Starting BF after a previous loss

[fazer6]

I lost my daughter in January 3 weeks after she was born. I'm due in December and so am trying to figure out how to feed him, especially at the start when I'll be tired, overwhelmed and trying to figure it all out again. Only this time I have the added bonus of a big chunk of paranoia. Although when I say paranoia I mean gut wrenching fear that my baby will die any second.

I know the theory that bf is best. Oh yes everything says it's best and I do agree that it is something I would like to do. I think it'll be easier (once established) to get out a boob rather than cart about bottles of milk (especially in a hot country). However I don't want to even risk having to organise another funeral again this year, I could not cope with that. I'd rather be one of those awful bottle feeding mothers and never bf than risk anything bad happening to this one. Hey I was bottle fed and I appear to have a full complement of limbs.

The issue with bf is you don't actually know how much fluid is going in. Until weight gain is established and you're into a pattern of what is 'normal' you really don't know what's happening. My first thought was to pump in the first week and bottle feed pumped milk and then bring on breast afterwards. Obviously this will bring on a lot of fun with nipple confusion, but it does guarantee that I know how much my baby's getting.

I'm now toying with the idea of using the medela supplemental nursing system at the start. This way I can put a measured amount in and see that he's getting something. Also in theory it can be tailored to suit his suck rate. Has anyone used one and how easy will it be to use?

I am guessing he will come 3 weeks early (my mum did it twice, I've done it once, I think that's just what we do in my family). So I know he may be not as good at sucking as a full term baby so the SNS should keep up my supply, get him used to the breast only, plus also make sure he is getting instant supply when he's on the breast so he's happy.

Am I better off pumping and bottle feeding or using the SNS? By better off I mean I can see my baby is getting milk and overall it's easier. Would the bottle idea be easier for that first stressful week and deal with nipple confusion later? Or would it be better to always use the SNS?

I'm trying to cover all bases and get organised. Last time things came a touch early and it was a bit of a suprise. Also we were 1 hour away from the hospital and lactation consultant, now we've moved and are 5 mins away. I've also got newborn prefolds so I can be sure they're wet. Modern nappys are too good at their job so I also want to really monitor wet nappys this time. It's taken ages to build up the courage to even write this. I plan to talk to the LC at 33 weeks (or so), but that will take a bit more courage to talk to someone in person, plus I think he's actually a man. Not that I'm saying he can't do his job before I meet him, but can someone who's not breastfed offer help? Theory's all lovely in books but real life is often different.

[rlmueller]

We are here for you

Forgive my curtness and directness please. If you are here and already lining up help and plans --I'm going to assume you did as much research into baby rearing, diapering, and feeding that we all did the first time around. Terrible things happen to the most innocent and Terrible things SUCK! And I'm sorry for your loss.

Normally, I'd say just feed and feed and feed as you would,

But, you need more piece of mind than most of us so...
1. How much you pump is NOT indicative of how much you can feed your babe--after 6months I could not pump a drop but could still breastfeed with no problem.

Here's what I would do.
1. First, read all about amount of pees and poops in the first days and weeks
2. Breastfeed only at first for that supply, the pump will only hinder it at first causing stress, to hinder let-down to not produce enough to cause stress---vicious cycle.
3. BUY A SPECIALTY SCALE. I think Medela sells them. For piece of mind I might weigh weekly or bi-weekly. The scale will allow you to BF and track intake. Very good reliability--I brought my boy in for fear he was not eating enough because he went from 20 min at breast to 6 min at breast in a day. Turns out, after a feeding, he was 6 oz heavier. I couldn't believe it!
4. Don't schedule baby feedings; just feed and empty breast for all of the fatty stuff at the end, then switch as necessary.
5. Lean on us. We are here. There are super-smart women on this board. Use us and abuse us (not saying I'm one of the smart ones )

The stress of bottles/nipples/confusions/ will only add to the fear/stress that you already carry. The pump to early in your nursing will only do the same because of its inablility to work as well as the baby.

You know there is a reason that the quickest way to a man's heart is through his stomach--cause MUMMY NURSED HIM!

[PatioGardener]

Mama, I read your posts about losing your baby and I can completely understand how distraught you must be.

If you were making lots of milk, but baby was dehydrated, there was probably a milk transfer issue happening. Do you have access to a good lactation consultant where you are? You need someone who can watch baby and make sure there is good milk transfer.

Having a system to watch output (poops and pees) is also really important. You may feel better if you have a chart for diapers every 24 hours. If you pour 3 tablespoons of water into a diaper you can see what a heavy wet diaper feels like. And you know if baby is peeing and pooping well, then enough liquid is getting in.

Also weighing, as the PP mentioned, may help to ease fears as well. But you'll need a good scale to get accurate weights.

Please come back and post often, let us help and reassure you. And remember that breastfeeding protects babies from illness. We just need to make sure that each and every baby can breastfeed well - and get that support during the learning weeks (1st 6 weeks).

[alegna]

I would plan a chart for your peace of mind and a scale. Weighing before and after and charting will take less time than pumping and bottle feeding.



-Angela

[MovingMomma]

I've read your story, Clare. I'm so sorry about Isabel.

Can you line up a team for support? An excellent LC and a breastfeeding friendly and compassionate pediatrician? You may find it helpful to have frequent checkups and someone you can call on at any time. And maybe you can get a professional to really hash things out with you and formulate a plan.

Ultimately, you have to make a decision that you feel comfortable with. Yes, nursing at the breast typically is best for both bringing in a milk supply and avoiding nipple confusion. Yes, weighing before and after feeds can be helpful. Yes, an SNS can show you some of what baby is getting. But an SNS won't even let you know exactly how much milk is going into baby, since some will be coming from the breast as well. Would you be ok seeing a partial intake from the SNS?

Do you know if the problem was a transfer issue or a metabolic one?

I'm not trying to pry with all the questions, momma. I don't need to know the answers, but these are things that you can ponder yourself.

I would need in person, frequent, professional support.

[Megan73]

I can only imagine what you must be going through, mama. I lost my first baby to stillbirth at full term. When my healthy son was born he kept losing too much weight and I felt sheer terror until we discovered that he just wasn't getting enough because of some combination of poor transfer and low supply. With domperidone and a small amount of formula in a Lact-Aid I've been able to successfully breastfeed. He's now 14 months and has been gaining weight steadily since he was two weeks old.
It was HORRIBLE. I felt like my body had killed my first baby and now I couldn't even nourish my second properly. Being able to establish a good nursing relationship was the most healing thing I've ever done.
I would encourage you not to pump and bottle feed or start supplementing unnecessarily. If you decide you have to for your peace of mind, that is totally understandable.
But instead, I'd rent or buy a Medela baby scale. Normally, people would tell you to just weigh baby once or twice a week.
However while breastfeeding is getting established it might make you feel better to do pre and post-feeding test weights in the same clothing and diaper to make sure your baby is transferring milk well. (This is what I plan to do if I'm lucky enough to have another nursling.)
Then, when weight gain is established, you can continue to weigh often to monitor gain. Kellymom.com has good info about breastfed babies' normal growth.
That said, do what you need to do, whether it's pumping and bottlefeeding or FFing. Only you know if that's a choice you might come to regret.
Please keep us posted on your progress

[hezasan]

Hi, I'm so sorry to hear of your loss, and for the fear you are going through now.
I would like to recommend some resources from a lactation consultant in my area that specializes in breastfeeding after a previous loss. She herself is unavailable right now, but her web page has a lot of resources.
http://lifecirclecc.com/breastfeeding.html
I think she's also been in Mothering magazine before, maybe there is info on this website.
one link in her resources page is www.mobimotherhood.org, Mothers Overcoming Breastfeeding Issues
All my best to you, lookl forward to hearing how it goes.

[fazer6]

Thanks for your replies, wow this part is really getting hard. Being pregnant is one thing, facing up to the reality that we will have to start feeding a baby again is another thing.

The reason for Isabel's death is completely unknown. They took loads of blood from us and her to check for rare genetic disorders to do with metabolism. But they warned us it's very likely to get a false negative so it's something to watch for this time. Transfer could have been an issue as she was 3 weeks early so could have had a weak suck. I gave birth at Christmas and was 30 mins from the ped and 1 hour from the hosptial and LC. It took me till a week after the birth to get to see a 'normal' non emergency doctor at my normal medical centre who told me I needed to go to the ped 30 mins away once a week. Naturally they weren't open though. So yes we did possibly slip through the net and just not get the support at the start because of the time of year. I'd planned to get to see the LC but with the timing I was going to ring on the Monday as my mum had gone home and normal non Christmas opening hours had started. Unfortunatly we never made it that far as she ended up in ICU. On the Saturday I thought we had the best feeding day ever, but somehow she refused to feed on Sunday and we ended up in hospital. All the doctors looked at me asking if I was sure I actually had milk. Considering when I put her on one side the other started leaking and I was a one woman wet t shirt contest yes I am sure I had supply.

I'd love to BF exclusively after birth, and will while we're in hospital and getting daily checks. Once we're back home and my milk comes in that's when I think the SNS will come in handy. Although it won't give us an exact amount of the total that's going in my OH has agreed with me that it's an acceptable solution. He's not bothered about bf and only wants a live baby. I think it was a combination of factors first time. So this time we're ruling them all out so we will need some visual guarantee of something going in.

Apparantly there is a male LC at the hospital, thankfully only 10 mins from the house. Yes the move down to civilisation was the most important thing. I've also got the helpline based in the same town for support. Apparantly it's telephone help only but with any luck there might be someone who'll meet me and just have a chat. There's also a local mothers support group that meets once a month 30 mins down the motorway so I'll try to get there before birth and then start going afterwards.

I hadn't thought of getting a scale so I might have a look at one. I'm trying to read everything I can, on top of everything I read last time. It's a touch difficult because no matter what I read I always find things I could have done differently, or useful things to know. Those kellymom charts look good and at least if I have something written down to take to the ped then we hopefully can assess if there are any transfer or metabolic problems. The ped is so close this time so my normal doctor told me if I wanted to go in every day I could do. I think I'll go for 3 times a week when we first get out of hospital.

It is just such a difficult thing to face up to again. I feel so let down by my body first time, what mother can't even keep their own kid alive. The guilt, regret and grief I feel is just imense. I know with all the hormones after the birth it is going to be an emotional ride. I'll try to go for just SNS and breast, but am prepared to move to bottles if necessary, I think I have about 3 different brands now. At the end of the day although I'd like to bf I'd rather have a live baby.

[Lil'Momma]

Mamma, I am so sorry for your loss. I can't even imagine.

I want to second the scale idea. Medela has one where you weigh before and after in the same clothes, same diaper, ect, and it will calculate for you how many ml the baby has taken in.

I would probably do that before the SNS. The SNS is a pain in the butt! Yet it is still better than the bottles.

I have had two little ones in the NICU and have dealt with the pump/bottle feed route and it is a VERY hard one to come back from. We failed to get back to nursing with ds... I regret it deeply, but it was what we had to do to get him to eat.

With DD, I was determined to nurse, an attitude which seriously led to severe dehydration and a huge dip in weight. She was born at 34 weeks and just too weak and sleepy to nurse effectively. She kept losing and kept losing , got down to around 4 lbs from 5lbs 9oz. She was dehydrated and her bilirubin was skyrocketing before they finally pulled out the Medela scale to find out she wasn't transfering milk. The Neo's immediately made us go to pumping/bottle feeding with HMF to get her weight up and to rehydrate her. She started gaining just fine with the bottles, but I was so scared at that point.

I took her home but was too scared to nurse her, even as she got older and stronger, I didn't trust myself or her (she never cried to tell us she was starving). It took a lot of work with an amazing LC and a pedi who trusted me more than I trusted myself to get her nursing. We got that scale and I weighed EVERY feeding for a week (not recommended, but what I NEEDED) to know exactly what she was transferring. It then took me three months of doing that to trust me and my daughter. We had serious nipple confusion until we got the SNS, but no one ever warned me about the FLOW confusion that the SNS can cause. It was very hard for us and not something I EVER want to go through again.

I guess my advice to you would be not to do those things unless you have no choice. I highly recommend a scale and weighing after every feeding and if you start to notice a problem, then pull out the pump, bottle, SNS, ect.

Again, I am so sorry for your loss and I do understand that the fear itself might be more than you can deal with, and if that is the case, and bottles are best for you and your new baby, there are many other ways to bond with your precious little gift!

The mama's here are wonderful to talk to, keep us posted, I'm sure you'll be in all our thoughts and prayers!

[MovingMomma]

Originally Posted by Lil'Momma

no one ever warned me about the FLOW confusion that the SNS can cause. It was very hard for us and not something I EVER want to go through again.

This is an advantage the Lact-Aid has over Medela's SNS.

[fazer6]

Well it's getting easier and easier to come in the bf section now so that's a little better.

LilMoma, I'm glad I've ordered the SNS then so I've got that option before going down the pumping bottle route. It wasn't something I wanted to do as I could see problems later on, but I'm too scared to just trust he's getting the right amount of milk again. The thought fills me with dread and that stress is not what I need at the start. NICU is an awful place, yes they do wonderful things, but I just dread all that machinery and the alarms and noises.

So dehydration isn't that uncommen then. I just think of myself as such an awful mother and wonder how on earth it could have happened. Isn't it meant to happen to teenage mums who have no idea what they're doing. I feel constantly labeled as a bad mother.

I do want to bf and admire women who can just sit down and start feeding in public, and do it with dignity and ease. If it does all become too much I am fully prepared to move to formula. I know bf is technically better, but it won't be the end of the world if I don't manage it. I think coming to terms with this first has been quite important.

Well I think I'll give birth any time from the 24 Nov so in theory I could be back here some time soon, hopefully with 'normal' trivial problems.

I'm at the hospital tomorrow so I'll see if I can get in to see the LC in the next week and see if I can get hold of some scales to cope until we become naturals at this bf lark.

[heartandhands]

Mama, I too am SO sorry for your loss. I can not even imagine the pain you went through and I think you have more need for reassurance than the average mom...and that is okay.

One thing i just wanted to emphacise wrt the scale: make sure when you do test weights (before and afer babe has nursed) to check for intake that you do this over a 24 hour period AT LEAST. The reason is, nursing isnt like bottle feeding and sometimes babe will take in say, 1.5 oz and the next feeding will take in 3.5 oz. if you only test weigh once in a while you will not observe the full range of volumes that babe takes in. we are the same--not every meal is a 4 course dinner! just keep this in mind. you need to track for 24-48 hours to get a true indication of how much babe is getting. time at the breast does not necessarily indicate how much they take ie, short time isnt necessarily a small feeding and long time isnt necessarily a big feed.

keep track of wets and poopies.

consult kellymom.com for a lot of reliable advice and use it as a resource. it is excellent.

get yourself a good lactation consultant before the baby arrives. check around for word of mouth referrals from other moms and health care providers.

ultimately, physicians do not know much about bf so arm yourself with lots of knowledge and people around you who DO know what they are talking about.

good luck mama.

God Bless.

[Lil'Momma]

Fazer,
I know exactly what you mean about feeling like a horrible mommy. The nurses and staff in the NICU kept making comments around me, where they thought I couldn't hear, like "Didn't she know her baby was dehydrated?" or "Yeah, breastfeeding is really better than formula... your baby starving is much prefered over that formula". That seriously didn't help. You are in my thoughts and prayers.

I agree with the PP, if you are going to weigh, weigh each feeding for at least a day, maybe two, then add it all up to make sure they are getting the right number of oz for 24hr period.

Also, if you are going to go the SNS route, make sure to pump after each feeding. With the SNS, the baby won't be taking everything out of your breast and that can cause your supply to dwindle away and you don't want that.

Don't be afraid to ask for help and suggestions here with the SNS... it is a pain in the butt to figure out. It gets MUCH easier, but the first couple of times I was totally lost. The mammas here were wonderful about helping!

Remeber that the baby's stomach is only the size of a marble at the begining and won't need much to eat. (My friend didn't know and started out feeding her son 4 oz of formula after he would nurse for thirty minutes.) Just thought I would remind you so you wouldn't worry if your lo only took a few ml the first day.

Again, Good Luck!!

[fazer6]

I hadn't thought about them taking on different amounts at different times of the day. It makes so much sense but you do need someone to state the obvious sometimes!

Oh I am going to monitor absolutly everything that comes out of the little man, I am going to be far too interested in poo and wee and am glad I've got people here who will also take an interest in his 'output'. I have got newborn size CD's aswell so I can monitor a bit easier than using disposables. If I use a disposable I'll also put a tissue in there so I can see when it's been used.

At my antenatal class today I explained to the nurse what had happened and that I wanted to talk to a bf specialist beforehand to put my mind at rest. She set up a meeting with the hospital bf person and his wife Milagro (is it a good sign if her name means miracle). They're part of LLL and big into bf. Milagro offers telephone support and Jorge works from the hospital. Apparantly there's no problem they can't solve and they will put my mind at ease that I do have support afterwards so that the stress doesn't affect supply.

Yes that's the thing I had. The nurses were just amazed, are you sure you had milk. OK so perhaps it's a rare situation to see dehydration in a baby, but it just made me feel absolutly awful. Failing at mothering is one thing, failing at bf is even worse, I mean how many womanly failures does that add up to. I did hypnobabies to protect my baby from the effects of any drugs and also to have a quick uncomplicated birth. The emergency doctor who we went to first at the local health centre asked if I'd given her any water. I said no as that was meant to be the worst thing you could do. Everything says do not feed them water as it's fluid with no nutritional value. Also the first bottle is the beginning of the end, the first one leads to another which leads to formula.

To be honest I reckon if we get these kids to about 18 and they still have all their limbs and no major problems and some signs of intelligence then we're doing well. Vaccinating is bad, but illness is also bad. Bf is good, but dead babies are bad.... Does anyone ever get this mothering thing right?

[Lil'Momma]

I'm not sure anyone gets it "perfect" but if you follow your instincts and love your baby, then I think you are parenting "perfectly".

I had that same comment from a nurse, the whole, are you sure you have milk? They knew I pumped after every feeding and was bringing in 4-5 oz every three hours and they still asked... can we say "idiot"?

Some nurses have no tact.

I am so glad you have a support system lined up!

I know this has nothing to do with breastfeeding, but if you are using cloth diapers in the very beginning, I would suggest using some kind of liner because meconium is a bi*ch to get out of cloth.

[ewe+lamb]

I am genuinely sorry for you loss , although I have never been in your situation I can sympathise with the not-so-subtle nurses in the neo-natal units - when they think that you can't hear - or understand, the comments are cruel and unnecessary.

I think having a good LC lined up is essential for you, may I recommend that you try to find one who is also a LLL Leader, personally I find there's a difference between a LC and a LLL Leader/LC, just my impression but something worth remembering maybe. Finding and joining a LLL group for the support and information - if needed, may also be of help to you.

And also you have all of us - worldwide here to help, support and provide as much information as we can for you

[fazer6]

Well I went to see the LLL/LC people. It's a husband and wife, the wife works in the delivery section, the husband up on the ward. He's become the self appointed reference point for bf help and him and his wife provide all help for anyone in the area. They've been on various courses and read up on everything they can to do with bf, I think they're LLL leaders. They're a fantastic couple and I'm so glad they're there, and also working in the hospital. I talked to the wife (seeing as I'll probably see her when I give birth), and as long as there's not anyone in need of the room she's fine to just leave us be after the birth and see if he'll self attach.

After the birth obviously I've got her husband up on the ward (he was unfortunatly not here over Christmas when I had Isabel) and then afterwards they'll give me all the support I need. I can ring them, go to their flat, or they'll come to the house. Milagro even pointed out that if I'm unsure how much is in a nappy to cut it in half and see how much of the gel stuff has absorbed (lightbulb moment, that makes so much sense). They're also sure they know another midwife who has some scales I can hopefully borrow for a few weeks.

They're such a nice non standard couple, non vaxing, co sleeping... don't believe lifestyle choices such as extended bf or co sleeping should be something to discuss with a doctor unless it has some real reason for affecting a child's health.

Lill'Moma yes I've got some disposable liners. I have a pack of 100 and I think there might even be an ecobaby shop in town which sells them. I remember cleaning it off the skin and that was enough fun.

[MovingMomma]

Clare, I came across this article today and thought of this thread: The Importance of Newborn Stool Counts

[boobs4milk]

just wanted to add that you can weigh outputs as well. put a dry unused dipe on the scale and weigh it, then take it off the scale and weigh the used dipe subtracting the amount from the unused dipe.

example: unused dipe weighs 15 grams. wet/dirty weighs 65 grams. total output is 50 grams.

then, you can total these for the 24 hr period and subtract that from the total inputs you get from weighing baby before/after feeds.

hugs clare!!! THINKING OF YOU AND KNOWING YOU CAN DO THIS!

[Cheshire]

Clare,
I lost my second son in August 2008. I gave birth to my daughter in July 2009, exactly 11 months from the day I gave birth to my son.

It sounds like you have a great support team lined up. Keep them close.

I don't have any bf'ing advice but I wanted to let you know, for me, caring for my daughter has brought up so many moments of joy mixed with grief that I didn't expect when I was pregnant with her. The pregnancy was emotionally a roller coaster - all PALs are. Loving my daughter is such a reminder of what I lost. I wonder constantly what her brother would have been like, when he would have hit his milestones, etc.

I was so scared of losing her that I didn't look past the pregnancy much. Actually, I don't think I could have - her brother's birth was very traumatic and he died 12 hours later in our arms. I was in such shock after and ill myself that I had to deal with how to have a safe birth for her. I just wanted her here alive (you know what that's like). I didn't really do much to prepare for life after getting her home.

So, here I am almost 4 months later and I'm starting to get a little more sleep which helps.

Having been in a similar pair of shoes I just want to tell you to not beat yourself up over the decisions you will make over your son's lifetime. Having lost a child will forever color the way you look at the world. Actually, it takes off the rose colored glasses like no one can imagine unless you've had them ripped off your face. You look at life differently and always will.

I'm sure with the help you've lined up your bf'ing relationship will be great and your son will be fat and happy. If, for whatever reason, you come to find that it isn't great and is causing you and your son great stress you will have to make the decision that is best for your family.

Having your son in your arms will bring up so many feelings and bf'ing him will add to that mixture considering how your sweet Isabel died. As you mentioned you know bf'ing will be emotionally challenging but you can get through it because you have a plan in place. Part of that plan will be knowing when enough is enough. I hope you never reach that part of the plan but knowing, just thinking it through, will give you the courage to try because you know you've planned for most possibilities (I don't want to say all because I know that I thought I had planned for all possibilities with my son's birth but I never knew what happened to him could happen, yk?).

When you know better you do better. Hugs and congratulations on your sweet little one. You and your family will be in my thoughts and prayers.