section vs going into labor and then a c-section. I felt a lot more awake and able to enjoy having a new baby. Julian was fairly large at 10 lbs 6 oz. Unlike Longmont, BCH allowed Julian to start nursing as soon as I was in the recovery room instead of insisting on getting the results of his blood sugar test results first. Not surprisingly, Julian, just like Calvin, really liked nursing.

The first day went pretty well. Julian tried breastfeeding frequently and while it wasn’t comfortable it wasn’t excruciating either. He kept passing his blood sugar tests. On the second day I saw a lactation consultant who looked at Julian’s latch and said it looked fairly good, though she offered some suggestions to make it better. In the middle of his second day we had a complication. Julian didn’t pass his oxygen test. This could mean a number of things, including a heart defect. Julian was transferred to the NICU and two hours of tests followed. He had to stay on his back in the same position the entire time. He spent most of that time sucking on my little finger which kept him a little calmer than he would have otherwise. After all the tests were done he wanted to breastfeed. He seemed pretty traumatized by all the testing so I let him suckle for 3-4 hours without a break. In retrospect, I probably should have asked for a pacifier but I didn’t think of it at the time.

That evening, my left nipple was bloody. I stopped feeding on that side and instead just fed on my right side. Of course, that was putting extra stress on my right nipple and it was starting to look dodgy. I started supplementing to put less stress on my right nipple.

The third day I saw the lactation consultant again and she suggested I start pumping to try to get my milk supply to come in sooner. In addition, she told me to ask my doctor for APN ointment for my nipples. I did pump, though somewhat reluctantly as my nipples were still incredibly sore. In the afternoon they weighed Julian and noted he had lost 7% of his birth weight and they would have suggested I start pumping if I hadn’t already. In any case, I kept breastfeeding him and then would supplement with donor breast milk that the hospital provided.

Some people claim that bottle fed infants tend to me more obese than breastfed infants because the caregiver unconsciously try to get the child to finish the bottle, even if the child isn’t hungry enough to finish. With Calvin, I was very careful to watch and never force him to eat more than he wanted. However, I discovered with the donor breast milk I was much less likely to want to “waste” the milk. I remembered pumping for Calvin last time and every mL of milk I got was precious. “Wasting” the breast milk was almost like sacrilege. Finally one of Julian’s nurses pointed out to me that the women who donated breast milk had plenty and it was ok to not finish the bottle.

During one of the lactation visits, I don’t remember which, the lactation consultant suggested I try using a supplemental nursing system (SNS) to feed Julian. Before having Julian I had decided I wouldn’t try an SNS this time. I tried it with Calvin and it was a disaster. It didn’t do anything except make both of us upset. Because of this, I was prepared to dismiss the suggestion out of hand. Then I realized that Julian’s issues were different than Calvin’s. While Julian’s latch wasn’t prefect, he was sucking. I decided to give it a shot and found, to my surprise, that it worked pretty well.

Julian regained a little weight before checking out of he hospital on the 4th day but wasn’t up to birth weight. Upon discharge the hospital pediatrician told me that I needed to make sure to wake him up at least every four hours at night to feed. This was a little aggravating because he was sleeping so well and it seemed wrong to wake up a sleeping baby. We stopped by the hospital pharmacy to rent a Symphony. While I already had a breast pump at home, I wanted to be able to pump without thinking about it too much (since I used the Symphony for Calvin I could pretty much use it in my sleep). When we got home we started supplementing with formula since the donor milk was no longer “free.”

We had scheduled Julian’s first office visit for two days after discharge because at the time we weren’t sure if he was going to be coming home on oxygen or not. It turns out he didn’t need oxygen. His normal pediatrician wasn’t available so we saw one of the other doctors in the group. She said he was looking good but to continue waking him up every 4-5 hours to eat and schedule a weight check with his normal doctor in a week.

Even though I was determined ahead of time not to worry if I couldn’t breastfeed, I got a little depressed Saturday. This provided enough push for me to overcome my dislike of phones to call the lactation consultant and setup an appointment on Monday.

I noticed the SNS I was using seemed to be getting clogged. The lactation consultant at the hospital had given us an SNS that was meant to be used for longer term but I didn’t like it. On Monday Jaeger and I wandered down to Westminster to a breastfeeding shop that had the SNS that I liked. While there, we learned the one that I liked wasn’t suppose to be used for more than a couple of days but we got another one anyway. After buying the SNS I needed to feed Julian so we drove to a shaded spot in the parking lot and I breastfed Julian in the backseat. Weirdly, the latch that we had been struggling with just seemed to work.

We picked up Calvin from school and then got to the house just a bit after the lactation consultant arrived. She started by weighing Julian. Then she examined his mouth and noted that he had a high palate and a slight upper lip tie but other than that seemed fine. She watched him feed but it was nap time so he wasn’t very enthusiastic. She ended by coming up with a plan to try to boost my milk supply and suggested I ask my OB to check my thyroid and prolactin levels.

It was either Monday evening or Tuesday when I decided to stop using the SNS. It seemed to me that Julian’s latch was worse when we tried to use it and I felt that the more comfortable I was while feeding the more likely I would continue the attempt. I pumped some after each feeding for a bit. However, when Jaeger went back to work I stopped because I did not feel I could give Julian enough attention while I was pumping.

My thyroid and prolactin levels came back and were within the expected range for a breastfeeding woman.

Early the following week we went to Julian’s weight check. The doctor briefly checked him out and said he looked great but also mentioned he should be back to birth weight by that point. So, he also said we had to keep waking Julian up every 5 hours at night.

At this point I was breastfeeding Julian every 2-3 hrs during the day for 15 minutes each side and then, if he wasn’t falling asleep, offering him a bottle which he would often drink anywhere from 1/2 oz to 2 oz.

I went to the BCH breastfeeding club that Friday and weighed Julian and he hadn’t gained any weight since the doctor visit 4 days earlier. Our lactation consultant was concerned and said we should talk to the pediatrician again. We scheduled a weight check for the next week. By that point, he’d gained a couple of ounces so the doctor said to keep doing what I was and to come in the following week for another weight check. About a month after Julian was born he reached his birth weight again. Finally they told me I could stop waking Julian up in the night. Except, at this point he appeared to have gotten use to waking up and tended to wake up every 3-4 hours.

I returned the Symphony and experimented a bit with the Spectra S2 pump. While the actual pump was fine, I preferred how the Medela flanges worked. I used some of the extra parts I had and converted my Spectra to use Medela parts. After using it with the Medela parts, I agreed with the other reviews that it works as well as the Symphony. For a while I was pumping after a couple of feedings during the day and then an extra pumping session right before I went to bed. Based on both weight at the breastfeeding club at BCH and my pumping output I figured out I was producing between 1 1/2 to 2 oz every 3-4 hours. Like last time my right breast got slightly over 1 oz while my left breast got slightly under.

I reviewed what breast pumps my insurance would pay for and decided to order the Spectra 9 Plus Advanced through one of their suppliers. The advantage of this version is it could run on batteries. It also used the same parts as the S2 so the modifications I made to use Medela parts would work with it also. I was impressed when it arrived. It was very portable. I could slip the pump into my robe, put on my pumping bra 2, and do things around the house while Julian slept.

Unfortunately, after about a week of pretty steady pumping my nipples felt overworked. They weren’t getting enough break between feedings and were getting sorer and sorer. Regretfully, I cut out the pumping except when I missed a feeding for some reason.

At two months I was still feeding Julian 10-15 minutes each side and then supplementing with a bottle after most feedings. Breastfeeding was still quite uncomfortable. In addition to being uncomfortable, I was experiencing nausea when my milk first let down. My mother-in-law talked about how when she was feeding Bethany, she would have her arm around Jaeger and read stories to him. I tried that with Calvin but it was incredibly difficult for me. I really, really hate being touched when breastfeeding. I also don’t like being talked to or being expected to talk back. Basically, breastfeeding is like labor for me. I have to sit and concentrate until the experience is over each time.

I was talking to my therapist about how I was feeling guilty for snapping at Calvin when he asked quesitons while I breastfed. She asked me whether I felt better when I breastfed or bottle fed Julian. I told her bottle feeding was usually more relaxing. She then asked me what I hoped to gain from breastfeeding since it didn’t appear to help with my bonding and I couldn’t really answer her. Since I had to supplement, it isn’t any more convenient than straight bottle feeding. In fact, it’s less convenient. It was marginally cheaper since we weren’t exclusively using formula, but not a huge amount. I don’t put much stock in many of the other claimed benefits of breastfeeding. Calvin is remarkably healthy, has never had a single earache, and is quite bright.

Eventually, I decided that my biggest reason to consider breastfeeding was passing on antibodies. Most of the other benefits were negligible once you consider all the benefits Julian is already going to get because of his genetics and socioeconomic environment. I wasn’t sure that antibodies by themselves was a good enough reason to keep breastfeeding. I decided to talk to Julian’s doctor about it at his two-month checkup.

Julian’s two-month checkup was on June 1. About a half hour before Julian’s appointment I took him upstairs to change into a clean diaper before we left. To my surprise, I found blood in his diaper. There wasn’t a great deal, just a few strands intermixed with his poop but it was definitely blood. I confirmed it wasn’t from any sort of diaper rash or other skin cut. I was quite thankful we were already heading for the doctor. I took a picture with my phone and then packaged the diaper to take with us.

When we got to the doctor’s office he got his weight, length, and head circumference taken. Weight was 40th percentile (remember he started at 99th), length was 50%, and head circumference was 90%. Overall the doctor said he looked like he was in excellent health and everything looked fine. Then, we discussed Julian’s diaper. The pediatrician said this was most commonly from a milk protein allergy. He said I should cut all dairy out of my diet and change his formula to a hypoallergenic formula.

The pediatrician gave me a small can of Nutramigen. Since Target is right on the way home, I stopped and got a bigger can so we wouldn’t have to go back to the store as quickly. Not surprisingly the specialized formula is more expensive. It costs about 80% more per ounce than the regular brand name formula.

Julian hated the new formula. Jaeger was able to feed Julian some formula that evening. However, for the next two days he wouldn’t eat any formula. I started to think that maybe Julian didn’t need supplementation. Except he kept getting crankier and crankier even though I reverted to breastfeeding every two hours, the minimum period I could handle. Finally, after about 48 hours of trying, he took the bottle again. He finally ate and was much happier. Julian still doesn’t eat the new formula particularly well but he no longer outright refuses it.

While I had been seriously considering stopping breastfeeding, I’ve temporarily reconsidered, at least for now. While we luckily can afford it, the new formula is much more expensive. Also, while I really appreciate formula exists, food is really important to me. I have a hard time only giving Julian food that I think tastes terrible. While the formula certainly provides the nutrition Julian needs, he obviously enjoys the breast milk more.

I was originally hoping I could breastfeed while working. However, that isn’t going to happen. Both Julian and I have to be completely concentrating on breastfeeding to make it work. Instead, I will pump which I can do while I keep working.

I don’t know how long I’ll keep breastfeeding. However, I think I can make it work, without too many trade-offs, for a little while longer.

  1. Last time I’d never used consumer-grade pumps, only hospital grade pumps so I didn’t have any prior experience to draw on. In addition, my insurance company said they had researched and found no benefit to hospital grade pumps over consumer grade pumps so wouldn’t pay for a rental. I don’t know if I had pushed if they would have backed off this stance or not.
  2. A cheap Walmart nursing bra with holes cut in the middle for the flanges

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