Tuesday, 4 June 2013

Triumphant Tuesday: Breastfeeding with Large Nipples

When a mother is blessed with nipples the size of dinner plates, can this interfere with her baby's dining experience? Indeed it can. Very large nipples can make it hard for the baby to get enough of the areola into his mouth to compress the milk ducts and get enough milk. Fortunately, the latch for babies of mothers with very large nipples will improve with time as the baby grows. However it can take several weeks to get the baby to latch well. In the meantime, if your baby is losing weight and you're being bullied by relatives and health professionals, how's a mom to preserve her sanity as well as her breastfeeding relationship? This is the story of one anxious new mother. Her breastfeeding journey was so stressful that she ended up collapsing and being sent to hospital. If this story had a soundtrack it would surely be the Queen song 'Under Pressure', thankfully followed by their other great hit 'Don't Stop Me Now'.

“From the start, my parents didn't support my breastfeeding efforts. My mother had breastfed me for 11 weeks and then she thought her milk had dried up. I had started losing weight at that age, so she stopped abruptly. At that point her milk came in abundance, but she didn't try to breastfeed me again, for she liked the fact that she could now see how much cc I was getting . When I was pregnant she had very old fashioned ideas about breastfeeding, as well as my father. They wanted me to harden my nipples with hard towels and icecubes. I did try the icecubes, but only a couple of times before I found out it was bad for your nippels and ultimately bad for your breastfeeding success. 

I tried to counter-act my parents negative influence by gaining as much knowledge as I possibly could. I attended prenatal courses, I went to breastfeeding classes and I read numerous books on the subject. My husband advised against searching on internet, for there would be lots of contradicting information, so I didn’t use that medium unfortunately. With the information I did have I wrote a detailed birth-plan, which I gave to the doctors at hospital. I had lots of complications during pregnancy, so I had to deliver my baby in hospital (which isn’t standard here in the Netherlands). 

My birth-plan was mainly around breastfeeding. For example I didn’t want any drugs or pain relief, I wanted my baby on my stomach for at least an hour after birth and I didn’t want the staff to give formula. These requests were uncommon, for I had pregnancy diabetes. But I knew my baby was fine, because I discovered it when I was 24 weeks along (considered early). Since that time I stopped eating sugar and lower my carbs, so the sugar level of my blood was always within limits. Furthermore every other week during my check-ups I received an ultrasound and my baby was always of average size. He never did get an explosive growth, common for babies with mothers with diabetes. So I wasn’t afraid of a hypo. The gynecologist agreed, so I felt good about the forthcoming delivery. 

Delivery day

The day came and we drove to hospital. But when we arrived it was really hard to convince the staff that my baby didn’t need a check-up from the pediatrician right after birth, although our gynecologist didn’t only agree, he had looked it up and discussed it with my diabetes doctor and was convinced it was best for my baby to be with me right after birth. But the hospital staff needed to consult it with him, even though he had written a consent form. Arguing my case whilst in labor was very stressful. In the end they agreed to let the baby stay with me for an hour, but no longer than that. Then my husband could hold him and dress him and bring him to the pediatrician for a check-up. 

Within 4 hours of arriving at hospital and being in labour for only 6 hours, it was time to push. My contractions and my pushes were so violent that our little guy’s heartbeat dropped to an alarming level. The gynecologist came in and said he had to help the delivery by using a pump. So my little one came to this world with a headache. For all the information I had consumed, I’d never read anything about that being a hurdle to breastfeeding. However the reality is that it would take an average of 2 days longer for my milk to come in. As it turned out later, the books I’d read, advised to me by my breastfeeding class-instructor were seriously out of date and at least 20 years old, riddled with false assumptions. 

Should it hurt?

As I lay with my baby, the nurse told me that he seemed to be latched on. I asked her if it was supposed to hurt. She said that it almost always hurt in the beginning. The next ‘feeds’ hurt even more and I didn’t think my baby was latched on properly or getting anything. I didn’t see or hear him swallow; it looked more like a nibble to me. But what did I know? He was so tired after the traumatic delivery that he slept a lot, so the nurse said that he must be getting something or else he wouldn’t be this satisfied. 

Meanwhile the staff tried to convince me to give him formula because of the diabetes. I refused, and consequently I had to stay in hospital for another 24 hours so that my baby’s sugar level could be checked every 3 hours. All the results came back perfect. Phew.

Latch issues

That night another nurse reluctantly stayed with me when I tried out different positions to nurse. She didn’t watch me feed and her advice was beyond questionable. She said that if you feed in a laying down position where you and your baby both lay on your side, your baby was supposed to suck on the upper breast so to speak. This didn't work at all and for a long time I believed I could only feed sitting up as these were the only 2 positions she discussed with me. 

Luckily there was a better nurse in the morning shift. She saw that my baby actually hadn’t latched on properly yet, just as I had thought. He didn’t have the right technique - he tried to push his tongue over my nipple, slipped off a lot and just found a place to suck, just right of my nipple, where there was now a big blister. Ouch! With her help my baby finally latched on and I immediately felt the difference. But latching on was difficult. It took me 20 minutes to get him properly latched on. By that time he was so tired, he didn’t drink very long before he let go again. We both didn’t have the right technique figured out yet, but despite this we were told was time to go home after just 24 hours in hospital. 

Harrowing home visits

We phoned maternity care and they promised to have someone at our house before we would arrive there, as is normal in the Netherlands. Every woman has the right to a nurse a couple of hours per day for the first 8 days after birth to help learn how to take care of the baby or help out around the house. She arrived 4 hours late and was not in a good mood. She was supposed to help me through the weekend with my breastfeeding problems and even though it was her job, she was upset to have been called and have her plans disrupted. She noticed our poor latching technique and my now split nipples, but couldn’t help. I told her that my nipples were flat and asked if it mattered. She said it shouldn’t. My baby was so hungry that he slept for 20 minutes, took 20 minutes to finally latch on, tried to nurse for 20 minutes, was too tired and then sleep for another 20 minutes. And this went on day and night. By the time I laid him down and had fallen asleep, he was up and ready again. 

The maternity care nurse told me my breasts must be empty and I shouldn’t feed my baby so often because my breasts needed rest, time to heal and time to fill up again for a couple of hours. My commitment to feeding on demand was ignored. By this point I was so insecure as a mother that I believed her! I didn’t know that breasts are constantly making milk. In retrospect, I realize this was really bad advice in general, but especially for a mother like me, who had large flat nipples. By the time I was ‘allowed’ to feed, my breasts looked like balloons, completely round, and my baby had an even harder time latching on to them! The nurse also told me to start using nipple shields, but I duly did. However my large nipples kept scraping up and down the shield. Consequently my pain increased tenfold. I promptly stopped using them, against her advice.  

I must admit that I thought about quitting many times. Especially after 'professionals' told me that I would fail. They were supposed to know and had lots of experience. One reason I didn't stop was that I was terrified of SIDS and I knew one could reduce the chances by breastfeeding. And that's the only thing that kept me going in the beginning. I knew that if I would quit I could never forgive myself if something would happen to our baby. I asked the nurse how much chance there was for babies to die of SIDS. She said that it didn't matter.

It was now Saturday night and my poor little baby kept crying. I didn’t know what to do. I tried to feed him, but nothing seemed to work. Worst of all I heard his stomach grumbling. I felt like a failure of a mum and cried along with him. Because the nurse had told me to leave my breasts alone for a couple of hours after every feed, I thought that my breasts were empty and didn’t know what to do but hold my crying hungry baby. Thinking about that night still makes me cry even now, and feel like the worst mother in the world.

The nurse came back in the morning and in tears I told her about my baby’s hunger. She criticised me for not having formula as a backup. She also told me of her worries about my baby’s weight. At this point he’d lost almost 20% of his birthweight! Yet this was the first time she had mentioned it. She’d never shared her worries before, so this was the first I’d heard about it. I felt terribly guilty. Why had I been so obsessed with breastfeeding? I had let my baby starve! 

The nurse also told me that the baby had lost so much weight because of all the visitors we’d had. So we were not allowed to have any visitors for at least week, to give my baby a rest. My husband and I were in shock. What had we done to our child? Looking back this comment was appalling, for only our parents, my brother and my husband’s sister had seen our baby at this point, and not even all at once.

A midwife came to perform a check up. She was concerned as well, but much sweeter about it. She saw my breasts and they were a mess: bloody, split, awful. The nurse told her and me that she thought breastfeeding wasn’t an option for me, that I should start to formula feed. The midwife, after seeing my nipples (they were the worst she had ever seen apparently) and seeing the weight of my son, agreed. I told them that I really wanted to breastfeed and asked if there wasn’t another option for me. The midwife said that I could try pumping my milk after every feed and to top up with formula. They provided a handpump for me and told me to only feed or pump during day hours, “so I could give my breasts a rest at night”. They also provided formula, which they gave to my husband to feed. In my weak state I still asked if this could cause nipple confusion and diminish my chances of getting to breastfeed my baby. They both told me that “nipple confusion is a myth” and the nurse repeatedly said she believed I should give up on the breastfeeding thing altogether as clearly I would fail anyway.

Bullying grandparents

My parents instructed me to feed on schedule as my mother had done. Every 3 to 4 hours. I told them that it was better to feed on demand, but they didn't listen. They would ask how many times I was feeding and told me it wasn't normal and that this was the reason I had slipped into a dark state, why my baby didn't sleep through the night, why I was tired, and so on. 

Meanwhile I felt terrible about the formula. I cried whenever my husband fed our baby. That should have been me, with my breasts! I cried even more whenever I got downstairs to nurse my child and discovered that the nurse had beaten me to it. There was a stranger feeding my child. I started pumping and I could only pump 3 cc left and 6 cc right. My nurse told me it should have been 40cc by now, because it was the fourth day. So I felt even more guilty. My breasts must have been empty, my poor baby! I was so stressed that sometimes I couldn’t pump anything at all. Not knowing that pumping is a really bad indicator of how much milk your baby gets straight from the breast.

On Monday another nurse came to visit. Because of our poor technique the tops of my nipples now had literally come off. So the new nurse told me that I shouldn’t even try to put my baby to the breast anymore. I asked them about my production. If I didn’t put baby to the breast, how was I supposed to get my milk started? The doctor prescribed oxytocin. I was to use it every time right before pumping to make letdown easier. The nurse advised that I buy an electric double pump.

I started to pump day as well as night, against their advice. Here I had the same problem as with the nipple shields. My nipples were too big even for the largest flange, so it hurt, but I was determined to breastfeed. Afraid they might forbid me to pump and that they would force to completely formula feed, I didn’t mention the pain to anyone.

The new nurse gave my child the bottle as well. I told her that I didn’t like it, that I wanted to be the one to feed my baby, even though I couldn’t give my own milk all the time, and that I especially wanted to be the one to give my son my pumped milk. I wanted him to know that that taste and smell belonged to me, his mother. She told me that giving a bottle was the highlight of her work and that I shouldn’t be so emotional about it. She said I was being ridiculous, and asked how I thought children got fed in daycare. I told her that I was to be a stay at home mum. But this didn’t get through to her. 

I missed nursing my child so much. I cried every day, every hour, every feeding time. And felt like a terrible mum. I thought my baby must be so confused, maybe he didn’t even realize that I was his mother with this nurse feeding him all the time. I certainly didn’t feel like much of a mum. After 5 days I begged in tears to please let me put my baby to the breast again. Imagine how low my self-esteem as a mother was at this point, to think it necessary to have approval from a maternity care nurse, before making a decision which benefited my child. The first time that little body was on top of mine again, searching for my breast and successfully doing as nature intended I sobbed. I hadn’t felt this happy and emotional in a good way since the birth.

Sent back to hospital

Having a baby is the best thing that happened to me and made me realize how fragile life is. At night I kept checking that he was still breathing. When he was quiet I was scared, but even when he made a sound I was scared as well. I hadn’t slept at all since the birth. Meanwhile my baby kept losing weight, even though he was topped off with formula. I was absolutely exhausted, sad and frightened, and I couldn’t think straight anymore. I even fainted. At that point my doctor sent my baby and me back to hospital. He was worried about us both. He advised me to think about stopping breastfeeding, for it was such an ordeal for me. But breastfeeding was the only thing at this point that I felt remotely good about. I really believe it saved me from even deeper postnatal depression. 

In hospital I finally got a nurse who had breastfed herself! And she was able to help my baby to use a better technique and teach me how I could tell when my son had a poor latch. She also spotted the beginning of mastitis and helped me get rid of it before it got worse. 

Unfortunately she wasn’t there all of the time. There was one nurse who said I was to feed my baby for 30 minutes every 3 hours. When I mentioned that I was feeding on demand, she simply asserted that baby’s need structure. At this point it still took 10 minutes to get him to latch on, so he’d have only 20 minutes to feed according to the hospital rules. At home he easily took an hour, sometimes an hour and a half each feed. I also had found out that if I changed my son’s diaper after one breast, he was awake enough to be able drink the other as well. But here I was not allowed to do that. My baby was being weighed before and after every feed to find out how much he’d gotten and how much formula he ‘needed’. This nurse came in exactly 30 minutes later, took my child away from me and left me to pump alone. But I couldn’t pump without my baby. I was down to 3cc and 6cc again or even nothing, if I couldn’t see, hear, smell or feel my baby. If he was with me I could pump 50cc in total after every feed. I told the nurse that this wasn’t working for me or my baby, but she wouldn’t listen. My baby was still topped up with formula if he didn’t weigh enough or couldn’t get enough pumped milk to top up with. And because he didn’t drink long enough, he wasn’t gaining enough and because the nurse took him with her and left me to pump by myself, I wasn’t able to pump enough, so he started to get more and more formula. 

In tears I told my husband the next day that this particular nurse wouldn’t listen to me and was standing in the way of our recovery. Fortunately my husband got angry and spoke to her. She told him I was to recover as well as our baby, so I needed my sleep (which indeed I desperately needed, but I needed my baby even more) and she didn’t have the time to weigh our son before and after a diaper change in addition to weighing him before and after a feed. My husband arranged that he was to take over a part of the night-shift, so he could weigh our son 4 times each feed; he’d change the diaper in between breasts and he gave the bottle of pumped milk to our son in my room, so I was able to see, hear and smell our boy while I pumped. Fortunately in a couple of days my son was only getting my milk and formula was no longer necessary!

However he was still being taken away from me at nighttime and I wasn’t allowed to cuddle him much during the day either. It broke my heart. I wanted my baby near me and I still felt he couldn’t possibly know who his mother was, for other woman held him more than I was allowed to. I’d asked several nurses to bring my baby to me. As I had a very low hb level, for I still was losing a lot of blood, I wasn’t able to walk, let alone carry my baby myself. At last I found a nurse who saw that a mother should be with her child and she brought him to me every day. 

It wasn’t until this point that my production finally kicked in and soon there was no need for bottles any more. I was over the moon. As my hb levels were reaching the norm as well, we were finally released and ready to go home. Funny enough, my boy never again so much as touched a bottle or pacifier again! I believe he just naturally knew what was best for him and never wanted anything else again.

At last I was able to breastfeed my baby, but it was far from ideal. It still hurt at lot, so much that I dreaded the moment my son would wake up and need another feed. I used to have tears in my eyes all the time and sometimes I wasn’t able to withhold a yelp of pain. But I was too afraid to ask for help at this point. Afraid someone might say I needed to stop breastfeeding all together. So I bit my lip and kept going. 

Lactation consultant with a hidden agenda

After 6 weeks my husband called a lactation consultant. We drove to see her, so she could check if my son was properly latched on. She said he did have a funny way, but she couldn’t find anything particularly wrong with his latch. Since his lower lip was curled around my breast, it was just 'his style' and that there was nothing she or anyone else could or should do about it. He didn’t have a tongue-tie and milk was coming, so that was that. She said she was an expert on breastfeeding and had helped lots of new mothers in her years as a nurse. She'd never mentioned that she herself never successfully breastfed her own children and that she never even took a breastfeeding course as a nurse.  To her credit though, she recognized that my nipples were in such a state, so bad as she had never witnessed before, what with the tops being sucked off altogether and the wounds constantly reopening every feed and bleeding. She advised me to use ‘Mother Mates’, to heal the wounds on my nipples. Mother Mates are silicone gel pads, with a substance in them. This substance is also used in hospitals, it is designed to make wounds heal faster. You use them in between feeds and you have to wash your breasts before each feed with warm water.

The mothermates helped, I must admit. My nipples did heal with them and it did relieve some of my pain. But it took another 10 weeks before breastfeeding was pain free and another 3 months after that before it became easy and enjoyable. Then when my son got his upper front teeth it started to hurt again! As I later found out, my son might not have had a tongue-tie, but he did have a severe lip-tie. This prevented him from properly curling his upper lip around my large nipple. He sucks a part inwards, so to speak. Why hadn’t the lactation consultant looked into that? She must have had the knowledge? And with hindsight it was quite easy to detect. This probably caused his latching problems in the beginning and my production problems too! On the upside: now I know what to look for if we are blessed enough to have more children.

Family dismay at extended breastfeeding

Even though at 6 months there were no longer any technical problems with breastfeeding, the hurdles were far from over. At this point my family and friends started to question why I wasn’t stopping and just giving ‘normal’ milk. I thought they must have lost their minds! After all the trouble I had been through it was finally easy to feed and these people wanted me to stop?! There was not a hair on my head thinking about that. When I started, I never imagined to feed past 8 months, for that was the longest anyone in my family had given bf. I just didn’t have the experience that one could feed after that. When the time came though, I was determined to carry on. My in-laws found me very selfish. How were they able to babysit for a full day, if my son was on the breast? How was he to sleep over? 

Tricked into early solids

In the Netherlands there is an organization called the Consultation Bureau. This bureau keeps an eye on the development of your child until the age of 4. You see the nurses and doctors who work there frequently and they weigh and measure your child and ask questions, give simple tasks to your child, etc. What I am about to say still makes me feel utterly ashamed of myself. The CB nurse told me that my baby needed to be fed fruit or porridge from the age of 4 months onwards. Even though I never heard of the virgin gut at this point, I didn’t feel right about it and so didn’t start to give the prescribed porridge until my son was 5 months old. I still feel so guilty about giving him solids before 6 months. 

At 6 months old my boy had had an explosive growth in weight. The nurses asked me how many feeds I was still giving him. I told them truthfully I was at about 7 feeds a day. They told me that this was abnormal and was the reason for his weight gain. They instructed that I should reduce the feeds to 3 or a maximum of 4 a day or my son would become too heavy. Naturally I wanted what was best for my baby and since I had nobody to compare this information with, as everyone I knew just gave formula, I thought this must be normal and I started to reduce the feeds. How foolish I had been! I should have been more observant, mindful and responsible. Even more so when I found out, when my boy was 8 months old that the baby porridge prescribed contains formula! When I found out I was horrified and stopped immediately. I had been very clear to the bureau that I didn’t want my baby to have another drop of formula after our rough beginning and I had trusted these professionals. I felt betrayed and like a terrible mother. How could I have been so naive! From this moment onwards I started to read as much information I could find on the subject of breastfeeding - on the internet. I found out that it is not normal to reduce feeds, that a baby is very capable of deciding for himself when to reduce feeds. I started to feed on demand again and was able to increase my production. 

Interestingly from the minute my son ate the porridge containing formula he gained a lot of weight very quickly. At 8 months he was really chubby. When I stopped the porridge, but increased the feeds again, his weight centile slowly dropped to match his length again. Personally I feel that this cannot be a coincidence no matter what my doctor says about it. Now I was finally feeding my son as intended by mother nature. We both enjoyed it at last. Whenever I did have questions I was now a member of a breastfeeding forum online, which was a relief. I should have sought out more help a lot sooner, but unfortunately I can’t go back. 

Incest jibes

When my son reached the age of 1 there was a renewed flow of critique that I was still breastfeeding him. My parents couldn’t believe I was still feeding my son more times per day than my mum ever did with me. As he was “no longer a baby” a lot of people found it strange to keep nursing him. Even the ‘professionals’ at the bureau were no longer pro-bf. There was one nurse with the nerve to tell me that I really should start reducing my feeds, for when my boy turned 1 she thought breastfeeding was turning into incest!! But at this point I had learned that none of the so-called experts there had successfully breastfed their children, so I just discarded this advice and keep breastfeeding as I felt was right, natural and logical. 

Today, despite my problems, or perhaps because of them, I am determined and extremely motivated to continue breastfeeding. My parents advise me to stop every month or so. My mother is envious that I still feed my son when she 'couldn't' bf me. Yet nothing will keep me from reaching the WHO goal of 2 years. Nothing except my son that is, who is the one to choose when our breastfeeding-period will end. He is 17 months old and still wants at least 7 feeds a day, so luckily I don’t see that day coming any time soon. Secretly I hope it will take at least another year or more. And if I’ll ever have another baby, I now know what to do, what to look for and first and foremost what not to do!

I really feel sorry for the mums who have never breastfed their babies. It is such a unique experience, it gives such joy and is such an act of love, I wish every woman could experience that! And I feel sorry for the babies as well.”

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onesosmall said...

Oh my goodness, the nurse who suggested it was incest really should have whatever license she maintains revoked! I swear these "professionals" might as well be Monopoly characters with false licenses to practice. I am so sorry about your troubles. I can't even imagine the depths of depression you embraced from such an unsettling experience. Good for you for overcoming such terrible obstacles.

Mdegraeve said...

Your story BLOWS my mind! I can not believe how many health care "professionals" could treat you so poorly and give such awful advice. I'm so glad you were so strong and brave. You stuck it out and now you get the sweet reward :)
I hope you get another year!
-many blessings

breastfeedingquest said...

My God, what a journey to successful breastfeeding. It feels like this mom went through most of the issues possible. But I think lack of support and knowledgeable medical personnel were the worst. Makes me re-evaluate some things I take for granted... Thank you for posting it!

Barley, Bean, and Boo said...

Gah, I thought the Netherlands were supposed to be BF friendly, but this is out of a horror movie. The steady stream of incompetent "professionals" with an attitude is disconcerting to say the least. I'm so glad you have found good information and a helpful on-line community! :)

imperfectlynaturalmama said...

I am so surprised by the help this poor lady was given, I really thought the Netherlands were more progressive than this. She did amazingly to recover from the barrage of bad advice. I am so thankful I was able to access accurate information to help me to breastfeed.

ME said...

Just want to say that the WHO recognizes GMO franken foods as "safe".. sure trust them and feed your kids with teeth til he's an adult why not. Also, not sure about you but I use deodorant, deodorant is applied on the armpit area which is near one's breasts- don't you think that you're feeding your child- aluminum, EDTA, triclosan and BHT? Last tie I checked these penetrate the skin therefore find their way into the breast milk... looks like th ebreast is not the best unless you live in a third world country without deodorants.

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