Breastfeeding Charlie: It Took A Village

Breastfeeding Charlie: It took a village
Yvette ODowd 2013
Breastfeeding Charlie it took a village

April 10th 2013: my daughter Kaitlyns first baby is due today. We go out to run some errands as a distraction. She has a bit of back ache and some cramps. We visit Centrelink to drop-off some paperwork, pop into the bank, buy her some new shoes. We cancel our planned visit to the swimming pool she says she cant be bothered changing. Unspoken between us, those cramps are progressing. Later that evening, a Facebook message: Things are definitely starting will let you know when it gets serious. I gather my bits and pieces, preparing to join her and her husband Ashley at their home for the labour. I hope to be there for the birth my modest daughter says maybe, but I have to stay at the head end and not look at the business end. She has packed a top to wear in the birthing pool. I keep my thoughts on this to myself I know how that will play out I dont take my usual sleep medication, so while I rest in bed, I dont sleep. We communicate by text while her husband gets some sleep. At 1am, they are a bit anxious and want to go to the hospital. I know it is far too soon from what she describes but jump in the car for the five minute drive to be with them. We make our first visit to the hospital. The baby is fine, the contractions are still prelabour, she is sent home with pain killers and sleeping tablets. Her husband takes the bags back to the car. They head to bed for some sleep and I spend the rest of the night on the couch, online but keeping quiet on Facebook. The contractions wake her and we spend the day applying heat packs, walking the hallway and rubbing her back while she sits on the fit-ball. In the afternoon, we make our second visit to the hospital. The baby is fine, the contractions are still pre-labour, she is sent home with pain killers and sleeping tablets. Her husband takes the bags back to the car. They head to bed for some sleep and I spend a few hours on the couch, online but keeping quiet on Facebook. The contractions wake her and we spend the day applying heat packs, walking the hallway and rubbing her back while she sits on the fit-ball. In the late evening, we make our third visit to the hospital (this time we leave the bags in the car!), planning on getting more pain killers and sleeping tablets to get through the night. They need to check the baby on the foetal monitor this time and Kaitlyn lies on the examination table for the 15-20 mins. This causes her back to spasm, a constant pain that has nothing to do with the contractions. The baby moves too much, they need another ten minutes. Despite the amusing distraction of the babys hiccups sounding like a frog croaking with her heartbeat in the background, the back pain becomes distressing. There are tears. The midwife doesnt really understand the pain is from lying in a bad position and not being able to move. Having arrived walking up the staircase (side-ways, to rock the baby down!), she requires a wheelchair to return to the car. The contractions are early-labour. She is given her drugs and returns home to try and sleep. I also take my drugs, hoping I can also sleep for a while. At 4am, I am woken by my son-in-laws mother. Kaitlyn is distressed and they think she needs to be in hospital so her pain can be managed. I work out he tried to rouse me from my induced sleep but couldnt, so phoned his mother and sister. They had all helped Kaitlyn out of the shower where she was naked on her hands and knees modesty, be damned! I explained the contractions were still
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not close enough or long enough for her to be admitted and the hospital had done what they could. They tucked her up in bed beside me and I spent the rest of the night applying heat packs and massaging her back while her husband got some sleep and her mother-in-law lay on the beanbag timing contractions. By morning, we were out of the prescription-only pain tablets, still only in early-labour and knowing she would need to physically visit the hospital to get more. Ashley and his sister went to the chemist to see what they could get over the counter to tide her through. Her mother-in-law had gone home for a while. I rang our chiropractor about her back pain and he planned to visit her at 11.30am to offer some relief. At 9.30, her waters broke! Putting aside the now-unneeded pain tablets, we headed off for our fourth (and final!) trip to the hospital and she was admitted. Exhausted from lack of sleep and contractions for almost 48 hours, she was desperate to get into the bath for her planned water birth. I asked what she wanted to wear, she declared NOTHING! She stepped out of her clothes and into the water. Almost instantly, the water calmed her. Over the next six hours, she laboured almost silently in the water, using the gas when she had a contraction but mostly floating blissfully and dozing between contractions. Her midwife was only needed for observation and we chatted about birth, breastfeeding and more. Ashley poured water over his wifes belly. I stroked her hair and cycled cold wet face washers around her face, neck and head until they became warm. The midwife handed over at 3.30pm, said her goodbyes and went home to dream about the beautiful water birth that was to follow. Gently, Kaitlyn transitioned into small pushes and I reflected on my three caesarean deliveries and what might have been. Then a senior midwife, Mel, entered the room. I had known her for many years, from my time of weekly post-natal visits to talk about breastfeeding and antenatal classes shared with midwives. Mel had to see how things were progressing as Kaitlyn was approaching the one-hour cut-off point for pushing without constant foetal monitoring. Examination showed the baby was well-down the birth canal but despite her greatest efforts, Kaitlyn could not move her to the point of birth in the time available and had to be transferred to the delivery room instead. Exhausted and defeated, wrapped in only a sheet, she slowly walked along the corridor, past her father and brother, in obvious pain and distress. That walk signified a change from the natural water birth she had hoped for into a more complicated birth than anyone expected. Once in the delivery room, a portable monitor was attached, with the hope of allowing her to labour in the shower. Unfortunately, it didnt work properly in this position and a clear signal of the babys heart-beat was not consistent. So she had to move onto the bed. After a short period of exhausting pushing, it was decided that intervention was needed. I stood explaining to Ashley what and who all the people and things that began appearing in the room were. He was distressed at the turn things had taken but had his mother there to support him. A doctor arrived and soon Kaitlyn was in the position we all dread, legs raised and on her back.
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The doctor was saddened to see just how close the baby was to crowning and again encouraged really strong pushes while we waited for instruments to be brought. But all those days in labour had sapped her energy reserve and Kaitlyn was just not able to do it alone. A ventouse (vacuum) delivery was to be tried. With her husband, mother and mother-in-law encouraging alongside the midwives and doctor, Kaitlyn pushed with all her soul and with the doctor on the ventouse, a head began to appear. And then she was here! Charlie arrived with a tuft of dried hair from the vacuum, a small raised dome on her head and a fanfare from the doctors mobile phone ringtone playing Princess of China by Cold Play for the third time during the delivery! Placed skin to skin on her mothers chest, her parents and grandmothers greeted her. But Mel came and whispered in my ear: we needed to get colostrum into the baby asap as Kaitlyn had a third degree tear and needed to go into theatre for stitching. Our vision of breast crawl and unassisted first feed went out the window as Kaitlyn experienced hand expressing rapidly by the midwife and Charlie was unceremoniously attached to her breast to get oxytocin pumping to prevent haemorrhage.
I asked that Dad do skin to skin since Mum would not be available and this was happily supported. After an all too brief time together, we transferred the baby to Ashleys chest and Kaitlyn was wheeled out to have a general anaesthetic and repair. For two hours, my son-in-law held Charlie Winter against his chest, delicately feeding precious colostrum to her by dipping his finger and letting her suck. Gradually, her body started to pink up
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and she slept against his hairy chest. Not quite the first feed I had envisaged, I found myself coaching my granddaughters father through the process!
When it was time for the family to move to Kaitlyns postnatal ward, the new father led the way procession-like, his daughter tightly held against his chest, blankets trailing like robes and the family following with bags and other items. The skin to skin continued until Kaitlyn returned from recovery and Charlie was placed in her arms. By now exhausted and recovering from the effects of a general anaesthetic, she was nonetheless keen to cuddle her baby and spent some time holding her by her side before moving on to skin to skin and an attempt at the breast. The new family were able to be together until Ashley returned home to get some sleep, at which point it was just Kaitlyn, Charlie and I alone. Eventually I dressed the baby for the first time and placed her in the cot alongside her mother and left them for the night.
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Day Zero: Saturday. April 13

I arrived in time to see my friend, fellow counsellor and hospital lactation consultant Janette help Kaitlyn successfully get Charlie on the breast. Janette had come in on her weekend to see the new mother and baby and give them all the help she could. There had been one feed attempt in the early hours of the morning and the midwife had helped with hand expressing. This would continue to be the pattern for the day, attempting the breast, hand-expressing colostrum and feeding that by finger and almost constant skin to skin in between. Both mother and baby were in recovery mode after the birth, Kaitlyn finding the cannula in her arm both annoying, painful and limiting the use of her hand to support attachment. Charlie was starting to become jaundiced and beginning to show signs of neck discomfort after the assisted delivery. I got to reacquaint myself with my old skill of hand-expressing and was declared to be gentler than the midwife that morning! My modest daughter had gone for good and happily had me handling her breasts like my own. I spent some time holding Charlie against my chest, with her face against my skin while Ashley helped Kaitlyn shower and she had some brief moments in the arms of immediate family visiting, but otherwise she was with Kaitlyn through until I left them to sleep for the night. Janette made a second visit in the early evening and I returned from a quick trip home to again find her successfully helping Charlie attach. Janette also brought in the Medela Symphony Pump with a Premmie card and showed Kaitlyn how to use it before feeds, to stimulate her breasts. Then they had a quiet evening, as Ashley was out wetting the babys head and then getting some sleep, so it was just mother and baby, with me there to assist. It was reluctantly I took Charlie from her cosy snuggle with Mum to put her again in the cot, complying with hospital policy on bedsharing, but I couldnt stay all night to supervise their co-sleeping, so it had to be done!
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Day 1: Sunday April 14
Today was all about getting milk out of the breasts and into the baby. The clock was ticking towards the 48 hour weigh-in at 7pm and we werent seeing much in the way of wet or dirty nappies. Every drop that could be expressed was gathered and carefully syringed into Charlies willing mouth and her cot was placed in front of the window to help with her now-official mild jaundice. Kaitlyns increasingly-annoying cannula was finally removed and Charlie was sucking at the breast, though likely not very effectively. Skin to skin continued to be the priority, along with hand-expressing, the stimulating cycle on the pump and my hands providing compressions during feeding and expressing. The midwives were fantastic, all on the same page as we were with regard to the breastfeeding management. Most mothers complain of the conflicting advice they receive at this stage but this wasnt an issue, as my role was fully respected and often we would suggest a plan which they were happy to follow. Positive discussions about breastfeeding eventually led to a seed being planted that what Charlie needed most right now was breastmilk. Due to Ashleys history of asthma and his mother not having breastfed, we were very conscious of avoiding formula at all costs. Kaitlyns body was working hard but the medical reasons for later milk transition were stacked high. What everyone needed now was time. A quick text to a breastfeeding friend resulted in the swift delivery of some donor milk, which we began feeding Charlie by cup. Plans were made to go home that afternoon, to allow Kaitlyn to be in her own space and take away the normal intrusions of a hospital ward despite having a single room, Charlie had been disturbed the night before by the sound of other babies crying. They were home by 6pm, with the weigh-in now delayed until the first domiciliary midwife visit the following morning. Armed with the donated milk 100mls in all and the Symphony double pump I had arranged the day before, we worked as a team on the two goals: getting milk into Charlie by cup and milk out of Kaitlyn by hand and pump, with skin to skin and time on the breast in between. Grandpa was sent on a mission to buy nipple shields to help Charlie attach more easily.
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Day Two Monday April 15

Morning came and so did the midwife one we had met previously! Almost at the same time, our chiropractor arrived, responding to my phoned request for a visit. The donor milk had done the trick and kept the weight loss above the 10% and the adjustment saw an improvement in Charlie almost immediately. The use of the donor milk was completely accepted by all and another visit was arranged for Wednesday afternoon. Another visitor was also on her way Pinky McKay bringing a supply of lactation cookies, books and love. The appearance of Kaitlyns milk moved quickly to transitional milk and we celebrated the first measurable out-put we collected: 1ml!
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Day Three Tuesday April 16

Just when things seemed to be improving, Charlie began not going on the breast at all. For a whole day, attempted feeds were unsuccessful and she was cup-fed donor milk entirely. She was starting to come out of the newborn fog and didnt seem to have the patience to attach. It was another day of skin to skin and concerted pumping Kaitlyns milk was steadily increasing and being fed before each donor feed. And then, almost magically, they went to bed and Charlie attached immediately to the breast and continued to do so!
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Day Four Wednesday April 17 The day began with a second adjustment by the chiropractor, this time at his rooms and also a routine one for mum.
This was followed by a visit to the breastfeeding drop-in run by the hospital and staffed by Janette for some reassurance and support. My suspicions of tongue and upper lip ties were confirmed by Janette, who had spotted them on the first day but was watching and waiting. We made the first available appointment with a GP/LC who assesses and treats tongue ties, for Saturday, and I put out feelers online for who treats lip ties in Melbourne and was consistently told the same paediatric dentist! We decided to wait on the opinion of the GP/LC before following up on the lip.
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Then it was home to wait for the second midwife visit. A different nurse, she was highly supportive of Kaitlyns breastfeeding plan but also noted Charlie had dropped another 10gms. There had not been any dirty nappies since Monday and although the jaundice had cleared, we were not out of the woods yet. Knowing we were using donor milk, she suggested we increase the volume of feeds and give them by bottle, rather than continue the cup with larger amounts. While both parents and baby had a nap, I used social media and my network of breastfeeding supporters and by the time they all woke, the first delivery had been made, others were on the way and we had offers of even more if we should need it! Suddenly, there was about a litre of breastmilk in the freezer! We moved to offering 50-60ml after every breastfeed and Kaitlyn began a marathon of milk stimulating strategies. In addition to the lactation cookies, I purchased supplements combining fenugreek and milk thistle. The jury is out on whether such galactagogues work there are no evidence-based studies to draw a conclusion from a science perspective (probably because no drug company would bother funding such a study into natural herbs already widely available) but anecdotally, many women claim an increase in supply. They were worth having in our tool-box. But the important thing we do know about galactagogues is they do not work in isolation milk must be actively removed to increase production. One tool I have found very successful with other mums is the practice of hands-on pumping: breast compression during double or single pumping, followed by hand expression, done frequently. I told Kaitlyn I was going into nagging-mode and sent her older sister off to Mothers Direct to purchase a bustier-bra designed to allow hands-free double pumping, which then allows free hands for breast compression. This also allowed pumping while the hands were at rest or while eating etc. This would ease the strain of holding the kits in place.
Yvette ODowd 2013
Yvette ODowd 2013
Day Five Thursday April 18th

One familiar goal today get milk into Charlie, get milk out of breasts! With the pump moved to the lounge room, Kaitlyn set up a nest where she sat pumping, compressing, expressing, feeding, eating, holding Charlie skin to skin and watching TV or using her iPad. Apart from toilet breaks and lying in bed feeding when they both slept, it was really about 36 hours of rinse & repeat! This cycle was unexpectedly, but willingly, interrupted when the GP/LCs office rang to say they had a cancellation and could we be there at 2pm today! We said of course and headed in to see her. She confirmed there was a sub-mucosal tongue-tie and an upper lip tie, was able to get Charlie on the breast and observe milk transfer and suggested a wait and see approach. The tissue available to snip might not be enough to make a significant difference, a week or two of growth could make a big difference and although Charlie was feeding with nipple shields, she could attach without them. Happy with this advice, we headed home to the couch and the pump!
Yvette ODowd 2013
Day Six Friday April 19

Weigh in day! Kaitlyns breasts were now releasing about 40mls from each breast, in addition to milk taken during direct feeds and we still had donor milk in the freezer. We were still nervously awaiting poo, have only seen a hint of it on Wednesday and none since! We knew the amount of milk going in and were getting heavy, wet nappies, so were confident in our anticipation! We arranged for a fellow counsellor who is also an osteopath to visit on Saturday morning, hoping an adjustment might help. We headed in to the hospital for the final midwife check and hearing test and were greeted by one of the midwives I have known for twenty years! She placed the baby on the scale and all Kaitlyns hard work had paid off Charlie had gained 120gms! We were confident it was now just a matter of mother and baby getting in sync and going from there. Released from pumping, Kaitlyn and I headed out for some errands and time-out. After a stop at the drop-in at Preggi Central to see the community midwife we had met during the pregnancy, Charlie then slept through a visit to Centrelink, popping in to see her aunty and friends at Savers and a quick lunch stop at a caf and then woke to feed when we got to the chiropractor for my adjustment!
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Day 7 Saturday April 20

Still waiting for poo, we welcomed Lauren to give Charlie some osteopathy. Kaitlyn was still pumping frequently and topping up with her own EBM, but we had stopped offering donor milk now.
Well, Lauren must have found and activated the poo button, because soon after the first arrived and then they started coming almost constantly! Swiftly transitioning into the familiar mustard-yellow breastfed-babys bowel output, we were soon in the familiar territory of barely a urine-only nappy! Correspondingly, Charlie also began acting like a Day Four baby and was more wakeful and unsettled. Catch-up mode had begun!
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Day Eight Sunday April 21

Only pumping occasionally now, Charlie took over milk removal full-time. Although feeding with a nipple shield, Kaitlyns supply was now good to abundant and there was plenty of milk being transferred. In fact, maybe a little too much! Where only days before she had been switch feeding, now I suggested keeping Charlie on one side until she complained, even if she went to the breast multiple times in a feeding session. Hopefully this would get more fat into her, satisfying her and slowing down the now high-speed poo! Remembering my own over-abundant supply and my mother saying she always had more than enough, I started to wonder if some genetic factor had kicked in!!
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Day Nine Monday April 22

Having gone home at night the past couple of nights, I was dismayed to find out Kaitlyn had been up with a constantly-feeding, unsettled baby. Despite me saying to ring if she needed me, she was reluctant to and also didnt wake her husband who was working the next day. Now that Kaitlyn had completed her antibiotics, I was alert to the potential for thrush and had started her on probiotics. Charlie was beginning to get a bit of redness on her bottom, possibly due to the influx of poo. I started to keep an eye on it. Kaitlyn still had one small area of damage on one nipple which had been there since before they started using the shield. We were keeping an eye on that, too. Kaitlyn had managed to stay on top of her pumping and feeding while her milk came in and avoided engorgement. She had used breast compression to effectively drain areas of fullness during feeding and her breasts were comfortable. And when she wasnt unsettled, Charlie was pretty blissed-out on breastmilk! The Maternal and Child Health Nurse visited and revealed that Charlie had gained a whopping 130gms in 3 day!
Yvette ODowd 2013
Yvette ODowd 2013
Day Ten Tuesday April 23

Another unsettled night, but this time Kaitlyn woke Ashley. Charlie was happy to feed, but only when Kaitlyn was sitting up, not content with her usual bed-sharing feeding lying down. Even her third bath at 2am didnt settle her but in the end, a womb-sound app on mums iPad did the trick. We had tried some white noise a few days before with mixed results but this time it did the trick. I packed my overnight bag and planned to stay again. I also bought a white noise toy which played various sounds and we began trying that when settling her. She seemed to like the whale sounds best.
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Day Eleven Wednesday April 24

Because I cannot sleep without medication, I was awake all night, unlike Charlie and Kaitlyn. Turns out the night before had been the last in this fussy period and they both slept well. The hours lying beside her as they bed-shared are an insight into how natural breastfeeding was designed; it was like being the camera used in Helen Balls' research! Kaitlyn was surprised to hear how much Charlie actually feeds during the night, as she felt it wasn't very often. To the contrary, feeding was almost continuous! Recognising their sleep stages by their breathing, I could feel when a feed would start and end. Kaitlyn would rouse only enough to make sure the nipple shield remained in place and that Charlie went on, then fall straight back into her light sleep stage. Charlie would actively suck until she too fell asleep. Every time I checked the point where mouth and nipple meet, they were connected, even when both were in a deep sleep stage, indicated particularly by Charlie's completely relaxed and heavy arm falling away from the body. Kaitlyn mostly remained on the one side, staying in the natural co-sleeping position and only once did she wake having rolled over leaving Charlie on the other side - apparently waking because of that. At no stage was Charlie anywhere near my body, in fact, she did not move from the position she took when they first lay down. All this just consolidates further my commitment to bed-sharing as a normal, natural part of breastfeeding. Awaking refreshed (Kaitlyn and Charlie) and functional (me) we headed to the chiropractor for Kaitlyn and the breastfeeding drop-in. Here my suspicions of impending thrush were supported by LC Nicole and Daktozin cream was suggested for Charlies bottom and Kenacomb for Kaitlyns nipples: both treat fungal AND bacterial infections. Research shows that many cases of thrush are actually staph infections, leading to ongoing infection if only treated with anti-fungals. We needed to visit the GP to get a prescription for the Kenacomb. Then it was time for some time-off! Kaitlyns sister joined us for a walk to the shops, lunch and some girl time.
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Day Twelve Thursday April 25

I stayed over but got a full nights sleep. Today would be a session with the photographer, another friend and ABA member and supporter, Susan Drcy. All went well until we were ready to do the sleeping shots, at which stage Charlie decided sleep was a concept with which she was unfamiliar and wanted a feed marathon instead! So we rebooked for Tuesday, Susan and her own 4mo baby left for the next job and Charlie promptly went to sleep! So much so, we were able to head to the shops by car, move her from car-seat to hug-a-bub and shop and eat lunch while she slept! She even went back into the car seat and slept when we got home!
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Day Thirteen Friday April 26

Down to visit the Maternal and Child Health Nurse for the two week check. Charlie was bang-on her birth weight, the goal to be reached by two weeks! The nurse also thought the nappy rash looked like thrush, so we headed off to the GP to get the prescription for Kenacomb for the nipples. But later that evening, Kaitlyn messaged me to say she thought she might be developing thrush in the area of her stitches. We agreed to head to the GP first thing, for prescriptions for thrush treatment for both and assessment of her sore perineum.
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Day 14 Saturday April 27

Back to the GP, printout of thrush in lactation policy in hand, to his relief, I seemed to know exactly what he needed to do and he wrote the needed scripts. He also took a swab to confirm if Kaitlyn was infected by thrush/staph or nothing at all at the wound site. Back again to the chemist for more tablets for mum and oral gel for Charlie. Then back home to boil everything that had touched the breast or milk, to reduce risk of reinfection and instigate a higher level of hygiene.
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Day 15 Sunday April 28

Today was a relatively normal day and the end of this daily narrative. Charlie is a frequent but contented feeder who mostly sleeps well at night in the bed she shares with her parents. I love watching my daughter practice natural breastfeeding. No timing of feeds, no stressing over how long they take, just responding to her daughters needs with love and respect. Keeping her close and providing the breast whenever it is sought, day and night, keeping her in arms between feeds. The calm, contented baby has an unsettled time each day and her mum surrenders to the cluster feeding and soothes her in arms as needed. None of this was taught but all was learned though growing up around women who parent gently and know natural breastfeeding is unstructured and unrestricted, so vital in these early months and years. My granddaughter will also grow up to know this truth. She continues to feed via nipple shield and will do so until her tongue tie snip on May 9th and upper lip tie on May 22nd. After that we will wean her from the shields and correct any attachment issues as needed. Ashley is now back to his normal work hours overnight so Kaitlyn and Charlie will be on their own, unless they need to call on me for support. We have started freezing excess breastmilk pumped for comfort.
You might wonder how Kaitlyns visitors and home support have been over the past two weeks? As requested, only immediate family came to see them in hospital and that was by appointment only, with Dad making the arrangements - everyone would contact him and make a time to come. After their return home, visits have continued to follow this arrangement, as the circle of family and friends have slowly been introduced to Charlie at times that suit the family. Dad makes sure they get a quick cuddle and a photo, then baby goes back to mum to start, continue or complete the feed she was bound to be ready for! Numbers of visitors at any one time have been limited and drop-ins not
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encouraged. (Even I always let them know when I plan to visit and check that works for them - and they let me know if they want me to give them space - or sleep over for extra help!) From a support perspective, Ash's Mum has been providing a steady stream of nourishing meals, while I have been on washing and kitchen duty. Cycling the laundry through and keeping on top of it began during the days (!) of labour and continues to be part of my daily visits. As well, I keep the dishes under control and have been in charge of all milk expression equipment maintenance. As we head toward the halfway point of the traditional 40 days, Kaitlyn has been able to focus on breastfeeding and caring for Charlie while Ashley has been able to nurture them and manage his return to work just days after they returned from hospital.
Three Weeks:
Kaitlyn and Charlie are now venturing out into the world more widely and confidently manage feeds with the nipple shield. When asked how often Charlie breastfeeds, Kaitlyn shrugs and answers that she cluster feeds! Charlie is a very frequent feeder who comes off the breast sleepy, burps easily and briefly naps in arms before repeating the process. She sleeps longest in a baby sling or carrier or when held. Luckily, she was born into a family of baby-wearers and cuddlers who think this quite normal! At night, she co-sleeps and her feeds barely interrupt her mums sleep - rarely her dads! The planned visit to the LC/GP for the tongue tie snip saw her defer to the upcoming laser treatment in preference to her treatment. As she explained, the laser would reach more tissue and meant one invasive experience instead of two for Charlie. However, she did prescribe further treatment for mother and baby in the ongoing battle against thrush.
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Four weeks: May 10th

At her check-up, Charlie has gained an impressive 3cms in length, more than one centimetre in head circumference and 175gms in weight. The length is evident in her arms and legs in the week beforehand, when she had visibly looked longer and her family are confident in her growth. However, the expected weight gain of 200gms had not been reached and the child health nurse suggests expressing and topping up, with a follow-up weigh-in the following week. Charlie is a prolific pooer and a heavy wetter, so nobody is really too concerned. in fact, in the hour prior to weighing, she did an impressive wee all over the playmat beneath her standing mother, who was holding her nappyfree in the third attempt to get her newborn photos taken! She then weeed all over the nurses counter when being stripped down for weighing! The photo shoot was successful; when Kaitlyn figured out that breastfeeding Charlie in-situ would result in a long enough nap to get those precious, sleeping photos!
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Five Weeks: May 17th

After an informal weigh at the breastfeeding drop-in on Wednesday, when Charlie had gained 130gms in five days, it was no surprise to find she reached a 170gm by the Friday weigh-in. She had gained in one week about the same she had gained in two weeks! A good example that gain in length often occurs first, with an increase of weight to follow, as the child fills out their growth.
Six Weeks: May 24th

Charlie was treated for her sub-mucosal posterior tongue tie and upper lip tie. There is one paediatric dentist in Melbourne who uses laser to do frenectomies, so that's who we made an appointment with after seeking opinions from LCs and an LC/GP. We left home very early to drive to the other side of Melbourne for the 8.45am appointment! They like to treat the babies first thing, to minimise delay. Kaitlyn, Kaitlyn's MIL Di and I all went, her dad being unable to get time off work (and best not there, as he doesn't handle blood very well!). The dentist was fantastic, very respectful of the LC/GP's opinion and my role as a counsellor and spoke to me in technical terms, but also explained everything very simply for Di - who has not breastfed and had no experience of any of this - and for Kaitlyn - who has a surprising knowledge even before it became first-hand! He then explained how they restrain the baby: they use a good cop/bad cop system: mum is the good cop who offers the breast immediately the procedure is complete. And I got to be the bad cop, who lies reclined on the dental chair, with the baby lying on her back with her head on my right shoulder. My left hand covered her eyes while my right held down both arms. Yay! Granny of the year award!! Kaitlyn was out of line of sight so she didn't see the procedure and Di supported her. There were a few tears.
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It was very quick. He had shown us exactly where he would laser - above and below the salivary glands under the tongue and the quite extensive lip tie. He said there would be a burning smell, but that was his instrument, not the baby and said older children and adults describe it as a pins and needles sensation. As soon as it was finished, I was to be sat up and pass the baby straight to the breast. Charlie cried, but I think it was more about being on her back, restrained and having gloved hands in and around her mouth. As I handed her to Kaitlyn, there was a spot of blood on her shirt. We had previously decided to feed her with the nipple shield, as usual, rather than try her straight on the breast in the circumstances. She went straight on and fed for about 15 mins. When she came off, there was smeared blood around the part of her face the shield had touched, but not a great deal.
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While she fed, the dentist asked me to tell him all about nipple shields and their reasons for use!
Charlie fed normally until about 1pm, when she must have caught the underside of her tongue on the shield. We then had a bit of a meltdown which finally resolved with some baby panadol, which he had said she might need. He had also said, because her lip tie was extensive, that there might be some swelling in the lip and a slight risk of infection but that breastmilk would minimise that and was also the best thing for pain relief. The after-care is some exercises and applying vitamin E oil from day 3 to day 10. There is a check-up after 7 days. If any revision is needed they will do that at no extra charge. The cost? $500!! Ouch. We are pretty sure it won't be covered under their general dental cover. However, the expected effect on her breastfeeding is well worth it. Charlie has been able to attach to the breast without the shield but not maintain the latch. Her lip tie has meant that the lip doesn't flange at all over the breast and there isn't a good seal, with milk leaking. The tongue was not able to remain extended for more than a moment or two. She has fed via nipple shield since coming home from the hospital.
Seven Weeks: May 31st

In the spirit of keeping me on my toes, the dreaded infection/thrush cycle has been in place, with Kaitlyn's wound (perineum) becoming infected with a little bit of thrush and a little bit of bacteria, meaning she has been on treatment for one followed by treatment for the other for most of the six weeks since birth. The small area of infection on one nipple was resolved with the cream which treated both and her wound is no longer showing signs of either infection. But Charlie's nappy rash has flared up again in the past few days. She is back on Dakatrin for her mouth and Daktozen for her bum. Kaitlyn has started her repeat prescription of Nilstat just in case. With barely any sign of the laser treatment, Kaitlyn attended the breastfeeding drop-in to get some support to help teach Charlie to attach and feed without the nipple shield. Just because she now could didnt mean she would! After six weeks feeding via the silicone, there was a chance she would refuse the naked breast.
Yvette ODowd 2013
After trying in the cradle-hold and underarm-hold, both without success, Nicole encouraged Kaitlyn to lie down on the floor mat. This worked! After a few attempts, she latched without the shield, had a long feed, needed an outfit change with her nappy, had another feed and fell fast asleep on the floor! When she later woke, she fed on both breasts in the cradle position with Kaitlyn sitting on the couch (a relief, as the thought of only being able to feed lying down would seriously impact on their coffee shop habits!)
Yvette ODowd 2013
Yvette ODowd 2013
Sixteen weeks: August 2nd

Charlie continues to breastfeed, mostly with the nipple shield. In the end, it is what is easiest for mum and baby. Kaitlyn has a healthy milk supply and Charlie now feeds quickly at the breast. This week is World Breastfeeding Week and the theme is one of mother to mother breastfeeding support. There is no doubt at all that, without the support she had, Kaitlyns breastfeeding experience could have been over barely after it began. In fact, this story illustrates just why so many do not meet their breastfeeding goals. Mothers do not fail to breastfeed, we as a society fail to give them the support they need to overcome the challenges that we often create for them. As I have 21 years experience as a volunteer breastfeeding counsellor, many people were surprised that my own daughter should have such complex problems establishing breastfeeding. After all, she had grown up learning about breastfeeding, hearing me take calls on the Breastfeeding Helpline, seeing me teach antenatal classes and spending time with breastfeeding mothers. I think this illustrates just how vital it is that we do not under-play the difficulty of breastfeeding in our modern society and encourage all pregnant women and their partners to attend breastfeeding-specific antenatal education. As a community, we should demand excellence from our health professionals in their skills and knowledge of human lactation and the teaching of new mothers in the techniques to establish and maintain breastfeeding. The bare minimum we should provide to all new mothers is a continuum of care from labour through the first 40 days, with skilled lactation support offered seamlessly between hospital and home. As a new mother, I dreamed of a future for my own daughters where organisations such as the Nursing Mothers Association of Australia (now Australian Breastfeeding Association) would no longer be needed, as the whole community would provide breastfeeding education and support. Almost thirty years later, I find that the issues I faced are largely still factors and that new ones have added to the challenge. Now I look forward another generation, to the time Charlie comes to breastfeed her own babies and I wonder if I will look back to this time as the bad old days or will I need to step up alongside Kaitlyn to seek out the very best support possible? Only time will tell.
Yvette ODowd 2013

Breastfeeding Charlie: It Took A Village

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Yvette ODowd 2013