Friday, April 9, 2010

The Grind

Eleven days in, and J and I are really struggling. We seem to have moved beyond the fun and exciting phase and entered The Grind.

It's not just the lack of sleep that’s bothering us—it's that we feel like we aren't getting a moment to enjoy the babies. This is especially true for me. At least J gets to feed them their "top off" bottles, and burp and change and re-clothe them. And that might not sound like much fun, but it's a hell of a lot better than my relationship with them, which consists of me fighting with them to get a decent latch, and struggling to keep them on the breast when it's hurting so badly. It really seemed like they were both on their way to being champion feeders, but we seem to have slid backwards. Or maybe Dex is actually doing better (he had his tongue-tie fixed on Wednesday and now appears to have a decent latch, but it's hard to tell because my boobs are so sore that it might just hurt even if he's doing everything right). But Gretchen's latch is going downhill fast—she's doing a lot of chewing on me rather than sucking. And then if she doesn't get a lot of top-off milk she screams for two hours. And when your baby is hurting you feeding eight times a day, it can wear you down fast.

I'm also really on the border of not having enough milk for them. Each of them is getting a full ounce of top-off bottle after every feeding, and that's almost exactly what I've been able to produce. The problem is that it isn't enough. When they feed well at the breast I don't manage to pump that much, and even then they always want more, which means that sometimes they cry through an entire cycle where we were hoping to get our precious 1 1/2 hour of sleep. It isn’t a medical problem—they gained five and four ounces respectively in three days earlier this week. But they’re not satisfied. And unhappy babies just plain suck.

This morning I realized that I'm on the verge of giving up breastfeeding altogether. I just want to start enjoying being a mom. I want my babies to stop being mad and me, and I'd like to stop being mad at them. In either event, we'll probably be supplementing with formula by the end of the day. No matter how hard I've been pushing at the pump (and I've REALLY been pushing—I pump till dry after EVERY feeding), I can't seem to get my milk supply to kick in more. I am more exhausted than I ever thought was possible. Every day I think I’m as tired as I could ever be, and every day I discover a whole new level of exhaustion. We're on a strict 3-hour timetable for feeding—it's really the only way to get 8 feedings in a 24-hour period, which is the minimum. And with G's size we can't yet go four hours at night with a couple of short feed cycles during the day.

When people used to say their child was sleeping for three or four hours at a time, I would ask myself—what’s the big deal? What’s so bad about getting a few three- or four-hour sleep cycles in a night instead of eight straight hours? But what isn’t generally explained is that the three-hour clock starts at BEGINNING of one feeding session, not the end. So if you add in how long it takes to wake, change, feed two sleepy babies at the breast, burp them, supplement with a bottle, burp again, change again, lull them back to sleep, and then pump for at least 15 minutes (which I have discovered I can’t skip even once at this critical stage of trying to get my milk to come in enough to feed two), two hours can go by easy before you even look at the bed again. And then you have to decide—is it worth a catnap, or should you just stay up and get something done? J and I have managed to work the cycle down to an hour and a half, with him doing the bottle supplementation, burping, and changing. But we still usually only get an hour and a half at a time, and that’s if everything goes perfectly. Maybe that works out three times a night, assuming no one's refusing to go back to sleep. And we can't really sleep during the day yet. Too much to do with doctor's appointments, etc.

J and I refer to Super-G as our small-mouth bass—her head is so tiny that, though willing, her mouth is too small for a latch that doesn’t hurt. (She has mastered the hippo mouth, which is hilarious, though we don’t always manage to get it on the boob at the right moment, and often there are tiny hands in the way.) The lactation consultant who we saw on Tuesday recommended that I put her on a nipple shield, which I’ve been using for Dex (more on that below). I was willing to try that (and trust that we could get her off it later on, when she’s bigger), but the first time we tried it at home she HATED it and “bit” down so hard on the shield that I yelled out and immediately started crying. And believe me, once I start crying these days, it’s hard to stop. Can’t tell you how many times I’ve cried all over my breastfeeding babies. She did it one more time that feeding, and did it again on the next breast (though not so hard) the next feeding. So I said “fuck it,” and ditched the shield. I’m already at the end of my rope, and the last thing I need to be doing is fighting with BOTH my babies every time I have to feed them, which is essentially my entire relationship with them right now.

And Dex has had his own set of problems. In the hospital, he was trying to feed, but would always pull back from what looked like a good latch into a terrible one at the last minute. And, desperate to make breastfeeding work with this baby, I would let him. So my nips were getting mangled, to say the least. Then we took him to the pediatrician the day after we got out of the hospital, and he noticed that D was tongue-tied, which kept him from sticking his tongue out to suck when his mouth was wide open. So we started using a nipple shield with him, which allowed me to keep feeding him at the breast while we waited for an appointment to get the string tying his tongue down snipped.

Through fairly Herculean efforts on my part, I managed to get Dex an appointment with an ENT on Wednesday, and managed to get my HR department to get him enrolled on my insurance in time to not have to pay out-of-pocket for the procedure. The procedure was pretty scary, though it only took moments. Ended with poor Dex wailing through a wad of gauze sticking out of his mouth, which was just pathetic. But within a few minutes he was trying to feed, and he managed to get a pretty nice, pain-free latch a few minutes after that. The problem now is that I can’t tell if he’s adding to my tenderness problems or if I’m just so sore from G’s feeding technique that he’d hurt me no matter what he did. In either event, with either of them on the boob I just sit and watch the clock and try to hold out for 15 minutes before I call it quits and hand them off to J for the top-off bottle.

This morning I managed to pump enough that we are doing one “pump-only” session (which is how I’m writing right now—after five days of computer withdrawal I finally got wise and moved the pump to my computer desk), while J feeds both from the bottle. Just to give my nipples a solid five hours off from the evil twin mouths. I’ll call the hospital lactation consultants today, though I’ll have to pay a chunk of cash to go see them in person (which I probably will do). But my guess is by the end of the day I’ll be introducing formula. This shouldn’t feel like a failure to me. I know that, I really do. But I was so proud of having gotten this far without, and truly believe that we were into the home stretch with this.

I know this will get better. But it’s really hard to see that future right now.

21 comments:

Unknown said...

Well done, I breast fed my four children but looking back it was really hard work. My first was starving and cried all the time. At ten weeks I gave her a bottle of formula, after that she began to sleep. The difference a well fed baby makes to your quality of life is immeasurable. Breast feeding is not easy, they only drink a small amount at a time and are therefore hungry most of the time. If you give it up you may feel guilty for a week or so but the difference to your life will make up for it. Do you worry that they might spew up the milk and you will have none to give them?
The moment you start them on bottle that is when they start to refuse the breast cause it won't flow quick enough for them. This is a really diffficult time for you, the amount of work involved with twins must be staggering, I had only single births and that was over whelming. I really enjoy your blog, I found it accidentally. It will get easier, most people find the first few weeks hard. You really need to rest when they are asleep. Best wishes from Ireland.

Sue said...

Breast feeding just one baby is really hard work - I can't imagine doing it with two. Don't be hard on yourself and feel like a failure if you have to supplement with or switch to formula. You're doing such a good job taking care of your babies and that's all that matters. And as wonderful as it is to finally have those babies, it will probably feel like an increasingly exhausting grind for a while. I hope the lactation consultant is helpful, but just do whatever works best for you.

Me said...

Breastfeeding can be really really really difficult. For us (tongue tie snipped on day 10, only 1 baby), the first 3 months were hell. I spent most of that time breastfeeding, pretty much continuously.

Honestly, it does get easier as they get bigger - you are all just learning and it's hard!

I hope the LC is helpful and that things get easier, whatever you end up doing.

Mindy said...

I'm so sorry things are so hard right now. I haven't had twins, so I can only try to imagine how much harder it is for you. I did want to offer two bits of information. Babies are all different and I am no lactation consultant, but I will say that both my babies (for different reasons) were given bottles very early on. My daughter was a preemie and she started out exclusively on bottles and my son had low blood sugar at birth so we had to supplement him with formula early on. We were extremely fortunate that with both babies they were able to transition from bottle to breast or breast to bottle without hardly any trouble. I know that's not true for all babies, but I did want to say that not all babies have trouble doing both. Also, since my daughter received about 99.9 percent breastmilk in her first year I had assumed I'd do the same for my son. But, then we had to give him some formula in the hospital because of his blood sugar. We also ended up giving him about 1 bottle of formula each night for his 2nd and 3rd months because that way my husband could feed him and I could get extra sleep. I was trying to pump at the same time as breastfeeding him, but I found it quite difficult to do regularly. But then after awhile he started sleeping more and I felt better and I was later able to pump more and then we stopped using formula for many months (until the little bugger weaned himself!). Anyway, my point is that (1) I know how disappointing it can be when your expectations aren't met, but supplementing will probably make you all happier, AND even if you start supplementing you may find that without the pressure and with less pain, your supply improves and you might be able to return to exclusive breastfeeding down the road. UGH -- sorry for the length and sorry if I sound know-it-all ish. My son is about to turn one and while he's been a good eater, we've had a pretty hard year for various other reasons. Nothing horrible mind you, but I'm still feeling a little worn out and sensitive myself, so I really feel for you. Good luck with everything. I hope the LC helps out and things get a bit better. Lastly, I hesitate to suggest this, because I know if I'd had twins I wouldn't have been able to afford it, but I have 3 close friends with twins and all three ended up resorting to hiring a night nurse for at least a couple of days a week. Ok, enough from me. Take care and congrats on your adorable babies!

Rebecca said...

Don't forget that Breast feeding doesn't have to be all or nothing. If you need to suplement with formula so that you can sleep it's ok. Sleep also helps production so it's a win win. You'll also have more patience to deal with latch issues if you're a little more rested.

Good luck.

PS sleep with ear plugs when your husband is in charge.

kate said...

Ugh. Just... UGH. That sounds really, really hard. REALLY. REALLY. HARD.

I wish I had advice for you (or could commiserate-- not yet, at least!), but I'll just offer what my friend told me after having a ridiculous time trying to breast feed each of her two singletons (and never having much success):
Don't beat yourself up over it.

Seriously, she told me repeatedly that if I have a hard time with breast feeding, the best thing I could do for myself was to give it as hard a try as I could, but then forgive myself if it wasn't working, and MOVE ON to enjoying the babies.

I know that's probably easier said than done in the heat of the moment-- we want to do everything we can to give our babies a great start, we want to feel like our bodies can do at least ONE thing right-- but I'm going to do my damnedest to follow her advice.

I hear that it's hard for a while (and gets even harder for a bit), but then it gets really, really good. So here's hoping that the hard, hard, hard part passes quickly and moves on to the smiles, and personality, and sweetness, and all the other stuff that makes all the crap worth it. Know that I'm virtually sitting there along with you, and that if I could be there physically, I would, in a heartbeat!

Good Egg Hatched said...

Everyone needs to find what works for them -- you will too -- but I can tell you that for us, supplementing with formula has been a lifesaver. We started in the hospital as my little one lost more than 10 percent of his weight...when we got home I tried going back to exclusive breastfeeding and I felt completely wrecked 24 hours a day (and I only have one). Even when I started adding formula in (i.e. breastfeeding first and then doing formula) it was exhausting because that process took forever. So I switched to doing breastfeeding sessions in the morning and early afternoon, then doing formula-only feedings in the late afternoon/night. It has made all the difference in the world -- he is satisfied, my supply is better when I do breastfeed, and everyone is happier. I can totally understand the drive to breastfeed as much as possible, but please don't beat yourself up if you have to add formula. Your babies are still getting the benefits of breastfeeding but without the stress and extreme (unhealthy) fatigue. And I know some babies do get "nipple confusion" but it has never been an issue with my guy. FWIW we use Playtex Vent Air bottles with NaturaLatch nipples (as recommended by our LC) and he goes seamlessly from those to the breast. Best wishes as you figure out what works best for your family.

Rebeccah said...

I can't speak at all to breastfeeding, much less breastfeeding twins. But I can say that I'm in complete awe that you're giving it a go! I found it hard enough to survive the early sleepless stage with just one formula-fed baby and a husband doing the alternate feedings. Just keep following your gut, whether it tells you to keep bf'ing or switch to formula or some of both -- it all comes down to what is right for you and your family.

Peeveme said...

No advice just complete empathy. Breastfeeding is very difficult. Do whatever you think is best and don;t beat yourself up....Ok I guess that was advice.

Kate said...

I'm right there with you with the feeding issues, pumping, the ouch factor. Thankfully I only have one...
Hope things improve soon!

annacyclopedia said...

Sweetie, what you are doing now is hard work. Breastfeeding is hard work. And you are doing it and doing it really well. Your babies are gaining - they are doing so well. You can do this - you have enough milk, even if it doesn't feel like it.

I know the pain. My nipples were just scabs for the first two weeks. But then they got better and it ALL got better. Now that Dex has his frenulum clipped it should help, and hopefully the LC will help with Super G's latch, and things will get so much better. I promise.

**Assvice follows - it is fairly informed assvice, but still - I offer it in a spirit of solidarity and with a desire to help. If it's useful, I'm glad, and if not, please just forget you ever read it. Ok?

Remember that a baby, no matter how tiny, is way better at getting your milk out than a pump is. So the amount you pump is not a reliable indicator of how much they are getting. You need to do what you can to deal with the pain and get your nipples healed, but at the same time, the best way to bring up your supply is to let them nurse as long as they want and as often as they want. (My toes are curling in sympathy with the very thought - I get it, I really do, the pain, and I know I only had one baby to deal with.) This will probably mean you spend all your time in bed/in your nursing chair nursing the babies - but if you can do that for a couple days your supply will almost certainly be up. If you can let everything else slide for a few days, and let J wait on you hand and foot even more than he probably already is, it will help. (I basically didn't go downstairs for the first week - I know it's harder with twins, but if you can...try, cause rest is the next best thing to sleep.) If your LC hasn't shown you the lying down nursing position, get her to show you. Drink lots of water and eat lots of protein. Don't know if you have tried any of the herbal teas for milk supply, but I found it really helped. Look for something with fenugreek - the "Earth Mama Angel Baby" brand is pretty tasty. You can also get fenugreek capsules and take it that way.

**End of assvice

I support you no matter what you decide and how you feed your babies. But I know you can breastfeed them - you are already doing it.

It will get better. I promise. This time feels like it will last forever, but it will be over soon, and you will feel competent and strong. You are doing great. You are a superstar. You are enough.

xoxo Anna

annacyclopedia said...

Hi again - I finally tracked down my friend who is a La Leche League leader and she is also pregnant with twins right now. She recommended a few sources of info. One is a book put out by LLL called "mothering multiples" - you can order it through a local LLL chapter or online. She also said that it would probably be helpful to connect with women who have breastfed twins and recommended the message boards on both LLL international website and mothering.com - both have folders for multiples and will be good places to find support and information. Your local chapter of LLL might also be able to connect you with someone who has breastfed twins who could offer some support.

Thinking of you and sending lots and lots of love.

Carrie said...

I'm cringing remembering the nipple pain you are describing. I had to use a nipple sheild as well and after a week and crying every time I had to feed K, I re-read the directions and discovered you are only supposed to use it for a few minutes at the beginning of each feeding to get your nipples to pull out and your milk to let down and for no more than five days. The lactation consultant never bothered to tell me this...

We switched to pumping exclusively shortly after and I have to say it was the best decision I ever made. I didn't have milk supply issues (I believe in part because I was on Metformin, which is similar to Fenugreek which helps with milk supply) and pumping made me sit down and take a break, gave me a chance to document things (ie, blog) and kept me sane. Plus by pumping, anyone who wanted to help feed the baby could... so that I was able to get more than three hours of sleep at a time and, like you said, kept me from being tied to the baby all the time.

My point is, please do not feel like a failure if you can't breastfeed... pumping and feeding them that while supplementing with formula is absolutely fine - especially if it means saving mommy's sanity.

Jill said...

I can't imagine how hard it is with twins! What really helped me at that stage was almost exclusively pumping. She would nurse for over an hour if I let her, and it was just way too much! I finally gave up and gave her breastmilk in a bottle for most of the feedings and fed her from my breast for 1-2 feedings a day- the ones that had been the most productive in the weeks before. Eventually she got better at it all, and now she exclusively nurses all weekend and almost exclusively bottle feeds (with ebm)during the week.

There is nothing wrong with supplementing with formula, either. As long as they're getting at least one bottle of breast milk a day, they will be getting your immunities, and the extra nutrients only you can provide. I know it's hard to believe, but you will find something that works, and you will enjoy being a mom. Breastfeeding is hard, but you can do it!

Ms Heathen said...

OK. Now I'm going to put my tuppence worth in.

Firstly, the early weeks of breastfeeding are really hard - and I speak as someone who only had one baby to contend with; I cannot even begin to imagine how much harder it must be with two. For the first few weeks, I just kept telling myself that every day I carried on was a bonus and got a little bit more of those invaluable antibodies into my baby. I think that you've done brilliantly to have got this far.

Secondly, do remember that everyone is different - what works for one woman may not for another. If the advice of one lactation consultant doesn't feel right, then seek the help of another. While some people may well find that pumping helps, I like Anna's suggestion--difficult and painful as it may sound--of letting them nurse for as long as they want and as often as they want for a couple of days. As she so rightly says, a baby is far better at getting milk out than a pump and you may well find that this brings up your supply (I would also echo those who recommended fenugreek in this respect). You may also find that letting everything else slide and simply being with your babies may help you enjoy the whole experience a little more.

But, whatever you decide to do, we are all here to support you. YOU ARE AN ABSOLUTE SUPERSTAR!

Much love all the way from the UK.

Holly said...

Hey Darlin'-Congrats on the babies...sorry to hear your struggles...call teh lactation consultant back in...don't worry, it DOES get better, you must be crazy with 2, one was crazy work! Teh first 6 weeks are a blur. The first 2 weeks, not sure how I survived. I will be sending you lots of good thoughts and saying prayers for you two and your precious G & D!

Me said...

I hope things are going better for you and your family now... ((HUGS))

MissNoAngel (find me on Twitter) said...

Oh hun. I feel your pain. I tried and tried and tried to breast feed my twins and just finally couldn't do it anymore. I was a much better mommy to them once they were on formula (we tried and pumped for 3 months). BUT, I am breastfeeding Nolan and it's going GREAT! It just depends. Don't be too hard on yourself. That said, I'll share some things I did differently with Nolan that I wished I'd known with the twins:
a) If it's uncomfortable after they latch try pulling down on the chin and flipping the top lip out after they've latched. There is sort of an art to this and you'll get a feel for it. This is to make the latch deeper after they're already on and eating...I wish I'd known this was possible before because it made a huge difference for Nolie.
b) Fenugreek. It's an herb. Take 2 3x per day and it makes TONS of milk. Mother's Milk Tea works great too. (and lots of water)
c) Very young babies (preemies in particular) latch and unlatch. It's their sucking pattern and it's frustrating as hell and they will outgrow it.
d) Babies will drink a bottle after breastfeeding even if they are not hungry. Try a pacifier. If that satisfies them then they are getting enough. Also weigh them before and after you feed them so you know how much they are getting from the breast.
e) It *will* stop hurting. I promise.
f) Don't be afraid to supplement with formula.
g) www.kellymom.com

I hope this helps some. If I had known these things with the girls I think I may have been able to pull off BFing them. But as it was I thought they weren't getting anything out of me because they kept unlatching and then relatching and then screaming. If I had just waited it out it probably would have been fine but I was SO exhausted and couldn't find the time to pump and take care of twins.
BIG ((((hugs)))

Shinejil said...

You are doing an amazing job. Amazing. Really. Just take that in and now that there are people out here in the computer in total awe of your commitment.

It *is* a grind the first few weeks. The rainbows and unicorns don't arrive until around 3 months, the bastards. Though it does start to get better at about 6-8 weeks. Of course, YMMV.

Is there a good lactation consultant you can talk to about the pain issues? It does hurt at first (people who say it doesn't are bullshitting you, even with the perfect latch), but it shouldn't make you sweat bullets and want to scream. Just to know you're doing it right, that your supply is good, etc. can be a big incentive and keep you in the game longer.

Because EVERYONE will tell you your supply is the problem. Except a good lactation consultant.

Bottles don't doom breastfeeding per se. Our guy used a bottle exclusively with pumped milk until he got really good at latching at 3 weeks, and then he was all about the breast and would have rather starved than sucked that stupid silicone stuff. :)

It took me about three weeks to get enough of a supply/rhythm rolling to get Bruiser to actually latch--we used a bottle until he did--and to deal with his marathon feeds. Those feeds continued for the first 12 weeks of his life, but he was a little pipsqueak trying to make up for sucky service in utero. Your cuties look bigger.

Barb said...

This sounds just like my beginning comments even with ONE.

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