Breast is… hard work

At the NCT breastfeeding class (which we attended with Elphie in tow), the tutor asked each of us to say the first word that comes into our head when thinking about breastfeeding. Many of the other women came up with words describing the joy of breastfeeding such as “natural” and “bonding” and “protection”, myself and Fred were less full of the joys of the breast proclaiming “nipple shields” and “painful” respectively, to which I would also add “frustrating”.

I am sure most women out there take to breastfeeding like a duck to water, their baby latches on beautifully, their breasts provide just the right amount of the golden nectar, and they can whip them out in public at the drop of a hat and satisfy their infant’s hunger pangs instantly. Unfortunately I am not one of those women.

It may all have been different if I had seen the breastfeeding videos before giving birth. Then I would have known what “skin to skin” was and how my baby was supposed to be left to rootle around before miraculously finding and clamping down on the breast and that they only need a little bit of colostrum in the first few days as their stomachs are the size of a marble. All this knowledge would have been mine.

But we tried… In the delivery room we attempted some vague rootling and after some encouragement Elphie located a breast, then the trouble began as said breast was not performing. The midwife had to show me how to milk myself to get the colostrum flowing and also suggested squeezing my nipple into a cone to introduce it to Elphie.

http://m.youtube.com/watch?v=6ZViuYKX5LU

This seemed to work (ish) and Elphie had her first breastfeeding experience.

Once left alone with her for the night, however, things didn’t seem to go to plan. I thought I was doing the same as in the delivery room except she seemed to struggle to latch on so I don’t know how much colostrum she was actually getting. As a preterm baby, Elphie was more at risk of neonatal hypoglycemia, so when her blood sugar tests showed low blood sugar levels they asked me to start “topping up”. Topping up in this case meant giving her formula via pre-prepared little bottles which she would drink very little of initially and the rest would be thrown away. I couldn’t even get her to feed on that either – one of the midwives had to feed her, and at the time I was just glad that someone could feed her!
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It’s quite telling that the Aptamil website itself has the following disclaimer upon entering:

“Breastfeeding is best for babies and provides many benefits. It is important that, in preparation for and during breastfeeding, you eat a healthy, balanced diet. Combined breast and bottle feeding in the first weeks of life may reduce the supply of your own breastmilk, and reversing the decision not to breastfeed is difficult. The social and financial implications of using an infant milk should be considered.”

I don’t know if it would have been an option, but if I had my time again I would ask if I could express the colostrum and try feeding her with that. But I guess they thought the problem was a lack of colostrum, whereas I suspect the reality was that she was simply not getting much from me due to neither of us knowing what we were doing and some physiological constraints.

So we were sent home and told to continue topping up. Those first couple of days were a nightmare – I seemed to be producing nothing and however little colostrum they are supposed to survive on in those first few days, what I could get out was certainly not enough.

I was at my wits end about it come the fifth day since her birth, and a midwife came to visit that day and said Elphie was now 5lbs 9oz and if she lost any more she’d have to go back into hospital. This is the last thing I wanted to hear – that my baby was losing more weight than she should (they expect up to 10%, but she was 13% and from a low pre-term starting point). So I was pretty upset. The midwife said another midwife would be coming the next day to do blood tests and that we should have her weighed again and in the meantime get as much into her as possible.

That was the low point from where the tide turned as my milk started to come in that day and the breast pump arrived. The breast pump would add bottled breast milk to the menu of food options offering a middle ground between the tricky breast and the quick release formula bottle, but at least it would provide breast milk even if it was from a bottle not a breast and that Elphie should have as much breast milk as possible in order to get all the good antigens, enzymes and general goodness it contained was my highest priority.

So following the scare that Elphie may be sent back to hospital, we started a 24 hour “Feed Elphie” campaign. Anything we could get into her we would, breast first while expressing on the other side, then whatever got expressed, then the formula. The slightest squawk resulted in some feeding implement being shoved in her mouth. We were on a mission to get her out of the danger zone.

My next visitor the next morning was a breastfeeding specialist (the first midwife having seemingly called in the cavalry). She could not for the life of her wake Elphie up – she tried changing her, swinging her from her shoulders – all her tricks, nothing. A by-product of “Feed Elphie” being that she was almost permanently in a milk coma. But she did look at my breasts, proclaimed that I had slightly flat nipples and recommended nipple shields since these pieces of silicon that you put over your breast would draw the nipple into the teat and hence provide something more substantial to latch on to, they would also help build a bridge for Elphie who was probably a bit nipple confused at that stage.

Nipple confusion occurs when a baby, used to one kind of nipple rejects the other because it cannot apply the same technique for suckling a bottle nipple and a breast so is frustrated and refuses the one it isn’t used to. In our case, the formula feeding had certainly created a preference for those lovely quick-release formula bottles, but it can also happen in the other direction when, for example, a mother is returning to work and needs to bottle feed the baby but the baby is having none of it (after all breast is best). The bottled expressed milk provided a bit of a bridge for Elphie since the nipple on the Avant bottles we got was harder to suckle than that from the Aptamil. The nipple shields were the next step – a more bottle-like nipple but attached to a real life breast.
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It was slightly depressing that my baby preferred bottles to my lovely jubblies and that what was supposed to be such a natural process was proving anything but, but as the breastfeeding specialist said – “feed your baby, nothing else matters”.

Then came the midwife’s visit, a different one to last time, and we were keen to see what the impact of our campaigning had been. At first she refused to weigh her – saying her weight couldn’t possibly have changed in 24 hours. Then on reviewing the notes and deciding that having lost 13% she should have been sent to hospital the previous day and would definitely have to go now. I protested that if she was going to send her to hospital on the basis of weight, then she better actually weigh her herself! And there was the mystery, according to the new scales Elphie had put on 7oz overnight and was now only 8% off her birthweight. The midwife claimed this was impossible and that the original midwife’s scales must have been faulty (and to this day the 5lb 9oz weight has been expunged from her permanent record). I don’t know if it is impossible, but given she was going from a state of receiving very little food – who knows if anything was coming from my breast, and we were limiting the formula intake – to being force fed and with proper volumes of breast milk, I think it could be possible to see dramatic weight gain. I guess we’ll never know if it really was a faulty scale or a true packing on the pounds. Either way, she was on the path to the edge of the forest if not quite out of the woods.

I was booked in for another midwife visit on the next Monday and from that appointment another was booked for the Monday after to check she had reached her birth weight again and could be discharged.

Over that week, we transitioned to the nipple shields which Elphie loved and slowly moved to just nipple shielded breast and expressed breast milk (taking the formula out of the equation) and then mainly nipple shielded breastfeeding with the occasional expressed bottle when she’s driving me insane in the middle of the night or when we’re out in public and she and I are too stressed to breastfeed.

Now the aim is to move her to breastfeeding proper, this could be even harder now as silicon as milk provider is pretty well established in her mind. But we will persevere, and you my dear readers will hear all about it.

The important thing for now is that she is well fed and on 100% breast milk – anything else is a bonus.

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