Thursday, August 6, 2015

When Breast isn't Best

...or, "Why we're never leaving the house again."  Lochlan will be seven weeks old tomorrow, but technically he should've been born yesterday.  All the nurses in the hospital said that eating is usually the last hurdle for preemies, and while it was Lochlan's only hurdle we are still in the thick of navigating challenges.  Within a few hours of his birth, one of the nurses noticed that Lochlan was tongue-tied.  When he was about a week old, one of the neonatal doctors clipped his tie and we tried breastfeeding again.  He was able to take a whole ounce(which, at his current size, was a full feeding), but it was excruciatingly painful for me.  We'd given Lochlan a few bottles of my expressed milk, but he seemed to be actively offended by bottles so we mostly stuck to tube feeding and nursing.

Evergreen is a very pro-breastfeeding hospital, which I love.  To a point.  One of his nurses was so adamant about protecting Lochlan's breastfeeding instincts that he went so far as to hide Lochlan's bottle so the other nurses wouldn't offer it.  After another week went by and Lochlan still wasn't taking significant amounts at the breast, I had to tell that nurse politely but firmly that I was going to get my baby home any way I could, nipple confusion be damned.  I think he underestimated my stamina, fearing that if I started giving Lochlan bottles I'd never break the habit.  Had I insisted on waiting until Lochlan could successfully breastfeed before taking him home, we'd still be in the NICU.  Eventually they'd probably have kicked us out, because even after getting his tongue clipped three times Lochlan still isn't breastfeeding.

When he was about two weeks old and there was still no end in sight to our NICU stay, I decided to try bottles again.  Lo and behold, he took almost a whole feeding by bottle!  By his third day of bottle feeding, he was taking 100% of his food by mouth and his nurse had removed his feeding tube.  I still tried breastfeeding him sometimes, but now that he was bigger and stronger he could suck a lot harder and nursing felt like I was being stabbed with 1,000 white-hot needles.  That's not what nursing is supposed to feel like.  We tried a nipple shield, we tried different positions, we tried different cushions, but everything was painful.  I made a lot of phone calls and eventually found a doctor around the corner from Evergreen who could see us a week after we were discharged for an assessment, and the following week she clipped Lochlan's tongue for the second time.  He immediately began sticking it out further than he ever had, and we went home with a list of stretches for his tongue and a follow-up appointment for next week.

Meanwhile, I scheduled a lactation consultant for a home visit.  I highly recommend this.  A lovely woman named Joy spent about an hour and a half with us, gave us some additional tongue stretches(which are really more like games) and remarked that to her, Lochlan's tongue still seemed restricted.  I chose this particular lactation consultant because on her website she mentions that her own son was tongue-tied, so she had personal experience with what I was going through.  She asked me to let her know how Lochlan's follow-up appointment went, and to call her if breastfeeding remained painful.

At the follow-up appointment, the doctor declared that his tongue looked good and said to keep doing the stretches and come back in a week.  I said that breastfeeding was still as painful as ever, but she said it would take time and not to worry.  I've done a lot of reading on tongue-ties, and although Lochlan is my first tongue-tied baby I felt like his tongue was still doing a lot of the things that tongue-tied babies to.  I called Joy and described what I was seeing, and she said she would text Dr. O'Hara for me and tell her I needed to be seen.  Dr. O'Hara is the premier tongue-tie doctor in this area, and she is very, very difficult to get an appointment with.  She's so busy, she doesn't do initial consultations.  Your baby has to be diagnosed by another doctor or lactation consultant, and her entire practice is comprised of "complex" cases.  Lochlan is a complex case.  I scheduled an appointment with Dr. O'Hara, as well as another doctor who is also a lactation consultant.  I kept both appointments, and after a thorough exam and observing Lochlan breastfeeding the doctor/lactation consultant said she didn't think Lochlan needed further clipping, just cranio-sacral therapy.

A few days later, we saw Dr. O'Hara.  Thirty seconds into the appointment, she confirmed Joy's diagnosis and said Lochlan's tongue was still restricted and she would clip him that day.  That was Monday.  We went back for a follow-up today and she re-stretched the incision site(awful, awful, awful), but numbed it with some lidocaine first.  She said that the way it's healing is a little "fibrous," so she gave me some steroid ointment to keep the inflammation down and we go back again next week.  She said she would likely clip Lochlan a fourth time then.  I asked her how often she has to do multiple clippings, and at what point should I accept that maybe Lochlan will never breastfeed.  She said his tie is definitely on the more difficult side, but it's not uncommon for many of her patients to need multiple clippings.  She is such an amazing doctor to watch, and if I didn't trust her so much I'd give up and go buy formula right now.  She is the only doctor I've ever met who sings to babies while she examines them, and Lochlan seems almost as comfortable in her arms as in mine.

So we'll try one more time, but after that I think we're done.  I'll continue pumping breastmilk for Lochlan as long as I can, but eventually I know I'm going to need to sleep.  I'd also like to have a social life again someday, but in the event that I eventually have to start giving Lochlan formula I want to ensure that I left no stone unturned before deciding that he's never going to breastfeed.  I pumped for eight months when Jack was a baby, but I don't think I have it in me to do that again now that I have three kids instead of one.  Aaron said he's afraid that all our friends are going to think we don't like them anymore, so just to be clear, it's not you, it's me.  I just don't have the energy to go anywhere or have anyone over.  Pumping takes a lot of time, and when I'm not pumping I'm washing bottles and pump parts and trying to sleep.  My parents haven't held Lochlan, and my dad hasn't even met him.  In fact, my mom and two sisters are the only people in my family who've actually seen him.  I'm a pretty tough cookie, but right now all I can do is take care of my baby and try to keep my head above water.  Good thing he is such a delicious baby and I am so madly in love with him, because for now he's really the only person I hang out with :)

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