Sunday, August 17, 2014

Too much of a good thing

Well, here I am...on the other side of the birth of our second child. It's been about two months (when I started writing this and three months at the time of its publication...I've been busy), and because of some things we've experienced, I feel compelled to make this post since about nursing. It all comes back to feeding with this blog. It was my nursing experience with my first son that motivated me to start this blog to begin with and then to ask my friends to share their stories.

But this wasn't the first blog I planned to write after baby's arrival. There were several others floating around in my head:

Like the one about my first outing with the boys by myself...where I went to put them in my car only to find a spiderweb going from the garage ceiling to my car door. Yeah, it may have been a while since I had left the house.

Or the list of hilarious (sometimes impish) things our three-and-a-half year old is doing and saying.

Or my candid take on my first six weeks and how hard it was to just enjoy baby what with all the healing, nursing, preschooler-entertaining, baby-cry-interpretting, spit-up-wiping and midnight-waking (and 2am-waking and 4am-waking) I was doing. And how nothing gave me more joy and hope and relief and perspective than hearing my husband coo with or talk to or even sarcastically joke with our new little one. His demonstration of patience and joy during such a difficult time (albeit a precious time) was a lifeline for me.

But I don't have time to write four posts. Truth be told, I should be paying bills right now or five or ten other things. I mean every moment that my children are not making an immediate demand is a moment I still must choose between cleaning myself, nourishing myself, cleaning the children, cleaning the house, reading up on the latest newborn or preschooler problem we are facing, or -- in a moment of indulgence -- texting other mom friends to solicit or offer support. And only one can win at a time. And notice how blogging (among many other things) is not on the list.

And yet I feel compelled to get this out there.

Both of our sons have dealt with infant reflux -- what doctors tell me are moderate cases. Gavin -- though always a spitter -- wasn't bothered by his until he was six months old (at the exact time when Josh went to London for a mandatory 12-day trip with his PhD cohort -- yikes!) None of the meds worked for him, so (with our doctor's blessing) we tried a kids version of the digestive enzymes that helped my reflux, and they worked wonders. I'm going to come back to this, but this post is really about Callen.

Sweet Callen was bothered by his reflux from about week 2. We did all the positioning techniques, I cut out dairy and caffeine (including chocolate -- kill me), and we reluctantly started him on Zantac. All of this did help a little, but it was still very bothersome to him and also interrupting his sleep (double kill me).

Spit up is a serious affair around our house. In the interest of clothing preservation, we retired our burp cloths and chose instead to drape ourselves in receiving blankets.
I wanted to try him on enzymes since they worked for Gavin, but my doctor wanted me to wait until he was two months before I tried them. So I'm counting down the days until he turns two months. Meanwhile, I am a constantly-hungry nursing mother getting sick of her dairy-free snack options. I mean I normally don't eat a ton of dairy anyway but especially when you're sleep-deprived you should at least get to indulge in some mac-n-cheese or some pizza or something! Okay, where was I... Three days before Callen turned two months, I happened upon a message board where moms were talking about dairy-free snacks. Unfortunately there were no good ideas to be had, but one mom commented that she went off dairy for a while but discovered that her problem was really a foremilk/hindmilk imbalance. I had heard of foremilk and hindmilk and knew you were supposed to let the baby empty each side to get to the fattier hindmilk, but I'd never heard of an imbalance. So of course, I did the scientific thing and googled it. (Sidebar: Right now there is a red squiggly line under "googled." You would think Google would relish their name becoming a verb and add it into their [Blogger's] spell check dictionary...)

Well, Google did not let me down. I found this article from La Leche League International.  It talks about how an oversupply of milk can mean the baby is not getting to the hindmilk, especially if the mom switches sides as a rule or for her comfort. Hindmilk is important for development, but also digestion. Just like in cow's milk, the thinner foremilk has more lactose. If the baby is getting too much foremilk, his or her system is being flooded with more lactose than it can handle. According to the article, symptoms include:
  • Baby cries a lot, and is often very irritable and/or restless
  • Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
  • Baby may seem to bite or clamp down on the nipple while feeding
  • Milk sprays when baby comes off, especially at the beginning of a feeding
  • Mother may have sore nipples
  • Baby may arch and hold himself very stiffly, sometimes screaming
  • Feedings often seem like battles, with baby nursing fitfully on and off
  • Feedings may be short, lasting only 5 or 10 minutes total
  • Baby may seem to have a "love-hate" relationship with the breast
  • Baby may burp or pass gas frequently between feedings, tending to spit up a lot
  • Baby may have green, watery or foamy, explosive stools
  • Mother's breasts feel very full most of the time
  • Mother may have frequent plugged ducts, which can sometimes lead to mastitis (breast infection)
We had all of the symptoms. So I decided to try to reduce my supply through the block nursing method suggested in the article. Please look at the article for a better description, but basically block nursing is staying on one side for a block of time -- for me it was for an entire nursing session -- then switching to the other side. Since he was on a 3- to 3.5-hour schedule, I was going 6-7 hours before switching sides. Pretty uncomfortable at first (the article has tips for avoiding plugged ducts and mine are at the end of this post), but I noticed a difference in Callen the very first day.

It is important to note that you should not restrict nursing, which for schedulers like me is a little nerve wracking. If the baby is hungry again, let him or her nurse, but on the same side. When it's time for the next feeding, then you switch sides. You also want to make sure the baby is gaining weight at the proper rate. Of course, (disclaimer, disclaimer) nothing on this blog should be taken as medical advice. Only you can decide if this is right for you. Breastfeeding is a wonderful gift to your child, and the last thing I would want is for someone to reduce their supply too much.

Our experience was a very good one. Sometimes I felt my milk supply dipping too low. I would either let him nurse on that one side until I let down again (and sometimes a third time) or go ahead and let him nurse on both sides for a couple feedings (2 or 3) and then go back to block nursing.

One question that didn't seem to be answered in any of the articles I was reading was "How long do I do block nursing?" When I googled it, I found a message board where a mom asked that same question (caution new moms - I know I've referenced them twice, but most message boards are scary places to find answers). I guess I'm not the only one who had a hard time finding the answer to the "how long" question because the first three responses were moms saying, "Yeah, I was wondering that same thing." One mom quoted a lactation consultant who said:

"If she hasn't gotten to the bottom of the barrel - if that side isn't nice and soft when she finishes - use it again next time. Here's where your intuition comes in. You may find that sticking to one side for a couple hours is all it takes. And after your supply has settled down to match her needs and things are running smoothly, you'll largely forget this notion... although you often see nursing mothers hefting one side and then the other to decide which they want to use. If your "oversupply" has been dramatic, or your baby is really fussy, you may find you need to spend 4 to 6 hours on one side before using the other. What's happening to the other side in the meantime? The sense of over-fullness is sending a message to cut back on production, which is what you want. If you're too overfull, you can nurse or express on that side just enough to relieve it somewhat, then go back to the side you're trying to soften completely. These sound like rules, but they're actually just temporary rules to help you get past those two initial rules that probably started the problem - making a point of switching sides, and spacing nursings to two hours or more. As your supply settles down, you may worry that you've "lost your milk." You may be so accustomed to heavy breasts dripping and spraying, and to seeing your child splutter, that a quiet, calm nursing from soft breasts feels "wrong." But you'll probably notice that those diapers are still very wet, and that your child nurses contentedly, with a relaxed and comfortable body, letting go gently when she's full or dozing peacefully at breast. Those are all signs of an ample - but not overfull - milk supply. If she wants to increase your supply further, all she has to do is ask to nurse more often, or fuss to go to Side Two after Side One is completely soft. Trust her to know her own needs, and trust your body to respond appropriately. Cutting down on an oversupply is usually a simple, straightforward process, and you should begin to see a happier baby within a few days."

And we did see a happier baby! What a relief! He still spits up (which is common even in healthy babies), but he does seem so much happier and has more normal diapers and less diaper rash. Now that my supply has balanced out, I am more comfortable, too. I am so thankful God blessed us with that solution!

So back to Gavin: I'll never know for sure, but I imagine that his reflux was related to the same problem. It explains why digestive enzymes helped him so much--because they were dealing with that excess lactose. I certainly had never heard of foremilk/hindmilk imbalance or block nursing -- not from MD's, naturopathic doctors, lactation consultants, baby books or friends/family. Of all the people I've talked to so far, only two have. (If you want another article on the topic in addition to the one I linked to above, click here.)

So I toss this out into cyberspace, hoping someone who needs it finds it. As always, please feel free to share it if you think it may help a mom you know.

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