rivka

A couple of times in the past, I've had a simple upper respiratory infection spiral into a massive case of reactive airway disease: shortness of breath, wheezing, dizziness, brain fog, and prolonged fits of coughing in a spasmodic, wheezy, and completely nonproductive manner. The first time I was amazingly ill and wound up in the ER, and then on multiple daily nebulizer treatments at home. I lay on the couch like a zombie for a couple of weeks. I occasionally needed an inhaler for months before my breathing finally returned to normal.

The second time, the acute illness wasn't as bad. But I still wound up on home nebulizer treatments, and carried - and needed - an inhaler for months afterward.

I've been having episodes of wheezing and shortness of breath recently. Not consistently, but sometimes. Michael caught me having a can't-breathe-coughing-helplessly episode and browbeat me into going to the doctor. Fortunately, they've opened up a new urgent care clinic right near my office, for members of the university community only.

I went there this morning. My inconsistent symptoms obligingly appeared for the nurse practitioner. (More accurately, I started having them on my way in to work, and that reminded me that I'd promised Michael I would be seen, so I went.) She gave me a breathing treatment in the office. The heavens parted and choirs of angels sang hosannas as I found myself able to take deep, satisfying breaths.

The breathing treatment had albuterol and something else in it. She looked up the something-else to see whether it was safe for breastfeeding. Class B; fine with me. She wrote me a prescription for an albuterol inhaler, which I dropped off at the university pharmacy.

This afternoon I went to pick up my prescription. There was a bright yellow sticker on the inhaler box: "Not recommended for use while breastfeeding." I asked to speak to a pharmacist, who hunted through the package insert and found that the "not recommended" label was due to animal studies, that human studies are lacking, and that the manufacturers suggest that one "consider whether to stop breastfeeding or stop use of the medication."

Refused the prescription. Called the nurse practitioner, who has yet to call me back. Came back to my office and did some googling for albuterol breastfeeding.

According to the National Library of Medicine's LactMed database: "Although no published data exist on the use of albuterol by mouth or inhaler during lactation, data from the related drug, terbutaline, indicate that very little is expected to be excreted into breastmilk.[1] The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use."

So I don't know what the hell is going on with the Proventil package insert, or whether I should believe the folks who actually made the medicine or the database. I understand that for liability reasons they are on much safer ground if they tell pregnant and nursing women to never take anything, and online sources seem to be pretty much in agreement about the safety of albuterol. But. But.

The wheezing and coughing aren't really that bad. Crap. I don't know.

I have mastitis.

I thought mastitis was something that happened very early in the course of a breastfeeding relationship, so when I didn't get massively, massively ill in the first few weeks with Colin the way I did with Alex, I foolishly thought I was home free.

Ha.

It started yesterday afternoon with a sore, aching breast and the feeling that I was waaaay overdue to pump at work when, in actuality, I had just pumped. I came home and tried to nurse Colin a lot on that side. I took a long hot shower at bedtime and tried to use massage, but honestly it didn't feel a lot like the plugged duct I had before (i.e., noticeable lump, very localized, easily fixed).

Today my breast feels awful, like it's full of ground glass, and I also ache all over and have nausea and chills. I keep trying to nurse and nurse Colin but I still feel horribly engorged. And then this afternoon I noticed a bright red patch on my breast, like a 2x2-inch sunburn. That's mastitis.

The good news is that after a brief phone consult my midwife called in an antibiotic and Michael has gone to pick it up. It hurts like hell to nurse, and I feel sick all over.

I can't believe how quickly this came on and how lousy I feel.

So the church Christmas pageant has three Sunday morning rehearsals followed by an evening dress rehearsal the night before Christmas Eve. Only this year we got about 20 inches of snow the day before the last Sunday morning rehearsal, which meant that it didn't happen. Instead, on Wednesday night a bunch of excited hyper pre-Christmas kids showed up for the first rehearsal with costumes (which weren't done, incidentally), the first rehearsal in the sanctuary (which always leads to insane aisle-running), and the first rehearsal without scripts (which was supposed to have happened that missed Sunday).

They had done a surprisingly good job of learning their lines, but everything else about the rehearsal was pretty awful. It's hard to nail down a lot of the blocking before you have the sanctuary to work with. The kids were pretty crazy. I honestly left the rehearsal expecting the performance to be a disaster.

Christmas Eve I was so flustered that we were parking outside the church when I realized that I was still wearing a pair of jeans and a grungy brown wool hoodie over a faded red T-shirt. "I forgot to get dressed!" I wailed to Michael. He looked down at his own jeans and sweater. "...So did I." It was 5pm. I had told the kids to arrive no later than 5:10. I was planning to be onstage for much of the pageant.

We dashed in carrying the last few props and an eleven pound ham. Threw the ham in the oven in the church kitchen and asked someone who happened to be in the kitchen to put the brown sugar glaze on it at 6:30. I took both kids with me to the sanctuary while Michael ran home to change and bring my clothes. The majority of the kids didn't show up until sometime after 5:30. We had no chance to rehearse, but we did go over my list of Important Last-Minute Reminders: Everyone speak LOUDLY and SLOWLY. Face the audience when you speak. When the Herdmans are being bad kids, they shouldn't actually make any physical contact. When the Herdmans are in the pageant-within-a-pageant, they stop goofing off and take it seriously. Angels and shepherds need to be quiet when they're onstage.

Also in this time period, one of the mothers went to town on the Herdmans' faces with a mascara wand to make them appropriately grimy and smudgy. They were all thrilled to be at church in their oldest and most awful clothes. I did not tell them how adorable they were, because they would've taken it the wrong way.

Ten minutes before the service was supposed to start I herded all the kids out of the chancel to the robing room. No, they were too loud to be there. To the little entryway behind the robing room. Still too loud. To the upstairs hall. I tried to engage them in conversation about Christmas to stop them from shouting and chasing each other. Michael brought me Colin to nurse at the last minute before church. I kept on chatting with the kids on my end of the hall until I looked over and saw a few of them at the other end of the hall looking at me like this: O.O O.O O.O "It's just how babies eat, guys," I said and hoped that I wouldn't be hearing from their mothers later on.

6:05. I marched the kids down the stairs, through the entry, through the robing room, into the chancel, and down the steps to the front pew. There was a welcome and a chalice lighting and then we were on.

And the pageant went beautifully.

We had some luck with the play-within-a-play format, because I could stay on stage the whole time (as a parent helping out the pageant director, very realistic) and move people into place if necessary. But the kids needed very little help. They said their lines beautifully and with feeling. They were mostly in the right place at the right time. They did not burn down the church when I let some of them hold candles. They looked fantastic, even the ones who were in totally makeshift last-minute costumes. And they had the pageant spirit, just beautifully.

Afterward during their shaky and confused bows acceberskoorb swooped down on me with a bouquet of white roses and, um, something else pretty. I don't know flowers.

And then we went to the Christmas Eve potluck. Last year there wasn't enough food and Michael didn't get any dinner. (That's partly why we brought a ham this year.) This year there was plenty, and we feasted on turkey and ham and smoked gouda mac and cheese and horseradish scalloped potatoes and tzimmes and all kinds of miscellaneous side dishes and desserts. And Alex actually ate food instead of just running around being hysterically excited. (Colin had a jar of pureed turkey-apple-cranberry holiday dinner, because I fall for marketing tricks like that.)

And we went home and put the kids to bed and hauled presents out of hiding places and wrapped a few things and hung candy canes on the tree from Santa and I lost one of Colin's stocking presents. And poured ourselves glasses of red wine and curled up on the couch to watch the first-season West Wing Christmas episode, "In Excelsis Deo," except that Colin kept waking up and finally we went to bed without finishing it.

Christmas Eve was good. The pageant was wonderful. We have amazing, amazing kids at our church. Is it too early to start worrying about what story we'll do next year?

I just called the Institute director's assistant.

"Uh, hi, Beth, this is Dr. Rivka calling about the Faculty Retreat. This may not be a situation that's come up before, but I have a nursing baby at home, and so I'm going to need to pump milk during the retreat."

"Oh!" Beth sounds flustered. "No, that hasn't ever come up before. Oh. Um, well, I guess that when you need to, you just excuse yourself and go pump."

"I'm going to need a private place with an electrical outlet."

"I don't know if any of the bathrooms have electrical outlets..." The retreat is held at an old mansion that's been converted to a conference center. I wouldn't normally be willing to pump in a bathroom, but I know that the bathrooms in this place aren't grungy at all. If they have outlets.

"Yeah... should I call the conference center?"

"No." Now she sounds much more assured. "You know what, you can go into a bedroom and lock the door."

"I won't be staying overnight." Many of the faculty do, but I have always resisted.

"That's okay, we can still make one of the women's dorm rooms available to you. We can definitely make that happen. Just, when you get to the conference center find me and we'll set it up."

"Thanks." I wanted to say, did not dare to say, and hope I didn't need to say: Please don't mention this to Dr. Gallo or any of the other [male, it goes without saying] senior faculty.

I hate feeling awkward about this.

Elsewhere on the net, someone posted asking what she should do with a free sample of infant formula. After commenting on how gross and creepy the ingredient list is, she says, "I'm a little uncomfortable with donating it to a foodbank, I'd rather donate MY milk to help other Mamas.

Is it safe to give my cats?"

I replied:

So *are* you donating your breastmilk to a food bank, and in your experience are most mothers who use food banks comfortable accepting donated breastmilk from a stranger? And do they have proper storage for frozen milk, and the resources and knowledge to do home pasteurization? Will places that distribute food to folks who are very poor even deal with breastmilk?

Donating milk to a milk bank is a great idea, but it's probably going to go to a mother who has the resources to keep her baby from going hungry even if she couldn't get milk donations. There's nothing wrong with giving to help that mama and that baby get the really good stuff instead of formula, but it's not equivalent to a food bank situation.

I guess I'm saying: please don't give something to your cats that could be used to keep a poor or homeless baby from having to go to sleep with an empty belly. It's not like a homeless mother living in her car is going to relactate if she finds that the food pantry doesn't have any formula.

Fortunately for my blood pressure, the comments are running 8 to 1 in favor of donation. But that one opposed is a doozy: Honestly, I throw mine in the trash. I figure if that crap wasn't readily available then more women would breastfeed instead of automatically reaching for it. However, PP's have made me feel terribly guilty about trashing it.

I hate the Mommy Wars in all their incarnations, but what drives me furthest up the wall is the idea that we can somehow improve the state of American motherhood by punishing mothers who are poor or desperate. No: by punishing their children.

I understand that privilege, by its very nature, is often invisible to those who possess it. I understand how someone can thoughtlessly say "all mothers should..." or "all children should..." without stopping to consider whether they all have the resources or privilege to do so. But what kind of person still thinks that way even cued with the specific context of a homeless shelter, battered women's shelter, food bank? Who thinks of a mother caught in that situation and thinks that if her kid goes hungry at least she'll finally realize that she made the wrong choice at birth?

I just won an Ebay auction for a Medela Pump In Style electric breastpump which, according to the seller, was only ever used for a handful of times. It comes with all the accoutrements - bottles, lids, extra tubing and membranes, extra breast shields in larger sizes...

The Pump In Style retails for $250-300 new. On eBay they seem to go for around $150-200, depending on how much they've been used and what's included.

I won the auction for $62.

Dude.

The only thing I can figure is that the little cooling packs are missing - you know, the gel things you stick in the freezer. We have half a dozen of them already. Would that really dissuade people from bidding?

Colin update: We had him weighed yesterday, because our pediatrician likes to check breastfed babies' weights at one month. (Colin is five weeks old, but I figured the neurosurgery appointment was all the medical care we could stand for last week.)

If he had continued to gain about an ounce a day, he would've tipped the scales at 9 pounds, 8 ounces yesterday. Instead? TEN POUNDS. Over the last month, the boy has increased his weight by 25%.

I declare an official and permanent end to me being neurotic about whether nursing is working.

Also? Social smiles have appeared, and man are they awesome. All three of us have gotten big happy smiles from him in the last couple of days.

Alex update: Her behavior is pretty typical for a displaced formerly only child, which is to say that she's acting up a lot. Last night's festivities included the wholesale removal of books from her bedroom after she decided to throw them all to make a point about not wanting to go to bed. (How did "you can have a few paperbacks in bed to look at by nightlight" lead to the pile of twenty-three books she had next to her pillow and ready to throw? Because she's our child, that's how. Oh well, twenty-two of them are gone now. Pandora is just lucky that there was one under the blanket that she didn't notice when she was throwing them.)

On the other hand, she really floored me yesterday with a surprising bit of thoughtfulness. She's been invited to a birthday party on Sunday, and when we opened the invitation she told me "You can just drop me off." This is starting to be the age of drop-off playdates, and the party invitation specified that drop-offs were okay, so I figured maybe the birthday girl had mentioned this special big-kid possibility to Alex.

Then, in the car on our way home from buying a present, she told me: "Clara has a cat, Mom. That's why I planned for you to drop me off."

Aww. "Thank you, sweetie, but I'd be okay at the party as long as I don't touch the cat. So if you want me to stay, I can."

"You're allergic to cats, Mom," she said with finality. "That's why I planned for you to drop me off."

I am just amazed that she put that together. I've known plenty of adults who aren't that capable of forseeing problems that might exist for other people.

Rivka update: I pretty much rest and feed the baby, and watch TV. I am not very interesting right now. But! I am excited that the SUUSI catalog is out. It lets me dream of having a more interesting life months down the road.

And I'm looking forward to our trip to Montreal next month, which is really going to happen now because we have plane tickets and a hotel reservation and all of us now have passports in the works. (Mine had expired. Michael's was going to expire while we were in Montreal. The kids didn't have them. Getting our passports was an exciting and colorful experience which I hope never to repeat, although now I know an awesome way of getting passport photos for a newborn.)

OMG the three-week growth spurt. It's killing me.

It's not just that he wants to nurse every waking moment. It's that the waking moments have also gotten a lot closer together, because he isn't able to sleep for very long before he wakes up hungry. I did absolutely nothing today except feed him, change diapers, and try to steal a few minutes of sleep.

On the plus side: he is noticeably fat, so much so that even I have stopped being neurotic over whether he's getting enough milk. He used to - used to! he's only three weeks old - have these frail twiglike fingers that I worried would snap when I tried to guide them through a sleeve cuff. His hands were so skinny that the skin was wrinkly. Now he has plump juicy sausagelike fingers, and his cheeks look like he's storing up nuts for the winter, and his clothes look less like he borrowed them from a second grader and more like they are his actual size.

He has started to make a slightly greater variety of sounds, which is fun. And he's started really looking around and focusing on things in his environment. Mostly, as far as I can tell, straight lines and areas of high contrast. Michael's birthmother sent a quilt made of big bold black-and-white patterns when Alex was a baby, and Colin really seems to enjoy it. He is surprisingly willing to have floor time and even tummy time on that quilt, when he isn't, you know, trying to nurse the chrome off a trailer hitch.

Six more days until the earliest experts say it's okay to introduce a pacifier. (Don't worry - or lecture - we intend to use it sparingly.)

We went back to the pediatrician's office today for a weight check. Since Thursday, Colin has gained 4.5 ounces, bringing him to 7lb, 12.5 oz - just a few ounces under his birth weight. So now I feel as though I can finally relax and say that nursing is going well.

After the total nightmare of trying and failing to breastfeed Alex, this is a huge relief. I've been so worried that history would repeat itself with Colin. But from the very first, he's been a completely different baby to feed.

Within a few hours of birth, Colin already had strong feelings about how he wanted to nurse. I would try to latch him on a half-dozen times and he would refuse. Then I'd hit the right combination of size, shape, and angle, and he would latch on like a remora and start sucking vigorously. Over the first 24 hours, he figured out how big he should be opening his mouth, and latch-on quickly got a lot easier. Whenever he nursed, he was focused and persistent. When I took him off the breast and rested him against my chest to burp him, he opened his mouth like a baby bird and sort of bounced it along my chest, actively searching for the other nipple. When I put my finger in his mouth, he slid his tongue rapidly and firmly along it in a repeated milking motion.

What I'm getting at here is that from the first hours of life Colin has been a vigorous, enthusiastic, reasonably skilled, and rapidly improving participant in our nursing endeavors. And I had no idea. After Alex, I had no real understanding that the baby was supposed to contribute all this stuff. I thought of nursing as something the mother was supposed to get right.

It's possible that someone more skilled, persistent, supported, and experienced than me coul've made nursing work with Alex. But any half-alert halfwit could successfully nurse Colin. The baby makes a huge difference. And in our collective societal rush to make breastfeeding the hallmark of good infant parenting, we totally neglect that difference.

I'm glad he's my second baby. Because there might've been a possibility that I would have been one of those judgmental and sanctimonious nursing mothers, if I hadn't had such a clear demonstration of how little I've earned our nursing success.