Nursing Ivy Lyn
"We don’t treat asthma in mothers to whom breathing is important. The importance of breathing is assumed by everyone at every level, and anyone having trouble with it is going to do what she needs to do to get it to work. Period. What a wonderful world it will be – and how much more easily successes will come – when breastfeeding is nothing more than what our own culture does.“
-- Diane Wiessinger, Author, IBCLC and La Leche League Leader
"As our collective understanding is replenished, concerning the importance of feeding our children well, our society will change for the better. It is Not A Good Thing to have a generation of infants who can't suckle, toddlers who are "picky", and kids who crave foods that don't nourish their bodies and help them feel good. Eating is a public health issue that affects us all."
This article, and the fact that I have two healthy, fully-breastfed girls, is due to the amazing assistance of Jeanette McCullough, IBCLC, Awesome Individual, and Support Person Extraordinaire. Jeanette spent many dozens of hours helping, coaching, problem-solving, comforting, encouraging, understanding, and Possibly Praying in order to help us get our little girls fed.
To say that feeding my children has been challenging is one of those understatements that makes me ponder an appropriate analogy until my sleep-deprived brain begins to wither into a puddle of Sad Thoughts. There is nothing in my mothering career that has brought me to my knees the way Nursing and Feeding has done - it was WAY harder than riding my bike across the country, and much more challenging than any of the other Personal-Growthy-type endeavors that I used to pay money to experience. I've spent thousands of hours doing some of the most heartbreaking/exasperating work in the world, and I wish so heartily that I could go back in time to chat with myself as a new mom, and anyone else who has ever struggled to nurse a baby or feed a child, and share even a shred of useful information.
Jeff's and my babies were each born via beautiful, peaceful home births, with no medications or trauma involved. They were all four tongue- and lip-tied, but when Ben was born, I had never even heard of the term (nor did anyone mention it to me until he was five years old).
I remember sitting in a La Leche League meeting in early 2004 with six-week-old Ben, and we were a bit of a mess already. I was exhausted, nursing was going absolutely terribly in terms of my pain level and his screaming and barfing and waking up all night, and the best advice the nursing professionals had given me, was: "It's not supposed to hurt."
Yeah, well, on what planet? I had tried everything: the cross-cradle hold, the football hold, block feeding, nursing lying down, nursing sitting up, sleeping while propped up with baby on my chest, latching carefully, breast compression, breast massage, cabbage leaf compresses, ice, heat, making sure more of my breast tissue went deep into the baby's mouth....the list went on forever. And it still freaking HURT. Even when we weren't nursing, my breasts hurt. And so...if I wasn't lying about the pain, which I definitely wasn't, then La Leche League must be lying about the painless possibilities of breastfeeding.
When I ventured to relate, at that long-ago LLL meeting, the strange emotions that I was experiencing - such as bursts of extreme rage when my milk let down - the other mamas looked at me politely but distantly, like I might have some strange and possibly contagious disease. It was clear that their breasts didn't feel like explosive cantaloupes.
"Just enjoy him!" one of the moms recited. "It goes so fast, and before you know it, this stage will be long gone!"
Ben nursed till he was three...but that other mom was right: my Baby is now twelve years old. And it is with some sorrow that I remember his infancy, how little I was able to enjoy it, and how much pain I (and later he) was in.
After Jem was born (2007) my moods were slightly better, though not great, but then-three-year-old Ben was getting extremely difficult, with severe challenges again relating to eating, to the point where it was hard to enjoy the baby along with everything else that was going on. Breastfeeding went better from baby's perspective (he latched and got plenty to eat), but it was still awfully painful for me - though we persevered, and Jem nursed till he was four.
And then came Eliza's pregnancy and babyhood, like a speedy kick to the skull in terms of enjoyability - she never learned to successfully suck at the breast nor suck on a bottle with a standard nipple, and our days and nights were spent in an endless cycle of pumping, feeding, screaming, and Failure To Thrive on a family-wide scale.
During none of my older kids' infancies could I relax in bed and cuddle them. There were feeding challenges, reflux, tummy issues, "colic," screaming... None of my older babies, for various reasons, could stand to stay still (though all of them hated the rocking chair, too - parental aerobics was really their preference). I remember in 2003, when I was first pregnant, imagining how awesome it would be to cuddle in bed with my newborn...and during my first eleven years of parenting, I never got to experience this fantasy.
Anyway. Mostly I have tried to forget all this, since we were never ever going to have another child.
And then along came Ivy http://lifeisapalindrome.com/updates/birth-ivy-lyn . Her birth was amazing, we had a team of Midwife/Assistant/Lactation Consultant at the ready, and by day #2, my nipple pain announced that Ivy had a posterior tongue-tie, and probably a lip-tie as well. Jeanette confirmed this, and we made an appointment in Albany to get the tie revised the next day. My theory this time was that because it was still so early, Ivy wouldn't have a chance to develop any bad nursing habits, and the surgery would free up her tongue/lip and allow her to learn to nurse normally with no further problems.
We drove to Albany, had the procedure done, and drove right back home again. I sat gingerly in the backseat with Ivy, wincing and bouncing as little as possible in due respect for what my bottom had just been through. On that ride home, my milk came in, and I looked forward to pain-free nursing sessions with my little newborn nursling to relieve the engorgement.
Unfortunately, it didn't go quite that smoothly.
I still think the surgery is hugely necessary, for some babies (like mine), with some types of ties. But I also think that the surgery is a stress on both baby and family, and that a released tongue is an injured tongue (even when a laser-which-has-analgesic-effects is used for the procedure) - and all this chaos right after birth is not the same experience for baby as it would be if she had a perfectly-non-tied-and-non-injured-tongue. Stretching the incision multiple times per day is hugely necessary too, especially for babies like mine whose bodies seem intent on re-attachment at all costs - but again, this is a trauma that impacts feeding.
Ivy did continue to nurse through all this, but she wasn't using her tongue very efficiently, judging from the way it felt on sensitive parts of my anatomy. I was also dealing with oversupply again, and the constantly rushing milk made Ivy pull off the breast repeatedly and struggle to compensate with a shallower latch - which in turn repeatedly traumatized my breasts, which began to throb and ache in all sorts of familiar and new ways.
Postpartum pain is not so great, I've found, but the worst of it is usually over within a month or so. Breastfeeding pain, however, is a sign worth recognizing. I have finally learned that the experts are right: Nursing Isn't Supposed To Hurt! And when it does, there is a problem.
My expert Support People agreed that I seemed to have a low-grade infection, but my attempts to quench the infection (using soap and water, baking soda, medi-honey, etc.) seemed thwarted by Ivy's consistently poor technique at the breast. It didn't make sense to me to use antibiotics if the reason for the infection was damage induced by nursing my baby, which had to happen every hour or two. Every time my breasts would start feeling a little bit better, Ivy's tiny jaws would clamp down, I would cry out in increasing agony, and the cycle would begin again. I found myself second-guessing everything, and very often the horrendous memories from Eliza's infancy came flooding back on a wave of sick-feeling hormones. I definitely felt rage welling up then, and a desire to hurl something large out the window - no way no how can I do this again!!!!
During those first couple of weeks, yet again stressed and bewildered by something that "should" be so simple, trying to understand what was "normal" and what wasn't, crying three times per day while we stretched yet another infant's tongue and lip incisions while she howled sadly...we were in a situation that wasn't really normal to begin with. Let me just say that Ivy and I had a really loving and generous bunch of people on our side: papa/husband, birth team, grandparents/parents, family, friends.
Once Jeff had to go back to work (the beginning of week 3), I started to panic. Nursing was NOT going well, even though I was trying every position, every possible feeding technique I could think of. In order to deal with the pain, and to reduce the damage to my breasts caused by an even slightly more-worse latch, I had to shut myself in the bedroom with absolutely no interruptions, and set up our pillows, props, and water glass. This would be a cool trick if Jeff wasn't home and Eliza was flipping out (she hadn't yet grown to adore her new sibling) and dinner needed cooking at the same time...
We hired Karen to come for a week, and Mom was coming to help for a week after that, so I kept careful accounting of how much time I had "left" to figure this out. I was grateful for help, yet increasingly worried: what if I couldn't get breastfeeding to work, and soon? What if this pain got worse? I could not again become a shut-in with the breast pump for a year, yet I didn't want to feed Ivy formula, yet I couldn't survive the pain for much longer.
Two more weeks ticked by, with varying levels of Pain pain pain pain pain, and I was desperately clinging to hope that the next day, the next hour, the next feeding would Turn Things Around. I started getting these blade-like shooting pains, deep in my breast, during and in between feedings. I could barely let Ivy nurse for long enough for her to get full, and none of the techniques we kept trying was enough to reduce the nipple pain to manageable levels. Jeanette thought there really must be a continuing low-level infection, but I really didn't want to use medication that might also dose Ivy, and possibly do any damage to her tiny gut. Plus: Ivy had poor technique, and antibiotics just didn't make sense when there was such constant trauma occurring at the poor, sad Situations otherwise known as my breasts.
When Ivy was four weeks old, despite her rapidly plumping-up, apparently Good Health, she started having reflux. Hours of "colic" each day/night added a new level of urgency to the must-figure-out-the-nursing situation. And so I did what everyone says you're supposed to do when you need help: I asked for help. Various friends took shifts, watching the older kids, and Ivy and I spent yet another week, practicing nursing.
When Ivy was five weeks old, the reflux got REALLY bad. And it was at this point that Jeanette and I finally managed to one-by-one address each seemingly intractable problem with actual, permanent solutions. This will sound a lot more linear than it felt at the time, but here's what we did.
ISSUES #1 AND #2: my continued oversupply, and Ivy's newly-really-bad reflux
Solution: I did a ton of googling, and eventually found this helpful article http://dianaibclc.com/2012/06/15/understanding-oversupply/ . The author discusses food allergy and baby reflux, and then continues:
'...Does this even relate to oversupply? If so, how? It’s clear that the symptoms in babies are similar. Some professionals suspect a cause and effect relationship, that something about the mother’s gut health causes both oversupply AND allergic sensitivity in the breastfed baby. There is no current, specific research linking maternal gut health to oversupply, but it has been my experience that most mothers with oversupply also have babies with allergic reactions to something in their milk. (Tongue tie in the baby is also very often present, but this goes beyond the scope of this post.) To me, this suggests that the mother’s digestive issues (which she may or may not be aware of – she may feel perfectly healthy and well), can result in a host of abnormal outcomes, among them oversupply and forceful let-down. While not “evidence-based practice,” rather, “practice-based evidence,” I’ve noticed over the last 7 years that the mothers who eliminated one or more allergens from their diets were delighted not only with their happier babies and normalized milk production, but with how terrific they felt without the allergen!...'
I don't regularly eat any of the allergens mentioned in the article except for dairy. And I have absolutely no other symptoms of dairy allergy that I know of. However: within one week of removing all dairy from my diet, Ivy's reflux subsided substantially. And the interesting Other Effect was that within 36 hours, my oversupply vanished. Poof. No more oversupply. I still have no clear theory about why a dairy allergy would be invisible apart from some vague impact on my pituitary hormones and milk supply...but I do know that if I eat any dairy at all, even now that Ivy is ten months old, my breasts become slightly engorged, inflamed, and tender. (And me eating dairy also causes Ivy to shit in her pants at 3am. Every. Single. Night. With no dairy, the shitting reverts to much more manageable hours.)
Taken together, these facts mean that for the time being, I do not eat dairy.
ISSUE #3: Ivy's poor latch
My general feeling is that while tongue- and lip-tie surgery made it possible for Ivy to latch better, and to have a lot more overall Potential in the nursing department, she wasn't able to develop great habits even though the revision happened so early.
Some symptoms of her poor latch: "falling off" the breast while she was nursing (I had to be super still, and even then she would gradually slide off until she was chowing on the nipple shaft), having to re-latch at least 3-5 times per feeding, my pain wasn't helped by switching positions, and I was constantly sore with plugged ducts, Absolutely Unhappy Nipples, and that breast infection that wouldn't heal.
Finally, I looked under Ivy's lip for the first time since I'd stopped stretching it, and noticed that the frenulum had re-attached somewhat. It wasn't "multiple thread-like adhesions" (like the ones I'd had to break under her tongue, which I did with tears streaming down my cheeks during some of Ivy's "stretching" exercises a couple of weeks before), and it wasn't super wide like when she was born, but it had definitely re-attached about halfway down her gum. Her tongue seemed to be mostly still free, but the re-attached tie must be causing some of my continued pain. Ivy's upper lip never flanged outward when she latched - and her upper gum blanched if you stretched her upper lip.
I thought: we'll need to go back to Albany! And then I started to cry, because I did NOT want to cut my baby again. But what could we do? How come my babies' ties always reattach?! Maybe she'd never be able to nurse properly if we didn't get her anatomy to cooperate...
Solutions (included those described below, but also): I found useful information about how to deepen a baby's latch when baby has lip tie (lip ties can cause even more pain for mom than tongue ties) http://thefunnyshapedwoman.blogspot.com/2011/03/introducing-maxillary-labial-frenulum.html . Combined with the reprieve granted by the diminishing reflux, this seemed promising: it made sense to me that it wasn't the lip tie alone causing problems, nor only the reflux, and that in theory at least, there must be ways for Ivy to Do More With What She Had.
But just to be on the safe side, I made an appointment with the Doctor in Albany for later in the week.
ISSUE #4: Pain associated with what I call the Mild-Neurological-Problem-Induced-Nipple-Clamping-Suck-of-Doom.
During these episodes, it was like Ivy simply Forgot What To Do With Her Tongue In Order To Get Milk, and she compensated by clenching madly in between pulling-off and screaming. I would end up dancing (or crying) in pain, or letting her cry, until the episode would finally pass. The episodes would last between 3-24 hours, and they happened every day or two or three - definitely oftener than I'd like!
I never could find any correlation with anything specific. Sometimes after a traumatizing trip in the car, her sucking was just terrible. And sometimes not. And sometimes the Problem Sucking happened mysteriously in the night, and at other times she nursed totally fine (well, relatively) at night, and it would be 10am on a lovely morning when she suddenly couldn't quite remember how to nurse.
Solution: addressing all the other issues, and Waiting Until She Got To Be About Three Months Old.
ISSUE #5: My sub-clinical breast infection had a sudden flare, introducing amazing levels of excruciating agony
Jeanette felt this was a multi-factoral issue. My breasts were being traumatized by poor latch, but when I was in so much pain, I couldn't even tell if Ivy's latch was improving.
Solution: Since rinsing my breasts with various natural substances, including soap, baking soda, vinegar, etc., was not offering lasting relief, I decided to try washing and drying after each nursing session with only water. (I promised that if the acute pain had not subsided over the weekend, I would use the antibiotics.)
And then Jeanette set up a Skype consult for me with Cathy Genna http://www.cwgenna.com/ , a lactation consultant who, as Jeanette says, Literally Writes The Books on breastfeeding special-needs and tongued-tied infants. Jeanette facilitated the consult by sitting next to me and making sure I understood what Cathy said. And Cathy packed an amazing amount of information into our consult, concerning Ivy's positioning, her impediments and weaknesses, her particular asymmetry and how to balance her skills by targeted strengthening exercises. Cathy confirmed that at this point, Ivy might be able to do a lot more with the amount of tongue that still remained un-tied. Cathy said that it was possible for my nipples to heal once Ivy stopped traumatizing them. She gave me muscle-strengthening exercises to reverse the beginnings of Ivy's torticollis. She showed me how to employ traction on the soft tissue of Ivy's chin to allow her a few millimeters more length in her tongue. She showed me ways to maximize Ivy's ability to nurse...without requiring more trauma. I was finally gaining more and more hope. Ivy seemed to like the exercises, and we called it Baby Physical Therapy.
I postponed the appointment in Albany.
http://www.cwgenna.com/quickhelp.html Latching 101 - if your baby is having trouble doing this, professional help CAN help!
http://www.newmommymedia.com/episode/tongue-ties-lip-ties-symptoms-treatments-aftercare/ Cathy Genna discusses frenotomy aftercare, and impacts on breastfeeding
Although there were a few more tense moments in the area of nursing, the consultation with Cathy truly turned the tide. The ferocious pain in my breasts actually subsided (without the antibiotics). Over the next four weeks (Cathy's uncannily accurate estimate for how long it might take Ivy to become a Good Nurser), Ivy got stronger and stronger and soon started nursing like a pro 97% of the time.
I canceled the appointment in Albany.
Ivy and I no longer needed pillows and props, although to this day we have to shut ourselves in the bedroom in order to complete a feeding. It's annoying, but also a minuscule price to pay:
I now have a happy, healthy, dimpled, plump, friendly, joyful nursing baby! There are millions of 'em...but this one is ours, and I am profoundly grateful.