Showing posts with label Breastfeeding-related. Show all posts
Showing posts with label Breastfeeding-related. Show all posts

Wednesday, January 7, 2015

The Breastfeeding Story: A Renewed Course

Introduction



Driven by the random discovery of this old key chain while I was looking around what's in the drawer at home (being a busybody when it comes to "treasure-hunting" at home since I was a kid, a habit that dear Alvin has inherited), I am reminded of a topic that I have long wanted to share about but somehow didn't have enough motivation to do so due to more limited time nowadays.  It belonged to my mother, obtained during the times when she's still at work before her retirement in 2004.

Here's sharing something on breastfeeding, or breast milk feeding experience with whoever happen to drop by.

I am not an advocator as to what milk is superior or inferior.  As someone who had gone through 2 different routes with 2 children i.e. formula-feeding and breastfeeding, I respect and understand the various reasons cited by mothers with regard to formula vs breastfeeding.  Please don't outwardly condemn a formula-feeding mother without first knowing the reason behind it.

Breastfeeding vs breast milk feeding... The former means direct latching (DL) while the latter is to pump-and-feed.  DL is the most ideal of course, but in the event where the baby doesn't suck, whether due to baby's downward refusal, baby's inability to do so, or having to be away from baby due to work, moms nowadays are fortunate with the availability of various good breastpumps.  If you're passionate about breastfeeding but you're unable to help your baby latch correctly, it's a good idea to see a lactation consultant before committing to EP (exclusive pumping). EP is very tough-going because you must pump consistently in order to maintain milk production... but nevertheless a viable method to ensure that your baby gets your breast milk. 

I shall organise my note as follows:  learning from past mistake, my new journey, and the challenges I have encountered so far.

Lesson from Past Mistake
During the second pregnancy, I was still a little affected by my failure to breastfeed my eldest for longer (it stopped on exactly the 53rd day).   That was back in 2012 and I ended up ranting about it on this blog.  The regret was aggravated primarily because he is a very preterm baby, and secondly because he became constipated when on various formula milk.

So what did I do wrong that caused the sudden cessation of breastfeeding back then when I was initially into the "minimum 12 months target"?

As Alvin was separated from me because he was admitted into the NICU, DL thus could not take place.  When I finally roomed in with him, I made a mistake of listening to one of the personnel at the NICU who told me to only pump and feed with syringe since Alvin lost weight when given DL.

When I think of it now, I should have ignored that advice and continue to let him latch for at least twice a day, on top of pumping.  So what if Alvin's weight gain is slower and thus we had to stay in ward for longer?  Maybe the instruction was given due to the fact that places are very limited at the NICU. 

Had I been adamant, I might have continuous stimulation.  The routine of pumping and feeding every 3 hours was physically too taxing on me.  Mind you, at 1.4 kg when I roomed in with Alvin, he took close to 1 hour to finish 30 ml of milk.  I ended up with a sharp decline in milk production, from 120 ml per session to just 30 ml.

Worst, I did not have a good pump back then and only relied on the sole unit of Spectra 7 at the NICU and subsequently at ward 4A to express milk.  The queue to use the breast pump at the NICU can be long at times esp day time, so imagine how hard it is to adhere to the once-in-three-hours pumping schedule.

Renewed resolution: To turn over a new leaf
My past mistakes coupled with the useful info gained from The Breastfeeding Advocates Network, or TBAN on Facebook,  I have made a resolution to try again this time.   But with an open mind, prepared for all possibilities.  I am grateful to my long-time friend Mei Mei for introducing me to TBAN.

The Spectra M1.   It's a middle range pump (price-wise), but has excellent performance - good suction, compact, light-weight and  low noise level.  It comes with rechargeable built-in lithium  ion battery and very few parts, so cleaning is easy.  Ideal for those who pump part of the day. (NB: A hospital grade pump such as Spectra S1 will be better for EP mommies because the S1 is more durable, and is super quiet too)

The Second Journey - It's not what I thought it to be
Contrary to my initially-innocent impression that breastfeeding would be easier because the baby's right in front this time, it was all dreadful for the first few days.

Unlike previously when I started having drops of colostrum on the night Alvin was delivered, even in the absence of stimulation from latching, for this time, colostrum only came in on Day 4.  It's no joke, for reason unknown, this time, there's no secretion whatsoever and (.)(.) felt very soft as if I was back in my early teenage years.  Ken-ken would latch but within seconds, he would scream in hunger again.  It would happen every hour even with correct latching.  So stressful.

So what's for a hungry newborn to drink while waiting for mom's milk to arrive? 

There was no choice but to sparingly seek the kind nurses to top up with formula.   Before anyone starts to condemn me for resorting to formula while waiting for my own milk to come in, below are the reasons why I did it:
i) I had no colostrum until Day 4;
ii) More than half a day after birth, Ken-ken still had not passed meconium (newborn's first stool); 
iii) There is an increased risk for jaundice when the passing of meconium is delayed.  In this case, although I foresaw jaundice to occur, I would not wish it to go too high. Sufficient hydration = normal BO frequency = getting rid of bilirubin faster.

As for other times when I forced him to do "empty" DL, I ended up with a screaming baby.  I was thinking, "A baby-friendly hospital is only friendly when mom has milk... otherwise it's not".

My insufficient lactation during the initial days is very obvious, as evident from Ken-ken's significant loss of weight ( 12%) for the first one week.   Normally, a newborn would lose at most just 10% of his/her birth weight in the early days before re-gaining weight later.

Beneath what's good, lies many untold stories
People will usually only tell you what's good, and breastfeeding is certainly not an exception.  "My daughter-in-law has abundant milk... my grandson is gaining weight very well...", said one aunty.  "So-and-so exclusively breastfed her baby for 1 year, that's why the baby has Michelin-looking arms", said another. 

Very rarely would anyone come around to tell you the "pains" involved in ensuring successful breastfeeding, unless that person is someone close.

Here's sharing some of the challenges that I faced in my attempt at breastfeeding:

"Alone on an island"
I shall not put a blame on anyone for not having sufficient understanding with my needs when I decide to go for breastfeeding, as no one in my close family circle had breastfed before.

According to sources, in my infancy, all that I'd ever had was colostrum for the first 3 days before being forcibly weaned off as my mother's doctor told her she needed to resume her thyroid medication soon, which was said to be contraindicated in breastfeeding.  Both my husband and I grew up with the same formula milk - S26.

E.g. of familiar remarks:
(a) "Do you have to be so extreme...pump every "x" hours... that you even wake up in the middle of the night?"
Answer: To ensure continuous stimulation when baby is not sucking/when you're away from baby, which in turn ensures steady prolactin level.  Milk production correlates to demand.

My faithful companion wherever I go...

(b) "This can't go on you know... it has to stop one day" 
Answer:  True, lactation cannot go on forever.  It's important to strike a balance between loving your baby and taking care of yourself by having enough rest.  But the making of such a statement at an early stage before baby is even 6 months old sounds very discouraging.

(c) "Never seem full... "
Answer:  Human breast milk is easily digested, which is why breastfed infants get hungry faster.  Cow's milk based formula takes longer to digest, and thus a baby who consumes formula feels full for longer.

Conclusion
In view of the routine of waking up at least once past midnight to express/feed, I do feel physically drained out.

On the statement made by many that breastfeeding moms slim down quickly, here's my scenario - While I've lost a few kg by now, I don't look slim.  Flabby tummy seems so stubborn that with the right type of clothing, I may still pass as a pregnant woman... perhaps in late first trimester.

Appetite-wise, I get hungry almost all the time that I cannot imagine how I can look as slim as last time.  If I eat a bit less, it affects milk production.   If I eat a bit more, then I have enough.  But just enough because I am not a high-yield mom. I used to have a little frozen stock when Ken-ken used to consume very little last time, which I have fed to Alvin and also given to a few other babies.  Ken-ken rejects frozen milk after thawing+heating up.

Monday, October 1, 2012

The Breastfeeding Talk

The perfect diet
General rule:  Human's milk is naturally-tailored for human babies and thus, it explains why mother's breast milk is best for baby.  But what about in situations when the ideal is challenged?


A history so brief?


Experience-sharing
There are many good resources on the benefits of breastfeeding available online, so I shall not discuss them here.  Instead, I'll go specifically into my recent experience.

I'm not a lactation consultant and therefore only wish to share my humble experience as someone who'd gone through it at one point of my life, and in a different manner from the majority. It's a brief, yet valuable experience.  It's something that I wish I'm able to do as planned, but alas!  There are many things that we humans can only plan, but the ultimate outcome is beyond our control.

An advocator of breastfeeding who uses formula - a treachery, or not?
Just in case if you're curious as to who that person is, I'm referring to no one but myself.  Ahaxxx.... why and how on Earth did I betray myself?

Long ago, I used to wonder why does infant formula sell so well despite breast milk being superior to formula.  Surely there are many reasons to it, but why?  

I used to pledge to myself that I'll try my best to breastfeed and express my milk for as long as possible. 

Mother's milk is not only highly-economical, but it provides all the necessary nutrients for a baby in the right proportion, crucial antibodies, and there's generally no need to worry about intolerance or constipation when it comes to mother's milk.

So what forced me to suddenly change in just 2 months' time?  Here's the story:

Ensuring continuity
In order to sustain lactation for a long duration, say 6 months, 1 year or more, there are some practices that need to be done.

Apart from a nutritionally-balanced diet and enough rest, a mother needs sufficient stimulation in order to lactate smoothly.  The more frequently you breastfeed, the longer you get to continue lactating. Direct latching is best, followed by pump.  As for the latter, if you're pumping exclusively, then you must be very consistent to pump once in every 2, 3 or max 4 hours round the clock.

The challenges that arise when you deliver very prematurely 
When a baby is delivered very prematurely, he/she is thus very small in size and physically not strong enough to suckle from the breast.  Or else why do NICUs resort to OG tube to feed our "mini babies", whether slightly bigger, as small, or smaller than Alvin?  

In my case, by the time my Alvin is strong enough to suck reasonably (when he's around 1.6 kg), my milk production had decreased by 80%, despite expressing milk religiously. 

If it had been the case of a baby who's much bigger and developed, and thus able to start breastfeeding sooner (say 1 week after birth), then perhaps lactation may not be as greatly affected as in the case of a baby who's only able to start breastfeeding more than a month after birth.  In the case of the latter, who knows if my body started giving wrong signals for it to stop lactating and resume fertility because "after so long, there's no baby around to feed, maybe the baby didn't survive, and so we need to start reproducing soon".   Well, I do not know. 

Babies of other people keep quiet and turn serene upon being offered to feed directly from their moms.  But my baby screamed at me when I tried to do the same with him, because I do not have sufficient milk to satisfy him. And his appetite isn't even tremendous, though considered OK for his size and age.

That's right before our discharge from Ward 4A.  And so, I had resorted to using my final resources, namely frozen EBM (expressed breast milk) to feed him until we're home and out of "stock".
 
Hard work but low yield
Relactation is not easy but I just gave it a try without much positive expectation.  Medication didn't work out for me.  Attempts to stimulate production by ways of letting the baby suck and expressing milk did not result in any difference, with a maximum yield of only a few cc per 30 minutes session.  That's a lot of hard work, but the result is negligible.

And thus, breastfeeding is only a sort of comfort or snack in between meals for Alvin as opposed to other babies who receive their full meals via the same.   Although having a few drops of milk is almost useless, a little is arguably better than none.  And of course, it comes with a string of screaming from the angry baby, unless he's falling asleep or if I bring in formula.   

So many reasons for using the formula
Having looked into the goodness of breastfeeding and some of the challenges in this case, let's divulge now into the pros and cons of formula-feeding.
 
The good and bad
Infant formula is costly because it's highly-taxed, it may or may not suit the baby, and is never the same as breast milk no matter how much fortification is added to it.   

Trying out infant formula is somewhat similar to trying out contact lenses; what's good for one person may be lousy for another, and vice versa.  Not surprising, this is why sometimes we see why a number of families (who use formula) use different brand for each child.  What's well-tolerated by Child A may not be the case for Child B.   

Formula-feeding requires stringent practice of hygiene, and any neglect in doing so puts the baby at risk for serious food-poisoning.  Bottle-feeding causes a lot more gas to be gulped in compared to direct breastfeeding.  But of course not many of us have the privilege to breastfeed directly due to work and thus the second best option is to express milk to be bottle-fed to the baby.  

Some babies become constipated as a result of formula-consumption.  As a result, special formula has to be resorted to, which costs a lot more than ordinary infant formula. 

Apply not the blanket rule
Before we outwardly criticise or condemn mothers who formula-feed their babies, we have to first ascertain the reasons why they do it.  

Is formula-feeding done for convenience reason per se, or with the belief that it's better than breastfeeding, or is it due to the body's inability to produce sufficient milk for its baby due to unavoidable circumstances?  What about the case of mothers who are prevented from breastfeeding due to genuine medical reasons that do not allow them to?


Is this kiasu attitude?
Contrary from people's impression that I'd "go private", I let Alvin receive his vaccinations at the Government clinic (Klinik Kesihatan Ibu dan Anak, or KKIA).  Ever since the shocking delivery incident, I'm have no qualms going to some Government clinic/hospital because they're actually much better than what most of us expect.

Despite the long waiting time as there are many other babies going there, and despite having to go on-leave for that purpose, because it's free.  And since the nurses and doctors at the local KKIA near my place are generally nice, I don't mind the waiting time.  

I don't mind anything, except when it comes to going into the "Bilik Penyusuan" (feeding room) at the KKIA to feed Alvin or to change his diapers in the midst of our queue.  Wait........... didn't I praise the availability of such a facility in the past? 

During the first time I went into the room, I saw many mothers breastfeeding their babies there.  I seldom see anyone who bottle-feed babies as small as mine in that room.  It made me feel "paiseh"  (or embarassed in Hokkien dialect) when I wasn't doing the same, and yes, I was bothered by what others may possibly think of me. 

Conclusion
Having said the above, if anyone were to ask me about my opinion on breastfeeding, I'd still maintain my stand, that breastfeeding is the best for your baby and you should thus do it for as long as your body permits.  It's even beneficial for the mother herself, because breastfeeding may help (note: I say may, because everyone is different) in shedding extra pounds, and in the prevention of breast-cancer (speaking of estrogen levels and stuff hormone-related).

P/S (26.09.2014):  After going through extensive reading up (books, articles and TBAN group), and in analysing where did I go wrong, I am of the opinion that my early cessation of lactation after Alvin's delivery was due to - 1) Not using a good pump; 2) I should have pumped milk once in every 3 hours instead of 4 and above; 3) I shouldn't have skipped midnight and early AM pumping because prolactin is high during these hours; and 4) I should have bought and brought a more silent pump along with me when rooming in at the NICU because the queue to use the only breast pump at the NICU was long most of the time.  I regret my past ignorance, so please do not commit the same mistake as mine.

Friday, August 3, 2012

Milk oh milk!

Advocating Breastfeeding, but....
Mother's milk is surely the best nourishment for babies.  I'm a supporter of breastfeeding and would like to do so for as long as possible.  Coming from a different path from most mothers out there as I didn't have the privileged opportunity to breastfeed my baby from Day 1, I later realised that it's actually easier said than done.

The Sudden Cessation
Yes, milk just kinda dwindled from about 100 ml per yield to 20 ml.  Who wouldn't be concerned, especially when there's someone in need of milk?

The doctors at Ampang (while I was still there rooming-in with baby) told that I was probably too exhausted but should be able to resume production as usual once I'm back home.

Back home, the situation did not improve.  Left without a choice but to top up.  :(

The Gamble Thus Begins
Similac Neosure
Similac Neosure is formulated for premature babies or babies in need of catching up. My kid likes it... and so do I because it doesn't taste sweet. But still, nothing beats breast milk. 

However, my big nightmare came within a week thereafter when he became constipated.


Eek!
And then we brought the kid to our local pediatrician, who prescribed enema (it contains normal saline solution) to help ease his constipation.  I  dread the idea of having to administer enema to my kid, bearing in mind the discomfort that ensues in the process of "receiving" it.  

My father had told me before that I used have enemas as a baby too.  Oh gosh, my kid seems to be very similar to me... us being premature babies although I was not as prem as him, etc... and now constipated babies.  Poor little fella.

A week later, the kid's constipation didn't improve and we went to the pediatrician again.  This time, she had recommended us to try either Frisolac Comfort (formulated with bean gum for babies prone to reflux and constipation) or Novalac IT (specifically formulated for constipated babies).

Frisolac Comfort
Not really sure which is better, we've first decided to try a small tin of Frisolac Comfort (FC).  2 days after usage, we still didn't see any difference.  In fact, I thought my kid looked more restless and his constipation unimproved with FC, which means FC is not suitable for him.  Sigh......

Taste and texture-wise, FC is thicker than ordinary milk, doesn't taste sweet but smells a bit vanilla.  I notice that the thickness is more so when the milk gets cold, hence making it more difficult to suck through a normal hole on the teat.

Note (added later):  Frisolac Comfort is more suitable for those with reflux problem.  A thicker texture = less likely for milk "come out" after feeding.

Novalac IT
The Novalac IT formula is available at pharmacies.  Here, it costs RM62.50 per tin of 900 g. 
I do not know if this will work or otherwise.  If it doesn't, I really don't know what to do.  It's all because of my own bodily failure,my kid may not be so badly constipated if I had more milk of my own although he'd experienced constipation twice when in NICU where he was exclusively fed on my expressed milk (but it's just twice over a period of 1 1/2 month... not everyday like now).  Why does my body always work against the innocent kid?

Conclusion
Each time I see the restlessness on my kid's face, I feel helpless.  Tummy massage doesn't work, switching formula hasn't proven to work, and my milk production hasn't shown improvement despite consuming what I was advised to consume, and also despite being on a medication to so-call increase prolactin level.  

I wouldn't dare to put a blanket-blame on all formula-using moms.  Not all mothers who use infant formula are lazy.  Although some may use it for convenience reason, there are a number who use it either because they're unable to naturally produce sufficient milk to feed their babies, or the nature of their job is such that there's not opportunity to express milk at workplace (or due to insufficient knowledge about breastfeeding which leads to premature cessation/decline in lactation).

P/S: 
1. The Novalac IT started showing its effect upon consumption for 2 days. Poop comes out soft.  
2. This post is not intended to promote formula milk but only to share a personal experience.  Mother's milk is the best.