Tuesday, February 8, 2011

Babies and Boobies, Part Two

Sorry for all the booby talk round these parts, but that's pretty much my whole life right now. I'm just about four weeks into motherhood and I have to admit that everyone was right, breastfeeding does get easier. Sure, my nipple is still cracked and sometimes the latch still hurts, but either I've toughened up or my skin has toughened up. Either way, it's working for us.

One of the benefits of trudging right along is you actually learn things about your body and your babies along the way. Remember when I thought that we had permanently scarred Reese by introducing a bottle too soon? Turns out the bottle (and the bottle nipple) weren't the culprit at all.

I've known since I started nursing the twins that I have a really forceful letdown and a strong milk supply. One of my LC's showed me how to block off some of the milk ducts when nursing to slow the flow so the babies don't choke. But it wasn't until this weekend that I did some research and realized that what I actually have is called an oversupply - you can read more about oversupply here.

Basically my babies were gagging and choking while nursing because the milk was coming too fast. Reese often pulled off the breast, while Ryan would just clamp down to slow the flow (which explains all of the bruising I had around my nipple). I didn't realize what was happening until last week when both babies starting spitting up (a lot) and both became colicky. Turns out my oversupply created a foremilk-hindmilk imbalance - more on that here and here. They were filling up quickly on foremilk and/or getting frustrated by the speed of my letdown, so they stopped nursing early. This meant that they were filling up on the more sugary foremilk rather than the richer (in fat and calories) hindmilk, which created crampy bellies, colic symptoms and babies waking every two hours hungry.

One of the other side effects of oversupply and foremilk-hindmilk imbalance is that some babies refuse to nurse. So poor Miss Reese was refusing to nurse because my boobies were trying to kill her, not because she liked bottles better. How dumb do I feel now?

To help combat my oversupply, I pump for 5 minutes on each side before nursing the twins. This removes some of the sugary foremilk so that when they latch they are starting with a higher calorie milk to begin with and it initiates my first letdown so that the speed of the milk flow is much more controlled when they latch. Then while they are nursing as I letdown again (sometimes I can feel it happening, but mostly I look for cues from the babies) I remove them, burp them and then manually express my breast a few times. This has helped tremendously.

But don't get me wrong it's a giant pain in the ass. So in addition to my oversupply (which I prep for), my cracked nipple (which requires a saline soak and Dr. Jack Newman's APNO after each nursing session), I also ended up with a milk blister which requires a saline soak before nursing, then a hot compress, then more APNO after nursing). My set up before each nursing session takes about 20 minutes and after each nursing session takes another 5-10. God forbid either of the babies wakes up early and catches me off guard - all hell breaks loose until we are nursing and happy again. One of the many reasons I'm trying to get them on a more concrete schedule (more on that another day).

Good times people, good times. The best part is that I'm a full month into my six month nursing goal and it *is* getting easier. Even after writing about all of the issues that we've had, I don't think that pumping or formula feeding is any better or easier. I think each method presents its own issues and challenges. I guess these issues are my newborn cross to bear. Four weeks down, twenty more to go...

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