When Extended Breastfeeding Hurts

Notice the bruise on her left cheek? There is a story behind it.

I’d brazenly packed only summer clothing without any long pants and just one cardigan into our luggage after checking Accuweather and assuming the weather would be as warm as Singapore’s. It wasn’t (actual summer with Singapore type weather is in July and August). Elise ended up developing a high fever and blocked nose towards the end of our trip – we were sleeping one night and I touched her to realise she was burning. Since it was late at night, I nudged her and latched her so she could take in more fluids. The next day, my brother-in-law bought baby paracetamol from the pharmacy. We didn’t bring her to the PD because she was still active and not lethargic, although she had a decreased appetite.

The upside to this was that she mastered the technique of picking her nose due to all the mucus. Once, she even handed over her dried snot to her father like it was a prize. I continued latching her because it gave her comfort and apparently, there’s still some milk in there. The nights were hard to bear as both of us had interrupted sleep; her from her blocked nose and me from attending to her. She also vomited her formula milk and spat out medicine.

Back to the bruise. We were in a fully loaded flight back to Singapore from Seoul via Taipei. Even in the cold airplane up in the air, her entire body was hot to the touch. She was grouchy, exhausted and wanted to latch, so she started fussing. In a confined space such as an aircraft where ALL EYES will be on you when your kid cries for a longer time than what is socially acceptable i.e. 3 minutes max, you do whatever you have to to get her to quieten down. So, I unbuttoned one button of my dress and latched her in my seat. It is possible to be sufficiently covered whilst getting the job done. Why not in the aircraft toilet for privacy? Because if you don’t eat your delicious aircraft bento in the toilet whilst enjoying the smell and airborne poop particles, Elise shouldn’t have to drink in a toilet either.

Anyway.

Being cranky, sick and uncomfortable, she absolutely refused to stop latching. Occasionally, when she dozed off, I pried a finger in between her teeth in an attempt to unlatch her, which resulted in a full-blown cry, forcing me to start all over again. Cry, latch, doze off, (attempt to) unlatch, repeat. Learning quick, she realised that if she used her teeth to clamp shut on my nipple, she could defend the boob. Pregnancy boobs are more sensitive than normal. How does it feel? Clip one of these onto your nipple. That’s how it feels. I tolerated it for many times, but there was just ONE moment where she intentionally bit down hard onto it, so I pinched her cheek. HARD. She awoke in pain. I had hurt my sick daughter. -_-

She recovered the day after we returned to Singapore without seeing a doctor.

Now that she is 19 months old, I’m starting to hear uninvited opinions about weaning. One of the remarks came from my mother-in-law. She was on the phone with my husband before we went to Korea and it was audible enough for me to hear. “It doesn’t even have nutrients anymore. It’s useless. I don’t care if she hears. It’s the truth.” My husband replied that I was sensitive regarding this issue and told her to stop. That night, I searched for articles in Korean which supported breastfeeding until 2 years old and beyond and sent it to the family chat group. After reading the articles, my husband agreed that it does help with her immunity. My in-laws also stopped commenting about weaning after seeing how she was soothed easily. On our last night in Korea, she signaled to latch and I latched her in the restaurant while we feasted on crabs. After Elise unlatched, she immediately went over to her grandparents and kissed them. -_____-

Korea is a relatively child and breastfeeding-friendly country. Last year, I latched her on demand practically everywhere – in the KTX, buses, eateries, even in the sauna. Nobody said anything nasty, because I was decently covered. Because breastfeeding is nothing to be ashamed of. Because mature adults understand. I believe that one day, she will tell me that she’s a big girl and “big girls don’t need to drink from boobies anymore”. Support from family is the most important factor in successful breastfeeding.

There were two incidents where I was criticised for breastfeeding Elise, both by other women and in Singapore. The first time was in a nursing room with no curtain, so I latched Elise in front of them. The two women in the room made comments in another language, spattered with English words like “must be from China”, “disgusting”, “cannot cover”. The room was locked. We were all women. It’s sad to see how some women put down other women for feeding their child with mom’s milk. I have two friends who are still latching their kids of similar age to Elise. Like me, they are pro-extended breastfeeding and still nurse their little ones to sleep even though they’ve heard nasty remarks from co-workers and strangers. Weaning should be determined by either the mother or child, no-one else. Not family members, not in-laws and much less work superiors and strangers.

EXTENDED BREASTFEEDING

Q: Do you even have milk left?!
A: Supply decreases during pregnancy and milk changes into colostrum which some toddlers either dislike, like or are neutral with. I asked Elise if there was still milk and she nodded, so… I guess there’s something left inside? I’m quite sure it’s mostly for comfort. I also feed her formula milk once a night for satiety but she still nurses to sleep after milk.

C: It’s so disgusting to see a big kid dangling off your boob. They’re old enough to wean when they have teeth.
R: Here are the benefits of extended breastfeeding, which include healthy emotional development in addition to building their immune systems. You know what’s disgusting? Humans drinking cow’s milk. It came from the tit of a cow meant to nourish baby calves. I’d rather wean her off cow’s milk. The World Health Organisation recommends exclusive breastfeeding for a minimum of 6 months, continued till a year and stopped whenever the children want it. Most children wean themselves off between 2 to 4 years of age.

To tell the truth, I DO find it unnecessary once the child is no longer a toddler. I hope Elise will quit boobin’ way before she turns 5. The good news is, kids will self-wean between the ages of 2 and 4. It will be a bittersweet day for sure.

Q: Why do you continue latching even when it hurts? Can’t she be soothed in other ways? Are you breastfeeding for attention?
A: No amount of attention can be worth a clamp on the nipples with baby teeth. The reason is simply because for my child, there is nothing more soothing than a boob, especially when she is ill and has no appetite. Well, even grown men can’t resist breasts! Except that grown men sucking on boobs = sexual. Babies latching = natural and NOT sexual.

Q: Not all women breastfeed. Are you insinuating they are less of a mother than you are?
A: 
Breastfeeding is but one component of motherhood. Boobing alone doesn’t make you a great mother like how feeding formula doesn’t make you a bad mother. -_____-

The Rain

It is never easy sending your child to the operating theatre. Though it is just going to be a simple examination under anesthesia (EUA) and mold creation for her prosthetic eye, she will still have to undergo General Anesthesia. This will be her third time in 3 months. 🙁 I’ve asked both the surgeons if the procedure can be done under sedation but they told me that sedation would not be sufficient as the process of creating the mold is uncomfortable. It would be more traumatising for her if she wakes up halfway instead.

Tomorrow’s procedure is considered low-risk so I hope everything goes smoothly. I still remember when the nurses were waiting for her to recover from anesthesia in the holding area after her enucleation. Her non-eye was covered with an eye patch and blood was seeping through. 🙁 She likely will not need to be warded tomorrow. After Chinese New Year, we will need to visit the hospital for 3 consecutive days for the construction and fitting of her prosthetic eye. On the first day, they will see if the mold fits. On the second day, they will commence on hand painting the acrylic customised eye. On the third day, the eye will be ready and we’ll be taught how to insert and maintain the prosthesis.

As with every procedure requiring anesthesia, she will need to fast. The deadline is 12 midnight for solids and all sorts of milk and 4 am for water, glucose water or honey water. She’s currently knocked out but I managed to feed her some milk. She won’t be able to consume anything until after the operation ends. Hopefully, it won’t be too taxing for her. We have the earliest slot so we’ll need to wake up extra early to cab over.

It has been raining heavily for days on end. The laundry takes forever to air dry and we have been confined to the neighbourhood for the past week. It’s like free air conditioning and the weather is the closest it gets to “winter” in Singapore. The downside is that the coldness just makes me want to curl up under the comforter and hibernate the day away. There’s also the immense boredom of being cooped up at home…

Elise turned 15 months a few days ago. Ever since she was born, breast milk has been her main source of milk. She was nursed exclusively for 6 months and has been latching daily up till now. I’m not sure if the problem lies with my supply, but I find myself becoming increasingly annoyed when she wakes up to latch in the middle of the night. She’ll climb over me, change sides, switch positions all while chomping down onto my boob, refusing to let go until I pry open her mouth with my fingers. I chided her and commanded her to “stop it” and it wasn’t a good feeling for either of us.

That’s why I made her a bottle of formula milk this evening from a sample tin of Gain IQ which I received earlier. She drank all 120ml of it in one go. I still believe that breast milk is best as it’s customised for the child but knowing that she is receptive to formula as well as a range of other types of milk (oat milk, fresh milk, thawed frozen breast milk) is comforting because it provides a back-up solution for when I need to rest. Formula is overpriced and it doesn’t make sense to rely entirely on it when it’s not essential for growth. Besides, she has such a voracious appetite, her nutrient requirements can easily be met through solids. Normally, she doesn’t pay much attention to her father but when he is eating, she’ll toddle up to him and act coy. She’ll sit on his lap and say “AH-MM!!!”.

I’m quite sure I’ll feel bittersweet when she weans but such is life. For every beginning, there will be an end.

 

 

After The Operation

There are some questions which I’ve repeatedly received, so I’m answering them here.

Q: Will the doctors put her eye back later? Can she get an eye transplant?
A: This is probably the most commonly asked question. Honestly, when I get asked this question, my eyes roll right up and I really feel like shaking the person up and down.

If the surgeon could delicately and precisely excise the tumour from the eye and carefully fit her eyeball back in its socket, we would not have fought and argued within ourselves – put back can already, what. Please, people. THINK before asking. It was a cancerous, malignant tumour which multiplied and replaced normal retina cells.

The simple answer is – No. Enucleation includes severing the optic nerve that transmits signals to the brain and removing the entire eyeball. “Eye transplants” as we know it, are actually cornea transplants. Even if the eyeball could be transplanted and reconnected, there would be no way to link the brain to the eye.

She will get her prosthetic eye fitted in a few weeks’ time, but it will not be her old eye because it is diseased. At this point in time, it has probably been chopped into bits and pieces, poked and prodded and is either lying somewhere in the hospital’s lab or disposed as biomedical waste.

Q: How did you find out about her condition?
A: I answered it in this article. She had a lazy eye condition where her right pupil would be slow to follow so I got a referral to NUH after the opticians in Korea urged us to have her eyes checked. The “white glow/white reflex” which showed her tumour only ever appeared in one photo which was taken during her first birthday party. The pictures were received after her diagnosis, so it didn’t matter.

This is the photo which I sent to her surgeon. The white spot in her eye is due to the tumour blocking the light into her eye and is an indicative symptom of Retinoblastoma.

Q: Is Elise okay? Will she need to do chemotherapy?
A: She is still coughing (for more than 2 weeks now). The cough sounds like it’s tapering off. Her appetite has increased and she’s still the same baby. We have to wait for the doctor’s report next week before we determine if she’s okay or if she requires chemotherapy. We hope not because it will mean more hospital stays and Elise will be weakened significantly. More importantly, the side effects of chemotherapy may stay with her for life.

She seems happiest when she is latching. If I flash my boobs at her, she brightens up into a smile and crawls over to latch. Since it’s recommended to breastfeed until the child turns 2, I won’t be weaning her. Weaning should only be decided by the mother or the child and not by a third party who has no business interfering. I received some lactation oat balls which I’ll review soon! I’m just glad my boobs still serves its primary function which is to produce milk.

Q: What about your work?
A: I switched to part-time work the week before she was diagnosed. When my boss knew, he offered me a freelance position which will stand until I decline it or I can commit enough time to work part-time again. Before Elise was diagnosed and I was working full-time, I already had thoughts of reducing my work commitment because I knew that every minute spent at the office was a minute that I could have spent with her. My dad is an awesome caregiver to Elise but it is extremely taxing to look after a child alone.

Q: Are your finances okay? Do you need crowdfunding?
A: Luckily, I bought an integrated shield plan for Elise which covers up to private wards. This means that you can seek treatment as a private patient and make claims for consultation, surgeries, hospital stays and follow-up treatment. For Elise, she sought treatment as a subsidised patient. What insurance does not cover, though, is the cost of prostheses. I’m not sure how much a prosthetic eye costs, but it shouldn’t be too expensive.

Our family is probably considered as a lower income family (we hold a Blue CHAS card) but we don’t currently need crowdfunding. There are many needy people and other children in worse circumstances. The other 3 young patients in Elise’s ward had cancer too. All had surgery which lasted many hours more than Elise’s 2-hour operation.

A 22 month old in that ward has neuroblastoma. He had a 13-hour surgery on his liver and is now on his 5th cycle of chemotherapy. The doctor was telling his mother that it’s a long journey and they were only halfway there. Imagine having your child undergo so much with no absolute way of treating the cancer – they could fly to US, but it would cost at least $200,000. These are the families who will benefit from crowdfunding. Those who have a shot at treating illnesses but are deterred by the astounding medical costs.

The sad thing is children do die from pediatric cancers. A friend I made recently told me that it happens more often than we think. In the metal cabinet where they keep hospital linen, there’s one compartment labelled Mortuary Shroud. In a pediatric ward. Children signify life. Some children have their lives cut short abruptly due to illness.

Q: Are YOU okay?
A: I don’t know how happy or okay I am supposed to feel. Having survived a depressive episode a few years back has made me stronger. I went to the office today to work. I haven’t been missing my meals or sleep. Like my dad says, “That’s life”. Maybe we’re all only healthy until we’re diagnosed. If I hadn’t brought her to the doctor to check on her squint, we would have missed out on her condition until the symptoms became too obvious to ignore. If so, we would most definitely lose her, so we should be happy that we saved her life.

After the operation, her eyelids were sewn shut to aid healing. We were supposed to apply ointment in between the eyelids and apply a thin layer over. It took three of us to apply ointment for her during the first few days. Two held her down and one applied ointment. Yesterday at the hospital, Dr Ganga removed her stitches. A new friend whose daughter had her eyes removed warned me that it would be red, raw flesh underneath the stitches and I had to brace myself for the sight.

I couldn’t look, so I had my back turned when Dr Ganga snipped the thread. He coaxed me to come and take a look. Thankfully, it looks nothing like what we see in horror movies because he placed a conformer. It is somewhat like a black contact lens. He says some parents who find it okay decide to stick with it and forgo prostheses, but we’ll definitely be creating a prosthetic eye for her.

Her right eyelids are still swollen and bruised. When she opens both eyes, the right side is significantly lower than her left. It doesn’t look proportionate but I am quite sure once her swelling goes down and her prosthetic eye is in place, it will be “normal” again. I’m quite confident of this because Dr Ganga has shown me his previous patients and we couldn’t tell which eye was fake, at least from photos. With her prosthetic eye, she’ll look like she has a lazy eye because it won’t move around as freely as a real eye.

Today, I couldn’t control myself and cried when looking at her. She is behaving normally and being herself. She learnt how to identify some animals on her picture book and can move our fingers to the correct animal when we ask her. She wolfed down many blueberries and is still her cheerful self.

“Looks are not everything”, “It’s not permanent”, “At least she’s alive”. These phrases are supposed to be encouraging but my husband and I feel quite crushed. She used to look so cute. When she waved at others, people would always wave back and play with her. We brought her out yesterday and we can already feel the difference. One particular cleaning lady at the food court (bless her socially challenged heart) asked me point blank “What’s wrong with her eye?”. Lazy (ashamed?) to explain, I brushed her off, saying it was an eye infection. I took photos of her but I won’t be uploading them because I don’t want people to snigger or laugh at her current appearance. People can be mean sometimes. Audrey posted photos of Fighter as a preemie and some utterly vile animals cursed him. I don’t want that happening to Elise.

I’m her mother. I’ll love her regardless of whether she looks like the old Elise or an alien or a pancake. If the test result comes out clear next week, we can start rebuilding our lives.