birth - La Leche League New Zealand

Coping with a Prem Baby

Post category:Challenges
Reading time:6 mins read

I would like to share my experience so that it may help anyone out there who has been told that you cannot breastfeed a premature baby.

I had six weeks to go and I was enjoying myself at a Warrior’s game at Ericsson Stadium. Half way through the game the pain in my back started. My thoughts were that the baby must be sitting in a funny position, causing me discomfort and I tried to ignore it. At 11pm the same night I thought maybe there was more to it and rang my backup midwife as my midwife was on holiday at the time. The next morning I met the midwife in hospital and yes, unfortunately, I was in labour. Things slowly, very slowly, progressed. The doctor at the hospital did not see any reason to stop the labour, as the baby was a good size.

Forty-one hours later my beautiful baby boy, Antony, was born at six pounds six ounces (2.89kg); a good size for a prem baby. I got to hold him for about 30 seconds before he was taken away for testing. I kept saying I wanted to put him straight on the breast but this just fell on deaf ears. He was taken to SCBU (Special Care Baby Unit) and put in an incubator just as a precaution. I was told he was very healthy.

The next day was when things became emotionally exhausting for me. I was expressing every three hours to try to bring on my milk. Being so early my body was not yet ready for this. Antony came out of his incubator and went into a cot.
He had a tube up his nose going down to his tummy to feed him, to my horror, formula. I was getting a little bit of colostrum but not enough to feed him completely so he was topped up with formula.

I spent all day and night with him until I had to sleep. That was the hardest time.
Everyone around me in the room had a baby and I felt, after a not so normal birth experience, that I had nothing to show for it. A lot of tears were shed over this week. I’ll never forget crying in bed one night when a nurse came along and asked me if I was OK. I said, “No.” and she asked me if I would like a Panadol. You can imagine what went through my mind. There really should be a separate ward for mums with prem babies.

On day four my milk came through, to my delight. Breastfeeding had always been the only option in my mind. It’s funny, I always thought, you put the baby to your breast, they latch on and hey presto, baby feeding. Boy was I wrong. The nurses at Middlemore Neonatal Unit were a great help. It’s just that they each had their own style. One would say, “Do it this way.” You would try that, then on the next shift the nurse would say, “Not like that, try this way,” and I really didn’t need anymore confusion at this time. Luckily I am a strong person and I put my foot down and said, “This way feels right and this is the way I am going to pursue”. One night I was upset because I had a nurse who didn’t have many patients and insisted on tube feeding my baby. I felt he was not going to learn if he was given the easy way out all the time.

Finally my original midwife (Lesley) came back from holiday and things took a turn for the better. I could not praise her enough. She suggested that to help Antony with latching on I first express to soften the breast, because I was expressing so often I was over producing milk and my breasts were quite firm. She also suggested using a nipple shield to help with latching on. To my relief this worked; not fully, but enough to take the tube out of his nose and allow him to be topped up using a cup. I could see the looks on some of the nurses’ faces but I didn’t care. Day six ended my stay at Middlemore, which had really felt like a prison sentence, and I was transferred to Botany Downs Maternity Unit. Then things got so much easier and better. I think I relaxed more knowing there was no longer the option of a tube being put down Antony’s throat. The charge nurse was excellent and worked well with Lesley, together making things happen.

By about day nine Antony was fully breastfeeding without the nipple shield. I was so proud. Each feed took about one and a half hours and I had to feed every three hours so it was exhausting but definitely worth it.

There were mothers in there that I spoke to who gave up trying after two days with a full term baby, saying it was too hard or that it hurt. Each to their own but I do feel that people give up too easily.

In my mind from the time I fell pregnant the only option was to breastfeed. As a child I was not breastfed due to my mother having a bad experience with my older sister. Today I suffer from Irritable Bowel Syndrome (IBS) and wonder if this is due to formula. So you can see why I was going to take every precaution possible to avoid this happening to Antony.

I successfully fed him until he was 15 months old and I am now pregnant with number two, due in October. I’m hoping to go full term but this time I will be much stronger and wiser with my opinion.

So to anyone out there with a prem baby I would like to say don’t give up. It’s never too late to start breastfeeding even if it takes a week or two for your baby and you to learn to latch on. If I can be of any help please don’t hesitate to contact me through LLLNZ.

Lastly I would like to thank La Leche League for all their support. To be honest my antenatal classes put me off ever contacting LLL and made LLL women out to be a bunch of alternative hippies that breastfed until their babies were ten. This ignorance needs to change. A friend from my coffee group convinced me to go one day, which took a lot, as I was not confident about feeding in public.

The women in the LLL Group all made me feel so welcome and comfortable, with great helping hints for breastfeeding. Learning to feed in bed was the best thing.
So thank you La Leche League, for all your support.

I hope my story helps anyone out there coping with a premmie and I wish you all luck.

Tania Cross, Howick, Auckland
ArohaMay/June 2004

Keeping Baby Close at Birth

Post category:Pregnancy
Reading time:4 mins read

“Because of health problems developing late in my pregnancy, I must be in hospital for the birth. I’ve read that having my baby as close as possible (skin to skin) at all times is the best way to breastfeeding success but I’m not confident I can do this in a hospital ward. How have other mothers managed to keep their babies close when staying in hospital?”

Responses

Robyn Watkins, Pukekohe – Owing to my recent work with the local maternity hospital – Middlemore – I can tell you that if the hospital you plan to give birth in is accredited under the Baby Friendly Hospital Initiative skin to skin contact between the mother and her baby is always offered and encouraged. At Middlemore it is done as soon as possible after birth and for at least an hour if there are no health concerns. Middlemore also will initiate skin to skin whenever a baby is unsettled or temperature is unstable. Skin to skin contact often leads to baby lead latching.. There are health board pamphlets available and I am sure if this mum talks to her L.M.C and makes it clear she would like this to happen ASAP it will be seen through. Middlemore even encourages and provides for skin to skin contact in theatre after caesarean births and staff will often transport mums in beds from delivery up to the ward with the baby still skin to skin with mum. Lovely to see.

Claire Hargest Slade, Timaru – I think you will be pleasantly surprised at how keen they are for you to have skin to skin contact with your baby. Make sure you write it into your birth plan with who ever will be caring for you. Many mothers have extended periods of skin to skin contact way past the first few hours after birth. There is great evidence to support this practice. Babies are less likely to experience hypoglycaemia and hyperthermia and have lower levels of stress hormones while in direct skin to skin contact with their mothers. They use fewer calories because they are using less energy to maintain their temperature. Midwives all know this, so skin to skin contact will really be at your discretion unless there is a medical reason that it can’t be so. Be assertive about having your intention documented in your notes, and you may well be surprised how well supported skin to skin really is.

Janine Pinkham, Kaiapoi – For mothers concerned about keeping babies close New Zealand is probably the best place in the world to give birth in a hospital setting. Just about all maternity units in New Zealand are now accredited as Baby Friendly. This means that they adhere to the Ten Steps to Successful Breastfeeding. Two of these steps relate to mother and baby togetherness. Step 4 calls for babies (if well) to be placed in skin to skin contact at the time of birth for at least an hour and encourages ongoing skin to skin contact. Step 7 requires “rooming in” where mothers and babies stay together 24 hours a day, just like when you get home. Some facilities even have clip on cots so that babies never need to be more than an arm’s reach away from mum and most facilities encourage mothers to bring their babies into bed with them as long as this is done safely. These and other assistance that supports breastfeeding will help you get to know your baby and get breastfeeing off to a good start.

Lisa, Hibiscus Coast – I had both my babies in hospital, the first in Wellington 19 years ago and the second Tauranga 8 years ago. Both stayed with me skin to skin for at least the first hour and then after being weighed. I was very happy with the way both labours and births went. They were both vaginal births without any interventions. The midwife and my husband knew what my wishes were and supported them. I can’t see why you wouldn’t be able to keep your baby with you at all times in hospital too.
Best wishes for an uncomplicated birth.

Adjusting to a New Sibling, Open to Tandem Feeding

Post category:Pregnancy
Reading time:8 mins read

“I am expecting our second child in a few months. I don’t know whether my two-year old will still be breastfeeding – he has shown less interest in breastfeeding as my pregnancy has progressed. I am open to tandem feeding; however, I want to be prepared for our new arrival either way. What can I do to help my two year old adjust to having a new sibling, whether he’s still breastfeeding or not?”

Responses

Jessica Parsons, Central Auckland – My son was still a very keen feeder at about two when I became pregnant the second time. As with you, he was less interested both because of the reduced milk supply and my saying “Ouch, mummy all done!” But he still wanted to feed when he could.

For tandem feeding: learn some boundaries together with your first child well before the birth. We used countdowns during breastfeeding – “1 minute! 10, 9, 8…” (This helps with numeracy, as a bonus!) We also agreed to some breastfeeding manners, because older children can develop habits which make feeding less pleasant. That distractible phase is not really a phase and it only gets stronger. I also explained to my son that the milk would be for the new baby first and then he could have his turn.

I also weaned my son onto Daddy! I knew I could not handle night duty for my son and a newborn, so about mid-pregnancy, Daddy handled night-waking and so my son was night weaned. Very late in pregnancy we coached my son to go for his first sleep with only Daddy there. He still fed during the day and in the evening, but not to sleep.

For general sibling information, I highly recommend the book Siblings without Rivalry by Adele Faber and Elaine Mazlish. LLL Group libraries carry this book. It has specific strategies to practise (and avoid), and they’re not all just common sense. Perhaps some of them have worked, since Alex and Nadia get along fairly well and have lots of fun together.

Claire Hargest-Slade, Timaru – I tandem fed my second and third children. It is an interesting experience! I found that I never had an issue with supply because of two babies making the milk. Often the toddler gets stroppy just as you sit to feed the new baby. I found a great tool was a special toy box that was only opened while I was feeding. Have plenty of food and water on hand for both you and the big kid. Keep the doors closed so the toddler doesn’t disappear into the bathroom cabinet to tip $60 worth of makeup down the loo… or worse! Reading while breastfeeding involves the big baby and allows for closeness.

When the small baby is asleep, this is the time to reassure your big baby that she hasn’t been replaced – give all your attention, lots of fun cuddles, and mummy’s milk if that’s still on tap for the toddler. All children experience sibling rivalry. It’s normal and to be expected. Charlotte and Jemima are still great rivals; maybe that’s just their place in the family. Charlotte always feels sorry when she hears a new baby is on the way to “ruin the older one’s life!” A friend even suggested a homeopathic remedy to help with grief, which is worth a thought. It certainly is a big adjustment, but think of the benefits Charlotte!?

Lastly love the mother. Mothers are not bottomless pits of love and devotion. Call on dads, grandparents, friends, DVDs, new toys, to help support the big baby to realize that their life isn’t completely over when the new baby hits the ground. Caring for yourself well, with lots of nutritious food, rest, water and emotional support will help you be the best mum you can be to two babies.

Contact an LLL Leader or peer counsellor to talk over how they coped when number two, three, or more arrived. A problem shared is a problem halved. Good luck!

Cecil Tamang, Port Chalmers – I hadn’t intended to tandem feed, but my three-year-old daughter wasn’t ready to give up breastfeeding when I was pregnant with my next child. Breastfeeding did become less comfortable, and I night-weaned early in the pregnancy. By the end of pregnancy my breasts were making only small amounts of colostrum, but my daughter didn’t mind, and would breastfeed off to sleep for her day nap and have one feed first thing in the morning.

When the baby arrived, it was actually really rewarding tandem feeding. I had had lots of problems with mastitis and abscesses in my first lactation, so having a big robust breastfeeder was reassuring for me and I could call on her to help me with overfull breasts. I remember she grew enormous cheeks virtually overnight after her brother was born! As for my newborn, he benefited by having my milk supply fully there about 14 hours after the birth! There was certainly something special about feeding them both simultaneously, and I’m sure it supported my daughter’s transition from only child to sibling.

It took us a while to find a comfortable way to feed both children lying down, but eventually I managed by lying on my side, propping my newborn on a pillow with him feeding off my top breast, with my daughter curled in around him to reach my bottom breast. That way we all managed to fall asleep together for a long nap in the afternoon- a luxury I enjoyed (and depended on for survival) for the first six months.

After tandem feeding for six months, and in a trough of low emotional and physical energy, I felt that I needed to wean my daughter. She accepted gracefully, though she would likely still be feeding if it had continued to work for me. Overall, I found tandem feeding a very successful experience for all of us, and though I hadn’t initially set out to try, would certainly do it again, if only for the synchronised sleeping!

Stephanie Ross, Te Awamutu – We were not long ago faced with a similar dilemma. My girls, Eden and Heidi, are now four and 29 months. I was pregnant and I experienced similar challenges with a noticeable drop in supply, pain and incredible discomfort before, during and after feeding. I suffer from Reynaud’s, so the pain combined with the hormones of pregnancy was naturally making things rather difficult.

Around Christmas time last year we had family and friends staying for nearly a two week period when our farm workers were on holiday. Therefore I took advantage of other adults to mind Heidi, and I helped out in the dairy, at both morning and night milkings. Around this time is when feedings became like climbing Tongariro with one jandal, no wet weather gear and a 20kg pack. We hung in there until the beginning of February this year…trying to get by with the minimum every day, to keep Heidi’s sucking reflex alive. Baby arrived in April after a beautiful home birth, but Heidi had already forgotten the art of sucking.

I have experienced periods of sadness and a huge sense of loss. One day I was driving home from the hairdressers after having a special feel good session and I had tears streaming down my cheeks. I felt like I was losing my baby and there was nothing I could do to stop it. I was not ready to stop breastfeeding Heidi – even though, at the time, the pain was unbearable – and she was not ready to stop either. I don’t think she weaned by choice and I feel as though the new baby took some time away from her. I don’t think I will ever forgive myself!

When thinking about what is right for you try to envision what you would like to see when your new baby arrives and devise a plan that will help you get there. Share your plan with those around you who support you in your parenting and enlist their encouragement. Looking back I should have rested more and focused on my supply (no milking cows) and spent more time skin to skin with Heidi to achieve the closeness she craves. I could have used breast warmers 24 hours a day to help my comfort level.

She still has “milkies” in her own way and drinks EBM from a cup. Instead we now read stories and I stroke her face while in the traditional feeding position to achieve the special closeness of breastfeeding.

Active Birth

Post category:Pregnancy
Reading time:7 mins read

“I am halfway through my pregnancy, and really starting to think about this concept of active and alert birth. I am keen to find out what worked for other mothers. My husband is really keen to be well armed with practical things he can do too. What are some ideas?”

Responses

Claire Hargest Slade, Timaru – It’s easy to get hooked into creating labels for how we want to birth. Instead, think about creating an environment where you and your partner feel safe, secure and at ease to do and be how you really are. The actual venue is without consequence, but the relationship of trust and partnership you build with your birth attendants will help this. When women have freedom to move, to position themselves in any manner, to be held as they want or conversely have the peace and privacy they desire at any given moment; then they birth in the instinctual way that is right for them. I created an eight point guideline for birth support people that goes a little like this.

Be her support person, offer comforts, drinks, touch or don’t touch as she needs it. This will change throughout her labour.
Privacy and intimacy enables the love hormone oxytocin to create effective contractions. Try to keep disruptions and worry at bay for her.
Be a tree. Let her hang off you in weight-bearing positions to help weather the storm of each contraction.
Care for yourself well during the labour. Eat, drink and emotionally refuel as need be; so you can stay strong for her as she is swept along by the power of her labour.
Create an atmosphere of quiet confidence in her ability to birth. Smile at her, hold her.
Praise is a wonderful tool in any circumstance. Warmly praise her to encourage her efforts.
Be her advocate, be willing to ask for things you have already discussed she wants. Ask again about the birth pool being filled. Know her birth plan, support her wishes.
However she births, validate her strength and courage. Giving birth is a huge achievement.

A great book you may enjoy is Gentle Birth, Gentle Mothering by Sarah Buckley.

Rosemary Roberts, Hamilton – This may not be for everyone, but for my second birth I used childbirth hypnosis. It was amazing. I was able to keep myself deeply relaxed through self-hypnosis and since the programme includes a special part for dads; my husband was able to be very active in keeping me relaxed and diverting my focus when needed through cue words and firm touch.

Phoebe Quinlivan, Wellington – I had a beautiful home birth experience with our first son, and a big thing for me leading up to and during it was my wholehearted belief and trust that my body knew what to do, and that I was not mentally going to be ‘in control’. My body would just do its thing and I just had to concentrate on keeping as calm and relaxed as possible.

When the contractions started amping up in the early stages, I imagined my cervix as a big thick rubber band that had to be slowly stretched to let the baby through, so each time I began to feel uncomfortable, I imagined pulling that rubber band slowly more and more open. Once things were a little more intense, I stopped thinking anything and just concentrated on breathing through it (and squeezing the bottle of lavender essential oil that I was holding in my hand!). Staying as calm as possible is important in order to let all those lovely pain reducing hormones flow.

Your husband can be a big part of that by staying really calm himself and reassuring you. I really wanted my hubby to stay up near my face and leave the midwife to do the delivering which worked well for me. I found the pressure on the two points at the base of my spine during contractions really helped, then ice cubes fed into my mouth, and a great big hand to hold (squeeze!) while I was at the pushing stage.

Being at home, everyone was able to potter about, help themselves to food, read and relax and slip in to be with me when I needed it. I think this also contributed to me managing well and being able to just focus on what I needed to do during the contractions (be in the zone). Because I didn’t have everyone focusing on me all the time, I wasn’t feeling self conscious.

Having said that, some mothers feel more relaxed in hospital and so that’s where they choose to be and that’s good too. I was ready to go to hospital if we needed to, and had decided before the birth that I would be okay with whatever happened. Once I was fully dilated; I got into the pool – I was loath to move at first because I had found a good position (squatting on the floor with my elbows on the couch) where I was managing, but once I was in, I felt the pain ease off by about 30 to 40 percent. Lovely!

Your body was made for this. I am sure you will have a peaceful and empowering birth experience.

Jillian Grant, Wellington – Yoga ball, lavender oil, tens machine were helpful, but an emergency caesarean meant I had to leave all that behind, quite literally! But the thing I could take with me was in my head – the visualisation and relaxation techniques from the hypnotherapy CD I’d casually listened to through pregnancy.

I hadn’t taken it too seriously as it kept sending me to sleep, but something had filtered through. It helped me get through the medical procedures as calmly and alertly as was possible. My partner had listened to the CD too, so he knew what I was doing. There are probably local hypnotherapy CD’s or
classes. I hope your birth and breastfeeding go well.

Stephanie Gudgeon, Te Awamutu – Relaxation and positive affirmations is a great place to start. Get super comfy with cushions and a blanket if needed. Doing this everyday is the ultimate and as you get into the groove, you will be able to call upon this technique when you have a spare moment or need some reassurance if you come across negative vibes.

Create a space of ‘you time’ every day, use this time to relax with some deep breathing. Breathing from the stomach with big belly breaths, feeling each breath relax you into the floor. Imagine each new breath bringing in new energy for you and your baby within. Send your breath around your body soothing any anxiety and creating a state of calmness and confidence. Visualise colour, either red for love, blue for healing flowing around your baby bringing it love and strength.

Create a positive affirmation that is focused on you, or look up online for some help. It might be, “my body is growing a beautiful healthy baby and I am going to birth this baby with ease and joy.” It could be shorter, or have a different meaning; but it is important that it is significant to you. On your exhale, think to yourself or quietly say your positive affirmation. Do this for as long as you can. Start with maybe two to five minutes and who knows where it will take you. Positive affirmations wire the cells in our bodies and our mind, helping our desires and dreams to become a reality.

Once you are well practiced, you will be able to use it during birth to keep you going and to bring you into a state of calm. Your husband may even say it with you. It’s a great way to focus together during birth.

Mothering Through Breastfeeding

Post category:Mothering
Reading time:6 mins read

When I had my first baby, I had already decided to give breastfeeding a go. But the main
focus for me during pregnancy was coping with sickness, and the approaching labour.
The antenatal classes had dealt with labour pain and management and the stages of
labour but my birth plan went out the window, when at 37 weeks, I had a haemorrhage at
1.30am (whilst in bed trying to pretend to be asleep). I ended up having a very scary time
trying to make the midwife believe my story over the phone. She said, “Is it just a show
dear?” I really had to convince her that it was more of a flood than a show!
So my husband and I raced to the maternity ward and met the midwife shortly after. She
spent the next half an hour reassuring us, “Baby is OK”. Shortly after, my Lead Maternity
Carer (a General Practitioner) arrived looking very brassed off at being woken up at this
hour. He heard my story and decided to break my waters. It was incredibly painful. I was
in constant agony and I couldn’t feel the contractions through the pain. The waters
contained blood among other things, so the he rang the specialist on call who then
suggested they prepare me for a Caesarean. A general anaesthetic was required because
of the speed needed and blood pressure problems.
Suddenly everything moved very quickly. Going into the lift I remember saying to the
anaesthetist, “Am I going to die?” and him replying, “I don’t think so”. At 4am, Kieran was
born rating just two on the Apgar scale. An hour after he was delivered, I returned to my
room – no baby there yet. He had been put into the special care ward. He had also been
given formula as his blood sugars were low.
I was lying down feeling so drugged I could hardly stay awake. I was wheeled down to
special care to be handed my son and give him his first feed five hours after he was born.
I will never forget that feeling for as long as I live – holding and feeding for the first time
ever. All I can say is thank goodness for breastfeeding.
Kieran was a baby who liked to be up all night, and sleep for long spells during the day for
the first few months. I fed him on demand and felt this was one major way to regain the
loss I felt from not witnessing his birth. I found breastfeeding very challenging. I suffered
frequently from mastitis. I became quick in recognising the symptoms and promptly sought
help after a couple of bouts. I found homeopathic remedies worked sometimes
(Echinacea, Erysidoron, and Phytallaca). But most times, I needed antibiotics. My doctor
provided me with a backup
prescription just in case. He was an excellent support person.
I also had nipple trouble initially and I used Lansinoh cream which was fantastic with
healing them. I found the ionozone treatment at Hutt Hospital a great help too.
When I was desperate with doubts I had a great mentor in La Leche League Leader, Fran
Crossland, who gave me fantastic advice and support, and a Plunket nurse who took time
to more clearly explain how babies feed. Luckily my husband was also in favour of me
providing the best food for his child.
However I had my lowest point when Kieran was 10 weeks old. I phoned the Plunket line
desperate for help. The nurse advised me (after hearing my story of recurring mastitis) to
give up. I put the phone down and burst into tears. My husband (also my rock) turned and
said, “You do what you want to do!”
I felt breastfeeding this unsettled baby was the only choice, and so I continued. I made the
right choice. He was rarely ill and it made us into a unit. At 15 months he weaned himself
when I became pregnant with son number two.
The next story is very different. Callum was born after an easier pregnancy, and a
reasonably easy labour. I fed him immediately after he was born. What a different
experience. To actually see my baby born plus feed him straightaway was a double
bonus.
I had a much more relaxed and confident attitude with Callum. I decided to breastfeed
again, although I had mastitis when he was two weeks old, caused I think by a blocked
duct. I have had few blocked ducts since and have been able to clear them myself. I also
always feed two sides every feed as this keeps me balanced. This balance helps the milk
flow more regularly on each side. I wasn’t always able to do this with Kieran because he
always preferred the right side (the left was often the one playing up) so some feeds were
one side only and when he was very young he would go to sleep after this single side.
Another two things happened: Firstly, I had campylobacter food poisoning when Callum
was eight weeks old. This was horrific for me. I couldn’t eat, and basically lived in the toilet
for a week. However the human body is amazing. I just kept producing breast milk for my
baby. In hindsight I am wonderfully impressed. The second thing was that I slipped a disc
in my back so I had to deal with that one as well. Looking back I am pleased that I
continued to breastfeed Callum. I have a very healthy boy who is now nearly two years
old.
Things I have learned
· Have a relaxed attitude. (If your child needs feeding then feed him – generally it is only 20-30
minutes – don’t worry about waiting 10 minutes for him to scream)
· Feed babies when they want to be fed.
· Don’t necessarily give solids first – give the child what they want first (breast milk is fine)
· Be proud to be a breastfeeding Mum
· Listen to your own instincts not other people’s
· Watch the baby not the clock
· Relax and go with the flow
· Experience gives you heaps of confidence
· Ask questions about breastfeeding but don’t always believe the answers
· Don’t worry if you (like me) can’t express milk
· Breastfeeding is a total package
· Breastfeeding is for such a short time in your life – it is over so quickly – enjoy it while it lasts
· Be aware of medication and make sure that it is safe to take
· Wean together

By Deb Williams, Lower Hutt
Originally printed in Aroha, March/April 2004