WILL HAVING A GENTLE BIRTH PREVENT ALL BREASTFEEDING PROBLEMS?

I had briefly spoken by phone with Kimberly while she was pregnant and developing her birth plan. Kimberly and her husband, Doug, had hired a doula to support them in labor and were excited about becoming parents for the first time. Several weeks later, the couple called to report that Gabrielle was born following a rapid labor and natural birth. Now that she was home from the hospital, Kimberly was having a difficult time breastfeeding Gabrielle.

The next day I went to visit the family and found that Kimberly had significant bruising and bleeding on both nipples. During the consultation, I assisted Kimberly with positioning Gabrielle for feeding, and I prescribed ointments for Kimberly’s nipples. Over the next few days, Kimberly healed and Gabrielle became a better breast-feeder. Because Kimberly had a gentle birth, she had the energy to focus on quickly solving her breastfeeding difficulty. Likewise, Gabrielle remained alert and was able to learn to breastfeed without causing her mother further nipple trauma. Gentle birth may not prevent all breastfeeding problems, but if problems arise, you will be fortified by your positive birth experience to work toward a solution.

Although not impossible, it is more challenging to cope with a breastfeeding problem while simultaneously recovering from a difficult birth. When Becky went past her due date without going into labor, she was admitted to the hospital to be induced. Two days after starting the induction process, her labor rapidly progressed, but once fully dilated, Becky encountered difficulty and ended up having an emergency cesarean section. Becky finally arrived home with baby Emily after spending nearly a week in the hospital.

During our consultation, I could tell Becky had been through an ordeal. She was pale and exhausted. Becky’s feet and ankles were so swollen that her slippers did not fit, and she had painful purple bruises on both arms where her IV had been. Becky was discouraged because she was not making much milk, and baby Emily was still losing weight. I explained to Becky that her milk production was suppressed due to her long arduous labor and cesarean birth. Determined to work through this difficulty, Becky began regularly using an electric breast pump to stimulate her milk supply. While Becky worked on increasing her milk supply, we devised a plan to supplement Emily with her mother’s pumped breast milk.

Unfortunately, several days later, Becky developed an infection along her incision site that required antibiotics and daily dressing changes. As she recovered from this unexpected setback, Becky never lost sight of her breastfeeding goal. Her progress was slow, but Becky healed from her birth, built up her milk supply, and is still breastfeeding Emily

Causes, Diagnosis and Treatment of Endometriosis

• What Causes Endometriosis?

No one is certain of the cause of endometriosis, but several good theories exist. Some believe that menstrual cycle flow can go backward from the uterus, move up through the fallopian tubes, and spill into the pelvis. Others suggest that endometrial cells can be carried through the blood and lymph vessels to various parts of the body. Still others suggest a more complex method involving antibodies and changes at the cellular and hormonal level. Endometriosis seems to occur most commonly in women who are in their 30s and 40s. It also occurs more frequently in women who have never had children. Endometriosis appears to have a genetic component. In fact, women with a mother, sister, or daughter who have endometriosis are more likely to have it themselves

• How Is Endometriosis Diagnosed?

First, your doctor will take a detailed medical history and perform a physical exam, including a pelvic exam. If you and your doctor are suspicious that you may have endometriosis, your doctor may perform a laparoscopy to view the inside of your pelvic cavity. If endometriosis is found, your doctor will determine the extent of the disease and in some cases also destroy or remove the tissue at the same time.

• How Is Endometriosis Treated?

Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis can be treated with medication, surgery, or a combination of both. You should be aware that treatments may temporarily relieve pain and infertility, but the symptoms will most likely eventually return. That’s because whatever process caused the endometriosis in the fi rst place is probably still taking place within your body.

In some cases of endometriosis, medications are prescribed to relieve pain and cramping discomfort. Nonsteroidal anti-infl ammatory (NSAID) medications such as Motrin, Advil, Aleve, or Anaprox may be recommended. Various hormones, such as birth control pills, gonadotropin-releasing hormone (GnRH), progestin, and danazol, are sometimes prescribed. Such hormones may relieve pain and also help to slow the growth of the endometrial tissue and new adhesions. These hormonal medications almost always prevent pregnancy and therefore are not used when a woman is trying to become pregnant.

In many cases of endometriosis, surgery is the best choice for treatment. Surgery is usually performed via laparoscopy. During the laparoscopy procedure, the endometrial tissue is either destroyed or removed. After surgery, you may have relief from pain and your doctor will be able to discuss your fertility chances. Some studies have shown that pregnancy rates after surgery for women with moderate endometriosis can be as high as 47 percent. Rates for those with severe endometriosis may be about 38 percent. These rates may not seem great, but they are much better than the chances of conceiving without treatment