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K in 2009

She is two weeks old, and I can't believe she's not a month or more. The last couple weeks have been crazy with a Norwalk type illness in the older boys, and being postpartum, having tension headaches, and travelling to visit Grandparents.

We already have way too much milk, not as bad on the left side, but overwhelming on the right side. Even three or four "times" on each side I still choke her on that side. We've fallen into a routine of mostly a "quarter" day on each side.

I had chest pain last night I think the left side was so full that the weight and the fluid brought up my costochondriatis. I still choked her lying down on the left side, and I sometimes am able to hold her up on my arm, but if I have to support the breast with the right hand it hurts from the hand being so numb (even typing this is really hard and I want my hand to get back!)

She weighs over 10lbs, mom and I weighed her on the shipping scale and it said 10lb6oz. She's gaining 4oz a day! But there's no green poo or anything, and she's burping well. She's also gaining length and fitting into new outfits already so I don't think it's too much. She's very good at coming on and off and dealing with the milk, like a much older babe.

I'm thinking about using soy lechithin this time (and trying to be better about my efa intake as well). See what that does to the milk. Two weeks and we're already trying to slow things this much. I could nurse triplets I'm sure. I just with the headaches, arm pain and chest pain weren't all happening at the same time.

Nightime Latch

I think that the night is going nicely until about 3 am, then she wakes up and nurses almost continuously, nurse, sleep 15 min, scrunk, then nurse, then wake, then nurse, then sleep, then wake up srunking again. Grrrr. By about 5 or 6 I was in tears cause I hadn't slept through any of that. My right arm goes completely numb, and my left goes partly numb after sleeping on it. Even when I get to roll over I just hurt so much I'm not sleeping well.

At 7 or 8 I'd done this up down routine so much that I couldn't even latch her, my arm was too numb to support the breast, there was too much milk (even overnight) and I was too tired to focus on getting her on.

I think I went back and forth too much last night cause the letdowns were strong all night. They're still coming on after about only 10-20 seconds I think. Certainly not a long time. And she's already gulping before the letdown so she gets mad at the letdown, and then after that there's tons. The left side has a slightly lower supply so it's not as bad. But I need to slow the right so that it doesn't get so full overnight.

Right now she's sleeping in the evening, which is not the best as it seems that if she's awake in the evening she sleeps longer into the night. I'd rather have the nurse, nap, wake, annoyed in the evening and cluster nurse, than overnight. I have to move the cluster feed somehow, I don't love it at 3 am.

When space aliens don't visit at night

... the world is completely different. When she doesn't nurse over and over in the middle of night, but then still wakes up and just does NOT go to sleep... the next day just goes so much better. I can think through the morning nurse and get her fed on the first full-from-the-night breast much more calmly, I can think through when to switch to the other side. I can not crash at the same time as she starts to scream (and was it less than last night? maybe?), I can cluster nurse all night, and then guess what ... SHE SLEEPS again better the NEXT NIGHT!

The better it gets, the better it gets. I'm amazed how much the day before affects the next day. I always think of this journey as what affect the morning or day before has on the nightly colic-y behaviour etc but I'm always learning new things that factor into just what makes it better or worse.

Unilateral Ad Hoc

The first thing that people talk about when you have overabundant milk, is block feeding, or foremilk/hindmilk imbalance, and it feels like it's some countable, quantifiable *thing* that's broken that can be fixed with just the right number of hours of nursing, or not drinking the "bad" early milk or all kinds of things that confuse and "box" the mother into what's wrong with her or what prescription will fix her problem instantly, and if it doesn't she's not doing it "right". So what do I do about needing to nurse many times in a day, but staying more times on one side? Do I "block" it up into 3, 4, 5 hour chunks? When do I switch sides? How do I know what to do when?

I prefer the more, no pun intended, fluid term for what is needed to cope with switching sides - unilateral ad hoc. It sounds like a technical term, but it really just means "one sided, as needed". It puts the control back in the mothers hands. Yes, it means that I have to figure it out. But it also gives me permission to say I'm the best person to figure out what's right. But where do I start?

In a breast with "average" milk flow, over the course of one feed the baby gets a small amount of early milk that immediately available , and then the milk speeds up with the letdown in a few 10's of seconds and quenches the baby's thirst, then that subsides and slower, higher fat milk is drawn down from the breast to fill the baby up and "fatten" them up. In a breast with higher flow there is so much early milk, and so much milk is ejected at that letdown that the baby never gets to that later higher fat milk.

Nursing on the same side again allows the baby to "finish" that later milk (though sometimes with a bit of another letdown of milk as well, though that often decreases as the days go on and things improve, and the second letdown on the same side is usually calmer anyway).

But milk flow slows down in the evening, so it might take less time to use the first breast. And my milk is often hugely full in the morning so I would like to stay on that first side for a long time, but then the side that didn't get used much overnight AND all morning feels like exploding. So I have to play with it. Right now I nurse one side in the morning to get it a bit more comfortable and then I switch sides and nurse on that side for a few times, maybe for the rest of the morning-ish (I never look at a clock, just listen to the fullness of the other side and what it's telling me). And then I switch to the "afternoon" breast and try to stay on it til the non-nursing breast is starting to feel just on the edge of uncomfortably full again (yes you want it to be a bit uncomfortable, that fullness is what tells the non-nursing breast to slow the flow, cause the milk is just not needed as fast as it's making it).

Then in the evening I stay maybe a second nurse on the same side, but often she wants to nurse enough that sometimes I even switch back to get her to cluster nurse more in the evening. Sometimes I don't because it just didn't feel like it was going well and she needs some slower milk still, and sometimes it really seems like she needs a bit more milk to get to sleep, and if I get too full on the one side, I'll wake up in the morning ready to explode again, and when we have bad morning nurses that's the day she grumpiest in the evening cause of all the gas from that bad morning nurse.

So it's a constant play by play. And teasing out the right thing to do. And she's still so young and we'll see what we have to do with her, but I know that if I start to think about it now that I'll be better at finding her pattern sooner.

Back home alone

We're back at home after visiting my parents, and sitting on their couch and nursing for a week. Now we're on our "own". It's been a busy week of appointments and getting laundry done and dealing with life (and brutal cold here which isn't usual).

My back and my hand have been very sore and that's lead to not as much babywearing as I'd hoped. She's also 12lbs now! Babies coping with OAM often gain fast and lots! But it means that they sometimes don't get what they need -- lots of time on mommy's chest so they can nurse often on the one side. Unilateral nursing sets you up for mastitis because you're purposefully not draining the breast, I've had it almost every time I've been really stressed, so nursing has to be often and comfortable for baby. And as K gets more irritated by the flow she needs to be comforted more, and it's so easy to just hand her off rather than keeping her on my chest. I did this more with my first, because it was frustrating that he was so sad all the time. But what he needed was to stay at the breast and nurse more often. This is especially important later when they get "colic" at a few months old and spend time with a hurting gut. They need to know that mommy is with them and stay comforted at the breast.

This week has been all about figuring out the "flow" of my day switching back and forth. If we nurse all evening on one side so she gets a good long cluster nurse, then I have to think about whether I should switch the "last" nurse of the day, and potential get her annoyed and not fall asleep, or do it earlier and not nurse as long in the evening on one side and have more milk supply over night. It's work, and when she sleeps extra long in the car, sometimes both breast get "too full" and then I have to figure out where and when to nurse next.

Luckily my left is lower supply, so it seems to drain faster even from "full". So I keep that in mind when switching at night, if I switch on to it, it's likely to be easier for her to handle. The right is still the real issue, but we're going longer on each side to see if it will settle and it hasn't become truly engorged for a few nights. When it gets bad, the breast is so heavy and full that I actually get a sore chest wall -- but I am a 38G! So there's a lot of breast tissue to get engorged. Though don't think that you need large breasts to have oversupply or overactive flow, I've seen it in women of every size!