My daughter Eleanor is approaching her first birthday. I think it is fitting to write about her birth and our breastfeeding journey now as a way to celebrate her and for me to heal my wounds regarding both. I am not able to discuss our breastfeeding relationship without first discussing her birth, which are interrelated.
We had planned an intervention free birth experience at the Mountain Midwifery Birth Center, but after 48 hours of labor and not progressing past 8cm, I was transferred to Swedish Hospital for “maternal exhaustion.” My choice was epidural or cesarean section. After such hard work from the entire birth team including my husband (Matt), our doula (Sara), the certified nurse midwife (Tiffany), our nurse (Karen) and our birth photographer (Megan), I felt such disappointment that I somehow failed them and myself in our goal of having a natural birth. I wanted to birth Eleanor in the water in the peaceful environment of the birth center surrounded by people who I knew into the loving arms of her father. Instead, in stark contrast, I gave birth in a brightly lit room, surrounded by people I just met, and unable to move from the bed due to the epidural and essentially being temporarily paralyzed from the waist down. At the time, I tried to maintain a positive attitude and make the most out of the situation and I wasn’t going to let a change in my plan sour the birth of our daughter. It wasn’t until months later that I came to mourn the birth we didn’t have.
Our beautiful Eleanor was born after 52 hours of labor and 2.5 hours of pushing. Although I wanted her to find the breast herself with the birth crawl, the well-meaning nurse forced my nipple into Eleanor’s mouth and we had her first latch. At the time, I wasn’t considering the importance of the first latch via birth crawl that we didn’t get, because Matt and I were both just so in love with our new family member we couldn’t think of anything else. However, we soon came to notice more and more people in the room and the doctor was calling out, “It’s been 31 minutes since Eleanor was born” and I knew something was wrong. Suddenly, they took Eleanor away from me and gave her to Matt and forced our photographer to leave the room. There must have been 15 people in the room. My placenta wasn’t being born. After the doctor did a manual extraction, there was suddenly a high risk OB present and they were preparing the table for a procedure to remove any remaining placenta from the uterus. After the procedure (I still did not have control of my legs and wouldn’t have full control for several hours), the doctors stitched up the grade 2 laceration and people began to leave the room and I was able to again hold Eleanor. Falling deeper and deeper in love, I breastfed her what felt like constantly and my nipples became so painful. When I asked the nurse in our room about the nipple pain she handed me a bag of nipple shields but didn’t instruct me on how to use them. When the lactation consultant came to our room to assess our breastfeeding, she commented that I was breastfeeding great and the latch looked good but gave me some tips on positioning. I thought the pain was normal.
After we returned home, my nipples became damaged and bleeding. I saw the IBCLC at our pediatrician’s office and she commented that the pain is normal at first and that it would get better. Eleanor was not gaining weight as quickly as the doctor wanted, and they asked us to come back over the weekend to weigh her and ensure she was gaining appropriately because my milk hadn’t fully come in yet at 3 days. I wasn’t worried because I read it could take up to 5 days for my milk to come in. At 5 days it seemed my milk had come in, we weighed her at the Ped’s office and she was gaining slowly, but it was enough that it didn’t worry the doctor. She was nursing around the clock, which I knew was normal, but I began to dread when she started to show signs of hunger, which was frequently, as the pain was intense when she latched and nursed. When she was 9 days old I told Matt that I wanted to get out of the house and have Amanda Ogden, IBCLC, give me tips for my nipple pain at breastfeeding group at The Mama’hood. When I arrived at group, Amanda approached me and asked what was going on. I told her about my nipple pain and showed her my nipples and she said, “poor mama.” Then she asked to see Eleanor nurse. I latched Eleanor with 8/10 pain, she began nursing, and then Amanda said something I will never forget: “I don’t think she’s getting any milk.” She asked me to perform a breast compression and there was no change with how she was nursing. She then asked me to weigh her, which indicated that she had gotten the equivalent of a few swallows. After asking a few questions, Amanda deduced that I may have some retained placenta from when I gave birth. She quickly wrote a list of interventions out, as she still had group to lead. It was at this point that Eleanor had her first and only bottle of formula. Again, I felt failure. I thought to myself, she’s not supposed to have a bottle for 4 weeks, she’s only 9 days old, I don’t even know how to bottle-feed. Amanda assured me that it would be okay but Eleanor needed to eat. She went and found Matt and quickly went over the list of interventions with him which included calling our OB and making an appointment for an ultrasound, renting a hospital grade breast pump, and getting a prescription for donor milk from our pediatrician who just so happened to be at The Mama’hood that day.
Matt and I were overwhelmed and shocked. I thought everything was going fine and I was just going to group for some tips on how to treat my nipple pain. That afternoon we went to the milk bank and spent several hundred dollars on donor milk and made an appointment for the next day to see my OB. That night I pumped for the first time and started giving Eleanor bottles of donor milk and the small amount of milk that I was pumping in addition to nursing. The next morning we went to our OB’s office where he performed an ultrasound and determined that there were 100ccs of placenta retained in my uterus and yes, this was impacting my milk production. If your placenta is retained, your body doesn’t fully release prolactin, which is responsible for milk production. A dilation and currettage was scheduled for that night at Swedish Hospital to remove the remaining placenta. I was frightened but determined and fortunately the surgery was a success. Dr. Michael Hall is a skilled surgeon who removed the adhered placenta from the uterine wall without rupturing it. After the surgery, I nursed and pumped to increase my supply and Eleanor began to gain weight really well.
Over time I eliminated bottle feedings and only nursed because I had built up my supply and now had an oversupply problem. Eleanor was getting the milk very easily from my breast due to oversupply so the other barrier to breastfeeding wasn’t apparent until she was 3 months old. I was still having pain with her latching in my left breast. I was still going to breastfeeding group regularly and I asked Amanda about the pain and also the creasing of the nipple after Eleanor nursed. I asked her to assess her for tongue-tie. What she discovered was not only did Eleanor have a significant posterior tongue-tie, but she also had a high palate and lip-tie. These elements were making it difficult for her to adequately compress the nipple and express milk. Because I nursed on demand and nursed frequently, my supply was not impacted. Because of the pain and risk for late onset decreased milk supply, Amanda referred us to Dr. Jesse Witkoff. Dr. Jesse evaluated Eleanor and she had a laser frenectomy of her lip and tongue-tie. The procedures were ultimately successful, and within 2 weeks Eleanor had relearned to use her tongue and the pain had improved. Nursing is now much less challenging and much more enjoyable.
Although we faced many obstacles, I have loved breastfeeding Eleanor. When I look into those beautiful eyes and know that I am feeding her the way nature intended and am forming a beautiful bond it shows me that everything my family has been through has been well worth it.
I don’t think that our experiences are typical but I hope anyone reading this can learn from what we have gone through and that we ultimately persevered. I would not be breastfeeding Eleanor today if it weren’t for the support of my loving husband, Matt. He stood by me every step of the way and supported me and our goals of breastfeeding Eleanor despite many obstacles. I also could not have made it this far without the loving guidance of our doula and friend, Sara Krafft, and the wonderful and knowledgeable IBCLCs at The Mama’hood, specifically, Amanda Ogden. If it weren’t for her expertise and instinct, I would likely not be breastfeeding Eleanor now and I may have faced other medical complications due to the retained placenta.
I have learned an immense amount over the last year and have become even more passionate about breastfeeding. I would advise other soon to be mothers who are interested in breastfeeding to go to a breastfeeding support group while you are still pregnant and/or take a breastfeeding course so you are prepared and learn what “normal” is. There is so much bad information from well-meaning people out there so find a lactation professional you can trust. You may learn that there is a wide range of obstacles you may encounter in those first few months but they are not insurmountable and maternal persistence is the key to success. Most importantly, seek help at the first sign that something doesn’t seem right and hang in there, it can be challenging but with support and time it DOES get easier.
Matt's story: Understanding the lifelong benefits of breastfeeding, and knowing how important it was to Amanda, and our family, I was intent on doing everything I could to support Amanda’s breastfeeding relationship with Eleanor. When Eleanor latched just minutes after she was born, I naively thought that it was going to be a smooth ride. Little did I know that in the weeks to come we would be making countless trips to our local breastfeeding support group, we would visit a breast milk bank in order to ensure Eleanor had the milk necessary to gain the appropriate amount of weight, that Amanda would undergo a dilation and curettage (D&C) procedure to remove remaining placenta that was hindering her full milk production, and that I would watch my 12 week old baby undergo a frenectomy to resolve both a lip and tongue tie that were inhibiting her from maintaining an effective latch. Those first few months were anything but smooth, and our family faced challenges that we knew little about, but we were determined.
With these setbacks thrown at us all at once, I found myself thrust into what I initially assumed would be a two-person breastfeeding relationship between mother and daughter. I quickly realized that in order to make it work, I needed to take a much more active role in supporting Amanda and Eleanor. Words of encouragement and a hands-off approach were no longer sufficient. Instead, it meant that I would have to take time away from work to be there while Dr. Jesse, our pediatric dentist, clipped Eleanor's tongue and lip ties, it required me to care for Eleanor while Amanda underwent surgery and took medication that was incompatible with breast feeding, and it required financial sacrifices by our family to ensure that Eleanor received donor milk while Amanda was recovering from surgery.
As Eleanor approaches her first birthday and I look back on the breastfeeding adversity that she and Amanda faced (and to some extent are still facing today), I am confident that we made the right decisions at every turn. I am also certain that the steps I took to support Amanda and Eleanor were minor compared to what they went through, but at the same time, I now know that a successful breastfeeding relationship does not only include mother and daughter. Although it may be limited, I strongly believe that a father plays an important, albeit indirect, role in this important relationship.