Thursday, November 4, 2010

Breastfeeding Dramas

Of all the shocks I had in joining the new world of Parent, the difficulty of breastfeeding was probably the greatest.  I had vaguely heard people remark that it could hurt a bit when the baby first latches on - that breastfeeding looks so sweet and gentle, but the baby's mouth is surprisingly powerful.  But boy oh boy, did I have no idea just how complicated and painful it could be!

And it wasn't as though I hadn't made an effort to be informed.  I had attended antenatal classes that covered breastfeeding, including videos and diagrams on correct attachment.  I had the Australian Breastfeeding Association (ABA) "Breastfeeding... naturally" book, as well as "The Nursing Mother's Companion", and had at least read the first few chapters and skimmed over the rest.  I had talked to many parents about parenting generally and what to expect with a baby, and no one had alerted me to this.

The hospital I attended (Royal Darwin Hospital) vigorously pushed breastfeeding, and had midwives and a lactation consultant to assist.  And I still struggled to work it out.

Within two days of my daughter being born, my nipples were so painful that every suck felt like they were being sliced by razors.  I couldn't persist.  I had to stop and express.  But then it was impossible to express enough, and my daughter cried and cried until I agreed to let the midwives finger feed her formula.  I was crying and upset because I felt I had failed her as a mother.  As soon as the nipples were rested, we tried again, this time taking extra special care with attachment, but it was only another day or two before things were just as bad.  Someone finally told me about nipple shields and I tried those and that helped.

But then after I was discharged from the hospital, after 6 days (so a decent stint) my baby managed to clamp and chew my nipple even through the nipple shield - it was so painful, and I just couldn't get it right. No one could seem to help.  Midwives and lactation consultants just looked puzzled and said it looked like I was doing it right, but if I was doing it right it wouldn't hurt.  I ended up exhausted and hysterical.  Finally, it was my obstetrician (who is pro-breastfeeding and breastfed her own children) who told me it was ok to go onto formula for a few days to let my nipples heal, and to get some help so I could get some sleep when I wasn't expressing.  Luckily, my sister and my mother in law were available to help feed my baby the bottle and I just concentrated on expressing.  I did about 4 days and then went back to the breastfeeding.

At first my baby was a bit confused - and grumpy that the sucking did not produce instantly large quantities of milk - but she got the hang of it again after a day or two, and after that we were right.  At least with the pain.

But then came the Week 3 Growth Spurt.  My daughter had come out with her days and nights back to front, as so many babies do, and while she was a sleepy newborn, that was ok.  Come week 3, she was up and crying for hours.  I was really pushed to settle her in her pram (which she slept in) with patting so she didn't learn 'bad habits'.  It worked once.  Then she became completely hysterical when placed in her pram.  She woke all hours of the night and wanted to stay awake.  She did not want to sleep anywhere but my arms.  She cried and grizzled for about five hours of an evening feeding on and off.  I was so unbelievably tired, but I had to keep waking up and waking up to feed her.  That was when it hit me, that breastfeeding meant the sleep deprivation was a burden my partner couldn't share with me, and just how hard that would be.

I almost gave up again round Week 6, where we were having a particularly fussy growth spurt / wonder week type time, but my baby developed a skin infection under her double chin, and I felt it was not the time to lose the immunological benefits of breastfeeding.  Then things slowly got better, until just after the three month mark, when there was a complete regression in her sleeping and feeding habits.  She went from needing approx 2-3 hourly feeds during the day and one at night to hourly during the day and 1-2 hourly at night.

I was startled to learn that the Oestrogen Cream I had been prescribed for dry skin could have the side effect of affecting milk supply and no one had told me.  She was feeding so much the nipples were rubbing raw against despite good attachment.  I stopped taking the cream and after a few days supply improved, but my baby got a cold and continued to wake 5 times a night.  Even after the cold went away, the 5 times a night wakings continued - and each time she wanted to feed.  She had used to be a fast feeder - done in 10-15 minutes and back to sleep.  Now she wanted to suck and suck - 45-60 minutes each waking.  She wouldn't take a dummy.  Only the breast would do.  My husband was away and I had no family nearby, so couldn't have got assistance even if I had have wanted to bottle feed.  I resorted to co-sleeping, which I had firmly thought was not for me, but I just couldn't sit upright, feed her, and stay awake.

So I am breastfeeding her exclusively at (almost) 4 months, which I am really happy about, but it has been quite a saga.  I found it really hard to get the right advice for me.  Breastfeeding advocates refused to acknowledge that things were as difficult as they were, and the only other advice I got was to just give her the bottle.

Here is what I wish I had been told:

On the pain:

  • For many mums, breastfeeding a new baby hurts even if you're doing it right.  The sucking is like attaching a vacuum cleaner to your nipple, and the constant rubbing of the baby's tongue is like rubbing your nose raw with tissues (or wearing in a new pair of shoes).  Your nipples do toughen up and it gets better, but ignore the breastfeeding propaganda that says it should be 100% comfortable and pain free.  From talking to many other mothers, I would say most women do not find it is pain free until 2-8 weeks after birth.
  • It is really, really hard to get a newborn baby to attach correctly every time.  They only open their tiny mouths for a split second.  They only need to attach wrongly a few times to do the damage and for things to get really painful.  What's it like?  It's like a cross between "Hungry Hungry Hippos" (the game where you have to quickly feed the hippos when they open their mouths), and "Operation"(the game were you get a painful electric shock if you touch the sides of your 'patient').
  • As a new mum, getting the nipple in your baby's mouth correctly is a physical challenge, akin to mastering patting your head and rubbing your tummy at the same time.  If help is available, ask for the help and supervision in getting it right.  Practice first with a doll or teddy bear.
What you can buy to help:
  • Forget screwing round with 6 pillows that slip about.  Get a proper breastfeeding pillow - or as a budget alternative, go to a foam and rubber shop and get a really firm piece of foam the size of a pillow.
  • Buy Lansinoh (a special purified lanolin to put on your nipples).  Use it as much as you need.  Ignore any idiot midwife who suggests it will make your nipples soft and the cracking worse.  It is the ONLY thing that helps cracked nipples - plus expressing a little milk and letting the nipples airdry before you put the Lansinoh on.
  • There are these things called 'nipple shields', which are a thin latex shield that fits over your nipple to stop the baby doing as much damage.  Don't use them unless you have to, because they make it harder for the baby to suck out enough milk - BUT, if you need them they are available, and if you have decent let-down, your baby will probably manage.
  • Have a steriliser, bottles, and formula ready - because when you need them, you need them at 2am.  If you have to use a bottle and formula to give you enough sleep to protect your sanity and milk supply, or to let your nipples recover, then you just have to do it.  Yes, it is possible that your baby will never take the breast properly again - but chances are that they will - and you make it possible for yourself to continue through the early difficulties and pain and keep trying.
On sleep:
  • Make it as easy as possible for yourself to get back to sleep after a night waking.  A red night light doesn't wake you up as much, allowing you to get back to sleep more easily.
  • Have a safe co-sleeping environment available (this checklist is taken from Elizabeth Pantley's "The No-Cry Sleep Solution").  You may also have a cot / bassinet / hammock etc, but when you've had 2 hours sleep in about 50 hours and your baby will not settle anywhere except in your arms, it's much better to have a safe place to co-sleep than to exhaustedly fall asleep together somewhere unsafe.  Nearly all mothers I have met have co-slept with their baby at least once, out of sheer exhaustion.  A firm foam mattress on the floor is one cheap alternative.  Another is sticking something like a Snuggle Bed next to you on top of your bedding is one way to keep your baby within arms reach but without investing in anything as complicated as a bassinet which attaches to the side of your bed.
  • Breastfeeding releases a hormone that makes you sleepy.  If you can master co-sleeping, research indicates you may actually get more sleep than mums using a bottle, because you don't have to wake yourself right up to prepare bottles, and you will fall asleep easily during the feed.  Its hard to start with but easier in the long run.
  • Forget teaching a newborn baby to sleep - unless you're lucky you'll be fighting them all the way - and you still won't be getting any more sleep.  Teach yourself to sleep.  Wind yourself down.  Remove any excess stimulation.  Listen to relaxation / hypnosis CDs.  Darken your room so you can sleep during the day.
  • Don't be misled into thinking it's normal for most babies to sleep 8+ hours by three months.  It is not at all normal for breastfed bubs.  Schedules and routines may look attractive, but even if you have a compliant baby (and most babies aren't) schedules don't work with feeding on demand and growth spurts, so you will cause problems with your milk supply.  Unless you are switching to formula, revisit these ideas when your baby is on solids.
  • Recruit people to help you with other baby related activities (laundry, playing with the baby, settling the baby etc) so that you can get some extra sleep.  
  • Adults sleep in one and a half hour cycles, so try to sleep for at least an hour and a half at a time.  You'll feel better rested.
If it's too hard:
  • Don't be surprised and don't think there is something wrong with you.  Yes, breastfeeding is great and breastfeeding is 'natural', and it's how the human race survived for millenia, but we do not live in a 'natural' social environment for breastfeeding.  Traditionally, women lived a lot closer together than in our nuclear families.  They didn't sit at home all day by themselves, exhausted, in social isolation, getting post-natal depression.  In hunter-gather societies women share breastfeeding each other's children, and share all the other work associated with child-rearing.  Breastfeeding was a public activity so there were women on hand constantly to help and model attachment.
  • Don't feel guilty.  Remember there's much more to being a good parent than breastfeeding.  Yes, breastfeeding is ideal for your baby's digestion / immune system, and formula fed bubs do not get these same benefits... but if you're so tired and upset you're unable to be pleasant to your baby, or you're about to crash the car, then you may be breastfeeding at too high a cost.  There are many happy, healthy, well-attached kids raised on formula.  You have to make the choice that is right for you and your family looking at the entire situation, not just the benefits of breastfeeding.


  1. One thing that helped me (after 4 failures!) was advice to toughen the nipples before the baby was born--tug on them half a dozen times each in the shower, rub with a rough washcloth. I started about 6 weeks before and it really did help!

  2. Hi mehitabel - I had this recommendation too, but then I read that stimulating your nipples can induce labour. Stimulating your nipples produces oxytocin, which is the same chemical that triggers labour. Whether it produces oxytocin in sufficient quantities to really trigger labour, or whether it will trigger labour without other factors present is something I do not have any quality info on - and it likely varies depending upon the individual as well. But I guess that perhaps it is something to be aware of - maybe do it in the last three weeks before the due date only if you're cautious.

  3. Definitely toughen those nipples. I used a soft shoe shine brush in the shower at night and ordinary old lanolin, this certainly helped a lot. Still got cracked nipples but was through the worst of it within 2 weeks. Of course my babies are now 33 and 21 yo and never heard anything about stimulating your nipples can induce labour!

  4. Oh goodness me, please don't toughen your nipples, you want soft, supple nipples, not tough ones. I think getting used to handling your breast antenatally is a good idea, ie practice some hand expression gently but there is no evidence scrubbing you poor nips makes it better in fact I'm pretty sure there is evidence to the contrary.
    Scrubbing them to your hearts content won't cause premature labour unless you were already going to go into prem labour. While they aren't exactly sure what causes labour, they do know you need receptors to oxytocin on your uterus which develops over pregnancy. So it won't put you into labour unless you were already heading there :)

    Feeding a newborn doesn't = cracked nipples automatically, it's poor attachment that does it. I had disgustingly cracked nipples with J(number 1) but no cracking with any of the next three. I did have pain, and you're right, everyone will (well most) but it's not the rubbing that does it as such, it's hormonal. I had the same initial discomfort with my second despite having fed my first right up to the day she was born. This hormonal discomfort is different for poor attachment because it'll ease after 30-60 seconds of a feed. If it's still painful then it's probably attachment, even with severely damaged nipples it shouldn't hurt if the baby has a good latch. This hormonal pain should disappear within a week or two. It is nasty though, I have always found it toe curling, I tell mums that at antenatal classes.

    Oh one more thing, lansinoh isn't the only way to heal nipples, in fact there is evidence that it's no better than smearing hind milk on them and letting them airdry. *Discalimer, I used it with my first and, like you, swore by it. Second time around, it gave me thrush!

    Nice post :)

  5. Sam, I don't know that it is just attachment. I think there is also a toughening process. Bethany still attaches poorly sometimes, and I can see she has really bent the nipple out of shape, but it never cracks and bleeds anymore, and doesn't hurt nearly as much as it did in those first weeks.

    I think the other reason learning proper attachment techniques is not the entire answer is that your baby is not necessarily cooperative. Bethany would slip off the nipple during the feed so that she'd be pinching it, and when I tried to stick my finger in to break the seal, unless I did it exactly right, which was very difficult for a new mum, particularly one with fairly large boobs who couldn't see what she was doing, that's when she'd really clamp down and do the most damage. I used to let her go on badly attached sometimes because it did less damage than removing and reattaching her.

  6. Yes that's the thing with attachment, you have to watch it the whole feed.
    Perhaps there is an element of 'getting used to it', not that I've come across anything like that while studying breastfeeding but in my own circumstance I had the same discomfort with all my children despite feeding their older sibling right up until their birth as I did with my first and no nipple preparation. Makes total sense with the evidence. Do you really mean toughen? I just wonder because tough nipples wouldn't be as stretchy or pliable as they need to be to pull back to the back of the baby's mouth.
    That pull off can be pretty sore sometimes! Little newborns latch on pretty hard. I was quite surprised when feeding my first two together that my toddler was a lot more gentle than my newborn!

  7. I had lots of breastfeeding issues around 3 months, when my doctor misdiagnosed me with vaginal atrophy. I was prescribed oestrogen inserts for the vagina. It stopped my milk - huge saga. I told him, and he said halve the dose - tripple huge saga. I refused further treatment, and since I wouldn't let him slice open my vagina in his office, he called me a nun. DH was about to punch him. It was a huge effort to get milk back both times - evenings of steak, beer, and a rich brew of herbs from my naturopath. It worked - but what we were left with was a paranoid baby, afraid that if he didn't suck all day, and every half hour during the night, there would be no milk ever again. The ABA were worse than useless - I wanted my baby to feed on demand, and he was, wasn't he? So I had to solve it for myself. Sore nipples wasn't the issue - I'd tanned my nipples prior to birth, and used vitamin E cream before and after every feed as my doula had advised, and also fed side-lying from day one, which makes attachment easy. The issue was the sleep depravation. I had to rope a very unwilling DH, who had no idea what I was going through, into helping me at night. I put him on clock duty, and he was to record what times DS fed. In the first week, if DS had fed less than 1 hour ago, DH was to hold him for five minutes, patting him if he cried. If he cried more than 5 minutes, I assumed he really was hungry, and fed him. If he went back to sleep, we didn't feed him until he woke up again. The next week, it was 1.5 hours. The third week, it was 2 hours. Halfway through the third week, he realised that there would always be milk, and so he felt safe enough to sleep again for 4-6 hours. The advice you give all makes sense - and I'm glad you are sharing your wisdom. It's true there is grace in suffering. I'd be interested to know whether the lanolin cream you recommend were organic or not - one advantage of pure vitamin E cream over lanolin is that there isn't any risk of residue sheep dip contaminating it - which was why I understood lanolin was advised against. I'd not heard anyone say not to oil the nipples - it's a shame anyone would advise that. I hope the breastfeeding continues to go well - watch out for teeth, that's the next big hurdle.

  8. The irony of being prescribed Oestrogen therapeutically whilst breastfeeding, over and above it being contra-indicated, is that contributes to suffering by making new mothers get less sleep as they try to feed their babies all night with diminishing milk supply. A factor in low Oestrogen production is lack of sleep. Low Oestrogen production has another contributing factor - insufficient protein consumption. Having low Oestrogen is very painful and debilitating after birth if it is severe enough, and it's a priority to get the body producing a balanced array of hormones again for quality of life. It can be addressed in two ways. Firstly get more rest. Put up a notice at your local convenience store asking for a mother's helper (really should be called a father's helper, since it's the father who's not there and needs someone in his place!). Get someone in to help for a few hours a day, playing with the baby, doing dishes etc, so you can at least let it all go for a couple hours and relax - you'll sleep much more soundly at night if you're feeling relaxed. I like to lie still and feel the sensations in my body, and think nothing. Secondly, address the low protein intake. To get my Oestrogen levels in balance, I needed a steak for breakfast, lunch, and tea. I had a huge feeder, a boy in the 95th percentile for height. This came as quite a shock to someone who'd been vegetarian for years! If I ate any less protein than that, I started to feel the effects of being low on Oestrogen. I also found a supplement helpful, called Endura Optimizer. It's a protein and magnesium supplement, taken by body builders. It's made of milk, but the milk has been processed so that even people who are milk intollerant (my baby was allergic to any dairy in my diet) can take it. Also, it's not soy - instead of drinking dairy, I'd been drinking soy. Soy consumption, when it hasn't been fermented, actually affects the thyroid, which is not what you are wanting when you need your thyroid in peak performance! There may be other ways of addressing the causes of low Oestrogen rather than just the symptoms, but these two are pretty easy and non harmful (except for the cows!). I was very grateful to the women who pointed these remedies out to me.

  9. Something that can help get attachment right from the very beginning is Biological Nurturing. This approach to establishing breastfeeding uses all the innate reflexes of baby (and mum) rather than requiring the mum to play an active role in attaching the baby. Suzanne Coulson has done a lot of work in this area and I heard her speak at a LLL conference - fascinating stuff! Having just used the approach to establish feeding after the birth of my second child I am a total convert, and know a number of other women who have also used the approach with high success rates. It's definitely worth checking out.

  10. I don't suppose you have a link, anonymous? Is this when you put the baby between your boobs and let them wiggle towards the nipple themselves?

  11. Look up the Breast Crawl video, I think that is what the previous commenter is referring to (and yes, basically putting them on your chest and letting them self latch). I wanted to do that with my son after he was born but was not able to due to complications. Having said that, I never found breast feeding to be painful unless his latch was bad, though admittedly when you are sleep deprived and barely awake, often you are not paying a great deal of attention to their latch! (As evidenced by the hickey I had beside my nipple one day where my son had been happily sucking away until I realised something wasn't quite right! Hahaha)