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Monday, August 1, 2016

Our Journey to Breastfeeding

I love this little milk drunk face - makes me so happy.

In honor of World Breastfeeding Week, I am sharing our story that it may help someone else. I also wanted to share some of the resources and tips I received throughout this journey (bottom of post). I wish I had read more about others experiences with breastfeeding before my sweet boy was born. 

Short Version:

After five weeks of exclusive pumping, lots of hormones and tears, endless visits to lactation consultants, a chiropractor, a craniosacral therapist, an upper lip tie revision, lots of tongue exercises and mimcry, my baby boy is finally breastfeeding at five weeks old. I could not have done it without the support of our amazing lactation consultant, Alison Smart, La Leche League of Salt Lake City and Murray, my mom and almost daily texts, one of my best friends, Ally, and of course, my amazing husband with his endless support and encouragement. In the end, it was all about the SUPPORT system I found in this amazing network of people that led us to this incredible outcome. Scroll down to read more about some of the tips and resources I encountered and my thoughts on each. 

Long Version: 

I have always looked forward to breastfeeding. It was definitely part of the plan. I took three different breastfeeding courses during pregnancy and read three books to prepare. I felt prepared and confident. I had seen so many videos about the "breast crawl" where baby will crawl to mom's breast after birth when placed on mom's tummy and latch all by themselves; babies have special reflexes on their ankles, knees, wrists, etc to help signal them to the breast for food. I also planned to have skin-to-skin contact at least for the first hour and to breastfeed within the first hour after birth to start things off strong. I thought this is how it would happen for us.

The first five weeks of little David's life, I was exclusively pumping. By that point, we had worked out a pretty good system - pump every 3 hours, then bottle is ready for the next feeding. Our little boy was growing strong and healthy. I still had a strong desire to breastfeed. In fact, the first two weeks of his life, I cried every time I thought about it because I wanted it to happen so badly. Over time, I resigned myself to the fact that he may not breastfeed and that was okay. I was neutral.
When little David was born, I had chills for about 2 hours after birth and it was difficult for me to do skin-to-skin or try to breastfeed. I did kind of get him to latch for a minute but he was quickly falling asleep and it was hard for me to hold him. My husband took our little boy during that first two hours and had him sucking on his finger the majority of the time. That first night, we all fell asleep and slept 7 hours straight. Our little guy was so sleepy and exhausted from birth as well. We woke up in a panic realizing we had not fed him yet (which we have since learned is okay since baby was sleeping to recover too). We tried for almost an hour to breastfeed but eventually our little newborn started crying (more like squealing) inconsolably. Finally I hand expressed some colostrum and we dropper fed baby boy while he sucked on our finger. We did this for 3-4 days before we started using a bottle as his feedings were getting larger. So I started exclusively pumping and preparing bottles. I still offered the breast to baby before every feeding but same thing every time - he would root around and try over and over to find the nipple and latch then became quickly frustrated and started crying inconsolably. We would then give him the bottle and he was just fine.

We met with our first IBCLC (International Board Certified Lactation Consultant) when David was 4 days old. She did an evaluation of his mouth and determined his jaw and tongue were really tight so that was probably making it hard to breastfeed. She gave us a few simple tips to try and we setup a follow up the following week. She also referred us to a Craniosacral Therapist - we reached out but her first available appointment was over a month out. In that following week, we realized our baby had an obvious upper lip tie (ULT) that the IBCLC had not mentioned. We pointed it out to her at our follow-up and she said she didn't think it was impacting breastfeeding but encouraged us to have it checked out at some point because of how it would impact oral health down the road. In that second session, we did a little more practice with her and left with a few words of hope and encouragement but no real actions on how to change things. She did have us switch to a Philips Avent bottle (instead of Como Tomo) so baby was forced to open wide and essentially "latch" onto the bottle - I think this was really helpful.

In the meantime, we started going to the Chiropractor immediately and baby had some severe subluxations in his neck (C1 and C2). We have had regular newborn adjustments since then (sometimes up to 3x/week) and baby is doing better and better. It is amazing to see how calm he often is after an adjustment. Here is an interesting article on Chriropractic care for breastfeeding and newborns: “Chiropractic Care for the Breastfeeding Dyad”

I have the most amazing resources through my employer and they have a "Mothers at Work" program with lactation consultants available 24/7. I called them during that first week. One of the most helpful pieces of advice they gave, "Breastfeeding is a natural process and can be very intuitive but many people forget that mother and baby still have to learn - they have never done this before so it is a process to figure things out." This helped me feel so much relief - I was not "broken" and my baby and I would figure this out together.
The first week after you have a baby is emotional. It is the happiest time but there are also so many new things to learn and it is overwhelming. I wanted to breastfeed so badly....I was devastated. I would cry every time we tried. I felt rejected by my baby and at the beginning, it did hurt my relationship with my baby boy. Eventually, an IBCLC told me to remember that my baby loves me and is not rejecting me. I learned not to take it personally.

I continued to do more research on my own and we continued to offer the breast. A turning point came we changed to paced bottle feeding (sit baby upright and hold bottle upright and hold bottle down when baby stops sucking). Baby did start to show a little more interest in the breast with this technique and started to latch and suck every once in a while (but still no milk transfer). I think it ultimately helped him to successfully latch and breastfeed.

When baby was about 3 weeks old, I went to my first La Leche League (LLL) meeting. It was perfect timing because around this time, I had thoughts of giving up. I told my husband a few times to "just go buy a can of formula." My husband was so so supportive through all of this - he knew how important it was to me. He encouraged me to keep going but told me we could set a date and if things weren't working by then, we could change things and either resign to exclusive pumping or use formula. We never got anywhere near that date.

I needed the support of the LLL community. It was so helpful to hear of other challenges women have faced and to know I was not alone. I also had the support of multiple Facebook groups (Dairy Queens, LDS Breastfeeding, Utah Birth Forum, Utah Tongue and Lip Tie Support Group) that helped. I had a friend suggest trying another IBCLC to check for tongue and lip ties (we already knew about the ULT) and it was suggested again by the LLL Leaders. I was referred to Susan Johnson and Alison Smart of Motherfed. I met with Allison a few days later and I was so glad I did! She gave me so many different things to try. She also said we needed to get the ULT and a possible tongue tie (TT) checked immediately and we had an appointment with a pediatric dentist that Thursday (3 days later). Their IBCLC group also has a breastfeeding support group every 2 weeks or so with an intimate group of 6-8 women or so. I went to my first meeting the next day. Again, support! You need support. It made all the difference. I was re-inspired and motivated to make things work.

Through all of this, I did learn that I had larger nipples. I bought larger flanges for my breast pump and it was much more comfortable. I had several people tell me that with my larger nipples, baby would "grow into them." One woman at the LLL meeting suggested this did not even make sense biologically because baby needed to be able to drink the milk to "grow into them." This made me laugh and I stopped worrying about my "large nipples." I will say, growing up in a very conservative community, I had not seen much breastfeeding growing up. I'm embarrassed to say, I've also since learned there are lots of different breast shapes, nipple shapes and sizes, etc. and chances are, they all "work" (except a very small minority that really cannot breastfeed for one reason or another).

When we met with the pediatric dentist, he spent 30 min evaluating and we determined there really was not any restriction of the tongue but by releasing the ULT, it would make a big difference for baby to flange upper lip and release tension in the mouth. This made me a little nervous because I had done my research on ties and over 90% of the time when there is a lip tie, there is also a tongue tie. We did the revision and it was so much better than I expected. Baby slept through it! The first few days were a little rough and he was fussy. For pain relief, we use arnica tablets (half dissolved in water), a very diluted mixture of coconut oil with some clove and lavender EO drops, and then Hyland's teething gel. The hardest part of the revision is having to stretch the lip and do massages every 3-5 hours for 3-6 weeks after the procedure (this article gives you an idea of what the exercises look like). We are still doing this and it does not hurt him anymore but he still hates it. He is really snugly after though. Also, in the first 5 days after the release, baby stopped even showing interest in the breast and was anxious anytime the bottle or breast came near his mouth. I was worried he may just never breastfeed but I was pretty neutral at this point and whatever happened was okay with me.
At about 4 weeks, I read this and this awesome blog post and decided to just focus on "making my boobs a happy place." No longer did I let him cry inconsolably at the breast. If he starting crying, I held him upright and loved on him and cuddled him. We took loving baths together, lots of skin to skin, and just lots of love with the breast close by. 

We met with the Craniosacral Therapist (CST) 3 times - once before the revision and twice after. Baby boy started nursing just 2 days after our second appointment. He was also so calm after our sessions with Lesha. CST is a light touch therapy used to work on all the different muscles in the cranium and sacrum and support the central nervous system. I am a believer! I honestly think the work she did had a major impact on loosening his jaw and helping him to open wide enough to latch.

Finally, about 10 days after the ULT revision, baby started to refuse the bottle. He would cry for 10 minutes before finally taking it. Finally my husband asked if I had tried breastfeeding recently and admittedly, I had not. He handed him over, we laid back and boom! He latched right on. We were shocked and ecstatic! So at 5 weeks old, baby boy is exclusively breastfeeding.

We are still learning together - we are both most comfortable in a laid back position and my nipples are adjusting to it all but I am so happy with how far things have come. It was a hard journey, but it was so worth it. 

I am grateful for modern technology that made it possible for me to pump (in a reasonable amount of time) and still feed my baby breastmilk the first five weeks. I'm grateful to all of the professionals we worked with who each made an impact on our little David. I am a firm believer in a holistic approach and I think each person we worked with played an important role in our journey and I would not change the way we did anything. I'm grateful to my sweet husband for his endless support and all of my friends and family that kept encouraging me. I am so grateful to one of my best friends, Ally, who sat with me one night and gave me so many tips to try and talked me through everything. She has been constantly checking in with me and sympathizing with me. She was an angel and kept me going through this journey. 

Here are my recommendations for professionals in the Greater Salt Lake area:

Things to think about and resources:

  • Oral Restrictions - tongue and lip ties - check out Dr. Bobby Ghaheri's blog - his downloads are a great place to start or this is a great article: Rethinking Tongue Tie Anatomy: Anterior vs Posterior Is Irrelevant”
  • Mimicry - Different playful exercises help baby explore new mobility and develop a normal range of motion. When looking at baby, do lots of open wide (like a yawn), move tongue up and down and side to side to help them learn how to use their mouth. Talking and singing go a long way as well to help baby explore their mouth.
  • Tongue Exercises - play with their tongue, do some lateralization (move finger along upper and lower gums to have them move their tongue to the spot where your finger is), tug-o-war (having baby suck on finger and slowly pull out to have them suck back in), side-to-side (while baby is sucking, move your finger from side to side along the roof of their mouth), and downward stroke (stroke tongue to have baby extend toward chin) - you can do all these exercises whether or not they have a revision; here is a fun video of playful exercises to make it fun for baby.
  • Tummy Time - helps baby to increase head and neck support and optimize tongue and oral function. It also helps baby to bond with parents and attune baby's calm and relaxed state. Some of the above "mimicry" exercises can be more effective in tummy time. 
  • Laid Back Nursing (essentially biological nurturing but a little more upright) - I had not heard much about this position and this was ultimately the position we were in when he started breastfeeding. Baby hated the cross-cradle position (I think because we had tried it so many times when he was crying inconsolably) and the cradle position at first.
  • "Natural Breastfeeding" (again similar to laid back and biological nurturing) - Read this article to learn more. This is a movement that uses baby's natural "pressure buttons" and works with gravity (rather than against) to help baby lead the latch and latch deeply. 
  • Flipple Technique (this is my favorite!) - holding above and below the nipple/areola and putting nipple just above baby's upper lip, when they open wide, you flip the nipple into the mouth and pull your finger out and it helps the upper lip flange. Watch this video to learn how. 
  • "Thumbs Up" (Flick it) Technique - holding the side of your breast with your thumb to make it more firm and then when baby opens wide, moving your thumb forward and flicking the nipple into the mouth. Watch this video to learn how. 
  • Nipple Shield - The nipple shield was painful and uncomfortable for me and popped off continuously. It didn't feel worth the struggle. And it can also hurt supply since it is a little harder for baby to get milk out. Because I have larger nipples, I had to special order a larger size from Mamovac. 
  • SNS (Supplemental Nursing System) - I finally ordered an SNS just before 5 weeks. I didn't have it for long before baby started breastfeeding but I can see how this could have been more helpful early on; however, you have to be very coordinated, otherwise you will easily get milk everywhere. I would recommend trying this early on if baby is struggling to latch in order to keep them at the breast for feedings.


Karli said...

This makes me so happy! You are proof that breastfeeding is possible for nearly everyone no matter what challenges you face! I recognize that choosing to give up on breastfeeding is a very personal choice, but I always feel so proud of someone when they choose to power through and figure it all out. Our favorite position was also the laid back position, and we used that exclusively for the first two weeks until we were both a little more comfortable with breastfeeding. So happy it all worked out for you!

Chantel said...

I absolutely love how well-researched and knowledgeable you are. You took such an active and constructive approach through the entire process of getting David to breastfeed. And everything that you went through seems like such real things that new mothers go through in their efforts to breastfeed - I love that you talk about it so openly! So much of this I had never heard of before. I so appreciate you taking such a solid and honest approach to everything.

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