Failure to Thrive

This post has been a long time coming.  It’s also going to hurt to write.  But it will also help explain my sparseness in posting since Baby ButIF’s appearance.

I’m pretty sure that if you went back and read through a lot of my pregnancy posts you’d catch me saying here and there, “if I’m able to breastfeed,” or, “I talked with my counselor about ways to overcome my disappointment if I can’t breastfeed,” or even, “With PCOS and thyroid disease I’m pretty sure breastfeeding’s gonna be a total crapshoot.”  So, yea, I knew the cards were stacked against me.  Just as surely as my F-ed up hormones made it damned near impossible to get and stay pregnant, I knew they could also make breastfeeding a challenge.

Rather than be fatalistic about it, I thought I was being rational and proactive in preparing coping strategies in advance.  Though I have endless angst over it, I’ve become used to my body not working quite right.  At least, I thought, I could put that hard-won knowledge to use and spend some time – say 9 months – setting my expectations.  So, as the months of my pregnancy went on and my breasts failed to change one single bit I was pretty certain I was getting my answer.  We’d go to the hospital, I’d deliver, I’d skin-to-skin and attempt to feed him, I’d fail to produce anything, and we’d jump on the formula train.  Easy, peasy, no?

In fact, I was so worried about setting unrealistic expectations that I – yes, Type A, research everything to death me – didn’t do a lick of research into breastfeeding.  I called our insurance just to have an idea what my breast pump benefit was, I registered for a bottle brush and a nursing pillow, and watched a BabyCenter video on breastfeeding holds, but that was literally all I did to prepare.  Just as I’d avoided all pregnancy and parenting conversations for 4.5 years, so too did I spare myself from all things breastfeeding for fear I’d never get to put that knowledge to use.

Trouble was, that lack of preparation led to some pretty uninformed assumptions on my part.  I’d assumed it would be an all or nothing scenario.  I’d either have milk, or I wouldn’t.  My body would work, or it wouldn’t.  I’d be pregnant able to breastfeed, or I wouldn’t.  Black-and-white with no room left for gray.

When the day came for what I thought was the final verdict on breastfeeding, I was anxious.  I asked for a lactation consultant (LC) as soon as we were transferred to the postpartum floor and she quickly arrived despite it being almost midnight.  The first words I said were a simple, “I don’t know if this is going to work.  My breasts didn’t change at all during pregnancy and I have PCOS and Hashimoto’s.”  She was encouraging and said, “Well, let’s try and hand express and see what’s there.”  I was skeptical but started squeezing as instructed and giggled like a silly school girl when a blob of gorgeous yellow colostrum quickly beaded up on my right breast.  “This is going to work!” I thought.  “I’m going to be able to breastfeed!”

For the rest of my stay in the hospital I followed instructions and woke him every three hours to feed.  In the 36 hours between little man’s delivery and my discharge from the hospital I saw 4 different lactation consultants and heard different versions of the same advice multiple times.  He didn’t need much right now.  It was normal for a newborn to be sleepy.  Yes, I’d need to wake him to feed until he regained his birth weight.  No, it was far too early to start thinking about pumping.  Everyone can breastfeed as long as they try hard enough and have enough support along the way.  And, yes, I was doing wonderfully.

On the morning of our discharge out little man had dropped 11% of his birth weight, but we were still cleared to leave.  They reminded me that since he’d been born in the evening and we were being discharged in the morning that a full 48 hours hadn’t passed and that was why he’d lost slightly more than their 10% upon discharge standard.  He was having wet and dirty diapers, latching like a champ (when awake), and I had the support and education I needed to be successful.  I accepted it – happy to get home to my own bed, my own shower, and start my so longed-for life as “mom.”

We were discharged on a Saturday, meaning our first appointment with the pediatrician would fall on a Monday – his fourth day of life.  When Monday rolled around he’d lost an additional 7 ounces.  Our extremely breastfeeding friendly ped felt that our problem was his sleepiness; he just wasn’t awake enough to get an adequate amount down each time.  She sent us off with hugs and words of encouragement and scheduled us another appointment for the following day.  24 hours later – despite 8 hours of active nursing logged in my baby tracking app, no matter the fact that my husband dutifully jabbed his thumb HARD into our little man’s foot every 3 hours like clockwork – he’d gained exactly 0oz.  Nothing.  The ped said not to worry.  As long as he wasn’t losing at this stage they were happy.  Keep at it, drink lots of water, keep waking him however possible, and return in a week.  You’ve got this!

I put my heart and soul into breastfeeding, while, at the same time, I felt like I was falling apart.  The morning of his 2 week appointment Mr. ButIF asked, “Do you think there’s something wrong with your thyroid?  You really don’t seem right and I know I’ve seen this before.”  I knew he was right.  The fatigue I was feeling was more than typical new parent exhaustion.  And, given my med-free birth, I couldn’t think of a single thing that could account for the all-over body numbness I was feeling.  I’d only felt that once before…

But, I knew I’d sacrificed my sleep and sanity for a good cause.  I just knew my baby had grown.  Turns out, however, he’d lost yet another ounce.  My perfectly average, 50th percentile 7lbs 6oz boy at birth was now barely on the breastfeeding growth charts at 6lbs 7oz at 2 weeks old.  Now the ped was getting a little worried.  She recommended the herbs Fenugreek and Blessed Thistle, talked about the drug Domperidone – which she couldn’t prescribe as 1. It’s not available in the US market, and 2. She’s not my doctor – and sent her practice’s LC in to teach me how to use a supplemental nursing system, or SNS.  I was barely holding it together when the LC entered the room with a jug of ready-made formula and the SNS – basically a torture device syringe the lactationally challenged mother fills with formula or expressed breast milk, tucks into her bra, and hooks up to a feeding tube she can either tape to her breast or hold with one of her 4 available hands and sneak into her fussy, hungry (and obviously endlessly compliant) newborn’s mouth when he isn’t looking.  I tried out the SNS in her presence for about 5 minutes – it took the combined power of six hands (mine, hers, and the misters) to get it working – before she sent me off, soaked through my shirt, bra, pants, and even underwear with formula, with a “Good luck, you’ve got this, use the SNS at every feeding!”  I spent the next several days (coincidentally, the first days I was home alone with Baby ButIF since the mister was back to work after his 2 week “vacation”) crying more than my hungry newborn.  I stunk of formula, I hated my body, I was lower than I ever thought I could get with my longed-for miracle in my arms.

When we returned home from that 2 week appointment I immediately called the high-risk OB who’d managed my pregnancy.  Three agenda items:

  1. Please test my thyroid, something is off!
  2. Can I got back on Metformin?  I can feel my PCOS reemerging and it might help me breastfeed.
  3. Will you prescribe Domperidone to help with breastfeeding?

I got the following three answers from the triage nurse.

  1. No, you’ll have a thyroid panel done 6 weeks postpartum, and no sooner.
  2. No, Metformin is not safe while breastfeeding.
  3. Absolutely not.  Take Fenugreek and drink water.

I cheered myself up by crying over my tiny son while I attempted to shove the SNS tube down his throat again.

Our 2 week appointment was on a Thursday, we ordered an infant scale and had it overnighted to us on Saturday, and when our precious baby boy woke up with sunken eyes and even more lethargic than usual on Sunday we weighed him.  He was now 6lbs 4oz.  From a birth weight of 7lbs 6oz.  It was time to stop fooling around with the SNS.  We mixed a giant bottle of formula and my husband fed him while I called and cried my eyes out to the on-call LC at our delivery hospital.  She assured me “true” supply problems were very rare, and that I should keep on with the bottle today and pump religiously every 3 hours for the next 48 hours just to see what we were working with in terms of my supply.  I did exactly as ordered.  Pumping through the night, through the days, pumping with one hand while trying to comfort a newborn just learning what it felt like to be well-fed with the other.  In 48 hours of round the clock pumping I pumped 5 ounces.  Total.

I did two things on Tuesday.

  1. Called my endocrinologist seeking thyroid testing.
  2. Found an amazingly supportive low-supply Facebook support group.

The support group informed me that Fenugreek – that herb that had been recommended by friends and family members, our ped, and, yes, even the high-risk OB practice who had carefully monitored my thyroid throughout my pregnancy – was, in fact, contraindicated in women with thyroid disease.  As in it could make my supply WORSE not better and totally throw off my thyroid in the process.  I immediately stopped it.

The endocrinologist consented to the retest, but wanted the labs drawn at their offices over an hour from my home.  That wasn’t happening with a 2.5 week old that needed to be forced into being fed every 3 hours, with a husband that was back at work full-time, and with a mama that was barely sleeping.  I begged them to let me do it locally.  The cheery nurse on the other end of the phone agreed and said, “OK, I’ll send off the requisition today!”  I said, “Great, here’s my email address.”  She replied, “Oh, no, we can’t email.  I’m sending it in the mail.”  I celebrated that minor victory by crying as I prepared another bottle of formula for my teeny, tiny son.

We first suspected my thyroid was off at 2 weeks postpartum.  I got my bloodwork results at 5 weeks, 1 day postpartum.  Normal range 0.3 to 2.5.  Mine?  0.07.  I forwarded the values to my husband in an email with the subject line, “I’m not fucking crazy!!!”

Things started to turn around then, but remain a challenge.  I’ve since found a fabulous IBCLC (International Board Certified Lactation Consultant) through our county health department who makes weekly home visits to help out (and, oh does she!).  I restarted my Metformin (against doctor’s orders) and saw an immediate increase in my supply.  I ordered Domperidone from a foreign pharmacy and, again, saw a supply increase.  And, most importantly, my breast AND formula-fed baby started staying awake, gaining ounces, and smiling, cooing, and doing all things happy and healthy babies should do.  On any given day he gets around 50% from the breast and 50% from the bottle and that’s a HUGE increase from where we stood a few short weeks ago.  I try to remain realistic with my goals – he’ll never be exclusively breastfed – but I know I’m doing the best that I can, and that’s all I can ask of myself.  I worry about how things may change when I return to work on September 10, but that’s a bridge I’ll have to cross in the coming weeks.  Thankfully that’s a bridge I’ll cross armed with the info and support I most certainly didn’t have in the beginning despite all the LCs and MDs and random strangers on the Internet who told me otherwise.

No, not every woman can breastfeed, but I’m thankful that I had the hard-won strength, determination, and drive that IF gifted me to accompany me on this difficult journey.  Breastfeeding is not black or white, all or none.  I’m finding my way living in the gray.