Babies Not Breast pumps

All hands on deck to help while mom is pumping....or blogging about pumping.
As Beatrix Potter fans, we have read all about Jemima Puddle Duck who set about to sit on her own nest of eggs but everyone knew she was a bad sitter.  Through teaching Tomas to breastfeed, everyone now knows what I have known all along, which is that I am an equally bad pumper as Jemima is a bad sitter.

I know some people have gone back and forth or been unsure about nursing their babies, but from the moment I was pregnant with Aidan there was never any question in my mind that I would breastfeed my babies.  They asked, I answered, and that was that.

Well, sort of.

See when I went back to work with Aidan I discovered what I now know, which is that I am a bad pumper.  No matter what I did, I could not pump enough milk during the day to keep him full and content.  As I was working full time, nursing on the weekends wasn't enough to get my supply to a good level even during the times I wasn't working.  Breastfeeding was so important to me, however, that I actually quit my job to help him grow (he reached 6 months of age and only weighed 11 pounds) rather than give in to supplementing for him!

When Caleb came along, I was working again but with a much more flexible schedule.  I arranged to have him at work with me part of the time and kept my shifts short whenever possible to nurse him when he needed.  We did some bottles, but we were able to hang on and keep going without supplements or quitting my job.

I never went back to work outside the home after Kylee (or Logan or Lucie) and they all did just fine.  I knew I wasn't producing a large amount of milk, but since I was able to be with them pretty much all the time, it didn't really matter if I was able to pump or have any sort of surplus.

As I was a mother longer, I learned my body which is to say that I learned I can make enough milk to feed my baby but that's about all I'm gonna make.  I never had too much trouble with engorgement, even when my milk came in after Siena died, because I just don't make that much milk unless there is a baby there asking for it!

Enter a baby in the NICU... with a breathing support device that means he also needs a feeding tube and/or IV nutrition until he can breathe properly.


I know all about the importance of offering the breast on demand, early, and often in those first few days when it comes to establishing an adequate supply.  Even before I was up and walking after my c-section with Tomas, a nurse brought me a hospital grade pump and parts kit.

What she did not bring me was much in the form of instructions.  She more or less handed us (my friend Jamie was there with me) the parts and said I should pump every 2-3 hours and they would save whatever I pumped to be sent over to the other hospital.

Whatever I pumped.

That turned out to be a funny concept.

Jamie is an experienced pumping mom, having chosen to pump for her babies rather than breastfeed them directly.  She has the opposite problem I do and can fill bottles and bottles and bottles of milk on demand.

We tried, we really did.  After playing with the buttons and connections we made it through and pumped, well, exactly nothing.

In fact, I pumped exactly 1 ml in the entire first day of my son's life.

We saved that 1 ml (and the 3 I pumped the next day) and when he had his first tube feeding it consisted of 4 ml or 100% of everything I pumped in his first two days of life.

First tube feeding with all that liquid gold colostrum.
All gone in about 15 minutes.

This started a quasi-war between myself, the breast pump, and the NICU staff.  See they have these tables for how much a baby should be taking in based on all sorts of factors such as what day of life it is and how much the baby weighs.  Despite the fact that all of these studies necessarily HAVE to be based on formula fed babies and breastmilk is more bio-available from a nutritional standpoint, no amount of facts could convince the nurses and mid level practitioners that supplementing was not needed in order to reach the "optimal" intake rather than the "minimal" intake.

I am such a bad pumper and I was in a terrible environment and I was struggling to meet the minimum and all anyone would ever do was tell me why I needed to pump more or supplement.  I kept asking what signs they saw in Tomas that said he needed more, but no one could give me them.  In fact, more than one neonatologist agreed that we could keep his fluid intakes at the minimum level as long as his electrolytes and/or diapers remained normal.   Even after his electrolytes came back normal, however, the mid level practitioners (the pediatricians and the NPs that did most of the hands on work and developing of care plans that were later signed off on by the neonatologists) tried to guilt me into supplementing by throwing around things like the importance of proper nutrition on brain development, long term cognitive effects of malnourishment as an infant, etc.

I kept insisting that from what I could tell, he was perfectly nourished....I was told that I may have maternal instincts but they had science.


After that I was much less friendly about the feeding issues and I admit I don't even feel bad about it.  In fact the longer I'm home and we continue to struggle through the less I feel bad about it.  At one point the NP that I liked the least asked me how I would even know if he wasn't getting enough.   I rattled off a list of things like hard to wake up to eat, less wet or dry diapers, sunken eyes/skin, etc. and she got really quiet.  That may have been when she realized that I wouldn't be bullied into doing it their way unless they could convince me that there was a legitimate reason for doing so.

I finally fell behind their minimum intakes, which as much as I don't believe in, I had nothing against feeding him what he seemed to be hungry for and he did seem to be hungry for that much (about 1.5 oz every 3 hours).  I asked about feeding smaller amounts more often and I was told "that's just not how they do things".

Great, reason-based argument right there.

In all honest, the problem was this:  every time the neonatologists weighed into the conversation they fully supported keeping him at the "minimum" requirement unless he was showing signs of not doing well or I was able to pump more.  Every time the mid level practitioners wrote the care plan, however, they were writing his intake as the minimum "with goal to increase to xxxx".  So every time I left the hospital (which I needed to do for my own sanity and because I pumped almost twice as much away from the hospital) the nurses would increase his feeds.  I would come in in the morning to discover that they had used more breastmilk over night than they should have (and thus I was behind for the day) or had "topped him off" with formula since the "goal" was to get to the higher amount.

While I fully supported the use of formula to get to that minimum level, I did not support giving him formula he had no apparent need for just because we could or some table said we should.  I did not support giving it to him so that he could grow faster even though I knew growing faster meant getting out of the hospital sooner.  To me, formula was exclusively a temporary tool to use when I could not pump enough milk.  I took a lot of flack for this from medical professionals, including some from people who were not involved in our care or case in any way.

I also had a lot of support from people who happen believe in the importance of breastfeeding.

People who believe in following babies' cues and making feeding decisions accordingly.  Not in using a feeding tube to draw back up a babies' milk after nursing to make sure they took in the minimum and then assuming they didn't take the minimum because they were too tired and then "finishing" the feed in the tube with formula.  I certainly know that preemie and small babies tire out more easily and that is something to watch for, but to assume that a baby doesn't know when they are full when all signs point to a baby who is doing just fine?  I'm not ok with that.

One of Tim's science research friends has a theory that doctors are no longer scientists.  Our time in the NICU showed me that was very, very true in many cases.  They are not making observations, gathering data, or creating or testing hypotheses.  There is no scientific method in their work, only the application of other people's science.

The problem with that approach is that in statistics and research there is always a range.  Those statistics and research results can provide a great starting point for the care of a new patient, but from there you have to use your powers of observation to decide if this patient falls into the "average" amount or if they might in fact need more or less (which any statistician or researcher will tell you could still be within the range of normal).

We ended up coming home at 10 days on mostly breastmilk with 1-2 bottles of formula each day, but entirely through bottles.  Feeding him would be an 60-90 minute ordeal of pumping and feeding and cleaning up.   I set up a dirty/clean system with plastic buckets in his room and my kitchen counter was piled with milk storage, bottles, and pump parts around the clock.

Continual Dishwashing

In the first few days, we stuck with that and I would try to help him latch on when he seemed particularly alert or awake.  This wasn't all that often and he didn't do particularly well with transferring any milk when he did latch on and was clearly still very sleepy so we stuck with the bottle.  Thankfully upon arriving at home, my milk supply shot up enough that within a few days we were able to stop the formula.

At his weight check a week later, he was back to birth weight so he and I had a little conversation that went like....Mommy is really sick of pumping and we need to figure out something different.   PLEASE PLEASE PLEASE will you try this nice nipple shield they gave us.

Then we tried the nipple shield and in all honesty I'm not entirely sure he noticed that it was different from the bottle.  I know he noticed, however, that he didn't have to wait nearly as long when he was hungry!  It was a really quick transition of only a day or two total.

My sleep volume doubled.

I heard from many moms of these not-quite-preemies, not-quite-full-term babies that they had to make similar accommodations and that their little one was able to take over full time nursing sometime around baby's original due date.   The week of his due date I started attempting to latch him directly to the breast and he was able to occasionally be successful for most or even all of a feed.  We slowly increased (over more like a week this time) until he was not using the shield at all.

I would love to say this means that we are 100% problem free at the breast, but unfortunately we are still working on it.  We are strangely having milk transfer issues and/or supply issues again.  Particularly at night he is having a harder time latching and not eating much.   I am back to pumping overnight and he is taking some milk by bottle again because he is getting so frustrated towards the end of the day.

He's also having a lot of reflux/gagging/spitting up issues, which has been pretty common for all of my kids, but seems to be worse with him.  Our pediatrician says that it *could* be related to that feeding tube and holding that muscle open for so long that makes it just a little weaker right now.  She says regardless of cause it might just get better and we won't treat it unless he's not growing well or starts having other issues.  So far he's minimally holding up his end of the bargain so we will just watch and see while trying less bothersome things like positioning during and after eating.

I am also wondering if he is trying to have a growth spurt but doesn't quite have all the energy he needs for that yet?  He's still a pretty little guy, so it's possible I guess?  Even though he wasn't my smallest baby, it seems like losing that nursing time in those first couple days has had a really big impact on him.

I am so grateful that our NICU stay was short and relatively uneventful, but as much as I'd love to say we came home without any long term effects I think that is probably still a story waiting to be written.   I know without a doubt that it has had (and continues to have) a huge impact on our breastfeeding journey.  I'm grateful for technology like hospital grade pumps that made breastfeeding Tomas even possible, but I'm not that thrilled that we haven't been able to totally get rid of it yet.  I'm not sure how I would have made it through without Tim being home and available as much as he has been.

I remember asking the social worker a day or two before we were finally discharged if anyone went home fully breastfeeding.  Her answer:

Not really.

Lots of babies go home on breastmilk, but not so many actually breastfeeding.  That makes me sad because from this mom's perspective, even with knowledge, experience, and a relatively healthy baby the very system that should be promoting breastfeeding is totally stacked against it.

Help From the Cat
Even the cat helps...

1 comment:

Andrew said...

There'll be a selected quantity of pill or resolution to use looking on the quantity of water. the answer is improbably effective for utterly cleansing the microorganism from your baby's bottles, pacifiers and different things Shara.