Archives: health issues

Birth and beyond: breastfeeding after a reduction

Such a long time between posts, these days. Truncated posts die on my laptop from neglect. I’m sure I planned to write this one 10 weeks ago. It’s about boobs.

Breast and bottle feedingI love to breastfeed, and I’m embarrassed occasionally when I bottle feed in public as I’d much rather be displaying just how comfortable I am breastfeeding my baby anywhere. But you do what is necessary. And often, for me, a bottle is necessary.

Bosom bits

With the momentous cliffhanger that was the reveal of this baby’s gender well past, the next mystery on the list was whether these truncated breasts could do their milky thing. If you’ve visited this blog before, you may remember that, confident my family was complete, I enjoyed a breast reduction about 6 years ago and donated much of my milk-manufacturing tissues to medical research*.

My immediate post-partum doubt lay in whether there was anything left in the soon-to not-be-so-pert lumps that would be of any satisfaction for the little fellow. (I did, after all, tell the surgeon to “take as much as you bloody can”.)

I’d spent hesitant pre-birth months wondering: will they work? Or are they now mere decorative objects?

The short answer is: yes, they work. Kind of. The manufacturing part still happens. However, the storage facility doesn’t seem to be up to premium capacity. So we’re doing both, breast and bottle. Effectively it means I’m feeding double (twice?). I started the first month or so feeding breast first (twice and sometimes thrice each side), then a bottle of formula a little later. Manic pumping, I tried daily, in between actual feeds, to stimulate these remaining milk ducts and store a little of my own milk. My arse was permanently attached to that bloody couch, boob or bottle or pump in hand. I managed a mere ounce each pump, and gave the process up, leaving a handful of sad little milk bags in the freezer.

Excuse this detail, if you’re freaked out by it (not sure why, but that’s your issue) – but this is the kind of information I couldn’t find when I was pregnant and wondering about feeding post-reduction. So here’s some more bosomy news: my milk came in a day later than the last two babies. A was born Friday morning; I decided to comp-feed (give a complementary formula bottle) on Sunday night. I had thought he was satisfied because he hadn’t cried after I’d fed him virtually nothing on day three; I now know he’s just a chilled little man and maybe I should have started the comp feed on Saturday night. He lost 10% of his birth weight in the first four days, which is on the outer reaches of acceptable. His nappies were mostly dry and he was still passing a couple of urate crystals, suggesting dehydration. He soon made up for it, though, and is a bonnie lad these days. We are fortunate that he has always taken a bottle comfortably, and readily switches between bottle and breast. (He prefers breast.) I understand there’s a battle avoided right there.

Incidentally, when my milk came in, it was never with the lumpy sprinkler-like tidal wave for the other babies, rather a fuller swelling. The breast pads in the bathroom cupboard, I fear, are superfluous. I can get uncomfortably swollen, but not to bursting, it seems.

Now, nursing a three month old with a healthy appetite who’s hovering around the 80-90th percentiles on the growth charts, I still kind of demand feed, but it’s established a rough pattern. He takes a standard formula feed every 3-4 hours during the day, with breast feeds in between on demand. Bottle before bed around 6pm, and another when he wakes in the middle of the night (often 3am-ish). Then breasts when he wakes again (and by then, we’re both really ready for that!).

So there you go. Quite a specific post, this one. Wonder how many readers we lost along the way?

 

*As a side note, I now live across the back fence from a scientist whose breast cancer research is quite possibly using that same tissue. Weird or cool?

Permanent birth control: tied up in knots

Knots

Dr Atticus is jaunting around Europe on his annual sojourn, so I’m to see a locum for my regular check-up.  I get an inkling of the type of appointment we’re in for when he asks for my sample jar. I don’t think anyone has asked for my “wee wee” in four decades.

It does make me wonder, this certain generation of obstetricians who really don’t seem to like women, who patronize them at best. (I’m oldish, too, Imma be generationalist if I want.) All this bloke has to do is go through the steps: check my blood pressure, have a little feel of my bump, and test that “wee wee”. But no, he has bigger plans for my visit.

“So I guess this is it for you, then,” he starts.

Brilliant deduction. Yes, my partner is planning his vasectomy as we speak, I tell him.

“Why? You should be having your tubes tied,” is his immediate response. I have known this man for less than five minutes. Note: not “why aren’t you”, but “you should be”. Interesting.

I explain that I do not want to have a tubal ligation. That a close family member, one whose genetic and obstetric profile is virtually identical to mine, suffered some heavy-duty negative side-effects after hers. I do not add: dude, I have had two caesarians (and am about to embark on another), from necessity, for this family. Daddyo is more than happy to even the ledger a little with a procedure that can be done in a doctor’s surgery with the assistance of local anaesthetic and, later, a bag of frozen peas.

A vasectomy and tubal ligation are not identical procedures. Comparing them is not a straightforward appraisal. But this doctor seems to think that, since they’ll be “in there” doing a caesarian, I may as well go ahead and seal my fallopian tubes, too.

He tells me that my fears are completely groundless, that tubal ligation is safer than a vasectomy, and that it can decrease my chances of future ovarian cancer. (To be fair, a meta-analysis of 40 studies supports this.) He cites a study that followed a group of women who had their tubes tied, and another group whose husbands have had vasectomies. He tells me that both groups reported heavier bleeding as they got older: “It’s just a part of ageing, nothing more”. I get the feeling he trots this one out frequently.

This doctor has no idea about my medical history; in fact, he doesn’t even seem to have looked at my contraception, or caesarian, history on the file in front of him. (If he did, he’d read that I’m a “bleeder”, that I’ve hemorrhaged after varied surgery.)

He declares all is well with baby; actually says I’m a “wonderful incubator”. Since a sense of humour has been absent so far, I can’t assume that he’s joking. I wonder if any patient has ever hit him.

He frequently drives the conversation back to having my tubes tied.

I feel railroaded. Bullied, even. “I will consider it,” I say. “Fuck you,” I think.

I will mention this conversation to my obstetrician next visit. However, not for the reason this man wants me to.

Now there are many places to research these two options. You can do the Google, too. Try a question like “Is a vasectomy safer than tubal ligation?” There’s even a Facebook page for Post Tubal Ligation Syndrome.

I’ll copy one summary below. It’s from a site called Male Health Centre.

Once you’re confident that you’re ready to put your reproductive years behind you, there are two options: vasectomy (male sterilization) or tubal ligation (female sterilization). Vasectomy makes you sterile by cutting the pipelines (the vas deferens) between the testicles and the penis. These small tubes are located just under the surface of the scrotal skin, and it takes less than 15 minutes in the doctor’s office to snip them and seal the ends under a local anesthetic. 


Tubal ligation involves cutting and tying a woman’s fallopian tubes, which are well below muscles and other tissue in the abdomen. It requires a general anesthetic and a hospital visit.


A couple of statistics might make the differences even more clear:
  • Fatalities per 100,000: tubal ligation = 3.51; vasectomy = 0
  • Approximate cost: tubal ligation = $2,500; vasectomy = $750 – 850
Vasectomy is simpler, safer, cheaper and takes less time to recover from than tubal ligation. Their failure rates are just about the same: 1 in 2,000.
KnottedVasectomy: lower risk. Lower cost. Is somewhat reversible. Importantly for me, it involves my partner taking contraceptive responsibility.

As I leave, he has another shot.

“If it were me, I’d be having my tubes tied.”

“You don’t have any tubes to tie,” I reply.

“Yes I do, and nobody’s getting their hands on them.”

He says this. Seriously.  How dare we women expect our menfolk to sacrifice their gonads in the name of birth control?

What a prick. Good manners hold my tongue (which surprises me, too) and I walk out.

 

And then I realize: if I go into early labour before my regular doctor gets back, this is the jerk who will help deliver my child. Please hurry home, Dr Atticus.

Surfing the small stuff: third trimester torments

So far, I’ve been fortunate to avoid the bigger complications of some pregnancies, like gestational diabetes or public tracksuit-pant wearing, and other, lesser ones such as varicose veins or delivering an actual crying infant.  But, third trimester, third pregnancy has returned me some old nemeses.

 

Drama: Heartburn.

Why is it the moment I finish eating breakfast I need to bend over to do something essential, like pick up a dirty sock or dislodge ninja Lego from between my toes? Oh, that’s right, because I have a couple of pre-teen sons. And I’m yet to learn: bend before breakfast, not after.

Pregnancy-related heartburn isn’t just reserved for those special moments felt immediately after eating. No, it’ll save itself for the moment you’re drifting off to sleep, too. Or when you’re out in public attempting that thing that some call “pre-baby date night” (but others may call “let’s sit in an overpriced restaurant and bitch about our son’s useless teacher while I gaze bitterly at your alcoholic beverage”).

Solution: Quick-eze, the old-fashioned chalky tablets that come in a roll (not the useless chewy squares). Bought in bulk, crushed up, and mainlined.

Drama: Restless legs.

Restless legs are an utter motherfucker. You’ve just got your ample bulk arranged in its pillownest, you’ve bum-shoved the notpregnant person sharing your bed over to their allotted edge, and you’ve finally fallen asleep after your third toilet trip. Right as you hit the good REMs, it starts. Niggle, niggle, niggle, that junky’s cursed feeling of ants sneaking around inside your sciatic nerve casings.

Solution: Waking up. Walking around the fucking house. They say magnesium supplements can help, too. Stretch your legs a little during the evening And drinking more water. So if the restless legs don’t raise you, the bladder will. Checkmate.

Drama: Curious foot spasms.

This one’s a personal treat. Following spinal surgery, I had a minor neural after-effect, resulting in an occasional night-time left foot spasm (varying in intensity from a big toe standing up, unbidded, at right angles, to the whole Daniel-Day-Lewis-Academy-award-winning left foot and leg spasm). Of course, pregnancy exacerbates this. If my hormonehorrorshow didn’t have a go at such an easy target, we’d be almost disappointed. Over a few months, the hormones have progressed a minor nighttime ballet of restless legs and freaky toe spasms to a major choreography. The growing fetal weight pressing down on the base of the sciatic nerve way up there in that slackening pelvis does its bit, too.

Solution: Not being pregnant. Failing this, keeping well hydrated. Pilates. The magnesium helps. It’s most effective taken just before bed. An unexpected side-effect of taking magnesium at night is its effects on dreams. Apparently it can act as a bit of a psychedelic neurotransmitter, resulting in crazier dreams. I don’t make this shit up.

Because pregnant women need to experience even crazier dreams.

Oh, and a couple of weeks ago I started visiting a chiropractor (even though I’d sworn off the creatures) who specializes in old knocked-up broken women. She’s pretty much stopped the spasms. So maybe I should have mentioned her first.

Drama: Shortness of breath.

I’ve never claimed any level of aerobic fitness, but panting at the top of two flights of stairs was a scary revelation – and that was a couple of months ago, before there was even much of a bump to bitch about carrying up the stairs with me. I was almost relieved when Dr Atticus advised that rather than pitiful fitness, I could blame pitiful hemoglobin levels. You know, pregnant ladies need more iron, hemoglobin carries oxygen in the blood, low hemoglobin means less oxygen getting around the body. It was all the hemoglobin. Nothing to do with the lack of fitness.

Of course, now, with a bump encroaching on valuable lung space, there’s another dimension added to the breathlessness. Now, it’s also about internal organ real estate.

Solution: Iron supplements. Stand taller. Surrender.

Drama: Tiredness.

Tired, mid-40s pregnant woman? Quel surprise.

Solution: A nap. Right now.

 

Smells like hyperosmia

Pregnancy develops superpowers. Particularly, a herculean sense of smell. This is not the ideal sensory gift. Especially when the only other soul on the bus takes the seat right in front of you. A dude with a personal aroma so intense, it’s clear the grunge meister spent the past week basting in the bourbon that seeps from his own pores, smoking 200 cigarettes a day, and dear Uma, how long has it been since he washed that shoulder-length hair? The bus is almost empty. Which means you could move away, but surely that would hurt stinky-hair’s feelings? So you stay seated in nausea town.

Noses know

Noses know

BTW>>> Although pregnant women tend to say their sense of smell is heightened, this study says that’s baloney.

A test of the breasts

Let’s talk tits.

First, a brief, yet fulsome, history.

My chesty endowment arrived sometime during winter 1984, in a massive rush. I think hormones were to blame, but that’s yet another tangent. From slender, overnight I became an E-cup freak. I hated them. People spoke directly to my bosom. Some boys thought I must be easy. Some previously amicable older girls became crisp, sometimes catty. The way that many people now addressed me, it seemed they’d assumed my IQ was riding in reverse proportion to my bra size. This continued, obviously, through my 20s, and it was only when I was quite underweight during the crazy late 1990s that I could ever wear a strapless anything. But boobs defined me, and personally I didn’t dig it: the assumed sexual persona baggage, and the physical, actual, weighty baggage.

I vowed early on that I would get rid of this baggage the moment I stopped breastfeeding my family.

So, in 2008, when CC was nearly 2, I donated my breasts to science. Most of them. It was as awesome as I had hoped. When they’d healed, I ran along a beach. In a bikini.

Running on a beach in a bikini is something you should never take for granted.

My surgeon, a sensible man who saw the beauty in subtle dimensions, asked if I was sure I’d finished my family.

“Hell yeah,” I replied. After all, I was nearly 38, with two beautiful boys. Any more children would be environmentally selfish, anyway. But why?

“Because it’s pretty bloody difficult to breastfeed after a reduction,” he replied.

I love breastfeeding. I love being able to. I breastfed both my boys for nine months. S-Man weaned himself at nine months, so I chose to wean CC at the same age, later, for (psychoanalytically-influenced?) symmetry.

This time around, the first indication that I was pregnant was via my bosom. It ached. It still does, at 18 weeks, but a little less than that first trimester. Perhaps there are ducts in there trying to work, trying to reconnect. I’ve been fortunate, post-reduction, that my nipples are still as sensitive as ever. (Joy!) Dr Google leads me to pages that promise I’ll be able to feed, perhaps with less milk. We’ll see. My breasts are different this time around. Last pregnancies, they swelled to H-cups. Hideous. I had to visit “specialist retailers” for underwear. I marvelled at the silly women who chose this weighty burden willingly, porn stars or glamour girls or otherwise, pumped up with saline or silicone. Why??? This time around, they’ve swelled back from C/D to DD again, which I can handle. They’re still gorgeous, these pert little hills that seem stolen from a 17-year-old: the bosom I should have had at 17. Better enjoy them now. They won’t be so cheeky in 18 months.

 

 

Backbone

In 2010, I had surgery on my lower back: a laminectomy, discectomy, and rhizoplasty (which is where some more bone is removed, rather than a bit of nose attached, which is the image “rhizoplasty” evokes for me). My discs had been “slipped” for most of my adult life, causing a raft of sciatic issues – it’s the reason I started practicing yoga a million years ago. But somehow one particularly slippery little bugger had edged that little bit too far, trapping a nerve and causing a problem or two for my left foot. Paralysis was one of these problems.  The disc had to go.

Apart from some surgical stuff involving emergency adrenaline, which we needn’t go into here, all went ok and, although I wondered if I’d ever interpretive dance again, my post-op recovery (with painkillers employed judiciously) approached something resembling contentment. At the time, I was reviewing books for a micro-living, which is an ideal job to do supine. The dearest of friends and neighbours organized meal rosters and child logistics. I spent hours on a vintage daybed watching birds fly above my backyard. After a fortnight, I could walk down the back stairs.

I began Pilates when I was upright. I attended a studio called Pondera in Brisbane; I still go there today. It hums with post-op recoverees, fit and hearty baby boomers, and broken ballerinas. Reformer-based Pilates helped developed some core strength so that I could return my former hyper-flexible self to yoga. I would recommend it to most, and I hate exercise.

Dr Atticus says my crappy back (that was the neurosurgeon’s official pronouncement: “you have a crap back”) will be one “issue” to watch. (Stay tuned, there will be more.) With that in mind, my Pilates program has been adapted to keep as much strength around my spine as possible for as long as I can. So far, so good.

13-and-a-bit weeks

The morning of the Nuchal scan, and I still haven’t received my results from the non-invasive test. (They shouldn’t be far away.) Having this test in your 40s feels a hell of a lot different to 10 years ago. Actually, come to think of it, I didn’t have a Nuchal 10 years ago with #1.

I am anxious as Ryan Gosling’s new girlfriend.

It is a difficult tightrope to balance: watching your baby’s features on the ultrasound, and trying to maintain some sort of emotional distance, just in case. S/he’s perfect, floating along there, waving a little hand. The sonographer can’t get a neck reading, and quietly says she’s going to ask her boss to come in. My heart stops. After some dodgy attempts at small talk, a wave of the wand, and a bit of prodding, I’m told it looks ok. Numbers are clicked on the keyboard. I’m told my Downs probability, based on this scan and my earlier blood test, has dropped from 1 in 30 to 1 in 600-ish. Which is a relief. They don’t recommend an amniocentesis.

We visit my obstetrician, who waves two thumbs up. The iGeneScreen results have just arrived via email, and they’re good. That’s two positive screening results. I am so relieved my legs turn liquid. Dr Atticus tells me I’m fine to “go shout it from the rooftops”. I think we’ll quietly tell our 7 and 9 year old sons first.

Elderley multigravidas business

I am having bloods taken today for an iGeneScreen and the Nuchal test, for which I’ll have a scan around 13 weeks.

This morning, I read something that says by my age, 90% of my eggs will have something wrong with them. Now that’s a pleasant thought for today.

I go have a chat to the chickens.

Eggs

There are eggs, and then, there are eggs.

Off to Dr Atticus

The morning before I visit my obstetrician, in my head, I run through a medical history since last time I saw him (nearly 8 years ago). It takes a while.

Bring on the tests.

It’s reassuring to visit my doc. We both agree the priority is chromosomal tests. (And I’m itching to get an all-clear, so I can tell my family about this baby — and stop sucking in my stomach!)

I visit the pathology center in the hospital to organize a non-invasive test: it’s called iGeneScreen, and it has to be done on a certain day so the blood can be couriered to the airport to the USA. It tests for Trisomy 21, Trisomy 18, and Trisomy 13. I could also find out the sex, which I decline. I’ll also have a Nuchal Translucency Scan, so I book that in for three weeks’ time.

Limbo angst

Angst

This limbo, somewhere around 9 weeks, where nobody knows save him and me and a couple of medical/allied folk. This limbo, it’s almost like the baby doesn’t exist. All smoothly rolls; I’m a little tired, nothing noteworthy. Nobody would guess. Sometimes, not even me.

Until this morning.

This morning, when my eldest advises me of a project due TODAY involving printing pictures on vaguearama topics: his culture, his aspirations, as well as the usual family and friends happy snaps. (I can’t find a picture of all four of us more recent than 2009.) The first computer cracks a spaz. The printer refuses to cooperate. I cough on a mouthful of muesli and choke with sudden nausea. Everyone is late. We have no bread. My back aches, and I dread how it could feel with another 10 kilos hanging off it. My breasts ache, as always. I am blue, and angry. Making the boys’ lunch, I try to snap Saladas in half, and they shatter. That’s when I start crying. One son disappears down to the chickens, the other pats my arm, confused.

I can’t do this.

My old body is not up to this pregnancy.

My mind is not ready for the depression I’d forgotten comes freely with pregnancy hormones.

I am not the person to do this. I didn’t enjoy being pregnant the last times: I suffered some depressive episodes both pregnancies, plus PND after #2. I am scared shitless of losing the wonderful positive mental frame I’m in right now.

I lost about a litre of blood with the birth of #2. I am a bleeder. I don’t want to die giving birth.

I don’t even like babies much. I gag changing nappies. I’m not really into kids, either: I don’t like all children, just like I don’t like all people, or I don’t like all dogs.

We can’t afford this.

I will be 65 when this child turns 21. (Daddyo will be 69.)

We were quite content and comfortable as we were. How are we even going to fit a baby into the house? (I’m going to lose my new bookshelves!)

It’s not fair to do this to my sons. Maybe it’s not fair to do this to this unborn little one, either.

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