Eternal Goober of the Monkey Mind: February 2008

Warning: This is kind of a long post, but it has a happy ending. :)

A lot of folks have been asking if parenthood is what we expected, how we're doing, and what's been hardest. Before Kai was born, never in a million years would I have expected my answer to be breastfeeding, but there it is. In some ways, I'm hesitant to answer truthfully, and hesitant to write this post, because the thing is, for me, plodding through the challenges we've had in this area (more than most) has been and continues to be both worth it, and in fact, much easier (not to mention better for Kai) than the alternative (formula). I REALLY don't want to deter anyone from pursuing a breastfeeding relationship with their child. So please, if you haven't had kids yet, and are reading this, realize that many people have no problems with breastfeeding, and most of the folks who do are able to resolve their problems by the time their kid is about four weeks old.

Kai was born with a short frenulum, otherwise known as tongue tie, and a high palate. In other words, he couldn't stick his tongue out very far because the paper thin tissue connecting his tongue to his mouth was too short. And the roof of his mouth is much higher in the front than normal. Try sucking your thumb for a moment. If you pay attention to the way your mouth works, you'll notice that your tongue sort of cups your thumb and probably extends over your bottom teeth all the way to your lip or beyond it as you suck.

Kai's tongue couldn't reach so far, so he spent a lot of time gumming my nipple instead of sucking it. Result? Blistering, cracking, tiny bit of bleeding.

Fortunately for him, my milk supply is ridiculous. He barely has to work to get milk, so weight gain was never the issue it is for many babies with tongue tie. Unfortunately for me, babies spend nearly nine months practicing a suck and because his way got milk, he had no real incentive to change his method.

Fortunately for me, however, I knew that problems with breastfeeding should be brought to a lactation consultant (LC) as soon as they occur. We got Kai's frenulum clipped at our LC's recommendation and based on lots of Internet research. It's a very common procedure, though one that sounds much worse than it is. He barely noticed it happening (I still think he was more upset that we were holding his hands away from his face than he was about the experience). If the frenulum isn't clipped in cases of tongue tie, there can be other negative consequences for a kid, ranging from speech problems to difficulty with french kissing. We're lucky that the staff at our hospital noticed the tongue issue, as many labor and delivery folks are unaware of or unconcerned about the issue.

Sometimes frenulum clipping is all that is needed to get things back on track with nursing. Not for us. His latch was still quite painful for me. Working with our LC, we tried a variety of positions for nursing, tried letting him self-latch, and had lots of skin-to-skin time. All of these things worked initially, but briefly. We also tried something called a nipple shield, which is a small piece of silicone that suction fits over the nipple and helps the baby draw it out. Nipple shields can be dicey, because many babies get "addicted" to them and refuse to latch without the aid of one for many months, but they protect nipples from additional damage, so when nothing else is working, sometimes an LC will recommend one.

The shield worked beautifully for a day. Then Kai decided he hated it. He refused to nurse if I was wearing one (so much for fear he would get addicted to it). It was recommended that I break his latch and relatch him whenever the pain was a three or higher on a scale of one to five - this was probably the most miserable time for both Kai and myself, since his latch was pretty much always painful. The more I broke it, the more frustrated he got. It was a terrible cycle and one Saturday, he just refused to nurse at all. He slept and slept and wouldn't nurse. That was the only night so far he has slept six hours straight, and it was most definitely not something to celebrate.

I felt completely petrified, overwhelmed, and vulnerable about my role as the sole source of food and beverage for my child. I also felt trapped by the situation, was in a lot of pain and was at a loss for how to proceed. To give myself some space and a break, I pumped all day, and we introduced something called the Playtex Natural Latch bottle/nipple to Kai. It mimics the breast and requires babies to latch on well in order to get milk. Wow, does my kid HATE that bottle. It took hours to give him each bottle that day, and there was lots of screaming and crying.

And something surprised me. I REALLY, REALLY, REALLY missed nursing him myself. So much that I determined I was going to just let him suck his own way for at least the rest of the day, and was definitely going to keep working on the latch. I didn't feel trapped, because I'd spent time that day researching the possibility of exclusively pumping (seriously, breastmilk is SO much better for babies than formula for so very many reasons), and felt that I had an "out" that I was comfortable with should I feel it was necessary.

And something magic happened. He latched on effortlessly, painlessly, joyfully. Over and over again that day. Whenever he finished he would fall asleep with a silly gummy grin on his face. THIS was how I had pictured breastfeeding and it was such a relief. So yes, he caught on at about four weeks old, and that particular bottle played a role in it.

For the next two weeks, things were great. I enjoyed the connection it provided and also the ease that it provided to our lives. Outings were suddenly no problem, I felt human again, and began to feel that this whole parenting thing was manageable. My nipples started to heal.

Then suddenly last Friday, there were a couple of nights that went poorly...his latch became occasionally shallower. My nipples started looking and feeling angry again. He still has difficulty taking the Playtex Natural Latch bottle, and pumping had inexplicably begun to hurt my breasts. Between the pain of pumping and his frustration at being bottle fed, the bottle didn't feel like much of a relief and the fall back of exclusive pumping that I once pictured no longer sounded any better than trying to feed him with raw nipples. (People sometimes say that if breastfeeding isn't going well, why not switch to formula - you can see here why that wouldn't make much of a positive difference - he HATES bottle feeding!)

Then this week, there was a new twist. In the past, my oversupply seems to have meant that no matter how he latched on, he got food. No longer. The shallow, tip of my nipples latch he was suddenly favoring was only getting him milk for the first few minutes of a feeding. And when I gave him my finger to suck (there are all sorts of tongue exercises LCs gave us to help him suck better), I realized that this was not his old latch, it was an entirely new problem. He wasn't actually sucking at all.

Wednesday, in the middle of the night, my son and I both had a massive breakdown. He kept trying to latch and relatch himself, frustrated by the lack of milk he was getting. I kept trying to help him, frustrated by the feeling that I was failing him even though I knew I was doing everything possible to make this work. Both of us just wailed together for a little while, until my husband woke up and sat with Kai, patiently trying to give him a bottle of expressed milk in the living room while I posted for advice on a favorite breastfeeding support bulletin board online.

To make matters worse, my lactation consultant was on vacation this week. So was the other LC I have used in the past when she has not been available.

My tale takes another turn for the better now, though. Again, I'm really lucky to plugged myself into a number of excellent breastfeeding support resources, including the LCs who've helped me, the La Leche League, the online breastfeeding forum at Ovusoft.com, Jack Newman's books about breastfeeding, and the weekly support group I've been going to.

Having heard that long labors like mine, tongue tie, high palate, and being born in a funny position like Kai was (head first then an arm) could lead to issues with breastfeeding that responded to craniosacral therapy and chiropractic adjustment, I had already scheduled an appointment with a chiropractor who specializes in work with pregnant and postpartum women and infants and was able to move the appointment up yesterday (Thursday) morning. Well, we're going again on Saturday - it wasn't necessarily supposed to make such an immediate difference, but ever since the appointment, he's been latching like a champ. I'm amazed. I also further explored a gut feeling I'd had a few days after Kai's birth that he might have thrush (a yeast infection in his mouth - common with both both formula and breastfed babies). I was GBS+ and had to receive antibiotics during delivery via IV, creating an increased likelihood of Kai getting thrush. Several days later, I noticed white spots on his tongue. Everyone said it was just milk residue so I stopped noticing it and assumed I was just being paranoid. After our meltdown the other night, though, I asked Bob for a damp paper towel and discovered that the "milk residue" doesn't wash off - a telltale sign of thrush. And then I put two and two together and realized that even when the latch feels good, there's this vague itchy burny feeling on my nipples that I've assumed was the feeling of milk ejecting. Also that things got worse for both my son and I after I stopped using the APNO (All-Purpose Nipple Ointment, it's miracle cream containing an anti-fungal, anti-biotic, and topical steroid that they give you if the skin gets broken on your nipple in order to prevent infection) I'd been prescribed when he was still gumming my nipples early on. And that his on again off again issues with my breasts during the last week might just be discomfort from thrush, not necessarily my forceful letdown, which he had previously seemed to get used to. Also, that pumping got uncomfortable after I stopped using APNO regularly. And it feels itchy, bruisy inside my breasts when I do it. All of these are classic symptoms of thrush. So now we're using gentian violent once a day (a topical treatment that paints his mouth purple - I keep thinking of Harold and the Purple Crayon when I look at him) plus got the pediatrician to write me an prescription for oral diflucan. It also turns out that Kai has the cold that is going around Boston right now. We also weighed him at the pediatrician's office yesterday, in large part for my sanity. Even with all the problems we've been having this past week, the kid managed to gain a pound and six ounces during those seven days (average weight gain is half an ounce to an ounce a day). So I relearned the lesson that I really should stop worrying about his weight gain when he has the occasional difficult morning or night.

I also talked to an LC who was not on vacation last night. She said that every time she'd seen a child who had the latch down for a couple of weeks "lose" it, thrush was responsible. This made me feel a bit more optimistic and slightly less vulnerable about all of this repeating.

But if it does...I'll keep working at it. I can't even begin to put into words the attachment, bonding, and closeness I feel with my son because of breastfeeding.

We're getting much more skilled at taking Kai out into the world. Kai and I made some new friends recently at breastfeeding and new mom's groups, and we've started going to mommy and me yoga every week. Bob and I managed to go out for lunch with him to celebrate Valentine's Day, and we take regular strolls in the winter weather outside. I even survived my first disastrous outing when I attempted to bring Kai to the Fogg Museum to meet up with my friends Sam and Deji for an afternoon...the day involved a freak whiteout blizzard during our walk to the T, several hours of nursing and bouncing in a corner of the museum with the new realization that here was a place that people would definitely not welcome his crying if it really started up, being kicked out into the cold upon closing and Bob picking us up after he finished work, only for us to discover that we had no idea how to fold the stroller up and put it into the car!!! We figured it out eventually.

I'm continually finding that the challenges that I expected (like lack of sleep) are less challenging than I expected (don't get me wrong, sometimes when he wakes up to nurse for the umpteenth time in an evening, I'm pretty darned exhausted), and the things I didn't think about are really challenging (um, no one told me I'd have repetitive stress injuries in my wrists and shoulders from nursing...sometimes the only thing he wants is to be nursed while I bounce on a bouncy ball...all well and good except I can't really use a nursing pillow under those circumstances...Bob's developing tennis elbow from holding Kai so much!).

Every day that passes, though, finds me falling even more in love with this child. His smiles are utterly captivating and he always manages to pull one out when I'm really, really tired or frustrated. He's a pretty sweet kid, that much is already clear. And you know, it's tough being a baby. The books all call this a time when babies get "organized"...hunger, digestion, and pretty much every single experience strikes them as new and needs to be processed and incorporated. It's pretty amazing, really.