Interview 22

Age at interview: 28

Brief Outline: Difficulty with latch-on; poor weight gain; mixed breastfeeding and bottle feeding (expressed breast milk and formula); baby on regular 6 feeds during the day.

Background: At the time of interview, this 28 year old, Sri Lankan woman was breastfeeding her 4 month old daughter. She and her husband were both physicians.

More about me...

This woman said that she'd 'figured that people are mammals and mammals have been around for millions of years and they've had no problems breastfeeding so why should I have any problems'. She had also seen women feeding in cafes and supermarkets and they seemed comfortable and happy, so it came as a real shock when she found the first eight weeks of breastfeeding very hard. The other revelation for her was how little her medical training had prepared her for the realities of breastfeeding. She knew about all the benefits for the mother and baby and how the lactating breast functioned but nothing about how to breastfeed or how to teach somebody to breastfeed. At first she felt like a failure when things were going wrong (sore and cracked nipples, a fussy baby who gained weight slowly) until she attended a breastfeeding clinic and met other women who were also struggling. Eventually, she and the baby settled into a pattern, that suited the family, of six feeds per day at set times and no night time feeds. She feeds the baby at both breasts first, then she expresses her breasts and offers the baby a top-up bottle of expressed breast milk. When the baby was not gaining weight she offered top-up bottles of infant formula and believes that at that time it was exactly the right thing to do while she got breastfeeding 'back on track'. Often the baby's father gives her the top-up bottle so that he can experience feeding as well. The baby is happy with this pattern and gaining weight.

Her mother bottle fed but she had a strong desire to breastfeed because of the benefits for her...

So can you tell me about your experiences of breastfeeding?

I was very keen to breastfeed, because I knew all the health benefits for my daughter as well as the health benefits for me I've got a very strong family history of breast and ovarian cancer so I was very keen to breastfeed for that reason as well, so I went into it with quite a positive attitude. And at first it all seemed to be going very well, the first twenty-four hours seemed absolutely fine and I thought this isn't as difficult as anyone makes it sound but then once we came home and she was a bit more awake and feeding more often that's when the trouble really started and, and I had very, very painful nipples, cracked and bleeding nipples and it was just agony to breastfeed. And so the first, I'd say the first six to eight weeks really were really quite hard. 

Right, can you tell me what you knew about breastfeeding before you had your baby?

I, about, I knew about the, the health benefits of breastfeeding so I knew that it was better for the baby, baby's immune system to help her fight infection, that it had all the right blend of nutrients and the right amount of water and all that sort of thing, and I knew that it was good for bonding, and I knew that it was much more convenient and cheaper and, easily packaged and portable, and I knew that it was good for mums in, that it reduced risks of cancer and osteoporosis and so on. I didn't really appreciate how hard it would be and how much of a skill it was to, to breastfeed, I, I'd figured that you know people are mammals and mammals have been around for millions of years and they've all had no problems breastfeeding so why should I have any problems I, I thought it was, it just must be natural and it must be very easy and I was very wrong.

Where did you get that information?

I guess it was more of a perception because the women that I'd seen breastfeeding, or the women that I'd seen in caf's or breastfeeding in supermarkets they all looked so comfortable and happy and I thought well it can't be that hard really. Not very many people in my family have breastfed, I just haven't been around people the right age to be breastfeeding and I think out of my female relatives a lot of them bottle fed rather than breastfed so there wasn't much family input but it was just sort of, the women that I'd seen out in public and they seemed to be very happy with it so I thought it must be easy.

Right, so your mother didn't breastfeed?

I think she tried, to breastfeed me, my mother tried to breast me, feed me for the first few weeks but she'd had problems that I think, she thought that she didn't have enough milk and therefore she moved me on to formula very quickly.

Mm-hm, what country was that in?

I was born in Sri Lanka, and that's where my mum moved from breastfeeding to bottle feeding.

Her medical training did nothing to prepare her for the practicalities of how to breastfeed or...

I'm a doctor.

Just muse with me for a little while about the training you had about lactation as an undergraduate.

I had remarkably little training about breastfeeding when I was, when I was training, in fact I, you know, I learnt all the physiological mechanisms of breastfeeding all the hormonal things that went on and so on but nothing about, you know, even why it was important actually in, we probably had like five minutes of a lecture saying, 'Oh yes it's important for mother-child bonding and it's, you know, good nutritional value', etcetera, etcetera, but that was probably about it, and certainly nothing about how to breastfeed or how to teach somebody to breastfeed, we were given to understand that it was all very straightforward.

So this training did not prepare you for your breastfeeding experiences?

No, not at all, I don't think it helped at all, in fact I think it was, it was negatively helpful in fact it, it made me think it was a lot easier than it was, and it just didn't prepare for it at all.

She used expressed breastmilk in a bottle when feeding in places where she or other people may...

If you're out do you miss a feed? A breastfeed.

It depends on where I'm going, I think it took a while for me to get enough confidence to breastfeed in public so there were times when I would take a bottle of expressed milk and give her a bottle rather than breastfeed her and then I would just express when I came home if I was very full. And, but I've become more confident and I will feed her in more places now, so I'll feed in caf's and restaurants, there are some places where I just don't feel comfortable breastfeeding and sometimes when I'm out with you know, members of the family, my father-in-law for example, my father I just would not feel comfortable breastfeeding in front of them, I think they, they would find it quite odd as well and sort of you know, workplace's and so on that I'd prefer to give a bottle rather than breastfeed her there.

In your own home would you not feed her in front of the male members of your family either?        

I think it's more a question of my male members of my family not feeling comfortable watching me rather than me feeling uncomfortable. I mean my father and my father-in-law and my brother-in-law for example have just never grown up around breastfeeding women so, they would find it really odd to be confronted with it and that would make me uncomfortable. And I'm originally from South-East Asia and although a lot of women do breastfeed there, but it's very much a woman's thing and they'd go off into a different part of the house to breastfeed and men just wouldn't be around when they were feeding their babies, so I think that's why Asian men sometimes feel uncomfortable seeing a woman breastfeeding. I mean obviously it's not a problem with my husband but you know as I said the older members of my family it certainly is.

She received variable advice from a variety of health professionals and doubted her ability as a...

No, as it became more and more painful I became less and less keen to feed and, it was so much so that I was just putting off feeds for as long as I could and every time she cried I thought, 'Oh no it can't be that she's hungry it must be something else and, you know, maybe she's wet or, maybe she just wants a cuddle and she can't possibly want to feed, I really don't want to feed her' and so sort of extended to about four hours and a couple of times, even five hours just because I really was not happy to feed just 'cause it was so painful.

What sort of help did you get at that stage? Did you tell somebody that you were experiencing this pain?

I did, I came home from hospital quite quickly which in retrospect perhaps wasn't a good idea I, it had just been very crowded, very busy and noisy and I didn't really have very much help in the hospital because the midwives were completely overrun that day, very, very busy delivery suite, so I came home after about ten hours and, maybe if I'd stayed in hospital for a bit longer maybe things would have quietened down and there would have been the midwives available to help me in the ward, but I just wanted to get home at that stage. Once I got home I had my mother-in-law at home with me and she was very supportive but unfortunately she hadn't had very much experience with breastfeeding either, she'd had trouble breastfeeding her baby so and she had forgotten what she had learnt so she, she was supportive but couldn't actually offer much practical help. The midwives came home to visit me every day for about two weeks and I found them kind of variably helpful, some of them had obviously had children of their own and knew what to do and sat with me and showed me how to position the baby but quite a few of them had never had children and knew the theory of it but couldn't actually help practically. I mean they knew about as much as I did really 'cause I think it was very easy to read a book and say oh nipple to nose and you know, make them gape and so on and so forth but unless you've actually physically done it I don't think you can teach somebody else to do it. So I found that a bit frustrating, and I thought, I didn't really realise what other resources were available to me for help so I just thought all I had were these midwives and, and I'd see a different midwife every day so I was getting inconsistent advice and it was all really frustrating and stressful on top of the, you know, the tiredness and the soreness, and just the stress of having a new baby so I found those first couple of weeks really awful. At the end of that I discovered that my local hospital had a breastfeeding clinic and I went along there and they were incredibly supportive and very, very experienced and, and, really a help to me to get things back on track.

Two questions, what did you do about that inconsistent advice, how did you deal with that, in the first couple of weeks when you were seeing a different midwife every day?

It was very hard to deal with so many different opinions from so many different people and I kind of just decided which ones I thought were the most sensible and went with that and tried that for a, maybe forty-eight hours and then if that didn't work pick somebody else's advice and go with that, but it was really hard and, the days just seemed like a haze now because, you know, there was just so much information being thrown at me and not all of it was very useful and, and I felt like I was being, I was a complete failure actually because all these women were saying, 'Oh well you know it's all about the latch, it's all about this, it's all about that' and I tried so hard to do everything that they told me to do and I just couldn't seem to do it and I found that really upsetting.

Her first breastfeed was uncomfortable but then the baby fed every two to three hours for the...

I do remember my first breastfeed and it wasn't entirely pleasant because the labour had been very long, I was very tired and I didn't really know what to do and I just remember the midwife taking the baby and holding my breast in one hand and the baby in the other hand and just putting the both of them together, and I didn't really know what was going on, and it was just quite a shock to have a baby to hold really I wasn't really think, watching what she was doing or thinking about what she was doing and it did hurt a little bit but you know the midwife said, 'Oh no that's fine, that's normal, it's because, you know, she's got a small mouth and your nipples are very tender yet, and that will sort itself out' so I didn't enjoy that very first breastfeed subsequently it became a bit easier in that first twenty-four hours I think, I don't know whether I was doing it correctly or not but it seemed to me a bit easier at first.

Do you remember how often you put her to the breast in that first twenty-four hour?

In the first twenty-four hours I'd read that you have to put the baby to the breast as often as possible, so I, I think I was doing it about every two to three hours, she was quite sleepy the first day so it, I did, I didn't I don't think I woke her up but it seemed to be quite often I think it was about two to three hours.

Breastfeeding has been a fantastic experience for her and she has an incredible feeling of...

I think it's, I think of having it now four months down the line, I think it's been a fantastic experience, I've not enjoyed every minute of it but on the whole it's been incredibly positive and I've enjoyed it overall. There are really, it's hard to start and there are times when it seems very hard to keep going and all I would say would be to get help and to keep going because at the end of the day you just feel this incredible feeling of satisfaction and achievement at having done it. I think it's important to not feel like a failure when it is going wrong and, because, every woman's different and every baby's different and, and some people will just find it harder than others, and I think it's also important to, to not listen to some of the kind of, you know, sort of expectations that you get from, from other health professionals. I found, you know, for example, my health visitors were very unhelpful, they kept saying, 'Oh well you must breastfeed, of course you must breastfeed' and, and not actually helping me learn to breastfeed but just making me feel that I ought to be doing it. And at the times when I was feeling it, when I was finding it quite hard to breastfeed and, and my baby wasn't putting on weight, and I was looking for alternatives or just other ways in which I could supplement my breastfeeding I found them very unhelpful and you know they would say, 'Oh you mustn't ever give the baby formula that's just entirely the wrong thing to do' and I think in retrospect when I did top her up with formula, you know, it was exactly the right thing to do because I had to top her up so that she'd continue to gain weight until I could get my breastfeeding back on track. So yeah be strong and don't let yourself be cowed by people telling you that there is only breastfeeding and that's the only way to do it 'cause there are other ways to help breastfeeding, I think you know such as expressing milk or giving a bit of formula occasionally, and there's nothing wrong with that, you just have to find out what works for you and then stick with it, and forget about what everybody else says really.
 

Her baby's weight gain slowed so she gave her top ups of expressed milk and infant formula. She...

I went to the clinic on and off for about five to six weeks, what happened was that I eventually got the latch right but I had a couple of other hiccoughs along the way, and one was that I developed mastitis a couple of times and I suspect that was because I hadn't got the latch quite right, and that was a bit of a, again that kind of took my confidence away because once I thought I had my latch right then something else happened and, you know, I have these horrible painful red sore breasts and I had to take antibiotics and I felt dreadful and, you know, I just needed to go back and get a bit more emotional support I think if nothing else, but that sorted itself out. However I think after about, when she was about eight weeks old I noticed that she wasn't really putting on weight quite as well as she ought to have been. She'd dipped down quite badly in those first two weeks which I assume was because I was breastfeeding her so badly but then she'd started to pick up again but she never quite followed a centile, she started sort of crossing over centiles going downwards, and that was very worrying. When I went to the breastfeeding clinic they were, they were very good about sort of talking me through what exactly I was doing, you know, sort of routine-wise how many feeds she was getting a day and at that stage she was getting about eight feeds a day but she still didn't seem to be getting enough milk at each time, so they suggested a sort of variety of strategies to increase my breastmilk production. So what I first did was I started expressing at the end of each feed so that I'd have a bit of extra breast stimulation so I would feed her, express, and then give her whatever expressed milk I had at the end of each feed so she was having sort of a double feed if you like. And I did that for about two or three weeks and it was very time-consuming and quite draining because, you know, it's bad enough I think feeding every three hours through the night but when you also have to be up and expressing and then giving her the bottle and sterilising the bottles and so on and so forth it got, very tiring. Then what happened was at, but that still didn't really seem to be working and again I started getting quite upset because I thought, you know, 'What more can I do?' so I started topping her up with formula, I'd breastfeed her and then give her a bottle of formula, and she'd have sort of between say two and four ounces after a breastfeed and then at the same time I started taking some Domperidone which is what the breastfeeding clinic recommended, to increase my breastmilk production. And the Domperidone's actually an anti-nausea drug but it has the side, the side effect of increasing lactation, so I was taking one tablet three times a day for about two weeks. And it did actually increase my breastmilk production so that I was getting more each time I expressed at the end of a breastfeed and you know so there I was, I went back to breastfeeding, expressing and giving her the expressed milk, and that would seem to settle her actually. Once my breastmilk production had gone up a bit her own growth picked up a bit and she went back onto the centile that she was born on and has followed that ever since, so that's what I've continued doing, she's down to six feeds a day but I breastfeed her and top her off with expressed milk at the end of each feed, and it sounds a bit of a bother but it's worked now for the last two months and she's incredibly settled and is happy with her six feeds a day and she sleeps through the night and I just don't want to rock the boat so I think I'm just going to just continue doing that until it's time to wean her.

Are you still taking the Domperidone?

No I stopped taking the Domperidone after about two weeks, but I really do think it had an effect, I noticed it myself, I mean I could see the effect i