Putting Down the Pump

In past posts when I wrote that I would only breastfeed if it were easy and recognized that there are many instances where breast is not best, I really had no idea how difficult it would be for me. Despite my hypothetical understanding of breastfeeding difficulty, the truth is I never thought it would happen to me.  I bought a breast pump when I took prenatal lactation classes “just in case” but was really only expecting to use it for when I went back to work and to store extra breast milk. Oh how naïve I was…

Ellie was born unable to latch. She was born via c-section with apgar scores of 10 and had no tongue-tie. She just would not latch. When she was first born, I immediately tried to breastfeed. But being a first-time mother and dazed from surgery, I had no idea what I was doing and no one was there to help me. It wasn’t until the next day that I realized she wasn’t actually latching.

With that discovery began postpartum hell. The nurses treated me and Ellie terribly by trying to force her to latch. One nurse even pinched her to get her to cry so she could cram my nipple into her mouth. The few times she actually got her mouth around my nipple she sucked a few times before unlatching and continuing screaming.

We ended up having to feed her with syringes so as to avoid nipple confusion. So every feed started with repeatedly trying to get her to latch and finishing off with syringes of formula. The nurses didn’t want me to use my pump. So I didn’t begin that until I was home. Then I was at least able to give a mixture of colostrum and formula syringes.

Once we got home, there was still no improvement, so we hired our prenatal preparation midwife come lactation consultant to help us out. She wasn’t able to offer any solutions. I had the idea to try nipple shields, which she approved. The nipple shields allowed my baby to latch. They didn’t, however, allow her to suck successfully. She would suck for a while, but she would be so tired from the effort that she would fall asleep only to awake screaming for food. Also, my frequent pumping would leave her without a sufficient supply. It was a vicious circle that was just not working.  By this time, Ellie would cry every time I tried to put her on the breast, and I would dissolve into a sobbing mess. At that point everyone was concerned with my mental health. My midwife/lactation consultant suggested that I stopped trying to get Ellie to latch at all. But because my production was lacking, she suggested that I pump every two hours during the day and every three hours at night. I wasn’t able to keep up that schedule. I pumped every three hours during the day and after every feeding at night.

Through pumping alone, I was able to give Ellie breast milk for all but one feeding a day. This has gone on from since Ellie was three weeks old. She’s exactly 10 weeks today. I don’t mind pumping, but I’ve had mastitis twice already. To express what I need, I am attached to the pump for about three hours a day (more if I do a power pump session that can last from 1 to 2 hours). I’ve been prepared to continue on this way until it became clear that my anxiety levels are very elevated and that I need to get back on Lexapro (a medication I have taken intermittently for the last 10 years).

In that vein, I told my GP that I wanted a prescription for Lexapro about a month ago. She refused to give it to me by saying that my high levels of anxiety were normal given all the difficulties I’ve had breast feeding. This was also around the time of my first bout of mastitis. She said that before I stopped breastfeeding, I should talk to the pediatrician (for permission) and the local midwife (for support). When I talked to the pediatrician, I was given a huge guilt trip. She essentially said that since I only had one child I should really make the effort to give Ellie breast milk. It wasn’t until I was sobbing in her office that she conceded that I had made a great effort and that I shouldn’t feel guilty for stopping. However, I felt a bit more empowered after visiting the midwife. She told me that some people have these problems and that I shouldn’t feel guilty. But she also said that even though I couldn’t produce all of what my baby needs, that even 20% was better than nothing. And so I continued pumping.

But I got mastitis again about two weeks later. And my mental health has only improved a bit after I joined the gym and have been able to get out of the house nearly every day. Thank goodness I have a wonderful husband that works from home and is able to care for the baby while I get some “me time.” I went back to my GP and said that I wanted to quit pumping. She once again requested that I see the pediatrician again for permission. Also, she decided to refer me to a psychiatrist because my mental health had improved. My GP, pediatrician and I met up about a week later. It was agreed that I would try to continue to pump until Ellie reaches three months, depending on what the psychiatrist said and ultimately prescribed. I was relieved that I was finally getting an appointment with someone who could help me get my medication, but I was disappointed that I was pressured into continuing to pump. I know it is ultimately my decision, but the pressure and guilt really prevented me from being my own advocate.

The psychiatric appointment was weird, nothing like what I was used to in the US. Her office wasn’t the cozy room with a sofa that I was used to. I sat across from the psychiatrist at a desk while she asked questions and typed on the computer. Anyway, she didn’t want to give me Lexapro because I was still pumping. She didn’t ask me if I wanted to stop pumping. She didn’t suggest that I stop pumping. Instead, she referred me to a psychologist and stated that if the psychologist decided I needed more of a push, I could get another psych appointment for medication. So once again I left feeling dejected. How could it be that these medical professionals, including a psychiatrist felt that giving my child breast milk was more important than my mental health? It was like I was in an alternate reality. And again, I knew I wanted to stop pumping, but the pressure and guilt continued to consume me.

Today, I had the appointment with the psychologist. For the first time, someone asked me what I wanted. She is the first medical professional to understand that my mental health is paramount. When I said that I felt stupid that I let the other doctors pressure me, she was empathetic and said that it was totally understandable because they are the professionals. I finally feel like I can do what I need to do, which is to STOP PUMPING. She said before I could deal with the rest of my issues (of which there are many), I’d need to resolve the lactation issue. So I’m going back to the psychiatrist next week to get my prescription and then having an appointment with the psychologist to see how things are going.

I wish I could say this is a guilt-free decision. It is not. I still feel a lot of internally and externally imposed guilt. But I know that this is the best decision for not only myself, but also my baby and my husband. I need to reduce my stress levels, so that I can get well. Yes, I am aware that Lexapro is supposedly safe to take while lactating. Unfortunately, my doctors do not accept that so taking Lexapro and pumping is not an option.

For the moment, some of the pressure has been relieved. I am going to taper off pumping. I no longer have to constantly worry about supply. I no longer have to schedule my life around pumping. On one hand, I feel liberated, but on the other, I feel a bit like I’m giving up. Nevertheless, I am absolutely certain that this is the right decision.

Ellie is here!!

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This post has been a long time coming, nearly six weeks in fact. I really have gone to the computer several times to write this post, and I have been thinking about writing every single day. But once a certain amount of time has passed it feels really overwhelming to try to get started, especially when you have a sweet little newborn to care for.

With that said, I’ll give you a few details about the birth (although I must say I’m not really into birth stories). Right at 38 weeks, my water broke. Well, I really didn’t know it had broken. I woke up in the middle of the night to use the restroom, as pregnant women do several times a night, but when I went to pee I could feel myself losing liquid without peeing. It’s a bit hard to explain. I just chalked it up to incontinence issues brought on by being very pregnant. When I woke up that morning, however, I my underwear were unusually wet. My husband and I went through the whole, is it pee or isn’t it thing? See, at our hospital tour the Ob said, if it doesn’t fall to the ground, it’s not your waters. Well, I was having some little gushes, but nothing I’d expected given what I had been told.

After some investigation, we decided to go on to the hospital, despite the fact that I really didn’t want to be sent home and told that I had just peed myself repeatedly.  This was the morning of Tuesday, June 4th. The midwife on duty informed me that my waters did break, but that I wasn’t in labor and I was only slightly dilated (by the way, having your cervix checked when you are only at 1 cm is extremely freaking painful). So they sent me to a pre-delivery room with a suppository to soften my cervix.

Eventually I started getting contractions. That night the contracts weren’t very painful, but they were one right on top of each other, so I got a shot of something for pain. That was very nice and let me get some sleep.

The next morning I had dilated a bit more to 3 cm, but I really wasn’t progressing where I should have been. They decided to move me to a delivery room and give me pitocin to induce. I had heard about pitocin contractions, so I let the OB know that I wanted an epidural as soon as possible. Fortunately, they were able to get me the epidural before contractions got unbearable. Let me just say the epidural was everything I hoped it would be. We could tell I was having strong contractions from the monitors, but I was able to rest and hang out with my husband. It also made the cervical checks a lot more bearable.

Throughout the day midwives and doctors would come in and check only to discover that I was not progressing and the baby was not engaged. At about 7 pm that evening, the doctors determined it had been about 33 hours since my waters had broken and that there was little chance that I would progress before the chance of infection got too great. They told us that a c-section was going to be necessary. I had been prepared for this eventuality but was surprised that when I asked when they said, “now!”

During the hospital tour, we were told that the protocols were changing and that birthing partners would be allowed to be in the operating room (this is not at all common in Spain). Nevertheless, when we asked if Tim would be allowed in the room, they said no. Cue a lot of tears because that was quite literally my biggest fear: being alone in the operating room. I don’t know if it was the tears or what, but they changed their minds and allowed Tim to accompany me. 

Ellie was born at 7:15 pm on June 5th with perfect Apgar scores.

So the pre-delivery and delivery experience was very positive for me. I was treated really well by everyone and was very relaxed up until they said Tim would not be allowed to accompany me.

Post-partum recover in the hospital, however, was a total nightmare. I’ll have to say more about that later.

PUPP Post 3: Finally some relief

After nearly a week of suffering, I’m finally feeling better…like I can go on. I started on the second pill I was given in the ER on Friday evening: Atarax (or Hydroxyzine as it known in the US) . I could finally sleep. And I ended up sleeping all weekend. That’s the only problem. This antihistamine makes me very drowsy even if I only take it once a day. But I’ll take that over scratchy myself bloody. It could also be that the combination of antihistamine, corticosteriod cream and everything else I’m doing finally worked), but I’m not going to change my routine.

I’m back at work today and feeling human again. I should say that I am still itchy, and I’m still covered in the rash. But the difference is between what is bearable vs. what is unbearable. And that makes all the difference.

PUPPP Post 2

Things are pretty much the same. The rash is still spreading. In addition to my body, it has now spread to the tops of my feet, in between my fingers and two toes, and I’m even getting bumps on my palms. I suppose the itch is more or less the same. I can’t really perceive any improvement despite the antihistamine. But to help out with determining whether the antihistamine and the other things I’m taking do anything at all for me, I’ve started a spreadsheet to log what’s going on hourly. When unbearable itchiness and type-a personality collide! I hope it will give me some sense of what treatments seem to have an effect. Or not.

PUPPP (Pruritic urticarial papules and plaques of pregnancy)

I made it to nearly 36 weeks without any complications. I’ve really had a relatively easy pregnancy up until now (ha! tell that to my husband). But the last two weeks have been utter hell, and I’m so afraid that it’s just going to get worse.

I had no stretch marks whatsoever until about 32 weeks. Then it was like the floodgates open and every day there were more. At first they were normal looking and slightly itchy. But soon they were like red raised welts on my belly and the itchiness was at times unbearable. In fact, the stretch marks were so raised that you could see their outlines through my maternity t-shirts.

Of course when I had my last appointment with the (rotating) OB on last Monday, May 13th, I brought up the extreme itchiness and redness of the stretch marks. The OB’s suggestion? Put cream on them. Ah yes, just what I needed to hear. It’s not as if I had been using all manners of oils and creams and exfoliants to avoid getting stretch marks in the first place. WTF? And of course I had only been using more cream as the itching increased. But whatever if there’s been one constant in my contact with the health care system here it has been dismissive doctors.

Shit started to get real the next day. I started with a few little itchy bumps on my right arm just under my wrist. The next day it had spread to the other arm. More little itchy bumps appeared throughout the next few days. By Sunday, I realized I was not going to be able to wait until my next doctors appointment. The itchiness was intense and it was getting worse. By this time, I had consulted Dr. Internet and was fairly certain that I was suffering from PUPPP.

So we headed over to the ER Sunday afternoon. At this point the rash was located on the underside of my arms, my underarms, parts of my belly, the back of my knees and around my Achilles tendon. The internist there asked me all the usual questions. She said something like “maybe it herpes” like herpes zoster i.e., shingles. I said, “Look, I know doctors hate when patients do this, but this is what I think I have,” and showed her the images and Wikipedia entry on PUPPP. She had a dermatologist come in to consult. The dermatologist took one look at my belly and said (in Spanish) PUPPP. The internist confirmed it was what I suspected. They gave me a steroid cream called Lexema containing Methylprednisolone aceponate (metilprednisolona aceponato), which in the US is called Advantan. I was directed to mix the Lexema with liquid paraffin to reduce the potency and apply twice a day. I missed the whole twice a day thing and was applying frequently Sunday evening and Monday.

I was up all Sunday night itching, scratching and applying cream. When I got up for the last time Monday morning, I was covered even more. This time I had a rash on my back and legs. Worse, the scratching had made the bumps even more sensitive. When I got to work, I realized that the internist mentioned that I should see my GP. So I made the next earliest appointment I could: Wednesday morning. At work, I was going crazy with itchiness and sleep deprivation. I ended up coming home and being miserable there. Tim went to a pharmacy and got me ioox Calamina body lotion for €20. At first this helped due to the cooling effect, but honestly, relief was short-lived. I applied the Lexema as directed that night.

I was up again Monday night/Tuesday morning. The rash was still spreading. This time I could feel little pustules in between my fingers. The skin of my hands looked like frog skin. I decided I would try to do some work from home. I had been doing some research. I learned that the most I could expect from an anti-histamine was some sleep. I had heard some good things about dandelion root tea and capsules. Tim went on an expedition. He found dandelion capsules (not sure if its the same thing as dandelion root), but of course the one herbal tea that didn’t have was dandelion root. So I started taking the capsules because at this point I’d be happy with even a placebo effect. That night I applied my Lexema as directed, took a Benadryl with my other vitamins and supplements and put my fingers in gloves. I woke only once to find my feet scratching each other. I applied some more ioox, re-gloved my hands and was able to go back to sleep.

Today is Wednesday. I had the appointment with my GP. I was quite optimistic that she would be able to do something for me. At the appointment, she seemed to recognize the rash as PUPPP (or prurito gestional in Spanish). But when I mentioned the ever increasing bumps in between my fingers, she said it was eczema unrelated to the rash covering the rest of my body (now my entire belly, most of my legs, the underside of my arms, my buttocks, and back). It’s worth noting that the pustules on my fingers are exactly what I’ve seen on other parts of my body. I wasn’t going to argue with her, though. If she gave me something that worked for the rash, then those bumps would go along with it. Unfortunately, she didn’t want to give me something stronger, so she sent me over to the ER to get checked out by an OB, since my next appointment wasn’t for another week.

At the ER, I was taken quickly up to L&D. The doctor there was one of the rotating doctors we’d seen for our regular appointments. She looked at my arm and said it was an allergy. I really didn’t want to argue with her, but this was clearly not an allergy. She seemed to accept as much when she read the report we received from the ER on Sunday. The good thing is that she went ahead and took a look at the baby (who is doing amazingly) and monitored me for about 15 minutes. Here’s something that actually worked: listening to my baby’s healthy heartbeat. The OB sent me downstairs to get some blood drawn and she gave me two prescriptions. One pill to take immediately and if that didn’t help over the next few days, another pill to try. Stupidly I assumed that it was an oral steroid, since that is really the only thing that is supposed to work for PUPPP. I thought the risks outweighed the risks for such a treatment, so I said, “So you feel it is safe.” She was quite convinced. Well, no wonder. Later I realized it was just an anti-histamine. And the second stronger medicine was just an anti-histamine as well.

So here I sit, feeling quite sorry for myself. I know I have so much to be grateful for, first and foremost a healthy baby that seems to be in no hurry to get out an meet me and Tim! But damn this is really terribly unpleasant. There are points that I am just reduced to tears because I don’t know if I can make it to my next appointment, let alone until my due date. I am going to take what the doctors have given me. While they are not infallible, I think that my best shot at being listened to is to follow their instructions to the letter. I’m going to keep taking the dandelion capsules, because why not. I’m still going to use the ioox Calamina. And I suppose just continue with the cold wet washcloth trick and cold showers. But more importantly, I’m going to be doing daily walks for my mental health and maybe just maybe this baby will choose to come a little bit early. I’m full term on Saturday.

For now, I’m drowsy from the anti-histamine and itchy as hell.

Maternity, Obamacare and “Baby Killers”

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Last week I decided that I really needed to look at how much individual insurance would cost for the three of us if we move to the US without a job lined up. So I went to ehealthinsurance.com and made a number of assumptions to get a rough idea. As I was perusing the plans, I noticed that not a single one offered maternity coverage. Only a few plans even covered maternity costs if there were complications. Indeed, I remembered that I had heard a number of women on various forums talking about having to pay out-of-pocket for prenatal appointments, testing and birth. I thought this was because they were uninsured. I literally had no idea that this was so pervasive, even though my own US individual health insurance plan does not cover maternity (it does, however, cover prenatal).

So after consulting Facebook, I discoved that no maternity coverage is indeed the norm for individual health insurance plans (if you are unemployed, freelance, you work one or more part-time jobs, or your employer has less than 50 employees). Indeed, if you want maternity coverage, you need to add a maternity rider for an additional cost (try $400 bucks a month more). Moreover, many maternity riders stipulate waiting period of 10 months, 12 months or even two years before getting pregnant. So assuming a 12-month waiting period, a woman has paid $4,800 in specific maternity insurance before she can even get maternity coverage, add 9 months of pregnancy to that and the total cost she’s paid just for insurance is $8,400. Obviously, that’s the bare minimum because it usually takes time to get pregnant once you start trying. In some cases, it might actually be cheaper to not carry maternity coverage and pay cash to doctors and the hospital (costs are usually discounted for the uninsured).

Given that I have been receiving excellent care with Spanish National Health Service (Seguridad Social), I was pretty outraged on the part of women who do not have maternity coverage and do not qualify for Medicaid. I’m still outraged, in fact, but I’ll get to that later.

Then I discovered that one of the key features of the Affordable Care Act (AKA Obamacare) is ensuring that all women have access to affordable maternity coverage. This means that “[j]ob-based health plans and new individual plans are no longer allowed to deny or exclude coverage to your baby (or any child under age 19) based on health conditions, including babies born with health problems” and “[s]tarting in 2014, essential health benefits such as pregnancy and newborn care, along with vision and dental care for children, will be covered in all new individual, small business and Exchange plans.”

So — phew — that is a huge step in the right direction for women’s and children’s health! Initially, I was really relieved, but then I started to get angry.

Angry that this is what Republicans are railing against: Spreading insurance risk so women and children have access to affordable health care.

Angry because I know while US infant mortality is declining, we are still ranked 27th in the world (and 30th — 50 percent more than all the other industrialized countries in the report combined — for first day infant dealth rate).

Angry because I know that the US is the only western industrialized nation without universal healthcare.

Angry because I know that these abysmal death rates are related to access to adequate healthcare.

And so I’m angry because conservative politicians and pundits and master manipulators on the right have been wailing and screaming the inalienable rights of an embryos and fetuses. But when it comes to making sure that ALL pregnant women have proper prenatal and maternity care, they put up their hands and wail and scream about freedom, the free market, and the rights of employers to make health care decisions for their workers. It seems like they completely fail to appreciate the fact that access to affordable health care is a huge factor in whether a woman chooses to carry a pregnancy to term, especially when she has other children that need to be fed and cared for. If they put the energy, effort and money into making sure that pregnant women and children received good affordable healthcare that they do into passing personhood amendments and blocking funding to Planned Parenthood, then we might be able to work together to build a country with a much lower infant mortality rate, maternal mortality and a lower abortion rate.

But it seems to me that they don’t actually care about the lives of women or the lives of babies. They care only about fetal and embryonic life as a principle. But when it comes to actually taking steps to actually save lives, they either fail to provide meaningful contribution or, in the case of the Affordable Care Act, actively work to take us backwards.

I just can’t fathom why.

Here’s what I do know: It’s us, the pro-choice liberals that the extreme right so often tries to portray as immoral baby killers, who are actually making strides to save babies and mothers and fathers, brothers, sons, sisters, daughters, aunts, uncles and cousins by making sure that protecting the true sanctity of life includes the essential element of affordable healthcare.

 

2 Months!

Assuming that my due date is actually June 11th (I have three different due dates to choose from, but this is the earliest), I have two months of pregnancy left!  Now, the normal conversation starter is people asking me how I’m doing. Great, actually. My feet are swollen more often than not, but other than that I’m good. Oh, except for being utterly terrified that I’m going to be handed a newborn baby to care for very soon.

I’m not actually too terrified of giving birth. I’ve decided that my birth plan is to do whatever the doctors and midwives attending me tell me to do. Our prenatal class last week alleviated most of my fears about Spanish hospitals. I understand that the key is to be flexible and trust that they know what they are doing. I’m not in this for a birth experience. I just want to go home healthy with a healthy baby.

And that brings us to the scariest thing: being responsible for another human being. I have no experience with babies. I’m reading everything I can. But honestly, does anything really prepare you for parenting? I guess maybe caring for siblings or babysitting… Alas, I never experienced that.

I think that healthy level of terror is quite normal. However, everytime I mentioned that I’m freaked out, people seem surprised. I guess it’s not discussed openly? I’m sure that there are some people that are totally confident in their ability to care for a child despite having zero experience, but I’m not one of them. Still, I know the best way to prepare for becomming a parent is the same as preparing for birth: being flexible, open and kind to yourself. No one expects me to have all the answers, so I shouldn’t expect it of myself. I just have to do the best that I can.

In other news, I’m so huge that women are the metro are starting to get indignant when I am not offered a seat on crowded cars. When there are no empty seats, I position myself near the reserved seats, as those are the seats reserved for the elderly, disabled people, pregnant ladies, and people carrying infants. Most of the people sitting in reserved seats appear to not fall under any of those categories. Nevertheless, I would never ask for a seat because I think it’s ableist to assume someone is not disabled (or pregnant) just by looking at them. But this morning, as the car I was on got more crowded, I was very kindly ushered to a non-reserved seat. A couple of well-meaning women told me that I should ask for a seat. It was very nice of them to make sure I got a seat (non-reserved as it so happens), but it’s not my responsibility to ask people to give me a seat. It’s up to the seated person to be decent and give up their seat. So I will continue to passive-aggressively flaunt my belly in their full view knowing that they are in fact being judged by sitting there while I stand. That’s just my style.