Tuesday, November 30, 2010

Nursing my early arrival, and battling illness as a breastfeeding mom

In honor of his 9th birthday today, my story of nursing Scootch!

My second son, “Scootch”, was born prematurely at 34 weeks. He was a good size at five pounds, 11 ounces. I was happy that he made it to 34 weeks. At 29 weeks, I started leaking amniotic fluid. Assuming that delivery was imminent, I was given a shot to mature his lungs and sent by ambulance to the nearest hospital with a neonatal intensive care unit (NICU) over two hours away from our home. We were lucky that I stopped leaking fluid and I was sent home and put on bed rest. I spent the next five weeks in and out of the hospital in an ongoing game to stop my labor. The hardest part of this was being away from my other baby, my 16-month-old son.

Scootch was born healthy and breathing well, but he was sleepy. He did not wake up when I delivered him. It was 24 hours before he cried. I began pumping right away so he could be fed through a tube and almost cried when I saw the few drops of colostrum in the bottle. "This would never be enough! They will insist on giving him formula!" I thought. The doctor then told me he had ordered that he be given five cc of colostrum every three hours. What I had was plenty!

It felt like one frustration after another. I asked that he be given no artificial nipples. I wanted all of his sucking to be at my breast. I was angry when I came in after a shift change to find a pacifier in his mouth. "It says in his chart no artificial nipples!" I informed the new nurse. "Oh, I thought that just meant no bottles," was her response.

I spent the next six days sitting in the bright, noisy NICU trying desperately to get Scootch to nurse, and then pumping afterward. The hospital was very busy at the time and sometimes there wasn't a pump available for me. I often had to track one down. It was almost impossible to get Scootch to wake up to latch on. He would just lie there with his eyes closed and lips shut tight. The nurses watched us. The lactation consultants watched us. "You are doing everything right. Just keep trying," they all said. I tried to hold him and give him as much skin-to-skin contact as possible. He was jaundiced and the nurses wanted him in the incubator under the lights as much as possible. At one point they gave him a special vest with the bili lights so that I could hold him more.

We were over two hours from home, staying in the Ronald McDonald House and going back and forth to the hospital. I was exhausted. There was no place for me to lie down at the hospital. I could only sit in a chair in the NICU. After a couple of days I had to give up on a few middle of the night feedings and try to get some more rest. I was able to leave enough pumped milk for them to give him through his feeding tube while I was gone.

After six days, I got to bring Scootch home. He had only nursed successfully a handful of times (I'm still a little surprised they let me take him home!). When we got home I was terrified. Would I be able to wake him and keep him alert so that I could get enough milk into him? At the same time, I knew nursing would be so much easier to do at home. I could lie on the couch or in bed with him all day and night and let him nurse whenever he wanted. I couldn't do that in the NICU.

After a couple of weeks, things got a lot easier and I no longer worried about Scootch feeding. He was nursing on demand without me having to wake him. He was thriving!

My biggest hurdle was yet to come. When Scootch was just over two months old, I got a bad stomach virus. It hit me really hard and I was taken to the emergency room (ER) by ambulance. At the hospital, the ER doctor was very concerned because I was so sick. He insisted on giving me a strong antibiotic that was not compatible with breastfeeding. I refused, asking to only have fluids and the medication to stop the vomiting. After a few hours, I decided to take the antibiotic. I checked with my local La Leche League Leader and she confirmed that this was one of the few antibiotics that are not compatible with breastfeeding. I could not nurse for 48 hours. This began 48 hours of "pumping and dumping" while Scootch was fed pumped milk from the freezer.

A few weeks later I still was not feeling 100 percent better. I went to the doctor and she ran some tests. It turned out I had clostridium dificil (C. dif). This is an intestinal bug that takes over when you have been getting too many antibiotics and have killed off too much of the "good bacteria." Looking back, I had been on IV antibiotics most of the time I was hospitalized for pre-term labor (just in case the labor was caused by an infection that they did not detect). I had also taken antibiotics when I had mastitis when Scootch was about a month old. The antibiotic from the ER was enough to push me over the edge. A "new" antibiotic, I was told, would cure me. Over the course of the next four months I took several more courses of antibiotics in an attempt to get rid of the C. dif. Every time I would feel better at first, then it would come back worse than before. I was rapidly losing weight, and I was already thin to begin with. Sometimes the diarrhea and cramping were unbearable. It was scary to be alone with my infant and toddler and not know if I was going to end up stuck in the bathroom, feeling as if I might pass out from the pain.

Sometimes I would get dehydrated, too. One time I became so dehydrated that I needed fluids by IV. When that happened, I completely lost my milk supply. I had no more milk in the freezer. "Should I give him some formula?" I wondered. I really wanted my son to only have my milk for as long as needed, but I didn't want him to go hungry either. I knew that if I gave him formula, he would be full and would not want to nurse, and right now, I needed him to nurse to tell my body to make milk. I told myself that as long as he was wetting enough diapers, and was not miserable and screaming, I wouldn't give him formula. I would get in bed with him (I was exhausted) and let him nurse continuously. It was about all that I had the strength to do. As long as he was nursing he was content, even though I was almost back to my pre-pregnancy A cup size and my breasts were soft and limp. After about 24 hours of constant nursing, my breasts were full again. My bra was no longer loose, and he was no longer eating all the time, he was back to every couple of hours. I was amazed at what my body and baby could do, even when I was so sick and weak.

I would feel my supply go up and down depending on how well I was able to stay hydrated. Normally, I had an abundant supply and Scootch would only take one breast per feeding. I could tell when my supply would drop because he would start taking two breasts per feeding. If I got really dehydrated, he would nurse constantly.

After a couple months, even my very breastfeeding supportive husband mentioned the possibility of weaning. I was so sick and weak and having such a hard time keeping any weight on. But I refused to wean.

Even though it took four months, a colonoscopy, and several doctors before I got better, I'm glad I never gave up on breastfeeding. I am so thankful I found the doctor who treated me with probiotic bacteria and special probiotic yeast that kills C. dif. It was very important to me because I knew it was best for Scootch. He went from the bottom of the growth chart as a preemie to about the 75th percent in weight during that time. At the same time, it was important to me because it was something I could do. Here I was, the mother to these two wonderful little boys, and I couldn't even care for them. I can remember my toddler asking me to push him in his swing during this time. It was out on our deck, no more than a few yards from the living room couch. It broke my heart that I was too tired to walk out there and push him in the swing. I could nurse lying down, and even in my sleep. Even if I could do nothing else as a mom, I could nurse my baby. Scootch went on to nurse for 14 months, and is now a happy, healthy nine year old.