Tuesday, June 11, 2013

Triumphant Tuesday: Breastfeeding After Breast Trauma

Many women’s breasts have endured a battle or two, whether as the recipient of an excited baby’s kick, manhandling by midwifes, over-enthusiastic ‘admiration’ by menfolk, or even a stubborn handbag strap. Most of the time, these everyday jolts have zero impact on the breast’s ability to lactate. However, occasionally trauma to the breast can injure tissue, potentially interfering with milk drainage and even production.

You are about to read the story of one new mother that experienced injury to her breasts well before her baby was born. Little did she know that this accident would come back to haunt her. By reading her story, you will gain valuable insight into the warning-signs indicating that previous breast trauma may have future consequences.


“We planned to have a natural childbirth and breastfeed. However planning and doing are not always the same thing, as I came to find out.

At the start of my pregnancy I was in a car accident. A woman was on her phone while speeding and had hit me head on. The seatbelt was so tight that it created huge bruised sections of my breasts. I was unaware at the time what a huge impact this relatively minor accident would come to have.

Distressing Birth

We opted to induce labor because my son’s positioning was cutting off circulation to my legs and they were turning blue regularly. At almost two weeks past due he was making no plans to come out on his own. I wanted a natural birth and figured I could accomplish that at least partly with an induction.

All I can remember about the second half of labor was passing out after every contraction and waking up only to scream in pain. It was horrible. My poor husband was nearly in tears and my mother was nervously watching the monitors as I became tachycardic.

When I was told to push I was giving it everything I had but it wasn't good enough. I pushed for almost four hours straight. The final few minutes were so scary. The doctors and nurses got suddenly very scary looks on their faces. One nurse started pushing on my stomach, nearly standing on me. Another took my right leg and laid it flat back while one more did the same on my left. I heard the doctor yelling "call the NICU!" repeatedly. My mother moved back as they kept yelling for me to "push with everything you have".

Finally, our son was born, measuring 23” long and weighing a massive 10lb 8 oz. He was so large that he got stuck (Shoulder Dystocia) and broke his collarbone on his way out. Our plan of having him laid on my chest and being able to breastfeed him right away was stalled by tests. He was taken by the infant care unit and they placed a line in his arm for an IV and he was given a long list of tests to make sure he hadn't been injured further. He was beautiful and I was barely conscious. I couldn't even swallow sips of water without choking because I was so exhausted.

I was given antibiotics because I was group B strep positive. I wish the nurses had not done this, for reasons that will become apparent, but it was considered mandatory routine. All pregnant women at our hospital are tested for Group B strep at 38 weeks. A positive result, which is according to them one in three women, are given a mandatory IV of antibiotics. I did not want it and protested but was told it was mandatory.

With time I regained some strength and was excited to finally have my son with me and thought that we would just breastfeed naturally. After all, I was built to do this so how hard could it be? Well, as they say, nothing worth doing is ever easy.

Coerced Supplementation


As my son was so large and I was so weak I was told that I needed to supplement. I fought it but the lactation consultant was not in that day and I had to go off the advice of the nurse who was all too happy to give my son the free formula. I cried when they told me to supplement. I had come prepared with nursing tops, breast pads, and the attitude that my child would keep his 'virgin gut' and get nothing but the best. The nurses said they understood my worries but that because my son was so big I wouldn't be able to feed him exclusively. I knew he was large but did he really need 3 ounce formula servings? According to the nurse he did. So, we supplemented. The nurse brought me a pump to try to stimulate my milk coming in but we didn't make nearly as much as he was drinking. It was depressing. I spiralled into the baby blues quickly. I felt inadequate and underprepared for motherhood. After we were discharged I wanted so desperately to never see a bottle again but he was so hungry and the milk wasn't coming in fast enough. Had I known to just put him to the breast so I could build my supply we might have had more success sooner.

Feeding my son formula was a disaster. The milk gave him gas and bloated him. He was extra irritable. Not knowing any better, we just assumed this was normal. It wasn't...

Latching Issues

Latching difficulties began early on. My son was so eager for food that he latched hard and it was extremely painful. I kept seeing the consultant and it wasn't until my mother-in-law commented on my husband being a tongue tied baby that I realized our baby had the same problem. From there we had to find a doctor to clip it for us. When he opened his mouth it was so very obvious. The very tip of his tongue was attached and when he cried out it curled up on both sides making a V.

Since breastfeeding is not the norm in America, the doctors are no longer looking for tongue tied infants so he was overlooked. We spent 3 weeks trying to get it fixed. For something so simple, it was extremely complicated. We went to our doctor first who then called the lactation consultant. Our consultant verified it and then we had to search for a doctor in our practice that had clipped a tie previously. None had. Not a single one. It was a total shock. My husband had been tongue tied and his mother had taken him to the doctor where they clipped it immediately, not an issue. We were eventually sent to the maxillofacial surgery section of our hospital where they had to find someone who could do it. By the rules of the hospital, the doctor had to sedate our son to do it but because of his age, we had to have him monitored for 24 hours before and after sedation for safety. So, to clip his tongue we needed to spend 48 hours in the hospital for a 10 second snip. Absurd. We argued that this was irrational and the doctor agreed. He said that he would ask around and came back with the solution that he would consider it a "pathology sample" and a teaching tool to get around the red tape. So we came back and there was a room full of doctors and nurses who watched and took notes on how to clip the frenulum. If it wasn't such a pathetic statement about modern medicine it would have been comical. I once again felt helpless and defeated.

To complicate matters, feeding was so difficult that he was being bottle fed more than breast fed so my supply wasn't where it should have been. It took weeks to make up for lost time.

Burning Thrush


To add to the list of 'what else can possibly go wrong now', I got thrush. Bad thrush. I had to diagnose it myself and fight for it to be taken seriously. I had cracks on my nipples that were painful, deep and everywhere. Half of the latches would result in my baby having a mouthful of blood. The other half I just closed my eyes and prayed for the feeding to be over. I felt like I lived in fear of feeding my son. I was taking Percocet to deal with the pain because it was so bad. We had been given antibiotics in the hospital when he was born and that had depleted our systems, causing the thrush.

To treat the thrush, they gave me more antibiotics, creams and drops for his mouth. 3 weeks consisting of 2 rounds of the treatment and no change. It was excruciating. I didn't want to shower because the water stabbed my chest, I wanted nothing to touch me. I was also feeling deep pains in my breasts once he started feeding and these lasted until up to two hours after feeding. Since my son feeds often and for long periods, the pain became a round the clock event. I became deeply depressed. That is when I decided that if I could just make it to 6 months, I could stop there. I was determined not to quit. My husband's mother breastfed him until 3 1/2 so I had a good role model and she had sent me a copy of "The Womanly Art of Breastfeeding" which I read cover to cover three times during all of this. I still use it as a reference guide.

I did hours of research online regarding thrush and found that a simple over the counter dye could treat it. Why had I not heard of this? Why had my doctors and lactation consultant not heard of this? The answer was very simple. There is no money to be had by drug companies when people can fix their own problems. I bought a bottle of Gentian Violet online and used it. Within 24 hours, the latch pain was over. The burning was over. The only thing left was deep throbbing pain.

My lactation consultant, who I was seeing every single week and calling constantly was a gem. She was determined to help me through it all. She had asked me how committed I was and wouldn't quit looking for answers to my questions. At this point, we pretty much already had a Bingo. I had survived:


  • supplementation by the hospital staff,
  • bad latches,
  • thrush,
  • mastitis,
  • a plugged duct (from my baby being so large that the chest carrier was pushing down and plugging things),
  • peer pressure from unhelpful friends and family who said it wasn't worth all the hassle and another who said that breastfeeding "wasn't normal. That is why we have formula so we don't have to be so stuck in old ways.
  • one inverted nipple (ouch!)
  • difficult birth and large size
  • tongue tie and incompetent medical staff
  • and an unknown deep throbbing persistent pain


Public Breastfeeding Raised Eyebrows


Because we live in the South some people on the streets are very against feeding in public. I sat in my car once with a cover over my son and had to hear women outside my car saying that it wasn't descent. I was horrified. It was my first time feeding him outside the comfort of our own home. To add to the mental pain, I was still dealing with the physical so it was what almost ended it. That was the day that I found The Alpha Parent and I decided to keep up with it and surround myself with positive role models and support.

When the pain wouldn't leave, my lactation consultant started asking to do a series of tests. I was supposed to look at the nipple and watch for color changes. I had to try feeding after warming my breasts and after cooling them off. She then asked if I had ever had trauma to the breasts. I told her about the car accident. She had figured out the last barrier....Raynaud's.

Raynaud's Phenomenon


What in the heck is Raynaud's Phenomenon? My doctor asked the same thing. Not a single doctor at my hospital had heard of it for breastfeeding. The lactation consultant we had been seeing said that she had only ever heard of one case of it before and had to print journal studies out for our medical staff to read through. The car accident severely damaged the breast tissue and I was to need blood pressure medicine to act as a vasodilator to stop the pain. Whenever it gets even a bit chilly the whole area shuts down and the pain starts. To counter this, the vasodilator keeps the veins open and the pain stays away. I was put on the smallest dose and eventually worked up to the maximum dosage 4 times a day. Additionally I have to keep warm. Anytime it gets cold the pain comes back, the nipple goes bright white and the breast starts to turn blue and white. With the warm weather it is not so bad but once the cold air hits it is a downhill slide. I took to heating rice filled bags to lay over myself during feedings to ensure warmth.

So, it ends there right? I fixed the thrush, the Raynaud's and all the other supply and pain issues. It can't get any worse from there.
Wrong. What is life without a little adventure?

Allergy


Through an elimination diet and the guidance of our doctors, we have discovered that my son has multiple protein intolerance (The official diagnosed is FPIES ‘Food Protein-Induced Enterocolitis Syndrome’). For me that means that I literally cannot bottle feed him. There is even a lab created formula that is supposed to be free of milk proteins but it is still made from cow's milk. Since he does not have the enzymes to digest animal proteins, casein, dairy and soy in all forms I am his only way to get nutrition for a long time. We had to remove almost all food from our home and start from scratch. On the list of offending foods is turkey, chicken, eggs, beef, all dairy products, all soy products, pea products, and peanuts.

My son was born a vegetarian which would not be a problem since I am an avid gardener but as I’m his food supply I have to follow his diet. So for now I have a strict diet of no processed food whatsoever.  No dairy, no meat, no vegetable oil (soybean derived), no beans, no peanuts (soy family), and no eating out at all. My diet is a complete 180 from what it used to be. Imagine going to the grocery store. Before I would walk the aisles and pick out groceries and snacks. Now, I read every label looking for hidden dangers. Food, once my friend, is now my son's enemy. I have reduced the grocery store to one section: the fresh veg. Even the bread aisle is off limits because soy flour sneaks into everything. Soy hides everywhere. Milk hides everywhere. I can no longer eat out. If I can't read the label or trust that vegetable oil isn't being used to grease the pan, I can't eat it. I end up with a plain chopped salad, no dressing and veg on top. That gets old quick. If I cheat on my strict diet, my son pays for it in horrible gas, bloating, bleeding intestines, irritability and weeks of diarrhoea. I just cannot do that to my sweet child just because I want a cheeseburger.

The pediatric allergist said one of the two factors contributing to this (luck of the genes being the first) was the antibiotics at birth and again to treat the thrush. Had we not been forced to have the antibiotics this might not have happened. I wish I could go back and talk to the nurses that forced an IV on our precious newborn baby. She thought she was doing best but really she set him up for failure, and our family will be fighting through this until he is 5 or 6.

Solid food introduction was put off until he turned 1 to help him from going into shock if an offending food enters his system. This meant that I exclusively breastfed him for 12 months. I am grateful that I didn't quit breastfeeding because clearly my son needs what only my milk can provide.

Is it worth it?


Absolutely. I have zero reservations about making a sacrifice for my son that will ultimately lead to a longer life for the whole family. For me, breastfeeding is important because it is a gift for both of us. Not only is it the best health for him, but it is also great for me. I enjoy how it has made my body bounce back quicker, how it gives me a closer bond with my son and how it nourishes both of our souls. It is something that can not be bottled, replicated or sold by anyone. For me, there is no other way to raise a child. It is not easy, it can be downright painful and hard at times but it is worth every milk blister, crack, swollen and tender breast and hiccup along the way.

Do I miss ice cream, the option of free time and nights out with a babysitter feeding my little guy....not as much as I value the gift I am giving to him. I know, without a doubt, that I am doing the best possible thing that I can possibly do for my child. I am giving him the gift of a future that is limitless because he has a start that can't be bottled.

Mothers Who Don’t Breastfeed...

I feel bad for mothers who don't make an attempt to breastfeed. They miss out on the bond, the health benefits and the freedom it offers. I don't have the stress of walking around with coolers or timing when the milk will be too contaminated to keep using. I have the freedom to just be a mother to my child and have food on demand. I met a woman who was changing her little one in a room with a few women breastfeeding. She was clearly feeling guilt about propping the bottle up into the face of her baby girl so she stated "I tried breastfeeding but I didn't make enough milk." I wanted to laugh because she had just told me her girl was only 3 weeks old. At that moment I realized that she simply didn't want to breastfeed. I thought about telling her all about how she could easily re-lactate at this point but I realized it would be falling on deaf ears.”


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