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Tuesday, June 18, 2013

Breastfeeding - what a journey, what a lesson

I've been wanting to write this post for the longest time ever since I delivered the twins but I just haven't had the time in between diapering, feeding, burping and pumping. My day starts at between 5.30 to 7.30am daily depending on whether I've managed to get out of bed to pump at 3am, and ends about 10pm, a far cry from those days when I could not crawl out of bed earlier than 8am (pre-pregnancy) and could sleep about 2-3am.

So, about pumping (breast-milk). When I delivered the twins, it was assumed that I would be breastfeeding and the nurses pushed in Twin A into my room the morning I delivered. I had been examining my breasts and they looked the same as they did pre-delivery and I wondered where in the world would the breast-milk come from, especially when I didn't go through the hours of labor which would send a signal to my body to produce milk. Nonetheless, I duly lifted up the little one from her bassinet and latched her on with the lactation consultant's instructions on how to position the baby (body to chest) and how to ensure that her mouth would suckle properly. Well, my little Twin A started suckling well enough which gave me a happiness I have never experienced but my joy lasted only about 1min because she realized there was nothing and turned her little face away.

The lactation consultant (LC) then taught me to how to power massage my breasts which would open up the pores in the nipples, express the colostrum (liquid gold) and encourage milk flow. Then, the LC massaged my breasts each and the pain, oh, the pain was blinding. I kid you not when I compare the pain to having someone use a clothes peg to pinch each nipple and twist. Twist. I could not breathe, could not think - all I felt was pure agony. The pain from the 10cm c-section wound at my lower belly (which I was on painkillers on but did nothing for the breasts' pain) paled in comparison to this pain.

I am not ashamed to mention that I did moan out loud and tear as the LC massaged my breasts. I swore that this was the final straw (that broke the camel's back) and I bemoaned my being born a woman once again. First the horrible pregnancy to bear the twins and now the agony I had to go through to feed the twins. And I was told by the LC that if I wanted to have my breast milk kick in, I had to massage my breasts like I was taught every 3 hours.

Now, my mother had repeatedly told me that I had to breastfeed no matter what - she said that not everything could be bought with money, and unfortunately like my pregnancy, having my body produce breastmilk is one thing that money can't purchase. My CEB and I also knew from reading and the pre-natal sessions that breastmilk was best (full of antibodies). So to me, giving up because of pain wasn't an option. In fact, I even asked my CEB to rent the hospital Medela breast pump for the 4 days I was there as I heard the suction was more powerful than the Medela PISA model I had bought.

So, I started the 3 hour massage. The first 2 massages on my own yielded nothing and I asked for the LC who massaged my breasts again for me. She told me that if I didn't apply enough pressure - i.e. too soft on myself and not pressing hard enough despite the blinding pain, I would not have breast milk. She stood over me and rolled, rubbed, pressed until I had to bite my lips to prevent myself from asking her to stop. I wanted her to stop so the pain would stop yet what I needed overrode what I wanted so I just allowed myself to be lost in the waves of pain.

After what seemed like forever, the LC told me that there was colostrum emerging from each breast and she used a syringe to collect the yellow stuff seeping out of each nipple. I think I could only watch open-mouthed - I was in too much in pain to feel any joy. But But BUT, I was inspired. I figured that since the massages were yielding results, I should just keep at the massaging despite the crazy clothes-peg-on-nipples pain. So from then, I set my alarm to wake up every 3 hours to massage my breasts and grit my teeth through the pain. That, with the hobbling bent in half to the toilet because of the c-section wound was a new lesson in pain for me. Thank goodness my CEB stayed with me throughout. Honestly, I could not have managed on my own - I'm so grateful he booked me an A class ward so he could be there every single hour with me and the twins, to experience this one-in-a-lifetime experience and to help in all the ways he could from supporting me to the toilet to managing visitors to learning how to diaper and feed the twins (he was very hands-on!).

Anyway, back to the breastfeeding story. My mother watched in fascination as I massaged each breast futilely and collected the little colostrum each time in a syringe. Whatever was in the syringe (about 5-10ml after 4-5 rounds of painful massaging) went into each twin's mouth.

I remember on my second night about 2am after I had woken up to massage and pump my breasts (no milk still), I made my way to the nursery to pass the syringe to the nurse to give one of the twins. I remember waiting outside the nursery while they wheeled out one of the little ones (Twin B I think), I remember the satisfaction I got when I pressed the syringe into her mouth to fill it with the precious colostrum (20 mins of pain each massage). I remember wishing I had more so I could give each of the twins some, instead of that pathetic amount which only 1 twin could have every 3 hours, and I told the nurse how I felt like such a lousy mother because I had no milk and so little colostrum.

The next morning, I heard the night shift nurses briefing the day shift nurses outside my room on what I had said. Within an hour, the LC was at my bedside massaging my breasts and squeezing out even more colostrum. At her angle standing over me, I think she was able to exert more force and open more pores (the pain was unforgettable!). Again, I was told to massage like she had taught me every 3 hours which I diligently and desperately did regardless of visitors.

My mother-in-law (MIL), while watching me massage and seeing the pain I was in with so little yield, told me to just give up and give formula milk which she herself had done when she could not stand the pain of engorgement (no breast pump during her era). I told her I wanted to try to get breast milk, and if really after 10 days of massaging and pain there was no yield, I would reconcile myself to the fact that I had no breast milk. I didn't want to take the easy way out and deprive my twins of the best milk possible merely because I as the mother did not want to suffer for them. And what about the colostrum full of antibodies that at least my body was producing? No, giving up at that point was not an option. And to his credit, my CEB never said a single word to discourage me from my efforts - he just held his tongue, helped me with the hospital breast pump and supported my efforts to get the breastmilk in. We even brought the PISA I bought to the hospital as well as the bottles (But of course, we went back with these untouched as there was not enough milk to even cover the base of the bottles).

So after the 4th day in the hospital, we went home and I continued with the 3 hours pumping. My breastmilk only came in on the 5th day and this was the amount yielded by both breasts after 20 mins of pumping - less than 50ml. And the color was not pure white but yellow. Still, my confinement lady (CL) deemed it suitable for the twins who were drinking about 30ml each per feed

On the 14th day, I was confident enough to pump with both pumps at the same time. The yield was only  20-30ml per breast and that was enough to dissuade me from using 2 pumps when evidently it was going to be a waste of time cleaning 2 bottles, 2 shields and 2 membranes. Still, I stuck to the 3 hours routine telling myself that it was all about effort and commitment. Although I had plenty of support from my CEB, my mum, my in-laws, my maid especially and of course the invaluable but very expensive CL, the sleep deprivation (waking up every 3 hours to pump for 1/2 an hour is seriously very tiring, especially when you do that 24/7) was enough to exhaust me and make me one very grouchy mama.

But because I am a mama, I have to do what I have to do for the twins, no matter my feelings. I only had time to look at their hospital cards 2 weeks after I got home and it may be hormones, but I teared when I saw the yellow sticker on each of their cards. The sticker said "I am breast fed". And I could not stop crying when I thought back on the journey, on finding the strength and determination to sit with and bear pain I never thought I could, on waking up every 3 hours when previously I had such a good relaxed life waking at 8-9am and sleeping uninterrupted at whatever hour I liked.

By the third week with religious constant pumping 3 hourly and plenty of fluids intake, as well as lots of threadfin and cod fish, my supply was up to 130ml for both breasts every pump.

And after 3-4 days, the output increased even further to 200ml. And that's where the tender care lanolin which I purchased from the USA (and my boss kindly brought down) came in useful. All the pumping had resulted in very very sore nipples and I was (and am) deathly afraid of pumping strawberry milk  (milk mixed with blood from cracked nipples) which the twins would not be able to drink.

As the twins' one month approaches, my milk supply has stabilized to 220ml every 3/4hourly pump. This is just enough for their day feeds but we still need to rely on formula milk for their night feeds - as of now, their intake has increased to 110ml per baby every 2-3 hours.

I have read about some mothers breastfeeding for more than 1 year and I take my hats off to them, especially if they are exclusive pumping. I would latch my twins on more often but suckling would take one hour plus each and I would not know how much they are drinking. I'm also not sure how I could possibly hold one to each breast at the same time or when holding on, latch the other one. So, exclusive pumping it has to be - I spend my days in a blur between pumping, helping with the feeding and diapering.

When asked how long I wanted to continue being tied to the pump, my answer would be 4-6 months but the truth is that I recently even ordered more spare parts for the pump from the US which my colleague kindly helped me bring back to SG. I guess this shows that I am not really ready to stop pumping BM for the twins despite the soreness of my nipples and the sleep deprivation. At minimum, I'm going to be at this for 4 months and maximum would be 1 year.

Breastfeeding has been and is a memorable journey, and I am thankful as always, to the good Lord for providing me with such a decent supply of milk (average of 1.2 litres a day), for enabling the twins to accept without difficulty both BM and FM (for now at least), and for the lesson that I have learnt - one indeed reaps what one sows. My friend, the Slug was right about one thing - giving up is always the easiest route but if one can sit through the pain no matter how bad it gets, and hold true to one's commitment to persevere, there will, God willing, be results.

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