Back on the grid

Returning from a week without internet access is pretty daunting these days. My reader is overflowing with gems. I missed the whole ACOG homebirth survey thing, and the Dr. Stuart Fischbein needing legal support thing, which led to the Dr. Stuart Fischbein vs. Amy Tuteur thing, and then the ACOG giving women permission to drink "modest amounts of clear fluid" in labor (golly gee willikers, thanks!) thing . . . what else have I missed? Fill me in! I'll post more when I've caught up (no promises on when that might be . . .)

In the meantime, a snapshot of what we've been up to (forgive the phone-camera quality):

One-Minute Childbirth

Weekend movie: please take 60 seconds to watch this great 3D animation of a vaginal birth, if you haven't seen it already. With that, I'm heading offline for a whole week (egad). Enjoy!

VBACtivism

Has anyone thought of that title before? I'm 99% sure someone has. But anyway . . .

I'm getting ready to head off into a week of extremely limited internet access, but before I go, I have to share a great post on VBAC resources by Knitted in the Womb. The question comes up regularly for anyone involved in birth advocacy, even for me, and I'm not even an official anything birth-related just yet. Knitted in the Womb begins:

A friend recently asked me to pass along some information to help a friend of hers decide whether or not to pursue VBAC. This was my answer to her:

That can be a tough decision for many women!

The reason for her previous cesarean is important to consider in assessing her odds of having a vaginal birth this time around. If it was for twins, breech or fetal distress; then it had nothing to do with her ability to birth vaginally, and she is a good candidate for a VBAC (assuming a low transverse incision). If she had her cesarean for “failure to progress” (FTP) at a low dialation, many women think they are not good candidates for VBAC, but actually, the research shows that they are MORE likely to successfully VBAC than a woman who had a cesarean for FTP at a high dialation…simply because the cesarean was probably called before there was even a chance to find out if her body could do it! Not to say that a woman who had FTP at a high dialation can’t have a VBAC…one of my clients pushed for 3 hrs with her first baby and then had a cesarean, only to have a VBAC with a baby that was 11 oz bigger than her first baby–and no tearing as well.

I would add to this that it may be helpful to find out (if she doesn't already know) whether her incision was stitched with double-layer sutures, which some practitioners believe is important to VBAC, though there is some controversy over whether or not single-layer sutures should rule out VBAC as a possibility. Regardless, it's good to read up on for yourself in either case. Knitted then addresses the matter of uterine rupture in great detail, breaking down some statistics and dispelling some misconceptions. She includes some very important questions to address with one's care provider.

She then goes on to share some good linkage, including VBAC Facts (which is the source of a very handy VBAC Facts card), some great books, and of course ICAN. I would add to this list the My Best Birth website and the "Your Best Birth" book itself, as well as this page (and anything else) on The Unnecesarean's blog. All of the above combined adds up to an immense amount of practical AND empowering information.

Reducing Infant Mortality - watch it online now!

I was going to save it for a weekend movie, but it's just too important to not spread around ASAP. This excellent short film talks about reducing infant mortality and prematurity from a number of different angles. Please share it far and wide!

Reducing Infant Mortality from Debby Takikawa on Vimeo.

The Mickey

We've been reading so many outrageous violations-in-birth stories these days: Catherine Skol's case, forced confinement, the parents who lost custody due (in part or completely is still up for debate, but still) to refusal of a c-section, sterilization without consent, and on it goes. Finding out about "pit to distress" was insane enough in & of itself. I was starting to think I'd heard it all - and then I was told a story a few weeks ago that I'm still completely gobsmacked by.

A friend of mine on a forum that I belong to - let's call her L - has a mother who is a very old-school Labor & Delivery nurse. She is quite devoted to the medical establishment's approach to childbirth. During a conversation on a birth-related thread, L sent me the following PM (posted here with her permission):

This woman showed up at the hospital to have her baby, and was adamant that she did not want a C-section. For whatever reason, the monitor eventually started to show fetal distress (mom didn't say whether it was pit or some other issue). The doctor recommended a C-section, the mother refused, the nurses begged, the mother refused. The doctor sent for a court order to force her to have the C-section, but the court order was taking too long, so finally the doctor slipped something into the woman's IV to knock her out and the did the C-section while she was unconscious. Yes, really.

I was completely shocked. My mother was one of the nurses who participated in this - for all I know, she was the one who administered the knock-out drug; it seems likely - and she maintains they did the right thing by intervening to save the baby's life. She said the woman didn't sue after she woke up, she was very grateful because she loved her baby, but I was so completely appalled; I said that was one of the most egregious examples of assault I could imagine but my mother (a very devout Catholic and pro-lifer) said the baby's right to live trumped the mother's right to refuse a C-section.

I have no idea how to process this and would be very interested in your thoughts. Is this common?! Do you think they did the right thing by saving the baby? Can you imagine making your peace with the natural progression of life and then waking up to find out you'd been drugged and sectioned against your will? Yowza.

It's hard to even know where to begin with this one, even after picking up my jaw off the floor.

One thing that's automatically frustrating about this is the fact that we have no way of verifying any of this, and simply have to take L's mother's word for it. The part where this is most maddening, of course, is the part where the patient was "grateful" for having been slipped a mickey in order to perform a surgery which she had specifically declined - numerous times.

We have to extrapolate so much here, but I don't think it's much of a stretch to say that a signed consent form for a c-section couldn't possibly exist. Even putting ethics aside, on what legal grounds does the hospital stand? Me, I would have not only sued but looked into criminal charges, depending on the details, of course.

L went further and asked:

As a doula, would you have counseled her to go ahead and have the C-section if the fetal distress was really that bad? Or if she understood that the baby might die and she was okay with that, would you have accepted that and told the hospital staff to fuck off and take care of her as the baby died?

There are just no easy answers here, especially without knowing what led up to this situation. I feel confident in saying that a doula's presence MAY have helped her avoid things getting to this point in the first place, depending on, say, whether certain interventions known to cause fetal distress (i.e. hyperstimulation of the uterus via Pitocin or worse, Cytotec, resulting in diminished oxygen supply for the fetus), but it's pure speculation.

L's questions bring up a potent and controversial point: It should be clarified what a doula can and cannot do in the delivery room - a matter that can be delicate when the mother is laboring in an environment that is hostile to her objectives, or even in settings that are more supportive of the mother's aims when things get complicated. What does “advocating for” her client in a hospital setting mean?

Here's my best understanding of it at this point: In addition to helping give literal physical support in the form of pain relief and effective positioning (using water, massage, breathing), a doula is there to empower the woman to stand up for herself, and to help keep the mother's birth plan on track as much as is reasonable according to the mom's own research and desires, knowing that things do sometimes have to change - helping the parents to recognize when intervention is truly in their best interest.

What doulas cannot do is run interference with hospital staff in any sort of direct way. This is not only beyond her scope of practice, it can risk getting her thrown out of the room altogether, which does the mother no favors at all. If I told the hospital staff to fuck off, even figuratively, well, that would be the end of my role in that woman's birth.

A doula CAN help avoid unwanted interventions by first helping the mother to ask for more time to think things over each time something not on the plan is suggested, and then taking that time to discuss whatever's been brought up, reminding the mom of the risks and benefits and how this step may affect the course of her labor. Or if an unwanted intervention is on the verge of being done and the mother isn't quite realizing what's happening, the doula can bring it to her attention so that she can decline it. Jennifer Block cites a clear-cut (no pun intended) example of this in "Pushed": a doctor poised scissors at a mother's perineum, though this was something the mother specifically wanted to avoid, and said, "I'm just going to help things along with a little cut here." The mother, being very off-in-laborland, nodded vaguely. The doula quickly pointed out, "She is about to perform an episiotomy. Is that okay with you?" And the mother sat up and shouted, "NO!"

So how to apply this to the situation L described? I have no clue. Certainly no firm answers, especially, again, without knowing the details. If Pitocin was the culprit, a doula presence could possibly have helped avoid it or kept it to a reasonable level, and could have made labor progress more effectvely. Once they slipped her the mickey? To answer her second question above, I could not have told the staff to fuck off, much as I would have liked to. It just would not be within my abilities, and like I said, would have most likely left her without my support at all. I don’t think there’s anything I could have done short of offering to serve as a witness in the trial (preferably criminal) that the care providers involved so richly deserve.

I have to wonder where the father was in this whole awful situation - and this illustrates another point about the specific kind of support doulas offer. Some dads have resisted the idea of a doula, insisting that they are all the support their wife needs. Many men can indeed be wonderful support, but many are quite out of their element in births, and can be easily intimidated by hospital scare tactics when those cards start getting played. This is where the doula can be of great aid to both parties. I'm digressing and starting to ramble, but I think it's relevant to this anecdote, wondering whether the father (if he was there at all, which, again, we just don't know) could have protected his wife.

Again I feel compelled to quote Navelgazing Midwife: "Women don't just need doulas anymore, they need bodyguards."

Experienced doulas, care providers, mothers, what do you think of this horrible scenario? Have you ever seen such a thing? Does it shock you? What, if anything, would you or could you have done?

Birth trauma - and the daughters of hope.

WEEKEND MOVIE:
August 15th is Birth Trauma Awareness Day, so I'm sharing this link to Citizen's for Midwifery's information on birth-related PTSD, along with this simple but touching video on birth trauma from Joyous Birth.

Almost forgot -

One of the best outcomes of the ICAN meeting I attended the other night: one of the doulas I connected with brought up the possibility of joining forces in a sort of group practice, which I am beyond psyched about. The perfect opportunity for me to start out doing some postpartum work for a while - of course I'll be moving into labor support soon enough, but I think it'll be best to start with this at first, due to my daughter's age and needs.

Woot!

I think ICAN

I went to my first local ICAN meeting last night and, not unexpectedly, found a fabulous group of women right here in Erie. With a 16 month old who mostly hates the car (though she's getting better), I hadn't been getting out much since we moved to Erie, until recently. Anyway, I'm so glad I finally made it.

The official purpose of attending was to see what I could find out about VBAC-friendly hospitals and care providers in the area, but the topic for the evening (a CPM came to give a talk about midwifery) let to a broader discussion on the safety of well-supported birth, including home birth, that was every bit as valuable. One newly pregnant mother was seeking general support on pursuing a natural birth and possibly a home birth, despite the objections of some members of her family, her mother in particular, as an RN. Boy, hadn't most of us in that room been there! My father was a doctor until his retirement a few years ago, so I'm all too familiar with that whole story. (I should blog about that sometime, huh? Note to self.)

The conversation shifted to another running theme for pregnant women: the tendency for everyone from friends to family to complete and total strangers to inundate you with horror stories about the worst labor they've ever seen/experienced/watched on some TV show. One woman mentioned beong cornered in the bathroom at her own baby shower - a scenario that was far from unfamiliar to us. Exasperated, I remarked "What if every time you went to get in your car, people ran up to you and yammered at you about a horrible car crash they'd seen/experienced/watched on some TV show? It makes about as much sense!" They thought this was an apt analogy.

Shifting again, we discussed ways of sussing out for yourself what your care provider's (and hospital's, if applicable) policies and attitudes about birth really were. The CPM speaker recommended an INformal tour of the hospital, thinking you might get a better idea of the climate from one of the nurses in a more casual, off-guard setting than an Official Tour. There are quite a few great lists of questions to ask your care provider, including this fantastic PDF from Choices in Childbirth and this guide to birth plans from Nursing Birth, but sometimes a single, thought-provoking question can tell you a lot more than a lot of specific yes-or-no answers to pragmatic questions, valid as those pragmatic matters might be. The book Your Best Birth is also chock-full-o' great questions and birth plans, as well as thorough and very easy to understand explanations of why each question and item in a birth plan is important (it doesn't do a lot of good to ask the questions if you're not really clear on why you're asking them). The website is a fine resource as well.



Back to the meeting. One of the local members, a doula and a gorgeous mom to four with a fifth on the way (with three VBACS under her maternity belt) had a nicely worded example of just such a question: "Tell me about an experience where the outcome was less than ideal, and tell me what you took away from that experience." This came up specifically when we were talking about interviewing home birth midwives, but wouldn't this be revealing no matter who you're asking? I for one would love to hear some OB's responses to that as well.

I'm also a big fan of a single but rather loaded question. Ready? "How do you feel about doulas?" That's it! Think about how much that will tell you about your doctor or midwife's whole worldview.

Through the mother above and another midwife in attendance, I got some great info on a woman who offers local workshops (I had been considering a lot of travel to attend trainings and visit family simultaneously), got invited to some other gatherings, and just generally got plugged in to the scene, or so it felt. I also watched a lot of exceptionally cute little one playing in the center of our circle - yay, I can bring Lily in the future if I can't swing coverage for the evening! Most excellent.

If you haven't been to an ICAN meeting, think about attending one, even if you're not seeking a VBAC or aren't even currently pregnant - hey, if you're reading this in the first place, you're clearly interested in the topic. So check it out! They're everywhere.

Once Upon a Boob

I came across this gem, a breastfeeding fairy tale, in my meanderings today: The Princess and the Chickpea (and the Grape and the Walnut). Please share it far and wide! Frankly, I think this should be illustrated and published.

She forgot the ending, though: And they nursed happily ever after, of course!

Size isn't everything - and even when it is, it still might not be.

Weekend Movie: "Too Big". Oh yeah?

It's one of the most common scare tactics used to pressure women into either early induction or into outright c-section, for supposed macrosomia, leading to cephalopelvic disproportion, a.k.a. CPD. I wish all women in America knew two things. First, ultrasound estimates of weight are notoriously, laughably inaccurate, by up to TWO POUNDS. I cannot tell you the number of birth stories I have read where the big baby card got played and they got pressured into a c-section, because it looked like this baby was going to be 9 or even - gasp - 10 pounds (more on that in a sec) . . . and the little slip of a thing turns out to be 7 pounds plus change after all. Whoops!

Second: True CPD is very rare, and our perception of what is "too big" is skewed by mainstream birthing practices. Case in point: when I was pregnant and attending regular home birth support group, 4 women had their babies within the same month, all at home, none with any complications. Three of those four babies were over ten pounds. And only one of those three had any tearing at all (and I'm told it was very minor, requiring maybe two stitches). What made this possible? Well, I very much doubt any of these women were immobilized flat on their backs during any of their labors, much less during second stage (pushing). A ten pound baby with a numbed woman in lithotomy position, well, sure, you might encounter some difficulty. The risk of true shoulder dystocia (which is what practitioners are worried about when they play the big baby card) is, again, rare, and minimized when one is able to move and assume normal, efficient positions for labor, especially pushing.

But don't take my word for it! Read up. For starters, here's some thorough info on CPD from ICAN. It includes suggestions for things you can do to improve your odds if CPD ever becomes a concern, such as chiropractic care and fetal positioning. Oh, and hiring a doula. *bats eyelashes* And here's a great post by Enjoy Birth on the topic with lots of great linkage throughout. Both include the very video I'm sharing with you here. Watch and be inspired, especially if VBAC is part of your journey.

Backlash, the next generation

Katie Allison Granju wrote this staggeringly brilliant piece on Babble today, putting the "breastfeeding backlash" in perfect perspective. I could quote practically every sentence she writes, but here are a few choice snippets:

The current breastfeeding backlash is a reaction to a certain intensity surrounding the issue of breastfeeding that did indeed gain currency over the past decade or so. But what today's mothers - the ones who are fueling the breastfeeding backlash with their criticisms and complaints - don't appreciate or maybe even realize is that the activism and advocacy they are slamming was actually an important, grassroots women's health movement that managed to fundamentally change the way our culture views and treats breastfeeding within only about ten years (!!!). And any time you have a movement that erupts out of a sense of frustration and oppression, and manages to turn that frustration into the kind of power it takes to create meaningful change on a big issue, that movement is going to have to be both pushy and loud.

She goes on with the perfect analogy:

Sort of like those women who casually enjoy the obvious fruits of second wave feminists, even as they criticize them, I suspect that many (most?) of today's mothers of babies and young children are completely unaware of how different our cultural landscape is when it comes to breastfeeding than it was only a very brief time ago. They take it for granted that their hospital has a lactation consultant, and that their insurance company will help pay for the breastpump needed to express milk for their premature baby. They can't imagine a world where ALL breastfeeding mothers (and there weren't that many) excused themselves to a cloistered location every time the baby needed to eat, or where the idea of continuing to nurse into toddlerhood was seen as pathologically bizarre. New mothers today can't imagine these things because, before becoming pregnant or having a baby themselves, they never even thought about the topic of breastfeeding, so their only context is Right Now, Today. As a result, far too many women fail to appreciate the "zealotry" that gave birth to the readily accessible breastfeeding resources, support, protections, acceptance and information they now have available; they just don't get why anyone would feel the need to engage in activism or advocacy on a topic that seems so mainstream. I meet many current moms who have this opinion because I, too, am currently the mother of a toddler, just like them.

But I also happen to be the mother of an almost-18 year old, a 14 year old, and an 11 year old. So I remember what it was like when I gave birth to my first baby, in 1991. Things were very, very different even that recently for mothers in this country who wanted to breastfeed, which I did.

She goes on to elaborate, from this unique and insightful perspective, on exactly how and how much things have changed. I could keep quoting ad nauseum, but really, go check it out.

The post also mentions articles that she herself had written over the last decade - and I actually remember some of those articles, as an avid Salon reader from its earliest days. Good stuff. This piece in particular, "Formula for Disaster", from almost exactly ten years ago, is every bit as valid and gripping today as it was then.

Katie, I owe you. I can only hope to be some small but effective part of the third wave.

Lifesaving devices

I have some other topics coming up, but since it's World Breastfeeding Week, I'm running with the theme. The folks in charge of WBW selected this theme for 2009: A Vital Emergency Response.



PhDinParenting wrote a characteristically great post on this and the Best for Babes "Beat the Booby Traps" campaign. I want to shout this particular quote from the rooftops: "Breastfeeding promotion is not about bashing formula feeding moms. It is about creating conditions that will help moms overcome the barriers to successful breastfeeding."

The campaign promotes three important facts:

• 95% of breastfeeding problems can be easily avoided and corrected.*
• Less than 5% of women aren’t physically capable of making enough milk.
• Babies—and your boobs—are hard-wired for breastfeeding.

They then go on to spell out 9 prenatal and 8 postpartum "Booby Traps". It's really thorough, well-organized and easy to understand. Check it all out!

I also love these Best for Babes graphics:



The latter could be a motivational poster for strippers as well! Love it.

*As in, please DON'T be scared by stories like mine! We were extreeeeeemely unusual. I shared my story to help the small percentage of women who do have major obstacles to overcome. Most common obstacles, if any, are far more surmountable in both duration and difficulty. BE NOT AFRAID!

Epilogue to the nursing saga: Three lessons

This started out as a reply to the comments from the previous post, and it eventually rambled its way into its own entry. Like I said, if it helps even one other mom, it'll be worth it.

While I wouldn't want to live through it again - and I admit I'm a little anxious about baby number two, though even if some of the same issues presented, we'd be much better prepared - I'm grateful for the lessons.

First, that I was able to see firsthand just how difficult it can truly be. I admit, before I walked a mile in these moccasins, I just didn't quite get it. I'd hear about a mother who had "trouble" nursing and eventually quit, and, I am ashamed to say, I judged her, in a way. I didn't intend to, and it wasn't mean-spirited, but I did. I figured in most cases she just didn't try hard enough, didn't want it enough. And thus I found myself enduring another 4 am syringe feeding, with all the coordination and concentration it takes, and I found myself looking longingly over at the bottles I had only planned to use for expressed milk months and months later, when I went back to work a few days a week, long past the window of danger for nipple confusion. And I understood. I still remember that moment as clear as day.

Second, it made me realize just how crucial support is, especially in the form of well-educated lactation consultants, and how much availability of such support affects breastfeeding success rates. As much as I wanted to breastfeed - and I wanted it SO desperately it's hard to even describe without seeming maudlin - there is NO WAY I could have done it without Jennifer, IBCLC extraordinaire. Not a chance. Even with good books and online resources like kellymom.com and Mothering.com, which I had and used vigorously. These are still wonderful and I can't praise them enough, but it's no substitute for one-on-one expertise.

Finally, no real lesson would be complete without the epiphany of gratitude for what one DOES have. Believe me, I could and did get caught up in feeling sorry for myself. And I bargained a lot - the kind of fruitless yet addictive fantasy bargains we've all indulged in. I had managed to dodge a c-section due to placenta previa and had a wonderful home birth that I had prayed for (see my birth story, though I'll write more about the pregnancy and previa in the future). But now that I was in the midst of this struggle - would I trade? If I had to choose between a c-section with zero nursing difficulty and what I had, which was a fantastic home birth, with our nursing issues, what would I do? This kept me up many a bleary, weak and weary night.

I still don't have an answer to that. What I do know is how low I felt when I started attending the support group Jennifer hosted, and epiphany struck - there were women there who were dealing with issues at the same level of difficulty as I . . . and they had ALSO had c-sections. Gulp. Yeah. Let's at least be gracious for what I did have. Similarly, and also through the support group, I saw women with, again, similarly intense problems . . . who ALSO had serious low supply issues on top of everything else. And here I was, producing enough milk for three babies at once. I never once had to supplement with formula or even donor milk.

Because of these lessons, and the gifts of empathy, humility, and gratitude, I have hope that I can bring all the more compassion into my future work in and around birth.

Thanks.

Our nursing saga

In honor of World Breastfeeding Week, I thought I would share my saga with you. If I can give even a glimmer of hope to any mom out there who is struggling like I was, it is all worthwhile. I tried to condense it somewhat, but in order to really tell the whole story I had to, well, tell the whole story. Buckle your seatbelt and bear with me.



So this is the tale. I’ll start at the end: Lily will be 16 months old as of August 14th, and we have been fully and purely on the breast for just about 11 months now. It took a long time after finally succeeding for it to seem real. It’s a dream come true, and something I’ve worked for harder than I ever worked at anything in my life, hands-down.

Lily had what amounts to a Perfect Storm of elements stacked against her. They were:

• A posterior tongue tie. This was probably the most significant hindrance to her nursing. For those who don’t know, a tongue tie is a condition where the frenulum underneath the tongue is too restrictive for the baby to latch on properly. There are 4 different grades of tongue ties, too. Some care providers may mean well but are not familiar with anything but the most obvious tie – the anterior one that’s right up at the front & very obvious and stringy. Hers was much further back, and the tongue itself appeared to be 'bunched' in the back of her mouth. Some babies are able to nurse with some kinds of tongue tie (though it’s often with the cost of pain to the mom), but this one was totally non-functional.
• Extreme molding to her skull from birth. All babies born vaginally have some degree of molding – the fontanels are designed to work that way – but this was really dramatic, and it didn't normalize after birth the way most babies' heads do (normal nursing actually helps this process along). This resulted in two things: first, there were some structural problems with her jaw function (think about how interconnected everything in that area is), making it a bit recessed; she simply could not open her mouth wide enough to latch. Second, the molding may have contributed to a couple of neurological delays (nerves essential to coordination can be impinged due to molding and also the associated swelling). When her suckle was checked by various care providers, they all noted the lack of organization.
  
• Being an early arrival. She was born at between 36 and 37 weeks – she qualified as full-term according to her newborn exam, but was just an early bird. According to a lot of practitioners, the early ones can just have a harder time getting started sometimes. This caused some concern in the first few days even BEFORE we started to figure out that the two issues above were going to cause serious problems. She had no rooting reflex at first, and for the first 2 days would barely suck – whenever an expert finger was inserted to assess what was going on, rather than sucking the way normal babies do, she would mostly just clamp down on it. I had to squeeze colostrum into her mouth, and out of concern that my milk wouldn’t come in without her actively, regularly suckling, I started pumping right away – and thank GOD I did (more on that later).
• My nipples being small and kinda flat. If there were no other issues, a normal baby would probably have done okay with me, but Lily’s challenges made this an added factor.
• And if the above weren’t enough, her tongue, even after being clipped, is a small one, and her palate is very high (this is common with tongue-tied babies) – making it very difficult for her to get my nipple in her mouth far enough to pump it against the roof of her mouth, the way an efficient nurser can.

Are you exhausted yet?

So. Man, I’m not sure where to begin with explaining what our approach was. The first few weeks were so terrifying, which made way for a prolonged period of stressed-out, anxious grief, and then settled into just months upon months of hard, hard work. All day, every day, every feeding, and with all the work that surrounded every feeding, including pumping every 3 hours around the clock, after every feeding, no matter what. This included setting the alarm clock for 3 am and 6 am, even if Lily was asleep - I couldn't risk going more than 4 hours without pumping, as prolactin levels will then drop, and supply is compromised.

I should also note that due to a complicated if temporary long-distance situation, her father, Aaron, was only with us about ¼ of the time, so the rest of the time I was also doing this as, essentially, a single mom, living in a pretty isolated area, with one good friend who was willing to come by about once a week. Aaron was a supportive as he could be under the circumstances, but I was still just plain alone the majority of the time. The Food Network was my most significant adult contact on a day-to-day basis.

I think I can best illustrate it with a list, in order, of the techniques and treatments we used.

1. Finger-feeding with a syringe. The story of our first two weeks is really a saga in itself, and as this is already verging on epic, I won’t recount the entire thing. Here’s a thread I started at MDC when she was two weeks old describing the situation at that point, if you want the details. Suffice it to say that it became clear that she simply was not latching on. Syringe feeding was recommended by the first lactation consultant that helped us, and it did the trick to get food into her (always priority one) while avoiding nipple confusion, which is extremely important, but it also did nothing to help her learn to latch on. I kept trying to offer the breast at every feeding, but had no real skills or game plan – and I think we had come to the end of this LC’s ability to help us. This went on for a ridiculous 5 weeks.



2. During this time, I started taking her to get craniosacral/chiropractic work, starting at about 3 weeks. This was to help with her jaw function, to get her to be able to open her mouth wide enough to latch, and also to encourage the tongue to come forward. This would also help with some neurological disorganization (the coordination required for nursing, and taken for granted with most babies, was simply not there). She has gotten regular work done ever since, though decreasing in frequency after the first 4 months. This was very important, despite our financial hardship, and helped tremendously in ways that extend even beyond breastfeeding, but during that first 5 weeks, I was hoping that the combination of finger feeding and craniosacral would cause her to magically be able to open wide and latch on all of a sudden. This was not to be – there was no way this could happen without . . .

3. Getting her tongue clipped. Her tongue tie was finally identified by the second lactation consultant we went to, Jennifer, an absolutely brilliant IBCLC that came highly recommended by several different people who had had difficulties similar to ours. There are 4 different grades of tongue tie, actually, and hers was a posterior one, probably the hardest to identify to a non-expert. Here’s a great list of resources about tongue tie, including an article written by Dr. Elizabeth Coryllos, the pediatric surgeon who performed Lily’s clipping.

4. My mom was visiting from out of town when I went to get this clipping at 5 weeks, requiring a drive to Long Island with our 5 week old babe. After that was taken care of, Jennifer had us switch to finger feeding without the syringe – simply putting one end of the tube into a container and requiring Lily to much more actively suck it out. This didn’t last long, as it was taking her about an hour and a half to finish a feeding of about 2 ounces, giving me only an hour or so relief in between each feeding, in which time I had to pump* on top of doing everything else involved with caring for a baby, as well as, ya know, eat and pee and maybe even sleep occasionally.

*NOTE: Speaking of pumping, this was, despite the work and time involved, an extremely lucky break. Attempting to mimic my baby’s feeding pattern, I pumped for 15 minutes after every feeding of hers (so on top of at least a total of four hours of that combined per day, there was the associated cleaning of equipment and maintenance of the milk). I was blessed (though it’s a mixed blessing) with an oversupply, and by the time I went to see Jennifer, my freezer was overflowing and I was producing enough milk for three babies. Fortunately, she had a few clients who needed donor milk, so I was able to make use of my oversupply and help other moms and babies – this felt really good. I’m grateful beyond words for this, as it meant that despite our extreme challenges, Lily has only ever had my milk. Not only did she never have to take any formula, preserving her virgin gut, but she never even had to take the next best thing to my own milk, donor milk (though I would never hesitate to use donor milk or cross-nurse if necessary). This is not something to take for granted - as I learned through Jen’s weekly support group, there were plenty of moms struggling with very similar situations who also had to deal with low supply on top of everything else.

5. As I was saying, that new method of finger feeding was totally nonfunctional, she just was not strong enough to do this yet, and we dropped it after less than a week. Finger feeding really is not meant to be anything more than a temporary means of feeding (which avoids nipple confusion, which is the advantage), anyway, and by 6 weeks it was getting ridiculous. So at that point it became appropriate to switch to a very specific upright bottle-feeding technique, sometimes known as “paced” feeding. It’s true that introducing bottles carelessly can result in nipple confusion, but Jen explained that nipple confusion is really more accurately described as flow confusion. If you hold a baby at a reclined angle and basically dump the bottle into his mouth, the difference in flow between that and breastfeeding is the difference between drawing liquid out of a straw and doing a beer bong (which is a big part of why bottlefed babies can so easily be overfed, but I digress). In paced feeding, the baby is held upright in a seated position, and the bottle is at a 90 degree angle, so the baby really has to actively draw milk out. I also used a type of bottle called Breastflow to do this, which is designed to encourage babies to use similar action to that of breastfeeding (though it's never really going to be the same).



6. But as you can imagine, just doing this alone wasn’t going to get her back on the breast. I did this for several weeks just to try and get her strength and weight up (she was doing okay, but just felt she needed the extra safety net), but knew Jen would have me trying something different soon. So, we tried using the SNS with a nipple shield. The Supplemental Nursing System uses the same kind of tube used for finger feeding, connected to a tube of milk you attach to your clothes, and you tape the tube next to your nipple (lots of adoptive moms have used this to induce lactation, training their babies to nurse without even having to pump). Because of my flat-ish nipples, we also had to thread the tube through a nipple shield, since she was nowhere near able to latch on to my naked nipple.

This was an utter nightmare, honestly. Every feeding became a wretched ordeal, trying to thread the tube and get the shield on while she cried, then either one turn of her head knocked the shield out of place or one flail of her hand yanked the tube out, and we had to start it all over again. After a few days of this bullshit, I decided that we HAD to try something else or I would soon be giving up & EPing for her with bottles.

7. So I basically went back to paced bottlefeeding for a while, and then we decided to try and work with the nipple shield before and after each feeding, getting her to latch on before switching over to the bottle. (It took a while for her to even be able to get onto the shield itself – I eventually coaxed her into it by putting it on my finger for her to suck – she was used to sucking my finger for comfort – and this helped her get used to the feeling and to open her mouth progressively wider. I then was able to get her to latch on to the shield at my breast, however ineffectively at first.) Because it was a big interruption to her to sit her back up each time, I figured out a way to hold the bottle so she could lay on her side close to my body, like in a standard nursing 'cradle hold', while still keeping the bottle horizontal & at a 90 degree angle to her. She got better and better at this switcheroo, especially as her mouth and tongue were getting bigger (Jen and her craniosacral therapist both agreed that a lot of this was just a matter of time, letting her grow, and finding a way to keep her active at the breast in the meantime, until she was able to get entire feedings that way). Her suckling action started to induce letdowns and she would actually nurse through the shield for a few minutes before I switched her over to the bottle.

This actually led to one of my sort of premature breakthroughs (which happened about three times – I’d get my hopes up and think we were further along than we were, and then have to take a step back a few days later). At about three months, she was doing so well with the shield that I tried, for about 2 days, to go off the bottles entirely – hoping to just nurse with the shield until she could latch on without it – but it was too much too soon.

Digression: There was a point at about 3 ½ months when I was so close to giving up. SO close. I was so wrung out and demoralized and tired of struggling through every moment. I felt like an absolute failure, and had never wanted anything so badly in my life, or worked as hard for anything. I bargained, I begged, I prayed (and I’m not usually the praying kind), I sobbed – it’s no exaggeration to say that I cried more than she did. At that crucial point I really feared that it was just not going to happen. This didn’t just make me feel like a bad mother, it made me feel like I was simply not really her mother at all. It’s hard to describe this kind of hell to someone who hasn’t been there. Not being able to feed your own baby, it is utter despair.

The real breakthrough moment was a sign of hope for the future that came about almost impulsively. I had been working with the shield at the beginning and end of each feeding, as described in step 8, and in between feeds I also tried to occasionally offer the breast, with shield, for comfort, to try and get her associating the breast with comfort as well as food (she couldn’t physically take a pacifier, which was fine by me in principle anyway).

One night in about mid-June, we were lying in bed and she was almost out for the night, but started to fuss a bit. I had been in the habit of offering her my pinky occasionally when this happened, but I wanted to try comfort nursing her. Alas, the shield was all the way in the other room, and I didn’t want to get out of bed if I could help it. So almost impulsively, I positioned her and moved my breast in the direction of her mouth. It wasn’t even all that precise, as I was doing it in the dark – but she latched on. SHE LATCHED ON. And “nursed” (not really swallowing, just comfort-sucking) herself to sleep. I lay there in shock, my mouth wide open, afraid to move or even breathe, wanting this moment to go on forever, with tears of joy streaming down my face. It felt like nothing short of a miracle.

So that proved it – there was hope. The next day things we were right where we had been, but still, there was proof that it was possible. I had to continue, but it was still a brutal struggle. I started to wonder how I could try to find some peace with it – I knew of a few incredibly devoted mothers who had exclusively pumped for their babies for a year or more. That way, even though she would be “bottle-fed” technically, she would still be getting breast milk (as far as I’m concerned, as long as I was able to lactate, this was the absolute minimum I could do; formula would never be an option as long as I had the ability to produce milk). And that would be the most important thing, of course. But by that point she had given me a glimmer of hope in her occasional bareback comfort nursing. She was nowhere near efficient enough in her latch to get a full feeding that way, but she WAS getting on to the breast in her own way.

So I was torn – pump and bottle-feed for nourishment and also get the bonding of comfort nursing. Could we be satisfied with that? It “wouldn’t be the end of the world”, as some pointed out, trying to be supportive. And they were right. But the thing that nagged at me, as I tried to see if I could accept this, was that she had come so far JUST to get onto the breast for moments at a time. How could I give up now? It would be unfair to her – it wouldn’t just be giving up, it would be giving up ON her. Her progress had been slow, agonizingly so, but she was progressing. Baby steps, two forward, 1.5 back, true, but it was still progress.

I decided that if I was going to give up, I had to make absolutely sure that I had done absolutely everything that I possibly could. And there was one more thing, the thing that I had been so reluctant to try because my first experience with a similar device (the SNS) was such a nightmare. The Lact-Aid.

Jennifer insisted that this really would improve her latch and train her to be at the breast for entire feedings, and that it wouldn’t be as bad as the SNS, since the device itself is more user-friendly (utilizing a bag that is worn around the neck instead of a tube clipped to the clothes, for example), and since I would not have to use a shield at the same time anymore. I was reluctant, and put it off for a few weeks, because my experience with that SNS was just so godawful.

But finally, after treading water for awhile with the shield-n-switch, I decided that if I wasn’t going to ‘make it' with Lily, if we truly were unable to nurse and I had to EP for her, I could live with and make peace that – but only if I had really tried everything. Including this. If I gave up before I tried the Lact-Aid, I’d always wonder if THAT would have been what helped us finally succeed, and I’d never, ever forgive myself for not being willing to try.

8. So, of course, this is what I eventually did. I went for the Lact-Aid. I had my doubts, but my last one evaporated when I was having trouble coming up with the $65 for the device –and we found out within a day that another mom in our nursing support group just happened to have an extra one (missing one minor part, hence the replacement that she got). So I threw myself into it.

This was a LOT of work, setting up the apparatus each time, cleaning after, plus I was still pumping 8-9 times a day right after each feeding, and the feeds could be grueling. So often she’d have a decent latch but the tube wasn’t all the way in her mouth, or the tube would be good but she’d barely have the tip of my nipple, so I’d have to start over. Then of course there were the times that she’d catch the tube with her hand or turn her head, and again I’d have to reconnect everything. I also had my doubts about how this would improve her latch mechanics. But I decided to just throw myself into it and actually trust the process and try not to overthink everything too much.

Well, it took over a full month of working with the Lact-Aid, but slowly and surely . . . it did the trick. We started out using the tube throughout each feeding, and after a while, it started to seem like she was getting overwhelmed with milk – because she was getting so much from my nipple AND the tube. At that point I would begin some feeds with the tube pinched off, and then release the supplemental milk only when she started to slow down. Long LONG story slightly shorter, this paved the way to start doing some feeds only at the breast, and after about 2 weeks of her only getting about 1 to 1.5 oounces from the Lact-Aid total each day, we decided it was time to go all out.

From there, I continued to pump after feedings for another month, even though it was no longer to create milk for supplementing, it was to make sure my supply didn’t drop too quickly. If you’re too abrupt, you can end up with plugged ducts, mastitis, or even risk your supply dropping TOO much despite having had an oversupply (if your breasts are suddenly never being emptied, this can happen). I gradually started to eliminate pumpings, dropping one about every 4 to 5 days. It took another two months to eliminate all but one daily pumping - which I continued for a while longer to make sure I have reserves, and just to be on the safe side (though if you saw the motherload in the freezer you’d laugh at my concern about the reserves).

***

So there you have it. She did it. It took five months, but she did it. And frankly, I plan to let her go just as long as she likes – my goal is for a minimum of two years. If she really wants to wean after that, I’ll follow her lead, but no way I’m kicking her off myself.

If you made it through all that, I’m impressed, and also grateful. It’s been good for me to write it out – I haven’t been able to get it all out before now, both because I literally didn’t have the time, and also because I didn’t want to start talking about it unless – or until - we ‘made it’. There are still times when I fear that it’s all going to fall apart, every time we have a crappy feed, especially since we’re just getting started at an age when they’re extremely distractible (nursing in public is almost impossible). But I have a bit more faith every day. NEVER take it for granted if you are able to nurse, and thank your lucky stars even further if it comes relatively easy to you. There are women out there who would give anything – everything - to be able to do what you’re doing.

I give thanks every day for what we’ve been able to do, and for the many helpers we’ve had along the way, from the fundraiser some friends helped me organize to pay for Jennifer & her craniosacral therapists, to the woman who gave me her Lact-Aid, to the phone calls that came in when I needed to be talked off the ledge but was feeling too down to even ask for help. and especially for Jennifer herself, without whom we never could have done it. They are all answered prayers – and that’s also a surprising thing; this experience has (don’t laugh) restored my faith in some form of God. I’m not exactly sure what form this will take, but it’s there.

So there you have it. The crazy thing is, believe it or not, I could write more, so intense and intricate was the whole experience. If you actually made it to all the way through this, I'm sure that sounds ludicrous, but it's true.

The end . . . though it's really just the beginning.


(Epilogue follows in the next post: Three Lessons.)