What Amarissa did when her breasts were very swollen and painful and her four-day-old baby wouldn't suckle

Disclaimer: the case below is an amalgam of multiple cases that have presented to me, and is not derived from any specific or identifiable mother-baby pair who have seen me as patients. All names are fictional.

Amarissa’s breasts are in real trouble, she feels sure, and she can feel the panic rising. Goodness knows how she’d managed to fall asleep in the noisy maternity ward. Now she woke to her baby's screams, trembling out from the clear perspex bassinet in the dimly lit room, strange shuddering little cries. Her partner Tom had left for home a few hours ago, late evening, promising he’d be back before breakfast.

"Go", she’d said firmly. He’d spent the last three nights by her side on a fold-out bed and he too was sleep-deprived and exhausted.

Amarissa’s breasts feel as if they might burst. The fierce hot pain and stabbing sensations are unbearable. Her perineal tear with its sutures continues to throb painfully, too.

She'd given birth to their baby four days ago. Tom had been amazing, and she thinks in a blur of pain that she's never loved him more than she does now that their baby had arrived. The little one had nestled in for skin-to-skin time in the hours after birth, sometimes bobbing down to lick and nuzzle her breast, but never quite suckling. There was just once when she thought the baby came on and suckled, but it was very brief.

After that, their little boy had never really come on to feed, no matter how much skin-to-skin time they had. The days since had been a nightmare, in fact.

Today Tom, who could sometimes be a little on the aggressive side when he was rattled and feeling out of his depth, had been sharp with the poor lactation consultant. The lactation consultant was a tall greying woman in her forties who told Amarissa she had three children of her own. The lactation consultant had been unable to help, despite suggesting Amarissa try various positions, despite showing Amarissa how to shape the breast with her hand, despite trying what the lactation consultant called the ‘baby-led’ approach, despite various cushion arrangements, despite trying a feed lying down.

Before she left, the lactation consultant advised Amarissa to continue hand expressing or pumping and to feed the baby using the syringe or bottle. Then she left for the bedside of the next woman who was having trouble with breastfeeding, promising at the door to come back in tomorrow.

And now this, in the night. Amarissa’s breasts are three times their pregnancy size, each one hot and red over the whole of the skin, and unbearably lumpy and painful.

She’s already tried to bring the baby on, once again, but he only screamed louder. A midwife came in and said she should stop trying. "Just hand express," that midwife said kindly. "I’ll be back in ten minutes."

Amarissa begins to practice the strategies she uses when she feels desperately upset and overwhelmed. She’d rehearsed them again in pregnancy.

The pain is awful. The midwife comes back with anti-inflammatory tablets and a paper cup, fills it with water from the plastic jug on the bedside table, and suggests Amarissa swallow a strong dose, which she does. Then the midwife asks if she can look at Amarissa’s breasts, which feel like hot pulsing watermelons.

Amarissa puts her little boy down with soothing words, though the baby keeps screaming. She lifts her nightie, feeling oddly ashamed at these huge and ineffectual things which had attached themselves to her – then catches herself.

My mind is being very unkind to me again, she says to herself, always blaming or shaming me when things are stressful. No, my breasts are beautiful, she insists to herself silently, as the midwife looks at her bared chest for a moment. What is true is that Amarissa's breasts are very generous, and extremely full - they are doing their best to make milk, and they are beautiful. Tonight, my breasts are working out how to do this new thing. Tonight, they are suffering. My beautiful breasts are in pain, on fire, in crisis, she tells herself. We’ll work this out together, she says to her breasts, all the while not making a sound.

The midwife shakes her head a little, wincing and making sympathetic noises, letting Amarissa know she understands how much pain she must be in. Then with a quick look to check that Amarissa agrees, the midwife picks up the crying baby, and drapes the newborn across her strong midwifely forearm so that he can look at his mother. He starts to settle just a little. With her free hand and arm the midwife helps Amarissa’s aching body into the shower.

Under the warm water Amarissa begins a very gentle movement of her great aching milk-filled breasts, cupping them in the palms of her hands. She touches and moves her nipples too, very gently, as best she can. The nipples have nearly disappeared because the breast under her areolas is tight and bulging with milk. For a moment she finds herself crying, her tears mingling with the water, her chest heaving with sobs. The midwife places a kind hand on her wet upper arm.

But they continue to focus on the task at hand. Amarissa remains very tender with her breasts. Her nipples weep a few drops of dense yellow-cream milk, and then some more. She continues to lift them and move them gently, in various directions, still cupped in her palms, still weeping quietly in despair. Some more hot sticky new milk leaks from them. The midwife asks for consent, leans in, and shows her how to express the milk by hand, gently. She repeatedly checks in with Amarissa to make sure that it's not too painful. The midwife is very careful, and although it really hurts, Amarissa can see more milk, drop by drop, join the warm water running down her aching body.

The baby begins to scream very loudly again. The midwife puts him back in the bassinet and helps Amarissa out. Amarissa dries herself and reclines back on the bed, supported to about 45 degrees, her legs out reasonably straight. Then the midwife shows her how to apply some light pressure over her areolar with her fingers, pressing back for a period of time.

"It’s called reverse pressure softening," the midwife says. More creamy yellow drops leak out. Amarissa presses with her fingertips for twenty seconds in one place, then moves to another.

The midwife explains that she'd like to use what is known as the gestalt method. Amarissa looks at her blankly. "Sure."

The midwife places carefully rolled up cloths under Amarissa’s breasts, which feels rather weird but definitely alters where her breasts fall and her nipples look, and the midwife – asking first - actually tucks the baby’s little hips up under Amarissa’s other breast. This feels even weirder by a long way. The midwife lets the baby’s face plant into Amarissa’s breast above the nipple and areola, into the whole hot red lumpy flesh of her beautiful fiery breasts.

The baby grizzles, licks, pants, shakes his little head over her breasts, his cheeks and mouth sweeping over and bumping against those tender nipples. Amarissa winces but speaks to him with encouragement.

"You can do this sweetie, I know you can!" she murmurs.

The midwife helps, her hands firm on Amarissa’s forearm, using the forearm to help the baby bury in and begin sucking, showing Amarissa how to use micromovements, keeping the little boy tucked up firmly under the other breast as the whole of that breast rests on his hips and body. It hurts a lot ... "But it’s a good kind of hurt," Amarissa says, as they watch the baby – suck suck suck suck suck.

"Oh my God, he’s on, I can’t believe it!" Amarissa says, glancing up at the midwife.

And soon there is some relief, just a beginning, but they are underway.

"What matters is let-downs, letdowns, letdowns," the midwife says. "You won’t feel these, so for you that means bringing the baby to the breast as often as possible, even for very short periods, and also some gentle hand expression again, whenever you can." They are underway.

For the rest of her life, Amarissa would sometimes tell the story of that midwife, the angel with the kind, matter-of-fact hands who knew just what to do when her newborn was hungry and her milk wouldn't flow and her breasts were on fire and she was sobbing in the shower.

By morning, when Tom comes, Amarissa hasn't had much sleep but her breasts aren't as red and tight and painful, and the baby suckles enough milk when he comes on to make him milk drunk and drop back into sleep.

Tom hadn’t known what to expect, after waking to a few distressed texts from his wife. He'd dressed as quickly as possible, hadn't even paused for breakfast, and now stood stock still at the door, gazing at them for a moment, worriedly checking out the situation.

"How are you," he murmurs, hardly daring to ask.

Amarissa smiles, shaking her head in disbelief, tears rolling down her face once more, slowly caressing the soft cheek of the baby sleeping in her arms.

"We’re getting the hang of it," she says bravely, looking up at Tom for a moment "- aren’t we baby!" Their little boy didn’t stir, breathing softly, his mouth a rosebud. "My breasts still hurt, but they’re getting better."

Tom comes over and ever so awkwardly, ever so carefully - because he loves them both beyond words and he doesn’t want to hurt his partner's aching body which he cherishes, and he doesn’t want to wake his precious sleeping little son - gathers Amarissa into an embrace.

"I have no words," he says, voice choking. "You. Are. Amazing."

And if you don’t have a Tom or a Jane or a loving person to say that to you, and the fact is many of us don’t, say it to yourself over and over. Or hear me saying it to you.

You. Are. Amazing.

Really.