22 October 2011

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.


Female Relic said...

What a sad story un many ways my sweetness. I think the saddest is that I didn't really realise how down or depressed you were - and therefore couldn't/didn't help you!
I am so sorry about that.
For the rest, I know that you are tough and can/will always cope. That is our/your way. You will always be there when needed for your offspring.

Know that what you have done with your breastfeeding has been very important....but ultimately, if you couldn't give E another drop from the breast, does not make you any less a perfect mother! You have given your all and that is all that is asked of you. You cannot give what you do not have, whatever the (unimportant) reason may be, so please rest assured my beautiful girl that you are the tops in the lives of your parents.

We love you.

Beth said...

Oh the pursuit of that magic bullet... You have been doing the hard yards. The second night of your rooming in sounds truly desperate. Of course not being able to boost your supply for your beautiful earlybird must leave leave you feeling bereft, especially as he feeds beautifully :( I wish so much that we were nearer as I would happily pump for you.
It is great to have formula as an option, but the preparation must be gruelling. I'm wondering if there are dairy free options you might try (though you are probably already all over this). My only other idea, that you may have already done, is join (or begin) an online prem baby mums group. You know, with all that spare time you have ;)

I have been following that GGC blog too. And rest assured, her mother has been there for the first month - AND she's already done the baby thing twice before. But doing it double? I boggle too.

You have really been through the wringer, and it's so hard to reconcile the unanticipated difficulties with what you thought it all might be like. Feeding issues are traumatic because you just feel like it's down to you to fix what isn't working, but that can be so difficult. I did elimination diets to try and solve the feeding issues I had with Small Z, ironically a combo of dairy and oversupply (sorry). The first few months where all that is going on is just a warzone, with sparkles of wonder and many nights of soggy hankies. Hang in there. You're doing such a hard job, but it will get incrementally easier.
I don't know if mother-of-one-year-old milk is any good to you and how expensive couriers are...? You could put the word out via ABA forums to see if anyone closer would donate? Then you'd just be paying for transport...

beth said...

Am not using phone now, so could look at those links. That's an ace one - the mobi motherhood page - and they refer to my guru - Jack Newman.
Getting sidetracked - here is link to that formula I was thinking of - in case the reflux/wind things are dairy related...
(You may already be using dairy free and if so, IGNORE ME because I CAN'T SLEEP - which sucks as I get such little sleep as it is...yada yada yada...)

Keiran Lusk said...
This comment has been removed by the author.
little earth stories said...

Aw... overwhelmed by your lovely comments! :)

Thanks Female Relic for your heartfelt and reassuring words. A hard time but getting much easier. And I so appreciated my visiting domestic army! Much love. xxx

Beth - thank you so much for empathy and suggestions! I haven't yet tried a dairy-free formula as am a bit baffled by conflicting advice I've read on this. Also not yet convinced the wind etc is a reaction to milk/formula and not bottle induced. Sometimes it's not too bad which makes me wonder if it's just normal. Anyway, I plan to call the hospital's dietician for more advice on all this. As for donor milk... wow, what a totally lovely gesture! Though I'm sure you've got enough on your plate... I'll give the ABA forums a gander. There is a group for premmie parents that I never followed up but should do.

Anyway, thanks again for all this! Hope you've managed to find sleep.

austin said...

I am probably commenting way post these very stressful early moments. I was reflecting the other day how amazingly unprepared we, new mums are and how regardless, these new beings find their way to thrive. Looking at my now huge daughter, it is slightly incredible to remember the endless nights of screaming, the tininess, the fumbling ignorance that was only absolved by the fierce love I felt for this tiny mewling creature. Sending much love your way and sounds like you are now settling into a much smoother routine. What an extraordinary learning curve giving birth is!
I was incredibly impressed that you were heading off to life on an island (though I know it is a wondrous place and suited to to you all in so many ways). As I know how much I navigated those early months by the company of other mums and even though our situations were different (Rory was the only premmie in the group) - I somehow felt stronger and relieved to share so many issues with a group of new Mums.
Take care and big hug- Nat xx

little earth stories said...

Ah thanks Nat! Yes it is incredible how quickly he is growing - in the 95th percentile for weight + length so obviously thriving despite the early challenges. And I am too - also learning how to let go of the high ideals I had of being a mum and accept that 'good enough' is OK.

I have to say I do miss the company of other mums - though the internet is my daylight saviour, for research mostly but also sharing with other mums. And living where we live helps make up for it!

Anyway, it is great to look at Rory and know that Ellery will one day be a kid like her!


... oh and I've just realised the deleted comment is visible - this was me unintentionally commenting on a shared computer when K was signed into Google :/