What I Wish I’d Known About Breastfeeding, Part 2

Continuing the breastfeeding discussion we started last week when we discussed risk factors…

When we left off, I had insufficient supply, and the babies didn’t know how to nurse because they were born too early. I was pumping all day for a small amount of milk, but most of the twins’ nutrition came from formula.

I tried all sorts of tactics to make breastfeeding go better, including:

• Consultation with lactation consultants (LCs) in the hospital. I saw half a dozen different LCs when the twins and I were in the hospital, some on the post-partum unit and some in the NICU. Despite having had many visits from many people, I feel like they failed us. We left the hospital with neither baby able to nurse without a nipple shield, and with me having little idea how to help them nurse nor do basic skills like breast massage. In terms of the latter, I asked an LC to show me, and she demonstrated in a very cursory way on her own breasts. As a result, for weeks afterward I was massaging in a wrong and totally useless way.
• Consultation with an LC at home. We had several sessions with a nurse home visitor who happened to be an LC. She helped us a bit and made some suggestions like fenugreek to improve supply, but we still didn’t learn to nurse.
• Pumping to increase supply. This started the day the twins were born, probably about 9 hours after birth. They weren’t able to feed by mouth for more than a week, so pumping was the only option. I was told to pump at least 8 times per day, but I was also told that because of my severe blood loss, it was more important that I rest. I did my best reconciling this conflicting advice. Usually, rest won.
• Fenugreek. This made more difference than anything else I tried. I ended up on quite high doses since the lower doses didn’t do much.
• Domperidone. For dumb reasons having to do with the FDA’s misinterpretation of outdated findings, it is very difficult to obtain domperidone in the U.S. I used an international supplier. This helped me somewhat. Note that I did not take reglan because I was already struggling with enough postpartum mood issues and didn’t want to risk the side effects. Domperidone was also appealing because it does not cross the blood-brain barrier as reglan does. I worked up to the recommended dose but ended up upping my dose several times to a much higher alternate maximum recommended dose because the lower doses ceased to be effective.
• Pumping techniques to encourage supply. I power-pumped at various intervals. I kept the pump on stimulation mode until let-down occurred (which always took a long time for me). I turned the dial as high as I could stand it.
• Chiropractic. I actually started seeing the chiropractor for a different problem resulting from my months on bedrest, but The Breastfeeding Mother’s Guide to Making More Milk said that it could help. I don’t know whether it helped the milk supply, but it did help my other issues.
• Massage. Massaging two specific acupuncture points related to let-down helped quite a bit. My massage therapist worked on them when I saw her, and I often massaged them myself at home (or got DH to do it).
• Relaxation. There were long periods when I would cry every time I pumped, so relaxation was not so easy for a long time. It got better.
• Food and liquid intake. Some people say that you need adequate food and lots of fluids to produce milk. Some people say it doesn’t matter. I don’t know the truth, so I made a big effort to get enough, even instructing visiting family to tend to my intake as part of their baby duties.
• Edited to add: Oatmeal. Eating oats seemed to increase supply a bit, at least for a little while. When I got sick of eating oatmeal, I became a fan of yogurt with maple syrup and lots of rolled oats stirred in.
• Consultation with one more LC. After four months of misery, I decided to give it one last shot. I asked our pediatrician if he knew a great LC (because I was fed up with mediocre ones). He sent me to the head of his hospital’s lactation department — a different hospital from where I delivered. She helped me figure out that the babies had permanently lost the ability to nurse. She was outraged that the LCs at the other hospital had sent us home with the twins not knowing how to nurse, and she said that our situation made her sad. That really touched me. She encouraged me to exclusively pump as long as I could manage, but to feel free to stop when I needed to for the sake of enjoying being with my babies. Unlike most LCs I’ve encountered, whom I’ve found dogmatic, she was committed to doing what was best for us, not just committed to breastfeeding. She also reinforced what a fantastic job the obstetricians did during our birth at saving my life and my uterus — from what she’s seen, it’s rare to have such a good outcome in a situation like ours. Milk supply problems are a small price to pay compared to what could have happened.

Despite trying all of these strategies, there are so many things I wish I’d done differently.

• Insisted on pumping immediately after birth. It did not occur to me to pump in recovery while I was twiddling my thumbs. As soon as I got to the postpartum unit I requested a pump, but it did not arrive for hours.
• Insisted on more active help from LCs. I knew that they weren’t doing much, and I knew that I needed more help, but it seemed like asking for help on a daily basis should have been enough.
• Pumped more in the first few weeks. This is a biggie. The Breastfeeding Mother’s Guide to Making More Milk said that supply is calibrated based on the demands in the first 2 to 3 weeks. I really wish someone had told me this!! Because I was producing so little, I got discouraged and didn’t feel like there was much point. I pumped as often as was convenient, but not nearly as often as I could have. No one ever said that the point of pumping in the early days was not to produce milk now, but to teach the body to produce milk in the future.
• Not taken the LCs’ instructions so literally. In the hospital they said to pump every two hours. When I left they said that every two hours was not tenable, and I should pump every three hours. In my compromised state, I took these instructions very literally. If it had been 2 hours and 40 minutes since the last pumping and both babies were asleep, I waited 20 minutes to pump again; invariably, one or both babies would wake up and turn 3 hours into 4 or 5. I should have pumped whenever I had the chance instead of watching the clock. It seems so dumb and obvious now, but sticking to the time screwed me multiple times a day.
• Found an expert LC quickly. I had a list of experts in low supply from The Breastfeeding Mother’s Guide to Making More Milk, but none of them were in my area. Because I’d had such unimpressive interactions with so many LCs, I didn’t trust that anyone out there could help me. I was not enthusiastic at the idea of seeking out someone (or a few people), paying them a lot of money, and then being disappointed. It turned out that the LC at our pediatrician’s hospital was free.
• Read The Breastfeeding Mother’s Guide to Making More Milk earlier. I didn’t know it existed, so this isn’t a regret as much as a retrospective wish. In addition to the suggestions, having a better understanding of the lactation process really would have helped me, as would the encouragement the book provides.
• Seen more doctors. I saw OBs at the scheduled intervals for postpartum follow-up, but I didn’t mention anything about breastfeeding at my 2 week checkup because I was waiting for my milk to kick in. By the 6 week appointment, the situation felt desperate and I was forlorn. Seeing an OB, or even a PCP between 2 and 6 weeks might have done something.
• Tried harder at direct breastfeeding. I was in a quandry because I had so little supply that it seemed pointless to have the babies nurse, especially given that nursing was a struggle for them and for me. However, it is possible that proper stimulation by the babies in the first weeks would have increased supply. Being fair to myself, though, I don’t know if I could have handled more. Burrito in particular had a very hard time at the breast, and his rearing and fighting really aggravated my preexisting repetitive stress injury in my wrist. I also got very frustrated when I would nurse them both and then they would each take as much in their supplemental bottles as they would have eaten if they hadn’t nursed at all. After a couple of months of mostly pumping with a couple of attempts at nursing each day, I made a conscious choice to pump exclusively. It felt better to know exactly how much they were taking in (at best, a couple of ounces per baby per day, with formula making up the difference), because I didn’t feel comfortable with my preemies taking in an unknowable amount of milk from the breast. I hoped that I could increase supply further with drugs and other tactics and then maybe go back to nursing — which I now know probably wouldn’t have worked.

I have more regrets about breastfeeding than about probably anything else in my whole life. What’s most frustrating is that despite my many regrets, there’s a very good chance that nothing I could have done would have made a difference. The most consistent thing I ever heard from health professionals, from LCs to obstetricians to neonatologists to nurses, is that because of the extent of my blood loss during delivery, there was little chance that nursing would ever work for us. Add to that the preemies who didn’t know how to nurse, and the prematurity meaning that the last 6 1/2 weeks of breast preparation didn’t happen, and the c-section, and the possible influence of endocrine issues and infertility, and it’s quite clear to me now that we were pretty doomed.

I have so many regrets about breastfeeding, but at the same time I have to feel proud of myself. I have truly never tried so hard at anything in my entire life. Many people asked me what the point was, or why I was trying so hard. I have seen the data on the benefits of breastfeeding, and I find the data compelling. Particularly for preemies, there were too many benefits not to do my best. I feel good about providing what I could for them. They are so healthy and big now. I worked hard at bedrest before they were born to get them here, and I worked even harder after they were born at making milk. My love for them is astronomical, and contributing to their well-being was one way that I wanted to show my love.

Paradoxically, by showing my love for the twins in this way, I cost them love in other ways. So many hours each day were spent pumping alone, and more time almost every day was spent crying or otherwise upset. Too much of the time in their first months they got a mother who was preoccupied with breastfeeding, instead of a mother who was marveling at their wondrousness. The same way that pregnant women and babies used to make me sad during my years of infertility, now it makes me sad to see nursing mothers, as well as mothers who could but choose not to nurse. Infertiles are still my peeps, but now those who struggle with breastfeeding are also my compadres. I feel doubly connected to those who belong to both clubs, and so very sorry that the joy that we anticipated for so long has to be dampened by our bodies failing us yet again.

I’m almost done weaning from the pump now. It’s liberating, but it’s also scary. Many times I’ve panicked and wondered if I’m making a huge mistake — because there’s no going back. Relactation is hard enough for mothers who had nursed successfully; I can’t imagine that it would go well for me. I’ve also had crazy thoughts of having another baby just for the sake of breastfeeding successfully. I’m trying to find peace with it all, and the best way I know to find that peace is to blog about it and hopefully help someone else avoid what I’ve gone through. I’ve sobbed all the way through writing this post, and I just need to hit Publish and be done with it, but if there’s anything I’ve left out, or anything anyone wants to know, please ask.