Pre-eclampsia and high blood pressure in pregnancy

Experiences of breastfeeding and expressing breast milk

Women we interviewed who had pre-eclampsia or HELLP syndrome gave birth at very different gestations. Some babies were born prematurely and so needed to be cared for in a neonatal unit for a few weeks, so feeding was not always straightforward. Many premature babies didn’t have the ability to feed by sucking from a breast or bottle; they tended to be tube-fed and so their mother’s breast milk could be given to them this way. 

Expressing breast milk and breastfeeding was seen as a good option for helping their babies get stronger and healthier, and also a way to bond. Paige explained: “because she was in neonatal, you want to do it rather than feel you have to do it; you want to feel close to your baby; you want to do anything to try and get them home”. 

A few women said they hadn’t intended to breastfeed before the birth but that seeing their baby in a neonatal unit like SCBU (Special Care Baby Unit) or NICU (Neonatal Intensive Care Unit) changed their minds. Kelly saw expressing breast milk for her baby as “the only thing I could do” as she couldn’t bathe or hold him much. Betty thought “it was good to know that he was benefitting from my breast milk” and she liked being involved in his care. However, when her baby was transferred to another hospital the nurses were a “lot more militant about” establishing a schedule with her for breastfeeding and visits.
However, several women had difficulties producing breast milk, expressing and breastfeeding. Some women who gave birth early found that their bodies were not ready to produce milk. Despite trying, their milk did not start. Babies born early were often too young to have developed the ability to feed from a breast or bottle. Some of the medicines women were given to help their pre-eclampsia could also reduce their breast milk supplies. Paige found her supply dropped when her medicines were changed and so eventually she used formula milk. Another difficulty was being separated in the hospital or when women were discharged home with their baby still in hospital. Samantha X thought it was a combination of medicines, her baby being born early and herself being unwell which meant she couldn’t breastfeed. 

There are also some medicines which mean that women shouldn’t breastfeed whilst taking them. This includes some types of medicines for lowering blood pressure and some types of pain-relief. When Aileen’s blood pressure wasn’t being controlled by medication, her doctors suggested she try another type which would mean she couldn’t breastfeeding anymore: “I was getting conflicting advice at that stage, and the midwives would say, “Keep on doing it, keep on trying, keep on trying,” and then the consultants were saying, “Well, yes, I know breastfeeding is good but we have to look after you as well”. And in the end I thought […] if I'm not well then I can't look after my baby”.
Having problems with breastfeeding could be upsetting and have a lasting emotional impact. Some described feeling failure or guilt about the problems they faced with breastfeeding. Emma said she felt “horribly disappointed” and Kate said “my body was quite useless really”.

Sometimes problems with expressing milk and breastfeeding resolved after a while. Dominie found it “very disheartening when you only get a 0.2 of a ml” but was eventually able to pump bigger quantities. But some women continued to face difficulties with expressing breast milk and breastfeeding. Claire tried hand-expressing and then had some success with an electric pump, but her milk supply alone was not enough to feed her baby. She talked to doctors and decided it would be best for her daughter to have formula as the feeding issue was “holding her back in SCBU”.

While some women said they had good support with learning how to express breast milk and breastfeed. Paige said her hospital were understanding and not pushy. Often women had started out hand-expressing and then either moved on to using a breast pump or directly breastfeeding their babies.
O
ther women felt they were left on their own to work it out. Sometimes they felt pressured by doctors and midwives to express breast milk or try to breastfeed. Often there didn’t seem to be recognition that the woman was very ill herself. Emma found SCBU a difficult environment to try and breastfeed as it was “chaotic, noisy” and she was still very unwell. Julie recalled one time when she was “shouted at for not breastfeeding properly and I am thinking ‘you’ve got no idea what I’ve just been through’”. Samantha X “felt like a failure” because of her breastfeeding struggles and pressure from medical professionals didn’t help. Josie felt there should be “a bit less worry and emphasis on the issue of breastfeeding” and women should be given more “support to hold and to nurture and cuddle the babies”.

Establishing a routine with hand-expressing, pumping or directly breastfeeding their babies could be tiring. Helen X remembered this adding to her exhaustion as she wasn’t sleeping very well. Paige found it hard sometimes to get up during the night to express breast milk without her baby physically there with her. Despite the challenges, most women we spoke to who had tried expressing or breastfeeding were glad. As Aileen explained, even relatively small quantities were an important achievement: “I thought, 'I have given the colostrum, I have given a little bit of breast milk.' Ideally I'd want to breastfeed more but I don’t think I'm producing enough milk anyway. So I said, “That’s fine””.

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