Starving surrounded by abundance.

[rivka]

So, despite my confidence last Friday that we had the whole nursing thing worked out, Li'l Alex continues not to gain weight. At Monday's weight check, she had lost an additional ounce over the weekend. Today, she was steady with Monday's weight. This isn't good.

Yesterday I took her to the lactation clinic at a local hospital. The women there were just phenomenal. They spent two hours with me, despite the fact that my consultation fee only entitled me to an hour's help. They weighed Alex before and after a feed to see how much she ate (1.3 ounces, perfectly respectable for an eight-day-old baby), watched us nurse and made adjustments, and came up with the following diagnosis:

My tits are too big.

They're heavy, which makes them prone to drop out of position while she's nursing. One is larger than the other, and on that side she has trouble getting her mouth around enough of the nipple to get a really good latch. That side is therefore not draining completely when she nurses, which means that it stays engorged, which makes it harder for her to get the damn thing into her mouth. I've developed a nasty crack in the skin on that side from her improper latch. My small arm is also creating minor positioning difficulties, which they helped me work out.

But seriously: it seems that she's not gaining weight because I'm too well-endowed. They fitted me for a nursing bra? Size 36J. I bet you didn't even know that size existed. If it weren't for the fact that nursing bras are the ugliest damn things in the world, I'd belong on the cover of a porno mag. It's a wonder I don't tip forward when I walk. 36J. I know other women who are probably J-cups, but for heaven's sake, they don't have a 36-inch chest.

In addition to the massive support garment, the nice women at the lactation clinic supplied me with a nipple shield, which provides a more well-defined target for Alex to latch on to and also protects the cracked nipple. They rented me a hospital-grade breast pump, at least for the first month, so that I can (a) pump out the extra milk that's staying in the breast, and (b) supplement her breastfeeding with bottles of expressed milk. That's already helping with the engorgement, and hopefully it will allow her to put on a few quick and easy ounces.

Best of all, my involvement with the lactation clinic appears to mean that I am exempt from receiving any further stupid breastfeeding advice from the nurse practitioners at my pediatrician's office. (Latest sample: "don't nurse more than ten minutes on a side, because she'll burn more calories nursing than she'll take in.")

I go back for a re-check tomorrow. Please let her have gained some weight.

(Yes, I am considerably more worried than this post makes me sound. I am actually sick with worry that I am starving my baby, and that even though she is nursing and filling diapers and looks well to me she isn't getting adequate nutrition and it's all my fault. I cried all over the lactation clinic ladies yesterday, and expect that I'll do the same tomorrow. But we'll get by.)

Comments

[janetmiles.livejournal.com]

Okay, we all know that I don't know a whole lot about babies, but I do know about math.

She started out at 8 lbs, 4.8 oz, right? She's lost 15 ounces. That puts her at 7 lbs, 5.8 oz, which seems to me to be a perfectly respectable weight for an 8-day-old baby.

I feel certain that with the help of the lactation consultants (who I am sure have nice absorbent shoulders), Alex and you will do fine.

[almeda.livejournal.com]

Also, I recently ran across in other contexts the fact that 'standard weight-gain' charts were compiled in the 50s from formula-fed white middle-class babies. Making them 'normal.' Apparently it is well known that breastfed babies gain weight a little slower but are at the same place at one year of age.

Though probably the lactation consultants already knew that.

[pariyal.livejournal.com]

The baby clinic tried to bully me into supplementing with formula for months, until I gave up (not "in") and said I'd only be back for inoculations and would they please stop harassing me. I had twins, and they were little, and they grew exactly according to the chart only just under the broad band that says 'average'.

Yay lactation consultants. There are some in this country, but they're few and far between and mostly in volunteer organisations that are slightly too ...evangelical... for my tastes.

[rivka.livejournal.com]

It would be a perfectly respectable weight for an 8-day-old baby who had started out at, say, 7lb 10oz. The absolute value isn't what's worrying them, or me, it's the failure to gain. All babies lose weight after birth, as they make the adjustment from having everything provided free of charge to having to make the effort to eat. But at a certain point they're supposed to stop losing and start gaining, and Alex has been very slow to do that.

[purplepaisley.livejournal.com]

Are you updating or are you interested in more advice? I understand advice overload, so feel free to ignore the following. I don't know what you've tried and what you haven't tried, so I'm just throwing a bunch of stuff out there.

Is she having lots of wet diapers? Is she having one or two instances of quiet alert time every day - 15-20 minutes is all I'd expect to see. Are her eyes bright and her skin looking healthy and springy? Weight is not the only measure of well-being. (And if a single before-and-after weight check was reassuring, that's great. But it is generally considered a bad tool for breastfeeding mothers. There is so much variation from one feeding to the next, and it encourages the sort of quantity focus that can sabotage a breastfeeding relationship very quickly. Watching the scales too closely can be almost as bad as watching the clock. She make take several weeks to get back to her birthweight - if the other indicators are good, that may just be normal for her.)

I've worked with several large-breasted women, and I see different issues with different women. There can be an overactive milk ejection reflex. Big boobs have lots of storage space, and the initial let down can be pretty impressive. (You can have overactive milk ejection with smaller boobs too, but I've seen it more with bigger ones.) With babies who suck happily for 2-3 minutes and then come off coughing, that's usually what's going on. Holding her in a more upright position can help. I even had one woman holding the baby so he was straddling her knee. Leaning back so the baby is leaning into you can help too, as the excess milk can then drain out the side of the baby's mouth rather than down her throat. That kind of positioning can feel very, very awkward at first, so you need to experiment and be patient. She'll get more proficient at managing the flow as she grows and gets more experienced. If milk is spraying with letdown, then one option is to let the baby suck for those 2-3 minutes until the letdown starts, take her off and let the milk spray freely until it slows, and then put her back on.

Be careful about the pump. If you are pumping frequently your breasts may decide that they have two babies to feed and increase milk production accordingly.

Supporting your breast may be more important for you than for a small-breasted woman. A washcloth rolled up like a sausage and placed under the breast can help. Just be careful about getting into a habit of holding the breast away from the baby's face, as I've seen plugged ducts result from the constant compression. Leaning back, as previously mentioned, can help breast tissue fall naturally away from the baby's nose.

Side lying can be a good position. If you're having trouble getting the hang of it, having someone help is good. Basically, start out with the most natural side-lying sleep position for you. What feels good in terms of pillow and arm placement? Now bring the baby into the equation. A receiving blanket rolled up like a sausage behind the baby's back can help keep a young baby in the side lying position and make it easier for you to scoot her in close to you. Then use your upper arm to support your breast and your lower arm to bring her into you, and then once she's securely latched you can let go and put your arms into a more comfortable position. Place a towel under both of you if there's lots of milk. You mentioned a short arm, so I don't know how that would factor into getting her latched, but experiment with the rolled receiving blanket and perhaps a thin blanket under her that you can pull on to get her in close. If you find that you can manage lying on one side but not the other, you don't necessarily have to lie on your other side to change breasts. You may be able to roll yourself farther towards her and offer the top breast after the bottom one is done.

(to be continued)

[purplepaisley.livejournal.com]

(crap, this is long)



If milk supply continues to seem excessive after the first few weeks, you may want to try using only one breast per nursing. That can reduce the amount of stimulation your breasts are receiving and gradually reduce your supply a bit. I'd be cautious about trying that now, however, because your supply is still getting established, and your wee one needs every chance to get as much milk into her as she wants. Getting lots of hind milk is important, though, so keeping her on one breast as long as possible is good, as I'm sure you know. Green poop can indicate foremilk/hindmilk imbalance, so if she's getting too much of the thirst-quenching stuff and not enough of the fatty weight-putting-on stuff she will probably show you.

Hang in there! Each week will bring change, and things will gradually get easier. The first two weeks tends to be the most challenging, and then I see another settling at about six weeks. You and Alex will get this sorted.

Health and happiness to you both.

[beckyzoole.livejournal.com]

I second the side-lying nursing position. I have big boobs, and found that lying in bed on the nursing side gave my babies the best position for latching on and keeping their little noses clear.

An advantage to expressing and getting Alex used to taking a bottle, is that you will be able to leave her with a sitter and get out on your own for a couple of hours. You probably don't want to spend a minute away from her now. But at some point you and your husband will benefit from going out on an adults-only date, even if just two hours to get dinner and talk quietly. If you can leave a bottle of milk with the sitter, you'll feel a lot better about leaving Alex with the sitter!