Most of you will know that I am rather pro-breast-feeding. While I won’t criticise you for deciding to formula feed, I will offer lots and lots of advice and tips if you’re undecided or having problems (which, let’s be honest, probably comes across like sanctimonious criticism). Most of you will know that I breast-fed Rosemary for over two years. Most of you will know that I felt myself to be a bit of an expert at the old breast-feeding lark, though not a trained breast-feeding counsellor.
So, when embarking on being a mum to a small baby for the second time in my life, I felt pretty darned confident that breast-feeding would come easily. She would latch on the second she was put on my chest after birth and there would be no positioning problems, no need for Lansinoh, no cracked or bleeding nipples, no mastitis, no topping up with formula. None of the problems we had last time. Because I was breast-feeding mum extraordinaire, who lived through many a tooth and gave her eldest daughter absolutely the best and healthiest start any child could possibly have.
You see where we’re going with this story, of course?
She didn’t latch on immediately. She did feed briefly after the birth and again in the morning. She continued feeding when we went home, but her positioning was really pretty awful.
I had completely forgotten about my oddly shaped nipples, which cause problems at the start – or I’d assumed they’d still be ‘fixed’ from Rosemary’s two years of administrations. The left one has a kink and tends to bleed, crack, warp in various ways at the bend. The right one is somewhat inverted and gets all horrid in the inverted bit, to the point where it looks like bits of the nipple are actually going to fall off. The left one is bearable and the baby learns quickest with that one. The right one is the most problematic. That’s where I got mastitis with Rosemary. That’s where I got mastitis with Eleanor.
The mastitis with Eleanor came at the same time as the inverted bit was so infected that Eleanor would not touch it. She actually sniffed it and turned away – sniffed the other one and latched on (with a bad latch, but latched on nevertheless). Many of you will know that what you need to do to get rid of mastitis is to feed, feed, feed on that side. But that was not happening. So I was hand expressing – just onto a muslin, didn’t occur to me to try to catch it and give it to Eleanor somehow – to try to get rid of the mastitis.
Then Eleanor was weighed. She had lost a pound. She was below 10% under her birth weight. The midwife (not my usual one) just told me to ‘Feed, feed, feed. Feed yourself, then feed, feed, feed.’ Uh-huh. Difficult when your baby won’t feed from one side. My midwife phoned the next day to talk it through with me and explained that between 10-15% under birth weight they have to put together a weight-gain plan and that if it goes below 15% they are obliged to refer it to the paediatricians.
I said I wanted to try pumping from the right side to try to get the mastitis out of the way, and Chris and his dad went up to the maternity hospital that evening to pick up the pump and a feeding cup, to try giving Eleanor the expressed milk. We tried the feeding cup, but it was no go, and I recalled that Rosemary never managed to take anything from one either. The pumping was fine and it got rid of the mastitis, but the nipple was still very infected and Eleanor was still not interested in it. In fact, by that point I was reluctant to offer it to her as I didn’t see how it would ever heal if I did.
In the meantime was starting to fret a lot on the left breast, taking 15 minutes to latch on and screaming the whole time. She wasn’t even managing to feed a normal amount of time, let alone extra in order to stop losing weight. When she did finally latch on, she’d only stay on for a few minutes and then come off and scream and scream again.
The midwife came on Sunday to weigh her. She had lost an ounce and was now 13% under her birth weight, which was scarily close to the referral percentage. Somewhere I really didn’t want to go. We’d avoided SCBU this time, I really didn’t want to end up in hospital anyway, with Eleanor being tube-fed. I told the midwife that I wanted to try offering the breast-milk from a bottle. Rosemary had had a bottle (formula top-ups, rather than expressed breastmilk) and had managed to combine it fine with breast-feeding – giving it up voluntarily after a couple of weeks and never touching it again. I knew the risks, of course, but felt it was probably the only way we had a chance of her not losing more weight, with the current state of my right nipple and her latching-on issues. The midwife agreed.
Chris gave her some breastmilk in a bottle. She loved it. Drunk it all up and I had to pump to keep up until she’d had enough. The trouble was, the next time I put her to the breast, she had forgotten what to do. She latched on and then either fell asleep, if she was tired, or came straight off again and screamed… and screamed… and screamed. I tried and tried and tried and tried and she could not do it.
I cried and cried and cried. My daughter was losing weight and she wouldn’t take my milk. I couldn’t feed my daughter. I felt useless. I felt like my whole raison-d’être had been taken away from me. I felt like I was dying inside. In fact, I even wondered, at a particularly low point, whether there was any point in my continued existence. Fortunately, a picture of Rosemary came into my head and got rid of those darkest thoughts.
By Monday morning, I was in a terrible state and didn’t really know what to do. I was expressing as much as possible, but it really wasn’t enough to satisfy her. I was reaching the point where the only thing I could really consider was formula. But I wasn’t considering it so much as a top up, but more as a complete alternative. I phoned the maternity hospital to speak to my midwife, but she wasn’t in that morning. She was due in in the afternoon. I spoke to her counterpart, who told me to keep doing what I was doing – expressing from both breasts (now that she wasn’t taking from the breast at all) at least every three hours and feeding it to Eleanor. Keep offering the breast before the bottle, but don’t leave it too long if she still refused, otherwise she wouldn’t get enough. And she scheduled my midwife to come and see me in the afternoon.
I broke down when my midwife came. Told her I thought I would probably change to formula as I just couldn’t cope any more. I wasn’t getting any sleep or any time for anything other than trying to force my baby to take milk from my breasts, express milk, and feed her the expressed milk (though other people could and were doing this sometimes, of course). I was hardly seeing Rosemary at all and just wanted to spend an hour reading with her or baking or doing something normal together, or even just having a good cuddle. I couldn’t see how it would ever be possible for me to leave the house, do any work, or basically do anything other than attempt to feed, pump and bottle-feed. Oh and cry. I couldn’t stop crying.
My midwife understood. I think she may have been the only person who really did. And she knew me well enough to talk me out of making a snap decision when I was at such an incredibly low point. She pointed out that I wouldn’t be able to stop cold turkey anyway, at that point. I’d need to keep expressing for a few days, otherwise I’d be in real trouble with my breasts. And she asked me whether I didn’t think it was a decision that I might very well regret deeply in the future, given my history. So, between us, we came up with a way to take a bit of the pressure off for a few days, so that I would be in a better position to make the decision later on.
Stop offering the breast completely. Keep pumping. Give her all the expressed milk and top up with formula (I would like to stress that, at no point did my midwife bring formula up or try to pressure me into using it; it was my idea and she agreed that it was probably the best way in these very difficult circumstances) until she’s satisfied. She said that, if it weren’t for the weight loss, she would suggest stopping offering the breast for 24 hours, anyway, maybe trying a feeding cup. Because sometimes babies and mums just need to stop and try again fresh. She also agreed to look for no loss when she came to weigh Eleanor on Tuesday afternoon, rather than looking for a gain. Which took a bit more pressure off.
And that was fine. It was still hard work, expressing eight times a day. It took 40 minutes each time and did hurt – not as much as the bad latch at hurt, but still painful. Working out the timings of expressing and feeding was a bit of a logic problem, but it worked out that I expressed immediately after a feed during the night and about an hour after in the day. That maximised the chunks of sleep I could get at night and the time to do things like eat breakfast, have baths or spend time with Rosemary, during the day. Not having to deal with the screaming and flailing of arms and the incredibly depressing feeling that your baby does not want to take nourishment from you, made me a thousand times calmer. Which was good for everyone.
The next day, I got a fever. There were no red patches on my breasts, though the left one felt very engorged. I was very shivery and dizzy and just wanted to sleep lots, just like I had on the first day of the mastitis the week before. Despite this, I still managed to keep up with the expressing, though I handed over most of the actual feeding to others. In the afternoon, my midwife came. She agreed that it didn’t look like mastitis, so the next obvious culprit is the uterus. Looks like there was an infection there, which had quite possibly been there since the birth, if the lochia odour was anything to go by (stupidly, I had no idea it wasn’t supposed to smell like that). She was onto my doctor immediately to get some antibiotics and took a swab to send off for testing (results tomorrow, though I have improved enough to know that the antibiotics are working).
Then it was time to weigh Eleanor. She had gained – just under two ounces. What a relief. And she doesn’t have to be weighed until Saturday now, then not until next Wednesday, which will be the last midwife visit and the health visitor will take over from then on (all being well, of course, but there should be no reason why it wouldn’t).
My midwife came back yesterday morning to check how I was – not to look at Eleanor at all, as she was no completely happy with her (and assured me she would poo). And then she told me I could try putting Eleanor to the breast any time, if I wanted to. She said that Eleanor was getting enough food into her and had gained weight, so there was no pressure. I didn’t have to try, but if I wanted to, I could just put her there, and she might have a bit of a comfort suck. Or she might not. But it would not be a worry, because we knew we could get the food into her. I nodded and smiled, but didn’t really feel like trying anytime soon.
Last night, Eleanor did her first proper, non-meconium poo. This was cause for much celebration, as I have already mentioned. This morning, at around 10.30am, after giving Eleanor 30ml of expressed milk, I unclipped my nursing bra and held her to my left breast. She latched on immediately and sat there and fed for over 10 minutes, then swapped to the right breast and fed for another 10 minutes. I sat there for a few moments, silent tears of joy trickling down my face. Then I called upstairs ‘Guess what Eleanor’s doing?’ ‘Breastfeeding?’ came the reply and Chris came downstairs to witness me bawling my eyes out yet again – but this time in absolute happiness, rather than despair.
She has since breast-fed a few times and is currently sleeping peacefully in her crib having fallen asleep on the breast (oops – not supposed to be doing that, but I am so not going to worry about bad-sleep-forming issues at this point!). We will continue with the formula top-ups, at least until next Wednesday, so as not to risk her losing weight again. I was only managing to express 30ml at a time, so it’s possible that I’m not yet overly productive in the milk department. I know it will come, but I’m not going to risk her losing weight again just yet, especially as she seems to now be quite happy to mixed feed. (And, frankly, it’s nice to have a break sometimes – and Chris enjoys it, too, so maybe we’ll keep one or two formula feeds in there for good, or buy our own pump.)
Hopefully you can imagine how happy I feel at the moment, because I really am not able to put it into words.
Did you have feeding ups and downs, or were you one of the lucky ones? Now I’ve come out the other end, I’m happy to hear all your stories – even if they make me a little jealous!