Wednesday, August 3, 2016

The Moo Diaries: Lessons in Lactation Part I

After labour comes nursing and sometimes it can be more difficult than the labour itself. In the first few weeks your nipples are sore, bleeding and clamped down on as if your toothless tiny baby snaps around you and stabs you with an army of ready daggers. It's no wonder you can be afraid of your newborn as they zoom in on your nipple and voraciously approach with their ready jaws. Unfortunately the baby senses your trepidation (or outright panic) and this leads to further latching problems.

Then there's the sleep deprivation. Additionally, and particularly for first time parents, the stress of whether baby is getting enough to eat. The good news is that nursing gets easier as you go on. If you are crying in pain and stressed that you are not producing enough and enviously wondering how mothers nurse their toddler and satiate him or her for a few minutes as they nonchalantly talk to you, it's because they are not dealing with the latching issues and pain that you are. Toddlers may have teeth, but they know how to nurse. Newborns have no idea what they are doing - they stab in the dark and our nipples bear the consequence. Unfortunately no amount of coconut oil or your own milk (which do however help heal the scabs) will cure the bruising, which is internal.

This time round for me has fortunately been much better than the first. With my first son, I didn't understand that the pain I was feeling was due to his inability to suck properly from a tongue tie until I sought the advice of a lactation consultant in week 6. In the meantime, I suffered through bleeding nipples, bruise areolas, plugged milk ducts, vasospasm, two bouts of mastitis and consequent yeast infections. In short, I had everything that could go wrong and was told by two different and respected lactation consultants that maybe in my case, my pain was not worth it. However, I preserved (to some extent I was more determined to continue because the universe was making it so difficult for me). Unfortunately, this had a lasting consequence on my milk supply (which is set during the first two months) and while I nursed for 15 months and change (stopping due to being in the second trimester with my second son and deciding I didn't want to wean right before his birth), I had to supplement with formula.

This time round, we saw a lactation consultant immediately who noticed a tongue tie and we had him clipped in the second week. I was also provided with a hospital grade pump right from the hospital, herbal supplements and a "nipple safety" regime (no more than 10 minutes each side and then expulsion) with weekly lactation consultant visits. The knowledge we garnered from our first experience and the support we received from our health insurance company/staff (Kaiser) and possibly the fact that I was lactating only a few months ago resulted in a good shop. I haven't had to supplement a drop and am over producing. I did however have intolerable pain which has eased with my son realizing the aptitude of his new tongue mobility, securing a better latch and stronger suckle.

Lactation is not easy - particularly the beautiful brutal of the first few weeks, and it takes two to tango. In the first few weeks, it's a special dance involving the whole family. My husband had to help me latch in the beginning - I couldn't hold my son and his flailing hands which were invariably in front of his mouth preventing a latch. So the three of us would sit and nurse as a family affair. Due to his tongue tie, he wasn't suckling properly, so after nursing, my husband, with a spoon and ready syringe as if about to fabricate a Class A substance, expelled while I tried to meditate to increase the let down. Later, between nursing sessions, I would pump while my husband fed our baby a previously pumped supplement through a nursing system involving a string rather than the bottle so that our son would receive the milk in no faster manner than nursing, lest he get ideas and become recalcitrant to go on the breast. Now, he is more efficient at the breast and fusses with the supplemental nursing system.

Lactation takes energy and patience. You are on the clock, every 2 to 3 hours you will nurse - and that's from the start of a nursing session, which can last about half an hour. I also pump to supplement and ensure I'm expelling enough for fear of mastitis and to keep an ongoing supply in the fridge, but it's not necessary.You need to ensure you are getting sufficient vitamins and minerals in your diet because your milk is only as good as your diet (or rather, if your diet is lacking, the body will take what it needs from you and your bones will suffer the consequence). I don't know whether to laugh or cry when I look at all the supplements I'm taking - my prenatals, DHA, calcium, magnesium, goat's rue and a lactation supplement with fenugreek, blessed thistle, nettle and fennel. I'm also drinking a lactation tea that tastes like grass which is fitting to my new bovine lifestyle. The only way I can drink it is to let it cool and then down it. The good news is that I get to eat cookies and feel good about it. My husband, an avid baker and brewer, bakes me the most delicious lactation cookies, full of galactagogues - brewer's yeast, rolled oats, nuts and dark chocolate. Now we're talking!

As it is with almost any topic, the more you read and the more advice you seek, the more you are pummeled with contradictions. Some say do both breasts equally as after 10-15 minutes the baby goes from nutritive suckling to merely comfort suckling, some say do only one to get the "hind" milk (the full fat milk that's been stored longer) and offer the second only if the baby asks. I have observed that after 15 mins or so, the suckles taper out as if he is moving to a more comforting suck, so I move him to the next breast. However, he usually spends more time on the first, so I switch it up every session, starting from the side I did second in the previous session. With so many alternate theories as to what to do, it's difficult to assess whether you are getting it right and you may worry that while you are applying one advice you thought was sage to practice, whether you should have done the opposite. Then you may worry you are worrying too much because worry and stress reduce milk supply, something that everyone seems to agree with. Well, as long as your baby is satiated and you don't feel engorged, you should be on the right track. The question is whether your baby is satiated or is just exhausted from struggling or sedated from the oxytocin - a sure way to know is to check your baby's weight rather than guessing. If in doubt of the scales, dimples never lie!

I don't have all the answers, I may not even have any. I'm surprised that this time around, I seem to have abundant milk supply, but then again, the first time round, we unwittingly did everything wrong in the crucial first month that establishes supply. All I know, and I know this viscerally, comparing my first son's and second son's experiences (albeit they say you need three to see a pattern) is that when baby is suckling properly you are connected on a primitive wireless that is always working, even in hilly San Francisco (ironically, the tech mecca where connection is wanting to say the least). I always wake up a few minutes before my son, knowing he needs to nurse on some inexplicable visceral level. If I'm out, I feel a tingling and know that it's time to return because my baby needs to nurse. It's a beautiful experience and worth the brutal beginning.
















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