Why I breastfed for 33 months (or why breastfeeding is like running)

When I gave birth to Junior J, I was determined to breastfeed him for at least six months. We had not attended any classes or talks, however, I had read about the benefits of breastfeeding, and it all seemed so doable. After all, you just need to latch the fellow and he'll drink, and everything would be easy peasy, right? But it turned out to be not so easy after all: After ten hours of labour and and TWO epidurals, I was shivering and feeling nauseous after I delivered. He did manage to latch on, and I requested for him to room in with me, so I spent the night trying to feed him the best as I could. 

It became a lot more challenging when we went home, since the house was a mess (the baby room wasn't ready yet, as it formerly was a guest room and we had some relatives staying with us before that), and we were just scrambling to get everything in order. Junior J seemed to be hungry all the time, and kept crying as he didn't seem to be getting any milk, and I was struggling to get him to latch properly. In desperation, the hubby had to drive down to the hospital in the middle of the night to see if they could spare us more milk samples, and we ended up having to supplement his feeds with formula until my milk came in after a few days (I nursed him, then we topped up with formula).

Things got even worse, as we were exhausted, and there was a steady stream of visitors to entertain (it was Chinese New Year, and everyone was just so excited, since Junior J was the first grandchild of the family on both sides!). I was in pain and wasn't getting much rest. The boy refused to latch properly, and his shallow latch made nursing painful, and contributed to sore and bleeding nipples. Still, I was adamant on nursing him, so I took painkillers when it was unbearable, pumped when I could, and soldiered on.

The first month went by in a haze of naps caught in fifteen minute intervals, and marathon nursing sessions. Junior J had reflux, and I had to carry him upright after each feed. I was nursing him every two hours round the clock, because he could only take small feeds due to the reflux. I had multiple episodes of blocked ducts (which the lactation consultant helped to clear, with a lot of screaming from me), I got mastitis, I also had nipple thrush. I dreaded nursing sessions, which were painful, but I continued feeding, because I really wanted to. Six months, I told myself, just hang in there for six months. Those around us got rather worried. "Just feed him formula, and stop starving him!", I was told, when people saw me struggling with the long and frequent feeds. But I either ignored them, got into quarrels, and went on feeding, feeding and feeding.

Then after the first month, things became a little better. The boy's latch was improving, I knew how to deal with the frequent blocked ducts, I was getting used to the lack of sleep motherhood entails. And it progressively got easier. He was still nursing in two/three hour blocks, but at least I wasn't dreading the nursing sessions so much, and it was satisfying to see the little one put on weight and become chubbier.

I loved how chubby he was!

I was on maternity leave. However, I had to attend night lectures two weeks after giving birth, as I was doing my Masters then. So we learnt to juggle, where either my mum would take care of Junior J at home, or the hubby would bring the boy along to wait for me on campus. I would dash out during lecture breaks to pump, and was so thankful that there was a nursing room on campus where I could store milk and pump in peace. Pumping during lectures was still manageable, however, the time came when I also had to finish up my dissertation, which required me to be out in the field for my research. Initially, my supervisor was horrified when I refused to take up a proposed topic, which involved having to go offshore for half a day each time to gather data. I couldn't do that, how was I to pump when I was out in the wild? Even if I was to pump, it would not be feasible to store the milk in a cooler for half a day in the hot sun! Thankfully, I was able to find an alternative topic to research on, where I could pump at home, dash out during low tides to gather my data, and rush home after to pump again.

Amidst the juggling, the supply dropped, and I remember panicking at times when I was unable to pump much before leaving the house. However, eating fenugreek worked: the supply went up, and we managed to continue to feed the little one all the way until I finished my studies and research.

So the six months went past in a blur, and by then Junior J was a seasoned feeder. He was easy to feed outside, since he would drink quietly under a nursing cover, and I could more or less feed him anywhere. I didn't see any reason to stop, the boy was enjoying his feeds, it was no longer painful to nurse, and I hated the hassle of having to wash and sterilise bottles. So we just continued nursing. Travelling overseas and going out was much easier because I didn't need to carry bottles, and could just nurse him on the go, so we managed to travel and even went on a mission trip with him tagging along. By then I was glad that I had persevered with breastfeeding, and it was much easier as I eventually resigned from my job and stayed home to take care of him.

How could I say no to this boy?

The nursing went on, and on and on, and Junior J showed no inclination to wean, even after he hit his two year old birthday. By now we were facing a different challenge of feeding beyond the "norm" of six months, and I was getting strange looks when people saw toddler legs sticking out from under the cover when I had to feed him outside. People had all manner of comments about feeding an almost three year old, ranging from advice that I should wean him, or to nasty comments like "he'll turn out anti-social". Well, I just did the same thing as when I was told to stop starving my boy in the initial days. Which was to ignore, and continue feeding, because the boy wanted to nurse, and I didn't have the heart to stop him.

I tried to wean him when we learnt that we were expecting Lil J. We tried to tell him that nursing was only for babies, and that he was a big boy. However, he absolutely refused and continued feeding throughout the entire pregnancy. However, all that preparation helped, as once Lil J arrived, Junior J decided that he was a big boy, and did not ask to be nursed anymore. So that concluded my 33 month nursing stint with my oldest.

So he became a big brother. And "big boys don't drink nen nen".

So Lil J took over the nursing shift, but this time round, breastfeeding turned out to be much easier as I knew how to latch him. He turned out to be a great feeder, and the blocked ducts were less frequent (and he also cleared them pretty effectively!). Nursing him was smooth sailing, save for the couple of months where he only nursed when I was lying down.

I also nursed him while expecting baby J, and again, we prepared him for the arrival of his little brother. However, he refused to wean even with the arrival of the baby, and I ended up having to tandem feed both him and baby J for about a month or so, before he decided he was ok not drinking from mama. That period was rather stressful, as I was always worrying if baby J had enough. I made sure baby drank before Lil J could drink, but the advantage of feeding Lil J then was that it helped to prevent engorgement and cleared all those blocked ducts!

Lil J, taken just one day before I gave birth to baby J.

So now, baby J has taken over the milk shift, and it has been more than five years since I started this whole milkmaid business. I'm glad I tried to stick to my six months goal way back then!

And now, the one currently on the milk shift.

~~~~~~~

Finally, I thought I'd share some things I've learnt during this breastfeeding journey. Basically, breastfeeding is like running, because:

:: Each person's journey is different. There are those who like to run marathons, while others like to do a once a week 1 km jog in the park. Some are gym rats, while some prefer to run amidst nature. The distance, and how you do it doesn't matter, what matters is that you get out and start moving. It's the same for breastfeeding. It's no matter if you've fed for one month, six months, or four years, or whether you express or latch, what matters is that you've tried. Like how the distance you choose to run is a personal choice, it is not for others to judge someone who is still nursing her three year old child, or someone who nursed only for a week. Also, like how there may be those who would tell you how long you should run, there would be those who would like to share their thoughts and opinions on how long you should feed for. Just ignore them!

:: You need to be prepared. I did not read up much about latching the baby, as I thought it would be easy and natural, and I regretted it. Now I tell my friends who are expecting to read up and prepare, since that really helps. (Get some preparation tips here.) Also, having a small tin of formula on stand-by for the first few days would really help, so that you can top up after latching on, while waiting for your milk to come in.

:: It helps to get good gear: Like how good running shoes really help in supporting your feet, and how nice exercise wear may just motivate you to get moving, having a good pump and suitable bottles help if you intend to breastfeed and pump. Please get a double electric pump if you need to express frequently, instead of a  single or a manual pump. It's the equivalent of wearing proper running shoes compared to flip-flops when doing a 10 km run!

:: Starting may just be the hardest part of all: For those who don't run, the first few jogs would usually seem the hardest as you are not used to it. You huff and puff and its difficult. But it gets easier in the subsequent runs as your body gets used to it and it takes less effort to get moving. So its the same for breastfeeding. Most mums I know that nurse struggle in the first few months, but it usually gets easier as baby learns to latch and mama learns to handle the various challenges of breastfeeding.

:: It may not be smooth-sailing, and there may be pain involved, but having a goal really helps. Running can be a challenge when you've hit a wall and can't seem to move another step, but having an end goal in mind does help to push you on. For breastfeeding, it helps to set a goal so that you have something to push towards.

:: There are limitations, because we are only human. While running is good for the body, not everyone is able to run, since some might have health or physical issues (I used to run and I loved it, but these days I can't because of a knee problem). Likewise, while I'd encourage every mother to give breastfeeding a go, please remember that mothers have limitations too. Some may not be able to feed because of physical issues, others because of supply issues. Feeding a baby formula does not make you any less a good mother, what is important is that mama is FINE and baby is FED!

:: A trainer, or good advice also helps a lot: I don't think I would have lasted beyond the first month if not for the help of my lactation consultant. She was no-nonsense and practical. I remember how she told me matter-of-factly that I was to eat painkillers before I saw her for blocked ducts, because it was going to hurt real bad when she squeezed them out! And she was instrumental in helping me through all the nursing issues.

:: Support and cheerleaders are essential: Just like how a run is so much easier with a friend cheering you on or running with you, having family and friends to support you in this breastfeeding journey is key. My hubby really helped to encourage me in the first month, and bore with all my screaming and crying, and did what he could to help. I had friends to talk to, some just listened, some gave me helpful advice and patiently answered all my questions. 

:: It may or may not help you to lose weight: Running helps you to burn more calories, so does breastfeeding. However, weight loss has to do with using up more calories than you consume. So if you were to consume two pizzas for dinner after a 2 km run, I doubt you are going to lose weight. Likewise, breastfeeding does help you to lose weight, but if and only if you are consuming less calories than what you are burning by producing milk. I can vouch for this, as in the case of Junior J I lost a lot of weight, as I watched my diet very strictly, as we suspected that milk and soy were contributing to his reflux. However, for Lil J's case I actually lost very little weight, and subsequently gained some weight, simply because I was eating more (We were in Europe, and dairy was cheap. Who could resist those ice-creams and cheese!). On a side note, it is pregnancy that causes the saggy boobs, and not breastfeeding!

This post is part of a blog train hosted by Madeline at MadPsychMum. I have been most encouraged by all the stories on the breastfeeding journeys shared by other mums, which you can read by clicking on the icon below. 

Tomorrow, Angeline would be sharing her story. Angeline is a stay-home mom to two lovely children, who have given her new insights to life as she now finds herself on a journey of re-discovery of the world through their little eyes. She has breastfed since July 2008, tandem-fed for 9 months and is still currently breastfeeding her 29-month-old. Find out more tomorrow how she overcame the initial hiccups, and ended up extended breastfeeding in the end at Simply Mommie. 

Weaning Wednesdays: Breastfeeding and dental caries

Just recently, I was browsing through a motherhood forum and came across a discussion on dental caries, where quite a few mothers were lamenting about their children having tooth decay.  I remembered how a friend commented about how frequent night feedings may increase the risk of dental caries, and that started bugging me, since I really wanted to take good care of Junior J's little pearly whites.  So I did a quick search online, and browsed a couple of websites, as well as some dentistry journal articles (Its all that scientific training that makes you try to obtain information from reliable sources. But you do end up with alot of medical mumbo jumbo, which resulted in me never getting beyond the abstracts for some!).

So here's what I unearthed:

1. How teeth rot: These nasty buggers (microbes like Streptococcus mutans) gate-crash a party on someone's teeth, decide they like it there, and move in.  They feast on the sugars left on the teeth, and leave a thank-you gift of acids.  These acids then start to eat (or to use the proper term "de-mineralize") into the enamel of the teeth.  Since the enamel acts like the wall of a fortress, breaching the wall would be like the orcs storming Helm's Deep in the Lord of the Rings: Lots of noise (thanks to the dentist), and pain.  (Get the more scientific version here.)

2. Preventive measures that one can take for young children: Eliminate all those factors mentioned above...

:: Brush regularly to prevent sugars from sticking to teeth.  No happy food, no party for those microbes.

:: Reduce exposure to sweet stuff, and limit it to meals.

:: Don't let the bugs gate-crash: Parents are advised to avoid giving babies kisses on the mouth, as well as avoid feeding babies food that has been in placed in their mouths, to prevent the bad bugs from moving in.  (We're guilty of those things on all fronts, since we sometimes do try to remove sauces containing MSG from foods before feeding Junior J... oops!  And how can you not give kisses to your little boy?)

Plus:

:: Latch direct for feeds if possible, since bottle feeding increases the risk of dental caries (due to the method of delivery of milk, as milk tends to pool around the teeth during bottle feeding).

3. Then there comes this whole controversy that has sparked alot of discussion: Does extended breastfeeding (beyond 12 months), and frequent night feeds increase the risk of dental caries?

:: One study showed that the duration of breastfeeding did not affect the incidence of caries (Abstract of study here).

:: Continuous night feedings (where baby is permanently attached to mum most of the night, which isn't the case for me!) may increase the risk of caries (Discussion here).

:: Some reviews stated that the studies that showed that extended nursing was a risk factor for caries had weak methodology (eg. small sample size, did not account for confounders like diet, dental hygiene etc).

4.  All that left me still doubtful as to whether I should ignore Junior J at night when he wants his "nen-nen", for the sake of a brilliant smile... So I continued reading, and found out about the properties of breastmilk:

:: Breastmilk does not cause a significant drop in pH in the mouth (the nasty bacteria thrive at lower pH).

:: Exposure to breastmilk results in the deposition of calcium and phosphate on enamel (that's rebuilding the walls of Helm's Deep so the orcs can't storm in... Get the details of the study here.)

:: It contains lactoferrin and antibodies that prevent bacterial growth (This is an excellent article on the entire topic of breastfeeding and caries).

The boy doesn't like his food that much, but he loves his milk...  

Which explains the mess, and the hubby pinching his nose!

So all in all, most articles that I read concluded that there was no conclusive evidence that extended breastfeeding, or night feeds increased the risk of developing dental caries (If you've lost me in all my ramblings, here's a good article that probably explains it better!).  However, parents do have to  pay close attention to the child's diet and dental habits as well...  So if someone tells me to stop breastfeeding since the boy is already 15 months old, I'm going to ask them to read this, and take a hike. (Which was what I told a GP when he told me to stop feeding Junior J when I was down with the flu, in case I spread it to the boy.  I'm sorry if I'm such a "lactivist"!)

Breastfeeding basics

Okok, I promised a breastfeeding post for some of my preggy friends, so here it is!  I'm no expert, but having been able to feed baby J up til now and after surviving almost every problem described in the breastfeeding books, I thought I'll just share what I've learnt so far!

Things to get for breastfeeding:

1. A double electric pump (especially if you are intending to go back to work), most of the mummies I know recommend the Medela pumps.

2. Bottles/storage bags for keeping milk, along with a insulated carrier if you have to pump milk outside.  Check that your plastic bottles are certified BPA free, or use glass bottles.  For feeding baby, use those bottles with wider teats (clear silicon teats are better, yellow latex ones can taste funny) to simulate breastfeeding. 

3. A nursing cover, which allows you to breastfeed in public.  Very useful especially since not all public spaces in Singapore have nursing rooms.  For example, most parks (including botanic gardens!) do not have nursing rooms, and some shopping malls have only one or two rooms which may be occupied when you need to feed.  Its important to cover up since our society here isn't very open about breastfeeding in public *rolls eyes*. 

4. Nursing bras, which allow for easy access during feeding.  Moms in mind sells pretty good ones and a wide variety, including those that can be worn under tube tops etc.  Get them nearer to your due date as your size may change.

5. This sounds odd, but get a small tin of formula on standby for the first few days, just in case.  Or see if the hospital can give you samples in bottles.  For my case, baby J cried non-stop the first night he was home and we had no formula in the house, so hubby had to drive out late at night to see if the hospital had samples! We ended up feeding him formula for 3 days before the milk came in.  Of course, if the baby nurses and seems satisfied (but note baby'll nurse very very frequently initially), then you won't need to give formula, but best to have some, just in case.

6. Lanolin nursing cream, which can be applied after every feed to reduce the dryness.  I'm using the Medela PureLan nursing cream, which is pretty good...

7. Fenugreek capsules, which you can eat to increase milk supply.  But take these only if you find that your milk supply is insufficient even after the milk comes in around the 4/5th day... otherwise you might end up with an oversupply which also causes problems!

8. A steriliser for all those milk bottles and your pump (alternatively, you might just want to sterilise using a normal pot and boiling water).

Before you pop: Things to note

1. Read up on breastfeeding, by visiting websites or reading books.  Learn how to latch the baby on properly, and what to expect in the weeks to come!

Useful websites to check out will be:

Kellymom (her site is very useful and I like the way it presents scientifically sound information based on research papers)

Dr Jack Newman's website (has videos to observe latching etc)

2. Have chats with breastfeeding mums to know what to expect.  I had so many problems in the first few weeks, that if not for all the mummies who gave advice and encouragement, I would have just given up and stopped breastfeeding altogether!

3. Determine how long you intend to stick to breastfeeding, that'll keep you going if you encounter any problems along the way...

Directly after popping: Things to note

1. Request to breastfeed baby immediately after the delivery if possible.  Its recommended to do so as baby will be most alert then and will be willing to latch on and feed.

2. Inform the hospital that you would like baby to room-in with you, or if the nurses take baby to the nursery, ask the nurses to bring baby to you when he/she is hungry, and request that no formula be fed to your baby.  This way you can start nursing and that will help to stimulate the milk to come in.

3. Make an appointment to see a lactation consultant during your stay in hospital.   Use the time with the LC to learn how to latch the baby on if you are not sure, and to trouble-shoot any problems you have.  So far, my experience is that the nurses will tell you all sorts of different things which can be confusing, so the LC's the best way to go.  If possible, see if your LC is willing to give you her work/mobile number so that you can call her in the future if you encounter problems.  Do note that LCs in Singapore will charge consultation fees if you make appointments to see them later on after you are discharged, and it costs way more than seeing a GP!

4. Most hospitals will provide you with a nursing cushion to use.  Try it out when you are there, and if you find it helps with feeding, you may want to get one of your own.

The first few weeks: Things to note

1. In the first few days, what will be produced will be colostrum, which will then be replaced by milk.  Sometimes, due to the milk "coming in" there might be engorgement, which can be relieved by using cabbage leaves chilled in the fridge.

2. You will need to feed frequently in the initial weeks.  To start off, even if baby is sleepy, you'll have to feed baby at least once every 3 hours around the clock, and you may have to wake baby up to do so.  This is important cos it'll help to establish your milk supply.

3.  Initially feeding may hurt, and most mums that I spoke to talked about soreness.  However, if it really hurts alot, you may want to check that baby is latching on correctly.  Usually babies will improve their latch after 1 month when they gets better head control.  The lanolin cream will help alot of terms of combat dryness from the frequent feeds.

4. For those having someone else to cook for you and are on confinement food, you may want to request for green papaya (the unripe fruit) slices to be added to your sliced fish soup and for the herb dang sheng to be added to the red date drink.  Both are supposed to help with milk supply.

5. It will be very tiring with such frequent feeds, so take it easy and concentrate on feeding.  Nap when baby naps and leave the housework to others initially.   If you can master it, try breastfeeding lying down with baby next to you, and it'll be easier for you if baby sleeps in the same room as you at least for the first 2-3 months.

6. Try to avoid using pacifiers and bottles for the first few weeks if possible, as it'll help baby to learn how to breastfeed properly.  If introduced early, baby may get "nipple confusion".  As we had to formula feed baby J in the first few days, he gave me alot of problems after that as he got very impatient with the flow of milk during breastfeeding! 

7. Bear in mind that breastmilk jaundice (jaundice caused by breastfeeding) is pretty common and not harmful.  One of my friends who has 3 breastfed kids told me all 3 kids had jaundice for a pretty long time each, and baby J also had it too.  Some people will advise against breastfeeding if baby has breastmilk jaundice (but the doctor should run tests to see that its not jaundice due to other reasons), but do stick to it as the jaundice will clear up eventually.

Continuing after the first few weeks: Things to note

1. Your milk supply would be set by the first month, so the first 4-6 weeks are crucial in setting up a good supply, so feed frequently during these weeks.  Bear in mind that milk supply works on a supply demand basis, the more you feed, the more you produce.

2. Milk supply may drop in the 4th month sometimes due to unknown reasons.  Mine did, and it freaked me out as suddenly I couldn't pump enough for baby when I had to leave the house for research, and the stress made the pumping output even lower!  In such cases, you may have to resort to eating fenugreek.

3. If you fall sick, continue breastfeeding as its the best protection you can give your baby, as antibodies pass over from you to him in the milk.  So far, I've fallen sick a few times (caught some flu and cold bugs), and even though baby J had to be with me most of the time during those periods, he's never fallen sick so far. 

4. Storing breastmilk: Breastmilk stored in the fridge can keep up to 8 days (at least its mentioned in some sites), but the CDC recommends a 5 day period instead.  I find that after 5 days, it starts to smell different, and baby J doesn't really like it.  If you freeze breastmilk, it can keep up to a few months, depending on what kind of freezer you use. 

5. The recommendation now is for mummies to exclusively breastfeed for 6 months.  Solid food should not be introduced until baby is 6 months old, so try to explain nicely to your mother or MIL if they try to push porridge on your baby when he's 4 months old (which used to be the case).  My mother was aghast and thought I was torturing baby J when I refused to feed the boy rice cereal when he was 4 months old!

All in all, I would say that these 8 months of to trying to breastfeed baby J even through mastitis and blocked ducts etc was worth it.  So to all the mummies-to-be, happy breastfeeding!  And all breastfeeding mummies, do feel free to comment and share your tips too! :)