Breast Is Best
Before Jessica was born, I had firm views on how I would feed her.
In antenatal class, we were told that “breast is best” and that 96% of mothers have sufficient supply to feed their baby. We even did an exercise where we got into groups and shared whether we were breast or formula-fed. About 18 of us reporting back that we were breast-fed and two who weren’t. Even though I was firmly in the “breast is best” camp, I couldn’t help but feel it was a shitty exercise to single out those whose mothers didn’t toe the line… Classes like that appeal to me, because I like to take information like that and adhere to it to the letter, that way I know I’m getting it right.
I completely understand why breastfeeding is so heavily promoted in NZ. I was horrified watching My Big Fat Gypsy Wedding (Britain) where they all bottle feed their children because breastfeeding is unacceptable/taboo/disgusting to them. I’m all for normalising breastfeeding. I believe as a society we should support breastfeeding mothers as much as possible. It’s natural, convenient, nourishing and an important bonding time between mother and baby.
However, I was to find out for myself it’s not as easy and straightforward as all that.
I was warned about halfway through my pregnancy how small my baby was. I’m quite small myself – and I pointed that out, just in case my 5 foot nothing stature wasn’t apparent to the midwife – but no, my baby was going to be small even by my standards. Jessica was born 2260g (about 4 pounds something) and being under 2500g she was whisked away to the Special Care Baby Unit and I went to recovery with my morphine shakes and itchy face. I chose not to get upset at only holding my baby for ten quick seconds, and was glad that my partner was going to stay with her.
The student midwife offered to milk me – a delightful offer which I gratefully took her up on! In the few fleeting days of maternity leave I had prior, I’d managed to eek out about 1.5mL of colostrum through much effort and concentration, which was left at home in our haste. So, the milking began while I chatted away through my shock. I was very proud of the first mL.
Next minute, Andrew is at my side ashen-faced: “They want to give her formula.”
Me: “But I’ve got some colostrum coming.”
Heavy set Nurse behind Andrew: “You’ve got two options – an intravenous drip or a gastro-nasal tube. She’s got to get her blood-sugar up!”
Me: “But I’ve got some colostrum coming…look” (pointing helpfully towards the milking action, in case that wasn’t apparent)
It felt like the Nurse wanted to put a drip in my tiny baby. I started to get upset and thankfully the student midwife went into bat for us and handed over the colostrum and assured the nurse we could definitely provide more. Three long hours later, they wheeled my bed into the SCBU for me to have my second ever hold of Jessica and attempt to breastfeed her. The little darling took to my nipple immediately. It really was the most natural thing. I was so relieved, proud and in love. After the feed and a cuddle, I had to leave her there for further monitoring.
Fast forward to 9 hours after birth and I got Jessica back and was instructed that she be fed every three hours. I’ve never stayed in hospital before, but always thought it was a place where you recouperate and rest. This was not the case. This was the start of my new life in 3 hour blocks:
Feed one side
Feed the other side
Put baby to bed
Clean Pumping equipment
20-30 “spare” minutes, for maybe a shower, toilet, food, visitors, nurse, doctor, physio, nap?
Time to feed again
I was awake for 3 days, and started introducing myself that way to nurses until one took pity on me and offered to look after Jessica for a while so I could have 2 hours solid sleep (I still had to pump and clean the equipment though!)
Breastfeeding at Home
We spent the full five days allowed in hospital and when we got home, I was to keep up with the 3 hour feeds, often waking her for them. Under midwife and then Plunket care, she was gaining well and “thriving on mum’s milk”.
I had decided to feed ‘on demand’. I never really looked into what that meant, but wanted to be able to feed Jessica whenever she demanded it. Having a little baby meant to me that if she was ever upset, then she must be hungry. So feeds generally happened every 2-4 hours with long clusterfeeding sessions in the evening. I recorded all the feeds in an app, in the hopes I could recognise a pattern.
A few weeks in and sore nipples are pretty normal, but my left side had a gouge. Feeding on that side was toe-curlingly painful. I told the midwife about it. She said I was to treat it with a prescribed cream, but I was to persevere with feeding on that side. I did, but it was so painful and I got into a state each feed time in anticipation of the pain that I decided it was best to try and rely on my right side. I felt a lot happier not having to worry about feeding from the sore side and it took its sweet time to heal.
At around 2 months, we started to notice that we had an upset baby around evening feeds. I wrote a list of 15 symptoms and that’s when we started regular visits to the GP who thought perhaps reflux, constipation or colic.
We ended up treating her for all three but the upsets kept gaining intensity and starting earlier in the day. We noticed:
- pulling knees up to her chest
- arching her back
- pulling away from the breast
- shorter and shorter feeds (down to 4 mins at worst)
- miserable from lunchtime feed onwards
- not sleeping during the day bar a couple of 20 min catnaps
- sleeping longer stretches overnight
- Irregular bowel movements (only every 4-7 days)
Those symptoms can match up to trapped wind if you are researching on google. We had tried everything – burping in different positions, spending longer burping, rocking, swinging, leg pumps, tummy massage and plain old gripe water. It’s so stressful to have an upset baby. A baby you think is unwell and you’ll try anything and everything to make her feel better. Jessica liked going in the car and I thought it was the movement that was soothing.
Just shy of 4 months, all three of us had reached breaking point. None of us were getting any sleep and Jessica and I were both miserable. So I was back at the Drs, basically saying that something needs to happen. This is not normal. We were referred to a paediatrician.
At the same time, someone from our SPACE group had sought help from a baby whisperer for what she thought was trapped wind. She had thought of us, as each time we turned up to SPACE, Jessica was always upset and irritable unless we distracted her with singing. This so-called baby whisperer was a Karitane Nurse and had quickly ascertained that this baby’s problem was that she wasn’t getting enough breast milk from her mother, and formula was added in. I thought to myself, that’s not going to be our problem because it’s such a rare problem and I’m feeding her all the time and it must be something digestive.
Because the problems were worse around the evening feeds, I had decided to try and give a formula topup to see if that made any difference. I discussed it with Andrew, as if it were this heavy life-changing decision to add in one formula feed. I stood in the supermarket aisle in tears, waiting for an intercession, as if I was about to make a really bad move. Well…night time feeds got a lot better.
Magic Fairy Lady and Formula to the Rescue
A couple of days later this baby whisperer, an older lady who I refer to as ‘Magic Fairy Lady’, turned up on an afternoon when once again Jessica hadn’t had any sleep for the day. She asked me a few questions whilst admonishing me for having the bassinet in the lounge. I didn’t care. I was broken and was ready to be built up again with answers. She asked me to make up a bottle of formula. We made up 50mL, which Jessica hungrily smashed. Then we made another 100mL, again smashed but this time Jessica was drowsy. This lady kept saying how sad she was. “This is so sad, this is so sad” about how hungry poor Jessica was. I was numb by this point and just sat there, nodding. Magic Fairy Lady busied herself putting the sheepskin under the fitted sheet in the bassinet to make a comfortable bed in Jessica’s own bedroom. Then instructed me to bring my drowsy, quiet, satisfied baby into her room. Told me to whisper-sing her a song as I pulled on her sleeping bag. Then put her down with my hand on her chest and shush shush shush. I was ready to keep going for another 20 mins, but then she asked me how I would feel about us leaving the room. So I did. And Jessica slept. I had never experienced that since she was a newborn. Then I cried. And cried and cried and cried. And gave the whisperer $270. Then she left.
I was to feed Jessica formula exclusively for the next 24 hours and write everything down so that we knew how much she was getting. The Magic Fairy Lady had told me to “give up the breast”, however I was adamant that Jessica still needed my milk. Before her visit I was only able to express 40-100mL and only got an opportunity to do so 1-2 times a day as Jessica didn’t really sleep. Now we were on a routine, so I wanted to spend some of my newfound spare time on the pump. I kept this up for another month. Eeking out 100mL max. per time. I was a stressball for that month and I don’t know if I’d make that same decision again. As Jessica has eczema I wanted to protect her from allergies for as long as possible.
Next we saw the Paediatrician, who listened to our story and did some checks. She felt that we were now doing everything right. Jessica’s weight had gone from 2nd centile to 10th in less than a fortnight. The Paediatrician and Magic Fairy Lady told us that there are babies all over the country who would benefit greatly from formula, as they’re not getting enough from the breast. But in my opinion this is still hush-hush, taboo.
Part of our new routine was a dreamfeed at 2.30am. I would still breastfeed at this feed. Jessica had rejected my breast for all of her awake feeds. I don’t blame her. She’d given me enough chances to provide for her. Then a few weeks later, she refused at this feed also. I knew it was coming, but it was still very emotional to say goodbye to that part of our relationship.
That’s how we made it to formula. I’m not suggesting that anyone needs to have extenuating circumstances to end up on formula. Not at all. I wish I had it in mind earlier as a viable option to meet Jessica’s needs. There’s still so much stigma surrounding formula feeding. And the time and tears I’ve spent perservering with pumping certainly took its toll. I think breastfeeding absolutely should be promoted and supported, but on balance there needs to be good info available on signs that baby isn’t getting enough and how to address with the help of formula.
In hindsight, Jessica’s symptoms were those of a hungry baby. The GP didn’t pick it up because she still had numerous wet nappies a day and she was putting on weight.
- pulling knees up to her chest – hunger pain
- arching her back – hunger pain
- pulling away from the breast – not getting anything from there
- shorter and shorter feeds (down to 4 mins at worst) – supply runs out
- miserable from lunchtime feed onwards – supply is at its best first thing in the morning after sleep…from lunchtime onwards we’re moving into a deficit of supply
- not sleeping during the day bar a couple of 20 min catnaps – hungry
- sleeping longer stretches overnight – pure exhaustion from lack of sleep and being so upset
- Irregular bowel movements (only every 4-7 days) – they say this is fine for breastfed babies, but it’s definitely something worth looking into. Jessica didn’t have the volume of food required to keep her regular and we were giving her lactulose twice a day
Back to that stat quoted at antenatal class: 96% of mothers have enough supply to meet their baby’s needs. Well out of the coffee group five of us formed from the same class, four of us have needed to add in formula either exclusively or to mix feed. Somehow I think that stat is very misleading.