Sunday, February 10, 2013

Trust Is Such A Delicate Thing

If motherhood doesn't make you crazy enough as it is, there are people out there who will make you even crazier. You suspect these people will be the obvious choices, mostly family members who know how to push your buttons; like your mother-in-law, step-parents, siblings or co-workers, or even just really nosy strangers in public. You don't expect it to be the people you really trust.

In our 4th week we saw our family doctor for the first time. Our care had been with our midwives up to this point. However, due to both the initial weight loss, then the later issue where she neither gained nor lost in 8 days, our midwives asked us to make an appointment with our family doctor in case further tests and follow up might be required. That was in week three.

Our family doctor was away on vacation until the following week, so we made another appointment with our midwives, and with our family doctor the day after that appointment when she was back. We left with a promise to continue supplement through co-feeding while tracking regularly and calling if anything went wrong.

We have had our family doctor for almost four years. We were able to get in with her shortly after we moved to Ottawa. We have always felt we had a good relationship with her. She is someone I trusted faithfully. When she found out we were pregnant she was ecstatic. She cannot deliver babies but offered to follow us through the pregnancy if we were unable to get on with a midwife. She even said, almost lovingly, that if she was there when I went into labour that she promised to catch the baby. Later on in my pregnancy, SuperFox had an appointment. She was so happy for us and insisted we call her "as soon as that baby was born" she told him excitedly. This was someone I trusted & respected.

Over the following 6 days between midwife appointments we tracked details, fed well continuing to supplement with my pumped breastmilk, my supply never being a concern. I spoke with my lactation consultant that weekend who was also concerned about the lack of gain, but we assured her we were back on track, we had appointments set up, everything would be fine and that we would contact her if we needed any further assistance.

On Tuesday we saw the midwives, and things were great! Her weight was up, 7 oz in 6 days. Right on track with healthy weight gain. I was so happy with our hard work and our progress. She had developed a head cold with a cough over the weekend, no fever. There was no concern by the midwives over the chest congestion but instructed that if things got worse to take her directly to CHEO.

The following morning the cold got worse. I didn't feel like I could wait until our appointment that afternoon. So I picked up SuperFox at work and the three of us headed to CHEO. While we were there we gave them the Coles notes of her first four weeks, including the weight gain issues. They weren't concerned about the chest congestion, however her blood oxygen levels were a little low due to her nasal congestion. But after they suctioned out some heavy mucus she inproved and we were on our way. The doctor in emerg had asked about the weight issues, we told him about the recent gain and he seemed comfortable with her whole image of health.

I almost considered canceling our appointment that afternoon. Her weight was on track and her cold was much better, but I remembered how excited our doctor had been to meet our new arrival and so I kept the appointment, to show off this little doll.

When we first sat down with my doctor she caught me off guard by asking what birth control we were planning to use, stressing that breastfeeding doesn't protect you from getting pregnant. My husband joked about "Irish twins". It seemed like a strange way to start the appointment. Then I proceeded to explain that we'd been at CHEO that morning and the congestion.

When she asked a bit about the weight issue I mentioned that I had been pumping after each feed and using some of it to suplement. I also mentioned that I had so much pumped that I had donated this extra breastmilk to a friend in need who couldn't produce enough for her little one. She went to check weight charts (I'm assuming) and came back quite flustered.

She was very upset that our little one hadn't gained back her loss in the first 10 to 14 days. She was shocked that the staff at CHEO hadn't been more concerned about her weight issues. I tried to explain that we didn't know about the initial loss until day 5 and that at day 10 she had oral surgery to release a lip tie and posterior tongue tie, and we had gained before that. I explained that we were seeing a lactation consultant who was also a RN and that we were finally back on track and gaining again but these did not appease her.

Her strict instructions were to immediately stop pumping, that I was thinning my milk production. She then told me to replace every second feed with formula from a bottle. She seemed perplexed that I wanted to pump at each of these replaced feeds to keep up my milk production for after things got better. She said she supported breastfeeding and that "breast was best" but her instructions spoke differently. She didn't give us a timeline but insinuated that these changes could continue for weeks.

I feel very strongly about breastfeeding for myself and daughter. I knew I was producing more than enough milk for our little angel and that we had struggled but were figuring it out. I knew that stopping pumping would make me engorged, that giving my daughter a bottle this early and after all of our difficulties might case nipple confusion. And I was horribly afraid that she would prefer formula and never take my breast or my milk again.

Unfortunately I was not able to express these feelings. I was not able to tell her my reasons for wanting to breastfeed over formula feed and bottle feed. I sat there and cried. She made me promise to make the changes. That it was the best for my child. That there was too big a risk of hindering her mental development if we didn't make these changes and have her "start gaining" (but she WAS gaining again!).

I cried all the way home, I cried well into the evening, I cried overnight when I tried to add a feeding and it was thrown up all over me. I was hysterical for many of the following 12 hours.

Someone I had trusted hadn't listened to me, hadn't heard me, hasn't tried to work with me, and put the fear in me that I was damaging my newborn child. A child that showed no signs of any problems. She was pink in colour from birth, many wet and soiled diapers, lots of alertness, lots of sleep, great muscle tone and just an all around perfect baby.

We have only seen our doctor once more since that appointment. My daughter's weight was up and my doctor was placated by that and by the fact that we had an appointment with a pediatrician to whom she had referred us, promising follow up with him. However, I feel like our relationship has changed.

We have our 2 month immunization appointment and my first post-partum appointment with her scheduled. I'm hoping that these weeks away from her will help me to feel more confident going back to her. A good doctor is hard to find, but so is any doctor. And many doctors taking patients won't take you if you have an existing physician.

I know she was only doing what she thought was best. That as a doctor she has to prescribe the best course as sees it. I know physicians are expected to know EVERYTHING, but that there is much they don't know, other than through exposure and experience. But I felt like my doctor didn't listen to me. She didn't take the time to understand how hard we had worked and that we were getting results. That there were no signs that I was thinning my milk by pumping but rather protecting my supply. That here was a healthy baby who had HAD weight gain issues but who was making great strides forward and who if simply monitored would continue to improve. And that the changes she wanted me to make could have had major medical implications for both myself (engorgement & mastitis), not to mention the emotional toll it had taken on me, but for my daughter too. Such drastic changes might have caused her to start losing again. She might not have taken the bottle or the formula, what then. And giving me less than 2 days for a follow up with her did not give us enough time to make major changes and not fail.

I felt like I was strained at our follow up with her. I really want our relationship to go back to where it was. I'm not sure if I can ever feel safe with her again. If I won't question every prescription, diagnosis or opinion she gives. I am trying to let go of my anger, my distrust and my heartbreak from that one appointment with her but I'm not sure if I'll ever shake the feeling that she created. She made me feel like I was the worst mother, like I was killing my daughter, and I don't know if I can ever forget that.

The best advice that I have received from other professionals, friends and family alike is to trust my instincts as a mother. Trust that I am making the right choices for us. I am learning to trust these feelings but every time she has a feed that doesn't go as long as it should or where she is fussy or not sucking well I feel like I am hurting her. If she sleeps too much or doesn't sleep enough I worry that my choice to continue to breastfeed might cause her major developmental issues. I worry that she might die because I'm not feeding her properly, even though her weight continues to be up. I no longer trust my doctor, and yet I still trust her enough to no longer trust myself.

With love
~sarah~

Saturday, February 9, 2013

To Wake or Not To Wake - That is the Question

We had some feeding issues initially. She lost 14% of her birth weight in the first 5 days which is more than the medical community likes to see in a newborn. We consulted with a lactation consultant. So through co-feeding, with the help of my husband and the use of a syringe and catheter of my pumped breastmilk at the breast, we started helping her put weight on at a healthy-ish rate (still on the low side). She put on some weight. Then we had her lip tie and posterior tongue tie released at day 10 to continue to help with the feeding issue. Over the next 8 days after that she neither gained nor lost. We then continued to co-feed and she began gaining again slowly.

Then two weeks ago, even though she was beginning to make some real progress, our family doctor made me even more paranoid than before about feeding and her weight gain. She insisted we supplement with formula, cutting out every second feeding at the breast. Telling me to stop pumping, which I have been doing after each feed to protect my milk supply. She was concerned that I was thinning out my milk.

Both of the these instructions upset me beyond belief. My child is healthy. Her colour is fantastic, she has never been jaundiced. She pees and poos like a champ. The doctor had commented on her fantatsic muscle tone. When she is awake she is alert and meeting her "age markers". And when she sleeps, she sleeps like a dream. So if she's fine on all other counts why should we make such drastic changes to what has been working?

Ever since she was born night feedings have been difficult. She does not like waking up at night. Even early on I believed if left to her own devices that she would sleep through the night. But due to all of her feeding and weight gain issues it was recommended that we wake her every couple of hours to feed. Going an hour extra between feeds overnight was fine, but I was still waking her.

We have a co-sleeper basinette attached to my side of the bed to help facilitate healthy feeding. I love this crib as it gives me the benefits of co-sleeping but creates the separation of our own beds. Occassionally she would wake me and prompt me just before my alarm would go off. Giving me the faith that she will feed when she's hungry.

In the past few days I have been setting my overnight alarms to check on her a little later each night. Most of the time she wakes me or when I check on her with the dim light on (thanks to my husband for the side table lamp dimmer switch) she wakes from my movement and the light.

However, each time the next feed goes a little later, the crazy person the doctor turned me into 2 weeks ago rears her ugly head. Should I wake this perfectly healthy baby from a wonderful sleep in order to insure that she feeds? My doctor talked about needing to eat and gain properly to build all the millions of neural pathways and synapses (not sure if I'm getting this right...it IS the middle of the night right now) that a baby needs for brain development in her first weeks and months of life. But doesn't she need healthy sleep too? Won't she wake me on her own when she's good and hungry?

So last night, all evening, she fed really well. She appeared to be cluster feeding at 4, 5, 6:30, 8 and 9:30. These were all good and solid feeds, some of which even lasted more than 30 minutes (we aim to feed 15 minutes each side). And at the two later feeds when I was concerned there might not be enough milk because of her constant interest, I added a little pumped milk supplement, through the syringe and catheter which I am now able to do on my own, and she took an additional ounce from that. So she prepared for a long rest. Can't I be confident in this? Can't I trust that she was bulking up for a long night's sleep?

Now it is 4am. My alarm went off at 3:30. I checked on her and she was still sleeping soundly. I reset my alarm for 4:30, but as soon as I tried to go back to sleep the panic set in. In letting her sleep am I hindering her development? Am I causing her untold problems? Is she going to start loosing weight again?

Everyone tells me to trust my instincts. That she is a beautiful and obviously healthy baby. That there is nothing wrong with her. If a baby sleeps through the night accept your blessings and let her sleep. But I have trouble trusting these instincts. I was told there was something wrong and I didn't notice. What if there is something wrong now and I'm hurting her by not waking her?

The biggest problem I have had with breastfeeding is that I am constantly questioning myself and stressing myself out in the process. Am I doing the right thing? Am I hurting her? Am I keeping something from her by not feeding her formula? All of my friends who formula feed their babies are doing fine. Heck, I was primarily formula fed and so was my husband and we are both fine. So why not add a little extra? However, I am fanatically paranoid about introducing a bottle of even pumped milk for fear that she will prefer the bottle and reject my breast. This last idea breaks my heart.

So I started writing this post over an hour ago to share my experience but also to stop myself from cycling over and over again in my head while listening to her breathe in the crib next to me, worrying. Since beginning to type I heard her begin the stir and then I took the sound of a diaper being filled as my cue to change her (and yes, wake her). While changing her she immediately started making her "boobie faces" (sucking motions with her mouth), and after the change we started feeding.

And even now as she cuddles next to me I worry, she only fed for 18 minutes. 10 on the right, 8 on the left. We always try to do 15 each side. Is she slipping into old patterns? Should I wake her, strip her down, blow in her face to get her to do another 12 minutes? So I leave her lying next to me, hoping she's just taking a break and will feed some more shortly (which she sometimes does).

I have an almost 7 week old who will go almost 7 hours between feeds and sleep for more than 6 hours. Why am I complaining? And yet even now I continue to ask To Wake or Not To Wake...because right now...That IS the question.

With love
~sarah~


Thursday, February 7, 2013

Nursing in Bed - Bliss or Burden

After some initial nursing difficulties, we are finally on the right track with her regularly prompting me to feed and her gaining weight steadily, if still a little slowly.

And about a week ago we figured out how to nurse lying down in bed for our overnight feeds. Amazing, right?

It means I don't have to get up to a scheduled feed (with an alarm) in the middle of the night, put on my glasses, stumble around with a sleeping, swaddled baby and try to get her to wake long enough to feed to make the whole process worthwhile in the middle of the night. Perfect! Now I just listen for her to prompt me from the basinette attached to our bed, lift her in next to me and let her eat, while I lay here half asleep.

At least that's what I hope it will eventually turn into. Because at the moment...not perfect, because we're still learning, but mostly because I'm still concerned about weight gain (my doctor having made me a crazy person).

So turn on the light, luckily not too bright as my husband installed a dimmer on the lamp next to my side of the bed, then I bring my phone into the bed too, and check the time on it when she starts feeding, and do breast compressions when I feel like she's too sleepy at the breast, and check the time regularly to make sure she's feeding enough, and flip her to the other side before she's finished nursing on the first side to make sure she feeds evenly so I don't get engorged, and then stress when she won't take the other side because she's fallen back asleep, and then worry that I shouldn't have changed sides because she was feeding fine and would have gotten enough and now she's not and she won't gain enough (see...? crazy!), and then try to figure out if I should leave her in the bed with me in case she wants more right away or just put her back in her crib, and should I set an alarm to wake her just in case because she really didn't eat enough.

By this point I'm awake, so I put her back in her basinette, I go to the bathroom (I might as well since I'm up), then I go back to bed and talk myself down from my craziness and just as I'm falling back asleep I hear the little prompt (which I call boobie-noises) from her bed next to me and I'm relieved that she wants more and we start the process again.

Plus I usually pump after a good feed, as I have been doing to help protect my milk supply through this chaotic time, but when she feeds all over the map like this I don't feel comfortable pumping as I have no idea when she'll feed next and I worry about trying to feed her when there's nothing there, making her upset and possibly rejecting breastfeeding forever (I didn't say my worries were rational!)

Luckily my husband has not yet been disturbed by this process (at least I don't think he is), thank goodness he's a sound sleeper. I am blessed that he is and has been so supportive of this whole process because it has been difficult and has made us both a little crazy about her weight gain and feeding issues. Although he might say something when he gets up this morning, as I may have dropped my phone noisily down the back of the bed and then spent 10 minutes trying to retrieve it using a clothes hanger.

But although this has been quite a learning curve and not initially the most natural thing, I think nursing in bed when it works is blissful. The moment when she is properly latched, drinking voraciously, both of us half asleep. I can see her profile in the dim light and I just feel calm, peaceful and connected to this little life. Nothing tops this wonderful feeling.

The burden comes from the learning process, mixed with the worry given to me by my doctor. That being said I'm not sure I needed the doctor's help, worry seems to have been delivered along with this little bundle; is she eating enough, awake enough, asleep enough, playing enough, alert enough, enough wet diapers, was that mark there before, is she having trouble breathing, is she getting a cold, does she feel hot to you, and so on.

So we will continue to find these little moments of bliss in these overnight feeds as I expect the little moments of bliss will simply become the norm. And really this process of breastfeeding, which has been a challenge and stressful and chaotic, has been the most amazing and rewarding thing I have done since having her.

With love,
~Sarah

Wednesday, February 6, 2013

Cuddles & Excuses

I've been meaning to blog for weeks now. Ever since the birth of our little angel; to document every marvelous and wonderful experience of being a new Mum. However, I've been busy, but I also think I've been avoiding it and making excuses, although I'm not exactly sure why.

Our precious doll was born a little over 6 weeks ago. I am currently lying here on the couch with her snuggled up on top of me. Usually I would nap with her, or throw her in the Baby Bjorn & get things done around the house, or watch another episode of Lost Girl (I'm addicted), but I realized while making excuses not to blog that now is the perfect time to break out of my writer's block.

I find it amusing that half of my posts are about how I'm trying to get started blogging. Obviously I've started, like a smoker quitting smoking again each week, now to stick with it.

My blog post ideas usually swirl in my head after my middle of the night feeding. I write full blog posts in my head, but am too tired to roll over and pick up my phone to write them out.

Well I'm hoping that this post will be the prelude to my Mommy-blogging days.

That being said, now that I've started things I think I'll take that as a cue to take that nap with this little darling :) because nothing on earth beats this feeling, lying here with this precious gift sleeping quietly and soundly on my chest. Smelling of that baby smell (clean, warm, breastmilk and joy), warm and cuddly, loving me and trusting me without thought or constraint. These days are numbered, some day she will be too big and grown up to share wonderful moments like this one, but for now I'm just going to soak up each second so I have a giant fountain of memories to remember as we create new moments.

With love
~sarah~