Wednesday, August 4, 2010

The Best Advice

My original due date was April 24, 2009.  We all know how due dates go.

I had been in the hospital on bedrest with pregnancy-induced hypertension for 24 hours when they told me I could go home.  I had called my ride, packed my stuff, and was pacing the floor when they politely told me that the 24-hour urine test results were back, and I was dumping protein in my urine.  The doctor said get back in bed, and called a specialist to consult.

Said specialist met with me and my mom and told us some fear-inducing story about a mother with the same condition (HELLP syndrome and pre-eclampsia) who died right after delivery, so I would be staying put.  (I later learned about a SMC who died of the same condition in her third trimester and I cried and said thank-you prayers for three days.)

My OB group agreed with the specialist, and I was told that if I made it to 37 weeks without my blood pressure spiking (or having a stroke, whichever), that (a) I would be lucky and (b) she would then be born 3 weeks early.

I looked at my calendar and realized that the breastfeeding class I had signed up for was AFTER the big 37 week mark, so I called the wonderful nurse who had done my pre-hospitalization registration and left her a tearful message about needing to reschedule.  She managed to "work me in" to a class with Jo, who turned out to be the. best. lactation. consultant. on. the. planet.

She's at St. Elizabeth Medical Center in Edgewood, Kentucky, and if you ever have a lactation question, call her.  She is amazing.

So in honor of Jo, and World Breastfeeding Week, I give you the best advice on breastfeeding that I ever got.

1.  You need a good pump.  A really really really high quality pump.  I had already received a pump as a gift.  It was bought at a discount store.  It was on her list of the ones to not use, so I had it returned.  I got a Medela Pump In Style Advanced as a group gift from the women where I used to teach, and was very very grateful.  I think it definitely helped me to have good supply in the beginning.

2.  You need a good latch.  Good latch requires the baby to open is mouth wide.  How do you get them to do that?  Get in their face, and open your mouth wide.  They will mimic you.  Then shove the b00b in their mouth.  She recommends this as the way dads can help with the process.  She showed photos and told stories of dads from her previous classes who swear it works.  She was dead serious as she was telling and showing this part of the class.  It was rather hard for me to keep a straight face.

3.  The cradle hold is for older babies, not for newborns.  They are too tiny and their heads are way too floppy.  Do the football hold or what she called the reverse cradle hold, where you hold the back of the head and neck with the hand/arm opposite the side you are nursing on.  And don't put your finger on the back of the head, that pushes the head into your flesh and its hard for them to breathe.  I was practicing with the floppy headed heavy baby doll that was losing its stuffing in the class, and I found that to be the hardest part.  Practice definitely helped.

4.  Nurse (a) as soon as you can, and (b) as often as you can until your milk comes in.  Throw the schedule out the window, babies aren't born with a watch.  Later you can try to extend the feedings and the time between the feedings.

Another great piece of advice I got from a book that came with, of all things, a formula sample.  It is the only place in print I ever read about Overactive Letdown Syndrome, and what to do about it.  I had this issue, only I didn't really know what it was.  I just knew the baby was really gassy, and really fussy, and threw up all. the. time.  Overactive letdown means you release milk with the force of a fire hose, and there is alot of the foremilk.  That's the really sweet, thin milk that helps ease thirst and entice nursing.  If you do the classic "x minutes and switch", the baby ends up getting nothing but foremilk.  Foremilk has a ton of lactose in it.  Not all babies make the lactase enzyme right away, so that milk ferments in their gut and makes gas.

To combat some of these effects of overactive letdown, you should nurse on one side only, for as long as the baby wants to nurse.  When they pull away, you can offer the other breast, but they will likely refuse.  If they want to nurse again within a 3-hour window, nurse on the same side again.  This pattern allows the baby to nurse on one side long enough to get both the foremilk and the hindmilk that is nutrient and calorie dense, and nutritionally necessary.  They don't get too much of the foremilk (and the gas and bloating and crying) and they get the nutritionally good hindmilk (so they can keep gaining weight). 

While this method might not work for everyone, it has worked well for us.  Our pattern has always been to nurse on one side for each feeding, rather than to nurse for a period of time and then switch.  I did this after my supply was established, so if you are trying this method in the beginning, definitely pump on the other side too.

Those were the pieces of advice that helped the most.  And we did good, because she nursed in the recovery room for 40 minutes total, and hasn't stopped since!

Anyone else have a great nugget of breastfeeding advice, or a good source?  How are you celebrating World Breastfeeding Week?

p.s. the first night after Wee One was born, Jo was the LC doing rounds.  She gave us a few minor suggestions, then she put a gold star the crib card.  I was proud that we got a gold star for breastfeeding, but it grew as people came into the room over the weekend and exclaimed "wow, you got a gold star from JO!  That's impressive."


Laraf123 said...

I was unsuccessful nursing my first but it's been a wonderful, unexpected surprise to nurse my second child. (When my first was born the hospital L.C. was horrible to me--it was all downhill from there.) With my second, mostly I just figured it out on my own because it was the only way I was allowed to stay in the NICU with him.

Overactive Letdown Syndrome: I had not heard of this but once my milk shot out 4 feet across the living room for about 30 seconds. It was the most bizarre thing I've ever seen!!!

Funky Mama Bird said...

I really wish that I had taken a class in breast feeding before Gunne was born. He's tongue tied and couldn't latch, and add in the fact that my milk didn't come in until verrrrry late and you get a recipe for formula AND PPA.

MommieV said...

we had one night in the NICU where they weighed her, I breastfed her, and then they weighed her again. If she didn't take in enough, they force-fed formula down her throat with a syringe.

Worst night of anxiety I've ever had.