Not Only about Milk
Fort Myers FL USA
From: NEW BEGINNINGS, Vol. 22 No. 3, May-June 2005, pp. 108-109
I began attending LLL meetings when I was 11 weeks pregnant. My mother was an LLL Leader and I joyfully anticipated breastfeeding my own baby. My son, Stephen, was born at home. Within a couple of hours, he latched on well. I nursed him frequently on cue and through the night as we coslept. I never had sore nipples, got engorged, leaked milk, or felt my milk let down. My LLL Leader assured me that this was normal for some mothers, so I considered myself lucky not to have the discomfort of engorgement and leaking.
After three days of passing meconium, Stephen didn't have a bowel movement for three days (although he always had plenty of wet diapers). After that, his stools were green for a couple of weeks. He was very active and alert, but sometimes fussy after feedings. I also wasn't sure if I could hear him swallowing as he nursed.
At 12 days old, he weighed about a pound below his birth weight, so our pediatrician recommended weighing him again in a week. In the meantime, I kept Stephen at my breast around the clock and in skin-to-skin contact as much as possible. We were shocked to find that he hadn't gained any weight after that first week, nor when we weighed him again three days later. I tried pumping with a manual pump and feeding him my expressed milk with a cup after breastfeeding, but I could never pump even half an ounce.
Although Stephen didn't lose any more weight, when he was three-and-a-half weeks old and still steady at a pound below his birth weight, we knew we'd reached a crisis point. Our pediatrician examined Stephen's mouth and found no problems with his palate or tongue, ordered a complete blood count and metabolic blood work (the results of which were normal), and recommended that we begin supplementing with formula immediately.
Our lactation specialist noted that Stephen started out sucking well at the breast, but would slow down because my milk wasn't flowing fast enough to keep him interested. A pre- and post-feeding weight check showed that Stephen consumed only one ounce after 30 minutes of breastfeeding. She recommend that, in addition to "topping him off" with formula after each breastfeeding, I do breast compressions while he nursed, begin taking the herbs fenugreek and blessed thistle, and rent a full-size, electric breast pump to use after each feeding to help build up my milk supply. Unfortunately, neither the herbs nor the pumping increased my supply noticeably, although the breast compressions seemed to be effective at stimulating my let-down. After a month on the herbs, I started taking a prescription medication instead. Even though I took it for four months, it did not increase my supply significantly.
Because I was still having fairly heavy postpartum bleeding at three weeks, I had an ultrasound to check for retained placenta fragments, which can sometimes cause low milk supply. None were detected. I also had blood work done to check my thyroid, prolactin, and progesterone levels, which were all normal.
It broke my heart to think that I might not be able to feed my baby. I never imagined I would have to supplement. I'm very healthy, had no problems with fertility, pregnancy, or birth, no breast surgeries, and had great support from my family and my LLL Leaders. I had read several books about breastfeeding. I was with my baby full-time and never used artificial nipples or feeding schedules. Over and over I told myself that we had done everything "right"—why was this happening to us?
One of my LLL Leaders, Amanda, in Lubbock, Texas, USA loaned me Diana West’s book, DEFINING YOUR OWN SUCCESS. It provided me with great practical advice on building my milk supply and supplementing, as well as emotional support from other mothers who continued breastfeeding with less than a full milk supply. Amanda provided invaluable phone support following each of our frequent weight checks and she was our partner in researching possible solutions and adjusting our strategy as time went on. Information from Dr. Jack Newman's breastfeeding clinic handouts (found online at www.bflrc.com/newman/ articles.htm) taught me how to evaluate Stephen’s sucking pattern to see if he was receiving significant amounts of human milk. His book, The Ultimate Breastfeeding Book of Answers, also helped me understand that low milk supply can happen to mothers and that continuing breastfeeding is very worthwhile, even if supplementation is necessary.
Once we began supplementing with formula, Stephen gained weight for the first time since his birth. The nursing supplementer allowed me to feed him exclusively at the breast. A supplementer consists of a thin tube taped to each breast to deliver a supplement to the breastfeeding baby from a plastic container, which hangs around the mother’s neck. In addition to keeping feeding as close to a natural breastfeeding experience for the baby as possible, it can further stimulate the mother’s milk supply and avoids the need for bottles, which might lead to nipple preference or early weaning.
At each feeding, we nursed first without the supplement. When Stephen stopped sucking and swallowing regularly, I released the tubes and he was able to drink formula, along with any remaining human milk, until he was contented.
Everyone thought that we would only need to supplement for a few weeks. We tried many times to stop, but every time we decreased the formula, Stephen stopped gaining weight. We tried nearly everything to increase my milk supply, including suck training for Stephen and a diet high in calories, fat, and protein for me (which only caused me to gain 10 pounds in eight weeks!).
Despite all our efforts, my milk supply seemed to be fixed at its maximum. We estimated that I produced about half of the milk Stephen needed. It was very helpful during this time to have rented a special scale, which freed us from going to the doctor or lactation consultant’s office for weight checks. Even once he was gaining well, we had to increase the amount of formula every week until he starting eating solids because he needed more formula as he got bigger.
One thing that was very helpful for me psychologically was to always nurse Stephen at least a couple of times each day without the nursing supplementer. Fortunately, I had an abundant enough supply to keep Stephen happy through the night. He always loved to nurse, with or without any milk. We rarely nursed with the supplementer away from home, instead supplementing with formula before we left the house. During this time, it was very difficult for me to discuss my low supply openly. I felt guilty and inadequate for not being able to produce a full supply, and especially for not realizing it right away and having a baby whose growth lagged behind the norm for several months.
I think being comfortable nursing with and without a supplementer helped Stephen and me to make a smoother transition to breastfeeding without the supplementer once his diet included solid foods. When he was 13-and-a-half months old, we were able to stop using the supplementer for good. His refusal to drink from a cup until after he was one year old made it take longer than it probably otherwise would have.
Stephen is now a very healthy, intelligent 19-month-old and is still an enthusiastic nurser. He asks to nurse at least six times a day and nurses throughout the night (frequently enough that my menstrual cycles have not returned yet). We continue to explore possible causes for my low milk supply. I may have insufficient glandular tissue (breasts that did not develop completely during puberty and pregnancy). I may have had an undetectable retained placenta fragment, which compromised my initial milk supply. Maybe we began the herbs, pumping, and medication too late for my supply to increase. We may never know why my body didn’t make enough milk for Stephen, but we do know that we have a very beautiful breastfeeding relationship.
This experience taught me that breastfeeding is truly not just about the milk. I cannot imagine what mothering would be like without nursing. How else would I comfort him when he is sick, calm him after a temper tantrum, or soothe him quickly back to sleep when he wakes during the night with teething pain? Supplementing at the breast allowed us to bond like any other breastfeeding pair and to continue nursing into toddlerhood.