by Kasey Stacey
My breastfeeding story is a story with a long, winding plot. It’s a story with some intense internal conflict and self-discovery. Mostly, though, my breastfeeding story is a story of relationships—with my son, of course, but also with my husband, with myself, with a kickass lactation consultant, with a group of supportive women, and, begrudgingly, with my breast pump.
From well before I was married or pregnant, I had known that I would breastfeed my children. It is what the women in my community do, it is the best source of food for a baby, it is the ideal way to initiate bonding between mother and child, and it is what my breasts were made for. It was simple and clear and it would be easy. I would breastfeed my children just as all my friends and acquaintances do.
I took Katie’s prenatal breastfeeding class at The Birth Center, but other than that, I didn’t do anything to prepare to breastfeed. Reproductively speaking, my body had always done exactly what it was supposed to do. I had no difficulties getting pregnant, I had a low-risk, relatively easy pregnancy, and I had wonderful natural birth more or less according to my birth plan. I’ve always seen breastfeeding as a natural extension of having a baby, so I assumed that I’d be able to nurse my baby right after birth with no problem.
After he was born, Vincent was really sleepy. I hadn’t slept much in the days preceding my labor, so I was exhausted, too. Vincent didn’t latch right away, so we decided to let my husband hold him skin-to-skin while the midwife stitched me up from the birth. We tried intermittently during the post-partum stay at The Birth Center to get Vincent to nurse, but he kept falling asleep at my breast. I was too tired to push the issue, and I thought that he and I would both be more interested in the process after we got some much needed rest. Peggy, the post-partum nurse, tried to help Vincent to latch on, but he had his own agenda. My husband and I took Vincent home after a few pathetic half-latches, hoping that he’d fare better once we were settled in.
Those first days at home are a bit of a blur now, but they were filled with failed attempts to get my son to nurse followed by my husband helping me to hand express whatever colostrum we could get and spoon-feeding Vincent. Every three hours, we would try again, and after a while I began to add a pumping session after hand expressing because I wanted to be sure that my milk would come in. Peggy came to do our home visit a couple days after delivery, so we once again worked on Vincent’s latch, but we were largely unsuccessful. Peggy assured me that she’d get into contact with Katie and that we would figure out and fix the problem.
I called the midwives to check in each day after delivery, and they said that they’d e-mail Katie on my behalf, as well. In desperation, I also sent Katie what would be the first of many ranting, frustrated, scared e-mails, begging for help with breastfeeding. Meanwhile, my husband had arranged an appointment for me with the lactation consultant at our son’s pediatrician’s office.
As it turns out, Katie was violently ill the weekend my son was born. (She likes to tell the story of how she dragged herself out bed, shoving her face full of Immodium, to take her IBCLC recertification exam that weekend.) She responded to my e-mail a couple days later and we set up an appointment to “put breastfeeding back together.” I can’t express the relief and reassurance I felt when Katie responded to my e-mail. I had been devastated, convinced that I had ruined my chances at breastfeeding because when my milk transitioned from colostrum, I had started bottle-feeding Vincent what I pumped. Katie gave me confidence that we’d be able to save the nursing relationship that I so desperately wanted and had previously thought I’d have no problem developing with my son.
When I met with Katie, Vincent had finally latched, albeit with a nipple shield. I had met with the other lactation consultant, and she instructed me to do my best to nurse Vincent without the shield, but I was hesitant. I had an abundance of milk and Vincent was eating like a champ. I felt that Vincent and I had finally made progress with nursing and she wanted me to start from scratch. I was five days post-partum, more exhausted than I have ever been in my life, and I just wanted to continue successfully feeding my son. I was starting to develop some nipple pain, but whatever. My son was nursing and life was getting better.
I’m so, so glad that I didn’t cancel my appointment with Katie. Although Katie also encouraged me to ditch the nipple shield, her approach was entirely different. Katie explained that the nipple shield being too small was causing the pain that had developed; unfortunately, I was using the biggest nipple shield available, so the pain wouldn’t get better as long as I was using the shield. However, Katie let it be my choice to wean from the shield. I felt that we were coming up with a breastfeeding plan together. Katie also noticed that Vincent was taking a rather shallow latch, so she gave me some tips for getting him to take a wider, deeper latch that would be more comfortable for me. At the end of our appointment, Katie encouraged me to attend the Friday breastfeeding support group at The Birth Center and above all else, this may have been the best advice that Katie has ever given to me. The group has been my source of solace and comfort when breastfeeding has gotten really difficult as well as my source of camaraderie and friendship when breastfeeding is going really well.
I almost didn’t go back after my first support group. Breastfeeding was going well and I felt terribly out of place. All these women had real problems, but at two weeks post-partum, I felt that I had gotten the hang of breastfeeding. My son was gaining weight beautifully, and although I had some nipple pain, it wasn’t anything that I couldn’t handle. I didn’t have breastfeeding problems and I didn’t think I needed support. Most of the other women in the room that week were dealing with low supply issues, and I was making enough milk for twins. I had no idea that low milk supply was such a prevalent problem. It was after this group that my paranoia about my own milk supply began. If all of these women struggled to make enough milk for their babies, could that happen to me? What if I woke up one morning and my milk had suddenly dried up? I feared that everything I had dreamed of for nurturing and nourishing my son for at least the first year of his life could suddenly be taken from me. I knew then and I know now that the fear is irrational, but I still can’t quite shake it.
I kept going to support group because I like being at The Birth Center. My life changed irrevocably when I delivered my son there, and I didn’t want to let go of that experience and the people who were a part of it. After a couple weeks, though, breastfeeding had suddenly gotten really difficult and I found myself needing Katie’s support and the support of the other women in the room. Even if no one else was experiencing my particular issue, they had had struggles, too. When I saw women with older babies, women who had overcome any number of problems and who really had gotten the hang of breastfeeding, I felt relief. There was clarity and enjoyment and peace of mind on the other side of this hardship.
A bit of nipple soreness turned into excruciating pain. At three weeks post-partum, I had intense vasospasms. By week four, I thought my son was trying to chew my nipples off. I was sitting in the upper room at The Birth Center at new moms’ group one Wednesday when Katie came into the room to microwave her coffee. She casually asked how I was doing and I could only shake my head “no.”
“I have holes on the sides of my nipples. Holes. I just don’t even know,” I told her. Katie looked at them and asked me to schedule an appointment with her. The damage was bad, she concluded, but I could overcome it. She gave me breast shells to wear around the house between nursing sessions, which would allow air to get to the nipples to speed the healing process. This would make the vasospasms worse, but vasospasms were now the least of my concerns.
Weeks passed and my nipples were only getting worse. Every time they’d begin to heal, Vincent would pull the wounds back open again when he nursed. His latch was still terribly shallow and he acted like a puppy playing tug-of-war with my nipples as he nursed. Katie had suggested pumping for a little while to give my nipples a rest, but no part of me was interested in that. Despite the pain, I loved breastfeeding. I loved spending that time with my son, providing for his needs, and being his source of comfort. The thought of not having that relationship with Vincent, even if only for a short time, was heartbreaking. Also, I’m extremely lazy. As I told Katie, it’s way easier to breastfeed than to pump. I’d much rather clench my teeth and suffer through each nursing session than deal with an endless cycle of pumping, washing and sanitizing pump parts, feeding the baby pumped milk, washing and sanitizing bottles… No thanks.
I remember the night I decided to follow Katie’s suggestion to pump, when my son was about seven weeks old. Vincent’s latch was more painful than ever, and for the first time, I cried out in pain. I sent Katie another of my crazy-lady 1:00 am e-mails asking her to help me come up with a pumping plan. I would pump some and nurse some, to see if those longer stretches without Vincent tearing up my nipples would allow healing to begin. This way, Vincent and I would still get to maintain our nursing relationship.
It didn’t work. Despite the longer stretches between nursing sessions, the holes on my nipples were still getting wider and deeper. I was at moms’ group again when my right nipple bled for the first time. I knocked on Katie’s office door to show her the damage and we quickly came up with a plan. I would cease nursing on the right side altogether, pumping instead. I would nurse Vincent on the left and bottle-feed when I would have normally fed him on the right breast. Once the right side was healed, I would reverse the plan, feeding on the right and pumping on the left.
I thought that it would take maybe a week to heal each nipple, but no. The hole on the right side was deep and since it had to heal from the inside out, it took a while to completely scar over. Meanwhile, the left side was still getting worse. Desperate to heal and feeling defeated, I decided to primarily pump both sides. I would nurse only twice a day, just so that Vincent remembered how to eat from my breasts. I pumped both sides eight times a day, including in the middle of the night. My son was sleeping through the night, but I was setting alarms and getting out of bed to pump. Paranoid about my milk supply, I would pump until my milk stopped flowing and then let the pump run for an additional five minutes in order to stimulate a second let-down.
I was miserable. I wasn’t getting much sleep; it was like the first two weeks post-partum all over again. I was spending four hours each day hooked up to my pump and then additional time washing and sanitizing the parts. Since we were barely nursing, I felt disconnected from my son. I had rather suddenly taken away his primary source of comfort, and he began having periods of fussiness and I didn’t know how to soothe him. I was devastated and exhausted and I wasn’t sure if this was ever going to end. My nipples were finally healing, but much more slowly than I had anticipated.
I hated that damned pump. It took over my life. I couldn’t leave my home without worrying about when I’d have to pump next, how I’d manage to pump in some strange location, how many bottles to bring, and how long it would be until the pumped milk spoiled. I certainly couldn’t go out without bringing my husband, my mom, or my sister with me so that someone could hold the baby while I pumped. My days were structured around pumping and washing and agonizing over quantities of milk. I wanted to crawl into a dark hole and, if not die, at least get a solid stretch of sleep before reemerging. But I’m grateful for my pump. I love my pump. I am fortunate to have a high quality double electric pump. Twice now, the pump has saved my ability to breastfeed my son, and for that, I am thankful.
While working through the nipple pain, Katie and I tried to figure out the cause of the trauma. Katie’s theory was that I had a ton of milk, causing Vincent to take a shallow latch in order to regulate the amount of milk he was getting when he nursed. Additionally, I had had flat nipples with adhesions, so early on, Vincent had pulled out my nipples and they had sort of split on the sides, causing the holes to develop. Because his latch was so shallow, the tears could never heal; nursing was causing constant friction on the site of the trauma. The new goal, then, was to teach Vincent to take more of my breast when he latched so that I wouldn’t have a resurgence of damage after the original wounds had healed. I tried, but he wouldn’t do it.
When Vincent was nine weeks old, Katie asked to check the anatomy of Vincent’s mouth again. She had checked it at our first appointment because when he was born, the midwife said that he had a posterior tongue-tie—very slight, nothing to worry about, we all thought. At support group that week, one of the other moms also happened to be a speech-language pathologist who worked with babies in the NICU who had trouble latching. After Katie examined Vincent’s mouth, she asked this woman to take a look. The SLP found that Vincent had little lateral motion of his tongue due to the posterior tie. Katie referred me to a pediatric otolaryngologist, so I took Vincent to have his tongue-tie evaluated early the following week.
When I reported that Vincent tended to tuck in his upper lip when he latched, the ENT recommended not only a frenotomy of the tongue, but also of the upper lip. He couldn’t promise that these procedures would fix breastfeeding, but it would at least give Vincent the proper anatomy to do what we had tried to make him do all along.
A few weeks after the frenotomy, I begged Katie to tell me that I could wean myself from the pump. I was pretty well healed on both sides, Vincent had the ability to latch better, and I needed some normality in my life. Once I offered Vincent the breast more often, he decided that he was done with bottles, so we have returned to our former nursing relationship. For the first time, nursing is comfortable more often than it is uncomfortable. I can’t say that we won’t have more hiccups in the future, but I’m feeling pretty good about breastfeeding these days.
Katie has been a Godsend. I was determined to make breastfeeding work, but without Katie, I don’t know how I would have been able to do that. Katie’s ability to evaluate my situation and help me to make plans to improve it has been invaluable. One thing I value most about Katie, though, is that she doesn’t demand. She doesn’t come up with plans and insist that they are followed. Katie listens, draws on her experience to assess, and makes suggestions. Every path that I have taken on this breastfeeding journey has been my decision. Katie is part friend, part mentor, and part therapist, and I am blessed to have her in my life. I think I’ll continue to send her e-mails at one o’clock in the morning just to say, “Hey. Everything’s going great. Thank you.”
My breastfeeding story wouldn’t be complete without mentioning my husband, Mike. At support group, we occasionally talk about how husbands don’t always “get” breastfeeding. They’re supportive, but they sometimes say things that are inadvertently more hurtful than helpful. And how can we expect them to “get” it? Breastfeeding is something that fathers will never do. I’m fortunate, though. My husband is not only supportive of breastfeeding because it’s good for the baby, but he understands how important breastfeeding is to me. In those first few days, he fought for my ability to breastfeed when I was too out of sorts to do it myself. He scheduled and drove me to appointments, he hand expressed my colostrum, and he made sure that both the baby and I were awake to nurse every three hours. He sympathizes with how difficult pumping is, he empathizes in my hatred of the pump, and he values the relationship that I’m able to develop with our son. He celebrates my breastfeeding victories and he struggles when I encounter challenges. He recently asked me if breastfeeding still hurts. I saw the glint in his eye when I told him that it doesn’t really. I love that he can be excited for me, even though he can’t directly experience breastfeeding.
As I continue to breastfeed instead of pump, I can no longer see how much milk I’m making, so I’m learning to trust my body; I grew this baby and I have the ability to make plenty of milk to feed him. I’m blessed to be able to do so and while I never want to take it for granted, I know that I need to let go of my irrational fears.
I’m growing into my role as a mother, and breastfeeding has been a vital part of that growth. I’ve never known a love like the love I feel for my son. I love the connection that we have. I love when he stares into my eyes while he’s eating, when he looks up at me and smiles. I love when he’s nursing and he wraps his little arms around my breasts, almost as if he’s guarding them. I love when he falls asleep at the breast; in my arms, he feels safe and comfortable. I will be so sad when the inevitable day comes that Vincent weans. Through breastfeeding, I’m learning the true meaning of sacrifice. Motherhood requires complete self-sacrifice. During pregnancy I sacrificed my body to grow my son in my womb and now I sacrifice my body to feed him. As he grows, he’ll need my physical sacrifices less and less, but his needs and well-being will always come ahead of my own.
Love is sacrificial, breastfeeding is sacrificial, and I am so thankful that I’ve been able to begin my journey through motherhood by nursing my son.
Katie’s Notes Kasey’s Story
By Katie Madden
Kasey is right. Breastfeeding is sacrificial. Breastfeeding means being willing to give of yourself completely to another person whom you have just met, but you feel like you have know all your life.
Here’s what I know about Kasey. Kasey is one of the most stubborn, determined, and selfless women I have not only worked with, but known. I have seen some seriously jacked up nipples in my ten years of helping women breastfeed, but Kasey’s rank in the top five. They were bad. There are a few specific memories I have of Kasey that I will never forget; memories that will forever remind me that when a woman gives her one hundred percent to breastfeeding, I give my hundred percent, too.
Kasey has always loved breastfeeding.
At support group, I often ask the question, “Who loves breastfeeding?” to prove the point that very few women with babies younger than 12 weeks love breastfeeding. Some hate it, some endure it, some like it sometimes. But, oftentimes, it isn’t until 10-12 weeks that a woman falls in love with breastfeeding. So, I asked this question of the group and Kasey was one of three women in a room of more than 20 who raised her hand. Now, I can’t remember what horrific stage of breastfeeding she was in, but Kasey was at some point of enduring the pain of what she calls “holes” in her nipples. They were like canker sores, one on each nipple. But, despite that pain, she never stopped loving breastfeeding.
Kasey always told me the truth about what she was and was not willing to do.
Kasey knows herself really well and she owns who she is. She let me know she is lazy and wasn’t all that interested in pumping to heal her nipple canker sores. Eventually, the pain got so bad that she had no other choice. The fact that she had told me that she was “lazy” (I beg to differ, by the way), helped me to really empathize with her as she struggled through pumping and bottle-feeding. We were able to tweak breastfeeding plans together nearly weekly because she would tell me what was working and what wasn’t. She was transparent and honest, not a martyr following instructions simply because I told her to.
Kasey is forgiving and understanding of the process.
I practically sat up in bed one night and realized Vinny had a posterior tongue-tie and possible upper lip tie. I thought about Kasey’s nipples a lot. That sounds really weird, but cases like hers haunt me until they are solved. I believe deep down in my soul that severe nipple pain and trauma is never normal in breastfeeding. Kasey had been pumping for weeks at this point and the time was approaching that we would re-introduce Vinny to the breast and I was petrified that the wounds would just reopen. Sure, my adhesions theory made sense, but it wasn’t enough for me. There had to be another reason why Kasey’s nipples were so badly damaged.
So, the next day, I looked at Vinny’s mouth again. Posterior tongue-ties are tricky, as are upper lip ties. It has been only in the past few months that I have found a physician I really trusted to refer these cases to. As a nurse first, I will admit I am apprehensive to refer a baby to have a release of a posterior tongue-tie or upper lip tie without a compelling reason. It is a relatively new elective procedure and although there is little risk involved, it can be upsetting to mom and baby. It isn’t a quick fix and often the breastfeeding issue is multifaceted.
I missed Vinny’s tongue-tie. I waited too long. I am frustrated knowing that if I had acted just a little sooner, I could have saved Kasey even a little of the pain and trauma she endured. Maybe. Maybe not, since there were other factors at work, but I am not ashamed to say I made a mistake. I am not too proud. Every mama and baby teaches me something new about breastfeeding and about myself.
Over the past few months, thanks to Kasey’s case and a few other key cases, I am much quicker to refer a baby to have his mouth evaluated if I suspect there is limited range of motion in his tongue or upper lip. The results have been really great. So, although Kasey endured way too many weeks of discomfort, she has paved the way for so many of the mothers I will see in the future.