Episode 209

Each birth is unique. I had different pregnancies and 3 very different births. Some labors are fast and intense, as was my 3rd labor and some are very long, drawn out events perhaps lasting for several days from start to finish. Some moms make firm decisions ahead of time to have a medicated birth and to their dismay get to the hospital too late for any pain medication as their labor was quicker then they thought it would be. Other moms plan a homebirth and need to be transferred during labor as they needed the assistance of medical intervention and the skills of a physician who could offer a surgical birth.

Once the baby is here, the first few hours are about feeding the baby. What happened during the labor, birth can have a significant effect on the baby’s readiness and ability to breastfeed. During this Series Birth Matters, you have learned how a postpartum hemorrhage can prevent a mom from even breastfeeding during the early pp period. She may be dealing with a medical emergency that can make it impossible for her to be with her baby in the early hours after the birth. We have talked about a major blood loss being responsible for a low supply or no supply of milk once the baby is born.

I worked with a mom, just today, who is very angry about not understanding ahead of time, how her choices in birth will impact her immediate postpartum. I saw Beth several months ago when she had her partner Louise took my breastfeeding class. When I teach childbirth classes, I go into much more detail on this subject, however, during breastfeeding class, I only have time to touch the surface about the impact of birth on breastfeeding.

Beth experienced something I see on an everyday basis. She went into labor, feeling in her own words “big and uncomfortable, very pregnant an anxious to get the baby out. So at 41 weeks, she agreed to an induction of labor. This led to all sorts of interventions, one being given IV fluids. She had a very long labor and received a lot of IV fluids. Beth tells me that as uncomfortable as she was going into the hospital, she felt almost worse upon discharge. She was filled with extra fluid from her thighs all the way down to her toes. It was quite painful for her as she attempted to walk from her wheelchair to the nursery to see her baby a few hours after the birth. It hurt her to put one foot in front of the other and standing for more than a few minutes caused her feet to have a weird sensation she said…this in between stage of it hurting while at the same time, almost feeling like her feet were not attached to her.

I saw Beth on Day 6 postpartum. She was feeling much better and her thighs were back to normal size, however, she was still dealing puffy ankles and feet which continued to affect her comfort level during breastfeeding. However, the greatest impact was felt in her breast tissue as she suffered from extreme engorgement which made it very difficult for her baby to latch on come the 4th day pp, when she began having different difficulties. It seemed that the early days of breastfeeding caused her nipples to crack and bleed, but at least her baby was latching on. Now, however, her breasts were very tight and much to her horror, she said her nipples were quite flattened practically flush with her breast tissue. She said: her baby just could not latch onto her breasts anymore. She was a bundle of nerves when I saw her and quite distraught as to how breastfeeding was going. Once we sat down and she began talking, Beth described how much and how many times she had supplemented her baby. She had already begun to feed baby formula from a bottle as the prolonged crying of her hungry baby was too much for her to bare. She was already expressing guilt over this. I have such compassion for moms who find themselves in this position. I told her what I truly believe and that is that she did what any good mother would do. Hear her babies cries for hunger and feed her baby the best she knew how, until she could figure out how to breastfeed.

She did take BF class with me and I do go over what to do if you find your baby is not breastfeeding well and you are told to or feel you need to supplement of the first things to do is to remove the milk.

When I asked her about pumping, she said that she thought she should not pump, otherwise this would take milk from her baby. I explained to her that while she was right on the one hand on the other hand, if she did not remove the milk, she was putting herself at risk for getting clogged ducts and a breast infection. I talked her through a method of hand expression and reverse pressure softening. This helped relieve all the edema around her nipple/areola area and the release of the milk helped to soften the area just enough that I could work with her and her baby with latch.

Beth’s experience is one I see often in my practice. She is not alone in her experience, however, as far as she is concerned she is. She had no idea how having so many extra fluids on board might cause her extreme engorgement or her level of discomfort in moving around, walking and sleeping after the birth. While I see this frequently, this is all news to her. My hope is that you learn from others experiences and be fully informed on how certain medical interventions can make breastfeeding more difficult.

The mom I referred to earlier who had a birthing center birth with a midwife and doula attending her, well, this birth was a very long time ago and I have to admit that while her story still resonates with me, I fail to remember her name, so I will just call her Sally.

Sally was a video photographer who produced documentaries of wildlife around the world. I did teach her childbirth classes. During the course of her class, she did tell the rest of the class that she just could not wait to have her best friend who was also a film producer to video her birth. She had documented much of her pregnancy, her prenatal visits and now planned to add the birth for a complete package. Her plans were to share this documentary with the world, hopefully selling it to childbirth companies that sold birth related videos.

As per usual, I could not keep silent. I chatted with Sally and her husband a few times after class. I suggested they think about having a Plan “B” in place in the event she changed her mind about the cameras during her birth. The staff was a team and met on a regular basis and I found out that she had also been warned by the midwives that this puts a lot of pressure on her to perform, to get it right, to perhaps be something she is not, during her labor, for the purpose of this film looking great. Both Sally and her husband were so excited about documenting the birth that they just could not “hear” what others were telling them.

As if to convince me, they shared some of what they had documented already. I did have to admit that with the music and the scenery and the narration, even though it was a rough cut, I already loved what I saw. It was easier for me to understand her desire to film her birth also. I still worried about the impact of being “on” for the cameras during her labor.

I have been to many births before where it has been filmed. This was different though, her desire to have every moment of her birth filmed, with all her emotions, her pain, her interaction with others and have the camera be really up close and person when she was in the pushing phase.

It was her excitement and intensity and attachment to getting everything just right is what concerned me. I wish this is one of those instances that I could say my instincts were wrong, but they were right on. Her labor progressed fairly normally, however, it stalled at about 8 cm. She grew very tired and her constant verbalization to her crew about choreographing the birth as it unfolded really began to affect her. Plus she had 3 extra people at her birth. There was one person whose job it was to work the lighting. As she followed her around during her labor, the set up for the lighting had to constantly be changed. Sally barked orders about how she wanted things to be and I just know this did not allow her to fully relax and just be present in her labor. She was too busy worrying about everything else that was happening around her.

At one point, she got into a verbal argument with her husband about the angles and the lighting. She was trying to put herself into a better position for the camera and rather than work along with her labor, when she started to make those natural birth sounds that I know help move her labor along, she began to shut down. I did not know for sure at the time, but I suspect that she did not want her “roaring like a lion” sounds as part of her documentary.

As it turns out, her midwife Patty got to a point where she overrode what Sally wanted and kicked the whole crew and doula and everyone out of the room except for her husband, her mother, myself and herself the midwife. No more lights, camera action. Sally was wound up so tight, she had not progressed past 8 cm. for 3 hours and was becoming quite exhausted. Patty knew that an exhausted laboring woman, who has been stuck at the same place for hours and whose tolerance to for increasingly painful contractions is at risk for a transfer and possible epidural and possibly c/section. She turned off all lights, lit a few candles and had Sally begin to hum during her contractions. She encouraged her to let go and move about and make noises that just came naturally to her. Patty literally made some noises herself and encouraged Sally to just mimic her, even if she was not feeling it.

It took a while, but Sally was able to let go and labor uninhibited and we began to visibly see her attitude change and soon she was ready to begin pushing. Sally went on to have what I feel was a beautiful birth. Her husband snapped a few pictures with his fancy hand held camera, but there was no video. Once her baby was born and Sally moved from being in that lovely labor zone where she is just one with her body and not thinking too much about her surroundings or what she is doing, once she became present in the room again and her logical mind came to terms that the birth had not been video taped, she became quite upset.

I had never seen something like this, to this degree happen before. Sally let her emotions out and declared how angry she was that she did not have this documented. Poor Patty, the midwife as she took the brunt of it. Patty tried her best to explain to her that being stuck at 8 cm. for several hours, seeing her exhaustion, checking her and realizing that for no obvious reasons she was not dilating, she could see the writing on the wall. If things did not shift very soon, her exhaustion and rising pain level, would likely mean a hospital transfer for her.

I had the privilege of being at about 30 or so births with Patty. I have seen her help moms move through tough times during their labor. She was quite successful in walking moms through the many emotions during their labor that caused them to get stuck. Patty did not transfer lightly and her transfer numbers were so low. Not only from the births that I attended with her, but I know were her overall statistics for transfers low. While she did take over, I believe her instincts were right on. If Sally were transferred, there would be no cameras documenting her birth and she would not have had the birth she desired. This was over 18 years ago and hospitals were not allowing cameras into labor rooms as they are now.

Given what I have shared with you up to this point, how do you think Sally handled the first few days postpartum? her baby was finally in her arms, she had a beautiful vaginal delivery with her husband and mother present, which were both every important to her. I fully expected her to relax with her baby in arms, luxuriate in the beauty and blessing of it all, smile with exhaustion and happiness and perhaps even fall asleep for a short while with her newborn safely tucked in with her.

It is with a heavy heart that I am going to tell you one of the saddest postpartum stories I have ever witnessed coming from what I considered to be a beautiful end stage birth. Sally demanded to see her video team who had been waiting outside in the family area of the birthing center. Once there were told to leave the room, they hung around outside. They ate, they drank, they watched TV, they engaged in conversation with each other and Sally could hear them outside her room. When they came into the room, all ready to congratulate her, Sally began barking orders at them. She began yelling at how angry she was at them not staying in the room and she even through a babies blanket at one of them. Of course, the blanket flying across her bed was harmless, however, it was just seeing how crazy, yes my words, how crazy she had become, that was alarming.

It had been a long, long labor and I needed to leave and get back to my family after a few hours. I did my best to help Sally relax. I thought skin to skin, which Sally was eager to do, would help. But she was like so incredibly wound up, she was talking a mile a minute as I tried to talk her through the first latch. I did my best to keep hands off and just let her be with her baby. However, after a long time, probably a half hour, with a crying baby, I offered more hands on help. Her baby was receptive to this, but Sally had a hard time with it. She had a hard time with whatever we did. Her voice and demeanor and body language were all loud, all while holding her newborn in her arms. Her exhausted husband had gone out to the family room area and fell asleep in one of the chairs.

I took inventory of this whole scene and thought to myself: what a mess! I have been to many births, in many different locations, with different caregivers. Never have I witnessed any scene so awful as this. I was at a loss as to how to be helpful because nothing I did worked.

After being off for the next 2 days, I sat in on report that morning and heard how Sally’s rest of the stay at the Birth Center went – about 5 hours, and what her follow up visit was like on the second day. She came alone. no husband or baby. She was angry at her husband for allowing the birth photography team to leave the room and her baby was sleeping so she left her baby home too. She apparently was proper with the midwives, however, the tension could be felt in the room. When asked how breastfeeding was going, all she said was fine.

I contacted her on Day 5 pp and we talked about breastfeeding. She told me her baby didn’t like to breastfeed and so she was formula feeding. Now, this is from a mom who dreamed of an unmedicated birth, had not purchased a crib as she planned on breastfeeding and keeping her baby close to her in bed so baby could have easy access to the breast. I really never got to square one with her.

I am not sure how you feel about this story. Perhaps you feel her midwife had not right to kick everyone out of the room. I recognize the irony of this situation with all the shows I have just completed on birth, how it matters, how importance it is that woman feel empowered during their birth and that they need to have options and that they be able to make choices about their birth. I still agree with all that I said. I also believe that we don’t live in a world of always or never and therefore we should not judge the choices that are made for some moms, some of the time.

I remember feeling relief that Patty, her midwife took charge in this scenario as I really do believe, Sally would have had a cesarean section in the hospital. Along with not having her documentary, she would have been mourning the loss of the birth that she desired. It was scary to me how attached to her documentary she was and how this seemed to overide a different decision she may have made if she were not so attached.

I sincerely hope that you have enjoyed this Seasons Theme Birth Matters. Feel free to send me an email and let me know your thoughts. If this information changed the way you looked or approached your birth, or will approach your next birth, tell me about it. I would love to hear your thoughts.

I am putting the finishing touches on this show the night after the Las Vegas Shooting. I have been up all night. Just could not sleep a wink. I cannot help but get emotional w hen I think about the mothers and fathers who will not be returning home to the their children. My thoughts go to the young people who never had a chance to become a parent. And, of course, to the parents, to the family members who lost a child who was a kid or a grown up adult. It is not only those who died. It is all the injured and the unknown, long term impact this is going to have on their lives, forever more. I walked around feeling bummed out all day. On the way home from a consult, I stopped off at whole foods and heard a voice call my name as I got into my car. I turned and there was a beautiful woman with a huge smile on her face. She said that I helped her with her baby 2 years ago. She was just on the brink of giving up and thanked me for saving her breastfeeding relationship. We talked for a few minutes, as she told me that she continues to breastfeed her 2 year old. She smiles from ear to ear as she tells me how much she loves breastfeeding and how much her daughter is benefiting from the breastfeeding relationship. I am happy for both of them and I told her: Thank you so much for taking the time to stop me in the parking lot and than me. This has really made my day. So, thank you Hannah – I needed a huge dose of sunshine from a loving mom to brighten up my day.

I hope every day for you is bright and that you always have a way of finding the light through the darkness. Always have a way to focus on the goodness of others and be thankful for all that you do have.