by Dr. Erin Teeple
I had no idea that breastfeeding would be important to me. But as a well-educated, prepared pregnant woman, I dutifully signed up for a breastfeeding class. During the class, the lactation consultant talked about latching, suckling, and nipple pain as I took feverish notes. Then she showed a video that would become more educational than any of the words she had spoken. The video was of a baby’s initial latch just moments after being born with eyes still closed, lanugo and vernix still coating the infant, rooting for the areola. And, much to my surprise, I began to cry. Now, I am not a “crier.” In fact, I was mortified and afterward sent the lactation consultant an apologetic email. My husband was nearly giddy because I had “emoted.” And the worst part was that I could not figure out why I had cried nor why I had such a strong emotional response to this image. But I at least had figured out that breastfeeding my child was viscerally important to me and that I was committed to making it work.
Then I had a late pre-term baby. Molly was born at 36 weeks and four days after a precipitous delivery that lasted less than four hours from spontaneous rupture of membranes at home to delivery. As a surgeon, I am a plan-a-holic. I was definitely thrown off by the premature delivery of my daughter as well as by her complete disregard of my “birth plan.” And then, in the fog of trying to understand what had just happened, we had to learn to breastfeed. Because she was pre-term, a friend of mine, a neonatologist, was asked to attend the delivery to assess my daughter. When she asked about breastfeeding and I stated that my daughter had already latched in the delivery room, just like that beautiful video, she spoke words that resonated in my head like a bell ringing: “Be careful of these late pre-termers. They can be tricky.”
This powerful statement, along with a series of other fortuitous but seemingly random events, have led to our breastfeeding success. There was no clear cut path or plan from the beginning as to how we would succeed. And I know that if I did not have such tremendous resources, including a supportive partner, well-educated and experienced friends, and the financial resources to consult with a lactation expert, we would not be a breastfeeding success story today. There were many times we could have been derailed but were able to serendipitously find our path.
As I stated, Molly initially latched in the delivery room. And in the haze of worrying about her sugars and temperature as she was observed in the late pre-term nursery, I would wheel her back to my room every two hours to nurse. Then I would bring her back after our half-hour visitation was up. The next resonant moment was when the post-partum nurse asked me if I had begun pumping, as this was a new recommendation for late-preterm infants. She ordered a pump for me and I was shown by the nursing technician how to put the pieces together and how to use the machine to express milk. Although the utility or long-term outlook for my friend, the pump, had not been discussed, it was a fairly straightforward process. In the meantime I was trying to wrap my head around what exactly had just happened and the fact that now I was no longer pregnant but had a baby. Although obvious, this was a fact I felt wholly unprepared for. The initial lactation consultant who saw me in the hospital missed a feeding but said everything sounded great when I described a typical feed. I felt comforted by these words and also by the fact that the nurses were keeping excellent records of wet and soiled diapers and no one seemed to be alarmed. Although Molly continued to lose weight, I was assured this was on the spectrum of normal. The following day (which was our day of discharge), Molly was jaundiced and would need to go home with a bili blanket. As we were waiting for the home supply company to deliver this blanket, a different lactation consultant was able to observe a feeding. She told me that, in fact, everything was not fine. Molly was not latching well and was not transferring milk, so we would need to supplement with formula, as I was not pumping enough to sustain her. The plan that we were released with was to attempt nursing for 15 minutes each side, syringe feed her my expressed milk followed by formula, increasing the total volume daily. Then I would pump for the next feed. We were to follow up with the pediatrician two days after discharge for a bilirubin and a weight check.
When were arrived home, my husband and I dutifully followed the plan. We desperately wanted her to gain weight, so we fed her every two hours. The problem was that her feeding regimen took anywhere from an hour to an hour and a half. Then we would feed again. She was constantly sleeping, as jaundiced pre-term infants will do, so trying to keep her engaged for over an hour was challenging.
Although I had a short-term plan for how to feed my baby, I did not have my plan for how I was to make our breastfeeding relationship work, so I emailed the initial lactation consultant that I had cried with. She was kind enough to come to my home three days after Molly was born and look at her latch. She agreed that her latch was poor and recommended I purchase a nipple shield. She described what it looked like and how I would use it and recommended the size I should buy. She said I should get it immediately, as it may have a vast effect on Molly’s ability to glean milk from my breast. She also recommended that I begin taking fenugreek and blessed thistle and drinking mother’s milk tea.
My husband and I tackled these tasks as if they carried the importance of curing cancer or landing a man on the moon. We gathered all our things and drove the three of us to Target and the Vitamin Shoppe, which was no easy feat during those early days of shell-shock, hormonal imbalance, and exhaustion. We began to use the nipple shield and saw a visible difference in latching. I wasn’t sure what the next step would be but was simply happy that she was latching.
Again, fortuitously, the same friend who had warned me about the late-preterm nursers emailed to check in on our breastfeeding progress. I explained through tear-filled eyes about our struggles with latching, weight-gain, jaundice, and somnolence. She promptly recommended a breastfeeding support group that she had found useful. Although I did not want to venture out yet again given all the pediatrician visits and lab testing we had done, I was desperate to find a way to make breastfeeding sustainable. It was at this support group that I started to feel like our struggles were part of a normal process. For the first time in eight days, as I looked around at all the mommies who had similar stories but who were now thriving in their breastfeeding relationships, I was hopeful.
A few days later I met a fourth lactation consultant as recommended by our pediatrician. This is when were introduced to the supplemental nursing system, which is a small feeding tube attached to a syringe of formula that would be snaked under the breast shield to allow Molly to think she was getting all her nutrition straight from the breast. She also recommended that I hand express during nursing. This, unfortunately, made the feeding process even more untenable, as I could no longer do it myself and needed my husband to push the syringe as I nursed Molly. It was cumbersome and messy and felt ridiculously onerous. If this was what our breastfeeding relationship would look like, it would not be sustainable.
Two days later we met our fifth and final lactation consultant. We explained to Katie the different techniques we had tried. I told her we were syringe feeding to avoid nipple confusion. I told her that we were using a nipple shield. I told her about the supplemental nursing system, hand expression, and herbal supplements. After we rehashed our journeys of the previous 11 days, she asked me: “What are your breastfeeding goals?” And with this simple question she put me, the mother, back in the equation. She recognized that breastfeeding is not just about feeding the child, but about working within the confines of the mother as well. Each mother has different acceptable thresholds of desire and execution of breastfeeding practice. She let me know it was okay to not do every last thing possible to be able to breastfeed my daughter if that wasn’t going to work for our family. She explained to me how my milk would be stimulated and sustained. She explained that Molly was too sleepy and scrawny to latch and that in order to make progress in our breastfeeding relationship she would have to gain weight and become more alert by taking formula. We then came up with a hard and fast plan to give ourselves the best chance at breastfeeding success. I felt relieved and, once again, hopeful.
We met with her twice weekly: once in an office visit and once at support group. For our own sanity, we abandoned the supplemental nursing system and bottle fed Molly with supplemental formula. We limited her attempt at suckling on the breast to make the whole feed time around 45 minutes. Molly cleared her jaundice and the bili blanket was returned. She began gaining weight and becoming less somnolent. Ultimately, at three and a half weeks, we took a transfer weight and I learned that my daughter was getting enough milk from my breasts alone! I cried with pride and joy. Because our previous difficulties had robbed me of my confidence, I did not trust this transfer until she consistently gained weight without supplementation as checked at our visits. She eventually weaned off the nipple shield at five weeks old, just before I returned to work. Again, I was so proud I sent my husband a picture of Molly nursing and asked him if he could tell what was missing.
Now, Molly is exclusively breastfed and, at four months of age, weighs 13 pounds. I am so proud of what we have accomplished. When I took the initial breastfeeding class, I did not know why I was so moved. Now I know that seeing the video highlighted the inherent physiologic ability of mothers to feed our children from ourselves just as we do while we are pregnant. It is an extension of the nurturing that I can offer as a mother. It is a special relationship that only my daughter and I share. I am so grateful to the people who entered our lives and made this accomplishment successful for us.