- Email: [email protected]
Breastfeeding against the odds
Journal of Neonatal Nursing (2012) 18, 17e19
www.elsevier.com/jneo
LETTER FROM AFRICA
Breastfeeding against the odds Africa is experiencing wonderful sunshine e it is summer in our country! This time I would just like to share an experience and a journey in my own life and I do hope that this will be inspirational and motivate both mothers and healthcare professionals to support and enhance breastfeeding. Breastfeeding is the route to go. It has all the benefits that any newborn needs: protection against illness, bonding between mother and infant, improved IQ, economic benefits and so much more. I breastfed our firstborn and was motivated to do the same when I fell pregnant the second time round. I even had milk as early as the fourth week of my pregnancy. Everything went well and I experienced the usual pregnancy niggles such as nausea and tiredness. Our firstborn was born by caesarean section due to placenta previa and this time round I asked a midwife colleague to manage the delivery for us e a VBAC of course. Everything went well during the pregnancy, although I felt quite nauseas the last two weeks of the pregnancy. I attributed this to the baby growing and pushing against the liver while the space decreased, but I later learnt that this was not the case, but that I in fact contracted Hepatitis A. This only became evident during the labour when I started to have a yellowish glow, my eyes also appeared yellow and I was so tired, partly due to the fact that I did not have any appetite, especially not for rich food. The delivery was an experience. I laboured for less than 8h, the midwife ruptured the membranes by 8am, the contractions increased and I got in the bath for pain relieve and by 10 am our little boy was born e coming out with his hand next to his head, just to ensure that I had a nice second degree tear. His Apgar was six and he was not very responsive, but being passionate about the effect of skin-to-skin care he was placed on daddy’s
chest with a bit of supplemental funnel oxygen while I was sutured. He grunted the whole time and the midwife considered taking him to the newborn transition area for some additional heat and oxygen. I convinced her to give a bit more time and as soon as I was ready I’ve put him on my chest e and not surprisingly his temperature raised, he stopped grunting and latched. Mom was tired, daddy glad all was over, but mom and baby was healthy and our little bundle was happy with a full tummy, cuddled warmly on mom’s chest. And then stressful the period started. My blood results were returned from the laboratory and I had Hepatitis A. Not sure where I contracted it; it might have been in the water or from the nursery school, since one of the mother’s there was also diagnosed with Hepatitis A and it is then carried by the toddlers (who only experience flu-like symptoms) and passed on to me, being pregnant and having a low immune system due to the fact. The gynaecologist wanted to admit me to a nearby hospital, but I delivered in a birthing unit was about one and a half hour’s drive away from our home in another province. So we organised that I am admitted in my hometown. However, I had a newborn of a few hours old and was sure that the physician will have my baby separated from me to protect him from being infected as well and in addition prevent me from breastfeeding, since Hepatitis A is passed on by bodily fluids. So, on the way I phoned the paediatrician on call e o, yes, it was a Saturday e and explained the situation to him. I pleaded with him to double check whether it would really be necessary to isolate me from my baby and cease breastfeeding. He called me back later, while we were still on the road and said that it should be safe to keep us together and continue breastfeeding and that he will inform the physician accordingly.
1355-1841/$ - see front matter ª 2011 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jnn.2011.11.006
18 As we arrived at the hospital, we were both placed in isolation in a medical ward and the paediatrician came to visit. He examined our little one and was happy with his condition. We stayed in hospital for about four days, during which I fed although I was so tired and nauseas. On day three the paediatrician did an SBR (serum billirubin) on our little boy, since he presented with a yellow skin tone and the SBR was elevated. He decided to start phototherapy and I continued breastfeeding. The next day I was healthy enough to be discharged, but our boy had to be admitted to the paediatric ward to receive phototherapy, so the roles changed and he became the patient and I the lodger. The next day his SBR still raised and double phototherapy was started and the next day the SBR levels started coming down. The following day the doctor was willing to discharge him on still another day of home phototherapy. Exhausted, but still breastfeeding we went home. At this stage I was so tired from the Hepatitis that I just wanted to sleep and our toddler now became very demanding due the turmoil all of these events caused in her twoyear old world. On top of that my nipples started to crack, not due to poor positioning, but just because that little boy sucked to hard. I just had to treat the nipples and live through the pain. I was still bleeding moderately and the Friday evening e one week after the delivery the perineal stitch came loose and the bleeding became worse. This time I really panicked and started to feel depressed. I fed our boy, called my husband and asked him to take me to the emergency rooms. Thankfully, grandma visited to help and we left both children with her. On our way to the emergency rooms I made all kinds of plans, since I am the provider of food for our baby. Arriving at the emergency rooms, crying we waited on the gynaecologist and I called my mum to arrange for the dreadful tin of formula, since I was sure a dilatation and curatation was inevitable. The doctor then confirmed that this was the case, but the good news was that he would only have to do it the Saturday morning. So back home we went and I expressed with every feed, trying to have some additional milk available for my baby for when I am still under the spell of the anaesthesia. The next morning, after only a little bit of interrupted sleep and not a lot of expressed breast milk, we left for the hospital e baby boy coming along. I fed him just before they took me to theatre and then the anaesthetist decided that with the history of Hepatitis a spinal may be a saver route. So the procedure was done and I was taken back to the ward, where I was able to feed about 4 h after the previous feed and was discharged later that
Letter from Africa afternoon e stressed out about my milk volume, but still breastfeeding. The dreadful tin of formula stayed sealed in the cupboard. As if this was not challenging enough, I developed severe diarrhoea during the following week and had to be very careful not to dehydrate. We still don’t know if it was a result of the iron supplements or the liver going haywire, but I could barely go out of the room, so severe was it and I got very depressed wondering if my life would ever return to normal again. It did stop after about a week and new medication from my physician. I was still extremely tired and would fall asleep during a conversation e not something I do. Therefore the wonderful thing about breastfeeding a newborn was that I could just breastfeed and sleep with our little boy after that e all day long for a whole week. Luckily he enjoyed feeding while I was lying down, since I also developed a wonderful, strong flow of milk. Daddy had to return to work very soon after the birth, since he runs his own business, but despite his challenging schedule, he cared for our toddler, fed and bathed her and dropped her of or picked her up from school. He was very understanding and supportive and would carry our little one to a different room whenever I needed a change of scenery e I was so tired that I was scared I would let my baby fall. I had a great support system in the form of friends who draw up a roster and delivered a warm, cooked meal every evening for at least two weeks after I’ve been discharged. That really helped a lot. I slowly started to gain some energy and was only able to go for a short walk about a month after the delivery. I used supplements for my liver for more than a month and pain medication from time to time. This of course after feeds, and preferably not at night time, since the medication that I could take with the mall functioning liver, really knocked me out. When he was three months old I had to return to work. I decided to breastfeed till at least six months and this turned out to be a real challenge. Some days I’ve expressed enough milk for the next day, but other days I really struggled to get enough. I can now appreciate the effort working mothers and mothers with infants in NICU put in to ensure successful breastfeeding. We are still breastfeeding, and even though it does take a lot of effort, it is worth every moment. The support on different levels is essential to ensure successful breastfeeding especially when times are rough. Most new mothers do not live in an extended family environment and may feel very alone and isolated. I believe that if we are able to
Letter from Africa
19
provide an effective support structure for new parents, we will have a much higher success rate for successful breastfeeding e against the odds! Until next time. Welma
Dr. Welma Lubbe School of Nursing Science, Potchefstroom Campus, PO Box 19227, Noordbrug, South Africa Tel.: þ27 (0) 18 299 1898; fax: þ27 (0) 18 299 1827. E-mail address: [email protected]
Available online at www.sciencedirect.com
www.elsevier.com/jneo
LETTER FROM AFRICA
Breastfeeding against the odds Africa is experiencing wonderful sunshine e it is summer in our country! This time I would just like to share an experience and a journey in my own life and I do hope that this will be inspirational and motivate both mothers and healthcare professionals to support and enhance breastfeeding. Breastfeeding is the route to go. It has all the benefits that any newborn needs: protection against illness, bonding between mother and infant, improved IQ, economic benefits and so much more. I breastfed our firstborn and was motivated to do the same when I fell pregnant the second time round. I even had milk as early as the fourth week of my pregnancy. Everything went well and I experienced the usual pregnancy niggles such as nausea and tiredness. Our firstborn was born by caesarean section due to placenta previa and this time round I asked a midwife colleague to manage the delivery for us e a VBAC of course. Everything went well during the pregnancy, although I felt quite nauseas the last two weeks of the pregnancy. I attributed this to the baby growing and pushing against the liver while the space decreased, but I later learnt that this was not the case, but that I in fact contracted Hepatitis A. This only became evident during the labour when I started to have a yellowish glow, my eyes also appeared yellow and I was so tired, partly due to the fact that I did not have any appetite, especially not for rich food. The delivery was an experience. I laboured for less than 8h, the midwife ruptured the membranes by 8am, the contractions increased and I got in the bath for pain relieve and by 10 am our little boy was born e coming out with his hand next to his head, just to ensure that I had a nice second degree tear. His Apgar was six and he was not very responsive, but being passionate about the effect of skin-to-skin care he was placed on daddy’s
chest with a bit of supplemental funnel oxygen while I was sutured. He grunted the whole time and the midwife considered taking him to the newborn transition area for some additional heat and oxygen. I convinced her to give a bit more time and as soon as I was ready I’ve put him on my chest e and not surprisingly his temperature raised, he stopped grunting and latched. Mom was tired, daddy glad all was over, but mom and baby was healthy and our little bundle was happy with a full tummy, cuddled warmly on mom’s chest. And then stressful the period started. My blood results were returned from the laboratory and I had Hepatitis A. Not sure where I contracted it; it might have been in the water or from the nursery school, since one of the mother’s there was also diagnosed with Hepatitis A and it is then carried by the toddlers (who only experience flu-like symptoms) and passed on to me, being pregnant and having a low immune system due to the fact. The gynaecologist wanted to admit me to a nearby hospital, but I delivered in a birthing unit was about one and a half hour’s drive away from our home in another province. So we organised that I am admitted in my hometown. However, I had a newborn of a few hours old and was sure that the physician will have my baby separated from me to protect him from being infected as well and in addition prevent me from breastfeeding, since Hepatitis A is passed on by bodily fluids. So, on the way I phoned the paediatrician on call e o, yes, it was a Saturday e and explained the situation to him. I pleaded with him to double check whether it would really be necessary to isolate me from my baby and cease breastfeeding. He called me back later, while we were still on the road and said that it should be safe to keep us together and continue breastfeeding and that he will inform the physician accordingly.
1355-1841/$ - see front matter ª 2011 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jnn.2011.11.006
18 As we arrived at the hospital, we were both placed in isolation in a medical ward and the paediatrician came to visit. He examined our little one and was happy with his condition. We stayed in hospital for about four days, during which I fed although I was so tired and nauseas. On day three the paediatrician did an SBR (serum billirubin) on our little boy, since he presented with a yellow skin tone and the SBR was elevated. He decided to start phototherapy and I continued breastfeeding. The next day I was healthy enough to be discharged, but our boy had to be admitted to the paediatric ward to receive phototherapy, so the roles changed and he became the patient and I the lodger. The next day his SBR still raised and double phototherapy was started and the next day the SBR levels started coming down. The following day the doctor was willing to discharge him on still another day of home phototherapy. Exhausted, but still breastfeeding we went home. At this stage I was so tired from the Hepatitis that I just wanted to sleep and our toddler now became very demanding due the turmoil all of these events caused in her twoyear old world. On top of that my nipples started to crack, not due to poor positioning, but just because that little boy sucked to hard. I just had to treat the nipples and live through the pain. I was still bleeding moderately and the Friday evening e one week after the delivery the perineal stitch came loose and the bleeding became worse. This time I really panicked and started to feel depressed. I fed our boy, called my husband and asked him to take me to the emergency rooms. Thankfully, grandma visited to help and we left both children with her. On our way to the emergency rooms I made all kinds of plans, since I am the provider of food for our baby. Arriving at the emergency rooms, crying we waited on the gynaecologist and I called my mum to arrange for the dreadful tin of formula, since I was sure a dilatation and curatation was inevitable. The doctor then confirmed that this was the case, but the good news was that he would only have to do it the Saturday morning. So back home we went and I expressed with every feed, trying to have some additional milk available for my baby for when I am still under the spell of the anaesthesia. The next morning, after only a little bit of interrupted sleep and not a lot of expressed breast milk, we left for the hospital e baby boy coming along. I fed him just before they took me to theatre and then the anaesthetist decided that with the history of Hepatitis a spinal may be a saver route. So the procedure was done and I was taken back to the ward, where I was able to feed about 4 h after the previous feed and was discharged later that
Letter from Africa afternoon e stressed out about my milk volume, but still breastfeeding. The dreadful tin of formula stayed sealed in the cupboard. As if this was not challenging enough, I developed severe diarrhoea during the following week and had to be very careful not to dehydrate. We still don’t know if it was a result of the iron supplements or the liver going haywire, but I could barely go out of the room, so severe was it and I got very depressed wondering if my life would ever return to normal again. It did stop after about a week and new medication from my physician. I was still extremely tired and would fall asleep during a conversation e not something I do. Therefore the wonderful thing about breastfeeding a newborn was that I could just breastfeed and sleep with our little boy after that e all day long for a whole week. Luckily he enjoyed feeding while I was lying down, since I also developed a wonderful, strong flow of milk. Daddy had to return to work very soon after the birth, since he runs his own business, but despite his challenging schedule, he cared for our toddler, fed and bathed her and dropped her of or picked her up from school. He was very understanding and supportive and would carry our little one to a different room whenever I needed a change of scenery e I was so tired that I was scared I would let my baby fall. I had a great support system in the form of friends who draw up a roster and delivered a warm, cooked meal every evening for at least two weeks after I’ve been discharged. That really helped a lot. I slowly started to gain some energy and was only able to go for a short walk about a month after the delivery. I used supplements for my liver for more than a month and pain medication from time to time. This of course after feeds, and preferably not at night time, since the medication that I could take with the mall functioning liver, really knocked me out. When he was three months old I had to return to work. I decided to breastfeed till at least six months and this turned out to be a real challenge. Some days I’ve expressed enough milk for the next day, but other days I really struggled to get enough. I can now appreciate the effort working mothers and mothers with infants in NICU put in to ensure successful breastfeeding. We are still breastfeeding, and even though it does take a lot of effort, it is worth every moment. The support on different levels is essential to ensure successful breastfeeding especially when times are rough. Most new mothers do not live in an extended family environment and may feel very alone and isolated. I believe that if we are able to
Letter from Africa
19
provide an effective support structure for new parents, we will have a much higher success rate for successful breastfeeding e against the odds! Until next time. Welma
Dr. Welma Lubbe School of Nursing Science, Potchefstroom Campus, PO Box 19227, Noordbrug, South Africa Tel.: þ27 (0) 18 299 1898; fax: þ27 (0) 18 299 1827. E-mail address: [email protected]
Available online at www.sciencedirect.com