I Know This Much is True Part 2
I’m sure you have all been in suspense wondering what else I could have possibly endured as a breastfeeding mother after reading part 1. Well I assure you, there is more to share.
This blog will hi-lite the following 3 challenges:
#1) Raynaud’s Phenomenon
#2) Bottle Refusal
#3) The Boobie-Bob
Raynaud’s Phenomenon....What happened then: I would have to honestly say that my most painful breastfeeding experiences involved my first daughter, Kayla. As a new and inexperienced mother, I really struggled the first 6 weeks and literally seemed to have every breastfeeding issue under the sun. Despite my challenges, Kayla was a happy and healthy baby. She was getting lots to eat, napping very well during the day, and started sleeping through the night at 6 weeks of age. On paper, all should have been a breeze, but my poor breasts were taking a beating.
The pain associated with Raynaud’s of the breast can be difficult to distinguish from other sources of nipple/breast pain. Quite commonly, Raynaud’s is mistaken for a yeast infection and treated as such. Unfortunately, diflucan and canestan are not the cure for this issue. My fiery relationship with Raynaud’s started at approx 2 weeks post-partum. I can’t exactly say when I noticed the nipple pain changing as I had pretty much experienced pain since day 1, but I can definitely remember that the pain now felt different from just ‘damaged nipple pain’. The pain I started experiencing didn’t happen right after I was done feeding. It took a minute or two to set-in, and when it did, it was excruciating. It was a deep stabbing pain that started in my breasts but also radiated all the way around into my back. It truly felt like nerve pain and I could hardly stand it. Then I started to notice that my nipple was turning white while this pain was radiating through my body. “What the heck is going on?” I thought to myself. And that’s basically where it ended for me. I knew there was something wrong and I knew this pain wasn’t normal. I just assumed it had something to do with the way Kayla was latching and figured it would eventually get better. Eventually it did, but I never knew what I had until years later.
Raynaud’s........What I know now: Raynaud’s phenomenon of the nipple is usually caused by a poor latch. A poorly latched baby will spend most of her time compressing the nipple on the hard palate leading to eventual vasospasm (constriction of the blood vessels). It is the vasospasm that causes a color change in the nipple. Often the nipple will turn white after feeding but sometimes can turn red or blue. This is extremely painful and can be described as a burning or shooting pain in the breast that can radiate into the back. First and foremost, the latch should be corrected. If the vasospasm doesn’t go away after correction, a few other comfort measures can be taken. #1) Pectoralis muscle stretches before a feed help to increase blood flow to the breast area thereby decreasing the likelihood of a vasospasm. I usually have moms do these stretches in the frame of a door. #2) Applying heat to the center of the back during breastfeeding helps to ‘calm down the nerves’ that innervate from the breast into the back. A magic bag or heating pad work very well to achieve this. #3) Covering up the breasts or applying heat to the breasts as soon as the feed is over helps to reduce vasospasm. If these treatments fail, sometimes Nifedipine 30 mg long acting tablet once a day for two weeks is prescribed (calcium channel blocker, used in high blood pressure).
Bottle Refusal....What happened then: I’m not going to spend too much time on this topic because as a Lactation Consultant I am not an advocate of bottlefeeding. But as a busy working mother, I know that for a lot of families, bottles are a reality. With my first daughter Kayla, I gave her an occasional bottle every once in a while the first 2 weeks. Then I stopped altogether and decided again around 6 weeks to try bottlefeeding again. By that time it was too late. She would have nothing to do with any type of nipple I tried and I literally bought every bottle out there in hopes that she would drink my pumped milk that was quickly filling up my freezer!! I tried every trick that was suggested. I left the house, I had my husband, my brother, my sister, and my mother offer her the bottle but to no avail. I tried waiting until she was starving to finally cave into the silly silicone device that was being shoved into her tiny little mouth. But she was too smart for any of that nonsense and refused every single time. So I really couldn’t be away from her for more than 3-4 hours for the first 6 months. It wasn’t easy for me but especially stressful for anybody that I would leave to watch her. If she got hungry, there was nothing that could be done until I returned home. So with my second and third babies I basically combined fed them right from the beginning. My second daughter Alyssa, was small for gestational age and required supplementation right from the start. I continued breastfeeding and bottlefeeding her until she weaned herself at 9 months of age. (Side note: I do think that her early weaning and early introduction of bottles are related) Maya, my third daughter was also combo fed but I waited until she was a few weeks old before I started giving her the occasional bottle of pumped milk. She transitioned nicely from breast-bottle and I nursed her until she was 13 months old.
Bottle Refusal........What I know now: If you would like your baby to have the occasional bottle (of pumped breast milk of course), don’t wait more than 4-6 weeks to introduce it. After that time, most babies will refuse to feed from an artificial nipple. It doesn’t matter if it’s Dad, or Grandma, or the babysitter giving the bottle, most of the time it is not going to happen!!! The reason for this is that babies are very very smart. The way they suck on a bottle nipple is very different from the way they suck at the breast. They coordinate their jaw muscles, ligaments, and tongue very differently. It frustrates them when we change up their feeding routine so most of them flat-out refuse. I have worked with quite a few clients who want my help with introducing a bottle to their older babies. Most of the time, it doesn’t happen and I spend time counselling them on why it won’t work and we end up having the discussion around introducing a ‘sippy cup’. If the infant is closer to 4 months of age, I say forget the bottle idea altogether and start working with the cup. Most babies at 4-6 months of age are ready for the sippy!
The Boobie Bob.....What happened then: This little phenomenon occurred with my middle daughter Alyssa, and then again with my third daughter Maya. I call this section the boobie-bob, because they would bob on and off the breast like little birds. There were times when I was pretty sure the girls were hungry so I would try to breastfeed but they would just latch on, then pop off and cry. Latch on, then pop off and cry. I would get super frustrated and stressed out because I was positive they needed to eat but for some reason just would not stay latched onto the breast. So this little battle would persist for 10-15 minutes at a time. Sometimes it would end with them feeding, other times it would not. Bottom line, it really frustrated me and I’m pretty sure my girls could sense my frustration too.
The Boobie Bob.....What I know now: The Boobie bob is your babies was of saying “Mom, I know that sucking is soothing and I am tired and want to use your nipple to soothe, but I really don’t want to eat at the moment.” That is why they bob. They want to suck to help them settle but if they sense that the milk is starting to flow, they will pop off and get mad because they aren’t hungry. Most babies for the first few months can only stay awake for approximately one hour. Quite often the cues a baby shows when they are hungry are the same they show when they are sleepy. So most moms assume if baby is rooting and putting her hands in her mouth that she must be hungry and needs to feed again. Yes, sometimes she is especially if it’s growth spurt time. But most of the time, if she has just fed within the hour, and she is acting hungry again, it’s because she’s tired and she wants to pacify in order to fall asleep. I always tell my moms, “When in doubt, offer the breast”. If baby is acting hungry, then always try the breast first. But if you latch baby on and she starts to bob and it becomes a battle to keep her there, she’s not hungry. So now would be the time to help her settle for a nap without using your breast as a pacifier. I suggest, rocking, swaddling, having her suck on your finger, or passing to daddy for a little cuddle time. If I had known this when I was breastfeeding, I would not have gotten so flustered and frustrated when my babies refused to breastfeed. But as mother’s we are always worried if baby is getting enough to eat or what is wrong with them if they don’t calm down and settle nicely after they have fed. I see this issue a lot with my clients and know how utterly frustrating it can be. I am happy that I can share my own experiences and knowledge with them in order to make their breastfeeding journey as enjoyable and stress-free as possible. I’ll say it again as I have said it before......KNOWLEDGE IS POWER!!!!!
That concludes part 2 of ‘I Know This Much Is True’. I hope you have enjoyed reading it and again, please feel free to comment or contact me with any questions.
Happy Breastfeeding!!!
Leanne Rzepa RN BN IBCLC