Going back to work

Monday is my first day back at work.  I’ll be working part-time through August.  I also can work from home (except for meetings), good thing since the Nushka is not “quite” at that stage where I thought she would be, i.e. me proudly pumping giant bottles of breastmilk for her to enjoy while I am away.  My in-laws are here now so they will help with child-care and I just need to pop out of the office in order to dish up the ole boob.

Note: since her tongue-tie operation last week she has gotten a lot better at breastfeeding – she can eat from both boobs!  Baby, we have just doubled our pumpless milk-transfer capability.   Now “all” I have to do is double my milk production and we will be home free… well, I will work on it.

In any case, in the meantime, I went in for one meeting this week as kind of a trial run.  That’s when I realized… I’m stupid.  Yeah, sleep deprivation has pulled one over on me.  I didn’t really notice how dumb I have gotten when most of my activities were fairly brainless.  But at the meeting where I actually had to do some very minor mental gymnastics I realized that the ole memory is pretty much shot, or at least my access to it has been radically curtailed.  Holy poo, am I going to be dumb for at least several months.

I am really lucky that at my work you can take so many months at part-time but be paid full-time.  But if I had to do it over again, I would take unpaid leave for a few months before going back at part-time.  I’m looking forward to working some and getting back in the fray a bit, but I had no idea when I made my plans of just how much time childcare takes, and just how much joy it can bring…

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Book recommendations for breastfeeding…

Two book suggestions, one for those who have breastfeeding in their future, one for those who are currently struggling with it.

Before I had the Nushka, I read “The Nursing Mother’s Companion.”  This is an excellent book to have… after the baby comes, as a reference manual.  I found it pretty confusing and overwhelming before the baby came.  I would suggest instead for getting the idea of breastfeeding the book “Breastfeeding Made Simple” by Nancy Mohrbacher and Kathleen Kendall-Tackett.  It is a great basic explanation of the principles of successful breastfeeding.  Sure wish I had read it a little earlier…

The book I would recommend to anyone currently breastfeeding and having difficulty is “The Ultimate Breastfeeding Book of Answers” by Jack Newman and Teresa Pitman.  Great, extremely detailed book that explains how to deal with many breastfeeding problems.  Jack Newman is the authority on breastfeeding.   This cuts through a lot of the bull you’ll find people telling you.

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Breastfeeding is hard

The Nushka turned 6 weeks old yesterday.  She is a bundle of joy.  She is happy and healthy and we love her to death.  We are very, very, very lucky.

The only part of the having-the-Nushka experience which is not so good is the breastfeeding.  I really wish that childbirth classes spent more time (or maybe, any time at all) preparing you for how hard breastfeeding can be.  Our childbirth class did have one week on breastfeeding, which focused on pounding in the “breast is best” mantra.  But it didn’t explain that you needed to be well-prepared for what could go wrong and how to handle it.  I knew lots and lots and lots about labor and delivery, I had read lots of books and had educated opinions on my options.  But breastfeeding?  I figured that would just… work.

So… here’s what actually happened.  At the hospital, the Nushka and I couldn’t figure out a good latch and I got very bloody and scabbed nipples.  We ended up using a nipple shield, which seemed to work well.  “Seemed” being the operative term here because with the nipple shield  (a) we didn’t learn to latch well without it and (b) the Nushka wasn’t getting enough milk and (c) my boobs weren’t getting enough stimulation to keep the milk production up.  I didn’t realize these things until we found out from a lactation consultant we called to find out why the Nushka wanted to nurse 24 hours a day that the reason was… she was starving.

We’ve spent the last 5 weeks in a constant stream of problem-solving with the help of two very good lactation consultants.  For a while the Nushka preferred the bottle to the breast, it took some training to get her back interested in the boob (now she much prefers it, fortunately).  We worked hard to get a good latch, but even now, 5 weeks later, she still does not latch on very well.  For example, she still is not capable of triggering a milk ejection reflex on one side (i.e., basically, she can’t eat out of one boob). I have been pumping for 5 weeks to try to keep the milk production up, but have had various problems with the pump as well including scabbing from the flanges and mysterious sudden drops in production.  We spent 5 days fairly early on trying to wean her off the supplements by continuous nursing, which should in theory get your milk production up but in practice didn’t really work.  So mostly for us feeding has consisted of (1) nursing then (2) bottle feeding then (3) pumping – lather, rinse, repeat 8-10 times a day.  Now I am trying to get a supplemental nursing system working (a system whereby a tube taped to your nipple delivers formula while you nurse), which should let me cut out stages (2) and (3) of the daily grind, but so far for mysterious reasons the Nushka is not getting enough food out of it to meet her needs.

Why is all this happening?  Some of it is just mysterious and apparently random.  But some of it is starting to be clear.

1) I am hyperthyroid.  Actually, I am or at least was hypothyroid during my pregnancy, and it seems like my thyroid function is returning after pregnancy and, combined with my thyroid meds, is making me hyperthyroid.  Did you know that thyroid levels play a major role in breastfeeding?  No, I didn’t.  Sure wish I had known that earlier.  And that my thyroid levels were very near the hyperthyroid cut-off before I gave birth already.   The midwives had just told me they were “normal.”  They were normal, but only by a sliver…

2)  The Nushka had an obscure form of a tongue-tie.  This means she could not move her tongue freely.  She had been checked for tongue-tie by her pediatrician but because she has a subtle kind it hadn’t been caught.  The lactation consultants had been wondering if it might be why latching wasn’t working, but it took a while to rule everything else out.  Finally we had the tongue-tie snipped this past Monday.  Right away – well, after she had stopped crying because she was so traumatized by the anesthetic – she started really sticking her tongue out and Mr. Nishkanu and I realized that this tongue-tie thing really had impeded her.  Now she is learning to breastfeed again, but old habits die hard.  Maybe, maybe, maybe she can learn to latch on without pain.  If that is the case we can try to get my milk production up.  And if that works maybe we can finally get rid of the supplements.  But I have my doubts.

My behavior in response to all this has really surprised me.  I never would have guessed that I would be plowing on through all this to try to breastfeed.  In fact, if you asked me beforehand, I would have told you I would not do it.  Breastmilk is best, that’s true, but formula isn’t so much worse really.  But after I had my Nushka… and after I knew what it was like to snuggle up with her and feed her (even with the scabs)… then I didn’t want to stop.  The idea of weaning her makes me feel intensely sad, even though I am not really supplying that big a part of her nutrition.  I don’t really care about the health benefits, what I care about is the relationship. I want to be a breastfeeding mama to my Nushka.  That’s it.  If they had said that in childbirth education instead of sticking with the “best nutrition” argument maybe I would have listened a bit more.   Or maybe not, after all I am pretty pig-headed.

So here’s the thing.  “Breast is best” is the public education mantra.My childbirth education class did point out that most American women do not successfully breastfeed to the extent that they planned or hoped to before the baby came, and said the reason for that is lack of societal support.  But I have had a lot of societal support – I am motivated, my husband was mostly home for the last 6 weeks and pitched in 100% in childcare, I had my family here for 4 weeks helping as well, I am working with 2 excellent, super helpful lactation consultants, I have 6 weeks of paid full-time maternity leave (actually 7 – it was extended one week because of the tongue-tie operation) and I am still only partially breastfeeding.  How is the average new mother supposed to do this?

For many mothers, I guess, breastfeeding  does come relatively easily.  But for many others, it doesn’t.  When I called work to ask about getting additional leave, the person who answered my call explained that she had had the same problems that I am having.  But the doctor she went to poo-poo’d her when she suggested it could be a tongue tie, and she gave up.   It’s really pretty sad.

On the positive side:

1) My nipples are pain-free enough that I can wear a bra or a shirt now!

2) My milk supply is stable!

3) The Nushka managed to get milk out of the right boob once or twice recently!

4) She likes breastfeeding!

so there is progress, just in tiny tiny steps.

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She arises for air…

I wanted to post a long long long time ago but somehow the energy was missing… now random missives from the front.

The first week with the little one (who we will call here the Nushka) was super totally 100% awesome (if you ignore the severe pain in the nether regions).  We feel like we hit the lottery with our little one, she is a super mellow, alert, happy baby, easy to keep content, very interested from her very first day in what is going on around her and likes to keep us company throughout the day.  We are also lucky that she came at a slack time for Mr. Nishkanu’s work so that he can stay at home for a few weeks with me and we can split the parenting 50/50.   Being born late and large, she sleeps pretty well through the night, 4 hours at a stretch. We spent the first week just enjoying her, introducing her to new experiences like her first ex utero music which she listened to with rapt newborn attention, and marvelling at how absolutely awesome it is to finally be parents to our beloved daughter.

Then breastfeeding hell began.  Apparently my nipples are “semi-inverted” and in an attempt to get them latch-onable my first night nurse applied a manual pump to them which caused the nipples to crack and start bleeding.  Learning to latch on the next few days aggravated matters until my nipples were a bloody, scabby mess (sorry for the TMI). The nurse gave me a nipple shield to protect them and things seemed to straighten out.

Until a week later when the Nushka started getting fussy, very different from her default mellow personality.  We thought at first it was gas or a reaction to something I was eating.  Then Mr. Nishkanu read in one of our books that nipple shields can interfere with milk production.  We tossed the shield and I gingerly latched her on to my scabby nipples (this provided excellent motivation to work on a good latch….). She ate quickly and happily, covered in breastmilk by the end of a short feed and then good-bye fussiness.

Problem solved until that night, where she started fussing again and then wanted to be fed continuously from midnight until 4 AM… and beyond, but my nipples hurt so badly I woke Mr. Nishkanu and asked him to give me a half hour respite…  What were we doing wrong?  Were we misreading her hunger signals?

The next day we called a lactation consultant.  Fortunately she could come by the same day.  When she did, she told us that our baby was underfed and dehydrated.  That seemed weird given how much she was feeding.  In retrospect it seems like the nipple shield had interfered with my milk production and I was no longer producing enough milk to feed her.  The consultant recommended we start supplementing with formula immediately to get her rehydrated.  S*ck!  Was this the beginning of the end of breastfeeding?

To put this in context, before I had the Nushka I figured that I would try breastfeeding, if it didn’t work I would bottle feed and that would be that.  But once I had the Nushka… once I knew what it was like to snuggle up to a little being you have waited so long to meet, and to be able to fill her needs with what your body produces… well, I didn’t want that to stop.   Like, I guess, so many other things about parenting, I had massively changed my tune.  So, this felt like a huge loss.  But bigger than that loss was the blow to our parenting confidence… we thought we were getting the hang of it but we were starving our baby without even realizing it.   So much for parenting instincts.

For the next week we fed her a bottle after every feeding, and while Mr. Nishkanu gave her the bottle, I pumped to get my milk supply back up.   It was a drag – all the overhead of bottles, plus breastfeeding, plus pumping, and I can tell you that after a 3AM feed the last thing a person feels like doing is getting out of bed to sit in a chair and pump and then carefully wash the various pumping parts… but it would be worth it if it restored my supply.  Except my supply wasn’t being restored, it wasn’t getting worse but it didn’ t seem to get better either.

Finally, we decided to go cold turkey.  We cut the formula out altogether during the day, only using it for two feeds at night so we would get some sleep.  Now finally something seems to be working.   The first day she nursed continuously the entire day.  The second day she took two one-hour breaks.  The third day she started to take breaks more often, between 10 and 45 minutes a piece, though she still nurses continuously in the late afternoon and evening.  Today when I got up there was actually milk leaking from my breasts, and she is taking a break after every feed, though not always a very long break.  We may be back in total breastfeeding business soon… I hope!!

In the mean time I have a couple of random thoughts to note down before they are gone in a haze of breastfeeding sleeplessness about labor and delivery…

It was not really a transcendental experience, just really really long and hard.  At the time, I thought to myself “People want to remember their birthing stories.  But why would anyone want to remember this?”  I was in fact  forgetting it even while it was happening… but now I too would like to remember it…

I can not recommend strongly enough for people to have a doula accompany them for labor.  Our doula was fantastic.  I truly believe that without her I would have ended up with a c-section.  And the whole experience would have been really, really traumatic (or at least, really much more traumatic than it already was).

I thought that giving birth would be this amazing experience of meeting your child.  Instead (maybe because of the length…) it was a lot more like taking the worst, most horribly painful poo of your entire life.  At the end, they then hand you this baby and say “here, this is what came out.”  And you think, “who the heck is this baby and where did it come from?”  It is hard to connect the experience with the outcome.

And when we first saw the little one, really she was just a stranger to us.  But it did not take long for us to fall in love with her.  After a day with her we couldn’t imagine having a different baby.  When they checked her ID before letting us take her home we said, “well, if there has been a mistake, we would still like to have this baby…”

What I learned from this experience is, you don’t love a baby because it came out of your vagina.  And you don’t love a baby because it is genetically related to you or your sweetie.  You love a baby because you take care of it.  And you love it for its own nature, for its own way of being.  The fact that the Nushka is a DE baby is irrelevant to our love for her.  She is not a second-best baby, she is our miracle and our precious daughter.  We would not trade her in for anything.  The DE aspect does add a dimension to the experience, it means there is a stranger somewhere in this country who gave us this amazing gift.   She is a miracle of science and of the human heart. We are unbelievably lucky to have her.

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We are a family

After 6 days of Braxton-Hicks contractions, I woke up Friday night just after midnight and knew… “these are different.”  18 hours later our new little girl arrived in the world.  It was a long and grueling labor; active labor went relatively speedily but I got stuck in transition for 3 hours and pushed another 3.5.   A dose of temporary anesthesia after 2 hours of transition gave me an hour’s rest and made it possible to make it through the Iron Triathlon.  At the last minute during pushing her heartbeat dropped but we got her out quick and she perked up right away.   The hardest thing I’ve ever done but very, very worth it.

She is happy, healthy, mellow, and doing great.  When they were done making sure she was OK, we got to see her and said to each other, “how did we end up with such a beautiful baby?”  It is amazing to realize that she is the being who has been living in my belly for the last 9.5 months.  Mr. Nishkanu is a puddle of melted love and is taking great care of me and her. I always knew he would be a great dad and now he finally has the chance.

Hope to provide more details when I’m back on my feet more regularly (and can sit down – 3.5 hours of pushing has left a lot of pretty horrifying mementos).  For now the short stats:

12-12-09

6:11 pm

8 lbs 8 oz.

It’s a girl!

p.s. My great gratitude goes out to the inventors of… the donut pillow for sitting on, the sitz bath,  the nipple shield, and the My Brest Friend nursing pillow (despite the stupid name).

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Forecast brighter

I had my midwife appointment this morning and altogether it was pretty much as awesome as Monday’s was awful.

First was the non-stress test and biophysical profile.  To Mr. Nishkanu’s disappointment, the little one was not cooperative in a face shot during the ultrasound, but on the positive side it passed all its tests with ultra flying colors – a super happy and healthy baby.

After talking it over with the midwife, we decided to do the membrane sweep – she said that it might not make much of a difference, since the data collected on membrane sweeping is on doing it once a week from 37 weeks, not once at 41 weeks, but she also said that the negative risks, aside from discomfort of the procedure, are very, very small.  In fact, the procedure turned out not to be too painful, the midwife had a knack for it apparently.   And once you have had a uterine biopsy for embryo co-culture (“you might feel a little pressure”) all other forms of pain down there become relativized…

In general, the midwife said that everything looks good, I can coast for another 4 days on this good test.  On Monday I will go in for another test and they will start talking induction., and probably plan it for Tuesday (the day I am 41 weeks 6 days… that is starting to sound reasonable).  She also gave me tips to try at home to see if we can get things started before the induction.  There are a billion suggestions out there in the  world about what might get things going but here was the scoop she gave me:

1) People say sex will start labor, it won’t actually, but it can help to soften your cervix and get it ready to go, so not a bad idea (and it’s funny how enthusiastic the husbands are to help out).

2) People say walking will start labor, that is only true if you are already having contractions.  I’ve been having contractions for days so we’ll chalk that up to a yes.   She recommended especially walking uphill, as long as your heart rate doesn’t get too high.  The other couple that was in our childbirth class, it turns out, went into labor on the day the woman decided to walk into work up a big, giant hill… so anecdotal evidence supports this recommendation as well.

3) Nipple stimulation, she suggested 20 minutes every 3 hours with a breast pumping machine… holy poo, I am not sure I am up for labor jumpstarting attempts as a full-time job… but maybe this is a good reason to actually read the directions and see how it works…

Overall it was a very positive appointment.  I think when the other midwife on Monday was giving us the scare job with all the negative outcomes, she was talking about the outcomes of being “post dates” (ie. after 42 weeks) and not “overdue” (ie. after 40 weeks).  All in all I think we had a super non-communicative interaction, we were pissed off, she was pissed off… if she turns out to be the midwife on duty when I go in we will have to try to find a way to get on a different footing with her.  Kind of a bummer to have to deal with that when you are ALSO in labor, but on the other hand, it is in our interest to have a good relationship with her, so I guess we will have to make an effort.

The good news is my very favorite midwife is on call from Friday evening through Monday morning, so we have a pretty good chance of having her if we can get things going soon…

In the afternoon I had an acupuncture appointment in another bid to do anything that doesn’t seem risky to try to get stuff moving.  It was a pretty intense appointment, I got nauseated and dizzy several times and she had to reset the needles once to make sure I didn’t actually pass out on her.  I don’t know if it will help with getting labor started but in the “total miracle” department, she placed some needles as well to help with heartburn and for the first time in months I do not have heartburn tonight (even after eating sausages and brussel sprouts for dinner and drinking a nonalcoholic beer).

That’s the  scoop for now, stay tuned and find out what happens…

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More on interventions – a post for geeks only…

I have another midwife appointment tomorrow so I spent some more time doing background research into postdates pregnancy, induction of labour, and membrane sweeping.

First, I gotta say that if you are a research geek like me you should hurry on over to the Cochrane Review to check out all their meta-reviews on pregnancy and childbirth practice.  All the stats a girl could want.

Second, their meta-review on membrane sweeping suggests it’s not really a bad idea.  Not such a great idea that I have to kick myself for not having done it already, but a good enough idea that I’ll ask the midwife tomorrow to do it.

Third, they have  a pretty interesting meta-review on induction of labour for post-dates pregnancies, suggesting that 41 weeks might not be a bad time to do so.  On the other hand, they say that waiting until 42 weeks has very small absolute risks, even though they are higher than induction at 41 weeks.  Personally, I think you have to weigh things differently for first-time mothers.  If you take into account that the average first-time mom delivers at 41 weeks 1 day, and that induction in first-time moms doubles the risk of c-section, then inducing everyone at 41 weeks would mean doubling the chance of c-section for more than half of first-time moms… and that doesn’t really sound like a great idea for avoiding what is a pretty small risk.  Especially given that, in many areas of the US, once a c-section always a c-section…  But I am a layperson here, so don’t quote me on that logic.

We’ll see what the midwife says tomorrow.  In the meantime the little one is still doing all-day judo competitions so seems like things are still going well.  Lots and lots of contractions but they seem to all be in the Braxton-Hicks category so no excitement around here.  The wait continues…

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