1 October 2011, by Tan Yi Lin
(* the breast, not the bird)
Disclaimer: I’m not blaming breastfeeding for anything, because as we all know, “breast is best”. It is just that I have come to realise how much the wellbeing of a newborn depends its mother’s breasts. And admittedly, at times, figuring out how this new pair of milk taps work has been nothing less than exasperating. Read on.
We talked about fertility (or the lack of it), conception (and its elusiveness), IVF (failed, pending and successful), pregnancy, babies, family, friends, work and blogging. Our husbands joke that we are the trying-to-conceive support group for one another – we hold our meetings online over Whatsapp – but it’s not far from the truth. It was really nice to have them visit (together with a very expensive chewy giraffe named Sophie) and miss ene even dedicated a blog entry to Coco. Lovely.
On with the entry: it is about the ups and downs (literally) of breastfeeding.
Unfortunately, no. As with all new mums, my boobs didn’t get the memo to start producing milk – and lots of it – pronto, until a few days after the delivery. Colostrum, high in fat and densely packed with good ol’ nutrients, was suppose to be sufficient for a newborn’s first few meals. Coupled with the fact that most newborns are famously sleepy during their first few days of life, keeping them nice and full on colostrum alone wouldn’t be too difficult.
But noooo…. guess who got the little tamagotchi who:
a) was awake and alert 24/7;
b) was ravenous all the time;
c) made it very clear through her intense screaming that she wasn’t too pleased that the supposedly free-flow milk buffet wasn’t being replenished as often as she would have liked;
d) all of the above.
The first night at home was immensely trying. Nothing we tried would pacify her and I sat up all night in bed holding a baby to my chest and wincing from the pain of raw nipples.
The next day, we returned to the hospital to check on the baby’s jaundice level and were dismayed to be advised to re-admit her for phototherapy. For the uninitiated, jaundice – as indicated by the distinct yellow tint of the baby’s skin and whites of the eyes – is a symptom of having too much bilirubin, a yellow bile pigment in the blood.
How does bilirubin get into the blood in the first place?
– Infants are born with an abundance of red blood cells, so that they can survive without oxygen longer during birth.
– After birth, the excess red blood cells are no longer needed. In the process of being broken down, the red blood cells release bilirubin, which is normally excreted by the liver and passed out with faeces and urine. Breast milk contains a hormone that slows the breakdown of bilirubin.
– A newborn’s immature liver cannot cope with amount of bilirubin, which collects in the blood and may cause brain damage if left untreated. Phototherapy uses ultraviolet light to break down the excess bilirubin.
Phototherapy alone cannot cure jaundice. The baby needs to be properly hydrated so that she can pass out the bilirubin through her pee and poop. This is where breastmilk comes into play. Because she wasn’t getting enough to clear her jaundice, we agreed to let the nurses supplement my feeds with formula milk.
I had read countless websites that warned against feeding a newborn formula because total breastfeeding is best for the baby. But faced with a choice between letting your baby starve and fall ill, and having to swallow your pride and admit that your breasts simply cannot provide adequately for your baby for now, which mother would not do whatever it takes to let her baby thrive? I think that sometimes, in the face of all this “breast is best” pressure, we forget that formula is not poison, and that formula and bottle feeding, when necessary, will not destroy our babies.
Coco was discharged after two days of phototherapy and just yesterday, was given the all-clear by the doctor that all signs of jaundice had finally disappeared. But not before I spent a couple of nights during the first week – the most trying period – crying alongside my hungry baby because I could not feed her enough.
(Note to parents warding their babies at KKH for phototherapy: If you intend to continue breastfeeding throughout the baby’s stay in the hospital, a more economical option to rooming in with her in a Class A ward, is to admit her in Class B2 and for you to stay in the Ronald McDonald Family Room, a hostel-like facility within KKH. We paid $48/night for a single room with en suite bathroom. There is always a waiting list for the double room, so my advice is to just take any available single room and have your spouse bunk in – even if it means sleeping on the floor.)
Crying Over Fore Milk
As a result of the jaundice episode, I frantically did everything I could to increase milk production – down cups of brown rice tea, Fenugreek herb capsules, empty breasts by pumping (so as to send a signal to my body to produce more milk). My body got the message, loud and clear. It went into overdrive and suddenly, I had a problem of oversupply. By that, I don’t mean that I was producing enough milk to feed a nation, but rather, I was producing more milk than what my baby could drink.
Oversupply may sound like a happy problem but it is nevertheless a pain (literally) for both mother and baby. Breasts became engorged and the baby had difficulty latching on, swallowing air in the process. When she did manage to latch, she choked on the too-fast letdown. She suffered stomach cramps caused by wind trapped in her tummy, cried constantly and slept poorly. My mum noticed that she seemed to be soiling diapers too frequently and passing out frothy green stools instead of the usual mustard-yellow poop.
I consulted Dr Google on “newborn green stools”. I found out that breast milk comprises fore milk and hind milk. Fore milk is thinner, high in water, sugar and lactose. The hind milk comes after the baby has emptied the fore milk. Hind milk is thicker and packed with fat and nutrients. Hind milk keeps the baby feeling full and is necessary for growth and development. Fore milk quenches the baby’s thirst and passes through her tummy quickly – but too quickly for her immature digestive system to break down the lactose properly, resulting in trapped wind. So if your breasts are producing too much milk, the baby will fill up on fore milk and thus be unable to get to the hind milk. It’s a problem of “fore milk/ hind milk imbalance”. Expressing the excess milk by pumping will only worsen the situation by telling your body to produce even more milk.
The Internet is a godsend and Google is an angel – I don’t know how mums coped with a crying baby before the era of the Internet. I found multiple websites that advised how to resolve the problem: hand express before feeding to reduce the speed of letdown and the amount of fore milk, nurse only from one breast each time instead of switching sides, use cold compresses to reduce engorgement, etc. My milk supply rectified itself over a week or so to suit my baby’s demands – but once again, it wasn’t before I spent another couple of nights crying alongside my baby, feeling sh*t awful because I was causing her pain and misery by feeding her “bad” milk.
See Saw, Up & Down
Breastfeeding is challenging – it is all about helping your body find the right balance between demand and supply. A few weeks on, baby and I have found just that and are doing well.
However, change is inevitable. She hit her 6-weeks growth spurt on Monday and her normally regular schedule has been swinging between hibernation and feeding frenzies. On days when she is hungry 24/7, this is how I feel:
Once again, I worry that I cannot produce enough to meet her sudden increase in demand. But other than a couple of intense crying episodes where she cannot seem to get enough and goes to sleep a little less than full, we seem to be pulling through this week. The growth spurt can last anything from two days to a week, so we could be seeing the light at the end of the tunnel soon.
The next challenge is to start building up a stock of expressed breast milk as Dan and I are planning to take a short couples-only vacation to Bangkok with a few friends in November. Once again, brown rice tea, Fenugreek and pumping will do the trick. But how do I prevent the problem of oversupply from returning?
With all these different challenges to surmount on a daily basis, it’s easy to see why some women throw in the towel and give up on breastfeeding totally, choosing to turn to formula instead. It’s just easier not to blame the boobies for feelings of frustration, anxiety and inadequacy. I, for one, have shed a fair share of tears over feeding.
Does anybody out there have any tits, er, tips?