Thursday, 30 June 2011

My Breastfeeding Story

I thought it only right to start the blog with a little about my past, explaining how I became a self-confessed 'Alpha Parent'. I’ve found writing this story to be a very therapeutic process, albeit painful to recall. Breastfeeding hasn’t been an easy journey but it’s made me stronger.

My Breastfeeding Story

I’ve never written about my first breastfeeding experience publically or otherwise because I found the memories too painful. However as I have recovered and gained strength I have realised that my experience is certainly not shameful and there is no reason to keep it in the dark.

After giving birth to my daughter I quickly fell ill with postnatal depression. A good place to start this story would be at the birth. As someone who had never given birth before I can only speculate, but I would say I had a good pregnancy and birth. My daughter was delivered naturally and laid on my chest and even latched on for a little while. But almost immediately after giving birth, as I lay on the bed and watched my mother and my husband cooing over the baby, I felt dead inside. I looked at the little creature and I felt nothing. I was scared to hold her, scared to change her. I felt out of my depth. I wept when my mother and husband left the hospital. It was night and I was left in a dark empty ward, just me and my new baby. This little creature with red blotches on her face and slits for eyes would cry and I was the only one there to attend to her. But I had no idea what I was supposed to be doing. I held her to my breast and hoped for the best. I was exhausted after giving birth, starving (no food had been offered), and sitting in a growing pool of my own blood on the bed. I pressed the buzzer but no one came. I held my baby and rocked her and walked the dark corridors of the hospital barefoot in nothing but a blood-soaked nightdress looking for someone who could help. I’d never breastfed before and didn’t know if my breasts were even producing anything. I never saw any drops of cholostrum and my baby wouldn’t quiet. When I eventually found a midwife she looked frustrated that I had bothered her. After giving me a new maternity pad she glanced at my baby on the breast for a few seconds. She said the latch was fine and walked off. It was a long night. Whenever my baby cried I immediately put her to the breast. I had to blindly trust my body. I still didn’t feel any great bond with my baby. I simply went mechanically through the motions – check nappy, put baby to the breast, wind her, lay her down. When I looked at my baby, the only positive emotion I felt was astonishment at producing a human being. The biggest emotion I felt was fear. Life was never going to be the same again. What on earth had I done?

The morning couldn’t come fast enough.

When my husband arrived and we finally went home I felt a little better. At least I wasn’t in this alone anymore. Well, that was the theory at least. He helped change her nappies and bathed her but when it came to feeding it was me and only me who could answer her cries. Was she even getting anything from the breast? The answer came when the midwife arrived and weighed Amy when she was one week old. Amy was born on the 25th centile and by one week she had crept up to the 50th! I was very shocked and overwhelmingly relieved. My boobs worked! I couldn’t see anything come out of them but they obviously worked! (Note that it wasn’t until months later that I read that the baby’s weight gain in the first week is down to the effectiveness of the placenta, and as my baby had been one week overdue my placenta would have been pretty knackered, which would explain why she did so well after she was separated from it. So not really super-boobs after all. Sigh. Ignorance was bliss).

Despite Amy doing well I still felt numb, tearful and dead inside. I remember sitting on the sofa weeping at my husband: “I miss you!” even though he was sitting right next to me. I guess I was mourning the loss of our twosome. I felt incredibly lonely.  I took the baby to show the neighbour and she said to me, “You must be so happy. You must be over the moon”. I thought to myself, I’m certainly not happy. I feel like I’ve made the greatest mistake of my life and now I’m trapped in this black hole. But of course, instead I just force a smile.

(1 week old)

When the health visitor arrived to introduce herself I told her how I was feeling. She said it was the ‘baby blues’ and not to worry, because it would pass soon. It didn’t pass. As the weeks went on I fell deeper and deeper into depression. I had a sinking feeling that this wasn’t just the baby blues. I felt I was actually losing my mind. Sometimes when I was alone with Amy I would just curl into the foetal position and weep out of disappear at not knowing how to be a mother and not feeling confident at anything I was doing. My favourite place to cry was in the bath, as I bathed my stitches from the 2nd degree tear I got whilst giving birth. I had to do it several times a day because the pain was unbearable, and our water bill rocketed. Still, it was an excellent opportunity to cry in peace and not worry whether people thought I was being a drama queen or feeling sorry for myself. I DID feel sorry for myself. I resented every time I had to get my breasts out. I resented how long it took Amy to feed. Every night I would sit in bed propped up by a cushion as Amy fed for an hour at a time. I tried to lie down with Amy lying beside me so she could feed that way but she wouldn’t stay latched on. The only way she would feed was if I was sitting up. It was relentless. I resented the fact that only I could feed her and no one could help. I had read the dangers of using a breastpump/bottle too soon into the breastfeeding relationship so couldn’t express my milk and to be honest even the sight of the breastpump scared me. It looked like it would be painful.

My mum visited often, which was helpful. Just having someone else there so I wasn’t left alone with Amy was a relief. You can imagine my horror when my husband had to go back to work after his two weeks paternity leave. I was terrified of being left alone with Amy. I was terrified how I would cope. How would I capably cater to her needs, feeling as incompetent as I did? Whilst my mum’s presence was helpful in itself, some of her comments were not. She would constantly ask if Amy was feeding properly, if she was “getting anything”. I didn’t know what qualified her to comment as she had never breastfed any of her children. It was frustrating. How could I argue back when I wasn’t even sure of my breastfeeding abilities myself? WAS Amy getting enough? I had no idea. I guess if the chart says she is gaining weight fine, then my breasts were fine. But why was my mum asking such silly questions to me, a new mum, trying to master a skill (breastfeeding) for the first time?

It wasn’t long before an NHS breastfeeding counsellor visited to check how I was doing. I had a few lumps in my breasts that I was concerned about. She said it was blocked ducts and to bathe and massage them. It took a fortnight for them to go. It hurt whenever I rested on them. Every time the breastfeeding counsellor came she gave me a breastfeeding leaflet and a DVD. It became a running joke between my husband and me because it wasn’t long before I had piles of the same leaflet and DVD. I kept throwing them away, and the breastfeeding counsellor would bring more with each visit. I appreciated her visits. I saw her as the Holy Grail, a knowledge resource, an expert, a professional whose job it was to assist a naive new mum like me.

I bought a “Milk Band” which is simply a bracelet you wear on your arm to remind you which breast you need to feed from next. I would feed Amy from the left breast and when she latched off I would put the bracelet on my right arm to remind me to use the right breast next time. I had read online that you should alternate your breasts with each feed. This was difficult as Amy took an instant dislike to the left breast. It was really hard work persuading her to feed from it. She would latch on then pull off. This would happen multiple times. She never had a proper feed from the left breast.

Thankfully despite this, Amy carried on gaining weight as expected. She hovered between the 9th and 25th centile. She was alert and interactive. Nevertheless, every time I took her to the clinic to be weighed, waiting in a queue of mums, I felt as though I was taking a public exam, and I could fail at any moment. Only I was responsible for Amy’s nutrition. So if anything went wrong on her chart there was only me to blame. I have always been an anxious person. And with the depression swamping me, the pressure and fear I felt was immense. I was always relieved to leave the clinic. It meant that at least I wouldn’t have to endure another weigh-in for a week.

Trips to the clinic were my only ventures outside the home in Amy’s early months. I was too scared to leave our flat for longer periods. Even leaving at all seemed a huge mountain to climb. It seemed close to impossible. My pessimistic and frightened mind would place obstacles in my path. Either the pram was too big to manoeuvre, or I was too fat to be seen in public, or I had nowhere I deemed worthwhile to go. But I perceived the biggest obstacle to be breastfeeding. As Amy was still a newborn she fed every 2-3 hours.  I would just arrive at my destination and then I would have to turn around and go home because Amy would need feeding. There was no way I could get my breasts out in public! I had not been brought up in a breastfeeding environment. None of my relatives had breastfeed. The concept was alien and certainly not to be seen in public. Breasts are private right? Breasts are SEXUAL. I had an innate fear of pervy old blokes leering or other women thinking I was an exhibitionist. So I stayed indoors. Sometimes weeks would go by and I had not stepped foot outside. Every day I would sit on the sofa with my breasts out, Amy constantly attached to one of them (mostly the right obviously), me crying and counting down the hours, minutes and seconds until my husband came home. Only then could I have human contact. Only then could I talk to someone. I was incredibly lonely and isolated. I was in the deepest depression of my life. I cried a lot. I think it irritated my husband, to see me so weak. We argued. In the middle of the night I lay next to him in bed and I pleaded, “Is this going to get better? Are these feelings ever going to go away?” and he replied no. He said it was always going to be this way and I just had to get used to it. I had never felt so lonely and hopeless in all my life. The thought of living like this forever was unbearable. I cried myself to sleep many nights.

When Amy was about two months old I noticed that my breasts had stopped feeling full. It was almost as if they weren’t filling up properly. I was very worried. I had still never seen a drop of milk come out of my breasts – ever. I phoned my mum and I phoned the breastfeeding counsellor. To her credit, the breastfeeding counsellor visited straight away. When I explained to her that I was worried about my milk supply I burst into tears. She asked if I had a breastpump, and I explained yes but I’d never used it. She asked me to get it out and sterilise it but I’d never sterilised anything in my life. I had a steriliser but had never used it. I felt useless! But the breastfeeding counsellor, my savour, showed me how to sterilise the breastpump. Then we sat on the sofa ready to start pumping milk. I was nervous. The breastpump looked like a scary painful device. I reluctantly held the shield over my breast and grit my teeth in anticipation as the breastfeeding counsellor switched on the machine. She turned the power up to the max. Thankfully it wasn’t painful as I had feared, but the sight of my breast being dragged into the shield was unsettling; as was seeing actual milk dripping from my breast for the first time. However even more unsettling was the fact that after 30 minutes of pumping I had got very little out of the right breast and barely a dribble out of the left breast! My heart sunk. I got a sickly feeling in the pit of my stomach. What was I going to do?? I had no milk! How long had I been STARVING my child? Even though she appeared well I was obviously starving her because her only source of nutrition was my breast, and they only produced tiny amounts of milk! My poor little girl. No wonder she was on such low percentiles, I thought.

Just then, my mum walked in. She saw me sitting on the sofa weeping uncontrollably, with my breast still inside the breastpump, and the breastpump pumping away furiously yet no milk coming out. It looked pitiful. I felt like I had been reduced to a public freak show. The breastfeeding counsellor looked concerned. She said that my milk had “dried up” (her words) and that she had to phone a colleague to find out what to do next. After speaking in a panic to her colleague over the phone she asked me if I wanted to continue breastfeeding. I said yes, of course. What kind of question was that? In my extreme mindset it was tantamount to asking “Do you love your child?” The answer was a no-brainer. I was shocked that she had even asked. She said to me, “breastfeeding isn’t the end of the world. Breastfeeding is not everything.” I assured her that I wanted to do whatever it took to breastfeed my baby. As far as I was concerned, breastfeeding was the only decent thing I was doing for my child. In my state of depression, whereby I had no confidence in my abilities as a mother, being able to provide sustenance from my breast WAS everything. The breastfeeding counsellor phoned her colleague again. She then told me that the plan of action was as follows: I had to use the breastpump for at least 20 minutes on each breast. I had to do this every three hours. I had to do this day and night, whilst feeding Amy in-between. I had to write down how many oz I gained from each breast so she could see the progress. Then she said “it would be wise to top-up Amy with formula, at least whilst we’re trying to get your milk supply back.” I questioned her. I felt that giving formula was wrong as “breast was best” – this was something I had drilled into me at my countless NHS and NCT antenatal classes. Ironically it was what the leaflets that the breastfeeding counsellor always gave me said, and what the tag she wore around her neck said. My baby had survived from my breastmilk alone so far. It felt wrong to give formula. The breastfeeding counsellor insisted, “One bottle per night won’t hurt. Honestly”. My mum agreed. She said I really ought to top-up Amy with the formula. I said I’d discuss it with my husband. The breastfeeding counsellor then packed up her stuff and left, repeating “breastfeeding is not everything you know” to me as mum showed her to the door. Her parting words were said to my mum: “it’s not worth breastfeeding if it’s damaging her mental health”.

After she left I wanted an hour or so to clean my face up, collect my thoughts and reflect on everything that had happened. But there was no time, Amy needed feeding and mum couldn’t do it for me. Then I had to start the relentless ritual of pumping and feeding, and writing down my efforts. It was demeaning. I would feed Amy first, then I would sterilise the breastpump and bottles, then attach the pump to the right breast for 30 minutes, then I would attach the pump to the left breast for a following 30 minutes (remembering that the counsellor said AT LEAST 20 minutes on each breast). Each session would take at least 80 minutes including the washing and sterilising of the bottles and pump. No sooner had I finished sterilising and pumping then Amy was hungry again and I would have to attach her to the breast. My breasts were constantly being tugged, sucked, prodded and pulled. My nipples were red raw from over-stimulation.

Few minutes passed where there was no a device or a baby attached to my breasts. I felt like cattle. Like a cow sitting with her udders out for everyone to inspect and pass comment on. My every drop of milk inspected and recorded. When my husband got home from work I wept as I told him what had happened (I actually had a breastpump pumping away on my breast pitifully extracting a few measly drops, tears streaming down my red, blotched face. What a sight for my husband to return home to!) I told him that the breastfeeding counsellor said it was best to top Amy up with formula before bed each night. Mum said she agreed. My husband said he also agreed that it would probably be a good idea. I said nothing. I didn’t feel comfortable with the decision. Breast is best and breastfeeding is supposedly what I’m designed to do. I nurtured my child in my body for 9 months and breastfeeding is nature’s extension of this. Breastfeeding was the only decent thing I was doing for my child, and I was going to supplement that with a foreign substance? It felt wrong but I was too shaken up, too exhausted, and too humiliated to argue. Mum said it was a very good idea to top up Amy with formula. “I knew she wasn’t getting enough you know” she added. I’m sure it wasn’t meant as a dig, but in my deeply depressed and anxious state I saw it as a criticism of my abilities as a mother, almost as if mum was saying “See, I told you so, you shouldn’t have breastfed, you should have formula fed, like me”. So my own mother was saying top up with formula, my own husband was saying top up with formula, and my breastfeeding counsellor, my “savour”, the professional, was saying top up with formula. I was the only person who didn’t think it was a good idea. Yet I was weak, mentally unstable, so what did I possibly know about what was right? I went against my instincts, and, it shames me to say it, but Amy had her first bottle of formula that night. My husband gave it to her while I sat on the sofa watching her suck from the plastic bottle as I held the breastpump to my breast. I cried watching her suck from that bottle. There was my baby drinking the milk of another species, whilst me, her mother has a mechanical device attached to her breast and then writing down the pitiful amounts obtained. Sometimes I produced such a small amount that the measuring gage on the pump could not even measure it. My breastfeeding future seemed hopeless.

I kept asking myself “how long had this been going on? My poor baby, I had been starving her all this time!” The next week was the same routine of feeding and pumping, 30 minutes each breast, every 3 hours, day and night. My life had been reduced to an endless battle with my breasts. My breasts and their contents were the whole focus of my every waking moment. I would set my alarm for 9am, 12 noon, 3pm, 6pm, 9pm, midnight, 3am and 6am. Every night I sat alone in the living room with the breastpump attached to my breast, the sound of the pump’s mechanical motors the only thing which broke the silence of the night. It was soul destroying. As my baby and husband slept I sat pleading my breasts to produce more milk. I would try not to look at the pump while it pumped my breasts. Then when I removed the pump I would take a deep breath and look disappointedly at the amount of milk I had obtained.

While pumping I spent my time on the laptop researching milk supply issues. During this research I read that hand-expressing can often extract more milk than using a breastpump alone. However learning to hand-express was harder than I anticipated. For the first few days I couldn’t extract any milk with my hands at all. Eventually I self-taught using YouTube video clips. It was a long process of trial and error. There’s nothing like the pride of being able to produce a projectile stream of milk from your breast. After using the breastpump I found that I could get at least another 1oz of milk from each breast using my hands. So I added hand-expressing to my three-hourly routine. Every three hours I pumped for 30 minutes on my left breast then hand expressed my left breast for 5-10 minutes, then pumped my right breast for 30 minutes then hand expressed my right breast for 5-10 minutes. It was exhausting but I wanted to salvage my supply and get as much milk for Amy as possible. In my research I had read that breastfeeding is a supply and demand process. So the emptier your breasts are, the more milk they will produce.

And it was working. Over the days the amount slowly crept up. The right breast improved dramatically, going up to 5oz per 30 minute pumping session. The left breast always trailed behind. It was always worryingly shy in its production. The most I ever gained from it was 2-3oz. And just then, my pump broke! I was panic stricken. We decided to buy double pump. However after a few uses it became clear that the suction on the double pump was not as strong as the single pump had been, so we had to get a different double pump. Our bank account took a thrashing.

The breastfeeding counsellor visited after two weeks to check my pumping progress. She was pleased with the right breast and said I could stop using the pump on that breast. But, like me, she was still disappointed in the left breast and said I should carry on with the pumping routine on that breast. I was relieved that progress was being made, and appreciative that I was getting advice and direction from a professional.

Even though all but one of Amy’s feeds was from my breasts, every night it pained me to see my baby sucking formula from a bottle. It was the ultimate slap in the face. It said to me “YOU HAVE FAILED”, not only failed at breastfeeding, but failed at being a mother, being a woman. The only decent thing I was doing as a mother, and I couldn’t even do it right. I posted on Mumsnet: “Does anyone else have no choice but to top-up with formula?” I explained the situation and how ashamed I felt. The mums who responded said that they were shocked at the advice to top up with formula. They said I should throw away the breastpump and simply feed, feed, feed my baby. They told me that babies can get a lot more milk from their mother’s breast than a machine. Many of the mums said they could barely produce 1oz via a breastpump and yet their babies were healthy and gaining weight fine. Then it dawned on me: Amy had been gaining weight appropriately. There had never been any concern with Amy’s weight. Even feeding from my breasts alone, her weight gain was healthy. I spent hours researching breastpumps, milk supply, formula top-ups and related topics. I made sure to stick to reliable sources such as NHS, NCT, La Leche League, World Health Organisation, and similar organisations. From this research I made two startling discoveries:

1.       Your breasts regulate at around 2 months. When a mother’s milk first comes in her breasts produce an abundant supply that can literally engorge them. A lot of women describe this as feeling that their breasts are like melons. Before a feed it would not be unusual for breasts to feel tender and heavy.  I remember when my milk came in I could use my fingers to feel the ducts in my breasts full to bursting point. However when a baby is around 2 months their mother’s breasts learn to become insinc with her baby. They regulate with the baby’s needs, only producing the amount of milk that the baby requests. It’s a process of supply and demand. At this point of regulation, a mother’s breasts will normally feel less full. This is NORMAL. This is what happened to me. My breasts started to feel less full when Amy was 2 months old but being a new mum I wrongly assumed that this meant my milk supply was dwindling. But why did the breastfeeding counsellor never mention breast regulation when I contacted her in tears? Why did she head straight for the breastpump? The pump had been sitting in its unopened box all that time and Amy had been gaining weight well. Why did she insist that the breastpump was evidence of how much milk my breasts were producing? I now know that she was wrong on several counts. I’ve been “boobie trapped”. I had fallen victim to the unfortunately common phenomenon known as “professionals dishing out bad advice”. When I contacted her about my breasts not feeling full anymore she should have reassured me that such an occurrence was normal and healthy at 2 months. The situation would have been resolved right then. No need for breastpumps, setting alarms at 3am, no need for formula. Also, she should never have used the breastpump as a gage for milk production. Some women produce no milk via breastpump at all, and yet their babies flourish – why? Because baby is best at extracting milk from the breast. A baby’s mouth has a sucking reflex that has evolved over millions of years. Why had my breastfeeding counsellor been so misinformed? I started to wonder whether she had actually breastfed herself. If she had then she would have experienced breast regulation for herself. Later I learn that there is no prerequisite for breastfeeding counsellors to have actually breastfed their children, and many of them have never breastfed. A short course is all that qualifies someone to become a breastfeeding counsellor. And people wonder why the breastfeeding rates in this country are so dire? To say I am angry at my breastfeeding counsellor is an understatement. I feel upset and betrayed. In my despair she was supposed to be the one person I could rely on to provide accurate, supportive advice. It’s ironic that instead of supporting my breastfeeding relationship with my daughter, she actually sabotaged it. Rather than being positive and empowering me, instead of instilling me with faith in my body, she undermined my efforts by saying “breastfeeding is not everything”. And then to suggest topping up with formula, was the absolute worst thing she could have done. Every formula feed you introduce to your child tells your breasts not to bother making milk for that feed. Giving formula diminishes breastmilk supply. For a lot of women, introducing occasional formula top-ups is a slippery slope to full formula feeding. But this is not the only reason why suggesting a daily top-up of formula was appalling advice, particularly in light of the fact that my baby was flourishing and gaining weight satisfactorily. Read on...

2.       The Virgin Gut. Have you ever heard of the virgin gut? Neither had I until I researched exclusive breastfeeding versus combined feeding. I’m going to give a brief overview of this interesting ‘debate’. A newborn’s gastrointestinal tract is sterile; there are no bacteria or other microbes. The immune system of a baby is very different from that of an older child or adult. In addition to a lack of antibodies, the baby’s system has immature immune responses. What makes babies even more vulnerable still is that until around six months of age they have what is often referred to as an “open gut”. This means the spaces between the cells of the small intestine will allow large molecules to pass directly into their bloodstream (keep with me!) If breastmilk is all that has ever entered baby’s gut, it is often referred to as a “virgin gut”. This is because it is a unique environment only found in an exclusively breastfed baby. Antibodies and other constituents of breastmilk create this environment. Acidity levels differ dramatically from than of a non-breastfed baby and so does the profile of bacteria present. Positive bacteria thrive, aiding digestion and interfering with the growth of bad bacteria. And here comes the killer fact. Only small amounts of formula or solid foods cause a shift that destroys this environment, changing acidity and destroying the immunoglobulins that coat mucosal surfaces. “Just one formula supplement per 24 hours will result in an almost immediate shift from breastfed to formula-fed gut flora - in which good bacteria (Bifidobacteria) are no longer dominant” (Mackie, Sghir, Gaskins, 1999. Bullen, Tearle, Stewart, 1977). In short, I had RUINED my baby’s gut lining with just one bottle of formula per day. All because a “health professional” told me to. I felt betrayed. I felt I had failed my daughter. I had not acted in her best interest. I had ignored my instincts to my baby’s detriment. This is why the NHS and WHO recommend EXCLUSIVE Breastfeeding. But all was not lost. “Following formula supplementation, if breastmilk is given exclusively again, thereafter it would take 2-4 weeks for the intestinal environment to return again to a state favouring Grampositive Flora”(Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932). So I could rectify this! If I cut out the nightly formula top-up, after 3 weeks Amy’s gut would be repaired. This was a challenge I was eager to start. (For more info on the virgin gut, see my post here).

Amy never had another bottle of formula. It was very hard to cut out the formula feed as my breasts did not produce milk for that feed. But after a few days of putting Amy to the breast and then pumping afterwards to give my breasts double-stimulation for that feed, Amy slowly became satisfied by her evening breastfeed again. I decided that from now on, I was going to trust my body to do what it was designed to do. But this was not without consequence...

For the week it took to re-establish the missed formula night-feed, Amy did not gain weight. At the weekly weigh-in she had simply maintained her weight from the previous week. I got a hard time from the health visitor at the clinic. I explained to her that Amy’s maintenance in weight was probably due to the fact that I eliminated her evening formula feed as I was re-establishing exclusive breastfeeding. She said I should probably keep the formula feed. I found this suggestion bizarre considering her employer’s (the NHS) aim for exclusive breastfeeding. Another boobie trap. But this time I was wise enough not to be taken in by the trap. This time I understood that so-called professionals have poor training in breastfeeding. By this point I understood why 78% of all mums attempt to breastfeed their babies but after four months only 7% of mothers exclusively breastfeed while at six months the proportion of mothers who breastfeed exclusively is negligible (NHS Infant Feeding Survey 2005). The most common reason cited for their failure to breastfeed is “lack of support”. I can entirely understand it. I can emphasise with these mothers. The injustice breaks my heart.

I carried on with my exclusive breastfeeding journey, but it wasn’t easy. I was still suffering with untreated postnatal depression. I was still scared of being left alone all day with Amy. I still felt incompetent as a mother. Some days I truly felt as though Amy hated me. Whenever she cried in my arms I would think it was because she couldn’t stand to be near me, that she sensed my incompetence. Whenever my mum soothed Amy after I had failed to, I genuinely thought that Amy loved mum more than me. In my darkest hours I thought that mum should adopt Amy. As mum often criticised me (“are you sure Amy is feeding properly”, “the flat is a mess, you should be ashamed”, “why won’t you use baby bath products?”  etc) she must assume she could provide better care for Amy than I could.

My intense feeling of failing Amy acted as a barrier to me bonding properly with her. I felt guilt for not enjoying motherhood. I felt guiltly for not being the best mum I could be. However on the upside, my feelings of failure propelled me through my exclusive breastfeeding mission. Repairing and maintaining my baby’s virgin gut was the only decent thing I could do for her. Every feed came from me, day or night. All day every day I was on the sofa with Amy attached to my breast. All this time on the sofa meant that I had plentiful opportunities to research parenting and breastfeeding in more detail. It was during this time that I became a passionate lactivist. I bought books about breastfeeding, participated in breastfeeding debates on forums, trawled through journal papers, offered advice to other mothers, boycotted formula companies and signed petitions. Part of my research suggested that expressing breastmilk and feeding it via a bottle (which I did occasionally so my husband could do some night feeds) could weaken the baby’s latch and their ability to extract milk from the breast properly. This is because the baby has to work harder at suckling at the breast than they do at the bottle. Milk flows out of the bottle with more ease. This can make babies lethargic at the breast. It made perfect sense, and I figured that I could improve Amy’s breastmilk intake even further by ceasing expressing and simply putting Amy to the breast whenever she was hungry. I packed away the steriliser, breastpump and bottles. They have not seen the light of day since. I felt guilty and foolish for wasting so much money on them.

Things seemed to be getting on some sort of positive track. I was making productive changes to Amy’s feeding and started to feel confident - in those decisions at least. This new found confidence led me to research what local mums groups there were in my area. And that’s where I met my wonderful “Pram Mafia” girls. They don’t know it, but they rescued me from post-natal depression; not immediately but over a period of months as our friendships strengthened. This was my first opportunity to chat and spend time with other imperfect mums who made mistakes occasionally, lacked confidence sometimes, and got irritated by their babies/husbands/mothers sometimes – people just like me. When I first joined the Mafia there was only one other breastfeeding mum. It was refreshing to hear that she was frustrated at being the sole provider of her baby’s nutrition. I could certainly identify with that!

However before I had recovered from my depression, there were bleak times ahead. I still hated breastfeeding (I wrote this post: "10 Things I Hate About Breastfeeding"). I hated how breastfeeding meant that I was restricted with what I could drink, where I could go and for how long, and even what I could wear. Whilst the other Pram Mafia mums could hand their baby over to someone else at any time, and have their baby stay overnight at relative’s homes, I couldn’t and I envied them.

Also I was still too scared to breastfeed in public so restricted any outings to a few hours. The only way I got through this period in my breastfeeding journey was to say to myself “I’ll just get through today”. I remembered the NHS slogan “Every Day Counts”. This got me through when other people’s negative vibes swamped me. For instance, every time I breastfed mum would still ask “is Amy feeding properly? Is she getting enough?” I continued to feel like a worthless mother and felt as though Amy preferred other people to me. Sometimes my depression had no particular focus. I would just feel unbearably weepy and that life was hopeless. I told the health visitor and she instructed me to discuss antidepressants with the doctor. The thought of going on antidepressants was not an appealing one. I didn’t like the idea of putting mind-altering drugs into my body. I was secretly relieved when the doctor said that he wouldn’t advise me going on antidepressants because I was breastfeeding. He did however put my name on a waiting list for counselling.

A few weeks passed, and still the depression persisted. I remember one night it was snowing heavily. I’d just had an argument with my husband (a regular occurrence. It must be hard living with someone with depression, and adjusting to fatherhood, and holding down a job like my husband had to). He drove to the shop and while he was out I put Amy’s warm clothes on, put my warm clothes on, and then put Amy in the pram. I dragged the pram through the snowy streets in the darkness with tears streaming down my face. Dragging it backwards because the snow was so thick. It was a blizzard. I had no idea where I was going or what I was going to do. All I knew is that I didn’t want to live at home with all the depression, the failure, and the arguments. Luckily my husband came searching for me and he found me sat in some snow outside the community centre. Amy was sleeping snug in her pram. All I kept saying was that I couldn’t do this anymore. “This” being parenthood. My husband persuaded me to come home.

The next day I saw the health visitor again. She told me to see another GP because “the male GPs have no idea what they’re talking about”. So I made an appointment with a female GP but was told that I’d have to wait two weeks for it.

Meanwhile I was still exclusively breastfeeding. I took it one day at a time. I still felt resentful of breastfeeding, and reaching the NHS goal of six months seemed near impossible, but I clung to breastfeeding because it was a good act. It reminded me that I wasn’t a completely useless mother. I was doing something right. There are not many things in motherhood that you get positive validation from, but I saw breastfeeding as an act that I could feel proud of.

However one day I put Amy to the breast and I felt intense burning pain, like someone was holding a lighter to my breast. The pain shot all through my breast, not only the nipple, which led me to believe that it wasn’t a latch problem. I reluctantly phoned the breastfeeding counsellor (yup, that one). However I was told that I could no longer see her because “my time was up” and mums only get one month with her. However because of my depression I was referred to a breastfeeding specialist from the local hospital. Apparently she was very “high up” in the breastfeeding hierarchy, a guru. I felt privileged and appreciative. She would visit me the next day, but in the meantime I was in excruciating pain, especially when I put Amy to the breast. Whenever it was feeding time I felt sick to my stomach. I took paracetamol to try and ease the pain but it didn’t work. All I could do was sit and cry through it. It got so bad that I couldn’t feed Amy because the burning was too intense. I phoned the health visitor but she wasn’t there so I left a message explaining about the pain. A few hours later the health visitor phoned back and said I must go straight to the GPs surgery and see the nurse. I somehow got myself there with the pram. I don’t remember the trip there or sitting in the waiting room but I can remember walking into the nurses office in a flood of tears and not being able to talk properly because of crying so hard. I told her I was in pain because my breasts hurt. Amy started crying. Another nurse came in and asked if they should take Amy away so I can have some space. Before I could answer she had whisked Amy away. I still resent that moment. I didn’t like being separated from my baby without my consent.

I described the pain in my breasts to the nurse and let her examine them. She said I should see a doctor for a second opinion as this was “beyond her expertise” and she took me to a private waiting room. Thankfully Amy was there waiting for me. I was relieved to have her back. Thirty minutes later I was called through to the doctor’s office. The nurse was there, along with a middle aged male doctor. The reason I mention his age and gender is that perhaps it can go some way in explaining what happened next? His first words to me were “what on earth are you crying for?” I told him I was depressed and in pain and he said that was no reason to cry. Then he said “most women are happy when they become mothers”. I looked at the nurse but she avoided eye contact with me. The doctor then said “Do you want antidepressants then?” and even though the answer was ‘no’ I said yes because I wanted to end the appointment and go home. He wrote the prescription for the antidepressants and said they would be safe to take whilst breastfeeding (Sertraline 50mg). Then he checked my breasts and said he couldn’t find anything wrong. He told me to keep taking paracetamol. His face was full of scorn and he signed impatiently. (Interestingly, this doctor has since been found guilty of serious misconduct and struck off - read the story here).

I left the surgery feeling disheartened but relieved to be away from those people. That night I took one of the Sertraline antidepressants. I was desperate for some kind of relief. I was in physical pain and mental pain so I figured that if I could remove one of those ailments then I may make it through this. I understood that antidepressants don’t work overnight and that it could take two weeks or more for any effect but I had to start somewhere. However I wasn’t expecting the relentless insomnia that the antidepressants caused. That night in-between attending to Amy I lay in bed with my mind buzzing. I felt hyper, like I had consumed a large quantity of caffeine, and yet completely exhausted. I had migraines and being exposed to light was painful. However when I closed my eyes, my brain would flit from one random thought to another. No matter how hard I tried to relax I couldn’t calm my active mind. I decided that I wouldn’t be taking the antidepressants again. There would be little benefit if they kept me awake all night.

The next day I was a wreck from pain and lack of sleep. On the plus side, the “breastfeeding guru” arrived. I explained the pain I was experiencing and yet again, let another professional examine my breasts. After examining them she pulled a wincing face and then asked to see Amy’s bottom. I was confused but obliged. After taking a quick glance at Amy’s bottom and then looking into Amy’s mouth she said “you’ve both got thrush”. She explained that Amy and I were passing thrush back and forth between us. The thrush was in my breasts and passed to Amy via her mouth and then from Amy back to me via my nipple. It was a vicious circle. She prescribed some cream for my breasts and another cream for Amy’s bottom. She advised that I alternate between paracetamol and ibroprofen to cope with the pain. I was relieved beyond words and felt incredibly indebt to her. It was very comforting to know that the pain would be temporary and that it was not part of the normal breastfeeding experience. Why hadn’t the GP noticed my thrush when he examined my breasts? Why didn’t he ask to examine Amy or even ask any questions about her?

Following a few more days of pain and applying medications religiously to both Amy and myself the thrush finally cleared. Also I received a letter from the local NHS counselling service saying that I had to attend an “assessment”. The appointment was at a local hospital. I phoned them to make sure that I could take Amy to the assessment with me because she would probably require feeding. The receptionist passed me to her manager who said “no babies allowed” and that I must come alone. I explained that I was breastfeeding and my baby was still young enough to require regular feeds. She told me to feed Amy beforehand, but I explained that in the time it took to travel to the hospital, attend the hour long assessment and then travel back, my baby would need feeding. She repeated “no babies allowed”. So I muttered that I would speak to my health visitor and hung up before bursting into tears. Another boobie trap. Cater to my mental health or cater to Amy’s nutritional needs? It was no contest. I would have to let go of the counselling opportunity. I wasn’t prepared to leave Amy at home with mum and some formula and thus damage Amy’s “virgin gut” after I had worked so hard to repair it.

I carried on meeting the Pram Mafia for an hour each week at my local children’s centre. It was only a short walk and of course, I had Amy with me if she ever needed feeding. Every week I prayed that she wouldn’t require feeding whilst I was out as by this point I still hadn’t fed in public. I always ensured to feed her before we left, even if this meant being late for the meeting. Eventually and inevitably the day came when she required feeding during the meeting. Fearing this moment I had dressed accordingly and managed to discretely feed her around the corner from the rest of the group. Of course my disappearance from view alerted everyone to what I was doing!

As each week passed I eventually summoned the courage to feed Amy in front of the group. It was difficult as by this point I was the only breastfeeder left in the group. The other breastfeeding mum had switched to formula. I felt I’d lost the only person I could identify with on feeding matters.

(5 months old)

Then when Amy was around 5 months old a vomiting and sickness bug spread around the baby group. As it passed from baby to baby it was soon Amy’s turn. She refused the breast a lot during this time, also known as a ‘nursing strike’. I offered the breast hourly through the day to try and ensure she was getting enough fluids and to prevent my supply dropping. It was a daily battle of constant latching on and off with Amy crying and me crying almost as much. A week after Amy had contracted the bug it was time for a scheduled health visitor appointment in my home.

As I had previously confided in the health visitor about my fear of clinic weigh-ins, she had taken it upon herself to bring weighing scales to all of her home visits, whether I liked it or not. What was supposed to be a supportive check-up became a regular exam. When Amy was placed on the scales I was relieved to see the number on the scales had risen from when she was weighed a week before. Phew!

However apparently I had still failed. This weight gain, the health visitor informed me, was too measly and as a result Amy had dropped from the 25th centile to the 9th centile in one week. I explained that Amy was currently ill and that this had caused her to lose her appetite. The health visitor said that Amy’s weight gain was not acceptable and that I would have to top up with formula.

I refused to do this. I explained about the virgin gut and the health visitor tilted her head to one side with a smirk on her face, eyebrows furrowed as if to say “you’re crazy”. She explained that she topped up both her children with formula and that she used SMA. Her actually naming a brand made me even more determined to hold my ground. Biased personal experience does not equate to scientific advice. After my encounter with the first breastfeeding counsellor, the nurse and the two GPs I now had enough experience to know that health care professionals were not a reliable source of breastfeeding knowledge. Most of them do not have even a barely adequate level of training on the topic. I told the health visitor once more that I was not going to top up with formula. She said “you’ll have to” and then she got out her diary and scheduled an appointment in one week time to check Amy’s progress. Before she left she asked how the antidepressants were going. I explained that I took one but it caused terrible insomnia. She rolled her eyes, shuck her head, sighed and said she’d see me next week.

Amy continued to be ill for the following week. Her nose was blocked and she often had a temperature. When she tried to feed she couldn’t stay latched for long as she couldn’t breathe through her nose. Every time she refused the breast I was painfully aware that her weight would continue to suffer and my supply would dip. I spent hours re-latching her and switching breasts. Tears flowed from both of us.

When the health visitor arrived with her scales I was upset to see that for the first time in her life, Amy had lost weight. She had lost 5oz and had dropped to bellow the 2nd centile. She had never been bellow the 2nd centile before! The health visitor said “if you refuse to top up with formula I will have to refer you to child services and a paediatrician”. What is “child services??” I thought, now filled with immense terror and a fear that Amy would be taken away from me. All I could do was nod and say that I’d see a paediatrician. Formula was not an option.

Later that day I got a phone call from the local hospital saying that an appointment had been made for us to see one of their paediatricians in a couple of days. In the meantime, I tried to pull myself together and carry on. I offered the breast frequently and attended the Pram Mafia baby group. I was so fearful for Amy’s health that my mind started playing tricks on me. As I sat in the baby group I would look at all the plump babies and when I looked at Amy playing alongside them I would see a skinny baby “wasting away”. In my eyes she had skinny arms and legs. It broke my heart. However no one else could see it. Whenever I voiced concern over Amy’s weight, my husband, my mum, the other mothers at the group, and the children’s centre staff said Amy looked healthy and happy. She was meeting all of her milestones and was bright and alert, but in my fearful state of mind, I was fixated on her weight. I couldn’t stop studying the chart and wondering what “child services” was. I was a wreck of nerves, barely even able to hold myself together at the baby group. When I got home I would cry for hours thinking that my baby was wasting away, that my breasts were broken and I couldn’t do anything right no matter how much research I did or how much I painstakingly adhered to all guidelines.

When it was time to attend the hospital paediatrician appointment I was eager to hear what they had to say. As we waited in the waiting room I looked at all the sick children and it broke my heart that Amy was deemed as in as much need as them. The paediatrician weighed Amy again, then laid her on the bed and examined her with a stethoscope, then checked inside her nappy, checked down her throat, in her eyes and then prodded her tummy. She said she couldn’t see anything wrong with Amy but we would need a second opinion. I was told to go to the reception and make an appointment with the Consultant Paediatrician. I did this, and as we were leaving, the receptionist called to us, “Make sure you bring a bottle for the baby! It could be a long wait”. What made her think we were bottle feeding?

It was at this time that I discovered a breastfeeding group that was held at a children’s centre a short train ride away. I saw this as my ‘last hope’. So I traveled to the group. When I arrived I was greeted by the health visitor who worked there. When she asked how I was I broke down in tears. All the other mums were looking at me, but I didn’t care because I didn’t have any pride left. Upon seeing me that way, Amy cried too. The health visitor encouraged me to sit down, have a drink and explain what had happened. So I explained, including the fact that my health visitor had been pressuring me to top up with formula. I could hardly get my story out through weeping, eyes streaming and nose running. (Great first impression for the group!) The health visitor said “I’m sorry you have experienced this. You should never have been treated this way”. She weighed Amy and then measured Amy’s length. This was the first time that Amy had ever had her length measured. I was told that she was on the 2nd centile for length and that this was in perfect proportion to her weight. This health visitor told me that Amy was healthy and to “keep doing what you’re doing”. She said that Amy’s weight had temporarily suffered because she had a bug for a few weeks and that this was normal. She said she would phone my health visitor and “have a word”. I felt as though a huge weight had been lifted. This was a turning point in my journey.

Getting validation that I was not a bad mother and that I had never endangered my child reassured and empowered me. I believe it helped me to bond with my daughter on a deeper level than I was previously able to. I had always had a strong instinct that so much professional interference was unnecessary and that my baby was thriving at her own pace. I am after all a member of a very petite family. However I had been intimidated by professionals because as a new mum I assumed that they knew better than me. Now I realise that many professionals are prone to over-reaction and simply cover their backs erring on the side of caution rather than looking at each baby on their individual merits.

My new-found confidence played a significant role in my recovery and as the clouds of postnatal depression began to lift I decided to give the antidepressants another go, to help the clouds on their way. Furthermore, a new member joined the Pram Mafia – an experienced breastfeeding mum! I was over the moon.

A few days later Amy had recovered from her illness bug and we had our appointment to see the consultant paediatrician at the hospital. He thoroughly examined Amy and then said that he couldn’t find anything wrong with her. He said that she looked like a healthy baby. “Some breastfeed babies need weaning before 6 months” he said and directed that I should introduce solids now. This advice went against all the NHS and scientific literature that I had read. I wondered if he had been influenced by the British Medical Journal ‘opinion piece’ that had recently been sensationalised in the press. I nodded at the consultant but I knew Amy would not be weaned early. Not on my watch.

The consultant paediatrician made us an appointment to see a hospital dietician to help with the weaning process. I’m not exactly sure why he thought I needed such help, as he didn’t explain but I was glad to have the opportunity for extra input. I had attended a weaning course at the children’s centre a few weeks previously but didn’t find it very helpful. Neither was the dietician, as it turns out.

At the time of writing, Amy is approaching her first birthday. She is still breastfed although solids form the bulk of her diet. I will now happily breastfeed her in playgroups, cafes, pubs, on the train, in the park. I’ve realised that most people are too busy with their lives to notice a mum feeding her baby. Although Amy has reduced the frequency and duration of breastfeeds, she is thriving following the 9th centile, and my health visitor has never mentioned formula again.

Furthermore, my postnatal depression has gone. I think a combination of developing faith in myself as a mother, establishing a strong social network, taking antidepressants, and growing confidence in breastfeeding helped me to heal. My bond with Amy is now so strong that she’s knocked my husband off the number one spot. I am the happiest and least anxious that I have ever been in my life. I wished I had known many months ago that there IS light at the end of the tunnel of postnatal depression and breastfeeding difficulties.


MilkChic said...

What an awful experience. I damaged my back in pregnancy, so can relate to the need to continue and be "a success" at breastfeeding when other things are falling apart, but to be let down so many times by the people who are supposed to help... You must have incredible determination to keep going through all that. It's just wrong. Makes me so angry.

045d4d7a-3740-11e0-942f-000bcdca4d7a said...

What an amazing story. You are a remarkable woman and your daughter is Blessed to have you. I just cannot put into words what your story has made me feel. Thank you for sharing. Thank you from the bottom of my heart.

mummabear said...

You are fantastic <3

Pickles and Onions said...

Wow. You are inspiring that you continued through all of that. I struggled also with breastfeeding but thankfully didn't have all of that bureau-crap-cy to deal with!

I wrote about my experiences on my blog:

Sister said...

I love love love this. Thank you so much for sharing.

Kayla W said...

I'm so proud of you. I'm a doula, and see so many mums pressured into giving up breastfeeding by friends and family and "professionals". I'm so, so proud of you for trusting your gut, and researching. I wish more mums would do that.

Fiona said...

This is incredibly sad. I've read it straight after today's post about the "choice" to formula feed. It has been very illuminating. There are many parallels in our stories, yet unlike you, I can't blame my child's failure to thrive (ugly term, you know what I mean) on bad advice, inadequate support, bureacracy or family culture. Every woman in my entire family had breastfed. I felt no shame about it. Before I had a baby, I couldn't for the life of me understand why people would say bottlefeeding was good because you knew how much a baby would get. My dh had been breastfed. We all believed it was natural and I fully expected that after an initial three months of feeding constantly and maybe some nipple soreness, I would have a plump happy baby fed solely on my breastmilk. I had nothing but outstanding breastfeeding support. I quickly became an expert on all things to do with breastfeeding.. yet still, my son didn't gain and rapidly cycled, from day one, down through the centiles and eventually off the chart. No one ever asked me to top up but eventually the overwhelming feelings of failure led me to offer some formula because I couldn't stand another weigh in with no change. And so began an endless cycle of pumping and refeeding to re-establish ebf, a lot of obsessive-compulsive behaviours and a year's worth of depression and ocd.

Reading your post makes me sad for you, for me and for what I suspect are a lot of women out there who struggle on with untreated perinatal mental health conditions and focus the pain on their feeding experience. Some of these women will continue to breastfeed, some will choose to formula feed and feel guilt about it, some will do a bit of both. Yet it strikes me reading this that the issue is not hwo the child is fed, the issue is the worry and anxiety about how the child is fed. In all your story, the saddest part for me is that you struggled on in the grip of anxiety and depression with inadequate support, when that was potentially more damaging and dangerous for you and your infant than formula could ever be. I did it too - been there, done that. Thankfully, when I became pregnant a second time I sought help and am one of the lucky few who have a dedicated perinatal mental health team and mother and baby unit so have had excellent specialist support. I am breastfeeding my second son and getting better and although I haven't fully overcome my first experience. I just don't think it's about breastfeeding anymore. I love breastfeeding, it's been very important in my life but I will never judge another woman for introducing it because I don't and can't know the circumstances of why she has done so or whether or not that will be best for her child's health and development in the long run. Maternal mental illness kills more mothers and babies than formula, in the end of the day. It also potentially has far-reaching consequences for a child's development.

I would still find it very difficult, if not impossible, to switch to formula. However, I recognise now that my feelings related to breastfeeding are excessive and symptomatic of anxiety. If I could go back and change one thing in my life, it would be to have dealt with anxiety before getting pregnant and sought help as soon as it ramped up after birth.

Unknown said...

OMG! In the US there is no help after you leave hospital, but it looks like too much "help" from health professionals in the UK might be even worse!
I felt the same, but in my isolation I was doing reasearch on internet and early on knew what to expect and that gave me strenght, and as you said, the more confident I grew, the less depressed I was. But it took a year...

Brooke Renfro said...

Your experience is so sad. It is amazing that you kept breastfeeding with so much pushing against you! You should be so proud of yourself for learning to trust your body and trying to seek help (even if the help wasn't helpful) and building your own support! Breastfeeding is definitely a psychological ordeal. It is a lot of pressure providing for your baby. Thank you for sharing your experience despite how painful it is. It will surely help someone else that feels the same struggles that you have.

Amanda C. said...

I read your story and am amazed at all you went through and how hard you've worked. I'm also glad that your depression has finally been treated too! Your story was an odd mix of inspirational and saddening for me, as I had my own feeding problems in the beginning with my babe. But my ending hasn't been as happy as yours. Though I had a fantastic pregnancy and an amazing natural birth, and though both of my midwives and my doula were "lactivists," I haven't been able to breastfeed. I tried so, so hard at it, but I think because of some (what I consider) bad advice from my midwife (she had me supplementing -- with donor milk, not formula -- after my baby didn't gain weight or have a BM in her first week) my milk never came in fully. I pumped and fed and pumped and fed and didn't sleep and descended into depression...but still there was not enough milk. I quit pumping at 5.5 months, just so I could spend time with my beautiful baby without a pump attached to me. I still breastfeed her before naps and bedtime, but I know she gets very, very little from me. It's devastating. But, your post inspired me to be more strong in my convictions next time around if I have another child. Now I know what is possible.

nanayhood said...

I was touched by your story. I felt the same way at first, and because I went through the same thing, I think sharing this to other women empowers all.

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