Just came across this breastfeeding assessment tool  and wanted to cry. Wow. Wish I'd had this a long time ago. We could have avoided a lot of heart ache AND the hospital visit if I'd known about this. ;(
Especially the "answer key."

REAL progress. And MATH.

So, today, she took 11 oz. of formula. Which means, based on the formula of 2.5 oz. per pound of body weight, she should be taking about 30 oz. That's awesome! It means she's taking more breast milk than formula now! (Based on the same formula, she was getting 9 oz. or less of breast milk 16 days ago. Now it's more like 19!)
I might be able to do this! I need a day or two to take a "nursing vacation" and power pump, but I need my husband to have a day off to do this. Soon, soon, I hope.
:)

Okay, I'm pretty sure I AM making more milk. If a baby eats 2.5 oz. per pound of body weight, Lola should be getting about 30 oz. a day. And she's been taking about 10 oz. of formula. Sometimes a little more, sometimes a little less. Tomorrow, I'm going to keep track of every feeding again and see how I'm doing. It's hard to remember, because some bottles she'll gulp down, and some she'll take a little and refuse the rest.
AND, I got a notice in the mailbox that my domperidone is at the post office. Woo! No more stressing about that.

Giving up, Giving in.

I'm giving up trying to feed her the donor breast milk. I have to wait until she's ravenously hungry to get her to drink it, and that's going to affect my own supply. Plus, we've both been miserable. She was happy and gaining well on my milk and formula, I think we'll stick with what we know, and what we're good at.
At least I know she prefers me over everything else. I tried to offer her a bottle of formula after trying to get her to drink some donor milk, and she refused the bottle, but latched right on. If only mommy could make enough.
My husband thought I was giving up breastfeeding altogether when I told him I was going to buy more formula. "No way!" I told him, "As long as she'll have me, I'm going to give her what I can."
It's the least I can do.

Lola's been doing better about accepting the donated milk. I'm still mixing it with formula, but its now 2 parts donated milk to 1 part formula.
I'm not going to take the shatavari anymore. I think it decreases my supply, since my problem isn't hormonal, anyway.
I hope my next shipment of domperidone gets here soon. I'm going to run out in a few days... Eek.

Love that little face. :)

Squee! Oh *ahem* Hooray.

I almost hesitate to post this, because whenever I think I see real progress and comment on it, the next day really sucks. But here goes:
I am pretty sure I am making more milk.  Why?

Lola is satisfied after nursing. I don't have to jam a bottle into her frantic mouth as soon as she comes off the breast.
She's taken LESS THAN 10 OZ. of supplements today, and she's been just as alert and happy as usual.
She went TWELVE HOURS without a bottle last night.
She still has a good number of wet diapers, and her fontanel is only slightly sunken (but was like that on formula, too.)
Now, it's just a waiting game to make sure she's still gaining well. I hope, I hope, I hope she is.

The Good, the Bad, and the Ugly.

The Good:
Lola went 12 HOURS without a bottle last night! I thought for sure she'd wake me up for a middle-of-the-night bottle, but she was satisfied with nursing all night. And in the morning, after we nursed, she gave me a huge smile!

The Bad:
Lola isn't too fond of the donor milk. I think because it's been frozen, and has a grassy smell to it (which is totally normal.) I've been mixing it with formula, and I'm going to keep trying. Hopefully, she'll get used to it.

The Ugly:
I've managed to put on 5 pounds since I started the domperidone. It shouldn't surprise me; it's a stomach emptying drug, so I'm hungry all the time. Time to start working out more!

New Pill Regimen

Went to the health food store, and got some alfalfa and flax/borage oil. I haven't tried borage before, but besides being a galactagogue, it's also supposed to make the milk creamier.
So, here's what I take in a day:
6am - 40 mg domperidone, 3 fenugreek, 1 shatavari, 2 marshmallow root, 2 nettle leaf, 2 alfalfa, 2 flax/borage oil  caps
12pm- 40 mg domperidone, 3 fenugreek, 2 marshmallow root, 2 nettle leaf, 2 alfalfa, 2 flax/borage oil  caps
6pm - 40 mg domperidone, 3 fenugreek, 2 marshmallow root, 2 nettle leaf, 2 alfalfa, 2 flax/borage oil  caps
Bedtime - 50 mg domperidone, 3 fenugreek, 1shatavari,  2 marshmallow root, 2 nettle leaf, 2 alfalfa, 2 flax/borage oil  caps

I also eat 2 bowls of steel-cut oats a day.

An Incredible Gift: Donated Breast Milk

Today, I became the honored recipient of a freezer full of donated breast milk. Yes, there are mothers out there with extra-large milk supplies, and extra-large hearts willing to give up their freezer's stash of liquid gold to help a baby in need.

If your first thought is "That's weird. Feeding your baby someone else's bodily secretions," I totally get it.

I had mixed feelings about donor milk which is why I hadn't really pursued it myself. But when someone offered, I accepted. Because, when you think about it, why does feeding something called "formula," (which sounds like a science experiment, is made from another mammal's milk, mixed with artificial ingredients,etc. etc.) make more sense than feeding HUMAN milk to my HUMAN child? It doesn't. Yes, formula works in a pinch. But, if someone has milk to spare, I'll gladly use it to feed my baby.

Read about the risks and benefits of Milk-sharing vs. Formula Feeding.

This really encourages me to keep trying, even if I never have all the milk she needs coming from my breasts, I could still have a nearly-exclusively breast milk fed baby!

Since you're not using them, can we trade breasts?

Nothing like watching someone squander their milk supply while I fight so desperately for mine...
It isn't fair. It just isn't fair.
I know it's every woman's choice whether to breast feed or formula feed. Except, I have no choice! I CHOOSE BREASTFEEDING, can I have your glandular tissue please?
*Sigh.*
Vent over.

Whenever I feel weak or useless...

I just have to look at these pictures, and I feel like a warrior!

You can read my birth story here.

Long night.

Oh boy. I thought we really weren't going to make it without a bottle last night the way Lola was cluster-feeding. I felt like I was just switching boobs all night!
But then, 6:30 came and we'd made it! And she didn't even want a bottle until 45 minutes later!
So, today, I am tired...but triumphant.

YUMMY!

I got my batch of Mama Munchies lactation cookies! Yum! I had two right away. :)


Read more about them (and get the recipe) here:

Breast Crawl

I witnessed the "breast crawl" myself last night as I was rocking my daughter. She had her head on my chest and started wiggling and wriggling until she reached the nipple. It was awesome.
Lola's been comfort nursing a lot more, too, even after a bottle, so I don't think I'm risking much by skipping pumping. I think I'll continue my pumping vacation over the weekend, at least. :)

Good Friday in more than one way...

Took a break from pumping, today. Lola nurses so much better when I don't pump, I'm not sure why. She nursed much more frequently, and even refused the bottle once! And she went from 10:30 - 3 pm without a bottle, just 2 nursing sessions. (This is a baby who eats little meals frequently, so that is an accomplishment!)
She's also skipped her middle of the night bottle the last few nights, instead only nursing between the hours of 10ish - 6ish.

 The homeopathic "breast help" drops have helped with the nipple pain/breast tenderness I've been dealing with. I'm sure not pumping helped also.
Waiting on some delicious lactation cookies to come in the mail. :)

Acceptance.

Lola started smiling yesterday. Not just sleep smiles, real smiles. Directed at me. And that makes all the struggle, all the heartache, worth it. And it tells me that we're going to be just fine.
She's such a great nurser from 9 pm to 6 am. She doesn't get frustrated after a few minutes, she doesn't cry for a bottle; she latches right on, she drinks deeply and peacefully.
I hope she keeps up the night nursing for a long time. It's so easy and sweet. She sleeps right next to me, and at her slightest stirring, I can get her latched on without either of us fully waking.
I can accept my lot. So, I'll never have a full milk supply. I've been so happy lately, despite that. I have a beautiful family. My children are healthy, happy and intelligent, no matter how much (or how little) breast milk they received.
But accepting that I'll always have a low supply doesn't mean I won't keep looking for things that might help. It doesn't mean I won't keep trying. I will keep nursing as long as she will have me. And, if she won't have me, I'll pump as long as I can. Because she deserves the best I can do.

Same ol', same ol'.

Yesterday's 2 oz. at once was just a fluke. Back to 1 or less per pumping session. *Sigh.*

Our Story (So Far)

I have always thought there was something wrong with my boobs, they had always looked so different any others I had seen. Not really full, and even as a teen, they hung down like flat, empty sacks. But I had no idea that it would have an impact on breastfeeding. I had ALWAYS planned on breastfeeding my children.

Rio

When I had my son, he latched on like a pro the very first time.  Everything seemed to be going well, except he had jaundice, and he had it bad. I had to leave him behind at the hospital. I cried the entire ride home. I tried to keep up my milk supply, but I only had a single, manual pump and my nipples were so raw, every time I'd pump, I'd get more blood then milk in the bottle. When he finally came home, I tried everything I knew of to build up my supply. I pumped, I used fenugreek, I sat skin-to-skin for hours, I used an SNS, but it wasn't working. He was always crying and hungry. Eventually, I gave up because I was so disgusted with myself for failing him. I wound up with serious, severe postpartum depression. I was suicidal. I did the stupid thing I could ever so, I left home. Left my baby with his father and I was gone. I'm honestly not sure how long I was gone, but eventually, I sought help, started antidepressants, and got my life back.

Lulu

When my first daughter was born, I thought things would go better. When she became jaundiced, too, I almost had a panic attack in the hospital. I wanted to breastfeed SO BADLY, and I didn't want to be separated from my baby and risk ruining my supply. Luckily, her numbers weren't so bad, and she got to come home with us.
She nursed constantly. But my milk never "came in." I was so worried, because she wasn't pooping, and she needed to poop to get rid of the jaundice. I was terrified when she was still dehydrated, and sent my husband out to get some formula. I sobbed as I fed it to her. Nursing was extremely painful. I wanted to see an LC, but because I had given birth around Christmas time, the hospital LC was on vacation. When I finally saw her 2 weeks later, she determined that my daughter had tongue-tie and that was causing the bad latch and extra pain. The pediatrician didn't think it would cause any problems, though, and so the tongue-tie was left to resolve itself. I started doing a lot of research online, and realized I probably had IGT and hypoplastic breasts. I had all the symptoms. The breast shape, the lack of changes during pregnancy, the lack of engorgement.
I took so many herbs trying to build up my milk supply, but to no avail. Then I got my period back, and I'd lose what little supply I had every month. Then, I'd spend all month trying to build it back up, just to lose it again. After 4 months of this, I decided I wouldn't nurse for nutrition anymore. I was too stressed out all the time, and the baby wasn't gaining well. We comfort-nursed for a few more weeks, and then she fully weaned from the breast around 10 months.

Lola

 

As soon as I found out I was pregnant with Lola, I started taking alfalfa, and rubbing progesterone cream on my breasts, hoping it would build up more breast tissue. I also knew I wanted to have a natural birth so there wouldn't be any drugs in our systems that would make breastfeeding more difficult. I had a beautiful, natural birth with a midwife. We had her latched on within 20 minutes of the birth. The first day, she had several poops, starting with meconium and then becoming "transitional." Then, she stopped pooping. She nursed constantly. If she wasn't nursing, she was miserable. I noticed her diapers were getting lighter, and the uric acid crystals were getting darker. I felt her fontanel, and it was sucken. I sent my husband for formula. I couldn't stop crying. My midwives came for a home visit. They gave me syringes for feeding and mother's milk tea. But Lola and I couldn't figure out how to use the syringe for feeding and we both wound up frustrated and crying. I got the same kind of bottles I'd used with my first daughter, and that cleared up the nipple confusion. We continued to nurse on both sides, twice, and then I'd offer her a bottle with an ounce of formula. If she was still hungry, she went right back on the breast. She was just meeting the number of wet diapers, but only pooped every 5 days. I thought she was miserable because she wasn't pooping. Then, we went to the pediatrician for a weight check and the roof caved in.
She hadn't gained any weight in 2 weeks. She was still 10 ounces under her birth weight. They handed me a 2 ounce bottle of formula, which she guzzled down. I cried my eyes out. I'd been starving my baby. We were sent straight to All Children's Hospital. In 3 days of nursing first, and then getting 2 - 3 ounces of formula every 2 hours, she put on 3 ounces of weight. She was no longer miserable, and we finally really got to know each other. We finally got to look into each other's eyes. I finally got to fall in love with my baby.

Now, Lola's a happy baby. She nurses like a champ most of the time, has a good latch (no tongue-tie!), and she's a healthy weight. I'm now taking domperidone to see if that will help build my supply. I hope we can continue our nursing relationship for at least a year, if not longer. (My ultimate goal would be 2 years or baby-led weaning!*) Even if I never have a full supply, and I'm not holding out hope that I will, I want to get every drop of breast milk I can into my baby.

I think I can, I think I can, I think I can.

Update: 14 months and going strong!

Update, Update: We're a week shy of 17 months, and still going strong as ever!

Edit: *I thought baby-led weaning meant weaning from the breast, not weaning onto solid foods. :)

If you have IGT, also known as hypoplastic breasts, and you'd like to share your story, please e-mail me at nyssaretter@gmail.com with the subject line "IGT moms."

Progress! 2 whole ounces pumped an hour after nursing! I used to only get 2 oz. if I didn't nurse for 3 hours or more.

A 24 hour study

1:30 am- boob
2:40- 1 1/2 oz. formula
5:10- boob
7:00- 2 oz. formula
7:20- boob
8:30- pumped 2 oz!!!
11:30- boob
11:45- 2 oz expressed breast milk
12:00pm- 1 1/2 oz formula
1:30- boob
2:00- 3 oz.
4:15- boob and 2 oz in SNS
5:00- 1 oz formula
5:45- Pumped 1 1/4 oz.
6:00- 2 oz. formula
6:30- 1 oz. formula
7:40- 1 oz. formula (refused to nurse, pumped 1/2 oz.)
8:30- 1 oz. expressed breast milk
9:00 - 10:00 pm-  Nursed non-stop!
10:00- 1 1/2 oz. bottle

 She takes about 16.5 oz a day of formula, which means, she probably gets about 10 oz. a day (based on this table from kellymom.com) from me at this point. Let's wait and see how much (or how little) the domperidone improves that in about 3 -5 weeks.

Lola's been nursing longer the last two days. She'd been down to 5 minutes or less, and now she's usually latched at least ten. Not sure if this means there's just more milk coming out for longer, or what. But, it's good, either way.
Tomorrow, I'm going to document every feeding and ounce of formula, just to get a better idea where we are and at the end of 4 weeks to see if we've made any progress.

1 Month Well Baby Check Up

Lola's up to 11 lbs, 5 oz. and 23 inches. YES! That's over a pound since her last weight check 12 days ago. It's still just 1 lb, 3 oz over her birth weight, but it's 2 lbs, 2 oz. over her lowest weight (the weight she stayed at for 2 weeks even though I was already supplementing.) She's now over the 95th percentile for height and weight.
We've found a system that works for us. She gets all the benefits of breast milk and nursing, and she gets to feel full from the formula, and I don't have to constantly cry and stress that I'm starving my baby. I can live with that.

Pumping and doing the math.

Got almost 2 oz. while pumping just now. Of course, it's been a good 3 hours or more since our last nursing.
So, I think I have it figured out. If I average 1.5 oz. every 3 hours, I should be making between 8 - 12 oz. a day. And, according to kellymom.com's milk calculator, babies need an average of about 25 oz a day for the first 2 months (longer for an exclusively breastfed infant*), whether from formula or expressed breastmilk. So I make about half, or a little less than half, of what Lola needs a day.**

*In exclusively breastfed babies, milk intake increases quickly during the first few weeks of life, then stays about the same between one and six months (though it likely increases short term during growth spurts). Current breastfeeding research does not indicate that breastmilk intake changes with baby's age or weight between one and six months. After six months, breastmilk intake will continue at this same level until -- sometime after six months, depending in baby's intake from other foods -- baby's milk intake begins to decrease gradually. http://www.kellymom.com/bf/pumping/milkcalc.html

So, I've been sitting here, with the pump still on me the whole time I was writing this, and thought I'd give the "let down" button a push, just for fun, and I had a (very) brief second let-down! It didn't give me much more, but it did get it up to a good 2 1/8 oz. Little victories.

** I know babies are more effective at removing milk than a pump, but Lola sometimes loses interest at nursing before she's really "emptied" me. 

Little victories.

Almost got an ounce from one boob when I pumped, just now. But, Lola hadn't nursed thoroughly for a while. Taking my second 40 mg dose of domperidone and heading to bed.

Argh.

So, Lola refused to nurse, and my hubby was home, so I made her a bottle and decided to pump to see if I could see a difference. Nope. Same 1 oz I always get. I know, I know, I know the pump isn't as good as the baby. But I can't help but feel discouraged. I'm going to bump it up to 40 mg, 4 times a day of domperidone. I hoped I wouldn't have to, because that means $50 worth will only last me about 18 days. Worth a shot, though, to see if it does any good.

Breastfeeding Grief and Redefining Success.

Living With Low Milk Supply

Going Through Breastfeeding Grief and Redefining Breastfeeding Success

Mothers experiencing supply issues are frequently grieving the loss of exclusive breastfeeding. Mothers who are unable to feed at the breast sometimes say that they feel as they are grieving a death. These mothers are often frustrated that their family and friends are not sensitive to their mourning process. Some mothers even stay at home because they feel ashamed to bottle feed in public. They feel upset or humiliated by the perceived stares and comments of strangers. (This is something I struggle with, personally! I avoid going out alone with the baby, because I hate to be seen bottle-feeding, even though I breastfeed first. If I am out with my husband, I will breastfeed, then hand her over to him and let HIM bottle feed her, and I'll walk away. No one is going to judge a man for not breastfeeding, right? -L.F.)
Many mothers find that redefining their breastfeeding success and their mothering goals can help with the resolution of breastfeeding grief. They find closure by understanding that they did or are doing the best possible in the circumstances. Some mothers come to see the challenge of going out into the world as an opportunity to inform others about the issues that can undermine breastfeeding.
Redefining breastfeeding success restores a mother’s self-confidence, and enables her to feel that while things are not perfect, they are as right as they can be. For example, for some mothers, nursing can mean breastfeeding at the breast with a supplemental nursing device for some or for all feedings. This allows even mothers who produce no milk at all to keep their babies at their breasts. When the baby is old enough to get her calories through solids, this same mother may continue to “comfort nurse” for as long as she and her baby likes. This is a nursing relationship.
Other mothers and babies may need supplementing (topping off with supplement) after nursing at the breast. This is a nursing relationship.
Some mothers exclusively pump milk for a baby who can’t nurse. The mother can take pride in providing her baby with a special gift. She is a lactating mother and her body benefits form the hormonal benefits of lactation. Her baby benefits by receiving her milk.
Still other mothers wean and do not pump or supplement at the breast. They may also grieve and feel concerned about what their babies may have missed. Redefining mothering goals can help mothers find resolution: life with a newborn and young child affords many opportunities to develop a bond and to work on health-enhancing behavior. 
http://mobimotherhood.org/MM/article-LMS.aspx

I have always had trouble "redefining breastfeeding success," because, in my mind, true success would be an exclusive breastfeeding relationship. But, as the third time is not a charm, I'm working on accepting hand I've been dealt.
I need to remember:

• Some breast milk is better than none.
• A happy, well-fed baby is better than a miserable, under-fed baby.
• Every day we continue to nurse at all is a mini-victory.
• Bottle-feeding can be done with just as much love.
• The most important thing is to FEED THE BABY.

Too good to be true?

Trying not to get my hopes up too much, but Lola's been taking about an ounce less per bottle today. Instead of 3 oz, she's been stopping around 2.
I'm afraid to be excited. Time will tell.

IGT and low milk supply resources

Do you have Hypolastic Breasts?

Typical characteristics:

• High mammary fold - the base of the breasts is higher than normal, usually at rib 5.
• Narrow (flat) breast base - the breast is oval or flattened at the base where it attaches to the rib cage rather than round
• Breast tissue cascades over mammary fold producing ptosis even in small breasts - breast tissue droops over the high mammary fold
• Central herniation of breast tissue into the areola resulting in plump nipples
• Patchy areas of milk producing tissue
• Little or no prominent veining
• Large areolas
• Darkly pigmented areolas
• Widely spaced breasts > 1.5’
• Marked asymmetry
• Stretch marks
• Little or no growth during pregnancy
• Little or no engorgement
• Normal prolactin levels 

Pictures of Hypoplastic Breasts (with Type 1 being a normally-developed breast) 

• Type 2 – Hypoplasia of lower medial quadrant
• Type 3 - Hypoplasia of the lower medial and lateral quadrants
• Type 4 - Severe constrictions, minimal breast base

Type 2

Type 3

Type 4

(Note: I got this pictures from a website that's no longer in existence.)

Breastfeeding Assessment Tool for the first 4 weeks and the Answer Key


Mother Food: A Lactogenic Diet

Yes, you CAN breastfeed successfully, no matter how much milk you make!

La Leche League on mammary hypoplasia

PCOS can also lead to low milk supply

An IGT self-diagnosis check list.


More about IGT

Markers of Lactation Insufficiency (with pictures of hypoplastic breasts)

lowmilksupply.org

MOBI Motherhood: A valuable resource to any nursing mother.

An article about lactation failure, and how doctors need to recognize that not every woman can breastfeed.
"Preserving the 'every woman can nurse' myth contributes to perpetuating a simplistic view of lactation and does a disservice to the small percentage of women with primary causes of unsuccessful lactation."

Podcast: When the “booby fairy” doesn’t arrive: A podcast interview on insufficient glandular tissue/breast hypoplasia, with Diana Cassar-Uhl

Dr. Jack Newman's website (email him for advice!)

A free audio download for relaxation and increasing milk supply.

Mama Munchies lactation cookies, good for a supply boost!

Recipe for Mama Munchies if you'd like to make your own.

When Lactation Doesn't Work (read the comments, too!)

Make Your Boobs a Happy Place

What to Do If Your Baby Won't Nurse

My favorite instructions for using an SNS

An EPer's Guide to Pumping

Maximizing Milk Production While Pumping

Facebook groups:
Breastfeeding Grief
Low Milk Supply Mamas
Diary of a Lactation Failure
IGT Support Group


Interested in using donor milk? Check out Human milk 4 human babies!
I will add more as I remember/come across them.

Domperidone Day 2.

I'm not sure if I can credit the domperidone, but Lo went bottle-free from 9:30pm to 6am, with just a couple middle of the night nursings. And at 6, she didn't wake up voraciously hungry, either. Trying not to get my hopes up too much, but it's only been 2 days on the domp. Time will tell.

Domperidone. Day 1.

Yesterday, I started taking domperidone, 30 mg, 4 times a day. I'm hoping it does something to help. I've never tried a prescription drug to increase my supply (though I wish I'd known where to get it last time), but I've tried every herb under the sun thought to help. I'm still taking fenugreek four times a day, along with nettle and marshmallow root.

The domperidone gives me a slight headache, so I've been chasing it with advil. I should see an improvement in my milk supply in 4 to 6 weeks, if I'm going to see one at all.

Cross your nipples for me.

Introduction.

This blog is mostly for me. To remember the ups and downs of day to day life as a low supply mama.
See, I have IGT, insufficient glandular tissue and hypoplastic breasts. That means I have underdeveloped breasts, and not enough milk making stuff in them. So, I can make some milk, just not enough.
 Breastfeeding is supposed to be a supply and demand system. Only, I can demand, demand, demand, and the supply never goes up. This is heartbreaking for me, because I've always known I would breastfeed my children.
And now, here I am with baby number 3, and I've never had a full supply.
With my first child, he spent a week in the NICU, and I couldn't pump enough with my single, manual pump, but I tried. When he got home, I used an SNS and nursed all the time, but it wasn't enough. I just gave up because I was so disgusted with myself, and wound up with some really nasty PPD. With my second, she had tongue-tie and so couldn't latch well. We nursed and bottlefed well for a few months, until I got my period, and then my sad little supply suffered even more, and I couldn't build it up enough between periods. I still managed to get a little breast milk into her for a good 10 months. With my third, I took herbs during my pregnancy, had a natural childbirth, had her latched on 20 minutes after birth, consumed my placenta,* nursed her around the clock, and she was miserable all the time. My milk never "came in" and by day 5, my daughter was very dehydrated and I sent my husband out for formula. And I bawled my eyes out. But I only gave her a little bit, to try and keep her from getting too dehydrated, and then she was right back on the breast. But then, she didn't gain any weight for 2 weeks, and her pediatrician sent her to the children's hospital for observation and testing, even though I told her I knew what the problem was. She gained 3oz in the hospital, and she's been happier ever since.
We're still nursing, but following every nursing with a bottle. She's happy and healthy, but I'm still grieving the loss of that elusive, exclusive breastfeeding relationship.


*I had my placenta dehydrated, ground up, and put in capsules. And, no, it wasn't gross.