Note: this post is about breastfeeding and, therefore, includes explicit discussion of breasts. If this makes you squeamish, don’t read this post!
I prepared for breastfeeding. I knew that there would be a learning curve getting her to latch properly, that it would be tiring feeding her every 2-3 hours, that my nipples might be sore, and I may have to deal with engorgement and leaking and that I needed to look out for lumps so I don’t get mastitis. I attended a breastfeeding class and read Breastfeeding Made Simple… twice. Things did not go as expected. I knew that there are women who have trouble breastfeeding or cannot breastfeed for some reason. I did not expect to be one of the women who have challenges.
Actually, looking back my first inkling that something may not be right was after the breastfeeding class I attended. The lactation consultant who ran the class recommended that we start hand expressing colostrum (which comes in early in pregnancy – I believe by 20 weeks?) so that we get used to the feeling and to encourage production. I tried many times. I watched videos online demonstrating several methods of hand expressing. I never got any colostrum. This made me nervous. So I asked my midwives and polled women in the online forums on babycenter.com and thebump.com to see if I should be worried and what I should do. I got the same response – some women cannot express anything until after birth. The separation of the placenta triggers hormones that trigger colostrum and milk production. My midwives told me not to worry.
Within an hour after being born, Tiny One latched really well and was sucking. It didn’t seem like she was getting much, if anything, but I was told not to worry – babies benefit greatly from just a few drops of colostrum each feeding, and they don’t actually need anything for the first few days. The first couple of days, it seemed like she was chewing on my nipples – they were a bit cracked and even started bleeding a little bit – but I figured it was the normal learning curve and we were still figuring out the proper latch. It bothered me that I still could not express or see anything coming out, but everyone assured me everything was fine and normal and I just waited for my milk to come in.
When we got home I kept getting more and more worried that things were not going well. By the time of our first pediatrician’s appointment my milk had still not come in and I never saw her getting anything. At that first appointment, the pediatrician found that she had lost about 10% of her birth weight and she had not bottomed out yet, and she was a bit dehydrated. He said that we should supplement in order to get her body weight up and rehydrate her until my milk came in. I knew that supplementing was the right thing to do for her, but it made me sad that I had been starving my baby and could not feed her on my own. So I just hoped my milk would come in soon and did what we had to do. We scheduled another trip to the pediatrician a few days later for a weight check.
Over the next few days it still seemed like she was not getting a lot from me and was taking most of what she needed in formula. My mother suggested I pump, and ordered me a nice Medela double-pump. However, I was impatient and really wanted to know if she was getting anything from me, so I had Mr. S go out and get my the cheapest pump he could find. His parents actually went with him and got us a Medela swing pump – which is a single side pump. That night, I pumped every time we gave her a bottle and at other times too. In four pumping over the course of the night I got barely an eighth of an ounce from both breasts combined… that did not seem like very much since one week old babies usually take 1-2 ounces at each feeding, and two week olds take 2-3 ounces.
At our next pediatrician appointment she was doing well. She had regained several ounces. I explained to this pediatrician (there are several at our practice) that I had pumped and told her the amount. She said to keep doing what we had been doing and to wean her off the supplements once my milk came in. (This was more than a week after her birth, and milk usually comes in within 4-5 days. The pediatrician did not mention this nor did she seem concerned.) At this point everyone was still telling me to relax, and I was getting frustrated that nobody was taking my concerns seriously. We asked about seeing a lactation consultant, but the doctor seemed ambivalent about it and I was hoping everything would just work itself out like everyone said it would.
Over the next few days we tried to follow Tiny One’s cues and decreased the amount of formula we were supplementing. I was afraid she wouldn’t want to breastfeed anymore since it is easier to drink out of the bottle and I preferred her breastfeeding all day to giving her formula. Unfortunately, even breastfeeding all day was not enough… When we went back for our two week appointment, she had lost half of the weight she had gained back. We were back to supplementing. This pediatrician, however, encouraged us to see a lactation consultant and gave us a list of places. We scheduled yet another weight check. Once we started supplementing again, she finally came up to her birth weight.
The first lactation consultant we called never called us back (I gave her a few days), so we didn’t end up seeing one until a few days before Tiny One’s one month appointment. A wonderful consultant from The Breastfeeding Center came to us for a home visit. She observed a nursing session and brought a special scale to weigh Tiny One before and after the feeding to determine how much milk she was transferring. The consultant was actually impressed with our technique and said that she clearly loves breastfeeding, she is just sleepy and is not getting much. Unfortunately, she only transferred half an ounce during a 30 minute feeding… Babies at 3-4 weeks normally take 2-4 in a nursing session (which the lactation consultant said is usually 15-30 minutes long). By four weeks, babies eat 25-35 ounces a day, and continue to eat this amount until they are introduced to solids around 6 months.
After talking with us and observing us a little longer, the consultant mentioned to me that she thought I might have insufficient glandular tissue (IGT). This is a rare disorder where the mother did not develop enough milk-making tissue. This tissue develops during puberty and during pregnancy. My breasts had not grown much at all during pregnancy – I still fit into my per-pregnancy bras. It is more common in women who have a history of PCOS – a hormonal condition which I have been on the borderline of for years and was actually given medication for as a teenager. There are things you can do to try to increase the tissue and increase the milk production in the existing tissue, but many women with IGT never make enough to exclusively breastfeed their babies. While I am incredibly saddened by this, I actually felt so much better after our visit with the lactation consultant. I now have an idea of what is wrong and a plan moving forward. (Which I will cover in another post.) She validated me, telling me it was ok to be angry and sad, but to remember that any little bit of breastfeeding is great. She also praised me for working so hard to make it work and encouraged me to keep trying and giving Tiny One what I can.
So that is where we are. We have not so good days and better days with breastfeeding and pumping. We are doing the best we can, she seems happy and is growing, and I am definitely learning about myself.