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

April 20, 2010

(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.

17 Responses to “What I Wish I’d Known About Breastfeeding, Part 1”

  1. Kate Says:

    I’m eagerly awaiting your next post, as I’m currently struggling with low supply and pumping to try to increase mine. It’s so not fun.

  2. Lavender Luz Says:

    This is a hard topic for me to read about.

    But I wanted to tell you that I’m sorry you had such a rough time with it, and I’m glad you’re able to help others who may have the same issues.


  3. Amanda Says:

    I’m glad that you are doing this. I only have a singleton and not too many checks, but I do have pcos and did have a really hard time with latching. But I can totally relate to the sentiment of being trapped in a room with a pump while other people are spending time with your babies. It is a horrible feeling, especially if they are crying.

  4. a Says:

    I had only one check (c-section) and had supply problems. But, I watched my sister with my nephew and the problems they had, and knew that sometimes it just doesn’t work.

    I cannot imagine pumping instead of nursing. How would you ever get anything (ie sleeping, staring in wonder at your babies, eating, etc) done? There isn’t enough time in the day for that. I’m in awe that you managed to do that for so long.

    Very useful information – something I wish I’d known before my daughter was born.

  5. Photogrl Says:

    First off, I’m proud of you.

    Very proud. I can only imagine how hard it was to write this post.

    Secondly, thank you. I had no idea, either.

    Even though I did somewhat breastfeed Miss O., I have nightmares about whether I’m going to be able to feed the twins.

    I’m going to be buying both books ASAP.

  6. strongblonde Says:

    it’s so crazy. i spent/spend a lot of time feeling broken and like i couldn’t do something that was supposed to be “natural”. 😦 i totally get this.

  7. Ana Says:

    agree with all of the above. the part you wrote about being trapped alone in a room while others are with your baby(ies) really resonated. How much time with him have I lost while pumping?

  8. Sara Says:

    I found this blog a little while ago, and I found it very supportive. It isn’t just those that decline to breastfeed, but those that want it with all their hearts that need support. I think this writer is great at it, and I hope that since you are at a point of writing this post, you will also find support here.


  9. Heather Says:

    I’ll also state nursing twins is very hard. I was able to nurse my singleton daughter for 7 months, without too many issues, even though we struggeled with thrush for a few months (gentian violet finally fixed that).

    The boys were also 31-week premies and were on IVs and then naso-gastric tubes for eating. I did not have supply issues. The nurses were surprised I had so much supply. I was able to nurse them until a week after they were both home. They were 7 weeks when I stopped. I don’t regret stopping at all. They both needed a lot of individual attention latching on. They could, but sometimes they would prefer one side or just have a hard time latching. We could do it, but it would take a long time times two. I tried getting them to both nurse together, but they needed so much help and they were so small, it was frustrating. And then Tommy would have been attached to the boob buffet all day if he could. I was exhausted. I think it was also the exhaustion. Taking care of two newborns around the clock is exhausting. Even with both me and my husband trading off nights. I didn’t get a decent night of sleep until they were 5 months old.

    I don’t regret stopping nursing them. I know I’m capable of nursing as I had no issues with Phoebe. Being able to hand a family member a bottle and going to take a nap, was the most freeing thing I could do in the beginning. I will admit to crying when I had to discuss with the pediatrician that we started formula, but looking back now that they are almost 11 months old, I’ll admit that I was just trying to survive the newborn phase. It’s the toughest ever. No wonder sleep deprivation is a form of torture.

    Hang in there and great post!

  10. Dora Says:

    Late to comment here, but I really wanted to add my thoughts to this.

    You have done amazingly for Burrito and Tamale. I mean, you kept them cooking all those extra weeks after you went into labor! You were a textbook bed rest patient. Pumping for so long when you’ve been getting so little is an incredible accomplishment. I can’t imagine how frustrating that must have been. B & T are round and delicious and happy. I’m so sorry you missed out on many moments with them because you were in another room pumping. There will be many, many more wonderful moments to cherish. I hope giving up the pump is freeing for you.

    As for my experience, it has been mixed. From the beginning, I approached it with a moderate mindset. My sister is a militant LLLer. It was such a turn off. I really don’t understand why people like that don’t get that they are not advancing their cause by equating formula with poison and child abuse. (Yes! It really comes off that way!) I have longed for this child for so many years, I was determined to relish her infancy. I have know women who had trouble breastfeeding, and I knew I’d be going back to work after 12 weeks, so I decided in advance that although I planned to breastfeed, I would not make myself crazy.

    Squeaker had a pretty good latch right away. I was very lucky that post c-section, I was able to nurse her within an hour. But as is normal after a c-section, my milk was slow coming in. They became concerned at the hospital that she had lost a little more than 10% of her birth weight. Despite everything else being fine, no jaundice, peeing and pooping plenty, 10% is the magic cutoff where they become concerned. So she was supplemented with formula in between nursing. They even kept me several extra hours the day we were to check out so we could supplement and do another weigh in.

    I really feel I shouldn’t complain, my nipples didn’t crack, no clogged ducts, etc., but still … I found nursing painful. Here again is where I have an issue with the BF militants who insist that if you are doing it correctly, it doesn’t hurt. Bullshit! Lactation consultants who’ve checked have assured me that Squeaker had a good latch, but her mouth was so small compared to my large areola, and she would nurse for sooooo long! For the first 3 months (basically my maternity leave), she would get very fussy and hungry every evening. Supplementing was the only way to get her to calm down and go to sleep. I really tried to resist giving it to her at first, but after 2 to 3 hours of on and off nursing, I was losing it. As she would get more frustrated she would gnaw on my nipples. BTW, despite getting bottles so early, she NEVER had nipple confusion. She easily went back and forth between bottle and boob. She still does.

    Going back to work and having her in day care (exposed to other germy kids) I wanted her to have the extra immunity from breast milk, so I’ve been pumping at work. But I don’t have a private office. By law, my company is required to provide a space, but it doesn’t have to be nice. I am pumping is a stuffy utility room. I started off pumping twice a day. I got a reasonable amount, but not enough for the whole day at day care. My hope has been to eventually get my supply to accommodate nursing at home and not pumping at work, but initially when I would go to pump I would feel this internal pressure to get as much as possible. Then a few weeks ago my supply suddenly dropped off. I was getting less in two pumping sessions than I used to get in one. So about a week and a half ago I started pumping just once a day. Last Thursday I got less than an ounce. This just didn’t seem worth the time and effort. So last Friday I didn’t pump at all. I was feeling pretty full when I picked up Squeaker from day care, but we took a leisurely route home (the weather was gorgeous), picking up something for my dinner, stopping at the pharmacy. All was fine. I was REALLY ready to nurse when we got home and she happily gulped it down.

    Sorry for the essay! All this to say that a combo has worked well for us. I do hope that I can continue to nurse at home. It’s so much easier in the middle of the night than getting up to get a bottle, and my chubby girl has been in day care for 2 months now and has not gotten sick. Although, she still chews on me when she get’s frustrated. OUCH!

  11. Cat Says:

    I can’t believe I missed seeing this post until now! I’m so glad that booked helped you, but sorry it was after you’d already been through so much. That’s a very long list of risk factors stacked against you! I am in awe of your determination and dedication to breastfeeding for so long when it was that difficult. You’re amazing!

  12. Over from Creme de la Creme…

    Great post. I was very lucky in that I had TONS of people telling me from the beginning not to feel pressure re. breastfeeding, and thus, I kind of went into things thinking that I wouldn’t be heartbroken if BFing didn’t work out. And then, when it did end up working out (despite shitty “support” from the LCs at the hospital), I found myself surprisingly defensive of our BFing relationship. We’re at six months and still BFing, but that wouldn’t be the case if I had believed various people’s advice (specifically KellyMom) that I couldn’t possibly be having supply problems. Luckily, I trusted my own instincts and immediately took steps to boost my supply when I realized that I was having a supply dip. And I also happily and shamelessly supplemented with formula (still do once a day) when that supply dip happened. (I have PCOS-ish issues, and multiples and had a c-birth, too)

    Anyhow, I really wish posts like this were more readily handy, along with the many posts (and comments) I’ve read helping us to feel like it’s pointless to even try to BF multiples, or that we should just either buck up and suffer or give up completely. There’s middle ground to be found, I think, and I appreciated reading your perspective in this post.

  13. WaterBishop Says:

    This is such an important topic.
    I have pcos and while my supply was good the first few months, it tanked drastically and my son began losing weight. I pumped like crazy, but it was of no use. I miss it.
    BFing is really hard. No one told me that. I had no idea how isolating it was.
    Thanks for this post

    (from the creme)

  14. Thanks for being so informative. Knowledge is power.

    You just dished it out. (thanks!)

    Visiting from Creme de la Creme and will be back often.

  15. Sara Says:

    Here from creme

    I loved this post. It will save some readers a lot of grief. Good work!

  16. Lut C. Says:

    Breastfeeding was a tough cookie for me too. I had only a few of the complicating factors listed there, clearly they don’t know all the secrets of BF yet.

    I pumped, and pumped, and pumped, with no result. Terribly frustrating. After a few months, I settled on a compromise (BF with a SNS).

    (Arrived from the crème de la crème list)

  17. Esperanza Says:

    Oh god. Breastfeeding. I had such a hard time (though not as hard a time as you had). We had latching issues, oversupply, thrush (for two months), more latching issues, insufficient weight gain. I felt like I lived at the Lactation Center. It was awful. I just want you to know that I also struggled. I hope you found a way to make breastfeeding a positive presence, if that is what you ultimately wanted. And I hope you know you are a wonderful mother, no matter the volume of milk you were able to produce. Thank you for sharing this.

    Creme de la Creme #125
    Creme de la Creme 2010 Iron Commenter Attempt

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