Here's to the ladies who pump

Nothing funny here, folks — just some straight-up information that might be useful to those who are facing some heavy-duty pumping. I learned a lot of this late in the game, so I'm posting it in the hope that someone who's just starting out might benefit early on. It's mostly Medela-specific, but some of it might apply universally.

1. Lube it. Grease up your areolae with lanolin before you start. It will help create a good seal within the cones and will reduce irritation from the friction. Do this every time; the difference when you don't is noticeable.

2. Soup up your collection kit.
   
   • If your cones are uncomfortable you may need a different size. Older collection kits come with only a single-piece unit, so if that's what you have you might consider switching to a newer set; Medela has now moved to a two-part system that allows you to swap out the cone as necessary.
     
   • Speaking of swapping out cones, the Medela SoftFit breast shields, which are made of some kind of flexible space-age polymer — okay, silicone — are infinitely more comfortable for me than the standard hard plastic set.

3. Go hands-free. I do this by the simple method of pulling up the cups of my nursing bra enough to hold the cones in place. There are more esoteric ways of doing it, ranging from special bras to the rubber band trick. If you want to move around while you pump, these methods are a better bet than mine, but I spend my time pumping in front of the computer, so I don't need the cones to be all that secure. Note that the SoftFit breast shields are not compatible with Medela's hands-free pumping rig; you'll have to engineer your own.

4. Acquire multiple collection kits. Stock up especially on the membranes, which do wear out eventually, acquiring little tears that will compromise effectiveness. I don't mean just one extra set, either — I have four and still spend more time cleaning parts than I'd like. Which brings us to...

5. Throw your rig into the dishwasher. Every part of the Medela system is dishwasher safe except the SoftFit shields and the tubing that connects the collection kit to the pump itself. Even the tiny white membranes are dishwasher safe, but I haven't come up with a good way to contain them within the dishwasher so that they don't get lost and mangled. However...

6. You can use a collection kit more than once before washing it. Some women use the refrigerator trick, where they put their pump parts into a Ziploc full of water then refrigerate; it keeps any remaining droplets of milk from spoiling. I, however, live dangerously: since breast milk keeps at room temperature for up to 10 hours, I don't bother. I usually use a setup twice before washing. Since I'm pumping every three hours, I stay well within that time limit. Plus...

7. Reduce the number of parts in play by pumping directly into the bottles you feed with. I'm using Avent bottles, which are incompatible with Medela pumps, but I bought a set of couplers that allow me to pump into Avent bottles, eliminating Medela's collection bottles entirely. I cap those and refrigerate; when it's time for a feeding I just clap a nipple on the bottle and go.

8. A manual pump is probably insufficient for more than just occasional use. While I get my highest yield per pump with the Avent Isis — man, is that thing comfy — it takes much longer than a double electric and makes my hand and shoulder sore to use it more than once a day.

9. Conventional wisdom says that if you're going to be pumping exclusively, you'll need a hospital-grade pump. I don't know if this is because they're more efficient and extract more milk, or because they're heavier duty and won't wear out like a pump made for occasional use might. I have both, a rented Lactina and a Pump In Style, but have no opinion about which is better for my milk supply. I prefer the Lactina only because it is much, much quieter — you'd be surprised how grating that wheezing noise can be at 4 A.M.

10. If you have a choice in hospital-grade pumps, the Medela Symphony rocks the motherfucking house. It has two independent pump actions so that if you lose suction on one breast — say your jury-rigged hand-free arrangement slips — the other side keeps pumping unabated. It also has a gentle letdown cycle; on other pumps you can mimic that by manually adjusting the speed and suction, but in the dark of night it's nice not to have to.

11. Don't make yourself suffer with low supply. There are plenty of ways you can increase supply if you notice it's dwindling — increasing the number of pumps, decreasing the time between pumps, so-called power pumping, herbal supplements, et cetera. For me the biggest increase has come through profligate use of domperidone. It's not approved for use as a galactagogue in the U.S., but it's easily available on the Internet without a prescription if you're feeling bold. With domperidone my supply has doubled, allowing me to keep pumping happily — well, not happily, since this is me you're talking to — instead of being discouraged by the fact that Charlie's demand was far outpacing my supply.

Pumping mothers, what other tips do you wish you'd had when you were first starting? Let us give the Internet the rich, nutritious hindmilk of our collective experience.

Uh.

Move over, Iron Eyes Cody

I did not know this until I had one: babies aren't born with the ability to cry tears. Although from birth they make moisture enough to keep their eyes wet and healthy, what we commonly think of as tears — the kind that slide down a fat satiny cheek reddened by frustration or pain — don't come until later.

As we undressed him this morning at his neonatologist's appointment, a hungry, pissed-off Charlie cried his very first tear. He is one month adjusted today.

Detachment parenting

Some days (not today, thank goodness) you just can't win. Charlie starts crying, so you pick him up and he starts crying louder. Offer him a pacifier, he screams. Offer him a bottle, and he screams while arching his back into a semicircle while whipping his head from side to side like the lead in some devil-baby slasher flick.

Swaddle him, rock him, sling him, shush him and all you get is more evidence that his lungs have recovered from RDS just fine. And why did you spend all that money on the NICU when you were just going to murder him anyway, he asks in tones that might well reach downtown.

So rather than throwing him across the room or tearing him limb from limb like he says you're doing, you put him down and step into the next room just to get away from the screaming.

Silence.

You step back in, very softly, and there he is lying on the changing table or the couch, gurgling quietly and looking up at ceiling. Waving his arms and legs a little. In that mood the books call "quietly alert". What he really wanted wasn't food or a return to the white-noise confines of the womb or "non-nutritive sucking", it was for you to stop goddam bugging him.

Our local doctor once commented that ICSI babies tend to be developmentally delayed, because their parents never put them down. If that were really anywhere near true, it would be a wonder that any survive...

Turns out you can judge a book by its cover

Infants and Mothers: Differences in Development, T. Berry Brazelton, M.D.	Your Baby and Child from Birth to Age Five, Penelope Leach
Baby requires support of an adult to stand	Baby stands proud and free, unpropped and unassisted (unless there's a concealed steel rod somewhere I don't know about)
Baby is modestly clad in sporty rugby onesie	Baby performs a ringing indictment of restrictive social norms by going naked and unafraid into the harsh, cold world of the bookstore
Baby betrays unattractive tendency toward homophobia by making a stereotypical gesture of limp-wristedness — perhaps an unkind swipe at the pinky-ringed doctor?	Baby signals gang members just outside the frame to come kick that playa-hatin' baby's ass, yo
Advantage: Leach

---

What to Expect the First Year, Arlene Eisenberg, Heidi E. Murkoff, and Sandee E. Hathaway, B.S.N.	The Happiest Baby on the Block, Harvey Karp, M.D.
Cartoon baby drawn in an awkward perspective that seems to warp the very fabric of space	Real baby surrounded by an attractive pink aura of health and well-being
Baby's hairdo constitutes an unfortunate throwback to the darkest days of the overmoussed '80s, like mine at present	Baby's hairdo looks an awful lot like mine on its very best day ever
Baby clings to a stuffed bear as if it were a life preserver and he a floundering castaway bobbing in the briny drink	Baby embraces the calm but heightened consciousness brought about by the devoted practice of Iyengar yoga. Also, feet!
Advantage: Karp

---

Dr. Spock's Baby and Child Care, 8th Edition, Benjamin Spock, M.D., and Robert Needlman, M.D.	The Baby Book, William Sears, M.D., and Martha Sears, R.N.
Two babies; a manageable, streamlined number unlikely to alarm a feckless parent-to-be	Four babies; a shocking and profligate display of the repellent and uniquely American viewpoint that more is better
Babies touch to show their profound acceptance of each other despite differences in color and culture	Babies are so uncomfortable with the proximity of the Other that they stare determinedly off to the left, unwilling to meet each other's eyes and acknowledge their fundamental equality
Two naked babies' bottoms are adorable	Four naked babies' bottoms are downright gratuitous and probably got the photographer thrown in the pokey when he showed up to pick up his pictures at Fotomat
Advantage: Spock

My son the doctor

Dr. Batman to the rescue

[...] It is still a rarity when someone adopts Batman as their legal name.

[Norwegian] medical student Anders Mjelle, 22, is studying to become a pediatrician, and prefers Batman to more supernaturally powerful heroes like Spiderman or Superman, newspaper Nordlys reports.

Mjelle, now Anders Batman Mjelle, told the paper that the idea came to him while he was practicing his signature during a prescription class.

"It just wasn't as cool as doctor signatures usually are. So I tried signing with the name to my old hero of heroes, Batman. That was much better," Mjelle told Nordlys.

[...]

"I have naturally assessed the risk of being called Dr. Batman if I want to be taken seriously as a physician. But my goal is to become a pediatrician. In this case I believe being called Batman can definitely be something positive," Mjelle said.

(Full story at http://www.aftenposten.no/english/local/article967931.ece.)

Reflux redux

Last night was a bad night. There was an awful lot of crying: uncontrolled sobbing, ear-splitting wailing, inconsolable heaving, and a long stream of crystalline snot quivering from the tip of a gem of a nose.

And when I woke up today, boy, were my eyes swollen and bloodshot.

Charlie has been having a rough time with reflux. He left the NICU armed with Zantac; we adjusted the dosage upward as he grew. After a while, he reached the maximum dose, at which point the medication lost its efficacy. A pediatric gastroenterologist switched him to Prevacid, which initially helped and made us almost comically optimistic: one day of two-hour naps and we were sure we had this thing licked.

Not so fucking fast.

Last night Charlie was in pain once again as the acid rose from his stomach up into his esophagus, causing a burning feeling bad enough to make him scream as he tried to drink. He'd shriek, arch his entire body away from the bottle, and twist his neck as far to the side as it would go, emphatically rejecting his milk. Yet because he was ravenous, once the worst of the burn had subsided he'd cry out of hunger. As he screamed, he'd stiffen; there was simply no cuddling him into comfort, not that there ever has been.

It'll get to you after a while. Let's leave aside the knowledge that your helpless baby is in pain and there's nothing that makes him feel better, because that's just plain unspeakable. Instead let's consider the relentlessness of it, the screaming at every feed, the feeling that there's no end in sight: "Reflux usually clears up before the baby is a year old," the books cheerfully promise, not all that reassuring when the baby in question is a mere five weeks adjusted.

Or how about the way it disturbs a baby's sleep, with the pain yanking him from a sound slumber into an abrupt howling cry? Mind you, we don't expect much to begin with, especially considering the following passage from Preemies: The Essential Guide for Parents of Premature Babies:

Sleeping. Healthy premature babies are expected to wake up and fuss about every two hours until they're three to four months corrected age. (A long time, if you ask us!) By about six to eight months corrected age, they will have settled into longer periods of sleep, to everybody's understandable relief.

So let's discount that and focus on the sad possibility that even when Charlie might reasonably be expected to settle down for longer than two hours at a stretch — a possibility that seems fairly distant — he could still be jerked back into agonized consciousness by a simple ill-timed gurgle.

Or we could talk about how beaten I feel when I see his face redden just as he starts to scream. How angry and how cheated, when I remember the hopes I'd had that we might be granted an infancy that was only ordinarily hellish. How endless it seems, this just another twist that stops me from enjoying a pregnancy, a birth, and a babyhood that will only come once.

It'll get to you after a while. After a while, it's all too fucking much.

Last night I cried and cried. I was agitated and upset about everything I've just said, but it was the most absurd thought that finally brought the tears: Charlie doesn't like me.

It's absurd because I understand that for infants his age, liking isn't at issue. Infants his age need and recognize and bond; liking doesn't enter into it. Inasmuch as he can love, I suppose he does, but that blind devotion driven by hunger and a desire for warmth is a far cry from a smile, a face lighting up when I enter the room, a small body relaxing into mine with a sigh of contentment.

As crazy as my thought was, there's a kernel of disturbing truth to it, and that truth is that I'm finding it hard to bond with him at this stage. When he rejects every comfort I try to give him, it's difficult not to be discouraged. When I stay still as he sleeps because I dread waking him rather than because I'm relishing his weight on my chest, it's almost impossible not to feel disgusted with myself. At the moment I'm seeing each day and each feeding and each ten-minute nap as something to be gotten through rather than something to look forward to, and it's deeply distressing to acknowledge that.

Charlie doesn't like me yet. I know he surely will, but every day of screaming makes it harder to believe.

WWM: Woman wastes medication

Ladies and gentlemen, we have another entry in the World's Worst Mother contest!

The Prevacid we give Charlie comes in what they call solutabs — tablets that are supposed to dissolve instantly on the tongue. Because an infant can't be trusted to wait compliantly while producing the necessary tide of saliva, we're supposed to dissolve the tablet in water, then give the whole watery mess to Charlie by bottle or dropper.

When the tab is dissolved, most of it disintegrates, leaving the water spiked with what I am told is a delectable strawberry sweetness. The active ingredients remain visible, tiny orange beads that sink to the bottom of the mixing vessel. It is those we must get into Charlie.

So we use the medicine dropper, carefully positioning it to suck up as many beads as possible with as little water ditto. We hold the dropper vertically, waiting for the beads to sink down to the business end, and insinuate said business end into Charlie's mouth, which he has obligingly opened like a hungry baby bird. He sucks on the dropper, we squeeze the bulb, and the medicine is gradually introduced into his mouth and thereafter his gullet.

With me so far?

Today Paul took apart the dropper to wash it thoroughly. I usually just give the open end a wash in hot water; he, more fastidious, removed the bulb. And what do you think he found?

An orange muck of medicine beads, beads Charlie should have gotten, left instead in the dropper.

If you incline the dropper while it's full — say, to keep it from dripping out while you wait for the ravenous baby bird to open his tiny pink maw — the medicine runs into the bulb..and does not run out again.

Our baby was hurting because I'd held the dropper wrong.

World's. Worst. Mother. Winnah and champeen!

Passing the Torch

Back when Julie and I were first thinking about leaving Manhattan, we helped install plumbing in the house a couple of ex-urbanite friends were building for themselves in the backwoods of Maine. Along with us came the propane torch that had been sitting in my mother's basement for 20 years.

I was watching over Julie's shoulder as she sweated a joint somewhere in the half-built attic when the torch's main seal sprang a leak and flames started spitting from the junction between torch and propane tank. Without a second's hesitation, she handed the potential bomb to me, I blew the fire out, and we took the torch down to the front yard to fizz its way peacefully into oblivion.

Handing Charlie off sometimes seems a lot like that (maybe with a little less shrapnel risk). One of us will hand the other a compact shrieking bundle of fury: "Here. You deal with this." I feel bad when I do that to Julie. When she does it to me, I feel a little terrified but mostly useful.

When else should we hand him off? In Baby Utopia, one of us could put him down to sleep and the other one could pick him up when he wakes again happy and ready to eat. Or drop him in the baby gym for takeover when he's bored with his rattles and squeakers and music stars. And a pony.

But c'mon, who would want to stop hanging out with Charlie when he's being sweet instead of pissy? Or dare to move him when he's just started to go to sleep after a half hour's vocal exercises? Or in the middle of a bottle that he's slurping down without arching and yelling his fool head off?

We don't mean to pass him back and forth like a ticking bomb or a hot potato. That's just the way it tends to work out for now. And a good thing he won't remember.

I've got a secret

There's something I've been keeping from you.

First, the background. I am beginning to suspect, to my dismay but not my surprise, that Charlie has colic. The yelling has diminished now that the Prevacid has taken hold, but there are still three or four nights a week when he howls for no apparent reason, for a few toe-curling, jaw-clenching, sphincter-twitching hours at a time.

Since we've gotten the reflux more or less under control and he's no longer arching in pain, the screaming is easier to take. Instead of sobbing along with him, I march around the room with him tightly slung, singing loud enough that I can't hear his cries, or I bounce him on my knee emphatically enough to surprise him into silence for a moment, or pat my hand gently over his mouth while he shrieks so that it makes a "bah-bah-bah-bah-bah" noise. (It amuses at least one of us.) The goal is diversion, to distract him from yelling for even a blessed moment so that Paul can hear me when I ask for a motherfucking drink.

This is how I discovered the shameful secret I am about to reveal. Charlie, I found, can latch.

A few days ago, in yet another creative attempt to divert him, I unbuttoned my shirt, yanked loose the cup of my nursing bra, unceremoniously flung Charlie across his Boppy, and presented him with a fleshy ultimatum, ramming him onto my nipple with an authority I had not known I possessed. And he latched like he'd been born to it — as, in fact, he was.

I did it again tonight. And he did it again tonight. He suckled for a good five minutes, swallowing diligently, until he remembered he was supposed to be screaming — and I swear I could see the tiny Christmas tree light-sized light bulb go on above his head — and geared up again into full voice.

Here is what I plan to do with this information: absolutely nothing.

I was surprised by how I felt about his latecoming aptitude — specifically, not much. I'd have expected to feel elated, or relieved, or even, if I'm honest, chagrined. Instead I feel neutral, as if he'd done a trick I'd seen before that didn't impress me then. Big deal, you can latch. Come back when you can photosynthesize.

Giving up breastfeeding was a decision I made with no small degree of grief. A month later I'm over it, and have even grown to appreciate certain advantages of bottle feeding. (Those certain advantages are called sleeping through the 2 AM feeding, nonchalantly sashaying out to the spa for a massage and exfoliation, and never, ever letting my father get even the quickest, most accidental glimpse of my tits.)

I can't imagine retracing those painful plodding steps between anguish and acceptance, much less setting myself up for several weeks of sore nipples, patient positioning, and making myself available for every single one of Charlie's evening clusterpaloozas just when I've started enjoying him.

Will I regret it? Doubt it. I'm a little apprehensive since I know there's no turning back once I stop lactating. But I'm looking forward with indecent pleasure to throwing out my pumping gear, having regretfully concluded I cannot lawfully burn it under current EPA regulations — a clue that I won't be sorry to see the end of this mammalian phase of motherhood.

Smile, grunt, snort

Charlie finally smiles.

He also coos, grunts, and snorts like a pig (QuickTime, 1 MB).