Breastfeeding Take Two

Given my issues with breastfeeding Phoebe and Sophia, I was a bit apprehensive about what was going to happen with my next baby.  I went in for my repeat caesarean knowing I wanted to do two things:

1. Have skin to skin contact with baby ASAP

2. Breastfeed baby ASAP

I also went in prepared to get absolutely no sleep for at least 3 nights and put her on the breast every time she cried to help bring my milk in quickly.

 

Baby Georgia was put on my chest for skin to skin contact immediately after she’d been checked over by the paediatrician and weighed.  Looking back at the photos I can calculate that it took 3-4 minutes to put her on my chest so I am very happy with that.  She stayed there for 16 minutes while I was sewn up.  Then Simon (hubby) took her outside to the recovery area and cuddled her for me. 

I was taken to the recovery area and she was put back on my chest about 10 minutes later (30 minutes post birth).  She was very alert and looking for a feed so I started to try to feed her while the recovery nurse was doing my observations.  The nurse told me to wait until she was finished and wait for a midwife to help me.  However, I just ignored her and as soon as she left me for a second  I juggled Georgia onto the breast.  I say juggled because it was a bit tricky with the blood pressure cuff and oximeter still attached to me.  Oh, and she was flapping her arms about, fussing and crying as they do!  I did the “mother led” attachment technique I was taught in special care 3 years ago. 

Georgia had an excellent attachment (something I only know from experience) for her first breastfeed and she stayed attached until I took her off 25 minutes later!  I then put her on the other side and she fell asleep 30 minutes after that.  I had read somewhere that babies were most alert in the first hour of birth and I was concerned that if she spent all her time on one side that the other side wouldn’t get a look in for a long time.  This is why I made her switch sides.  Well, I was wrong because she only slept for 30 minutes and woke up again to feed.   She then fed for 10 minutes, slept for 10 minutes, fed for 10 minutes, slept for 10minutes, etc. for about an hour and then had a decent hour of sleep while we had our first visitors.  Then she started to alternate 20 minutes of feeding and 20 minutes of sleeping (roughly) from 3pm-1am.  Then she finally “crashed” and had a solid 2 hours of sleep 1am-3am. 

It was bittersweet that Georgia was such a great feeder and fed better than either of my twins did in the 2 months I struggled to breastfeed them.  Here is this baby barely an hour old who is able to do something my other children never achieved.

Day 2 she started to spend about 90 minutes doing the feed/sleep/feed/sleep alternation but then have a nice hour of sleep before repeating the pattern again. 

Days 3-5 my milk had started to come in and she was staying longer on the breast before falling asleep.  We started to progress to a little routine:

1.       Feed on one side (about 20minutes) until she fell asleep

2.       Nappy change

3.       Feed on other side (about 20 minutes) until she fell asleep

4.       Sleep for 1-1.5 hours then repeat

She would still have a couple of hours at some point in the day when she would cry quite a bit and keep alternating from sleeping to wanting to be fed but then she would have 2 hours of sleep following this fussy period which was nice.

Day 6 I started to become engorged.  I woke in the night to feed and had a terrible time trying to attach her and I had no idea what to do because I had never been engorged while feeding Phoebe and Sophia.  My nipples were already sore at this point but she really hurt them badly while trying to feed that night.  I had gone from sore and slightly cracked nipples to severely cracked and bleeding nipples in one night!  This was partly due to actually trying to get on and partly due to her pulling off when no milk was flowing and then pulling off again once it did come and she couldn’t cope with the volume of milk! 

It was a sad irony that I didn’t have enough milk to feed my twins and here I was struggling with too much milk for my singleton.  Part of me wanted to pump the milk and keep it for later or give it away but I knew this wouldn’t help with the engorgement that was contributing to my cracked nipple problem.

Reducing Engorgement

The pain of feeding on damaged nipples is excruciating.  I completely understand why mothers give up breastfeeding at this point.  There is that terrifying moment before they latch where you know it is going to hurt like a ***** but you have to grit your teeth and cry about it later.  I needed to find a solution to the engorgement problem ASAP!   Not only was it making attachment difficult/painful but it was probably contributing to my fast let down.  I consulted Dr Google and found 4 techniques/tools that I found helpful for engorgement. 

1.       Heat pack.  I bought a little heat pack so I could put it on the breast when she latched.  This helped with let down and distracted me from the pain.

2.       Reverse pressure.  This was a great technique for me to use when I had the initial engorgement. 

3.       Breast Shells.  These do the reverse pressure for you!  They also prevent your nipples from touching anything which is ideal for healing.  Best $20 I’ve spent in a long time!!!  Without these I would’ve had to resort to nipple shields or maybe even introducing bottles and pumping.

4.       Block feeding.  I started to only offer one side per feed in an attempt to decrease my supply.  I had so much milk that at one stage I was doing 2 feeds on one side and then 2 feeds on the other side! 

Healing Cracked Nipples

When I had cracked nipples feeding my twins I was told by the Special Care nurses to slap on some lanolin and a breast pad and try using a breast shield if it got too painful.  I was told that the cracks were due to poor attachment (which made me feel guilty!!).  My cracks didn’t heal until I stopped breastfeeding and pumping and I found the shield impossible to use while tandem feeding.

Knowing that Georgia had excellent attachment but I still got cracked nipples (prior to the engorgement) it made me think that the cracks would  have formed no matter what.  I also remembered that my nipples were very sore in exactly the same spots when I was only pumping for the twins (ie. no attachment issues were possible!).   I now have a theory that my nipples are naturally “missing” very small pieces of skin that when stretched to the limit cause cracking.   It’s not like I have odd looking nipples -  the tiny creases/dents are miniscule and not noticeable at all.

This time around I consulted Dr Google for ideas on how to heal cracked nipples.  When I came across this website I had an epiphany.  The salt rinse technique reminded me of something I did for a wound I had post surgery years ago.  I now realised that I should treat the cracks as open sores that needed to be mended by new skin growing in the crack.  By squishing the nipple back into my bra protected by a breast pad I was basically encouraging my body to try to “stick” each side of the crack together rather than grow new skin INSIDE the crack.  Also, breastpads are designed to absorb moisture which means you are left with a dry nipple after a few hours. This isn’t ideal if you are trying to achieve moist would healing!  So, here was my new technique for dealing with cracked nipples:

1.     Salt rinse.  This seems to draw the moisture out from the wound.

2.     Lanolin.  This speeds up healing and makes it feel more comfortable.

3.    Breast shells.  They prevent anything touching the nipple.  This means the nipple is nicely coated in the lanolin until you wipe it off before the next feed.  I cannot emphasise the relief I felt wearing these.  If you thought lanolin made your nipples feel better what until you try these plus the lanolin!  They do make you look a bit more "perky" but they feel awesome!

4.    Hydrogel breast discs. These are great to use at night when you can’t wear the breast shells.  In my opinion they are much more effective than lanolin and a breast pad because they don't dry out.

There are also a couple of things I do while feeding to try to prevent further damage.  Firstly, I feed with baby’s chin on the side of the nipple that is least damaged as this seems to hurt the least.  This makes sense because this is the section of the breast that is moving back and forth in baby's mouth.  I also feed with my free hand right next to baby’s mouth ready to unlatch her if she’s about to pull off.  Pulling off without unlatching seriously damages the nipple.  Being able to unlatch baby right before she pulls her head back is an art!  Finally, if she’s particularly frantic and is likely to grab my nipple with her hand I wrap her before trying to latch her on – those tiny fists can hurt!

By following all of these techniques the bleeding stopped within a day and the breastfeeding became "bearable" within two days.  Georgia is now 4 weeks old, so it has been 3 weeks since that night when the bleeding began.  My less damaged nipple is completely healed.  New skin has grown!  It still hurts a bit when Georgia latches on but I would describe it as a “sore” nipple not a damaged nipple which is fantastic!!  The other, more damaged side looks like it is about halfway there in terms of healing.  I will have to come back and update this post when it is completely healed in a few weeks.

What should I buy for baby?

Car Capsules.  If you are having preemies these are essential for safety reasons but if you are having a full termer these are still safer and very convenient if you have a stroller to clip it into.  You will also need some inserts to help stabilise their heads.

Carseats.  If you want to eventually fit three across your backseat look for compact versions.  We got the Safe n Sound Compaq for all three children. 

A good pram.  You need a sturdy, lightweight and easily foldable pram.  Check out Baby Jogger and Bugaboo prams – I think they are the best.  We had a Baby Jogger Citi Mini Double for the girls and have purchased the single version for the next baby.  The Baby Jogger Select and Bugaboo Donkey did not exist when we bought the girls’ pram and I probably would have considered buying one of them.

Bassinet with wheels.  We bought the Kingparrot bassinet (apparently called the Boori bassinet now) for the girls and found it essential.  It has breathable sides, it’s slightly bigger than the average bassinet, it has wheels and you can pop a wedge of foam under the mattress to prop it up if needed.  They slept in the bassinets in the lounge room during the day and beside my bed during the night.  You will also need at least 2 bassinet mattress protectors and 4 sheets per bassinet.  Pillow cases and muslin wraps work well as “sheets”.

Pretty blankets/wraps.  This is what your precious one is going to be photographed “wearing” when they are first born so invest in something nice.  I especially like the stretchy wraps.

Sleepsuits/Onsies.  You’ll need a LOT of long and short sleeved ones.  The wrap across the front style is the easiest to put in followed by the button all the way up the front style followed by the over the head and button at the crotch style.  Do NOT get the Bonds “easy suit”.  Worst. Invention. Ever. However – I am keen to try their new zip wondersuit.

Nappies.  For the girls we used 1244 nappies from when they got home from hospital until they were 3 months old..so that’s  average of 10 nappies per child per day.  We used Huggies but then switched to Aldi when we realised they worked just fine for my girls.  The same goes for wipes – we started out with Huggies but then switched to Aldi.  At 3 months I started to do cloth nappies during the day and disposable at night.  I used Bambooty quick dry sized nappies but if I were to buy some new ones I would get their one size fits all version or try out Bonnibuns and IttiBitti. 

First Aid.  You need baby paracetemol, barrier cream, a thermometer and nipple cream.

Breast Pump and Bottles.  This is only essential if you are going to pump or formula feed.  I hired a Medela Lactina pump for the first 2 months and then borrowed my friends Medela Swing pump.  I found both pumps ok but I hated pumping and blamed it for my cracked and bleeding nipples.  I don’t think this had anything to do with the pump brand though.  I used Pigeon bottles as they have a peristaltic nipple (aka super slow flow) and a good choice for combining breast and bottle feeding.  Look into Dr Brown bottles as well – I hear they are good.  I am looking forward to (hopefully) not having to pump or bottle feed my next bub.  

Baby carrier.  You NEED one of these…two if you are having twins.  It just made it easier to soothe and carry the girls around when they needed to be.  I was using a baby bjorn and carrying one on my hip to get them in and out of people’s houses, get them to a trolley, get them inside the gym, etc…. until they were 14 months old and exceeded the Bjorn 10kg weight limit!  I have fond memories of Simon and I strapping the girls on and going for twilight walks around the neighbourhood.  We would find a pair of swings and swing together with the babies strapped to us – lots of fun!

Baby swing.  Essential if you have twins or a baby with colic/reflux.  We had two of these and would not have survived without them.  The ones we had were quite noisy so if I used them in the middle of the night I used them in the lounge room so as not to wake up Simon and mum/MIL.  I would fall asleep on the Giant PVC playmat next to them.

Giant PVC playmat.  We have wooden floorboards and having this mat has made our life so much easier!  I spent hours lying on this mat sleeping and playing with my girls.  It’s super easy to clean and it hasn’t faded at all after 3 yeas of use, even though we’ve left it outside for hours.  We now have it outside on our deck as a nice soft place for them to sit and play with Duplo.  We sometimes put pillows under it to make it into a “mountain” obstacle course.

A Cleaner.  My MIL paid for 2 hours cleaning once a fortnight for the first 2 years of the girls’ life as a baby shower present and I found it to be essential for my sanity!!!  I paid the cleaner for an extra hour to do our ironing.  She still cleans and irons for us and I don’t intend on letting her go.  It really is money well spent.  

A meal roster.  Get someone to organise a 3 week meal roster after the baby is born.  Otherwise you will be eating takeaway and sandwiches every night for dinner.