My nipple is a lemon
Ina May Gaskin’s “Guide to Childbirth” popularised the pithy affirmation ‘your body is not a lemon’ to bring home for expecting mums the understanding that our bodies were made for birth and that pregnancy and childbirth are not diseases. This is a noble message worthy of consideration, more today than ever before as birth intervention rates soar far above what we know is helpful or necessary.
I will give this “not a lemon” idea some positive attention in another article, but for now let me say that there are times when our bodies throw us a curveball and these can be the oddest little anomalies that make a big difference to our journey through motherhood. For me, one of these things has been the discovery that I have a lopsided nipple.
Yep. You read that right. But let’s rewind for a minute to catch you up on the story of a breastfeeding mum who - like most of us - knew next to nothing when she started.
My breastfeeding journey for my two kids so far has been a wild ride. Four days in with my eldest my milk came in and I had no idea how much was actually there (it was a lot). I was not prepared for how soft my breast would have to be to make latching easier for my daughter, nor did I have anywhere near enough information and advice about the anatomy of a boob to know how much excess fore milk can occur when milk comes in quickly. I thought the watery stuff gushing out of my rock hard breasts was ‘transitional’ milk, because it didn’t look like milk to me at all. I was told to express some off before feeding but I didn’t know that it could take a while for letdown to start during pumping or handexpressing, and so I thought I was in low supply when in fact I had too much. So Madisen didn’t latch well at all and got a few mouthfuls of water essentially. I needed to get the milk in her and that was when a midwife suggested a nipple shield.
Looking back, this was the right move. Maddy was desperate. People often worry too much about baby weightloss in the first week after birth but she was one who was actually losing it very rapidly from lack of good latches. My mum nipped to the pharmacy for the nipple shield while I softened my breast by expressing off some milk under the hot shower. I put the shield on and Maddy drained the breast in a few minutes.
Hindsight is a handy thing and I now believe that the advice I would give to a mother in that situation would not be to use the shield for x number of days (I was told 2) but rather to take it one feed at a time. The problem had been identified as breasts that were too full and a very hungry - even hangry - baby that needed to drain that breast ASAP. We did that. After that I could have tried to offer the naked breast again now softer. I needed a lactation consultant there and then who could come in and make an inspection of my breasts and how I was using them, but we were in level four lockdown and I didn’t get around to that for weeks. When I finally did Maddy was dependent on the shields and the community lactation consultant didn’t recognise the problem of thin watery milk (what I came to call “trim” or “green top” milk!) because she wasn’t asking enough questions or looking very closely for all “potential hazards”, shall we say.
So two days of nipple shields turned into more than ten months, with formula top ups and power pumping helping us to get through between two and four months old so that Maddy would gain weight better via fattier milk. At four months she was back to exclusively breastfed, and I was learning what good milk looked like.
If someone had told me at the start “the emptier the breast the fattier the milk” I would have had a different roller coaster ride than the one we got, but I didn’t hear about that until Maddy was 12 weeks and I had a friendly visit from Cheryl Benn, a local midwife who is also an experienced and thoughtful lactation consultant.
The result of this shield-dependent feeding was that I didn’t really get to know my nipples the whole time I was breastfeeding Madisen. At about ten and a half months she decided they were a neat teething toy and I couldn’t convince her otherwise. I switched to pumping which she didn’t seem to mind as she’d been offered bottle a lot when she was smaller, and pumping was such a hassle to me that I probably underpumped (it can take more pumping than breastfeeding to get the same amount of milk because it doesn’t stimulate the nipple like a baby’s latch) and my supply dwindled to almost nothing within two weeks. That was the end of Madisen’s breastfeeding, but given what we’d been through together I was absolutely chuffed to have made it that far.
The most important thing I have learned from breastfeeding my kids is using up all the hind milk so the body makes more of the good fatty stuff and gets better at storing the milk (so we don’t get engorged).
11 months later I gave birth to wee Arthur. His first latches were a shock to my system. He was a Hoover. Where Madisen had struggled to get a hold of it with her gob Arthur suctioned himself on there like there was never gonna be another feed. I got lovely colostrum and transitional milk (what I came to affectionately call colostromilk or caramilk because of its buttermilk appearance) but this phase lasted a little long and it wasn’t until day seven that I began to discern mature milk. It came in more gently than last time, which is great, but I probably needed it a bit sooner. Seven days was a long time to be hoovering my breasts without the flow of mature milk “letting down”, and this caused avoidable trauma to the nipples in the form of blistering. I had not been expressing anything while Arthur slept, and he was a very sleepy boy. If I have another baby that sleepy I would express or offer a ‘dreamfeed’ so that I am using the breasts much more frequently than I did, as I know now that those first few hours and days are when the prolactin receptors are laid down and the body prepares to letdown mature milk sooner. The infrequent feeds also meant that, again, when the milk finally did come in I was fuller than Arthur perhaps needed. I was still learning to trust the softness of the breast when offering more regular feeds and that my body indeed is not a lemon when it comes to squeezing out enough milk for my baby!
I will stop here to point out that often the question put to mums by midwives or Well Child carers when they want to check in about how the breastfeeding is going is this: Does the breast feel full before the feed and soft/empty after the feed? It’s important to remember that there are degrees of softness and that we don’t want the breast to be TOO FULL. If mama is left with this question as her only guide for whether there is enough milk flowing out for baby she may become anxious about her breasts being full enough. She may not know (like I didn’t) how full is full and how soft is soft. I have heard of women who held back some of their milk because they worried that next time they offered the breast it wouldn’t be full enough, or they might think that if their breasts are not chockablock then they have insufficient supply. It’s easy enough to see the mistake from the outside looking in as a birth worker or lactation help, but in the early days of breastfeeding (and sometimes beyond) supply anxiety can be very strong and causes a mum not to recognise other potential sources of complication (such as the quality of the milk). She needs her support people to be thinking of these things and to give enough basic information for her to be confident offering the breast often. Let’s remind this woman to take it “one feed at a time” and not worry about running out. Next time, there will be more milk there, so use it all up now and the breasts will replenish. The body is learning.
The issue of quality over quantity is also significant for women who have “abundant” milk and are not worrying about supply, therefore her support team is not looking for other clues about how nursing is going. For example, constantly full and hard breasts can seem like a blessing if she only thinks in terms of quantity, but oversupply can mean the “green top” watery milk that doesn’t satisfy baby. This happens when we keep getting rid of the fore milk but don’t drain the hind milk (‘holding some back’ or having so much that baby fills up on fore milk and leaves the rest) so that the breasts continually top up with water. This means baby gets hungry again very soon and/or doesn’t seem to be gaining much weight as time goes on. Mama may not realise just how jelly-soft her breasts will be when they are truly empty. When I experienced this with Arthur it made me wonder at how Maddy had managed! This also has implications down the line as the body is getting signals about how much [fatty] milk is needed now but also longterm. The first few days, weeks and months establish a pattern even for when the mother’s cycle will return. Good quality milk flow offered frequently is the way the body learns not to get pregnant again any time soon!
At the same time, that first week of hoovering brought on nipple trauma that I’d not dealt with when feeding Maddy. This also discouraged me from frequent feeding. My nipples cracked and blistered. I didn’t get a close inspection in the first few days and I did not recognise - as I later did - that the positioning of the nipple can by a bit sneaky when you are looking down from above the latch. A second opinion from a wisened lactation helper can be all-important, particularly if you are sustaining injury to the nipple!
Eventually I came to depend this time on Rite Aid Hydrogel Breast Discs and Lucas’ Papaw Ointment, which genuinely saved my breastfeeding journey with Arthur. I have come to believe, however, that it is not normative to be dependent on these external things in order to breastfeed joyfully. Frequent feeding, good positioning, comprehensive inspection of the breast and the latch, can go a long way to getting out of nursing crises.
And yet! Here I am now 12 and a half months in with Arthur and I am still treating my left nipple which has never fully healed. And because I love my whole family and have seen myself losing my patience with both my children from disruptive nightfeeding and general discomfort I have decided to give him a bottle of lactose free milk like his sister before bed. He loves being like her and this has made it so that he can be resettled at night without feeding until morning. I’m using Hexton Bee Company’s Mint Kawakawa healing balm to get off the hydrogel discs which is the best thing I’ve used so far and has worked a charm, especially now that it has time to actually assist healing between the few feeds Arthur still has. My nipples are soft but not too soft. The breast discs kept my nipples so soft that they could still blister too easily and if I’d recognised this earlier I would have weaned my way off them by applying balm much more frequently until they settled down. I also would have saved a lot of money! I would recommend the hydrogel discs for soothing nipples that are in crisis, but not for continued use for minor cracking as I really believe in the end it produced a cyclical effect.
So, back to my wonky nipple. It actually looks like the tip of a lemon, so calling it a lemon after Ina May’s affirmation is quite apt. It’s semi-flat on one side and Arthur draws it out fine while feeding, but the milk comes out off centre, so that the true centre of the nipple which gets the most suction in the latch doesn’t have anything coming out, and that means that the skin in the middle is being pulled to no avail. No amount of adjusting position has been able to mitigate this effect, and I have just muddled through with healing balms all this time.
Would it be possible to breastfeed a third child (godwilling there will be one) with my lemon nipple without being dependent on products? I don’t know until I apply everything I’ve learned from my first two experiences and see how it goes. I look forward to having a crack at not cracking (or blistering)!
What is the best breastfeeding advice that you’ve ever had that you would share with a new mum who is choosing to nurse her baby? Mine would be “the emptier the breast the fattier the milk” and “take it one feed at a time”. Let me know yours in the comments if you wish.
With love,
XO
Deborah