All week, we’ve been nursing. No more pump. Joey has seemed to nurse better, but he still seems confused about what to do with his tongue some of the time. I stretch his frenotomy incision so that it will heal “opened” instead of closing back up and limiting his tongue again, several times a day. I try to do “suck exercises” with him, but he normally doesn’t participate.
Thursday, we went to the chiropractor again to get him all adjusted and in alignment. His T4-T5 area was still tight, but not as bad as it was before. The DC said everything else was a lot better and looser than before, too.
Friday, we went to the doctor for the well-baby visit we had scheduled ages ago. (Anneliese also had an appointment.)
From his frenotomy on Friday to his weight check Tuesday, he hadn’t gained (or lost) weight. We had decided to try nursing more, and to weigh again Friday to see if he would get better at sucking and swallowing. I had high hopes. He seemed happy (but this isn’t new) and occasionally would let me know if he was hungry, and I would give him a bottle at that time. He pooped every morning.
Still, his suck was often disorganized, and he would still lose suction, “popping” before re-latching… not good things.
So his weight gain wasn’t enough. Just a couple of ounces.
The doctor used terms that frustrated me, not for myself, because I’m determined and educated about breastfeeding and know what my options are. But for other moms who might be going through the same thing. He used phrases like, “maybe your milk isn’t good enough this time” (Excuse me? And that would explain his great gains while bottle-feeding 95% my own expressed milk, how?), talked about fortifying my breast milk to make it higher-calorie, feeding rice cereal, and using formula.
I told him (nicely) that I’d like to stick to breast milk until he is 6 months so that his gut can develop fully and he’ll be better-prepared for digesting food, but that if I were to give him food at this point, it wouldn’t be empty-calorie rice cereal. It would probably be mashed sweet potatoes, carrots, avocados, bananas. Even the AAP recognizes that feeding rice cereal is just a “cultural tradition” in the US, and that there’s really no reason to start with rice.
I also pointed out that formula is #4 on the WHO infant feeding hierarchy, after breast milk from the mother, expressed breast milk from the mother, and breast milk from another human. I told him I had a wonderful friend who would provide Joseph with donor milk (which I had already mentioned to him), and that formula wasn’t an option for us. (After that, he stopped bringing it up.)
From the World Health Organization:
18. The vast majority of mothers can and should breastfeed, just as the vast majority of infants can
and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered
unsuitable for her infant. For those few health situations where infants cannot, or should not, be
breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother,
breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup*,
which is a safer method than a feeding bottle and teat – depends on individual circumstances.
19. For infants who do not receive breast milk, feeding with a suitable breast-milk substitute – for
example an infant formula prepared in accordance with applicable Codex Alimentarius standards, or a
home-prepared formula with micronutrient supplements – should be demonstrated only by health
workers, or other community workers if necessary, and only to the mothers and other family members
who need to use it; and the information given should include adequate instructions for appropriate
preparation and the health hazards of inappropriate preparation and use. Infants who are not breastfed,
for whatever reason, should receive special attention from the health and social welfare system since
they constitute a risk group.
*Note from me: I have tried cup feeding, finger-feeding with a syringe, and spoon-feeding Joseph. He cannot use those methods at this time. Most of the milk comes right back out of his mouth when I try those.
After our appointment, I met with the IBCLC and tried to figure out a good plan. We chatted a bit and ended up deciding I would continue nursing Joseph, but use an SNS to supplement 6-8 ounces a day (2 ounces at a time, supplementing 3-4 feedings per day, the rest “bare”).
But after about an hour, I got a phone call from her. She had talked with the doctor and our plan wasn’t “acceptable” to him. He expressed his significant concern, and didn’t want us to “lose any more time” with helping Joey gain. And honestly, I wasn’t super confident about the SNS idea either, because of Joey’s uncoordinated suck/swallow… I wasn’t sure if he would be able to use it properly.
Maybe he also thought more about my comments regarding Joey’s disorganized mouth movements, because he also put in a referral for us to see a GI specialist to check for oral motor dysfunction. Since I’m going out of town soon, they called around and pulled strings, and we already have an appointment without having to wait for Tricare to approve it.
So I am exclusively pumping again. My amazing friend is helping me with more milk this time, and I will be pumping a little bit less than before… more like every 3 hours instead of every 2, and no more power pumping. It’s just far too draining.
This is my first pumping session after a long break of no pumping… over 4 ounces, combined, in the middle of the day. I was glad to see that nursing Joseph and Anneliese in the last week had at least maintained my milk production, even if it wasn’t enough to “grow Joey” significantly.
Right now, we’re testing out a schedule of naps, waking times, eating, and pumping. I’m trying to feed him frequently, in amounts he can tolerate… we experimented with bigger bottles last time (3.5 ounces instead of 3) and he ended up spitting up a bit more… though it seems like he can handle a little bit more at bedtime without spitting up.
Basically, it’s some variation of this throughout the day:
- Joey drinks a bottle, goes down for a nap.
- I pump.
- We wake Joey an hour and a half later, and he has a mini-bottle.
- Joey is awake for an hour and a half, playing, etc.
- Joey drinks a bottle, goes down for a nap.
Then, he can wake 1-2 times through the night and get a bottle, and I will pump, but I’m not setting alarms to wake up this time… I will wake when he does, and pump when he has a bottle. If he wakes 2 times that’s a “bonus,” getting more milk into him, but 1 time would still give him a good total intake for the day.
So, this is happening.
But I’m still trying to do some of this. Even though nursing won’t “count” for total intake records since we can’t measure how much he gets… I nursed him today after my shower, and he did get in some good gulps. When I pumped, I only got an ounce instead of the 3 I expected for that time of day, so he at least transferred some.
And the snuggles were so nice.
And I’m letting Anneliese nurse AFTER I pump, also trying to arrange her nap times for post-pumping periods so she can nurse before sleeping if she wants to. It’s a really good way for us to “reconnect” when I am so focused on Joseph right now, and also has the bonus of keeping my supply up, since my body will think “oh the baby wanted more than that? Ok.” and try to make more for tomorrow.
In a few days, we’ll see the GI specialist and talk about what else could be going on. I’m not sure what else will happen after that…
I guess for my trip across the country, I’ll need to pack my rented hospital-grade pump (though the IBCLC said I would probably be okay with nursing through our travel days -in addition to giving him some bottles- but pumping while we are at our destination).
I’ll need to pack a cooler full of frozen milk from my friend in my carry-on (and hopefully not have to battle security too much over it), since I’m not pumping 100% of what he needs to take in right now (again, pumping isn’t the same as nursing… if he were nursing effectively, he would be getting more than what I’m able to pump). I’ll need to take bottles, and the bottle-brush, and so forth.
And I guess I’ll try to stay close to the condo where we are staying, for most of our visit. We will go out and get meals with family members, but not hang out for hours and hours… I’ll need to get back in order to pump, and the kids will need naps anyway. We can hang out on the beach (our condo is oceanfront!) but again, I’ll have to carefully time everything…
Of course we’ll go to my sister’s wedding and celebrate with her at her reception, but other than that, my focus will be on growing Joey. It has to be.