Tuesday, April 22, 2008

Finger feeding and baby hickeys: the challenges of breastfeeding

Welcome to the April Carnival of Breastfeeding: "Thrush and mastitis and blebs, oh my!"

This month we're bringing you posts on the topic of breastfeeding problems and helpful solutions. Be sure to check out the links at the end for great stories overcoming thrush, blebs, plugged ducts, oversupply, and other breastfeeding challenges.


I feel a little shy offering any advice on breastfeeding challenges. For the most part, my baby and I have had a very easy time of it, but every once in awhile I remember that first week -- boy, howdy. I made sure my husband took no pictures of us feeding him that first week, because I wanted to forget it.

We felt like we had to be an octopus, holding feeding tubes and bottles of expressed milk and wrestling with the flailing, grabbing fists of our little one, and somehow trying to get it all to coordinate so that our baby ended up fed. And as soon as we finished...another feed came along.

So, here I will offer my story of a week of terrible feedings and how we came through victorious. One week doesn't seem like very long to have breastfeeding trouble, but I will say that it seems like a loooong time when you're so anxious to nurse your newborn and you have no idea where the light is at the end of the tunnel!

First of all, Mikko was born in the hospital after an extended try at a home birth. He was a very big guy, almost 12 pounds, so the nurses were all concerned about blood sugar levels. He was fine, but that didn't stop them from fussing over potential health problems. One nurse in particular noted that he screamed off and on all that first night, and she attributed it not to being fresh out of the womb or being in a hospital or just general screaminess (we have since discovered Mikko is just an intense sort of baby) but to his not getting enough to eat from my breasts. Sadness. I know, it's such an old story; I don't doubt that some new mother somewhere this very minute is being told she's letting her baby go hungry when...oh, there's such a nice big bottle of formula right here that could make him feel all better. I felt terrible that Mikko was apparently so unsatisfied by me, and I let the nurse feed him a bottle of formula, just to check that he could eat, she said.

And so our week of breastfeeding misery was off and running.

After the bottle, Mikko really thought the breast was pathetic. That slow drip of colostrum -- bah. Give me fast and full and give it to me now. It took only a day for my milk to come in, but Mikko already had his preferences down.

By this time, though, Sam & I were out of the hospital with our little charge and feeling more like parents than patients. We determined (1) to get him off the formula immediately, and (2) to get him breastfeeding naturally as soon as possible.

Point #1 was taken care of with an electric double pump we rented from the hospital. It was about $18 a week, unfortunately not covered by our insurance, but it was certainly affordable for the couple weeks we estimated we would need it. Since my milk had come in and was plenty for my big little guy, we were off formula within a day, and I was so happy. I know formula has its uses, but besides being inferior to breastmilk nutritionally, yikes -- it tastes terrible. We had to taste it frequently because of our responses to point #2:

We decided not to give him any more bottles, despite being sent home with several. The nurse, who was at least helpful in gathering useful supplies for our ordeal, had given us various tubes and syringes along with the nipples and formula. So we quickly figured out what in the bag would make the best feeders.

I found this page to be very helpful in illustrating and giving some guidelines on all the methods I'll speak about in the order we used them, on our road to total breastfeeding:
Alternative Feeding Methods for Breastfed Babies (This is the page that the images illustrating this post come from, since we purposely took no pictures.)

And here's an overview of the variety of non-bottle supplemental feeding options:
Alternatives to Bottles

We tried these options in this order: syringe feeding, finger feeding, supplemental syringe at the breast, and supplemental tube at the breast. For us, that was basically easy to hard, in terms of coordinating a squirmy, screaming baby with whatever method we were trying. Even as we progressed, if we just needed to get some food in him fast, we would start him off or top him up with an easier method.

With syringe feeding, we would fill a small syringe (without a needle, natch) with formula or expressed breastmilk and basically just squirt it slowly into his mouth as he swallowed. This was certainly the easiest and least messy of the alternative feeding methods we tried, but I was concerned that he wasn't getting his sucking needs met by this style. It was more like he was a baby bird we were pushing nutrition into, without really treating him like a human baby.

Finger Feeding with a TubeSo we tried out finger feeding next, where you thread a very thin tube alongside one finger and let the baby suck on both your upturned finger and the tube; the tube is either attached to a syringe or dipped into an open bottle of breastmilk or formula. Dr. Jack Newman describes it in this link: Finger Feeding. It's a good method in that it lets babies suck, and as Newman mentions, trains them in the technique they'll need at the breast. It does take some coordination, though, and parents can tape the tube securely all the way up their finger and hand if they want less to fidget with. We tried to time pushing the syringe with his sucking motions, and later we just let him suck the milk out of the tube like a straw, but we always had to get it started for him by sucking it to the very tip of the tube. That's where we got to taste the difference between formula (seriously gross) and breastmilk (surprisingly -- or not! -- delicious).

But, as Dr. Jack Newman says: "Babies learn to breastfeed by breastfeeding." This was very important for us to realize as we moved toward total breastfeeding -- it wouldn't happen without practice!

So, we were on to trying Mikko at the breast.

Newman promotes at-breast supplementation this way: "Babies learn to breastfeed by breastfeeding. Mothers learn to breastfeed by breastfeeding. The baby continues to get your milk. The baby won't reject the breast. There is more to breastfeeding than the breastmilk."

Syringe Feeding at the BreastI would try to latch Mikko on, and Sam would stand by with a syringe that he would dip into the corner of Mikko's mouth and push so that Mikko was rewarded with any sucking by a whole mouth full of milk. Eventually, though, we wanted to make Mikko suck the milk under his own power, just as with the finger feeding, so we moved to a homemade lactation aid.

Here's Newman's handout for using one, which is where the above quote is from: Using a Lactation Aid.

Tube Feeding at the BreastWith this method, I would latch Mikko on to the breast and then Sam would slip the tube into the side of his mouth. Again, we usually had to prime the tube to get the milk flowing fast enough for Mikko not to scream bloody murder and refuse to latch at all. (Did I mention he's an intense baby?) But, very soon, Mikko got the equation of suck on this nice warm breast = mouth full of nummies.

And, it was a miraculous dawning, at just about a week after his birth, when we realized that he would continue to feed when the tube ran dry and was removed. We also had increasingly tried him at the breast without the tube, to start off or finish a supplement session. One day we realized -- our baby was breastfeeding!

Again, I feel a little sheepish that that was the only difficulty we had with feeding him. Since then, he's gained (and gained and gained) weight -- one of the concerns of the discharge nurse was that he had lost about 10 ounces during his stay in the hospital, but our midwife reassured us at our first postpartum visit that (1) he had plenty to lose, (2) that the amount he'd lost was not a dangerous percentage, and (3) that his birth weight was probably inflated by several ounces from the IV fluids they'd given me to reduce my fever. Hindsight suggests that we could probably have skipped this whole discouraging week in favor of straight breastfeeding if we had gotten off to the right start and were prepared for a little screaming (his and ours).

I would certainly recommend breastfeeding over supplemental feeding when it's possible, because our circuitous journey was exhausting and cumbersome. Mikko would wiggle and throw his head around, popping off the breast, grabbing at the tube with his little grabby fists, screaming that the milk wasn’t flowing fast enough. Meanwhile, milk would spill out of the sides of his mouth and the end of the tube as he whipped his head around, all that precious liquid I worked so hard to pump and that he needed every minute portion of an ounce of. Added to this, the air passages in his nose were very narrow, and his nose was stuffy, so every feeding felt and sounded like we were suffocating him, which was part of the problem for getting him to stay latched onto the breast properly. All day and night I was either feeding him or pumping, or pumping in the middle of feeding him so that he could continue to eat enough. Plus, there was all the washing of supplies in between each feed. I couldn’t imagine the joy of just being able to pop him on the breast and let him feed. I equally couldn't imagine ever being able to leave the house again, since Sam & I had barely enough hands between us to manage all the equipment required at once to feed this baby.

It was a long week.

But I can definitely see the value in supplemental feeding as described above, when there really is a latch or supply problem, such as with a premature baby or an adopted one. It's a lot of work, but if these methods can push you through until the latch or supply problems are worked out, then it's so worth it. It can help you avoid or limit formula feeding and nipple preference, and it puts you on the road to breastfeeding without supplementation. And, I would imagine, if supplementing remains necessary, that it gets easier as time goes on! It's still so wonderful to give a baby the comfort and release that feeding at the breast gives, even if all the milk isn't coming from the mother alone.

My post title comes from the one hilarious, if painful, spot in the week. I had gotten Mikko latched, and he was sucking away. There was plenty of milk in the bottle, and it was being sucked up through the tube perfectly. For the first time, I felt some pain as Mikko sucked at the breast, but I chalked it up to nipple soreness and figured I'd put some lanolin on later. I really, really didn't want to unlatch him and check, because he was so intent in eating and would be so upset by being interrupted. The pain was getting worse and worse, but I gritted my teeth and let him continue. When he finally came off, I looked down and saw a big welt on my breast -- and it was nowhere near my nipple. His latch had slipped to a different section, and he had Hoovered up the tissue into a big, swollen bruise. My first hickey, and it came from my baby!

But, despite all the trials of that first week, I was highly motivated to breastfeed, and I knew it was what my baby needed and truly wanted. Sam was committed to helping us and encouraging me to continue, even when it meant that he could no longer share in the feeding of our newborn son, as he could when we were finger feeding. It was wonderful to have my commonsense midwife, who's also a lactation consultant, supporting breastfeeding by expecting that we would get the hang of it, giving me accurate information, and helping me achieve a proper latch.

Mostly, it was essential to expect that we would succeed. Babies are born to breastfeed, and mothers are made to breastfeed them. I wouldn't have bothered pushing through that horrible week if I hadn't internalized that truth. I had this vision in mind, that I would eventually be like one of those beautiful breastfeeding mamas, who could confidently and easily feed their babies anywhere and at any time.

At one month old, I was feeding Mikko on a fast-moving sailboat ride, while I braced myself on the highly-angled deck for dear life. I was terrified we'd fall into the briny deep, but Mikko was calm and happy as long as he was nursing away. That was when I knew for sure that we had gotten the hang of this breastfeeding thing!


Please read our other carnival participants:

Mama's Magic writes about challenges and triumphs with each of her children, including a lactation-aid setup like mine -- but with a c-section (see, I shouldn't complain)
Half Pint Pixie conquers oversupply, flat nipples, a bleb, blocked ducts, and mastitis
Speech Act remembers contortionist nursing with plugged ducts and blebs
Tales of Life with a Girl on the Go confronts reduced milk supply after going on the mini-pill
Nurturing Notes discusses a long battle with thrush
Breastfeeding Mums goes through her list of issues, from embarrassment to sore nipples to engorgement, that prompted her to start a site just for the breastfeeding mother
The Motherwear Breastfeeding Blog shares a mother's story of a tongue tie
Blessed Nest Perch overcomes painful mastitis, cracked nipples, and low supply
Breastfeeding 1-2-3 recommends gentian violet and grapefruit seed extract

Wow -- it sounds kind of scary put all together like that! The good news is that they all figured out how to work through their problems and breastfeed happily. A key was finding the proper information, so enjoy their stories!


Anonymous said...

What an informative post! I am glad that you talked about the troubles one can have in the first week. If people think that breastfeeding is easy and they face challenges, they are liable to give up. I had some trouble the first week and was stubborn, like you, and persevered. I think that my initial troubles made me more committed - I would nurse anywhere and anytime my baby needed to because I was so darn grateful that she was breastfeeding.

Lauren Wayne said...

Absolutely! It was such a thrill to be breastfeeding suddenly with so much ease. I think part of convincing women to persevere and be stubborn, as you put it, is to give them a vision of what could be -- pain-free, easy, convenient. Every time I breastfeed in front of other people, I feel like an advocate in that way. Because it is so good once you and the baby get things down!

Anonymous said...

I was shy at first in the hospital as well but then I just became frustrated with the lack of help and forgot about what the DR's/nurses may be seeing. LOL
My second baby was given formula becasue of low blood sugar..it was tricky to get her excited about nursing but it happened!
Great post!

Jen (Mama's Magic Studio) said...

What a fabulous post!

I *totally* could relate. That is absolutely such a LONG week when you're having to mess around with tubes, etc. I really love your descriptions and information about the different supplemental feeding options. (I was too lazy to look all that stuff up, LOL). And hey, you have every right to "complain" .... it's a tough situation and I admire you (and Sam!) immensely for hanging in with it. Blessings on you all!

Anonymous said...

Brilliant post! Wow you are one determined breastfeeding mama... welcome to the club! It's great to see that it all worked out in the end fopr you. I firmly believe the first week is the worst and the first six are pretty flat out as well but it's so satisfying to see your baby growing and putting on weight because of the milk you produce :)

half pint pixie said...

That was an amazing read, well done on going through all that to establish breastfeeding. It was once remarked to me that many women who go on to have successful breastfeeding relationships after rough starts have legendary stubbornness. I agree, in those first weeks, stubborn determination and self-belief can be all that gets you through and it is so worth it! Well done :)

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