Breastfeeding And The Medical Profession, Part Two

By Tiffany Holley

Let me start by briefly reiterating what I explained in my previous post of medical escapades:

I appreciate my doctors. I appreciate the medical system that got me through a variety of health issues. They know a lot about what they were trained in…

…But they do not necessarily know anything about breastfeeding.

It makes me so sad to think of all the babies that lose out on this amazing food (and relationship!) because their mother took the inappropriate advice of an ignorant (on this subject) medical practitioner.

Let me tell you some more of what I went through to learn this lesson…

Sadly, the Emergency Room visit and hospital stay I talked about last time was not the end of my troubles.

Over the next few months I underwent two outpatient procedures to treat my (newly discovered) kidney stones. The machine uses sonic waves to break up the stones from outside the body, so there is no “surgery” involved.

The first time, the doctors fought me tooth and nail about my choice for anesthesia, or lack thereof. Since I am unable to pump (physiologically), their advice to pump and discard my milk for 24 hours after the procedure was simply not an option.

I talked to my La Leche League leader, and consulted my copy of Dr. Hale’s book, but all they could do was confirm that the medications in question were not recommended. Nobody was able to offer an alternative.

So I opted to have a spinal block, but no intravenous sedation.

Although I was warned that it would be painful, their primary concern seemed to be that the thumping noise of the machine was rather loud, and the experience might be traumatic. This seemed really strange, since obviously the medical personnel involved are all in the room with this noise – presumably several times a day!

Over the week between talking to the anesthesiologist and having the procedure, several people from the hospital called me, trying again to talk me into breastfeeding-incompatible sedation. It was exhausting!

In all those conversations, no alternatives were offered – and believe me, I asked everyone!

My choice was either to suffer and be traumatized, or give my baby formula for 24 hours, with the possible consequences to our nursing relationship. I would also risk engorgement and other consequences due to my inability to pump out the accumulated milk. And how would the medicine even get out in 24 hours, since I couldn’t pump enough to “flush it through”? Nobody had an answer.

As a concession to their concern about traumatic noise, I brought earplugs… And the staff in the treatment room all laughed that such a big issue had been made about it.

There were some challenges with the spinal that had me bleeding and in tears before the procedure even started, and it seemed clear would lead to a post-op “spinal headache” as well.

The noise was just annoying. I lay on the table and cried during the entire procedure, however, as the spinal immobilized my legs but “did not come up high enough” to numb the pain in my kidney area.

I managed to hold my torso still, but the doctor and technician still felt they could not work as aggressively as they would have if I was unconscious. There was already a plan for a second procedure, but this cast the unpleasant possibility of a third session being needed.

Later I learned that my husband had spent the whole time walking the halls with an inconsolable screaming baby. (The wild advice he got from passers-by, nurses and patients alike, is probably worthy of a post in itself!)

Having had only the spinal, I was able to nurse Mr. Big Baby in recovery, but it was quite a while before we were able to leave.

Needless to say, we were dreading a repeat. Medically, things made it necessary to go ahead, and we hoped that the two months in between would put the baby in a better place to cope with it.

We were much better cared for the second time, however. The anesthesiologist who happened to be there that day was actually the chief of pediatric anesthesiology for the hospital, and he was shocked when I told him what I wanted to do (and had done the previous time).

He explained that there were plenty of breastfeeding-compatible ways to sedate me! For starters, he would use the medications that they would give my child if he were the one going under anesthesia – that way if things did pass through to the milk, it would still be safe.

I was medicated, and the next thing I knew I was sitting in the recovery room with my husband and children coming around the corner.

It had gone much faster, and the baby was less upset. It had also been much more effective, as the doctor felt free to “pummel me” harder. I even got to go home sooner.

This procedure was the best of everything, for everyone. And, according to the anesthesiologist, the procedures he used were common knowledge.

So why did nobody offer those options to me the first time around? Even if they didn’t know what to do, why didn’t they ask someone when I pressed the issue?

I thought I had been diligent… I asked the doctors, nurses, and anesthesiologists for breastfeeding friendly options. I refused to take no for an answer. I stood up for my baby and our breastfeeding relationship.

But I still missed it.

I hope other moms can learn the “take away” lesson that I stumbled upon by chance. If I had it to do over again I would call an obstetric anesthesiologist and a pediatric anesthesiologist right off the bat!

If your health care provider says there is no safe option, it doesn’t mean there isn’t one – it only means they don’t know.

Have you had similar experiences with the healthcare profession not knowing about safe, breastfeeding-friendly alternatives? Please leave a comment on this post to share your experiences!

Tiffany Holley has nursed three children (currently 18 mos. – 15 years old) for a total of 8 years – and counting. She and her family live, breastfeed, urban homestead, cloth diaper, homeschool, and write in Southern Florida (but hope to remedy their location situation soon). You can read about their adventures on their blog, As For My House.

Breastfeeding And The Medical Profession – One Mom’s Story

By Tiffany Holley

I appreciate my doctors. I appreciate the medical system that got me through a variety of health issues. They know a lot about what they were trained in…

…But they do not necessarily know anything about breastfeeding.

It makes me so sad to think of all the babies that lose out on this amazing food (and relationship!) because their mother took the inappropriate advice of an ignorant (on this subject) medical practitioner.

Let me tell you what I went through to learn this lesson…

Towards the end of my pregnancy with Mr. Big Baby, I was under close observation for borderline pre-eclampsia. Somehow, still, we missed the fact that I was harboring a bladder infection – did you know they are often asymptomatic during pregnancy?

Untreated, this developed into a kidney infection (pyelonephritis).

When the baby was about five weeks old, I ended up in bed with raging chills and fever from the worsening infection. The next morning I woke up with a bright red, inflamed and streaked breast. I now also had mastitis.

The ER doctor told me I would have to stop nursing so that I could get myself well. Overwhelmed, tearful, I acknowledged that I had been afraid of that, and agreed.

Since I am physiologically unable to pump any meaningful amount of milk, his advice was not helpful: pump and discard my milk, and feed the baby from my frozen stash (of course I had none) or formula. I had already found someone in my LLL group who was willing to wet-nurse Mr. Big Baby if it came to that…

But still, I would be putting myself in danger of worsening the mastitis issues by becoming engorged, and jeopardizing our entire nursing relationship by potentially losing my milk supply.

After sitting there for hours, I had plenty of time to think through the issues more logically. Eventually I began asking to see my children, who were anxiously waiting outside.

Children are not allowed in the ER, period, they said. They have a separate pediatric ER area to treat children, so they keep them out of harm’s (germs’) way in the adult area. And I was not permitted to leave the treatment area because I had an IV placed.

Undeterred, I suggested that they could take me to the pediatric area, and allow me to have a treatment room there, with my family present (as we had all been together when my daughter had an ER visit).

Again I was rebuffed. I was told that my baby would be able to “visit” me once I was admitted and moved up to a regular floor. That would mean, then, the next day during visiting hours – probably some 24 hours of separation.

The more they came up with these reasons, which sounded more and more hollow, the more adamant I became.

Finally, I told the shift nursing supervisor (who had been called in to deal with my “unreasonableness”, I’m sure) that I wanted to sign myself out AMA, so that I could go nurse my baby.

She was shocked – or pretended to be – and asked how I could possibly want to leave without treatment when I was so ill.

I told her that the hospital was making me worse instead of better, and that I would go seek *better* treatment somewhere else.

Whether she gave in because she saw the light, or because she saw a potential lawsuit, I’ll never know… But give in she did.

They wheeled me and my IV pole out to a (relatively) quiet corner of the ER, and my son eagerly nursed – and nursed, and nursed, and nursed. It had been hours by then, which is an eternity if you are 5 weeks old.

One of her grumbled “threats” as she allowed this was that she was going to go get the lactation consultant from the OB department and “have her talk to me.”
My husband and I sat there wondering if it was really possible that they had a lactation consultant who had so totally sold out to the hospital machine that she would support them on this.

Nope.

The lactation consultant was a sensitive, wise, outgoing woman who was as shocked and baffled by the situation as I was. She became something of a liaison for us for the remainder of this ordeal.

Because there was more. Lots more.

Let me try to condense the next few days for you:

The ER staff eventually moved all of us into a big room in the back of the department to await transfer upstairs. Then the next shift came on and tried to kick my family out again.

We got transferred upstairs. The deal was that the baby could be with me as long as there was another adult(ish) present. I accepted this as a reasonable compromise – after all, I actually was too ill to care for him alone very much!

Then there was a shift change, and they tried to kick my family out.

Then a new doctor saw me, and told me that I needed to stop nursing on the affected breast. (Contradicting all medical literature and wisdom on the subject of mastitis).

Then a new shift came on, and they tried to kick my family out…

Since it was across a weekend, we had the same nursing staff only twice in five days (15 shifts). And, I kid you not, at every single shift change we had to argue the situation all over again.

Some went easier than others. Several times I called on our new best friend the lactation consultant.

I had a protracted argument with the infectious diseases doctor who was considered my primary caregiver. He knew nothing about mastitis, and treated it as he would have treated strep on my breast.

He was horrible, and rude, and I was ready to check out AMA again if I could not be assured that I could receive care from someone else.

On two other occasions I had to threaten to check out AMA to keep them from separating me from the baby. I spoke to several different nursing supervisors.

All of us were stressed out and exhausted by the time I was discharged. It was not good medicine.

Thus ends Round One of my adventures in the medical system.

Why do doctors and nurses know so little about breastfeeding?

It’s frightening that so many people are willing to take their word as law, trusting that these medical professionals know what is best for them.

I beg you, as the only advocate your child has, not to mention for yourself, investigate anything that you are told with regards to your nursing relationship.

As in this case – A simple internet search quickly yields dozens of creditable sources explaining that one important step in dealing with mastitis is to nurse frequently, especially on the affected side.

And if you have the opportunity, do a future mother and baby a favor: print it out and show it to your practitioner!

Tiffany Holley has nursed three children (currently 18 mos. – 15 years old) for a total of 8 years – and counting. She and her family live, breastfeed, urban homestead, cloth diaper, homeschool, and write in Southern Florida (but hope to remedy their location situation soon). You can read about their adventures on their blog, As For My House.

One Mom’s Breastfeeding Story

By Tiffany Holley

I’ve got a lot of years of nursing under my belt, er, bra… And three very different experiences.

Mom nursed my sister and I, so formula was just not something I ever considered. She went with me to my first La Leche League meeting when I was pregnant with my first.

My oldest child, a boy, was born after a smooth hospital birth in 1994.

Although he sprayed all over the doctor as he emerged, nobody wrote that down. They refused to discharge him until they had noted on the chart that he had urinated. He was too agitated to nurse, and things began to slide downhill. The nurses wanted to put him in a warmer and give him a bottle.

I signed us out AMA and went home. We cuddled in bed, nursed happily, and slept… And, of course, he wet his diaper.

He had a strong preference for the right breast, but other than that our nursing relationship was pretty simple and happy. When he became verbal, he described it as “the hot side” and “the cold side.”

My ex-husband and I divorced when the baby was a little over a year old, and naturally things became more challenging in my life. I got a job as an apartment resident manager, so that I could continue to stay home with him. I also started a mail-order business for natural pregnancy, birth, breastfeeding and parenting books.

Sometime after his third birthday, my energy reserves were simply *gone*. I informed him, in simple language, that he either needed to wean or potty train, because I could no longer handle both of those things.

I was stunned when he chose to wean, since he still seemed very attached to nursing (albeit only a few times a day). He never mentioned it again… And to this day it is something that I look back on with regret.

We muddled along alone together for the better part of a decade, until we ran across a suitably wonderful man, who I promptly married.

Princess J came into our lives not too long after (2005), in dramatic style.

After our relaxing home birth stalled in transition for some 6 hours, the midwife didn’t get any argument from me when she called for us to take the show on the road. Fortunately, the obstetrician she works with was on the floor, so we were allowed a “trial” rather than an immediate C-Section.

I had some of those interventions I generally avoid – but at that moment was profoundly grateful for. My mother caught her, and we went home four hours later.

J and I had a challenging time getting started.

She was a dainty little girl (little? 9 lbs. 6 oz. is hardly little!) with a tiny little mouth. I am a big girl, and busty besides… and the fluids from the hospital IVs had made my breast tissue hard and swollen. Unlike engorgement, this wasn’t relieved by hot showers, pumping, or any of the other things we tried.

Finally, someone suggested a lymph draining massage. What a relief!

We went through some of the normal trials of nursing, the occasional plugged duct / mastitis type situation, but our relationship was a joy. She was an eager nurser, and never seemed to care which side was due.

I did not even consider weaning her (at age 2.5) when I found out I was pregnant again. There were times during the pregnancy when I gritted my teeth a lot, and times when I limited her to “let’s nurse while we sing the ABC song, then we’ll be all done.” But even through those days, I knew that it was worth it for all of us to continue.

Big Baby (an 8 lb. 12 oz. boy) was born in 2008, just before J turned three. He ejected himself out into the tub at a local birthing center after a brief but intense labor. Again, we were home in bed a few hours later, bonding as a family.

He is my laziest nurser, although he’s always been tall and very chubby. He never had any problems, but this has probably been the most challenging period of nursing for me.

I tandem nursed my two “Littles” for about nine months. For the first few weeks I had to have them take turns, while I figured out ways that they could possibly share.

As I struggled with my post-partum hormones and exhaustion, I was afraid for a while that I had pushed Miss J into weaning. When I realized that she had gone two days without nursing, and I cried myself to sleep.

The next day she tripped and fell, and I was extra quick to offer her nursing. We got ourselves back on track – she was happy to nurse, and I was able to set limits to make the experience work better for me.

One of our favorite positions became side-lying in bed. Big Baby would nurse on my lower breast, while his big sister hung over the top of me and nursed (semi-upside-down) on the top breast.

When Big Baby was about six weeks old, I became very ill. I woke up one morning with angry red swelling over most of one breast. I had extreme chills and fever all day. It got worse instead of better, even though I knew how to treat mastitis, so eventually we went to the Emergency Room.

It turns out I had been suffering from a bladder infection for quite a while (often symptom-less during pregnancy), and it had developed into a kidney infection. They said I needed to be admitted to the hospital, and I would have to stop nursing my baby.

The struggle we went through in the hospital deserves to be told in its full “glory” as a separate story. Let me just say that it took my husband, the hospital’s lactation consultant, and my declaration that I was willing to sign out AMA and leave at any time to keep the baby in the room with me and continue nursing.

It was probably the longest five days that our family has ever had to live through. But we made it, still happily nursing.

Over the next few months I underwent two outpatient procedures to treat my (newly discovered) kidney stones. Again, we struggled with some of the medical professionals involved over nursing and medications. It was dismaying how quickly they advised women to give up nursing, or to pump and discard for a time, or give the baby a supplement…

But we made it through, a happy nursing couple – or triad, as the case was.

At 44 months, Princess J announced that she was weaned. And so she was. Since she was such a grown up girl, we had a weaning party, and she and Papa went to the ballet downtown, in full formal dress.

Like the older two, I introduced solids to Mr. Big Baby around six or seven months. He enjoys the idea of eating, but at 18 months he is still clearly getting the majority of his daily nutrition from nursing. I would estimate that neither of the older siblings passed the point of more food than nursing until around age two, so we’re right on schedule.

Tiffany Holley has nursed three children (currently 18 mos. – 15 years old) for a total of 8 years – and counting. She and her family live, breastfeed, urban homestead, cloth diaper, homeschool, and write in Southern Florida (but hope to remedy their location situation soon). You can read about their adventures on their blog, As For My House.