19 days - hungry hungry hippo

When I started this daily diary, a lot of the reason was because I was finding it hard to spot changes in Sophie. It turns out there might be a reason for that.

She had her birthweight back at 13 days; the midwife visited today and we discovered at the weigh-in that she has since gained a grand total of...10 grams. That is well within the margin of error for 'nothing', and kind of getting into 'problem' territory. My little girl is neither longer nor heavier than when she was born - no wonder everything seems so 'same', hm? Last week the midwife had told me to try to get 400mL daily into her, which we've been doing, and which ought to be enough to see her putting on some weight, so it was a nasty shock to see that she'd put on basically none. And here I'd confidently said yesterday that I would do my best to stop fretting about weight after today.

However, this makes one thing rather starkly clear - all that screaming over the past couple of days must have involved a lot more hunger than we'd given her credit for. We were at least very relieved to have the problem there identified (and over the course of today, when we've been feeding her a lot more, she's been sleeping a whole lot and hardly crying at all. This would seem to rather resoundingly confirm the diagnosis.)

I've been feeding Sophie all this time by pumping breastmilk, since she has not managed to take the breast despite several rounds of opinion, technique critique, and ignominious nipple smushing and shoving by various nurses and midwives in the early days. Our midwife is of the opinion that things are likely to get easier once she gets up beyond the 3kg mark. So I'm in this holding pattern of pumping and occasionally getting her to practice nursing until she puts on more weight; it was therefore extra-frustrating to see that basically an entire week of growth has been lost.

The pumping has also given me my ups and downs of stress and worry all this time about whether I'd manage to produce enough. Yesterday evening sometime I came to the conclusion that the worry over this was getting out of hand, and if I had to top up some of the bottles with a few mL of formula, so be it. I'm pumping as much as I can manage, the formula feeds are not going to make me pump any less, and there's little else I can do to maintain or increase my milk supply, so there is no danger of the formula interfering with that.

Well, today I had to put that into practice. The typical rule of thumb for 'how much should I be feeding my baby?' is to take the body weight in grams, take 1/6 of that, and feed that number in mL. (More laid-back advisors suggest between 1/10 and 1/6; these are the same ones who say birthweight should be regained in 10-14 days rather than insisting on 10. Our midwife is the more laid-back sort; the local community advisor is not.) That gives a range of 280-460mL for Sophie, and we'd been feeding her ~400 per day; today we have offered something whenever she has been fretful and quested for something to suck, she's always taken some, and she's had closer to 500mL. And she's kept almost all of it down. That is one hungry hungry hippobaby.

Of course now one can ask, why was my milk not good enough? It's pretty clear that my father-in-law (who is a retired doctor) doesn't see much point in breastmilk over formula (although he very much sees the point of colostrum), and has little faith in its ability to adequately nourish a baby; it's also clear that Mike hates to see me chained to the pump, and can't help but think that life would just be so much easier if we'd move over to formula. And clearly Sophie hasn't been getting enough out of the milk I've given her. (I'm sure some people will be happy to argue this point, but I'm pretty sure that 'still at birthweight after nearly 3 weeks' is not within the range of healthy normality on any scale.) So I've been under a little bit of pressure to ease up on the breast milk and make sure she gets plenty of formula to bulk her up before the midwife comes back next week.

But actually I think the problem lies in the pumping, not the milk. The amount I produce varies wildly - sometimes I get 110mL, sometimes I get 40. When the numbers are low, I can usually feel the milk backing up in there. In retrospect I think it's not been very often that I've pumped all the milk out, and as a result the thin watery stuff has been in the bottle while the thick fatty calorific stuff has, as often as not, stayed behind in my breast. This is not something I'd have expected from using the big industrial pump we have on loan from the hospital, but it does seem to fit the evidence. So one of my projects over the next week (besides 'fatten the baby up') will be to see if I can figure out why the pumping is not as effective as it should be in extracting milk, and see what happens to my supply if I can get the rest of it out.

I'm sure this post could get me pilloried by a certain subset of breastfeeding activists. But I think it's important to lay it out there, and set out a feeding situation that is not in the standard 'you can solve this, easy!' troubleshooting guides for breastfeeding.