Thrush. AGAIN.

Can I just say how truly SICK of having thrush I am? This is, I think, the third, maybe fourth, time that I've had it in the five months that I've been breastfeeding. ENOUGH IS ENOUGH. It is quite possibly the most painful, but most definitely the most unpleasant, thing I could possibly ask to experience. It hurts like hell, I'm bleeding, I cry nearly every time I nurse my babies, and pumping isn't any more pleasant than nursing, so it's not like I can just pump and forgo nursing for a bit.

Gah!

It's not enough to make me stop nursing, but ohmygodpleasemakeitstopseriouslyplease!

Answer to Anonymous

I still hate that Blogger doesn't do threaded comments, so I'll respond to Anonymous' questions on pumping here:

While driving to and from work can you steal some additional pumping sessions using something like a Whisper Wear pump?

My commute to work, thankfully, is really too short for this to be useful. And I do pump while at work, of course, but there's just only so many times I can do that. I'll point out that the Whisper Wear Pump has been discontinued by the manufacturer. While I don't know why, my guess is it's because it doesn't work. I actually have a Whisper Wear Pump and my experience is... it doesn't work (and, oh by the way, it's LOUD). From the reviews I can find online, it seems that it definitely does not work with women who are, uh, how shall I say... ahem... well endowed. And people who are small breasted seem to have only minimally good experience with it. I'm in the well-endowed category and I can't get a drop out of it, so I found it to be a phenomenal waste of money.

While a baby nurses from one side can you hand pump the other?

If I'm nursing only one baby, and I haven't recently pumped, I nearly always pump the other side. But I don't use a hand pump, I use my hospital-grade electric pump for that. But it also depends on whether I'm about to nurse another baby. My experience is that if I pump and then feed a baby, the baby doesn't get enough (remember that I weigh Ellie before and after feeding her, so I do have a quantitative way of measuring this), so if I'm feeding Sam and I know that I'm going to be feeding Ellie immediately afterward, I might pump for a few minutes on the other side just to get to the hindmilk stage (higher calorie), but I won't do a full pumping session. I am often, however, feeding two babies at once, so there's nothing to pump at the same time. (I've backed off on simultaneous feeding recently, because I'm finding Ellie doesn't eat as much if I feed them both at the same time... I'm not sure why this is, but it seems consistently true)

I do often pump AFTER nursing the babies, because in THEORY this is supposed to boost my supply. However, my experience is that I nearly NEVER get more than a couple cc's if I pump after feeding the babies. They're pretty good at fully draining me, which is a good thing. I can't pump after nursing them EVERY time they nurse, because, honestly, there are only so many hours in the day.

On Breastfeeding Triplets

You're pregnant with triplets? Well, you're obviously not going to breastfeed them, you're going to spend a fortune on formula!

I heard that a lot when I was pregnant. Over and over, I heard unsolicited opinions from people telling me that there was no way I would ever be able to breastfeed triplets. It's not possible, they would say. I didn't even bother trying with my twins, I would hear. Why would you even think about it? You'll never do anything but feed them all day long if you try! the incredulous voices would cry. They'll be preemies. You can't breastfeed preemies, you know.

I never expected to be the militant type...certainly not about breastfeeding, and certainly not about breastfeeding triplets. But these constant, unsolicited words of discouragement absolutely convinced me that I was going to do everything I could to breastfeed my babies, at least for the first few weeks. My premature babies were going to NEED the benefit of my colostrum and my milk for as long as I could give it to them, and I knew it wouldn't be forever, and even during my pregnancy, I mourned the loss of the ability to just KNOW that I could breastfeed with reckless abandon, but I set a modest goal. I wanted to get 3-4 weeks of exclusive breast milk into them if I could. And if I could do that, well, we'd go for 6 weeks and after that, I would give myself permission to supplement with formula, because it would be a miracle if I made it that far.

The babies did get a little bit of formula in their first few days. My colostrum was mixed with a few cc's of preemie formula to make up for lack of volume, but they DID get my precious drops as well. In their first 3 days they received a couple ounces of formula between the three of them. TOTAL. And then I started producing enough to feed them exclusively my milk. It helped that Abby started out with 2.5 cc feeds and Ellie and Sam started out with 4cc feeds, so the demand wasn't huge from the start. They were still getting the bulk of their nutrition through a TPN at that point while they figured out the whole suck/swallow/breathe thing.

And on Day 4, my husband asked the nurse how long it would be before I could try actually breastfeeding my babies, and she checked with the doctor and got permission for me to breastfeed them. She helped me get set up with Sam and showed me how to hold him and support him, and I fretted about whether he'd be able to latch, but he did! He didn't latch on for very long, but he definitely knew what to do and figured it out pretty quickly. He tired very quickly, so we gave him a feeding through his gavage tube afterward, but it was miraculous. I had no idea how amazing an experience nursing my baby could be until that moment. It felt strange and awkward and perfect and amazing all at the same time. My tiny little three and a half pound baby knew what to do and he nursed like a little champ! How incredible. And then it was time for Ellie's feeding, but she was having a harder time, so we gave her a gavage feeding while she was nursing so that she could associate a full tummy with mommy's breast...a technique we employed a lot with her in the NICU, actually. I was shocked at how exhausted I was after nursing just two tiny babies. Abby was still too small to try to nurse, so when her turn came, I held her skin-to-skin while giving her a gavage feeding, and then I pumped afterward while gazing at my beautiful two and a half pound angel and had the best production I'd ever had before. It was amazing to see that it was all true... being around your babies really DOES improve milk supply. Who knew?

And that was my first day breastfeeding my babies. The next day, believe it or not, I was able to breastfeed all three of them, even Abby, and I breastfed them at least twice a day every day until they left the NICU and I pumped 8-12 times per day, every day. And then, on day 24, they came home. My once champion breastfeeders suddenly would not breastfeed anymore. None of them! I continued to pump 8-10 times per day, fed them expressed milk, attempted to breastfeed them at every feed, and never slept, because of the constant fight to get them to remember how to breastfeed. I thought all was lost. I developed my second clogged duct and was in misery until it resolved. And then... a few days later I woke up with painful, red, tender, swelling in my breast, a high fever, chills, flu-like symptoms... you guessed it, mastitis! The way to get through mastitis, I'm told, is to let your baby nurse as much as possible, but my babies wouldn't help me, so I gave up for a few days and just pumped, pumped, pumped, pumped and pumped some more. And gradually, it got better, and I was able to see the light at the end of the tunnel.

I thought there was no way my babies would ever return to nursing... but on the advice of a nurse, I got some nipple shields, even though lots of people told me that nipple shields would only lead to nipple confusion. Seriously...these babies were drinking from bottles, so how much more confused could they get? And lo and behold... suddenly, Ellie was nursing. Then Sam was nursing. Only Abby remained skeptical. She would latch occasionally, but would usually scream her head off at the mere mention of breastfeeding (er, that might be a SLIGHT exaggeration). And eventually I was able to rid myself of the nipple shields all together and I had two, perfectly normal nursing babies and one baby who would not nurse, but who still received only expressed breast milk.

I called the pump my FOURTH baby, because I spent as much time with her (I named her Maggie) as I did with my three babies, in order to make sure I always had enough milk for Abby. And pump, I did. I was able to reduce to 6-8 times per day without changing the amount I was producing, since I was nursing so much, and I still got lots of snuggle time with my beautiful Abby. Even today I still try to give her the opportunity to nurse occasionally, but she still hates it. She's got a tongue-tie, and has a really hard time latching, so it's not shocking that she won't nurse, but it's a little disappointing.

My babies will be five months old next week and today, for the first time, I'm faced with the need to supplement them with formula. I've finished my stash of milk in the freezer. And I'm pumping like mad. But I'm producing 40-45 ounces of milk per day in addition to whatever they get via nursing directly, and the three babies together are eating 52 ounces of milk per day, so I'm falling a little bit short on the supply. I've tried everything... domperidone, fenugreek, blessed thistle, some weird herbal concoction, reglan, oatmeal, breast compression before and during pumping... but I just can't produce more than I'm producing now, without adding additional pumping sessions in each day. I'm pumping about 6-7 times per day right now, and if I pump any more than that, I'll probably lose my job.

A piece of me feels like a big, giant failure, even though I'm obviously not going to STOP breastfeeding and pumping at this point. I'm not sure when my 6 week breastfeeding goal turned into a 3 month goal, or when that 3 month goal turned into a 6 month goal, or when that 6 month goal turned into a 6-month-adjusted goal, but I know now that I'll breastfeed as long as I can, as much as I can until they're a year old, and then I'll work on weaning them before moving on to my next round of fertility treatments. I'm not getting any younger, but I do want at least one more chance at this pregnancy thing. And I want my children to have lots of siblings. I had only one and he loathes me, so I've been determined my whole life to make sure that my children are surrounded with a big brood. They don't all have to like each other (though that would be nice), but at least the odds are good that they'll each find SOMEONE to love in the family.

But I digress. I do feel like I'm failing my children, though I don't feel that way toward any other woman who feeds their babies formula. I've told countless mothers of multiples that they should not ever beat themselves up over their breastfeeding decisions because it's HARD, and sometimes darned near impossible. And I know I should celebrate my five months of accomplishment, rather than focusing on my failure to continue the same pace, but I just can't get past it. I know very few women who made it through five months of feeding triplets only breast milk... so I should be thrilled, right?

But then this morning, the first morning that I was guaranteed that the babies weren't going to have enough of my own milk for the day, the guilt poured on. I thought it would be wise to try giving Abby a bottle of formula while there was still breastmilk in the fridge, just in case she didn't like it. After all... what would we do if she refused it and there were no other options? So when the nanny arrived this morning, I handed her a bottle of formula (no way was I going to be the one to give her the yucky stuff). Sure enough, Abby screamed her little head off. My poor persnickety Abby wanted NOTHING to do with the formula. NOTHING. I thought maybe she just wasn't hungry, but we gave her a bottle of breastmilk and, sure enough, she gobbled it right up. Sigh. Sam, fortunately, had no problem drinking the formula, little piggy that he is. Next week, I'll try making 50/50 bottles and see what happens with Abby, but oh gosh, my heart was breaking knowing how much she hated the taste of the formula! I was completely failing my child! Thank heavens I tried it out while there were still options!

In a couple months, we'll be starting them with some solids, and eventually their consumption of milk each day will go down slightly, so I may actually be able to return to being able to feed them 100% breast milk. But for now, each of them will probably get 2-4 ounces of formula each day. And I know that's still pretty amazing on my part. And I know there's nothing to be done, and no way for me to get around it.

And once again, I feel like a failure. Once again, I feel like my body is betraying me. It's infertility all over again, even though I know that logically, this is the polar opposite of infertility. Somehow, I simply MUST make myself okay with supplementing, because there's really nothing wrong with it. It won't hurt my babies. They'll still grow and they'll still be healthy. I'll still be able to fortify for the extra calories that Ellie needs. I'll still be able to breast feed any time I'm home and feed them breast milk most of the time. 2-4 ounces per day just isn't the end of the world, so why do I feel like the world's worst mommy?



~~~~~~~~~~~~~~
Also, a quick update on Ellie... at her appointment yesterday she hadn't gained any weight, but on Wednesday we were able to convince her to start taking 120 ml bottles, so we're hoping another week of that will be enough to boost her back toward gaining. Bigger babies need more calories to grow, of course, so hopefully that's all that's going on. For the moment, she is a bit of an enigma, but she's definitely improving. She's more alert, and smiling and cooing almost as much as Abby now. She looks good, but is still far more sleepy than the other two. We'll go back in a week to see how she's improved.

I Deserve a Medal (Updated Again)

For those of you who have never had the pleasure of fortifying breastmilk for a baby, it's disgusting stuff. But it's pretty simple. You use a recipe to add formula to breast milk so that the final product equals whatever calories per ounce your goal is. When we were trying to get 22 calories per ounce, we added a half teaspoon to 3 ounces of breast milk. You could barely tell the formula was in it. Now we put a full scoop of formula in a bottle and add breast milk until the total volume equals 5 oz (so we add approximately 4ish ounces of milk). It's disgusting stuff and smells to high heaven and pours out really thickly. Yick. No wonder poor Ellie doesn't love the stuff.

But anyway, tonight I had the displeasure of going and purchasing a can of formula for the first time. Do you know how much this shit* costs??? One 16 ounce can costs $27!!! Fortunately, CVS had it on sale for $22 with your ExtraCare card, and I had a $5 coupon a friend had given me. But seriously, even $17 per can! Imagine if I was really feeding formula to my babies as their primary foodstuff! I used to say that I HAVE to breastfeed my babies because we can't afford formula for all three babies, but I had no idea that I WASN'T JOKING. I don't think I could afford formula for ONE baby if I were feeding formula full time! (Hell, I'm not sure I can afford it just as the fortifier, sheesh!)

Okay, so I have no idea how much money I've saved our family by breastfeeding triplets for this long so far, but I do know I deserve a medal. Or perhaps a new laptop. Which, um, I need because mine died a grizzly death. Now, if only I could breastfeed them all through college to save on tuition too... we'd be all set. Except, um, I don't think it works that way.

*Okay what is UP with me and the profanity lately?? I have GOT to cut this out!

Update Answer to Anonymous:
No you can't fortify breast milk with breast milk. Simmering breast milk down to concentrate it wouldn't really work and would damage the breast milk. The proteins and antibodies in the breast milk would be damaged by the cooking process. Plus, you'd have no way of knowing what the calorie concentration was. The main reason for me to keep giving my babies breast milk (aside from formula costing a FREAKING FORTUNE as I just discovered tonight) is to give them the benefit of the antibodies and other good stuff they get from me. Cooking the milk destroys that goodness. I can get the concentrated calorie benefit by simply adding formula. Processing is not the root of all evil, in my opinion. (and I certainly don't have such an excess of pumped milk that I can afford to concentrate my EBM by simmering... it would be a guarantee that my babies would end up on formula supplements, because I could never pump enough to make up for that difference)

P.S. You didn't upset me with the way your question was phrased. It's just that it's an unrealistic solution. There's no way to really calculate the number of calories you'd end up with in your breast milk concentrate, and when you're dealing with a baby who's struggling to get enough calories , it's important to really work hard to get those calories into her. Spending the money on one can of formula to use as fortifier for her isn't a big deal. It would be a HUGE deal if I were using the can of formula as intended by the manufacturer... particularly with three babies. I'd be spending a FORTUNE on formula! As it is, this can that I bought last night should last for several weeks, thankfully. I have no idea how long a can of formula would last if I were making it straight for three babies full time. I don't think I want to know!

Updated Again: Anonymous says:
and what about WIC? Maybe you make too much money to qualify...but worth a try... especially since you have triplets to feed!

If we still had only one income we make too much money to qualify, now we have two incomes. (I'm quite grateful to not qualify, mind you) On top of that, since I'm not using formula for anything other than fortifier, I only need one can every couple weeks, so the WIC benefit would be wasted on us. We can certainly afford one can every once in a while. It's just the idea of having to pay for this all the time that makes me very grateful that I breastfeed.

Moo!

I have pumped 7432.5 ounces of milk since September 19th, 2007. That is 58 gallons of milk. That is not counting any of milk they've gotten from direct breast feeding. My next project is to add up the number of hours I've spent breast feeding. When this is all over, I'm totaling up all the gallons I pumped, the hours spent breast feeding, and the number of diapers changed (I have a log of all of this stuff) and I'm sending them a bill before they go off to college.

But seriously folks, I do it with love. Really. Still, 58 gallons??? Can you believe it? I can't!

Finally Getting to Your Questions

Ilahee asked:
as a breast feeding mom of a singleton, i'm curious as to what and how much you eat... are you still constantly hungry?

I'm supposed to eat 3500-4000 calories per day. In reality, I eat far less than that. I eat at least ine Quaker Oatmeal To Go bar per day, as that's the only way I like oatmeal. When I do eat, I eat ridiculously sized portions, because I never seem to be hungry until I start eating and then I'm positively ravenous. I definitely crave more protein than I used to, and I have to work harder to make healthy choices because I don't have so much time to make food, so convenience foods are tempting. Mostly, though, I have unquenchable thirst and I go through water like you wouldn't believe.

Anonymous Wrote:
Is this the OB/GYN for whom you weren't sure of the best way to switch to the perinatologist without harming the relationship? It sounds like things between you are well. How nice that he visited you in the hospital!
Would adding calories to any EBM feedings Ellie takes be useful? Is the issue more to figure out what is going on, why she isn't eating enough, and that if it weren't for the hunger strikes, she'd be gaining fine?

Yes, this is the very same OB/GYN, and things did work out fine. I told him he'd be delivering my next baby, darnit, because my NEXT baby is going to be a SINGLETON, so help me! It was lovely that he visited me in the hospital and if I ever get around to writing about my last couple days in the hospital and my birth story (yes, I was supposed to write that before I start work tomorrow...yeah, um, that just didn't happen), I'll write about that visit.

Adding calories to Ellie's EBM feedings wouldn't necessarily have been useful before because she really wasn't getting any EBM feedings. Now that I'm going back to work she's getting many more EBM feedings so it may be more worth it. HOWEVER, what it will accomplish is curing the symptom (poor weight gain), but it will be unlikely to solve the underlying problem, if there IS any underlying problem. The real question is why doesn't she want to eat more often? Babies, as a general rule, do not go on hunger strikes, so why does she? Today she ate like a mad woman, but that's unusual. Most days she has to be woken up every 4 hours and force-fed. Anyway, it's not a bad idea, and certainly one we've thought about, but not necessarily one that fixes the problem.

My Reality writes:
I have a question. Can we have more pics of the trio? Please?

Yes! I'll take care of that next!

Carol Asked:
Speaking of weight - how's yours going? are you still losing? I'm down 23 pounds from my pre-pregnancy weight now. Breastfeeding multiples is great!

I'm down 65 pounds from my pre-pregnancy weight, but that's a little unfair considering that I lost about 30 pounds while I was pregnant. I lost another 35 pounds within a few weeks of delivering the triplets and have been holding steady since then. Considering how much I'm eating compared to how little I normally eat, I'm surprised I'm not packing on the pounds. Truth be told, I still have about 40 pounds to lose before I'm down to my "ideal" weight, so I have nothing to brag about!


On a personal note... a lot of people write that they are in awe of me for breast feeding triplets... If I could get my shit together to write my birth story, I've got a post brewing about bresat feeding also, but the long and the sort of it is that I can't imagine it any other way. I can't say that I believe formula would be any easier, and it would certainly be more expensive. We've had every single breast feeding problem you could ask for... plugged ducts, mastitis, thrush, latching difficulties, short frenulum, sore nipples, you name it, but I still cannot imagine not breast feeding them. They have received no formula since they were four days old and the three of them together received a TOTAL of fewer than three ounces of formula in their lifetime (not counting fortifying Abby's EBM for a while), and I'm very proud of that. I'm terrified that when I go back to work I won't be able to keep up with it, but I'm going to do my best. I've got 99 ounces of milk in the freezer to help me keep up in case I slip with the production at first, so I feel fairly confident that I'll be able to keep up once I get a handle on my schedule.

Finally, two great things happened today: First, I got to meet Jessica and her Five Little Monkeys and her fabulous husband Jon today. They were fantastic and I'm so glad I finally got to meet them in person. Second, my friend Connie delivered her triplets at 34 weeks, 5 days gestation. She's a superstar. She had 2 girls and a boy, just like me, so I have someone I can pass on lots of stuff to! I'm so thrilled for her and now I have to convince her to start a blog! :)

Boy Does This Suck - and other random points

My fever kept spiking up to 102 all day, no matter what I took for it. I was not enjoying it. I hate having a fever. Consequently, while I pumped as much as I could today, I didn't attempt to nurse any of the babies at all today. I hope that doesn't cause a set back because I imagine tomorrow will be more of the same. None of them are good breastfeeders, but I was thinking we had started to make progress with Ellie at least. Our little guy is totally too lazy anyway and I'm sure he was relieved that I wasn't shoving a breast in his face half the day. Abby's so little that while she's got good technique, she's not physically strong enough to breastfeed effectively anyway. None of them would have done anything to help unblock any blocked ducts today, so I just pumped as much as I could and left it at that.

I hate having fevers. Pain I can handle (and boy is this a LOT of pain), but fevers are so miserable to me. Yuck.

I heard some bad news about a friend of mine today and I will hopefully write about it tomorrow. I feel just awful about it.

I completely copped out and Tuesday I had a baby nurse come for three hours. The advantage was that she fed the babies while I SHOWERED and then she organized the nursery for me and then she gave the babies baths. She was awesome and worth every penny. I don't know WHAT I would have her do if I had her here for 12 hour shifts, but she's pretty good at self-directing, so I'm guessing she'd figure something out. Anyway, her three hours here left me feeling completely calm and in control all day Wednesday. I would still have felt that calm and collected today, except that I felt like death all day. Fortunately, I had a friend here in the morning who rushed over when she heard about the mastitis because she said what I really needed was to get into the HOT shower immediately, but I couldn't shower without another adult here because of Ellie's heart monitor. And then this afternoon a teenager came to help for a bit. And finally, the baby nurse came from 4-8pm which was terrific, because I got a nice long nap to sleep off the fever a little, and she fed the little ones while I pumped pumped pumped some more.

I feel a little guilty for not taking care of them much today, but honestly, I was lucky to be upright at all. I'm just lucky today happened to be a day I had lots of help. Normally I don't have people here during the day, but I happened to accept an offer of help for the afternoon just yesterday, even though I had no idea what I would have her do with me. And when the baby nurse emailed me yesterday to say she could give me a couple hours this evening, I debated not having her come, but I'm so glad I took her up on it. She will probably come for at least one feeding tomorrow also, which makes her an angel or a saint as far as I'm concerned, considering that she's working overnight with twins tonight.

The good news is that this will pass. No one ever had permanent mastitis, right?

A new milestone?

Fever over 100.4? Check (100.9 before I took medicine to relieve it).
Flu-like symptoms? Check.
Tender painful breast and sore nipple? Check.
Probably cause, missed pumping/breastfeeding times? Check.

Can we spell mastitis, boys and girls?

UGH.