Tuesday, 11 March 2014

Triumphant Tuesday - Breastfeeding With Hypothyroidism and Postpartum Depression

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

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


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

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

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


The birth

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

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




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

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


Refusal to latch


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

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

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


Jaundice


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

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


Sinking into depression


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


The bottle


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

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


A love-hate relationship

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


Supply issues


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


Quitting

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


Formula and projectile vomiting


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


Depression intensifying

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

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

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

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


One last chance


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

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


Power pumping

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


Not out of the woods


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

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


Recovery from depression

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



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



Regrets

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



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