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Our Foundation for Health and Happiness

Ziva Mann
Cambridge MA USA
From: NEW BEGINNINGS, Vol. 21 No. 4, July-August 2004, p. 129

The decision to breastfeed my son, Elisha, was an easy one. Breastfeeding had always been part of my life and family. When I was tiny, my mother breastfed me despite the dire warnings of a pediatrician. She told me once that, though pediatrician visits left her in tears, she was sure that she was doing the right thing by nursing me. Looking at his distraught wife, my father found the perfect remedy: a new pediatrician. With my father's help, my mother's commitment to breastfeeding remained strong, and she breastfed all three of her children, eventually becoming a La Leche League Leader. I remember groups of women discreetly disappearing into our basement for meetings, and later, once my mother became a lactation consultant, I would hold tiny, furious (and hungry!) babies, giving her and the baby's mother time to talk. I was proud to be helping, and a little mystified by these small, wrinkly beings. And then it was my turn, and despite all the reading and the chats with my mother and other breastfeeding mothers, I was no less mystified.

My son, Elisha, is two years old today. He's no longer warm from the oven-now he is a chattering, running, and tower-building little person. The past two years have been one heck of a ride, and the one constant in that ride has been my nursing relationship with Elisha. The other sources of support have been my husband, my mother, and the unanticipated help of a team of caring, supportive doctors and nurses.

My labor and delivery went well initially, but after three hours of pushing, Elisha was extracted via cesarean. I remember seeing a little pink blur and hearing my husband, Ezra, singing a lullaby to his new son. I'd planned to breastfeed him as soon as possible after delivery, but I have little memory of that first feeding. I know that my arms were shaking, the morphine made me ill, and that this scrap of life had been given to me to care for. It felt like a bad joke. Feed him now? How? My mother got me through that first feeding somehow, assuring me that we were aiming only for an introduction, rather than trying to give him a full tummy. He tried hard to latch on, but couldn't, and rooted and cried repeatedly. Over the course of the four days in the hospital, it became clear that Elisha's suck was pretty bad, and it seemed to get worse with each feeding. I started pumping before Elisha was a day old, but pumping seemed to produce only drops of colostrum. Within 30 hours of birth, Elisha had lost nearly 10 percent of his birth weight and hadn't had a wet diaper. Ezra was wonderfully supportive and loving, but Elisha and I became increasingly tired and frustrated. Hungry and upset, Elisha cried and cried. I finally lost my temper on the second night, when a nurse brought in a bottle of sugar water. No way, I said, and promptly burst into tears.

The next day, my mother and the hospital lactation consultant went into a huddle with one of the nurses. He needed calories, they decided, and if those calories were from formula, then so be it. We wanted to give him the energy he required to learn how to breastfeed. I breathed a sigh of relief. This immensely pragmatic approach took some of the strain off of me, since I didn't need to worry about my baby dehydrating or going hungry. I could now think less in terms of life support and more in terms of acquiring skills. We tried the Medela Hazelbaker Finger Feeder, but Elisha's suck was so poor that he couldn't get enough food from it. Instead, Ezra did most of the feedings by syringe. Things started to improve, but it was slow. Elisha seemed to be syringe and finger-fed as often as he breastfed straight from the breast. I was anxious, but his eyes were bright, and Ezra was convinced that he actually knew who we were.

We left the hospital a day early and settled in at home. My mother slept across the hall, waking up to help with nighttime feedings. She was always patient and calming. Each feeding was still a struggle, but we were successful in getting him to latch on, though he wasn't actually getting enough nourishment at the breast. Instead, we used finger-feeding to provide the extra food as well as for suck training. By Elisha's fifth day, despite very full breasts, I was still producing only about 10 ccs per pumping because of his poor latch-on combined with my weak milk ejection reflex. Still, I felt better-we were slowly replacing the formula with human milk. During the day, my mother would go online and email updates on Elisha's progress to her fellow lactation consultants. They would send back notes urging us on, offering to help, even if from long distance. I have no idea how I would have continued breastfeeding without my mother.

When Elisha was eight days old, he had a ritual circumcision, or bris, performed by my uncle, a doctor who flew in from Australia especially to perform the ceremony. My father, who is also an MD, assisted my uncle in a lovely ceremony. We announced his name, and presented him to our friends and family. Soon after the bris, we introduced him to the staff of the Boston Children's Hospital emergency room. It seems that Elisha has severe hemophilia, which means that his body is missing a protein that is needed to clot the blood if his skin gets cut. An infusion of the missing blood factor will solve the problem but we didn't know that at the time. All I knew was that my baby was bleeding, there was blood all over my skirt and hands, and that he hadn't stopped bleeding despite my uncle and father's best efforts. We sat in the emergency room feeling terrified and helpless. The attending physician explained that they were doing their very best to help Elisha. He also wanted to know how Elisha was fed. When he found out I was exclusively breastfeeding, the doctor said it was the very best thing that I could do for him as often and as much as he wanted-especially during that stressful time. Well, I could certainly do that! The doctor had given me a job to do, and I felt far less helpless. Now I was part of the team that was helping heal my little boy.

We stayed in the hospital for nearly a week while they ran tests and worked out a diagnosis, and in that time either my husband or I was with our baby for every procedure, talking or singing to Elisha, or even holding him.

Elisha's suck improved and he began to take more control of my milk supply. Most importantly, the nurses and the hospital lactation consultant supported us and helped me breastfeed around tubes and wires. In the middle of all that anxiety and uncertainty, I somehow rediscovered my baby. He was still the little fellow with the bright eyes. He just happened to be wearing the hospital's paraphernalia. That recognition helped me get through the shock of the diagnosis. Hemophilia became just one more part of the package that is my son, and not the defining feature. Instead of being characterized by his clotting disorder, he was characterized by the little noises he made while nursing, and the slightly silly expression that he wore when his tummy was full of my milk.

Since then, we've been in the emergency room multiple times, had nurses at home weekly, and have been admitted to the hospital multiple times. Elisha has gone under general anesthetic twice for surgery. Both times I was prepared. Beforehand I talked to my local Leader, Kimberly, about nursing and anesthesia, and I had the confidence to talk to the doctors about my role. Each time we've been in Children's Hospital, I've felt valuable and necessary as a nursing mother. And when the nurses come to our home, Elisha and I would breastfeed during his infusions, since the home-care nurses are skilled enough to find his tiny veins while we snuggle. Those are the best infusions, and being able to breastfeed at times like that means that Elisha and I have become more independent, more secure, and more confident.

Our hemophilia center and home care nurses have been amazingly supportive, joining my husband and mother as invaluable parts of a team that is, as it turns out, much bigger than the group of three (mother, father, and baby) that I had anticipated. Like so much of parenthood, this is not what I had planned. But it works.

Hemophilia will always be a part of our lives, and this means always needing just a little extra care, a little extra planning, and-of course-a little extra stress. With that added ingredient, moments and sources of comfort are all the more important. Breastfeeding has provided us with that oasis, and Elisha and I can nurse for food, for comfort, and for a kind of emotional healing after a particularly traumatic episode. And, while the team of people caring for our baby may be large, it is so very important that it can also sometimes be just me and Elisha, creating our little bubble of milky peace and quiet.

Now Elisha is two years old. He is an extraordinary bundle of energy and words, and seems to have learned something new each time I blink. I'm awed and overwhelmed by him, and I watch this transformation extend even to our nursing sessions. Now, Elisha breastfeeds with a foot waving in the air, wriggling on and off my lap, as he is barely able to sit still. But for all of the acrobatics, he is still attached to me, holding on even as he wriggles away. His hemophilia is under control, and Ezra and I handle his daily infusions ourselves. When we discovered multiple, severe food allergies a couple of months ago, the doctors told us how lucky we are that Elisha was breastfed, because it probably protected him. I just laughed. Lucky to have breastfed? Oh, you bet. Breastfeeding helped us build and protect our child, and it also helped us build and protect our family. It provided a strong, loving foundation on which my two-year-old whirlwind grew.

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