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…’

Nipple solutions 3: pumping

bottleIn addition to using a nipple shield, both the health visitor and the NCT helpline lady suggested I try expressing milk and feeding it from a bottle, to give my nipples a bit of a rest. C’s response to the shield was not encouraging, so using a breast pump was really the only option I had left if I wanted to carry on. So far I’d just about been able to put up with the pain: if I gritted my teeth through the initial agony, the remainder of the feed was just about bearable. The sight of my nipples, however, was really quite perturbing. The open wound on the outside edge of one was so deep it looked as if the nipple were in danger of detaching. The psychological effects of seeing this type of damage were considerably worse than the pain. I could only assume it was getting worse with each feed, and therefore that I was mutilating myself further.

Despite the obvious arguments for using a pump, and possessing one that was bought before C even arrived, it took me another couple of days to get around to using it. I don’t know quite why I was so reticent, but I think it had something to do with feeling guilty and inadequate not being able to get it right on my own. The turning point was speaking to my friend Zara. It turned out that she’d had exactly the same problem – right down to the fissures in the same place – and had pumped to help with the healing. She’d also had the same feelings of guilt and inadequacy, but had come through the other side and said that it made a massive difference. I wasn’t going to get any extra points for prolonging the pain, so I should just get on with it.

Some women find expressing milk easier than others. The key is prompting the letdown reflex – after that getting milk out is reasonably straight forward. Without your baby actually suckling, however, letdown isn’t always that easy to initiate. Looking at a picture of your baby (or indeed your baby herself) is one way of getting the vital oxytocin flowing. The solution for me was pumping from the really mangled left hand side, while C fed from the slightly less injured right hand side. For about four days, I expressed on the left and fed on the right, feeding C the expressed milk in a bottle if she was still hungry.

Using the pump and feeding simultaneously gave me an interesting way to monitor the extent to which the expressing helped. I had the same injury on both sides (albeit not as badly on the right), but only used the pump on one. It definitely provided me with some relief – expressing was much less painful than feeding – and the nipple did heal eventually, but the right side also healed completely, without any intervention. The healing actually occurred slightly faster on the right hand side, although this might be expected, as the injury wasn’t quite so serious. It seemed that the midwife who told me that things would eventually improve of their own accord was right after all. I think the problem for me was caused by the fact that my nipples weren’t quite the right shape initially (for C’s mouth at any rate – I don’t know if it would be different with another baby) and the skin broke so they could be stretched into a better one. Certainly, they now look quite different to how they did originally – pointy where they were once quite flat. When they healed, extra skin grew over the fissures where they’d stretched, rather than the skin knitting together at the point where it was originally joined, providing further evidence that my nipples were simply going through a (very painful!) transitional process.

Although it seems that both nipples would probably have recovered of their own accord if I’d continued feeding C as normal, I would strongly recommend using a pump if your nipples are suffering. It really helps to relieve the pain, and if you plan to bottle feed later on (whether with expressed milk or formula), introducing it early (and continuing regularly) means you should meet less resistance later on. Even if you take into account the constant pump dismantling, sterilizing and constructing, it’s a win-win situation!