Thank you

A special thank you to my parents and to Kurt's mom, Elizabeth, for coming out to help us during the first few weeks of Erin's life. We really appreciate all of your help and are so glad that Erin got to meet you.

Love,

Christine

Breastfeeding

or: My Daughter Doesn't Suck

What could be simpler or more natural than a baby suckling at his or her mother's breast?

Apparently a number of things, because breastfeeding seems to be a rare skill set that is difficult at best, and seemingly impossible to master. I'm amazed that humanity as a whole survived the time period before the first infant formula was created. Perhaps things were simpler back then, and babies just knew how to suckle. And perhaps the crops grew taller, families were happier, and politicians were honest. Who knows?

I do know that our daughter has what is known as a "weak suck". Laugh all you want; I did. I didn't, however, even know that "suck" was a noun. I do know that just about everyone agrees that the best food for a newborn is breastmilk. However, hardly anyone agrees on anything else regarding the production, distribution, or consumption of it.

Oh, sure, there are a few common points: Mom produces as much milk as baby demands. The 'hindmilk' has more fat and protein than the 'foremilk'. But it falls apart after that. Some of the more extreme breastfeeding advocates condemn pacifiers, bottles, or anything that's not connected to a mother's breast; it can lead to 'nipple confusion'.

Some on the other end feel that in many cases, formula can be healthier than an unhealthy or poorly-fed mother's milk, and claim that 'nipple confusion' happens in less than 5% of cases.

And some of us in the middle need to supplement mom's milk because of other considerations (See: Jaundice), and feel guilty about not meeting the strictest standards for breastfeeding.

Others want to give breastfeeding a try, and get frustrated because breastfeeding is not as intuitive, natural, or simple as we would like to think it is.

For successful breastfeeding, there are a number of elements that need to be properly lined up. The baby has to latch on correctly; if you haven't breastfed, it's not quite how you're thinking. The baby has to know how to suckle (note that I didn't say 'how to suck'; this isn't a sports bottle or straw we're dealing with). The baby has to have enough endurance to get through the 'let down' phase, and to keep suckling long enough to get more out of the feeding than he or she is putting into it. Mom's milk has to have 'come in' properly. And mom has to produce enough milk to support the baby, and express it fast enough for baby to feed properly.

None of these elements will necessarily occur intuitively or instinctively, much as we might like to think they will. When things don't work right, it's easy to blame oneself or to consider it a failure of the first test of motherhood. Don't. There are resources out there that can help.

It's also easy to doubt yourself, especially when there are so many opinions out there regarding 'proper' breastfeeding. Did that bottle of formula screw up Baby's breastfeeding? Did the pacifier the nurses used in the hospital cause nipple confusion? Are you enough of a milk producer to feed your child? What do you do when your milk isn't quite in, but Baby's screaming for food? What if you do 'ban the bottle', but Baby loses too much weight before your milk comes in? Will your (perceived) failings cause your child to fail later on in life?

What we've found:

• Don't be a perfectionist. Don't make the best the enemy of the good. While regular breastfeeding may be the best possible outcome, there are many elements that have to be lined up to make it happen. Don't be afraid to supplement, to use a pump and bottle, or to do whatever it takes to get your child fed.
• Stop the cycle of questioning and doubt. Define what's important, and do what it takes to make it happen. We decided that breastmilk is more important than formula, but formula is better than a hungry or under-fed baby. We also decided that we don't care how the breastmilk gets to Erin.
• Get help. Ask your friends who've breastfed and your doctors to recommend lactation consultants. Ask them why they recommend them. Use your judgment when picking one, and when listening to them. Don't be afraid to get a second opinion.
• Talk to your friends and family. Our neighbor happens to be a mother-baby nurse who is pursuing her lactation consultant certification. I ran into her while Christine was having a tough time with Erin, and the ten minutes of advice and assistance she gave was invaluable. Other friends surprised Christine when they told her that they had also had a tough time breastfeeding, but were afraid to mention it at the time because they felt inadequate as mothers.
  
• Don't stress yourself. Get enough food and sleep, and remember that all of the opinions out there on breastfeeding are just that, someone's opinion. Read up on breastfeeding and get a good overview of it before your baby shows up. Life with a newborn is difficult enough without having to sort out all the strongly-worded opinions on breastfeeding on little sleep and even less free time.
  
• It will get better. Both mother and baby are learning a very new skill set, and it takes time. As baby develops, he or she will get stronger and have more
  

Jaundice

An Eyewitness Account
of the Battle Between
the Courageous Erin Anneliese
and that Yellow Coward, Billy Rubin

Like all babies, Erin was checked at the hospital for jaundice, a condition in which the baby turns yellow. Jaundice is caused by the buildup of bilirubin, a by-product of the breakdown of red blood cells. Bilirubin is normally cleared from the blood by feeding; a compound in milk binds to it, where it is filtered out and excreted through the bowels. Elevated levels are treated through phototherapy (light breaks down the compound); extreme cases can be treated with transfusions. Because Erin was breastfed, and didn't get much milk for the first few days, her bilirubin levels went up after we left the hospital.

As far as we know, Erin's bilirubin levels peaked at 17.4 ml/dl on Tuesday after she was born. This isn't in the danger zone, but it's close to it. Her pediatrician called us with the report, and started the clinic on a search for a suitcase light or fiber-optic blanket for her. They weren't able to find one, and he suggested that we keep Erin near a window with her shirt off as much as possible. Some limited direct sunlight was okay, but because newborns are particularly sensitive to sun, indirect sunlight would work fine. Dr. Grier also prescribed supplementing Erin with formula so that she could get enough volume of food to process the bilirubin from her system.

At that point, the fight was on. Bilirubin was represented by Billy Rubin, a yellow coward who had wronged Erin and (in Texas terms) "done earned himself a beat-down". No offense intended to anyone, but he wore a number of personae over time, from Yankee carpetbagger to the classic Western 'citified' and cowardly villain to the spoiled brat of a Bronx diamond merchant. (Sue me, but the last name fits.)

Erin scored points by the unconventional method of bowel movements. Every soiled diaper was met with cheers of "Go, Erin! You show that mean old Billy Rubin!" or "Erin's kicking the crap out of Billy Rubin!" etc. We were a bit troubled by supplementing with formula, mainly because some of the more militant breastfeeders say that anything but a living nipple will sabotage your child's development, but we figured that a known condition trumps an unknown possibility any day.

Erin's bilirubin was checked the next few days, early in the morning, and trended downwards, slowly at first. After a few rough nights and early mornings, I realized that a 10:00 or 11:00 AM appointment would retain more parental sanity than an 8:00 AM one, so we switched to a later time for our lab visits.

At Erin's latest Well Baby checkup, her bilirubin levels show at 12 ml/dl. It's still a bit high, but is in the safe range and trending downwards. Our daughter showed Billy Rubin that his type ain't welcome here.

Birth Day

Christine's water broke on the night of Wednesday June 4th, just after 8:00 PM. We were talking on the phone to my mother, and Christine took off for the bathroom in a hurry. She came back, and said "I think my water just broke." I asked her to repeat it for my mom, but she had already heard it, and replied, "Isn't this exciting!". We said quick goodbyes and called our doctor's office. The doctor had us come right in to the hospital; luckily we had packed our bags a couple of days before, just in case.

Erin's due date was June 21st, two and a half weeks away. It would be a severe understatement to say that we were not quite ready. Christine had just finished the "What to Expect" chapter on childbirth, and was planning on reading the chapters on baby care next, and I had about four unfinished projects strewn about the house.

We made the hospital by 9:00 PM, and Christine was hooked up to various monitors, IVs, and such. Since it was after hours, our chosen doctor (Dr. Sally Grogono) was not available, and one of her partners (Dr. Patrick Nunnelly) was on call. We were told that delivery may well take until late in the morning, and looked forward to Dr. Grogono delivering our child. But we had nothing to worry about, as Dr. Nunnelly was excellent.

Christine's sister Heidi, her husband Larry, and their 3-year-old Lauren showed up to support us, and probably expected a long wait (as did we), but Christine's contractions started getting more intense, and they left us after a couple of hours. We appreciated their support, but we didn't feel comfortable with Lauren seeing how much pain Christine was in.

We went in to the delivery with open minds regarding pain management, open to either an epidural or a drug-free approach. From our 'baby classes' , we understood that Christine needed to be at a certain dilation, and be in an "active labor pattern" in order to receive an epidural. But because the baby was already so low, the nurses and doctor were unable to check Christine's dilation. In addition, we had expected dilation to take about an hour per centimeter.

So we assumed that Christine wasn't quite ready for an epidural, although she definitely wanted one. But when Christine's contractions started to hurt so bad that she curled up into a ball and cursed her way through them, we decided to ask what exactly the threshold was for an epidural, and if we were yet in an "active labor pattern". We were floored when the nurse said that Christine had been in an active labor pattern since her water broke, and she could have had an epidural at any time; all she had to do was ask.

There was the briefest of pauses, and then (very politely, but very firmly) Christine asked, "May I please have my epidural now?"

The anesthetist was called in, and was very professional and confident with his procedure, but he zinged Christine's leg nerve, and her leg kicked HARD against my knee, then back against the bed. I honestly expected bruising on her leg after the delivery. He adjusted the insertion, finished his procedure, and told Christine that it should start to take the edge off after the next few contractions.

Apparently the epidural worked fine, because a couple of contractions later, Christine was giggling and outright laughing her way through them. She'd press on her backside and giggle that it felt like it was about to fall off... The nurses said they'd seen all kinds of reactions to the drugs, but this was new to them. The giggling continued until the pushing began.

As I mentioned, we were unsure of Christine's dilation. Once the epidural was in effect, around 12:45 AM or so, the nurse checked her again, and we were all surprised to hear her announce that Christine was already dilated to 8 cm. I'm incredibly proud of Christine for making it that far into labor without any pain medication. Even the nurse said that she was surprised because she didn't feel that Christine was showing enough pain to be that far along.

And then the hard part started: the pushing. At one point during labor, one of the nurses mentioned that it may take a while to push, as this was a new experience for Christine. But she did beautifully, taking only two hours.

I'll skip over the details, but at one point a mirror was brought in so Christine could see what she was doing, and a pair of grips was added to the bed so she could have something to push against. I was holding Christine's right leg; the epidural had left her unable to move it at all (although her left leg was merely numb). Once Erin made it past the pubic bone, she started to move right out. In fact, she moved so far and so fast that she started crowning and coming out before the doctor answered his page! One of the nurses closed Christine's legs, and Erin slipped back in. We were a bit crestfallen, and dreaded another hour of pushing, but the nurse assured us that the baby would have no problem slipping right back to where she was.

Dr. Nunnelly arrived shortly, and another nurse arrived and started warming up what looked like a McDonald's fry bin, but turned out to be an incubator. Christine pushed a few more times, and Erin slowly began moving out. The mirror was still in place, and Christine got to see the tip of her head before the doctor mentioned 'episiotomy', and I asked a nurse to please move the mirror now.

At 4:54 in the morning of Thursday June 5th, Erin was born, only taking a little coaxing from Dr. Nunnelly. He artfully flipped her over and said, "Congratulations, it's a girl." We were both pretty surprised. Christine had expected a boy, although she wanted a girl. I had wanted a boy, but prepared myself for a girl. And about 90% of the people who guessed, told us that it was a boy.

But regardless of our expectations, Erin was beautiful. Dr. Nunnelly cleared her mouth and nose, clamped her umbilicus, and handed me a pair of medical scissors to cut her free of Christine. I did the honors, and have to say that the umbilicus is tough; it feels like cutting a garden hose with a sharp pair of shears.

Erin was then checked for her Apgar scores (8 and 9), cleaned up, and checked out. There was a lot of talk about 'immediate mother-child skin to skin contact' in our classes, but it was quite a few minutes before Erin was laid atop a cloth over Christine's gown, and covered with warm towels. During that time, Erin was weighed and checked out, and Christine was stitched and cleaned up. While I was watching our little miracle through tear-filled eyes, Christine asked me who she looked like, and I will forever regret my immediate thought of "Gollum". Sorry, Erin.

Erin lay on Christine's chest, and we hugged our daughter and cried tears of joy and relief, and said, "Look at what we did!" Dr. Nunnelly came over, congratulated us, and took our first family picture. Despite doing all the work, Christine managed to look far better in the pictures than I did.

Christine was wheeled to a recovery room, and I followed Erin to the nursery, where I learned to bathe her, put on a diaper, and do a proper swaddling. Apparently shift change happened right in the middle of everything, and it was about two hours later than Erin and I were escorted to Christine's recovery room a bit later.

Prologue

We're absolutely positive that Erin was conceived on the night we celebrated our first wedding anniversary, in a castle in Dublin, Ireland. We even discussed the possibility of an "Irish Baby", and what names we would choose. Erin will be relieved to hear that her name won out over Brigid, Reagan, and Caitlin. (Although I secretly was pulling for Reagan.)

When we returned from Ireland, both of us walked in the Breast Cancer 3-Day. Not knowing that she was pregnant at the time, Christine was frustrated with how much more difficult it seemed this year than last. But when we did a home pregnancy test, and then a doctor's visit, we knew why.

At the doctor's office, right before Thanksgiving, I saw my daughter for the first time. I'm not ashamed to say that I got choked up, and nearly cried when I saw her on the sonogram monitor, even though she looked like a gummi bear. Of course we announced it to everyone at Thanksgiving.

Christine's pregnancy wasn't effortless, nor was it notably difficult. The worst issue by far was gestational diabetes, a temporary condition that develops when a placental hormone interferes with her insulin. Christine's normal diet is heavy on fruits, vegetables, and juices; the transition to a low-carb diet was difficult for her.

Another issue was anemia, and its effect on Christine's mood. At the beginning of the second trimester, Christine went through some abrupt mood swings, occasionally sliding into depression. We both knew that something was not right, but we didn't know what it was. A regular checkup showed that Christine had developed anemia, and once her iron prescription started to work, her mood changed back to her normal self. We even noticed that if she took her iron late enough in the day, she'd have a few hours of grumpiness before it kicked in. This is a bit personal, but Christine wanted me to include it because she doesn't want anyone else to suffer through this without some advice and support.

Considering that some of our friends had to be hospitalized for malnutrition or dehydration due to morning (and every other time of day) sickness, we feel pretty blessed.

Our OB was Dr. Sally Grogono, a graduate of Tulane, and a mother herself. She's got a great manner, and went through a difficult pregnancy of her own, so we knew she could handle just about anything we could throw at her.

And finally, some advice for those expecting:

• Ride it out. Pregnancy is a temporary condition; focus on each other and what's important: the child.
• Take your vitamins and eat healthy.
• Get some sleep; building a baby is hard work. And you'll need that sleep when baby gets here.
• Keep a sense of humor. You'll definitely need that when baby gets here.
• Don't start any new projects unless you are absolutely, positively sure that you can finish them well before the baby shows up. Trust me on this.
  

-Kurt