See, I struggle with low supply issues. Yes, it's a genuine issue and not made up.
Its frustrating to struggle with supply issues. In my experience, most professionals who I have sought advice from give the same suggestions; drink a gallon of water a day, eat oatmeal daily, nurse on demand, work on latch, take fenugreek or blessed thistle or Gaia lactation support or Mothers milk tea and did I mention drink more water? And above all DONT STRESS!
And I know that this advice is effective for most mom's. For pretty much any mom... any mom without supply issues.
As it turns out, I have insufficient glandular tissue. You can google it and find out however much you want, but its suspected that the root cause of my supply issues is hormonal. Possibly related to the cause of my multiple miscarriages, as well. Harriett, the main LC I've worked with has suspected as she's worked with me through three pregnancies and deliveries and attempts at breast feeding that my asthma and my family's generational history of low supply put me at risk of the same. Not only has every woman in my family struggled with supply, but we all also have milk that is very similar to skim milk... light blue in tint and almost no fat to separate off and rise to the top if left out... meaning, its low in calories/fat.
Thats a double whammy! So the small amount of milk that I DO make is less filling than preferred.
Does this mean that I cant nurse my kids? Absolutely not. What it does mean is that I cannot solely nurse my kids. They need more calories, more fat, more MILK than I am able to produce/provide. Supplementing with formula is simply a necessity.
Knowing all of this going into my delivery with Lainey (baby #3 for us), I knew the obstacles I would face. And I did my best to prepare for the best, most successful experience I could. I ordered Gaia Lactation support, some tea by Mothers love more milk special blend and lastly, Domperidone.
When I nursed Rhyan, I eventually took Reglan (a Rx from my OBGYN) to help produce more prolactin therefore more milk. Reglan, however, is no joke. It has plenty of side effects, not the least of which is depression. So after my experience with her, I was sure I was not willing to try Reglan again. And the only other prescription proven to help with milk production is not FDA approved and therefore not sold in the US. So, I bought some from Canada :-)
I asked Dr Pohl (my obgyn) about it and he assured me of two things: He could not encourage me to use it but assured me that if I did, i would make more milk than I previously have.
You can also google domperidone but long story short, its not sold in the US b/c it has been shown to have affects on cardiac rhythm when given via IV in higher doses than is prescribed for milk production. I decided to use it, obviously, so I felt fine about the risks. Bottom line, lobbyists determine the majority of what gets FDA approval and what doesnt in the US and theres just not a huge demand for something like Domperidone... because the main purpose/use of the drug is as an anti-nausea med. Not really a huge life changer for most people, especially when you have meds like reglan and phernegan available that accomplish the same thing.
Prepared for the worst and hopeful for the best, I started the Domperidone in the hospital the day after I delivered Lainey. I knew that the colostrum I would produce would be all she would need for the first day or so and that there was no pressure to start producing much milk that early.
While I was in the hospital, on Friday, I asked a LC to come work with me on latch with Lainey. After evaluating her, she advised me that she had a short round tongue, a high narrow palate and a small mouth. She warned me that latch with her would likely be difficult but gave me some tips on suck training with her using our finger to teach her to keep her tongue down.
That afternoon I had already offered her a paci because the night before she had lived on the breast and I was getting super sore already. Which I was worried could cause issues, but I needed a break! I asked the LC about the paci and she said it would be better to offer our (clean) finger and work on suck training while allowing her the non nutritive sucking she was desiring.
That afternoon, Dr Sheth (our pediatrician) came in to evaluate Lainey and one of my main concerns was her tongue. Both Rhyan and Mack were tongue tied (thanks to their Daddy's genes...) and that is a HUGE issue in getting a proper latch for nursing! And of course, Lainey was tied as well. So she called the office and let them know that we were being discharged and would be heading over for Michelle or Dr Messick to take care of Lainey's tongue and for a consult with Harriett. But before we left the hospital, Dr Sheth encouraged us to give her about 1oz of formula to keep her from being so worked up at the breast and to help her to calm down a little. Dr Sheth is a HUGE proponent of breast feeding, however, she said that when babies get so hungry, it can be really difficult for them to nurse because they get so worked up.
So at about 26 hours old, Lainey had her first visit to Pediatric Associates of Lawrenceville and had her tongue clipped. She weighed 7lbs 4.3oz that day. Harriett gave me some similac breastfeed supplementing formula and encouraged me to squirt a little on my nipple before she latched on to encourage the latch and to keep a syringe full by my side in order to squirt a little in her mouth as she fed if she got lazy to again, encourage active suckling.
That next couple of days at home, Lainey seemed very frustrated at the breast. She had a VERY hard time latching and after latching she would almost immediately pop off the breast and cry. Sometimes it would take as long as 25 minutes to get her to actually eat and this was typically only after using the formula in a syringe to help her.
Each night at around 1-2pm I would give her an ounce of formula to help her because she would get SO worked up and not be able to latch on.
It was hard. I kept in CONSTANT contact via text with two of my best mommy friends, Emily and Laura. Both of them have exclusively breast fed two babies and I had made sure to ask for their help before delivering Lainey. I knew that more than the struggle to make milk that the mental breakdown I was likely to go through would likely be my biggest hurtle. When I was sleep deprived, exhausted, hurting, doubting myself and worried as to whether or not I was doing what was best, the two of them were constantly encouraging and giving practical advice. They responded to my texts day or night. I cant say enough how grateful I am to both of them!!!
Another real struggle (if we're just being honest here) is that Jeff was not on board with my plan. He SAID he was on board, but when it got tough and I doubted myself and Lainey would cry and have a hard time, he was the first to encourage just giving her formula. Because its "easier". But knowing that Lainey is likely our last child, i wanted to be SURE to have NO regrets! So I did my best to press on.
Saturday was insanely hard. I felt like we were struggling to get a latch at all pretty much all day. Then, on Sunday something just clicked! Honestly, I think I finally started getting milk and so she was actually getting something from me! I took a video of her nursing and texted it to Em and Laura to make sure the sucking and swallowing were in fact indicative of her getting milk and they assured me it was!
However, I was still REALLY hurting. The initial latch was most painful, as is common, but it hurt the entire time I would nurse her. And I was nursing her every 2-2.5 hours. For about 45 min each session. Thats a lot of the day that I spent hurting. I suspected that we still did not have a good latch. Every time she came off the breast, my nipple was flattened out like a pancake. And I had some pretty bad blisters on the tip of my nipple that had cracked open. I had bought Medela soft shells and found them to be VERY helpful in allowing my nipples to "breathe" and heal but damage had been done and that just takes time to get better. So with each nursing session, I didnt know if it was painful because of a poor latch or if it would have hurt even with a perfect latch due to the damage that was already done.
But I was super encouraged on Sunday! I really felt things were going well!
Then, on Monday I noticed that she was looking pretty jaundiced. Not just her skin, but her eyes. Its pretty common to see some jaundice of the skin but once the whites of the eyes go yellow, its a pretty big concern. So I felt much more anxious about my decision to try to avoid formula (minus that one nightly 1 ounce). I continued to count wet and dirty diapers... I was seeing her produce a MINIMUM acceptable number of wets. And she had not had a dirty diaper since Saturday. I was getting concerned. Not only that, but she was also starting to sleep a lot. She was not waking to eat on her own and had actually gone 6 hours at night once, which shouldnt happen at 5 days old. I tried to stay positive and continued to try to use the formula in the syringe to rouse her to eat, etc.
Tuesday... our weight check appointment. I was extremely nervous and while I was hopeful of at least maintained weight, I was really scared of what the scale was going to say.
When the nurse brought us back, the first thing I told her was that I was nervous and that I knew she was jaundiced. I didnt want her to think I thought everything was great or something. I knew there was cause for concern and wanted her to know I was aware and wanted to address it. We headed to the scale and I saw something I dreaded... the number started with a 6. She had lost more weight.
6lbs, 14oz. Down 11oz from birth.
We went back to the room where I waited for Dr Sheth. As I sat there, I just rocked Lainey and cried. I just knew this path all too well. I knew what it would take to continue to nurse and I knew that I just couldnt give the time and effort into nursing her while taking care of two kids on my own (Jeff had only taken off Thursday, the day I delivered her, and Friday and was already back at work on Monday leaving me to get Rhyan to school each day and care for Mack and Lainey solo. I know thats pretty typical and am NOT trying to say he did anything wrong! But it was a lot to try to balance and nursing was dominating my life... and it couldnt take more time). I was right back to where I was with Rhyan. I knew what the recommendations would be. And I felt like a failure. A failure for not producing enough milk, regardless of what illegal drugs I took in attempts to keep up with demand. A failure for being stubborn and ignoring signs that she needed more than what I could give her and keeping formula from her. A failure for sitting in that room, crying about the whole thing.
Dr Sheth came in and by that point I had pulled it together. Till she looked at Lainey's chart and saw her weight loss and said "so are you breast feeding?". Then, i burst into tears again and said "clearly failing miserably but yes, trying". So then she immediately thought I was in some deep postpartum depression, suffering and on the verge of a break down. I assured her that 5 years ago, Dr Messick got to see me fall apart over feeling like a failure in the nursing department and that this was the same. Just a breakdown over the heartache of knowing what was to come...
She examined Lainey and let me know that she was pretty concerned about her jaundice and that I'd need to take her to the hospital for a bili check :-(. Oh my. She assured me that Lainey was beautiful and perfect and that with some supplementation with formula, she'd be fine in no time! But that supplementing was simply necessary at every feeding at this point. Then, she had Harriett come in and work with us again. Harriett said exactly what I expected her to.
-Pump for a minute or two before each feed to make it easier once Lainey latched on to start getting milk.
-Feed every 2.5-3 hours. No sooner than that.
-Limit her suckling to 15-20 min on each side. (allowing a baby to continue sucking after the breast is empty burns more calories than they are getting. The stimulation is good but its not ok to ask baby who is already lacking energy to do for you what a pump can do)
- Pump after for 10-15 min for extra stimulation.
- And give 1-2oz after nursing.
- Eat some fatty foods to try to increase the caloric content of my milk.
It was all exactly what I had done with Rhyan and what I did with mack for the 3 days that we lasted in our little nursing relationship.
I also let her know that Lainey had not pooped since Saturday so she got out her "bag of tricks" to help the situation. She broke out the KY jelly and rectal thermometer and went to work. Lainey released a LOT of gas and eventually a tiny dab of stool. Harriett assured me I could expect a blow out later.
She also told me she had done some research on the Domperidone and to be aware of any symptoms I may have and gave me a list of potential issues... one of which was chronic headaches. My heart sunk. I had been having headaches for days at that point. Non stop. But I was scared to take any meds for it and didnt even really want to take any advil or tylenol.
We left the office and headed to the hospital for the bili test. And I cried the whole way there. It was an emotional day, friends. I knew I simply could not devote the time to nursing and that my only practical option for our family was to attempt to pump and give her what I could produce for as long as I could produce it. I also knew that I would dry up by the end of the week.
Why was pumping my only option (in my mind/experience)? Well, when you take a baby who already has a not so great latch and you start offering her a bottle 8-10 times a day and her latch does one thing and one thing only. It gets worse. And she will get frustrated and lazy at the breast. And its a downhill spiral from there. My nipples were already bleeding pretty badly at each feeding and I was really hurting so I also knew that mentally, I probably wouldnt be able to handle the latch getting worse. I like to think I'm pretty tough and I deal with most pain fairly well, but nursing is HARD. And i tend to be like a dog when it comes to pain... I want to be left ALONE. I snap at people if they try to "help" or mess with me when i'm hurting. I just deal with pain better solo. But when you have two older kids who need your help and need to be in the room with you while you nurse, you cant bite their heads off when they ask you a question just because your baby just latched on and you think you're going to die ;-).
So that afternoon when i got home, I tried to nurse her one last time. And once again, I cried (shocker). Partially because I was 99% sure her mouth was full of razor blades... but mostly because I grieved being able to nurse. It seems so unfair that so many moms CAN nurse and choose not to and I'd do about anything to nurse and cant.
I skipped my next dose of domperidone and within a couple of hours, my headache was gone. I decided to take another dose that night just to see if it was truly the culprit and literally within 30 minutes my raging headache was back.
So that evening, i basically just asked the Lord to help me to be ok with the fact that I wasnt going to nurse Lainey. To help me to remember that the MOST important thing is that I feed my baby. And that I stay sane in the meanwhile so as to best be able to care for all our kids.
Jeff, obviously, was very encouraging and said he was proud that I had tried but I could tell he was relieved that all the guesswork was over.
Or so we thought!
Post to come on the difficulties that lay ahead... but I'll post what some may find to be offensive but for me, is a picture of a precious, brief moment. My sweet baby girl nursing at 2 days old.
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