I have been helping a mother for the last 10 days through problems that most
of you will think are just basic lactation help.  And it is.to her, I am the
local La Leche League Leader.  However, there is no "just" about it!

 

By the time I saw this mom, her nipples looked like raw hamburger - and she
was still breastfeeding, because, she said, the nurses at the hospital told
her the baby was "breastfeeding fine".   Despite this, baby was only 2
ounces below birthweight and she could easily hand express her milk!

 

There was no way to accomplish any sort of latch without total agony, so the
plan was to have her pump and feed her baby using any of the options she and
her husband deemed appropriate - I taught them a variety of methods I'm sure
you all know.finger feeding, tongue extension (AAABBRE is my "trigger word"
as "open" is a tiny mouth), finger sucking/massage, etc.

 

Two days later her nipples were in much better shape and a painless latch
was accomplished with my help on one side and by mom by herself on the
other.  By the next day, mom was e-mailing me about other questions - but
latch-on and breastfeeding was wonderful, she said.we continued with various
e-mails with the usual questions.

 

But this is not the end of the story.  Three days later, mom called me
crying and crying and unable to stop.  Baby had latched on and slept next to
her, and her nipple had again been damaged.  Mom was terrified - didn't want
to see me - could not sleep.  The next day she  called the doctor and was
prescribed Zoloft for PPD.   

 

In my opinion - this mom was not suffering from PPD - but from
Post-Traumatic Stress Disorder!  We often (in our specialty) want to blame
poor childbirth care as a cause for PTSD - long labors caused by inductions,
more interventions followed by unplanned c/s due to failed inductions and
many other "horror stories".  

 

But what about a mom who had a natural, normal vaginal delivery and then
reports, over and over, that her baby is hurting her nipple.and no one
believes her, diminishes her reality and sends her home with no
breastfeeding follow-up?  In her case, I would even compare this to a woman
who reports a rape and people tell her "don't worry, it'll get better".

 

I believe she was re-living the horrors of her first breastfeeding days.and
even though she wanted to breastfeed, she could not bring herself to put her
baby to her breast - this contradiction was playing on and on in her head -
making it impossible to eat, sleep or even care for her baby - she just
cried and cried.  

 

This situation has improved - she got some sleep (thanks to the medicine),
we talked about how she is in total control of whether and when to put her
baby to the breast (she pumps all the milk her baby needs and more), and
yesterday she breastfed (baby was hungry, they had no more bottles and they
were out, and she did.with no pain), and we also went over better
positioning techniques while in bed.    

 

At the same time,  I reviewed with her how she was feeling the first three
days, how helpless and fearful she was when breastfeeding was so horribly
painful - and how that may re-emerge when (for whatever reason) she has pain
when breastfeeding.  Even though this sort of pain is usually transient
(most of us breastfeeding moms have had periods in which breastfeeding is
painful), to her - it re-ignites the memories of the helplessness and fears
she felt the first few days.  She needs to be aware of this, and develop her
own ways of dealing with it.  I encouraged her to attend La Leche League
meetings so she could meet other mothers she can talk and even walk and have
play dates with, but if these fears emerge again, she should try to talk to
a counselor.    

 

This is a cautionary tale.  I know you are aware to never diminish the
report that a mother has pain. (I cannot imagine if mom reported pain in any
other part of her body that was a 7/10 that Health Care Professionals would
ignore it.)  

 

Hospital policies need to go beyond the childbirth experience - and
"exclusive breast milk feeding" is not the only measure of adequate
maternity practices.mothers need to be heard, and helped, too!

 

Jeanette Panchula, BSW, RN, PHN, IBCLC

Vacaville, CA

 

 

 


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