Health: A scare at feeding time

In national breast-feeding awareness week, Anya Sitaram describes how her first attempts led her new-born baby straight to special care

Maya was delivered at lunchtime on a hot sunny day last October. A breech baby, she arrived by planned Caesarean 10 days early. The operation went well and she emerged into the world with a shrill cry and wide-open eyes, glaring at us furiously for her abrupt exit from the womb. Weighing in at a healthy 7lbs 4oz, she passed all the initial checks and within an hour was latched on to my breast, feeding eagerly.

Everything appeared to be going well. I fed Maya every two hours as I recovered from surgery. On the third day however, we noticed that Maya looked yellow. The doctors said she was a little jaundiced, but as long as she got lots of fluid from me she would be all right. Maya herself seemed to know that, wanting to feed constantly. With hindsight, I can see that was a sign that something was wrong.

On the fourth day a routine test found that her blood-sugar level was very low and hours later laboratory results confirmed that she was severely dehydrated. At midnight she was rushed to special care, with me trailing tearfully behind as doctors and nurses plunged needles and drips into her tiny limbs. By that time her blood-sugar level was so low that it did not even register on the scale. I had been told that dehydration could lead to brain damage. As I watched helplessly I could not believe that my previously healthy baby could end up in special care alongside seriously ill and premature infants.

Maya was put on a glucose drip and given phototherapy. Within hours her condition improved and after two days she was considered well enough to return to the ward. I had been going up to special care every three hours to breast-feed her, but she was also given formula milk to make sure she got plenty of fluid.

It came as a surprise to learn that Maya had become dehydrated because I was not producing any milk - and very little of any other fluid. I learnt that when staff sent me off to use the electric breast pump, so that I could get some sleep while they bottle-fed Maya: all I could produce was a few drops of colostrum, the fluid present before the milk "comes in" on the third or fourth day. It came as a shock to me: I had seen the baby suckling away and assumed all was well. Nor I had I been prepared to expect that kind of problem: my antenatal class had focused on difficulties such as sore nipples, while several mothers I spoke to had described the initial stages of breast-feeding as a case of "breaking through the pain barrier".

In fact a delay in milk "coming in" is not unheard of among women who have had Caesareans and is thought to be associated with the trauma of the operation. Yet the doctors seemed bemused, with one doctor saying that my milk "really should have come in by now". Another paediatrician, no doubt well-intentioned, joked that babies had survived the Mexican earthquake for 10 days without fluid. Maya's illness had quickly ended but my problems were just beginning: no one seemed to agree on what I should do next.

Mothers are taught that breast-feeding is completely natural. We are told that "breast is best" - so the implication is that bottle is worst. I had always assumed I would breast-feed and never thought I would have to resort to a bottle, so it was with a profound sense of guilt and failure that I fed Maya formula milk to make sure her health did not deteriorate again.

But I still wanted to breast-feed. In hospital a week later, I began a routine of nursing Maya for 20 minutes to get the milk going and then topping her up with a bottle to ensure she had enough fluid, following the instructions of a midwife who had warned that too long on the breast might tire the baby. But another week went by and I was still not producing milk: Maya always seemed hungry after a feed. By that time I was back at home, where the midwife who visited said 20 minutes at a time was neither enough to stimulate the milk supply nor satisfy the baby. She said the first 10 minutes was the thin foremilk. The full-fat, nourishing meal came after that.

My days turned into endless breast and bottle feeds. I was totally confused about what to do. Midwives came and went, all with different advice. One told me that babies get everything they need in the first 10 minutes of a feed. What about the foremilk/ hindmilk business? I thought. By that time I had started to produce milk but not in the fountain-like quantities described by most new mothers and certainly not enough to satisfy Maya.

"Are you massaging your breasts?" another midwife asked, appearing surprised that I had not been told before. "Perhaps you could get your husband to help you," she added coyly.

A breast-feeding counsellor told me to express milk after each feed to stimulate the supply. That helped a little, but not enough. In the end my health visitor concluded that the only way I would produce enough milk would be to stop bottle-feeding totally, spend two days in bed breast- feeding Maya and drinking lots of water. She warned it would be hard work. I could not face the effort and carried on combined feeding. When Maya was three months old, I weaned her from the breast, and had to regretfully accept that for us it just had not worked.

It seems absurd that it took Maya's short but potentially serious illness, in an expensive neonatal intensive-care bed, to alert medical staff that something was amiss with the feeding. I could also have done without so much conflicting advice about my scarce supply: everyone said something completely different. Perhaps most midwives are dealing with more common difficulties such as latching on or mastitis; the problem of someone having too little milk seemed to baffle them. much of the advice I did get seemed to be based on hearsay. It was only through trial and error that I managed to feed Maya at all. No one told me the simple things: that being tired can affect the milk supply or that there is more milk in the morning, for example. (I found that a good night's sleep works wonders, but that is a tall order when you have a small baby.)

I have since met several mothers who had simular problems to me. One did not start lactating properly for three weeks. She refused to give in to the temptation of formula milk, even though her baby did not gain any weight for a month, and she eventually went on to breast-feed her child for more than a year.

Luckily for me, Maya swapped from breast milk to formula at every feed without a murmur, disproving the golden rule of breast-feeding, that you should not give an infant a bottle because they will reject the breast. I wish I had been more successful at breast-feeding. One consolation is that no midwife, doctor or health visitor discouraged me from using a bottlen

Anya Sitaram is a news reader with ITN.