Starting this blog in December meant that the first month’s posts were predominantly Advent- and Christmas-related. So with the start of a new year, it’s time to introduce a few topics that are more on-going. A new year always makes me think back over the highs and lows of the previous year, and 2011 was for me an amazing year – the best so far I have to say, of course thanks to Andrew. I also think about what I’ve achieved in the year, and in 2011 came the hardest but best thing I’ve achieved in my life so far.
It must be the PhD, I hear you say? But wait, that was 2010, right? Up until 2011 I probably would have said it was my PhD. But then Andrew came along, and with him a very strong, instinctual desire to breastfeed no matter how many problems came our way when we tried to do it, a desire which wasn’t even present during pregnancy. 11 months later, and I believe that breastfeeding Andrew is my hardest but best achievement so far. I must acknowledge that I couldn’t have done it without the support of several people, in particular Tom (who made it clear every day that he would support me in whatever I decided to do about feeding), my parents (who gave us so much practical help around the flat so I could concentrate on feeding), and our friends who prayed for us all during the hard times.
Since I now feel very passionately about breastfeeding, I know this will feature quite a bit on this blog. I don’t want to give the impression that I’m one of those people who bang on about ‘breast is best’, full stop; you’ll see that from experience I know that breastfeeding is not black and white, but rather there are many, many shades of grey, with every mum and baby pair having their own breastfeeding relationship.
So to start with, I think it’s best if I share our breastfeeding story to date. This is in fact a bit of a cheat of a post, because I’m posting an article that I already wrote which is published in the latest issue of Breastfeeding Matters, the regular magazine of La Leche League (GB). I’ll say more about this organisation in future posts, but for now let me give you the background behind my passion for breastfeeding….
Making the most of what we have
It must have been around 30 weeks into my pregnancy, when I saw that the NHS-run antenatal classes we were about to attend had an optional breastfeeding workshop running one day quite soon. I’d thought that I’d like to breastfeed; my mum had breastfed my brother and me until around 8 months, and I’d read about the health benefits for baby. But I guess I always had it in the back of my mind that I had small breasts and so wouldn’t be surprised if I couldn’t. So I thought it was worth going to the workshop; after all, they would know if breast size would likely affect my ability to feed. Indeed it was helpful, and I came away with knowledge of latching baby on, feeding on demand, and various other important things. Most importantly in my mind, though, was the assurance that it is very rare that a woman cannot physically breastfeed, and small breasts certainly didn’t matter. Excellent, I thought.
Andrew arrived 4 days overdue (clearly he was waiting to share his birthday with his daddy!), in a much faster time than I’d expected for my first baby. At 7.30pm my waters suddenly broke, then my labour progressed very quickly, with Andrew arriving at 10.22pm. I had no pain relief, other than being in a pool for about an hour, but that seemed to slow me down, so the midwife suggested I get out, and he was delivered without complications soon after. She put him straight onto my tummy, and after just a few minutes, he lunged quite spectacularly across to my breast, latched on, and began sucking. Great, I thought, my baby knows what to do!
12 hours later we were home, and things went well for 3 days. I breastfed on demand, whilst my husband, Tom, and my parents did everything for me. On day 4, Andrew became very unsettled – he wanted to feed literally all the time, and when I desperately needed the toilet or a shower, Tom could do nothing to settle him for that short break from me. Although I’d heard that feeding constantly in the early days was normal, I wanted some reassurance that Andrew was OK. As my midwife was on annual leave until day 6, Tom, rang her team of colleagues, who advised us to go to a breastfeeding drop-in clinic (which was on day 5), where I explained Andrew’s unsettled situation, and that I didn’t feel any changes in my breasts, like my milk hadn’t come in. They assured me that it would, and advised us to have lots of skin-to-skin contact; they knew that my midwife would come tomorrow to assess Andrew. After another sleepless night, we were greeted at the door bright and early by the midwife. She looked him over and was happy with his appearance. But her expression turned more worried as she put him on the scales; she couldn’t quite believe it, and checked it again 3 times. He had lost nearly 20% of his birth weight. She sent us to A&E, as this was more than the normal post-birth weight loss.
I cried most of the rest of that day, sitting in hospital, watching them do all sorts of tests on my little baby, and thinking that I had failed as a mother already at less than a week. The doctor explained that he was dehydrated, so they would have to keep him in hospital and give him formula milk through a naso-gastric tube every 3 hours until he improved. We were lucky, though, that breastfeeding was not ruled out altogether by the doctor’s introduction of formula. First, he told me to continue breastfeeding as much as possible; second, the hospital’s infant feeding specialist came and looked at Andrew’s latch, which was good in her view, as well as my breasts, which she admitted were small, but she hand expressed something from them, albeit still colostrum at 6 days. As I was clearly physically and emotionally exhausted, she asked whether I wanted to carry on breastfeeding. Since Little Miss Determination should be my nickname, giving up on this was not an option for me, despite the exhaustion. Her suggestions were to use a supplementary nursing system (SNS) (see pictures below), and express with a pump between feeds, as these would make sure Andrew got as much breastmilk as possible and build up my supply. She’d even brought an SNS to the ward, and fitted it onto me for his next feed. Although this was a bit sneaky (because the doctors wanted him to be tube fed), it was the best thing that had happened for 3 days – Andrew fed amazingly well, latching on and draining the SNS of formula in no time, no problem. He had that lovely drunken full look, and I felt better already knowing that he was being nourished, but still getting whatever colostrum I had.
By the next day, his dehydration was back down to the higher end of normal. The question of discharge came up, and between discussions about his blood test results, Andrew yanked out his naso-gastric tube in a moment of arm flailing! It was as if he was telling the doctors: “I don’t need this tube, I can feed like a big boy, thank you very much! And now I’d like to go home, as would my mummy.” We were discharged that evening. Great, I thought, we were back on track with feeding.
Whilst my parents cooked us dinner, Tom and I set about sterilising the SNS in our microwave steriliser (which we’d been given before the birth along with an electric breast pump and bottles, as I thought I might need them when I returned to work). However, disaster struck, and the rubber band holding parts of the SNS together melted a hole through the plastic – it was no longer usable. It was Friday night, and despite my mum’s best efforts to google an SNS supplier, nowhere would deliver until at least Tuesday, plus we knew the infant feeding specialist was away for a few days. We had no alternative but to bottle-feed him some formula after he’d fed from me. That was it, I thought, he’d get nipple confusion and not stimulate my breasts enough to improve my milk supply.
After at least some hours sleep during the night, it occurred to me that we could contact La Leche League (LLL) Cambridge, as they might know where we could get an ‘emergency SNS’ at the weekend. I’d heard of LLL, as their website had come up whilst I’d googled breastfeeding in my antenatal research on the subject. Tom rang one of the contacts, Mary; not only did she know a lady who used to be a Medela rep and had an SNS for demonstration purposes, but she also offered to drop it round to us there and then. Within the hour we had an SNS, and Andrew and I were back in business as a breastfeeding pair, all thanks to Mary.
By day 14, Andrew had regained his birth weight. Also on that day I managed to squirt some milk into my eye whilst hand expressing, and the drops that followed were runnier and more opaque white than the creamy colostrum. What an amazing feeling, the almost 2 week wait had been worth it and finally my milk had come in, though not in great quantity.
Over the next month or so, Andrew started to settle into a daily rhythm of feeding, sleeping and being awake, whilst Tom and I tried to figure out how to manage the mixed breast/formula feeding. We wanted to make it as close to demand feeding as possible, though that seemed trickier with formula than if we could rely on breast milk alone. However, Andrew’s weight gain slowed down, and he gained only a few ounces maximum between each of his weekly weigh-ins, which our health visitor advised so we could keep an eye on him. We increased the formula supplement little by little each week as we didn’t want him to plateau on the baby-weight graph. Andrew and I also went along weekly to the breastfeeding drop-in clinic, as well as the fortnightly LLL meetings, to get support and remind myself why I was persevering when it was so easy to feel like there was no point giving him next to no breastmilk. During the clinic when Andrew was 8 weeks old, Mary (who volunteers there as well as LLL) was holding him; as he was showing off his wide smiles, Mary noticed that his tongue looked quite anchored towards the back, and it preferred to move to one side. She suggested that we could see a tongue-tie specialist, as she wasn’t an expert. I’d heard of tongue-tie, but nobody at the clinic or hospital had ever suspected it in Andrew, as I’d had no nipple damage and his latch seemed good from the outside.
We decided to get a private lactation consultant, Ann, who specialises in tongue-tie, after two GPs told me something along the lines of “oh well, you’ve breastfed for 8 weeks, that’s great; he’s on formula anyway, so there’s no point referring you to an NHS tongue-tie specialist if it’s a posterior tie and snipping it might not make a lot of difference”. Ann came to our flat when Andrew was 10 weeks old, and did a 3-hour assessment of his mouth and my breasts. Not only did she diagnose a 50% tongue-tie in Andrew (and incidentally an 80% tongue-tie in me, even though I was exclusively breast fed), but also breast hypoplasia in me. This is basically underdevelopment of the breasts, so there is insufficient glandular breast tissue. In LLL’s online article ‘Supporting Mothers with Mammary Hypoplasia’ (Cassar-Uhl, 2009), breasts are likened to a ‘milk factory’, and in the case of hypoplasia, the ‘“milk factory” is either missing key parts to its assembly line or is absent altogether’. In my case, there clearly was something happening in the assembly line, but perhaps there weren’t enough key parts to produce enough milk to satisfy Andrew’s growing appetite.
My breasts are small, I knew that, but this was the first time someone was totally up front with me – Ann said that their wide spacing and bulbous nipple and areola that merged into each other were signs that I had a medical condition which meant I was unlikely to produce enough milk, even if I tried really hard (which I felt I was!) She snipped Andrew’s tongue-tie, and showed me how to latch him on to make sure as much of my breast went into his mouth as possible. No wonder his latch had always been praised by others – my small nipple-cum-areola fitted into his small mouth no problem, so no darker skin was visible outside. After Ann left, I felt a sudden sense of built-up tension being released, and I slept for the rest of the evening after Tom got in (except when he woke me to feed Andrew before his bedtime).
For the next month or so, Andrew gained 7 or 8 ounces each week, and we went from weekly to monthly weigh-ins. I felt like I had more milk in terms of what I could express, though obviously I couldn’t see how much he could get out of me, but his sudden increase in weight gain suggested that it was more than previously. The snipped tongue-tie must have helped on a practical level, but I also think that the release of tension I’d experienced helped on an emotional level.
Now that Andrew is nearly 4 months old, I’d say that we’re making the most of what we have. I know my milk won’t be enough to drop the formula completely, and I’m coming to accept that there’s nothing I can do about my breasts, that’s just me. Don’t get me wrong, though, I still have days when I resent the faff of sterilisation and formula preparation, and wish I could just go out not worrying about how much milk to take. I see myself as a breastfeeding mum, who’s giving her baby all the goodies in breastmilk, with some extra calories in the formula milk (which at the end of the day isn’t awful – Tom was bottle fed and turned out alright, well, I married him!) Ann said I deserve a medal for persevering as long as I have given what was stacked against us; but I haven’t carried on for any prize other than seeing my son develop and grow after giving him the best possible start I can. Andrew has always been an alert, interested and bright little boy, even when he was admitted to hospital with dehydration – the doctor noted it on his discharge document. So even though he’s not exactly heavy for his age, we’re not worried about his development, and he’s reaching all the milestones as he should. And anyway, breastfeeding for us isn’t just about food for growth, it’s about the bonding and comfort we both get from being snuggled up close, which I wouldn’t change for anything right now, and (give or take the interesting distractions now that he’s getting older) I don’t think Andrew would either.
Since writing this piece when Andrew was nearly 4 months old, I’ve continued to breastfeed him, and he’s now over 11 months. If someone had have said to me at 11 weeks that I would still be breastfeeding at 11 months, I would not have believed them! My goal was to get to 6 months if possible, but when we got there, and he started eating solid food, I found I started to enjoy breastfeeding him even more. I think the reason is because I feel less pressure on myself now that I know milk isn’t his only source of energy. He loves his food, and will eat most things we offer him, shovelling it in messily with his hands and chewing away merrily. So I know that this food is complementing the goodies that he’s getting in my milk; more so than ever, breastfeeding is less about ‘feeding’ and more about snuggling up for quality time together, and me comforting him if he’s upset or calming him down if he’s agitated. He generally has one feed first thing in the morning, and one last thing before bedtime, though if he’s ill or upset, he sometimes wants more during the day or night.
There have been times over the past few months when I’ve worried that he was losing interest in me and my low milk supply, as he wanted fewer feeds. (One particular time turned out to be he start of a tummy bug, which Andrew and I only got mildly compared to Tom – probably due to the immunological help that we, the breastfeeding pair, give each other 😉 ). A LLL Cambridge leader, Justine, reassured me that this is quite normal at his age, even in babies whose mums haven’t had supply issues, as they start becoming independent, crawling off to explore the exciting world around them, and dropping feeds particularly during the day. This gave me confidence to carry on, and I’m happy to continue to meet his needs for as long as he would like me to, even if that means into toddlerhood.