Monday, February 18, 2013

First vacation - a photo pictorial

We went on our first vacation with Magpie this past week. We have wanted to take advantage of my maternity leave and take a big trip. And so we decided to go to Costa Rica. We always said we wouldn't stop doing the things we love if we were lucky enough to have children. That we would make sure to still get out and do the things we enjoy. We thought (naively), how hard could it be to travel with one baby?


Actually, it hasn't been all that hard. Mostly it's just been different. We can't do many of the things we would have done before having her. And she dictates our schedule entirely with her naps and bedtime routine. This is all as it should be, as she is just a wee little one.

The travel itself took a lot of logistical planning, especially because I had to bring donor milk with us, using dry ice to keep it frozen solid throughout the journey (five hour plane ride followed by a three hour drive to our destination). So that was a bit stressful. But we were successful - we got it here solid as a rock!

The exclusive pumping that is currently my reality also required a certain amount of planning ...picture me pumping in the airport bathroom (thank goodness for family restrooms!), on the airplane, and in the rental car. If you can imagine it, I have pumped there. A little bit crazy, but it is what it is.

Despite us being on vacation, we remain as sleep deprived as ever. Magpie seems to be going through a phase where she wakes up every two hours or so...but luckily since we're on vacation we can nap and give each other breaks throughout the day and night.

I think Magpie has loved the bright sun (although we keep her from direct exposure to it) and warm weather. She is old enough to be looking around a lot now and I think has found the whole trip very stimulating from that perspective (of course she would find any trip out of our apartment equally stimulating...but it is nice to see her so interested in everything around her).

It's beautiful here, even if we aren't getting out as much as we would sans baby.

The view from our condo balcony

I think the key to this trip has been to have realistic expectations. There have been (of course) no canopy tours, no ziplining this trip. We took one shortish morning walk in the rainforest, but it was still hot hot hot! And I worried about Ms. Magpie, so we didn't repeat it.

Hot baby!

Magpie drinking her breakfast as we enter the national park at 7am.

So what have we done this vacation?

In addition to cooking, we have gone to restaurants within walking distance...

Magpie hanging out at the table

And we have spent a lot of time at the condo relaxing. Because we knew that would be the case, we picked a condo that had monkeys right off of the balcony so we could enjoy watching them while Magpie was safe and comfortable.

Squirrel monkey on the balcony

Capuchin monkey in tree at our condo

We also found a local beach that has a lot of shade and have taken Magpie there a few times in her sunsuit and hat...

And we've gone to the pool when it's shady...sometimes accompanied by a monkey or two...

We leave today, heading back to the capitol of San Jose and then flying back to NYC. May the travel gods be with us!


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Sunday, February 17, 2013

Partial wean from an exclusive pumper's perspective

Over here in Mo and Will and Magpie Land, we are several days into weaning my left breast. It is emotionally so difficult to close up shop on this tricky breast, but I won't miss the fevers and constant blocked ducts.

My doctor suggested I take the opportunity while on antibiotics to do this weaning, and so I've been working at it for several days.

The process is fairly simple physically...although emotionally, it's a whole other story. Basically, because I'd been so sick, my supply was way down already, and when I resumed my every three hour pumping schedule, I only pumped for 15 minutes on that side. Then every day or every other day (depending on how uncomfortable I've been physically), I've cut down each pump time by 3-4 minutes on the left breast. I go the full amount of time (approximately 30 minutes) on the other breast. I'm down now to four minutes on the left breast, and it produces very little milk in that amount of time. Just pumping on the right breast makes milk let down from the left, though, so that I get about 10 mls just leaking out from that. Not sure how long that will go on for, as I plan tomorrow or the next day to stop pumping on the left side entirely.

So that's the physical part of this. Emotionally, it is so difficult to take actions that reduce my hard-won milk supply, and will eventually stop it on that side. I put in a great deal of effort to get my supply up enough to feed Magpie, particularly challenging for me because she never did really latch on at all. Everything in me emotionally tells me it is wrong to stop pumping from that breast. That my baby needs my food. It must be hardwired, some primal mama thing, because it is soooo powerful. I have to remind myself every time I shut off the pump prematurely why I am doing this. And talk myself out of the idea of, "Maybe now it won't be so bad. Let me try it one more time." I have to remind myself I have tried, and I've gotten mastitis six times, each time more quickly than the time before. I have to tell myself we were headed nowhere good with this. That I needed to stop.

So here we are. At the moment, I'm making about three ounces on the right breast most pumping sessions, which is not enough to feed Ms. Magpie. Once I've fully weaned from the left breast, my doctor said I should wait a couple of days and then can restart the domperidone I was previously taking. With it she thinks I might be able to get my supply up higher. I will try it very cautiously. I think taking the domperidone is part of what has made me susceptible to mastitis. I can't find anything on Google suggesting a link, but it is a suspicion of mine. So I will try the domperidone again, but we are expecting to have to supplement with donor milk or formula. Fortunately these other options exist.

In other news, we are currently on our first real vacation as a family of three! It has been a lot of fun. A real logistical adventure, to be sure! I will post about our time away soon.

But for now, just sign me

Uniboob (Mo)

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Sunday, February 10, 2013

Pump, wean, or supplement, Oh My! A response

My last post drew a lot of comments - thanks for your thoughts and for taking the time to share them. And thanks for keeping the comments mostly constructive. I know this is a really hot button issue. As such, I wanted to share my thoughts on some of yours:

First of all, thank you for all of you who wrote in about successfully feeding using only one breast. Reading your stories was inspiring and encouraging. All I can say is I'll give it my best shot. If I could make enough milk for Magpie with just the one breast, that would be awesome. It had honestly not occurred to me that that could be a possibility.

Jenny F. Scientist, PhD: Thanks for sharing your story on your use of long-term antibiotics to prevent recurrent mastitis. I talked to my doctor and she recommended against it due to the risk of developing C.diff or another related infection. So that'll be a no go for me. So glad it worked for you!

Amy and Alexicographer: Thanks for the warning about inflammatory breast cancer. Scary stuff. I didn't realize the ultrasound I had last week might not have picked it up. I know the chances I have IBC are slim but not none, so I will speak to my doctor about how to rule it out.

Dora: The major downside to combo feeding from the beginning of a baby's life is the increased risk of allergies because of the introduction of foreign proteins (cow's milk or soy) into the baby's immature "open" gut (see this well-written explanation regarding the importance of delaying solids for infants for the same reason). As I understand it, this risk gets smaller and smaller as the baby ages. You're completely right otherwise, the addition of some breast milk to formula is a great solution and gives a child all those yummy immune factors, making combo feeding very appealing.

Shannon and MaybelB: Hormones, yup. Got those going on, big time. I've never felt so driven by them in all my life, for pointing out the role they may be playing in my decision-making right now. I wouldn't be surprised. I am humbled by them, but will try not to be just swept away by them. Also, the sleep deprivation...that does a number as well on my rational thinking abilities. Not a good thing. I miss sleep.

zerodoll and Becky: Thank you for sending info on milk sharing. What an awesome thing that these communities are forming! At the moment, I'm not comfortable with it, however, because of the slim risk of viral and bacterial contamination. I know the risk is very small, but it's still too frightening for me.

Where I'm at today:

I am in the process of weaning the left breast while on antibiotics. My doctor gave me two more courses to have on hand in case I have a recurrence while I start and complete the weaning process on that side. I am sad to do this. It feels so final, and I had so hoped to find another solution. But I, and my family, can't afford me continually getting sick with such high fevers. Enough is enough.

I purchased banked donor milk Friday to supplement and get us hopefully to Magpie's four month birthday. Yes, I'm aware that pasteurized donor milk is lacking some of the benefits of fresh, but you do what you can.  Perhaps my supply will have increased enough by Magpie's four month birthday that I can make up for the loss of the left breast's milk. I doubt it. I expect to combo feed with breast milk and formula after that point. If I could, I would eek it out with exclusive breast milk to six months and then happily combo feed with formula upon the introduction of solids, but I'm not expecting to be able to make it that far with exclusive breast milk and the banked milk is too expensive and difficult to obtain to be anything but a short-term solution. So we'll see, but I'm expecting we'll be a combo feeding family soon enough. Any thoughts or recommendations on the healthiest/best  formulas is most welcome.

Finally, I wanted to respond to Anon and Carrie and anyone else offended by my post:

I'm very sorry you were offended or annoyed by my post or felt that I was disparaging formula feeding. I wouldn't want anyone who needed or chose to use formula to feel badly. I was merely trying to express my struggle with my personal situation.

To respond to a few specifics:
  • "You are really sort of making anyone who has ever used formula feel like you think they are an abusive parent." 
  • "What EXACTLY are all of these terrible, scary, no-good, very bad things that so many of you believe will happen to a baby upon having formula touch her lips, and that will render her forever identifiable as a (insert shameful whispery voice here) "formula-fed baby?""
I never said there were any "terrible, scary, no good, very bad things" or that anyone who chose/needed to use formula was "abusive" in my post.

In fact, I said, "Thank God for formula. It is a lifesaver."

We NEED to have formula. I am grateful it exists. I am taking a trip with Magpie and Will this week and we will have formula with us...just in case. That said, breast milk has been demonstrated to have anti-allergic, anti-neoplastic, and immune-enhancing properties.

This does not make anyone "bad" or or "abusive" for using formula and does not make formula "evil." It does make me want to explore avenues to continue to offer Magpie breast milk while she is so little, exclusively, if I am able.

My personal situation is my own. I had cancer, as did both of my siblings, all before we turned 40. Will and I both have asthma. We both have eczema. There are major food allergy issues, again also on both sides of our families. None of these things were "caused" by formula, but they are our personal vulnerabilities. I am motivated to want to reduce the likelihood that Magpie might experience any of these things if I am able.  I realize that she may have to struggle with any or all of them anyway, but I would like to try.

It is a shame that the issue of baby feeding has become so contentious in our culture that one person's wish to continue feeding with breast milk feels like an attack on others. It wasn't meant to be, and so if it felt that way, I apologize. We all want the same thing: to love our hard-won kids the best we can at each moment in time.


photo credit:

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Friday, February 8, 2013

It was the breast of times, it was the worst of times

We took Magpie to the pediatrician yesterday. She continues on her track, tenth percentile, steady as she goes. Her head and length are both 40th percentile. The pedi agreed her muscle tone is "at the high end of normal" and said an eval with a physical therapist would not be a bad idea, so I will be pursuing that soon.  Everything else checked out just fine with her - she is rolling from front to back and back to front, holding up her head pretty well, "tripoding," reaching for things, cooing, following us with her eyes and head.

On the home front, though, things have been a bit rough. I had a mild case of mastitis last week. I talked to one of my doctors about it and they suggested an ultrasound was in order, because five bouts of mastitis in three months - all in one breast - is a lot of mastitis. So I got that and luckily there was nothing major, but it did show that some of my ducts on the affected (infected?) breast are "knuckled," and basically go in one direction and then bend backward the other way, offering, the radiologist said, lots of opportunity for kinks and clots. So boo. The other breast has nice ducts that flow like rivers toward the nipple.

not me
As though to drive home the point that my left breast is doomed, I promptly got another clogged duct later that day (Tuesday) and by that night, I'd developed mastitis again. Yup, that's six times now in three months. This time's infection came with a raging 103.8 degree fever. Fortunately my mom was here visiting and took care of Magpie for the day I was completely out of commission, but yowza. Adding insult to injury I'd developed some kind of GI issue (food poisoning? mild gastroenteritis?) and was holding my painful belly and yeching Tuesday night. The next morning I was too afraid to eat to even take an ibuprofen, and so delayed the antibiotics, etc., until that afternoon, despite the growing fever. So it is now the wee hours of Friday morning as I'm typing this, and I'm feeling better today. The breast is sore but not exquisitely so like Wednesday. Half of it is still beet red and hot to the touch. The skin now feels like it is a different texture from my other skin - somehow this infection, or the heat of it?, has affected that as well.

So I'm pretty much at my breaking point. I think I'm going to have to wean off of this breast or risk ongoing, escalating illness. To say I am sad about this doesn't even begin to cover it. Providing the food the Magpie has needed to eat has been a singular joy for me and has felt so vitally important.

So I told the pedi all this and that I didn't think I would make enough milk without the left breast and she handed me a package of formula. Hypoallergenic formula since major allergies, asthma, and eczema run in both Will's and my families, but still formula.

I took it.

Sheepishly, unhappily, I took it.

And I thought I would be ok with it, I really did, but the more I thought about it, the less ok I felt. Right after Magpie was born, when my milk was slow to come in, I looked into human donor milk. It is available, but it is ghastly expensive ($5 per ounce). So I had ruled it out and haven't considered it since. But today I thought...well, wait a minute...I'd just need to top off with the donor milk hopefully...and we've gotten to three months, so getting to four months is only 16 days away...getting to six months 60ish days after that, but way closer than it was before. So I am looking into it.

I'm also looking into milk sharing programs. I'm much less comfortable with this, but it's also significantly cheaper (approximately $1-$2 per ounce). The worry there is that the donor would have some undisclosed medication they are taking that could harm Magpie or that they are infected with an illness they could pass along (HIV, syphilis, HTLV, Hepatitis, etc.). I would ask for testing (and pay for it) if I were going to work with someone, but they could still engage in some risky behavior after that and get infected, and makes me nervous. The cost however, has me considering that if I could find someone I felt comfortable with, it could be a way to eek out the next two and a half months of exclusive breastfeeding I had been so hoping for for Ms. Magpie.

It's tough. Will is not on my side with this. He thinks I should have stopped pumping and fed formula long ago and he is not inclined to be very supportive about it now. And I feel just as strongly that breast milk is important if there's any way I can provide it, and if I can't, well, so be it, but that it's worth looking into all of the possibilities to see what we might be able to come up with. I keep thinking that this is such a short period of time, two and a half more months!, that could help Magpie out for a lifetime. How can I not look at every option to offer her what is the normal and most appropriate food for babies? Thank God for formula - it is a life saver. But the fact that it is more convenient or cheaper is not compelling to me.

My strong desire for continuing with breast milk is based on my understanding of the policy statement published by the American Academy of Pediatrics in March 2012. Will reads it entirely differently than I do, but I thought they presented some cogent, data-driven arguments about the short and long-term health benefits of a minimum of four...and even better six....months of exclusive breast milk (breast milk via breast would be, by far, more superior healthwise, but alas, that is not to be.)

So I'm wrestling with recovering from illness and with some marital discord around this feeding issue (I know I probably sound crazy regarding it - Will certainly thinks so). But the girl is growing and time is passing. Tomorrow is another day. Let the left-sided weaning begin.


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Tuesday, February 5, 2013

Littlest girl

Magpie is now 3 months old and just hit 11 pounds. She is little. But she wasn't born little. She started life at the 50th percentile (8.1 lbs) and has been steadily dropping ever since. She is now down to the 10th percentile. We have been able to keep her from dropping further through valiant efforts.

She is beautiful, but she has not been much of an eater. Breastfeeding has been a complete bust. Despite many, many meetings with a lactation consultant, she was not able to drink from the breast. Bottle feeding (with my pumped milk) was also not going so great - she had a hard time getting the milk from there as well. Along the way, we tried the starter SNS, full-size SNS, the Haberman bottle, and most recently are using the Playtex Nurser bottle. And we've gone from an every 2 hour eating schedule to an every 3 hour one (we briefly tried a four hour schedule, but abandoned it after one day because it took her over an hour to eat).

photo credit:
Our lactation consultant finally recommend we see another lactation consultant who is a sucking specialist since Magpie was having so much trouble consuming her calories no matter  how we tried. And then this specialist recommended we travel to Connecticut to see a speech language pathologist ("I refer the most difficult cases to her" - ouch!). We've seen this person twice.

Apparently Ms. Magpie is missing some of the reflexes that would help her suck. Her tongue has continued to be tied despite three frenotomies, so poor girl endured a fourth one last week. We are doing exercises with her daily to help her learn to use her mouth and tongue and to develop those areas better. This specialist also wants Magpie to be evaluated by a physical therapist because she is worried about her muscle tone - she feels Magpie is too rigid.

All along she has been gaining approximately 0.5 ounces a day, which the pediatrician says is acceptable for her at three months. It was apparently not acceptable prior to this, when she should have gained 1-1.5 ounces daily, so she missed a lot of potential growth during the first three months. We go back to the pedi tomorrow for a check up, so we will see what she has to say about her at that point, and also what she thinks about a physical therapist evaluation.

Who ever knew it could be so difficult to feed a baby? And breastfeeding, ha ha! A complete disaster. I'm fairly established with the pumping at this point, although Will really wants me to stop because I keep coming down with mastitis (five times with it so far...all in one breast). I think it is vitally important, though, for Ms. Magpie and really want to keep it up as long as I am able. I want to try to do the very best I can by her. She was and is so wanted. Who am I to give up on her with the most nutritious food just because she has so much trouble eating? So I am trying to keep it going, day by day, feed by feed.

Magpie is absolutely lovely, just small. And I am so thrilled to be her Mama.


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