Breastfeeding: 3 weeks into our journey with Maverick

Breast is best. That’s what I’ve always learned as a nurse, and that’s what I’ve always believed. There is so much science to support why breast milk has a step up on formula since it’s pretty much an individualized recipe formulated just for your baby and their needs. When I’d give my breastfeeding patients education, everything I was saying seemed so easy to do. I wasn’t naive. I knew before having Maverick that breastfeeding was challenging for any mom, whether it was their first kid or their fifth kid. And after three weeks, I can see why my thoughts on Breast is Best changed to Fed is Best.

White Sands National Monument, New Mexico

In the first week of Maverick’s life, we were still supplementing with formula because of him being jaundiced and my milk not coming in. There were nights where I told Sean to feed the baby formula if I was too tired to get up and breastfeed. Breastfeeding is taxing on your body. Every time I feed I have to eat something or I get dizzy. After feeds, I’m hit with such a hard headache that I have to take a gram of Tylenol every 8 hours just to be able to function or even sleep. And it seems like no matter how much water I drink (almost 96 ounces) a day I still feel dehydrated.

Week two came, and my milk finally came in (it sounds like it’s a package you’re anxiously waiting for from Amazon Prime…) I go back to working 12-hour shifts after maternity leave and I’m nervous about what it’s going to do to my supply especially when I’m more tired, more stressed, and more active. I’ve heard many women say that when they go back to work and when they start working out again that they notice a major drop in their supply. I’ve made it a priority to try and pump at least twice a day now. So far, I’ve been pretty lucky to stash 1-2 pouches in the freezer for my lil’ stash but I’ve noticed that my sleep takes a toll on my supply. Then there was a few days where I was taking antihistamines for PUPPPs and my supply dipped. Thankfully it came back when I stopped taking the meds.

Museum of Agriculture, El Paso, Texas during the poppy season

It’s been a rocky road

This journey has brought on many sleepless nights. Maverick likes to feed every 2-3 hours. It becomes tiring when 30 minutes of that is spent feeding him and another 20 minutes trying to put him down to sleep. It’s been hard on Sean and I because I become very frustrated at night when it’s hard to console Maverick after feeding. I’ve read so many stories from women who say trying to breastfeed made them feel so bad that it lead to PPD (postpartum depression). This worries me a lot since I already receive mental health treatment. And last night, my son broke me. For the past three weeks we’ve been running low on energy and last night I hit a wall. At 3 AM when my son wouldn’t fall asleep, I gave in and gave him to Sean. I didn’t ask for help, I gave up and made Sean take over. I cried myself to sleep because I didn’t know what else to do and I could feel my patience slipping. The last thing I want to do is let it get too far where I start to resent breastfeeding Maverick.

I’m really hoping that we can find our groove together as a unit so we can avoid that. It’s still a learning process for all of us, so if you have any recommendations or suggestions, we’re very open to them. We’re new to all of this. No matter how many babies I’ve taken care of at work, I definitely was not prepared to be a mom.

Hyperbilirubinemia: My baby is yellow and it's not because he's Asian!

You should’ve seen the unease in our pediatrician’s face when they told us Maverick’s bilirubin levels went down, and we said, “oh so he’s just yellow because he’s Asian then.” We never fail to make people feel uneasy with our Asian jokes. But with all of that aside, the word hyperbilirubinemia can already be scary to someone who can barely break it down to pronounce it correctly. So I’ll try to do a quick breakdown on what it is.

Disclaimer: The content on my website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

A tough time trying to be the mom and not the nurse of Maverick

Maverick had to be under the phototherapy lights for 2 nights. The first night we had him back in our room was extremely difficult on me and Sean. We were up every 2 hours to go to the NICU and feed Maverick on the first night and we were up the entire first day after delivery. We were extremely excited to have him in the room with us, but he was not excited about the phototherapy lights. I thought I would do okay with this since I’ve helped treat so many “bili-babies” as a nurse, but I was so wrong. The emotional attachment that I had as a mother was hard to overcome. Every time Maverick started crying, my first instinct was to take him out. It was extremely hard to not soothe my baby. When I would breastfeed him, I’d still hold the bili-blanket underneath him, but even that irritated him.

His level at initial testing was 11.4, and after one night of therapy it went down to 11.3. Not much progress was made and that was probably due to the fact that breastfeeding was new to us both, and because we kept pulling him out from the lights. We opted to put him back in the NICU for phototherapy hoping that a more controlled environment would help him get better. His levels did go up to 15 the second day, but since he was getting older, the threshold for therapy went up as well. It wasn’t enough to keep him admitted for phototherapy, so we changed the treatment to breastfeeding with formula supplementation and was seen the next day as an outpatient. When we came back, his level dropped a little bit, and we decided to treat his tongue tie by having the pediatrician do a frenulectomy. After a few days of great breastfeeding sessions, formula, and sunbathing, we noticed his jaundice start to go down. At his first well-child check up, they drew labs and said the would call us if his levels were abnormal. It’s been a week since the lab was drawn and we’ve heard nothing back, so it looks like we’re in the clear!

What is hyperbilirubinemia, and is it normal in babies?

So let’s just break down the word: Hyper as in excess of; bilirubin as in the compound that is made due to the breakdown of RBCs (red blood cells); and -emia as in the suffix that refers to something to do with blood. So basically, there is an excess of the remnants of broken down blood cells circulating in babe’s blood. It isn’t uncommon that a baby will be slightly jaundiced after birth. The reason that babies appear yellow when jaundiced is because bilirubin is pigmented yellow!

When a baby is in utero, the placenta works hard at removing bilirubin from the baby’s bloodstream. After delivery, the baby’s liver takes over and sometimes needs a little time to catch up. Don’t be surprised if your baby is more jaundiced after a more traumatic delivery that causes bruising or a hematoma. There is a certain level that babies have to reach to receive phototherapy, so not all jaundiced babies need to be put under lights.

How is hyperbilirubinemia tested and treated?

So this is where nursing comes in! Aside from physical assessment of the skin every shift, at the 24-hour mark, every newborn is screened. This screening includes things like hearing screen, congenital heart disease test, PKU (phenylketonuria) screening, and a TcB test. TcB stands for Transcutaneous Bilirubin. This is done with a device that is pressed against the newborn’s forehead and takes a reading of how much bilirubin is detected through the skin. If the levels are above the facility's recommended threshold level, that’s when the nurse will draw a TSB, or Total Serum Bilirubin. This is done with w a heel stick and drawn in a pediatric blood tube.

American Academy of Pediatrics

The American Academy of Pediatrics has a chart showing the serum level vs neonatal age and what the risk zones for treatment are. If the TSB levels are high enough then phototherapy will be started. If they are considered low-risk, encouragement of breastfeeding with supplementation of formula may be recommended. This is because bilirubin is excreted in stool and urine. This could be another reason why it is more common for exclusively breastfed babies to become jaundiced after birth. It can be the learning curve that momma and baby have as they begin their breastfeeding journey and waiting for mommy’s milk to come in. So if your baby does require more than just frequent breastfeeding sessions and supplementation, your pediatrician will go over what phototherapy is.

What is phototherapy? Can it be dangerous?

The risk of putting your baby under phototherapy lights is pretty low. Proper precautions are taken to monitor the baby’s well-being under the lights, such as an eyemask, continuous temperature monitoring, and a new one I’ve seen, continuous pulse ox. Phototherapy lights are blue spectrum lights that mimic what the sun would do for Baby. It helps breakdown the bilirubin through the skin, which will come out in Baby’s diaper as soiled diapers. Most facilities have triple light therapy which just means in addition to the two lights that are placed above Baby, a special blue light fiber-optic blanket will be placed under Baby. Baby will only be wearing a diaper while receiving light therapy to maximize skin exposure. This is why it is important to monitor Baby’s temperature to make sure that it isn’t too hot or too cold under the lights. I hadn’t seen continuous pulse ox monitoring until Maverick received phototherapy. They told me it was because they wanted to make sure they could see his oxygenation was normal since the blue lights could cause him to be mistaken for cyanosis. I didn’t think it made any sense, so I just appreciated the continuous pulse ox since he had been admitted to the NICU for oxygen therapy. Good thing I’m a nurse, right?

So if it’s so common, why should we be worried about jaundice in a newborn?

Though most of the time jaundice in newborns an be harmless, the reason to treat aggressively is to prevent any brain damage. When severe jaundice is left untreated, the excess bilirubin can cause seizures and brain damage. Kernicterus is the name of the disease when bilirubin levels reach too high of a limit and cause this brain damage. Signs and symptoms of kernicterus include drowsiness, fatigue, fever, uncontrollable or high-pitched crying, trouble feeding, fever, abnormal muscle tone/spasms, and abnormal eye movement.

So if you are concerned that your newborn could be developing jaundice after you have been discharged from the hospital, make sure that you bring it up at the first well-child check up, or sooner if you’ve got a few days before.

Holy Sh*t Labor Day: Maverick's Arrival

That was probably the hardest shit I’d ever had to do in my entire life, but it gave me the best blessing I could ever imagine. After 23 hours of trying to labor down, my son Maverick James was born on 28 February 2020, at 1255. He weighs in as a light featherweight champion of 6.4 lbs, measuring 20 inches long. The adrenaline was surging when they placed him in front of me as I stared down at him while I was still on all fours.

26 February 2020 @1500

Sean and I had a 39-week appointment this day, but I was already having contractions. Mild as they were, the clinic still thought it was best to send me up to be checked in case I was going into labor. While I was triaged, I found out I was 3 cm and 75% effaced. The OBGYN that saw me asked if I wanted her to strip my membranes, and I said yes! Little did I know this was going to kick start the process fairly quickly. I went home that night and was cramping and contracting throughout the night.

27 February 2020

I woke up to slower contractions, not as intense, and all of a sudden felt a little disappointed. The contractions had been fairly strong throughout the night, but the fact that I was able to fall asleep through them to have them completely fade away? Rough. Sean and I still stayed home though because even though they were irregular, they were still there. The OBGYN told me to wait 24 hours, so that’s what we did. I called LND asking what admission criteria was, and she said that she would bet I still had 48 hours or so before I came in. So Sean and I went on a few walks, to include a very short 10-minute hike on the Franklin Mountains. This was barely a hike, it was a slightly elevated gravel trail, some kind of joke to a PNW’er. We ate lunch at an overpriced crab boil restaurant, and then walked to Wal-Mart to get milk, and that’s when it hit me.

I told Sean I needed to go home because I started having intense cramping. When we got home, I laid on my birth ball while Sean started a warm bath for me to relax in. I sat in the bath for about 15 minutes when I thought I felt a trickle come out, we thought nothing of it. Then a gush of fluid came out and formed a cloud in the bath, “HOLY SHIT” both of us exclaimed. I stood up, “THIS IS IT!” Fluids kept leaking out like they do in the movies!

“YOU’RE STILL GUSHING!”

“GET ME PADS AND MY CLOTHES.”

“HOLY SHIT IT’S HAPPENING!”

“I’LL CALL LND AND FLORA AND WE GOTTA GO!”

The adrenaline was rushing, but we honestly could have moved a little slower. But with every gush that came out, we became more and more excited. We were going to meet our little boy soon and we couldn’t wait! Sean drove us to the hospital in record time (safely of course), and I was still in the backseat trying to gather all the mental courage I was going to need for the big push.

Disclaimer: Graphic images included in this blog. Photography by Kai Lanzi Photography - El Paso Birth Photographer

We got to the hospital, and I barely progressed. I was at 4 cm and 80% effaced. I came in with a birth plan but God decided that he wanted to switch things up on us. I wasn’t contracting. I wasn’t in labor. My water was broken. My risk of infection would grow with every hour that passed by. So the question of, “do you want to start Pitocin” came up and it was the one thing I wanted to avoid. I’ve always heard that laboring on Pitocin was a different kind of hell. I ended up giving in after a couple of hours. I was going to feel the pain either way, so we might as well kick start it. I labored unmedicated (without epidural) on Pitocin for almost 8 hours. My night nurse, Maria, was the most soothing nurse ever. Every time she came in and massaged me through a contraction, I fell asleep. Then as soon as she left and Sean took over, I was screaming. There was something so calming about her that really helped me through those first 8 hours of labor.

28 February 2020

At 0430, I tapped out and asked for an epidural when they got the Pitocin up to 14 milliunits per second. They missed twice on my epidural, but gave me a hefty dose when they finally got it in. I slept until 9 AM. By then I was a complete 10 cm and 100% effaced and baby was at station 0. I was feeling mighty fine after hearing this, thinking that my labor was going to be sunshine and rainbows, but this was more like the PNW where a sunny day can turn into a rainstorm real quick.

After having the hardest time trying to push with an epidural, we ended up taking it off after 4 hours to let my body feel the contractions and the pushing. My legs were so heavy and I could not for the life of me focus my pushing to my butt. I also wasn’t having strong enough contractions to help me push baby out, so they had to start the Pitocin again. This was enough to put me through three hours of hell. My birthing team was the most encouraging team of nurses though. My midwife, Regina, didn’t give up on me at all and was pulling out every trick in the hat to get me to deliver. My nurse, Pat, didn’t give up on me at all and was so encouraging throughout the entire process. My husband was a trooper in supporting me. And my birth photographer, Kai, was doing way more than just taking photos. She was holding my hand, my legs, wiping the sweat off my face. My team was strong, and they believed in me; so I had to believe in me.

We tried EVERY position possible to push in. My son was NOT wanting to evacuate his hot tub of 9 months. We started in the traditional on the back push. I moved to both sides. I was squatting with the bar. My midwife put me in a weird rag doll position called Walcher’s position to try and get baby to drop. I went back to my back. I went back to my side. I felt EVERYTHING. The epidural was GONE. By the time 2.5 hours hit, I was hysterical and exhausted. I wanted to give up so bad and throw the towel in and opt for a c-section. I was losing my focus, but my team kept me on track. I started to lose hope after being started on antibiotics for a 102 degree fever I broke during labor. Everything seemed to be stacking up against me and my ideal of how my labor would go. Our last resort was on all fours. I don’t know if it was because my midwife said, “I’ll give it two more contractions and we’ll talk options on what to do next.” All I thought of was forceps, vacuums, episiotomies, and c-section. ALL things that I wanted to avoid.

If I thought I dug deep for the Athens Marathon, you’d be surprised at how deep I had to dig to get this baby out. The entire 2.5 hours before that I was screaming and crying. The last 30 minutes, I pulled focused, stayed quiet, did my breathing, and pushed that motherfxcker out. As soon as I felt his head pop out, it was just a burst of adrenaline to get the rest of him out.

At 12:55 PM, my baby boy was born. Would I do that again? Right now, no. I’m thinking “one and done.” I know in a few months, I’ll forget it was like and I’ll want to give my boy a sibling. Until then, I will cherish my cone-headed baby. I am overjoyed with how beautiful my son is. I am SO grateful for the support I had at the bedside. I couldn’t have done it without them. If there’s anything I aspire to be, it’s to be like the nurses and midwives I’ve had work with me during my labor.

Baby Boot Camp: Why are these classes so helpful?

Today, Sean and I attended baby boot camp. These classes can be extremely helpful if you haven’t spent too much time around newborns, or it can be a refresher if it’s been awhile since you’ve had a child. These are normally taught by registered nurses that have vast experience in labor and delivery and the postpartum period. For me, it wasn’t too much new information since I’ve spent quite some time as a nurse helping take care of infants and mothers, but it was an eye-opener for my husband that’s only held one baby in his entire life.

The class went over going into labor, what to expect at delivery, and the postpartum period. Some things that you may want to discuss are:

• What should I expect in early labor, and when should I go to the hospital?

• What will I need to bring with me in my hospital bag? Will the hospital provide a lot of the essentials to recovery and send me home with some?

• What are my pain management options - pharmacological and non-pharmacological? When’s the latest the anesthesiologist will give me an epidural?

• What will my diet be leading up to labor? Will I still be able to eat or is it going to be just clear liquid or ice chips?

• Are there other methods of delivering baby rather than just being in bed on my back? Water births? Squatting?

• What are your c-section rates or thoughts on episiotomies versus tearing during birth?

• If you’re having a boy - should I expect to have baby circumcised before we leave or at a later appointment?

• Are there lactation consultants to help me with breastfeeding afterwards?

• What’s not normal during postpartum recovery?

• Are there support groups I can attend during the postpartum period?

• What to expect from baby during feeding and how to tell if they’re hydrated and fed? (Importance of diaper counts!)

• Help on learning to swaddle a baby, change a diaper, and how to hold baby

• What are the signs that my baby blues is starting to develop into postpartum depression? (Because mental health is SO IMPORTANT!)

Preparing for baby is more than just making sure you have enough diapers, wipes, and onesies ready for baby at home. The nursery and gear can be totally set up, but if you aren’t mentally ready to take on baby, make sure you’re asking the right questions. There’s no such thing as a dumb question when it comes to the care and well-being of your child. Even as a nurse that’s helped a lot of moms after delivery, there’s still so much that I don’t know about when it comes to baby being at home.

Disclosure: Sometimes these classes can be giving outdated information, or they just haven’t “updated” with the times. There’s so much advancement in childbirth from the early 2000s, that it’s still best to discuss with your provider on what their recommendations are. With that being said, here are some photos of Sean learning what it’s like to carry around a belly and how to be a new daddy!

Sean had no idea what to expect from the class, but by the end of the class he said that it was becoming more and more real for him! As you can see below, he becomes very protective over our make-believe simulation baby.

This is the kind of face I expect to see in the first few weeks postpartum with the baby. A daddy who is lost, a baby that’s half naked, and me behind the camera laughing. I can’t wait to see you be a daddy!

A halfway there scare & our trip to the hospital

  I was ecstatic to be over the halfway hump because you could start seeing my halfway bump.  It didn’t last for very long though before I was scared something was wrong.  At 21 weeks, I started having severe sharp right flank pain followed by diffuse abdominal pain.  I was able to withstand it for one day at home.  I went to work the next day thinking that it was just gas pain, constipation, or simply baby trying to make room in my small torso for it to grow.  I did the most mom thing a girl could do, and I went to Facebook for Facebook answers from women who had gone through pregnancy.  They all agreed that it could be gas or constipation, but many still said to go get checked out.

  I said I’d wait.  I’m a nurse, and if you don’t already know, we make the worst patients.  We often wait too long to be seen, and when we are seen, we demand our care to be nothing less than stellar.  As I was driving home from work that night, I barely made it home without tears in my eyes.  I barely lifted myself out of the car and into the house.  I thought a shower and Tylenol would make a difference.  I tried simethicone and docusate to see if it would help kickstart things.  I knew it would take a few hours before I felt any different, so I told my husband we’d try to make it through the night.

  I got out of the shower and couldn’t stand up straight.  I cried, and I cried hard. The pain had become so unbearable that I had my husband stop everything he was doing so we could go to the hospital.  I was running through all the things it could be, right lower quadrant pain, guarding, tenderness… Appendicitis? Cholecystitis?  Where were my organs anyway now that my uterus was an inch above my navel? Do these normal signs and symptoms still apply to a pregnant lady?!  (You can see how nurses think, I guess.  Our minds are basically our own WebMD.)

If you have anything in your gut telling you to go get checked to make sure baby is okay, GO GET CHECKED. Don’t try to be strong because that’s how you were before you got pregnant. You’re not just thinking about you anymore, you have to think about baby. Follow your intuition as a mother and be safe!

  When I got to the Labor & Delivery unit, I was seen by an OBGYN and general surgery.  They wanted to rule out the two things I thought it could be.  They admitted me for observation and further testing.   They tried to get an MRI on me, but I couldn’t stand the procedure due to the pain.  I was so afraid of what the outcome could be, especially since I’m pregnant.  The worst possible scenarios kept playing through my mind.  Until we came to a conclusion after seeing an ultrasound showing that I have hydronephrosis.  Totally normal in pregnancy around this time due to the growth of the uterus and displacement of the ureters.  Unluckily for me, I had a little sprinkle of kidney stones.

  I’ve had kidney stones before.  They’re awful.  There’s some belief that passing kidney stones is just as painful as giving birth, just not as rewarding at the end.  I spent four days in the hospital for pain management and hydration to try and flush out the stones.  Nothing.  Just sediment accompanied by a lot of pain.  I asked to be discharged because I didn’t want to do the invasive procedures they were talking about, especially with baby on board.  So I’ve been on convalescent leave and I’ve been struggling with managing pain at home.  Being on oral pain medications, I’ve had to maintain a very strict schedule so I don’t become overwhelmed with pain.  I thought that I could wean myself off of my discharge medications, and that was the worst idea.  I didn’t sleep and neither did my husband.  The pain is still hard to control.  I can’t walk very far without my right flank feeling like I’m being shanked from the inside.

  As long as there’s nothing else wrong with me, I’ll power through this for baby.  We’re exhausted all of the time.  My movements throughout the house are very short and always take the breath out of me.  As if pregnancy wasn’t already getting harder with my growing belly.  But hey, I’m just taking it one pain pill at a time.