Posted in Baby Foxes

The Supplementation Trap

In over 2.5 years I have counseled over 3,000 breastfeeding mothers as part of my paid work as a WIC Breastfeeding Peer Counselor and as a volunteer La Leche League Leader.  As a supporter and volunteer for Best for Babes Foundation, I am very aware of the many “Booby Traps” to breastfeeding because sadly, I have encountered many of them myself.

 

 While I don’t get tired of talking about breastfeeding, it can be very hard to not take things personally and feel defeated when a mom doesn’t reach her breastfeeding goal.  It saddens me to see so much unnecessary supplementation and premature weaning that could have been easily avoided if mom had more confidence in herself and learned to listen to her gut.  Oftentimes I can’t blame the mom as the bad advice comes from a health authority figure that they mistakenly assume to be an expert even if their lactation knowledge is minimal at best.

 

I hear it all of the time, a nurse says “your baby lost weight, you are not making enough so you have to supplement” or “your baby has jaundice so you will have to stop breastfeeding for 24/48 hours and give formula”.  That could have been me…

 

When Shammy was 2 days old a nurse woke me up at 2am to say that he had lost weight and had to be given formula right now, I must have been the first mother in her career to question that order.  In my groggy state I had to attempt to engage my brain because the nurse was pushing all of my emotional buttons to get me to agree.  To her it was just standard protocol of infant weight loss= give formula.  She didn’t know about breastfeeding and adamant that I couldn’t wait until I asked the doctor in the morning about the formula, she insisted that my sleeping newborn had to have formula RIGHT NOW.

 

So I told her that if it’s truly such an emergency that he needs to supplemented that she will then wake up the doctor and have me tell him himself.  Obviously that wasn’t an option so I insisted that if he had to be supplemented he would be supplemented with my breastmilk so please get my a breast pump.

 
After almost 15 minutes of arguing she finally gave up and came back with a breastpump.  My milk wasn’t in so I pump some colostrum and she complained about how that wasn’t enough but put it in the fridge anyway.  Shammy never got that milk.  The next morning I asked the doctor and he agreed that while supplementing with formula would help, it wasn’t necessary and I did NOT have to do it.

 

The next day my milk came in and Shammy gained all of the weight loss plus some.  But how many new mothers know to question a nurse?  They think the nurse knows it all, oftentimes they mistakenly assume that the nurse is acting on doctor’s orders.  How much supplementation could be avoided?  Also a lot of mothers think that supplementation = formula.  It doesn’t occur to them that their baby can be supplemented with their own breastmilk.

 

A lot of people say “it’s just one bottle, what harm can it do?”.   If you spend 1 day with me at the WIC office and you’ll be surprised at how much damage just one bottle can do to breastfeeding.  Not counting the fact that a lot of nurses and doctors tell a mother to supplement but don’t tell her for how long so mom thinks she will always have to supplement when in reality they could have stopped days ago and by the time they get to me we are faced with the problem of dropping milk supply, lazy latch, nipple confusion, etc.

 

Jaundice does not equal formula supplementation.  Zen was born Coombs +, what this means is that his blood type is different from mine so he gets jaundice while his blood clears out the leftovers from mine so he had to be under bili lights as a preventative and still got mild jaundice. On top of that he had (at the moment undiagnosed) posterior tongue tie and upper lip tie so his latch was not good and he was losing weight due to improper milk transfer.  The first nurse said that I could only nurse for 20 mins every 3 hours due to the lights.  The second nurse said that I had to supplement because he was losing weight and his bili levels were rising.

 

I saw another argument like the one with Shammy’s nurse brewing but thankfully this time it was daytime and my demand for a doctors order wasn’t so unreasonable.  I knew that limiting nursing would only make his jaundice and weight loss worse but the nurse was set in her ways.  The doctor agreed with me and I got permission to nurse on demand by getting under the lights with baby as long as I wore sunglasses.  The doctor had no trouble discharging us from the hospital despite still rising bilirubin levels and weight loss because she knew that I would “nurse him a million times a day”.

 

Jaundice did not interfere with exclusive breastfeeding but only because I fought for it.
Jaundice did not interfere with exclusive breastfeeding but only because I fought for it.
As soon as we were discharged I made an appointment with Dr. Punger to get Zen’s tongue tie and upper lip tie diagnosed and fixed and while his jaundice took a while to fully clear, we never had to supplement, we never had to go back to the hospital and he gained all of the weight loss plus some.
The moral of the story is:
  • Always ask questions if you are told that your baby has to be supplemented.  If a nurse tells you to supplement, demand to hear it straight from the doctor.
  • Know that you can supplement with your own breastmilk.
  • Pediatricians can still be quick to recommend supplementation when it’s not truly needed so it’s ok to get a second opinion and talk to an IBCLC
  • If you are told to pump and dump or stop breastfeeding due to medication, contact an IBCLC or LLL that can look up the drug on Hale’s Medication’s and Mother’s Milk.  Doctors and pharmacists play it safe and tell you not to breastfeed because they don’t know better when in reality it’s perfectly safe.  Most drugs are compatible with breastfeeding.  Lactmed and the Infant Risk Centers are also good resources for this. (You can use the Lactnet search widget on the right column of this page to research a medication).
  • If you are told to supplement “until your milk supply increases” know that your milk supply will go further down because production is supply and demand and every ounce of formula that baby drinks is one less ounce that baby will drain from the breast sending a signal to your body that it’s not needed.  While pumping can help, a breastpump is not as efficient as baby to increase milk supply.
  • If you must supplement it doesn’t have to be with a bottle (anything but a bottle is preferred; SNS, syringe, cup, spoon or finger feeding are options) and get clear instructions on exactly how long that is necessary while getting counseling on how to protect your milk supply and baby’s latch.
I believe that breastfeeding support is important for pediatric practice and which that all pediatrician offices either have a CLC/IBCLC on site or were quick to refer a mother to one as needed.
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Posted in Baby Foxes

Zen’s 1st week… 4 months later

Zen will be 4 months tomorrow and I finally had the chance to finish the recap of his 1st week.  That is how busy things are over here!

 

I was delighted to see Zen do the newborn crawl that I had heard so much about.  He was very sleepy and had a very shallow latch which we later learned was from being tongue tied in addition to having an upper lip tie but it was still awesome.  I had requested to postpone the first bath until after nursing and later found that the nurses treated giving Zen’s bath like a hot potato, they were all too busy/nobody wanted to do it.  He finally got his first bath on the 3rd day in the middle of the night.
A few hours after birth we learned that Zen was Coombs Positive.  What this means is that he got his father’s blood type which is incompatible with my blood type and it can lead to jaundice if unchecked until his body got rid of my blood cells.  The nurses were super strict with the bili lights as a result and tried to limit breastfeeding to only 20 minutes every 3 hours, this is contrary to normal advice for jaundice which lots of feeding is encouraged to help baby have lots of dirty diapers, it was also contrary to my mothering instinct of having skin to skin and bonding with him.  Thankfully I was able to get permission from the doctor to put myself under the lights so Zen could have unlimited skin to skin and nurse on demand.  Due to the bili lights ordeal we missed out on Zen having pictures taken by the hospital and that made me sad but I try to not dwell on it.
Unlimited skin to skin and nursing despite the bili lights. It CAN be done!
He was having lots of dirty diapers which was great but since he was so sleepy and had an ineffective latch he still managed to lose a lot of weight.  I knew this was coming and I was prepared, I would express colostrum and feed it to him and would practically hand express in his mouth to get something in him.  Thankfully the pediatrician understood my desire for a virgin gut and didn’t push supplementation and instead told me to “nurse him a million times a day” which I was glad to do.   I am glad that despite them having an option of invoking a “medically necessary” excuse they didn’t push formula and I didn’t receive a “Breastfeeding Success Kit” aka formula gift bag on discharge.
Zen looking fashionable under the lights
My recovery was much harder this time.  I lost a lot of blood and some of the nurses would forget about my request for pain relief until I was in agony.  I snapped at one nurse that was 45 minutes late giving me painkillers and then had the nerve to tell me to not cough because it would hurt.  Does it look like I want to cough?!
Overall the hospital experience was better than with Shammy with it being a different hospital.  The only truly bad experience was a fiasco where an immature food service employee spilled my husband’s coffee while delivering my dinner and didn’t apologize nor try to help clean it up.  The coffee spilled over lots of important papers, pictures and gifts.  I made a scene about it because I was furious that she refused to at least apologize.  The rest of the staff were great at trying to salvage what they could and replace the rest and the person’s supervisor paid me a visit right before discharge to apologize.
Discharge at Martin Memorial is different than at St Lucie Medical.  With Shammy I was required to carry Shammy out while sitting in a wheelchair.  At Martin Memorial they required Zen to be strapped to the carseat and carried out and I had to walk myself out while being escorted by a nurse that verified the carseat installation.
I went home knowing that it is normal for his bili levels to rise before falling so I planned to nurse often and make sure he got sunlight several times a day.  He was a very sleepy baby compared to Shammy.  I was blessed that Dr. Punger was kind enough to work with us and fit us into her schedule quickly to get Zen’s tongue tie situation addressed.  Over that weekend that we had to wait my nipples started to suffer from nursing so often with a bad latch and my milk supply was suffering.  I don’t think we would have lasted longer than another day without supplementing.  Dr. Punger clipped Zen’s tongue tie AND upper lip tie.  He looked like a vampire baby and I couldn’t help but giggle while refraining from taking a photo.  His latch immediately improved and although it took him a couple of days to figure out how to work his tongue things only got better and my milk production increased.
By this point Zen had gotten a little orange due to breastmilk jaundice/Coombs + but with lots of nursing and sunlight we were able to avoid the hospital and he gradually went back to a normal color.
Zen only got better from there.  Shammy has grown to love Zen and Zen really looks up to his big brother, I look forward to lots of playing together and bickering in the future.  Shammy didn’t develop any jealousy over Zen nursing and I am proud to be a tandem nursing mama.
First of MANY tandem nursing sessions
My anemia got very bad with a hemoglobin level of 7.3, thankfully thanks to being able to have my placenta encapsulated I was able to get my hemoglobin up to 12.1 in just 5 weeks without taking any other supplements or paying any attention to my diet.   The rest of my recovery however has been a long and painful road.  My incision bled from any physical exertion for up to a month.  Even though I weaned myself from painkillers after 10 days, I sometimes have to pop a Motrin to recover from carrying Shammy or cleaning something.  Almost 4 months later I still experience residual pain and I sleep in a recliner because it’s too painful to lie down to sleep.  I hope to be able to feel normal again… someday.
Posted in Baby Foxes

The Hidden Side of Motherhood

This post has been in the works for over a year.  It started by floating around my head before I decided to write it, then a draft kept changing and changing, sitting idle and then changing again.

As much as I enjoy motherhood and my son brings me immense joy, the whole journey has not been entirely rosy. As you already know from my birth story, my homebirth plans went down the toilet and resulted in an emergency c-section.  I ended up suffering from PTSD which evolved into PPD, people immediately assume that it was from the surgery  but that is not so.

As detailed in my birth story, when I was hooked to the monitors and I could hear Shammy’s heartbeat, I would notice that his heart rate would drop every time I had a contraction and would practically stop every time I pushed.  The doctor wasn’t in the room most of the time so I had the midwife still telling me to push while my husband and doula cheered.  Nobody noticed but me so I did the only thing that I could think of at the time I started to fake push.

I didn’t expect my husband or doula to catch on because they’re not trained and not even focusing on the monitor but the midwife kept looking at the monitor to check for contractions yet seemed oblivious to the drop in heart rate.   It wasn’t until days later that I shared with my husband what had happened in that room.

I realized that I couldn’t fake pushing forever so as soon as the doctor came back into the room I pushed for real, it took 1 push for him to notice and immediately ask me to stop and say that for baby’s safety a surgery would be best.  By then I already had plenty of time to evaluate the situation and had come to the same conclusion so I admit that for a moment felt relief knowing that there was an end in sight.

I was surprisingly calm for the circumstances but at the same time I was terrified.  By then I was sure that Shammy would be alright so I only had to deal with my fear of the surgery itself.  And the rest as they all say, is history.

After the birth I had to deal with frequent flashbacks of being told to push and listening to the beeps in the monitor slow down only to pick up again when I stopped.  This scene has replayed in my mind endlessly for the past year. I was so happy to have a healthy baby yet I was crying regularly at the reoccurring memory.  After several days of nightmares I realized that this wasn’t the typical baby blues brought on b the typical hormonal changes.

At first I didn’t know what to do, therapy wasn’t an option at the moment and I was too exhausted and overwhelmed with a newborn to really apply my spiritual practices that have helped in the past.

At 1 week postpartum I broke down crying while the OB checked the healing of my incision.  I could see by how uncomfortable he was that talking to him was not an option so he helped in the only way that he knew how but pulling out his prescription pad.  I was prescribed an anti depressant but I didn’t immediately take it and instead chose to suffer longer.

The prescription for Zoloft had been filled, the pills were sitting on my desk but I wouldn’t take them.  I kept researching it’s effects on breastfeeding.  I was scared that the OB said that I would have to take them for a minimum of 3 months and couldn’t just stop them cold turkey, it felt like such a huge commitment since I couldn’t expect immediate results either.  My fears were somewhat calmed by Dr Punger sharing that I could only take it for a week if needed.

At 3 weeks postpartum my parents were flying in from Puerto Rico to meet their grandson.  Anyone that knows me knows that I don’t have a very close relationship with them and any sort of interaction with my family brings a wave of anxiety oftentimes resulting in full blown panic attacks.  In the past a shot of tequila would help but that wasn’t an option this time.

At the encouragement of my husband that is when I finally surrendered in hopes of having an amiable visit with my parents.  It helped a lot and I could see results sooner than I expected but I also started to experience side effects just as quickly.  I had to take the daily pill right before bedtime and I had 15 minutes to get settles before “the high” would kick.  But this wasn’t a good high, I felt like I was on a bad trip along with hallucinations, the only way to really deal with them was to sleep through it.  If Shammy woke up within 4 hours of me having taken the pill I couldn’t walk with him because I was just too unstable and would literally walk into walls.  Despite all of that I felt that the benefits were outweighing the side effects.

I did have to keep a close eye on how the pill was affecting Shammy.  I did notice that the fat content in my breastmilk had dropped greatly while I was taking Zoloft but that is something that I knew would happen and I just made sure that Shammy’s weight was regularly monitored.  He may not have gained weight as fast initially as other breastfed babies but he still held his ground on the growth charts and it was never an issue.

Another weight related side effect that I did notice was in my personal weight loss.  Before the pill I had lost 32 pounds of pregnancy weight by just sitting on the couch and breastfeeding but that stopped once I started the medication.  At first my weight just plateaued but after a month I gradually started to gain weight.  It wasn’t until I stopped taking the pill that I started to loose weight again but even then it has been slow but I blame that on my sedentary lifestyle and being less careful with my nutrition.

My original plan was to take the pill until my parents left town but then it became time for me to prepare to go back to work and that brought a whole new round of anxiety so I took it a little longer.  As you already know if you’ve been reading this blog a while.  I didn’t last long at work.  I was hopelessly depressed while at work and I spent more time crying at my desk or in the bathroom than getting any work done.  Add to that the challenges with pumping and management trying to change my schedule I don’t want to imagine how it would have been if I was not on medication.

Overall I took Zoloft for almost 4 months, once life started to feel stable and I felt like I had the hang of motherhood I started to self wean.  By then I didn’t have health insurance so even though I was supposed to step down with a doctor’s care that was not an option for me.  I started to take the pill every other day, after a while I went to once every 2 days.  Until one day I just forgot to take it, and forgot again the next day, and the day after that.

During that time I was experiencing some weird symptoms that had started to scare me, for a moment I even thought I had vertigo or some other sort of weird disorder but with no health coverage I couldn’t seek a diagnosis.  I had problems with vision and balance.  After about a week my husband wondered out loud if my symptoms were related to me not taking the pill anymore.  The thought had not crossed my mind!

So I consulted the doctor for the uninsured, Dr. Google and found no shortage of people in my situation.  I was experiencing withdrawals and my only option to feel better was to start taking the pill again.  I did not want to become a junkie, it had already been over a week so I decided that cold turkey was how it was going to be and I would just have to grin and bear it.  It took over a month for my body to fully detoxify and for all of the withdrawal symptoms to disappear.

For months I lived in fear of a relapse but thankfully it didn’t come to that.  I regret not having been able to have gotten traditional counseling but thank the support of strangers in PTSD/PPD and C-Section recovery forums for doing the part that the pill could not do.

I consider myself lucky that things didn’t get as dark as they could have and I have to give credit for me accepting that there was a problem early on.  It would have been a much steeper hill had I been in denial.

I am disabling comments on this post because just like I didn’t want to talk about it during the first year, I still struggle with bringing my vulnerabilities out in the open so this is being posted for that new mom days, weeks, months or years down the line that finds herself in the same situation and just needs that stranger’s story to know what she needs to do.  Just like that stranger mom with her blog post did for me.