Having talked in Part One about my work experiences, I feel that this gives the other half of the story of what breastfeeding means to me. It wasn’t best practice, but know everyone I encountered wanted to help me as best as they could and made me aware of the gaps in my knowledge.
By the time I had found my wonderful husband and was pregnant with my first child, I had been nursing for over 10 years, had had training in breastfeeding at work, and even been in position to advise and support Mum’s with breastfeeding (briefly) while in A&E – the hope being that specialist infant feeding midwives or community midwives/health visitors would offer further support once home. My experience was in no way best practice, or experience, but without going through this, I doubt I would be able to empathise with the Mum’s I meet, or even now training to be a HV.
There wasn’t any doubt in my mind, the baby would be breastfed, I didn’t anticipate any problems, my only ongoing concern was how small my bump was – I’d always anticipated turning into a big ball (being a bit of an “apple” at the best of times), but the bump was almost indistinguishable. I was always reassured at scans and midwife appointments that baby was growing well, if at the lower end of the centile charts. At 28/40 I was diagnosed with Gestational Diabetes (GDM) which I luckily controlled with diet, and helped debunk the myth of GDM causing big babies.
A friend who also had GDM had mentioned hand expressing when we’d met up (as a non-tea/coffee drinker, I became really boring company… “Oooo, just a water for me then”), but it wasn’t something I was familiar with, and couldn’t find clear information on it, and mild arrogance on my part meant I thought if it was important, I’d have heard of it, so I had no colostrum pre-saved or practice at hand expresssing.
19th September and half an hour after arriving in hospital (although 24hrs since my very first contraction), E, my gorgeous daughter arrived. Despite being ready for her being small, it was a huge shock to realise she was only 2.1kg (4lb 10oz). It was a surprise to find the midwife who had been amazing throughout my pregnancy (our GP surgery has a caseload midwifery team) looked worried and there was a certain urgency to try and get her latched on – we did immediate skin-to-skin, and E’s blood sugar as normal, but she wasn’t interested in latching on – her mouth seemed so tiny, and she didn’t seem keen to open wide enough. I started to feel a bit stressed – this wasn’t the plan, and it felt the more I wanted to feed, the less it was happening – My nipples were suddenly flat as pancakes and the midwives were adaption a syringe to try and vacuum them out (NEVER do that – really painful which cause even more stress to me). We moved down to the post natal ward and trying to feed continued.
My A&E experiences combined with my reading up on GDM, left me well aware of E’s risk of hypoglycemia and weight loss, and how serious this was given her tiny size, as well as recognising in myself that having been awake for over 24hrs meant I needed some rest too. So, with my agreement, after trying to latch her on, we gave a small amount of formula. I always saw this as a temporary measure, and with every feed, had some support to try and encourage E to latch on.
Having asked for referral to them, I was visited by the breastfeeding specialist midwife (working within the hospital I knew of them already). 28hrs after E’s birth, I was shown how to hand express colostrum, use syringe to collect it drop-by-drop & finger feed to encourage suckling & then try to get her to latch before giving formula/EBM.
Following the meeting, we were advised that if we were happy, the midwives were happy to discharge us. So we went home with a 3hr routine of hand expressing (1/2hr for 1ml of colostrum) then finger feeding/encouraging latch, before bottle feeding. I remember it so clearly, and yet it can only have been a few days before my milk came in and hand expressing was replaced by the electric pump once my milk came in I would then express ready for subsequent feeds – my husband didn’t realise how unusual our experience was until he spoke to the other dad’s from our NCT group.
A friend visited within days of us returning home, who’d had two premature babies (each bigger than E!) who suggested nipple shields. It was a revelation. The first feed I attempted to use them, E latched on and (having been disappointed by the lack of fuel gages on either my boobs or E’s stomach) seeing a pool of milk in the shield following the feed, gave me huge reassurance. I felt hugely disheartened by a community MW suggesting I stop using them ASAP at our next visit. I visited a local breastfeeding group and felt much better that although they spoke in terms of looking to move off using them, they were supportive of them preserving breastfeeding.
It took us 12 weeks to stop using the nipple shields altogether, and E was never exclusively breastfed – in early days, although never loosing weight, she tracked under the 0.4th centile and without a small top up her weight gain would plateau. I felt happy to do this for my own reassurance as well as the professionals but, having thought E was taking enough at the breast, I abruptly stopped expressing. At her next weigh-in we realised her weight had plateaued again and I wasn’t able to express as effectively again, so the small bottle of EBM had to become formula, but I continued to mixed feed until E was 14mths.
My experience with health visitors wasn’t great (in fact I cite it as the prime driver for my own move into the profession). Far from getting reassurance, I felt I was having to reassure them about her size & was sent to see GP who was v non-plussed by the obviously bright & healthy baby she saw before her.
I remember them asking me to attend fortnightly in a tone that suggested she may fade away in the mean time. On leaving their clinic, I would make tearful calls to my husband as I sometimes felt that my professional as well as my motherly judgement wasn’t being respected & felt huge guilt at how despite being a paediatric nurse who’d thought everything would be easy as I knew so much about breastfeeding before I even thought about being a mum.
Looking back now, I still feel I did the best for my daughter, for over 10mths, the majority of her nutrition was from me, even if not totally, with better advice, support, reassurance or if E had been a few lb’s bigger, then maybe totally breastfeeding would have been possible as it was for my son a few years later.
Writing this all down and reflecting upon it, I’m unsure that I’d have managed any of this without 2 things
(1) my nursing background, in those first few days I went into nurse mode and had to remind myself that I was her mum rather than looking after her for someone else.
(2) Being my first child. I wouldn’t have had the energy or time to do this if I had another child, I relied on my hstband so much in the early weeks & even putting some of this down to first timer cackhandedness, I know I wouldn’t have been able to have the same support/attention from him if we had another child already.
Having this experience has left me understanding much more about how difficult breastfeeding can be, and the importance of support parents need in those early days particularly the positive effect of empathy.