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Breastfeeding: Our times in the hospital

I'll just say up front that I had researched breastfeeding, taken a class, and prepared. What I had not done was learned what I needed to know; I didn't see the right things on the internet, and the class didn't teach me either. Had I attended La Leche League meetings, perhaps I might have; but there were no meetings for me to attend in my area and, at any rate, I was biased against LLL (I am not now to the same degree, and that's another post for another day if I ever write it, but it's no reflection on the organization, more on me and a couple individuals).

So we got to the hospital (there was never any chance I'd try a birthing center or home birth; I wanted to be near interventions if they were needed), and my son was born. And he was large (over 11 pounds), and injured (shoulder dystocia that pulled a nerve in the shoulder, plus a torsioned testicle that apparently happened in utero), and I tore. I had only my husband with me, and he had to stay with me or go with our son when they took him off to check the injury. He stayed with me, because I was scared and shaking and we trusted the hospital with our son. I wasn't thinking clearly and I doubt he was either. I still cringe when I think of that moment - I wish he'd gone with our son. But if he had, when they said "medically necessary," he still would have yielded. It helps a little to ease the guilt. A little.

Because, see, my son was low blood sugar. (After an eight-hour labor, start of active labor to delivery, a birth that the doctor told me if it HAD been an induction - which it wasn't - she would have dialed back the pitocin. Good grief. Oh, and the hospital had pulled the standard "no food" thing on me. Which I now know better but wasn't braced for then.) And so they deemed it medically necessary and gave him formula, from a bottle, before he breastfed, before he even had more than about one minute of skin-to-skin with a parent (I did get to hold him briefly right after he was born, but that was it). And they told us we needed to continue to supplement because I probably couldn't make enough milk for a baby his size, and certainly not before my milk came in.

I remember feeling, not anger, but stubbornness then. I was too tired and too busy for anger, but I was. going. to make. enough milk. But I believed them when they said I wasn't yet.

Especially because they brought in the hospital lactation consultant, who agreed and said we needed to supplement with formula and I needed to pump to bring my milk in faster and more because I would have to work hard to make enough milk for my son. Fine, I said, bring on the pump. The lactation consultant, at least, told us to ditch the bottles and use syringes or SNS feeders to get the formula into him while he nursed. But she did say he still needed formula supplementation and gave us quotes of how many ounces of formula and breast milk, combined, he ought to be getting per day. "But I thought in the first days," I tried, "they don't need very much." She told me yes, that was true for most babies, but it was based on size and he was very large so he needed more.

We had trouble with latch. Actually, considering I was a first-time mother who had seen no breastfeeding modeled and my son started off with a bottle, we didn't have as much trouble as you might reasonably expect.

My son's pediatrician, who is very pro-breastfeeding, came in somewhere during all of this and was (quietly, politely) appalled - at least, in retrospect. All she said to me was that she didn't think the formula was necessary and my body could make enough for this baby. And I said that since we'd started, I'd keep it up until I was sure I was making enough. I rejected her advice. On the other hand, I took great comfort from it and believed it. I just needed proof.

(Rant 1 about unsupportive support: Why did I turn down her words, which were so right? Because the lactivists I knew had emphasized that you always trust the expert, the LC, over the pediatrician. I've since seen some in the breastfeeding community say "well of course, when we say LC, we mean an IBCLC" - ARGH. Seriously, people? If you mean IBCLC, ALWAYS say it. Never say LC. Or those of us who don't know any better will preference the word of an "LC" who is not an IBCLC over a pediatrician who knows what she's talking about and probably, if asked, could have directed us to better resources.)

So at 5 days old, my son (who is still nursing, but getting some formula) goes in for surgery for the testicle. And an overnight stay on the pediatric ward. Different hospital - one of the two touted as a "children's hospital" in our region, and in the same system of hospitals as the one I gave birth in. EXCELLENT surgeon. But in retrospect I should have told them to take their post-op procedures and put them...well, someplace indelicate.

See, after they come out of surgery, I was told I couldn't see him until he'd woken up and they'd confirmed he was doing okay. I feel guilty for giving in to this one. He should NOT have had to wake up with his Mommy not there. (I'm sure they worry about parents freaking out. I've seen animals come out of anesthesia and I know it's woozy and problematic and if there's a medical emergency I might have to stand back against the wall and let them do whatever. But I. should. have. been. there.) I wasn't. Before they confirm they're okay, they give them a bit of sugar-water in a bottle to be sure they can drink it.

When they brought him to me, they were concerned because he was awake and otherwise okay but had gulped the sugar-water violently and sputtered and gagged. I didn't realize until some hours later - after they gave us the same stupid nipples with the formula bottles they gave us - that they'd used a medium-flow nipple. ON A FIVE-DAY-OLD BREASTFED INFANT (yes, supplemented with formula, but we were using only SNS for supplementing at that point). (Insert more indelicate language here. Use your imagination - really go to town.)

I wasn't angry then. I was horrified, and guilty I hadn't been there. I couldn't afford to be angry, because anger consumes, and I needed to be consumed in the care of my baby. I couldn't afford the energy the anger would take. Now? Now I can be angry, and I am. I'm freaking furious, in fact, because there is SO MUCH WRONG with what happened there.

Moving on from that, he was still woozy from the anesthesia and was being monitored for sleep apnea. He'd get hungry, but couldn't breastfeed or cope with the SNS - not enough coordination. So we gave him a bottle of formula. Then he'd gulp and not breath - couldn't coordinate it - so we'd have to take the bottle away until he breathed. He'd be angry and cry and his heart rate would spike, and when his oxygen sat normalized, we'd give the bottle back. And so on. Over and over. I pumped all that night, but they whisked my bottles of breast milk into the fridge - I thought it could only sit out safely an hour, so I accepted this. Had I known better, I could have kept those bottles sitting in the room with us and given him breast milk, not formula.

They had listed him as formula-fed, which I argued and corrected to mixed feed (EBF and formula - they wrote EBF, not nursing, apparently not believing that he did because he couldn't cope in a post-anesthesia haze). Not that it really changed their approach except to bring me a pump and whisk the EBM off to the fridge.

He was doing much better by morning, and here came one of the bright parts of this horrible experience. I'd asked when we set the surgery up whether I could see the hospital's LC the next day before we checked out, and she came by. She couldn't help with our latch - he was still not up to nursing and, I think, slept through her visit. What she COULD help with and did was the pumping - she asked me about output, looked at fit, and said I needed bigger flanges. She tested up one size, then two, and suddenly pumping was getting a lot more output, and hurt less. This was useful both for my confidence, and because I would in fact need to pump when I went back to work, not just to initially up my supply. She was a godsend, and gave me some good advice (I forget the details) as far as dropping formula supplementation, trusting my body, etc.

But to this day, I remain convinced that the second hospital completed what the first started in sabotaging our early nursing relationship. My son's latch problems had multiplied and he didn't want my nipple at all. We ended up having to use nipple shields for four and a half months, because he'd only latch with them.

But hey, by the two- or three-week mark, I forget which, we'd confirmed that he was gaining plenty, and we dropped the supplemental formula from the regime. Bye-bye, SNS. He did get intermittent formula through six weeks, during long outings when we ran out of EBM, because we couldn't nurse without our nursing pillow and a nipple shield, and there was no way I was going to NIP while dealing with those; I simply wasn't capable of dealing with it. After six weeks, we were out in public for long times less (I couldn't hermit during the first six weeks: he had too many medical appointments, some an hour away from the house) and we were able to ditch the formula completely from use (still had some packets around in case we had a long trip, but I managed not to ever have to use them).

I am not sure how low his blood sugar was. I am not sure if that first bit of formula was medically necessary. I am reasonably sure that every bit of formula he got after that probably wasn't, and I suspect all our long-term problems could have been avoided with more competence on the part of the hospital staff at both hospitals (but especially the second). I want to go back and snatch my baby away from them (gently, so as not to scare him), and cuddle him close, and feed him properly.

On the other hand, we survived, and I learned to respond to a pump really well, and my son got breast milk from his first day and after about six weeks was exclusively breastfed until he added solids at six months, and continues to be breastfed to this day (over a year old). So in spite of a really cruddy start, we did pretty well. But I think we could have done better, given the right support, the right systems.



(Digression below, related more to hospitals but not to breastfeeding.)


Oh, and both hospitals fed me (one since I was a patient, the other since I was a nursing mom of a patient). Except the second hospital didn't ask my nutritional needs, and the first one asked but couldn't seem to manage them. I am lactose intolerant - if I eat dairy products and don't take enough pills (and "enough" is half art, half science - it's hard to guess with a new dairy food, but once I have it down it's consistent at least), I will get violent cramps and diarrhea, even bloody diarrhea. Not something you want to play around with, let alone after giving birth. But both hospitals, one of which - the first - had asked and KNEW I needed meals with no dairy, and what the symptoms would be if I got dairy and didn't counter for it with the right pills BEFORE eating it, COULD NOT MANAGE to do this. No, seriously, they kept trying to feed me things that would have made me miserably sick.

(The second one sent a heavily cheese-filled omelette. My husband ate it and I bought breakfast at the cafeteria. It would have been the reverse if they'd sent something I could eat, so it didn't really cost us any money, but it was amazingly stupid. The first one, when I asked them to send 'just some sandwich meat' instead of the chicken-in-cream-sauce that was planned for lunch, sent me a sandwich. WITH CHEESE ON. I picked it off and ate it, but not without a certain number of dark-humor comments to my husband.)




End of digression. It's taken me a long time to write this post - I've contemplated it for months. But I needed time to sit and type, and time to sit and be angry and grieve while I wrote it. I can't write it without grieving for what could have been. I'm proud of what we pulled out of what happened, I'm proud of what IS and WAS. But I'm so sad for what wasn't, and could have been.

The system needs to support all mothers in their parenting choices, give them information and support. What those hospitals did was so unsupportive of breastfeeding - a choice that, if anything, they should prefer due to its health implications - that it's insane.

And ostensibly, both support and encourage breastfeeding. The hospital where I deliver gives classes, talks it up, etc...then brings free formula in and gives it to your baby before you can even nurse him, if you're me. No, that is NOT supportive. Especially not doing it with a nipple, creating nipple issues before he even nurses. Especially not telling me before we even see what my body can do that it probably can't feed him.

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