Birth Nightmare -- Breastfeeding/Nutrition question (long) page

[ShannonPA-S]

It's been awhile since I've been here. Last time I was here, I was pregnant with my beautiful son. He is now 2.5 weeks old and things have not been easy.

To start out, I knew I was having an early c-section with him because I have a previous t-incision and the risk of uterine rupture is higher. I had an amniocentesis at 37w2d and surprise, lungs were NOT mature. So the c-section for the next day was rescheduled to 39 weeks. However, I had developed strange symptoms of itching, especially in my feet/hands and then everywhere. I went in to labor & delivery at 37w5d and my liver enzymes were skyrocketing. I was diagnosed with cholestasis of pregnancy. I had a c-section on Easter Sunday and (thank God) baby's lungs were okay. By day 2 post-op, my liver enzymes were back in range -- really the only treatment for cholestasis is delivery. No one knows why I developed it and my doctor can't believe it -- she's never had a patient with it.

Breastfeeding didn't start well. My son was severely tongue-tied and though he tried and tried, he lost a pound from his birth weight (from 7#13oz to 6#13oz). I started pumping like crazy and he started gaining. He's not quite to birth weight yet, but getting close. He had his tongue tie clipped, but then still didn't breastfeed well -- he was very, very sleepy. I kept trying, but he kept sleeping. I've seen several lactation consultants, but they are encouraging me to keep pumping until he is back at birth weight and that he will become more awake then.

HOWEVER -- 3 days after I got out of the hospital from the birth, I developed sudden onset shaking chills and fever of 104. I went to the ER and was promptly admitted. No one could find the source of infection, but I had bacteremia (proteus mirabilis). My urine, CT scan, incision, breasts were all clean and did not show infection. I was in the hospital for 5 days and got out a week ago. I have still been pumping and pumping. He has gotten a few bottles of formula, but mostly breast milk. I had to dump some because of some of the meds I was on in the hospital.

In any event, I am EXHAUSTED. I also just found out also that I have low serum protein, low albumin, and low immunoglobulins, which could explain why I came down with bacteremia of unknown etiology. I know those can be related to liver issues, which I clearly had at the end of pregnancy, but I don't know why it's still lingering. My hemoglobin is finally stable at 12.0, but ferritin is only 6. My thyroid is (thankfully) okay on 200 mcg of synthroid, but I am freezing all the time.

I do not want to give up in breastfeeding, but at what point am I a martyr? My husband is trying to be supportive, but for me to continue to get up and pump is literally exhausting in the face of my health issues (for which I have no answers right now). I have never felt so exhausted in my life. My doctor is also trying to be supportive, but is pushing formula at this point. I have talked to several lactation consultants, who say to keep pumping and giving bottles, but not trying to breastfeed at this point because he is still so sleepy and it takes forever to feed him...and then I still have to give bottles so my life revolves around feeding him. And nursing in bed isn't an option -- doesn't work at this point.

Also, does my nutrient deficiencies affect my milk? I keep wondering if I'm doing him and myself harm by giving him breastmilk from a mom who clearly has health issues. And am I doing both of us harm by continuing this even though I am beside myself with exhaustion? I really don't know what to do.

(And as a comparison, I pumped exclusively for 9 months for my daughter who would NOT latch despite heroic efforts by many lactation experts...so I am not one to give up...but I am wondering if I have the strength this time. And I feel like the most awful mom if I do give up. I know I have been through hell, but at what point do I throw in the towel? I know this is rhetorical and no one but me can answer it, so I don't even know what I'm asking.)

The major question is: Is my health issues harming the quality of my milk? Most things I have read say no, but my doctor, who wants me to give up says it could be harming the quality of the milk. My doctor believes I need to rest to get better, not get up and pump. She says I'm being stubborn because 99/100 moms would have stopped pumping in the hospital. I don't believe that, but I understand she's saying I have to take care of myself first. I just feel like I'd be a complete failure if I give up.

Any advice? Opinions? Sorry so long.

Thanks in advance,
Shannon

[jenn26point2]

I have no answers about the infection but can sympathize regarding the pumping and exhaustion and breastfeeding problems. I was never able to successfully breastfeed either of my kids and it depressed me terribly. I chose to pump and bottle feed for 6 weeks with my son and only 4 weeks with my daughter because it was nearly impossible to do it on a schedule once the second baby came along. I also had both of my kids via c-section.

If you fear your son is not getting adequate nutrition, it might be wise to supplement with formula but keep pumping to continue to build your supply while you work to get healthy again. However, breastfeeding is taxing on the body - like pregnancy - so if you're having energy issues, quitting one "process" might help ease the fatigue.

I think the question is what you want to do and what you feel right doing. There's no doubt that breastmilk is best for the wee one, but formula has come a long way too.

[Saoirse]

Is my health issues harming the quality of my milk?

yes, possibly. but it's still nutritionally superior to formula. formula only covers the bare-bones basics to keep a baby thriving. your baby will be better off on your breast milk (even with your health issues) than formula.

as far as how breastfeeding is effecting your stress levels, only you can really answer that. you've gone through a great deal of stress and your body does need to heal. one consideration is that your iron levels will improve faster if you're breastfeeding (Assuming it delays the start of your period) vs. not breastfeeding. also, once you're able to ditch the pump and bottle, nursing will be so much easier than bottlefeeding. breastfeeding will also probably be better for your health in the long-term. however, if you determine that nursing will be too much for you right now, PLEASE don't guilt trip yourself about it. you're making a difficult decision, and obviously you love your little one. either way, he will be okay.

[Pamsc]

What would happen if you pumped less often to get more sleep, and mixed the pumped milk with formula? Would your supply necessarily fade away completely? I had a big hungry baby who slept well. I would go to work for 6 hours and not pump at work, just come home really full and have her nurse on one side while I pumped the other. When she started sleeping through the night I would do the same in the morning. Can your husband do a nighttime bottle feeding?

[sunnysara]

Sorry to hear about your issues!

I would bet that your breast milk is still healthier than formula... Maybe you can commit to pumping for two more weeks to see how it goes & then re-evaluate? Baby is still so young to be getting formula (despite what your CW doctor thinks). You would have to get up at night anyway to give him a bottle, right? Maybe hubby can feed him pumped milk while you are pumping for the next feeding? (Pumping - especially waking up to do so in the middle of the night - is no fun! I have been there!)

Good luck! I bet he will stop being so sleepy soon & things will change quickly!

[Sabine]

Okay, first: don't worry. Whatever you decide, things will change, most likely for the better. I found the hardest thing in dealing with post-birth child and nursing experience was to keep the long term perspective. What is happening is SO important and immediate, that it is easy to lose sight of the fact that you are in a process: of recovering from the birth, from the surgery, from your complications, of adjusting to a second child, having fatigue and sleep issues. These are all things that will alter, so don't worry if you can't deal with all of them right now. Tomorrow may be a completely different day.

Second, congratulations for wanting to give your child the best you can. Whatever that turns out to be.

(My bias is pro-breastfeeding. I'll let you know that up front, so you know where I am coming from.)

From what you wrote, you don't seem to be having problems with the actual pumping, more that it is difficult to take the time for pumping AND bottle-feeding. Also, the milk quality question.

Knowing only what you have written about your doctor, I would say you might want to trust what you have researched yourself a little more. Many doctors are not educated on breastfeeding and breast milk. Do you know your doctor's background on this?

And, this might sound weird, but I think the phrasing of your sentence is very revealing. "My doctor, who wants me to give up says it could be harming the quality of the milk." (My emphasis.) Did the desire for you to give up come first, or milk quality questions?

What research has the doctor done to make him/her think the quality is bad? You might ask for the references as a non-confrontational way of checking what he/she has looked into. Say you want to get the situation clear in your mind (which you do). If he/she can't give you any references, well, that tells you something.

Also, if it has been 2 /2 weeks, what effects could be lingering? I am seriously doubtful. The meds from your infection stay should clear out pretty quickly. Have you seen the stuff they give women that they say is fine to nurse with? It would have to be something pretty amazing to be effecting you now, and if so, they should be able to cite it, chapter and verse. They don't mess around with the truly dangerous stuff. Since you didn't mention it, I'm assuming you didn't get anything too weird.

Practical considerations: do you have an electric or manual pump? Electrics can make it much easier and quicker. It will take just as much time to bottle-feed formula as breast milk, so if you aren't using an electric pump, try renting one. So worth it if you can reduce the extra pumping time. (Slightly risque-depending on your sensibilities- suggestion here: your husband can help you by suckling one breast while you pump the other. It makes the let-down much quicker. Most husbands are happy to do it. If you are deeply concerned about the milk quality, he could always spit it out. This of course, is given you decide you want to continue keeping up your supply for future nursing, regardless of whether the present milk supply is compromised.)

Is there a helper who can do the bottle-feeding for a few days to a week while you are recovering? All those people who say, 'call me if I can help,' they mean it. They would feel so useful to be useful to you.

Do you have any nursing friends who could nurse him a little to help with 'training' him? Sometimes a different breast configuration can help the little dickens to get it. And be giving him breastmilk as they do it. Then, by the time (and it may be just a few days) you feel your milk is a-ok, he'll have a better idea of what to do.

And lastly, remember your hormones. Talk it all out with calm people you trust. This can be a rough time emotionally, even without all the extra stuff you have going on.

Good luck to you, Shannon. The best decision is the one that is right for you and your family.

[activia]

there are some lacto-milk sharing groups. I would start researching them in your area and see if you can find a modern version of a "wet-nurse". Someone that can provide you with breastmilk so you have that as an alternative. I'm so sorry you are having it so rough

[spughy]

First off - congratulations on your new baby!

Now about the breastfeeding - yes, it's hard work, but pumping is harder. I really, really doubt that your milk is seriously deficient nutritionally, but pregnancy and breastfeeding do take a toll - which is WHY I doubt your milk is compromised, because your body is putting a lot of resources into your offspring. Your exhaustion is to some extent normal, but exacerbated by the major surgery you've had (don't kid yourself, a c-section IS major abdominal surgery) and the infection. These will resolve with time.

Your doctor is most likely pressuring you to stop breastfeeding because she's looking at just you as her patient, not you-and-your-baby, but your brain and your body are definitely treating you and your baby as a single entity at the moment and that's probably the most useful way of looking at the problem. You no doubt know the risks of formula - greater susceptibility to infection, compromised gut flora, unnatural growth patterns, etc. You also know how hard it is to pump, and your past experience with a poor latch doesn't give you any insight into how easy breastfeeding CAN be. At 2 1/2 weeks, your decision-making skills aren't at their strongest (no criticism intended here, I clearly remember some dubious decisions I made at that point!) and it's really, really hard to think through this sort of stuff clearly when all you really want to do is go to sleep and stay there for at least 15 hours.

Plus, you have another child who no doubt needs you, so you don't have the same luxury of time that you had when she was a baby. But at the same time, exhaustion and hormones can make things worse than they really are, and future-you might not be happy if you gave up without examining everything.

I would suggest, before you throw in the towel on the breastfeeding, that you get some really good help with the baby's latch AND look at why he's sleepy. As a breastfeeding counselor, I've seen a lot of babies (my own included) be lazy nursers simply because they were too warm. Don't crank the heat in your house, and nurse the baby in just a diaper. He's back to birth weight so should have no problem with temperature regulation. Also, don't wake the baby from a deep sleep and expect him to nurse well. Again, he's back to birth weight and can manage his own hunger.

If you're bottle-feeding, stop, and use a cup or something less convenient for him (best would be a supplemental nursing system, but that's probably too much fiddling for someone in your situation). Nurse first if you can, before you supplement with breastmilk or formula. Give him every opportunity to learn to breastfeed properly.

You're the only person who can give yourself "permission" to stop breastfeeding - that's not a role you want to hand off to anyone else, especially random internet people. If you stop, you need to KNOW it's the right decision so you're comfortable with it years from now. Ask yourself, at what point would I happily take any formula risks actually happening over doing this for one more day? If you get to a point when you say "I would rather deal with digestive issues/chronic ear infections when this kid is 3 than pump one more ounce or spend one more minute with a lactation consultant trying to get the little bugger latched" then it's probably time to stop. But only you will know when that is.

[Emseven]

It sounds as though trying to continue to breastfeed is really important to you, but you also might need to cut yourself some slack. I hereby grant you permission to do what you have to do in order to look after yourself. And a big hug. At 2.5 weeks, you're still in the black hole with a newborn, on top of all the rest. What's great is that it sounds as though you have a good support network around you.
Whatever you decide is right for you at this point will also be in the best interest of your little one. You're no good to him if you're not healthy.

Edited to add: But listen to the above poster (whose response wasn't there when I started writing mine) because she has some seriously good advice!

[EvansMom]

Oh my goodness! That is a lot to deal with. Whatever your choice is, don't guilt trip yourself! You have been through so much!!!!

If I were you I would hire in some help, even if it means charging it to a credit card. OR if you have a very supportive person around I would lean heavily on them. You need some support, please consider this!

Pump during the day, don't pump at night. Let everyone sleep as they will.

Your breastmilk *should* contain the same amount of nutrients no matter what your condition is, however advanced age and perhaps sickness will change it a little. Some supplementary formula will not harm anyone, and if it is your choice longterm don't feel guilty, just get well~~ However, IF he is gaining, it does not suggest to me that your milk is a problem at all! Babies who "fail to thrive" lose weight or are stable weight long-term, so irregardless of his sleepiness if he is gaining then I would just continue with your breastmilk during day and pumped milk or formula at night.

HUGS!