The Short Version of How Breastfeeding Improved

This post is long overdue.  For those of you who supported me in the early days of my breastfeeding difficulties, I wanted to share that in September when Calvin was 6 months old, we saw a new lactation consultant who LOOKED IN HIS MOUTH and said, oh yeah, "this isn't you -- he has a lip tie." That explained EVERYTHING.  Lip ties and tongue ties are related to problems in the baby (difficulty latching, failing to establish a good suction and therefore gets a lot of air, causing acid reflux and other indigestion -- eventually leads to malformations in jaw that can narrow the jaw, leading to dental and orthodontic issues) AND problems in the mother (sore breasts, mastitis, under or over supply issues).  Lip ties and tongue ties, I am discovering, are highly undiagnosed.  We had it corrected with a laser, and within two weeks ALL those symptoms in both me and Calvin were GONE, and breastfeeding become so much easier.  So did pumping.  It was like a miracle.  Within three weeks he preferred breast over the bottle.  Who saw that one coming?  Certainly not me.  I feel so fortunate.

Knowledge about Tongue and Lip Tie passed out of the realm of common medical knowledge in the early 30's when formula was considered better than breastmilk and women were encouraged not to breastfeed.  I have scholarly articles from well-respected medical journals if anyone is interested in the research, but for those of you out there who either are having problems breastfeeding, had problems breastfeeding and are curious about a possible cause, or are pregnant and would like some information about something that could affect your infant feeding (whether you plan to bottle- or breast-feed), please check out this link.

How to Diagnose Tongue and Lip Tie

Just to be clear to everyone, I didn't post this hoping to villainize my friends who have opted for formula. I have posted it as a general PSA. The fact is that I have a lip tie, too (it can be heritable) and I still have all the acid reflux, dental, and orthodontic problems that are the later-in-life possible consequences of untreated ties. I would love it if someone had caught it when I was a baby.

Crying Over Spilled Milk

Anyone who knows me knows that I meet adversity with determination.   And if it’s not working, I assume it means I’m supposed to try harder.  I am accustomed to success somewhere along the way.  This is the story about my milk supply – still not quite enough to feed my lad.  “Big deal,” say some.  “No, that’s not possible – keep trying!” say others.  But here’s my journey from producing nearly no breastmilk to producing almost enough to producing maybe 60%  of what my baby needs.   I have never felt more like a failure in my life.  But after everything I’ve done and gone through, I have to accept that my best is good enough.

I wanted want more than anything to breastfeed my baby.  I always saw myself as exclusively breastfeeding him from the beginning and couldn’t imagine that I’d have troubles with it.  After all – it’s natural.  It’s how we all got here, right?  And animals don’t seem to have problems with it.  Let’s start from the start.  Calvin and I had a rough delivery despite my plans for an easy, natural childbirth – a story for another time – and he was in the Level 2 Nursery for the first 29 hours of his life.  I was recovering from a fever and an infection, too, so it didn’t occur to me to ask for a breast pump in the hospital to initiate my supply in that very critical period.  Despite the hospital’s excellent staff and care, no one thought to offer it to me, even the lactation consultants on staff.  I didn’t breastfeed him until about 18 hours after he was born, and, even then, the schedule was nowhere near the recommended “every 2-3 hours or on demand” because of continued care (injections and IVs on both of our parts).  Why do I bother recounting this part of the tale?  Well, according to the lactation consultants I saw later on, that first couple of days is really crucial to establishing the hormone receptors that tell your body how much milk to make.  That’s a window of opportunity that we missed.  “Keep trying!  It’ll work; it’s biology!” was the message that I went with.  My knowledge from my nutrition program, from the nurses, from lactation consultants, and from well-meaning friends and family all dictated that if I just kept nursing him often enough, my milk would come in. 

But it didn’t.  It turns out that we had what is called an “inefficient eater.”  So even though he would spend up to an hour on each side, he was getting very little indeed.  Some milk was there – he just wasn’t drinking it.  As a result, I became painfully engorged – and not just for the usual 24 hours.  For 3 days.  I did everything you’re supposed to do: warm compresses, hot showers, leaning over basins of water, massages, and above all, continuing to nurse while hand-expressing, but it was bad news for the milk supply.   Two weeks later, we found out he still wasn’t gaining enough weight despite my very best efforts…. He still didn’t eat.  This kid loves to breastfeed! … or at least to be on the breast.  But he just wasn’t eating. 

So I became determined.   I tripled my protein intake.   I doubled my already considerable water intake.  I took really expensive supplements.  I ate more oatmeal (considered a galactogogue).  We paid to have a lactation consultant spend a long couple of home visits with us.  The scale she had told us that he was only getting  .6 oz of milk from me after an hour of eating.  What?!  That’s not much at all!  Two weeks in, he hadn’t literally sucked enough to establish any kind of milk supply.  So we rented a hospital grade breast pump and eventually bought the best home model of it that money can buy.  I started pumping after every time he ate – even if that meant I was pumping 14 times a day for 20 minutes a pop.  Dan was home with me, so I had help during that time.  I was on a mission.  “It’s biology!  Supply and demand!”   That’s the message I ran with. 

Meanwhile, rule number one of low milk supply is “feed your baby!”  So we did.  We used a supplemental nursing system for the first three weeks, but he could take a half-hour to work through a mere half ounce, so that wasn’t a good weight gain option.  Plus, it was such a stressful contraption that it took all the joy out of breastfeeding him.  So we started using nipple-friendly, slow-flow bottles just to get some food into him. 

Well.  He LOVED that.  And soon he started refusing the breast.  But he was a much happier baby.  Not being hungry all the time will do that to a person.  That said, I can’t possibly describe the emotional anguish I experienced every time he screamed at my breast, knowing that there wasn’t enough milk to feed him – despite my slowly- building supply and my increasing optimism that someday I still might be able to exclusively breastfeed him.

I won’t go into the rest, but I just want you to understand how hard  I was working despite knowing that he still had no interest in breastfeeding, and I cried every single time he refused my breast.  (That’s a lotta tears!)  I desperately wanted this to work. 

After pumping after every feeding for 6 weeks, (and with great effort to trick him back onto my breast by luring him with the bottle) he took my breast again and started breastfeeding.  We noticed that he started turning down the bottle after breastfeeding, indicating that he had had enough.  Then we noticed that, when I was at school, Dan was able to give him enough breastmilk from the prior day’s pumping that he didn’t have to use formula every day.  In other words, it was working. 

Two weeks later, school ended, and I was home alone with Calvin every day.  And to my surprise and great delight, he seemed cool with exclusively breastfeeding.  I had the best week with him!  I was feeding him all the time, and he seemed full.  And for a week there, he was a good eater.  I was cautiously overjoyed!  ….Then, things started turning.  He started sleeping more and crying more.  And refusing the breast again.  And getting seriously crazy similar to how he behaved before we realized he was starving all the time.  And then it hit: mastitis in my left breast.  He never did like lefty as much because it’s slower (lefty’s the one that was the most engorged and blocked at the beginning, and I don’t think it ever fully recovered), so he doesn’t totally drain it most of the time.  But YOU try pumping after every feeding when you’re home alone all day with a kid who screams when you put him down.  I just don’t have the gumption or resilience or whatever to say, “Hey, kid.  I know you’re miserable right now because your cries are hurting my eardrums, but try to chill out in your bouncy seat for another 20 minutes until your mom is done pumping.” 

Oh, yeah – mastitis is bad-news-bears for milk supply.  A 32-hour fever of a 102 before you recognize what’s going on will do that to ya.  So it’s back down again to about 60% of what he needs.  And I am devastated.  No, seriously.  Devastated.  I am in mourning over my milk supply.  That’s where I finally broke down enough to need to write about it. 

The number of times I have broken down and cried for 2 hours at a time about this whole thing is absurd.  Let’s not go into the full-scale meltdowns I’ve had when he spits up a lot of what I just fed him.  No matter how much I tell myself, “I just have to accept that I have what I have,” I can’t seem to feel OK about it.  The fact is that I had enough for him – he just didn’t drink it.  And he’s simply too much of a handful for it to be realistic me to keep up with the pumping while I’m home alone with him all day. 

Why am I recounting his?  To deal with the number of times I have thought that I had finally come to terms with my situation only to have a complete emotional breakdown about it 2 days later.  To publicly announce the shame I feel so I can try to get past this.  Partially, it’s so that other mothers out there who might have low milk supply who have also tried this hard can read something they can relate to.  Partially, it’s to address the people who don’t understand. 

How many more times do I have to answer the question, “well, did you see a lactation consultant?”  Yes, two.  And I had several hour long home visits and lots of phone calls from both of them.  “Are you eating oatmeal?” … yes – around 2 cups a day.  “Are you eating enough protein?” “Drinking enough water?”  “Taking fenugreek, fennel, golacta?”  “Drinking nursing tea?  Beer?” “Co-sleeping?”  “Nursing all the time?”   Yes, yes, yes!  Well-wishers say, “Just nurse more often!”  Well, given what a lazy breastfeeder he is, that’s what got me into this mess – twice!  For the love of god, I’ve done everything a person can do. 

Through it all, I’ve had every nipple and breast ailment that accompanies breastfeeding that a poor woman can have.  Engorgement, cracked nipples, two cases of nipple thrush (yeast infection), vasospasms that make my nipples turn  cold and white, milk blisters, blood blisters that exploded in his mouth and made him spit up blood (absolutely frightening!), blocked ducts, and finally, a breast infection (the mastitis).  My husband pointed out to me that this is the first time in his recollection that I have not listened to what my body was telling me.  But it’s more complicated than that, see?  My maligned nipples might be telling me one thing, but my every biological and emotional impulse is telling me “feed this baby from your boobs!”  I desperately want to provide milk for my baby.  Furthermore, I like breastfeeding.  The connection is wonderful.  But the look on his poor face when he realizes that the bulk of the milk has run out before he’s full is not. 

Oh, yeah, did I mention that my milk was giving him bloody diarrhea?  We’re working on that one – presumed cow allergy, so I’m cutting out all dairy.  Really, it was just yogurt since I am sensitive to dairy, too.  Still, it’s too bad because it seemed like eating a lot of yogurt increased my supply.  Add that one to the list of “Oh, well”s.

I hate feeling implicitly judged by people who tell me it should work, not because I think they’re actually judging me (though I am sure some secretly are), but mostly because I am judging myself.  I have wanted so much for this to work for the last three months.  I have worked so hard, and I am used to things working out when I try hard enough.  But what I have to remember is that breastfeeding is a two-person job, and three months in, he’s still asleep at the wheel.  No amount of hand-expressing and poking and prodding to wake him up can drain my milk into his mouth.  And to those of you who say, “pump while he’s sleeping!” – what am I supposed to do when the kid only sleeps on me?

The fact is that I have been so obsessed with my supply that I haven’t enjoyed what a fun and engaging baby he is.  And I think that, finally, I think I have to accept where we’re at so I can get on with my life and enjoy my kid and prevent him from getting so hungry that he goes insane.  I will provide him with milk as long as I can, whether it’s 6 months or 3 years, and I have to feel OK with what I can do.  My breast may be his absolutely favorite place to enjoy a warm snack and take a long nap, but it is not where he gets enough food to eat.  And it’s not for my lack of trying.

P.S. Appropriate responses are messages of support.  Please don’t ask me if I’ve tried anything or offer advice.  I’ve done my research and tried everything.  At this point, it’s important for me just to feel good about what I have.

UPDATE: 
Please read my post at http://spokeschicken.blogspot.com/2013/03/the-short-version-of-how-breastfeeding.html
Believe it or not, things improved because of a lot of support and help from a friend of a friend.  I'll write the whole story up one of these days, but in the meantime, I just wanted all you out there who can identify with this process all too well that there is hope.

A Short Treatise on Thermodynamics

I wrote this little paper for the biology class that I took over the summer as a pre-requisite for my upcoming masters' program. Dan suggested that I post it on my blog. Why not?

The first two laws of thermodynamics address the constant amount of energy available in the universe, or, otherwise stated, the amount of energy in a closed system. The First law of thermodynamics states that energy can neither be created nor destroyed, or that the amount of energy in a closed system is constant, even if you change energy from one form to another. To test this law, set up a track on a ramp with a motion sensor at the top and place a cart with a velocity meter at the top of the ramp. The cart will bounce up and down along the track, decreasing in its “bounce height” each time. The velocity will decrease with each bounce, and the specialized motion sensor at the top of the ramp track will detect an increase in vibrations in the track, measuring the potential energy. At the end of the experiment when the cart has come to a complete stop, you can calculate that, even though kinetic energy was lost, potential energy was increased, and the amount of energy in this closed system was therefore conserved.

Scientists have had inklings of this law from the times of the ancient Greeks, but it was Julius Robert von Mayer of Germany who concerned himself with it enough to publish a paper on it in 1841. Growing up in a town that depended on water power, he endeavored to build a water wheel that incorporated an Archimedean screw to pump the water back up to the top of the wheel, negating the necessity of the river as a source of power…or so he thought. He discovered that, no matter what he did, running the water wheel always relied on an input of power. He concluded that no work can be done for free. With a strong backbone from the Antoine Lavoiser’s 1775 Law of Conservation of Mass (matter can neither be created nor destroyed) and to test what happened to the lost mechanical energy, Mayer devised a series of experiments where pistons were mechanically raised by gasses that had been activated by fixed levels of heat. He calculated that chemical energy was converted to mechanical energy, and that the work gave off a measurable, definite quantity of heat. Despite the loss of mechanical and chemical energy, heat was released, conserving the total amount of energy in the closed system. He termed his conclusions the Law of Conservation of Energy, stating that energy can neither be created nor destroyed.

A natural progression of the first law, the second law of thermodynamics is concerned with what happens to energy every time it is converted from one form to another (e.g. matter to chemical, mechanical to heat). Energy flows from higher, more organized states to less organized states; in other words, every time energy is converted, some will be lost in the form of heat. Since heat cannot be converted to any other form of energy, everything will eventually disassemble into heat through a process called “entropy.” Scientists from Lord Kelvin to Albert Einstein have worked with the implications of this law, and a good example of it is that no energy transfer system is 100% efficient and always results in the release of heat. Cars lose energy in heat, as do all living things.

Valentine's Day

Dan and I had the strangest experience the other day.

For Valentine's Day, we have a tradition of going to the Bombay Club Indian restaurant for their Valentine's Day extravaganza where they do a once-a-year gala and pull out all the stops -- a tremendously indulgent experience that we look forward to every year. Last year, we enjoyed their new digs in the South End, even if we missed the romantic location in Harvard Square.

Having made reservations on Open Table a couple of weeks prior (a necessity given the high demand of this event), Dan and I got a little primmed up and hopped on the Orange line to the Back Bay T stop where we would then walk the mile out to their South End location on Washington Street. The South End carries its own romance and made a lovely pallet for a pre-dinner stroll. Thanks, The Gays!

We rounded the corner of Washington Street, pausing to admire the display and bustle of Foodies Market, and arrived at the Bombay Club. Except that the windows were dark. Really dark. And then we noticed the imposing "FOR SALE" signs all over the windows. "Is this the right address?" "This is where it was, right?" "Well, yeah...It still says 'Bombay Club' above the door." After inspecting all the posters on the off chance that there was a helpful "WE'VE MOVED!" sign -- of which there were none -- we made an about face and walked back to the train station.

A local chocolaterie on Dartmouth Street let us in and sold us delicious chocolate truffles of lavender, homemade marzipan, and sesame caramel while we parleyed with its proprietor about the strange experience. "We got a reservation confirmation and everything. It just seems a little odd," I puzzled. The proprietor, a bubbly and nurturing woman with curly hair and a flair for life, copuzzled, "Isn't that strange?! Just the other day, I was talking with a girl who tended bar there when it was still the Pho Pasteur. Just this past Sunday, she said she thought the Bombay Club might close. Something about trouble with the lease. Wow. That was fast! That's how it is with restaurants; they can close just like that! Here one day, gone the next." One of her friends in the tiny room chimed, "They closed their stand in Faneuil Hall, too." Noooooooooo!!!

In the end, Dan and I went back to JP after our romantic stroll and tasty chocolates in the South End. We were greeted with a warm reception at the Ghazal, where we grab Indian food every other week or so. They know us there, and they were pleased to see us. Similarly, it did us good to see our favorite neighborhood Indian spot doing such brisk business. We had a lovely meal and we made attempts to order things that we don't ordinarily get so it would still feel special.

It wasn't the same, but nothing stays forever. We'd been going to the Bombay Club for special occasions for years and it had become a staple in the corner of many important memories. Valentine's Day was the typical cause, but we also went there the evening that Dan proposed to me. Further, it is the first Indian restaurant where Dan had eaten -- and only at the behest of an Indian friend of his, who has since passed away. The idea that a vessel of our traditions was so fragile and broken swiftly was cause of great disorientation and sadness. We're happy that we have the Ghazal, our favorite neighborhood Indian restaurant, but we will sadly miss the Bombay Club, its wonderful staff, food, and memories.

Christmas 2010

Christmas this year was a whirlwind as usual, but it carried the blessings of tradition and ritual to buffer to the blow of what could otherwise be crazy. The last few years, Dan and I have had Christmas Eve with my mother's family, Christmas morning with his mother's family, Christmas night with my father's family, and the day after Christmas with Dan's father's family. It sounds a little crazy, none of the driving distances are too great. Furthermore, as previously mentioned, there is something to be said for knowing what to expect, for knowing how the day generally goes. We know when to get there, when we should leave to get to the next destination, and what generally used to be pretty stressful became lovely. I was exhausted by the end of it, but I had a lovely time.

Christmas felt extra-special this year for some reason. Perhaps it's because I'm getting older and I can appreciate everything my parents did for me as a child in a whole new light. Perhaps it's because Dan and I kicked things up a notch this year with the Boston Holiday Pops. Perhaps it's because my mother is doing amazingly well and it's a blessing in and of itself how she came alive again to decorate her whole house for Christmas. Perhaps it's because my talent for making peanut butter balls and needhams has matured to a real skill that brings smiles to my friends' and families' faces. Perhaps it's because there is a new baby in the family: my cousin's wonderful new son. Perhaps it's because there was snow on the ground, and nothing can replace a true New England white Christmas. Perhaps it's because I am really happy. Whatever the reason, this year felt special.

Due to a Blizzard (and yes, the capital "b" is purposeful), Dan and I were compelled to drive home a day early. We managed to get all the way to the Mass-NH border before hitting any real snow, and I was able to keep up a pace of 80 mph until somewhere close to the 495 split. At that point, however, we quickly reduced to 40mph, and shortly thereafter, it was 20 mph all the way home. I was truly impressed with the fortitude Boston drivers showed as everybody on the road managed to drive safely. I bore witness to no accidents or sliding cars, unlike previous times driving in poor conditions. Truth be told, this was not the worst weather I've ever driven in -- I didn't even slide around when changing lanes! However, I know that had we delayed our departure a mere 20 minutes, for example, it would have been a different story.

It was just as well that we came home last night. Let's face it, folks, I am not a spring chicken anymore, and extended visits with friends and family, as wonderful as they always are, completely exhaust me and I generally need a day off to stare at the wall and play with my new toys before re-entering the workforce. The drive and the exhaustion didn't put a damper on my sheer bliss about all the snow, though! As soon as Dan and I managed to find a store/restaurant that wasn't closed so we could get something to eat, I put on an extra layer and tromped around in the snow along the bike path next to our apartment. I couldn't help myself but to make a snow-angel.

Today, my plans are to put our new sheets on the bed, play with my new Kindle, and go snow-shoeing along the pike path. There's no place like home.

Are you eating your veggies?

Told to Eat Its Vegetables, America Orders Fries

Courtesy of the New York Times, this quick little article looks at why even America's health care professionals aren't eating their veggies. We're issued the tall order of eating 4 and a half cups (considered 9 servings) of fruits and vegetables a day, I'm not sure that even my veggie-lovin' self eats that much.

On that note, I'm sure that you all won't be surprised to hear that I'm considering a Master in Public Health with a focus on Nutrition and/or Epidemiology. Considering how many posts I make about food and health, I am shocked that I didn't think of this sooner. No time like the present!

Alarmist-Titled Article with Good Information Nonetheless

Courtesy of WebMD
6 Best Foods You're Not Eating