Nikki Lee Health

Mary called me for help with breastfeeding her 3rd baby, a girl, when the baby was 11 weeks old; her initial complaint was that this baby had gained only 2ounces in 2 weeks, and that the baby frequently “backed away” from the breast. Mary also complained that her baby nursed, “all the time”.  Mary mentioned in passing that she had had a baby who died, and that there was a “lot of baggage” around this new baby.

Mary’s first baby, a boy, nursed well, for over a year; Mary only spoke about him when asked directly; she said that he was “doing fine.”

Mary’s second child was a son named Troy who died when he was 8 months old, a consequence of Meinche-Stilhaus syndrome, an inability to metabolize copper. Troy never rooted well and had a weak suck from birth; he never matured past a developmental age of 2 months. His mother perservered with breastfeeding and pumping, determined that her baby would have nothing but mamma milk. His parents chose hospice support; Troy died in his mother’s arms, at home.

(Mary remarked that she never kissed Troy; she remembered thinking how odd that was, as she had devoured her first baby with kisses. She wondered if she had sensed from the beginning that there was something wrong with him. I believe that could be true.)

She reported an “amazing and unwavering  clarity” about her decision to have another baby as soon as possible. Genetic counseling had yielded no family history, had identified that she was a carrier (most likely the result of a spontaneous mutation) and suggested that another son would have a 50-50 chance of having the disease. As this syndrome is sex linked, she was inseminated with her husband’s sperm that had been washed to flush away the faster moving, lighter male sperm in order to make the next baby a girl.  After 3 tries, she conceived and gave birth to a healthy daughter 15 months after Troy’s death.

3rd baby Brittany, had been born at term, weighing 7 pounds , 11 ounces. Labor was induced and Demerol and an epidural were used in labor. Mary reported that at the time, she felt that she couldn’t handle labor; later on, she realized that she “undid herself with those thoughts.”  After delivery, Brittany breastfed well in the hospital, and was discharged home after 2 days, weighing one ounce over birthweight.

At a 3-week pediatric visit, Brittany weighed 9 pounds, 5 ounces; at 9 weeks, she weighed 11 pounds, 10 ounces. At 11 weeks of age, Mary brought her baby to the pediatrician to be weighed out of concerns about breastfeeding; at that time, Brittany weighed 12 pounds.  Mary still insisted that breastfeeding wasn’t going well, and complained so much that her pediatrician reluctantly gave her 2 cans of formula,  while maintaining that her baby was healthy and doing well, and suggested that Mary get help from a lactation consultant.

In her home, Brittany showed herself to be alert and bright, with two chins, wrist wrinkles, triple thigh rolls, a sweet rosy glow, and a perfect attachment and easy milk transfer. She was one of those babies that slept for 7 or 8 hours at night, and then nursed often, sometimes hourly, for 10 to 20 minutes at a time. Brittany filled her diapers at least twice a day, and also peed plenty.

Their home was sparkling clean, and clutter free (no easy task with a newborn and a 5-year old)! Jars and cake servers decorated the immaculate kitchen counter, filled with cookies and cakes Mary had baked herself, from scratch.

Mary reported 2 episodes of mastitis, one at 2 weeks, and another at 5 weeks. The first episode was treated with antibiotics, and the second was treated with vigorous nursing, rest, and increased fluid intake. Mary was receiving counseling from the local nursing mothers’ group to which she had belonged, since her first baby, 5 years earlier. Mary was also giving nystatin “prophylactically” to her baby; admitting to great concern about thrush because Troy had it “all the time”.  Brittany had never shown any signs of thrush.

Mary spent most of our visit talking about Troy, her dead son. Once, while her mother was talking, Brittany asked to nurse, but then began to fight the breast by pounding her mother’s chest with a tiny fist, stiffening and making noise. Mary was advised to take some deep, slow breaths through her nose, filling up with air, and then letting it out slowly through loose lips. (I did this along with her, for 3 big breaths.) She was also encouraged to let her shoulders drop on the exhale. Once Mary relaxed this way, Brittany attached and breastfed easily.

Troy had cried all the time, no matter what Mary did. She was unable to console him and had to take care of all his needs in spite of his constant crying. She felt that she never made any impact on him. She managed every spect of his care, and never really rested nor slept well during his short life. She had received some counseling after his death, but hadn’t continued past a few months.

Mary reported that breastfeeding was going well until Brittany was 2 months old. Her husband, a traveling salesman, was supportive, although he was not home much, leaving each morning about 5:30 am and getting home around 8 pm. Her friends all said, “Why bother? If breastfeeding isn’t going well, just give her a bottle.” Mary did not want to give her baby bottles; she said, “I know in my brain that breastfeeding is the best and I don’t want to do anything else. But there is something wrong, we are just missing each other.”

Mary said that she had wanted only one child, that it was her husband who wanted three. Her fantasy was to be able to go away to an island resort with her husband for 4 days of alone time together. She was looking forward to rejoin her profession in computers and was setting up a home office for herself. In terms of material things, she lacked for nothing.

Mary had suffered many losses. She had lost her dreams of the perfect healthy baby. She had lost a baby after a difficult and painful 8 months. She had lost her dreams of a one-baby family, and had lost touch with her career. She also said that if she had waited for a longer time after Troy’s death,  that she wouldn’t have had Brittany. She saw all of Brittany’s nursing behaviors as pathology. She was also fearful that something dreadful would happen. She wouldn’t go out and leave her baby as she feared Brittany waking up, crying and needing her mother.

When asked if there was any connection between the fact that nursing Brittany had gone well for 2 months, and that Troy had never advanced beyond a developmental age of 2 months, Mary, startled, said that could be true.She was then asked if it felt like there were 3 people in a relationship when there should be 2; stunned, she thought for a moment, and then replied, ” That’s exactly it.”

Mary was encouraged to attend local nursing mothers’ meetings regularly, to be reminded of what a normal baby does. She was given the number of a psychologist specializing in childbearing depression and grief. She was encouraged to to celebrate a baby who slept so well by arranging for a sitter for an hour or two and going out with her husband alone. If that went well, then she could consider spending a few more hours away on a date.

At the first follow-up telephone call, Mary reported a great change. she was now playing with her baby. She said that it had been “cathartic” to talk. She was surrendering to her baby more; as a result, Brittany was nursing less often but for a longer time. She had not left her baby yet.

Women who have lost a baby are at risk for difficulties in their next mothering relationship. All their worst fears have come true. They have felt the devastating and profound sadness and ache of loss; they know what it means to have a baby die, and are often on constant watch to prevent a recurrence with a subsequent baby.

Mary’s story poignantly illustrates the complexities of mothering where the usual vulnerability has been magnified by grief, guilt, and loss. While unable to provide the on-going therapeutic counseling relationship that Mary needed, the LC gave empathetic listening,  asked a a few questions,  and made some suggestions that broke Mary’s emotional log-jam and opened her to mothering her sweet thriving baby.