February 9, 2017

A (Not So Successful) Breastfeeding Journey

Forgive me in advance as this is a lengthy post. I didn’t realize how much I had to say, and how traumatic the experience was until I started writing it all down. I share this in hopes that others who experienced the same will realize they are not alone.

I also need and want to give a really big thank you to Shiraz who was there by my side and supported me every single step of the way through this journey, and continues to do so today.

TO BREASTFEED OR NOT, THAT IS THE QUESTION

Prior to getting pregnant I never really gave any thought as to whether babies were fed via breastfeeding or formula. I felt (and still do feel) that how a parent feeds their newborn is not my business. As long as the baby is fed that’s all that matters. For the first few months after that positive pregnancy test I continued to live in ignorance and not think about this subject. However, as the pregnancy progressed and we started prepping his nursery, buying all the adorable baby clothes, and thinking about what else we would need for those first few months of his life, the subject of breastfeeding vs. formula become unavoidable.

Shiraz expressed that he would like me to at least try to breastfeed (because he wanted the baby to receive the immunity that comes with breastmilk) and my mother gave her two cents in the form of “so you are going to breastfeed, right?”.  While I was not enthusiastic about the idea of a baby attached to my breast, being the baby’s only source of food, and the potential difficulties around making it work, I had read all the literature about the positive benefits of breastmilk so I committed to at least trying (plus breastfeeding is the cheaper option). When we checked into the hospital we reaffirmed this intent.

THE FIRST 48 HOURS

Immediately after Kian was born and they had cleaned him up they handed him to me and we did the first latch. While the sensation was weird I wouldn’t describe it as painful or uncomfortable. He ate for only a few minutes and then immediately drifted off to sleep. Over the next 24 hours he spent most of the time sleeping and periodically nursing for that little bit of colostrum. As the day progressed I became more and more uncomfortable with the breastfeeding. He wasn’t staying latched, I couldn’t get the proper positioning/hold, and it started to become painful. I was reassured that this was all normal and that we would eventually find our rhythm. In the meantime, until my milk started coming in, I would need to keep at it as even just letting him suckle would stimulate the milk. Since newborns don’t need much to eat in that first 24 hours we managed to make it through the first 24 hours. And then everything went to hell.

Because babies do nothing but sleep that first 24 hours you get lulled into this false sense of “oh hey this won’t be too hard” (on a side note I highly recommend you don’t let any visitors come that first 24 hours so that you can rest, I wish we had done this). At about 36 hours of life our angelic newborn suddenly woke up and would not stop crying for food. For approximately 9 hours he cluster-fed. He’d nurse for 10-15 minutes, then be ok for 15-30 minutes, and then would start wailing for more. By about the 3rd hour of this my nipples had started to feel dry and chapped. By the 5th hour every time he latched on it would send sharp shooting pains up through my chest that I would have to fight through for the first couple of minutes. By the 7th hour I was at my breaking point and cried, a lot. By the 9th hour I was pretty much going crazy, not able to understand what was going wrong, and wishing the nurses would just take him out of the room for a little while so I could sleep (at that point I think I had only slept 4-5 hours over a 72 hour period, including labor). The nurses reassured me that this was all normal; that most babies have a period of time on the second day where they are ravenous and non-stop feed, that eventually my nipples would become stronger, and that once my milk came in everything would be ok. When the nurse finally took him for his next set of newborn tests I was so relieved that it was finally quiet. When she brought him back (after only 45 minutes or so) I was so exhausted at this point and couldn’t think straight so I had Shiraz take the baby and walk around the ward with him just so I could close my eyes for a little while. At some point while I was half asleep my Dad stopped by and left a cup of coffee for Shiraz and a pint of raspberries for me. I was so grateful that I nearly started to cry.

Right after Kian was born and the first latch.

GOING HOME

Before we left the pediatrician came by to check Kian. Because he had already lost over 10% of his birth weight (7-10% is generally considered normal) and was showing signs of jaundice (not uncommon for newborns) a follow up appointment was scheduled for the next day. When we left the hospital later that morning (around 10:30 am), I was still determined to make breastfeeding work. The first 24 hours at home continued the trend of the previous two days at the hospital, only this time we were in the comfort of our own bed. I sent Shiraz out to get lanolin nipple cream and a nipple shield to help make the experience easier. Armed with those items I continued to try and breastfeed while fighting through the extreme pain. At about 4 am Kian became inconsolable and I finally reached my breaking point and became despondent. The baby cried, clearly wanting food but unable to get enough from me, until we left for the pediatrician at about 8:15 am.


The day we went home. Looking back on this picture it’s so obvious how yellow (jaundiced) he is.

As we were driving to the pediatrician I had a feeling we were going to have to supplement with formula because he wasn’t getting enough and my milk still hadn’t come in. Part of me also wanted to just switch over to formula for good and give up any attempts at breastfeeding. At his appointment the doctor told us he had now dropped over 12% of his weight and he was looking fairly jaundiced. I meekly told him if he thought it was a good idea that we would supplement with formula until my milk came in. He agreed that supplementing was a good idea and gave us some samples. We gave one of the two ounce bottles to Kian right there in his office. He drank it down so quickly, as though he was starving. The minute the food was in his belly he immediately became a different baby. He was content and calm. I wanted to cry with relief. I think Shiraz did too. The doctor also confirmed that Kian had a tongue tie, something that I noticed in the hospital but the nurses didn’t, and that this likely impacted his ability to properly latch (and thus the reason he was wasn’t getting enough food). Before we left he gave us a referral for a ENT that could do a frenectomy (releasing the tongue tie).

SO NOW WHAT?

When we got home we talked about still trying to get my milk to come in and breastfeed. Before the baby was born, knowing that I would eventually be going back to work and would have to pump, we had bought a breast pump. We decided that I would would pump until my milk came in, supplement in the meantime, and then go back to breastfeeding after Kian had his tongue tie released (which did happen that Monday). Within the next 24 hours my milk slowly started to come in and we were able to stop feeding the formula and instead feed breastmilk from a bottle. Worried about my supply I began taking Fenugreek and Milk Thistle (both of which are galactagogues) and continued to pump 7-8 times per day. Over the next week or so we established a good pumping and feeding rhythm in which I would pump and Shiraz or my parents would feed the baby. Kian started rapidly gaining weight, we began getting some decent sleep, my milk supply increased, and peace returned to the house. Kian never ate directly from the breast again.

Eleven weeks later and Kian continues to exclusively consume breastmilk via a bottle. I attempted to breastfeed a couple times after his tongue tie was released but he had ZERO interest in getting his food via the breast (a bottle is so much quicker to him). I also like that other people can feed him when needed so the responsibility does not only fall to me. Additionally after the trauma my nipples suffered I am extremely hesitant to go through that kind of pain again (which would be necessary to reestablish a good nursing rhythm and latch post tongue tie).

I AM A DAIRY FARM

While it was a slow start I have been extremely lucky that my supply has been fantastic; in fact it is so good that so far I have been able to freeze over 1000 ounces (I pump 45-50 ounces a day and the baby only eats 24-30 per day). Basically I am a dairy farm (I use these for storage and freezing). As I was establishing my supply I was pumping 7-8 times before dropping it to 5 times a day for the last month. The last few days I recently started cutting out the middle of the night pumping and one pumping in the middle of the work day so I am now pumping three times a day (about every 8 hours, my max time between pumping for it to not feel painful). Despite only pumping three times a day I am still generating 45-50 ounces in a 24 hour period (about 15-17 ounces each time I pump for 20 minutes). I will likely continue to pump until he starts eating solids at which time I will slowly start decreasing the volume I produce and use the frozen breastmilk (for which we had to buy a small chest freezer after filling up TWO freezers in our current refrigerators). By the time he hits one year old I hope to have weaned from pumping completely, though we will likely still have leftover frozen breastmilk which we will continue to feed him until it runs out.

A couple days worth of “excess” pumped milk.

WOULD I DO IT AGAIN?

There were likely many things that led to the inability to breastfeed. It certainly didn’t help that even before he was born I wasn’t enthusiastic about the experience and that I had gotten it in my head that it was going to be difficult. Additionally the nurse that was responsible for us the night that Kian decided to cluster-feed (and when I was the most vulnerable and desperately needed guidance and assistance) was less than helpful and actually scolded me at one point for not holding him properly while attempting to feed. And then of course there was Kian’s tongue tie that prevented him from properly latching, thus causing me excruciating pain, and the fact that my milk took a full 4-5 days after giving birth to come in (this is normal for a first child, but combined with the above made it very difficult). By the time all of the above had resolved it had already been one week since his birth, he was used to a bottle, and I was irreversibly emotionally scarred.

If we were to have another child I am honestly not sure if I would even attempt to breastfeed. It’s likely that I would do the first latch immediately birth and then exclusively pump from there on out. Even though Kian is not fed directly via the breast he still receives breastmilk, and we still have a strong bond (we did a lot of skin to skin those first few weeks). However, if I were to get over my fears and give it a try there are many things I would do a lot differently. Before giving birth I would take a breastfeeding class (I did not do so this time), I would inform the hospital of my unease and inability to successfully breastfeed the first time, I would reach out to La Leche League for assistance and guidance, I would immediately have them check the baby for a tongue tie after birth, and I would ask for formula in the hospital if I am not able to provide enough and the baby is starving. But even if I did all this and the baby and I were unable to successfully breastfeed I would have ZERO qualms or guilt about pumping or even formula feeding.

SO WHAT ADVICE WOULD I GIVE?

Don’t be afraid to ask for help; whether that is help from the hospital staff, your significant other, your parents, or another group or individual. If something doesn’t feel right (physically or emotionally) say so immediately. If you need a break so you can get a couple hours of sleep while still in the hospital ask someone to wheel the baby around the birth center or have them take them to the nursery so you can get some peace. If you feel like your baby isn’t getting enough food and you are ok with it, ask them to provide a little bit of formula (many hospitals won’t offer, you have to explicitly ask). Formula won’t hurt your baby, but being extremely stressed can ultimately impact your supply and make breastfeeding less likely to be successful. Don’t every let anyone judge you for the decisions you make about how to feed your child; not the doctors, your family, your friends, or even yourself. And whatever you do, try not to feel guilty if you aren’t able to make breastfeeding, or exclusively pumping, work for you. At the end of the day, no matter what all the articles and studies say, FED IS BEST.

January 6, 2017

Kian | A Birth Story

This took me a lot longer to write and share than I thought it would and I am not sure why. Every time I would think about writing it down I would get overwhelmed, or find something else to occupy myself with. However, I was determined to get it written down for posterity’s sake. So here it is…only 6+ weeks after he was born…

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I was lucky enough to start working from home on November 1st. On November 14th, six days before my due date (November 20th), I went on official maternity leave. For approximately two weeks prior to giving birth every morning I would wake up and wonder if today would be the day. Every night before going to bed I would think to myself “I hope it happens tomorrow”. This was particularly true thanks to the severe pubic pain I experienced the final few weeks, and once my father and stepmother arrived on the 17th. Honestly, with the couple of small scares we had at 29 weeks (bleeding) and 34 weeks (false labor) we thought the baby was going to arrive early. Yeah…no.

At approximately 38.5 weeks I ended up visiting the Birth Center due to decreased fetal movement and fairly regular contractions. I thought for a few moments that they would end up admitting me and inducing, but I was sent home with a nurse telling us she wouldn’t be surprised to see us back within the next 24 hours for the real thing. I am pretty sure she jinxed it. Over the next couple of days my contractions continued, but were no longer frequent nor consistent. They were dilating me but VERY slowly.  At my 39 week checkup with my OB/GYN she did a membrane sweep in hopes of kick starting labor (the pain from the sweep was on par with the pain of pushing the baby out). For the next few days I tried every trick in the book including various foods, prenatal massage with acupressure, vigorous exercise, special teas, and more. Nothing worked. Some days I would have contractions consistently for the entire day only to go to sleep and have them completely stop. Frankly it was maddening. At my next OB/GYN appointment (40 weeks plus 2 days) I still had barely progressed in dilation/effacement; in fact I might have lost progress. I declined another membrane sweep so she offered to schedule an induction if I didn’t go into labor soon. This was the Tuesday before Thanksgiving. In severe discomfort and pain thanks to the SPD I asked her when was the soonest she was willing to induce. When she responded with “today” I nearly cried with relief.

After the appointment we headed home to get a few items, let my parents know what was going on, and then headed to the Birth Center. At approximately 1:30 pm on November 22nd I was hooked up to the IV and the Pitocin was started. The first few hours of labor progressed slowly. I could barely feel the contractions, though I could of course see them on the monitor. We passed the hours watching Netflix and Shiraz even left briefly to get some food. At about 4:30 pm my doctor came back and broke my water to move things along further (the weirdest feeling ever, FYI…it legit felt like I peed myself). For the first hour after progress slowly continued. The nurse encouraged me to get up and walk around, while hooked to a mobile IV, in an effort to move things along. After about 15-20 minutes of doing so the pain had gotten bad enough that walking around was difficult (particularly when combined with the pubic pain) so I headed back to bed. Over the next couple of hours things continued moving forward; the contractions getting stronger and the pain getting worse. At about 8:45 pm the pain had gotten to the point where I was ready for the epidural so they sent the anesthesiologist in.

It took a couple of tries to get the epidural right and fully working. It turns out there is a phenomenon where some women get a “window”; a small part of their uterus the the epidural medicine doesn’t reach. When this happens you are numb everywhere except this one small section where you can feel the contractions…and boy does it hurt. And of course this happened to me. They had to send the anesthesiologist back in to move the needle around and rotate me to help the medicine spread throughout. Once they did this and the epidural hit everywhere it was supposed to the relief was instant. I actually felt so good I could have slept…in fact, I probably should have. Instead we watched some Scrubs on our iPad, I talked with my Mom on text message, and we waited for things to progress further. At some point they had to top off my epidural medicine. Around 1 am (this is a best guess because things got hectic toward the end) the nurse came in and checked me and I was finally at 9 cm. It was time to start prepping for delivery…the final countdown, so to speak. For the next hour it was a blur of pushing, intense pressure in places you don’t want pressure, and me wondering what the hell I had gotten myself into. Finally, around 2:15 am they called my doctor in for the delivery.

Once the doctor arrived time seemed to slow. I remember the final hour VERY clearly. They thought it would only take another 30 minutes or so for me to push him out so they didn’t give me more epidural medicine when it ran out, as what remained in my body would get me through to the end. Well it turns out it took me about another hour, which means I felt EVERYTHING during the moments when I wanted to feel nothing. As I was pushing I would want to scream and the doctor would tell me “don’t scream, put it all into the push”. Honestly, I wanted to rip her head off, but then I would do what she suggested and it would make my pushes far more productive. I never actually swore or yelled mean things at Shiraz, though I did sternly tell him he had no idea what I was experiencing during the peak of a particularly intense contraction. At one point the doctor and nurse said something encouraging about how I could do this and I just responded with “I don’t know if I can….” in a sad, pathetic, painful tone. Eventually I did do it and Kian entered the world, with a luscious full head of hair, at 3:34 am on November 23rd after 14 hours of labor. The minute he was out I cried with relief that the unbearable pain and pressure was over…oh and because I finally got meet the spawn I had been baking for nearly ten months. Over the next 30-45 minutes my doctor stitched me up (I had a couple bad tears), and the nurses attended to the baby. We were now parents.

From the beginning of the pregnancy I had no specific way I wanted the birth to go. All that mattered to me was that the baby arrived healthy and safely. Even if I was induced, and even if the epidural did wear off, in the end that is exactly what happened. I wouldn’t have it any other way.

Kian Xander Olmstead Khan
Born November 23rd, 2016 @ 3:34 am
7lbs 3oz, 20 inches

November 7, 2016

Pregnancy | Third Trimester Thoughts

Sunday, November 6th, marked 38 weeks into my pregnancy, which  means the baby is full term (technically full term is 37 weeks and on). Since theoretically the baby could decide to make its debut at any moment, which is actually terrifying to think about, I figured it was time to share some thoughts about the third trimester. My second trimester saw the arrival of mood swings, the intense need to pee ALL THE TIME, and some serious swelling. The third trimester continued that trend and brought some additional friends.

MOOD SWINGS: I thought the hormonal mood swings I experienced in the second trimester were “extreme” (or at least extreme by my standards since I am a robot). Well let me tell you that the last few weeks have blown that thought out of the water. While I definitely had a bit of a shorter fuse in the second trimester, I never actually felt like I was out of control of my emotions or being irrational. However, as the weeks progressed in my third trimester I definitely felt like I was slowly losing control and that it was a matter a time before I finally broke down and cried or snapped. I finally did that about a week ago after a few extremely rough nights of sleep (or complete lack there of). The extreme exhaustion combined with general physical discomfort and overall anxiety resulted in me turning into a crying mess for a good 5-10 minutes. Poor Shiraz had to deal with me blubbering and making no sense and getting angry at him over something I normally would not care a lick about. Eventually the moment passed and I called it a night and went to bed. Mostly my mood seems to fluctuate between “I’m so tired I could sleep for the next year”, “Holy crap I need to clean and organize everything in the house for the umpteenth time”, and “WHAT HAVE WE GOTTEN OURSELVES INTO? I AM SO NOT READY FOR THIS!”. Which leads me to my next point…

ANXIETY: Back in the early second trimester I wrote a short post about some of the anxiety I have around having a child. As the weeks have continued and the due date has drawn closer the anxiety has only increased. Some of it is the same continued anxiety about being good parents, about liking parenthood, about not sleeping, and about our dogs taking to the child. Some of it is new, such as what kind of country we are bringing our child into (thanks to the rather disgusting 2016 election), how much labor and birth is going to hurt, the subsequent postpartum recovery, what are we going to do for childcare when we return to work, and of course the anxiety around not actually knowing the exact date the child will make its debut (which is seriously maddening). To handle all this stress and anxiety I often remind myself that people have been parenting for millennia and that if they can do it, so can I. I also look to Shiraz and my network of family and friends for encouragement and reassurance. And when none of that works, frankly I just let it terrify me for a couple minutes, and then think about something else.

35 Weeks

SYMPHYSIS PUBIS DYSFUNCTION: I was lucky enough to make it through nearly the entire pregnancy with minimal physical discomfort (outside of having to always pee and the nausea). That all came to a screeching halt in the last few weeks when I developed SPD. This lovely condition makes it so every single step I take, and even getting out of bed, causes severe pain in my pubic region. It is affectionally dubbed “fire crotch”, an incredibly accurate descriptor of how it feels. It has gotten to the point where I heavily minimize how much I am out of bed and moving around, which frankly is quite frustrating as moving around can help to induce and speed up labor. There are some physical therapy exercises you can do which help to lessen the pain, but the only cure for this condition is giving birth. Come on kid, it’s time to get out.

SWELLING. OH THE SWELLING!: I thought the swelling of the second trimester was bad. At this point I have two pairs of shoes that I can wear. My feet are the size of shoeboxes, the cankles have arrived in full-force, and my fingers look like marshmallows. I am pretty sure I could fill a tub with all the extra water I am retaining.

38 Weeks

While the last 38 weeks+ of pregnancy have been difficult for me I do know that I am lucky. Though we had a couple small scares (bleeding and false labor), overall this has been a relatively complication free and textbook pregnancy. For that I am extremely thankful. That being said I am ready for this baby to vacate the premises and I am in no rush to do this again anytime soon. In the meantime, until he makes his debut, I am going to go back to watching Netflix in bed while I wear the only pair of pajamas that currently fit (now that I am on leave I don’t intend to put on real clothes until after giving birth).