Tuesday, August 31, 2010

BF Post Part II

First of all, thanks to everyone who chimed in with some comments and helpful advice on my last post about separation anxiety. To clarify, I am completely attached at the hip with my two girls but it is really hard for me to hear them cry when I so much as leave the room. They cry if I'm in a store with them and I've been behind the stroller too long and they can't see me. I love that they love me so much but I wish they weren't so afraid of...well, afraid of the world it seems. In any event, I'm hoping this is a phase they're going through and that they'll grow out of it.

Back to the topic of the hour...

Part II of my post about BF. These are observations that I didn't necessarily read about in a book that I thought would have been useful to know. These are just my ramblings and random thoughts about BF and I know everyone is different so take what I say with a grain of salt. I'm no expert and I'm not pretending to be some lactation guru or anything like that. This is just me, my experience, my thoughts.

In no particular order, here goes...
  • Did you know that you can have lots and lots of milk and a very good supply, but it is actually the removal of that milk from the breast that will help to maintain that good supply? If you are no good at milk delivery, you will then be no good at milk production either. There is a protein in breastmilk called the "feedback inhibitor of lactation (FIL)" that builds up in the milk that is left in your breast. The more milk that is left in your breast, the greater the FIL. This then signals your body to stop making so much milk. I used to think that if you had lots of milk and didn't pump it out, it would remain there in your breast for the next feed, not realizing that leaving it in my breast over and over again was negatively affecting my supply!

  • my milk supply varies depending on the time of day. I don't have the same amount of milk all day long. I knew that the hormone that makes milk is manufactured by your body overnight so your milk levels tend to be highest overnight and in the morning, but I would have thought that your body would do a better job of portioning out that hormone throughout the day based on demand. In my experience, I found that my supply was really low around dinnertime which was very frustrating for both the kids and myself because they wouldn't nurse and nurse and nurse and not be full only to be put to bed and then wake up pretty quickly because they were still hungry. To combat this, we've been giving them bottles of EBM for the last feed of the night before bed instead of nursing so we ensure that they get a full feed. The girls are also much faster at taking a bottle than they are BFing so it makes the bedtime routine more predictable and shorter in duration.
  • you have to be really careful about the whole supply=demand thing. I do have enough to feed both my girls without any formula but I don't necessarily have the milk when I need it (see the point above). This is another reason why I pump - to keep up my supply and to ensure I have enough at other points of day when my supply is low.

  • the thing I struggle with the most right now is getting a letdown of the milk. I can feel that I still have milk in my breasts but I can't seem to have a let down. I try to put on a warm compress right before nursing and that seems to help

  • did you know that you have more than one let down in a nursing session? Apparently you'll have about 2.5 letdowns in one session and I have to make sure that the girls are patient enough to nurse through the first letdown and get to the second letdown. Sometimes, if I'm having trouble getting a letdown, I'll take the first one off the breast, nurse the second one on the other breast and then return the first one back to the original breast she was on. The little break seems to help me get the second letdown so the girls get all the milk that's in my breast.

  • breast milk tastes different depending on when it was produced and whether it's fresh vs. frozen. My girls can tell when there is frozen breast milk added into their fresh EBM and Caitlyn has refused to drink it because the taste is so different to her. She'll take a sip from the bottle and then spit the nipple out and do that over and over again. The very first time she had frozen milk, she made such a face and then blew a raspberry at her father who had the misfortune of feeding her at the time! Needless to say, Daddy got a very clear message about what Caitlyn thought of the frozen milk in addition to being sprayed! Picky picky!

  • my bra cup size jumped from a "C" to a "DD" (or an "E" depending on which naming convention you're following according to my friend L!) and I think that's the normal increase - 2 cup sizes. Never would have believed it until it happened to me but yes, it's true. I think my boobs are going to sag afterward too when they shrink back to their original size. For the time being, I'm enjoying being so busty cause it ain't going to last!

  • if you're going to pump on a long-term basis, it is so worth the $20 to buy a hands-free bra for the pumping unit. It really frees up your hands to do something else while pumping. When I think about the early days when I was so tired and just sitting there, comatose, and holding onto the horns with my hands and falling asleep and losing some precious milk because the horns weren't on just so...totally worth the money I spent to get the bra so I could stop holding the pump up.

  • they say that there are signs that indicate whether your child is BF properly. They include a wiggle in the ear, a pause in the chin dropping down and audible swallowing. As far as my two kids are concerned, I only started hearing swallowing about 3 months ago (they're now 6 months old) and I still have a hard time hearing Victoria swallow. Neither of my girls' ears wiggle when they swallow but I do see the pausing in the chin dropping down when they are BF really well. They say the pause is on account of their mouths filling up with milk which I believe because after these long pauses, that is when I hear the audible swallowing.
That's all that comes to mind for now. Anyone have any questions or want to know something specific that I don't talk about already? Ask away...

Monday, August 23, 2010

Separation Anxiety

I think Caitlyn is having separation anxiety. Yesterday, while shopping at Costco, my DH was pushing the stroller and he wandered off away from me. Caitlyn could not see me and she started getting more and more upset and anxious. Then the crying started, so loud I could hear it from where I was standing in line. By the time I finally got checked out and back over to them, she was very, very upset. She was so upset that by the time we got to the car and I had loaded her in, she wanted nothing to do with not having Mama around and she just started screaming, so much so that I thought she was hurt in some way. I know what complaining crying sounds like and this was not it - this was full blown, full body screaming and she was UPSET. I had to take her out of her car seat to console her and there were still catches in her breathing for at least a half hour after.

Anyone have any good suggestions on how to deal with separation anxiety and is there anything you can do to help it to pass? I can't even take her out to the grocery store now without her getting upset...

Friday, August 20, 2010

A Post About My Experience Breastfeeding

Sue from A Good Egg asked me whether or not I am exclusively breastfeeding my twins. The short answer is yes. For those of you who are interested in the details and my experience with BF, read on...

I decided to write this post in response to Sue's question to me and also, I was reading through Jill's experience here and thought that it was a great idea to share all the gory details in the event that another new Mom trying to BF would benefit from my experience. I've split this topic into two posts - the first one being how I got to this point from the time the kids were born to now. The second post (to come) is about what I've observed along the way and my own personal experience.

Onto how I got to where I am today...

BF is not easy, at least it hasn't been easy for me. I have gotten where I have gotten out of sheer determination, bullheaded stubbornness, persistence, dedication and a very hot and heavy relationship with my Madela Pump 'n Style. I think that my breasts have a mind of their own and the key to breastfeeding is to think like a breast. I used to think that you could just stick the baby on your breast and everyone would magically know what to do. Wow was I wrong. I knew nothing about latching on, milk flow, let downs, milk ejection reflexes, oxytocin, blocked ducts...there turns out to be a lot to learn!

Since my babes were born 6 weeks early, they were in the NICU and Level II nursery for almost 3 weeks after they were born. My milk supply was slow to come in because I lost about 3L of blood at the delivery and I needed to physically recover first. I had next to no colostrum and my milk came in after about 10 days. I was able to start my supply by using a hospital grade breast pump and I was pumping about 8 times per day to simulate when and how many times the kids would have been BF. It was very discouraging at first as there would be so little in the bottle after each pumping session and sometimes, nothing at all so I started tracking the amount pumped per day on the recommendation of a lactation consultant. Slowly, ever so slowly, I saw the daily total rise which was encouraging and what I needed to see to continue. The chart was very simple - time pumped and how much I got with a column for every day of the week with a total at the bottom.

In the hospital, the girl both had feeding tubes down their noses through which they were fed formula and any few drops of colostrum that I was able to produce. The hospital was really good about not pushing formula but after three days of pumping 8 time a day with next to no colostrum coming out, we decided that we would give the girls formula. They had lost about 10% of their birth weight at that point which is normal but seeing as they were being fed next to nothing, I didn't see that sliding trend reversing anytime soon. I think the most colostrum I ever got was one half mL. We had to collect it using a syringe and I cringed as I had to split it in half so each of my girls only got 1/4 of a mL. Their stomachs at that point were only the size of marbles but still, 1/4 mL doesn't fill a marble.

For those of you who are struggling, I hope that this gives you hope - we started off on 100% formula with the girls being tube/bottle fed and over the course of the next 2 months, were able to progress to the point where they girls were transitioned completely off of formula and put onto 100% breast milk. Please don't get me wrong - I am not anti-formula. It saved my girls' lives as I did not have any milk to give them. Heck, *I* was formula fed as the wisdom at the time I was an infant said formula was better than breast milk. It is just my personal preference to feed my girls EBM (expressed breast milk).

When the feeding tubes were removed, the girls started BFing and bottle feeding all at the same time. When I was at the hospital for a feed, I would let them latch on and nurse as best they could and then I would give them a top up of EBM in a bottle. They would get so tired so easily being preemies and by topping them up with a bottle after each feed, they were getting more milk and therefore more calories for less effort. I am still continuing this practice even today. I BF them first and then offer them a top up bottle at every feed. This has more to do with my supply now but I am still topping them up.

We discovered soon after bringing them home that Caitlyn was tongue tied and needed to have her frenulum clipped. It was a simple in office procedure at the doctor's and apparently it is quite painless for them. What has to happen is that they had to keep Caitlyn's mouth open while them clamped the part of the frenulum they wanted to clip so that all of the blood was squeezed out. They had to keep the clamp on for a minute or two (which sound like an eternity to me as I chose to wait in the reception area while DH stayed with her and she screamed through the whole thing). The actual snip it self - a split second and then it was all over. No blood, no bleeding after and she wanted to nurse right away. There was no freezing or anesthetic needed and she was in an out the same day.

What breastfeeding looks like for me now on a typical day:
  • 6:30am wake up. Offer bottles of 30mL first with Tri-Vi-Sol vitamins added. Then nurse both individually for about 10-15 minutes each.
  • 10:00am wake up from nap and nurse both again for about the same amount of time offering top up bottles of 30mL again after nursing each one
  • 12:30pm nurse both and offer top up bottles of 50mL after. Both girls then go down for a nap which is their major nap of the day which lasts about 2 hours.
  • 3:00pm wake from nap and nurse again for about 10 minutes each. Offer top up bottles of 30mL after nursing
  • 5:30pm final bottle of 110mL and no nursing. Girls go down to bed at around 6pm for the night. I pump after they go down for about 20 minutes instead of nursing them. I usually get about 50mL from each breast.
  • 9:30pm pump for 20 minutes and get anywhere from 75mL to 100mL from each breast
  • 2:30am pump for 20 minutes and get about 150mL from each breast. Girls are usually awake and are fed and changed. Bottles of 110mL are given rather than nursing so that feed can be started and completed in 30 minutes and DH can help me.
Next post - things I have learned along the way and observations I've had about BF that I didn't read about in any books. Also, I wanted to open up the floor to answer any questions anyone else had about BF twins or just BF in general.

Monday, August 16, 2010

Frustrating Night

Victoria would not go back to sleep for the longest time tonight.

She began to fuss at 10:30pm, just as I was about to go to bed. I changed her diaper, I rocked her right to sleep only to have her wake up again 15 minutes later for no apparent reason. This pattern continued - she would fuss and then get quiet for a few minutes, fuss again for a few minutes off and on. Nothing I did stopped the fussing for more than 15 minutes at a time. I fed her not once but twice and then rocked her again. I changed her PJs because she was sucking on her top so much that it was soaked. I rocked her again. I held her. I put her down, patted her back, rubbed her back and begged her to go to sleep.

Now it's 2am and she has finally fallen back asleep. I still don't know why she was fussing and crying off and on for so long. I guess it's just one of those mysteries I will never understand. Maybe she was suffering some teething pain? No pearly whites to show for all that fussing. I don't know. Just frustrated.

Blessedly, Caitlyn slept through all of this. There are some small mercies.

Wednesday, August 11, 2010

Don't They Look Like Us?

A fun post!

When we saw our kids, we knew they were ours. There was always a little remote fear in the back of my head that they weren't really ours and that someone else's egg and sperm were mistakenly mixed and labeled with our names at the lab. How else could you explain success after 7 years of IF? However, there are so many similarities that there is just no doubt. We're also very lucky in that Victoria looks exactly like my DH when he was a kid and Caitlyn looks exactly like I did when I was a kid. You be the judge. I couldn't figure out how to post the pictures side by side so I had to settle for one right after the other...





The resemblance is striking right? Caitlyn also has an ear tag and I had an ear tag as a child and I had completely forgotten that I even had one until my DH told me Caitlyn had one.

The resemblance gets even stronger with Victoria and my DH. See?






Are they our kids or what?!

Wednesday, August 4, 2010

First Road Trip

It's a long weekend here and we braved up and took a road trip to visit my sister in Ottawa. That's a 4-5 hour drive from Toronto depending on how much traffic you hit and it was only after much discussion that we decided to take the plunge and just go for it. Yes, the kids would probably be off their routine but sometimes, changes to the routine are good. I want to continue to expose them to new environments, new people and new things so they aren't afraid of their own shadow and what better way than a little road trip?

I also figured that Ottawa was a very safe place for us to go...we were going to stay with my sister so she has one of everything already so we didn't have to bring up both of our things. Besides, there are a lot of helping hands in Ottawa so it's not as if we would be completely on our own either.

The plan was to leave at bedtime so the girls would fall asleep in the car and then sleep all the way up. We left at 6pm right on the dot which I thought was a pretty good accomplishment given that being on time with two small kids is a challenging feat these days. The girls fussed and cried for a few minutes but then fell asleep for a little while. This being Toronto though and the traffic to get out of the city being what it is on a Friday night of a long weekend, we hit stop-and-go congestion on the way out of the city. They woke up. They fussed and cried for about a half hour and then finally fell asleep shortly after 7pm. After that, they stayed asleep which was a relief as two crying kids in a small enclosed space...well, not fun by any stretch of the imagination.

We arrived in Ottawa at around 10:30pm and we even managed to get everything set up in our room and transfer the kids out of their car seats into their play pens without waking them up!! That was awesome as I was planning on feeding them and then trying to put them down after that if they woke up while being transferred. Not necessary - amazing! The kids were great and I was beginning to think that this wasn't such a bad idea to get away for a weekend.

Sure, it was a little inconvenient as I had to pump twice in the car on the way up but it was worth the effort to get there. I started feeling cocky and wondering if I could take the kids up to Ottawa myself without my DH when he travels later this fall. If traveling with the kids was that easy, a road trip by myself would be a piece of cake!

The weekend was a lot of fun with more social time with adults than I've had in a loooong time. We went out for brunch both days (I know! Two days in a row!!), enjoyed a BBQ dinner on Saturday at my sister's house, the weather was awesome...for a first road trip, this was fantastic. We couldn't have asked for a better weekend and we really enjoyed ourselves.

Then, the ride home.

Not so fantastic.

Let's say that I am not so cocky anymore and I won't be attempting a solo road trip anymore. We started out a half hour late and it doesn't sound like much, but we missed getting Victoria to bed on time and that resulted in an overtired child that fussed and cried the entire trip back.

The. Entire. Trip. Back.

The poor thing. I think part of the problem was that she was overtired and so then had trouble falling asleep. To compound the issue, she is a stomach sleeper and she realized that she wasn't sleeping on her stomach in her car seat like she wanted to which added to her general state of being upset. So, the result was one very upset child that fussed and cried off an on for the whole trip. Plus, when we got back into Toronto, the highway lights really bothered them and both girls woke up even though I had draped their car seats with blankets to stop the lights from shining directly into their eyes.

I was exhausted when we got home from listening to all the crying. As both girls were wide awake, we decided to feed them and then put them to bed again. They happily ate their extra meal but then very unhappily went to bed, loudly complaining (read: screaming) for a half hour before finally settling down to sleep. I also realized that if I attempted to make this return trip by myself, I would have had to get the two kids into the house and fed when I got home late at night plus then I would have to unpack the car by myself, all after driving for 4 hours straight. No can do - I'm not that energetic unfortunately.

A great weekend until the trip back home. We don't regret going but we are certainly noticing the impact this has had on the girls. Victoria is still a little out of sorts with her napping and sleeping still not back to normal yet but we are working our way through that and it is getting better. I'm glad they were exposed to so many new things and with all things, it's a trade off. We're juggling as best we can and figuring things out along the way but this was one trade off that I think was worth a few days/nights of bad sleeping.

Yay road trip!