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Friday
Apr092010

Nursing After Surgery - 1986

 

 Look! A corded phone in a hospital room!

Okay, that's not what the picture is about, but I couldn't resist pointing it out.

So, after Aimee was born in the car, I kept feeling like something was still inside me. I didn't know enough to explain it, but I thought perhaps I had a lobe of the placenta or something in there. My wonderful midwife Mary Carol Akers checked me out about three weeks postpartum and didn't feel or find anything.

Sarah went with me to my six-week exam, nine months pregnant and wearing Aimee in the Snugli (she was hugely pregnant herself!). Mary Carol felt a mass when she did the bimanual exam and wanted a doctor to check it out.

The doctor who'd caught Aimee, Dr. Mark Repka (great OB!), happened to be in his office, so she sent me down to him for an exam. During the exam, he, too, felt something. He used a scope of some sort to look inside my uterus (damn that hurt!), but didn't see anything so sent me for an ultrasound. The u/s saw some sort of mass or cyst in my pelvis, outside the uterus. Remember that u/s in those days wasn't anywhere near as clear as it is today, so it was harder to pinpoint what and where than it would be today.

Dr. Repka quickly said I needed to have surgery to remove whatever was in there. When I asked when, he said asap. I said I needed to wait until Aimee was on solids, about nine months old. He looked me in the eye and said if it was cancer, I could be dead by then. He gave me six weeks. I asked him about the incision and he held his hands apart, about a foot, and I laughed, thinking he was joking. I can still see Sarah next to me, holding Aimee, and Dr. Repka looking at me, in all seriousness, and said, "I'm not kidding. The incision will be about a foot long." I cried.

I was going to stay in the hospital for six days after surgery. This was totally in the olden days when insurance paid for people to stay a week or so... unheard of today.

I was a pumping madwoman for six weeks. Sarah and I were friends by that time and she rented a freezer for both of us to put our milk into... she was pumping for when she went back to work (before we knew I was going to nurse Darren).

Two nights before the surgery, I had a Thanksgiving dinner. I was really scared, Sarah's mom was visiting and my friend Pam was leaving Germany, so I wanted to have a nice dinner for all of us. I remember it being really wonderful.

I was so nervous leaving Aimee. I was a La Leche League leader by that time and the prospect of leaving my infant, even with her father, was unnerving.

I'd negotiated with Dr. Repka to have access to Meghann and Aimee throughout the day and evening even though kids weren't allowed on the ward and I wouldn't be in a private room. I also talked with the anesthesiologist who highly discouraged my wanting to nurse. I depended on the CNMs to find me as much info as possible to back me up that it was okay to nurse after general anesthesia; they were great. (There was no "Medications in Mother's Milk" back in those days... and certainly no Internet!) I insisted on nursing and that was it. The anesthesiologist said he'd use as light an anesthesia as he could. 

One of my biggest concerns came from reading "A Woman in Residence" by Michelle Harrison. In there, Dr. Harrison describes the horrid misogyny of medicine in the 70's and 80's. She tells of doctors making fun of fat people, using their opened bodies as puppets and saying cruel and hateful things about anyone that looked different. She talked about how she was nauseated by the humiliations the patients never knew about because they were under anesthesia. She realized that some patients did, in fact, know what was happening when they would talk about it, usually groggily, in the Recovery Room. Doctors poo poo'd it, passing it off as delusional ramblings, certainly to assuage their guilt as perpetrators. I was terrified I would be made fun of; I was very fat and had a lot of hanging belly (a pannus). I begged Dr. Repka to forbid anyone to make fun of me, to keep the OR talk kind and respectful. He promised he would and, a nurse told me later, he had. To this day, my psyche blesses him for his kindness. (Every time I have had surgery since that book, I ask my surgeon to please be respectful and purposeful during the operation. My heart is too tender to endure teasing and verbal torture about my body.)

In those days, patients checked in the day before surgery so they could prep you (shave you/give you an enema), keep you NPO and such. So, I spent my first night away from the girls.

My former husband brought the baby to nurse before surgery, which was early as all get out. I'd asked to be the first surgery of the morning so I wouldn't have to wait too long to nurse again. Then I was wheeled into surgery.

When I came out of the operating room, I was taken into the Recovery Room, where folks usually stayed for two to four hours. I got out of there in one. While I was lying there, though, a couple of nurses were chatting around me, saying how I planned on breastfeeding right after surgery and they couldn't figure out why I would want to do that, that it would be so much easier to bottle feed. In my quickly-becoming-coherent state, I said, "But, I can't bottle feed laying down." "I guess you're right!" one of the nurses said. Dr. Repka came out and I asked, "Do I have everything?" I was so worried about having a hysterectomy... assuming I was going to have more kids. (I never did.) He leaned close and said, "Everything's there and you're fine." Later, he described to me what he'd pulled out of my peritoneum -two large free-floating, blood and fluid-filled cysts, one the size of a grapefruit and the other the size of an orange. As he picked them up out of my belly, they burst like bubbles, spilling the fluid inside my body. There were other, smaller cysts that he was able to scoop out. They were nothing but blood and bodily fluid, said Pathology.

(When I had Tristan, I didn't poop for about 4 days postpartum. When I did, I tore my rectum, spilling blood and poop into the toilet. After Meghann's homebirth, I was able to poop fine, but the second day postpartum, when I thought I was peeing out my butt, the toilet had filled with bright red blood. The colo-rectal specialist found a tear in my colon and wanted to repair it - at least a week's stay in the hospital. I asked to have 24 hours to decide [I was three days postpartum!] and by the time I saw him the next day, the bleeding had stopped. So, when Aimee was born, I fully expected to tear again, but, when I didn't, it wasn't a total shock that these cysts seem to have come from my bowel. Instead of the blood flowing out my butt, they formed cysts inside, blowing up like balloons, sealing off and then floating around waiting to be absorbed -or scooped out by Dr. Repka.)

The picture above was taken (look, a Polaroid!) when I was one hour post-surgery. I barely remember that moment, but totally remember the pain. My incision ended up 13-inches long, from hip to hip. This was a pretty typical length of a cesarean incision, too. They've gotten much smaller. There's a pillow over my incision so Aimee couldn't kick it. Meghann was right there, too, but was lifted over the rail, dangling, and nursed that way.

A dear LLL friend named Mary Hart (who became a CNM in St. Louis... anyone know her?) hung out with me every single day, from 8am (when the kids were allowed to come) until my former husband could bring the kids later, usually about 4-6pm or so. Then he would take over until 8pm when everyone had to leave again for the night. Mary was so amazing, sitting there waiting until I was awake so I could nurse Aimee as often as she needed to. I knew it was wonderful then, but am flabbergasted that someone believed in the nursing relationship so much that she would sit, day after day, for six days. I am eternally grateful to her.

When Aimee was brought to me in the morning, she would nurse nurse nurse and then throw it all up. Then she'd nurse again, this time slower, and suckle for some time after that, finally falling asleep in my arms. She would not take a bottle or spoon from her father, so waited to eat all night long. How brilliant is that?! Each day, it was the same thing. Nurse, barf, nurse slowly.

I am generally a whiner anyway, but let me tell you, that incision was the worst pain I have ever felt. It was worse than the vertical incision I had in 2001 for the gastric bypass. Of course, this laporatomy incision was under my pannus, so that made it a challenge to keep clean and dry; that didn't help. (This is a common issue with fat women post-cesarean. I make sure fat women know how to take care of their incisions, minimizing the risk of infections, including yeastie ones.) 

The nurses were evil. They wanted me to get out of bed on DAY TWO! I refused. (Today, they would be discharging me on Day 2!) On the morning of Day 3, they took my catheter and IV out and said if I didn't want them back in again, I was going to have to get up. They knew right where to get this girl. (I am HELL to get an IV into. I've had them in my feet and even jugular vein for one surgery.) The first two times I just sat up in bed, I passed out from the pain. I thought I was going to live and die in that bed. Mary helped me learn to use my legs instead of my belly muscles, putting a pillow tightly over my incision, and I was able to get up eventually. Then they forced me to flippin' walk. WALK! They made me WALK! Sheesh. Witches.

The post-op days are a blur of pain, allergy to pain meds (got a lovely rash on my ass that I kept trying to show Dr. Repka -and every time I showed him my big butt, the rash was gone!), and continuous daytime nursing.

I went home, still doped up on drugs, but nursing like crazy. Aimee never seemed phased by any of the meds, general or otherwise. If she did, I sure didn't notice. I slept on a single bed with Aimee in another room while the kids' dad slept with the other two. I remember sleeping in that bed for another two weeks before I felt safe enough to sleep in the family bed again. I kept a pillow (that Mary Hart made for me) in my belly to protect it -and, amusingly, still sleep with a pillow tucked into my belly today.

When I hear of women who have to have surgery while nursing, I tell this story so they know there are possibilities beyond weaning, no matter what a doc tells them. Happily, there are more resources today than then, letting us know which meds are okay and which aren't. I help women tap into those, too.

I know old people say things like this, but, it seems like yesterday that this happened. How is Aimee 23 already? (24 on April 20.) How did they grow up so fast? Nurse your little ones, ladies. Surgery or no surgery. Hold them close.

Reader Comments (6)

I'm very impressed! I don't know if I would have the determination to stick with it through all that. I think, that I would want to, but in practice, I'd say "screw all of you, go away and someone bring that nurse back with more morphine. ZZZZZzzzzzzz"

How wonderful that your friend was able to stay with you all week to help Aimee nurse. Quite the story!

April 9, 2010 | Unregistered CommenterStassja

Wonderul story. I sent this to m SIL who needed to have her gallbladder removed a month after her daughter was born and thankfully she didn't listen to her mother about weaning for surgery. Thank you for sharing!

April 13, 2010 | Unregistered CommenterKendra

I had an appendectomy two weeks post partum - I had to fight the night nurses on the floor to get me a breast pump, and asked for a lactation consultant as well. The nurses said they only had pumps on the maternity floor. I told them to send someone to go get one then and bring it to me. I had to insist. They eventually did, but no one knew how to work it. I figured it out on my own, and although I was there two days, they never sent a lactation consultant. But - it was worth the effort. Unfortunately I had not built up any milk supply (being an appendectomy and all), so my boy had a few bottles the first night as I pumped and dumped. :( But no nipple confusion and he nursed from day 2 on, with me on ibuprophin. He weaned himself around 15 months.

You story is very inspiring. Your support system was beautiful! :) Thank you for sharing!

April 22, 2010 | Unregistered CommenterAnisa

Thanks for sharing this.

I just had a hysterectomy at 4 months postnatal. I am tandem nursing my baby and my toddler. I didn't nurse much in the hospital though -- I pumped to keep my supply up and opted for lots of pain meds. My doctor said it was fine to nurse on the meds though so I sent the milk home. I was up and walking the next day and discharged on the third.

I think all the walking (I had to do a lot of extra hallway laps to manage my milk supply) really helped me recover quickly. I can't imagine getting up and moving without painkillers though.

My point is I think pain management is crucial for recovery and I'm really glad all my caregivers were very supportive of me continuing to breastfeed because it means the world to me.

I was very anxious going into the surgery -- to be seperated from my babies overnight! -- but it turned out to be much less worse than I expected.

April 23, 2010 | Unregistered CommenterBetsy

AHH!! I've just found your blog through a link on a friends Midwifery profile.. and have now gone through about 100 posts. I love the way that you write, and of course, the subjects of natural, supported birth are near and dear to my heart.

As I'm sure it's many a nursing mommas fear, I'm so glad that you wrote about nursing through difficult medical circumstances. It's so empowering to read stories like these that blow common misconception out of the water.

Also, I feel so close to you as I read page after page of your heartfelt stories.. only now to learn that Aimee and my son share a birthday! (April 20th, not the year though.. ;D).

Cheers.. and thanks so much for being so fantastic. Looking forward to reading another 10 pages of posts!

December 18, 2010 | Unregistered CommenterSarah

Well, cool beans, Sarah! Thanks for the kind words... I could use them today. :)

I hope to keep you entertained, even if you don't always agree. ;)

Thanks for being here.

December 18, 2010 | Registered CommenterNavelgazing Midwife

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