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Breastfeeding is Hard

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Breastfeeding is Hard

I couldn't think of what to title this post except, well, this. When I was preparing to become a mom, I never imagined it would be so challenging to breastfeed. Once we were faced with the obstacles described below, I was so discouraged and frustrated. Mostly, the support of a few key friends and family members have helped me to persevere and be able to succeed at breastfeeding.

For some, "success" means feeding only by breast with no props, tools, or bottle feeding. That hasn't worked for us. For us, success has been getting Sammi to develop a preference for the breast, keeping my milk supply up, not having to supplement with formula, eliminating obstacles to successfully latching, and getting the baby to latch on a bare breast.

Nursing Sports Bra by Love and Fit

Nursing Sports Bra by Love and Fit

Bottle to Breast after the NICU

Sammi was in the NICU for 10 days after birth, so she started on the bottle. I'll be doing a post on how I got my milk supply to come in while Sammi was in the NICU soon. I attempted breastfeeding a few times in the NICU, but it was clear that we needed a more relaxed environment. So I waited until I got her home to attempt the transition to the breast.

I found that by offering her some expressed breast milk from the bottle at the start of a feed took the edge off, so she was less "hangry" and able to tolerate me offering her the breast. She was very used to the fast flow of the bottles in the NICU, so we also switched her to the Dr. Brown's bottle. Eventually, she figured out how to feed off my breast with the use of a nipple shield.

One day about halfway through that two week transition period from bottle to breast, we "boot camped" her by only offering the breast for about six hours, per my pediatrician's recommendation. ALWAYS FOLLOW THE ADVICE OF YOUR PEDIATRICIAN WHEN IT COMES TO FEEDING. It took about two weeks of patience and diligence to get her to feed consistently off my breast, without needing to be coaxed into a feeding by the bottle.

Baby is Slow to Gain Weight

Early in our breastfeeding experience, Sammi was very slow to gain weight. My doctor told me never to let her go more than three hours without eating after that first boot camp, because of the slow weight gain. Sammi has never woken up to eat at night. She prefers to sleep for 6-7 hour stretches, only having woken up at night a handful of times.

My doctor was recommending that I wake her for at least one nightly feed, but after attempting this a few times I found I wasn't successful at getting her to eat at night. Even when I would change her diaper and other things to rouse her, she just fussed and went back to sleep. This is just how she's wired. Despite my attempts to apply our pediatrician's advice, Sammi's never been a night eater.

I shared this with my pediatrician and lactation consultant, and they both advised the same alternate course of action. Instead of trying to force a night feeding, we focused on making sure she was getting at least 7 solid feedings in during the day time. After a lot of experimentation, we found a combination of breast and bottle feeding (all breastmilk) was the best solution to help her put weight on. It took a month for Sammi to get back to her birth weight. It wasn’t until around 2 months that she began to gain weight at a consistently healthy rate, once we'd figured out the right combination of feeding modalities.

Using a Nipple Shield

Sammi fed off a nipple shield until about 10 weeks old, never able to latch on a bare breast. I worked with a lactation consultant several times to successfully get her to feed without the shield. 

We identified that she had an upper lip and both anterior and posterior tongue ties, which were the main obstacles to her being able to latch without a shield. More on how we addressed those below. 

Both my lactation consultant and pediatrician encouraged me to not worry about the use of the shield during this first 10 weeks. Because Sammi was a slow gainer, it was much more important that she eat, period, than that she eat in the way I wanted her to. Feeding without a shield moved way down the list of issues I wanted to address until later in our journey.

Supplementing with Bottle Feedings

While her weight gain was slow and we were working on feeding issues related to her ties, I was going back-and-forth to the pediatrician for lots of weight checks. At one weight check, a different doctor at our pediatric practice came down on me for not switching to formula or bottle feeding. I was enraged.

We had been deprived of so many experiences because of her NICU stay, such as me being able to hold my baby right after birth, or have skin-to-skin in the first 24 hours. I was resolved that we wouldn't be formula fed or feed exclusively from the bottle. This may make sense for some families, but it didn't feel right for us.

I did ultimately decide to give her expressed breastmilk via bottle for a few feedings a day. I fought this, because it was so challenging to get her from bottle to breast initially. I finally relented at six weeks, when she still wasn't gaining weight quickly enough. I was pleasantly surprised to find she went very easily between the two, sometimes even during the same feeding. No nipple confusion at all!

Tongue Tie and Upper Lip Te Revisions

At about two weeks, we had a frenectomy done on Sammi's anterior tongue tie. This didn't really make a big difference in her ability to latch or feed. She continued to gain weight very slowly for the next month, when we decided to do a second revision, this time more drastic.

We had her lip ties (all three on the upper lip) and further, posterior tongue tie revised at around 8 weeks old. We diligently performed exercises to help proper healing. The same doctor who had told me to switch to formula (jerk) told me that tongue and lip ties are a "fad." Well, I can definitely say from our experience that they were a very real obstacle to her latching, and it was necessary to revise those ties before we were able to latch on a bare breast.

My regular pediatrician verified that the ties existed (as did my lactation consultant). They both encouraged me to get the procedure done, not only for feeding but because ties can also contribute to speech impediments later in childhood. ALWAYS FOLLOW THE ADVICE OF YOUR PEDIATRICIAN WHEN IT COMES TO REVISING TONGUE AND LIP TIES. But find a doctor who is supportive of you trying to breastfeed, even when difficulties arise.

Successfully Weaning Off of Nipple Shield

Truthfully, I wouldn't really say we "weaned" Sammi off the shield. She weaned herself when she was ready and we'd performed the procedures to free up her ties. After the ties were revised, I kept offering the bare breast not quite every feeding, but at least a few times a day. By 10 weeks and a few days, she just popped on my bare boob one day, as if she were saying, "I know how to do this now." She decided she was ready, not me.

At 11 weeks, we're now successfully gaining weight and feeding off the bare breast for several feeds a day. She takes only breast milk, but by giving her at least 3 x 4-oz of expressed breast milk from a bottle, we ensure she takes a sufficient volume of milk each day. This has helped her to gain weight consistently.

My lactation consultant has suggested that she may develop a stronger suck as a result of getting more milk, and having her ties revised, so one day we might be able to scale back on bottle feeding.

Weaning Off of Bottle Feedings

Once she's been gaining really strong for at least a month or so, I would like to see if we can decrease her reliance on the bottle feedings. But I'm not going to force it or do anything that slows her weight gain. Until then, I'll continue to do her "suck training" and give several bottles until we feel that she's strong enough to feed off the breast for a majority of her feedings.

In some ways it's more convenient to feed Sammi from the bottle, when we're out and about or traveling, or when I need a break and want to hand her to someone else to perform the feeding, like Daddy or Grandma or other care giver. So in reality we probably won't ever fully wean, but it would be a better quality of life for us both to do less pumping, cleaning, and mishigas around those bottle feedings. But I'll do it as long as it remains necessary for her well-being.

Should I Breastfeed?

It is such a deeply personal choice to breastfeed or not. For some families, it's just not the right thing. For me, I've never felt there's an alternative. In my bones, it just seemed like Sammi needed to be able to breastfeed, and so we've committed tremendous time and resources to make this happen. But every family must do what is right for them. And you MUST follow your doctor's advice navigating this journey. That said, find a doctor who is willing to support you in trying to breastfeed, if that's what you want to do. 

Here are the resources we used to succeed with breastfeeding, in the way that makes sense for us!

Northern Virginia Lactation Consultants
Smile Wonders Pediatric Dentistry
KellyMom.com

Do you have questions about breastfeeding? Or an experience to share? Leave it in the comments and let me know!

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NICU Mommy Survival Guide

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NICU Mommy Survival Guide

Two months ago I waddled out the door to the hospital. I was 41 weeks and two days pregnant, and we had an appointment to induce that evening. But one hour before our induction appointment, I started having contractions. 

Last mirror selfie before leaving the house on the day I went into labor!

Last mirror selfie before leaving the house on the day I went into labor!

From that moment on, it’s been a whirlwind. This little lady has definitely kept us on our toes! Our first two months have been far from perfect. My daughter Samantha (Sammi) spent the first 10 days of her life in the Neonatal Intensive Care Unit (NICU) due to Meconium Aspiration. At the time, my husband and I didn't share what we were going through because something about our daughter's health felt sacred and off limits for public consumption. I hesitated to put this blog post out for that same reason.

But ultimately, we decided to open up about our experience in the interest of supporting other moms. NICU mommies are like a special, secret tribe. In order to support other women who find themselves an unhappy member of this tribe, like I did, here are my tips on surviving the NICU, based on what I went through.

Embrace the Pain

One of the coping mechanisms women are taught as they prepare for labor (particularly, natural labor) is to embrace the pain, rather than try to avoid it or resist it. Once your child is taken from your arms after delivery (if they ever make it there--mine didn't) and whisked off to the NICU, your first few days are going to be very different from how you may have imagined them.

Meeting my daughter for the first time. She needed immediate medical attention, so I didn't get to hold her until a day after her birth.

Meeting my daughter for the first time. She needed immediate medical attention, so I didn't get to hold her until a day after her birth.

As a NICU Mommy, your story isn't going to look like you thought it would. It's not going to look like anyone else's story, or like the stories you see in movies, or on Pampers commercials. You won't have that happy, smiling photo of you and your partner holding your baby in your arms moments after her birth. But Mama, this is your story. Your beautiful, imperfect, painful, exhausting, but ultimately triumphant story.

It may be days, weeks, or months before you get to take your infant home. No matter how short or long your NICU stay is, there will be setbacks and challenges before your little one can discharge. Your patience and strength will be tested. If you let your mind go to the, "This isn't how I thought it would be," or "I wish it weren't happening like this," or "It's so unfair this is happening to us," place(s), you'll only making the experience harder on yourself.

For better or worse, this is how your story is playing out. The best thing you can do for both yourself and your infant is to embrace this imperfect story, and be super present for the days to come. It will end, eventually. At some point, you'll look back and wonder, "Did that really happen?"

Be Present

Once I learned my daughter would be staying in the NICU for at least a week to undergo a course of antibiotics--and therefore, would not be coming home from the hospital with me when I discharged two days after her birth--an instinctual part of me took over. This part of me knew that I would need to be completely present in order to get myself and my daughter through this experience.

I turned the notifications off on my phone's various messenger apps. I stayed off social media. I only checked in with a few people to update them on my daughter's status. I didn't read, I didn't watch T.V., I didn't listen to podcasts, or the radio. Not even news. In the car on the way to the hospital, and at home or during pumping sessions, I listened to music. Coldplay, reggae, and silly but familiar artists from the 80's, or my favorite bands from college, were heavy in my Spotify rotation.

My first time holding my daughter, in the NICU, a day after she was born.

My first time holding my daughter, in the NICU, a day after she was born.

I also limited my social interaction to only people that I felt really safe with, and who were read-in on the situation, so that I didn't have to go into a lot of exhausting explanation of what was happening with my daughter, or "perform" for anyone. Really, the only people I had meaningful interaction with during this time were my husband and my mom. I did have a few light interactions with friends, but I kept that to an absolute minimum.

It's important to note that I didn't cut myself off from the outside world and screen time to punish myself, or deprive myself of pleasure. I did it to conserve my energy, and as an act of self love. I didn't want to drain myself by rehashing updates to countless people, or having to manage comments and replies, or deal with other people's feelings about the situation.

Being off-the-grid was a gift I gave myself during those agonizing 10 days, as someone who is SUPER on-the-grid most of the time. I wanted to conserve all of my mental, emotional, and physical energy to support my daughter's recovery. And that meant staying completely present, rather than numbing out on my phone.

Be a Slave to Your Routine

Routine is your savior during any stressful time. As a NICU Mommy, you've got to eat, sleep, pump, take care of your postpartum recovery, and be at that baby's bed side as much as you can (while not draining yourself or going crazy). Once you get through the first few days of sheer survival mode, try to establish a routine, in collaboration with your partner and support system. Stick to that routine as best you can, so that you're not constantly having to expend energy on deciding what to do next, or allowing anything (especially your own self-care) to slide.

My routine looked something like this:

NICU Mommy Survival Guide

If you try to be in the NICU for 12 hours a day, you will go crazy and that stress will effect the baby. I wanted so badly to be there every second, but I found that taking a break for my own self-care mid-morning helped a lot. This ensured I didn't have any postpartum recovery issues, and kept me energized for the times that I was there next to her, so that time was more high quality.

Obviously, your schedule will vary depending on how far you live from the hospital, the NICU hours at your hospital, you and your baby's own medical situation, and the other demands upon you and your partners' time (work, etc.). You don't have to keep the same routine I did, but sticking to this allowed me to get 4-6 hours of sleep per night, squeeze in a short nap, pump at least 8 times a day, eat 3 times a day, get 2 "sits baths," be present for 3 bedside feedings, get skin-to-skin time with my baby, plus attend doctor's rounds every morning. However you manage your time, make sure you're getting it all in! 

Lean on Loved Ones

I have to plug my husband here--he was my rock during this time. I couldn't have gotten through this without him, and I'm so grateful to have a loving, supportive partner by my side. Even if you don't have a significant other that you're co-parenting with, this is a time to lean on those you love, and who love you. As I said, I kept this limited to my husband and my mother. But call in the people that you feel safe with, and lean on them hard for support.

My husband and I also wrestled with whether or not we should both try to be there together all the time. You have to do what is right for you, and what allows you to maintain sanity and keep your life on track. Ultimately, we decided it would be best for him to go back to work after the first week of Sammi's life. He would come and relieve me in the NICU in the evenings, when I would go to pump for the final time at the hospital. This also gave him a chance to bond with her.

I couldn't bear the thought of being alone in the NICU those last few days while my husband was at work, so my mom came to town and did the NICU hours with me for the final few days. She made sure I remembered to eat, and take my sits baths. She did chores while I got a quick nap in during the day. She went home when my husband arrived at the NICU in the evenings to cook dinner for us, so we could eat, pump, and crash when we got home. Between my husband and my mom, I never drove myself to-and-from the hospital, which was best for all of us. Having my mom by my side was so comforting, and one some level she understood my feelings and what I was going through physically better than any man could, so it meant the world to have her there with me!

As a new mom, your hormones are still all over the place, in addition to the stress of having an unwell child. So don't be afraid to ask for what you need from your loved ones, and make sure you and your partner have communicated clearly about what everyone needs to make it through this stressful time. Don't put pressure on yourselves to go it alone. These are the times that your loved ones can step in and support you!

Be Kind & Do No Harm

Above all, be sure to be so, so kind to yourself during your infant's NICU stay. If you need to stay away for part of the day to maintain your sanity, or use the NICU's family room to be fully present for a 24-hour period (I did this my daughter's final day in the hospital--I had to ask, they didn't tell me it was an option), do whatever is right for you, your child, and your family.

Remember that you are no good to your child if you aren't taking care of yourself, so don't let your self-care slide. Postpartum recovery is difficult under the best of circumstances, and even tougher when you're sitting upright in an uncomfortable hospital chair for 8-12 hours a day. That baby needs you to be your best, healthiest, most energetic self when you are able to take her home. Do no harm to yourself during this difficult time, and stay on top of your self care so that you're able to be the best mommy you can be!

Finally welcoming baby Sammi home after 10 days in the NICU

Finally welcoming baby Sammi home after 10 days in the NICU

Ultimately, we are grateful to have a happy, healthy baby. The medical care we received was outstanding and we are blessed to have that kind of care available to us. Now that I have some distance from it, my experience of motherhood is no longer defined by this early trauma.

Our family is sending so much love and support to all the NICU Mommies out there--you can do it, Mama! Even though it will feel like an eternity while you're in the thick of it with your baby's NICU stay, the time will pass, and your baby will make it home with you. We are so happy to have Sammi home with us and living a happy, healthy life! 

Do you have a story or some tips to share? Please post those in the comments below!

Note: some NICU stays do end in fatalities, and for those dealing with this type of situation, my heart goes out to you. I haven't addressed those circumstances here, but this piece is a great resource for anyone dealing with the loss of an infant.

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