Survey on Lactation Support in Hospitals following Childbirth

If you are on my blog, you are interested in breastfeeding, right? Great, now please help me out for a minute as I try to learn more about the lactation support given to moms after having a baby.

I composed a very short survey (it should take you no more than 3-5 minutes to complete) that focuses on the support received in the hospital after you had your baby, if you got any help, that is. I read lots online about "bad" LCs and nurses who think they know how to consult a new mom but offer pathetic, unhelpful advice and I am curious to know how often this is happening. Other moms say that their hospital LCs were so amazing that if not for them, they wouldn't have breastfed longer than a day. So let's see.

Here is a link to the survey.

Some questions we'll consider:

• Do mothers receive lactation support in the hospital after childbirth?
• Do mothers receive help from IBCLCs or non-certified lactation consultants?
• How knowledgeable is that consultant?
• How effective is that help?
• Do mothers receive all the help they need at the hospital or do they require follow-up later on?

Breastfeeding vs. formula-feeding pros/cons for Mom

It's interesting that some of the very pros of breastfeeding are the same as those for formula-feeding, but in different ways! Just goes to show you that either method may work beautifully for each individual mom. At the end of the day it's up to you and your baby to figure out which method to use.

I've compiled a list of some of the benefits and disadvantages for both sides of the debate, from the mother's point of view. I've actually enlisted the help of my mom friends who formula feed so I can get some accurate and useful information from them. Stay tuned because I'll keep adding as I think of more pros and cons!

BREASTFEEDING PROS:

• You can breastfeed almost anywhere, any time, etc. without worrying about leaving bottles and formula at home. 
• You get to sleep more (at least in the early days) because you don't have to go make bottles in the middle of the night, nor do you have to be so on top of burping during and after feedings.
• You lose your baby weight faster.
• You lower your risk for contracting certain diseases (ovarian and breast cancer, for example)
• Lactational amenorrhea can give you months and even years of no periods!
• If qualifying for WIC and nursing a baby, you may be eligible to receive food benefits for a full year (instead of 6 months if you formula-feed).
• No nasty odor on your baby or his clothes (from spit-up) or in his diaper! 
• Baby is protected from lots of illnesses and receives your immunity from even more illnesses so you don't have to tend to a sick child as often.
• Baby may take to solids easier since he is exposed to a variety of tastes from his mom's milk since birth.
• You can use your breastmilk for so many physical ailments (e.g. in ears for during infections, in the nostrils as a moisturizer, to heal bruises quicker, for conjunctivitis).

FORMULA-FEEDING PROS:

• You can give a bottle almost anywhere, any time, etc. You don't have to pull over during car rides.
• You can leave baby with a caregiver for extended periods of time. You're not tied down to the baby's schedule.
• You don't get any of the hormonal ups and downs associated with breastfeeding
• Anyone can feed the baby, like Dad! Especially handy in the middle of the night.
• Easy option for feeding a baby if a mother has a complicated delivery and is unable to nurse.
• You know exactly how much your baby drank in a feeding so no second-guessing there.
• Your figure doesn't change much so you can actually fit into clothing you used to (no automatic boob jobs for you).
• Bottle-feeding is more accepted in public situations so you don't have to leave the room to go nurse.

BREASTFEEDING CONS:

• Hormonal differences - your body might not behave the way it did pre-pregnancy. 
• Physical issues such as inverted nipples, nursing pain, latch issues, IGT (insufficient glandular tissue)
• Milk supply levels can be a concern at times
• You have to pump if you work out of the house and can't nurse your baby.
• Only you can feed your baby, nobody else! Unless, of course, you pump (ugh).
• Not all contraceptives are ok for a breastfeeding mom.
• Mother has to watch what she consumes: no alcohol, unsafe medications, foods causing an allergy in her baby etc.
• It may be impossible to switch to nursing if you haven't early on, or if a long while has elapsed since you last nursed.
• Nursing may make you feel like a "cow" (or like having one!)

FORMULA-FEEDING CONS:

• Formula has a nasty smell and is annoying to prepare the right way (following the guidelines).
• The nasty smell continues to spit-up, diapers, etc.
• Formula stains clothing.
• Formula is expensive! So is a full stock of baby bottles.
• You can't just decide to give your baby a bottle anywhere if you're not properly equipped.
• Washing out bottles isn't that fun.
• Baby may be allergic to some formulas

Nursing at night and milk supply

On a parenting forum, someone wanted to know if she can skip feedings at night (and have her husband give the baby a bottle those times) and still keep her milk supply at a good level. It got me thinking about the ramifications of this breastfeeding "shortcut".

In the beginning, when your baby is a newborn, you start founding your milk supply "factories". Nurse often, on demand, and you are setting up lots of factories in full production mode. Nurse only sometimes, or most of the time (but not each time baby has to eat) and you're leaving out some valuable establishments. In the beginning your milk is just being produced based on your hormones that were set into motion when you experienced labor and delivery.

It's also so important to nurse AT NIGHT especially because your milk-making hormone called prolactin functions at its best during the night. So one nursing session at night can be much more effective in maintaining your supply than a session by day.

Now, at some point your milk supply will regulate. Your hormones that accompanied labor and delivery are phasing out and your milk won't be gushing out like there's no tomorrow. This point varies in women. Some find that their milk regulates at six weeks, while for others (especially those with oversupply issues) tend to find their supply regulating several months later. My supply regulated when Sam was three months old. This can happen overnight, suddenly, or gradually (for me it was rather suddenly).

At that point, your system of supply and demand takes over. Now is when your factory system comes into play. If you have 5 factories in working order versus 15 factories, it'll obviously be way harder to keep up to the demands of your baby. That's why it's so important in the early days to nurse, nurse, nurse. Your baby cannot overdose on nursing.

Some mothers who skip feedings at night will have no problem with nursing later on. But many do. A key difference would be whether the mother is separated from her baby during the day or stays at home with her child. If a mother has to pump because of a separation, it can be a lot more difficult than nursing on demand if she was at home. Say you can't produce enough with the pump, now what? But if you're at home with your baby it's a lot easier since you can nurse several times that day if your baby doesn't fill up with less feedings.

Additionally, lots of mothers have oversupply issues so skipping a feeding might make them uncomfortable later on, but wouldn't really harm their supply. Also, just because a lot of people can manage doing something, doesn't mean that this is the norm and the "right" way to approach something. A lot of people don't wear seat belts and don't die in car accidents, just as a dramatic example.

What does breastfeeding feel like?

I saw this amazing quote in a thread on La Leche League's forum, written by MaddieB:

"ONLY mom has the goods. No one else can provide your child with what you can when it comes to nursing. Nursing is not really like anything else. Imagine the most delicious drink, the most satisfying meal, the most loving hug and the sweetest kiss all wrapped up in one package. Throw in a magical balm that instantly relieves both physical pain and emotional anguish, and you will begin to have some idea about what nursing feels like to a child."

Hungry? Or not?

I met a cousin of mine over the weekend. She is a new mother to a 6-week-old baby. When I casually inquired how breastfeeding was going, she smirkingly answered, "Oh, my baby gave up on me after a few weeks!" Then she explained that her baby was always "hungry" after nursing and "she always wanted a bottle afterwards" so "I wasn't going to starve her."

After hearing that I really felt bad that this happened. Of course every mother knows what's best for her child but sometimes a bit of myth-y information can really lead her to make uneducated guesses and then decisions that probably aren't best for her baby. Let's see if we can figure out what went on with my cousin's baby.

My cousin was able to pump normal amounts of milk so she did not have a milk supply issue. Her baby was able to suck ok and transferred milk fine. Her latch wasn't a problem either. So then what happened? Babies love to suck. If a baby is given a pacifier, he'll probably enjoy it! A bottle is like a pacifier in that sense so many babies will gladly take a bottle at any time if offered (although Sam was NOT that kind of kid) even if they aren't hungry. Think of yourself after having eaten a delicious dinner of rib steak, fries and vegetables. You're probably feeling well-sated and going "ahhhh". But if I then served you a gorgeous dish of gooey chocolate brownie and mocha ice cream with fudge sauce, would you honestly turn me down? Babies love a good dessert too (and formula tastes great).

My cousin nursed her baby. Her baby was probably satisfied with the feeding, but probably not overly full (like bottle-fed babies tend to become after a feeding). Her baby cried for any of the following reasons: gas, general fussiness, the need to burp, dirty diaper, wanting to nurse for dessert, wanting to be held, or one of the other thousand inexplicable reasons why baby cry. She assumed her baby was hungry and offered her a bottle, which she slurped down (think of yourself attacking your dessert plate with gusto). Was her baby truly hungry before the bottle? No.

There's actually a condition called "Perceived Insufficient Milk" (which I believe I've experienced at some point!) where a mother honestly thinks she doesn't have enough milk for her baby. This happens when a mother misinterprets her baby's cues for hunger and she therefore thinks her baby is always hungry even though she isn't. This often causes premature weaning because the mother will just end up supplementing, assuming there are no solutions anyway.

Sleeping through the night and breastfeeding correlation

I randomly thought about this the other day and I wonder if this idea is of any significance. I noticed that mothers of babies who sleep through the night early on (sleeping longer than 6-8 hour stretches, in this case) are less likely to nurse their babies past the half-year mark. It's just that whoever I talk to whose babies were such good sleepers as newborns and young infants said they didn't nurse beyond a few months.

Here's why I think that happens. It's widely known that milk production gets a real boost during the nighttime when prolactin, the milk-making hormone, is at its best. Nursing (or even pumping) at night really gives your milk supply an edge even beyond the nighttime. Now, if a mothers isn't breastfeeding her baby at night because the child sleeps through the night (and why wake a sleeping baby?) her prolactin doesn't really get chance to shine.

If milk supply isn't given that extra oomph from nighttime nursing, it might not function so well during the day. This is even more hampered if a mother works full time and has to rely on pumping during the day to keep up her milk supply. If a mother can stay at home with her child and nurse on demand then this probably isn't such an issue because a nursing baby can effectively extract enough milk (whereas a pump doesn't do that great of a job).

Now this is far from a scientific fact; it's just a speculation on my part. What do you think? Do you have evidence to support or disprove this claim? If yes, share it! I will try to conduct a poll about this on a breastfeeding website and share the results here.

Finger-feeding a baby who can't breastfeed

Sometimes a baby is born with some sort of difficulty which makes it hard for him to nurse properly and or obtain a good latch. Sam was like that. Due to his tongue tie he wasn't able to latch onto my nipples or even suck that well. Only the second day did he attempt a little sucking and by the third day he was able to actually nurse for an entire feeding. So what happened during this time? The hospital staff fed him bottles. I had no choice, really. They did not tell me anything about hand-expressing colostrum (idiots) and they just found it easier to feed him formula, so that was what happened. My sister did give me great advice about that, though. She said to have the nurses use a breastfeeding-friendly method when administering the bottles.

If you read what the internet has to say about that, you'll see all kinds of suggestions from using an SNS (supplemental nursing system), to cup-feeding, spoon-feeding, dropper-feeding, and finger-feeding. The SNS is a really helpful tool (based on what I've read online and heard from mothers who have used them) but I don't have much info since I've never tried it out. Cup-feeding and spoon-feeding sound very messy to me. I know that Sam couldn't easily drink from a cup until he was several months old so no way could I see that working when he was a few days old! Droppers don't sound bad, and I've resorted to using that at times when he was reluctant to eat (I have plastic pipettes).

Which leaves finger-feeding. How does this work? You (or whoever is feeding the baby) wash your hands (important!) and fills a bottle with milk or formula. Then you attach a lactation aid which is really a thin tube that can attach to the baby bottle. Tape the other end of the tube to your finger and let your baby suck your finger as if it's a nipple or pacifier. Release the milk into the tube and your baby is now being fed!

This was a great method to use in our case because Sam was able to build up his sucking muscles while eating, but without the nipple confusion a regular bottle would have caused. I wanted him to learn to suck on skin, not silicone. I actually never did this because the nurses in the hospital were doing it for me, but the technique did work to help Sam suck better, and it got him fed without a bottle!

So if you're in such a situation where your baby can't nurse for whatever reason, don't give up hope. You probably can sort out your breastfeeding issue, whether it's a physical issue like tongue tie, or a milk supply issue. But in the meantime, there is no reason your baby has to be given a bottle. Bottles don't help as well as other breastfeeding-friendly methods do. Plus you can give your baby your own milk most of the time!

Getting a breast pump from your insurance company

I recently got a message through my contact form at the right from Shaffizan, who wrote this post on her blog. She brought up a valid point about obtaining breast pumps from one's insurance company. I'll elaborate on that a bit now.

A good double electric breast pump is an expensive item, no question about it. It's this machine trying to replicate what the human body does, so I guess that's why it isn't cheap. When you have a baby, your expenses rise like a newborn's cry and the last thing you want is yet another important but pricey item to send you over the edge. Just to give you an idea, Amazon has the Medela Pump In Style Advanced Backpack model for $218 and the Ameda Purely Yours for $159. And these are priced at below retail price. If you're like me, you're just not interested in one for that price. Especially when you know they won't last for more than a few years at best.

Enter the new Affordable Care Act which you may or may not approve of. But one thing's for sure, they definitely had breastfeeding mothers in mind (yay!). Under the ACA*:

"Your health insurance plan must cover the cost of a breast pump – and may offer to cover either a rental or a new one for you to keep.

Your plan may have guidelines on whether the covered pump is manual or electric, how long the coverage of a rented pump lasts, and when they’ll provide the pump (before or after you have the baby).

But it’s up to you and your doctor to decide what's right for you."

So the best thing to do is to call your insurance company directly, preferably before you have your baby, and ask them about their breast pump policy. It's probably easier than to go through the ten-inch thick insurance contract book. They will tell you which suppliers they're affiliated with, and you will have to be in touch with them about placing your order. Some insurance companies require you to order the pump within 30 days of giving birth so it's best to find that out early on. It's really that simple.

Now what's if your insurance company won't provide you with the model you really want? Or what's if you want to own a second pump (so you can leave one at work and keep one at home for days off)? Here's a little tip. Since basically everyone's insurance company is providing them with pumps, what's if you don't actually need a pump? They'll still give you one. So these folks now have pumps that are not in use, just collecting dust. Then they sell them on eBay or someplace.

It's not too hard to find brand new still-in-the-box pumps being sold on eBay by people who got them from their insurance companies. How do you know? They come in the same insurance-given packaging (instead of the retail packaging you find in the store). Often, you can find a good deal on these pump since the sellers don't mind making a quick buck and aren't asking for the full retail price anyway. This is how I bought my second Ameda Purely Yours pump for $45 (brand new, never used).

I personally would not use somebody else's already used pump unless I just use the base and buy my own attachments. Even though most parts could be sterilized depending on the model, there are some areas that can't be sanitized well enough without damaging the equipment. Sometimes this works as another cheap alternative: borrow or buy off somebody's actual pump, but then buy the new pump parts.

You can read more about my pumping experience here.

*The ACA will also cover other breastfeeding-related needs such as lactation support. It also requires larger companies to allow pumping time and a place to pump for mothers who require it.

Sleeping training and schedules with a breastfed baby

The words "sleep training" are all a frazzled mother needs to hear to bring on a case of night terrors. We all want our babies to sleep peacefully through the night like little adults, but we don't want to teach them. Much like toilet training - we wish they would just finally use the bathroom like big kids, but who wants to mop up the accidents? Yet, we've all got to do it one way or another, unless you give birth to an angel who sleeps through the night since being a newborn.

First I must mention a few key points:

• Maybe the most obvious one, every baby is different. The sleep tactics that work for your friend's baby may not work as well for your baby. And formula-fed infants may sleep differently than your breastfed baby.
• A sleep problem is only a problem if it's a problem for you. Your baby is fine and is probably getting enough sleep the way he/she is. You only need to sleep train if it bothers you.
• Babies who sleep through the night from day one - sounds like a dream, doesn't it? Well, if you are a full-time working mom and need to pump more than once a day, you probably want your baby to nurse at night to maintain a good milk supply. Which brings me to my next point:
• Nighttime breastfeeding is SO good for your milk supply. This is because the level of milk-producing hormone prolactin is much higher at night and you want to take advantage of that.
• What I found - and this is by no means a scientific, proven theory - is that mothers whose babies sleep through the night very early on stop breastfreeding earlier than mothers whose babies nurse throughout the night. That's just what I noticed among friends and family.
• If you want to sleep train, you and your spouse have to be 100% committed to doing it right. You can't chicken out mid-way. If you don't feel ready, wait. 
• The term "sleeping through the night" (or STTN) has a wide definition. It can mean anywhere from 5-7 hours in a shot, to sleeping 12 hours straight. So take it with a grain of salt.
• Sleep training technically shouldn't be tried until a baby is four months old. However, that's precisely the time their sleep becomes all wacky anyway, so I wouldn't bother until about 6-7 months. Also that's when babies are distracted by daytime feedings, so they cash in on the calories they could get in the peace of night. Don't deprive them!
• Normal napping ensures good night sleep. If don't let your baby nap, thinking they'll be "good and tired at night" you'r just setting yourself up for an overtired baby.
• Follow established sleeping guidelines to know approximately how much sleep your baby needs at night. For example, a one year old shouldn't really be sleeping from 11pm to 8am and having random naps (though this schedule works great for a much younger baby!). 

There are basically two schools of thought regarding sleep training: (1) methods that involve letting a baby cry it out (CIO), or (2) gentle, no-crying sleep solutions. The first has been popularized by Richard Ferber, the second by Elizabeth Pantley. It's really up to you to decide which to use. The first is much, much quicker, but it can be pretty heartbreaking to let your baby cry when you know that a quick feeding will heal all. It's almost always effective and working after a 3-5 days. The second method is long drawn-out process that involves keeping sleeping logs and gently getting your child to sleep through the night, and it can take several weeks to months to achieve STTN.

I'll admit, I bought Elizabeth Pantley's book and found it really enjoyable, as a book. I learned a lot about baby's sleep habits and things like that, but I did not find the ideas implementable. For one, I work so I'm not with Sam all day and can't keep track of all his naps and stuff. Besides, the book kind of relied on the fact that the reader's baby is having normal, long naps each day. Sam took 3-4 smaller naps each day at that point.

Also, I have to say that I don't mind a little seemingly harsh training if the results are effective and if they would help both Sam and I sleep better. So I looked into Ferber's theory and found it pretty simple. I would have to let Sam cry for small increments of time before going in to calm him down and increase those amounts each time.

At the time of training, Sam was about 8 months old. Each night, I would nurse him before bed and then put him (awake) into his crib. He would cry a few minutes later. I'd go in and reassure him. Come out. Cry. Go back in. Usually I'd just rub his back till he fell asleep. Eventually he fell asleep. He'd wake up 2 hours later or less, and I knew he wasn't hungry since he just ate, but I still fed him. He wouldn't even nurse for that long (proof that he wasn't really that hungry). I know some of you might argue that he needed the comfort and all that, and maybe that's true. But he definitely got comfort from all the other breastfeeding times that he didn't absolutely require it every two-three hours at night.

After so many nights of broken up, choppy sleep, I decided we had to train him and we'd do it gently. No cold turkey for me. So I decided to go with reasonable chunks of time, which was 4 hours. If Sam woke up before 4 hours since his last feed I'd let him first cry for a minute or two to see if he actually needed me or would go back to sleep on his own. If his crying persisted, I'd go in after five minutes and then pat him and reassure him and help him find his pacifier. I walked out. If he went back to crying, I'd wait 7 minutes before going back in. Then 15 minutes. I never had to go back in more than 3 times. By the fourth night, he fell asleep for the night on his own without crying. And if it was four hours or more since his last feed, I'd just nurse him back to sleep like I've always done.

You know what? When he put himself to sleep he slept much, much better! He would sleep for longer chunks of time. We used this method to eliminate the 2-3 AM feeding which I really felt was unnecessary since he ate a lot at the 11-12 feeding (right before I went to bed).

So if you're feeling brave and or if you've had it with the incessant feedings and comforting in the middle of the night, try this. You have nothing to lose. Just give it your all. This won't work if your husband feels bad and will sneak into baby while you're chewing your nails in the other room during a crying bout. Both of you should follow the plan you create (e.g. creating a time limit, such as four hours, and using Ferber's method for when your baby wakes up earlier than that).

A baby who sleeps well at night wakes up HAPPY.

Let me know what works for you and what doesn't!

Printable feeding clock for new moms

When you're discharged from the hospital after delivering your baby, the staff will send you home with a badly photocopied feeding chart with all the hours written out, and you're supposed to circle the corresponding hour each time you feed. This way you can keep track of how many feedings your baby gets over a 24-hour period. That's great for the really early days, maybe a week or so. But afterwards, all you really want to know is when you last fed your baby. It can be hard to remember little details like numbers when you're so busy nursing, sleeping, changing diapers, etc. while your sleep tank is running on empty.

Printable feeding clock

So I created a handy printable clock that lets you keep track of prior feedings when you don't have a pen handy, or can't write (great for Sabbath). You can hang it on your fridge with a magnet and your baby's last feeding time will be prominently displayed in either pink or blue.

INSTRUCTIONS: Download and print the feeding clock or click the thumbnail to the left. Cut out the circle of the clock, along with both handles. You can use pink or blue for a girl or boy, respectively, or you can use both to show the last two feedings. Poke a hole in the center black dot of the clock, and the dots on the hands. Affix the hand/s to the center of the clock using a paper fastener. Alternately you can use a small magnet to hold it in place on the fridge, or affix the hands to the edge of the clock with a paper clip.

To use, simply move the hand to display the correct time when you finish feeding your baby.

What I wish I could tell every new mother

New! This list is now available as a printable!

I get so outraged when breastfeeding mothers receive inaccurate information and advice, especially when it does more harm than good. And the eager-for-education, naive new mother believes everything! So this is an ongoing list I wish I could share with all new mothers out there. I'll keep adding as I think of new things:

• Nursing is supposed to be uncomfortable in the beginning. But not for longer than a week or two. If it does hurt for longer than it should, have your baby's latch evaluated to make sure that that's not the issue.
• There is NO need to "practice" giving a bottle a day to your baby in the early weeks. This does not make your baby any more willing to take it when he or she is a few weeks old. I know this from experience. We gave Sam a few bottles when he was under 3 weeks old, which he took fine, but then he refused each proceeding bottle for a long while. We later figured out it was due to excess lipase in my expressed milk.
• If your baby is jaundiced, there is really no need to stuff your baby with formula instead of breastmilk. Breastfeed as usual, or even more than usual, and that should help in almost every case. The goal of formula in those cases is to pump digestion and elimination to rid the body of bilirubin, but breastmilk can do the same thing.
• Using an electric pump should not hurt at all. If it does, it doesn't mean that pumping is not for you - it's simply a sign that you're wearing an ill-fitting pump (or you have a plugged duct).
• Not everyone gets engorged in the beginning. I never did and milk supply was pretty fine for a while. In fact, I was probably experiencing oversupply in the early days!
• Don't be ashamed to breastfeed your baby out of the home. If you find it uncomfortable to do so in public, find a quiet or unused room and face away from other people. Don't let that stop you from venturing out of your house!
• There is no good in nursing your baby for 10-15 minutes on each side. Why is that a magical number? It isn't. Nurse on one side until your baby won't take anymore from that side, and then switch. Next feeding start with the second side. 
• Nursing babies don't normally sleep for long stretches at night until much, much later. If friends are bragging that their breastfed babies go 12 hours at night without eating, take it with a grain of salt. And remember, that's no way to maintain a healthy milk supply.
• Plugged milk ducts are NOT breast infections. They may cause one if left untreated for a very long while, though. For the record, I've had plugged ducts lasting up to a week without any infection (and the infection I did have was not even caused by a plugged duct).
• You don't have to give your baby bottles in the hospital (or any time) if he is nursing well and gaining weight. If you offer your baby a bottle after nursing he will probably guzzle it down because it's fun to suck, but it does not mean that he was hungry!
• Pumping after nursing is a great way to boost supply but there is no need to pump if you are not planning to be separated from your baby or if you already have enough milk. When doing so, pump immediately after a feeding to bring out the hindmilk (fatty stuff).

There's nothing better...

... than breastfeeding a sleepy Sam until he falls asleep on the boob, then picking him up and letting his soft freshly-washed body lean on my chest, his fuzzy head nestled on my shoulder, breathing little puffs of air against my neck as he exhales each contended breath. It's pure bliss.

It makes me feel so grateful to be a mother, and so proud of my accomplishment of breastfeeding him thus far. It wasn't - and isn't - an easy street all of the time, but there are lovely scenic views along the way. You just have to make sure to stop at them and realize how beautiful they are. Moments like these need to be treasured. Before I know it, Sam will want to wean.

I don't get this every night, though. Often, bedtime feedings will still find Sam awake afterwards, only to promptly fall asleep in his crib a few minutes later. Which is good. It's great for babies to wake up in the same place they fell asleep. That way it's less confusing to them. If I feed Sam before I go to bed for the night then he will fall asleep while nursing and I get to enjoy him like this. But in the middle of the night, you gotta admit there isn't much appeal to nursing and no fun in sticking around to cuddle when you're so tired.

Fresh frozen and the excess lipase saga

Oxymoron? A scary thing happened to me, I freaked out, I worked to combat it, and it miraculously righted itself with an easy solution: fresh frozen.

Last week Monday Sam refused his normal amount of milk at the babysitter. He usually has a 5 oz bottle at around 11ish and then a 4 oz bottle at around 2-3. That day he had a total of 5 oz. Tuesday he did that again. Same with Wednesday. Each of those days he came home with the remainder of the milk in the bottle. It looked yellowish. I smelled it. I almost barfed. But milk smells, I've heard, so I daringly tasted a drop and BLECHEROO! It really tasted soapy and metallic. No wonder Sam turned it down. He has better taste than that. 

Turns out my milk has excess lipase. There are SO many articles out there that discuss it so I won't go into too much detail. But basically, everyone's BM has lipase, which is an enzyme that breaks down the fat so the baby can digest it. Usually this breaking down of lipase does not happen right away (I think it takes place inside the baby's body), but in some people, they have so much of it that the milk fat becomes broken down much quicker. Some people 4 hours later, some a day later, and some only find their freezer stash of one month old milk is bad. So it's really a unique situation for everyone.

What does one do about that? Some babies are totally cool with the yucky taste and drink the milk anyway. It's perfectly safe. Remember, the milk is just broken down, not spoiled. If baby will not drink it, don't blame him because it truly is yucko. The solution? Heat the milk (aka "scald" it) to 180 degrees and then quickly cool it before storing - this deactivates the enzyme and keeps your milk tasting delicious. That's such a pain, though, if you have to scald at each pumping session because your milk won't last the day in the fridge.

I decided to see how long my milk can "last" before it gets that ewwy taste/smell. I pumped a bit and put it in the fridge. After 4 hours it was fine. After 8 hours it already had a faint metallic taste. 24 hours later it's a strong metallic/soapy taste, plus it smells bad when heated. It didn't smell in the fridge when cold. 

Now this brought back to mind the early days when I went back to work. Sam did not take the bottle willingly at all. He would drink just an ounce or two and then another ounce or two a few hours later. He ate just to tide him over until he got hungry again. Poor boy. He did nurse well once at home and made up for it so I wasn't too worried. He was gaining weight as well. After about 3-4 weeks he would take a complete bottle. Now I think I know why. I'll bet that milk was also lipasey. In addition, Sam doesn't eat warmed up milk that slowly thawed in the fridge. Only milk that went straight from freezer to hot water. 

Later on he either A) got used to the taste and realized this is the situation and you gotta adapt, or B) the lipase was only really bad in the early days, which is common because there is more fat then or something. 

Well, now it seems to be bad again. Also lately I would freeze my milk only once I prepared the bottles for the next day - which was nighttime. Many hours after I'd pumped. So it was in the fridge during most of the day, slowly ickifying itself until the next afternoon when Sam would unwillingly drink just a bit. In the past I'd freeze the milk at work already, right after pumping - I don't know why. I just did that. Turns out that was the key to my solution.

I sent Sam some milk for this Monday that was scalded. He drank it beautifully. It also did not turn yellow, according to the babysitter. And the residue remaining in the bottle by the time he came home did NOT stink. On Tuesday I sent him with fresh frozen milk - milk that was frozen immediately after pumping - and he also drank it all really nicely!

Top: milk unaffected by lipase
Bottom: milk affected by lipase

So for now we are sticking with fresh frozen so I am spared the time-consuming task of scalding it each day. Freezing, I will dutifully point out, does cause some of the milk's important properties to be lost (scalding can also do that, btw), however it is MUCH better to serve this than formula. It's really of no health concern unless the baby only drinks frozen milk - we are talking just two bottles a day here, so no biggie.

Just a reminder: Milk that was affected by lipase activity looks yellower when thawed (but whiter when frozen), looks really fatty when warmed up, you can often see small globules of fat, it smells really bad, and has the taste of metal or soap. It IS safe to eat. The best thing to do if your baby is refusing bottles is to not blame it on the bottle - just taste the milk and you'll know for sure! Also, if you store milk for a freezer stash, defrost a bag every two weeks or so and make sure it tastes/smells fine.

Notice the picture on the left: The milk on top looks like milk should look when frozen. Pale yellow color, of even consistency. The bottom bag contains milk in which lipase already did its thing. You can see separate fatty sections and the milk is overall whiter and thicker looking.

No more pain at 3 months!

At three months breastfeeding stopped being painful, which is a ridiculously long amount of time to have to wait for it to start being enjoyable, if you asked me. What happened? One Sunday evening I came down with a stomach bug that totally cleared out my system from all fluids. I couldn't eat a thing or drink much either. At the time I didn't realize what not eating and drinking can do for your milk supply.

The next morning I woke up feeling fine but my boobs were like they were before I got pregnant! Very soft and small and empty. I nursed my baby and to my shock, it was a completely pain-free experience. I never had that. My supply definitely did drop, but I am thinking that maybe my milk supply suddenly regulated at that time.

Milk supply is initially regulated by hormones produced during childbirth and the body usually produces a lot of milk. Many moms feel engorged in the early days (I never did) and have oversupply issues. I think I had the latter. I always felt full. I often got plugged ducts. Sam's poop was lime green and frothy a lot of the time. That's a sign of a foremilk/hindmilk imbalance, by the way. More on that a different time. I guess I produced a lot (I was able to pump way more than my baby needed), I always felt full - which leads to two things:

A) Full breasts means that a baby with a tongue-tie can't latch on so well so that leads to painful nursing and all that soreness.

B) Full breasts means that there is lots of foremilk (watery, sweeter, lighter milk) that gets eaten in the beginning of the feed, and by the time he's full, he's hardly even touched the hindmilk (fattier, richer milk). That's probably why he had green diapers.

Another thing: I began to feel letdowns for the first time!

How a tongue-tie is resolved

The proper term is actually "revision". Tongue-ties are revised. On a fine Monday morning when Sam was about five months old, we took him to Dr. Tali Lando of ENT Faculty. She checked his mouth and agreed that he has a posterior tongue-tie, but it's not one of the bad ones she's seen. Still, the good doctor claimed, it pays to just deal with it now while he's a baby and the procedure is no big deal to perform and recover from. Here's how it went.

We laid Sam down on the examining table and held his hands and feet. An assistant held his head down so he faced the doctor. Dr. Lando gave him a quick shot to numb the area (Sam cried for just a few seconds after that) and then snipped the offending frenulum, which took just a few seconds! Then she pressed a gauze on that area to stem the bleeding. When she removed it, the gauze just had a pale peach-colored stain - no bleeding! I was told that I should try to nurse him right away as that would help the area heal quicker. I was only too happy to oblige. Nursing really comforts Sam (and me!).

I nursed him and didn't see any remarkable difference yet. His suction felt like it always did. For the next few days after the procedure, Sam nursed a little less than normal and it did not feel any different than it did before. THEN we noticed a change. A few days later my nipples got sore! Oh boy, did they get sore! Sam also went from nursing for 15 minutes to about 7-10 minutes. By now, at 8 months, he nurses for about 5 minutes. His lips also flange out the proper way, surrounding the nipple in a proper latch. No more lipstick nipples either.

I wondered why I didn't see a change in his feeding right away. Then it occurred to me. He was using brand new muscles that had never yet been within his range. When using them in the beginning, just after the revision, these muscles would tire easily until he exercised them enough to endure an entire feeding.

Tongue-ties

Myth: It's normal for breastfeeding to hurt for the first few weeks.
Fact: It's not.

I thought I was normal when my boobs were sore, uber-painful, bleeding, cracked and chafed at three months postpartum. Everyone said they'll stop being painful at around 3 months. It's true that they got better then, but this is NOT the norm. There must have been an underlying problem.

When Sam was 3 months old, I called Chonyi Glassman, a lactation consultant and IBCLC. After a full assessment of his mouth and sucking capabilities, she determined that he had a posterior tongue-tie which isn't so visible to the eye when you look at him face to face. Also, she said he doesn't suck well, probably because of the tongue-tie. She recommended asking my pediatrician about it. I asked him and he said that since his tongue can't reach past his lips, I should take him to a pediatric ENT. Then she measured how many ounces Sam consumed in a feed. It was 1.5 ounces - but he wasn't so hungry at the time. Still, that amount in 10 minutes is hardly efficient. These are the pacifiers she recommended to help his sucking become stronger.

So what is a tongue-tie? Grab a mirror and stick your tongue out at it (say "ahhhhh"). Notice that string-like band connecting your tongue to the floor of your mouth? In some babies it's either too short or too thick, and this restricts the movement of the tongue. If it's further back, it's a posterior tie. This doesn't let a baby suck properly. It can even cause speech and feeding problems later on. It's also genetic. In fact, people with an MTHFR gene mutation are prone to midline defects, and tongue-tie is one of them. I know this runs in my family and a niece/nephew or two has had a tongue tie.

Other signs Sam presented that can be tied to tongue-tie (at the time I did not realize they were all connected to his condition):

• Narrow and painful latch
• Vasospasms (spasmodic nerve-like pain in the nipple)
• After a feed, nipple looked like the top of a lipstick
• He would latch and unlatch repeatedly during a feed
• He couldn't stick his tongue out past his bottom lip
• Top lip curls under and cannot stay curved outward during a feed
• Breasts never really felt empty after a feed

My pain mysteriously disappeared one day when Sam was three months old (not too long after my appointment with the LC), an experience you can read about here. If you don't have patience to read about that, suffice it to say that BFing became enjoyable - finally! - and I didn't have any major motivation to go to the ENT and check it out. But then I found out about the ramification of leaving it unresolved (see above) so one day I booked an appointment for the ENT, whose next availability was in two months from then! Read on to see how his tongue-tie was resolved....

The early days

When Sam was just born, the nurses handed him over to me and encouraged me to nurse him then and there, in the delivery room. I was waiting for this bonding moment for so long, and now it was finally happening! I would provide liquid gold for Sam to enable him to grow and thrive. But Sam had other plans. He was licking my nipples like they were lollipops, but not sucking at all. Aren't babies supposed to be born already knowing how to suck? That's what I had read, but that's not what was happening here. The nurses then whisked him out of my arms and went to measure him, weigh him, and all that.

They brought Sam to me a few hours later and still, he wouldn't suck at all. I held him and we did lots of skin to skin contact, and no go. A few hours after that, a really persistent, pushy and stubborn nurse tried to force Sam's mouth over my nipples and squished my breast into his mouth. He just cried. What a moron of a nurse. You can't force a baby to nurse, and even Sam knew that. Then the nurse tells me that since he hadn't eaten a thing since he was born (about 9 hours), they have to give him formula. Nobody mentioned the concept of hand expressing. Why not? I did know enough to tell the nurse to finger-feed him, rather than using a bottle. This would encourage Sam to suck properly and learn the texture of a finger, rather than a silicone nipple.

So Sam had formula for a day in the hospital. The second night we got an amazing nurse who happened to be training as a lactation consultant (she just wasn't a certified one yet) and she showed us both how to nurse. It was so great to have an educated and patient person showing you what to do, and working along with you, till you got it. By the end of that training experience, Sam was sucking. Not perfectly yet, but definitely doable.

I could have stopped then and just continued with formula. It was definitely easier than getting him to latch on and have him stay interested for long enough to get an entire feed. But I'm pleased and proud to say that we stuck it out. By the time we left the hospital, Sam could breastfeed!

Sam and I - our history

A little background about our breastfeeding dyad (begins with the word die, which is what a new mom feels like the first few attempts at nursing). My baby son Sam is now almost 8 months old. Yes, I also wonder why I am starting this now and not like 8 months ago. But why not? I'm smarter now than I was then. I chose the BF route simply because I know that it's the best for my baby and for me (might as well push off AF for as long as she'll stay away), and because formula (to put it crudely) stinks. It leaves its potent stench on babies' skin and their clothing. Ewww. To be totally honest, Sam did actually have some formula right after his birth (more on that later) but since then we've been EBF. Not without its own set of monstrous challenges.

When Sam was 2 months old, I went back to work at my job which keeps us apart from 10-5 Monday through Thursday, and 10-1 on Fridays. I pump two times a day except for Friday, which just has one pumping session (thank goodness for small mercies). I can't wait to pump-wean and cut out first one pumping session, and then the second. That will be freedom because I dread pumping. Always fretting if I'll pump enough for the next day (even though I do have a freezer stash for low output days).

So this blog is about my breastfeeding experiences, good and bad, weird and normal, tricks that might work for you or might not, odd discoveries, and a bunch of non-scientific theories that I concocted. If you're like me, you are desperate for someone to understand you because internet stories are just not real life. People write what sounds good on screen, but not necessarily the real facts. Here I present to you accurate anecdotes and lots of other stuff. Who knows, you may just become inspired to BF if you aren't already doing that. I just hope this won't scare you away from your decision, though ;)