Ruth

Age at interview: 43

Brief Outline: In Ruth’s first pregnancy, she developed pre-eclampsia at 32 weeks and stayed in hospital till the birth of her son by emergency C section at just over 35 weeks. Her baby weighed 4lb. Ruth was unable to physically breastfeed and used an electrical pump to expressed her milk for 4½ months. The experience was both emotionally and physically exhausting. She felt a failure as well as under pressure by health professionals to feed her son breastmilk. In her second pregnancy, Ruth developed severe gestational diabetes and was also at high risk of developing pre-eclampsia. Her second son was delivered by planned C section at 38 weeks. Her second son received her expressed milk for four weeks, and then she started a mix-feeding routine and then formula.

Background: Married, two children ages 6 years and 7 months. Works full-time for a university. Ethnic background: White British.

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Ruth became a mum for the first time in her late thirties and was forty-two when she had her second son. She has a condition called polycystic ovaries. During both pregnancies, she was closely monitored by the hospital medical team because of her age; the onset of gestational diabetes and the high risk of developing pre-eclampsia during pregnancy. Ruth developed pre-eclampsia with her first son at 32 weeks and stayed in hospital till the birth. She was transferred to another hospital fifty minutes away, because her local maternity hospital had no special care unit beds available for her baby. The plan was to induce her but there were complications and the baby went into distress and she ended up having an emergency C section at just over 35 weeks. Her premature baby weighted 4lb and was in an incubator for two days to regulate his temperature and in a special care unit for another 9 days due to his size and jaundice.

When she recovered a bit from her C section, Ruth tried to breastfeed her baby, but he wasn’t interested and she found it physically difficult due to the size of her breasts and the size of the baby. She started to express her colostrum, and then her breastmilk using an electric pump, which was fed to the baby first by nasal tube and then by bottle. There was very limited support to help breastfeed in the hospital but when she left hospital the midwives and health visitors reassured her that breastfeeding was going to happen when the baby was more settled and slightly bigger. They advised her that she should breastfeed for at least six months especially as her baby had been premature, but in the meantime she should keep pumping and feeding him her breastmilk from the bottle. As a first time mum, she felt under pressure to comply with the advice of health professionals and she herself wanted to give her premature son a good start in life. Ruth’s mother was very supportive and engaged a breastfeeding consultant. She had four sessions with the expert but all they managed was for the baby to latch on once just for a few seconds. She was pumping her breastmilk every four hours - day and night as advised to maintain her milk supply. Her baby was growing well, but he was not breastfeeding as predicted by health professionals. The four hourly routine was exhausting, and her mood was low.

She felt a sense of failure because she had not achieved a natural birth or succeeded in breastfeeding. She felt bullied by the health professionals into keeping regularly pumping and attempting breastfeeding, which she did every day for four months. Her husband supported her in her efforts but convinced her that she had done enough and that she had succeeded in giving their son all the goodness from her milk. It was time for her to stop pumping and to start using baby formula. As Ruth had been maintaining such a good supply of breastmilk, she had been storing the surplus in the freezer and had enough to feed her son for a couple of months. But when her son was given the defrosted milk it was rejected or vomited up. The frozen breastmilk was then donated to the breastmilk bank at the local hospital. Ruth then started to wean the baby onto formula and reduce her milk supply, which took a few weeks.
 
The experience of birth and breastfeeding with her second son was more positive. Before conceiving, her new GP advised Ruth to lose weight; and she managed to lose two stone. Despite being in good health during pregnancy, she developed gestational diabetes again but much more severely than with her first son and that involved being treated with tablets and insulin three times a day. She did feel very well cared for by the consultants in hospital, her GP and the midwife. Overall, she felt more confident. Her consultants advised her to have a planned C section at thirty eight weeks due to the risks of gestational diabetes, pre-eclampsia and failed induction with her first son. The planned C section went ahead at 38 weeks and went well and she delivered a baby who was within normal weight (7lb) and did not need special care. Regarding breastfeeding she felt that the attitude of health professionals had changed for the better in the five years between her pregnancies; that the priority was to feed the baby, not ‘you have to breastfeed for six months’. In hospital, she was helped by a midwife to latch the baby to her breast and he showed an interest in it - but like before, he was unable to successfully feed.

A particularly helpful midwife figured out that although Ruth has large breasts and lots of milk, her nipples were not very long and the soft palate of her son was too far back in his mouth to enable him to latch on successfully and suck the milk. In other words, it was the mechanics that prevented the baby from breastfeeding. This finding came as a big relief to Ruth. There was at last an explanation as to why her baby and perhaps her other son as well had been unable to breastfeed. She and her husband agreed that she would not use an electric pump again so she used a hand pump for four weeks to express her breastmilk and then alternated feeds with formula till six weeks. Her second son was then exclusively on formula from six weeks old. Unlike her first experience, she felt relaxed and able to make decisions that were appropriate for her baby, herself and the whole family.

Ruth says that the health professionals' priority was for her to feed breastmilk to her baby. The use of an electric pump, every four hours for months, gradually made her feel exhausted.

But this pump experience was just, I kept telling myself, ‘It’s only a short-term thing. It’s going to be in the hospital.’ Everybody says “You’ve got to give him breastmilk. He’s a premature baby. He’s been really sick, you know breastmilk is best. Breastmilk is best. You must give him breastmilk.” So as far as the hospital and the nurses were concerned the priority wasn’t me breastfeeding him, it was giving him breastmilk. So there was a lot of emphasis on keeping my milk supply going and my milk supply up, which meant that I had to pump every, I think it was a minimum of every four hours, all the way through the night and all the way through the day to keep the milk supply going because they said, “If you do it less than that, you’re not going to keep your milk supply up for when he gets home and all the rest of it. You want to keep your milk supply up because you might get him breast, you will get him breastfeeding.” There was no question at this stage where they said, “You might not be able to breastfeed him or it won’t work.” Everybody was trying to convince me, carry on pumping and you will be able to breastfeed him…
 
So I then took this very tiny little baby home sort after eleven days of being in the special care unit and the fun began [laughs]. So I was, I, my attitude to breastfeeding was that I’ve always thought I would breastfeed my babies. There was no question about it, I was very pro-breast feeding. I knew the benefits of it, I knew the literature. I’d read up on it, there was, I didn’t agree with, you know, bottle feeding for the sake of bottle feeding. It was always going to be breast-fed. So with the troubles that I’d had in the hospital and the fact that he just wasn’t breastfeeding and the most important thing was to give him breastmilk, so I took a pump home with me from the hospital. I hired one of these massive great big pump things and it’s not one of your little hand held things. This is a big electronic thing that does a double pump business. It’s like a milking machine, it is, I came to loathe the thing and it had a big stand and it stood in the corner of the room and every four hours out came the suction cups and you had to sterilise everything and clean it all down and then you know, it used to take about it used to take ten/fifteen minutes to prepare everything before you had to do the, do the expressing and then you plugged yourself in to this machine and I did. At night I used to double pump because I was just too fed up with it. Otherwise I’d just do one breast and hold the baby on the other side and give him cuddles and things like that but at night because I’m so tired I just used to do both boobs because if you didn’t do both boobs you’d end up really sore and you risk mastitis and all the rest of it, so at night I did the double pumping. So you’d go and do the pumping for about half an hour and then you’d then have to feed the baby.

Ruth’s message to new mothers is ‘Happy mother, happy baby, if you can breastfeed on top of that, fantastic’.

Again, as I said, my attitude has changed. I’m probably a little bit more bolshie than I was before because I’d had such a bad experience with it last time and I’m not going to let people bully me in the same way as they bullied me the first time. But it does, I think there’s been a shift back more to the fact that it’s, mothers well-being is also important. That, you know, if you stress the mother out then they get over anxious. Then they either end up with more depression or the baby ends up with taking on the anxiety, getting more stressed and the baby can be more colicky and more cryie and less settled and not feed as well because it’s feeling stressed because the mother is stressed and all of that so I just think, you know, ‘Happy Mother, happy baby.’ If you can breastfeed on top of that, fantastic. If you can’t, don’t stress about it. And I think that’s certainly my message to other mothers is, don’t discount breastfeeding because I still think it’s a really, really good thing to do. But don’t stress yourself if you can’t do it. And there are lots and lots of people out there that have problems. They might all not talk about the fact that they’ve had problems but there are lots of people out there who have problems. So you’re not alone in having problems if you can’t do it and you’re not alone in not being able to do it if you can’t do it but don’t feel guilty about it. Don’t get stressed about it. The most important thing is a happy, feeding, gaining weight baby. So, you know, go with whatever works to be able to accomplish that for you.

With her second baby, Ruth said that midwives and health visitors supported rather than pressured her into breastfeeding. She also found out the reason why she couldn’t breastfeed both her children.

So completely, it wasn’t, it was a different attitude with the midwives from before on the ward. It wasn’t, “You must breastfeed. You must, you know, you must feed them breastmilk”. It was much, much more open. I don’t know whether that’s down to different hospitals or whether or not it really has progressed further forward than it had done when I had my son five years before  because it was five years now the gap between them  and or five and a half years. And they were, they said, “Right, okay it’s not working but we, you know, we do have lots of formula here, all different types of formula you can try them. There’s no problem with combination feeding. We’ll, we’ll do whatever we can to help you. It was much more relaxed and there was no, “You must breastfeed and then if you don’t breastfeed, you can use formula.” It was, “We will get you feeding, that’s the most important thing, get the baby feeding, whether it’s breast, or bottle or combination of both. We’ll get the baby feeding and you know, so that you can return back to some normality and be able to go home and all the rest of it.” You weren’t, felt, I didn’t feel like I was being pushed out the door. That wasn’t their objective to get you out the door but I did feel it was a different attitude. Different, much more relaxed to the, to even the idea of combination feeding which was apparently a big no, no before, you know, “No you shouldn’t combination feed, you should breast or bottle. But you don’t do both and it should be breast.” Whereas this time it was, you know, “We’ll feed the baby, basically.”
 
…So the very nice midwife who I’d seen the night before who was on the nightshift came back to me as promised, as she said and again was with me for a good hour and we tried everything. We even tried nipple shields which are a big no, no. The breast feeding people think they’re absolutely xx and she worked out through you know, working out what was happening, where his mouth was getting in, where he was attaching, where he was sucking that his soft palette in his mouth was really far back and my nipples are not very big. So I’ve got very big boobs but not very big nipples and they just weren’t reaching the area in his mouth far enough back for him to be able to get a decent latch on and be able to suck and draw milk off the breast. Because you needed to get more of the, there needed to be a longer nipple for him to be able to get that action going. And finding that out when I was in the hospital was the biggest relief that I think I’ve had about the whole situation because I suddenly realised it was the mechanics that was wrong. It wasn’t me, it wasn’t you know, it wasn’t my lack of trying. It wasn’t… just the compatibility between my baby’s mouth and where his soft palate was and the size of my nipples. The mechanics just didn’t tie up and that’s why the breastfeeding was not working.  Again, she said, “Look we can try again, it’s not a problem. You’re going to be in for another night at least, so we’ll, we will try again but I think it’s not going to work because of the size of the nipples.” She said, “You can try the nipple shields because obviously they make the nipple protrude more and, and look bigger.” But he just couldn’t get attached on there and he just didn’t like the plastic at all. He, he wanted skin, he just didn’t want plastic on there and so that was, you know, I, wasn’t worried at this stage. I hadn’t discounted the fact that I couldn’t breastfeed at this stage and she said, “It might be that you know, when he’s a little bit bigger, you know, couple of weeks’ time, if you keep going, keep encouraging him. As long as he’s still comfortable with the boob, he might go on the breast.” And I thought, ‘But again it was might. It wasn’t keep trying, it will happen. It was it might happen.’ There is an option, don’t discount it but it was, again, there was, there wasn’t that expectation from health professionals, the midwives that I saw and I saw three or four midwives from that ward. It was all very much, “The priority is to feed the baby. It doesn’t matter what you feed the baby on. Yes it’s better to have breastmilk but you know at the end of the day as long as they’re feeding, as long as they’re putting on weight. That’s the most important thing.” 

For Ruth the pressure to provide her milk to her premature baby came from herself and health professionals.

The Health Visitor comes and comes and has a look at it when you are at home, especially when you are a first time mum, they come, oh, I think I must have had four visits I think. I think it was about four visits. Lovely health visitor but she again, like the, the nurses in the hospital said, “He’s a premature baby. It’ll happen. Just keep trying, just keep pumping. Just keep going. I mean you’re giving him breastmilk, that’s great. Just keep trying with the breastfeeding. Try every feed.” And again pressure, “Try, keep going, keep going.” And again all the health professionals, incredibly pro-breast feeding and again I have to say my attitude was as well if I can do this, I really want to, do want to get him to breastfeed. But, you know, having to be up every four hours and pump and, and feed the baby and try the breastfeeding every time you were feeding was getting very stressful and I was getting quite stressed about it and you know the health visitor came, she tried to give me some lessons. She tried and couldn’t get the baby to latch on at all. “Oh, no don’t worry. We’ll try again in another week when he’s a little bit bigger.” It was always, “When he’s a little bit bigger, when he’s a bit stronger, it’ll happen. It’ll happen. But in the meantime do, do your expressing because you’re feeding him breastmilk and you must do that. You must have breastmilk for six months.” Hammered in to you every single time you saw any health professional. 

Giving breastmilk to her premature baby was the priority for Ruth but the use of an electric pump every four hours for 4 months was exhausting.

So I then took this very tiny little baby home sort after eleven days of being in the special care unit and the fun began [laughs]. So I was, I, my attitude to breastfeeding was that I’ve always thought I would breastfeed my babies. There was no question about it, I was very pro-breast feeding. I knew the benefits of it, I knew the literature. I’d read up on it, there was, I didn’t agree with, you know, bottle feeding for the sake of bottle feeding. It was always going to be breast-fed. So with the troubles that I’d had in the hospital and the fact that he just wasn’t breastfeeding and the most important thing was to give him breastmilk, so I took a pump home with me from the hospital. I hired one of these massive great big pump things and it’s not one of your little hand held things. This is a big electronic thing that does a double pump business. It’s like a milking machine, it is, I came to loathe the thing and it had a big stand and it stood in the corner of the room and every four hours out came the suction cups and you had to sterilise everything and clean it all down and then you know, it used to take about it used to take ten/fifteen minutes to prepare everything before you had to do the, do the expressing and then you plugged yourself in to this machine and I did. At night I used to double pump because I was just too fed up with it. Otherwise I’d just do one breast and hold the baby on the other side and give him cuddles and things like that but at night because I’m so tired I just used to do both boobs because if you didn’t do both boobs you’d end up really sore and you risk mastitis and all the rest of it, so at night I did the double pumping. So you’d go and do the pumping for about half an hour and then you’d then have to feed the baby…
 
So you know this is a month on from having the baby and still not breastfeeding. And still getting the message through from health professionals, “You must breastfeed. You must give him breastmilk. You must, you will get there, he’s just small. He’s just premature. It’ll happen.” you know, so first time mum, being a little bit naive and you know, I would count myself as quite a, you know, intelligent vocal person normally but, you know, this is my first baby. I’m a little bit hesitant about knowing what I want to do. I want to do the best for my baby so I follow their advice and I keep going and I keep going and I’m pumping and I’m getting tireder and tireder because I’m up all night pumping and then you know without, and my husband feeding the baby, you know we’re doing it in shifts as we go along. But, you know, that two o’clock in the morning and you’re just sitting there pumping. I mean, I lost a lot of weight when I was pregnant which is unusual but I did lose a lot of weight. But at that 2 o’clock in the morning feed I’m sitting there and I’m eating half a packet of chocolate digestives biscuits because I’m stressed and bored and tired and when you’re tired you eat, you want to eat sugar and you want to eat crap. So, you know, I ended up putting all the weight I’d lost when I was having the baby back on again over the space of six months I think.  

Ruth’s first son was born prematurely and delivered by C section. While in the incubator he was fed through a tube with Ruth’s expressed milk. She was advised to wait until he was stronger to start breastfeeding.

So, still hadn’t even got to the stage where I hadn’t really even thought about the breastfeeding or, or attempting the breastfeeding because he was in the incubator and I wasn’t allowed to hold him yet. So it was twenty fours afterwards before I actually got to have him out of the incubator and hold him and I did skin to skin contact and put him against my boob and all the rest of it but there was very little interest and it was just basically having a cuddle and I said, “Oh, you know he doesn’t seem to be interested at all.” And they said, “Oh well, you know, he’s still very little and you know, we’re tube feeding him and things like that.
 
Meanwhile, about sort of, twelve hours before, the midwives had come to me and said, “Well, you know do you want to start expressing some milk?” and to get the colostrum off and stuff like that. And so they’d given me a pump and shown me how to use the pump and I’d started producing colostrum which I’d pumped out and I’d started off producing quite a lot actually. A lot more than they were expecting initially and so from about twelve hours in, I, he was only getting my breastmilk. So he was getting my breastmilk, but he wasn’t actually being breastfed and my, so I, he was being tube fed with my breastmilk. So I wasn’t so worried and they kept saying to me, “Oh, don’t worry, it’ll be, it’ll be a while, you know, he’s a premature baby. Sometimes it takes them a little while to get the hang of it and all the rest of it.” And, you know, while he was still in the incubator, I’d sort of thought, ‘Well you know, I can understand him not really being at that stage to be able to do the feeding.’
 
But we tried the breastfeeding and the midwife came round and, and you know tried to, but I’m quite well endowed in the breast section and he was so tiny, it just didn’t work. Size wise he was so tiny and my boobs were so big. Actually getting my boobs in to a position where he could get it in to his mouth, actually took three hands and at which stage he was just not, he just didn’t understand the whole latching on process and just, you know, kept trying and you know presenting him with nipple. Doing all the things you’d seen in the books or been told to do and you know the midwife, they, they spent a little time with me. I didn’t have too much help with the breastfeeding in the special care unit but and there was apparently a special care, a specialist breastfeeding nurse in the hospital and they booked me in to see her the following day so that we’d have another go and they just said, “Oh you know, keep taking him to breast and keep trying.” And oh it was an absolute palava, so me and my husband fighting my boobs around this really tiny baby in his mouth and it just, he just didn’t want to put my nipple in his mouth. Or he, he put it in but then just not know what to do with it at all. And this carried on for another three or four days. We had some sessions with, I had two sessions with the breast feeding, specialist breast feeding nurse, which went no better than our self, the ones we’d been doing ourselves or with the midwife and she, she just. He wasn’t having any of it and they said, “Oh, he’s too small, he’s too little. He’s too premature. When he gets a bit bigger, when he’s come off the tube feeding and, you know, you’ve got him home, it’ll be fine. Just keep expressing the milk.”