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From:
Chris Mulford <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 10 Jun 2006 07:28:43 -0400
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June 10, 2006
Dear Colleagues,

I recently spoke on the phone with a friend who is the mother of a
three-year-old, weaned in the last year (Sept 16, 2005). The thing that got
us started talking was a question about normal post-weaning breasts that I
couldn’t answer. How long after weaning IS it normal for a mom’s breasts to
feel “not normal”…because of pain, nipple sensitivity, etc. Are these
phenomena ever normal? (yes, e.g. nursing during pregnancy) 

Should women expect to settle into some new “normal” after weaning? That
makes sense to me. As I understand it, the breasts grow new glandular tissue
with each pregnancy and lose some of their glandular tissue with each
involution. Other body parts and systems find a new non-pregnant,
non-lactating “normal” after awhile…hormones, uterus, vagina, vulva, and
perineum, fertility/fecundability… (How long does it take to get to “normal”
for all of these??? and what is the range of variability in how long
“recovery” takes?)

[Ranting begins.] The more I consider the complexity of the female mammal,
especially the human mammal, the more I appreciate that window of protection
from a new pregnancy that we get with exclusive breastfeeding, and the more
angry I get about the casual attitudes in so many parts of the world and so
many cultures towards early supplementation and mixed feeding. 

And by the way (this is “Chris the language police” taking over), I usually
try NOT to refer to the non-pregnant, non-lactating state as “normal.” When
you’re pregnant, it’s “normal” to tire easily, to put on fat, etc. When
you’re lactating, it’s normal to have a dryer vagina and leaky breasts and
feel different emotionally than you do when not lactating. But being a
pregnant woman and being a lactating woman are both “normal” states of
being, just like being an adolescent or a menopausal woman. [Ranting ends.]

Michele is a myotherapist, so she knows what it is to understand a body
system (in this case, the musculoskeletal and nervous systems) really well.
She spoke with some heat about the lack of knowledge among mother/baby care
professionals about women’s post-partum course and the care she herself
received after her child was born. Three years later it still bothers her.
She still has questions about the physical and emotional side of mothering
that no one seems able to answer. She gave permission for me to post a note
to you 3,000 people who take mothers, mothering, and care of mothers
seriously. I will pass your responses along to her.

Now I’ll let Michele speak:

Dear Chris,
 
Funny you should ask.  Last night...after two milk-less months... milk came
out!  I think the soreness I'm noticing is the same mild soreness one has
while nursing.  Not pain, but not pleasant if nipples are brushed in any
way.  Nursing felt good until she backed off the frequency enough that my
supply dwindled.  Then the nipples felt sore and I was overwhelmed while
nursing not by that lovely endorphin rush but by a sense of irritation,
physically and mentally.  I attributed this to being sucked on with no milk
let down or endorphins (waitaminit- I think it’s a different happy hormone
with nursing but my memory fails me - but you know what I'm talking about)
to counter the irritation.  That's when we quit once and for all (9/16/05).
I could express a drop or two for another six months, but then couldn't get
any out.  Figured I had dried up, but I now wonder how long there is
lactation and lactation-related breast physiology going on even without
visible milk.  And if that's what is making me sore.  Maybe my breasts
simply have not returned to normal yet.  Is there any consensus about what
to expect after weaning, breast-wise?  I can tell you there would still be a
no-touching-the-boobies rule if I was sexually active right now.
 
As for failure of information on post-partum mother care, that must be a
book worth of collected essays.  My key beefs, not adequately covered by the
paragraph or two most books provide on this subject, if at all:
 
The variance in amount of time it can take for different women to recover in
all the different ways.  ie: it's OK if you aren't back in the gym four
weeks later.  Or seven months even.  It can take nine months for your pubic
symphysis to reconnect.
 
More on after care for the body; skin, muscles, hair, pain, what's going on
"down there" during recovery.  All the different treatments and remedies
that can be tried for all the different possible... uh, things.
 
Thyroid.  It's not uncommon for thyroid levels to tank post-partum, even
months later.  It's also very easy to mistake the symptoms for
infant-care-related exhaustion.  Undiagnosed hypothyroid can be very
dangerous.  What every mother should look out for.
 
Post partum depression.  There must several different varieties.  This can
NOT be covered by the patronizing caution to be on the lookout for the baby
blues and see your doctor for some pills.  A woman needs at least an
overview of the various causes and their respective effects in order to be
adequately prepared to recognize a problem early enough.  There's that dip
in hormones a couple days after birth, there's the flatness over the next
few weeks coming from the shift of everyone’s attention from mother-to-be to
baby, there's stuff that can hit you weeks or months later like the major
adjustment to "Birth of a mother" (ref book of same name); becoming a
different person - très mindbending - the change in relationships and roles
within the family, sometimes huge stress on a marriage.  and of course the
famous isolation, especially for those women who don't have a big
baby-friendly social circle or nearby extended family in place, or those who
can't get about easily.
 
And my number one beef to the whole medical profession and society in
general: recognize that a nursing mother-baby pair (and even beyond that to
varying degrees) is a symbiotic unit and should be treated as such.  You can
NOT responsibly and sufficiently treat illness or wellness in one without
treating or at least being observant of the other at the same time.  If the
mother has low thyroid, you MUST check her milk supply or the baby may be
suffering (happened in my case). If the baby is ill, the mother needs care
too because her immune system needs to be kept up and it's a given that the
stress of an ill baby will be lowering it.  (Thank god for nursing here, but
it's not always enough).  Actually, “props” here to the pediatricians'
offices that will give flu shots to mummies along with their children.
That's the one time I've seen us both get treated as a family.
 
I could rant for days!  and I haven't even started collecting other women's
stories.  This is one of those areas that is SO important and probably
doesn't get what it deserves because the ones who really know about it best
have their hands full of babies and don't have time or energy.  I was
dismayed at how little my previously super-attentive midwives had to offer
in terms of post-care or information.  Maybe LC's could help fill the gap?
I don't know if I can ever get this done on my own, but I'd collaborate in a
heartbeat with anyone who wants to help me write this.  I'll be interested
in any feedback you get.  Thank you so much for asking!
 
Michele


Chris Mulford, RN, IBCLC
LLL Leader Reserve
working for WIC in South Jersey (Eastern USA)
Co-coordinator, Women & Work Task Force, WABA
 
 

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