I never thought one of the first things I wrote about motherhood would be about breastfeeding. Nor did I think that piece would include the word "nipple." But, as a breastfeeding, first-time mom to a 3-month-old, nipples are never far from my mind. In fact, I've been utterly consumed with mine ever since my son Cody was born.
Why? Because breastfeeding is hands down one of the hardest things I've ever done. There comes a point in nearly every day that I want to quit, and that point usually comes around 3 in the morning...
I'm lying in bed after nursing. Cody's back in his crib, snoring. All I want to do is sleep, but my breasts are throbbing and I'm sobbing. The tips of my nips are white; blood flow's been cut off again. This is known as nipple vasospasm. I think nipple strangulation sounds more like it. I tell Cody's dad I'm "done. I can't do it anymore. The pain is worse than labor; it's simply inhumane." I declare that I'm going to quit. He says he supports my decision. I say there's no way I can quit. He says he supports my decision.
What a good guy. And what a wild ride breastfeeding has been. I've never been so determined to do anything, or so ill prepared. I was so preoccupied with getting ready for labor and delivery -- watching graphic birth videos, taking classes with Tyler, practicing my "hee-hee-hoo"'s -- that I remained in denial about almost everything that was to follow. And what followed was this: in an unexpected turn of events, Cody had to be rushed to the NICU right after being born. This meant he did not get to nurse during that golden first hour after birth, missing out (initially) on the nutrient- and antibody-rich pre-milk, called colostrum, and on that precious time to bond with mom. Breastfeeding as soon as possible after birth increases increases the chance of continued and successful breastfeeding. We were not off to a great start.
Fortunately, Cody took to the breast almost immediately the next morning, and the lactation consultant ordered me to pump after every time I nursed. In my deliriously tired, drugged state, this felt like a cruel joke. I thought this lactation lady was as mean as she was crazy. Now, I know better. After lots of pumping and visits to the NICU to nurse, my milk came in strong, and it did not take long for Cody to become addicted. His frantic, siren cries of hunger would come to a complete halt as his heart-shaped lips closed around my nipple and he cuddled in close. He'd suck feverishly at first, and then lazily, as his eyes rolled to the back of his head and his whole body sunk into mine. His eyes shut as the corners of his mouth turned up into a satiated, sleepy grin. Drunk on milk, he made the silliest faces and settled into the deepest sleeps, arms spread above his head as though surrendering. One thing was clear: this boy loved the booby!
After two days in the NICU, Cody was discharged and Tyler and I were given a chart on which to track his feedings and bowel movements. We were told he'd need to eat every one to three hours, for about 10 to 20 minutes. It sounded easy enough. But this is when things got dicey. I fed on demand, as I'd been instructed to do, but the demand seemed awfully high. Cody was giving hunger cues -- or as we like to say, doing "the booby dance" -- every hour, on the hour, and his feedings lasted 45 minutes or more. You can do the math, but basically this amounted to no break between feedings and no sleep for me. I stared at the chart in disbelief. This couldn't be right. But it was, according to everyone I asked. (And I asked anyone who set food in our room.)
"Some babies take longer to eat than others."
"He'll come off the breast when he's ready."
"It'll get better with time. The first two weeks are the worst."
And oh, they were. But things didn't get better. Cut to three weeks postpartum: I'm sitting in my glider chair with Cody. He's resting on the Boppy pillow, his mouth around one of my nipples, where it's been for the last two and a half hours. From what I read online, this is called a "cluster-feed." Seems more like a cluster-you-know-what to me. The pediatrician says it could be a growth spurt, which should last only a couple of days.
A few days later, the "growth spurt" isn't over and Cody and I hardly leave my room. I eat all my meals while nursing, spilling crumbs on top of his head. My nipples are red and raw and I can't get any relief. When Cody latches on, it feels like a piranha clamping down, or shards of glass shooting into my skin. Tyler starts giving him expressed milk at night; pumping isn't as agonizing. I worry that my son will have psychological damage from seeing me cry every time I feed him. I believe that only sick, masochistic people could actually take pleasure in breastfeeding. I wonder how I'll ever be able to enjoy my baby when he's attached to my boob all day.
I decided I was done, and went online to read about people who had decided the same. I sought solidarity. I needed support in my choice to stop the madness that was breastfeeding. I did not find what I was looking for. Instead, I found post upon post on blogs and online forums about how it does get easier. I found article after article about the amazing benefits that breast milk offers babies: increased immunity to illness and infection, increased cognitive development, decreased risk of a number of diseases. The more I read, the less certain I became that I was ready to throw in the towel. But, I had no idea how to combat my misery. Every day was a struggle and I felt myself falling fast into a scary depression that I hated subjecting Cody to. This was not how I wanted to spend our first month together and not at all how I wanted him to experience me. If I was going to keep nursing, I needed more inspiration. And if I needed for it to be tolerable, I had to get to the source of the problem.
I began reading everything I could get my hands on about breastfeeding. God knows I had the time, while chained to my rocking chair. And I enlisted the help of another lactation consultant who came to my home. Thanks to her -- a woman I now refer to as My Savior -- I discovered that my hungry little man was tongue-tied, and transferring minuscule amounts of milk at a time. Apparently, it had not been detected earlier because, unlike most babies with tongue-tie, Cody was gaining weight like a champ. (Which I suppose is what happens when you never come up for air!) After doing our research, we took Cody to a Frenulum Clinic, where he underwent a quick procedure to release his tongue. Nursing did not improve right away, like we were told it probably would. And in truth, it's still a challenge months later; old (chomping) habits die hard. But, the procedure completely changed Cody's efficiency and that's a huge deal. He doesn't have to work so hard to transfer milk, and nursing now takes 25 minutes tops, every two to three hours (not counting comfort nursing). I now eat my dinners downstairs and can enjoy my baby boy. We do so much more than nurse; we read and talk and play!
And I've come to really cherish the time I do spend nursing. I finally understand why it's considered a bonding experience. I find it amazing that I can nourish my son with my body, just as I did for nine and a half months. I love that I'm able to instantly soothe him and provide that safe, snuggly place to which he can always return. When he slides off my breast and breathes that sigh of satisfaction, pursing his milky lips and launching into the longest, most luxurious stretch, I think to myself, this is more than worth it. This is what keeps me going when the crack in my right nipple just won't heal and I put Lanolin on my toothbrush by mistake. This is why I set goals of "one more month" when I once again have mastitis and my bed smells like sour milk.
It's what makes me especially miss my beautiful mother, who I'm told breastfed my brother and me. It's a conversation we never had in our 18 years together, and now there's so much I want to ask her, so much I'll never know. I think of how different this journey would be with my mom by my side, with her sage advice, delicious humor, and boundless love. I also think about how cool it would have been to bond over motherhood, womanhood -- for us to know each other in this whole new way. No matter what my choices are as a mother, I know she would be proud of me, because that's the kind of mom she was.
Thanks to the Internet, I've connected with other breastfeeding moms who also keep me going. I've learned that I'm far from the first mom to have nightmares about her nipples. So many women face much greater breastfeeding hurdles than I have, and their stories simply astound me; they will move mountains to breastfeed their babies. And I also feel the deep pain of those who want so badly to breastfeed, but truly can't.
Breastfeeding is something I take pride in and take painkillers for. It's a love/hate relationship that I look forward to ending and fear losing. It feels like the toughest commitment I've ever made, but there is no one in the world I'd rather make it for than my sweet, wonderful, lovable Cody.
UPDATE: I wrote this piece when Cody was about 3 months old, and boy, what a difference a few more months makes. At nearly 8 months old, I am so happy to report that Cody is still breastfeeding, and that it is going better than ever for the both of us! I never thought that I'd make it this far with nursing or that I'd come to love it, but I have and I absolutely do! I feel very fortunate.
Dr. Ann Borders, an OB-GYN who works with NorthShore University HealthSystem, recommends that her patients and their partners go to a breastfeeding class before Baby is born. In class, they don't just focus on why breastfeeding matters, but what you can actually expect in those daunting first few days. And Borders doesn't just recommend this for newbie families, but also moms who may have tried breastfeeding before and found it difficult. "You're not going to know everything from taking the class, but it gives you a groundwork that you can build on at the hospital once you have the nurses helping you," Borders said. Most OB-GYNs will be able to give you a referral to a breastfeeding class nearby, but if for some reason yours doesn't have any suggestions, a quick online search should bring up options in your area.
When you're in the hospital or birthing center, or while you've still got your midwife with you after a home birth, make sure you speak up and ask for help getting started. "Every health care person should know the basic mechanics of breastfeeding," said Mary Ryngaert, a board certified lactation consultant with the University of Florida's Center for Breastfeeding and Newborns. "I joke that the person who empties the trash [in labor and delivery] should be able to help someone latch on." Even Borders, whose professional life and research centers around breastfeeding, said that when her first baby was born, she had to ask for guidance. Women should feel 100 percent empowered to ask their care provider to help them start breastfeeding within the first hour after a vaginal birth or two hours after a C-section if the circumstances allow for it, she said. Don't leave the hospital until you've gotten the help you need.
There's a reason why hospitals hoping to earn the coveted "baby friendly" designation for breastfeeding support stress the importance of skin-to-skin: It works. Research shows that essential contact helps relax both the mom and baby, stimulates feeding behaviors and triggers the release of certain hormones that spur breastfeeding. Experts say it's important to do it both early -- ideally right after birth -- and often. "Keeping the baby skin-to-skin as much as possible in the early days after birth is very important," Ryngaert said. "If the mother is 'touched out,' then the partner can hold the baby skin-to-skin. It still helps the baby move instinctually to what [he or she] is supposed to do." If you're not in a "baby friendly" hospital with policies in place to promote skin-to-skin, don't be discouraged. Tell your doctors and nurses that it's important to you, Borders said. As long as your baby is stable, there's no reason why they shouldn't let you hold him or her close.
Engorgement, or a feeling of heavy fullness in the breasts that can be very painful, is common several days after delivery, but Borders said a lot of women don't know to expect it because no one talks to them about it. Having a game plan in place can help curb the pain and keep women from throwing in the towel when they're sore and freaked out. She suggests an over-the-counter pain medication, like Motrin, and ice. Two bags of frozen peas can also work, Borders said, and -- bonus! -- they tend to fit nicely into nursing bras. Some women may also want to take a hot shower to express some of their milk.
Susan Burger, president of the New York Lactation Consultant Association, finds few things as irksome as telling women that they need to try specific holds. Moms hear those tips and get "all twisted up with finding the perfect position," she said. What matters most in her book is that breastfeeding mothers get comfortable, which often means leaning back a bit and putting their feet up. "If she's comfortable, it's so much easier to get the baby into a comfortable position," Burger explained. This is one area where partners can really step in, looking at moms to spot any ways in which they might be uncomfortable, then helping by giving them a pillow, a shoulder rub ... whatever.
Your partner, or your mom or friend can also help by agreeing to sit with you while you breastfeed. Why? Since moms are often extremely relaxed and drowsy while they're breast-feeding, your partner can agree to be on "alert" -- maybe quietly reading a book or checking e-mails -- while you get some sleep. "Invite her to take a cat nap while breast-feeding," Ryngaert said. It may sound like a simple trick, but Ryngaert said it's such an easy, often-overlooked way for women to fully relax while breast-feeding, which only increases bonding and enjoyment, and also, possibly, catch up on some much-needed sleep.
Drop your mouth down to your chest, then open your mouth. A bit tricky, no? Now tilt your head back slightly and open it again. See how much easier that is? Burger said that one of the biggest ways to help babies drink is to make sure their heads are tilted back a bit. You can help support them in that position by putting a forearm under the baby's neck, or even a rolled-up receiving blanket. "There are a lot of different ways to achieve it," she said.
While experts may not poo-poo specific holds, at least ones a professional hasn't personally recommended for you and your baby, they do offer broader positioning advice: "I like to see the baby and mother have almost no space between them," Ryngaert said. "You're not just putting your breast in their mouth, you're really bringing your bodies together," she said. That helps babies bring a big, wide open mouth to the breast, giving them the deep attachment that they need. If you're not sure what that means, a good first place to look is the internet: There are videos online that demonstrate the concept, Ryngaert said, and places like La Leche League have helpful illustrations as well.
Burger said that one of the mistakes women can make is to focus too much on duration and not enough on the frequency of pumping. Often they're too hard on themselves, sitting there for long stretches and pumping away in an attempt to produce more milk, when really, they'd be better served by just a few minutes here and there throughout the day. Burger likened it to training for a marathon: "You wouldn't just go out and run 13 miles," she said. "If you're just starting out, you'd try a mile or two and do that three or four times a week. That's a much better approach." In the same vein, if you can work it into your schedule, frequent, brief bouts of pumping help build milk supply better than sitting there, rather helplessly, and pumping for one long stretch.
Borders said that women shouldn't just write off sore nipples -- which can sometimes become so bad they don't want to breast-feed at all. She recommends something called Newman's all-purpose ointment, which your pharmacist can mix for you. For women who don't have thrush (a generally harmless yeast infection) La Leche League also recommends applying freshly expressed breast milk to your nipples, which can help them heal. The bottom line? If your nipples hurt, don't just accept it. Talk to your doctor about what might be causing it and what you can do.
"Make sure you leave the hospital with the number for someone you can call with questions," Borders said. Many pediatricians offices now have lactation consultants on staff, which makes it easier for women to find someone who can offer guidance when you're they're in for one of those many new baby visits that happen after birth. In many cases, lactation consultants are covered by insurance, Ryngaert said, but places like La Leche League also have a call system where you can speak to someone for free. Many nurses and pediatricians are also board certified lactation consultants, which can help with insurance coverage. Women shouldn't feel pressure to figure everything out in the first week, Ryngaert said. "If a baby needs to go on formula for a time while the mother's milk supply is being established, that doesn't mean the baby's not going to be breastfed," she added. "I've seen babies that didn't latch on until eight weeks." But new moms should never, ever hesitate to ask for help. "If a mother is having more than a little tenderness, she should not just tough it out. She should get some help" Burger said. "And if that person says, 'Oh, it's normal, suck it up,' that's not a good person to get help from, and they should see someone else."
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