Nikki Lee Health

SS gave birth to her second child, a son, Mark, who lived only 8 months. He was born with an inability to metabolize copper, a diagnosis reached only 2 months before his death. Some manifestations of his Meinche-Stilhaus syndrome. were neurologic; Mark never rooted well, and had a poor suck from the beginning. He never matured past a developmental age of 2 months. SS was able to breastfeed him for 6 months, through months of counseling, coaxing and constant thrush. She and her husband chose hospice support. Mark died in his mother’s arms, at home in their kitchen.

SS reported an “amazing and unwavering clarity”. about her decision to have another baby. as soon as possible. Genetic counseling revealed that she was a carrier, probably from a spontaneous mutation and told that another son would have a 50-50 chance of having the syndrome. She was inseminated with her husband’s sperm that had been washed to flush out the faster moving and lighter male sperm to ensure that the next baby would be a girl. After 3 tries, she conceived and gave birth a year and a half later to a healthy baby girl.

She called me for help for breastfeeding when this daughter was 11 weeks old, saying that her baby had only gained 2 ounces in 2 weeks, and that the baby frequently “backed away from the breast.”  She also said that she had had a baby who died, and that there was a “lot of baggage” around this new baby.

This third baby, Ann, had been born full term, weighing 7 pound 11 ounces. Labor was induced, and she used demerol and an epidural. She described feeling that she couldn’t handle labor. She realized later that she “undid herself with those thoughts.” After birth, Ann initially licked the nipple and then latched on, breastfeeding well during the hospital stay.  She was discharged home weighing one ounce over birthweight. At 3 weeks, Ann weighed 9 pounds 5 ounces, and at 9 weeks, 11 pounds 10. ounces.

At 11 weeks, SS took her baby in for another weight check because of concerns about breastfeeding; at that visit, the baby weighed 12 pounds. SS had a long talk with. her pediatrician about the poor quality of her breastfeeding relationship, and he reluctantly gave her 2 cans of commercial milk formula, said that her baby was healthy and doing well, and suggested calling a lactation consultant.

Ann was a bright, alert baby with two chins, wrist wrinkles, triple thigh rolls, a sweet rosy glow and a perfect (and pain-free) latch.  She breastfed well, and was not distracted when her 5-year-old brother was present. She slept between 7 and 8 hours every night, and nursed at 1.5 to 2 hour intervals for about 10-20 minutes at a session. She peed and pooped plenty.

The home was sparkling clean and completely decorated, with several jars and cake servers filled with homemade baked goods made by SS.

SS reported two episodes of mastitis, one at 2 weeks and another at 5 weeks. The first episode was treated with antibiotics and the second with nursing, rest and fluids. She was giving her baby nystatin “prophylactically”. She admitted to a great concern about thrush because Mark “had it all the time.”  Baby Ann had never been diagnosed with thrush, nor had any symptoms.

SS spent most of the visit talking about Mark, her dead son. She talked about having a successful breastfeeding experience with her first baby, a son; she never once voluntarily spoke about. him. When I asked, she replied that “he was doing fine.”

While her mother was talking, Ann showed feeding cues, but began to fight the breast by pounding her mother’s chest with a tiny fist, stiffening and making noise. I suggested that SS take some big deep, slow breaths, filling up with air through her nose, and letting it out slowly through loose lips. She was coached to take several of these breaths, letting her shoulders drop on the exhale. The baby relaxed along with her mother, and then latched on easily.

Mark had cried all the time, no matter what SS did. She was unable to console him and had to go. about the chores of mothering (bathing, dressing, feeding and giving medications) in spite of his crying. She felt that she never made any impact on him. She managed every aspect of his care, and never rested or slept well during his short life. She had received some counseling after his death, but had stopped this after a few months.

SS remembered that she had never kissed Mark after he was born. She thought that was odd, because she recalled devouring her first son with kisses. She wondered if she had sensed from the beginning that there was something wrong with him.

SS stated that the nursing was going well until Ann was 2 months old. Her husband, a traveling salesman, was supportive, although he was not home much. He left for work at 5:30 am and got home around 8 pm. Her friends all said, “Why bother? If nursing isn’t going well, just give Ann a bottle.” SS rejected this advice. She said, “I know in my brain that nursing is the best, and I don’t want to do anything else. But there is something wrong, we are just missing each other.”

She said that if it had been up to her, she would have had only one child; it was her husband who wanted three. Her fantasy was of going away to an island resort with her husband for 4 days, to be alone with him. She was eager to rejoin her profession in computer work, and was setting up an office for herself in the home.

SS had suffered many losses in a short period of time. She had lost her wish for a one-child family. She had lost her dreams of a perfect healthy baby. She had lost a baby after a difficult and painful 8 months. She had lost touch with her career. She said that if she had waited a while to conceive again, that she would not have had Ann.

SS viewed all of Ann’s nursing behaviors as indications of pathology. She described her fears of something happening to Ann. SS would not go out and leave her baby; she feared Ann waking up, crying and needing her mother.

I asked if there was any coincidence between the fact that the nursing with Ann had gone well for 2 months and that Mark had never advanced beyond a developmental age of 2 months. She thought that could be true.  I asked, “Do you feel like there are 3 people in a relationship where there should be 2?”  She looked stunned for a moment, and then replied, “That’s exactly it.”

SS was given encouragement to attend local nursing mothers’ meetings so that she could build her confidence in seeing what normal babies do.  She was given the number of a psychologist, herself a nursing mother, and the names of several support groups for grief and loss. She was also encouraged to enjoy that her baby slept so well, and arrange for a sitter for one hour and go out with her husband. If that went well, she could extend the time to two hours.

At the first follow-up phone call, SS reported a great change. She was now playing with her baby. She said that it had been “cathartic” to talk. She  made more time to nurse and surrendered to her baby more.  The nursing relationship had relaxed.  She had not yet left her baby.

Birthgivers who have lost a baby or had a baby with problems are at risk for difficulties in their next parenting relationship. All the worst fears have come true. They have felt the profound sadness and ache of loss; they know what it means to have a baby not make it, and they maintain a constant vigil to prevent a reoccurrence with a subsequent baby,

SS’s story poignantly illustrates the complexities of mothering where vulnerability has been magnified. by grief, guilt, and loss. I was not able to provide the counseling that SS needed, but the empathetic listening plus a few practical suggestions broke up an emotional log-jam.