Intrepid Murmurings

The Elephant in the Room

So, breastfeeding.  I've been avoiding writing about this topic this time around, even though its the number one thing I do (and obsess about) these days, hands down. 

After all the issues I went through with Emma, a lot of this is old hat, and writing about it here would just be rehashing all the same stuff.   The short story -- I have mild PCOS, and because of it (most likely) my body does not make enough milk.  The list of things I've done and tried is LONG, the number of people and resources I've consulted is MANY, but the fact remains that despite all that I do (or ingest), the milk does not overfloweth.  The girls are not gaining as well as they should, and trying to balance both formula supplementation and breastfeeding (times two) is running me ragged.  

The first time around I swore I would not throw in the towel, but this time, I am not so sure.  There are a million times a day when I think about just getting over myself and switching to formula full time.   Basically, the time needed for them to get milk from me is greater than I am able to give.  Feeding literally around the clock got them a fair bit of milk for awhile, but now, even nursing both babies All Day Long -- long sessions more often than every 2 hours plus supplementing ---is not cutting it. The amount of "top off" bottles is rising to the point that it seems like all I do (still!) is nurse, prep bottles, bottlefeed, clean bottles. Repeat, repeat, repeat.  And I don't even see much weight gain to make it feel worthwhile! Gah.

Just quit!  you tell me.  I know, I know.  But the thing is, we all really like breastfeeding.  I believe in breastfeeding, not only for the health benefits but the emotional attachment as well.  And the babies love to nurse -- they won't take pacifiers and nursing is often the sure fire way to soothe, calm or get them to sleep.  Even when they are full after a bottle they will often want to nurse.  And I don't mind this.  In fact, I like it.  I just don't like the worry of being an inadequate food source.  Or the constant pill and tincture popping and stressing about stimulating my supply enough by nursing frequently, which basically chains me to the house and my nursing chair. 

So, I am not really sure what is going to happen.  I think they are getting a fair bit of milk from me still, and I know any amount of breast milk is good for their health.   But, we are upping the formula quite a bit, and I could easily see them weaned in a few months -- that is often what happens as they learn the bottle is where the bulk of their nutrition is coming from.  Maybe, though, since they are such comfort nursers, they will stick around and nurse too.   I am not going to cut them off, in any case, so if they want to nurse I will let them, happily!  Just not as long and often as they have been....

Crackers and tofu and cheese, oh my!

I don't think I've posted much, if any, about how the food stuff has gone lately.  Emma has come a long way since the food log days!  On the advice of a pediatric allergist, we have been delaying introduction to the major allergens to hopefully help prevent any food-related allergies like Lonnie has (his is dairy).  Around her birthday, we introduced wheat, and then soy, with no problems.  Oh, glorius carbs!  Emma is a HUGE fan of all things wheat, including bread, waffles, pancakes, crackers, cereal, etc.  Soy has been a welcome addition since a ton of packaged and processed foods have soy products in it, especially all the dairy-free stuff that we get for Lonnie.  Both of those have opened up her options a lot, and have allowed us to feed her a lot more of our table food. 

But then, in the past two months, we have encountered a road block.  On the heels of our wheat/soy success we rapidly (well, within two weeks of each other) introduced both dairy and egg.  She also had a bunch of other things thrown in, like raspberries.  And then, we realized she was having some problems.  Boo!

Mostly it was diaper related issues, really bad rashes and a consistency issue that is rather unpleasant with cloth diapers.  Icko!  The latter, which didn't seem to cause her any discomfort,  was easily cured by pulling back on all dairy -- not just milk and cheese but also small bits of butter and yogurt, as well.  Everything was totally back to normal.  I don't think this is an allergy, per say, more of an intolerance or sensitivity -- not to lactose (breastmilk is full of lactose) but to milk protein.  Which is a pain, but not too hard for us, since Lonnie is dairy-free already.  Lots of alternatives in the house!  I might experiment with goat milk to see if that affects her too (Lonnie can't have it) because I would really like a healthier milk alternative for her -- rice and soy milk not as nutritious and she seems not to like them anyway.  Good thing she is still nursing!

The other issue -- really bad, screaming and crying in pain blistery diaper rashes -- is not so great.  We thought it was egg, and then realized it could also be raspberries.  We took both out of rotation, then retried egg a few days ago.....and that night, super bad rash.  Damn.  Egg is really more difficult to avoid and we were hoping it wasn't that.  We tried just egg yolk, and that definitely caused problems as well, so its not just the more-allergenic white.  We are going to try one more test with just small amounts of egg in baked goods, to see if she reacts to that.  I have a hunch that she will, as we didn't give her much whole egg at first and I think thats when the rashes began.

Also still to retest -- raspberries.  She acquired quite a taste for them fresh of the bush in the backyard!  They are mostly gone now, but if we get a later crop we will have to do some more research, once we have the dairy/egg thing sorted out.  I think we may take her in to the allergist to get it all confirmed, too.  I'd like to see what they have to say about the allergy/intolerance line and if small amounts of the offenders are okay as long as we don't see any other signs of discomfort.  Luckily, many childhood food sensitivities tend to disappear around age 3-5, so we are really hoping this is just a passing phase for her (unlike Daddio's adult onset, here-to-stay food allergy).       

Breastfeeding at One Year

Today, I started tracking again, in an last minute attempt to have a couple days worth of sleep/food logs that were recommended for our upcoming meeting with a fancy shmancy sleep consultant.  Well, parenting consultant, is more her title. Ha! More on that later.  But in trying to accurately fill out the food log, I am realizing how different breastfeeding has become.  A year ago, oh lordy, I was in the midst of a tough time.   It is amazing the difference a year makes!

I can still say with assurance that those first 6 months of breastfeeding were the hardest thing I have ever done.  Without a doubt.   Our struggles with latch, ongoing pain, and low milk supply were definitely a hallmark of those early months, and while, luckily, thats not all I remember (and its amazing how the intensity of it all fades, with time) I do think I am changed because of it. 

While the pain (and therefore the needing of props, and the difficulty & uncomfortableness of nursing in public) dissipated around 3-4 months, I think it wasn't until 6 or 7 months that I was able to get past the worst of the milk supply/supplementing stuff, and therefore really relax about breastfeeding.  And its funny, right about then, I started noticing that some folks around me, in my moms group or elsewhere, were starting to talk about (and act on) weaning.  Egads, I thought!   How can they be thinking this?  I knew intellectually that it was their choice, based on their own circumstances, the cultural norm, yada yada yada.  But in my gut, I still felt it -- after all our troubles, we were finally on track, and I wanted to savor that, for a good long time yet.  The thought of weaning was so far from my mind.

Now, things are going swimmingly in terms of nursing.  I've been off all the supplements for months yet there is plenty of milk, she is gaining tons of weight (thanks in part to a healthy appetite and a hollow leg) and the actual act of nursing is so second nature I barely think about it (unless she is teething, and feeling nippy -- yeowch!).  But today, as I tried to track her feedings, both solids and breastmilk, I realize how integral breastfeeding still is to how I parent Emma.  She nurses frequently, still, sometimes 2 or more times in the span of an hour. Other times, she'll go 3-4 hours without.  Sometimes its just a reconnect, a comfort after a frustration or bump, or a pick-me-up snack (or meal!) if she is getting hungry.  Sometimes its an attempt on my part to get her to sleep (ha!) or even to quiet/entertain her if I am busy with something else (we are good at the multitasking here).  I am trying not to do that last one very often, but sometimes, at key moments, it is clutch.  Nursing is my one fix-all trick, and I am not about to lose it as we enter this next stage of parenting a toddler. 

A lot of people say it -- that they never thought they'd be breastfeeding a toddler.  Not when they can ask for it, etc, etc.  Well, she has always asked for it, in one way or another, and now its just easier to know for sure what she is saying.  Her milk milk milk sign is sometimes more of a shout, it is so clear!  But it doesn't feel wrong, or demanding, or too much to ask/provide.  Not at all -- nowadays, it is actually fun.  None of the worries of if she is getting enough, or how many minutes on which side.  Also, she is (for the most part) much more distractible, so its not a worry about where I'll be and how I'll nurse, when we are out.   But then again, for some reason, I care so much less about all that now.  If she wants to nurse, dammit, she'll nurse, and I don't care who sees.  It has taken a long time to get to this point, I used to be so obsessed about it all.   

In some circles, I am definitely in the minority now; not a ton of people in this part of the world nurse past a year.  I think at least half of my moms group have weaned, and I know others are nearing the end.  Which is understandable, certainly. I so get it, at least on one level. I do think about getting my body back, I do think (longingly?) about the day when I am not a critical sleep accessory. And at some point, I will be thinking more about my (currently nonexistent) fertility -- I have a sneaking suspicion I will be one of those folks that won't ovulate until weaning happens. Who knows what will happen with all that, but its an issue, in the back of my mind. But thats where it is staying, for the time being. We have a Good Thing going, and I'm not about to mess that up.

Retirement
I think I am going to retire the food log, for the time being. I will keep it up on the website, but will not add entries, at least for awhile. I feel like we have the food thing down, now, and she is liking more foods than she is disliking. Woo hoo! We currently have a Good Eater (knocking on wood, I know this can change in an instant) and the scale last week at the doctors office (we were in for an ear check) proved it — she was up to 19lbs 4 oz (with clothes), which is more than a pound and a half since her 9 month appointment a month and a half ago. I knew it — all that beans and rice had to be going somewhere! And my arms are getting tired (and more buff), too!

Food Log
I have asked Lonnie to add another page to the blog as sort of a food log of sorts....so I can record what Emma eats. Not as an obsessive how much is she eating thing, heh, I promise, but more to remind myself of what she likes and dislikes, since I tend to forget and fall into ruts. Also, maybe it will be helpful for others who are thinking about doing Baby Led Weaning. We shall see. I may get bored of it, and will probably not remember to do it every day. I want to note that since Emma is now accepting food on a spoon, we are not doing BLW exclusively; she gets something by spoon at most of her meals. Some of her favorites are spoonable foods, so it seems silly not to give them to her!
Hopefully this will have its own page soon, but for today:
Breakfast Rice apricot congee "O" cereal: first time, and they were a hit! I got the "Trader Joe's O's" because they are wheat free, unlike the other well known brand. Peaches & Plum puree (not so popular) Freeze dried bananas bombed again. I think they will be my snack from now on!
Dinner Polenta (chunks and some by spoon) Applesauce Frozen pear/mango puree (in the mesh feeder, at first, to soothe her sore gums) Avocado wedge O cereal
She ate a ton for dinner....and it took forever! Lately she seems totally uninterested in eating any fruit herself, which is frustrating. When we first started BLW she devoured pear and a couple times banana, and would enjoy some dried fruit now and then. Is she just getting lazy? Uninterested in anything that is not applesauce? I think I will try some baked apple, soon, to see how that goes over, since it would be very similar. I also bought a honeydew melon and am hoping she enjoys that...if its not too slippery!

Food Glorious Food
Well, Emma is becoming a regular food hound, finally! And since we are rather into it ourselves, we have been enjoying making up new things for her to try, and figuring out what parts of our meals we can give to her. I am having a hard time sticking to the "only introduce one food every 3-7 days" rule because it is so much easier to just give her what we are eating. Which is usually a mix of many things.
A few days ago she has had polenta, adapted from Alton Browns recipe (none of the extras, other than chicken broth), refrigerated, cut into sticks and sauted. She loved them, and sucked down two pieces rather quickly. We will definitely make this again soon, though next time I think we'll go with half water or at least low sodium broth, since it was a little saltier for her than I would have liked. And I think grilling them would be a good way to crisp them up without adding fat, though I don't think a little olive oil now and then is necessarily a bad thing...
Tonight, she enjoyed her first bit of quinoa. I had read about it on another baby led weaning site, and wanted to give it a try, since it is high in iron & protein, as well as other vitamins. We just made hers with water (ours Lonnie doctored up to be sort of a pilaf) and put it in a bowl so she could feed herself. She had a great time eating the quinoa grains and was pretty good about getting it in her mouth, though later I started helping her by mixing it with some apricot puree and giving the mixture on a spoon. She ate the whole bowl that I set out, as well as all the apricot, and some squash.
But, she also likes other things! Here are a few of them.
Emmas Top Ten Foods (for the moment):
Avocado (wedges) Applesauce (restricted somewhat due to constipating qualities) Chicken Brown Rice Congee Oatmeal and Apricots, (actually, apricots and anything) Polenta Sticks Prunes (whole dried or puree) Toast sticks (rice flour based) with shmear (usually avocado or fruit puree) Sweet Potato fries/wedges (puree will do in a pinch) Steak (only had this once so far, but it did go over well) Squash (pureed and mixed with applesauce is preferable, we call it "squapple")
Whoops, thats eleven! Note the utter lack of green vegetables (unless you count avocado)! So far peas and broccoli have not been much of a hit. I want to try spinach soon, and think I will be able to work that into things like the polenta, for instance. She tried baby carrots (whole, cooked) last night and seemed to think they were okay, but I bet she would like them pureed.
She is taking things from a spoon now, which is nice, though we still like the philosophy (and ease) of giving whole foods so we are doing that as well. Each meal usually consists of something by spoon and a couple of finger foods. She is eating solids with breakfast and dinner, and sometimes lunch or snack (that is not very established yet). For a few days there it seemed like she was not nursing enough, but in the past few days we seem to be back on track for that. She seems always willing to nurse for a few minutes, any time I offer (and often she requests it), but doesn't always have the time to hang around for a real meal. Its hard to know sometimes if its that there is no milk there (same old low supply issues) or if she is just not interested or patient enough to work for it.
She is also making a sign that is remarkably like the "milk" sign language sign, which would be awesome, but she seems to use it more as "I want", which isn't very specific. I want, I want, I want....directed towards the dog, her toys, the TV (ugh), me, or any time she is on the changing table and doesn't want to be. If I make the sign and she's in my lap she'll lunge at my boobs, so she does seem to get it in that context!

She joins the carnivores
We are really liking this baby led weaning thing. It is fun to give her real food, and easier than having her eat something entirely separate from us. Also, nice to not stand by hovering with the spoon! She is getting two meals a day, most days, though since she's still not relying on it for nutrition (milk is the main event until a year or so) its not a biggie if we miss a meal here or there. Usually, I give her a late breakfast/early lunch, and then we all sit down for a dinner together (In the kitchen! Not watching TV!) Often, we can give her something off our menu, like today. She had her first ever steak dinner!

But that was not it, after all, she is a meat and potatoes kind of gal.
She rounded out the meal with some baked apple. What a good little eater! I weighed her yesterday and she is 16 lbs on our scale. Ha, more meat and potatoes for you, little miss!

PCOS, Low Milk Supply & Meds update

The more I learn about this issue with PCOS and low supply, the more it seems there are a lot of folks out there with it. And yet not a ton of info out there about it, either. I've gotten a few questions from folks in the form of emails and comments lately, so I thought I'd post a few more things about what I'm doing and how its all working.

What did/does your pumping schedule look like?

After day 4, when Emma was dehydrated, losing lots of weight and my milk was only just coming in (slowly!), I started pumping about 8 times a day with a hospital grade double pump (while also taking fenugreek and blessed thistle capsules). I tried to pump right after feedings (which took about 40 minutes, usually, and were every 2 hours or less) for about 10-15 minutes (I later found I get another letdown if I go longer). Pumping hurt like hell (it doesn't now) and I would get somewhere between a few drops and a quarter of an ounce, total. I was never really religious about pumping the 8-12 times they recommend because she was on the breast constantly, as well, and it just seemed impossible with all the cleaning of the parts and regular baby care. After awhile, I went down to 4 times a day, but was getting a bit more each time. I soon stopped pumping and taking herbs altogether since she was gaining well. We also quit supplementing. Oops.

After that she did not gain well, though she didn't lose weight, either. But she was still at birth weight at 7 weeks or so, which wasn't good. She was starting to get fussy and seemed hungry again, a lot of the time. I started pumping again, only 6 times a day, and started the herbs again. This time, I was getting a bit more, usually about an ounce to an ounce and a half total, after feedings. Definitely a lot more than the first weeks, but still not a ton.

Now, I rarely pump, but probably should. I still get about an ounce and a half after feedings, sometimes two ounces. I get about three let-downs per session, which is a lot more than I did those first weeks. If I pump with full breasts, after she feeds from a bottle, I can sometimes get close to 3 ounces. Supposedly, a baby is "more efficient" than the pump so hopefully she is getting more than what I can pump, most times.

What does your supplementing look like?

Those first two weeks we offered her 2 ounces in a bottle after offering the breast, every other feeding or so (she was nursing a TON, however, like an hour at a time, 10-12x a day). When we started up again at 8 weeks, we would offer 3 ounces, every other feeding. She didn't always take it all. Once she started gaining well again, I stopped offering it quite as much, and only do it when I can tell she's still hungry, which is about 3 times a day. She is getting about 6-9 ounces a day of formula now at 15 weeks old, sometimes in a supplementary nursing system because she does start to prefer the bottle after awhile, but sometimes a bottle anyway, because its easier, and someone other than me can do it. I have absolutely no idea how much breastmilk she is getting, but she must be getting more breastmilk than formula.

What ever happened with the Metformin? Did you start taking it?

No, I did not. I did get an acknowledgment from my RE that I "fall into the gray area" of PCOS, and while I do not have a full blown case, I do have a lot of the symptoms which could qualify as a mild case. That is the closest to an explanation/diagnosis we've ever had for all our infertility struggles! Since the RE doesn't work with postpartum women, she suggested I go to my OB. My OB was not comfortable prescribing Metformin since its such an experimental thing to use it while breastfeeding and for increasing milk supply. Since I have never actually been on it previously, I decided not to push the issue this time, but I will think seriously about it if I we have trouble conceiving again, or if I do get pregnant, since it supposedly helps with breast tissue growth and development during pregnancy.

Where did you get your prescription for Reglan and Domperidone? Have you noticed much of a difference using them? Between the two?

I got my prescription for Reglan from my OB. She would not give me one for Domperidone, and the nurse who I had to go through seemed slightly ignorant about the details of it, saying that the local pharmacy I had found that would give it to me (with a prescription) was "breaking the law" (in fact, compounding pharmacies in the US do not have to follow FDA guidelines, so its not illegal for them). I ended up getting the Dom online from New Zealand, with no prescription necessary, after much research and a discussion with my lactation consultant.

In terms of the two, I do think both meds increased my supply, but how much I can't tell. It wasn't like I woke up one day engorged and overflowing, thats for sure! I have seen a slight increase in my pumping quantities, but the biggest sign is that Emma is fussing on the breast less, and growing the way that she is (quite a bit!) with the only the amount of supplementing that we are doing now. As for differences between the two, I haven't noticed any. I have been lucky to not have not noticed side effects with either. I prefer Domperidone because it is safer in terms of it getting into my breastmilk and because of the huge risk of depression thats common with Reglan.

What are you doing now? How are things going?

First off, we are finally past all of the horrible pain and problems with latch, and totally off the nipple shields. Finally!!! It just slowly got better and better around 10 weeks or so. Egads, that was a long time, though! As mentioned above, we are still supplementing with formula. I have accepted that this will probably continue at least until she starts solids. I am now taking Domperidone, Fenugreek and blessed thistle. I just ordered some of this from Motherlove Herbals, and after reading some of the testimonials, am excited to give it a try. Goat's Rue supposedly has some effects similar to Metformin. I'm also doing a lot of research into foods that help increase milk supply and have a review coming on a good book I've found on that. I've also officially joined the La Leche League, too, so I suppose I now count as a crazy lactivist. Geesh. As if you didn't see that coming....

Any more questions? Keep them coming! To all you out there who are in the midst of dealing with low supply issues, I wish you the very best. I know how challenging, frustrating, and heartbreaking it can be, especially in the early days when you are dealing with learning how to breastfeed and take care of a newborn, as well! There are so many things you can try, though, and I think they can really be worth it. And if they don't, it really will be okay. I feel really good about how things are going, after slowly working my way through some tough emotions. One thing I have discovered is that, at least for me, there is no silver bullet to make my low supply issues go away. I know I've been lucky, too, in being able to give my baby as much breastmilk as I do. And while I look forward to trying some new things as we go along, I'm now to the point where I won't be crushed if they don't work. We have a great thing going over here now, and Emma is doing marvelously, which is the most important thing.

Send Her To Therapy
Sadly, the napping did not continue. And, unfortunately, the numbers were not so big this week, either. She gained 3 and a half ounces in the past 12 days, waaaaay down from the 18 ounces in the previous 9. A half to a full ounce a day would be ideal. It is probably due to my dosage of Reglan (the med I'm on to increase milk production) going down, but it may also be due to the fact that she is not downing as much formula with the SNS. She just doesn't seem to finish it, and we're not sure if its because it is too hard to suck, or if the tube is posoitioned poorly or something, or what. I was hoping that she was just getting more breast milk, because she is on the breast longer with the SNS. Because of this, and because she does seem take FOREVER downing bottles sometimes (though not other times, so what gives?) and is pretty much on the boob continuously (yet not getting it out,since I can immediately pump more afterwards?), she is being referred to occupational therapy for suck training. Ha. My kid's in therapy at 3 months! I'm also upping the dosage again of Reglan, but am planning to switch to the other med, Domperidone, when it comes to me in the mail later this week. Dom is a more effective drug and with much fewer and less serious side effects, because it doesn't cross the blood/brain barrier, and can be used more or less continuously, unlike the Reglan. And its approved by the American Academy of Pediatrics (Reglan isn't) though not the FDA (Reglan is). Can't we just catcha break, here? I'm dreaming of a day when my life is not ruled by feedings....

It's World Breastfeeding Week!
My mom emailed me a pretty good article about breastfeeding today. Much of the article was about a NIP (nursing in public) incident that happened to a woman in Portland, who started a blog, The Reluctant Lactivist. I am just now starting to feel confident enough to NIP on occasion. I no longer need a thousand pillows propped just so, I no longer have to fumble with the nipple shield, and most delightfully, I no longer grimace or audibly gasp in pain each time she latches. Thank God! It is still a slightly stressful thing for me yet, however, this NIP stuff, and I am always obsessing when I go places about where I'll do it, and how. I time my trips out around feeding. I dread something like what happened to the Reluctant Lactivist happening to me, but it very well could. And I think it would make me embarrassed, then pissy, then hopefully emboldened to make more of a statement. I am already somewhat of a lactivist, I'd say. If there was a "nurse-in" somewhere around here this week, I'd go. Instead of that, I am going to post some pics of me nursing, which some other bloggers have been doing lately, as well. This is me nursing in my new ring sling, made by my mom! Yahoo! And for what its worth, am way more embarrassed about that double chin than the bare breast. This is Emma nursing with the Lact-Aid, an SNS (supplementary nursing system) that we use about twice or three times a day so that she gets the formula without a bottle. She was starting to prefer the fast flow of the bottle, so this helps prevent early weaning. That tube comes out of a bag of formula that hangs around my neck.

New (to me) information: PCOS & Low Milk Supply!
Geek that I am, I have been doing a fair bit of consultations with Dr. Google regarding our current breastfeeding issues. I've discovered something very interesting and oddly reassuring to me. There is a strong link between true milk supply issues and PCOS (polycystic ovarian syndrome). Much of this information is linked to a woman named Lisa Marasco, who did her Masters thesis on this issue. Throughout our infertility struggles, I kept coming back to PCOS as a possible explanation of what was going on, despite it never being diagnosed by my doctors. I do have some of the symptoms of PCOS (the biggest being infrequent, irregular menstruation and lack of ovulation). Why it took me 8 weeks to learn about this connection is rather frustrating. There was nothing in all of my books on lactation and nursing, nor on the websites I had found about lactation and milk supply issues. In all my years of researching my infertility issues I never ran across it, and nobody asked me about it until the third time I called the lactation consultant to ask yet more questions about my supply issues (if she hadn't mentioned it, I still wouldn't know now). Most of the breastfeeding resources say to "take your baby to bed with you, declare a breastfeeding emergency" and nurse nurse nurse until the magic happens. After doing that for the better part of 9 weeks now I am pretty damn sure that that is not going to work for us. So now what? Right now we are nursing all the fricken time (as usual) but also offering a bottle of formula or breast milk after most feedings, which she eagerly downs. I am pumping 4x a day, though from what I've read that may not do much for PCOS related issues. I've been taking herbal supplements and just yesterday started Reglan, a drug that has the potential to double your milk supply by increasing prolactin levels, though it may not be as effective for people with PCOS. In one of the articles linked above, it was mentioned that Metformin can help those with PCOS related milk supply issues, and while it is better to start during pregnancy, it can help even postpartum. Today I send off an email to my RE at our fertility clinic to see what she has to say about that. Though it is excreted in breastmilk (I think?), it has been deemed okay for breastfeeding mothers to take. This paragraph from an article Lisa Marasco wrote for the La Leche League definitely hits the nail on the head: "The inability to fully nourish her baby at the breast often comes as a shock to the new mother. For the woman who has struggled through infertility, another unexpected pothole in the road to motherhood can be devastating, especially when she had no idea that she might be at risk for lactation problems. Further compounding her trauma may be the mistaken judgments of others that the mother is simply not trying hard enough, or the mother herself may assume that she is somehow to blame." Not being able to breastfeed Emma exclusively has been incredibly hard. But knowing that it may not be something I have done (or not done) really makes me feel more at peace with it all (I think Kateri's recent post is relevent here, as well). Anyway, I'll keep y'all posted on the Metformin front. And the next weigh-in, scheduled for next Wednesday...

Chubbin' up the string bean
Last week we went to the pediatrician for Emma's check up and shots, and found that she still hasn't gained much weight. She was 9lbs4oz, only one ounce more than her birth weight....at almost 7 weeks! Yipes! We did go in Monday for yet another meeting with the lactation nurse, and she was up 2 more ounces, but still, not so great in the gaining department. Babies are generally back to birth weight by two weeks, often before that, and gaining an half to a full ounce a day. Definitely not happening, here! Looking at all the babies I encounter, in my moms group, on the street, pictures in blogs, etc, all I can think is yeesh, those babies are chubby compared to my string bean. And Lonnie and I were definitely not skinny babies. She did drop quite a bit early on...about 15% of her weight by day 4 (usually its 5-7%), so she has had a lot to come back from. We had some early supply issues -- my milk wasn't coming in fast enough, she was dehydrated, etc, etc, so we supplemented a bit for two weeks, while I pumped & herbed it up, and by week three she'd gained back to 8lbs 14oz, not quite birth weight but definitely on the right track. We were off the formula after that, and I thought things were going well. She did feel bigger....but it turns out it was almost all height. She is in the 97th percentile for that, having gained an inch and a half since birth. The ped was concerned, but supportive of breastfeeding and said since everything else looks good (and she was big to begin with), we can wait and see for another month. It could be my supply, some issue with her digesting/metabolizing, or just that this is the way she is. It is freaky, freaky, freaky, however, to spend most of my time each day feeding her, and not to have the rolls of baby fat to show for it. If she continues on this trend, she will be off "the charts" soon. I had actually felt my milk supply was pretty good up until this point, but since then I'm realizing its not. In the past week, I've noticed she is sucking more, is frustrated at the breast, sometimes whining and crying, and popping on and off a lot. Two nights ago I was so exhausted, after feeding all day long so Lonnie took her for an hour while I took a nap and she sucked down 3 ounces of formula, and then was a chipper smiley baby after that. Later that night, she was frantic again when she woke and would not stay on the breast, so I tearfully resorted to formula and when she was finished she had the hugest smile on her face. Egads. My child likes formula better than me! (though, she did still need a few sucks to get to sleep, ha, at least I'm good for something)! So, its back to the routine, with a fancy new breast pump and supplementing with herbs (fenugreek & blessed thistle, plus mothers milk tea). There are the big guns, the pharmaceuticals, one thats legal with crappy side effects, and one thats not that you have to get from Canada. Not quite ready to make that step, but I am thinking about it. Hopefully I won't need to. It could be that she's going through a growth spurt, frustrated that there's not enough, and building it up by feeding so often. In my obsessive researching, I've found that people who've had infertility problems may have supply issues and just not be able to make enough milk. Damn infertility biting me in the ass again! It was hard to come to the realization that this breastfeeding thing just may not work for us, but now that I've admitted it I am much less worried, actually. Whatever will happen will happen. Lonnie thinks she has enough IQ points to spare a few, ha ha, and I have to agree. Formula is not the devil, though that new ad campaign might want us to think that. Its not all gloom and doom, in any case, and the past two days, after meeting with the nurse and chatting with the LLL leader, I'm actually feeling pretty good. Most of the time she feeds fine, and her latch for the most part is better. We are off the shields, though the nurse recommended using them whenever she fusses and seems not to be doing well. I am pumping a fair amount, not huge but thats to be expected, so she is getting those extra bits as well. And in all other respects she seems fine, and getting more and more cute each day...

5 weeks
Its funny how time continues to be measured in weeks, even after you have given birth. So its been 5 weeks today since the big event....and holy cow its hard to write blog posts these days! My life (well the daytime part, at least) is broken into two hour cycles, and those two hours are broken into 15 minute or less chunks, much of the time. The things I do with those chunks, when I have a free moment unrelated to baby care, tend towards showering, eating, household chores (laundry, anyone? Thank you notes? Baby announcements? Bills!) and when I can, checking the internet. I do get to you, my dear webby friends, but most often that time is spent bouncing on an exercise ball with a (sometimes very unhappy and squirmy) infant in my arms, which is not at all conducive to typing much of anything. Alas. At least I can browse & surf! I have several half-written posts in the works, one about the enormously overwhelming challenges I've encountered with breastfeeding, started in one of my darker hours (I am pretty sure, knock on wood, that we are on the upswing of all that now...) and one commemorating the one-month mark of Emma's existence (a cheerier topic!), which happened last Sunday. Both of those posts require some thought and structure, and therefore time, which is why they still hang unfinished in my draft box. In order to actually post something, I am going to resort to a mishmash of things that are jumbling around in my head... Changes: As mentioned above, Emma is now a month old (5 weeks today!) and has already grown so much. Maybe not too much in size (though I do think she is bigger, as she is starting to grow out of a few of her clothes) but definitely in her alertness and general habits. She smiles and is vocalizing more (not just crying, either!), She is awake and alert more of the time, is tracking things with her eyes, and clearly enjoys looking at certain things more than others (like trees, windows, colorful objects & patterns, and of course, faces!). She is definitely becoming more "settled", and we now know or are at least able to predict more of what she likes and what she does not. Every day has beautiful moments, we are still loving this new gig we have going! But I do sometimes miss that fresh newborn baby a bit already.....she disappeared so fast! Sleep: I am going to post much more on this in a later post, as well, but for now, I do think we have been blessed with a fairly good sleeper (at least for now!), and for that I am terribly grateful. Most days she sleeps more than half of the day (well, she is a newborn, after all) and she is now starting to sleep longer and in more places (not just in our arms or chest), which is nice. She has currently been sleeping for more than 2 hours this afternoon (upstairs, in her own bed!), a trend that has been occurring most days for the past week. Yahoo for at least one long daytime nap each day! Also, three cheers for long nighttime sleeps as well! Though we have a way to go in terms of getting Emma into her own bed for some of her sleep (yes, we are cosleeping, and liking it a lot, more on that later) and able to be put down without the boob, we are getting 3-4 hour stretches at night fairly regularly. Excellent! It is wonderful to only wake briefly once or twice each night, and it makes for a much more chipper Mama and Daddy, indeed. Breastfeeding: Sucks! But its getting better. I knew it might be hard, very hard, but until you are in the throes of it I don't think you can really get it. Mainly, our/my problems have been pain and latch related, after the first week or two of scary low-supply/dehydration issues. After seeing 4 lactation specialists over the past 5 weeks (3 of whom mentioned what a STRONG sucker she was, as if I didn't know, ha ha), I am still dealing with the nipple shields and raw, sore nipples. Her latch does seem to be pretty good, and getting better, though we struggle a bit with positioning to make each of us more comfortable. As we ween off the nipple shields its like we are starting all over in terms of that (making it very difficult to go OUT and nurse in public). I have heard, more than a few times, that things really start to get better around 6 weeks, and I am thinking that may be the case for us, too. Will post more, hopefully soon!

Chug-a-lug
We just got back from Emma's third weight check appointment, and she gained 8 oz in 6 days! Yahoo! She is up to 8lbs 8oz, and while they like to see a return to birth weight in two weeks and we probably won't make that due to our rocky start, we definitely should in 3 weeks, which is fine. This also means we can start weaning her off the formula supplements! She's been getting about an ounce after breastfeedings 4 times a day, so we will start stepping that down. I'm still pumping, so she will get breastmilk bottles occasionally for a bit longer, at least until we are off the formula completely. Next step....weaning her off the damn nipple shields! They are really annoying, but they were a lifesaver for a while there and now she likes them a lot, of course. I am able to get her latched without them for a bit at the end of a feed, so I think there's hope. I'll try a lot harder with that after another week or so of good feeding, when I'll be less concerned about interrupting her or pissing her off a little. Ha. On Sunday we went on our first (non-doctor related) family outing! We went to the farmers market, and she went in the sling with only a bit of a whimper when she first went in. We all three LOVE the sling! She goes into it pretty easily when she is sleepy, and just hunkers down into a ball in it. If she is alert and awake she is not a huge fan, yet, I think because she can't see out all that well. She does settle down pretty quickly if we go for a brisk walk with her in it, which we did last night during a fussy time, so thats good, too! Now that she is feeding well and settling a bit, she is becoming an easier and easier baby! No more screaming after feedings, during diaper changes, and when we try and put her down for a second -- she is just a lot less fussy in general. The last three times we've put her in her Amby slightly awake, she's just laid there peacefully for a few minutes and then drifted off to sleep. Yahoo! Before that she's had to be totally asleep before we transfered her or she'd let out a huge yowl. Last night she slept for 4 hours straight in it! Thanks kiddo! Here are a few more photos from the past week.

Emma's First Week

Emma is one week old! Right now she is next to me in her bouncer, enjoying a jiggle and listening to the soothing sound of waves. Last week this time I was checked into the hospital, probably laboring in the tub and wondering how the heck I was going to make it through it all. Whew....glad to be on this side of that excitement!

So things are going well, though we've had some bumpy times this week, mostly having to do with breastfeeding. Right away in the hospital she seemed to be latching well, but had a super strong suck that left me soooooo sore. They gave me a nipple shield, which I was hesitant to use because I've read they can lead to more trouble, but ended up using because of the pain (the lac. consultant did say the new ones are a lot better than the old, however). Now, of course, she cannot go without it. Of course! Knew that would happen...hoping to ween her off them soon. Anyone have tricks for that?

The next issue, which caused us much more worry, was her rapid weight loss. Though babies usually lose weight after birth, she was losing too much, going from 9lb3oz at birth to 7lb14oz on day 4, a 14% loss (should be between 5-10%). She was showing signs of dehydration and rooting and screaming after feedings because she was still hungry. Oiy, that was heartbreaking and exhausting! My milk was not coming in fast enough, I guess, and I realize now I was probably not feeding enough, too. Could it be the nipple shields were messing with sensation and stimulation? Who knows.

It was really hard, but at the recommendation of her pediatrician and a lot of worry on our part (were we going down the slippery slope to more & more breastfeeding issues? Early weaning? Colic? Allergies galore?), we decided to abandon our plan, supplementing with a small bit of formula (albeit the fancy non-allergenic kind, but still) after breast feedings. We picked up the frequency of feedings and I was put on herbal supplements (I was impressed they actually suggested that, actually) to boost supply. I also had to start pumping after feedings to help my milk come in faster and to keep up with the formula supplements. Pumping sucks, literally and figuratively, by the way. Not fun at all, but of course its worth it.

After two days of this new regimen she did gain 2 oz, a step in the right direction! She seems sooooo much better, too, not fussy or screamy after feedings, for the most part, just delightfully sleepy. Also, much more alert during her awake times, which is nice. We are going back for another weigh-in in a week and hopefully after that we can start backing off on the formula.

Other than the feeding stuff, things have been pretty great, though. I am feeling better and better, and its been great to be home together as a family getting into the swing of things. Her favorite spot is on one of us, on her tummy in what we like to call her "frog pose". Check it out: