Breastfeeding tips

During first few days when milk doesn’t come in yet

-skin-to-skin as much as possible, more time with baby means more time to try latching and more chance of success

-avoid using nipple shield unless really necessary (nipple shield may create nipple confusion and hinders milk transfer)

-hand express breast milk (study shows hand express in first few weeks to empty breasts increase production down the line)

-track weight daily to avoid drastic weight loss (if weight drop more than 10%, suggest starting formula supplementation of 15-30cc per feeding)

-no bottle feeding (may create nipple confusion), please use Medela Supplemental Nursing System to keep baby at breasts

-mum only nurses and rests, no other housework

-get hospital grade pump with battery/car charger

After breast milk comes in

-use both hand express and breast pump after feeding to increase production

-set clock to empty breasts regularly (even one time of delayed emptying may cause clogged ducts and mastitis)

-to prevent mastitis, wash nipples with warm water  and clean pump tubing every day

-if any breast pain/redness/fever, start taking antibiotics and once feels fluctuation/pus formed, get needle aspiration as soon as possible to avoid I&D

-if clogged duct, warm compression every 2-3 hrs right before pumping/electronic tooth brush and cold compression in between; lethicin?; if not relieved in 24-48hrs, be more aggressive and be careful of mastitis

 

 

 

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How I ended up with a 4cm hole in my breast one month after delivery…

The title says it all.

I am in a dark mood now but I plan to write about my experiences of how mastitis turned my life upside down for the past week.

Among all the outcomes of lactational mastitis, having a 4cm by 1.5cm hole in the breast is not the worst outcome but does stand on the ‘bad’ end of the spectrum of all possible outcomes. From a very quick recovery and resuming breastfeeding, to a series of needle aspiration and eventual recovery without scars, to an emergent incision and drainage with a gaping wound on the breast. But anyway, I didn’t develop bacteremia/septic shock/death and still alive so thank goddess for that.

But this is the true reality of healthcare. A mixture of bad luck, rapidly progressing disease and subsequent clinical decision making behind the disease progression curve, you will find yourself end up in some place you never imagine would be.

Even now, I am still waiting to see where it goes since the wound is not healed.

I think it started on last Saturday when I found some area near my right nipple painful and bulging – thought it was some milk pouch since it was clogged duct there with hardened clots and it was difficult to see the redness as it was near areola. But I kept pumping – the next day pumping was so painful I even went to the hospital to borrow another hospital grade pump and the lactation consultant pointed out to me – isn’t that more red than usual?

Actually no, I think it all started when I was still staying in the hospital and son didn’t learn how to properly latch. Because he did not learn how to properly latch so I had to pump and nurse at the same time to increase my milk production (which never exceeded 3-5oz per day), and I had developed lots of clogged ducts which never went away and eventually developed into mastitis?

Chain of events.

My journey of breastfeeding (1)

Young parents usually underestimate the work needed for feeding their newborn.

First night

Our son was born around evening time, and on that specific night, I was so tired from the 12-hour long laboring and really wanted to sleep through the night, but when the nurse asked if I would like to have some room-in time with my son to try breastfeeding, I said yes. As you know, we’d better take advantage of newborn’s suction instincts, the earlier we try to let them latch on, the better. If you put them on your breasts for the first hour of their life, they actually start seeking out your nipple just by instinct. But trust me, when you are so tired, you forget all things learned from breastfeeding class took weeks ago (early room-in, early hand expression of colostrum, etc).

So, when I tried and failed my attempt for breastfeeding for that night (there was no lactation consultant  to help you at night) and overwhelmed by the desire to sleep, I tried to send him back to nursery (during the tour of the labor & delivery ward, they told us we can leave the newborn in the nursery overnight). It turned out I am too naive about this.

After I sent him back and started to fall asleep, my door was knocked and a nurse assistant wheeled him in. Instantly I knew what was wrong, the nursery staff didn’t want to deal with a crying baby! With the very last strength in me, I picked him up and held him on my breast and he calmed down a bit.

He slept on my breasts for a few hours and started to cry again. I noticed he has a poopy diaper so I tried to send him back to nursery again to change his diaper. This time I even walked him to the nursery myself with the hope that he won’t be sent back to my room again. I was totally wrong – in 15 minutes, the nanny wheeled him back to my room again saying he was hungry and he needed to eat. I was so tired thinking – “I tried, there was no milk yet…” and almost argued with her about this practice of bringing him to my room every one hour just because he was smacking his lips…

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Looking backward, there were a few things we could have done better to kick-start our breastfeeding journey.

  1. Put the baby to your breast right away after delivery – I felt very weak after the labor and initially didn’t even want to have a screaming baby on my chest but once he was there I felt a flush of love and joy for this little guy.
  2. It is not a crime to give some formula to a baby if you felt too tired to feed him the first night, but you need to discuss this with your nurse.
  3. You can hand express some milk and feed to him if the baby still hasn’t got the hang of latching yet. Check out “hand expression Stanford hospital” for the video.

Continue reading “My journey of breastfeeding (1)”

Delivery

Our son was born.

Similar to my memories of OB rotations while in medical school, my labour and delivery experience was full of painful screamings and jokes about “poop and baby coming out at the same time”, as my nurse said in a funny way “you know that this can’t be changed as physiology doesn’t allow that, right?”. Haha, yeah, I know, when you push down and your abdominal pressure increases, both orifices open up for passage. Sometimes a third orifice also opens – I heard someone was able to push Foley out as well.

Several lessons learned – first, would you rather have a practitioner with 25 years experience to do the procedure on you or a resident who just came out of medical school? I thought I bypassed that choice by choosing a private practice as my primary OB, but I was wrong as the very last minute a resident showed up at bedside and vacuumed my baby out – at the end of the day, this was a teaching hospital and residents need to learn from doing.

Secondly, epidurals are god-send. I got my “last-minute” epidural just fine but I might not be this lucky next time. I was offered epidural when the cervix was 3cm dilated but I declined it thinking pain is still durable. Later when the pain became not that tolerable, I asked for morphine – and then things went downhill. Because once I got the morphine, I felt an overwhelming flush of warmth and I had to lie down for some sleep which cost me the mobility. The only way to keep the pain under control during labour is to sit up or stand or walk around. It turned out lying down on a bed is the worst position for labor pain. So once the morphine wore off and I was still lying down with limited ability to move due to the drowsiness from morphine, I was really left with the only choice of epidurals as the pain became really unbearable after another pelvic exam. Considering I was induced with contractions coming at every 2 minutes for the last 6 hours and with oxytocin running at its highest possible dosage, I asked for an epidural. Once it was done, my cervix changed to fully dilated upon exam. Luckily, I was able to feel the contractions and push without feeling the pain. The funny thing was that initially, I was still able to feel severe pain from contractions on the right side due to the catheter inserted was likely on the left side in the spine canal; after I turned onto my right side for a few minutes, the magic juice of anaesthesia dripped down due to gravity to the right side and then my right side pain was gone. However, I pushed for 2 hours under epidural and baby still not out so they had to use vacuuming. I don’t feel too much regret for enduring the labor pain for many hours without epidural as it might slow down labour and I wanted to wait until I absolutely needed it but next time I might just have it once cervix turned out to be three centimetres as I might not have that much time for active labour for second babies.

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Healthcare for immigrant parents

When your parents come to the United States, what should you think about regarding their healthcare?

If they come here for a short-term visit, like a six-month stay, a short-term healthcare insurance for visitors could be your choice, but those usually don’t cover for existing conditions. If your parents have chronic conditions like diabetes, hypertension, heart diseases, etc, they may need medications and maybe some visit to the clinic or emergency room.

US healthcare insurance is largely based on employment and due to parents’ immigrant status (B1/2 visitor visa), there are very limited choices for healthcare insurance. A few options are as belows, but I suspect better knowledge is with local healthcare brokers.

-some employment-based healthcare insurances allow you to add parents as dependents, such as VA or Tricare

-some supplemental healthcare insurance offers some cost deduction by providing low out-of-pocket costs

-some visitor healthcare insurances offer choices for acute onset of pre-existing conditions

So what if an emergency happens and parents are not insured or under-insured?

-emergency rooms, according to law, all the ERs in the US have to accept patients no matter what, so they will be seen in the ER but you are going to expect to receive some bills with large numbers. Well, you can negotiate with their billing department later but it is always not pleasant to receive a bill that may make you broke. But if there is really any life emergencies, don’t hesitate to bring your parents to ER.

-free clinics or fee-scaled community health centers, usually different states and cities have some free clinics run by government or charity groups but they usually open on 9-to-5 regular hours. If they need hospitalization, the social workers at a hospital will help you apply for emergent Medicaid (depends on states), which will cover the costs of in-patient stay.

-private cash-only clinics, you can find some private clinics in lower Manhattan/Chinatown or Flushing, NY that accept cash for visits.

-call your own primary care physician and see if he/she can fit your parents into a schedule and charge a reasonable fee based on cash or fee-scale.

-some cash-based telemedicine services

How about medications?

They can bring enough medications to the United States for the duration of stay.

Or

-some pharmacies provide low-cost common medications like CVS, Target, Walmart’s low-cost Rx program

-use GoodRx for wholesale prices for medications

-ship medications from home from mail but sometimes the Customs may be scrutinous about that since there are regulations to prevent smuggling cheaper medications to the US

If you have any experience exploring the US healthcare system with immigrant parents, share it in the comments section!