2010 Breastfeeding Report Card from the CDC, in 2007 (the most recent year for which data are available) 70% of new moms in Indiana, my home state, initiated breastfeeding; nationally 3 in 4 women start breastfeeding. I expect the data are pretty similar today and if the data were analyzed regionally, I imagine it would be even higher in Bloomington, where we live.
I was also really looking forward to breastfeeding, and I didn’t anticipate I would have a difficult time. I fully acknowledged that I knew next to nothing about nursing an infant, but convinced myself that with research I could adequately prepare myself for the real thing. So I immersed myself in breastfeeding books, websites and blogs. I took pages of notes during the three-hour session of our eight-week childbirth education class devoted to breastfeeding and taught by a respected and knowledgeable, board-certified lactation consultant. Finally, because I would be returning to work when Ezra was 6 weeks old, I took a pumping class with the same lactation consultant about a month before he was born.
In retrospect, my “research” wasn’t well balanced at all. Much of my reading focused on blissful tales of breastfeeding. I daydreamed about breastfeeding rather than thinking about the reality of it. I should have expected that somewhere along the way breastfeeding wasn’t going to be easy. I ignored the fact that several nursing mothers told me breastfeeding in the first few weeks was difficult. I still thought it wouldn’t be a big deal. “How hard can it really be,” I thought. “It’s natural,” I reasoned. “It’s normal. We’re supposed to breastfeed.” Oh my naiveté.
As I learned from first-hand experience, breastfeeding is far from straightforward. It’s true that breastfeeding is natural. And it’s normal. It’s also easy to see that mothers and babies are hardwired to breastfeed. But that doesn’t make it easy to do. Unless you’re really lucky – I think a few women are – successful breastfeeding requires some help after birth from a good lactation consultant and lots of practice and patience.
For me, breastfeeding started really well and was pretty easy for the first two weeks. Ezra first latched on about an hour and 15 minutes after birth. My milk came in on the third day, and I didn’t suffer from engorgement. Because I breastfed on demand, Ezra was eating frequently – about 10-12 times a day or about every two hours – and had the right number of wet and soiled diapers. He gained weight well and had returned to his birth weight plus an ounce by 10 days postpartum. Most importantly – I didn’t have any pain!
My beginner’s luck was short-lived. At two weeks postpartum my nipples started turning white and throbbing with pain after nursing. A little reading revealed a diagnosis: nipple blanching (literally, turning white), which occurs when blood flow to the nipple is cut off. According to Kellymom.com, the most common cause of nipple blanching is nipple compression. Compression restricts blood flow and pain starts as circulation returns to the nipple. A diagnostic indicator is a white compression stripe on the nipple. There are multiple causes of nipple compression, the most common being poor positioning or poor latch causing the baby to compress the nipple while nursing.
A less common cause of nipple blanching is vasospasm, a sudden constriction of blood vessels in the nipple. Blanching due to vasospasm appears a short time after nursing or in between feedings, and is extremely painful. Vasospasm in the nipple has two primary causes: nipple trauma (such as soreness from poor latch or thrush) and Raynaud’s phenomenon. In the case of Raynaud’s, nursing does not cause blanching. Raynaud’s Phenomenon, which is known to cause vasospasm in the extremities (fingers and toes), is an intrinsic physiological condition that affects nursing.
In a sleep-deprived state of confusion, I didn’t know whether blanching was caused by latch problems or vasospasm. Many of my symptoms seemed consistent with Raynaud’s, but I also knew Ezra’s latch wasn’t quite right though I wasn’t sure what was wrong with it either. So I waited to get help thinking the problem might correct itself on its own or even just disappear. As you can imagine, that was a terrible idea! Within a week, my nipples hurt ALL … THE … TIME.
After a week of painful feedings when I was feeling truly desperate (meaning I was in a ridiculous amount of pain), I realized I couldn’t continue breastfeeding without help. I scheduled a home visit with the lactation consultant who taught the aforementioned breastfeeding and pumping classes. Ann Marie Neeley Burkhart, IBCLC (certified lactation consultant) came to our house at four weeks postpartum and discovered that Ezra was not always keeping his tongue over his lower gums. This tongue retraction was causing nipple compression. I hadn’t even realized Ezra was retracting his tongue. How had I not noticed my nipples were compressed after nursing? Ann Marie spent two hours at our house and helped with positioning and exercises to improve Ezra’s latch and encourage him to use his tongue correctly.
Breastfeeding quickly improved. Within three days of Ann Marie’s visit, my nipples were considerably less sore. I could take a deep breath and relax my jaw while nursing. At this point I was just beginning to feel calmer about nursing and relieved that finally breastfeeding was going to be easier. The fourth day after Ann Marie’s visit (just shy of five weeks postpartum) I had a sudden onset of pain during nursing. A phone call to Ann Marie followed by a consultation with her confirmed thrush.
I had a fungal infection on my nipples! Thrush is a Candida infection, the same variety that causes vaginal yeast infections. I knew thrush was common in babies, but somehow I had glossed over the fact that I could get thrush. The pain from thrush has been described as “toe curling” and “ground glass through the nipple” and those statements are pretty much accurate. Treating thrush was demanding and it was hard to get rid of. Ann Marie recommended some protocols described by Dr. Jack Newman, a physician, lactation specialist, and author of the very excellent book, The Ultimate Breastfeeding Book of Answers. I used gentian violet, which is a purple dye, bacterial stain, and broad spectrum anti-fungal and anti-bacterial. In addition to painting my nipples purple with gentian violet – I felt very punk – I made a “triple cream” of an antifungal, antibiotic, and hydrocortisone using over-the-counter products. I had to use nursing pads and change them after every feeding. All towels, nursing bras and tanks had to be washed in hot water after every use or wearing. Thankfully we weren’t using bottles yet or we would have had to sterilize those in boiling water every day.
While treating thrush (which persisted for about 7 weeks before finally clearing up completely), I continued to deal with tongue retraction, pain from nipple blanching, and I had several episodes of plugged ducts. Yet, I honestly never wanted to quit breastfeeding even though it was painful for weeks. I was so doggedly committed to breastfeeding, I just knew it had to get better. From four weeks on I reassured myself that it would get better “by next week.” At seven weeks I settled on next month. I needed that next month. Ultimately, it took nearly the first three months of breastfeeding to resolve complications.
I’m so glad I kept at it. Breastfeeding after the first three months was a breeze. Ezra was exclusively breastfed until he was six months old, breast milk was his primary source of nutrition until he was one year and at fifteen months he’s still breastfeeding. It’s been as enjoyable as I had envisioned it would be when I was pregnant.