Let Down

Until about 6 years ago, I had no interest in breastfeeding. I think it was mostly discomfort with the "granola" aspects of nursing and partly my (mis) conception that nursing would be a nuisance and time consuming.

By the time I started thinking about having kids, I no longer thought nursing was weird and had read a lot of research about the benefits, including decreasing risks of autism and other childhood disorders. That being said, I wasn't looking forward to nursing. I had heard (accurately) that it was very painful at first and everything I read reiterated how challenging it could be. Statistically I would not be nursing my children the 1 year minimum recommended by WHO and AAP.

When I was pregnant with Isla I took a nursing class (with Andrew), and read all the chapters in my baby books about nursing. I delivered at a hospital that was known for being extremely Breast Feeding Friendly and my birth plan detailed my desire to exclusively breast feed, even in various scenarios where neither Isla or myself would be physically able to nurse immediately after her birth.

Isla was able to nurse within minutes of being born. Every nurse that worked in L&D had extensive lactation training and we left feeling confident about nursing. Isla lost a lot of weight because it took time for my milk to come in, but our pediatrician let me continue to nurse without supplementing and we were rewarded with a massive weight gain a week later. From then on, I routinely took her in to weigh her and nurse her and then weigh her again to see how much she was getting.

It turned out that I'd been wrong about nursing. It wasn't something to be endured, it was a wonderful bonding opportunity and a special way to continue the care I'd given Isla when I was pregnant. I loved nursing Isla. In the first few months would nurse for literally an hour or more at a time and I spent hours sitting in my rocker with an Anne of Green Gables book nursing and reading. I reread the entire series and many other books.

When Isla started having reflux (aka - arching her back and screaming during and after feedings and having projectile spit up during and after feedings) and was put on medication at 1 month old I brought her to a lactation consultant and learned all the environmental modifications I could make to decrease her reflux. I learned to nurse her sitting upright and then held her upright for 30 minutes after her feedings. I perfected various burping methods that would bring up a burp without bringing up her meal. I was anxious about using medication, but we started it too and eventually tried two others until having success with prevacid.

When she was diagnosed with Milk/Soy Protein Intolerance and allergic colitis (bloody, mucusy diarrhea) at 4 months I met with the lactation consultant again, stopped eating all soy and dairy (a cooking revolution in our home), started taking "More Milk Plus," a fenugreek concoction to increase supply, and started attending 2 nursing support groups (Yep, a bunch of ladies sitting around nursing and talking to a lactation consultant and each other about nursing and other baby related challenges. It was really nice & I miss it.).

At 11 months Isla & I developed thrush (I think because of some reusable nursing pads). It took 3 miserable months to resolve thanks to my very uniformed primary care provider, but I continued to nurse (that was the low point, and the only time I thought about quitting). When Isla did not outgrow her allergies by 1 year I kept nursing until she was 16 months old.

In retrospect, breast feeding Isla was not easy, but, perhaps because of my complete commitment and my expectation that it would be "SO hard," it never seemed as difficult as I expected. The nuisances were vastly outweighed by the rewards. I loved the regular opportunities to bond with Isla. On a selfish level, I loved that I alone could nourish her, just as I had when I was pregnant. Breast feeding was convenient, FREE, and from everything I read the absolute best thing I could do to ensure her health and well being. It seemed to work too! Isla didn't get a real cold until she was over a year old and her ear infections, sinus infections, and major allergy issues didn't kick in until after weaning.

Isaac proved to be another nursing challenge, but I felt prepared. With 16 months of experience, a knowledge of my supply, and a general idea of what breastfeeding entailed, I was a lot less anxious.

The mechanics of nursing were much easier this time. I quickly learned to nurse one handed while reading to Isla, making her lunch, doing laundry, etc. With less time to spend with Isaac, I appreciated the regular opportunities to snuggle and provide for him. Since Isaac may be our last child, I was particularly appreciative of this bonding time. I hoped to nurse him until I he was 24 months.

Wanting to distinguish himself from Isla immediately, Isaac had a hard time latching on, so I met with a lactation consultant daily in the NICU, learned to use a nipple shield, watched videos about pumping (the one thing I really dislike about nursing), started pumping around the clock while he was in the NICU and continued after he came home.

Two episodes of apnea & some vomiting in the NICU confirmed that Isaac was also a "GERDling." Episodes of cyanosis in the first few weeks led to medication at two weeks and this time I did not hesitate or question the switch to PPIs (the big guns) at 4 weeks (although I did ask for a GI referral at that appointment). I used all the environmental modifications I'd learned with Isla and re-read everything I could. Isaac spent almost all his time upright, being held or in a swing, we used a loose diaper, burped him incessantly and used the same nursing techniques I learned with Isla.

By 4 weeks Isaac had also developed allergic colitis and I started cutting foods - this was harder to do the 2nd time! Eventually, at the GI's request, I completely cut all soy and dairy, nuts, eggs, and beef and started taking supplements again to ensure adequate supply.

At 3.5 months the GI warned me that elemental formula may be in our future, but I didn't dwell on it. We'd been told the same thing for Isla. When Isaac hadn't gained any weight at his 4 month appointment I had a sinking feeling (weight gain was never an issue with Isla), but I continued to try all the interventions prescribed by the GI. A few weeks later, when he still did not gain weight and was dropping off the charts it did not come as a surprise when she told me she was concerned with malabsorbtion and it was time to try elemental formula. I was fine with it until the nurse brought in the formula sample and then I burst into tears. The idea of weaning overnight was heart breaking.

Since Isaac refused the formula at first I ended up weaning over 2 weeks. I pumped for all feeds except once in the evening. This was precious time and I tried not to focus on the fact that I wouldn't be nursing for long. When we made the switch to the bottle at night Isaac was not happy, but eventually he learned to fall asleep without nursing. I kept everything else - books, songs, rocking, & paci the same, which seemed to help. Now when I give him his paci after the bottle he turns on his side, as if he was nursing and falls asleep.

Isaac seemed to have more energy and less symptoms and gained a pound with the switch to formula. This made me very happy and a little defeated and sad. I spoke with his GI and decided to stop pumping, since he was no longer taking any breast milk and she did not anticipate a return to nursing. Stopping nursing quickly was just as painful as the first week of nursing and doing it while Isaac went through and recovered from surgery was extra difficult. The hormonal madness didn't make the stress of surgery easier.

Now Isaac is eating again and seems to really love the formula. I no longer worry that he is not getting the best nutrition, because I know he is getting the absolute best nutrition for him. All the antibodies in the world won't change the fact that he can't get adequate nourishment from breast milk. On an emotional level I am also feeling better. When I first mentioned weaning, some well meaning people pointed out how nice it would be for other people to feed him or put him to bed. At the time this just made me sadder, since I saw this as part of my exclusive role as his mama. I still always put him to bed, but Andrew does 3 night feedings a week and my parents baby sat him last week and Andrew and I had our first date night in ages!

I have also gotten the routine of formula feeding down. We have mixing pitchers, a gram scale (because this formula is a "medical food" it can cause GI issues if not mixed exactly), lots and lots of bottles, bottle dish-washing racks and a chart with all the recipes for 20 kcal concentration in numerous amounts laminated on the fridge. I now know that we need to order the formula at least a week in advance so I don't have to call around to every pharmacy in town trying to track down a can (I ended up finding the competing elemental formula, Neocate, at the Children's Hospital Outpatient Pharmacy - if you want to see some desperate parents, visit this pharmacy on a Saturday. Everyone in there had some sort of medicine related crisis.).

Weaning so soon feels like a special part of Isaac's infancy was cut short. The unexpected change in (my) plans has been a little disappointing. This is just another reminder that with parenting (and life) things do not go as planned. (A lesson I guess I did not fully learn during my 3rd trimester! Haha!) However, with a few weeks perspective and a happy growing baby I my arms, I'm coming around to the idea that food is food.

PS - The one thing I miss is the support of the nursing support group. My (very pregnant) friend Amanda and I were talking about how great they are today. I wonder if you can still go, even if you aren't nursing?)