Daphne and I puttered through traffic to see the MD who specializes in breastfeeding medicine.  Fortunately, Daphne was good and hungry when we arrived.  Unfortunately, the doctor was a bit late.  She was quite nice, however, and we got started off right away with nursing on the first side.  She had a number of suggestions for positioning, and we implemented one or two and then waited for the other side to do the rest, which included letting go of my trust MyBreastFriend pillow.   Ugh!  It was like taking training wheels off your bike when you were a kid – you were fine, but it was nerve wracking!  In the end, I must say, I HATE the learning of the logistics of breastfeeding.  Do this, not that.  No this, not that.  No, no, this other thing, not that one.  BLAH!  While I can accept that this is a case where the internet is far less helpful than it should be (and even spreads misinformation), I have the experts telling me different things, and that gets annoying!  But the doctor today reminded me of the most important thing – keep trying these different suggestions, and find out what works for us.  Did someone say that earlier on in the process?  Sure.  Probably many people, but now that I’m more experienced at what works and what doesn’t, it’s actually something I’m capable of listening to.  But not using the prop and having her so slanted and slightly facing up seems so precarious.  I think, like learning to ride a bike without training wheels, we’ve just got to practice.

She did before/after weighings, and Daphne ate 2.5oz on the right and 1.5oz on the left – and both sides, but moreso the left, were less than stellar feedings since we were in a new place (new shiny objects!) and she was already fussy and overtired.  So, four ounces at an ok feeding is great!  (FYI, she’s just about 12lbs at this point, up from 11lb 6oz two weeks ago.)  And she suggested continuing to do breast compression when Daphne stops taking eating very seriously, and to continue limiting her time at the breast.  Being an attachment parenting person at heart (tempered by much, much realism), the idea of doing this bothers me on some level, but it does seem to work best – for both of us, really – if the breast is mostly about feeding, and not fluttering at for half an hour a side.  I’m glad that I can fairly easily tell when she’s actually eating, so that the time I limit is the random snooze-sucking (and if that isn’t a word, it should be one) and not productive eating.  She also mentioned going back and forth from side to side if Daphne is getting too fussy about the slower flow at the end of a feeding.  While she’s off of one boob, it “repackages” (the doc’s words) the milk still in there so that it will flow at a faster rate when she comes back to it.  (Daphne has a habit of head turning and other unpleasant boob-manipulations (another word that should exist) when the flow rate gets low, so we think.)

To continue the rambling account of this appointment, she then checked on my nipples.  She could immediately see the irritation (they look chaffed) and that there was still a bit of compression (though, really, it’s MUCH better than it used to be, so my standards are somewhat low!).  She couldn’t identify any blanching, but around 10 minutes of chatting later, when I noted that I was getting the “something is stabbing my nipple” pain, she looked and sure enough, it was blanched.  So, she definitely believes that there is some vasoconstriction going on.  While this isn’t true Raynaud’s, which is an autoimmune condition, it’s similar in manifestation.  Sometime between 10 and 30 minutes after feeding, I’ll get waves (often 10 minutes apart) of a stabbing and then burning sensation right in the nipple.  Definitely a different sensation than let down (though I also find letdown to be a burning type of sensation, and it took a few weeks to be able to differentiate the sensations), it’s apparently classic vasoconstriction symptoms.

What I had been doing – warm compresses (really, a warm buckwheat pillow) over the nipples after feeding – is definitely something I should keep doing as it helps maintain blood flow.  She also suggested making sure to NOT let the nipples air dry (moist healing being more effective), and try to use something like oil to keep them from drying out and from sticking to my bra or nursing bra pad.  (Yet another thing I didn’t know – the nipple should not stick to the bra and have to be peeled off!  And that the nipples are NOT supposed to be hard after feeding!  Who knew!)  So, I’ll try to keep my lanolin/st.john’s wort mix handy, and maybe a little tiny vial of olive oil.  (Another newborn use of olive oil!  It can do everything!)  She also suggested that I try an OTC hydrocortizone ointment to reduce the inflammation in the irritated (traumatized) nipples.  In theory, reducing the irritation that Daphne is causing every time she feeds should help reduce the vasospasm (since it appears to be induced by the damage to the tissue), so we need to keep working on good latch and good function, but treating the inflammation in the meantime is important too.

I feel good coming out of that appointment that we can continue to improve the situation.  I’m not quite hopeful enough that we’ll get to the “she can breastfeed as long as she wants” stage, but I’m definitely feeling more confident that we can keep going for at least a year.  Heck, we’re nearly 25% done with a year already!  (Crazy!)  Hopefully, the PT will be able to help us continue improving the symmetry of Daphne’s feed, which the doc noted was something that could still use improvement.

On the way home, I opted to stop at a store in the  area and look at another carrier.  Jason was a bit less than enthused by me trying another one, but I really want something I can carry her for longer times in and let her fall asleep and still have support for her head while facing out.  (I do plan to attempt to “moby train” her, to borrow that other mom’s phrase, to be accepting of facing inward, but I know that it will not be a permanent solution.)  Baby carriers are expensive, though, so I can understand his reticence.  (I’m opting not to do a 300-hr yoga teacher training this year, since working it around her would be challenging, so I’m using a little bit of the money I’m saving there for other things. 🙂 )  Fortunately, there is a return policy at the store in case he really really hates it and I don’t love it.

And, finally, with all that going on today, Little Miss Daphne had some horrid napping, so I allotted extra time to getting a good nap in for her.  After she ate, I swaddled her up, held her in the rocker, and gave her a pinky finger to suck on (human fingers >> pacifiers, still).  She got to the first asleep stage, and I went to put her in the bouncer she often sleeps in, but she woke up and was less than pleased, doing more abdominal scrunching, like she had been.  Sensing that she was continuing to change her sleep habits, I put her down on the bed (cleared of poofiness) still swaddled, squished a pillow along her side (below head level) and myself along the other, with a leg draped (gently) over hers.  I gave her back the finger, hummed at her, and she feel asleep, on her back, on the bed.  (And has been there nearly two hours.)  I think we’ve moved on to another stage in the sleep game.  Now, will she do this on her mattress, and not our memory foam mattress?  (Though, we have the option of buying a memory foam mattress in “portable crib size” for the cosleeper, if we want.)

In the next few days, look forward to a not-totally-baby-centered post, as Hike-a-thon is just around the corner!