Waiting for Agnes

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Fun parent has left the building February 9, 2011

Grab your cup of tea and a large snack. This will not be brief.

Here I was almost six months ago, mother of a one year old who had zero interest in expanding his diet, and wrestling with the questions of follow versus lead, surrender versus control. My enthusiasm to embrace small’s transition to toddlerhood and our family’s transition out of the hazy circus of babyhood meant that the pendulum tipped to lead and control. And for a time all was well. Somewhat smugly, I felt I had achieved quite a coup: the small one ate a small amount of food and continued to breastfeed a large amount of the time. Huzzah  for extended breastfeeding thought I. Time whooshed by. My work hours stretched into two days a week, the beloved’s compressed to three or four. At some point, small let go of his hatred of bottles and cups. Freedom! The beloved could give him expressed milk and no longer had to plan their day strategically around small being brought in to work for a breastfeed. We could even (gasp!) go out without him, just the two of us.  Just look at us go! Embracing change left and right! Ah, the maturity.

Summer arrived, rainy, humid. Ate a lot of ice cream, lurched onto the mad pre-Christmas treadmill of catching up with friends, worked a bit, got chiropracted a lot (yes, well, if other people can make up words, I don’t see why I can’t join in), got sucked into the shopping frenzy, and expended a lot of energy secretively hiding and wrapping presents. And some time in there the small one just kind of stopped eating again. One day I realised I was still carrying around food for him every day, still offering him three meals plus snacks, but that it was all going uneaten. He was toying with his cereal, having the odd rice bubble or bran flake, crumbling his previously beloved fruit bars and mooshing them into the furniture, turning his nose up at toast, hiding his dinner under an upturned bowl, not really ever eating. He was breastfeeding as much as ever, maybe more, with night feeds escalating wildly to the point where once he grabbed on he wouldn’t let go until dawn. Bloody hell it was exhausting. What to do? I stopped expressing at work, reasoning that a drop in supply might increase his appetite for the alternative. I tried to reinject a little stability in his day, making sure we were at home for mealtimes and sleeps, not varying the food too much.  In the new year I made just one resolution: to night wean.

 

Oy, the trepidation. I had toyed with the idea of night weaning for a while, longing for sleep like a strung out addict. I talked at all and sundry about it. Predictions were dire and unanimous…night weaning and bed-sharing would not be compatible, small would not be off the boob until he was out of our bed and he wouldn’t get out of our bed until he was out of our room and presumably wouldn’t be out of our room until he bought his own house some time in 2039. What the hell, I thought. Can only give it a go. I struck a deal with the small one – you can have all the cuddles you want, all night, but it’s last drinks at 10pm then the bar will reopen when it is light outside. Miraculously, with just one night of outraged shrieking, we succeeded. Yes, he may sleep on my head, or at least on 70% of my pillow, and do a bit of break dancing and occasional squawking through the night, but it’s surprisingly easy to sleep with a toddler on your head and not on your breast. He even stopped the hopeful groping after a few nights. Smug parenting moment. Sleep. Bliss. But mysteriously no increase in appetite. Still no eating. And still attached to the breast at any opportunity through the day. It dawned on me one day that whenever I was stationary, he’d come for me like a homing missile. My latest theory is that the breastfeeding weight loss starts when you start running away from your toddler.

And then it was January. Lazy, sandy, lolling January. Still no eating. No talking. And not really growing much either. And then he got a virus, not a bad virus, just persistent enough for us to go to the GP. Unsurprisingly the GP said ‘small is too small, take him to a paediatrician…really, it won’t be that bad, he won’t bite you’. Coming not long after the new and disliked maternal child health nurse snippily said ‘well, I have to tell you to see a paediatrician, even if you won’t go’ and right on the back of a close friend having the courage to tell us that she didn’t think all was well with small and his food strike, it was the straw that broke this mama’s resolve. I’d grown hardened to the insensitive, offhand and sometimes plain ridiculous comments coming from any old schmo in the street. It’s hard to hear but even harder to ignore it when it comes from someone who loves you and your baby dearly.

So to the paediatrician we went. Grimly prepared, list of questions in hand, contents of Blue Book virtually memorised, I felt like I was going to sit a test for which I couldn’t possibly study well enough. Yes, this could be taking a healthy wariness a little too far, but the clawing anxiety was hard to suppress. What was my worst fear? Being told ‘you must wean and give your baby formula’. And what happened? I was told ‘you must wean and give your baby formula’. It played out like so:

Me – So, I have x, y and z concerns. I’m not really concerned about his size. Genetically, he’s going to be small.

Dr Notsochatty –  (after about twenty minutes of silently examining, weighing, measuring, charting and noting developmental milestones) None of x, y or z are concerning to me at all. These things will be fine. He is too small. It’s a very simple issue – not enough calories.

Me – Why doesn’t he seem hungry? Why doesn’t he take the abundant food or drink offered to him? I assumed he would instinctively take what he needs.

Dr Tactless – He is like a baby in the 3rd world. He’s just used to not getting enough so he doesn’t ask for more.

Me – Wow. That makes me feel great. So, I have been effectively starving him for months. But he seemed so happy.

Dr Slightlyobtuse – Lethargy can look a lot like contentment. The solution is to wean and put him on toddler formula. He needs to be having (tappity tappity of calculator) one litre a day.

Me – I’m quite devastated. (trying not to embarassingly cry) I don’t want to wean him completely. I still feel there is value in breastmilk for him.

Dr Sceptical – What’s your problem with formula?

Me – Urhh. That’s not really what I have the problem with. I have a problem with weaning completely.

Dr I’mdonenow – Well don’t then. Just make sure you give the formula first. We’ll see you in 3-4 weeks. If he’s not improving we’ll look at admission to a hospital or a mother-baby unit.

Me – ……………

That was that.

I thought ‘I could fight this, I could ignore this advice and carry on waiting for small. But why did I come here? Wasn’t I ready for something to change? Yes. We have tried it small’s way and that hasn’t worked. So we’ll try this other way’. And before I could get distracted by the competing voices in my head, I stamped over to the supermarket and bought a tin of toddler formula. On the up side, it is organic.

Then we went home and I was introduced to a new side of the small person – the you-thought-I-was-stubborn-before-ha-you-aint-seen-nothing-yet side. Again I say – goddamn genetics. Since before I was pregnant I was repelled by the advice given to always dominate your child, to show them who’s in control, to wield all the power, to not give the inch for fear of losing the mile. I so dearly wanted to respect my child’s individuality, to recognise the limited ways he has to voice his own wants, to honour his right to exercise his own willpower. I didn’t want to get into power struggles with him. I wanted to negotiate peacefully…….. It’s fine. You can get up off the floor now. Wipe away the tears of laughter. Oh ho ho ho. And yes, I have met toddlers before, but obviously mine was going to be special and different. Be careful what you wish for indeed. Small obviously feels that his right to exercise his own willpower is indeed honoured.

 

 

So, the formula. The first day I managed to cram 100mls into him. It took four hours. Mainly he did angry backbends over my lap, his face contorting in his efforts to escape what was effectively waterboarding with powdered milk. God it was dreadful. Not only was I the worst mother ever, with my third world toddler, but now I was torturing him. But as the week has unfolded, things have improved. Cooperation up, bodily restraint down. And despite my scepticism, and being completely aware of my ability to rationalise any decision I’ve made, the regime is working. This week has been like watching the small one come out of hibernation. He’s more vibrant, social, curious, vocal. His concentration span has soared. His sleeping has improved out of sight. He’s incredibly affectionate. It’s amazing to watch.

Yet painful. While I’m grateful that there’s nothing wrong with him that food cannot fix, it kills me that he’s been doing without for months. It challenges my faith in extended breastfeeding. It really challenges my faith in baby-led weaning/solids. It scares me that this could have gone on for longer. It makes me feel foolish for being so, so sure of my convictions.

 

Not in the zone October 5, 2010

I’m feeling very gloomy this evening. A bit short and snappish, preoccupied with the unfolding of events at work over the past two days. Usually it’s other people’s inadequacies and crappy decision making which send me home fuming, but tonight I’m just gloomy about my own.

I cannot count the number of times I have heard other maternity care professionals justify their decisions/refusals/interventions with the phrase “I’m just not comfortable with ______________” (insert any of the following: waiting for you to go in to labour on your own/allowing you to birth on the floor/you using the bath during labour/not giving you antibiotics/not doing this test/not giving this drug/letting you go home yet…). The list is endless and the language is always saturated with notions of permission-giving and implications of women being naughty, rule-breaking girls who don’t give a fig for their babies’ welfare. This notion of practitioner comfort as a guide for practice irks me as much as the statement “If it was my wife ____________ (having a breech baby/questioning the necessity of a test/being female and pregnant and conveniently oppressed by archaic obstetric care) I would advise her to _____________ (just do what I say even if it’s based on nothing but fear or financial incentive/not question me/just shut up already). Midwifery and obstetrics and having babies are not meant to be about being comfortable, not for anyone. As an aside, there is never a dumber question asked of a labouring woman than “Are you comfortable?”. This job of caring for women as they step into motherhood should be about understanding the normal and knowing the evidence for intervening in the abnormal. It should be about providing the information and honouring the woman’s ability to make decisions for herself and her baby. Should should shmould.

So, what have I done? I have run smack bang into the invisible wall of my very own comfort zone. Let me set the scene:

On Sunday evening, around seven o’clock, a woman gave birth to her first baby. I was not there, but I know she had a spontaneous, vaginal birth, using only nitrous oxide (the gas) for pain relief. She did not bleed excessively and is otherwise well. At birth, her baby was handed straight into her arms and lay, skin to skin, on her chest. She wants to breastfeed but her baby is not interested. Sensibly, she keeps her baby skin to skin with her, allowing him plenty of opportunity to breastfeed. Over night, the midwives help her to try and express some colostrum, but report that they are unable to express even a drop. By eleven o’clock the next morning her baby still has not been able to breastfeed. He has attached on and off a few times but hasn’t attempted to suck. He is settled and remains skin to skin on her chest. He has had a poo, but no-one is sure if he has had a wee (disposable nappies can be tricksy for detecting the teensy wee of a newborn). The woman’s husband is with her, anxiously attentive, lovingly stroking her and the baby. Her mother in law is sitting by the bedside, tutting and tsking as hard as she can, muttering about starvation and formula and glaring hard at everyone. The unit lactation consultant is off for a training day. All very helpful. The midwife looking after her asks me for help. I whip out my breastfeeding cure-all and show the woman how to position herself and her baby to feed lying down (really, it is a very useful skill). Baby has a go at attaching but still isn’t swallowing. He is starting to cry and is no longer easy to console. Together, we have another go at expressing some colostrum. Three glistening drops appear. I suck them up painstakingly with a 1ml syringe. It is twelve o’clock and has now been seventeen hours since birth. Conferring with my fellow midwife, we decide to finger feed the baby these three precious drops of colostrum mixed with 1/2 a ml of sterile water. Gently sliding a finger into his mouth and dripping the liquid in slowly, I hope fervently that this will trigger the switch in his brain – that he will start to connect sucking with swallowing with feeling something in his belly. As he starts to suck my heart sinks a little. His mouth is dry and he is so very uncoordinated, not sealing his mouth around my finger, not bringing his tongue forward but instead using it to push against my finger. But afterwards he turns back towards his mother’s chest and settles again, so we don’t give up hope. I step out of the room and back to into the relentless pace of another October day.

A few hours later, just before we morning midwives finish our shift, I check back with this woman and her baby. No change. It is now twenty hours since birth and he is starting to look truly hungry, crying and crossly pushing at her breasts. She is tearful, her husband more anxious. On the upside, her mother in law has tutted herself to sleep in the bedside chair. I step out again, seeking out the midwife who will care for her next. Hating the words coming out of my mouth, I suggest that while the woman should continue to keep her baby skin to skin and keep expressing, the baby may need a supplementary feed of formula. Then I go home.

Today, I’m back on the ward, every room full. Our lactation consultant is back on deck. She is frantically busy and she is furious – furious that this woman’s baby has been given formula with no medical indication. On paper this is true. The baby is not lethargic, jittery, under 1.5kg, admitted to the nursery, septic, hypothermic or hypoglycaemic (that we know of – no blood sugar measurement was done). His mother is not sick or absent. I feel horrible. I have great respect for our LC and we usually work well together. Usually she respects my professional judgement. Now, buffeted by the wave of her anger, I suddenly find myself questioning my decision. Should I have been more trusting? Should I have waited longer? How long? I ask this and the answer is firm – no medical indication, no formula. But really, how long? Until a medical indication arises. How do I feel? Uncomfortable.

And there it is. Discomfort. Have I really interfered unnecessarily because I wasn’t comfortable? I come home and haul all my breastfeeding textbooks off the shelf. Am I trying to justify my decision? Or can I find something to stretch the boundaries of my comfort zone a little? There are answers, sort of. Although the authors vary in how many feeds they feel should occur in the first 24 hours post-birth, they concur on one point: if a baby has not latched on and fed by 18-24 hours of age, the mother should be assisted to express colostrum and feed it to the baby by finger, cup or spoon. But none of these texts suggest what to do if there is no colostrum. In a perfect world, this woman would have a sister/cousin/friend who was breastfeeding, someone who could donate some breastmilk to tide her baby over until her own milk comes in. Or we could access donor milk from a breastmilk bank. But this world is far from perfect. This woman’s only family in Australia are her husband and tutting mother in law. And if they were here, the idea of sharing breastmilk amongst family and friends is disappointingly taboo. We will have a breastmilk bank up and running in Victoria soon, but even then it may not have enough to provide milk for babies not under nursery care. So what is the answer? How long can a baby wait?