31 Oct 2012

Using an At-Chest Supplementer

Homemade at-chest supplementer consisting of a bottle, nipple and tube.
Making an at-chest supplementer is easy and cheap.
Note that this post is not medical advice. I am sharing here what I have learned through personal experience. If you are concerned about your baby's health, seek help from a doctor.

Using an at-chest (at-breast) supplementer is a great way to feed your baby if you are unable to produce all of the milk he or she requires. This method is completely supportive of the nursing relationship, and does not involve your baby latching on to any artificial nipples, such as bottle nipples. As wonderful as it is, this kind of supplementer can be brutally hard to use at first. I've been using one for over eighteen months, so I'll share some tips!

First, let me explain what it is. All the different versions consist of a container to hold the supplement and a long, narrow tube. One end of the tube goes into the supplement, and the other end is placed right by your nipple. Your baby latches onto both the tube and your nipple simultaneously, drawing supplement from the container and getting all the milk that you are producing, too.

What's great about it? Using an at-chest supplementer allows you to do all feedings at your own chest. This is amazing for your nursing relationship and all the bonding that comes with it. It's also important for promoting normal jaw development in the infant – the physical action of chestfeeding develops a baby's muscles differently than bottlefeeding does. Using the supplementer helps you produce more milk, too, because even at times when your baby is only receiving supplement and you are not producing any milk, your chest tissue is being stimulated to make more. For those who produce little to zero milk, using the supplementer makes it possible to still have a nursing relationship.

Jacob latches with the supplementer near the corner of his mouth.
How do I get one? You can buy a commercial supplementer, or you can easily and cheaply make your own. I prefer the homemade kind, so that's what I'll describe first. You can use any baby bottle to hold your supplement. Get gavage tubes from a pharmacy, or in bulk from a medical supply store. The kind to look for is 5 French (that's the diameter), 36 inches in length. You might want a tube with a bigger diameter if your baby has a weak suck, a complication of some conditions such as cleft palate or prematurity. Using a shorter tube is super irritating because it forces you to hold the supplement container so close to your baby's mouth (who has enough hands to do all that?!). Cut off the extra plastic bits, if there are any, on one end of the tube. The other end will be closed and rounded and will have two or three holes just before the tip – I cut off this part too because otherwise the supplement doesn't seem to come out easily. Some don't do this because they believe that cutting this end makes the tube sharp (we never experienced a problem with this). Thread one end of the tube through the bottle nipple (expand the opening of the nipple with a knife if required) so that it is sitting in the supplement. To clean the tube after use, just suck some hot water through it. Do not boil this kind of tube – it is not made from materials designed to withstand such a hot temperature.

The main difference between the homemade and commercial systems is cost. The Lact-Aid is $48.75 or $62.50, depending on whether you get the deluxe or standard model. The Supplemental Nursing System (SNS), made by Medela, was $42.99 on Amazon when I checked at the time of writing. It should be noted that Medela is a company that violates the World Health Organization's code on the marketing of bottles and artificial nipples. Unfortunately, its product name, SNS, is often incorrectly used as a generic name for a supplementer. You can make your own supplementer for the cost of any baby bottle and nipple and a $5.00 gavage tube. If you use this system in the long-term, you will end up spending a fair bit on tubes. They can be bought in bulk for about $1.00 a piece, and most people replace them once per week (or when they get too stiff to use) – so, you could spend $52 on tubes if you use the homemade supplementer for one year. I've been told by several people who used an SNS or Lact-Aid for over a year that both systems hold up very well to wear and tear and rarely need replacement parts.

With both the SNS and the Lact-Aid, the supplement container hangs around your neck. I like my homemade version because I can put the container down beside me on a table or hold it between my knees – I hated the idea of something relatively heavy dangling from my neck. I also like being able to have a decent amount of supplement on hand. The containers of the SNS (re-usable) and Lact-Aid (disposable bags) are smaller than most baby bottles. My number one reason for using my homemade version is that it is simpler – it has only three parts (bottle, nipple, and tube).

I mould my chest tissue using my middle finger and thumb, and position the tube with my forefinger. End of tube is in line with the end of my nipple.
Moulding the chest tissue and positioning the tube
How do you actually use this thing?? Some people latch the baby on first, and then sneak the tube in through the corner of the baby's mouth by moving a bit of breast tissue gently out of the way. This never worked for me. I have so little chest tissue that if I moved any part of it, my baby would lose his grip immediately. A downside of this method that a friend of mine learned the hard way is that it may become impossible to sneak the tube into your baby's mouth once he or she has teeth getting in the way.

There's a lot to have to juggle between latching your newborn and placing a tube. This is how I do it: I get my baby in position and latch him first without the tube (otherwise he gets too antsy waiting for me to have everything ready). Then I take the end of the tube and get it near the end of my nipple. I briefly un-latch my baby. I use my thumb and middle finger to mould my chest tissue into a shape that my baby can latch to, and use my index finger to position the tube so that the end of it is in line with the tip of my nipple. The tube comes from above my nipple so that it points to the roof of my baby's mouth when he latches. I slip my index finger out of the way just as he is latching on and then I hold the tube in place for an extra second or two until the supplement is flowing up the tube. Some people tape the tube to their chest, but this didn't work for me. The tube would always flip in the wrong direction when I tried to mould my chest tissue for my baby to latch.

Immediately before latching, Jacob's mouth is open and the tube is already well-placed.
About to latch
Using a supplementer is initially very challenging. I couldn't position it on my own for the first two weeks! My partner had to help me with every single feeding until I developed this method of doing it on my own. It helped when my baby's latch became stronger. Nowadays, at eighteen months, I don't even think about it. My baby latches himself on, and I know exactly where the tube needs to go so that the supplement will come up easily.

Have you used a supplementer? Do you have any additional tips to share that we should know about?

15 Oct 2012

The End of Donor Milk

Yesterday, Jacob turned 18 months old, and tonight I thawed our last remaining bag of donated human milk. About two weeks ago, we saw that the end was near and started mixing donor milk about half and half with cow's milk. So far, Jacob has tolerated this reasonably well. We'll continue to give him donor milk when we can find it and families with younger babies don't want it, but at the moment, our freezers are storing nothing but the summer's vegetables.

I can hardly believe that we did this for 18 months. Jacob took about 25 ounces of supplement a day for much of that time, adding up to nearly 14 000 ounces of donor milk in total. We never needed formula. Some donors gave us a few two-ounce bags, while others filled our deep freezer. We are deeply grateful for every drop of it.

When Jacob was four days old, and we began supplementing, we wanted to make it to just one week on only human milk. We knew that even this would make a difference to his rapidly developing gastrointestinal tract. When we got to one week using human milk, we wondered if perhaps we could find donations for him for one month. Then two months. Then three. Six (plus solid foods). One year?! 16 months?!!! Yes. The World Health Organization recommends breastfeeding to two years of age and beyond, remember?

Finally, in the last few weeks, Jacob's first set of molars finished coming in and he has been starting to chew food with considerably more ease. I guess it's time. He's ready to start munching solid foods as a large part of his diet!

I suddenly had the thought as I thawed this last bag, "Tomorrow will be Jacob's first day having only cow's milk and no human milk." Then I realized what an incredible disservice that notion is to myself. I have been breastfeeding, and producing breast milk for my boy, for the past 18 months. The donor milk is what I see all the time. I collect it, store it, thaw it, pour it into bottles, and Jacob sucks it up the at-breast supplementer. It's easy to feel as if I make nothing for him.

I don't know how much I actually produce considering how much supplement Jacob takes, but I can still spray milk when I hand express. Perhaps this amounts to a few ounces per day. Eventually this evening it dawned on me: Jacob will keep getting human milk as long as I keep breastfeeding him. I'm really doing it.

8 Oct 2012

I LOVE Toddler Nursing

Nursing my kiddo has never been more fun than it is now.

Boy covers my nipple with his hands. Looks at me. Grins. I show my surprise and confusion: "Where, oh, where did my nipple go? I just can't seem to find it anywhere!" Boy takes his hands away, with a triumphant ta-da type gesture. I demonstrate my delight: "Oh, there's my nipple!" Repeat in classic peekaboo-with-toddler fashion.

Boy looks at my nipple. Yep, he's got that I'm-about-to-latch look on his face. He obviously wants to nurse. He leans in, kisses my nipple, and then pops back up and laughs uproariously. He tricked me! Repeat and repeat.

Some of the best moments of all happen after my boy has had a usual toddler tumble. He reaches up for my arms. Once I'm holding him, his right thumb goes in his mouth and his left hand searches through my shirt buttons. "Do you want to nurse?" I ask him. He nods his head quickly between full body sobs. There is no more guessing – he knows what he wants and how to tell me. He can affirm that, yes, absolutely yes, the only thing that will do right now is nursing.

We started out assuming we would formula-feed with bottles, and now I'm nursing an 18-month-old. I can't wait to see where the rest of this amazing parenting journey will take us.