Wednesday, August 27, 2014

Breastfeeding is Natural and Beautiful... Or Not.

So it's been over 3 months postpartum from Waylon and I'm almost resolved with my initial breastfeeding troubles. So, how, you ask, could this experience be worse than with Wilson, who never latched, looked at my boob like a monster that wanted to eat him, where I had undersupply, had to pump every 2 hours to get my supply up to 20/25 ounces a day and had a case of mastitis along with a blood blister on the nipple (something which should not be possible, I think)? Even given that, I exclusively pumped for a year, until I got pregnant with Waylon. How could it be worse? Well buckle up; I'm about to take you on my natural and beautiful breastfeeding journey with Waylon.

During pregnancy, I felt hopeful! Instead of a size L bra (I kid you not) like last time, I was a double J. Almost immediately after having Waylon, he latched beautifully. We spent 3 days in breastfeeding bliss, he latched, I was producing colustrum and transitional milk well and I finally got to feel the oxytocin and feeling of utter (ha!) love burst from breastfeeding my baby (rather than the mechanical pump, which does not feel as good). It was beautiful... those 3 days. The following are a timeline of events following these three days of bliss. 
  • Waylon kept latching...every hour. My nipples were so sore that I had a dream that I sprouted a third nipple...and I was happy. Seriously. I woke up sad that it wasn't true.
  • On Night 4, Waylon started crying at the breast. I gave him expressed milk in a dropper and he still acted upset. I finally broke down and gave him the milk in a bottle and he gobbled it up. At 2 a.m. I woke up Mike to get some back-up formula because he was acting super hungry. Mike was thrilled at the early-hour request, but ran to the 24-hour CVS and brought back some formula. 
  • My milk came in. A lot of milk. Like 60 ounces a day, cow-on-the-dairy-farm amount. I begrudgingly got out my trusty old breast pump since Waylon was not latching. We also had to buy a stand alone freezer just to house the inordinate amounts of milk I was making. Last time, I had too little milk. This time too much. I was the Goldi-tits of breastfeeding.
  • Went to the renown Breastfeeding Resources (Dr. Smillie's office), they said Waylon's latch was great, but my one nipple was too big for him and he had bruised it. In case you were wondering, yes a bruise on the nipple hurts. And although he was an average weight, he was acting like he was underweight, which they expected to stop in a few weeks.
  • On Doctor's instructions, I took mint and sage teas to lower my production. Didn't even make a dent. It continued to increase. I had to take Sudafed for several days to get my production down to 50 ounces a day.
  • I pumped 5 times a day and having grabbed my pump bag from a year before, I did not think about the flange size (the part that connects to your nipple). The year before I had switched to a smaller size after my milk supply and subsequent bra size had gone down significantly. I forgot that I originally needed a larger size and began using a size which was inappropriate for me. Apparently, this matters.
  • On one side, I had a bruised nipple. On the other side, from the too-small flange, I had what began to look like a zombie nipple. the skin was coming off, but had not fully detached. So every time I breastfed or pumped, it detached a little, then began healing during the down time. Each time was excruciatingly painful, so I showed it to Mike to get his input. He made an incredible horrified face and said, "I'm pretty sure you should talk to someone about that." Oh, the romance after having a baby.
  • So, I consulted my trusty friends in my Yoga Mommies Facebook Group and began to employ everything that was suggested. I used cabbage, lanolin, coconut oil, saltwater rinses, air drying with breastmilk. Out of pure pity, my BFF bought me soothie pads that are put in the refrigerator. Finally, the skin fell off. To reveal pure zombie nipple. It looked like I had taken a cheese grater to it. Not kidding. Oh, the beauty of breastfeeding.
  • The next night I started getting a fever and chills - along with a painful feeling in my right breast. I knew what it was immediately. Mas-freaking-titis. Mastitis is a bacterial infection that can occur when milk stays in the breast too long OR if it has access to the inner breast - say like through a zombie nipple.
  • So, back to Breastfeeding Resources I went. It's always good when the doctor slightly shrieks upon seeing a body part of yours and says, "Oh my god. That hurts me to look at!" I immediately started antibiotics and went home with instructions to NOT breastfeed as it would be too painful, but I should keep pumping as much as I could AND got the correct flange as the doctor had figured it out.
  • My fever and chills went away and I was finally feeling better. Then on Day 5 of antibiotics, I decided to go with Mike and Wilson to the children's museum. I was so happy to be out - I wore a spiffy new bra (that was a little tight) and babywore Waylon the whole time. At one point, he slipped from the middle and had his head on my left breast. Not a big deal. But when I took him off, I could feel a hardness in my breast and my fever was starting to come back. Seriously, universe???
  • I called Breastfeeding Resources and they changed my prescription to a new antibiotic and I struggled with full-blown mastitis again, but this time in the left breast. I had plugged ducts that would not open. It was like having a large rock in my chest, accompanied with the feeling of having a plugged sink with the water on full speed as well. HORRIBLE. Apparently, too tight of a bra or the baby's head on my chest for that long could have done it. Awesome Sauce.
  • Every pump was a manic attempt to get those plugs to break. I would apply hot compresses to get the milk flowing, then a cold one to lower inflammation. I was bent over a pump, massaging madly, squeezing, whimpering in pain...You know... experiencing the beauty of breastfeeding.
  • Fever finally broke, plugs finally resolved and I began feeling better...for a few days. Then all of a sudden my right breast began getting hard. I wanted to punch something. How could this happen???? My doctor put me on a second antibiotic and assessed me to make sure I didn't need to be hospitalized. I also had the bacteria in my milk cultured - we later discovered it was an antibiotic-resistant strain that was incredibly rare. As if you don't have enough TMI on me, apparently the infection was so bad that all that came out was a small amount of thick yellow milk. Needless to say, after having it cultured, I dumped the rest. And Retched. BEAUTIFUL BREASTFEEDING.
  • I continued to try every remedy under the sun, including chiropractic care - I have an awesome chiropractor who came in on his day off to give me an adjustment to help. I went in for an ultrasound to make sure I didn't have an abscess (which I didn't) and then went home to rinse and repeat the pills, pumping and assorted cures.
  • The plugs in my right breast would not budge... for five days. Please picture that awful pumping experience four times a day for five days. I finally went back to Breastfeeding Resources (who knew me so well that they texted me, called in to check and had a file the size of Mt. Everest on me) and they tried to get the plugs out themselves. Now, having another women "milk" you is embarrassing enough, but honestly if it worked, I wouldn't care. It didn't. She told me that the plugged ducts would resolve on their own and probably close, lowering my supply in that side. I was down to 35 ounces a day, which was more than enough to feed Waylon, so I didn't worry too much.
  • She also asked if she could take a picture of my nipple for publication purposes. Yay! My necrotic nipple will be famous. Awesome. So pretty. She told me to buy a hibiclens soap and wash it twice a day.
  • The hibiclens stuff is amazing - cleared up and healed my nipple very quickly. I did get some more ducts expressing and my supply was going up again. Everything seemed to be better as my supply came back to about 50 ounces a day and I was starting to breastfeed Waylon again.
  • Waylon has a unique (ahem) way of eating. On the breast or on the bottle. He latches. Looks at you. Unlatches. Looks at you. Latches. (repeat that 10 times). Then waits five minutes. Then drinks two ounces. Seriously. At the breast, that is seriously annoying and seriously painful. I began to consider exclusive pumping again. I loved when he latched, but the weird latching was hurting my nipple. I still wasn't feeding on the left side because it was STILL bruised (and I was postpartum 2 months at this point). 
  • Got two blood blisters from pumping. Both healed quickly. So fun!
  • I noticed on my left nipple that it was turning white. Oh, good! More beauty! Breastfeeding Resources diagnosed a yeast infection and prescribed an ointment. Luckily, Waylon did not have it or we would have passed it back and forth. Back to no breastfeeding.
  • I continued to pump, but after the yeast infection resolved, I felt more pain. Nipples turned a bright shade of pink, pumped out some blood (soooo natural), found more white on my nipples and it kept getting worse. It was so painful that nothing could touch me - even through my shirt without making me want to punch something. I had to bite my hand every time I started pumping. I went BACK!! to Breastfeeding Resources and they diagnosed that both of my nipples had eczema. Oh Universe, you little joker! Thanks so much. Now I put steroid cream on both of my nipples at every pump and FINALLY they began to improve. 
Which brings us to today. I am still on the steroid cream, having little pain. I joked with Mike that a story like this belongs to the superhero comic mythology. You go through such tragedy and pain to develop a superhuman ability. My superhero name will undoubtedly be Iron Nipples, the woman whose nipples can cut through steel and deflect weapons! Oh, and feed her babies.

So why keep breastfeeding/pumping you ask? You aren't alone - my husband, my mother, my friends - everyone questioned my sanity with continuing to breastfeed and pump through this. But the bottom line was I was not going to let ANYTHING stop me from experiencing breastfeeding and providing breastmilk for my baby. I saw with Wilson how healthy it was and that it has protected him from having to take any medications (breastmilk and garlic drops for beginning ear infections; breastmilk and coconut oil for eczema was all he has needed). I have heard that each drop of breastmilk contains millions of white blood cells in it. I see how whenever one of the kids or I has a scratch, I can put it on it and it is gone the next day or two. The healing ability is amazing. Oh, and I am losing weight like gangbusters. Can't hate that.

Let me be clear: I totally respect anyone's decision to do whatever feeding they want for their baby, including not breastfeeding for whatever reason. For me, I just wanted to provide breastmilk for as long as I could. There are a few things in life that I set my mind to - surviving graduate school, writing my dissertation, becoming a psychologist and counselor, escaping poverty, becoming a professor, writing several research reports, getting through a 50 hour labor... These things weren't to try to one up on someone else or compete or to show my skills. This was about wanting something for myself or my family and doing everything I could to achieve it.

And so far, I have. Waylon is 100% breastfed. I decided to use the extra milk I was making (since I have over 1200 ounces stocked in a FULL freezer) to feed my toddler when he wanted his bottle before bed. They are both super happy and thriving; I am producing lots - all things for which I feel very lucky and blessed.

I don't mean to scare anyone with this story either. Just to tell you that you need lots of support when you breastfeed - emotional, physical, psychological. Making the decision to breastfeed is a sacrifice that many of us gladly make for our little ones (and it does help to prevent breast cancer for us, so there's that).

But, is it natural for women? Is it beautiful for everyone? I call bullshit on that...and I have the iron nipples to prove it.

Tuesday, August 26, 2014

What I Decided to Do with My Placenta...and Why

So....Placentas. With Wilson, I didn't look at it or even really give it a second thought. But, as my due date approached for Waylon's birth, I had heard a lot about Placental Encapsulation and given that I KNEW what the first few months with a newborn were going to be like (i.e. awfully terrible), I decided to look into it. I have to be honest: from the beginning, it grossed me out - even thinking about it as an organ made me want to heave. But, I first considered it for its stated impact on Postpartum Depression. I had PPD with my first son; the transition to motherhood coupled with a difficult tempered baby was not an easy one. It was only moderate PPD which resolved with support and counseling, but having had it before and now having 2 boys under the age of 2, made me rethink some of my options. 

So I first checked out the research. There are not a lot of good empirical studies, but there are some. They indicate that consuming the placenta postpartum increases lactation production, pain relief, speeds up recovery, increases bonding, boosts energy, stimulates the immune system and replenishes iron. Um, great! Those would be all the things that make the "fourth trimester" awful - you are fatigued, feeling like you should be more bonded with your baby, stressed out, struggling with breastfeeding, feeling crappy and probably anemic. Although the studies are few in quantity, it is important to remember that clinical trials can cost millions of dollars; and what company (particularly pharmaceutical companies who usually fund trials) would be interested in funding a study like this - where patients make their own medicine and you can't profit from it? 

So, the lack of research is not surprising; but the preliminary studies are promising. So I decided to take a case study approach: I then asked other women who had done it if they would do it again. It was a resounding YES. Some swore by it and some stated that maybe it was a placebo effect, but either way, they said it was a lifesaver AND that it did all the things that the research said it would. 

I looked at the history of placental encapsulation and found that it had its roots in Chinese medicine, with its utility first published in 1578: not exactly what you would call a fad as I initially thought it was. It was used sporadically in Europe during the 1700s and then brought back into use in the 1980s by an American midwife. 

So, some good research, good word of mouth and a history. Even so, I kept thinking....but ew. EW. I know most animals always consume their placenta after birth, but I don't feel the need to copy my dogs in their efforts of licking their butts or eating some rather disgusting things. So the ick factor really still pervaded despite it being a natural phenomenon.

As it got closer to Waylon's D-Day, I realized that even though I was hoping for a positive, perfect outcome, what if? What if it wasn't? What if many, numerous crappy things happened as they did when I had Wilson? I remember being anxious, depressed, wanting to kill my partner, questioning my decision to have children, hating the universe and crying ALOT. It was not what I had pictured in any way, shape or form.

So, I researched some companies, but finally went with Birth Partners, who I have used for my doulas (both first and second births); and they are pretty much the best out there for lots of reasons. You sign a contract, get a form from your doctor maintaining that you do not have any diseases and await the birth. When we had Waylon, my midwife set aside his placenta and cord and Mike took it home to our fridge. More ick factor. I looked at it once. It was huge, gross and even though I loved it for keeping my baby alive, I couldn't imagine ingesting it. Dawn from Birth Partners came on day 3 postpartum and prepared the placenta, dehydrated it for 8 hours, then came back the next day to grind it and put it in capsules. When she first got there, she asked me if I wanted some raw placenta for shakes. I made her repeat that several times before I said, "Oh God, No!" with an audible retching sound. Before that, she gave me the "umbilical keepsake" and a placental print. Now, I'm pretty granola, but I promptly threw out the keepsake (dried bow of umbilical cord) with another retch and although a placental print (pressing the placenta onto a piece of paper so you can see the outline) sounds equally gross, it was kind of pretty - they look like a tree, which is a great metaphor for creating life. By the way, that's not my placenta in the picture, but that is what they look like. I have no desire to share pictures of my own beefy appendage.

So, I got 250 capsules out of my placenta and was instructed to 1) take 1 or 2 a day as needed, and 2) do not take it when you have an active infection (it increases immune system dramatically and can make your fever higher than needed, apparently). So on day 5, I took my first dose.

So here is what I noticed immediately.
  • My mood was excellent - at all times. When I felt a little down or anxious, I took a second one and felt better within hours. Within the first week, I experienced breastfeeding problems, a shredded (not exaggerating) nipple and in a few weeks, an antibiotic-resistant strain of mastitis that took 3 weeks to resolve. I never felt depressed, nor hopeless. My doctors even commented on it, given the situation it would have been normal for me to feel down. But, my mood was incredibly stable.
  • I did not have to take any pain pills once I was home despite having a second degree tear. The healing was MUCH faster and I barely did any intervention. Even when I had the shredded nipple (actually it looked like I took a cheese grater to it - breastfeeding is awesome), I only took a small amount of ibuprofen a few times a day. Once I had the mastitis and could not take the capsules, I saw a big difference with my pain tolerance. Even after the mastitis resolved, I still had pain, but when I took the capsules in the morning, I never needed any pain meds.
  • My skin was great - people commented on how quickly I was recovering.
  • I lost all of the baby weight in 1 week, then another 20 pounds in the first 2 months. To be clear, I lost all of my baby weight quickly with Wilson too, so that may not be an effect, but I continue to lose weight this time, so I'm not complaining.
  • I was not as fatigued with Wilson's newborn period, nor even when I was pregnant. I was taking care of Waylon through the night by myself (Mike was on Wilson duty) and I felt fine even after getting very interrupted sleep throughout the day.
  • I could definitely feel the bonding influence - I would find myself feeling such love and wanting to just baby-gaze after taking one. The hormones were definitely palpable and helpful in all ways. I did not argue with Mike (an hourly occurrence with Wilson's birth) and was able to be present for Wilson, my impatient and fiery toddler as well.
  • My lactation production was, ahem, boosted. With Wilson, after pumping 2 hours around the clock for a week, I finally got up to about 25 ounces a day. This time, out of the gate (as soon as my milk came in), I was pumping 60 ounces in ADDITION to Waylon breastfeeding. My mastitis was not a result of the over-production, but we did end up lowering it a little to make things easier (with Sudafed). I now make 50 ounces a day, which provides all of the milk for Waylon and my toddler, plus I have over 1200 ounces in the freezer. 
 So is my experience a good case study? I could see a difference from the days I took them and did not. However, one could argue that given this was my second birth, I could have had an easier time anyway. And that could be. However, I would argue that having a newborn with a difficult toddler would make it WORSE than the postpartum period with my first child. Either way, my experience is just one to add to the numerous others that have experienced positive effects.

I wanted to share this because I wanted my story to be out there for moms considering it themselves. I am incredibly grateful for the input for the moms who convinced me to do it. And, I continue to still (at 3 months postpartum) use at least one a day to continue feeling great. I have not had any symptoms of depression or any other difficulty (besides the breast issues caused by the unfortunate antibiotic-resistant mastitis - which I would even argue should have ended me up in the hospital, but I was able to fight it off). My verdict: Yes, it's gross, Yes, it seems strange, Yes, it was undoubtedly worth it.