The downhill slide.

[rivka]

Alex has stopped gaining weight.

We went to the pediatrician on Friday, and she'd gained a grand total of one ounce since the previous Saturday. I admitted that we'd slacked off some on the supplemental bottles - partly out of complacency, because she'd gained an ounce a day for ten days, and partly because mastitis hit me like a Mack truck. He suggested that we go back to doing exactly what we were doing before, and I agreed to get her re-weighed on Monday at the lactation clinic. So I did.

Today, she weighed what she'd weighed a week ago Saturday. That's not good at all.

I spent a long time with the lactation consultant. She pointed out that Alex's sucking isn't anywhere near as good as it was a few weeks ago. (I'd noticed that she seemed to be doing some lazy nursing, and that it was hard to get her latched on to the supplemental bottles - she was just mouthing.) She tried various diagnostic measures, including feeding Alex some sugar water from a special plastic tube. Alex struggled to get it down, and then spit it up. So then she started asking me how often Alex spits up (fairly often, and much more than before in the past week), and then about a series of behaviors which I wouldn't even have thought to call symptoms: does Alex arch her back a lot? Yeah, she's started doing that recently. Does she shake her head and stiffen when we try to feed a bottle? Yeah, she's started doing that recently. Does she make noises like she's clearing her throat? Now that I think of it, she totally does. Do we see milk in her mouth after a feeding? Yes, sometimes, and then she re-swallows it. Has she been fussier? Good heavens, yes. Has she been having lots of short feedings and then acting hungry again a little while later? Yeah, that's definitely Alex - at least, a lot of the time.

To make a long story short: she thinks it's gastroesophageal reflux disease. She said it often happens that a baby will gain well for a few weeks, and then will start to fall apart around four weeks or so, as she starts taking in enough of a volume of milk to make reflux really painful. So even Alex's timeline makes sense. And then I started thinking of additional corroborating evidence: Alex used to go down without a complaint after night feedings, and now she cries when I lie her down in bed. (Babies with reflux need to be kept upright after they eat.)

The lactation consultant tried to call our pediatrician, but he was gone for the day. She'll call him tomorrow morning, and then I expect that we'll take her in to be seen. Hopefully, the consultant's diagnosis is right, a trial of Zantac will clear up Alex's problems, she'll go back to nursing contentedly, and she'll gain weight like a little pig. Hopefully.

The consultant was also very concerned about my mastitis. I've got a big lump on my aureole which hasn't gone away with hot showers, hot compresses, massage, pumping, and antibiotics. Because Alex isn't sucking well (because eating is painful and frustrating and she's tired from not getting enough calories), she's not helping drain the breast and clear the lump. I'm in danger of coming down with mastitis again as soon as I come off the antibiotics. So she gave me a larger pump funnel to use on the infected side, in hopes that the lump will get pulled into the suction better and will actually clear.

She told me to stop nursing for 24 to 48 hours, and instead to pump 10 times a day. In the meantime, Alex is to be fed bottles. If I can't pump enough to give her 8-10 2.5oz bottles (and I can't), I'll need to supplement the pumped milk with formula. I can do some "comfort nursing" after I've pumped, but I'm not supposed to be nursing for her main nutrition.

This is a physically intimidating program (pumping ten times a day?!), and also... emotionally devastating. I feel like a failure for giving my baby formula, even mixed with breast milk, even for only 24-48 hours. And I feel tremendously sad about not nursing her. She loves to nurse. I love to be able to provide her with that comfort and security. I feel empty and inadequate for not having that to give her, even just for a day. I'm afraid that this will be the beginning of the end of our nursing relationship - that we won't be able to re-establish breastfeeding, or my milk will disappear. And I feel like I'm setting myself up for a hailstorm of criticism and disapproval for allowing her to have something besides breast milk.

(Incidentally, if you're planning to leave a comment explaining why we shouldn't give formula or why I should fire my lactation consultant, please don't. We are trying this. Our decision has been made. Second-guessing us will not be helpful.)

Comments

[kate-schaefer.livejournal.com]

What a painful thing to be going through. You remember all the variations Sam had to go through before she came up with the combination of goat milk and (I think) soy-based formula that Aurora did quite well on? Not that what you're going through is similar to what she went through, but keep in mind how many backup sources of nutrition are available if you need them.

Boy howdy, are you ever not any kind of failure. You will get better. Alex will gain more weight.

[eeyorerin]

It sounds like the coincidence of both problems (Alex's GERD and your mastitis) is really making things difficult for everyone right now. I hope that both things clear up quickly and that you can get back to nursing.

If it helps to hear this, I have every confidence that you are making the right decisions for you and your baby, and I don't think you're a failure.

[iamjw.livejournal.com]

*hugs*

I have absolutely no experience with babies, but I do have pretty firm ideas of what a mother should be - and you're being it. You're doing what you have to do to keep your baby thriving, and that's your job as her mother. I'm truly sorry that this is happening to both of you; I'm truly sorry that you're feeling emotionally devestated by it all; but you are doing what best advice tells you is best for Alex, and ultimately that's what matters.

*many many many more hugs*

[janetmiles.livejournal.com]

I know you. I know you do your research. I trust you to make the best possible decisions with the available information.

[ororo.livejournal.com]

I couldn't have said it better, so I'll say, "what she said."

[brian1789.livejournal.com]

Give yourself some slack... you're doing fine. Mastitis is not uncommon, and most nursing mothers I've talked with about it said that one month out is sort of like a lactational "max-q" -- cracked and sore nipples, the baby's digestive system changing (colic starts soon, in some infants, others have reflux or nothing) pent-up sleep deprivation, infections and mastitis...

All I can say, really, is I think you guys are doing great, and things should get better over the next week or two.

(hugs)

[papersky.livejournal.com]

I can't say anything, I'm still feeling guilty fifteen years later about not being able to breast-feed. But you're not as silly as I am, at least I hope not!

[wiredferret.livejournal.com]

You're doing fine, really you are.

Formula is not the end of the world, and reflux can be worked around, and you can still do comfort nursing, which is really the important part to me, the emotional connection. Yeah, the "I grew that baby with my boobs" is good, but mostly, I just want the sweet baby cuddles.

I think you'll re-establish fine. Your production sounds like it's reasonable, and as long as you keep pumping, you will have a basis to build back up from.

Please consider finding a theraputic relationship to help you through this. I know that this is a shoemaker's-children thing, but I clearly remember my deep anger, sorrow, and craziness about breastfeeding. And I didn't have /nearly/ as good a reason for breastfeeding-specific angst. I did have PPD, and breastfeeding guilt was one of the manifestations.

[johnpalmer.livejournal.com]

When it's painful and difficult, and emotionally trying, you're doing your best to provide the best you can for your baby.

Your baby is not only getting all the breast milk you can express, she's getting all the love any child could want. No one has any right to say anything bad to you over this.

[heidi8.livejournal.com]

You can't feel bad about having to supplement. And I know a number of people who pumped a lot to provide food for their babies in that way. They won't stop you nursing 100%, and if that's the most important thing for you, and it would be completely reasonable if it was, then you can know that you'll be fine. There's nothing wrong with supplementing - what's wrong is when people don't even consider trying nursing, and you're far, far beyond that.
Fyi, my best friend went back to work at 6 weeks and from 8am to 7pm her son had expressed milk - she did it until he was 8 months old and didn't want much milk during the day anyway. Pumping can be cumbersome but it's the same nutritional benefits as direct nursing is.

[ailbhe]

Your last paragraph shocked me, because... well, I suppose people would, but it wouldn't occur to me. Formula won't hurt her. It might not be as excellent as breastmilk, but it won't hurt her.

If I were you, only with my family history instead of yours, I'd want to ask about dairy intolerance, because back-arching colic, lots of spitting up, and very exciting nappies are all dairy intolerance things. And that's the easiest thing in the world to fix.

My nephew has reflux. Had. Has. I don't know which. But I do know it makes life incredibly hard. And my mother had it; she thinks now that this is what damaged her relationship with her mother - no-one knew what was wrong or how to stop it, only that she was a scrawny, pukey, screamy baby. I'm glad you know that reflux is what's wrong and that it's not your fault.

I know someone I consider to be a successful breastfeeding mother whose daughter had mostly formula from very early on due to serious lack of weight gain, but who still (13+ months) breastfeeds both for food and for comfort. She and her baby have a great relationship. Not as good as I do with my baby, but no-one has as good a relationship as one has with one's own baby, because one's own baby is best :)

[ailbhe]

Also, I still get the not-breastfeeding hormonal blues when I go too long without a real skin-to-skin feed, and my baby is over a year old. So you've got hormones and biology to deal with on top of regular guilt. Have you considered chocolate ice-cream?

[purplepaisley.livejournal.com]

I'm so sorry you're going through this. I can't imagine how overwhelming it must be. Hang in there. You and Alex will be back nursing together in no time.

Milk Bank?

[purplepaisley.livejournal.com]

BTW, if you are eager to avoid formula, is there a milk bank near you?

[ailsaek.livejournal.com]

And I feel like I'm setting myself up for a hailstorm of criticism and disapproval for allowing her to have something besides breast milk.

Oh pooh. *hug* I couldn't breastfeed David. He's stubborn as, well, anything you want to name, and he wanted absolutely nothing to do with nursing. So I pumped for months, but my breasts do not produce enough milk to make a baby thrive by pumping, so we had to start supplementing with formula (that's why I have two notebooks full of detailed notes about what David ate and when), and I finally gave up pumping completely when it was obvious that my breasts were shutting down production for good.

It didn't make me a bad person, it's just what David needed. I do wonder now if the gluten in my diet is why he wouldn't breastfeed, but I could never have known that then. You just make the best decisions you can with what you know at the time.

Somehow it'll work out OK. Not the way you'd planned, obviously, but it'll work out somehow. And if anyone faults you for doing what you believe is the best thing for your daughter, rip them a new one.

[windsea.livejournal.com]

And I could have written *exactly* this with Colin, who never once nursed.

It's terribly emotionally draining, but you're not alone in your fears and your angst. And you will work it out, you and Alex and Michael.

*hugs*

[kate_nepveu]

I'm so sorry that you all are having a tough time. Your lactation consultant has sounded very knowledgable throughout this, and I hope her advice, as emotionally difficult as it is, will work out for the best.

[zeldajean.livejournal.com]

Wow does that sound stressful.

For what it's worth, *I* don't see this as any kind of failing whatsoever. Getting mastitis wasn't something you did, it was something that happened to you. Pumping for her (still a demand on your milk! it won't go away!) and supplementing with formula is doing what's best for both of you.

I'm sure it's incredibly difficult, on many levels. But you can do it, because you're Mom!

*cheering section!*

(and please, don't fire your lactation consultant! From what you describe, I think she's WONDERFUL!)

[baratron.livejournal.com]

Actually, I think your lactation consultant is fantastic. The amount of time and effort and sympathy she's put into trying to help you is truly impressive.

I imagine you are fairly well equipped with Google yourself, but if anyone else is wondering, this is a lengthy article written for intelligent laymen about GERD in babies. I also found an entire organisation with a lot of information. Apparently GERD can range from a comparatively minor, "50% of babies get this" type of problem all the way to a "doesn't even respond properly to surgery" type :/ I hope for everyone's sake that Alex's problem is sorted out quickly and easily.

Regarding how you're feeling, I think that maybe only 10% of the hailstorm of criticism and disapproval is external, and that can be dealt with by pointing the critics at information about the disorder and its severity. The remaining 90% is internal, and that's the hardest thing to deal with. I suppose you can try to tell your frustrated mother-instinct that right now, you need to do everything you possibly can to improve the health of your baby. While you feel that you should be able to, it is not physically possible for you to produce on demand enough milk for 4 babies, which is essentially what her vomiting is asking you to do. Failure to thrive caused by GERD is classed as organic and is in no way the fault of the caregiver. Try to ignore the feeling of failure ("But I can't even feed my baby!!") and focus on positive steps you can do. Forget the long-term "oh my God I might not be able to breast-feed ever again!" (almost certainly not the case anyway) and just focus on the next few hours.

Apparently it is often recommended that parents mix breast milk with some rice starch or oat starch to make it easier for the baby to keep it down - every site I looked at suggested this as the usual first treatment. There is also a colossal list of foods that the mother should try to avoid eating as they can increase the acidity of breast milk. Hopefully if you try the 14 steps for improving acid reflux, it'll happen less, so you'll be able to feed her completely yourself.

Finally, *hugs* and good luck - I think you need it.

[minnaleigh.livejournal.com]

I'm sorry this is so hard. It does sound a lot like reflux so hopefully some medication will make it less painful for her to eat.

[the-siobhan.livejournal.com]

Poor little bun. And poor you, having to go through this.

You are absolutely doing the best you can. Good luck that this stage is over soon.

[epi-lj.livejournal.com]

Because I have a habit of wording things poorly, I should say from the get-go that I would never in a million years wish any of this on you, and it sounds like a terrible thing to have to deal with.

However, as I was reading this, I kept thinking to myself, "rivka is strong and tough and could get through anything. I don't know curiousangel that well, but in the time I met him, he seemed to have the same competence and strength. Alex must have inherited some part of that. If any group of people can make it through this and come out strongly on the other side, it's this group of people."

I'm so sorry that you're going through this. :( Try not to feel like a failure, though. You're doing everything what you can, and you've given her the gift of life, the gift of parts of you that will express themselves in ways you've yet to see, and you will continue to give her support and strength and love for all of your futures. I've seen as much of the information on the importance of breast feeding, of the bond that happens during breast feeding, of the nutritional impact. However, those are *all other variables being equal*, and I know that you're going to provide her with not just an adequate family and home and sense of self as she grows, but excellent ones. You're not a failure. You've given her so much already and you still will. Be strong and always remember that you're doing the best you can.

[hobbitbabe.livejournal.com]

Okay, so this pumping thing, how long does it take each time? And can you do anything else at the same time, like feed Alex a bottle or read or eat lunch?

It sounds overwhelming anyway; I just wanted to quantify it for some reason.

Good thoughts from here. You are a good mother.

[rivka.livejournal.com]

Okay, so this pumping thing, how long does it take each time? And can you do anything else at the same time, like feed Alex a bottle or read or eat lunch?

I pump for 15-20 minutes at a time. Unfortunately, because I pump both sides at once and have to hold the collection bottles in my hands, I can't do anything like hold an awake baby (a sleeping one can, and does, drape across my lap), read, or eat. I can (and do) watch television.

The lactation consultant is of the opinion that pumping should be a beautiful restful time when I put my feet up and think of nothing. I'm waaaay too Type A for that. Besides, there is a very real danger that I will fall asleep at the pump and break the suction, thus decreasing my milk haul, if I do nothing but relax.

[kcobweb.livejournal.com]

Oh my gosh. I think you know that I've just been to this very same place - minus the mastitis. The EB has reflux, and Zantac has helped so much. She's gaining weight slowly, but she fits the curve where she should be (and I think she's just genetically predisposed to be a Small Person, but anyway).

We had to give her formula her first week, when she lost so much weight in those first days, and my supply was not well established. They had me pumping on an insane schedule to try to get my supply up. (And I've used all that pumped milk once I was able to keep up - we haven't used formula in weeks.) It's only now, 8 weeks later, that I'm cutting way back on the pumping, and reverting to breastfeeding solely and directly - that's a novelty for us and we haven't really done that (or been able to) since she was 4 days old. She doesn't like formula (spits up worse than usual, etc.) - as our lactation consultant told us, it doesn't taste as good. (Try it, you'll see. Bleah.)

Anyway - this is all by way of saying that you know formula won't hurt her, and neither will bottles. Pumping all the time like that will help keep your supply up, I think, and not hurt it, so you should be able to resume breastfeeding no problem.

I see people talking/bragging about how their babies are 100% breastfed (in various LJ communities, for example), and a weird thing inside me turns over, because I haven't been able to say that since the EB was 4 days old. But you know what? That isn't really a measure of success. If she had been 100% breastfed and we had been stubborn about that, things would have continued to get worse, and she likely would have been *hospitalized* - we did what we needed to for her best interests. As you are doing for Alex's.

Incidentally, I'm starting to think that babies with reflux are the norm.... It seems like all the new mothers I know are going through this. My mother thinks maybe that's why I was such a fussy baby, only they just called it colic and shrugged their shoulders.

[ailbhe]

I see people talking/bragging about how their babies are 100% breastfed (in various LJ communities, for example), and a weird thing inside me turns over, because I haven't been able to say that since the EB was 4 days old.

My baby was 100% breastfed. Because for me it was easy as pie. I don't know anyone at all who had it as easy as I did. Do.

I have no idea how I'd have managed had it been difficult. I'm glad I never had to find out. It being easy as pie for me doesn't make me a better person, any more than needing lots of intervention during birth makes me a worse person.

[erisian-fields.livejournal.com]

What they all said.

Just don't feel guilty for being the best mom for Alex.

[beaq.livejournal.com]

Many enormous pettings and concern. You're the best-ever mom.

[(Anonymous)]

Since one of the recommendations for adults (like me) with GERD is to elevate the head of their bed, would that also be a good idea for a baby?

On an adult bed, a 4" or so rise is quite helpful. That may only work out to an inch or less for a crib floor. Be careful that the slope doesnt open any edge gaps however.

Anatomy also makes laying on the left side better than laying on the right.

Both of the above help this full grown adult. I should think it'd also help a baby but applying it may not be as simple.

[rivka.livejournal.com]

Yes, we're going to elevate the head of her cosleeper. Just with a folded towel at this point, until we get more specific recommendations from the doctor.

Just feeding her sitting up (one nurses, of course, in a fully horizontal position) and keeping her up for 30 minutes after feeding seems to help a lot with the symptoms.

[jonquil.livejournal.com]

Bless you.

And remember that Americans raised, what, three generations of bottle babies who grew up bonnie and blithe and good and gay. Your darling can be funny and smart and kind and wise without ever drinking another drop of breast milk.

I wish you all the best, as ever.