Boob Juice and Embarrassment

Warning: This post might get lengthy. 

This week, I'm linking up with Kaitlyn over at Wifessionals for her series Preparing For A Little One.  You see, Kaitlyn is pregnant, and I am so EXCITED for her, but I'm sitting her contemplating another margarita because both my kids are *finally* sleeping.   This week's topic for PFALO is breast feeding vs. formula feeding, and I felt like I should chime in because there are two sides to every story.   With Hadley, I was dead set on BFing.  It was important to me, and you know what the research says.  It's what's best for baby, plus it's cheap, so why wouldn't we do it?  I was a first time mom, so I had the 'my way or the highway,' attitude.  We tried, and we tried to get the hang of breast feeding, but the truth was we both hated it.   I spent so much time attached to my pump and to this day, I hate loathe despise the word 'breast pump.'  After a hard fought battle, and HOURS attached to my pump in style advanced, I threw up the white flag.  I was DONE.  And Hadley was just as happy to be getting formula as she was that breast milk I worked so hard for.   And then I found out about Emmalyn (approximately two months to the day after my surrender) and I knew that because "breast is best,"  I would try again.  Emmalyn was evicted and brought into my recovery room about 30 minutes later for her first attempt at breast feeding.  She latched on like a champ and nursed for about 10 minutes.  And again 3 hours later.  In a 4 hour time frame,  Emmalyn was already a better nurser than her older sister had ever been.   After that, we met the pediatrician and she told us about the cleft palate, discovered by accident.   I have some training in the area of cleft palates, and I instantly knew that Emmalyn would not be able to produce the internal pressures required for breast feeding.   And I was not devastated.  I kept trying through out the day, but when it became obvious that she was getting hungry,  I called the nurse for my similac advance.   Formula feeding TOTALLY changed my newborn experience.  I'm not writing this to dissuade anyone from breast feeding because we're planning on a third baby, and I'm planning on trying the boob juice again, but seriously!! formula feeding made my life so much easier.   I wasn't stressed out all the time about how much milk I was producing.  I wasn't constantly laying around with an infant stuck to my chest.  My husband/parents/random guy at the store could feed her and it would be fine!  I didn't have to tote my breast pump everywhere I went.  I didn't have to time my showers with her feedings because the ridiculous let down issues in the shower.   My baby was happy, and getting all her nutrients, and I wasn't on the verge of freaking out ALL the time.   In addition, my body was much happier.  With Hadley, I never lost any baby weight, I was moody and depressed, and just not a happy person.  I haven't had any issues like that with Emmalyn.  I returned to my normal self pretty quickly.  I lost all my weight from both babies (plus 10 lbs).  My boobs don't leak every time she cries.  I don't have a fridge full of half bottles of breast milk.   In fact, my fridge is full of wine and skinnygirl margaritas.   My kid is formula fed, and we're all happier that way.   I've decided to link up with Jenni at Story of My Life for a blog every day challenge.

The truth about today's prompt for the every day challenge is that I don't embarrass easily.  I'm kind of take me as I am type person, and I should probably feel like a general ass much more frequently than I do.  

Embarassing: My kid, Hadley, pulled my boob out at her first birthday party.  Seriously? Did you not just read about the fact that she hates my boobs?  She hates drinking from them, but isn't so concerned about exposing them to other people. 

Embarrassing:  When my patient called his wife a "sex toy" in front of her, and More Embarassing: I was the only one disturbed by this.  

Embarrassing:  When you run up to an old friend and smack him on the booty (am I the only one that greets friends this way?) and his new girlfriend threatens to kill you.  Loudly.  In a book store.  While your with your husband.  Seriously?

But seriously, none of this stuff really bothers me.  

Emmalyn: 2 Month Update

At 2 months, Emmalyn:

• finally weighs 8 pounds (8lbs 13oz)
• is 21.25 inches long (This is a joke with me and the nurse at the pediatrician's office, because the hospital had her at 21 inches at birth.  The nurse measured her 3 times at her first check up and she was only 19.25, so she's finally back at birth length.)
• Smiles

• is starting to make some noise. 
• drinks 5 4 oz bottles a day.  We do have to increase the concentration of her formula though.  
• holds her head up pretty well. 
• loves her momma. 
• loves nuk pacifiers. 
• is drinking from Mead Johnson Cleft Lip/Palate bottles with orthodontic nipples with the tip cross-cut.

The Craniofacial Clinic Visit #1

On Thursday, we loaded up in the car and headed to Shands.  We had an appointment at 1:00 with the craniofacial clinic.  My dad went with the hubs and I, and I was thankful for that.  He has the knowledge that my hubs and I don't possess about all things medical.  We met a ton of doctors and went in with dibs on how many times Emmalyn would get gagged.  Our suspicion was at least 4.  The clinic was very efficient with time management.  We checked in about 5 minutes before 1:00 and we were the first family called back.  Emmalyn was stripped down to her birthday suit, weighed (7lbs 2 oz.) and measured (20 inches, I think). 

We met...

{A Speech-Language Pathologist and a Speech Pathology Student}

I had the student pegged from the beginning.  She was in the hallway when we walked back to our exam room.  I remember that deer in headlights look.  It wasn't that long ago.

The speech pathologist that we met with asked us about feeding.  I explained to her that we were using the Mead-Johnson Cleft Lip/Cleft Palatebottles that they gave us in the hospital with a standard orthodontic nipple because Emmalyn didn't like the nipples that came with the Mead-Johnson bottles.  I thought she was doing ok with these, but her meals were lengthy, usually greater than 30 minutes, and often she acted like she was getting too much at once and would pull back and try and catch her breath. 

Image Courtesy of Google Images

The SLP said that there were 2 things that made the Mead-Johnson bottle awesome.  The first was the fact that you can squeeze them to assist with fluid flowing through the nipple.   The other thing that made the Mead-Johnson bottle unique for kids with clefts is the cross cut nipple.  This means the opening in the nipple is literally shaped like an X.   This makes sucking/flow easier. 

So she cut the tip of the bottle.

This was my first guilty parent moment of the day.  As an SLP, someone who has been trained in feeding/swallowing problems, I honestly thought Emmalyn was doing ok.   She appeared to be getting a good suction, but she's really struggling a lot to eat.  One pair of scissors to her nipples, and her meal time went from 30+ minutes to 10 minutes.

In my defense, I've NEVER seen a patient with a cleft lip or cleft palate!

She also said that excess gas was normal for cleft palate kids, but her excess spit up/vomiting was not.

{An Otolaryngologist/ENT}

The ENT came in and took a quick peak in Emmalyn's mouth.  He stated that as far as clefting goes, her kind was definitely the most mild.  He also explained that children with cleft lip/palate are prone to more ear infections because the muscles that open and close the eustation tube are tied in to the muscles of the soft palate.  Because the muscles in her soft palate aren't formed correctly, then her eustation tubes probably aren't opening and closing correctly.  This puts her at a higher risk of ear infections and usually when one of the repair surgeries are done, then they go in and put tubes in her ears.  He said if she needed the tubes earlier, that they could put them in earlier. He also said that they would continue to test her hearing over time, but because she passed her newborn hearing screening, he thought any issues that came up would be secondary to ear infections.

{A Photographer}

A guy came in to take before and after pictures of Emmalyn.  She was very upset about having her pacifier removed from her mouth and her pictures probably didn't have the most pleasant look to them. 

{A Social Worker}

She basically came in to say that she helped with insurance and billing, helped families get assistance if needed, and for caregiver support. She also told us about a Facebook support group.

{A Pediatric Psychologist}

This guy was kind of a hippie. He said he was there to support children and there families that have long term involvement with the medical community. He said that Emmalyn would probably be followed by the craniofacial team until she was 18 or so. He also asked me for one word to describe her. The first word that came to my head was cranky. Looking back, it probably wasn't the best word to describe her, but really, how do you appropriately describe a 4 week old in one word.

{A Plastic Surgeon}

The plastic surgeon came in.  She was kind of a blur.  My dad compared her to a tornado.  That's pretty much adequate.  She looked in Emmalyn's mouth and said, "Oh, her surgery will be easy. I did 3 of these on Tuesday."  It was really nice to talk to someone who knew what they were doing.  She said that the surgery would probably take place between 9-12 months, and she was looking at doing it in December.  She said Emmalyn would be in the hospital for 24 hours and we would have a follow up in 3 to 4 weeks. 

{A Pediatrician and Pediatric Resident}

This guy was kind of intense. He kind of led me to my bad mommy #2 moment. We talked about prenatal care, which I started in the first trimester, and prenatal drug/alcohol use (none). We then talked about weight gain and feeding and he basically said that she should weigh more than she does, and that her not being back at her birthweight by 3 weeks out she was at risk for developing failure to thrive (mom fail).

He told us that the only reason to fix her palate was to allow her to develop normal adult speech patterns

He also talked to us about some of the complications that may require repeat surgeries. As she grows, her palate may require another repair to increase contact with the back of the mouth for more normal speech. In addition, sometimes cleft palate babies have bottom jaws that don't grow properly which also results in need for another surgery.

{A Pediatric Dentist}

The pediatric dentist took a quick peak in Em's mouth and basically said that kids with cleft palates are more likely to develop cavities and we should start cleaning her gums with a wet washcloth now.

{An Oral Surgeon}

This guy was obviously a student. The door to our exam room was open and he looked at his supervisor and said, "Do I just walk in?" And I said, "of course. Come on in!" He introduced himself and basically said they were here if we needed them, but since Em didn't have any maxillofacial abnormalities, they didn't think that we would need them.

Overall, it was a good visit. I was impressed with there efficiency and I wasn't nearly as overwhelmed with information as I thought I would be.

Cleft Palate- The Referal Process

I mentioned in Emmalyn's birth story that upon initial exam, the pediatrician discovered a cleft palate.  Her cleft palate has been determined by 4 pediatricians to be mild, but will still require repair. 

The first pediatrician, Dr. B., came in to see us.  She's the one that initially told us about Emmalyn's cleft.  She said that at our first office visit, they would set up the referral work for us to go to UAB.  She stated that when checking Emmalyn's sucking reflex, she could feel the malformation, but had to get a flashlight out to see it.  She stated that Emmalyn might have some feeding problems, especially with breastfeeding, and might require speech therapy later.  Good thing I know an abundance of speech therapists, right?

Dr. B. saw us Tuesday, Wednesday, and Thursday in the hospital.  She was able to answer our questions as we came up with them, but really, I didn't have a lot.  The lactation consultant also came to see us several times in the hospital.  She provided us with feeding strategies and special bottles to use with Emmalyn.  The lactation consultant was able to show me Em's cleft palate without a flashlight.  It was much larger than I thought it would be based on Dr. B's description.

Dr. W.  discharged Emmalyn from the hospital, and he also reported that the cleft was very mild.    She was having some feeding issues at the time, but Dr. W stated if we could get an ounce in her every 3 hours, he would be happy with that.  We did manage that.    We called and made an appointment with our pediatrician, Dr. S.  

Before discharge, they gave Emmalyn her newborn hearing screening which she FAILED.  What?  I performed newborn hearing screenings in graduate school.  I know how common it is for babies to fail, especially csection babies, and what do I do?  Panic, of course.  I consulted my favorite doctor of all, Dr. Google, regarding  cleft palate and hearing loss.  For the record, there is a correlation between cleft palates and hearing loss. 

At our first appointment with Dr. S, he told us some great things.  The first was that Em was gaining weight, even if it wasn't as much weight as they wanted.  The second was that he thought we could have her palate repair done closer to home due to the mild nature of it.  The third was that we could keep doing exactly what we were doing, which was significant to me because it meant feeding on demand vs. waking to feed at night.  Don't judge.  I have a 15 month old and a newborn.  I'm in a state of permaexhaustion without waking up every 3 hours if I don't have to.

He also set us up to have Emmalyn's hearing rechecked.

SHE PASSED!! Thank God...

Our second appointment was scheduled to be with Dr. S, but ended up being with Dr. P due to an emergency at the hospital.  I really like Dr. P too, so I was down with this.  Dr.  P explained there had been some bumps in the referral process.  First of all, there is a group of doctors in a city about an hour from us that advertises cleft repairs, but none of the pediatricians in the area use them.  They all refer to Shands- Gainesville.   He then called around in another city about an hour from us.  He found one doctor who said he would, "try it."  Apparently, he's never repaired a cleft palate.  NEXT....

We finally got a referral to Shands Craniofacial Clinic for next Thursday.  

Our family has grown by two tiny feet....

I should have posted this earlier, but things have been hectic. 

On Monday, January 7, I had my last scheduled OB appointment.  It was 8 days before my scheduled c-section.  I went back to the back, they weighed me (total weight gain: 16 lbs), and took my blood pressure.

The conversation with the nurse went something like this:

Nurse: Your bp is a little elevated.

Me:  What was it?

Nurse: 150/90

Me: Shit. SHIT. 

So they took me to an exam room, and I laid on my left side.  The nurse came back in 10 minutes to re-check my blood pressure, and my doctor, Dr. N., came in.  I cried.  We talked for a minute about how I had been feeling.  I told him I was fine.  I promise.

He said, "You know I have to send you to l&d right?" 

My response came out jumbled and something like this: 

Listen, I mean, I'm sure a trip to l&d would be fun and everything, but I can't have this baby today.  She's scheduled to come next week.  I have to work this week.  I haven't finished all my paper work.  And my Christmas tree is still up.  And I have 1000 sq. feet of wood floors in my living room.  And I have a 15 month old.  She's in the lobby.  With my mom.  I can't take a 15 month old to l&d. And you know, she woke up this morning, and I laid her on the changing table.  I unzipped her pajamas, and there was poop laying inside her pajamas.  My first thought was, OMG, how did the poop get outside of your diaper?  Then my second thought was, OMG, you blew poop out of your diaper, and then finally, I opened the diaper, and there was no poop inside the diaper.  HOW DID YOU POOP OUTSIDE OF YOUR DIAPER? And then we cleaned up, and got dressed, and I can't have a baby today because there are poopy kid pajamas in my sink, and I have to go to work.  Then on the way here, she was starving because they feed her lunch at like 10:00 at daycare.  That's a stupid time for lunch anyways, so I gave her some applesauce in a pouch.  She's been a master at applesauce pouches, but yes, today, I felt applesauce hit me in the back of the head.  And I'm not ready to have a baby today.

 And breathe.....

Dr. N. said

We'll send you over there for a few hours.  You can relax.   Listen to the baby's heart beat.  If your blood pressure goes down, we'll send you home.

What followed was a conversation about going back to work.  I just asked to work a couple of more days.

And off I went to L&D where my BP did not go down.

Dr. M., the on-call doctor,  came in.  He told me to relax a little while longer and we'd see where my BP was.   My BP never ever went down.

The hubs called.  He was leaving work.  He asked me if he needed to go get anything.  I told him no.  I called him back and said, "Maybe you should bring my pajamas."  He called me back, "Do you want me to bring anything for the baby?"  I said, "No, I'm sure we'll go home tomorrow. "

Twenty minutes after hubs left the house, which would make him about halfway to the hospital, Dr. M. came back in and said, "We're going to have this baby tomorrow."  WTF??

I was not prepared for this.  I hadn't made child-care arrangements.  I didn't have anything for baby.  How was this possible??

I spent the night in labor and delivery and the next morning, the nurse woke me up for my c-section.  Our second baby girl, Emmalyn,  was born at 7:49 A.M. on 1/8/13 weighing 7lbs 1 oz. and 21 inches long.

I remember her first cry.  It was kind of nasal and echo-y.  My speech-language pathologist voice came out and said, "Something's wrong," and the hubs said, "No, no.  She's perfect."  She is perfect, and beautiful.  I'm so in love.

But there is a thing.

The pediatrician came in about 2:00 in the afternoon, and said, "Your daughter looks great, and everything's fine.  There's just something we need to talk about."

She told me that Emmalyn has a cleft palate.  She has a very mild cleft of her soft palate.  She will need surgery, but she's amazing, and healthy, and that's what matters.