Tag-Archive for » breastfeeding «

Jul
03

No, no – not sleep training.  Sleep train, as in “getting on the sleep train’.  ‘Cause that’s what I’m trying to do with Daphne, get her on the sleep train.

Kate came over yesterday.  I’m sad that it was our last visit, but I hope I’ll see her again in the future.  (It’s one of those things where you start out with a professional relationship, and hope you can be friends.  That’s always a funky transition in life, I think,  Happens in the yoga studio sometimes too, and it seems like “delicate” water to tread, but not for any particularly good reason.) But it was good to catch up and get some more very helpful advice.

We talked about general things – how breastfeeding is going and how she’s developing – but a lot of it was talking about sleep.  Like most veteran parents, she was shocked that Daphne was only getting 11 to 12 hours of sleep a day.  She needs closer to 15.  Even though a few babies can go so little sleep in a day, really, it just tends to make them wired and cranky.  (This will be item one on my future post “Forget the Pooping: Important Things They REALLY Never Tell You”. :P)  Daphne was doing a great job of demonstrating the issue and fighting sleep through the yawns and eye rubs while Kate was here.

I’m sure that if Kate had a dollar for every time she told a new parent to swaddle, she’d be a millionaire, and she did indeed tell me to swaddle her.  (She probably also wondered why the heck we weren’t doing it in the first place.  It’s not like the concept was new to us at this point.  But I’m sure we’re not the first thick-headed parents she’s had to deal with. 🙂 Stubborn runs both ways (I’m still breastfeeding, but had mostly given up on the swaddling).  So, Kate swaddled her, and held her sideways and bounced her (really, the gentle head jiggle seemed to be the important part of the bounce), and saw that calmed her.  But she was staying quite awake.  She tried the pacifier, at which point I learned another “Important Things They REALLY Never Tell You”, a baby has to learn how to use a pacifier.  (Sure, sucking is instinctual, but sucking something like a pacifier and holding onto it is NOT!)  She still demonstrated herself to not be a big pacifier girl, but made use of it for a little bit.

(Sidebar: This brings me to my third “ITTRNTY” (and that is a horrid acronym) – regardless of your feelings on pacifiers (I’m not a big fan, but not stringently against them), it’s worth introducing a baby to them at the appropriate age, because you never know when you may need to make use of the calming aspects of sucking when a boob isn’t around.  And the first time you NEED it is going to be an awful time to teach it.)

When the basic approach didn’t work, we tried putting Daphne, swaddled, in her swing.  She kept spitting out the pacifier, but wasn’t all that fussy during this process.  Over the next half hour, however, she did a lovely demonstration of what she does best – close her eyes and snooze for a few minutes, then open her eyes and just look around.  It’s nice and calm and all, but it does not get her good, needed sleep.

Eventually, we took her into the bedroom, where we have curtains over our blinds to make it quite dark, and put her in a bouncy seat that has vibration.  (To make it easier, we put the seat in the cosleeper, so she wasn’t on the floor.)  The sound machine we have is also in the cosleeper, so when the vibrachair (I love that word) wasn’t quite enough, we turned out the sound as well (ocean waves).  Eventually, with another 10 or 15 minutes of teasing, she went to sleep.  She was fine with our talking, but all the other sensory input had been too much to give up.

She then slept for nearly three and a half hours!

In the end, I did take advantage of one of her waking spells where she might have gone back to sleep and got her up to nurse.  It had been four and a half hours in the middle of the day (when she usually goes two and a half hours) since her last feeding. In the end, she slept yesterday morning for 6hr, 35min overnight (waking once in the middle to eat) until she woke up at 8am, and then napped from 9:15-10:15am, 11:25-12:30pm, 2:30-5:50pm, and 7:30-8:45pm.  (The last two naps were after this work with Kate.)

Jason, and to a lesser extent I as well, was worried about the extra sleeping during the day keeping her up at night.  He was  quite worried we’d have another six hour fussy stint, though clearly willing to try this sleep experiment.  And while I know that all experienced parents will note that it’s a silly concern, I think we had to experience it to believe it.  And experience it we did.

Last night, she slept from 9:50pm to 8:25am, waking up once to eat.  She did take a little longer than usual to get back to sleep during that waking (40 minutes), but I think it was as much because she was gassy as anything else.  So far today, she’s also had a morning nap (9:25-11:20am), two short afternoon naps that were less than ideal car ride naps (12:55-1:25pm, 2:30-2:55pm), and is currently taking her early evening nap which started at 4pm.

That’s 15hr, 20min last night, and we’re on 10hr, 55min so far today, with seven hours left in the day and some less than stellar napping during the afternoon.

I kind of feel like the vast majority of the day is spent either nursing her, getting her to go to sleep, or waiting for her while she sleeps.  (She’s sleeping in a seat or swing of some variety at the moment, so I don’t feel comfortable leaving her with a monitor on and walking away.)  But if that’s what it takes to teach her how to sleep, I’ll do it.  As Kate said, pick the crutches you can live with, you can get rid of them when you don’t need them any more.  Bouncing her on a ball is as much a crutch as the swing, but we’ll take what works at the moment.

Interestingly enough, and I was wondering if this would happen, so far, the breastfeeding has not been as painful.  I’ve been concerned about the frequency of feeding, since she’s sleeping so much.  She normally nurses seven to eight times a day, and has been growing quite well with that.  But yesterday she only nursed six times, and today has been four so far, and I expect she may nurse twice more today.  She’s not acting hungry except right before she eats, and she’s nursing almost every time she wakes up, so I don’t think there is a problem, but it’s a little disconcerting not knowing how much she’s getting.  (I strongly suspect that, though she’s not nursing for any longer, she’s being a little less lackadaisical about the whole thing and getting more in the same amount of time.  Perhaps that’s just my optimism, but I’ll stick with it.)  Ironically, so far, since this experiment began, nursing has not been as painful as it previously was.  I don’t have enough data to be sure this isn’t a coincidence, but I remain hopeful.

She’s still fighting her naps, and though I’m not picking her up and doing anything with her, I’m sticking around to help make the environment work for her as best I can.  I’m certainly not a cry-it-out parent (particularly not for an eight week old, who can’t really learn how to self-soothe just yet), but there’s something to be said for me giving her the space to fall back to sleep on her own in the middle of a nap, rather than disturbing her even more.

At the end of the day, I’m managing it as an input threshold problem.  She’s getting input from a number of sources – visual, oral, aural, tactile, olfactory, proprioceptive.  If I can minimize the unique input of these sources, by either eliminating input or masking them with rhythmic “noise” (the bouncing, the sucking, the sound machine), then she’s got the lowest input state, and she can let her body listen to the sleep cues, rather than trying to get her brain to override them.  If I think about it that way, really, it becomes a lot easier of a problem to manage.

Hopefully, we’ll continue to manage it well, and perhaps in a few weeks, she’ll even learn not to fight sleep quite so hard. 🙂

Jul
01

It’s funny how inconsistently  I can get to writing this blog.  Ah well, such is the life of a new mother with attachment parenting tendencies.

Yes, we’re still having breastfeeding issues.  I’ve been keeping track of … well, most things (except diapers, oddly enough), and have found that the average pain levels may have gone down somewhat, but not by all that much (not even 30% since our visit with the PT), and not as much as I’d like.  I’m still working towards the plan of waiting until three months and then deciding what to do about continuing feeding at the boob or pumping and bottle feeding.  My midwife did note that it is not uncommon for women to start losing their supply if they go to exclusive pumping, which is one of my fears, but she also had a great reminder – what’s right is what gets the most needs met for the most people, and that may not be the perfect solution for everyone, but is best for the family as a whole.

I’ve mentally moved on to the next issue.  (Well, not so much moved on, but moved in addition to.  Motherhood is neither linear nor binary.)  After looking over the data I’ve been gathering for about three weeks now, I’m fairly certain that little Miss Daphne is sleep deprived.  8 week olds are supposed to be getting (on average) 15 hours of sleep a day.  Sure, that can vary widely, but she gets 11 to 12 (sometimes slightly less!), and shows plenty of signs of often fighting sleep and being extra cranky in the evening.  So it’s off to work on sleep!

There appear to be as many ways as parents to “work on sleep”. Depending on the philosophy, different (contradictory) biological “facts” are stated, so, I’m doing a read of a number of approaches for background, and plan to synthesize/evolve what works for us.  Neither Jason or I are a fan of various “cry it out” methods.  For one, even most of those methods say she’s too young, and for two, it seems an unnatural approach for us.  (I’m not criticizing those who use it, however.  If someone finds it works for their family, that’s awesome!  It’s almost certain that there are going to be child/parent combinations out there for whom this is the most effective method.) A completely rigid schedule doesn’t make sense to me either, since I know of few humans who work that way, and Jason and I certainly aren’t examples of that few.

My current plan (no input needed from the peanut gallery on “why it won’t work”, Daphne… See More will be the arbiter of that), is to take advantage of the natural 90minute rest/active cycle in humans, and encourage her to nap when she shows signs of sleepiness (yawning, droopy eyelids, vacant stare, fussiness, and whatever else I can learn to read from her).  Yes, this is marketed through a book – what method of sleep training/teaching/improving/whathaveyou isn’t.  So, calming the environment, not stimulating her, and providing some variety of boring but gentle rhythmic input to help her ignore the other sensory stimulate around her. This may include swaddling/shhh’ing (though she’s seemed meh about swaddling), walking, gentle bouncing on a ball, escalating to dancing/singing, her swing, or even a car ride if necessary. I’d prefer to keep it as simple as possible, however, so she doesn’t become too reliant on those external influences. And sucking is on the table, but almost certainly not at the boob unless/until we resolve the breastfeeding pain issue.

If she take the opportunity to fall asleep, great! She seems to fairly obviously fight sleep, so I’m going to try to get to this as soon as she shows signs of tiredness, and be really patient about encouraging her to sleep. If she doesn’t, she doesn’t, and I can’t force her, but I’ll keep stimulation a little lower so she isn’t overstimulated by the time we get towards then end of the next rest/active cycle to try again. If she does take advantage, and falls asleep anywhere but already in a sleeping location (cosleeper, crib, playard), I will keep in mind what sleep cycles are like and try to wait until she’s in deep sleep, not the active REM sleep that babies start their sleep cycle with, to move her to a sleeping location.

The theory here is that babies (particularly after two weeks, but before six months) need help learning to voluntarily go to sleep, ignoring the overwhelming new sensory input that they want to take in. Many will, given the opportunity, stay awake until the get fussier and fussier and crash. But because they are overtired, they won’t sleep as deeply or as long, waking up unrefreshed (so they don’t learn that sleep is a rewarding thing that they can do) and tired, leading to more fighting sleep fussiness.

It may mean that she’s taking naps every hour and a half, rather than trying to go five or six hours in the day without one. (This is NOT a good thing for an 8 week old; she needs sleep to integrate what she’s learned while awake!) It may do that, or may lead to a few longer breaks of wakefulness in the day. It may also mean that it takes half an hour to get her to go down.  But we’d be managing her in some fashion during that time anyway, so now we just do it in a different way.  We will see what works for her. It is likely going to impact how I get out of the house (being out is very stimulating, and I’ve got to prioritize her sleep a bit more), but breastfeeding already does that – and on a similar time scale, since she often goes two hours between daytime feeds.

I don’t think either Jason or I were paying enough attention to her sleep signals, since she used to drop off more readily. But as she has become more alert, she’s wanted to stay awake (at all costs) more, and we were, unintentionally, helping he do that. I’m sure the reflux and gas didn’t help (providing discomfort that woke her fully during the lighter stages of the cycle), but that’s getting better too.

I like the approach because it’s very baby centered, and goes along with my general “attachment parenting light” approach. But who knows if it’ll work as I hope. If it doesn’t, we will try something else.

Jun
23

Since the PT appointment yesterday, feeding (you know, the thing my life revolves around) has been up and down.  We had a couple of intensely painful feeds (like, just cry through it, because there’s nothing else to do – especially when you don’t have pumped milk available and you’re already there and you’re a stubborn pain in the ass who won’t give up until she decides, independent of the heat of the moment, to switch plans) and some good feeds that weren’t completely not-uncomfortable, but were totally manageable and probably as good as I can expect until my nipples heal.  It makes me skittish to go into a feed – or really, just to latch her on, even if it’s one feed but switching sides.

Having a tentative plan, however, makes me feel much better – I plan to “grin and bear it” as best as possible until three months, and re-evaluate the situation then.  If necessary, we’ll use “strategic pump&feed” once or twice in a day, and I’ll keep using my magic nipple cream (really, just a combination of lanolin, st. john’s wort oil, and using the cotton nursing bra pads I have), and get through it if at all possible.  Clearly, if things go downhill and it’s just no longer a tenable situation, then I’ll change that plan.  But I have at least two other professionals I would want to see first.  If, at three months, things are not improved, I will probably move towards more (and possibly exclusively) pumping and bottle-feeding the breastmilk.  If things do improve, well… problem solved.  (This problem, anyway.  I’m sure there will be others.)  While I want to be optimistic every time we have a good feed, the bad ones tempt me to flip over the other way, so having this plan in mind makes me feel better – I’m working towards an end, rather than some open-ended who-knows-what.

I had commented on the overwhelming attention breastfeeding is taking in my life to Jason the other day.  He asked when I was thinking of taking Neo back to obedience class, and I said “when we have this feeding thing figured out; my life is kind of on hold until then”.  And that’s really how it feels, outside of teaching four (and a half) yoga classes a week (and three of those are at home, and are likely to be our pump&feed feedings), my life really has been on hold until this gets resolved, since not only do feedings take a long time, but I just have to spend some time recovering afterwards, and being so very careful of how I move and what comes near my breasts, including her feet and hands while we’re playing.

Jun
22

We saw the PT this morning, and she had a couple small things she worked on.  She did a little bit of work on her head, at one of the spots between the cranial bones where the innervation for the tongue, mouth, and upper traps comes through (it was a bit tight), and a bit of work on her tongue and shoulders which appeared to be tighter on one side than the other.  She talked a lot about the effect that small tightnesses can have on various portions of the nervous system and how it controls mechanical movement.  She was hopeful that the changes she was able to see after adjusting her will make a difference (over the next week or two) in how Daphne feeds by making it easier for her to use her mouth symmetrically and by releasing some of the tension that may have been restricting movement.  She also suggested doing a little bit of work just training Daphne’s nervous system to understand how to move her tongue better by lightly touching the gums for some oral sensory input.

I feel both hopeful that this can make a difference and worried that this will be another partial solution that doesn’t quite get us where we need to go.  And, I’ll admit, I’m frustrated that we didn’t see the OT and PT at the same time (as I didn’t give enough credence to just how differently they would be approaching the issue) and that I didn’t pursue craniosacral therapy on her earlier despite my instinct that it was an important avenue to go down.  Learning to trust my mommy instincts isn’t  quite like I anticipated – sure, I feel confident saying that if my instincts tell me something is wrong, there is something wrong.  I wasn’t prepared for my instincts to be so accurate as to WHAT the problems are – craniosacral issues (likely from the birth) impact the neck, tongue use issues (possibly related), gas from reflux and foods…  Of course, now that I say that, I’m going to be wrong the next time. 😉

We go back to see the PT again in a couple weeks (July 6th?), and she’ll check out how things are going, not expecting to need to see us any more than that.  Keep your fingers crossed!

Jun
20

Someday, my breasts will no longer hurt.  Someday, my nipples will not be pink and raw.  Someday, I won’t pause, mid-whatever, and just wait for a wave of burning through the boob to pass.

To say I’m frustrated is an understatement.  I’m too stubborn to give up on breastfeeding, as I don’t feel that this pain is yet worthy of being a reason to not provide the quantitative and qualitative benefits of breastmilk.  But I can see the line where that’s no longer the case drifting in front of me at some unknown distance.  I don’t particularly want to go to pumping and feeding either, for both practical reasons (it’s incredibly inconvenient, and I don’t know how it would work logistically when I’m by myself as there are times that she won’t go to sleep or be on her own after eating or be asleep before eating), selfish reasons (it’s so convenient to just have a boob available if we go anywhere for more than an hour; pumping while out and about would be far, far less convenient), and for her (the skin to skin time is great, and she gets good comfort out of it).  But I either have to get used to the pain, or something.

For no particularly good reason other than “lots of things change then”, I’m hope, praying, that at three months, she’ll get better about using her mouth and things will improve.

I’m sure that this isn’t the only painful, long-term tradeoff I’ll be making as a mother.  I’m sure there are other difficulties (physical and emotional) that will make this seem like barely a speedbump on the way to raising a child, but I’m not feeling that at the moment.  I’m feeling uncertain as to what the future holds, and how I should handle it.  If I knew it would be better by three months, it’d be easier to hold on for another five weeks and wait it out.  I mean, pregnancy was nine months of discomfort, so what’s another three months?  But if I knew that it would be no better by three would I do anything different?  Would I stop now just because there wouldn’t be improvement then?  I don’t know!  I don’t think so, but it’s hard to make good decisions when you’re in the middle of confusing things.

Jun
18

Ok, the title implies more than there really is.  But we did decide that we wanted to try treating the reflux, and Daphne’s pediatrician was good with that plan, so she now gets baby Zantac twice a day.  I’m not thrilled to be using pharmaceuticals on her, but having her be somewhere between uncomfortable and pissed off after every meal is only setting us up for nursing strikes in a couple months.  And we also did a pumped feeding – Jason gave her a bottle at the kitchen table while I pumped at the kitchen table (a little surreal), but it was *totally* the right thing to do – my nipples felt so much better the next time she nursed!  And we got in with the physical therapist on a canceled appointment next Tuesday.

Seems like life with a baby moves much slower – I’m either feeding her or holding her, so not much gets done when I’m on my own.  But I did have two classes to teach on Wednesday, and we’ll see if the 6am class that takes place at the Y is going to continue to be on my calendar.  She was quite hungry when I got home, and Jason was NOT happy that he didn’t remember what time class ended.  (We won’t mention that I’ve been teaching this class for almost a year. 😉 )  And both classes I’ve taught at home have had her eating right at the end of class.  I do hope that will get better, but this is one of the tradeoffs with teaching out of your house to reduce costs. 🙂

Jun
16

while I don’t remember what spurred it, I ended up doing some online research about overactive letdown yesterday. basically, the thought is that some moms have some combination of either too much milk getting stored in their breasts and/or the milk that is there is ejected from the ducts very forcefully. this can cause a number of issues. baby gags or gulps her food down, taking a lot of air with it, leading to burping and spitting up. baby fills her stomach too quickly, which leaves her uncomfortable after eating and more prone to reflux. baby fills up on a larger quantity of lactose-rich foremilk, rather than fat-rich hind milk, causing her to eat more often (for calories) and possibly get gassy from insufficient lactase enzyme. mom may notice pain during letdown too and significant leaking from one side while feeding on the other. well, we have all of those things. there are some other signs that we don’t have, so I’m suspecting that it’s not a hugely overactive letdown, but it’s there.

frustratingly, I probably contributed to the problem. for a few days, we were worried about low supply, so I supplemented with fenugreek. (regular readers may remember exactly why we did this, but, even though it was only two or three weeks ago, I certainly don’t!) that clearly wasn’t necessary, and I did stop after about two or three days. and then last weekend, I had two days notice to pump enough milk for two extra feeds, telling my boobs, over the course of two days, to produce a total of what was probably 54 oz, instead of 48oz. that’s a nontrivial difference!

in an attempt to deal with this issue, in the hopes of reducing Daphne’s reflux and/or gassyness, I’m attempting the standard first approach to the problem – stop feeding both sides each time she eats, and offer one side for an extended time, offering the other only if she decided she’s still hungry after seemingly finishing the first. of course, I don’t have fill lines on my boobs, so “after finishing the first” is as much educated guess work as anything else. basically, after she has gotten a couple (3 or 4) good rapid swallow sequences down (appears to coincide with multiple letdowns, another overactive letdown sign), and is just comfort sucking for a while, if she hasn’t fallen asleep or come of herself (or tried to), I take her off. as much as I rely on those signs, though, I’m also watching the clock; our (new) normal feeds have generally been 20 to 30 minutes. I figure that she has to work a little harder for food now, so I encourage her to stay on the same side for at least 20 minutes. I’ll giver her the other side only if she seems hungry after initially coming off one side and seeming relatively content, and is she’s stayed on that first side for 20 minutes.

yesterday afternoon was the first time I tried this. I only got two iterations in (each side twice) before the first (expected) night feeding. it seemed to be going well during the day, going about two hours between feeds (finish to start), which isn’t abnormal during the day. but then there were two more feeds an hour apart, and when I first gave her both sides before her expected long nap, it was just two and a half hours until she ate again. we got a longer three and a half hour break after that, but then again two and a half and one and a half for the next two feeds.

it hadn’t seemed to make an obvious difference in fussyness, but it’s hard to say since her daytime and nighttime fussiness levels are diffeent. she’s certainly still showing subtle silent reflux symptoms and gas symptoms. it does, however, mean more unproductive sucking at one breast than she had been doing in a while, and since she’s still compressing my nipple, it’s making things more raw and painful.

after talking to Jason, with neither of us seeing any real improvement in reflux or gassyness, but seeing bruising coming up on my nipples, we think we’re going to abandon this experiment (yes, I know it wasn’t for long, but my nipples are well guarded assets at the moment). as we’ve been talking about for the past week, though, we are going to look into treating her reflux for a while, and see if that helps things. my midwife noted that often treating reflux early means not having to treat it as long, and I’m hopeful that is the case.

such a puzzle! and not the fun, exciting kind.