"Success is not final, failure is not fatal: it is the courage to continue that counts." -Winston Churchill

Monday, August 22, 2011

Guest Post: My Breastfeeding Experience: Dealing with Low Milk Supply

 by Brandy Marie Mitchell

(a good latch)
“You're young and healthy...breastfeeding should not be a difficult option for you.”
  This is the standpoint that many medical professionals and thus the general population have on breastfeeding. However true it is for the majority of the population, there are a small percentage of women who this simplistic view does not pertain to. For this small, yet no less significant, percentage of women, this view can be seriously detrimental to their confidence, self esteem and future outlook on breastfeeding.

  My name is Brandy. When I went through puberty, there were obvious changes going on. I started getting thicker hair in places, I smelled bad, I started my period, my chest grew and the word,(small but there) “whatever,” accompanied with an eye roll was my answer to 90% of everything. I remember thinking that my breasts weren’t quite as big as I thought they should be. After all, my mom had DD cups and my older sister was well on her way there. “They are still on lay away!” a family joke started by my grandfather when my mother was going through puberty, was often said to me. I remember the vain wish I wished for on shooting stars, 11:11 on the clock, birthday candles, fallen eyelashes, every chance I got, “I wish I could lose weight and get bigger boobs!”

It was about my junior year in high school when I realized that they weren’t that bad. Boys were still interested in me despite my itty bitty titties, they didn’t get in the way when I was doing things like swimming and reaching, and they actually were small enough so that I could get away with not wearing a bra. (Curse that underwire!) I actually started to really like them. Even though they weren’t what I expected, I now tried to picture myself with my mother’s buxom chest and thought that I would look rather silly.

Like many women today, when I found out that I was pregnant, I knew that I wanted to breastfeed. I mean, what better way to really establish your womanhood than to create a life inside of your body and then continue to nourish that life with your body after birth? Not only is it the best food for babies, it is also cost effective, good for the environment, and creates a bond that nobody else can mimic between you and your baby. It’s the only way things were done all through history until the invention of formula in the 1800’s. Breastfeeding isn’t some new age trend that was recently discovered and is making a rise in our society; it is what we as women were DESIGNED to do!

 I was lucky enough to have an outpouring of support from my friends, family and soon to be in laws. I felt good that out of all the decisions that every parent has to make in raising their children that there was at least one that I had made that nobody would look down upon. “Breast is best!” after all.

My mother, who had breastfed me for two months and gave up due to my being a, “baby vamp,”  who regularly drew blood and would only latch to her right breast, along with my older sister who’s youngest two both had problems with nursing due to a weak suck and a tiny preterm mouth, were both very supportive but sure to inform me that there could be problems with nursing, to which I scoffed and thought, “Not for me!” and swept away into my day dreams of a perfect baby suckling at my breast with an abundant supply pouring out.

My fiancé’s mother would tell me stories about how she nursed her boys each for two years. Initially, like most people confronted with the thought of a nursing toddler with teeth and the ability to ask to nurse, I was horrified! But the more I thought about it, the more sense it made. Why would you trademama’s milk for cow’s milk just because they could finally drink it at age one? It doesn’t even make sense! Thus was the foundation for my decision to nurse as long as my baby wanted me.

After an easily complicated nine months of hyperemesis and diet controlled gestational diabetes, I reached the 40 week mark. At 39 weeks my baby was measuring okay, fluid levels were normal, he was head down and I was dilated to 3cm 90% at the appointment three days before my due date, butjust in case we were missing something my OB/Gyn decided we should induce two days past my due date if I didn’t go into spontaneous labor before then.(the big hand off!)  The morning of my induction I woke up to back labor pains and headed to the hospital. It was a beautiful day, the summer solstice of all days!

My labor went off track from what I had planned but I asked many questions before each change and discussed my options thoroughly before proceeding and felt okay with the experience overall. The only thing that was different that I wished I had been able to speak up about was my desire for skin to skin before he was whisked away to the other side of the room to be cleaned up as I lay there getting well over 20 stitches from a tear. They had him back to me within ten minutes all bundled up, my fiancé was sobbing tears of joy as I took our baby from him. At last! Our chance to breastfeed! Our glorious first shot that I had dreamed about for the past nine months and the most perfect little face looking back at me to do it with! It was euphoric! I don’t remember how things looked, but oh, I remember how it felt.

The next two days were spent nursing, nursing, nursing, and applying lanolin to my very pink burning nipples. I didn’t think anything was wrong with our latch as I had heard hundreds of times, “It is normal for it to hurt for the first two weeks.” We checked out and in the days following I saw the transition from colostrums to milk. I remember seeing the fluid come out white for the first time and yelling to my hubby, “I’VE GOT MILK!!!”

I never really had any period where I would say I felt engorged. My small breasts felt full but not bursting by any means. A week and a half passed and I felt like my baby was insatiable, not to(two weeks old and frail)mention looking very slim compared to the plump 8lb9oz baby that I gave birth to. “Don’t worry;” said my mother, “you were a very skinny baby too!” Everyone reassured me that he looked fine. He wet some diapers,(my chubby baby just after birth) he had periods of awake and sleeping and he didn’t cry all the time. No, if anything, most of his time spent awake was spend observing. A true intellectual solstice baby!

Call it mothers intuition, but at the two week appointment we weighted him. When I asked what his weight was the nurse responded, “7lbs9oz.” My heart stopped and my stomach wrenched. He had lost an entire pound. For us, one pound is  nothing! We want to lose ten pounds if we can. But for a tiny baby, one pound is almost everything. She left to get the pediatrician like normal, and the tears started. I sobbed. I had been starving my baby all along. I KNEW that I had not been making enough milk for him and that he looked frail and sick. I KNEW I should have trusted my gut and not listened to the voices, however loving, that told me he was just fine.

Several minutes passed and the doctor came in. He told us that we would need to supplement while I built my supply up so that he didn’t starve any longer. He called a lactation consultant over and she discovered he had a shallow latch and helped me correct it. The rest of the visit was a blur. I was so overridden with guilt that I could no longer function. I couldn’t eat the rest of the day because I felt awful. The guilt and shame was far worse than anything I had experienced in my life. FAR worse than the time I was brought home by the police at 3am, 15 years old and wandering around Old Town with two of my friends on summer break.

The next day I attended my first La Leche League meeting. It was nice to see so many babies, all different ages, EATING at the breast. Finally I witnessed what it should look like. I was a little shy to speak up and ask for help and waited for another mother to raise her question first. The question was discussed and the whole time I was in my head, sweating, shaking slightly, the same nervousness as when you know you have to give a presentation in front of the class. I recited over and over in my head, “My baby is two weeks old and yesterday we found out he has a shallow latch and was still losing weight. Can someone check out our latch and help us?” Would they think I was a bad mother? Still losing weight after two weeks! It was as if the leaders had their eye on me through the whole beginning of the meeting and were waiting for me to fess up to my problem. These ladies knew what a healthy newborn should look like. Mine was frail. Screaming for food as I tried to latch him.

Finally the first question was resolved and the leader asked if anyone else had any problems they would like to discuss, looked around, and stopped on me. She could see on my face that I was yelling out for help. I opened my mouth and told everyone the problem. I don’t really remember everyone’s reaction; I think it was mostly sympathy, not judgment. The leader offered to step aside with me and assess my latch. She was wonderfully helpful and much more insightful than the lactation consultant at the hospital the day before. I don’t know if it was because she was a mother and more sensitive, because she knew more, or if it was just that I had been so numb to the world by the time that the LC came in the doctor’s office, but the LLL leader was definitely easier to talk to.

The advice given to me was to pump, pump, pump, put baby to breast as often as possible and to give(MOM! Im eating!) him formula until my supply was where it should be. When pumping I never really got much out, but what I did get out I would add to the formula and I knew he was getting the good stuff. I called my OB and explained the situation and they told me they would put me on a regimen of a medication called Reglan™ that is actually for alleviation of symptoms from slow stomach emptying such as nausea, heartburn, indigestion, etc. but had been used off label in their practice (and many others) to successfully build milk supply in mothers who had a bad start to breastfeeding, had stopped but wished to start back up, and even in adoptive mothers wishing to breastfeed their new babies.

I was excited! I was to take the pills for fifteen days. Three pills for five days, two pills for five days, and then one pill a day for the last five days. Sometime around the seventh day was when I should expect to see a significant boost. Fifteen days came and went and hardly any change occurred.

I stopped pumping as it was too much time to nurse and pump and nurse and give a bottle and nurse and pump and another bottle. I switched to nursing before and after every bottle and in between when he wasn’t hungry but would still suck. We supplemented between 10 and 12 times a day. I would PUSH to go two hours between every 2oz bottle and nurse him as much as I could in that time.

I started looking up other ways to increase my milk supply. I came across the term “galactagogue”. Ga-lacta-gogue. Galactagogues are substances that increase your milk production. Reglan and Fenugreek were the ones that I had already tried before coming across the term. I found several websites that listed all of the different ones there are. (1)(2) I decided that I would seek out these herbs and make a tea with them.

The Natural Health and Living Center in Bangor had the majority of the herbs I sought out. I brought them all home and stitched a little cloth teabag and mixed (hand stitched teabag)all the herbs together. It tasted AWFUL! Worse than the mother’s milk tea from the store. That tasted like black licorice. This tasted horrid! Like dandelion flowers. Horrid and bitter. The next day I went through one by one and tasted the herbs and found out the bitter flavor was from the blessed thistle. Round two of tea came (minus the blessed thistle) and it was much better but still not very tasty, so I mixed in a can of Juicy Juice™ 100% juice liquid concentrate. It was better but it still didn’t give me that full feeling.

By this time I was at wits end. I had tried everything I could think of (and afford) twice over. I made chocolate no bakes with REAL oatmeal and flax seeds that were so tough they stuck in my teeth. I drank gallons of water a day. I ate enough calories and good fats. I was nursing 10-20 times a day. NOTHING was working. “What is wrong with me? What am I doing wrong?” I would think, blaming myself for not having any significant increase. “What more can I be doing that I am not yet doing?”

In a normal working body milk production is a fairly simple concept of supply and demand. The more milk that is removed and more stimulation there is, the more milk you will produce. For me, this wasn’t happening. Each hour spent nursing without formula was a HUGE success. We had made it down to 4-7 supplements a day but that was still 8-14oz, half of what he must be eating to be gaining an ounce a day. Why wasn’t anything working to get my supply where it should be?

After searching the different causes of low milk supply I came across another term that I had never heard of: insufficient glandular tissue or IGT. Insufficient glandular tissue is when there is a lack of the glands that produce and store milk in the breast tissue. I had never heard of such a thing before, so I read further on it. IGT easily diagnosed with a simple breast exam done by an international board certified lactation consultant (IBCLC). It is characterized by very little to no breast change during or directly after pregnancy, no period of engorgement in the days following childbirth and low milk supply requiring supplementation.

“This is it.” I thought. “This is what my problem must be.” I mean, after what was 3 weeks of constant trying to get my milk supply up through every means possible this (or something similar) had to be what my problem is. I found a blog about a mother who was diagnosed with IGT and was on her third child while writing the blog. (3) I spend an evening cuddled with my baby, nursing, reading, crying tears of sadness and joy for her story and accomplishments and how true so much of what she said rang in my heart. Reading her blog and her slow but steady accomplishments gave me the hope that I too one day would be able to work down to just a few supplements a day. From there I found a few other websites and articles about IGT and resources and why medical professionals should further educate themselves about it. (4)(5)(6)

On August 6, 2011 I attended The Big Latch On at the Central Street Farmhouse in Bangor. It was wonderful to be surrounded again by baby mother dyads. I knew that even though I wasn’t making as much milk as them that I did belong there. After the event was over I stayed and talked to one of the ladies who worked there (who was also one of the LLL leaders) and also my Fiance’s friends aunt who I had talked with on facebook in various “crunchy mama” posts about cloth diapering and breastfeeding.(using our SNS)They suggested I get a supplemental nursing system (SNS™) so that instead of nursing before and after bottles, he could just get his meals at the breast and learn what it is like to eat there and not just comfort nurse with some milk there. It turned out that the aunt of my fiance’s friend actually had an SNS™ from the hospital that she got for free and never used and offered to give it to me.

What a wonderful gift it was! I tried it in the car later that day before we even got home. It was tricky to use it without the tape but we got it and it was so wonderful to see him completely satisfied when unlatching from my breast instead of screaming because he guzzled a bottle too fast and had it ripped from his mouth so he didn’t swallow air. I could simply take the tube out and let him keep nursing as long as he wanted to.

Today, roughly eight weeks since the birth of my beautiful boy, six weeks since we corrected his shallow latch I have worked up to and plateaued at about a half of a supply. Depending on the day he gets between six and twelve ounces of formula. Our record(co-sleeping and nursing) since supplementing was a 12 hour stretch of nursing at night, which co-sleeping helped with (but the co-sleeping is another story). We are happily using our SNS™ and he is getting all his meals at the breast. I am choosing to continue breastfeeding and supplementing because I KNOW that breast milk IS the best thing I can give him right now and some is better than none at all, and formula makes it so he is actually a thriving baby with adequate nourishment.

Though it is a far stretch right now, it is my hope that one day in the next four months I can exclusively breastfeed before starting him on solids, even if it is only for one day, and if I can’t I know that it is not my fault as I have done and will continue to do everything I can to make this so (with the exception of starving him again!). After we start him on solids I hope to replace the formula in his diet with the solids and keep my supply where it is and then continue to nurse and give solids for anywhere up to two years, but by then, we might even choose to go longer depending on how I feel about it when we get there.

It is only in the last few days that I have come to terms with the fact that I might never make enough (I do it all for this cute face!)milk, and I think it has made me a bit less tense and able to be a better mother to my baby and enjoy these cuddly days instead of worrying constantly about what percent of his diet is breast milk and what percent is formula. He’s getting enough to eat and the benefits of breast milk are present in his diet and he enjoys comfort nursing to the point where it’s sometimes the only thing that calms him down. So, I’m happy with our nursing relationship, however far it is from what I imagined, it is what it is, he is growing and we are happy and THAT is a fact that nobody can take from us.

It is my hope that people will educate themselves about this real problem that affects a small percentage of women. Without proper education people will continue to perpetuate the stereotype that, “Every woman can breastfeed,” because this isn’t always true. For the women who, like me, have struggled to get up and maintain even a portion of a supply, this view can cripple their determination to breastfeed to the point where they might give up all together and resort to using just formula.

However with the proper education, support and guidance, women with this problem can come to terms with the fact that even though they cannot provide 100% of their babies food needs with their milk, they can still have a nursing relationship with their babies and provide some breast milk, which is far better than none at all. This education can help medical staff direct women to supportive communities of those with the same problems and resources like Human Milk 4 Human Babies (7), which hooks mothers with low milk supply up with mothers with the opposite problem- an abundance of milk, and provides expressed milk in place of formula supplementation. With this guidance we can take this “difficult option” for these women and make it an enjoyable experience close to what they initially had expected.

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."

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