What I Wish I’d Known About Breastfeeding, Part 1

(Note: Discusses babies, pregnancy, and postpartum issues, but also discusses the biological aftermath of infertility. If you’re not in the mental place to read it now, perhaps file it away for the future. I sure wish I’d had a post like this. If you could have used it earlier, I’m sorry — I’ve wanted to write about this for so long, to help others and to process it myself, and I’ve had this post half-written for half of my babies’ lives, but it was always too painful to keep working on it. I’m finally ready.)

I had no idea.

I had no idea that breastfeeding would be my Achilles heel. I actually have Achilles tendonitis right now as a result of the months on bedrest, and it’s nothing compared to the tsuris of breastfeeding.

There are so many things I didn’t know, even though I thought I was prepared ahead of time. I read Mothering Multiples cover to cover, and it seemed doable. I trusted that the lactation counselors in the hospital would help us with anything that the book didn’t cover.

I was so wrong.

My preemies started on IV nutrition then nasogastric tubes, and once they were put to the breast they didn’t yet know how to suck. I couldn’t even hold my daughter for the first day of her life, much less nurse them right after birth as is recommended. In the just over two weeks the babies were in the hospital, my supply was low but some LCs and doctors thought it might increase over time. Given my more than 6 units lost due to hemorrhaging during delivery, the general feeling was, “Of course you don’t have much milk. You barely have any blood left.” Some ‘experts’ said it might get better, and some said it never would. I tried not to listen to the latter group.

My low supply continued, and continued, and continued, and meanwhile my babies still didn’t really know how to nurse. Meanwhile my postpartum hormones were all over the place, and much of the time I couldn’t stop crying. Nursing went horribly almost every time, and I barely had anything to give them anyway, so eventually I decided to focus on supply and pump rather than nursing. This meant that literally most of my waking hours were spent either feeding a baby or pumping. Sometimes I didn’t have enough help from others and had to postpone pumping to care for the babies, which invariably sent me into a panic. Other times, my husband or visiting family or friends took over the baby duties, meaning that I was locked alone in a room with my pump while other people got to be with my babies. I also had to schedule my life around the pump, and most activities outside the house were out of bounds because they didn’t fit into my pumping schedule. For the most part, we barely left the house, which in retrospect wasn’t good for any of us.

There were many low points, but one of the lowest came during a rare time I left the house. I went to a friend’s house with the babies and I had forgotten to bring any formula or breastmilk. Suddenly the babies got hungry, and although my breasts had milk for them, none of us knew how to get it into their tummies. We tried to nurse, but they’d never learned to latch. They couldn’t extract what little milk I had to give them, and all they could do was scream.

Everything about nursing made me feel terrible, and there was nothing I knew how to do to solve our problems. The only thing that made me feel worse than failing at nursing was the thought of stopping. I spent far too much of those first months being miserable, and far too little time enjoying my babies.

My first turning point came when I read the last chapter of Healthy Sleep Habits, Happy Twins. You may recall that I was in the middle of reading this book when I went into preterm labor at 28w, but I was so afraid of something bad happening and not ending up bringing home twins that I couldn’t bear to read it. It remained half-read until after they were born, then I only had time to read the specific section relevant to them. It wasn’t until they were 7 weeks old and I was hiding away in my bedroom to escape my visiting MIL that I noticed the last chapter about breastfeeding. This chapter, more than anything else I’ve seen, dealt with the emotions I’d been having. Unlike the Mothering Multiples book, which basically told me to suck it up, the chapter acknowledged how very hard it was to try to nurse twins, and that sometimes it just doesn’t work the way you’d hoped.

My next turning point came soon after, when longtime blog reader (and mom of triplets) Cat recommended The Breastfeeding Mother’s Guide to Making More Milk. I wish that I’d found it sooner — it changed my life! The associated website is also rather helpful. Suddenly, it all made sense.

Some of the factors the book lists as increasing risk of low milk supply:

• Multiples, just because there are more mouths to feed. Check.
• C-section, for several reasons including different hormonal and biological process than vaginal birth leading to the nursing process not beginning in the same way; likely delay between birth and first nursing; anesthesia side-effects which can inhibit the milk onset. Check.
• Blood loss during birth. The book says it’s not really a problem unless you lose more than 2 units. I lost more than 6 units of blood. Big check.
• Preemies, who aren’t allowed to nurse at the breast for days or weeks then aren’t as capable at nursing once they do start. Check.
• Babies who are sleepy. For over a month my babies would regularly fall asleep in the middle of feeds. Check
• Formula supplementation, which reduces the amount of milk that the baby will need from the breast which then reduces the body’s production. Supplementation was mandatory in my NICU once the babies were off IV nutrition. Check.
• Feeding on schedule instead of on demand. The NICU runs on a strict schedule, so check.
• Endocrine issues. My thyroid is typically on the very low side of normal, but I have no idea what my levels were like during pregnancy or postpartum. I also could have other endocrine problems that have never been diagnosed. Maybe check.
• Infertility. I repeat, INFERTILITY. Big fucking check.

The book talks about PCOS as one specific infertility-related cause of low supply. I don’t have PCOS, but many infertile women do, so it’s important to know in advance.

There are a few other causes of low supply that I don’t have, like inadequate breast tissue (ha ha), but I have oh, so many.

To address the common causes of infertility and low supply, the book recommends figuring out what caused your infertility as it may help you diagnose the root of the supply problem. This is the only time that I wasn’t totally happy with this book. I spent many years and tens of thousands of dollars trying to figure out why I was infertile, thank you very much. I remain “unexplained.” That ship has sailed.

All of this is not to say that every woman who deals with any of these risk factors will automatically have problems nursing. Most won’t, and very few have the degree of problems that I have had. Still, I think it’s good to keep the potential for problems in mind beforehand so that you can be aggressive in squashing problems at the first sight of them. Next week I’ll talk about the ways that I tried to address the problems, as well as the things I didn’t do that I wish I had.