Ruby's Nursing Story

Most women write birth stories, and I am sure someday I will write hers, but more important I felt to share is Ruby's nursing story. Ruby, our youngest daughter, was born during a January ice storm after 2 days of off and on labor. Once my water broke she was born within the hour and greeted the world with vigor! Ruby latched on and began nursing right after birth. She nursed hungrily while we were in the hospital, but her latch was shallow and painful, though I was told it "looks good".

Our older daughter, Grace, was tongue tied and had nursing trouble so I asked those who examined Ruby to check for one. None was noted at this time and I tried all the tricks I knew to help her latch better. With sore nipples and a sinking feeling in my stomach we were discharged the following day. I was completely committed to nursing this baby, but knew that something wasn't right.

Our second night home I wrestled with a hungry baby trying desperately to help her latch properly but she wouldn't or couldn't. My nipples were bleeding and she was not producing the requisite wet diapers. I texted a trusted lactation consultant for help and got out the hand pump and syringe to feed colostrum to our hungry baby.

The lactation consultant came right out and confirmed Ruby's poor latch and also found that she had a posterior tongue tie (PTT). We syringe fed Ruby for a few days and started a pumping schedule to ensure establishment of a good milk supply. Because I experienced low supply with my first I also started lactation herbs, an aryurvedic supplement called shitavari and ordered domperidone online to have on hand if needed. I pumped every 2 hours around the clock and syringe fed our newborn while my nipples healed. It was overwhelming to be going through this again, but the hope was that Ruby could compensate for her tongue tie and learn to latch / nurse effectively soon.

Ruby was a very mellow baby, she rarely fussed or cried about anything. So when the time came to nurse her again and she threw back her head, balled her little fists and wailed I was shocked. Despite gentle repeated attempts to offer her the breast she wanted nothing to do with it. Her crying would start me crying and we would offer her the syringe which she readily accepted to fill her tiny tummy. Emotionally I was a wreck, my perfect newborn baby was rejecting her natural food source emphatically. Her pediatrician was concerned that she had lost > 10% of her birth weight. Rationally, I knew what to do as I arranged for a medical grade pump rental (Medela Symphony) and breast milk from a good friend. Ruby initially needed a few more ounces of  milk than I could provide for her and I did not want to feed her formula unless absolutely necessary. A good friend of mine pumps exclusively for her 18 month old and I felt very comfortable asking her for milk to feed baby Ruby. She was happy to help and it allowed me to get a few feedings ahead of Ruby with my pumping and removed some of  the stress. I will always be grateful for this amazing gift she gave my baby girl. Our pediatrician was not enthusiastic about this, but I was very confident in my decision and would milk share again if Ruby needs supplementation.

We did this for two weeks, offering the breast first and then syringe feeding increasing amounts of milk that I pumped for her. Once ruby was getting 3 oz / feeding it became impractical for us to solely syringe feed her. She was already refusing or unable to nurse and so we reluctantly introduced a bottle to maintain our sanity. It made feeding far easier and allowed us to cuddle her more easily in a relaxed position. We used slow flow nipples and paced feedings in the hopes we would be getting her back to nursing soon.

I tried any and every suggestion I could find to entice Ruby to nurse. I offered her the breast when she was sleepy, wide awake, before feeding, during feeding, after feeding . . . you name it, I tried it! We also tried every nursing position, lots of skin to skin, nipple shields, and a homemade supplemental nursing system (SNS) I made out of a 5Fr red rubber feeding tube, 35ml syringe and medical tape. More often then not we would both end up crying and covered in milk and I would reluctantly give her the bottle. We had some minor successes with her nursing for a minute or so and us giving more milk via curved tip syringe or homemade SNS to encourage her attempts, but they were short lived and required lots of assistance. Each time I came up with a new "plan" to tempt Ruby to nurse I got my hopes up, way up, and felt crashing disappointment when she consistently refused.

There was something very viscerally painful for me about Ruby refusing to nurse. Each time her little fists would ball up and her lips purse I felt like I was being punched in the stomach. I wanted nothing more than to nurse her but she was resolute in her preference for the bottle. No doubt I was experiencing depression though I felt it was very justified. I cried every day and would spend hours researching "nipple confusion" and "posterior tongue tie" instead of getting the sleep I so desperately needed. Pumping around the clock also prevented me from socializing as I was worried about missing a pumping session or not having enough milk with me to feed her. I packed a 5oz. bottle in her diaper bag every time we left the house. It was unnerving and exacerbated my anxiety to not be able to simply breast feed my baby when she was hungry. I worried about the car breaking down, losing electricity, or being stranded in traffic with a hungry baby. Our dependance on the pump and bottle shook me to the point that we had a generator installed during a winter storm. 

I also struggled with guilt daily. Plenty of moms had bottle fed babies and did not cry all time, what was wrong with me? I also felt guilty for putting Ruby through this routine, she was gaining well and perfectly content to drink from a bottle, a smiley, happy cheerful little baby. She would only cry or get upset during our attempts to get her to nurse. My 3 year old often asked me, "Mommy why are you crying, are you sad?" and I had to also consider how it was affecting her. Grace is an amazing little soul, she would "pump" milk and syringe feed her baby dolls, happily, right along side me. She also loved "helping" to feed her baby sister.

Our amazing lactation consultant stuck with us through all of this and helped us to comply with the cardinal rules 1) feed the baby, 2) maintain milk supply. Without her help there is no way I would have been able to maintain a milk supply or ever get this baby nursing again. She tirelessly answered my questions and provided guidance and insight I will forever be grateful for. She told me again and again that the odds were in our favor and that with enough perseverance Ruby would likely nurse again. She also provided me with a link to stories about non-nursing babies who had learned to nurse, I bookmarked this webpage and read it every night, sometimes out loud to Ruby for inspiration.

I finally decided to brave leaving the house and go to a new moms gathering. There I met another mom who had similar struggles nursing her baby boy. She had his tongue tie revised by a specialist and he was then able and willing to nurse. As I listened to her story I realized so much of what she was saying resonated with Ruby's struggles. I decided to take Ruby to Albany for a consult with Dr. Kotlow, a pediatric dentist who specializes in laser revision of tongue tie. Our LC supported our decision and set up a referral and an appointment was scheduled. We decided to go for a consult and decide whether to have her revised based on how the visit went.

The office was incredibly efficient and Dr. Kotlow was kind and confident. He examined Ruby, confirming both a tight posterior tie and a lip tie. We quickly agreed that she needed revision and handing her over I felt comfortable and very hopeful. She was gone for only a few minutes and was crying when she came back. I offered her a breast with nipple shield and jiggled her a little to settle her down, she immediately started nursing! I started crying and was in disbelief, she nursed for 10 minutes and when I took the nipple shield off to switch sides she nursed without it. Dr. Kotlow came back in to show us her revision sites and the exercises we were to do for the next 2 weeks. Ruby had a large hole under her tongue which honestly shocked me, but I was still flying high from the fact that she could nurse.

Ruby continued to nurse for the next 18 hours, and seemed fairly comfortable, though did have a swollen upper lip from her lip tie revision. When she started fussing at the breast I gave her a bottle thinking she was fatigued and sore from nursing. She then went right back to bottle preference and refusing to nurse again. I was devastated as I thought we had left this all behind us and were well on the path to nursing. Though I now knew Ruby could nurse, but just wouldn't. Again I tried all the tricks I could think of and Ruby had appointments with both a craniosacral therapist and an acupuncturist to help her adjust to her new tongue movements. I did the prescribed stretches (though perhaps more gently than prescribed) and tongue exercises. We continued to attend the new moms group, but I found it was very hard to watch the other mom's nursing their babies while I gave Ruby her bottle. Though I found no judgement, only hugs and support there.

We tried bathing together again, though it didn't result in nursing, it was an amazing bonding experience. One of my biggest fears about Ruby was that I would not bond with her as much as her sister if we didn't  have a nursing relationship. Bathing with her and spending time skin to skin helped to allay some of those fears for me. Our acupuncturist also helped me  to realize that my stress surrounding nursing was affecting Ruby's response, she gave me some herbal tea and I worked on not caring whether she nursed and just casually offering the breast at each feeding without fuss. Ruby was much calmer and did start to move her mouth and root when offered, but still did not nurse.

One and a half weeks after her revision our lactation consultant came out to see Ruby and I went to show her how Ruby reacted to the breast. Ruby did her typical mouthing and then started to nurse! We carefully gave her milk via syringe to increase the flow she was getting and encourage her to continue nursing. This was the moment I had been waiting for, the switch to flip and Ruby was from then on a nursing baby! We continued to use the homemade SNS for a few weeks. Nursing was still very new to Ruby she did not transfer milk effectively and was also fussy at first so making sure she had adequate milk flow to keep her nursing was very important. I continued pumping and the herbal supplements, as our LC explained having some oversupply was very helpful to encourage Ruby to nurse and also to make sure she was able to transfer enough milk. Ruby had her 6 week growth spurt at this time and nursed very frequently so she had lots of practice. We had a few more minor setbacks (blisters and sore nipples) due to her learning to latch but they paled in comparison to what we had already been through.

Ruby is now 9 weeks old and competent at nursing, she still needs help with her latch and I still pump to maintain my milk supply but I am happy to say she is a nursing baby. Though she is 9 weeks old, she has only been nursing for three, so in many ways I am still adjusting to having a tiny nursling as I learn her nursing hungry and full cues. I am so incredibly grateful to my supportive husband, mom, little Grace, nanny Grace, our incredibly smart and committed LC, the new moms' group, Dr. Kotlow and everyone who believed in little Ruby.