Tuesday, 29 October 2013

Triumphant Tuesday - Breastfeeding With Postpartum Depression

Recently, a study has found that women who struggle to breastfeed in the first two weeks after giving birth are more prone to postpartum depression. This finding, whilst hardly groundbreaking, gives scientific credence to what mothers have been saying for decades – we need more support and less sabotage, particularly in the early days. Young mothers are especially vulnerable to postpartum depression, as are those who did not plan their pregnancies.

It would seem therefore that the odds were stacked against the young protagonist  in this story who unexpectedly fell pregnant in her teens. She was immediately launched into a battle against the very people that were under duty to care for her. Despite being sabotaged from every angle, she somehow managed to pull through, against all odds. Here, she explains how she did it:


When I was 19, and I fell pregnant with my first child. Although I was married, the pregnancy was a surprise, to say the least.

Induced without warning

For the entire pregnancy, there was no doubt in my mind that I would breastfeed. It seemed like the obvious choice, and, as I mistakenly thought - the easier choice. At 40+5, I was at my final prenatal appointment, where I was told I was being induced due to low fluid. No warning, I wasn't allowed to gather my things, I had to beg to eat. I was given a stretch and sweep without permission. I was told nothing I should have been told, given no information. The midwife simply told me she was going to do a cervical check and then I felt an immense pain, yelled out and told her to STOP and she told me she was doing a stretch and sweep and if I couldn't handle that then I had better ask for an epidural because I surely couldn't handle natural labor. I was distressed and frustrated and wanted to cry - not only was I teased for being in pain but I very much felt violated, and seeing the blood of my plug coming out scared me. She stretched me from 1cm to 3cm. I was then brought into a Delivery room, hooked up to pitocin, given a catheter and that was it.

My husband and I were, frankly, taken aback. I had an epidural a few hours later. 14 hours of labor, 1.5 of those spent pushing. Near the end, nearly 10 doctors and nurses rushed in and all I was told was that everything was okay, I just "might" have to have a c-section. When asked why, I was given no answer. So I pushed, as hard as I could, and got him out. I asked if everything was okay, and I was told yes.

Baby removed

Except, if it was okay, why, the second I pushed my son out, was he taken from me?

I didn't get to see him. My husband didn't get to cut the cord. I didn't get immediate skin-to-skin, he was given all his shots and such without my being informed of anything. He was taken, and doctors surrounded him for nearly an hour. My husband got to see him but they wouldn't let him touch him. And to this day, almost 4 months later, I still don't know why.

My birth plan expressly stated that I wanted the vernix to remain on him for a few hours. Yet the nurses were sitting my baby in the tub and beginning to wash him when they asked, "Oh, by the way, did you want him to have a bath?" At that point, it was too late anyway!

Clueless and confused

When my baby was finally passed to me, he was thrust into my arms and all the doctors and nurses left. My husband left, as well, to get me something to eat. And I was alone, with a baby. My baby. And I had no idea what to do. No one was there to help me. I'm only 19, just went through some scary things, I was getting no answers, no help. And I didn't feel a rush of love like I thought I would. I felt strange, exhausted, and hollow. I had no idea why. But nonetheless, he was beautiful, and wrinkly. Riven was finally out, and real, and 6lbs 14oz, and oh so tiny.

He wouldn’t stop crying

I pulled my top down and tried to breastfeed. But I didn't know how. And it wasn't easy, and he wouldn't stop crying. Soon, I was crying. My husband came back, took him and called for help. The nurses told me he wouldn't breastfeed for a while. I thought that was okay.

The first night was horrible. The nurses and doctors refused to help! They told me everything was normal. They acted like my concerns were absolutely insignificant. I begged for a lactation consultant, who eventually came in and told me he probably wouldn't latch at all for about 3 days and that was "normal" and "okay". That didn't seem right, but no matter what I did, I couldn't get him to latch... so maybe it was normal?

But then why did he scream all night? We had no idea. We were lost, and upset, and I was scared that because I didn't get skin to skin, I had ruined the bond already. It was my fault.

“If you don’t formula-feed, he will die”

The following day, we'd had enough. They told me he was healthy, and we fought tooth and nail to be able to leave early. The pediatricians told me despite my baby being healthy, if we left, he would die. I KNEW that was wrong.

The only explanation given was that breastfed babies get jaundice easily and, if he got jaundice and we left early, he would die, and it would be our fault. By wanting to leave the hospital after 36 hours, I was apparently risking my son’s life. The decision was ultimately up to the pediatricians and they were horribly rude. When I kept pressing the matter, an older woman pediatrician came in and yelled at me for trying to go above her. All because my baby apparently would die of jaundice. I didn't even know what jaundice was.

In the end, they finally let us leave - but only after giving us formula, giving me the mini pill (and telling me to start IMMEDIATELY) and telling me I probably couldn't breastfeed because I was already 'troubled', and I'd definitely need to supplement. Another prerequisite for us being allowed to leave was if we agreed to take him back the next morning. The same pediatrician who yelled at me seemed gleeful that he had dropped more weight, and said if, by his one-week appointment, he wasn't back to his birth weight, they'd take him and call social work since we were insisting on leaving.

Before leaving, I was shown the football hold, once, and told to twist my nipples. The staff literally meant twisting my nipples around with my pointer finger and my thumb. I'm not quite sure the best way to explain it... ever heard of a "titty twister"? It sounds terribly vulgar but that's what they told me to do, just lighter, to harden my nipples so he could latch. Then they reminded us of the formula and sent us on our way.

Giving formula


The first night home was the epitome of hell. He still wouldn't nurse. I tried so hard and felt like such a failure. Nothing seemed right. Nothing was how I imagined it. I thought it would be a breeze, easy and perfect and simple. I locked myself in the bathroom and sobbed for hours as my husband gave him formula. Our son barely drank any, but he tried anyway. And I cried. I didn't want to look at my own baby. I didn't want to see him, or hear him, or be near him. I didn't care if he disappeared overnight. I didn't want him. I had already ruined him, so what did it matter?

But we made it through. I tried again to get him to latch, and he did for about 45 seconds. And that was it. He was forming big, bubbly blisters on both lips.

Tongue-tie

Shortly after, I got my Zoloft anti-depressants. But we still didn't bond. It was a little more bearable, though. We made an appointment with a certified LC, because I just didn't feel right giving my son formula. At a few days old, we met with her. She checked him over, showed me good nursing positions, taught me different holds, and then informed me that he had an upper lip tie, AND a tongue tie, causing a shallow latch, which caused those blisters... and that nursing would probably be pretty rough until we got the ties cut. We set out to make an appointment for that, but the hospital (same one I delivered at) told us it would be about three months. I felt in despair, like the world was absolutely against me.

But we kept going, and it was hell. There was more formula supplementing and me pumping than anything else. I was pumping 24-30oz a day, though, and I'd put him to my breast when I could. But he would scream and wail and fight and vomit. And I had no idea what to do when he WOULD latch, and it would pinch, and hurt, and he'd nurse for 14 hours straight. I wish that was an exaggeration but it isn't. It happened, constantly.

Retained placenta

When I was close to a month postpartum, I got a fever of 104.3. A trip to the ER revealed mastitis in both breasts, and retained placenta. A few days later I had a vacuum DnC. I got 6 shots to help numb my cervix and I was completely awake for the whole process. I got to watch the ultrasound. I had a female Hispanic doctor and a young Scottish male doctor - I was the first DnC he had seen. The look on his face was priceless, the poor guy seemed shocked. But it hurt, and it hurt a lot. They couldn't even get all of the 'products of conception' out, there was so much, and I had to be given a pill, inserted into my cervix I believe, to force contractions to get the rest of the placenta out. It was frightening.


Then, my son and I promptly developed thrush, and my nipples become sore and cracked, and even began to bleed. It felt like, instead of milk in my breasts, there was shards of glass. To treat the thrush naturally, I chopped up raw garlic and ate it like a pill. I also consumed probiotic capsules emptied into organic probiotic yogurt and rubbed on my nipples. Vinegar and water after feedings... yeah, it was pretty painful.

By this point, my milk supply was down to nearly nothing. I continued pumping, every hour, putting him to breast, every hour. I tried so hard. I drank Mother's Milk Tea, took Fenugreek and Blessed Thistle, ate oatmeal, did a couple of nurse-ins. But nothing worked, nothing helped, he'd scream and wail and vomit.

“You must give him rice cereal”

We visited his ped at his 2 month checkup and were informed that he had reflux. We were told to give him Zantac, and that we had to switch to formula and give him rice cereal at every feed... but that didn't sit right with me. In fact, it only made me more determined. I wanted to scream at her that he was too young for rice cereal, that he'd never touch rice cereal. And man, I was wrong.

Unsupportive husband


Within a few days my husband had enough. He started making bottles the second our son cried, and, yes - putting rice cereal in them. He told people that I was too stubborn to give formula and he didn't like me breastfeeding because it "wasn't doing anyone, any good". We butted heads, big time. This went on for about two weeks. I still put the baby to breast constantly, pumped constantly, took my supplements, everything. But the formula always seemed to win out and it never stopped. It seemed like everyone was pushing formula - "It's not that bad, you NEED to do it," or "YOU were formula fed and you're just fine".

They didn't understand. No one understood! I kept falling into deep depression where I would cry, and yell, and I kept wanting to just punch things. I hated feeling like such a failure. I hated not being bonded with my first child after 2 months. It was WRONG. Something was wrong.

Still no bond with baby


Mid-July we went on a ten-hour roadtrip, where, to my glee but my husband's dismay, I HAD to breastfeed, for three whole days. Our son fussed, and fought, but latched more, as if he could sense my own urgency. He rarely got full, because my supply was ruined, but at least he nursed. But where, where, where was the bond I so hoped for? It wasn't that I didn't love him, I did. I just felt hollow. It was no secret that I was struggling with PND... but instead of helping, or even humoring me, everyone around dismissed me. Told me I was being silly, or stupid, or I shouldn't be a mother.

“You are selfish not to formula feed”

The ENT called us, finally, around 2 1/2 months after he was born. We went in to get it all checked and they... well, they refused to cut the ties. They told me by cutting the ties I would be endangering him. They said his tongue tie was "thick" and he had to be anesthetized to cut it, and cutting it during the appointment would endanger him, yet anesthetizing him would endanger him. So either way, according to them, he could bleed out, or die from anesthesia. They refused to even admit there was a lip tie! They told me it was selfish, why not just formula feed? Not everything was about me breastfeeding after all... and once again, I was crushed. I was devastated.

Resentful and jealous


Two days later, with no milk supply to speak of and a baby who didn't want anything to do with me, I quit breastfeeding. And I sobbed, and cried, all while my son smiled at me. It made me feel worse. I hated myself. The ONE thing I was supposed to be able to do for him without fail, I couldn't do it. I was resentful and jealous of every woman who could. Everyone around me seemed to have it easy. Little to no problems, yet some of them quit just because breastfeeding was 'inconvenient'. Whereas I was doing so much, trying so hard. I kept thinking that it was just unfair, why did I have ALL of these problems yet others, who didn't appreciate that they had it much easier and much more natural than I did, throw away that gift? It didn't seem right. I was wallowing in self-pity. I had expected breastfeeding to be a challenge, but nowhere NEAR as much of a challenge as it's proven to be, and this was my lowest point. I was just livid at the world, and at every mom who had been able to persevere and continue breastfeeding, and every mom who could do it, but gave up.

But that's when it all turned around.

The next morning, I woke up with my breasts hugely engorged and a squalling baby. I had the inspiration to put him back to the breast after guzzling two water bottles, some oatmeal, and my usual herbal supplements. And somehow, for some reason, after I lost every bit of hope... he latched. It hurt, it wasn't perfect, it was shallow, but he latched and began sucking like he never had before. I was shocked, and I cried. I cried so hard. I cried even harder when he unlatched to look at me, and coo, and then latched again by himself.

Right then I decided I would throw every single bottle out if I had to, I would throw the formula out, because I would not give up.

Using donor milk

But with my supply still low, we HAD to supplement. And as luck... or maybe fate, would have it, I found out about Human Milk 4 Human Babies that day. And that day, I decided my baby wouldn't touch formula ever again. I quit the mini pill (saw a near-immediate supply boost!) and set out more determined than ever.

And he hasn't touched formula since that day. In fact, he's only had 4-6 ounces of donor breastmilk a day for the past week (one bottle a day). My supply is finally being rebuilt. I'm taking nettle, Blessed Thistle, Fenugreek, Garlic, Ginger and I'm eating lactation cookies. And while his latch is still shallow, and his ties are still there, we're making it. He nurses VERY often, but he's happy. I'm happy. I mean, we're all happy. Even my husband is supportive now!

And the best part is, we finally got our bond. I don't know when it happened but now I can't get enough of my little one. And I'm so happy, and finally thoroughly enjoying motherhood. We definitely plan to keep this up until HE decides when he wants to wean.

The biggest lesson I have learned is genuinely to not give up. This is probably my single greatest accomplishment, we overcame so much. I'm so proud of it. I'm so proud of US. It was so hard, but it's been oh so worth it, and I would honestly do it all again.”


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Sunday, 27 October 2013

Ironing Out The Misconceptions – The Truth About Iron In Formula and Breastmilk

I’ll be the first to admit it, breastmilk is low in iron (0.2–0.5 mg/L low to be precise). I’ll even concede that over the initial months of life, breastfed babies deplete their iron stores. In recent years, this fact has roused a smorgasbord of media outcry, spewing forth headlines such as: “Six months of breastmilk alone is too long and could harm babies” and “Call for U-turn on when to wean”.

It has been a lactivist’s worst nightmare: apparently, evidence surfaced that was unavailable when the WHO made its 6 months exclusive breastfeeding recommendation – and this new evidence wasn’t good. It suggested that breastfed babies had a greater chance of iron deficiency anaemia, “known to be linked to irreversible adverse mental, motor or psychosocial outcomes” (The Guardian 2011). Image stock photos of babies with pale complexions, sunken eyes and dry nails decorated the pages of news sites and blogs around the internet and beyond. Formula feeders lapped it up, hailing it as “good news for once”.

Unsurprisingly, formula companies also joined the media circus, seizing it as an opportunity to exploit the public’s fears.

Aptamil (owned by Danone) devoted an entire section of their website to iron deficiency.

Competitors to Aptamil, SMA (own by Nestle) undertook a similar tactic.

On the SMA website, it is suggested that breastfed babies may
need supplemented with formula to increase their iron intake.

Now For The Truth:

So has Mother Nature been caught with her panties down? Is iron the one domain where man-made formula can save the day? Well, don’t reach for the bottle (the baby bottle or even the alcohol bottle) just yet. You may be refreshed to hear that rather than being a biological deficit, there is compelling evidence to show that breastfed babies’ lower iron stores are actually an adaptive mechanism – they are a good thing. They are normal. Indeed, they are protective.

The fact of the matter is that many of the bacteria involved in infantile illnesses require iron for growth and replication. By gradually reducing infant iron stores, Mother Nature has limited breastfed babies’ susceptibility to these bacteria. This explains why breastfed babies have a lower frequency and severity of infection.

However, whilst this is awesome news for breastfed babies, it’s a slap in the face for their formula-fed counterparts. For those poor mites, Mother Nature’s adaptive strategy for iron regulation is undermined by the excess dietary iron commonly found in formula. This excess iron promotes the growth of pathogens (read: bad bacteria). This bad bacteria disrupts the synergistic microflora (good bacteria). Result: sick formula fed babies.

In other words, iron deficiency (but not anemia) is a biological strategy for minimizing infection. This mechanism is vitally important for babies because, unlike children or adults, babies shift from a comparatively low risk food (breastmilk) to foods with an increased risk of contamination (solids). With their immature immune systems, babies are at increased risk of contracting novel infections. Thus, by reducing iron stores during infancy, breastfeeding appears to be protective against contracting infections, and, should one nonetheless be contracted, also seems to limit the severity! Nifty stuff!


If we look at this in evolutionary terms and warp ourselves back to prehistoric days, breastfed babies that had lower iron stores at the time of solids introduction were likely to survive on account of having limited iron available for the bad bacteria. Thus, from the perspective of natural selection, breastfed babies’ lower iron stores and their consequently reduced risk of dying from infections, provided positive selection for reduced iron stores. Babies are supposed to have gradually diminishing iron levels. They evolved that way for a healthy purpose! Conversely, the contemporary fortification practices often boasted by formula companies with their fancy “high in iron” claims are, in reality, mismatched to this evolutionary adaptation - they contain an excess of iron. The continued accumulation of iron in formula fed babies combined with the introduction of solids contributes to the increased risks of infection found among formula fed infants (Quinn 2013).

This correlates with past studies which provided evidence that decreased iron intakes appear to be beneficial to infants without increasing the risk of developing iron deficiency anemia. For instance, among babies in Honduras and Sweden randomized to different concentrations of iron supplementation, the babies with reduced iron intake had lower rates of infection and greater head growth than supplemented peers (Domellof et al., 2001).

Formula and Iron: The Risks Examined


If we look at the iron-related risks of formula feeding more closely, the facts can only be described as worrisome. Formula fed babies have a significantly higher likelihood of iron overload - whereby excess iron is absorbed by the baby and accumulates in tissues. This can lead to tissue damage which increases the risk of a wide range of disorders. For example, iron accumulation in neural tissues is linked to the development of Parkinson’s Disease (Youdim et al., 1991), Alhezimer’s (Castellani et al., 2007), and metabolic syndrome (Psyrogiannis et al., 2003). In children specifically, exposure to high levels of dietary iron is associated with decreased linear growth (Dewey et al., 2002), decreased cognitive performance (Lozoff et al.,2012), and altered immune function (Wander et al., 2009).

Looking at the intestines specifically (because many infections in babies begin in the GI tract), the presence of unused iron provides sustenance for bad bacteria to thrive. This reflects recent studies which show marked differences in the composition of the intestinal microbiome between breastfed and formula fed infants.

But wait, aren’t our bodies designed to absorb all the nutrients we need and then expel (read: poop out) the rest? To a certain extent yes, that is true. However I say ‘to a certain extent’ because although a baby’s iron absorption does indeed decrease when iron stores are plentiful, it does not cease completely. Babies have underdeveloped iron uptake regulatory mechanisms and continue to absorb considerable quantities of iron despite sufficient iron stores.

'Lactoferrin' - my bessy mate.
Perhaps even more interesting (or worrying, if you’re a formula feeder), is the fact that iron stores are distributed differently in breastfed babies and formula fed babies. Breastfed babies have normal distribution of hemoglobin, whereas formula fed babies have a skewed distribution (Domellof et al., 2002). Why does this occur? Again, it’s due to the awesomeness of breastmilk. Human milk contains a protein called lactoferrin; this protein plays a very important role in regulating iron uptake. It binds to excess iron, making it harder to absorb. But wait, there’s more! It also binds to the cell membranes of bad bacteria, destructing the cell! So if a breastfed baby has been infected with bad bacteria, the presence of lactoferrin means that they will fight the infection faster. And, as the iron concentrations in their guts are low, they are unable to support large colonies of iron-requiring bad bacteria. Mother Nature is a smart gal after all. The beauty of breastmilk is more comprehensive than commonly thought. Likewise, the risks of formula feeding seem far greater than we had imagined.

What Does This Mean For Weaning Age?


By ‘weaning’ I am referring to the introduction of solid foods into a baby’s diet; this introduction (whether baby-led finger foods or spoon-fed mush) is a physiologically dangerous time for babies. Archaeological records contain numerous examples of deaths occurring around the time of solids introduction (Turner et al., 2007; Wright and Schwarcz, 1998). This is the time period when babies' exposure to pathogens will increase greatly. The WHO (The World Health Organization - not the 60s English rock band) currently recommends waiting until 6 months before giving solids to your baby. However, baby food manufacturers, greedy for evermore profits, prefer a lower limit, stating “from 4 months” on their packaging. If we consider the science about iron discussed above, when should we be introducing solids to our babies? Recent news reports have cited lower levels of iron in breastmilk as a reason to wean early - earlier than the WHO recommendation.

Who is right? You may ask.

Well you’ve just answered the question yourself, silly! WHO is right. Babies – breast or formula fed – should be offered solids no sooner than 6 months. Now, you may be confused, thinking, ‘Really? Wait until 6 months, even when breastfed babies have lower iron stores?’ Yep, and here’s why: a healthy baby is born with sufficient iron stores, accumulated prenatally, to last them until 6 months. So by the time he reaches this age, his iron stores are low, and as we have discussed, low levels of iron at the time when solids are introduced are beneficial  - they reduce the risk of illness (Quinn 2013). Mother Nature has struck a delicate balance between, on one hand, ensuring babies have sufficient iron requirements for growth, whilst on the other hand, being careful not to provide a ready source of iron to pathogenic bacteria. Genius. Then, by the time babies are older and consuming a range of iron-rich foods, they have more mature GI tracts that are more resistant to infection.

Conspiracy?


So why were the lower iron levels of breastfed babies presented to the public as pathological? Why weren’t they celebrated as the defence-mechanism that Mother Nature designed them to be? Perhaps the science was negatively skewed because of the common misconception that more iron means better health (‘the more – the better’ fallacy); or alternatively, perhaps exploitative formula company marketing is to blame; or, on the other hand, perhaps it was an innocent methodological mistake on the part of researchers who have, until now, failed to look at the evolutionary context – a context that would have revealed why low levels of iron evolved in human milk, and the effect of this on infant physiology.


Or maybe, just maybe, the low levels of iron in breastfed babies has been negatively framed because the study which suggested it was written by an author who had received hefty cash payments from several pharmaceutical companies that make iron supplements. I’ll let you decide.

Tuesday, 22 October 2013

Triumphant Tuesday - Resisting That Formula Sample

While nearly all mothers start breastfeeding their newborns, around half will quit after just a few weeks (Pediatrics 2013). First time mothers are especially likely to quit. Formula companies know that the first few weeks of a baby’s life are crucial in terms of netting long-term consumers of their products. If they can seduce a mother during her vulnerable adjustment to new motherhood, it is likely they will have her custom for at least 12 months - and that’s a significant amount of wonga!

This mother's story illustrates the vulnerability of new motherhood and the illicit temptations that can lie in a formula can.


“I knew I was going to succeed at breastfeeding, simply because I had decided I would.

Placenta previa and premature labor 

I had a lot of problems in my pregnancy. I had very bad morning sickness, and then at 12 weeks, after a bleeding incident, I was diagnosed with placenta previa and put on pelvic rest. At 33 weeks I went into labor. I was one centimeter dilated with contractions two minutes apart.  I was put on a magnesium sulfide drip for 60 hours. It was torture, but worked to stop the contractions. I spent five nights in the hospital on complete bed rest, catheter and all.  I was released and put on the drug procardia, one pill exactly every eight hours. Procardia is a heart medicine, but it's off label use is to prevent contractions.

The next day, after four doses of procardia, my husband noticed that the name of the drug on the prescription bottle was not procardia, and the patient's name was not mine. I still can't tell you why I didn't notice this myself. So we rushed straight back to labor and delivery so they could get with the pharmacy and investigate what exactly I was taking and had it harmed the baby. It turns out the drugs were correct, the pharmacy had out the wrong label on the bottle, thank goodness. While I was in the hospital, it was discovered I had a urinary tract infection. So I was given an antibiotic along with my freshly labelled procardia, and was sent home. Not a good start to my relations with health professionals.

All that night and the next day I had terrible back pain and a fever. It was so bad I thought I was in labor. But that next afternoon I had a follow up appointment at my obgyn so I waited to see her. When I got there she discovered my uti had spread to my kidneys. She sent me straight to the hospital for IV antibiotics. It was my eighth consecutive day of spending sometime at the hospital.

I was ordered to be on strict bed rest and to keep taking the procardia.  I made it to 37 weeks! I got off bed rest and even went back to work for a week. By 38 weeks I was four centimeters dilated and my water broke while I was at work.

Drugged birth = dosy breastfeeding


After 12 hours of overnight labor I started to feel a little uncomfortable and the nurse offered me an epidural. I said the pain wasn't that bad yet. So they offered me some other drug. I don't know what it was but they said it would make me loopy and not care about the pain. And that's exactly what it did. I did not like the way it made me feel and I would not take it again.

Around 8am the real pain started. I thought I was dying. I wanted the epidural and I wanted it now! When I got it, it was immediate relief. My doctor did a check on me and I was 8cm. After the epidural I fell back asleep. I woke up to my doctor telling me I was 10cm and it was time to push. It was 10am. At 10:12 Anders was born. It was almost too easy.

Within minutes of my son's birth I said 'its time to breastfeed.' And he latched on and nursed. I thought, this is going to be easy!

But I was still numb everywhere from the drugs, and didn't realize he had a bad latch. A very bad latch.

When all the feeling returned to my body it was too late. One of my nipples was bleeding and scabbed up. The other was what can only be described as one giant bruise. I think initially he only had latched onto my nipple rather than the areola. It felt like he was sucking so hard. I dreaded feeding times. It was too painful to nurse. It was toe curling get-him-away-from-me pain.

Finger feeding


Luckily the nurse helped me through it. She literally milked me like a cow. She hand expressed the collastrum from my breast. I felt relief when I saw those little drops come out.  I then put those precious drops on my finger tip and fed them to my baby. I pumped every two hours to stimulate my supply. Whatever I pumped, I finger fed to my baby.

Fever

Two days later I went home. My nipples were still cracked and bruised. But I no longer had the hospital’s breast pump. I nursed and sobbed. I nursed and screamed. My husband was scared. When my milk came in - it really came in.  I had the biggest boobs in the history of boobs.  It made it even harder for my baby to latch on. I ran a fever. I’m not sure of this was because I had mastitis or just because I very badly engorged.

Formula sample

And then.... the formula sample mysteriously showed up in my mailbox. I don't know how the company found me. But they did.  A six pack of pre-mixed formula bottles. I didn't throw it out - I'll donate it, I told myself.

But every night at 4am when my engorged breasts were throbbing and bleeding and my newborn was screaming and hungry, I thought about that six pack. It was calling my name. "Your baby is starving," that six pack yelled at me! My husband, bleary eyed and desperate, even reminded me we had it in the house. I ended up receiving three in those first few weeks! If I had to guess, I would hypothesise that got my information from Target, where I was registered.

But I stayed strong. I rented a breast pump and almost exclusively pumped while my nipples healed.

Slowly I added nursing sessions back in my routine. By 10 weeks I was almost exclusively nursing straight from the breast.

I never touched that six pack. Breastfeeding has become that easy thing I thought it would be. I could not imagine quitting now, after all the hard work. My goal is to make it to his first birthday.

That six pack still lives in my house. Maybe someday I'll donate it. But for now I like to pass it, give it a smirk, and think about how I won.

I think it's terrible when mothers don’t try to breastfeed. The people that shock me most are the ones who had an easy time breastfeeding and quit after a few months. I want to scream at them, don't you know how lucky you are! Don't you know what some people had to go through to get to that point!”



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Monday, 21 October 2013

Child Diagnosis Diagrams

Have you procreated a child? Does that child ever get ill? Then by Jove, you've come to the right place!

If your child displays symptoms of an illness but you are unsure what has caused them, this visual resource can help. The following collection of diagrams looks at different parts of the body and lists symptoms common to babies and children. Problems affecting the skin in general, such as rashes, are also included. Because it's impossible to give a definite medical diagnosis from only one or two symptoms, these diagrams instead help you to make an educated guess as to the possible cause (if your child has more than one symptom, look up the major one first). By clicking to this page, you've brought diagnostic information, quite literally, to your fingertips!







Note: this resource is, of course, not designed to replace your physician's guidance, but rather, is an accessible complement to it. Bookmark or Pin this page for future reference.

Tuesday, 15 October 2013

Triumphant Tuesday - Breastfeeding a Baby Born Without a Nose

Many babies are born with facial deformities. For instance, did you know that every year, one in every 800 babies born will have a cleft palate (Cayuga Medical Center 2013). Often their mothers, understandably, need specialist support to enable them to breastfeed successfully. Yet as their scenario is atypical (being a 0.1% minority), such specialist support is hard to come by.

Now, imagine that your baby is only 1 of 37 in the history of the world to be born with a specific facial deformity! That’s exactly what happened to the mother in this week’s story. Unbeknown to this mom, as her water-birth reached its climax and she lifted her brand new little one out of the pool, it was discovered her perfect baby girl had not developed a nose. How could this little girl ever manage to breastfeed with her mouth as her only airway?



“It was the 14th of February. St. Valentines Day. I had just achieved the birth I had been dreaming of. A vaginal birth after 2 cesareans or VBA2C. A Valentines VBA2C! A water VBA2C at that, with nothing but gas and air …And I should have had my moment, the moment I missed out on with my two previous babies, the moment that I see immortalised in so many birth photographs – the moment you first meet your baby and lift them on to your chest and the two of you melt into each other. My ‘I did it’ moment, my ‘my body isn’t broken’ moment ….but what happened was quite different. Let me tell you my story.

My daughter, I call her ‘T’, was born without a nose. She has what’s known as Complete Arhinia.

Totally unexpected

Despite concerns about her facial profile at our 20 week scan and subsequent amniocentesis, no-one was expecting this. So when I lifted my tiny miracle out of the water and the medical team saw her face, alarm bells, literally, started ringing, and people started shouting… and people started running… and people started crying. The midwife, hastily, severed her cord and whisked her away before I could even speak. To say it was traumatic would not do it justice. My whole world had been snatched from me and I was reeling …and bleeding, as it happened, and alone in the pool. As moments go, I wish someday I might forget how painful that one was.

Taken from me



When T began to breathe and stabilised (her cord should never have been cut as it was supplying her oxygen, but that’s for another rant) I was allowed to see her for one brief cuddle (see photo) before they took her to NICU.

I wasn’t able to feed her. A baby needs two airways to breastfeed. The cruelty of it cut me like a knife. I was a breastfeeding advocate, activist even. I was still breastfeeding her big sister, ‘Miss C’, who had just turned two, I had a painting of myself breastfeeding Miss C hanging in my living room, I had attended conferences, I was training in breastfeeding support to help other mothers, I write breastfeeding poetry for crying out loud!!  Breastfeeding was a huge part of my life and here I was with a baby I couldn’t feed. It felt like the cruellest joke, it was hard to believe.

To be honest, the shock of everything and the physical aftermath of a long labour and jarring emotional trauma, means that I’m a bit fuzzy on exact events for the following 48 hours, but what I do remember is how broken my heart felt. I remember being in the room that night after my husband had gone home to my other two babies, who were just two and three years old. Being alone in that room. Alone and empty.  I remember crying so hard I couldn’t breathe and I remember how it hurt not to have my baby, how it hurt not to know if she was, or ever would be, alright. The pain inside was so raw, so heavy, I didn’t think I’d ever recover.

It was shocking


When they wheeled me down to NICU to see her, it was shocking! As I’m sure it is for every mother who has to see her new born baby lying behind a plastic wall with wires and tubes coming out of them. Her face, the face I love so deeply and completely now, looked strange to me then, although the layers of tape holding her breathing and OG (oro-gastric) feeding tube in place, didn’t help. I was so scared.

I was scared for her and for me and for what this meant. My head hurt with questions; Would I love her enough? Would she be ok? Would I ever be able to feed her? Would I be able to cope? Would anyone else ever love her? Would she forgive me for leaving her in that box with strangers every night? Would she ever be happy? Would I?  The list seemed endless. Of so many things, I was scared.

A miracle

I cried while the consultants explained what they could about T’s face. They admitted they had never dealt with, or even seen this condition before. We were told that a total of 37 cases has been recorded in medical history.

Thirty seven.

That’s historically. Worldwide! T was a miracle.

That feeling of being alone was magnified with this information. We were very alone. We were, 1 in 500 million, alone. There was no website for this, no support group for us, no charity championing our cause, no glossy leaflet about what to expect.

Healthy and normal


I was only allowed to hold her briefly every couple of days due to the strict ICU staff. On the positive side, I got some good news - tests revealed her brain and heart were healthy and normal, (apart from one small hole in her heart that we were told was not uncommon and not to worry about). And initial genetic tests showed a normal karyotype and no evidence that T had any known syndrome. It was just the news I needed and I clung to that information while doctors scrambled to provide us with any other insights.

I cried when they explained that she would need a tracheostomy (a surgical procedure where the surgeon creates an opening in the neck at the front of the windpipe) so she could breathe while sleeping and eating.  A tracheostomy would require huge amounts of care, it would mean I wouldn’t be able to hear her cry or coo or giggle. It would mean a huge change to our family life and much less freedom. I couldn’t imagine how we’d cope and I was sure you couldn’t breastfeed a baby who didn’t have a nose and breathed through a hole in their neck. It was devastating news, any hope I had was disappearing.

Breastfeeding – theoretically possible


...But I was wrong, finally one consultant said she couldn’t see why we wouldn’t be able to try, at least, and some further research proved that we had every reason to be hopeful. It took a little digging, but I did find a short thread online discussing breastfeeding babies with trachys. It was theoretically possible. We would just have to wait and see if T’s sucking and swallowing co-ordination were up to the task. Until then she would be tube fed. I was told to take comfort in the fact that she would still be getting my breastmilk. It was a small consolation but I knew where she needed to be and every cell in my body ached to feed her.

I expressed my milk for her. I found the pumps kept causing me pain and I already knew how to hand express so that’s what I did. Quite quickly I established a good supply. I continued hand expressing every 2-4 hours. I couldn’t bring myself to leave the hospital without her so I stayed in a family room in the ward. Walking down the corridor at night to make a milk delivery was so important to me. It was the least I could do.  Walking back to my bed without her never got easier.


The operation

She had her tracheotomy operation when she was 8 days old. I felt sick to my stomach the whole time, but by now I was anxious to have the procedure done as it would mean she would get out of the incubator and that the large intubation tube, that was so crudely taped to her mouth, could come out. It meant we’d get to see her sweet little face. She was admitted to PICU (pediatric intensive care unit) following her operation and…

...and there she was:


I could see her and kiss her little lips and hold her tiny body. And of course I hoped against hope that I could feed her.

The staff wanted her to recover from surgery before attempting to breastfeed so I waited.  I was now allowed to hold her, so much of this waiting was done while she slept in my arms. How much faster the time went now I was holding her. It felt amazing, I never wanted to put her down. It was so healing and not surprisingly my milk supply took a giant leap. Oxytocin for the win!

The first breastfeed


When we did get a chance to try a breastfeed, it was awkward and tense. I was terrified of hurting her by pushing on the trachy, which, as she was so small, came out further than her face. Positioning was difficult and circumstances were far from optimal. Sitting in an upright, armless chair, watching this wire and that one, trying to get her face close enough to latch without touching her new neck accessory with my swollen post-partum breasts. It’s no wonder we struggled. I told myself to give it time, that it was to be expected after this long being tube fed.

After much fumbling and failing, late at night on her 10th day in the world, we did manage a latch eventually and we celebrated our first breastfeed! It was a moment I will treasure forever.

“She’s doing it, she’s doing it” I whispered to a nearby nurse, not daring to breathe or move in case the magic stopped. We would struggle to repeat this moment in the coming days and weeks but every now and then it would happen and my world would feel right again. They were scattered moments of bliss throughout some of the worst days of my life.

Tube and bottle feeding

It would take us another 4 weeks of OG tube feeds and 3 more of bottle feeds before our dreams of exclusive breastfeeding became a reality.

T struggled to latch. Every path I knew to get a baby to the breast was blocked by obstacles and despite having the most amazing support network any woman could ask for, (outside of the hospital I might add) the whole situation felt impossible.

Staff attitudes were a huge stumbling block. I’m not sure whether it was because they had no idea what a baby like T would ever be capable of or if the indifference was endemic, but breastfeeding was certainly not a priority and I felt that my requests for extended periods of privacy or time to try to breastfeed were seen as an inconvenience by many.

Biological breastfeeding in a laid back position, which is known to stimulate baby’s natural reflexes to root and latch, was impossible as her trachy came too far out in front of her chin and chest. Laying her on my chest just couldn’t be done. Besides I was never given anything except a ridged, armless chair in which to try.

She vomited at least every other feed and I was told that until she put more weight on that the tube would remain in place. Of course this severely hindered any attempts to breastfeed since the poor girl had to try with a tube taped to her mouth. Taking it out to try would mean it would need to be re-inserted in time for her next  tube feed and since passing a tube down her throat made her gag and often vomit it all seemed like a catch 22 situation. It left me conflicted and confused. I didn’t know what to do for the best. Usually a feeding tube would be passed through the nose as it is generally less invasive. Poor T didn’t have that option.

I did manage to get her out of the incubator by causing some fuss and insisting that if there was no medical need for her to be in there then I wanted her out. But they wouldn’t let us out of NICU even though her medical needs were minimal and she was breathing room air (albeit through a hole in her neck).

Physical contact discouraged


So in a corner of a busy intensive care unit with babies being kept alive on machines and IV’s my baby girl slept in a cot and her mumma attended to her every need throughout most of the day.

Skin to skin, or kangaroo care, which studies have proven to help babies thrive by reducing stress and helping regulate temperature and heart-rate, not to mention increase milk supply, was never encouraged. Actually if I’m honest it was actively discouraged. In fact, despite a shelf full of leaflets purporting its benefits in the family room, during my 5 week stay I did not witness a single act of skin to skin by any other mother.

My own attempts were awkward and half-hearted as staff made their feelings clear.  “MINIMAL HANDLING RECOMMENDED” was written in her notes. This was due to her supposedly not “tolerating her feeds” and the belief that “handling” her would cause her to vomit more than she already was. I was incensed by this and, over the course of the next weeks, gradually fought (when I had both the mental and physical strength to) for more and more contact with my baby, until I was in charge of nearly all her day-to-day care. I learned how to tube feed her, how to suction her trachy, changed all her nappies and expressed day and night.

Supplementation without consent


Although a healthy, if not huge, 6lb6oz at birth, her rocky start and having had surgery, meant T was slow to put weight on. I was asked, repeatedly, to consent to high calorie fortifier, (which had actually been given in her first week without my knowledge or consent until I discovered it and quickly and vocally made my displeasure known. I had been clear that nothing but breast milk be given and this was a major violation for me). I wanted absolutely no foreign protein in her diet and was trying to remain confident that my milk was sufficient just as it had been for my other two babies.

Then there was her terrible reflux or ‘not tolerating feeds’ as they put it. Their solution was to add thickener and again I had to deny permission on several occasions and to several different medical professionals. I felt if they would only allow her to feed upright, rather than flat on her back, (as per hospital policy) that maybe, just maybe, she wouldn’t throw up quite so often. They also wanted her on three hourly feeds but this meant bigger volumes and a higher likelihood of vomiting. When I explained that my previous breastfed babies would have fed more often than every three hours in their first month I was told that it “was not sustainable no matter how good a mother you are.” Well that was me told.

Barely hanging on

The hospital stay was gruelling and I was being worn down by the pressure and stress of everything and my confidence in myself was waning. I often broke down when I let thoughts of what the future might hold for us, creep in. I still cried every night when she wasn’t with me. I couldn’t stop my tears when I was told of her multiple eye conditions and that she had little hope of ever seeing out of her left eye. It was a lot for anyone to cope with and I was barely hanging on.

After weeks of frustration and sporadic successful short feeds at the breast, one consultant declared that “T’s feeding was what was keeping her in hospital”. I had to make a choice and by this stage we needed out of hospital so badly that I switched all my efforts from trying to get breastfeeding established to simply getting her weight up sufficiently to get her discharged. I insisted on tube feeding her in an upright position on my knee and held her up for hours afterwards to keep her milk down. Even feeding her in a wrap on occasion. It worked and her weight gain improved - proving that neither fortifier or thickener had ever been truly necessary and finally after 5 weeks in ICU, we were going home. I was terrified. And happy …but mostly terrified.

Getting T home to her big brother and sister was a truly beautiful moment for me. To finally have my babies all in the same place was a powerful tonic. T was finally where she belonged; Home. I felt the pressure of the hospital slowly begin to lift.

Against motherly instinct


I struggled through 4 days and nights of truly exhausting tube feeding at home. It went against every motherly instinct I had, and now free of the hospital, I was beginning to regain some of my lost confidence. It required so much effort and watching her arch and cry in pain as soon as the milk began to flow down the tube was wearing away at my soul a little at a time until finally, on the 4th night at home, after T had just thrown up an entire feed that had taken me nearly an hour to administer, I had had ENOUGH.

What was I doing? What was I doing to my baby? I asked myself over and over. Why was I putting her and me through this? When I knew in my heart of hearts that she was capable of breastfeeding? There had to be a better way. I was the kind of tired that makes your insides shake and sitting on the edge of my bed crying into my hands and the only thing I knew for certain was that I wasn’t putting that tube down her throat again. We would try anything but not that. Not again……..

That night after about 20-30mins she latched and fed and I sighed and tried to enjoy it and to not think about what tomorrow would bring.

I never did put that tube back in.


I soon discovered that T would take my milk in a bottle easier, as she was having real difficulties actually latching onto the breast, despite much rooting and a strong urge to suck. When my good friend and LLL (La Leche League) leader came to help, I showed her how T would root like crazy, back and forth over my nipple, but not open her mouth and latch. Pressure on her chin didn’t work, it was impossible to get her to open her mouth enough.

The role of scent in breastfeeding

Watching her with a bottle we could see that her suck reflex was triggered as soon as the teat reached her soft palate. The problem was, you can get a bottle into a baby’s mouth without their participation. This was not the case with my nipple! We wondered if not having a sense of smell was hindering T’s efforts and decided that perhaps we need to re-asses how important a role, scent and smell play in breastfeeding.

Baby-wearing to aid breastfeeding


We still occasionally got lucky and she would feed from me. I began using the bait-and-switch method. I would get her to begin sucking on her bottle or dummy and try and quickly swap it for my nipple. The exaggerated latch or ‘flipple’ technique helped too, as did trying when T was sleepy. I often wished I had an extra set of hands, as T latched best while I was walking and I still had to make sure not to push on her trachy, and we’d have to stop regularly to suction her tube. My trusty ring-sling came in very useful. Each latch took an average of 20mins to achieve. I’ve honestly never worked so hard in my life. Every success felt like the Holy Grail, like climbing Everest, like my Sistine chapel.

The failures hurt in a place deep inside. They were more than failures, they were rejections. The agony of holding your own baby, offering yourself and being rejected was painful on a cellular level. When I had tried every position and trick I could think of, I would sink down into the chair, give T the bottle it felt like she was crying for, and dry my tears until it was time to try again.

The days seemed so long and were only possible due to the incredible support of my extended family. They cooked, cleaned and looked after me and my toddlers, while I dedicated my time and efforts to our newest member. I will be forever in their debt for the way they cared for us during that time…… then something happened that strengthened my resolve to continue -something so wonderfully powerful that I believed we could move mountains every time it happened…

T started smiling! She started and did not stop!

 


Slowly, (agonisingly slowly to me) the tide began to turn and we had more successes than failures, I remember realising one day that T had had more breastfeeds than bottle feeds. It was just the sign I needed, I was spurred by our milestone and so we continued to work hard, and my family continued to keep my household running, and T continued to thrive!

Exclusively breastfed!


Unbelievably three weeks after being discharged from NICU, fully tube fed, T was EXCLUSIVELY BREASTFED!! She was eight weeks old, and I no longer had to express milk or measure feeds. I was done with tubes and over bottles. We had made it. We were living our impossible dream. Our baby, born without a nose, who breathes through a tracheostomy is still exclusively breastfed at six months. She made it without fortifier, without thickener, without formula. She thrived without introducing solids early or weaning my toddler. I believed in her and in my body’s ability to feed her. I believed in breastfeeding and it came true.

Tandem feeding

We even celebrated our first tandem feed recently with Miss C (T’s trachy had previously made positioning tricky for tandem feeding). Another amazing moment that I never thought we’d get to experience. I was so proud of us and so full of love for my babies, it was beyond anything I had dared to hope for.


We would face more challenges in the coming months including, a traumatic surgery on her eye, that caused her weight gain to slow and subsequent pressure from our dietician to offer solids and or fortifier again. But we held firm and now at six months she is back on her original centile line, has met every milestone and continues to develop normally in every other way. She brings so much happiness and love to our lives, we can’t imagine life without her.

Our consultant is planning to de-cannulate T (remove tracheostomy) before her first birthday and any nasal construction will likely not be until she is a teenager. There is still much uncertainty about the future and our options regarding her face but these last months have shown me that she is stronger than we could have ever hoped and that with the right support, sometimes things aren’t as impossible as they seem.”



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