Game boy

Charlie has an umbilical hernia. This isn't an uncommon condition, though it's more common — just like everything — in premature babies. It occurs when the ring of abdominal muscles around the umbilical cord fails to close after the baby is born, and in most cases it resolves without treatment within a couple of years.

It's not serious and it's not harmful. It is also not so pretty.

Instead of a tidy and respectable innie, babies with an umbilical hernia have a protrusion that ranges in size from, I don't know, cat's-eye marble to basketball. What is it that causes this protrusion? What's sticking out through the opening in the abdominal wall? What in the name of all that's holy is that fucking thing?

Glad you asked! It's intestines, of course!

We knew about Charlie's hernia early on because, hey, it's the kind of thing you notice. In those weeks in the NICU we were concentrating on weightier matters than an unsightly navel, and I didn't give it much thought. It wasn't until Charlie's last appointment with the local neonatologist that the subject came up.

"Have you pressed on it?" the doctor asked us.

"Ummmm...no..." Paul and I stammered in unison, spooked by the very thought of poking that roiling little mound.

"Go on, mash it," she instructed gaily. And mash it I did. It sank abruptly into his abdomen with unnerving ease, then sprang immediately back out when I removed my finger. It felt like...like...well, exactly like you'd expect a protruding loop of intestine covered only by a couple of layers of membrane and skin to feel.

Since then I have found myself compelled to press on it every time I change his diaper. Though I want to, I don't actually do it. The one time I did, I was rewarded by an ominous rumble from deep within Charlie's belly, followed by a loud release of some of the foulest-smelling gas this side of the river Styx. This thing is like a goddamn Popomatic Bubble.

Oh, yes, we got Trouble. Right here.

Now, in the last several days he's found it difficult to empty his bowels, straining and turning a dark purple-red as he grunts with exertion. There are many things I can try to help him along. But rectal stimulation — thermometer, ointment — doesn't work. And a warm bath with gentle abdominal massage doesn't work. So naturally I keep thinking, What if I just pressed his navel...right...there?

In the hospital while Paul was changing a diaper, peering closely to make sure Charlie's tiny anus was left fresh as a daisy, Charlie let loose a gout of liquid excrement that shot out in a malodorous stream, making an arc no less impressive than the Gateway Arch. Paul responded with a loud announcement that made the nurses whoop with laughter: "Shit." I'm still not sure whether he was exclaiming or describing.

We know, therefore, that Charlie is capable of expelling his intestinal contents with all the force of a firehose under full pressure. (Riot cops, take note.) This knowledge is the only thing that keeps me from giving his navel a gentle poke when I know he'd like relief — among all the plans I have for Charlie's room, chiseling solidified baby crap off the walls is not included.

Well, that and my grudging awareness that it's probably not a good idea to play with the kid's intestine every time I'm feeling lucky.

Too bad. I'll just have to satisfy myself with playing Operation on him. It'll come in handy if his hernia turns out to need surgical correction.

WWM throwdown

Tertia claims she's the world's worst mother. But the crown is not uncontested: I contend that I, too, am in the running. See, I'm so bad at keeping Charlie's nails from turning into razor-sharp talons that the poor kid looks like he was in a goddamn bar fight from scratching his own face. I am imagining a gang of pissed-off babies whacking their bottles against the edge of the bar to make a jagged edge for menacing their tiny enemies. I am fashioning a teeny bandana for him in his gang's colors, in fact.

I haven't the heart to tell him that tiny ducks scattered on a background of butter yellow won't exactly strike mortal terror into the hearts of his arch-rivals.

I clip his nails frequently, but always forget to use a junior-sized emery board to round off the sharp corners. Even so, at ten weeks old — ten weeks old tomorrow! — he has a nicer-looking manicure than I do. We will not talk about the haircut I was due to have two days after his birth and never rescheduled, or the lizardy dry patches of skin I can't be bothered to moisturize, or the appalling state of my toenails, pedicured five days postpartum and neglected ever since. (Talk about razor-sharp talons, to say nothing of the giant flakes of Essie's Scarlett O'Hara that trail behind me everytime I go barefoot.) I shower every day, but until I do, I shuffle around the house in a saggy plaid bathrobe and a lanolin-stained nursing bra pulled up over my breasts but not fastened, with my scaly, hairy legs as awkwardly naked as if I were poultry.

So not only does my infant son bear more picturesque facial scarring than a Barbary corsair, I have officially let myself go. Not only am I negligent, I'm ugly to boot. Top that, Tertia, you asshole.

0 days adjusted

Charlie reaches his due date today.

When he was still in the hospital, I used that fact to protest every inequity, no matter how picayune. My indignation knew no bounds. "What do they mean, no turn on red?" I'd exclaim, shaking my fist righteously at a road sign. "Don't they know my kid's in the hospital?!"

Since then, I've cut him all kinds of slack — after all, he was still technically early, even though we'd have had him at 36 weeks if everything had gone according to plan. "Well, of course he doesn't like being bathed!" I'd croon, getting all up in his face, scaring the tiny bejesus out of him. "He isn't even born yet!"

Now there are no more excuses. 40 weeks gestation today.

Nipple freakishly implacable antipathy

Whoever came up with the term "nipple confusion" is a fool. Charlie's not confused; he is a baby of rare discrimination who knows exactly what he wants. He doesn't have nipple confusion. He has nipple preference. Nipple aversion. Nipple seething white-hot hatred, if you really want the truth.

We dislike breastfeeding, Charlie and I.

We started out in the NICU with the make-a-nipple-sandwich method, which involves jamming a big fistful of areola into a defenseless baby's mouth, stuffing him into muteness as if you didn't want him squealin' to the cops, see?! With this method he'd latch briefly, give three strong sucks, then look bewildered. I'd remove my nipple from his mouth and start all over again. "He'll get it," promised the flaky hospital LC, in between fits of crooning, "There you go, mama. C'mon, baby. Mmmmmama," as if she were a white, female, sub-moronic Isaac Hayes.

When I told the local lactation consultant about this, she rolled her eyes so hard they clacked in their sockets. When they finally rolled to a halt, she broke out a nipple shield, a clear silicone sombrero that comes to a point so emphatic I feared I'd put out one of Charlie's eyes with it. It fits directly over your naked nipple and is used to make it easier for the baby to draw the nipple into his mouth; it's especially helpful for babies with a suboptimal latch or suck and for women with suboptimal anatomy. That would be Charlie, and that would be me.

We tried it, and it seemed to go well. The local consultant watched Charlie and me together and pronounced herself well pleased. "He'll get it," she declared, and sent us off to work on it together with instructions to try at every feeding with plenty of skin-to-skin contact.

And then I had houseguests for ten days straight.

I was able to slip away to pump; at the beginning of the visit I was discreet, disappearing without warning, but by the end I was bellowing, "Gotta pump!" as I trudged up the stairs yet again. Although the guests were family members, I was too uncomfortable to spend time with them naked from the waist up, coaxing a screaming reluctant baby onto my sombreroed nipple.

They weren't even out of the driveway before I'd stripped and presented my plastic prosthetic once again to Charlie. But by that time, his initial goodwill had turned to rancor. He'd open obediently and allow me to draw him aggressively onto my breast, and he'd take a few experimental sucks. But when no milk was immediately forthcoming, he would scream.

And scream.

I'd wait for him to calm down, give him a few milliliters from a bottle, and then try again. And he would scream the scream of the thwarted, the betrayed, the milkless, the pissed.

Now here is where we talk about the letdown reflex, or milk ejection reflex. It's this that causes some women's breasts to leak when they hear their baby cry, and what some women feel as a tingling that precedes a gush of milk. Apparently it's a conditioned reflex that can be inhibited by pain, anxiety, or negative feedback. You know, like the pain of sore nipples being relentlessly hoovered into a mechanical pump, or the anxiety of watching your supply diminish, or the negative feedback of, oh, I don't know, a baby yelling in fury when you're not delivering the goods fast enough.

My letdown, friends, is for shit. So Charlie would give a few healthy pulls, get no milk, and then scream. I can't entirely blame him. Having been bottle-fed for the first ten weeks of his life, he had no patience whatsoever for meals served in a less expeditious fashion. If the nipple of a bottle — even a slow-flow nipple — is a McDonald's drinking straw, my nipples are those whisper-thin coffee stirrers. Now how would you rather drink your milkshake?

A classic case of nipple confusion. But Charlie is not confused. He simply hates my breasts.

I called the local lactation consultant, a mother of a preemie herself, and explained the situation. She sighed. She said, "Well, you can work on it. You can do more skin-to-skin, and you can continue to try. Or" — and here is where I burst into grateful tears — "you can just enjoy your baby."

I needed that permission, thinking, If a hardcore breastfeeding advocate says it's okay to stop, it must really be okay to stop. I've been working very hard for the last ten weeks. I am ready for something to be easy, for feedings to be pleasant and amicable. I'm tired of trying, and desperate to stop being a special case, to stop having to work so much harder than almost everyone at something that should come more or less naturally. I am not going to try anymore.

That said, I'm still pumping. In fact, I'm committed to doing so at least until Charlie hits twelve weeks. I've heard that at twelve weeks a baby has received about 60% of his mother's antibodies, with the rest accruing only gradually thereafter. (I was not able to find a citation for that figure, but it pleases me so I embrace it.) It's important to me to give him that much, especially during RSV season.

Beyond that arbitrary milestone, I don't know how long I'll keep it up; a lot depends on how well I'm able to build and maintain my waning milk supply. To that end, I'm already pumping so frequently I don't know night from day, guzzling so much Guinness I smell like a brewery, and popping so much fenugreek I smell like a mapley brewery. I've also ordered domperidone without a prescription from a shady overseas pharmacy, and will frantically swallow it in giant handfuls immediately upon its arrival.

After that, we shall see. I will report back, unless I'm too busy enjoying my baby. Or slowly decomposing in a drawer in the morgue, a sad cautionary tale against ingesting controlled substances acquired from fly-by-night charlatans somewhere in the South Pacific.

It happened one night

Usually Paul tends Charlie around midnight. I take the 4 AM feeding because I need to be up to pump anyway. This generally allows each of us to get a short stretch of unbroken sleep, although it's imperfect; pumping every two to three hours plays hell with a girl's slumber. I'm philosophical about that, since I know that if Charlie were nursing I'd be up then, anyway.

I say "usually" and "generally" because we've been known to switch off when one of us needs to crash. Last night Paul was in dire straits, so I volunteered to be on duty all night.

I started feeding Charlie at 10:30, confident that he'd be finished and sleeping peacefully by the time I needed to pump at 11:30. Somewhere along the line, though, he started getting pissy. He'd suck on his bottle, but a few pulls in he'd start arching back, making a terribly angry face, and screaming. After a few rounds of this, I concluded that he wanted to suck but had a full stomach, so I put his pacifier in his mouth. He'd suck on that for a while, then repeat the same routine of angry contortions. I tried to pretend we were playing a game of charades at a sophisticated '30s house party, but he remained unamused by my guesses: swaddling? No. Rocking? No. Jiggling? No. Swing? No. Shushing loudly into his ear to drown out his angry yowls? No, and quit that, goddamn it.

Inconsolaboy.

Nothing was working, so as a last-ditch effort I shucked off what little clothing I was wearing and put him to breast, sans nipple shield, sans ceremony. I thought he might find some comfort noodling around with my nipple, smelling my scent. (Because the fenugreek has apparently infiltrated my every gland, I smell like the unwashed nether folds of Mrs. Butterworth, thanks for asking.)

My friends, he nursed like a motherfucking champ.

He latched. He sucked. He gulped and swallowed and practically chewed with his mouth open and drank the contents of his finger bowl. When I switched him to the other breast once he'd seemed to slow down, he took to it like, um, like a mammal to milk.

That boy can nurse.

However, since I'd managed to get in some pumping while he howled unhappily in the swing, I knew my breasts weren't full, so when he dropped off my breast a while later and still looked hungry, I investigated the bottle I'd been trying to give him when our peaceful mealtime went to hell. I thought maybe the milk had gone sour, so — I can't believe I did this, much less that I am confessing it — I put the nipple in my mouth and gave it an experimental suck.

Nothing happened. No milk, though the bottle was half full.

A few more sucks and...something...worked its way free. The holes in the nipple had been blocked, and all of Charlie's formidable sucking power could not dislodge that...something.

My boy was yelling, and my boy nursed at last because he was practically starving.

We finally slept, with Charlie dropping off exhausted and me eventually drifting off after making grand plans to sweep into the lactation consultant's office, Charlie nursing contentedly in his sling, modestly declaring that it was really nothing, after all. Just a little patience was all it took! (It goes without saying that in my vision, I was svelte, Charlie was cherubic, and the sling had an impeccable cut, making me look fashionable and maternal all at once.)

This morning I pumped a bit first to get my letdown going, and put him to breast again, eager to hold the ground we'd gained last night.

And he would have none of it.

None.

He screamed. He wailed. He would not latch. He would not suck. He hated my breasts again, or still.

I'm fucked. As long as I lactate, I hope. As long as I hope, I'll try. And as long as I try, I suspect he will scream. I am fucked, my friends. Just fucked.

And the Grammy goes to...

Next time I'm sticking with 160-Pound Tumor

The problem with TiVo is that it makes it impossible to claim, "I was just flipping past, and I happened to see..." No, I explicitly requested the Discovery Health program, Babies: Special Delivery, the episode slugged, "Crisis Mode: Pre-eclampsia at 31 weeks." (It is irrelevant but interesting to note that the same channel offers such edifying fare as 160-Pound Tumor and 14 Kids and Pregnant Again! — exclamation point theirs, not mine.)

A pregnant woman with chronic hypertension is admitted to the hospital when her blood pressure spikes and she begins to spill protein into her urine. Her condition is worsening, so the delivery cannot be postponed, and in short order she gives birth to a baby boy weighing 3 pounds 14 ounces at 31 weeks. The baby shows immediate signs of respiratory distress syndrome. He does not respond well to the first course of surfactant.

Now, um, why did I think it was a good idea to watch this?

I watched it as I cradled Charlie against my chest, rubbing my cheek against his fuzzy head while he slept. I kept thinking, I could have lost you. I could have lost you. That's when I wasn't thinking, Good Christ, she's bloated.

...

I got e-mail a couple of weeks ago from a woman who also had HELLP syndrome. She wrote,

I'm having a really hard time coming to grips with what happened, and what COULD have happened.  I could have lost my baby.  I could have lost my life.  I could have lost my life AND my baby's life.  I could have left my older child without a mother, and my husband without a wife. My older child probably would never have remembered me.  I think about that a lot.

I've had three doctors tell me now that I shouldn't have any more children.  It's hard to hear that I can't have more children if I wished to try again.

I'm wondering how you dealt with your HELLP. Did you have a hard time coming to terms with it and has it gotten better as time has gone on?

I'm astonished to say this, but I hardly think about it at all.

When I was discharged from the hospital, leaving Charlie behind for the night as we'd do for the next forty days, it was almost impossible to believe it had happened. I couldn't grasp the enormity of it at the time — the fact that I'd gone in pregnant, come out not, not far from death but now quite well, a scant fast four days later.

I had a lot of time to think about it over the next six weeks, especially as Charlie's condition changed from day to day. And yet I rarely did. I thought about him, of course, all the time, and I occasionally resented the slow pace of my recuperation from surgery as I regained my stamina, but I didn't dwell on the danger I'd been in myself.

When Paul and I talked about those first few frightening days — and we did, a lot, at my obsessive insistence — I learned that he'd been scared for me. Strange; I never was. When my abdominal pain was at its most severe, I knew I was ill but was sure that it couldn't be serious. And when the obstetrician on call told me they needed to deliver the baby, I was certain it was on Charlie's behalf; it didn't occur to me at the time that it was necessary for my safety.

Behold the awesome power of denial.

I can't really account for any of this because, hey, I'm as self-absorbed as the next person. (Okay, I'm as self-absorbed as the next ten people.) All I can conclude is that my mind was full of Charlie. I had to think of someone else. I had to keep moving.

Even now that things have settled down and Charlie and I are perfectly well, I can't really accept it, can't honestly confront how sick I was. Did I have a hard time coming to terms with having had HELLP, with having been so desperately ill? You tell me.

Is it hard to hear that I shouldn't have more children? If I'd been asked this while Charlie was still in intensive care, I'd have said no — in fact, I did. Now my answer's different. Now I have a newborn, and I feel a pleasure close to intoxication as I watch him change from day to day, on the cusp of new awareness with every single blink. I can say now with conviction that I want another baby, and I'm sorry I won't be having one.

...

It could be much worse. I'm here and well and so is Charlie, and that should truly be enough. Beyond that, I could have been the patient I mentioned before, the one on the show who delivered at 31 weeks; her son was on a ventilator for 20 days. I could have been another patient on the same show who extruded a second set of spontaneous twins through her artfully pixellated vagina. (Tertia, take note: two sets of twins at home. Two. You piker.) Or I could have been still another patient, one who had a severely abscessed tooth, requiring delivery before she went septic — the camera zoomed in on her mouth, and as God is my witness I swear to you I'd rather be barren than have a luminescent throbbing oral pus-pocket like hers.

Cake, steak, take

There are some things I've been meaning to tell you:

1. When I was still slogging through the dark and carbless doldrums of the gestational diabetes diet, I valiantly tried to give myself a pep talk. "Why, this pregnancy thing is easy! Nothin' but blue skies ahead, I tell you. In fact, it's a goddamn cake walk."

   "Yeah," said Paul, "without the cake."

2. I do not like the term breast milk. It's a weird kind of synecdoche that makes me imagine disembodied breasts being processed like soybeans: soaked, crushed, cooked, and pressed for their rich and healthful juices.

   Yuck.

   Since breast milk seems to be the term of record, however, I think I am going to start calling the kind that comes from a cow steak milk.

3. The cat, barely a year old, is a little too playful to be trusted around baby-related implements. The nail clippers routinely end up on the floor. The pacifiers have to be washed many times a day because he's fascinated by the clicking sound they make when batted across the kitchen tile. And this morning he made off with my nipple shield.

   Here's what upset me most about that: even the cat has a better latch than Charlie.

The happiest baby on the block

Charlie welcomes in the weekend.

Boppy courtesy of Abby. Blanket courtesy of Layla. Milk-drunk stupor courtesy of Julie.

Congratulations

When Charlie was born, everyone in my family said, "Congratulations!"

No one said, "You must have been really sick," or "What a scary time for you," or "Is he going to be okay?" No one acknowledged the seriousness of the situation. Now, it is a thoroughly documented fact that in my family we don't talk about unpleasant things, so it wasn't a surprise, but it added to the unreality of the experience to be warmly congratulated on the dramatically early arrival of a baby who might not make it.

A few weeks after Charlie's birth, I told my friend T. with some indignation that a well loved relative on Paul's side "didn't even call to say congratulations." T. said, "You know, it's funny — when Paul called to tell me about it, it didn't even occur to me to congratulate you. I thought to say, 'What can I do to help?' and 'Is Julie okay?' but 'Congratulations!' was the farthest thing from my mind."

No one said the right thing because there is no one right thing to say. If I was confused about my own feelings — and I was, and still am — and if even I didn't know what I needed to hear, I couldn't hold it against the people who care for me when they were unable to voice precisely the right combination of validation and optimism. You can't really expect people to blurt, "I'm worried about you. I'm worried about your baby. I'm shocked and sad at how it came about. I'm apprehensive about what the future might hold. But amid all this I feel a thrill of joy to think you have a baby at last. Hang in. I'm here for you."

Kind of a mouthful, really.

It's this same complexity of emotion that sometimes makes it hard for infertile women to accept congratulations when they're pregnant at last. The knowledge that that positive pregnancy test could eventually bring anything from joy to desolation is tough to reconcile. It's what makes us say, "Well, we're cautiously optimistic" when we're twenty weeks along, or tack on, "...if everything goes okay, fingers crossed," when strangers wish us well.

Charlie's twelve weeks old. I've reached my goal of pumping until we'd reached that milestone. Coincidentally, today we are using the very last of the frozen milk I'd stockpiled while he was in the hospital. I'm tremendously ambivalent about both the prospect of stopping and the possibility of continuing. I've done right by him so far, and I'm proud of that. Now as I enter uncharted territory — the place where I have no concrete goal and assume a "one day at a time" approach — I don't know what I need to hear. I don't know if I need encouragement to continue or reassurance that I can stop. I'm not sure what would make me feel good. I don't think there's any one right thing to say, when my feelings are so complex and often contradictory.

But I think "congratulations" would be a good start.