Breastfeeding 2.0

Oooh, breastfeeding.  You and I, we're not friends.

It's no secret that Jack's and my breastfeeding relationship did not go well.  I went into it thinking that breastfeeding was a totally natural process and it just happened.  Well, it doesn't quite work like that.  I quickly discovered the learning curve involved, but then real problems developed when I didn't produce milk like I was supposed to.  It never even entered my mind that we would have problems, I didn't realize it was possible, to be honest, so it was a big surprise when it didn't work.  After struggling for 2 weeks and dealing with Jack needing to take formula, but not wanting a bottle, we switched exclusively to formula feeding when it was apparent my milk supply was never going to "come in".

This time, we went into breastfeeding with eyes wide open.  We were very hopeful that my experience last time was isolated and it would go differently this time around.  I REALLY wanted breastfeeding to work for us and part of the reason that I was working so hard for a VBAC, and hopefully an unmedicated one, is because I wanted the best start possible (well, in general too) to kick off our breastfeeding relationship.

In the hospital, right from the start, we did all the right things.  Molly latched on and nursed less than an hour after birth.  During our hospital stay I literally had her skin-to-skin or latched on nearly the entire time.  The only time she wasn't was if someone else was visiting with her or if they took her for a quick test.  Other than that, snuggled on my chest or nursing.  Luckily, she has a very strong sucking reflex (she's much more into sucking than I remember Jack being.  Her hands are constantly in her mouth and she's already sucking on her thumb quite a bit) so she was perfectly content to nurse, nurse, nurse.

I know she got colostrum the first couple of days.  We saw a lactation consultant each day we were in the hospital and she was able to manually express some colostrum (she's magical!  I wasn't able to do this.  I am not skilled in the ways.) so I know it was there.  Molly had way more than the required number of wet and dirty diapers the first day she was born.  The second day she was still ahead of the game with wet and dirties.  The third day she drastically slowed down.

Her birth weight was 8lbs 11oz.  By day 2 she had lost several ounces... I'm thinking she was down to just over 8lbs, but I don't remember specifically.  She had lost less than 10% of her body weight, so it was still within the realm of normal (I *think* at that point she was at like 9% lost).  By day 3 she was down a full pound.  Her discharge weight was 7lbs 11oz (down ~11% of birth weight).  The nurses were in contact with our pediatrician to see what they thought about the weight loss and unlike last time (where we were advised to start supplementing with formula in the hospital.  Although, the circumstances were a little different.  The weight loss was similar, but Jack was not happy at the breast.  He would latch-unlatch-cry-latch-unlatch-cry.  Molly was content to just continue to suckle even if she wasn't getting much of anything) they advised us to wait through the weekend to see if my milk would come in (it was still early, both my OB and the lactation consultant at the hospital had said it could very well take 5-7 days for my milk to come in post-surgery) and then come in for a visit with them Monday morning.

Hearing that she had lost a full pound was really hard for me.  I cried.  I was so frustrated because at that point I just knew we were headed down the same road.  It was the same experience as last time and there was nothing additional I could do about it. 

Over the weekend we nurse, nurse, nursed and hoped that one morning I would wake up and the breastmilk fairy would have visited.  Again, if she was willing to latch on, she was there.  She would constantly fall asleep at the breast so we were trying to keep her awake and actively suckling for 20 mins per side.  Still no increase in milk.

By Monday I still hadn't had any noticeable changes with my breasts.  We went to our office visit and Molly weighed in at 7lbs 6oz (at this point she had lost ~15% of her birth weight) in addition to lacking adequate wet and dirty diapers.  At that point the pediatrician recommended formula supplementation.  So we nursed and supplemented with a little syringe and that day I made an appointment to meet with another lactation consultant.     

Last Wednesday we went back to the pediatrician's office for a weight check and Molly was back up to 7lbs 10oz.  Yay!  They want at least a 1oz gain per day and she was doing great at 2oz per day.  The doctor said, "so I take it your milk has come in?".  Nope.

Later that day I met with the LC.  She checked out my technique and Molly's latch, both were great.  Molly latches well, sucks well, doesn't have a tongue tie or anything else that would cause problems with breastfeeding.  I physically look fine.  We discussed my past experience and my experience this time.  We went over possible red flag circumstances which could cause milk production issues (things like breast surgery or PCOS, etc.) and I don't fit any of those factors.  We stripped Molly down to a dry diaper and the LC weighed her with a special, sensitive scale, had me nurse on one side, weighed her again, nursed on the other side, weighed her again and found that she got 2/3 of an ounce after she emptied my breasts.  That's not enough milk :/  AND this is my milk production on the maximum recommended amount of Fenugreek supplements per day and drinking Mother's Milk Tea. 

All things considered the LC believes that I either have insufficient glandular tissue or the hormones aren't working properly.  Either way it's not something that can really be "fixed" and bottom line, I'm not making an adequate amount of milk even though I'm doing everything right.  GAH!  So tired of hearing that things aren't going to work out despite doing everything the way it's supposed to be done! 

We discussed a plan of action and the LC recommended that for a week we nurse (and during that time I only nurse for the time when she's actually getting milk rather than comfort sucking because I'm to the point where my nipples are cracked and bleeding and we have to get them healed!  She showed me what to look for and also how to massage the ducts to make sure she's getting everything.  I was surprised to discover that non-productive/comfort sucking actually doesn't stimulate additional milk production the way productive sucking does.), then supplement with formula, then I follow each feeding with pumping for 10 minutes to make sure I'm definitely empty and to hopefully stimulate additional milk production.

We've been doing this, but unfortunately I haven't seen any improvement.  Frustratingly enough, it seems that I'm making even less milk.  I could be wrong about that, but Molly seems to be productively nursing for less time and sometimes I end up just pumping instead of actually nursing (the way we're feeding her takes quite a bit of time so sometimes it ends up that the amount of time that has passed by the time I get a chance to pump ends up with a missed feeding, if that makes sense) and I'm getting less and less from the pump now.  I know that nursing is far more effective than pumping, but I can't see a reason that I shouldn't expect to see the same/more milk if I was continuing to make the same amount of milk or more.

I don't know.  We're going to stick with it and see what happens after a week.  I said that because Molly doesn't seem to mind going back and forth between breast and bottle the way Jack did that I would try to do a hybrid of breast- and formula-feeding if I could produce milk on my own.  I can't keep up with the nurse-bottle feed-pump routine for obvious reasons, but if I can just put her to breast and she'll get something that's okay, but I feel like it's not even looking like that's going to happen at this point.

So frustrating.  My body just isn't cooperating with anything right now.  Also, something like 5% of women can't produce milk.  WHY do I have to be part of that 5%?!  I mean really...



I wrote this post last week and I'm just getting around to posting it now so I thought I would update with how things have played out so far.  

We did the nurse-formula feed-pump thing for about half a week.  After that I was just so sick of the whole process (it's just so involved.  Basically, to feed my kid, I was utilizing every technique out there.  Most moms either bottle feed, nurse, or pump.  I was doing all of them, all day long.  With a newborn.  And a toddler.  And while healing from surgery.  Do you know how much time that takes?  All of it!  Oy, it was just too much and was enough to make me want to throw in the towel on breastfeeding completely and just switch exclusively to formula-feeding.  

When I met with the LC last Wednesday she had said not to drive myself crazy with this protocol and if it got to the point where I was starting to hate the whole thing to stop.  I was getting to that point so I stopped.  I don't regret it because it didn't seem to be making a difference.  It's obvious to me at this point that I'm never going to have a full supply regardless of what I do so I need to simplify if I'm going to be able to continue our breastfeeding relationship at all.  It's already incredibly frustrating not to produce enough milk, I just can't deal with the demand of nursing and bottle feeding AND pumping around the clock.  I would rather spend that time snuggling my sleeping newborn than hooking myself up to a pump to try to slightly increase my sad milk supply.  

So anyway at this point we've decided to do a combination of breast- and formula-feeding to get the job done.  This was something that the LC and I talked about during our meeting - that unfortunately the reality may be that I may never make enough milk to provide for all of her nutritional needs, but that doesn't mean that our breastfeeding relationship has to end completely.  That doing a combination of breastmilk and formula is an option as well and for some women, this is just how it has to be and that's okay.  I'm really glad we had that discussion.  Some breastmilk is better than none and I still have some so I start by nursing Molly and then we give her a bottle of formula to finish it up.  For the most part this is going okay.  Molly still seems to be fine with taking both breast and bottle.  I have had a couple instances where I just couldn't get her to latch on.  I don't know if she was just too hungry or if it was nipple confusion or what, it's like she forgot what she was doing, but then the next time she latched just fine :shrug:  

The other problem has been that she's a snacker.  Feeding a newborn takes a good amount of time even when they're actively participating the whole time because you have to stop and burp them frequently and make sure that they don't over-indulge their tiny tummy (I'm talking about formula-feeding in this instance).  But Molly likes to take a little bit of food, then fall asleep for a cat nap, then wake and eat more, fall asleep... and so on.  It can easily take a few hours to get a single feeding completed.  She's especially sleepy at the breast (not surprising, I think this likely has to do with the slow flow of the milk.  I know it's comforting to her to nurse and added to that she's a sleepy eater anyway and on top of that because I have such a low supply the flow is even lower than it would be otherwise.  All of these things combine so that at least half the time I latch her on and she's asleep very soon thereafter and I have to work to keep her going so that she actually drains the milk from my breast as much as possible.  Lucky for me, it doesn't take all that long.   

So a combination of nursing and formula is the plan for now.  I do enjoy nursing her (it's become much more enjoyable the last day or two now that my nipples are doing better!  Before that it was like torture to nurse knowing that it wasn't even necessary considering my supply is crap and she's getting the vast majority of her nourishment from the formula.  It's still not a totally pain-free process, but I think we're over the hump and headed that direction!) and it makes me happy to know that she's at least getting some breastmilk and the benefits that go with it.  

It's hard to say how things will play out with my supply, or if she will continue to be content nursing from the breast when she knows that the instant gratification of a bottle is coming shortly, but for now we're just taking things one feeding at a time.