Saturday, November 27, 2010

Make this. Right now.

If you like gingerbread, apples, and wonderful holiday smells, this cake is for you. Plus it comes out bakery-gorgeous. Wow.

Dr. Babs' Ginger Apple Torte from Food52.

Also, Fletch is volunteering to nurse straight from the tap, once per day only and in the morning. I know it's ridiculous, but it heals my (ridiculous) feelings of rejection -- as do his loving little monkey-face expressions.

(Pictured: monkey-face. Very blurry. But that's the expression. Awwwww....)

Life is good, and I am THANKFUL indeed.

Now, go make the cake. Yes, turbinado sugar. Don't fuck around with this, the crunchy topping is too good to risk on substitutions. You heard Auntie Linda.

Monday, November 15, 2010

Not dead, just sleepless and busy... and in love. Also, TMI about nursing, probably.

Oh my! Life with a newborn is wonderful. Fletcher is already displaying a lovely personality and lively intelligence, seen in glimpses in the short hours in which he is awake and the fleeting smiles that cross his face on the twilight edge of sleep. (Gassy grimace "smiles" are different.) He makes earnest attempts to communicate, through eye contact and the simplest and most pure signs and gestures: for instance, he roots all the time, for his knuckles, my pinky finger, the pacifier, nipples, and for food, but if he is HUNGRY, he makes pointed eye contact and then opens his mouth wide, like a baby bird. He copies facial expressions -- sort of -- although he has patience only for sequences of three or four of them. He clearly loves and trusts his father and mother. And he is strong -- raising his head from Day Two, although he cannot maintain it, and becoming Tiny Fists-O-Fury when upset or gassy.

Guess what upsets Fletcher? My breasts.

He won't nurse, for various reasons. When he was born, he was lethargic from Magnesium Sulfate and morphine, hypoxia, and a precipitous blood pressure drop. He was "sleepy" and the instant the nipple went into his mouth, he fell asleep. Tickling or chilling him during nursing to try to keep him awake only (predictably?) annoyed him further.

He clearly dislikes having a lot of breast tissue in his face along with the nipple, but there's not much I can do about that -- I am both fat and busty, and I have a lot of breast tissue. The "breast sandwich" is too fat for his little mouth, and my nipples are too big for him. And after being injured by the well-meant pinching of the lactation consultants and my own desperate attempts to compress my size Fs into size As for the baby, I have been wrestling with engorgement that makes this problem worse, much worse: the nipple is perched on a taut, swollen areola that cannot be "sandwiched."

And he hates to be confined (except in a swaddle, which is most DEFINITELY not nursing attire in his book) and doesn't like to be "positioned" tummy to tummy with me (or any variation thereof, in which he has to lie still and stop swinging fists and feet). He doesn't open his mouth wide enough to latch, ever, and might be tongue-tied... but at this stage of the game I would not consent to elective surgery (however minor) to correct it.

But he was jaundiced and we were in a major hurry to get some nutrition in him to flush the bilirubin out of his system. So we fed him expressed colostrum, by finger feeding and through a bottle nipple, with the assistance and blessing of the lactation consultants. He is now nipple-confused and just gnaws the bottle nipples instead of sucking on them -- though he does suck my pinky and the pacifier, if he can get his tongue properly depressed to do so.

The only position in which Fletcher appeared to enjoy the process of unproductively mauling my nipple, licking off the droplets I hand-expressed to tempt him at least, was oddly gymnastically equivalent to the reverse-cowgirl (or at least the 69) of nursing: too contrived, lacking in intimacy, and simply not as pleasurable as it is adventurous. I can lie on my side with the baby's tummy toward my face and his head toward my breast, and instead of arching, screaming, and pummeling me with his brutal little fists and seizing handfuls of areolae with his sharply kitten-clawed fingers, or falling asleep, he simply gums my nipple and whimpers. But when they tried to teach me to do this in the hospital, I was in agony from my incision, and I am not sure that it's the answer now, either. I mean, nursing at the breast instead of simply lying together skin-to-skin and feeding him satisfactorily from a bottle is a matter of my convenience: for social reasons, I cannot exactly strip, lie down 69-fashion with the baby, and try to force him to suckle instead of gnaw in a "mothers' room" at Babies-R-Us -- let alone at my chair in a restaurant!

So. I've been exclusively pumping breastmilk for the little guy. And, when necessary due to engorgement or blockage or when encouraged by nurses in order to help push out bilirubin, a supplemental bottle of formula every other day or so.

I've researched nursing through every website and book I can lay hands on, and am mightily annoyed. All of them assume that you will read the books before starting and NOT as a matter of troubleshooting, and all of them assume that if you just stick with it everything will be magical and will work out perfectly and unicorns will fart rainbows on every street corner. They make dire predictions that if you ever, ever give a baby formula, you have condemned him/her to a life of obesity and diabetes, amid other complaints. They tell you not to "give in." They assume that doggedness is all it will take to nurse a baby. And I am here to tell you, it doesn't always work out that way.

Also, there's a lot of disinformation out there. Nice and well-meaning people with lots of professional experience will give some of it to you. They probably do a lot of good for people without serious problems, but for those of us who have some stubborn obstacles, the advice itself can cause suffering.

Here are the little things about expressing breastmilk that I've learned so far.

1. DON'T let pumping or hand expression cause you pain. If the pump hurts you, you may have too small a flange for your nipple, or too sharp an edge in your flange: use lanolin to grease the flange edge if you need or file it down with a fine emery board before you wash it next. Or you may have the suction turned up too high. Just -- don't. Be gentle and kind and loving to your breasts.

2. DON'T worry. If you are stressed, you will give less milk (that session.) Take the time to relax, breathe deeply, think happy thoughts, get a massage or get your back scratched, get comfortable, have someone hold the baby, have your significant other massage your breasts (NEVER toward the nipple, always away! and massage up to the collarbones and out to the edge of the armpits, you have glands everywhere), use hot compresses or take a warm shower if you like. Kick your relatives out, even if you would let them watch you nurse: pinching your breasts or being hooked up to the machine is not shameful, but it is qualitatively different. You will be amazed how much this affects your milk production.

3. About quantities: all the books will tell you that so long as your baby is peeing or pooping the requisite number of times and appears to be thriving, you have enough milk. This is probably true; all babies are different. And yet... if you're like me, you want to know what would be ideal production. You will start out producing a milliliter or two a session of expressed colostrum, the sticky yellow stuff that is so great for babies and which comes in before your milk. That amount will increase until transitional milk comes in (much wetter and whiter). By the end of the first week of the baby's life, you will probably be producing at least half an ounce to an ounce of milk a session. By the end of six weeks, when your milk is done transitioning and your supply becomes more or less stable if maintained, you'll be producing something like 25 ounces a day.

4. Pump every 2 1/2 to 3 hours during the day and every 3 to 4 hours at night, for 12 to 15 minutes a session. This is tough to balance if you get tender: you'll need to stop if you are making yourself sore and aren't producing much milk, but you will want to express a goodly quantity every session to "order" the milk you want for the next session (you get back what you remove from the breast.) Don't crank up the pump strength. Don't pump more frequently. Don't pump forever in a session. Painless and efficient is what you want.

5. Use an ice-pack after pumping if you are sore. Don't use it too close to the next session, as a cold boob is not an optimal milker. Use a warm compress to loosen things up again if desired.

6. Try to get ahead of the baby's needs. If baby is crying, it will stimulate your letdown, sure, but it'll raise your stress. See #2 above. Have someone entertain the baby if possible while you focus on pumping.

7. Don't focus too hard on pumping. Feel free to relax & meditate, fantasize, scheme, watch TV, read, whatever. I catnap because oxytocin makes me a zombie.

8. WEAR A BRA. Not a tight bra that leaves lines and compressions on your skin, because that will impact the glands and could cause mastitis or engorgement. A nicely-fitting, soft, stretchy sports bra.

9. While you pump, use gentle compression on the engorged glands in your breast to increase milk flow. You'll be shocked at how well this works. GENTLE is the watchword here -- and you do not want to squeeze-and-pull toward the nipple, just to press the milk sinuses that are reluctant to release their bounty.

10. Don't squish the flanges into your flesh so hard that they create compression areas. The ideal is to hold the flanges gently onto your skin in a "natural" position. This ideal is ridiculous, because there is nothing comfortable about leaning forward with your hands tucked under your knockers and trying to hold on hard-plastic cups that will spill milk down to your navel if you jostle them at all, but it's just that -- an ideal. Shoot for it. And learn to live with the spills.

If I think of more, I'll add them. But there you go.

Sunday, November 7, 2010

Oh! And a guest post at Perfume-Smellin' Things -- go check it out! (A top 10 post contribution, not a solo post)

Woohoo! The top 10 of Fall.

It went out while I was in the hospital, but do enjoy.

Home again, home again!

We were supposed to go home on Thursday, but they held us another day to keep an eye on Fletcher -- and on me. Little Fletcher's bilirubin numbers continued to go up gradually, but as jaundice can be dangerous if it gets bad enough, and the hospital has access to transcutaneous bilirubin testers (a light shined through the fat on baby's noggin that returns a level of "yellow", so far as I can tell) and didn't need to draw blood unless the numbers got scary. As for me, my blood pressure was a little elevated again and the doc wanted to make sure it didn't continue to climb. Also, my feet are HUGE because of IV fluids and he wanted to watch me for blood clots. All good.

But. They said the words "brain damage or death" about jaundice and then took my blood pressure. Imagine! And then, they rotated in nurses from another department to cover the night shift.

Fletcher still does not like to nurse. I was trying, at 7 p.m. on Thursday night, to nurse him, and we had arrived at a perfect "I will try this and NOT scream like you stabbed me, but we're not good at it yet" situation. And then, the fire alarms in the hospital started making noise. The bulkhead-style hall doors locked themselves down with talking security locks (the closest one about 2 feet from my room door) and started droning canned warnings about fire. SEVEN strangers ran into my room, where I was trying to feed an upset newborn, all nekkid, and one threw a cloth at me: "You might want to cover yourself, we have an emergency."

The fire alarm located in the attic of our room had malfunctioned, automatically shut off the air conditioning to the entire hospital, and closed all the bulkheads, and the only cure was for the lone Operations manager to be on a ladder in my attic for three hours while his phone went off every minute and a half because the laboratory and clean rooms COULD NOT OPERATE without the air conditioning...

The night nurse forgot to give me my pain medication on time THREE TIMES, resulting in a lot of pain. I was also suffering some weird sore/inflamed breast symptoms because the lactation consultant pinched my nipple too hard (I know, right?) and had had me lie on one side to try another "hold" -- which made my incision tender. When she DID finally come in (when I demanded medication) in her street clothes, she waxed horrified and alarmed at how my baby's bilirubin level had "spiked" and WHEN were they considering putting him under bili-lights, because the levels were dangerous? (She's from another department: babies' tolerance for bilirubin exceeds that of adults, but I didn't know that... and neither did she.)

Pat spent hours researching jaundice online. Medical studies of jaundice that he found online were neither comforting nor able to confirm anything scary. All we knew was that we were doing things right and that the baby had multiple risk factors and that his numbers were borderline.

Guess when they elected to take my blood pressure? Right. Plus the nurse's assistant who took the BP did not sanitize her hands, coughed the entire time she was in my room, and grumbled about having been reassigned to mother/baby from pediatrics -- all of this while the room next door had CDC warnings posted on it for "respiratory contagion." Ohmigod.

So I told them that, if my baby was well enough, I was going home no matter what my fucking blood pressure might be, because it would surely be lower at home.

In the morning, my doctor saw no reason to keep me: I look to be healing well, my blood pressure was going down, nothing to especially worry him. He told me what to watch out for.

The pediatrician who stopped in scoffed at the baby's bilirubin level and told us to take him home and continue taking good care of him, and get him to the doctor for a check up on Monday.

We got him dressed, fed, and checked out. We stuffed him into his baby carrier. We brought him home, where, excited by the change of scenery and habits, and the reduced noise level, he could hardly sleep.

It's bliss to be home. Pure bliss. And life with a newborn, although challenging, is wonderful. He is charming, funny, and smart already (a being of pure Id), and can Houdini his way out of any mittens, socks, or swaddles he is put into. (And twice, his diapers along with the swaddling blankets.... oy!)

My mom, now known as "Grandma" despite her sworn oath never to let anyone call her that, is cooking copious and delicious meals for us and is a blessing. My darling friend and doula April, trusty by our sides throughout the hospitalized period, has offered to do any errands or help any way she can. The wonderful ladies at church are offering to make casseroles, come help, and provide sympathetic ears if I need them. The only cloud on my horizon, a very small cloud, is that my hormones are crazy out of whack and I can go hysterical with weeping over something like a bird-rescue call too difficult for us to take in our current situation. (I guess I frustrate easily right now -- and the idea of leaving something helpless without assistance just got to me. But I am still blissful, not depressed.)

More pictures of our little yellow Oompa-Loompa are surely to come, but I'm just catchin' you up, right now. :)

Love you guys. Be good.

Thursday, November 4, 2010

Fletcher is here!

I am posting from the hospital, where the nurses are the BEST and nicest, and although I am tired of being here, I am glad they're watching over me.

Thursday morning, I had a check up at my obstetrician's office. I woke up late and hustled through a shower, having not even washed my hair. So it was Murphy's Law that he took one look at my scary-high blood pressure and sent me to the hospital to be induced -- do not pass Go, do not collect $200, do not go home and get your hospital bag or wash your hair first.

I checked in and they instantly (against my wishes) installed an IV. They wanted it there "just in case." (It was put in wrong or somehow compromised, because it inflated my hand in 2 days and I had to be IV'd on the OTHER side too -- and then that IV was in long enough that it had to come out before they were sure they were done with it. That's how long I've been in the hospital.)

They tried 2 12-hour torture sessions involving Cervodil. Cervodil, in case you are blithely innocent of its existence, is a 2" x 14"-ish kite-shaped affair made of medicine-impregnated cardboard and shoestring. (Yes, really.) It makes everyone sore. It made ME so sore that, after the first 12 hours, I begged them to find something else to try -- and after 8 hours of the 2nd dose, I asked them to contact my doctor NOW because it had to come out. He and I split the difference -- agreeing that it would come out in an hour or two instead of immediately. The only unpleasant nurse I had went on duty and ignored that order completely, ensuring that the second dose was in for just under 11 hours. As it turns out, my misery was justified: I am allergic to Cervodil.

So. Then to Cytotec. It is not approved by the FDA as an inducer of labor, so the doctor on duty -- not my normal doctor, as it was now the weekend -- did not want to continue it. 2 doses of Cytotec later, nothing much had happened other than contractions, but my blood pressure had skyrocketed. So the doctor on duty -- again, very sweet but NOT my doctor -- put me on magnesium sulfate, which they use to delay labor, to lower the BP. And Pitocin, which does nothing but induce contractions. Predictably, this did nothing for inducing labor. It also did nothing good for my blood pressure (maybe!) because it got to 210/112 before my doctor showed up on Monday and told me it was time to do a C to keep me healthy.

Three different anesthesiologists argued about whether or not it was okay to do an epidural or spinal with me, because of my genetic condition -- which made a bleed inside the spinal column, which could be permanently paralyzing, more probable than with the general population. This was balanced against general anesthesia, which is dangerous for anyone and more than usually so at my weight. We decided on a spinal.

During the C section, my blood pressure dropped precipitously to 90/60 (from 200/100ish). The baby was delivered limp and waxen, had to be resuscitated, and had an Apgar score of 2. He was taken to the NICU to be evaluated and was, fortunately, swift to recover (although the magnesium sulfate and BP drop has affected him, it's unlikely to cause anything permanent.)

The baby won't latch on to nurse (he is early, my breasts are fuller than he likes, and he's a "sleepy" baby because of the drugs) but feeds well with pumped or expressed milk, which has come in so well that the day nurse today yipped "God A-mighty" when she saw how much we are getting. We gave him formula to help move the bilirubin out of his system faster, because he's a little jaundiced.

They are watching me for high blood pressure tonight, because it crept back up after delivery, and are watching him for a dangerous increase of jaundice.

NOTHING here is as planned. I wanted a natural delivery, no formula, nursing, no drugs, absolutely no induction before baby was ready, and no C-section.

But, listen to me. I WOULD NOT CHANGE A THING. They saved my life. They saved my beautiful, healthy, already-smart, precious miracle child. They delivered our little son and I am totally at peace with everything that happened.

I had the good fortune of getting "unvarnished" advice from my friend Kate, a total super-mom by the way, who does all the "right" things with her toddler and newborn even as she jet-sets to conventions and publishes articles and grades graduate students' work and teaches. She advised me to "be reasonable." She said that if changes to the plan needed to happen, to welcome them.

Oh my God, thank you, Kate. Better advice was never given. At each step, I have been serenely confident and filled with trust and joy (and I have to admit, impatience -- boy, I wanted a shower, and to have the IV out, and to have the baby, and now, to go home. But still confident, serene, and joyous.)

This is my reward: