Ruth
In Ruth’s first pregnancy, she developed pre-eclampsia at 32 weeks and stayed in hospital till the birth of her son by emergency C section at just over 35 weeks. Her baby weighed 4lb. Ruth was unable to physically breastfeed and used an electrical pump to expressed her milk for 4¬¨¬®≈í¬© months. The experience was both emotionally and physically exhausting. She felt a failure as well as under pressure by health professionals to feed her son breastmilk. In her second pregnancy, Ruth developed severe gestational diabetes and was also at high risk of developing pre-eclampsia. Her second son was delivered by planned C section at 38 weeks. Her second son received her expressed milk for four weeks, and then she started a mix-feeding routine and then formula.
Ruth became a mum for the first time in her late thirties and was forty-two when she had her second son. She has a condition called polycystic ovaries. During both pregnancies, she was closely monitored by the hospital medical team because of her age; the onset of gestational diabetes and the high risk of developing pre-eclampsia during pregnancy. Ruth developed pre-eclampsia with her first son at 32 weeks and stayed in hospital till the birth. She was transferred to another hospital fifty minutes away, because her local maternity hospital had no special care unit beds available for her baby. The plan was to induce her but there were complications and the baby went into distress and she ended up having an emergency C section at just over 35 weeks. Her premature baby weighted 4lb and was in an incubator for two days to regulate his temperature and in a special care unit for another 9 days due to his size and jaundice.
When she recovered a bit from her C section, Ruth tried to breastfeed her baby, but he wasn’t interested and she found it physically difficult due to the size of her breasts and the size of the baby. She started to express her colostrum, and then her breastmilk using an electric pump, which was fed to the baby first by nasal tube and then by bottle. There was very limited support to help breastfeed in the hospital but when she left hospital the midwives and health visitors reassured her that breastfeeding was going to happen when the baby was more settled and slightly bigger. They advised her that she should breastfeed for at least six months especially as her baby had been premature, but in the meantime she should keep pumping and feeding him her breastmilk from the bottle. As a first time mum, she felt under pressure to comply with the advice of health professionals and she herself wanted to give her premature son a good start in life. Ruth’s mother was very supportive and engaged a breastfeeding consultant. She had four sessions with the expert but all they managed was for the baby to latch on once just for a few seconds. She was pumping her breastmilk every four hours – day and night as advised to maintain her milk supply. Her baby was growing well, but he was not breastfeeding as predicted by health professionals. The four hourly routine was exhausting, and her mood was low.
She felt a sense of failure because she had not achieved a natural birth or succeeded in breastfeeding. She felt bullied by the health professionals into keeping regularly pumping and attempting breastfeeding, which she did every day for four months. Her husband supported her in her efforts but convinced her that she had done enough and that she had succeeded in giving their son all the goodness from her milk. It was time for her to stop pumping and to start using baby formula. As Ruth had been maintaining such a good supply of breastmilk, she had been storing the surplus in the freezer and had enough to feed her son for a couple of months. But when her son was given the defrosted milk it was rejected or vomited up. The frozen breastmilk was then donated to the breastmilk bank at the local hospital. Ruth then started to wean the baby onto formula and reduce her milk supply, which took a few weeks.
The experience of birth and breastfeeding with her second son was more positive. Before conceiving, her new GP advised Ruth to lose weight; and she managed to lose two stone. Despite being in good health during pregnancy, she developed gestational diabetes again but much more severely than with her first son and that involved being treated with tablets and insulin three times a day. She did feel very well cared for by the consultants in hospital, her GP and the midwife. Overall, she felt more confident. Her consultants advised her to have a planned C section at thirty eight weeks due to the risks of gestational diabetes, pre-eclampsia and failed induction with her first son. The planned C section went ahead at 38 weeks and went well and she delivered a baby who was within normal weight (7lb) and did not need special care. Regarding breastfeeding she felt that the attitude of health professionals had changed for the better in the five years between her pregnancies; that the priority was to feed the baby, not you have to breastfeed for six months. In hospital, she was helped by a midwife to latch the baby to her breast and he showed an interest in it – but like before, he was unable to successfully feed.
A particularly helpful midwife figured out that although Ruth has large breasts and lots of milk, her nipples were not very long and the soft palate of her son was too far back in his mouth to enable him to latch on successfully and suck the milk. In other words, it was the mechanics that prevented the baby from breastfeeding. This finding came as a big relief to Ruth. There was at last an explanation as to why her baby and perhaps her other son as well had been unable to breastfeed. She and her husband agreed that she would not use an electric pump again so she used a hand pump for four weeks to express her breastmilk and then alternated feeds with formula till six weeks. Her second son was then exclusively on formula from six weeks old. Unlike her first experience, she felt relaxed and able to make decisions that were appropriate for her baby, herself and the whole family.