Sunday, February 13, 2011

Adventures in Feeding

I never expected that feeding babies would be easy.  During pregnancy, I heard and read endless advice about breastfeeding.  Recommendations for breastfeeding classes, support groups, various books, numbers of lactation consultants.  I didn't expect it to be easy, but I did expect it to happen.  It was something I so easily took for granted.  It never occurred to me that I would number among the women who didn't breastfeed.

But then again, I didn't expect a lot of things that we have been faced with.  So when our little girl ended up in the hospital and wouldn't feed, we needed to get the volume in her.  We were told she wouldn't be released unless she was taking in her "quota" and gaining weight.  And attempting to nurse was frustrating for her (and me), left her sweating and panting and unable to take in even close to her required volume.  Breastfeeding is often a challenge for babies with Down syndrome, and can be very difficult for babies with congenital heart defects.  Combine the two and we were stuck with a girl who just couldn't seem to eat well, in spite of the genes of those who love to eat and eat well.  And we were desperate to get her eating in order to get her home.  So the pumping began...

Her NICU stay lasted 18 days primarily due to her difficulty feeding, but we managed to convince the doctors to let her come home with a temporary NG (nasogastric tube) with the hopes that she would steadily improve.

And improve she has.  Since arriving at home, her ability to eat has increased dramatically and her weight has increased too.  After a few days at home, she pulled out her feeding tube and we miraculously didn't have to have it put back in, since by then she was consistently taking in her quota.

At this point, her record is maintained.  She has gained 14 ounces since leaving the hospital 12 days ago.  She is plumping up nicely, growing out of her newborn clothes.

But all that said, it doesn't mean feeding Miss Cora is an easy task.  In fact, it can only be done after extensive training and practice, and requires considerable patience.  Not an endeavor for the hasty or the lazy.

During feeds, our girl has multiple personalities.  At the top of the list is what I call the "Little Horsey", due to her practice of horsing around.  This usually starts off with an awake, alert and mostly happy little girl.  Sometimes the horsing around seems like genuine excitement, with her chomping down on the bottle, mostly failing to get a good latch, and wriggling and looking around at anything and everything.  This Little Horsey can sometimes get down a good amount in a short time, but must be tightly managed:  swaddling, guiding her head, holding her chin are all good tactics, as well as some skillful bottle maneuvering.  But sometimes the Horsey fights.  She flails, arches her back, holds her breath, turns read, twists her head this way and that.  Again, more discipline can usually help, but this Little Horsey is considerably harder to feed. 

Then there is the Sleepy Girl.  This sleepy girl has two faces.  One is the difficult Sleepy Girl,who absolutely won't wake up (or maybe just pretends not to wake up), absolutely will not latch on and will not suck.  This Sleepy Girl requires lots of patience:  unswaddling, burping, moving around, playing with limbs, rubbing cheeks, lifting chin, twisting bottle, moving bottle in and out, changing diaper.  And strangely the Horsey can turn into this Sleepy Girl in a matter of a split second.  Very, very strange.

And then there is my favorite Sleepy Girl.  This one never opens her eyes, but manages to suck away.  Suck, suck, suck, suck, followed by the inevitable frequent breaks for a few pants to catch her breath, then sucks away again.  She can finish a bottle in less than 30 minutes without opening her eyes.  Very nice little girl to find in the middle of the night feeds, especially when I still need to pump before trying to catch a little bit more sleep.

And even rarer is the alert hungry eater.  This one doesn't even have a name yet, but manages to be awake without horsing and drains her bottle in no time flat.

But all these little eaters are worth it. They all more or less manage to get in the numbers.  There is a mathematical formula that Nick uses to determine how many mililiters of milk she needs per 24 hour period, divided into exactly how much she needs per each 2, 3 or 4 hour feed.  There's a little leeway (if she goes over for a bit, she has room to go under on a few feeds), but overall she needs to take in her total quota.  And it can be stressful, always shooting for the numbers, warming up the bottle when the girl is sleeping away because it's her time to eat.  She rarely cues for food, and only recently has started crying a little with hunger.  And as with all babies, I am sure, it feels like we are always feeding her.

I was talking to my sister the other day, whose first child is only 4 days older than Cora.  Erin is blessed to be able to nurse her little Kai, and he is a wonderful eater, having gained over 3 pounds already in a little over a month of life.  When I asked her how long it takes to feed him at night, she told me that sometimes she can just roll over and he'll latch on and that's that.  And that sounds like such inconceivable bliss, especially after being awake for an hour and a half feeding, changing and pumping, then trying to get back to sleep for another hour and a half before the cycle begins again.

But what we don't do for love.  Luckily my milk supply is filling our freezer and our fridge, despite my recent bout of mastitis.  And our little girl is eating and eating well and is still practicing her breastfeeding skills a little every day.  Just now, Nick is feeding what seems to be the hungry Little Sleeper.  What a beautiful Little Sleeper she is.  She is worth every moment, every drop, every effort.  We are so blessed.