milk (and other catastrophies)

I have been wanting to write for so long now (writing as therapy etc) but have been utterly bereft of time. It is hard enough finding windows in the day to perform minimal personal hygiene, let alone reflect and document. Lord knows how some bloggers do it. Anyway, to catch up...

We brought E home from hospital on the second day of Spring, after three long and tres difficult nights rooming in at hospital*. K had only been back at work on the island for a day when the doctors suddenly declared, after several days of breastfeeding without tube feed top-ups during the day (babe was initially fed via naso-gastric tube as he was born before he learnt to suck), that babe was fit to go home. Naturally I was super excited, though with only 24 hours notice, barely managed to dash home between feeds and pack a bag for our hospital stay. The short notice meant K couldn't get back from the island to join us for our first night of rooming in. Which in the end was no drama as night one went really well. Thankfully he was there for the second night, which was, at best, traumatic. After a whole day and night on our own, without any tube feeds, E's hunger caught up with him by night two. By the wee hours, he was in such distress that the breastfeeding that had gone so well in the daytime in special care turned to mud. The special care nurse assigned to check in on us took one look at him and said 'that is a hungry baby'. I'd been doing everything possible to boost a low milk supply since his birth, however it was now clear I did not have nearly enough to feed him. After anguished hours, and hankies full of tears - and then some more - I gave him a bottle, thinking it would probably be the end of breastfeeding for us but at least he wouldn't go hungry nor be in such distress.

Reputable breastfeeding advice says that low milk supply is rare, that all babies fuss, especially at night. I knew this was different. His crazed hunger coincided with the withdrawal of regular tube feeds, and we had only been breastfeeding solidly during the daytime (mostly) without tube-feed top ups, for a few days. I was feeding or expressing eight times a day, had been on Domperidone and fenugreek for weeks, tried (and failed) using a supply line, and read and tried everything else: protein-loading, guzzling water and herbal nursing teas, massaging pressure points and trying failing to rest and keep stress at bay. I saw enough lactation consultants to qualify as one myself. Still, I only ever expressed a mournful milli-fraction of what might be considered in the orbit of normal.

In the end, I obsessed. The whole 'trying to find a solution' thing just depressed me, to the point of utter despair. I cried and sobbed and self-diagnosed PND, the whole experience being far more traumatic than the birth, and coming on top of an already stressful time. (Oh, and did I mention we were are also moving house?) I obsessed about how tragic it was, because he breastfeeds beautifully. And my god, how I loaded my body with goodness for him when I was pregnant. The supply issue was the icing on the cake of the whole baby thing not going at all how I had expected.

In the end I let go the pursuit of a magic bullet, for my own sanity, and accepted that we would have to formula feed in the main, while I continued my supply-boosting regime. I have accepted it, but still hate it. (Other than the obvious nutritional and wellbeing differences, formula and bottles are a lot of work, give him loads of wind, and combined with breastfeeding, are mind-bogglingly time consuming.) We did buy donor milk for a while, but at $80 a pop for 20 x 100ml bottles which may or may not be full, plus a car trip or courier from the Gold Coast, probably won't continue with this. Anyway. I am grateful that my initial fears with the first bottle have not eventuated and we have been able to continue to breastfeed, even if it constitutes a small part (volume wise) of his feeds.

There has been much agonising over why, why, why. My GP reckons my body wasn't ready. My midwife reckons that's crap, though I noticed that many first-time mums in special care seemed to struggle with supply. But then others didn't. I think it's a combination of his very early arrival, blood loss at the birth, and a possible predisposition to low supply. Perhaps my body was not ready. I had not laid down any breastfeeding fat stores during pregnancy - I was possibly skinnier immediately after the birth than before I was pregnant (it annoys me when people get jealous of this because I would be happily fat to properly breastfeed). I could also be a candidate for the confidence bustingly named (excuse the pun) 'insufficient glandular tissue'. I think the early separation played a large part... it's tempting to wonder how things would have gone if I'd got to hold him after the birth, if he wasn't stuffed away in an isolette for those first weeks, if I'd been able to feed him round the clock when he first learnt, at around 34 weeks, to suck. Also, no one suggested I start expressing until at least 12 or more hours after he was born, and then the interruptions on the maternity ward meant this was nigh impossible. Anyway, a girl could go spare wondering...

As for the depression, it has all but abated. In fact I have not followed up on a referral to an antenatal psychologist - partly due to the logistical issues of living between the city and the island, and partly because I've cleared the worst of it. OK, and partly because I'm not a talker. I'm keeping a watching brief. I recently ran into an old work colleague who now has two babes - both born about a month early - and it was so good to briefly talk to someone who has had a baby in neonatal care. Because I have felt somehow an unequal member of the mummy club. All of the preparations you do, all the things other mums tell you when you're pregnant about having a newborn relate to having a full-term baby. None of this really held true for us. It's a totally different road, one we've walked with the guidance of nurses and Google searches. Apart from a few couples in hospital we gelled with, we haven't really had that peer support, I guess.

Anyway, life evolves, and I've realised it's not the worst thing that could happen. We are more preoccupied now with wind and reflux (if I can be so bold as to call it that), and when those nasties abate, enjoying E becoming more alert and interested in the world. Let it be said, I am completely over the politics of breastfeeding. And moving on...

*Stupidly, after choosing to spend two nights instead of one rooming in, we were made to spend a third night after E lost 40 grams between discharge from special care and our planned day of departure from hospital. Bitter, much. The third night is now just a blur and I think they would have discharged us regardless of any further small weight loss as they belatedly gave in to the realisation that the environment was not doing us any favours.