Wednesday, May 18, 2011

Booby Traps

When I got pregnant, I knew I wanted to exclusively breastfeed my child. I cringed at the thought of formula-feeding--not just my baby, but any baby. I was an insta-advocate. I don't know why I was so convicted, or where I got the idea that formula was poison, or how I became such an advocate for breastfeeding, both in the personal and political sense. But I was, and am, and I armed myself with knowledge and support long before my daughter was born. I bought a copy of The Womanly Art of Breastfeeding and read it cover to cover during my pregnancy. I looked up my local La Leche League Group and began attending meetings even before my daughter was born. I chose a pediatric physicians' group that had a lactation consultant on staff, and I made sure I knew who the independent lactation consultants in the area were. I thought, as with preparing for an unmedicated childbirth, that if I were educated, I would be prepared to beat any challenges that presented themselves.

What I wasn't prepared for were the bruised and battered nipples that were a result of my daughter's narrow latch and vigorous suck. I wasn't prepared for breasts the size of cantaloupes, or the pain of carrying around cantaloupes in my bra, or the difficulty a baby might have latching on to cantaloupes, or cantaloupes that could spray milk two to three feet in every direction during letdown. I wasn't prepared for my milk to let down at random times and soak my shirt, such as when I heard other people's kids cry, I saw a sappy commercial on television, or I heard an ambulance siren, and I was less than thrilled to realize I would be wearing nursing pads in my bra for as long as I would continue nursing. I wasn’t prepared for the fever and chills that could accompany plugged ducts, the pain and swelling that signaled mastitis, or the daily breast maintenance that was required to avoid both of these.

As it turns out, I wasn’t prepared for a lot.

While my pregnancies may not have been pretty, I have been blessed with many things: easy labors, quick deliveries, and an overabundance of milk. I didn't realize just how abundant my milk supply was with my daughter, because I had no occasion to pump my milk on a regular basis, and never around the clock for any 24-hour period during the entire 26 months of our breastfeeding relationship. When our son was born five weeks early, he spent two weeks in the newborn special care unit, so I began pumping every three hours around the clock from the time he was born. The postpartum nurse was proud of me when I pumped a full ounce of colostrum three hours after delivery, but I cringed, remembering how difficult it had been to regulate my milk supply for Ella. And yet, I worried about not being able to pump enough milk for Benjamin, especially since we were separated and would only get to spend at most eight hours a day with each other, and not even with skin to skin contact. So, I dutifully pumped for 15-20 minutes every three hours around the clock. By the third day, I was bringing enough milk to the nurses that I had filled up two drawers in the hospital's freezer. When I came in the fourth day, the nurse told me I could start leaving what I was pumping at home, at home.

When I started feeling like I was carrying a ton of concrete in my bra engorged barely two hours after I last pumped, I started paying attention to exactly how much milk I was producing. Within ten minutes of pumping, I had ten ounces between both bottles. I started doing the math, and realized that if I was pumping eight times in 24 hours, 10 ounces each time, I was pumping 80 ounces of milk per day. I knew newborns didn't drink much and vaguely remembered the nurse showing me small balls that represented the size of their stomachs at one week, one month, and so on, but I didn't know what a "normal" amount of milk was. I did, however, know that I had more than whatever “normal” was. I immediately contacted the hospital's lactation consultants, who practically choked when I told them how much milk I was producing and how painful my breasts were. When I filled them in on some of the oversupply challenges I'd experienced with my daughter, they immediately suggested that I change my pumping routine, and that I begin drinking sage tea.

So, I started “pumping to comfort”--meaning, I tried to only pump for about 5-7 minutes, since in that time I was still producing at least 5-7 ounces, and since “comfort” being a relative term, I couldn’t gauge by that standard. And I started drinking sage tea. It’s like trying to enjoy a relaxing cup of chicken stock--only without the salt. Needless to say, it’s not the most palatable drink. Thankfully, I didn't mind the taste, especially as a sage-peppermint iced-tea sweetened with just a bit of honey, because I needed to drink about 8 cups of it a day in order to keep things under control. And if this time around was going to be similar to the last time, it would take 2-3 months before I could safely cut back, and then completely stop, drinking the tea.

When the doctors at the hospital finally gave the okay to bring Benjamin home, I was anxious about establishing our nursing routine. Everything I’d learned the first time about not using pacifiers or bottles until nursing was well established had to be revised, since in the newborn special care unit they don’t spoon- or dropper-feed breastfed babies, and since sometimes the paraphernalia required to keep the little ones alive and well restricted the ability to soothe and comfort them by touch, a pacifier was the only tool available to keep them calm. In addition, the lactation consultants at the hospital had recommended I use a nipple shield to help Benjamin latch, since he was so little and trying to nurse required so much energy. Everything was about energy--he couldn’t expend too much energy trying to eat or else he’d burn up all the calories he was taking in. 

I fully expected, given what I had learned with Ella, what I was learning from the hospital staff, and what I was experiencing with Benjamin, that I would be tethered to the pump for weeks. I worried about finding time to pump milk and nurse Benjamin while trying to also care for Ella. While I knew I had the determination to help Benjamin become a successfully exclusively nursing baby, I was exhausted just thinking about how long it might take and how frustrating it might be to get us to a place where we could just sit down together and nurse, when my breasts didn’t feel like rocks an hour after nursing or pumping, when I could just pack up the damn pump, throw away the nipple shield, and forget about the bottles altogether. I knew the day would come, but I assumed it would take weeks.

The funny thing about knowledge is this: no matter how much you know, there is always so much more to learn. And luckily, some things don’t even need to be learned. Because for everything I knew, my son knew better. Before he’d even been home two days, we had stopped using the nipple shield. Within four days, he was nursing at almost every feeding. By the end of the week, not only did I not need to pump, but my 36F cantaloupes had shrunk back down to a far more respectable and familiar size.

I keep learning again and again that when it comes to parenting, you can never really be prepared; knowing about the booby traps so that you will be equipped to avoid or deal with them is the best that you can do.

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