09 Oct 2019

6 months postpartum, and still wanting to breastfeed.

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RP was clearly anxious and guarded during our initial telephone conversation, where she told me of her dream to breastfeed, even after all this time, and of her hope that craniosacral therapy would help.

My intuition spoke to me after she hung up. On the day of her appointment, as the time drew near, I went away from my office so that when she arrived, she would see the open door a note on the floor, inviting her in to wait for my return.

I imagined that she had been told to do so many things by different healthworkers and might have a low level of trust in others. I wanted her to have the free choice to sit exactly where she wanted, and where she would be most comfortable;  when I entered my office, I saw that she had chosen the davenport. As she held her baby and talked, she came close to weeping at least 6 times. She never did completely breakdown, never let herself go completely though; her level of expression was genuine and was the most she could do at that time.

RP got pregnant after the first act of aiming (“Surprise!”) and felt pretty good all along. In the 5th month of pregnancy, her baby was found to have several organ defects. The world changed.

At 28 weeks, she started weekly ultrasounds. She always felt that her baby was fine, despite the continual worry of and monitoring by healthcare workers, and hearing messages like “We’re not looking at a stillbirth this week” after one of these regular ultrasounds. She described the pregnancy as stressful, and cited being told “You might be an unfavorable environment for your baby” as an example of a stressor.  RP needed some guidance to re-discover her emotional reaction to these comments as her first reaction was to “understand” why the healthcare professionals might have said those things. Women are quick to understand and see the other side; while this coping mechanism can be helpful, it can also bury a mother’s own reaction and become a defense or a way to negate a reaction. After some probing, she owned that those comments, “Hurt my feelings, I was sad. I was mad.”

She did everything she was advised to do, even when it went against her own desires and intuition. After going into labor spontaneously, her doula kept her on track to a completely unmedicated labor and delivery. She described the birth as ecstatic; she wanted to boast, “See, I told you things were alright” to the healthcare workers. Her baby was gorgeous, pink and breastfed immediately after birth. The labor room nurse let the baby stay longer than the usual hour, part of the joyful memory.

The baby was sent to the NICU because of the prenatal diagnosis. She, discharged as a patient after 2 days, spent the next 2 days in the parent’s room of the NICU, pumping and wanting her baby. She was angered and dismayed when staff refused to understand or recognize the reason for her distress with giving her baby formula. She had read about the health risks of formula and said “I didn’t want my baby to get diabetes” and felt unheard and unvalued for having this desire. She wanted to breastfeed, especially because her baby was going to have corrective surgery. She saw breastfeeding as a way to compensate, and make things better. She wanted her baby to have the best milk.

The hospital policy of checking on a postpartum mother every hour made it impossible to sleep. She described being wakened many times, and of having her baby forcefully applied to her breast every 2 hours. An extremely modest person, she hates being naked and has trouble with open physicality. She found sharing a postpartum room with another mother uncomfortable and unsafe. She worried that her baby would keep the other mother awake by crying; her roommate’s baby kept her awake by crying.

She went home with her sweet new baby, and worked on breastfeeding. A nipple shield helped some, but she felt wrong about using it. She was pumping, and her baby was getting her milk in a bottle, in addition to some formula and some fortifier added to her milk.

At age one week, her baby went from the follow-up pediatric office visit immediately to the largest children’s hospital in the region, as what she had perceived as normal sleepiness was actually organ failure.  She berated herself for not knowing this on her own. This feeling reinforced what she had been told in pregnancy, that she “was an unfavorable environment”. She felt wrong, and was scared beyond measure, and also felt angry.

It took 2 months postpartum for her to be able to relax  at home, especially at night. She feared missing some sign, some warning that her baby was in distress. She became angry again, after doing research and discovering that the lactation specialists could have done more to help her at the beginning to both increase her milk supply and to breastfeed. She started using the bottles more after breastfeeding because that was the solution to her baby’s fussiness. No one ever did a complete evaluation of this fussiness. The distress because she couldn’t make enough milk lowered her confidence that led to more distress; this situation  become a vicious circle.

At the office visit, I saw a dyad where the attachment was weak. At one point, she put a finger into her fussy baby’s mouth for comfort. The baby suddenly shrieked. The mother apologized, saying that her fingernail probably cut the baby’s mouth. I was stopped by this admission. She said that her nails had scratched the baby several times before. She hadn’t considered that her baby might be reluctant to get closer physically as a consequence of intermittent injury by her mother’s nails.  Her baby often played with or pulled her mother’s fingers towards her mouth. “That’s what babies do” I said, “So you should cut your nails.” And I showed her mine, trimmed below fingertip length.

Her baby was carried akimbo,  with RP’s shoulder twisted up and with her arm held out to the side; the whole posture looked disconnected and uncomfortable. The full body embrace didn’t start until the start of the 3rd hour of the consult, after somatoemotional release while she was telling her story. She had a tendency to rush past particular important or emotionally charged events; a goal of our work was to slow down to give self-awareness time to emerge. By the end of the visit, she and her baby had become completely physically intertwined and finally looked connected.e.

We discussed her ecstatic feeling after the birth. She had missed celebrating this major achievement as a result of the medical response to her baby’s condition. I told her that in 30+ years of working with women, and reading about ecstatic births in Spiritual Midwifery and Mothering Magazine and Sheila Kitzinger, that I had never before met a mother with that experience. She was my first. I encouraged her to claim that feeling and revel in it. She did make a perfect baby; that joy, that glory is hers. What happened a week later, when a well-nourished baby outgrew its organ, is another story. What an inspiration. Her eyes welled with tears as I spoke of my admiration.

She retrieved another good feeling. She spoke of her amazement that her baby is so well adjusted and certainly this baby is quite a personality, a real extrovert! We spoke of what a good mother she must be to have such a dynamite baby. We spoke of ways that she could remember these good feelings too, along with the other stuff. She mentioned writing notes and taping them to the breast pump.

Her initial complaint was “feeling so emotional when my baby rejects my breast.” I applauded her feeling “emotional”, saying that it is completely real and understandable. She listened intently to a description of the parts of the brain, the side that deals with thoughts and action, and the side that deals with feelings. She came to understand that her feelings hadn’t caught up with her actions; this was part of the reason she was so “emotional” when her baby refused to nurse. The feelings need to be brought to light, examined, honored, and let go. She was invited to ask any question, give any feedback, and to do what made sense to her. I was there to open doors.

As our visit progressed, her baby became increasingly fussy. I suggested skin to skin, and showed her a way to lift her shirt over her head while leaving it on, so her shoulders would be covered while her chest was bare. (Dr. Tina Smillie has mentioned this as a way that mothers can feel safe and comfortable with bare breasts.) and left them alone to get together. Up until that time she’d jiggled and swung her baby, and prodded at its mouth with a pacifier fitted over her index finger. I left the room to give her privacy to adjust herself.

When I returned to the room, I was surprised to see her completely nude from the waist up as I was expecting her, in view of her self-stated modesty, to have kept her shoulders covered. Her baby initially snuggled, started to root to the faster producing left side, and then became furious and cried and raged for at least 20 minutes. When the crying started, the mother could accept that her baby was telling a story, and that she herself probably carried that same emotional story. During the outburst, I was coaxing and coaching the mother to listen to her baby’s story, ask to understand, and engage in some intimate dialogue, and keep the baby from falling off her chest. (Her first reaction to the baby’s rooting was to grab her breast and try to bring it to the baby’s mouth.)

After about 20 minutes, I reminded the mother that it was her baby and that she could do whatever she felt to be right. She then sat up, and started to bottle-feed. This was fine, and her technique was adjusted some to make the intake under the baby’s control. I told her that little groove, the philtrum, is actually the place to put the nipple or teat. Let the baby reach up each time. Drop the level of the fluid below the teat hole every 5-7 sucks and let baby catch up , breathe, and re-initiate the feed. The mother was able to do this and see her baby’s reaction.

After taking about 2/3 of the contents of the bottle, the baby went to sleep, one arm outstretched, with the little hand open on mother’s chest. The mother spoke of not wanting the baby to cry, of wondering what the difference was between telling a story and crying for some reason. We talked about exploring, of figuring that out, and of some mothers that can hear different in a cry or feel some energy change. She was reminded that she could decide what to do with her own baby, based on her intuition.

She admitted to having a lot of feelings inside and listened to a selection of activities of expression: scream out loud in car when driving and alone, paint, take walks outside, and write in a journal. She choose taking a walk outside and writing in a journal. She considered searching the Internet for women whose babies have had major surgery at a very young age. There is sure to be some sort of list or group or chat.

Her main questions, after a lengthy debriefing, were “Why did my baby breastfeed for a while, then stop? What went wrong?” She made some statements about breastfeeding that showed she was following some rules about it, rather than letting the baby lead.

Her baby will show the most rooting in sleep, so they nap together. I referred her to the UNICEF/UK website with a lovely safe bed sharing pamphlet.

I noticed her baby start rooting after s2s while the mother was reclining and the baby was lying alongside her mother. This is another good sign that the basic nervous system reactions are present.

We spoke of her desire to protect her baby, and of how she could understand the reason for the surgery. But her baby couldn’t. All her baby knows is that there was intolerable pain and mamma wasn’t there. She spoke admiringly of the surgeons, “that do one of these (surgeries) a day” that still apologized to her baby for causing pain. She was very impressed with the level of caring she experienced at the children’s hospital.

“Maybe” she’s been overcompensating for the horrible scary time by being a perfect mother every single second. Interesting that at first she admitted to this, then went on to deny it. That’s fine. She’s spoken the words, the thoughts and feelings will follow. She welcomed a suggestion to wear her baby and start catching up on housework, instead of spending all day trying to make the baby happy.

She feared her baby lying on the incision, by now a scar. She was taught and encouraged to use the craniosacral touch, melting her palm into her baby’s skin and connecting with the different tissues (skin, muscle and bone) below the skin to evaluate her baby’s healing. We spoke of a ritual to make with rubbing some of her milk into the scar, and thanking it for holding her baby together.

She was praised for her dedication and intelligence, her ability to stay home, for a helpful partner, and for loving her baby so much. It’s amazing that she is still seeking the breastfeeding relationship, still making milk and still wanting to do more.

Three hours went by the blink of an eye!

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