Goodbye, My Silicone Friends!

Me feeding Rosa at 8 months with no nipple shields – hurrah!

It’s not what you’re thinking. Although this post is boob-related. After 8 months, we have finally stopped needing to use nipple shields to breastfeed.  I never thought that this would happen, so I’m over the moon!

When Rosa was born, she couldn’t latch on properly. There was a lot of licking and rooting going on, but she just could not latch on to my rather flat nipples.  Added to this, she was ill and in SCBU and had a naso-gastric tube fitted for a while so it was always going to be a bit more difficult for her to breastfeed well.  A nurse in SCBU suggested we try nipple shields so we bought some Boots own-brand ones and although it still took up to about 20 attempts each time, we managed to achieve a workable latch.  Then after leaving SCBU we got some new Medela nipple shields and never looked back. I could get Rosa to latch on first time every time and I was thrilled.

If you look through breastfeeding information, virtually everything you read about nipple shields is negative.  They can affect milk supply, stop babies receiving as many antibodies in breast milk and make feeding last a lot longer.  However, the research quoted in these articles mainly focuses on the old-style nipple shields which were a lot thicker and often made of rubber.  The Medela Contact shields that I used (tee hee, past tense!) are thin silicone with a cut-out area at the top. This is so that the baby’s skin can make contact with your skin, as it’s not just removing milk from the breast that stimulates supply, but the skin to skin contact involved too.  Silicone shields affect the milk transfer rate much less than the old rubber ones.

I will always be immensely grateful that the lovely nurse, Sonia, suggested nipple shields. If it had not been for her, and them, Rosa would never have been a mainly breastfed baby. It was very hard work getting Rosa to breastfeed, in fact the hardest thing I’ve ever done, but so worth it.

From my experience, I would say the following about nipple shields:

  • Do seek out breastfeeding support as soon as you experience problems. Expert peer supporters from La Leche League, the NCT or the Association of Breastfeeding Mothers might be able to sort out your attachment and positioning issues very quickly and you may not need to use nipple shields.
  • Nipple shields are not evil and can save the breastfeeding relationship, as in our case.
  • They should only be used as a short-term measure if possible, as they can make it more difficult for the baby to get the hang of latching on to a bare nipple. But with the new silicone type it’s so not the end of the world.
  • They did not affect my milk supply, but then for the first few weeks and months I did express a lot.
  • Feeding Rosa with nipple shields took a long time.  For several months it took me an hour to feed her.  This is because the milk transfer rate is lower as babies feed from nipple shields using just suction rather than suction and tongue action, which is how normal breastfeeding occurs.  Feeding her without the shields is a revelation.  Often less than 10 mins each side.
  • Breastfeeding in public with nipple shields is a faff and makes it harder to feed discreetly.  Use a pashmina or breastfeeding shield if this bothers you.
  • If you do end up using nipple shields, keep trying to feed without them every few days or weeks.  I would often manage one or two feeds without them but it would become too painful after a few goes.  In that eventuality, whip the shields back on, let your nipples heal again and forget about trying without for a little while.  It could be that a few weeks or as in our case, months later, your baby’s mouth may have grown enough to overcome any issues.
  • They don’t need to be sterilised after every use, as breast milk is naturally anti-bacterial. I would wash them with hot soapy water between feeds and then sterilise them each night.
  • Buy 2 pairs, so that you always have spares, because you will lose them temporarily!
  • On a stranger note, be aware that for some reason kids LOVE nipple shields and the bright yellow case that came with the Medela ones. Whenever toddlers or older kids were around, they pretty much always picked up my freshly washed nipple shields to have a closer look.

How To Survive The Special Care Baby Unit – Part 2

After having shared our experience of the Special Care Baby Unit (SCBU) in my last post, I thought that in this post I would give our top tips for surviving a SCBU stint.

1) Get all the support you can. Ask your partner, parents, extended family and friends to come in and visit, bringing anything you or the baby need in addition to offering emotional succour.  In common with many, our unit had a ‘grandparents and siblings only’ rule for visitors. It’s for infection control purposes, so you can understand that. Bless ’em, my parents came every day bar two out of nineteen. Every day they would call and ask if we needed anything.  Our unit asked that you provide your own nappies and cotton wool balls, so getting top-ups of those was a perfect grandparent task.  It was so good to see my parents each day. Richard and I really appreciated them having made the effort, and Rosa seemed to enjoy their company too.  Randomly, they would bring us nice desserts sometimes, which was a small gesture but meant a lot to us, especially after days and days of hospital food.  As for the ‘grandparents and siblings only’ rule, in the event that parents of a poorly baby did not have living or involved parents themselves, it was possible to negotiate and nominate someone else for those daily visitation privileges.

2) Get out of SCBU sometimes.  Although we wanted to be with Rosa 24/7 when she was in hospital, the Special Care Unit was small and overwhelming. At times when it became claustrophobic and oppressive, Richard and I would escape for an hour or two. This could be a trip to the chemist’s to buy something Rosa needed, or a visit to our home, or lunch or dinner at a nearby restaurant. It was wonderful to get out and get back to the normal world just for a short while, no matter what the nature of that time away was. There was also a room with a TV and tea/coffee-making facilities attached to the unit, which we would go to for a drink and some time out at least once a day. We would return to Rosa feeling refreshed and able to cope with the intensity of the unit once more. And in the words of one of the nurses, “You might as well make use of the best babysitters you’ll ever have!”.

3) Be assertive. As your baby’s parents you have choices when it comes to medical treatment. You do not have to passively accept what is suggested.  When the doctors wanted to perform a lumbar puncture on Rosa, but said that the results would not have any effect on their course of action at that point, we declined the procedure.  Why inflict that on her when it wouldn’t affect what they were going to do?  Also, when the ward manager of the post-natal ward wanted to discharge me after 10 days, Richard told her I wasn’t leaving as we didn’t know if our baby was getting better or not.  If, as I was, the new mum is feeling too weak to stand up for herself then she needs to find someone who can do it for her. If not a partner then another family member or a friend.

4) Resist crazy feeding. When Rosa came out of SCBU, and for the entire duration of her stay there, our feeding regimen was completely bonkers.  Every 3 hours or so, I would attempt to get her to feed on the boob, followed by feeding her my expressed breast milk by bottle, then a formula top-up. Then I would express breast milk for 40 mins. This process, punctuated by a nappy change and winding would take me 1.5 – 2 hours.  I have really mixed feelings about what happened with regard to feeding in SCBU. Rosa being given bottles of formula by the nurses in the first few days is the likely cause of her not being great at breastfeeding.  On the other hand, 2 of the nurses suggested nipple shields as a means of getting Rosa to latch on to the breast.  This worked and although we are still using them 8 months later, if it hadn’t have been for that advice Rosa would not have been breastfed. However, I was staggered to learn months after discharge that there is an Infant Feeding Coordinator at the hospital whose role it is to promote breastfeeding.  In 3 weeks there, we did not see or even hear mention of her!  I would strongly recommend that any mother with a baby in SCBU who is determined to breastfeed gets expert advice immediately if she is having problems.  And by expert advice I mean either from someone like an infant feeding coordinator within the hospital, or from someone from the outside, like a La Leche League or NCT breastfeeding counsellor. Don’t get sucked into the kind of crazy feeding schedule that we did. It is not sustainable and could interfere with establishing breastfeeding.  As soon as we left, I stopped this madness and we established a routine where Rosa is breastfed apart from one bottle of formula each day.  This has worked for us and although I have never managed to breastfeed exclusively, at least 80% of her daily milk is breast milk and that is pretty damn good given the start we had.

5) Do not get freaked out by doctors. It’s worthwhile pointing out that doctors work by ruling stuff out.  For us, this meant that, on one particular awful day in SCBU, Rosa was seen by 3 separate sets of doctors.  One set was concerned that she might have an infection in the bone of her elbow, one set thought that she needed a lumbar puncture to determine whether she had a brain infection and another set thought she had a heart murmur.  We were distraught.  Anyway, we declined the lumbar puncture for the reasons above and the elbow and heart were scanned and no problems found.  I think we found it very difficult because the paediatricians at our unit were not great at communicating.  I would advise any parent struggling to understand what the doctors are saying to ask the nurses to translate.  One thing that we found stressful was that tests were performed on Rosa, but we would not be informed of the results unless we chased them up.  We found that the nurses were generally excellent on SCBU and were a great source of useful advice and information.

Having an ill baby is always going to be a very difficult experience for the parents of the child. But hopefully, some of the things which we found helped us through our time in SCBU may be useful in helping other parents to cope too.

10 Things I Wish I’d Known About Breastfeeding

1) It’s all about the angle of the dangle. Positioning and attachment is everything. If you are big-boobed like me and don’t have nips like those old-fashioned wooden clothes pegs, then the position that works for you might not look like the illustrations on the web.  For example, for us, a breastfeeding pillow like a Boppy (the sort that wrap around your front) is really unhelpful.  It’s better for us for baby to be on my lap directly.

2) You really need to have loads of drinks and perhaps some snacks to hand when feeding.  How many times have I found myself stuck on the sofa watching my cup of tea going cold on the coffee table because it’s out of reach? If you have access to a CamelBak  water rucksack jobbie (no, really) that might be a good option at home during growth spurts or in the early days when it seems like your baby is feeding 24/7. Otherwise, a water bottle with sports cap is an excellent option!

3) Use a wedge. Again this may be one for the well-endowed ladies, but I have found a wedge under the boob works wonders in getting my babe attached well for feeding. You can buy specially designed ones, but a rolled up muslin, pashmina or thin blanket will do just fine. I use a mini pillow that came with a Mamas and Papas changing mat cover.

4) It may take aaaages. My little one has always been a slow feeder. She was 5 months the other day and has recently got slightly faster and more efficient at feeding.  However, until very recently it would take me about an hour to feed her (both sides with nappy change in the middle).  If you have a slow feeder, you can’t do anything to make them feed faster, so embrace it and make sure the telly remote is within reach and also….

5) Get a smart phone. Although I spend time looking lovingly into my daughter’s eyes when feeding her, she usually closes her eyes for a lot of the time she feeds.  She’s not asleep, just deeply relaxed and concentrating on the job in hand. I recently got a smart phone and it’s fab for the breastfeeding mother.  I can blog, Facebook and Ebay one-handed whilst feeding.  Not to mention call and text.  Just brilliant.  I even managed to play Angry Birds a bit today, albeit badly! What on earth did I do before?

6) Master feeding lying down asap. Although (unexpectedly) I am always pleased to see my little munchkin at 3.30am or so for her night feed, I am obviously still tired.  Being able to feed lying down has made a big difference to night feeds.  They are much more restful for me and I have even fallen asleep or dozed during a feed on occasion.

7) Scarves are really useful. I took my little one out in the sling today.  I was running late for baby massage, as usual, and ran out of the door with baby and my small rucksack-style handbag.  I just packed a nappy, wipes and nipple shields and off I trotted.  I wore a pashmina and variously used it as a soft blanket for the baby to lie on at baby massage, a boob wedge at my parents’ house (see above) and to aid discretion when feeding at a café in town.

8) Big is not necessarily best. If you have big boobs, you might be under the impression that they’d be great for breastfeeding.  You’d be wrong.  Obviously not in every case, but they certainly can be more of a hindrance than a help.  They do not produce any more milk than those of our smaller sisters and getting the angle of the dangle (see above) right with big boobs is often harder. In addition to this, wrangling big knockers and a wriggly baby can mean that trying to feed discreetly is tricky.

9) Do what feels best. This follows on from point 1, above. Breastfeeding is a team sport, which you and your baby learn to play together.  Your positioning may look spot on, but if it’s painful, it’s wrong for you. Detach your baby and try again. Doesn’t matter how many times.  It’s all about what is comfortable for you and your baby using your combined anatomies. The more comfortable feeding is, generally the better the baby is attached and the better the milk transfer will be.

10) Vest tops are your friend. I haven’t bought many clothes especially for feeding.  I have found that wrapover tops and dresses are great, as well as cotton jersey tops and dresses with lycra. I often wear these with a vest top underneath usually in the same colour as my bra.  I can then pull the stretchy top or dress down and the vest top up, which creates a smaller area of flesh to be exposed whilst getting my baby attached. Once she is in place, I can pull the vest top down so there is very little, if anything, to see.

What are your top tips for breastfeeding?  Do you have any advice that might help new or expectant mums?

Is it possible to breastfeed discreetly? And why should we?

Ooh, rant alert! Why is it that perfectly lovely people add little conditions to the end of sentences expressing their support for public breastfeeding such as, “as long as it’s done discreetly”?  To my mind, thus rendering themselves bastards.  It makes me very angry.  Having had a baby and struggled with breastfeeding the whole 5.5 months of her life so far, it makes me particularly peeved.  I have worked very hard to continue feeding her and unless we were to stay in and not go anywhere ever, I have to feed her in public sometimes.

Everyone knows that breastfeeding is incredibly beneficial to babies.  My little girl had an infection just after birth and spent 3 weeks fighting it in the special care baby unit.  So I am very motivated to get as much breast milk into her as possible so she can benefit from all those lovely antibodies.  I can tell you that wrangling a big ole boob, a wriggly baby, my special under boob feeding wedge and a nipple shield (yep, we’re still using those at nearly 6 months) in public is not easy at all.  Especially not when the aforementioned child is pulling my top up every time I try to pull it down to cover the boobage.

I will never feed my baby in a toilet, because toilets are not where you eat, are they?  Breastfeeding a baby in a toilet would be both uncomfortable and unhygienic. And what sort of message does feeding in a toilet give out about breastfeeding?  That breastfeeding is ‘rude’ and/or dirty.  WTF??

In summary, I shall be feeding my daughter in cafes, restaurants and wherever else I need to.  If someone has a problem with seeing a bit of boob, then they need to move. And get a frigging life, too!

Slow Weight Gain And The Evil Red Book

My baby is a skinny minny. She was 8lb 7oz at birth but has only gained weight slowly.  She’s now nearly 13lb at just coming up to 5 months old. She has never, ever lost any weight. She is and always has been incredibly alert and active and developmentally she is either bang on or ahead of her milestones.  She is also a very cheerful little soul.  I say this because I am 100% certain there is nothing wrong with my baby.

Every Mum in the UK is given a red book when she has a baby. This is your child’s personal health record. It contains various forms for medical professionals to fill in, so it has details of our daughter’s six-week check, batch details of vaccines she has been given etc. It also contains growth charts. These chart your baby’s weight against age. It has centile lines marked, one of which your baby is supposed to follow. The red book has become the bane of my existence!

My baby is not following a centile line (sorry, I don’t think she’s read your policy) and as a result, I have felt really under pressure.  I am quite certain that the reason the small one is not piling weight on is that she is rubbish at breastfeeding. As a result, at the health visitor’s suggestion, we give her one formula feed per day.  I want to mainly (if we can’t manage exclusively) breastfeed her until she is at least 6 months old, especially as she had an infection just after birth and spent 3 weeks in the Special Care Baby Unit. She needs the antibodies in breast milk more than most. I won’t be bullied into giving her more formula and less breast milk just because she isn’t following a centile line.  If there were any other indication that she were in anything other than rude health, I would do so.

The poor breastfeeding (more about this in another post – trust me, I have sought out every bit of help available) and slow weight gain have caused me so many tears.  There’s something really primal about feeling like you’re feeding your baby adequately.  I dread attending the Well Baby Clinic for weigh-ins.  Not least because our health visitor wanted us to come weekly and kept calling me at home to “remind” me.  Not that I ever didn’t turn up when I said I would. She once came to our house to weigh my daughter 3 times in a week, with 2 of these visits being just 24 hours apart. I have no idea how a baby is supposed to gain a significant amount of weight to that timescale. I ended up giving the baby a massive bottle of expressed milk just before she arrived to get the health visitor off my back!

The interesting thing is that the red book states that babies should not be weighed more often than once a month. Illness, teething and various other things can cause a baby to gain weight slowly or remain static for a week or two and this is normal.  That’s been the case with my little one.  Because she’s rubbish at breastfeeding, any change in routine or even a snuffle can stop her gaining weight for a week or two.  She always piles it on in the next few weeks then and averages out ok over a month.

It has taken me some months to stop worrying almost obsessively about my baby’s weight and be able to relax enough to really enjoy being her Mum. I think that as a Mum you know if your baby is unwell or if something is amiss.  If your baby is alert, developmentally spot on and generally happy with him or herself, then weight should be seen as part of the picture and not all of it. Surely that’s just common sense.

PS Happily, our GP and Paediatrician also see things my way and that’s made me feel a lot more confident about my daughter’s weight being ok.

The NHS Hates Breastfeeding

I am angry.  Having had my first baby 4.5 months ago, I have discovered something about breastfeeding in the UK. Namely, the NHS spends about 15 billion quid (or a lot, anyway) advertising the fact that breast is best (erm, yeah I did actually know that having not lived in a cave for the past 20-odd years).  This means that when your baby is born, if you do not breastfeed, odds are you will feel extremely guilty about this. Maternal guilt is horrible at the best of times (and there are so many variants of it too) but I will stick my neck out and say that in those first fragile days after giving birth, if you have trouble breastfeeding your infant child you will feel maternal guilt at its worst.   The NHS has told you that breast is best in its myriad forms of propaganda, no? So the NHS must be willing to help Mums struggling with breastfeeding to achieve success with it, right? Wrong, wrongety, wrong! Guess who aren’t experts in breastfeeding?  That’s right, midwives and health visitors!  I have had a lot of trouble with breastfeeding and the best help that I have had has been from volunteers working for the NCT or La Leche League, who receive far more training in breastfeeding support than midwives or health visitors.  I would recommend that any expectant mum planning on breastfeeding gets the numbers of local breastfeeding counsellors through either the NCT or La Leche League towards the end of her pregnancy so that if breastfeeding doesn’t come easily she can get help quickly. Because although the NHS spend tons on promoting breastfeeding, I can tell you they spend naff all on supporting it.  Certainly in my area.