Breastfeeding and childbirth – parallels and retrospective

So I breastfed the little dude for 16 months, stopping after I found out I was pregnant with number two because no no no way nup nope not supporting two other beings with my body, one extra is quite enough thanks.

I’ve read a few pieces recently on some of the other mama blogs I follow about breastfeeding, and I’ve been thinking of the parallels between a birth experience like mine was (heavy interventionist, fairly traumatic, and with an ongoing legacy of damage to my pelvic floor muscles that will require surgery to fix when I’m done having more babies); and a breastfeeding experience that ends in formula. I know a lot of the homebirthy-type feminists have written about these issues – about how women are alienated from the capacities of our bodies through a patriarchal system that sees us as a potential barrier to scientific care of the babies. How we are not equipped to see childbirth as something we can do, and how we are therefore not supported to do it in a non-medicalised setting. An alternative feminist analysis is that the pain and danger of childbirth has been minimised by men who prefer to believe that women complain unnecessarily over the idea that women live through extreme pain in order to produce each new person in the world, and that this stigmatises the use of pain relief and other interventions which would otherwise be routine. Thought-provoking stuff. From my own experience, I suspect there is a lot of truth in both.

In my circle of friends and acquaintances who have had babies in Wellington in the past few years, there seems to be an alarmingly high proportion who have Bad Birth Stories and/or Bad Breastfeeding Stories.

I was so lucky with breastfeeding, it so very nearly didn’t happen. When the little dude was 8 days old and refusing to latch and clamping down and yanking and fussing at the breast, I was soaking through my nursing bras and dripping milk on the floor and dealing with engorged painful breasts and several blocked ducts and blistered nipples. If a few things had been different, we might have ended our breastfeeding relationship that day. The engorgement was actually a blessing, it gave me an overabundant supply that enabled me to produce enough milk to feed my baby despite his extremely compromised latch. I was fortunate that my mother breastfed me and my brother, and was so affirming of my efforts. My husband had been sternly instructed by his own mother that his job when the baby was born was to do everything else so that I could take time to breastfeed. My worst day was a Sunday, which  meant that I could go straight to the free Monday clinic the very next morning. I was able to afford to go to a private lactation consultant and got an appointment on the Thursday of that week. And finally there was a dentist in our town who does the laser surgery that was needed to address the little dude’s fairly severe tongue-tie and lip-tie. We had to pay quite a lot for the dentist to do the surgery, about $200. It’s simple procedure, essentially burning through the excess frenulum with the laser. It didn’t take long. It can be done on the public system, but there is a waiting list which can be months long. Needless to say, not everyone has the money. (Side note – the dentist said “on the positive side, this level of lip-tie would eventually need to be treated and fixing it before his baby teeth come through means you might end up saving thousands in braces down the line!” Thanks dentist.)

Once we were sorted, we were sorted. The little dude was an extremely eager feeder. He didn’t take quickly to solids, he was still having almost all his food from my milk at 7 months. For the first few months, I felt that breastfeeding was the intermediate state of separate but joined, after he exited my body and became his own being in the world. Breastfeeding mediated our relationship, it symbolised comfort and nurturing that he received only from me, and it shaped my sense of myself as a mother.

It had limitations too: an intermediate state of separate but joined meant that we were kinda joined. I never went far away or for long until he was in creche, whereupon the breastfeed he received as soon as I arrived to pick him up was the best comfort and reassurance I could provide.

Some people find they faced insurmountable obstacles to breastfeeding, and others find they didn’t really like it, or want to stop earlier than they thought they would, or do it out of a sense of duty but never really enjoyed it. For me, it was just right – until suddenly I felt like it was time to finish up when I saw the two pink lines, and so we did. I hate to think of other women who read about my breastfeeding experience and feel saddened that they missed out. Though when I read about positive birth experiences, it makes me sad, but I also think it’s important that all the different stories be told. It’s ok to be sad about what might have been. Especially when there’s a next time to think about, and there’s scope for next time to be different. My experience breastfeeding started badly and then turned out fine. My birth went from bad to worse. In childbirth, I was at the mercy of hospital admission policies and felt like I had no power to follow through on my instincts within the constraints of the system. Breastfeeding could have gone the same way, except I was able to access good professional support and also had some strokes of luck with my milk supply and support from my family.

New Zealand’s health care system has a confused and problematic towards pregnancy, childbirth, and breastfeeding. It has adopted the idea that these are natural processes and should be allowed to occur without unnecessary intervention; but at the same time, if something goes wrong, we’ll go down the intervention route – basically episiotomy or caesarean for childbirth, and formula for feeding. This sounds reasonable enough until you realise that experiences can’t be divided into “all goes well” and “all goes wrong”. The New Zealand Maternity Clinical Indicators makes for grim reading. We have a very high rate of caesareans and episiotomies. My totally anecdotal diagnosis of the problem is that the health system doesn’t seem to give much space to the middle ground of “things are not going so great and we don’t need to look at the Last Resort yet but we do need to do something other than just wait and hope it gets better.” It seems more like the attitude is “don’t worry, it’ll be fine, don’t worry, it’ll be fine, don’t worry, it’ll be fine FUCK IT’S NOT FINE FUCK”.

Since the late 1980s, when I was born, the introduction of the Lead Maternity Carer (LMC) model has sought to bridge the gap between the “medical” mode of care and the “natural bodily function” mode of care. Women see a midwife during pregnancy for free, or can pay to see an obstetrician. Midwives are contracted by the Ministry of Health, and there’s no formal referral system – you basically just find a midwife based on word of mouth or google. The midwife attends the birth at a hospital, birthing centre, or a home; and if the birth is at a hospital there will also be an obstetrician available if needed (in theory). The hospital system is managed at a regional level, so there are real differences across the country in facilities, policies, and resources. Women who elect a midwife as their LMC might not see an obstetrician at all – but if there is a reason for the midwife to refer the pregnant person to an obstetrician, it will be free. When it comes to the birth, the midwife is not employed by the hospital, and is subject to the hospital’s admission policies. The most common model is for the woman to labour at home with any chosen support people, and for the midwife to be present at the hospital once the woman is dilated enough to be admitted according to hospital policies.

With the little dude and breastfeeding, I want to once again emphasise that the lactation consultant and the dentist who did the oral surgery were private, completely removed from the health system. The lactation consultant at the hospital didn’t examine his mouth and just gave me lanolin cream for my blistered nipples and was completely fucking useless and it makes me furious that this is the level of support available through the public system. Because the birth went badly, I don’t entirely know what should have or could have been different to make it go well. Too many factors, and I have no point of comparison. It’s simple when you have a near miss to identify what made things go well, but when you have a crash it’s harder to know how it could have been avoided.

This time I’m going with a private obstetrician. I wanted to have an initial consultation with an obstetrician to get some guidance on whether vaginal birth with a rectocele and cystocele prolapse is even possible, or whether I should plan for a caesarean. We talked about my experience with the last birth, how I was a week overdue when contractions started, and then I had an extremely long first stage and then an extremely long second stage (my second stage, known as the pushing bit, was over 3 hours – the little dude’s head was not quite at the right angle), how the episiotomy extended almost the whole length of the perineum and how the little dude was born in respiratory distress and had to go to NICU straight away. The obstetrician was reassuring in many ways. First, and actually this was most important, she was resolutely affirming of my view that NONE OF THAT SHOULD HAVE HAPPENED. It’s been hard for me to talk about my birth experience because so often I encounter the attitude of “yeah well birth is bad, duh”. And I’m like, no, uh, my birth was really bad. And then I feel all shamefaced because I don’t want to oversell how bad it was? But I feel like it was fairly bad? So the obstetrician was all “yeah that sounds horrific”. Second, she also seemed to agree with me that my midwife hadn’t done anything wrong. I really liked my midwife and I felt well supported by her and even though I was not in a great place when I was finally admitted to the hospital at 10pm, 2.5cm dilated, after 24 hours or so of regular painful contractions and nearly 40 hours of continued awakeness, I could tell that she was not pleased the hospital had refused to admit me sooner (hospital view: not dilated enough, baby not in distress, go away). I feel like the hospital let me down badly. I feel like the health system let me down badly. And I feel like things could have been even worse without my wonderful midwife (who has since moved to Christchurch).

The obstetrician straight up said that the hospital would have admitted me sooner had I been her patient. The reason they don’t want to admit people “too soon” is not primarily an issue of beds, it’s primarily an issue of managing the workload of the obstetricians who are there on a given day. It follows that they are willing to bend rules if you BYO doctor. I’m very aware of the privileged position I’m in that I can pay for the additional private care this time. And I’m angry both personally and on behalf of the women of New Zealand generally that the medical care we get during birth is hit and miss.

It remains to be seen how this birth goes. I don’t feel anxious about it any more. The first consultation with the obstetrician and subsequent appointments have removed that anxiety. It reminds me of how I felt after the appointment with the lactation consultant. I turned up desperate, really desperate, holding my borderline starving child and with my blistered and destroyed nipples literally wrapped in cotton wool to prevent chaffing against the nursing bra, which was fast becoming wetter and wetter. She asked me to describe what was going on, and I immediately felt (and yes, I have to use this word, it is genuinely appropriate) empowered. I can use words to describe experiences! That is something I’m good at! You have asked me a question and now will listen to me! She asked me to describe the little dude’s behaviour at the breast – was it eager, was it reluctant? I said without a second’s pause “frantic”. I remember that so clearly, that when I said frantic, she sort of smiled like asking me for the word had been a test and I’d just given an unexpectedly perfect answer. After I had finished describing things, she examined the little dude, and she said something like “I thought from your description that this sounds like textbook tongue-tie and possible lip-tie also. It is both, let me show you his mouth so you can see.” I knew there was something wrong with the little dude’s ability to feed. I was so not surprised (another memory of the early days, my husband said “maybe just one bottle of formula”, I respond “THERE IS NOTHING WRONG WITH MY MILK I AM DRIPPING ON THE CARPET, THERE IS SOMETHING WRONG WITH HIM!”). I left feeling enormous relief that I had been heard and validated and we had a plan.

This is the bit that was the same with my first obstetrician consultation. I went in somewhat anxious – what if she rolled her eyes at me and told me that childbirth was just like that, what if she told me that it would be the same again and I had received perfect care and there was nothing more that could have been done? What if she told me that it was somehow my fault, something I could have done differently? I had a list of questions/concerns to run off with her. I had written it down and slipped it into my wallet to pull out in case I forgot. I never even needed to because she covered them all off without me having to raise them. No, I didn’t have to worry about an interminably long first stage – she would make sure that if I was past my estimated date and had been having hours of steady contractions painful enough to prevent sleep, I would be admitted. No, I didn’t have to worry that my pelvic floor was too weak to push the baby out. Yes, another vaginal birth will make it worse but it’s still a better option than a caesarean unless there are other reasons for a caesarean. Once I’m done with babies I can see a gynocologist to assess the damage. If the episiotomy scar is too tight to allow the perineum to stretch, it’s ok, she can cut out the bad scar tissue and then make sure it’s stitched up in a way that promotes better healing. I’ll write about it afterwards (still a very distant event, this birth), but for now, I feel pretty damn relieved that I’ve been heard and validated and we have a plan.