The downhill slide.
May. 9th, 2005 07:40 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaAlex 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.)
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.)
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no subject
Date: 2005-05-10 01:22 am (UTC)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.
no subject
Date: 2005-05-10 01:31 am (UTC)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.
no subject
Date: 2005-05-10 01:45 am (UTC)no subject
Date: 2005-05-10 01:48 am (UTC)no subject
Date: 2005-05-12 08:12 am (UTC)And so does good, clueful, supportive help.
no subject
Date: 2005-05-10 02:44 am (UTC)no subject
Date: 2005-05-10 02:54 am (UTC)You know, in 7th grade we wanted other people to think we were twins - do you think our daughters were separated at birth? :)