We did everything right.
Attended breastfeeding classes, Le Leche League meetings and a breastfeeding moms’ support group, read several books, surrounded myself with other breastfeeding moms including most of my coworkers, planned and executed a low intervention birth with an incredible midwife. So it was quite a kick in the gut when a nurse in the pediatrician’s office said, “She isn’t gaining fast enough. You need to supplement her. You *could* pump and supplement with that but…here, take this formula. It’s not the end of the world. But if she hasn’t gained an ounce by tomorrow, we’re sending her for blood work to rule out metabolic issues.”
Despite all that preparation, one thing you can’t plan for is a stubborn, bilobed placenta leading to a postpartum hemorrhage that leaves you with no appetite for a week. I was back to my pre-baby weight in less than seven days. Every woman’s dream, right?
One of the things I most looked forward to while planning our unmedicated, out of hospital birth was allowing Ruby to find her way to my breast on her own immediately after birth, a phenomenon known as the Breast Crawl. At one of my breastfeeding classes, we watched a video showing a breast crawl and it was magical. And to be honest, our birth was magical in so many ways (stay tuned for future posts about our birth story and how we came to choose a home birth midwife), but this just wasn’t in the cards for us. By the time the bleeding was under control, I got some food in my stomach, felt strong enough to sit upright, and we attempted to get Ruby to latch, it was probably a good three hours after birth. At that point, she was exhausted and much more interested in snoozing than suckling.
Over the next few days, we continued trying to keep her alert enough to feed but all she wanted to do was sleep. I didn’t know it then, but babies who aren’t getting enough calories sleep to conserve energy. I also didn’t know that a hemorrhage can negatively impact milk production but I certainly do now. When she wasn’t sleeping, she was wailing. I recall one night, sometime late in the first week, she was so obviously starving and would not stop crying. It was about 2AM and, desperate to calm her, I called my midwife. She asked if my milk had come in yet and I really had no idea. She suggested I try pumping and to spoon feed her any milk I was able to express. Low and behold, it was milk I expressed, not colostrum so my milk had indeed come in. When you hear women talk about their milk coming in, they often describe the sudden appearance of porn star boobs overnight. Well, porn star boobs I did not have. But it was still encouraging to see that I was actually producing milk.
So, fast forward to that appointment with the nurse. We were not unaware that she wasn’t gaining as quickly as the docs like to see. We were going in for daily weight checks because of that very concern. However, it wasn’t until that appointment that anyone made it seem like it was an urgent situation. Had it not been for all of our breastfeeding research and preparation, that appointment would have been the beginning of the end of our breastfeeding relationship. The second the nurse downplayed pumping, shoved formula in our faces and threatened to stick our daughter with needles, alarm bells were blaring. I knew enough about breast function to know that when a woman is experiencing supply issues, supplementing with formula will only exacerbate those issues. Less time at the breast = less production. Phil and I left that appointment, drove straight to Target and purchased the last Medela double electric pump in stock (dropped $100 more on it than we would have had we ordered in online, but time was of the essence) and headed home to set it up.
And so marked the beginning of an exhausting routine. Nurse Ruby, pump until my breasts were empty, nurse Ruby and supplement her with what I pumped last time, pump again, nurse Ruby. You get the idea. We went back to the pediatrician’s office 18 hours later and to our relief and utter joy, she had gained 2/3 of an ounce and the nurse was satisfied. When we came in for the appointment, the front desk staff informed us that they had actually rescheduled us with different nurse who happened to be a lactation consultant. We got the impression that our original nurse was not a friend to nursing mothers. The kicker was that the new nurse pretty much said that Ruby was on the right track, and that the situation was not really at a critical level yet. We continued our routine through the weekend, came in for another weight check on Monday and she had gained three ounces and was finally back to her birth weight, 3 1/2 weeks after birth. For reference, babies often lose some weight immediately following birth. I believe this is more of an issue in breastfed babies as it can be several days before mom’s milk comes in. Pediatricians don’t like to see more than a 10% loss and the ideal time for a baby to be back to birth weight is 2 weeks. The pediatrician we met with that day was comfortable enough with her progress that we didn’t have to come in again until her two month appointment.
While this was encouraging, we knew we still had a lot of work to do. We visited an excellent lactation consultant who explained that Ruby’s latch wasn’t ideal, nor was our positioning. She loaned us an infant scale so that we could do our own before and after feeding weight checks to see how many ounces she was getting at the breast. I began taking fenugreek supplements and kept up our pumping routine.
I don’t recall how long we pumped round the clock. I do remember it was grueling at times. It turned a 20 minute nursing session into a 40-50 minute ordeal and we did it day and night for at least a month or two. P.J., my dear sweet P.J., washed pump parts until his hands were raw and cracking. But once it got the point where Ruby refused to take any supplementation, we knew we were in the home stretch. At this point, we were using a homemade version of supplemental nursing system (SNS) similar to this and Ruby would yank the tube out of her mouth as soon as I put it in. The benefit of an SNS is that the baby gets the supplementation while at the breast which aids in supply stimulation and avoids nipple confusion and bottle flow preference. When she started refusing it, I began freezing it and before I knew it, we had more than we could fit in our freezer.
My goal was to exclusively breastfeed for six months and to continue until at least one year. Today, Ruby is 16 month old, we are still going strong and I no longer have a goal in mind. We’ll continue until one or both of us is ready to move on. We had our bumps in the road in the form of nursing strikes, mastitis, biting, galactoceles, etc., but this has been one of the most rewarding and wonderful experiences in my life. I can say with 100% certainty that if I did not have the resources and support that I had before our birth and during the early days, breastfeeding would not have worked out for us.
Let me be clear on one thing. There is nothing wrong with formula feeding your child. Infant feeding is a very personal decision, one that only mom, dad and baby can make. I was formula fed, my brother was formula fed, P.J. was formula fed. Had pumping not solved her weight issues, Ruby would have been formula fed. What I hate to see is for a family who wants to breastfeed not succeed because of a lack of information or support or, in extreme cases, intentional sabotage. There are many great things about the US, but support for new parents and breastfeeding mothers is not one of them. If you plan to breastfeed, learn as much as you can and find as many resources as you can BEFORE you have your baby. Identify an international board certified lactation consultant (IBCLC) BEFORE your birth. Yes, the hospital will likely have lactation consultants, but you may or may not have the hang of it by the time you are discharged.
In closing this post, I’m listing a number of resources I found valuable in my breastfeeding journey. I’ll likely add more as I remember them. Take what you like, leave what you don’t. But if you are interested in learning more about why breastfeeding is currently so difficult in our country, consider seeing the documentary, The Milky Way. It is screening on Saturday, May 10th at 12:00pm at Southside Works Cinema in Pittsburgh. Tickets can be purchased here. This event is a fundraiser for the Three Rivers Mothers’ Milk Bank, a group working to establish Pennsylvania’s first donor milk bank by 2015. Read more about their mission and development plans on their Facebook page. I plan to see the movie myself.