Sabre Ruth At Home

(This post is a continuation from Enter Sabre Ruth.)

___________________________

Okay then. At home with new baby. Now what?

It has been said many times that babies do not come with an instruction manual. Okay, some people are true masters of understatement. The next four weeks would prove to be the most educational in my life, bar none, and the featured methodology would again be called “just-in-time” learning. I hate that damn phrase, but that doesn't mean there's one better! Among the things that we learned:

First, let nobody distract you from this Golden Rule: context is the most important “detail” you can get. Lemme 'splain...

In the first week, little Sabre didn't seem to follow any of the expected behaviors. It started with acute narcolepsy at the breast: she would try to latch on but whenever she managed to do it, she'd take a couple of sucks and fall right asleep. (This is far more frustrating to a new mother than it may sound.) Sabre never refused the breast; she was always interested—she just zonked out right as she managed to latch on. As well, she had started out with some simply amazing fuss fits through the night, which changed to lots of sleepiness later in the week. And right before the first week checkup at the midwifery, it occurred to us that she hadn't had a dirty diaper in over 24 hours (this was something specific we were told to watch out for), after a most impressive start with passing the meconium. (Dad had had the first diaper change, at the midwifery, which was comedy incarnate. The sheer volume of that black tar was eye-popping, and because even the preemie-sized diaper was like a muu-muu on her, meconium had already smeared all over the carefully chosen first outfit as well. Sigh...Not to be deterred, dad got the diaper out of the way and made with the wiping, carefully observing the front-to-back guideline...whereupon...you guessed it: Sabre re-flooded the torpedo tube with approximately the same payload, at the exact moment when dad had two feet in one hand and a maxed-out wipe in the other. We have since established that Sabre Ruth can specialize, at will, in diaper changes featuring multiple diapers per change!) Anyway, at that one-week checkup, we found her weight was 5lb 11oz, and our jaws hit the floor.

It is expected that babies lose a little weight after they are born, and that they tend to re-gain their birth weight after about two weeks. So, we were expecting to lose a little bit, but not almost 20% of her body weight, which was surprisingly low to both of us to begin with, and 5lb 11oz really did start to sound like “preemie”. When we saw some concern about her weight from the midwives, we latched on to that concern, hard. Now...in hindsight, we may well have misjudged the amount of importance others were placing on weight as the preeminent indicator of health (I suspect it, now), but our biggest mistake was then focusing so hard on the singular goal of getting weight on her, that we lost sight of other indicators of health.

We felt horrible about this. We could now see that the symptoms we were seeing before, pointed to Sabre actually not getting the food we thought she was getting: no dirty diapers because there was nothing to poop out; increased sleepiness was actually the lethargy that the books warned us about; and the screaming fits were because our new daughter was actually going hungry. We thought she was getting food at the breast but now it was pretty clear that was not right, and there are few feelings that can compare to the utter pit-in-the-stomach sense that you have been starving your first-born child without even knowing it.

We kicked into high gear, steering everything toward getting weight on this girl. She continued not to latch on in the way that everyone told us that a normal baby would—not helping already exhausted and now nearly panicky parents—and we turned to other means. Eventually, one of the midwives (who were being heroically accessible to us the whole time) suggested manually expressing milk and spoon-feeding it. And so a heart-wrenchingly frustrated Cathy tried this one afternoon, and the effect on Sabre was immediate. Her eyes opened up wide and alert, she calmed down, and then slept naturally. Okay, so...when we know she gets food, she suddenly starts acting exactly as we'd thought she should from the beginning. Great. So, now, the best way to get food into her? The midwives suggested a pump and a plastic-needled syringe, and Dad sprang into action to secure the equipment. (Hey, it was something to do other than feel utterly helpless!)

The syringe imposed its own imprisoning box, again inadvertently. Pumping and feeding with syringe meant two things: one, that she did start getting food, and two, that we knew exactly how much food that was. That was fantastic, because we could see her getting the food she had not been getting before. And that was also very difficult, because knowing exactly how much food we were putting in her imposed new and very specific expectations on mom, dad and baby, that in hindsight we probably paid way too much attention to. Over the next roughly two weeks, through both visits to the midwifery and housecalls by the midwives and a lactation specialist, we kept a close eye on her weight, and it did start to come up, well enough that we could even see the rate of weight gain increasing.

On the syringe, our problems turned to managing the pump, keeping the “right” amount of food going into Sabre, and trying to figure out how to do a proper latch at the same time. This involved a three-step process at each feeding: 1) try to nurse, working on the latch, then 2) feed Sabre pumped milk via the syringe, and finally 3) pump for the next feeding. For poor Cathy, this often meant that a feeding lasted three times as long as it would for a “normal” nursing mother, prompting one of the midwives to comment sympathetically, “you know, we often say that new moms feel like they do nothing but feed their babies, but for you, it really is like that, isn't it?” Even with Dad volunteering to take some feedings, Cathy still had to be awake to pump, and the fact that we now knew that our daughter was getting food, kept us going. In the middle of all this, too, Cathy even tried using a nipple shield (which essentially fits over the natural nipple and presents a different shape to the baby's mouth...we had established that Sabre's mouth was both very small, and that like her mom she could not open her jaw as much as one would expect) to work on getting her the best chance for a good latch.

The lactation specialist, Heather, was an absolute godsend. Now the midwives are no slouches when it comes to nursing help and advice, but the specialist over several visits was able to help Cathy work through her frustrations, help her find the latch she needed with confidence, and help encourage her to try going off the syringe and back on to the breast. (What I find interesting in hindsight was that Cathy and Sabre seemed to “figure out” the latch almost all at once, after one of Heather's visits. We had been told, both by Heather and by Sue O'Dell in Denver, that many babies having trouble finding a latch seem to “just figure it out” in the third or fourth week. In the end, Cathy did the work herself, but I suspect that the outside help was invaluable in reassurance and confidence.)

It was during the help-with-nursing stage that we got a few little pieces of context that were amazingly enlightening, in hindsight. First, we learned somewhere in there that the amount of weight that Sabre lost that first week was certainly on the high side, but not unprecedented—and one resource specifically said that people too often use weight as a singular measure of success, rather than taking into account other indicators of health. Other indicators of health? It was at that point that a few other things swam into focus. It occurred to us that at no point had anyone actually said that she didn't look healthy...her skin and color looked great, she seemed normally alert, not abnormally distressed, and so on...just a little on the light side, something to try and work on, and a little jaundice. From the beginning we had felt that something wasn't quite right, without knowing exactly what...and when we heard that the weight had dropped more than we'd expected, we zoomed right in on that, putting everything into remedying that problem. Classic tunnel vision.

Other little things came into focus as well. Not too long after going on the syringe, the wee miss had started to make up for lost time with regard to both wet and dirty diapers. It turns out that this is another indicator of health—you know she's getting enough food when you can see it coming out the flipside! Also, we had started to notice that Sabre would fuss badly after she had nursed a little bit, which did not bode well for weaning her off the syringe and back onto the breast. We did not consider that we might still be looking for a nail for our hammer—it never occurred to us that she might have been fussing over the syringe, not over the breast. In hindsight, it seems pretty clear that it was the syringe that she wasn't entirely happy with. (The little critter probably took it the same way we did, in the end: “this is not my preference, but it's getting me what I need, so I'll do it”) In short, each time we backed out and took a broader-context look, things became much clearer, and much calmer.

At the end of the third week, with new confidence in the latch (brought about at least in part by a slightly bigger baby!), Cathy and Sabre went “cold turkey” off the syringe, and onto the breast, and seem to be doing fine. (Happily, we made it through this process without resorting to formula.) The concerns about “how do we know she's getting enough, now, when we can't see it going in her?” seem to have abated (since we can certainly still see it coming out), and each day things get a little closer to what seems “normal” to us. Looking back on it now, it seems pretty clear that we lost sight of the right context, and probably chased our tail unnecessarily. Context is hard on a new parent—how on earth do you even know what you don't know?

So, we learned things that we expected to learn, but got caught in some of the traps anyway. Perhaps this was simple vanity on our parts; I still believe that one of our strongest assets is our ability to keep things in perspective, but I am humbled at how we still managed to lose sight of many things that probably could have kept us much more calm and rested during the process of figuring out how to get Sabre successfully to the breast. Likewise, I know that I usually have the ability to adapt to change pretty flexibly, but I gotta say, when your newborn daughter seems to throw something new at you every hour or better, challenging everything you think you have learned to this point, it can get rough. (I have had cause to be thankful for every bit of background reading and knowledge that I have managed to acquire, and yet I'm not sure anything could have really prepared me for this.) And I suppose we should take some solace in some of the comments from the midwives who complimented us on being very aware and observant about things that might not be right. Here we felt that we had failed so miserably that we were literally starving our daughter, but the comments from others suggested that we were actually ahead of the curve. I guess that's what happens when you want to succeed that badly.

We learned that you really do know more than you think you do. At various points in this process, we got what seemed like conflicting information, or at least conflicting priorities, from multiple parties. Sometimes we were faced with the choice of doing what people were recommending, or doing what we knew to be getting ounces on our little girl. In the end, we made our choices and are happy with where we have come, and as we continue to incorporate what seems right to us with what people recommend to us, things continue to get better all the while. (It is important to note here how significant it is that the midwives and Heather supported our right to do this at all times. Had we been in a traditional environment with this set of circumstances, it is quite possible that the loss in weight may have prompted an immediate mandate for formula supplements, which we really wanted to avoid. We were able to work it out naturally, if not without challenge, simply by some attention and investment of time. Now obviously we don't know that it would have been different, but having the conspicuous choice is intensely gratifying.)

We certainly have learned that a new parent's sense of time changes. Before Sabre, neither Cathy nor I would have ever believed that you could put one or two ten-minute items on your day's task list and not be able to get to them, literally. With a due nod to The Powers That Be, okay, we get it now. (And that seems to be the crux in making it seem a little less impossible the next time you attempt it, by the way.)

Finally, I have learned just how much of a rock star my wife is. I know I've been singing her praises elsewhere in this tome, but please allow me to close with another accolade. I am intensely grateful to have been around pretty much the whole time since Sabre was born; I work during the days now but I am still here at the haus when I do, and I've only been away for a handful of supply and grocery trips. This means both that I get to help out a lot (which I am very happy about), and it also means that I have been able to see how Cathy interacts with Sabre, frequently and uncensored. In a nutshell, her patience and devotion has surprised even me—and I had some pretty big expectations. I mean, I figured Cathy would be a good mother, but I have been here to see what she has been through, the frustrations, the triple-time feedings, the inconsolable newborn fits, the obvious soreness from the enthusiastic munch that produces a good latch...but most of all, I have now seen her try everything that her considerable mind can come up with to do right by her new baby, in spite of scares, all sort and manner of little curveballs, and of course all of it on broken or no sleep. When I know good and well that she must be crazy tired, and nothing that I have tried is calming the fussing miss down, she calmly takes her from me, sits down with her and starts to work her patient magic. At her level worst, she is still more impressive than I could have ever asked for. Sabre Ruth may be the most beautiful creature I have ever seen, but Cathy is the most beautiful creature I have ever seen. Of course that doesn't make sense, except that it does.

Trust me on this.