The fifth lactation consultant made me cry

The first three were at the hospital. (I'm not counting the nurses, all of whom had opinions too, of course, although they at least all jammed the mouth onto the boob the same way.) The very first was cheerful and charming. She must have come in before phrases of doom (weight loss! lazy mommy!) got transcribed in our file. The second was a bit more officious, and started me off on pumping for 15 minutes after every feeding attempt. To mkae my milk come in faster, see. Never mind that it was less than 36 hours since I'd given birth and NOTHING ABNORMAL WAS HAPPENING YET. The third was part of the team that tried to keep us at the hospital longer. GRRRRRRR.

So we went home. My milk came in. I engorged violently and really painfully and panicked. One evening Tabby could not latch on to my plasticky boobs. I was smart enough to stop pumping after the feeding attempts, and to find this random web page. Thank you, anonymous author, thank you. Brief pumping before, with aggressive massage, saved the day.

We went for weight checks at the pediatrician on Saturday, Monday, and Thursday. Monday we spoke with the lactation consultant (number four, if you're keeping track) at their office. She was not helpful. Most telling comment: so Tabby latched on in front of her. "Your toes didn't curl! Mine always did, with my kids." Uh, thanks. How many times did I tell you that nipple pain is not the fucking problem?

So, what is the problem? Tabby sleeps. A lot. Six hours at night, and really can't be woken to feed. Everyone has been telling me to have starts every two hours during the day. For several days I had to wake her up for many of those, too. But now she's on continuous feed, more or less, for most of the day. An hour and a half or so on, and maybe 20 minutes, or half an hour off. Her suck is often pretty lazy; pause, suck suck suck, pause. She'll look asleep, but any effort to remove her from the nipple wakes her and she sucks again. Every now and then she'll have a maybe 2 hour nap: after the first big feed in the morning, maybe around lunchtime. But those are not very predictable. Sometimes she sucks long enough that she gets annoyed at how empty things are and starts fussing, or punching my boob. If I take her off and lay her in the middle of my chest, though, she lifts her little head, roots hard, and sort of newborn-crawls over to a nipple, usually the one she just left.

She's clearly much better hydrated than she was back before my milk came in, and she's switched to breast milk poop.

I had high hopes for the fifth lactation consultant. She comes highly recommended by both local friends and my doula. Sadly, her visit only left me more panicked. She got to see the second hour of a two-hour long feed, bad latch, grumpiness and all. She got to see that nothing other than more boob time would actually comfort the poor babe (I think she was embarrassed that her highly honed baby-soothing skills failed to put Tabby to sleep, after a ful half hour of walking and jiggling). And she was left flummoxed, and with no specific advice beyond: try taking her off afer 45 minutes sometimes and see if you can calm her. Maybe craniosacral therapy would help with the suck intensity? And have you though about fenugreek?

She's not convinced about the weight gain (even though the pediatricians are, at last) and thinks there aren't enough poopy diapers. (One per day, except there hasn't been one yet today.) When I said she latched better lying on her right side, regardless of nipple side, LC5 brought up the possibility of torticollis. And, finally, after repeatedly poo-pooing actually feeding Tabby the milk from the nighttime pumping I'm doing, she finally allowed that, well, it might be good idea to try. Just, you know, she's worried about the lack of poopy diapers, and the lack of apparent curds in the mustardy poop we see.

I started zoning out as she picked out handouts from her big folder and tried to explain how to get my insurance to pay for her visit. I needed to disconnect. After she left, I cried. Oh, I cried, as Beaker and I syringe-fed Tabby an ounce or so of expressed milk—all she'd take.

I've never leaked, it's quite hard to hand-express, and, the middle-of-the-night pumping gets only about 10 ml on the left, although 40 ml on the right. The right is clearly larger, but Tabby prefers to suck on the left.

Many friends tell me their milk didn't really fully come in for two or three or perhaps even four weeks. But none of the LCs seem to buy that as a possibility. Hence supply panic.

I feel: I feel like, however this was supposed to get working, it hasn't, and I don't know how much is me and how much is Tabby and how much is our trying to follow too much of the advice we were given. Did forcing her to nurse before my milk came in get her used to sucking when there's not much there? Did the aggressive pumping early on force the excessive initial engorgement that made me panic? What would happen if we tried letting go of the clock and feeding when she wants to feed? But no one wants me to do that, no one at all.

Comments

[timna]

yes, letting go of the clock can be fine. yes.
I also got nasty marks for inadequate weight gain. LLL was most helpful with practical suggestions, esp just sleeping with my baby and nursing whenever.
It sounds easy from this distance (14 years), but I understand the panic. You've done so very much in the last week and month; I wish someone had told me that it would be ok, and I could indeed relax a bit.

Hope you have a good night.

[YelloCello]

The two friends of mine who have recently given birth both experienced similar anxieties around nursing. But both their infants are thriving now ...and they chalk that up to setting their own rhythms with the feeding. In one case, my friend ended up bottle feeding expressed breast milk to her daughter, because of her unusually extreme nipple pain. I'm not saying that's the solution (because I'm certainly no authority on this subject), but I am gathering that women find many different ways to make nursing work. So I second Timna's words and hope that you won't worry too much.

[M.]

Delurking to say with firmness, it's not your fault! Also, don't let yourself dwell on things that happened at the start, as if they've launched a chain of events you can't stop or change. Babies, and you, are more flexible than that. We put so much emphasis on the first few days, you can end up wishing "if only we'd done this" or "if only we'd not done that" over and over again.

Remember, with a baby, the last thing you try is always the one that work!

[Leslie]

All those lactaction consultants sound less than helpful. Is Tabby having the requisite number of wet diapers? I can't remember how many a day is appropriate for a newborn - my youngest is 10. I nursed all three kids, never paid attention to a schedule just pretty much nursed whenever for as long as they wanted when they were tiny. And the business of curds or not in the poop sounds weird to me - from what I can remember it varied all over the map for no discernable reason.

I think if she's having enough WET diapers, is pooping at least once a day and is gaining weight and you're not miserably engorged (some engorging off and on was my experience, especially with baby number one) I wouldn't worry - just enjoy her. And you might look for a mom's group or la leche league group just because talking to other moms in the same situation may be more helpful and less obnoxious than those consultants sound. Oh and one more thing - many newborns are really sleepy for the first couple of weeks and will then wake up a lot more and be much easier to feed. It sounds to me like you're doing ok so don't panic!

[Ancarett]

Just so you feel better, from the third day, youngest slept six to eight hours through at night. She was, like Tabby, more wakeful during the day as a result and we did have longer morning feeds.

Every baby is different. As long as your doctors and you, as parents, see progress, the other consultants and specialists are just going to give you more anxiety.

[martha]

Delurking to say, congratulations on the birth of your daughter! And also, I'm sorry it's so so difficult at the start. My son also slept for long stretches at first, and rarely nursed for less than an hour. I ended up nursing him when he wanted to eat, and in our situation, it worked out fine. I also remember that my children would go days without a poopy diaper. We gauged how much milk they were getting by the wet ones, and of course by overall weight gain.

My heart goes out to you. I hope things start to smooth out for you soon.

[Anna]

I'm not a lactation consultant, or really anything other than an interested mom of a breast fed 4 1/2 month old. I can tell you that I didn't pump during the first week, and when my milk came in (on day 3), it was like having two rocks attached to my chest. My boobs were HUGELY engorged (like, pornstar boobs), and extremely hard to the touch. I wound up having to pump an ounce or two before each feeding otherwise my daughter couldn't latch. So I doubt pumping led to your engorgement; it was probably inevitable. To this day, I still get engorged on the (too infrequent) mornings where a certain small someone has slept through the night!

I think, if she's gaining weight and having lots of wet diapers, you're probably in good shape and should let her set the schedule for a week or two, see what happens. Her poop has switched to yellow, right? Not merconium? My DD is a frequent pooper (5, 6 times a day), but you may have lucked into a once-a-dayer.

[Heidi]

Learning to nurse can be really difficult for you and the baby, and it sounds like your baby is "sleepy" like mine was and difficult to interest in nursing consistently. We fended off well-intentioned nurses and LCs whose suggestions (supplement with sugar water; use a cold wet washcloth to wake up the baby to nurse) verged on punitive and irrational. Ignore any scare-mongering--you'll know if there's a problem looming--and don't forget that you know your baby better than anyone else does. Try to make sure that you're taking care of yourself as much as you can--it will get better!

[alecia]

We had a really sleepy baby too. He was jaundiced so the doctor was very concerned that he get enough fluids. The only thing that seemed to work for us was making him uncomfortable - taking off his clothes so he was a little cold, leaving the lights on, and constantly stimulating him. One of the LCs also recommended giving him some chest-to-chest time (both of us naked skin to skin) before feeding. We tried that once or twice, but I found that rubbing his face worked best because it activated the rooting reflex. I also did the trick of starting to pull him off the breast and then (like Tabby) he'd wake back up and start sucking again. I would sometimes have to do that over and over during a feeding session. We also found it helped to really wake him up before starting a feed - we'd undress him, play bicycle with his legs, and do anything we could to get him as awake as possible (we even have a funny video of this) before I would put him on the breast. Maybe some of these tricks will work for you - best of luck and hopefully things will start to go better!

[Moxie]

I'm not exactly sure what your problem is. Your baby nurses and has plenty of wet diapers, no? She cluster feeds during the day and sleeps a good long stretch at night? She's gaining weight?

It sounds like the only problem you actually have is that she falls asleep during feeds (which will improve as she gets older and heavier) and that your supply isn't completely up yet. Drink a ton of water and eat several bowls of oatmeal, and nurse her when she wants to. Just hang out in bed or on the couch all day and nurse. If you really want to work on your supply, pump for 5-10 minutes after each feed.

Oh, wait. I think I did figure out the problem. Too many lactation consultants trying to "manage" you.

FWIW, one of my friends had a baby who pooped once a week from day 1. There's no such thing as normal with breastmilk poop. Both of mine have changed pooping frequency at every growth spurt.

FWIW #2, leaking is a function of the muscle in your breasts that controls the milk flow. Some women have tight muscles (no leaking) and some have looser muscles (lots of leaking). It's possible to produce a ton and still not leak if you happen to have tight muscles there.

FWIW #3, if you or your boobs need a break from the constant feeding during the day, have Beaker put her in the sling and take her for a walk for 30 minutes outside. It's amazing how well outside works.

FWIW #4, I think you're doing a great job. Trust your instincts.

[bj]

no advice for you, just a comment that I found nursing really really hard in the beginning. And, every piece of advice made me feel inadequate, like I wasn't doing it right. No one just said to me, it's hard in the begining (or, maybe more realistically, for some women and their babies, it can be hard in the beginning). And, the beginning can be a long time. With my first, that's what I needed to hear, and for my second, I'd learned to say it to myself. I quit nursing my daughter at 3 weeks, but stuck through with my son because I'd told myself that it was going to be hard, but I was going to do it anyway, at least for 6 weeks (and then, at 6 weeks, I said, OK, another 6 weeks). It took 3 mo before we got into a comfortable nursing relationship, and it was touch and go that whole time. But, after sticking through it for 3 mo, we had a 16 mo nursing relationship, which we both enjoyed, and for which I am very greatful.

bj

[dish]

I haven't even had time to chime in and say congrats- so I'll start with that...congrats!

Don't worry about the poop- it's the pee that matters. I about freaked when my son went three days without a poop- called the doctor and they said that with a breastfed baby they are comfortable with 5-7 days between poops as long as there are wet diapers (and the pee is color- and odor-less). Initially, he was pooping with just about every feed, and it dropped off dramatically very quickly by two weeks.

I have no great advice with the nursing. I had to supplement after a few days because of jaundice, and we're still supplementing to this day because I couldn't keep up with the growth sports. I am 100% ok with that. The kid actually prefers to nurse, but also knows that he'll be fuller if he takes a bottle, too. That works for me, and I'm not recommending it to you- just telling you the story of another mom. You do the thing that is right for *you*.

[Amanda]

My baby just turned one, and nursing him was a very big trial in the beginning. It got dramatically easier as he aged. I mostly wanted to give you a pointer to http://www.kellymom.com/. I am particularly fond of the site for its effort to present evidence based information on nursing. Reading all about it helped me get through the aweful parts. You are doing well, and remember: every day she, as well as you, gets older and learns more. Together you will make it work. As long as she's gianing appropriate weight, things have a way of sorting themselves out.

[liz]

Lots of baby books say that you may not get poopy diapers for 3 or 4 days and that it is okay. If you're getting growth, I think that's what really matters.

Ummmm....that being said...After she's woken up from a longer nap, try some of your expressed milk and see how much she takes, maybe?

Muffin Man HATED breast feeding, so we gave it up after a few weeks and bottle-fed him expressed milk for nine months.. Boring, and disappointing and very sad for me, but it worked for him. I'm not encouraging you to give up, just wanted to let you know that it's doable to feed breast milk even if your baby doesn't breast feed well.

[selzach]

I'm sorry the LCs haven't been a help. I ended up seeing 3 different ones and phone consulting with a 4th during Peanut's first few weeks. We ended up going the expressed milk route and he's a thriving 10-month old (and I'm proud to say I'm still expressing). I wish bfing had worked, I was so dissapointed when it didn't.

I completely understand the worries and fear that your little one isn't getting enough to eat. Hang in there. You two will figure out something that works.

[Ally]

Congrats on the birth of your daughter! I'm sorry you're having problems bfing.

As always, what Moxie said. And I second the kellymom.com recommendation. And a LLL meeting might be just what you need. You should find lots of sympathy and support at one.

We had a sleepy baby too. Undressing, feet tickling, bright lights worked sometimes and sometimes they didn't. He cluster fed and cried 3-5 hours a night the first 3 weeks. Eventually things came together. But the first weeks are rough.

[Karen F.]

Ooohh. You need a hug. {{{Hug}}}
I, too, found nursing to be very challenging in the beginning. And nobody told me how hard it was going to be. It seemed like my daughter was permanently attached; there were no 10 minute quick feedings for me. It was more like two hours "plugged in" one hour off. In the grand "pumping" scale, I was also never very good. In the beginning I would get at most an ounce. During the whole first two years, I got 4 ounces only a handful of times. I just nursed often and for long periods of time, and it somehow managed to work out for us. Don't be hard on yourself if you're not able to pump a lot - I had a stash of freezer weight ziplocs, and I froze every ounce of milk in them, and somehow I always had enough. I do remember crying in the pediatrician's office at the two week checkup. I had nursed her every two hours around the clock, I was exhausted, and although while she was gaining weight, she still cried a lot. Oh! This too will pass. The first weeks ARE rough. You will get through it.

[nate]

Hi;
You don't know me--I'm a lurker--WAHM (med librarian) at a large midwestern univ. I've been following your blog for a couple of months. So first, congratulations! Second, here's my attempt to make you feel better.
1) BF'ing is very hard, and often demoralizing, for 1-2 months. At about 2 months it got better, and at 3 months--just when people start asking you how long you're going to nurse--it became easy. Of course, that's when I had to go back to work & start pumping, but that's a different issue. In any case, she's 2 1/2 now, and she shows no inclination to stop any time soon. It CAN be done.
2) My dd was constantly attached to me for about 2 months--her nursing pattern was very similar to yours. Some annoying LC told me that "she's probably not getting much milk after about 20 min and is just comfort sucking." Guess what I came to realize? Breastfeeding is NOT just about food. And with a LOT of people it's totally normal to be confined to your rocking chair for hours at a time. Here's my advice: get a pile of magazines or paperbacks, stock up on NetFlix, make sure your chair is comfortable, and settle in.
3) re: poops--I've heard it said that lots of bf'ed babies don't poop much, and that the lack of poop is really just indicative of what a perfect food mama milk is, b/c it's so completely digestible. At about 2 weeks my dd went to 1 poop/day. AT 4 weeks she started going 3 days, which gradually spread out to once/week. Of course, those would be doozies, but it was SO nice to have so few dirties! We asked her dr., and she said "that's just the way she is!" The only thing that matters is that she's gaining wait & peeing. I've heard of babies that go 12-13 days.
4) I 2nd the recommendation to KellyMom. Also, I'd hang out for a while at Mothering.com, on the "Getting started" breastfeeding board. The best advice I got was from other nursing moms.
5) If you feel like you have to supplement, don't feel guilty. If you're worried about nipple confusion, try a Lact-Aid or Supplemental Nursing System.
6) You said: "What would happen if we tried letting go of the clock and feeding when she wants to feed? But no one wants me to do that, no one at all." DO IT! Well, you might try to wake her up for a middle-of the night feeding, but don't try to put her on some schedule that someone who DOESN'T KNOW YOUR CHILD suggests.

Well, here I am giving tons of advice when I was going to try to limit myself to telling you that you really are doing things right. And it'll be fine. Oh, and if you can bring yourself to do it, stop pumping after she nurses--pumping is a horrible way to find out how much milk you have, is demoralizing, and takes away from the time you can be sitting & enjoying your baby when she's NOT nursing. The only people who suggest pumping after a feeding are those who've never had to do it.

If you feel like you need to submit yourself to a 6th LC, but are running out of options there, you might want to call the consultant here. http://www.happybambino.com/page.asp?redir=aspx&pgid=150062
I've never talked to her, but the place she works is a great resource (and good place to spend money).

And finally, the only piece of advice I still remember, from the Family Med doc my dh took dd to when she was 4 days old, to check on her jaundice: "Tell your wife, if breastfeeding stayed this hard nobody would do it." I can't tell you how valuable that was to me...

Also, what Moxie said.
-Nate

Posted by Emma Jane at 01:34 AM in Baby! | Permalink "

[nate]

OMG.
I just looked at my comment, and realized how insanely long it is. Can you tell I'm still processing my own experience, 30 months ago?
Sorry about that. I hope there's at least one piece of good information--or reassurance--in there for you. I don't think I said it before, so here goes:

You're doing a great job. You'll be okay. And Tabby will be okay.

[suz]

1. My now-6mo-old was attached constantly for the first month or two, often nursing while sleeping. Are you using slings? Ours were *huge* help- the only time I could get a break from nursing was when she was in a sling. She has slept progressively less at every stage since birth, and now is awake 16-18 hours for every 24 and always wants to play. Sleep while you can.

2. Sometimes she pooped every day. Sometimes she went a week. Sometimes it was six times a day. Usually the pattern changed around a growth spurt.

3. Drink more water. I had a little trouble with my supply but I was really having a hard time staying hydrated. I drink almost a gallon a day, every day. I also had very good luck with mother's milk tea, and used the fenugreek suggestion as an excuse to eat Indian food every day.

4. Hang in there. You're doing a good job. Don't let anyone convince you otherwise. Breastfeeding is hard work, and has continued to be tough for me, even though the challenges are different as time goes on. It was very hard for me at first to trust that it was working okay.

Oh, and CONGRATULATIONS! :)

[Jody]

What Moxie wrote. WHAT MOXIE WROTE.

I have no idea of your LCs' credentials, but I'm totally mystified by the lot of them. Your baby is nursing continuously during the day, has plenty of wet diapers, has steady weight gain after initial difficulties, and is pooping? You're not experiencing nipple pain and you're having reasonable luck with waking a sleepy baby?

WHAT'S THE PROBLEM?

In my experience, the single biggest threat to breastfeeding is that early fear that you're starving your baby. "She's nursing all the time, my breasts don't feel engorged anymore, I must be hurting my baby." And speaking purely for myself, it's obvious in retrospect that all my BF anxieties arose from all sorts of subterranean fears I had about being able to nurture my babies. It was the first place that my childhood ghosts and nascent insecurities emerged: I had this unconscious assumption that I wasn't good enough.

Therefore, it's really hard to read your story, because Tabby's patterns sound EXACTLY like my girl Gemma's. Long stretches of sleeping at night right from the get-go, willingness to stay on the breast all day, lazily sucking, and punching at what seemed like empty breasts to me. I started supplementing her more and more, I had less and less confidence in my body...the road to hell is paved with good intentions.

Truly, if Tabby's peeing regularly and pooping regularly (even if infrequently) and if she's gaining weight, and if you can manage the insanity of constant breastfeeding, then I would try to relax. Drink lots of fluids, have lots of snacks nearby, find some good books that you can read one-handed or prop next to you. Do you have a laptop? Settle in for the long haul.

If your gut tells you Tabby's still sleepy (and it sounds like it does), then keep on offering the breast as often as you're doing. Don't worry, because she will wake up. But be wary of supplements: they don't sound necessary to me. And they can really mess things up, on the demand-driven milk-production factory floor.

Oh, one last piece of advice, from Karen Gromada, shared with me long after the fact: how much you pump has no correlation to how much you're producing. NONE. That you aren't pumping very much means NOTHING in terms of how much Tabby's getting.

Truly. It sounds like you are doing a fantastic job.

[kimcee]

If you have ever experienced pain during nursing, or are planning to breastfeed, you must visit this site:

http:/www.nursingessentials.org

The nursing device is worn during feeding which is when it hurts most! I was about to throw in the towel when I could not find anything to relieve my pain, but I used this product and made it over the hump. Finally a product used during feeding Not afterwards... breastfeeding does not need to be painful anymore!

[mdavey]

Great advice, esp Nate, Snuz, and Karen F. I breastfed both kids till age 1.5 back in the early 80's when nursing was still uncharted waters. I agree that your worst problem is the "lactation consultants". Dump them. Make contact with LLL now.

Forget pumping (and, WHY are you pumping, anyway???). You have enough on your plate, plus, it may be contributing to your engorgement. Nurse on demand till 3 or 4 or even 5 months, and be glad for the 6 hrs sleep a night. Your breasts will adjust to your baby's particular routine, and in the meantime, relieve engorgement with hot compresses. Don't use a machine, ever. Learn to do it with your hands. It's not hard. Farmers have done it for years with cows & goats, and humans aren't that much different in this most mammalian regard.

Oh, and throw all your nursing bras away. An unbound breast promotes better milk flow, and prevents engorgement and mastitis.

I too had difficulty with beginning nursing the first child. Though my OB/GYN was very supportive & encouraging, at that time, he had little knowledge of managing the nursing couple. (The hospital had less, and unintentionally gave a lot of bad advice). He actually told me about LLL, and they saved the day for all of us, more than once.

Call LLL today.

BTW, I am happy to report that both my old OB/GYN and the hospital now do an excellent job in lactation support, in part thanks to working with LLL.