Thursday, November 17, 2011

Breastfeeding, Increasing milk supply and a "tongue-tied" baby

Contact me on Facebook (link below) about this if you have any questions.  I realize I am not a trained lactation consultant, but I might as well be!  I have been through the ringer on this one, but I'll give you a summary.

Breastfeeding - I am so pro breastfeeding it's not even funny & will do everything I possibly can to avoid formula.  No offense to the formula feed babies, this is just my opinion.  I am also VERY stubborn so I'm sure this played a role in my mission to have a breastfed baby.  Sometimes when you have a c-section it takes longer for your milk to come in.  From her first initial latch it hurt bad.  She basically bit my right nipple so hard it was bleeding on Day 1.  She obviously had a taste for blood because she wanted nothing to do with my left breast.  I ended up having to pump in the hospital.  Mainly to stimulate my left breast, but also to kick start my milk supply.  I was pumping every hour almost and getting mere drops.  I would then feed these drops via syringe to Addison. Which I was told this small amount of colostrum is "normal".  A baby's belly is the size of a small marble after being born.   You can feed several ways - directly from the syringe to the baby's mouth, through a tube that you place next to your nipple & control the flow via syringe or turn your pinky upside down (nail facing baby's tongue) to encourage sucking & place the syringe with milk in the corner of baby's mouth.  When I breastfed at the hospital, the lactation consultant gave me a nipple shield.  The one they gave me was made by Medela & it was amazing! Using this to feed her was an absolute must.  The pain was unbearable to try to feed her without it. Well, I still wasn't making enough colostrum & she was loosing weight.  Babies will normally lose weight after birth, but once it becomes 10% of their initial weight, they start to worry.  On Friday at birth she was 7 lbs. 3 oz. and on Sunday when we left she was 6 lbs. 8 oz. so she was getting close.  The only reason why they even let me leave the hospital with her was because by Sunday afternoon I had just pumped 7 mL when the discharge nurse came in my room and it wasn't just colostrum anymore.  It actually had breast milk in it.  If I wouldn't have been able to do that, I'm afraid they would have admitted her to the NICU and fed her formula.  Once we got home, I still had to take her to the doctors office for almost daily weigh ins.  She got down to 6 lbs. 7 oz. on Monday's weigh in, but then back up to 6 lbs. 8 oz. on Wed.  Her weigh kept going up and down.  She hardly gained, we were going to weigh ins several times a week.  I knew my milk would come in & I didn't want to supplement with formula.  Confession - I would sometimes feed her in the car before the weigh ins just to see the increase in the numbers so they would leave us alone.  By 2 1/2 weeks she got up to her birth weight, but then dropped back down to 7 lbs.  She stayed around 7 lbs. for another week. - not good.  Finally a friend of mine from my prenatal yoga class told me she was going to go check out the lactation group/class at the hospital she delivered at & wanted to know if I wanted to go with her.  Thank heavens she did.  It was twice a week & they weigh Addison naked, weigh her in clothes and diaper before she eats & then after she eats so you know how much she is getting during a feeding.  My parents ended up buying us the scales from Babies R Us so I could monitor her weight daily at home.  My pediatrician was almost worthless when it comes to giving me a direct answer and we have changed to a new pediatrician.  When I asked how much she should be getting everyday, she said every baby is different.  Well here I am thinking breastfeeding is going great because my kid has the correct number of wet & poopy diapers, she's eating and kind of gaining weight, just not very fast.  Well, she was starting to want to eat every hour and was fussy a lot.  I had already cut out dairy & cabbage from my diet thinking that was why she was so gassy & I didn't want to give her medicine for gas at such a young age if I didn't have to.  After going to the lactation group/class with my friend, I found out that the previous lactation consultant at the hospital should have explained things a little better.  She told me to feed on each side for at least 15 minutes. She failed to mention that I needed to start feeding on the breast I left off with at the last feeding so the baby can get the rich, fatty hindmilk that comes after the foremilk.  The foremilk is very watery & not filling.  This is why she was wanting to constantly eat & was getting gassy which made her fussy.  Once I changed that, she hasn't been gassy or fussy & her feedings immediately increased to at least 2 hours apart.  As she has gotten older (and had her tongue clipped - a different post) she eats about every 4-6 hours and is getting between  5-9 ounces per feeding.      

Increasing milk supply - Now, it took a long time for my supply to increase & I have tried everything!  In the beginning, I was taking fenugreek and blessed thistle supplements, drinking 3 glasses of Mother's Milk Tea a day, eating big bowls of oatmeal for breakfast and oatmeal cookies throughout the day, eating fennel in my salads everyday, drinking water with chlorophyll twice a day, pumping at least every 4 hours, pumping every time after I breastfeed, doing compression of the breasts when I breastfeed & pump and I still wasn't getting full or engorged.  One time we fell asleep (including Addison) for 8 hours and I still wasn't engorged or full.  At first, when she breastfed, she was only getting around an ounce from me, but I could pump another 4-5 ounces out after she fed.  I found out she might be tongue-tied and that is why it was still painful for her to feed (without the nipple shields) and she hasn't been able to get enough milk from direct feeding.  I shouldn't be able to feed her and still pump 4-5 ounces afterwards.  She was obviously not getting enough to eat at each feeding.  Even now at almost 6 months of breastfeeding, I don't get engorged or full unless it is a night where she sleeps for more than 9 hours and I don't pump it out.  

Tongue-tied baby.... to clip or not to clip - At the recommendation of 3 lactation consultants I made an appointment with a doctor to see if she is tongue-tied and to cut the frenelum if she is.  I wasn't going to get it cut, but now I think I am. Since he was the best doctor for doing this procedure, I would leave it up to his recommendation as to what we should do.  I was considering getting it clipped because she was getting enough milk by bottle of my pumped milk and breast feeding was basically supplementing the bottles.  But then I realized how much easier it would be on all of us if we didn't have to take bottles of milk in the cooler for her & dragging the pump around if we were going to be gone from the house for more than 2 1/2 hours. I'm sure I look pretty classy with a bottle between my breast (yes, in public) trying to warm up the milk from the cooler to feed her if we aren't somewhere I can microwave a cup of water. I even have to pump in the car when I'm driving.  If she is tongue-tied and it gets cut, she should be able to take more milk, and since I come equipped with the milk jugs already, there would be no need for bottles & coolers.  Since she would be taking more, if I pumped after she ate, it would tell my body to produce more milk, so then my supply would increase.  Then I could start freezing & storing some milk instead of playing catch up (basically what I feed her in a bottle is what I pump right after). Right now, my left side produces double of what my right side does. There could also be a chance she could develop a speech impediment due to the tongue-tie.  Let me tell you - even though I said I was going to do what the doctor suggests, that was easier said than done.  After his exam he said we should absolutely clip her tongue.  My emotions took over and I immediately began to cry.  He explained it would be a very quick (10 seconds) procedure and then we would put her on my breast and let her eat and she would forget all about it.  Sounds good right?  Well, it didn't go that smooth.  Once the procedure is done, it would have been nice to know that I would have to use a tongue depressor and stretch her tongue each feeding for the next two weeks.  If I didn't do these stretches every time she ate, her frenulum would grow back together and we would have to do the clipping again.  Below are the entries in my journal about her tongue clipping.

7.27.11 --- We decided to get her tongue clipped. Honestly I thought her feedings were getting better (she takes in more milk & I am able to nurse without nipple shields), so I was kind of shocked when Dr. Murphy said he would recommend it. I was slightly hesitant, but I know Dr. Murphy knows his stuff, so decided to proceed. 

She didn't cry as hard as I expected her to. I'm sure it didn't help that after he cut it & she kept bleeding he couldn't find the Afrin (it is supposed to constrict the blood vessels). 3 gauze pads later, she is still bleeding & crying. 

The first feeding in the office was not immediate. I tried to get her to latch on the right side several times. She was crying too hard & I couldn't get her to calm down. Thoughts of regret were in my head as I looked down at my breast covered in bloody slobber & my baby screaming her head off. Finally I got her to calm down with the help of the nurse giving her .6 mL of Tylenol. After 3-4 times, we got a good latch, but it still hurt a little bit. She took in about 1 oz. from the right side. I burped her & started the left side. After 3-4 tries, we got a good latch. It hurt less than the right side, but Dr. Murphy said it was a good latch. She got a little over 3 oz. from the left side. 

The next feeding at home (around 6 pm) she got about 3 1/2 oz. and there wasn't too much pain. We stretched her tongue before the feeding. 

Next feeding she started nursing on the right side. It took 6-8 tries before getting a semi-decent latch. It still hurt, maybe even worse than before the procedure. No position I tried made it feel better & she kept putting her hands in her face. It just seemed like she never opened her mouth wide enough. I stretched her tongue after the right side feeding and before the left side feeding. I noticed a small, white patch on her right side to the outside (left, closest to the cheek) and the diamond (where the cut is) looked like it had a small yellow area bordering the edges of the cut. Perhaps this is scar tissue or an infection. I will have the LC at Scripps look at it tomorrow. The left side initially hurt, but got a little better. She consumed almost 3 1/2 oz. 

So far I must say I regret the decision. I'm sure her mouth hurts, but as of right now she is eating less than she did prior to the procedure, I am having a more difficult time getting a good latch & it hurts when she nurses (possibly more now). 
7.28.11 --- The right side still hurts pretty bad, not just during initial latch, but the whole time. She is getting a little more milk than yesterday, but only from the left side. The right side is far behind. 

The whole incision area is yellow, so I guess that's normal for a mouth scab. I haven't seen the white patch at all today. 
7.29.11 --- It breaks my heart to have to use the tongue depressor every time she eats knowing I hurt her & that's why she's crying. 

It still hurts very bad (on the right side more). Very painful for initial latch & only eases up a little. She is getting a little more milk at each feeding today. I really hope this gets better soon. As of today, I still regret having her tongue clipped. 
7.30.11 --- It still hurts very bad on right side. I just can't seem to find a position where it doesn't hurt. She has the whole areola in her mouth, so I'm not sure why it hurts so bad. The left side doesn't hurt as bad. The initial latch is painful, but it gets better. I had to give her 1 feeding today in a bottle to give my sore nipples a break. She is getting more in a feeding now. Twice she got 8 oz.
8.4.11 --- I gave it a few days to see if I would get better & it has a little bit. It still hurts really bad on the right side for the first few minutes. 

She is eating more at each feeding & eating less times during the day. She also seems to be sleeping longer & there is more time between feedings. However, my milk production is getting lower. There are times where she has to eat for twice the time to get the same amount of milk she did for the previous feeding. 
8.13.11 ---- Today (6:40 pm feeding) was the very first time she got a perfect latch on both sides & it didn't hurt at all. I thought she wasn't even on because there was absolutely no pain. Hopefully this will be the norm from now on. 

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