Lact-Aid Demo: In which I take one for the team and bare it all for the greater good.

If you're a mother who found herself struggling with either supply issues or your baby's serious latch issues, you might have needed to supplement, whether with your own pumped milk, whenever possible, donor milk, or, if neither is available, formula. With getting back to exclusive breastfeeding as a goal, if you were getting informed support from a reputable source, you may have been advised to try an at-the-breast supplementer, such as a Lact-Aid or an SNS (the "supplementary nursing system" by Medela) in order to avoid the pitfalls of using a bottle too early, nipple/flow confusion in particular. Finger- or cup-feeding are also frequently recommended by good lactation professionals, and are great in the short term, but some mothers occasionally need to supplement for longer while their supplies are established or their babies suck coordination is improved.

But without adequate instruction - and good demonstration - these supplementers seem devilishly complicated to the point of maddening, and understandably, many mothers get fed up with trying to figure them out. A search online for a decent YouTube video turns up a few Jack Newman offerings. I have the utmost respect for Jack Newman, and the information he makes available is incredibly valuable - but to be brutally honest, these supplementer videos are of little to no use to a mother who is trying to figure the damned thing out, and in particular, how to get their baby latched using the supplementer all by herself, which is going to be the reality for 99.9% of all moms out there. He's doing it all FOR her. It's nice to show it in action, and promote its benefits, but not helpful at all in learning HOW.

Moveover, the way he pushes the tubing into the baby's mouth after the latch is established is completely impossible to do if you're using a Lact-Aid instead of an SNS (which I do strongly recommend; more on that later), because its tubing is so much softer than that of the SNS. This is one of the reasons a Lact-Aid is preferable in the first place, but you MUST put the tubing in at the same time the baby latches on.

So, I'm taking it upon myself. Pretty much literally. Why? Because I believe so strongly in supplementing at the breast whenever supplementing is needed, whenever it is possible. In addition to the way supplementers circumvent nipple confusion, it also makes it possible for mothers who have supply issues to increase the amount of stimulation, and thus production, their breasts are getting. (Regular pumping sessions may still be advisable for a while - please consult an IBCLC about this if it is your own situation - but why not kill two birds with one stone? Pumping and supplementing is hard enough.)

And perhaps most importantly but more challenging to quantify, it IS breastfeeding, and will help to improve baby's latch (again, see IBCLC for advice on how to monitor this) AS you are feeding, whereas with a bottle, even slow flow and/or "breast-like" bottles like the Breastflow, one can only cross one's fingers and hope too much damage to baby's technique isn't done. Using paced feeding and an upright position helps, but it's challenging.

This is also personal: The Lact-Aid made it possible for us to make the transition to the breast after struggling for months, and I firmly believe we never would have made it without it.

An important note: I mentioned that there are two major types of supplementers out there, the Lact-Aid and the SNS by Medela. I have used both, and FAR AND AWAY, I feel that Lact-Aid is the superior product. I write about this in our nursing story, but in a nutshell: It is much, much more user-friendly in several ways, including the way you wear the bags around your neck, the fact that no taping is necessary, and the fact that the tubing itself is very soft and shouldn't disturb baby at all - they probably won't even notice, especially if they're newborns. I started using it when Lily was 4 months old and she was fine, whereas the harder tube of the SNS makes many a baby balk. YES, it's true, I also have ethical issues with Medela, but I promise you I felt this way long before I learned of some of Medela's questionable practices.

Make no mistake: if you choose to use the Lact-Aid, and I sincerely hope you do if supplementing is necessary, there is still going to be a learning curve. I cannot tell a lie: the first few days are pretty much gonna suck. But every feeding is practice, and within a few days, you'll start to really get the hang of it. And in a week or possibly two, it'll be down pat. To be honest, for the first couple of days, I only did Lact-Aid feeds a few times a day, during the times when Lily (and her mom) was at her 'best', i.e. not in the middle of the night. And then I gradually added more Lact-Aid feeds in. You might want to try phasing-in this way, too. Take it one feed at a time.

OKAY. Without further ado, here's a very short video, starring my boob and the baby of one of my clients, with whom I became friendly. I actually had been donating some milk to her privately as a result (she had breast reduction surgery years ago, and like some, though not all, BFAR moms, had to supplement a bit). I also occasionally babysat, and we mutually decided, Well, if she's getting my donated milk anyway, why not offer it from the tap?

Let me be clear: this isn't exactly an official extra service I regularly offer to clients, it just kind of worked out that way. I had worked with them on using the Lact-Aid, too, and one day, after struggling with descriptions and coaching, I said hey, since I've nursed her anyway, would you mind if I simply showed you on myself? She was totally fine with that, and so I did. It was IMMEDIATELY much easier for her. And then it occurred to me that, due to the dearth of existing videos it might be helpful for the internet masses to see as well. She offered up her beautiful little one for me to film (isn't she precious?), and here we are, our other kiddos chattering in the background.




There you have it. Please, in the comments, ask me about anything that needs clarifying, or anything to do with the Lact-Aid. One thing I can think of right off that merits a bit more explanation: If you want to start off the feed with milk from the breast and add the supplementation at the end, which is preferable, you can either delatch and relatch, or, even easier, as I demonstrate, simply start the feed with the tubing pinched off in one of the notches in the body of the Lact-Aid device, then, when babe's sucking slows down, release the tube from the notch and the supplement will start to flow. Oh. and one other note, the bag of milk is hanging kind of low here - you can adjust the strap so it's much higher, and you can nurse in lots of different positions.

Again, feel free to deluge me with questions.

Somehow I knew it would just be a matter of time before, one way or another, I showed my boobs on the internet. But here it's for a noble purpose, right? RIGHT? If it convinces even one mom go with the Lact-Aid instead of a bottle, or instead of tearing her hair out with an SNS - and then giving up and going with the bottle, it is all worthwhile.

*~*ADDENDUM*~*

When I shared this with my own LC, Jennifer of Intuitive Parenting Network, she quoted my statement, "Because I believe so strongly in supplementing at the breast whenever possible, any time supplementing is needed," and said "I am allowed to smile, right?"

I feel it's only fair to point out what she's getting at, which is that when faced with doing this myself, I fought it tooth and nail. I talk about this in the link to our nursing story I posted towards the beginning, but I think it's worth repeating here as well. Yeah, I literally resisted using this for months. MONTHS. My experience trying to use an SNS at about 6 weeks was just so indescribably awful that I desperately wanted to avoid using anything like it ever again if I could. So I kept pumping around the clock and bottlefeeding my milk to Lily. I was using the upright "paced" technique, and I would try various ways to offer the breast before, during, after, and in-between feedings, but I was still bottlefeeding her. And was really making little to no progress towards our goal. Treading water is all it really amounted to, and driving myself nuts with frustration in the process.

Jennifer, and other moms in our support group who had trod the Lact-Aid path tried many times to convince me that the Lact-Aid was going to be a much different, much better experience, and more importantly, because I was at a total standstill in progress with the bottlefeeding, it would likely be the one thing that got me over the hump. And they were absolutely right about both things. If I had tried using the Lact-Aid earlier than I did, I could have started nursing her many weeks, even months earlier than we finally did. No exaggeration.

People often commend me for sticking it out the 5 months it took to get Lily nursing, and I appreciate that and do take it in, but honestly, the stubbornness that I tapped into to get her ON the breast is the same stubbornness that made me resist using the Lact-Aid, and therefore held up our progress much longer than was probably necessary. I just had to get to the end of my rope, my absolute wit's end, the point where I was truly on the edge of just giving up altogether and EPing for her. I was trying to figure out how I could make my peace with this decision, and I realized that the only way I would ever be able to be okay with giving up on breastfeeding is if I truly KNEW that I had tried everything. And the Lact-Aid was the final frontier. If things didn't work after that, then I would be able to forgive myself, knowing that I had done my very honest best. But only then.

So I took the proverbial deep breath and threw myself into it. And it was tough for a few days, but after that, grew progressively easier - and I saw progress. Real progress. Within 3 weeks she was only taking about 2 ounces per day from the supplementer (I used it at every feed, but only released the flow of the tubing when she was starting to slow down). I kept using it for another week, just to be on the safe side, but really, we had made it. We had crossed over. And it was totally the Lact-Aid - and those who convinced me to try it - that did it.

I'm grateful beyond words that Jennifer can now smile at my stubborn ass. If you're facing anything similar to what we faced, any variation on it - look, DON'T follow my example. Don't torment yourself for months, fearing that breastfeeding will be impossible for you, out of fear of some frustrating feedings and having to learn a new technique. Supplementing at the breast is a godsend in the right situation. Just do yourself a favor and use the superior product, commit to overcoming the learning curve (because you WILL), and go for it. I'm rooting for you!

Lactation Luminaries: Founder of Lact-Aid Passed Away

As I went to add a link to the Lact-Aid site in my last post, I noticed a memoriam to the inventor and founder of Lact-Aid, Jimmie Lynn Avery, and couldn't pass it by without remarking on it.

Jimmie Lynne Avery, age 65, of Athens, TN, died Monday, October 26, 2009 at her home, surrounded by family and loved ones. Succumbing to a life long lung birth defect and resulting lung disease of which most of her Lact-Aid mothers and babies never knew she had.

She successfully nursed her adopted children via a Lact-Aid prototype invented by herself an her husband. Read the whole story here - it's an inspiring one.

As I've written before, both here in my unabridged story and on countless message boards where advice on optimal supplementation is inquired about, the Lact-Aid was a significant contributor to my eventual success in nursing. Having tried both, I feel strongly that it's far superior to its mass-produced counterpart, the Medela SNS - and I said so long before I had an inkling about some of Medela's questionable business practices (a complex issue, of course).

But her passing away is even more personal than that, for me. When I called the company to order some parts - a friend gave me a partial unit to use, as we were beyond strapped - I spoke to Jimmie Lynne directly. I expected to simply place my order, give my credit and shipping info, and be done with it, but her friendly voice inquired gently about my situation. I gave it to her in as much of a nutshell as I could.

"You must be exhausted," she said - such a simple statement, but the compassion and sincerity in her voice came through so clearly that I instantly burst into tears. She continued to listen and offered more kindness, telling me a little more about how the device would work and to make sure I called back if I needed any help at all, any time. This was our only conversation, but I'll never forget it. The human touch (well, so to speak, via telephone) was indelible.

It turns out this personal connection was part of her entire philosophy. From the memorial on the site:

She was still helping and counseling mothers four days before her death. Jimmie Lynne helped countless thousands of mothers and babies with a sweet touch that only she had. For nearly forty years Jimmie Lynne would not let any one else at Lact-Aid answer the phone or take orders. She would say that was the most fun job there was “ talking with and helping mothers and babies”.

When Lily was about a year old, I sent the company a thank you letter with an abridged version of our story and got this back:

Anne,

Thank you for sending us your story about your experience nursing Lily. We are so happy to know that Lact-Aid had a helpful part. Thanks for sharing with us, and with others out there on the web. If anyone asks, let them know we love to hear from them, whether it is for questions, support, suggestions, whatever.... The best part of being involved with Lact-Aid, to me, is the contact with so many wonderful people who care deeply about their babies and families, and contact with the LCs and other health professionals who do their part to support breastfeeding.

Give Lily a big hug and kiss from us.

Warmest regards!

Jimmie Lynne

I pray that the company continues on without Jimmie Lynne, and in her spirit. I'm going to offer free advertising on my site, in fact - something I thought of and should have done a while ago.

Thank you for your legacy. The lives of mothers and babies have been forever changed for the better because of you.

Ready, Set, Suck: On breastfeeding marketing & Medela's WHO violations

It came to my attention not too long ago that Medela, probably the largest manufacturer of breastfeeding-related products, might be less than squeaky clean in terms of their compliance with the very important WHO Code regarding marketing of formula, bottles, and other breast & breastmilk replacing products. But I managed to coast along in denial for a while longer, having had Medela products play such a huge role in my daughter's long and exhausting road to the breast.

Their high quality, extremely efficient Advanced Pump in Style double electric breast pump was what got Lily fed, period, for the first 5 months of her life, while my LC and I worked at various strategies to get her to latch. Using the SNS was an important step we needed to take along the way (though I ultimately found the Lact-Aid to be superior), as were their nipple shields. And primarily because I became emotionally invested in them, I also purchased accessories like their breastmilk storage bags, breast shells to help draw out flat or inverted nipples (and to air-dry them if sore or healing), their travel wipes for the pump, and the microwave steam cleaning bags. It’s convenient when the pump you’re using fits with the bottles you want to use, when replacement attachments are readily available, and when you feel like there’s a consistent quality there that you can trust. I completely understand that kind of brand loyalty.

Because I was such a loyal customer, it was all the more stinging to read this post by PhD in Parenting last week, full of serious truthiness as it is. I won't rehash the entire thing here, as she has done such a good job already, as did the above much earlier post from Hoyden About Town - do go check them out for yourself. Suffice it to say that not only has Medela flipped the bird at the code, marketing bottles in violation, they're now making matters even worse with this sly, underhanded "Medela Mom Mavens" campaign.

I can understand, to a degree, that it's a tricky line to walk at times. Having some of these products available, like the ones my daughter and I benefited from during our insane nursing saga, is important. They should be available to moms who need them, and easily so. I am thankful that when I needed a different size nipple shield, I was able to run out to the local big box baby store (more on that in a sec) and pick one up. I'm thankful that replacement attachments for the pump were similarly conveniently available. I am thankful that the moment it seemed like my situation might call for an SNS, my LC was able to hand me one immediately. Such breastfeeding support products can make a HUGE difference in breastfeeding success when there are complications. As Annie at PhD in Parenting says:

I don’t want to be overly critical of Medela. I think the company does a great job promoting and facilitating breastfeeding. Most of the information on its website is wonderful. Most of its products are of the highest quality. I have been nothing but happy with my Medela products. However, I do think that some of their current actions to promote their bottles are inappropriate. It would not be difficult for Medela to continue to promote breastfeeding and sell its bottles without promoting them. However, it has chosen to ignore the WHO Code and push more bottle imagery and bottle messaging on moms (more on why bottle imagery and messaging is hurtful here). The result is that Medela is directly pushing bottles on moms and also doing so indirectly via the Medela Mavens and others who might pick up on the message about how breastfeeding ties you down, so you really need a pump and bottles so you can get your hair done.

To be clear, on a sliding scale this is not even close to Enfamil or Nestle or other formula companies. Not even close. But I would argue, and others do argue, that any violation of the WHO Code weakens its potential impact. We cannot say “it’s okay because you are Medela,” but then slap Nestle on the hand for everything it does wrong.

Lines have been crossed, not only in the clearer terms of promoting their "breastmilk bottles", but in the more nebulous grey area of promoting products over breastfeeding. I've been mulling all this over for a few days, and trying to find a way to put that thought into words, and then I went to the big box baby store yesterday, a trip that was disappointing on two levels.

I was there to drop off some flyers for the upcoming doula training I'm sponsoring, as well as some business cards. The last few times I was there (hey, pickin's are slim in this town), probably 2 months ago or so, there was a small table behind the registry area where local birth and baby-related services could leave their materials. There was never a lot, but there was a brochure for an independent childbirth class, cards for a breastfeeding support group, a small calendar of mom's playgroup activities, that kind of thing.

When I walked in yesterday, the table was empty. I asked an employee whether it had moved, or if there was another area to post about things like childbirth classes - a community message board, perhaps. She told me that no, they had decided to not allow outside materials any longer. Disappointment #1, in terms of small businesses and independent agencies. But hey, she said, they have some classes of their own! She pointed out the board below:

Here's a closer look:

A "Breastfeeding 101" workshop, sponsored by You Know Who! A basics of breastfeeding class whose description begins with "Ready, set, pump!"

If that doesn't make their priorities clear, I don't know what will. Believe me, I know firsthand that a pump is sometimes absolutely essential. And certainly it is for mothers who work outside the home. Hallelujah for them, seriously. But a breastfeeding class that focuses first and foremost on pumping? The rest of the description: "Get the scoop on breastfeeding and all the great products sure to make it easy to feed baby naturally." I mean, it's not that I was surprised to see a live, in-person infomercial for Medela products disguised as a breastfeeding "class". Especially not at a big box store (with similar classes in car seats, sponsored by Graco, and the like). I'm not so naive. Just very, very disappointed.

So, like many other lactivist moms out there, I can no longer in good conscience continue to promote Medela products. So what to recommend in its place? Just West of Crunchy has an excellent and thorough post on the matter, which starts out bemoaning the same state of affairs and then goes on to explain the Hygeia and Ameda pumps, both of which sound great - in addition to being WHO compliant, and proudly so, unlike some people, they are also closed system pumps, much preferable to Medela's open systems. She explains it all adeptly here:

If more mothers knew the facts about their beloved Pump in Style pumps, Medela would be selling a lot less of them. And I can speak from experience, I have a PIS sitting in my closet, waiting to die a slow death in a landfill.

Why? Because it can't be given to anyone else. That's right, my $280 breastpump has to be tossed in the trash. It's not FDA approved for more than one user. Even though I only used it maybe 30 times. And I know there's a huge black market for the sale and donation of used single-user pumps, but you know what? Even if I could, I wouldn't give the thing away to another mom. Because once you know the facts on the Medela pumps, you won't want to use them.

There are "closed system" pumps and "open system" pumps. Medela is the latter. Having an "open system" means that milk can contaminate the tubing and the motor to the pump. And while the tubing can be cleaned or replaced, the motor cannot. Which means if my milk makes it into the motor, so could a hypothetical seccond user's, at which a time they'd mix. The motor can't be cleaned or sanitized, and there's no way to know if milk ever contaminated it. So, if you're using a second-hand pump, it might be clean, or it might not. Your guess is as good as mine.

But even if you follow the rules an purchase a new Medela pump, keep it, and never allow it to be used by a second party, you can still have problems. It's important to note that Medela is completely open about their pumps being single-use only, they're very forthright about that. The information that's lacking, though, is that you can actually end up with MOLD in your pump motor and tubing, due to the open system design. The milk that you can't see in the motor - that you have no way of knowing whether it's there or not - can grow mold inside your pump. You can also end up with mold in the tubing (a lesser problem, as that's replaceable).

I don't know about you, but I'd rather have a pump that has ZERO chance of developing mold in its motor. Both Hygeia and Ameda offer pumps that have closed systems. You're not going to get milk in them, because the way they're designed, there's no backflow. Not only are these WHO Code compliant companies, they make superior products!

I took a look at Big Box Baby Store's pumps to see if they had either of the above. Nope. [See update below!] They had one Lansinoh electric pump, and one Evenflo hand pump, and the rest was, of course, all Medela, all the time. So, it's frustrating. Medela is no doubt the most widely available. You can go see them for yourself, talk to a salesperson, and take one home the same day. Ordering things online is less appealing and even prohibitive for some people. But I have to recommend doing so nonetheless, at least until/unless Medela does a serious 180 (and I would be thrilled if they did). If you're lucky enough to live in an area with smaller businesses that might sell alternative pumps directly, then hooray (for that among other reasons).

What about some of the other products, though? Smaller ticket, yes, maybe not as big a deal to the company, but still. I can make a few recommendations. For the best storage bags: I always liked Lansinoh's. And I honestly would recommend the Lact-Aid over the SNS even if Medela was behaving ethically - same basic concept, but the difference in user-friendliness is HUGE, and again I must point out that Lily would NOT be nursing today were it not for the Lact-Aid - along with the brilliance of my LC of course. But I digress: As for nipple shields, that's one where I'm stumped. Breast shells as well - I know that for drawing out inverted nipples, Supple Cups are now available, and reputed to be very good, but for helping to air-dry sore or wounded nipples, I'm not familiar with an alternate brand. Lactation pros, moms with nursing challenge experience, do you have any ideas? Please chime in.

I close with the following from the Hoyden About Town piece, on the insidiousness of Medela's current marketing:

[Medela's commercial states:] “When you choose to breastfeed, you’re doing what’s best for your baby. When you choose Medela breastfeeding products, you’re doing what’s best for you both.”

Medela is saying, directly, that breastfeeding is not best for women. It might be ok for babies, sure, because they get the breastmilk, but Medela is telling us loud and clear that pumping is better for mothers than breastfeeding is. No qualifications, no circumstances; just “pumping and bottle-feeding is best for women”, with a side serve of “and it’s just as good for babies”.

This isn’t just a WHO Code violation; it’s not true. And it’s a lie fed by all of our dysfunctional societal issues around breasts and breastfeeding and public feeding and mother-child attachment and women and the workplace. It’s fed by the huge pile of myths about how easy pumping is, and about how bottled stored breastmilk is just as good, and about how it’s vital to schedule feeds and “see how much babies are taking”, and about how babies don’t know when they’re hungry or thirsty or full or in need of comfort. The problem is, it isn’t just fed by those dysfunctions, it’s feeding back into them, reinforcing them.

These sorts of advertisements are part of the huge coercive societal mechanism denying support for mothers and children, part of the capitalist machine preventing women from being able to afford time with new babies, and keeping them being good little workers and consumers. I think it’s no coincidence that two countries with no moves towards a full legislative implementation of the Code, the USA and Australia, are also the only two industrialised countries in the world without mandatory paid maternity leave.

Words mean stuff. Marketing is powerful. Advertising works.

And it makes a whoooole lot of money.

*****

UPDATE 8/31/10: Ameda pumps are available in Babies R Us nationwide now, and not only that, the Lansinoh double-electric pump for $150 is actually an Ameda pump, rebranded, and at half the price.

*The hospital-grade pump Symphony pump IS a closed system, so this is the one exception in the Medela line, ethical issues notwithstanding. Moms needing to rent these when there's not an alternative brand available should feel safe.

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.)