My breastfeeding journey

A reader of this blog asked me to share my own breastfeeding story - I am pleased to do so, because I had a somewhat difficult time, and I think it's useful to share this sort of story, in the hope that other women who are struggling can see that there is a light at the end of the tunnel.

Warning - this is loooooong!

I felt very well prepared for breastfeeding.  The preparation I had included:

• I had read a couple of books specifically on breastfeeding - I consider the best ones to be Breastfeeding... Naturally (which is so comprehensive, and you actually get a free copy if you subscribe to the Australian Breastfeeding Association), and Breastfeeding Your Baby, plus you can find some other excellent ones HERE;

• I had watched YouTube clips on attachment, latch and breastfeeding positions - there are some AWESOME clips here http://www.drjacknewman.com/video-clips.asp ;

• I had spent extensive time on online forums and blogs, reading the stories and advice from other mothers;

• I had extensively researched the benefits of a baby having milk from its own species, and the problems associated with artificial feeding;

• I had chatted at great length with my own private midwife, herself an IBCLC (International Board Certified Lactation Consultant), about possible problems with breastfeeding, and felt confident of receiving excellent support from her if I needed it;

• I was familiar with the international Baby Friendly Health Initiative, outlining the ten steps most important in the early days (in hospitals, primarily) for breastfeeding;

• Importantly, I had actually observed a lot of breastfeeding - I lived at home while my mother breastfed my younger sister (I was 17 when she was born), and she breastfed for over 18 months.  Breastfeeding for me, growing up, amongst my friends and family, was completely normal.  I have watched my aunts breastfeed many children, and some of my earliest memories are of my friend's mother breastfeeding her younger two siblings.  I remember the cabbage leaves, and how nice and cosy they looked, curled up with their mother;

• Importantly - I had no experience, really, with artificial feeding.  I don't know anyone who simply did not breastfeed at all, and every close family member and family friend has breastfed their children - including twins and even triplets.  The idea of 'formula' was very foreign to me, and didn't register with me as an option.  I considered - and still consider - artificial milk to be an absolute last resort.  I do not judge women who use artificial milks, however I am saddened that they are normalised in our society, and that women who want to breastfeed (nearly every woman, it seems) are not given better support and information.  When I was younger, I observed my aunt donating her excess breastmilk to other mothers in her area, and remember thinking to myself "well, that seems sensible, I'm glad those other babies can get milk".  I learnt recently that breastfeeding initiation rates are lowest amongst women who plan to return to paid work the earliest - so it seems that paid maternity leave, better support for expressing women, and good facilities with paid lactation breaks at work are all really crucial in increasing breastfeeding rates (these are all part of international codes which Australia does not adhere to).

So, you can see, I thought I was pretty prepped for breastfeeding.  And truly, I suppose that I was - there is nothing else, really, that I could have done.  Which really underscores just how vital support is in the early weeks and months of breastfeeding - no matter how much preparation a woman does, breastfeeding DOES often require support.

Many women think, quite logically, that because breastfeeding is natural, it will come naturally.  However, I believe breastfeeding is more akin to dancing, singing, speaking - things that are natural, yet us humans learn and improve at by watching, observing, copying, and receiving instruction.  Many women have never observed breastfeeding 'close up' - that is, the actual latch between mouth and breast, the positioning of the head etc.  Other mammals are fascinated to watch their kin breastfeed - in fact, I recently watched a television show about a zoo, where an orang utan was pregnant, and the keepers were concerned about her raising a baby, since she had not been exposed to other orang utans.  What did they do?  They brought in a breastfeeding woman!  The orang utan sat and watched, closely and with fascination, checking out the breastfeeding from every angle.  So it seems that it is natural for mammals to learn about breastfeeding through observation.  It is also known that primates in the wild will assist each other with breastfeeding - repositioning an infant, and sharing breastfeeding duties if a mother's milk supply is low.

MY STORY

So, what happened when Tabitha was born?  After nearly 45 hours of labour, out came this active, wriggly baby, who promptly latched on (by herself, as I had asked for in my birth plan), and fed voraciously for over two hours!!!  That's right!  She latched on one side, and after about half an hour, she pulled off and rooted around for the other breast.  Because I was exhausted, the midwife showed me how to feed her lying down on my side.  She fed on the other side for half an hour, the switched BACK to the first breast, and thirty minutes later, back to the second breast!  She seemed happy, relaxed, and very focused on her task.  At the end of this marathon 2-hour feeding, both of my nipples already had a small blood-blister.  I must say, from the moment she latched on, I was absolutely shocked at the strength and force of the sucking of this little, seemingly helpless, creature.  She sucked much more forcefully that first day than she ever has since, and fed for longer.  It is clear to me that this initial feed was important for her to connect to me.  It is a powerful memory for me.

I had a fair amount of colostrum (the first, thick and rich milk which the breasts produce in the initial few days), and Tabitha didn't actually loose any weight at all (most babies loose some weight in the early days, which they then re-gain).  For the first few days, while the feeding did hurt a little, I was quietly confident about breastfeeding.  I am thankful that we didn't have any extra initial complications, such as cleft pallet or tongue tie, to deal with.

Our problems really began on day two.  Two days after Tabitha was born, it was my birthday, and I woke up 'with new breasts for my birthday' - I had gone from a B cup, to a D cup during pregnancy, to an absolutely bursting, painful, shiny-stretched-skin F cup.  My breasts were burning hot, painful to the touch, and leaked milk constantly.  I suffered from a fairly dramatic 'Oversupply'.

For many women, under-supply is a problem - they don't seem to produce enough milk.  This is very common, and often symptomatic of poor hospital practices such as timed feeds, scheduled feeding, poor latch instruction, induced and augmented labours, and drugs during labour which can affect a newborn's feeding for hours or even days, as well as a woman's own production of milk.  All of these things, however, can be rectified with the appropriate information, support and instruction (feeding more regularly, for longer, improving latch, increasing fluids and food, sometimes taking prescription medications, plenty of skin-on-skin time to increase hormones which may have been interrupted during augmented labours, etc).  Under-supply is a common reason given by women who felt they could not breastfeed their babies.  It is really sad, because almost all of these women can breastfeed with the correct support - it is absolutely not the fault of the women, and none of them should ever feel guilty for doing the best that they could.  Over 95 per cent of women can physiologically breastfeed (according to the World Health Organisation and all other reputable medical organizations, including our own government).  Of those women, most do want to breastfeed - so it is always my hope that they can receive the support they need to do so.

I had the opposite problem - I had a massive OVERsupply of milk.  This comes with its own real problems.  The problems that I had with breastfeeding, over the first six weeks, were:

• The engorgement I suffered was particularly painful - the skin was stretched so tightly that it felt like a bad sunburn, and the entire breast area was burning hot (to feel, and to the touch);

• Because the breasts were so engorged, Tabitha couldn't latch on properly, as there was no 'give' in the skin for her to grip her mouth onto.  This was combined with the fact that there was SO much milk, everything was all slippery.  So basically, for the initial month or two, the latch was dreadful, with poor Tabitha trying to suck hard on the nipple, instead of getting a good mouthful of areola and breast.  This caused MAJOR nipple damage;

• When breastfeeding, the nipple should be right down the back of the mouth, against the soft palate.  Instead, because she couldn't take it in properly, the tip of the nipple was constantly mashed between her bony gums and the hard palate.  My nipples were so, so damaged - they started to take on the shape of triangles (the ends being so mashed and flattened), and I developed deep, deep cracks and fissures;

• The cracks and fissures were, at worst, a couple of mm across, with whole chunks of skin sometimes being sucked from the nipples.  Because the baby feeds ALL the time, the nipples never have more than a couple of hours' break, so the damaged and wounded, broken skin can never heal.  The open wounds were just constantly being re-mashed!  There was a lot of blood - in fact, at one point, I was expressing only from one side (the damage got too bad) and the milk was all tinged pink, because of the blood!

• It was somewhat inevitable, with my oversupply, that I ended up with mastitis.  My amazing midwives were over at our house every day (sometimes twice) right from day one, and every time they would carefully check my breasts for lumps, which would be heated with a hot compress and massaged out (OUCH!!!!!!).  I used hot compresses before every feed, and cold compresses (and cabbage leaves, and frozen cloths) after each feed - yes, for weeks!  A couple of times, my midwife hand-expressed a breast, to empty it completely (this is more effective for getting lumps out than a pump, but is more painful I think!).  Sadly, despite all of this, one morning I woke up with the awful flu-like symptoms of mastits, feeling like I'd been hit by a bus, not able to get out of bed (can you believe a visitor, who came to see the baby, had the audacity to complain that I didn't get out of bed for the visit?!).  I spent the next few days at a physiotherapist, getting ultrasound treatment - this is incredibly effective at getting rid of stubborn blockages.  It is also very expensive;

• My midwife came to visit first thing one morning, then had to go to a conference for the day.  She rushed over straight afterward, bursting into the bedroom, stating, "oh goodness, I haven't been able to concentrate at the conference all day, I couldn't stop worrying about your breasts!" which I found quite amusing;

• Another problem I experienced was associated with the oversupply, though can also be a separate issue - I had a very forceful letdown (I still do).  The letdown is a reflex, triggered by the sucking, where the muscles suddenly contract in the breast, making the milk come out - only in my case, the milk SPRAYS like a hose.  Still now, if Tabitha pulls off while feeding, I have been known to accidentally spray someone in the face!  This meant that poor Tabitha would gag, choke and sometimes vomit during the feeds in the early weeks, because there was too much milk, too fast.  Thankfully it's not so bad now!  Also - the vomiting never seemed to bother her - she would vomit, then just go back to her milk;

• It might seem trivial, but one of the most demoralising parts of my early breastfeeding experience was just being constantly soaked in milk.  I was producing literally litres a day, and much of it ended up in my hair, my clothing, drenching my sheets.  I would easily soak through 5 or 6 breastpads during a feed, so instead I had to use a whole bunched up towel for every feed.  I got really down, emotionally, and stopped wanting visitors, and didn't want to leave the house.  Everything smelt like milk, I was incredibly sore, and just felt miserable.

So, in short, the first 6 weeks were utter hell. I was often in tears - when Tabitha stirred, or looked hungry, I would often burst into frightened tears, I was so scared of feeding her because the pain was unbearable.  We had to take it 'one feed at a time' with The Daddy holding my hand while I squeezed it, and cried, every time I fed her.  I am SO HAPPY that not once did he suggest to me that we try a bottle of artificial milk - he knew how important breastfeeding was, and it would have really tipped me over the edge, emotionally, if anyone implied that I should give up.  No one did, not one person - my parents, husband, midwives, friends and family were all incredibly supportive, and I am so thankful.

For nearly a week (around week 3) we expressed and bottle fed (the expressed milk), to give my nipple damage a chance to heal (we hired an excellent Madela Symphony Double Pump from the ABA).  I was really upset about this (I found it upsetting to watch Tabitha drinking from a bottle), and it was hard (with sterilising the bottles and equipment, sitting up to pump during the night while The Daddy bottle fed etc), but it did help the healing process.  I made several midnight calls to the ABA, which helped (both with practical advice and lifting my spirits - the women on the phones are all just lovely).

I'm no martyr.  Many women go through the same things as I did, and worse - it is surprisingly common to have real trouble!!  It does frustrate me when I hear women say they couldn't breastfeed, when what they really mean is 'it became too hard'.  I do not judge these women at all - it truly IS bloody hard.  What frustrates me is knowing that, with better support, most women could get through those initial hard times, and go on to an enjoyable, easy and fun breastfeeding journey.  There is nothing special about me - I went through absolute hell, sobbed and sobbed, complained bitterly, however I had such excellent support that I kept on, and was able to get through.  A lot of women I have spoken to, who stopped breastfeeding, didn't call the ABA or seek any support beyond their GP (who, in many cases, recommends artificial milk, as most GPs are not trained in breastfeeding).  I urge you - if you know anyone who is struggling with breastfeeding, suggest that they call the ABA's free helpline 1800 MUM 2 MUM.  Also - give them a hug, a cup of tea, and mind the baby for them while they take a warm bath!

Being able to donate my excess milk to other mothers who were building up their low supply helped, by keeping my spirits up, and seeing some 'positive' out of a pretty crappy situation.  Another thing which really helped was going along to the ABA meetings, where there were lots of mums with older babies - many of them had been through similar problems, and reassured me that it DOES get easier, and that those early troubles soon fade from memory.

This is important:  It DOES get easier.  For the majority of women, the first 6 weeks or so are the worst.  As the baby gets bigger and stronger, the latch often naturally improves.  If you get support (phone, face-to-face with a lactation consultant or ABA counselor, full support at home etc), there is every chance you can breastfeed (over 95 per cent of women can).  Once you pass the initial hurdles, it is the most wonderful, rewarding experience - to just scoop up your baby anywhere, any time, and put them to the breast to feed.  Instant comfort - a bumped head?  No worries, straight on the breast and the crying stops instantly.  Breastfeeding used to be so painful, and is now one of my favourite parts of parenting.

BODY CHANGES

Someone also asked me about breastfeeding and its effect on my weight, and hunger.  To start with, I found that the pregnancy weight fell off - for the first few weeks and months, every time I looked in the mirror, I felt like I was smaller, just melting away.  In a good way!  I wasn't actually too much hungrier than usual - I spent a lot of time, in the early months, at home and in bed with the baby.  I made sure I ate nourishing foods (lots of protein, particularly), and didn't notice any real change in my appetite.  

After around 4 or 5 months, however, I realised I had actually started to put ON weight - just a couple of kilograms.  I thought about my diet, and realised I had been eating a lot more cake and sweets than I needed to.  Partly, would you believe because of all the Mothers' Groups and ABA meetings etc., where there was always an endless supply of cakes, biscuits and muffins!  So I made an effort to avoid all these empty calorie 'extras', and found this was enough to keep the weight loss back on track.  

After around 8.5 months, I am now back to the pre-pregnancy weight - however, my shape has certainly changed!  My waistline is a few centimeters bigger, which I noticed when I tried on some old dresses and skirts, and I'm not sure if it will ever go back.  I suspect it's a result of the changes to the body from inside (moving of ribs, internal organs etc.) during pregnancy, rather than due to weight changes.

Now, I find that I am always thirsty (I drink 3 - 4 litres of water a day, and have since the birth), and while I am not particularly hungry (no more than pre-baby), I do notice that I can't go too long without eating - more than a few hours, and I become dizzy and faint.  I suppose this is because the body is constantly working to produce milk.

So.  That is my story (believe it or not, there is looooads more!).  I guess the main reason I am training as a breastfeeding counselor is that it makes me really sad when women who want to breastfeed, really want to, end up not being able to - it is so rarely the mother's 'fault'.  But when we know that over 95 per cent of women CAN breastfeed, it is clear that more support and education is needed - so that  all these women who want to breastfeed, are able to.

This is a really excellent article articulating the Australian Breastfeeding Association's views on artificial milk and low breastfeeding rates.  I think it's kind and supportive to all women.

Here is a photo of me feeding Tabitha.  She is about 2 weeks old, and it is the first time I fed her out in public, I think.  I was grimacing through the pain, with the nipple damage, but I remember feeling really proud to be able to sit and feed her in a restaurant.