Wednesday, August 27, 2014

My Breastfeeding Journey

Eleven years ago I was 6 months pregnant with my first baby. I knew absolutely nothing about breastfeeding. I had not been breastfed as a baby and I didn’t know anyone who had breastfed a baby. I read a lot of books about pregnancy but nothing specifically about breastfeeding. From the books that I read I discarded my past ideas that breastfeeding was weird. It was what would be best for my little girl and a lot less expensive (yes, this was a huge deciding factor). I took a class thru my hospital about breastfeeding and thought I was prepared. That was my very first mistake.

When I had my first baby I also thought not having pain medication was crazy. I was lucky enough to have a pretty fast, easy labor although I was given pitocin to kick start things after my water broke. I ended up having both narcotic pain meds and an epidural. My sweet, tiny little Emma, just 6 pounds 5 ounces was born just before 5pm, just 8 hours after my water broke. They wanted to weigh, measure, and vaccinate her right away and I didn't know enough to ask them to wait. Within the first hour after she was born they whisked her off to the nursery for her first bath. I was still numb from my epidural so I didn't get to go. I hadn't even gotten to really try to breastfeed. After her bath she got cold so they kept her under the warmers in the nursery. Again, I didn't know enough to ask for something different. How I gave birth was the very first of many "booby traps" in our breastfeeding relationship.

Emma had a terrible latch and by Sunday, two days after she was born, my poor nipples were cracked and bleeding. No one had explained cluster feeding to me or talked to me about a poor/shallow latch. Because I gave birth in the evening on a Friday and went home on Sunday I never saw a hospital lactation consultant. Where I had given birth they didn’t have any one staff on the weekend. I was in tears because I was in so much pain every time I fed her so I took my mom’s (well meant) advie and gave her a pacifier. I had no idea this could cause issues down the road with my supply. Eventually my nipples healed and I felt like we had figured out breastfeeding for the most part. I had what I would now consider over supply. Emma came home weighing 5 pounds 9 ounces. At her two week checkup she had gained a whole 2 pounds! I would leak so much at each feeding that my clothes would be drenched. If she unlatched milk would shoot across the room in a huge fountain. If I missed a feeding by even a small amount of time I would get engorged. Unfortunately my oversupply did not last.

When Emma was 12 weeks old I had to go back to work. I was a waitress and wasn't allowed breaks during my 6-8 hour shifts to pump. I would pump at night to have milk for the next day. I rented a pump from a local medical supply pharmacy. I had no idea about pumps and assumed for my $75 a month I was getting a great pump. I was sadly mistaken. The pump I was renting was an old school Medela Lactina. It’s basically a motor that pulls the old style manual pump for you. I could only pump one side at a time. As time went by I started getting less and less. Because I wasn't getting much when pumping I assumed Emma wasn't getting enough either. I contacted her pediatrician and my obgyn. My OB had me start Reglan. It didn't do anything for my supply but it made me feel awful. I personally believe it is one of the worst things you can give to a post-partum mother. Emma's pediatrician told me to supplement with formula. Of course, the more I supplemented the less milk I made. It was a vicious cycle. By the time Emma was 4 months old I was doing 100% formula. I still tried to pump for a couple weeks at night but I got such a little amount I quickly gave up. No one ever suggested I see an IBCLC or seek help from a Le Leche League meeting or that I had any options other than supplementation. I was heartbroken that my body had failed me. That was really what I believed, for years, that my body had failed me in providing this amazing source of nourishment for my daughter.

3 years later we got pregnant with our second baby, another little girl. I was determined to breastfeed and to make it to a year this time. I read more books and gained a lot more knowledge about breastfeeding and giving birth. I bought a top of the line Medela Pump in Style Advanced Double Electric breast pump. I planned to continue being a stay at home mom. I even attended a Le Leche League meeting. Unfortunately I was so uncomfortable and felt like such a failure with my first, that I never went back. I switched to a midwife and was determined to go without pain medications this time. Unfortunately this pregnancy didn’t go as smoothly as my first. There were major concerns about my little girls growth in utero, or lack thereof. I was scheduled to be induced at 39 weeks bc she had stopped growing and they thought she would be better off out than in. I was disappointed bc I did not want pitocin, narcotics or an epidural again. Just 5 hours before my induction I went into labor. Less than 3 hours later my sweet baby girl, Ella, was born weighing in at 6 pounds 9 ounces, quite a bit bigger than her estimated under 5 pounds. No pain meds, no pitocin, no nursery, no warmers. She never left my side from the moment she gave birth. I wish I could say that being better informed, having a better birth experience, etc. made a difference and that we reached my goal of breastfeeding for a year. Sadly, that was not the case.

By the time Ella was a week old, on top of latch issues and sore, cracked nipples we were dealing with reflux, inconsolable crying for hours, and blood and mucous in her stools. Ella's weight gain was poor and she didn’t get back to birth weight until she was a month old. Her pediatrician thought that she most likely had food intolerances, which are common in my family. I started out doing the MSPI elimination diet (Milk & Soy Protein Intolerance) when she was just a couple weeks old. When she was a month old she had a sigmoidoscopy done. They took a couple biopsies and noted intestinal inflammation. Her diagnosis of food intolerance/allergy was confirmed. After a couple months doing the MSPI with little to no improvement and continued poor weight gain I started doing the TED diet (total elimination diet). It was one of the hardest things I have ever done. I could only eat a few foods. Turkey, rice, potatoes, pears, olive oil and salt and pepper. By the time she was 4 months old I had lost over 60 pounds. I was determined to do whatever I had to do to breastfeed. Unfortunately her pediatrician and her Gastroenterologist were no longer confident that my milk quality was good enough to help her gain the weight that was needed. I did not want to give up so I drove 45 minutes away to get help at an amazing place called Milkworks. They have a staff of IBCLC's and are a wonderful resource for breastfeeding moms. The Pediatrician/IBCLC tried really hard to help me continue to breastfeed. She got me set up with an SNS so that I could supplement Ella with the milk I was able to pump while she was also eating at the breast. Her weight gain was still poor so her GI doctor pushed for me to try supplementing with formula.

Ella would take a bottle of breast milk with no problem but refused to take a bottle of formula. They pushed and pushed and we tried everything to get her to drink the formula. I even dropped her off with a nurse at the local feeding clinic to see if she would take it from someone else. All this did was cause her to refuse to take a bottle of anything. Not breast milk, not formula. At this point Ella also lost weight and it was decided, at 5 months, that she would have to have an NG (nasal gastric) feeding tube placed. After she got her feeding tube I was only "allowed" to breastfeed her twice a day. I pumped every 4 hours when I couldn’t put her to breast. Ella did not tolerate the bolus feeds and was quickly switched to receiving 1 ounce per hour 24 hours a day. While at the hospital Ella and I were both diagnosed with thrush, which I had asked her pediatrician about several times. Not long after this she refused to take the breast at all. I was still determined, that someday she would get my milk again and continued the TED diet and pumping every 4 hours round the clock. Ella still gained weight slowly with her feeding tube but she gained. She had it for 7 months. It was the end of our breastfeeding relationship. I tried to console myself with the fact that I had breastfed longer than with my first and exclusively pumped for 3 whole months before finally giving up. To add insult to injury Ella never drank any of that pumped milk. I have excess lipase and my frozen milk tastes soapy. I had this same issue with Emma but thought it was a fluke until it happened with Ella too. Many babies don’t mind that change in taste but both of mine did. All that milk I had starved myself to pump was thrown into the trash. I had "failed" again.

Fast forward to 2010. I decided to become a birth doula and my breastfeeding knowledge grew exponentially. I read a ton of books specifically about breastfeeding. I did lots of research on all the different things that contributed to my struggles with my daughters. I wanted to be able to offer support to new moms and help them avoid the things I hadn’t been able to. I learned about lip ties and tongue ties and their effects on breastfeeding (Ella definitely had a missed tongue and lip tie; it was diagnosed when she was 18 months by our dentist and I suspect Emma did as well). I learned about excess lipase. I learned about the effects pain medication on breastfeeding, the importance of uninterrupted skin to skin contact between mom and baby. I found tons of amazing resources and support options. I was amazed with all that I had learned. I began teaching childbirth education for Baby Love Birth Services in 2012. I started teaching a breastfeeding class. I kept educating myself and learning as much as I could. In 2012 my husband and I decided we wanted to have another baby. In April 2013 we found out we were expecting our 3rd baby, another little girl who I was determined to breastfeed.

I now knew that one of the vital things I had been missing with my first two was support. I was determined to change that. I had become friends with an IBCLC who was also a doula named Kristen. She was wonderful and reassured me and answered questions for me all during my pregnancy. I also decided, after 10 years, to make the switch to a new pediatrician. One who would actually know how to support and help me and my breastfeeding goals. A wonderful pediatrician, Dr. Laura Wilwerding was recommended to me by several moms. Dr. Wilwerding is also and IBCLC and has a passion for breastfeeding. I felt so much more prepared after meeting with her and talking during my pregnancy.

December 12, 2013, one day before she was due, my sweet Eliza was born in an unmedicated, beautiful water birth. She was an entire pound bigger than my last baby! Dr. Wilwerding came to see us that evening. She noticed right away that Eliza was tongue tied but said we would wait to see if clipping was necessary. Breastfeeding was going ok. My nipples were getting pretty sore but not cracked or bleeding. Dr. Wilwerding had told me on Thursday that she would be out of town until the following week. I knew that Eliza's tongue was going to need clipped to help our latch but decided to wait until we saw Dr. Wilwerding that Tuesday. Saturday night I started having trouble getting Eliza to latch on my right breast. By late Sunday morning I was unable to get her to latch on either breast. I tried calling the hospital lactation consultant but since it was Sunday no one got back to me right away. By Sunday evening I had to send my husband out to by formula. Eliza hadn’t had any wet diaper all day and I was concerned about her getting dehydrated. I had been trying to pump (thank you again Britani D. for lending me, a virtual stranger, your breast pump) but was getting very little. I was in tears when my husband left to buy the formula. I couldn’t believe, after all my hard work, I was going to fail again and after only a few days!

Tuesday morning we went in to see Dr. Wilwerding. My nipples were a disaster at this point and I was desperate for help. She clipped Eliza tongue and tried to help me get her to latch. Each time we would put her to breast she would be in a kind of frenzy. We kept working at it for over and hour (can you believe the wonderful patience of this pediatrician?) and finally got her to latch on my left side. I continued to try at home but was still really struggling. I decided to give a nipple shield a go. Eliza would finally latch on both sides with the help of the nipple shield! We saw Dr. Wilwerding again on Friday and I shared my excitement that she was latching better but I was still struggling with the right side which now seemed to be quite engorged with milk and uncomfortable. Dr. Wilwerding massaged and massaged while I had Eliza at the breast to help her not get frustrated quickly. I left feeling like this wasn’t the end and that I still might be able to succeed. That evening, while Christmas shopping with my husband and 3 girls I began to feel poorly. I thought either I was coming down with a cold or I was just extremely tired. I get achy body when I don’t get enough sleep so I chocked it up to that. My breasts were both very sensitive to the cold, especially my right but I just figured it was my poor damaged nipples. I didn’t put two and two together that this might be something more serious. Saturday I noticed that I had a very small red area on my right breast and an area that felt hard. I felt much better after a good night sleep, no aches, fever, etc. so I thought it was probably a plugged duct. I spent the weekend trying a variety of remedies for plugged ducts but nothing seemed to help. It actually seemed to be getting worse and worse. I had an appointment that Thursday with Dr. Wilwerding for Eliza's 2 week check and with Christmas I didn’t think she would be able to see me before than anyway. By the time my appointment came around things were much worse.

When I finally got in to see Dr. Wilwerding the inner half of my breast was an angry red and warm to the touch. I had a large hard area as well. Dr. Wilwerding was concerned that I had mastitis and possibly an abscess! She started me on antibiotics that day. The next day I had my 2 week follow up with my midwife and she was shocked when I showed her my breast. She was positive that I had mastitis. By the following Monday my breast had showed little improvement. The redness was less but the lump had gotten much larger. It was about the size of a small orange now! I called Dr. Wilwerding and she switched me to a different, stronger antibiotic. The redness finally went completely away as well as the pain but I still had a huge, hard lump. I also had some much fluid buildup that I had pitting edema around that whole half of my breast. Dr. Wilwerding wanted me to see a breast specialist at a local hospital. Unfortunately the doctor she wanted me to see was out of town and so I had to see someone else. The appointment was very frustrating for me. The doctor came in. Looked at my breast for 1-2 minutes and said he wanted to give the antibiotics 2 more weeks to work. I really felt like, at this point, if they were going to work it would have already happened. I kept breastfeeding with the nipple shield on both sides and, with Dr. Wilwerding’s encouragement, I stopped supplementing almost completely. Eliza got one 1 ounce bottle at night so that I could give her probiotics to, hopefully, avoid thrush. Thank you to Ashley C for donating milk to us so that had to supplement with formula very little!

January 24th, over a month after my symptoms of mastitis had first appeared I was able to see Dr. Griffin Miller, the specialist Dr. Wilwerding had wanted me to see originally. I still had a large lump but it had shrunk down to the size of a cutie orange. I had an ultrasound done and it was confirmed that I had an abscess. Dr. Griffin tried needle aspiration of the lump first but was able to get out virtually nothing. It was decided that I would have to have my abscess surgically drained. I did not want them to cut my breast open and deal with all the challenges that come with that. I had read about catheter draining on the wonderful Dr. Jack Newman’s website and asked to have the abscess drained that way. The interventional radiology department agreed to try it. I asked to only have local anesthetic so that I wouldn’t have to worry about not breastfeeding immediately after the procedure. The catheter draining was a success. The amount of super thick puss that was drained was pretty disgusting. I also had to have a drain left in for 5 days to let any remaining infection drain out. I still kept on breastfeeding on that breast, even with the drain in! When I got my drain out the lump was virtually gone! It was maybe the size of a dime! I was on Bactrim at this point, a very strong antibiotic, and continued that for a few weeks after my procedure was done. I had a little scare about a week after my drain was removed when my lump grew slightly. I was terrified my abscess was returning. I had an ultrasound and it showed that I did not have an abscess! After 8 weeks of dealing with mastitis I was finally cured and Eliza and I had managed to avoid thrush thru all those weeks of antibiotics! I had never had a fever and actually felt pretty great during those 8 months and I was very thankful of that but I wish I had gotten help sooner! I am still kicking myself for waiting until after Christmas to see anyone and for not pushing for treatment when I saw the first specialist!

When Eliza was around 4 months old we were able to wean off the nipple shield! It was an adjustment and we dealt with sore nipples again, temporarily, while she learned to latch without it. I also ended up doing a course of Dom Peridone to help boost my supply in my right breast bc it had been decreased by my long battle against mastitis. It worked wonderfully and we haven’t supplemented a bottle of donor milk or formula since Eliza was about 3 months old! We worked thru Eliza refusing to take a bottle when I started teaching childbirth education again. I discovered the wonders of the manual breast pump and use that exclusively to pump even though I have both a Medela and Hygeia breast pump! I can get more milk in less time with the manual pump! I’m using the Medela Harmony. We are rocking a dairy, soy, peanut, treenut, strawberry, pumpkin, banana and avacado free diet. Its really hard and I desperately miss regular chocolate, Nutella and Ben & Jerry's but I have discovered some amazing alternative foods along the way! Thru my friendship with Kristen I fell in love with Le Leche League and attend not one but two groups! Eliza is 8 ½ months old and we are breastfeeding rock stars now! I never really believed I could make it this far! I am almost to my next goal of 9 months and have no plans to wean anytime in the foreseeable future!

Breastfeeding is the normal, natural way to feed a baby but that doesn’t mean its not hard. It doesn’t mean that it comes naturally to everyone. Breastfeeding is something moms learn from seeing other moms breastfeed and hearing other moms experiences. It’s something that we really need to have a network of amazing support for. Every mother deserves to have the help and support she needs to successfully breastfeed. Set yourself up for success by getting good solid information, find a pediatrician who really supports breastfeeding, an IBCLC that you love and have a strong support system in place.

Thank you to my amazing breastfeeding support system; Kristen T., Dr. Wilwerding, Britani D., Ashley C., my midwife Heather Ramsey, Dr. Griffin-Miller, all my lovely LLL ladies and my amazing husband Eric. Without all of you I wouldn’t be where I am! I finally feel like I've got this breastfeeding thing down! I know now that I didnt "fail" with my first two babies. I just didnt have the right support or resources. I am so thankful that I do now. Thank you from the bottom of my heart. You have no idea how much the help and support from each one of you really meant to me.

To celebrate my journey and 8 months of exclusive breastfeeding Eliza and I had breastfeeding photos done by an Amazing photographer, Meri Valentin. Enjoy!

All three of my gorgeous girls compliments of Penny Lane Photography

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