mommyonthegreen

Converting back to a green life, one week (and nap time) at a time

Born Hungry: Part II

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September/October 2015-March/April 2016

What does breastfeeding have to do with going green, you might wonder. Primarily the waste reduction aspect – no formula containers to recycle, no bottles to wash. Additionally, the nutritional benefits of a “natural” food.

In my first post (Born Hungry Part I) I described my struggle to breastfeed my daughter (MD). There have been many days when I wished I could do it all over again, and do it right.

When we became pregnant with our second child, I knew I wanted to try breastfeeding again.  But this time I was ready. I purchased a breast pump, had bottles and formula ready, and purchased a bottle of fenugreek from The Healthy Bug health food store down the road.

Most importantly, I was armed with information. I knew what breastfeeding was supposed to feel like, and how beautiful it could be. I went in with the opinion that as no two pregnancies or no two babies were the same, there was no reason to believe my breastfeeding experience would be repeated.

I had a relatively healthy and uneventful pregnancy (noticed breast changes right away, which continued throughout the pregnancy), and LM was born the day before his due date (see And Finally). Labor and delivery again were very fast but without any complications, and he was a healthy weight.

DSCN0607

When he latched on in the delivery room and immediately started the now familiar suck-swallow, I was so relieved it was almost orgasmic.

I continued to nurse on demand (trying to wake him every three to four hours the first day), and it just felt so much better than it had with MD. It felt natural. I was experiencing some pain in the left breast when he first latched on, but I expected that would improve in a few days. The lactation consultant that came to see us in the hospital (wow so the health care system had learned something in the last four years!), she commented that my nipples seemed large but otherwise everything seemed ok.

So when after day two when LM and I had been up all night, his weight was still dropping, he was jaundiced, and he still wasn’t peeing as much as he should have been, I was disappointed but still determined. I knew that all of this except the peeing part was normal, and he was still well above seven pounds so he had a little more weight to work with than MD.

After much discussion with the nurses and the OBGYN at the hospital, we decided to supplement. I didn’t want to go through what we’d gone through with MD. I could feel that my breasts were getting bigger and that my milk was on its way in. But I knew a little bit of formula now would help flush his system and make sure he could pee, give him calories to breastfeed effectively, and give me some much needed rest. This time the health care practitioners were very supportive of formula.

Within an hour he had a pee. He also only took a little bit of formula before settling down for a long sleep, which the nurse said was encouraging, as it indicated he was likely full of colostrum and transitional milk.

That afternoon we were discharged, and we brought LM home. I fed him on demand, every two to three hours during the day and every three to four at night.  There were a couple of nights he slept nearly six hours. I wasn’t going to set an alarm, as I knew we both needed rest, but I woke him as soon as I woke.

I started taking fenugreek the day after we got home. We also supplemented a couple of times, as it was August and very hot, and I felt I had nursed him with all that I had but he was still screeching for more.

On day five I woke at midnight to full, leaking breasts. Hallelujah! My milk was in! I nursed him until he wouldn’t take any more and he drifted off to sleep. He drained one side and part of the other, and I pumped off what was left.

PHN came in the next afternoon he had gained weight – horray! She suggested we stop supplementing. I asked her about the painful latch on the left side. She said, oh that’s ok, it should clear up in a few days.

I was relived and happy to be breastfeeding my baby, and did not anticipate any problems. But then . . .

Over the next day or two he still wasn’t peeing as much as he should have been. I was concerned about both the jaundice (which seemed to be getting worse, not better) and dehydration since it was so hot. I wanted to have the PHN come two days later to have him weighted again, but she wasn’t available. So at one week I was out and about to take him to a mom and tot group to have him weighed. Sure enough, he had lost two ounces. The PHN was stumped.

He was pooping regularly and it was the right consistency, he was sucking and swallowing at the breast, he was latched deeply (on the right side anyway), I could see milk in his mouth, I could notice a difference in my breasts before and after nursing, he was now waking every three hours on his own most of the time to eat, and was taking anywhere from 10 minutes to 25 minutes to empty a breast. He was alert and not lethargic. He was falling asleep while nursing, but most newborns often do this. He was still jaundiced though (the other nurse told me not to worry about the jaundice. How could I not worry when my whole family was worried!) It was also still very painful when he latched on the left side. Something just wasn’t adding up.

“Do you mind if I look in his mouth?” the PHN asked. Of course, go ahead I replied. “Aha”, she exclaimed, “he’s tongue tied, and lip-tied. He can’t get a proper latch to empty the breast or stimulate the breasts to make more, and he’s tiring himself out trying. Keep supplementing him for now and speak to your GP at your next visit to have it clipped.” After telling her about the experience we had with MD, she said chances are my daughter was tongue tied too. (That would certainly explain why I had such a hard time with her).

At two weeks of age he had the tongue tie clipped (they wouldn’t cut the lip tie). The Dr. said to have the PHN check the latch and have him weighted in a few days. Oh, and by the way there are these exercises you should do to keep the tongue tie from growing back, but you can see them on Youtube. Really? A Dr. is directing me to YouTube for medical information? Oh my postpartum nerves!

Within a few days I noticed that he was no longer falling asleep as easily at the breast. Now that he was staying awake to empty my breasts, it seemed like he was rarely satisfied at the end of a feeding. It was like I was playing catch up all the time. I continued supplementing when it seemed necessary.

At one month check up he was gaining weight, but just barely, and he was rarely content at the end of a feeding, even after giving formula. I asked the Dr. for domperidone again, and she provided a prescription. In hindsight I probably should have asked for this at one week, but my Dr. is hesitant to prescribe medications that aren’t needed and I don’t know if she would have considered this “necessary” at that time.

At two months it was the same story – the domperidone and fenugreek had helped, and most of the time I could feed him (usually between midnight and noon) and just supplement a few times a day (usually afternoon and early evening). I felt like I was just about there.

But my Dr. still wasn’t happy with the weight gain. She suggested that maybe I made “skim milk”.  That is, that my milk does not have a high enough fat content to satisfy him or help him gain weight faster. She agreed that based on genetic endowment (he comes from a family on the large size on all sides) and activity level (holding his head up at 45-90deg at 2 months of age) I should continue supplementing him whenever he needs it, and that he would stop when he had enough (something we were concerned about with MD).

When I pumped I took note – sure enough, about 2 ounces of foremilk, toped with a skim of hindmilk (much like gasoline on a puddle). I also noticed how much slower the hindmilk came out: the foremilk sprayed out forcefully, while the hindmilk was more like a “drip drip drip” resembling a leaking faucet. At this point I’m thinking I would love to have my breastmilk analyzed by the Dal Food Sciences group, for example. Do we really know that all breastmilk is the same?

Of course, when I mentioned this to the PNH, she said that “skim breastmilk” was a myth. Oh why can’t all health care practioners have the same information? See KellyMom for a really good article explaining human milk production and fat content. See BalanceBreastfeeding for a more balanced perspective, that leads me to believe I had impatient babies who wouldn’t wait for the “drip drip drip”!

At one Parent & Tot drop in session I did a before feeding and after feeding weight, with the PHN. The difference was about two ounces. The PHN seemed alarmed at this, but really couldn’t explain it or offer any other suggestions.

I am drinking lots of fluids, getting lots of rest, nursing every 2-3 hours during the day and 3-4 at night, pumping when I have time, taking the highest dose possible of domperidone and fenugreek, even drinking mother’s milk tea. I continue to offer the same breast until I can’t express any more, doing breast compressions, and nursing in different positions to make sure he’s emptied each breast (as much as possible, acknowledging that milk is constantly produced). If I feel another let down I put him back on the boob before I resort to bringing out the bottle. And yet . . . I still don’t seem to have enough milk (based on baby’s behaviour, diaper ouput, and weight gain).

When I have spare moments (when LM is napping on my chest but I can’t seem to sleep myself), I’ve been doing some research.  I came across some information I’d found when I had MD but decided to take a closer look – IGT.

Insufficient glandular tissue (IGT) means that some women, for whatever reason, just don’t have enough glandular tissue in their breasts to make enough milk. And not just for a hungry child, but for any child. It is hard to diagnose, because it usually only becomes apparent when a woman first tries to breastfeed.

Some of the signs are listed in this article by La Leache League and Best for Babes.

Breast asymmetry (one higher and slightly larger than the other), wide spacing (lack of cleavage), lack of changes during pregnancy, and downward pointing breasts with “empty sack” appearance are a few of the traits that I have.

It would explain why when I look at photos of myself, it always looks like I’m not wearing a bra even when I am. It would explain why I find bra shopping difficult; why my breasts are barely a B-cup, small in proportion to my 5’7” 170 lb frame and 38-40 bra diameter, or why no matter how I adjusted the shoulder straps I couldn’t get enough lift. It would explain the proportionately large nipples the lactation consultant in the hospital noticed. It might also explain why, even though my babies weren’t latching properly, I never developed mastitis.  It’s like aspects of my life were finally starting to make sense.

The scientist in me craved more information. I wanted to see a photograph or other image demonstrating these traits. I finally found some, and I was floored. I held the iPad in front of me while I stood in a mirror. It’s like the illustrator was looking at me when he drew the picture. I couldn’t believe it. “It’s not you it’s your boobs” I thought to myself.

One day I finally broke out the ruler and measured – one inch. One inch between my breasts. So not technically IGT. So I decided to ask for another opinion.

When I mention the possibility of IGT to PHN, I’m met with “oh, I doubt it, that’s pretty rare”. I feel like saying, “well, how many clients have you had? Maybe I’m your first.” I wish I could track down that one PHN that I spoke with months after having MD.

This is where I just want someone to look at my boobs (something no one, for either child, has done, except for that one lactation consultant who noticed my nipples while looking at the latch) and tell me I’m not imagining things.

I’m not trying to come up with an excuse to quit. I just want to be reassured that I’ve done everything I can and that it’s not my fault.

I’m not the only one having trouble getting health care practitioners to acknowledge this.  Many others have written about their own experiences and the struggle of others:

Little Help from Doctors

Diary of Lactation Failure

Why I don’t breastfeed

The Manly Art of Breastfeeding

 

And others go a step further, questioning some of the benefits of breastmilk and breastfeeding culture altogether, and the lack of science behind some claims:

Breastfeeding Conspiracy

Breastmilk not a pure food

Tyranny of Breastfeeding

The Case Against Breastfeeding

Lactivist Crusade

Meanwhile, there are some helpful resources on the internet that further explain IGT and what you can do to help yourself and your baby, even if the health care system won’t:

Kelly Mom – IGT

When Breastfeeding doesn’t work out as planned

Dr. Sears – Getting Enough Milk

Hidden Cause of Feeding Problems- IGT

Nipple Size & Breastfeeding

Not everyone can breastfeed

Delayed or lack of lactation success – Insulin & DNA

The Booby Traps

Yes you can breastfeed

Baby Centre – Underdeveloped Breasts

How to supplement if you have low milk

Domperidone

Fussy Babies – it doesn’t necessarily mean you have low milk (but sometimes it does)

Pros and Cons of Breastfeeding

10 things I wish I’d known about breastfeeding

Markers of Lactation Insufficiency

 

Another resource I’ve found helpful is the book A Breastfeeding Mother’s Guide to Making More Milk.

This book describes numerous possible problems that can affect breastfeeding success. There are a couple that might have affected me:

  • Hormone receptor generation period – for some women there is a small window of time when the body has to be cued to produce milk (through frequent nursing), and once this window is past milk production stabilizes;
  • Delayed letdown – I thought there was no milk there when there really was, it just took a few more minutes than usual to let down. As I waited, LM grew more frustrated which made me tense which further inhibited the let down;
  • Milk “withdrawal” – in some women when the baby unlatches, milk draws back up into the breast, and it can take a minute to come back down when they latch back on. Again, the baby might get frustrated, thinking there is no milk there.

 

While I may never get LM off the bottle completely (which is ok – he could still go to med school after all 😉 and his weight will more likely be linked to his activity level and our eating habits (MD is perfectly fine at age 5 🙂 ), I think I’ve finally made peace with it. I am still breastfeeding, even if not exclusively. I know in my heart it’s not my fault even if the health care system doesn’t.

And who cares – he’s eating and growing and getting the best of both worlds. When you think about it, back in the day, if a woman had difficulty making enough milk, there would have been other women around to help – wet nurses, and cross nursing. There was sugar water, there was boiled cows milk and corn syrup. Or the child would have died. Infant mortality rates were high, and who knows why some babies “failed to thrive”.

In all my discussions with breastfeeding moms, I have run across just as many moms who had “too much” milk. They regularly developed multiple cases of mastitis in the beginning, and had to pump at all hours just to feel comfortable, because it never seemed like their babies were taking enough.

What would have happened to these women back in the day? They would have offered their breasts to nurse babies of other women who were struggling or had died in childbirth. When you think about it, we didn’t evolve as individuals. We evolved living together in caves, huts, etc., cooking and hunting together and rearing our children together. Women with good milk supplies would have passed on their genes through their female children. But the genes of women with low milk would have also been passed on, if their babes were nursed by other women.

Cross nursing doesn’t get nearly enough attention, and is generally considered socially unacceptable. Of course, there are also some legitimate medical concerns. La Leche League has a very interesting article documenting concerns and history of cross-nursing and wet nursing. See also this ABC story and this Babble blog post about one woman’s experience cross-nursing.

The closest we have is donated human milk, such as through the Human Milk Bank and Northern Star in Alberta,  available to premature babies through which is a great start. This health magazine article provides an interesting summary of the breast milk banking process.

It makes me wonder whether receiving breastmilk, full of antibodies and proteins from another mother, would reduce a baby’s chances of developing allergies, for example. I wonder if this has ever been studied? Of course, premature babies receiving milk would already be compromised . . . Anyway, it does get me thinking.

 

So what went wrong this time? In some ways, nothing, because, after all, I am breastfeeding.

This time around, I may have been a bit too quick to supplement, and maybe I am one of those women who has a very short window for generating receptors (not enough milk removal while LM was still tongue tied or maybe I let him sleep too long). Or maybe I do have IGT. Who knows if I’ll ever know.

But this is what still frustrates me. Are we doing enough to help women who want to breastfeed? Sure there’s lots of support out there to “keep trying”. But telling them to “keep doing it” or “try harder” doesn’t answer why she’s having the problem. And you need to know the root cause of a problem to fix it.

What if IGT is more prevalent that we thought? (And it’s likely to be, based on some info I’ll get to later) What if its closer to 5% rather than 1%. Well, out of approximately 8500 births in Nova Scotia last year (so approximately 8500 potentially breastfeeding moms), 5% is 425.  Four hundred twenty-five women who might not generate enough milk for their babies. 425 too many not to help as far as I’m concerned.

Even for the women who don’t have IGT, society as a whole is still not providing the support we need. There are the women who breastfeed exclusively very successfully, who due to work and/or travel obligations end up having to wean prematurely or “pump and dump”, for example.

In the words of a fellow blogger, we are set up for failure. But what if we set them up for success?

If governments, health care professionals, families and society were serious about breastfeeding:

  • Prenatal education would include all available information about both breastfeeding and formula feeding, including when formula may be medically indicated;
  • Prenatal messaging would include potential breastfeeding difficulties and what to do, along with the message that “everyone can breastfeed, not everyone can breastfeed exclusively”;
  • Prenatal education would include information sessions for families and secondary caregivers, to educate about any breastfeeding myths or outdated information and allow families to provide the support new moms need (because you can’t be arguing with your family when you’re looking after an infant);
  • New mothers who have decided to breastfeed, and who are experiencing difficulties breastfeeding, would be permitted to stay in the hospital for three to four days or until their milk comes in;
  • Newborns would be examined for tongue tie and have it treated in the delivery room;
  • New moms with breastfeeding difficulties would have their thyroid levels tested as standard procedure;
  • Public Health would work with 811 to provide 24-hour breastfeeding support hotline;
  • could provide a prescription for domperidone to pregnant woman who have struggled to breastfeed previous babies. Alternatively, to avoid long waits to see Drs. Nurses would be authorized to prescribe domperidone for women who have had difficulty breastfeeding previous children, so moms have access to it as soon as possible after delivery;
  • Pharmacies would stock fenugreek and blessed thisle and have scales available for weighing newborns;
  • Public Health Nurses, OBGYNs, Pharmacists, and GPs and other health care professionals would be required to attend breastfeeding workshops as part of their licencing and continuing education, to ensure all health care professionals are providing new mothers with consistent information;
  • A team approach would be applied for new mothers experiencing difficulty breastfeeding, involving the OBGYN, GP, Public Health and other relevant practitioners, to ensure everyone is on the same page for treatment (and the new mom isn’t constantly relaying messages between the groups);
  • OBGYNs and PHNs should be trained in recognizing IGT, and women should be screened during pregnancy;
  • The breastfeeding support team should help a woman set breastfeeding goals. Six months is a long time; goal setting needs to be broken up into smaller increments, much like weight loss or preparing to run a marathon. SMART objectives might also work here as they do in project management. While many women do breastfeed six months and beyond, when you’re struggling that length of time is overwhelming and feels like an eternity.
  • Breastfeeding physiology would be taught in high school biology and home economics classes, in an effort to both educate on and normalize breastfeeding.
  • Governments would work with the airlines and the TSA/CASA to ensure no breastfeeding mother has to “pump and dump”.

I know, it’s a tall order, especially considering the stresses the health care system is already under. And not being a health care practitioner myself, maybe I’m completely out of my tree. Either way, maybe it doesn’t have to be that hard. Maybe the breastfeeding community of practise, a few interested health care practitioners, support groups like La Leche League, and a few moms like myself can work together to turn these ideas into reality.

It’s also a tall order considering women who breastfeed without difficulty are shunned by society for doing so in public. But that’s a blog post for another day . . .

I don’t know how much longer I’ll keep breastfeeding. I keep telling myself every ounce he gets from me is golden, and is one less container of formula in the recycling. But its just as much effort to wash a bottle that’s had one or two ounces in it vs. four or five. I just don’t know how much longer I’ll keep going. But I’ll let you know.

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Update March 2016

It’s 7 ½ months and counting and yes I’m still breastfeeding. The six-month mark was rather anticlimactic – there was no medal presented or confetti thrown at the Dr.’s office at LMs six month check up. A little pat on the back or “good job” from my GP would have been nice. But I guess that’s what Facebook is for, right?

Think again. When I asked a simple question looking for ideas to get LM to stop biting, it almost started a riot. I know this is a passionate topic, but the “Mommy Wars” have got to stop.

 

I don’t know how much longer I’ll keep going. The love-hate relationship I have with breastfeeding continues, and as with anything there are good days and bad days. I definitely see light at the end of the tunnel.  I’m offering less, he’s asking less. I don’t think I’ll miss it in the end, but I am satisfied I stuck it out as long as I have. By breastfeeding at all, I am confident I provided the best possible start to life that I could for both of my babies.

The Australian Breastfeeding Association has a great article explaining the benefits no matter the length of time you are able to breastfeed.

For anyone who wanted to breastfeed and struggled, I salute you.

For anyone who didn’t want to breastfeed and struggled with being shamed or made to feel guilty, I salute you.

For anyone who was able to meet their breastfeeding goals, I salute you.

Because we are all in this together.

 

A letter to breastfeeding moms who struggled: Dear Mom Who Breastfed

Read about how one mom broke up with her breast pump.

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