Bionic Mamas: April 2011

(It's taken me two days to write this, so the time references are all off. I know you don't care, but For The Record.)

This morning, during the twenty minutes that the Bean deigned to sleep not on me (not that it isn't adorable, but pretty soon I'm going to form adhesions to the Boppy and the couch) I wrote my GP a thank you note.

Now, I am southern and everything, but I am not that devoted to the note-writing -- I'm not caught up with the baby gift thank-yous (or COUGH the wedding ones) -- but sometimes it is just Called For. And now, a few glorious days into my new life as a person who doesn't spend six or more hours a day gritting her teeth and feeling her eyes protrude from the pain of invisible vice-grips on her nipples, now is one of those times.

In short: Nifedipine is amazing stuff. My GP rules. I am ever-more angry at Dr. Russian's nurse, the practice as a whole, and, sadly, Dr. Russian herself.

(Ha! I just got back from several hours outside, where I walked around pain-free in only a tanktop! I nursed outside, even, without agony! Yes, it's beautiful and warm today, but it is usually hot as blazes in our apartment at night, thanks to a very enthusiastic heater over which we have no control, and that never stopped my nips from seizing up for hours on end.)

In long: I started having vasospasms over a month ago. Or at least, that's when I realized I was having them. It took me a little while to sort out that pain from the typical surface pains of early nursing and the pinching of Mr. Crocodile-Jaws's lazy latching (corrected by the Hippy But Not Dippy LC), but those things don't turn your nipples white even when you haven't nursed in hours or leave you cussing like a sailor while clutching your chest in an attempt to warm them up through two layers of cloth nursing pads, two shirts, a thick sweater, a wool shawl, and a coat when it isn't even properly winter any longer. Once I figured out that's what they were, I told myself to be patient, that it was all due to an injury from a bad latch that was fixed now, that I was exaggerating. I also managed to repress that my mother has Reynaud's and that we both have migraine, which is related.

After a week, I called my ob's office and asked about nifedipine. The nurse called back, all patronizing and unhelpful. "Oh, we wouldn't do that." Why not? No reason, just vague admonitions about taking medications while breastfeeding. Use warm compresses. I am, I said, and it's not helping. Use warm compresses. I lost it. Not pretty. Crying. Raised voice. Accusations that they didn't care about my health -- I'm going to stand by that one. The fact is that they did not care enough to, you know, do anything about the quarter or more of the day (and I mean out of 24 hours) that I was spending in pain. Only it wasn't pain, I guess, since the nurse kept referring to it as "discomfort." (This is the same woman who, when Sugar called in to ask if we should go to the hospital and I was having a terrible contraction in the background, told her that I "needed to calm down." Because back labor is so much less painful if you're quiet about it. Very helpful bitch, she is.) She called back later, probably because I was so obviously enraged, said she'd talked to the doctor (whoever was in that day), confirmed that they wouldn't prescribe for me but here was the number of the LC around here who is also an MD...who doesn't take insurance (reprehensible) and who charges you to read her website (seriously).

So I wrote to the HBND LC, and even though it was Friday afternoon and she takes Shabbat seriously, she wrote back immediately with a number of suggestions. I dutifully added more horse pills to the supplement brigade (calcium/magnesium and oatstraw in addition to prenatals, brewer's yeast, folic acid, and vitamin D) and tried to soak my nipples in hot salt water (which is awkward as hell and just left me with a damp, salty baby nursing the non-soaking side while the first side went bananas the minute the air hit it anyway). I heated nursing pads in the microwave -- they went from scalding to clammy in a nano-blink -- and tried unsuccessfully to position a heating pad over the first boob without letting it touch the baby as he nursed side two, electric boogaloo. Eventually, I gave up everything but the supplements, dressing like a wrestler trying to sweat down a weight class, and weeping. I made extra-warm flannel nursing pads and layered them until I looked like I was stuffing my already ginormous bra. I tried not to scream at the baby for crying, although every time he did so, the let-down reflex made my nipples crush themselves. My efforts to avoid cussing while nursing met with mixed success. (Mother of the YEAR, I'm telling you.) I refused to leave the house.

At six weeks postpartum, I had my ob check-up, at which my mention of vasospasms was ignored. When, at the end of the appointment, I mentioned that I thought it would be nice if they made a postpartum phone call to check in before then, Dr. Russian treated me to a strangely vehement tongue lashing, complete with raised voice and pointed use of my first name. I was accused of wanting them to do things "no one" does, of asking them to follow up with the baby (which would have been strange, considering how many times we went to the Bean's pediatrician for weight-checks). It was strongly implied that I had called the nurse too many times, despite the fact that every call I'd made had been for something on the hospital discharge paperwork, like a high fever, UTI symptoms, and a large and terrifyingly hamster-like clot. She kept returning to the idea that "this" was a job for family -- "We're not your family, Bionic, we're DOCTORS" -- as if I'd asked for emotional support rather than medical help. As it happens, many of my family members are doctors, and try as I may, I can't imagine any of them behaving that way to a patient, no matter how pushy and crazy the patient was. It was horrible, not least because it forced me to admit that her similar behavior during labor wasn't clever tough love intended to motivate me but just plain emotional instability. Farewell, Dr. Russian. I liked your shoes and your sass and your meat obsession, but if you aren't family, I don't have to put up with that shit.

As a confident, independent, properly-raised woman, it pains me to admit what a funk that visit left me in, but there you are. More weeping, more telling myself that this pain was something I just had to deal with, that it wouldn't even bother a good mother. I wondered how soon I could give up breastfeeding without hating myself for doing so.

Eventually, my pissed-off, entitled side beat the weepy bit into submission. I read up on nifedipine and discovered that the bitchy nurse was full of shit -- it's perfectly safe for breastfeeding and plenty common enough that problems would have turned up by now. Even the NIH thinks so, and they don't even think you should take aspirin because your baby might magically get Reyes Syndrome from the teensy bit that gets into your milk (not to mention that the Reyes/aspirin connection is not actually that convincing, says my father, whose field this is, after all). I trolled PubMed -- and yes, I will totally be using this as an example of why my students should PAY ATTENTION on the days we spend in the library, learning database searching -- and found several articles to the effect that Reynaud's of the nipple is real, is serious, and ought to be treated, if only because it hurts like hell and will keep people from breastfeeding. (I suppose it is too much to ask that it be treated just because it makes the mothers' fucking nipples fucking hurt, regardless of whether it might mean the babies get formula and therefore become dyslexic, asthmatic axe murders.)

I called my GP, whose receptionist told me to talk to my OB, but she agreed to see me anyway. (Meanwhile, Sugar went to see her ob/gyn, who asked after me. When Sugar mentioned the vasospasms, she said, "Why isn't she on nifedipine?" She assured Sugar it was very safe and said I should come see their practice if the GP didn't prescribe it. I had wanted to go to that practice in the first place, but they weren't accepting new ob patients when I got pregnant. Now that I'm a plain old gyn patient again, though, I am so there.) At the appointment, my GP listened to my description and the logic of my self-diagnosis and asked, "is there a treatment?" I trotted out my notes; she copied down my citations and wrote me a scrip for the dose I had found in the articles.

Sugar and I go to the same GP, and at times we have wondered whether her willingness to put us on or take us off of drugs we ask about means that we like her for the wrong reasons, because she does what we want rather than saying no. But really, why shouldn't she? We don't come to her with frivolous or dangerous requests, for one thing, but also, shouldn't we have some say in our own healthcare? If I want to try a drug that won't hurt and has a good chance of helping, maybe my desire (and pain) should be important enough that my doctor is willing to learn something new. My GP didn't do anything Dr. Russian couldn't have done. Even if Dr. Russian and her practice do not generally treat vasospasms (which, PS, they should -- 20% of women in childbearing years have some version of them), she could have listened to me, read the journal articles and/or consulted with colleagues, and done something to help, instead of turfing me to another doctor (on my own dime, too), and blaming me for needing help. As a child of doctors, I've spent a lot of my life arguing with people who claim that all doctors are arrogant. Besides my own family members, I grew up surrounded by doctors, and most of them were more like my GP than not. Most of them were like my father, who works insane hours seeing patients with tricky diseases, dictates notes late into the night, goes into the hospital every weekend (which requires sacrifices from families, too -- no camping trips or even full Christmas Days together), and still finds time to listen to his patients and their parents and think more about their needs than his ego. It pisses me off to no end (though I will end this post someday, promise) when a doctor acts like such a stereotype.

Enough ranting for the moment. The nifedipine is wonderful. The Bean is wonderful, too. He's smiling more and spending a higher proportion of his waking hours not screaming. We take baths together every night, which I love -- I haven't had a good bath buddy in 25 years. This morning, I think he really saw one of our cats for the first time. I'm so happy to be out of pain and able to focus on having a good time with him and bombarding my friends and family with pictures of his every move. Since you've been so good as to suffer through this interminable post, allow me to bombard you:

Hello, internets. I owe you a post or ten -- or at least some pictures (I got one with a smile yesterday! A smile!) -- but as I am typing one-handed, marooned under a finally-sleeping Bean*, I must beg your continued patience. However. I am seeing my GP tomorrow -- one of the stories I owe you is "In Which I Realize I Must Break Up With Dr. Russian" -- and, being sick to death of being in pain and (horrors!) losing precious sleep over this vasospasm business, I intend to talk to her about trying a low dose of Nifedipine (see here). She isn't likely to know much about it (as this is more in the purview of obstetrics, but See Above), but I've poked around PubMed and, since I'm already taking a large handful of supplements from the hippy-but-noy-dippy LC and doing everything else suggested in the article**, I think it's time to try it. I'd like to come to the appointment as educated as possible.

Right. The afforementioned Questions:

Any of you spasm-y sorts ever look into Nifedipine? Your thoughts appreciated.

Less pressingly but also of interest: What did your ob/midwife/Very Surprised Cab Driver do in terms of post-partum care -- appointments, calls, what-have-you?

And while we're here: 13 nursing sessions a day? Is it possible The Bean thinks he's a marsupial (as, in fairness, my mother says I did)?

*oh. He woke up. But he is nursing the non-typing side first. Score!

**except giving up my one daily cup of coffee, which, dear God, is an unacceptable request to make of a new parent, particularly one who is losing sleep above and beyond the usual and whose offspring refuses to sleep in the day except on her body or in a rapidly moving stroller near heavy traffic, making her own napping a difficult not to say dangerous thing to attempt. Next person who tells me to sleep when the baby sleeps gets stabbed right in the eye.