well, I’ve got hope for there being light at the end of the tunnel. I don’t see the light yet, but I now have hope it is there, and after the past couple days, that’s saying something.

we met with the OT, Judy Simmons, this morning. Daphne cooperated well, just barely making it to 9:30a after her last feeding ending at 6:30a (we got kinda lucky, and I made Jason take her when she started thinking about waking up so I could remove the smell of milk). The OT liked her suck/swallow pattern, but first had to correct my handling of her. since my nipples point to the side, rather than straight forward, the traditional advice of wrapping the baby around my body and lining up her nose to my nipple doesn’t quite apply. I do want the nipple pointing up into her palate, but I also want her body lined up with my breasts, and her head in a closer to neutral position (mostly due to the nipple pointing issue). my tendancy is to turn my body into her, in order to get ahold of her head, but it leads me to, as Judy described it, chase the baby around.

after watching and listening to Daphne and I nurse, she checked out some anatomy and physiology. one of the first things she noted was that, particularly after the initial feed, which goes relatively well, she would start over opening her mouth which led her to close too forcefully, much like babies start flailing their arms, rather than move then with control. so, she put a finger on the bony part under the chin to offer a little resistance when Daphne opens her mouth – not enough to move her head, just to stabilize her jaw muscles. this makes her not ram her jaw open, but pause to get a good draw that’s not possible with a flailing jaw, and not over close her mouth as well. of course, timing the resistance on her chin to when she’s opening her mouth isn’t the easiest thing in the world, but it does seem to be helping. over time, as her jaw strengthens, I shouldn’t need to do this for her.

she also noted that Daphne was doing a pretty good job curling her tongue (which they need to do in order to wrap around the nipple and get a good long suck), but only the first third of her tongue, and only at that initial suck where the milk was flowing fast. she was adapting to using a weaker tongue to pull milk out by rounding the middle of her tongue and compressing my nipple! (this is what’s been leaving the big tell-tale crease across my nipple, and rubbing one half of it raw.) so, we have exercises to do to help press down and draw forward on her mid-tongue as she sucks, either using a finger or a pacifier like a soothie. I’m happy and all that she’s adaptable and figured out a way around the slower flow and weak suck issues, but not when she causes another problem! besides the tongue exercises, though, we’re going to try occasional use of a nipple shield, not only to let my nipples heal, but to encourage her to use her tongue properly, since it changes things just slightly. (nipple shields, however, are a pain in the butt to use. I’m sure we’ll get the hang of it, but I look forward to not having to use it for the next year!)

additionally, she saw the lip curl that Daphne often likes to do, and thinks that she’s got tight muscles around the lips at the moment. it’s particularly hard to try to suck properly with your bottom lip is curled under (go ahead, try it), so we have a couple of lip exercises to work on that as well. the top lip curls under a bit too, and Judy is hopeful that it will only be a couple of days before I notice her not curling them under so often with these exercises.

she talked to us a bit about bottles, and finding the slowest possible flow rate we can for when we have Jason give her a bottle in the evening to help me keep my sanity. she also gave us a reference guide that gives us estimations on how much she should be getting in each feeding if she’s eating breastmilk alone. (she gave us that along with the caveat that the numbers on it are rough approximations, she’ll vary from feeding to feeding and from day to day. as best we can tell from weighings and her growth rate, she’s doing just fine.) she was fully supportive of not only taking her off the breast if she’s just hanging out there flutter-sucking (as it doesn’t encourage proper sucking action), but mentioned that babies this young don’t yet have the ability to unlatch themselves (without falling asleep and having their muscles relax involuntarily) so the pulling and flailing at the end of a feeding is her trying to get off the boob, but not knowing how. oh, it’s wonderful to know that it’s a sign I should unlatch her, because that is an uncomfortable experience.

in the end, we hope to get to feedings that are 20 to 30 minutes, as the 60 minute feedings are hard on her (tiring from all that work) and me (tiring from all that work!). and she was supportive of encouraging Daphne to try to get two or even two and a half hours between most feedings, not only because Daphne feeds better that way. she clearly didn’t suggest putting her on a schedule, but reinforced our current plan of trying to distract her for a little while if she starts indicating hunger an hour or hour and a half after she’s eaten.

finally, Judy mentioned that she saw a number of minor signs of reflux – the wet burping, the distinctive swallow, spitting up a bit after eating (fairly regularly), the fussiness in the evenings, and even the short time between feedings. so, keeping up the burping, keeping her upright after feeding, looking into an elevated surface for sleeping, not trying to get her to go too long between feedings, and possibly more regular use of the gripe water. I’ll also keep an eye out to see if anything I’m eating is making it worse (I’ve already eliminated onions, though I’m not certain I had to; chocolate may be next, which would be sad).

so, we had a lovely combination of (at least) three or four small issues that came together to make breastfeeding quite less than ideal.

all in all, I see hope in the tunnel of breastfeeding problems we’ve had. not quite light yet, though her first feeding after that appointment went better than they had in a little while. this may have been essentially a placebo effect – there were things I could do, so I felt better about it – since I still had some creases on the nipples. but we don’t expect this to be an overnight fix; it may take three or four days to notice a difference, and may take longer than that to provide a bigger change. still, in times like these, hope is almost as important as a fix. and I’ll take whatever hope I can get.