Melissa's Breastfeeding and PPD Experience

In 1991, I was 23 years old and miserable with my breast size. I was incredibly self-conscious, and decided to have a breast reduction. My surgeon told me that I would have a 50-50 chance of breastfeeding, which was better than if I didn't have it. (NOT TRUE!) He scared me by estimating how large I would be once my milk came in. I wasn't ready for children yet, and had no clue about the benefits of breast- vs. bottle-feeding, or how much I would regret my decision later on. I wish I had done more research, but I was young and naive. I made the best decision I could with the information I had at the time. Before my son Quinn was born, I did extensive research on breastfeeding after reduction surgery (BFAR). I joined a wonderful listserv dedicated to just that, met with a Lactation Consultant, and came to believe that I would be able to do it. I had every sign of it since I could express colostrum easily from about 5 1/2 months on. Even though I knew that most BFARs must supplement with formula, I chose not to believe that I would need to, thinking that a positive attitude would make a big difference. Here is my story.

Quinn's birth was nothing like I expected (which is another story altogether); I ended up having a general anesthetic for my c-section. But I was at least partially awake within about 45 minutes, and just an hour after his birth, Quinn was brought to me by his daddy, and we nursed for the first time. We were both groggy from the anesthesia, and only nursed 2 more times in that 24-hour period.

We had a lot of trouble nursing in the hospital. Every time we were ready, a nurse had to come and help us get latched on. He cried a lot, and Andy and I were very frustrated. I was really getting scared to go home, because I could not get him latched on without help, especially on the left side. The nipple on that side is less responsive than the right; it's not flat but doesn't come out as easily. The nurses are all highly trained, and were really wonderful, helpful and patient. Andy learned how to help, and soon we didn't have to call the nurses every time. Quinn spent all his time in either my arms or his daddy's, and since Andy pretty much moved into the hospital room with us, we were able to have the baby in bed with one of us from the beginning, which was really wonderful since we'd already been planning to do family bed. I absolutely loved waking up with Quinn's tiny, warm body snuggled against mine, and having his beautiful face be the first thing I saw when I woke up. Twice, though, I latched him on and we went to sleep, only to find when we woke up that he'd repositioned himself and was kind enough to give me a great hickey next to my nipple! That happened once on each side. Ouch!

Before we went home, my Lactation Consultant had been by a couple of times and on discharge day, we had an extensive meeting. She and Quinn's pediatrician also met. Although my milk had begun to come in on day 3, we were already beginning to suspect by day 4 that my supply was low, partially because I was very " lumpy" after the milk came in. Quinn had gone from his birth weight of 8lbs. 3oz. to 7lbs. 5oz., and had urate crystals in his diapers. He seemed miserable; he cried all the time and nothing we did made him feel any better. We nursed a lot, and I pumped several times a day, although that was just for stimulation; there was no output, which was expected at that point. When my LC visited that morning she did a breast exam, and my left breast actually squirted! It was very cool. We were told to bring him in the next day to be weighed, and we'd probably decide either that day or the next regarding supplementation. So on Tuesday we brought him back and he'd lost 5 ounces. His diaper output was good, but that weight loss in one day was too much. We had to start the supplementation. So while my LC taught Andy how to dropper feed the formula, I had to sit on the other side of the room and cry my heart out. I felt like I wanted to die, it hurt so badly to have to give him formula after everything we'd learned about the benefits of breastmilk and breastfeeding, and the "evils" of formula. We got our Lact-Aid, my LC gave us a bunch of formula (we were using ProSobee but have since changed to Enfamil due to soy intolerance), and we went home. Andy made up the first supplement in the Lact-Aid, and another BFAR friend called as Andy helped me latch him on. It helped so much to have someone that could really, truly understand to talk to as I gave that first supplement. By the end of both the conversation and the nursing session, I felt okay.

Over the next few hours, Quinn became like a whole new baby. He had some quiet alert time, and we finally got to see those beautiful eyes! He stopped crying all the time, and allowed us to touch and stroke him. It was obvious that he had been hungry. I felt so much better knowing that we were doing what was best for our son, even though it was breaking my heart that it had to be the formula. I was glad that we hadn't let it go any longer than we had.

When he was 2 1/2 weeks old Quinn had just finished a growth spurt and took 11.5 oz. of formula which was the most up until then. We nursed very frequently, both because he seemed to want to, and because we wanted to get my milk supply up. My LC suggested trying Reglan, a drug that is supposed to help bring in milk, and I talked to my OB, and Quinn's pediatrician. We tried Fenugreek first, and I tried to increase my fluids. The pediatrician only wanted to wait a week to see if there would be any significant increase. I had been putting it off because I had some trouble with my stomach and I wanted to try and clear that up first. We think it was stress; the fact that I rarely had letdown was probably stress also (not that I don't feel the letdown; I know that not everyone does. I knew it wasn't happening because I rarely heard or saw Quinn doing a lot of swallowing). I did end up trying the Reglan, but it caused me to feel on the verge of an anxiety attack all the time, so I couldn't stay on it. I wasn't able to stay on long enough to know if it would have had an effect on my supply.

Things got better for a time. That weekend (just after he turned 3 weeks old), my LC wanted to try an experiment. She told us to take him off the breast for 24 hours, and give him whatever formula he wanted. I was to pump whenever he fed. He took 19 1/2 oz. (that was the first time we gave him bottles - the Lact-Aid had just become too much, and we realized that it would be ridiculous to try and do it for 24 hours using Andy's finger instead of my breasts) and I pumped just 2 1/2 oz. Even though I knew that I didn't let down to the pump, and Quinn was much more efficient, I was just devastated. Then when Andy went back to work, it was nearly impossible to get anything done, like feeding myself, going to the bathroom, and showering, and I got very depressed. Monday night (July 14th - Quinn was 3 1/2 weeks old then) I called a friend and asked her to come over the next day. She did, and took Quinn while I took a nap. When I got up, she told me that she understood what I meant about him - that he was harder than her babies had been! I was really down and cried a lot while she was there. Another friend came to visit, and throughout the day I just deteriorated. I couldn't stop crying. My LC called, and recommended that we just pack formula into Quinn - as much as he would take. My second friend that was visiting started giving him bottles (we had the little nursettes) while I got even worse. She offered to take Quinn for the night so that I could get some sleep, because she firmly believed that I was as bad as I was because I was so sleep-deprived. It hurt me even worse to think about it, but when Andy came home we decided to let her take the baby because I was really out of it by then. I completely lost it when they left and had to take an anti-anxiety medicine to calm down enough to sleep. It was so awful. It didn't help to find out the next day that in that 24-hour period, Quinn took *30 oz.* of formula! I did wake up leaking, and pumped to make sure he wouldn't get any of the medication I had taken. (It took months to throw out that milk; Andy finally did because it had obviously gone bad. When I found out, I was so sad. It was as though I had somehow lost my final link to nursing Quinn.)

The next day I was a bit better, and yet another friend (I have some really wonderful friends!) picked up the baby, and came over and did some housecleaning. For the rest of the week, my friends would alternate either coming over, or having us over and doing really great things for us. I did better until about a week later, and then I had another "meltdown." I had gone that morning to a local playgroup, and then to lunch. I got completely overwhelmed by everything - the heat, the logistics of it all (one of the members came over so I could shower, and we ended up riding together - that was a nightmare in and of itself!) , but especially being surrounded by fat, happy babies that had gotten that way on breastmilk alone. When I got home, I just fell apart over it all. By the time Andy got home from work, I was a mess. I felt completely hopeless, and so disheartened. I just wanted to stop breathing. Although Quinn was still nursing some, it wasn't much because he was taking so much formula to make up for being hungry for so long, and we were also dealing with nipple confusion by then. I felt so guilty for starving him, and for being torn about nursing - for having the reduction at all. The next day I called my LC and asked her what to do. She said to give him his bottle first, and let him take what he wanted, and *then* to offer the breast. She was concerned (as I was) that he was wearing himself out trying to nurse but not getting enough (he has always had a poor suck), so when he got his bottle, he was just too tired to eat what he really needed. I decided to try this. In the meantime, he had his 1-month checkup, and was up to 9 lbs., 2 oz. The pediatrician was very pleased with his progress, and that helped me feel somewhat better.

When Quinn was 1 day shy of 7 weeks, we took him to the pediatrician because he was fussy, constipated, crampy, spitting up constantly, and had a horrible rash on his face. We were advised to switch his formula, and that made all the difference. The rash was gone within 48 hours, and he spit up with much less frequency. He weighed in at 11 lbs., 7 oz.

At 8 weeks old, I wrote:

Quinn is thriving. He is very alert, loving, and cuddly. He can hold up his head without too much bobbing around, smiles often (he has a beautiful smile - he wrinkles his nose and his eyes crinkle up), "talks" all the time, and loves to play with his daddy and me. He is sleeping better, starting to take decent naps, and will allow himself to be put down. He loves his swing, and his baby gym! We are still nursing, though the frequency varies widely. Some days he nurses 5 times. Other days he will only nurse once. I have noticed, though, that in public, he will almost invariably nurse, and for long periods, until he falls asleep. It's as if he is just overstimulated and needs to be comforted by me. (Not that I mind!) His latch has become rather poor, and my milk supply is beyond low. I'm still taking fenugreek just to maintain what I have now, and am thinking about pumping again. I don't know if it will do any good, since we can't seem to overcome Quinn's poor latch, and his suck is still not great. I have a Medela nursing bra coming soon, and will be able to use their hands-free system, so it will be much easier to pump.

I am doing much better, too. I have had two counseling sessions, although I'm not sure I like the counselor. I'm also taking St. John's Wort tincture and L-Tyrosine as antidepressants, which is really making a difference. I still get a little flaked out sometimes, but not like before. I can handle my days, and have even found a way to get a shower every day! I know that Quinn and I are bonding - I am head over heels in love with him! I try to make bottle-feeding as nurturing as I can, by holding him, or sometimes, I put him in his carrier for a bottle if I know he's really sleepy. That way, I can hold his bottle with one hand, and touch and stroke him with the other, until he drifts off to sleep. I just hope that we can continue to nurse, even just for comfort, for a long time.

Just past 9 weeks old:

He is so amazingly beautiful that it stops my heart; his smile lights up my world. I love my son more than life - I never knew that I could feel love so deeply for anyone but Andy. It is wholly different - purer somehow. Sometimes when I touch Quinn, it's like I'm touching Andy at the same time. I can feel them in each other. We have been having so much trouble with nursing and it has hurt so much. I know in my head that I have done all I could and when I look back, there is nothing I can find that I could have done differently. My heart, however, is a different story. It breaks over and over when I think about not being able to breastfeed exclusively. Today, though, I had a conversation with someone and am coming to realize that what's important is how much I love Quinn, how attached we are, and that the kind of mother I am does not hinge on what my breasts can or cannot do. So many people have told me what a wonderful mother I am, and that I do so much more for my son than most mothers would do. I know they're right, but still, I am not ready to give up nursing. Even if we only nurse once a day, I can't give up that once. Not yet. All day Quinn has been a bit fussy, only wanting Mommy. Even his Daddy can't please him enough. Still, though, he wouldn't nurse. So tonight, we got into a warm bath together. Snuggling his soft, wet, naked body to mine, cupping his little bottom in my hand, I offered to nurse. He latched on! It was so wonderful - I knew that I was right, that the time for stopping has not yet come. He would pull off repeatedly as he began to drowse, but each time his little mouth would open, searching to latch back on. After a while, I switched him to the other side. He latched right on and stayed, falling asleep in my arms. It was the most amazing feeling. I talked softly to him as he slept, telling him all about how his daddy and I waited just for him, and how much we love him. I thanked him for picking us to come to, and for giving us the privilege of being his parents. I told him that I hope we can do him justice. Tears poured down my face as I sat with my son in this wonderful warm tub of water, with birds and ocean singing from the tape player, as we nursed, and, trustingly, he slept in my arms. I felt indescribably happy.

Today is September 27th, and Quinn is just over 14 weeks old. Things didn't stay as wonderful as they were when I wrote the above. I did try pumping again, but it was fruitless. It would have been like relactating, and since my supply was low to begin with, it didn't make sense to keep going. I brought out the Lact-Aid again, and we tried nursing with that. At first, it worked okay, although Andy had to latch him on for me, since Quinn never did learn to latch on by himself and the Lact-Aid made it even harder. Sometimes he would even stay on after the bag was empty, which made me feel so wonderful! But soon he realized that the food didn't come as fast, and would scream and scream every time we tried. It became apparant when I tried it at a LLL meeting that he was miserable, and I realized that I was torturing both of us.

After a couple of days without nursing, I wrote:

I have finally decided that I just cannot torture Quinn any longer with regard to nursing. He DOES NOT want to -- that much is clear. I do not believe that it is worth the battle we go through every time, when I haven't got enough milk to satisfy his hunger, or his needs. He doesn't derive comfort from nursing -- he gets it from cuddling. When he is upset, nursing is the LAST thing he wants. I know this, and understand that trying for this long has been for me, not for Quinn. He is fine, thriving, and happy. I, on the other hand, have not been. I needed desperately to know that I had done everything that I could, and now I believe that. The only thing I can think that could have been done differently would have been not to introduce bottles at 3 weeks, but the Lact-Aid requires so much work -- constant filling and cleaning -- and it was killing both Andy and me. But other than that, I know that I did everything possible to make it work. I have been told by 3 LLL leaders and my lactation consultant that I did far, far more than many mothers would have, and although that offers me little comfort, it was nice to hear. Now I think I can (and must) grieve, and get on with life with my wonderful, beautiful child.

Today I boxed up all my breastfeeding supplies, books and clothes, including the Lact-Aid. It is time to get on with life, and stop trying so desperately to make breastfeeding work, when it has been apparant for quite awile that it isn't going to happen. There are so many "what ifs" -- what if I had never had the reduction, of course, is the biggest one; what if Quinn had had a more effective suck, a better latch, or was a more aggressive nurser? What if I hadn't had to have general anesthesia for my c-section? What if I hadn't been so anemic? But none of those things is reality, so I must move on, as hard as it is. The hurt is huge; the grief, at times, is overwhelming. I wish that my mother had impressed on me how wonderful breastfeeding is, and not made me feel self-conscious about my breast size. I wish that my surgeon had not given me false information. I've even wished for a time machine so I could go back and not have the surgery at all. But I must be here, in the now, with my gorgeous, cuddly, sweet son, and my wonderful husband. There is much more to mothering than breastfeeding, and I know that I am a great mom to my miracle baby boy.

A last note:

It is October 23, 1997. Quinn turned 4 months old just 5 days ago. We have not nursed in about a month now, and we are both doing okay. Actually, Quinn is absolutely thriving. He is beautiful, and BIG! He is so bright-eyed, alert, and alive. We enjoy our days together, and spend lots of time snuggling. I am on medication now for the postpartum depression; I wish that I had recognized and gotten treatment for it earlier, although I understand that many mothers realize it much later than I did, and lose a lot of time enjoying their babies while they are still little. I am very lucky to have the incredible support system that I do, and that my friends were so supportive and helpful in my darkest hours. I am also so blessed to be married to the most wonderful man in the world. I could never have made it through everything, and managed to nurse as long as I did, without him. I will never be able to articulate to him how thankful I am for him, and how much I love him. Life is going on, and although I will forever wish that things had turned out differently when it comes to nursing, I know that I am a good mommy to my son, and that it has nothing to do with my breasts. I think that the one thing I would change if I could would be that I would have had a more realistic attitude about what could happen. I would have prepared myself better for the probability of having to supplement, rather than choosing to ignore the possibility altogether. I think that one thing could have made a big difference in my depression. But life is short, and so is the time that Quinn will be my little baby. I have no more time for regrets, so I share my story in hope that it will help just one person to understand, and perhaps to avoid, the heartache that I went through.

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