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Michelle

I had a breast reduction at the age of 18 after years of feeling embarrassed and encumbered by my breasts. To this day, I maintain that having breast reduction surgery was one of the best decisions I have ever made regarding my health. My back pain disappeared, I felt proud of my body and my physical activity level increased. Six years later, I became pregnant, and for the first time had to contend with the reality that my decision to have breast reduction surgery might have negative consequences as well as positive. Throughout the pregnancy, I was constantly concerned that I was about to discover the cloud in the silver lining.

I was followed by a midwife at one of two birthing centres located in Montreal. The care that I received was unparalleled; each visit was an hour long and my partner and I were encouraged to participate actively in my pre-natal care by reading, researching and asking questions. I believe that having such a supportive and empowering care environment is what ultimately compelled me to take action early on with regards to breastfeeding. My midwife’s approach to breastfeeding seemed to be very hands-off. She suggested that I wait until the baby was born to assess whether any help was needed. While I trusted her judgement on most things, I felt that I needed a more concrete plan with regards to breastfeeding, and I began to research local lactation resources as well as herbal galactogogues. I found a breastfeeding clinic at a local hospital and made an appointment for two weeks after my due date. I also researched fenugreek and blessed thistle and stocked up on both. In hind sight, these were the best possible things that I could have done.

At seven months, I began to produce colostrum. I would wake up in the mornings to find drops of dried colostrum on my pyjamas. Needless to say, I was overjoyed as I took this to be a sign that my ducts were at least partially intact. I continued to plan for a natural birth at the birthing centre.

Ten days after my due date, my son was delivered by caesarean after four long days of labour. After two days of labour, I had decided to transfer to the hospital so that I could receive some pain medication. The labour failed to progress, and on the fourth day, it became clear that a caesarean was the only option. Both myself and my partner were exhausted. Having anticipated a natural birth at the birthing centre, I had not made a birthing plan to bring to the hospital. The baby went to the nursery with my partner immediately after the operation, and I was sent to the recovery room for two hours without having put my son to the breast. In hind sight, I wish that I had been better able to advocate on my behalf. I would have insisted on putting my baby to the breast and on having him close to me. I have since written a letter to the hospital that details my dissatisfaction with the care that my son and I received. I was frustrated that after all of the decisions that I had made about my birth, my son was kept from me for two hours for no medical reason. As soon as I returned from the recovery room, I attempted to breastfeed. My son seemed to be latching on relatively well, but having never breastfed before, it was difficult for me to tell whether he was getting enough colostrum. He was born just three days before my scheduled appointment at the breastfeeding clinic. My son soon began to lose weight, and by the time my appointment at the breastfeeding clinic came around, he had lost close to 14 percent of his birthweight. He still seemed to be latching on well, but his weight loss was becoming dangerous.

The lactation consultant at the breastfeeding clinic immediately saw that my son was severely tongue-tied. Neither the nurses nor the physician who had examined my son had noticed this. After a quick procedure to cut the membrane that was holding his tongue, my son latched on and began to suck perfectly. The lactation consultant showed me how to express milk by hand, and I was thrilled to discover that there really was milk in my breasts. I was lucky to have had a surgeon who intervened minimally with my breast ducts, as well as a body that recovered well from the breast reduction. I was told that the first six weeks of breastfeeding are crucial, and so began pumping with a hospital-grade pump after almost every feeding and taking fenugreek and blessed thistle.

At two months of age, my exclusively breastfed baby continues to gain between 35 and 40 grams each day, which is a very healthy weight gain. I have since stopped pumping after every feeding and use only a manual pump to express milk for bottles when I am away from my son. We use bottles only rarely, and the closeness and comfort of breastfeeding is something that I truly cherish.

I realize that I was very lucky to have had access to such great support and resources. Firstly, being a citizen in Canada meant that I did not have to pay for any of the medical care that I received, either at the birthing centre or the hospital. Moreover, the breastfeeding clinic that I went to was also free, which is an anomaly even in our public health care system. Having to pay for the services of a lactation consultant would have been a serious financial burden for my husband and I, who are both still in the process of finishing our university degrees. I was also lucky to have the surgeon that I did ­ even the lactation consultant continues to be impressed by my success at breastfeeding. Finally, my husband’s support has meant that my breastfeeding is valued as a crucial contribution to the family, and has given me more energy to do my job as a nursing mother as he takes care of other tasks such as making meals and caring for the baby in the early morning so that I can catch up on sleep lost during night feedings.

My suggestion to other women attempting to breastfeed after breast or nipple surgery is to be prepared. Find out what services are available before you give birth, and arrange a pre-natal consultation with a lactation consultant if you are very concerned about being able to breastfeed. Having an appointment already scheduled at the breastfeeding clinic meant that I didn’t have to worry about where to find help after the birth, and helped me avoid a lotof stress.

 

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