The Labor of Nursing

As I anticipated the birth of our first child, I worried about many things, but one thing I never worried about was breastfeeding.  Visions of peacefully nursing and rocking my baby helped to sustain me throughout those interminable final weeks of pregnancy.   I was totally unprepared for the difficulties that would follow.

From the moment of her birth, Emily was completely uninterested in nursing.  Every few hours for two days the nurses tried to bring breast and baby together, but my flat nipples made it difficult for Emily to latch on.  Without nourishment she remained sleepy, which weakened her already feeble instinct to suck.  When we left the hospital, Emily still had not latched on.

Once home, I became increasingly concerned and frustrated by my inability to feed our daughter.  By midnight, we were so distraught that we called a La Leche League contact person, but we had already tried all her suggestions.  After that long night, we called a lactation consultant, who visited us almost immediately.  She was very encouraging, but no matter what position we tried, Emily refused to latch on.  I alternated between feeling determined and despondent.  While I pumped my incipient milk, my husband tried feeding Emily, first with an eye dropper and later through tubing; having read all about “nipple confusion,” we were trying to avoid giving Emily a bottle.

The next day, our family doctor told us Emily was slightly dehydrated, evidenced partly by the fact that there were traces of “brick dust” urine on her diaper.  She needed more milk than I could pump.  Disappointed and worried, we bought some soy-based formula to supplement my milk.

Things got worse before they got better.  Despite a determined effort to get Emily to eat, she seemed even sleepier and less interested in eating than before.  By the next morning all she wanted to do was sleep.  Nothing roused her.  Despondent and in tears, we returned to the doctor.  “Our baby won’t eat!” we cried.  She told us the obvious – Emily needed food.  If we didn’t get more fluids into her she could end up in the hospital. At that moment “nipple confusion” – as well as nursing – became trivial.

For the next 24 hours, Mark and my mother took turns bottle-feeding her while I tried to pump as much of my own milk as I could.  We kept detailed records of how much and how often she ate, wet, and pooped.  Every additional ounce she consumed was another milestone and each empty bottle was held up like a trophy.  By the next day, not only was she eating with enthusiasm, but she was less sleepy and her color had changed.  We had not realized how jaundiced she was until she suddenly pinked up!

Now that Emily was eating, we began to refocus our energies on nursing.  Who knew that it would take four more weeks before she would latch on!  Working closely and frequently with our lactation consultant we tried various positions, and Emily and I
spent afternoons lying in bed together, skin-to-skin.  We tried using a cup and, of course, I kept offering her the real thing.  Occasionally I tried to nurse Emily with a nipple shield, but it tended to curl back over itself and fall off.  Nothing worked.  She was a happy, alert baby who got upset only when being pushed against her will to my now milk-laden breasts.  Many days I ended up in tears.

A friend agreed to try nursing Emily, but she cried and pulled away from her breast, too.  I was beginning to resign myself to the fact that nursing might not ever work.  With a history of allergies and asthma, though, I wanted to do everything possible to keep Emily from following in my footsteps.  Disappointed, I told myself that if I could just maintain the discipline to pump until Emily was three months old, I would be satisfied.

Feeding Emily gradually became routine.  We weren’t delighted with our arrangement, but at least it was predictable.  During the night either Mark or my mother would feed her while I pumped; breastmilk now made up over one-half of her food. Between Emily’s third and fourth weeks, I stopped nursing attempts altogether, trying to get a respite from the stress and frustration.

Gradually, however, I tried the nipple shield more often, maybe once a day. Sometimes it didn’t work at all, but occasionally it did, with Emily in the football hold atop two pillows, and she would get a small amount, fresh from the spigot.  Over time we became more successful, though not consistently.  I began to remove the shield after Emily nursed, offering her my breast directly.  More often than not she cried and refused it, but occasionally she latched on.  Still, she seemed unable to draw the nipple into her mouth.

To this day I don’t know what changed.  All of a sudden, Emily was nursing!  It was as if after 5 weeks, she just decided, “Hey, I can do this!”  Gradually I could nurse her in the cradle hold or lying down, and later I no longer needed pillows or assistance from another pair of hands.  But it took a while to feel confident and secure.  Every evening Mark would make enough formula to last through the next day.  Each day he threw out more and prepared less.  Eventually I felt secure just having a container of formula in the cupboard.  It remained unused.  Ultimately we returned the electric pump.

Although I don’t know what the trick was, I do know that the emotional and physical support I received from my husband and mother were invaluable as were the guidance and encouragement from our lactation consultant.  Without them, I surely would have given up.

As I write this, Emily is 6 months old and is a delightful, strong-willed, independent and very healthy baby.  Her weight is in the 95th percentile and her mouth is open to nurse before I have time to pop out my breast.  She nurses to satisfy not only her hunger, but also her need for comfort.  When she looks up at me with her milky smile, it’s easy to forget the difficulties we had at the beginning.  Was it worth it?  Definitely!

© 1995 Barbara Behrmann, for Common Sense Breastfeeding

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Note regarding cross-nursing:

One of the methods this mother used to encourage her baby to latch on was to ask a friend to nurse the baby.  In this case, it didnít work.  However, “cross-nursing” is an ancient breastfeeding tool.  “Breastfeeding: A Guide for the Medical Profession”* states:

“The hazards to cross-nursing are undocumented but worthy of consideration.  The physical problems are the potential for infection, either of mother or of baby; interruption of milk supply for the mother’s own baby; and the difference in composition of milk if babies are of different chronologic or conceptual ages.  The psychologic hazards could include failure of mother to let-down, refusal of infant to nurse (which does occur when infants are introduced to the phenomenon beyond 4 months of age), and negative impact on siblings and the household environment.  The long-range effects are not documented.

“Reasonable caution is certainly appropriate, taking care to ensure that the cross-nursing mother is healthy and well nourished without any general or local infection, not taking any medications, and not smoking.  The infants should probably be close in age to the mother’s own baby and also free of infection, especially thrush.  If this were a commercial venture in a public day-care setting, regulations of certification screening for tuberculosis, syphilis, hepatitis, cyto- megalovirus, herpesvirus, HIV, and other infectious agents would be in order.  Documents of liability might be required with signed consent forms.

“Perhaps as breastfeeding knowledge and understanding reach a greater number of professionals and women, such opportunities may be more common.  At present, it is significant to recognize cross-nursing as a viable option, as long as appropriate infection precautions are taken.  The hospital or physician cannot be the agent of arrangement.”

*Lawrence RA. Breastfeeding: a guide for the medical profession, 6th edition. 2005. Mosby, St. Louis.

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