Monday, December 17, 2007

Breastfeeding: story of a letdown

Warning: this is a 'gratefulness aside' post. Feel free *not* to read
about the one problem area I've experienced on the other side.

In brief: What is this engorgement you speak of? Milk production
issues, no solution found. A compromise: give formula at the breast.

One thing I was really looking forward to was breastfeeding my baby.
It felt like the natural thing to do for me, especially after having
been forced to give up on natural conception and a natural delivery.
Though these losses are not in the same league, they do all touch the
theme of womanhood.

To prepare myself, I had read the La Leche League Breastfeeding
Handbook, in a translated and localized version. This book notes that
a C-section ought not impede breastfeeding, though it may require a
little more effort than usual.

During the preparations for the C-section, I was asked whether I
planned to BF. With a vaginal delivery, the baby can be introduced to
the breast immediately after birth. Not so with a C-section, as all
the sterile drapes were in the way and my arms were tied down. About
an hour after delivery Linnea and I were offered the first opportunity
to try our hand - or I should say boob - at breastfeeding. She latched
on quite quickly and to all appearances seemed to suckle vigorously.
The midwife seemed pleased, and so was I.

It takes a few days for your milk to come in, that much I knew. Those
days were spent practicing, as advised by LLL and the midwives. Linnea
showed a strong suckling reflex and was always enthousiastic. After
each feed she went straight back to sleep. All was well, or so I

Her weight loss in the first days didn't overly concern me, this is
normal in breastfed babies. As a rule, full term babies are allowed to
lose 10% of their body weight before the doctors intervene.

In the third night something changed. After her feed, she would cry
with that heartbreaking cry of a newborn. She would only be consoled
by laying on my chest, so that's were she slept. I thought she was
suffering from cramps. Hunger did occur to me, but weren't newborns
supposed to have stomachs the size of a marble? And all that energetic
sucking had to be good for something? Right?

Wrong. On the fourth day, she had lost just over 10% of her birth
weight. Time for action. The pediatrician prescribed supplement
formula. Linnea would be weighed before and after each feed, and
depending on how much she had gotten from the breast would be given a
bottle of formula.

Being concerned about 'nipple confusion', I asked whether I could use
a soft cup to give Linnea her formula. Advice I had read in the LLL
book. The pediatrician brushed my concerns aside, claiming she had in
all her years never encountered 'nipple confusion'. (So, LLL is lying,
I thought?) I didn't protest, being a frightened new mom, besides with
the 2 midwives also on the doc's side I was pretty much outnumbered. A
bottle it was.

I was all for giving Linnea whatever she needed, but did have mixed
emotions as well. I was failing my little girl. I felt it all the more
when she collapsed into blissful sleep straight after her first
bottle. Poor girl had been wailing with hunger those times before.

The weigh-ins just increased my anxiety. The very first time, Linnea
supposedly weiged 60g more after her feed then before. Puzzling,
because that is a full meal for a newborn, yet a bottle of 50 ml was
given to her and she guzzled it down. I was reassured that things
weren't as dire with the BF, but the next weigh-ins proved the first
one to be a mistake. Over the course of 30 feeds, she digested
anywhere between 4g and 20g of breastmilk. This was way to little and
at no point was there a consistent increase. In the end, this achieved
nothing but increasing my stress and anxiety levels, 2 factors that
impede BF by the way. It also made me feel like I was under constant
scrutiny, that they didn't trust me to take good care of my child.

In an attempt to increase supply, I was told to pump after each feed.
A fancy heavy duty hospital pump was rolled into my room and I was
given instructions on it's use.
Me: "Right. So, can this machine do double pumping?"
Midwife: "Erm. Let me check with a colleague."
Me (to myself): Am I the first person to ask this?!
"The machine can do that, but we don't have the necessary parts."
Me : "What a pity." - (to myself) Are they serious? What kind of
half-assed policy on supporting breastfeeding do they have here?

The next day I sent my husband out to rent an electric pump with all
double pumping necessities. I think that's when it dawned on the staff
and pediatrician that I was serious about BF. Not that this changed

Though many of the midwives and nurses were brimming with good will
and did their best to assist me, still I was left with the feeling
that I was being set up to fail at BF - in particular by the
pediatrician who so easily brushed aside my concerns.

Arriving home was overwhelming. For one, there is the sheer sense of
responsibility for this tiny baby. Then there's the rush of hormones.
Adding BF trouble to the mix was just more than I could handle. I
wasn't ready to give up, but I had no idea what to do next. I needed
help urgently, with each bottle I gave her I expected her to reject BF
more. How could I blame her, the bottle is food for free, while BF
demands hard work.

Something had to be done, so I called a number of independent
midwives/lactation consultants until I found one that was available to
come over the same day. That's how I met Muriel, who was to be my
lifeline for weeks to come. She listened to me, gave me pep-talks and
advice. I needed that. She also took charge of the situation, and I
needed that even more.

Fast forward 8 weeks: BF is still not the main act (Sideshow Boob!
:o), but I can rest assured that I've tried everything. I know I'm not
the first and won't be the last to go through this, so let me describe
some of the things we did.

The bottle feeding - or more precisely the risk of Linnea no longer
accepting BF - was my biggest concern and Muriel tackled that on the
very first evening. She recognized my fear wasn't unfounded. Guzzling
down a bottle IS much easier for a baby than BF.
So she taught me how to supplement by finger feeding, using a syringe
with a flexible tube. You let the baby suck your pinky (your nail on
the tongue is most comfortable) and then slip in the tube next to it.
Each time the baby suckles you squirt in some milk. Just like on the
breast, the baby needs to work for it's food, but with the advantage
that you can control how much they get better. The amount of effort
required from the baby is in between BF and bottle feeding. Linnea
took to it immediately. Anyway, this approach took away the sense of
urgency in my mind.

Next step was to assess how much supplementing Linnea really needed.
As I thought, the 50 ml given by the hospital is more or less a full
meal for a newborn. Sure, babies 10 days of age are given bottles of
100 ml (says the pediatrician), but they're not expected to empty them
(says the midwife).
Muriel advised to supplement only 20 ml after each feed for a couple
of days while monitoring her weight daily. Unfortunately, Linnea
slowly lost weight again, so the supplement was increased to 30 ml.
Lather, rinse, repeat and we ended up supplementing 50 ml again.
Supply was definitely a problem.

We tried a couple of strategies to increase my milk supply. First I
pumped after each feed. Linnea was supposed to feed every three hours,
but very often she wouldn't wake that often. Sometimes I let her
sleep, other times I woke her up (generally taking a lot of effort and
costing me precious time to rest).
At first, I would set my alarm for a night feed at about 3 am, because
a night feed is supposedly extra stimulating. But after just a few
nights I was so tired, I just switched the alarm off without waking!
Whenever Linnea started stirring, I'd wake up without a problem, thing
is she would snooze until 5 am. And if a baby wants to sleep at night,
why would you discourage that unless absolutely necessary?

A week or so of this didn't yield any results in terms of noticeable
increase when I pumped. Then I started taking Motilium (domperidone)
in the hopes it would help boost supply. At the same time, I stepped
up the pumping. I aimed for pumping every 2 hours during the day,
while feeding Linnea every three hours. Two days of this madness ought
to have resulted in increased supply, but didn't.

I had my blood tested, specifically prolactin and thyroid function.
Both came back normal.

By this time, I had two LC's stumped (Muriel consulted a more
experienced colleague). Both assured me I had tried everything in my
power to make BF work. There's no obvious reason why it wasn't
working, though there were a number of contributing factors. The
C-section made for a bad start. On average this sets milk production
back a day or two.
Linnea was on the small side at birth. Small babies often don't have
enough energy to kickstart BF on their own. What about all that
enthusiastic suckling I saw? In hindsight, she played me for a fool,
or more accurately, used me as a dummy. What better pacifier than
mom's boob? So all that chomping on my breast looked impressive, but
did little to nothing in terms of stimulating milk production, and
caused me very sore cracked nipples.
I'm still wondering why all the pumping didn't seem to have any effect.

After about 6 weeks, I was pretty tired of the BF - supplement - pump
regimen. I bought a supplementing nursing system (SNS), so I could
give Linnea her formula at the breast. The SNS is a bottle you can
hang around your neck with two tubes that you stick close to your
nipples. Getting the baby to latch on to both nipple and tube can be a
bit tricky, but I got the hang of it quickly enough. Since switching
to the SNS, I haven't been pumping. Supply has remained stable, but
hasn't increased, unfortunately.

Failing at BF is a disappointment, not in myself or in Linnea, but in
the situation. I've felt sad, frustrated and angry. On the one hand,
such feelings are normal and it's ok for me to have them. On the other
hand, I feel like I have no right to feel them at all, after all I do
have a lovely little girl, breastfed or not.
I've been using the SNS for 2+ weeks and have enjoyed the peace it's
brought back to nursing Linnea. I've given up on exclusive BF and
feel I'm as good as over it. Compaired to the pain of IF, this is no

If anyone ever tells you that with enough support and/or effort anyone
can BF their baby, they're lying.



At 17 December, 2007 23:58, Blogger Hekateris said...

First of all, I can't believe she's 2 months old already!! And second of all, wtf with the attitude towards BF'ing at the hospital? Thank goodness for midwives and doulas...which reminds me I gotta start meeting some of them and right soonish.

I know Thalia had big problems breastfeeding, too, and recommended a book called...Mama Knows Breast? Something like that, I've got it in my Amazon queue.

Nonetheless, I'm glad both you and Linnea are doing better now. :)


At 18 December, 2007 00:30, Blogger Beagle said...

I'm sorry that bf couldn't just be easy after the hell of inferility.

You're not alone, a lot of women have posted about the very same frustration and the poor advice from the medical experts.

At 18 December, 2007 01:31, Blogger Furrow said...

Following you from Hopeful Mother's blog...

For me, ultimately, it just wasn't worth it to keep struggling with BF. I didn't really try for all that long (4 weeks), but it was a miserable experience for me and my hungry baby. I'm much happier being a formula feeder, and she is, too.

From IF I learned empathy, from my BF struggle I've learned not to judge.

good luck, and don't stress over not exclusively BFing.

At 18 December, 2007 01:42, Anonymous Anonymous said...

I am sorry that this hasn't gone exactly as you had hoped. You do sound like you are in an ok place with it. I am glad she is doing well!

I know you won't post pics on your blog, but would you consider emailing one? I would love to meet Linnea!

At 18 December, 2007 05:47, Blogger Bea said...

A lot of bloggers have posted with similar problems. Well done on hunting down and getting support and advice - you really have done your job well. I'm just sorry it wasn't easier.


At 18 December, 2007 08:09, Blogger Meg said...

Hi Lut - Well. I tell you I am certainly impressed that you managed to cover in one post what I needed a whole second blog to do, haha!

I think you're doing spectacularly to have come to terms with the need to supplement and to still beat on with an SNS - they're hard work. It sounds like you have done everything.

I'm actually convinced the IVF drugs mess with lactation - there are studies showing that women who conceived via IVF are less likely to breastfeed, but no one has bothered to try and find out why, as far as I know. Of all the IF/mum blogs I have read, only one mum has managed to breastfeed successfully. And that's out of about 20 blogs.

My supply never got beyond a certain point either - even with herbs and dom, I was never able to exclusively BF - at my best I made about 120ml/3hrs but usually it's more like 70-90ml. But yet, we're still going at nearly ten months now - supplementing doesn't have to mean the end of a breastfeeding relationship, as you know.

I also get really peeved about the "experts" saying that all it takes is some work - that everyone can breastfeed. Since when is the breast the only body part not susceptible to breaking down?

At 18 December, 2007 15:52, Blogger Anna said...

I was very spotty with my BF. I'd have pockets of exclusive BF, but mostly supplemented. I couldn't really exclusively BF until about a year, and I kept it up for the whole weaning process until he was done at 15.5 months.

I had to give into the reality that he needed more than i could produce, and it was more important that he got his nutrition. He's a happy and healthy 20 month old now, so it's all turned out fine, but jeez there were some days during BF that were SO hard!!! Hang in there - you'r doing great! :)

At 18 December, 2007 18:41, Blogger Thalia said...

Well, as you know, I can empathise. And you have my undying admiration (not that you didn't already) for using the SNS, that thing drove me bananas, not to mention the fact she couldn't get much out of it. I'm glad you've found something that works for you, hang in there.

At 19 December, 2007 12:37, Blogger LL said...

oh Lut, you are not alone, Lil'mooey lost weight all the time in the first 2 months. I b/fed & pumped (fortunately didn't have to give formula once we were out of hospital)and I think that the haberman bottle - - that I bought did the trick, you can adjust the teat so that it makes it harder or easier for the baby to . You sound like you're doing everything you can... it's so hard.. good on you!

At 19 December, 2007 20:21, Anonymous Anonymous said...

Wow Lut! You did so many sensible things while struggling -- good for you to keep your head on straight!

With my son, I just spent a lot of time crying about it all.

At 19 December, 2007 22:21, Anonymous Sassy said...

I'm sorry BF didn't work out for you.

At 20 December, 2007 02:58, Blogger Rumour Miller said...

Been there done that... I was not able to BF either. I didn't last quite as long as you but I wanted my baby home and they weren't letting her out of the NICU until she was feeding regularly.

At 21 December, 2007 19:55, Blogger Angie said...

I am sorry that you have had so much trouble. It seems like everyone has something different to say about BF. I'm glad to hear you're doing better now!

At 22 December, 2007 03:13, Anonymous Anonymous said...

BF is damn hard work and those that say it is "easy" I think must have forgotten the early problems! With my DD, I BF, pumped and even bottle fed for about 3 months and was so mixed about when it was time to stop. I am proud of you for sticking in there...


At 28 December, 2007 22:38, Anonymous Anonymous said...

I am sorry that it couldn't be easy Lut. I am glad that you were able to find something that works though.

At 29 December, 2007 00:18, Anonymous mia said...

Hi, do you get a let down sensation when you feed? See, my sister-in-law mentioned to me that she has never had a let-down sensation. She feed her first daughter for six weeks at which point she got pregnant again and for the sake of not overtaxing her body she ceased BF. Her second child is now coming up to the six/ seven wk mark. When you mentioned that heart breaking scream it struck a cord as i have seen my sister in law wearied by this regular occcurence! I guess my question is to anyone who can help. Is it possible to exclusively BF and have a sufficent milk supply without experiencing a let-down, does anyone know someone who has done so? Because this is what she is attempting to do at this point. She expresses and has been to numerous LC but to no avail.

At 29 December, 2007 15:57, Anonymous Sassy said...

Hey, how are you going?

At 31 December, 2007 18:06, Blogger Aurelia said...

Lut, I had this saved to come back to, and I just wanted to say that I feel so bad for you having to deal with such a stupid hospital and ped and nurses.

Sweetie, I'm proud of you for persisting, but make no mistake, you were not given proper support, and frankly, it sounds like they have sabotaged you completely right from the start.

I'm glad to see you still trying and still making the effort with the SNS, keep it up, and know that you are NOT a failure, others failed you.

Yes, like Reality, send me a photo pretty please!

At 03 January, 2008 21:24, Blogger projgen said...

"Sideshow boob" *snort*

I'm sorry you had such a frustrating time with this. It seems like at least ONE part of the whole process should be easy. But, I'm glad you've found a way to be at peace with what you are doing.

I'm also bookmarking this entry - I want to be able to send it to loved ones in the same situation as an example of not giving up, not letting dr's push your concerns aside, and finding alternatives that will work for you and baby.

Happy New Year!

At 04 January, 2008 14:52, Blogger Kath said...

Dear Lut, I'm checking in late after my return from a Christmas break. Oh how I sympathize with what you write, including your last paragraph. Your situation sounds so much like mine, and I take my hat off to you for your dedication and persistence in spite of a whole range of obstacles. (BTW, that hospital really needs a kick up the backside.) I'm so glad the SNS is working for you.

Happy New Year to you and Linnea!

At 18 January, 2008 12:54, Blogger Sara said...

I'm so sorry that things didn't go the way you hoped. If life were fair, all of that hard work would have paid off, and you wouldn't have to make "but I'm still grateful..." disclaimers. Sigh.

At 19 January, 2008 20:21, Anonymous said...

Hi, I followed you over from HerVeryOwn, and read this moving post. So sorry you've had such a rough time with breastfeeding, it surely must *feel* like failure but it isn't! You accomplished so much for yourself and your little one, you should get a medal. :-) Bully for you for going out and getting solid support.
I know that exclusive b-fing is the ideal, but you're giving your baby breastmilk which is *fantastic* even if it's supplemented.
Maybe have a look at other blogs, one example I can think of is Cecily of, who had a rocky start b-fing after a c-section, supplemented, and then at 4 or 5 months things got easier.
You have not failed! You have garnered great success, in fact, in the face of tough odds. I'm inspired by your hard work and spirit. All the best to you!


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