Thursday, 6 August 2009

breastfeeding revisted

Thanks to Mummy Whisperer's comment and fabulous blog project, which is bound to result in a few posts about my first experiences as a mummy, and just in time for this week's World Breastfeeding Week, I've decided to give baby blanket knitting a break and reflect on my experience of breast-feeding, with the benefit of hindsight.

There's been a lot of discussion going on about this topic, and this contribution is really just a personal reflection, in the hope that it may be of use to those who find themselves in a similar situation. My experience though is very individual, and will not mirror that of others. Having lots of friends with different experiences, some of whom very reluctantly stopped breastfeeding, others who never touched a tin of formula has shown me that no two mummy-baby pairs are the same.

When I was pregnant, there was no question that I would breastfeed. I didn't even think about it. It's what my boobs are for, and though the thought of milk coming out of them was utterly unthinkable and very strange indeed, I never anticipated any problems. At one NCT workshop, a fellow pregnant woman mentioned something about pain. I had never heard of pain and simply filed it as a myth, especially as the NCT breastfeeding counsellor insisted that pain was due to wrong latch. I read all the info, had an NCT and NHS workshop. I had no issue to feed in public.

I felt prepared, and, truth be told, rather smug about it all. Until Cubling was born. It was a long labour, I'd had diamorphine and after 3 hours of pushing without any progress, a last minute spinal for a potential c-section (which became a mid cavity forcepts delivery). Cubling slept and slept and slept. Throughout the 3 days in hospital, she hardly showed an interest in feeding. Midwives hand expressed pithiful amounts of colostrum (this was painful!), sucked it up in a syringe, put it into Cubling's mouth, who spat it out. I was distressed. Cubling slept. I wished she would cry and feed constantly like the baby in the opposite bay. On day 3 she started wanting to feed. It was a Sunday and at each of the 3 instances, no midwife was available to help me get the latch. I didn't get it myself. It hurt, I got very upset and felt helpless. Thankfully, Monday morning brought a trainee volunteer for the breastfeeding initiative to me, who helped me with latch, gave me confidence. Also thankfully, Cubling's digestive system was slow so her weight loss was just below 10% and I got discharged. Her first deed at home was a massive meconium poo (yuck!!!) which surely must have brought her post birth weight loss up to 15 % or so.

At home, she started to feed regularly and in nice intervals, 20 minutes, every 2-5 hours. Then my milk came in, just that in my naivity, I didn't know what this extremely unpleasant feeling was, just that my breast were hard, Cubling could not latch and it felt like I had lumps of... cancer? I consulted books, found out that it wasn't cancer (phew) ways to ease the worst feeling, finally got a latch and ... what a relief! More milk than Cubling could stomach, but oh the bliss to see the white stuff drip beside her mouth. I cried tears of joy. I had milk. I could feed my little girl. I was the king of the castle.

What followed was this though: broken, bleeding and painful nipples for 8 weeks. Painful let down at nighttime for months. Feeding marathons. Effectively, Cubling would never come off herself, would feed incessantly if I let her. She cried blue murder at nighttime unless she was latched on. We had 7 hour long screaming marathons, where I had to phone Cry-sis because I was losing it. They said feed less frequently. Breast-feeding supporter said feed on demand, feed more. Feed on demand was beyond my ability, I literally would have had a baby permanently latched to me. I got a volunteer breast-feeding supporter to visit who said all was fine, I was doing great. When I was still nursing exclusively at 8 weeks, the boxed got ticked and no further direct support was available. What remained was a drop-in (where I met my mummy friends) and the bounty forum, kellymom and the lalecheleague website.

I became the expert on every aspect of breastfeeding. Determined to keep going I would do anything recommended. I took fenugreek tablets, tried a dairyfree diet (to see if the screaming was caused by lactose intolerance) took breast-feeding holidays where I'd do nothing but nurse. I expressed in the morning to top up at night time, just that this meant Cubling would then also scream after feeds in the morning because she didn't get enough. She continued to nurse frequently (I never made it to less than every 2.5 hours), very long (45-1hr, which is when I'd take her off without complaint, any earlier and hell would break loose, she would never finish a feed herself), not put on much weight, be unable to fall asleep, cry a lot, not poo (we went 12 days without one, bliss in a way, but worrysome in others). There were occasional days, once every fortnight, where her hunger in the evening was obvious and all the nursing wouldn't stop the frantic screaming. Then, from 12 weeks onwards, I would reluctantly and with tears in my eyes offer a top up of formula on those days where nothing would settle her. She gulped a whole bottle down, and settled beautifully afterwards. My girl was hungry, no matter what anyone else said, and I could not satisfy her hunger fully, especially in the evenings. It was only a bottle every fortnight, and if I'd had a break during the day/night to actually express, I'd have done that. But with a baby feeding so much, there was no time where I could have expressed any additional amount. I did try. I failed.

She woke a lot during the night, and we slowly took to cosleeping. This way, I could latch her on and not fully wake. It was a life saver especially when I went back to work. I got used to the broken sleep and would do ok if she went 3 hours between feeds, combined with co-sleeping. If there were a few nights in a row that had a higher number/frequency of wakings, it took a real toll on my wellbeing. Yet co-sleeping kept me going, especially whenever yet another tooth came through.

At 4 1/2 months, she took to waking every hour during the night and demanding a feed. She did this for a month. I was shattered, saw a paediatrician in Germany (where I happened to be when the effect of her waking made me short tempered) who told me that probably I didn't have enough milk and that I should offer top-ups after every feed. I didn't have that many bottles to offer 12 top ups a day (that's how often she fed) or sterilising equipment (I was on holiday after all), so I decided to top up at the last feed before her bedtime, and after the first waking. She didn't take a lot, but it helped a bit. After two weeks, she refused this top up bottle and never accepted a bottle offered to her by me after that. Looking back, this episode of constant feeding wasn't about hunger, but probably about teething.

I started solids at 24 weeks, or rather, Cubling did. She grabbed food from my plate and I went along with it. It was from then that Cubling finally gained weight properly. She went from slim to very chubby. I also went back to work at that time, expressing 3 times a day for one 60ml-120ml bottle to give to the childminder, supplemented by a second bottle a day. I did this for 3 or 4 months, giving every minute of a break at work I got, for ever decreasing amounts of milk. It was disheartening, so much work, so little milk. The days I was off were easy - the combination of nursing and solids worked a treat and finally breast-feeding was easy. I stopped expressing when I realised that to stay sane I needed to have at least one break a day and that really, I'd done as much as I could. I continued to nurse on my days off, and Cubling continued to refuse bottles given by me or hubby. She took bottles from the childminder, so we had a good balance.

I continued to breastfeed on demand until Cubling was 17 months old and when she had her full set of teeth. At this point I gently weaned her off night time feeds (she still woke once or twice a night for a feed), so she would not get a feed between midnight and 5 am. This led to her sleeping through to 5am regularly. Because I had planned a holiday away from her when she would be just 2, I felt I should wean her before her second birthday so she wouldn't have the combined difficulty of having to deal with mummy not being there and losing her main comforting tool. I wanted to take weaning easy, and start well before the second birthday. At 21 months I gently weaned her off the bedtime feed, as she seemed much less interested in it, substituting it by reading books which she loved instantly, and at 22-23 months I weaned her off the morning feed (5am), allowing her to still nurse when she insisted (i.e. it took a month to do this).

Looking back, I'm glad I persisted with breastfeeding because it did become very convenient after I introduced solids. However, I would not ever wait so long to offer top ups because I really believe that she went hungry in the evenings on occasions and the distress of seeing her in so much pain cannot be justified by the principle of breast is best. There has to be balance. I longed for support which would take my concerns seriously and not just recite the general advice which I knew anyway: how often did I hear "let her come off herself, don't finish a feed, let her finish" but how on earth can you do this when your baby will not ever come off? I did try, for hours, until I felt my nipples dissolve in a baby mouth. At 5 months, I still fed 12 times a day for an average of an hour each time. That's 12 hours a day. And still she would cry for more for hours in the evenings. Not good. Yet I was also stubborn and whenever I got a suggestion to give a bottle I got very defensive. It's such a delicate subject and what is needed is very delicate support which looks properly into the individual situation and doesn't just recite the manual.
I know I wouldn't embark on this marathon again. I would always breast-feed again, just that I'd be much more inclined to trust my feeling that something is wrong and mix feed. None of the top up bottles led to the end of breast-feeding, as long as breast is offered first, for many mixed feeding can actually extend breast-feeding as was the case for me. At the end, for as many breast-feeding mums I've known, nobody has continued to breast-feed as long as I did. There is no pride in this statement, just the fact that once a balance is reached, breast-feeding may work better and last for longer rather than shorter.

I got myself a lot of support, being proactive and informed, yet still I could have done with more. I longed for someone to have a look at my latch after week 4. Nobody did. I still wonder if the latch was the problem. Some of the best support, the one-to-one home and hospital visit by the breastfeeding initiative, was only offered to me because my GP was based in a health centre in a multiple deprived area. The support wasn't aimed at people like me (who were keen to breastfeed anyway) but at the low breastfeeding rates in that area. There are issues around that (the initiative could count me as a success, when really I wouldn't have done any different anyway, and maybe I took support away from someone else). But really, this support should be there for everyone, which comes at a cost unfortunately, a cost the NHS is probably not able to meet.


Metropolitan Mum said...

Oh dear. I feel for you, I really do. And I admire you for your strength and determination.
When little L was 6 weeks, we reached the 24/7 feeding stage, too. I went to see my GP for the check-up, and when she asked me why I was doing 'just ok', I burst into tears. She said something that changed my life: 'Your baby is testing you, and you have to test her back.' She recommended to stretch the breaks in between the feeds with dummies or water. I talked to friends and one friend in particular recommended to use fennel tea, which also helps with constipation (been there, too...). The tea worked wonders. I used Hipp Baby Fennel Tea. It is recommended to use as of week 2 in Germany. The same product is available here, but the recommendation differs (as of 4+ months). I suspect that's to do with government guidelines.
Little L still has a bottle of tea every now and then, especially in the hot weather. We never had a problem with weight gain, so I felt confident enough to 'experiment' a bit. Still, I cried when I gave her the first bottle.
One thing that lead to 24/7 feeding in my case was the wrong interpretation of feeding on demand. I gave little L my nipple to soak it, whenever she demanded it. Thus she feeded a little here and a little there, but never enough to go for a longer stretch.
To feed whenever your baby is hungry would be the better advice, I think.
If I wouldn't have had my friend who's been through that all before me plus the GP and her hands-on advice, I might have ended in the same situation you found yourself in. Or, to be honest, I would have given up at week 7. I was so exhausted and depressed, I couldn't have gone on like that for another day.

cartside said...

Met Mum, I tried the dummy but it got spat out, again and again. I've got photos of it, so funny, Cubling was a very early smiler and there she would be, in her moses basket, spitting out the dummy with a big grin.

Never gave fennel tea a proper try, although I heard of it - well, to be fair, I did offer it to Cubling once and she liked it as much as I did (i.e. not at all) but of course with persistence that might have changed. It sounds like a life saver! I know I wouldn't do that marathon ever again, but with the weight gain worry I never dared increase the spacing between feeds (although a very good and trusted friend of mine, mother of 2, said I should).

Great to hear that things have improved so much for you and you're still going strong!



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