Thalia's fertility journey

Sharp turns and no entry signs on the road

I started composing a post yesterday about how much better things were with the feeding. Sadly I went to the clinic today to get Pob weighed, and she is precisely - to the nearest 100gs - the same weight as she was 2 weeks ago. Since she was only on the 30th centile for weight to start off with, this isn't good. So all the progress we've made with feeding over the last 2 weeks seems to be for naught. Sheesh this is difficult!

What we've been doing: 

About 2 weeks ago now I was so tired of all the pumping (about 11 times a day) that given your advice and the advice of the maternity nurse we had, I decided to just go for it and stop pumping during the day, and just put all the milk into the baby. So we stopped doing top-ups after day time feeds, and just kept putting the baby on the breast whenever she said she was hungry. The first few days were very tough. I did try using the supplemental nursing system, but just couldn't get it to work. So it was just me and the baby. Given she was still producing wet and dirty nappies I did know intellectually that she was doing ok - or I thought I did. We continued to give her a bottle at night - as much as she could take - and I kept pumping after the evening feeds and the night time feeds. Then she started to sleep longer at night, up to 8 hours (I know, I am very very lucky) so I started to wake up to pump in the middle of the night to pump even while she was sleeping. I've been getting around 200 mls from 3 pumping sessions so felt that the supply issues weren't the issue any more.

The baby seemed fine. She is more alert after a feed now, she plays happily for up to 40 mins or so on her mat or chair after each feed, then says she's tired by starting to grizzle, she settles to sleep via rocking or singing or both, and sleeps for 1.5-2 hours until the next feed. She was producing at least 2 dirty nappies a day and plenty of wet ones, so there was no reason to think she wasn't getting enough to eat. So it was a real shock today to find out she hadn't gained at all.

The health visitor was concerned and told me we had to start adding more to each feed, via a bottle since she's already on the breast for an hour at each feed. I do know that her sucking etc isn't great, so I've been trying to tickle her etc to keep her awake, and take her off if she really falls asleep, sit her up etc. until her eyes are open again and I can put her back on. I think at least part of the issue therefore is that she just doesn't eat fast enough - clearly not the child of her mother! - so even in an hour she isn't getting quite enough. She's getting enough that she isn't upset and doesn't feel hungry, but not enough for her to be gaining in the way she should.

It's all rather depressing, just when things seemed to be going better! The thought of adding bottles back in is really depressing after gaining some time back in the day by not using them. But clearly we need to get more food into her, so that's what we'll do, at least for the next week. Wish us luck.

All about Pob

I'm determined to write the birth story, plus to write a little about Pob rather than the nightmare of breast feeding. I tell you, this stuff better be really good for her because otherwise, I'm not sure what the last 4 weeks have been about...anyway this post is not about that. More later (and suffice to say, your advice has been invaluable, thank you all for taking the time).

Pob turned 1 month old on Saturday. She is, of course, very advanced for her age. She can find her hands and put them in her mouth. This is followed by vigorous sucking which makes quite a noise. She is an extremely forceful personality and demands that her environment is tuned to her every need. To whit, she falls asleep on the breast regularly, but take her away from the breast and she screams blue murder. Put her back, and she'll take a few sucks before drifting off again. And being put in the moses basket for day time naps is simply not acceptable. She wants to either snooze with a nipple in her mouth, so that she can have a gentle suck whenever she feels like it, or she wants to be held. The sling we have has proved invaluable as a trip in that rarely fails to get her to sleep - so long as you leave the house. Somehow walking up and down inside the house with her in it doesn't do the trick, but climb up the stairs from our basement to the street, and she's asleep before you get to the corner. Luckily the weather has been pretty good so we've simply been taking her for a walk both morning and afternoon to ensure she sleeps for a bit. And sometimes, having fallen asleep during the walk, she will even stay asleep once you get home, so long as she is allowed to remain in the sling.

She loves music. Even the nasty tinny tunes that her chair and playmat make. She loves being sung to, and that's the only other trick to get her to sleep. I've taken up making up my own words to favourites such as 'daisy daisy' and 'baa baa black sheep' and even got out the lyrics sheet for 'Joseph and his technicolour dreamcoat' so that I wasn't simply singing 'jacob, jacob and sons' over and over again. It doesn't work as reliably as the sling, but it does work.

She has a period of about 30-45 minutes after the second morning feed where she's very awake and interactive. Her playmat will keep her entertained for a good 20 minutes, particularly looking at herself in the mirror. Then she likes to have a chat and maybe a singsong. Once she's had enough, she screams until we find a way to put her to sleep.

On the terribly advanced front, here she is reading her first book. I hope it's the first of many:

One step forward, about 75 back

Well, I did say we were only celebrating small victories, but we seem to be losing the war. My pumping production is stuck at about 400ml a day, that's about 13.5oz for you US people. It's been that way since Sunday, so nearly a week. I do well in the early morning, then in the evening I'm struggling to get more than 40ml in one 20 min pump - whether it's between feeds or after a feed. Pob is still happy to stay on the boob for a good long time with the nipple shield, but she then wants between 70 and 100ml top up, so I'm not producing enough from the pumping to satisfy her. And as she grows, she needs more. Instead of being able to cover 4-5/6 feeds in 24 hours with breast milk, today I've only managed to cover 3.

I spoke to the good lactation consultant today, and she started to say things like, well, you've done really well so far, it's great you lasted this long, looks like things are tough etc. She admitted that given supply has not climbed this week (at least the supply which doesn't go straight into Pob), she's less optimistic we can achieve our breast feeding goals. She's asked me to try the supplemental feeder, which I've been resisting, and suggested a quick jolt to the breasts of pumping once an hour for 10 minutes for a four hour period. I've done that pumping this evening and got 20mls each time which is fucking depressing.  I tried the supplemental feeder and it didn't seem to make the critical difference to Pob - she still sucked in a somewhat lackadaisical fashion and seemed to enjoy herself but still needed the rest of the milk left in the supplemental feeder when she'd finished, delivered to her in a bottle. And then she needed some more.

It's like the infertility game all over again. And yes I know oh how i know it's not the same loss by any stretch of the imagination, I just mean the process seems similar. You keep going because you can't bear to give up. You hope, you hope really hard that in the end it will all be ok, but the process is painful and tiring and stressful and sometimes you wonder why the hell you're putting yourself and your other half through it. You wish you could take a peek into the future and see whether it worked or not, so that you'd know if it's worth persevering. Right now I can't leave the house for more than an hour because I'll have to either pump or feed. I have to hand Pob over to someone else when she's had a certain amount of time on the breast, so that I can pump. People keep telling me to enjoy my baby. And that formula isn't so bad. And I know that's true, but right now I can't let go of the dream I had to feed my baby. To sit in my chair and just put her on the breast and to sit and commune with each other while she fed. And I'm angry with people who don't have any problems with this. And feeling like a heel for not just being happy to have her. Ugh. It's hard, much much harder than I had set myself up to deal with.

Small victories

Well, it's been quite a week but we seem to be winning a little ground, albeit with some set-backs along the way. Pob hasn't had any formula since 530am yesterday. That is a big win. Supply is up due to some combination of pumping as often as I can and the drugs. It makes me wish a little that I'd waited to take the domperidone until we saw how much my supply increased without it. But I just keep telling myself there's no reason it will do her any harm, and the bonus of breastmilk is worth it. In a few weeks if things keep going ok, I might try decreasing the domperidone dose, just to see. Not sure we'll get through another 36 hours without some use of formula as my supply is lower later in the day, but I'm trying to celebrate these small wins.

The screaming and kicking every time she goes near the breast has also pretty much ceased, due to starting to use nipple shields. I kept looking at her rooting around at the breast, pushing and pulling at it, burrowing her head this way and that, and it just looked like she didn't know how to get a purchase on it. So thanks to you and various real life friends, we decided to give the nipple shields a try. She will now latch on just fine with minimal fussing with the shields, and on the left breast she'll often latch on without. For some reason trying them seemed less of a concession than trying the supplemental nursing system. Our lactation consultant still thinks it would be a good idea, but I'm just not there yet.

Today was another milestone in that for the first time since day 2 or so she settled after a feed without a top up. Just once. Let's hope tomorrow it might even be twice. She's started to feed a bit more frequently - every 3 hours so far today, so rather than trying to pump in between feeds as well, I'm just pumping after each feed. That will still get me to 8 pumps today which I think should be ok.

Pob seems pretty unscarred by all of the drama. She is very alert after some feeds now (thankfully not at night, mostly) and looks very hard at the world around her, often with a puzzled look on her face as if she is contemplating the mysteries of the universe. She sleeps well, we have been thanking our lucky stars for that. She loathes nappy changes or having her clothes taken off or being put on, and howls the place down as we try to talk her through the torture with minimal fuss. She loves being in the bath with me and calms right down as she enters the water - although of course getting out of the water is a cause for much more screaming. When she gets really upset her chin trembles and her eyelashes get wet. Thank goodness she's no longer doing that just because I offer her the boob. She remains, of course, utterly beautiful. We are counting all our lucky stars. 

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Pretty much the same here. I am pumping after each feed and in between the day time feeds - 9 times a day. Volume has gone up - today we will be able to do three feeds which are completely breastmilk - but she still pretty much hates the boob unless she's already had something from a bottle to take the edge off her hunger. She'll then go on and suck for ages, fall asleep looking all happy and content, and within 5 minutes is screaming with hunger again. As I speak H is topping up after she spent nearly 35 minutes on the left boob and 20 on the right, having had approx 40 mls of breast milk to start the feed. I dunno. I know getting breastmilk into her is good, but the whole thing is so bloody demoralising and such hard work, I'm not sure what to do for the best. I guess for now I will keep going but I'd love some sign that things were going to be ok - with the sucking as well as with the volume.

I am taking domperidone which we have scored by sending H and my mum to the various local chemists, complaining of bloating and nausea. They can get a packet at a time of motilium, the brand name for domperidone in its approved, over-the-counter, form. This packet gets me through 1.25 days. So far H has been to 4 chemists and mum to 2. Hopefully my internet order will come through and stop their dodgy activities. Not sure how much we can ascribe the increased volume to the drug and how much to the increased pumping, which I started at the same time.

Thanks again for all the advice. Given how many of us have had such difficulty breast feeding, not to mention the problems our fertile sisters have too, does anyone wonder how the babies got fed before the internet?