timeline and update on Harlan's feeding issues

As some of you may have read on Facebook, Harlan is tongue tied and has to have surgery this week to have his fredulum clipped. This has been a long journey and one that I will probably forget in a few months just out of pure sleep deprivation. So I figured I would write it out so that I can remember but to also explain to our family and friends and those that love Harlan on how we got to this place. So I figure the easiest is to explain it by time line. Here goes....

10/7/09 ~ Harlan is born! He weighs in at 8lbs 14oz. He initially latches well onto the breast or so I thought. I have not breastfed in 2+ years so I am a but rusty. Our Midwife thinks he is latched well and getting breastmilk.

10/9/09 ~ Our midwife comes to do our home visit to check on Harlan and I. Harlan weighs in at 8lbs 5oz. He has lost 9 oz since his birth. At this point we figured this was just typical newborn weight loss and that he would start to regain once my Breast milk was fully in.

10/10/09 ~ My milk comes in but not to the extend that it has in the past. With all my previous children when my milk comes in I usually run a fever and get really engorged. This time I can feel the milk but it is not in huge abundance like I had previously experienced. It planted a seed of doubt about Harlan's latch in my mind, but I figured I would wait to see what the next few days held before panicking. I figured the most he nursed the better my milk supply would get.

10/13/09 ~ Our Midwife comes to do another home visit. This time Harlan weighs in at 7lbs 14oz. He has lost a full pound at this point. And he is still trying to clear meconium from his bowels. This is the first time that I am starting to question whether or not he is getting enough milk. He also seems very orange from the jaundice. My midwife seems to think that he is doing OK and that we will weigh him again in a week. She encourages me to nurse like crazy and wake him up every 2-3 hrs around the clock to feed.

10/14/09 ~ I develop a large painful blister on my nipple. It is bleeding and it hurts very badly to latch (an indication that his latch is not right and therefore gave me a blister). I decide that I should pump to allow the breast to heal. Usually this would take 24-36 hours and then it would be fine to resume nursing. But once I discovered is that once I started pumping that my breast milk supply was very low. This confirmed in my mind that he was NOT getting enough food. I was barley getting 1 oz out at each double pumping session. I knew I needed to increase my supply and that Harlan needed to have his bilirubin checked. His Jaundice was not getting better and I was starting to worry. So I called his Dr. and made an appointment. Also I realize that he does not really bottle feed that well. He seems to chomp on the bottle rather than "latch".

10/15/09 ~ I had been pumping for 24 hrs and I was still not seeing very much milk. I check one of my breastfeeding books and according to his current weight he needs 3 oz of food at each feeding in order to start gaining weight. We were NOT getting that much breast milk. So I decide that until my milk supply increases and we get the jaundice under control that I need to supplement with formula. I go to Wal-mart and buy a can of formula. I cried at the check stand. I HATE using formula, but I know that I need to "feed the baby first" and worry about supply and all of that later. His jaundice needed to be under control before anything else. Later that afternoon I took Harlan to his Dr. Appointment. Dr. W agrees that he is way to orange and that he needs to have his bilirubin tested. He also weighs in at 8lbs 3.5 oz. I contribute his weigh gain to me pumping and bottle feeding as well as the formula. Dr. W tells me to continue to supplement with formula and to pump to get my supply back up. Dr. W also orders a bilirubin test. She tells me depending on the numbers she may have to put Harlan in the hospital for photo therapy lights to reduce the bilirubin. Later the night we got the bilirubin results back and his level was at 15.9. Dr. W wants to recheck his levels tomorrow before doing anything. Basically she needs 2 values to compare to see if his bilirubin is going up or coming down.

10/16/09 ~ We take Harlan back in for a recheck on his bilirubin. His weigh is doing great at 8lbs 6.2 oz! The formula and pumping is working to get his weight back up! We test his bilirubin and it is down to 14.2. Woot! It is down! And he has cleared all the meconium from his bowels and now he is pooping the mustard colored stools that comes with breastfeeding. Finally he is getting enough to eat! Dr. W tells me that now that he is getting enough to eat and the meconium is cleared from his system that his jaundice should go away. It will not go back up, it will just continue to decline. She tells me she wants to see us again in a week or so.

During the next week I pump and feed and we supplement until my supply is reestablished. I start taking fenugreek and drinking mother's milk tea to help stimulate my supply. I see a dramatic increase in my supply and we slowly decrease the formula until we are no longer using it because I am able to pump 3oz at each feeding. Yay!!!!

10/22/09 ~ We have a follow up with Dr.W. Harlan weighs in at 9lbs 2oz. Woot! He is doing great with his weight gain and his jaundice is basically gone. Dr. W decides that he is just fine and that he does not need to have a repeat billirubin test. She gives me the go ahead to try to get him back onto my breast.

I decide to rent a baby scale to do before and after weigh checks to see how much breast milk he was getting from straight nursing. I am bummed to find that he is not getting hardly anything from my breast. I continue to pump for him.

Soon after this I start running a fever and my left breast starts to hurt. I was not sure if it was the flu or mastitis or what was making me sick. Within a few days I as so very sick and my breast was so sore.

10/24/09 ~ I got up at 6am to pump for Harlan and my breast was so sore and my fever was back. I decide that I probably have mastitis. But it is Saturday so I have to go to Urgent Care. After a long wait I finally get to see the Dr and she says yes I have mastitis and gives me antibiotics and some pain meds. She tells me to keep pumping and to rest as much as I can. I decide to wait until I am over the infection before trying to get Harlan back on the breast since it hurts so bad to even pump.


10/28/09 ~ I am feeling much better now after a few days of medicine. I decide to call the lactation consultant to see if they can help me get Harlan on my breast. At my appointment we try everything we can to get him to nurse. He just does not seems to be able to latch. At the end of the hour long session the lactation consultant takes a look at his mouth and tells me she thinks he is tongue tied. I go home and look up tongue tied on the Internet. It seems that it is a simple fix with an office visit to get his tongue clipped. I call his Dr to get an appointment for a consult.

10/29/09 ~ Dr. W takes a look at his tongue and agrees his frendulum is restricting his tongue motion. She refers us to an Ear Nose and Throat specialist to have them clip it. The earliest appointment isn't until Monday. Dr. W says that most often once the clipping is done that babies have dramatic improvements in the ability to breastfeed.

11/2/09 ~ We got to the appointment with the ENT. Dr.M. takes a look at Harlan's frendulum. He looks for a long time. When he gets done with the exam he tells me that Harlan's frendulum is quite thick. Usually the band is just the width of a flap of skin. But in Harlan's case the band is thick and involves blood vessels. Clearly a simple clip is not an option because of the potential bleeding risk. Harlan needs to be in a controlled environment where they have the tools to control the bleeding if it occurs. Dr.M is concerned not only about his inability to breastfeed, but also that he does not bottle feed very well either. When we feed Harlan you have to lay him down almost flat to get him to coordinate his tongue enough to get the milk out of the bottle. If you sit him up he fights with the bottle nipple and chokes and swallows lots of air. Also Dr.M is concerned that the severity of the tongue tie could cause speech delays when he starts trying to speak. Suddenly this problem is not just about feeding but about his ability to learn to talk. Clearly we have to have the procedure done. Dr.M puts Harlan on the schedule for Friday to have the surgery done at Sacred Heart Children's hospital. We are hoping that he will just use gas to sedate him without the use of a breathing tube or an IV. But that is up to the anesthesiologist. We won't know for sure until the day of the surgery and we meet with the anesthesiologist.

So that brings us up to date. I will keep everyone posted as things progress.

Fall Fun

I have posted a bunch of pictures on my Facebook profile of all our Fall activities. Pumpkin Patch, pumpkin carving, Trick or treating, and just some fun pictures of the kids together. Youshould be able to access the photo album even if you are not a member of Facebook. Just click here!

Enjoy!