Monday, July 28, 2008

Two week seperation

Speaking of the reserves, I decided to do a research project/case study to see if my daughter would continue nursing after being apart for my two week active duty training. Here are my findings minus the research which I am still working on and will write up for publication in Attachment Parenting International's newsletter next spring.

The topic of my study was decided upon because I was required to take a two week business trip at a time when my 16 month old daughter was still an avid breast feeder. I spoke with a coworker who had similar experience a year earlier with her then 16 month old son and she had decided the absence meant they had to wean and so she weaned him about a month before leaving. When she returned her son had a readjustment period where he would not go to her and then after that she told me how he still fell asleep holding her breast as if it was a source of comfort. My hypothesis was based on her experience; if I continued nursing until the day I left and then offered to nurse upon returned (keeping up my milk supply by pumping) then my daughter would readjust to my return quickly, have a less traumatic separation, and continue the breast feeding relationship.
I began preparing two weeks before leaving. Up until then I had only been pumping milk once a day while at work and then nursing her on demand while we were together. At two weeks prior to leaving I started pumping twice a day and then with only one week until I left was pumping three times a day. This was based on knowledge that it is easier to produce milk the more I am around my daughter. Before I left I was pumping 300mL of milk during the weekdays and nursing on the following schedule; 10 to 20 minute sessions at 430am, 330pm, 530pm (this is usually for 20 to 30 minutes), 730pm, and then throughout the night averaging about 2 times between 900pm and 415am. As my daughter was 16 months old she was supplementing solid foods and juice or water during the day. She had refused taking any form of milk other than directly from my breast since she was 12 months old and at that same time refused the bottle.
I left on Sunday morning and provided my husband with 6 bags of fresh milk (pumped during the earlier week). He offered her this milk throughout the first week in a bottle and then from a cup and she refused it every time. Throughout my absence the only contact I had with her was over the phone (voice only) or over the internet (voice and video) via a webcam. My husband noted that each time we spoke she would calm down and I noticed she recognized me and would smile during our online conversations. Several times over the two weeks she would be upset and then hear my voice over the phone and calm down. I believe a lot of this was separation anxiety. Our first day apart my husband noted that she did not sleep well (we practice co-sleeping) and when she woke up she immediately went walking through the whole house as if searching for me. Our sitter noted that when her grandmother picked her up that day, which is the routine, she was very excited. I believe that was in anticipation of my scheduled pick up from her grandmother’s, which the routine was before I left. My husband noted this anticipation behavior lasted the first two days we were separated. While we were apart my husband tended my daughter during the evening, morning, and weekends and her usual sitter (my husband’s cousin) and my mother-in-law tended her during the day. She kept her normal routine while I was absent except I work 6am to 3pm and would pick her up by 330pm and my husband works 8am to 5pm so he could not pick her up until 520pm.
On a personal level I would be tempted to argue this separation was more difficult on me then on my daughter. I not only had to deal with the daily tasks required for my work, but also pumping at least six times a day, and the stress/guilt/separation anxiety a mother feels being away from her child. The first day was especially difficult and I found that pumping forced me to take time to reconnect with my daughter in my mind and relaxed me. I used pumping as a form of relaxation the first week as it seemed I was calmer after I was done than before I had started. Notably I noticed my heart rate seemed to lower and my mind clearer and able to focus better. The contact over the phone and internet also helped me to stay connected with my daughter during this time.
The first three days were the most difficult. It seemed as if my breasts were accustomed to the nursing schedule my daughter and I had established and when that changed I suffered from engorgement (from not nursing or pumping at night). I had not anticipated this so I did not plan to pump during the night and only did so early in the morning if I woke up in pain. The first day I was unable to sleep and found that two times I had to massage the milk ducts in order to get milk flowing during pumping times. The second day I felt some nipple pain most likely caused by the pump so I applied lanolin cream and turned down the setting on my pump. The third day was the most difficult, I work up at 320am with severe engorgement and pain and was only able to pump 60mL which did not relieve the pain. I also noticed I had a low grade fever, 100F which I associated with the engorgement. When I woke up at 610am I immediately pumped again hoping to relieve more of the engorgement and found I was not able to pump any milk. This was very distressing so after 5 minutes I stopped for a warm shower and used the warm water as a way to relieve some of the pain from engorgement. After that I was able to pump 100mL and felt considerably better not only physically, but emotionally seeing that I could still produce milk boosted my moral. I felt some of my symptoms may be mastitis so I contacted my OBGYN and discussed the symptoms with the nurse and was told to alternate warm and cold compresses and watch to be sure my fever does not go over 101F. While this was the correct information to get I felt somewhat distraught over it because I felt my pain was severe enough that it was an infection and I was concerned that without antibiotics it would not get better. Since I did not have access to cold compresses I used the shower as my warm compress and began expressing milk during my showers starting that night. This step alone relieved nearly all the fullness and engorgement I had been feeling. I found during this separation the pump was not as adequate at emptying my breasts as my daughter’s nursing was.
On the 5th day I felt my supply was dwindling in spite of my pumping efforts so I began drinking whole milk in hopes it would help my supply. This first day I noticed a dramatic increase after drinking milk and began drinking 3 to 4 glasses each morning. My supply became steady after this day and I felt very confident that I could continue the supply until returning to my daughter. I believe the milk was positively affecting my supply as I noticed my daughter had a reaction to the whole milk I had been drinking even though I had my last glass Friday morning and did not nurse her until more than 12 hours later and after several pumping sessions.
After the fourth day my body seemed to have adjusted to the change and I did not feel as engorged in the morning as I had been. I continued pumping 6 times throughout the day until the day I returned home.
There was an exceptional amount of stress related to this project in addition to the physical pain and difficulties I experienced I ran into many difficulties finding time and places to pump. My two week separation was to serve two weeks of active duty as a Navy Reservist so I may have experienced more difficulties than others might have in this respect. I was the only female in my group to ever request time to pump and found the course leaders were not as understanding as I expected they might be. I found it easier not to mention and just disappear for my own pump time throughout the day after discussing it with one of the administrators of the course I was taking. Several days I was unable to pump on a regular schedule so I had to supplement with two pumping times close together before and after the scheduled events.
I also was distressed to have to throw away the milk I was producing and was so concerned this might affect my supply (my breast feeding experiences thus far showed a lot of it is mind over matter) I would close my eyes and turn on the water in the sink before throwing it away so I could not hear it and would not see the milk being dumped. This was not as much of a problem the second week as I felt I had made it far enough that my supply was not in danger of drying up and the time was nearing when I would be reunited with my daughter.
At the end of these two weeks I found for my case my hypothesis was correct. My daughter continued nursing and I even found she nursed more than she had before and I felt we were able to reestablish our bond as mother and daughter easier thanks to continued breastfeeding. The day I returned my daughter recognized me right away at the air port and came running to me. She then insisted I only hold her the rest of the time we were at the air port. She did not immediately request to nurse, however after I asked if she wanted to nurse she requested it twice and nursed for 5 minutes each time within a 20 minute time frame. I did not feel as though she was getting much milk at that point, it was almost as if she was testing to see if there was still a milk supply after so long. Once we returned home she nursed long enough to start the flow of milk and continued nursing for 30 minutes. The next two weeks she nursed more intently then she had before I left. After two weeks being home she has gotten back into the same nursing routine we had previously established and seems to feel comfortable that I will not be leaving again soon.

1 comment:

Me said...

What a great story. I am having to leave my son, who will be 19 months, for a week in Spt. I am trying to wean him, but it is not happening. (I secretly hope he doesn't wean) ;) I will take my pump on the trip to continue to help my supply. My biggest concern is for him and the anxiety this will cause. Your story, as with others I have read, give me hope that this trip will be harder on me than my son.

I found your blog a few weeks ago and have enjoyed reading it. Like you I have had such a great experience with bf'ing I am becoming an IBCLC to help women.

Keep up the fun blog :)