It seems appropriate that on Martin Luther King Jr. Day, I was reflecting on love and nonviolence. Dr. King did, after all, reshape an entire country nonviolently because of his love for his fellow human beings and the tragedy of segregation that separated us and limited our ability to fully love one another as people.
I mentioned previously that I intend to start reading Nonviolent Communication by Marshall Rosenberg. To be honest, getting through the first few pages was a real struggle. When I read his words, I found myself thinking, “What about me? What about my needs? I’m not a doormat.” There were several times that I put the book down and just walked away after reading only a few paragraphs.
As I progressed (slowly) through the chapter though, my thoughts evolved from, “What about me?” to “Hmm, so I can use this to get people to do what I want?” And then I felt horrible because, really, doesn’t that seem pretty manipulative? And that’s not who I am at all.
But I stuck it out. As I got to the end of the chapter, the puzzle pieces began to fall into place and I realized what I am getting myself into. This isn’t a book to learn a different way of talking so you can move through life more easily. This is a complete shift in how you think, feel, and respond to others. This book isn’t about dealing with other people. It’s about inner change.
To be honest, that scares me a little. I don’t want to lose who I am. In a lot of ways, I am a fighter. I’ve got a stubborn spirit, and I believe in standing up for what’s right even if that means ruffling some feathers. But then I think of my friend Paris who stands up for what’s right every single day and who inspired me to learn more about this whole nonviolent communication thing, and I go back to the quote I posted the other day from Dr. King:
Returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars… Hate cannot drive out hate: only love can do that.
Paris truly loves the people around her. She surrounds herself with love. She doesn’t do it to get people around her to change. She just truly and honestly loves her fellow people. She manifests that love by reaching out and empowering other women to nurse their babies. Yes, really.
Look at it this way, what is a more basic act of love than nourishing a baby at the breast? When you do that, you are flooded with love hormones. It’s hard to be angry while you are nursing. And that place of love is where Paris builds a sisterhood. We are all sisters in motherhood. We all go share so many experiences. And there is a tremendous power to change the world when so many loving women come together. We gave birth to our babies. We feed them with our bodies. We are physical manifestations of the divine. We certainly can change the world with our love.
I am so grateful to count Paris among my friends. It is people like Paris and Dr. King and Gandhi and others who shape anger into love and create peaceful and lasting change.
Here is a link to a fantastic post from Mamas at Work. Cynthia worked hard to research these letters for a friend of hers who was struggling with finding a place to pump at work. The letters included here are fantastic and could help any mom who needs help talking to her employer about finding space to pump at work. She also included a letter for childcare facilities that goes into detail about breastmilk and the USDA food program and babies older than 12 months.
At the time this post publishes, I will be sitting down with Scott Elster, Prolacta CEO, and Susan Neumann, Prolacta VP of Milk Procurement to talk to them about what caused me to write Prolacta, For-Profit Milk Banks, and Predatory PR Tactics, an article detailing my encounter with a Prolacta public relations representative.
I am pleased at the opportunity to meet directly with Scott and Susan. I hope this meeting turns out to be the opportunity I believe it can be to help Prolacta improve their transparency and make positive changes to their business practices.
Here are the points I am presenting to Scott and Susan during our meeting. I look forward to the conversation that these points will spark.
Choosing a name other than “milk bank” for your milk collection agencies is absolutely necessary. These are collection agencies and referring to them as banks is confusing and misleading. Banks retain milk, process it, store it, and ultimately distribute it. These agencies simply collect the milk and pass it along to you.
Find a new way to refer to milk given to your company. “Donations” are something given to a non-profit, not a business. Using the language of charity confuses people.
State very clearly on the front page of each and every collection agency website that you are a for-profit company, not a non-profit milk bank. This should be found on the front page and in the pages describing what happens to the milk once it is shipped out. As an alternative, eliminate the middle-man milk collection agencies and collect milk under your own name.
Create a concrete set of communication guidelines to ensure that all employees and contractors know how to engage with the public in an open and transparent way. Ensure that this is communicated cross-functionally, including (and especially) to third party public relations firms and to your milk collection agencies.
Make it very clear on your website and on your milk collection agencies’ websites that you have a partnership with Abbott. This should also appear both on the front page and continue to appear in the FAQ and on the front pages and FAQs of your associated milk collection agencies.
Increase transparency surrounding your Ready to Feed line of products and ensure your FAQ and associated information pages has complete information on this, particularly with regard to the competition with HMBANA banks section.
I hope to come back to you with real and concrete actions that Prolacta is willing to commit to. They have invested time and effort in this meeting and I hope that they do not squander this by turning it into a simple PR stunt. I hope that they come away from our meeting with a deeper understanding of the impact their lack of transparency has on so many mothers, and I hope they turn that understanding into meaningful change.
I finally have to admit to myself that Katie is a toddler. She’s walking, starting to talk, getting more and more active, and starting to lose her baby rolls and chub. I’ve been mourning this quite a bit. She is my last baby, and while it’s amazing to see her grow, I have a lot of nostalgia for the cuddly baby stage.
These days, cuddles are short and to the point. So is nursing for that matter. Sometimes. And then sometimes nursing takes hours and hours.
That’s right. We’ve entered the land of…
Anyone who has practiced full-term breastfeeding (also known as extended breastfeeding) is going to be able to empathize with me on this.
Toddler nursing can be exasperating. Now is when the acrobatics start. They nurse standing up, upside down, standing on one foot while balance on your leg (Katie’s personal favorite). They latch on and off as people walk past and daily activity happens around them. Can you blame them? The world is interesting!
They’ve learned to verbally (or with sign language) ask to nurse* and, like any new exciting skill, they like to practice. A lot. This means that they seem to constantly ask to nurse.
They are also learning to control their environments, which means that some babies (Katie) may take to trying to open the shirt themselves. Often in public. Or in front of your male boss.
It is absolutely okay to teach nursing manners. In fact, it is critical to do so at this time. Teaching baby to show respect and kindness to Mama helps them to learn respect and kindness for themselves and others. For shirt opening, I immediately either put her down or pass her to Juan. Consistency is key. She is gradually getting better.
Between the ages of 15 and 20 months, they seem to nurse like newborns! Round the clock! This is because they are in the middle of growth spurts, teething, and learning that they are independant people. Is it any wonder they need to come back to Mama so much for reassurance?
“I want to run and play, but I need to make sure you will still be here Mommy. You’re still here, right? That was a fun slide! Wait! Where’s Mommy? Oh, thank goodness. There you are! I still need you, Mommy. Don’t leave without me.”
Toddler nursing is just as wonderful as it is wild. Finally, they can thank us and show appreciation for our hard work. A kiss on the cheek, clapping, words of thanks, and hugs are just a few of the ways toddlers show us that they love us. Those bedtime nursings are still the soft quiet times that they were in the beginning. We still get to watch those big eyes slowly close in sleep. The magic is still there.
Like everything else, toddler nursing is a stage. The hard parts and easy parts and parts that you want to remember forever.
We are in the autumn of our breastfeeding relationship now, and every cuddle and every nursing is precious and fleeting.
*Let me be very clear for the “When they can ask for it, it’s time to stop” crowd: Babies ask to nurse from the moment they are born. We just don’t always understand their language. Believing that they should stop nursing when they finally learn our language is like telling an adult that he can’t have sushi anymore because he learned Japanese.
Recently, a friend of mine forwarded me an email she received from Enfamil. Now let me be clear: This friend is a breastfeeding mom. She’s never purchased formula. She’s never signed up to receive emails from formula companies. She’s never received any emails before now.
Here’s what appeared in her inbox:
There is so much wrong with this email that it’s hard to know where to start. It is so carefully crafted and timed so precisely to drive women away from breastfeeding and onto formula. Let’s break it down piece-by-piece.
Perhaps you’re getting closet to a time when you’ll be going back to work. Or maybe you’re doing a bit more outside the house these days – like getting some exercise or running a few errands.
As carefully timed as this email is, it likely will coincide with a mom returning to work. The US has pitiful provisions for maternity leave, so many moms have to go back to work at around six weeks. Additionally, by this time, many moms have reached a point in their postpartum recovery that they would be feeling self-conscious about the way their bodies have changed post-baby. They may feel like they want to get out more and more.
They go on to say,
This could be a good time to supplement with Enfamil. Supplementing gives you added flexibility and also allows other family members or caregivers to feed the baby when you’re not there.
Let me just stop you right there, Enfamil. Breastfeeding does not shackle you to the couch. It doesn’t prevent you from exercising. It doesn’t prevent you from returning to work.
Here’s the thing that’s weird about this. They talk about all of this needed flexibility. So why don’t they mention breast pumps? Not one single mention of expressing milk. No mention of breastfeeding in public which most of us do on a regular basis, either. Remember folks. This wasn’t an email targeted to a bottle-feeding mom. This wasn’t an email targeted to a mom who reached out asking for this information. This was targeted at a breastfeeding mother who, at seven weeks, has an established breastfeeding relationship.
Let’s read a little further in this email.
[Blah blah blah, Enfamil is so great and awesome.] Thinking of a time when you’ll switch to formula entirely? Check out our tips for weaning your baby.
Notice the wording here. They don’t say, “Thinking of switching to formula entirely?” They don’t say, “Are you thinking you might switch to formula entirely?”
Thinking of a time when you’ll switch to formula entirely.
When you will switch to formula entirely. Will. Not might. Not thinking of. Will. As if this is the regular course of action. As if it’s what’s done. You nurse for six weeks, supplement a bit longer and eventually wean entirely over to formula. It’s normal. It’s what everyone does. Why wouldn’t you? It’s not like there are no alternatives, right?
Alternatives like maybe breast pumps. Hand expression. Nursing in public. Federal laws protecting mothers’ right to express milk during the work day.
They go on to provide some very “helpful” links. Here’s what they have to say about supplementing.
The very top section says,
If you’re weighing the decision to supplement your baby’s diet with formula – for extra nutrition, back-to-work flexibility, or to give dad and other caregivers a hand in feeding…
Excuse me? Extra nutrition? Is Enfamil really going there? Let me be very clear. Breastmilk is the perfect food for a baby. No extra nutrition required, thankyouverymuch.
But good on Enfamil for preying on a mom who might be feeling stressed and inadequate if she didn’t know that the six-week growth spurt was coming. When that baby nurses and nurses all day long, plenty of moms think their milk is drying up. Unless they’ve got a good support network built, they may not realize that this is completely normal infant behavior that only lasts a week. Remember what I said earlier about how carefully timed this email is?
She may also not realize that bottles of breastmilk don’t need to have more than a few ounces. She may be using the common formula method for calculating bottle size instead of just figuring on 1 ounce of milk per hour. She may be fresh back to work and looking at the huge 6 oz bottles that formula fed babies are getting and feeling like she can’t produce enough milk to feed her baby. Extra nutrition indeed. Well played, Enfamil.
Also, let’s not forget, breast pumps are available and, while not cheap, they’re far less expensive than formula. Only the briefest mention of that here, though, and only as a stepping stone to prepare a baby to receive formula.
We read several times in this article how Enfamil’s formula is “patterend after breastmilk.” They emphasize how “low” breastmilk is in Vitamin D (Uh, really?) and how great the DHA and ARA in formula are. There is so much wrong with this page that it’s hard to know where to start.
Let’s also have a peek at Enfamil’s kind-hearted tips for weaning your child entirely onto formula.
Again, it starts bad right at the top:
1. Know when to say wean. Sometimes babies lose interest in breastfeeding on their own when things like walking steal their interest.
Okay, really? They say walking could steal their interest, but right around this time, many babies realize they’re no longer inside Mama’s womb. They become interested in the world around them. Then at four months, BAM! Distractibility hits. This is biologically normal. Every baby does this. It’s simply part of the natural course of breastfeeding. This doesn’t mean a baby is weaning.
In the policy statement, “Breastfeeding and the Use of Human Milk,” published in the March 2012 issue of Pediatrics (published online Feb. 27), the American Academy of Pediatrics (AAP) reaffirms its recommendation of exclusive breastfeeding for about the first six months of a baby’s life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.
Let me be very clear. Formula is not poison. Formula can be a medical necessity and a life-saver. Moms who feed formula are not bad moms. Gabi required formula supplementation during the first few weeks of her life because of the side effects of pitocin I received during labor and lack of breastfeeding support available to us. This post is not about that.
This post is about a company that is using half-truths, misinformation, and predatory tactics to market its product at the cost of the health of babies and mamas. This is unacceptable.
Stop it Enfamil. Stop preying on the insecurities of breastfeeding moms. Stop. Right now. Stop with your “breastfeeding support” emails, hotlines, and websites. Stop trying to get into the middle of the relationships we have built with our babies. Stop lining your CEO’s wallets at the cost of our children’s health. Stop putting the almighty dollar over the well-being of our babies. Stop right now.
We don’t want what you’re selling.
Update: This post has gotten way more of a response than I expected. I’m not the only one mad about this. Please take a moment to tell Enfamil to stop this kind of marketing. Tell them on their facebook page or tweet at them using #stopitenfamil as your hashtag. Call them. Email them. Make your voice heard!
I think it’s finally time to admit to myself that I’m having an issue with plugged ducts. A plugged duct is when one of the milk ducts becomes blocked and milk can’t exit the breast. A hard, painful lump can form as the milk backs up. If the milk isn’t removed, a plug has the potential to develop into mastitis, which is an infection of the breast. Think fever, chills, nausea, etc. Plugged ducts are not fun.
I’ve had six instances of plugged ducts in the last month and a half, which is more than I had the entire three and a half years of nursing Gabi. Twice now, the plugs have been especially exciting because I’ve gotten a bleb along with them. A bleb is a hardened bit of milk that forms a blister right at the nipple. Once, I got a mild case of mastitis and ended up missing work because of it. Obviously, there’s something going on.
I brought it up the last La Leche League meeting, and I got some great help. We really thought together about what kinds of things I notice before a plug occurs. Here’s what I came up with. My plugged ducts coincide with:
Juan travelling for work
Eating fast food
Especially wakeful periods for Katie
Missed pumping sessions at work
Feelings of stress, anger, and disconnect
Allowing Katie to roll her lips in for a lazy latch
Priority number one with all of this is to clear the plug and remove the milk. Easier said than done. My old stand-by trick is to lay the baby on her back on bed, turn myself around so that her chin points at the plug, and nurse over her so that her suction and gravity can clear the plug. Trouble is, that hasn’t worked the last two times. The resulting let-downs from the nursing just seemed to make the plug worse.
At this point, hand expression seems to work best. I express most of the milk out (or have her nurse for a while). Then I start hand expressing very gently over the area. If you don’t know how to hand express, here’s a YouTube video. This is an incredibly valuable skill.
Once I get to the point where I can look really closely and see the pore that is clogged (I typically see a bit of white that just isn’t coming out), I gently squeeze on the nipple to work that bit out. A warm wet washcloth or even getting into a warm bath really helps with this. Typically, that bit will come out with a POW! and I’ll be able to very easily hand express the backed up milk out. Massaging at the front of the plug, instead of trying to push it from the back), can also help loosen things up and get it moving.
If you have a clog that you just can’t get out, get help! Find a lactation consultant. Ask for help from (dare I say?) your husband. Don’t let it sit around. Having a plug long-term is not only really painful, but it can lead to mastitis.
At this point, I’ve got my plug clearing routine down. But how do I keep from getting them in the first place?
Here’s what I’m doing to try to prevent plugs from forming:
Removing milk often (as in, no more skipping pumping sessions)
Taking a few minutes each day to relax and have some time for myself
So far, this seems to be helping, but I think to a certain extent, the occasional plug may just be part of my landscape right now with my oversupply. I’m okay with it happening once every few months, but I’m looking forward to a few plug-free weeks.
Here are some more resources that I found on plugged ducts.
I mentioned in my post about maintaining my stash that I have seen both sides of the supply coin. With Gabi, I struggled to keep up my supply. Now with Katie I have an oversupply. My friend over at gratimood (check her out, she’s a fantastic writer), emailed me and asked me how I keep up my supply while I work.
I remember when I had to go back to work with Gabi. I had so many questions as a first time mom, but my biggest concern was this: How much milk would she need and how would I keep up? She was a pretty big baby after all. How could I pump enough milk?
Imagine my joy when I learned that breast milk isn’t based on Baby’s age and weight! Not even a little bit! The breast milk grows and changes with your baby, so you don’t increase the volume over time like you need to do when feeding breast milk substitutes. So forget those complicated weight-based formulas. Let them leave your mind forever like lost kites in the wind.
Replace that idea with this:
Breastfed babies take in, on average, 25 oz per day. That’s roughly 1 oz per hour. So all you need to do is figure out how many hours you will be away from your baby at daycare, and that’s how many ounces you send! I kid you not. It really is that simple. For more help with this, check out this article from Kellymom.com that includes a nifty milk calculator: http://www.kellymom.com/bf/pumping/milkcalc.html. The idea is this: Baby’s stomach is small. Big bottles (over 4 oz) stretch out the stomach. Smaller, more frequent bottles are better.
Here’s how that played out with Gabi: She was in daycare from 7:30 AM to 5:30 PM. That’s about 10 hours. I would send three 3 oz bottles and then I would feed her when I picked her up at the school at 5:30. I only needed to get 9 oz. So when I pumped for her, I would typically get 4 oz at the first pumping session, 3 oz at the lunchtime session, and 2 oz in the afternoon. Those 9 oz were enough for her at school and whatever she didn’t get at school she would make up for at home.
Here’s how it’s playing out with Katie: She is also at school from 7:30 AM to 5:30 PM. With her, though, I am able to go at lunchtime to nurse her, and she wakes often in the night. I nurse her at around 6:30 AM, pump at 9:00 AM (she takes about 1 oz at school at the same time), nurse her at 11 AM, pump at 3 PM (she takes 3-4 oz at school around this time), and nurse her again at school at 5:15 PM or so. So I don’t need that much milk for Katie at school either. Just 5 oz each day.
That said, I remember with Gabi that it was a real struggle to get those 9 ounces. We had some pretty serious nursing issues during the first few weeks and she was not able to set up my supply early on. This is why it’s so, so critical to bring baby to breast as often as possible during the early weeks. Do not space out feeding. A newborn eating every hour is letting your body know that it’s time to produce milk. If you let your baby nurse as often as he or she wants, you’re setting yourself up to have great supply later on.
This brings up another important point: What you pump is absolutely not an indicator of what your supply is. I pump a lot of milk these days. I’m not going to tell you how much. It’s completely abnormal. Instead, please read this article about what is normal: http://www.kellymom.com/bf/pumping/pumping_decrease.html#normal
Pumping is a funny thing. With Gabi, I struggled and struggled to pump enough. I know that if I could have been with her and allowed her to just nurse, I would have had zero supply issues, but when it came down to it, I just didn’t respond all that well to the pump. Totally normal.
But still,I needed to get those 9 ounces for her for daycare. So here are some things that I did:
Drank Mother’s Milk Tea every morning instead of my regular green tea. But really, don’t rely on tea alone if you’re dealing with pumping supply. You’d have to drink gallons of it to really have that strong of an effect.
Took herbal supplements. Sometimes I did a combo of Fenugreek and Blessed Thistle (3 tablets of each 3x/day), and sometimes when I was feeling extravagant, I took the MotherLove herbal More Milk Special blend. I found the Goat’s Rue to be very helpful. The tincture seemed to work better than the pill.
Took a Calcium/Magnesium supplement from the day I ovulated until a few days after my period started. I got my period back with Gabi early on, and something they don’t tell you is that getting your period can cause a supply dip between ovulation and when your period starts due to calcium loss. The Cal/Mag helps with that.
Never, ever skip a pumping session. Milk production is supply and demand. Skipping sessions gave me more milk the next session, but much, much less milk the next day. The short-term gain was absolutely not worth the long-term loss.
All of those things really seemed to help.
Below are a few more tips that I compiled for the corporate lactation program that I helped to found within my company. I’m cross-publishing here because I and other moms within the corporate support group have found them to be pretty tried and true.
Pumping Quick Tips
Come up with a pumping plan(when, where, what you do, etc.) and stick to it. Set your times in your outlook calendar so you won’t get too busy and forget to go pump.
Pump at around the same timethat your baby would be nursing or taking a bottle.
Pump for a full 15-20 minutes even if no milk is flowing. Remember, milk is a supply and demand system. You have to demand it so that it will be there for the next time. Please be aware that pumping for longer than 20 minutes at a time can cause breast tissue damage.
Typical output is 2-3 oz, so if you aren’t getting 8 oz like some people talk about, don’t worry! It’s normal! Those 8 oz ladies just respond really, really well to the pump.
Feed only what you can pump. Remember, it doesn’t take as much breast milk as formula, so don’t let a formula fed baby’s 6 oz bottle make you feel inadequate. Breast milk grows with your baby, so you don’t need to increase your bottle size. 1 oz per hour is the rule of thumb, so if you’re away for 9 hours, three 3 oz bottles should cover you!
RELAX! Kick back, read a good book, don’t try too hard to multi-task if you find it interferes with the flow. Just take the time to relax and think about your baby.
Keep up with your pump maintenance. Medela users, don’t forget to change those white membranes regularly. I change mine every 10 days.
Don’t shake the milk! Mix the fat back into the milk by swirling it gently and warming it. Human milk is full of live white blood cells that carry your immunity to your baby. Shaking the milk breaks those cells open and “bruises” the milk. It’s precious gold. Treat it with respect.
Use slow flow bottle nipples. A breastfed child never needs a faster flow than a newborn nipple. Slow flow, wide mouth nipples more closely mimic the flow from the breast.
Go hands free! Using an Easy Expressions Bustier or a homemade hands-free system gives you the flexibility to do other things while you’re pumping.
Do you have any tried and true tips that help you pump?
With everything that Katie and I have been through so far on our nursing journey, I’ve been thinking about what all we (and by we I don’t mean me, I mean society) ask of breastfeeding moms. This particular line of thought was sparked by a conversation with a cranial osteopath who was seeing Katie to help her with her jaw muscles. He grilled me a bit about my diet, and I felt ashamed to tell him that I’m just so thrilled about being able to eat again that I am just eating whatever I can get my hands on. Lots of meat, cheese, spices, Indian food, Thai food, Mexican, etc. I was embarrassed to admit that we don’t always eat home cooked meals. In fact, we eat out fairly frequently.
This confession of mine predictably earned me a lecture on healthy eating. I should eat only organic food. Whole grains. Home cooked. Gluten free. And while I’m at it, I should stop eating dairy and soy because that’s probably why Katie has a stuffy nose. What I eat goes directly to her, didn’t I know, so I must avoid foods with chemicals of any kind and by the way, I should only eat brown rice, not white rice. Scratch that, don’t eat rice at all because of the gluten in it.
I left the appointment feeling guilty, overwhelmed, and exhausted. The more I thought about his speech to me, though, the more irritated I got. Aside from any rare allergy issues in kids (where there are specific clinical signs) milk is milk. Milk is not made from stomach contents. You don’t go to the drive through and then have cheeseburgers coming out of your nipples. Milk is made from blood. Unless the situation is one of extreme famine, a mother’s milk will always be rich enough, nutritious enough, and wonderful enough.
I kept turning this over and over in my head and getting madder. If I was another woman, one who wasn’t as plugged in to breastfeeding resources, I might have walked away from that conversation believing that since I couldn’t live up to this doctor’s impossibly high standards, my child would be better off on formula.
I experienced this kind of situation again following Katie’s tongue tie clip. First I had to get her clipped by a very specific doctor out in L.A. Then I was supposed to see a very specific lactation consultant (also in L.A.) to retrain her to latch. On top of that, I needed to get her in to see a cranial osteopath to get her jaw muscles working properly. Follow that up by special exercises and speech therapy, and you’ve got one seriously overwhelmed mama. How many specialists do I need to take my kid to? Can’t we just nurse?
Confession: I took her to LA for the clip, but I stuck with local lactation consultants to help with the latch. I only saw the cranial osteopath three times instead of the recommended five visits because darn it, it’s expensive and I don’t really dig it anyway. I haven’t been doing the exercises very religiously. We probably won’t do speech therapy at all unless we find out that she actually has a speech issue. Her sister didn’t. Her father and I didn’t. If she does, we’ll deal with it, but I’m not prepared to assume that she will.
Want to know something else? I eat fast food sometimes. Sometimes I even feed my family fast food. I don’t always cook. I do my best, but some nights, it just doesn’t happen. I take ibuprofen when I have a headache. And I cook with butter. So there.
There is so much pressure for breastfeeding moms to be perfect. Setting the bar so high (organic food, expensive doctor visits, no medicines, no wine, etc.) can ultimately drive women away from breastfeeding, and it’s critical that we not do that.
So nursing moms–all moms for that matter–Be good to yourselves. You’re not perfect and that’s okay.
When we left off last time, Katie and I were nursing better, but something still wasn’t working quite right.
Sheila (she gave me permission to use her real name), the IBCLC I had been working with, was puzzled. What we were seeing mimicked a tongue tie: the slower growth, the loss of suction, the odd shaping of my nipple after a feed… But Katie could very clearly stick her tongue out. What was going on?
She referred me to the director of breastfeeding medicine at one of our local hospitals: a pediatrician and an IBCLC all rolled into one. unfortunately, she wouldn’t be able to get me in for another two weeks. If there was a tongue tie, I needed to get it corrected immediately.
I called her pediatrician back. Her regular pediatrician was in Africa providing medical care to orphans. His partner, who happened to also be a lactation specialist, could see us that day.
Again, poor Katie had to deal with people poking around in her mouth. And again, we were told that there was no tongue tie.
That night, on my twitter feed, I happened to see some tweets regarding tongue tie that were a part of an #LCchat. One in particular stood out to me:
I often see sucking blisters on lips with both posterior tongue-tie and lip-tie, and/or lips are blanched after feeding. #LCchat
This was what was going on! I tweeted back to @NurturedChild and she sent me this link with pictures of the much more difficult to diagnose posterior tongue tie. This, especially the cupped tongue when she cried, really helped solidify my belief that we were dealing with a tongue tie. I just had to find a medical professional who would really listen and take my concerns seriously.
I called Sheila back and explained the situation. She told me that she had previously encountered one other really difficult case like this. She had referred this case to the breastfeeding medicine doctor who, in turn, referred them to an oral therapist who then referred them to a surgeon to get the tie clipped.
What if we skipped the middle man and went straight to the oral specialist?
That’s exactly what we did. She was able to see us the very next day, which was a Saturday.
This is what she saw:
She very quickly agreed that the tongue was certainly tied. The posterior tie meant that she couldn’t life the back of her tongue to squeeze milk out of the breast. Instead of using her entire tongue to nurse, she was using the front of her tongue and her gums to scrape the milk out.
That explains the pain! It also explains why she was breaking suction. She couldn’t lift her tongue to maintain suction. She was having to break suction in order to swallow the milk and control the flow.
But there was more:
The ties on the lips were also interfering with nursing.
When a baby nurses correctly, her lips should be flared out in almost a trumpet shape. Katie couldn’t flare her lips out because of the ties. This added to the chewing action that she was having to use to get milk.
No wonder I was in pain! No wonder she was struggling to latch and nurse properly!
So what do we do now?
We get the tongue ties clipped, that’s what.
Stay tuned for Breastfeeding the Second Child Part 3: Tongue Tie Clip and Recovery.
I thought it would be so easy. I mean, it’s not like I haven’t nursed a baby before, right? Three and a half years of nursing should make me an old pro, right?
This journey, while not quite as difficult as it was learning to breastfeed Gabi, has been incredibly difficult.
Katie latched on almost immediately after birth. It was fantastic. I thought we had it made. But by day three, the pain was starting to get intense. Note that I said “pain” and not discomfort. Breastfeeding shouldn’t be painful, but this was.
She was born on Tuesday, and we took her to see her pediatrician on Friday. He checked her for a tongue tie, but didn’t see one. He encouraged us to meet with an IBCLC, Rhonda (not her real name). We called her and scheduled an in-home visit. Good thing, too, because by the afternoon I was in tears every time she latched.
She came and helped us to latch correctly. Things got better for a few hours, but in the night it got much worse. By morning, I was a bleeding, crying mess.
Saturday, I called her in tears because I was reaching the point where I just could hardly stand to bring her to breast anymore. She recommended pumping and syringe feeding until my nipples healed. I did not want to do that, so I called my midwife who came right out to the house and helped me learn a new position to nurse Katie in.
I still wasn’t healing, though, and the pain and bleeding were getting worse.
Monday, I went to a group meeting that Rhonda leads. She helped me latch on there as well, but the meeting made me very uncomfortable. Believe me, when you’re a deeply attached parent, hearing other parents talk about night weaning 5 month old babies through is not something you need to hear at 6 days post-partum. Most of my tears were from the pain of nursing, but some were from grief for those poor babies who just needed their mommies at night.
Monday night, I went to a second meeting, where I met two angels: Shirley (not her real name) and Paris (this is her real name and here is her awesome blog!). Both are IBCLCs for one of the hospitals here (NOT the hospital where they tortured me). Paris taught me a 3rd way to nurse Katie, and it didn’t hurt!
Unfortunately, by the time I left the meeting at around 7:30 PM, I was shaking. As I drove home, the shaking got worse and worse. When I got home, I took my temp and it was 102 degrees.
Juan ran to the pharmacy to get my antibiotics (God bless my midwives for acting fast and calling it in immediately), and I had to pump after every feeding so that the milk didn’t sit and grow bacteria. It was a long, brutal night.
36 hours later, I was feeling much better.
It was Thursday, and we had an appointment to meet with Shirley. She helped us again with Katie’s latch and taught me to tuck her little hips in against my body. This is a natural way to get a baby to extend her neck a little more and to keep her from tucking her chin. It worked!
But I had a suspicious tingle in my nipples and Katie’s mouth was coated in white. We walked a block over to the pediatrician who took one look at her and diagnosed thrush. I asked him to look in her mouth again for a tongue tie, but he very confidently said, “This babe is definitely not tongue tied.”
So after a week of Katie taking Nystatin and me taking Diflucan, we were ready to move forward.
But something still wasn’t right. She was growing slowly and her lips were blanched after every feeding and full of blisters. She also clicked and lost suction as she nursed. Nursing wasn’t bringing me to tears anymore, but it wasn’t very much fun either.
What was going on?
Stay tuned for Breastfeeding the Second Child Part 2: Tongue Tied or Not?