Arthritis sufferer - want to b/f DC2, advised to mixed feed... advice please

[LenniEd]

Apologies in advance for long post...

I have a type of inflammatory arthritis similar to rhematoid which stopped me from breastfeeding DD at all due to meds. Am 28wks pg with DC2 and am not on meds at the moment. Really want to breastfeed. Because my arthritis is active even during the pregnancy (last time it wasn't) there is a good chance that it could flare badly after the baby is born and if/when that happens I have to go on meds straight away which I wouldn't be able to breastfeed on. That would be the end of b/f for me unfortunately as once on the meds I can't come off them again for a few months. Last time I didn't have a flare for 10 months though, so there is hope of 6 months exclusive feeding.

With the potential flare in mind (and also my reduced mobility at night when joints are stiff) I have been advised by consultant to introduce bottles from early on so that DH can help with nights if needed and if I need to stop b/f quickly then the baby is already used to bottles. I asked about expressing, and he said this was fine, but the baby just needed to be used to the bottles.

I spoke to my v experienced midwife about this and she told me that the early morning feeds are the most important to establish supply so really I need to be doing all of those myself. She also said that suddenly stopping feeding would not be a good thing to do for me or the baby. Now feel very confused about my options and am starting to wonder whether I should just give in and bottle feed.

Would love some advice from some experienced Mums...

Should add that I do realise that it may not be as easy a decision as this anyhow and things might not work out with b/f but what I mean is it is my fullest intention to give it the best go possible iyswim

Can I just double-check at the risk of being patronizing - are you completely confident there aren't any bf friendly meds you could take in the case of a flare-up?

This is the section on anti-arthritic meds from the Hale forum:
66.230.33.248/discus/messages/48/48.html?1217015054

I would question the logic of needing to introduce bottles just incase you end up needing them. If there was a situation in which you needed to end breastfeeding quickly there are plenty of immediate options - finger feeding, cup feeding, syringe feeding. You can also get a cup feeder from medela that look a bit like a bottle in that it has a reservoir but avoids that teat/ nipple confusion issue. I really wouldn't introduce a bottle to a young baby before breastfeeding is established just incase. You just don't need to and could be risking latch problems,issues with tongue positioning, flow confusion, supply issues etc. And if you did need to stop bfing suddenly you wouldn't necessarily be at risk yourself of blocked ducts and mastitis if you had a decent pump and reduced pumping gradually. Basically what I am saying is that the possibility of having to stop suddenly is certainly no reason not to breastfeed. Every day and every feed counts.

Your midwife is right that the early morning feeds are very valuable to supply (as prolactin hormone levels are higher then) but in the early days (and for several weeks) every feed counts. Milk supply is all about supply and demand and long intervals without breast stimulation can have reprocussions.
It's going to be important to have a real good pump at hand. Obviously not one that requires you to do manual work so I would spend time getting the best one you can afford and looking into different pumps. And if someone else does need to do a feed you can pump as an alternative to try and break up those long intervals. But DH can also help by bringing baby to you and helping with positioning if you feel uncomfortable.

And just to respond to your paranoia - if you can get your soldiers lined up and have your support network in place breastfeeding works for the VAST majority of people. Find out where the local bf counsellors are, the local groups. Phone the national helplines and ask where the local counsellors from each organisation are close to you. Find the good message boards. Do you have a lactation consultant near you?
Breastfeeding often doesn't work out when people are let down and unsupported. They may be given poor information or just not have the support there at the times they need it. Make sure your DH knows how important it is to you as well. Latching and positioning are key. Getting enough breast stimulation is key. You don't want to be scrabbling around looking for support when things are already going pear-shaped. You want to think 'this feels a bit sore. I've already spoken to this bf counsellor about maybe visiting to me post-partum and here's her phone number'. Believing that it will work (putting aside the flare-up issue for a moment) is a big psychological help.

you could try getting an electric pump and bottle feeding with ebm, if it comes to that? i know of a mum who was separated from her baby but he is still exclusively fed on her breast milk from a bottle.

Thanks ladies - the meds I need are very specific as I have issues with my white blood count on most of the drugs so can only take a couple of different ones and can't b/f on either of them.

Excellent advice to get to know the helplines etc in advance, hadn't thought of that, will start doing some research.

Midwife implied that suddenly switching to formula once feeding is established could cause stomach upsets and things with the baby - does this happen often? Am I going to need to freeze a lot of EBM in case?

It would be ideal to pump like crazy and get as much ebm in the freezer as possible but obviously this has consequences for your immediate supply and can tip you into oversupply. Yes some babies react to formula but to be honest I think that is probably not the concern here. If you have a flare-up and are back on meds I'm sure you will have other worries. You could transition to formula using ebm but a lot of babies who use formula make the move abruptly - a breastfeed followed by a bottle of formula. I'm sure your midwife would not want her advice to discourage you from bfing at all.

I would also caution about storing large amounts of early breastmilk for use over time as your milk changes to adapt to your baby as s/he grows. And certainly at 3 months my ds wrinkled his nose when offered ebm from when he was a newborn.

I think the consultant actually makes some sense in suggesting you offer your dc a bottle everynow and again. I can recommend tommee tippee closer to nature ones.

and maybe (don't shoot me here) it is worth buying some single feed cartons of formula and offer your dc a few oz of each in the early weeks to see which one they like/tolerate so you knw which one to use if needed.

I think you are fab for doing all this planning and thinking ahead so you can breastfeed. it is clearly very important for you and I keep everything crossed that the flare up stays away.

OK, thank you - will start looking at pumps, TBH I had been seriously procrastinating on getting one as really don't know anything about them and I take so long over making decisions, really need to read up and search for some info on them. So expressing+freezing a good idea but not too much.

A couple of practical issues then - have invested in a co-sleeper cot that attaches to our bed so that I don't have to get out of bed at night to feed the baby as my hands are the biggest issue at night, followed closely by my knees. How much control do you need of your hands to be able to get the baby latched on? I can pick up a glass of water during the night, but wouldn't be able to turn the pages of a book very easily - is my fingers that are the problem really I guess.

Also, I am uncomfortable if I am sat leaning backwards - have to either be sat bolt upright or laid down. Can you b/f sat bolt upright or do you need to lean back slightly? A bit of a strange question I know, but all the Mums I have seen feeding always seem to be reclined in comfy chairs

reclining is not a good position for feeding in. hard to get the position right and not great for milk flow. up straight with lots of cushions/pillows is better, lying down works for lots of women (just not me for some reason), how are your shoulders/elbows? would they get stiff if you would rest on one arm for some time?

latching on will be harder at first in terms of hand dexterity so your dp may need to help. later your baby knows what they are doing and it will be easier.

Could you contact an nct/lalechleague breast feeding counsellor to talk about position with you right now? If you practise with a doll or big teddy you may have some idea whether lying down or sitting straight works better for you. also investigate rugby hold, where baby lies kinda next to you on a cushio while you sit up, this means you carry little of the baby's weight.

Thanks MM - Elbows fine in terms of the joint (just about my best joints!), but have psoriasis on the skin over them so can't prop myself up on them for a long time when that is bad, but I can lean on my upper arm. Shoulders can be bad but respond well to exercises so can usually control any stiffness and pain in those quite well.

I still do NCT things having done NCT antenatal classes and gone to bumps and babies with DD so know the b/f counsellor. Will be contacting her as soon as I know what I need to ask, just want to be forearmed first as she is lovely but very matter of fact about things and doesn't suffer fools.

How long will it be before the baby knows what they are doing in terms of latching on? And when you are lying down how do you support them, or do they just lie down too? And are my big boobs going to cause any additional problems?

Sorry for all these questions, just want to make sure I am going to make a good go of this.

I hope someone with experience of feeding lying down comes along soon.

If your boobs are big it may make things easier for your poor hands. Mine are big and I have always made a 'sandwich', placing thumb above and fingers below areola (so fairly coarse work for fingers I hope), then move breast to stroke baby's top lip with nipple and when mouth open widepull baby close with your other hand which is in his neck/shoulder area, again fairly coarse work for your hands with little work for fingers.

It's possible to breastfeed in virtually every position you can fathom. Some people do get on well with reclining (www.biologicalnurturing.com)but it is certainly not compulsory. Big boobs give you quite a bit of flexibility with lying down. You can both be on your side for starters. A young baby does have the instinctive ability to want to latch on. As long as they don't need to lift their head weight to stay in position it's remarkable what they can achieve but it's hard to make fast rules. For lying down you don't need to support them necessarily. You could maybe buy a sleep positioner like this one:
www.amazon.co.uk/Babytec-Sleep-Support/dp/B000P5U3WA/ref=pd_sim_by_1
and rip off the pieces (which are removable) so you can be tummy to tummy but it gives some support along baby's back.
If you do a search on google images for 'breastfeeding lying down' you'll see tons of options. The main priorities are keeping your bedding away from baby so if you are using a pillow you are right on one corner of it for example. Your arms can be completely free or supporting baby gently but often with lying down need to do very little. You don't need to be up on an elbow. You can lie down completely. Bigger boobs does give you that flexibility.
With feeding in a sitting up position you may find that a good breastfeeding pillow is pretty crucial to minimize using your hands too much. If you have a short torso then 'my breast friend' can be good but NOT if you are taller. I see a lot of mums using them and having to lift their baby using their hands and arms and baby ends up only resting its bottom on them. If you are longer you may want a bigger one or maybe try this one:
www.johnlewis.com/230195202/Product.aspx
or the widgey.
I think big boobs will generally make things easier as you won't have to raise baby up into position so much. You may find that both baby's nose and chin are tucked fairly close to the breast. Bfing advice normally emphasises tucking in chin and keeping nose clear but with big boobs that isn't possible. Baby nostrils can cope with being smushed against the breast quite well.
Sounds daft but even though you have a bump you can do some practise with a doll as the PP says when it comes to positioning especially lying down.

LenniED

i do have have rheumatoid arthritis as a part of my Stills Disease, I was breast feeding straight until last week when the pain became unbearable (and I'm not in the middle of a flair) so now i'm exclusively pumping and feeding ebm. it's a lot easier on my hands. I'm not sure if i should feel terrible or not but i dont. i feel a little better now that my fingers and wrists are only sore after the day now, vs the horrible pain, i say this because my rheumatologist only suggests i take medication when a complete flare is about, but so far since the pain has come donwn i'm not on anything.

not sure about your specific case, but if you have to take your med, you have to take your meds, they enable you to take care of your baby and keep you from deteriorating at a time that bonding with your child is at the utmost importance. if you can only ff, then so be it as long as your condition is being controlled.

LenniED you've had some very good advice. I'd add that stopping breastfeeding abruptly is not usually advised for you because of the possibility of mastitis. YOu could alleviate that risk by pumping, though.

I thoroughly recommend the Ameda Lactaline double electric pump. I pumped at work for 6 months and found is brilliant.

Thanks everyone - food for thought. Have spoken to NCT b/f counsellor now and she has said the same as most of you and offered any help I need when baby arrives. Am also going to contact a couple of others just in case things don't go well and I need a second or third or fourth option. Thanks again.