Local myths (pamahiins) about breastfeeding

I understand that as a developing country not everybody gets a good science (anatomy and reproductive health) education, so it was no surprise that I heard many many myths about breastfeeding. Even the real science behind bfing can be bizarre after all, why wouldn't the whole mystical process inspire mistaken conclusions about how best to bf your baby? A couple of the strangest I encountered:

1. The left boob only has water, and the right boob has rice (this is Asia after all, rice is a staple so why shouldn't Asian mommies have rice in their breastmilk)? This only naturally means that the baby should drink from both at all meals.
2. Don't breastfeed if you're tired, cranky, or in a bad mood because your milk will be sour. Who wants to drink sour milk? Maybe this one was thought up by a tired and cranky mom to get her husband to take better care of her.

We live in the city so we don't hear a lot of these, but whenever I visit my in-laws in the province their helper likes to school me on all things baby and breastfeeding. She thinks using a baby carrier/sling will make the kid bow-legged...so there...

Funny moments in breastfeeding

What many moms neglect to tell other moms, is how bizarre and funny the breastfeeding experience can be. It's not even having this little "pet" baby suck on the end of your booby, that's nothing. It's witnessing your body do these strange things, or rather, your boobs do these strange things. Seriously, there's MILK squirting out of your BOOBS! That's totally weird. Literally I have laughed out loud while I pump milk as I witness the stuff coming out of the boob at full force. Other funny things:

1. There were drops milk all around our room during the first month. In the first few weeks you will find yourself basically topless most of the time, there's hardly any point bothering to put on a shirt when you are on boob duty every hour. So, you walk around and leave a trail of milk behind you.
2. Once I was sleeping beside Baby J, woke up, reached over him to pick up my phone on a table beside the bed. On the way there SOMETHING latched on to my boob! It was like some 6th sense the baby, had, there's a boob coming at me! Wake up and grab it!

Photo credit: http://www.myspace.com/breastfeedingsupport

3. Several times, I turned over in my sleep and ended up sleeping either on my side or on my stomach. When I woke up in the morning the sheets beneath me were drenched in milk.
4. The experience of attempting to shove my milky boobs into an old bra was hilarious, it was like trying to fit a melon into an egg cup.
5. The bottomless milk duct. No matter how empty I think my boob is from pumping and nursing, when I squeeze on this one milk duct, milk goes squirting out and hits the ground 2 feet away.
6. Seeing the baby try to latch onto your boob through your shirt...funny. Seeing your baby try to latch onto your friend's boob through her shirt...funnier. Seeing your baby suck on daddy's nose in hopes of getting milk...funniest.
7. Babies will go through this phase where they're feeding and you're watching them, then they will look up, see your eyes, and smile at you with a big grin with your nipple in their mouth. Funny also.
8. Lately, my baby will be nursing on one boob and fiddling with the other boob. It's embarrassing in public but kinda funny at home. Not a behavior I encourage, but sometimes he just likes to have something to fiddle with and that other nipple is right in front of him.

TWENTY-FOUR (COUNT ‘EM, 24) HOURS OF LABOR

“Childbirth is not beautiful,” she writes. “Children are beautiful. Childbirth is disgusting. Anyone who says otherwise has never met a placenta. I’m surprised ob-gyns don’t have post-traumatic stress from seeing a few of those a day.” - Scottoline

What does it mean to go through 24 hours of labor? What does one do through 24 hours of labor? How does one keep sane through 24 hours of labor? Have I mentioned I went through 24 hours of labor? Only to end up with a C-section, oy. 

It is true that the pain and the details can get blurry in one’s pregnancy and post-birth brain. I can’t exactly remember all the pain, but I remember getting pissed. Pissed that they don’t tell you how unpleasant and violating it can sometimes feel to be in labor in a hospital. So I’m telling you now what to watch out for.

1. Several doctors peek into your hoo-ha. The longer you’re in there, the more doctors and nurses you will encounter because they change shifts. These doctors, they do internal exams every few hours. One might poke you in there to break your water, another might go in there to check how far you’re dilated, and yet another might go in there to check that the estimation of dilation of the first doctor was correct. 
2. Internal exams are a bitch. They are a bitch. A bitch. I am aware that the previous two sentences are not exactly grammatically correct, but it just feels right. In the medical shows they say so-and-so cm dilated, but they don’t tell you how they know. I went into labor mistakenly thinking that they measure the cervix through ultrasound. But NOOOOO! They measure it by sticking their fist in there and seeing how many fingers they can poke through your cervix. For me this meant check at 1cm, 3 hours later it’s 1.5, 3 hours later it’s 3, 3 hours later it’s 1.5 again! It took a lot of strength not to smack the doctor upside her head. 
3. When they say they will break your water, watch out. They will come in with a monstrosity of a crochet hook. It really looks like a crochet hook, a really big one. It will be scary, I can allay fears only by saying that it doesn’t really hurt. After all those internal exams a skinny metal wand with a hook at the end is a piece of cake.

If you've never met a crochet hook, here's what it looks like. Photo credit watermarked.

1. If you are in a teaching hospital there may be up to 50 doctors and nurses attending to you by the time the 24 hours are through. Some of them will stand around doing nothing, learning I guess. It’s annoying. It sort of makes you feel like you’re part of some  freak show as they watch someone else stick their fist up your hoo-ha.
2. Boredom. Bring all your gadgets and tricks to entertain yourself.
3. The royal annoyance of hearing activity in other delivery suites. As I lay there for hours on end, I had to listen to squads of nurses and shouting “push!push!push!” in unison as they cheer on the nth woman lucky enough to be at that point. This is followed by rehearsed gushes of cheerful congratulations. I must have heard 5 deliveries by the time they wheeled me to the OR.

OK so those are the annoying and painful things. I don’t want you to think that there is nothing magical about childbirth, after all most other women say it is magical. It can be fun if you have someone around to talk with. I was lucky that my husband can see the humor in the smallest things, so a lot of chuckles were shared as we ribbed nurse after nurse about their silly uniforms. 

So after giving the little guy a more-than-fair shot at squeezing himself out of my womb, my wonderful and unusually-perky OB decided it was time to open up a new door. They had already popped my water bag which made my belly deflate considerably. It was sort of freaky, like my skin was shrink-wrapped around the baby. To be honest I was glad he made the call to do a c-section. I was exhausted beyond the ability to push. It is a total cliche, but it needs to be said, it truly is worth it.

A Medicalized Birth

Now I am all in support of home births for those women who have the courage and emotional balance to do it. I am not one of those women. There was never a question in my mind that I wanted a magical birth free of pain. I had already gone through so much physical pain during the saga of our (equally medicalized) conception, was not in the mood for more. I would not necessarily advocate pain medication during birth, it is really and truly a personal choice based on a woman’s threshold for pain. Some superwomen can smile through the sensation of having a jaws-of-life clamp squeezing their belly and pushing a baby through their 10-cm diameter birth canal. I am not one of those women.

So I asked for all of it. Before the drip by kind OB told me that he was feeling generous today, he would let me eat whatever I wanted. By this time I was starving, I must have not eaten for more than 12 hours. What was near Medical City that was still open late at night? McDonalds ick. So I went full monty and sent my dutiful husband out for a quarter pounder, a large coke zero, and a large fries. He took a picture of me to commemorate the moment, some of our final moments as DINKS (dual income no kids).

Photo from McDonald's

Except for a few choice friends, nobody will ever be shown that picture. I looked horrid, all swollen in the face, but happy. Until I saw that picture I imagined myself as I was pre-pregnancy, with a full face of make up and looking ready to conquer the world with eager eyes. Instead I found that I looked fat and tired, pale with bags under my eyes, acne across my face, and hair all unwashed and askew. 

I digress, this is supposed to be about the medication. Through 24 hours of labor I must have had, on top of the initial epidural drip, 4 “refills.” Those things don’t last very long, after a few hours you start feeling the pain again. Epidurals are magic, it made my painful contractions feel like Braxton Hicks contractions where I can feel only a pleasant squeezing. For the epidural virgins out there, the procedure can be intimidating. First, it’ll take an army of doctors and nurses to administer it, including a big burly man whose job it is to hold you down in a fetal position while someone else administers a spinal tap. There’s a small needle pinch to numb you in the site where the big needle goes. Then the big needle goes, into your spine, you can feel the doctor poking around in there looking for the sweet spot. After you’ve been tapped, they run a thin plastic line across your back and tape it to your shoulder, Through this line they feed the magic contraction-numb-ers. 

Photo from: http://solutions.3m.com.sg/
This is what an epidural looks like

On top of the epidurals, I also had the rest of the stuff they give women for a C-section. Was numbed completely from the waist down. That was very very strange and scary, good thing I was already so tired and almost in shock from the cold of the OR that I couldn’t completely process it in my brain. 

So all in all it was an extremely medicalized birth, with all manner of pain killers. What would this mean for my breastfeeding prospects? The question I never did get to ask myself. I only realized what it meant a week after Baby J was born.

The Day I was Admitted to Give Birth

*I realize these posts are out of chronological order, sorry about that. This blogging thing started out late in the game so am just now catch up with the birth stories.

I had already been “phoning it in” at work for a couple of weeks, partly because I was expecting Baby J to arrive at any moment, but mostly because it was just getting too darned difficult to move around. I felt huge, heavy, unwieldy, and all other synonyms of “large” you can think of. Mostly I was sitting on the couch watching reruns of Law and Order until it was time for naps. Except for random Braxton-Hicks-type contractions several times a day, which were painless, this pregnancy was exactly where it should be at 38 weeks. 

Photo from: http://www.totalfitnessexperience.com/wp-content/uploads/2012/01/pregnant-belly.jpg

On one of these weekday mornings the contractions suddenly felt painful, very painful! I was groaning in pain, holding my belly, and kneeling on the floor waiting for each wave to subside. Time to alert the husband to take me to the pre-delivery room at Medical City, where I was going to give birth. This was a first pregnancy, so I had absolutely no idea what contractions would feel like and how to know when I was supposed to go to the hospital. We texted the doctor and he said just go and get checked. When we got there, I was hooked up, checked, poked, and put on standby. Wouldn’t you know it, contractions stopped when I was there. Feeling silly for pressing the play button too soon, we were discharged and sent home with instructions from the doctor to come back only when contractions were 15 minutes apart and coming in regularly.

After the false alarm my husband, my giant belly and I went out to lunch with friends, hung around the house, I may have even gone to the mall to walk around. In the early evening the painful contractions started again and this time we know enough to actually time them. 

You know how some women who give birth say they have a high tolerance for pain? Well, this one has a very low tolerance for pain. I was squeezing B’s hand, twisting and writhing in pain with each wave of contraction. At 10pm, we went back to pre-delivery room. There they waited and waited and waited, contractions were very irregular but very painful. Internal exams show I was dilated 1cm, that’s nothing! That’s a polite way of saying “honey you are so not ready yet but i’ll say 1cm so you don’t feel stupid for taking up our time.” Baby J hasn’t dropped into my pelvis, he wasn’t going anywhere. Still, since I was in so much pain the residents probably took pity on me and got me ready to move to the delivery room.

Brilliant tip from our OB, book the Lamaze room, the best room and you don’t actually have to use Lamaze techniques to give birth. It was huge, had a couch, a tv, its own bathroom and enough floor space to do a Zumba class for 6 people. Sure it was windowless, but it had an entire wall covered with a mural of a pretty garden of flowers! I had my Kindle, my ipod, my phone, and my husband, I was ready for the wait. So we waited, and waited, and waited. 12 midnight became 4am which became 11am and became 6pm. This baby was not dropping! There were long stretches of time with no contractions, then some contractions close together, then they’d disappear again. Poor intern had to sit there half-asleep recording all my contractions. 

Photo from: http://www.mommylace.com/2010/02/21/cost-of-giving-birth-normal-and-ceasarian-delivery/

I don’t remember exactly when I asked for an epidural, it was probably halfway through my labor. My OBs resident asked me if I was in pain and I enthusiastically said hellz-yeah I’m in frickin’ pain! At this point I sheepishly asked when I can get pain killers to which she replied “ anytime you ask for it ma’am!” See, if they had explained this to me when they admitted me then I could’ve asked for it 6 hours earlier and I wouldn’t be so exhausted. 

There were all manner of unpleasantness during this period of labor which I will warn all you out there about in a following post. 

Milk not coming in? The importance of pumping

All pregnant women who want to breastfeed should have a pump before they give birth. Full stop. No negotiations.

It does not have to be a fancy branded electric pump, if all you can really get is a manual pump (new, borrowed, used, doesn't matter) then get one. In fact for me the manual pump got more milk out. Yes yes you can hand express, but that will really take a lot of time and patience which you DO NOT HAVE when you have a newborn.

Since I had such a medicalized birth (c-section, induced labor, epidural, da works) it took probably a full week before my milk came in in any real volume. I had colostrum only for a week and had no idea. The only reason I found out that my milk had not come in yet was at my baby's first week checkup with the pedia his weight had dropped significantly (insert mom meltdown and hysterical fear here). At that point I desperately wanted to supplement with formula but my doctor said wait a week, make sure I nurse as often as I can and in between, pump and feed expressed milk.

So I did that. I was attached to the pump between feedings for a full week almost every hour. Eventually the milk came, then the problem became too much milk (that's a different post). Pumping as often as you can is so incredibly important during the first two months as you establish your milk supply. Even if you do end up deciding to supplement, you can still move to exclusive breastfeeding eventually if you pump religiously at least every 2 hours (even at night) and every time the baby takes a bottle of formula.

When pumping, pump until nothing comes out and then keep pumping for another few minutes before stopping. Also, squeeze your boob and massage from the outside in while pumping, Piga-in ng husto! It will be frustrating seeing 1 ounce of milk after half an hour of pumping but this is normal, eventually you will get more.

I am lucky that my pedia held out on the formula and my baby at 7 months has not had a single drop. However for some moms it REALLY can get scary when baby is not gaining weight or is losing weight so I understand the instinct to grab the can. What is important to know is that even if you supplement, you can still move to exclusive breastfeeding when you have enough milk. and that pumping and nursing are the most important things you can do to bring your milk in. The more you pump and nurse, the more milk you have.

Breastfeeding through growth spurts

Breastfeeding through growth spurts can be harrowing, and I suspect, the reason why many moms who set out to exclusively breastfeed, end up supplementing with formula. When baby goes through a growth spurt he can make you feel like you are not making enough milk, in reality what he is trying to do is to make your body adjust to his demand. Supplementing with formula through a growth spurt diminishes your supply, the best way to deal with a cluster feeding baby undergoing a growth spurt is to just be there if you can be. What to expect and how to cope:

1. Expect baby to basically camp out on your boob. We had our first growth spurt at 2 weeks. He went from nursing every couple of hours to nursing ALL THE TIME. Literally, on the boob from feeding to feeding. I'd put him on there, he would be there for an hour (no joke), and then he would sleep. In an hour he would want to be on the boob again. This can go on for 2-3 days. I once had some guests in the house, they were there for 3 hours and the entire time except for the time it takes to switch boobs, he  was on my boob under a nursing cover. Good thing our guest was also a nursing mom, she made me feel ok and explained that maybe the baby is just making me make more milk.
2. Get comfortable and surround yourself with entertainment. It will get boring. Thankfully, the pain is not so bad because for me the pain was bad when he was latching on, it'll last for a minute then i'd be fine. SInce he was nursing almost nonstop the pain was few and far between. Have a nursing station where you can raise your feet up, keep your nursing pillow there, celphone to have text conversations with your friends, have water and snacks on hand, a book, and a tv.
3. Have your husband or partner or maid check up on you every half hour. Just to ask if you need anything. Useful for bringing you water or changing the tv station etc.

When it seems like the baby is just never full and you think your milk is not enough, take comfort in knowing that you won't need to supplement. What the baby needs is just more time on your boob. It is temporary and you can weather that storm. Sometimes baby is just comfort nursing, not really drinking but he just wants to be near, hey, that can't be a bad thing.