Are Injury and Illness a Cause of Breastfeeding Fail?

Mary and John were prepared for breastfeeding, as prepared as you can be. They had waited nearly a decade for baby James. They took a class on breastfeeding. Mary attended La Leche League. They hired a Doula to accompany them through labor, birth, and the first few weeks. They selected a hospital and a midwife with a good track record of natural childbirth.

Mary’s labor was long and she managed the pain until the very end, when James got stuck. They cut a large episiotomy, and he ended up in the Neonatal Intensive Care Unit (NICU) with a broken collarbone and on oxygen. Mary hemorrhaged and received a blood transfusion, and more than 20 stitches. They were apart for 36 hours, and when they were brought together, breastfeeding did not start well.

This is chaos nobody thinks will happen to them.

Birth is relatively safe, but some mothers will begin their life with a new baby and chaos: postpartum preeclampsia, hemorrhage, infections, or injuries from surgery and childbirth. Regular illnesses also happen, like the flu and colds. Even car accidents happen! Nobody plans for these in their birth plans–it’s impossible to, really! They just happen and they throw a major obstacle in the way of learning to breastfeed.

If you, or your baby, are injured or ill, you will naturally be focused on the illness, or injury, and trying to recover. You will find it hard to focus on learning to breastfeed. You will feel anxious, scared, worried and frustrated. All of these emotional states hinder learning new skills, especially breastfeeding.

Beginning breastfeeding while sick or injured, also creates its own problems. 

Often, mothers and babies are separated and this causes upset, anguish, and frustration in both. They are prevented from getting to know each other. They can’t practice feeding frequently, and this causes frustration and low milk production that can last for weeks, or months. Babies may be confused and disoriented when trying to breastfeed and then, parents assume their baby “doesn’t like breastfeeding.” Everyone gets discouraged and quits practicing.

Postpartum mood disorders (PPMD) interfere with breastfeeding, but breastfeeding helps control PPMD.

Postpartum mood disorders include the baby blues, depression, anxiety, PTSD, and more. They can start before birth, at birth, or months later. Even if you don’t have a history of mood disorders, it is a common occurrence for many mothers. Perinatal mood disorders can be long term, or short term, and range from intermittent, to incapacitating. You may feel on edge, jumpy, unable to rest, relax or sleep, or you may feel like you are living in jello, or a fog. You may be crying all the time. You may be wandering around, unable to think, eat, or do anything. You may have intrusive and scary thoughts or images, that just pop into your head. You may think you are a terrible mom and that your baby would be better off without you. 

Postpartum mood disorders still carry a stigma, and occasionally, mothers are separated from their baby, because of them. This interferes with breastfeeding. It makes women afraid to reveal how they feel inside. And also, the nature of the illness is paralyzing, so that you literally can’t seek help.

An injured or ill baby may not be able to breastfeed.

There is nothing worse than having an injured or ill, child, except having an injured or ill, newborn, especially a premature baby. When this happens, all parents say they feel helpless and scared. Babies aren’t just babies, they embody a dream of a happy future with breastfeeding, playing, first teeth, toddling, riding bikes, holidays, camping, school plays, graduation, and so much more! A sick baby brings nightmares of losing that dream.

You may be expecting a preterm baby, or two, or three! Or a baby with lung or heart problems. Or you may have learned of a birth defect like cleft lip or palate, Down syndrome, sickle cell disease, or PKU through prenatal testing. Many premature, or sick babies, will start their life in the NICU without you, and breastfeeding will be more difficult to learn.

Three other common situations many newborns face that interrupt breastfeeding, are jaundice, circumcision and tongue tie. Fortunately, these situations are ones that parents have some control over.

It may seem silly to others, but for a new mother, an interrupted “babymoon” is a loss.

Most mothers will feel guilty and anxious about being injured or ill, even though they can’t help it. They spend a lot of time wishing the situation was different. The bad feelings can continue, even months after life normalizes. It’s normal to grieve a loss, and nobody can predict how long the regret and grief will last.

It’s not fair to say women “fail” at breastfeeding, when they, or their baby, are injured or ill.

Imagine having to learn a new skill while you are sick, or trying to recover? While most people never imagine it will happen to them, illness and injury can derail breastfeeding like nothing else. Even though you are excited about your new baby, if you are seriously sick or injured, you may not be able to do anything other than sleep, rest, and try to recover. And, nobody anticipates these problems, and nobody tells you how hard breastfeeding can be, especially when you or your baby are injured or ill. Sometimes, even after a number of lactation consultations, and weeks of practice, parents still feel overwhelmed and decide to bottle feed with formula. 

How do you get around this barrier?

There simply is no way to predict, until a family has given it a chance, whether a breastfeeding relationship will survive the stress of the mother, or baby, being sick, or injured. If this is your situation, you are not alone. It’s not easy taking care of newborn, triple-feeding and managing all the other day-to-day stresses in your life. Something has to give, and only you can decide what works best for your family.

Learning any new process requires skills like patience, focus, studying and practice.

Depending on your situation, if you can breastfeed, do it as much as possible. If you, or your baby, is sick, the immune factors in human milk are exactly what your baby needs. Your body makes specific antibodies for each illness, and starts doing so as soon as it detects the virus, or bacteria, in you or your baby. There are countless stories of mothers getting sick, and their breastfed baby does not. It really is Miracle Milk!

If you can breastfeed, but you can’t hold your baby, because you are weak or injured, find someone who can lift and support your baby to nurse. Leaning back and nursing means that gravity and your body do 90% of the supporting, and your helper has only to balance the baby.

If you can’t breastfeed, pump as much as possible, and get help when the emergency has passed.

Most of the time, delaying breastfeeding is a safe choice. Preserve the opportunity to breastfeed, by breastmilk feeding the baby with as much of the mother’s milk as possible. Even if you can’t hold the pump, and even if you are unconscious, your milk can be pumped.

There is a ample evidence that initiating pumping within 4 hours after birth helps your body produce much more milk, than if you delay pumping. If your baby is premature, your milk is going to be different from full term milk, and it’s especially valuable. Remember, your baby benefits from even tiny amounts of your milk.

If milk production is adequate, a mother and baby can recover, start from scratch, and go on to successfully breastfeed. They will also need education, support and timely advice from their medical team, and support from their family and community.

Postpartum mood disorders are common and treatable. 

Nearly all mood medications are compatible with breastfeeding and pregnancy. 

While many can be treated with medication, we are also finding that medication may not be as effective, as we once thought. When it’s going well, breastfeeding is calming and helps moms cope with mothering stresses. It also reduces inflammation, a cause of anxiety and depression. Breastfeeding empowers moms, and many mothers find that breastfeeding helps them feel like good moms, so all treatments should aim to preserve breastfeeding. 

It’s vital for you and your baby, that you get support and help, in what ever form you need it, yet PPMD can paralyze and prevent you from seeking help. This means that your partner, your parents, friends and neighbors need to be proactive in learning the signs, and supporting you in ways that work for you.

Jaundice, circumcision and tongue tie are fairly common situations.

Breastfeeding frequently from birth, prevents jaundice in most babies. If parents are aware of this, they can make a greater effort to focus on breastfeeding, rather than entertaining visitors, for example. A baby may have to skip breastfeeding and receive a bottle of formula for a few hours, while they are under bili lights, depending on the doctor or the hospital policy. The formula supplement causes them to poop, reducing bilirubin levels. A proactive parent will remind staff to bring the baby back ASAP, so breastfeeding will resume as soon as the baby’s treatment is complete. If your baby becomes nipple confused from the bottle, then keep them skin-to-skin on your chest, as much as possible to help them figure breastfeeding out again.

Many baby boys nurse well enough before a circumcision. But being separated from mom, the pain of the surgery, and the pain and discomfort following, cause breastfeeding problems. Circumcision is a surgery that is not universally practiced, so carefully consider its value to your baby.

Tongue tie and lip tie in the baby’s mouth can make it painful, or impossible, to breastfeed in the beginning. While many parents are aware of this condition, there are some things you should do before revising any ties. It is important to get a functional exam from a lactation consultant, or speech language pathologist, to determine the structure and functioning of the baby’s mouth and tongue. Appearance is one test, but not the important one. Your baby might have a tongue tie and be able to move their tongue just fine. Then, on examination, it turns out that the pain you are experiencing, is coming from a jaw misalignment.

Preparing for problems, when you can.

If you are expecting a preterm baby, or multiples, or if you know of a birth defect through prenatal testing, prepare yourself for them through education, breast massage, clearing your schedule and delegating household tasks during the early months at home. There is an online support group for every kind of problem you might be facing, and I encourage you to join them. Other parents share what their experience has been. They know the resources and will give you a better idea of what is realistic and what to expect.

The last thing any parent willingly does is let their baby out of sight, for even a second, but many injured or ill babies will start their life in the NICU without a parent nearby. NICUs are full of life-supporting machines connected to babies bigger, and smaller, than yours. Fortunately, there is also a team of nurses and doctors that want you to breastfeed your baby, or at least breastmilk feed your baby, until they are ready to nurse. They can assist you in learning to hold your baby, to pump, and teaching you how to breastfeed.

It may take a village to get you through this. 

Every mother and baby needs a lot of care, and if you are injured or ill, even more care. After it’s over, you will be surprised how many people touched your life. Your team of helpers may include close family, doctors and other health care practitioners, doulas, relatives, neighbors, friends, old and new, and support groups. And in some cases, dedicated and caring strangers that come together to help you, and your baby.

Resources for help if you or your baby are injured, or ill.

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