Guest Post: Breastfeeding Through Adversity

This was written by Stephanie. Her birth was my first observation birth and though, it didn't end as planned, the experience taught me a lot. Even more impressive was the way that she and her husband Kevin are handling the aftermath of a non-healing incision post-c-section, with grace, humor and dedication to each other and their daughter, Sierra.

From Stephanie:

Adversity and Breastfeeding
*Please note, this is a lengthy post to try and convey our breastfeeding experience
Background
I was due to give birth with our first child toward the end of January 2009 and I currently live in South Korea because my husband is in the military. Since I was living “outside of my comfort zone” I didn’t feel prepared to give birth and wanted a little more reinforcement. I was put in touch with a doula that a friend of mine used during her delivery about 5 months prior. After meeting with our doula, Amy, I realized that she was going to aid in my ability to have my baby naturally. I had never even thought about having a baby without the use of pain medication until I reached a certain point in my pregnancy and I thought about how I didn’t even want to take over-the-counter medication that was approved, why did I want to take “a cocktail” of drugs to just give birth.

Short summary of labor and delivery
I was 41 weeks and 1 day when I finally went into labor. I did not want to be induced and I had been monitored on a regular basis to make sure my baby was not under any stress. I spent several hours in a place set-up for expecting mothers that do not live on the army installation where I was going to give birth. I had my husband, Amy, and a doula-in-training, Karen, with me to help me achieve the birth plan that my husband and I set-up. I spent approximately 12 to 14 hours in the alternate location working through my labor before we decided as a group that it was time for me to be admitted to the hospital. I then spent another 14 to 16 hours working through contractions in the hospital. After a total of 30 hours of being in labor, the current doctor came in and told me that I had been in labor for too long and I was not progressing on my own and they had to intervene medically. At that point, I had been through a tough labor because my baby had flipped and was in an OP position several hours prior. My doula’s, husband, and I were all getting exhausted after my lengthy laboring process and once the doctor came into the room and made her statement that I wasn’t going to be able to do it on my own terms, my concentration was broken and I broke down in my husband’s arms. I remember stating to him, “get this baby out of me if she is not going to come out the way I want…NOW!!! I didn’t want to feel another contraction if it wasn’t going to result in the birth that I had discussed and worked for over the past 2 days. I would like to note that if the doctor would not have stopped us I would have probably continued for several more hours because I didn’t want to have drugs or a c-section. Would the outcome changed, I don’t really know. I do know that at the time both the baby and I were still medically okay. I then felt required to allow them to give me an epidural, what other choice did I have, and pitocin to help regulate my contractions and to allow them to “break my water.” I was then allowed to rest for about an hour while the “medical intervention” took effect. I had finally dilated and began to push for a few hours, but my baby stayed at 0 station and was not descending. My husband and I were then faced with the question of if we wanted them to use forceps or a vacuum. Thankfully I was semi-educated, due to my own research and my doula, and I didn’t want something attached to my unborn child’s head, if preventable. We opted for a c-section because it was the safest choice for our baby. In hindsight I wish I would have asked to push for longer since we were both still medically fine. However, I don’t know if I would have been allowed.

Recovery
The recovery following a c-section is very difficult and changes what you anticipate following birth. I was very firm when I told the nursing staff I did not want my baby to have formula or a pacifier after birth, unless medically there was a reason and my husband and I needed to be consulted first. After birth I was separated from my little girl, Sierra, for a little over an hour, but began to “try” my hand at breastfeeding almost the minute I was given her. She latched right on and I was elated to say the least. This was only the second item on our birth plan that was accomplished. The first was my husband announcing the gender of our baby.

1st Breastfeeding hurdle
Our attending pediatrician came into our room on one occasion to discuss with us his concern because Sierra had not began urinating and it was now a day after her birth. He told us if she didn’t urinate within the next 12 hours she would be transferred to a Korean hospital for additional care and treatment. My mind went into immediate overdrive. I knew that my body was providing Sierra colostrum and it should have been adequate, so I wasn’t worried about her getting the correct nutrition because I knew she was. Amy had helped with the education and I also read a couple of baby books and searched the internet. However, we now had another hurdle. I asked what can we/I do to help this along. I told the pediatrician that I really wanted to continue breastfeeding, but if she needs more liquid in her diet that my body isn’t producing at this point to help her urinate that I was willing to do what she needed so that she didn’t have to leave me. At that point, it was a double-edged sword because if she left she would be given formula anyways because I couldn’t be released yet. He suggested that I nurse Sierra for five minutes and then I let my husband give her formula. We did this every hour for the next three hours and Sierra probably consumed less than 2 ounces of formula the entire time. However, she peed on the nurse while she was being examined 3.5 hours later. A huge relief!!! We were in the clear.

Incision
7 days after the birth of Sierra a portion of my c-section incision opened up. This is one aspect of a c-section that is not publicized and is fairly common. My husband and I were very concerned for my safety because we didn’t know what had just happened. I didn’t feel any pain, but I had a substantial amount of fluid on my clothes, fluid on the seat where I was sitting, and it was still minimally coming out of my incision. We called our medical care provider in our area and were advised that I would be fine and to come in the morning. Just what every new, paranoid mother wants to hear. After seeing the medical team in our area they called my attending OB doctor and we had an appointment with her the following day. We were told this is fairly common, and that we should begin packing it with gauze and changing it twice a day. I also started having medical appointments twice a week at the hospital I delivered at which is over an hour away, one-way. My husband was now my primary provider of the dressing changes. I was still recovering from a c-section, now had an open incision, and was still nursing Sierra exclusively. I did not even let the idea of a bottle and formula into my mind. She was too young and I wanted to prevent the likelihood of nipple confusion. There would be times in the early days of breastfeeding that I would be feeding Sierra and my husband would literally be feeding me food because there was so much going on around us. My husband could not have been a better provider to Sierra or me and still takes care of a lot of my medical issues. I couldn’t have done any of this without him because he took care of her in the early days of her life and my only function in the beginning was to breastfeed.

Over 4 months later we were still changing my dressing and my incision was still not healing. However, I was able to maintain my ability to breastfeed Sierra. In hindsight, it sounds like we didn’t ask enough questions, but we had complete confidence in our current OB. He has been an OB doctor for over 35 years and I am the only case he has EVER seen where the patient did not heal. I also need to note that I was in the United States for a month during this time and I also went to a doctor there and he told us the same things. I just needed more time because a wound takes time to heal. After the OB doctor consulted with many other doctors in his field and in surgery, I was being referred out of the OB area to a surgeon.

Surgery
I had exploratory surgery on my abdomen on June 4. My CT scan did not show anything that was alarming so he had to get in there and see what the problem was. My surgeon removed a rind of tissue that was not allowing me to heal. Prior to my surgery I couldn’t get an answer on the type of anesthetic that was going to be used so that I could continue to breastfeed. Because of this I had to stop breastfeeding Sierra for 24 hours and this broke my heart. I hadn’t stored any milk for her because she refused to take a bottle. She just couldn’t figure it out and my husband tried on numerous occasions with milk that I had pumped. This is when our breastfeeding journey begins to get very difficult for me, Sierra, and my husband. My husband had to take care of our baby who had been nursing on her mom for the past 4 months and try a bottle. At that point we had tried almost every nipple known to man to see if she would take one and my husband had to feed her with a syringe the first few days. Then we began getting nipples that are used for newborns in the hospital because she could figure those out. Throughout my 22 day hospital stay there were many instances when I had to pump out milk that Sierra should not have because of the medication that I was given. She began to take the formula from my husband, Kevin, and it broke my heart, but I was happy she adjusted so quickly. My milk supply was no longer what it used to be, but my baby stayed loyal. She still latched on right away every morning when she can to my room. This was a very difficult time for me because this was a bond with my daughter that I wasn’t ready to give up yet, but I didn’t know what else to do. It still brings tears to my eyes to even think about my time in the hospital. After 22 days in the hospital I no longer had a sufficient milk supply for Sierra and we even started her on vegetables a little over a month earlier than I wanted. Sierra still wasn’t a huge fan of formula and I thought at least she is getting nourishment from me, formula, and vegetables.

Back Home
By the time we were released from the hospital we had finally found a nipple that she could figure out. By figuring out I mean she could still use her breastfeeding latch and the formula would still come out. I continued to breastfeed Sierra and I wanted my milk supply back and was even given information from Amy on how to make this happen, but after I thought about it, I couldn’t let myself stress about the formula anymore. Our days were still very stressful because I had/have doctor appointments that are an hour drive one way from where we live two to three times a week. Plus, I am still attached to a wound VAC that I have to carry around because it is attached via cords to my open wound. I needed to make peace with myself that she was still getting some breastmilk and I needed to come to terms with the fact that she may wean herself off breastfeeding before I wanted because of our circumstances. I was also being faced with the good possibility that I may have to undergo another surgery and I couldn’t put Sierra or my husband through that painful transition again from breastfeeding to formula because I wasn’t ready. As of today, August 4th, I am still recovering and Sierra is a little over 6 months old. I still have an open wound and a slight possibility of another surgery, but Sierra is back to breastfeeding exclusively and formula is not a part of her nutrition as of yesterday, but she still enjoys her veggies daily. When I began to realize the little amount of formula she was actually taking I began to get really excited. The one thing I did do to help increase my milk supply was to keep her at my breast for longer to help with stimulation if she was nursing/sleeping on me.

If my story can influence anyone to push pass the physical pain that you may feel in the first few weeks or adversity you might be facing, I am happy to share.