Saturday, December 14, 2013

Offtopic: My Low Milk Supply Journey

This is going to be a long story related to breastfeeding and milk supply issues, so feel free to skip it if these things do not interest you! I've had such a weird and difficult journey, I feel I should share it somewhere that might help at least one other person.

Having a baby is a scary thing, especially when you have a personality such as mine where you want to know everything ahead of time and prepare appropriately. There's too much to know that can only be gained from experience and every baby and parent combo is different. From the time I knew I was pregnant (at 5 weeks, essentially) until I delivered, I was always researching one thing or another. Of those things, some amount of time was devoted to breastfeeding (but not a huge amount). I knew I wanted to do it for some pretty logical and non-emotional reasons, which seems a little out of the norm. I did not dream of a magical bonding experience with my little bub (though if that would happen, that's neat!) but I wanted to feed him for free (more or less) with the best stuff I could provide and burn some extra calories all at the same time.

I did some reading and watched some videos, it all seemed quite straight forward. Ha ha, cough, sputter. Yeah. So, come delivery day, with the help of the labor and delivery nurses we get him latched on about 1.5 hours after he's born and he seems to be doing well. We also had lots of skin to skin time from the moment he was born. As the rest of the day and the next proceed, I'm having difficulty getting him to nurse. Latching and positioning are so much harder than I ever would have expected based on those videos I watched. I got help from nurses, but they just guide his head and pop him on without me really getting what I'm doing wrong. But we plug away and he'll hang out for a while sometimes, other times I get nowhere. He was very sleepy and we were constantly trying to wake him to eat. My nipples were getting pretty sore and dry, the lanolin I had packed didn't help much either. We're into day 2 and I haven't had my milk come in or any breast changes for that matter. The pediatrician brought up that formula supplementation might be an option we need to visit but we'll see how things are doing the next morning before we go home. Day 3 arrives, no more milk and he's lost 10% of his birth weight which is a concern. Diapers are slacking off as well. Lactation consultants come in, given a crash course in pumping and supplementing with formula via dropper with the explanation that this can get him over the hump until my milk comes in (hopefully a few days). The plan is to nurse every feeding, supplement with formula, pump afterwards.


I think I made it 3 or 4 days home before I was so overwrought with frustration nursing him that I decided to take a break and do pumping only. He wasn't eating as often as a normally breastfed newborn would (8-12 times a day), going 7-8 times usually. When he did try to nurse, he'd fall asleep. And that was after the fight of getting him to latch while he's screaming frantically and whipping his fists in front of his face.

Day 5, we went to the pediatrician (he was born on Wednesday, we left hospital on Friday, pediatrician was Monday) and she informed us had a tongue tie. He couldn't extend his tongue past his gums. They released it and said it should help him nursing. We had our first follow up with the lactation consultant on Tuesday. Got some tips here and there on latch and positioning and increasing my milk supply. They recommended Motherlove More Milk Plus - one thing I would throw out there is that on their site they mention Fenugreek can lower T3 levels, so it should be avoided by people with hypothyroidism. I was not aware of that at the time. Having the thyroid levels be off is something else that can affect supply, I had mine checked regularly while pregnant (no adjustment to medication was deemed necessary) and about 6 weeks after delivering. Still were mainly pumping, but would have a week or two of nursing attempts daily before I'd go back to just pumping. Still no significant milk increase or any breast changes. Somewhat early on, I was getting 1/3-2/3 ounce (within the first week I think) per session but he was eating a fair amount per meal and we probably were over supplementing him without realizing. As time went on through 2 months, I was mainly pumping and nursing 1-2 times a day. He was slowly getting better at nursing, we were better at latching/positioning and he was extracting milk without passing out.

I posted a few times on the La Leche League forums, while I think there is a ton of great information and support there I do confess to coming away feeling like a complete idiot many times. It wasn't the best experience. I did though get some information about bottle feeding in a breastfeeding supportive way (paced so he wouldn't gobble it down) that was intended to also help not oversupplement, letting him tell us when he's full. Unfortunately, my little guy just cries frantically for food whenever bottle feeding so it's really easy to overfeed. Even with pacing and nearly 4 months of experience, he cries when we take the bottle away until he's burped. Then he'll be all smiles!

Around 2 months, I decided to move from pumping most of the time to nursing most of the time and pumping after. That did not work out too well during the day, often once I got him settled it would be very close to his next feeding and I didn't want him to struggle nursing for quarter of an ounce. In not much time, I switched to nursing every feeding. This also in theory would help my supply a bit since they all say a baby is better at getting milk out than a pump. Somewhere in this mix, I rented a Medela Symphony hospital grade pump and a BabyWeigh scale. The pump I was using before was a Medela double electric of sorts, and I can't say I've seen really any difference in amounts I can get between the hospital grade and single user (yet another thing that's said would help with supply). The BabyWeigh scale though has been pretty great, we can see how much exactly he's getting at a feeding and then supplement accordingly. So we have a lot of data on what he's getting from me and the bottles. The husband and I are very data-oriented types, so it's been pretty awesome. And turns out with nursing every feeding, he gets about 11-13 ounces a day.

I decided at 3.5 months to make one last push to increase my supply. La Leche League pretty much universally agreed I needed to either nurse him overnight or pump. He started sleeping through the night (a stretch from 6-9 hours) around 3 months. I was very reluctant to get up to pump and knew I really didn't want to try nursing him because he doesn't nap much during the day (30 minutes every 2 hours more or less). So I went with pumping between nursing sessions during the day. In theory I was getting double the stimulation with a little extra milk removal. I also consulted the lactation consultant (IBCLC) seen before, she said increasing at this point is difficult but recommended some different herbal supplements I could try. I went for 9 days with the extra pumping during the day with no change. I'd get 5-10mL pumping and he'd get a little less nursing. I had about 4 days where he either ate overnight or I set an alarm to pump so I wouldn't go more than 4 hours without pumping or nursing. I was exhausted and also saw a marginal change. I can see how I might get a little more (maybe an extra ounce or two?) with the overnight pumping but it's not worth the fatigue to me.

This is when I decided to stop trying, researching, thinking about increasing my milk supply. Maybe it was something we did "wrong" in the beginning, maybe I should have been pumping 12 times a day in that first month. I do believe that it was a combination of his tongue tie, tendency to fall asleep at the breast and something on my side. I didn't experience breast changes other than weight gain increase early on during the pregnancy (except for very painful vasospasms in the cold). My capacity seems fine because I can nurse him fully after his long sleep, he often is getting 5.5 ounces. But I never can seem to get past making around half an ounce an hour. It's really quite consistent!

My little guy is growing like a champ (he's already grown out of 6 month clothes lengthwise and comfortably into 9 month), he's happy and so are we. I nurse every feeding and I do love that first feeding in the day when we don't need to worry about making a bottle. But bottles aren't so bad, and I'm really glad I have the option to do both. It is a little bit of a bummer that I can't stock up on any breast milk, so I need to be with him at every feeding - but really, he can always have some formula and I can pump while away for later or just fill up a bit for when I get home.

I know how much pressure we put on ourselves, and it really feels at times that you failed your baby if your milk isn't enough. But we tried our best, our babies are happy and eating and growing and that's ultimately what is important. I'm happy I have let go of that constant research and fiddling to increase my supply business, it can really get you down! Thank you so much for taking the time to read this, and if you have had any struggles with milk supply or breastfeeding I'd love to hear from you.

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