Annique’s story - navigating painful latching, a baby with a tongue-tie and returning to work

-October 2022

I'm a first-time mom of a beautiful six-month-old baby girl, and, like most other mothers - first-timers or not - my breastfeeding journey has exceeded both my highest and my lowest expectations: it has been life-altering. Breastfeeding completely changed the way I view myself and the world and I could easily talk about it for hours on end. Instead, I decided to write my story down to keep it very specific.

I'm a medical doctor working in government paediatrics in a tertiary level hospital; yet I had many struggles. Doctors appear to be confident most of the time. In reality though, and in all honesty, our training does not teach us how to be mothers or parents and it teaches us way too little about breastfeeding. What I know today, I learned from courses that I enrolled myself in, as well as from support groups, amazing lactation consultants and La Leche League Leaders, and now also a little bit of personal experience.

I was fortunate enough to give birth in a hospital where my baby was allowed to be with me the entire time (although I was prepared to fight for no separation if that wasn't the case!). Even in theatre, straight after having an emergency C-section that I hadn’t planned for, we started being skin-to-skin (we don't plan emergencies, do we?).

My baby latched on in the recovery room already and I actually thought we were off to a good start even though I struggled to wake her up during the first 24 hours. I did all I was taught to make sure that the latch was good - and it did look good - but even before leaving the hospital, I had to have laser therapy treatment by a physiotherapist due to painful and slightly cracked nipples. My baby's mildly painful latch at that point had been checked multiple times and I was reassured that ‘it would get better’.

However, by the time my baby had her 2-week weight check at home, my nipples were badly damaged. The visiting lactation consultant attempted to help me fix my baby's latch. We tried multiple breastfeeding positions and she suggested seeing a physiotherapist again for laser treatment to my nipples. Over the next few weeks I had three more laser and ultrasound therapy sessions and was visited by a lactation consultant numerous times. The latch always looked good from the outside, but breastfeeding remained painful and my breasts were not healing at all. By five weeks I was almost ready to give up on breastfeeding altogether if I had been just a little less convinced of how important it was, and if I didn't get the support that I so badly needed.

At that time my baby was feeding more or less 10 times a day - sometimes for an hour at a time. I received many well-meaning comments and suggestions from family, friends and even my baby’s paediatrician. For example, they suggested I use a pacifier to shorten the duration of feeds. Another misguided piece of advice was to supplement with formula as she was feeding ‘all the time’. I battled through all of this. My baby’s weight gain was at the lower end of the normal range which, of course for me as a doctor, was worrisome. Out of desperation I contacted a colleague who is a medical doctor, IBCLC and La Leche League Leader. She was one of the trainers who ran a breastfeeding course I attended two years before.

I am so thankful for making the decision to reach out to her! My encounter with her was a game-changer! After having spent a few minutes in consultation with her and a hands-on examination of my baby, she diagnosed my baby with a tongue-tie. She guided us to adopt the so-called Concord breastfeeding position and koala hold (I still use this feeding position today) and she recommended using anti-inflammatory and pain medication which in the previous five weeks I didn’t even consider using myself. [LLLSA comment: more info on Concord positioning can be found here https://llli.org/news/what-is-the-concorde-hold/]

Now, I have to tell you that my husband’s family has a very strong family history of tongue-ties. So much so that, after delivery, I asked the paediatrician to check for it and during follow-up consultations I kept on asking the initial lactation consultants to make sure a subtle tongue-tie wasn’t missed. As a young doctor I had little experience with tongue-ties and they can be tricky to diagnose. I couldn’t help starting to wonder whether I wasn’t just desperately looking for an excuse for failing at breastfeeding the way I felt I did. I must admit that, even though I felt very relieved that a diagnosis had finally been made - which meant we could take it from there - my initial thoughts and feelings were that so much precious time had been lost with my baby.

At six weeks the tongue-tie was released. It was by no means easy afterwards. It felt as if we were starting all over again. She didn’t gain any weight during that first week after the procedure and then started to gain very slowly. She was still feeding for long periods at a time and her stools remained green. You can imagine how worried I was as a mother and a doctor!

Fortunately, I now was surrounded by people who helped me filter out all the misguided advice I received up until then. I was in frequent contact with my doctor/IBCLC/Leader colleague; she regularly checked up on me and was always approachable and willing to help. On her recommendation, I joined the Parow La Leche League WhatsApp support group and suddenly I didn't feel so alone anymore. I received good advice in abundance from ladies who have had completely different experiences than me.

I came to realise a few things: in the end, what ensured the success of our breastfeeding story was actually the basics, which we all think we know. Firstly, breastfeeding shouldn't be painful - even if the latch looks good!

Secondly, skin-to-skin care is powerful. My baby and I spent days upon days in bed, skin-to-skin, breastfeeding on demand, trying to reset everything. Even though at the time I was very, very worried, this was probably the most special time during my maternity leave. Now that I am back at work, I still get in bed with my baby sometimes and we are skin-to-skin just because I miss it so much. I also still try to respond and breastfeed on demand, like I learned while we were spending that much time together in bed.

Thirdly, bed-sharing is amazing. I can't believe how I robbed myself and my husband from valuable rest early on just because I believed that bed-sharing wasn't safe. My baby negotiated herself into our bed and never left.

Fourthly, you need support and it's available! I couldn't do it without my husband’s wholehearted and constant support. Even though he saw that I was in pain (and afterward confessed there were times when he was angry at our baby for causing me such pain), he not even once suggested we switch to formula or bottle feeding. Also, the support I received from my colleague and the La Leche League support groups carried me through and still does, because breastfeeding is not a destination; it’s a journey.

Often a new stage poses different challenges. Just when I thought we were doing great, I returned to work and we had to learn and adjust once again. Being a working, breastfeeding mom is even harder than I thought it would be. Before I had my baby, as a doctor in a government hospital it was difficult on most days to find time to have lunch or even to go to the bathroom while at work. Now I had to also find time to express breastmilk, ideally more than once a day!

Although the hospital where I work is thought to be breastfeeding-friendly, in practice it really depends on the team you're working with. Not everyone is supportive! Even female colleagues who are mothers themselves often do not understand. Most of my senior colleagues unfortunately couldn't manage to breastfeed their own babies and switched to formula feeding. Thus, instead of helping me have time to express breastmilk, they just casually suggested that I switch to formula milk.

There is a lactation room for employees to use at the hospital, which sounds great, but is horribly impractical. It is located on the second floor. I work on the ninth floor. Most of the time only one out of the four lifts are working. The lactation room’s key is kept at a nearby clinic, where one has to sign a register to obtain it. The clerk at the clinic only works until just after lunchtime, then locks the clinic door - lactation room key and all! There used to be an after-hours key that went missing. So, even if I manage to find time to express within the clinic’s opening hours, it takes me at least 10 minutes just to get there and set up before I can actually start.

At times I’ve managed to express in the ward where I am on duty, but this, too, comes with a lot of challenges. First I have to find an open room and, often, there isn’t any available. Understandably, I wouldn’t want to sit on a toilet in the bathroom… If there is a room available, the next annoyance is having to deal with people opening the door to enter the room because they’re not paying attention to my notice outside. The doors can’t lock and so I have to sit in a chair against the door while they are trying to get in.

Even though I work in paediatrics, where we try to fight for breastmilk for our patients every day, I feel very alone in fighting for breastmilk for my own baby. Yet, I do fight hard for her; maybe even harder than I would for my patients.

Nowadays I talk openly about breastfeeding and expressing breastmilk. I’m not afraid to publicly announce that I’m on my way to express my milk, as I realised that colleagues don’t easily criticize me when others are around. Luckily, I have discovered a few like-minded colleagues who support me and I do the same for them. 

Also worth mentioning is that I've become remarkably more efficient at work, especially because I know I will be taking a break to express. I even started to arrive at work earlier, which is remarkable while having a small baby.

The circumstances remain extremely difficult though, and are likely not going to change. Sometimes we work with a skeleton staff. Many times I had to make phone calls referring patients to ICU, holding a phone in one hand and a breast pump in the other. The extended hours away from my baby is very tough. I have on occasion arrived home after a 28-hour shift. Both the long hours and finding time to express during such a short-staffed shift, is a struggle. Then add to that having to clean the breast pump and finding a way to keep my breastmilk chilled. I cannot yet say that I'm always managing to do it all, but that's okay because I've learned some very valuable lessons by which I live.

Every night when I'm with my baby, we ‘reset’. We breastfeed on demand and we continue to bed-share. Night feeds basically happen in my sleep. Feeding throughout the night will hopefully help keep up my milk supply - we will have to wait and see if it does - and it also makes me feel a little bit less guilty for leaving her alone for so long.

Before my breastfeeding journey, I underestimated the power of support groups. Every single mom in those groups has offered me support and encouragement - sometimes even without knowing it, by encouraging another mom in the group or answering someone else's questions (that I was too scared or ashamed to ask myself). Moreover, I was comforted every time a mother was willing to show vulnerability by asking for help or by sharing her feelings, knowing very well how hard it can be to first acknowledge and then to share that in a group setting like that.

I've realised that I'm not alone. I'm not alone in my struggles and I'm not alone in this ocean full of emotions that breastfeeding sometimes showers upon us. To sum it up: I think that breastfeeding is definitely the hardest thing I've done so far, but I can't think of anything I've done that's more special, more irreplaceable and more valuable for both my baby and me - that is, for both me as a doctor and me as a mother. Breastfeeding has changed me completely and I’m looking forward to seeing where this will lead me. I have so much more to learn.

As a final note, I would like to thank everyone who has supported me, even without knowing it. This includes the IBCLCs who ran the breastfeeding course, the LLLSA breastfeeding support groups and Tobie of LLLSA who presented a communication skills development course. Thank you so much! I want to encourage you to know that what you do makes a difference. It has for me; not only as a mother, but as a doctor too. This journey has put me on a whole new trajectory in both my personal and professional lives and I'm very excited to see where that's going to lead me.

So just to say, with all the challenges, we are still successfully breastfeeding.