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I was always going to breastfeed – Jo-Anne’s story

Posted on November 14, 2008
Filed under: Caesarean/cesarean birth, Engorgement, Expressing, Inverted nipples, Latch problems, Nipple pain, Nipple shields, Oversupply, Premature baby, Tounge tie, Tube feeding

I was always going breastfeed. It was just how babies were fed. At least that’s what seemed to happen in my family. I distinctly remember various aunts and cousins breastfeeding. So while being pregnant was a major surprise the fact that I would breastfeed wasn’t. I did lots and lots of reading and researched breastfeeding and all looked good. I was all set to join the breastfeeding assocation and do a breastfeeding education class.

However then it all went wrong. With my first pregnancy I had a complete placental abruption. Basically my placenta fell off and our little boy died. He was 36 wks gestation and just lovely. It was a hard to cope with and made even harder by my first experience of lactation – which was to suppress it. Most people that have such a huge bleed don’t even get their milk in. Mine was there in buckets.

Life settled a bit and I became pregnant 6mths after Liam’s birth. Due to my history and Liam being 36wks I booked for an elective caesarean at 34 weeks plus 6 days. This of course would result in the baby going to the Centre for Newborn Care (CNC). Not that I really cared about that but it was going to be odd given that my husband worked there permanently and I also did casual shifts there.

My booked LSCS (lower segment caesarean section) was on time, a blessing for someone who doesn’t do the whole fasting thing very well. I tend to get very cranky. I had a spinal – similar to an epidural. That went well pain/feeling wise. Although the wardsman seemed to think bending over a baby wasn’t difficult and wanted more bend!! The block went right up to my arm pits, making it quite difficult to breathe. Oliver was fine as he came out and I was able to see him briefly. My husband whisked him off to the isolette to keep him warm (with stories of cold babies ringing in our ears) and off they went to the CNC.

I took a while in recovery as the block just wouldn’t go. My left leg was numb for 8hrs. I went back to the ward via the CNC. I couldn’t believe my eyes that there was Oliver. I had wanted to get him out for a breastfeed but he was having problems breathing and was needing O2 and in an isolette. Nothing unusual for a LSCS and a boy. Visiting the CNC post delivery was fantastic. There is nothing worse then arriving in your room post delivery with no baby.

Back on the ward the midwife got me to express. Well that was fun: lying slightly propped, so bombed on pain relief I couldn’t focus or speak without slurring, trying to capture colostrum. Most of it ran down my hands but we got a bit and my husband Mick took it up to the CNC.

The next day I went up to the CNC in a wheelchair. I had given up on the IV pain relief by that stage, so I could use my brain. Oliver was looking much better, off O2 and in an open cot.

So we had a go at breastfeeding. Trying to attach a very small baby (he was 2.4kg) was tricky and time consuming. He had no idea and didn’t think a nice wide mouth at all necessary. It also turned out he was just too small to suck hard enough to draw out my inverted nipples. Luckily for me there was a lactation consultant on. She came and assessed the non attaching feed and suggested using nipple shields. Once I started using nipple shields it all fell in to place. Oliver was able to attach and suck well. It was certainly not comfortable feeding, in fact down right excruciating would be a good term. Sucking basically rips all the tissue attachments that keep the nipple in. I screwed up my toes and breathed deeply. Feeds hurt the most at the start and then settled to a dull pain which I could cope with.

I found feeding problematic in that it was hard to get everything organised post caesarean – pillows, baby, the towel to catch vomits (his) and leaks (mine and his), nipple shields (those things are tricky to get on and then just as you’re ready they fall off). The lack of privacy didn’t help either. My top was always in the way and really I would have liked to just get rid of it. Nevertheless once I was set Oliver fed well. He was getting more than enough milk, even though it took an hour each time. Oliver also vomited lots. He had reflux and didn’t like formula. Once I had enough breast milk happening the volumes of his vomits decreased. I later discovered that he didn’t tolerate cow’s milk anyway. Custard, cream, cow’s milk all led to vomiting.

To start with Oliver only breastfed twice a day because it he was too tired to do more. Being under phototherapy for 24hrs didn’t help either. To start with Oliver breastfed once in the morning and once in the evening – as far apart time wise as we could manage. The rest of the feeds were via the nasogastric (NG) tube, a tube through the nose into the stomach. I expressed each time he didn’t breastfeed and was having a hard time keeping up with the volume required. Babies in the CNC receive set volumes calculated on the baby’s weight. It is very disconcerting to know exactly how much milk you need to produce. And the likelihood that you will immediately produce this much is very slim, particularly with first time breastfeeders.

Expressing was a bit of a shock too. I seemed to need to express every time I turned around. I’d go and visit Oliver and need to express, I’d finally make it back to the ward only to realise I needed to express. I was OK up in the CNC as the expressing room was quite close. However on the ward the room where the pumps were kept was way down the corridor. Then the pump had to be returned after use in case someone else needed it. It all turned out to be an awful lot of exercise for someone who was supposed to take it easy post caeser. Then of course was the added extra that I’m sure those pumps were an instrument of torture. For the first time breastfeeder the suction on pumps is so strong. I couldn’t turn it down far enough and so gritted my teeth and screwed up my toes again. A lesson on how to hand express to start with wouldn’t have gone astray. I had a picture of Oliver to have with me when expressing. Although I think the pain associated with pumping probably negated any good psychological effect the photo may have had.

Of course once I really got into breastfeeding I could have used a pump with suction twice as strong. I remember shocking a newly breastfeeding mum with turning the suction and rate right up before I’d even started. She didn’t believe me that she’d get there too.

I spent most of my day in the CNC. It was easier then going up and down and doing lots of walking. I would nurse Oliver and read in between breastfeeds and tubes – tubes being feeds via a tube into Oliver’s stomach. The CNC was busy as usual, so I did most of the NG tube feeds. I mean I’d had the practice before. I also took Oliver down stairs with me frequently. So much so that the other parents were questioning why I could do that and they couldn’t. They didn’t seem to understand really that we both worked in the CNC and it really did make a difference.

The expressing room was also an eye opener regarding what the parents knew about babies other than their own. Basically they knew most of the information that they could understand – and all this with out having asked the babies parents. Also there was a lot of gossip and discussion about how stupid it was they couldn’t look at other people’s babies and had to leave during handover. There was no recognition of confidentiality at all. It wasn’t all mothers but a majority. I just sat and listened and got out quick.

I was discharged on day 6. Oliver stayed for 14 days. We could have taken him home a bit earlier but I had a panic attack about coping with breastfeeds and tubes and expressing.

Once I was discharged I got lifts back to the hospital and stayed until someone could pick me up. My husband Mick had gone back to work at this stage so I would go in with Mum at 8.30 and come home with Mick at 9.30pm when he finished his shift. Between not being able to drive and trying to get in enough suck feeds so we could go home I ended up staying at the hospital for 14 hrs a day. Not very restful. I would however manage to fit in 3-4 breastfeeds each day. To go home with the neonatal early discharge program the baby needs to have 4 sucks feeds and the parents be taught to do the rest with tubes. The tubes weren’t an issue but those breastfeeds were hard to get in. I could have agreed to a bottle at night but I really wasn’t keen to do that. I can see that if I had other children at home I may have gone with that option in order to get home though.

We were booked in with early discharge program. They would come and do 2 tubes a day, check and weigh the baby. It’s a brilliant service and means you get the baby home much more quickly.

Finally on a Tuesday I had had enough of being in hospital and at work with my baby. We were booked to go the next day, that being when early discharge program could fit us in, but I wanted out NOW. Mick was on a morning so finishing at 3.30pm so we went home with him. I was lovely to be at home. Straight away everything was easier. I was able to do alternate tube breastfeeds that night. The only unfortunate thing was when my milk came in there was masses of it. So I still had to express once I’d breastfed.

Having to breastfeed or tube and express every 3 hours was mind numbing. I had a sheet of paper with feed times, which side and how much, written down. Otherwise I had no idea what was happening. The alarm clock was also a life saver. Once Oliver was only having the odd tube feed things were a lot easier. I wasn’t so tired and just breastfeeding meant a lot less cleaning, sterilizing etc.

Oliver was a keen breastfeeder and we got the hang of it reasonably quickly. I had masses of milk so I never had a low supply issue even though I used nipple shields for 4mths. In fact he was such a pig he would vomit because he drank too much and then vomit from his reflux. Very very messy and meant lots of clothes washing. After a week we did away with the NG tube. Oliver helped by pulling it out. He continued to grow well and we were discharged from early discharge program.

My next baby Sophie was a different ball game.

With my 2nd pregnancy I had used a manual pump to express at home and I wasn’t going to do that again. So very early on I found out about hiring pumps. The person I spoke to suggested expressing prior to the baby’s birth. Given I knew she would be early it seemed like a good idea. I expressed once a day the week before my booked caesarean. I managed to express 100mls. It was quite amazing how quickly I had milk given the few times I expressed.

On the day of Sophie’s birth Mick took the breast milk round to the CNC. They were all very impressed.

Funnily enough Sophie was also born at 34+6 wks gestation. She only had problems with maintaining her temperature and was in an isolette on and off. The temperature was partly to do with her size. Sophie was only 2kg.

The block from the spinal with Sophie’s caesarean was much lower, only to my belly button to be exact. This was on the painful side during the delivery. Though it also meant I was out of recovery visiting Sophie with in a couple of hours. Sophie was wide awake looking round. So she was popped out and put to the breast. My position, lying fairly flat wasn’t optimal but she knew what to do and managed to lick and have the odd suck. There was milk going everywhere so we were both fairly wet by the time she finished.

Back on the ward I hand expressed 20mls of milk to the astonishment of the midwife. The next day the milk had gone and the colostrum was back. It only took 2 days for my milk to come in though. So Sophie didn’t ever have any formula.

Breastfeeding this time round was so much easier even though I had started to wonder did I still know how to feed a newborn. But it was fine. Sophie knew what she was doing. I knew I needed to use nipple shields and I remembered all the positioning and attachment. Of course I wasn’t learning everything from scratch. And any privacy issues didn’t concern me, having breastfed all over the place with Oliver I was used to it. All I wanted was to get home.

One of the other things I remember well was that I was starving. I am always hungry when pregnant and it increases when I’m feeding. I wasn’t able to walk the distance to the café post-caesarean, Mick only came in, late in the afternoon with Oliver. And my sister had just had her baby so my visitors were a bit light on too. There just wasn’t enough food in the place. I was glad to get home and be able to eat lots!

On Day 6 I was discharged home and Sophie came too. She was still having issues with her temperature so we had to check that frequently. She also was only having 2 breastfeeds a day at the start. Meaning I had to tube 6 feeds. Thankfully she progressed quickly to more breastfeeds. We came home again with the early discharge program follow-up. We were discharged from the early discharge program after 4wks. About the same time as Oliver even though he was in hospital longer.

It was exhausting doing that many tube feeds and I had a major oversupply issue. I had to write everything down again. Sophie only fed from one side, and then I would need to express the other for comfort. It took about 4wks to decrease my supply to Sophie’s needs. She continued to fed on one side at a time for about 6mths till she grew a bit more.

When Sophie was 4 weeks old I realised she had a tongue tie. Enough to make her tongue a bit heart shaped. This really didn’t seem to affect us. It remained there until she got her bottom teeth at 12 months and cut the frenulum.

So the same age babies in the CNC and 2 very different experiences.

I continued to feed Oliver with no real problems till he and I weaned at 19mths when I was 18wks pregnant. Sophie after a great start had lots of different issues cumulating in breast refusal at 17mths. She completely stopped, going from 5 feeds plus a day to zero.

Filed under: Caesarean/cesarean birth, Engorgement, Expressing, Inverted nipples, Latch problems, Nipple pain, Nipple shields, Oversupply, Premature baby, Tounge tie, Tube feeding

Comments

One Response to “I was always going to breastfeed – Jo-Anne’s story”

Toni Scarlett on March 27th, 2009 11:28 pm

I can’t agree more – there’s nothing worse than returning to ward post-delivery with no baby… and hearing everyone else’s babies crying.

My son was born with a cleft palate and I couldn’t breastfeed him directly. Got straight onto expressing (endless, isn’t it!) and managed to get him having pure breastmilk (no formula) by about week 2. Unfortunately my milk ran out by 3 months…

Thanks for being someone I can empathise with!

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