PART 2: The Second Time Around – New Challenges
Ok, so I will warn you, this is REALLY long! I tried real hard to condense it but I wasn’t very successful. So read on if you like! It is very interesting in the end though!
When I found out we were expecting our second, I didn’t think twice about the decision to breastfeed, it was a given. I also thought it would be much easier this time. I thought I could prevent any mastitis/plugged duct issues by using the hand pump if I had some engorgement in the first weeks. I felt confidant that I knew what I was doing the second time around. I had both a hand and electric pump, plenty of breast cold packs if needed, and Greg made sure to check Walt after birth for any vertebral fixations/subluxations and soft tissue inflammation to ensure he would be comfortable nursing on both sides and to avoid the problem Jack had.
However, it wasn’t that simple. Nursing was going pretty well the first few days, then, when my milk came in, just like with Jack, I had quite a bit of engorgement. At least I knew what it was this time and some methods to try to control it. Although, I wasn’t expecting the engorgement to be so bad the second time around. I thought my body would know what to do by now. I think some women, me included, just produce A LOT of milk! However, I did find out later there was another variable this time causing the problem (keep reading to find out what).
During these early days of milk and engorgement I tried to nurse as often as I could but Walt was very sleepy all the time. It was hard to keep him alert as often as I needed him to nurse. I also tried not allowing Walt to sleep long periods without nursing. Well, I did allow him to go 4 hours at night (this kid wanted to sleep and after 2 yrs of sleep deprivation with Jack I really didn’t want to interrupt that) yet I didn’t want mastitis either but I thought 4 hours would be ok at night. I tried to nurse on both sides at each feeding. I mistakenly cut him off early on the first side and switched sides for fear he would fall asleep and not nurse on the 2nd side. I was using the hand pump a little to relieve some pressure but I didn’t use it to empty my breasts completely (mistake again). I also tried hand expressing in the shower and using cold pack’s to decrease inflammation and prevent inflamed ducts. However, I was a milk producing machine and my efforts could not keep the engorgement under control. I felt like Walt was latching on alright and to me, appeared to be sucking the same as Jack did (although that was 3 yrs ago). I didn’t think the problem was Walt. Also, he didn’t have trouble being uncomfortable while nursing thanks to Daddy’s adjustments.
I was getting desperate though. The engorgement was getting out of control very quickly despite my efforts and experience. I talked to my midwives and told them I was struggling with the engorgement. Abby gave me several articles on different nursing techniques and info on mastitis and plugged ducts all from La Leche League. It was great to have so much info but it was a little overwhelming because I didn’t know which of the many tips to try first, but it was all great info to have! (I will share some more of that in a future post). It reaffirmed I was doing some things right, a few things I needed to change and it gave me new techniques to try for relief of the engorgement. I did try some of the suggestions in the articles but continued to be engorged. I was really worried I would end up with a fever and the whole cascade of symptoms that followed with Jack. I had already started to get a small headache, the first sign I had with mastitis with Jack. Midwife Kelley then suggested calling Jessica Buell, a lactation consultant-in-training (and apprentice midwife, and doula – lady of many talents). I was feeling VERY desperate by the time I called her, and probably hormonal and emotional from just having given birth less than a week prior. She was fabulous on the phone. She listened, asked me questions, then gave me a regimen to follow for 24 hours then I was to check back in with her. I felt so much better after talking to Jessica. I think the 24 hr. regimen gave me a focus and she seemed very confidant in it on the phone which made me feel confidant and a little more in control of things. I followed her instructions exactly and started to feel some relief. I checked in with Jessica the next day and she modified my regimen slightly for the next 24 hours (I was better but still over-producing milk). By the third day I felt back in control, engorgement was nearly gone and Jessica gave me some tip’s to continue doing and said to call if I had a future problem. I was SOOOOO thankful to have avoided mastitis, fever, aches, ect.
A week or 2 passed and then it started again, UGH!!! I know many moms out there would love to be overproducing so I shouldn’t complain so much. I woke up in the middle of the night with mild engorgement (yep, Walt was sleeping through the night woo hoo!). I immediately got up and pumped, emptied my breasts and felt much better and went back to bed. I thought it wouldn’t be a problem since I pumped as soon as I noticed the mild engorgement. Well, I have a really sensitive system apparently! The next evening, even thought the engorgement was gone, I started to get a headache and slight fever this time, Whaaat?! One little mild engorgement and I was proud of myself for pumping right away…I did not expect this at all! I wasn’t even engorged anymore after pumping but I still was having the familiar unpleasant symptoms. I immediately went back to Jessica’s 24 hr regimen she gave me a few weeks prior (I should have called her). I continued this for several days but continued to feel worse. I thought there was no use calling her since I already had what I thought was mastitis and couldn’t prevent it anymore, it was here. Well, that was a bad idea, should have called her. Should have looked up natural remedies, should have asked friends. I wasn’t thinking and gave up too soon. I figured it would just go away after a week like the episodes I had with Jack. I started taking ibuprofen to reduce the fever which was going on 7 days now. I REALLY did not want to take any medication while nursing. I felt defeated and desperate. But I wanted to avoid an antibiotic even more so I tried the ibuprofen. It did control the fever but any time I tried to get off of it the fever was right back there. Man, this thing was stubborn. And all along I should have called Jessica, don’t know what I was thinking. By day 11, still with a fever and been on ibuprofen for way too long in my opinion, I did finally contact Jessica. I didn’t give her a fair chance at helping me by calling her so late in in the game. But she tried and gave me a regime to follow. I did but I think it was just too late. I also gathered some tips from friends at this point too and tried lecithin supplements (supposed to possibly thin out the milk) and Poke Root Salve, but neither helped me (you will learn why if you continue reading). By 14 days straight with a fever and completely worn out, Jessica and I decided I had to go to the doc for an antibiotic. I was extremely disappointed that I had to do this but it was necessary. I actually hadn’t taken an antibiotic in 8 years, which I was very proud of! It killed me to make that appointment and drive to the doctor’s office. I was so mad at myself and I felt HORRIBLE that Walt would be exposed to an antibiotic at such a young age but I also had no choice at this point. I did not expect to be in this position being what I thought, a breastfeeding veteran. I took the antibiotic and the fever and symptoms improved in a day or 2. I did wonder if they would have improved anyway without the antibiotic but I was just torturing myself by thinking that way. I did need it after 14 days of a fever, maybe should have gone in a little sooner.
I was so confused as to why I was having so many problems. I felt like I was doing everything right by now and didn’t understand how one mild engorgement could lead to 14 straight days with a fever and mastitis/plugged duct. About 1-2 weeks after taking the antibiotic it was deja vu! How on Earth could this be possible, I was incredibly annoyed! Again, I woke one night with very mild engorgement and a day later the dreaded headache followed by fever a few hours later. I went back to the frequent nursing and Icing, pumping when needed and gave it a day or 2 before I called in the troops. I emailed Jessica to tell her it was starting again. I told her exactly what was going on and shared my frustration, wondering why I continue to have problems despite following all the recommendations. I also mentioned to her that at Walt’s postpartum midwife visit, we were told he may be borderline Tongue Tied.
“Tongue tie can be defined as a structural abnormality of the lingual frenum. When the frenum is normal, it is elastic and does not interfere with the movements of the tongue in sucking, eating, clearing food off the teeth in preparation for swallowing and, of course, in speech. When it is short, thick, tight or broad it has an adverse effect on oromuscular function, feeding and speech. It can also cause problems when it extends from the margin of the tongue and across the floor of the mouth to finish at the base of the teeth.” – http://www.tonguetie.net
Our midwives weren’t too concerned because Walt appeared to be nursing fine and was WAY ahead of the game in the weight gaining department. Most babies with tongue tie have A LOT of trouble nursing and gaining weight. They did suggest we talk to Dr. Hazelbaker (more about her below) or our pediatrician about it. We planned to ask our pediatrician to look at his tongue at his appointment in a few weeks. In the mean time we also Asked 2 dentists and both took a look and said it looked mild at worst and probably wouldn’t need treated. Jessica responded and recommended the same regimen that helped before but also suggested I schedule an appointment with Dr. Alison Hazelbaker, PhD, a lactation consultant who does lymphatic drainage, and happens to be an expert on the condition of Tongue Tie. She also is a CranioSacral Therapist. I promptly contacted Dr. Hazelbaker and scheduled an appointment for Monday. It was friday and Dr. Hazelbaker was kind enough to give me her cell phone number in case I ran into problems over the weekend before my appointment (which I did). Despite the icing and frequent nursing my fever was climbing Saturday evening. I took a hot shower to calm the body chills I was getting and that hot shower really spiked the fever, 104.2! I typically like to let fever’s run their course. The body is smart and creates a fever for a purpose – to kill an infection. But this was a bit high for my liking (damage can start to occur above 105 deg). I took 2 Ibuprofen but the fever was still holding strong. I wanted to take a cold bath (well didn’t really want to but needed to) but just my luck, a thunderstorm was in our area so that was out. I could have called my doctor but it was Saturday evening and I figured they would just have a recording saying something to the effect of “In case of emergency call 911, otherwise call back during business hours”, neither of which I thought sounded good. I decided to take a 3rd Ibuprofen and started icing my neck and groin areas where a lot of superficial blood vessels exist. It appeared to be working because I was starting to sweat! Within 20 minutes the fever was down below 102 and dropping, wheeew! I was so glad when Monday finally arrived and I could get to my appointment. Dr. Hazelbaker was great! Right away she noticed a very deep plugged duct. She did a lymphatic drainage technique and I could feel immediate relief! She also observed me nursing Walt and gave me some tips on how to hold him so he stays latched on (I didn’t even realize he wasn’t staying on appropriately). She then checked Walt with her own Tongue Tie Assessment method (Assessment Tool for Lingual Frenulum Function (ATLFF)) and determined he was Tongue Tied.
Photo from tonguetie.co.uk
There was a definitive deficit in the function and range of motion of his tongue, despite his tongue appearance not scoring too bad. This is why we weren’t in a hurry to get his tongue looked at initially. 2 dentists and 2 midwives, 4 practitioners had looked at his tongue already and it appeared to be mild tongue tie if that. They all had seen much worse cases with many more obvious symptoms so Walt’s was tricky and not that obvious even to a trained eye. Dr. Hazelbaker has done extensive studies on this condition including writing a book. She concluded the Tongue Tie was not allowing Walt to suck appropriately and he was unable to empty those deeper ducts causing the frequent plugged ducts and all of my symptoms. She mentioned it could also cause him to have large belches and increased drooling, both of which I had noticed – some monster burps and drooling at 10 weeks like a teething baby! It all made sense and I was relieved to finally know what was causing all the engorgement. If left untreated it could cause speech problems in the future. The solution was simple, to have his tongue clipped. It was a vary simple procedure and was quick and painless (for Walt, but harder for me watching). He is now 4 months and we haven’t had a problem sense! I hope to write more about tongue tie and the clipping procedure in the future. I am so grateful to have figured out the cause of my nursing challenges and to have it all taken care of now. Thanks to Jessica for all of her help and Dr. Hazelbaker for her expertise and care, and of course to our wonderful midwives who gave me info and directed me Jessica and Dr. H.
Lessons Learned – Quick tips if you are getting engorged
- Before giving birth, find a lactation consultant to have incase you need help. Ask them questions before birth and don’t be afraid to call them if you have a question.
- Nurse often if – every 2 hours – 24 hours/day when engorgement is bad
- Completely empty one side before switching to the second
- If needed, pump to get both sides emptied
- Ice your breasts if you have signs of inflammation/plugged ducts/mastitis i.e. redness, heat, hard nodules, pain, swelling. Intense icing 15 minutes EVERY hour may be needed for 24-48 hours or longer
- Anti-inflammatory such as ibuprofen may be needed.
- Monitor your temperature
- Lymphatic drainage works! Find a practitioner in your area if you get plugged ducts
- If your baby might be Tongue Tied have it checked out sooner rather than later. (some cases can look mild but still be problematic!)