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Difficulty breastfeeding following traumatic birth and now possible infection

(26 Posts)
Benjy Tue 22-Jul-08 16:03:36

Hi

I gave birth to my daughter 11 days ago. The labour was v. difficult: back labour, failure to progress so ended up with several interventions and whole thing lasted 40 hours from first contractions five minutes apart to the birth. Drs. and midwives refused my request for pain relief until I had been in labour for nearly 24 hours: contractions by this point were practically on top of one another and lasting over a minute. Epidural then did not work but they would not resite or top it up. End result highly traumatic labour for me though amazingly baby showed no signs of distress.

She breastfed once after delivery but from then on would latch on for comfort but would not feed (I refused pethidine so she wasn't affected by my pain relief choices). I desperately wanted to breastfeed and asked for help in my birth plan and from the midwives on the maternity ward but I didn't get any other than instructions on how to do it. Nobody stayed with me through an attempted feed to show me how. End result was that I had to top up with formula because she wasn't feeding at all and now I feel like I have failed at that as well as the birth. I continued to latch her on and have expressed so she has had some breastmilk each day but I have never produced more than about 1 floz a day - my mature milk hasn't come in. Also I am only producing colostrum from one breast; I had a large lump removed from the other a few years ago and imagine some of the glandular tissue must have been lost. I have told several midwives about my difficulties but none has been able to offer help. They are surpised my milk hasn't come in and that only one breast is producing but can't tell me why or what to do about it.

The other issue I have is that she cries constantly and will only settle eventually if she is held. The second she is put down, she starts to scream. Have checked for all the usual causes of crying. I think we're giving her enough formula but am not sure to be honest how much she should be getting and at what rate to increase her feeds. She is on 60ml per feed (every 3 hours) at the moment (she weighed 6Ib 8oz at birth). I think she is just a baby that needs to be held but I'm finding this so difficult. My DH returns to work next week and I have no family or friends nearby so I am worrying about how I will cope.

The other issue is that I have been in severe pain the last couple of days with heavy bleeding. I went to see the GP today and he has put me on antibiotics for a suspected urine and uterine infection - Ciprofloxacin - so I can't feed my daughter breastmilk for the next few days. If it hasn't cleared up by the end of the week I have to go back to the hospital for a scan to see if I have any retained placenta. I wondered if this was maybe a reason why my milk hasn't come in because it was my understanding that it was the expulsion of the placenta that triggered the hormones needed for milk production but the doctor said he hadn't heard of this (he was an OB/GYN before training as a GP).

I know I have posted a lot here and will probably copy the post onto other boards as it crosses a lot of subjects. I am finding it hard to cope with, particularly the birth and it's aftermath and my daughter's constant crying and need to be held, so I would really appreciate any help and suggestions.

MamaG Tue 22-Jul-08 16:06:13

Hi Benjy

I replied to your other thread as follows

OK, others will be along who are much more knowledgeable than me, but here is my 2p worth.

Firstly: well done for posting and asking for help. No need to feel bad about anything IMO.

Re feeding, I recommend that you ring a breastfeeding counsellor for advice and have a look at hunker’s website www.howbreastfeedingworks.com

Re holding – your baby is so little, give her lots of cuddles and maybe think about co sleeping, don’t panic about getting her to settle on her own just yet, she’s only tiny.

Best of luck

VeniVidiVickiQV Tue 22-Jul-08 16:07:36

oh what a tough time you've had sad

I dont know the answer to your question, but will namecheck tiktok and hope she comes along soon smile

KristinaM Tue 22-Jul-08 16:10:45

again, sorry i have no advice but bumping for you

Becky77 Tue 22-Jul-08 16:27:09

I really feel for you... No advise but just hang in there and don't feel bad about bottle feeding if that's what you need to do to take the pressure off. The early days after birth were the most emotionally traumatic of my life... Not being able to provide for my beautiful perfect daughter (she wouldn't latch on without screaming and it would take forever) was heart breaking... She's 6 weeks old now and things are easier... But I still remember vividly where you are. I hope things get better soon

tiktok Tue 22-Jul-08 16:27:52

Oh, Benjy What a terrible time you have had and angry at the people who are paid to help you properly and who have failed you

Firstly, in answer to specific questions:

* retained pieces of placenta can affect milk coming in, yes (and why your doc doesn't know this, I really can't tell!)
* the ab you are having has info here toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~G6LRmv:1 - share with your doctor. Other abs might be more suitable if you decide you want to avoid ciproflaxin

Expressing needs to be done often often often to preserve the supply - at least 8 times in 24 hours inc at least once at night. Otherwise the milk disappears. This is hard work, but these are the facts.

Has your daughter been weighed recently? If bf is not going well, she may need more milk to stay happy - it is fine to cuddle and hold her but of course you need support and someone to cuddle and hold her, and you, from time to time I would say it would be important to weigh her at this point, and also to check she is pooing lots, which is a sign of sufficient feeding.

Lots more to deal with, but you need to talk to someone, I think - I am a bfc with NCT and we have our line on 0870 444 8708 but there are others and you can try them all There may be a no. of reasons for things getting off to a slow start and it's worth talking about them.

Your dh - can he take more time off?

Hope this helps.

kiskidee Tue 22-Jul-08 16:28:03

here is a document from the Breastfeeding Network about the antib you were given. Look near the bottom for the one I think you were prescribed.

So far your PN care has been appalling. I can't believe the MW's attitude. To me it amounts to neglect.

I find it amazing that they are waiting till the end of the week to see if you have retained placenta. Someone with more experience will hopefully tell you how to get a rocket up some backsides because IMO something like retained placenta should be investigated as soon as it is suspected, not wait and see.

Do you have a good relationship with your GP? I would try to get an urgent referral now.

Please phone the helplines already recommended. I cannot imagine how distressed and lonely you are feeling right now.

ScaryHairy Tue 22-Jul-08 16:35:39

Firstly, congratulations on the birth of your daughter.

It sounds like you have had really crap post-natal care. Can I make a suggestion? You must still be under the care of the community midwives who work out of the hospital.
I suggest you try them first, and failing that call the post-natal ward that you were on. Explain to them that your milk has not come in and that you are worried because you are bleeding and are concerned re retained placenta. I would suggest that maybe I should not have been discharged if I were you. Ask them to get a consultant to call you and speak to you. They may be able to get you in sooner than the end of the week for a scan.

Alternatively get your partner to call your GP and explain that you need to have a scan sooner than the end of the week. I am concerned that your GP would leave you hanging like this, and it is simply not on.

Heated Tue 22-Jul-08 16:41:21

So sorry you are having a rough time. Your experience could be mine with my first, from terrible hospital delivery & advice, delayed milk & infection. I was stuck on a breast pump, struggled with bf for 3 months, ended up expressing and went on to bottles. I realised through MN I should have contacted a bf counsellor who could give day-to-day practical support and there's even bf groups - had no idea they even existed!

Benjy Sun 27-Jul-08 10:07:03

Thank you for all your advice.

I am allergic to penicillin and cyclosporins, which is why I was prescribed ciprofloxacin. I took my last tablet about 48 hours ago and I was wondering when it would be safe to give DD expressed milk again. Should it be ok now?

Also, I saw a health visitor last week who said I should be expressing manually rather than using an electronic pump (have been using medela swing pump). I think she was suggesting it would be better for milk supply. Is she right?

WilfSell Sun 27-Jul-08 10:32:10

Hi BEnjy, Sorry you've had such a terrible time - i hope you've managed to call a BF counsellor now? MW's advice about the pump doesn't seem right given you need to pump so frequently if you want to keep the supply up to move back to BF. An electric pump is going to be speedier and you'll need to pump a lot. Are you sure she knows what she's talking about re BF? Ask if she has BF and what training she has done?

I'd just go straight to the BF counsellor TBH - they're the real specialists and will have the very latest and best advice in a way that most (not all) MWs won't.

ILikeToMoveItMoveIt Sun 27-Jul-08 10:38:28

Benjy - I believe the Medela swing is the most efficient on the market, so I would say your HV is talking out of her rear-end.

I hope things improve for you, you've been doing brilliantly.

WilfSell Sun 27-Jul-08 10:42:42

Sorry - it was a HV not MW - IMHE they know (on average) less than MWs about BF...

kiskidee Sun 27-Jul-08 10:51:39

I would go with the electric too. I believe the Medela swing is a single pump and for the amt you are expressing in the short term, it may be worth considering renting a double pump as it will reduce the expressing time.

The NCT rents them. Please please please call a help line if you have not already done so. You seem v determined and they can make these difficult times easier for you.

bladders Sun 27-Jul-08 11:22:59

Sounds like you have had a very hard time. My fullest sympathies. I had a very similiar experience and just wanted to offer a little bit of advice with the formula feeding. I followed the guidelines on the back of the packet religiously when I started using it. Sometimes they just need more though! Or more frequently. So I would always make up more than they suggest. My little girl kept crying and crying and wouldn't settle and it was because she was hungry. When the midwife suggested giving her more she got a lot better. we also tried infacol as well, and then gripe water when she was a little older. Fab stuff if they have wind.
I used the mendela pump to express and it is excellent.
Its horrible dealing with the after effects of a difficult labour. Everyone expects you to just put it behind you and focus on the new baby, but its easier said than done. It does get easier with time. I hope you are getting better support now medically and with the breastfeeding as well. its fab if you can breastfeed, but if it comes to it and you can't, try not to beat yourself up about it. You will still be a great mum.
People on here rave about slings with babies that cry a lot, could you try one of those.

Keep talking to people. You can get marvellous advice here. I wish I had used it when I was in your situation.

Benjy Fri 01-Aug-08 16:32:13

I spoke to a NCT breastfeeding counsellor who wasn't very helpful. She reiterated other advice I've received that I should express eight times a day but didn't give much advice about how to establish feeding at the breast, which is what I really need. I am trying my daughter at the breast before each feed. She latched on three days ago and had a short feed but ever since she has become distressed if I try and latch her on and screams and pulls her head away and hits out at my breast. I am worried that by continuing to try I am reinforcing her rejection of the breast and making the problem worse but if I stop trying then that's giving up on breastfeeding, isn't it? Or is there another approach to getting her to latch on and feed I could try? The counsellor did mention a tube that I could attach to my breast that I could feed my daughter formula through but said that this was a last resort and I wasn't there yet so didn't give me any details. Has anyone else heard of this/know any more about it? I'm also wondering whether I should try nipple shields as she is used to artificial nipples now. I think this is part of the problem with her refusing to latch on and wondered if I could use nipple shields as a means of reintroducing the breast and then drop these if she has a few successful feeds using them. Is this likely to help or is it a bad idea?

I did meet a different health visitor this week who has been more helpful than any midwife/health visitor I have met with so far. She watched me try to latch DD on and said my positioning was fine but agreed that DD seemed too distressed to feed. She runs a breastfeeding workshop at my local health centre and I am going there on Monday for more help but I am concerned about keeping going over the weekend. If I persist when my daughter is so upset will I make it worse?

Also, my DD still refuses to be put down so I am just not able to express 8 times a day. I am doing what I can but even at the beginning I only produced 10-20ml from both breasts over a day and now the most I get is a few ml, too little to give to her by bottle.

I am beginning to feel that I can't do this but I don't want to give up. Does anyone have any more advice or ideas? Any suggestions about how I can get my daughter to latch on, in particular, would be appreciated. I manually express a little before each try so she tastes the milk, rub her upper lip with my nipple, position her correctly, etc. so it's not that. Am at a loss what to try next.

gybegirl Fri 01-Aug-08 17:02:44

My DD used to hit out with her hands too so I tried just wrapping her very gently in a muslin to help latch her on initially. Don't think of her waving her hands as her rejecting your breast - it's not!

Try to feed near or at the breast, even it's from a bottle and maybe try when you think she'd not hungry (the cry is the last part of the hunger request).

www.drjacknewman.com is also a great source of info and has vid clips etc to help. Plus hoping this bumping will get someone on who's more experienced (although may have crossed posts).

Really well done you on keeping going. She's a lucky girl to have you smile

EmmyJo Fri 01-Aug-08 17:05:25

Hi Benjy
I went through something very similar with my ds - now 3 months and breast feeding fine. For me the nipple shields were the key to getting him to latch on. I did have to sterilise sveral shields per feed as he would knock them off regularly and also struggled to wean him off these later on but at least it got us started.To begin with he would cry and scream and scratch/ hit my breast and pull away but I was helped by a lovely MW to just give him loads of time - ie expect each feed to take an hour plus - and slowly he began to latch on with the shield. I was also using a dummy to settle him as he was very colicky and I think the similar sucking sensation with the shields got him used to the BF. We were using formula to keep his weight up at the time and now he is happy with a bottle as well as the breast - so mixed feeding has been easier in the long run. I think you are doing brilliantly with little support - especially to keep offering her the breast and preservering. Have you tried different positions? My DS loved lying down feeds once we were shown how to do it.
With the expressing - it sounds like you need someone there to help hold your DD while you express. I did manage to develop a way of holding the LO while he was asleep and expressing at the same time and although we had the odd spillage sometimes it is the only way! I was using the medela as well.
Good luck. Everyone told me it would get easier and I didn't believe them but it really did in the end.

Benjy Fri 01-Aug-08 17:23:07

Could you tell me how to use the nipple shields? Am I meant to hold them in place?

Unfortunately, friends and family are miles away so I don't have anyone who can help with DD while I express. I am doing what I can but get so little this way that most of it sticks to the side of the container so she gets no more than a mouthful or two a day. I don't think EBM is going to be sustainable or much of an advantage to her long-term because the amount I able to give her like this is so small so really want to get her latched on and feeding properly.

skydancer1 Fri 01-Aug-08 17:40:55

Yes congrats on your child! I had a very similar experience to you but my baby was in special care for eight days which made it even harder to start breast-feeding (Ds was being fed fluids thru nose at first then bottles by the staff there). I ended up just bottle feeding despite many attempts at expressing a tiny bit of milk and giving Ds some of that to supplement formula for the first couple of months but then dried up completely. In retrospect I wish I hadn't given up so easily on actually putting my Ds to the breast and seeing what happened. I wasn't experienced and didn't have any practical help with it either, but I think I was just so stressed out by the birth and anxiety about my Ds (also my first) and the fact that he would seemingly get frustrated quickly by being on the breast (I think he got accustomed to the easy old bottle within four days and couldn't understand why the sucking didn't work on the nipple. Anyway not to worry if you end up having to bottlefeed (there are a few little advantages) and your baby will no doubt be fine with that. I think if I had been a 2nd time mum I would have persisted more with breast, but I remember being frantic to get everything right instantly for my child.

What I would say is get your own health sorted, when you're off the antibiotics get a visiting midwife to spend proper time with you helping you with technique (or there's the "La Leche leauge" to support you via the phone. Just try it before bottle-feeds or if your baby too impatient try it between bottle feeds. Get all the help you need from friends or family for household stuff. And this is going to sound impossible I know but it is going to help both of you most if you can relax and de-stress yourself. You could try going to children's osteopathic clinic as I did after my back to back/ventouse birth. My baby was crying a LOT for the first two months but not constantly. Some people told me that there is a slight chance of temporary neck pain for babies born that way. The children's osteos are incredibly gentle and mainly work through holding the baby, diagnosing and cranial suggestion - definitely nothing like adult osteopathy. BUT - they also give you a bit of help/attention too - wonderful! As it turned out they thought my ds just had a bit of pelvic cramping from his womb position and his neck hadn't been effected by the sunny-side up or ventouse issue. www.patient.co.uk/showdoc/26740271/ - 21k - This may of course not be at all relevant to you but you did say any ideas welcome! Good luck and just to use that old cliche - will get easier.

EmmyJo Fri 01-Aug-08 20:28:12

The shields we used kind of stuck to the skin - especially when you take them straight out of the steriliser and they have a bit of moisture on them. Holding them in place with one hand as you bring baby's head towards your breast definitely helps. Can you have your partner or a midwife with you for the first attempt to hold the baby and bring her to you while you get used to it? I ended up having to be very demanding with midwives re them visiting me everyday until BF was established - I think I drove them crazy. I hope it helps and that your mature milk starts flowing as a result. Mine did once he got the hang of the shield - I had to endure some painful sucking with nothing coming through until eventually I started supplying to meet the demand. Keeping my fingers crossed that the same happens for you.

Benjy Tue 05-Aug-08 10:21:40

I am using the shields now and she is feeding from the breast if I use them.

She has only ever latched directly onto the breast without the shields on two occasions since she's been born but when she did so she had a really good latch taking in plenty of areola and feeding did not hurt.

Now I'm using the shields, she will feed each time but she is only latching onto the teat and therefore my nipple and I now have v. painful and cracked and bleeding nipples. Is there anything I can do to improve her latch onto the shields?

Benjy Thu 07-Aug-08 17:22:46

Bumping

Can anyone help with this? Close to giving up now.

ChasingButterflies Thu 07-Aug-08 17:46:44

So sad for you Benjy, but wowed by your perseverance. My ds had trouble feeding in his first couple of weeks, not as drastic as your dd, but here are some things we tried that might help:

- the tube the bfc referred to sounds like this. I used a version of this, but under the guidance of a lactation consultant - I'd suggest getting some help as it can be tricky. But it got my ds back on the breast

- it sounds as though you could benefit from an expert spending some proper time with you and your dd, watching her feed. I think the bf helplines can send someone if you ask, but if you can afford it, you could try here. (Click on "find a local lc".) This was the single best thing I did to get ds bf-ing again. One of her tricks was dabbing EBM over my breast and just letting him snuffle his way on to the nipple; it worked.

- see kellymom for brilliant advice on how to maintain your supply through expressing and also here for storing the milk you do get - it's worth keeping even tiny bits as you can refrigerate/freeze them and build up a full feed that way.

- I've never used these but have heard only good things on MN about how quickly they can heal cracked, bleeding nipples. Also do use lots of Lansinoh cream

Good luck and do keep coming back here - there are lots of experts who will be able to give you good advice

LynseyKCalvert Thu 07-Aug-08 18:03:40

You poor thing. Are you still on meds? When are you seeing GP next. You need BF friendly meds. Have you contacted the Breast Feeding Network?www.breastfeedingnetwork.org.uk tel 08709008787 They will help and give advice about meds.

Next order a sling, fabric is best, look at ring slings, mei tai etc My DS was the same and a sling was my saviour.

Then GO TO BED! Strip off you and babe, eat chocolate and drink alcohol free beer (becks is my choice) the brewers yeast helps boost supply (chocolate is just to make you feel nice )
Try to get as much skin to skin contact as possible as this will stimulate your supply.

I hope this helps for now. Please let me know how things are going.

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