April 20th, 2014 – Moo Cow

    We have officially been parents for 21 days now!  It has been an interesting journey.  We have had so much to learn and so has our son.  There is just so much that they don’t tell you about being a parent and even what they do say doesn’t make much sense until you live it.  So far we have had adventures with circumcision and upper respiratory junk and had several appointments to see the pediatrician. 

    Our little guy has been quite the trooper as we learn on the fly.  The moment he was born we had learning to do.  My first lessons were in feeding him.  Something that seems so natural and normal is surprisingly complicated.  The first thing I learned was OUCH!  Breastfeeding hurts.  No one talks about that.  Everything I knew about breastfeeding came from watching videos, reading, seeing friends do it, and knowing that pediatricians all recommend it.  In all my knowledge seeking no one mentioned pain!  Breastfeeding hurts, at least at first.  No one mentions that you essentially need to build up callouses on your nipples and that in order to do that they first crack, blister, and become very, very painful just like any other skin that is building a callous (only on your NIPPLES!).  So, for anyone reading this that is planning on breastfeeding I am saying it.  Breastfeeding hurts and it hurts every time you feed until your breasts are healed which is a couple of weeks.  Stick with it if you can, but if you can’t I don’t think anyone can blame you.  Work with lactation specialists and learn how to get your child to latch properly.  Our lactation specialists were amazing and totally saved my breasts!

    This skill is learned in the hospital while surrounded by people telling you what to do.  And while our hospital has an amazing lactation consultation service our nursing staff had their own opinions about how things should be done.  So at times I heard conflicting advice and felt pressure to supplement when I really didn’t need to.  I took the route of the student and asked everyone who came into my room questions.  I took advice from pediatricians (who were also moms), nurses, and lactation specialists.  I breastfed in front of a lot of people just to make sure I was doing it right.  Here is what I learned.  First off, no matter what the nurses tell you, you don’t need to supplement.  If you are waiting for your milk to come in you just need to offer the breast more frequently.  Doing this will help your milk come in.  Supplementing can actually interfere with your milk supply, so don’t do it if you can avoid it.  I started by offering each breast for 5 minutes at a time every two hours or as soon as Monkey started rooting (which was any time he was awake).  By the time I left the hospital I was up to 10 minutes a breast for every session.  The hard part with a newborn is keeping them awake for the entire feeding! 

    Second, all babies lose weight just after birth.  The nurses were freaking out because our little guy was down 5% of his birth weight.  This had them making me feel like a terrible mom for not giving up on breastfeeding and using formula instead.  However, every pediatrician who saw him noted his weight loss and said it was fine and I didn’t need to supplement.  Ask more than one person if you are getting conflicting advice.  If it hadn’t been for the doctors and lactation consultants I would have been shamed into formula feeding by the labor nurses. 

    Newborns need to eat every 2-3 hours and they need to feed off booth breasts in order to help establish a solid milk supply.  We left the hospital a day early and my milk had already come in before I left.  This is super early for a first time mom and I think it had a lot to do with the pediatricians and lactation staff supporting me in continuing to offer the breast instead of supplementing.  The nurses did convince me to supplement on a couple of occasions and what I learned was that our little guy was eating plenty from the breast and he really preferred breast milk to the formula.  The formula also seemed to make him very gassy, which made him fussy and that was no fun for anyone. 

    Finally, offering the bottle and even the pacifier was interfering with his learning to latch properly.  Even still if I offer the breast after he has had a pacifier I have to take him off the breast and work on getting him properly latched.  Improper latch is SO painful!  Toe curling pain.  I have kicked the dog off the foot rest of my chair repeatedly when he latches improperly, it is that painful.  Thankfully our little guy doesn’t seem too fond of the pacifier! 

    I also learned a couple of tips for helping keep the nipple damage and pain to a minimum.  The first was to use hard plastic shields to keep anything from touching or rubbing your nipples.  Our hospital had Medela shields that they offered me.  They look ridiculous (like old school Madonna) but they really do help.  Although once your milk comes in they just get gross, so I stopped using them.  The second is to use lanolin on your nipples to help with the chaffing.  Our little guy would refuse to latch when I used it, so it wasn’t really an option.  He would literally latch and instantly open his mouth wide and remove himself from the breast.  I had several doctors and all the nurses tell me this was nonsense (in my head).  Then I spoke with a lactation consultant and a pediatrician who both had seen it before.  Some babies don’t like lanolin, but it seems most don’t notice it.  This epiphany did lead me to a better solution though.  Instead of using the lanolin, hand express at the end of the feeding and allow the colostrum to dry on the nipple.  This actually healed my cracked nipples in no time.  Much faster than what I was seeing with the lanolin.  So, you might give it a try if you are suffering the way I was.  

    The other side of breastfeeding that I hadn’t really considered much before is that you become the sole provider for nourishment, which means you are up every time he needs to eat.  We are 3 weeks in and the longest Monkey has gone between feeds is 5 hours.  Even that is only once or twice a day.  He averages about 7 feeding sessions a day, so the average time between feedings is less than 4 hours.  Each session takes about an hour.  I get him up, change him, feed him for 10 minutes on each breast, and then we need to spend about 20 minutes up right to help him with his reflux.  That leaves 3 hours for me to get any personal chores done and sleep.  I average no more than 2 hours of sleep at a time for the past 3 weeks.  One day Doc took him and I got 4 hours.  It was glorious.  But for the average day I am seriously sleep deprived.  I have started pumping, but we haven’t really used any of that supply yet.  We are saving it up.  It was recommended to us that we save it for when he is older and gets sick.  I pumped and save colostrum for that very purpose.  We know a pediatrician who swears by it, and since she gave me the rub colostrum on my nipples tip, I believe her. 

    Overall I think breastfeeding has been worth the time and pain.  Little man picked up a little upper respiratory junk and it seems to have resolved quickly.  Doc said he thinks the breastfeeding is what helped.  I think it also helped me establish a schedule, which makes all of our lives easier.   Little man is a very happy and easy going baby and while I think a large part of that is just his personality I also think that the schedule helps with that.  I have noticed that when his schedule is disrupted by visits or appointments he is a lot less easy going and gets fussy.  At 21 days old his is starting to tolerate small disruptions and adjustments to the schedule, but he really prefers when he knows what comes next in his day.  Finally, I think the time I spend feeding him is full of quality bonding.  I was the first person he made eye contact with and it was while he was attached to the breast.  It is a very special feeling to be able to provide nourishment and comfort to your child no matter where you are or what is going on.  If that doesn’t sell you on breastfeeding, then maybe this will… you burn 500 extra calories a day breastfeeding!  That is like 2 snickers bars.  ;-) 

April 6th, 2014 – Labor, Labor, Labor of Love

    After our 2 previous attempts and failure at inductions I was exhausted.  Bed rest for the week was a breeze because I felt awful all week long.  The contractions had continued all week, so it was very reminiscent of the miscarriage.  My body was exhausted and so were my emotions.  By the time Saturday rolled around I was dreading our trip to the hospital and another round of induction.  Doc and I had spent a lot of time discussing the possibility of a C-section and it was sounding better and better to both of us in comparison to another failed induction. 

    We arrived at the hospital Saturday night and began the process all over again.  I was still only 2 cm dilated and my cervix had actual become less effaced because the baby had moved off of it the day before and flipped himself around.  They applied the cervical ripening agent every 4 hours to prep me for another day of Pitocin.  They also hooked me up to all the monitors and gave me a half dose of Ambien.  Our nurse for the evening was brand new and it was obvious.  She was very sweet, but she was in my room at least once an hour checking on me because I was having contractions so frequently.  I repeatedly explained that it was normal and had been happening all week, but it didn’t seem to alleviate her fear that I would spontaneously deliver a baby without complaint during the night as I slept.  It was a horrible start for what I already knew was going to be a long and rough day.  By the time morning rolled around my fear about another day of Pitocin had ramped up to the point that I felt like I shouldn’t be doing the 3^rd induction at all.  Despite this, my new nurse hung the Pitocin.

    In the morning I got a new nurse, one with a lot more experience, and a new doctor.  The doctor was one my doctor worked with frequently.  Apparently it is common for them to labor each other’s patients and then call the other in for the delivery.  It was nice because it meant they kept in contact and didn’t step on each other’s toes.  I felt much better about being in his hands than I had with the previous doctors on call.  The first thing they did was explain that the night nurse shouldn’t have hung the Pitocin.  Again, great start to the day.  Then they explained that they wanted to break my water because they didn’t believe I would progress without it.  Rupturing the membrane allows the cushion between baby’s head and cervix to be removed and increases pressure on the cervix, which usually results in labor progressing quickly.  I have previously discussed my concerns about breaking my water so early.  I had really hoped to wait to do it until I was at least 4 cm, preferably 6 cm and labor was progressing more regularly.  The doctor and nurse were convinced that breaking my water was the answer to my failure to progress, I thought they were under appreciating the fact that my cervix had failed to dilate for a miscarriage and 2 previous inductions.  They did a lot of talking at me.  I did a lot of trying not to cry in front of them.  The doctor finally got called away and the nurse stayed to talk at me.  When I couldn’t hold back the tears any longer she gave us a moment to discuss it.  I felt very strongly about not wanting my water broken this early in the process, but they had made it clear that they thought I was in for another day of labor not progressing without it.  My biggest fear was a full day of horrible labor only to end up in C-section any way.  There just wasn’t a good option available.  I didn’t want the C-section unless I knew I had to have it, but I wasn’t going to find out if it had to happen unless I consented to having my water ruptured at only 2 cm.  It was a hard decision to make on a clear day, it felt like an impossible decision to make after no sleep and dealing with the aftermath of 2 failed inductions.  Bawling and feeling totally overwhelmed and defeated, I consented to the process.  We discussed a time line with the doctor to make sure we were all on the same page with regards to how far we would let things go and how long we would allow me to be ruptured.  Thankfully he agreed with the more conservative pediatrician recommendations and so did my nurse, so that would be the end of the battle and we could go forward on the same team. 

    At 9:30 am they ruptured my water.  No meconium staining and baby boy handled the change beautifully.  Contractions increased immediately.  They increased my Pitocin and my nurse remained with us at all times to monitor my progress.  I opted to labor in the tub again because the contractions were back to back and it was impossible to get comfortable in the bed or to walk.  I spent over an hour in the tub.  Doc and my nurse kept refilling me with hot water because I couldn’t move to do anything.  We played music to help keep me distracted and I got over any modesty I may have had.  My contractions were so intense and so close together that I couldn’t carry a conversation.  I just focused on breathing and floating. 

    Around 11:30 the contractions started spacing out.  By spacing out I mean they were now 2-3 minutes apart.  I decided to get out of the tub, because even that comfort only lasted so long.  My nurse wanted to place internal monitors to monitor the intensity of the contractions, which means I would be confined to the bed.  We discussed it and I agreed it was time for the epidural if they needed me to sit still for the remainder of the process.  I was 4 cm by the time the epidural and monitors were in.  My contractions would follow a strong pattern and then begin to space out.  They would increase the Pitocin, the contractions would increase, and then they would space out again.  We couldn’t get my body to show signs of steady progress despite strong contractions. 

    By 2:30 I had made no additional progress.  My nurse had tried placing me in all kinds of crazy positions.  You haven’t lived until you have been naked, immobilized and had your body placed in positions that make your privates a show for anyone who comes in the room.  The doctor came to check on me and was disappointed that we hadn’t progressed despite all of our efforts.  We asked him for a time line of how far we were going to go with this.  He felt that if we hadn’t progressed beyond 4 cm by 6:30 we most likely were not going to be able to deliver this baby naturally.  He was concerned that being stalled for so long wasn’t good for baby or me. 

    By 6:30 we had made no progress despite continued increases on the Pitocin and my nurse attempting to stretch the cervix by hand.  Baby boy decided he had had enough too and flipped face up and started to struggle a little more with contractions.  I worried every time I heard his heart rate slow and Doc’s eyes were glued to the monitor.  The nurse came in and explained she had been watching the monitor too and it was time to call in my doctor for a C-section. 

    At just before 7:15 I was being wheeled into the OR.  I was so exhausted that I couldn’t keep my eyes open or respond when people spoke to me.  I felt like I was struggling to remain conscious.  Baby boy was born at 7:22, 6 lbs and 14 oz, and 19.5 inches long.  I knew his cry the moment I heard it and fought to find consciousness so that I could see him.  I could hear Doc and my doctor talking.  I heard the nurse ask Doc if he wanted to examine him and I was so proud when Doc responded with, “No, I’m not his doctor.  I’m his Dad.”  It is hard for doctors to separate the 2, and he was starting off on the right foot.  My doctor teased him about his son’s full head of hair (Doc is bald).  They were doing well and that made me so very happy.  As they finished up I began shaking.  The shakes were so bad that I couldn’t keep my arms down on the table.  It was like I was having a seizure.  So not fun.  I couldn’t hold or touch my baby, but I could talk to him.  Doc said he oriented to my voice immediately and when he was held next to me he stopped crying. 

    The first hour after the C-section was torture.  The shaking was so bad that I wasn’t able to hold my son.  I had to wait to regain control over my hands before he could be in my arms.  Doc and I were both madly in love with him from the moment we saw him.  He is just perfect.  Holding him for the first time and nursing him were just magical moments I wouldn’t trade for anything. 

   We ended up leaving the hospital a day early.  I was exhausted and the hospital is no place to try and sleep, so we decided we could all recover better at home.  We have been working on getting a schedule established.  It is important to do it before Doc has to be back to work.  I have 2 weeks where I am unable to drive and I can’t pick up anything over 20 lbs for the next 6 weeks, so I am really glad he is home.  Not to mention recovering from the C-section has its own difficulties.  Baby boy is a good eater and has already begun to gain weight.  His nights and days are confused, like most babies, but we are working on getting that straightened out.  He is absolutely amazing and we adore him, despite the lack of sleep.  Doc and I are both enjoying every moment, but also looking forward to the day when we are able to sleep in the same bed at the same time again.  Until then, we just have to be full of joy for the wonderful thing that is life with our son.