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Interview 17

Age at interview: 38
Brief Outline: Difficulties with breastfeeding including positioning, sore nipples (used nipple shields), low milk supply, poor weight gain, possible depression. Having nightmares about going back to work.
Background: At the time of interview, this 38 year old, Australian-born woman, who lived in Wales, was breastfeeding her 11 month old son. A documentary film producer, she was married to a free-lance researcher.

More about me...

This woman had recently produced a documentary series about midwifery and childbirth, so she knew what she wanted from her birth and breastfeeding experiences. She had an undiagnosed breech baby, a traumatic labour and a caesarean section delivery. She found the medicalisation of the whole process very disappointing and thinks that it compounded a lot of the breastfeeding problems and depression that she later suffered. Initially, she received a lot of advice which she found confusing and led to a 'spiral of problem after problem'. For several months, she travelled ten miles almost daily to sit with a breastfeeding counsellor trying to get breastfeeding right. As a last resort she tried nipple shields but they led to a drop in her milk supply (for which she took domperidone as a galactogogue) and problems with her baby's weight gain. In an attempt to improve the baby's weight, for a few weeks her husband gave their son infant formula for one evening feed, while she expressed breast milk and put it in the freezer. Eventually, they decided that was madness and reverted to fully breastfeeding. It wasn't until they started solid foods at six months that the baby began to put on weight and then breastfeeding became a pleasure. Because of the problems, her six months of maternity leave went very quickly so she took another six months leave without pay to enjoy being with her baby but was having nightmares about returning to work and being separated from him.

 

She grew up in a bottle feeding family environment but saw friends from work breastfeeding.

She grew up in a bottle feeding family environment but saw friends from work breastfeeding.

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Well I wasn't a breastfed baby [laughs], I was bottle fed and, you know, and my mother always told me, and I think it's a traditional thing that got passed around in the sixties was, 'Oh I couldn't breastfeed you I didn't have any milk'. So, you know, that was just the attitude that she had experienced and I never grew up in a family environment where breastfeeding or seeing women breastfeed at all, I just think it was just something that I had explored myself or something that I just felt was the right thing to do, I think possibly when I went to work and I was mixing with other women who had gone off on maternity leave and they were talking about the fact that they were breastfeeding that I thought, 'Well yes I'm pretty sure that's something that I would do too' but I didn't come from a background or a family where breastfeeding was a norm.

Friends? Have you seen friends doing it?

Yes friends at work but as a child I hadn't experienced and even my mother's friends it was a bottle fed generation I think to be quite honest. So I'd say friends at work who had delivered a lot earlier than me because, you know, I was thirty-eight years old when I gave birth to [son] so, a lot of friends who had their babies in their late twenties and early thirties at work I was aware that they were breastfeeding and had seen that.

 

Her twelve month old baby is having solid food and wants to feed less often so she thinks that...

Her twelve month old baby is having solid food and wants to feed less often so she thinks that...

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Sorry [laughs] I would breastfeed the baby before he would have his solids in the morning before his breakfast, lunchtime I would probably say that he would have like a ten-thirty or eleven-thirty breastfeed, then he would have his lunch and then I would offer him a breastfeed again. What I found was that once he'd started to have a wider variety of solids and that we were combining foods, he would then start [talks to baby]. Once the baby started getting wider solids, a wider range of solids, I noticed that when I would put him to the breast that sometimes he would bite me.

Ah.

And I knew then that he was starting to say he didn't want that midday feed, or he didn't want the one after lunch, and you know sometimes we would have a bit a battle with me trying to get him on and he would go on and he would smile almost and then bite me, and I would think, 'Well that's very naughty, that it's not nice to bite mummy' but I knew then that he wasn't really wanting it, so we then sort of would drop one feed off. We've got to that stage now where he's on three a day, which some people would say, 'Well that's quite disappointing isn't it?' but he sometimes doesn't want his afternoon one, and seeing as that I will be returning to work, I feel I can now keep my breastfeeding going longer because if he only really wants to top and tail the day i.e. have one when he wakes in the morning and one before he goes to bed, I feel between us we will breastfeed longer, and that I don't have the pressure at work of finding a room to express. So the fact that I've stayed off with him longer rather than going back to work after six months and that he himself has decided that he just wants a breastfeed in the morning and night and he can take or leave it at lunchtime, I think will, we don't have a date now when we're going to stop breastfeeding. We just are breastfeeding, and even my husband asked me the other day he said, 'So, you know, do you think you're going to keep going with [son]?' and I'd said, 'Yes' he said, 'Do you think you'll keep going till we have another one? Because of course you could always keep feeding him and feed another baby' so all these things that we hadn't thought about, initially my goal had been, 'If I could get to three months, if I could get to three months, because of the pain, if I could just get to three months that would be great', then it would be, 'Well if I could just get to six months so that he starts weaning that would be great', and now it's just well there's not that pressure any more to think about if only, because we're doing it. Of course you get another load of problems now where you get people sort of saying, 'You're not still breastfeeding are you? Are you still breastfeeding him?' So you have other attitudes to deal with about being a longer breastfeeder.

 

She avoids public toilets and always goes to a mother and baby room but sometimes the furniture...

She avoids public toilets and always goes to a mother and baby room but sometimes the furniture...

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I'm not put into the social positions outside where I would have to feed him publicly, now he's an older baby, so I don't get members of the public like some women perhaps do looking at them if they're feeding in a supermarket.

Have you had that in the past?

I've always gone to places to be quite honest with you where I perhaps wouldn't encounter that, so I would go to places that I knew had mother and baby rooms so that I could feed him, with other people there who may be feeding. Or I would go somewhere where I could feed him in the back of the car. I always made a point of never feeding in toilets because I mean you wouldn't eat your own dinner in toilets would you so. And in fact I do sniff where I see signs you're welcome to breastfeed here in the women's loo's, I think, 'Well, you know, you wouldn't eat your dinner in the toilet would you? So I've always gone to places that have been breastfeeding friendly I suppose, baby friendly where I knew it wouldn't be a problem, or if I'd been out somewhere with my husband then I've just asked, 'Do you mind if I sit there and that if I can breastfeed my baby thanks' that's always been fine.

And you've always had positive responses to that question?

All the places that we have gone to, perhaps we've always known before that it would probably be okay. It's always funny when you go into a place where it, it's a mixed feed area, because there are some mother and baby shops where you can go and they have a nursing room as well as a room where you can change the baby, and it's really interesting to see the divide that there is between the still, the bottle feeding culture and a breastfeeding culture. Because there tends to be a larger area of mums with the bottles and then there's a tiny little room with maybe a sofa and you look at the furniture that's provided for you as a breast feeder and you think, 'Well actually this furniture isn't properly appropriate, why would I want to sit in a rocking chair to feed my baby? Because actually I'm not sitting upright, he's not going to be able to be brought up to my breast, I can't latch on, this furniture isn't appropriate' so it's even within a mother and baby shop they're not really aware of what is required for breastfeeding women, so the culture is still very much predominantly geared towards breastfeeding your baby in, rocking in a chair, bottle feeding your baby, rocking in a chair which with a very young baby you wouldn't do because it's all about positioning and making sure that your baby can latch on if you've had problems, and you, we had so many discussions at the breastfeeding group that I went to with the counsellor about sitting upright, you know, everybody's got a kitchen chair so you can sit upright and bring your baby up to the breast and it's about finding that position that's not only comfortable but that is correct for you and not everywhere provides the [laughs] correct furniture for that.

What about the communication between the mothers, the bottle feeding and the breastfeeding mothers in that environment?

It's really hard not to come across as smug when you breastfeed, because you obviously know (a) it's the best thing for your baby, you're obvious and if you'd had problems you can also be very proud that you stuck at it, and it's almost easy to sometimes come across with an attitude, 'Well you didn't try hard enough then did you? Because look at us we're continuing to breastfeed and we're doing it. Did you throw the towel in too early?' I also know that there are mothers out there that have just turned round and said straightaway, 'Well I'm not going to even entertain the idea of breastfeeding', and these are bright articulate women
 

Her advice is to say that you want to breastfeed your baby and to hold onto that thought - it is...

Her advice is to say that you want to breastfeed your baby and to hold onto that thought - it is...

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I think that the best thing that you can do is say that you want to breastfeed your baby and to hold on to that thought and to find as much help and advice that you can get to be able to continue breastfeeding. Now that can be from a breastfeeding counsellor at the hospital, it might be from your midwife, it may well be from a very supportive health visitor that you have in your area, it might be from a mother and toddler breastfeeding group, it may well be from someone like the La Leche League, but tap into it because it is there and there will be someone who can put you onto someone who will help you. If like me that you need to go and see somebody every day and you want to do supervised feeds there will be someone somewhere who can help you. There might be a breastfeeding mother mentor group in your area, but there will always be help to, for you to get through it. The other thing is if you do have problems is to realise that it's not going to be over and done with within a week or two weeks, it is an on-going learning process for you and the baby. And that was the hardest thing to come to terms with because of the worry about my maternity leave just going away on the whole problem with breastfeeding. But once I accepted it, this is my job to breastfeed my baby, my maternity leave is not a holiday it is maternity leave, it is here to look after my son. So once I looked at it from that attitude and once I then thought if I have to go to the hospital every day and breastfeed with a load of mums in a room then I will see this as an opportunity to meet other mums who I wouldn't have met had I stayed at home with my breastfeeding being absolutely excellent. So it's a, starting to look at the problems as being positives and opening up a new world for you really. But I would say don't give up because the power of breastfeeding is that you can go and do it anytime, anywhere, any place, you and your baby, and it is just so much easier in the long term. It's cheaper, it's easier, it's healthier, you bond better with your baby, and it's just the best thing.

 

She preferred to stay at home with her children as her own mother did and was dreading going back...

She preferred to stay at home with her children as her own mother did and was dreading going back...

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Have you made any preparations for going back to work?

I'm dreading going back to work, partly because I know he's nearly a year but I still feel like my place is to be with him, because there's so, he's learning, he's taking on everything, you can tell him 'clap, clap, clap' and he will for you, you can sing him songs and he knows the songs, we go swimming together, we go to mother and toddler groups together, he's a bi-lingual baby because he's being taught Welsh and English, and he will be educated through the medium of Welsh so there's so many things going on that I feel that I should be there with him, but unfortunately these days, having a mortgage and even providing the roof over [laughs] your head is a joint salary in order to do that so we both have to work and I've had a year off. My preparations for going back to work have been to see my manager to say I am returning, I have problems getting childcare for him because my cr'che at work is so over-subscribed. So he won't be able to be on the same site as me till he's one and a half, so the finding other suitable childcare has been a pressure and a nightmare. The not being with him is the bit that I can't quite emotionally come to terms with because somebody else is going to be feeding him his solids and I just can't imagine what that will be like not being with him for all those hours in the day, because we've always been together and even through the problems of breastfeeding we've always, together, in the car together, off to the hospital together, you know, it's like my little mate's not with me any more so it's very, it's very upsetting but it's something that's got to be done. But to be quite honest with you if there was a choice I would not be returning because I really feel my place is with him, and I would dearly love to have another child and I think my place is at home, because my mother was at home for our years up until we were eleven years old and went to secondary school. And we did so many fun things, you know, we learnt to read newspapers, we learnt about cooking, we were always round the kitchen table, they're very old traditional ideals [pause]. The things that I'm talking about can sound quite old and traditional and perhaps aren't particularly modern but I felt always that I had an extremely happy childhood and we weren't a very rich family, and just my father worked, and my mother stayed at home, but I know that that's not the position that I am the major bread winner, my husband is a freelance worker which means he goes from contract to contract so there isn't always the guaranteed income that my job and my salary provides for us as a family, so I know I have to return, but I have nightmares about it.

 

Her baby failed to thrive so she tried extra breastfeeds, expressing breast milk and medication...

Her baby failed to thrive so she tried extra breastfeeds, expressing breast milk and medication...

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Breastfed yes from birth, not totally because we did have a problem where his weight was declining quite a lot and the difficulties with breastfeeding as well, meant that we did have to supplement with one or two bottles of formula which I wasn't happy about but was advised by health advisors to have to do that because his weight was just falling off him.

Okay.

Which is very, very worrying. And to be quite honest we tried so many different positions, [son's] weight was going like this, he might put some on then he, it was like a roller coaster and he was constantly along the bottom centile of the charts, so we always had the problem with the health visitors saying, “Well what is your problem?” and if you, in your practice, your GP's practice you have professionals that say, “Well what is your problem? My boys were bottle fed it didn't affect them” you think, 'Well no, I am trying to do this because I believe it's the best for my baby, I feel I've got support from a really good breastfeeding counsellor, I'm meeting other women that have problems, I want support to continue', 'He's only put an ounce on this week' but it's again, and to be quite honest I don't think really until [son] started to be weaned that suddenly the breastfeeding got better. So when he was weaned at six months and he started on baby rice that's when he started to put weight on consistently, the breastfeeding got better, everything just got better, and it was like we were struggling to get to this six months. 

I was having to put him to the breast quite a lot in order to increase.

What does that mean, quite a lot was how much?

Well quite a lot for me I mean I was always one of these mothers I suppose that liked to leave quite a bit of gap between each feed so that he could digest. So I, he wasn't feeding on me like twenty times a day or something, I would always try and leave a couple of hours between each feed, for him. So as long as he was having five or six feeds within twenty-four hours everybody was happy but of course once his weight stopped it was a case of cramming all these feeds in, in the day. Because I didn't want to disrupt his sleep pattern because he slept really lovely, he would go to bed about seven-thirty, eight o'clock and would not wake up till five for a feed, so I didn't want to then start waking him at ten-thirty for a feed if he was sleeping okay. So I would try and do a lot of my feeding from five-thirty in the morning till seventy-thirty at night so that he could sleep as he wanted to sleep rather than be woken up and put to the breast. So I was doing about seven or eight feeds between five-thirty and seven-thirty at night.

So you were counting the feeds you were doing and doing them regularly, were there other signs that you were looking for that he was okay, that he was thriving?

I was constantly paranoid about his soft spot on the top of his head and that he was dehydrated that really, really did worry me and one day it was just so, so bad that I did end up having to give him a bottle of formula.

So how could you tell what were you looking for?

It was inverted, it was like a divot and even now I still look at it now and again and, but it was really, really low, we knew that he wasn't well, we.

Any other signs of him being dehydrated?

He was always having wet and dirty nappie's but the problem was that we knew that he wasn't feeding properly because he'd

 

She suggested that all health professionals should do 'Baby Friendly' training and that all women...

She suggested that all health professionals should do 'Baby Friendly' training and that all women...

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I'd say all health professionals probably have to do a Baby Friendly Initiative training course from the World Health Organisation, I think there are certain health professionals that have the right attitude about Baby Friendly, training and status, there are some that don't quite see it like that and I think a lot of health professionals are trying to get their hospitals up to that standard and sometimes old attitudes die hard. We have to realise that some of these health professionals maybe didn't breastfeed their babies themselves, and they are human beings and they have their own emotional baggage and attitudes about how they feel about breastfeeding and not everybody will be seeing it from your point of view or sitting in your chair, and some people may see it is a, especially if the baby's not thriving, that you are just being stubborn and ignorant and, 'Look at the baby, the baby needs feeding'. So I think, you know, as a mother you have to sometimes realise that not everybody is going to support you. Of course the literature and the government's attitudes are, you know, to encourage breastfeeding but the baby marketing of products of baby milk, of baby food, it's so strong even subliminally it's strong, even if it's not meant to be advertised, you know, breastfeeding your baby for the first six months is the best thing that you can do. And I would also advise anybody if they can afford to take extended maternity leave to take it, because it just goes so quickly, it really does, and you don't get it back, and all those other little milestones somebody else will be. But some people have to go back at six months because they have to pay the bills and have to pay the mortgage, we just used our savings so we won't be having holidays for a while.

 

She did not have the birth that she had planned and found breastfeeding difficult. She thinks...

She did not have the birth that she had planned and found breastfeeding difficult. She thinks...

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But the disappointment was huge and I think the disappointment, I can feel myself getting emotional about it now, but I think that obviously compounded a lot of the breastfeeding problems I had afterwards because I was probably slightly depressed, and although I didn't want to acknowledge it, I think that's probably a, another problem, not just with the breastfeeding problems it was addressing the whole fact that I didn't have the delivery that I wanted, and also trying to be big and brave about it and saying, 'Look he's here, he's healthy, for goodness sake that's all that matters at the end of the day' and then actually thinking, 'Gosh I do feel slightly robbed that I didn't have that experience' and I, straightaway made the decision that I would want another child because not just because of wanting to expand our family but also that whole experience I had, I hadn't had. So you do feel slightly guilty because you feel selfish about it, because here he is, he's healthy, he's happy, he's arrived safely, we should thank god for that, but, also thinking but it's not how I wanted it to be, or it should be.

Do you want to explore that idea of depression a little bit more at this stage?

Yeah, I didn't, I've only ever suffered once from depression and that was after my father died, with bereavement, but I think I didn't acknowledge that I was, I'd, I wouldn't say it was post natal depression as in the puerperal psychosis type thing, it wasn't, it was just down, feeling down, feeling overwhelmed and I also think that perhaps with it being your first child slightly later in life, you know, you're very in control of your career and suddenly life isn't in control anymore, you don't know what it's going to be like, nobody can tell you what it's going to be like to have a baby, suddenly you come home with this newborn, little thing, that just completely needs you and you sit there and you think, 'Well what am I going to do next? What do you do next?' so the overall, overwhelming feeling of responsibility and then coupled with the fact that the breastfeeding was just declining and it looked like, 'Oh my goodness don't say that (a) I haven't been able to have a normal delivery and now (b) I'm going to end up having to put him on the bottle', it just made me feel so low.

What about fatigue did that add to that as well?

I was tired a lot, and I think I remember being in the kitchen one night and I just said to my husband, 'Do you know I don't know if I love him' and that was the most dark I suppose it got, but I think I, my husband helped me realise, 'Look you're tired, you're, you know, you need to sit down, have something to eat, you know' and I was expressing at the time as well and that was the other problem that, you know, my nipples were so sore and they were cracked, they were bleeding, I was double expressing, I didn't seem to be able to get much off, so the worry of constantly thinking, 'He's hungry all the time I'm not getting enough off', it was just, you know, it was draining, draining, and when you're tired you can't think straight so, you know, it's a hard cycle to get out of really, you know, something has to change, for in order for you to get some rest, to be able to reassess the situation and continue.

You're looking back at it now; at the time did you think to yourself I might be depressed?

No not really I think I probably put it more down to being overwhelmed with having a newborn at home and the fact that things weren't going well with the breastfeeding, and I knew that I was going to be, while, whilst these problems were happening to me, I knew that I was the type of character that gets very, very disappointed if things don't go righ
 

After her caesarean section, the midwives showed her lots of different positions but that...

After her caesarean section, the midwives showed her lots of different positions but that...

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Because I had the caesarean, the problem was I think, was that we weren't able to feed sitting up, so a lot of the feeding was had to be done lying down, and I don't think I was ever taught how to do that properly [Pause]. Sorry do you want to?

So let's just.

Talk about those problems…

Yeah.

…how they started? Well I think I first realised that I was having problems was when my nipples started to get sore and this was possibly around day four after the birth, and then I came home from hospital.

So your milk had come in by then?        

Yeah. And I suppose again I didn't really understand what was a good latch, was it, was he suckling well? I just didn't understand these things were explained to me but some, for some reason it just wasn't going in my head. So they started to get really sore, a number of midwives that came through to see me were showing me different positions, how to feed, I mean by that time I could sit on the sofa etcetera, but he just seemed to be, every time he was latching on it was so painful, and I suppose by day six it was excruciatingly painful that I'd started to dread each feed. Every time he cried I used to think, 'Oh my goodness, oh no he's going to want to be on me again and it's so painful'.

And was that pain right through the feed?

Oh yes absolutely from the moment he clamped on, I understood that people said, “Oh it might be a little bit painful to start with 'cause they're a bit sore and you haven't breastfed before so, you know, it will go” but it never went within the feed it just was dreadful to be quite honest and I knew then that I've, if I was going to continue I had to seek help.

Okay, and so the midwives showed you lots of different positions? Anything else in the hospital, that may or may not have helped?

My problem was and I know a lot people won't want to acknowledge it, my problem was is that I didn't feel that all the midwives were singing from the same song sheet. A lot of them had different positioning, different theories, different attitudes, and it's very difficult I think then to know which is the right thing to do, what is the best advice to follow to be quite honest.

How did you cope with that, maybe conflicting advice?

When you get lots of different advice sometimes you think, 'Well I'll try them all and then the best one for me I'll stick with', but of course once it's breastfeeding, it's very difficult because you constantly try one idea like a rugby ball position, or trying him under you, trying lying down, and you just think, 'Well this is so confusing, I'm getting confused, he must be getting confused, he's not latching on right' and because of the nature of needing to feed a child they're not happy they need to latch on and it should be the most comforting thing for them and it wasn't like that so, it's very difficult to then know which is the best thing to do. It's very hard.

So you went regularly to the hospital, daily…

Daily sometimes, yeah.

…to get help? What sort of things was that counsellor doing?

She was, the breastfeeding counsellor I went to see at the hospital who

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