Thursday, September 22, 2011

Breastfeeding a Newborn

I'm back in the "breastfeeding a newborn" phase of life. Actually, the new baby has been amazingly good to me. I've written about how my second son was a snacker, eating every hour. This new guy, he eats very enthusiastically, sometimes only for 10 minutes, other times for 20, but he cluster feeds for a bit, then takes a nice long nap, sometimes close to two hours. (Not that I can make any definite statements about his habits at 17 days old, but this is sorta how it's been so far.) It's kind of amazing. I was prepared for another every-hour eater, so this is pleasant.

Before my milk came in, his latch was horrible, it was hot as heck here (no A/C), and he would not let go of my nipple without screaming. I dreaded latching him on, I cried, thinking I couldn't possibly handle a baby like this, I despaired. And then my milk came in, and he became the most content, easy-going guy. I'm very lucky.

I read a very good article yesterday - which I wish I'd read two weeks ago! - about how positioning is more important than how the latch looks, and how the latch feels is more important than it looking like they describe in the books, and suddenly he's latching better, with just a few simple tips. Hold the baby tummy-to-tummy with you, so his ears, shoulders, AND HIPS are in one line. Bring the baby to your breast, with the nipple in line with his NOSE, and let your breast brush his CHIN. This will stimulate him to open his mouth, and then you can drop the nipple in. If it doesn't hurt, you're fine. Also, it helps keep him latched comfortably if you recline a bit. This is called biological nurturing, or laid-back nursing, and it helps keep the baby from flinging his head backward and coming off the nipple in a rather painful way.

I would like to brag a little at this point. Baby was born 8lbs., 3.5oz. By day three he had lost about 6 ounces, and was down to 7lbs., 12oz. The very next day, day four, he was up to 7lbs., 15.5oz. (yes, he gained 3.5 ounces in one day, once my milk came in). Today, he had his two-week appointment, and at 17 days old, he's 9lbs., 14oz. Yes, folks, he gained over two pounds in two weeks. He's a good eater, that one!

Anyway, I have mastitis. I've preached up and down, here and in my book, about getting rid of plugged ducts and avoiding mastitis, and here I wake up yesterday morning with a horribly engorged right breast, chills, achy joints, and a hard, sore spot on the outside of said right breast. Damn. I tried my usual tricks, massaging the spot while nursing, nursing a lot on that side, letting the hot water from the shower help open up the duct, massaging some more. I thought I'd taken care of it, until my 600mg dose of ibuprofen wore off and the chills came back last night. I spent the night alternately having chills and sweats, so I called the doctor this morning and asked for antibiotics. If you can't clear the infection with home remedies within 24 hours, it's not worth taking any chances. Mastitis can be serious stuff. I was hoping to avoid antibiotics, because that can lead to thrush, which is its own ball of trouble. Ah well. I got some probiotics to take along with the antibiotics, so hopefully this will be the end of it.

And, finally, I've decided to start pumping and storing breastmilk again, like I did with my second son, in order to donate it. I have someone in mind to give it to, if she wants it. A friend of my housekeeper's had a baby who was in the hospital for a few weeks after birth. She desperately wanted to breastfeed him, but she didn't have good support, and she didn't have a full supply established. I tried to pass along some tips, but I think it was too late. At three months old, now, her milk is dried up, and her son has had four ear infections already. She's terribly upset. I asked my housekeeper if she thought her friend might take donated milk, and said I'd be very happy to start pumping for her. I won't be able to give her enough to get him off formula, but even one bottle a day may help. Poor baby.

Tuesday, September 13, 2011

My Third Son's Birth!

Hello out there. You may have gathered from my longer-than-average hiatus that I've been indisposed. You were right. I gave birth to my third son on September 5 (Labor Day!), and I've finally had an opportunity to sit down and write about the experience. I'm very excited to share with you my birth story!

For over two weeks, I had been having strong, recurrent bouts of contractions. They weren’t painful, but they were strong enough to make me stop and wonder, then look for other signs of labor. And then they’d stop. Starting at 36 weeks, at each appointment with my nurse-midwife, she’d check my cervix (per my request), and each week, I had opened another centimeter. Each week, we were both certain that I’d give birth before the next appointment. But I was there, still pregnant, at 37 weeks… 38 weeks… By my 39-week appointment, I was 3cm dilated and 80% effaced, and still no labor. I was getting antsy. Very antsy. But I knew baby would come when he was ready, and I sincerely wanted to let nature take its course. I was determined to have a spontaneous labor and successful second VBAC.

It was the Sunday of Labor Day weekend. I was due the following Wednesday. I had convinced myself that I couldn’t possibly have this baby before 40 weeks, because otherwise I was going to lose my mind. On that Sunday, we went to the park with the boys and had a picnic, then to a community barbecue. The whole afternoon, I’d have occasional strong contractions, much like before, but they didn’t come to an end. I started to toy with the idea that maybe, just maybe, they meant something this time. But, by that point, I’d had so many, “Maybe this is it!” moments that I was not ready to commit.

Around 10:30 that night, I decided the contractions were actually getting stronger, and I started timing. Five minutes apart. Well, that’s the tell-tale sign, right? But, they didn’t hurt as much as I thought they should, and I could walk and talk during each one, so I still wasn’t totally convinced. I decided to take a bath and see if I could relax them away, then try to get some sleep. If I was going into labor soon, I should try to get a few hours of sleep first.

I took a bath, and they didn’t stop. I got ready for bed, laid down, and WHAM, I had a really strong contraction. My thought was, "Well, I won't be able to sleep through these!" Five minutes later, another one. Okay, I said. This is it. I put clothes back on and told my husband I thought it was for real this time. We called someone to come stay with the kids and called the hospital to make sure it was okay to come in (it was). By the time everything was arranged, the hospital bag was double-checked, and we were ready to go, it was about 12:30am, Labor Day. We took off for the hospital. We didn’t want to wait at home too long, because the hospital was 40 miles away, and I didn’t want to take the chance that we would be “too late,” as it were. I also didn’t want to be too early and hang around in the hospital for more hours than necessary, or to get there and find out it was false labor again, but I was pretty certain. I was completely certain about halfway there when I realized I was no longer able to carry on a conversation during a contraction. Whew.

My husband drove… er… rather fast, and I think we got to the hospital in about half an hour, around 1:00 in the morning. To my delight, the nurse-midwife on call that evening was none other than the one I’d been seeing for my prenatal appointments. We were mutually excited, since that rarely happens at Kaiser. They triaged me and checked my dilation, and I had gained another centimeter and was having regular contractions. Time for baby!

My nurse-midwife told me I could have the epidural whenever I wanted. I wasn’t sure that I wanted one at all, and I said I knew I could have it, and that I’d ask for it if I wanted it. I definitely didn’t feel that I “needed” it yet. The contractions were definitely growing in intensity, but the five minute break in between was enough for me to catch my breath. My husband knew I was hesitant to have any medications during labor, and I’m really glad we talked about that beforehand, because the idea of the epidural becomes very, very tempting at 3:00 in the morning in active labor, let me tell you.

Sidebar: I wanted to avoid epidural and Pitocin during this labor, if possible, because I was intent on having another VBAC and because I knew that any interventions could lead to further interventions, which might eventually lead to c-section. Additionally, I had Pitocin with each of my previous deliveries, and in each of the previous deliveries, I had postpartum hemorrhage, and both boys had jaundice. Pitocin is a risk factor for both postpartum hemorrhage and jaundice in the baby. I did NOT want Pitocin, and, by extension, I did not want an epidural, in case it created a “need” for Pitocin.

They kept offering to break my water to move labor along, but I kept refusing. The amniotic sac protects the baby from the brunt of the contractions, and it also lessens the intensity of the pain. Once the water is broken, everything gets ramped up. I didn’t want that. I wanted my water to break naturally. I think they really wanted to do it, but I didn’t. I really really didn’t. So I kept refusing. Besides, labor seemed to be moving along quite quickly!

I had dilated to about 6cm when labor went crazy. I was managing the every-five-minutes contractions reasonably well, but all of a sudden they went from every five to every 1.5 to 3 minutes! There was no break in between to breathe or relax. One ended and the next began. The nurse, who was wonderfully attentive, strong, and worked with me very well, was coaching me to blow and breathe, which is NOT EASY. At the end of each breath, I desperately wanted to push, but I couldn’t, because it wasn’t time. I started to hyperventilate a bit, and they gave me oxygen. I’m not sure if it helped. I had to breathe so fast to stay ahead of that “push” feeling, I barely had time to exhale before I had to inhale again.

And that’s when I said, “I want the epidural!”

The nurse and my husband both knew that I wasn’t so sure about it. I knew I wasn’t so sure about it. They asked if I really wanted it, and all the fears about what might happen if I got one surfaced, and I backed down. And then said I wanted it. And then backed down. I just couldn't make a decision. Between them, my husband and my nurse were very good about putting me off without making it seem like they were. I did want it, in that moment, but then I didn’t. I was so tired. I think my feeling was that if I could just rest a little, I’d be okay to continue, and an epidural would let me rest.

The other nurse-midwife on call came in, because mine was taking a break until I was ready to deliver (she was staying around because she wanted to deliver me, but I think she was technically supposed to be off). She suggested that I try the shower. So I got in the shower for a bit, and the hot water felt really good, but the contractions were just coming and coming and coming, and I was so tired. I hadn’t expected it to hurt quite so much, and I hadn’t expected the contractions to be so close together or so intense. How much longer did I have to endure these? Hours? I couldn't do hours. I just couldn't. I got out of the shower and returned to the bed, somehow hoping that sitting or lying down would help. Maybe I was just tired of standing.

I think the nurse realized that I must be close, because she said to me, “Jessica, listen. I want to tell you something about the epidural. I’m happy to get you one if you want it. But by the time we get the anesthesiologist up here, and we sit you up and do it, it will still be 20 minutes before it kicks in. By then, you might be ready to push, and you won’t even get to enjoy the epidural.”

That convinced me to keep going, and, sure enough, I was almost fully dilated. At 4:40am, my water broke with a pop. The nurse checked and found that I had just a lip of cervix left. She said I was absolutely NOT to push until she got my nurse-midwife up there. I distinctly remember saying, “Tell her to RUN!” She got there quickly, checked me, and said the words I’d been longing to hear, “Go ahead and push!”

I pushed. Boy did I push. I wanted this labor OVER WITH. I wanted that baby OUT. Besides, it hurt a lot less when I was pushing then when I wasn’t. I heard the nurse-midwife call for a local. She said my perineum just wasn’t stretching quite enough. She made a little cut, I made another few pushes, and I felt that baby slide out. I had never felt that before. My previous VBAC had been with an epidural, and I’d had a c-section before that, so I had no idea that you could actually FEEL the baby slide out. Wow. He was born at 4:57am, just 17 minutes after my water broke!

They put him right on my stomach, whereupon my first words were, I believe, “I made a baby!”. They dried him off, but otherwise waited, per our request, for a couple minutes to cut the cord, and then we brought him right to my chest to nurse. At the same time, there was a flurry of activity around me, administering medications by injection in each leg, Pitocin to contract my uterus - I had actually YANKED my IV out of my hand while pushing, so first they were frantically trying to put a new one in while I was trying to hug my new baby - and stitching up the episiotomy. They were working furiously to prevent a hemorrhage, and, you know what? I had blood loss within normal limits! Spectacular!

They waited until I felt he was taking a break from nursing before weighing him. He came in at a healthy 8lbs., 3.5oz. Pink and strong. They gave him right back to me.

Just before we were ready to head up to the postpartum ward, they made me go pee. I had never been ambulatory right after giving birth before. This was all so new to me. I sat in a wheelchair (rather than lying on a bed) to go up to my room, and I got to hold the baby while we went up there. So cool.

My stay at the hospital was really good. The breastfeeding support was phenomenal. I was actually told that I should sleep with him skin-to-skin on my chest! I will be writing a separate blog post in more detail about the hospital, so I won't get into it too much here.

We went home the next day at noon. The baby did become jaundiced, but his numbers came down on their own, rather than his needing phototherapy like my first two had. I don’t know if the method of birth had anything to do with the jaundice or not.

The second day home was very hard. We were in the middle of a heatwave. It was 90 degrees, and I had no milk yet, just colostrum. The poor baby was so thirsty. I couldn’t unlatch him for two minutes without him screaming. My nipples were sore beyond belief. I was having horrible hot flashes, crying jags, the postpartum hormone surges. It was pretty awful. But I’m already feeling better. My milk came in Wednesday afternoon, and the change in the baby was incredible. He became so content!

Overall, I feel that the birth went just about as well as you could ask for. Only 4 hours of labor in the hospital? Wow!  Natural birth (even if it was kind of by accident), immediate and constant skin-to-skin. I got pretty much everything I wanted out of this birth. If we have another child in the future, G-d willing, another birth like this one would be just fine!