Saw the OT today. She definitely saw improvement in her lips, and some in her tongue, but she was still using her tongue inconsistently. Between the humped tongue in the middle and cupping at the tip, she suspects she likely has a very slight posterior tongue tie. It might not even be worth treating surgically, but may be one little piece of the puzzle. She also confirmed my suspicions that the shoulder tension I see in Daphne when she’s eating (shoulders sometimes scrunched up around her neck) may be contributing to the poor tongue use since that posture pulls on the hyoid bone, which needs to move freely to operate the tongue.

She gave us one other exercise to do, helping to stretch out and release the muscles and tendons on either side of the base of the tongue. We are also going to have Jason do the exercises, since I have been unable to successfully do anything but the lip stretches. Turns out that baby girl is smart, and picky. Mom doesn’t get to put things in her mouth that aren’t a human nipple.

She was certainly pleased that Daphne showed some signs of improvement, but noted that we are getting close, developmentally, to the stage where her patterns are starting to set and getting improvement is going to be difficult. She suggested that we see a local physical therapist who also specializes in newborn feeding issues, and who may be able to help work on the head/neck/shoulder issue from another angle. She was also very supportive of my thought of seeing an osteopath who was recommended to me for cranial osteopathy work. (I’m keeping my fingers crossed that it could help with her reflux as well.)

I was even able to get ahold of the PT, who seemed to have an idea of where to go with this just based off of the description I gave her.  Unfortunately, she doesn’t have an appointment for another three weeks.  I’m feeling a bit time-pressured by the whole thing, but we scheduled an appointment for early July and are on her wait list.  It’s a good thing I’ve got pretty much all my days wide open!  Wednesday, when they’re open again, I’ll be calling the DO and seeing if they can get her in soon as well.

We’re headed back to the OT today. While we had seen a little bit of progress, and while I had stopped doing all the exercises (except the chin counter-pressure) while she was having her incredible gassy/fussy/crying/wailing spell, she should be farther along towards not causing mommy extreme pain than she is. I’m still in the “I dread feeding her, because it’s going to hurt like hell during, and for at least an hour afterwards – then it starts all over again an hour after that” phase, which is really depressing. (It’s always tricky using that word to describe anything postpartum, because I don’t want anyone to jump to the PPD assumption, because individual “things” can be depressing even if you aren’t depressed over all.) Jason and I were playing a card game on the dining table while Daphne spent some awake -quiet time in the swing, and I commented that when the feeding goes particularly badly over the span of a day or two, I get into a phase where I don’t really want to be around her (hey, she’s a reminder of lots of pain!) but when she’s quiet and in the swing, I want to take her out and hold her. Definitely feeling the attachment growing, but oh do we need to stop the bad feeding. And, so far, I continue to be too stubborn to go to exclusively pumping and bottle feeding. (Yes, some of it is my own self-expectations given the situation, but some of it is just the convenience factor of being able to pull out a boob and feed her, regardless of having the accoutrements available.)

In happier news, she has come to love the changing table. I was told this was likely to happen, but it’s really humorous to see. She’s getting a little less pissed off about having to fart, but she still gets “fussy” – but it’s just a very active sort of thing with arms flailing around and legs kicking and her squirming and being variable. But she’ll smile a fair bit during it, so last night, trying to get her to poop without a diaper on (oh, I do love having prefolds I can lay everywhere), we spent 40 minutes “playing” on the changing table. Ok, most of it was me cheering on a poop, but hey, that’s what moms of newborns do.

And in other, other news, tomorrow I start teaching yoga again. First class is at home at night; keep your fingers crossed that she doesn’t start screaming. Then six in the morning Wednesday, where I hope she feeds at a convenient time. Then Wednesday night at home again. Whew. I hope we get lucky with her behavior!

Today was the day to get my ultrasound done. As the birth center doesn’t do ultrasounds, they called the facility that did my prenatal ultrasounds, affiliated with one of our local eastside hospitals. That maternal/fetal medicine facility doesn’t do postpartum care, so they referred me to a women’s clinic in Seattle.

But no one warned us it was an abortion clinic we were being sent to.

I will state up front that I am pro-choice, even after having Daphne. But Jason started having reservations when he checked the website last night. It noted that they provided other services (dealing with miscarriages, free pregnancy tests, etc.), but gave him the “low cost abortion clinic” feel. I had hopes that it was a more general women’s clinic that wanted to be supportive of reproductive rights. Turns out that Jason was right.

Keep in mind that I had been told not to eat or drink for 6 hours prior to the appointment, in case they had to do a D&C, and they last thin I had was at midnight. So I was hungry and very thirsty – hence cranky. They also told me that I would need someone else to drive, in case they used anaesthesia, so Jason drove, which meant Daphne came with us. (Not to mention we expected her to want to eat just before the appointment.) But when we arrived to a full room of women (most of whom were sitting next to and leaning on or holding hands with what looked like a significant other), the receptionist told me that they had a policy of not allowing babies in the clinic, and she would have to wait outside.

WTF?!

Ok, I “understand” that you want to be sensitive to the people there who are looking to do a termination, but I you are going to offer postpartum services, making the baby wait outside is ridiculous. It’s fortunate that Jason had driven, or I would have had to skip the appointment entirely. Instead I filled out paperwork on the bench right outside the clinic’s office, and immediately in front of the entrance to the building. I’m not sure how that helps their clients feel any better, or makes it any better.

Suffice it to say that Jason’s misgivings were realized, and I was getting rather annoyed. We spent about twenty minutes in the front lobby, while I waited for my appointment and fed her. And we discussed the unhappiness we had with the place. The forms I was filling out were entirely geared towards termination, which was mildly traumatic since it was so unexpected. And combined with the fact Jason wouldn’t be able to come in with me (since he had to stay with Daphne), I was not feeling the love. We did decide that if they did find something, we were not doing the D&C right then and there, as neither of us were feelig very comfortable about the whole situation. I really wish I had been warned about what I was getting into.

Fortunately, the doctor I saw was very nice, and seemed to know some of the background (and appears to know one of my midwives). He didn’t find any retained placenta and my uterus is just the size it’s supposed to be, but he walked me through what we were looking at on the ultrasound screen the whole time. At this point, the options are waiting a bit longer (as some women bleed for up to 8 weeks) or doing a D&C now (since that’s what would happen if I kept bleeding in order to “reset” the uterus or if there was something hanging around caught in the cervix, which is even more rare than retained placenta). Suffice it to say that we were all on the same page to wait and not do anything right now.

It was an odd experience. It’s not that I thought the care was subpar, but I felt discriminated against because I had a baby. I felt misled about the type of facility, though, honestly, that feeling is based entirely on my assumption of the type of facility and care that I expect. Since it was an “accessible” clinic, it certainly didn’t have the pretentions that higher-cost practices do, and since it had a particular niche it served, it wasn’t trying to be all inclusive. I hate to feel elitist or biased, but I certainly felt distinctly out of place, and as though I really did not belong there – not quite unwelcome, but not quite welcome either.

Of course, getting good news goes a long way to making me feel better about the experience (read: no rather angry anymore).

We had our 5.5 week appointment yesterday, and the midwife who delivered her was very pleased with how she was doing. Jason had to remind me to tell her I was still bleeding, which left her a bit concerned. She’s sending me to get an ultrasound to look for retained placental fragments, though nothing looked like that would be the case during the birth. If there is, I have to have a D&C, which honestly sounds horrid and awful. They may also put me on antibiotics, which would suck because I think that’s what set off Daphne’s digestive issues. Fortunately, I don’t have to wait longer than Saturday to find out. Unfortunately, I have to try to pump enough for a feeding or two since I have to dump my first breasts-full after a procedure, should it happen.

She’s been having good days, and I took my chances and finally made it to my first yoga class since the day I went into labor. She wasn’t the most cooperative, and wanted to feed (but badly) when we got there, and again an hour later. She also had to be held for a while (which the teacher did, but not quite the way I suggested since she had just eaten and spit up twice). But it was great to get out and move, even if just a bit.

Monday sucked. You can read the previous blog entry if you want to know how much it sucked. Hours and hours of crying and then handed the baby off to daddy to I could go cry in my room while I heard her cry downstairs. Thank goodness Jason was able to take her, because I was just spent. And I knew the crying was not just “I want to cry for crying’s sake” but something wasn’t quite right. And, after not hearing back from the midwives, I decided to schedule her with her pediatrician (who is also my doctor) to see if anything was going on.

Monday night, we talked about what we were noticing, and decided to try not burping her after eating. Not even really lifting her all the way upright, but very very slowly transitioning her from side lying (but still slanted) to a little less side lying, but still reclined. Less reflux-face, less gas, and hence – less crying. They say to keep babies more upright for reflux, and to burp them for gas, but … well … apparently not this one. I continued this pattern during the night and next morning, and still she was doing good. Granted, I also significantly changed my diet to very basic foods for the moment, but I’m not sure how much that played a role and how much was the moving, but I don’t know that I care.

The doctor’s appointment was rather uneventful, and as the doctor predicted, she was perfectly content and quiet during the visit (for the most part, she wasn’t thrilled about the stethoscope to the belly while naked and lying on her back). But the doctor could easily hear and feel a pretty large amount of gas in her stomach/intestines. Not much we can do for it, but as she gets bigger, she should grow out of it – better coordinating her breathing/swallowing, getting a bigger stomach, and better managing the movement of gas through her system. She noted that gripe water may be hit or miss, and since Daphne is also showing signs of mild reflux, simethicone (gas drops for infants) may help or may make the reflux worse making her swallow more air leading to pain from the reflux and more gas. We’re going to take a pass on that one for now and see how things continue to go as they are. (And I’ll be avoiding and only slowly reintroducing gassy foods. 🙂 )

Net result is that she spent Tuesday fairly happy. There were a couple of spontaneous “oh god, that’s uncomfortable” cries, but they were brief; you move her or bounce her and she’s feeling better. Of course, she really only was comfortable being held and bounced on a ball most of the time, which makes for a sore back, but a sore back and a happy baby is a win over an unhappy baby (regardless of how the back feels) any day. But the shocking change from nearly incessant crying to fairly content the whole day is so dramatic. Don’t get me wrong, I’ll take it, but it’s almost shocking to the system!

And this morning, she was doing so well and so content that after a little down time post-feeding, we played! In a five week old this consists of moving her limbs around (hand to hand, hand to foot, bicycling the legs, flexing/extending the legs), putting her on her belly (and then putting her on her belly on my chest when she screams bloody murder about being tummy down on the carpet), sitting her up facing me and facing out (encouraging her to do a bit of sitting on her own, but offering lots of support, of course), and talking at her (describing the room) while she sits facing out on my lap. About 20 minutes of this, and she’s done. But it is, literally, the first time we’ve really had a “play session” that lasted longer than 60 seconds.

For those who ask “isn’t it all worth it” and “are you bonding” now that we’ve had some more good days and she’s more interactive, not everyone bonds immediately. For some of us, it’s a love that grows over time. That doesn’t mean I’m less protective of her, that I’m less of a parent to her. It means it’s a relationship that is being built, and not one that appears entirely formed, magically, on the day of birth. But we are getting there, and that’s all I can ask.

She’s been crying for … 24 hours? Sure, not non-stop; she has to eat sometime, and she’s had a couple of little 20 minute naps. But otherwise crying, calming down for a minute when I do something, then crying again. Bouncing her on an exercise ball was the only thing that worked, and it’s hard to do that for hours on end. Swaddling didn’t help for very long and only when combined with the swing (but I took what I could get), and I had no luck with the pacifier. I tried various holds, and so on. Her hunger cues were not terribly clear, but I made my best guesses, and she never seemed too hungry, but would cry as soon as she was done and moved an inch.

I’m definitely feeling at my wits end, and fortunately Jason worked a short day and came home and took her. He’s had more luck with the pacifier than I have, but I don’t know that it’s going to last. Yes, half an hour of quiet is good, but I want to find out what’s wrong. I hate to rely on a pacifier, and worry that it’s going to make the breastfeeding issues worse, but we have to use what we have to use.

I can’t begin to describe the soul-deadening despair that sets in when NOTHING you do can get you more than enough time to eat a piece of chicken. The OT exercises are out the window, the dietary changes are being implemented, the gripe water didn’t do anything, trying having her go naked didn’t do much (10 minutes of quiet once). She’s got a pediatrician appointment tomorrow, which, at 15 hours away, seems like an eternity, and I’ve got a call in to the midwives since Friday. I don’t feel like I’m going to go insane, but I do feel like the only way to get through the day is to just go numb and automaton my way through it. It gets the job done but I feel bad at what I’m not giving her.

“Colic” gets better by four months or so. Three months of this is some kind of inhumane punishment, and I’m hoping and praying that there is something that someone can do to help us.

After the meeting with the occupational therapist, we now have a bunch of stuff to do to work on Daphne’s feeding. I’m starting to get the hang of giving resistance on her chin when she’s opening and closing her mouth, and she’s getting used to the lip exercises. But neither of us is doing great with the tongue exercises yet. She hates it with the pacifier (as in turning red, looks like she’s choking, and screaming hates it) and I’m not a whole heck of a lot better with my finger yet. I can feel what she’s doing with her tongue (no wonder my nipples hurt!), but she has a strong tongue and it’s hard to press against it without REALLY pissing her off. But we’re working on it.

It’s probably just the resistance on the chin getting a better suck, but feedings have definitely changed since we started this. They are MUCH shorter – 10 minutes on a side is a long feeding – and they’ve been almost all spaced out farther, to at least two hours between feedings. She is still, however, crying like mad for hours in the evening, and we don’t know if it’s too much food in her stomach, too fast of a fill of the stomach, or some other digestive issue. It’s fairly clearly digestive, and gripe water is somewhat helpful (though sometimes she need two doses, and it seems to also be helpful if I drink tea with the same fennel, chamomile, ginger ingredients) and she seems to have some degree of reflux (based on the spitting up and pain she’s displaying), but we’re not sure the best way of dealing with it. At the moment, though, those “now 20 minute” feedings are still close to an hour, as I try to keep her upright and not slumping on her stomach for half an hour after she eats.

I’m keeping my fingers crossed that we can get the tongue exercises worked out, and she’ll stop trying to squish my nipple to get milk.

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.

Four weeks (well, four and a half), and we’re still dealing with breastfeeding issues. “It’s learned, by both mom and baby,” is an understatement at best. The real trouble is that there isn’t a whole heck of a lot of support in that learning, and let’s just say that self-teaching breastfeeding is a recipe for disasters of the “oh, I didn’t know that wasn’t normal” kind. Really, there should be like a daily “meeting” with someone who knows about good/bad latching/feeding every other day for the first two weeks of breastfeeding. Because the line drawings in books and that movies on the internet (which is still a big step up for my generation) just aren’t good enough – this is the sort of thing, much like yoga, where it’s really quite useful and important to have someone give you feedback from an external viewpoint.

The story so far: I have been concerned that Daphne’s frequent feedings (eat for 30-60 minutes, then eat again 60-90 minutes later; lather, rinse, repeat the whole day long) were a sign of something not being right. Add to that the crease across my nipple, and I was pretty sure *something* was up. Since she’s feeding regularly and gaining weight well (8lb 0.5oz at birth, 7lb 6oz at day 4, 7lb 10oz at day 9, 8lb 7oz at day 25), Jason hasn’t been convinced there’s a problem. Of course, he’s not the one with her mouth chained to his boob. (Seriously, I picture a pierced nipple with a link chain attached to it that ends at a studded bracelet on Daphne’s wrist. S&M for the mom/baby dyad. -Speaking of which, apparently, english is one of the few languages that does not have a unique word for the mother/baby pair as a single item! Who knew!) But I followed up with a rambling, no-actual-question-asked email to my doula, which Jason pointed out was kind of unfair since it didn’t really have a clear question/issue. While true, it was one of those “my brain can’t function but thinks something is wrong” sorts of things. Seems to be a specialty of motherhood.

Following up on her suggestion, though, I went to a La Leche League meeting that was the next available day. It was interesting, and seemed very open ended (“what do you think of when you think of breastfeeding”, “have there been issues with the family about it”, etc.) but then did have some help from the leaders for two of us with feeding issues. The woman who worked with me for a bit tried a number of holds (which I seem to be fairly terrible at – it seems like I have oddly short arms and small hands for the things they want me to do, but maybe I’m just not getting the hang of it yet) but overall seemed to think I had a latch problem related to her not opening her mouth enough. We thought we had worked through this problem earlier, and to some degree, we must have, since my nipples had been able to heal, but there is clearly some variety of issue going on preventing a deep enough latch since there is nipple evidence to show.

After everything we’ve tried, however, we’re on to stage 3 – the pros. After a referral from the midwives, we’ll be seeing an occupational therapist Friday morning. Let me say, I *KNOW* that this issue is not life or death, or even “emergency”, but it feels like waiting three days to fix a latching issue is horrid. I’m hoping that we’ll discover something more useful than “well, she has a small mouth compared to the size of your nipple”, because that problem will take a lot longer to fix, I expect, than many other options.

It’s certainly not comfortable to continue with the latch issue as it is now, but it’s manageable, from my end of things. I am hopeful, however, that fixing this issue will make breastfeeding less uncomfortable, and perhaps help make her more efficient, which would be nice so we don’t always have to spend 30-60 minutes feeding! In the hopes of preventing a supply issue due to bad latch, however, I’m taking fenugreek in the meantime, and continuing to pump once a day so we can have some spare around for supplementing on those nights she seems ravenous.

In other news, but baby related, she’s had a couple days where she’s had a couple smiles (not intentional yet, but she had enough stomach upset that she was doing mostly a lot of less than happy faces). Those make everything a little more bearable, because hours on end with a stink-face baby is tiring, and with a crying baby is exhausting. In an effort to address that digestive upset, however, I’m trying to be more consistent in her supplementation with probiotics (I just came off antibiotics myself) and will be making my own gripe water (fennel, ginger, and chamomile) and probably give her a bit more regular dosing. She definitely seems to NOT like the process of farting, and seems to get fussy a good fifteen minutes before she needs to. Pretty much the same for pooping.

She’s also getting stronger – if I have her in my lap, facing me, leaning forward, she’ll push herself off my chest and sit upright momentarily before falling to either side or backwards into my hands. Her head control is improving right along with it, able to keep her head up for a few seconds at a time, and seemingly able to often stop it from just rolling around. That doesn’t mean she’s really enjoying the non-chest-to-chest tummy time she gets, but she tolerates it for a while. (Which is ironic, because – bad parents that we are – we allow her to sleep on her belly when we’re in the room, and she much prefers sleeping on her belly, but if she’s awake, she wants to be upright!) Fortunately, I picked up a K’tan baby carrier yesterday, which is easier to use than the Moby and lets my hands be free while she’s snuggled against me.

The trip out to pick up the carrier and attend the meeting, however, was slightly more than I had brain space and energy for yesterday. (As you can see by the disjointed nature of this post, brain space and concentration are at a minimum these days.) The driving was taxing, even without significant traffic, and the frustration of trying to feed her without the pillow I usually use for support and dealing with the bad latch AND what was growing gas just made for a draining day. When followed, upon getting home, with two and a half hours of feeding back and forth trying to get a good latch, it was exhausting and emotionally draining, and I just had to have Jason sit with me while I fed her – eventually giving up on trying to improve the latch – because I was overwhelmed with it all by that time. I’m glad he got home soon after I did so he could just be there. And I’m very glad that she slept relatively well last night so that I could recover a bit.

Hmm… perhaps some day soon I can have things in a blog post that aren’t entirely baby. But right now, my life revolves around my boobs and her digestion. What a life!