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In Their Own Words: Jessica

Posted on August 15, 2012 at 4:10 AM Comments comments (0)
This post was written as part of Sweet Pea Birth’s "In Their Own Words" series. For more info on the ITOW or if you want to participate, contact Krystyna Bowman: krystyna{at} sweetpeabirths {dot} com. Today's post makes reference to one of the most important goals: Feed The Baby.  This mom used ALL the tools available to her and in the end, settled on breastfeeding.  The breastfeeding ITOW series runs through the month of August. 

Today's breastfeeding success story is shared by Jessica Mangieri, an alumni from our Winter 2011-12 Class Series.
 
 
While I was 8 months pregnant, a friend asked me what I was most looking forward to about motherhood. "Nursing my baby", I said without hesitation.  I surprised myself with this answer. There were a million and one things I couldn't wait to do, but breastfeeding was something special that only my son and I could share.  I wanted to give him the nutrition he deserved, but also create a bond that went beyond feeding my baby. 

Bradley Method(R) studentsFast forward to the much-anticipated birthday. Bennett Clay Mangieri entered the world after the most exhausting, yet most beautiful, day of my life. He greeted his daddy, Jeff, via emergency cesarean section. I had to be completely put under after laboring naturally for 25 hours, 7 of which I was stalled at 9cm dilated.  When I finally met him in the recovery room, a nurse helped me begin to feed him. I was groggy and sobbing, and he was sobbing along with me. I think he latched on a little because the nurse left us alone for a while.

The following day, we experimented with nursing. He would seemingly latch for a few minutes, but I didn't feel like it was working. I asked to see the lactation consultant, and she wasn't very helpful.  She repositioned him slightly and was in and out of our room in less than 5 minutes. I felt frustrated and completely overwhelmed.

That evening, Bennett was taken away to be under lights for jaundice for 24 hours. The nurses brought him to me every 3 hours to try and nurse for 30 minutes. I felt devastated that we were under time constraints for nursing. There was so much pressure for me to feed him in this short time, but we were just learning about each other!  At this point, our nurse suggested I try and pump to see if I could express any colostrum.  I was able to do quite well! Jeff would carefully syringe the precious 5cc of liquid gold and take it to the nursery where it was fed to Bennett. 

After he spent about 12 hours under the lights, one of the nursery nurses told us that he was "inconsolable" and she wanted to give him a bottle of formula.  I was so angry and sad that she even suggested this, mostly because I couldn't do anything to help him.  I reluctantly agreed that she could give him 10cc of formula through a syringe.  After she left the room, I cried harder than our newborn.  I felt completely defeated.

Our last day in the hospital, a new lactation consultant came to help us. She was amazing and spent time answering all of our questions.  I left the hospital very sore, but with the feeling that we could make this breastfeeding thing work.  The next day, everything changed and I needed help, fast.  My milk had come in and I was HUGE and engorged.  I wanted to yell at everyone I'd ever met who said, "Breastfeeding shouldn’t be painful."  When he latched on, I would have to use my relaxation techniques to keep from screaming.  It was toe-curling, eye-watering, want-to-throw-baby-across-the-room type of pain.

We made a call to Debbie Gillespie, an IBCLC that was recommended to us by our Bradley ™ instructors. She came over to our house the following morning and was the wealth of knowledge that we needed. After examining his mouth, she knew right away what our problem was. "This little guy is tongue-tied", she said as I held back tears.  I was scared to hear something was wrong with my tiny little baby. 

She recommended that we follow a protocol of breastfeeding with bottle supplementation until he received the frenectomy (procedure that would fix the tongue tie and improve breastfeeding).  She also suggested that I pump using a hospital grade pump after each feeding to maintain my supply.  As she left, I remember her cautioning me about mastitis.  My overactive supply, damaged nipples, and inefficient nursing babe were the recipe for the condition.  I kept that in the back of my mind, but was much more concerned about our nursing relationship.  How were we ever going to breastfeed if bottles were in the picture?  I was heartbroken, but knew I needed to follow rule number one: feed the baby.

Four days later and our smart little man quickly weaned himself from the breast.  The bottle was getting him exactly what he wanted, and nursing was much too difficult.  His tongue-tie procedure was scheduled for 3 weeks away, and just holding Bennett in the nursing position produced a screaming, arching baby.  I spent hours and hours attempting to get him to latch for just a few moments, followed by the bottle.  He wanted nothing to do with the breast.  I was devastated and couldn’t see a future where my baby was nursing.  I continued to pump every 2-3 hours around the clock, which was incredibly difficult physically and emotionally. 

A few days later, I called my mom in a panic early in the morning.  I felt as though I had been hit by a truck, my entire body was aching.  My head, calves, back, shoulders, everything!  It had been years since I had the flu, but I was positive that’s what it had to be.  I took my temperature and it was 102˚!  It finally occurred to me that I might have mastitis.  When Debbie said it comes on quickly and without warning, she wasn’t messing around.  A quick trip in to see my midwife, and I was out the door with a prescription for antibiotics.  My instructions were to keep pumping at least every 3 hours and rest.  Rest…funny.   

About a week later I was feeling much better, but entirely frustrated that my little babe wanted nothing to do with me.  Just cradling him in the nursing position still sent him into a fit.  After doing some reading and feeling at my wits end, I tried a nipple shield that was given to me by the lactation consultant in the hospital.  She had shown me how to wear it and told me that it was meant to be a tool, not a permanent fix. 

Desperate, I tried it.  Sure enough, Bennett latched right on and began nursing, no fuss.  I was so excited, but still knew that this was a tool, just like the bottle, where he would need to wean.  After doing my research, I was also very aware that a nipple shield should be used under the care of a lactation consultant and can decrease milk supply.  Seeing as how I was overproducing, it didn’t end up becoming an issue.  The biggest issue was keeping one on hand at all times and away from our golden retriever.  The dumb dog ate two of them!  :)  

After the tongue tie procedure was over, Bennett continued nursing using the shield.  I spent days and days using techniques to gradually and peacefully wean him from the shield.  I began by removing it while nursing in the middle of the night.  He was too sleepy to realize what was going on and latched right on!  I remember waking Jeff up out of a dead sleep (poor guy) to show him that “He’s doing it!!”  I was so proud of my little baby and proud that we were seeing progress. 

Over the next few weeks, I gradually replaced one or two feedings each day without the shield.  There was crying and protesting, both mom and baby, but in the end, we did it. At two months old, he was nursing without the shield all day.

Just about two weeks after our nursing sessions had been free from the shield, I got news that Bennett had sagittal craniosynostosis, a condition where two plates in a child’s skull fuse prematurely in utero. We were beyond devastated.  This was why his birth had been so difficult.  The poor little guy was truly “stuck” because the plates in his skull couldn’t overlap to descend down the birth canal.  The only correction for the condition is surgical, which sent us straight into the office of a pediatric neurosurgeon.  Surgery needed to be scheduled quickly so that Bennett could be a candidate for an endoscopic assisted technique.  Hearing your child needs surgery on their skull at 3.5 months old is heartbreaking and frightening to say the least.  In addition to thousands of other worries I had, I worried about him nursing.  We had worked so hard to get to this point, and now it seemed as though it could be jeopardized. 

When surgery day came, I swallowed my pride and brought all my tools with me.  Bottles, pump, and nipple shield were in tow.  I wasn’t going to let my desire to nurse get in the way of him getting breast milk after a major surgery.  They handed me a groggy, pale child in the recovery room and we tried to nurse.  No success.  We tried again 3 hours later and 6 hours later, still no success.  He was most likely unwilling to eat due to his pain level and morphine intake.   Of course, I was worried about him receiving enough nourishment, but the nurses reassured me that his IV fluids were adequate.  About 23 hours after his last feeding, his pain was managed a bit better and he took his first feeding from a bottle. His second feeding was also from a bottle.  My emotions were so much different than the initial bottle feedings when he was an infant. 

Previously, I felt such anxiety and sadness every time I had to give him a bottle.  This time, I was just so happy and relieved he was eating.  In this moment, I realized that although breastfeeding was important to me, nothing could ever be more important than my son and his health. 
Surgery is now 6 weeks behind us.  I can happily report that he is nursing like a pro, despite our numerous challenges.  I’m glad I was persistent in making our breastfeeding relationship work, but often persistence is not enough.  Often, the choice is made for us due to circumstances we cannot predict.  No matter how a baby is eventually fed, breast or bottle, we should never be critical of a mother doing what it takes to keep her child nourished and growing.  More than anything, I’m so thankful that Bennett is a strong, happy, and thriving little baby.  

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. 
This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

 
   
 
 

Newborn jaundice

Posted on November 8, 2011 at 2:58 PM Comments comments (96)
We are back from our babymoon!  It has been a wonderful five weeks of enjoying our baby instead of doing all of the regular day-to-day activities.  I didn’t do any blog writing or homeschooling through this time…we are slowly getting back to our routine.  We have continued on with our class series and all of our students have seen our baby grow into her 12-pound, 1-ounce weight and 24 inch length in the last five weeks.  Breast-milk is nature’s perfect food!!
 
Which brings me to one of the topics that we covered briefly at the end of class last night.  One of our Coaches asked if we are going to spend some time talking about jaundice.  The topic of jaundice has actually affected the care and breastfeeding relationship of three students in the last six months, up from absolutely none since we started teaching.
 
As with many things involving pregnancy, labor and newborn care, it is imperative that parents do their research and know where they stand before they arrive at the hospital.  Although complications from jaundice are rare, true complications lead to irreversible neurological damage to the child.  Because treatment is available and the damage is preventable, charges of substandard care or neglect are plausible.  Thus hospitals and pediatricians are pro-active and aggressive in their treatment of jaundice.

I have to ask myself why I am seeing red instead of yellow when it comes to jaundice treatment.  Answer: because pro-active and aggressive care that is not truly medically necessary can separate babies from the nurturing breast of their mother and the loving arms of their parents.  This can have a long-term and possibly negative effect on the breastfeeding relationship and family bonding.
 
“Bilirubin is a yellow pigment that is created as the body gets rid of old red blood cells. The liver helps break down bilirubin so that it can be removed from the body in the stool.”  (See Link 1 below)
Bilirubin in and of itself is beneficial to the body.  It is a bacteriostatic agent, meaning that it stops bacteria from reproducing.  This is a good thing in a newborn’s body – we want bacterial growth to be inhibited in our precious babies, especially if they are exposed to hospital germs.  It is also an anti-oxidant that inhibits the growth of free radicals in the body.  Free radicals cause damage or death to a cell, so inhibiting their growth is again, a good thing.
 
The condition known as jaundice is diagnosed because the skin, and maybe the sclera (the “white of your eyes”), look yellow-tinged.  An excess of bilirubin causes the condition.  It takes a few days for the body to process bilirubin effectively, however, as the newborn gets their systems “on-line”, the liver becomes efficient at processing the bilirubin and the yellowish pigment of the skin and eyes goes away.
 
Jaundice can be considered pathologic or physiologic.  The distinction in diagnosing which type of jaundice your baby has is determined by when the jaundice is noted in the newborn. 
 
Pathologic jaundice, which occurs within 24 hours of a child’s birth, needs to be treated immediately to avoid the neurological injury called “kernicterus”.  Kernicterus happens when an accumulation of bilirubin in certain brain regions causes irreversible damage to those areas.  It manifests as various neurological deficits, seizures, abnormal reflexes and abnormal eye movements.
 
Physiologic jaundice, which occurs on or around the second or third day after birth, is not generally considered dangerous and occurs in almost all newborns.  In the case of physiologic jaundice, the bilirubin levels never rise to the point of causing permanent injury to the child.  The bilirubin functions, as it should: ridding the body of bacteria and free radicals, and eliminating them through the baby’s stools.
 
There are two ways to treat jaundice.  If bilirubin levels are on what your pediatrician considers a safe increase, phototherapy may be the treatment of choice.  If the bilirubin reading is borderline dangerous or at dangerous levels, a blood transfusion is the quickest way to reduce bilirubin levels; and more than one may be indicated.
 
As I read up on jaundice in preparation for writing today’s post, I was so glad to read that many medical professionals agree that there is NO REASON TO STOP BREASTFEEDING your baby.  I put it in caps because I feel it is important for parents to know they are supported in their right and their desire to breastfeed their child.  Breastfeeding is not the same as supplementing with breast-milk in a bottle, or substituting with inferior formula products.
 
Since this is not a medical blog, I am going to add in some vocabulary words that you may want to add to your list of “things to research”, and listen for them as your baby is evaluated for jaundice. I will close with an excerpt from a site that delineates when parents should be concerned, and with some suggested links to serve as a starting point for additional reading.
 
Exchange transfusion – used to rapidly remove bilirubin from circulation
 
Hyperbilirubinemia - increased levels of bilirubin in the extracellular fluid
 
Intensive phototherapy – uses blue light for treatment of jaundice – can be an “incubator” or a blanket (note: you could hold your baby on your lap if you use a blanket)
 
Phototherapy – standard treatment for jaundice: at home, daily exposure to indirect sunlight; in a hospital setting, most commonly uses fluorescent white light 
 
TSB – total serum bilirubin
 
Transcutaneous – noninvasive techniques for measuring bilirubin levels
 
Note:
If the bilirubin concentration is found to be greater than 10 mg/dL in a pre-term infant, or greater than 18 mg/dL in a term infant, additional testing will be done.  Here is a list of what those additional tests might be: Hct, blood smear, reticulocyte (red blood cell) count, direct Coombs’ test, G6PD test, TSB and direct serum bilirubin concentrations, and blood type and Rh group of infant and mother.
 
When you are evaluating what course of testing or treatment to follow for jaundice, remember the following assessment tool.  I included some sample questions for this situation.

“BAR”
B – Benefits:  What are the benefits of this test over the other available tests?
A – Alternatives: Are there any alternative tests we could consider if we feel this is too invasive or the risks are too great?
R – Risks:  What are the risks or side effects of the test you are recommending?  How do you do this test?  What else will you do - or can we expect to happen - to our child if we agree to this test?
 
Excerpts from “The Merck Manual” (See Link 4 below):
Red flags: The following findings are of particular concern:
  • Jaundice in the first day of life
  • TSB > 18 mg/dL
  • Rate of rise of TSB > 0.2 mg/dL/h (> 3.4 μmol/L/h) or > 5 mg/dL/day
  • Conjugated bilirubin concentration > 1 mg/dL (> 17 μmol/L) if TSB is < 5 mg/dL or > 20% of TSB (suggests neonatal cholestasis)
  • Jaundice after 2 wk of age
  • Lethargy, irritability, respiratory distress

Pathologic hyperbilirubinemia in term infants is diagnosed if
  • Jaundice appears in the first 24 h, after the first week of life, or lasts > 2 wk
  • Total serum bilirubin (TSB) rises by > 5 mg/dL/day
  • TSB is > 18 mg/dL
  • Infant shows symptoms or signs of a serious illness

Some of the most common pathologic causes are
  • Immune and nonimmune hemolytic anemia
  • G6PD deficiency
  • Hematoma resorption
  • Sepsis
  • Hypothyroidism
 
Links for additional reading:
 (1) US National Library of Medicine
 
(2) U of Iowa Info – with a CHART to help with evaluation of severity of jaundice
 
(3) Pediatrician’s Info – IN SUPPORT of breastfeeding
 
(4) The Merck Manual – Jaundice

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.
 
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