Breastfeeding Woes or . . . Pumpin' Ain't Easy

Before John Paul was born, I prepared like mad for his birth. I spent hours upon hours reading about labor, attending classes, watching online videos, hiring a doula. You name it, I probably did it. I was a birth master and dang proud of it.

But when it came to all the stuff that happens after birth, I prepared for nada. I never once picked up a book about how to, you know, care for and raise a baby.

WHAT WAS I THINKING?!

After a most lovely birth experience, we quickly realized we had no flippin' clue what we were doing. And all our challenges started with breastfeeding.

To my credit, I did take a 2-hour class on What to Expect When Breastfeeding, but only because our birth class instructor recommended it. The class was very basic and essentially only covered what to do when things go right. It made breastfeeding seem so beautiful, so natural, so easy. *Sigh*

IF ONLY it were that easy.

Oh, breastfeeding.

How I love thee. And also hate thee.

As soon as John Paul started life on the outside, he was put directly on to my chest, exactly as I wished. We had the best snuggles for a while, I shared my body heat with him, and he shared his precious newborn cries with me. Those first moments sure were something special.

After a short while, I was ready to try nursing him. Of the little that I learned, I was taught that newborns basically just know how to breastfeed right away. They know how to open their little mouths and latch on perfectly. And they know how to find your nipple by sense of smell. So I was ready for John Paul to take charge and make food happen.

Except it didn't go like that at all. Instead, John Paul awkwardly rubbed his cheeks from side to side across my nipple, never once trying to latch. I'd gently shove my nipple into his mouth and he'd just wiggle it right out. He also wouldn't stop crying through the whole process. Poor little man was so confused, and his ill-prepared mom had no clue what to do either.

After about 5 minutes of this, we decided to stop fighting and instead let him rest. The plan was to try again after he had a good post-birth nap. Surely he'd latch then. Surely he'd be hungry enough by then to figure it out.

But we tried again a few hours later and he was still not having it. He'd rub his face all over my breast, but never successfully found the nipple and latched, even with all my help.

A little later, John wanted to do some skin-to-skin with John Paul, so I handed the little guy over. John took his sweater off and laid John Paul on his chest. It was such a sweet moment to behold, until a minute in, John half-screeched, "He's trying to latch on me!" That's right. Our son was trying to latch onto my husband's tiny, milk-less, hairy nipple. He had his mouth wide open, perfect form actually, ready for his meal, only he was trying to eat off the wrong boob. Oh, John Paul.

So, without skipping a beat, John quickly handed John Paul back to me and we tried having him latch on the right nipple, for what felt like the bajillionth time. Still no luck. He preferred Dad's hairy nipple to Mom's milk-filled one. *Double sigh*

Soon after, we called in the hospital lactation consultant. Surely she'd help us figured it out! After she helped us try several tricks and different positions with no luck, she deemed him too sleepy and told us to give him another nap before trying to feed again later.

I was starting to worry.

But finally, at about 8 hours after his birth, our little man figured it out. Our sweet nurse came in to help and encourage me. I pointed my nipple straight at John Paul, probably thought to myself, "TAKE THE BOOB, GOSH DARNIT!" and plopped it in his little hungry mouth.

Praise the LORD, he finally started to suck!

At first, getting him latched was a huge, HUGE relief. However, things mostly just got worse from there. Little did we know, his 8-hour delay in learning how to latch was just the beginning of our breastfeeding troubles.

It wasn't long until the latch became painful. It felt like he was slightly pinching the nipple with every suck. Like he was just chomp, chomp, chomping away at my dainty little nipple. OUCH!

We quickly put in a request to see the hospital lactation consultant again, hoping she'd fix the problem before we were sent home to do this all on our own.

Again we tried several different positions, tweaked my holding style, popped him off and re-latched him several times. Every time we'd try something new she'd ask, "Any better?" But nothing was working. Even though we were thrilled he was latching, I was bummed it never felt good or right. After an hour of trial and error with no success, she basically said, "You guys will figure this out. Just keep trying!" and left us with that. We figured she probably had lots of other patients to see and just didn't have time for us anymore. *Cue more sighs*

Within minutes of her leaving our room, we were discharged from the hospital and making a plan to see a different lactation consultant if things weren't better in a few days.

And they weren't. In fact, things kept getting worse.

My breaking point was seeing blood in my son's vomit. The latch was so bad, he had cracked my nipple and I bled into his mouth during the whole feeding.

I was also in excruciating pain. I'd have to kick the bed or couch several times whenever he latched to prevent myself from saying horrible, horrible words that no one-week-old should ever have to hear.

So my husband, wanting to solve the problem (like men usually do), made a bunch of phone calls and made me an appointment with an International Board Certified Lactation Consultant (IBCLC) ASAP while I sat on the couch and cried through another feeding.

When we found out we couldn't get an appointment for another week, I cried even harder. I had already gone through this week of painful feedings and I was going to have to go through another before any help was available?

So my helpful husband made another call. This time to the Tennessee Breastfeeding Hotline. While it wasn't exactly the help I was looking for, it was something. They recommended we pick up some of Dr. Jack Newman's All Purpose Nipple Ointment to hold me over. And so we did.

Looking back, I can almost say for sure that if it weren't for that numbing, healing, high-powered ointment, I probably wouldn't have made it another week. Thank you, Tennessee Breastfeeding Hotline! THANK YOU, All Purpose Nipple Ointment.

To get through the week, I relied heavily on that ointment and the motto, "Just one feeding at a time." That's all I had to do. One at a time. And if it got really bad, I could always pump. Or I could even give him a little bit of that formula we had stashed away as a just-in-case. While I never did pump or feed him formula, it was still nice to know we had back-ups.

When we finally made it to appointment day, I was so proud of myself for making it that far and so relieved to finally be getting proper help.

The first thing our lactation consultant (the IBCLC) did was weigh our little John Paul. We were thrilled to see that he was gaining weight, and lots of it! So at least we didn't need to worry that he wasn't getting enough milk.

Next, she watched me feed him, and wouldn't you know, he had a really lovely latch. That stinker was showing off for the IBCLC! She did do a little position correcting, but for the most part said we had good form.

And then she looked for an upper lip tie and a tongue tie -- when the connective tissue under the upper lip and under the tongue are too tight for the baby to be able to form a proper latch. She did see an upper lip tie, but since she was able to flip his lip up without much trouble, she told us it likely wasn't causing our issues.

(Bad advice #1)

Basically, by the end of the appointment, she said we were doing a great job and that, with a little more time, John Paul's mouth would grow and we'd likely no longer have pain issues. She chalked up all my pain to a small mouth and left it at that.

(Bad advice #2)

Phew! Easy enough. All I had to do was wait it out a short while and things would probably get better.

Only that wasn't the case at all.

While things did start to get better, I still had pain at every feeding. Mostly mild pain, but there was the occasional feeding with extreme pain, which included more couch kicking to avoid screaming expletives. Also, whenever he'd finish eating, he'd come off the breast and my nipple would be shaped like lipstick with a big ol' crease in it, meaning he wasn't getting the nipple far enough into his mouth.

While I wanted to believe our troubles were all behind us, I knew things were still not right. At the time I was convinced things were getting better, but in reality, I was just learning to tolerate the pain better. And that numbing, healing All Purpose Nipple Ointment was probably the only thing keeping me afloat.

Fast forward two weeks after that lactation consultation and we were back in her office for another appointment.

This time, she watched my technique a little more closely and asked a bunch more questions. John Paul was almost 4 weeks old at this point, so it was time to get down to business and solve our problems.

First, she heard him make a click, click, click noise while he was feeding, but then quickly dismissed it. The clicking meant he was popping his latching with every suck, but she said if it wasn't painful while it was happening, then it wasn't a problem.

(Bad advice #3)

Then I asked her about the lipstick shape of my nipples when he was done feeding. She dismissed that too saying it didn't look that severe.

(Bad advice #4)

We also asked if it was ok for me to still be using the All Purpose Nipple Ointment so heavily. We had heard it was only supposed to be used for about two weeks, since it can thin the skin of the nipple and end up causing more harm then good. She said she knew folks who had used it for months on end, so it was no big deal.

(Bad advice, #5)

Finally, after asking several questions, she said our issues were due to oversupply and a fast flow. We talked about how strong my flow was when my milk first came in. She speculated that in that moment (when he was 4 days old), he was overwhelmed by my milk and learned to close his mouth off to prevent himself from getting too much milk at once. And now that I still had a lot of milk, he was continuing to do that. Closing off his mouth was causing all our pain.

(Bad advice #6)

So our solution was to have me wear cabbage leaves in my bra at night, which apparently helps reduce milk supply, and to have me recline far back when feeding him so that the milk wasn't flowing directly down into his mouth.

(Bad advice #1,000,232)

As you can guess, especially from all the bad advice hints, this didn't solve our issues.

I was convinced for a while that my fast flow was the culprit because. . . why shouldn't I trust the advice of an IBCLC? Sure, she was a bit brusque at times. And she always seemed like she was too busy for my annoying problems. But she had the credentials, so surely she knew what she was talking about. Right?!

But, no. WRONG. Totally wrong. And unfortunately, I only know this now in hindsight. If only I had been smart enough to seek a second opinion at that point. *Sighhhhhh.*

So my pain persisted.

And then we moved across the state and got busy with that, so we put all the breastfeeding stuff on the back burner.

Sure, I was still in pain at almost every feeding. But the All Purpose Nipple Ointment was still getting me through.

Though, in the back of my mind I was starting to worry John Paul wasn't exactly gaining enough. He wasn't chunking up like I was expecting, just getting long and lanky. BUT we really didn't have time to worry. We had just moved and needed to get settled before we could even think about seeking out another IBCLC. Plus, I was getting even more used to the pain and breastfeeding didn't seem as much of a hassle anymore, so we just let the saga go for a while.

That is, until. . . green poop.

Forest green poop.

Kid, I'm sorry I'm talking about your poop on the internet, but oh well. It's important.

John, my pediatrician husband, wasn't too concerned because green poop is on the spectrum of normal.

But, the more I read, the more I was convinced that his bright green poop was from, yet again, breastfeeding issues.

Apparently when baby only gets mom's protein-rich foremilk and none of her fat-dense hindmilk, the poop turns green. So basically, I was starting to think John Paul was not draining my breasts. He was only getting the first part of his feeding, the foremilk, and then getting too tired (from his bad latch) to get to the finish, where the hindmilk was hiding. It made all the sense to me, especially because he was getting lankier by the day. I was nervous I was underfeeding my baby, so we sought out an IBCLC in our new town STAT.

Enter Gloria.

Gloria is AWESOME.

Gloria is the IBCLC we've been working with for over a month now and I'm thinking I can finally say things are on the up and up, all because of her.

Our first appointment with her was O V E R W H E L M I N G !!! I don't know how I avoided a major breakdown in her office, but I did. Just barely did.

The very first thing she did was weigh our John Paul. At two months, our little man was clocking in around 10 lb 4 oz, putting him in the 15th percentile for weight. Considering he was in the 75th percentile at birth, I was pretty bummed to see such a huge drop.

Next, Gloria watched him eat. He maybe ate for 5 minutes, then fell asleep at the breast, which was pretty normal for him. I'd wake him, change his position to the football hold, he'd eat some more, then fall asleep again. This was our normal feeding routine. But this time, Gloria was there to weigh him to see how much he was taking in. After eating for almost 30 minutes, John Paul only took in 2 ounces.

According to Gloria, at two months old, John Paul should have been taking in 4 - 5 ounces during this morning feeding.

:(

I was underfeeding our little guy and we were finally able to prove it. It wasn't easy to hear, but at least my suspicions were finally confirmed. Thank you for pointing us in the right direction, green poop.

But why? Why was John Paul only taking in 2 ounces per 30-minute feeding?

Gloria said my form was perfect. I was holding him right and doing my best to get him latched on right. So I was doing my 50%. It was time to check on John Paul's 50%. She assumed the culprit was a lip and/or tongue tie, especially because he was still click click clicking with nearly every suck and taking forever to eat. I told her our previous IBCLC saw one but said it wasn't restricting his lip movement, so we never went any further with it. But when Gloria flipped his lip, she thought otherwise.

"Here's your problem!" she said.

That flippin' lip tie.

In a nut shell, his lip tie was making eating a chore for him (and painful for me!). He'd have to work so hard to get milk that it was tiring him out and putting him to sleep. Since he wasn't getting much at each feeding, he was telling my boobs, "make less, make less!" and was accidentally weaning himself in the process. So his latch was bad, his intake was low, and my supply was decreasing by the day.

None of this had really presented as an issue with our previous IBCLC because his weight gain was on track. But at that point he was only two weeks old and didn't need to be taking in 4 - 5 ounces per feeding. Now that he was bigger, he was still taking in amounts appropriate for a two-week-old and it was catching up with him.

If only our previous IBCLC had really tried to help us. UGH. If only. Our problems would have never gotten this far.

*ALL THE SIGHS*

Gloria quickly made a very intense plan-of-action for us. Since we wouldn't be able to get his lip tie lasered for another few weeks, we had to make sure he was getting enough in the meantime. We also needed to work on getting my supply back to normal. While I definitely wasn't starving him, he was getting just barely enough to stay at the minimum healthy weight. So we needed to up his cals quick.

This was when our new feeding routine started.

Feed John Paul at the breast for 5 minutes on each side. (I usually ended up feeding him for more like 15 minutes on each side because I enjoyed it and he did too.)
Feed John Paul a bottle of previously expressed milk, as much as he wanted.(It's easier to get milk out of a bottle vs. the breast, so John Paul really liked this addition.)
Pump each side for 10 minutes with a hospital grade pump.
Clean pump parts and bottle parts.
Put John Paul down for a nap and hope he didn't fight it.
Repeat 0.5 - 1.5 hours later, depending on how hungry he was.

Also, stop using the All Purpose Nipple Ointment after every feeding, because it was likely thinning my nipple skin (eek!). Instead I bought Motherlove Diaper Rash & Thrush ointment for the nippies.

And take Motherlove More Milk vitamins, a natural way to boost the milk supply. BUT! Be careful because they can lower your blood pressure and make you feel faint if you don't eat or drink enough. Oh, and they have a kinda gross aftertaste.

It was a doozy.

And the first day was so discouraging. When I'd pump after each feeding, I was only producing 1/3 to 1/2 of an ounce.

Enter massive meltdown.

I cried for about an hour that first day. I was so overwhelmed, so disappointed by where we were in our breastfeeding journey, feeling bad that my son had barely been eating enough for two months, and thinking I could not handle the new routine. I mean, I was about to start pumping like it was my full time job! At least 6 times a day! And feeding him on the breast on top of that. AND doing all the other mommy duties on top of THAT. Plus, I had this horrible feeling that we were at a point of no return with my milk supply and that our breastfeeding journey was quickly coming to an end.

It was not a pretty moment for me.

BUT! God has a way of redeeming these messes. Within a few days, I was finally getting the swing of things. I was pumping loads more milk and John Paul was a much happier baby as a result of all this extra foodage. I even got 12 ounces one morning after he ate off my breasts. 12 ounces!!! Life was good.

One trick I learned rather quickly was to keep John Paul distracted while pumping. This play gym from Ikea saved my butt, or boobs, rather.

Also, thank goodness, improved eating and improved sleeping went hand-in-hand. The more our baby ate, the easier nap time became. Phew! It was a weight off this weary momma's shoulders.

Two weeks flew on by and we took John Paul back to Gloria for a quick weigh in and check up before our lip tie lasering the next day. In just two weeks of our new routine, she was super impressed by how quickly my milk supply came back AND . . .

Drumroll please!

John Paul weighed in at a whopping 12 lb 3oz!!!

Our little stinker gained 2 lb in two weeks AND was now up to around the 30th percentile.

BOOM baby!

Oh, and yes. His poop was back to that pretty brownish-yellow color again, thanks for asking! He was finally getting my fatty hindmilk (via pumping and bottle feeding), packing on the pounds, and pooping the prettiest poop color I ever did see.

*Sigh of relief!*

The next day, we headed 30 minutes north to the nearest dentist capable of doing the lasering procedure. I was super nervous, because LASER. And kind of skeptical of how effective it'd be, but figured it was worth a shot. Almost all of our problems -- the clicking noise, green poop, slow weight gain, low supply, the way he tucked his lip funny whenever he was latched or eating from a bottle -- were, based on my research, all related to an upper lip tie, so I felt it was worth a try. And if it actually worked, it meant we could ditch the pump and bottle feeding all together since, with an improved latch, John Paul would be able to get more than just 2 ounces from my breasts and draw out the hindmilk on his own. So while I wasn't thrilled to have someone lasering my little baby's mouth tissue away, we decided to go through with it in the name of better breastfeeding.

The procedure was actually super quick. The dentist took a look at his lip tie to make sure he was a good candidate for the procedure and right away she said his case was pretty severe. A level IV lip tie! Yikes! I snuggled John Paul in my lap and held his head in place while John held his arms and legs, and within a minute, the dentist had successfully lasered his tie. John Paul was not super happy with us, but I put him to the breast as quickly as I could and he was basically good from there.

A few days after the procedure, we were already noticing a big difference. He was barely click click clicking anymore while feeding! I also wasn't feeling as much pain while he was at the breast. And he was more active while he was eating. Instead of falling asleep several times throughout his 30-minute feeding, he was awake and actively sucking. Were our problems finally fixed?

We saw Gloria a week after the procedure to weigh John Paul again and to see if the procedure had made a difference in John Paul's intake at the breast.

In just one week with his new latch, he was at 12 lb 12 oz and got 5 ounces off me in one feeding! 5 ounces!!!

PRAISE THE LORD!!

Also, before we started all this with Gloria, I was feeding him in several different positions at each feeding to help keep him awake and get access to my milk from different angles. Cross cradle for 5 minutes, football for 10 minutes, then switch sides and repeat. But NOW, we were just doing the cross cradle hold for about 10 minutes on each side because he didn't need all that help. As much as I didn't want to believe the lip tie was our problem, GOSH. . . we're seriously the poster family for lip-tie laser now, aren't we??

And now, two weeks after his epic 5-ounce feeding in Gloria's office, we're still in a good place.

I'm only pumping once or twice a day, which is way better than six or seven. John Paul gets only one bottle of expressed milk at the end of the day, to bulk him up for the long overnight sleep. No more lipstick shaped nipple after feedings, which means he's getting my nipple all the way into his mouth. Still seeing that beautiful brown poop ALL THE DAYS. And I only experience mild pain during feedings, if any at all.

That's not to say things are perfect. I still do experience some pain and haven't quite figured out what that's all about. Perhaps it's leftover from those first two months of his bad latch. Or perhaps I have a mild yeast infection that has gone untreated for a while. Or mayyyybe it's because I still haven't 100% given up on my All Purpose Nipple Ointment. Still using it twice a day because. . . I think I'm an addict.

But, baby steps, folks. We've come a long way since that first day of his life when he wouldn't even take the breast. If you'd told me at the beginning that breastfeeding would be this much of a hassle, this unnatural, THIS complicated, I'd have probably backed out a long time ago. But at this point, it seems the bulk of the troubles are behind us, and for that I'm extremely grateful.

Who knows? Maybe I'll get a raging case of mastitis tomorrow and really be ready to throw in the towel. I'm just going to keep taking it one feeding at a time. It's amazing what we've accomplished with that mindset so far, so we'll see how much further it'll take us.

Oh, and there's one other thing that's kept me going this long, and keeps me going still when we have a bad feeding here or there. The breastfeeding snuggles. Breastfeeding gives us happy hormones -- those lovely, happy-sleepy-drunky feelings both John Paul and I get when he's at the breast. And these days, I live for that. 

*Sigh of contentment.*

Lesson learned, folks. Next time, accumulate ALL THE BABY KNOWLEDGE before baby arrives.

;)