1 October 2011, by Yi Lin

Blame It On The Booby*

(* 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.

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Aaaahhh. There is nothing better to inspire a new post than a visit from two of my favourite bloggers, miss ene and yAnn.

Poor miss ene being ambushed by Coco's sudden transformation into an Angry Bird

Lucky Yann gets a much happier Coco after yet ANOTHER feed. Coco seems to be dancing some sort of jig!

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.

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On with the entry: it is about the ups and downs (literally) of breastfeeding.

Got Milk?

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.

Poor baby looking listless while warded for phototherapy, complete with a bad rash from the eye mask

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.)

Other baby also tired out from sleeping poorly on the floor for two nights

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.

Lying on the tummy helps a gassy baby sleep better

The Importance Of Being Burped

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:

How I felt this week

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.

Hopefully this is the face of a well-fed baby!

Levelling Up

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?

8 Comments

Yi Lin

Yi Lin

October 24th, 2011 at 4:11 am    


Thanks Celine 🙂 Coco’s 5.35kg now! Packing on the pounds.

Madeline: Thanks for the encouragement and advice. My freezer has been filling up! A tad worried about over expressing but like Jesz says, supply should correct itself over my holiday (IF we’re still going to flooding BKK! Phuket sounds very good at this moment now.) And yeah, I’ll have no worries about supply once I go back to work in Dec 🙂

Madeline

October 18th, 2011 at 5:35 pm    


The 1st few weeks always the hardest! Keep at it it’ll get better! I’m still breastfeeding my 16 month old and it’s a breeze now, but it wasn’t like tt at all in the beginning!

We went to Phuket just 1.5 months after I gave birth and what I did was start expressing just slightly more after every feed (e.g usually bb drinks 120ml, I’ll express 150-180ml) so tt I don’t over express. Buy those nursing bags to store I find them very useful. And I agree, over supply can b useful for u when u return to work 🙂

Celine

October 7th, 2011 at 9:47 am    


Love the last photo of Coco, picture of bliss and contentment 🙂

Congrats on getting back to pre-pregnancy shape!

Yi Lin

Yi Lin

October 7th, 2011 at 6:20 am    


Thanks everybody for the encouragement and the tips, and also to my readers who have emailed me their very detailed tips too. Really appreciate it.

Trace: I’m back into some pre-natal clothes – the stretchy ones – but not all yet. But with the baby getting heavier (4.5kg at 6 weeks, up from 3kg at birth) and still lovin’ being rocked and walked up and down the house, I’m sure I’ll be shopping for nice new non-maternity wear in my original size soon!

Tracy Su

October 4th, 2011 at 6:27 pm    


Poor you hunny! *HUGS* Glad it got better =) You both look very well though, Coco’s a cutie and you’re in pre-natal clothes already? Wah lau, well done!

Alex

October 4th, 2011 at 12:26 am    


Ease up on the fenugreek… agree with Jesz, regular pumping even in bkk would prevent engorgement. Hot towel worked for me to get the flow going.

Colette looks happy enough in the last pix. 🙂

Mandy

Mandy

October 3rd, 2011 at 3:07 pm    


Hi babe, glad you’ve managed to survive the tough times and continued with breastfeeding despite the challenges! Hope it gets better from here on!

You can start building stock by expressing in place of a feed: when baby starts dropping the middle-of-the-night feeds. I found this helps to avoid oversupply!

Also, don’t pump for too long, coz I think that signals the boobs to produce more. Maybe stick to 20 – 30 min max. Just some things I figured out along the way. 🙂

jesz

October 2nd, 2011 at 2:27 pm    


Well done so far… Can fully empathize with u over the crying episode cos 1st 2 wks most stressful. Moreover, I was heading back to work & 2week overseas worktrip after the 2mth milestone. Worry abt building up supply, maintaining supply, if wound is healing well etc… Felt Super duper lousy until hubby said to me that not being to give breastmilk doesn’t make me less of a mom – I’ve done my best. That woke me up from my idea.
Anyway, I dun think u wld hv a problem of oversupply when u r back cos expressing milk at regular intervals while on a vacation is different (one tends to forget or prolong the duration resulting in dropping demand signal to the breasts).
But even if u shld hv, jus pump the milk & store it. U wld need them when u go back to work.

To relieve engorgement (wch is super awful), try hot towel or cold cabbage leaves but there’s a rumour too this may reduce supply.

All the BEST & take care!!!

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