Day 3 and 4 Not enough breastmilk

So happy that both Gynae and Pd said we were allowed to go home. Bb jaundice level was 142 but this was considered low for Day 3. Bb needed to go for jaundice check again on Day 6. Pd mentioned that jaundice normally would spike at Day 5.

Diaper check

I checked with the nurse the number of diapers used for Day 3. She said there were two soiled diapers which were also wet.

I thought, "One more wet diaper to go! Bb must be getting enough milk!"

Home sweet home

Latched for longer and longer

Bb started to latch for more than 25 minutes on each side. She was sucking and sucking and so I thought I had enough milk.

Nearing to midnight, I started to see some whitish things on her lips that looks like dried milk. I thought that meant that my milk had come.

However, Bb started to latch very long on one side and kept on sucking and sucking sometimes for more than 40minutes. I remember reading that we should always offer one side first in order to get the hind milk and also newborns might nurse for comfort. Hence, I thought that was quite normal and started to only offer 1 side everytime she woke up.

Sometimes she only latched on one side for 25 minutes and dozed off and I did not offer the other side. I thought that meant that she was full. I didn't know it was because she was too tired from all the sucking and her jaundice level was going up causing her to be more tired.

This was despite the fact that I knew jaundice babies sleep longer and needed to wake them up more frequently so breastfeed them. Somehow it didn't occur to me that bb's jaundice level mighy have gone up and I did not consider waking up Bb when she slept for almost four hours.

I thought babies would be smart enough to wake up if they were hungry and I was to latch on demand and not to watch the clock.

There was only one soiled diaper and no wet diaper on day 3 night. I didn't think much about it. I remember that babies had enough nutrients storage in their body to last them till day 4 and as long as I keep latching, I would have milk.

Day 4 Bb kept crying

She started to latch longer and longer but each time I only let her latched on one side. Sometimes after she unlatched, she would start crying. I thought she was just tired and my mother-in-law would carry her and coax her to sleep.

She started to latch more frequently and by evening time, the diaper was still dry and the diaper indicator did not change colour.

I thought perhaps the diapers were too absorptive. After all, I saw some whitish milk on her lips yesterday. Or perhaps, my milk supply would go up soon to meet her demand.

Finally, on day 4 night, I felt my right breast a little bit hard and there was 1 slightly wet diaper. My mother in law started to place tissue inside her diaper to see if there was any urine at all.

Bb began to cry continuously and could not be coax to sleep. My nipples were sore from the hours of latching.

Day 4 "pumping"

I began to sought for help online. I wrote online saying that I was producing breastmilk as I thought I saw her swallowing. I also stated wrote that baby was hungry despite frequent feeding. Many people asked me to continue to latch on. One of them told me to pump out my foremilk as I could have too much foremilk.

I tried to use the massage mode of my medela for first 2 minutes and saw there was practically no milk. After two minutes, it was the let down mode. Knowing that I wouldn't have "let down", I off it again and on it to stimulate more. My nipples brush against the flanges and I realised my flange were too small. I disregarded that and bear with the pain and continue to on and off every 2 minutes. After maybe 8 times of doing so, there was less than 5ml of some greyish diluted milk in the bottle.

Buying Formula Milk

I broke down and my hubby took cab at 4am to 24 hours NTUC to buy formula milk.

I felt so guilty, thinking that baby had been sucking nothing but air for hours.

Day 5 depression?

Day 5 morning, baby started to have wet diapers after drinking formula milk. But we finally realised her face appeared to be more yellowish. There were also streaks of pink in the urine.

I cried for the whole day and I couldn't sleep at all. I was too tired but couldn't sleep. I stopped breastfeeding for that day and I started to blame myself for everything including

- not producing enough breast milk
- did not buy formula milk
- not pumping earlier
- never wash and prepare my pumping accessories
- not knowing how heavy a wet diaper should be
- And began to think about previous bad memories including my miscarriage, my dad's stroke and other things. I felt unfortunate things would start to happen again.

Day 6 jaundice up, dehydration & hospitalised

We went to Pd and we were told that her jaundice level had shot up. We could choose between letting her stay in hospital or renting the equipment home. We chose to let her stay in hospital.

I also decided to let her take formula milk.
By day 5 morning, I finally could feel both my breasts becoming harder and I started to express out milk.  I decided to feed the baby with formula milk instead of sending my expressed milk to hospital as I knew I really needed to have proper rest.

Pd also mentioned that the streaks of pink meant Bb was dehydrated and dehydration could be one of the factors that cause jaundice to shoot up. We were giving only 30ml of formula milk and Pd mentioned that we were giving too little amount of formula milk.

During the two days, I started to express out my milk and store them in the fridge as chilled milk. I caught up with my sleep and pull myself together.

My reflections

I was sitting on a hard plastic chair and my vaginal stitches hurt badly. The new Aircon was not circulating the air and I was sweating even though I was practically naked. The red dates tea turned icy cold in the air con room but I still drank it. And the list goes on. Somehow I just "suffer in silence" and was dumb enough not to do anything about the two days.

Hormones and lack of sleep caused me to become too obssessed with breastfeeding. I didn't know how to take care of myself nor feel that I was a mum. I felt like a cow which had failed its most important duty of providing milk.

I did not realise I was tired and too stressed up. These have caused me to lose myself and fail totally as a mum. Not that I failed to provide breast milk but failed to notice that she was too hungry. I should have noticed the lack of wet diapers too.

On top of these, I should have been more prepared. Breastfeeding involves many things. Not just latch and expect milk would definitely be sufficient for the baby.

Rest, food and comfort for mother were the most important things. 

For food, I suggest green papaya soup with fish. I only started eating it in my 2nd week. I should have eaten from day 1. 

So here are my suggestions or rather these are the things I will do when having my second baby:

- Latch,  sleep and eat the moment you reached home.
Don't bother about unpacking things or taking care of the baby.
If you can't sleep, just close your eyes and rest on the bed.
Get your confinement lady and your hubby to change diapers and coax baby to sleep.
Just stay on the bed except for meals.
Scream for your hubby when baby wakes up. Stay on the bed and just wait for hubby to carry baby to your arms. Then get hubby to pour warm red date drink for you. (You may need a straw or a water bottle).

- Wear comfortable clothing for nursing. I thought I could just strip and nurse and don't spend money on nursing clothes. But stripping and wearing back takes time and you might catch a cold. There are actually cheap and comfortable tank tops, shirts or dress with padding. You can buy from uniqlo airism series ($19.90 to $29.90) or qoo ($10-$12).

- Don't just research and follow blindly! Do practicals with your HUBBY before giving birth.

1) Pour 4 to 6 tablespoons (60 to 90ml) of water on a diaper and weigh! Feel the weight and look at how the diaper indicator changes colour!

2) Put a scoop of formula milk, follow by volume of water indicated on the formula tin. Hot water: room temperature ratio 1: 2. Swirl to make sure the milk powder dissolves completely. Hold and grab the bottle in your hand or pour a few drops on your palm to know the suitable temperature.

3) Wash, sterilise and get ready your pumps! Learn to use and try out your sterilizer and warmer! You can try placing the milk in the fridge and see how long it takes to chill it and to warm it. Or simply use a warm water bath instead of warmer to warm up your chilled milk.

4) Do trial runs of picking up a baby from the cot to breastfeed, pulling down your clothes to breastfeed, latching, holding the baby in the same position for at least 40 minutes, burping the baby, swaddling the baby and placing the baby back into the cot. (Consider using a doll?) You should also consider where to place your red date tea and some snacks near your bed. (You may want to ensure your red date tea doesn't turn cold in air con room like mine)

I have attached a picture below of my "set -up" when breastfeeding baby. (The blue and pink mats are in case when baby pukes milk. If you look closer, I have also swaddle on the mat. This set up is for daytime and the long green pillow is  placed on my right if I latching on my right breast. So baby's neck would be on my right arm at my elbow and my elbow would be resting on the pillows. After latching and she falls asleep, I will place her directly infront of me on top of the swaddle and swaddle her. 

Finally, no matter how prepared you are there will be problems. And don't panic when baby cry. Take good care of yourself! Happy mummy = Happy baby! Don't try to be the perfect mummy. Remember your hormones can be controlling you, making you depressed! Stay cool and tell yourself you have done your best!

Reviews on My Brestfriend pillow

My Brestfriend Pillow

I used My Brestfriend Pillow to help to support the baby while breastfeeding in the hospital and at home for the first two weeks.

Pros
1) Allows newborn to lie down comfortably on a flat sturdy surface for baby to lie and breastfeed.

2) Position baby at the ideal height for breastfeeding. Mummy will have less tendancy to slouch and bend down to breastfeed the baby as the baby would be at the correct height afforded by the pillow.

3) Useful for newborns when their necks are still weak and FTM who can't hold newborn properly. With the support provided by the pillow, FTM can easily change from cross cradle when latching to cradle hold when breastfeeding.

4) Support weight and posture of baby, especially useful when nursing for long duration.

Cons
1)Very expensive

2) Very troublesome when I had to grab and clip on the pillow everytime. When she is crying for milk, every second is crucial! So I only used it for two weeks!

3) Difficult to tilt the pillow such that her head would be higher than her stomach to prevent reflux. The baby would be lying 180degrees when using my breastfriend pillow. I had to raise one of my legs ever so slightly to create a slope.

4) Require you to sit upright on a chair. I find it a struggle to use on the bed as I  have weak stomach muscle and can't really sit upright with legs straightened on the bed. Moreover, I had vaginal delivery so I had greater difficulty in sitting upright, as I had painful stitches at the vaginal area.

5) I needed to clip it on before I "scoop up" the baby. I find it difficult to bend down and "scoop up" my baby with a hard and bulging pillow at my waist. Usually, I needed the assistance of my husband or mother in law to help me "scoop up" the baby and placed her on My Brestfriend Pillow.

6) I usually cradle hold baby while breastfeeding and baby would fall asleep on My Brestfriend Pillow. I would then have to pull out my hand, unclip and place the pillow on the bed, carry my baby up again and place her into her co-sleeper cot. In the process, she sometimes would wake up.

Now I do not use any nursing pillow and I breastfeed on my bed. After she sleeps, I simply place her into co-sleeper cot and swaddle her. (I would be blogging on the Mini Arc Convertible Co-sleeper and how to breastfeed without nursing pillow).

Overall
I am still glad that I have bought the pillow. It is useful for newborns and first time mums.

But as I become more experienced in latching and baby's neck becoming stronger, I find it more convenient to sit on the bed to nurse without nursing pillow, without having to clip and unclip it, without having to sit in a upright position. Perhaps, I would use it again for the first few weeks if I have a second baby. But I would definitely use it when sitting on a comfortable sofa and have someone to help me unclip it so that I can easily transfer my baby into the co-sleeper cot.

Breastfeeding in Thomson Medical Centre including my views on rooming-in newborn

Episode 1: The First latch in the delivery room

The delivery nurse held the baby's head near my left breast while I held my left breast and used my nipple to tease baby's lower lips. Her mouth opened wide and the delivery nurse quickly helped me to latch her on. She then placed the baby on me and I cradled hold her. She started to suck and maybe in less than 5 minutes, she let go of my nipple or maybe my nipple slipped out of her mouth as I was not holding her properly). I told the nurse that I was done with the breastfeeding and the nurse placed the baby back into her "cot".

My reflections on my first latch

I was tired after the delivery and wanted to just let the baby had a feel of latching.

I guess I should have
1) Latched for a longer duration

2) Latched on both breasts

3) Allowed baby to rest on my body longer for more skin to skin contact

Before your milk comes in, you should latched both breasts, each side at least 15minutes. I only knew about this after the lactation consultant came on the next day.

Episode 2: Baby sleeping in nursery

My original plan was to get the baby to "room-in" with me in the ward as I read that co-sleeping would help the "milk to come faster". However, I wanted to have more rest and I was not confident enough to take care of the baby yet and so I decided to have the baby to sleep in the nursery. The nurses would push my baby to my ward every three hours or so for breastfeeding.

My views on baby "rooming-in"
vs leaving baby in nursery

For my second baby, I would want to let the baby "room-in" with me although it would mean

1) More tiring for me.

The "baby cot" comes with a clipboard which requires the nurse to note down the timing & duration of each breastfeeding session and the number of wet and soiled diapers. The nurses will also keep track of time and push baby in for breastfeeding every two three hours.

If rooming-in,  it means that I would have keep track of the time and  breastfeed at least every three hours. I would also have to check the diapers and change diapers. Most importantly, I would have to record these information on the clipboard.

2) Baby would have to be pushed back periodically for

bathe ? (I guess hospital do bathe the baby once daily?),

vaccinations and paediatricIan checkups
and maybe other things.

Well, I think for FTM, it is very stressful especially the monitoring of wet and soiled diapers and keeping track of time. However, for my second baby, I think it will be good to try. If I can't cope, then can always push the baby back to nursery? After all, tiredness and stress are milk killers!

I found this blog on room-in experience at Thomson. Do read up especially for first time mum!

Episode 3: Latching with the help of the nurses
       
Every two to three hours, the nurse would push in my baby to let me latch.

Some nurses were super nice. They offered to help me to latch and stayed for at least 10 minutes to help. They helped to wake my sleepy baby and came back 20 minutes later to check on us and push the baby back to nursery.

On the other hand, some nurses simply left immediately after baby latched on. Sometimes, the baby stopped latching and fell asleep the moment they left the room.

Some ways to wake a sleepy newborn
1) Unswaddle her

2) Dim the lights in the room (funny right but we tried and it works!)

3) If she latched on but not sucking, try to do breast compression

I found this link on waking up sleepy baby and some useful tips about breastfeeding newborns. FTM, do read up!

Episode 4: The Lactation Consultant visit

I gave birth at around 1pm on a Sunday. They did not have lactation consultants around on Sundays. So the lactation consultant came on Monday morning.

I told her that I was unsure my breasts were already producing colostrum and she told me to hand express to check. I wasn't sure how to do it so she hand-expressed my breast to check if I was producing colostrum.

I was so happy when the lactation consultant told me that my baby was latching well and I was producing colostrum for her.

How to do hand express

To hand express: simply place your thumb and two fingers on opposite ends of the areola (e.g. 12 o'clock and six o'clock) and PUSH IN, follow by "rolling forward" to squeeze the aerola.

I found this link on hand expressing breast milk very informative. 

By the way, note that hand express techniques is a life saver during engorgement! And if you plan to fully latch during the first few months, make sure you learn how to do hand express before your baby starts to sleep through the night (STTN).

My reflections on the lactation consultant visit

1) Glad that she show me how to do hand express. Although I read up on how to do hand express, the best learning is still hands on practical.

2) I did cradle hold to latch on the baby. She taught me to use cross cradle to latch and then change to cradle hold after latching. (See my blog on latching and breastfeeding newborn)

3) I did not bring my medela breastpump to the hospital. I did research on breast flange and I thought the flange was correct size. I regretted that I did not get the lactation consultant check to see if they were correct size. I actually upsized from 24mm (default size) to 27mm and finally to 30mm! (Had bruise nipples and spent so much money.)

Overall reflections

I enjoyed my breastfeeding experience at Thomson. At the hospital, I thought taking care of a newborn was easy as I simply latched & burped her and then "send her back to nursery" after I latched her. However, she could still be crying and asking for more milk when she was at the nursery. And this, I wouldn't know.

When I went home, I realised that baby continued crying after I latched her 15mins on each side and I had difficulty coaxing her to sleep. At that time, I didn't know she cried because she was still hungry. Perhaps, if I had latched her longer at the hospital and also asked for her to room-in with me, my milk supply would be more.

Also, I should have at least try to pump once or twice at the hospital and ask the lactation consultant if I was usong the right size of flange.

Before giving birth, I read that milk would definitely come by Day 4 and baby would have enough "storage" in her body to wait for the "milk to come" . And that to know whether you are producing sufficient milk, you can count the number of wet diapers and see if baby is swallowing. However, as a FTM, I didn't know how to see if baby was swallowing, how heavy was a wet diaper supposed to be and how to use a breastpump. By Day 4, my baby became dehydrated and I used the "undersized- flange" breastpump wrongly. My nipples was bleeding. Realizing my baby had been "sucking nothing" for hours,  I felt so guilty and almost went into post-natal depression.

Do look forward to my blog on what happened on Day 3 and Day 4 when we went home.

Latching and breastfeeding a newborn

I found a super good video on breastfeeding! Click on the link below before reading my blog. How I wish I had found this video before I gave birth!

Suggested Steps to Breastfeed a Newborn

To breastfeed a baby, it is easier to use the Cross-Cradle method to Latch the baby as our hand supports the baby's neck and push the head into our breast.
(You may wish to see this website for illustration of what is a cross-cradle (fig. 3). I find this website very informative.)

Follow step 1 to 6 to latch a baby on the LEFT breast.

1) Have your baby lying sideway on a pillow and her head near your LEFT breast and her body very close to you. (I used my brestfriend pillow for the first two weeks.)

2) Hold the baby's head & neck using your RIGHT hand.

3) Imagine your breast as a burger. When grabbing a burger, we usually pinch the burger with our four fingers on top and thumb below it. 

4) Similarly, using your LEFT hand, grab your LEFT breast like the way you grab a burger. But your thumb is to be on top and four fingers below. Make sure your fingers are away from aerola. 

5) Grab your breast to direct your nipple to tease her lower lips.

6) Wait till she opened her mouth big. Use your right hand to quickly PUSH her head to latch on the nipple.
(Move your baby's head so as to eat "Burger". Do not bend and feed your Burger to the baby as you will end up straining your neck or slouching for at least the next 15 minutes.)

Make sure it is a deep latch by checking if her mouth covered most of your aerola.

Follow step 7 (cradle hold) to breastfeed the baby.  (Fig 1 of the same website)

7) Once she latches on correctly, your left hand can then let go of your left breast. Then slide your left arm under her body such that her neck rests on your left elbow in a cradle hold position.

Why are there so many steps ?

Most people will use the cradle hold for breastfeeding a newborn. A cradle hold supports the baby's neck at your ELBOW. 

However, during latching, newborn has difficulty "aiming". Cradle hold is difficult to latch as you need to use your ELBOW to direct her to your nipple.

It is easier to support the baby's head and neck with your right PALM and push the baby's head to latch on left breast while your left hand holds your left breast . This is known as cross-cradle (steps 1 to 6).

After which, change your hands to cradle hold position by having your left hand letting go of your breast and sliding under baby's body such that your left elbow is supporting her neck. Changing to cradle hold is necessary as it is more comfortable for yourself and baby (step 7).

Most IMPORTANT Rule about breastfeeding

Make yourself comfortable! Have nursing pillow or normal pillows to help you.

Other Tips
1) Practice makes perfect. Use a doll to practice before giving birth.

2) Massage your breasts before latching.

3) Have a water bottle near u. (I have two, one on each side)

4) Have the remote control for air conditioner and fan beside you.

5) Wear clothing which are suitable for nursing. I wear shirts that comes with padding. I simply pull down one side to nurse.

6) Nothing beats having an experienced person to teach you how to latch and also to check on your latching. The nurses in Thomson Medical Centre were very helpful and a lactation consultant will check on your latching (first time free at Thomson).

Look out for my blog on my first breastfeeding experience at Thomson Medical Centre!