Breastfeeding complication Nipple Infection

I wanted to feed HX till 23 months , like what I did for HE. However, I had to stop much earlier at 19th month due to complication. I never expected that I developed nipple infection at the late stage of breastfeeding journey. For the past one month, I had on and off sore, then cracked nipple. It was painful as it happened on both side, but resolved when I apply saline rinse and vaseline. However, it recurred, then resolved when I applied fusidin cream.
Suddenly, it cracked again, but the wound looked different, with some sloughs and with oozing. At the same time, HX was coughing and her mouth had really bad smell. I applied the fusidin cream consistently, hoping that it would heal. Only left side was affecteed, hence I only fed HX the right side. However, as I noticed that there was one tiny pustule on my right too, and my left was inflammed and pain till I cried, I needed to see Dr Koe. I started with oral antibiotic too. As Dr Koe concerned that HX might have passed on the bacteria to me, she had to start oral antibiotic too.
Then I got to ask for babysitter help to take care of HX for overnight for a week.
I seeked a nurse help, and she helped to clean my wound and apply dressing. However, as I was still lactating, I got to take out twice a day, to empty the breast, and it was truely painful, Above was the picture of the dressing I took out, could tell how bad my left breast was. It basically affected the whole area of arveola. It seemed different from mastitis and more superficial skin infection, but a real bad one.
How about HX? After 5 days, I tried to bring her back to home at night. First night of not breastfeeding was difficult. However, it only took her one night. Next day onwards, she never asked for nen nen...sch adorable girl. Need to tell details in next post.

I have Mastitis!!

My girl is going to be one year old. Unexpectedly, I got mastitis (or so I think)! My left breast start to feel pain at one side in the morning. I thought it's just blocked duct and will relieve after a few pumping session. However it is still there after 3 pumping session.
Then after I pour the milk to another bottle, to my surprice, one of the bottle has some sendiment at the base. "I thought the bottles were clean when I used them in the morning?" Anyway, thinking that my bottle is not clean, I throw some of the milk that may be in contact with that bottle. On the same day, I had fever too and I needed to take paracetamol twice.
Since I still felt pain, I try to hand express my left breast. To my horror, I did find the milk looked different in colour, its more yellowish! Then the next day, as I compare the bottle containing the milk from different side, this was what I found

The one on the right was from my left breast, it looked more yellowish and thicker. Then I realised that so called sendiment could be the 'pus'. Since then, I tried to empty during shower, its started on Tuesday and persisted till Friday.

Finally, the pain was gone. Just as I felt the relieve, it started again on the following Thursday, this time its my right breast! Again I was feverish and needed to take paracetamol once. But this was not as painful as the first episode and the pain was relieved after I empty, however the yellowish thick milk could only be hand-expressed as it couldn't be out with electrical pump.
Really didn't expect this could happen to me. Hopefully it won't recur again when I reduce daytime pumping session to twice only after HX turn one.

Breatfeeding, pumping and travelling

My friend has been successfully expressing milk while she is travelling abroad. below is her experience. She also shared her experience in suzette's blog, which has encouraged her a lot. Hope this will encourage more mothers to breastfeed even need to travel more.

"I managed to bring back frozen milk from my last trip to Lyon, France. Transit Amsterdam. Total travel time after checking out from hotel ( after packing the frozen milk in the cool box) till Malaysia: 19 hours.

What i learnt:
KLM air line latest policy: one luggage per person. ie we must check in our ice box in our luggage bag

How to obtain dry ice?
I had difficulty obtaining dry ice from Novotel, Lyon, France. Actually bought techni ice ice pack from babyland, SS2 ( RM25, cheaper than other shops) , freeze it in the freezer at -18 celcius for 5 days, and used it as dry ice. My husband was creative enough to get paper bags from small cafes so we didn’t have to wrap the ebm one by one with oversized newspapers. Once we took the frozen ebm out from the freezer we just put each packet of ebm in those paper bags.

How to fill up space in the ice box as towel was bit bulky. my ice box was smaller then your’s.
We scrunched newspapers to fill up the spaces in the ice box, these were also useful as insulators.

Where to find place to pump?
Initially while i was touring around the old town of Lyon, i tried to pump in toilets, hospital toilet, hotel toilet.. after that i gave up finding toilets. I just brought a scarf, wrapped it around me, and pumped at the benches along the park. That was more feasible.

How was the security in Lyon, France?
They didn’t allow me to bring in ice packs and my chilled milk that i had expressed at the air port. I had already checked in my luggage. So had to throw that away ;( i tried to explain that i’m a breastfeeding mom. They said only if my baby was with me, then only i could carry milk. Otherwise i need a doctor’s letter.)

Airlines and local securities are totally TWO different things.
I emailed airport securities at KLIA, AMSTERDAM, LYON and also my airline: KLM.

Reply from KLM CRM MANAGER: Breastmilk is not a restricted item and may be taken onboard. You may carry a total of 2.5 KG in dry ice packs. If you are expressing at the airport/onboard you can arrange a request with our KLM reservations to have a note made in your booking : SRFRAG IN CABIN – we can then confirm that you are taking the pump/milk with you. Do take note of course that the actual security check at airports is not controlled (or owned) by the airlines – so if the officers at the security check have any doubts they have a right to question and make a final decision. (which i DID have problems with the security in Lyon. STRICTLY NO LIQUIDS UNLESS YOU HAVE A BABY WITH YOU OR DOCTOR’S LETTER.

Reply from KLIA Corporate Communications Office:
Please be advised that the exemptions for baby milk/food as hand carry is as below:
•Baby milk/food must be accompanied by infant of age 7 or below.
•Proof of authenticity and justification for exempted liquids for medical or special and dietary needs
If the traveller is travelling without her baby, she must provide a letter to prove that she has a baby and certified by medical practitioner that the liquid is her breast milk.

 i feel so happy after this success !! glad that u could do it for Cherilynn. tough though!! but thanks for all the support from u and my husband and friends
michelle

My spectra breastpump need service after 3 1/2 years!

So busy with my house reno and so busy at work, and of course busy taking care of the 2 kids, making me hardly got time to blog.
I have been using spectra 2 to double pump. I must say, apart from bulky ( 2 kg weight!) and require to plug in, it is a good and durable pump. I only need to send it for service after it has been used for 3 and half years. The reason for service is the switch is broken, and that's likely I have put too many staffs in the bag ( it a shoe bag actually), and the book has pressed against the switch so hard, causing the plastic covering the switch broken.
I send to Histopoint at Subang Jaya. The switch only cost RM5, and the service cost RM60. Since its an electrical item and has been in use for that long, so I agree to pay for the service, which claim to clean up incase any milk gets in.
Now its as good as new.

So I highly recommend Spectra for any working mom.

Postnatal blues...breastfeeding

As mentioned in my earlier post, HX is a better suckler. She suckle strongly. However, it is not easy to latch her properly. I have to attempt a few times before she is willing to be lactch on and suckle strongly. HX seem to be choosy, sometimes I manage to put whole areola into her mouth, but she would push it out with her tongue. As she can suckle strongly and my breastfeeding skill has dropped ( after one year not breastfeeding), on the very first night, I see blister on my nipples.Then it progresses to cracked nipples. They are painful. Whenever HX starts suckle, I feel a sharp pain till lifting up my leg, not to mention coping with the uterine pain and backache that come in the same time. It is really suffering.

On third day, my breasts are heavy. Mature milk is in. Hoo...the milk come earlier compared to HE time which come only on 5th day. I attempt to pump as HX couldn't empty them. However, I am so stupid that I forgot to adjust the suction setting of my Spectra 2. The moment I put the funnel on my right breast, blood shoot out! I am stunt at one moment. what happen! I see my right nipple bleeding. Later I adjust to lowest setting and managed to pump out 2 oz plus from bothe breast in 5 mins time. ( see the bottle on the left, that's the milk mixed with blood, compared to the milk pumped on other times)


Painful, painful, but at least the engorgement is relieved. Hence I need to see Dr Koe, not only for her to check HX jaundice but also to advise me on breastfeeding. True enough, we need to learn again how to breastfeed with every baby. Now HX is getting more patience, hence I am taking time to latch properly to ensure that she takes in big mouthful. Till now, a few attempts are still required for proper latching, hopefully we gets better once HX has better control of her head.

HX day 1 and 2

On 5th April 2010, 1749, HX was borned at birth weight of 3.19kg. Same as the elder sister, she opened up her eye browsing the world right after delivery. There was a dimple at her left cheek, almost like my husband family. However, the nurse also informed to the gynae that a whitish hard lump was found at the left thigh. We were later informed by the Paed that the lump shouldn't be worrisome but just need monitoring.

After she was cleaned up, HX was put on my chest to be breastfed. Although I had already had breastfeeding experience, I had to admit that HX was good in suckling and she suckled strongly. Hearing HX swallowing the milk was so satisfying.

Back to the ward, I was still prescribed pitocin infusion for further 6 hours. I felt really exhausted post delivery. I passed out lots of urine and 'gas' too. Only after that, I felt more alert and was able to take my dinner.

Later at night, while there were only husbad, I and HX, HX began rooting for milk. I breastfed her, thought she would be well fed and sleep for the next hour just like when I fed her around 8pm. However, same things happened again when I had HE, just this time it was more challenging as HX seemed to be less patience. When I failed to latch her probably, she would cry and became fussy. At certain times, she even cried till there was tears! As I couldn't really sit for long, I breastfeed her at lying position. With that position and the jelly like baby, it wasn't easy to latch her on. Furthermore the nurses were not helping at all. At one moment, a nurse came in with a bottle of formula 'baby lapar ke, nak bagi susu?". Another time, I got worried when HX kept hiccuping, hence I called nurse in, 2 nurses came, they commented the room could be cold and asked to put the baby in nursery as there was no aircond, when I asked her if they could bring to me the baby whenever she cried for milk, I could tell the hesitation, even near to frowning face, ' kalau you nak baby dengan U, U kena off aircond." ok, fine, I opted to off aircond though I was sweating away and also the fact that HX kept sneezing.

The whole night, I kept struggling latching on HX, sometimes successfully, sometimes not. She fussed, cried, sometimes screams. At certain times, she would let go and cried to the point I was worried that she might have stuffed nose that make her refuse to be fed. I kept praying, so that she had no respiratory problems, as that would really put an end to breastfeeding.

Things was not quite improved the next day. Fussiness continued during feeding time, though there were times she was settled. I managed to pull through and HX behaved when my colleagues drop by to visit me. After waited for paed to examine her, we were ready to be discharged around 4 plus pm.

Guide to self making hooded nursing cover

This is consider the supplementary instructions to the original intruction provider mama monster From my experience, it took me a while to understand the instructions until I draw out to visualise it. Hence I think the pictures drawn out below will help especially for the amateurs. This is also for my records so that I can remember how to make it again.

The ingredient required is
1 yard (~ 1 meter) of fabric,
16 inch of boning,
2 metal D rings,
thread and fabric marker.

For the fabric, the shop where I made the purchase has fabric width as long as 45", if to save money, may even ask for 3/4 meter only as we only need 26". Of course, this depends on the pattern of the fabric so that you can judge the orientations to cut the fabric accordingly. Here are the stepd for making the nursing cover.

Self made Nursing Cover

During the Chinese New Year season, I visited a friend. She was also breastfeeding her son for 5 months plus then. One interesting things she showed was the hooded nursing cover which she asked her neighbour to make for her. She was kind enough to pass me the extra boning that she had and the website which gave a tutorials on how to make one ourselves.

Being amateur in tailoring, I could hardly understand the instructions until I draw it out accordingly to visualise. As I went to SS2 to have my hair cut, I dropped by one of the shop to get a fabric. I looked for 100% cotton as I thought it should be cooling. Hence the shop keeper recommeded me Japanese cotton as it was better quality. As much as I wanted to have cute pattern, the price really put me off, about RM39/meter! If that's the case, I better got one from here. Since this was just a try out, I got a man shirt like pattern japanese cotton at sale price of RM15/meter.

Then my next move was to look for someone who got sewing machine to sew for me. I thought my babysitter got one but hers couldn't make a straight line hence I resort to a tailor shop. I cut the fabric accordingly ( with extra 6" from the recommended length and width) so that it would be easier for me to explain to the tailor. So on saturday afternoon, I brought the fabric and the boning and the instruction print out to the tailor shop. I even drawed the line to show the connection point. After waited for her to entertain other customer for 1/2 hour, finally I got the chance to talk to her. However, while I was halfway showing her, suddenly she raised her voice " you are wasting my time you know, unless you pay us RM20, otherwise you get your friend to make it for you..." She kept emphasize and repeat "waste our time", "RM20". I really got upset and even got the urge to cry. I hold back and decided I shouldn't be mistreated like this. So I just bought the D-ring and asked her to machine sew the 2 straps and left the shop. But I won't come to this shop anymore.

Instead of looking for people to help, I decided to hand-sew it. My mother and auntie were tailors and I basically grew up in a tailor institute. Ya, I did have some regret for not picking up the skill while having the chance but no time keep regreting. Anyway, after spending 2 days plus burning midnight oil, I finally complete making my very first nursing cover!
Here is my pride:

Here is the supposed view if I wear the nursing cover. The boning form the hood which allow me to see my baby and let the baby see me while nursing. :)

Will try to put up the picture for better illustrations on making the nursing cover if got time.

Received a newsletter from Fabulousmom boutigue on breastfeeding campaign. The programme look interesting, but it could be too far for me to go. Actually I am more interested in getting some stuff for 15% discount. :)

Increasing milk supply

I was once confirmed to have low milk supply, as judged from my first born slow weight gain, despite the adequate daily wet diapers and bowel outputs. When back to work, I also need to pump frequently day and night to make up the daily requirement. This time, I hope that I am able to have abundant milk supply, so that I won't be so stressed over the output(hopefully oversupply like my friend who can easily reach 10oz persession of 5 mins only!).

I found this http://www.lowmilksupply.org/pumping.shtml and got some tips. Here were the notes I got
"balancing active suckling time and pumping time to no longer than 45 mins in total"
"fit in 8 to 10 pumpings during waking hours"
"...pumping for additional stimulation...pump each breast for at least 10-15 mins..."
'....pump one breast while baby nurses from another...' (this was the method that I had adopted, though I was not sure if it increased the supply, but at least it was the most time saving method to keep milk stock and kept the stock sufficient throughout my BF journey with HE)

I found that many references just give advice on nurse frequently, let the baby lead the cue...pump after 'finish' feeding to extra stimulate the breast....but hardly advise on how long to pump. A book by G*** F*** suggestion on boosting milk supply is the most ridiculous suggestion. It does suggest frequent pumping too, but instead of suggesting the duration, the amount to be pumped is suggested, assuming all mothers have good production, not thoughtful that some mothers like me may take minimum 30-60mins just to get that pathetic 1oz!

Anyway, I plan to do more breast compression during first few days of birth, and start the tandem pumping when mature milk kick in or from second week onwards, hopefully that make me a mother with abundant supply.:P

Also, I will try to listen to music to keep myself relax. My loving hubby just bought me an iPOD which is just in time to keep me relax to pass through the early difficult days to establish milk supply and later pumping time while at work. :)

My Breastfeeding story overview part IV

Then came the next issue, where could I pump while going to work after maternity leave?
My eletrical pump needed electric outlet. As I thought I managed to get a friend to lend her office to me for expressing, only on my first day of work then she suddenly told me that her office would be in use all the time. I panicked but I made myself calm and managed to use the mother room just behind NICU. I managed to pump 4oz in 1/2 hours of dual pumping, not plenty, but already better than I expected. Later I was blessed that I had understanding colleagues who let me used their office to express milk. I understood that pumping 3 times a day was not enough, as my baby need at least 16oz at babysitter place and later become 24 to 30oz a day. So I pump 3 times at work, then tandem pumping when home, pump once before sleep, then tandem pump at 1am and 5 am, about 7 times in 24hours. I thank God that I was still able to adjust to this busy routine and able to work despite less sleep. I kept the same routine even during weekend to stock up. As time passed, we were able to see that my baby actually had her own growth curve, slow but increasing. After my baby started solid, my freezer stock started accumulating, I couldn't believe that I could one day had my freezer full of breast milk. It was then I drop the expressing at midnight and allowed myself to sleep more. Although my baby was petite still, but she was healthy, active and met the development milestones.
I was so glad that I managed to pull through. She was going to be 14months old, and I am still BF fully"

My breastfeeding story overview Part III

One day, after came back from clinic for vaccination, I finally broke down, as compared to other babies in the clinic, mine was so pathetically very small, even those born as premmie earlier was bigger! Was I wrong? Was my decision to fully BF eventually cause my baby to suffer? I cried, I couldn't sleep and felt again resentment towards my baby. One week after discharge from ward, the paediatrician, who was also lactation consultant thought that I had low milk supply. I was prescribed medicine and was asked to supplement with the breast milk pumped after each feeding 2 times a day. Frankly, I had no idea what was "each feeding", I fed continouosly! As adviced by my friend, I learned to pump one side while feeding another side.
Not easy initially, got milk leaking out from funnel when I was still not good in positioning. My wrist was in pain and my fingers was started to be stiff, but I still did that. I fed right side and pump left side for 15 mins, after one hour, I changed to left side and pump right side ( Yes, still feeding, very often these was repeated for next 1-2hours). One night, I prayed and promised that "no matter how, when mummy started working, even what I pump in a day enough for one feed only, I will still continue to give you the best." Hence, to ensure that I could keep my milk supply, I invested in electric dual pump, despite my husband doubt the worthiness of the purchase, "you better be sure you can BF for one year with that gadjet" that's what he said. So I continue the routine of feeding, pumping and supplemeting for another month. After she was 2 months plus then it started to have gap between feedings and she started to sleep for 3 hours stretch once during day time. Only then I dare to try bring her out for dinner. BF was a little bit easier then.

My breastfeeding story overview part II

On the fifth day, my baby was jaundice and needed to be admitted to hospital, from home door to the ward, my baby practically attached to my breast. As she was still not settled for the UV light therapy, I reluctantly agreed to the nurse suggestion to give formula. I felt so embarrassed and defeated the moment I saw her sleep soundly in the cot after the formula. That very night, I started to feel tingling sensation on my breast and next day I found my bed wet so I quickly take my pump and happily get my mature milk of 2oz after 20mins of pumping. Then I thought my nightmare was over, I would only have to feed my baby 2-3hourly, not continuously as before, and I would have a good sleep. I even had the consultant neonatologist to teach me feed left side 10mins then right side 10mins, done. However, it turned out it made no difference. My baby was still fed continuously. However, thanks to the Paediatrician who thought me to correct latching on and how to feed lying down then I was able to get some rest. Then later only I accept the fact that its common to have clustered feeding. So I said to myself, just feed on demand. I checked my notes again, reminded that adding pumping in between feeding could help to boost milk supply. so I did that, I pump at night when my baby was sleeping. Later, when she was 21st day old, the bilirubin increased again, and need to be admitted again. As the weight was checked, her weight gain was found to be slow, less than 20g perday, even the doctor also said " is she fed enough?" My only evidence of her probably fed enough was my records of her daily urine and bowel outputs which I religiously keep track of. I felt embarrased too with a conscience that I was labelled as a mother with inadequate milk supply. While in the ward, I pumped 3 hrly, for almost one hour each time, but only able to get 1-2oz, while my baby was already drinking 3 oz of formula, I started to lose confidence, I felt myself so "dry".
After that she was discharged, diagnosed as breast milk jaundice.
When, the important day, the full moon arrived. While my husband happily inviting people and /my mother in law happily preparing, I was so dragged to celebrate the day. She was basically attached to my breast all the time, and I was too shy to BF in front of people, even if I did, what would people commented if they saw that the baby never came off mummy breast even when they left the house!? Anyhow, I managed to get through it by resorting to bottle with my accumulated pumped milk. However, I really felt tension to have visitor at that time.

My Breastfeeding story overview part I

I wrote this when Mamaparadise.com called for a competition of breastfeeding story. Hence I wrote the following in July 2008. Its a short version, there are lots more I wanted to share about BF. Let take this as overview.

"While I was still pregnant, I have already start searching for resources and read about breastfeeding. I borrowed notes from friends and attended antenatal classes, search online to see the video on BF and tried to remember how to latch baby to breast as I read that that's an important "skill" in order to have a success in BF. I also had put into my birth plan that I wanted to BF right after my baby was born.
Then, the important day came, I delivered my precious daughter at night. As she was brought to me, I was so amazed that she could suckle my breast. She was just born with the skill! Then as I was transfered back to my room, even though I was still drowsy due to the Pethidine jab earlier, I declined the offer from nurse to feed my baby milk powder. Whie in the ward, I fed my baby again, after a while she doze off. As I remembered from my reading, newborn tend to be sleepy,and need to wake up to feed, I literally shake my baby ( only after a few days later I knew its dangerous to do that :P oops), then she suckled for a while, and doze off again. "she's probably well fed", that I was thinking. After I put her down to the cot, I went to sleep, thinking, "that's easy...thanks to my readings beforehand". soon after, she cried again. So, throughout the whole midnight, I'd been "pick up, feed, put down" action repetitively till nurse to pick her up for her morning bath.
When we got home the following day, the same had been repeated. I basically didn't sleep at all, I felt pain and sore at my breast, as baby suckle, I also felt pain at my tummy, also I need to handle my mother in law comments and keep saying no to her suggetion on giving water. I was really exhausted and tired, plus all the confinement rule of not touching water, no fan, etc...my whole world was like up side down. I even started to feel angry towards my baby, " why can't you just keep awake and drink enough! why sleep already, then wake up again the moment I put you down! how and when will you be satisfied, my breast was cracked and bled and yet you still want to suckle!" as this persisted for 3 more days. My husband who was the one that wanted me to breastfeed while I was still pregnant, also went to buy a tin of milk powder and fed my baby. I also begin to be doubtful as I don feel anything like engorgement.