River's Breastfeeding Journey w/ Gina Caruso-Rissing
To celebrate National Breastfeeding Month, I’m sharing my breastfeeding journey with my daughter, River. I’ve worked at The Center for over 15 years now, so I knew about all the challenges breastfeeding could bring, but I didn’t expect to experience so many of them! I had planned a home birth for many reasons, one of the big ones being that I wanted to set myself up for as easeful a postpartum as possible, which for me meant allowing my body and my baby to experience birth without intervention or medication. Unfortunately, the universe had other plans for us and I ended up birthing River via unplanned cesarean at 38 weeks due to severe preeclampsia. And from there our breastfeeding journey began!
Thankfully, River was born totally healthy, albeit very small at only 4lb 11oz. We were able to get our golden hour and River latched, and I was able to hand express a few drops of colostrum very soon after she was born. Because I was still preeclamptic, I was medicated with a magnesium drip for 36 hours which made the world very fuzzy and because of that, I wasn’t as vigilant about latching or expressing colostrum in the first 24 hours as I could have been. That combined with the dramatic way River made her entrance into the world and my postpartum preeclampsia delayed my milk from transitioning from drops of colostrum to a robust supply. We spent 8 days in the hospital, during which time I pumped with a hospital-grade pump around the clock and fed River in a myriad of ways (trying to find what worked best). Latching wasn’t working well because her mouth was just so small, so we tried spoon-feeding, finger feeding with a syringe, finger feeding with a tube, and feeding at the breast with a nipple shield and tube. We were fortunate to be in a baby friendly hospital that had donor milk available for us to supplement with, as supplementing was very much needed for us during our hospital stay and beyond. We eventually settled on a combination of feeding Rivi at the breast with a nipple shield and tube and finger feeding with a tube.
Once we were home from the hospital, the amount of milk I was able to pump slowly started to increase, although we still needed to supplement for months. We continued with our finger feeding and nipple shield/tube combo at the breast, and eventually added bottles overnight to speed up feedings so we could get a little more sleep. Those first 6 weeks were all hands on deck all day and night - I don’t know that I could have continued with my intense pumping/feeding/supplementing schedule without having my husband home with me and helping constantly. We are so fortunate that he gets 12 weeks of paid parental leave, which seems like the bare minimum for any new parent and I feel for those families that don’t get at least that.
Throughout those early days/weeks, I kept telling myself that I just needed to make it to 4 weeks and then things would get better. Then at 4 weeks, when I was still pumping 9-10 times a day, still supplementing, still unable to feed River directly from my breast, I had a little bit of a breakdown and almost gave up on trying to get to exclusive breastfeeding. Two days later I had an in-person appointment with my lactation consultant (we had been doing telehealth up until that point) and reworked our plan and also picked up a wearable pump. This was a turning point for us. First, my lactation consultant identified both lip and tongue ties and we immediately scheduled our evaluation with a pediatric dentist. Second, getting a pump that allowed me to move around while I pumped was a game-changer. Apparently I’m one of the few that gets just as much milk with a wearable as I do with a hospital grade pump, so I gradually switched my pumping sessions from the Medela Symphony to the Willow Go and felt so free! I felt like if I had to exclusively pump, I could do it!
We ended up getting River’s tongue and lip ties revised just before she was 6 weeks. From there, we saw gradual improvement with River’s latch (she was finally able to maintain a latch without a nipple shield!). Over the next couple weeks, I continued pumping around the clock, and supplementing using the tube and shield, and latching her without the shield a couple of times a day to get her used to it. The post-frenotomy exercises weren’t fun to do, but they became part of our routine quickly and we all got used to them after a couple days. We had a couple of bodywork sessions with a craniosacral therapist to address some tension in Rivi’s jaw and neck. Those appointments were like magic! I remember after the first appointment I latched River and was like “OH! That’s what a latch is supposed to feel like!”. It was finally not pinchy and something I had to bear, but felt so gentle and comfortable.
Finally, around the time River was 2 months old - once her lip and tongue tie revisions were healed, her latch felt comfortable, and she was able to remove at least small volumes of milk without the nipple shield - we were able to start working towards exclusive breastfeeding. We started with short “baby buffets”, where Rivi would have constant access to nursing but not bottles, to help get her more active at the breast and effective at removing milk. We started with 4 hours a day, and gradually increased that window over the next couple weeks. Sometime around 2.5 months postpartum, my milk supply finally matched River’s needs and I was able to stop supplementing with anything other than my own pumped milk. I had worked so incredibly hard to get there and it felt like such a huge victory for me!
Just before she was 3 months old, Rivi was (what I consider) exclusively breastfed. She took bottles here and there and at least one overnight, but she nursed the majority of the time and was eating my breastmilk exclusively. We had a new issue pop up (or maybe just worsen; it’s hard to remember) around this time - reflux. She was spitting up during/after every feed and her weight gain started to slow down. Because she was so small at birth, I’ve always been very cognizant of her weight gain and noticed pretty quickly when she stopped gaining like I expected. We met with another one of my lactation consultants, and after observing a nursing session (during which Rivi spit up 3 times) and listening to some of the other issues we were having (slow weight gain, tons of uncomfortable gassiness, small/frequent feeds, and mucousy stool), she suggested I try eliminating dairy and see if symptoms improved. Very soon after cutting out dairy, River seemed much happier and more comfortable and started gaining well again, so no more dairy for me! I also figured out she was sensitive to eggs, so I’m effectively vegan again for the foreseeable future.
River is now 4 months old and still a tiny little thing, but growing on her growth curve and super healthy. She’s exclusively breastfed and I’m down to pumping 3-4 times a day. Our journey to get here hasn’t been easy, but exclusively breastfeeding was important to me. Especially after having the end of our pregnancy, birth, and immediate postpartum go absolutely nothing like the peaceful transition I’d hoped and worked for, nursing was something I felt like I had more control over, even if it was way harder than I anticipated. I was so determined, and I’m so glad we stuck with it, because the breastfeeding relationship we have now is so special to me.
If River’s birth and breastfeeding journey taught me one thing, it’s that none of this is black and white. It can all be both beautiful and heartbreaking, the hardest thing and also the most natural, filled with love and also with anxiety and uncertainty. What’s best for me and my daughter is best for us, but that doesn’t mean it’s best for everyone. That’s the beauty of it all - we all get to feel into the best path for ourselves and our families and make decisions to get ourselves there. I also acknowledge the incredible privilege I had and I have no idea how I would have persevered through all our challenges if I hadn’t had paid leave, if my husband hadn’t had paid leave, if my family wasn’t supportive, if I didn’t have access to the best medical care, midwife, lactation consultants, pediatric dentists, bodyworkers, etc. Honestly, I had all the support in the world and it has still been incredibly hard. I just wish every new parent had the same level of support and access to care, which I recognize is sadly not the norm in our country. And I hope, even more now, that the work I continue to do at The Center brings greater access to some of that same care that was so vital for me and River.