Tuesday, 30 July 2013

Triumphant Tuesday: Breastfeeding despite hospital interventions

Parents and physicians alike are torn on the issue of how, and indeed if, hospital interventions have a detrimental impact upon maternal and child welfare. Medical procedures, for instance, labor inductions, epidurals and circumcisions, as well as the introduction of man-made devices such as nipple shields and bottles of formula, have all been linked to breastfeeding failure. They certainly didn’t help this week’s mom, Rebecca, on her quest for success. Indeed, opposers of home births would be wise to read the following story. Whilst it certainly does not reflect all cases, Rebecca’s story illustrates how the hospital environment and its inhabitants, often work together to undermine a mother’s breastfeeding efforts.


“I'm lucky that in my circle of friends and acquaintances, there are dozens of mothers who have nursed their babies.  When I was pregnant, I'd see my friends nursing their babies, and I assumed that of course I would breastfeed, that's just what people do!  I was breastfed until I self-weaned, my husband and his siblings were all breastfed.  Because I saw it all around me, I assumed that it was simple and easy, and I blissfully ignored any suggestions that I needed to prepare to breastfeed.  I also blissfully sailed towards my due date with the assumption that I'd be able to have a natural childbirth without preparation because I had a positive attitude.  Please, have a good laugh on me! I've had two miscarriages that passed naturally, so in my mind I already knew what contractions would feel like, but of course contractions with an 8 and a half pound baby are a little different than a 10 week fetus.  Adding insult to injury, I voluntarily chose to be induced, not having any clue how that would affect the labor process or my baby.  So here's what happened...

Induction followed by epidural

My induction started off with pitocin - very medical, no stripping of membranes, just an IV of pitocin. Within a handful of hours I was on the full dose of pitocin without my body taking the hint to get into labor.  I was having contractions but they weren't productive. Within 12 hours, the nurse broke my water, and then the contractions became far more painful than I was prepared for (obviously, since I hadn't prepared).  I was also shocked at the quantity of amniotic fluid and the continuous gushing, so I didn't want to bounce on the birthing ball or walk around.  I opted for an epidural.  

For the next several hours I laid there, pitocin pumping through me, feeling very little pain, and not progressing.  About 12 hours after they had broken my water, I was only at 6 cm dilated.  I was told that if I didn't progress within a few more hours, I'd need a C-section.  I went for it.  (Side note--- next time I'm pregnant I am absolutely preparing, working with my doctor in advance, taking classes, and having a VBAC.  I could kick myself for how ignorant I was throughout this process)

C-section


During the C-section, because of some scar tissue in my uterus from a previous surgery (that corrected the problem that caused the miscarriages), my placenta was stuck and had to be hacked up to be removed.  I lost a lot of blood - apparently I was right on the threshold of receiving a transfusion, but thankfully didn't get one and recovered relatively quickly in that regard.  

Here I was, fresh out of major abdominal surgery, weak from having lost a lot of blood, and for 24 hours I'd been pumped full of pitocin, followed by an epidural and whatever pain control they used for the C-section. Of course my baby therefore had all of these drugs in his system as well.  

Unresponsive nipples, unresponsive baby

I had a friend with me who was in training to be a doula, and she tried to help latch the baby on since I could barely move.  But with all that medication in me, my nipples wouldn't harden at all, and the baby was too zoned to try anyway.  

Circumcision

We planned to have him circumcised at the hospital, which was done the next morning without pain relief. My son’s discomfort added to his lack of motivation to nurse. I was told he'd be extra sleepy as his body responded to the circumcision procedure. It was probably a good 48 hours before he realized he was hungry and could bring himself to eat.  Despite me placing him to the breast every few hours as instructed, he hadn't been interested for two days. 

I gave birth at a pro-breastfeeding hospital, so all the nurses are trained to encourage breastfeeding, and there are lactation consultants on rounds every day.  On my first day following his birth I actually turned the LC away, since my baby wasn't interested in nursing, I figured I didn't need her help!  I can be so dense!

Misinterpreting hunger cues


Throughout my 4 days at the hospital, I discovered that when he did become hungry, it appeared to happen very suddenly. He'd stick his tongue in and out, but I didn't know that was a hunger cue, so we'd be admiring this silly cute face he was making and then wham! - we were into purple face screaming hardcore crying.  By this point, he was so agitated that if I couldn't latch him in a few minutes he'd wear himself out screaming and fall asleep. 

Separation

To aggravate matters, there was a hospital policy which required parents to have the baby in the nursery overnight. Staff would bring the baby back to your room when the baby wakes to eat.  So again, by the time my son was returned to my room during the night, he'd be screaming hungry and unable to nurse.

Nipple shield

We had three more chances with the lactation consultant, and she spent an hour with us each day.  My nipples still wouldn't harden. Combine this with the fact that my nursing breasts are a G cup, and it was hard for my baby’s tiny newborn mouth to open wide enough. So the LC suggested that I started out using a nipple shield, which I promptly did.  

A few of the nurses at the hospital tried to be helpful but weren't - they'd give advice that contradicted the LC, or they'd just reach over and touch my boobs while I was trying to latch the baby, without asking if I wanted that kind of help.

Positioning juggling act

Also because of my C-section we were limited to the football hold.  I felt like I needed four arms to successfully nurse.  In order to get my son to latch, each time, we'd need one hand tweaking my nipples or holding on the shield, one hand bringing his head to my breast, one hand holding my breast (G cups) so it was flat enough for him to get his mouth around it, AND another hand dripping formula or expressed colostrum on his lips/my nipple to help him make the connection between nursing and food.  

Formula supplementation

Without the help of the lactation consultant, in our 4 day hospital stay, my son only successfully nursed once.  Due to ‘excessive’ weight loss, I OK'ed him getting formula twice in the hospital. My son was born at 8 lbs 8 oz, and was 7 lbs 11 oz after three days, but then didn't lose any weight from day 3 to day 4 in the hospital. It doesn't really sound excessive looking back.

Family and friends

I healed so quickly from my C-section that we were told we could leave a day early, but I was reluctant to do so because I felt unable to breastfeed. I felt unprepared and scared and even hopeless. Yet we were told to leave the following day. 

Once we got home, I was at the point of a mental breakdown.  I was utterly exhausted and scared and felt like a failure.  Thank goodness my mom was in town - she had been discouraged from breastfeeding with my oldest brother and gave in to current medical "wisdom" of the day (back in the early 70s), only to become a La Leche League leader later that decade, and fed me expressed breastmilk from a spoon when I wouldn't latch properly, vs giving me formula.  But I wasn't ready to listen to my mom, surprise surprise.  I started texting all of my mom friends with babies, saying how hard the breastfeeding was, and basically I was just waiting for ONE person to tell me I should give up and go with formula.  I just wanted one person to tell me that my situation sounded abnormally difficult, but none did (thank you, good friends!!!)  

In fact one mom, who herself had a 6 week old and 3 older kids, called me in response to my text.  She stayed on the phone with me while I sobbed, and told me how hard it was with her first, and how she fixed her attitude on breastfeeding success, and how she basically resolved to stay in bed with the baby all week while other people handled the house and food for her.  After that conversation, my mother insisted I have a drink (like, an alcoholic one, to CHILL THE HECK OUT), and insisted on giving the baby one more formula feeding so I could get enough sleep to recharge my batteries, and we'd start fresh the next day.

Honeymooning with baby

And we did.  I kept the baby in bed with me, and I rested, and I offered him the breast, and told him that was his only option for food.  Those first several days, there was a lot of screaming and difficulty latching, but each day he'd have a few successful feedings, enough that I knew he wouldn't starve. 

Between trying to latch him, and pumping after a failed attempt, I estimated that 12 hours of every 24 were spent on feeding-related activities.  I also developed a shockingly awful rash from the Boppy pillow.  This is actually embarrassing:  the Boppy was a hand me down from a family I know and trust.  It was the ONE hand me down I didn't remove the cover from and wash, I just got lazy.  I realized afterwards, it had been in storage in their attic.  I had been using the boppy while wearing nothing but underwear, and the rash began everywhere the boppy had been touching my skin.  I'd been laying a blanket over it where the baby was touching it, so thankfully he wasn't affected. The rash took a month to go away, and spread all over my stomach, lower back, butt, my entire legs, feet, etc.  So when I wasn't nursing or pumping, I was rubbing ice and creams all over myself, trying not to scratch.  Or, scratching anyway.  The doctor said that because I was recovering from surgery, my immune system was likely unable to fight off what otherwise might have been just a minor issue.

Thank goodness for my mom being in town, helping out.  She'd literally put food in my mouth while I was nursing so I could rest when the baby rested.  My nipples were, of course, really sore as I was adjusting to all this, and nursing was painful.  I assumed that was par for the course.  

Infected nipples

Finally at my 6 weeks postpartum checkup, the doctor said my nipples looked irritated (ya think?!) Turns out they were riddled with thrush and other infections. The doctor gave me a prescription for a topical cream which helped. I began taking probiotics and using the cream, and about a month later I no longer had pain nursing.


Within a few weeks of his birth, my baby was latching consistently without the nipple shield. He is now 11 months old, and we're still breastfeeding.  I originally hoped to manage even for just 6 months.  Then 6 months came and went and I said I'd breastfeed to a year.  Now that we're planning his first birthday party, I can't imagine why I'd stop breastfeeding as long as he's into it!!  

My husband had his doubts about whether we'd succeed at breastfeeding and was worried about the baby getting enough to eat initially. However he wisely kept his mouth shut and only admitted this weeks later when we were well-established. I even managed to donate several gallons of my pumped milk to a mother with an adopted infant, and a mother with twins who couldn't make enough milk.

When I find out that acquaintances are pregnant, in addition to congratulating them, I encourage them to seek out information BEFORE the baby is born, and to take classes on breastfeeding.  I wish when I was pregnant I'd seen as many messages about preparing to breastfeed as I saw formula advertisements.  The idea in society seems to be that feeding your baby should be easy. Nobody talks openly about it being difficult. This is particularly bad in light of the lack of common knowledge that formula is so inferior to breast milk.”


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