Monday, 18 June 2012

Month one of breastfeeding...

As part of my mini-series of blogs giving a warts 'n' all account of my first few weeks or months (whenever I get bored of writing about it or you get bored of reading it!) of life with a new baby, it seemed appropriate to include something about breastfeeding, particularly with National Breastfeeding Week coming up at the end of this month. One of my pet peeves (I have a few) about how we treat breastfeeding is the lack of transparency and realism used in promoting it to expectant parents. Most of the literature pregnant women receive about breastfeeding contains beautifully shot photographs depicting calm, romanticised scenes of a laid back mother and a content, snuggly baby. Very lovely to look at, very lovely to imagine yourself doing. Not entirely representative of the early days establishing breastfeeding, and thus not actually terribly helpful.

When my first son was tiny and I was trying to get to grips with feeding him, I struggled. He didn't latch well, I felt awkward holding him, my arms ached from lifting him and holding him in position to feed, my nipples were sore, I developed mastitis, I felt self-conscious about exposing bits of wobbly postnatal belly when lifting my jumper, I leaked milk everywhere between feeds and from whichever side I wasn't feeding from at the time - never mind the fact that he CRIED. A lot. I was certain that there was something wrong with what he was being fed, either the quantity or the quality. Why else would he cry?? I remember loudly lamenting to my midwife that boobs really should be see-through and have little marks down the side to help keep track of how much milk babies had taken! Looking back now, I see that comment as sadly indicative of how far we've marginalised breastfeeding and normalised bottle feeding in its place.

 It wasn't a snuggly and calm experience, and I thought I must be doing it wrong because it didn't feel like the pictures suggested it should. The remedy to this was chatting with a bunch of other breastfeeding mums I knew from baby groups and realising that we had all experienced varying degrees of discomfort and awkwardness, worry and frustration. I wasn't weird and certainly wasn't doing it wrong! That's just what it's like trying to learn a new skill when you're already tired and uncomfortable from having given birth days or hours before. Imagine trying to learn to drive when you haven't slept properly in days, then giving yourself a hard time for struggling to coordinate your hands and feet to control the vehicle!

So. This time would be fine for me, right? I've breastfed three other children for around a year each. I'm a trained peer supporter and have read an almost absurd amount of stuff about how breastfeeding works. So I wasn't going to have any problems getting to grips with feeding this baby... HAHA. How wrong was I.

The very first time I fed him was lovely. Ok so I may be remembering that through rose-tinted glasses. I was still very uncomfortable after the birth, covered in blood and sweat (I promised honesty!), still high from the pethidine and gas & air, starving hungry and really, really tired. But he latched like a pro and quite happily munched away for about half an hour while his Dad & I cooed over how beautiful he was. Later on when we had settled into the postnatal ward, I tried to feed him again. He promptly clamped his mouth shut and wanted nothing to do with me. "Alright", I thought, "that's fine. You've been born with plentiful fat stores to keep you going, you're probably a bit zonked from the pethidine. This isn't a problem". I held him and he went to sleep, so I lay down and snoozed for a while myself. Throughout the following morning I tried again to feed him, anxious to tell the midwives that he was feeding well so we could go home at some point that day. No matter what I did - all the tricks in the book about stripping his clothes off, tickling his feet, skin to skin contact, changing feeding positions - he wasn't interested. Even when we got home that evening, he didn't want to know. I was still reminding myself that this is ok, he was very awake and alert but just preferred to be held and look at faces.

Around midnight, something happened. I don't know what, but it's like someone flicked his 'hunger' switch on and peaceful snoozy baby morphed into Screaming Booby Monster. He fed and fed and fed and fed for three hours straight. I knew he wasn't latching properly, I could see that his mouth wasn't opening enough when I was putting him to the breast and I could feel that something wasn't right as I was feeding him but he was busy munching away and I didn't dare disturb him in case he resumed screaming. After 3 days, I was at the stage of toe-curling pain when he started feeding. Every now and then, I'd manage to get him to open his mouth really wide and the pain would be virtually non-existant for that feed, so I assumed that the issue was purely my laziness in getting him to latch properly and all I needed was to really concentrate on getting him to open his mouth wide enough each time and we'd be onto a winner. Oh, and to apply lashings of Lansinoh in between feeds. Not to digress, but I really do love that stuff, perhaps too much. I remember day five, waiting for family to come and visit and being in floods of tears because that particular morning he had fed solidly from 6am to 1pm without more than a few minutes break, and I felt like I was either going to lose my mind, or my boobs were going to fall off. I dreaded having to try and explain that he was just having a fanatical feeding day and I was fine with this, potentially having to field suggestions to maybe give him a bottle or justify why I didn't want to do that. Thankfully he mellowed out just as our visitors arrived and was mostly lovely company for the afternoon.

Through a series of clerical mishaps, we didn't see the midwife again until Baby T was 10 days old, at which point they weighed him and announced that not only was he back to his birth weight, but he'd actually exceeded it by a further 3 ounces. That was very exciting news to me and reassured me that although latching him on still hurt quite a bit (less so since I'd taken to smearing myself in Lansinoh!), he was clearly getting enough milk, so it was all worth it. I casually mentioned the discomfort to the midwife, but said I wasn't worried because he was gaining weight really well, had masses of wet and dirty nappies so everything must actually be going fine. She decided to check him over anyway and within seconds had spotted that he had a tongue tie. This was a relatively new concept to me as tongue tie wasn't as widely known about when I did my training or when my other children were babies. If you feel underneath your tongue, you'll find a tiny thin bit of flesh attaching your tongue to the bottom of your mouth. In babies with tongue-tie, that bit of flesh is too short and/or attached too far forward, preventing them from thrusting their tongues forward and thus latching on to the breast properly.

I can't tell you how thrilled I was when she said that to me. That may sound really ridiculous but I was starting to lose faith in myself. As I said before, I've breastfed three other children, trained in breastfeeding support and spend an inordinate amount of my spare time reading up on issues surrounding breastfeeding. Establishing breastfeeding with my own baby should have been a doddle! Admitting that I had sore nipples from a poor latch was pretty embarrassing to be honest, so being told that it wasn't my fault was music to my ears! Best of all, it was something that could be remedied! She rang the community midwives office to ask for a referral to our resident lactation consultant, who happens to be a bit of an authority on tongue tie, and I was astonished for her to then ask if we were available to pop in and see her the following morning for a consultation and possibly to have Baby T's tongue tie divided. That's pretty fast moving for any NHS procedure, but in the context of what I've read of other parents waiting weeks to see someone, battling to have a tongue tie properly diagnosed or even find a doctor who recognises that such a thing exists, this was absolutely monumental.

As the evening wore on, I started to feel nervous about the morning's appointment. The excitement had worn off, and instead apprehension about the idea of dividing his tongue tie crept in. It's a tiny, tiny procedure. It takes half a second at most and the staff who do it are very well trained. From what I'd read, it's less distressing to a baby than the standard heel prick test almost every baby in the UK has at 6 days old, or the vaccinations at 2, 3 and 4 months old. But still... something about the idea of anyone sticking a pair of surgical scissors into my baby's mouth to snip a bit of flesh... Well quite frankly the very idea of it brought me out in cold sweats.  I prepared myself mentally to argue every which way against having it divided until I was absolutely certain that it was necessary and that doing so would improve Baby T's wellbeing.

The appointment was actually much less alarming that I'd convinced myself it would be. The midwife was lovely, very comforting but also straightforward and no-nonsense. She went through the assessment paperwork with us and explained how they determine the severity of a tongue tie in terms of how it impacts a baby's ability to feed. We also talked through how long and frequently Baby T had been feeding - not easy considering that I hadn't been paying attention and just fed him if he wailed! I pointed out that I was very reluctant to have the procedure done as my pain and discomfort was reducing through me really concentrating on getting his latch right, and he was clearly getting enough milk because his weight gain was really good. It wasn't until we looked again at his feeding pattern that I realised his weight gain was so good because I had probably spent about 70% of my time doing nothing but feeding him over the previous eleven days. Newborn babies are supposed to feed a lot; their tummies are tiny - walnut sized really - so they fill up quickly and also empty very frequently! I had simply put down his frequency and length of feeding to normal newborn behaviour, but actually from the midwife observing him feed, we could both see that he wasn't getting a lot of milk in one go, so needed to feed for ages on end to fill up. Closer examination of his mouth showed us that his tongue tie was actually pretty bad and he could barely move his tongue around - certainly not enough to ever be able to latch on properly to be fed. Although his weight gain had been great so far, that would most likely tail off quite quickly and he'd start to struggle. I didn't want to leave it until he was older to have the tie divided because it would be more distressing to him then, so we decided to go for it. I wimped out of holding him and asked my husband to take over while I got ready to feed him. The moment it was done, he squawked a little but he was handed back to me immediately and settled down to feed. I promptly burst into tears and gripped him fiercely but once I calmed down it dawned on me that I couldn't feel any pain from him feeding!

For the next couple of days, I carried on really concentrating on getting him to open his mouth wide and latch properly - the midwife had warned that he'd effectively need to re-learn what to do with his mouth now that he could move his tongue properly - but the real surprise was how much shorter his feeds suddenly were. Whereas I'd previously sit for half an hour or more to feed him, he would now either fall asleep or un-latch himself after something more like ten minutes. I haven't had him weighed again yet, but he's outgrown a handful of his first outfits and started to develop chubby cheeks and thighs.

Since having the tongue tie sorted, I've tried very hard not to worry about anything breastfeeding related. I'm no longer in pain, Baby T is most definitely putting on weight and becoming more alert and interactive, he's sleeping well (that's another blog in itself ;-) ) and is generally wonderful to be around. Aside from a couple of days feeling under the weather with mild mastitis, all has been much smoother for the last two weeks. The health visitor is coming again this Friday and will weigh him again so I'm looking forward to seeing how well the weight gain is going now - especially as there is a small part of me competing with a friend whose baby is the same age and is gaining weight like a professional!

If there is one thing I would hope an expectant mother to take from this post, it is to accept that the early days are not going to be a picnic - and that that's ok! Read lots, talk to other breastfeeding mums and health care professionals, but also accept that when you're sore, aching, exhausted and bewildered by a tiny, wailing creature for whose wellbeing and survival you are entirely responsible, all that preparation will go out of the window and even the most seasoned breastfeeder will falter without the right support at hand. Without the local midwives and lactation consultant really knowing their stuff and reaching out to offer me the help I needed, this last month would have been infinitely more troublesome than it has been. I think we've just about settled down now and I feel confident and comfortable with breastfeeding. Now all I have to sort out is my wardrobe! Finding summery tops that I can breastfeed in comfortably is harder than it sounds - particularly as 'comfortably' for me absolutely has to mean that I don't worry about flashing bits of wobbly belly at anyone. So far I've favoured the two layered approach with a vest top underneath a baggier top, so I'm exposing the minimum amount of flesh possible. That's fine while the weather is so grim, but if it warms up over July & August, I'm going to have to go shopping!

While I'm on the topic of breastfeeding, I'll take the opportunity to shout out to a few other blogs worth reading if you're a breastfeeding woman, or pregnant and want to read more:

For great tips on fashionable clothes and breastfeeding (because I'm still a girl and still love clothes!): Milk Chic Breastfeeding Fashion blog and website

For amazingly eloquent and stirring pieces on new research or responses to coverage in the media:
The Analytical Armadillo blog (from a certified lactation consultant)

For great info and more bare-bones truth about breastfeeding:
Dispelling Breastfeeding Myths blog

Edited to include the lovely Kim of the Little Leaf (I've just discovered her blog and am a little bit in love with it)


And a list of helplines from the NCT is available HERE

One final edit - I saw this just now and needed to share it!




Next time - Bedsharing!

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