Sunday, October 25, 2009

Sleeping through the night

For the first 6 weeks of Fig’s life, I dutifully fed him every 2 hours during the day and at least every 3-4 hours during the night. At first, he often woke up and wanted to be fed (i.e., cried) more frequently than 3-4 hours at night, but after a couple of weeks I actually had to wake him up most of the time. His nurse practitioner had told me to wake him up to feed him—partially because his weight gain was marginal, and partially because of my ailing milk supply. As I’ve mentioned before, milk production is (theoretically at least) a supply and demand issue. Feeding him frequently would signal to my body that it needed to produce a lot of milk (though my body ended up doing nothing of the sort), whereas going too long between feedings would signal my body to shut down production.

When Fig was 6 weeks old, I was talking to another grad student and his wife, who had a baby just 2 days older than Fig. They were telling me how their baby slept through the night—8 hours at a time. I thought, that’s all well and good, but there’s no way she’s nursing the baby. Going 8 hours between feedings would lead to uncomfortable engorgement and a reduction in milk supply. As our conversation continued, however, she said how she was breastfeeding, and I was astounded. I had no doubt that Fig could sleep 8 hours or even more. Most of the time I had to wake him up in the night to feed him. But what would happen if I didn’t continue to do this? Would he waste away? Would my milk supply completely dry up? I thought that this couples’ daughter must be some kind of super-baby, and I wrote it off as a fluke.

But lo and behold, I talked to a few more friends and neighbors—revealing how I still woke up Fig to feed him in the night. They all confirmed that I was crazy to do that. “Let a sleeping baby lie!” seemed to be the refrain. So one night I let him go 5 hours instead of the prescribed 4. I was terrified of what would happen. To my surprise, nobody died.

At our next doctor appointment, I asked about whether or not I still needed to wake up Fig in the night to feed him. The nurse practitioner told me I could go ahead and let him sleep, as long as I still fed him about every 2 hours during the daytime. So I tried it. On October 1st to be exact. I fed him and put him to bed at 10pm. I woke up at 2, instinctively getting out of bed to wake him. But I made myself stay put. I woke up again at 4, feeling like my boobs were full of cement. I thought, I need to wake him, don’t I? What should I do? Will he sleep forever if I don’t wake him? My milk will surely dry up if I don’t wake him. I lay there in a panic until 6am, when he finally began stirring and I jumped up to feed him. It had been 8 hours. He had slept through the night.

Since then, I have not been waking him to feed him anymore. I was so terrified of what would happen to my milk supply, but as long as I keep taking 90mg of Domperidone every day, it remains okay (knock on wood). Typically what happens is that I feed him and put him down sometime between 9 and 10 pm, and he wakes up at 3am to eat, then goes back to sleep until 7am sharp when he wakes up bright eyed and bushy tailed, ready to eat and get started on his day. It’s really not that bad. Even though he has spent the majority of his life crying non-stop during the day, ever since about 2 weeks of age, he’s been very good at night. Usually he goes right back to sleep without a fuss after his nighttime meal. This has been the one thing (well, aside from all the times my mom has driven down from Peoria just to scrub my floors and do my laundry) that has saved my sanity.

Sometimes he doesn’t even wake up for his 3am feeding. Take last night for instance. We had been to D-ville to visit Rob’s extended family (Fig’s first trip out of town, if only 30 miles). I fed him around 9pm before we left Rob’s grandparents’ house, and he fell asleep on the way home. He didn’t really wake up and we put him right to bed when we got home. He didn’t wake up until 6:30am this morning. And that was only because Rob’s alarm was going off. He looked like he would have been perfectly content to keep sleeping, but my boobs were horrifically uncomfortable, so I hauled him out of his bed and made him drink about a quart of breastmilk. He was pretty happy about that, actually.

I still get a little paranoid about his possibly excessive nighttime sleeping. Mainly I am paranoid about my milk drying up (given that my supply is still somewhat marginal). Everybody always asks me how the baby is sleeping at night, and if the asker is a parent themselves, I always ask them, “Should I be worried about this?!” So far everyone has told me, “Thank your lucky stars.”

Sometimes I think this sleeping through the night is a double-edged sword. When he wakes up, he is generally ravenous and he wants to eat at least every hour for most of the morning and even into the afternoon. One of the nights that he slept for an 8 hour stretch, he woke up with a bit of a diaper rash because I didn’t change him during that time. And since he’s slept so well at night, he generally has no intention of taking any kind of nap during the day. This all makes it quite difficult for Melissa to finish her dissertation.

At any rate. He had a pretty good day yesterday and for most of the day today. But long about 5pm this evening, he decided to cry for several hours, and then begin screaming hysterically (as in, Oh my god, should I take him to the emergency room?!) about 8pm. The only way to get him to quiet down was to nurse him continually. Whenever I tried to take him off (like if I had to pee or needed a drink of water), the screaming began anew. Then abruptly about 9:30, he fell asleep.

Well, I need to fold 3 loads of laundry, clean up the kitchen, put away random piles of crap that have accumulated throughout the house, and floss my teeth.

Thanks for reading.

Sunday, October 18, 2009

She must not have noticed the baby vomit on my shirt

I went to the grocery store one morning last week, and as I stood in the check-out line, the woman behind me said, “You make it look so easy.” I had no idea what she was talking about. “Getting groceries with a baby,” she clarified. I stared at her in disbelief. This was anything but easy. The whole endeavor required the planning of a military operation and the speed of world-class athlete. I couldn’t remember the last time I washed my hair, and my shirt was still wet with some vomit Fig had deposited there after his breakfast. I had made the calculated decision to go ahead and go to the store wearing the baby vomit shirt because I didn’t have time to shower anyway, and I didn’t see the point in putting on clean clothes when I myself was dirty. “This is not easy!” I assured her, mentally noting that nothing in my life had been easy since I got pregnant. “I know,” she told me, “I have a 10-month old that I dropped off at day-care just so I could come to the store.”

The mere fact that someone thought I made it look easy was mind-boggling, because I never do not feel like I am hanging on by a thread. The past couple of days though, have been a definite improvement. All of a sudden, there are multiple periods per day when he is awake and not crying inconsolably. This is a completely new thing to me. He had given us a few smiles before, but his smiling time has now increased by an order of magnitude. There have even been a few feeding bouts when he didn’t fuss at the end and he actually looked like he was satisfied. It’s like a miracle. I can understand why people have children now. I hope to god that the worst of it is over, but I know we’re not out of the woods yet. The crying hasn’t completely ended, but at least it hasn’t been as incessant as before and it seems more like how a normal baby would cry.

Today was a good day

I’m not sure what it is that has done the trick. I’ve got so many things going on. The Domperidone to increase my milk supply. The Prevacid to help with his acid reflux. This week also marked the 3rd week that I’ve been off dairy, so I suppose it could be that too. His reduced crying also coincided with a reduction in the weird green poo, which is supposedly a sign of a food intolerance. In the meantime, I gave up soy as well, so it could be that. It seemed to me that he was especially bad on days when I had a lot of soy products, and according to the internet, soy is a very common allergen for infants. Particularly for infants who are also intolerant of dairy. I was sick of waiting around and listening to him cry, so I cut out soy just to see what would happen. It was about 5 days later that things got better. Since I don’t know what it was that actually helped, I am just going to keep doing everything for the foreseeable future. It isn’t the easiest thing being a vegetarian/vegan who cannot eat dairy or soy, but once I actually did it, it wasn’t as hard as I thought it would be. The biggest change I made was to switch soymilk for almond milk. I wish almond milk wasn’t so expensive and had more protein in it, but oh well. I figure I’ll keep off both dairy and soy for another week or so, then cautiously eat something with soy in it (soy flour or soybean oil is in everything, so it won’t be that hard to find something with a small amount of soy). If he tolerates that well, I will eventually try soymilk or something and see what happens.

Hoping for more smiles and less crying. Thanks for reading.

Saturday, October 10, 2009

The things I've done

My milk first came in on August 14th, my 30th birthday. I felt like Mother Earth herself. I thought having milk would solve all my problems—Will’s latch would stop hurting, he would stop crying, and life would be happy again. But none of this happened. Will persisted in crying relentlessly, inconsolably, all times of the day and night. And his latch continued to hurt just as bad as it had in the hospital whenever I wasn’t in the lactation consultant’s office. I had plugged duct after plugged duct. The crying never ended.

I’m not sure when it was—when Will was 2, maybe 3 weeks old? He only gained 4.5 ounces that week. Not dangerously low, but enough that the lactation consultant told me that she thought I had a low milk supply. It hit me like a ton of bricks. Here I was, nursing the baby for hours at a time, at least 12 times a day; in fact, I was doing little else besides nursing. I couldn’t believe that his weight gain was so low after all that nursing. But what I didn’t know was that most of the time he was “nursing,” he wasn’t really nursing. I didn’t know there was such a thing as “non-nutritive sucking” and that he was doing it. I didn’t know what it sounded like when babies swallowed and that if I didn’t hear that noise, he wasn’t getting any milk.

All of us have gone to extraordinary efforts to increase my milk. Will is now 8-1/2 weeks old and we’re far from in the clear. I’ll be honest, my life has pretty much been a nightmare during this whole time.

We tried the simple things first:

  • Skin to skin contact—didn’t help.
  • Breast compression—got more milk into him but didn’t increase my supply.
  • Eating oatmeal—did nothing. I still eat oatmeal every day though, just in case.
  • Eating alfalfa—nothing.
  • Mother’s Milk Tea—nothing.
  • Pumping after feedings—I really think this only made things worse. In theory, if the breast is more frequently emptied, that should signal your body to produce more milk. But I feel like it did the opposite for me. I’d feed him, pump, and then when I fed him again (often with very little break in between), a lot of times I’d be completely dried up—not a single drop of milk in me. I’d have to give him the pumped milk, and it became a vicious, vicious cycle. Plus, all this was hard to do, practically speaking. He took forever to eat—often 45 minutes or more, what with all his non-nutritive sucking. When I finally decided the feeding bout was over and took him off, he would cry inconsolably. I could try to calm him down, or I could pump. Most of the time I ended up pumping while listening to him scream. And as soon as I was done, he wanted to eat.
  • Power pumping—the same as pumping. In this technique, you pump 10 minutes on, 10 minutes off for an hour, and you do that several times a day. It was virtually impossible to do when I was home alone with him, as I often was.

We tried all kinds of different galactogogues:

  • Fenugreek—the lactation consultant put me on this. It didn’t do very much. When you’re taking fenugreek, it’s supposed to make you smell like maple syrup (fenugreek is what they use to flavor artificial syrup). I took as many as 12 pills a day, and I never smelled like syrup, and I never noticed much of an increase in my milk or a decrease in Will’s hungry cries.
  • Blessed thistle—sometimes fenugreek works best in combination with blessed thistle. We tried this. Nothing.
  • Goat’s rue—this may have helped a tad, but the package instructions say not to drink anything 20 minutes prior to and 20 minutes after taking it. And you’re supposed to take it 4 times a day. Try doing this and also getting the 90+ ounces of water you’re supposed to have while nursing, all the while taking care of a screaming baby. Not good.
  • More Milk Special Blend tincture—the lactation consultant didn’t know I tried this, but I was really desperate. It might have worked had I taken it for weeks, but it had goat’s rue in it and I had the same problems as above.
  • Domperidone—This is actually a drug for acid reflux (or some type of gastrointestinal problem) and I believe it is not technically FDA approved as a galactogue. I’m not really sure what the deal is. But one of the side effects of this drug is to increase your prolactin levels, which in turn increase milk production. The problem is that insurance companies do not cover it, and it is very expensive—around $1 per pill. I took 9 pills a day. Plus, you can only get it from certain compounding pharmacies. I had to go to the St. Joseph Apothocary, which sounded very medieval, but ended up not being very medieval at all.

After a full week on Domperidone, I noticed nothing. In desperation, I went back to the lactation consultant and she said it might take 3 weeks or more to notice a change. She said I might be one of the 5% of women who actually cannot breastfeed, and we might need to redefine success. That I would need to stop feeling like I was a failure if I had to give him formula and could not exclusively breastfeed.

But I’m Melissa. I don’t redefine success. Life would be much easier if I could do that, but I just don’t know how to. They prescribed me anti-depressants I guess so that I would just give up and give him formula and not hurl myself off a bridge as a result.

I have not given him formula. Not one drop. He’s gained a good amount of weight every time except that one appointment, and it has all been on my milk—whether pumped or from the breast. But it's killing me. Every night I think, this is one more small victory, one more day that he hasn’t had formula. Every morning, I wonder if this will be the day when I break.

After two to three weeks on the Domperidone, I finally felt like I had more milk. Not exactly as much as I should have, but enough that I finally felt like some of his crying might not be a result of hunger pangs. Around this time I also started drinking almond milk, after my yoga teacher recommended it. She’s from Israel, and she said that is what women do there to increase their milk supply, but I haven’t found any information about it. When we went back to the lactation consultant (also a pediatric nurse practitioner), she said two things. First, he had characteristic signs of acid reflux (crying after feeding, etc), so she would put him on Zantac. Second, he also had signs (green, foamy poo) of being intolerant to dairy products (i.e., the cheese and sour cream in my diet), so I would have to stop eating anything containing milk protein. Fine, consider it done. I was vegan before, I’ll be vegan again. I could be a vegan in my sleep. Especially if it would stop him from crying.

And yet.

The crying persists. Zantac did nothing. After 2 weeks, I went back yesterday and they put him on Prevacid, which is super expensive. Still waiting for results. Going off dairy products could take up to 3 weeks for any noticeable improvement. So I’ve got a week left to see if that helped. After my milk supply seemed stable for a while, I also began trying to slowly wean myself off the Domperidone... from 9 pills a day to 8 and so on. By the time I got down to 6, it seemed like maybe there wasn't so much milk as before, but I tried to convince myself that it was just my imagination. At his appointment yesterday, Will had gained enough weight, but it was less than before. The lactation consultant said that it didn't seem like a good idea for me to go off the Domperidone yet. She wrote me a prescription for another 10 days (back to the apothecary I go) and suggested that I look into ordering some from Canada to save money. It might be that I have to take it the whole time I nurse.


The latest verdict on Will's persistent crying is: colic. Great. I don’t even believe in colic, and now he has it. Anthropologically speaking, babies of non-western societies do not suffer from colic. Their mothers wear them in a sling as they go foraging through the forest or savanna, and the babies nurse on demand and don’t cry relentlessly. I thought if I held him all the time, and wore him in the Baby Bjorn, and nursed him, that everything would be okay. But it’s not.

He’s sleeping at the moment. There are a million things I should be doing while the house is quiet, but for some reason I felt like I should write this. Thanks for reading.