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My Post-Partum Journey through Sleep-Deprivation, Breastfeeding failure, and PPA

Thursday, December 11, 2014

I’m one of those women that has wanted to be a mama for as long as I can remember. I was more obsessed with pregnant and new moms than I was with their babies. I nannied full-time through grad. school for a family who had a newborn and a nearly two-year-old at the time little brother was born while I was working for them. I’d seen early motherhood up close and personal. I loved nannying for two babes under two. I don’t remember feeling stressed or over stretched, and I thought, “I don’t even have the ease of using my own breasts to feed this little guy. Just think how much easier this would be if I did!” I realize now that nannying isn’t even a glimpse of actual motherhood. It’s the steps without all the rest. “The rest” is the hard part.


I had a really wonderful pregnancy. I read excellent books. We had a private birthing class with a doula educator our midwives in CT recommended. We ended up needing to move from New Haven, CT to Princeton, NJ when I was 36 weeks pregnant and prior to that move I interviewed all the local midwife practices, many doulas, and both hospitals at which I could possibly give birth. My choice of midwife practice and hospital was an easy one, Midwifery Care Associates was everything I wanted in a practice! My favorite phrase from my initial meeting with them was, “By choosing us you’re essentially choosing a birth plan, there’s no need for you to craft one.” Sold. I loved their philosophies, I loved that I would have the option of having a home birth with future pregnancies with them and still to date, I am their biggest fan. I gave birth at Capital Health at Hopewell, a Baby Friendly certified hospital. I had an amazing birth experience. I’d say it was probably as much like a home birth as a hospital birth could be. If you’d like to read my birth story you can find it here. Upon discharge and at my six-week check-up I was scoring well on the PPD screeners.



My daughter latched within an hour or so of giving birth. Within 12 hours of giving birth my nipples were cracked and bloody. The nurses provided breastfeeding support and I saw a Lactation Consultant twice, at my request, while I was in the hospital. They attempted to help with latch as her latch was shallow and also provided me with a few tools to try to help heal my nipples and with pain relief. After three weeks of toe curling, wincing breastfeeding pain and still open wounded nipples (despite trying ALL THE THINGS to heal them) I requested a prescription for Jack Newman’s All Purpose Nipple Ointment from my midwives. Within 12 hrs of applying it I was experiencing relief and within 48 hours I was nearly healed. I thought I’d endured the worst of it. I was so relieved.


Our baby was patient with us from birth, her temperament was really quite pleasant. She was plump and gained weight like a champ (weighing over her birth weight by the time we were discharged and nearly 12 lbs by her one month check-up). By the time she was six-weeks I was already starting to unravel though. She slept as well as I thought a newborn would for the first few weeks (she was born on her due date so it wasn’t pre-term sleepyness) but then all of a sudden it got bad, fast. At this point I’d read and re-read 4 highly recommended breastfeeding books and every sleep book in our local library and that had been given to me.

She would only sleep if we were upright, holding her while either bouncing or rocking her, and tightly swaddled. I assumed a 6 week baby would sleep some on her own, you know, at some point within a 24 hour period. But alas, she did not. Breastfeeding was going decently well though the latch was still quite uncomfortable. She was spitting up all the time and sometimes projectile vomiting. I took her to the pediatrician at 6 weeks for her spitting and our then-pediatrician affirmed she had absolutely normal spit-up habits, we had nothing to worry about, and that she was in fact teething and instructed us to promptly purchase and begin applying baby Orajel. Needless to say, that was the last time we saw that pediatrician (she was not teething, and I wouldn’t put Orajel in a struggling-nursers mouth ever (or my child’s mouth ever, at all)).



We went to GREAT lengths to get her to sleep. I eventually learned she had a not too uncommon sleep integration issue where she woke up at every sleep cycle (which for her is between 40 and 45 minutes (still is)) day and night… for nearly 6 months. She wasn’t able to transition sleep cycles independently. Sometimes I’d get her back to sleep enough that I could place her separate from me and by the time I’d get to sleep another 40 minutes had passed. This went on all night, every night, for about 6 or seven months. At 6 weeks we decided to introduce a pacifier to see if that would help. It did. She had a VERY HIGH suck need as evident by her now being a champion thumb sucker with two calluses to prove it. Turned out though, she couldn’t hold it in herself. I thought at first it was a learning curve issue. Then I thought it was a brand issue. I bought EVERY pacifier on the market. No lie. I was desperate. None of them helped so I just went with one and decided I’d help her hold it in as it did help her to fall asleep easier. And that’s how we started down the path of alternating who would hold in her pacifier as she slept. We took shifts sitting by her crib, arm over the rail, finger in the hole. My arm would go numb every 20 or so minutes and I’d shift arms. We just sat there on the physioball we used to bounce her to sleep (while holding the paci in) all night long, in the dark. Feel free to go ahead and think we’re insane. Insane and desperate I’ve learned are best friends. I finally came to the conclusion that she wasn’t getting the hang of it and so I broke her of that habit. She wasn’t thrilled.


Her spitting got worse but she continued to be a beautifully plump baby and so no one was concerned. I was. I was at this point a super sleep deprived, very concerned, mess. I called my midwives to get a referral for a therapist who could assist me with post-partum anxieties. I did nothing with this referral. I knew we couldn’t afford therapy for me and assumed I was really not actually struggling with a disorder but rather just seriously sleep-deprived and too neurotic and controlling for anyone’s good. I put so much pressure on myself to figure it out. I didn’t blame her, ever. I blamed me. I’d read everything. I was trying everything. I loved her so, I was so committed. It didn’t matter. It wasn’t working. I had this happy baby that rarely cried, that wouldn’t sleep and soon, wouldn’t eat.


I was so insistent she didn’t have food allergies as I thought those to be FAR over diagnosed (still do) with many mom’s on strict elimination diets unnecessarily but by about 4 months she was starting to refuse to breastfeed, she was projectile vomiting all the time, my milk supply was taking a hit, and her poop was all kinds of funky. I finally decided it must be an allergy or intolerance of some sort. So then I read all the things about that and put myself on a super strict elimination diet. During this time I blacked out twice in her room, luckily both times just after putting her in her crib. I woke up who knows how much later. I thought our worst issues were all sleep related. I was wrong.


Over Christmas break I broke from my elimination diet to eat some special cinnamon rolls. Within a week she was the worst she’d ever been. I blamed myself. I felt so guilty. She screamed, she refused to nurse, she arched her back and screamed at me as I attempted to breastfeed her. I’d get her to nurse maybe twice in a 24 hour period until one day she just wouldn’t anymore. After both nursing sessions she’d usually projectile vomit as it was just too much at once for her tiny stomach. She was 4.5 months old at that point. She also wouldn’t take a bottle. I assumed it was stubbornness.


I should mention here, I’d reached out to lactation consultants at the hospital and La Leche League Leaders via phone. They encouraged me to come to meetings, to make appointments, to come to support groups. I was such a mess at this point and leaving my house was such an anxiety trigger. I couldn’t seem to get myself out to any LLL meetings and I didn’t make appointments for private lactation consultation as I knew (thought) we couldn’t afford it. Now I of course know that’s actually just wrong. We had resources in that family would have been more than willing to help, I was just paralyzed. I felt like I was failing and it was no one else’s responsibility. I never saw a lactation consultant. I never made it to a LLL meeting. I also never reached out to the therapist for many of the same reasons. Might I add, I’m a trained therapist and worked as such for a few years in a Pysc hospital. I knew plenty about mental health. I didn’t think I was struggling at a clinical level. I thought I was just sleep deprived and failing as a mother in all the ways that mattered most, getting my helpless babe to eat and sleep.


So after nearly three days of her not nursing without vomiting immediately afterwards I stopped attempting and we committed ourselves to getting her to take a bottle. After purchasing every bottle on the market (There’s a pattern here, no?) and being made fun of (not by my husband) for how seriously I was taking it all (“Does this one look more like my nipple than the rest?!”). What I really needed was to just chill out, so they all said. Right. Because, duh. It was all my fault. Ugh.


Anyhow, so she eventually took a bottle. It required a VERY specific set up of her lying flat on her back and us replacing the nipple every few sips until it was gone, with zero distractions around. My milk supply was atrocious at this point and I’d given away my stash of some 60 oz. of milk when I went on my crazy elimination diet as I thought she could no longer benefit from that milk. I couldn’t keep up with my hand pump so I borrowed an old pump that had gone through two moms before me and began pumping around the clock and doing everything I could to increase my milk supply (goes to show that a fancy pump is really unnecessary — goes to show that fancy anything is pretty unnecessary). My milk supply began to pick up and she was consuming milk as I was pumping it for a good while, once or twice I had only an ounce or so to give her at a time. That sucked.


One strange thing is that she would still breastfeed in the middle of the night. She wouldn’t breastfeeding before she went to sleep or when she woke up, or during or after naps, but she would breastfeed in the middle of the night. For this I will be forever grateful. I got to breastfeed her as she slept or when she woke until she night weaned herself. I have theories as to why she did this, but I don’t care, I’m just thankful.


The super rigid bottle feeding continued. It was not a loving, cuddly alternative to breastfeeding. It was the opposite. It was overwhelmingly anxiety producing and it was only possible in our home. And so continued our being home-bound. Overtime my supply picked up and I began to build my stash back up. That was stress relieving. Around 6 months she began to sleep through one or two sleep cycles per night. Praise all the things!


At her six-month pediatrician check-up, our wonderfully caring Pediatrician asked if she could call my midwives, I obliged. I then received a call from my midwives regarding my palpable level of anxiety and they again encouraged me to reach out to various support groups, a therapist, and possibly a doctor for medicinal relief. And super contrary to my general leanings the only one I pursued was seeing an Internalist, my daughter’s Pediatrician’s husband, who diagnosed me with PPA and wrote me a prescription for the preferred SSRI for breast-milk-feeding mothers. Within a month we all noticed a difference. Sweet relief.


 

So, worth mentioning again… I had left a community I was SUPER ingrafted in, many super supportive and a couple sister-like friends, a job I loved (though I thought I was leaving it for a job I’d waited my whole 27 years of life for so it wasn’t a sad leaving of the outside-of-the-home workforce) it was just me leaving a job I felt overwhelmingly successful at, where I felt like I was improving lives on a daily basis (Pilates instructor), to a job I felt was my life calling that I was failing at and flailing through. In this new community of mine I was none of the things I was before. I was a new community member, loosing her shit, without friends really. I mean, I’d met people, people I really liked, and people I tried to loose my shit with at first, but that got uncomfortable fast — it’s something I could have done with my sister-friends in New Haven, but it was a bit too much for my friends of a few weeks or months here. I’m sure I just seemed like a super neurotic person. Who wants to be friends with that? I was a burden friend, for a new friend. And we all know old friends don’t see burden friends as such, but I couldn’t not feel like that with my new friends. I felt alone and judged. I was treading water so damn hard with a weight around my ankle. I was a damn good swimmer too, but it just wasn’t good enough to really ever make much process. My daughter, though I was doing my best, wasn’t getting what I’d dreamt of giving her — a loving, low stress, fun, explorative, happy first few months of life. My marriage suffered. My husband had just begun his first year of his PhD at Princeton Seminary. He was trying to help as much as he could, but he also had a TON of responsibility otherwise. I was a stay-at-home-mom. After the first few months of relying on him a little too heavily I knew I needed to step up as the full-time provider. I knew I needed to ask less of him, to need him less.



I’m a capable person! Why is this not working?! Doctors aren’t concerned. Friends think I’m neurotic. Internet “friends” think I’m laughable. Old friends were too painful to talk to. We had little financial resources with my husband being a student and my being at home with the baby, and I’d read everything already, how could professionals have helped me even if I could afford their support (ugh, pride)?!


Around 9 months she began sleeping better, and I was exclusively pumping like a fiend. My milk supply was great, I’d figured out how to bottle feed her so long as we were home for all feedings and there were zero distractions, and my SSRI was providing relief. We continued along this path until I weaned myself from the pump when she was 13 months old. She continued to drink breastmilk from a bottle in this super restrictive way until my stash was gone and she transitioned to cow’s milk (which she had no problems with because I don’t think there was ever an intolerance issue), after which I weaned her off the bottle (which also wasn’t easy).



Feeding her continued to be a challenge. Sleeping was improving. By the time Spring came (before her first birthday) I was feeling much better. By the time her first birthday came around I was ready to try for another baby (don’t question it). When I got pregnant (a baby which I lost at 9.5 weeks, whose story you can read here), I weaned myself off the SSRI within a few days and I felt just the same as I did on it, despite feelings of incredible grief.

So, the final bit to this story is that at 16 months, after my sweet little love had grown teeth with an adorable but enormous gap, I went looking around her mouth. As soon as I saw the area above her teeth underneath her upper lip my stomach sank. I didn’t know what I was seeing, I just knew it didn’t look right. Within an hour of googling I’d discovered she had a serious upper lip tie. She also wasn’t speaking much relative to her peers. I wasn’t concerned but the Pediatrician thought we might consider testing her for possible hearing impairment (I knew she wasn’t hearing impaired… another reason I began looking in her mouth). Within a week we had an appointment with Dr. Kotlow in Albany, NY. Come to find out she had a mild to moderate posterior tongue tie, and a severe, class IV upper lip tie. Within one week of her revision she said “mama.” I wept.



And so ends my post-partum journey. From it I’ve learned an overwhelming amount. Here goes an attempt at summarizing some of it: PPA is crippling. Sleep-deprivation is a real thing. Pride is ugly. Doctors miss really important things even when parents are doing their best to advocate for their little people. I need support. I need an overwhelming amount of support despite having read all the best books, despite having training in so many related things, despite it all, I need friendship AND professional support. I know that I didn’t fail. I still feel great sadness about much of how her first year went. I grieve not still breastfeeding her. I’ve also learned that while I hope to be more relaxed with future babies, this wasn’t all just a product of my being too uptight, there were serious, chemical-imbalance issues mixed with or a result of sleep deprivation. I also think a lot of what folks are willing to say to new moms is bullshit, “Oh she’ll eat when she’s hungry.” “She’s fat and happy, the spitting is just a laundry problem.” “You just need to chill, seriously.” “You’re forcing her to sleep when she’s clearly not tired. You’re being too rigid.” And on and on it went. Despite knowing I am not designed to do this on my own, without community and professional support, I do know best. I will try harder, fight harder, and love her more than any other person on this planet. So if I say something is wrong, it is.

I exclusively pumped while not consuming dairy, soy, or eggs (and I’m a vegetarian) until she was 13 months old. She was exclusively breast milk fed. She was on the highest dose of prescription Zantac until about the same time. She was most certainly not teething at 6 weeks old. She likely didn’t have GI intolerances. I likely never needed to be on an elimination diet. And her reflux was likely a symptom of her tongue-ties. If those had been found early, I might still be breastfeeding my toddler. I might not have struggled with PPA. It’s wild (and nauseating) to consider.


I’m thankful for the friends that did listen. I’m thankful for my pediatrician who despite not having found her tongue-ties did reach out to my midwives on my behalf. I’m thankful my little lady is a healthy, happy two-year-old that eats and sleeps I think on the better end of average. I’m thankful my husband was so committed and helpful through her first year. 


I’m thankful I get to be her mama and at the end of the day, I think we’re both lucky to have each other.


[All photos in post are iPhone pics filtered who knows how. No judgies photographer friends.]

Addendum: I now know the early breastfeeding pain was due to her lip and tongue tie. The sleep issue was likely a result of the level of air she was swallowing as her latch was less of a latch and more of an open mouth ready to catch the waterfall of milk I had for her. The reflux-looking symptoms was a result of the same. What looked like GI issues is also a known result of her lip and tongue tie. And she refused to breastfeed about the time my milk (and all mother's milk) regulated, between 4 and 5 months. Once my milk supply adjusted to a more reasonable amount she had to work for it and essentially didn't know how. I was no longer pouring milk into her mouth. The "refusal" to nurse was more of a, "WTF mama?! What's with the game change here? I don't know what to do. I'm lost. I'm hungry. Help me!" And so on and so forth. Essentially, after learning what I've learned over the past two years I can point almost all of our feeding/sleeping issues to the upper lip tie, an issue that is extremely controversial as to whether or not it actually has much of an impact on anything. I'd like to submit that it does.

One Response to “My Post-Partum Journey through Sleep-Deprivation, Breastfeeding failure, and PPA”

  1. I could've written the same story! SOUNDS so much like my 1st (though he ONLY BF) would NEVER take a bottle (though I TREID them all too). My second will be ONE in 2 days, and it DOES get easier! She is the TOTAL opposite him (sleeps like a champ), but was a POOR nurser like yours. Glad to see you came out of the PPA/PPD. I did the 1st time and am now begining to wean the meds the second time! They are there for a reason, and PPD/A is REAL. Even with out sleep deprivation !

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