Breastfeeding and being sick

thermometerAt 3.00 am, C started coughing. The cough turned into a whine, and as my heart sank, a full-blown wail. As I got out of bed to comfort her, I felt a bit odd, but put it down to the early hour and my chronic tiredness.

I sat down to feed C, who was still grumbling, hoping that I’d feel better shortly. I didn’t. After what seemed like an age, C finally had enough milk to send her back into a doze and I put her back into her cot. I then bolted to the bathroom. I only just got there in time.

After I had vomited every last bit of the lovely meal my husband had cooked the night before, I collapsed on to the floor filled with worry. It was one thing for me to be sick, but what if C was too? What if we all were? My thoughts then turned to breastfeeding. To avoid C catching a virus (if that’s what it was) surely the best thing to do would be to steer clear of her? But this would also mean not passing on valuable antibodies, not to mention ruining my milk supply and risking engorgement or mastitis. It was also highly likely that C had already been exposed to any infectious illness before I started exhibiting symptoms, so continuing to nurse as I usually did was really the only sensible option.

I carried on breastfeeding C as normal, washing my hands first and trying to minimize the germs she encountered. Or at least I tried to feed her as normal. After half a day of this, I realised that germs were only a small part of the problem. My energy levels were at rock bottom, I couldn’t keep anything down and I was massively dehydrated. Engorgement was the least of my worries! My let-down reflex took an age to kick in and C ended up bawling in frustration. I’m still trying to work out why exactly my ability to breastfeed was so depleted, but I can only assume it was related to my poor ability to keep food or drink down, and the resulting plunge in fluid levels and blood sugar. Assuming I had norovirus – the winter vomiting bug – this acute phase of sickness shouldn’t last more than 24 hours. I sincerely hoped this would be the case.

Thankfully, 6 hours later, I was sick for the last time. Although it took me several days to recover completely, my milk supply soon picked up and C remained impressively illness-free.  Whether she had developed sufficient immunity through exposure to antibodies in my milk, or simply didn’t come into contact with the virus I don’t know, but she didn’t show a hint of being sick. Unfortunately, the same couldn’t be said for my husband, who started racing to the bathroom the minute I stopped…

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Breastfeeding in public: is nine months really the end of the road?

bibAlthough the NHS recommend breastfeeding for at least a year, and the World Health Organization for two years and beyond, I’m well aware that Western culture doesn’t really allow for this. Thanks possibly to hard-line health awareness campaigns, it now seems generally acceptable to be seen feeding very little babies in public, but it’s also still acceptable for people to vociferously object to anyone breastfeeding an older child. Gauging the point at which breastfeeding goes from ‘good’ to ‘bad’ is a tricky business, however. When does your gorgeous little infant suddenly lose their innocent penchant for breast milk, and turn into an ‘older child’, apparently in danger of being psychologically damaged by continued nursing?

Many people I know have given me their opinion on breastfeeding beyond this (as yet undefined) ‘baby’ stage.

After a television programme on extended breastfeeding, a fairly inebriated friend of my husband held forth about how how unpleasant it was to see people breastfeeding children (which doesn’t entirely explain why he spent an hour watching it on television). It wasn’t clear why he held this view, but the fact he is an avid reader of such publications as The Sun, Nuts, FHM and Maxim perhaps gives some indication of his attitude towards, and personal interest in, breasts. ‘Surely it’s got to do some long term psychological damage – f*** up your attitude towards breasts,’ is an argument that is wheeled out quite frequently (as demonstrated in this discussion of Nell McAndrew’s decision to breastfeed her toddler), although interestingly, I’ve yet to hear it from a woman. It is of course possible to turn this argument on its head – in many other countries, breasts are viewed as primarily practical, rather than sexual, so if you must view these things in black and white, you could argue that this is the ‘right’ way round – but such men seem strangely unreceptive to this possibility.

The idea that a child may be negatively affected by a memory of breastfeeding is another charge that comes up quite frequently. I’ve never got to the bottom of quite why this would be the case, but it seems, again, to be to based on the premise that breasts are for grown-ups, and getting them out for children is slightly suspect.

I had a recent discussion about feeding older children with a couple of very good friends, and although a concrete age was never mentioned, the topic came up when I started to breastfeed C, who is now nine months old. Although obviously still a baby (she can’t yet walk), she is able to sit up, wave, clap and generally communicate. It’s presently quite unusual for babies in Britain to still be breastfed at this point – according to the latest Infant Feeding Survey, only 20% of mothers make it to nine months. The timing of the conversation may have been entirely coincidental, of course, and nothing to do with me giving C an afternoon snack, but I found it hard to dismiss the thought that there was a coded message in there.

I’ve since talked to my friend about this, and while she was adamant this wasn’t the case, she also admitted she has a bit of a problem with breastfeeding toddlers. When she asked me how long I was planning to feed C, I said I wasn’t sure, but I couldn’t dismiss the possibility of continuing for another few months. She understood my reasons for this, and agreed that this was, in theory, a positive thing, but it clearly wasn’t something she felt entirely comfortable with. I’m ashamed to say that it isn’t something I feel entirely comfortable with either. The idea of feeding C (behind closed doors) is lovely, but the thought of admitting to anyone that I’m ‘still’ doing it is less appealing. I am, however, convinced that this is something I have to address: it isn’t much good complaining about our society’s attitude to breastfeeding, unless I’m prepared to challenge it myself.

Let down by my let-down

pramIn theory, I am a strong supporter of nursing in public: it is the perfect way to demystify and promote breastfeeding, and the only realistic way to feed your baby when you’re on the move. In practice, I have always struggled with it. In the first few weeks, when it was excruciatingly painful, and the latching on ‘dance’ (as it is optimistically termed) C and I performed actually resembled a boxing match, my reticence was understandable. Three months later, with a finely-honed technique, I had run out of excuses.

One weekend, I decided to get some much needed public nursing practice in on a trip to a family-friendly department store. Previously, I had fed C in the car, or in the specially provided breastfeeding area. One trip to this part of the store was enough, however (it was an open-plan extension to the nappy changing facility) and I decided to feed C in the cafe, where I’d previously seen lots of other women breastfeeding.

To set the scene: this particular store is packed with the kind of educated, middle class parents who understand the importance of breastfeeding, and wouldn’t dream of raising any objection. My husband J went off to get some drinks, and I settled down to feed C. She was peckish, but not overly so, and was happy enough to spend some time performing the short suckling movements that help initiate let-down. Ten minutes later, she was starting to get frustrated. What was going on? Nothing was coming out! I hadn’t nursed for several hours, so had plenty of milk on board, but for some reason my let-down reflex was failing to function.

After another five minutes of suckling, and a bit of time reassuring a very confused C, my milk finally kicked in. I’m not quite sure why my let-down deserted me on this particular day, but I can only put it down to the noise and stress of feeding in a public place. In situations which other mothers find problematic, such as expressing milk when their baby is absent, I have no problem at all. When I think someone might be watching, however, I often end up in a vicious cycle of stress->no let-down->more stress.

As time has gone on, I find it easier to relax, and haven’t yet had a repeat of this particularly serious let-down failure. Although I can still suffer from performance anxiety from time to time, I try not to let it put me off completely, and as ever, things are improving with time.

Battle with the bottle: persistence pays off

bottle_2When C was about 10 weeks old, she started refusing to feed from a bottle. Initial reluctance rapidly turned into violent resistance, and if I actually managed to get the teat near her mouth, it was met only by screams.

My despair at the situation was tempered only by the fact that it turned out not to be particularly unusual. Two mothers I knew had had the same experience – trouble free bottle feeding morphing into complete refusal – and several others (including, ahem, my own mother) had never managed to get their babies to feed from a bottle.

On the web, several discussion forums were devoted to the topic, and here I found a glimmer of hope: many parents who had experienced similar problems had eventually been able to get their babies to accept bottles. Reading the advice was nevertheless confusing. There were a multitude of conditions that apparently dictated whether infants would feed from a bottle: mothers needed to be around to provide comfort/mothers needed to be completely out of the house; babies shouldn’t be really hungry (they might get too upset)/babies should be really hungry (they won’t let themselves starve); silicon teats were better than rubber/rubber teats were better than silicon…

The only thing that all the success stories had in common was that the parents persisted in offering their children bottles. This in itself is not a great revelation – if a bottle isn’t offered, then it cannot be accepted – but it was reassuring to know that just because a baby resolutely refuses a bottle at one point, it doesn’t necessarily mean she always will.

Keeping this in mind, we started to offer C a bottle everyday, containing just an ounce of expressed milk to start with. I abandoned my frustration, and decided not to worry too much whether she took it or left it. Perhaps because I was no longer anxious, C stopped crying when the bottle was near her. Sometimes she drank a little bit of milk, sometimes she just chewed on the teat, sometimes she spat it out. Eventually, she became so comfortable feeding this way that she’d grab the bottle with both hands and help push it into her mouth! Whether it was decoupling the stress from the situation, the increasing familiarity of the bottle, or a sudden turnaround that would have happened regardless of what we had done is impossible to know, but for now at least, bottle refusal is thankfully in the distant past.

Battle with the bottle

bottleWhen C was a few weeks old, and I was expressing to take the pressure off my beleagured nipple, she would gulp down whatever ended up near her mouth – even milk straight from the fridge. I didn’t enjoy feeding her bottles, but it was a necessary evil, and as the health visitor told me, if I wanted her to take a bottle later on, I needed to introduce it at that point anyway. She also mentioned that if I wanted C to carry on accepting bottles, I’d need to keep it up, giving her at least one per week. I endeavoured to do this, more or less, although I was reluctant to do it really frequently as it seemed to make her windy and more likely to be sick. I have to admit that part of it was laziness as well. Since breastfeeding had become less painful, it was proving to be amazingly convenient, whereas expressing and bottle feeding was a bit of a hassle.

On my husband J’s birthday, we went out for a meal without C for the first time. My sister came over to look after her, and even though we were only going to be a couple of hours, I wanted to have a bit of wine, so thought it would be better to give her a bottle that evening. I expressed milk in the morning, and defrosted some frozen stuff just in case. My sister didn’t need to use the milk in the end (C had a substantial meal just before we left), but I thought my blood-alcohol content was probably a bit high when I got back, so I decided I ought to leave it an hour or so. C seemed pretty peckish, so J settled down to bottle-feed her. Half an hour and a lot of agitation later, very little had gone down, and we ended up trying to distract her until I could feed her again. I wasn’t particularly worried by this turn of events, but realised that we were going to have to make this bottle thing a lot more regular to ensure that C would take one readily when I wasn’t available to feed her.

The plan was for J, who would normally be feeding her in my absence, to give her a bottle of expressed milk each evening. Simple. Except that rather than making bottles appear more desirable, it transformed her into a small bundle of rage who wouldn’t have them anywhere near her. She turned her head and pushed them away with her hand (at least it was helping her motor coordination), refusing to swallow even the milk that happened to leak into her mouth by chance.

After a few nights of this, I was at my wit’s end. I hadn’t really considered that she might refuse to feed from a bottle in my absence. It had been so easy! Now I realised that I might have to accept that she’d reached the point where she might flat out refuse, even if she was really hungry. It wasn’t that she didn’t know how to do it (a couple of times she’d sleepily suckled for a few seconds), but rather that she didn’t want to. C had realised that she could decide what to take into her mouth, and unfortunately for me, milk from a bottle simply wasn’t on the approved list…

My mystery rash is mastitis!

telephoneSix weeks down the line, I felt I had really turned a corner with breastfeeding. My nipples were definitely starting to heal, and C seemed to be getting plenty of milk. Admittedly, she was pretty noisy at times (‘clicking’ noises were a regular occurrence) but as the milk was clearly going down her I didn’t really worry when I noticed a pinkish patch starting to appear on the inside of my left breast.

A couple of days passed, and the patch had turned into a definite rash: a wedge-shaped stripe running from the top right to the nipple of my left breast. It didn’t hurt, and I still wasn’t overly perturbed, but I thought I should probably find out what it was.

By this stage, contact with the health visitor had long since ceased, and although I had planned to ask at the weighing clinic, in the end it just didn’t seem the right time. In any case, my recent experience had taught me that the most likely response of any health professional would be to recommend I speak to a counsellor, so I decided to pre-empt them, and got on the phone.

This time I decided to call La Leche League. Like the NCT counsellor I had spoken to previously, the lady who answered the phone had a pretty brusque bedside manner. Never mind – I needed answers, not sympathy. When I had described my symptoms, she replied, without skipping a beat, ‘ah, classic early stage mastitis.’ What?! But it didn’t hurt! This, she agreed, was unusual, but she suspected it was because I had caught it so quickly. If I left it any longer, the pain would definitely arrive. How old was my baby?, she asked. When I said 6 weeks, I could almost hear her wearily shaking her head at the other end of the phone. ‘This is such a common problem at this stage. Women think they’ve really got the hang of breastfeeding and become complacent, so they don’t adequately respond to the fact that their baby has started to get much heavier, and he ends up being poorly attached.’ My heart sank. I had been thinking that I’d pretty much got it sorted. I’d been a bit worried about the clicking noises, but had put them down to the torrent that was released by my letdown these days. Whether or not that was the cause, it seems I should have heeded them as a potential sign of a poor latch.

I put down the phone relieved that I had caught the problem early, but somewhat panicked at the thought of what it might turn into if I didn’t (a fever and a potential hospital admission. No pressure then.) Although her advice – to avoid further inflammation by keeping the breast as empty as possible – seemed straightforward enough, following it involved solving a latch problem that I hadn’t even realized existed. Feeling pretty fed up, I picked up C, and set about perfecting my breastfeeding technique all over again.

Not enough milk… and then far too much

angry person

In addition to my nipple trauma, I had been swinging wildly between having a screaming infant and nothing to offer but (seemingly) empty breasts, and ending up with a couple of beach balls whenever C went more than three hours between feeds. I heard this was quite normal, and that my supply would ‘settle down’ soon, but it ended up adding yet another major stress to my day.

For at least a couple of weeks, the problem was particularly horrendous. C was wanting to feed almost every hour (including all through the night), making me feel as if she wasn’t getting anything out of me at all. I put this prolonged period of frenzied feeding down to a growth spurt, despite the fact that the books claim these only last 24 hours (not my experience at all – C’s last at least a week, it seems!) Eventually her ravenous hunger ceased, and she managed a four hour sleep overnight. At the moment, four hours to me is virtually sleeping through, so in theory I should have had a reasonable night. Unfortunately, I awoke two hours after her last feed with my breasts buzzing, and proceeded to lie awake watching her and almost willing her to wake up, while I swelled to watermelon proportions…

In theory I could express a bit in these situations to relieve the pressure, but I’m terrified to do this in case C then wakes up and I don’t have anything left (which is silly, because I know it doesn’t work like that, but I’m awash with paranoia). Of course, when C does then want feeding, the milk shoots out of me like an industrial water gun, leaving her gagging and gulping down significant amounts of air. Arrgh! I was almost reduced to rocking in the foetal position, repeating, ‘my supply will settle down soon, my supply will settle down soon…’