Doing What Comes Naturally: The (Absolutely NATURAL) Need for Wrap Around Support to Facilitate Early Breastfeeding
written by Caitlin Spear ©2013
As a current doctoral student, I’m a big reader. I’m used to approaching learning new things by reading current research, and using that information to understand issues, solve problems, and make informed decisions. So when I found out I was pregnant with my first baby, I jumped right in, reading everything I could get my hands on. I know it’s impossible to be prepared for everything a new baby brings, but I wanted to give myself a step up. I read everything I could about fetal development, diet and exercise during pregnancy, nesting, and of course labor and delivery. When I got to my eighth month of pregnancy, I started thinking that I should start reading more about what would happen after my daughter arrived, but I have a fair amount of baby experience, and figured I more or less knew the basics, and so, beyond developing my birth and post-delivery plans with my doula and doctor, I somehow kept putting off reading my books on newborns.
“My daughter Ida arrived fast and furious almost three weeks early.”
I figured I’d cross that bridge when I got there – I still had a month, and with the prospects of labor looming, all of my efforts were focused there. My daughter Ida arrived fast and furious almost three weeks early. It wasn’t as I’d planned, but the birth went smoothly, though incredibly quickly (I pushed for only 9 minutes!). While we barely had time to look at my birth plan, or follow any of the procedures I’d been planning to deal with pain, focus, or meditation, I was proud of myself, and what my body achieved during the process. I felt powerful, strong, and centered, and the second I saw my beautiful girl the rest of the world disappeared, and I could do nothing but hold her and look at her in amazement. Though she was early, she wasn’t tiny – 6lbs 11oz – and she was strong-willed and fierce (born at the end of December in the year of the Dragon) and she nursed ferociously within the first hour. After we left the delivery room, a flurry of nurses and doctors came in over the next few days to check on us. I was exhausted, blissed out, staring at this amazing little creature, and falling completely in love as we got to know each other. But while Ida nursed constantly, she also cried a lot, and seemed to never be completely satisfied. A few of the nurses mentioned that her latch wasn’t great, and a few offered some ideas, but each was different, and I had no idea what I was doing! I’d just assumed breastfeeding would come “naturally” – that both Ida and I would know what to do when it was time!
“Over the next few days at home, we did the best we could.”
I couldn’t have been more off. I found out, much later, that Ida’s early arrival, coupled with her speedy birth, and the fact that she had a teeny tiny mouth left her at-risk for feeding issues. I think if I’d known this I would have been more on top of requesting information and making sure I had an action plan in place for when we left the hospital, but I didn’t, and so I just kept going as we were. When Ida was examined by the pediatrician the day after her birth, she’d dropped down to 6 lbs 5 oz, but he assured us this weight loss was fairly normal, and to just keep going with the breastfeeding. I did request a session with a lactation consultant, however beyond making me feel terrible (telling me all the possible things that could go wrong if we didn’t get her latch right), she never really took the time to work with me, or offer accessible steps to improve Ida’s latch, or build a plan to make sure that Ida was getting the food she needed moving forward. One nurse recommended using a nipple shield, and that seemed to help some with her latching on, but she still seemed to be hungry all the time and having a hard time. Another nurse had me pump to make sure my milk supply was coming in, and then had us feed Ida what I’d pumped after she nursed. This nurse suggested that we try this the rest of the time at the hospital, which we did, but she was only on duty for one shift, and we only used the pump after that because I asked. We left the hospital after two days having no plan in place beyond visiting the doctor a week later, due to New Year’s, and a hand pump that we’d been given.
Over the next few days at home, we did the best we could. I felt like I was feeding Ida round the clock with the nipple shield, and that she wanted to nurse forever! I’d read that she should eat every two or three hours, but she kept sleeping through, and was difficult to wake up. My mom told me to just let her sleep and see what happened. One night she slept over 5 hours – amazing for my exhaustion, but the next day she seemed even fussier. When we finally got to the doctor’s office and checked her weight, she’d dropped down to 6 lbs, and was having very infrequent BMs. The nurse practitioner immediately said that this was too much weight loss, and worked closely with me to examine Ida’s latch, offer suggestions, get me information on lactation consultants. She diagnosed Ida as an inefficient eater, which was leading to my supply being low, and she said we needed to develop an intervention. We gave her formula there in the office, because at that point she just wasn’t getting enough calories. I was upset, as I wanted to exclusively breastfeed, but hearing that my baby wasn’t getting enough food was heartbreaking, and at that point that was what mattered most. We left the office with a plan to do triple feeds – nurse, supplement with 1 oz expressed breast milk or formula if I wasn’t able to get enough breast milk, and then pump to increase my supply and get her the supplement – every 2 hours until Ida returned to birth weight.
“She would eat, sleep, I would pump, try to sleep, and then we would start again. It was exhausting; the hardest thing I have ever done. But it worked.”
With the plan in place, things moved forward at an insane pace. The nurse practitioner offered to come in specially to the office the next day, which was a Saturday, so that we could weigh Ida and make sure things were going well. My birth doula offered to come with me, as my partner had to work that day. My sister went out and got me an amazing electric breast pump, which was fully covered by insurance (whoohoo!), and met with a lactation consultant who came to the house. She brought a scale, and we saw that Ida had gained an ounce, but she was very straightforward about the fact that being early, and with all the weight loss, Ida was fragile. We set up a follow up appointment for a few days later so we could check in and ensure that Ida was staying on track. We fed her round the clock. Each feeding took an hour. She would eat, sleep, I would pump, try to sleep, and then we would start again. It was exhausting; the hardest thing I’ve ever done. But it worked. Ida was slowly but surely gaining weight.
“It really felt like a lifeline had opened up two blocks from my house.”
We continued with the triple feeding, and to check in with the lactation consultant. She noted that there was a new-mothering support center that had just opened up around the corner from my house, and that while they might technically be “competition,” she felt they would be good for me and for Ida. Daisy C.H.A.I.N. not only had a scale where I could stay on top of Ida’s weight gain, all within walking distance (avoiding the dreaded car seat!), where I could pop in and nurse Ida comfortably, but also offered amazing free lactation consultation, and new mother peer groups. So much of those early weeks are just a blur, but knowing that I could leave the house on foot, wearing Ida in her sling, nurse or change her if needed, and stay on top of Ida’s weight gain and well-being offered such a tremendous sense of relief and control; it really felt like a lifeline had opened up two blocks from my house.
At Daisy C.H.A.I.N. we worked closely with Jennie, an IBCLC, to make sure Ida stayed on track. It’s hard to know exactly how much milk newborns are getting just based on nursing, so we used the scale to weigh her after each feeding, and to tailor how much supplemental milk she still needed. I was nervous when we started to reduce the supplements, because they felt like the only way I could absolutely ensure that Ida was getting the nutrients she needed; Jennie understood this and scheduled extra appointments so we could weigh her and continuously monitor her progress as we adjusted her plan. Jennie also worked closely with me to help us transition from using the nipple shield to nursing without it. Looking back on this, Ida made a natural transition, getting stronger and stronger without it, and then eventually not needing it all. But, as an overwhelmed new mother, who went from feeling empowered and ready for everything pregnancy and birth entailed, to suddenly feeling like I’d lost all control, and that my body was failing my baby by not being able to feed her effectively – this transition away from the nipple shield was another difficult one for me, and Jennie’s support in that process was so important. After a couple of weeks, it became clear that Ida had become quite the efficient eater – she started gaining almost a pound a week!
Ida is now four months old, and thriving. She went from the 8th percentile for weight at her two weeks doctor’s appointment, to the 95th percentile at four months. She is a giant, loves to nurse, and has the most amazing chubby cheeks! We still continue to go to Daisy C.H.A.I.N. every week or two – to check up on Ida’s weight, to visit, nurse when we’re out and about, or chat with other new mamas at the peer group sessions. We’ve also continued to work closely with Jennie to diagnose some issues with Ida’s digestive system. She finally seems to be on track, and is a healthy and happy baby.
I am so thankful for the amazing support I have received throughout this process, and feel lucky to be part of a community with so many supports for new mothers. Despite this happy ending (or beginning, really), I still wish some things had happened differently. I wish I’d read more about early breastfeeding issues, and had been able to manage my expectations of the process more realistically. I wish I’d received more information early on at the hospital about Ida’s risk factors, as I could have been more vigilant about nursing in those first days, and perhaps have avoided many of her issues. I wish I could go back to feeling strong and powerful about my pregnancy and Ida’s birth, instead of feeling guilty about her early and fast arrival, and the fact that it made her first month so hard for her (I’m working on this!). I wish I’d had a plan in place leaving the hospital. And I wish the types of community services I eventually received were available from day one, to all new mothers.
The more I’ve reflected on those early days, the more I realize how lucky I am to have had access to these resources. I was comfortable using my social and financial capital to get the help I needed to ensure that I could continue with my commitment to breastfeeding my daughter. While breast pumps are supposed to be available to rent for all women who medically need them, my partner drove to three different medical supply stores in search of one, only to be told each time that none were available. We were ready to just pay for a $400 dollar pump out of pocket when my sister did some digging, and found out that my amazing insurance would cover a pump fully, so we got one to own on the spot. This insurance not only completely covered my breast pump, but also paid for my private-practice lactation consultant. But this insurance is not the norm, and I completely understand why women stop nursing. It can be so hard early on, and without support, it’s such a challenging process. Recent changes to federal healthcare policy like the Affordable Care Act have helped to make some of those supports more readily available to women in various communities, but my experience with lactation support (or lack there of) at what is generally considered a top-rate hospital, and with trying to track down a breast pump highlight the policy-to-practice gaps that affect so many families. It’s organizations like Daisy C.H.A.I.N. that fill those gaps, and make such a huge difference in mothers’ and babies’ lives. Lucky for me, all the women I worked with throughout this process were incredible, and helped me build the community of support that Ida and I needed to ensure that she is a healthy, happy, breastfed baby girl.