Tuesday, December 24, 2013

Birth/Breastfeeding Connection? (2 of 2)

As it would turn out, while my little girl’s being small (5 pounds, 10 ounces) may have been beneficially for me during birth, it would prove a stumbling block to establishing a good latch.  Her mouth just seemed to be too small to take in the appropriate amount of the areola, nibbling instead on the nipple itself.  Furthermore, having come a couple of weeks earlier than expected, she fell into a category no one mentioned before – near-term baby.  As such, her rooting motions were quite jerky, and her sucking not very well coordinated.  Add to that a mom traumatized by early nipple damage, resulting in an inability to boldly and quickly maximize the few nanoseconds baby’s mouth stays open before attempting to suckle, and painfully sore nipples are bound to happen. 

Although everyone not directly involved with La Leche League claimed that a painful beginning (days? weeks? months?) was part of the deal, I had a hard time believing that my threshold for pain was that much lower than all of these other moms’. The aforementioned nipple damage traumatized me quite a bit. It was the last straw on a heap of a week’s worth of painful nursing sessions.  Contrary to what I knew had to happen once I began lactating, I was so afraid of anything coming anywhere near my damaged breast that I neither nursed nor expressed any milk from it for 12 hours.  When the scab came off in the bath, I was able to attempt to express milk using the manual pump I had “just in case”. But because my milk had just started coming in the day before, I spent two hours in all sorts of crazy positions, trying to maximize the amount I got with the help of gravity, yielding just enough for one feeding – by miniature bulb syringe – before realizing that I simply could not keep up with my little one’s needs.

First bottle feeding, day of trauma and drama :(
Utterly disappointed in myself for my inability to nourish my child the way nature intended, I had to succumb to allowing formula into the picture.  We had received some formula samples in the mail which I had gathered to donate, since formula did not fit into the ideal I was trying to establish in my early days of parenting.  But now I was so thankful that there was a way I could feed my baby, even if it was no thanks to me.  Alex, bless his heart, offered to take the entire night shift (since this became a possibility with the introduction of formula into the picture) so that I could sleep and thereby try to recuperate a bit from the day’s drama.

The next day, I found my damaged breast to be severely engorged, leaving me with a fever, chills, and later night sweats.  I proceeded to nurse my baby on the one good breast during the day, leaving the night feedings to my husband.  The following day, I began to wear cabbage leaves in my bra to soothe the heat and pain that I felt in my damaged breast, and tried to express milk with my manual pump.  I was convinced that between that and the rest I was getting, everything would just fix itself.  It wasn’t until four days after the damage first occurred that I finally called my midwives.  I was no longer just dealing with painful engorgement; I had a breast infection.

That whole day was spent trying to follow the midwife’s instructions for how to best begin the healing process.  After trying to no avail to find a medical supply store in our area that (a) sold electric breast pumps and (b) would bill our insurance, Alex drove around town picking up my antibiotics and nipple ointment.  As it finally turned out (thanks to the insight offered by whoever answered the phone at the lactation office I called), the idea that we could purchase a breast pump and have it go through our insurance was a rouse.  In fact, we had to order through our insurance and wait for it to ship in 4 – 6 weeks.  Well, I needed the pump that same day.  And so we paid for an electric pump out of pocket and I began pumping more efficiently.

However, over the weekend, I noticed one stubborn area of my breast where the redness and bumpiness was not going away.  Convinced that it was a blocked duct that wouldn’t go away (I tried warm compresses, massage, even putting an electric toothbrush to the area), I called my midwife back and asked about a solution I had read in The Womanly Art of Breastfeeding – an ultrasound that could break down the old milk proteins in the ducts and get the milk flowing again.  Since my two week postpartum visit was a few days away, the midwife preferred to wait until then before sending me in for an ultrasound which she wasn’t convinced would work. 

The night before my appointment, as I was flipping through The Womanly Art for the umpteenth time, I came across a small section about an “uncommon” problem called a breast abscess.  I had Alex read it to see if he thought – as I did – that perhaps I didn’t have a stubborn blocked duct; perhaps I had a breast abscess.  We both agreed that it was a possibility, and it was confirmed the next day.  My midwife scheduled an ultrasound to confirm her diagnosis for the following day.  From the ultrasound, I was sent directly to a breast surgeon who could drain the abscesses (turns out there were three!) that same day.

Over the weekend, there was noted improvement, though a lump remained, albeit somewhat smaller and less discolored.  At my follow up visit, I had the remaining abscess drained again, this time via an incision that would be left open to allow for ongoing drainage.  (It’s as creepy as it sounds.)  I also found out that the abscesses were resistant to the antibiotic I was on was.  However, my options of an alternative were a bit limited.  I’m allergic to penicillin, and I needed something that was safe for continuing to breastfeed. This left three options, all IV-based.  And so I ended up with an antibiotic that wasn’t quite as effective but still better than what I had been on up until that point, with the instructions to pump and dump my milk for the first few hours after taking each daily dose.

However, since the week I had already been on a supposedly breastfeeding-safe antibiotic caused Maya to have pure liquid poop (I’m not talking runny the way you’d expect on breastmilk, but basically what looked like brown pee), Alex and I agreed that it was best to eliminate it from her diet until I was no longer on an antibiotic.

It has been a week since I breastfed my daughter.  This brings tears to my eyes, in spite of the fact that often times, nursing her literally brings tears to my eyes as well.  But I’ve found the silver lining in this challenge.  While the pro-exclusive breastfeeding folks would have me believe that I am – and ought to be – the center of my baby’s universe if I know what’s good for her, I in fact believe that God has used this time to humble me instead.  I have to share my daughter with formula, bottles, and pacifiers, because pain prevents me from being able to fulfill all of her suckling needs on my own.  And this helps me to remember that Maya is a child of God first and foremost, and I have merely been tasked with the responsibility and privilege of raising her.

Here I am experimenting with a couple of holds to try to keep breastfeeding.

Football/clutch hold. For some reason it helped to stand up.

The whole first week we nursed in the clutch/football hold, as it is supposed to work better for tiny babies.

The cross cradle hold on the Brest Friend pillow.  Supposed to help by freeing my outside hand to hold breast in a "C" and observe her latch.
Yesterday I took my last dose of antibiotic.  Today, we began nursing at the breast again.  So far, it would seem that allowing my nipples to rest and giving Maya practice on the bottle and pacifier seems to have helped!  (We use paced bottle feeding to keep the flow similar to breastfeeding, ie. slow.)  She wasn’t too keen on Leftie (the traumatized breast), but she latched onto Rightie (you guessed it - the breast that had been holding down the fort on its own) no problem.  I kept trying to check her latch because it didn’t hurt going on, but it seemed fine, and she nursed for a half hour before falling asleep and letting go.  My nipple came out not looking like lipstick for the first time!  I immediately put on the nipple ointment, and it is sore right now.  But what I learned over these last couple of weeks is not to try to be a hero and to find that happy balance where I’m giving my daughter my best while still enjoying the miracle and blessing that she is.

Birth/Breastfeeding Connection? (1 of 2)

One of the main reasons I chose to have a natural home birth was to maximize a solid start to a successful breastfeeding relationship with my baby.  Everything I read about the multitude of interventions that are common in hospital births seemed to point to the beginning of the end of breastfeeding for mothers and babies who were “drugged” during birth.  And since I didn’t trust myself to turn down interventions in a time as vulnerable as labor, I opted for a homebirth instead.
Mine is not a story seen through rose-colored glasses, though.  While the convenience and psychological comfort of giving birth to my daughter at home cannot be surpassed, I will not sugar-coat the physical pain of active labor contractions, transition, and pushing.  Having “been there, done that”, as I read over descriptions of natural childbirth now, I’m able to see the descriptions in a new light and realize that I made a decision based purely on objective intellect.  My higher education background would have me believe that this is the mark of authentic truth-seeking; only objectivity leads to facts.  However, my recent experiences fly directly in the face of this assumption.  As Albert Einstein once said, “information is not knowledge.”

Only now do I notice key words and phrases like “chances”, “more/less likely”, “tend to”, “may/might/can”.  These are vague descriptors at best.  Did I seriously stake my entire birth and early postpartum experience on mere potentiality?  There is a chance of an unnecessary cesarean section at a hospital birth.  Hospital births are more likely to result in prolonged or even stalled labor. Mothers and babies who experience unmedicated birth tend to go on to have strong, successful breastfeeding relationships.  The epidural may lead to other, unwanted interventions.  Note how none of these are actual facts.  None of these are universals or guarantees.  Perhaps I’m the only one who got caught up in the ideals of a natural birth and exclusive breastfeeding.  Now I see that that’s the problem – I allowed an idea (an ideology, actually) to make my decisions. 

Gentle birth sounded so enticing, precisely because I assumed that it would be gentle for me, too.  And what can be more natural and empowering at the same time as providing your baby’s nourishment all by yourself?  I assumed that in order to fit in with a group I identify with, I had to ascribe to every single one of that group’s principles, whether they be spoken or presumed.

My drug-free, natural home birth, which lasted just under 19 hours total (including 13 hours of early labor) seemed to go by in a flash.  Time seemed to stand still when I was in the midst of it all.  The truly difficult part lasted roughly 6 hours. My contractions did not fit the pattern I had read about and learned about in childbirth class, and even the midwife on call, whom I consulted several times, did not think there was any hurry. But everything changed rather quickly.

Since our little one was coming nearly 2 weeks earlier than expected, Alex hadn’t yet finalized everything at work before taking family leave. We agreed that since birth was most likely another day away, he should go into work right away rather than in the early days after baby’s arrival.  And so I labored alone for about 6 hours, during which time I moved into active labor and my water broke two hours before Alex returned.

Perhaps it was this confusion and time of solitary labor that prevented my birth experience from being as gentle and empowering as I had imagined, or perhaps I just set my expectations too high.  Either way, in the throes of these quite literal labor pains, I was not thinking about breastfeeding my baby.  I wasn’t motivated by the fact we had waited to find out the sex of our baby until after birth.  It made no difference to me that transition and pushing were the shortest parts of labor. (These were all nuggets of insight I had read that were supposed to ease childbirth for me but didn’t.)  In fact, I wasn’t thinking about the future or the past, nothing other than getting through the current contraction.  I don’t think I’ve ever been more focused in my life.  I am constantly pondering what might have been or what could happen. But during labor, I was no more and no less than a laboring woman. 
Taking a break from pushing.
Maya getting weighed old-school.
To be fair, my plan against interventions did work.  I never thought of requesting a transfer to the hospital, where I could ask for an epidural; I simply worked through each contraction and waited for the ordeal to be over.  I knew there was no way around it.  But is this really the gentle birth I had imagined and hoped for?  Perhaps it was gentler for my baby.  Though I wonder just how gentle life needs to be for a little person who screams at the top of her lungs during a diaper change, leading anyone within ear shot but to assume that the child is in dire need of immediate assistance.

When I finally held my daughter in my arms for the first time (not yet knowing that she was a girl!), I did not think any of the crunchy poetics I had read about from other natural birth moms.  I did not think for one second that it was worth it, or that I’d do it all again if I had to.  It was over; that’s all that mattered.  Now my daughter was here, and I just remember thinking how tiny she was.  There was a definite disconnect between her presence and the manner of her arrival.  Other than giving me bragging rights, I did not feel particularly empowered by the natural birth.  And as I’d learn over the following days and weeks, the experience did not naturally (pun intended) lead to establishing a smooth breastfeeding relationship, either.

Thursday, December 19, 2013

Maya's Birth Story

Maya was born at home at 10:15 pm on Monday, November 25, 2013, weighing 5 pounds 10 ounces, measuring 18.5 inches.

Days after birth.
I was in labor for a total of 18 hours and some change, going into active labor shortly before my water broke 13 hours into it.  Alex ended up going into work for a few hours when we realized it was either that or once baby came.  It was a tough call, bc I did not do well laboring alone.  He finally got back home around 7pm, and at this point my contractions were lasting a minute and 2-3 minutes apart.  I was not a happy camper.  I think not having Alex really messed up our hypnobabies system. I tried laboring with the CDs but it wasn't helping.  I ended up doing a lot of vocalizing.  Birth assistant came shortly after Alex, and midwife wasn't too far behind.  I ended up not getting antibiotics for GBS as midwife felt baby was going to come very soon, not the 4-8 hours after the first dose that is standard.  Indeed, she was born 2 hours after midwife arrived.

They spent a good deal of time trying to fill the birth pool, but they were having problems with the water not being hot enough.  I only got a little bit of hydrotherapy in the shower before all the hot water in the house apparently went out.  Never got in the birth tub.  :( Huge disappointment.

The tub all ready, except that the water never got hot enough :(
I labored on the toilet for a while, but didn't want baby born in there, and they were telling me that I was sounding pushy.  Labored on all fours on the floor for a while, then agreed to have a vaginal check and was almost fully dilated.  They had me move to the bed, midwife pulled the lip of my cervix over baby, and when she came out, she came flying out!  I birthed Maya on all fours, and the placenta in a squat.

Apparently, Maya is a miracle baby in more ways than one.  She had her cord wrapped around her neck and torso, and the cord was not directly linked to the placenta, what is known as a velamentous cord insertion.  They asked if I had had any ultrasounds done, because this normally would've been found at the 20 week sono.  The problem is that if the veins and artery connecting the cord to the placenta happen to run over the cervix (vasa previa) instead of above the baby, then if the water breaks, the baby can cut off the blood supply and not survive birth.  Midwife was shocked that my last sono was just last week!  Alex and I are just amazed at what a humongous blessing this baby is.

We each held Maya for about an hour before finding out if we had a girl or a boy.  I finally cried when Alex peeked and then introduced me to her by name

Daddy showing off her footsies.
I ended up getting a shot of pitocin to cut down on bleeding, a couple of pills under my tongue that were supposed to give me cramps to expel whatever may have been left of the cord/placenta in my uterus, which I think ended up giving me horrible chills, which then led to a fluid IV.   Luckily, I had a chance to hold Maya for a bit before I started with the chills, and after that Daddy got lots of hands-on time with her bc I was a hot mess.  Just laying there half asleep. My perineum stayed intact, but I got little tears on my labia, so I got a couple of stitches.

I had just gotten belly henna done Sunday evening, on our way home from our Ignatian retreat.  I originally was going to get it the Friday after Thanksgiving, but something kept telling me that Maya may be early.  The henna artist advised me that it was unlikely that the henna would still be there for the Birth Day 2 weeks away, but I couldn't risk waiting too long.  So it was pretty cool that I got to have it done just on time after all.  I feel like so many things lined up for us!

My belly henna design.
Maya is such a good baby.  Very cuddly, smiles a lot.  When she's awake, she's so alert and looking around.  Unfortunately, breastfeeding woes started soon after birth, in spite of taking all the precautions.  But that I will save for another post.  

Thank you, Lord, for our miracle!