Tuesday, April 01, 2008

Latch Please

The lactation consultant and the nurse stood at the foot of my hospital bed. They exchanged a glance. That glance was eloquent: it said that they had no idea why my baby girl was not breast-feeding. We had tried all the tricks and positions. At each feeding I would put her hot little tummy next to mine and guide her to my breast. She would frantically root around for a few seconds and then eventually purse her lips before erupting in a hungry cry. Or she would simply refuse to wake up at all. I'm not sure which was worse. We pumped and fed her with with a finger feeder. We moved on to using a bottle. Each nurse who came on duty had a different trick and I eagerly tried each one. That worried glance exchanged at the foot of my bed taught me my first lesson of parenting: even the experts don't have all the answers.

Right. Okay. So babies don't come with instruction manuals. I knew that. But I didn't realize how much I depended on instructions manuals. Though I may have my nonconformist streak, I have always deeply trusted the authority of experts. I may not be a rule follower, but I am a people-truster. With my new baby in my arms I finally learned that I was now supposed to be the expert regarding my new baby. I would have panicked if I had an extra ounce of energy to fire up the appropriate hormones. As it was, our failure to enter into that lactation love zone had me in a raw emotional state that threatened a composure implosion.

After our beautiful natural birth (see previous entry), I was ready to take my place in the creaky rocker for the 3 am feeding with my baby at my breast. We would gently rock and gaze into each other's faces, no matter how bleary my sleep-deprived eyes might be. Instead, there I was at 3 am with two suction cups attached to my breasts, the persistent whir-whir of the breast pump providing the lullaby for my baby if I was lucky. Often she would just wail while I tried to pump enough (2 - 4 ounces / about 10 minutes) for the next feeding.

Here was our routine:
1) arrange a vast and complicated array of pillows, (cycle through blaming the chair, the nursing pillow, the disarray of pillows)

2) place baby next to my breast, (baby whose face is scrunched up in hunger, but whose lips are pursed)

3) watch her attempt to latch and fail and usually wail with hunger, (become convinced that she has a fever and send Grandma and Tata on a frantic search for the thermometer)

4) feed her my breast milk with a bottle, (notice that the loving sweet words I whispered while she tried to breast-feed were absent and attempt to be loving even as my heart breaks)

5) burp/rock/soothe to sleep, (Grandma or Tata took over this part as I pumped)

6) pump for ten minutes, (ten long minutes feeling like a cow)

7) store milk, (worry that I am not properly handling the milk storage paraphernalia and that spoiled milk will sicken her)

8) obsessively write down time of feeding, amount given in bottle, as well as her wet and poopy diapers,

9) somewhere in there change her diaper and get her dressed,

10) every several hours wash the pump parts with hot soapy water and

Start over at two to three hours from the beginning of feed.

Day and night became irrelevant. Time was marked by daytime talk shows--Ellen, The View, and Oprah became milestones. (We don't have cable or decent reception. Still I had to have something on to keep me alert.) It was bleak.

There were moments of joy--friends dropping by, muffins, a lobster dinner, and a surprise baby shower. Washing her hair. Oh how she loves to have her hair washed! She has "electric hair" that stands up straight no matter what we do. I love to smooth it down and watch it spring back in rebellion.

All the books say that the baby will naturally root to the breast and begin to feed if placed on the breast immediately following birth. Sounds natural. We are mammals and we are born to suckle our mamas. Why didn't/wouldn't Iza?

I think there were many factors. In part it was due to a mechanical problem with her mouth and tongue because she had a slight to moderate tongue-tie (which we had clipped in the hospital)-- although some experts say that the tongue-tie doesn't interfere with breast feeding. I think that my nervous nature compounded by postpartum hormones and emotions didn't help. Tense. You haven't seen tense. My obsessive nature inhibited our efforts, yes, but it also meant that I refused to give up. Six weeks is an eternity.

I have heard that some women keep up a similar pumping regime for months or even a year. I am not made of that mettle. We barely left the house and I hardly left our bedroom. Iza became this little entity defined by the fact that she would not feed instead of my sweet, hot, little newborn.

In the effort to make it work, we stayed an extra day in the hospital, saw five lactation consultants, a speech and feeding specialist (who told us at four weeks that her compression suck was not conducive to breast feeding and that if we wanted permission to quit, she would give it), and returned to the pediatric surgeon who clipped her tongue tie for a reevaluation. Some of these experts gave me diametrically opposed evaluations. More than one person told me to "trust my instincts." But I had no instincts! Or rather my instinct was to consult the "experts" for help.

It turns out that no one seems to truly understand the science and art of breast-feeding. For Iza and me it was a simple matter of time--she needed to learn how to organize her tongue and grow in strength. As I look back I can see that she was making progress over the weeks. I didn't see the progress, however, because I didn't know what the final result would look and feel like.

We returned to the pediatric surgeon on a Monday. I had called him in tears the previous Friday. He examined her and concluded that her mouth and tongue should not be impediments to her feeding. This was good news--there was nothing wrong with her. Yet is was frustrating to find out that there was no one problem to be solved. He was wonderful--he sat in his office with me and discussed his wife's struggles. She pumped for a year as their son wavered between the breast and the bottle. By the end of the meeting, I was crying, of course. He gave me a hug. Iza screamed all the way home. We sat down amidst our pillows and she latched on for thirty minutes, falling into the textbook milk-drunken state of sleep I had only imagined. The next day she went to the breast for most of the day. The rest of the week I breast fed and supplemented with the bottle because I was afraid that she wasn't getting enough sustenance. A regular pooper, she didn't poop for two days and I was frantic. (The only way to know a breast fed baby is getting enough is to measure what comes out the other end.)

At my six-week appointment with my midwife that Friday we made the transition. After Iza performed brilliantly at the breast, my midwife suggested that we were ready to stop using the pump and the bottles. Lactation Liberation.

We have been feeding only from the breast since then!

We drove home from the midwife and immediately I reorganized our rooms, putting all the pumping gear out of sight and mind. I cleaned and prepared the way for a new phase in our parenting lives. Tata was was pretty shocked at my sudden and complete resolution to start fresh--pleasantly shocked of course. And it has been a huge change. We have a little girl.

Key to our success: Grandma. My mom came and stayed for three weeks and then returned for another week! She spent countless hours in the rocker with Iza while I pumped and generally freaked out about being a new mom. And of course Tata was essential as he took over the daunting tasks of keeping me fed, hydrated, and sane. It was a three-person job to get Iza to the breast, with a supporting cast of at least ten. But we did it.

Also key to our success was Susan Davies, a lactation consultant who came to our home on two occasions and checked in by phone several times. She gave us good tips about the hows of feeding and also was relentlessly optimistic and supportive. (I need to write an paean to the women in our communities who work to support breast-feeding. Truly they have a treasure of knowledge gained from years of hands-on experience.)

Another key in making the transition from a bottle-fed baby to a breast-feeding baby--a struggle that took six full weeks of around-the-clock attention--is the fact that I am not working outside the home right now. If I had to go to work, I am sure that the struggle would have been too costly. Breast-feeding seems to have become an option for those who can afford to pursue it. It is cheaper than formula in terms of dollars paid out, but extremely costly in terms of time invested both in the initial establishment of the relationship and the normal feeding schedule. I became a mother at a point in my life where I can afford to breast-feed, meaning I can stay home and allow my daughter's feeding needs to set our daily rhythm.

At about week five I started to come to terms with the fact that we might have to go to formula. I can't explain why breast feeding had become so important to me. I suppose it had something to do with the fact that it felt like I wasn't able to make a choice about how my baby would eat. Instead we were being robbed of an opportunity. I knew breast milk was the best thing for my baby and I had an aversion to using anything artificial with her. But when it become a reality that she might not go to the breast, I had to imagine myself as a mother who bottle feeds. This involved much grief. In the end, however, I can say that I changed my perspective on formula. I can say now that I am grateful that formula exists. What if Iza couldn't have gone to the breast? Formula would have been her only option. And I am sure she would have thrived as bottle fed babies do. But feeding her from my breast sustains us both in ways that cannot be fully articulated, at least by me. At least not yet.

By week 7 plus several days, yes, I am starting to feel like the authority on Iza. Not an expert. Not yet. But certainly I know her better and better each day.


Cicily Janus said...

Having attempted to nurse twins, one of them REALLY eating well, the other ended up on a nasogastric feeding tube, I am no expert on my children. the twins are just now turning six and all I can say, is that every minute I think I've got them figured out, they change.

Whatever you decide, it will be best. Both of the girls, even though they grew up with totally different feeding methods are in the gifted programs and are above average intelligence*whatever that means* and achieved all the same milestones.

Good luck!



Khageman said...

You have so many years to get to know Iza. But I agree, as soon as they settle into one pattern and you learn it, they are off to something else. 17 years later, I am certainly not an "expert" on my children. But each and every day I love them even more than the day before. There will be so many joys and there will be so many strugles. All of it just another day in the life of a parent!

István Albert said...

There is a sports commentator whose favorite quote is one from boxing: "The punch that hurts most is the one that you don't see coming"

As a new parent one is preparing for various "expected" difficulties, colic, persistent crying, waking up at night, sleep deprivation etc ... then BAAAM you get to take a "punch" from an angle that you've never expected.

In the boxing match against Fate one tough round is now in the books.