Tongue Tied

Eleanor is 9 weeks old today and it feels like we are finally getting to a good nursing relationship.

My first Peace Corps assignment was to promote breastfeeding among women who had just delivered at the local maternity ward in our health clinic. The midwives and matrons laughed me out of the waiting room when I told them this so I turned to HIV prevention and sex ed at the high school instead. But I have a long history of believing that breastfeeding is best, and it's what I wanted for my baby when the time came.

Right after she was born our doula latched her on, and helped me out every day I was in the hospital. Another lactation consultant came to our house the day after we got home and had us get a pump from the hospital so that Josh could give Eleanor a bottle in the middle of the night and I could sleep a little longer.

The cracks started at some point; there were weeks of weeping and screaming at about half the feedings, exacerbated by lack of sleep. I went to two lactation groups a week once I got out of the house (week 3). I searched the internet endlessly for clues as to what might be causing the pain - thrush, tongue tie, lip tie, all of which were ruled out by our pediatrician. I reviewed videos and illustrations about latching. Nothing was helping. She would chomp vigorously on the nipple, click and lose suction, and the cracks remained.

Around week 5 or 6 the pain began to lessen from excruciating to very, very painful. I was getting more sleep, however, and it seemed like this might be manageable. Josh was upset at seeing me in pain and kept suggesting that I pump to put an end to the cycle, to let everything heal. I could only make it a couple days before I began to fear that giving her a bottle would just make things worse in the long run - she would forget how to latch, and I missed having her close. The logistics of pumping, feeding her, warming milk and washing up were too much for me. Breastfeeding was painful but at least it was simple.

I got another lactation consultant, an IBCLC with international certification, to take a look, and she broke it down for me. "It's some combination of flow and function," she said. Flow was the fact that my milk came out super fast, overwhelming her and causing her to chomp down in order not to choke. Function in that her tongue was a "little tight". I scheduled an appointment with an ENT who was known for doing tongue-tie cuts (most pediatricians don't believe that tongue-tie presents a problem); he clipped what he called a posterior tongue tie on June 20th. Things were a teeny bit better afterwards but I was still concerned that her lip, also tightly connected to her gum, was preventing her from getting a good latch. So we scheduled another appointment with Dr Kotlow in Albany, after much agonizing. Is this just elective surgery for no good purpose? Were we going to inflict serious pain on our tiny daughter with no result because the pediatricians were right? The day before we left I got mastitis, but it resolved in time for us to make the drive up to stay with the Ratners. It was a go. Nine days after her first surgery Dr Kotlow used a laser to fix her lip tie and to re-do her tongue tie, which had healed over because we hadn't done any stretches (following the ENT's directions).

Three days after the laser surgery as I fed her at a Wendy's on our way back to Philadelphia, I noticed that one side had healed up completely and we were having a pain-free nursing session. I felt like telling everyone I saw! But I refrained. The other side looked like it still had a ways to heal, but she was now sucking instead of chomping. The clicking hasn't gone away entirely but most of the time it's no longer the click-and-chomp. For the 10 days after the laser surgery we did stretching exercises 3 times a day and massaged the areas each time she nursed.

Bottom line - I won't ever really know if the surgery was the tipping point - it's possible that she is growing into her mouth and things would have gotten better without it. But it's hard to believe that, really. It finally feels like this is what she is supposed to be doing, rather than something that feels wrong. I had been living with the pain for so long that I was afraid I wouldn't ever know what breastfeeding was supposed to feel like. But this feels pretty good. Let's hope it continues that way!

Before surgery:

Accomplishments

I think it was the Rookie Moms blog that introduced me to this - the "did do" list. Not your "to do" list, which is always longer than you want, but a list of things you did do. So without further ado (har har):

1. vacuumed (once) while wearing E
2. ate a burger at North Star and fed E
3. ate a burger at the bike race with neighbors and their nice friends
4. ate a burger at The Belgian Cafe
5. cooked two real dinners!
6. figured out one must use the liners in the GDiapers for them to be leakproof
7. went to moms' group
8. got phone number of two moms from moms' group
9. had lunch date with mom1
10. had two new and one veteran parents over for tacos
11. grew E by 2 lbs
12. did laundry
13. sent birth announcements
14. read one book (Bringing Up Bebe)
15. did (minor) revisions and submitted my first peer-reviewed article
16. went to a job interview
17. went out to dinner for my birthday (thanks grandma and grandpa!)
18. took E on the bus!

Cute things

1. ear fur
2. her 'baby fox bark' when she is sleeping. This is one way I know she is asleep.
3. snuggling into your neck.
4. when she is done eating, she stretches, raising both arms over her head like she is champion of the world
5. cooing
6. baby sneezes
7. big blue eyes
8. milk breath
9. the way her hair gets curly in the humidity
10. grins (of course!)

Meet the New Boss

It was Monday, and she was due Friday. I assumed she would be late, like most first babies, but I knew time was running out and I had a PhD proposal to turn in and a lot of work left to do. I sent a draft to my advisor saying that I was panicking a bit about the delivery and that I wanted to get him something to look at now, and I would fill in additional sections on Wednesday. Tuesday I spent most of the day revising an article I had contributed to, promising to make additional revisions the next day. Eleanor had other plans.

Around 9:30 Tuesday night, May 1st, I went to bed, but had some cramping. Irregular and mild, they got a little more intense around midnight. I spent the night mostly awake, timing them with an iPhone app, staring at the dog as my point of focus. In the morning Josh woke up and I told him he wasn't going to work. We called the doula around 9:30 and she arrived at 10:30, just as we were about to head to the hospital. It seemed like it was time - they were four minutes apart, but still a bit irregular. Ellen calmed me down.

Our tub was useless - too cramped, not deep enough. The birthing ball was also useless. I spent most of the rest of the morning holding onto the sink or the banister, and focusing on one of Josh's eyes. I was worried it would just go on forever.

Around 2:00 we decided it was time to go - I was starting to feel the baby moving down. I figured I was about 5cm and I was in for a lot more labor at the hospital. Josh grabbed the bag and put down a garbage bag and a small Ikea rug in the backseat; I knelt on the floor of the backseat facing the rear of the car and he drove to the hospital. The whole way I focused on this one dog hair. I was not as affected by the potholes along the way as I feared I would be when we did the dry run. My water broke at Pennsylvania and Fairmount.

At the hospital I was still leaking fluid as I checked in, giving them my social security number between contractions. Multiple times. I just wanted to get into the PETU for evaluation. Signs on the walls said "Quiet hospitals promote healing" and I felt bad but damned if I wasn't going to keep on yelling and moaning from the pain. The midwife checked me out and when she said "you're 9cm" I was so relieved. I figured things would go quickly - she certainly seemed to think so. Josh had left the birth bag in the car and left to go get it. There was some discussion about whether or not to put in an IV, I didn't care. Just put it in.

I walked down to the delivery room, making more of a mess on the way. They had me start pushing on a birthing stool (which didn't seem very effective; I wasn't really feeling a huge urge to push). A couple times my blood pressure went down (or up?) and they had me lay on my left side for a bit. I did some pushing holding onto the end of a length of cloth. An hour passed. They put me on my back and told me to push with my feet up against their hands. Josh, the nurse, and the doula and the midwife all took turns. This didn't seem like the best position for pushing according to my birth classes but here I was, making slow progress. Another hour passed. There were a lot of ice chips. The pushing didn't hurt, but I was exhausted.

I hadn't had any back pain, and the ring of fire the nurse was telling me I was feeling was nothing much either, so I figured she was coming out face down and evenly. They told me they could see her head and I thought I was almost done, but it was another half hour at least before she came flying out, face up, all at once. In two seconds she was on my chest, wailing, pooping and peeing. Josh cut the cord. We decided on her name. I delivered the placenta.

They called in a doctor to do the repair of my third degree tear. I sang as they stitched, sang to Eleanor. Josh held her for a while after they weighed her - 8lbs, 1 oz, not a small baby. The nurses and the midwife kept telling me what an amazing mom I was, what an amazing job I did; it was nice, but I was thinking they must say that to all the women! They're never going to say "you know, that was pretty average."

I called my mom and started crying when I told her how sorry I was for all the pain and suffering I had put her through during labor, and afterwards! They were so shocked to hear that Eleanor was already here, I think we had told them we would try and let them know when things had gotten started. But we weren't thinking of that. We called Josh's parents. They were still stitching me up. Our doula got us started breastfeeding, Eleanor latched on like a champ.

I felt like I had pushed my eyes right out of their sockets. The tissue around them was swollen for days. I just wanted to sleep, but she had to breastfeed every two hours, so the nurses kept bringing her in. In the morning she wouldn't stop crying until the orderly who brought my breakfast leaned over to her saying "Who did this to you, sugar? I'm gonna get 'em, yes I am, you just tell me who did this to you!" My roommate was French and they spoke so softly, and their baby was so quiet. It was their second, and I believe they walked home. I could barely move.

The breastfeeding problems started immediately. She was losing weight and had high bilirubin. We rented a pump from the hospital on Saturday. Her heel was pricked for four days until she turned the corner. I was delirious from lack of sleep and nauseated and ravenous at the same time. Josh made me smoothies and I ate mostly granola bars. My thirst was endless. I'm still not sure how I made it through that period. The first ten days were impossible. Everyone had competing priorities - the lactation consultants wanted me to feed her every two hours; the pediatrician and therapist wanted me to sleep as much as possible, six hours; the doctors/midwives wanted me to find 20 minutes to soak so that my tear would heal, 3 times a day. It did not seem possible, at the time, to do all those things at the same time. I felt bombarded and pulled apart. When we added pumping it got even worse.

Putting together blocks of 3 hours of sleep began to help; my appetite improved by the time my parents arrived, when she was almost two weeks old. I could smile and make a little conversation. The more I was able to sleep the cuter she got. I did not expect to get such a cute baby! She was hairy and jaundiced just like Josh was, but was definitely not an ugly baby. At one point I dissolved into tears, so confused as to how it was possible that she was ours, that she had even come into being. "Where did she come from?" I asked Josh. "It's so amazing, how could it possibly be true?"

Weekend Update

• went to see "Fame" at WPC on Friday evening - much fun had by the very large cast, some very excellent singers (particularly among the 'shy' students). Both fun and terrifying to be back in a high school. We now await Josh's report on whether his students are now aware that I am preggers.
• Italian Market Saturday afternoon, where there were no ducks for Bittman's cassoulet. All in good time. We did pick up fresh tortillas at the tortilleria and about $50 worth of tea and spices from the spice shop. The Spice Lady as we walked in was educating her male friend on where to put the awl if you really want to damage someone's tires..."right on the Firestone!" When we only had $27 in cash she said "just give it to me - it's for the baby." We protested. "Don't talk back." We shut our traps, thanked her, and wandered on home against the wind.
• Josh made chili powder and I made chili. He made cornbread. A good time was had by all. 
• Kima is pretty gimpy these days after naps. Time for a check-up (and some more Trader Joe's Doggie Glucosamine?).
• Sunday; more futzing on the internet and finishing of paper about Kongwa for which data was collected three years ago. Hit send to my colleagues for final review. 
• Vacuuming; epic walk with Kima (if only because she was able to chase the first squirrel of the new year); 'prepping' her new bed with a pile of Norton Anthologies as it was much too poofy for her to handle at first (will post photos later). 
• Adding diced candied ginger to brownies is not a bad idea!
• Bug has been awfully wiggly. Also Braxton-Hicksy. 
• Next weekend - dinner party!

Observations

1. Wow! I am now an official PhD student.

2. Sitting in one's advisor's office with computer but no internet access for an entire afternoon is VERY productive.

3. Trains in Switzerland can be very picturesque in the winter.

4. Things to think about, "all in good time".

Now off to the train station to buy victuals. Possibly a nap later.

"Guest Blogging"

I offered to be interviewed by a sweet bicycle blog, Girls and Bikes, about cycling while pregnant - and here's the piece. Special thanks to Simply Bike for facilitating.