Thyroid & anaemia - no milk and desperate ....

[Teaandflapjacks]

I don't know if anyone can help but I hope so and thanks in advance.... it is rather long.....

So I finally had my little girl 9 days over due after a difficult pregnancy - extreme MS all the way through, and early labour started at 34 weeks - so had been 1cm dilated for weeks of bed rest etc, and then we went over! The birth turned out to be rather traumatic, with no pain relief since gas and air is banned in germany (where I live) and the bloody midwife didn't check my cervix often enough and I missed my epidural window. I ended up pushing for nearly 2 hours and then the placenta got stuck after all. They wanted to avoid an epidural or full anaesthetic at the end as this would be 'better for me' and gave me a local and shoved there hand in to remove left over placenta. I cannot describe how painful this was and kept screaming for them to stop. I then needed quite a few stitches...

Fast forward to the ward. She was hungry straight away, and I could not get her to latch on, eventually we tried with nipple shields to some success at suckling. Nothing would come out, I know this is quite normal though at first. She screamed and screamed. This went on for 3 days - in between I tried EVERYTHING they suggested - pumping every 2 hours, latching her on nipple shields when she screamed and screamed, every position possible. My nipples were expressing blood into the pump by the end. So I asked to use formula to at least give her something. She lapped it up - but the would only let me give it her via a syringe and small amounts on my little finger, I was also not allowed to give her a dummy in hospital. They then got me to use a syringe on my breast through the shield to mimic breast feeding, again she screamed a lot but got some milk in from the formula. She ended up very gassy from all the crying and this caused her more pain.

I finally got her home yesterday and she was still crying. We decided we would try a bottle out of desperation- we gave her basically double what we were 'allowed' in hospital - she had the whole lot and slept for 6 hours. The same pattern has been repeated today - sleeping for longer and just totally satisfied and content. So back to the BFing - I have had acupuncture today to help the milk come in still - nothing there - about 1/4 of a teaspoon I got from the pump and breast very soft etc, red raw nipples still. Still been pumping away in vain and it's become agony, I vomited earlier after the acupuncture, and been having hot and cold sweats all day and just sobbing on and off. I know BFing is hard, I would do anything for her, and indeed during the pregnancy did it all by the book including totally avoiding alcohol etc. But this just isn't working and I know that Hashimotos (under active thyroid really) and my anaemia is probably impeding the production. I just feel really sad about it all - all the medical staff keep telling me that it is not very often women don't produce milk - but it seems this way for me.

I just really wanted some perspective on it all - has anyone else had this and did you overcome it? I find her on the formula so great now she is satisfied but after so much 'breast is best' and me being determined to do the right thing after a miscarriage it's become all to much. I worry I wont bond as well with bottles? but then when she just screamed at me this was so awful too.

Thanks if you have stuck with me so far...!

[Teaandflapjacks]

I should add DH being totally wonderful and after another meltdown by me earlier firmly put the pump away and does not think having more acupuncture and me vomiting again is the answer, says he was FF and he is fine and if milk comes in without all this fussing great, but not to force it now. He was fairly firm about it which has helped me a bit (he's not trying to control - just take care of me).

[ZeroTolerance]

Poor you OP. I can't offer any advice but hopefully someone knowledgable will see this. I am expecting DC2 soon and have been diagnosed with under active thyroid in this pregnancy for which I am taking levothyroxine. It does worry me whether it will impede bfing. Is that what you think the problem is?

Don't feel bad. You are feeding your baby in the best way you can right now.

[mercibucket]

is your underactive thyroid under control with medication, and are you taking iron for the anaemia?

it does take ages for milk to come in, more than just the colostrum which is a nightmare to pump. did they show you how to hand express? you might prefer that in the beginning

it is still early days and if you keep putting her to the breast, this will stimulate milk production

please get your levo dose sorted though, it should have been closely monitored during pregnancy so you were not underactive, and may need adjusting again, but shouldnt affect milk production if you are adequately medicated

[Janek]

You don't say how old your baby is (i don't think...), my milk took a while to come in with dd1, by which time she'd lost more than 10% of her birthweight and we were taken into hospital (where i saw an amazing breastfeeding consultant who showed me how to do it).

I have no experience of thyroid trouble, although would have thought that if you are medicated for it, that would make you 'normal' so that shouldn't be an issue. But i don't know.

But what i do know is THE QUANTITY OF MILK YOU GET FROM EXPRESSING BEARS NO RESEMBLANCE TO THE QUANTITY OF MILK THE BABY IS GETTING so put the bloomin machine away and stop tearing yourself to shreds. Let your baby suckle for comfort and this will help stimulate your supply.

I really feel for you, breastfeeding is really difficult, even though i'm out the other side now and have successfully fed two dds i still think of breastfeeding as a hard-won skill.

Hopefully Tiktok or someone equally knowledgable will be along in a minute to help you. Good luck!

[Teaandflapjacks]

Yes - should add am on Levothyroxine and being monitored by an endocrinologist - during the pregnancy and now. Same with the anaemia - taking iron but even with that recent tests (as of yesterday) showed it's running too low and to take more iron again still - but with all my stitches this affects going to the loo properly so they then said to wait a bit and take every other day instead. This messed the whole other end production up now too and having to take stuff for that - ahh! I will go back and see her again next week for a check up and chat. Have also tried hand pumping too but actually found the electric pump the lesser evil weirdly, even with the blood coming out rather than milk.

[Teaandflapjacks]

she's 5 days old - I know it is really really early days, just with sleep depravation and all the pains in various body parts it feels like forever... I probably sound like a right moaning minnie.

[ZeroTolerance]

OP, can I ask a question purely in self-interest? Is your thyroid problem pregnancy induced? Did your endocrinologist say you could come off the tablets after baby was born?

I am on a low dose of 50mg and had never been tested for thyroid issues until this pregnancy. I think my level was not excessive. The doc said it was up to me if I wanted to carry on taking the tablets after the baby is born and that I should have a blood test after two months to see if my levels are normal - which would confirm whether or not it was indeed pg-related.

I'm worried stopping the medication suddenly might give me bf problems but maybe staying on is just as bad!

[Teaandflapjacks]

Zero - no worries. Basically I have hashimotos - which I had before I was pg. In fact I miscarried before which was linked to this and my lack of progesterone (I had nothing) so needed to take this (prog.) to hold the pregnancy, and took me over a year to get preg. I was also misdiagnosed with MS and anxiety (by docs on Harley street!) before we found out I had hashimotos, which gives the symptoms of the other illnesses. I am also on 50mgs. I can't stress enough how much taking it changed things for me - even with that I also offered to the doctors to stop taking it to help with the milk production which was met with a firm no - they want me to keep taking it since my illness will never right itself - I will always need to take this medication, but it has stopped me having the following issues - weight fluctuation, hair falling out, depressive/over anxious thoughts, memory loss, and on and on... It was like something turned the lights back on for me, even at such a small dose. Hashimotos is based on your TPO antibody levels - don't know if you have this tested but worth a look. I don't know what symptoms you had with your thyroid, but I really struggled for years not knowing what was going with my body and it was miserable. Some people do in fact just have fluctuating thyroids though .- and yours can then go over active, then under active and so on - so you may not need to take the thyroxin - its best to keep linked to a decent endocrinologist if you can and get them to monitor it during and after for you.

[mercibucket]

5 days in is so early, there is plenty of time for this to work out. its a long time since i bf so i dont know all the latest advice, but thyroid and iron i am more up to date on! if your levels are ok, you are not as suchnhypothyroid so milk should be ok. glad it is all being monitored closely tho. wrt iron, there are different types of iron supplements that dont cause constioation, so maybe try another? i just use spatone or floradix personally

[Shlurpbop]

Another one here with Hashimotos.
No real advice I'm afraid but just wanted you to know you're not alone. My milk didn't come in and after 36 hours of a screaming newborn I turned to bottle feeding.
I will say that that was the best thing I could have done for me - no matter how much my baby suckled, my milkdid not appear. The midwives kept saying it would stimulate my supply and it just didnt. My breasts didn't get bigger, swollen or leak at all. Not one drop. I got more miserable and upset and felt useless. Switching to the bottle made me feel better as I was feeding my baby and therefore maDe me feel like a better mum, which made my baby happier too.
I was on thyroxine and my levels were normal, but it still affected my milk supply.
You're not alone OP

[FadBook]

Firstly congrats. She's here, she's safe and you are in a country where formula is available if you need it. Try and stay positive.

Secondly, using formula doesn't mean you've failed or that you are shit parent or that you wont breastfeed.

Hand expressing is far better, if milk hasn't come in, rather than pumping. Pumping colostrum milk is difficult, it is thick and not worth the effort to pump it (gets clogged in pump, only several ml will come out. Hand expressing (you tube it, or get husband to do as you need 2 hands and a syringe to catch it).

Her tummy size is that of a marble. It's small. It only needs small quantities of milk often. So feed, little and often. Your body works on a supply & demand system, the more she sucks, the more you will supply. I would not let her go more than 3 hours (probably even 2) without offering your breast for a feed. 6 hours is too long to let her sleep without feeding from you.

Retained placenta can hinder milk "coming in" so LOTS of skin to skin with your daughter - lie on the bed, both naked, keep a light sheet over your bottom half, and her face close to your breasts. Try a bath together too, the warm water on you may also help - your hormones (oxytocin) will help too, so keep her close to you, and remember how amazing she is.

formula can cock up milk supply if when you use it, you don't express. So, if you choose to use formula, try and hand express. Like pp said, the amount that comes out isn't necessarily an indication that you're not producing. The key is for your baby to extract that milk - they're far more equipped to do this than you hand expressing or your pump.

Have you tried the 'flick' technique? You hold baby across your breast with face / head near nipple area, and with your spare hand, you hold your breast upwards away from baby and when she opens mouth wide, 'flick' your nipple in to her mouth, aiming to get your nipple as far in to her mouth as possible.

In Germany, are there any breast feeding support groups? You need some real life support too - the above is only from experience of being a peer supporter - I'm not medical qualified at all- but be assured that if you need to give formula, you can, it isn't the end of the bf relationship. With time and the right RL support, you can bf fully or mixed.

Also, keep an eye on your bleeding. I had a similar delivery and manual removal of placenta afterwards (fucking painful...worse than labour). They didn't get it all out. I had a further operation (ERPC) when baby was 11 weeks. This is common I believe because they have to be care trying to get it out in the first place (ie could tear cervix wall). BUT if you have some left, it can hugely affect milk supply. I was asked this several times during the checkups and it didn't actually affect mine (over supply) but once removed I had over over over supply so keep an eye on it (bleeding at 6 weeks, see doctor for check up)

Chin up, you're doing great

[amyboo]

I have Hashimotos and took levothyroxine throughout my pregnancy with DS3 after losing DS2 at 35.5 weeks because of the undiagnosed Hashimotos. I had no trouble breastfeeding and my milk came in about 2 days after my EMCS. I was also having to pump with an electric pump as DS3 was born at 31.2 so was in the SCBU. The nurses told me one of the worst things for affecting milk supply is stress. So I'd try and relax, give some formula and see uf your milk comes in. If it doesn't, FF would not be the end of the world. We're 3 kids in my family - my brother was ebf for 6 weeks then had formula, my sister was formula fed completely and I was ebf till 9 months. It really doesn't make mch difference in the long term and you have to do what works for you.

[Teaandflapjacks]

thanks for all the help and replies so far. I am taking an oxytocin spray to get rid of any left over placenta (Fadbook - fucking painful - couldn't have put it better myself - was worse than labour!). This has brought on contractions sometimes which are just what you need after all of that. I have to then take ibuprofen to dampen them down a bit. I just feel like i am rattling about with various drugs - lthyroxin, iron, oxytocin, ibuprofen, stuff to keep things 'regular', and then the boobs with blood coming out and not milk.

We have in germany a great system with a midwife coming to you everyday in your own home for up to 8 weeks if you want it - mine can administer acupuncture and she is a homeopathy specialist. I really like her and she is very supportive. But even she said yesterday that at day 7 we need to stop and take stock and see which way to go since there is just nothing there at all now. We have tried al the different tricks with skin on skin, squeezing nipples, clamping her head and mouth around nipple, formula on shield, two midwives forcing nipple in as far as possible (I have very inverted nipples so this is why I have had to use the shields, the pumping helps pull them out) honestly every trick in the book. We had about 5 minutes of her suckling ok from my right boob (albeit with no milk but still) and I just have this sole image haunting my thoughts all the time at the moment as it was beautiful.

amyboo i am so sorry for your loss - I also had a miscarriage thanks to undiagnosed Hashimotos so I really do sympathise with you - though mine was much earlier, my heart goes out to you.

My mother keeps saying to stop worrying, she couldn't feed one of us (me and my siblings) as her milk just did not come whatever she did, and for the rest of us it was a doddle.

Going to try more skin on skin and see how this works as it is less stressful and I know that the stress hormones play havoc with milk production anyway, also going to speak to doctor about the three issues I am having with placenta (need another scan to check anyway), anaemia and thyroid and no milk and see whats what.

Being a parent is hard - never got how much the actual feelings you have associated with it impact you - the actual physical caring side is straightforward, its what goes on in your head and heart that I hadn't really anticipated.

[midori1999]

Sorry to hear about all this Tea.

I don't know much about thyroid problems and breastfeeding, but milk coming in is endocrine led, so it's not impossible it could affect it. However, if you are getting hot sweats arc then it's possible your milk is coming in, as this can cause hot flushes etc.

What I can say is that it doesn't really sound like the help you e been getting is that great sadly. Two midwives holding a baby's head in an attempt to get a latch is something that should absolutely never happen. It's appalling quite frankly and is likely to give your baby a serious aversion to the breast.

If I were in your position, I'd want to get as much skin to skin as possible, to bathe with baby, to give baby as much chance as possible to be close to a naked breast so they had the chance to latch on if possible. I would also want to get some solid advice from someone more qualified in regard to breastfeeding than a midwife or similar, so a breastfeeding counsellor or international board certified lactation consultant. If you can use a supplemental nursing system, this is a way to get your baby to take formula while at the breast and certainly will be easier than the syringe/shield combo, but obviously your baby will need to latch for that.

Do try not to worry. I've supported one Mum whose baby didn't latch at all and was virtually fully on formula (with a tiny bit of expressed milk) at 4 weeks old. 2 weeks later she was being fully breastfed. So it can happen, but proper help and support is needed for that.

[FadBook]

I've supported one Mum whose baby didn't latch at all and was virtually fully on formula (with a tiny bit of expressed milk) at 4 weeks old. 2 weeks later she was being fully breastfed. So it can happen, but proper help and support is needed for that

^^ I've known this too... it is hard, but it isn't impossible for a baby to randomly start latching after several weeks.

LOTS of skin to skin, keep baby close to your boobs at all time!

You're doing great Tea many would have given up a number of days ago. I think it is safe to say you are trying everything you can.

[delasi]

Lots of for you Tea. I think you have done so much and been through so much, imo the best thing is to just enjoy your newborn as much as you can and do whatever works for you. Also try to find the best support possible - it could be family to help out, and particularly feeding counsellors if you have access to them.

I have an underactive thyroid (diagnosed pre-pg), for which my dosage increased during pg, and I happen to know a few other hypothyroid mums. From collective knowledge, a mix of docs/consulants' advice and personal experience, an underactive thyroid can most definitely affect supply even when treated. It is not always the case, but it happens. Domperidone can be prescribed to try and help the supply but it doesn't always work.

I can't say I struggled with bf only because of my thyroid - I have a separate medical history that made chances of bfing a bit sketchy. I was very fortunate with my labour experience, but I got an infection several days after and was in agony. I also had to have daily injections which weren't entirely pleasant. My MWs felt that the combination of these factors probably didn't help as I felt stressed and in pain, and I never felt any milk come in or any changes. At 1wo DS was starting to show signs of dehydration, still going down the weight chart (just shy of 10% loss so HCPs weren't yet concerned), even sitting or lying down hurt so much for me, DS was never satisfied... we also went to formula at that point and everything just got better. DH took over, I slept at night, tried to rest and heal, bfed during the day (which was now a happy, beautiful experience), until it became apparent that nothing seemed to be coming out and so we eventually moved to fully ff.

Perhaps I was 'wrong' - perhaps I could have waited it out, or tried harder - but for us, and in our circumstances, it was just what worked. It made me happy, as it did DH, and DS, and I am currently looking at my gorgeous 9mo boy who is strong and well developed and am now contemplating when to do this all over again...!

[Teaandflapjacks]

Hi Ladies,

I just wanted to come back and update - thanks again for all your advice and kind words.

Well it turned out I had a retained placenta - i canned the bf attempt at day 7 after pumping more blood and both the midwife and my husband said it had to stop at this stage. More worrying was I felt very detached and started to run a high fever. I went into hospital on the sunday to see what was up, and was given antibiotics, but i still didn't feel right. On tuesday we went back, and then it was very clear then on the ultrasound I had a chunk of placenta attached to the front wall of my uterus.

I had a D&C under general, and lost half a litre of blood (well 800 mls). afterwards I kept fainting and started to haemorrhage. I had a blood clot the size of a baby's head formed in my womb and was wheeled back into theatre to remove it - I lost another litre and a half of blood, nearly lost my womb and was at risk myself too. I ended up in intensive care and i needed four blood transfusions. I am very pleased to say home safe and sound and well and feel right in myself!!

Basically the breast feeding has not worked out - and to be honest it was the best thing that could have happened given the circumstances. Luckily we live in a world where formula is safe and easily available, and I had access to good medical care that ensures my daughter will have me around- and this has given me a real sense of perspective on the breast feeding to be honest. She got what little colotsrum I could give her, and she is a heathy strapping girl. I would say to anyone else, try your best, but if it doesn't work out, don't tear yourself up over it - it isn't worth it, and you could drive yourself into despair when it should be a happy time.

I also wanted to say a thanks to Fadbook as it was your post that made me more aware of my moods and make a fuss!

[mercibucket]

wow, what an ordeal, you poor thing, i am so glad you are ok now and wish you all the best for a speedy recovery. sounds a v scary time!!

[ZeroTolerance]

Oh Tea, what a terrifying experience - I read your last post with my heart in my mouth. I'm so glad you are safe and on the mend but so sorry you've been through hell in the short time since giving birth. I had a ruptured ectopic pg a while back and was in similarly dangerous territory so I know the shock you must have felt. It does indeed make you think about what's important. You are so so right with what you say about the breastfeeding. It pales into nothing compared with what you've been through.

I absolutely empathise with your comment about the wonder of modern medicine and just being here for your beautiful daughter.

I hope you have some support over the coming weeks as you combine getting back on your feet with caring for your baby girl. Good luck

[FadBook]

Fuckin' hell was what I just said out loud Tea and I've just had to explain to my DP why I was talking and swearing to the computer

It sounds horrific what you went through, I hope that you are ok now and resting. It puts BF'ing in to prospective doesn't it?!

I'm so glad I mentioned retained placenta in my post - I believe it is common when you've had a manual removal after delivery as they can't 'tug' on it too hard in case they tear the wall; and if it is missed, there is huge risk of septicaemia because of it too.

Thanks for updating us. I hope you enjoying cuddles with your DD. So pleased you are ok now

[Trying2bMindful]

Christ. You poor thing. I came late to this and was about to post my story but then read your latest post OP. so glad you are on the mend.
Keep well & enjoy the lovely snuggles. Formula was invented to deal with emergencies and it sounds like you def fell into that camp.

For anyone else who reads this later I will add that I too have hashimotos hypothyroidism which was diagnosed before pg & i take 150mcg thyroxin daily. I too had milk supply issues at the start, not helped by PFBs PTT. However we addressed that AND I followed Dr Jack Newmans advice re taking 9 tabs of domperidone daily, pumping, skin to skin, fenugreek supplements, right latch etc. This worked.
I understand that there is anecdotal evidence that thyroid patients can have bf issues, despite medication. I gather this hasn't been researched so there is no understanding why.
Domperidone really did make a difference so it is worth getting hold oaf supportive LC who will write a letter to yr GP requesting the prescription & sending them dr jack Newmans info.

[Ragusa]

My goodness, you poor woman. I am not surprised bf didn't work out - it would have been nothing short of a miracle if it did given your perfect storm of medical challenges. First thing I thought when I saw your post just now was 'retained placenta'.

I BF my first after a huge struggle, mind. However.... I formula fed my son (second child) for various reasons and largely against my will, and I can categorically say it has NOT affected bonding AT ALL. I think that is largely nonsense and I say that as someone who is very pro-BF. Just snuggle, don't let randoms feed her and take her off for hours at a time, and hold her close while you do it.

I hope things get better for you from hereon in. Don't feel guilty about bottle feeding - you've been nothing short of heroic!