Archive | July, 2012

More on nursing and economic privilege

11 Jul

My last post sparked some lively discussion, but much of it was on my personal Face.book wall, so I thought I would summarize some of what we discussed. First of all, a few clarifications. As one commenter pointed out, I probably should have given the post a different title — perhaps “what is costs when your baby doesn’t latch.” Because it is absolutely true that breastfeeding is the most affordable way to feed a baby. No question. That’s why it’s so evil when corporations like Ne.stle give out free formula samples in poor countries. Because once your milk supply dries up, it’s gone. And then you are left forever dependent on a product that comes in a can. That being said, I don’t think it’s wrong to bottle-feed a baby. Formula is not poison. I respect parents’ choices when it comes to feeding their children. Full stop.

My intention in spelling out what it cost to get Daphne on the boob was not to imply that breastfeeding is a choice that only rich people can make. It was to be totally transparent about the steps we took and recognize that those decisions were influenced by our economic/class position. There are lots of free resources in the city, and I look forward to exploring them soon. I was fortunate to be able to access in-home help during the most desperate, teary-eyed days. But I know that there are lots of peer-to-peer supports (including La Leche League) that could have provided similar advice.

Also: in pointing out my relief over not having had a c-section, I certainly did not mean to imply that a vaginal birth is the key to a good breastfeeding relationship. I have many friends who successfully latched their babies after a surgical birth. I just cannot imagine what it would have been like to struggle through the last two weeks, if I hadn’t had physical mobility. Kudos to anyone (especially single parents) who manage to heal from major surgery while dealing with a newborn. My hat is off to you. You are truly amazing.

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The economics of breastfeeding

10 Jul

The title of this post may seem counter-intuitive. Because breastfeeding is free compared to buying formula and bottles, right? So it should be the cheapest and easiest option for women to feed their babies. But if anything, my two-week struggle to get our baby on the boob has encouraged me to reflect on how my own economic and class privilege is allowing me to persevere, with many excellent resources at my disposal. According to Statistics Canada, 87.5% of mothers attempted to breastfeed their babies in 2009, if only for a very short time. But the disparities are more apparent when you dig deeper into what the numbers tell us:

  • Women with a postsecondary diploma or degree were more likely to begin breastfeeding their babies than those without a postsecondary diploma or degree (90.4% compared with 81.9%).
  • Of the 12.5% of new mothers who did not attempt to breastfeed, 28.4% cited medical factors (e.g., C–section, premature birth, multiple birth, or medical condition of mother or baby) as the main reason for not breastfeeding.
  • Of those who did begin to breastfeed, 6.9% stopped after less than one week and by one month 21.4% had stopped. However, in terms of those who continued to breastfeed, 53.9% who initiated breastfeeding continued for six months or longer; 15.9% breastfed for more than a year.

This all makes sense to me. Without a rock-solid support network, an involved and attentive co-parenting partner and a significant financial outlay, I don’t know if I would still be working so hard to get Daphne to nurse.

I am passionate about breast feeding, because I have read the research. I know that breast milk is the best possible food for my baby, tailor-made to her physical and neurological development. I am a married middle class Caucasian woman with a  graduate degree, a mortgage and a full-time job with excellent benefits. My employer is topping up my government maternity benefits to 93% of my full salary. I am literally being paid to parent, so I am not terribly concerned if I spend most of the next few weeks teaching my baby this crucial skill.

I also shelled out a significant amount of money over the last two weeks, to help facilitate Daphne’s breast feeding ability. Here’s a list of what we did and what it cost:

  • Two chiropractic appointments: $130 (will be covered by workplace health benefits)
  • Tongue tie laser surgery: $500 (will be covered by workplace dental benefits)
  • Two sessions with a lactation consultant — one in a group setting, one at home: $150 (not covered by insurance)
  • Rental of hospital-grade breast pump: $75, plus $50 worth of bottles and non-reusable parts (not covered by insurance)

Total financial outlay: $905 — so by no means free.

In reality, there are many free breast feeding resources in the city I live in, including daily drop-ins at community health centres in lots of different neighbourhoods. Some of these centres also lend out breast pumps for free. But I only heard of this after the fact, through word-of-mouth. And accessing these free resources means having to leave the house in the very early postpartum days. It also means that you need to have access to a car or be willing to take the bus with a three-day old baby. I would hazard to guess that by the time most new moms are ready to leave the house, the precious window for establishing a solid latch and an adequate milk supply have probably passed.

Also: I can tell you that if Daphne’s birth story had ended in a c-section. I cannot imagine that I would be persevering. I am convinced that I largely avoided a c-section because I was under the care of midwives (there is a shortage in Ontario) and because our amazing doula helped me hold off on getting an epidural for as long as possible.

Thanks to all of the (expensive) professional resources that we accessed in the first two weeks of Daphne’s life, I am now happy to report that she is nursing — finally! We are using a nipple shield for now and it seems to be an excellent tool to transition her off of the bottle. I don’t plant to use it forever, but it seems to be doing the trick to help kick-start her mouth reflex. Two weeks and $900 later, we finally have a baby that sucks.

Our baby does suck!

My doula, my hero

9 Jul

This woman looks radiant after providing 20 straight hours of labour support. Seriously!

I would like to introduce you to our friend Caro and tell you why she has been our super hero over the last two weeks. Caro is a student midwife, our closest friend and acted as our volunteer doula when Daphne was born. Since then, she has been the fiercest advocate for our tiny baby and she deserves some sort of major award. Instead, I will let this post serve as a public record of her sheer awesomeness.

When I first started thinking about how our childbirth experience might play out, it didn’t occur to me that we would want or need a doula. We were receiving excellent care from a team of talented and compassionate midwives. Caitlyn has always been a rock of support and tenderness. I figured that we had a good team in place and wouldn’t want or need any extra people at the birth. When Caro offered to act as our doula, I was thrilled, but also a bit skeptical. As the sole parent to an adorable, active and very attached 8-month old, I figured that she would perhaps be able to provide telephone counsel and drop in for a spell. I never expected that she would be by our side for our entire labour and delivery experience.

Somehow, miraculously, only days before Daphne was born, Caro found an amazing babysitter that her discerning daughter fell head over heels for. And when I went into early labour, Caro counseled us by phone and text, until her sitter arrived in the morning. Then she pretty much spent 20 hours by our side, providing comfort measures and documenting Daphne’s birth. Here is a short and by no-means exhaustive list of all of the amazing things she did for us and for our baby. I am quite sure that most doulas wouldn’t provide all of these services, but many will provide some of them. If you can afford to hire a doula, I would say it’s well worth it (though I understand that this is not an option for many people).

  • She supervised and provided hands-on comfort measures, taking over for Caitlyn, who had been up all night with me. This allowed my wife to get a couple of hours of sleep and be in better shape for the marathon of labour.
  • She timed contractions and called the midwife when things really picked up.
  • She coached me through the most painful contractions and helped me make the decision about when to head to the hospital. If it wasn’t for her, I am fairly sure I would have ended up there much sooner.
  • She gave me sips of apple juice and helped coach me through the pushing stage (which lasted almost three hours!)
  • She took photos and videos of Daphne’s delivery.
  • She and a friend went to our house the morning we were getting out of the hospital and washed our sheets, made our bed and set up the portable crib in our bedroom.
  • When Daphne was becoming lethargic and at risk of jaundice on day #3, she arrived at 10 pm with bags of frozen breast milk, a pump, and her own daughter. She put her baby to bed in our guest room and stayed up all night with us, as we bottle-fed her back to health. She also put Daphne to her own breast, to help test her suck reflex.
  • She arranged for a chiropractor to do a home visit on her day off, to provide some cranial sacral therapy. She also convinced the one dentist in town who does laser surgery for tongue ties to stay late on his last day before his vacation, so Daphne could have the procedure done without delay.
  • She helped us connect with lactation consultants and other community resources.
  • She calls daily to check in and serves as our number one cheerleader.

Conclusion? Doulas are amazing, but ours is a super hero. Daphne is so lucky to have her Auntie Caro in her corner and so are we.

My baby doesn’t suck

4 Jul

I alluded to some of the challenges that Daphne and I are experiencing with nursing in my last post. I’m not going to lie, it’s been a rough go of it so far. Here’s the full story on my baby’s continuing strike against the boob.

After Daphne was born, she was immediately whisked away to be suctioned and only placed on my chest a few minutes later. We didn’t really establish an initial latch in the hospital, but I wasn’t terribly worried. I knew it would take a while for my colostrum to come in and that babies don’t need to eat for the first 24 hours of their lives (they are still full of the nutrients and fluids they received on the inside). But 48 hours after she was born, she was still uninterested in breastfeeding, and she started to get a bit too lethargic for my taste. I tried to perk her up by stripping her naked and placing a cold, wet towel against her skin. She barely stirred. I felt a mild sense of panic.

I called our midwife, and she insisted that I feed Daphne some formula, as she was at a birth and couldn’t come over immediately to help out, Luckily, our heroic and amazing doula was able to come over in a flash, arriving with a breast pump, bottles and bags of her own frozen breast milk. She also brought her eight-month old daughter, put her to bed in our guest room, and spent the night getting up every two hours with us, to bottle feed Daphne and encourage her to get on my breast. Caro even nursed our daughter herself and noticed right away that her suck reflex seemed weak.

Being a super hero, our doula managed to arrange an appointment with a chiropractor who came to our house the next day. She did some gentle cranial sacral work on Daphne and also checked out her palette and her sucking reflex. She agreed with our assertion that something wasn’t quite right.

I kept bottle feeding donor milk to the baby, pumping my own milk (which fully came in on day 4), and took Daphne to a lactation clinic at a local centre. Two lactation consultations took one look at her mouth and identified that she had a posterior tongue tie. Our midwife noticed the same thing when she visited the next day. Our doula was present for that appointment and immediately got on the phone to the one dentist in town who does laser surgery to correct tongue and lip ties. He agreed to stay late and see us at 7 pm the day before his vacation. So before I knew it, we were packing up the car and driving Daphne to the suburbs to get this thing checked out.

The dentist diagnosed her as having a “severe” tongue tie and recommended that we have it clipped. We made a gut-wrenching but very quick decision to allow him to do the laser surgery. It took only a moment and the Moms cried way more than Daphne did (she let out a short squawk and that was about it). He gave us a series of exercises to do with her mouth to help ensure that the tongue tie doesn’t grow back. And we returned home in a daze, hoping we had done the right thing.

A week after having the procedure done, Daphne’s suck reflex seems to be improving, but she hasn’t properly latched on to my breast yet. Which means each feeding session is rather exhausting. First, she roots for my breast, chomps down a couple of times, lets go, and then wails in frustration. I let her do this until she gets too upset, then I bottle feed her my pumped breast milk. Then I need to balance her on my chest (or hand her off to her other Mom), while I pump enough for the next feeding. It’s enormously sad and frustrating to have to feed her a bottle, when my milk is literally running down my chest as I do so.

The question of whether or not to give a baby a bottle is a controversial one in the breastfeeding community. I know that she is doubly frustrated, because the milk clearly doesn’t come out of my breast as fast as it does from a bottle. But I am confident that we made the right decision on day 2 of her life. She immediately rebounded and became bright-eyed again. We avoided dehydration or jaundice and she was nearly back at her birth weight after a week.

My first priority is to feed her and make sure she is getting the nutrients she needs. The second is to get Daphne on the boob. The extra step of pumping and washing bottles makes each feeding a major challenge. And I am basically housebound until we figure this out. Breastfeeding is portable. The hospital-grade double electric pump is not.

Since posting about some of these challenges on Face.book, I have received dozens of messages from other parents who faced similar challenges. Some took weeks to establish a functional breastfeeding relationship with their babies. I am trying to be zen about the whole thing and remember that Daphne is only 9 days old. She is also learning to use her mouth in a whole different way. I can tell that she is getting frustrated too and I feel like a breakthrough is just around the corner. Until then, I have a baby that doesn’t suck.

We are both tired, but coping okay.

Daphne’s birth story

2 Jul

Meeting our daughter Daphne for the first time

Our daughter Daphne was born at 12:08 on June 25th, making all of our dreams come true. For those interested in the nitty gritty of childbirth, here’s a short account of her birth story.

I started having mild contractions last Saturday night. By 10:00 pm, they were painful enough that I knew the real deal was about to begin. I took my midwife’s advice to take a combination of Gr.avol and Ty.lenol to try and take the edge off and sleep. No such luck. Every time I laid down to rest, another contraction began. They were sporadically spaced out, but painful enough that I needed to change position and get Caitlyn to press on pressure points and push on my lower back. I was up all night. We called the midwife at 4 am and she suggested more Gr.avol in another attempt to rest. Cait ran out to a 24 hour pharmacy, because it turns out that the stuff I had taken earlier had expired in 2009.

Once again, the drugs had no effect. By 7 am, we called the midwife to come to our house, as well as Caro, our amazing doula/student midwife (more on her heroism in my next post). She sent Caitlyn to sleep for a couple of hours and quickly took over administering comfort measures. She encouraged me to moan, bounce on a yoga ball, and shift position periodically. When our midwife Sarah arrived, contractions were roughly five minutes apart, but I I still had a sense of humour and could maintain a conversation in between. After listening to the baby’s heartbeat a couple of times and observing me for a couple of hours, she told me that I was on the cusp of active labour and had quite a while to go. She left to do a post-natal visit with another client and told Caro to call her when things picked up.

And boy did things pick up. By the time the midwife returned at 11am, I was in the bathtub, moaning incomprehensibly. My contractions were closer together and I started to feel pressure on my bottom. The midwife measured me in the bath and she told me I was at eight centimetres — when she had checked me three hours before, I had only been at three. It was time to make a critical decision — to go to the hospital as planned, or stay put and give birth at home. At that point, I couldn’t imagine moving, so we decided to stay at home. Caro and Sarah snapped into gear, setting up our bedroom with various delivery items, towels, and bed pads. It all swirled around me as I moaned through contractions.

But after a while, I got out of the bath and something changed. The contractions were suddenly sharp and much more painful, mainly focused in my back. Our theory now is that the baby flipped posterior at that point, so the excruciating pain I experienced was due to back labour. We made the decision to have the midwife break my waters (which was agonizing). She also did another examination … and announced that I was only at seven centimetres — her bath-time examination was somewhat inaccurate. At that point (about 3:00 pm), I decided to invoke the safe word and request an epidural. I had reached the limit of my pain threshold, and the knowledge that transition was far away was enough to convince me that I needed a break.

So in a split second, Caitlyn threw last-minute items in the hospital bag, I waddled out the door (mid contraction) and we made it to the hospital in eight minutes flat (with the doula driving, thank goodness). And then we waited over an hour for the anesthesiologist to administer the epidural. I kept praying, “please let this be the last contraction that I have to feel.” I was not so lucky. But once the needle was in my back, I finally relaxed and slept for a couple of hours. The midwife administered a drug to augment my labour and open my cervix. Caitlyn went out to pick up Chinese food for our birth team. I sipped ginger ale and rested.

By 9:00 pm, the midwife declared that I was fully dilated and I started pushing around 9:45 pm. After a much-needed break, I suddenly got so excited. I was going to meet our baby! But the pushing was physically taxing and started to take a long time. Our midwife became concerned that the baby’s heart rate was fluctuating, so she brought in two OBs for a consult. They told me that we needed to get her out soon, but that they much preferred that she be delivered vaginally. I was so relieved. We agreed to a brief transfer of care to the OBs, so they could administer forceps or suction if necessary. But everyone agreed to allow me to push for as long as possible, as I was making good progress getting her to descend into my pelvis.

The next hour was a blur of breathing, pushing and taking sips of apple juice. The midwives and a labour and delivery nurse got me to change positions and talked me through each contraction. As the clock struck midnight , I was starting to lose stamina. The OBs came in and told me that it was time to meet my baby. One Herculean push and a little help from a vacuum brought our daughter into the world.

Our sweet baby Daphne was born at 12:08 am on Monday morning. I started sobbing hysterically, asking “is she okay?” Caitlyn got to cut the cord, but the doctors whisked the baby away to be suctioned. I was disappointed that they didn’t put her on my chest right away. But Caitlyn and our doula followed her and kept calling out to tell me how beautiful she was. “A full head of red hair … she’s cute, we swear …” A few minutes later, they brought her over to me. She was wide-eyed and alert, staring right into my eyes. And our whole world changed in an instant.

The first week has been a challenging one. I’ll write more about it soon, but we have been having some significant problems establishing nursing. Still, Daphne is thriving on my pumped milk and is almost back to her birth weight, a week later. We are learning to function on little sleep as we pinch ourselves and stare at the beautiful creature we created — from scratch! Life is pretty sweet right now.

Hello bright eyes! We’ve been waiting for you.