Friday, June 28, 2013

Mastitis

Around the last week in May I developed mastitis. As if I hadn't had enough breastfeeding struggles so far, we had to get this one under our belt as well. I'd had mastitis with my second daughter, and while I'd had a fever and felt ill, a weekend of rest and some antibiotics cleared it up. It was NOTHING compared to this time.

I woke up in the middle of the night and noticed my back felt a bit achy, but I went back to sleep. When I woke in the morning, I just didn't feel right, and my left breast was a bit sore. I mentioned to my husband as he was leaving for work that I didn't feel very well, and was a bit sore and achy. As the day progressed, I felt much worse, very quickly. My breast became very hard, hot and painful to the touch. I developed a fever of 99 degrees, which slowly crept upward to 101. I thought I might have a blocked duct and tried the home remedies that were recommended - a hot shower, hot compresses, and massage. After lunch I took tylenol, but my breast was so sore I could barely lift my arm to bring the capsules to my mouth. By 2 pm I had chills and was basically incapacitated. Thankfully my mom lives nearby, and I called her to come watch the kids while I took a nap. When I woke up an hour later I was shaking all over and felt so weak I didn't want to walk up and down the stairs. I called my doctor and got an appointment for the next morning. I was told to go to the ER if my fever reached 102 degrees. By the time my husband got home from work, I was laying on the floor barely able to move.

It was a very long night. I was in a lot of pain, and ached all over. I alternated being hot and having severe chills, but mostly I had chills. My fever reached 103 degrees, but I opted to wait until my doctor's office opened in the morning. I couldn't sleep for more than a few minutes at a time, and I was in a lot of pain. My husband helped with the kids, and brought the baby to me when she needed to nurse.

The next morning my husband stayed home from work to drive me to the doctor, as I felt I was too weak to drive myself. The doctor was very concerned about me, as she said that the infection seemed to be very deep within my breast and she thought an abscess could be forming. She considered hospitalizing me for IV antibiotics, but decided to give me a shot of antibiotics if I agreed to come back the next morning to be checked again. She also sent me for an ultrasound of my breast to check for an abscess, which did end up being negative. I picked up my prescriptions, including a strong antibiotic, and went home. It was another long day, and my mom again helped with the kids as my husband headed to work. I was so tired and miserable, and just waited for the antibiotics to help. I napped whenever I could, but again found I could not sleep for very long.

The next morning I was back at the doctor. She again mentioned hospitalizing me, but I had improved slightly and my fever was down to 100 degrees, so she felt I was doing well enough on the regimen I was on and could stay at home. I was offered a second shot of antibiotics but we decided it might not be necessary. It would just take time to feel better, and I was warned it could take 2-3 weeks.

I was unable to function for several more days. Thankfully I had my mom and husband to help with the kids, as it took an entire week before I was starting to get back on my feet. My milk supply took a hit due to the illness, but I continued to nurse frequently and drink lots of water. I also took fenugreek capsules for about a week, and I eventually saw my supply begin to rebound.

Today, baby is getting close to being 4 months old, and she is still exclusively breastfed. Somehow we have managed to push through all our problems and continue to breastfeed, and I am very thankful!

Monday, May 20, 2013

Summer Funtime

Our oldest daughter turns 6 in just 3 weeks. She just graduated preschool and will start Kindergarten in the fall. This is a very bittersweet time for us, as it is hard to watch your baby slowly move away from you and out into the world. Right now, I am feeling like this is our last summer to really be together as a family, before our lives become dominated by school schedules, testing and homework. This is our last summer in which my husband and I are still the main influences in her life, soon to be joined by her teacher and classmates. It is her last summer of pure innocence.

So I am proposing a plan to cherish these weeks. I want to make good memories for all of us and make the most of our summer. We are going to do one special activity (Summer Funtime) per week. The requirements are simple. 1. We must leave the house, and 2. It has to be something a bit out of our normal routine. Bonus points if it is no or low cost, educational, or can involve my husband (being a graduate student, my time is a bit more flexible than my husband's, who works 40+ hours per week). I plan on keeping most trips simple and hopefully most won't involve travel, since we do have 3 young kids, one of which is a nursing newborn and i am only one woman. 

My goal is to do a different activity each week, with the exception of story time at the library, which I hope to do weekly (and is only "allowed" to count as the week's Summer Funtime activity once a month).

Ideas for Summer Funtime activities:
Park
Zoo
Local science center
Craft store (if we purchase a craft to take home and do together)
County Fair
Story time at the library
A wedding (where the older girls will be flower girls)
Local metro parks activities 
Pool (only achievable if daddy is available - no way am I taking 3 non swimmers to the pool by myself!)
A sporting event of some type
Hiking

Let the summer of fun begin!

Breastfeeding update, 6 weeks post revision

We're breastfeeding! Exclusively! (No pumping! No bottles!)

A few days after the revision, I was not convinced we would ever reach this point. I went to my 4 week postpartum visit with my midwives feeling depressed and very downtrodden. I didn't have much to say as I attempted to nurse my baby during our visit, finally pulling out a bottle of expressed milk to top her up. It was all I could do to keep from crying as I expressed my frustration with our lack of improvement.

But things did improve. Very slowly. A little over a week after her revision, I noticed a change in her suck. Her jaw action had improved, and, for the first time, I heard her swallowing. I began to cut back on the bottles, only giving her a bottle of expressed milk when she indicated she needed one, rather than automatically feeding her after she nursed. I cut back on pumping as well, although I wasn't able to cut back very much because my body was now convinced I was feeding twins due to my nurse-pump schedule, and I had quite the oversupply.

Eight days after the revision, we visited the lactation consultant and did the weight-nurse-weigh session again. We discovered that she was transferring an adequate amount of milk! Happy dance!

Since that time, I have been able to gradually wean off the pump, and I put away the bottles. I had built up a very nice frozen stash of milk during my time with the pump, so that was one small benefit.

Freezer stash! 
At her one month check up (done at 6 weeks of age due to a scheduling issue) we learned that she was now weighing 10 lbs 6 oz, so she was finally up above her birth weight and had recovered all the weight she had lost. Another happy dance!

Today, 6 weeks post revision, we are doing well! Breastfeeding is finally no longer painful 95% of the time. It is still a bit of a struggle, I find that unless she is held in just the right position she has a lot of trouble maintaining her latch and will fall off the nipple. As a result, I always feed her in the recliner, since nursing side lying just does not work for her. She has issues with achieving latch, and will often latch and unlatch up to 5 or 6 times before she is finally able to latch and nurse successfully. When she gets excited about starting to nurse, she clicks very hard and her jaw action becomes very exaggerated, more like chewing. Putting a finger on her lower jaw and pulling it down seems to help remind her to use the right action and helps improve her suction. She does still click while nursing about half of the time. I'm still not convinced she is a very efficient nurser, and she nurses very frequently - I personally think she uses quantity of nursing sessions to make up for lesser quality of transfer.

Other than those minor issues, nursing is a success for us now! It's been worth the struggle for us, and I look forward to a long and rewarding nursing relationship with my baby.

2 months old

Monday, April 22, 2013

Breastfeeding Journey, part 4 - Recovery

After the tongue and lip tie revision, we were instructed to do stretches and gentle massage on the wound sites three times a day for three weeks following the procedure. These exercises were also heart wrenching to perform, as she screamed whenever we did them.

The first 3 days:
L was fussier than usual, but still attempted nursing. I continued to nurse, pump and feed around the clock. The main changes we noticed is that she now absolutely refuses to use a pacifier, which she liked previously, and seemed to struggle more with the bottle. She had trouble maintaining suction on the nipple and took in more air. Sometimes she seemed to just let the bottle drain into her mouth. I noticed only minimal improvement in her latch, and nursing was still painful. At around day 3, we noticed wet, white scabs had formed on the wounds, which is healthy and normal healing.

Day 4 -6:
L was back to her normal self and was no longer fussy. Everything else was the same as I mentioned above.

Day 6:
Late in the day on day 6, I noticed her jaw moving downward during nursing and I could hear swallowing! She was nursing! I slowly began reducing the number of times I pumped and the number of bottles she was receiving. After 2 weeks of only pumping my cracked nipple, it had finally healed. I began nursing her on that side as well. After my rigorous nursing and pumping schedule, my body was convinced I was feeding twins and my milk supply had responded accordingly. I had an oversupply of milk, and was freezing approximately 20 ounces of milk per day beyond what my baby could consume. As I reduced bottle feedings, I was very anxious about how much my baby was actually taking in. She was showing signs of nursing properly, making adequate wet and dirty diapers, was content after feeding and was sleeping normally. All signs pointed to a well-fed baby. However, I had been wrong before, and it made me nervous.

Day 8:
We had a follow up appointment with our lactation consultant to weigh her before and after feeding. After nursing on both sides she took in nearly 3.5 ounces! It was slightly less than the expected amount, but close enough that we counted it as SUCCESS! I went home and unplugged my pump, though I had to plug it back in later when it became apparent that I still had an oversupply of milk. I occasionally pumped whenever the pressure became extremely uncomfortable.

April 22, 2013
Today we are nearly 2 weeks out form the procedure. The scabs appear to have healed, and we continue to do her stretches, though she no longer cries and only protests a little. Some days she nurses better than others. She has to be in the perfect position in order to nurse well and seems to benefit from being in laid back nursing positions, with gravity to help hold her suction. She still clicks quite a bit during feedings and seems to take in quite a bit of air while nursing. I am no longer pumping and am feeling very relieved and better able to care for my baby and other children without the burden of pumping. Nursing is still painful, but much less so than it was. She does not nurse very effectively on the side that had the cracked nipple, and has a great deal of preference for the other side. I don't have much pain on the side she doesn't like, but the preferred side often aches and has shooting pains through my nipple and breast after she nurses, as she still likes to chew and tuck her chin.

Healing upper lip tie

Improved tongue motion

6 weeks old

Saturday, April 20, 2013

Breastfeeding Journey, part 3 - Posterior Tongue Tie Revision

We had to wait a week and a half for our appointment with the dentist who was able to do the posterior tongue tie and upper lip tie revision with a laser. We were fortunate to discover that our dentist is one of the top dentists to perform the procedure and that he was only a 2 hour drive from our house. Through an online support group, I discovered that many people have to travel great distances for the procedure, some driving or flying hundreds of miles to go to the best providers.

During this time I continued to nurse, then pump and supplement L with my expressed milk. I attempted using a supplemental nursing system to get away from using bottles, but found it tricky to keep in place and I often found myself frustrated as I dripped my precious milk all over my baby and myself as I attempted to thread the tiny tube in the corner of her mouth. If I happened to get it in place and flowing correctly, she usually managed to yank it back out. For my sanity, I went back to using bottles to feed her my milk. She even struggled to maintain an adequate latch on the bottle nipple, and often clicked while sucking.


Upper lip tie
Posterior tongue tie








Posterior tongue tie, restricted movement


April 9, 2013 - The Procedure

On the morning of L's one month birthday we had to leave very early for our appointment with the dentist, and my mom came to watch our older girls. During the drive we felt very nervous about the procedure, but hopeful that it would provide the answers to our feeding and breastfeeding struggles. We also knew that if we didn't have the ties released, they could potentially cause feeding and/or speaking problems in the future, so it was important to have it corrected as soon as possible.

The doctor examined her suck, and mentioned that she didn't suck properly. She sucked too hard and formed her mouth as though she were sucking on a straw, rather than nursing. She also rolled her tongue and pushed forward, rather the forming her tongue into a cupping motion, and chewed with her gums rather than thrusting her tongue forward. All of these things were less than ideal for breastfeeding, and were probably contributing to her inadequate transfer of milk and my pain and nipple trauma. He recommended laser revision for her posterior tongue tie, as well as for her upper lip tie, which he described as "double attached." We went over the stretches we would be required to do to keep the wounds from reattaching and to make sure the new frenulum under the tongue healed with as much length and flexibility as possible.

An assistant joined us in the room, and we were handed protective goggles for our eyes. My baby was placed in a tight swaddle blanket, and my husband and the dental assistant held her on the dental chair as the procedure began. The laser was the size of a pen, and the procedure was very quick, though it felt like an eternity. The tongue tie took maybe a minute or two, and while the upper lip tie took a bit longer, the entire procedure was over in probably under 5 minutes. There was no blood, but L  did scream with heart-wrenching sobs, the kind of cry no mother wants to hear coming from her baby. We were told there were very few nerve endings in the frenulum, but I believe it must have been somewhat painful, and compounded by the added insult of having someone's fingers in her mouth.

We were taken to a 'quiet room.' She was unable to be consoled immediately, but I was encouraged to try nursing her. I made several attempts to latch her on, but she did not show any interest and continued to cry in  pain. I held her to my chest and gently rocked her as I attempted to comfort her, my tears flowing with hers. We gave her a dose of tylenol, and I had brought a bottle of expressed milk with me, which she did finally accept and she was able to calm down. Afterward she fell quickly asleep and we headed back home.

 
1 month old, after her procedure. Upper lip slightly swollen

Friday, April 19, 2013

Our Breastfeeding Journey, part 2

March 26, 2013
When baby L was about 2 and a half weeks old, we had another checkup with our midwives. On the way in, my husband and I were guessing how much we thought our 10 pound 4 ounce newborn would weigh now. We knew that by 2-3 weeks of age most newborns had regained their birth weight, and we were interested to see how much our not-so-little-newborn weighed now. We guessed she might be around 10 1/2 pounds.

After the appointment was over, we popped her on the scale. Even with her clothes on, she weighed only 9 pounds 5 ounces, which was down nearly a pound from her birth weight, and down almost a half pound from her weight at the pediatrician's office a little over a week before.

We were stunned. Despite my pain and her difficulties nursing, we had not suspected that she was losing weight. She was having a normal number of wet diapers per day - in fact, they were usually soaked. Her stool was the right color, frequency and consistency. She was a sleepy baby, but still had alert times and wakeful periods. I was nursing on demand and then some - I even woke her for feedings. She seemed content after feedings - she slept well, and was not a fussy baby at all. She had given us no signs that she was slowly losing weight and provided all the right signs that would indicate that our breastfed baby should have been thriving. We were alarmed by her weight loss - my husband and I knew something wasn't right.

We called our pediatrician's office as soon as we left the midwives. Because it was late in the day, they were unable to see us for a weight check that day (we wanted to verify that she had, in fact, lost that much weight)  but scheduled us for the next morning.

Her weight check with the nurse revealed her weight to be 9 pounds 3 ounces. Thankfully, she still looked healthy and alert, and appeared to be healthy despite her weight loss. We were referred to a lactation consultant, who was able to see us that day.

During the initial exam, the LC commented on her strong suck and tucked jaw, as well as the chewing motion she used while nursing. L was weighed both before and after nursing to check and see how much milk she transferred, and we discovered that she transferred barely more than 1 1/2 ounces of milk even after nursing for over 45 minutes and on both breasts. The LC examined L's mouth, and said she thought she may have a posterior tongue tie, and that hers looked to be very thick and at the back of her tongue. The LC gave me some information about some online support groups, as well as information about a dentist that uses lasers to release tongue ties. We also discussed how to get my large crack in my nipple to heal, as well as how to provide enough milk to L to help her gain weight. I went home and got out my breast pump, and began a rigorous schedule of nursing L on my one non-cracked breast, followed by pumping both breasts and feeding her the milk that I pumped with a bottle.

Two days later, a follow up weight check with a pediatrician revealed that my efforts were working - L was now gaining weight, and in fact, had gained more weight than they would expect in just 2 days. I called the dentist and set up an appointment to have her tongue tie evaluated, and began researching posterior tongue ties. I was now nursing my baby full time as well as pumping full time and caring for 3 kids. Add in cleaning pump parts and bottles, and preparing and feeding bottles of expressed milk, and it quickly became exhausting and almost overwhelming. I felt tied to my pump, and it hurt to watch someone else feed my baby a bottle while I sat and pumped. However, I was committed to providing her with my milk, and was determined to do whatever it took to make sure she had what she needed.

Our Breastfeeding Journey - Struggles with a Posterior Tongue Tie andUpper Lip Tie

I breastfed my first two daughters. It's something important I chose to do for my children and it's something I am passionate about. I breastfed my first daughter (C) until she weaned at 18 months, and my second daughter (A) until she weaned at 2 years. I breastfed exclusively for the first 6 months of their lives, when I introduced baby food I made myself and I pumped when I had to be away from them so they could still have my milk even when I couldn't be there myself. Breastfeeding is important to me. I know the joys of breastfeeding - the sweet milky smiles, the closeness of being tummy to tummy, the precious time spent gazing at and admiring my beautiful child, the feel of the wisps of fine baby hair while I gently trace the top of her head, the simplicity of being able to pull my sleepy baby to my breast in the middle of the night and knowing that the perfect food is right there waiting for her.

I also knew some of the lows. My second daughter and I struggled with her tiny mouth and shallow latch. I developed a crack around the base of my nipple and then also mastitis. I had to pump exclusively for one week on one breast to allow the crack to heal, and nursed her exclusively on the other side. It was a painful struggle in the beginning, but we persisted and as she grew in size her latch improved as well. We went on to have a successful nursing relationship.

March 9, 2013
When my third daughter (L) was born, I considered myself a breastfeeding pro. She was 10 pounds, 4 ounces at birth, and had a very strong suck. The first time she latched, I was surprised by the intensity of her suck. She was a sleepy baby, something I had not experienced before, and I often had to wake her for feedings. Feedings lasted a long time, and she usually fell back asleep while nursing and I struggled to keep her alert. She tucked her bottom jaw up in a chewing motion, and no matter how wide her mouth was during latch, she immediately tucked her jaw so that she was mainly sucking on my nipple. If I managed to get a deep latch, she slid back down. If I tried to pull her jaw down she would only tuck it up tighter, and I tried without success to help her flare out her lips, both of which rolled under. She also made a loud clicking noise when she nursed, and I could feel the clicking as well as hear it.

March 12
My milk came in when she was about 3 days old, and despite her lengthy nursing sessions, my breasts still felt hard and engorged after nursing, so I pumped to relieve the pressure. That day we had an appointment with the midwife, and her weight was 9 pounds 8 ounces, which was within the range of acceptable initial weight loss for a newborn. My nipples were already sore and misshapen like a tube of lipstick. After she finished nursing, there would be a white crease down the side of each nipple, and within minutes I would feel shooting pains in my nipples, and my breasts would begin to ache and throb. By the fourth day, I saw the crack reappearing on the base of my right nipple.

March 14
When she was almost a week old she had her first pediatrician check up, where she weighed 9 pounds 13 ounces. By this time, the crack on my right nipple was beginning to open up into more of a fissure, and a small crack was forming on the left. However, her weight gain was good, and being extremely stubborn I refused to get out my pump. I worked very hard to make sure every initial latch was perfect, and I figured out that if I nursed her in a football hold on the right side the pain was manageable with her tongue on the crack, rather than her hard palette. Latch was nearly excruciating, but the pain lessened to barely-tolerable as she nursed, so I was determined to heal the crack while continuing to nurse. Both her pediatrician and our midwife had examined her mouth and declared that she did not have a tongue tie. When asked how breastfeeding was going, my response was that it was going well for her, but not so well for me.

Until it wasn't going well for her, either.