Monday, August 20, 2012
Nursing two not-so-different babies
After he was weaned, I was looking forward to having another baby and getting it right this time. The next would be easier. And it has been -- but it still hasn't been effortless. It's required some thought, and I've spent awhile trying to figure out various issues. On the other hand, it's cast a lot of light on the problems I had with Marko.
With Marko, you may remember, he didn't nurse right away when he was born. He was taken away from me to suction and didn't show any interest in nursing when I got him back. I was told that he would sleep for about twelve hours and I could feed him when he woke up. About nine hours into his epic sleep (only as a second-time mom do I now realize how weird it is for a baby to sleep twelve hours!) a lactation consultant had me wake him. He still showed no interest in nursing. He was sleepy and wasn't rooting at all. The LC kind of shoved his face at the breast a few times, and when that didn't work, she told me I had flat nipples and he would never be able to latch. Then she gave me a silicone shield, and we got him to latch with that.
It was only the next day that I learned that it's very hard to wean a baby off a shield, and also it might harm my supply. The second LC told me I would have to pump after every feed. I was very upset. I had thought nursing was going to be so easy, and all of a sudden it was getting really complicated. It was only the third LC I saw in the hospital that actually got Marko to latch on without the shield ... once. But then I was discharged and it took me 11 weeks to get him off that shield for good.
When I weaned Marko off the shield, my supply went through the roof, and my cycles, which had returned, went away again. (I have never heard of this happening to anyone else!) Clearly that shield was doing some harm. I was thrilled to have more milk and all was well for about ... a week. But then suddenly Marko started doing something strange. He would cry as if he were hungry, and I would put him to the breast, but he'd turn his head away and scream.
That got worse and worse for about two months. I had to fight to get him to nurse at all. Some weeks I had success by nursing him really often -- like every 45 minutes. Some weeks he would only nurse lying down, or while I was walking around. Going on a strict every-two-hour schedule helped more than anything, which was a surprise to me. It didn't mean ignoring his cues, because he never asked to nurse. I had been just nursing whenever he fussed because it was the only cue I had. When, at nine months, he crawled into my lap and lunged at the breast, I almost cried. It was the first time in his life he'd ever shown that he actually wanted to nurse.
I considered many issues: teething, oversupply, undersupply, overactive letdown, underactive letdown, tongue tie. I dismissed tongue tie, though, because he seemed to be swallowing fine when I did get him to nurse, and because I wasn't having any pain. It couldn't be undersupply because I could easily express milk when he was refusing it. It really seemed to me like nursing was hurting him somehow. I suspected reflux, and went on an elimination diet which did help, or which at least seemed to help. Occasionally, when stressed or overstimulated, he still refused to nurse occasionally.
When, at five and a half months, he was looking pretty thin (he'd been quite chubby at three months, but had actually lost a little weight during the worst month) I let him grab food off of my plate like he'd been trying to do for weeks. He scarfed it right down. There was very little he tolerated at that age -- mostly just meat and beans -- but he was soon eating three meals a day and loving it. He still nursed in a businesslike way, though usually because I offered it. He was easily fussy and frustrated while nursing; the only way to calm him was to let him play with (read: pull) my hair.
He nursed till 19 months, when excruciating pain confirmed that I did not at all want to nurse through pregnancy. He hasn't seemed to miss it, and I don't really have any regrets about that. I figured we'd had a good run.
Well, let me tell you, it was a huge shock to me when I noticed one day, while brushing his teeth, that he has a tongue tie. A very visible one -- a thread under his tongue that you can see whenever he lifts it. When I asked him to stick out his tongue, he could only get it a little way out,and it turned heart-shaped. I asked him to touch his nose with his tongue, which I did to show him, and he could barely get it over his upper lip.
All I could say was no.freaking.wonder I had trouble nursing this child! It was actually a relief, realizing it wasn't all my fault. That silicone shield might have been the only thing that got him nursing at all, when his mouth was still tiny and nursing would have been hardest. And I have recently learned that nursing with a tongue tie may be painful for the baby and not for the mother. Stretching the tongue up to nurse makes that tight frenulum hurt. I wonder if that could have been one reason he was so resistant to nursing. On the other hand, a tongue tie can also cause reflux, because it gets the baby swallowing air. So he might have had that too.
So then I had another baby. Michael had a much smoother start. He latched on within thirty minutes of birth. And then he pretty much stayed latched on for the first 48 hours or so. Once my milk came in, he shifted to nursing every hour or so, which was delightful to me -- I could eat and go to the bathroom! It was pretty obvious to me from the start that I had an oversupply. I had a lot of milk with Marko, but this was way more. Michael was sometimes overwhelmed by it, choking and pulling off to let the milk spray everywhere. But it didn't discourage him from wanting to eat all the time.
He is a very burpy, spitty baby. Our biggest issue with cosleeping was having to get up after each feed to burp the baby. It was hard for awhile to get him to burp at all -- it's much easier now. But he still spits up a lot. I wondered for awhile if he could possibly be keeping anything down, but he was gaining weight at a phenomenal pace, so clearly some was getting through. But around three months old, I started trying to work on that oversupply by doing block feeding. Nothing drastic -- just trying to make sure he was emptying one side before offering the other. I'd made the mistake up to then of switching sides every time he pulled off to burp, when really he wasn't finished.
Only that was not a success. Michael does not want a half-empty breast. He wants a full breast. He wants the milk to let down instantly, and he wants it to flow so fast he can barely keep up. He might be choking, but he likes that. I think he is used to it. If I put him on the emptier side, he fusses and yanks at it. The same for after the letdown is over -- he pulls off and on again, or clamps his gums and pulls. There is definitely milk there; I can express it easily. But it isn't hosing him in the face like he's used to. Like Marko, he always unlatches himself when he's done. He rarely stays on for a leisurely nursing marathon -- instead the yanking-off increases until I declare the nursing session is over. Once I've burped him, he doesn't often want to get back on again, unless I give him the other side. But if I give him the other side, he spits it all back up again. Occasionally he does what I dread more than anything -- flings his head away from the breast and screams. Luckily I can deal with that easily enough, especially compared to Marko (who once starved himself for four hours, screaming the entire time, before I calmed him down enough to eat). I just calm him down, do something else, and try again later. Or I put him in the wrap and he falls asleep instead. I'm not worried because he still nurses really often.
Elimination communication has been very reassuring to me, because I have been able to see that he isn't at all dehydrated and has been getting plenty of milk. On the other hand, he is rather constipated. (Yes, I know exclusively breastfed babies aren't supposed to get constipated. But he IS!)
It's frustrating though. I thought with this one it was supposed to be easy!
I can't be quite sure Michael does not have a tongue tie. He doesn't have an obvious one like Marko has. He does have an upper lip tie, but that is stretched out enough now that he has no trouble flipping his lip out correctly when he latches on. But I know there is such a thing as a posterior tongue tie that isn't visible. I don't know of any local expert who could tell if he has one or not. They do run in families, so it is quite possible that I could have multiple children with tongue ties. (If you are interested in the genetic causes of tongue tie, read the last link on this page -- apparently one issue is not being able to turn folic acid into folate, which leads to a folate deficiency resulting in tongue tie and other problems in a woman's unborn children. Certainly motivated me to eat my liver instead of relying on prenatal vitamins, whether or not I have this mutation.)
It could also just be that he's accustomed to a fast flow now, and doesn't want it to slow down. He never learned to suck hard because he never had to learn. So now he's kind of lazy about it. He can't keep a pacifier in either. He'll suck on it for a bit, and then it falls out. Marko was the same. Neither of them has ever been willing to nurse on an empty breast to increase supply. They could be starving, but once they realize the milk isn't going to come rushing out, they scream and refuse to try. It's of course hard to say, because I have so much milk that this rarely happens and so maybe they just haven't been hungry enough to try. All I know is, they have both preferred a full breast and a quick letdown.
Here are some links that I've found helpful. The first two are about oversupply and the second two are about tongue tie. You'll notice that a lot of the symptoms are the same for both. And if I have oversupply AND the kids have tongue tie ... would those help cancel each other out? Most tongue tied babies have trouble getting enough, and supply goes down. In that case oversupply might be a blessing.
Colic in the Breastfed Baby
Gaining, Gulping, and Grimacing
Feeding problems from a tongue tie
One genetic cause of tongue tie
I'm going to see if I can get to a La Leche League meeting, just to ask around for some tips. Since Michael is eating well -- albeit every hour, with lots of puking -- and gaining just fine, I'm not exactly worried. But I'd like to know what's going on. Is this his personality, or is he honestly having trouble? And am I going to have to nurse five kids before I can say I know what I'm doing?