Friday, July 25, 2008

Newborn and premie stuff

So, as many of you know, I'm a breast feeding mom. I am not a militant about it, but it is what I chose for my kids, even though we can get free formula for a year through hubby's work. I support nursing moms and formula feeding moms, but really encourage all women to at least try it. But I'm not one to bash anyone for NOT trying it, okay? But I am committed to try everything I can to make it work for us.

So here's the problem that led to the hospitalization: Mojo's tiny premie mouth is too small for my giant milk-producing boobs (which are still smaller than *ahem* some of my friends' boobs). He was fine when it was just the colostrum (mom-speak: the initial "milk" that moms make during pregnancy and right when the baby is born -- it is calorie rich but not much in volume), because my boobs weren't ginormous yet. When my milk came in, it hit about the same time as the jaundice (mom-speak: when the liver isn't getting flushed enough and makes a substance called bilirubin build up in the baby, causing the skin and eyes to go yellow and it spreads; if it gets bad enough can cause brain damage) started getting bad enough to make him more sleepy and tired, and he was spending more calories trying to get milk out than he was getting out of the milk, partly because he's a premie and they have to work so hard to nurse because their muscles just aren't quite developed enough. He wasn't making enough wet or messy diapers, either. I'd called our pediatrician Monday, but his bilirubin wasn't high enough to cause concern (yet), but Tuesday's level had jumped almost to 21 (brain damage = 25). SO, we went to the on-call pediatrician's office Tuesday for a weight check and found that he'd lost a pound in 4 days. NOT GOOD. The dehydration and jaundice feed off of each other. After a bit of drama (sparing details), we got him admitted to the hospital.

The way to get rid of jaundice is to put the baby under special "bili" lights, which force it out (the sun helps, but only if they're getting enough fluids) and hydrate with lots of fluids. So they gave him two bottles of formula and some expressed breast milk while he was in the crib under the most powerful lights they have. For whatever reason, even though there is milk in the boobages, it is not coming out well for a pump, not even with the power hospital pump. The next time they let me feed him from the tap, he decided to nurse on one side then opened his mouth and acted like, "okay, pour it in mom." Well. Hormones are just raging anyway, and this made me sad and depressed. However, his bilirubin level after that first 8 hours under the lights and with the fluids dropped to 17.6, which is a huge drop for just a few hours. So I decided I didn't care if we supplement with formula, but asked the (same on-call) doc and nurses to please do so with a syringe since he wouldn't take the boob afterward. The day nurses did, but the night nurses didn't (which pissed me off).

The next morning, they had a lactation consultant (mom-speak: a nurse who specializes in helping moms breast feed better) come in and help us figure out how to get his tiny mouth latched on correctly to get enough milk coming out. We're also supplementing with a tiny tube that we stick in his mouth while he's nursing that is connected to a syringe which holds either expressed milk or soy formula, and she taught me how to use that. She spent about 15 minutes with us and really helped out, although she said she hadn't told me anything I didn't already know. lol. Not true -- she really helped a ton.

The regular pediatrician recommended we continue supplementing with expressed breast milk and formula until my milk supply builds enough to be all that sustains him, but he also has to work through the premie "lazy" suck. The pediatrician doesn't like those tubes, but when I told him how he acted after the bottles, he said, "oh, let's put our foot down on his laziness. We'll use the catheter after all." Which, the catheter was totally my idea in the middle of the night (thank you Lord for inspiration) when I was crying and frustrated about how to get enough fluids in my baby boy.

One other problem we faced was the fact that, after the initial bottle, every time they gave him a cow-based formula, he started puking everywhere. So I asked to switch to soy, which he drinks and processes just fine. Hubby is lactose intolerant, but really I think he has a cow's milk allergy, and I had one too when I was a kid. So it made sense to me to try the other, and the doc agreed to give it a go.

So, the routine now is that I breast feed 10-15 minutes per side, giving him the tube feed once the milk rate slows to a point he gets lazy so he has to suck more, then I pump for 10-15 minutes (all of which takes 45-60 minutes total), and then we sleep for two hours. Then we start all over again. BUT he is nursing better, he is flooding out diapers (on his sister, hehehehe), he is pooping (which is cause for celebration even if it is gross), and he is gaining weight. He put on 3 ounces in two days at the hospickle, and I'll take him for a weight check on Monday to the lactation clinic (probably) to see how much he's gained since we left the hospickle.

So that is that, so if you don't hear from me much, now you know why. Hoping by the time I have to go back to work in a couple weeks we're off the pump and formula, but we'll see!

Gotta shower -- have to get the bilirubin checked again. Mwah.


Melanie said...

Hey, it's Melanie. Congrats!!!Here's a huge HUG!!! I know just how you feel on some of this stuff! Tanner was early and did the same thing that your new one is doing. Hang in there it will get better. Just keep working with the nursing thing, it's worth it!!
And give me a call if you need anything! I have premie boy clothes!! I know they can be hard to find.

oh just ehu. said...

Wow! I thought breast feeding was a lot easier than that. Crazy business!

THANKS for the "Mom-Speak"! I totally appreciate it!!

"power hospital pump"--does that hurt?! That doesn't sound too pleasant.

evitafjord said...

Do you have a pump for home? I have a good electric double that I don't need anymore and could possibly bring you in about 3 weeks (or mail sooner).

By the way, I'm not sure I said CONGRATULATIONS yet :-).

stewbert said...

I have one my sister gave me to use -- it's an Ameda pump, light green ... spacing out the name though.

evitafjord said...

Mine is an Ameda Purely Yours. Well, if you don't want it, maybe I will bring it for Jen or my SIL who is getting all of my maternity clothes.

stewbert said...

Oh, that is the same one (I looked!). Thank you so much for the offer -- I really would've taken it if sis hadn't brought me hers. :)

evitafjord said...

No problem. I booked a flight tonight, (Sam and I) will be staying at Melanie's 8/14-8/16. Jen is thinking of coming down on the 14th. Want to party? (or at least visit?)

stewbert said...

Yes, I do. I responded to your email. :)