Tuesday, 1 April 2014

Triumphant Tuesday: Breastfeeding Through Breast Milk Jaundice

Journalist and best-selling author, Florence Williams, was prepared for the blood and pain of childbirth. She was less prepared however, for the blood and pain of breastfeeding. Here, she shares her story with The Alpha Parent.

Her journey is as poetic as it is real, as heart-warming as it is painful. It is what inspired Florence to author her bestseller, and Winner of the 2013 Los Angeles Times Book Prize, "Breasts: A Natural and Unnatural History". With her characteristically blunt brand of honesty, Williams asks the question "How did humanity ever make it this far?" - what with yellow babies, nipple fissures, clogged ducts, milk fevers, and no ER. But, as we mamma-mammals know, the female body is a resiliently stubborn sod, and Williams' experience is certainly an ode to it...


The Birth


"I didn't bother to read the sections in the pregnancy books about breastfeeding. I was much more concerned with the pain and blood and gore of childbirth. I got stuck on the terrifying bit about pushing a head the size of a bowling ball through what was now bluntly called 'the birth canal'. I found that part so colossally distracting that I waved off what the books call the fourth stage of childbirth: lactation. I was a mammal. How hard could it be? I would flip through those sweetly illustrated sections later if I made it through the delivery alive.

How wrong was I.

What I didn't know. What I couldn't know, was that childbirth ended up being the easy part. It turns out I was a bit of a champ at it. Nurses filed into my room to watch my breathing technique. In between contractions, they talked about real estate. I didn't need drugs. I didn't even accept an Advil when it was over. "You're tough" said my doctor, shaking his head. My son was beautiful, if a little orange looking. My pride swelled.

The latch

But then came the pain and the blood, and it came from breastfeeding, the part of the deal that was supposed to be all saccharine and drenched with love hormones. The first time Ben latched on was wonderful, a little strange, but the fact that he knew what to do seemed a miracle. His strong little mouth created a vacuum like a particle accelerator.

Nipple Fissures

The second time he latched on, it hurt, and the third time, it hurt more. My nipples grew inflamed, then formed canyons of fissures, then bled. They looked mangled. I couldn't wear a t-shirt, much less a bra. My mother-in-law came to visit, and I staggered around the house looking like a crazy bleeding topless person who'd had an unfortunate accident with farm equipment.

The 'Art' of Breastfeeding


I was doing it all wrong. What I learnt the hard way is that neither women nor babies "know" how to breastfeed, despite this enterprise being a fundamental part of our humanity. (To be fair, the babies know more than the mothers. Studies have shown that right after birth they are capable of a heroic 'crawl' to the nipple, which might be colored extra dark for their blurry-eyed benefit). If we human mothers once instinctively knew how to nurse babies, we lost it along with thinks like the ability to make vitamin C. Through our evolving social context, we learned from each other how to eat foods with vitamin C and how to tickle an infant's chin so his mouth will open bigger for breastfeeding. Now, though, we have lost the social transmission that came from living in kin groups. We are replacing it with the paid profession known as "lactation consultant".

'Hands-On' Support

Mine was called Faylene, and she made house calls. Friendly but no-nonesense, she showed me the football hold, the lying-down hold, even the upside-down (the baby, not me). She helped me open my son's mouth wider and stuff more of my areola in it, and she showed me how to gently break the force-of-nature suction with my pinky when it was time to stop. It was bewildering, but I was getting the knack.

Breast-Milk Jaundice


Then a relative noticed my son was now even more orange-hued. He was diagnosed with a condition called 'breast-milk jaundice', in which some unknown component of my milk was temporarily interfering with the ability of his liver to break down bilirubin. A pediatrician told us that if this weren't corrected by a twenty-four-hour break from breast milk and immediate application of artifcial light to his skin, he would suffer brain damage.

We fed him formula from a bottle for a day and a night while I tried to pump my engorged breasts. Ben looked at my nipple like it was a foreign metal object. Faylene told me this is called 'nipple confusion'. I called her back for more body contortions and face stuffing to reaquaint Ben with the real deal. We were bfinally getting everything sorted out on day 10 when I suddenly felt like I was going to die. My temperature spiked to 104 and my right breast turned to red, hot cement. I went to the emergency room.

Mastitis

Yup, I had mastitis, a blockage or inflammation of the milk duct that triggers a systematic infection. I needed antibiotics, and I needed them fast. I couldn't help but wonder how humanity had made it this far. What happened to cave women with yellow babies and clogged ducts and no ER? Breastfeeding might have helped the species evolve, but not before killing off a good percentage of its mothers with what used to be called 'milk-fever'.

Finally... A Love of Breastfeeding


I would get mastitis three more times that first year. I'm not sure what propelled me to stick it out. Faylene, probably, and a dogged sense of granola-girl duty. But then, once the agony ceased, I found I really liked breastfeeding. In fact, I loved it. Ben and I would settle into our bright-yellow glider at all hours of the day and night. I learnt about things that went on along my street at four in the morning that I never imagined. Sometimes I flipped through a magazine or just marveled at my son's now-porcelain skin. I loved the surges of prolactin, a gentle stoner hormone, and of oxytocin, which, as one writer describes it, produces "slight sleepiness, euphoria, a higher pain threshold, and increased love for the infant". I loved the lazy intimacy with my son, and the way he panted and flapped his arms with joy when it was time for dinner.

We are a team."


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Tuesday, 11 March 2014

Triumphant Tuesday - Breastfeeding With Hypothyroidism and Postpartum Depression

Experts now consider thyroid hormone one of the major ‘players’ in depression. Unfortunately, problems with the thyroid, which are more common in women, often go undiagnosed. Then, when a woman reaches her childbearing years, this can cause extra problems with fertility, pregnancy and lactation. For instance, did you know that thyroid hormones play an integral role in mammary function? During lactation, they aid in the regulation of both prolactin and oxytocin. Thus, excess thyroid hormone (hypothyroidism) has been linked to inhibited letdown, for example.

Depression and thyroid disorders are often quoted as reasons why moms quit breastfeeding. However, it doesn’t have to end that way, as this brave mother illustrates…


“Back in 2009, I was very sick. The doctors diagnosed me with Graves Disease, an autoimmiune condition, and told me that I may not be able to have children. I wasn't even able to go on walks because my disease had started affecting my heart. To improve things, I had a total thyroidectomy (an operation to remove my thyroid gland). During surgery they discovered that my thyroid had started to overtake two of my parathyroid glands (which help you absorb calcium) so they were removed as well. I was now 100% reliant on a drug called Synthoid, a kind of pretend thyroid.

Then… I became pregnant. The doctors’ fears about my infertility were unfounded.

In the beginning, my pregnancy was extremely normal and easy going. The synthroid medication I took daily was adjusted accordingly as my pregnancy progressed. Then, at the tail end of my first trimester, my blood pressure started creeping up so my doctor put me on some blood pressure pills and decided to monitor it. By the end of the second trimester I was on two different types of blood pressure medication and modified bed rest. Throughout my third trimester I was on bi-weekly non stress tests at the hospital and then, when I hit 34 weeks, it was decided that the baby needed to come out at 37 weeks, and I would be having an induction. I felt extremely anxious but happy that I would be meeting our son, Ryland, a bit early. Looking back, I wish he could have stayed put for that extra month because my little boy needed those weeks.


The birth

At 37 weeks I was induced. The process was long and gruelling, involving 3 days of going to the hospital every 6 hours for a new dose of cervidile. I was exhausted, couldn't sleep, couldn't even rest because the medication made me feel like I was on fire down below.

On the morning of December 10th, my water broke at 2 am. We got to the hospital at 3 am after labouring at home for only 45 minutes. By the time I reached the Labor and delivery floor I was already pushing!




Ryland was born after a 4 hour labour. He was in shock and was still full of liquid since my labour hadn’t been long enough to empty his lungs. Thankfully, we got the delayed cord clamping I had wanted and, after a short while, he was placed on my chest. He was perfect. 6.8lbs of tiny beautiful baby boy. I placed him to my breast in hopes he would latch. I tried, the nurses tried, but he couldn't seem to attach. He wouldn't even open his mouth, it was like he didn't even know what to do. The nurses said we would try later and I was taken to the recovery suite where we would stay for the next 4 days.

I quickly became extremely Hyper thyroid. Symptoms included: rapid heartbeat, anxiety, fatigue, puffy face, difficulty sleeping, and depression.


Refusal to latch


I tried hand expressing some colostrum onto the area around my nipple to help him understand that that’s where the milk came from, but he would just fall asleep or seem uninterested. After 3 days of zero sleep, followed by an intense natural labour, I felt beyond exhausted. I was physically done. There was this tiny new life that needed me, he needed to eat and yet I couldn't get him to latch. I was getting increasingly anxious and frustrated. I felt like a failure. I questioned my breast size, nipple, size, my areola color (mine never got that dark bullseye, they stayed 100% pink & skin colored).

The nurses still couldn't get him to latch. They tried everything they could think of to help him along but, in the end, I was always told by everyone I saw, that he just wasn't ready. They said that even though he was considered full term and "looked" like a full term baby he was more like a preemie and needed to be treated as one, that he wasn't strong enough to nurse. They called Ryland an imposter baby. While he was technically "full term" he had the behaviour of a preemie, with the same issues preemies had, such as keeping heat and weight. I feel like if my body had been healthy enough to carry him full term he would have been strong enough to at least attempt to nurse. It was undoubtedly one of the most frustrating things I experienced at the hospital. So I did what any mother would have done - I painstakingly hand expressed whatever colostrum I could to feed my newborn by spoon.

Never had I felt like more of a failure. My baby was screaming out of hunger, he was desperate for food and I couldn’t feed him the way nature indented. A lactation consultant was called in, she couldn't get him to latch either. I was heart-broken. This was something i had looked forward to, something I wanted so desperately for my son.


Jaundice


Then things went from bad to worse and he started turning yellow, and getting sleepy, and would hardly even take the colostrum off the spoon. The nurses and doctors diagnosed Jaundice and I was told he had to be put under the lights. Then, when the nurse said: "your son is sick, you aren't able to breastfeed clearly [her words], so you don't have a choice, we need to feed him formula to get him healthy", at first I was relived. The promise of Ryland getting better was all a mother really wants to hear in those dark moments. He'd lost 20% of his body weight, but, as time passed, I realized how much that moment hurt us. I should have been offered a hospital pump when he couldn't latch. I had the milk, it was there, but they never gave me the chance to use it.

Reluctantly, and with a heavy heart, we cup fed him, or at least tried too, but Ryland had other ideas. He would gag and vomit the formula back up.


Sinking into depression


After almost 5 days of not sleeping myself, with a child who wouldn't sleep and couldn't eat, I was begging the nurses to take him away and give him to a different family, a family who deserved a baby more than me. I said that I wanted to talk to someone about adoption because I felt like I wasn't going to be the best mother for him. Clearly I couldn't feed him, he wailed every moment he was awake, from either hunger pains or because the formula was so hard on his stomach. Those aren't moments I am proud of. I look back and wish it was different. I have such regret now about those early days, about my feelings of hatred towards my baby. My breaking point was my sitting in the bathroom vomiting, shaking on the floor and sobbing my eyes out and the nurse taking my child away to the nursery so I could finally sleep for more than 1/2 hour. They fed him with a bottle nipple, and he drank, and he started to get healthier. While he started to get better, I started to feel worse.


The bottle


I don't exactly blame staff for the way it went down, but looking back, there was a lot that could have been done to help us. I finally begged for a hospital breast pump and started pumping, and Ryland started to take my milk from a bottle. I was finally feeding him! At last! Maybe not the way I had always dreamed of but it was still my body that was keeping him going and he was starting to thrive.

We got to go home on day 4. The nurses were worried about my mental state but I knew if I just got to go home, things would be better, and I was right. Our first stop when we got out of the hospital was to purchase a breast pump, bottles, drying racks and everything that I didn't have prepared because, who could anticipate him not being able to latch?


A love-hate relationship

My pump… it was my saving life-line to breastfeeding, but how I hated being stuck on it, pumping… and more pumping. Then washing bottles, and then more pumping, it never ended. I was sinking deeper into my depression. I felt angry towards my child because he couldn't breastfeed. I became over-consumed with the amount of oz I was pumping from each breast. Would it be enough?? I needed to pump but I also need to eat, shower, do laundry and interact with my little boy. My whole world revolved around pumping when it should have revolved around Ryland.


Supply issues


I learnt that the synthroid medication I had been taking following my thyroid operation was out of whack and this was likely causing my breastmilk supply to dwindle. As my medication was being slowly adjusted I was going from 2-3 oz each breast to 1oz if I was lucky, even when using deep breast compressions. In desperation I promptly started taking donperidone and herbs in an attempt to boost my supply.


Quitting

Somewhere around the 3 week mark something inside me gave up. I was tired pumping, I was tired of trying to get Ryland to latch. I had spent the first 3 weeks of his life angry at him, not appreciating those first beautiful amazing moments of having a child and that is my number one regret. Tearfully, I confessed to my husband that I was done trying to breastfeed, that Ryland never would get the hang of it and that I needed to focus on trying to build a bond. So I let go of my breast feeding dreams, and turned to formula.


Formula and projectile vomiting


Within the first 3 days, Ryland was crying non-stop. My doctor said it was colic. Ryland would squirm in pain and projectile vomit his feeds. I dreaded feeding him and would even tell him that feeding him had become the worst part of my day. He would cry, I would cry and by the end we would would both be covered in vomit and he would be covered in sweat from the crying / flaying that he did in discomfort.


Depression intensifying

My depression was at its peak. It's not something I've been public about, until now. I feared the reactions of other people. I feared what they would think when I said I didn't feel love or a connection to my child, that I felt as though I was taking care of someone else's baby, and that some days I regretted getting pregnant and having a baby. I felt like even family members to whom I had let slip about my depression judged me, so I became even less open about it. I didn't want to leave my house, did not want to socialize. My husband and my mother were the only two people who I let know the full extent of my depression. The two people in the world I hoped wouldn't judge me.

To make matters harder, my husband worked away from home so there were often weeks where it was just me and my baby alone together. I never understood why someone would shake a child until I was left alone with a colicky baby of my own, with no chance of a break from him. There were moments when I'm not sure who cried harder my son or me, as we sat in the bathroom listening to the fan, my praying he would sleep for more than an hour.

The only time I would leave my house was to go was the breastfeeding clinic. The people there helped guide me in the right direction. Sometimes I went just to cry and have someone give me a hug and tell me I was doing a good job.

Then came a scare… blood in his stool. We were sent to a paediatrician and they diagnosed milk allergy, so we got put in an allergy formula. Ryland began doing better and I started the painful process of drying up my supply. My breast were rock hard at times. I would only pump enough to relieve the pressure, and also used cabbage leaves and some tylenol when the pain got too bad.


One last chance


Ryland was 5 weeks old when I gave him one last chance at breastfeeding. I'd been drying up my supply for days, so I knew there wasn't much, if anything, left. But something inside me compelled me to bring him to my breast and try one last time, if for nothing else than the reassurance that I had done everything in my power to feed him nature's way.

I sat down, laid him on the pillow and offered him the breast…. and he latched. He latched and I burst into tears. I sobbed, and thinking of that moment still makes me cry. It was everything I had wanted, it was the connection I had longed to feel with him. This was MY baby, he was mine. He wasn't screaming, he was quiet, cuddled up to my body and peacefully feeding. I was so close on giving up, doctors, nurses, laceration consultants, my family, they all had given me permission to quilt but I just couldn't and this was why.


Power pumping

It took almost a week for me to get my supply back up. I was feeling so guilty about having let it dry up, now that he wanted to breastfeed there was nothing for him to eat! I power pumped, encouraged him to latch as often as he wanted and supplemented him as needed. Power pumping saved our breast feeding relationship. I offered Ryland the breast at every feed, knowing there was hardly any milk left but that I needed him to stimulate my supply to get it back. Then I would bottle feed him, and then hook myself up to the pump, five minute intervals on each side for an hour, a few times a day. After a week I was getting 2-3 oz from each breast again!! The relief!


Not out of the woods


Just as things were going smoothly, Ryland got thrush… it was such a blow. My breasts ached with deep sharp pains. Ryland was in such discomfort and begun having a hard time latching. I mentioned it to my doctor at one of Ryland's appointments and she diagnosed it. We were given some oral medication for Ryland and I was told to apply some of that to my skin as well.

Then came the acid reflux. It was horrible. At every feed, Ryland would arch his back away from my breast, and would claw at me, bite my nipple, and scream. He also started projectile vomiting his breast milk. After days of him constantly crying and being unable to eat, after several dry diapers in a row, I took him to ER. The doctor said bottle feeding him upright could help, but I was on a mission to not use the bottle unless we absolutely had to. So I tried feeding him in a different, more upright, position. The doctors also gave us some acid reflux medication and suggested probiotics. Within days Ryland was a new baby. I was thrilled.


Recovery from depression

As feeding was going smoothly, gradually, month by month, the fog of depression began to lift and I could see clearly again. I lay in bed breastfeeding and looking down at Ryland and thought for the first time in his life that I loved him. That we would be okay, that I had made this beautiful baby and he was mine to love and cherish until forever. It was then that I realized just how dark of a place I'd escaped from. I wish I had been more open about it at the time, since it’s common to have Postpartum depression.



We lay on the floor and play now, he smiles at me, this big toothless grin and I melt. I am always met with surprise when a health professional reads my chart and is thrilled that I have made it, that after everything Ryland and I had gone through together, we had become the breastfeeding team I had always wanted us to be.



Regrets

I have so many regrets about his first months of life. Sometimes I get overwhelmed looking back on it and feel the overbearing weight of shame about my feelings, I don't remember his newborn smell, or those wonderful cuddles. I reflect on these weeks with frustration and sadness. But what’s been done is done. In my moments of breastfeeding self-doubt I went on thealphaparent.com and read every Triumphant Tuesday story. It inspired me to keep going, to not quit. I hope perhaps my story will hit home to another mom struggling, and provide some comfort. Keep going mamas, you're doing great!”



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Monday, 17 February 2014

15 Things You Never Knew About Your Tits

Only 50% of women actually feel letdown.
1. Feeling Letdown: Fifty per cent of women will know the moment it happens, the other 50 per cent won’t (Fredregill 2004).

2. Leaking Littles: Large breasts actually leak less than smaller breasts (Fredregill 2004).

3. Righty FTW: Milk output is often greater from the right breast versus the left breast (Riordan 2008), even though right-handed mothers instinctively use the right-hand to position the baby and breast, thereby making it easier to feed from the left breast.

4. Superior Sugars: Human milk gets more of its energy content from lactose than any other animal milk. Lactose gives your milk a sweet taste and won’t cause diarrhoea, as the processed sugars in formula often do.

5. Boner: Weaning stimulates your body to increase bone density, meaning your post-lactation bones will be stronger than they would have been if you had never breastfed at all! Nifty. (Williams 2013).

6. Camouflaged Cups: Cotton tops and dresses with prints are the best clothing for the nursing mother. Prints tend to hide the telltale bull’s-eyes of breastmilk leakage that solids only emphasize.

Elderly women can and do breastfeed.
7. Mammary Lane: From puberty to death you can produce milk – yes, that long. Menopause is no obstacle.

8. Subsequent Servings: If you breastfed your first child for over 6 months, with your next child your milk is likely to come in a day or so earlier than before - AND your supply is likely to be better! (Cave and Fertleman 2012).

9. Sibling-Friendly Squirting: Over-supply is more likely to occur if your children are closely spaced. See: 'What No One Tells You About Child Spacing'.

10. Freezing Fail: It’s better to store breastmilk in the fridge than the freezer where possible. This is because the antimicrobial properties of human milk are better preserved with refrigeration (La Leche League 2012).

11. Farewell Freebie: As your child is weaned, your breasts produce colostrum again, so that the child receives an extra dose of antibodies before moving on (Giles 2003).

12. Telepathy Tits: Breastfeeding has enabled humans to communicate on a higher, more complex level. Higher-order thinking - including speech and learning - grew out of lactation! (Williams 2012).

Milk-making cells that are never activated
will sleep until your next pregnancy.
13. Lactation Launch: When a baby nuzzles his mother’s breast prolactin is released into the mother’s bloodstream. It is then detected on a sensitive area on each milk-making cell, switching it on. Cells that haven’t been fully primed in this way will start to shut down – and they can’t be re-activated until the next pregnancy. Breasts which only have a few cells switched on are set up for minimum milk production only (Rapley and Murkett 2012).

14. Placenta Post: Hormones called placental lactogens talk to the breast during pregnancy when it is building the structures it will need for making milk. One of the messages sent by the hormones is whether you are going to nurse a baby boy or baby girl (see 'Timeline of Breast Changes in Pregnancy').

15. Bothersome Bottles: Contrary to popular belief, breastfeeding is actually LESS tiring for babies. One of the reasons is that a bottle-feeding baby has to pause frequently to take a breath, whereas a breastfed baby can breathe while he sucks (Rapley and Murkett 2012).


Tuesday, 4 February 2014

Triumphant Tuesday - A Dad's Eye View of Breastfeeding

Studies show that when a nursing mother has a ‘significant other’ who is educated about and supports her choice to breastfeed she is much more likely to be successful at it. For many mothers, this significant other is the baby’s father. What role can Daddy play? Let Dave, a first time dad, guide you through the breastfeeding journey from a man's perspective.

Dave and his partner Lucy had done a lot of reading about breastfeeding, and spoken at length about the benefits.  For them, it was a no-brainer that breastfeeding was the best for their baby. Dave had been told that his support as the father was instrumental in successful breastfeeding, but he didn't realise just how true that was, until he embarked on this epic journey...  



The birth

Our son's arrival into the World was a dramatic experience for me.  As a first-time Father, my job was primarily to drive the first-time Mother (Lucy) the 22 miles to the hospital in time for the midwives to do their thing, ad for me to time the gaps between contractions, and to reassure my labouring partner that all would be well.

In the early hours of the morning, we carefully drove on icy roads (it was about -4.5C outside) towards the hospital.  About two minutes into the journey, the "Check Engine" light illuminated on my dashboard and I could feel all was not well with the car.  Somehow, I managed to keep this information from L as she contracted regularly beside me, and we proceeded on fewer cylinders than is normally recommended for a car! We made it in the end, the birth went better than we’d dared to hope in the midwife-led unit’s birthing pool (rather than in a frosty lay-by!), Edward was born and he looked just perfect.

Mother's instincts kicked in immediately, and L held our new son to her chest in the pool as the umbilical cord slowly pulsed the last of its goodness into our little boy.  Once it had stopped completely, I had the honour of severing the slightly crunchy tube that had been nourishing him for the previous 9 months.  Shortly afterwards, I held him from the first time.  I'd never felt so proud as that moment - of E, and of L (and, let's face it, of myself!)  What a team!

Tongue-tie

Immediately, it was clear that E was very eager to feed and had very strong suction (as evidenced by the hicky he left while sucking in the wrong place, that stayed for weeks!) However he tired very easily and slept a lot.  We kept asking the midwives to check his latch and tongue, but they seemed to think he was OK (apart from one, who merely said he had "a quirky tongue").  We didn't think too much of it, but later down the line we discovered through our own research that he had a posterior tongue-tie with corresponding lip-tie, and that it was seriously affecting the effectiveness of his feeding technique.

Latching problems

Feeding was tricky, as he just wouldn't seem to latch properly.  Again and again L would try to bring him to the breast, but the position never seemed quite right, and he'd unlatch himself quickly.  Occasionally he'd suck for a while, but he usually soon gave in.  Various midwives would come in to help position him, to show us tips on how to get him to open his mouth wide and so on, but it felt very tricky and E simply didn't want to open his mouth wide enough. They would also come in to help L hand-express little golden drops of colostrum into tiny syringes, which we'd drip into E's mouth, and he'd always lap it up - he simply couldn't get much from his Mum himself.

Formula

By the evening, the midwives were starting to worry.  They checked his blood-sugar level and showed us how it had been falling.  We were told it was getting towards dangerously low levels and that we should try to give him some formula to get his blood sugar levels up again.  E was still very drowsy, and fairly unresponsive, so we reluctantly and tearfully agreed to try it, because we were scared of the consequences of doing nothing.  If he couldn't stay awake, he'd never feed and it'd just get worse and worse.

We watched in aghast as the midwives tried to bottle-feed formula into our baby boy.  We had so wanted him to be solely breastfed, but that decision seemed to be out of our hands at this stage.  We hadn't slept, his condition was deteriorating and experts were telling us this was the right course of action, but it didn't feel right.

E didn't want to suck on the bottle and didn’t swallow much of the formula, clearly disliking the flavour.  He was jaundiced and sleepy, but they insisted on trying.  E never took to a bottle and, to this day, has never had a proper drink from one (despite us trying once with EBM).  He vomited repeatedly and it was a heartbreaking experience.

Infection

Later that day, E's blood was tested, and his protein levels were found to be elevated, indicating an infection of some sort.  We took him down to the ICU to have a cannula fitted, to allow them to give him antibiotics, and had to endure the hardest hour and a half of our lives.  The doctors really struggled to fit the cannula.  Every vein collapsed when they touched it, and despite enormously bright lights shining through his arm, it took ages to get a good fit.  L and I were there the whole time, supporting each other and trying to calm E's cries by letting him suck on our fingers. One of the nurses asked if we had a pacifier for him, but we didn't because we didn't think it would help with his feeding.  It took several doctors and numerous attempts to get it right, and it was really traumatic for us all.

They took blood cultures to look for infections, and gave him the first of a course of antibiotics (to be administered at 12 hour intervals, day and night, for 5 days).

Pain

Even with E being so sleepy and poorly, L still managed to do her best to feed him regularly as well as giving him syringes of colostrum.  It was emotional to watch the struggle.  We had been led to believe that breastfeeding was totally natural and should be easy.  We had also been told that any pain meant something was wrong, and L took that as meaning that she was doing it wrong, rather than there being a physical problem.

Leaving them at the hospital 

After 20 hours in the hospital, I had to leave to go home, feed the cats and get some sleep. It evoked mixed emotions. I was obviously exhausted and elated to be a Father, and looking forward to sleeping in my own bed, but it was really difficult to leave the two of them alone in the hospital.  I knew L wasn’t a big fan of hospitals, having had some bad experiences in the past, and with E not being 100% well, it was definitely a real worry having to leave their side.  Add into that the complication of having a sick cat at home, and having to take her to the vets every day or two that week, and it was a very stressful, busy, complicated time. I kissed L & E goodbye and drove the long journey home, wondering how their first night would go together. By the morning, I'd found out.  The pair of them had had a very difficult night, with E crying incessantly, and not feeding properly.

I was back and forth to the hospital a lot over the next few days, trying to spend as much time as possible with E & L, whilst also caring for a sick cat and trying to snatch a few minutes of sleep here and there.  Sometimes the antibiotics went in easily, other times the cannula became "stiff" and needed replacing.  During this time, L also picked up an infection, so the two of them were trying to recover together.

The doctors decided to X-Ray E's chest, to check for liquid on his lungs.  There was a little, but this was apparently consistent with the infection they were treating. The cultures were inconclusive, which meant that it was nothing too serious, and after narrowly avoiding a lumber puncture (something his mum had had before and so desperately hoped he wouldn’t need) he began to pick up.  After that first night, we were reassured by a different midwife that the best thing for him was breast milk and, somehow, L managed to get him to feed...albeit painfully for her.

Helping to lighten the load


On one occasion, when things had been particularly difficult the hospital let me sleep in the chair overnight, and I did everything I could to try to lighten the load on L.  I would change diapers (cleaning up meconium with cotton wool and water is basically impossible, I soon discovered!), I would make sure L had water and snacks when she wanted them, I’d call the midwives whenever she had a concern, I would accompany them both to all the appointments at the special care unit and would push the crib around the hospital to give L a break. Also, more generally, I just tried to be supportive and keep L’s spirits up by “normalising” the situation as much as I could.  Being there as a family and learning to be parents together was actually really lovely, despite the difficulties. I strongly believe that fathers have a very important role to play in “cheerleading” for breastfeeding, and making sure that the Mother knows they are 100% behind them in trying to do the best for the baby. I think too many Dads think it’s not their problem, or just don’t do the research beforehand, and so don’t realise what a precious gift Mother’s milk is to their child.

Nonetheless, feeding was still difficult, and she found herself with lumpy breasts as a consequence of E's poor technique. Watching L and E struggle was one of the hardest things.  I knew how much L wanted to breastfeed, and we’d been led to believe that it should be straightforward.  We had been told that “if it hurts, there’s something wrong”, which L had internalised as meaning she was *doing* something wrong, rather than there being an external issue.  I did my best to try to memorise all the tips and tricks the midwives were telling us, and small corrections to positioning, which might make things easier, but it was heartbreaking to see them struggling with such a basic human function.

Home together

Before we were allowed to leave the hospital, we had to check E's weight.  He'd dropped about 6%, which was perfectly OK over that period.  They checked his blood again and the protein levels had fallen, whilst the sugar levels had risen, so they allowed us to go home very nearly a week after we first arrived.  L was packed off with a selection of medication and we began the long journey home.

Tearful feeds

Over the next few months, feeding was extremely difficult, and L was in tears at every feed.  Feeds frequently took an hour, every other hour.  E was suffering with bright green poos and painful wind, was making “clicking” noises as he fed and was simply unable to latch well.  Often, he would open his mouth wide, try to latch, slip off the nipple very quickly and then fall asleep before getting a good feed – waking up a short time later wanting to be fed again.  It was exhausting and excruciatingly painful. Some days it all seemed too much for L, and she considered using formula, but we both knew in the cold light of day she’d regret it, so we managed to get through the dark moments together.

While this was going on, we also struggled to get E to sleep anywhere but in our arms, so we couldn’t even sleep when he did.  We spent the first month of his life taking shifts to get any sleep, but L never got more than an hour or so here and there before E needed to feed again.  She basically spent the first six weeks on the smallest amount of sleep possible to function.  Looking back now, I don’t know how she survived.  Having a baby that had so much difficulty feeding and wouldn’t be put down to sleep took its toll and we decided to try co-sleeping as a way of getting some rest.  It was - and still is - a big help!

Formula banned


We knew something was wrong and, after seeking help online, we were advised to see an IBCLC.  E was less than two weeks old when we first saw the lactation consultant on Boxing Day, and she confirmed our fears by diagnosing a Posterior Tongue-Tie and High-Arch Palate.  She was partially retired and couldn’t refer us to a specialist, but she suggested seeing our HV or GP, which we did…again and again.  Each in turn failed to see an obvious problem with E’s tongue (or his lip, as by this time we suspected a lip-tie as well) and we were repeatedly told that he was gaining weight so there wasn’t an issue. Health Professionals seemed totally cold to the effect the feeding difficulties were having on L and were unwilling to help her as long as E was thriving. We battled on as a family, refusing to “give in” and move to formula top-ups no matter how much pain L was in.  We both decided not to even have any in the house, but I was worried about how hard it was getting for L to feed our child naturally.

Our first family walk, with E snuggled close. One of the few times in the first three months, that L felt comfortable leaving the house.    

Pain hard to bear


It was clear that the pain was getting worse.  L would cry with pain before, during and after every feed. She is no stranger to pain either, suffering and coping with chronic back pain for 8 years prior to starting our family, but even so it was hard to bear. L was suffering lipstick-shaped nipples after a feed, blisters on the surface and a milk-blister, too. Her nipples didn’t have time to recover between feeds and to top it all they began to “blanch” at the slightest provocation. A drop in temperature, the lightest touch of clothing, or even a passing breeze if they were left exposed to the air would result in painful spasms.  It became a total vicious cycle.  Her nipples would spasm during feeds, reducing the milk flow considerably resulting in more pain and an even more frustrated baby. Often, mid-way through a feed E would “flick” his tongue enormously powerfully against the surface of L’s nipple in a desperate attempt to elicit milk, sending a paralysing bolt of pain through her whole body and making her literally jump in shock.

We did talk to a GP about vasospasm/Reynaud’s syndrome, but she knew nothing of the condition, offered treatment for thrush (which L didn’t have) and sent us back to the feeding clinic we’d gone to on E’s first day for help with positioning.  We went back there when E was a few months old and L was suffering from a blocked duct/early-stage mastitis that had occurred a few times by then.  They finally spotted the tongue-tie and referred us to the specialist we needed.

The whole process of feeding and nurturing our beautiful boy was a million miles from what either of us had imagined when we had, on so many occasions before he was born, discussed him being breastfed.  It was soul-destroying and so difficult to witness L’s suffering and E’s frustration at having to fight for his food.

No snip


When E was around 6 months old, we visited the tongue-tie specialist.  She confirmed the diagnosis immediately, saying E had an "obvious" posterior tongue-tie, but there was a problem.  By this stage, E was older than 6 months old and it was too late to have the tie snipped without going under general anaesthetic, which we weren't prepared to risk without knowing more about whether the tie might affect his speech later on.

Somehow, through sheer will and determination, and no end of painful shallow latching, L has managed to breastfeed for 12 months so far (and apart from the midwives attempts with FF it was exclusively for the first 6 and a half months) and she intends to continue for another year at least, leaving it up to him to decide when he is ready to stop.  I'm in awe at her staying power.  It hasn't been easy.  Far from it.  I'm so proud of them both, and the role model L is being to young E at this early age.

E is now thriving on his breast-fed, cloth-nappied, sling-carried, baby-led-weaned lifestyle.  Although feeding always regresses during growth-spurts and E's latch deteriorates even further, he still manages to get the milk he needs at the expense of L's nipples!

A dad's thoughts on public breastfeeding



L even happily breastfeeds in public, which is lovely to see. I’m extremely proud of her.  She started off very wary, as you might expect, but is now very happy to find a quiet corner when we’re out and feed the little chap.  She continues to do so to this day (although, these days he’s often far too interested in all the exciting novel sights and sounds to drink properly when we’re out, but that’s a different issue!)  I think it’s important for other women to see breastfeeding as a normal, natural thing to do, and I think that L feeding E in public (and he’s a big 13-month old now) can play a big part in reassuring others to do the same in the future.

Donating milk

Earlier this year, L decided to donate milk to the milk bank for sick and premature babies at the hospital where E was born.  She had got the idea from speaking to the breastfeeding coordinator when E was only a few days old, but had been delayed in starting due to the difficulties we were having with breastfeeding.  I can't imagine having the capacity to give so much to strangers at a time when L is already giving so much to E.

I have heard it said that Fathers need to be able to bottle-feed their babies in order to bond with them and feel involved in their upbringing.  This has not been my experience at all.  Through playing with him, cuddling him as he sleeps, soothing his tears, carrying him in the sling and generally being there for him, I feel totally “bonded” and “involved” with my year-old son.  Not being able to stick a plastic bottle in his mouth hasn’t affected that in the slightest.

Fingers crossed our second year as parents goes a little more smoothly than the first, but I couldn't have wished for E to have a more loving or selfless Mother, who always puts him first, even when times get hard. Our lives have been totally turned upside-down, but we are so happy as a family that we've managed to support each other and get through this first.


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Monday, 3 February 2014

I failed at formula feeding

“I really wanted to formula feed. There were just so many benefits to it. Everyone said so. The modern world is perfectly designed for it. Formula is specially manufactured to ensure the baby's nutritional needs are met in excess. I could see exactly how much the baby was getting. Someone else could take over my feeding duty.

I feel really bad that I failed. I really tried. I mean, so many people tried to make it easier for me. From the moment I announced I was pregnant, people were offering me bottles and discounts and vouchers. I was given a second hand steriliser as part of essential baby equipment from some neighbours. I feel I let all of those people down.

And then there's my baby. Those times when he was really little and all he wanted was a bottle full of heavy processed milk powder. I really let him down by not picking up on that need. Instead I let him suckle for hours at a time on my breast. Sometimes he wasn't even getting any milk out of it. I feel terrible for that.

And the bonding time with dad. I deprived him of that as well. Because there was no other way dad could possibly have bonded with him. I mean, dads are clearly designed to feed their babies. They've got two hands just like me. They can hold a bottle and a baby at the same time.

It hurts being a minority. In a bottle-centric culture, I feel painfully ostracised for my failure. Whenever I switch on the TV there is a formula company telling me that the reason my makeup is isn't perfect, my baby isn't walking at 4 months, and my house isn't interiored by Harrods - like the families in their ads - is because I don't use their product. I understand why they want me to feel bad. After all, their shareholders are limited to just three Caribbean vacations per year, instead of four, because of people like me.

Also, because my baby is sick less often, I am putting health professionals out of work. I just don't think I can cope with the guilt of that. Not to mention the poor garbage disposal men and the landfill workers.

I feel like I make excuses sometimes. I couldn't bottle feed, I don't have enough time in the day. I couldn't bottle feed, I didn't have enough money. I couldn't bottle feed, my own needs weren't important enough. The truth is, I wanted to spend the money for formula on other things. The truth is, I put my baby's happiness above my own.”

- Yours sincerely, 

A social deviant.

Tuesday, 28 January 2014

Triumphant Tuesday - Breastfeeding a Baby With Prader Willi Syndrome

You are about to read the story of a mother who got a shock when her baby was born with Prader Willi Syndrome. Routine ultrasounds had not detected this non-hereditary genetic condition which results from a problem with chromosome 15. The syndrome typically causes the child to suffer from low muscle tone with motor and cognitive developmental delays, short stature if not treated with growth hormone, and later, incomplete sexual development. Most children with PWS are floppy at birth with initial difficulties in feeding, but then in early childhood begin to show an insatiable appetite which can be life-threatening. Read on to discover why it IS possible to breastfeed a baby with PWS, albeit not without hardship.


“Our third child was very much wanted and planned. After two boys, people would often ask if we were ‘trying for a girl’. We always replied that we just wanted a healthy baby, and when routine scans and tests showed that he (yes, another boy!) was, to their knowledge, healthy, we were happy and looked forward to meeting him.

Warning signs

At 40+12 I hadn’t notice him move for a bit, so went to my local hospital. I wasn’t overly concerned: this had happened a couple of times previously. This time, despite it being late November, I left the house with no coat and flat shoes (which is testament that I expected to be back very shortly. I always wear heels!). This time however, the CTG was pathological and I was blue lighted to the big, city hospital.

Within an hour I was having a caesarean section. Even at this point, I made it clear that I wanted my baby passed straight to me for skin-to-skin and that I wanted delayed cord clamping. The hospital staff were supportive of this plan and assured me we could go home after 24 hours….

Very low Apgar rating


Unfortunately Gideon was extremely poorly when he was born. His Apgar was 1. His breathing was very shallow, his heart rate was slow and he was extremely floppy and unresponsive.  I felt terrified. He was whisked away with just enough time for the briefest of kisses on his forehead. I thought he was going to die without me being able to hold him. I planned what he would wear to be buried in.

At 20 minutes of age, Gideon was transferred to the Neonatal Intensive Care Unit. I didn’t get my undisturbed skin-to-skin, I managed a fleeting kiss to his forehead and I was left wondering if his first kiss would also be his last. The obstetrician who delivered him said that had Giodeon been born a few hours later he would have been a still birth - a terrifying thought which makes me thankful I listened to my instincts and went to hospital when I did.

Gideon was several hours old by the time I first saw him. The doctors thought his floppiness was due to a ‘bad birth’; lack of oxygen and a possible brain injury. They were treating this by placing him on a cooling mat, which meant I couldn’t hold him or even touch him as his temperature had to be maintained.  It was horrid knowing that I couldn't hold him, but I could understand it was for the best. He was being given sugar water via a line through his umbilical cord at this point.


Pumping frustrations

My husband Peter went home to our two older boys and the hospital found me a private room and a double pump. I started pumping and hand expression immediately.  I had never been any good at hand expressing, so I found this frustrating as well as tiring. Despite being pretty knowledgeable and experienced in breastfeeding (I was still breastfeeding the older boys), this was very new territory for me.

That first night I pumped every two hours through the night. Drops of colostrum which were getting stuck on the pump. It was disheartening and I was scared that if I didn’t start producing something then Gideon would be given formula. As none of my babies have had formula, I really didn’t want that for Gideon – he had enough to deal with as it was.  Providing him with milk was the one thing I could do, so it gave me something to concentrate on.

The next day a wonderful midwife sat with me and helped me express tiny amounts of colostrum. It really was a two woman job – one of us to express, the other to catch the liquid gold. I will be forever grateful for her practical support: on a busy ward she spent hours with me helping me do what I could for my baby.  I continued to use the pump every two hours.

Tests

By day three my milk had come in, but Gideon was not improving. The doctors started further extensive tests to try and find out what was happening – brain scans, MRIs, chest/lung x-rays, blood tests, genetic tests. Gideon was now being fed my milk via an NG tube: he was still extremely weak and still on the cooling mat so I was unable to feed from the breast, or even hold him.

Tandem feeding to boost supply


Peter was traipsing back and forth between home and hospital, trying to look after two small (and very confused) boys, run a house, support me and deal with the fact we had a very poorly third son in hospital.  I was expressing milk every two-three hours and encouraging my older two boys (aged 2 and 4 at that time) to feed as much as possible to stimulate my supply.

After four days, Gideon was taken off the cooling mat and moved from NICI to SCBU. I was becoming increasingly keen to try and feed him, but the doctors were less keen: they were concerned about his gag reflex and the danger of aspiration. I thought that if I could put him to the breast, then he’d know what to do and everything would be OK. It was frustrating.

After a week I was discharged from the hospital. Going home without a baby was very tough. Nights were the worst. He should have been sleeping in my arms in the family bed - but he wasn't. Obviously, my two older boys were a great distraction. They had been very upset by my sudden and prolonged disappearance. We’d been preparing them for a new brother, but were expecting a home water birth, not a very ill baby in hospital. I was still having to express every two-three hours and Zachary, the youngest, was still wanting to be fed lots. I had to make sure that I fed him after I expressed to ensure I got the ‘easy’ milk off first and help him stimulate my supply. Zachary soon learned to hate the pump though – both because it put me out of action so was less attention for him and because he had to wait his turn. I was advised to double pump but couldn’t do this during the day as the children often needed my other hand!

I was still recovering from my caesarean, but really had to ignore the recovery advice and just get on with a very busy life: recuperation was a luxury I didn’t have time for. Gideon was still in hospital so I was visiting him every day – via public transport as I wasn’t allowed to drive at this point. The SCBU was well equipped to deal with breastfeeding mothers: they had plenty of pumps available and I was able to express either in a private room or with screens next to Gideon’s cot. The staff were very supportive of breastfeeding and I often heard them explaining to mums how important human milk is for ill or premature babies.

Peter would accompany me when he could but pre-schoolers and SCBU don’t mix! We did try to find people to help look after the older two, but after such a turbulent time they wouldn’t be left with anyone else. This meant that Peter and I took it in turns to visit Zachary – me with my cool bag of milk and an eye on the clock for the next time I had to express.

Test results


One by one, the tests were coming back with nothing to show – ‘normal’ as far as they could tell. Then, when Gideon was ten days old, we got back some of the genetic tests – which showed a positive diagnosis for Prader Willi Syndrome. My first reaction was one of relief: I had heard of PWS, I knew what it was and I felt better knowing what we were facing.

Immediately I started researching breastfeeding a baby with PWS. In babies, PWS is characterised by extreme hypotonia (floppiness) and failure to thrive. Most PWS babies never breastfeed and many never manage bottle feeds, relying instead on NG tubes. I was determined that my baby would breastfeed and started research straight away.

At this point Gideon was still being fed by an NG tube. He slept almost all day and never showed any hunger cues. He was fed on a timetable, every three hours. I was still expressing milk every three hours, waking at night to try and ensure I established my supply.

Home at last – let the mayhem begin

After three weeks, and just in time for Christmas, Gideon came home. He was being fed via an NG tube and was on oxygen 24 hours a day. How lovely it was to have him at home, in my arms and in the family bed where he belonged.

In the New Year, Peter went back to work and I was at home with three small children, school runs and housework…. I look back now and wonder how I managed. I was expressing every three hours, day and night. I was also breastfeeding the older two. I had to make sure I expressed the easy-to-get milk before I let them feed at the breast. I really struggled to find any information on long term expressing, but did get wonderful support and information from a friend who expressed for over two years for her son.


Expressing in public

I felt very restricted by the schedule of expressing so often. I am happy to breastfeed anywhere, but you can’t really sit in John Lewis cafĂ© and express milk…. I have expressed milk in just about every car park and disabled loo in the North East of England though! We carried on as well as we could, oxygen and feeding tube notwithstanding. Having two older boys meant we had to just get on with life.



Latching on


I continued to try and put Gideon to the breast – he simply did not know what to do. He didn’t root, he didn’t latch. He would occasionally chomp down, but that was it. I found the experience frustrating and soul destroying. It was also very hard to find the time to keep trying whilst also looking after two other young children. Gideon’s hypotonia meant I had to be extremely careful with positioning as I had to make sure his airway was not compromised. All the tubes just made it harder still.

Bottle feeding

By 8 weeks, I’d met another mum with a daughter with PWS who helped teach me how to bottle feed Gideon. This meant his NG tube was removed. He took an awfully long time to take each bottle – up to an hour and would often fall asleep. He didn’t have the energy or stamina to eat any faster.

So I continued to express. I worried about everything – would my supply keep up, would I meet the needs of three breastfeeding children, would I ever breastfeed Gideon ‘properly’? I continued to have excellent support from friends, from LLL and from medical professionals. I spoke to PWS professionals across the world looking for an ‘answer’ – the magic technique that would enable Gideon to feed at the breast.

Eventually I did achieve a couple of occasions where Gideon managed a couple of mouthfuls of milk from the breast. But that’s as good as it got. Gideon just doesn’t have the strength to breastfeed effectively, nor does he have the correct suck/swallow/breathe coordination. When he was very young, any attempt to breastfeed compromised his airway, so he stopped trying.


Donor milk


I am now expressing milk four times a day and just about keeping up with the help of domperidone and donor milk. Giving donor milk was not an easy decision: my knee jerk reaction is that of course I’d rather have human milk than formula, but there are so many things to consider when accepting it, from the safety (does the donor smoke, drink, take drugs or medications) to the ethics (can I be sure the donor isn’t detrimentally affecting her own supply at the cost of her children’s wellbeing), but my informed decision was that I was happy to accept it.

That said, the first time I gave him donor milk I found it incredibly upsetting. I felt I had failed him in some way by not being able to produce enough myself. I’ve always had an abundant supply of breast milk – but I’ve never been much good at expressing!

Bottle feeding Gideon - even with expressed breast milk - has been a very different experience to breastfeeding my other two sons. I would rather have fed Gideon ‘from the source’ – giving Gideon ALL the benefits of breastfeeding that he misses by getting milk from a bottle, but I remind myself that every single drop of human milk he receives is giving him an advantage. I’m also very aware that quite simply, if it weren’t for modern medicine, he wouldn’t have survived birth and without tube feeding he would have starved.

Writing this, and looking back over the past 13 months, is bittersweet. Trying to pump enough whilst juggling the needs of three young children meant lots of guilt feelings for me – some of which remain! I felt I was not doing anything properly. I suspect most mothers of three feel like that at times, but I still feel terrible that my big boys have suffered, and I feel terrible that they will grow up having to be Gideon's carers.

I’m not sure when it sunk in that I would never feed Gideon at the breast. It was a slow dawning rather than a sudden realisation. It makes me very sad: I wonder if I’d persevered, or given more time, or spoken to more people…would we have managed?  Logically, I suspect the answer is that no, nothing I could have done would have helped him feed at the breast. There is no magic answer. Instead I try and focus on my successes: Gideon was exclusively breastfed for six month; he has never had formula, and at 13 months I am still giving him breast milk. Alongside that I am still breastfeeding his two older brothers who are now five and three. I am hoping to get to two years of expressing for Gideon, despite being back at work now.”


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