nursing – Incrementum

Breastfeeding pain

A peer breastfeeding counsellor asked on one of my old entries what would have helped me cope with the severe early (3 weeks or so) breastfeeding pain I had when V was born. I thought it was worth repeating my comment here:

Things that I think actually helped:

(1) opposing pain, kind of like some people use in labour. Andrew used to grip my shoulder really hard as V latched on. (The IBCLC suggested on the phone that some women sing or chant to themselves as an alternative.)

(2) expressing milk before each feed until my nipples were nice and soft and stretchy. At the time I didn’t do this enough because I was terrified of making my oversupply worse, but now I think, screw it, it wouldn’t have lasted long, and expressing 30mL or so is not going to increase supply that much. It did help some.

(3) the hot packs and hot showers I think did help a bit, if only in relaxing me. It was just that (I thought) they were presented as compulsory, so I thought I had to get up in the middle of the night and heat up a hot pack and apply it before feeding every single time.

(4) other distractions, especially having visitors. It’s hard to scream when trying to entertain visitors.

I think in an ideal world, this would have happened as well:

(1) feeding more often so that everything was softer and he was less hungry. But it hurt so much I couldn’t bring myself to do it. I can see how it works though.

(2) I would have seen an IBCLC just to definitively rule out latch problems and so on. He didn’t have a nursing problem, but I kept getting slightly different and confusing advice from midwives and it undermined my confidence a lot. So just for confidence it would have been good to see an expert LC.

(3) Drugs. I took codeine for blood pressure headaches when pregnant (while waiting for the BP meds to stabilise it), and I probably should have busted it out for this too. I suspect there’s a vicious cycle with being tense and scared that drugs might break.

(4) Visits from breastfeeding peers. However, because very few of my friends had babies at the time, there really wasn’t anyone to talk to a lot about it except my mother (she had more or less the same experience).

Things that I didn’t find useful:

(1) cold packs

(2) anything that made night feeding more complicated (hot packs, showers)

(3) fiddling around all the time with his angle of approach as recommended by various midwives

What I’d do differently

This was a dinner conversation: if I was having Vincent with foreknowledge (as opposed to having a second child) what would I do differently? (This is all stuff in reach of our current budget, not fantasy stuff like “have a nanny instead of daycare so that we don’t get sick all the time” or “buy a king sized bed” or “move to a bigger place”.)

got a new washing machine and a car before he arrived (although, an older baby is way less trouble on public transport because they don’t constantly eat and poop, he started getting better just as we got the car).
got a new GP before he arrived
put his name down for childcare before he arrived
gone to the breastfeeding class at the hospital (he was only 12 hours old, I was really tired and wired, but there wasn’t another one until I was discharged)
not relied primarily on Kaz Cooke’s Kidwrangling for information: we don’t need two nappy buckets, and the first two weeks did not involve me calling parenting crisis lines while crying constantly (I know that can and does happen, but she portrays it as universal)
gone straight to our current system of nappies (one-size pockets)
got groceries home-delivered for at least the first six weeks of his life
had him this summer (which is probably going to be cooler than average on Australia’s east coast) rather than last summer (heat records tumbling every which way): ok, that’s a bit fantastical
worked out the cost of daycare more clearly in advance and put the baby bonus away for it
not bothered with purchasing a manual breastpump: double electric all the way baby
got the baby fences sooner

The most important one though was not realising how quickly babies become more manageable. I thought this happened when they stopped being babies. It turns out that in fact those first six or eight weeks are actually much harder than the months after that just in terms of the sheer amount of constant work that went into babycare. Feeding needing to happen right now OMG starving, nappy changes even more urgent than that, meltdowns after half an hour in an unfamiliar location, that was all little V stuff.

So I’d much easier on myself for the first few months, because I didn’t have to steel myself up and learn to cope in the long term with that precise situation.

Andrew added that we probably would have introduced expressing and feeding milk earlier than we did. I’m not sure. With foreknowledge that he’d adapt to a sippy cup fine, I might have done it later.

Preparing for breastfeeding

This is more in my “just in case you wanted to know” series about early parenting. This should be shorter than my preparing for labour guide, because I spent less time on it personally. And I wrote some stuff while I was still struggling with it so if you have access check that out.

Onto some retrospective stuff. This assumes that you’re planning to exclusively breastfeed, with your breasts, for a while, because that’s what I intended and that’s what I have done. (I’m in fact yet to work out how to get him to take pumped milk, but that’s another post, please don’t leave advice on that in this one.) People intending to switch to formula or to mix-feed from early on say that it’s hard to find a lot of advice now, but I can’t help with that either. Early pumpers can find some advice about the place. If you want to make your own post about any of these, drop a link in my comments, but I’d prefer not to have a whole comment on them, I’d consider it a derail.

Depending on where you look, you’ll know this, but I really didn’t, so. Breastfeeding can be very easy once it’s established. Establishing breastfeeding can be hard.You and the baby need to learn what to do. I’m a bit wary of saying “expect it to hurt” because that means you might not ask for help. So I’ll be clear: ask for help if it hurts, but also, don’t be surprised if it does. Quite a bit in my case. It took a few weeks to really get a lot better in my case: I remember it still hurt quite a lot at 10 or 12 days old, I also remember breastfeeding relatively easily at about 3 weeks old. So, somewhere in that realm in my personal case.

OK, first big recommendation know what your help options are in advance. Basically, do you have the phone number and hours of a lactation consultant (you are looking for an IBCLC: International Board-Certified Lactation Consultant)? Make sure you have this well before your expected delivery.

My hospital had an IBCLC on staff who I was able to access up to, I think, 6 weeks after birth. I think the reason I didn’t know this was, again, being a doctors’ patient, they were basically making sure my blood pressure was acceptable and their attention to things like breastfeeding preparation was cursory at best. At least some of the local early childhood nurses are IBCLCs here too, and there are some who practice privately (often in addition to being private midwives). In Sydney I believe they charge about $100–$150 for a consultation, but I didn’t see a private one.

I could have gone to classes in hospital too, but they were super-poorly timed for us. Vincent was born on a Thursday afternoon. The classes were Monday, Wednesday and Friday mornings. The LC invited me to the Friday morning class but I’d barely slept and hadn’t yet got out of bed (I had a catheter inserted during labour and due to some confusion about the doctor’s orders it wasn’t removed until about 9am the next day). I was discharged Monday.

Not only would I recommend having contact details for an LC, given my experience of mastitis I’d see if you can figure out a number that reaches a house-call service too, because I ended up being told by HealthDirect to either get a house call or go to emergency, and it was 4 in the morning and I’d been running a fever and looking after a newborn all day. House call! (It ended up being about $30 out of pocket I recall, after claiming from Medicare.) In fact, consider that my advice regardless of your feeding plans, because your risk of mastitis is going to be higher, I believe, if you aren’t thoroughly draining your breasts. HealthDirect is itself a good number to have in Australia. (1800 022 222, they basically can distinguish between ambulance now, emergency now, see a doctor now, wait until you can get an appointment. They have numbers of local doctors and so on. Not that you should call them if you have any reason to expect “ambulance now” to be their reply.)

The Australian Breastfeeding Association has a hotline, but I actually didn’t find it that useful, frankly. It ended up being like having a post-dates pregnancy (try acupuncture! and evening primose oil! and long walks! and raspberry leaf tea! and visualisation! and sex! and don’t forget you must must must relax! and probably there’s no evidence for any of it!). That is, I was overwhelmed with about a million things to try, and just could not fathom how on earth in the middle of the night I was supposed to find time to heat up warm presses, apply them, express “a teeny little bit” to soften the nipple (I had massive oversupply and used to have to take 20–30mL out to soften it), have warm showers constantly, have cold presses ready to go for after and… oh yeah, feed the baby. But that was just one counsellor, you could give them a try if you think a supportive chat with someone would help.

Second recommendation know what to do right after delivery. I mentioned in my previous advice post that you should make sure you know roughly what to do in case all the staff disappear in a puff of smoke. And also, well, it’s your baby after all. Babies (generally speaking) are born primed to learn how to nurse, so you’ll want to take advantage if the baby can stay with you (as is normally the case). How to find this out? Look for literature and/or videos on “baby-led attachment”. Andrew and I remember finding videos of babies immediately after birth especially good, I think this is a fine way to learn what just-born babies are like if you can view videos.I don’t know how evidence-based this is, but I was advised not to shower or allow the baby to be washed for quite a while so we had scent on our side too. It seems sensible. My hospital was fully on board with the “we don’t need to weigh and measure until feeding is established” thing.

I don’t think that (given an intention to breastfeed exclusively) that having formula ‘just in case’ is a good idea. You will be tempted to use it if you’re like me, but if you have an oversupply like mine you need the drainage. If it’s adequate you need the demand. If you have latch issues or undersupply or etc you need a consultant, who can sort you out with supplementation when needed, and reducing/eliminating supplementation if suitable afterwards.

Other than that, I think the advice I wish I’d had/paid attention to was nurse more often. Given how much it hurt I’m not sure I would have followed it, but it sounds sensible now when we’re pain-free to make sure the newborn isn’t so hungry it needs to suck with all its teeny little frightened strength.

Resources

kellymom is the website everyone recommends for a lot of breastfeeding (and to some extent pumping) stuff. Although I had a bad experience with the ABA’s counsellors, that doesn’t mean that their extensive breastfeeding advice is bad: seems good to (layperson) me.

There’s apparently quite a lot of web breastfeeding advice sponsored by formula companies. The conflict of interest is fairly obvious, so be wary of that.