Something became crystal clear to me when Lucy was born - prematurity played the biggest role in Rebecca's breastfeeding troubles. The difference could not be more clear. Lucy knew *exactly* what she was doing from her first attempt, and never gave me a single problem. So - it was never really about my surgery scars after all. Lucy clearly had a voracious appetite, a perfect latching technique, and an alertness that we didn't see in Rebecca until at least a month after her birth.
Anyhow, I was pretty delighted by this turn of events, especially since I had promised myself to have no expectations either way. I wanted to make sure that I didn't put myself through the mental and physical hell of my previous experience.
One of the nicest surprises was that full term babies are not forced to be woken to feed every two hours. This meant I got more sleep, and was more relaxed. I didn't have to supplement Lucy's food, and I wasn't hitched to an industrial strength pump. I did have a bit of nipple damage, but not too much.
Everything was going perfectly until... the milk came in. The day after Lucy's first doctor's appointment (where I had said breastfeeding was proceeding marvelously), I woke up with severe engorgement. This is normal when milk comes in. However, given my already ample endowment yet nipples not resembling those of a porn star or National Geographic feature, this created troubles for Lucy. I suppose it flattened things out too much to permit proper latch. She was frantically hungry, and made attempt after attempt to feed - but was clearly frustrated. She kept trying, then removing herself, then trying again. I let her try for a very long time - by the time I admitted that she would be unable to feed, I don't think there was any skin left and I was bleeding. So - we opened up a can of formula and Lucy was able to satiate her hunger. Unfortunately, given the fact that I had let Lucy damage me, allowing her to attempt again, while still engorged and unhealed, was not a winning strategy. I hauled out my old manual pump, and began the process of trying to fix the situation. This is the fourth day since the engorgement, and I am only now starting to see it dissipate.
Given that I have been down the road of breastfeeding suffering before, I decided a few things. One, I would not use nipple shields again. Two, I would not rent a hospital grade pump again. Three, I would not hire lactation consultants again. The problem was quite obvious - and, unlikely to be fixed (in my opinion). Lucy had already received a great deal of benefit from colostrum, so I felt that had at least achieved something. I was not prepared to put my sanity on the line again, especially with two little ones to care for. And, to boot, I could easily see a recurrence of my Reynaud's nipple problems or nipple infections like last time. I decided that I would continue to pump in order to relieve engorgement, but would being the process of gradually weaning. This was a hard decision, but not as hard as the first time. There were tears, but I had the loving support of my wonderful husband, so that helped a great deal. The most important thing is to forgive yourself - even better, not to believe you have to forgive yourself in the first place. Feeding the baby is only a small part of what a Mom has to offer - and it's not the most important part (as I discovered with Rebecca). It's hard not to buy into the hype and propaganda when your brain is undergoing hormonal chaos and sleep deprivation, but it's so critical to keep the big picture in mind. To have things go awry after such a perfect beginning seemed cruel, but I have decided to put my faith in my own wisdom on these matters. While it worked, it was lovely to be able to do - and I will keep those memories. That being said, finding good advice on how to wean from the state I was in was not easy to find - however, after some internet digging, I came across some instructions that were very useful. This has been my strategy so far, and it is working quite well:
1 - Continue to use painkillers to ease the pain of engorgement (I was already taking them for my stitch discomfort, so this was easy - obviously anti-inflammatories are helpful)
2 - Use ice to help alleviate discomfort (I use a "magic bag" that I keep in the freezer)
3 - Massage sore areas to help milk let-down
4 - Manually pump, only as much as is needed to relieve pain, and then very gradually eliminate pumping sessions (i.e. one session is eliminated every few days)
5 - Apply refrigerated cabbage leaves (it sounds bizarre but it works wonders and is a very well-documented approach)
6 - Don't wear anything with an underwire, and make sure what you do wear breathes easily and is not too constricting