Breastmilk, formula and mother guilt

I keep seeing this issue come up for premmie mums. You’ve expressed for your baby while they are in the NICU (and often longer) as much as you could, you’ve given breastfeeding your best shot, but at some point despite all your best efforts it just doesn’t work out, you can’t keep your milk flowing and it feels like the end of the world.

You are not alone in feeling this way.

First, if you’ve expressed milk for your child while they were in hospital, woken up in the middle of the night at home to attach yourself to a breastpump far away from the child you want to be holding, and endured all the dairy cow comparisons, you are a legend. You have given your child the most amazing gift, one which has made the awful hospital journey that much easier for them to negotiate. You’ve dealt with stress, grief, fear and everything else on the emotional roller coaster and still delivered the elixir of life. As time passes, I hope you will look back on this achievement, as I do, with considerable pride.

If you’ve managed to establish breastfeeding, you are a champion – and so is your prem! It’s not easy trying to suck when you’re on CPAP or have an NG tube in the way. You might have had a prem with a weak suck, or who needed the help of a nipple shield, or other assistance. It may have been a battle getting nurses to stop tube feeding or topping up while you’re trying to move to all suck feeds. It’s nothing like the pictures in the hospital of chubby full term babies instinctively suckling within hours of their birth. Yet your persistence has been rewarded by the amazing feeling of your child connecting with you in one of the most powerful maternal bonding experiences around. This moment may be fleeting but it is definitely one to treasure.

Then things go pear-shaped. Your baby isn’t gaining weight, the stresses and strains of the whole prem experience lead to supply issues, you just can’t bear to keep expressing after everything you’ve been through. Or maybe you expressed or breastfed for months and months after coming home – but you wanted to keep going for longer, and it just isn’t working out. You’ve searched the internet for every possible means to increase your milk supply, you’ve been on prescription drugs but even they don’t help, and despite everything the pro breastfeeding lobby says (and you consider yourself a pro breastfeeding mother) sometimes mothers don’t produce enough milk to keep both baby AND mother healthy. Because ultimately your mental health is just as important as your baby’s physical health – and sometimes this gets overlooked. I was on the verge of serious postnatal depression because I was so worried about Talia’s lack of growth and my inability to produce more milk for her, when I desperately wanted to keep breastfeeding.

Then comes the awful moment, the time you had always thought you could avoid – when you have to go and buy a tin of formula. For me this came when Talia was about 6 months old, 3 months corrected. Personally I found this step so horrible that I looked at tins many times, picked them up and read them but couldn’t put them in my trolley. My mother (who was hugely supportive of my breastfeeding goals, and very impressed with the resources available to help me, such as the Breastfeeding Centre etc) reminded me gently that I had gone onto formula at 6 weeks of age during the 1970s when breastfeeding levels were at an all time low and support for mothers to breastfeed was minimal – and I’d turned out OK, and no-one could tell whether I’d been breastfed or not.

Eventually it was my sensible GP (who is a mother herself and had done all she could to help me by giving me a 6 month prescription of motilium) who asked me to consider making the move, because she could see I was digging a big hole for myself psychologically, and didn’t think depression would benefit either Talia or me. She also reassured me that I had done an amazing job to breastfeed under the circumstances – and eventually I believed her. Still, the first day I offered formula I was still a mess of tears and disappointment. I hadn’t cared about getting a big pregnant belly, I didn’t feel guilt about her early arrival, but not being able to continue breastfeeding felt so much like failure.

I continued to breastfeed as well as formula feed for several months, but Talia found the bottle so much easier and eventually my supply which had never been plentiful dwindled beyond redemption. However, I gradually relaxed and was able to enjoy it without worrying so much about her weight gain.

Now I look back and things are much more in perspective – the joy of 20:20 hindsight.  It’s true that no-one can tell which babies were breast fed and which were formula fed.  It’s true that giving my daughter breastmilk while she was in hospital was the most critical thing, and that anything beyond that was a bonus. It’s true that I fed for longer than some mothers did, and for a shorter time than others, that I produced more milk than some but less than others – but it’s not about comparing yourself to other mothers. I know I did my best under the circumstances I faced, which is as much I could realistically ask of myself, and that’s all that matters now. The guilt has gone the way of my breastfeeding cleavage, and it is not missed at all – unlike the cleavage.

This article first published at Prem in Perth

Talia at 18 months

Doesn’t time fly? It’s hard to imagine that a year ago this gorgeous almost-toddler was almost failing to thrive, and I was struggling with post-natal depression as a result.

Talia at 18 months

Talia at 18 months

Now she’s a little above the 10th percentile at 9.33kg and 74cm long, and has made the move into size 0 and size 1 clothing. I pulled out her summer clothing from last year and marvelled how 000 could look so small, when at first we could hardly imagine she would ever be big enough to wear it. We’ve come through winter with only two minor colds, which is fantastic given that she left hospital with chronic lung disease.

Developmentally speaking, Talia still exhibits global delays, but they do not stop her enjoying life immensely. She is nearly walking, having taken her first few steps, but is happier crawling at the moment – including some new crab walking with her bottom in the air. She recently started baby swimming classes (known here as “synchronised splashing”) and hopefully that will help her core body strength as well as giving her confidence around water.

Her favourite activities at the moment are going on the swing in the park, reading books, playing with balls, pegs and balloons, popping bubbles, starting games of peek-a-boo and hanging out with her bath toys. She has recently grasped the concept of putting pieces into a simple jigsaw (no interlocking pieces) but doesn’t have the dexterity to complete it by herself just yet.

Talia at 6 months (3 corrected) - one year ago.

Talia at 6 months (3 corrected) – one year ago.

Eating is still patchy, with the same problems of “loved it yesterday, hate it today, don’t even bother tomorrow”, but she’s continuing to gain (and grow out of things) despite the fact that she’s almost 100% self fed on finger food and I’m no closer to getting her to eat off a spoon, regardless of whether I’m holding it or she is. On the positive side, we can feed her a little bit of whatever we are having and no longer have to rely on food organised specifically for her (although we still do to some extent), and we’ve moved from formula to cow’s milk in the last month without any problems – in fact she clearly prefers it.

She will sometimes allow us to brush her teeth but it does take quite a bit of persistence. She sleeps well overnight and has one nap in the middle of the day, usually 1-1.5 hours long. I wish she’d sleep longer during the day but no luck so far – her room is probably not dark enough.

All in all, a wonderful, easy-care baby, even if she came without a manual! We feel very fortunate, and very proud.

Premature girls get more from breast milk

Premature baby girls appear to get greater benefit from breastfeeding compared than premature baby boys, according to new research.

Researchers from Johns Hopkins University in the United States tracked a group of premature infants in Argentina to gauge the protective effect of breastfeeding against respiratory infections in babies.

The results of their research are published in this month’s edition of Pediatrics.

They found that infant girls who were breastfed were far less likely than baby boys who were breastfed to develop serious respiratory infections requiring hospitalisation.

Previous research has shown that breastfed babies receive a range of health benefits compared to those given baby formula.

These range from combating respiratory infections, fewer ear, stomach or intestinal infections, digestive problems, skin diseases and allergies.

“There are many, many different diseases that are protected against by breast-feeding. It’s a great source of nutrition,” Dr Fernando Polack of Johns Hopkins University says.

“In the specific case of acute respiratory diseases like bronchiolitis and viral infections of the respiratory tract, it seems that there is greater benefit in girls than in boys. And that benefit is substantial.”

Breathing easier

Bronchiolitis is an infection of the airways of the lungs seen most often in infants between about 3 and 6 months old.

The researchers studied a group of 119 high-risk infants who weighed under about 1.5 kilograms at delivery. This population is highly susceptible to these kinds of infections, Polack says.

Fifty per cent of the baby girls who were formula-fed had to be hospitalised when they experienced their first respiratory infection, compared to about 7 per cent of the girls who were breastfed, the researchers write.

There was no difference between the boys who were breastfed or formula-fed, with about 19 per cent of both groups needing hospitalisation when they got their first respiratory infection, the researchers said.

The pattern repeated throughout the first year of life and in subsequent infections, the researchers say.

Polack said there may be something in the breast milk that better activates a baby girl’s ability to cope with such infections more so than it does for a baby boy.

Article from ABC Science 

The great spoon strike of April ‘08

Since she figured out solids at the end of last year, Talia has been fantastic, eating all sorts of homecooked meat and veg. She had started to catch up with her weight and all was going well… until now.

A week or maybe a little longer ago, she started objecting to receiving food on a spoon, pushing it away with her hands and turning her head to the side. With a bit of ingenuity (”say aaah Talia!”) I could get a spoonful in, and after carefully digesting this first mouthful with all the seriousness of a wine connoisseur judging expensive shiraz (up to but not including the spitting out stage), she would then allow me to feed her the rest of the meal.

I thought I had it all under control until the beginning of this week, when she decided that not even the first spoonful would be considered acceptable, under any circumstances. It has been very difficult to deal with, as I don’t want mealtimes to be a fight, but I can’t let her go without a healthy diet. It’s not that she won’t eat – just that she won’t allow herself to be fed. It wouldn’t matter so much if she was older and able to use a spoon, but at the moment she will only accept a limited range of finger foods – and they are subject to change without warning. Savoury pikelets were a hit on Tuesday but thrown out of the high chair on Wednesday. Raisin toast has come back into favour, as have avocado finger sandwiches, but baked ricotta is now out and her acceptance of random veges appears to depend entirely on her mood, the phase of the moon and whether or not the wind is blowing from the west.

This is the sort of point where you realise that being a mother is a full time job and then some.

Good to the last drop

The bottom drawer of our freezer (we have an “upside-down” fridge) belongs to Talia. It’s full of plastic tubs containing ice-cube-sized portions of stewed fruit, mashed veg, pulverised chicken, flakes of fish in cheese sauce etc. Wedged in the middle of this oyster of solids was a little pearl – the last remaining bottle of my frozen expressed breast milk (EBM).

I’ve rambled at length about the ups and downs of milk production. It wasn’t easy, but it was worth it. I wanted to do more, but now I’m happy that I did as much as I could. If I had to do it all over again, I would. So what’s the story with this bottle of EBM? Talia stopped breastfeeding exclusively last October, and ceased completely at the end of January. It’s now the end of March. This bottle of liquid gold was dated 21/6/07 – the day before Talia came home from hospital. This bottle of milk has reigned, happy and glorious, over the bottom drawer of the freezer for NINE months, as one by one all the other bottles (older) and baggies (younger) of EBM were defrosted and used up. (Don’t worry, my freezer is cold enough that it was safe to keep it longer than the usually recommended three months). This bottle was a testament to my hours of expressing but also a life-line which I had clung to for months in case of emergency, but which was no longer needed now that Talia is healthy and happy with formula and solids.

So last Thursday, a week after Talia’s first birthday, I liberated this vintage bottle from its cryogenic home and defrosted it. On Saturday, Talia’s bottles were half formula and half EBM, the final instalment of my first gift to her. It doesn’t usually happen, but she completely finished every bottle. That night we both went to sleep satisfied.

7 months corrected and eating, eating, eating…

I browse a number of websites for parents of premature babies, and the topic of “when should I start my premature baby on solids” comes up time and again. Some people believe you should go by corrected age, others feel that actual age is appropriate because prem babies are digesting milk from very soon after birth. However, regardless of which side you take, the fact remains that if your baby is not ready to eat, no amount of coaxing and saying “yum, yum!” is going to help.

When Talia was not thriving on just breast milk, I consulted the lactation consultants from the NICU, who suggested I start Talia on solids at 4 months corrected (7 months actual) rather than offer formula. What a joke! Talia was nowhere near ready to start, and my efforts only ended in frustration for me and bewilderment for for my baby. In contrast, she took to the formula like it was nectar of the gods.

Time passed, and every few days or so I would patiently offer up a spoonful of Farex. Perhaps if I’d tried it myself I might have realised how unlikely Talia was to ever show any interest in it. Her expressions of disgust said it all.

I lovingly cooked up pear, sweet potato and pumpkin, pureed it and froze it into ice cubes. I could sneak a smidgeon past her lips – but no more and no further. I expanded the repertoire to include apple, carrot and potato, and suddenly she would eat a cube, and I would think “yes, we are making progress”… but then she would reject the exact same fruit or vegetable the following day.

Somewhere around 6 months corrected (9 months actual) Talia started to accept about 1-2 cubes per day. I had a hit with pumpkin and avocado, figured out how to put peas and corn through the sieve and was starting to feel I was making progress, although it was hardly going to put any weight on her compared to the formula, and her tongue reflex was still strong, so I was spooning in food then having it pushed straight back out again, even when she seemed to enjoy the flavour.

Talia waves a spoon

Then, at almost 7 months, something clicked for Talia. Maybe it was when I started to blend more flavours, maybe it was the introduction of roast chicken or maybe it was just the way the planets were aligned, but suddenly she wanted MORE FOOD and she wanted it NOW.

In the last week, Talia has eaten 3 or 4 meals a day, including at least 2 with meat and veg. (She seems to prefer this to fruit, either mashed with milk, with farex or with yoghurt). She demands to be fed, and leans forward with mouth open to take the next spoonful. It goes in and it stays in – and the proof is in the pudding, so to speak. I had her weighed on Monday and she’d put on 405g in 2 weeks. Not bad for a baby who regularly put on only 30g/week on breastmilk.

I feel as if a difficult chapter of Talia’s journey – the section where I worried myself to the point of depression about her lack of weight gain – is finally over. At the same time, our breastfeeding routine has dropped down to one feed per day, first thing in the morning. Its days are numbered, and I feel a tinge of sadness that this part of our relationship will soon be over, but I am happier to let it go knowing that Talia is making progress in other areas.