It was 10 pm and he had slept solidly since his last feeding three hours earlier. He probably was just tuckered out from an extended fussy session in which I tried every hold, off-key lullaby, and swing motions I had in my developing arsenal. Sometimes the best medicine for a child that won't sleep is to have them tire themselves out; yet another maxim I've made for myself so I know everything's right.
I unbuttoned his onesie and saw his diaper's wetness indicator was a solid green. I put him on the changing table, wiped him down with water, restocked his urination catcher, and picked him back up. He slept through it all. Just a tired boy who's growing. Plus some books advise you to wait for a baby to wake for feeding and this was surely one of those times.
It looks just like my son!
I touched his cheeks, rubbed his hair, and tickled his feet and got no reaction. I tried my cache of positions, bouncing patterns, and songs again without any luck. He felt like a wet pasta noodle. More angel hair than spaghetti because he's my angel and has my hair color, but limp nonetheless.
I placed my finger in his mouth to kickstart his sucking, but he had little desire to open his lips more than a few millimeters and refused to open his eyes. His chest continued to rise and fall at a calm rate which seemed to be his only functioning bodily function. Why wasn't he responding???!!! Our first-time parents' anxiety levels went up or down another DEFCOM level; whichever direction means a situation is more serious.
We called the Kaiser-Permanente 24-hour helpline and were told that it's okay for a newborn to sleep through a feeding, but if he doesn't wake for the next meal in two hours, more action would be necessary. We sat with him in the nursery with this new knowledge that should've provided comfort, but didn't. We just wanted him to wakeup and couldn't wait until his next scheduled meal and our next attempt. He was limp in our arms afterall and wouldn't open his eyes! Normal is fine for everyone else after a situation is resolved, but we didn't know if that normal applied to our son here, right now.
From the moment our son was born, he had difficulty latching to breastfeed. Pushing his face into my wife's chest, as encouraged to do so by the nurses during his first two days only upset him. It didn't help that he had and still has a strong preference to suck in his top bottom lips. For the first two days in the hospital and the three days afterward at home, our routine had my wife pumping colostrum, me pulling it into a syringe, and together we'd feed it to him via a small wiry tube while he nursed (or pretended to) so that he'd enjoy the process of, ya know, taking in calories to survive this crazy mixed up world.
Midnight approached and two hours had passed since the last try. Please show more signs of life! By some miracle he opened his eyes briefly and moved his arms. He wasn't as limp of a noodle, something closer to al dente. My wife took him in her arms and coaxed a small opening in his mouth. I pulled 6 ml of colostrum into a syringe and connected the small tube to the end. My wife placed the other end in our son's mouth and I lightly pressed a few drops into his mouth with him against her chest.
His throat moved with every third tongue depression and he slowly took our offering. Never was it so good to hear his gulping noises that are mistaken for a warthog in heat. By the morning he had had his regular 5 or 6 ml feedings, but without the aggressive desire you want a newborn to have. His skin had a yellow tone and the whites of his eyes looked like watered-down mustard you get at ballparks.
We called the helpline again and with the impression of a jaundice case, saw a pediatrician at 4:40p. Our son didn't have jaundice, but had lost 13 ounces since birth. Babies are supposed to return to birth weight by their two-week appointments, but at this rate our son wasn't going to get there.
The doctor's bedside manner was just what the, um, doctor ordered. He recognized our fears, worries, and son's correct diagnosis (he's hungry and needs supplemental formula). He spoke in plain English that even sleep deprived parents could understand and use to make informed decisions. No question was dumb, silly, or too small. Even at the end of his long day he still had a relaxed manner and made an awesome first impression.
Our pediatrician pulled some strings and got us a visit with a lactation consultant just before everyone left at 5p. We gave our son a sample 60 ml bottle of formula and he ate it like it was his last meal, or rather, his first meal. Never had we seen him eat more than 6 ml at a time and now he destroyed 10 times that amount! Turns out a newborn can take 30 to 60 ml of liquid food per feeding, 8 to 12 times per day. We had no idea.
Had we been starving our child? Was he so dehydrated he couldn't move to take in calories? What if he hadn't shown signs of jaundice leading us to a pediatrician appointment and lactation consultant just before the day was done? How long would we have waited for him to be limp before calling this helpline again or taking a trip to the ER and dealing with that many more hours of worry? I sure hope the helpline would've told us to simply get him some formula, but who knows. If we were told to wait until the morning, that would've been agony and I wasn't going to wait that long to help my son; he's five days old!
This made me realize that Kaiser failed us in the post-delivery stay and instructional period for feeding our son. Considering he had issues latching early, whether my wife wasn't producing enough right away or he had trouble or both as they need to work together, why weren't we told that if we continue on this path of low production and our son's high caloric output from trying, he'd get hungry and scare the crap out of us by going limp? Why not send us home with some formula to get through until our first appointment of any kind within the Kaiser system or tell us to buy some?
It seems that if a woman is having trouble feeding, for whatever reason, then you can't count on the newborn to get enough calories because you can't tell how much is coming out. In our son's case he'd act like he was nursing and would swallow, but he wasn't getting enough. He'd hang out there for almost an hour, occasionally making the motions. So the test that says a baby will stop sucking and fall asleep when they've had enough may not be reliable because the baby could just be tired of trying.
I'm no doctor, but I think if a mother or child is having trouble feeding in any way, perhaps they should pump the colostrum/milk so you can see exactly how much is coming out so you know how much the baby's getting. You don't jump into a bathtub assuming the faucet knows how hot you want the water; no, you have to test it first using measured results so you know what you're dealing with.
Eventually the consultant in delivery just said that our child was special in that he nurses for 45 minutes to an hour to get his food. Okay, but this should've also set off alarms that maybe there's not enough colostrum for him or he can't get it working which, in two to three days, could lead to a hungry hungry boy and super worried first-time parents. Where was the foresight and projecting of problems down the road? We were told more about caring for his circumcision than we were for possible problems later related to less desirable breastfeeding results.
The next morning my wife had a previously scheduled lactation appointment which showed that overnight our son had put on 8 ounces. Phew! We asked that he get weighed again because we were in such shock. The consultant thought our son had an issue with his frenulum, preventing him from extending his tongue far enough to adequately nurse. Poor nursing by our son means less milk produced by my wife or vice versa. Considering it hasn't worked well since his birth, we were well behind the training schedule.
Not pictured: our son's frenulum below his tongue
The consultant referred us to a pediatric ear. nose, and throat doctor in Oakland. After some aggressive calling tactics on our part, we managed to see the doc on Tuesday of this week. Turns out that Kaiser has about 100 ENT docs and 3 pediatric ENTs so getting in can be difficult. This coupled with the fact that the phone tree you go through for an appointment had us on hold for phenomenally long periods of time. We never got a callback on Monday as promised and after being disconnected after a one-hour hold, my wife found a workaround with the ol'choose the wrong extension and in just a few minutes we were given two hours to make the drive.
Seeing a need to cut a frenulum (from what I've gathered) doesn't become apparent until a child has difficulty nursing or has speech challenges in their preschool years. Frenulum checking just isn't part of a newborn's long checklist. Some sites have said that "back in the day" midwives used to keep an extra long fingernail just to cut the frenulum at birth. These days it's also difficult to find physicians who will do the procedure. Some of this is because breastpumps can get the food and the newborn may feed by bottle; akin to circumcision, cutting a frenulum isn't a necessary procedure for survival.
In our son's case, the doctor said his anterior frenulum below his tongue was fine, but his posterior frenulum could use some assistance, as could his upper lip. He told his the pros and cons and that little data is available about the improvement gained by cutting the posterior frenulum; however, it would cause very little pain, infection is incredibly rare, and has the only downside of not improving things. We went ahead with the both two-second clippings knowing that it's isn't a surefire fix.
All of this could've been avoided. Besides the head's up that we should buy formula on the way home, all lactation consultants should check newborns for proper frenulum sizing. Had our lactation consultant, with whom we saw three times in the three days we were in labor and delivery, checked his mouth as a possible cause to latching issues, we could've had him "fixed" on site, thereby not delaying his training, and maybe delaying his learning that bottle feeding is the only source for the good stuff. I recognize cutting a frenulum doesn't guarantee success, but it could surely help to know if it's a possible issue and if there's a latching issue, why not take a look for frenulum challenges?
In the first day of trying to nurse after the frenulum was cut, he hasn't had an overnight turnaround, but it's still early and frankly, he probably needs to be trained again like it's his first day out of the womb. Until then, we will continue to pump and then feed him by bottle, hopefully increasing the percentage of milk as more is produced. From the looks of his diaper, he's definitely getting plenty of liquid while saving up his larger and smellier displays of thanks every two to three days. And wouldn't you know it, he was weighed again today and has matched his birth weight.
My mom said it best as I paraphrase, "welcome to parenthood and all of its ups and downs and times full of worry. It doesn't stop for your child's entire life. You did the right thing by being proactive."
