Wednesday, August 31, 2011

Breastfeeding and Work

No that is not me in the picture- I borrowed a random person's picture online.  This post is from a request and I still do not feel like I am quite the expert at this, but I will do my best to give my tips.

So breastfeeding was most challenging during my first two weeks. The first five days were colostrum and my daughter was loosing weight.  Colostrum has high calorie and fat and though very thick and so you may not be able to pump, your child will be ok.  But this was hard for me because I had everyone around me giving me look and asking are you sure you don't want to supplement.

I was so determined to nurse her that I refused to go out and buy formula.  It was very difficult but I knew if she got it elsewhere (i.e. formula) she would not need to work hard to get her food from the breast.  I was so desperate that I set alarms every 2-3 hours to get up and pump first for 10 minutes (at the beginning I got nothing) before trying to nurse her and then eventually my milk supply came plenty. This back fired since my brain felt that I had twins and I ended up with an overproduction. It is however better to have this problem than the opposite, especially with my type of job.

My mom was the generation that formula was starting to be promoted more than breastfeeding both her and my grandma had their opinions, to my surprise they did not support me completely, whenever the baby cried they would tell me it is because I am not providing her with enough nutrition.  It was hard for me and I almost gave up at that 2 weeks mark when everything else also seemed to be failing but started going to the breastfeeding clinic once a week and sometimes twice a week and the wonderful lactation nurses encouraged me and I was able to tell how much she was getting with each feeding.  Usually she will be weighed pre and post nursing and we will subtract the weights to get the amount in ounces.  Her weight gradually increased and I became quite the defensive one whenever anyone questioned she was not getting plenty.  I brag about how much she weighs and even add in, that she is all breast fed.  She is 13+ pounds (5.91 kg) at 11 weeks (all breast milk lol).

I had mastitis and a painful nipple bleb and so on; i had everything that could discourage one from nursing.  Men! I remember when I would cry when the baby would first latch and my husband had to help me with her- you can't imagine how far I have come.

Some tips
1) it is going to be challenging but you will survive
2) decide if you want to do it and stick with it;
3) don't compare yourself or your milk supply to anyone else.
4) Take all the positive support you can get- i was fortunate to have free breastclinic and the wonderful lactation nurses to go to.
5) remember your supply is dependent on how often your baby is on the breast, so if she is not on the breast at least every 2-3 hours for that first few weeks, your supply will be less.
6) At night may be tiring so pump during the day (best time is early in the morning) and save so that your partner or help can do one or two feedings to let you sleep.
7) It is very common for new mom's to have mastitis, if you can latch her and yes it is safe- it is the only way your breast will heal, if you can't stand her latching then take a nursing holiday and pump for 24 hours- you will feel better.  I didn't need antibiotics in less than 48 hours chills, fever, and pain were gone.
8) Your nipple will hurt at the beginning that is because, your baby is learning how to latch and you are learning how to nurse, change positions until you are comfortable, use a nipple shield as well as lanolin to keep breast from cracking, avoid soap around your nipple when you reach the third trimester and throughout nursing.
9) If you don't have breastfeeding clinic in your area, then carry your baby and weigh yourself with her in a clean, dry diaper, then nurse her and re-weigh immediately without changing her diaper.  Subtract and that should tell you how much she got from each breast.  She should get roughly add 1-2 to how many months old she is every 2-4 hours.  So if she is 0 months 2 oz every 3 hours is ok, remember their belly is very small. I have enough milk to feel her up with one breast but sometimes she finishes off with another breast especially now that she's bigger.
10) do what you can but if you are not enjoying it after 2-3 weeks, don't torture yourself
11) and take vitamin D or give it to the baby if you are solely nursing.
12) catch them when they are rooting, smacking or showing other signs of hunger rather than when they are hysterical and screaming.
13) again for the first few days latching will hurt, make sure her mouth is wide enough, and she is not getting just the nipple but the whole areola is in her mouth- your baby has to learn this- she gets more out this way and she causes mom less pain.
14) No pacifier for the first 1-2 months. Or until she learns to suck from the breast.
15) If you feel that your breast is not empty, pump, this will help keep your supply.  Pumping eventually gets old but you cannot get lazy in the beginning stages.

Why in the heck did I do it?  It seems like hard work but I felt useful, everyone fights to hold your baby, but they will give her back for you to nurse and there's no formula to make and feed. My reasons are:

For baby:

1) Because I wanted my baby to have the best and I feel that breast milk is genius! and God given and is better than man-made milk/formula.
2) I wanted all the bonding with my daughter because I know how demanding my job can be, my daughter knew me by 3 weeks old and gave me all the right cues to show that she recognizes me.  I can literally walk in on my daughter having a screaming tantrum and she hears my voice turns towards me, stop and smile.  Sometimes my grandma is surprised that she isn't even hungry, she just wants her mama's affectionate touch.  Nursing is one of your baby's soothing mechanism, and soon she begins to recognize your smell, touch, and your voice and even your face. It is heart warming when she stops and looks at me, learning my face.  As she gets older she will recognize you as well.
3) I saved money! I literally bought a ~$400 pump the advanced free style medela pump and if I were buying formula all these while I would have spent ~$470 by now purchasing formula. Now this has changed for low income earners because of WIC, especially if for some reason you are unable to meet the demands of your growing child.  WIC is a government sponsored program that provides formulas and milk for families who meet their criteria.
4) My baby has a stronger immune system- this is because your antibodies gets passed on and hence less sick days off work because my baby will not get sick as often.
5) I would like to think it will make her smarter but I am unsure how this works- I believe genetics, reading and interacting with your child may have more to do with this.  But hey anything from God is genius! and possible.
6) she will have a lower risk of leukemia, heart disease and MS; I told you in a previous post that as doctors, we see the worst hence, we tend to err on the side of caution.  I can also remind her of how mummy protected her from these things, so she better listen to me more than her dad. j/k
7) she will have fewer ear infections- this is likely from your antibodies and if she is solely breastfed she is less likely to accept a bottle in bed (very bad!!!!!).
8) she will be leaner for life- this is partly from expert opinion and in my experience, breast fed baby have to work to get their food, and hence they learn to stop when they are full.  It makes sense right? who continues to labor or farm when there is already abundance.  They tend to carry this on as they grow.  You cannot force them to finish the breast milk :) that being said if you have to bottle feed when your baby is full, remove the bottle from their mouth and try not to encourage them to finish it, I know it is expensive but it is bad for them and don't give em a bottle every time they cry- they are not always hungry.
9) it is easier on their gastrointestinal tract compared to formula

Benefits For mom:
1) I get to form the strongest bond with my daughter and the satisfaction that she will not confuse me for anyone else who cares for her.
2) The satisfaction that I am providing her with my best natural food that I can provide
3) I don't have to get up to warm milk or make formula; I just half asleep stick out my breast facing her and then after she falls asleep lay her on her bed.  I don't have to carry a bottle with me when we go out- just my nursing cover and my breasts are all I need.
4) I lower my risk of breast and ovarian cancer- while nursing you decrease your body's exposure to estrogen, which is associated to the risk of developing these types of cancer.
5) I help loose weight and hence obesity related illness such as heart disease, diabetes and so on- I had a c-section so I could not do anything for 6 weeks, but at my 6 weeks check up I had lost 40 pounds (18 kg) and with work (still no exercise routing) I am now fitting in most of my clothes.  My belly is yet to be back in shape but maybe I will write a post in the future about it.
6) Studies have shown that nursing protects against osteoporosis later in life- I cannot explain this because it makes sense to me that it causes osteoporosis but pregnancy itself helps with bone density.  That being said I love evidence based medicine and studies have show this.
7) again- save money!!! diapers and everything else are too expensive.

When you go back to work be sure to buy the hands free pumping bras- they are awesome! just go to a private corner and wear them over your nursing bra and pump both breasts at the same time. Remove them, then fold and store. Pump as often as she eats so that your supply does not decrease too much (typically every 3 hours).  Be sure that two weeks prior to going back to work, you pump in the early morning (your highest supply- oxytocin is high between the hours of 4 and 7) and store in freezer.  No bottles or pacifiers during the first month, or until she learns to latch/nurse and then you can do as you please.  Start introducing bottle the 2 weeks before you go back to work so that she can get used to the bottle.  My daughter hates pacifier's and rather use her hand or my nipples to soothe herself.  I don't discourage it- at this stage they need to soothe themselves and if she doesn't like the pacifier then o well.  My job is extremely busy and I had to make time as a resident doctor by planning each day ahead of time, i was able to pump and keep up with the others. I had a good pump so that i could pump effectively.  I got so good that I can do my paper work for admissions while in my private pumping corner.  Every 3-4 hours was my goal and maybe one or two times I got close to 5 hours but you don't want to make a habit of this.  I came home with bottles, poured them out in a bag and froze them, I had almost a month supply in the freezer prior to starting work because I had an over supply but it is ok because she is growing and will one day use them.  With my type of job, an oversupply is not a bad problem to have.

I hope these helps some of you, who plan to nurse. I realize that this may not be difficult to those who do not have a durable electric power supply (i.e. NEPA) or this may not just work for some people. What works for me may not work for you. What did you guys do?

Yay! I Survived

Yes! I survived my first month.  I had so much to blog about but there was never anytime.  I still love being a mummy.  I went to work all day and sometimes all night and came home to a lovely grin that missed me so much.  Today I had my last call as a resident (I ended with 3 straight night calls), this means I can now receive my real certificate of completion instead of the fake one I got on graduation.  woo hoo!  I was asked by some to talk about my experiences going back to work with a new little one.
My daughter is currently 11 weeks and I went back to work when she was about 6 weeks.  I originally planned to go back to work after 2 weeks, so that I wouldn't have to hang around here and also so that baby and I can quickly join her dad.  Well whenever I plan my life, God always seems to remind me that I need to let go and not be so controlling :) I ended up having an emergency c-section and breastfeeding was not as easy as I thought and I learned that I needed all the weeks off I could get.
The C-section complicated things a lot for me postpartum; because my breast milk did not come as quickly as I wanted and baby was loosing weight- it took about 5 days before it finally came in.  Recovery was not very easy, I had so much swelling/edema I looked like a balloon and had difficulties doing anything.  I needed help getting out of bed; I couldn't drive for a few weeks and couldn't start any form of exercise until 6 weeks.  My husband was very supportive and helpful, he did everything from cooking, running errands, driving us around, keeping me calm, putting the belly band every time, holding the baby for hours so that I could sleep,  even doing hot water compresses on my belly until I was able to do them on my own and so on really everything for 4 weeks. And then he had to leave :( he will be back soon yay!
I think I already mentioned that I didn't realize there was a huge waiting list for daycare around here including the one at the hospital (which is what most doc's such as myself tend to use), so I had to accept my grandma's offer to help watch her in my absence.  Most of you may know doctors see the worst things and so we tend to live on the cautious side.  I had many concerns- such as grandma is uneducated and how will she learn infant CPR, or that she could not speak English and how would she be able to communicate if she had to dial 911; also she could not drive- it will be nice if she could bring my daughter to work for some of her feedings; would she be able to figure out the bottle warmer for the breast milk in the fridge and understand how many ounces to fill it up to and so on.
There is good news we survived the first month, I figured out that my baby eats 3 oz or less while I'm gone, since she piles up to get the good stuff when I return.  SO I purchased 3 oz bottles and all grandma has to do is to fill it up.  Then I set up the phone so that she only has to push 2 to dial 911 and I told her to say it in igbo and if they cannot understand her they will trace the call and show up.  I pray hard that nothing happens and infant CPR was not needed.  I taught her to use the stove to boil water and place the baby's bottle in it (bottle warmer does the same thing) and so on.  Basically we made it work somehow, she did raise 12 kids after all including my mom.
Although I do have a small confession to make- my grandma and I did not get along and so before I start my real job I will work on finding someone else.  Most of it are normal things for her are not what we advise to our pediatric patient's mom's and she refused to learn these things.  And the scary thing is she pretended to hear me but did it her way in my absence.  I welcomed some of it a little but it got to a point that I got uncomfortable especially at the expense of my daughter. Also I found myself stressed at work; I walked on egg shells throughout the month and I decided that if I were going to be that uncomfortable then although that person may be able to provide her with all the love but she is not the best person to watch her.
I thought I would hurt her feelings but she was relieved that she will be going back to my mom since she is old and her great grandchild is quite active and doesn't want to sleep as much hence she is loosing her nap time. 
On another topic- I missed blogging and breastfeeding was an awesome accomplishment- to be continued on my next blog.

Monday, August 1, 2011

From Birth to Now

So I graduated from residency 4 days after I had her; enjoy her pics- 
I have been out a couple of times with my husband and even had some salsa dance lessons with some friends.  Thank God for the breast pump because I am able to just leave (usually for one feeding) and instruct people on what to do.  My goal is to feed her breast milk till she is a year.  It is free for one, and I also want to make show that she has all of the great benefits of breast milk, including decreasing her chances of obesity and its many complications; protect her from getting sick and potential for allergies which I hate dealing with by the way;  it also decreases my chances of breast cancer and so on and so forth (don't mind me- the doctor in me came out)
She has been growing like crazy and has started to do a lot of things especially smile back at me. The picture below was taken at 5 weeks old.
My sister lasted one week and went back to work but has unfailingly sent a lot of love our way; my grandma has been here ever since; my mom came for 3 weeks (that is all her work allowed her) and she is gone now.  My dad, brothers, and other sister wishes they could be here but we will be closer soon and they will have no excuse then lol My grandma and mom felt like I know too much for them to help me, because of my profession so I had to let them know a few times how much I have learned.  My grandmother is difficult to understand sometimes though but it is not her fault since she isn't educated and this is what she's always been told.

Some of the odd things that I can remember she's told me is that pregnant/ postpartum women shouldn't touch cold water; when I want to eat something she will tell me it is not yet time to eat that huh! I will often say and do as I please lol  She feels the baby needs to drink water (their kidneys don't know yet what to do with water and their little belly's gets easily full and water has no nutrients); she also needs "tangele" for her eyes- since it is itching (my response she is tired let me put her to sleep).  I didn't realize what that was so she showed me on tv a woman with an eye pencil and then I remembered seeing the "tangele" as a kid.  It isn't really make up.  I was told a few times not to carry her in attempt to comfort her since I'm tempting her with the smell of the breast milk. Then she asks me when does she start eating some crushed up food since my breast milk is not filling her up. This baby was weighing in last week at 11 ibs 9 oz, making plenty poops and pee, she is wearing 6 months old clothes, I pump out 6-8 oz each time what do we want for her to be? an elephant! Get this one if your baby's pee enters your pot of soup, you keep cooking (ok urine is sterile but how did this happen again???) and if the poop enters your pot of soup you scoop out that part and go on cooking (wait! again how did this happen???)

When her belle button stump fell she told me that you don't throw it away, as she was explaining what you do with it, I quickly threw it in the gabage for fear that she may want to feed it to the baby.  There is so much that i didn't know sometimes I feel bad asking her why since she has raised 13 children, my mom being one of them.

But some of these things makes no sense and she doesn't understand why I need an explanation and my explanations also makes no sense to her since her way worked, it has worked for many who came before me, what more explanations do I need. But my grandma is also very smart she can tell you from memory the important milestones that a child should meet- it is amazing. well I guess u should be an expert after 13 children.

On another note, we've been packing small, small to move.  Hubby and my siblings painted the baby's room.  I've been busy washing clothes, bottles, sterilizing and so on, my husband took care of these things when he was here, and now grandma is learning a ton of things.  My husband constantly tells her that "Beke wu agbara" lol
I only wish my baby would switch her days and nights, but Ive had a perfect baby so far and I thank God for her everyday and can't complain too much.
 I will someday post her birth story

Back to Work :((

So I have spent 7 wonderful weeks with my daughter.  For the first 4 weeks her daddy was with us but soon had to go back to work.  My husband is so good with her, and she loves to lay on her daddy's chest.  He even got many chances to feed her pumped breast milk.  He always asked to take her for a few hours so that I can get some sleep.  Do I sound like I miss him? yes oooo We would have gone back with him if I cut some of my time from my maternity leave but I couldn't afford to do that to her or myself.  I graduated from residency yay!!! but have a few weeks to make up.  So daddy will be coming back to get us. 

I have been more blessed after my pregnancy, Mmesoma attracted helping hands from all corners.  I wish she had those magic powers in utero lol.  At one point my grandma and my sister looked like they were fighting to hold the chic (nekwa nu mo).  Joke aside, my mom later joined us and spent 3 weeks with us.  It was great seeing all 4 generations together.

Today was a little difficult since it was the longest I've been away from her and was also sleep deprived.  But it was easier going back to work since I knew she was in the hands of someone who loves her very much.  And could you imagine the child boycotted bottle lol, she was hungry for the breast milk in the bottle but refused the packaging.  It did not smell or feel like her mom's nipples.  Could you imagine that she tortured herself until she couldn't bear the hunger.  When she decided to eat, my grandma said she pouted throughout her feeding.  My grandma couldn't stop laughing at my child and the frantic new mom on the other end of the phone (me). 
But what was great about the whole day was the happy grin I received when I came home.  She missed her mama and I missed her too.